This case chronicles three major challenges faced by the Niagara Health System, a seven-hospital network in the Niagara region in the province of Ontario, Canada. An interim chief communications officer has joined the Niagara Health System team on secondment to help with communications issues during a C. difficile outbreak. He soon realizes that the public communication issues were not isolated to this outbreak, but rather continued a trend of poor relationships with local media and the public. The case examines the field of hospital communications in Ontario, including trends and best practices, a history of communications struggles at the Niagara Health System, strategy options and considerations to manage the C. difficile outbreak and strategies to improve trust and reputation. See supplement 9B15M023.
In 2012, a highly controversial bill was passed that called for major reform and restructuring of Britain’s government healthcare system, the National Health Service. Public opinion of the reform was both highly polarized and volatile. The Secretary of State for Health faces two tasks: addressing key issues to ensure successful implementation of the reforms and developing a plan to ensure both long-term and short-term success.
Cancer Care Ontario, the organization that oversees cancer treatment in Ontario, is challenged with establishing an innovative approach to reducing wait times for breast cancer and prostate cancer therapy across Ontario after wait times increased to more than two months. The special advisor on cancer issues to the Ontario Minister of Health and Long-Term Care needs to report his recommendation to Cancer Care Ontario’s board of directors, who manage all regional cancer centres in the province. The major challenge is to balance the needs and values of all the various stakeholders, while developing short-, medium- and long-term solutions to the wait list dilemma.
The Change Foundation is an independent charitable foundation founded in 1996 by the Ontario Hospital Association with the mandate to promote, support and improve health and the delivery of health care in Ontario. In 2006, its board of directors undertook a renewal process to evaluate its strategic directions and measure the value-add of progress to date. A planning session with a variety of key stakeholders had resulted in the development of a draft plan for going forward, which included hiring a new chief executive officer. When she began assessing the plan in January 2007, she faced several major issues and concerns about how the foundation should refocus its activities and transform itself. Before she could start to rebuild, however, she had to decide what its future direction should be.
In the spring of 2003, the World Health Organization identified a worldwide epidemic of severe acute respiratory syndrome (SARS) that had started in China and spread to the rest of the world, with early cases reported in Toronto and Vancouver. Little was known about the disease, which meant that symptoms were often misdiagnosed as simple flu, and the infection spread rapidly. After the third SARS-related death occurred in Ontario in mid-March, the provincial premier declared a state of emergency, which was finally lifted on May 17 when it appeared the outbreak had ended. A week later, on May 23, four new cases were reported at Toronto’s North York General Hospital. The lack of public health infrastructure in Ontario combined with its hospitals’ noncompliance with following existing policies concerning infection control and especially the lack of communication between hospitals, health organizations and levels of governments, with numerous spokespersons making uncoordinated and sometimes contradictory announcements, all led to the public perception that the government and health care authorities did not know what they were doing or were lying about the severity of the outbreak. Before the next provincial election, the premier must examine and address what could have been prevented, how public health interventions were managed and the differences between public health responses in Toronto and Vancouver.
In 1997, the Ontario Health Services Restructuring Committee mandated the merger of four facilities that treated patients with mental health and addiction issues to create what was later named the Centre for Addiction and Mental Health. This new centre, to be situated in Toronto, would provide support and clinical care to those suffering from illnesses such as schizophrenia, anxiety and mood disorders, as well as substance addictions. In 1999, the newly appointed chief executive officer and his management team have to present their recommendations to the board of trustees for implementing this complex merger. The plan will need to recognize and address significant infrastructure, strategic, organizational and stakeholder challenges. The merger will be a large change for vulnerable patient populations and their families, as well as the staff at the four merging organizations and the neighbourhoods bordering the new facility.
Strongest Families is a 12-week distance treatment program for children with various mental health disorders and their families. The program was started in Nova Scotia in 2001 to address issues of stigma, lack of access to primary care specialists and difficulty of obtaining care, especially in rural areas. To meet these needs, the program utilizes long-distance communication methods such as weekly telephone meetings with trained personnel who are available days, nights and weekends, so access to care is easy and convenient for families. The founder of the program has already proven its efficacy in a major outcome paper that disseminated the supporting evidence to the research community. As chief executive officer of the Strong Families Institute, a federally registered not-for-profit organization, he and his founding partner, now chief operating officer, want to scale up the program to other provinces and eventually other countries, but they must get government ministries and other stakeholders on side in the interests of making mental health care widely available to the children and families who need it.
In January 2005, the vice-president of International Affairs at the Hospital for Sick Children in Toronto, Ontario, must decide how to respond to a request for proposal from the Hamad Medical Corporation of Qatar. In order to reach its global mission of “Healthier Children, A Better World,” the Toronto hospital, which had an international reputation for excellence in pediatric medicine, had established an arm called SickKids International. In addition, it was anxious to find new ways to recover from an operating deficit caused by the aftershock of the SARS outbreak. Hamad Medical Corporation, a major state hospital medical supplier in Qatar, was looking for international centres that would want to partner with it in the development of what it hoped would become the best children's hospital in the Middle East. The vice-president understood the enormous benefits that the partnership had to offer but recognized the need for a comprehensive strategy to mitigate all of the associated risks, such as the difference in cultures between Canada and Qatar, the pressure on the Toronto hospital’s staff to make the project successful and the uncertain political and business environment in the Middle East. Should she recommend to her executive team that they go ahead with their first international request for proposal?
In 2011, the Alberta government launched an aggressive campaign to raise awareness about the growing rate of syphilis in the province. It launched an incredibly successful campaign that incorporated elements of social media that went viral. Though awareness was raised, the health system struggled to keep up with demand. The case deals with the challenges faced by the different areas of the health care system in receiving approval for the campaign and managing the subsequent demand.
In February 2004, a physician working in the intensive care unit of a Toronto hospital wondered how to implement a strategy whereby an entire health care team could work towards better and consistent patient care based on best evidence. Doctors’ orders varied from one physician to another, and oftentimes the health care team had little insight into what worked best, what the best evidence was and how they could be sure their patients were receiving the best care possible. He wondered if it would be possible to adopt the airline industry’s “order sets” — step-by-step, evidence-based checklists that could be used by clinicians to order treatments for patients. He recognized that there were problems in implementing such a program, especially the lack of a standardized information technology strategy across the provincial health care system and physicians’ fear of losing their autonomy in making care decisions. Physicians already had access to clinical practice guidelines, which were designed to assist them to make informed, evidence-based decisions by removing the burden of tailored research and intervention design, but many found these to be too long, sometimes outdated and not integrated with the clinical process. How could these guidelines be integrated with physician orders to create a standardized process to ensure that every patient had access to the best care possible?
A large, international benevolent association operating 22 children’s hospitals and four research centres in three countries has been negatively impacted by a number of external factors. The effect of the 2008 global financial crisis on its endowment funds coupled with rising health care costs and flat donations, have resulted in the hospitals running at a loss. To ensure the long-term viability of their not-for-profit hospital system, management feels it must present drastic options to delegates at its annual general meeting, including reconsidering the policy of providing free medical care to children regardless of their ability to pay, shutting down research facilities and closing over a quarter of their hospitals. While management is confident that the quality of care for pediatric patients will not be compromised, all of the options being considered will significantly impact hospital operations and the organization’s culture. For the first time in the 87 years of the organization’s existence, some very difficult options are on the table.
This case chronicles the challenges of establishing an innovative tissue bank service to accelerate the research and development processes of biotechnology and pharmaceutical companies worldwide. Asterand’s two major challenges involved achieving a standardized approach to collecting tissue samples in hospitals all over the world and achieving the highest possible quality of tissue samples shipped to their primary customer, Amgen. Despite the identified need for high-quality tissue samples, Asterand was experiencing multiple quality control problems in their processes and procedures. Tissue samples were being packaged poorly, labeled incorrectly or delivered at the wrong time or to the wrong place. Additionally, there were quality issues with the RNA analysis of the samples, which was a critical factor in the usability of the tissue sample for research and development of new therapies and drugs. <br><br><br><br>The head of pathology at Amgen’s California facility was threatening to terminate their existing order and communicate the failure of Asterand to all company employees, which would have a devastating ripple effect across the industry and likely destroy opportunities for any future orders with Asterand. If this happened, Asterand would not be able to secure contracts with customers and was at risk of losing investors and going bankrupt.
Riverside District Memorial Hospital is a small rural hospital that must work within an operational budget that is determined by the Ministry of Health and Long Term Care. This case identifies the emergence of concerns for patient safety related to medication administration, and the challenges of ensuring that professional services are maintained by the pharmacy department to serve patients admitted to hospital. The chief nursing executive must decide what steps should be taken to reduce medication errors, in the context of the complex relationships at Riverside.