Accountability in Ontario's Health Care System: The Role of Governance and Information in Managing Stakeholder Demands

Abstract

This research focuses on nonprofit accountability because accountability failures, such as frauds and scandals, impede an organisation's ability to deliver on its mission and have raised concerns about an organisation's ability to manage their accountability demands. Previous nonprofit studies have focused on what accountability is and to whom organisations are accountable, while less focus has been given to how accountability is managed. Through the concepts of stakeholder relationships, governance mechanisms and information strategies, an accountability system is proposed and serves as the conceptual framework to understand how nonprofit accountability is managed.The objective of this research is to gain a better understanding of the nonprofit accountability system. As such, the study's research question is how do nonprofit organisations manage their accountability system?To answer the research question, a multiple-case study research strategy using a cross-sectional sample of health care organisations, with a particular focus on nonprofit hospitals and two of its salient stakeholders, Local Health Integration Networks (LHINs) and foundations.This study has provided a clearer understanding of the relationship between accountability, governance and information, which contrasts with a majority of studies that have concentrated on specific aspects of accountability. At the practical level, to iii view accountability as a system, makes it easier to identify weaknesses, which could be used as a governance tool to help nonprofit leaders improve their accountability management practices.iv Acknowledgements I would like to thank my research supervisor, François Brouard, for his valuable support. He guided me through the completion of this thesis with rigour, critical sense, sound advice, and a sense of humour.

CHEO Case Study Examining the Financial Relationship Between a Hospital and its Foundations

“…The present research takes a specific focus on a hospital and its hospital foundations in Canada to better understand the financial relationships existing among them. Further justification for studying both a hospital and its foundations simultaneously is based upon Pilon's (2019) research which identifies stakeholder relationships, such as those between a hospital and its foundations, as a component of the accountability system between them.…”

“…Accountability is important for non-profit organizations to maintain the public support that allows them to fulfil their mission. Prior research has seen hospital foundations as accountable to hospitals for assisting in achieving fundraising goals (Pilon, 2019). Reporting, when done well, helps foster accountability to build the trust needed to help non-profit organizations continue operating (Hyndman, 2017).…”

“…The budget of the provincial government allocates funding to the Ministry of Health and Long-Term Care (MOHLTC), which then allocates the available funding through Ontario Health to various health services. Government funding represents the largest source of hospital funding in Ontario (Pilon, 2019). Each hospital receives funding from the Ministry and enters into an accountability agreement with the province (Pilon, 2019).…”

“…Government funding represents the largest source of hospital funding in Ontario (Pilon, 2019). Each hospital receives funding from the Ministry and enters into an accountability agreement with the province (Pilon, 2019). As established previously, in recent years this funding has been inadequate to keep up with increasing health care costs, increasing demand for hospital services, and new infrastructure needs.…”

“…The role of various stakeholders in non-profit organizations can be seen through the concept of stakeholder relationships. Stakeholder relationships have been identified as one aspect of the accountability framework between an organization and its stakeholders (Pilon, 2019). An important aspect of the stakeholder relationship between an organization (the accountee) and its stakeholders (the accountor) is facilitating communication and negotiations between them (Pilon, 2019).…”