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Restructuring Health and Hospital Services: The Ontario Experience ,[object Object],[object Object],[object Object]
Conditions for Hospital Service Restructuring  ,[object Object],[object Object],[object Object],Report of the Select Committee of The House of Lords on the Metropolitan Hospitals (1892)
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Antecedents to Change The Health Care Environment Pre-HSRC
Changing Practice & Technology Beds Staffed and in Operation Type Number Acute 24,014 Psych 2,147 Rehab 1,890 Chronic 9,639 Private 714 Total 38,404
Source: MoH, Institutional Services Branch Inpatient Surgical Day Surgery All Surgery Total Acute Inpatients Changing Practice & Technology Comparison of Surgical Activity and Acute Separations: 1989/90 and 1995/96 1,500,000 1,125,000 750,000 375,000 0
Change in Hospital Employment (FTE) 150,000 120,000 90,000 60,000 30,000 0 1989-90  1991-92  1993-94  1995-96  1997-98  1999-00  2001-02  2003-04  2005-06  2007-08  2009-10
Circumstances when HSRC was created ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],between   the political will and   the administrative won’t ” Jonathan Lynn & Anthony Jay Yes Prime Minister vol. 2 (1987)
Why was the HSRC needed? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Authority ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
‘ Unique’ delegation of powers based on legislative change(s)… “ An independent body at arm’s length from the Government, empowered to develop, establish and maintain an effective and adequate health care system…” Delegation of Authority (Savings and Restructuring Act, Amendments to the Ministry of Health Act included in Schedule F)
HSRC Mandate ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],HSRC Overall Approach
[object Object],[object Object],[object Object],[object Object],[object Object],HSRC Process
“ Parallel Activities” addressed by HSRC to Support the Restructuring Mandate ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Communication Strategy ,[object Object],[object Object],[object Object],[object Object],[object Object]
Consequences and Reflections of HSRC’s Work
Consequences of HSRC’s Work Structural Change ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Reflections on the Process of Restructuring ,[object Object],[object Object],[object Object],[object Object],[object Object]
Political Accommodations ,[object Object],[object Object],[object Object]
Lessons Learned What Worked ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Lessons Learned What Didn’t Work ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Lessons Learned About Conditions for Change ,[object Object],[object Object],[object Object],[object Object],[object Object]
Lessons Learned About Arms Length Agencies ,[object Object],[object Object],[object Object]
Major System Changes Post HSRC ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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Restructuring Health and Hospital Services: The Ontario Experience

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  • 7. Changing Practice & Technology Beds Staffed and in Operation Type Number Acute 24,014 Psych 2,147 Rehab 1,890 Chronic 9,639 Private 714 Total 38,404
  • 8. Source: MoH, Institutional Services Branch Inpatient Surgical Day Surgery All Surgery Total Acute Inpatients Changing Practice & Technology Comparison of Surgical Activity and Acute Separations: 1989/90 and 1995/96 1,500,000 1,125,000 750,000 375,000 0
  • 9. Change in Hospital Employment (FTE) 150,000 120,000 90,000 60,000 30,000 0 1989-90 1991-92 1993-94 1995-96 1997-98 1999-00 2001-02 2003-04 2005-06 2007-08 2009-10
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  • 15. ‘ Unique’ delegation of powers based on legislative change(s)… “ An independent body at arm’s length from the Government, empowered to develop, establish and maintain an effective and adequate health care system…” Delegation of Authority (Savings and Restructuring Act, Amendments to the Ministry of Health Act included in Schedule F)
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  • 22. Consequences and Reflections of HSRC’s Work
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