Dr. Alan Gob discusses how to determine the root cause of a care gap as part of quality improvement processes.
August 14, 2025
Dr. Alan Gob is a hematologist at London Health Sciences Centre (LHSC) who works at both University and Victoria sites in general internal medicine and hematology. In addition to providing patient care, he teaches quality improvement and patient safety through the Centre for Quality, Innovation and Safety (CQUINS), a partnership between London Health Sciences Centre, St. Joseph's Health Care London, and Western University.
After joining LHSC as a medical student in 2003, Dr. Gob developed a passion for patient safety through quality improvement.
“It's given me a chance to really sink my teeth into challenging problems that we face, making our health care system better,” says Dr. Gob.
What is Quality Improvement?
“All the decisions made at an organization like LHSC are based on systems from testing to determining the appropriate treatments to the discharging process for patients,” explains Dr. Gob. “Quality improvement is looking at how to design a system to work better, examining each step of a process and how it can be improved to provide a better outcome.”
Dr. Gob teaches health-care professionals including physicians and medical trainees, nurses, health disciplines, and administrators through CQUINS educational courses. He teaches the fundamentals of quality improvement and how to think about problems as a system instead of just trying to fix something. It’s more about individual steps, potential barriers, and how to overcome them.
“From start to finish, the processes are made up of little systems that sometimes work perfectly but sometimes need tweaking,” says Dr. Gob. “What I teach, is that if you look at the way things are systematically done, if you see something that's broken, it's often better to try and fix that than just trying to do a workaround.”
What does patient safety mean to you?
“Patient safety to me is really the Hippocratic oath. It's first do no harm,” says Dr. Gob. “Patient safety is its own subset of quality improvement, which looks at literally not doing harm to a patient and identifying gaps in patient safety and how we can close those gaps.”
"While I personally strive to close those gaps in my own practice, I really feel that teaching others the systematic way of how to look at those gaps, especially from a whole system point of view, is critical,” he explains. “I feel like that's where we get insights, and that's where we can fix something so that it doesn't break again, so that the system is sustainable.”
For Dr. Gob, it is the patient’s experience of a seamless transition through the health-care system that is the goal of quality improvement. “That makes me feel really good, when the patient says they had the smoothest transition, and it was seamless. That's how we know that the system worked,” he explains. “Almost like they didn't even know what had to happen to get them from point A to point B, that invisibility is what we strive for.”
Dr. Gob knows there is still work to be done on this, especially as part of cultural change in health care. In particular, he sees the need to ensure blame-free investigation of events when they happen, looking at things from a point of curiosity as opposed to pointing fingers. LHSC’s Just Culture program is working to provide this support.
“When that happens, we get at the root of the problem,” says Dr. Gob. “After we've exposed what the roots of the problem are, we can deal with the roots and make lasting change.”
Patient Safety at LHSC video (October 2024):