Why the fifth estate rated Canadian hospitals

Rate My Hospital project marks a first in the country

Hospitals amass detailed information about their patients, but what is reported publicly? (Claude Vickery/CBC) Hospitals amass detailed information about their patients, but what is reported publicly? (Claude Vickery/CBC)

Almost anyone who has spent time in a hospital is familiar with the mix of hope and fear that can accompany such a stay.

There’s hope because hospitals are places where compassion, dedication and excellence can make what seem like miracles happen. Fear grows from the knowledge that hospitals can also be dangerous places where patients may be harmed or even die.

Yet in Canada, it has been next to impossible for someone facing a hospital stay to obtain an independent assessment of how patients at a particular hospital fare.

Hospitals gather a massive amount of detailed patient data annually and report it to provincial health authorities.

But much of it is hidden behind a wall of silence built by those who collect it or found in confounding databases designed for administrators and policy makers.

What is reported publicly often focuses on finances and efficiency rather than on quality of care, safety or patient outcomes.

Ratings website a first

The CBC's Rate My Hospital website hopes to change that.

A first in Canada, this online resource developed by CBC's flagship investigative news program, the fifth estate, is designed to bring more transparency and accountability to our health care system and to arm Canadians with the information they need to inform themselves when preparing for a hospital stay.

With the help of statisticians and other experts, we have determined which hospitals report better results on five key measures of hospital care.

We relied on data from the Canadian Institute for Health Information (CIHI) as reported by more than 600 Canadian hospitals. CIHI is a taxpayer-funded non-profit organization that acts as a storehouse of statistics on Canadian hospitals and other health-care data.

Users of the website can look up individual hospital profiles and make their own assessments based on information such as how many patients died after major surgery or how often patients are forced to return to hospital after being sent home.

We have supplemented these ratings with other information that should be easily available but isn't always — crucial data such as the incidence of the common hospital-acquired infections C. difficile and MRSA, emergency department wait times, nurse staffing levels and pain control.

Tool gives patients a voice

CBC’s Rate My Hospital is also the first website to give Canadians the opportunity to rate their local hospital on key measures such as respectfulness, cleanliness and communication, and compare its performance to that of other hospitals.

People in the U.K., the U.S. and other countries have been consulting similar hospital report cards to help them make informed health care choices for more than a decade.

Nine provinces and all three territories declined to provide hospital-specific information about patients, such as rates on infections and complications. (Claude Vickery/CBC) Nine provinces and one territory declined to provide hospital-specific information about patients, such as rates on infections and complications. (Claude Vickery/CBC)

CBC started work on Canada's first national hospital report card project last fall, shortly after the first public release of hospital-specific data on patient outcomes by CIHI.

We hoped to find a trove of important and telling details about patient care in the CIHI database, but we soon learned that much of what we expected to find is simply not collected in a standardized way across Canada.

In part because health care is a provincial rather than federal matter, there is still no uniform national system in this country for tracking important measures such as medical mistakes, hospital-acquired infections and wait times, which might allow best practices to be more widely adopted and the worst outcomes to be more easily identified and improved.

Health data barriers

We asked CIHI and the provincial health ministries for the information they do collect on measures such as infection rates, the number of patients who die or have complications in hospital and whether patients run greater risks by going to hospital on weekends.

But our path to obtaining this information was riddled with roadblocks and detours.

Ten of the 13 provincial and territorial health ministries declined to release the hospital-specific information.

Prince Edward Island, Nunavut, and New Brunswick provided the information after we filed a request with the privacy and information access coordinators of their health ministries.

Our overall hospital ratings are based on an analysis of five of the measures on which CIHI reports. (We used three measures for small hospitals.)

They paint a picture of how well a hospital performs in areas such as safe and effective surgery, nursing care and preparation of patients for discharge from hospital.

They do not measure everything a hospital does; nor do the ratings provide medical advice or recommendation. A poor grade does not imply that a hospital cannot provide quality care. Nor does a good grade suggest that patients who stay in that hospital will not encounter problems.

Goal to spur debate

CBC has supplemented the grades with additional information on hospital initiatives to improve safety and quality, gathered using an in-depth survey developed by the fifth estate.

The survey — the first of its kind in Canada — asked questions about everything from infection-control measures and the number of full-time registered nurses to parking rates.

We sent the survey to the chief executive officers of more than 600 acute care hospitals across the country; we received information from 132 of them.

We have also compiled an extensive list of hospital-specific infection rates for the hospital-acquired superbugs C.difficile and MRSA.

Above all, Rate My Hospital is designed to inspire discussion. Those preparing for a hospital stay can use it as a guide to help them ask the right questions.

We hope it will spur debate about the quality of our hospital system — the type of debate that in other countries has led to improvements in quality and greater accountability.

To contact the Rate My Hospital team with tips or information related to the series, please email ratemyhospital@cbc.ca.

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CBC did not rate specialized facilities such as pediatric hospitals.

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