Healthcare Management Forum

As population health programs, environmental health services differ fundamentally from other forms of health service delivery. At a time when the health sector is striving for integration, the incorporation of these unique services into the delivery system presents a unique challenge to policy makers and administrators across the country. The University of Alberta recently completed a comprehensive review and redesign of locally governed and delivered environmental health protection services in Alberta. This paper outlines the key issues and unique features surrounding the delivery of environmental health services and presents the study team's suggested approach to addressing these issues.

Tout comme les programmes de santé publique, les services d'hygiène du milieu diffèrent fondamentalement des autres formes de prestation de services de santé. À une époque où le secteur de la santé se bat pour intégrer ses disciplines, l'incorporation de ces services uniques au système de prestation présente un défi unique pour les décideurs et les administrateurs dans tous le pays. L'université de l'Alberta a récemment terminé une étude exhaustive des services de protection de l'hygiène du milieu gérés et offerts localement en Alberta, et en a proposé une nouvelle conception. Dans cet article, les auteurs décrivent brièvement les questions clés et les caractéristiques particulières à la prestation de services d'hygiène du milieu, et y présentent l'approche proposée par l'équipe de recherche albertaine pour aborder ces questions.

Fiscal restraint and government cost control have contributed to the downsizing and restructuring of Canadian health care organizations. As key players in the hospital sector, the role and responsibilities of first-line nurse managers have been significantly affected by these changes. This paper presents data from a survey of 200 first-line nurse managers in British Columbia which investigated the current scope of the first-line manager's role, the number of hierarchical levels within nursing departments, and views on managerial union membership.

The trend toward greater citizen participation in health care policy reform has its roots in the consumerism of the 1960s. This era witnessed the beginning of a dispersion of power in health care and an increase in the number and variety of stakeholders involved in the policy development process. Using the reform of Ontario's long-term care policy as a case example, this paper offers observations about the benefits and challenges of participative policy-making. Despite the challenges and the paucity of hard evidence pointing to benefits, the author concludes that broad citizen participation in health care policy reform is a desirable goal. However, the capacity for genuine collaboration remains underdeveloped and requires more systematic refinement.

When absenteeism threatened to raise health care costs and affect the quality of care at Tillsonburg District Memorial Hospital, a multidisciplinary team came together to develop a strategic response. The hospital seized the opportunity to initiate the “Partners in Health” program, an innovative and collaborative disability management program designed to improve its response to the health issues of all its staff. This paper describes how the program was developed and outlines its comprehensive approach. Partners in Health has proven to be extremely successful at increasing attendance awareness, improving work accommodation and/or rehabilitation after illness or injury, and reducing costs associated with health and lost-time claims. Partners in Health was recognized with the 1995 Health Care Quality Team Award sponsored by the Canadian College of Health Service Executives and 3M.

Drug utilization review programs have been recognized as an effective way to control health care spending while maintaining quality services. This article describes the structure, mandate and activities of Quebec's Drug Utilization Review Network. This 112-member network, which represents 45% of health care facilities in the province, was established to promote the optimal utilization of drugs through the provision of support to pharmacology committees, therapeutic committees and pharmacy departments. The network's main role is to coordinate multi-centre drug utilization studies. Future challenges include maintaining member interest and evaluating the clinical and economic impact of the network's efforts.

Administrators are currently being challenged to maintain high quality patient care in the face of shrinking health care resources. The introduction of different skill mix ratios has been suggested as one way to help manage health care costs. This paper briefly reviews the literature and research data on skill mix, discussing the relevant issues and identifying the positive and negative implications of this approach. It concludes with suggestions for further research.