What is the system challenge?

In the mental health and addictions system, a client’s perception of care is widely recognized as a key indicator of the quality of the care received. Though many organizations were gathering feedback from clients using a variety of tools, there was no consistent way that this information was collected and reported. Due to the lack of standardization in the surveys used across the system, the information gathered could not be adequately compared or used to guide quality improvement efforts at the regional or system levels.

What are we doing about it?

The Provincial System Support Program (PSSP) at CAMH developed and validated the Ontario Perception of Care Tool for Mental Health and Addictions (OPOC-MHA). This evidence-based tool standardizes how substance use, mental health, and concurrent disorder services obtain client perception of care feedback, which can be used to make valuable service improvements. The survey also captures extensive demographic information about clients that can inform the creation of a general client profile or identify inequities in service delivery. The OPOC-MHA survey meets the need for a standardized perception of care tool for informing, monitoring, and evaluating quality improvements and provides a consistent way to gather client feedback in both community and hospital settings. This brings the client voice forward as a source of evidence to support program, agency, and system quality improvement efforts.

There are currently five versions of the OPOC-MHA:

  1. OPOC-MHA for Registered Clients is for people registered in a program for treatment or support. This includes family members (or other supporters) who are registered to receive services, such as in a family support group.
  2. OPOC-MHA for Non-Registered Clients is for people who are receiving service but not registered in a program (such as a drop-in peer support program). This includes family members or supporters who are receiving service but not registered in a program.
  3. OPOC-MHA for Caregivers is for people who have a family member receiving services. This version enables family members and supporters to comment on the services received by their loved one.
  4. OPOC-MHA for Supportive Housing is for residents or tenants of organizations providing permanent supportive housing or long-term transitional housing.
  5. OPOC-MHA for Crisis is for clients of organizations providing crisis services or brief interventions.

Perceptions of care are gathered across several quality domains, with an opportunity for written comments following each domain. Demographic information is also collected to help organize the information and identify potential inequities in service. Each version is available in English and French.

A central provincial database and reporting portal gives organizations access to OPOC-MHA results, which can be filtered and analyzed in a customized manner. For example, organizations can select specific indicators they wish to track over time, examine data through a health equity lens, and then look at specific programs to support quality improvement efforts. Organizations also have access to aggregated, comparable provincial data.

Evaluating perception of care data is an important way to measure client experience within the healthcare system. Actionable items from the OPOC-MHA can be used to bring about necessary service change in areas such as access, quality of care, and safety. More broadly, system planners and funders can utilize results of providers to identify system-level quality improvement opportunities.

Who is involved?

All publicly-funded addiction, mental health, and concurrent disorder service providers in Ontario are in scope of OPOC-MHA, including both hospital and community-based programs.

Next Steps

OPOC-MHA implementation continues across the province. The measure is also providing a foundation for collaborative quality improvement endeavors – check out the Continuous Quality Improvement Collaborative

The Excellence through Quality Improvement Project (E-QIP) is a quality improvement (QI) initiative focusing on leadership and capacity building led by Addictions and Mental Health Ontario (AMHO) and the Canadian Mental Health Association, Ontario Division (CMHA ON) and delivered in close partnership with Ontario Health (OH) and the Provincial Systems Support Program (PSSP) at CAMH. For more information, check out the E-QIP website: https://e-qip.ca/