Have you ever wished that you could change the health care system?  Probably every nurse has at some point in their career.  But what would it be like to go to work every day and help incredibly diverse teams of health professionals and healthcare consumers to do just that?  Welcome to Agnes Gibson’s world!

Agnes has been a RPN for 14 years.  She currently works at Health Quality Ontario (HQO) as a Quality Improvement Advisor.  HQO is the provincial advisor on quality  with a mandate to

  • Monitor and report on health system performance
  • Assess evidence to determine optimal care
  • Engage with patients and give them a voice in shaping a quality health system
  • Promote continuous quality improvement aimed at substantial and sustainable positive change in health care

It’s the last point of the mandate that makes up the day-to-day of Agnes’ work.

A Durham College PN graduate, Agnes started her nursing career working a general medicine unit in a hospital and on a heavy care unit in a long-term care home (LTCH).  It was in the LTCH that Agnes was first approached to lead a project; the roll-out of the new resident assessment tool (RAI-MDS).  She and the work were well-suited and soon Agnes was leading this project as a part of Community Care Information Management (CCIM) in LTCHs across the province.  When another opportunity came up to lead the implementation of the community health assessment (interRAI CHA) and screener, this time in the Community Support Services  sector, Agnes jumped at the chance.  Again she was leading project teams across the province to implement new systems, including the Integrated Assessment Instrument (IAR) that would help to improve care.  After several years working to support CCIM projects, Agnes transitioned to work with the Central East Community Care Access Centre supporting the Health Links initiative.

A Health Link is a team of providers in a geographic area (primary care, hospital, home, community care, long-term care providers, community support agencies and other community partners) working together to provide coordinated health care to patients with multiple complex conditions – often seniors – with the patient.  These have been established across the province to help improve the health care experience of this specific group of patients and to reduce cost at the same time.

Three years ago, Agnes joined the team at HQO as a Quality Improvement Specialist.  She has worked with many teams across the province implementing quality improvement projects and now works in the IDEAS program.  IDEAS, which stands for Improving and Driving Excellence Across Sectors is a joint initiative of HQO, the Institute for Health Policy, Management and Evaluation (IHPME) at the University of Toronto, and the Institute for Clinical Evaluative Science (ICES).  Teams comprised of health professionals from different sectors come together to learn quality improvement skills and to apply them in an improvement project that touches different sectors of the healthcare system, resulting in an overall improvement in patients’ journeys and in system efficiencies.

In addition to her nursing education Agnes is a certified Project Management Professional and she has a Lean Six Sigma Black Belt in quality improvement from the Schulich School of Business at York University.  Agnes has also obtained a Bachelor of Allied Health Sciences from the University of Ontario  Institute of Technology (UOIT).

RPNAO: Do you think you do your job differently because you’re a nurse…if so how?

Agnes: I would say yes; having first-hand knowledge about the systems that are in place, I think it allows me to, for example, ask teams deep and relevant questions or help identify processes/tools they can leverage as they explore their improvement opportunity. Understanding the challenges of the workforce also gives me insight to potential roadblocks teams might encounter and we identify them early.

RPNAO: What do you think the advantages are of being a nurse and QI advisor? 

Agnes: Being a nurse allows me to relate to individuals/teams, often front-line nurses or allied health professionals, as I support them in improving something in their workplace. Having provided direct patient care, I can appreciate the environment and culture improvement teams are working in, and bring real-life experiences, compassion, caring, and critical thinking to the forefront of improvement work.

RPNAO: Do you see any particular disadvantages or challenges because you’re a nurse?

Agnes: Mostly, I see my nursing background and experience as an asset. Nurses, like other disciplines, are increasingly challenged to do more with less, and the environment can become task-driven and implementation-focused. As QI happens from the point of care up and there is a science and process to follow, it can be challenging to get people to slow down. I know where they’re coming from when they want to just go, go, go, so I’d say the challenge is finding the balance. I make a conscious effort to stop and remind myself and the teams to trust the process and go slow in order to go fast, which can be counter-intuitive when you’re used to a fast-paced environment.

RPNAO: What is the most rewarding thing about your work?

Agnes: I would say this is split between seeing the impact of individuals’/teams’ improvement efforts on various elements of patient/client care and experience, and seeing the QI capacity-building in action.

Seeing teams take action where they identify real/potential gaps or less-than-desirable results, and building the skills necessary to empower themselves to continue to take on improvement is richly rewarding, as is seeing the direct (and sometimes indirect) benefit at the patient/client level. I truly love what I do, and I’m constantly learning from the teams I support; the work is often cross-sectoral and cross-organizational, so there are always new things happening. I wouldn’t otherwise get to be a part of all that. These teams are so passionate about helping their patients/clients!

RPNAO: What advice do you have for other RPNs that might have an interest in pursuing a career in QI?

A common phrase we have in our world is “QI is not linear”, and similarly, there is not one single straight path to pursuing a career in quality improvement; this is a good thing! Ways to get started can include formal education, and there are programs (like IDEAS!) to support your training, however getting first-hand experience in various improvement initiatives is just as important. If you’ve ever said to yourself “why am I doing this?” or “there must be a better way”, you’re already seeing the potential for improvement. Start today; find your voice and get involved. You can begin by participating on a QI committee, joining a project team actively pursuing improvements, and by joining and participating in communities of practice. Learn about and become familiar with the Quality Improvement language, tools, and resources – HQO has many resources.

Don’t be afraid to take on a new opportunity if someone offers it to you.  Sometimes others see things in us that we don’t see in ourselves and taking a chance on something can really help you to grow in ways you didn’t think that you could.

What’s next on the horizon?  Maybe a Master’s degree, but for the moment Agnes is loving her current role and her busy home with loving and supportive husband Rob and their four children, ages 3-10.


Barbara Jones
Director, Nursing Innovation


Category: Special FeatureDate: Thursday, March 29, 2018