Most provincial governments have scorecards and other internal performance management systems in place to track actual to expected results. For example, if the goal is to reduce wait times to deliver healthcare services, a government can measure progress by tracking current to previous wait times within its jurisdiction.
But benchmarking results to peers and external indicators is beginning to play a larger role as government systems grow more sophisticated.
"You only know if you're doing well if you can compare your performance to others," says Adalsteinn Brown, assistant deputy minister of health system strategy at the Ontario government.
To this end, Ontario and Quebec are engaged in a collaborative exercise to work on benchmarking together, says Brown. "These are still early days but we're excited about this. An agreement made between McGuinty and Charest is providing a great framework within which the public service can work."
He says the Ontario government already uses a variety of external indicators to measure its performance, including the Canadian Community Health Survey and hospital data that's continuously maintained by the Canadian Institute for Health Information.
There's also movement to get more alignment across different levels and sectors, says Brown. "What happens at the local level contributes to provincial goals, and what happens in one sector like hospitals contributes to the overall goal of a sustainable, equitable system. Goals haven't been misaligned in the past, it's more like there was an absence of alignment."
While technology will accelerate this process, there are many simple things to do as well, he says. Accountability agreements between entities become more useful and relevant when performance goals are aligned across all the moving parts of the system.
"Reducing the rate of alternative level of care patients (ALCs) - patients who are in hospitals but could be in another healthcare setting - is a provincial goal. If you put that into the accountability agreements with the local health integration network (LHIN), they can then put it in their accountability agreements with hospitals."
Once this interlocking framework is in place, the addition of real-time data can create a powerful management system that adjusts to changing conditions across the province. "Then you can get into a progressive management cycle, with people constantly adjusting and re-benchmarking their performance."
The catch is that real-time data is not yet available, but the Ontario government is making progress on this front too. "In the past few years, we've taken steps to increase the timeliness of data. For ALC data, we've gone from having an idea about what's going on annually, often several months after the year-end, to now having it on a quarterly basis. This is a big shift."
The recent commitment to develop electronic medical records (EMRs) in Ontario will be a major boon in providing the information needed to improve healthcare delivery, he says. "We do have some centralized information which is not bad in terms of consistency, but it's shallow," he says.
The current basis for decision-making are the records generated after patients are discharged from a hospital or see a doctor. "These have some information about what happened, but they're more like bills or receipts," he says. "Imagine going from that to complete files with diagnoses, clinical data, blood tests and radiology. We would get that final bit of alignment with the clinicians, not just the LHIN or hospital."
Other provinces are also struggling to get meaningful performance measures in place. "In Quebec, there's tremendous pressure to get accurate statistics and reports. And like most provinces, healthcare and education are top priorities," says Mario Ianniciello, director for eastern Canada at analytics vendor SAS Inc.
Most governments focus on benchmarking their performance against external indicators on costs rather than policy goals, he says. "The big thing in government is managing costs, so they tend to stick to hard metrics. Policy goals are more difficult to measure, because data tied to legislation is scarce and most of the time it's not hard data. So we're not seeing much happening on that side."
Operational costs such as expenditures, human capital and absenteeism can be accurately tracked and compared to other government organizations of similar size and service orientation. "Hospitals can benchmark against each other, for example - a bed is a bed, and legislation doesn't have much to do with it."
Even on this score, many government organizations are struggling. "They still don't have a handle on the hard data. They've been collecting data for decades, and the volumes of information they have to deal with are phenomenal, so just understanding the information they already have is overwhelming."
Rosie Lombardi is a Toronto-based freelance writer. She can be reached atrosie@rosie-lombardi.com.
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