Healthcare Quarterly

Healthcare Quarterly 8(1) January 2009 .doi:10.12927/hcq.2009.20431

The Devolution Option: More Complex Than It Seems

Jim Saunders

[This paper is a commentary on Steering and Rowing in Healthcare: The Devolution Option by Colleen M. Flood and Duncan G. Sinclair.]

Colleen Flood and Duncan Sinclair colourfully describe the Canadian health system as an "illcoordinated non-system of health and healthcare services." They advocate a core theme that the underlying causes for this dysfunctionality relate to governments not devolving an adequate level of real authority, responsibility or accountability to healthcare boards and managements. They conclude that governments are micro-managing the health system and limiting the ability of healthcare boards and managers to effectively lead and manage their organizations. They then recommend seven steps to improve the balance of governance, management and accountability.



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