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Monday, June 4, 2012

Better local connections will make better nationwide indicators

Dr. Gary Teare joined the Health Quality Council (Saskatoon, SK) in January 2005 as Director of Quality Measurement and Analysis. At the Health Quality Council, Gary leads a team of researchers and analysts in the Council’s work of measuring and reporting on the quality of health care in Saskatchewan and helping to develop performance measurement capability in the health system.  Gary’s own research has largely focused on issues of health care performance measurement.

As we approach the denouement of the “10-Year Plan to Strengthen Health Care” put forward by the Health Ministers in 2004, the Health Council of Canada concludes in their Progress Report 2012: Health care renewal in Canada that while much progress was made, important opportunities were missed.  One of these they point out is the ongoing lack of nationally shared health system performance goals accompanied by a set of comparable metrics by which we hold ourselves accountable to the public for progress.

Indeed, in another of their reports,  Measuring and reporting on health system performance in Canada: Opportunities for improvement, released in May 2012, the Council  points out the virtual impossibility of their assigned task of monitoring and reporting on the provinces’ progress on agreed goals of the 2004 Federal/Provincial/Territorial Health Accord, given the largely inadequate and somewhat “chaotic” state of measurement of health and health care across Canada.

Not that there isn’t quite a bit of good measurement and reporting on health and health care quality and performance happening. It’s mainly that these efforts are being carried out by a variety of national, provincial and regional organizations in a largely uncoordinated manner.  Due to this lack of coordination, Canadians are not realizing maximal benefit from all the intelligent, detailed and costly work being done across this country to create metrics and report on health system performance.  I fear thus far our cumulative efforts may be generating more heat than light.

To realize the goals of all this measurement work – namely to stimulate and support health care improvement and contribute to public accountability, we will need more than carefully crafted, comparable indicators reported at facility, regional and provincial levels by means of user-friendly, media attention-grabbing public reporting.  While these have some effect, they also can divert attention and resources from development and support of more localized measurement for improvement.

Like politics – all health care is local.  Improvement happens at the interface of patients and the people serving them or it doesn’t happen at all. Thus far, we have collectively relied too much on a “top down” approach – hoping that by highlighting performance or quality gaps at a population level we can motivate and inform improvements to care processes and outcomes. Unfortunately, presenting data on outcomes of care processes in the absence of sufficient information about the underlying processes does not help those responsible for the performance to respond in highly productive ways.

In future, much more attention needs to be paid to providing the support that very localized care delivery teams (including both clinical and administrative functions) need to enable them to identify their performance gaps and measure progress as they focus on specific improvement aims.  Not all measurement at this local level need be highly standardized or comparable (though some should be) – mostly it has to be very timely (daily), highly visible, and meaningful to the people trying to make improvements.  Importantly – where local improvement work needs to be linked to regional, provincial or national improvement aims – a connection, via logical or arithmetical measurement cascades, needs to be made between local and higher-level measurement.

So, Canada – let’s certainly continue to invest in the development of indicators that are comparable across the country.  These are important to understanding disparities in health and care and can play a role in improvement.  However – let’s commit to working harder to coordinate the work of various agencies that measure and build capacity to measure health care performance, to avoid creating duplications and distractions. Instead let’s have national, provincial and regional players work together to build stronger measurement connections between local care processes and wider health system improvement ambitions.

1 comment:

  1. We need to focus more on educating the masses, which will lead to prevention. We should teach all about the body and anatomy in school. Most of us have no clue how our body really works so when we visit the doctor we are useless.