New structures for challenges in healthcare management.

Government initiatives aimed at improving the healthcare available to Canadians pose a significant challenge to leaders responsible for developing and implementing strategies to translate these initiatives into reality. This article presents a new approach to management structures and processes designed to address this challenge. The approach includes new senior leadership skills focusing on collaboration and influence, functional rather than hierarchical teams, and clarity in team mandates and team empowerment to facilitate achievement of expectations.

Implementing a physician leader compensation program at a major community hospital.

The roles of physician leaders in Canadian hospitals and health regions are becoming more complex and time consuming. Physician leaders are increasingly being seen by hospital boards and executives as key to achieving strategic and operational outcomes. Given the growing importance of these roles and the increasing performance expectations being placed on physician leaders, it is critical that organizations are able to recruit and retain individuals who demonstrate the skills required to fulfill these critical roles or commit themselves to acquiring them.

Individual pay-for-performance in Canadian healthcare organizations.

Pink et al. discuss some of the issues related to pay-for-performance for individual and organizational healthcare providers. This commentary addresses key success factors for the implementation of individual pay-for-performance in publicly financed Canadian healthcare organizations. Publicly financed healthcare organizations in Canada have been relatively slow to adopt performance-pay programs as compared with private sector organizations; and those that have been developed have been, for the most part, rather crude. In many cases, they have become an additional mechanism for delivering base pay, rather than a true variable-pay program that motivates and differentiates performance. In light of the many issues that need to be addressed, we feel that pay-for-performance should be introduced gradually, beginning at the most senior levels of the organization. Above all, it is critical for publicly financed healthcare organizations to recognize that introducing pay-for-performance involves not only a set of structures and processes, but also likely a profound change in organizational values and behaviours.

Paying for institutional quality: reaching the limits of funding policy?

As a recent issue of the Longwoods journal, HealthcarePapers (Vol. 6, No. 4), indicates, interest in pay-for-performance incentives is on the increase in both the US and Canada. Weighing in on the topic, the authors suggest that the heightened emphasis on quality and patient safety are two primary drivers.

Issues in the governance of Canadian hospitals III: Financial oversight.

This is the third in a series of articles examining governance in Canadian hospitals. These articles draw upon experiences gained from operational reviews of hospitals across Canada to suggest approaches to building more effective hospital governance.

Issues in the governance of Canadian hospitals, Part II: Hospital planning.

A hospital's board is directly accountable to the corporation of the hospital. Together they are accountable to the patients and communities served by the hospital, to the provincial government that funds the hospital on behalf of these patients and communities, and to the staff of the hospital. Thus, the board of trustees has a critical role in defining the purposes, principles and objectives of hospitals.

Issues in the governance of Canadian hospitals, Part 1: Structure and process.

Boards that develop robust structures and processes for governing their hospitals lay the foundation for: Long-range success. Responsible fiscal stewardship. Provision of a high quality of care. Effective governance will facilitate and enhance a board's advocacy for the hospital. In upcoming articles, we will examine these three remaining elements of effective governance in greater detail.

Issues in the governance of Canadian Hospitals IV: quality of hospital care.

The quality of hospital services is a fundamental responsibility of governance. This responsibility can be thought of in terms of three components: monitoring the quality of services; ensuring that management processes are in place to measure, monitor and maintain quality of services; and ensuring quality in all aspects of hospital operations.