Ontario's Ministry of Health and Long-Term Care posted proposed amendments to the Public Hospitals Act (PHA) on September 17, 2015.
Background Leading to Proposed Amendments
The Quality of Care Information Protection Act (QCIPA) was introduced in 2004. One of its purposes was to improve the identification and investigation of critical health care incidents so that their causes are fully understood and changes could be made to prevent subsequent similar incidents. QCIPA allows health professionals to share information and have discussions about improving patient care when there is an unintended and serious accident or error that harms a patient and the cause is unclear. Under QCIPA, the information from the discussions is protected from being disclosed in legal proceedings unless specified under the legislation, or disclosed to anyone, including patients and families, under the Personal Health Information Protection Act, 2004, or the Freedom of Information and Protection of Privacy Act. It should be noted, however, that QCIPA cannot be applied to prevent specific information pertaining to an individual patient's health care, including factual information regarding critical incidents, from being recorded.
More recently, some patients and their families have expressed concern about the use of QCIPA by hospitals. Additionally, the 10 year milestone since the introduction of QCIPA provided an opportunity to reflect on the use of QCIPA within the context of the evolving provincial health system, international practices, and trends related to quality improvement, information protection and disclosure.
In 2014, the Minister of Health and Long-Term Care convened a QCIPA Review Committee. The committee submitted its report on December 23, 2014. On July 1, 2015 the Minister announced that he would implement all 12 of the Review Committee's recommendations related to QCIPA, the PHA and critical incidents more broadly. The Review Committee’s 12 recommendations are available online.
Proposed Amendments
To implement the Review Committee's recommendations, amendments to Regulation 965 under the PHA are required. To comply with the proposed amendments to this regulation, each hospital would:
- Establish a system for ensuring that a committee appointed by the hospital reviews every critical incident, as soon as practicable after the critical incident occurs;
- Interview patients and their authorized representatives about the critical incident;
- Inform patients regarding the causes of the critical incident where possible, in addition to already existing disclosure requirements; and
- Include a staff person responsible for patient relations in the committee conducting the review (including where a committee under QCIPA is used to conduct the review).
Benefits of the Proposed Amendments
The proposed amendments are intended to increase accountability and transparency in the health system by ensuring that hospitals use consistent processes when involving patients and their families in critical incident reviews and disclosing information about a critical incident review. Improving and ensuring consistent, high-quality and safe patient-centred care in Ontario will ultimately benefit both patients and hospitals alike.
Provide Input and Feedback
The Ministry is soliciting feedback from the public about the draft proposed amendments until November 2, 2015.