Fellowship Program in Health System Improvement: A novel approach integrating leadership development and patient-centred health system transformation.

This article highlights a novel approach to professional development, integrating leadership, development and patient-centred health system transformation in the new Fellowship Program in Health System Improvement offered by the School of Public Health at the University of Alberta. Early assessment of the program is also provided.

The comparative performance of the Canadian and Australian health systems.

Using three data sets, each providing an overview of health service delivery in high-income countries, this article provides a high-level comparative analysis of health system performance against specified key performance indicators in two jurisdictions: Canada and Australia. Several variations, nuances, and points of comparison between delivery and organization of care are discussed. The article examines three policy and structural differences that may help explain the comparatively superior performance of the Australian system on most indicators, and two key areas of improvement for the Canadian system were illuminated: a stronger central government role and a national pharmaceutical plan. It is hoped that this article will empower health leaders to take action in these areas.

To fund or not to fund: development of a decision-making framework for the coverage of new health technologies.

BACKGROUND: Attempts to improve the acceptability of resource allocation decisions around new health technologies have spanned many years, fields and disciplines. Various theories of decision making have been tested and methods piloted, but, despite their availability, evidence of sustained uptake is limited. Since the challenge of determining which of many technologies to fund is one that healthcare systems have faced since their inception, an analysis of actual processes, criticisms confronted and approaches used to manage them may serve to guide the development of an 'evidence-informed' decision-making framework for improving the acceptability of decisions. OBJECTIVE: The purpose of this study was to develop a technology funding decision-making framework informed by the experiences of multiple healthcare systems and the views of senior-level decision makers in Canada. METHODS: A 1-day, facilitated workshop was held with 16 senior-level healthcare decision makers in Canada. International examples of actual technology funding decision-making processes were presented. Participants discussed key elements of these processes, debated strengths and weaknesses and highlighted unresolved challenges. The findings were used to construct a technology decision-making framework on which participant feedback was then sought. Its relevance, content, structure and feasibility were further assessed through key informant interviews with ten additional senior-level decision makers. RESULTS: Six main issues surrounding current processes were raised: (i) timeliness; (ii) methodological considerations; (iii) interpretations of 'value for money'; (iv) explication of social values; (v) stakeholder engagement; and (vi) 'accountability for reasonableness'. While no attempt was made to force consensus on what should constitute each of these, there was widespread agreement on questions that must be addressed through a 'robust' process. These questions, grouped and ordered into three phases, became the final framework. CONCLUSIONS: A decision-making framework informed by processes in other jurisdictions and the views of local decision makers was developed. Pilot testing underway in one Canadian jurisdiction will identify any further refinements needed to optimize its usefulness.

Health technology funding decision-making processes around the world: the same, yet different.

All healthcare systems routinely make resource allocation decisions that trade off potential health gains to different patient populations. However, when such trade-offs relate to the introduction of new, promising health technologies, perceived 'winners' and 'losers' are more apparent. In recent years, public scrutiny over such decisions has intensified, raising the need to better understand how they are currently made and how they might be improved. The objective of this paper is to critically review and compare current processes for making health technology funding decisions at the regional, state/provincial and national level in 20 countries. A comprehensive search for published, peer-reviewed and grey literature describing actual national, state/provincial and regional/institutional technology decision-making processes was conducted. Information was extracted by two independent reviewers and tabulated to facilitate qualitative comparative analyses. To identify strengths and weaknesses of processes identified, websites of corresponding organizations were searched for commissioned reviews/evaluations, which were subsequently analysed using standard qualitative methods. A total of 21 national, four provincial/state and six regional/institutional-level processes were found. Although information on each one varied, they could be grouped into four sequential categories: (i) identification of the decision problem; (ii) information inputs; (iii) elements of the decision-making process; and (iv) public accountability and decision implementation. While information requirements of all processes appeared substantial and decision-making factors comprehensive, the way in which they were utilized was often unclear, as were approaches used to incorporate social values or equity arguments into decisions. A comprehensive inventory of approaches to implementing the four main components of all technology funding decision-making processes was compiled, from which areas for future work or research aimed at improving the acceptability of decisions were identified. They include the explication of decision criteria and social values underpinning processes.

Health system organization and governance in Canada and australia: a comparison of historical developments, recent policy changes and future implications.

The Canadian and Australian health systems have evolved in very similar ways. Recent policy changes in each country, however, suggest a growing divergence with respect to governance. This paper traces the origins and key milestones in the evolution of governance models, with a selective focus on two provinces in Canada (Saskatchewan and Alberta) and the state of New South Wales in Australia. While divergent models seem to be manifesting, many similar underlying features remain. We assess these developments and comment on the current patterns of organization and governance, both to provide insights on future directions and to suggest what the two countries might learn from each other.

Preparing health science students to be effective health care team members: the InterProfessional Initiative at the University of Alberta.

The InterProfessional Initiative at the University of Alberta in Edmonton, Alberta, Canada, provides learning strategies to be effective health care team members for over 800 undergraduate students in 14 health professions. This paper traces the evolution of the initiative over the past decade and describes future directions. Particular attention is given to the administrative and academic structures and processes required to launch, develop and sustain an initiative of this scale in a major research-intensive university. The paper concludes by reviewing the evaluative work underway and reflecting on the key success factors.