In one Atlantic province, the health care system receives grades as if it were in school. For three years, the New Brunswick Health Council (NBHC) has produced a Health System Report Card that shows where improvements are needed, where things are getting better, and where they may be slipping.
Michelina Mancuso, the NBHC’s Executive Director of Performance Measurement, said the report card aims to help understand how to help deliver the best outcomes, the best quality care, at a reasonable cost. “We want to get a clearer picture of the citizens’ care experience in New Brunswick,” she said.
The 2012 report card grades a balanced list of health care indicators to arrive at overall marks for accessibility (C), appropriateness (C), effectiveness (C), efficiency (C), safety (A) and equity (C). It is changing perspectives in the areas of primary, acute and specialty care. While citizens know that their care experience is being assessed, health care decision-makers and physicians can see the forest for the trees—how various pieces of the system fit together. And health officials can better understand how to allocate resources.
Mancuso said they want to lead the province toward a sustainable health care system. CIHI is a key contributor to this mission.
Three years back, the NBHC used a swath of CIHI’s indicators (enabling provincial comparisons) as a base. From there, it added more indicators, many also from CIHI, such as readmission rates and cost per weighted case. As Mancuso puts it, “With 50% of our indicators, CIHI is the foundation of the report card.”
She said that CIHI’s involvement, which includes support and guidance, gave legitimacy to the NBHC’s approach. This sparked a trusting relationship with the province’s medical professionals. It also meant that the NBHC had access to the best data available.
The NBHC’s list of indicators has now evolved from 48 to 111 to 137. The organization is converting data into knowledge, particularly among the major indicators vital to the system such as access to care, whose picture can now be better understood. The report card revealed that access to family doctors is rising yet wait times for appointments remain a burden. This, in turn, affects inefficiencies elsewhere in the health care system.
Report Card in Action
In its first year, the report card made a splash. It issued a D grade to New Brunswick’s primary health care sector, while discovering that people headed to emergency more often. This emerged as an issue with the system.
Coincidentally, the provincial government aimed to reform the primary sector the following year. NBHC data wound up being used as the backdrop of a summit on that sector, Mancuso said. Today, the NBHC sits on a provincial Primary Care Operations Committee.
In this year’s report card, the NBHC is most proud of its safety dimension. Of its 20 safety indicators, many are from CIHI; others are based on data from patient responses to care experience surveys. The NBHC also added more indicators from CIHI’s Canadian Hospital Reporting Project, which yielded further insight into gaps in the system.
The safety dimension was the only one to receive an A grade. Mancuso said it’s possible that a recent focus on safety initiatives by regional health authorities, combined with measuring and monitoring outcomes, provided an opportunity for success.
There was a key new finding this year: the province succeeds more at avoiding mortality through treatment rather than through prevention. The indicators show a need to focus on primary health care (D grade) to reduce demand for hospital services. And, combined with CIHI’s Health Indicators 2012 (which includes three new indicators on avoidable mortality), the NBHC can tell the story that will resonate in the community. Namely: “Once a person is sick, we do well in treating him/her, but what are we doing to prevent him/her from getting sick in the first place?”
This is key not only for the report card’s impact but the impact of all CIHI’s reports. Indicators are relevant when they are linked to a greater purpose. How can they be used to make health care better? How do they affect patient outcomes?
The forest for the trees is a panoramic viewpoint. And that perspective will help drive the NBHC’s ultimate goal of seeing New Brunswick become a straight-A student.