Prsentation PowerPoint

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The Quebec Health Care Performance Paradox
Wealthy and Underdeveloped Presentation
prepared for the International Symposium on
Advanced Issues in Health Care Performance
Measurement Toronto, November 20th,
2003 François Champagne, PhD Université de
Montréal
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The setting

• Second largest Canadian province
• In many ways, at the forefront of several health
  care
• organisation developments
• -Primary care organizations (CLSCs)
• -Integration of health, social services
• -Pharmacare
• -AÉTMIS (Quebec Agency for Health Services
• and Technology Assessment)
• -Regionalization and citizen participation

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Regional Health and Social Services Board

• In each region of Québec, the government has
  established a regional health and social services
  board to oversee the planning, organization and
  coordination of programs and services, and the
  allocation of resources. The boards are called
  upon to adapt health and social services to the
  needs and situations of the clienteles they
  serve. Each region is free to develop its own
  method of organization that takes into account
• the traits of residents
• geography
• its socio-economic and cultural characteristics
• the establishments found there.

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Regional Health and Social Services Board (contd)
Under their mandate, the regional boards seek to
better adapt the system to the specific needs of
the regions and give regional communities a
genuine voice and power. In particular, they
plan, organize, implement and assess the health
and social services programs drawn up by the
Minister. The boards must also ensure the
participation by area residents in the management
of the system, guarantee respect for users'
rights, and ascertain the efficiency of the
services offered within their territory.
Moreover, they allocate the budgets of health
care establishments and offer grants to community
agencies, while ensuring the economical,
efficient management of the human, physical and
financial resources made available to them.
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The Quebec Performance Measurement Paradox
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A Notable Wealth of Data

• Widely available data on
• Health care services utilization and production
• Human resources
• Institutional resources
• Financial resources and expenditures
• Health status

Notable population health focus because of
integration of public health units within health
care delivery system (since 1976)
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A Notable Wealth of Data

• We can technically link data banks
• Through individuals
• Hospitals
• Physicians
• Ambulatory (ER/iclsc)
• Quebec Health Survey
• Through territorial regions
• Census
• Hospital financial data
• Patient satisfaction
• Etc.
• We can also delineate system-wide episodes of
  care
• We can link with death and tumor registry
• We can control for case complexity/severity

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Several Disjointed Systems

• At the provincial level a disastrous attempt
• at a hospital report card (Fall 2002)
• Each hospital received a grade (from A to E) on
• 6 dimensions of patient satisfaction
• ER effectiveness
• Financial performance

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Several Disjointed Systems (contd)
Despite wealth of data and very large number of
central and regional technocrats working on
performance measurement, this scorecard was
contracted out to a consulting firm and had to be
done within 3 months. Extremely low validity
cannot be accidental? Accessibility Are you
satisfied with the ease of access to the hospital
(e.g. getting there, parking, entering)? ER
effectiveness The average length of stay on a
stretcher in the ER Financial
performance Budgetary surplus/deficit Already
disappeared from web site
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Several Disjointed Systems (contd)
Hospital Association SOFI Unstructured
analysis of discharge abstract system sold
to members on demand Explorateur CD The
discharge abstract data bank interrogative tool
sent free of charge to CEOs every year since
1996
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Several Disjointed Systems (contd)

• At the regional level
• 16/18 have no system
• Estrie has an interactive tableau de bord
  software
• for its internal management control function
  (suivi
• de gestion)
• Montreal had a complex tableau de bord for
• following-up on its 4-year reform plan
  (1998-2002)
• 6 dimensions, 21 groupings of indicators,
  several
• hundreds indicators 94 pages

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No Users

• Although widely available and accessible, data is
  not
• disseminated / does not propagate throughout
  the
• network
• Researchers use it / managers and policy-makers
• do not
• 13/18 regional councils told me they did not
  have
• indicators they used to monitor the
  performance
• of the system or of the organizations in their
  region

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No Conceptual Model of Performance

• Despite the facts that
• Quebec has a long tradition of health services
• research on health care organization issues,
• including performance
• There has been thorough diffusion and wide-spread
• admiration and envy of Ontarios Hospital
  Report
• There is no current discussion or proposal to
  develop
• or adopt a comprehensive model of health care
• organization performance

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Why is Health Care Performance Measurement Underde
veloped in Quebec
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Why is Health Care Performance Measurement Underde
veloped in Quebec (contd)
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Ordonnancement des sous-dimensions de
Parsons Résultats canadiens
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Why is Health Care Performance Measurement Underde
veloped in Quebec (contd)
But accountability (reddition de comptes) is
operationalized very defensively, and limited to
volume of services provided and Absence of (or
tolerable) financial deficit.
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Possible Explanations
Contracts between central and regional
councils and between regional councils and
institutions

• Performance contracts inevitably restrict genuine
• interest in an expanded view of performance
• Tunnel vision concentration on specific areas
• Myopia concentration on short term issues

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Possible Explanations (contd)
For these, very effective performance
measurement system

• Two on-going issues
• ER stretchers
• Waiting lists

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Possible Explanations (contd)
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Possible Explanations (contd)
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Possible Explanation (contd)
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Promising experiences
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