Burdened by Indicators

IRIS recently published a study on health system indicators. While the topic might seem a little dry, it helps advance IRIS’s thinking on how corporate governance is being introduced in Quebec. Over the years, through our analysis of the evolution of the Quebec health system, we have come to understand the current transformations not as unstructured, piecemeal initiatives, but as a coherent (neoliberal) political project. After all, we can talk about specific indicators or the overall management of the system, but the whole apparatus is itself a crystallization of political decisions.

We must first take notice of the imbalance in health indicators. Be it result-based management, the Lean-Sigma streamlining methodology or the activity-based funding slowly being implemented in Quebec, the health and social services network produces more and more performance indicators and risks losing sight of the fact that an indicator is just a tool, not an end in and of itself. We are witnessing a harmful obsession with quantification, which is especially unwarranted when applied to treating human beings.

The government is trying to calculate how long it takes a nurse to get from point A to point B, how many bandages are applied each year, how much time must be devoted to a bereaved person, etc. It is trying to determine, through very complex calculations, how much healthcare episode X costs on average to initiate some sort of competition. It will afterwards be able to evaluate managers and healthcare institutions through excessively quantitative means.

Not only is it impossible to quantify everything, it is counter-productive and it comes with a cost. The human and financial resources being spent on producing performance indicators are directed away from care. The most effective services will therefore be cut: those related to prevention and the social determinants of health which, through public health policies, are provided to the entire population before it gets sick.

Correcting the current course of the approach to healthcare is impossible at the moment given the context of financial restraint (austerity) Quebec is stuck in, which pushes health into second place after budgetary concerns. Power is being concentrated in the hands of Health and Social Services Minister Gaétan Barrette, dead set on developing corporate governance in the public sector (in addition to increasing private sector share), making it even harder to reverse course.

Minister Barrette’s real priority should be to increase the population’s health, not to accelerate the march toward corporate management and privatization. Public policies meant to improve public health—and the indicators that go with it— would yield better results than those individualizing care.

Guillaume Hébert is a researcher with IRIS, a Montreal-based progressive think tank. 

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