As a technology platform, Maple provides online services that connect patients to healthcare providers to provide healthcare and informational services. Maple is not a healthcare provider, nor does it regulate or monitor the clinical activities of its providers. Instead, healthcare providers are responsible for the clinical services they provide through the Maple platform and are considered independent regulated health professionals registered to practice in select provinces or territories of Canada. As such, the quality and evaluation of care delivered ultimately come under the jurisdiction of the regulatory bodies to which each provider is registered.
While the mission of Maple is to provide an online platform that connects patients to healthcare providers to build a connected health experience, Maple has a vested interest in ensuring its providers provide high-quality care and maintain a consistent approach to treating patients. This is stated in section H of your Maple Provider Services Agreement:
Section H. User Ratings, Quality Control
Maple may occasionally conduct quality control activities to verify adherence to our policies, procedures, rules and this Agreement. Such activities may include 1) the use of simulated Users, 2) an analysis of statistics and metrics related to your use of the Maple Platform, and 3) an analysis of communications between you and Users (with User consent unless the communications are de-identified). You agree to Maple conducting such quality control activities and, on request, will provide reasonable assistance to Maple to permit it to conduct such activities.
QCC and medical review workflow
QQC mandate
The Quality of Care Committee is an independent group of healthcare providers that evaluates quality of care complaints from Maple patients, providers, and staff to ensure adherence to College standards, as well as to Maple’s policies, procedures, Provider Services Agreement, and Terms of Use.
The committee includes three to four anonymous active Maple providers selected based on their activity on the Maple platforms, patient feedback for the provider on the Maple platforms, and professional qualifications. In addition, there are 1-2 non-voting members on the QCC representing the Care Quality Admin Team and a member of the Medical Advisory Committee. QCC meetings are held every one to two months, depending on caseload requirements. The main activities of the QCC include:
Review appropriate cases brought forward. The QCC will review the case information, considering consultation data and medical records that the patient has consented to share in addition to the provider’s comments.
Provide a judgment on the case, including stating what category the deficiency of care falls under.
Provide a recommendation to the Care Quality Admin Team regarding provider disposition based on the level of shortcomings of quality of care and areas of improvement.
Provide peer-to-peer feedback regarding cases flagged as not meeting accepted quality norms. In many cases, this feedback will be passed along verbatim to the provider
Pre-QCC screening
Care Quality Admin Team
Maple’s Care Quality Admin Team is composed of Maple employees — Director, Operations, Manager, Support Operations, and members of the Provider Team — who manage all preparation, escalations and operations for the Quality of Care Committee.
The Care Quality Admin Team will:
Obtain consent from the patient/provider to support the Medical Review Physician’s initial review of each case.
Gather relevant medical records required for any necessary QCC reviews and provide these cases to the committee.
Following the Medical Review Physician or the QCC's ruling and feedback, the team will inform the patient and provider of the outcome. In many cases, this feedback will be passed along verbatim to the provider.
If a provider initially flagged the case, the Care Quality Admin Team will inform that provider of the steps taken while protecting the provider’s privacy.
Carry out recommended actions — for example, in cases where a recommendation is made to refund a patient and revoke a provider payment.
Track and retain providers’ cumulative pre-screen and QCC ruling scores and make recommendations to the Provider Operations team regarding the next steps if appropriate.
The QCC provides recommendations to the Care Quality Admin Team regarding provider disposition based on the level of shortcomings of quality of care. The team can modify actions based on that information. It considers whether the provider has displayed similar behaviour in the past and/or received multiple rulings against them from the QCC. Such actions may include but are not limited to granting a refund to the patient, implementing remediation steps for the provider, suspending their account, or imposing service restrictions (Appendix A).
Medical Review Physician
The Medical Review Physician operates independently of Maple. The Medical Review Physician conducts an in-depth review of the flagged cases from both providers and patients. The purpose of the Medical Review Physician is to provide an additional medical screening process to reduce the frequency of inappropriate cases reviewed by the QCC. Thus, the Medical Review Physician will:
Conduct a preliminary clinical review of the flagged case with patient and/or provider consent to access the full consultation record.
Determine the presence and severity of potential misconduct using the appropriate scoring system described below:
Any case with potential misconduct will be forwarded to the QCC for a full review. The purpose is not to replace the full QCC review but rather to ensure that the QCC doesn’t spend time on cases that are inappropriate for it, namely:
Cases where it is clear that there is no misconduct requiring a QCC review.
Cases where there is sufficient QCC precedent for a situation that the Medical Review Physician can confidently apply past rulings and actions.
Use independent medical expertise to determine areas of improvement and guide feedback when not forwarding a case to the QCC for full review.
Work with the Care Quality Admin Team to draft/relay clear and concise QCC feedback, peer-to-peer with providers, using their experience in their respective independent medical practice and convey the key takeaways from the QCC.
Pre-QCC Consultation Scoring System
The medical review physician will score the provider’s behaviour on a scale from zero to two in medical judgment and professionalism.
Score | Medical Judgment | Professionalism |
0* | No clinical concerns were identified.
The provider used sound judgment in accordance with College best practices and Maple MAC guidelines throughout the visit. | No concerns with provider conduct or ‘webside manner’ were identified. The doctor behaved professionally throughout the visit. |
1 | Minor clinical concerns were identified or the level of concern was unclear.
The provider deviated from College best practices and/or Maple MAC guidelines but did not endanger the patient. | Minor concerns with provider conduct or ‘webside manner’ were identified, or the level of concern was unclear.
There was room for improvement in the doctor’s conduct during the visit, but no significant individual example of unprofessional behaviour. |
2 | Major clinical concerns were identified.
The provider significantly deviated from College best practices and/or Maple MAC guidelines to the point that it was detrimental or dangerous to the patient. | Significant concerns with provider conduct or ‘webside manner’ were identified.
The provider behaved in a significantly unprofessional manner during the visit, such as discriminating against the patient or using abusive language. |
* Zeros are often cases of patients submitting fabricated complaints after not receiving their desired outcome. If a case is identified with a total score of 0, it does not qualify to contribute to the specific provider's cumulative score and will not be shown on their record.
Once the Pre-QCC scoring system is used to categorize the flagged cases, the case will be actioned via the following:
Pre-screen Score of 0:
Optional Educational Connect
Possible that no feedback is required if the case was flagged inappropriately or based on an untrue patient report
Option to connect with the provider to give feedback if appropriate
Pre-screen Score of 1:
Educational Connect
Mandatory educational review and connect to address areas for improvement
Pertains to main themes and occurrences previously identified by QCC
Additional educational outreach, communicated expectations, QCC feedback, and MAC guidelines were provided
Pre-screen Score of 2+:
Quality of Care Committee Review (QCC)
Consultation severity warrants additional clinical review and interpretation
QCC reviews cases and compiles feedback holistically directed at the provider
The Care Quality Admin Team and Physician communicate feedback and a scoring system
All cases will be reviewed and scored based on the individual case. Should a Provider receive a combination of pre-screen scoring that do not move forward to the QCC, the Medical Review Physician will further investigate the cases and determine the severity of the overall conduct of the Provider. If a specific Provider receives several cases that do not meet the pre-screen score of 2+, the cases can still be considered for QCC investigation.
Submitting a Case
If you wish to submit a case to the committee for review, we ask that you share the following information:
The provider’s name
A summary of your concerns regarding the case submitted
The date(s) and time(s) of the consultation(s) with the patient's initials
Any other pertinent information
Please email this information to [email protected]. Please do not take or send any screenshots.
It is important to note that not all cases will necessarily be referred to the QCC. This may be due to a variety of reasons, including, but not limited to:
The provider is already under review for similar concerns
The provider has already received feedback regarding their practice, and the case submitted precedes this
The provider's account has been suspended, or the provider is no longer providing services through Maple
The Care Quality Admin Team has provided education and feedback regarding Maple policy and expectations.
Closing a Case
Upon final review of each submitted case, a formal communication will be sent to at least two of the following as appropriate: the patient, the flagging provider, and the offending provider. The completion email is intended to provide closure to all issuers while ensuring the outcome of remediation and/or next steps for the provider remains confidential.
| Did Not Go to QCC Any cases that enter the Pre-QCC scoring system that have the outcome of net 0-1 will not move forward to the QCC | Full QCC Review Cases that move forward from the Pre-QCC scoring system with 2+ will move forward to the QCC |
Patient |
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Flagging Provider |
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Offending Provider |
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Rulings and Outcomes
All cases are presented to the QCC fully redacted — the provider’s and patient’s names are not shown to the committee. It should be noted that the QCC is strictly an internal process used as a quality control mechanism to protect patients and providers. Information in these reviews is never shared externally.
The QCC provides a ruling to the Maple Clinical Operations team regarding a provider’s level of shortcomings in the quality of care. This QCC ruling is then assigned a Maple score based on the category of deficiency found during the review:
QCC notes a minor area for improvement. (Rating 1 - 2)
QCC notes several area(s) for improvement. (Rating - 3)
QCC notes significant area(s) for improvement and/or significant concern with provider quality of care or medical judgment. (Rating - 4)
Maple does consider a provider's cumulative score, whether the provider has displayed similar behaviour in the past and/or received multiple rulings from the QCC when determining the next steps. Actions can be taken if a provider reaches certain thresholds to maintain the quality of care on the platform (see Appendix A).
Appendix A: QCC Recommendations and Actions
In addition to rulings on a case-by-case basis, a provider's cumulative score is also generated by adding the ratings of each case to determine if a threshold has been met for further action, including practice on the platform.
Cumulative Score | Possible Actions (not exhaustive; for illustrative purposes only) |
1 - 3 |
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4 - 6 |
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14+ |
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Appendix B: Categories of deficiencies of care
The below categories of deficiencies in care are not exhaustive.
Poor communication skills/lack of professionalism
Offensive/hostile communication
Poor medical assessment
Patient symptoms not addressed appropriately
Improper diagnosis or lack of diagnosis
Failure to consider Medical Advisory Committee (MAC) guidelines
Respiratory Assessments on the Maple platform