Obtaining public input for health‐systems decision‐making: Past experiences and future prospects

Abstract: Interest in finding more effective methods for public involvement in decision‐making about health systems is more widespread than ever in Canada since significant aspects of health‐care decision‐making were devolved from provincial governments to regional health authorities. Involving the public can be risky business, however, as the accountability and legitimacy of decisions made by governing authorities are often assessed against the nature and degree of interaction that occurs with the public. Consequently, decision‐makers in a variety of policy domains routinely struggle with questions about when it is appropriate to involve the public, what the most effective means are for doing this, and how to measure their success. The authors analysed these issues by documenting the experiences of health‐systems decision‐makers in two Canadian provinces (Ontario and Quebec) with public consultation and participation over the past decade. Their findings illustrate that despite the different roles and responsibilities held by Ontario and Quebec decision‐makers, decisions to consult with their communities are driven by the same basic set of objectives: to obtain information from and to provide information to the community; to ensure fair, transparent and legitimate decision‐making processes; and to garner support for their outcomes. Decision‐makers also acknowledged the need to rethink approaches for involving the public in decision‐making processes in response to the perceived failure of past public participation and consultation processes. While these experiences have clearly left some participation practitioners feeling beleaguered, many are approaching future community consultation processes optimistically with plans for more focused, purposeful consultations that have clear objectives and more formal evaluation tinged with a healthy dose of pragmatism. Sommaire: L'intérêt que I'on porte à trouver des méthodes plus efficaces pour inciter le public à participer à la prise de décisions au sujet des systèmes de santé ne cesse de grandir au Canada depuis que les gouvemements provinciaux ont transféré aux autorités régionales la responsabilité d'importants aspects de la prise de décisions dans ce domaine. Cependant, faire intervenir le public peut être une affaire délicate, car la transparence et la légitimité des décisions prises par les autorités existantes sont souvent évaluées par rapport à la nature et au degré d'interaction qui se produit avec le public. C'est pourquoi, les décideurs dans divers domaines de politiques ont généralement de la difficultéà déterminer quand il convient de demander I'avis du public, quels sont les moyens les plus efficaces pour le faire et comment mesurer leur succès. Nous avons analysé ces questions en documentant les expériences que les décideurs des systèmes de santé de deux provinces canadiennes (l'Ontario et le Québec) avaient eues en ce qui concerne les efforts de participation et de consultation publique au cours de la derniére décennie. Nos conclusions démontrent qu'en dépit des divers rôles tenus et diverses responsabilités assumées par les décideurs de I'Ontario et du Québec, leur déision de consulter leurs communautés est guidée par les mêmes principaux objectifs: obtenir de I'information de la communauté et lui en foumir; assurer des processus de prise de déisions justes, transparents et légitimes et obtenir I'aval de leur décision. Les décideurs ont également reconnu le besoin de repenser les approches visant à faire participer le public aux processus de prise de décisions suite à I'échec perçu des expériences antérieures de participation et de consultation du public. Alors que certains partisans de la participation ont été clairement découragés par ces expériences, un grand nombre envisagent avec optimisme les processus de consultation communautaire. Ils croient que les consultations pourraient être plus focalisées et plus déterminées visant des objectifs clairs et une évaluation plus formelle et empreinte d'une bonne dose de pragmatisme.     

Sex differences in the identity formation of college students from divorced families

This study was desgined to examine gender differences in identity formation in late adolescents from divorced mother-custody families. Fifty-seven female and thirty-nine male college students ranging in age from 17 to 25 years completed the Child's Report of Parental Behavior [E. S. Schaeffer (1965) Children's Reports of Parental Behavior: An Inventory, Child Development, Vol. 36, pp. 412–482] and were interviewed using the J. E. Marcia [(1966) Development and Validation of Ego Identity Status, Journal of Personality and Social Psychology, Vol. 3, pp. 551–558] semistructured Identity Status Interview. While no differences between males and females were found in ratings of overall identity status, significantly more females were in the achieved category within the domains of occupation and attitudes toward premarital sex. Also, males perceived their mothers as significantly more accepting and less controlling than did females. The absence of the father and the altered role of the mother appear to have a differential impact on males and females who have grown up in mother-custody families. Implications of these and other findings are discussed.Received Ph.D. in Counseling Psychology from Teachers College Columbia University. Research interests include adolescent identity formation, the intersection and integration of personal and career counseling, and career development.     

Private provision of public services: Contracting by large local governments

This study examines public service delivery by counties and municipalities of over 500,000 popula tion, through the practice of contracting out with the publicsector. It is based on responses to a question naire sent to purchasing officials in American and Canadian cities, counties, and state governments Results indicate the types of services contracted out the frequency of contracting out, procedures utilized and administrative attitudes. We find that a diverse group of non-professional,non-construction services are being provided by private contractors for these jurisdictions, but the jurisdictions are not providing a majority or even a significant portion of their services in this manner.     

Das einheitliche Bestandverhältnis

Bei Vorliegen eines Bestandverhältnisses und gleichzeitiger oder nachfolgender Inbestandnahme eines weiteren Objektes stellt sich die Frage, ob zwei getrennte Vertragsverhältnisse oder ein einheitliches Bestandverhältnis vorliegen. Diese Frage ist zB für das Vorliegen der Zulässigkeit der Aufkündigung der Objekte relevant, die im Fall eines einheitlichen Bestandverhältnisses im Allgemeinen nur einheitlich erfolgen kann, sowie für die Mietzinsbildung und das Vorliegen des Kündigungsschutzes des MRG. Die Kriterien, die die Rsp für die Beantwortung der Frage, ob ein einheitlicher Vertrag oder zwei gesonderte Verträge vorliegen, aufstellt und welche Rechtsfolgen sich im Einzelfall daraus ergeben, werden hier kurz dargestellt.     

Community involvement: a function of local government innovation

This paper discusses the implications of community involvement for the delivery of public services. It discusses exemplary case studies of community involvement in government, and provides an in-depth discussion of community participation in the affairs of the Engineering Traffic Division in San Diego, California. It finds a positive relationship between community involvement, and responsiveness, customer satisfaction, efficiency and effectiveness.