Search results

The purpose of this paper is to undertake an examination of the Local Health Integration Network (LHIN) Health Policy proposal. This policy established a decentralized approach to health system management in the province of Ontario, Canada by creating 14 crown agencies, LHINs.

This policy is examined against the five policy stages of the Stages Model: agenda setting, formulation, legitimation, implementation and evaluation. The examination was based on a review of grey literature, including key government reports and briefs.

This policy did not follow the Stages Model sequentially: the policy was implemented while it was still undergoing its legitimacy phase. Formal reviews were undertaken following implementation and found areas for improvement: poor integration amongst all the LHINs; poor patient navigation persists; LHINs lack the capacity and competency to engage in regional capacity planning; and planning and integration is not centered around patient needs. As a result, a decade after the introduction of LHINs, the Ontario HealthCare System has not achieved systems improvement when measured against accepted government indicators of performance.

This integration policy highlights the context and evolution of Ontario’s healthcare system governance in the past decade and contributes to the body of knowledge on the impact of regionalization on health systems and patient care.

This study looks at board governance in Ontario hospitals.

We conducted a research of the hospitals’ websites and a survey of board directors to study the board structure and examine governance practice in Ontario hospitals.

The findings suggest that the board structure and process in Ontario hospitals are in compliance with Accreditation Canada’s Governance Standards, and such administrative controls are appropriate. Ontario hospital boards, in general, have fulfilled their key functions of governance in terms of working as an effective board; developing a clear direction; supporting the organization to achieve its mandate; maintaining positive relationships with external stakeholders; and being accountable and achieving sustainable results. Building knowledge through information is an area where improvement is needed.

Ontario hospitals have implemented appropriate administrative controls in terms of board composition and committee structure. The results of a survey of 99 board directors from over 25 hospitals suggest that directors, in general, have a good understanding of their governance role and relationship with senior management as well as the government. The findings are also supportive of good governance practice where executives manage and nonexecutive directors monitor the performance of the executives. According to the respondents, Ontario’s hospital boards are actively involved in setting the mission, strategic goals and objectives of their organizations, and they take appropriate steps to ensure that risk management, client safety, and quality improvements are incorporated in their governance and strategic planning process. In order to discharge their fiduciary duty effectively, respondents would like to have more information from different sources. This is an area where management accounting professionals can become involved such that relevant information from a variety of sources, especially external sources, are provided to board directors for decision making.

Ontario’s hospital sector has undertaken initiatives through research and publications to promote good governance practice. Such leadership is critical to ensure that directors have the competence and skills to discharge their duties and responsibilities diligently. Hospital boards should focus on renewal while ensuring that board directors are equipped for the challenging task of governing through professional development and continuing education.

Limitations related to the use of questionnaire applies to this research study. Self-selection bias and low response rate limit the generalizability of the findings. Future research can examine the behavior of directors in the boardroom and the impact of governance variables on hospital performance, such as quality of care and patient safety.

The purpose of this paper is to exemplify the evolving applications of balanced scorecard and strategy map in the healthcare sector. This paper seeks to describe a number of innovative approaches adopted by healthcare organizations and health systems in their implementation of Kaplan and Norton's strategy map and balanced scorecard. Although strategy map and balanced scorecard are useful strategic management tools, policy makers and decision makers should be well‐informed about implementation issues and challenges of their adoption in healthcare organizations and health systems.

The paper is based on a literature review of the applications of strategy map and balanced scorecard in healthcare organizations and health systems. Also publications of the Ministry of Health and Long‐Term Care and its agencies are examined to assess the strategic priorities and plans for Ontario's health system.

From the literature review and case studies cited, an increasing use of strategy map and balanced scorecard was found in the healthcare sector. The implementation is both unique and innovative. Moreover, strategy map and balanced scorecard are effective communication and strategic management tools in aligning and integrating the strategic goals of various levels within the health system.

The paper gives an account of the different implementation approaches of strategy map and balanced scorecard in the healthcare sector; thereby providing policy makers and decision makers with choices on how to implement the strategic management tool in their organizations.

The literature review and case studies described here highlight the value and applications of strategy map and balanced scorecard in the healthcare sector.

The purpose of this paper is to introduce problem-solving therapy (PST) training to an Ontario health region. The aim of this pilot project was to increase psychotherapy access by training community-based outreach clinicians and to understand their satisfaction with the training program as well as their confidence in applying the principles of PST.

Clinicians from Southwestern Ontario who provide community-based mental health outreach services to older adults were invited to participate in this training opportunity. Selection was based on their existing client base, the geographic area they served, and self-reported foreseeable PST training benefits. Selected individuals received an eight-hour in-person didactic session, eight one-hour case-based learning opportunities, and individual case supervision. Acquired knowledge, perceived confidence in their skills, level of adherence to PST principles in clinical interactions, and satisfaction with the training program itself were measured.

Of the 36 applicants, eight trainees were selected. All trainees completed their training and seven were successfully certified in PST. Trainees indicated a high level of satisfaction with the training experience. According to the evaluation tools, trainee confidence in providing PST significantly increased, though there was no statistically significant change in knowledge.

This study provides the first evidence that PST can be introduced within a regional geriatric mental health service in Canada. The training involved both in-person training, web-based conferencing sessions and a supervisory component. The training lasted 16 hours and resulted in staff skill development in an evidence-based psychotherapy modality.

The South West Health Ethics Network (SWHEN) was created to bring together health care providers from a variety of health care settings across a geographical region. SWHEN’s mission was to connect health professionals who have an interest in ethical issues. SWHEN’s target participants are people with an interest in this field regardless of the individual’s capacity within an ethics profession. While other ethics networks exist, few of these expand beyond a narrow scope of ethics professionals (clinical ethicists). The preliminary vision in bringing together this group was to create a regional collaborative to educate, share lessons and begin to create a common approach to ethics issues in our region. Ethics networks increase collaboration and the exchange of resources, information and ideas among clinical ethicists. As a result, they address many of the ethical dilemmas faced in integrated care and facilitate the success of these systems in providing coordinated patient care. The paper aims to discuss these issues.

A Delphi consensus building approach was conducted to determine goals and priorities of the network.

Several priorities and counter priorities were discussed. In the end, the network was stifled by three major challenges: resource sharing, balance of network priorities and individual needs, and leadership.

While the journey to creating a sustainable network is long and complex, it is still worth the struggles. Network members remained connected through e-platforms, and the meetings have increased our region’s cohesiveness around ethics. We remain cautiously optimistic of SWHENs future and acknowledge that our initial plan may have shifted but our achievements are still meaningful and worthwhile.

The Healthy at Home (H@H) is an older adult day program that is in Toronto in Ontario, Canada. This is an integrated health and social care (IHSC) program that seeks to address the social isolation and health needs of a highly vulnerable older adult population living in the north Toronto communities. These are Russian-speaking Jewish older adult immigrants. The case provides a detailed description of the factors that enabled a diverse group of health and social care organizations to integrate their respective services to address the health and social care needs of their clients using a culturally appropriate and trauma-informed lens.

A case description comprised of key informant interviews, and a focus group was undertaken of representatives from health and social care organizations serving clients in the north Toronto area.

This case description identified eleven integration factors that enabled organizations to provide integrated care using a culturally appropriate and trauma-informed lens, and they include developing an aligned vision and goals, communications, an inter-organization culture of inter-dependence, champions, pre-existing relationships, and champions. In addition, operating in the not-for-profit sector, sector differences, enabling public policies and a strong sense of community have influenced integration of services across the organizational partners to serve its high-risk client group.

This case description lends insights into how IHSC can be leveraged to provide culturally appropriate and trauma-informed care for highly vulnerable client/patient populations. A lesson learnt is that social care partners can engage in successful integration leadership in joint health and social care integration efforts.

The Canadian healthcare system is recognized as one of the best health systems in the world. However, recent social and economic conditions have placed significant pressure on system administrators to demonstrate value-for-money for the investments made with an increased scrutiny on service delivery and cost structures. Challenges in providing more efficient healthcare often resonate two key constraints: the shortage of overall funding and barriers to accessing appropriate service providers in a timely fashion. The most common solution is simply to increase service provider manpower and invest further financial resources.

In Ontario, Canada’s largest province, The Shoulder Centre (TSC) has introduced a transformative solution to address system constraints through the development of an innovative and comprehensive model of care which builds on (1) novel partnerships between community providers and the Centre’s clinical team, (2) A Patient-Centered Specialty Practice (PCSP) and (3) Leveraging technology solutions.

TSC’s model of care suggests that many challenges in healthcare are attributed to the inappropriate management of human capital and the under-development of social capital. As a solution, TSC has transformed the organizational structure of its health services by converting service providers into partners with shared accountabilities, resulting in economic value through human capital optimization and improved system efficiencies through the building of social capital. TSC’s performance results demonstrate measured system savings, increased patient and provider satisfaction, targeted knowledge growth and confirms that the healthcare system contains a greater than expected abundance of human and financial resources to provide access to appropriate and timely care without any further system investment.

Strong leadership in primary care is necessary to coordinate an effective pandemic response; however, descriptions of leadership roles for family physicians are absent from previous pandemic plans. This study aims to describe the leadership roles and functions family physicians played during the COVID-19 pandemic in Canada and identify supports and barriers to formalizing these roles in future pandemic plans.

This study conducted semi-structured qualitative interviews with family physicians across four regions in Canada as part of a multiple case study. During the interviews, participants were asked about their roles during each pandemic stage and the facilitators and barriers they experienced. Interviews were transcribed and a thematic analysis approach was used to identify recurring themes.

Sixty-eight family physicians completed interviews. Three key functions of family physician leadership during the pandemic were identified: conveying knowledge, developing and adapting protocols for primary care practices and advocacy. Each function involved curating and synthesizing information, tailoring communications based on individual needs and building upon established relationships.

Findings demonstrate the need for future pandemic plans to incorporate formal family physician leadership appointments, as well as supports such as training, communication aides and compensation to allow family physicians to enact these key roles.

The COVID-19 pandemic presents a unique opportunity to examine the leadership roles of family physicians, which have been largely overlooked in past pandemic plans. This study’s findings highlight the importance of these roles toward delivering an effective and coordinated pandemic response with uninterrupted and safe access to primary care.