Canada’s health care systems are complex, and so are each of the sectors that make up the broader system. When measuring performance, you will need to examine the critical connections throughout to make sure you have a complete picture.
CIHI’s Health System Performance Measurement Framework provides a system-level overview of the key dimensions of performance and contextual elements that must be studied when assessing the achievement of health system goals for individuals and for the general population. It allows for the assessment of the collective contribution of all parts of a health system, as well as how each of the system’s distinct components (such as hospitals or long-term care facilities) connect to overall system performance.
The framework provides a foundation for selecting measures or indicators that you can use to monitor health system performance.
CIHI’s Health System Performance Measurement Framework
Source
Canadian Institute for Health Information. A Performance Measurement Framework for the Canadian Health System. 2013.
The examples were found during the environmental scan. The first quadrant, Health System Outcomes, consists of 3 dimensions: Improve health status of Canadians, Improve health responsiveness and Improve value for money.
The first 2 of these dimensions encompass equity to reflect the overarching goal of equitable distribution. Quadrant 3, Health System Outputs, has 1 dimension (Access to comprehensive high-quality health services) with 4 quality attributes of the health services delivered (attributes are Person-centred, Safe, Appropriate and effective, and Efficiently delivered), and these impact the 3 dimensions in Quadrant 1.
Quadrant 1 and Quadrant 2 (Social Determinants of Health) influence each other. The second quadrant, Social Determinants of Health, consists of 2 dimensions: Structural factors influencing health, and Biological, material, psychosocial, and behavioural factors. The first dimension influences the second dimension.
Quadrants 1 and 2 influence each other. Quadrant 4 (Health System Inputs and Characteristics) and Quadrant 2 also influence each other. Quadrant 2 is also influenced by Quadrant 3 (Health System Outputs).
The third quadrant, Health System Outputs, consists of 1 dimension, Access to comprehensive high-quality health services, and 4 quality attributes: Person-centred, Safe, Appropriate and effective, and Efficiently delivered. These quality attribute dimensions also encompass equity. Access to comprehensive high-quality health services is influenced jointly by the dimensions in the fourth quadrant: Efficient allocation of resources, Adjustment to population health needs, and Health system innovation and learning capacity. Quadrant 3 influences Quadrant 2.
The fourth quadrant, Health System Inputs and Characteristics, consists of 5 dimensions: Leadership and governance, Health system resources, Efficient allocation of resources, Adjustment to population health needs, and Health system innovation and learning capacity. This quadrant comprises 2 foundational dimensions that influence the capacity of the system to improve: Leadership and governance, and Health system resources. These foundational dimensions influence one another as well as the other inputs and characteristic dimensions in this quadrant. The dimensions Efficient allocation of resources, Adjustment to population health needs, and Health system innovation and learning capacity influence each other.
Quadrants 4 and 2 influence each other. 4 contextual elements — Cultural context, Economic context, Demographic context and Political context — surround the quadrants in the framework.
CIHI’s Health System Performance (HSP) Measurement Framework views performance as a dynamic process and is composed of 4 quadrants:
- Health System Outcomes (e.g., ultimate goals of the health system)
- Social Determinants of Health (e.g., socio-economic status, biological and behavioural factors)
- Health System Outputs (e.g., access to services, quality and value of services)
- Health System Inputs and Characteristics (e.g., what resources are used, how services are organized)
Each quadrant is composed of different performance dimensions linked through expected causal relationships, with a focus on the end goal of better health for Canadians due to a high-performing health system. These 4 quadrants sit within a demographic, political, economic and cultural context. The contextual environment influences the relationships among the dimensions of each quadrant and the way they interact with each other.
Learn more about the HSP framework
A Performance Measurement Framework for the Canadian Health System
Read about a performance measurement framework designed to measure health system performance from a pan-Canadian perspective.
Aligning health system performance frameworks
Learn more about how to monitor performance using the Health System Performance Measurement Framework.