Last Friday you may have caught Lisa Lisle's story on the release of a province-wide hospital report card which delivered mixed reviews for the performance of our area hospitals. And this past Monday you may have noticed a folded blue insert in the paper from the Government of Ontario. If you chucked it in the recycling bin, now would be a good time to fish it out, as it is your copy of the provincial report card.

It measured the performance of Ontario's 14 teaching hospitals, 65 community hospitals, and 14 small/rural hospitals across four major categories (each with four highlighted sub-categories from dozens of actual measurements ranging from asthma readmissions to clinical data collection to nursing care hours) of patient satisfaction, patient care, hospital finances and keeping up with change. On each measurement criteria, a hospital was eligible to receive a rating between one and five stars with one representing the lowest score and five the highest score.

The report card - which has been compiled annually since 1999 - is the result of a joint collaboration between the Ministry of Health and Long Term Care and the Ontario Hospital Association utilizing the data aggregation and analysis resources of the Canadian Institute for Health Information, the University of Toronto, University of Western Ontario, Wilfrid Laurier University and believe it or not, the University of North Carolina.

It is a useful tool to inform patients and taxpayers of hospital performance province-wide but more importantly, to show hospital administrators how they perform relative to their peers and where corrections and improvements are necessary.

Here in Ottawa, CHEO and the Heart Institute scored very well across most categories with the Montfort posting above average results and the Queensway-Carleton and finally the Ottawa Hospital scoring, on balance, slightly below average and below average respectively. However, what should be kept in mind is that these rankings are relative to their peer - or similar - hospitals, somewhat misleading not to mention dated.

For example, the Ottawa Hospital only received one star in the process quality indicator. Yet this ranking was actually 82.1% with the average score for teaching hospitals - which would yield three stars - just three points higher at 85.1%. In addition, the Ottawa Hospital also fared poorly on the financial health ranking (one star) but this was before the former board was dismissed and supervisor Dennis Timbrell was appointed. The data used for this report card is from the 2000/2001 fiscal year hence my earlier note about the rankings being "dated."

It is also interesting to note that in another sub-category the Ottawa Hospital scored very poorly in terms of food quality while the ranking for the Heart Institute was much higher. But get this, it's the exact same food! That's right, the food served at both institutions is prepared by the same cooks, in the same kitchen and served with the same trays, plates and cutlery.

This difference in rankings must then be a function of other factors and this is the key lesson in these report cards for all area hospitals. If a patient has a poor experience at admissions or with a specific nursing shift (just for the sake of argument), this will likely sour his/her perception of food quality, cleanliness of the room and the overall hospital stay. So our hospitals must strive for excellence in all facets of their operations.

In other words, the maintenance worker or parking lot attendant is as important to a patient's perception of the institution as is the standard of care delivered by the neurosurgeon or ICU nurse. In fact, it may even be more important because we often take for granted the everyday miracles that doctors, nurses and other allied health professionals deliver as a result of their training, professionalism and use of leading-edge technologies.

In fairness to our hospitals, this report card exercise is still in its infancy and with each annual iteration, development and research into appropriate performance measures evolves similar to Maclean's magazine annual ranking of universities which is now much more rigourous and scientific than it was several years ago.

But when it comes to our health, we should demand and accept nothing but the highest standards of excellence from everyone involved in the broader hospital community. When you believe your hospital care (or your food or the cleanliness of your room) is not acceptable, politely let the hospital's administrators know by way of a letter, fax, phone call or email. On the other hand, when a doctor, nurse or gardener goes that extra mile for you, let the hospital big wigs know as well.

By providing continuous feedback we can help all of our hospitals improve the quality of their care, patient satisfaction and hopefully outcomes. This is the lesson that patients should take away from this year's hospital report card.