In health care, the continual improvement of both the quality and delivery of patient care is paramount to all other goals.
Consequently, hospitals across the country are seeking ways to help staff work more efficiently and productively. They are doing so under tighter budget constraints than ever before, and amid work by the Health Council of Canada to achieve a fully interoperable electronic health records system for all Canadians by 2010.
Most people agree that arming doctors and health care professionals with complete patient histories and performance data will improve and even expedite care. However, Canadian hospitals need to balance cost, privacy concerns, external accountability, the need for accurate patient information and quality improvement imperatives.
The challenge is how to accomplish this delicate balance in an industry that has historically been paper-based and where information is often fragmented and housed in disparate locations.
Accountability versus quality improvement
In broad terms, it is possible to distinguish between two roles for performance data in the public sector. The first relates to discharging accountability relationships: that is, giving account to funding bodies, ultimately the taxpayers of Canada. The second role relates to quality improvement: an internal management role.
This involves the use of performance measurement data to monitor, analyze, prioritize and learn. In the province of Ontario, it appears that important advances have been made with respect to external accountability, while quality improvement - systemically using data generated to improve performance - lags behind.
Perhaps the most comprehensive example of performance measurement in Ontario health care is the
Hospital Report series, a joint initiative of the Ontario's Ministry of Health and Long-Term Care and the Ontario Hospital Association.
Since 1997, hospitals throughout Canada have been involved in editions of the
Hospital Report, originating with the publication of a systematic report on acute care in 1998 and subsequently extending into other areas, including emergency department care, complex continuing care, mental health, and rehabilitation.
These are comprehensive, annual, province-wide hospital scorecard reports based on a balanced scorecard methodology and comprise measures of financial performance, patient satisfaction, clinical utilization and outcomes, and system integration and change.
Together, they represent one of the largest balanced scorecard efforts in North America, in terms of scope, that has ever been made public. They also represent one of the largest surveys of patient satisfaction ever conducted. The
Hospital Report series has focused health care attention and made an important contribution from an external accountability point of view.
To this end, close to nine of every 10 Canadians think that publicly reported hospital scorecards are a good idea. However, research has consistently found a poor awareness of and access to these reports from within health care organizations; a lack of resources, time and support to understand, analyze and respond to the data; and dissatisfaction with the definition of many of the performance indicators.
Perhaps most alarmingly, survey research suggests that between 35 per cent and 50 per cent of frontline workers and mid-level managers within Ontario hospitals are unaware of the initiative.
Taken together, this suggests that while the public release of comparative data may help focus attention on the quality agenda within health care providers, greater efforts are needed both to develop internal systems of quality improvement and to integrate these more effectively with external data systems.
Continued:
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