Suchergebnisse

Following on the work of Marchildon (2013) this paper examines the political challenges faced by the government of Saskatchewan in rolling out their Lean reforms to the entire provincial health system. The government's Lean reforms were meant as a vehicle to empower patients and workers in the redesign of service delivery and the creation of a patient-centred system. Lean focuses on continuous improvement, priority setting, employee engagement and the elimination of waste. The reforms appear to have been derailed to a significant degree insofar as key actors inside the system, the media and the public have challenged the goals of the reform, the Lean methodology and process, as well as the cost of the consultants employed to oversee the process. The government's implementation of the roll-out suffered both from the ability of key actors to withdraw their support and challenge the viability of the reforms in public as well as from a public relations perspective that put the government on the defensive about how people inside the system were being treated with the reforms. As the government moves forward it will have to adjust its implementation processes and strategy in order to overcome the now strong resistance within the health sector.Cet article fait suite à celui de Marchildon (2013) et étudie les obstacles politiques rencontrés par le gouvernement en Saskatchewan quand il a voulu étendre ses réformes « Lean » au système de santé dans son ensemble. Par ces réformes, le gouvernement voulait donner leur mot à dire aux patients et aux producteurs de soins dans la recomposition de la délivrance des soins et la création d'un système centré sur le patient. « Lean » vise l'amélioration permanente, l'établissement de priorités, l'engagement des employés et la chasse au gaspillage. Il semble que les réformes aient achoppées pour une bonne part parce que des acteurs clé à l'intérieur du système, les média et le public ont remis en cause leurs objectifs, la méthodologie et le processus de « Lean », ainsi que les coûts des consultants employés pour conduire le processus. La mise en place de la généralisation par le gouvernement a été malmenée à la fois par la capacité des acteurs clé de retirer leur soutien et de remettre en cause publiquement la faisabilité des réformes, mais aussi par une opération de relations publiques ayant contraint le gouvernement à défendre la façon dont les personnels étaient traités par les réformes. Quand le gouvernement voudra avancer sur ce dossier, il devra ajuster les processus de mise en place et sa stratégie afin de dépasser des réticences maintenant fortes au sein du secteur sanitaire.

A key component of provincial health reform plans in the 1990s (and directly linked to the process of health system regionalization) was the attempt to move funding for service delivery to new models based on some notion of 'population needs'. The intent of these models was to fund newly created regional health authorities relative to the health service needs of the population as determined by demographic, socio-economic and other measures of the population. This was done in the belief that it would facilitate the reorganization of service delivery to focus on 'upstream' determinants of health rather than merely treating 'downstream' illness and injury. This paper, part of a larger multi-faceted examination of provincial health reform decision makers involving researchers from across the country, summarizes and compares the experiences of five provinces (AB, SK, ON, QC and NF). Drawing on lengthy interviews with policy makers, political actors and stakeholder organizations the paper to the strong institutional and interest-based barriers that have blunted efforts to reform system financing at the regional level. Overcoming these barriers continues to be a key challenge for advocates of reorienting the delivery of health services to upstream determinants of population health.

This paper examines the transition from the "era of the health accords" (from 2000 to 2017) to the new regime of individual bilateral agreements between Ottawa and each of the provinces and territories, allocating federal health transfers and setting agreed-upon health-reform priorities in each jurisdiction. The paper argues that the health accords of 2000, 2003 and 2004 were essentially unsuccessful for a number of reasons. First, they tended to raise expectations among the public, health system actors and health policy experts about the ability to transform health care in Canada in a relatively short period of time. This was, in part, a result of the accords' very broad and general commitments to change, but also their lack of recognition of the barriers to change that exist within the system. Second, and related to the first, attention was paid mostly to the amount of the transfer from the federal government to the provinces and territories, rather than to how those dollars were to be spent. At best, governments bought only a modest amount of change in the system, despite the billions of dollars of new investment. Unlike other industrialized federations, Canada appears to be the only one that relies on an ongoing, highly politicized process of intergovernmental diplomacy to negotiate the fiscal relationship in health care. This, combined with a somewhat amorphous and changeable understanding of the federal government's overall role in health care, complicates the process of reform and heightens the political stakes around the negotiations. The new model of bilateral agreements negotiated under an umbrella statementof common principles around health-reform priorities may yet prove to be an improvement in both process and outcomes. Bilateralism can serve to de-escalate the political stakes inherent in the federal-provincial diplomacy around Canada's most popular social program, by moving away from the "grand bargains" that characterized the accords. In short, there will be less opportunity for the kind of political rhetoric that unduly raises expectations of rapid change. More importantly, the bilateral agreements, although far from perfect, may actually better serve to focus attention on the specific health-service organization and delivery issues the provinces and territories intend to improve, restructure or expand. Under very broad principles such as "improving access to mental health and community care," the bilateral agreements articulate some very clear plans about specific approaches, programs and policies on which the transfers will be spent. This should provide amuch greater opportunity for the Canadian public to hold governments to account for progress in those areas, something the accords never really managed to do. Going forward, there is still room for improvement. Some provincial plans are decidedly vague, and governments should be urged to be more specific in their commitments and intentions. Common indicators continue to be difficult to develop, although big strides have been made in recent decades. Governments would be well advised to talk seriously and openly about the challenges and barriers to change that exist within the system and, in doing so, marshal public support to dismantle them. And the federal government itself needs to actively engage in assisting jurisdictions in learning from and adapting the successful reforms and initiatives of other jurisdictions. This could be an act of true system stewardship.

This paper explores how the passage of Saskatchewan's Health Facilities Licensing Act in 1996 created both a legal framework for private health facilities in the province as well as erecting significant barriers to virtually insure that no such facilities could effectively operate. This is done within the context of discovering how placing barriers to privatization has contributed to reform of the health care system and the conditions in which reform will be permitted. Data for the study were collected from a series of eleven key informant interviews including elected officials, civil servants, health care professionals, academics, members of key stakeholder organizations which both supported and opposed the legislation.

The Commission on the Future of Health Care in Canada, headed by former Saskatchewan premier, Roy Romanow, was one of the most important reports on Canada's health system in recent years. The authors, both intimately involved in its work, offer a critical self-reflection and analysis of the Commission, providing insight into the relationship between the processes involved in how a Royal Commission operates and the mediation of ideas that inform its work.