Ontario hospital data less than timely, transparent

How transparent is data from Ontario’s hospitals? And does it really tell the true story?

In July the far right Fraser Institute took a shot at Ontario hospitals claiming they lacked transparency when it comes to reporting performance indicators.

The Ontario Hospital Association shot back, claiming the Fraser Institute was likely unaware of  www.myhospitalcare.ca –an OHA site that provides data on more than 40 performance indicators.

The release quotes OHA President Tom Closson as saying Ontario’s hospitals are among the most accountable in Canada. The question is: how does Closson come to that conclusion? Is the OHA web site intended to be the evidence to support such a claim?

It’s true that there is a lot of public information on hospital performance, although what gets reported varies from hospital to hospital, the manner in which it is reported is often difficult to understand, and the information is usually less than timely.

The information is also in different places. Some of it is on individual hospital web sites. A select number of indicators are on the OHA site. Wait times information is on a Ministry of Health web site. To complicate matters, the information reporting dates are not the same on these sites, leading to conflicting data results.

It is also not unusual to see wild swings in the information reported, leading to questions about the quality of the data.

If you look up the Niagara Health System (NHS) on the OHA’s site, the infection rate for C-Difficile is similar to many other hospitals, although above the provincial average. That may have something to do with the fact that the data was collected in February of this year. Similarly, the Hospital Standardized Mortality Rate for the NHS is above average but below many other peer hospitals. These numbers don’t tell the real story – the Niagara Health System has recorded 37 C-Difficile-related deaths this year – so far.

In the age of real-time technology, is it reasonable for the public to try and make decisions based on data that is often more than six months old?

The OHA specifically cautions about using standardized mortality scores in determining which hospital to go to, instead suggesting such data should be used to track the performance of the hospital. What’s the point of standardizing such scores if they are not meant for outside comparison?

At the Local Health Integration Network board meetings, explanations over how to interpret this data are frequent. Yet the public is expected to go to web sites and understand such concepts as compliance with pre-surgery antibiotics, percentage of near miss reporting, or how inpatient weighted cases are determined. Could there not be at least a glossary and some explanatory notes to go with this data?

Try and decipher this reported action on the Peterborough Health Center web site: “Monitor and review VAP and CLI cases, rates and compliance with Safer Healthcare Now! Bundles.” Reading this, I’m sure the public can sleep more soundly now.

Clearly there is a need to provide a more simplified overview that puts this data into a more meaningful context.

Often data is hiding in plain site – on some hospital sites there is so much of it, finding what you are looking for is a considerable challenge on poorly organized web sites.

The myhospitalcare web site does provide provincial averages, but it does make it difficult to look at comparisons without going to each specific hospital location on the site.

Closson’s pronouncement of Ontario’s transparency ignores the fact that the province is the last to bring hospitals under Freedom of Information legislation. Ontario hospitals finally come under the Freedom of Information and Privacy of Privacy Act in 2012, but the OHA successfully fought to bring in additional exemptions for quality information as part of this year’s budget bill. In fact, the broad-based wording of the exemption will allow hospitals to conceal considerable information from prying eyes looking for public accountability.

Curiously, the OHA recently posted its advice to hospitals about the upcoming FIPPA deadline. You need a login and password to read it.

Ontario is also the last province in Canada to open up public hospitals to the scrutiny of the ombudsman. This is one office that has the expertise to cut through the dense jargon OHA members use in their reporting and to demand the data that isn’t publicly posted.

Last October Osler, Hoskin & Harcourt LLP raised eyebrows when they sent out an information bulletin warning hospitals that they should be “cleansing existing files on or before December 31, 2011, subject to legislative record-keeping requirements.” Osler was warning Ontario hospitals that they could face the same kind of reputation risk as e-Health if they failed to do so.

While there was shock and dismay, nobody knows to what extent Ontario hospitals took that advice to heart.

It is interesting that Closson used the word “accountable” and not “transparent” in the OHA’s defense.

Clearly there is a way to go for hospitals to be transparent in a truly meaningful way.

3 responses to “Ontario hospital data less than timely, transparent

  1. I was thinking of sending my resume to Ontario Shores’ HR Dept., as I expect they will be hiring a fulltime shredder in the near future.

  2. Improving transparency is a journey and there is always going to be more distance that hospitals can go. Myshospitalcare.ca was independently created by the OHA to try and bridge the knowledge gap for patients by giving them easy access to the best performance information available – indicators used by experts – all in one place. There is no other resource like this in Canada and the OHA continues to examine new ways of making it even better.

    Regarding FOI, it was the OHA Board that proactively called on government to extend freedom of information laws to hospitals in the fall of 2009. The recently enacted exemption for limited kinds of quality of care information will prevent a quality improvement “chill” from taking hold among individual physicians, nurses and other health care professionals, while also ensuring that organizational quality improvement information is publicly available.

    Compared to other provinces in Canada, Ontario’s hospitals deliver on an unprecedented number of transparency and accountability measures: annual value-for-money audits by Ontario’s Auditor General; annual quality improvement plans, with performance targets under these plans tied to executive compensation; the public reporting of various patient safety and wait time indicators, as well as patient satisfaction scores; and more.

    The evidence demonstrates that hospitals are doing a great deal and while there is always more to do, and it is useful to provide constructive criticism, it is equally important to give credit where it’s due.

    – Tom Closson, OHA President and CEO

  3. Speaking of giving credit where credit is due, perhaps Tom Closson could recognize the thousands of healthcare professionals such as dietitians, pharmacists, respiratory therapists, medical radiation technologists, pharmacy technicians, medical Laboratory technologists, ultrasonographers and others who provide a significant contribution to the health and well-being of Ontarians. The Healthcare system is made up of much more than doctors and nurses and instead of ignoring or minimizing their contributions to a well-functioning healthcare system, perhaps Tom could publicly thank and commend them. The day our members receive proper credit, perhaps he will get the same.

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