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Message from the Managing Editor
Healthcare Management FORUM Gestion des soins de sante Volume 6, No. 2/Volume 6, N o 2 Table of Contents/ Sommaire Original Articles/ Articles originaux 5 Governance of Hospitals in Canada: A Survey of Business LeadersWho Serve as Hospital Trustees by Francis W.H. Brunelle, FCCHSE 9 La gestion hospitaliere au Canada : Une enquite aupres de responsables d' entreprise membres du conseil d'administrationd'un hdpital par Francis W.H. Brunelle, FCCDSS 13 Toward NationalHealth System Guidelines in Canada: Reflections of a Comprehensive Audit by Denis H.J. Caro, CHE 23 Health Work Force Planning in the 9Os, Part II: Enough in the Right Place at the Right Time? by Linda A. Turner, Truls 0stbye and Linda L. Pederson 31 Health Care Managers in British Columbia, Part II: Exploring Future Directions by Arminee Kazanjianand Nino Pagliccia
Brief Reports/ Rapports sommaires 39 Policies and Procedures for Managing Stress in the Workplace: How Health Care OrganizationsCompare by Robert Loo 45 Change or Business as Usual? A Challenge for Health Care LeadersContemplatingTotal Quality Management by Jon R. Skakl, CHE and Paul Collins
Invited Essay/Disserta tion 49 Those Who Repeat History are Doomed to Condemn It by Dennis R. Timbrell 55 Book ReviewlCritique 5 7 Correspondence/ Conespondance 60 Executive Challenge/ Defi aux directeurs
Message from the Managing Editor A new paradigm for managing health care delivery in Canada is beginning to take shape. FORUMVolume 6, No. 2 contains articles that focus on current issues in the politics and economics of health reform. Recent developments in New Brunswick and Saskatchewan indicate that local boards have attracted considerable attention as provincial governments leverage the process of reform in health services. In our lead article, Francis Brunelle reports on a survey of business leaders who serve as hospital trustees. The survey results are discomforting. Many trustees experience frustration in addressing the complexities of medical politics and they also feel inadequately prepared to make decisions on the quality of care. Brunelle's findings give cause for reflection, as new and significant responsibilities are being placed on boards under regional systems of organization. Denis Car0 presents the results of a review of the Health Program Guidelines established by Health and Welfare Canada to serve as a clinical planning and health services management resource. This comprehensive assessment reveals that the current set of guidelines have limited management relevance and have not kept pace with many of the changes occurring in Canadian health services. Value-for-money issues were also a major concern. New Health Program Guidelines have been recommended, based on a systems perspective and a recognition of the shift in organizational focus away from discipline-basedand functional departments to more programmatic management structures. Implicit in Caro's analysis is whether resources ought to be invested in the development of national guidelines in the absence of a definitive federal agenda for health care. Linda Turner, Truls 0stbye and Linda Pederson continue their discussion of health care human resources. The first part of their article, which appeared in FORUMVolume 6, No. 1, examined the issue of supply problems and the need for policy responses based on needs. In part two, the authors discuss issues related to the deployment of health personnel. This is a timely contribution to FORUM. Health reform initiatives across the country are grappling with the sensitive issues of labour force adjustment, the distribution of physicians and the involvement of new professional providers. In the second part of an article describing the socio-demographicand employment characteristics of health managers in British Columbia, Arminee Kazanjian and Nino Pagliccia focus on
Gestion des soins de sante
knowledge competencies and skill sets necessary for effective management. Although their study was completed prior to the reforms that have been announced in British Columbia, the knowledge and skill items ranked most highly by respondents to their survey fit much of the future executive leadership profile. In our Brief Report section, Robert Loo reports on research into the management of stress in the workplace. Over half of the health care organizations included in Loo's study have employee policies for managing stress. He suggests that more can be done to address the problem. This is a critical issue because the stressors in health care have substantially increased over the past two years. Downsizingand restructuringactivity has resulted in heavier workloads, worries about job loss and a general climate of uncertainty. The health care industry in Canada is beginning to embrace the concepts of total quality management with enthusiasm and vigour. Jon Skafel and Paul Collins strike a cautionary note about the introduction of total quality into health care organizations. Their Brief Report reminds us that strong leadership commitment at the top is a prerequisite to successful implementation. As the authors observe, a shift in focus to total quality management also requires a corresponding change in corporate culture and in business strategy. Decentralizationis among the most controversial of our political issues. In a thoughtful Invited Essay, Dennis Timbrell, President of the Ontario Hospital Association, traces the development of health services in Canada. Through this retrospective, he argues that past experience with regional corporate management structures underscores the need to resolve delegation of decision-making and discretionary power. Many would agree with Mr. Timbrell's observation that there are inherent risks in making change strictly on the basis of fiscal necessity rather than on the principles of good planning. This issue of FORUMconcludes with all of our regular features: a book review, Executive Challenge and correspondence. FORUM welcomes your contributions and your opinions. The need to communicate the value of good management has never been greater.
Randall R. Steflan, MPA, CHE, Vice-president, Communications and Member Services
1
Brief Reports/ Rapports sommaires 39 Policies and Procedures for Managing Stress in the Workplace: How Health Care OrganizationsCompare by Robert Loo 45 Change or Business as Usual? A Challenge for Health Care LeadersContemplatingTotal Quality Management by Jon R. Skakl, CHE and Paul Collins
Invited Essay/Disserta tion 49 Those Who Repeat History are Doomed to Condemn It by Dennis R. Timbrell 55 Book ReviewlCritique 5 7 Correspondence/ Conespondance 60 Executive Challenge/ Defi aux directeurs
Message from the Managing Editor A new paradigm for managing health care delivery in Canada is beginning to take shape. FORUMVolume 6, No. 2 contains articles that focus on current issues in the politics and economics of health reform. Recent developments in New Brunswick and Saskatchewan indicate that local boards have attracted considerable attention as provincial governments leverage the process of reform in health services. In our lead article, Francis Brunelle reports on a survey of business leaders who serve as hospital trustees. The survey results are discomforting. Many trustees experience frustration in addressing the complexities of medical politics and they also feel inadequately prepared to make decisions on the quality of care. Brunelle's findings give cause for reflection, as new and significant responsibilities are being placed on boards under regional systems of organization. Denis Car0 presents the results of a review of the Health Program Guidelines established by Health and Welfare Canada to serve as a clinical planning and health services management resource. This comprehensive assessment reveals that the current set of guidelines have limited management relevance and have not kept pace with many of the changes occurring in Canadian health services. Value-for-money issues were also a major concern. New Health Program Guidelines have been recommended, based on a systems perspective and a recognition of the shift in organizational focus away from discipline-basedand functional departments to more programmatic management structures. Implicit in Caro's analysis is whether resources ought to be invested in the development of national guidelines in the absence of a definitive federal agenda for health care. Linda Turner, Truls 0stbye and Linda Pederson continue their discussion of health care human resources. The first part of their article, which appeared in FORUMVolume 6, No. 1, examined the issue of supply problems and the need for policy responses based on needs. In part two, the authors discuss issues related to the deployment of health personnel. This is a timely contribution to FORUM. Health reform initiatives across the country are grappling with the sensitive issues of labour force adjustment, the distribution of physicians and the involvement of new professional providers. In the second part of an article describing the socio-demographicand employment characteristics of health managers in British Columbia, Arminee Kazanjian and Nino Pagliccia focus on
Gestion des soins de sante
knowledge competencies and skill sets necessary for effective management. Although their study was completed prior to the reforms that have been announced in British Columbia, the knowledge and skill items ranked most highly by respondents to their survey fit much of the future executive leadership profile. In our Brief Report section, Robert Loo reports on research into the management of stress in the workplace. Over half of the health care organizations included in Loo's study have employee policies for managing stress. He suggests that more can be done to address the problem. This is a critical issue because the stressors in health care have substantially increased over the past two years. Downsizingand restructuringactivity has resulted in heavier workloads, worries about job loss and a general climate of uncertainty. The health care industry in Canada is beginning to embrace the concepts of total quality management with enthusiasm and vigour. Jon Skafel and Paul Collins strike a cautionary note about the introduction of total quality into health care organizations. Their Brief Report reminds us that strong leadership commitment at the top is a prerequisite to successful implementation. As the authors observe, a shift in focus to total quality management also requires a corresponding change in corporate culture and in business strategy. Decentralizationis among the most controversial of our political issues. In a thoughtful Invited Essay, Dennis Timbrell, President of the Ontario Hospital Association, traces the development of health services in Canada. Through this retrospective, he argues that past experience with regional corporate management structures underscores the need to resolve delegation of decision-making and discretionary power. Many would agree with Mr. Timbrell's observation that there are inherent risks in making change strictly on the basis of fiscal necessity rather than on the principles of good planning. This issue of FORUMconcludes with all of our regular features: a book review, Executive Challenge and correspondence. FORUM welcomes your contributions and your opinions. The need to communicate the value of good management has never been greater.
Randall R. Steflan, MPA, CHE, Vice-president, Communications and Member Services
1