No description available.

The issues surrounding health care and health care policy are of great concern to politicians and the public alike. Government efforts in restructuring medicare, the "jewel" of Canada's social safety net, also affects the medical profession. It has been argued that this once powerful and dominant profession is experiencing a decline in its powers and authority. Is this decline inevitable or can the medical profession adapt to government reforms in such way as to maintain and even strengthen its power base? This dissertation examines the themes of professional autonomy and professional resistance. The changing composition, and possibly the decline, of the medical profession's clinical, economic, and political autonomy, is analyzed through an historical case study of the British Columbia Medical Association (BCMA). Minutes from the BCMA's Board of Directors and Executive, along with interviews with doctors active in BCMA politics, and a media review, are used to generate a portrait of the social forces influencing medical politics in British Columbia from 1964 to 1993 and of the BCMA's relations with the various provincial governments of that period. The negotiating strategies of the BCMA and the decisions behind these strategies are the focal point for an examination of professional resistance, an area neglected in sociology. The dissertation looks at the external and internal conflicts that impact on the resistance tactics of the BCMA and at the various successes and defeats the medical profession experiences in its bid to maintain professional autonomy. During the time period under study, government intervention becomes more frequent and invasive. The BCMA has the least success in protecting the political dimension of professional autonomy and most success in controlling aspects of clinical autonomy. The vast variety of resistance strategies at its disposal distinguishes it from labour groups and most other professions. Forced to accept measures it once fought against, the BCMA's efforts become focused on ensuring that reform measures are under the control of doctors (rather than government) to the greatest extent possible. Although the BCMA has lost aspects of professional autonomy, it remains one of the few professional organizations today that can force compromise from the state.

This study examined hospital governance in British Columbia. Considered to be one of the most important issues facing the health care industry today, hospital governance is nevertheless an ill-defined and poorly understood concept. Foundational and exploratory in nature, the study’s primary objectives were: a) to define hospital governance within the context of British Columbia; b) to examine the structural and functional relationships among key participants; c) to investigate decision-making responsibilities; d) to investigate what, if any, variations exist in the governance of acute care, long term care, and specialized care hospitals; and e) to explore the critical issues which face hospital governance today and in the future under New Directions policy initiatives. All hospitals (N=107) in the province were studied, with the exception of diagnostic treatment centers, private for-profit facilities, military, and federal institutions. Utilizing documentary examination, survey administration, and interview techniques, the study included hospital chief executive officers (N=106), hospital board members (N=735), hospital board chairs (N=106), and selected high ranking senior officials from the Ministry of Health who had direct responsibility for hospital activities (N=15). Results of the study provide for in-depth demographic board profiles, and show that hospital governance is similarly defined across all hospital categories as “a complex relationship of overlapping structures and activities which has the responsibility and the authority to oversee the organization’s operation and to ensure its commitment of providing optimum health care to its residents.” The study identifies the key participants of hospital governance and delineates sixteen activities considered to be under the hospital board’s domain. Seven issues are identified as being critical for hospital governance in the future. Although there was general agreement as to the individuals most often responsible for recommending and implementing activities brought before the board, there were considerable perceptual differences between participants as to who possesses final decision-making responsibility. Data results consistently demonstrated important differences in responses between the hospital and Ministry populations. The study shows that overall, the participants of hospital governance are generally satisfied with the traditional roles and structures of hospital boards and are overwhelmingly dissatisfied with New Directions policy initiatives. This study further suggests that due to the discrepancies in priorities, perceptions, and ideologies of the hospital and Ministry populations, hospital governance is in a highly volatile and transitive state.

The issues surrounding health care and health care policy are of great concern to politicians and the public alike. Government efforts in restructuring medicare, the "jewel" of Canada's social safety net, also affects the medical profession. It has been argued that this once powerful and dominant profession is experiencing a decline in its powers and authority. Is this decline inevitable or can the medical profession adapt to government reforms in such way as to maintain and even strengthen its power base? This dissertation examines the themes of professional autonomy and professional resistance. The changing composition, and possibly the decline, of the medical profession's clinical, economic, and political autonomy, is analyzed through an historical case study of the British Columbia Medical Association (BCMA). Minutes from the BCMA's Board of Directors and Executive, along with interviews with doctors active in BCMA politics, and a media review, are used to generate a portrait of the social forces influencing medical politics in British Columbia from 1964 to 1993 and of the BCMA's relations with the various provincial governments of that period. The negotiating strategies of the BCMA and the decisions behind these strategies are the focal point for an examination of professional resistance, an area neglected in sociology. The dissertation looks at the external and internal conflicts that impact on the resistance tactics of the BCMA and at the various successes and defeats the medical profession experiences in its bid to maintain professional autonomy. During the time period under study, government intervention becomes more frequent and invasive. The BCMA has the least success in protecting the political dimension of professional autonomy and most success in controlling aspects of clinical autonomy. The vast variety of resistance strategies at its disposal distinguishes it from labour groups and most other professions. Forced to accept measures it once fought against, the BCMA's efforts become focused on ensuring that reform measures are under the control of doctors (rather than government) to the greatest extent possible. Although the BCMA has lost aspects of professional autonomy, it remains one of the few professional organizations today that can force compromise from the state. / Arts, Faculty of / Sociology, Department of / Graduate

This study examined hospital governance in British Columbia. Considered to be one of the most important issues facing the health care industry today, hospital governance is nevertheless an ill-defined and poorly understood concept. Foundational and exploratory in nature, the study’s primary objectives were: a) to define hospital governance within the context of British Columbia; b) to examine the structural and functional relationships among key participants; c) to investigate decision-making responsibilities; d) to investigate what, if any, variations exist in the governance of acute care, long term care, and specialized care hospitals; and e) to explore the critical issues which face hospital governance today and in the future under New Directions policy initiatives. All hospitals (N=107) in the province were studied, with the exception of diagnostic treatment centers, private for-profit facilities, military, and federal institutions. Utilizing documentary examination, survey administration, and interview techniques, the study included hospital chief executive officers (N=106), hospital board members (N=735), hospital board chairs (N=106), and selected high ranking senior officials from the Ministry of Health who had direct responsibility for hospital activities (N=15). Results of the study provide for in-depth demographic board profiles, and show that hospital governance is similarly defined across all hospital categories as “a complex relationship of overlapping structures and activities which has the responsibility and the authority to oversee the organization’s operation and to ensure its commitment of providing optimum health care to its residents.” The study identifies the key participants of hospital governance and delineates sixteen activities considered to be under the hospital board’s domain. Seven issues are identified as being critical for hospital governance in the future. Although there was general agreement as to the individuals most often responsible for recommending and implementing activities brought before the board, there were considerable perceptual differences between participants as to who possesses final decision-making responsibility. Data results consistently demonstrated important differences in responses between the hospital and Ministry populations. The study shows that overall, the participants of hospital governance are generally satisfied with the traditional roles and structures of hospital boards and are overwhelmingly dissatisfied with New Directions policy initiatives. This study further suggests that due to the discrepancies in priorities, perceptions, and ideologies of the hospital and Ministry populations, hospital governance is in a highly volatile and transitive state. / Graduate and Postdoctoral Studies / Graduate

Health promotion research and practice reveal that goal setting and monitoring have gained increased acceptance at international, national, provincial/state, regional and local levels as a means to guide health planning, promote health-enhancing public policy, monitor reductions in health inequities, set health priorities, facilitate resource allocation, support accountability in health care, and track the health of populations. The global adoption of health goals as a strategy for population health promotion has occurred even though few protocols or guidelines to support the health goals development process have been published; and limited study has occurred on the variation in approach to health goals planning, or on the complex, multiple forces that influence the development process. This is an exploratory and descriptive case study that endeavours to advance knowledge about the process and contribution of health goals development as a strategy for population health promotion. This study seeks to track the pathways to health goals in British Columbia (BC) and to uncover influential factors in rendering the final version of health goals adopted by the government of BC. Specifically, this study explores the forces that obstructed and facilitated the formulation and articulation of health goals. It considers also implications of health goals development for planning theory, research and health promotion planning. Data collection consisted of twenty-three semi-structured interviews with key participants and systematic review of BC source documents on health goals. Data analysis uncovered nearly 100 factors that facilitated or obstructed the BC health goals initiative, organized around three phases of health goals development. Key factors influencing the premonitory phase included (a) government endorsement of health goals that addressed the multiple influences on health, (b) expected benefits of health goals combined with mounting concern about return on dollars invested in health, and (c) effective leadership by a trusted champion of health goals. Key influencing factors in the formulation phase included (a) the positioning of the health goals as a government-wide initiative versus a ministry-specific initiative, (b) the "conditioning" of the health goals process through the use of pre-established health goals and "orchestrated" consultation sessions, and (c) the make-up and degree of autonomy of the health goals coordinating mechanism. The articulation phase of health goals development revealed several influencing factors in relation to two chief issues that characterized this phase: (a) the lack of specificity of the health goals, and (b) the variable portrayal of the "health care system" as a priority area in the BC health goals. This study also revealed several concessions and trade-offs that characterized the BC health goals process. For example, the formulation of health goals that addressed the broader health determinants yielded health goals without the capacity for measurement, (b) the operational and bureaucratic autonomy of the health goals coordinating mechanism led to feelings of alienation from the health goals process and product among some branches of the Ministry of Health and some established health interests, and (c) the use of pre-determined health goals and the delivery of educative sessions based on the determinants of health generated claims of bias and a lack of trust and fairness in consultation processes and mechanisms.

Health promotion research and practice reveal that goal setting and monitoring have gained increased acceptance at international, national, provincial/state, regional and local levels as a means to guide health planning, promote health-enhancing public policy, monitor reductions in health inequities, set health priorities, facilitate resource allocation, support accountability in health care, and track the health of populations. The global adoption of health goals as a strategy for population health promotion has occurred even though few protocols or guidelines to support the health goals development process have been published; and limited study has occurred on the variation in approach to health goals planning, or on the complex, multiple forces that influence the development process. This is an exploratory and descriptive case study that endeavours to advance knowledge about the process and contribution of health goals development as a strategy for population health promotion. This study seeks to track the pathways to health goals in British Columbia (BC) and to uncover influential factors in rendering the final version of health goals adopted by the government of BC. Specifically, this study explores the forces that obstructed and facilitated the formulation and articulation of health goals. It considers also implications of health goals development for planning theory, research and health promotion planning. Data collection consisted of twenty-three semi-structured interviews with key participants and systematic review of BC source documents on health goals. Data analysis uncovered nearly 100 factors that facilitated or obstructed the BC health goals initiative, organized around three phases of health goals development. Key factors influencing the premonitory phase included (a) government endorsement of health goals that addressed the multiple influences on health, (b) expected benefits of health goals combined with mounting concern about return on dollars invested in health, and (c) effective leadership by a trusted champion of health goals. Key influencing factors in the formulation phase included (a) the positioning of the health goals as a government-wide initiative versus a ministry-specific initiative, (b) the "conditioning" of the health goals process through the use of pre-established health goals and "orchestrated" consultation sessions, and (c) the make-up and degree of autonomy of the health goals coordinating mechanism. The articulation phase of health goals development revealed several influencing factors in relation to two chief issues that characterized this phase: (a) the lack of specificity of the health goals, and (b) the variable portrayal of the "health care system" as a priority area in the BC health goals. This study also revealed several concessions and trade-offs that characterized the BC health goals process. For example, the formulation of health goals that addressed the broader health determinants yielded health goals without the capacity for measurement, (b) the operational and bureaucratic autonomy of the health goals coordinating mechanism led to feelings of alienation from the health goals process and product among some branches of the Ministry of Health and some established health interests, and (c) the use of pre-determined health goals and the delivery of educative sessions based on the determinants of health generated claims of bias and a lack of trust and fairness in consultation processes and mechanisms. / Graduate and Postdoctoral Studies / Graduate

Up to the middle of the 1970's most government policies dealing with physician manpower dealt with the problems of increasing the supply of physicians, rather than changing the geographic disparity of physicians between urban and rural areas. In 1983 the British Columbia government introduced legislation (passed in a modified form in 1985) that would restrict certain groups of physicians from obtaining Medical Service Plan billing numbers in certain areas of the province, in an attempt to change the geographic distribution of physicians in this province. Regulation is only one of a number of approaches to altering the distribution of physicians. The purpose of this study is to attempt to recommend other approaches that could be used to alter the geographic distribution of physicians, based on the factors which the residents and interns of British Columbia would consider necessary before they will establish practices in the rural areas of the province. The literature was examined to determine the present supply and distribution of physicians in the province of British Columbia. It was shown that the metropolitan areas had much higher concentrations of physicians than did the non-metropolitan regions. The literature was then searched to determine what types of policies had been used in an effort to change this geographic disparity and also to determine what factors influence physicians to locate their practices where they do. From this research a questionnaire was developed and mailed to all residents and interns registered in the University of British Columbia medical program in the academic year 1984-85. A response rate of 31.8% was obtained in this survey. It was found that many physicians were raised in large communities and planned to locate their practices in similar geographic areas to where they were raised. It was also found that the factors which the residents and interns considered to be the most important fell into the "Fixed Determinant" category, that is factors that are personal preferences of the physician. This makes it very difficult to formulate any type of non-regulatory policy to affect the geographic distribution of physicians in British Columbia / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate