How using Think Research’s Order Sets helped SHN deliver high quality care by aligning with best practices across all hospital sites

It’s a common problem for health systems: how do you deliver consistently high quality care across a multi-site hospital network and decrease variations in practice?

For Dianne Tomarchio, co-chair of the Order Sets program at Scarborough Health Network (SHN), this challenge was seen as an opportunity for improving care for patients with mental health conditions. Health Quality Ontario (HQO) released Quality Standards for caring for this patient group but implementing them across multiple hospitals might be seen as a daunting task for a recently merged organization.

This was the case for SHN, which formed in December 2016 by bringing together three separate hospitals, each with their own clinical ordering practices and processes. Tomarchio and the wider team were tasked with creating 400 standardized order sets (including mental health) across the new health network.

With the release of HQO’s Quality Standards for mental health, and as participants in Ontario’s Digital Quality Based Procedures Order Sets Program (QBP Program), Scarborough Health Network’s mental health team saw potential to take a leadership role in delivering standardized evidence-based care.

“A substantial number of patients admitted to SHN face mental health challenges,” said Tomarchio. “We wanted to improve how we deliver care to an often underserved patient population. We also wanted to ensure that our clinical decision support tools reflected the latest, evidence-based research and clinical practice guidelines. Starting with HQO’s Mental Health Quality Standards gave us an opportunity to standardize mental health care across our network.”

Working from evidence-based content was appealing. “We knew we’d have a lot of clinician buy-in across our organization if frontline clinicians were engaged,” says Tomarchio. “They ensured our order sets were adapted to their workflows and understood the value of embarking on this transformation for both our patients and our workplace.”

Enabling high quality care and best practice through standardizing clinical practices

Think Research’s Order Sets are clinical decision-support tools to improve the quality of care while encouraging cost-effective and efficient ordering. Developed by company founder Dr. Chris O’Connor in response to his own challenges with delivering high quality care based on the best latest evidence, Order Sets now includes over 800 foundational order sets with 13,000 uniquely tailored order sets at healthcare organizations on three continents.

Watch: Diane Tomarchio describes her team’s clinical standardization journey


“How Scarborough Health Network used Think Research’s Order Sets to standardize their approach to mental health (while merging multiple hospital locations)” 

SHN began working with Think’s Order Sets in April 2012 and joined the QBP Program in 2017. To standardize their order sets, they first reviewed their frontline data to gain insight into their daily operations through Think’s Spotlight Analytics software. “We started with the Admission and Discharge Mental Health Order Sets because we recognized their benefit in facilitating the patient journey within the hospital while ensuring patients receive any necessary education before being returning to the community,” said Tomarchio. “Clinician engagement in adapting these order sets was crucial to meeting workflow needs and ensuring adoption.” 

Think Research’s team worked with SHN along every step of their journey, ranging from product installations to giving input on how HQO quality standards might be adopted to sending the company’s in-house team of pharmacy and clinical specialists to help perform medication safety checks.

“From the beginning, the team at Think always felt more like a partner than a vendor,” Tomarchio said. “It isn’t easy to gain consensus among clinicians across different teams, specialties, and hospitals. Think Research’s support across the Order Sets harmonization project made a world of difference.”

“I have clear memories of that meeting,” said Tommaso D’Ovidio, product manager for Order Sets. “I was impressed with how SHN took such a multi-disciplinary approach to making decisions about the project with patient outcomes always at the discussion’s forefront.”

Many staff at SHN saw the harmonization process as an opportunity to align with best practices while assessing other program areas within the health network that would benefit from using the new mental health order sets.

On September 14, 2019, the new library of SHN mental health Order Sets went live across all three of their hospitals. To date, SHN has harmonized more than 50 percent of their order sets across all sites. Through Think’s collaborative network, clinicians can access order sets wherever they have an internet connection to help them deliver high-quality care.

“Standardization in mental health treatment is essential to ensure that patients receive the same high-quality care across the care continuum,” said Dr. Stephen Barsky, Chief of Psychiatry at SHN. “It was amazing to see this level of commitment and collaboration from clinicians and the joint project team at SHN and Think Research made this transformation happen.”

“Scarborough Health Network’s experience is exactly why I believe in evidence-based order sets,” said Dr. O’Connor, Think Research’s founder. “We create opportunities to transform healthcare delivery when we embed best practices in a structured, intuitive manner at the point of care. Our entire team is pleased to support SHN in their efforts to deliver high quality care for their patients.”