"Are there enough health professionals in Canada, and will they be there when I need them? " Answers to these two seemingly simple questions cover a variety of complex and interrelated factors that are not fully understood, as the report about Canada's Healthcare Providers (CIHI 2001) makes clear. The report appears at a time when Canadian political leaders, healthcare organizations, caregivers and others involved with the healthcare system are looking for creative solutions to the human resources challenges facing the health system. Many of the issues are not new; over the last 50 years they have been raised by various groups and government commissions. But there is a sense of urgency today as options for renewing and sustaining Canada's health system are actively being explored. This essay offers highlights from the report, providing a portrait of what is known (and not known) about the people who work in healthcare across the country. It makes clear that whether there are (or are not) enough healthcare providers is not simply a question of numbers of health professionals. From changes in health and healthcare to shifts in the worklife and practice patterns of professionals, a better understanding of the wide range of factors affecting healthcare providers is essential to further the important debates taking place.
In 2005, the Canadian Institute for Health Information (CIHI) began a methodological journey to develop a Canadian version of the hospital standardized mortality ratio (HSMR). For two years, CIHI worked with hospitals, regional authorities and measurement experts to define the most appropriate methodology given Canadian datasets and systems of care. In November 2007, we made the findings publicly available for regional health authorities and larger facilities. In their lead article, Penfold et al. discuss their views regarding some methodological issues and potential limitations of the HSMR to monitor quality of care and, in particular, as a patient safety indicator. Here we respond to their specific concerns and maintain that the HSMR remains an important tool in the arsenal of information hospitals can use to focus the discussion of patient safety/quality improvement, monitor the provision of care over time and identify opportunities for improvement.
