Confronting Barriers to Improving Healthcare Performance in Canada
Bibliographic record
Abstract
I s substantive transformation of healthcare delivery in canada a fool' s paradise?Since this idiom refers to a state of happiness unconnected to underlying truths, it may be an apt descriptor given the many problems with the provinces' and territories' delivery of healthcare.Some of these problems cause harm, such as hospital-acquired infections, while others are simply wasteful, such as unnecessary tests or imaging.Moreover, meaningful transformation of healthcare delivery has been elusive and divisive in provinces and territories for decades (Martin et al. 2018; McIntosh et al. 2010; Ontario Ministry of Finance 2012).Many healthcare organizations in Canada and other parts of the world frame their health system' s performance with the "quadruple aim" (Berwick et al. 2008; Bodenheimer and Sinsky 2014).As many readers will know, the quadruple aim is a standardized framework for improving health system performance; it serves to guide healthcare organizations' policies, activities and behaviours in the direction of improving health system performance.The quadruple aim is used across clinical settings and health systems (Brown-Johnson et al. 2018; D' Alleva et al. 2019; Rathert et al. 2018), most commonly among integrated delivery systems, such as Kaiser Permanente (Gin and Courneya 2020) and the US Department of Veterans Affairs (Shekelle and Begashaw 2021).The quadruple aim includes four dimensions: patient experience, health outcomes, costs and provider experience.Improvement in these dimensions will, according to the framework, result in better health system performance.Currently, the Province of Ontario (Government of Ontario 2019), Alberta Health Services (2018) and British Columbia (Fraser Health Authority 2020) use the quadruple aim as a guiding principle in official policy documents.In spite of provinces' and regions' practice of using the quadruple aim framework to guide policy development and their strategies -to my knowledge -there are no Canadian exemplars to follow.None of our provinces and territories consistently collect or act on measures from all four dimensions. Confronting Barriers to Improving Healthcare Performance in Canada
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.024 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.006 |
| Science and technology studies | 0.020 | 0.007 |
| Scholarly communication | 0.012 | 0.003 |
| Open science | 0.004 | 0.007 |
| Research integrity | 0.004 | 0.007 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".