Came across an interesting little blurb reporting on a survey. In the the survey conducted in the UK, nearly 80% of patients want â€œmore information on how their NHS hospital performs available on the internetâ€. Nothing too shocking, right?
My first thought was to question whether or not this matters. From my personal experience working in the health care system, Iâ€™ve heard that some patients donâ€™t really want to know. They may want to know if their providers are doing a great job (i.e., excellent or above average), but if access to physicians or services is very limited, patients (at least anecdotally) donâ€™t want to know â€“ care, however â€œbelow averageâ€ it may be, is still better than no care at all. As I continued to read the report, I thought this finding was particularly interesting:
Of those surveyed, 38% said they would use it to challenge or seek reassurance from their doctor, whilst only a minority (around 16%) would use it to choose or change their provider
Aha â€“ just as I thought. People just want to know they arenâ€™t receiving sub-standard care.
Just some other thoughts that I have about making comparative performance data available to the public:
There needs to be some better efforts in helping the public understand and make sense of the data thatâ€™s available. In Ontario, hospital performance is reported annually (OHA/Ministry of Health Hospital Report). I helped compile some data for a hospital a few years back for the initial report and I donâ€™t think that the actual reporting and knowledge translation has gotten much better. Leafing through some of these reports is a challenge as you are just bombarded with numbers, tables, and figures.
A senior executive that I used to work for once told me that comparative performance data is mostly for marketing purposes (both internal and external). If you get excellent results, you promote the heck out of it and market yourself as a leader, hopefully being rewarded with either extra funding from the government or attracting more donations to your foundation. If your results arenâ€™t so great (or â€œbelow averageâ€), then you use it to kick-start some new internal â€œimprovementâ€ program while asking for more $$. â€œWell, we didnâ€™t perform as well as we could because of financial constraints and challengesâ€¦â€.
Now, what does â€œbelow averageâ€ or â€œabove averageâ€ really mean? I suppose from research perspective, itâ€™s like asking for the difference between statistical significance and clinical significance. When I take a look at some figures (Example: 2006 Acute Care report), Iâ€™d be hard-pressed to tell you what the difference on some of these tables. On page 50 looking at the table reporting adverse events for community hospitals, we see that Rouge Valley Hospital (Scarborough) was identified as â€œabove averageâ€ while Sault Area Hospital (Sault Ste. Mary) was only â€œaverageâ€ for the rate of Nurse Sensitive Medical Adverse Events. When we look at the actual numbers, Rouge Valley is 0.3 while the Sault Area hospital is 0.4 (note, I couldnâ€™t even find what the denominator is (I think itâ€™s a percentage, but I canâ€™t be sure). In the case of a below average, Ross Memorial Hospital is 2.6 which seems quite a bit off from the other two I mentioned. But in reality, what does this mean to a patient?
Hey, I donâ€™t want to give the wrong impression. I think itâ€™s great that this type of information is becoming easier to access. I think itâ€™s great that hospital executives are starting to examine performance (which I hope is a good proxy for the hard to define term â€œquality of careâ€). I think itâ€™s great that patients and the public are starting to become more interested in the type and quality of care they are receiving. My question is â€œwhat is the next stepâ€? Patients asked for performance data. The health system has responded. What is the response? Do we ask for more? Do we demand changes? Do we just say â€œthanksâ€ and go on our way because my health provider is doing okay? Was this a make-work exercise if we donâ€™t act on it? Where do we go from here?
I donâ€™t have the answers but Iâ€™m hoping that as a group, we can figure something out.