Hospital restructuring in smaller urban Ontario settings: unwritten rules and uncertain relations

Abstract

Important changes are underway in the management and provision of welfare service activities in advanced capitalist societies as governments scale back their responsibilities and commitments to social security and health care. In order to understand the processes by which the reform imperatives of the central state are implemented at the local level, it is necessary to account for particular organizational and place‐based contingencies which influence decision making and strategic response. This paper presents a framework for understanding the context of executive decision making in the human services sector and uses the framework to illustrate issues of locally designed hospital restructuring in smaller urban centres in the province of Ontario, Canada. Specific experiences of the Chief Executive Officers of two non‐metropolitan hospital settings are examined to explore the unwritten rules of hospital conduct and the relations of uncertainty that characterize efforts to restructure hospital services through formal arrangements with other independently governed hospitals and health care delivery organizations.

The greying of resource communities in northern British Columbia: implications for health care delivery in already‐underserviced communities

“…The medical geography literature in particular has highlighted the difficulty rural and small town places have in providing even basic health services (Joseph and Bantock 1984;Gesler and Ricketts 1992). Issues associated with the retrenchment of service availability have been shown to be important in both Canadian (Armstrong et al 2001;Hanlon 2001) and international settings (Kearns and Joseph 1997;Barnett 2000) and to have specific impacts on vulnerable populations such as the frail and elderly (Hayslip et al 1980;Windley 1983;Aronson and Neysmith 1997;Cloutier-Fisher and Joseph 2000;Crampton et al 2001). Another common research theme has been around the problem of overcoming, or at least coping with, distance in rural health care provision (Halseth and Rosenberg 1991;Higgs and White 1997).…”

“It's not only for sick people”: The place of the local hospital in a rural northern Ontario community

“…The hospital also housed a number of other services, including public health and diabetes care. Although there was little talk of the sustainability and future of the hospital, beyond the discussion of having a population to sustain the hospital (and the community, for that matter), increasing regionalization was certainly a possibility (Hanlon ). In 2006, Ontario moved to a regional model for health care services with 14 LHINs working to determine regional health service priorities (Local Health Integration Networks ).…”

“…In 2006, Ontario moved to a regional model for health care services with 14 LHINs working to determine regional health service priorities (Local Health Integration Networks ). However, with little community‐based control of services (Skinner et al ), sustainability and the future of small rural northern hospitals are uncertain (Hanlon ).…”

“…In Ontario, hospitals serving more remote and sparsely populated communities have not experienced the severity of restructuring in terms of hospital closures and reduction of in‐patient services (Hanlon ), but there have been numerous other changes affecting the structure of health care in Ontario, most notably the introduction of the Local Health Integration Networks (LHINs). The 14 LHINs in Ontario plan, fund, and integrate health care services locally (Local Health Integration Networks ).…”

Networks and partnerships in a resource town: A case study of adapting to an aging population in Mackenzie, B.C.

“…Regionalization entails the devolution and decentralization particularly aspects of decision making and priority setting (e.g., hospital closures and rationalization of services) from provincial governments to regional authorities. In this sense, regionalization represents the downloading of responsibilities for welfare to more localized levels of administration and decision-making (Hanlon 2001). At the same time, health care regionalization in…”