Here’s why it’s hard to know what’s going on in Nova Scotia health care

Nova Scotians are being hit with a “data dump” that isn’t telling the full story about the efficiency of their health-care system, according to one policy expert.

The province’s Action for Health plan, which it calls a roadmap to improve health care in Nova Scotia, was launched in 2022, providing public data through a portal called Tableau Public. The dashboard provides real-time numbers of hospital visits, occupancy, and a range of other health related metrics. 

Katherine Fierlbeck, a political science professor at Dalhousie University, says this health data alone can’t measure system efficiency without analysis of year-over-year comparisons, which are no longer required by law.

“You can’t attribute causality merely by looking at the data. The data is just the starting point,” said Fierlbeck.

The Administrative Efficiency and Accountability in Healthcare Act, passed in March, repealed legislation requiring the minister of health and wellness to submit an annual emergency department accountability report.

The annual accountability report included several performance indicators that are not available on the dashboards, like year-over-year comparisons, walkout rates, age brackets, and public consultations.

These indicators helped to broaden the scope of transparency and accountability in the health-care system by evaluating system performance over longer periods of time, according to Fierlbeck.

“Without a continuous set of consistent data, there is very little sense of how well the system is performing,” she said.

Fierlbeck says holding the government accountable hinges on the public’s access to complete and comprehensible datasets.

“The important data, the sensitive data, is hard to find in this big data dump,” she says.

Janet Hazelton, president of the Nova Scotia Nurses’ Union, submitted a letter to Health Minister Michelle Thompson in March, which emphasized the importance of annual reports for developing meaningful performance benchmarks and identifying emerging issues.

Hazelton was unavailable for an interview but provided The Signal with a copy of the letter in which she objects to the repeal.

“The annual report provides a beneficial summary of the Emergency Department system, allowing for year-over-year comparisons,” she wrote. “Similar comparisons are not possible using the publicly available data via the Action for Health dashboards.”

Hazelton recommended that the department incorporate the data tracked in the annual report into current public reporting platforms.

An example of a key data trend found in the most recent annual report before the repeal shows that unplanned emergency department closures increased by 10 per cent from the previous year.

The report’s yearly data analysis indicated that these closures were most common in hospitals located outside of urban areas. 

The sufficiency of the government’s current performance indicators in health care is under review by auditor general Kim Adair, according to a statement provided to The Signal. She did not provide a release date for the audit that would result from that review.

Political perspectives

In 2022, the province proposed the repeal of the Emergency Department Accountability Act, in an effort to reduce red tape and improve accountability.

“We have legislation that is outdated, redundant and no longer reflects the realities of our health-care system,” Thompson said in a news release announcing the repeal.

The Action for Health dashboard reinforces the government’s commitment to openness and transparency, wrote Thompson in an email statement to The Signal.

“By regularly sharing this information, we are holding ourselves accountable to make sure change happens and the system improves in the areas most important to Nova Scotians.”

Opposition leaders argue that the repeal contradicts the government’s pledge of accountability by scaling back public reports.

“Repealing this Act only makes it easier for the government to control the narrative and harder for Nova Scotians to see the true state of our health-care system,” said Derek Mombourquette, interim leader of the provincial Liberal Party, in an email statement sent to The Signal.

For Mombourquette, withholding information about the health-care system is part of a troubling pattern displayed by Tim Houston’s Progressive Conservative government.

Backpedalling on promises of transparency is not an unprecedented move for governments in office, said Fierlbeck.

“Parties say they want more accountability until they get into government and realize how hard it is when they’re being attacked on all sides, when people actually have this information.”