Research

New Publications Focus on System-Level Change to Improve Hospital Performance

Several new publications this fall, with contributions from Drs. Adalsteinn Brown (Assistant Professor, HPME), and G. Ross Baker (Professor, HPME), have focused on key issues in hospital performance, including strategic priority-setting, the use of system-level scorecards and the impact of performance reports on quality improvement.

Strategic Priorities of Ontario Hospital CEOs

In “Acute Care Hospital Strategic Priorities: Perceptions of Challenges, Control, Competition and Collaboration in Ontario's Evolving Healthcare System”, Adalsteinn Brown, Miin Alikhan, Guillermo Sandoval, Neil Seeman, Ross Baker and George Pink report the results of a survey of Ontario acute care hospital CEOs. Published in the August 2005 issue of Healthcare Quarterly (Vol. 8 No. 3), this paper has been the Longwoods Number 1 download since June 2005.

The survey identifies 29 strategic priorities senior leaders are grappling with. By identifying the priorities that are relevant to hospitals in Ontario , the results of this study will inform the ongoing development of performance indicators in the provincial Hospital Report Project. They may also assist senior leaders in reflecting on their strategic priorities and provide guidance for resource allocations and strategies to overcome challenges perceived to be outside of a hospital's control.

Uptake of System-Level Scorecard

In “A Comparison of Systemwide and Hospital-Specific Performance Measurement Tools”, (Journal of Healthcare Management, Vol. 50 No. 4) Clarence Yap, Emily Siu, Ross Baker and Adalsteinn Brown report the results of a study on the uptake of a system-level scorecard (SLS) framework into institution-specific scorecards. Study participants included 22 acute care and 2 non-acute care institutions in Ontario .

The SLS framework, based on the original balanced scorecard, includes four quadrants: system integration and management innovation, clinical utilization and outcomes, patient satisfaction, and financial performance and condition. The study found that teaching hospitals and larger hospitals were more likely to use the SLS framework than community hospitals and smaller hospitals. Study investigators conclude that the SLS framework can be useful to hospital management.

Impact of Performance Reports on Quality Improvement

In “Making Performance Reports Work” (Healthcare Papers, Vol. 6 No. 2), Adalsteinn Brown Hamida Bhimani and Hugh MacLeod review evaluations of the contribution performance reports can make to quality improvement. They find that the impact of performance reporting is largely dependent on the policy context, including clarity of strategy, incentives and support for performance improvement. Brown and colleagues recommend that performance reporting be directed towards improving the performance of groups of providers rather than individuals.

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