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Dr. Joshua Tepper

How Has Public Reporting Made a Difference Ten Years On?

The history of public reporting in Ontario is a short one. And its significance comes to a point as Health Quality Ontario publishes its 10th yearly edition of the performance of our health care system.

Measuring Up 2016 is filled with data on primary care, palliative care, wait times, hospital care, home care, health spending – and many more aspects of the health system. It gives a high-level overview of the health of Ontarians and the performance of our health care system. Here, we can see the big picture.

What this latest report shows is that we have often made improvements where we’ve used data to guide our collective efforts.

This may seem like a simple statement – but in reality, it’s involved not just reports but changes in policy and in public health interventions. It’s involved determining indicators for setting improvement targets, and for having a way of identifying outliers. It’s involved engaging meaningfully with patients and providers. It’s involved giving physicians data so that they can compare their habits with those of their peers. It’s involved collaborative partnerships across the system so that quality improvement can, in fact, be realized. We’ve seen it realized in decreased smoking rates, and in improvements in cancer and cardiac care.

What this latest report shows is the ability of public reporting working in synergy with other efforts to catalyze people into action. And that’s no small thing. When the U.S. Institute of Medicine published its groundbreaking report in 2001, Crossing the Quality Chasm: A New Health System for the 21st Century, it offered a new perspective on the purpose and aims of a health care system – one with quality improvement at the core. It would be another 10 years before a systematic review could offer this conclusion: That public reporting of performance data leads to improvement. This review was commissioned by the Agency for Healthcare Research and Quality, a government agency in the United States, and included 198 separate studies from eight countries. In looking at both the benefits and harms, evidence shows that individual clinicians and organizations respond to performance measurement and public reporting by making positive changes to their behaviours.

Measuring Up 2016 validates this finding as it provides context for a part of life that impacts us all. It reminds us that a report alone will not lead to improvement. It helps us understand the limits of individual efforts, and shows us where to work in partnership. It helps us better understand the lives of the wealthy in relation to the poor, the urban dweller in relation to the rural. And in this way, it can’t help but shine a light on areas in need. Areas such as palliative care and mental health and addictions care are clearly in need of attention; focusing collectively on reducing disparities between certain regions or groups of people should, too, be a system priority. But in showing us that we have moved forward, it also shows us that we can.

Public reporting is an essential part of health care improvement. This, we know.


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