Running to Stand Still:Change and Management in Canadian Healthcare

Abstract

There is a pervasive belief among health system reformers that new public management techniques such as decentralization and market-based approaches will provide the answers to what ails healthcare systems. In this first installment of a two-part discussion, the assumptions and empirical evidence underpinning these techniques are scrutinized, and the effect of their implementation on those who manage the healthcare system is assessed. Other paradigms for delivering healthcare will be considered and described in the second article of this series. Healthcare systems around the world have been buffeted by rising costs, perceived inefficient use of resources, and consumer and provider dissatisfaction with the delivery and outcomes of care.

A Measure of Daily Distress in Practising Medicine

“…The plight of GPs acting as gatekeepers to the scarce resources of the health care system, 19,24 and the frustrations of emergency specialists and surgeons in dealing with increasing regulatory procedures to gain access to specialized services, 22,25 are confirmed by our distress scale.…”

Creating a Culture of Accountability in Health Care

“…7 Increasing the accountability of employees will also reduce overuse, misuse, and underuse of resources while possibly reducing costs for payers. 8 Accountability also improves the quality of patient care by increasing the use of evidence-based medicine and performance measurement with the aim of reducing inappropriate care.…”

“…8 Accountability also improves the quality of patient care by increasing the use of evidence-based medicine and performance measurement with the aim of reducing inappropriate care. 7 Furthermore, accountability encourages the assessment of evidence from process and outcome measures by using feedback from performance measurement to improve processes and outcomes of health care activities. 9 Finally, accountability is synonymous with the utilization of evidence-based practices, such as CPGs, while enhancing learning and reducing variability.…”

“…9 Performance measurement is an important process in creating a culture of accountability because measurement informs on quality and you cannot manage what you do not measure. 7 The measurement of outcomes includes monitoring the performance of the organization against service standards and organizational goals. 19 However, it is also important to collect feedback from patients and other stakeholders (ie, community health boards).…”

The Institutional Construction of Consumerism: A Study of Implementing Quality Indicators

“…This development can be traced back 15 years and was driven by global organizations such as EU, IMF, OECD, UN and WHO. These organizations have inspired governments all over the world to address the universal challenges facing public health services of any kind (Frenk et al, 2003;Rathwell and Persaud, 2002). Many of the global trends during the last decade have emphasised a new role for patients in which he/she can actually influence the health care providers.…”