Democracy Gone Astray

Democracy, being a human construct, needs to be thought of as directionality rather than an object. As such, to understand it requires not so much a description of existing structures and/or other related phenomena but a declaration of intentionality.
This blog aims at creating labeled lists of published infringements of such intentionality, of points in time where democracy strays from its intended directionality. In addition to outright infringements, this blog also collects important contemporary information and/or discussions that impact our socio-political landscape.

All the posts here were published in the electronic media – main-stream as well as fringe, and maintain links to the original texts.

[NOTE: Due to changes I haven't caught on time in the blogging software, all of the 'Original Article' links were nullified between September 11, 2012 and December 11, 2012. My apologies.]

Friday, April 12, 2013

The CBC rates our hospitals — and the provinces panic

When the country’s public broadcaster starts ranking hospitals, you know something’s changed in Canadian political culture. This week, the CBC launched Rate My Hospital, an interactive tool which allows patients to rate 239 health institutions. The online tool is part of a special report on hospital care by the Fifth Estate, which will be broadcast this Friday, April 12.

The CBC may come late to this party, but its contribution is more than welcome. For decades, the Fraser Institute has released provincial annual rankings of medical wait times; this year the think tank also published a provincial cost-benefit comparison of health care.

The Montreal Economic Institute has sent experts abroad to compare Canada with its OECD counterparts. The Canadian Institute for Health Information (CIHI, which provided information the CBC used in part to determine its rankings) issued a flurry of data last year, and again last month, ranking 21 indicators of hospital performance.

Measurement is the key to improvement, for hospitals, schools, businesses — pretty much anything. And yet, when it comes to the sacred cow of health care, somehow those who dare to compare get pilloried for doing just that. Critics from the left routinely slam such rankings and their methodologies as somehow ‘un-Canadian’. They accuse those compiling such rankings of running some covert attempt to undermine the public nature of Canadian health care and install an American-style ‘two-tier’ system. The Fraser has been a frequent target; following its provincial report card in 2013, the government of Newfoundland and Labrador even issued a press release criticizing the fact that Institute did not take geography, age and chronic disease into account in its calculations.

In the case of the CBC, provinces went further — even before the report saw the light of day. According to a Freedom of Information request by the Fifth Estate, provincial health authorities got together to block the broadcaster’s access to hospital data. “On Dec. 19, 2012, CBC asked all provinces and territories to allow the Canadian Institute of Health Information (CIHI) — an organization that collects hospital and health-care data — to release information submitted by the hospitals … Some provinces denied the request, saying the data release could have privacy implications for small facilities and expressed concerns about comparing data between jurisdictions.”

Worse yet, said the CBC, “Nova Scotia’s deputy health minister, Kevin McNamara, initially approved the release of its hospital data with a letter to CIHI dated Jan. 18, but six days later revoked the approval … In those six days, freedom-of-information documents show that a federal Public Health Agency of Canada employee sent out an email to a network of health ministry officials and experts through the Pan-Canadian Public Health Network with a compiled list of all the provinces and territories’ planned responses to the CBC request.”

This is appalling. Canadians have a right to know how the system they fund is performing. The fact that it was the public broadcaster — which they also pay for — which was denied the data makes this highly ironic, and doubly indefensible.

Perhaps Canadian provinces could learn from another country which is often held up as a model for egalitarianism: Sweden. There, hospital rankings are routine, and have played an important role in reforming the country’s health care system since the 1990s. Rankings are produced by the Swedish National Board of Health and Welfare and the Swedish Association of Local Authorities and Regions. They are seen as a means of improving the system, and hospitals take pride in placing well.

I had the chance to witness this first-hand last year, on a study trip to Sweden, where I met with many health care professionals, including Marit Vaagen, CEO and founder of Sirona Health Solutions. According to Vaaren, rankings introduce the element of competition — though she guarded against using the term, which she said was sometimes negatively received. Instead, she spoke of ‘optimization’.

Call it what you will, but the process spurred hospitals to improve patient outcomes, and the public nature of the information meant that patients could make more informed choices about their care.

Optimization. There’s a buzzword that might be useful in Canada as well, where too many in the public sector seem allergic to crowning winners and losers. Thankfully, however, the CBC is not one of them.

So kudos to the broadcaster and its Fifth Estate team for shining the light on hospital performance — and encouraging excellence in an area of critical importance to all Canadians.

Original Article
Source: ipolitics.ca
Author: Tasha Kheiriddin

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