Improvement in health care services - is it possible?

6 October 2020

Talk about improving health care services in New Brunswick has existed for as long as health services have existed in New Brunswick. Yet, as we survey New Brunswickers, many have commented on an unmet need for improvement, or how they don’t believe that there is a commitment for improvement to occur.

If one wants to bake a cake, one needs to have all the ingredients in the recipe to make it a success. What if we are missing some of the ingredients in the recipe for health services improvement? In our over 10 years of measuring and monitoring the provincial health system, the New Brunswick Health Council has identified three ingredients that we believe would make a significant difference in improving the health system, as well as helping citizens to recognize improvement when it occurs.

New Brunswickers need to be reassured that completing a survey on health services is well worth their time and engagement, that health care decisions are made based on their experiences and that accountability and transparency are at the forefront of health services delivery. Establishing performance targets and a strong accountability framework for all parts of the health system can increase the possibility of success in improving patient care experiences. Combined with increased transparency and efforts to inform the public and their  staff about these efforts creates an opportunity to show New Brunswickers that improvement is possible and help them to recognize when success occurs. Let’s take a look at each of these.

Establishing performance targets 

By law, the Minister of Health can establish performance targets, developing the targets in consultation with the Regional Health Authorities. 
New Brunswick’s Regional Health Authorities Act states that:

" The Minister may establish performance targets for a regional health authority with respect to its development as an organization, its financial management, ensuring access to health services provided by the regional health authority, achieving satisfactory patient outcomes, the level of patient satisfaction with the services provided by the regional health authority, and any other matter prescribed by regulation. The Minister may establish provincial standards for the provision of health services in the Province and regions of the Province and with respect to the quality of health services provided. ” 


Citizens expect a high quality of care from their health system, but services and outcomes without performance targets make it difficult for citizens to form reasonable expectations and to understand whether these expectations are being met by hospitals and RHAs. It is also important that these targets be established in consultation with medical professionals and the leaders of the RHAs to ensure that they are reasonable and that they are taken into consideration during the business planning activities of the RHAs. While targets are crucial, by themselves they are not enough to create improvement. What else do we need?

Strong accountability structure

Targets need to be supported with a strong accountability structure. Imagine if we had speed limits (which are one form of performance   targets) with no one enforcing them. What would happen? People would begin ignoring them. The same measurement and responsibility for   meeting targets is necessary in the health system.

 The Minister of Health, along with the leadership of the various parts of the health system need to develop a structure that reviews performance and holds the performers responsible when targets are not met. Such a structure must reflect the different roles of the Department of Health and the regional health authorities, as well as all the other services and health care practitioners in New Brunswick. It must also be recognized that the ultimate point of accountability for the health system is with New Brunswickers and their needs for and expectations of service.

Public reporting and transparency

While targets combined with an accountability structure can support planning and working toward improvement, these can ultimately prove ineffective without one more ingredient. As we noted in the last section, the public is the last point of accountability for the health system. Public accountability can only be effective when the public is properly informed and supportive of health service targets and able to see the accountability structure at work. Without these, expectations may be set too high, too low, or there may be demands for change without knowing all the facts or how best to proceed.

This means that targets, performance results and the actions of those responsible for accountability must all be made public, along with what actions are being taken to create improvement. This transparent public reporting means that citizens have the facts necessary to choose how they respond to the health system. They can express satisfaction with what is working well and indicate what they see as needing more work.

Significant changes to the delivery or management of health care services should always be accompanied with transparent, publicly reported performance targets and accountability to measure whether the changes have met their objectives or not and to respond to the results. If health care reforms are on the way in New Brunswick, and performance targets are not developed, how will we know if these changes will have a positive or negative impact on the quality of health care? 

If funding continues for health services without creating public and transparent performance targets and effective accountability, there is a missed chance to show New Brunswickers how spending on health care is an investment in improved health service quality. Otherwise we keep on with the status quo.

Citizens have a right to be cynical if we stay on the same path

When citizens and patients are not being adequately informed on performance or on what is being done to improve hospital services, they can question everything related to those services. Comments received during the data collection for our three  care experience surveys indicate that several New Brunswickers are already demonstrating cynicism and discontent. Let’s mix these ingredients for improvement in the New Brunswick health system to give them something to be grateful for instead!