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A feature presented by Longwoods™ Publishing in collaboration with a pool of leading experts in the design and management of healthcare organizations. Ask your question at the bottom of this page.

What would be a good strategy to effect workplace change in the health sector?

There is significant personal injury risk associated with the provision of high-quality healthcare. Leadership, role clarity, trust, respect, values and workplace culture could be considered required ingredients of successful workplace health initiatives. For more details visit The Challenge of Effective Workplace Change in the Health Sector.


Michael S. Kerr, PhD, Assistant Professor, School of Nursing, Faculty of Health Sciences, University of Western Ontario and Cam Mustard, ScD, Professor, Department of Public Health Sciences, University of Toronto Faculty of Medicine: President and Senior Scientist, Institute for Work and Health

As a researcher in healthcare, there are concerns regarding the flow of health data especially since PIPEDA was enacted. How can I ensure privacy does not have to be a impediment to our research?

Researchers should embrace data protection laws because they help construct trust in research practices, mitigate the commercial imperatives that flow from the fact that research is a public-private enterprise and protect the accuracy of data. Good research design should recognize that privacy is a social value and an essential element of psychological health and social relationships. And since research databases do not exist in isolation, researchers must respect the fact that the non-consensual flow of information poses risks of harm, including the secondary use of health research databases for social control, that must be managed. For more information please click here to see the full commentary.


Valerie Steeves, PhD, Assistant Professor, Department of Criminology, University of Ottawa, 25 University Street, Ottawa, ON K1N 6N5; e-mail: vsteeves@uottawa.ca.

In terms of private clinics in Canada, what are the rules / acceptable practices associated with the storage of clinical patient data housed outside of provincial boundaries whereby clinical data could be maintained in an ASP data centre located in another province?

The answer to this question will depend on several factors which should be addressed through a comprehensive legal review of the extra-jurisdictional transfer in question. Canadian privacy laws have differing consent regimes, authorities for the collection, use, and disclosure of personal information, and contractual requirements for outsourcing arrangements. As such, an analysis must be completed to identify the relevant privacy laws and how the transfer of information in question is characterized (i.e. is the activity considered a commercial activity?). Finally, there are specific requirements in certain provincial privacy laws for organizations or individuals that implement new information systems to undertake privacy risk assessments and threat risk assessments on the information system.


Don MacPherson, B.Sc, Partner, and Sylvia Klasovec, B.A., LL.B., Anzen Consulting Inc..

What can the decision-makers do to recognize and take advantage of all the opportunities that already exist within the healthcare system to advance the wait times agenda so not to impede long-term, sustainable success?

Wait times and the wait times agenda are on the Canadian schedule. Although most Canadians support our healthcare system, they are concerned about access. Resolving the wait times agenda might help increase Canadian confidence in the system's ability to provide timely access to care. While the paper by Trypuc, MacLeod and Hudson demonstrates well how quickly governments can mobilize tools and resources to address pressing policy needs, it also reveals the limited and narrow approach taken by governments to the wait times agenda. The Ontario government should recognize that a more integrated and comprehensive approach can significantly advance the wait times agenda and make the system more accountable. Only a broad-based approach will ultimately succeed in reducing wait times and building a sustainable system. A shift in values needs to take place away from the current emphasis on acute care and toward an inclusive vision of home- and community-based care that puts more emphasis on disease management, chronic care and independent living, if there is ever to be any real progress in the battle. Governments will ultimately be held accountable by Canadian healthcare consumers if they fail to make this important shift. For more information visit here.


The authors of this are Judith Shamian, RN, PhD, LLD, President and CEO, VON Canada; Esther Shainblum, BA, LLB, LLM, Director, Corporate Support and General Counsel, VON Canada; and Jennifer Stevens, BA, Manager, Communications, VON Canada.

When leading change to create an integrated healthcare system what are the guidelines to consider?

Canada does not have integrated healthcare. Canada has a series of disconnected parts, a hodge-podge patchwork, healthcare industry comprising hospitals, doctors' offices, group practices, community agencies, private sector organizations, public health departments and so on. Each Canadian province is experimenting with different types of organizational structures and processes with the intent of improving the coordination of services, facilitating better collaboration among providers and providing better healthcare to the population. However, regional health authorities and their variants in Canada do not possess most of the basic characteristics of integrated healthcare such as physician integration and a rostered population (Hospital Management Research Unit 1996,1997). See the papers here.


Thirteen experts [including Dr. Peggy Leatt, Dr. George Pink, Dr. Michael Guerriere, Mr. Michael Decter, Dr. Judith Shamian, Mr. Tom R. Closson and Dr. James R. MacLean] provide advice, ideas and benchmarks for those developing integrated systems.

What can healthcare organizations do as they take responsible for population health?

The Canadian Council on Health Services Accreditation (CCHSA) accredits hospitals, regional health authorities (RHAs), nursing homes, community health services and other healthcare organizations. They are guided by three concepts: quality improvement; population health; and indicators and benchmarking. The inclusion of population health in this process is an important new direction in the Canadian healthcare system. For more information click here.


John Millar is Vice President of Research and Population Health at the Canadian Institute for Health Information.

What are the potential benefits and challenges of merging two or more hospitals? What can hospital leaders do to ensure they overcome merger challenges and position their organizations for long-term, strategic success?

Hospital mergers are now so widespread and diverse in nature that the term "merger" has become a generic term used to describe a variety of alliances. For example, some of the multi-hospital alliances that have emerged in Canada might more accurately be described as acquisitions, networks or joint management arrangements. Whether the amalgamation is voluntary or mandated, there are several different reasons why. For more information click here.


Michele Jordan, B.Sc., MBA, CHE, is a principal consultant in the Manage-ment Consulting Practice of PricewaterhouseCoopers in Toronto, and has more than 10 years experience developing strategic change solutions for public-sector organizations. Neil Stuart, Ph.D., is a partner in PricewaterhouseCoopers' healthcare consulting practice. He has led many high profile assignments involving health system restructuring, strategic and organizational change and the development and implementation of new policy directions.

Teaching hospitals were found to be at high risk for preventable adverse events. What can we as a teaching hospital do to ensure an environment of high quality and safe nursing care?

An essential outcome of professional practice environments is the provision of high-quality, safe nursing care. To mitigate the quality and safety chasm, nursing leadership at St. Michael's Hospital undertook a strategic plan to enhance the nursing professional practice environment. This case study outlines the development of the strategic planning process. For more details on St. Michael's Hospital's case study visit here.


Lianne Jeffs, RN, MSc, Director, Nursing/Clinical Research, St. Michael's Hospital; Jane Merkley, RN, MSc, Director, Nursing Practice and Education, Co-Chair, Nursing Council, St. Michael's Hospital; Jana Jeffrey, RN, Clinical Leader Manager Co-Chair, Nursing Council, St. Michael's Hospital; Ella Ferris, RN, MBA, Executive Vice-President, Programs and Chief Nurse Executive, St. Michael's Hospital; Janice Dusek, RN, MS, MBA, CHE, Executive Vice-President, Programs and Chief Nurse Executive, St. Michael's Hospital; Catherine Hunter, BScH, MBA, CMC, Management Consultant, Hunter Healthcare Consulting Inc.

I’m on the board of a regional health care organization including a hospital. What are the director and officer liability issues I should be aware of?

Here are one list of the acts Smoking in the Workplace Act, Workplace Safety and Insurance Act, Quality of Care Information Protection Ac., Retail Sales Tax Act, Personal Health Information Protection Act, Pesticides Act, Employment Standards Act, Environmental Protection Act, Discriminatory Business Practices Act, Employer Health Tax Act, Corporations Act, Dangerous Goods Transportation Act, Building Code Act, Business Practices Act, Child & Family Services Act, Pension Benefits Standards Act, Transportation of Dangerous Goods Act, Hazardous Products Act, Income Tax Act. For more details visit here. and insist on a full briefing from your CEO. For starters you may want to satisfy yourself that your organization's senior management is aware of these acts and provides a regular statement to the board that the organization is in full compliance.


How can we create a culture of safety within our organization? And how do we get to understand our staff and physicians?

The Canadian Council on Health Services Accreditation (CCHSA) released its inaugural Patient Safety Goals and Required Organizational Practices to its member organizations and surveyors in December 2004. CCHSA's first patient safety goal is to "Create a culture of safety within the organization." To help support a culture of safety, organizations need to have an understanding of staff and physician perceptions of the current state of client/patient safety culture. For more information click here.


Tracy Murphy is a Consultant with the Research and Product Development Team at the Canadian Council on Health Services Accreditation. Tracy is the project lead for CCHSA's Enhanced Accreditation Program, and is also involved in CCHSA's patient safety and worklife portfolios. Tracy holds a Master's Degree in Health Administration, and is a Certified Health Executive through the Canadian College of Health Service Executives. She is also an Educational Consultant for the Modern Management Program of the Canadian Healthcare Association.

What are the key ingredients of a high-quality work environment in Canada's health care sector and how can this goal be achieved?

Health human resources have emerged as a top priority for research and action. This paper echoes calls for a fundamentally new approach to the people side of the health care system - treating employees as assets that need to be nurtured rather than costs that need to be controlled. For more information: click here.


When I graduate from nursing school this year my preferred employer should give me an opportunity to contribute in a meaningful way. How do I assess my prospects?

Research finds that empowered employees are highly motivated in their jobs and find meaning in their work. This motivation allows them to achieve work-related goals and empower others, leading to greater organizational effectiveness. Ask your prospective employers what programs and policies are in place to enable this? For more information: click here.


How do I assess home care eligibility for seniors in their place of residence?

A simple and concise Housing Adequacy Checklist (HAC) is beneficial for case managers in assessing home care eligibility for seniors in their place of residence. The results of a systematic literature review and a focus group, involving representatives from stakeholder groups, determined that it is important that the HAC assess four factors: the physical and material infrastructure of a care recipient's place of residence; the range of amenities; the household geography; and the cohabitation arrangements and supports. Focus group discussion also distinguished areas that might be usefully assessed by other health professionals.

[To view a synopsis, please Click Here.]


Coyte, P.C., Mitchell, A., Zarnett, D. Development and Assessment of a Housing Adequacy Checklist for Elderly Individuals in Receipt of Home Care. Ontario Ministry of Health and Long-Term Care, Hospital Management Research Unit, July 10, 2003 (www.hcerc.utoronto.ca)

What are the most important questions I should be asking as a director?

A best-selling management guru offers a checklist that board members can use to keep their company focused on the real drivers of wealth.

As boards take charge of how they work, they must also take charge of what they work on. One way to ensure that a board is talking about the things that really matter is to consider the 10 questions every director should ask. The purpose of the questions-to which directors should, but often don't, know the answers-is to help them discover for themselves the areas on which the board might wish to spend more time. Each of the questions here opens the door to a set of follow-ups that determine the extent of the individual's knowledge-and that of the board-on particular issues.

[To view the full article, please Click Here.]


Ram Charan, a former Harvard Business School professor and the author of several popular books on management, is a consultant to companies ranging from GE to DuPont.

What are the practical and policy implications of the three governance models for Ontario Family Health Teams?

The Ontario Ministry of Health and Long-Term Care has described three possible governance models for Ontario Family Health Teams (“FHTs”), being the provider-based model, the mixed/blended model and the community-based model.  Which model you select will fundamentally depend on who will participate in the FHT and, more importantly, who will play a governance role within the team (e.g., physicians only, providers only, or a combination of physicians/providers and others, such as hospitals and community-based organizations, etc.).

Within each of the three possible governance models, a FHT will need to establish a legal vehicle by which to structure its organization.  Possible legal vehicles include a professional corporation, partnership, not-for-profit corporation, unincorporated association or a combination of them.  Not all of the legal vehicles can be used for each governance model.  For example, a community-based model can only use a not-for-profit corporation; however, a physician-based model (depending on the physician income stream) can use any of the above four legal vehicles.

There is considerable flexibility available to you when deciding on the FHT legal vehicle you prefer.  FHT members (as opposed to FHTs themselves) can also avail themselves of a variety of legal vehicles when structuring their arrangements with the FHT.  For example, in a mixed/blended model, a group of physicians can form a professional corporation, and that professional corporation can participate as a member of the FHT along with a hospital or other community-based organization (there could be tax advantages in doing so).  A wide spectrum of combinations and configurations are available when developing the full FHT legal structure.

There is also significant flexibility when developing the FHT’s governance framework, being the governance structures and processes that you put in place to direct the FHT’s affairs.  The framework would address your internal relationships with the FHT members and the FHT’s external dealings with others.  The sources of governance of your FHT will include: applicable legislation, depending on the legal vehicle chosen (e.g., Partnerships Act, Corporations Act, Ontario Business Corporations Act); the common law; governance best practices; the FHT’s funding agreement with the Ministry; the FHT’s arrangements with others, including hospitals, medical schools and community partners; the FHT’s internal governance arrangements (e.g., by-laws, contract of association, service agreements, etc.) and the FHT’s strategic and annual operating plans.  Each governance framework ought to be specifically customized to the FHT’s individual circumstances.

Suffice it to say that when all is said and done, each FHT has considerable flexibility to structure its arrangements as it sees fit.  We believe the best approach for you to take is not to get hung up on the academic/theoretical question of the practical and policy implications of the three governance models, as described by the Ministry.  Instead, you should consider and determine what is your desired result.  The available governance models, legal vehicles and governance frameworks can be manipulated and developed in a multitude of ways (through various combinations and configurations) to get to your desired outcome.

You can obtain additional advice on FHT governance models, legal vehicles and governance frameworks from our colleague, Lydia Wakulowsky, Partner and Chair of McMillan Binch Mendelsohn’s Health Law Group.  Lydia can be reached at 416-865-7066 or lydia.wakulowsky@mcmbm.com.


This question was sent to and answered by Graham Scott [ graham.scott@mcmbm.com] and Maureen Quigley [mqassoc@bellnet.ca]; experts in law & governance. Please submit your questions to Experts@longwoods.com

 

 

 

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