Glossary

A question-asking method used to explore the relationships between cause and effect underlying a problem to identify the root cause.

An obligation or willingness to accept responsibility. It’s an expectation of being responsible toward others.

Usually delivered in a hospital-like setting, acute care is the type of care that your health care team will provide if you are sick or injured, or recovering from a treatment such as surgery. When you are admitted to an acute care hospital to receive care, you are usually called an “inpatient”.

Harm to a patient, structure or function and/or any negative effect from that.

A concise and measurable declaration of the improvement goal.  It includes what, where, by how much and by when. An example:

“This is the third wave of Clear (which used to be known as CLeAR: A Call for Less Antipsychotics in Residential Care), and this time we’re focused on supporting care homes that have more residents receiving antipsychotics without a diagnosis of psychosis than the BC average of 25%.”

Learn more about how to write an aim statement.

All types of health services that are provided on an outpatient basis, in contrast to services provided in the home or to persons who are inpatients. While many inpatients may be ambulatory, the term ambulatory care usually implies that the patient must travel to a location to receive services that do not require an overnight stay.

A broad range of residential care services that includes some assistance with activities of daily living and instrumental activities of daily living but does not include nursing services such as administration of medication. Assisted living facilities and in-home living care stress independence and generally provide less intensive care than that delivered in nursing homes and other long-term care institutions.

Recognizes the importance of continuous doctor- patient relationships and aims to connect an individual with a primary health care provider who provides him/her with comprehensive, ongoing care.

Visual displays that show data that has been categorized and counted. It is used to compare different categories.

Created in 2008 by the BC provincial government, the BCPSQC provides leadership across BC’s health care system to efforts that support improvements in the quality of care.

A technique to organize and display ideas about what may be the root cause of a problem, designed to encourage innovative thinking (but not thinking about solutions, only potential causes).

To make something different.  See “Improvement” for contrast.

A documented plan to guide the work of an improvement team. A Quality Improvement Charter details the following:

1. What is the problem currently?
2. What are we trying to accomplish (aim, goals)?
3. How will we know that a change is an improvement (measures, data)?
4. What changes can we make that will result in an improvement?
5. How will the team manage the improvement effort?

A list of things to be done, required items, or things to consider. Checklists are often used as reminders. In quality improvement, they are used to improve the safety of care, by ensuring that proven standards of care are met when used. They improve compliance with standards and decrease complications. Example: surgical checklists.

Continuing Medical Education for doctors.

An action-focused dialogue between two or more people that brings clarity to an issue and develops a plan of action for tackling it. It is a facilitated exploration of an issue through discussion, different perspectives and neutral feedback, as well as observations to allow for self-reflection and action.

CEAN is a group of members of the public who support patient and public involvement in health service planning and decision-making at Vancouver Coastal Health.

CHCs provide a wide range of health services which may include prenatal, postpartum, health promotion, disease and injury prevention, bereavement services, communicable disease and school health, immunization and many other community care public health and wellness programs.

A set of skills, knowledge, attitudes and behaviours needed for a role.

A graph of data over time used to understand the type of variation in a process or outcomes.  There are three lines that are determined by historical data – average, upper control limit and lower control limit.

Cultural awareness: [a health care partner’s] recognition and acknowledgement of cultural difference – beliefs, languages and teachings – as a factor influencing and shaping [the patient’s] experience

Cultural sensitivity: recognition of the need to respect cultural difference.

For more information see the Cultural Safety and Humility Case Study Report published by First Nations Health Authority, the British Columbia Ministry of Health and Indigenous Services Canada.

Health professionals’ effectiveness in cross-cultural relations, which requires self-awareness and recognition of how this influences perceptions and treatment of others. Indigenous Cultural Competency refers to the knowledge, self-awareness, and skills that enable health professionals to work with and treat Indigenous people with respect. This knowledge includes cultural concepts, protocols, diversity and colonial context. (PHSA)

Cultural safety: an outcome based on respectful engagement that recognizes and strives to address power imbalances inherent in the healthcare system. It results in an environment free of racism and discrimination, where people feel safe when receiving health care.

Cultural humility: a process of self-reflection to understand personal and systemic biases and to develop and maintain respectful processes and relationships based on mutual trust. Cultural humility involves humbly acknowledging oneself as a learner when it comes to understanding another’s experience.

First Nations Health Authority. Cultural Humility [Internet]. 2020 [cited 2020 Jan 1].

When it comes to organizations, culture is sometimes described as “the way we do things around here.” It includes shared attitudes, beliefs, values and norms of behaviour, the way of making sense of the organization and the ways things are understood, judged and valued.

Statistical tools and techniques used to measure the impact of improvements. Some common tools for display and interpretation are the run charts, control charts, bar charts, Pareto diagrams, histograms and radar charts.

Divisions of Family Practice are community-based groups of family physicians working together to achieve common health care goals. There are currently 35 Divisions of Family Practice in BC that encompass more than 230 communities.

The Doctors of BC is a professional body of doctors in British Columbia.

A computerized medical record that may include medical history, medication lists, lab results, etc.

Emergency services are available 24 hours a day in regional and community hospitals across the province. Emergency departments are intended to care for individuals experiencing a health crisis or urgent medical condition. Examples of urgent medical conditions include but are not limited to: signs of heart attack or stroke, extreme pain, severe bleeding, broken bones, shortness of breath or respiratory distress, etc.

Engagement Leaders are part of the BC Patient Safety & Quality Council Team. The Engagement Leader is responsible for leading work within the Council’s patient and public engagement strategy. This includes supporting patient and health care partners to work together through Patient Voices Network.

Any process, event or committee in which patient partners are invited and supported to share their experiences and perspectives, with the goal of contributing to health care system improvement.

The branch of medicine which deals with the incidence, distribution, and possible control of diseases and other factors relating to health.

Failure to carry out a planned action as intended, or application of an incorrect plan.

A doctor who specializes in family medicine and provides health care to people of all ages. Family Physicians are sometimes referred to as General Practitioners (GPs).

A situation when the results from an event will influence the next time the event takes place. When an event is part of a chain of cause-and-effect that forms a circuit or loop, it is said to “feed back” into itself.

A type of diagram that shows the steps of a process and their order, by connecting them with arrows. There are several types of flowcharts, and sometimes the word is used interchangeably with Process Mapping (which is a flowchart, with some extras).

Groups of patients get together with their doctor to learn about their condition, ask questions, share knowledge with other patients, and gain confidence in themselves and their ability to self- manage their chronic conditions.

A circumstance, agent or action that can lead to or increase risk.

There is a provincial health authority, five regional health authorities, and a First Nations health authority that provide high quality, appropriate and timely health services to British Columbians.

Health care is the diagnosis, treatment, and prevention of disease, illness, injury and other physical and mental impairments.

Health care refers to the work done in providing primary care, secondary care and tertiary care, as well as in home and community care and public health.

A health system, also sometimes referred to as health care system or healthcare organization, is the organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations.

Any health authority staff member or similar stakeholder who, in the course of their work, seeks out, supports, and facilitates patient engagement opportunities. These HCPs are often the main point-of contact for patient partners taking part in engagement opportunities.

Health Sector Information Management is the practice of obtaining health information (digital and paper) and analyzing and protecting it to support the delivery of quality patient care. Health information technology is how health information is safely shared across computer systems between health care providers and supporting organizations.

An organization that has succeeded in avoiding catastrophes in an environment where normal accidents can be expected due to risk factors and complexity.

Graphs showing the distribution of continuous data (such as time).

A range of health care and support services for individuals who have acute, chronic, palliative or rehabilitative health care needs.

Home and community care services are designed to complement and supplement – but not replace – the efforts of individuals to care for themselves with the assistance of family, friends and community. In-home services include home care nursing, rehabilitation, home support and palliative care. Community-based services include adult day programs, meal programs, treatment for substance use disorders, as well as assisted living, residential care services and hospice care. Case management services are provided in both the home and community.

The scientific discipline concerning understanding interactions between humans and other elements of a system. It’s also a profession that applies theory, principles, data and methods to how something is designed, with the goal of improving human well-being and overall system performance.

IAP2 is the preeminent international organization advancing the practice of public participation. It created the well-known Spectrum of Public Participation.

Fundamental changes that alter how work or activity is done, producing visible, positive differences in results related to historical norms, with a lasting impact. Improvement always requires change, but not all changes will result in improvement.  Improvement comes from action. It means doing something better from the viewpoint of the customer or other beneficiary. It’s sometimes referred to as “Quality Improvement.”  See “Change” for contrast.

The discipline concerned with preventing infections associated with health care.

​Infection prevention and control measures aim to protect those who might be vulnerable to acquiring an infection, both in the general community and while receiving care due to health problems.

The use of computer systems to process data and derive meaning from it.

The process by which a novel idea or invention is put into practice, resulting in a change or improvement.

If you are admitted to a hospital or health care facility to stay overnight (for at least one night or longer), so as to receive the care and treatment you need, you are called an “inpatient”.

Mistrust or inability to interact with systems, such as health care and public safety, due to unsafe practices and trauma inflicted by the associated institutions.

Includes efforts to shift the management and delivery of health services so that clients receive a continuum of preventive and curative services, according to their needs over time and across different levels of the health system.

Untreated trauma-related stress, experienced by survivors, that is passed on to second and subsequent generations

A philosophy focused on maximizing value while reducing waste or inefficiency.

Long-term residential care services provide 24-hour professional supervision and care in a protective, supportive environment for people who have complex care needs and can no longer be cared for in their own homes or in an assisted living residence.

Measures are recorded observations which include quantitative (numbers) and qualitative (words, pictures, images) data.  There are three types of measures that can be used in improvement work:

• Outcome measures are related to the goal (aim statement) and show whether changes are leading to improvement.
• Process measures show whether a change is having its intended effect or is a sub-set of the outcome measure.
• Balancing measures ensure that changes to one part of the system are not causing problems in another part of the system.

Medical assistance in dying occurs when an authorized doctor or nurse practitioner provides or administers medication that intentionally brings about a person’s death, at that person’s request. This procedure is only available to eligible patients.

A preventable adverse effect of care, whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, infection or other ailment.

Giving advice and showing the way.

The Ministry of Health (the Ministry) has overall responsibility for ensuring that quality, appropriate, cost effective and timely health services are available for all British Columbians. The Ministry is responsible for provincial legislation and regulations related to health care, including the Medicare Protection Act and the Health Professions Act. The Ministry also directly manages a number of provincial programs and services, including the Medical Services Plan, which covers most physician services; PharmaCare, which provides prescription drug insurance; and the BC Vital Statistics Agency, which registers and reports on vital events such as a birth, death or marriage, etc.

For more information visit: http://www.gov.bc.ca/health

The Ministry of Mental Health and Addictions was created in 2017 to build a seamless, coordinated network of mental health and addictions services that works for everyone in B.C., as well as lead the response to the overdose crisis.

A mechanism that avoids mistakes by preventing, correcting or drawing attention to human errors as they occur. Examples: adding fields in a software program that will only accept certain formats (think postal codes); using dropdown menus instead of free-text, creating clear visual differences in labels for medications with similar names.

An action or circumstance that prevents or moderates the progression of an incident from harming a patient, such as double-checking for certain types of errors.

An approach to improvement which helps people develop, test and implement changes. The Model for Improvement includes three questions and a cycle for learning and improvement, called a PDSA Cycle. The three questions are:

• What are we trying to accomplish (aim, goals)?
• How will we know that a change is an improvement (measures, data)?
• What changes can we make that will result in an improvement?

Related terms:

• Measures
• Change
• Improvement
• PDSA = Plan, Do, Study, Act

To observe a situation for any changes that may occur over time.

Nurse practitioners are health professionals who have achieved the advanced nursing practice competencies at the graduate level of nursing education required for registration as a nurse practitioner with the College of Registered Nurses of British Columbia.

When a person is not admitted to the hospital for an overnight stay, but still comes to a physician’s office, clinic, hospital, day surgery office or other health care facility for diagnosis, treatment or to receive care, that patient is considered an “outpatient”. See also: inpatient

Care and supports for patients and families who are dealing with a progressive, life-limiting illness.

Pareto diagrams are bar charts with categories organized in decreasing order of frequency with the cumulative total represented by a line. A Pareto diagram is used to identify the areas of an organization or process that will deliver maximum benefit (“the significant few”) when improved. Related to the Pareto principle, also known as the 80/20 rule.

The concept that, in many situations, 80% of the outputs will be generated by only 20% of the inputs. For example, 20% of users will make 80% of the calls to a service desk.  Also known as the 80/20 rule.

A person who is receiving, has received, or has requested health care. This term includes caregiver: a person(s) whom the patient wishes to be involved with them in care, and acting on behalf of and in the interest of the patient. It refers to all other terms for patient including client, resident, person, consumer,etc.

Individuals who represent the patient perspective at all system levels. It includes champions, advocates, representatives, etc.

Angela Coulters’s well-known definition focuses on the relationship between patients and health-care providers as they work together to “promote and support active patient and public involvement in health and health care and to strengthen their influence on health-care decisions at both the individual and collective levels.”

Involvement of the patient perspective in decision making and active participation in all aspects of design, planning, delivery and evaluation of health services at all system levels.

A patient medical home (PMH) is a community practice where patients get the majority of their care. It builds on what GPs are already doing, and takes the practice to the next level. GPs get more consistent support from teams, networks, and clinical services in the community and use data to inform decisions.

Patient partners are British Columbians passionate about health care and who want to share their experiences to improve health services for everyone. They are patients, families and caregivers who:

– Have been involved with BC health care
– Come from all parts of BC
– Represent all ages, ethnicities, genders and professional backgrounds

Freedom, for a patient, from unnecessary harm or potential harm associated with health care.

The pursuit of the reduction and mitigation of unsafe acts within the health care system, as well as the use of best practices shown to lead to optimal patient outcomes.

The Patient Voices Network (PVN) is a community of patients, families and caregivers working together with health care partners to improve BC’s health care system.

A Ministry program and philosophy that promotes and supports the creation of patient- and family centred care through health care improvements. The principle driving the program is “nothing about me without me.”

PDSA represents the four phases in small tests of changes: PLAN a small test of change, DO (test) that change, STUDY the results – what happened, and ACT – decide whether to adapt, adopt or abandon the change.

A method for learning and improvement based on a scientific method. The PDSA cycle includes four phases: Plan, Do, Study, and Act. PDSA cycles can be used to develop, test and implement changes, initially on a small scale. They can be used sequentially over time to build knowledge about what changes work, why they work, when they don’t work and how the changes can be adapted.

PCC and PFCC are closely related approaches that guide all aspects of planning, delivering and evaluating clinical care decisions and services. The focus is always on creating and nurturing mutually beneficial partnerships among the care providers and the patients they serve. It means providing care that is respectful, compassionate, culturally safe, and competent, while being responsive to patient needs, values, cultural backgrounds and beliefs, and preferences.

According to the Institute for Patient & Family Centered Care, “patient- and family-centered practitioners recognize the vital role that families play in ensuring the health and well-being of infants, children, adolescents, and family members of all ages. They acknowledge that emotional, social, and developmental support are integral components of health care. They promote the health and well-being of individuals and families and restore dignity and control to them. Patient- and family-centered care is an approach to health care that shapes policies, programs, facility design, and staff day-to-day interactions. It leads to better health outcomes and wiser allocation of resources, and greater patient and family satisfaction.”

A system that is designed and delivered to directly address the health care needs and preferences of patients. To achieve person-centred care, the focus must be on following six principles: respect; choice; empowerment; patient, caregiver and staff involvement in health policy; access and support; and information.

A focus on respect; choice; empowerment; involvement of patients, caregivers and staff in health policy; access and support; and information. See also “person-centred care”.

Information in any form that identifies you and that relates to your health and health care including, health history, health card number and other personal identification numbers. For more information: https://www.cihi.ca/en/faq/what-is-personal-health-information 

Personal protective equipment (PPE) are items worn to provide a barrier to help prevent potential exposure to infectious disease. These items include:

gloves
gowns
surgical masks
surgical masks with visor attachment
respirators
face shields
eye protection
 goggles

A joint initiative of the Ministry of Health and Doctors of BC, this program helps doctors and their staff make improvements in their practices.

Health care provided by health care professionals who act as a first point of consultation for patients within the health care system. This is usually a general practitioner or family physician, or a non-physician primary care provider such as a nurse practitioner, but can also include speaking to a pharmacist or calling a health information line.

Depending on the nature of the health condition, patients may then be referred for secondary or tertiary care.

A primary care home is a collaborative primary care network or co-located team of full service family practices, whose services are enhanced by linked or integrated health authority delivered primary care services. Primary care homes aim to provide accessible, continuous, coordinated and client-centered care.

A clinical network of local primary care service providers located in a geographical area, with patient medical homes (PMHs) as the foundation. A PCN is enabled by a partnership between divisions of family practice and health authorities.

In a PCN, physicians (via patient medical homes), other primary care providers, allied health care providers, health authority service providers, and community organizations work together to provide all the primary care services a local population requires.

A series of steps required to achieve intended outcomes.

A visual representation of activities and steps involved in a process, including who is responsible for each step, what the standard of practice is, and how success is determined.

The province’s health authorities are the organizations primarily responsible for health service delivery. Five regional health authorities deliver a full continuum of health services to meet the needs of the population within their respective geographic regions:

• Fraser Health
• Interior Health
• Island Health (formerly Vancouver Island Health Authority)
• Northern Heath
• Vancouver Coastal Health

A sixth health authority, the Provincial Health Services Authority, is responsible for managing the quality, coordination and accessibility of services and province-wide health programs. The Ministry also works in partnership with the First Nations Health Authority to improve the health status of First Nations in British Columbia.

Source: Adapted from the BC Ministry of Health 2016/17 – 2018/19 Service Plan. Available at: http://www.gov.bc.ca/health

The science and practice of protecting and improving the health of a community according to the public health principles of disease prevention, health promotion, and public policy.

In the context of health and wellness, the BC Health Quality Matrix provides a shared definition of quality for British Columbia’s health care system. Quality is defined by seven dimensions that span the full continuum of care:

1. Respect
2. Safety
3. Accessibility
4. Appropriateness
5. Effectiveness
6. Equity
7. Efficiency

The Quality Forum is the BC Patient Safety & Quality Council’s annual two-day conference. The first day hosts full-day sessions that “dive deep” into timely topics, as well as our evening Health Talks event. The following day features the Quality Forum’s main programming: plenary speakers, presentations and workshops on topics related to improving quality across the continuum of care.

“Quality” is one of those words where, if 10 people were polled, 10 different definitions could be provided. In essence, when used in a health care setting, a common definition involves how well the right care is delivered to the right patient at the right time.

The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Seven dimensions of quality, as outlined in the BC Health Quality Matrix include: acceptability, appropriateness, accessibility, safety, effectiveness, equity and efficiency. See more at: www.bcpsqc.ca

These are structured ways of bringing together people who are involved in all parts of the process of delivering a service in order to allow detailed sharing of all actions undertaken (the current state), the process and opportunities to define a future state, and the improvement action plan needed to get there.

The ability of a system to perform and maintain its expected functions, not only in routine circumstances, but also in hostile or unexpected circumstances.

An assessment of the probability that a potential hazard will occur, and its consequences.

A problem-solving method that addresses, corrects or eliminates the root cause of a problem, instead of merely addressing the immediately obvious symptoms. By identifying the root causes, it is more likely that the problem will not occur again.

A run chart, also known as a time series plot, is a graph that shows observed data in a time sequence. It is used to show changes, patterns and trends in a process over time.

A term often used to describe the way in which safety is managed in the workplace, and often reflects “the attitudes, beliefs, perceptions and values that employees share in relation to safety.”

SBAR stands for Situation, Background, Assessment, Recommendations, and is a method of framing conversations, especially critical ones, as it allows clarification of information to be communicated between team members.

Health care services provided by medical specialists and other health professionals who generally do not have first contact with patients, for example, cardiologists, urologists, and dermatologists.

Secondary care includes acute care: the necessary treatment for a short period of time for a brief but serious illness, injury or other health condition, such as in a hospital emergency department. It also includes skilled attendance during childbirth, intensive care, and medical imaging services.

The term “secondary care” is sometimes used synonymously with “hospital care.” However, many secondary care providers do not necessarily work in hospitals, such as psychiatrists or physiotherapists, and some primary care services are delivered within hospitals.

The principle of self-determination states that it is ultimately the patient who should decide whether or not to accept suggested treatment or care.

Self-management, or self-care, refers to what we do every day to maintain our health and manage long-term health problems.

A joint committee of Doctors of BC and the Ministry of Health that is working to address the care provided by both family physicians (FPs) and specialist physicians (SPs).

The imitation of a situation or process. The act of simulating something generally involves representing certain key characteristics or behaviours. Simulation is used in many contexts to gain insight into their function. Example: modeling an emergency room environment in which teams can experience errors, practice responses and then examine where they can improve safety and efficiency

A set of management techniques for improving the results of a process by identifying and removing the causes of defects (errors), as well as minimizing variability, by using statistical methods and following a defined sequence of steps (known as DMAIC: Define, Measure, Analyze, Improve, Control).

A means of tracking movement in a specific area to identify wasted activity and movement.

The committee was formed in 2006 and supports the delivery of specialist services and support improvement of the specialist care system in BC. See also GPSC, SCC.

The intentional sharing of best practices and knowledge about improvement interventions, and the implementation of these interventions and best practices. (Source)

A Lean methodology concept, it is an agreed-upon method of following a process that maximizes value while minimizing waste.

The application of statistical methods to monitor and control a process

SPOR is an initiative of the Canadian Institutes of Health Research (CIHR). Patient-oriented research refers to a continuum of research that engages patients as partners, focuses on patient-identified priorities and improves patient outcomes. In BC, SPOR is being activated through the BC SUPPORT Unit (BC Support for People and Patient-Oriented Research and Trials Unit), a multi-partner organization led by the Academic Health Science Network.

The Surgical Quality Action Network (SQAN) is a forum for health care providers to discuss best practice, share local innovations, and connect to improve surgical care for patients in BC.

The capacity to endure. It’s the potential for long-term maintenance of well-being which has environmental, economic and social dimensions.

Interdependent components (items, people, processes) that work together towards a common purpose. Systems have structure, behaviour and interconnectivity.

Systemic racism is enacted through routine and societal systems, structures, and institutions such as requirements, policies, legislation, and practices that perpetuate and maintain avoidable and unfair inequalities across racial groups, including the use of profiling and stereotyping.

For more information see the In Plain Sight Report

Work performed by a team towards a common goal, often using agreed-upon activities and behaviours to assure quality and safety.

A phone call that multiple people can participate in. Everyone dials into a common number and, once connected, all participants can hear each other.

Specialized consultative health care, usually for inpatients and requiring a referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment.

Examples of tertiary care services are cancer management, heart surgery, treatment for severe burns, palliative care, and other complex medical and surgical interventions.

A trial of a new approach or process, usually starting on a small scale and then expanding. A test is designed to help a team learn if a change results in improvement, and fine-tune the change to fit the organization and patients. Tests are often carried out using one or more PDSA cycles.

GPSC was formed in 2002 as a partnership between the Ministry and Doctors of BC. The Committee supports BC doctors by developing and implementing programs that improve job satisfaction for family doctors and primary health care for patients. (See also SCC, SSC)

Refers to a pause in a procedure for a short amount of time. This allows team members to communicate to determine action or inspire morale. Teams usually call timeouts at strategically important points in a process to avoid members being misled or working with conflicting assumptions.

Trauma-Informed Practice is a strengths-based framework grounded in an understanding of and responsiveness to the impact of trauma. It emphasizes physical, psychological, and emotional safety for everyone, and creates opportunities for survivors to rebuild a sense of control and empowerment.

A means to measure the level of harm in health care by identifying adverse events. Because they are metric, trigger tools can be used to track improvements in safety over time.

A framework developed by the Institute for Healthcare Improvement (IHI) that describes an approach that simultaneously pursue three dimensions, (called the “Triple Aim”):

• Improving the patient experience of care (including quality and satisfaction);
• Improving the health of populations; and
• Reducing the per capita cost of health care.

The term “Triple Aim” refers to simultaneously improving the health of the population, enhancing the experience and outcomes of the patient, and reducing per-capita cost of care for the benefit of communities. It is a framework that serves as the foundation for organizations and communities to successfully navigate the transition from a focus on health care to optimizing health for individuals and populations.

A process adds value by producing goods or providing a service that a customer will receive. A process also consumes resources, which may produce waste when more resources are used than are necessary to produce the goods/services.

The term variation refers to changes or differences in something within certain limits. All systems contain variation. Knowledge of the type of variation is needed to determine appropriate actions in each case.

• Common causes of variation are those that are inherent in a process or system. They affect everyone working in the process and affect all outcomes. A system or process that only contains common causes of variation is often called “stable” or “statistically stable” or “predictable” within statistically-established limits. It means that improvement can only be achieved through fundamental changes to the process or system.
• Special causes of variations are those that are not part of the process or system all the time or do not affect everyone but arise because of unusual circumstances. A system that has both common and special causes of variation is called “unstable” or “”
• Structural variation is a sub-set of special causes of variation. It’s a repeating pattern of variation that is inherent in the process due to environmental factors. Examples: increases in emergency room visits on a Friday night; seasonality in employment rates.
• Intended variation is an important part of effective patient-centred health care, for example, when a provider, process or system responds purposefully to a patient’s individual needs.
• Unintended variation is due to changes introduced into health care processes that are not purposeful, planned or guided. Most improvement work is focused on reducing unintended variation.

A Lean technique used to analyze the flow of materials and information required to bring a service to a customer/patient.

Any step or action that is not required to complete a process, that doesn’t add value and  unnecessarily using resources that could be employed in other activities. The eight main types of waste are: defects, overproduction, waiting, unnecessary transportation, inventory excess, motion, over-processing, and not utilizing talent.

Short for web-based seminar, a webinar is a presentation, lecture, workshop or seminar that is transmitted over the internet. In a webinar each participant sits at his or her own computer and is connected to other participants via the internet and/or teleconference.

Good quality health care starts with asking what matters so that you do what matters. Whether it’s in person, or virtually, “What Matters to You?” reinforces a commitment to working together for care tailored to the needs of patients.

The Working Group is designed to bring together individuals possessing the relevant knowledge and skills who will act either individually or collectively to undertake assigned tasks and activities in order to achieve the project’s objectives.