1. Accountability and Performance Measurement in Public Health 2004 alPHa Annual Conference June 14, 2004

2. 2 Why is this important: Romanow: “Shape the Future of Health Care” “A new principle of accountability should be added to the Canada Health Act (CHA) to address Canadians’ concern that they lack sufficient information to hold the appropriate people accountable for what happens in our health care system.”

3. 3 Why is this important? Premier McGuinty to the Ontario Nurse’s Association on March 4, 2004 "We are working to make health care more responsible to patients and more accountable to taxpayers. We are tying funding to specific results that Ontarians want and need."

4. 4 Why is this important? Walker: “For the Public’s Health: A Plan of Action” “A public health system entails a clear vision for health protection and promotion along with articulated goals and objectives as well as the appropriate system infrastructures (human and financial resources, organizational structures) and strategies.” [Public Health] “should be obligated on an annual basis to publicly set clear goals, report on progress achieved (and not achieved), evaluate its performance against stated objectives and against stated goals, as well as any factors or barriers to achieving these goals.”

5. 5 “To help ensure compliance with legislation and the Mandatory Health Programs and Services Guidelines, the Ministry should: establish more valid measures for assessing the performance and overall effectiveness of public health programs and services delivered by local health units” Why is this important? 2003 Report of the Provincial Auditor:

6. 6 “The health of Ontarians is more than the amount of funding directed to the health care system through the Ministry of Health and Long-Term Care….Accountability requirements are about initiating a new relationship with health care institutions and providers - a relationship that for the first time ties funding to results, rewards good performance and has consequences for poor performance.” Why is this important? Ontario Budget 2004

7. 7 Brief Overview Where we’ve been: Accountability of Boards of Health to the Ministry Where we are moving toward: Accountability of Public Health to all Stakeholders including the public

8. 8 Ministry/Board of Health Accountability Framework for Mandatory Public Health Programs Health Protection & Promotion Act Mandatory Health Programs & Services Guidelines (1997) Setting Expectations Monitoring Performance AssessmentEnforcement Planning & Evaluation Education & Consultation

9. 9 Setting Expectations Legislation & Regulation MHPSG Directives and Protocols Service Agreements Setting Expectations

10. 10 Monitoring Performance Compliance Measurement (MPIQ) Program-based Budgeting/ Performance Measurement Accreditation* Benchmarking* Monitoring Performance * Peer-led quality improvement measures at the health unit level

11. 11 MPIQ: Measuring Compliance Compliance Management tool developed in response to revised 1997 Mandatory Health Programs and Services Guidelines (MHPSG) 5 years of implementation An important aspect of the Accountability Framework for public health

12. 12 Assessment Recommended by Justice O’Connor Statutory provisions Ascertain the extent of compliance with the HPPA Conducted 5 random assessments in 2003; 2 ‘for cause’ assessments Assessment

13. 13 Enforcement Statutory Provisions Applies in cases where no remedial action has been taken and non-compliance persists Boards of health $25,000/day Individuals $5,000/day Action of last resort to attain compliance Enforcement

14. 14 GOVERNANCE TRIANGLE AUTHORITY RESPONSIBILITY ACCOUNTABILITY - The obligation to report on the responsibility assigned

15. 15 Who are we Accountable to? Owners - government Clients Employees Public Existing Accountability Framework Future Directions

16. 16 Future of Accountability in Public Health A performance measurement system based on the planning and evaluation model (logic model framework) will be established Public reports on public health performance must be developed Compliance assessment will be strengthened

17. 17 Planning and Evaluation Model for Mandatory Public Health Programs for Mandatory Public Health Programs : Requirements & Standards -Activities Targets Short-Term Outcomes Long-Term Outcomes

18. 18 With Your Help... An accountability mechanism which meets the challenges identified in Naylor, Walker and Campbell will be developed extensive consultation with the public health community will be an integral component of the 60-day action plan developing a performance measurement system will enable government to fully articulate the important work that you do in your communities and your contribution to the health of our society

19. QUESTIONS/ COMMENTS Further Feedback? Please contact: Geoff Kettel (416) 327-7391