Every year, one in five Canadians experiences a mental illness. Yet, many struggle to access timely and appropriate care due to long wait times, high costs for some treatments, stigma, or a lack of available services. These barriers disproportionately affect populations experiencing marginalization and can contribute to poorer health outcomes.
Quality improvement (QI) is one way to address these gaps. By using data to understand where people are falling through the cracks, health systems can test small, targeted changes that lead to better, more equitable care.
Building on this approach, a recent study led by Dr. Tara Burra, Medical Director of Quality, Experience and Safety at CAMH, alongside co-authors Terri Rodak, Librarian at CAMH, and Dr. Sanjeev Sockalingam, Senior Vice President of Education at CAMH, emphasizes the importance of integrating equity into quality improvement efforts. Titled 'Equity in Action: A Scoping Review and Meta-Framework for Embedding Equity in Quality Improvement,' the study proposes a practical framework to help healthcare teams and organizations reduce barriers and ensure services are inclusive and just. Conducted in collaboration with leaders from the Centre for Quality Improvement and Patient Safety as well as other contributors across the Toronto Academic Health Sciences Network, this research incorporates diverse perspectives from within the sector.
"The findings have clear implications for CAMH," says Dr. Burra. "People who experience mental health and substance use challenges often face stigma within the healthcare system. This issue can be even more harmful when compounded by systemic barriers like racism, poverty, and discrimination. This research will help guide how we design and deliver improvements to care—focusing on safety, enhancing patient experience, and aiming for everyone at CAMH to receive equitable and inclusive support."
The project's primary objectives were to map existing equity-focused frameworks and develop a practical "meta-framework" that enables practitioners to effectively address diverse care needs with high-quality, accessible support.
The research team reviewed 40 studies from databases, including MEDLINE, Embase, PsycINFO, and CINAHL, applying thematic analysis and community consultation. This resulted in a framework guided by two key enablers: broadening the theoretical foundation of QI and reshaping organizational culture, leadership, and structures.
Six essential domains emerged from this work:
- Engaging people with lived experience,
- Defining the equity problem and goal,
- Diversifying and training the QI team,
- Examining broader root causes,
- Intervening to reduce inequities, and
- Measuring the impact on equity.
A crucial part of creating this meta-framework involved gathering insights from individuals with lived experience. To obtain these perspectives, the research team collaborated with Equity Mobilizing Partnerships in Community (EmPACT), an initiative at Women’s College Hospital focused on equity-promoting patient engagement. EmPACT’s members provided invaluable feedback on the framework and the work itself, enabling the team to make essential adjustments throughout the research process.
"The highlight for me was engaging with people impacted by inequities," Dr. Burra explains. "We worked directly with people experiencing these challenges to really understand growth areas and opportunities to improve collaboration. Their perspectives are at the core of our framework to ensure solutions are relevant and effective."
CAMH has already begun applying this framework, as several of the indicators on the organizational quality improvement plan include equity considerations. By applying this framework within CAMH’s quality improvement efforts, we help shape a more inclusive and responsive care environment, and lay the groundwork for broader change across the system.
