Competition, Organizational Change, and Conflict: The Changing Role of Case Managers in Ontario's Homecare System

By Randall, Glen E. | Care Management Journals, April 1, 2007 | Go to article overview
Save to active project

Competition, Organizational Change, and Conflict: The Changing Role of Case Managers in Ontario's Homecare System


Randall, Glen E., Care Management Journals


As health care costs climb, governments continue to seek ways of controlling expenditures and improving accountability. One approach recently used by the government of Ontario to reform the delivery of homecare services focused on the introduction of competitive market forces in conjunction with the establishment of greater managerial controls over the activities of frontline health professionals. The purpose of this article is to assess how this "managed competition" model impacted the role of homecare case managers and their relationships with frontline health professionals. Data for this case study were obtained primarily through 36 in-depth key informant interviews with representatives from homecare provider agencies and the community care access centers (CCACs), which contract with the provider agencies for client services. The managed competition reform dramatically altered the role of homecare case managers by requiring them to take on greater responsibility for monitoring budgets and rationing services. This shift from a collaborative to a competitive system promoted conflict between case managers and other health care professionals. In the presence of an increasingly bureaucratized case manager role, interprofessional conflict and a focus on cost containment seems to have left clients without any clear advocate of their interests.

Keywords: bureaucratization; health care reform; Canada; health policy

Since the 1980s, one of the most widespread approaches to improving efficiency and accountability in public administration has been the introduction of reforms that embrace market mechanisms and promote managerial control over the activities of frontline health professionals (Drake & Davis, 2006; Hoggett, 1996; Hood, 1991; Kitchener, 2000; Kitchener, Kirkpatrick, & Whipp, 2000; Scott, 1982). The primary goal behind these reforms has been to constrain the growing costs of publicly funded services. The health care sector has been a prime target of such reforms because of the speed at which health care costs have been rising. Market mechanisms promote competition while managerial controls facilitate the monitoring of care provided by health professionals and, in some instances, may include the establishment and implementation of practice guidelines or care pathways that promote the standardization of care.

Between 1997 and 2000, Ontario's Progressive Conservative government implemented a "managed competition" model as part of its province-wide reform of homecare services. The managed competition model was intended to introduce competitive market forces in conjunction with the establishment of greater managerial controls over the activities of frontline health professionals. Competition was promoted by requiring a separation between purchasers and providers of services. In order to achieve this separation, Homecare programs were replaced with community care access centers (CCACs), which were responsible for purchasing and coordinating the delivery of homecare services within Ontario rather than providing services directly.

Under this new model, for-profit homecare provider agencies were permitted to compete directly with the traditional not-for-profit provider agencies, such as the Victorian Order of Nurses and the Red Cross, for service contracts. Homecare service contracts were to be awarded based on a combination of lowest cost and highest quality. However, under this new competitive model, once contracts were awarded, the CCAC would need a method for monitoring both costs and quality and it was to be the case managers within the CCACs that were to take on this new role.

While reforming health care systems by embracing market mechanisms and managerial controls has become commonplace, research has tended to evaluate success based principally on economic criteria. The purpose of this article is to move beyond economic evaluations to assess how the organizational change resulting from the implementation of this "managed competition" model impacted the role of homecare case managers and their relationships with frontline health professionals since interprofessional relationships can have a critical impact on organizational performance.

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
Loading One moment ...
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited article

Competition, Organizational Change, and Conflict: The Changing Role of Case Managers in Ontario's Homecare System
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

While we understand printed pages are helpful to our users, this limitation is necessary to help protect our publishers' copyrighted material and prevent its unlawful distribution. We are sorry for any inconvenience.
Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.

Are you sure you want to delete this highlight?