Chapter 4: Reporting progress throughout the system

Hallway health care is a problem that presents itself in hospital hallways; however, it is really a symptom of system-wide challenges such as the availability of services in the community and low integration across care settings. The government should create a health system scorecard that measures the performance of Ontario Health Teams, aligned with the objectives of the Quadruple Aim, to track progress towards ending hallway health care in Ontario as well as overall system improvement.

It is important to keep a strong focus on transparency and accountability throughout the process of modernizing Ontario’s health care system. As the government works towards shifting the focus, planning and delivery of health care in the province it may take time to see meaningful change across each of these indicators. And that’s understandable, because with an appropriate set of indicators that are tracked and publicly reported, it will be possible to understand where things are working well and what may need additional attention.

The scorecard should report on access and availability of services across the health care system. In the short term, it should report on indicators that are currently available, and over time new indicators can be added where there are gaps in the government’s current data collection and reporting. Overall, the system should shift towards reporting on a small set of valuable indicators that can be used as a management tool to improve quality and value throughout the system. The indicators selected for a system-wide scorecard should cascade through the system and inform reporting and accountability of Ontario Health, Ontario Health Teams and other health service providers.

Short-term reporting priorities  

The following list is a possible set of indicators that the government could use to track progress on improving outcomes throughout the system.

Hallway Health Care

This is the top-line indicator for tracking progress towards improving the system and ending hallway health care, and it captures the number of patients waiting for a hospital bed in an unconventional or unexpected location. It is measured by counting the number of people admitted to a hospital but are waiting overnight in an unconventional space or emergency department stretcher for a bed to become available.  In May 2019, up to 1,147 people in Ontario were in a hospital hallway waiting for a bed.

Access to Primary Care

Patients should be able to seek care from their primary care provider.  Measuring primary care access reflects a patient’s ability to get timely health care services in the community, preventing them having to use the hospital for non-urgent care needs.

Mental Health and Addictions in Emergency Department

When people who require mental health and/or addictions services can’t access the care and support they need in the community, they often end up in hospital emergency departments. The government should measure how frequently patients with mental health and addictions issues are accessing emergency departments for non-urgent concerns.

There is also a gap in the government’s health care data about mental health and addictions services and patient outcomes. The government should work with the new Mental Health and Addictions Centre of Excellence in the Ontario Health agency to collect common data and report on indicators to demonstrate access to timely, effective and high-quality mental health and addictions services in the community. 

Emergency Department Wait Times

When emergencies happen, patients don’t want to have to wait a long time to access care. As the health care system provides patients with more options to access care in the community, including during the evening and weekends, fewer people should come to the emergency department seeking care.

Hospital Readmission Rate

When a patient is discharged from the hospital, they should be able to access health services in the community to keep them well. This measure would demonstrate where community supports are successful, and where there’s room for improvement.

Alternate Level of Care (ALC)

ALC is a measure of the proportion of patients who occupy a hospital bed but do not require the intensity of services provided there. This indicator identifies where there are opportunities to provide more appropriate care in more appropriate settings, often at a lower cost and with better outcomes for patients.

Long-Term Care and Home Care Wait Times

The median wait time for long-term care varies across the province. As new long-term care bed capacity is added and if other care models are introduced in Ontario, the time spent waiting for long-term care should decrease. Similarly, the time patients wait for home care services to become available differs depending on where they are. The government should monitor and reduce these wait times.

Patient Experience, Including Access to Digital Health

The government captures some information about patient experience and this information can be expanded to include questions about access to digital health records and availability of virtual care visits. This would demonstrate how digital innovation in Ontario’s health care system is spreading across the province and identify areas of success and areas for further improvement.

Areas for future development

As the government continues to modernize the health care system, it should also refine its approach to indicator development and reporting. The data that is available today is not necessarily the right set of information to support a shift in health care delivery or encourage future transformation across the system. Going forward, the government should move towards developing a more direct understanding of patient and provider experience, as well as value for money. In addition to ensuring patients are at the centre of care, these indicators will help ensure patients are being supported with the appropriate use of the system. 

Patient and Provider Experience

The government should work with patients and providers to co-develop direct measures that accurately capture their experience with the health care system. These measures should also capture the caregiver experience and include a focus on transitions in care.

Value for Money

In keeping with the objectives of the Quadruple Aim, the government should report not just on spending in health care but develop indicators that measure the value those health care dollars provide.  Indicators that measure patient and population health outcomes against the cost of delivering care will demonstrate where the system is achieving greater efficiency and achieving positive patient outcomes.

This suggested list of indicators and reporting priorities will assist the government in tracking progress towards an improved health care system and ending the problem of hallway health care. As the system modernizes, it will be important to know which indicators currently in use are no longer valuable and which ones should be tracked to demonstrate progress against the system’s goals. Overall, the system should shift towards reporting on a small set of valuable indicators that can be used as a management tool to improve quality and value throughout the system. Standardized patient and provider experience data will also help the system know if it is truly delivering patient-centred, high-quality, integrated care. Rather than focus on the performance of individual care settings, the system should be evaluated on its ability to deliver quality care across the full continuum of services, and any future investments can be allocated as required to achieve this clear and measurable set of goals.