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.