March/April 2001 Table of Contents
In this Article
By Claudia von Zweck, CAOT Executive Director
Our ability as health professionals and health consumers to ensure our governments remain accountable for the promises made in regards to the vision, principles and goals of our health system depends on our becoming good information consumers.
This is good news for occupational therapists and our clients. For many years, CAOT has lobbied for long term commitments for federal financing for our publicly-funded health system. CAOT has advocated the need for reinvestment of federal health dollars in a broad continuum of health services that includes health promotion and prevention programs and home and community care initiatives. Occupational therapy can play a valuable and vital role in the new vision for Canada's publicly-funded health system. Occupational therapy can provide solutions for many of the ills of our current "sick care" health services by proactively assisting Canadians to achieve the right combination of skills, abilities and supportive environments for a more healthy and satisfying life.
In September of 2000, the federal, provincial and territorial governments jointly articulated a commitment to strengthen and rebuild Canada's publicly-funded health system. In the Communique on Health (2000), the Canadian First Ministers outlined their vision, goals and principles for publicly-funded health services. These services will provide greater integration of hospital, primary, home and community care, create more emphasis on health protection and promotion, and ensure more effective information sharing across and within jurisdictions. With the promise of this collaborative approach to restructuring our health system, the federal government will incrementally increase health funding transfers over the next five years. But how can we ensure the recently announced increased federal spending on health will indeed result in the vision for health services outlined in the September 2000 Communique?
Accountable to whom?
As part of the consensus agreement articulated in the Communique on Health,
the federal/provincial/ territorial governments will develop a national
set of performance indicators for our health system. The primary purpose
of the performance indicators is not to ensure our governments are accountable
to one another - but to the public that is served by the health system.
It is therefore imperative that we become astute in understanding what
type of performance indicator information is collected, the results that
are attained and the implications of these results for the health needs
of Canadians. We must also help our clients to understand this data so
that they too can have an effective voice in ensuring the right decisions
are made for our health system.
What are performance indicators?
Performance indicators are objective measures that provide numerical ratings
or comparative statistics on attributes describing worth or quality. To
be most effective, performance indicators are goal, system and outcome
oriented, simple to administer and provide meaningful benchmarking information
on areas within our health system that can be changed (Brossart and Thompson,
2000). The federal/provincial/territorial governments plan to develop
performance indicators to measure health status, health outcomes and quality
of service.
Health status indicators
Example: The number of people who report excellent health on the National Health Survey.
Health outcome indicators
Include measures such as results of quality of life measures and caregiver burden surveys.
Quality of services indicators
Include measures such as the wait times for emergency services, results of client satisfaction surveys.
The development and use of health performance measures is not a new or recent trend. Much work on the development of performance measures has already been undertaken in Canada and internationally in countries such as Great Britain and the United States. In recent years, the Canadian media has shown an increasing interest in this information. Macleans magazine in Canada now regularly publishes health reports - compilations of health performance indicator data collected by sources such as the Canadian Institute of Health Information.
How should the data be used?
It is integral that this data is appropriately used and interpreted in
order that it be successful to drive positive changes in our health service
delivery. The distinction between the information provided by the different
types of performance indicators is important to note. Overall health as
measured by health status performance indicators is determined by a wide
range of factors including income level, housing, education, literacy
and early childhood development. Many of these factors fall outside the
scope and usual responsibility of the health care system, and therefore
health status performance should not be seen only as a reflection of the
performance of the health system.
It is clear that a superficial review of performance measure data can lead to incorrect assumptions about the achievements or problems of our publicly-funded health services. This can lead to the implementation of simplistic or inadequate remedies for the real problems within our health system. As an example, a common complaint heard in today's health environment is overcrowding in hospital emergency departments. While it is tempting to jump to a conclusion and implement "quick fix" solutions to alleviate public concern for the need to take action on the issue - it is often only through further research and analysis that we may be able to identify the true causes of the problem.
We can ask ourselves:
Why is my grandmother lying in a stretcher in the Emergency Room hallway?
Because there are no beds available on the inpatient wards.
Why are there no beds available?
Because there are many people using the beds on the wards who cannot return home and do not have anywhere to go.
Why can't they return home?
Because it is not safe for them to live at home.
Why is it unsafe for them to live at home?
Because they have not had the opportunity to build the skills and arrange the support they need to live in their own home.
As this simple example demonstrates, several layers of questioning may be necessary to discover the truly complex set of factors that lead to a health system problem. Through this analysis we often may discover that occupational therapy can offer a key solution to the true issues that lead to the end result. In the scenerio above, occupational therapy interventions, provided to clients on the hospital ward, could assist their return to community living.
Occupational therapy would benefit not only the clients, their families and community caregivers, but also would contribute to the effective use of our hospital beds, and would lessen the stress on our emergency rooms.
Conclusion
Health indicator performance data, properly used, can effectively lead
the restructuring of our health system. Canadians have been given the
obligation to become good consumers of this information. We need to take
this responsibility to become aware and informed about this information
and to share our knowledge with others. This involves effectively communicating
and advocating how we, as occupational therapists, contribute to Canadians'
health service solutions.
Brossart, B., Thompson, L. (2000). Making the grade? Report cards and performance indicators are key tools for improving health system performance. A Closer Look: The Publication of the Health Services Utilization and Research Commission, Fall, 1-2.
For more information on the Communiqué on Health...
von Zweck, C. & Clark Green, M. (2000). Opening doors to opportunity: Increasing access to occupational therapy services. Occupational Therapy Now, 6, 5-8.
Access this at:
http://www.caot.ca/otnow/nov00-eng/nov00-politics.cfm,
or
http://www.caot.ca/default.cfm?ChangeID=207&pageID=207.
March/April 2001 Table of Contents
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