Healthcare Management Forum

In the first part of this two part series, we demonstrated that the adoption of production engineering techniques and market-based approaches to the delivery of healthcare have not fulfilled their initial promise. Furthermore, this has placed managers under duress, because they are charged with implementing these mechanisms. In this second article, we propose a new philosophy for managing healthcare organizations that is closer to the roots of healthcare delivery in Canada.

The use of population-based information systems can help regional health authorities provide integrated healthcare. Administrative data from 1995 through 1997 for Manitoba's rural South Eastman Regional Health Authority and for the rest of Manitoba were used to aid South Eastman's strategic planning process. Three areas of concern were highlighted: the relatively high risk of poor health among residents of the RHA's Southern District, physician maldistribution and inconsistent patterns of service utilization. By improving population access to primary healthcare, regional imbalances are being addressed.

Despite the Canadian healthcare system's enormous achievements of the past 50 years, the system is now at a crossroads. The healthcare world in Canada in 2025 will be a confluence of five transformational forces, including social ecological paradigm shifts, virtual e-care, e-management networks, transnational systems and humane caring environments. What follows is a glimpse into the underlying forces that will reshape healthcare by 2025.

Health outcomes measurement has not fulfilled its potential. An important reason is the inability of the systems in place to properly utilize the information provided by outcome indicators to improve care. This paper describes a measurement framework that empowers healthcare professionals to act on information that is provided by using logical predetermined protocols. The benefits of this framework include enhanced evidence-based healthcare processes, organizational learning through knowledge generation and dissemination, and improved health outcomes.

Dans le premier volet de cette série de deux articles, nous avons démontré que l'adoption de techniques d'organisation de la production et l'application d'approches axées sur le marché pour la prestation de soins de santé n'avaient pas répondu aux attentes initiales. De plus, la situation impose de grandes contraintes aux gestionnaires qui se voient forcés d'appliquer ces mécanismes. Dans ce deuxième volet, nous proposons une nouvelle philosophie de gestion des soins de santé qui se rapproche davantage des véritables racines de la prestation des soins de santé au Canada.

Results of a survey conducted in all Ontario hospitals have shown that several new non-management professional leadership positions and a model of shared governance within a health professional group have emerged. The model was most evident in healthcare organizations with a program management structure. This article discusses the roles and activities of these advanced professional leaders and shared responsibilities for one professional group (physiotherapy) in light of the results of the survey.

In response to the healthcare industry's growing emphasis on accountability and leadership competencies, the Peterborough Regional Health Centre (PRHC) has adopted a Human Resource Strategy that uses a competency-based model to guide the full range of Human Resource activities for its leaders. This article outlines the model that has allowed for the strategic placement of Directors and Managers into positions in the corporation with an effective, measurable and core business oriented approach to the delivery of healthcare.

This article looks at hospital workers in a large Canadian teaching hospital that was surveyed from 1995 to 1997. It compares the perceptions of the working environment and the coping mechanisms of employees who lost their jobs with those of the workers who remained with the hospital. Those who left perceived themselves to be significantly more emotionally exhausted than those who remained. In 1997, employees still with the hospital reported greater anxiety and emotional exhaustion than the workers who had left. The conclusion reached is that as the public sector attempts to become more efficient, the human cost of downsizing should be considered.

A move toward individual responsibility for health is gaining momentum in Canada. Whether or not individual responsibility for self-care practices is in the best interest of the public is debated in this article. The origins of the self-care movement in the Canadian healthcare system, its benefits and pitfalls, are explored. The role that the nursing profession can play is also discussed.

The objective of this study was to examine open-ended responses by healthcare staff to a quality-of-work-life survey. The results of the study indicated that staff in six healthcare organizations (n=1,819, response rate 30 percent) completed a 65-item QWL survey. Applying Q methodology to open-ended responses, we developed an overall rating of salient and critical issues. The most salient topics were those pertaining to what staff liked best and least about their workplace. The most critical issues included benefits, compensation, staff orientation and job demands.