Healthcare Management Forum

Managed care, which is becoming increasingly prevalent in the United States, is virtually absent in Canada. Yet managed care, if implemented judiciously, has the potential to provide comprehensive, high quality care while containing spiraling health care expenditures. Managed care is also the foundation of integrated health systems, which have been widely discussed during the past few years. Then why has Canada been so slow to accept managed care? Since physicians have a great deal of influence on how healthcare is ultimately delivered, a group of Ontario physicians was surveyed to determine their perceptions of managed care. It was found that physicians were knowledgeable about the cost-containment capabilities of managed care but had misperceptions about managed care with respect to quality of patient care, preventive services and necessary medical care. Education and further research are recommended so that any debate about managed care, integrated systems or alternative physician payment can be meaningful, objective, beneficial and accurate.

In January 1999, the Eastern Regional Health Board began planning for a Regional Accreditation scheduled in November 1999. This would be the first time that our two programs (Addiction Services and Public Health), and two of the nine acute care facilities in our Region would be accredited.

This article describes a regional accreditation planning process. It suggests the resources required for such a project, suggests a workable time line, and indicates a communication strategy.

Mobilizing over 1000 staff, physicians, and the communities toward Regional accreditation was a challenge for the Steering Team. Defining a plan of action with defined time lines proved helpful; defining team chairs who were flexible and positive was vital, and engaging the communities in our review was rewarding. Informing the public was completed using strategies borrowed from our Newfoundland counterparts (an accreditation mural and a regular newsletter), and our own creative strategies such as “Sharing Day” and engaging community health board involvement on accreditation teams.

The project development was initiated by a steering committee, and spanned 21 teams. Both a communication and education plan were important in keeping the board, staff, physicians and residents of the Region informed.

En janvier 1999, le Conseil de santé régional de l'est (Eastern Regional Health Board) commençait à planifier son agrément régional prévu pour novembre 1999. Il s'agirait d'un premier agrément pour nos deux programmes (Services de lutte contre la toxicomanie et Santé publique: Addiction Services et Public Health) et pour deux des neuf établissements de soins de courte durée de la région.

Cet article décrit le processus de planification de l'agrément régional. Il énumère les ressources voulues pour un tel projet, propose un calendrier d'exécution raisonnable et suggère une stratégie de communication.

Mobiliser plus de 1000 employés et médecins ainsi que les collectivités en vue de l'agrément régional s'est avéré un défi de taille pour le Comité d'orientation. L'élaboration d'un plan d'action prévoyant des échéances précises a été utile; la nomination de présidents d'équipes conciliants et positifs a été essentielle, et consulter les collectivités dans le cours du processus a été enrichissant. L'information du public s'est faite grâce à des stratégies empruntées à nos homologues de Terre-Neuve (une murale d'agrément et un bulletin publié régulièrement), ainsi que par l'adoption de stratégies de notre cru, comme la Journée du partage, et enfin par le biais de la participation des conseils communautaires de santé dans nos équipes d'agrément.

La mise sur pied du projet a été confiée à un comité d'orientation et a mené à la création de 21 équipes. Des plans de communication et de sensibilisation ont constitué des outils importants afin d'informer le Conseil d'administration, le personnel, les médecins et les habitants de la région.

Drawing on a management perspective and the literature, this article suggests an ethical framework to be used at the meso or community level of resource allocation in a Canadian setting. The suggested framework enlarges on the program-level framework developed by Meslin et al primarily by building in stakeholder inclusiveness and public accountability, both of which are essential to resource allocation at the population-based level.

There is a growing need for an integrated health information system to be used in community, institutional and hospital based settings. For example, changes in the structure, process and venues of service delivery mean that individuals with similar needs may be cared for in a variety of different settings. Moreover, as people make transitions from one sector of the healthcare system to another, there is a need for comparable information to ensure continuity of care and reduced assessment burden. The RAI/MDS series of assessment instruments comprise an integrated health information system because they have consistent terminology, common core items, and a common conceptual basis in a clinical approach that emphasizes the identification of functional problems.

This article describes the approach used by the Queen Elizabeth II Health Sciences Centre to measure inpatient satisfaction at the recently merged institution. It presents some of the issues that arose in the planning stages, including use of prior consent. It is important to plan the methodology, the execution, the communication strategy and the follow-up before the process begins to ensure the results are credible, communicated and translated into quality improvement actions.

The purpose of this article is to report on the results of a workshop that introduced evidence-based decision-making techniques to Board members of regional health authorities in Alberta.

Results and conclusions: The workshop demonstrated that it is possible to design a process for the incorporation of evidence in administrative decision-making. The participants demonstrated that they were able to apply scientific evidence in administrative decision making and that the decisions taken were reasonably consistent. Also, in the absence of evidence, values took precedence in the decision-making process and the decisions taken were less consistent.

This brief report contains a description of a contemporary, coordinated new system for ambulance diversions, which was implemented in Edmonton area's Capital Health Region in January 1999. The development of this new system was precipitated by the combination of increasing pressures within the acute care system especially being felt within our emergency departments, and mounting evidence that the existing system for ambulance diversions was ineffectual in providing temporary relief of these pressures. The nature of the previous and the new system are compared and contrasted, and data are included to demonstrate that the new system has led to marked reductions in the number of ambulance diversions experienced regionally.

Two outcomes of the introduction of the Resident Assessment Instrument at Sunnybrook Health Sciences Centre in 1996 were (1) a communication plan and (2) patient unit RAI communication centres. This article describes a survey that was used to evaluate the effectiveness of the plan and centres in implementing the RAI. Staff identified the InfoRAInbow Newsletter as the most useful communication strategy. Satisfaction with communication about the RAI implementation was only 57 percent. Further investigation of this level of satisfaction is required. This result may be attributed to the “choices” staff make as to whether or not to read information, or to environmental factors that occurred at the time of the survey's completion. Future directions for improving the RAI Communication Plan should focus on environmental factors that may impede communication of information, especially information that affects integration of the RAI into the clinical care system.

Significant funding and structure changes to healthcare in Ontario in the mid-90's led The Hospital for Sick Children in Toronto to examine patient referral processes. In an effort to streamline access and encourage more appropriate referrals, the hospital tested and implemented three major changes. This article outlines these changes using the PDSA (Plan, Do, Study, Act) improvement framework and summarizes the results from this project.

Healthcare Management FORUM is a peer-reviewed journal published quarterly (March, June, September, December) by the Canadian College of Health Service Executives. FORUM encourages rigorous analysis of issues related to recent advances in health services management theory and practice in a Canadian context.

The journal serves the needs of a diverse and changing health services management community by linking scholarly inquiry with new ways of thinking about professional practice. Cooperative ventures between practitioners and academics are encouraged.