Making Health System Performance Measurement Useful to Policy Makers: Aligning Strategies, Measurement and Local Health System Accountability in Ontario

Abstract

This study examined the experience of the Ontario ministry of Health and LongTerm Care in enhancing its stewardship and performance management role by developing a health system strategy map and a strategy-based scorecard through a process of policy reviews and expert consultations, and linking them to accountability agreements. An evaluation of the implementation and of the effects of the policy intervention has been carried out through direct policy observation over three years, document analysis, interviews with decision-makers and systematic discussion of findings with other authors and external reviewers. Cascading strategies at health and local health system levels were identified, and a core set of health system and local health system performance indicators was selected and incorporated into accountability agreements with the Local Health Integration Networks. despite the persistence of such challenges as measurement limitations and lack of systematic linkage to decision-making processes, these activities helped to strengthen substantially the ministry' s performance management function.

Health system stewardship of National Health Ministries in the WHO European region: Concepts, functions and assessment framework

“…This involves: establishing shared values and an ethical base for health improvement; enhancing clarity in roles and responsibilities of health system actors and reducing duplication and fragmentation; and ensuring mutual accountability and transparency [6]. Enhanced health system governance can be achieved, for example, by engaging citizens more fully in policy development and decision-making through diverse engagement techniques such as citizen juries, consensus conferences or town halls [40]; by promoting shared clinical decision-making [41]; or by strengthening health system accountability and transparency through the public reporting of performance measures linked to accountability and strategy at various levels of the health system [42]. In the United Kingdom, the 2004 White Paper Choosing Health posed wide-ranging questions on how the country could tackle preventable health problems such as obesity and smoking [33].…”

“…Second, performance assessment and evaluation are important tools facilitating health system performance management and continuous performance improvement [43]. An example of this is the health system performance management framework adopted within the Ontario Ministry of Health and Long-Term Care (Canada), which links strategy, performance measurement, resource allocation, accountability and system improvement through an integrated performance management framework [42]. Similarly, in order to stimulate health system performance improvement, the health system performance measurement framework adopted in the Netherlands links a managerial framework for health care system performance (based on the balanced scorecard model) with a public health approach focused on health gains [17].…”

“…This is critical to the proportionate alignment of all the stewardship functions and resources towards these goals. Health system stewards thus need to not only put appropriate structures and processes in place to effectively steer the health system, but also to ensure that they have an impact on its performance [24,42].…”

Decentralization and health system performance – a focused review of dimensions, difficulties, and derivatives in India

“…Veillard J et al argued that despite the persistence measurement limitations and lack of systematic linkage to decision-making processes, the ministry’s performance management function in Ontario could be strengthened through specific interventions [71]. Gómez in 2003 pointed out that scholars may compare cases based on the horizontal and ex-post vertical political processes of decentralization reform.…”

Enhancing Learning, Innovation, Adaptation, and Sustainability in Health Care Organizations

“…1,2 This is reflected in health care policies in developed countries being directed toward improving the sustainability of health care provision. [1][2][3][4][5] These policies are intended to be an impetus for change by encouraging health care organizations to continuously adapt to their dynamic environments as a result of utilizing innovative evidence-based practices. [1][2][3][4][5] These policies are intended to be an impetus for change by encouraging health care organizations to continuously adapt to their dynamic environments as a result of utilizing innovative evidence-based practices.…”