Last week we posted a Q & A with Natalie Mehra, director of the Ontario Health Coalition, on the new provincial legislation that makes hospitals subject to Freedom of Information (FOI) requests. The Ontario Hospital Association asked if they could have an opportunity to respond to that blog post.
What do you think hospitals becoming subject to FOI legislation will mean?
Ontario hospitals already operate in one of the most rigorous health care accountability systems in all of Canada with accreditation processes; the public reporting of patient safety and wait times indicators; Hospital Service Accountability Agreements; annual reviews by Ontario’s Auditor General; and more. That said, Ontario’s hospitals also know that there is always room for improvement, which is why they asked for FOI legislation to be extended to their sector.
Applying FOI legislation to hospitals ultimately means Ontarians have yet another way to know their hospital, understand how it operates, and have confidence in its performance.
How will the OHA and its members be affected by the new FOI legislation?
A considerable amount of work on the part of the OHA and its member hospitals has gone into making sure hospitals can appropriately respond to the FOI requests they receive. They have worked closely with the Government of Ontario and the Office of the Information and Privacy Commissioner (IPC), looked to other jurisdictions for best practices, participated in education and training, and sought the advice of experts in this kind of work. Some hospitals have created new positions within their organizations while others have trained existing staff in their communications, or in their health records teams, to process FOI requests. Overall, the new FOI legislation should go a very long way in building an even better culture of openness and transparency between hospitals and the communities they serve.
There is an exemption for hospitals in the Freedom of Information and Protection of Privacy Act (FIPPA). With it, hospitals need not disclose information given to their committees for the purposes of assessing the quality of healthcare. Why is this necessary?
Improvements in patient safety come most quickly when physicians, nurses, and other health professionals feel they can raise and discuss issues of quality and patient safety without being “blamed or shamed.” Most patient safety incidents are the results of a complex series of factors in which many staff are involved. For example, if a patient receives the wrong medication, it is not only the nurse who gave the medication to the patient, but also the physician who ordered it, the pharmacist who dispensed it, and any other individuals involved, who need to discuss this event. In order to learn from these experiences, staff needed to deconstruct the event and identify how it could be prevented in the future. But experts and researchers in the area of quality improvement have found that staff are unlikely to have these important discussions outside of a protected environment. That is what the exemption is for.
The exemption for this very narrow class of quality of care records (i.e., only those provided to or prepared for a committee) help support the “culture of safety” that Ontario hospitals have worked hard to establish with their healthcare teams. The public can still submit requests under FIPPA for quality of care information, and hospitals may still opt to make some quality of care information and/or records available. The public also has access to all other quality of care records the hospital may have, including the quality of their own individual care. Also, any hospital’s decision to withhold information may be appealed for a review by Ontario’s Information and Privacy Commissioner, whose first priority is ensuring public access to all appropriate information.
Can you give us some examples of what might fall into this exempted category and what kinds of standards are in place to ensure this isn’t overused?
One example might be a review of system-wide quality issues. For instance, a hospital with C. difficile rates that are trending higher than the average would want health care professionals to be able to freely, and without reservation, explore why this is happening by reviewing individual practices, any recent changes to their working environment, and other contributing system-level factors. This may involve an independent review by an outside expert, or a review of hospital charts, and a discussion of their findings. Patients would still be able to submit requests to a hospital for their infection rates, how those infections may have spread, etc. Only records of what individual health care professionals said during their discussions may fall under the discretionary exemption.
What do you think will be the most useful applications of the information obtained from this new FOI legislation?
In the same way that transparency has helped improve hospitals’ performances in the areas of infection prevention and control, and wait times management, this new level of transparency and openness has the potential to improve performance in every single area of hospital operations. The most practical, useful, and responsible application of information obtained through FOI requests is to use it to drive hospital and health system improvements.
How would you like to see the current state of hospital accountability improved? Is there still more to do?
If there is one thing that Ontario’s hospitals do well it is that they always look for ways to improve. From establishing Hospital Report to www.myhospitalcare.ca, which features consumer-oriented indicator reporting, Ontario hospitals have either initiated or played a key role in shaping the many accountability measures that exist today. Continuing in that vein then, Ontario hospitals will never be satisfied with the status quo and will always look for new ways to engender the trust and confidence of their communities.
The questions in this blog post were written by student intern Gillian Wheatley.