The dissertation discusses the provision of mental health care delivery by the Government of British Columbia, and the role and focus of Riverview Hospital in a changing organizational environment. The developing policy of regional and community service necessitates reorganization of the hospital's programs, in order to integrate and coordinate the components of the system. The question of the optimal organization for delivery of service in Riverview is examined through a discussion of the theoretical background for the provision of care to the mentally disordered, the development of mental health services in the province, and the alternatives and externalities which impinge on the provision and operation of the hospital's services. The intra-hospital planning, designed to effect an organizational response to environmental pressures, is outlined. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

During the past five (5) to seven (7) years, the American hospital literature has reflected a growing interest in the concept of Risk Management. Today, Risk Management, as an administrative control mechanism, is well established in many hospitals in the United States. Risk Management focuses on a system of identifying, monitoring and taking corrective action for potential or actual problems (the risks) that may result in unwarranted and unplanned personal injury, property damage, or other form of loss. Ultimately, Risk Management is concerned with the hospital's overall objectives of providing safe, quality patient care while using available resources efficiently. The expression, Risk Management, has not been defined with any regularity or consistency with respect to British Columbia Acute Care Hospitals. A generalized concept of protection against risks has been evident for many years, although in Canada (and specifically, British Columbia), it has been approached functionally. For example, hospital administrators have been accustomed to providing a safe and secure environment through such means as guidelines, accreditation standards and quality assurance. In addition, they are obligated to consider legal issues relating to hospital care and to obtain appropriate insurance coverage for the various types of losses the hospital might be exposed to. A new interest in Risk Management appears to represent a possibly defensive position taken by those who anticipate increasing amounts of risk and subsequent litigation. The question to be studied in this paper is whether there is any need for British Columbia Acute Care Hospital Administrators to move from their present rather pragmatic decision-making process for problem solving in selected areas to the more assertive and defensive approach of Risk Management. The answers were be sought by: 1. Reviewing the pertinent American literature on risk management. 2. Considering whether this presented an applicable approach to the British Columbia situation by: a. reviewing pertinent Canadian (and specifically British Columbian) literature on the same topic. b. reviewing Canadian (and specifically British Columbian) health services against their ideological background. 3. Discussing selected Risk Management considerations with: a. British Columbia legal experts in the health field. b. British Columbia insurance experts in the health field. 4. Discussing selected Risk Management considerations vis a vis present practices and procedures with hospital administrators (at senior and department head level) in two (2) British Columbia Community General Hospitals and covering three (3) hospital departments. The information collected from these interviews was presented in a case study format. The discussions focus on the major differences between the Canadian and American hospital industries. In addition, the variances between the findings in the literature review and the responses by the case study participants will be described. The analysis will draw conclusions about the need for British Columbia hospital administrators to change their present practices and move to a system of Risk Management. Recommendations for planning the introduction and evaluation of Risk Management in British Columbia Acute Care Hospitals are presented at the end of the study. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

The purpose of this study was to provide a descriptive data base of the current status of nursing organizational structures and decentralization of decision-making mechanisms in acute care hospitals in British Columbia(BC). Data were gathered by means of a written questionnaire, developed by the investigator, mailed to the Chief Nurse Administrator(CNA) of all 94 eligible hospitals. Computer and manual analysis of the 62 responses provided information about the demographic characteristics of the institution, the nursing organization, and the CNA; and about elements of the nursing organizational structure related to system of care delivery, information systems, organizational decision making, participatory management strategies, and factors impeding decentralization activities. Additional information about management education and union status of head nurses, provision of education bursaries for staff, and need for comparative resurveys was also sought. The major findings of the survey are: that there is a need for administrative education and experience among CNAs, especially in hospitals under 100 beds; that CNAs need additional nursing management information reports, particularly related to patient classification and workload measurement; that decentralization of decision making to the staff nurse level has to be improved; and that, on average, fewer than half of the recommended participative management strategies are being used. The main factors reported as impeding the ability of CNAs to decentralize decision making in their nursing department(in order of descending importance) are lack of: staff nurse knowledge about decision making; funds to replace staff nurses to attend meetings; head nurse knowledge of management functions; and head nurse support for decentralized decision making. Recommendations are presented for further study and for changes that will facilitate increased decentralization of, and participation in, decision making. / Applied Science, Faculty of / Nursing, School of / Graduate

This study surveys the resources, facilities for care and medical treatment provided for the chronically ill of Vancouver. The historical development of the problem has been briefly covered, also, the probable future situations which will arise. As the care of the chronically ill has become one of the major public welfare problems in the post-war period, the economic circumstances and implications of chronic illness have been emphasized. Each of the institutions described was visited and over two hundred chronically ill patients personally interviewed. More than four hundred files and records were read in various social agencies; information was also secured from interviews with administrators, directors and owners of the various services described. The survey reveals many problems and inadequacies. Hospital, clinical and custodial facilities for the most part are seriously inadequate and not always properly utilized. A confused administrative structure and an unsatisfactory division of responsibility are further obstacles to more effective co-ordination. Recommendations for the improvement of existing situations and the creation of new services are made. The importance of the social caseworker in the establishment of an effective treatment program for the chronically ill is stressed. / Arts, Faculty of / Social Work, School of / Graduate

The purpose of this study is to critically examine whether hospitals located in high seismic risk areas such as Vancouver can respond as post-disaster facilities in the aftermath of a major earthquake. Earthquake experience in California during the 1971 San Fernando and the 1989 Loma Prieta earthquakes in particular demonstrate that hospitals may be vulnerable and rendered unable to fully respond to their communities needs. In the case of earthquakes, risk management methods are limited to two strategies: pre-event mitigation to reduce the effects of the earthquake on life safety and loss of property; and providing recovery services after the event. In the case of post-disaster hospitals, experience shows that mitigation strategies ensure the functionality of the facility. Therefore, mitigation strategies must not only include structural mitigation to protect the life safety of its occupants, they must also include strategies which ensure the functionality of both the building operations as well as that of therapeutic and diagnostic medical equipment in the aftermath of an earthquake. Vancouver General Hospital is used as a case study to critically examine seismic pre-event mitigation strategies which include: the structures; building operation and medical equipment which are dependent on the supply of potable water and power. Findings of this study indicate that the current supply of potable water is not reliable and that some of VGH's essential building operations and medical equipment will not be functional due to losses in water pressures and disruptions in service. This study recommends that VGH should consider mitigation strategies which make the hospital independent of outside sources of both water and power supply in order to meet its emergency role as a post-disaster facility following an earthquake. The functionality of VGH in the aftermath of a major earthquake will be seriously curtailed unless there is adequate storage of potable water on site to meet the emergency needs of this hospital.

The purpose of this study is to critically examine whether hospitals located in high seismic risk areas such as Vancouver can respond as post-disaster facilities in the aftermath of a major earthquake. Earthquake experience in California during the 1971 San Fernando and the 1989 Loma Prieta earthquakes in particular demonstrate that hospitals may be vulnerable and rendered unable to fully respond to their communities needs. In the case of earthquakes, risk management methods are limited to two strategies: pre-event mitigation to reduce the effects of the earthquake on life safety and loss of property; and providing recovery services after the event. In the case of post-disaster hospitals, experience shows that mitigation strategies ensure the functionality of the facility. Therefore, mitigation strategies must not only include structural mitigation to protect the life safety of its occupants, they must also include strategies which ensure the functionality of both the building operations as well as that of therapeutic and diagnostic medical equipment in the aftermath of an earthquake. Vancouver General Hospital is used as a case study to critically examine seismic pre-event mitigation strategies which include: the structures; building operation and medical equipment which are dependent on the supply of potable water and power. Findings of this study indicate that the current supply of potable water is not reliable and that some of VGH's essential building operations and medical equipment will not be functional due to losses in water pressures and disruptions in service. This study recommends that VGH should consider mitigation strategies which make the hospital independent of outside sources of both water and power supply in order to meet its emergency role as a post-disaster facility following an earthquake. The functionality of VGH in the aftermath of a major earthquake will be seriously curtailed unless there is adequate storage of potable water on site to meet the emergency needs of this hospital. / Applied Science, Faculty of / Community and Regional Planning (SCARP), School of / Graduate