UBC Theses and Dissertations

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UBC Theses and Dissertations

Alternative care delivery systems : an empirical study and commentary Ratsoy, M. Bernadet


The rising costs of health care and the lack of integration between parts of the delivery system has led to discussion and experiments on new forms of delivering care. Governments have included the development of ambulatory care in new statements of objectives and goals in the hope that expenditures might be reduced through the reduced use of acute care hospital beds. This is a study of the experience surrounding an acute care hospital's attempts to have a Medical Day Care Program accepted by the government as an adjunct to the existing Ambulatory Care Services of the hospital. As Director of Nursing at the hospital it was possible to follow the sequence of events, concept development, proposal design, ministry involvement, implementation and evaluation. A diary was kept for one year following implementation of the program as a pilot project and project documents have contributed to the analysis of events. What was not readily apparent were the many forces outside the hospital which were impacting on the likelihood of the proposal's acceptance. Since Ambulatory Care was the health policy of the 1970's it was puzzling to find the Ministry of Health unresponsive to a proposal which seemed most appropriate. In attempts to resolve the puzzle regarding the lack of interest in ambulatory care at the hospital level, other developments in the province were reviewed. Planning models were explored seeking explanation for inconsistencies observed between stated government objectives and government behavior in relation to the development of hospital ambulatory care. More satisfactory explanations were found in a political model than in planning models, in the light of actual developments. Some conclusions are drawn about the impact of political realities on management functions in health care institutions.

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