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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 Laboratory Services

Research Team:
Brenda Gamble (lead)
Lavern Bourne (student)

Project Details:
Accountability is a key component of many healthcare reform efforts, both in Canada and internationally. What are the appropriate accountability mechanisms and do they vary by healthcare sub-sector? Approaches used in one sub-sector may not be appropriate for another. This study, which is part of a larger project examining the approaches to accountability for 11 different healthcare sub-sectors in Canada, focuses on the medical laboratory sub-sector (MLS) in Ontario.

The approach taken is a case study design, which examines the implication of the core independent variables; policy goals (access, cost and quality), governance/ownership (including the public-private mix) and production characteristics (contestability, measurability, complexity) of the goods and services being provided on how accountability is defined within the MLS. The analytical framework includes four approaches to accountability; financial incentives, regulations, information directed at users (one form of exhortation instrument) and reliance on professionalism and stewardship. An environmental scan of all relevant literature (including both peer reviewed and grey), government legislations, regulations and guidelines produced by regulatory or professional bodies relating to the MLS was conducted.

Almost all laboratory services are publicly funded. However, controversy exist as to the true costs of testing which is related to a number of different factors; the volume of testing (e.g., high volume routine testing to gain economies of scales), level of automation (e.g., total automated laboratory testing system versus point of care testing), the extent of the technical expertise (technician versus technologists) needed to conduct and interpret the tests. Services are delivered by the public (e.g., public health laboratories), not for-profit (e.g., hospital based laboratories, Canadian Blood Services) and for-profit (e.g., community based laboratories, physician offices) organizations. Accordingly, the governance and ownership structures as well as the actors involved (e.g., Boards accountable to share holders) vary. The mix of services range from high volume routine testing to more esoteric testing that requires greater expertise and higher costs. Clearly, variability exists in the production characteristics. We will report this variation and how this relates back to the accountability approaches within MLS.

Approaches to accountability are mixed. However, regulation does play a key role in determining who is accountable and for what.  A number of different federal/provincial legislative structures and stakeholders both within government (public sector) and outside government play a key role in the regulation of MLS. Key stakeholders include: Ontario Ministry of Health and Long-Term Care, Canadian Society of Medical Laboratory Sciences, College of Medical Laboratory Technologist of Ontario, Ontario Medical Association (OMA) working through Quality Management Program – Laboratory Services (QMPLS).  QMPLS addresses the relationship between technical quality assurance and quality laboratory management.

Key informant interviews have been completed and Lavern Bourne is currently writing up her thesis.

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