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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.

Is Canada prepared to manage a pandemic threat from the perspective of response capacity and having in place adequate systems of governance?

The outbreak of SARS in 2003 exposed some of the limitations of this country's abilities in this regard, both from the perspective of response capacity and having in place adequate systems of governance. Considerable progress has been made since SARS to address these limitations, including increased investment in public health and strengthening of public health relationships across the country (Public Health Agency of Canada 2006). However, a remaining concern is the adequacy of existing federal legislation in this area and, in particular, the powers the federal government has at its disposal to respond to a public health emergency confined within the borders of one province. For more details visit here.

Kumanan Wilson, MD, MSc, FRCP(C), Associate Professor, Faculty of Medicine, Department of Health Policy, Management and Evaluation, University of Toronto and Research Associate, Institute of Intergovernmental Relations, Queen's University.

Correspondence may be addressed to:

What are some perspectives, strategies and behaviours that are required by healthcare leaders to successfully implement complex change within the system?

Leadership is cited as a critical success factor in virtually every publication on complex change. What is not as frequently described are the perspectives, strategies and behaviours that are required to effectively lead initiatives involving multiple independent entities in complex systems.
One key finding was that successful leaders were able to command and let go of control at the same time. These leaders did not work to find a balance. Instead, they used the tension in the polarity between these two extremes to deliver meaningful results on an ongoing basis. For more information click here.

Sharon King, BMath, the lead researcher on this project, is the president of Starfield Consulting. Starfield's expertise is in helping healthcare organizations develop and implement strategies to quickly create sustainable change.
Larry Peterson, BEng, DRel, is the co-author of Bridging Boundaries - Lessons from Leaders and a study researcher. Peterson is a Starfield Consulting senior associate.

How is the 'sharing' of system governance and management responsibilities evolving in Ontario?

In Ontario, in contrast to other provinces, has no history of sharing system governance. Like the relationship between RHAs and ministries of health, LHINs and the MOHLTC will share responsibility for health system planning; one from a regional perspective and the other from a provincial one. Since there is a significant interdependence between the two this can be expected to generate on-going tension between the two system governing organizations. For more information click here.

Steve Elson is Director, Integrated Strategic Alliances & Networks, London Health Science Centre and St. Joseph's Healthcare, London. He can be reached at

How do we change so that we become effective leaders?

Beyond "battlefield" tactics, access to reliable financial resources is a necessity and has been nursing's greatest dilemma. The politics of shifting money to support elements of healthcare are complex and risky. At a minimum, nursing leaders need collectively to ensure that every dime of money offered into the system is used to its maximum, and that the learning from new experiences is pumped back into the healthcare knowledge base. For more information: click here.

Kirsten Krull-Naraj, RN, BAAN, MHSc, CHE, Fellow (EXTRA)* Vice-President, Patient Programs and Chief Nursing Officer Royal Victoria Hospital, Barrie, ON

How do we ensure that our hospital facilitates an appropriate incident-reporting process?

A user-friendly tool is key in facilitating incident reporting. In 2001, University Health Network (UHN) implemented an electronic incident-reporting tool. Recently, the organization dedicated resources to upgrade the system with phase one of the new system, released in December 2006. Qualitative comments have been positive and implementation went as planned, with no technical problems reported. Planning for the second phase of improvements is now under way. The following article describes UHN's experience with developing the electronic incident-reporting system. For more information click here.

Anita Tepfers, ( BHA, is the Manager of Risk and Quality at the University Health Network.
Hannah Louie, BSc(H), MSW, MHSc, is a Senior Analyst with the Risk Management Department at the University Health Network.
Marc Drouillard, MCP, is a Technical Specialist with the Systems Engineering team of Shared Information Management Services at the University Health Network.

What are the lessons learned for Canada from the NHS adopting a new General Medical Services contract that provides new governance and incentive arrangements for general practice?

Despite differences between the two health systems, the mechanisms being developed to measure quality and reward practices are clearly transferable, and the new GMS contract has generated a lot of international interest. As suggested here, the use of the financial incentives in the QOF to change practice does work and is leading to improvements in clinical care across the UK. The more difficult assessment is whether these incentives produce the right improvements or, in fact, the best-value improvements. The QOF may actually discriminate against deprived area practices. Smaller practices in deprived areas do less well in the QOF than larger practices in affluent areas, reducing their ability to develop the kinds of organizational systems needed to tackle the problems associated with deprivation and to achieve greater success in meeting QOF targets (Wang et al. 2006). Two points that are highly relevant in the Canadian context are the need for good organizational structures and processes in family practice for a QOF system to operate (and for practices to improve the most), and concerns about the skewing of payments towards more affluent areas away from more deprived areas, creating further disincentives for practitioners to provide services to socially disadvantaged populations. For more information: click here.

Stephen Peckham, BSc, MA(Econ) Senior Lecturer in Health Service Delivery and Organization Department of Public Health and Policy London School of Hygiene and Tropical Medicine London, UK

What Makes A Great Board Chair?

Board chairs have the potential to affect virtually every aspect of their institution positively. They may influence: the future direction and performance of their hospital or health system; the leadership team’s careers; the organization’s physicians, patients, and employees; the overall health and social fabric of the community; and the economic vitality of the communities they serve. The position carries tremendous weight and responsibility while offering the opportunity for personal fulfillment. It can be tremendously challenging, but recognizing some fundamental precepts can help pave the way for success.

The chair creates the climate in which the board operates. Great board chairs typically create an environment characterized by openness, candor, positive energy and commitment to the mission of the organization. They often begin by creating a set of board expectations shortly after taking office.

While it is often relatively simple for a chair to develop a list of his or her own expectations, this exercise is most powerful when the chair gets input at the outset from the CEO, fellow trustees and other members of senior management, asking, among other things: What does the board expect of management? What can and should management expect of the board? What are individual trustees’ expectations?

[Click Here for full article.]

From the HayGroup who referred us to - Trustee Magazine. Authors of Article: Beverly Behan and C.J. Bolster.

We want to ensure ongoing value from our IT investments. How do we create an IT governance model that will help to ensure we obtain such value?

It is a mistake to think of IT governance in isolation from overall corporate strategy. An effective IT governance model links IT tactical/operational planning to the organization’s strategic plan. The Board therefore needs to be heavily involved in the design of the IT governance model. With the assistance of the CIO and IT executives, the Board can take the following 10 steps:
1. Engage in an IT governance self-assessment check: How is IT project success currently managed and measured?
2. Define an IT governance model that links IT operations to overall corporate strategy. For example, assessing the impact of IT plans from the perspective of underserved constituencies may be seen to advance the strategy of improving access to care.
3. Ensure that the model is sensitive to the organization’s mission, vision and values.
4. Test the model against an IT project or projects.
5. Attach performance indicators to each of the elements of the model.
6. Integrate the model with existing corporate scorecards.
7. Ensure an IT or governance committee of the Board reports results against the model.
8. When necessary, take remedial action and/or re-evaluate IT investment/planning strategies not yielding success under the model.
9. Review the currency of the model on a periodic basis.
10. Regularly review the compatibility of the model with other corporate scorecards.

Neil Seeman, JD, MPH is a Senior Consultant in the health care practice at IBM Global Business Services and teaches health law and institutional management at Ryerson University. Email:

How can the organization and structuring of care delivery systems impact how efficient and cost-effective they are in practice?

It is not well recognized by policy makers that a properly constructed continuing care system, in terms of public expenditures, would constitute the third-largest component of the Canadian healthcare system after hospitals and medical services. Using historical data, Hollander (2004) estimated annual public expenditures on continuing care to be $11-$13 billion in the early 2000s, about twice the amount of public expenditures on drugs for the same time period (Canadian Institute for Health Information 2003). To read Briefing Note 1: The Organization of Care Delivery Systems for the Elderly click here.

Marcus J. Hollander, PhD, is the president of Hollander Analytical Services Ltd.; Neena L. Chappell, PhD, FRSC, CRC, is the Canada Research Chair in Social Gerontology and a professor at the Centre on Aging and Department of Sociology, University of Victoria; Michael J. Prince, PhD, is the Lansdowne Professor of Social Policy, Faculty of Human and Social Development, University of Victoria; Evelyn Shapiro is a professor and senior scholar at Community Health Sciences (CHS), Faculty of Medicine, University of Manitoba.

What role has home support played in regard to the cost effectiveness of long-term, or chronic, home care?

It turns out that home support is central to this form of home care and the cost-effective substitutions it can engender. In addition to the role of preventive home care, as noted above, Hollander (2001b) provides evidence on the benefits of home support in long-term home care. He found that approximately 80% of the expenditures for long-term home care for people with higher-level care needs (i.e., at levels similar to people in long-term care facilities) were for home support services, while 20% were for professional services. Thus, the cost-effectiveness of home care compared with residential care is largely due to home support services. To read Briefing Note 2: Long-Term Home Care click here.

Marcus J. Hollander, PhD, is the president of Hollander Analytical Services Ltd.; Neena L. Chappell, PhD, FRSC, CRC, is the Canada Research Chair in Social Gerontology and a professor at the Centre on Aging and Department of Sociology, University of Victoria; Michael J. Prince, PhD, is the Lansdowne Professor of Social Policy, Faculty of Human and Social Development, University of Victoria; Evelyn Shapiro is a professor and senior scholar at Community Health Sciences (CHS), Faculty of Medicine, University of Manitoba.

I would like to pursue a career as Nurse Practitioner. What has been the response by administrations to placing and adapting to this new skilled worker? What are the job prospects?

Much work has been done to promote the role of the nurse practitioner across Canada as provinces and territories learn from one another and overcome barriers to furthering this advanced practice nursing role (CNA 2006). The context within which the NP role is being implemented across Canada is important. The role has the opportunity to evolve as a catalyst for change that may strengthen our collective thinking about nursing in a preferred future. For more details read this article.

Pamela Pogue
Chief Nurse and Professional Practice Executive, Trillium Health Centre, Mississauga, ON

What are regional boards' patterns of action in the governance process and how do these patterns favour policy implementation?

Analyzing the role of regional boards illuminates the ways in which governance structures can support complex changes. That said, we believe that if what is at stake is no longer to implement a health policy but to coordinate such policies to produce optimal efficiency, population-based regional governance is probably more effective than other models (e.g., governance centred on the organization of services by diseases). Regionalization's added value resides precisely in the coordination of disease-based networks with primary care services. Such coordination is essential to the continuity and comprehensiveness of care. For more information: click here.

Nassera Touati, PhD Assistant Professor, École Nationale d'Administration Publique Montreal, QC
Danièle Roberge, PhD Researcher, Centre de recherche Hôpital Charles Lemoyne Greenfield Park, QC
Jean-Louis Denis, PhD Professor, Université de Montréal Montreal, QC
Raynald Pineault, PhD Researcher, Direction de santé Publique de Montréal Montreal, QC
Linda Cazale, PhD Fellow Student, Centre de recherche Hôpital Charles Lemoyne Greenfield Park, QC
Dominique Tremblay Doctoral Student, Université de Montréal Centre de recherche Hôpital Charles Lemoyne Greenfield Park, QC
Correspondence may be addressed to: Nassera Touati, PhD, École nationale d'administration publique, 4750 avenue Henri-Julien, 5th floor, Montreal, QC H2T 3E5; tel.: 514-849-3989, ext. 3986; fax: 514-849-3369.

A new manager asks: Healthcare is more complex than any other type of organization. Do you have a guide to lead change in our hospital? We seem to be introducing new ideas, technologies and structures with wild abandon.

Though this will use the change at the University Health Network for illustrative purposes, its intended audience includes all healthcare managers, from the most junior to the most senior, in search of a systematic approach to creating order during complex change. Read more here.

Brian Golden, PhD, Sandra Rotman Chaired Professor of Health Sector Strategy at the University of Toronto and University Health Network, Professor of Strategic Management, Joseph L. Rotman School of Management and the founding Director of the Rotman Collaborative for Health System Performance.

How will patients know when an integrated healthcare system exists?

When patients

  1. do not have to repeat their health history for each provider encounter

  2. do not have to undergo the same test multiple times for different providers

  3. are not the medium for informing their physician

  4. do not have to wait at one level of care because of incapacity at another level of care

  5. have 24-hour access to a primary care provider

  6. have easy-to-understand information about quality of care and clinical outcomes in order to make informed choices about providers and treatment options

  7. can make an appointment for a visit to a clinician, a diagnostic test or a treatment with one phone call

  8. have a wide choice of primary care providers who are able to give them the time they need

  9. with chronic disease, are routinely contacted to have tests that identify problems before they occur; provided with education about their disease process; and provided with in-home assistance and training in self-care to maximize their autonomy

Peggy Leatt, George H. Pink and Michael Guerriere

The Campbell Commission (severe acute respiratory syndrome (SARS) review in Ontario) called for "whistle-blower protection" for healthcare workers. How should management respond to this?

Healthcare professionals who disclose risks to patients and healthcare organizations are often labelled whistle-blowers. In the United States, "credible reports are that 85% of whistle-blowers will suffer serious repercussions. In Canada, it's probably higher closer to 95%" (Quinn 2006). The result is that patients and communities often end up losing their most passionate advocates, and healthcare loses valuable ethical and moral leadership. For more details visit here.

Ronn Goldberg, MD, MBA, FRCPC, is adjunct professor, Faculty of Medicine (Medical Imaging), at the University of Toronto, and a lecturer, Schulich School of Business, Health Industry Management Program, at York University in Toronto, Ontario.




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