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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.

This research studied the integration of Ontario midwives into the hospital system, through analysis of 15 semi-structured interviews with midwives throughout the Canadian province. In 1994, following activism from parents and families who wanted “alternative” choices for childbearing, Ontario became the first Canadian province to legislate and publicly fund midwives. This followed nearly a century in which midwifery had all but disappeared in Canada, in part due to deliberate campaigns to discredit woman-centered health care and knowledge. The findings from this research were considered through the lens of Foucault’s concept of power/knowledge, to identify the ways in which medicalized norms have been privileged in Ontario birth care, and to demonstrate how pregnant people¹ and midwives have struggled against the power/knowledge of hospital environments. This research looked at the ways that midwifery, as a social movement born of feminist and countercultural activism, offers possibilities for resisting disciplinary power. Midwives in Ontario offer an alternative to medicalized childbirth which recognizes that a birth caregiver’s role is not only the physical care of parents and babies, but guidance for families during a liminal experience – the birth of a new child, which changes a family permanently and profoundly.

This article looks at the alignment of performance management system with the strategy, structure, and organizational outcome in Canadian health care organizations. In this study, balanced scorecard is the framework adopted for assessing the health care organization's performance management system (PMS) and outcome. CEO and clinical unit managers were surveyed for their perceptions on their organization's strategy, autonomy structure, PMS, and organizational performance. Path analysis was the methodology used in examining the relationship about the above organizational variables. The results indicate that patient satisfaction is the primary and most significant perspective of the depicted balanced scorecard in organizational performance. Patient satisfaction and research criteria, on the other hand, are the significant perspectives of a balanced scorecard in an organization's PMS, which are linked to strategy, autonomy structure, and organizational performance. Moreover, the results show that the strategy/structure links operated as suggested. Surprisingly, strategy on service innovation has a negative impact on the organizational outcome of patient satisfaction. Uncertainty from continuous development and organizational change in pursuing service innovation and cost-cutting measures in response to fiscal constraints are plausible explanations of the adverse impact reported.

Purpose – For much of the first half of 2003 world attention was captured by news of a mysterious but deadly virus that was claiming lives in places as distant as Toronto and Beijing. In a matter of months there were around 8,000 infections and over 689 deaths related to severe acute respiratory syndrome (SARS). In my hometown, Toronto, 43 people died of SARS during the outbreaks of 2003.

Approach – This chapter examines issues of class and poverty in emergence of SARS. The chapter begins with a discussion of the political economy of the emergence of SARS, and its relation to the spread of the virus. It then discusses issues of public policy, and particularly neo-liberal cuts to social services and public spending, that set the stage for the SARS outbreak, influenced its impact and contributed to the failures of response in Ontario.

Findings – Through analysis of the lack of social resources available to working people in the province and the prioritizing of corporate, particularly tourism industry, concerns, the chapter illustrates how issues of class underpinned public responses to SARS, exacerbating problems. The chapter concludes by giving attention to the need for social solidarity and community mutual aid.

Contributions to the field – The chapter shows the extent to which neo-liberal governments prioritize business security above the health and social security of workers and reveals some of the ways in which the pressures of capitalist social relations make people ill.

The 2003 global outbreak of Severe Acute Respiratory Syndrome (SARS) was an abrupt reminder that infectious diseases pose a continuing threat to human health. In 1967, U.S. Surgeon General William H. Stewart declared “it was time to close the book on infectious diseases” (Garrett, 1994, citing W.H. Stewart, “A Mandate for State Action,” presented at the Association of State and Territorial Health Officers, Washington, DC, December 4, 1967). In the latter half of the twentieth century, many shared this bold view that medical science had vanquished infectious disease. As a result, public health struggled to remain relevant in the face of advances in pharmaceuticals, surgery, genetics and other areas that were becoming increasingly dominant in the quest to extend and enhance human life. SARS forced many to rethink the significance of public health and the crisis, though relatively short-lived, (for commentary on the disparities between the responses to HIV and SARS, see e.g. Altman (2003)) underscored the need to rebuild public health capacity that had been allowed to slip down the health system priority list.

The goal of this contribution is to shed light on the benefits for research in health care coming from the use of administrative data, especially in terms of measuring hospitals’ outcomes. The main approaches to health outcome evaluation are reviewed and the possible improvements deriving from the use of administrative data are highlighted. Administrative data may be an essential element in the process of gathering to the public true rankings of health care organizations, reducing the degree of asymmetric information that typically arises in health care. Patients will be more aware of the best institutions, which will induce most of them to demand to be admitted in them, taking into account the costs associated with distance and with the severity of the illness. This in turn may ask for a reorganization of the sector, closing some organizations and expanding others, having as final goal to improve the health status of the population, without income barriers. This is one of the first attempts to provide an overview of the advantages that administrative data may gather in health care.