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Access and Flow in Hospitals: Analysis of the 2026/27 QIP Submissions

This summary shares insights from the Access and Flow section of the 132 Quality Improvement Plans (QIPs) submitted by hospitals for 2026/27.

Progress Report Themes

Most common successes or enablers:

  • Standard work, tools and processes

  • Data monitoring and dashboards

  • Education and training

  • Collaboration and partnerships

Most common challenges or barriers:

  • Workforce and physician vacancies

  • Data and EMR/HIS limitations

  • Capacity constraints and competing priorities

Narrative Report Themes

  • Wait-time improvement (81%)

  • Community, Ontario Health atHome and primary care partnerships (62%)

  • Home First and hospital-to-home approaches (50%)

  • ALC and delayed-discharge pressure (48%)

Workplan Performance & Themes

Progress on 5 Priority Indicators

  • 46% of teams selected time to physician initial assessment (↓ 4% from last year)

  • 29% selected ambulance offload time (↓ 10% from last year)

  • 21% selected time to inpatient bed (↑ 2% from last year)

  • 17% selected left without being seen (↑ 1% from last year)

  • 4% selected hip fracture surgery within 48 hours (new indicator this year)

Progress on 4 Non-Priority Indicators

  • 27% selected ED length of stay - low acuity (↑ 18% from last year)

  • 24% selected ED length of stay - high acuity (↑ 14% from last year)

  • 20% selected patients waiting for a bed at 8 a.m. (↓ 5% from last year)

  • 8% selected ED length of stay - admitted patients (↑ 1% from last year)

Indicator Uptake at a Glance

  • 368 indicators selected, up from 339 in 2025/26

  • 225 matrix indicators and 143 custom indicators

  • 185 of 224 matrix targets aim at improvement

Indicator Uptake Change - Percentage of Teams Selecting Access and Flow Indicators from 2025/26 to 2026/27

  • Time to physician initial assessment: 50% → 46%

  • Ambulance offload time: 39% → 29%

  • ED length of stay - low acuity: 9% → 27%

  • ED length of stay - high acuity: 10% → 24%

  • Average number of patients waiting for a bed at 8 a.m.: 25% → 20%

  • Time to inpatient bed: 19% → 21%

  • Left without being seen: 16% → 17%

  • ED length of stay - admitted patients: 7% → 8%

  • Hip fracture surgery within 48 hours: 0% → 4%

Common Change Ideas

Physician Initial Assessment

  • Staff huddles, rounding and communication (21%)

  • ED renovations, space changes and rezoning (21%)

  • Registration and triage process improvements (34%)

  • Data monitoring using dashboards and scorecards (34%)

Ambulance Offload Time

  • EMS partnership and collaboration on workflows (74%)

  • Data monitoring using dashboards and scorecards (55%)

  • QI processes (42%) and staff huddles and meetings (39%)

Waiting for a Bed at 8 a.m.

  • Inpatient unit collaboration (93%) and daily rounds (52%)

  • Maximizing bed availability (34%) and discharge processes (52%)

  • Admission prevention (21%) and surge protocols (66%)

ED Length of Stay - Low Acuity (Non-Admitted Patients)

  • Registration and triage process improvements (45%)

  • Data monitoring using dashboards and scorecards (45%)

  • Optimizing the nurse practitioner role in the ED (26%) and fast track (21%)

ED Length of Stay - High Acuity (Non-Admitted Patients)

  • Data monitoring using dashboards and scorecards (63%)

  • Diagnostic imaging and laboratory process improvements (47%)

  • QI tools (43%) and ED discharge process reviews (30%)

Overlapping Common Themes

  • Data monitoring, dashboards and scorecards appear in every indicator

  • Registration, triage and front-end ED flow redesign

  • Discharge planning and inpatient bed flow

  • Huddles, rounding and cross-department communication

Abbreviations: ALC, alternate level of care; ED, emergency department; EDLOS, emergency department length of stay; EMR, electronic medical record; EMS, emergency medical services; HHR, health human resources; HIS, hospital information system; NP, nurse practitioner; OH@H, Ontario Health atHome; QI, quality improvement; QIP, Quality Improvement Plan.



Equity in Hospitals: Analysis of the 2026/27 QIP Submissions

This summary shares insights from the Equity section of the 132 Quality Improvement Plans (QIPs) submitted by hospitals for 2026/27.

Progress Report Themes

Most common successes or enablers:

  • Education and training

  • Data monitoring and dashboards

  • QI methods and working groups

  • Partnerships with other hospitals

Most common challenges or barriers:

  • Documentation or EMR/HIS challenges

  • Low volume of cases

  • HHR shortages

Additional Insights

  • Teams continue to choose custom over matrix indicators: 77 custom versus 48 matrix indicators in 2026/27

  • Top custom themes: EDI education, sociodemographic data collection, and languages and interpretation services

  • Sickle cell work stays concentrated in the Toronto and West regions (6 hospitals)

Workplan Performance & Themes

Sickle Cell: Time to Physician Initial Assessment

  • 80 minutes to physician initial assessment provincially (↓ 16 minutes from last year)

  • 32 minutes in Toronto, down from 90 minutes last year and closest to the 15-minute target (n=2)

  • 5 minutes above the provincial target, narrowed from a 54-minute gap in 2024/25

EIDAR Education

  • 76% of staff EIDAR education completed across the province (↑ 6% from last year)

  • 24% spread across regions, from 88% in Toronto to 64% in Central

  • 50% uptake in North West, the highest of any region; Central was lowest at 7%

Indicator Uptake Change - Percentage of Teams Selecting Equity Indicators from 2024/25 to 2026/27

  • Staff and leadership EIDAR training completed: 2024/25: 52% → 2025/26: 41% → 2026/27: 33%

  • Sickle cell - time to physician initial assessment: 2024/25: 2% → 2025/26: 2% → 2026/27: 4%

Change Idea Themes

Common Change Ideas: EIDAR Training

  • Indigenous education (27% of organizations)

  • Anti-racism education (25% of organizations)

  • LGBTQIA education (21% of organizations)

Common Change Ideas: Sickle Cell (Time to Physician Initial Assessment)

  • Sickle cell education for staff (4 of 6 teams)

  • Pain management, including sublingual fentanyl and non-pharmacological options (3 teams)

  • Order sets and standard work or care pathways (3 teams)

  • Engagement with patients, caregivers and PFAC (3 teams)

Abbreviations: EIDAR, equity, inclusion, diversity and anti-racism; EMR/HIS, electronic medical record/hospital information system; HHR, health human resources; PFAC, patient and family advisory council; PIA, physician initial assessment; QI, quality improvement.



Experience in Hospitals: Analysis of the 2026/27 QIP Submissions

This summary shares insights from the Experience section of the 132 Quality Improvement Plans (QIPs) submitted by hospitals for 2026/27.

Progress Report Themes

Most common successes or enablers:

  • Data monitoring through dashboards and reports

  • Staff and leadership engagement

  • Digital survey processes

  • Standard work, processes and checklists

Most common challenges or barriers:

  • Low survey response rates limit available data

  • Survey platform, HIS or EMR challenges

  • Inconsistent use of standardized processes

Narrative Report Themes

  • 95% use patient experience surveys or feedback systems

  • 66% partner with patients and families through PFACs or advisors

  • 40% focus on discharge communication and transitions in care

Workplan Performance & Themes

Progress on Optional Indicator

  • 50 hospitals selected the information at discharge indicator (↓ 11 hospitals from last year)

  • 70% of patients felt they received adequate information at discharge (↓ 2% from last year)

Regional Differences

  • 80% Toronto region average, the highest regional result (↑ 15% from last year)

  • 62% Central region average, the lowest regional result (↓ 1% from last year)

Indicator Uptake Change - Percentage of Hospitals Selecting the Experience at Discharge Indicator from 2024/25 to 2026/27

  • Information at discharge: 2024/25: 44% → 2025/26: 42% → 2026/27: 38%

Common Change Ideas: Experience at Discharge

  • Standard processes for discharge education (46% of teams mentioned)

  • Review of survey results and responses (41% of teams mentioned)

  • Documentation improvements (39% of teams mentioned)

  • Staff education and training (30% of teams mentioned)

Abbreviations: ED, emergency department; EMR, electronic medical record; HIS, hospital information system; PFAC, Patient and Family Advisory Council.





Safety in Hospitals: Analysis of the 2026/27 QIP Submissions

This summary shares insights from the Safety section of the 132 Quality Improvement Plans (QIPs) submitted by hospitals for 2026/27.

Progress Report Themes

Most common successes or enablers:

  • Staff and physician education

  • Standard work and processes

  • Leadership engagement

  • Auditing and case review

Most common challenges or barriers:

  • HHR shortages and vacancies

  • Documentation and HIS challenges

  • Inconsistent workflows

Narrative Report Themes

  • Teams continue to select more custom indicators and fewer matrix indicators, year over year

  • Workplace violence, IPAC, falls and pressure injuries lead the custom indicator themes

  • The same change ideas appear among both successes and challenges; progress depends on the conditions to carry them through

Workplan Performance & Themes

Progress on Indicators

  • ↓77% drop in workplace violence incidents per 100 staff since 2024/25 (now 1.08; target 1.05)

  • ↓11% drop in medication reconciliation at discharge (84% to 74%)

  • 0.98% rate of delirium onset during hospitalization, up from 0.67% last year. Delirium is non-directional: an increase may reflect improved screening, identification and documentation rather than more delirium.

Indicator Uptake Change - Percentage of Hospitals Selecting Safety Indicators from 2024/25 to 2026/27

  • Workplace violence: 2024/25: 28% → 2025/26: 23% → 2026/27: 21%

  • Medication reconciliation on discharge: 2024/25: 28% → 2025/26: 17% → 2026/27: 23%

  • Delirium: 2024/25: 6% → 2025/26: 16% → 2026/27: 14%



Change Idea Themes

Common Change Ideas: Medication Reconciliation

  • Documentation and HIS/EMR improvements (44%)

  • Pharmacy and physician engagement (27%)

  • Staff education and standard work (18%)

Common Change Ideas: Workplace Violence

  • Named trainings: de-escalation and code white (41%)

  • Annual violence reviews and risk assessments (18%)

  • Personal alarms and safety equipment (24%)

  • Improved security processes and staffing (20%)

Common Change Ideas: Delirium

  • Staff and physician education (59%)

  • Screening process and audits (100%)

  • EMR tools and order sets (23%)

Abbreviations: EMR, electronic medical record; HHR, health human resources; HIS, hospital information system; IPAC, infection prevention and control.

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