Grant: Partnerships for Health System Improvement (PHSI)

Accountability means having to be answerable to someone for meeting defined objectives. Although it has been identified as a major priority, it is not clear how best to achieve it. The proposed Approaches to Accountability PHSI will fund an accomplished interdisciplinary team, working in partnership with policy makers across multiple sub-sectors, to clarify what is known about best practices to achieve accountability under various circumstances. We will concentrate on 4 currently-used approaches to accountability- Financial incentives, Regulations, Information directed towards patients/payers, and Professionalism/stewardship. We postulate that these approaches will have differing success when applied to various categories of services, and within various sub-sectors, with the likely outcomes depending upon: a) the policy goals being pursued; b) the governance/ownership structures and relationships in place; and c) the goods and services being delivered, and their production characteristics. Eleven related sub-studies are currently proposed, each with specified researcher leads and decision making partners, to enable us to analyze the strengths and weaknesses of approaches to accountability being taken by such groups as provincial governments, regional health authorities, Cancer Care Ontario, public health units, hospitals, laboratories, long-term care institutions, community support services/home care, primary health care, and health professionals. The sub-studies will be phased in over the time period of the grant, and we expect that additional sub-studies will be added, particularly in other jurisdictions. We are confident that the questions and partners already identified will provide rich and generalizable results to clarify what is known about best practices to achieve accountability in a broad cross-section of key services and categories.