How are Ontario hospitals measuring up?

Provincial health care advisor Health Quality Ontario recently released a comprehensive report on Ontario’s health system

Health Quality Ontario (HQO) recently released Measuring Up, its yearly report on how the province’s health system is performing.

Based on the Common Quality Agenda (created by HQO in consultation with health partners and system leaders), the report focuses on a wealth of information across 40 indicators, spanning all health sectors as well as integration of care. Although the report does not try to cover every aspect of care in the system, it looks at both health and health care from many perspectives – from the proportion of Ontarians who wait too long for some types of surgery, to the proportion of Ontarians who smoke

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Measuring Up’s section on hospitals highlights many examples of excellence as well as important opportunities for improvement. The data in the report is also enriched by the voices of many patients, providers and caregivers, many of whom provide a valuable perspective on individual care within hospital settings.

The report identifies timely access as an area where hospital care has improved, but still needs work. More patients are receiving urgent cancer surgeries and cardiac procedures within the recommended time frames (ministry-set provincial targets). In fact, the percentage of urgent coronary artery bypass graft surgeries completed within the target wait time improved to 87 percent (up from 74 percent) in six years. And the percentage of urgent cancer surgeries completed within the target time improved to 73 percent (up from 54 percent) in five years, even as the number of cancer surgeries performed in Ontario increased by 13 percent during a similar time period. Meanwhile, the time a patient spends waiting to see a specialist prior to a procedure remains outside of provincial targets.

As identified in Measuring Up, the percentage of elective hip replacements completed within the target time frame (182 days, or six months) has remained stable at 86 percent over the past five years. However the difficulty with measuring this wait time (which is calculated from the time a patient and surgeon decide to go ahead with the surgery to the time the actual procedure is completed) is that it does not include the entire time a patient spends waiting for care.

While some patients may experience difficulties in accessing care in certain parts of the health system, many are pleased with the quality of their care once they receive it. Patient satisfaction surveys show that Ontarians are generally happy with the hospital care they receive. Approximately three-quarters of Ontarians surveyed would recommend the hospital they received care.

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In addition, successful care in the hospital often relies on other parts of the system working effectively with the acute care sector. There are significant opportunities to improve integration and coordination. For example, the report shows that one in seven hospital beds designated for acute care is actually used by a patient who is well enough to receive care in another setting. And more than half of patients treated in hospital for conditions requiring follow-up still don’t see a doctor within seven days of discharge. These instances can create bottlenecks and return visits to the hospital, and they can have lasting impacts on the outcomes for patients.

The report also shows that patients requiring emergency department care with low-acuity needs are discharged more quickly (averaging a stay of 4.1 hours, an improvement from 4.6 hours in 2009/10), yet those with high-acuity needs often wait beyond the target time frame of eight hours. To give these average stay numbers some context, it is worth noting that there were about 5.3 million visits to Ontario’s emergency departments this year, up from about 4.9 million visits in 2009/10.

The report also brings to light some important regional variation across health sectors. While life expectancy in Ontario is the longest it has ever been at 81.5 years (more than 20 years longer than it was a century ago), there is a five-year difference in life expectancy between the healthiest region of the province and the north. Ontarians in the north also have higher rates of obesity and smoking, and twice the rate of premature avoidable death than those in other areas of the province.

Measuring Up is about encouraging quality improvement, while also celebrating success and taking pride in what is working. By sharing where hospitals and other sectors can improve – such as timely access, follow-up care, and reducing variation – HQO’s Measuring Up can encourage constructive conversations on quality and quality improvement. And that helps our health system get stronger and stay healthier. A high performing health system performs at its best when providers, system partners and patients all work together to continually provide better quality.