The Development and Implementation of a Quality Improvement Review Committee (QIRC): An Ethical and Pragmatic Imperative

Authors

  • Sarah E. McMillan Quality Improvement Review Committee, University Health Network, Toronto, Ontario, Canada https://orcid.org/0000-0002-9656-565X
  • Sarah Tosoni Strategy & Transformation, Quality & Safety, University Health Network, Toronto, Ontario, Canada
  • Kerry-Ann Smith Quality Improvement Review Committee, University Health Network; Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
  • Betty Chau Quality Improvement Review Committee, University Health Network, Toronto, Ontario, Canada
  • Paul Oh Quality Improvement Review Committee, University Health Network, Toronto, Ontario, Canada
  • Catriona Steele Quality Improvement Review Committee, University Health Network, Toronto, Ontario, Canada https://orcid.org/0000-0002-4294-6561
  • Lucas B. Chartier Strategy & Transformation, Quality & Safety, University Health Network; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada https://orcid.org/0000-0001-9716-1684
  • Ann Heesters Department of Clinical and Organizational Ethics, TIER & Michener Institute of Education, University Health Network; Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada https://orcid.org/0000-0001-8996-3484

DOI:

https://doi.org/10.7202/1114955ar

Keywords:

quality improvement, research ethics board, ethical review, risk mitigation

Language(s):

English

Abstract

Background: In complex academic healthcare systems, quality improvement (QI) projects designed to improve care and enhance learning proliferate, yet there is considerable variation with respect to how, or even whether, these projects receive ethical oversight. As a result of a high volume of projects that were submitted to one of our research ethics board (REB) panels, but deemed not-research and therefore not eligible for review, questions at our organization began to surface with respect to how the ethical dimensions of QI projects might be assessed, and which institutional approvals might be required to ensure compliance with emerging normative standards. Methods: A mixed-methods environmental scan led to a retrospective quantitative analysis of our organization’s QI projects coupled with in-depth qualitative consultations with staff, physicians, and learners across our health network. REB exemptions were analyzed via run charts to assess baseline QI project volumes and thematic analyses were conducted on field notes from 133 stakeholder consultations. Results: During a 34-month period, 117 REB exemption letters were issued for QI projects. Consultations identified the need for: a clearly defined ethical review process for QI projects, appropriate governance structures, and opportunities to identify and mitigate risk. Respondents also spoke to the ethical imperative to conduct QI initiatives. This paper discusses how these themes contributed to the development and implementation of our Quality Improvement Review Committee (QIRC). Conclusion: Since 2020, over 840 projects have been reviewed by our QIRC, with a view toward mitigating risks for patients, staff, and QI project teams across UHN.

(c) Han Han Li

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Published

2024-12-02

How to Cite

[1]
McMillan SE, Tosoni S, Smith K-A, 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;7:14-20. https://doi.org/10.7202/1114955ar.

Issue

Vol. 7 No. 4 (2024): Open Issue

Section

Articles

License

Copyright (c) 2024 Sarah E. McMillan, Sarah Tosoni, Kerry-Ann Smith, Betty Chau, Paul Oh, Catriona Steele, Lucas B. Chartier, Ann Heesters

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

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