Best Practices

Updated on October 27, 2015

“Insanity is doing things the way we’ve always done them and expecting different results”
Albert Einstein

Evidence-informed best practices are based on quality evidence and should be implemented into practice to optimize outcomes.8 Listed below you will find best practices graded according to the type of evidence. To view a description of the types of evidence, click here.

To help you move from best evidence to best practice, click on the + button next to each best practice to find details on how to implement, as well as change ideas to test using a PDSA approach. 

Change ideas are specific and practical changes informed by experience and research that focus on improving specific aspects of a system, process or behaviour. To learn more about change ideas see the QI: Getting Started tab.

  1. Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients' care.

    Lancet. 2003 Oct 11;362(9391):1225-30.
    Available from: http://www.ncbi.nlm.nih.gov/pubmed/14568747


Updated on October 27, 2015

“Some is not a number, soon is not a time.”
Don Berwick, former CEO and President of IHI, December 2004, at launch of the 100,000 Lives Campaign

How will we know if a change is an improvement? Measurement is one of the critical steps in a quality improvement (QI) initiative that assesses the impact of your tests of change. Quality indicators are used to measure how well something is performing. There are three types of quality indicators used to measure your QI efforts: outcome (indicators that capture clinical outcomes and or system performance), process (indicators that track the processes that measure whether the system is working as planned), and balancing indicators (indicators that ensure that changing one part of the system does not cause new problems in other parts of the system).

Type of Indicator Indicator of Quality Improvement How to Calculate:


Targets/ Benchmarks How is This Indicator Used?
Outcome Percentage of patients who would definitely recommend their hospital to friends and family:

  • Hospital Inpatient
  • Emergency Department
Number of patients who responded “Yes, definitely” (for NRC Canada), or “Definitely yes” (for HCAHPS)
Number of patients who registered any response to this question (do not include non-respondents)
Targets: As high as possible (100%)

Provincial benchmarks*:
Hospital Inpatients: 81.8%

Emergency Department: 70.6%
Quality improvement

QIP indicator

Publicly reported by HQO
Percentage of patients who would rate the overall care and services received at the hospital as excellent, very good, or good:

  • Hospital Inpatient
  • Emergency Department
Number of patients who responded “Excellent”, “Very good”, and “Good”
Number of patients who registered any response to this question (do not include non-respondents)
Targets: As high as possible (100%)

Provincial benchmarks*:
Hospital Inpatients: 96.4%

Emergency Department: 91.8%
Quality improvement

QIP indicator

Publicly reported by HQO
*The benchmark fell on the eightieth percentile of 2010/2011 NRC Picker Canada Ontario hospital data

Run Charts

Collected measures can be presented graphically by plugging the monthly results into a run chart.

Tools & Resources

Updated on October 27, 2015


Patient Experience Tools
QI Tools

For a more comprehensive list of tools and resources, visit the following links on our HQO website:



QI Resources


Updated on October 27, 2015


Patient experience is an important measure of Ontarians’ experience with the health care system. Patients and families have the unique experience, expertise, insights, and perspectives that can be invaluable to bringing about transformational change in health care and enhancing quality and safety.1,2 A paradigm shift toward a patient-centred health system is needed in order to deliver care that is sensitive to patients’ concerns and comfort, and that actively involves patients and family members in shared decision-making about their care.  The Picker Institute outlines eight principles of patient- centered care:3

  • Respect for patients’ values, preferences and expressed needs
  • Coordination and integration of care
  • Information, communication and education
  • Physical comfort
  • Emotional support and alleviation of fear and anxiety
  • Involvement of family and friends
  • Transition and continuity
  • Access to care

A gap still exists between the kind of care patients receive, and the kind of care they should be receiving. Provincial averages are still well below the benchmarks released in January 2012. The Table below demonstrates the benchmarks and provincial averages, as well as shows where there has been progress as reported in the 2014-2015 Quality Improvement Plans.

Call to Action

The Excellent Care for All Act in Ontario requires every hospital to have a patient relations process that reflects the content of their patient declaration of values.4 In addition, hospitals are to conduct annual patient/caregiver experience surveys and make reference to both the patient relations process and the results from the survey(s) in the development of their annual Quality Improvement Plan to address patient experience issues. Although the Act was established in 2010, the 2012 Quality Monitor has reported that about one in three hospital patients does not get answers to questions he or she can understand.5

There are exciting opportunities for improving patient and family experience around communication, engagement in decisions, and coordination of care. Enhancing patient health care experiences will ensure the Ontario health care system can provide the best care possible for the province.

  1. Johnson B, Abraham M, Conway J, Simmons L, Edgman-Levitan S, Sodomka P, Schlucter J, Ford D. Partnering with Patients and Families to Design a Patient- and Family-Centered Health Care System: Recommendations and Promising Practices.

    Bethesda (MD): Institute for Family-Centred Care and the Institute for Healthcare Improvement; 2008 Apr [cited 2012 Dec 18]
    Available from: http://www.ipfcc.org/pdf/PartneringwithPatientsandFamilies.pdf

  2. Governance Centre of Excellence (Ontario Hospital Association), Health Quality Ontario. Quality and Patient Safety Governance Toolkit.

    Governance Centre of Excellence (Ontario Hospital Association) and Health Quality Ontario; Section 4.0, Empowering Patients and Families.
    Available from: https://www.oha.com/KNOWLEDGECENTRE/LIBRARY/QPSGT/Pages/QualityandPatientSafety.aspx

  3. Picker Institute. Principles of Patient Centred Care

    [cited 2015 Oct 27]
    Available from: http://pickerinstitute.org/about/picker-principles/

  4. Excellent Care for All Act, 2010. Ontario Regulation 188/15.

    Patient Relations Process.
    Available at: http://canlii.ca/t/52hqm

  5. Health Quality Ontario. Quality Monitor 2012.

    Toronto: Health Quality Ontario; 2012 Sept [cited 2015 Oct 27], p. 30.
    Available from: http://www.hqontario.ca/portals/0/Documents/pr/qmonitor-full-report-2012-en.pdf