Let’s not confuse measurable with meaningful in primary care
performance measurement
Aiming for zero: a new approach to suicide prevention
Excitement and apprehension over shift to competency-based medical education
Change Day comes to Canadian health care – but will it make a difference?
A call to Health Ministers: Target public reporting to areas requiring improvement
When provincial and territorial Health Ministers meet Wednesday with the new federal Health Minister Dr. Jane Philpott, it is imperative they focus not simply on the amount of money coming from Ottawa but rather on what matters most: how to get value and performance from our health care dollar. The late Jim Flaherty set the table …
Can sports psychology help surgeons score better outcomes?
Stepping up to the free throw line, Toronto Raptors basketball players may find Dana Sinclair’s advice on their minds: to control their self-talk and lower tension. “The pressure shifts – the skills don’t,” says the sports psychologist, who has worked with the team, along with others, from the Toronto Maple Leafs to the Canadian Olympic …
What Canada can learn from Sweden’s health registry system
In 2007, a group of Canadian cardiologists found themselves in a unique position. New – and expensive – implantable cardiac defibrillators were being used by fewer than a dozen doctors. And the Institute for Clinical Evaluative Sciences was offering to help them create a registry that would track outcomes for five years. Soon, they had the largest registry …
From the factory floor to the emergency department: Hospitals explore Lean method
Can health care learn from assembly lines? Manitoba’s St. Boniface General Hospital thinks so. It’s been using Lean, a system inspired by Toyota, on processes around the institution. Last year, one of its projects was to reduce wait times for CT scans. Staff ran a Rapid Improvement Event, where a team mapped out patient flow and …
Does collecting data take away from patient care?
As a primary care physician, I support using data for quality improvement and research. But when I recently helped a family medicine resident complete a research project, flaws in our current system became evident. Her chart review was focused on women in prenatal care who had no health insurance at my workplace, the Somerset West Community Health …
The hidden waste in Ontario health care
This month’s provincial budget renews a pledge to eliminate Ontario’s $12.5-billion deficit in the next four years. The commitment ensures that health care, which accounts for almost half of provincial spending, will continue to be under the microscope and the search to make the system more efficient will continue. The challenge is that much of …
Hip and knee implants need improved monitoring, assessment
Hip and knee replacement surgeries are among the most cost effective medical interventions developed, with the vast majority of patients enjoying a greatly improved quality of life as a result. They are also among the most popular surgeries. You might be surprised to learn that Canada’s yearly 75,000 joint replacements, at an estimated $15 000 …
Rethinking health outcomes in the era of multiple concurrent chronic conditions
Modern health care is very much concerned with outcomes. The language of outcomes is common in policy development, clinical work, and research. For example, Health Quality Ontario states that the overall quality aims are: Better outcomes, better experience, better value for money. In the context of clinical care, outcomes are broadly considered to be the …
Missing the target on health care performance?
Setting targets has long been a mechanism in industrial psychology to motivate managers and workers to achieve specific organizational objectives. In the last decade, targets have become important methods of driving performance improvement in health care. However, deciding where and when to set targets is a challenge facing health care decision makers. Politics of performance …
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 …
The controversy over “pay-at-risk” for hospital executives
“Pay-at-risk” became a political flash point in Alberta last month when Health Minister Fred Horne fired the Alberta Health Services board when it didn’t agree to withhold the at-risk part of the compensation package for about 100 executives. Alberta Health Services (AHS) had introduced pay-at-risk for health care executives in 2009. With pay-at-risk — also …
Cycle Time – the new wait time?
Bill is an elderly patient living independently at home, who recently fell and was admitted to the hospital where I work (name and minor details changed to protect his identity). Bill clearly indicated his wish to spend as much time at home as possible. For some time we had been measuring our length of stay …
Can “bottom up” measurement improve the quality of Canadian health care?
Progress has been made in measuring the quality of Canadian health care. Yet there are still large gaps in what is measured in our health care system, and much of what is measured is only useful to top-level system managers, not to the front-line clinicians whose day-to-day work is so important to the overall quality of the system. This leads experts to question whether measurement is being used effectively to improve the quality of Canadian health care.
A hospital CEO’s take on CBC’s “Rate My Hospital”
Following the public release of Rate My Hospital report last week, I received the following question on twitter: “CBC 5thEstate is being pretty provocative, are hospital CEO’s cringing across the country? Reaction?” Personally, I welcome the public scrutiny, and support actions that increase the transparency and accountability of our health care system. Ontario has been publicly reporting on …
Why doesn’t Ontario report complete data on wait times?
Jane’s story Jane is a 60 year old woman living in Waterloo, Ontario (a number of details of Jane’s case have been changed to protect her confidentiality). For several years she has been experiencing worsening back pain, which was recently diagnosed as spinal osteoarthritis (a degenerative condition that can cause severe back pain). The pain has grown …
Oakville clinic sets an example for quality and accountability in primary care
Primary care is the foundation of Ontario’s health care system and more than 137,000 patient care visits are made every day to primary care providers – family physicians, general practitioners and nurse practitioners – in the province. However the quality of care that patients receive in primary care is largely unknown. Even primary care providers …