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Institute of Public Administration of Canada Toronto Region. Is There Accountability in Health Care? A Governance Perspective on Systemic Reform. Notes for a presentation by Denis Desautels, OC, FCA Centre on governance University of Ottawa April 4, 2003 .
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Institute of Public Administration of Canada Toronto Region Is There Accountability in Health Care? A Governance Perspective on Systemic Reform Notes for a presentation by Denis Desautels, OC, FCA Centre on governance University of Ottawa April 4, 2003
Outline of Presentation • Recent trends in governance and accountability • Health Care: an enormous governance challenge • The current delivery system • Why Canadians want accountability • Gaps and obstacles • Avenues for improvement • Conclusions
Defining Governance Governance is the framework of practices and structures which govern decision making and implementation in organizations and structures where power and information are shared. This applies to a country, a society or an organization be it private, public or civic.
Defining Governance (cont’d) • From the more simple to the very complex • A private corporation • A public company • A state-owned corporation • A hospital • A ministry • A health care system
Evolution of Governance in the Public Sector • Factors which encouraged innovation • Globalization • Technology • Horizontal management • Factors which imposed innovation • Crisis in public finances • Political ideology
Evolution of Governance in the Public Sector (cont’d) • General direction (attributes of new systems or models of governance) • Less hierarchial • More inclusive • More distributed • More horizontal • Decentralization and empowerment
Accountability and Governance • Good governance is not an end in itself • Good governance contributes to effective accountability • Effective accountability leads to superior performance, but: • Governance and accountability are becoming more complex
Impact of this Evolution on Accountability • Modularity and need for coherence between accountability and management systems • Less hierarchical accountability (more between equals) • Emphasis on results • Shared accountability • Can lead to better accountability • Need for experimentation and learning • “Soft” accountability
Governance & Accountability in Health Care • The public interest challenge is accountability to Canadians: • A conceptual challenge • High public expectation for information on the state of the health care system
Governance & Accountability In Health Care, being accountable to Canadians raises questions: • Canadians as stakeholders in society? >>access/coverage/equity • Canadians as users of health care system? >>performance • Canadians as taxpayers? >>spending
Do we have Accountability?Gaps and Obstacles • Data Gathering • Coordination • Incentives • Legislation • Funding and increasing costs • Acceptance of open evaluation
Avenues for improvement • Committing to accountability and transparency • Building the foundation for accountability • Technology • Service integration • Joint oversight
Conclusions • Resolving F/P/T tensions • Providing accountability to the public • Meeting the true challenge of creating a continuum of services locally