Users of the health care system have an important role to play in quality improvement.  
Health Quality Ontario publishes annual reports on the quality of the health care system, and identifies problems that need to be addressed.  While there are many messages in these reports about what health care providers and institutions could be doing differently, patients can also get involved, by playing a more active role in their care.  

Patient self-management

Patient education has long been viewed as an important part of medical care.  Patients need to be informed about their conditions, their options and recommended drugs or therapies.  However, “patient self-management” goes beyond just giving information.  It aims to teach individuals how to set personal goals, solve problems, and carry out a behaviour change in the name of better health, even when the old behaviour may have been a comfortable habit.  In doing so, patients take control of their own diseases, rather than having health care providers make decisions for them.  

This method has been developed at Stanford University and has spread to the US, UK and more recently, to BC and Alberta.  The Ontario Patient Self-Management Network helps to coordinate patient self-management activities and to provide momentum for this approach to be more widely accepted in Ontario health care.  For more information, visit:  
www.ontpsm.net/self_management.php

Understand your targets

For patients with chronic diseases, proper management means hitting certain targets for good disease control.  Examples include the following:

                                                           

For patients with:	Good control of your condition means:
Diabetes	- keeping your blood pressure less than 130 / 80. - making sure your A1C is less than 0.07. This is a three month average of your blood sugar. - LDL (bad cholesterol) less than 2.5. Levels above these targets increases the risk of complications like heart attacks, strokes, amputations and blindness.
Angina, past heart attacks, previous bypass surgery or angioplasty	- Keeping your blood pressure less than 140/90. - Keeping LDL (bad cholesterol) less than 2.5.  Levels above these targets increases the risk of complications like heart attacks and strokes.
Congestive heart failure	- Keeping your weight close to a target weight set by your doctor. (Any sudden increase may mean a change to your medications is necessary.)
Arthritis of the hip, knee	- You and your doctor should set personalized goals for weight reduction.

If you have any of these conditions and don’t know what your targets are, discuss them with your health care team. 

Better Communication

Better communication between patients and providers can help avoid medical errors and ensure that the most appropriate drugs, tests, and services are provided.  Better communication can give you more information about your treatment options so you can make a more informed choice.  Here are some tips on you to communicate more effectively: 

• The Ontario Hospital Association encourages patients to take five important steps to prevent adverse events when visiting a hospital or health care provider:

1. Be involved in your health care.  Speak up if you have questions or concerns about your care.
2. Tell a member of your health care team about your past illnesses and your current health condition.
3. Bring all of your medicines with you when you go to the hospital or to a medical appointment.  
4. Tell a member of your health care team if you have ever had an allergic or bad reaction to any medicine or food.
5. Make sure you know what to do when you go home from the hospital or from your medical appointment. 
   

• SAFE TO ASK is a Manitoba-based program which encouraging patients to ask three basic questions each time they visit a health care provider:

1. What is my health problem? 
2. What do I need to do? 
3. Why do I need to do this?
   

• SPEAK UP is an American program developed by the Joint Commission on Accreditation for Healthcare Organizations.  It offers the most detailed checklist of questions patients can ask their health care providers.  Visit: 
  www.jointcommission.org/NR/rdonlyres/484AD48F-C464-4B5B-8D70-AA79179B3970/0/Speakup.pdf

Ask about choice of provider or site

If you have been referred to a specialist or for a specialized test and wait times are long, ask your doctor if there are others he or she might recommend who have a shorter wait list.  Through the Ontario Wait Times Strategy, you can now see for yourself which sites have the shortest wait times for cancer surgery, cardiac bypass and angioplasty, cataract surgery, CT and MRI scans, and hip and knee replacement.  Visit: 

http://www.health.gov.on.ca/transformation/wait_times/providers/wt_pro_mn.html

Join a quality improvement team

If you have had a negative experience with the health care system, consider using your experience to help make the system better for others in the future.  Quality improvement teams are currently working in different parts of the health care system. Let your local facility or health care provider know that if there are any such teams opening up, that you would be willing to serve on them. 

Encourage your provider or institution to participate in quality improvement initiatives

Ask your health care providers if they are part of quality improvement initiatives in Ontario, and encourage them to join up if they haven’t already.  We will soon be posting an inventory of these initiatives to this website.