Health regions in Canada are primarily associated with the rationalization of conventional, historically expensive provincial health care systems. At the same time, it is unclear what contribution health regions make to advancing health system reform, particularly health-promoting activities. This work sets out to understand the relationships between regionalization and health-promoting activity by studying two health regions in Canadian provinces that have different approaches to regionalization (British Columbia and Ontario).
I use a constructivist grounded theory methodology (Charmaz, 2006) to analyse data from nineteen key informant interviews with senior management working in the two regional health authorities and in provincial health organizations. The iterative analysis of the empirical data and the review of corporate documents from both regional organizations result in the identification of three core themes grounded in the data.
The dominant theme emerging from the analysis is identified as place-making referring to a region’s ability to facilitate health-promoting activity by making the region a place with special meaning and resonance for the populations served. The other two themes are creating space within organizations for health-promoting activity and developing networks. The former refers to a region’s willingness and ability to operationally support health-promoting activity and the latter refers to efforts undertaken to establish relationships with other organizations in the health-promotion and healthcare networks. I conclude that these three themes characterize critical components of a therapeutic region.
A therapeutic region suggests a conceptualization of regional health authorities (RHAs) in which priority is given to health-promoting activities, alongside an entrenched curative healthcare agenda (the medical model). A therapeutic region is conceived of as a region that implements policies and develops structures aimed at achieving improvements in the overall health status of the population it serves. In this research I develop a four-cell matrix to frame the theory of therapeutic regions. One axis represents a continuum of place-making, while the second axis reflects a continuum depicting how regions develop the two other themes -- one extreme represents a piecemeal or patchwork approach, and the other an integrated strategic approach.
The implications of this research relate to practice and policy. The practice of improving the health of the population served requires regions to open pathways, and remove longstanding barriers by making place-making core to all community engagement and develop health-promoting activity within their organizations and their networks. Policy-makers need to bring clarity to the regions’ role in health-promoting activity. This research indicates that health-promoting activity, innovation and progress occur when a region has the ability to manage both conventional, curative health care and health-promoting activities. Whether that is through direct governance or new ways to bring together decision-making, service co-ordination and evaluation is a subject for future work. / Graduate
| Identifer | oai:union.ndltd.org:uvic.ca/oai:dspace.library.uvic.ca:1828/7660 |
| Date | 09 December 2016 |
| Creators | Harrold, Harvey James |
| Contributors | Cloutier, Denise |
| Source Sets | University of Victoria |
| Language | English, English |
| Detected Language | English |
| Type | Thesis |
| Rights | Available to the World Wide Web |
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