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Perspectives is the monthly newsletter of the New Brunswick Health Council

In this issue...

Stéphane Robichaud
CEO of the NBHC

Message from the CEO

January and New Year’s resolutions go hand in hand. While every resolution is not successful, there are many that seize the opportunity for improvement. In the public service, January is also the start of the last quarter of the fiscal year. Although planning occurs all year, this quarter brings specific opportunities. For starters, we can reflect on insights from our experiences in the current year. What lessons can we apply in our planning for the coming year?

Looking at the provincial health system, there are many such lessons to be leveraged. In addition to the shared reality of stakeholder organizations in the NB health system, the year has also included “positive” or “negative” moments depending on one’s organizational perspective. Some may have created the feeling of being part of the solution while others like being part of the problem. 

Whether these opportunities turn into improvements in health service quality or setbacks depends on the tone that is set by leadership, and the resulting work environment.  This leadership must be demonstrated in the governance provided by elected government officials and board members or through the management role of senior civil servants in the department of health, health authorities and other stakeholder organizations. This year, there have been conscious efforts to improve health system planning. These differ from past efforts in the recognition that everyone involved needs to change, and learn from previous attempts.

Considering that in 2008 there was no standardized health information available provincially, the NBHC has benefited from much collaboration in this regard.  The primary aim of this collaboration was to validate the credibility of the population health and health service quality information being produced. A by-product of this collaboration is enhancing its use by those responsible for improving health service quality.  Even though much work is still needed, we have come a long way in developing information to improve our understanding of the health system and the needs of New Brunswickers.

Eight years have seen a significant increase in available information and in efforts related to public reporting that have resulted in raising the perceived value of using this information for health system planning decisions. The experiences of failed resolutions to improve health system planning have contributed to the current acknowledgement that a change to information-based planning is required.  This change in perspective and the increase in available information represent valuable assets for achieving significant improvements in health system planning.

Recent announcements involving the NB Medical Society aimed at improving primary health services also present opportunities for improved health system planning.  Home care and mental health were identified as areas of focus in the recent federal-provincial funding agreement. Both benefit from a planning process that emphasizes an integrated system approach.  Improved coordination of care, better quality care for citizens as they transition through various services, is dependent on improved health system planning. In the lens of new planning efforts, each citizen interaction with publicly funded health services can be seen as an opportunity for improvement. 

As we start 2017-2018, the NBHC is excited by the fact that we have all the ingredients required for improving the performance of the New Brunswick health system, and we are planning our evaluation and reporting efforts accordingly.
 

NBHC's six dimensions of quality


What is quality? Each individual may have their own criteria for quality goods and services, but for public services like the NB health system, it is necessary to have common descriptions and measures that all users can understand and that service providers can use for improvement. NBHC’s six dimensions of health service quality provide a model that contains these common descriptions and measures.

The six dimensions of quality play a key role in the New Brunswick Health System Report Card, and indicators from our Acute, Primary and Homecare surveys are used to help determine the grades for each dimension.  Let’s go back and examine why and how we measure the performance of our health system, which will help highlight the importance of these dimensions.
 
Why is performance measurement important? This type of information is becoming increasingly important for provincial governments, particularly in helping to chart their progress in increasingly frugal times. Learning about how the health system performs in New Brunswick can help in understanding how different programs and services are performing within a particular sector. But more importantly, it helps understand how sectors relate to each other as part of an integrated system which is meant to respond to the needs of the population to support the improvement of health outcomes.
 
Where do the dimensions come from? The New Brunswick Health Council was established in 2008 via the New Brunswick Health Council Act. This act mandates the NBHC to measure, monitor and assess population health and health service quality in the Province, where “health service quality” is defined as the general quality of services in the health care system as measured by accessibility, equity, appropriateness, safety, efficiency and effectiveness factors.
 
Starting with a pre-existing framework, the NBHC developed a new framework that was conducive to public reporting; using the sectors of care (acute care, primary care, supportive/specialty care) and the six dimensions of quality, with the goal to help system stakeholders to identify areas for improvement using the indicators being measured.  
 
At the time, extensive research was done to ensure that the definitions of the dimensions were aligned with regional, provincial/territorial, national and international standards, and to accurately define the sectors of care.
 
What are the dimensions composed of? Each dimension is comprised of several indicators, drawing from various types (input, process and outcomes) and levels of measurement (client, program, system). The indicators selected by the NBHC include New Brunswick administrative data; indicators from the Canadian Institute for Health Information (CIHI), the National Physician Survey, Statistics Canada, or the NB Department of Health; as well as NBHC survey results.
 
What are the dimensions of quality?

Accessibility:  the ability of patients/clients to obtain care/service at the right place and the right time, based on respective needs, in the official language of their choice.

Examples of indicators in this dimension include whether or not someone has a primary care provider or has medication coverage, and if someone is able to get an appointment on the same day or the next day with their provider.
 
Appropriateness: care/service provided is relevant to the patients’/clients' needs and based on established standards.
 
Examples of indicators in this dimension include the fact that a patient talked with a health professional about things they could do to improve their health, and the rate of colorectal screenings after age 50.
 
Effectiveness: the care/service, intervention or action achieves the desired results.

Examples of indicators in this dimension include the percentage of people who feel very confident in managing their conditions.

Efficiency: achieving the desired results with the most cost-effective use of resources.
 
Examples of indicators in this dimension include the number of people who go to the emergency room as their regular place of care.
 
Safety: potential risks of an intervention or the environment are avoided or minimized.
 
Examples of indicators in this dimension include the percentage of the people who know what their medications are for, and those who have experienced harm or an error.
 
Equity: providing quality care/service to all, regardless of individual characteristics and circumstances, such as race, color, creed, national origin, ancestry, place of origin, language, age, physical disability, mental disability, marital status, family status, sexual orientation, sex, social status or belief or political activity.
 
Examples of indicators in this dimension include comparison of one or more of the indicators above for general population and target population to identify inequities.
 
The 2016 Health System Report Card reported grades to the public on overall quality, quality by health sector as well as by dimension. It also provided insights into the dimensions of efficiency and accessibility. For the first time it also included overall grades for each of the health zones, showing the variability between zones with regard to system performance.
 
The 2016 Health System Report Card (as well as prior years) is available on our website, www.nbhc.ca.

Upcoming hospital experience survey results


The New Brunswick Health Council (NBHC) is finalizing the results of its Hospital Patient Care Experience Survey for New Brunswick hospitals. The survey follows similar surveys in 2010 and 2013, allowing us to observe trends. This survey measures several factors touching on the quality of the services delivered during the overall hospital stay, from admission to discharge, from the patient’s point of view. The surveys were filled out between December 1, 2015 and March 31, 2016 by medical, surgical and maternity patients, 18 years of age or older with at least one overnight stay, discharged from acute care hospital facilities in New Brunswick.

The results of the survey will be published soon on the NBHC’s website and New Brunswickers will be able to see patient ratings for each hospital in the province. You can see previous survey results at http://www.nbhc.ca/surveys/acutecare.

Media stories and announcements

The NBHC receives a weekly report of media stories and announcements related to its core activities: Engagement, Population Health, Care Experience, and Sustainability. The following story is an example of the type of stories that are included. If this weekly report would be of benefit to you and you aren’t already a recipient, please contact us at info@nbhc.ca for information on subscribing for free.
  • CFHI: 50 hospitals, healthcare organizations adopt family presence policies
    The Canadian Foundation for Healthcare Improvement states that through its Better Together initiative, 50 hospitals and healthcare organizations adopted or are reviewing family presence policies, including unlimited visiting hours. That number includes New Brunswick, P.E.I. and Saskatchewan, which implemented accommodating visiting practices province-wide. The CFHI states family presence improves patient outcomes and experience of care, results in fewer medication errors and falls, as well as reduced lengths of stay, readmissions and ER visits.

Launch of Primary Health survey



We are launching the third edition of our Primary Health Survey, which gathers results from every community in New Brunswick. The NBHC needs to hear from New Brunswickers to identify changes to primary health services in the last 3 years. If you get the call at home or on your cell, this is your chance to tell us about your primary health care experience, so we invite you to take the time to complete the survey. Calls will be ongoing from the end of January until May.

The NBHC will use the results of the survey to make recommendations on how to improve the quality of New Brunswick health services. It is part of its mandate to report on the performance of the health system and to engage citizens in improving our health services.

Your Perspective


ParticipACTION recommends that kids age 5 to 17 spend no more than two hours per day doing sedentary activities, including recreational screen time.  According to them, “Preserving sufficient sleep, trading indoor time for outdoor time, and replacing sedentary behaviours and light physical activity with additional moderate to vigorous physical activity can provide greater health benefits.” What’s  your perspective regarding recreational screen time and sleep? How does recreational screen time in the evening or at bedtime affect your sleep or the sleep of others in your household?

Participaction guidelines https://www.participaction.com/en-ca/thought-leadership/benefits-and-guidelines/5-17

The NBHC has been established as an independent organization that measures, monitors and evaluates New Brunswick’s health care system performance and population health, and that engages citizens in the improvement of health service quality.
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