Tag Archives: Accountability

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.

A bad month for transparency and accountability

Private member bills seldom get passed at the legislature. Perhaps it was for that reason Bill 183 received little attention after the Liberal majority defeated it May 5th.

The NDP authored Bill was intended to expand the scope of the Ombudsman to include universities, colleges, hospitals, long-term care homes, school boards, children’s aid societies, and retirement homes. The Bill would have also given the Ombudsman an oversight role over the independent police review director.

Ontario is unique in barring the ombudsman from investigations into these sectors.

The Liberals argued in the legislature that these bodies already have sufficient oversight. In the case of hospitals, they argued hospital boards and LHINs provide this role. However, hospital boards and LHINs are decision-makers, and as such, have an interest in defending those decisions.

In fact, most LHINs have a staff of about 30 or slightly more. They also have about 200 health care providers to which they negotiate and sign accountability agreements. They are responsible for community engagement, funding, integration decisions, managing projects, as well as collecting and assessing key health care indicators. They are responsible for developing integrated health service plans for their regions. The thought that they could do all this and provide reasonable oversight to investigate complaints by individuals into hospital or long term care homes is absurd.

Surely the Liberals understand this.

However, the McGuinty government has been stung by a number of scandals, many of them health-related. Let’s not forget e-Health. The Ombudsman’s report on the LHINs, “The LHIN Spin,” was undoubtedly fresh in their mind as they contemplated this private member’s bill.

Together with Schedule 15 of Bill 173 (see related articles), it has not been a good month for transparency and accountability in the province of Ontario.

For the record, these were the MPPs in the legislature who voted down Bill 183:

Laura Albanese, Wayne Arthurs, Bas Balkissoon, Lorenzo Berardinetti, Margarett Best, Laurel Broten, Vic Dhillon, Kevin Flynn, Helena Jaczek, Kuldip Kular, Monte Kwinter, Amrit Mangat, Reza Moridi, Leeanna Pendergast, Gerry Phillips, Shafiq Qaadri, Khalil Ramal, Lou Rinaldi, Tony Ruprecht, Liz Sandals, Mario Sergio, and Charles Sousa.

The trouble with LHINs Part II – How do you integrate half a system?

One of the key problems with the Local Health Integration Networks was evident from the start: they were given responsibility to better integrate our health system, but couldn’t address key parts of that system.

How do you integrate health care without the ability to better coordinate primary care? Physicians have always remained outside of system planning, and it could be argued that much of our system is defined by the agreement between the Ontario Medical Association and the Ministry of Health. This is totally outside the LHINs.

Oddly, while Family Health Teams remain outside the LHINs, Community Health Centres are in.

OPSEU has argued for years that the health system would be more efficient and cost-effective if hospital medical labs also conducted community-based work. Funding for community-based volumes would allow hospitals to increase staffing in their labs, expand scope of testing, and assist in the purchase of new equipment. For community doctors, it would result in faster turnaround of medical laboratory testing and give local physicians a direct lab contact in the community. In a comparison with some of the smallest hospital labs in the province, consultants RPO discovered that these labs were performing the same testing at two-thirds the cost of private labs. Once the hospital loses community-based work (there are only a handful left that still perform community-based testing) it is totally out of the jurisdiction of the LHINs. The North Simcoe Muskoka LHIN washed its hands of this issue when we raised it at the time Bracebridge and Huntsville hospital labs were losing their community volumes.

In Owen Sound the hospital is attempting to divest speech language therapy for preschoolers to the health unit. Once it is gone, the LHIN will no longer be able to address that service given health units are out of its jurisdiction. Who will monitor outcomes once that service is transferred? What happens if it turns out the hospital was the better host for the service, or perhaps another community-based agency? Who hold the health unit to account?

Within the LHIN jurisdiction, integrations are often about moving services around rather than facilitating strong links between health providers.

Integration shouldn’t just be about moving services from provider A to provider B and C.

As the Central East LHIN recently recognized, two addictions services don’t need to merge in order to cooperate on strategic goal setting. While it has been orthodoxy to move services out of hospital, the LHIN recognized the role of Lakeridge Health in maintaining one of these two addiction services.

The LHINs have consistently drawn a line between hospitals and community-based agencies, but hospitals do exist within communities. If a hospital is to provide community-based services, would it not by its very nature integrate well with other in-hospital services?

What role does prevention play? Not only is health promotion outside the jurisdiction of the LHINs, it is completely outside the Ministry of Health and Long Term Care.

We know, for example, that a more active population would dramatically reduce diabetes costs. One estimate suggests that if we were to bring diabetes down to the same level of northern European countries Canada could save $6 billion a year in health costs.

It’s true the LHINs do have contact with health providers outside their jurisdiction. But it has no ability to evaluate the quality of the work done by these providers, or whether the services they provide might be better delivered somewhere else. Nor does a friendly contact necessarily compel these providers to work more closely with hospitals, mental health agencies, home care or long term care homes.

The idea behind the LHINs was to make our health system just that – a system.

Some say five years is not long enough to get the job done. But what significant changes have the LHINs really made to date?

How long will it take to see a system emerge from the disparate entities that presently deliver public healthcare?

Are we expecting too much from bodies appointed to manage when what we really need are signs of bold leadership? Is this even possible within a LHIN model?

And where does the accountability lie? At present everything leads to the Minister of Health. Should it not also lead back to the communities?

Everybody has a shopping list of how we could do better. While our system is in the middle of the pack with regards to cost, there is no question that we could do better from an organizational point of view.

Our LHIN discussion series continues.