Suchergebnisse

Multi-Service Accountability Agreements (MSAAs) have been put in place to hold Community Sector Service (CSS) agencies to account for services receiving public funding in Ontario. The MSAA seeks to support financial and performance accountability, requiring CSS agencies to report on their performance quarterly. The MSAA is an expenditure policy tool that has undergone several iterations, each informed by negotiations between the Ontario Ministry of Health and Long-Term Care (MOHLTC), the province's regional authorities—known as Local Health Integration Networks (LHINs)—and organizations/associations representing CSS agency interests. This approach to accountability is consistent with a broader focus on the government role as 'steering' service delivery rather than 'rowing.' The MSAA offers a standardized, politically acceptable approach to accountability. However, the MSAA relies heavily on performance indicators that may not adequately reflect quality care. The MSAA exemplifies the tension between the need for strong standardized accountability requirements for publicly-funded health service providers and the need for services that meet the needs of their communities. Les ententes de responsabilisation en matière de services multi-sectoriels (ERS-M) ont été mis en place pour que les centres d'accès aux soins communautaires (CASC) recevant des financements publics en Ontario puissent rendre des comptes. Les ERS-M visent à obtenir des redditions de compte financiers mais aussi à responsabiliser les centres sur leur rendement en leur demandant des rapports trimestriels sur leur rendement. L'ERS-M est un instrument de politique budgétaire élaboré par itérations successives, reposant sur des négotiations entre le Ministère de la Santé et des Soins de Longue Durée de l'Ontario, les autorités régionales de la province—connues sous le nom de Réseau Locaux d'Intégration des Services de Santé (RLISS)—et les organisations ou associations représentant les intérêts des CASC. Cette façon d'appréhender la responsabilisation s'inscrit dans un plan d'ensemble visant à concentrer le rôle du gouvernement sur le « pilotage » des services plutôt que sur la « manoeuvre » de leur production. L'ERS-M propose une méthode de responsabilisation normalisée et acceptable politiquement. Cependant, l'ERS-M fait un usage intensif d'indicateurs qui peuvent ne pas refléter correctement la qualité des soins. L'ERS-M est une bonne illustration de la tension existant entre le besoin d'imposer des standards stricts de responsabilité pour les fournisseurs de services financés sur fonds publics et l'adéquation de ces services aux besoins locaux.

Our study responds to calls for theory-driven approaches to studying innovation diffusion processes in health care. While most research on diffusion in health care is situated at the service delivery level, we study innovations and associated processes that have diffused to the system level, and refer to work on complex adaptive systems and whole systems change to guide our work. Systemlevel diffusion not only involves the spread of innovations across sector boundaries in a system, it may alter interactions and care delivery within multiple system components, change the nature of the interdependencies between components, and ultimately lead to whole systems change.

This paper focuses on accountability for the home and community care (HCC) sector in Ontario. The many different service delivery approaches, funding methods and types of organizations delivering HCC services make this sector highly heterogeneous. Findings from a document analysis and environmental scan suggest that organizations delivering HCC services face multiple accountability requirements from a wide array of stakeholders. Government stakeholders tend to rely on regulatory and expenditure instruments to hold organizations to account for service delivery. Semi-structured key informant interview respondents reported that the expenditure-based accountability tools being used carried a number of unintended consequences, both positive and negative. These include an increased organizational focus on quality, shifting care time away from clients (particularly problematic for small agencies), dissuading innovation, and reliance on performance indicators that do not adequately support the delivery of high-quality care.

While burnout among health care workers has been well studied, little is known about the extent to which burnout among health care workers impacts the outcomes of their care recipients. To test this, we used a multi-year (2014–2020) survey of care aides working in approximately 90 nursing homes (NHs); the survey focused on work–life measures, including the Maslach Burnout Inventory (MBI) and work-unit identifier. Resident Assessment Instrument Minimum Data Set (RAI-MDS 2.0) data were obtained on all residents in the sampled NHs during this time and included a unit identifier for each resident. We used multi-level models to test associations between the MBI emotional exhaustion and cynicism sub-scales reported by care aides and the resident outcomes of antipsychotics without indication, depressive symptoms, and responsive behaviors among residents on units. In 2019/2020, our sample included 3,547 care aides and 10,117 residents in 282 units. The mean frequency of emotional exhaustion and cynicism across units was 43% and 50%, respectively. While residents frequently experienced antipsychotics without indication 1,852 (18.3%), depressive symptoms 2,089 (20.7%), and responsive behaviors 3,891 (38.5%), none were found to be associated with either emotional exhaustion or cynicism among care aides.