CBC's the fifth estate has awarded 10 hospitals across the country top grades as part of a Canadian national hospital performance report card.

A range of facilities in small towns and urban centres from across the country achieved an overall grade of A+ necessary to make the top hospital list, which is part of Rate My Hospital, a sweeping investigation into Canada's hospitals by CBC-TV's the fifth estate.

Hospitals in Alberta, New Brunswick, Manitoba, Ontario and Saskatchewan are represented in the top 10 in the CBC's rating of acute-care facilities based on patient outcome data.

Watch the fifth estate's special report Rate My Hospital on Friday at 9 p.m. (9:30 in Newfoundland).

CBC based its assessment on data collected from hospitals by the Canadian Institute for Health Information (CIHI), a publicly funded, non-profit organization that gathers and analyzes data on Canadian hospital performance. A five-member expert panel advised CBC on the selection and use of the data.

Data used by the CBC included rates of patients who died after major surgeries, who were readmitted after treatment and who experienced unexpected complications, known as adverse events, tied to nursing care during a hospital stay.

Community hospitals were compared against similarly sized facilities in three peer-group categories developed by the health-care industry while teaching hospitals made up a separate category.

4 of 10 top hospitals in Alberta

Four of the 66 hospitals rated in the large-community category achieved A+: Sturgeon Community Hospital, a 143-bed facility just north of Edmonton; Chaleur Regional Hospital in Bathurst, N.B.; and two Winnipeg hospitals, Grace Hospital and Victoria General Hospital.

Only one hospital reached the top rung in the medium-sized community hospital category: Perth and Smiths Falls District Hospital, named for the small eastern Ontario towns in which the two sites of the 82 acute-care bed facility are based.

Saskatoon City Hospital was one of two teaching hospitals to get an A+ grade, which indicates its patient outcomes in the areas measured are substantially better than a typical hospital of the same size. (Kathy Fitzpatrick/CBC)

Alberta dominated the small-hospital category with three facilities: Lamont Health Care Centre northeast of Edmonton; Covenant Health Banff Mineral Springs Hospital, a 22-bed facility in the mountain town of Banff; and High River General Hospital, a 27-bed hospital in a small community south of Calgary.

Of the 25 hospitals in the teaching category, two facilities ranked in the top tier: the 70-bed St. Joseph's Health Care London in London, Ont., and the Saskatoon City Hospital, a 137-bed facility in Saskatchewan's largest city.

An A+ grade means that data reported by the hospital shows its patient outcomes in the areas measured are substantially better than a typical hospital of the same size; a B means they are similar; a C that they are lower and a D that they are substantially lower than a typical hospital of the same size.

The majority of hospitals — 140 in total — received B grades. Twenty hospitals received an A rating, while 34 received a C.

Only eight facilities had the lowest grade of D. They were:

Vancouver Hospital and Health Sciences Centre — which includes UBC Hospital and Vancouver General Hospital (teaching hospital).

Burnaby Hospital, Burnaby, B.C. (large community hospital).

Surrey Memorial Hospital, Surrey, B.C. (large community hospital).

Ridge Meadows Hospital and Health Care Centre, Maple Ridge, B.C. (medium community hospital).

Northern Lights Regional Health Centre, Fort McMurray, Alta. (medium community hospital).

Yorkton Regional Health Centre, Yorkton, Sask. (medium community hospital).

Bonnyville Healthcare Centre, Bonnyville, Alta. (small community hospital).

Daysland Health Centre, Daysland, Alta. (small community hospital).

Ratings aim to spark debate

Canadians can find out how their local hospital fared in the CBC ratings by visiting their hospital's profile page on the Rate My Hospital website.

Hundreds of hospitals couldn't be rated because the necessary data wasn't publicly available.

A screen shot of Ireland's Rate My Hospital website, which allows users to rate public and private hospitals and is run by a medical publishing company. Other countries have similar ratings websites but CBC's is the first in Canada.

CBC's the fifth estate tried to get additional data about individual hospitals from the Canadian Institute for Health Information, provincial health ministries and hospitals. However, many hospital leaders and most provincial governments opposed their efforts.

Documents obtained through requests to provincial freedom of information offices show that health ministries from across Canada agreed to block the release of previously unpublished data by CIHI.

They also agreed to ask hospitals in each province not to fill out a specially developed survey the fifth estate sent to the CEOs of more than 600 hospitals in January.

The survey asked about initiatives the hospitals are taking to improve safety and care, such as how often staff wash their hands, how much care is provided by registered nurses and whether cots are provided for people who want to stay with a sick relative or friend overnight.

But in many cases, hospitals and health officials ignored the pan-Canadian decision. The Ontario Hospital Association agreed to a request from the fifth estate to encourage Ontario hospitals to consider completing the survey. CEOs for 132 facilities, most of them in Ontario, responded.

Prince Edward Island, New Brunswick and Nunavut also bucked the Canadian trend and released some of the previously unpublished information the fifth estate requested.

About 630 acute-care hospitals have a profile page on CBC's Rate My Hospital website, which features a variety of hospital-specific data — from parking costs to the rates of hospital-acquired superbug infections.

Extensive details about hospitals were gathered from provincial ministries and health authorities and from a first-of-its-kind survey sent directly to hospital CEOs.

The website also features the first Canada-wide hospital ratings tool for patients. On each hospital's page, patients can score the facility on four key aspects — cleanliness, friendliness, timeliness and communication — plus give an overall recommendation.

The Rate My Hospital project aims to arm Canadians with hard-to-find, hospital-specific information and seeks to prompt broad discussion about the country's quality of health care.

Though many hospitals in Canada provide at least some of the information on their own websites, unlike other countries, Canada does not have a centralized, user-friendly way for patients to review the type of care individual hospitals provide.

"I would love to be able to check up on a hospital or medical professionals' record before hiring them," said Don Osbourn, whose wife died in hospital after contracting a C. difficile infection following routine surgery and who spoke to the fifth estate.

"I mean, you get references to a mechanic, a restaurant, and those things don't matter the way the hospital matters. And more importantly, I think if everybody had to show their cards, so to speak, I think it would up their game."

Hospital reports around the world

For nearly a quarter of a century, there have been efforts around the world to evaluate and compare hospital performance.

In the United Kingdom, where the public health-care system has been undergoing reforms and a push for transparency in recent years, the government publishes NHS Choices, a central clearinghouse of hospital information that allows users to access data on hospitals and enables patients to rank them.

One of the leaders in hospital performance measurement is the U.K. company Dr Foster Intelligence, which published its first hospital guide evaluating patient outcomes in 2001 and continues to put out annual guides.

Barbara Rudolph, a senior scientist at the Center for Health Systems Research and Analysis at the University of Wisconsin-Madison, participates in a discussion as part of a five-person expert panel that advised CBC on its Rate My Hospital project. (Evan Mitsui/CBC)

The London-based company works with the U.K. Department of Health to help hospitals develop tools for collecting and analyzing information on the quality of care and has also worked with hospitals in the Netherlands.

More than two decades ago, the U.S. News and World Report magazine launched a set of annual "Best Hospitals" rankings that have expanded over the years to include more than 5,000 hospitals and 16 medical specialties.

In 2001, the U.S. Leapfrog Group started a hospital survey that now allows users to compare data for about 1,600 hospitals. A hospital comparison website is also run by the U.S. Centers for Medicare and Medicaid Services.

Ireland's Rate My Hospital website, run by a medical publishing company, ranks public and private hospitals in the country based on user reviews.

Public rankings drive change

Hospital report cards can be controversial because of the variety of methodologies and data used and the lack of a standardized approach.

But if done well, they can "focus hospitals' and clinicians' attention on important quality of care issues that need improvement," says Jack Tu, a cardiologist at the Schulich Heart Centre at Sunnybrook Hospital in Toronto. Tu was a member of the expert panel that advised CBC on the Rate My Hospital project.

"Every hospital wants to do well on these reports, and so by making this information public, it can help to galvanize hospital administrators and clinicians into making the necessary system changes to improve their performance," Tu said.

Research to date suggests that patients don't generally use report cards to choose a hospital, said Tu.

"But I think this may change over time as the quality of information in report cards improves and the public becomes more aware of this information," he said.

However, research has shown that health-care providers make efforts to improve when performance information is displayed publicly, said Barbara Rudolph, a senior scientist at the Center for Health Systems Research and Analysis at the University of Wisconsin-Madison who was a member of the CBC project's expert panel.

"The best hospitals will acknowledge that there is much to do, even when they have made big strides," said Rudolph, who has helped to develop U.S. hospital report cards.

The key to making the best use of hospital report cards is to recognize their shortcomings but still learn from them, says fellow panelist Alex Bottle, a senior lecturer in medical statistics in the School of Public Health at Imperial College London who devised the statistical methodology for tracking patient outcomes used by Dr Foster Intelligence.

"Even noisy data and imprecise indicators can make a real difference if people acknowledge that they're flawed but that they may contain important signals among the noise," he said.

To contact the Rate My Hospital team with tips or information related to the series, please email ratemyhospital@cbc.ca.