The Excellent Care for All Act 2010 (ECFAA)1, which received Royal Assent on June 8, 2010, provides for significant changes to the governance of public hospitals. The overall goal is to increase accountability for health care executives and providers in providing quality health care.

On January 1, 2011 the requirement for hospitals to have a “Quality Committee” under sections 3 and 4 of ECFAA comes into force.

To support this move and in order to support the other quality improvements in hospitals brought about by ECFAA, updated regulations to ECFAA and the Public Hospitals Act 1990 (PHA)2, will also come into force on January 1, 2011, following a period of public consultation which has now closed.

The new regulations and ECFAA emphasise greater transparency in respect of patient relations and hospital governance and administration, in order to make improvements to the quality of care provided.

One of the key themes of ECFAA is a “patient led” approach to care by encouraging a dialogue with patients about quality of care through patient satisfaction surveys, and a requirement for all public hospitals to have a “patient declaration of values” brought about through public consultation.


  1. Changes to hospital board composition and voting rights

In connection with the introduction of ECF AA, the Legislature has introduced an important amendment to Regulation 965 of PHA (the Hospital Management Regulation)3 in respect of the composition of the board and voting rights of ex-efficio board members.

Previously s. 2(2) of the Hospital Management Regulation required certain medical staff (the Chief of Staff or Chair of the Medical Advisory Committee, President of the Medical Staff and, for most hospitals, the Vice President of the Medical Staff) to be voting members of a hospitals governing board.

As of Januar y 1, 2011, hospitals will be required to have the CEO (administrator), the president of the medical staff, the chief of staff (or chair of the medical advisory committee where there is no chief of staff) and the chief nursing executive on the board, but these individuals will be non-voting.

Specifically , as of January 1, 2011, any member of the medical, dental, extended class nursing or midwifery staff or any employee of the hospital is prohibited from being a voting member of the hospital board.

Members of the medical, dental, extended class nursing or midwifery staff, or any employee of the hospital can continue to sit on the Board, but they cannot vote.

Hospital by-la ws will need to be amended to deal with the impact of the changes. The extent of changes needed will vary between each individual hospital. However, regardless of whether or not the hospital by-laws are updated, voting rights for such members who continue to sit on the board will cease as of January 1, 2011.

  1. Requirement that all hospitals have a “Quality Committee”

As of Januar y 1, 2011, all hospitals are required to have a Quality Committee to oversee quality issues and report to the hospital board.4

The quality committee must be comprised of the CEO, one member of the medical advisory committee, the chief nursing executive, one person who is not a member of the Ontario College of Physicians and Surgeons, or the Ontario College of Nurses and any other person selected by the board.

At least one third of the members of the Quality Committee must also be voting members of the hospital board and in particular the chair must be a voting member of the hospital board.5

Quality Committees are tasked under ECF AA with monitoring and reporting on quality issues and on the overall quality of services, making recommendations in respect of quality improvement initia tives and policies, ensuring the dissemination and use of best practices information and overseeing the development of an annual quality improvement plan (QIP).6 The QIP is to be developed based on information gathered from patient surveys and patient relation programs as well as aggregated clinical incident data. It must also be made available to the public and the local health integration network, if requested.

The hospital board must ensure a ggregate clinical incident reporting to the Quality Committee at least two times per year to support the committee in these functions.7 

  1. Role of the Medical Advisory Committee (MAC)

The MAC will still advise the hospital board with respect to quality issues, however, they must now also make recommendations to the Quality Committee where they ha ve identified “systemic and recurring quality of care issues”.8 The Quality Committee must consider any recommendations made by the MAC. The MAC is no longer required to report on care provided by extended class nurses who are hospital employees.

It is noteworthy tha t amendments to the Hospital Management Regulation to compliment ECFAA which are already in force, also enhance the role of the MAC in respect of quality initiatives. Specifically, the hospital b oard is now required to extend disclosure of every critical incident to the MAC and the administrator, as well as to the affected patient and substitute decision maker.

  1. “Executive” compensation linked to achievement of quality targets

Executive compensa tion is linked to the achievement of quality targets under ECFAA.9 The new regulations coming into force on January 01, 2011 extend the definition of “executive” to include the CEO AND members of the senior management group who report directly to the hospital’s CEO, the chief of staff and the chief nursing executive.10 

  1. Changes to mandate of the Ontario Quality Council

The manda te of the Ontario Quality Counsel is extended to make recommendations to health care organizations on standards of care and to report to the Minister in respect of funding for health care services and medical devices. 11 

  1. Development of Patient Relation Programs

ECF AA requires health organizations to carry out surveys of patients and caregivers to collect information concerning satisfaction with the services provided at the hospital.12  

Hospitals are also required to have a pa tient relations process which reflects the organization’s “patient declaration of values”. 13 Hospitals that do not currently have a patient declaration of values in place, or have a declaration of values that was developed without public consultation, must have started a public consultation process by December 8, 2010 and must have a declaration of values in place by June 8, 2011.14


ECFAA and the new regulations which come into force in the New Year reflect a general trend of improving accountability in public organizations and an increasing focus on patient led care. The government is likely to take a robust approach to ensuring that the new requirements are complied with. The facilitation of public and local health integration network involvement in hospital quality assurance initiatives is noteworthy, as are the sanctions for contravention of a provision of ECFAA and/or its regulations.15