Looking Back at Ten Years of Clinicians in Quality and Innovation

Working on healthcare quality means constantly focusing on all the things that go wrong at various levels of the healthcare system. The deeper one delves into any given problem, the more barriers to fixing it one uncovers, often meaning this sort of work can feel depressing. However, this feeling is readily contradicted by seeing so many talented faculty members now engaged in quality improvement and other forms of innovation in healthcare. It’s hard not to find inspiring – even for me, an inveterate ‘glass is half empty’ type of person.    

Looking back on things now, I cannot actually recall to what extent I ever thought specifically about how this Clinicians in Quality and Innovation (CQI) job description would pan out. I mean, obviously I hoped it would work. I was fairly sure it would for the handful of faculty members who I expected to take up CQI faculty appointments around the time of its inception in 2012. But – I never thought that it would grow so much in 10 years that we would now have just under 80 full-time faculty members as CQIs.

I also don’t think I could have imagined the volume or breadth of work the CQIs would go on to carry out – from PDSA-type improvement projects and innovative models of care to trials evaluating improvement interventions, furthered by health services research characterizing quality problems, to innovative models of care, advocacy work and even healthcare journalism.

They have also published a phenomenal number of papers.  One of our ongoing missions has been championing measures of impact beyond publications and grants. I don’t at all want to undermine that mission, but I couldn’t help being proud when I saw that Department of Medicine CQIs have published over 1200 articles indexed in Medline. In recent years, I see more and more citations with multiple CQIs as authors, sometimes including the first and senior authors on a given paper.

A poignant quote included in our 10-year report made a point of noting how great CQIs are at collaborating within the department, as well externally, across hospitals, departments and working with other health professions. I saw evidence of that in reviewing their publications, with many examples of collaborations with colleagues including Family Medicine, Pediatrics, Surgery, and Radiology, as well as Nursing, Pharmacy, and other allied health professionals. Moreover, many of CQIs have collaborated with major national and international professional organizations and important provincial agencies, like Cancer Care Ontario, the Public Health Agency of Canada, and Choosing Wisely.

It's been heartening to see how quickly CQIs have grown into leadership roles. The medical director of quality at each of the major teaching hospitals is a CQI. The Physician-in-Chief (PIC) at UHN, Kathryn Tinckam, is a CQI and so was the past PIC at Trillium, Amir Ginzburg, until he left to take on a more senior role at the hospital. CQIs also play key roles in major hospital operations like informatics and infection control.

In recent years I have worried that we need to turn our attention away from microsystem problems on hospital wards and ambulatory clinics and focus on major threats to population health and the health system – the climate crisis, worsening inequality – the list (sadly) goes on. As these crises play out, we will need people like the CQIs to respond to them; people who are intimately familiar with frontline clinical work but also understand the healthcare system and know what it takes to make change happen. Both for that reason, and because of the many impacts the CQIs have already produced, I am deeply grateful for having had the chance to play a role in creating and sustaining this pathway in the department.

I am also grateful to members of the department’s Executive Committee, including the Chair, the PICs and the Department Division Directors (DDDs), who have put up with early ambiguities in the job description and its expectations and helped identify other issues in need of attention while being incredibly supportive of both the idea of this role and the people in it.

I have had the privilege of training and working at some of the top academic medical centers in the US. Places that had researchers carrying pioneering work in patient safety and healthcare quality. Yet, I can’t think of any place that has explicitly created a pathway like ours and has such a critical mass of faculty carrying out this sort of work. 

After living through the last few years and the never ending stream of problems the pandemic has either brought or shined a light on, it’s nice to have such an unalloyed success to celebrate as this 10-year milestone for the CQI job description and the accomplishments of the people in it.