What are some key factors influencing health care decision-making and how would you suggest the process is streamlined?

Health care decision-making is influenced by a combination of evidence, policy, politics, stakeholder interests, and available resources. The International Council of Nurses (2005) explains that health policy decisions are made through a structured policy process consisting of formulation, implementation, and evaluation. During the formulation stage, decision-makers consider research evidence, expert opinions, stakeholder input, and the broader social, political, and economic environment before selecting strategies and allocating resources. This means that decisions are influenced not only by clinical evidence but also by the context in which health care is delivered.

The Nursing Strategy for Canada (2003) emphasizes that effective decision-making requires collaboration among governments, health professionals, and communities. It highlights the importance of workforce planning, access to care, quality improvement, and ensuring that nurses and other health professionals participate in policy development. Decisions are therefore influenced by the availability of health care providers, organizational priorities, and the need to meet population health needs.
According to Power Dynamics, Health Policy and Politics (2009), political influence and power relationships are major determinants of health care decisions. Governments, professional organizations, advocacy groups, and the public all compete to influence health policy. As a result, decisions are often shaped by competing interests, political priorities, public opinion, and negotiations between stakeholders rather than by evidence alone.

How Government Policy is Made (Michigan State University, 2005) explains that policy decisions are also affected by the legislative process. Problems must first be recognized, policies developed, debated, implemented, and later evaluated. Throughout this process, elected officials, government agencies, health professionals, interest groups, and citizens all influence final decisions. This demonstrates that health care decision-making is an ongoing process that balances evidence, public needs, political feasibility, and available resources.

These factors work together to shape health care decisions, demonstrating that effective decision-making requires balancing scientific evidence with political realities, available resources, and the needs and values of the population.

3. How do Canadian institutions differ from those in the United States, and how has this affected policy change?

Canada’s healthcare model is publicly funded where medically necessary hospital and physician services are paid through taxes. The United States is a mix of private and public funding from several areas, including private insurance, employer plans, Medicare or Medicaid and individual payments.
Canada’s publicly funded model allows broader system-wide transformations because governments are the major funding bodies of healthcare. A challenge is that the process of change can be slow because the changes often require negotiation among federal and provincial governments. The United States may see the opposite and the competition and private investments might speed up the process for change. However, the system may not be equitable.

How do institutions differ in places other than Canada and the United States?

1. What are the key institutions and structures that shape health care funding and delivery in Canada, in Ontario, or in your organization?

Canada has a publicly funded healthcare system which is funded by the Canada Health Act (CHA). Provinces and territories are responsible for organizing and delivering most health services. In Ontario, health-care funding and service delivery is fulfilled by the Ministry of Health, Ontario Health, Ontario Health Teams, and hospitals, public health units, long-term care homes, and community agencies, etc. The Ontario ministry of health is responsible for funding and overseeing the provincial health care system.

My organization, which is an acute care facility, operates as a publicly funded healthcare system and is influenced by:
• Ontario funding models.
• Accreditation Canada standards.
• Ontario Health directives.
• Public Health legislation and guidelines.
• Professional regulatory bodies such as the College of Nurses of Ontario (CNO).

Recently our organization completed ED renovations using a 90/10 funding model. The hospital foundation was responsible for fundraising over $8 million dollars for the ED renovations, in addition to the Ministry funding. This would “cover a portion of the renovation expenses plus all costs for new or replacement medical equipment to be used for patient care in the new space”. Hope for Healthcare 2022 – Brant Community Healthcare System Foundation

What are some key factors influencing health care decision-making and how would you suggest the process is streamlined?

In my LTC experience, healthcare decisions are influenced by resident needs, safety, staffing, available resources, government guidelines such as Ministry of Long Term, and input from the care team and families. For example, when a resident’s condition changes, the team works together to review the situation and decide the best care approach.

Another example, during a period when our home experienced increased resident falls, the care team had to consider multiple factors before making changes. We reviewed incident reports, consulted with nurses, PSWs, physiotherapists, physicians, residents, and families, and considered available resources. The decision was made to strengthen fall prevention strategies, including more frequent assessments, environmental adjustments, and individualized care plans.

To streamline decision-making, I think clear communication and collaboration from the healthcare team who involved of the care are the ones who understand residents’ needs. Regular huddle meetings and standardized processes can help make decisions faster and more effective while keeping residents’ needs as the priority and also maintaining residents-care.

Health care decision-making is influenced by many factors, including government priorities, funding, legislation, workforce shortages and the needs of patients. Political priorities and ongoing discussions about privatization also play a role in shaping healthcare policy. At times, financial pressures and outside interests can influence decisions, making it difficult to balance cost, access and quality of care.

I believe nurses should have a stronger voice in health policy because they see firsthand how decisions affect patients and healthcare teams. The International Council of Nurses highlights the important role nurses play in influencing policy through evidence, collaboration and professional organizations. As the largest group of healthcare professionals, nurses bring valuable experience that can help make policies more practical and focused on patient care. Too often, decisions are made without enough input from front-line staff, which can lead to policies that are difficult to put into practice.

To improve the decision-making process, governments should reduce duplication between organizations, improve communication across the healthcare system and involve front-line providers earlier when developing new policies. Decisions should be guided by evidence and the experiences of healthcare professionals, rather than political or financial pressures alone. This would lead to policies that are more practical, sustainable and ultimately provide better care for patients.

Nursing Organizations that have influenced Policy:

One of the organizations is WeRPN. One of the things that they have been successful at doing is raising the profile of the RPN level of skills and promoting the use of RPN’s in many different healthcare environments instead of just long term care as was done in the past.

RPN’s are now working in many different areas of hospitals, community care and clinics. It appears that this has been done by advising the college of nurses on RPN education and entrance to practice and advocating provincial government to use RPN’s to full scope of practice.

There is a letter written on WERPN’s website by the new CEO, Lori Singh about how RPN’s and RN’s are both important to the health system and that it is not about which designation is better, it is about
using healthcare resources wisely.

This letter is a great example of advocacy as it is positioned to reach nurses and those who are in a position of power in many different organizations.

Identify nursing organizations in the province (or at a national level) that attempt to influence health policy decisions (especially your provincial association – such as RPNAO)? Do you think they have been successful? If yes, how did they achieve success and for what policy? If no, why have they not been successful in influencing policy development?

A key organization advocating for health policy at the provincial level is WeRPN. I firmly believe they have been successful in their mission to support and advocate for RPNs in Ontario. On a personal level, attending their in-person events has shown me the power of bringing nurses together to network and address shared challenges, creating a genuine sense of community.

Their policy impact is most evident in how the RPN scope of practice has expanded immensely over the last 20 years. WeRPN achieves success because it directly empowers RPNs to use their voices. By translating frontline practical nursing experiences into strong policy advocacy, they have effectively reshaped how RPNs are utilized and recognized within the healthcare system.

What are some key factors influencing health care decision-making and how would you suggest the process is streamlined?
Key factors: money to finance payrolls, policy makers and legislators, political will to make long term effective commitments that endure beyond elected office.
Streamlining: It appears that the public opinion of nursing, stemming from the reputation of care facilities that were shut down during Covid epidemic, is that we are not worthy of respect. Yet, in any individual crisis, a nurse is the most sought-after resource. The political and public perspective of nurses and nursing in general has to be augmented before any meaningful change can take effect. The verbal and emotional abuses from families endured by nursing staff in long term care facilities is excessive and shows an abuse of power that has been handed over to the family. A greater need for balance of power and respectful interaction on the ground floor of change is an area where immediate change can be made with positive results.
The processes already in place are showing strength and improvements with health care policies as demonstrated through WeRPN leadership programs that train voices for changing times. I am not one to focus on the greater umbrella sources as I do not feel the changes make a significant impact on the interpersonal relationships nurses have with their clients (including family members and friends). This (improved interpersonal relationships) is an area where job satisfaction, resilience, and commitment to stay nursing make a difference.
It appears I am taking an alternative approach on how health care providers are seen through the eyes of policy and public opinion. Instead of working from the top down, I tend to see things from the bottom up. Trusting that at some point the two ends meet and a comprehensive path to health care policy and how it works is laid out.