Hardly anything more open to scrutiny than a hospital

TheStar.com – comment – Hardly anything more open to scrutiny than a hospital: Ombudsman’s demand to oversee Ontario’s hospitals is an unnecessary duplication
June 23, 2008. Tom Closson

Frank and open debate and talking about new and different ideas is central to improving performance and providing safer, higher-quality care to the patients that our public health-care system exists to serve.

In his annual report, Ontario Ombudsman André Marin recently levelled a series of incendiary criticisms at hospitals in order to make the case that the ombudsman should have the authority to deal with complaints in the health-care sector.

Debating this important question must be based on facts, evidence and experience, and in this instance it simply isn’t fair or accurate for the ombudsman to call Ontario last in Canada in hospital accountability just because hospitals fall outside the jurisdiction of his office. Marin may be surprised to learn that Ontario’s hospitals actually operate in one of the most demanding health- care accountability systems in all of Canada.

Virtually every aspect of their performance is regularly subject to external, independent scrutiny.

Ontario is the only province in Canada to publish an independent report card on hospital performance. Hospital Report is widely acknowledged by experts as the North American “gold standard” in the area of evaluating hospital performance.

Hospitals’ internal operations are deeply scrutinized by an arm’s-length national body called Accreditation Canada. Virtually every hospital in Ontario undergoes an exhaustive audit of its activities – everything from administrative practices to patient safety and care standards – in order to receive a seal of approval from this independent and demanding health-care assessor. Health-care providers, in turn, are also regulated by independent colleges armed with the authority to investigate patient concerns about the conduct or actions of an individual health-care professional.

Hospitals are accountable to their Local Health Integration Network (LHINs) for meeting legally binding performance requirements via their Service Accountability Agreement. These agreements are public documents and spell out exactly what a hospital is expected to do, including measures of quality of care, in return for the tax dollars provided to operate them.

Hospitals are also required to publicly report on their overall performance in reducing wait times in areas such as cancer, cardiac, hip and knee replacements, MRI/CT scanning and cataract surgery. Public reporting is also being expanded to include pediatrics, general surgery and emergency departments. And beyond public reporting, there are financial consequences for a hospital not meeting its targets. Marin may be interested to know that the Ontario government and its hospitals and physicians were recently singled out by the Canadian Wait Times Alliance for exceptional national performance in this area.

The auditor general of Ontario has possessed the independent authority to conduct value-for-money audits of Ontario’s hospitals for several years.

Hospital representatives now appear before the Legislature’s Standing Committee on Public Accounts to comment on the auditor’s findings and answer questions from elected officials about the results. Giving the ombudsman a role in this area would actually duplicate efforts and result in a waste of the taxpayers’ resources.

And ultimately, under the Public Hospitals Act, the government has the authority to appoint an inspector, investigator or supervisor to conduct an independent third-party review, if there is a serious issue related to hospital performance requiring impartial and expert scrutiny.

Marin alleges that elected officials have “refused” to extend the ombudsman’s authority to hospitals because they are “trying to contain perhaps an embarrassing situation.” Experience demonstrates that the opposite is actually true.

A year ago, for example, Ontario announced that mandatory disclosure to patients of critical adverse events – significant mistakes and errors in hospitals – would be required through regulation. It was the Ontario Hospital Association that proactively and publicly first recommended this major policy change in November 2006.

Over the past year, hospitals and the government have been working to design the most comprehensive patient safety and quality reporting program in Canada. Under the leadership of external expert Dr. Michael Baker, beginning this September, patients will have access to information on C. difficile rates on a hospital-by-hospital basis. This is on top of public reporting of Hospital Standardized Mortality Ratios by the Canadian Institute for Health Information.

Can Ontario’s hospitals do even better in their performance? The answer without question is yes. Even one avoidable injury, illness or death is one too many. The drive to improve efficiency, access, quality and safety is an unstoppable force within Ontario’s health-care system.

Will expanding the authority of the ombudsman contribute to improving results?

With all due respect to the ombudsman and his “campaign” to increase his power, the Ontario Hospital Association believes that the facts suggest the contrary. It would duplicate efforts, expand bureaucracy and use vital tax dollars that should be devoted to front-line patient care.

Tom Closson is president and CEO of the Ontario Hospital Association.

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