The Quality of Care Information Protection Act (QCIPA), governs quality of care reviews after “critical incidents”.
Under this law, a critical incident is an unintended event when a client receives treatment in a hospital or independent health facility (such as a birth centre) that results in serious harm to the client and does not result primarily from the client's underlying medical condition or a known risk to treatment.
The first QCIPA legislation in Ontario was passed in 2004, allowing hospitals to form quality of care committees (sometimes under different names) as a legally-protected zone of discussion to facilitate frank and confidential reviews of critical incidents. It was intended to encourage people to speak freely to identify systemic safety problems and quality improvements without fear that comments or questions would be used in a lawsuit or college investigation, including those that may be speculative or unsubstantiated.
Some Ontario health facilities occasionally or routinely use QCIPA protection, while others do not. If the critical incident review is not conducted according to the rules defined in QCIPA, all discussions and documents related to the incident are “discoverable” and can be used in law suits and proceedings before regulatory colleges.
As of 2017, QCIPA and related regulations have been amended. The updated laws require that all critical incidents in hospitals or independent health facilities must be reviewed, and more information must be disclosed to the client or family than was required under the 2004 legislation. Reviewing every incident maximizes opportunities to learn and improve. Sharing more information with clients and families respects their rights to know what happened and to be assured that all possible actions will be taken to avoid a reoccurrence.
Following a review under QCIPA, facilities are required to disclose to the client or family:
- the fact that a review took place;
- the material facts of what occurred;
- the consequences of the incident for the client and any actions taken to address such consequences including any healthcare or treatment that is advisable;
- the cause(s) of a critical incident as identified by the committee or the hospital; and
- any steps taken by a health facility to avoid or reduce the risk of further similar incidents.
Opinions and speculation, minutes of discussion and documents prepared for the meeting cannot be disclosed to anyone who was not part of the review, including the client or family, if the review is properly constituted under QCIPA as a quality of care review. Midwives who want to learn more can see Participating in Critical Incident Reviews: Information for Midwives.