Hospitals are now accountable for monitoring various performance metrics, including the performance indicators set out in the Hospital Services Accountability Agreement (H-SAA), wait time indicators, and recently regulated patient safety indicators for hospital-acquired infections. In addition, management and boards are actively identifying internal balanced scorecard indicators to measure the performance of their hospital. Hospitals are now posting these performance metrics on their web pages, both voluntarily and as required by the Public Hospitals Act.

Despite these important changes to the manner in which the Ministry of Health and Long-Term Care is holding hospitals publicly accountable for their performance, hospital boards have not sufficiently modified their governance practices to discharge appropriate oversight over how these various performance metrics are prepared and, where applicable, selected. Furthermore, boards need to consider whether their board structure (including committees, agendas and reports) allows for sufficient and timely oversight of all relevant performance metrics. In our view, boards should consider morphing their Quality Committees to Performance Metrics Monitoring Committees.

In addition, hospitals boards have not sufficiently modified their governance policies and practices to reflect their obligations to their Local Health Integration Network (LHIN) under the legislation and the H-SAAs. In our view, the new obligations under the LHIN legislation and H-SAA require a complete review of the hospital’s accountability mechanisms to ensure they are aligned with their new legislative and contractual obligations. These changes may require considering and implementing fundamental changes to the hospital’s governance structures, decision-making processes, and to how the board evaluates its chief executive officer and chief of staff. The board’s accountability to its competing stakeholders (the LHIN, members, the public, employees and health care providers) must also be re-aligned, given accountability legislation and contracts. This re-alignment should be formally reflected in the hospital’s by-laws.