About Quality and Innovation
Read the sections below to learn more about the DFCM Quality Improvement Program.
We believe that health care professionals desire to continuously improve.
COMPLEXITY – We believe that:
- Within the complex adaptive systems of health care, primary care is the most complex. This implies that:
- Impact from interventions to improve quality is often unpredictable;
- Conceptual frameworks that rely on the intuition and tacit knowledge of front-line providers, as much as evidence-based explicit knowledge, are necessary to improving primary care processes.
- Navigating and improving primary care complex systems favours an approach of building relationships that share integrative solutions through generative reasoning with minimal specification, rather than reductionist thinking and standardization to increase control. 
TEAMS – We believe that:
- In providing care to populations who have increasingly complex needs, the best outcomes will be achieved through a high functioning, interprofessional team.
- When teams identify as learning organizations, they are energized and sustained through curiosity and reflection, challenge assumptions and beliefs, recognize improvement opportunities, test ideas for change, and implement those with meaningful impact.
- High functioning teams are patient focused – patient centered in their clinical application, conscious of improving the patient experience, feel an affiliation to their communities and engage with their patients and communities in co-designing all aspects of care.
- The optimal primary care team culture holds to a lived experience of continuously seeking improvement, mutual trust and respect amongst team members, setting team goals as priorities, and all team members feel empowered to identify, and contribute to improvement opportunities and system design.
- Effective leadership of primary care teams reflects concern for team creativity, team engagement in the design and testing of novel solutions, supporting individual learning and growth, and effectively interfacing with the team’s environment in building relationships in its community.
IMPROVEMENT– We believe that:
- There is a systematic approach to improvement, which can be effectively applied to improve primary care.
- There are many modalities in which improvement in primary care can be demonstrated. 
- The learning system of primary care teams is grounded in the interplay between a) content knowledge that is reinforced through experience, with b) Deming’s Theory of a System of Profound Knowledge and its study and interactions of its four paradigms (i) system complexity, (ii) variation, (iii) testing and learning from system performance and changes, (iv) and human behaviour.
EDUCATION– We believe that:
- There is a systematic approach to education, which can be effectively applied to improve primary care.
- Educating for improvement in primary care goes beyond enhancing competence; it’s a process of adaptation and learning from internal and external environmental change.
- Educating primary care providers and their teams must be supportive to their context and not prescriptive.
- The first stage in learning for primary care teams is reflection – in action and on action.
INNOVATION– We believe that:
- There is a systematic approach to innovation, which can be effectively applied to improve primary care.
- The dynamic and emergent nature of primary care systems, leads to ever changing patient, provider, and community health care needs.
- Ever changing health care and organization needs will require best practice application of innovative thinking to attain novel solutions for improvement.
- Fear of failure is a barrier to innovation; however, failure itself is often a necessary step to positive change.
DFCM QUALITY IMPROVEMENT PROGRAM– We believe that:
- We commit to holding ourselves accountable within academic family medicine to disseminate what we learn to enable others in building their quality culture.
- To ensure sustainability, the QI Program will need to attract new resources and leverage relationships into collaborative partnerships.
- Priorities for improvement as identified, must be aligned with real world system needs, such as access, better system integration, and challenges for system sustainability.
 It is seductive in addressing problems in complex systems to simplify and gravitate to linear thinking with solutions such as guidelines, “best practice” algorithms and standards. Our real world is messy where context is critical to understanding each environment. More effective solution finding processes arise from non-linear methods such as reflection and storytelling.
 Examples being improvement methodologies, organizational behaviour, education such as Continuing Education, knowledge translation, audit and feedback, academic detailing, etc.
Primary care teams living a quality culture.
The QI Program will:
- Enable primary care teams to live a quality culture as evidenced by continuous learning through team reflection, goal setting, purposeful testing, and implementing positive change via continuous improvement.
- Guide primary care teams to achieve better collaboration through communication, mutual trust and respect, and effective leadership.
- Facilitate primary care teams to sustain their quality culture in order to demonstrate impact on care effectiveness, patient experience, and value of service delivery.
- Share and disseminate what we learn.
Goals, Action Steps and Projects
Operationally Defining The "Quality Culture" of Primary Care Teams
DFCM Core Team
For all general inquiries, questions, feedback, or program inquiries contact:
|name||title||phone number and email||room #|
Dr. Tara Kiran, MD, MSc, CCFP, FCFP
*Read bio below
|Fidani Chair, Improvement and Innovation &
Vice Chair, Quality Improvement
|Dr. Jeremy Rezmovitz, MSc, MD, CCFP||Lead, Education and Innovation|
|Trish O'Brien||Program Manager||416-978-5112
|Marisa Schwartz||Program Assistant||416-978-3793
Continuing Education & QI Administrator
Quality Program Committee - Family medicine teaching unit and member name
The mandate of the Quality Program Committee (QPC) at the Department of Community and Family Medicine is to improve patient care by promoting and enabling the integration of quality improvement into all aspects of DFCM education, research and professional development activities.
The QPC is comprised of physicians from our 14 affiliated family medicine academic sites. Below is a list of current QPC members:
|Vice Chair, Quality Improvement||Dr. Tara Kiran|
Lead, Education and Innovation
Dr. Jeremy Rezmovitz
|QI Program Manager||Ms. Trish O’Brien|
|QI Program Assistant||Ms. Marisa Schwartz|
|CE and QI Administrator||
Ms. Laura Surdianu
|Department of Family and Community Medicine (DFCM)||
Mr. Cecil Canteenwalla - Strategic and International Relations Coordinator
Dr. Paul Krueger - Research Program
|Markham Stouffville Hospital||Dr. John Maxted|
|Michael Garron Health Centre||
Dr. Sam Tirkos
Dr. Tia Pham
|Mt. Sinai Hospital||Dr. Sakina Walji|
|North York General Hospital||
Dr. Joanne Laine-Gossin
Dr. Tiffany Florindo
|Royal Victoria Hospital||
Dr. Brent Elsey
Dr. Melissa Witty
|Southlake Regional Health Centre||Dr. David Makary|
|St. Joseph's Health Centre||Dr. Linda Weber|
|St. Michael's Hospital||
Dr. Tara Kiran
Ms. Susan Blackers – Division of Palliative Care
|Sunnybrook Health Centre||Dr. Debbie Elman|
|The Scarborough Hospital||
Dr. Susanna Fung
Dr. Rosemarie Lall
|Toronto Western Hospital||
Dr. Lesley Adcock
Dr. Mark Broussenko - PGY1 Resident Representative
|Trillium Health Partners||
Dr. Frances Cousins (Summerville)
Dr. James Pencharz (Credit Valley)
Dr. Manisha Sharma (Credit Valley) - Division of Palliative Care
|Women’s College Hospital||
Dr. Susie Kim
About Dr. Tara Kiran: Fidani Chair, Improvement and Innovation and Vice Chair, Quality Improvement
We are pleased to announce that Dr. Tara Kiran has accepted the roles of the Fidani Endowed Chair of Improvement and Innovation in Family Medicine and Vice-Chair, Quality and Innovation in the Department of Family and Community Medicine (DFCM) at the University of Toronto beginning July 1st, 2018.
"Throughout my career, I have always been motivated to improve the health care system and the care we provide to patients," says Dr. Kiran, an Assistant Professor at DFCM and a family doctor at St. Michael's. "It's a great privilege to be able to be in this position where I can help us take a step back to think about primary care and how we can do even better to serve our patients."
Through her work in both roles, Dr. Kiran will lead change in the delivery of primary health care through quality improvement and innovation initiatives within DFCM and its teaching sites, as well as influence health policy and practice provincially, nationally and internationally.
Dr. Kiran comes to this position with ample experience: she has worked as both a community and academic physician in various areas of Ontario and has held several leadership positions, most recently working with Health Quality Ontario as a Canadian Institute of Health Research-funded Embedded Clinician Researcher to better understand what matters most to patients in the transition from hospital to home.
Over the last seven years, she has served as QI Program Director at the St. Michael's Academic Family Health Team's, which includes approximately 70 staff physicians, 40 resident physicians and 60 non-physician health professionals serving over 44,000 patients at six clinics.
"I'm particularly proud of how we've been able to improve patient experience at St. Michael's by working with patients to design and implement QI initiatives," says Dr. Kiran. "Understanding and improving patients experience and working with patients to improve the health care system is an important lens I want to bring to this role."
Dr. Kiran vision for QI at DFCM is multifaceted: she aims to continue to inspire and educate residents and faculty in QI by building on an already robust QI curriculum, use tools like UTOPIAN to find new interventions that focus on improving health outcomes, and engage patients and partners to make system-wide changes. Dr. Kiran is also passionate about health equity and wants to ensure that DFCM's QI work addresses the needs of our most vulnerable populations.
"Overall I see us leading by example. I want us to demonstrate that we are a high performing health care system through data and stories," says Dr. Kiran. "And when people think of high performing primary care, I want them to think about the University of Toronto and our department."
Dr. Kiran assumes this position from Dr. Philip Ellison, who has led the Quality and Innovation program since its inception in 2010. Through his hard work and dedication to improving the health care system, Dr. Ellison's work has provided DFCM residents, faculty and family physicians throughout Ontario with the tools required to deliver the best in patient care.
"It's really important to recognize how far we've come," says Dr. Kiran. "I joined the Quality Improvement team when it was just getting started in 2011. We had so much to learn. Dr. Ellison did a tremendous job to getting us where we're at today – he and our department were really ahead of their time. It's an honour to build on his legacy."