National Consensus Subproject

The purpose of the National Consensus subproject was to develop a set of health measures for Canadian primary care mental health services, reflecting a multi-stakeholder perspective, and suitable for facilitating quality improvement.

Project Overview and National Consensus Model

Formation of a Multi-regional steering committee

The scope of this project was determined in part by the availability of human resources, by our commitment to a consensus based model and our determination to secure national and multi-regional input into designing a framework for the work of the project.

In January, 2004 each of our project partner sites (AB, BC, SK, ON, PQ) were surveyed regarding time and availability as well as their ideas regarding revised project goals and objectives. By March 2004, a Steering Committee and an Advisory Group were formed. The core Steering Committee members included expert representatives from the Universities of British Columbia, Alberta, Saskatchewan, the University of Toronto and the University of Western Ontario and from l’Institut national de santé publique due Québec.

We began with a preliminary “setting the stage” process

The Steering Committee, through a consensus process, defined in further detail, tasks and timelines for this initiative. This “setting the stage” component allowed for the delineation of three subsequent stages (see diagram above), each driven by the establishment of national consensus processes related to primary mental health care and quality measurement. During this preliminary stage, the project also grappled with a fundamental challenge: limiting of the scope of the project while maintaining continued inter-regional “buy-in.”

Highlights - “setting the stage” process

Overview of Stage 1 – populating and defining a framework

A flashlight in a dark room

The current challenge of quality measurement in health care has been compared to attempting to navigate a large, dark room with only a flashlight to illuminate one’s way. One must chose where to focus the light in order to navigate the room effectively and safely. Similarly, with health quality measurement, no current set of ideal measures exist that will allow us to have a full understanding of the whole system.

Use of consensus to develop areas of focus

In Stage 1, in order to address the challenge of a potentially limitless number of quality measures, our Steering Committee directed the project to develop a consensus process to determine key areas of focus ( that is, where the project would point our “flashlight in the dark room”). As part of this process the project developed a framework regarding various aspects of the primary mental health system (domains). This framework was adapted from both the Canadian Institute of Health Information (CIHI) Health Indicators Framework and Richard Hermann’s (2002) mental health framework. Additional domains were added to the above frameworks to increase the relevance to primary mental health care. These additional domains were generated through a consensus based process that involved a wide range of stakeholders with additional reference to current research literature.

Highlights - Stage 1

Overview of Stage 2 - expert review regarding evidence informed best practices and literature

In Stage 2 of the initiative, we conducted a second survey with a national and international group of experts to research best practices and existing quality measures associated with the domains or areas of focus identified in Stage 1 of the project.

Highlights - Stage 2

Overview of Stage 3 – results and final measures 

In Stage 3 of the initiative, we conducted our third and final survey with respondents from every province and territory in Canada and within those regions, with a range of stakeholders.

Highlights – Stage 3


Team lead

Paul Waraich
Assistant Professor, Department Psychiatry, UBC
Adjunct Professor, CARMHA, Faculty of Health Sciences, SFU

Other team members

Denise Aubé
Donald Addington
Ulrieke Birner
Ruchi Bhalla
Jana Carson
Lydia Cartar
John Conway
Alex Craciunescu

Martha Donnelley
Jennifer Hermann
David Haslam
Wayne Jones
Pamela Joshi
Hamish Khamisa
Tania Kyle
Elizabeth Lin

Eric MacNaughton
Nawaf Madi
Luljeta Pallaveshi
Radha Puri
Mélanie St-Onge
Ellisa Wee
Natasha Zaslavska


v 3 Sep 28, 2006