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System Performance

Guide to Hospital Patient Safety Reporting

Health Quality Ontario currently publicly reports on 10 hospital care quality indicators at the provincial level and at the individual hospital level.

In May 2008, the Ontario Ministry of Health and Long-Term Care introduced public reporting on nine quality indicators as part of a comprehensive plan to improve transparency and accountability related to hospital care in Ontario. All hospitals were required to publicly report on mortality rates, health care-associated infections, such as central line infections and ventilator-associated pneumonia, prevention of surgical site infections, and hand hygiene compliance among hospital workers (before patient contact and after patient contact).

A tenth quality indicator was added in January 2010 when Ontario hospitals implemented the Surgical Safety Checklist. Developed by the Canadian Patient Safety Institute, it lists 26 of the most common tasks that operating room teams carry out. The checklist can be modified to meet the needs of individual hospitals. Its use has been shown to reduce rates of death and complications among patients. This data is available for information purposes only. All of our data comes from external data providers, which may occasionally make adjustments to the data published here. We ensure the information we report is of the highest quality, and protects privacy and confidentiality. We do not access any data that identifies personal information.

Data sources

Most of the hospital care quality indicator results on this website are based on data collected by the Ministry of Health and Long-Term Care, which is reported to them by all hospitals in Ontario.

The Hospital Standardized Mortality Ratio is calculated by the Canadian Institute for Health Information, and the results are posted annually on their website.

Risk adjustment

When interpreting and comparing the results of quality indicators in different populations, regions or over time, it is important to account for the underlying differences in the populations being compared. We call this “risk adjustment” and it allows us to make a fair comparison across groups and to distinguish variation that is due to differences in practice. Results can be adjusted to account for differences in the age, sex, or other characteristics of people within a certain population. Characteristics such as age can significantly affect people’s health status and their need for health services. By accounting for differences in age, health status and other factors, data can be risk-adjusted so that quality indicators are comparable across the province and over time.

Risk adjustment factors are applied to modify the mortality quality indicator to reflect the multiple differences in patient populations across hospitals in the province. The Hospital Standardized Mortality Ratio allows for fairer comparisons to be made across hospitals. It compares actual number of deaths in hospitals with the expected number of deaths, giving hospitals a way to identify priority areas for their quality improvement efforts.

Results are adjusted relative to a standard reference population. The risk adjustment factors include patient characteristics such as age, sex, length of hospital stay, and health status.

To learn more about care in Ontario hospitals, visit:

If you have a question about system performance and reporting on the performance of Ontario’s health system, please email us at

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