Quality councils as change agents and drivers of quality improvement in healthcare

This commentary addresses four key questions raised in the lead paper. We recognize that health quality councils have a delimited range of tools available to bring about needed change. They have neither funding and regulatory powers nor day-to-day operational authority. Nevertheless, based on the Health Quality Council of Alberta's (HQCA) successes to date using a multidimensional change strategy, we are confident that quality councils can play a vital role in driving and sustaining quality improvement in provincial healthcare systems. The provisos are that the councils need to be sufficiently empowered, establish themselves as trusted partners and independent advisors, use effective change strategies, focus on strategic priorities and gain strong stakeholder support for needed changes. We are also convinced that multilevel measurement is an essential tool for learning, priority setting, establishing the imperative for action and assessing progress. Finally, in terms of the value proposition - the relationship between resource inputs and healthcare outcomes - we strongly suggest that health quality councils work collaboratively with service providers to obtain better value for money by improving quality rather than aligning themselves with funders and rely on "pay for quality" incentives to "compel" quality improvement.