John Church

Square Pegs in Round Holes The Relative Importance of Traditional and Nontraditional Scholarship in Canadian Universities

In May 2003 all university faculties of medicine, health sciences, nursing, business, and public administration in Canada were surveyed to document whether their promotion practices gave equal treatment to researchers with traditional disciplinary-based scholarly outputs versus those with nontraditional outputs flowing from an applied interest in interdisciplinary research, collaboration with nonacademics, and knowledge transfer. Forty-seven deans (response rate = 67 percent) and thirty-two promotion committee members (response rate = 51 percent) consistently rated research as more important than teaching and community service in promotion proceedings. Furthermore, in their considerations of research they accorded significantly more value in promotion to traditional than to nontraditional scholarly outputs. Among the deans, for example, the top ten ranked activities included seven traditional research outputs, two teaching-related outputs, and only one nontraditional research output. Scholars with nontraditional outputs were slightly less disadvantaged in health-related faculties compared to the nonhealth faculties. Despite broader acceptance of an evolving research landscape in Canadian universities, current reward structures may create barriers for academics interested in conducting nontraditional research characteristic of the emerging paradigm of applied scholarship.

Shifting the lens: The introduction of population-based funding in Alberta

This paper offers a detailed historical description of the development of Albertas population-based funding model for Regional Health Authorities (RHAs). It focuses on key political factors that may have facilitated this transition — in particular, the role of institutions, organized interests, and ideas and values. Understanding the politics of policy change as exemplified in this case can be useful in assessing future prospects for health system reform in Canada and laying the groundwork for further comparative study.

Development and Application of a Framework for Analyzing the Impacts of Urban Transportation

To adequately analyze the impacts associated with the rising use of automobiles, an assessment framework is needed that includes environment, health, economic, and sociocultural impacts. Such a framework was developed and applied to a proposed freeway-widening project in Edmonton, Canada. The assessment framework was developed using both Multi-Criteria Analysis and the Ecosystem Approach to Human Health (Ecohealth). Community participation was vital in the application of the assessment framework to this case study. Six stakeholder groups, including community members, City Councillors, and health, environment, and transportation experts, provided needed qualitative data for the assessment framework. Quantitative data were gathered from an ecological study design that associated traffic volumes with respiratory conditions in Edmonton. Community members’ perceptions about the impacts of the freeway widening differed from those of the expert groups in a number of areas. Environmental and health degradation was more of an issue to community members than to expert groups. Though respiratory conditions were not projected to increase by a significant amount because of the freeway widening, further analysis is necessary on other biophysical and socioeconomic impacts listed in the assessment framework. The divergence in opinion between community members and experts suggests that more communication is needed between these groups in relation to transportation planning. The Ecohealth approach ensures that community concerns are addressed in transportation planning.

Cross-ministerial collaboration related to paediatric rehabilitation for children with disabilities and their families in one Canadian province.

The delivery of paediatric rehabilitation services is complex due to the involvement of different service sectors and diverse models of care. Parents of children with disabilities find it challenging to navigate successfully through complicated service delivery systems. Cross-sectoral collaboration to improve continuity of care for children with disabilities and their families is viewed as ideal in public policies. The purpose of this research was to explore how ministerial cultures, processes and structures influence inter-ministerial collaboration for the purpose of enhancing continuity of care for children with disabilities and their families in a Western Canadian province. Six key informants from three government Ministries that funded paediatric rehabilitation services participated in individual, semi-structured interviews between January and May of 2007. Nineteen provincial public policy documents were reviewed. Halls framework guided the analysis of the key informant interviews and policy documents. Influences of organisational culture, processes and structures on cross-ministerial collaboration were classified into the categories of ideas-values and beliefs that underlie policy development, interests-influence of various policy actors and institutions-structures and processes used to deliver public policy. Fundamental ideological and structural differences were apparent across the three ministries that affected the ease of inter-ministerial collaboration towards ensuring continuity of care for children with disabilities. Variations in ideas (philosophy and values) and institutions (geography and service delivery structure, relationships with regional governance, mission and function, choice of policy instruments and financial processes) are presented and implications for service delivery are explored.

Pursuing Enterprise Risk Management: A Local Road Map for Canadian Healthcare Leaders

An in-depth analysis of organizational risk management in healthcare, and in particular the concepts of Enterprise Risk Management (ERM), has identified a 5-part model that can be used by Canadian healthcare leaders as an evidence-supported approach to successful organizational risk management. The Model for Organizational Risk Management, termed “the Model,” has been developed as a basis for linking the components of an ERM Framework into a Canadian health organization to overcome the barriers that commonly disrupt strategic risk management. The Model addresses how an ERM Framework can fit within an existing health organization by building off and enhancing existing processes and resources to ensure familiarity, acceptance, and sustainability of the risk management program. By approaching the Model in a stepwise fashion (based on individual organizational context), healthcare leaders are provided with a road map from which to advance their own organizational risk management program.

Neoliberalism and Accountability Failure in the Delivery of Services Affecting the Health of the Public

Since the 1980s, the emergence of neoliberalism as a dominant government paradigm has led to increasing instances of accountability failure, resulting in significant injuries or death. Employing a grounded theory approach, accountability failure is defined and explored through analysis of 18 public inquiries and reports in the United Kingdom and Canada. The analysis reveals that the combination of a neoliberal policy paradigm and flawed regulation, governance, culture, and performance management inevitably led to accountability failure. Neoliberal policies have precipitated uncoordinated and underfunded regulatory regimes, an oppressive culture focused on financial efficiency at the expense of quality, self-serving and willfully blind governance, and underfunded and inadequate tools for measuring performance. The evidence suggests that organizations have not learned from each other within or between countries, revealing a pattern of accountability failure in which citizens are placed at risk in their communities and hospitals for preventable injury or death within an increasingly politicized government and leadership environment.

Improving Physician Accountability Through Primary Care Reform in Alberta

Like other Canadian provinces and territories, Alberta has been attempting to reform primary care since the mid-1990s. Although initially these efforts were focused almost exclusively on the method of payment for physicians, since 2003, the focus of government policy has broadened to include other aspects of practice, including governance and accountability, improved continuity, the use of a team-based approach and the use of electronic information systems. Although significant progress has been made, Alberta continues to face challenges.