How many stars does your hospital have? According to the Ottawa Citizen, the Ontario government is contemplating a public ranking system for hospitals.
Ironically, as government MPPs bought the OHA argument that access to quality information from hospital committees would amount to naming and shaming, the ranking system appears to do just that.
The system was tried briefly in the United Kingdom, but ran into numerous problems. The naming and blaming turned back on government as hospitals with low ratings complained of lack of funding. Low rated hospitals also tried to spend their way out of the low ratings, resulting in escalating deficits.
The Citizen reports considerable gaming of data took place in the UK, including making patients linger outside hospitals in ambulances to meet the target of a four hour wait for treatment.
In 2005 the UK government ended the star system in favour of a two-part report card on quality and resource utilization. Hospitals were given a rating on a continuum from excellent to weak.
Some claim that shining the light on hospital performance spurs them on to improvement.
At present Ontario hospitals are posting performance information on their web sites as part of the Excellent Care For All Act. However, this information is not always easy to find. For the average Ontarians, it may also be difficult to decipher what the score card actually means.
In the case of emergency department wait times, hospital funding is connected to performance, as is CEO remuneration.
By attaching hospital funding to the report card it does pose the risk of penalizing not just the hospital, but the community accessing that hospital. Given few communities have any opportunity to elect members of their hospital board, it seems incumbent on government to fix poor performing hospitals rather than create a gap in quality access between communities. We can probably guess which well-heeled communities would have high-performing hospitals, and which would lose funding under such a scenario.
A quality agenda is always welcome, but it should focus on improving the whole system, not on creating winners and losers.