Nurses Influencing Change

Nursing Curriculum for Supporting Change

Learning Activity 6:
Influencing Health Care Reform

"When you blame others, you give up your power to change." - Douglas Noel Adams

"The first step toward change is awareness. The second step is acceptance. The third step is action." - Nathaniel Branden

Overview

Reforms in Canadian health care are currently centered around primary health care which is hinged on the premise that Canadians require connected collaborative care but also must embrace self care to a much higher degree than ever before. "...individual Canadians are not merely the consumers of, and the ultimate source of funding for, the health care system, they are also its largest and most important human resource. Harnessing this resource will require a long-term commitment to patient centered reform. An important first step in this commitment will be to identify and fill the self care policy gap that currently exists in our overall approach to health....What is now needed is a coordinated policy that reduces the barriers to evidence-based, responsible self-care; empowers Canadians with the knowledge tools they need to practice it; and provides the framework and incentives for health professionals to support it." (NDMAC, 2002, p. 3).

The current situatedness of health care reflects a very interesting pattern - that people in Canada do demand "tools they need to practice responsible , informed self-care" (NDMAC, 2002, p. 10) as well as access flexible, comprehensive health care services from a variety of providers including nurse practitioners, alternative and complementary providers and reliable cutting-edge health information and consultations via in-person, printed, online and telehealth mediums. The Canadian population are more than mere stakeholders in health care reform, they are slowly becoming active participants in the petitioning and planning of health care reform. Nurses are in a unique position to facilitate this new development both as agents of change themselves, and as guides/advocates for individuals, groups and communities working for change.

Primary health care initiatives "look beyond the traditional health care delivery; they link to schools and workplace environments and create partnerships and linkages. They focus on educating the public through health promotion and disease prevention. They encourage all Canadians to take an active role in their health" (CNA, 2002, p. 5). This encouragement is the central arena of 21st century nursing.

Various strategies to implement health care reform have occurred throughout the history of the Canadian health care system (Tuohy, 2003). These strategies can be categorized as:

• Big-bang Reform: includes attempts to make major, comprehensive changes to the roles of key players in the system within a short time frame e.g. Parallel public and private (niche) systems
  
  
• Blueprint Reform: includes the implementation of a comprehensive planned change framework in prescribed stages, e. g. current Primary Health care initiative.
  
  
• Incremental Reform: does not include a comprehensive overall design, but rather offers marginal adjustments to the roles of some key players, e.g. Hospital restructuring.

Ends In View

This learning activity is intended to provide learners with the opportunity to:

1. Analyze the process of health care reform from a Canadian perspective.
2. Recognize the current trends in Canadian health care reform and how nurses play an important part in this reform.

In Practice

1. Participate in class discussion related to health care reform history, current trends, and nursing's place in Canadian reform.

2. Read the following statement written by Dr. Anne Stolin, director of Women's Mental health at Mercy Medical Center in Baltimore. Although Dr. Stolin (2000) is a medical doctor, do her insights provide any helpful direction for nurses? Discuss in small groups. /p>

"My eyes usually glaze over as I skim the impotent statements that regularly emerge from American Psychiatric Association and American Medical Association leadership. By now we can all anticipate their content, and we have learned that their leadership doesn't lead anywhere. Yet despite the vagaries of politics and the probably wisdom of a pessimistic stance, isn't it nevetheless comforting to know that our leaders remain involved in the politics and process of reform? We simply shouldn't expect our leaders nor our professional organizations, good as they are, to fix too much of it. Although their paternalistic stance can understandably cause us to react in a regressed and childlike fashion and expect too much, their perhaps inevitable failures have generated much of the anger reflecited in the membership today. Let's not be angry, let's be realistic. It is one tough fight, but we should stay hopeful of victory, meanwhile each finding their own way of fighting for our profession and our patients."" (p. 2)

3. What sort of reform is now needed in Canada, to meet the needs of the Canadian population stakeholders and to ease the nursing shortage (big bang, blueprint or incremental?) Discuss in pairs or triads.

Considering that success with any of these modes of reform usually result in sub-sector reform at best, what is the best strategy for nurses who wish to work for health care reform?

4. In small groups, imagine that you are the executive of a local Regional Health Board. Write a one page list of your health reform goals for the region for the next five years and name the key players and stakeholders. Share with the class giving rationale for your choices.

In Reflection

1. Health care reform is often viewed as a political act used only by top administration and political party members. How does the individual nurse fit into the reform arena?

2. What key health foci motivate you enough to spur you to become involved in health care reform? Why?

References

Canadian Nurses Association. (2002). Primary Health Care: A new approach to health care reform.

Canadian Women's Health Network (2002). Women and Health Care Reform.

Centres of Excellence for Women's Health Program. (1999). Privatization and Health Care Reform in Canada: Analytic Glossary.

Grant, K. (2000). Is there a method to this madness? Studying health care reform as if women mattered.

NDMAC (2002). A Submission on the Future of Health care in Canada. Submitted to the Commission on the Future of Health Care in Canada by the Nonprescription Drug Manufacturers Association of Canada.

Stolin, A. (2000). Fighting for effective health care reform. Psychiatric Times, 17 (4), April.

The Standing Senate Committee on Social Affairs, Science and Technology. (2002). The health of Canadians - The Federal Role: Final Report. Volume Six: Recommendations for Reform. Chapter 4: Primary Health Care Reform.

Tuohy, C. H. (2003). The Political Economy of Health Care Reform: A Cross-national perspective. Presentation to the Conference on the Implementation of Primary Care Reform. Queen's University, November.