title: The use of 'arms-length' organizations for health system change in Ontario, Canada: some observations by insiders.
abstract: During the past decade, there has been substantial health system reform in the United States, United Kingdom, New Zealand, and many other countries. For the most part, Canada has not pursued 'big bang' health system change but rather a variety of strategies to achieve incremental change. In this paper, we present the ways in which three arms-length organizations have been used by government to effect incremental system change in Ontario during the past several years. We observe that, (1) the influence of politics and political interference can be reduced through an arms-length organization; (2) an arms-length organization with the power to make decisions entails more political risk for government and encounters more scrutiny and criticism by providers and the media than an organization with the power to recommend only; (3) an arms-length organization with a limited lifespan faces more delaying tactics by adversely affected parties than an organization without a limited lifespan; (4) an arms-length organization with perceived influence may attract causes that are not related to its mandate; (5) the importance and difficulty of communicating complex information about system change to a wide variety of audiences cannot be overstated; (6) system change informed by the use of expert opinion encounters less provider resistance and may result in better decisions; and (7) the reputation of the Chair and the perceived competence and experience of the CEO are critical success factors in the success of an arms-length organization.
authors.affiliation: Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Second Floor, McMurrich Building, 12 Queen's Park Crescent West, Toronto, Ont., Canada M5S 1A8. george.pink@utoronto.ca
authors.forename: George H
authors.initials: GH
authors.lastname: Pink
authors.forename: Peggy
authors.initials: P
authors.lastname: Leatt
mesh_terms: D002300:Cardiac Care Facilities; D002318:Cardiovascular Diseases / Q000601:surgery / Q000628:therapy; D032802:Committee Membership; D003659:Decision Making, Organizational; D018166:Health Care Reform / Q000458:organization & administration*; D006286:Health Planning Councils; D006287:Health Planning Guidelines; D006297:Health Services Accessibility; D006801:Humans; D009864:Ontario; D009936:Organizational Innovation; D011057:Politics; D012041:Regional Medical Programs / Q000458:organization & administration*