The End of Ontario’s Cancer Quality Partnership

Yesterday there were two announcements related to government policy in Ontario. The Premier announced a substantial expansion of his cabinet with a 33 per cent increase in his ministers and the bureaucracy that inevitably accompanies new ministers. As the best example, the Ministry of Health and Long-Term Care, previously led by one minister, will now have three political leaders at the cabinet table. The Premier also announced four new patronage appointments to open Ontario offices in the U.S. and Britain (two were revoked the next day).

Concurrent with this expansion of political bureaucracy and patronage was the quiet message that the new provincial super agency, Ontario Health, has eliminated about 170 positions at Cancer Care Ontario (CCO) and has cancelled the Quality Management Partnership (QMP). This important QMP program was started in 2013 in response to women undergoing unnecessary mastectomy for mistaken diagnoses of breast cancer. These tragic medical errors were investigated by an external panel that released a report with 19 recommendations.

Two of the recommendations spoke to the need for improvement in pathology quality across the province and instructed the ministry to work with Ontario professional organizations to initiate pathology quality improvement.

The ministry directed CCO and the College of Physicians and Surgeons of Ontario (CPSO) to respond to the recommendations of this report and the collaboration of these groups resulted in the QMP. The QMP was charged with tackling three important quality domains for cancer care — developing quality standards for mammography and colonoscopy (as part of cancer screening) as well as a comprehensive quality improvement program for pathologists.

Pathologists are the medical specialists who diagnose cancer. Poor quality pathology diagnosis can lead to tragic outcomes like unnecessary breast removal.

Developing quality standards for pathology requires a sensitive approach that involves both improvement in laboratory processes as well as the professional skills that pathologists must develop and update. With similar process and professional issues in mammography and colonoscopy quality, the collaboration of CCO (responsible for improving processes in cancer care) and the CPSO (responsible for ensuring high professional skills in Ontario doctors) was ideal for developing the QMP.

Over the past four years, quality standards in these three important areas of cancer care have been developed and the QMP was now at the stage of implementing standards and improving quality. Today, Ontarians are starting to benefit from steady improvement in the quality of our cancer care through the work of the QMP.

And now the QMP is terminated.

The decision to terminate improved cancer quality was presumably approved by the new Ontario super agency Ontario Health board. The board will undoubtedly say that the course was recommended to them by CCO management. However this course of action would never have occurred when CCO was governed by its own independent board, rather than a super agency responsible for governing all of Ontario health care.

CCO’s board would have refused to allow management to respond to the government’s impossible choice of terminating quality or cutting clinical services to achieve budget targets. The Chair of the CCO board would have been in the minister’s office and the premier’s office, protesting that the minor savings associated with terminating quality were not worth the risk of another unnecessary mastectomy. However, the chair of Ontario Health, presumably unaware of the crucial importance of cancer quality, accepted this budget cut imposed by the government.

The Premier has changed his pre-election promise to avoid lay-offs in health to state that he will eschew “front-line” lay-offs. As a former cancer surgeon, I can readily attest that front-line workers in cancer care need support from small numbers of staff who advise on quality improvement. Many of the people being side-lined are actually cancer clinical leaders — doctors who have a passion for improving the care that Ontarians receive.

On a day when patronage appointments were announced and bureaucracy bloats to service a 33 per cent increase in cabinet ministers, Ontarians can see what is important to this government.

Unfortunately, like those women who underwent unnecessary surgery for misdiagnosed cancer, Ontarians should be concerned that the government’s current priorities do not include improving the quality of cancer diagnosis and treatment.

Image Credit: ©Frank Gunn/The Canadian Press