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Module 3: Optimize Potential Impact
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Here’s a summary of features of the inner and outer context when the province decided to renew public health standards.

Features of inner context

Examples of inner context for Ontario Public Health leading to the renewal of public health guidelines

1. Structure of the organization

There was evidence that public health couldn’t meet some emerging challenges because of the lack of human and financial resources (Public Health Agency of Canada, 2003b).

New standards were thought necessary to rebuild public health capacity and meet emerging challenges such as new infectious diseases, environmental health issues and safety concerns (Public Health Ontario, 2008).

  • There are 36 public health units some serving areas larger than some Canadian provinces; population sizes vary significantly (MOHLTC, 2006).
  • Authors of several reports have concluded that capacity of the health system to respond rapidly and with increased resources to large-scale public health emergencies or disastersis a public health concern (Public Health Agency of Canada, 2005, 2003a).
  • Public health accounts for only 1.8 to 2.5 % of total health expenditures and 2.6 to 3.5 % of public government expenditures (Campbell, 2006, p.3); In Ontario public health costs are 1.5% of  the 34.2B$ spent on health care (Nosal & Turner, 2007).
  • Public health funding is complicated because it’s shared by municipal and provincial governments (MOHLTC, 2006).
  • The new standards expanded mandatory programs from chronic disease and injury prevention, family health and infectious disease, to include environmental health and emergency preparedness (Public Health Ontario, 2008).

2. Absorptive capacity for new knowledge

The old standards no longer met the scope and nature of public health practice, but there were many supports available to guide the development of new standards.

Various sources of knowledge were used in renewing the standards, and performance measurement approaches and systems were built in to support evaluation (Nosal & Turner, 2007).

  • The old guidelines were designed to identify and illustrate immediate and intermediate outcomes.
  • The guidelines set directions rather than numerical targets.
  • Renewing the standards required knowledge that crossed disciplines (health, education, environment), ministries (health, children and youth, health. protection, etc.) and levels of government (local, regional and provincial). Consultations were part of the strategy.
  • The new standards include a performance measurement system to measure the new OPHS outcomes (Nosal & Turner, 2007).

3. Receptive context for change

Several strategies were implemented to gain support and buy-in for new public health standards.

  • Stakeholders were included in the renewal. There were eight workshops for public health staff, e-surveys with boards of health, consultation with organizations (health, education, Aboriginal), and questionnaires to ministry staff
  • The new Ontario Public Health Standards were developed over a year, through workshops, committees, meetings of ministers, discussion papers which produced a draft document of the standards, and then revisions, before final document was sent for approval to the medical officer of health

4. System readiness for change

The public health system recognized standards had to be updated to respond to changing health-care issues and delivery.

  • The old guidelines were fully revised in 1984, 1989 and 1997 and partially in 1999 and 2003) had been undertaken to adapt to changing priorities. In 2006 there was a recommendation to change from guidelines to standards (Nosal & Turner, 2007).
  • There was support for an approach to health that recognized and responded to local needs and context (Nosal & Turner, 2007).
  • It was understood the standards needed to be broader and add environmental health and emergency preparedness to chronic disease and injury, family health, and infectious disease.


Last Updated on Wednesday, 16 September 2009 18:30