Insights
Before We Arbitrarily Select the Number of Healthcare Metrics We Monitor, We Would Be Wise to Engage Those Responsible for Delivering and Receiving Care
In December, 2024, the Canadian Institute for Health Information (CIHI) will release their annual Your Heath System (YHS) report on hospital performance at this link: www.yourhealthsystem.cihi.ca. In releasing 20 key performance indicators (KPIs) or metrics that compare hospital systems across the country, CIHI is allowing the public to view a portion of the health system’s performance. It is an important exercise. The release of these types of reports allows for accountability and benchmarking that should lead to quality improvement.
Publicly reporting on performance is arguably even more important now, more than ever, given our emergence from the pandemic that has led to increased patient complexity and health human resource shortages. In their November 2023 Toronto Star article, Adalsteinn Brown from the University of Toronto and Kevin Smith from the University Health Network argued as much, calling for a return to a more robust hospital report card system. Brown and Smith are correct. Canada needs to return to more regular performance reporting on our health system. And while most system leaders might agree that CIHI’s 20 publicly released metrics are likely too few, we must be careful in how many metrics we monitor.
In Ontario, CIHI is not the only government agency that requires reporting on metrics. In 2019, the Ontario Hospital Association and Health Quality Ontario reported that Ontario hospitals were required to monitor over 300 quality metrics mandated by a variety of government agencies including, but not limited to, the Ontario Ministry of Health and what is now Ontario Health. Canada is not alone in this phenomenon, often known as metric madness. In the US, it has been estimated that the National Quality Forum requires reporting on over 500 quality metrics. The United Kingdom and Australia health systems face similar challenges.
The unintended result of all these mandated metrics’ reporting has been a paralysis in large-scale improvement. This is due in part to front-line managers never having time to make a real impact on any metric, given we keep adding to the list of metrics they must monitor. It may also be because while the panels responsible for metric selection include clinical and data experts, they often do not engage the front-line physicians, nurses, managers and patients expected to use metrics to improve care.
To tackle this challenge, sector leaders need to consider the findings of change management, engagement and motivation research, in addition to measurement research. Researchers Ginsburg, Damschroder et al., and Langley and Denis all have concluded that it doesn’t matter how scientifically sound an idea, a piece of evidence or metric may be. Unless you build a culture of participation by engaging end-users on metrics they care about, results may remain stagnant. These findings match the goal setting and motivation theory that states if people contribute and see themselves in a proposed solution, they will be motivated to make the change the proposal articulates.
So, as we embrace the public’s desire for more data reporting on our broader health system, let us not assume which metrics are important to those whose daily job it is to make operational improvement. As system leaders, let us engage those closest to the front line of care – physicians, nurses, clinical managers and patients – on which metrics matter to them, and how we can support them in making the changes they see necessary for a better health system.
About the Author(s)
Michael Heenan, PhD, is the president of St. Joseph’s Healthcare Hamilton and an assistant professor within McMaster University’s Faculty of Health Sciences. Michael completed his PhD in 2023 in which his thesis studied how health service providers select metrics and how those processes may motivate managers to make change. He can be contacted by email at heenami@mcmaster.caComments
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