Nursing Policy and the Ministry of Health and Long-Term Care

Trent University

Wednesday March 24, 2004

Sue Matthews

Provincial Chief Nursing Officer

2Nursing Policy in Ontario

Ministry of Health and Long-Term Care• Administers the largest publicly funded health care system in North America.

• The annual expenditure for health care in Ontario is $28 billion dollars.

• Regulates hospitals, nursing homes and long term care facilities.

• Operates psychiatric hospitals and medical laboratories

• Co-ordinates emergency health services

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Role of the Nursing Secretariat• Mission

• To provide leadership in the development, implementation and evaluation of nursing policies, research, and programs, and strategic advice on emerging nursing and health system issues and trends

• Role• Advising on health & public policy from a nursing perspective

• Providing leadership and fostering collaboration

• Supporting implementation and monitoring of the provincial strategy for nurses

• Initiating and supporting strategies to strengthen the nursing profession

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The Nursing Secretariat

Operational Support• Joint Provincial Nursing Committee • Ministry Divisions

Policy Advisory Role• Premier’s Office• Minister’s Office / Deputy Minister• MOHLTC Divisions / Other Ministries • Intra-/Inter-ministerial committees

Policy Development• Provincial Nursing Strategy• Platform Commitments

Leadership and Collaboration• Ministry Liaison to Nursing Stakeholders • Federal, Provincial, Territorial Committees• Employer Associations • Professional Organizations• Research

Role of the Nursing Secretariat

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Policy Development

• Definition of Policy• everything a government chooses to do or not to do (Dye,

1972)

• set of interrelated decisions taken by a political actor...concerning the selection of goals and the means of achieving them within a specified situation, where those decisions should, in principle, be within the power of those actors to achieve (Jenkins,1978)

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Policy Development

• Definition of Politics• Study of power

• Conflicts and struggles over leadership, structure, policies

• Who gets what, when, how (Lasswell, 1958)

• Goal is power or influence

• Exists in most organizations

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Considerations in Policy Development

• Politics is about Policy• Policy is about making or preventing change

• Politics is use of power for change

• Politics are the MEANS, Policy is the END

• Goals:• Implementable and sustainable policies

• Balancing agendas

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Considerations in Policy Development

Power consists of one's capacity to link his will with the purpose of others, to lead by reason and a gift

of cooperation (Woodrow Wilson, 1913)

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Policy Options Formulation

Decision-Making

Program DesignPolicy Implementation

Evaluation

Agenda-Setting

Stages of Policy DevelopmentOpportunities to Influence

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Policy Development in the MOHLTC

Set Policy Agenda

Establish Accountability

Develop PolicyOptions /

Recommendations

Approved ProductLegislation

PolicyRegulationsGuidelines

Consultation Document

If Financial Implications

Approvals Funding & Accountability

Implementation

Stakeholders, government policy/ program areas involved in identifying issues•Provide information•Environmental scans•Strategic communication

Step 1 ConsultationsStep 2 Develop submission to cabinet/cabinet committeesPOLICY IS CONFIDENTIAL

POLICY IS MADE PUBLIC

Cabinet

EvaluationProgram,

Implementation, Communication Plan

Management Board Secretariat

POLICY WINDOW

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Influences on Policy Development

• Allocation of resources• Changes in external climate

• Health care context

• Consumer values and expectations

• Electoral cyclesChanges in government or key decision-makersCommitments made

• Continuing search for new ideas

12Influences on Policy Development

Platform Commitments for Nursing:• Hire 8,000 new nurses

• Create positive, rewarding working environments

• Create new nursing school spaces

• Recruit nurses who have left the profession or left the province

• 70% of nurses working full-time

• Fund more positions for nurse practitioners

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How Priorities are Operationalized

National Priorities•Romanow• First Minister’s Health

Accord• National Nursing Strategy

& the Canadian Nursing Advisory Committee Report

• Office of Nursing Policy, Health Canada

Environmental Drivers• Unpredictable Events

(SARS)• Determinants of Health• Aging and Changing

Populations• Cost Pressures• Public & Stakeholder

Expectations / Demands• Media & IT

Nursing SecretariatPriorities

Strengthening the Nursing Profession Through:

Education, Career, Professional Practice, Leadership, Research

MOHLTC Priority Issues

Priority Nursing Issues

Policy

14Priority Nursing Issues

• Priorities identified through reports and by stakeholders that impact on nursing include:

• Unemployment / underemployment

• Health and safety for Nurses (highlighted by SARS)

• Barriers to full scope of practice

• Supply of nurses: high rates of retirement, limited ability to recruit or retain, limited educational capacity

• Funding models for nursing services are efficiency based and challenge stability - e.g. sustainability/productivity vs. efficiency

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Nursing Secretariat’s Vision for Nursing• Ontario’s nurses will be leaders in Ontario’s health system through:

• Making nursing a profession of choice

• Having the best, most current knowledge

• Creating effective and supportive professional environments• Applying full scope of practice in all health care sectors

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Nursing Influencing Change

• Stakeholders & Interest Groups:• Connect individuals to political system

• Articulate political demands Define the problem Transform demands into public policy

• Seek support for demands

• Demonstrate leadership

• Influence choice of political personnel

• Influence processes of policy development

• Influence enforcement of policy

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Nurses Influencing Change

One person with a belief is equal to a force of 99 who have only interests

(John Stuart Mill, 1806-1873)

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• Be Aware• Knowledge of current issues and the policy process

• Be Involved - Spheres of political influence• Workplace

• Professional Associations (RNAO, RPNAO, ONA, NPAO)

• Community

• Government (political and bureaucratic levels)

• Opposition

Nurses Influencing Change

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• Be Strategic• Communication

• Collegiality

• Collectivity

• Capitalize on Policy Windows

Nurses Influencing Change

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• How to make a difference:• Understand the bigger picture, process, and limitations• Communicate effectively - facts and evidence• Explain the importance• Tell your story• Participate - associations, research, surveys• Build support, co-ordinate, collaborate• Avoid tribalism• Public criticism as last resort• No surprises

Nurses Influencing Change

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Our own success, to be real, must contribute to the success of others

(Eleanor Roosevelt)

Nursing involvement and influence in the development of policies will lead to improvements for nurses, impact and influence the health of Ontarians, and improve access and

quality of care for those requiring health care

Be involved!

Nurses Influencing Change