The Alberta Teachers’ Association

Each year Alberta spends in excess of $12.5 billion on health care services. This covers 2.2 million emergency room visits, 265,000 surgeries, 2.6 million patient-occupied hospital beds, and thousands of daily visits to doctors and nurse practitioners for health assessments, treatments and advice. Health care costs are rising and there are constant concerns about wait times, service standards and quality. Alberta’s $7 billion K–12 education budget serves upwards of 600,000 students each school year through the services of more than 40,000 teachers and administrators. There is a growing demand for health and education services combined with pressure for financial constraint. Where the two ministries differ is that Alberta Health manages its finances in such a way that the ministry has access to reserves. The nature of public assurance and accountability for these two systems is totally different.

Alberta Health Services (AHS) has chosen a balanced scorecard approach for its public assurance. The key components of its strategic plan ask “How are we doing?” That is, it looks at a number of dimensions of its work, not just specific outcome measures of performance (e.g., treatment outcomes or readmission rates). It describes this work in this way:

We have developed a system to measure how we are doing by looking across six dimensions of health care: accessibility, appropriateness, efficiency, effectiveness, safety, and acceptability. We are also examining the well-being of populations across the life cycle from early childhood to youth, adult, and seniors. On a quarterly basis, we do a thorough analysis of our performance measures to help us see where we are excelling and where we need to improve. Q4 Performance Report 2012/13 ¹

In contrast, educational system performance in Alberta is narrowly focused on a small number of specific outcomes (e.g., success in language arts, math, science, or the performance of First Nations, Métis and Inuit students). Alberta Education’s annual reports do not address efficiency, appropriateness or acceptability.

Further, the way in which the public looks at education is shaped by what is reported. For example, if literacy is the focus it only measures the outcomes of literacy. It does not look at the appropriateness of the work related to literacy, the system’s efficiency in enabling literacy outcomes, or the acceptability of the system’s outcomes regarding literacy to employers, postsecondary institutions or nonprofit and community organizations. In contrast, the way in which the public views health care appears much more complex and is rooted in experience and recognition of the professionalism of medical practitioners rather than scores on international assessments.

A quarterly performance report from Alberta Health looks at a wide range of measures, not just wait times or treatment outcomes:

• Staying Healthy and Life Expectancy—Measures include percentage of life lost due to premature death, life expectancy, participation rates in cancer screening.
• Strengthening Primary Health Care—Measures include influenza immunization rates (especially for seniors), childhood immunization rates, number of citizens enrolled in primary care network, children receiving mental health care within thirty days of referral.
• Improved Access and Reduced Wait Times—Measures include discharge rate from emergency (within four hours) and wait times for various procedures.
• Providing More Choice for Continuing Care—Measures include wait times from hospital bed to continuing care facility placement rates.
• Build One Health System—Measures include staff overall engagement, overtime hours to contract time ratio, head count to FTE ratio.
• Quality and Patient Safety—Measures include patient satisfaction, unexpected harm, 30-day unplanned readmission rate.

Some of the Alberta government’s accountability measures—wait times, for example—are problematic. Wait times in emergency have to take into account the fact that patients arriving in emergency range from those with a cut knee as a result of a fall on icy pavement to those with life-threatening conditions resulting from a car collision or heart attack. This is why the measures become very specific. Wait times are problematic for another reason—seeking to achieve targets can distort the system as a whole. For example, one cause of extended wait times in emergency is the number of seniors occupying hospital beds while they wait for services in a dedicated continuing care facility. Building more hospitals to reduce emergency wait times is not an appropriate response to this particular challenge.

Looking at how Alberta Health Services holds itself accountable also reveals another interesting feature of its work: it seeks to engage in public assurance. The media and public are rightly concerned about some of the data—for example, rates of hospital-stay infections or flu immunizations—but the bigger concern is about the well-being of the health care system as a whole and the way in which the professionals within it are being treated.

Educational accountability is much more narrowly focused on a few selected outcomes. Rather than looking at the system as a whole—for example, the contribution of schools to the community, young people’s role in arts and culture, staff and student safety, staff and student engagement, equity of outcomes—there is focus only on a few measures.

A Balanced Scorecard for Education

What would a balanced scorecard approach to educational assurance look like if the system adopted a similar approach to Alberta Health Services?

Such a scorecard would need to look at

• equity of educational access, processes and outcomes for different regions and population groups in Alberta;
• ·outcomes on measures deemed to be important by all stakeholders—employability, social and emotional skills, and the school as a contributor to society, as well as specific learning outcomes;
• staff, student and parental engagement (a key measure of future success);
• efficiency measures; and
• appropriateness of learning activities as measured by teachers, students, employers and others.

In short, such a scorecard would need to understand the system as a system and move us beyond a preoccupation with “quick and dirty” measures. There is discussion underway about this scorecard method (Cowart 2010), and such a scorecard approach was the basis of the work undertaken by the ATA on an accountability project in Livingstone Range and Grande Prairie.²

If Alberta is serious about the transformation of its school systems, then changing what is measured and how it is reported is an essential task. Alberta Health Services provides a prototype that could be used to help shape a new approach to public assurance.

References

Alberta Assessment Consortium (AAC). 2012. A New Look at Public Assurance—Imagining the Possibilities for Alberta Students. Edmonton, Alta: AAC. Available at http://bit.ly/1lkml7H (accessed February 25, 2014).

Cowart, S. 2010. “Driving Improvement with a Balanced Scorecard: How a School District’s Use of a Transparent Tool Coalesced Support for Systemic Improvement.” School Administrator 67, no 2: 16–19.

Murgatroyd, S., and P. Sahlberg. 2010. Accountability, Learning and the Teacher—Looking at Real Learning First. Edmonton, Alta: Alberta Teachers’ Association (mimeo).

Stephen Murgatroyd, PhD, is a journalist, the CEO of Collaborative Media Group and a regular contributor to the ATA Magazine.

1    Available at http://www.albertahealthservices.ca/833.asp (accessed January 5th, 2014).

2    See Murgatroyd and Sahlberg 2010 and Alberta Assessment Consortium 2012. Edmonton: Alberta Teachers’ Association (mimeo) and also Alberta Assessment Consortium (2012) A New Look at Public Assurance – Imagining the Possibilities for Alberta Students. Edmonton: Alberta Assessment Consortium, available at www.aac.ab.ca/resources/pdf/Public%20Assurance%20Doc_final_may31.pdf (Accessed 6 January, 2014)