CIHR - Team in community care and health human resources
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Provincial Governments/Regional Authorities/Hospitals

Provincial Governments and Public Health

Hospitals Internal Accountability

Cancercare Ontario and Hospitals

Regional Health Authorities and Community

Provincial Government and Nursing Homes

Local Governments and Homes for the Aged

Provincial Governments and Lab Services

Provincial Governments/Regional Authorities and Primary Care

Professional Regulatory Bodies

Provincial Governments and Public Health Units

Research Team:
Robert Schwartz (co-lead)
Raisa Deber (co-lead)
Heather Manson
Fran Scott
David Mowat
Alex Price (student)

Project Details:

Objectives:  Several national and provincial crises have inspired the development of new forms and systems for holding local public health units accountable for their performance.  Little is known about how to measure or about the impacts of different accountability mechanisms for different public health activities. We examine existing and emerging accountability systems, present an evaluation approach and assess intended and unintended, positive and negative, consequences.

Methods:  Key informant interviews, a web-survey of public health CEOs / MOHs, comparative case studies of five public health units, and focus groups are used to create both a broad picture of the state of the art in Ontario and in-depth understanding of challenges and successes.

Results:  Preliminary results indicate that both the type of accountability mechanisms in place and their effects vary with characteristics of public health activities, size and sophistication of public health units, and political-administrative environments. While several accountability mechanisms are in place (e.g. Ontario Public Health Standards and associated performance measurement, accreditation, reporting to Boards of Health) their impacts on performance are often not demonstrable. Public Health Units are more concerned with accountability to some accountability holders than others. In particular, at least some see their Board of Health as the primary accountability holder of concern.

Conclusions:  This first systematic study of the effects of accountability mechanisms on public health performance is producing knowledge useful for the design and execution of accountability systems. There is a need to focus more efforts on the use of information collected under the guise of accountability for actually promoting improved performance.  Accountability systems do not end with the collection of information. There is a need to interpret, compare to desired results and determine courses of action for improvement as needed.

Partners and Collaborators:
Ontario Ministry of Health and Long-Term Care
Public Health Ontario
Peel Public Health Unit
York Public Health Unit

Current project status:

A first round of key informant interviews with the Ministry of Health and Long-Term Care (MOHLTC), Ministry of Health Promotion and Sport (MHPS), Ontario Agency for Health Protection and Promotion (OAHPP), Public Health Unit (PHU) Medical Officers of Health and Chief Executives from PHUs have been conducted. This process has helped inform potential project sites for PHU case studies. The comparative case study component of the evaluation will involve a group of five Public Health Units, based on size, location, and level of sophistication, in order to explore the challenges and successes of accountability in Ontario Public Health Units. To date, two case study project sites have been identified and evaluation activities are under discussion with PHU Executives. Pending ethics approval the case studies will commence early this spring.

The web-based accountability survey has been designed, and is undergoing final revisions in partnership with MOHLTC, OAHPP, and PHU Medical Officers of Health. The survey will be sent out electronically over the coming weeks to all Ontario PHU Executives and Medical Officers of Health to capture the Public Health Unit accountability mechanisms and reporting structures. We would like to have the web-survey results compiled and analyzed prior to the release of the Ministry Accountability Agreements this spring.

Reports and Publications:

Schwartz R, Deber R, Krynen-Hill M and Price A. (Poster) “ Accountability for Public Health Performance:  The State of the Art”. Canadian Public Health Association. Montreal, Quebec. June 19- 21, 2011.


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