For most of us, measuring health care quality is a subjective experience. When a brush with serious illness or an emergency happens, we are very thankful for a responsive system that saves lives or resolves serious problems. And if we are treated poorly or have a frustrating experience – well – we can be very hard markers!
But measuring all the various facets of the health care system is complicated.
What matters most?
- Is it hospital emergency wait times?
- Overall population health?
- The quality of the experience for major user groups of health care?
- What about accessibility in rural communities?
- Or responsiveness to crises like opioid abuse?
- Should we be measuring the mix of community, preventive and hospital services?
Well, of course this is trick question! The answer is all of the above and many more dimensions of the health system.
This post is a companion to an earlier post on health care costs. As we run up to the next election we know two things for certain. First, each party must address health care costs. Secondly, we know nobody is in favor of lower quality!
The Alberta government has some key metrics that they use as big picture indicators of a well-functioning system.
- To assess population health, they focus on the percent of seniors that get the flu shot annually. Their target is about two thirds of seniors and 90% of those in care facilities.
- They measure the percent of the population served by Primary Care Networks (PCN) (target 80%). For the uninitiated, a PCN is a somewhat unique Alberta team-based approach that connects doctors, nurses and other professionals to deliver integrated services.
- The measure of a robust and stable health care system has a performance measure of a 3% budget growth rate.
Alberta Health Services, the mail delivery agent for government, has more than 108,000 employees. They operate 650 facilities (hospitals, clinics, continuing care facilities, cancer centres, and others). They have 8,500 acute care beds, nearly 24,000 long term care and supportive living beds, and 2500 beds for additions and mental health. They also manage a range of community based services.
They measure the system’s performance in a number of areas:
- Client satisfaction rating of 80% for adults and 78% for continuing care residents
- For safety, they measure infections acquired in hospital, and percentage of times staff wash their hands before treating a patient (90%)
- Measures of accessibility include wait times in emergency wards and how long patients stay in emergency wards before being transferred to other wards or discharged. Alberta ranking on these measures are third or fourth in Canada
- AHS has a variety of effectiveness measures, for example, early detection of cancer and mental health re-admissions.
- Their efficiency measures leave something to be desired – the key measure seems to be accuracy of the predicted length of a hospital stay.
Quality health care delivery is complicated. Here is a graphic that AHS uses to illustrate the system. See if you can make sense of it!
The bottom line is Alberta’s costs are out of line with the rest of Canada. And while our system can rightly boast of it, quality it isn’t head and shoulders above what you might find in jurisdictions that have lower per capita costs.
As we enter election season, Severely Normal Albertans should be cautious about buying those simple slogans. And beware, there is always a temptation to change the organization. We already have the tee-shirts that read: “we should amalgamate for efficiency” and “No, we should decentralize for responsiveness”.