If hospital performance falls in Saskatchewan, does anybody hear?

2013-03-15 If tree falls...

Last week the Canadian Institute for Health Information released new data for its Canadian Hospital Reporting Project (CHRP) which collects information on 27 indicators — 21 clinical and 6 financial — for 600 hospitals across the country.

The Saskatchewan results were not glowing.

Of the 27 indicators, Saskatchewan was worse than the Canadian average on 11 of them.  For example, when it comes to 30-day in-hospital mortality following a heart attack, Saskatchewan has gone from the best in 2010-11 to the second worst among the nine provinces for 2011-12.  We also have the highest rate of readmissions to hospitals 90 days after a knee replacement.  You get the picture.

Of course we need to be cautious and careful when interpreting year to year comparisons like these. It’s not always clear whether a change is real (statistically speaking) or simply a result of random chance.  When it comes to assessing health system performance, it’s more useful to monitor metrics over time. This way, you know whether the latest results fall outside the variation that previous time periods have shown to be normal.

Data interpretation and analysis aside, I was shocked that there was nary a “what the…?” reaction from our local media — and by extension the public. When a colleague contacted CIHI to confirm whether they had issued a news release about the latest results, he learned the agency has moved to a softer, quieter form of announcement. Reporters across the country receive an email notifying them updated data is available on the Institute’s website. And CIHI posts an announcement on the media page of its site.

So, no formal report. And no news release. Apparently this is the second year they have used this model.

And how was the uptake?

We received very limited interest and only had a handful of interview requests. (Angela Baker, media relations specialist, CIHI)

Is CIHI’s “kinder, gentler” strategy the reason reporters tuned out? Or has mainstream media tired of covering the same “health care could be better” stories year after year. Either way, if the media’s not paying attention, then whose job IS it to bring this stuff to light, to hold our health system’s feet to the fire?

Why aren’t we (the broader “we”) talking about how our health care system is performing (or not)?  And how do we build curiosity amongst the public around  the quality of health care and ultimately use that energy to help drive our transformation efforts?

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7 Responses to “If hospital performance falls in Saskatchewan, does anybody hear?”

  1. Maura Davies
    March 18, 2013 at 5:08 pm #

    I share your concerns. While pleased that Saskatoon Health Region has made some gains, I am concerned about many of our results, especially related to nursing-sensitive adverse events. I note that we have made good improvement in wait times for hip fracture surgeries, which ironically became a regional priority for attention when CIHI publicly reported we were among the worst in the country. This is a good example of what gets measured and publicly reported gets attention. Our challenge continues to be in prioritizing the many aspects of our care that need signficant improvement.We have the responsibility to make those informed choices and to make much more transparent our actual results.

  2. Dennis Kendel
    March 15, 2013 at 10:00 pm #

    Hi Bonnie,

    In an era in which both electronic and print media have virtualy no capacity for truly investigative reporting, I think it is critical that agencies like CIHI use data release strategies that serve to “wake up” the media to situations such as your have addressed.
    Since the HQC also has a public reporting mandate, I guess we also need to look inward to ask if it is our respossibility to “pick up the ball” with the local media when data such as these come out from CIHI. Have you and Greg given that some thought?

    Dennis Kendel

    • Bonnie Brossart
      Bonnie Brossart
      March 16, 2013 at 1:28 pm #

      Hi Dennis. I was surprised to hear of CIHI’s soft release. I think all agencies have a responsibility to assertively share-if you will-information to the public. Good and bad. You raise an excellent point on how HQC can initiate more public dialogue on health care quality. Blogging, tweeting are two approaches that we are using more. Absolutely this topic and situation requires more discussion and action.

  3. Maureen Klenk RN(NP)
    March 15, 2013 at 12:41 pm #

    I agree Bonnie, I am also shocked at the new ‘soft’ reporting done by CIHI. One has to ask oneself – why have CIHI as an organization if it is not going to flag performance issues. But I believe a better question is ‘why has CIHI moved to this approach’. Is this organization being asked to muzzle in this our democratic country?

    I do appreciate HQC for bringing this forward, but I also wonder if the HQC is able to dig a bit deeper to find out again the ‘why’. Why is SK falling behind?

    For example is the 60 million being spent by the surgical initiative just aimed at getting more OR time (to cut the wait list) or is it being spent on ensuring the patient knows how to self care once they are discharged to avoid readmission rate. I have heard many personal stories from either my patients or my felllow NP patients related to patients being pushed out of hospital before they are ready, therefore ripe for readmission. The reason they are being told they must go home is because the bed is needed for the next surgical case. If that is the case then why is there not a communtiy support system put in place?

    Saskatchewan has all these initiatives – Patient First, Surgical Waitlist, Primary Health Care Redesign, Clinical Office Redesign etc. It seems like we are spending billions of dollars to ‘improve’ and yet we are sinking in the overall ratings. Can the Health Quality Council investigate ‘why’?

    • Bonnie Brossart
      Bonnie Brossart
      March 15, 2013 at 2:21 pm #

      Hi Maureen. Re: your question about digging deeper – RHA CEOs had this exact discussion this morning as part of the Provincial Leadership Team bi-weekly call. HQC and Cheryl Craig will be chatting further to see what we can do to understand why SK is falling behind. Your second point is an important reminder that quantity does not all mean quality and we need to be as tenacious in ensuring surgical care is safe throughout the entire experience.

      • Marie Everett
        March 20, 2013 at 9:31 am #

        Bonnie, the Quality and Safety Committee of Regina Qu’Appelle, which I currently chair, met on March 14 and the recent CIHI report was definitely on the agenda. We are concerned about RQHR’s performance in several areas, especially our re-admission rates, 5 Day in-hospital Mortality following major surgery and Obstetrical Trauma. We will be discussing this at our full board meeting at the end of this month. Our committee has asked for a report at our May meeting answering the following questions; 1. What is the root cause of the poor performance on these indicators.
        2. What has been done to improve on these indicators, and, 3. What are the future plans for continuing to improve performance on these indicators.

        • Bonnie Brossart
          Bonnie Brossart
          March 21, 2013 at 9:58 am #

          Hi Marie. Wonderful to hear of the Quality and Safety Committee’s discussion and those going forward. Keep me posted on what the subsequent discussions yield. I am confident other organizations’ board members would be interested as well.

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