Management challenges in British Columbia's healthcare system

Purpose The purpose of this paper is to identify the operational and management challenges in a globally budgeted, regionalized healthcare system and their implications for public service. Design/methodology/approach Concentrating on British Columbia's regional health authorities (RHAs) and hospitals, this study utilized data from interviews of key informants, documents (histories, legislation, agreements between RHAs and provincial government, and RHA organizational charts), news reports, and participant observation at board meetings. Findings Challenges encountered by the managers include accommodating powerful stakeholders (elected officials, providers, and organized publics), adhering to fixed budgets, obtaining capital from public sources, and adjusting to government turnover. In response, the managers engage in balancing priorities of stakeholders, shifting of resources within and across sites and operating units, and working strategically with the capital allocation process. Responses of managers to these challenges have promoted stability but raise concerns about attaining the system's goals. Practical implications Management challenges and potential patterns of response should be considered in assessing the options for health system reforms. Many countries periodically reorganize their healthcare systems, and recognition of potential management challenges can contribute to the achievement of objectives sought in these reforms. Originality/value Although studies have demonstrated that management affects the implementation of public programs in several areas, little research has focused on the relationships between features of health systems, management responses, and potential outcomes.