North York General Hospital and MCC 360: Generating important conversations as part of quality improvement

North York  General Hospital (NYGH) is one of Canada’s leading community academic hospitals and has been serving the diverse communities in North Toronto since 1968. The hospital partners with 36 academic institutions, including the University of Toronto, to prepare future health care professionals to work in interprofessional teams to provide essential care in an academic community hospital setting. North York General is a top choice for University of Toronto medical students and residents in General Surgery, Medicine, Obstetrics, Emergency Medicine, and other disciplines.¹

In 2019-2020, the NYGH team saw 29,508 inpatients and 227,727 outpatients. As a learning organization, NYGH is committed to developing its people.²

In 2014, NYGH had already begun assessing their physicians on critical skills outside of medical competence, such as communication, collaboration, and professionalism, as part of their Quality Improvement (QI) program. However, the approach varied by department. Each program conducted assessments differently, some using existing surveys and others developing their own questions. Plus, with demanding schedules, completion of these assessments was often also an issue. Tracking each physician’s individual progress was time-consuming and, as a result, follow-ups to encourage completion were often inconsistent.

Choosing a multi-source feedback program

After looking for a tool that could provide more cross-department consistency for physician assessment, in 2019, NYGH became an early adopter of MCC 360, which is offered by the Medical Council of Canada (MCC).

Dr. Donna McRitchie, Vice President, Medical and Academic Affairs at NYGH, helped lead the MCC 360 implementation at NYGH. “One of the things that attracted me originally was the science behind some of these questions… I was really quite impressed by the scientific merit and validation of the tool.”

The MCC 360 survey design, questions, reports and program structure are based on existing research and new research by the MCC. All the survey questions undergo a psychometric review to ensure they assess and further develop physician performance in the CanMEDs roles of communicator, professional and collaborator. MCC 360 collects feedback from statistically valid cohorts of physician colleagues, non-physician co-workers and patients. It then collates responses into a customized, actionable report to be reviewed in a supported session.

A critical component of MCC 360 and its effectiveness is one-on-one coaching based on the feedback contained in the report. As an academic teaching hospital, NYGH opted to have their program leads run these sessions as educators and mentors.

“One of the things that attracted me originally was the science behind some of these questions… I was really quite impressed by the scientific merit and validation of the tool.”

— Dr. Donna McRitchie

Working with MCC 360

NYGH and the MCC 360 teams worked closely together to ensure the program fit NYGH’s needs and implement improvements to the program. One of the first enhancements made to MCC 360 was improved automation and structure for communications from the program to participating physicians and nominated respondents. Compared with previous programs, Dr. McRitchie explained that the MCC 360 program’s “emails and messaging set expectations around completion and has been very, very valuable, as before we would have to do that ourselves.” Even though the communications put some pressure on participants, from an administrative perspective, NYGH found it improved completion rates while still allowing some flexibility for physicians by offering deadline extensions.

Additionally, MCC 360 implementation adapted early to suggestions from NYGH to exclude patient feedback requirements for some specialities. It had become apparent that for some specialities it did not make sense to include a patient feedback requirement, such as for pathology or anesthesia, when the clinician may only have had a 10-minute encounter with the patient. Although MCC 360 and NYGH recognize the importance of patient feedback, this adaptation has ensured that the program is relevant across specialities.

“… Emails and messaging set expectations around completion and has been very, very valuable, as before we would have to do that ourselves.”

— Dr. Donna McRitchie

Consistently having important conversations

When implementing MCC 360, NYGH was looking for a tool to help bring consistency to physician assessment across the organization as part of their Quality Improvement program. Now, three years after the initial implementation, hundreds of NYGH physicians have completed the MCC 360 program. Approximately 95% of NYGH physician participants who enrolled in MCC 360 have completed it as of February 2022. Even throughout the pandemic, the median completion time was just 42 days. It is now standard process at NYGH that at the beginning of the year the number of physicians to enroll in MCC 360 from each department is established with the program lead.

Beyond enhanced assessment consistency, the main benefit for NYGH from MCC 360 has been the high-quality conversations generated between participating physicians and their program lead. Dr. McRitchie explained, “Consistency is one of the positives. It holds people to account in terms of our chiefs and what the expectations are when they review their group members. But it’s also the conversation that gets generated by the chief meeting with their members… It’s a springboard for additional conversation.” Conversations have touched on impactful topics such as physicians’ teaching, careers and retirement plans, as well as performance.

One of the other challenges MCC 360 helped address was adding a framework to report on the assessment and mentorship activities to the hospital board, executive team and stakeholders. Having a structured program has provided a standardized objective that demonstrates how the hospital is supporting its physicians and how it is accountable for the quality of care provided to patients by its physicians.

Learn more about the MCC 360 program

MCC 360 is a national multi-source feedback program designed for physicians practising in Canada to help develop their CanMEDS roles of communicator, professional and collaborator. The program focuses on the physician, helping them better understand their practice, including their strengths and areas for improvement by collecting feedback from colleagues, co-workers and patients and from individualized one-on-one coaching. By completing the program, physicians can earn 12+ continuing professional development (CPD) credits with the College of Family Physicians of Canada or the Royal College of Physicians and Surgeons of Canada. The program is delivered by leaders in physician assessment and the MCC and is supported by a dedicated team and customer service agents.

For more information, visit MCC 360.

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¹ Overview (2022-02-23)
² Statistics and area served (2022-02-23)