Lifting the veil on hospital performance

Last week the Canadian Institute for Health Information lifted the veil of secrecy surrounding the performance of Canadian hospitals with its Canadian Hospital Reporting Project, an interactive web site that measures the performance of Canadian hospitals based on 21 clinical and nine financial indicators.

This project, known by the acronym CHRP, is a bold and much awaited step toward greater patient rights, transparency, and improved health care delivery in Canada.

Thanks to the CHRP, healthcare providers can now learn from the successes of their counterparts across Canada and better identify areas where they may need to improve. More importantly, Canadians can now see data that can help them compare hospitals and better understand the variations in quality (like obstetric trauma rates, and nursing-sensitive adverse events) of health care provided by different facilities. Facilities that are, lest we forget, paid for by their taxes.

While the Canadian Institute for Health Information should be commended for increasing transparency in the Canadian health care system, one question must be asked: why did it take them so long?

As is often the case, Canada is only now catching up with Europe, the UK and the United States. Hospital reporting initiatives like the CHRP have existed in the U.S. since the 1980s, and since then, the reporting of hospital performance data has expanded considerably with reports available from federal and state governments as well as competing private-sector information providers. In the UK, both government and private-sector reports on hospital performance have also been available for more than a decade.

Even within Canada, several initiatives were undertaken during the past 10 years. The Ontario Hospital Associations’ report on hospitals in Ontario was likely among the first of such reports in Canada and has now expanded to detailed performance measures available on the web. Since 2007, the Canadian Institute for Health Information has also published aggregate mortality measures for hospitals across Canada.

Commencing in 2006, Albertans, British Columbians, and Ontarians also had access to an independent report measuring patient safety and inpatient quality: the Fraser Institute’s Hospital Report Card series. Unfortunately, this report series highlights an important problem with performance measurement in this country: only those funded by government, or closely associated with hospitals, seem permitted to freely report on the quality of care in provincial hospital systems.

Consider Alberta, where the provincial government refused to allow the Fraser Institute to identify hospitals alongside their performance measures. While Albertans might have discovered that one Alberta hospital had an injury rate for newborns more than four times the provincial average, and that patients in another Alberta hospital were, say, five times as likely to pick up an infection following medical care – they were not permitted to know the names of these hospitals.

While the situation was somewhat better in Ontario, where 17 of the province’s 136 acute care hospitals granted permission to be identified in the 2009 edition of the report card; British Columbia took the most significant step in terms of openness and public accountability - allowing the Fraser Institute to name all of BC’s hospitals in its report card there. Indeed, BC was alone among the three large provinces in providing patients, taxpayers, and health care providers the opportunity to make more informed decisions about health care.

For years, the majority of Canadians were permitted access to information on goods and services in all aspects of their lives, from cars to hotel rooms to restaurants - except hospitals, where a government-authorized cone of silence would descend. Not only did such cloaking measures limit the ability of patients to be fully informed about the quality of their health care consumption, but they also resulted in an acute lack of accountability for publically delivered medical services.

While the Canadian Institute for Health Information has undoubtedly improved accountability and transparency in Canada’s hospitals, the state of hospital reporting in Canada still lags far behind what can be found in countries like the U.S. and the UK. Many barriers still exist for independent providers who wish to produce quality report cards for the public, to improve care in Canada’s hospitals through greater transparency and accountability, and who wish to innovate and refine hospital performance measurement and reporting as their counterparts have done in other nations.

It is time Canada’s governments took the next big step and made hospital data, on which reports cards like the CHRP are based, available to all interested parties - not just those they fund or work closely with.