CQIC South West Initiative

South West Continuous Quality Improvement Collaborative (SW CQIC)

In the SW CQIC, regional stakeholders are partnering to use client feedback from the Ontario Perception of Care Tool for Mental Health and Addictions (OPOC-MHA) to identify and address opportunities to improve mental health and addictions services in Southwestern Ontario.

What is the system challenge?

SW CQIC partners looked at client feedback data from the OPOC-MHA and other sources of evidence, and identified services transitions as a priority area for action. In particular, the data pointed towards opportunities to improve communication during service transitions and to ensure discharge plans meet the needs of service users.

What are we doing about it?

SW CQIC partners reviewed different innovations to improve client transitions and decided to implement a strategy that includes a person-oriented discharge summary (PODS).2 PODS is a simple tool and set of processes that provides clients with key information to support their success after discharge. For an individual being discharged from a mental health program, this might include information about what to do if specific symptoms arise. Having this important information written down could prevent a crisis. In addition, by being directly involved in the discharge planning process, it is hoped clients will have more confidence in their ability to manage their care after discharge.

Who is involved?

The SW CQIC consists of representatives from 12 mental health and addiction agencies and several community members with lived experience. It is facilitated by two community co-chairs and an implementation team from the Provincial System Support Program at the Centre for Addiction and Mental Health (CAMH).

  • Addiction Services of Thames Valley
  • Alexandra Marine & General Hospital
  • Canadian Mental Health Association, branches in Elgin, Grey Bruce, Huron-Perth, Middlesex, and Oxford
  • Choices for Change: Alcohol, Drug & Gambling Counselling Centre
  • Grey Bruce Health Services
  • Huron Perth Healthcare Alliance
  • Mission Services of London: Quintin Warner House
  • Woodstock Hospital

How do we know it works?

PODS was developed by OpenLab at the University Health Network in Toronto in collaboration with many clients, supporters, and providers. In designing the tool, OpenLab made it a priority to involve hard-to-reach client groups like those with language barriers, mental health issues, and limited health literacy.[1]

A PODS pilot showed that 92% of clients understood their discharge instructions. The improvement in understanding was between 9.3% and 19.4%. Among providers, over 90% found PODS easy to use and valuable for clients, and over 80% felt that it did not add to their workload. Instead, providers found it increased consistency and helped guide client education.3

PODS has been implemented in approximately 30 hospitals across Ontario and is now spreading nationally. The SW CQIC is part of the Bridge to Home Spread Collaborative led by the Canadian Foundation of Healthcare Improvement. The goal of this Collaborative is to improve the quality of care and client and supporter experiences of care during transitions from hospital to home.[2]

[1] https://pods-toolkit.uhnopenlab.ca/about/

[2] https://www.cfhi-fcass.ca/WhatWeDo/bridge-to-home

Next steps

Between now and March 2020, SW CQIC partner agencies will work with client partners from their respective agencies to implement PODS and its associated processes. The group hopes this initiative will be the first of many opportunities that improve services using client feedback data and this collaborative model of working together.


This work was supported by the Canadian Foundation for Healthcare Improvement and Ontario’s Ministry of Health and Long-Term Care through the Centre for Addiction and Mental Health. Unmodified use or reproduction of this publication is permitted within Canada for non-commercial purposes only. This publication is provided “as is” and is for informational/educational purposes only. It is not intended to provide specific medical advice or replace the judgment of a healthcare professional. Those preparing and/or contributing to this publication disclaim all liability or warranty of any kind, whether express or implied.

For more information please contact:

Beth Powell

Implementation Specialist

519-858-5158 ext. 20082