April 24, 2013

Hospital administrators are skeptical about attempts by the CBC to rate hospitals across Canada because of the lack of data. Chief executive of Interior Health, Dr. Halpenny, said that “I am concerned that these rankings do not include many of the clinical indicators we look at in measuring and improving the quality care we provide in Interior Health.”

Yet, CEOs are part of the problem. The rankings would had been more dependable if CEOs had supplied the information requested by the CBC. The survey was sent to 600 CEOs and only132 returned them. It included questions about 18 measures associated with safety, patient experience and quality of care.

Provincial health ministries didn't help much either. The CBC asked 13 provincial and territorial health ministries for information and only received results from three. Those three: PEI, Nunavut and New Brunswick, complied only after requests were made to privacy coordinators.

Given the void of silence from hospitals and CEOs, the CBC turned to a panel of health-care experts who were eager to contribute to the project. One of the panellists, Patricia O’Connor, director of nursing at McGill University Health Centre, said the process would lead to better care.

“I think the public deserves to have more information about how hospitals perform.”

Ratings of hospital performance are based on data supplied by hospitals and published by the Canadian Institute for Health Information, of which Dr. Halpenny approves. “Interior Health relies on CIHI because of their rigorous methods and focus on accuracy, standardization, and reliable indicators.”

The least reliable component of the CBC ratings is patient ratings which are inherently subjective. Even with that weakness, Rick Turner of the B.C. Health Coalition says there not many other ways in which frustrated patient's concerns can be heard. “If you’re not happy with the treatment you’ve received, who do you go to?” he wondered.

Instead of circling the wagons around the hospitals, health ministries and CEO's would benefit from comparisons. The U.S. and U.K. have doing it for a decade in order to provide higher quality of care and accountability.

Sunlight is a great disinfectant. Canada's record of hospital infection and surgical errors is dismal says Rachel Giese in her feature-length article for Walrus magazine. According to a 2011 report from the Organisation for Economic Co-operation and Development, Canada ranks among the worst of the 34 member nations for adverse events related to surgery.

"The list of mishaps reads like a series of David Cronenberg plot treatments: obstetrical trauma, foreign objects left inside the body during procedures, accidental punctures or lacerations, and post-operative sepsis."

The problems are usually errors of omission, not commission, says Giese. Few are wilfully careless. Canada's health care system has grown from a cottage industry of small family practices to a high technology system with no adjustment along the way.

Patients are handled by a myriad of professionals - - paramedics, emergency room doctors, nurses, anaesthesiologists, pharmacists, medical students, - - with the predicable loss of communication and room for error resulting from the fog of complexity.

One health care expert likens it to “a series of tribes who work together but don’t really understand one another.”

Rating of hospitals should not be seen as a threat to administrators but as encouragement to establish best practices and better communication.




David Charbonneau is the owner of Thompson Studio
He can be reached at dcharbonneau13@shaw.ca