Quality improvement (QI) projects help health care providers identify gaps in care and improve patient outcomes and safety. However, many of these projects often lack the ethical oversight and clear frameworks to ensure they are conducted responsibly and with minimal risk. Researchers from Academic Affairs, Research, and Innovation group—the academic arm of the Patient Experience and Collaborative Academic Practice portfolio—and The Institute of Education Research (TIER) at UHN identified critical gaps in how QI projects were reviewed. This led to the creation of a multidisciplinary review committee to ensure safer and more responsible QI.
Dr. Ann Heesters, a senior author of the review and an Educational Investigator at TIER, led her team in engaging with over 130 staff members, physicians, and learners to better understand the process of assessing and approving QI projects at UHN. The stakeholders emphasized the need for clearer approval processes, better oversight structures, ethical reviews, and strategies to manage risk.
To address these concerns, the Quality Improvement Review Committee (QIRC) was established at UHN in 2020. This multidisciplinary committee offers ethical oversight and guidance for QI projects and includes experts in clinical care, ethics, quality improvement, research methodology, and organizational leadership. Since its creation, the QIRC has reviewed over 840 projects, developed educational resources, and created a project database to encourage collaboration and reduce risks for patients, staff, and teams across UHN.
By ensuring safer and more ethical QI work, the QIRC is supporting improvements in care and fostering collaboration across health care systems. Future efforts will focus on raising awareness, streamlining processes, and evaluating the long-term impact of this initiative.
The QICR is chaired by Drs. Catriona Steele and Peter Wu and supported by Stephanie Robinson the Director of UHN Quality and Safety, has two dedicated part-time specialists, Ms. Betty Chau and Ms. Konika Nirmalanathan, who offer ethical oversight and guidance for QI projects. The QIRC reports to Dr. Lucas Chartier, UHN’s VP Quality and Safety.
The QIRC also received UHN’s 2023 Local Impact Award for Quality and Safety, recognizing individuals and teams who support the mission of designing and delivering the safest and highest quality systems, experiences, and care. Read more here.
Ms. Sarah McMillan, the first author of the paper, previously served as a Clinical Research Coordinator in the Academic Affairs, Research, and Innovation at UHN.
Dr. Ann Heesters is an Assistant Professor at the Dalla Lana School of Public Health at the University of Toronto.
This work was supported by UHN Foundation and made possible through the support of many individuals, Executives, and Program Medical Directors from UHN. Detailed acknowledgements can be found here.
McMillan SE., Tosoni S., Smith KA., Chau B., Oh P., Steele C., Chartier LB., Heesters A., The Development and Implementation of a Quality Improvement Review Committee (QIRC): An Ethical and Pragmatic Imperative. Can J Bioeth. 2024. doi: 10.7202/1114955ar.