Healthcare governance in transition: from hospital boards to system boards ... a national survey of chairs of boards

Revisiting Health Regionalization in Canada

Twenty years ago, many of Canada’s provinces began to introduce regional health authorities to address problems with their health care systems. With this action, the provinces sought to achieve advances in community decision-making, the integration of health services, and the provision of care in the home and community. The authorities were also to help restrict health care costs. An assessment of the authorities indicates, however, that over the past two decades they have been unable to meet their objectives. Community representatives continue to play little role in determining the appropriate health services for their regions. Gains have been made towards integrating health services, but the plan for a near seamless set of health services has not been realized. Funding for health services remains focused on hospital and physician care, and health care expenditures have until very recently been little affected by regional authorities. This disappointing performance has caused some provinces to abandon their regional authorities, but this article argues that the provision of greater autonomy and a better public appreciation of their role and potential may lead to more successful regional authorities. Accordingly, the objective of this article is to reveal the shortcomings of regional health authorities in Canada while at the same time arguing that changes can be made to increase the chances of more workable authorities.

An exploration of policy options to assist district health authorities in attending to the health needs of African Canadians: a case study

Purpose

The purpose of this paper is to examine the governing boards responsible for health care in Nova Scotia to determine the extent to which they facilitate and/or impede efforts to attend to the health needs of African Canadians.

Design/methodology/approach

A case study method was employed. Qualitative interview and documentary data were interpreted by means of a hybrid of methods including discourse analysis, thematic analysis, reflexive ethnography and ethnography.

Findings

Key findings from this study suggest that the complex mandate of DHAs, a lack of processes to assess need and limited data (including a lack of research) to support decision‐making contribute to a limited understanding of the health needs of African Canadians among DHA board members and executive management. Policy options include improving access to, and development of, culturally competent health services, conducting research and improving access to data to facilitate decision‐making, and educating board members and executive management about black culture. DHAs need to explore new and innovative ways to engage and include the black community in decision‐making.

Practical implications

Continued public and political emphasis on the maintenance of the acute care system, limited resources devoted to “population health” and internal and external constraints that serve to limit the capacity for health boards to make independent decisions pose significant challenges for DHAs as they seek to fulfill their legislated mandate to improve the health of their catchment population. Policy options are presented to address issues such as research and information management, education and awareness, representation and building meaningful opportunities for inclusion.

Originality/value

There is a dearth of literature examining the roles and responsibilities of governing boards in attending to the health needs of minority populations.