How our health care system is doing

In health care, we have traditionally gauged system performance relative to specific targets or benchmarks. On its yourhealthsystem.ca website, the Canadian Institute for Health Information (CIHI) reports on a wide range of indicators related to access, quality of care, health system spending, health promotion and disease prevention, and health outcomes. From this information, we know Saskatchewan has one of the shortest wait times for hip or knee replacement surgery in Canada, but among the highest rates for 30-day readmissions. While this approach tells us how we perform relative to others or whether we have achieved a specific target or benchmark, it doesn’t provide us with much insight into why we did — or did not — meet the mark.

HQC is working with its partners – the Ministry of Health, eHealth Saskatchewan, the soon-to-be-launched Saskatchewan Health Authority, and the Saskatchewan Cancer Agency – on a new approach to measuring health system performance in Saskatchewan. As part of our provincial role in health system measurement and reporting, we are helping develop a framework that will improve our understanding of the factors that contribute to, or detract from, delivering high-quality care. In order to become a learning health system, we need to better understand the factors that enable us to achieve our targets or cause us to fall short. 

Measuring health care outcomes and processes to generate evidence for decision making is a strategic priority for HQC. In January 2017 the Saskatchewan Advisory Panel on Health System Structure released their recommendations. In that report, HQC was given a mandate to monitor and report on the experience and outcomes of patient care.

This new measurement framework is based on the understanding that health care is complex, with many interconnected parts – none of which function in isolation from the others. The framework includes health system inputs, activities, outputs, and outcomes/impacts. By showing the relationship between all of these different factors, the new framework promises to help shift our focus from targets to what is required to achieve those targets.

1

Inputs

What resources go into
the system

For example:

  • Financial Resources
  • Infrastructure
  • Technology
  • Processes
  • People & knowledge
2

Activities

What activities the system performs

For example:

  • Licensing and compliance
  • Developing programs and services
  • Delivering programs and services
  • Research
3

Outputs

What is produced through
those activities?

For example:

  • Licenses issues
  • Successful delivery of programs and services
  • Informed decision making
  • Program and policy development
4

Outcomes

The changes or benefits that
result from the system

For example:

  • Improved health
  • Regained functional ability
  • Patient satisfaction
  • Appropriate and effective use of resources
  • High-quality care for patients

A framework will illustrate the relationships between population health needs, what priorities must be set to address those needs, and the improvements required in those priority areas. 

By early 2018, senior health care leaders in the province should be using the new framework — and related reporting standards set for the new Saskatchewan Health Authority — to set health system priorities and assess progress toward meeting targets.

Measuring the patient experience

Our health care system can learn a lot from patients. One way to find out what’s working well and where we can do better is to simply ask them.

Since 2007, the Health Quality Council (HQC) has been supporting our system partners in surveying patients about their health care experiences.  We continue to work with the health system to encourage patient surveying in multiple care settings.

In 2016, health regions assumed local ownership of the survey process, which has provided them with more timely access to information from surveying and increased their measurement capability. As part of our role in building capacity to understand patient experience through measurement, we are also expanding and diversifying the way we hear the patient voice -- to move beyond surveying to experienced-based design. 

As well, a Care Experience Measurement Working Group has been formed within the Patient- and Family-Centred Care (PFCC) Guiding Coalition, to support continued application of patient surveying in Saskatchewan. This group brings together measurement experts, clinical leaders, and patient advisors to build the tools and processes to capture the patient perspective.

HQC plays a lead role with this group in developing patient surveys that meet health system needs. Since creating, in collaboration with our partners, the acute care survey in 2011, we subsequently developed surveys for primary care, and long-term care. 

Tools We’re Using to Listen to Patients

Acute care unit-level survey

The acute care unit-level patient experience survey is a standardized questionnaire that captures the experience of care from the patient’s point of view. HQC collaborated with representatives of health organizations across the province in the development and pilot testing of this survey.

The survey has been designed for individual acute care units to implement on their own as part of their efforts to improve patient experience. Because it is standardized, the survey can also be used by entire facilities or health regions as part of a coordinated strategy.

To support regions in processing their own surveys, HQC created a user-friendly tool in Microsoft Excel that generates graphs based on data entered.

The content of the acute care unit-level patient experience survey is approved by Accreditation Canada. However, Regional Health Authorities that wish to use the survey for accreditation purposes still need to submit their data collection plan to their Accreditation Canada surveyor for approval.

Primary health care survey

To support improvement in primary health care, HQC has developed surveys that can be given to patients in primary care practices, primary health care sites, public health sites, or chronic disease management programs.

We offer two surveys: a short version (five questions) and a long version (11 questions). Teams can choose the survey that best meets their facility’s needs, then use the results to inform ongoing improvement efforts.

The content of the long version of the primary health care patient experience survey has been approved by Accreditation Canada. Regional Health Authorities who wish to use the survey for accreditation purposes will still need to submit their data collection plan to their Accreditation Canada surveyor for approval. The short version of the primary health care patient experience survey is not approved by Accreditation Canada, as it does not address all of the required dimensions of care.

Since 2016, health regions and clinics have been processing their own primary health care patient experience surveys. This local ownership of the survey process ensures regions/clinics have more timely access to patient experience information and increases their measurement capability. To support this work, HQC created a user-friendly tool in Microsoft Excel that generates graphs based on the survey data entered.

Long-term care survey

We are gathering input from long-term care residents and their families using a standardized provincial survey launched in 2017. The information will guide improvements efforts in this care setting. 

The content of the LTC resident experience survey is approved by Accreditation Canada. Any facility or Regional Health Authority who wish to use the survey for accreditation purposes will still need to submit their data collection plan to their Accreditation Canada surveyor for approval.

Resources & Downloads: Long-term care survey


Patient surveying tools in development

HQC is committed to developing tools that help capture patients’ experiences with care in Saskatchewan. We are leading the Care Experience Measurement Working Group, which is developing a number of new surveys. An outpatient mental health survey will be ready in Fall 2017.

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For more information about our work to measure and report on how Saskatchewan's health care system is doing, please contact