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How to Achieve Meaningful Change.

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  • 1Professor Emeritus, Dalla Lana School of Public Health, University of Toronto, Founding Director, North American Observatory on Health Systems and Policies, Toronto, ON.

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Summary

Delegating health human resource management, including physician pay, to health authorities can improve accountability and performance. This incremental change offers significant promise for enhancing health system management.

Area of Science:

  • Health Services Management
  • Public Health Policy
  • Organizational Change in Healthcare

Background:

  • Provincial governments have delegated health system management to health authorities over the past 40 years.
  • Frequent structural changes in health authorities, particularly centralization, have caused significant disruption.
  • Further major organizational changes could exacerbate current instability.

Purpose of the Study:

  • To evaluate the potential benefits of delegating additional responsibilities to health authorities.
  • To explore an incremental approach to improving health system performance and accountability.

Main Methods:

  • Analysis of organizational changes in health authorities over four decades.
  • Assessment of the impact of administrative centralization on health systems.

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  • Conceptual framework for delegating health human resource management.

    • Main Results:

    • Delegating the payment and management of health human resources, including physician remuneration and bargaining, is proposed.
    • This delegation represents an incremental change rather than a major overhaul.
    • The proposed change holds significant promise for enhancing accountability.

    Conclusions:

    • Despite potential short-term upheaval, delegating health human resource management to health authorities is recommended.
    • This strategic delegation can improve overall health system performance.
    • Incremental changes in responsibility can lead to substantial improvements in healthcare governance.