UBC Theses and Dissertations
Qualitative standards-setting for Canadian health care services Allen, Elizabeth
The purpose of this study was to examine the process of standards-setting in the Canadian health care system to determine how quality health services are assured and maintained for the elderly population who require care. The interrelatedness of all aspects affecting the provision of quality services was examined: the professional, organizational and administrative aspects governing care delivery. The historical development of health care standards-setting revealed the unsatisfactory nature of regulatory activity in Canada. A shift from a focus on structural standards to a preference for peer-review mechanisms established the professional mechanisms as the preferred means of control; essentially, quality health care services were equated with meeting the normative standards of practice. These professional aspects of care delivery, however, increasingly have led to the medicalization of needs and the fragmentation of services. Standards-setting, from government legislative standards to quality assurance programs, supported and promoted normative practices that tended to escalate costs and provided the wrong incentives for acute and long term care services. The evolution of the long term care services in British Columbia was identified to illustrate the deficiencies in the current approaches to health care standards-setting. Gaps existed in the provision of services for the elderly who required long term care. The nature of long term care services was examined and discussed. Long term care services were not so much based on outcomes, as in the acute care system, but on the processes of care -- the aspects of care provision that would enhance the quality of life for the elderly who require health care services. Current standards-setting practices did not address or provide for these services. The administrative aspects governing care provision were explored as a means to assure quality service delivery. Canadian health care developments were compared to those in the United Kingdom and the United States. Regardless of the approach -- in the United Kingdom with its national Health Service, or in the United States with the proliferation of regulatory activity --costs continued to increase and conflicts arose between the professional and administrative aspects governing services. It becomes apparent, however, that as cost constraints increase micro-level decisions will become more dependent on macro-level decision making. Current standards-setting practices do not address or provide for services that require expanded models of care provision. Appropriate standards-setting for care processes, therefore, must include not only the professional aspects but take into account the administrative and organizational aspects when developing services. Based on the findings of the study, recommendations are made for standards-setting for long term care services.
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