Calling the public release of Ontario hospital death rates “revolutionary,” Health Minister George Smitherman said the province is contacting hospitals with poor scores to see what can be done to better protect patients.
“Those hospitals that have not been seen to perform well will feel under the most intense pressure to take remedial action,” Smitherman said. “The pressure will come from transparency.”
For the first time, Ontarians can know death rates in their local acute care hospitals thanks to the release of a breakthrough study Thursday by the Canadian Institute for Health Information.
“It’s not out there to be a consumer tool, it is more out there to help hospitals,” said CIHI’s Christina Lawand. “What are the factors making it higher or lower?”
It’s easy to tell which Ontario hospitals will be the target of ministry interest.
The numbers point out which hospitals have above-average patient death rates. The death rate figures – referred to as hospital standardized mortality ratios (HSMR) – compare actual deaths in a hospital with the national average after adjusting for differences in types of patients the hospital cares for.
A score below 100 is better than average while anything above is worse than average. Three Ontario hospitals top the list of worst performers in Canada. The Scarborough Hospital’s General site scored 134, while the Niagara Health System’s St. Catharines General site scored 135. Kitchener’s Grand River Hospital K.W. Health Centre scored 142. “Our first point will be to say: `Are there things we can do to be more helpful as you work to address this?'” Smitherman said in an interview yesterday.
The disclosure of hospital death rates follows a year-long Star investigation into medical secrecy that raised questions about a lack of public reporting in Canada. As part of the series “Medical Secrets,” the Star urged CIHI to reveal hospital names with reportable data.
The University Health Network, a large urban teaching hospital, has put measures in place to save lives and as a result the group of hospitals had the lowest death rate score in Toronto (at 87), said Dr. Alan Hudson, a neurosurgeon leading the drive to bring wait times down in five key areas.
“The boards will now pay attention because it is publicly reported,” said Hudson. “This is a spotlight shone on them publicly.”
But one Toronto-area hospital that has avoided the spotlight so far is Humber River Regional Hospital. The hospital’s numbers are not reported in the CIHI study, the result of a discrepancy in data-collection methods, said Gerrard Power, a spokesperson for the hospital.
“We didn’t withhold our data,” he said. “The way we code end of life patients somehow … became coded as unexpected deaths. (CIHI) said (they’ll) go back and look at it.”
If a hospital didn’t report its numbers, the Ontario health ministry won’t assume it’s hiding bad scores. But Toronto resident Joe Pingitore is angry Humber River Regional Hospital didn’t release its numbers.
“It really struck a chord,” said Pingitore, who is unhappy with the care his 89-year-old mother received at the hospital following her stroke. “If they aren’t reporting, there is a reason why.”
Many people living in Humber River’s catchment area are low-income earners. “The community deserves to know their numbers – there is no excuse for not releasing them,” said Paul Ferreira, a consultant who was the former MPP for York South-Weston. “This is one of the neediest areas in the city. Folks need to know they are getting first-class health care. Hiding numbers doesn’t tell them that.”
In the Toronto area, the best death rate scores belong to the University Health Network – made up of Princess Margaret, Toronto General and Toronto Western. Brampton’s Peel Memorial Hospital, part of William Osler Health Centre, also did well with a score of 81.
The publication of hospital death rates in Ontario is already prompting moves toward greater oversight of patient safety.
The provincial New Democrats are calling on the government to create an ombudsman’s office.
“It’s one thing to put out the statistics, but bringing in an ombudsman who has the mandate to follow through … would be a good way to make sure hospitals that rate poorly take it really seriously and do something about it,” said NDP MPP and health critic France Gélinas (Nickel Belt).
“(The statistics) are close to terrible … but I have all the faith in the world that our system is going to be able to react and the next time those statistics are measured we will do better,” she said.
But an ombudsman with the power to investigate individual cases and systemic issues would speed that up, Gélinas said.
The NDP will be reintroducing their private member’s bill calling for a health-care ombudsman in the coming weeks, she said.
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