Methods to stimulate national and sub-national benchmarking through international health system performance comparisons: A Canadian approach

OBJECTIVE: This paper presents, discusses and evaluates methods used by the Canadian Institute for Health Information to present health system performance international comparisons in ways that facilitate their understanding by the public and health system policy-makers and can stimulate performance benchmarking. METHODS: We used statistical techniques to normalize the results and present them on a standardized scale facilitating understanding of results. We compared results to the OECD average, and to benchmarks. We also applied various data quality rules to ensure the validity of results. In order to evaluate the impact of the public release of these results, we used quantitative and qualitative methods and documented other types of impact. RESULTS: We were able to present results for performance indicators and dimensions at national and sub-national levels; develop performance profiles for each Canadian province; and show pan-Canadian performance patterns for specific performance indicators. The results attracted significant media attention at national level and reactions from various stakeholders. Other impacts such as requests for additional analysis and improvement in data timeliness were observed. CONCLUSIONS: The methods used seemed attractive to various audiences in the Canadian context and achieved the objectives originally defined. These methods could be refined and applied in different contexts.