Pat Armstrong’s 15 minute talk encourages us to consider the structure and process’ of long term care (nursing homes). It shines a light to help us think about the role of “profit” in health care, and perhaps find our own ways to participate in decision making where ever each of us fits in our system of care.
The 2016/17 Annual Report and website of the Ontario Patient Ombudsman who is mandated to:
… champion for fairness in Ontario’s health sector organizations defined as public hospitals, long-term care homes and home and community care services coordinated by the Local Health Integration Networks (LHINs, formerly CCACs).
It would be useful to hear from practitioners/clients their local experience here in Ottawa as this new initiative has great potential to contribute to care change/improvements.
…we are asking patients and caregivers to continue to be fearless in bringing their complaints to our office and for health sector organizations to be fearless in working with us to help improve Ontario’s healthcare system.
See the report here:https://patientombudsman.ca/About-Us/Patient-Ombudsmans-Message
The Centre for Urban Studies via http://stmichaelshospitalresearch.ca/research-programs/urban-health-solutions/our-projects/building-healthy-policy-and-practices/increasing-collaboration-within-governments-to-improve-population-health-and-equity/ supports linking of policy to practice. One example of their efforts focus’ specifically on policy development within government itself, providing this paper below.
Using Win-Win Strategies to Implement Health in All Policies: A Cross-Case Analysis –http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0147003
- Agnes Molnar,
- Emilie Renahy,
- Patricia O’Campo,
- Carles Muntaner,
- Alix Freiler,
- Ketan Shankardass
Our results yielded no support for the use of awareness-raising or directive strategies as standalone approaches for engaging partners to implement HiAP. However, we found strong evidence that mechanisms related to “win-win” strategies facilitated implementation by increasing perceived acceptability (or buy-in) and feasibility of HiAP implementation across sectors. …
Win-win strategies were facilitated by mechanisms related to several activities, including:…
- the development of a shared language to facilitate communication between actors from different sectors;
- integrating health into other policy agendas (eg., sustainability) and use of dual outcomes to appeal to the interests of diverse policy sectors;
- use of scientific evidence to demonstrate the effectiveness of HiAP;
- and using health impact assessment to make policy coordination for public health outcomes more feasible and to give credibility to policies being developed by diverse policy sectors. …
I’ve been following the research of Judy Foster – who has been a leader in England on social work role in mental health. She takes both a psychodynamic and systems approach and has been involved at leadership levels of training for the practice end of mental health for decades.
She later shifted focus to research and a phd thesis which incorporates the everyday experience of: individual social workers within team as well as the context of the organization and its position in responding to government policy in the broader systems of care. Foster, Judy (2009) Thinking on the Front Line: Why some social work teams struggle and others thrive.
She also wrote a book on this https://www.amazon.com/Building-Effective-Social-Work-Teams/dp/1472480821
See more about the actual thesis here: http://drjudyfoster.blogspot.ca/
I thought, the above self questionnaire with its questions on the 5 factors that contribute to effective social work teams, will encourage us to reflect and assess as individuals within yea old system.
This article revisits how workers and organizational systems engage in practice change. It is rich with practical snapshots of individual perspectives from all levels of an organization. It brings a refreshing approach to the front line engaging in organizational… Vision and practice change.
- a voice at the table;
- interesting and relevant problem;
- shared vision and decision making
For me, especially exciting to see in discussion the endorsement of engaging practitioners themselves to contribute to the research on practice as a way to engage.
… The theme individual participation reflects the definition of medical engagement put forth by Spurgeon et al. (, p. 214): “the active and positive contribution of doctors within their normal working roles to maintaining and enhancing the performance of the organisation.” It is also consistent with the CFIR  domain characteristics of individuals and the multidimensional employee engagement construct from organizational research, which represents the notion of an individual being engaged in change [23, 24, 25, 26]. In contrast, stakeholders in our study predominantly referred to the action of engaging others (with the goal for individuals to be engaged) . This is an important distinction because it implies that engagement is a process or series of actions (arguably, an intervention) and an antecedent to engagement (as a state of being or mechanism). Engagement is not static but rather a process that requires cultivation over time. Like the predominant discourse throughout the implementation science literature, engagement was seen by stakeholders as inviting people to come together to participate across phases of healthcare improvement, from early priority setting to sustainment of initiatives. …
How do stakeholders from multiple hierarchical levels of a large provincial health system define engagement? A qualitative study
Lynn Sherwood’s article in Eastern OASW Summer Bulletin helps us step back, consider how we can say out loud “…the Emperor has no clothes.” She outlines the context for the individual worker within the organization and… the context of the organization in the system of care.
…It wasn’t supposed to be like this. The profession of social work began back at the turn of the twentieth century as a response to poverty and to the terrible living conditions of new immigrants to Canada. The agencies and organizations we work for have never been affluent, and we have never represented much more than a finger in the dyke, holding back the rising tides of human misery. This knowledge goes with the territory. Our focus on the relationship between individuals and their social environment, on advocacy for social change, has always been fundamental to our profession. However, in recent years ostensibly laudable expectations of efficiency, effectiveness, accountability, measurable outcomes, have devolved into an uncomfortable acceptance of “The Business Model” of providing social services, leaving us struggling to function in impossible, contradictory situations. …
See the article here https://www.oasw.org/Public/About_OASW/Eastern_Branch.aspx (scroll down to the newsletters, open then go to page 20)
From the journal of Implementation Science, https://implementationscience.biomedcentral.com/articles/10.1186/s13012-017-0607-7
…In this paper, we propose the use of architectural frameworks to develop LHSs that adhere to a recognized vision while being adapted to their specific organizational context. Architectural frameworks are high-level descriptions of an organization as a system; they capture the structure of its main components at varied levels, the interrelationships among these components, and the principles that guide their evolution.