Romanow Report Research Articles

A PERSPECTIVE ON AUSTRALIA’S NATIONAL MEDICINES POLICY

There is international interest in Australia's health care system for prescription medicines. The issue is particularly topical in Canada with the debate following publication of the Romanow Report into the future of health care in Canada. This Report recommended a new National Drug Agency. Australia has a National Medicines Policy with four arms-quality, safety and efficacy of medicines; equity of access; a viable and responsible pharmaceutical industry; quality use of medicines. The four arms of the Policy are interlinked and interdependent for optimal functioning. In this paper, an overview of how the prescription drug system in Australia works is presented. The manuscript focuses upon specific aspects of the Policy, describing how it functions and some of the processes integral to success, from the viewpoint of the author. The discussion includes some of the advantages of Australia's system for pharmaceuticals as well as some of the problems, as these present opportunities for development and change.

Call to action: Interprofessional mental health collaborative practice in rural and northern Canada.

Shared within health care is needed in rural and northern Canada where residents are challenged with greater social and health disparities. Compared to their urban counterparts, Canadians in these areas experience lower socioeconomic status; higher rates of disability; higher rates of unemployment; higher mortality rates; difficulty with transportation, thereby limiting access to essential health services; and higher rates of chronic illness (Barbopoulos & Clark, 2003; Canadian Institute for Health Informatics, 2006). Downsizing of hospitals in rural and northern areas is causing outmigration of health care services to centralized urban areas, forcing rural Canadians to travel greater distances to access health care services (Canadian Collaborative Mental Health Initiative [CCMHI], 2006). A lack of access to health care is frequently noted as a key issue facing rural and northern residents (Donato, 2015; Haggarty, Ryan-Nicholls, & Jarva, 2010; McIlwraith & Dyck, 2002; Ryan-Nicholls, 2004). Shortages of mental health professionals in rural, northern, and Aboriginal communities in Canada are well documented (Kulig & Williams, 2012; McIllwariath & Dyck, 2002; Pawlenko, 2005).Interprofessional mental health collaborative practice (IMHCP) is an emerging and vital response to meet the mental health-related demands in rural and northern Canada and is an enhancement of the current Canadian health practice of Interprofessional Practice (IPP; (CCMHI, 2006; Coffey & Anyinam, 2015; Commission on the Future of Health Care in Canada [CFHC], 2002; Haggarty et al., 2010; Heath et al., 2015). IPMHC involves developing and maintaining effective interprofessional working relationships with professionals, paraprofessionals, students, mental health consumShelley ers, families, and communities to ensure optimal health outcomes (Canadian Interprofessional Health Collaborative [CIHC], 2010). Effective collaboration requires individual professionals to reframe their views from the traditional 'we know best' mind-set to a holistic approach (CCMHI, 2006; Coffey & Anyinam, 2015; Petrie, 1976). Pearce and Sims (2001) define shared as leadership that emanates from members of teams, and not simply from the appointed leaders (p. 115). It is the authors' contention that psychology must fully embrace a shared role in IMHCP in rural and northern communities, not only within clinical practice but also within professional psychology associations and regulatory bodies. We discuss the opportunities and challenges this may create and how the scholarly literature can guide our next steps.BackgroundThe Romanow Report (CFHC, 2002) continues to be one of the most influential documents in modern health care delivery in Canada. Over the past decade, recommendations from this document have led to systemwide advances in IPP and interprofessional education (IPE). In response, provincial and territorial directives have been targeting collaborative practice as one of their priorities in streamlining quality health care (Canadian Health Services Research Foundation, 2011; Coffey & Anyinam, 2015; Health Professions Regulated Advisory Council [HPRAC], 2006; Province of Nova Scotia, 2014). IPP is now an explicit expectation within most standards of practice for self-regulated health care professions in Canada and is mandated by their respective regulatory bodies (Human Resources Professionals Association, 2015). National organisations specifically designed to promote awareness and education in this field, such as the CIHC (2010), are also emerging. As well, IPE is expanding within universities across Canada, supporting multimodal opportunities for clinical simulations in IPP (Church et al., 2010; Cornish et al., 2003; Curran et al., 2012; Dalhousie University, 2015a; Donato, 2015).Yet within rural and northern communities, there remain challenges with efficiently implementing IMHCP because these large, isolated geographic areas are being serviced by low numbers of health professionals representing a small number of disciplines. …

From me to we and back again: creating health system transformation through authentic collaboration within and beyond nursing.

More than 10 years after the Romanow Report (2002), other national reports continue to echo the call for change in health system design and delivery – specifically, the call for collaborative practice that responds to healthcare needs while attending to value, sustainability and improved outcomes. Despite increased financial investments in healthcare, Canada is lagging in its ability to provide care that promotes gains in health status (Health Council of Canada 2013). Why is this so? Is it because the care that is provided is disjointed? Or that care is organized and delivered in a way that meets providers’ needs rather than people’s needs? Or is it because the context in which healthcare providers are educated, and in which they work, has not evolved to support change? These are difficult questions to answer.

Rose-Coloured Glasses: The Discourse on Information Technology in the Romanow Report

Abstract: Here discourse about information technology in Canada’s health sector is examined. After an overview of the emergence of the Canadian Health Information Infrastructure, discourse within the Romanow Report is discussed in relation to three key themes: standardization, empowerment, and time/space compression. While an instrumental view of technology in the health care sector is the predominant discourse articulated in the report, we argue that, by emphasizing technology assessment, the Romanow Report makes room for a more nuanced analysis of technology implementations than is common to government reports. We conclude by suggesting how investigations of information and communication technology in the health sector, such as this, may offer opportunities to raise critical questions about technology and health policy from a communications perspective.
 
 Résumé : Dans cet article, nous effectuons une analyse de discours sur les technologies de l’information dans le secteur de la santé au Canada. Suivant un survol de l’infrastructure de la technologie de l’information sur la santé du Canada, nous passons en revue le discours du rapport Romanow relatif à trois thèmes clés : la standardisation, l’autonomisation et la compression espace-temps. Bien qu’une perspective instrumentale sur la technologie dans le système de soins soit le discours prédominant articulé dans ce rapport, nous soutenons que le rapport Romanow, en mettant l’accent sur la prospective, effectue une analyse plus nuancée des mises en oeuvre technologiques que celles qu’on lit ordinairement dans des rapports gouvernementaux. Nous concluons cet article en proposant que des études comme celle-ci, qui portent sur la technologie de ’information et de la communication dans le secteur de la santé, ont le potentiel, tout en privilégiant une perspective communicationnelle, de soulever des questions critiques sur les politiques en matière de technologie et de santé.

Written on the Landscape: Health and Region in Canada

Canada's health-care system is a cornerstone of the welfare state and, equally, a cornerstone in the country's national identity. Whether discussing access to services, the politics of providing particular kinds of services such as abortion, the distribution of health-care providers, the and treatment of chronic disease, or new global threats to health such as SARS, few topics stir the passions of Canadians like health care. Recent reports such as Revitalizing Medicare (Rachlis et al. 2001) and the Romanow report (Commission on the Future of Health Care 2002) suggest many strategies for sustaining and reforming health and, while they differ in their orientation and approach, both affirm Canadians' affection for Medicare. It is, however, equally important to acknowledge that this affection is the product of an imagined Medicare, one that emphasizes a story of access and equity. To use Michael Bliss's phrase, this imagined Medicare is the result of a brief but very important golden age of Canadian medicare (2002, 38). This golden age emerged from the reconstruction of health from the early 1950s to the early 1970s, took many forms including the implementation of the national health grants, the passage of the federal Hospital Insurance and Diagnostic Services Act (1957), and legislation for physicians' services (1966); but a complete analysis must address how this golden age quickly evaporated in the face of mounting costs and regional disparities. Indeed, the Romanow report itself highlighted major regional discrepancies in the quality of health care. The idea that place matters for health services and health outcomes is not a particularly novel notion. In introducing the inaugural issue of the journal Health and Place, editor Graham Moon wrote that the journal sought to publish research which contributes to an understanding of how, why and whether place and context really matter when it comes to health and health care (1995, 1). Canada, it would seem, provides a veritable laboratory through one can explore this question. In a general sense, the health-care system provides comprehensive coverage for inpatient, hospital-based services and for outpatient physician services. Among the early civics lessons Canadians learn are the divisions of power under the Constitution Act, places health (with some important exceptions, such as responsibility for Aboriginal health) firmly under provincial jurisdiction. Each of the provinces and territories is responsible for managing and delivering health services within its jurisdiction. The focus on federal or provincial responsibilities, however, obscures the fact that much of the real activity of health takes place in an even more local setting, in the town or municipality or, more recently, in the health regions that were established in most jurisdictions during the administrative reorganization of the 1990s. It is perhaps not surprising, then, that health services are uneven across Canada and health outcomes can vary tremendously from setting to setting, even for the same procedures. There is, for example, abundant evidence that a woman's chance of having a caesarian section is higher in some facilities, while similar women in other facilities may avoid the procedure (Anderson and Lomas 1985). Data from 2001-2002 demonstrate that primary caesarian section rates ranged from a low of 12.4% in Manitoba to 21% in Prince Edward Island. Provincial statistics obscure even higher variations: in the Region 6 Health Corporation in New Brunswick (centred on Bathurst), primary caesarian section rates reached 25.5% (CIHI 2004). Since 1994, the Institute for Clinical Evaluative Sciences (ICES), based at the University of Toronto, has generated a great deal of publicity, raised the ire of some hospitals, and prompted critiques from different quarters, through their clinical atlas initiatives and report cards on various clinical services. The institute's objective was to collect and analyze data on a variety of performance measures, paying particular attention to individual institutions and geographic setting. …

Pushing Right against the Evidence: Turbulent Times for Canadian Health Care

Throughout the history of Canadian Medicare, there have been those who have opposed the universal, publicly funded system and advocated for greater private sector involvement. Amidst widespread public dissatisfaction with some aspects of Canadian health care--wait lists for some medical services, inadequate out-of-hospital drug coverage, and difficulties in accessing primary care--a series of recent events has shifted the public debate toward privately financed medicine, even as more Americans have been drawn toward universal public coverage. Certainly Canadian health care is in need of system reform. However, in a remarkably short time, the debate about the direction of reform has been transformed from one rooted in rigorous policy science, careful consideration of the empirical evidence, and an explicit commitment to universality, solidarity, equity, and the efficiencies of a single-payer, publicly-funded, not-for-profit system to one dominated by support for private and profit-driven systems and cut loose from solid evidence about what promotes equitable, effective, efficient, and sustainable health care. In fact, the move toward privatization rests on the repudiation of evidence-based health policy. Canadian Medicare provides publicly funded, tax-supported coverage for almost all doctor and hospital health care costs. This system developed gradually after World War II and was codified in the 1984 Canada Health Act, which calls for universality, accessibility, comprehensiveness, portability, and public administration of a not-for-profit system. It is crucial to understand that the CHA applies to the public funding (federal and provincial) of designated services, primarily hospital and doctor-delivered care. The delivery of health care has always been provided by a mixture of public and private--not-for-profit and for-profit--providers. Since the beginning of Medicare, doctors have typically been self-employed agents billing a fee fixed through negotiation between the provincial medical association and the provinces. The key to understanding the egalitarian nature of the Canadian health care system is that, while some providers are for-profit, they almost all bill the publicly funded insurance plan so that patients are not required to pay anything when they receive care. User fees, copays, and deductibles are banned for services covered under the public plan. While 70 percent of the total cost of health care is covered by public insurance, there has always been a strong role for private out-of-pocket and employer-based insurance for services not covered publicly, such as podiatry, dentistry, and nonsurgical vision care. All told, about 30 percent of total health care costs in Canada are covered privately. Although combining public and private funding is in line with practice in other OECD countries, the Canadian strategy is unique. In most countries, public funding is for standard level of care, and private funding for a preferential level of care for the same service. Canada alone makes public funding available for some services and relies on private funding for others. In addition, however, both patients and doctors are able to opt out of the public system, although the conditions for doing so vary from province to province. In most provinces, doctors cannot be paid privately for services for which they also bill the public system. Some provinces prohibit the sale of private insurance for services that are covered by the public system--a restriction intended to protect the integrity of the public insurance system. As health care has expanded in scope, and as much of the delivery of care has shifted to home and community, pressures have built on cost and access, just as they have across the entire developed world. Canada has launched various provincial and federal initiatives to reform the system, adapt it to contemporary practice, and ensure its sustainability. The most recent federal initiative was the Commission on the Future of Health Care in Canada, known as the Romanow Report after its author, the former premier of Saskatchewan, Roy Romanow. …

The EXTRA Difference: Leadership Development

The development of leadership positions in nursing is paramount to strengthening the Canadian healthcare system and is one of ACEN’s priorities. National reports, such as the Romanow Report (2002) from the Commission on the Future of Health Care and the 2003 First Ministers Health Accord (Health Canada 2006), have highlighted the importance of building leadership capacities among healthcare professionals. In response to this need, the Canadian Health Services Research Foundation (CHSRF) launched the program Executive Training for Research Application (EXTRA) in 2004. EXTRA is an interprofessional two-year competitive fellowship program. Its twofold goal is to enhance the skills of Canadian healthcare executives (nurses, physicians and health administrators) to use existing research in their dayto-day decision-making and thereby increase the use of evidence-based decision-making overall. EXTRA’s accomplishments have led organizations to encourage those among their leadership ranks to take advantage of the program as one means to attain their own succession planning goals, and also to build capacity in their organizations for research literacy and use. The Halifax-based Capital District Health Authority (CDHA) has supported five EXTRA fellows and has made a commitment to continue to encourage its leadership team to participate in EXTRA. Dr. Judith Kazimirski, Vice President of Medicine for CDHA, said, “There is absolutely no question that this health authority has benefited as much from this program as have the participants themselves.” Now in its third year, EXTRA has accepted 76 fellows, one-third of whom were from nursing. The success of the fellowship is a direct result of the advantages that fellows have derived from their participation and work in EXTRA. Some benefits of EXTRA, in the participants’ own words: ACEN UPDATE

A First Nations Voice in the Present Creates Healing in the Future

This paper discusses the urgency for change and improvements in health policy determined by the exploding demographics and inequities in the health status of First Nation people. A historical overview of health services for First Nation clients was conducted as set out through government legislation and health and social policies. Until WWII ended, the federal government provided assistance to First Nations through Indian Affairs branches of several departments. This responsibility was gradually transferred to National Health and Welfare. In 1962, the federal government established a Medical Services Branch, later renamed First Nations and Inuit Health Branch, and mandated to provide services to First Nation clients, which fell outside the provincial jurisdiction of health care. Initially centered on public health priorities, services have expanded to include primary health care, dental, mental health, environmental health, home and continuing care, and Non-Insured Health Benefits. The Romanow Report substantiated the urgency for health policy improvements voiced by many First Nations. However, it generalized Aboriginal issues in health care on a national front. Furthermore, its recommendations were specific to health care providers and delivery models and did not address the social and spiritual determinants of health, which are fundamental to a First Nations' holistic approach. Health planners must think holistically, considering traditional and westernized medicine, First Nations' values, priorities and government systems, and present and evolving health systems. Universities, health authorities, provinces and the federal government are continually developing new research and health models, which will also need consideration. Further, the imperative of involving community-level input must be recognized.

Walking the talk: An opportunity and a challenge

Walking the talk: An opportunity and a challenge

Healthcare Reform in Canada: The Romanow Report

The recent history of the Canadian healthcare system has been increasingly one of shortages. There are delays for services that impose risk and hardship, disparities between the accessibility of healthcare for rural versus urban populations, and a lack of adequate coverage for or access to prescription drugs, diagnostic services, and homecare. Add to these problems shortages of healthcare providers—in particular, physicians and nurses—and state-of-the-art equipment, and we can understand the universal agreement that the Canadian healthcare system must change. The only question is how. Some argue for modifications within the basic framework of a one-tier single-payer system; others for more radical reform that will allow for infusions of money by expedients such as user fees, extra billing, or a full-blooded second tier where one can buy any healthcare one wants. I am indebted to Don Brown for comments and discussion.

Continuous Quality Improvement, Continuous Pharmacy Improvement

C J H P – Vol. 56, No. 4 – September 2003 J C P H – Vol. 56, n 4 – septembre 2003 Although it has been suggested that these changes merely reflect a profession that is trying to redefine itself, I see them more as components in a process of continuous improvement: such efforts are required to meet both the changing needs of our patients and the demands of society at large. In particular, the demands of society are increasing exponentially. Over the past year, the Romanow report, the Kirby report, common drug review, and many regional initiatives have highlighted the potential needs and demands of society with regard to health care. The increased provision of home-based care, concerns about patient safety, and primary health care reform are only some of the challenges that hospital pharmacists continue to address day-to-day. Others include pharmacy specialization, pharmacist prescribing, implementation of new technology, and staff shortages. As a result of these influences, many institutions and provincial health ministries are reviewing their regulations to optimize use of pharmacist skills. Given the changes now taking place in society and more specifically in health care, I feel that my professional experiences will help me to draw attention to pharmacists’ potential impact. I have witnessed pharmacists in various practice sites proposing, implementing, and refining programs and policies that aim to increase the effectiveness and value of pharmacist interventions. In the position of President Elect, I can help to identify further changes that are INTRODUCING CSHP’S PRESIDENT ELECT

President's Message: Romanow Report and Physiotherapy

President's Message: Romanow Report and Physiotherapy