​The Schroeder Arthritis Institute at University Health Network has launched its Integrated Quality Framework, which is grounded in innovative research, learning and patient care. The framework was co-designed with our patient partners, and Team UHN members to define structural, process, and outcome elements of quality that are Patient-centred; Equitable; Safe; Effective; Timely/Accessible; and Efficient. These quality domains of our framework are based on those put forth by the Institute of Medicine 1 and Donabedien 2.

3 concentric circles. Inner circle: Process, Outcome, Structure. Middle circle: Patient-centred, Equitable, Safety, Effective, Timely Access, Efficient. Outer circle: Clinical Care, Research, Education.
Schroeder Arthritis Institute Integrated Quality Framework

Defining What Quality Means

For our patients, providers and broader stakeholders, we define quality as:

Quality DomainDefinition
Patient-centredCare that integrates the patient(s)' values and perceptions of quality care into clinical decision-making and is reflective of the community/population that is served.
EquitableCare that does not vary in quality, outcome, provision, or access with respect to gender, ethnicity, geographic location, and socioeconomic status or other personal characteristics for current UHN patients as well as those waiting for, and/or needing care.
SafetyHolistic safety for patients with respect to the delivery and escalation of care that is intended to help them.
EffectiveCare that is aligned with expectations around what is achievable based on scientific knowledge, best practice, and with what patients identify they need.
Timely AccessProvision of timely and appropriate health services for both those who receive and those who provide care across the pathway.
EfficientCare that has a strong relationship between clinical performance and resource utilization and avoids waste (i.e., waste of equipment, supplies, ideas and energy) from both a provider and patient perspective.

This work has been led by the visionary leaders within the Schroeder Arthritis Institute, Silvi Groe and Dr. Zahi Touma.

Silvi Groe 

Silvi Groe

Silvi Groe is the Institute's Clinical Director responsible for overseeing the comprehensive clinical operations of the largest outpatient program at UHN with over 80,000 Orthopedics Visits, and its integrated surgical program with over 5000 Orthopedic and Hand surgeries. Silvi's portfolio includes enabling Arthritis Care Quality innovation, which is driven by converging discovery and learning with front-line clinical care. Most recently she led the establishment of a new integrated model of care for Hip  and Knee  surgery, as well as a partnership with St. Hilda's for convalescent care support for our complex foot and ankle patients.

Zahi Touma 

Dr. Zahi Touma

Dr. Zahi Touma is a Rheumatologist and Clinical Epidemiologist at the Schroeder Arthritis Institute. His research is focused on advancing care for patients with systemic lupus erythematosus (SLE) and discovering science to improve how disease and outcomes are measured to advance treatments and quality of care for patients. He has also led the development of the Neuropsychiatric Program at the Toronto Lupus Program with innovative research and care models to improve the assessment of cognitive impairment in patients with Lupus. Most recently, he edited a seminal book on Outcome Measures and Metrics in Systemic Lupus Erythematosus.

Our patient partners were instrumental in co-designing our quality framework.

Kate Mather 

Kate Mather

Kate Mather was diagnosed with Rheumatoid Arthritis at a young age. She credits her UHN/Schroeder clinicians for providing the expertise and care required to help her live a healthy and balanced life. "I know I can count on them to connect me to other appropriate specialists throughout the UHN network. It is truly a one-stop shop for my healthcare needs." While Kate credits us, we would like to thank Kate for her significant contributions to the program to drive UHN patient and family education, raise awareness of the effects of rheumatoid arthritis, the importance of #connectedcare and how patient education is key to ensuring patients can live life with arthritis.

Camille Orridge 

Camille Orridge

Camille Orridge had joint replacement surgeries at UHN's Orthopedic Program within the Schroeder Arthritis Institute and has been a valuable patient partner helping the program asses its care quality and access through a health equity lens. Camille is a Senior Fellow at Wellesley Institute and has made an impressive impact through her leadership roles to ensure health equity is a priority across the healthcare system. She has led various initiatives to advance the integration of care and services for patients seeking care, to ensure proper supports are in place to help them remain in the community and to improve access to Toronto's hospitals for those needing care.

Full Membership

This project is supported by Samra Mian-Valiante, Director of Strategy & Transformation; Sandralee Rose, Project Manager; and Jessica Crane, Project Coordinator. The Project team works closely with all experts and in collaboration with the co-chairs to ensure rigorous methodological, evidence-based and consensus-based processes are utilized to enable outcomes and deliverables from this endeavour.

NameSchroeder Arthritis Institute Program AreaTitle/Position
Silvi Groe (Co-Chair)UHN ArthritisClinical Director
Dr. Zahi Touma (Co-Chair)RheumatologyClinician-Scientist
Dr. Robert InmanUHN ArthritisMedical Director, Senior Scientist
Samra Mian-ValianteUHN ArthritisDirector, Strategy & Transformation
Terra IerastsPerformance & AnalyticsDirector, Performance Improvement & Excellence
May LuPerformance & AnalyticsTechnical Specialist
Camille OrridgePatient - SurgeryPatient Partner – Surgery
Kate MatherPatient- MedicinePatient Partner - Medicine
Marcia CorrealeProvincial RACClinical and Education Practice Lead
Marsha AlvaresOrthopedicsOutpatient Manager/APP
Vaidehi BhattOrthopedicsPatient Experience Project Coordinator
Dr. Christopher NielsenOrthopedicsOrthopedic Surgeon / Quality Champion
Diana Adams9A InpatientNurse Practitioner
Megan Lynch9A InpatientNurse Practitioner
Indira Gobin9A InpatientInpatient Manager
Lisa GiraldiHand, Osteoporosis, Rheumatology, Fracture ClinicOutpatient Manager
Dr. Andrea ChanHandHand Surgeon / Quality Champion
Dr. Lianne TileOsteoporosisPhysician / Quality Champion
Laura PassalentRheumatologyAPP and Education Lead
Nathalie RozenbojmRheumatologyLupus Clinical Nurse Specialist
Leanna GrahamProfessional PracticeDirector, Professional Practice
Meagan BlodgettProfessional PracticeManager, Professional Practice
Jessica MarangosPeople & CultureDirector, Workforce Development

Our Recent Publications

1 Institute of Medicine (IOM). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C: National Academy Press; 2001.

2 Donabedian, A. Explorations in Quality Assessment and Monitoring Vol. 1. The Definition of Quality and Approaches to Its Assessment. Ann Arbor, MI: Health Administration Press, 1980.

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