Putting the “public” in public reporting on health system performance

As both users and funders of health care, Canadians have a stake in understanding how well their system is performing. Polls repeatedly show health to be a top priority for Canadians and their appetite is strong for performance information, provided it is easy to access and digest. The challenge is in developing reports that are accessible to the public, credible for the system and sustainable over time.

In Canada, there is no shortage of data on the health system. The use of literally hundreds of measures has contributed to what those in the health sector describe as a state of “indicator chaos”.  With a large number of organizations reporting on health system performance in an uncoordinated fashion and a variety of different ways, information can at times be contradictory and making sense of it can be an exercise in frustration for Canadians, health system managers, and policy-makers alike.

Today, the Canadian Institute for Health Information (CIHI) is releasing OurHealthSystem.ca, an interactive website on health system performance designed specifically to meet the information needs of the general public. It represents a small but important first step in a larger initiative to better structure, coordinate and clarify health system performance reporting in Canada.

In creating this tool, it was important to speak to Canadians directly to understand which areas of performance are most important to them. Last February, CIHI conducted an online survey with a representative sample of more than 3,000 Canadians, as well as five in-person focus groups across the country with participation from both urban and rural areas.

The results from coast to coast were remarkably similar. By a solid margin, Canadians identified access to care as the single most important dimension of performance, followed in no clear order of preference by the following areas: quality of care, health promotion and disease prevention, health outcomes, and value for money. Canadians also told us they want the system to be fair and they want their fellow citizens to benefit equally from good health and health services. For this reason, information on equity is also presented on the website to provide important additional context to the overall performance picture.

A group of national and international experts then helped us select 15 key indicators that would best represent the priority themes of Canadians while providing a comprehensive view of health system performance in the country. Criteria included whether the indicators were valid, reliable and available at a pan-Canadian level. It was also important to achieve a balance between health care and population health measures to reflect the health system as a whole.

A team of analysts then worked with data from multiple sources to answer two basic questions:  how do results compare across the country and how are they changing over time? The website was designed to be simple but informative. It does not grade or rank, but provides top results for indicators when possible to encourage peer learning across the health system. It also allows users to learn about the big picture on health system performance or customize their view closer to home. Feedback so far from the target audience – members of the general public – has been overwhelmingly positive.

There is still a lot of work ahead of us. While Canada has a large inventory of health indicators, there are still important gaps in what we know about performance. The measurement of value for money is still in its infancy, and better costing data is needed to make progress on this front. We also need better measures of patient safety, patient experience and patient outcomes to round out the performance picture in Canada.

Our hope is that by providing this information in an accessible format, we can empower citizens with knowledge and enable the system to improve outcomes for all Canadians.

The comments section is closed.

  • Dr. Hebadacher says:

    This is all fluff.

    Access to care is a broad concept that needs more scrutiny. Do they mean access to primary care? Geriatric care? Surgical care? What about behind-the-scenes care like anatomic pathology services?

    Quality is another vague concept that needs to be more well defined. Does quality care mean that the doctor provides the patient with whatever the patient wants, even if it is not indicated? Does it mean that “turnaround” or “wait” times are within a certain benchmark? Does it mean complication rates, and does that take into account patient complexity? What about institutional complications like C.diff rates? None of these things by themselves define quality care, and some are entirely unrelated even if they are easy to quantify.

    The problem is that we haven’t defined what truly constitutes good “performance” because we haven’t yet defined our endpoints.

  • Elizabeth Rankin BScN says:

    The article is one step forward in outlining information by graph which is only one way of representing a “target audience.” It falls short in taking into account that those they target may overlook many others who would never be asked to comment. It would make sense to me that everyone that has an OHIP number in Ontario and those who have provincial or territory health insurance numbers should be part of the analysis. That would make a more informed discussion about the elements needed and represent what’s missing in the analysis under discussion and to see where the overall inequities rest. Bring all citizens of this country into the fold who wish to comment.

    Today, most people have access to technology. Using this mode of communication, sending letters to all health insured registrants would allow the broader population to submit both data and comments regarding their health care or lack of access to the care they need and want rather than limiting the collection of data to a select few, randomly or not. If this is considered a privacy issue than make sure the information is encrypted.

    If governments want to take a stand to cut costs and make the sustainable dollars and services continue there has to be a better way of implementing value for service. Transparency has been excluded. Asking patients for information isn’t the same as creating transparency. If transparency existed, we would, for example, have the provincial insurance plans send each person an account which would include: whom they saw by date, what the nature of their appointment was and the nature of each coded services provided, and what each code was charged as a service proved to the patient that day. Codes are based on doctor’s charges for each named service they say they provided while they see the patient or something they do beyond the visit such as a reporting letter. It is essential in my opinion that these services be made transparent to patients in all health care systems. It is especially important in any single payer system since we haven’t a clue how our health care dollars [tax. dollars] are spent, since people mostly think about use of the system is related to the doctors they see, not the costs for services such as paying staff, and the CMPA insurance [liability insurance paid for by Canadians] for the doctors we see. Make all these costs [and more] known to the patient since this is a cost to the system. Doctors won’t like this! Since this published information would “be transparent” it undoubtedly would uncover the behind the scenes hidden shows of medicine. But, we need to now what our care costs and be able to have a say in how we want our health care dollars spent. Patients need to ask or comment on the coded services they may or may not have received. For instance, did the doctor outline for the patient the drug side-effects when the drug was prescribed or did the doctor review with us the symptoms we are presenting with as a possibility of the drug’s intolerance? What code was inputted to the system? Was it specific to note whether this was done or not? If it was coded, refill for med, then this is one way the patient can validate whether the service was provided, that is, did the doctor actually discuss potential side-effects? Presently there doesn’t exist a check and balance in the system for codes/service rendered. This is because this the code…that doesn’t “require” explanation but “assumes” this is what doctors do. I can assure you the current system offers no transparency and it it highly unlikely, in my and other’s experience from my own research, that it just does;t happen. So, now here I’ve raised only two of many, specific issues for one area of transparency. The first is the cost of the code related to the service provided. The second is the lack of support for the code transparency because the patient doesn’t see the “input from the doctor’s office” about the code, not do they see if the code as described as a service provided matched what the patient actually said they received. Engaging the support of patients to help save the system requires a check and balance system, not just having promotional studies to show vaccines are important to have a healthy population and reduce the possible need for doctors services if they aren’t taking vaccines.

    In the age of algorithms this is possible. Will it occur anytime soon? LOL

    Elizabeth Rankin BScN

  • Timothy Clarke says:

    congratulations , John, Jeremy and Christina, for doing such a great job on the HSP and putting it all together

  • Tom Closson says:

    Great work on this. My congratulations to CIHI staff. I went through it on my smartphone and found it very easy to use. Now you need to make it into a smartphone app so that I can have an application icon on my home screen to easily access indicator information whenever I want it.


John Wright


John Wright is President and CEO of the Canadian Institute for Health Information.

Jeremy Veillard


Jeremy Veillard is the Vice-President, Research and Analysis, at the Canadian Institute for Health Information and an assistant professor (status only) at the Institute for Health Policy, Management and Evaluation at the University of Toronto.

Christina Lawand


Christina Lawand is a senior researcher at the Canadian Institute for Health Information and the manager responsible for the development of OurHealthSystem.ca

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