EIHR Featured researchers

Dr. Jean-Louis Denis

Who

Dr. Jean Louis Denis is principal investigator of the CIHR Team Grant in Reconfiguration of Health Care Organizations and Systems and holder of the Canada Research Chair in Governance and Transformation of Health Organizations and Systems (GETOSS). He is a Full Professor at the École nationale d’administration publique (ENAP) in Montreal.

Issue

The operation of health care systems is a subject that receives constant scrutiny both from governments and from the media. But to date, the many attempts to reform these systems do not seem to offer much promise of making them meet the public’s needs and expectations more effectively. My research involves analyzing change in complex systems, with a primary focus on health-care organizations and systems. Through this research, my team hopes to better understand the role that management and organizational methods can play in improving health-care systems. Some of the research questions that we are investigating include: what levers are available within the health-care system to ensure that care and services are better adapted to the public’s needs? what roles can government bodies (such as hospital boards and regional health authorities) and management play in improving care and services? How can health-care institutions and health-care professionals adapt to the reforms that governments are undertaking? what role does leadership play in adapting and improving care and services?

Approach

Our current research deals with the implementation of local health networks in Quebec and their potential to foster better co-ordination of care and services. We are also looking at the practices that managers and professionals are applying to introduce innovations such as program management and initiatives to promote public health within a target geographic area. In addition, we are examining the strategies that can be adopted to derive greater benefit from the expertise of the medical profession in the management and organization of health services. On the basis of a variety of Canadian experiences, we are working to determine what strategies will let patients participate more fully in the organization of care and services. We are also analyzing the factors that enable health-care organizations and systems to be regarded as exemplary in terms of performance. In all of this research, one of our constant concerns is to achieve a better understanding of the conditions that allow innovations to offer care and services that are better adapted to the public’s needs. Overall, our research provides the opportunity to better understand the management levers that organizations can use to improve the quality of care and services, as well as the role that government policies can play in efforts to improve the performance of the health-care system.

Impact

The primary audience for our research consists of managers, policymakers, and professionals in health-care organizations. One example of the positive results that we have produced is that we have provided a better understanding of how leadership abilities can be developed within health-care organizations and how these abilities can help these organizations to better adapt the care and services that they provide. Our research has also identified the roles and resources that government bodies such as hospital boards and regional health authorities should have in place to promote the development of higher-performance health-care organizations. The implementation of new organizational models such as the local care and service networks in Quebec requires major changes in the ways that professionals and managers do their jobs. Our research has led us to define a set of practices that enable managers and professionals to engage in major initiatives to transform and improve the health-care system. Lastly, through an analysis of recent health-care-system reforms in Canada, we have identified some priority action areas on which efforts should be focused to improve the operation of the health-care system and make it better adapted to providing the kinds of care that the public needs.

One goal of our future research will be to identity strategies for promoting the involvement of the medical profession in the improvement of health care and health services, as well as in the governance of health-care organizations. Another goal will be to investigate the role of new types of organizations (such as knowledge-exchange networks and consortia) in designing and implementing innovations in the health-care system.

Dr. Jeremiah Hurley

Who

Jeremiah Hurley
Professor of Economics and of Clinical Epidemiology and Biostatistics
Member, Centre for Health Economics and Policy Analysis
McMaster University

Issue

The long-term sustainability of Canada’s health care system demands methods for financing and funding health care that are efficient and equitable. To develop such systems of finance and resource allocation, we need two distinct types of evidence. First, we need evidence on how different methods of finance, in both the public and private sectors, affects the behavior of individuals, providers and others in the system, the amounts different individuals pay, and how this affects the distribution of services in the system. Second, we need evidence on what the public judges to be an equitable or fair allocation of health care.

Approach

Dr. Hurley and his team are drawing on insights from economics, psychology, ethics, policy analysis and health services research to assess how alternative methods of financing and resource allocation affect equity and efficiency in health care. Their research program has used experimental economic methods to investigate a number of specific questions. For example, how would introducing parallel private insurance for publicly insured health care impact individuals of differing incomes and health statuses? How should we allocate public funding for drugs used to treat those who suffer from rare, or “orphan” diseases? What are the social benefits associated with ensuring that everyone in society has access to medically necessary health care? And, how does the public’s understanding of “need for health care” compare to professional definitions of need?

Impact

Dr. Hurley’s research is strongly foundational, providing high-level evidence that can inform a large range of policy discussions related to system financing and funding. As a result, his work has garnered the attention of a number of relevant bodies. The study of public funding for orphan drugs, for instance, has been picked up and promoted through OrphaNews Europe, the newsletter of the European Union Committee of Experts of Rare Diseases. With the support of Health Canada, the Ontario Ministry of Health, and Public Health Ontario, they are extending their work on public judgments of equity in resource allocation to a detailed examination of fair allocation of both vaccines and flu medication during flu pandemics.

Dr. Gail Tomblin Murphy

Who

Dr. Gail Tomblin Murphy, Director of the WHO/PAHO Collaborating Centre on Health Workforce Planning & Research at Dalhousie University; Professor, School of Nursing, Faculty of Health Professions and Department of Community Health & Epidemiology, Faculty of Medicine, Dalhousie University; Co-Investigator, Faculty of Nursing, University of Toronto.

Issue

An effective, efficient and productive workforce is critical to the delivery of health services. However, health human resources (HHR) planning continues to present challenges to health-care systems in Canada and abroad. Many countries do not have a health workforce with the sufficient size, deployment or appropriate knowledge, skills, abilities and behaviours required to meet the health-care needs of their population.

Approach

The focus of the WHO/PAHO Collaborating Centre on Health Workforce Planning and Research at Dalhousie University is to build capacity for needs-based HHR planning through Canadian and international partnerships. The Centre carries out activities in three areas: 1) health workforce planning, 2) capacity building and knowledge exchange, and 3) evaluation. In addition to CIHR-funded research projects within Canada, the Centre is also engaged in research and capacity-building activities with partners in Brazil, Jamaica and Zambia, supported by Health Canada, the Pan-American Health Organization, and the Global Health Research Initiative.

Impact

The Centre has been successful in building a strong network of government, academic and clinical partners within Canada and internationally who are committed to improving health-care planning. Through its various research projects and Summer Institutes, the Centre has begun to see success in building capacity for needs-based HHR planning in Canada, Brazil, Jamaica and Zambia and looks forward to continuing success in these countries and others.

Dr. Steve Morgan

Who

Dr. Steve Morgan, Associate Director and Associate Professor at the UBC Centre for Health Services and Policy Research and Lead of the Pharmaceutical Policy Research Collaboration (PPRC), a CIHR/Health Canada Emerging Team grant on Equity in Access to Necessary Medicines.

Issue

Pharmaceutical policy is a key component of health system management. However, many stakeholders in Canada are frustrated that key pharmaceutical policy goals – including providing equitable and sustainable access to necessary medicines – have not been met. A lack of policy coordination and insufficient evidence to take major new initiatives in pharmaceutical policy are the main obstacles.

Approach

Dr Morgan works with policy makers from across Canada and around the world to identify current and emerging policy challenges and to prioritize and conduct policy evaluations and comparative policy studies. He and other members of the PPRC then engage in a variety of innovative strategies to share policy insights with policy makers and the public.

Impact

The lessons learned through policy evaluation and knowledge exchange help drug plan managers and senior health care planners to develop new strategies for managing drug expenditures. This new knowledge also helps decision makers map a course for policy development that might achieve long-sought goals of equity and sustainability in this important component of health care.