Take note! The Minister for Health and Long Term Care has published proposed regulations and updated guidance to support the establishment of quality improvements in hospitals.

The move is pursuant to the new Excellent Care for All Act, 2010 ( ECFAA)1, which received Royal Assent on June 8, 2010.

The ECFAA provides that health care organizations (currently defined as public hospitals) must develop annual quality improvement plans. “Executive” compensation will be linked to the achievement of quality targets under those plans.

The ECFAA includes a further requirement, not yet proclaimed into force, that hospitals create quality improvement committees to oversee quality issues and report to the hospital board.

The recently published proposed regulations contain some important operational changes that are intended to support hospitals to comply with the requirements of the ECFAA. They are open for public consultation until November 12, 2010.2


Amendment to Regulation 965 (Hospital Management) (Public Hospitals Act3).4  

  1. Changes to hospital board membership. The CEO (administrator), the president of the medical staff, the chief of staff or chair of the medical advisory committee and the chief of nursing to sit on the board.  
    • It is noteworthy that any member of medical staff, dental staff, extended nursing or midwifery staff or any employee of the hospital who would be required to be a member of the board, will not have voting rights.5  
    • The board would ensure aggregate critical incident reporting to the quality committee at least two times per year.  
    • The medical advisory committee would make recommendations to the quality committee where they have identified “systemic and recurring quality of care issues”.6
    • The medical advisory committee would no longer be responsible for making recommendations to the board about the quality of care provided by extended class nurses who are hospital employees.  
  2. New Regulation to the ECFAA.7  
    • The new regulation expands the definition of “executive” in the ECFAA to include the CEO (or equivalent) AND members of the senior management group, the chief of staff and the chief nursing executive. It is proposed that all of these persons will have their compensation linked to the achievement of quality targets.  
    • The quality committee would be comprised of the CEO, one member of the medical advisory board, the chief nursing executive, one member of a “health profession”8 and any other person selected by the board. It is intended that the majority of the members will be voting members on the hospital board. In particular, the Chair of the quality committee would be a voting member of the board.  
    • Expansion of the mandate of the Ontario Quality Council 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.9  
  3. And finally, the Minister has recently issued guidance on “Patient Declaration of Values” under the ECFAA.10  
    • If hospitals already have a patient declaration of values they are not required to develop a new one, as long as the declaration was developed through public consultation.  
    • Hospitals that do not have a patient declaration of values in place, or have a declaration of values that was developed without public consultation must begin a consultation process by December 8, 2010 and have a declaration of values available to the public by June 8, 2011.  


Hospitals and all health organizations should be aware of the impact of the ECFAA and the new proposed regulations.

The fact that executive compensation is now linked to quality targets confirms that the government intends to take a robust approach to ensure that hospitals are compliant with the new requirements and that improvements are made in achieving quality of care. The ECFAA and the new proposed regulations are in keeping with a general trend of improving accountability in public organizations, and in a health context, an increasing focus on patient-led care.

It seems likely that the ECFAA will be extended to include other health organizations in the future.