Stroke Quality Standard

Stroke Quality Standard

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Quality standards are tools for helping our health care systems deliver consistent, high-quality care to support the health of patients and the population. They describe key aspects of high-quality services for a condition or topic to guide opportunities for improvement. Quality standards feature concise future-focused statements and indicators to measure progress that service as common goals to which our health care system can aspire. They are evidence-based and progress toward them will lead to better health outcomes.

We’ve launched a new quality standard for BC’s health care system that focuses on improving stroke care.

The Stroke Quality Standard supports:

  • People with stroke to understand key aspects of high-quality stroke care, and to make informed decisions in partnership with their health care teams;
  • Health care professionals to make decisions about appropriate care; and
  • Health care organizations to examine their systems and policies, and improve the services they provide.

Stroke Quality Standard

Nine quality statements focus on specific areas of the patient journey where improvement can lead to better health outcomes. They’re accompanied by indicators to measure progress and guide improvement work.

Download the Stroke Quality Standard

Patient, Caregiver and Family Guide

This resource for people with stroke, as well as friends and family members who are involved as caregivers, describes key aspects of high-quality stroke care and supports them to make informed decisions in partnership with their health care teams.

Download the Patient, Caregiver and Family Guide

Who Leads Quality Standards?

Quality standards are a key element in the Provincial Health Services Authority’s clinical policy framework that aims to improve the quality and consistency of care for identified topics or conditions. The BC Patient Safety & Quality Council was asked to lead the development of quality standards because of our expertise on health care quality, our ability to coordinate action across the health care system and our unique role as a quality-focused organization outside of the direct delivery of care.

Stroke Services BC is partnering with health authorities to implement the Stroke Quality Standard. It will be used to prioritize and guide improvement work. Stroke Services BC will monitor progress using the indicators in the quality standard.

Why Was Stroke the First Topic?

Stroke is a leading cause of death and disability, but in recent years efforts to prevent and treat stroke are leading to improvements in stroke care and decreases in death and disability rates in BC[1]. This quality standard provides a provincially coordinated approach to continuing this improvement by focusing on reducing unwarranted variation (variation in care received that cannot be explained by a patient’s condition or preferences[2]).

How Does the Stroke Quality Standard Improve Care?

The goal of the Stroke Quality Standard is to advance high-quality stroke care across BC. This is achieved by focusing quality improvement efforts where they are needed most, which provides common goals for which the health care system can strive.

It features nine quality statements which guide improvement work to where it can have the biggest impact on patients’ health and wellness. This can help minimize unwarranted variation in care, and support care that honours all seven dimensions of the BC Health Quality Matrix, while promoting cultural safety and equity. The included quality indicators help inform local improvement efforts and measure progress.

How Are Clinical Practice Guidelines and Quality Standards Different?

Clinical practice guidelines aim to guide aspects of the direct care, assessment or treatment for a patient with a condition, whereas quality standards aim to guide priority areas for the health care system, across the patient journey, to focus on opportunities to improve.

While guidelines tend to focus on individual clinical practice, quality standards identify service- and system-level improvement areas to guide the health care system’s efforts.

How Was the Stroke Quality Standard Developed?

We brought together an expert group, including people with lived experience, clinical experts, health system leaders and researchers, to guide the development of the standard and its Patient, Caregiver and Family Guide. Drafts of both documents were open for public review and the final versions reflect feedback received through submissions and an online survey. They have been endorsed by Stroke Services BC, which has begun partnering with health authorities and community partners on using the quality standard and monitoring progress.

Learn more about how patient partners helped develop the Stroke Quality Standard.

What Was the Public Review Process?

Draft versions of the Stroke Quality Standard and its Patient, Caregiver & Family Guide went through a four-week public review process to ensure they featured a broad range of perspectives and are applicable to BC’s population. During this time, the public review page was viewed over 2,600 times, the draft documents were downloaded over 300 times and we received over 400 responses to the online survey. This process aligned with our commitment to collaboration and transparency, and helped us to:

  • Confirm that the Stroke Quality Standard is targeted appropriately to improve stroke services at a system level;
  • Determine if the quality standard identifies key areas for improvement during the care journey;
  • Verify that the quality standard is applicable across all regions of the province;
  • Establish that the proposed indicators will support improvement activities and monitoring progress; and
  • Ensure that the quality standard is appropriately worded for the target audiences (e.g., patients, caregivers, families, health care professionals and health care organizations).

Questions?
Contact us to share feedback on the Stroke Quality Standard and its use.


Frequently Asked Questions

Quality standards are tools for helping our health care systems deliver consistent, high-quality care to support the health of patients and the population. They describe key aspects of high-quality services for a condition or topic to guide opportunities for improvement that can lead to better health outcomes.

Quality standards feature concise future-focused statements, and indicators to measure progress, that serve as common goals for our health care system can aspire. They support:

  • People with stroke to understand key aspects of high-quality stroke care, and to make informed decisions in partnership with their health care teams;
  • Health care professionals to make decisions about appropriate care; and
  • Health care organizations to examine their systems and policies, and improve the services they provide.

In BC we know that variation in care occurs every day. Often these variations occur because of a person’s particular illness or choices. These are expected and often necessary to individualize patient care. However, there are also variations in care that are unwarranted and can only be explained by differences in health system performance and should be reduced whenever possible and appropriate.

Quality standards aim to improve the quality of care in BC by decreasing unwarranted variation in the health system. This is achieved by focusing quality improvement efforts where they are needed most and tracking the progress towards these goals. Approaching improvement this way means that action can take place to increase the quality of care across the province.

We bring together an expert group to guide the development of the standard and its Patient, Caregiver and Family Guide.  This standard development committee includes people with lived experience, clinical experts, health system leaders, and researchers. Drafts of both documents are then open for public review and the final versions reflect feedback received through submissions and an online survey. They are then approved by the standard development committee and endorsed by key partners.

Quality standards are unique because they are:

  • Focused – key areas of the patient journey are selected where the need for improving quality is the greatest;
  • Concise – less than ten statements compared to sometimes hundreds of statements in a best practice guideline or decision support tool;
  • Measurable – all quality statements have associated quality indicators that can be used to track progress towards the statement; and
  • System level – quality statements are written from a system-level perspective while best practice guidelines focus on specific procedures or treatments

Quality standards provide guidance on the priority areas for improvement in BC in a specific area of the health system. They are developed in BC for our provincial health system and therefore provide specific guidance for where improvement is needed most.

Standards used to accredit hospitals, such as those from Health Standards Organization (HSO), focus on governance, leadership, and seek to define all of the elements needed to be accredited. These standards are developed to be used across Canada.

Quality standards are aligned with accreditation standards to ensure consistency. However, quality standards in BC are focused on areas where there is known unwarranted variation and seek to define an aspirational set of goals for our province to work toward.

Quality standards also aim to promote cultural safety and equity within the health care system. Some statements will directly address cultural safety or equity concerns, while others will highlight cultural safety and equity considerations when implementing a statement into practice.

Equity is embedded within the definition of health care quality as one of seven core dimensions in the BC Health Quality Matrix. The Standard Development Committee considers all the dimensions of quality when creating a quality standard and could not have thoroughly addressed quality without considering equity and cultural safety. One way to address unwarranted variation is by ensuring people can engage in a health care system that is respectful and free of racism and discrimination.

It is important to continue the process of cultural humility when applying the information in this document.

Quality standards are a key element in the Provincial Health Services Authority’s (PHSA) clinical policy framework that aims to improve the quality and consistency of care for identified topics or conditions. We were asked to lead the development of quality standards because of our unique role as an organization outside of the care delivery system, our expertise in health care quality, and our ability to coordinate action across the health care system.

PHSA will partner with health authorities to implement the quality standards. They will be used to prioritize and guide improvement work and will help PHSA monitor progress using the indicators in the quality standard.

Together with PHSA, we will review each quality standard every three years to determine its effectiveness and relevance.

Quality standards help patients, families, and caregivers understand the care available from the health system and support informed decision-making in collaboration with their health care team. They highlight how patients, caregivers, and families can guide prevention, treatment, and recovery in ways that are most meaningful to them, while still upholding best practice recommendations.

If you have any further questions, please reach out to us at qualitystandards@bcpsqc.ca.


[1] Canadian Institute for Health Information. CIHI Portal [Internet]; 2003 [cited 17 February 2021]. Available from https://secure.cihi.ca/cas/login

[2] Unwarranted clinical variation resources [Internet]. Agency for Clinical Innovation; [Date Unknown][cited 21 July 2021]. Available from: https://aci.health.nsw.gov.au/resources/unwarranted-clinical-variation


Key Contact

Sybil Hoiss
Leader, Strategic Initiatives
shoiss@bcpsqc.ca
778.363.9165