John Church | University of Alberta (original) (raw)

Papers by John Church

Canadian Public Administration/Administration publique du Canada, 2006

... which includes Harvey Lazar, Pierre-Gerlier Forest, John Lavis, A ha Gildiner Aaron Holdway, ... more ... which includes Harvey Lazar, Pierre-Gerlier Forest, John Lavis, A ha Gildiner Aaron Holdway, Stephen Tomblin, Tom McIntosh, Claudia Sanmartin, Marie-Pascale Pomey, klisabeth Martin, and Vandna Bhatia. Josh Marko, David Schaaf and Kevin Wipf provided research ...

Health & social care in the community, 2010

The delivery of paediatric rehabilitation services is complex due to the involvement of different... more The delivery of paediatric rehabilitation services is complex due to the involvement of different service sectors and diverse models of care. Parents of children with disabilities find it challenging to navigate successfully through complicated service delivery systems. Cross-sectoral collaboration to improve continuity of care for children with disabilities and their families is viewed as ideal in public policies. The purpose of this research was to explore how ministerial cultures, processes and structures influence inter-ministerial collaboration for the purpose of enhancing continuity of care for children with disabilities and their families in a Western Canadian province. Six key informants from three government Ministries that funded paediatric rehabilitation services participated in individual, semi-structured interviews between January and May of 2007. Nineteen provincial public policy documents were reviewed. Hall's framework guided the analysis of the key informant int...

Advanced Tools, Technologies, and Applications

Hybrid learning models attempt to create an environment that can harness the best parts of both f... more Hybrid learning models attempt to create an environment that can harness the best parts of both face-to-face and online modes of content delivery. The creation of these environments can be achieved in a very straightforward manner. However, the challenge is to develop these ...

This essay explores the introduction of population-needs-based funding (PNBF) formulae for the pr... more This essay explores the introduction of population-needs-based funding (PNBF) formulae for the provision of health care services in five provinces (Newfoundland and Labrador, Quebec, Ontario, Saskatchewan and Alberta) as part of a larger project examining a range of health reform decisions in those provinces. Based on semi-structured key-informant interviews with civil servants, stakeholder representatives and political actors the paper examines why and how some provinces chose to move ahead with PNBF formulae while others did not. For two of the provinces (Alberta and Saskatchewan) the implementation of the formulae stemmed directly from the process of regionalization carried out shortly before, while Quebec's particular model of regionalization led to a slower and more gradual adoption of a PNBF formula. Although Newfoundland did implement a regionalized governance structure, it has not attempted to change how services have been traditionally funded, leaving much of the decision making in this area to bureaucratic and political actors. Ontario's decision to not pursue a full-scale form of regionalization meant that key stakeholders in the acute care sector could effectively block any significant discussion of changes to how health care dollars are allocated.

This review revealed that evidence exists for associations between aspects of the urban environme... more This review revealed that evidence exists for associations between aspects of the urban environment and behaviours contributing to obesity. Economic environments—For individuals, a lower socio‐economic status (education level, income, employment) was often associated with increased obesity among both adults and children. For instance, lower personal income affects affordability of food, which demonstrates the most consistent influence on food consumption. Similarly, individuals living in middle‐income to high‐income neighbourhoods are more likely to be physically active than their counterparts in lower‐income neighbourhoods. Lower‐income neighbourhoods are also more likely to contain greater access to sources of energy‐dense foods (for example, fast foods) and lower access to supermarkets or other stores stocking healthy foods. What this means is that interventions aimed at improving the income and educational status of individuals and families within urban environments may help add...

The Journal of the Canadian Chiropractic Association, 2012

Journal of Health Politics, Policy and Law, 2014

Although much has been written on health policy making in developed countries, the same cannot be... more Although much has been written on health policy making in developed countries, the same cannot be said of less developed countries, especially in Africa. Drawing largely on available historical and government records, newspaper publications, parliamentary Hansards, and published books and articles, this article uses John W. Kingdon's multiple streams framework to explain how the problem, politics, and policy streams converged for Ghana's National Health Insurance Scheme (NHIS) to be passed into law in 2003. The article contends that a change in government in the 2000 general election opened a ''policy window'' for eventual policy change from ''cash-andcarry'' to the NHIS.

Journal of Public Health Policy, 2002

Every couple of decades governments decide that they need to involve citizens more in public deci... more Every couple of decades governments decide that they need to involve citizens more in public decision-making processes. The significant changes that have occurred over the past decade, including a growing loss of faith in the traditional institutions of government, have once again prompted political decision-makers to explore options for enhanced citizen participation. In the health care sector, reforms occurring during the 1990s were couched in terms such as "enhanced responsiveness," "improved accountability," and "increased citizen participation." In the new millennium, governments and regional health authorities have been relatively silent on this issue. As has been the case in the past, a wide range of opinions exist about what citizen participation is and how governments should proceed. Without either conceptual clarity or practical direction, governments have been slow to articulate what they hope to achieve or how they intend to get there. The purpose of this paper is to examine the concept of citizen participation within the context of a series of basic questions from which decision-makers might draw some policy relevance. Rather than taking a particular disciplinary perspective (i.e. health promotion), the authors have chosen to review a broad spectrum of existing literature to provide a better understanding of what is known about citizen participation, both good and bad. As such, the paper is meant to be a point of departure for an informed discussion of the possibilities for improved citizen participation in health (care) decision-making.

Healthcare Management Forum, 2008

This paper offers a detailed historical description of the development of Alberta's population-ba... more This paper offers a detailed historical description of the development of Alberta's population-based funding model for Regional Health Authorities (RHAs). It focuses on key political factors that may have facilitated this transition-in particular, the role of institutions, organized interests, and ideas and values. Understanding the politics of policy change as exemplified in this case can be useful in assessing future prospects for health system reform in Canada and laying the groundwork for further comparative study. Résumé Cet exposé donne une description historique détaillée de la mise au point du modèle de financement basé sur la population appliqué aux régies régionales de la santé en Alberta. Il se concentre sur les principaux facteurs politiques qui ont facilité cette transition, notamment le rôle des institutions, les intérêts organisés et les idées et valeurs. La compréhension des aspects politiques du changement des politiques, tel qu'illustrés dans ce cas, peut être utile pour évaluer les perspectives futures de la réforme du système de santé au Canada et jeter les bases d'autres études. Methods Qualitative research-"an inquiry process of understanding a social or human problem, based on building a complex, holistic picture, formed with words, reporting detailed views of informants, and conducted in a natural setting," 6-was employed for this project. Specifically, we employed case study methods because they allow the researcher to examine the "motive,

Healthcare Management Forum, 2005

Over the post decade, provincial governments have embarked on ambitious plans to better integrate... more Over the post decade, provincial governments have embarked on ambitious plans to better integrate their healthcare systems, through the introduction of regional governance and management structures. The objective of this study was to examine physicians' perceptions of the current level and facilitators/barriers to integration in three Western Canada Health Regions. Three approaches to integration were investigated: functional, clinical services, and physician system integration. Physicians perceived that functional integration within each region was questionable. Clinical services were the least integrated approach. Physician system integration was rated highest of the approaches, particularly adherence to clinical practice guidelines usage. Physicians' perspectives of integrated health delivery systems do not appear to be influenced by regional size, maturity, urbanicity or facilities. Facilitators of integration were communication among health professionals and service providers, and using a multi-disciplinary team approach in delivery of healthcare in both regions. Barriers to integration were organizational culture, access to specialists and clinical services, and health information records. On a scale of 1-5, all three regions are at the beginning of an integrated health delivery system. Three global suggestions were provided to further integration of health delivery services: physicians should be involved in decision-making process at the Board level, clinical services should be patient-centred, and physicians endorsed the use of multi-disciplinary teams.

Healthcare Management Forum, 2013

An in-depth analysis of organizational risk management in health care, and in particular the conc... more An in-depth analysis of organizational risk management in health care, and in particular the concepts of Enterprise Risk Management (ERM), has identified a five part model that can be used by Canadian health care leaders as an evidence supported approach to successful organizational risk management. The Model for Organizational Risk Management has been J a m e s H a n e y 201 2 iv | P a g e Table of Contents 1.0 Introduction .

EcoHealth, 2004

To adequately analyze the impacts associated with the rising use of automobiles, an assessment fr... more To adequately analyze the impacts associated with the rising use of automobiles, an assessment framework is needed that includes environment, health, economic, and sociocultural impacts. Such a framework was developed and applied to a proposed freeway-widening project in Edmonton, Canada. The assessment framework was developed using both Multi-Criteria Analysis and the Ecosystem Approach to Human Health (Ecohealth). Community participation was vital in the application of the assessment framework to this case study. Six stakeholder groups, including community members, City Councillors, and health, environment, and transportation experts, provided needed qualitative data for the assessment framework. Quantitative data were gathered from an ecological study design that associated traffic volumes with respiratory conditions in Edmonton. Community members' perceptions about the impacts of the freeway widening differed from those of the expert groups in a number of areas. Environmental and health degradation was more of an issue to community members than to expert groups. Though respiratory conditions were not projected to increase by a significant amount because of the freeway widening, further analysis is necessary on other biophysical and socioeconomic impacts listed in the assessment framework. The divergence in opinion between community members and experts suggests that more communication is needed between these groups in relation to transportation planning. The Ecohealth approach ensures that community concerns are addressed in transportation planning.

Canadian Public Administration, 2008

In 1994, the Government of Alberta passed legislation, The Regional Health Authorities Act to abo... more In 1994, the Government of Alberta passed legislation, The Regional Health Authorities Act to abolish nearly 200 existing local hospital and public health boards and replace them with 17 regional health authorities. Consistent with the larger fiscal agenda, the intention of the government was to address the issue of efficiency of the health system through the creation of larger integrated management and governance structures. In this article, we examine why Alberta decided to create Regional Health Authorities through legislation to assume responsibility for the management and delivery of a significant range of health services? In examining the interaction of ideas, interests and institutions, we conclude that the government was partially successful in altering existing institutional and interest relationships to align with an emerging political consensus related to cost and sustainability of the health system.

Canadian Journal of Public Health, 2008

Canadian Public Administration, 2014

Journal of Health Politics, Policy and Law, 2010

Although the costs of doctors&amp... more Although the costs of doctors' visits and hospital stays in Canada are covered by national public health insurance, the cost of outpatient prescription drugs is not. To solve problems of access, Canadian provinces have introduced provincial prescription drug benefit programs. This study analyzes the prescription drug policymaking process in five Canadian provinces between 1992 and 2004 with a view to (1) determining the federal government's role in the area of prescription drugs; (2) describing the policymaking process; (3) identifying factors in each province's choice of a policy; (4) identifying patterns in those factors across the five provinces; and (5) assessing the federal government's influence on the policies chosen. Analysis shows that despite significant differences in policy choices, the ideological motivations of the provinces were unexpectedly similar. The findings also highlight the importance of institutional factors, for example, in provinces' decision to compete rather than to collaborate. We conclude that, to date, Canada's federalism laboratory has only partly benefited the Canadian public. Cost pressures may, however, eventually overcome barriers to cooperation between the provincial and the federal governments, enabling them to capitalize on Canada's federal structure to improve the accessibility and affordability of drugs.

Canadian Public Administration/Administration publique du Canada, 2006

... which includes Harvey Lazar, Pierre-Gerlier Forest, John Lavis, A ha Gildiner Aaron Holdway, ... more ... which includes Harvey Lazar, Pierre-Gerlier Forest, John Lavis, A ha Gildiner Aaron Holdway, Stephen Tomblin, Tom McIntosh, Claudia Sanmartin, Marie-Pascale Pomey, klisabeth Martin, and Vandna Bhatia. Josh Marko, David Schaaf and Kevin Wipf provided research ...

Health & social care in the community, 2010

The delivery of paediatric rehabilitation services is complex due to the involvement of different... more The delivery of paediatric rehabilitation services is complex due to the involvement of different service sectors and diverse models of care. Parents of children with disabilities find it challenging to navigate successfully through complicated service delivery systems. Cross-sectoral collaboration to improve continuity of care for children with disabilities and their families is viewed as ideal in public policies. The purpose of this research was to explore how ministerial cultures, processes and structures influence inter-ministerial collaboration for the purpose of enhancing continuity of care for children with disabilities and their families in a Western Canadian province. Six key informants from three government Ministries that funded paediatric rehabilitation services participated in individual, semi-structured interviews between January and May of 2007. Nineteen provincial public policy documents were reviewed. Hall's framework guided the analysis of the key informant int...

Advanced Tools, Technologies, and Applications

Hybrid learning models attempt to create an environment that can harness the best parts of both f... more Hybrid learning models attempt to create an environment that can harness the best parts of both face-to-face and online modes of content delivery. The creation of these environments can be achieved in a very straightforward manner. However, the challenge is to develop these ...

This essay explores the introduction of population-needs-based funding (PNBF) formulae for the pr... more This essay explores the introduction of population-needs-based funding (PNBF) formulae for the provision of health care services in five provinces (Newfoundland and Labrador, Quebec, Ontario, Saskatchewan and Alberta) as part of a larger project examining a range of health reform decisions in those provinces. Based on semi-structured key-informant interviews with civil servants, stakeholder representatives and political actors the paper examines why and how some provinces chose to move ahead with PNBF formulae while others did not. For two of the provinces (Alberta and Saskatchewan) the implementation of the formulae stemmed directly from the process of regionalization carried out shortly before, while Quebec's particular model of regionalization led to a slower and more gradual adoption of a PNBF formula. Although Newfoundland did implement a regionalized governance structure, it has not attempted to change how services have been traditionally funded, leaving much of the decision making in this area to bureaucratic and political actors. Ontario's decision to not pursue a full-scale form of regionalization meant that key stakeholders in the acute care sector could effectively block any significant discussion of changes to how health care dollars are allocated.

This review revealed that evidence exists for associations between aspects of the urban environme... more This review revealed that evidence exists for associations between aspects of the urban environment and behaviours contributing to obesity. Economic environments—For individuals, a lower socio‐economic status (education level, income, employment) was often associated with increased obesity among both adults and children. For instance, lower personal income affects affordability of food, which demonstrates the most consistent influence on food consumption. Similarly, individuals living in middle‐income to high‐income neighbourhoods are more likely to be physically active than their counterparts in lower‐income neighbourhoods. Lower‐income neighbourhoods are also more likely to contain greater access to sources of energy‐dense foods (for example, fast foods) and lower access to supermarkets or other stores stocking healthy foods. What this means is that interventions aimed at improving the income and educational status of individuals and families within urban environments may help add...

The Journal of the Canadian Chiropractic Association, 2012

Journal of Health Politics, Policy and Law, 2014

Although much has been written on health policy making in developed countries, the same cannot be... more Although much has been written on health policy making in developed countries, the same cannot be said of less developed countries, especially in Africa. Drawing largely on available historical and government records, newspaper publications, parliamentary Hansards, and published books and articles, this article uses John W. Kingdon's multiple streams framework to explain how the problem, politics, and policy streams converged for Ghana's National Health Insurance Scheme (NHIS) to be passed into law in 2003. The article contends that a change in government in the 2000 general election opened a ''policy window'' for eventual policy change from ''cash-andcarry'' to the NHIS.

Journal of Public Health Policy, 2002

Every couple of decades governments decide that they need to involve citizens more in public deci... more Every couple of decades governments decide that they need to involve citizens more in public decision-making processes. The significant changes that have occurred over the past decade, including a growing loss of faith in the traditional institutions of government, have once again prompted political decision-makers to explore options for enhanced citizen participation. In the health care sector, reforms occurring during the 1990s were couched in terms such as "enhanced responsiveness," "improved accountability," and "increased citizen participation." In the new millennium, governments and regional health authorities have been relatively silent on this issue. As has been the case in the past, a wide range of opinions exist about what citizen participation is and how governments should proceed. Without either conceptual clarity or practical direction, governments have been slow to articulate what they hope to achieve or how they intend to get there. The purpose of this paper is to examine the concept of citizen participation within the context of a series of basic questions from which decision-makers might draw some policy relevance. Rather than taking a particular disciplinary perspective (i.e. health promotion), the authors have chosen to review a broad spectrum of existing literature to provide a better understanding of what is known about citizen participation, both good and bad. As such, the paper is meant to be a point of departure for an informed discussion of the possibilities for improved citizen participation in health (care) decision-making.

Healthcare Management Forum, 2008

This paper offers a detailed historical description of the development of Alberta's population-ba... more This paper offers a detailed historical description of the development of Alberta's population-based funding model for Regional Health Authorities (RHAs). It focuses on key political factors that may have facilitated this transition-in particular, the role of institutions, organized interests, and ideas and values. Understanding the politics of policy change as exemplified in this case can be useful in assessing future prospects for health system reform in Canada and laying the groundwork for further comparative study. Résumé Cet exposé donne une description historique détaillée de la mise au point du modèle de financement basé sur la population appliqué aux régies régionales de la santé en Alberta. Il se concentre sur les principaux facteurs politiques qui ont facilité cette transition, notamment le rôle des institutions, les intérêts organisés et les idées et valeurs. La compréhension des aspects politiques du changement des politiques, tel qu'illustrés dans ce cas, peut être utile pour évaluer les perspectives futures de la réforme du système de santé au Canada et jeter les bases d'autres études. Methods Qualitative research-"an inquiry process of understanding a social or human problem, based on building a complex, holistic picture, formed with words, reporting detailed views of informants, and conducted in a natural setting," 6-was employed for this project. Specifically, we employed case study methods because they allow the researcher to examine the "motive,

Healthcare Management Forum, 2005

Over the post decade, provincial governments have embarked on ambitious plans to better integrate... more Over the post decade, provincial governments have embarked on ambitious plans to better integrate their healthcare systems, through the introduction of regional governance and management structures. The objective of this study was to examine physicians' perceptions of the current level and facilitators/barriers to integration in three Western Canada Health Regions. Three approaches to integration were investigated: functional, clinical services, and physician system integration. Physicians perceived that functional integration within each region was questionable. Clinical services were the least integrated approach. Physician system integration was rated highest of the approaches, particularly adherence to clinical practice guidelines usage. Physicians' perspectives of integrated health delivery systems do not appear to be influenced by regional size, maturity, urbanicity or facilities. Facilitators of integration were communication among health professionals and service providers, and using a multi-disciplinary team approach in delivery of healthcare in both regions. Barriers to integration were organizational culture, access to specialists and clinical services, and health information records. On a scale of 1-5, all three regions are at the beginning of an integrated health delivery system. Three global suggestions were provided to further integration of health delivery services: physicians should be involved in decision-making process at the Board level, clinical services should be patient-centred, and physicians endorsed the use of multi-disciplinary teams.

Healthcare Management Forum, 2013

An in-depth analysis of organizational risk management in health care, and in particular the conc... more An in-depth analysis of organizational risk management in health care, and in particular the concepts of Enterprise Risk Management (ERM), has identified a five part model that can be used by Canadian health care leaders as an evidence supported approach to successful organizational risk management. The Model for Organizational Risk Management has been J a m e s H a n e y 201 2 iv | P a g e Table of Contents 1.0 Introduction .

EcoHealth, 2004

To adequately analyze the impacts associated with the rising use of automobiles, an assessment fr... more To adequately analyze the impacts associated with the rising use of automobiles, an assessment framework is needed that includes environment, health, economic, and sociocultural impacts. Such a framework was developed and applied to a proposed freeway-widening project in Edmonton, Canada. The assessment framework was developed using both Multi-Criteria Analysis and the Ecosystem Approach to Human Health (Ecohealth). Community participation was vital in the application of the assessment framework to this case study. Six stakeholder groups, including community members, City Councillors, and health, environment, and transportation experts, provided needed qualitative data for the assessment framework. Quantitative data were gathered from an ecological study design that associated traffic volumes with respiratory conditions in Edmonton. Community members' perceptions about the impacts of the freeway widening differed from those of the expert groups in a number of areas. Environmental and health degradation was more of an issue to community members than to expert groups. Though respiratory conditions were not projected to increase by a significant amount because of the freeway widening, further analysis is necessary on other biophysical and socioeconomic impacts listed in the assessment framework. The divergence in opinion between community members and experts suggests that more communication is needed between these groups in relation to transportation planning. The Ecohealth approach ensures that community concerns are addressed in transportation planning.

Canadian Public Administration, 2008

In 1994, the Government of Alberta passed legislation, The Regional Health Authorities Act to abo... more In 1994, the Government of Alberta passed legislation, The Regional Health Authorities Act to abolish nearly 200 existing local hospital and public health boards and replace them with 17 regional health authorities. Consistent with the larger fiscal agenda, the intention of the government was to address the issue of efficiency of the health system through the creation of larger integrated management and governance structures. In this article, we examine why Alberta decided to create Regional Health Authorities through legislation to assume responsibility for the management and delivery of a significant range of health services? In examining the interaction of ideas, interests and institutions, we conclude that the government was partially successful in altering existing institutional and interest relationships to align with an emerging political consensus related to cost and sustainability of the health system.

Canadian Journal of Public Health, 2008

Canadian Public Administration, 2014

Journal of Health Politics, Policy and Law, 2010

Although the costs of doctors&amp... more Although the costs of doctors' visits and hospital stays in Canada are covered by national public health insurance, the cost of outpatient prescription drugs is not. To solve problems of access, Canadian provinces have introduced provincial prescription drug benefit programs. This study analyzes the prescription drug policymaking process in five Canadian provinces between 1992 and 2004 with a view to (1) determining the federal government's role in the area of prescription drugs; (2) describing the policymaking process; (3) identifying factors in each province's choice of a policy; (4) identifying patterns in those factors across the five provinces; and (5) assessing the federal government's influence on the policies chosen. Analysis shows that despite significant differences in policy choices, the ideological motivations of the provinces were unexpectedly similar. The findings also highlight the importance of institutional factors, for example, in provinces' decision to compete rather than to collaborate. We conclude that, to date, Canada's federalism laboratory has only partly benefited the Canadian public. Cost pressures may, however, eventually overcome barriers to cooperation between the provincial and the federal governments, enabling them to capitalize on Canada's federal structure to improve the accessibility and affordability of drugs.