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Performance monitoring

Health system analysis stymied by poor collection of data

TORONTO – While the federal, provincial and territorial governments are making gains on some commitments to renew healthcare, Canadians are not getting the detailed information they need to measure progress, the Health Council of Canada concludes in its annual report to Canadians. The report was released Feb. 1.

Four years after the 2003 First Ministers’ Accord on Healthcare Renewal – and following the infusion of billions of dollars in additional health investments – how far has healthcare renewal advanced?

“In some cases, we know governments are measuring up; in other areas, we know they’re missing the mark. But all too often, we just don’t know, or we don’t know enough. We don’t have sufficient evidence to evaluate the strength and sustainability of healthcare renewal on a system-wide basis,” said Jeanne Besner (pictured), Interim Chair of the Health Council.

“We need to strengthen our collective capacity to measure the performance of healthcare systems across the country; we need to strengthen transparency and accountability in healthcare,” said Besner.

The Health Council’s 3rd annual report to Canadians, “Healthcare Renewal in Canada: Measuring Up?”, tracks the progress governments have made in meeting such commitments as reforming primary healthcare, reducing wait times and health inequalities, modernizing health information systems, and improving drug coverage. And while there is good news to share, the Health Council was struck by the lack of comparable data and the prevalence of inconsistent or incomplete reporting across the country.

First Ministers did not report on comparable health indicators this year, as they had agreed to do, and the federal/provincial/territorial committee that oversees this work has been disbanded.

Information about how provinces and territories spend targeted federal funds is not easily accessible, or in some cases, not available at all. As of mid-January, it was not known if, or how fully, Health Ministers had reported to First Ministers on home-care goals related to a Dec. 31, 2006 deadline. Without better data, jurisdictions will fall short of their commitment to more transparent public reporting and greater accountability.

The Council’s report identifies both positive developments and troubling shortcomings, and highlights regional successes in making healthcare renewal a reality. Findings include:

• There has been progress in primary healthcare reform with further development, expansion and training of inter-professional teams across the country. But it is difficult to measure and compare this progress in a meaningful way, because jurisdictions do not collect and report information using agreed-upon indicators.

The implementation of the electronic health record is a crucial component of these reforms, yet the rate of adoption in primary healthcare settings remains slow.

• Wait times are being reduced in most of the five targeted areas (cancer treatment, heart procedures, joint replacement and sight restoration – benchmarks for diagnostic imaging are still needed, except in Ontario).

In the absence of a pan-Canadian approach to monitoring wait times for all procedures, it is not clear whether these efforts are inadvertently increasing wait times for other services. The Council advises that we standardize wait times measurement and reporting, create centralized registries, and continue to assess the impact of the focus on the five targeted areas.

• Medical and nursing school enrollments are up and most jurisdictions have developed health human resources plans, but only a few have set targets based on the needs of their respective populations.

• A progress report on the implementation of a national pharmaceuticals strategy was released with options for coverage of catastrophic drug costs. But to date, there has been no action on implementation and no indication if the federal government will help cover the costs. Meanwhile, 3.5 million Canadians – including 600,000 in Atlantic Canada – have little or no drug coverage and are financially vulnerable should they require expensive drug therapies.

• There are more patient safety initiatives underway across Canada than last year. But because information about adverse events – unintended injuries or complications caused by the delivery of healthcare that result in prolonged hospital stay, disability, or death – is not collected and evaluated in a coordinated fashion, it is difficult to determine whether patient safety is improving.

At a minimum, each jurisdiction should create a central mechanism for the mandatory reporting of all defined adverse events.

• In a study of eight jurisdictions, the Health Council found no uniformity in accreditation practices for healthcare facilities. Some have 100 per cent participation, while others do not, and it varies by province. Some accreditation reports are made public, but most are not. The Council is again recommending that all healthcare facilities be accredited as a condition of funding, and that the findings from accreditation surveys be made public.

• The development of national public health goals is complete, but to date only Nova Scotia has established targets. There has been a fair amount of activity at the provincial and territorial level in developing and implementing healthy living programs, but the federal government has not yet announced any projects from the Healthy Living Fund.

• Many governments – federal, provincial and territorial – offer programs to address health inequalities experienced by Aboriginal peoples, but the federal government’s intent with respect to implementing the Blueprint on Aboriginal Health and the Kelowna accord remains unclear.

“While there are many instances of progress and innovation, the picture we have of healthcare renewal in Canada remains clouded. In too many cases, the information is incomplete, inconsistent, or simply unavailable,” said Council Vice-Chair Ian Bowmer. “With billions of dollars being spent on this historic undertaking, Canadians expect more.”

This is supported by public opinion data. According to a Council-commissioned synthesis of public opinion polling from 2002-2006,Canadians clearly want to know what their governments are doing to improve the healthcare system, how money is being spent, and whether investments are resulting in a healthier population. This overview – Canadian Perceptions of the Healthcare System by Professor Stuart Soroka – was released as a companion document to the Council’s annual report.

The Council will be working closely in the coming months with governments, stakeholders, and the policy and research communities to develop a clearer picture of healthcare renewal. This will help build on successes, and provide Canadians with a more transparent accounting of how their healthcare system is measuring up.

The Health Council of Canada, created by the 2003 First Ministers’ Accord on Healthcare Renewal following the recommendations of the Romanow and Kirby reports, is mandated to monitor and report on the progress of healthcare renewal in Canada. The 26 Councillors were appointed by the participating provinces, territories and the Government of Canada and have expertise and broad experience in community care, Aboriginal health, nursing, health education and administration, finance, medicine and pharmacy. The report, federal/provincial/territorial information tables, public perceptions paper and a summary of the report’s success stories can be downloaded at