Confronting Barriers to Improving Healthcare Performance in Canada

Abstract

Is substantive transformation of healthcare delivery in canada a fool' s paradise? Since this idiom refers to a state of happiness unconnected to underlying truths, it may be an apt descriptor given the many problems with the provinces' and territories' delivery of healthcare. Some of these problems cause harm, such as hospital-acquired infections, while others are simply wasteful, such as unnecessary tests or imaging. Moreover, meaningful transformation of healthcare delivery has been elusive and divisive in provinces and territories for decades ; Ontario Ministry of Finance 2012).Many healthcare organizations in Canada and other parts of the world frame their health system' s performance with the "quadruple aim" . As many readers will know, the quadruple aim is a standardized framework for improving health system performance; it serves to guide healthcare organizations' policies, activities and behaviours in the direction of improving health system performance. The quadruple aim is used across clinical settings and health systems , most commonly among integrated delivery systems, such as Kaiser Permanente (Gin and Courneya 2020) and the US Department of Veterans Affairs (Shekelle and Begashaw 2021).The quadruple aim includes four dimensions: patient experience, health outcomes, costs and provider experience. Improvement in these dimensions will, according to the framework, result in better health system performance. Currently, the Province of Ontario (Government of Ontario 2019), Alberta Health Services (2018) and British Columbia (Fraser Health Authority 2020) use the quadruple aim as a guiding principle in official policy documents.In spite of provinces' and regions' practice of using the quadruple aim framework to guide policy development and their strategies -to my knowledge -there are no Canadian exemplars to follow. None of our provinces and territories consistently collect or act on measures from all four dimensions.

It is time for a national strategy on equitable access to assistive technology in Canada

“…Finally, the Quadruple Aim framework has been endorsed in health services in many Canadian jurisdictions with the goal of attaining the best possible performance within health systems. 37-39 Implementation of a strategy that enhances equitable AT access may fulfil the four inter-related aims with improvements in user experiences and unmet needs, health and well-being of citizens, and healthcare provider work satisfaction, and decreases in health and social services costs.…”