Excellent Care for All Act Updates

Employee and Service Provider Surveys

Update - as of November 22, 2011

According to the Excellent Care for All Act (ECFAA), health care organizations are required to conduct surveys of employees and others providing services within the organization every two years. Hospitals not currently surveying employees and those providing services (i.e. both clinical and non-clinical services), herein referred to as employees/service providers, will need to be doing so by April 1, 2012. The surveys must measure both employee/other service provider satisfaction with their experience working at the hospital, and their views about the quality of care provided by the organization. This data should be considered in the development of Quality Improvement Plans (QIPs). Physicians of the hospital should also be surveyed but the process for doing so may differ within the hospital from that of employees/other service providers. This is further explored in the Guidance Document [PDF].

What this means for hospitals

There is a great deal of variation in employee survey scope and complexity across the field. A survey of Ontario hospitals in September 2010 found that approximately 60% of hospitals currently conduct employee surveys and only 43% conduct physician surveys specifically (excluding those surveying with the Accreditation Canada Worklife Pulse tool). The frequency by which these surveys are conducted, which individuals are surveyed, and how surveys are administered varies significantly across hospitals. In light of this, the ECFAA IWG has produced a Guidance Document [PDF], outlining best practice recommendations for employee/other service provider surveys.

Next Steps

As 2011 marks the second year of ECFAA, organizations will be expected to strive towards improvement in every aspect of implementation. The focus of this guidance is on compliance with the legislation, however moving towards improved performance at the organizational level supports better patient care. Hospitals must survey their employees/service providers and physicians every other year starting April 2012 and the guidance document provides some advice with how this might be done.

In a recent (June 2011) survey to hospitals on the ECFAA implementation process, 91% of hospitals who responded felt that a set of standardized questions in the surveys would be helpful in order to enable peer-to-peer comparisons. This finding will be taken into consideration for future years as a provincial approach is further developed.

For questions about Excellent Care for All, please email

Update - as of January 12, 2011

There is currently a great deal of variation across Ontario hospitals in regard to employee and physician surveying. Hospitals are expected to have initiated employee and physician surveys by April 1, 2012. The ECFAA IWG is currently identifying best practices and developing guidance for hospitals. Further direction will be given in winter 2011.

For questions about Excellent Care for All, please email

Related Legislation

Section 5.
(1) Every health care organization shall carry out surveys, at least once every two fiscal years, of employees of the health care organization and of persons providing services within the health care organization.

The purpose is to collect information on the satisfaction of employees and other persons with their experience working for or providing services within the organization and to solicit views about the quality of care provided by the health care organization.

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