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. 2023 Aug;19(1):81-98.
doi: 10.12927/hcpol.2023.27154.

How Timid or Bold Are Ministries of Health and Provincial Health Authorities in Canada in Planning for Healthcare Quality?

Benjamin T B Chan  1 , Susmitha Rallabandi  2 , Dan Florizone  3
Affiliations

How Timid or Bold Are Ministries of Health and Provincial Health Authorities in Canada in Planning for Healthcare Quality?

Benjamin T B Chan et al. Healthc Policy. 2023 Aug.

Abstract
in English, French

Introduction: World Health Organization (WHO) guidelines recommend countries set quality plans for their health systems with clear priorities, indicators and targets. This paper examines whether Canada's federal, provincial and territorial governments are applying these principles.

Methods: We evaluated plans from 2010 to 2019 for 14 ministries of health and four health authorities in provinces with a single authority against a rubric that considered the existence of indicators, baselines, targets, time frames and progress reports.

Results: Ratings ranged from A+ to F with a median B/B-. Most jurisdictions had indicators, but only five of 18 jurisdictions had clear baselines, numeric targets and time frames. Irregularities were observed, such as vague indicators; setting goals to "improve" without targets; announcing targets only after plans had ended; setting minimal targets; removing targets after missing them previously; or inappropriate characterization of progress.

Discussion: Most Canadian governments are reluctant to set quality targets. We speculate there may be fear of criticism if targets are missed. However, several jurisdictions had clear, ambitious plans that may serve as examples for others.

Introduction :: Les lignes directrices de l'Organisation mondiale de la Santé (OMS) recommandent aux pays d'établir, pour leurs systèmes de santé, une planification de la qualité des soins qui comprend des priorités, des indicateurs et des objectifs clairs. Le présent document évalue dans quelle mesure les gouvernements fédéral, provinciaux et territoriaux du Canada appliquent ces principes.

Méthode :: Nous avons évalué les plans, entre 2010 et 2019, de 14 ministères de la Santé, et quatre autorités sanitaires dans les provinces ayant une seule autorité, en fonction d'une grille qui tenait compte des indicateurs, des données de référence, des objectifs, des échéanciers et des rapports d'étape.

Résultats :: Les cotes allaient de A+ à F avec un B/B- médian. Il y avait des indicateurs dans la plupart des administrations, mais seulement cinq des 18 administrations étudiées s'étaient dotées de bases de référence, d'objectifs numériques et d'échéanciers clairs. Des irrégularités ont été observées, comme des indicateurs vagues, l'établissement d'objectifs d'« amélioration » sans cibles, l'annonce de cibles seulement après la fin des plans, l'établissement de cibles minimales, l'élimination de cibles après les avoir ratées ou la caractérisation inappropriée des progrès.

Discussion :: La plupart des gouvernements canadiens hésitent à fixer des objectifs pour la qualité. Nous supposons qu'il pourrait y avoir une crainte des critiques si les objectifs ne sont pas atteints. Cependant, plusieurs administrations se sont dotées de plans clairs et ambitieux qui pourraient servir d'exemples pour les autres.

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Figures

Table 1.
Table 1.
Scoring results by jurisdiction
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