TORONTO, ON-Most Ontarians have no way of knowing if their
local hospital is one of the best performing in Ontario, or one
of the worst.
A new study released today by independent research
organization The Fraser Institute compares the performance of
Ontario's 136 acute care hospitals. But only 29 of the
hospitals agreed to be identified.
Stratford General Hospital is the highest ranked of the
hospitals that agreed to be identified, finishing 19th.
Stratford has ranked among the top 10 hospitals going back to
Anonymous Hospital #10 is the highest ranked hospital in
Ontario and has been a consistent top performer, ranked first
or second since 2002. But its top administrators refused to let
the Fraser Institute divulge its name. The eight lowest-ranked
hospitals also refused to be identified. These hospitals have
consistently been among Ontario's poorest performing
"The hospitals that agreed to be identified in this report
should be commended. These hospitals are obviously committed to
their patients and the public by being accountable and
transparent regarding their performance," said Nadeem Esmail,
Director of Health System Performance Studies at The Fraser
Institute and co-author of the
Hospital Report Card: Ontario 2008.
In the Institute's 2006 Hospital Report Card, 43 hospitals
agreed to be identified.
"It's unfortunate that even fewer of Ontario's hospitals
appear willing to embrace the values of accountability and
transparency, something I'm sure most people in Ontario will
Hospital Report Card: Ontario 2008 compares the performance of hospitals based on up to 50
indicators of quality (such as death due to a stroke) and
patient safety (such as a foreign body left inside a patient
during a procedure). The gold standard methodology was
developed by the US Agency for Healthcare Research and Quality
(AHRQ) and researchers at Stanford University and employs a
risk-adjustment system developed by 3M. This approach is being
used in more than a dozen US states, Manitoba, British Columbia
and Ontario. The current report card uses 39 indicators
calculated for the latest year for which results are available.
The indicators are risk-adjusted and are shown for acute-care
hospitals in Ontario from 1997 to 2006 (where available),
comprising more than 9.5 million completely anonymous patient
All of the information in the hospital report card is
available either in a series of free PDF documents or in a
convenient and interactive way at
The report card is based on data from the Canadian Institute
for Health Information's (CIHI) Discharge Abstract Database.
This information is derived from patient records provided to
CIHI by all hospitals in Ontario.
Hospital Report Card: Ontario 2008
allows the public to look up a given condition or procedure and
compare death rates, volumes of procedures, rates of adverse
events, or utilization rates for their hospital to those of
other hospitals in Ontario.
A key measure within the report card is the Hospital
Mortality Index, which allows the examination of the overall
performance of a hospital across nine mortality indicators.
Anonymous Hospital #10, the top-ranked Ontario hospital,
scored 91.2 out of 100. Stratford General scored 88.2. St.
Thomas-Elgin General Hospital is the second highest named
hospital with a score of 84.9, good for 39th place.
Since 2002, the top-ranked hospital has improved its score
to 91.2 from 79.6. The most improved hospital, the 12th ranked
Anonymous Hospital # 25, improved its score to 89.4 from 68.7
The worst hospital, Anonymous Hospital #18, scored 72.8 out
of 100. It was also in the bottom 10 in 2002 with a score of
67.2. Anonymous Hospital #55 has the third lowest score at 79.0
and is notable for showing the smallest improvement from 2002,
when it scored 74.7.
Esmail pointed to the measure of deaths from heart attacks
(acute myocardial infarction) as a way of comparing hospitals.
One hospital in the bottom fifth has an acute myocardial
infarction rate nearly three times the rate for one hospital
ranked in the top fifth.
"If you have a greater chance of dying from a heart attack
in one hospital compared to another, isn't that something you
would want to know? As health care consumers, patients have a
right to know how their hospital compares to other hospitals.
Are they more likely to get an infection? Is there a higher
rate of mortality for conditions where mortality is rare?" he
The report card also uses the Hospital Mortality Index to
rank municipalities (based on where patients live). It found
that Maple, Port Perry, and Orangeville had the highest
rankings, each with 91. Among the larger municipalities, Ottawa
was ranked 20th with a score of 86, Hamilton was 37th with a
score of 84, while Toronto was 40th , Windsor 44th, London
45th, Kingston 55th, Sault Ste. Marie 72nd, and Sudbury
The lowest ranked municipality is Fort Erie at 93rd with a
score of 62.2. Other municipalities ranked near the bottom have
consistently earned low scores, such as Huntsville, Brockville,
Tillsonburg and Port Colborne.
But Esmail cautioned that due to patient mobility, the
hospital in the highest or lowest ranked municipality is not
necessarily the highest or lowest ranked hospital.
"When it comes to the performance and services offered by
most Ontario hospitals, they don't appear to want the public to
know how they compare to hospitals nearby or in other
communities," he said.
"If we truly want to improve Canada's health care system,
administrators in the system must accept the need for
measurement and comparison while acknowledging the rights of
health care users to know how the system is performing."