D. David Persaud

Gaining and maintaining commitment to large-scale change in healthcare organizations.

Healthcare administrators have sought to improve the quality of healthcare services by using organizational change as a lever. Unfortunately, evaluations of organizational change efforts in areas such as total quality management (TQM), continuous quality improvement (CQI), and organizational restructuring have indicated that these change programmes have not fulfilled their promise in improving service delivery. Furthermore, there are no easy answers as to why so many large-scale change programmes are unsuccessful. The aim of this analysis is to provide insights into practices that may be utilized to improve the chances of successful change management. It is proposed that in order to effect change, implementers must first gain commitment to the change. This is done by ensuring organizational readiness for change, surfacing dissatisfaction with the present state, communicating a clear vision of the proposed change, promoting participation in the change effort, and developing a clear and consistent communication plan. However gaining commitment is not enough. Many change programmes have been initially perceived as being successful but long-term success has been elusive. Therefore, maintaining commitment during the uncertainty associated with the transition period is imperative. This can be done by successfully managing the transition using action steps such as consolidating change using feedback mechanisms and making the change a permanent part of the organizations culture.

An incremental cost analysis of telehealth in Nova Scotia from a societal perspective

We examined the costs of telehealth in Nova Scotia from a societal perspective. The clinical outcomes of telepsychiatry and teledermatology services were assumed to be similar to those for conventional face-to-face consultations. Cost information was obtained from the Nova Scotia Department of Health, the Canadian Institute for Health Information, and questionnaires to patients, physicians and telehealth coordinators. There were 215 questionnaires completed by patients, 135 by specialist physicians and eight by telehealth coordinators. Patient costs for a face-to-face consultation ranged from

The utilization of systematic outcome mapping to improve performance management in health care

240 to

Management competencies for Canadian health executives: views from the field.

1048 (all costs in Canadian dollars), whereas patient costs for telehealth were lower, from

Diagnosing and improving functioning in interdisciplinary health care teams

17 to

Creating a culture of accountability in health care

70. However, from a societal perspective, the overall cost of providing face-to-face services was lower than for telehealth: the total costs for face-to-face services ranged from

Running to stand still: change and management in Canadian healthcare.

325 to

Enhancing vision care integration: 1. Development of practice algorithms

1133, while the total costs for telehealth services ranged from

Restructuring the Healthcare Management Paradigm: Toward Organic Management:

1736 to

Cross-national comparison of capitation funding: the American, British and Dutch experience

28,084. A threshold analysis showed that, above a certain patient workload, telehealth services would be more cost-effective than face-to-face services from a societal perspective. This workload is attainable in Nova Scotia.