History of Medicine, Medicalization & Doctors - (up to 252) Flashcards
1
Q
earliest type of society
A
hunting & gathering band
2
Q
hunting & gathering band
A
small society
30-50 people:
adults & children less than 100 people
3
Q
Describe early society (hunting&gathering band)
A
society of equality
- no rich or poor b/c no possessions
- Nomadic
Had a CHIEF that formalized decisions of the tribe Gender equality
gender division of labor
had medicine women
4
Q
Gender Inequality taught by?
A
“white man”
5
Q
How does early hunter gather society relate to healthcare?
A
healthcare became women’s work b/c it evolved as an extension of women’s 2 basic roles
6
Q
womens B
A
1) childcare
2) gathering
7
Q
Describe womens 2 basic roles and how they relate to healthcare
A
1) childcare: involves HC, picked up skills, human biology became women’s domain, begins with childbirth
2) gathering - plants
medicine came from herbs & plants (an extension of cooking)
8
Q
How was the Human Body viewed differently by
a) Modern Male Medicine
b) Tribal Societies
A
a) mechanical model of human body
b) balance of nature - more holistic
9
Q
Describe Tribal Societies view of the human body
A
strong sense of ecology
people were a part of nature
had to maintain balance of nature
10
Q
Describe the importance of the Balance of Nature to Tribal Societies & its relationship to HC
A
if screwed up the people would suffer eventually nature was understood in spiritual terms so HC was about getting in touch with spirit world
11
Q
Deity
A
Goddess - idea of nature as a whole
supernatural being that is the embodiment of **nature **
12
Q
Why is the Deity female?
A
Deity had created the world & women are givers of life
therefore it is only logical that she is female
13
Q
Central Concept of Healthcare in Tribal Societies
Healthy vs. Sick
A
Balance
sick = out of balance with goddess
healing = restoring balance
14
Q
In Tribal Societies, HC was tied closely to?
A
**Spiritualism **→ became religion
15
Q
Describe the role of the Medicine Women
A
doctor + spiritual leader (priestess)
- expert on herbal medicine & healthcare
- interpreted goddess’s wishes
16
Q
Did men play a role in HC?
A
yes → Shaman (witch doctor)
17
Q
Shaman
- roles
A
male “witch doctor”
- led men into rituals & prayers before war/hunting = - boosted social solidarity (unity)
18
Q
What caused the change of societies from HUNTER-GATHERER to AGRICULTURAL
A
couldn’t feed increasing popn
developed agriculture
**- ** allowed popn to expand b/c it allowed for storable wealth
19
Q
Where did Agriculture begin?
A
in Middle East & Africa
20
Q
Problems with Agricultural society
A
led to
- social inequality
- class inequality
- gender inequality
21
Q
How did the shift to Agricultural society lead to social inequality?
A
agricultural society developed into slave empires
**- **prisoners of war became slaves
rise of CLASS INEQUALITY + aristocracy (military) > peasants > slaves
22
Q
How did the shift to Agricultural society bring about gender inequality?
A
increasing importance of army increased the importance of men
- men took over priestesses
replaced by male priest
men took over HC
23
Q
After shift to Agricultural Society, men took over (3)
A
- Politics
- HC
- economics
24
Q
Health in Ancient Greece
A
healing = women’s work
Hyglia - greek goddess of healing
25
Over time Greek society become more?
**militaristic**
**Hyglia **→ Apollo (male god)
**male medicine** dominated female medicine
26
Hippocrates
ancient greek physician
- made **Hippocratic Oath**
saw his techniques as **restoring balance**
27
Hippocratic Oath
**religious oath**
**- **do not harm
- do not betray patients trust
- contains prohibitions about sexual contact with patients (the fact that this clause was introduced shows it was meant for men)
28
The main goal of Hippocrates
to seperate **medicine & religion** for the first time
29
Greek Physicians made significant advances in...
anatomy & medicine
30
The significant advances made by Greek Physicians were brought together by? when?
Galen → **2nd Century**
31
Galen
summarized what others had learned before him
- published an **anatomy text** in **2nd Century AD - **
developed model of human body
32
Galens model of the human body
body is composed of **specialized organs** each performing **specific functions** & working **together**
33
Galen's text was the authority on human anatomy until **late 16th century** despite..
**never having dissected a human cadaver**
-based on dissection of **apes & pigs**
34
Early Christianity & human dissection
**4th Century:** Catholic Church forbade human dissection & anatomical examinations
- believed people were **resurrected** on judgement day and this could not occur if body was cut into pieces
- remained this way throughout **Medieval Europe**
35
After Greece & Rome Collapsed in 4th Century...What happened to the progress of science & medicine?
science & medicine came to a **halt**
Church decreed that **health was determined by spiritual things (not physical)**
**-** tied to religion once again
36
**Male medicine** after collapse of Greece & Rome
beyond prayer, reduced to **military medicine**
**-** bandage wounds & pray they live
37
Age of **Feudalism**
quiet resurgence of female medicine
- every village came to have **medicine women** (old religion of goddess never really died out)
- acted as **midwife**, **healer** (herbal meds) & **spiritual** leader
38
**16th** Century: Europe
feudalism → **CAPITALISM**
religion threatened by rise of science
39
**16th Century:** Italy
**Renaissance** - rebirth of knowledge before Middle Ages
- tried to resurrect **scientific approach**
**Galileo** defied Church with his astronomical revelations which undermined Church's teaching
- was forced to recant
40
Leonardo Davinci
one of the first to defy Church’s ban on human dissection
41
(2) things that Challenged the Church in **16th Century**
science
Prodestantism
42
**Germany** - Martin Luther
**German Preacher**
said Catholic Church had fallen **away from path of Christ** b/c they were all about **wealth & power**
43
How did the Church maintain its Authority?
found a **Scapegoat** that only the Church could save Europe from (pushed womans status down)
44
How did the Church use a scapegoat to maintain its Authority?
began **witch hunts** lasted through **16th & 17th Century** (200+ years)
**witches = medicine women**
- were believed to be in league with the devil
45
The **Inquisition**
**reign of terror**
- went from town to town & tortured/burned at stake/killed witches
**~100,000 to 1 million killed**
mostly **peasant** women
- blamed womens for societies problems
46
What was the beginning of Society blaming women for everything?
Eve → blamed for taking the forbidden fruit
47
How long did the Catholic Church remain as the primary authority in Europe?
over 200 years after beginning of witch hunts
48
Mid-18th Century: \_\_\_\_Revolution
Industrial Revolution
49
Industrial Revolution
people began to leave villages for big cities
- witch hunts died out
50
Since 1960's: Resurgence of \_\_\_\_\_
Wicca → religion
51
In the late 16th/17th Century, what emerged again?
Male medicine
52
What kind of new healthcare emerged from **17th Century** onward?
male dominated
- increasingly based on **science** not spirituality chemical meds replaced herbal
53
How did the shift from **Agricultural to Industrial **affect HC?
more industrial type of HC
- based on dif model of health & human body
54
Industrial society → model of human body
**Rene Descartes**
rediscovered & updated Galen's model → **MECHANICAL** model of body
55
**Mechanical Model of Human Body**
human body is like a **machine**
**simple** parts with simple functions
- could be taken **apart** & put back **together**
56
Basis of modern surgery (2)
**cuts**'n' **chemicals** (surgery & pharmaceuticals)
57
Descartes model lead to?
new approach of medicine → called **Allopathic Medicine**
58
Allopathic Medicine
based on **isolating** specific problem & dealing with it
aka **specific aetiology**
- more intrusive
widely accepted bc it showed results
59
Allopathic Medicine lead to?
**specialization** → localized **pathology**
**- **opposite of female **holistic approach **
60
Men → specialize /compartmentalize where as women...
Women → look at human body as a whole
61
Mechanical model lead to new medical technology such as?
microscope
62
the microscope lead to the rise of (2)
vaccination (**18th** Century) - Edward Jenner
germs/other microorganisms (**19th** Century) - Louis Pasteur
63
Modern Medicine
isolate from environment
- away from **psychological** support
- objective
ignores **social context**
**- ** downplays role of emotional support
64
Female vs. Male
care vs. cure
65
What types of problems do
a) **men's** approach
b) **women's** approach work best for?
a) **acute**
b) **chronic**
66
**Historical Development of Modern Healthcare** (sociological approach)
born not just from **technological advancements** but from **social struggle between different groups** that had different ideas of how it should be run
67
**18th & 19th Century-** Power struggle
Homeopathy vs. Mechanical Model
68
Barber-surgeons
through 17th & 18th Century
69
How did Academics gradually transform **Modern Medicine?**
**12th Century- Bologna **
**North Italy Universities** → **defied** ban on human dissection
- gradually brought science & medicine together
70
**Francis Bacon**
Founded Royal Society in **17th Century** Britian - promoted development of all empirical sciences including anatomy
71
With the help of the Royal Society, what was formed?
**Guild of Surgeons (18th Century)**
- not just barbers
- surgeons given more respect
72
**Ivan Illach**
**1970s**
one of the 1st to question role of doctors
- found that mortality rates declined long **before introduction of drugs & scientific techniques** (although antibiotics were 1st developed in **1920s**, over 90% of decline of disease rate had happened before antibiotics were available in **1940s/50s**)
73
Ivan Illach & **Iatrogenesis**
* (3) sorts of **Iatrogenesis **
- argues that contemporary medicine is **iatrogenic - ***creates disease & illness even as it provides medical assistance*
## Footnote
**1) Clinical - **pain/sickness/death result from provision of medical care (unneccessary procedures, Thalidomide)
**2) Social - **health policies reinforce industrial organization which generates dependancy & ill health
**3) Structural - **loss of individual autonomy & creation of dependancy
74
(2) things really improved peoples health:
improvements in
1) **nutrition** - world trade
**sanitation** - sewers
75
When French & British came to Canada.. early physicians were?
**ship** doctors
76
War between France & Britian
Britian took over Fur Trade from France but only **after 100 years **in **1763**
77
Military Medicine
particular type of medicine based on anatomy & surgery b/c it was mostly about sewing up military wounds
78
Doctors referred to as...
sawbones
79
**Inhalation Anesthesia**
not invented until **1840s**
- didn't become widely used in **1850s**
80
Antisepsis
keeping surgical conditions clean/sterile
- not introduced until **1880s**
- followed **germ theory** by **louis pasteur (860s) **
81
**Joseph Lister**
British Surgeon
- one of the first to introduce **antisepsis** into his surgery
- found 1/2 of his surviving patients died of post-**operative infections**
**- ** read Pasteur's work on Germ Theory & started sterilizing instruments with **carbolic acid** to kill germs
- decreased post-operative death to 15%
82
Medical treatments used by **19th century doctors**
still **based on Galens idea** but **influenced** by years of **military** medicine
83
Military medicine pushed Galen’s model to the extreme & developed ?
**Heroic Therapy**
**Galens model - **balance
**Military Mind - **if a little was good, alot was better
84
Heroic Therapy
based on principle of **huge intervention**
blood-letting
blistering
purging
vomiting
tonics
85
**Blood-letting**
- based on theory that if you let some blood out of body that it would heal person
- cut veins or used leeches
86
Blistering
believed to remove/suck poison from body
87
Purging
clearing bowels by giving patient a **diarrhetic** (causes diarrhea) - calomel & mercurous chloride
88
Vomiting
induced by giving an **emetic** - tartar (tartar ate of antinomy)
89
Tonics
made from compounds of arsenic or opium
90
Licensing system - **late 18th & 19th Century**
Canadian government tried to introduce **new legislation** to **restrict** medical practice to only physicians
→ **licensing system:** only licensed physicians allowed to practice medicine
91
First Medical School in Canada
was established in **1824** in Montreal
92
Monopolies in Canada
**Fur Trade** → **Royal Charter** gave monopoly to **Hudson Bay Company** → monopoly on fur trade given by king of England
93
Why did Canadian State support Doctors so strongly?
it is believed that it is because **doctors are good for peoples health**
## Footnote
*but the real reason is because they were always a **tight-knit elite group** so because of their **high social position** they were given monopoly*
94
Characteristics of Doctors in **18th Century**
only **male**
all went to medical school (**wealthy** bc they could afford it)
- **family/social ties** to **political/economic leaders** of Canada or **wealthy**/**influential** people in Britian
- mostly military doctors
95
Military were respected & had high prestige because?
Canada has started with century of warfare
96
course of medicine was determined by?
by power struggle between different groups trying to establish themselves as healthcare providers
97
**1830s**
**- (2) new brands** of medicine came to Canada from?
1) **USA**
2) **Germany**
98
1) USA
**ecclecticism/herbalism**
founded by **Samuel Thomson**
- **New England Farmer** rediscovered techniques of women's traditional herbal med.
- argued that conventional med = **disaster** & techniques of orthodox med. = **"instruments of death"**
advocated for herbal meds, steam baths & bed rest
99
2) Germany
**homeopathy: **German Doc- **Samuel Hahnemann - rejected** heroic therapy
- **like cures like**
also **rediscovered** herbal medicine
- argued drugs should be given in **microscopic** doses (anything harmful in large doses would promote good health in small microscopic doses) - however he did not use inoculation, used **herbal medicine** (**Echinacea**)
100
Similarities between **Samuel Thomson** & **Samuel Hahnmann**
both rejected Heroic therapy
- emphasized **bed rest**
rediscovered **herbal meds**
both aided in popularity increase of **eclecticism** & **homeopathy** that pressured gov. to license them in **1860s**
101
1869
conventional doctors formed **General Medical Council**
**- **eclectics & homeopaths invited to join **→** over 200 licensed to practice but they had to go to medical school first
**eclectics** agreed → became absorbed into regular med. & ceased to exist
**homeopaths** rejected - quit council & continued to practice
102
how did **Confederation** change Homeopathy?
**modern Canada was born**
* *federal** government introduced
- better able to **enforce** licensing system
- homeopaths driven underground in **late 19th century**
103
Resurgence of homeopathy in the...
**early 20th century**
104
Another group of men challenged Canadian physicians for control of HC
→ American Doctors
105
How was the **USA** different from **Canada** with respect to medical practice?
**no old boys network**
no pressure on gov to provide **monopoly**
**-** turned to **private** sector
- private med. schools tuition = relatively **cheap** entry virtually **unrestricted**
had far more docs
106
Why did American Doctors look to Canada for a place to practice?
less competition
- USA had more doctors
107
How did the Canadian doctors deal with US doctors coming to Canada?
**public campaign** → against influx of American Doctors (called **yankee loafers**)
**late 19th century** → law passed that only docs with Canadian degrees could practice
**late 1880s** → every province had this legislation
108
length of medical school in
a) USA
b) Canada
a) 2 years
b) 5 years
109
**3rd World Countries** → how did they challenge that you needed years of medical school
developed **6 month courses** → to train **paramedics** could handle 70-80% of what doctors can
110
1980s/90s → **recession**
pressure to develop cheaper HC
→ **nurse practitioners** by **2010**
→ just over **1,600 nurse practitioners** in Canada
111
**1910** - Flexner Report
responsible for **creation of modern scientific medicine**
- “the document that helped c**hange modern medicine** from **quackery** to **responsible practice**”
112
**Abraham Flexner**
**schoolmaster**
→ commissioned by **Carnegie foundation of NY** to conduct study on medical education
113
**Abraham Flexner **→ concluded that?
medical education = absolute **disaster**,
all medical schools should be shut down immediately
114
How many universities did Flexner give seal of approval to?
**5** - Harvard, Mcgill, U of Toronto & 2 others in USA
115
What were Flexners **recommendations**? (3)
- shut down **majority** of medical schools
- rather than private medical schools, medicine should be taught exclusively at **universities** at graduate level by full-time qualified faculty
- should have access to **lab**, **research** & **hospital** facilities (to connect medical education to medical practice)
116
Flexner managed to persuade both US & Canadian governments as well as the Carnegie & Rockafeller families to put a lot of money into reforming medical schools. What made his argument so persuasive?
the coming of WW1 (1914-1919) which introduced **conscription**
117
Explain how the coming of WW1 made Flexners argument so persuasive
many men who were conscripted **failed medical exam** meaning they were unfit for military service which forced gov. to change attitude & finally recognize HC was inadequate - beginning with medical education
118
The Flexner Report changed (2) major things
1) **structure** of medical education
2) **medicine** in general
119
How did the Flexner Report impact the USA?
- med schools either shut down or **affiliated** with universities
- outlawed other forms of medicine
- stricter regulations for medical care
120
How did the Flexner Report impact Canada?
had less impact on the structure but larger impact on CONTENT
- standards improved (research, HC, education)
121
What is the time period that genuinely scientific/effective healthcare began in North America?
1910s & 20s
122
When did the chance of patients being helped by doctors **rise above 50%?**
**after Flexner Report**
in particular, huge change from **integration of practical HC with universities** which led to **research**
123
Pharmaceuticals → **CHEMOTHERAPY REVOLUTION**
**1920s**
→ 1st time effective **chemical drugs** were invented - variety of antibiotics developed that greatly **improved health** standards,
especially after becoming widely available in late **1940s/50s**
124
Importance of
a) Alexander Fleming
b) Bantings & Best
a) discovered penicillin
b) discovered insulin in 1922
125
Chemotherapy Revolution lead to introduction of?
series of **MIRACLE DRUGS**
126
Miracle Drugs
drugs that could cure **so-called incurable diseases**
127
Miracle Drugs helped improve the public's view of doctors in what way?
led public to genuinely **respect** & want to go to doctors
- increased demand for doctors
128
How did **rural areas** concerns change after the Chemotherapy Revolution?
rural areas were **concerned** about the absence of doctors in their areas
129
difference between the **19th & 20th Century** in the publics demand for doctors
**19th** → gov tried to force people to go
**20th** → public demanded more access to doctors
130
What was the governments response to the public demand for doctors?
**Medicare**
131
Which province led the way for Canada in respect to Medicare?
Saskatchewan
132
How did SK lead the way for Canada (with medicare)?
SK is the most **agricultural** province
133
What dramatic change in HC was pioneered by SK?
change from **individual-based system** to a system based on **gov. paying doctors for medical treatments**
134
What (2) things resulting from SK being **the most agricultural province** contributed to the introduction of MEDICARE?
1) full of small rural communities where **few doctors wanted to live/work**
2) province of **farming communities**
135
Explain how SK being a province:
1) **full of small rural communities where few doctors wanted to live/work**... contributed to creation of medicare
most of SK served by **horse & buggy doctors** so they only visited each town every few weeks/months
- the ill had to wait or travel
136
Explain how SK being a
2) **province of farming communities ...** contributed to creation of medicare
**traditional** farming community spirit of **Mutual Aid**
- neighbours helping each other (**collectivity**)
- when they felt they needed to attract more docs, introduced **MUNICIPAL DOCTOR PLAN**
137
**MUNICIPAL DOCTOR PLAN**
allowed **towns/municipalities** to **pay doctor annual** fee to provide medical services (benefited doctors b/c they had guaranteed income)
138
Explain the problem of **default rates?**
doctors fees raised but many people were too **poor** to pay
- rise in default rates was a problem in the **20s**
- even worse in the **30s** because of US stock market crash **(great depression)**
139
How was the problem of default rates solved by intro of medicare?
**guaranteed income** for doctors in troubled time - **paid collectively** through taxes through **municipality**
140
Now in historical context, what can be seen as the first step in the **Healthcare Revolution?**
Municipal Doctor Plan
141
Sarnia - 1914
pilot project of **Municipal Doctor Plan**
142
the Municipal Doctor Plan was backed up by?
passing of **Rural Municipality Act in 1916**
143
**Rural Municipality Act** in **1916**
- allowed all SK townships for 1st time to **levy tax on citizens specifically to set up fund** to pay for doctor
144
**1917** - Union Hospital Act
expanded idea because it allowed **several townships** to **combine** into **health districts** so together they could **afford to maintain hospital**
145
Hospitals were built partly for the purpose of?
attracting doctors
146
Once these acts were passed...
**Municipal Doctor Plan** spread across SK & continued until **late 40s** after WWII
(by this time **~200 SK towns used MDP** & also spread to neighbouring towns of **MB & AB)**
147
How did the change from **municipal** to **provincial** government occur for funding of HC?
MDP **spread** swiftly across SK & neighbouring provinces (smaller scale)
- **more demands** that funding & organization of HC should be **funded by provincial level**
- demanded intro of **PUBLIC HEALTH INSURANCE**
148
What was the **obstacle** to public health insurance?
none of the leading politicians wanted it b/c they declared it was **"socialized medicine"** & it was a **stepping stone** to turning Canada into **socialist** & then **communist** country
149
How did SK overcome politicians who did not want public health insurance?
established new political party → **Co-operative Commonwealth Federation (CCF)**
150
Co-operative Commonwealth Federation (CCF)
**left wing party**
- demanded major changes in gov. policy most of which involved **intro of welfare state**
151
the **CCF** argued that...
Canadian government should take **responsibility** for well-being of Canadians through **introduction** of measures such as ***unemployment insurance**, higher **pensions**, **social security** & **universal government funded HC***
152
**1944**
CCF won **provincial** election & formed **provincial government** under leadership of **Tommy Douglas** (introduced medicare to Canada)
153
CCF popularity
grew slowly at first in the 30s but more quickly in late **30s/early 40s**
154
When did the CCF win the provincial election?
in **1944** under leadership of Tommy Douglas
155
Tommy Douglas
premier of SK from **1944-1961** deserves title of **Father of Modern Medicare** - universal medical care was his #1 priority
156
What led Tommy Douglas to his life-time commitment for providing universal healthcare?
as a child, suffered from **osteomyelitis** *- disease of the bone*
- couldnt afford series of operations needed to save his leg
- one **orthopedic** surgeon said he would perform operations for **free** if he could use it for **experience for other medical students**
- made TD realize many other Canadians may not be this lucky
157
**1945**
CCF introduced **free medical care** for the **poorest people** (pensioners & unemployed)
- free **mental** health care
- free **polio** treatment
158
**1946**
CCF introduced **first district-wide medical insurance** **program**
**-** pilot program in **Swift Current**
159
**1947**
Introduced the **Hospital Insurance Plan**
**-** intended to provide gov-paid hospital care to everyone in SK
- by end of **1947:** already guaranteed of **90% of SK** had access to state-funded hospital services
160
Throughout **1950s**, what made TD the most popular premier in SK?
these HC measures & other welfare state measures
161
The growing popularity of the CCF & their principles of HC pressured federal politicians to..
take these HC measures & expand them to the federal level
162
Who was in power (federal) by the end of **WWII?**
**Liberals** under **Mackenzie King**
163
What did the **Liberals** introduce for the 1st time that raised their popularity?
introduced **welfare state policy** at **federal** level
(the established pairing of Tories & Liberals was under threat)
164
**1948**
Federal Gov. began **program** in giving **hospital construction grants to provinces**
165
The **1950s** saw the... than any other comparable period
**fastest growth in hospital construction**
166
What became the centerpieces of modern HC?
hospitals
167
**1958**
Fed. Gov. passed **Hospital Insurance & Diagnostic Services Act**
168
Hospital Insurance & Diagnostic Services Act - **1958**
modelled on **SK Hospital Insurance Plan**
- made **hospital services** freely available **nation-wide**
169
What led to the creation of the **Hospital Insurance & Diagnostic Services Act in 1958?**
the success of **SK hospital plan** & resultant **public pressure to expand**
170
1959
TD announced CCF would be introducing **Prepaid Medical Care (Medicare)**
171
the purpose of **Prepaid Medical Care (Medicare)**
to **expand** government **funding** from just paying for **hospitals** to all **authorized medical services**
effectively cutting all financial ties between doctor & patient
172
Although the public was keen on the idea of Medicare, doctors were not. Why?
they were **not able to raise their fees** b/c they were taken **out** of free market & gov became their only client
173
Medicare put the government in the position of ____ which would allow them to?
**monopsonist** - one who is a single buyer for product/ service of many sellers this would allow them to lower fees
174
**1960 - **Provincial Election was all about?
those against and those for Medicare practically a referendum on HC
175
What stance did the **SK Medical Association** have?
backed up by all **right wing conservatives**
mounted visious propaganda campaign against **Tommy Douglas**
- called TD a **communist, fascist **
176
Despite the SK Med Association's attempts against Medicare...
Tommy Douglas was still reelected
177
**1961**
introduced **SK Medical Insurance Act** which put medicare into practice in SK
178
Tommy Douglas's last act as premier
the SK MEDICAL INSURANCE ACT
179
in **1961**, TD resigned as premier and the CCF..
formed alliance with Trade Unions of the Canadian Labor Congress (umbrella organization of unions) - - - **CCF** became the **NDP **
180
In **1962**, when Medicare was introduced...
most SK doctors went on **strike** & **suspended** everything but **emergency** services (1st doc strike in Canada)
CCF stood firm & after **3 weeks**, strike ended & doctors reached a sort of compromise with the government
181
SK government gave doctors the **option to opt-out** & still bill individually. However this option died out because...
public would rather government pay for HC services
182
by ___ over \_\_\_% of doctors were sending their bills directly to insurance commission
**1967 → **95%
183
by **1967**, over 95% of SK doctors were sending their bills directly to insurance commission, which means that..
SK established Medicare in the course of the **60s** and was the 1st province to do so
184
CCF became the?
NDP
185
At the federal level, the NDP continued to press for?
overhaul of Canada's HC system
186
After continued pressure from NDP to change our HC system...
the Federal gov. established a **Royal Commision** to look into it (**Hall Report) **
187
**1964** - **Hall Report** looked at?
both public & private health insurance in Canada
188
The **Hall** Report (**1964**) revealed that..?
private health insurance had existed for **over 25 years**
** **but **only 50% of Canadians** were covered & much of that coverage was **inadequate**
189
After the findings outlined in the **Hall Report**, What did the federal government do?
**Lester B. Pearson (Liberal PM)** announced his gov. would introduce **cost-sharing scheme**
190
cost-sharing scheme
federal gov paid **1/2 of prov. medical care program** if they met the **criteria** of **universal access**
191
1966
**Medical Care Act** - cost-sharing to provinces & brought Medicare to Canada as a whole
192
Which provinces initially qualified for this cost-sharing proposal?
SK & BC all other prov. govs were right wing & opposed
193
How did all the other provinces agree to Medicare?
SK & BC started recieving millions of dollars & other provinces wanted to get in on this
194
by the end of **1970**..
every province had introduced a **universal medical insurance plan**
195
Although initially most doctors opposed **Medicare**, it gained their support for **(2) reasons**
1) doctors realized they couldnt win
2) quickly learned that their fear of gov. lowering their fees was unfounded
196
Despite doctors worries of their fees being lowered, throughout the **late 60s/early 70s...**
doctors fees increased
197
by **mid-1970s**, doctors average income was how many times the national average income?
**5.5x**
198
between **1968** & **1978**, the # of doctors increased by..
**50%** which is the **largest single decade expansion** in Canadian history
199
Greatest expansion of government spending on HC
**late 60s/early 70s**
200
The public supported the increase in gov. spending in HC as long as...
**economy** was in a **boom period** & there was plenty of $ to pay for HC
201
However, the public's view on increased HC spending changed in **1973** because?
Arabs countries formed **OPEC (Organization of Petroleum Exporting Countries)**
- nearly **quadrupled** **price** of **oil** which **increased cost** of everything
- profits **fell** & more businesses were going **bankrupt**
202
This period of low wealth in Canada is known as?
the **Great Recession** - **late 70s**
203
Age of **Cutbacks**
**(70s)** following the **Great Recession**
**-** new laws introduced to **cut back on costs**
204
What act was established in **1977**?
**Established Programs Financing Act**
205
**1977 - Established Programs Financing Act**
changed **basic principle** of Medicare from cost-sharing to **block funding**
- lump sum barely 1/2 of what federal funding had been the previous year, meaning provinces had to pay 3/4
206
Since the change to **block funding** (global budgeting) Medicare has grown to be the ...
**largest single item on provincial budgets**
207
as of **2011**, \_\_\_% of all provincial budgets was for Medicare
42%
208
In order for provinces to pay for Medicare, the **1977** act also allowed them to..
**raise taxes** & **introduce user fees** on **non-essential HC services** (private room, tv/phone)
209
Controversial method used by provinces to cut costs
doctors accepted **lower fees** & in exchange they were given the **ability to extra-bill patients directly**
210
Extra-billing by **1980**
**Ontario & Alberta -** over 1/3 of patients being extra billed Federal gov put a stop to this
211
in **1984**
Canada Health Act
212
**Canada Health Act- 1984**
still the primary legal basis for HC in Canada
- **eliminated** extra-billing indirectly
- decided it was contrary to **principles of Medicare**
213
how did the Canada Health Act **indirectly eliminate** extra-billing?
**every dollar province** **saved** from extra-billing would be **lost from federal funding**
214
What was the problem with eliminating extra-billing?
doctors unhappy
215
When Ontario implemented act at start of **1986**...
led to 2nd doctors strike in Canadian history but quickly ended after only 3 weeks
216
Who was in power during the 2nd doctors strike in **1986?**
**Conservaties** under power of **Brian Mulroney**
217
With the doctors defeated, the conservative gov. quickly moved to restrict...
growth in HC spending
218
The conservative gov. restricted federal spending on HC in \_\_, ___ and in ____ ...
**1986**, **1989**, and in **1990** - straight freeze on HC spending for foreseeable future
219
While the **C****onservatives**were in office from**1984 to 1992**, they cut ___ \_\_\_ dollars from HC budget
30 billion
220
as a result of this 30 billion $$ budget cut...
beds, wards & even hospitals shut down
221
between **1986-1995...**
of public hospitals fell by 15% # of hospital beds fell by 11%
222
**1993** - Political Party in Power
**Liberals** took over under **Jean Chretien**
223
How did the Liberals change things in **1993**?
found **new way to introduce more cutbacks** to HC & **social programs** in general
224
**1995** - changes to Transfer payments
Liberals put together **Federal Transfer Payments** for **health**, **education** & **welfare** into lump sum - **Canada Health & Social Transfer (CHST)**
225
(2) advantaged of the **CHST** for the Fed. Gov.
1) **cut total amount** of $ going to provinces
2) **deflected public attention** to provinces
226
How long did the CHST last?
Until **2003**
227
Since 2003, HC funding from Federal Government comes from?
**Canada Health Transfer (CHT)**
228
between **1995** & **2003**
cutbacks led to more **closures of bed, wards & hospitals** (Plains hospital in Regina closed in **1988**)
229
Also introduced other problems for HC system
staff shortages
de-insuring of med. services
lengthening of waiting lists across Canada
230
most serious problem with the cutbacks introduced
hospitals turned away patients
- even emergency patients
- ambulances shuttled form hospital to hospital to find somewhere for patient
- people died in ambulance
231
**1999** - consequences of cutbacks
patients died due to **lack of beds/wards/hospitals** in **North Battleford, Yorkton** & **Prince Albert**
232
The cutbacks and resultant deaths led to?
This situation led to mounting public outrage/outcry
233
When economy finally improved in \_\_/\_\_\_ __ ...
**mid/late 90s →** provincial politicians began to demand more money from ottawa
234
**Premier's Summits** - all premiers agreed to...
demand more $$ for **social** programs in general & **HC** in particular
235
**1997**
**Turning point** - under pressure from politicians federal gov. finally agreed to put more $$ into HC - **1.5 billion dollars**
236
**1999 & 2000** - Funding for HC
further increases in federal funding announced
237
By the time the CHST was broken up in **2003**, how much had HC spending reached?
almost **20 billion dollars**
238
**2003** - GDP spent on HC
**9.46% of GDP** was spent on HC
239
in **2003**, **9.46% of GDP** was allocated to HC ... how does this compare to **1992**?
**less than in 1992** - which was **before liberal** cutbacks but **after conservative** cutbacks
240
**2003** also saw report delivered by ...
**Royal Commission** - headed by former SK premier - **Roy Romanow**
241
**Romanow Commission** concluded that?
concluded that HC in Canada still needed major infusion of $$
242
**2004** - HC funding
Premiers help special HC conference which demanded an increase in HC funding from fed. gov.
243
As a result of the **2004** special HC conference...
Fed. Gov. committed **41.3$ billion** dollars for HC over next 10 years
244
**2006** - Political Party in Power
**Stephen Harper** & **C****onservatives** elected - only had minority
245
**2011** - Political Party in Power
Harper obtained majority gov.
246
One of the first things **Harper** did once he obtained a majority government was...
cut **36 billion** from **Canada Health Transfer** to save money (real motive is believed to be because he wanted to open up possibility of private HC companies)
247
Harper's cutbacks put a lot of pressure on ___ & ___ \_\_
**politicians** & **HC workers**
doctors & nurses **told to do more with less**
- expected to treat **more** patients in **less** time with
resources
248
Inevitable result of this pressure on doctors
rise in **physical** & **mental** exhaustion which adversely affect their health & job performance (& indirectly affects the health of the public)
249
Occupation in crisis
Nurses
250
Impact of cutbacks on Doctors vs. Nurses
doctors have always been a **relatively privileged group**
- still had to work harder (reported **increased** stress) but incomes have remained high
Nurses have **received** the most pressure **yet earn the same** as national avg income
251
in 2012, average annual income of:
a) GPs
b) specialists
a) 180k
b) 350k
252
History of nursing begins with?
Florence Nightingale
253
Florence Nightingale - background before Crimean war
born into relatively wealthy family in 1820 - strong-willed woman - despite her familys strong objections to working as a nurse, she studied HC anyways - became director of nursing home in England where she transformed it into an efficient little hospital
254
Nightingale effectively transformed nursing from... into...?
FROM occupation restricted to untrained nuns/charity workers INTO genuine occupation requiring vocational education
255
Nightingale is famous for her work in? (years?)
the Crimean War (1853-1856)
256
What was the nickname Nightingale earned in the Crimean war? For what reason?
Lady with the Lamp - for her nightly rounds of checkin on patients with her lamp
257
When Nightingale and her group of nurses first arrived in Crimea, how were they recieved?
met with hostility from doctors there (doctors were obsessed about maintaining control/a monopoly over HC)
258
How did Nightingale respond to the doctors hostility? (3 pts)
reassured them that nurses were not competition and were strictly there to obey the doctors orders & do women's work (cooking & cleaning)
259
How did Nightingale make a difference by cooking & cleaning in the Crimean War (1853-1856)?
by taking over cooking & cleaning, she was able to introduce proper standards of nutrition & sanitation which was previously ignored by male doctors - mortality rates declined sharply
260
One famous case where Nightingale helped improve sanitation
persuaded military officers to go upstream & found dead horse spewing bacteria - convinced them to move it
261
Florence Nightingale -After Crimean War
took heavy toll on her, was ill & bed-ridden most of her life - became public heroine & used her fame to write about nursing, engage in political activism & organizational work that laid the foundation for modern nurse training
262
Nursing - occupation for women
virtually only paid occupation for women - therefore it was very attractive for those who wanted an education & career (middle-class womeN)
263
First Nursing School in Canada
St.Catharines - established in 1874 in Ontario - based on Nightingales model of nursing
264
of nursing schools in Canada in... a) 1900 b) by 1909 c) by 1930
a) 20 b) 170 c) 220
265
The first 30 years of the 20th Century were known as the period that..
saw the greatest expansion in nursing
266
Impact of the Flexner Report on Nursing
following the recommendations of the Flexner report, the \*\*first university degree program in nursing was established in 1919 at UBC \*\*
267
1900s: # of nurses vs doctors
200 nurses compared to 5,000 doctors
268
1930: # of nurses vs doctors
30,000 nurses compared to 10,000
269
After 1930, what happened to the rate of growth of nursing?
declined
270
Despite the decline in the rate of growth of nursing after 1930, Throughout the 20th Century...
nursing maintained average annual increase of 50% - compared to less than 10% for doctors
271
By 2006, How many registered nurses in Canada? What % were women?
320,000 94% women
272
Nurses made up __ of all HC providers becoming the...
2/3 single largest profession in Canada
273
In economic terms, the expansion of nursing allowed...
Canadian women to get back into the labor market from which they had been virtually squeezed out of by late 19th century
274
Routes for Economic Independance for women in early 20th century? (2)
1) Inheritance 2) nursing
275
Despite being the only route to independance (apart from inheritance) for women, there were still drawbacks/limitations..
hard road to travel only gave limited form of independance
276
Although Nightingale herself was strong & independent, her teaching methods demanded...
strict obediance to male doctors
277
Argument about Nightingale's teaching methods
some say she did a disservice to women but may have been the only way to be accepted & overcome the hostility of male doctors
278
Only way that nursing could be accepted by doctors was if...
they defined themselves as an AUXILLARY OCCUPATION to that of doctors (a supplementary occupation)
279
The general attitude about nursing by male doctors
women were still doing women's work, just in a hospital setting - which was acceptable to male docs at the time
280
Connection b/w Patriarchal relations that existed in Victorian family/society & HC
the patriarchal relations that existed in Victorian society/family (era: 1837-1901) were reproduced within the hospital
281
The Patriarchal (male-dominated gender) relations that existed in Victorian society/family were reproduced within hospital, creating...
a new gender division of labor in HC
282
Men providing cuts & chemicals (surgery & drugs) & women providing nutrition & sanitation was a reasonable division of labor. However, the problem was..
men ended up taking most of the money & power but the women did most of the work - particularly nursing students
283
Early 20th Century - nursing students
- treated like slave laborers - work consisted of hard manual labor (washing floors/windows, changing beds, cooking) - forced to work 12-16 hours/day in hospital WITHOUT pay - only received training, room and board
284
When did Nursing students get paid? How much compared to average male wage?
Only after they had graduated & recieved their Nursing Diploma - only 1/2 of average male wage
285
Nursing students training consisted of..
mostly on-the-job training which consisted of working hard while being supervised by small permanent staff of grad nurses - no time for actual study/theory
286
How long to finish a Nursing Degree in the early 20th century?
2-3 years
287
How did the hospitals benefit from nursing students in the late early 20th century?
provided hospitals with rotating pool of cheap labor
288
After graduation, where would nurses work?
some worked as private nurses but increasings #s found jobs in hospitals
289
The explosive growth of nursing schools was greatly motivated by?
the desire of hospital administrators & doctors to have cheap labor
290
What effect did permanent nursing staff have on hospitals?
no more cheap labor - less motivation for growth of nursing profession
291
How did nursing change hospitals in early 20th Century compared to 19th century?
19th century - hospitals were places people only went to die 20th - changed hospitals into hygienic centers of care & recovery which changed public image of hospitals
292
Nursing made major contribution to...
medical profession & doctors reputation yet still they were heavily exploited - paid virtually nothing for a lot of work
293
As the # of nurses rose, they begin to..
fight for their rights
294
Nurses realized the only way to get better wages & working conditions was through (2)?
self-organization & collective action
295
1908
Canadians Nurses established Canadian National Association of Trained Nurses (CNATN)
296
1924
reorganization CNATN and renamed as Canadian Nurses Assocation
297
Canadian Nurses Association
still remains main organization that represents nurses interests today
298
First goal of CNATN in 1908
establish provincial registries of qualified nurses -only these nurses could practice nursing
299
1910
began to set up registries & nurses became known as RNs
300
Through the process of registering nurses.. the nursing profession tried to...
gain monopoly on role of assistant caregiver but never been as successful as doctors in achieving a monopoly
301
By WW2 (1939-1945) ..Nurses
organized enough to gain some concessions - gained 8 hour day
302
1950 - nurses income
nurses pay was 60% of avg national income
303
by 1980 - nurses income
risen to avg national income - mostly due to pressure from nurses
304
In addition to pushing for better wages & working conditions, Nurses also demanded?
real education and not just on-the-job training
305
1964 - Nursing
Hall report - Royal commission looking into HC delivered report that was critical of nursing education in Canada
306
The Hall Report of 1964 recommended what change to nursing?
seperation of nursing training from hospital demands for nursing services (nursing education should be seperate from training)
307
How did the government respond to the Royal Commission's recommendations of seperating nursing education from training?
in late 60s/early 70s → nursing education moved away from hospital schools into newly created diploma programs in universities
308
Nursing ___ & ___ significantly improved after the government responded to the Royal Commissions recommendations.
skills & standards
309
What other change did the government make other than to nursing education?
changed immigration policy to attract more nurses
310
As a result of he change in Canadian immigration policy...
over 20,000 nurses immigrated to Canada - mostly from Britain
311
Britain's NHS
Britain's National Health Service/System (NHS) was more advanced & developed than Canada's HC system
312
NHS - impact on Canadian HC
Canadian government deliberately tried to upgrade nursing standards & increase # of nurses
313
The government's attempts to upgrade nursing standards & increase # of nurses by changing immigration laws was part of..
overall policy of Canada to establish Medicare by copying Britain's NHS
314
Time period that saw considerable expansion in # of nurses
1960s & 1870s
315
The expansion in the # of nurses in 60s & 70s was accompanied by..
a growing division of labor
316
Nursing saw an increase in (3) things
1) specialization 2) fragmentation 3) hierarchization
317
Nursing began to generate its own __ \_\_\_
auxilliary occupations (therapists, dieticians, orderlies, technicians)
318
specialization of nursing
some nurses took more education to upgrade their qualifications & specialize in one area of nursing - realized pay only increased marginally (still 3/4 of nurses are general duty nurses)
319
While there were some changes in nursing, more changes changes occured where?
at bottom of occupational ladder- auxiliary occupations
320
How did hospital administrator try to cut nurses wage bill after they had just gotten their wages increased?
replaced many nurses with registered nursing assistants (1970s) - when RNAs got organized & pushed for higher wages, they were replaced with nursing attendants (1980s)
321
The replacement of nurses with registered nursing assistants & then nursings attendants demonstrates...
class struggle in action which is seen in any area of the economy - cycle that is built into capitalism
322
Despite all these changes to the Nursing field, what remained constant? How?
Ongoing feminization of HC system - by 1990s, 2/3 of HC system workers were nurses (90% women) nearly 80% of all HC workers = women
323
Despite the increasing proportion of women in the HC system..
women's influence & power has not grown in proportion to their #s
324
in the late 80s/90s, how were hospital bills broken down?
into thirds 1/3 for doctors 1/3 for nurses 1/3 for administrative & support staff
325
Nursing expanded greatly in 60s & 70s, but in 80s & 90s, there was a major increase in..
administrative staff
326
(2) reasons for the major increase in administrative staff in hospitals
1) certain support services were removed from nursing & subcontracted to private companies 2) growth & change in kind of hospital administrators
327
80s → certain support services removed from nursing
hotel services (cooking, cleaning, laundry, catering) were no longer nurses responsibility & hospitals subcontracted these to private companies
328
What was the beginning of privatization of HC
subcontracting private companies for hotel services
329
Growth & change in in kind of hospital administrators
in 5 years (1981-86), # of HC administrators grew by over 2/3s - hospitals began to hire administrators outside of HC field - mostly managers from private sector who had an education in management & not HC
330
Before the 80s, who were hospital administrators?
mostly doctors or other HC workers that had climbed administrative ladder internally
331
by 1993.. HC administrators characteristics
1/3 of HC administrators had NO HC experience - mostly men - business degree/experience in management
332
Changes in control/influence due to the new kind of hospital administrators
doctors lost control of hospitals - womens influence decline
333
How did these new hospital administrators view their job & how did this affect working in the hospital?
saw their job as the same kind they had in private sector - pressure workers work as hard as possible
334
Why did most of pressure from hospital administrators fall on nurses?
doctors were still seen as relatively privileged group, middle-class professionals who deserved to not be pushed as hard
335
Managerial structure emerged in hospitals
private administrators \> doctors \> nurses & auxiliaries
336
To the hospital administrators, nurses were seen as..
the working class of the HC system which management has always pushed to work harder
337
How did Hospital administrators push nurses to work harder??
through the process of deskilling
338
deskilling
breaking down jobs into simple tasks so highly paid experts can be replaced with less-skilled cheaper workers
339
(2) advantages of deskilling for management
1) increased control over workforce 2) saves $$ by decreased wage bill
340
Deskilling - first noted in academic terms by..
Chares Babbaged in early 19th Century →known as Babbage Principle
341
Other terms for deskilling
late 19th century → Fordism (Henry Ford) early 20th→ Taylorism (named after Frederick Taylor who invented time & motion studies & scientific management) late 20th→ Mcdonaldization
342
Terms for Deskilling within the field of HC
Managerial Ideology Case-mix grouping Total Quality Management
343
Why should TQM be called Totalitarian Quality Management?
because it introduces total control over nurses work
344
What were nurses told that TQM do?
- provide greater autonomy - make jobs easier by improving job efficiency - hep assess staffing needs
345
What did TQM actually do?
breaks down nursing into specific jobs & assigning specific amounts of time for each task (based on polls asking nurses how much time they needed for each) - allowed administration to cut amount of time allowed for each job to force nurses to work harder/faster & save money by not hiring more nurses
346
Negative consequences of TQM
TQM was taken from factory work where assembly lines can be standardized to improve efficiency - However, people are not machines & HC cannot be standarized because it wouldnt account for personal differences
347
How does the standardization of HC by TQM affect nursing care how?
left nurses without enough time so that they were constantly falling behind on tasks - made decision making difficult b/c they had less time to make possibly life-or-death choices
348
Quality of Care given by nurses after TQM introduced
of mistakes increased # of people harmed increased because they did not have enough time
349
TQM's attempt to standardize HC ad negative effects on...
the patients & the nurses
350
Study by Canadian Institute for Health Information (2004) - main finding
over 5 million CDNs reported they or member of their family had been harmed by medical errors in hospital
351
Study by Canadian Institute for Health Information (2004) statistics given (5)
- 1 in 9 reported receiving incorrect medication/dosage - 1/9 adults & 1/11 children contracted infection - 1/81 newborns suffered birth trauma - 1/~1000 seniors suffer hip fracture - 1/~7000 reported having foreign object left inside them after procedure
352
TQM treats nurses as if they were?
interchangeable components on assembly line
353
How has TQM resulted in a lack of continuity of HC?
different nurses do different jobs on same patient → unable to learn patients overall health situation so nurses can't treat patients like individual with individual needs
354
TQM is the ultimate extension of? & denial of?
extension of male mechanical model & denial of traditional holistic female approach to HC
355
TQM turned the continuous process of care into?
series of compartmentalized cures that were about seeing to a patients minimum needs
356
TQM also eliminated..
subjective side of HC - part of nurses work called emotional labor
357
Explain how private sector administrators view HC & how that is reflected in their management.
administrators deal with balance sheets, numbers & money - the comfort that nurses provided is invisible & seen as a waste of time that must be eliminated to increase speed, efficiency & decrease cost
358
How does TQM treat a) nurses b) patients
a) as if they were uneducated unskilled labourers who have to be told what/how/when to do things b) treats patients in a standardized manner
359
In Sociological Terms, professionals want control over their own __ \_\_
labor process
360
TQM has greatly increased level of ___ that nurses experience from their jobs
alienation
361
How has TQM affected quality of care given by nurses? How has this affected hospital in last 30 years?
has forced them to do their jobs badly bc they do not have enough time or resources - health sanitation & nutrition levels declined over last 30 years
362
In general, how has TQM affected nurses?
- decrease in quality of care (more mistakes etc) - behind in work - decreased morale - blame themselves - increased physical & mental stress - rise in work-related injuries & illness
363
By the late 1990s, as a result of TQM, nursing has become known as..
the sickest profession in Canada
364
Nursing - Sickest Profession in Canada - Example
1997 - sick leave avg CDN = 1 week nurses = weeks
365
Nurse Burnout
in 1990s, as a result of TQM - many nurses quit because they couldn't take the pressure
366
Why is the phenomenon known as Nurse Burnout only happening in the later 20th Century?
in the late 19th/early 20th Century, nursing was really the only acceptable & paid job for women
367
2000 - Canadian Nurses Association study found..
~ 1/3 nurse graduates left canadian nursing within 5 years of graduating - 20% quit altogether - 10% went to USA to work in private sector (paid more)
368
What decade saw a sharp decline in the # of applicants & graduates of nursing schools?
1990s
369
Nurses graduated in Canada in 1999 vs. 2000
1999 - ~9000 2000- \<5000
370
How did Nurses try to fight back against the increasing stress put on them? (3)
in late 1980s, Nurses Union proclaimed TQM was endangering patients life through pressure putting on nurses Provincial Nurses Unions took a stand on SAFETY TO PRACTICE issues - went on strike
371
First Wave of Nursing Strike
bc they were being completely ignored, wave of nursing strikes swept across Canada in late 80s/early 90s
372
late 80s/early 90s Nursing Strikes
1988- SK & BC 1989 - BC & Quebec 1991 - Manitoba (longest strike)
373
What was the result of the Nursing strikes?
a professional responsibility clause was added to nurses contracts that established channels for nurses to express their grievances
374
Second wave of nursing strikes - when?
late 90s/early 2000s 1999- SK
375
How did SK government respond to SK nurses going on strike
NDP gov met nurses w/ great hostility despite being party of the working class - ready to enact back to work legislation - used courts to threaten unions with fines & leaders with prison time
376
Throughout the 2000s, nurses have been \_\_\_, ___ & \_\_\_\_
overstressed over-supervises over-worked
377
2003 Statistics - Nurses Overtime
CDN nurses worked over a quarter million overtime hours in a week - equivalent to work of 7,000 full-time jobs a year
378
2005 - Study on Ontario Nurses - findings
58% of nurses & 66% of junior nurses experiencing symptoms of nurse burnout 1 in 3 nurses under 30 plan to quit 1 in 3 over 50 plan to retire early
379
2005 Study on Ontario Nurses - Symptoms of nurse-burnout - reasons for symptoms of nurse-burnout? (3)
- depression, emotional/physical exhaustion, physical illness & growing cynicism of job 1) work overload 2) lack of fairness in workplace 3) lack of empowerment (increasing supervision & not in control)
380
How does TQM put more pressure on nurses to quit?
their job involves making life-or-death decisions - mistakes increasing because of lack of resources/time/people - worries nurses b/c patient life & health is compromised
381
How has SK addressed this issue of nurse burnout?
In 2012, Premier Brad Wall announced that SK will once again lead way for Canada in improving HC (just like TD did) → 1st province to introduce LEAN Management
382
LEAN Management in SK
in 2012, SK government signed 4 year contract with Seattle-based company John Black & Associates - pay 40 million over 4 years to teach LEAN management techniques in over 1,000 HC facilities
383
Origin of LEAN
Japan
384
Sensei (meaning)
one who has gone this way before voice of experience teacher
385
How did the public view LEAN?
initially well until 2014 - was criticized for 40 million $ price rage - Cam Broten of NDP called lean a "cult"
386
How has SK Premier defended Lean & its 40 million dollar cost?
says that LEAN management has already more than paid for itself - by eliminating waste & improving efficiency, has saved 35 million in blood services, 16 mill in design of new hospitals in Saskatoon & Moosejaw & million more in 100s of small savings in HC facilities all across province
387
How was lean created?
Toyota automobile corp. - the term was coined by American Analyst John Krafcik who wrote article about Toyota in 1988 - introduced idea of LEAN to the west
388
Toyota - History
founded in 1930s as small family business -has since grown to be the 5th largest corporation
389
The Toyota Way - History & Basis
based its production on assembly line techniques pioneered by Henry Ford In USA - concerned with efficiency & elimination of waste by standardized & simplified production process - an extension of Fordism & based on Taylorism (time & motion studies) - Flow System -production should flow smoothly - no bottle necks of unused resources - aka Just in Time system - each person finished their part of job just in time for next person to take over - dont need lots of backup inventory (save $$) -
390
The Toyota Way Philosphy (6) points
- managerial philosophy - established culture where everyone is committed to looking for ways to improve process - regular meetings to look for ways to do things better -emphasizes teamwork, mutual respect bw management & employees & constantly improving - decisions made by reaching consensus
391
How does the Toyota Way differ from standard manager-worker relationships
management regularly consults workers & gets feedback - workers are involved in the decision-making process & their opinions are respected - makes them feel like it is their company so they want to be more efficient & finds ways to do job better
392
What does Toyota literature say is the primary reason behind their time-saving techniques?
these time-saving techniques are by-products of the positive attitude,teamwork, mutual respect & culture of improving workforce
393
Why is the Toyota Way unsuccessful for many companies over the longterm?
most managers dont think & dont want to think this way - they beleive that managers should give orders & workers should obey (top-down manner) - rather than set up meetings, they hire Sensei's to tell workers what to do which makes workers angry, decreases morale & makes workers less engaged
