From good intentions to successful implementation: the case of patient safety in Canada

Abstract: Improvements to patient safety have become a major issue on Canada's already crowded health care policy agenda. This paper applies implementation theory to the practical issues involved with the adoption of patient safety reforms. It is based on a review of the literature and official reports on patient safety and on the author's experience as the chair of the Board of Directors of the Manitoba Institute for Patient Safety created in June 2004. The obstacles and possible solutions to advance the patient safety agenda are discussed. While implementation theory was found to provide a general guide, the author's experience leads him to conclude the literature on governance and organizational change offers more practical advice. Sommaire: L'amélioration de la sécurité des patients est devenue une question majeure du programme déjà chargé des politiques en matière de soins de santé. Le présent article applique une théorie de mise en œuvre aux questions pratiques découlant de l'adoption des réformes sur la sécurité du patient. II est fondé sur une étude de publications et rapports officiels sur la sécurité du patient, ainsi que sur l'expérience de l'auteur en tant que président du conseil d'administration de l'Institut pour la sécurité des patients du Manitoba, créé en juin 2004. II passe en revue les obstacles et les solutions possibles à la promotion du programme de la sécurité des patients. Si l'auteur trouve que la théorie de la mise en œuvre fournit un guide général, son expérience le pousse à conclure que la documentation sur la gouvernance et les changements organisationnels offre davantage de conseils pratiques.     

The accountants are coming! How accountants can help policymakers in social program evaluation

Recently, numerous writers, accountants and non-accountants alike, have considered the relative merit of extending the scope of accountants' activities to include a role in social program evaluation. This paper attempts, firstly, to offer a framework which identifies various aspects of the evaluation process and, secondly, to highlight the contribution accountants can make within that framework. The paper consists of three sections. The first section considers activities which are typically performed by accountants in the profit-seeking sector of economy. The second section describes various facets of evaluation and the stages of program development, and attempts to integrate the two via a differential evaluation process. In the concluding section, it suggests that accountants do have a significant contribution to make to social program evaluation, and that this contribution is consonant with their role in profit-seeking enterprises. However, the paper also seeks to caution about the areas where accountants cannot and should not be expected to make contributions without specific training beyond their accounting expertise.     

DEADLY FORCE AS A POLICY PROBLEM IN LOCAL LAW ENFORCEMENT: DO ADMINISTRATIVE PRACTICES MAKE A DIFFERENCE?

This article examines the impact of six administrative practices on the use of deadly force by police officers in American cities with a population greater than 50,000. Generally, departmental policies demonstrate little association with the frequency of shooting incidents per police officer, or in the number of incidents resulting in fatalities or injuries. It does appear that police departments which issue more traditional sidearms tend to experience fewer incidents than departments which issue heavier firearms. This same lack of association between administrative practices and the use of deadly force is discovered when controlling for city population size arid state legal codes. Notwithstanding that some of the relationships are in the expected direction, their lack of statistical significance suggests that the use of deadly force has its antecedents in sources other than the administrative policies of local police departments.     

PLANNING: LESSONS FROM THE PORTS

The National Ports Council, created in 1964 and abolished in 1982, was engaged in one of the rare sustained attempts at planning in Britain. This article explains the Council's decision not to carry out full-scale planning because of the difficulties of collecting information, assessing technological and economic changes, and reconciling rational economic planning with short term political pressures.     

Institutionalized Evaluation and Intergovernmental Relations: The Case of Coastal Zone Management

The enactment of national environmental management programswas prompted, in large part, by the perceived failure of stateand local government officials to deal adequately with pollutioncontrol and resource management problems. Paradoxically, theimplementation of several important environmental managementprograms relies heavily on these same state and local officials.Congress has sought to resolve this paradox by requiring federalevaluation of state and local environmental planning and managementactivities. Many of these evaluations are little more than routinefiscal audits. However one agency, the Office of Coastal ZoneManagement, has sought to develop a systematic evaluation processfocusing on all aspects of state coastal zone programs. Theseevaluative efforts have led to intergovernmental tensions, mostnotably with regard to the purposes and methods of evaluation,the appropriate roles of federal and state officials, and theresources available for evaluation. In spite of these tensions,there is broad agreement about the value of the evaluation processand its potential applicability in other contexts.