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Vol 38  No 6
November 24, 2005




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Health policy research published

Evaluating health system changes

By Sharon Gray

Deborah Gregory, project manager and PhD candidate. (Photo by HSIMS)

Health policy research done at Memorial University will serve as an important reference for future planning of the health care delivery system in the province.

The impact that the regionalization of health boards in the province had on the restructuring of acute care hospitals is documented in a series of articles by Memorial University researchers, published last month in the Journal of Health Services Research & Policy (Vol. 10, Supplement 2, October 2005).

“This is a peer-reviewed volume of articles based on our research,” said Deborah Gregory, project manager and PhD candidate. “It was a great team effort involving researchers from different disciplines and input from the Health Care Corporation of St. John’s, including a case study by Sister Elizabeth Davis. It’s a good reflection on the health care delivery system in the province and will serve as a useful reference for future planning.”

Dr. Patrick Parfrey, associate dean for clinical research in the Faculty of Medicine, said the research was undertaken because Sister Davis, past CEO of the Health Care Corporation of St. John’s (HCCSJ), felt an evaluation would help the restructuring process. “We had previously been involved in studies on the efficiency of bed utilization, and Dr. Christine Way of the School of Nursing had done studies on nurses’ perceptions of health care reform. On that basis we felt we could do a substantially more extensive evaluation based on the desires of Department of Health and Community Services and the HCCSJ.”

The research showed that regionalization facilitated the integration of services but failed to control costs, primarily because the number of workers was unchanged and wages increased. Access to services was a major problem, as was low employee morale and work-related attitudes. Another conclusion was that changes associated with restructuring probably contributed to the radicalization of the workforce throughout the province.

Dr. Parfrey said that restructuring as carried out in St. John’s was successful because the closure of a hospital, and transfer of the pediatric hospital and rehabilitation unit to a new site, happened without any deterioration in efficiency, work-related attitudes, in patient satisfaction with care, or in objective measures of the quality of care when compared with regions not exposed to aggregation of hospitals.

The study recommends that further integration of the regions, boards, services and institutions should occur in Newfoundland and Labrador and that strategic planning between the boards and government, involving provider groups and the public, should occur to ensure integration of services, continuity of care and reduction of costs. “Quality improvement initiatives to target problems should be encouraged and institutional cultures should be nurtured to improve employees’ morale and organizational commitment,” said Dr. Parfrey.

Ms Gregory said that research on evaluating health system changes in Newfoundland and Labrador will continue and the research group will be involved in monitoring and evaluating the current round of changes.

In addition to Ms Gregory and Drs. Parfrey and Barrett, researchers included Dr. Christine Way, Laurie Twells, Michael Doyle, Dr. Doreen Neville, Gwynedd Barrowman, Brenda Fitzgerald, Dr. Stephen Tomblin, Norma Baker, Dr. Sandra LeFort, Jackie McDonald, Dr. Bryan Curtis, Gloria Kent, Susan Jelinski, Dr. Scott Kraft, Daria O’Reilly, Carol Negrijn, and Angie Batstone.

This edition of the Journal of Health Services Research & Policy is available online at


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