Bringing Care Governance to Ontario's Retirement Homes Sector

In 2010, the Ontario government introduced Bill 21, the Retirement Homes Act, 2010 (the Act), which required the licensing of retirement homes (RHs), residents' rights, care and safety standards, inspections, compliance and a newly formed Retirement Homes Regulatory Authority (Authority). The Act and its regulations drew heavily from the content of legislation pertaining to long-term care homes (LTC homes), recognizing that many RHs provided high acuity care. However, the Authority was constituted with a multi-sectoral board, which was arm's length from government. The stated goal of the Act was to ensure the dignity, respect, safety and privacy of residents, though the government also recognized the importance of preserving autonomy and choice for the predominantly private, for-profit operators and their residents. A consultation process spurred considerable debate over the content of the proposed legislation as well as the authority that would oversee it. The unwillingness of the government to fund care services in RHs (unlike LTC homes) influenced its policy decision to pass the Act in a form that gave greater autonomy to the industry to oversee its regulation through a multi-sectoral Authority, rather than one directed by government. A formal five-year review showed the reform to be well received by the public and key stakeholders, and an Effectiveness Survey for Stakeholders conducted by a third party indicated positive results, pointing to the success of both regulatory content and oversight

Strategic Responses to Fiscal Constraints: A Health Policy Analysis of Hospital-Based Ambulatory Physical Therapy Services in the Greater Toronto Area (GTA)

Purpose: Ambulatory physical therapy (PT) services in Canada are required to be insured under the Canada Health Act, but only if delivered within hospitals. The present study analyzed strategic responses used by hospitals in the Greater Toronto Area (GTA) to deliver PT services in an environment of fiscal constraint

Attractiveness of employment sectors for physical therapists in Ontario, Canada (1999-2007): implication for the long term care sector

BackgroundRecruiting and retaining health professions remains a high priority for health system planners. Different employment sectors may vary in their appeal to providers. We used the concepts of inflow and stickiness to assess the relative attractiveness of sectors for physical therapists (PTs) in Ontario, Canada. Inflow was defined as the percentage of PTs working in a sector who were not there the previous year. Stickiness was defined as the transition probability that a physical therapist will remain in a given employment sector year-to-year.MethodsA longitudinal dataset of registered PTs in Ontario (1999-2007) was created, and primary employment sector was categorized as ‘hospital’, ‘community’, ‘long term care’ (LTC) or ‘other.’ Inflow and stickiness values were then calculated for each sector, and trends were analyzed.ResultsThere were 5003 PTs in 1999, which grew to 6064 by 2007, representing a 21.2% absolute growth. Inflow grew across all sectors, but the LTC sector had the highest inflow of 32.0%. PTs practicing in hospitals had the highest stickiness, with 87.4% of those who worked in this sector remaining year-to-year. The community and other employment sectors had stickiness values of 78.2% and 86.8% respectively, while the LTC sector had the lowest stickiness of 73.4%.ConclusionAmong all employment sectors, LTC had highest inflow but lowest stickiness. Given expected increases in demand for services, understanding provider transitional probabilities and employment preferences may provide a useful policy and planning tool in developing a sustainable health human resource base across all employment sectors

Understanding and Implementing Best Practices in Accountability

There has been much emphasis on accountability in health care in all jurisdictions across Canada. Using document analysis and key informant interviews, we assessed the extent to which the findings from our earlier Ontario-based study, Approaches to Accountability, applied across Canada. Accountability done well improves performance, improves the patient experience and promotes efficient use of resources. If implemented poorly, it can waste valuable resources, create perverse incentives and encourage gaming in the system. The findings of this study reinforced the earlier findings.  Our respondents stressed that it was important to focus on the goals being sought and transition points in the system; they emphasized that resources and stable leadership were key. Although good metrics are essential, they are not always available. Accordingly, what is easily measured tends to be what is reported. Organizations are also reluctant to be held accountable for what they cannot control. They noted that too many organizations are asking for too many indicators in too many forms. Although this is particularly problematic for small organizations, it is not exclusive to them.Moving forward, it will be important to streamline and prioritize reporting metrics, ensure adequate resources are available to support accountability and educate users as to the value of reporting accountability activities, by showing them that there is something in it for them. In addition, it is important to encourage coordination and sharing among the multiple bodies that request similar information in different forms. Finally, it is important to ensure that that which is difficult to measure is not lost in the shuffle.L’on a beaucoup insisté sur la responsabilité dans les soins de santé dans toutes les provinces et territoires du Canada. Par le biais de l’utilisation de l'analyse documentaire et des entretiens avec des informateurs clés, nous avons évalué la mesure dans laquelle les résultats de notre étude antérieure basée en Ontario, Approches à la responsabilité, s’appliquaient à travers le Canada. Mise en œuvre de la bonne façon, la responsabilisation peut améliorer la performance, améliorer l'expérience des patients et favoriser une utilisation plus efficace des ressources. Si elle est mal appliquée, elle peut gaspiller des ressources précieuses, créer des effets pervers et encourager le  contournement du système. Les résultats de cette étude ont renforcé les conclusions antérieures. Nos répondants ont souligné qu'il était important de se concentrer sur les objectifs recherchés et les points de transition dans le système; ils ont souligné que les ressources et un leadership stable ont été la clé. Bien que les bonnes mesures soient indispensables, elles ne sont pas toujours disponibles; en conséquence, ce qui est facile à mesurer a tendance à être ce qui est rapporté. Les organisations sont également réticents à être tenus responsables pour ce qu'ils ne peuvent pas contrôler. Ils ont noté que trop d'organisations demandent trop d'indicateurs de formes trop nombreuses. Bien que cette situation soit particulièrement problématique pour les petits organisations, le problème ne les affecte pas exclusivement.À l'avenir, il sera important de rationaliser et prioriserles mesures à la base des rapports, d’assurer que les ressources suffisantes soient disponibles pour appuyer la redevabilité et d’éduquer les utilisateurs quant à la valeur des rapports sur les activités de reddition de comptes, en leur montrant qu'ils y trouveront leur compte. En outre, il est important d'encourager la coordination et le partage entre les multiples organisations qui demandent des informations similaires sous différentes formes. Enfin, il est important de veiller à ne pas perdre de vue ce qui difficilement mesurable

Understanding and Implementing Best Practices in Accountability

There has been much emphasis on accountability in health care in all jurisdictions across Canada. Using document analysis and key informant interviews, we assessed the extent to which the findings from our earlier Ontario-based study, Approaches to Accountability, applied across Canada. Accountability done well improves performance, improves the patient experience and promotes efficient use of resources. If implemented poorly, it can waste valuable resources, create perverse incentives and encourage gaming in the system. The findings of this study reinforced the earlier findings.  Our respondents stressed that it was important to focus on the goals being sought and transition points in the system; they emphasized that resources and stable leadership were key. Although good metrics are essential, they are not always available. Accordingly, what is easily measured tends to be what is reported. Organizations are also reluctant to be held accountable for what they cannot control. They noted that too many organizations are asking for too many indicators in too many forms. Although this is particularly problematic for small organizations, it is not exclusive to them. Moving forward, it will be important to streamline and prioritize reporting metrics, ensure adequate resources are available to support accountability and educate users as to the value of reporting accountability activities, by showing them that there is something in it for them. In addition, it is important to encourage coordination and sharing among the multiple bodies that request similar information in different forms. Finally, it is important to ensure that that which is difficult to measure is not lost in the shuffle. L’on a beaucoup insisté sur la responsabilité dans les soins de santé dans toutes les provinces et territoires du Canada. Par le biais de l’utilisation de l'analyse documentaire et des entretiens avec des informateurs clés, nous avons évalué la mesure dans laquelle les résultats de notre étude antérieure basée en Ontario, Approches à la responsabilité, s’appliquaient à travers le Canada. Mise en œuvre de la bonne façon, la responsabilisation peut améliorer la performance, améliorer l'expérience des patients et favoriser une utilisation plus efficace des ressources. Si elle est mal appliquée, elle peut gaspiller des ressources précieuses, créer des effets pervers et encourager le  contournement du système. Les résultats de cette étude ont renforcé les conclusions antérieures. Nos répondants ont souligné qu'il était important de se concentrer sur les objectifs recherchés et les points de transition dans le système; ils ont souligné que les ressources et un leadership stable ont été la clé. Bien que les bonnes mesures soient indispensables, elles ne sont pas toujours disponibles; en conséquence, ce qui est facile à mesurer a tendance à être ce qui est rapporté. Les organisations sont également réticents à être tenus responsables pour ce qu'ils ne peuvent pas contrôler. Ils ont noté que trop d'organisations demandent trop d'indicateurs de formes trop nombreuses. Bien que cette situation soit particulièrement problématique pour les petits organisations, le problème ne les affecte pas exclusivement. À l'avenir, il sera important de rationaliser et prioriserles mesures à la base des rapports, d’assurer que les ressources suffisantes soient disponibles pour appuyer la redevabilité et d’éduquer les utilisateurs quant à la valeur des rapports sur les activités de reddition de comptes, en leur montrant qu'ils y trouveront leur compte. En outre, il est important d'encourager la coordination et le partage entre les multiples organisations qui demandent des informations similaires sous différentes formes. Enfin, il est important de veiller à ne pas perdre de vue ce qui difficilement mesurable