A Dialogue on Social Innovation:Regional Approach to Governance in Health, Education,

Municipal Government and Economic Development

PresentationDr Stephen Tomblin

PanelJoan Dawe Dr. David Dibbon Kelly Vodden

MEMORIAL PRESENTS

Managing Change Through Regionalization:

Lessons from Newfoundland and Labrador

Dr. Stephen Tomblin Department of Political Science and Faculty of

Community MedicineMemorial University of Newfoundland

October 6, 2005

MEMORIAL PRESENTS

Managing Change Through Regionalization: Lessons from Newfoundland and Labrador

• Focus on regionalization reform in four policy fields:

1. Education2. Health Care3. Economic Development4. Municipal Government

• OUTLINE:1. What is regionalization?2. Why regionalize?3. Examples from

Newfoundland and Labrador

4. Similarities across policy fields

5. Differences across policy fields

6. Policy lessons

What is regionalization?

• About delivery and decision making for programs and services at “regional” level

For this discussion: about regions within the province

• Innovation / change driven by idea that old ideas, institutions, processes are out of touch and must be replaced:

incrementally over time

orquickly through a “big bang”

Regionalization not necessarily Decentralization

• Irony that centralization and consolidation of power can and does often occur with regionalization

• The number of opportunities for citizen participation have actually been curtailed through the centralization of various services delivered by boards or authorities (School Boards; REDBs, RIHAs) Explains some of the resistance to regionalization

Why Regionalize?

Policy goals to:• reduce costs• respond better to the needs of local populations• increase local control over decision-making• coordinate and integrate services• achieve efficiencies in resource allocation• improve access to services• manage institutions effectively• increase accountability• achieve improved outcomes

Why Regionalization?Democracy and Citizen Participation

• devolution of powers by provincial governments potential to allow lay persons opportunities to participate in

decision-making and tailor decisions to the specific needs of local communities

• citizen participation can be problematic: requires specialized knowledge that most citizens do not

possess creating more voices and diversity makes it more difficult to build

common vision for the province regionalization experiments may work at cross-purposes may be ploy for avoiding blame for cutting public services rural communities lack capacity and volunteers lack of capacity can result in cynicism and apathy

Why Regionalization?Appointment vs. Election

• Appointed bodies are much more common than elected allows the provincial government to exercise more control over

the process of regionalization provides opportunity to ensure there is a balanced approach to

representation and key stakeholders are involved in the process allows government to reward friends

• Main disadvantage with appointed boards is the lack of legitimacy and accountability to citizens’ interests stakeholders may (through their actions in the process)

undermine reforms and defend the status quo where elections do occur (eg. school boards in NL), turnout and

interest are low Health Authority elections in other provinces have not generated

much citizen interest either

Building new forms of innovation is never a smooth process

Requires:• Mobilizing a new vision• Leadership• Mobilizing a coalition and public support around the new

regime• Finding the means to tackle and rethink old ways of

doing things• Getting the new vision institutionalized

either bring in or replace old institutions and interests

Lessons from Newfoundland and Labrador:Regionalization and Education

• Education reform driven by two factors: adapting to the needs of a “post-industrial” society reduce or eliminate the power of the churches to control the

education system• New vision from two Royal Commission documents: Building On

Our Strengths and Education for Self-Reliance (1986) upgrade “human capital” with training that was scientific and

entrepreneurial education viewed as a key to economic development

• Royal Commission Report, Our Children, Our Future (1990-92) focused on the delivery and organization of education in NL stated that “the denominational system in its present form

creates divisiveness and is an impediment to social cohesion.”

Regionalization and Education:Not a Smooth Process

• Negotiations between the province and churches were launched in 1992

• Agreement could not be reached• Government decided to seek public approval to amend

Term 17 via referendum• 1995 referendum called for government to retain

denominational education but to allow for the reduction in the number of school boards from 27 to 10 majority of voters (55%) endorsed the amendment boards would be elected

• However, new amendment was confusing as it permitted both uni-denominational and inter-denominational schools.

Regionalization and Education: “Big Bang”

• 1997 second referendum to remove all denominational control over education in NL turnout of 53%, 73% of voters approved amendment to Term 17

• 2004: further consolidation in the number of school boards from 11 into five Rationale based on declining enrolments and attempts to create

administrative and managerial efficiencies However, new regional entities were larger and no public input

was sought by government

(new Eastern School Board has 127 schools with approximately 44,000 students distributed across the Avalon, Bonavista and Burin peninsulas)

Regionalization and Economic Development

• Fall 1990: process leading to the province’s first strategic economic plan began with Economic Recovery Commission (ERC) 15 public meetings, 15 formal presentation meetings, five regional

roundtables, a pan-provincial roundtable and 261 written submissions key feature of the Strategic Economic Plan was plan to establish 17

economic zones across Newfoundland and Labrador

• Jan. 1995: Report of the Task Force on Community Economic Development Equal federal – provincial and community organization representation

on Task Force Call for Regional Economic Development Boards (REDBs) in 18 (later

20) economic zones Federal and Provincial adoption of recommendations REDBs not appointed by government Strategic Economic Plans to establish shared priorities for development

Why the creation of economic zones?

• each region is better able to participate in and respond to opportunities for economic growth

• better coordination and integration of economic planning

• citizen input in developing economic plans for each zone

• joint projects can be undertaken by zonal communities• major centres in each zone will have infrastructure

improved to attract new services and investments• greater regionalization of government administration• the unique characteristics of each region will be easier

to identify and will be better understood

Regionalization of Health Care

• 1990: comprehensive health restructuring began Wells government established a Resource Committee to review

the state of the health system; included key stakeholders National Health Ministers conference, regionalization emerged

as a potential solution to combat escalating hospital costs (everywhere but Ontario).

• province adopted several strategies for combating rising expenditures: regionalization focus on the population health model integrated approach to health care delivery shift from hospital to community level care.

Regionalization of Health Care

• Advantages associated with regionalization: reduction in costs due to economies of scale increases in quality of care, due to improved potential to attract

specialists greater justification for specialized administrative services

(increased capacity), such as data handling, and in-service education

• Disadvantages of regionalized health system: diminished community involvement potential for closing institutions in rural and remote areas possible decline in employment

Regionalization of Health Care

• March, 1993: Report on the Reduction of Hospital Boards consultations held across the province ten recommendations for government; most were

formally adopted14 regional health authorities established: two

integrated authorities, four community health boards, six institutional boards and two boards overseeing nursing homes and the NL Cancer Centre

appointed boards

Regionalization and Municipal Government

• amalgamation debate due to small population that is highly dispersed most municipalities still consist of small communities that are

isolated from one another

• 1997 Task Force on Regionalization conducted interviews and seminars with municipal officials and

the public throughout the province need for regionalization and the sharing of services However, the public was not very supportive: “overwhelming

response was one of ‘go away, leave us alone, we’re already doing the best we can to share with our neighbours.’”

Regionalization and Municipal Government

• One example of regional cooperation is the Avalon Waste project ambitious effort with the goal of merging 43 disposal sites into

one location new waste site would cover the Avalon peninsula up to

Clarenville

Similarities and Differences in Reforms Across Policy Fields

Similarities

1. Reducing costs for services2. Reducing levels of management and administration for

services3. Achieving efficiencies through centralization4. Claims of responding better to local and community

needs5. Improvements in services provided and access

Similarities and Differences in Reforms Across Policy Fields

Key Differences

1. Frameworks, Concepts and Objectives relied upon to define vision and strategies:

equity (health needs-based) efficiency- based vision more dominant in economic

development field

2. Selection of members for regional boards: in NL, most are appointed, not elected

3. Consultations: regionalization has been established with varying degrees of public input

4. Success of reforms: in health, positive perception but in education, municipal government more challenges and constraints

Policy Lessons

Points to Consider:• Regionalization adopted during times of crisis, whether

fiscal, social or political

• Ideas for reform came from external and internal sources

• Requires public buy-in or support

• Regionalization absolves responsibility for government to make the hard decisions but allows a more community-based approach to problem definition and solution.

Policy Lessons

• Regionalization adopted in some cases without widespread public input and consultation

• Lack of meaningful community participation

• Little policy learning across regional systems

• More recently, regionalization imposed from top down, from centre to periphery in education and health

A Dialogue on Social Innovation: Regional approaches to governance in health, education,

municipal government and economic development

Joan DaweChair

Eastern Regional Integrated Health Authority October 6, 2005

MEMORIAL PRESENTS

• September 10th, 2004 press release announcing restructuring:– “Creating fewer, more accountable health

authorities is a necessary step in renewing our health and community services system and meeting client needs. Fewer regions mean less administration and more opportunity for collaboration. Integrated boards will have the ability to focus on the full continuum of care, from community care to acute care and long-term care, resulting in better service for clients.” Minister of Health and Community Services

New Directions for Health and Community

Services

Four New RIHA

Population

• Eastern 295,000• Central 100,926• Western 82,034• Labrador 40,516

Former Boards:• Avalon Health Care Institutions Board• Health & Community Services - Eastern• Health & Community Services - St. John’s• Health Care Corporation of St. John’s• Newfoundland Cancer Treatment and

Research Foundation • Peninsulas Health Care Corporation• St. John’s Nursing Home Board

Eastern Health - Organization

• Broadest Level1. Service 2. Education3. Research

Regional Mandate– Full continuum of community, institutional acute and long

term care

Provincial Mandate– Adult tertiary care– Child specialty services – Cancer care – Genetics program– Mental Health

Mandate

• 18 member (volunteer) appointed Board

• $850 m. operating budget• 12,000 employees• 27 health care facilities

• 30 community offices

Eastern Health - Organization

Key concept and approach for program and policy development aimed at improving the health of the population.

Elements: Addresses the determinants of health and their

interaction; Base decisions on evidence; Increase upstream investments; Apply multiple strategies; Collaborate across sectors and levels; Employ mechanisms for public involvement; Demonstrate accountability for health outcomes.

Population Health

• Creating new organizational culture.

• Maintaining stability throughout reorganization.

• Very large geographic area.

• Urban / Rural issues.

• Competing demands for services and infrastructure –community / institutional acute care / long term care.

• Human and fiscal resources.

Challenges

Promote population health approach

Achieve better balance between promoting health / preventing illness / care and treatment

Build an integrated, seamless health and community services system

Improve access to services

Address gaps through reallocation of resources

Avoid unnecessary duplication of services.

Opportunities

Legislation: Regional Health Authorities Act (proposed)

Transparency and Accountability Act (assent Dec. 16, 2004)

Policy Governance Model

Governance

A Dialogue on Social Innovation: Regional approaches to governance in health, education,

municipal government and economic development

Dr. David DibbonFaculty of Education

Memorial University of NewfoundlandOctober 6, 2005

MEMORIAL PRESENTS

Newfoundland and Labrador School Districts 2004-2005

Eastern• Schools 125• Pupils 45,258• Teachers 3,000.7

Western•Schools 82•Pupils 14,742•Teachers 1,159.1

Nova Central•Schools 75•Pupils 14,741•Teachers 1,099.5

Labrador•Schools 16•Pupils 4,505•Teachers 343.3

Conseil scolairefrancophone•Schools 5•Pupils 193•Teachers 31.8

Regionalization in Education

Though pupil enrolment numbers have been declining, the number of school board districts and administration staff has remained constant. We will reduce the number of school boards by September of this year from eleven to five, for an anticipated savings of about $6 million annually (Budget 2004).

Governance in an era of mandated change

You can’t mandate what matters, but

Mandates can work if they are supported

Regionalization means many changes masquerading as

a single change

The Impact of Regionalization

• On the education system• On district office • School administrators• Teachers • Students

District Office Administration

0

20

40

60

80

100

120

140

Directors Assist. Dir. SEO/REO Prog. Spec.

2004-2005

1997-1998

1994-1995

Regionalization

Myths– Big is better– More efficient = more

effective– It is possible to do

more with less– Downsizing to

prosperity– Shared vision

Realities– Era of fiscal restraint– Top down model of DM – Loss of capacity – De-professionalizing – Rational is not always best

Opportunities– New model of governance– To adequately resource the

system– To involve the community

It is only when responsibility for education is shared by the community can education ever be reformed ( Dewey 1952).

A Dialogue on Social Innovation: Regional approaches to governance in health, education,

municipal government and economic development

Kelly Vodden Dept. of Geography,

Center for Sustainable Community Development Simon Fraser University

October 6, 2005

MEMORIAL PRESENTS

1995

1. Strategic economic planning

2. Coordinating business support

3. Supporting communities and organizations

4. Coordinating social and economic initiatives

5. Public education and participation

1998

• SSP implementation

•coordinated approach to social and economic development

• building and supporting community involvement, action and partnerships

• input into policy and decision-making

2005

• focal point for partnerships with government

• rural voice

• support for communities and regions

• develop regional approaches that link economic, social, cultural and environmental issues

Rural Secretariat

• “develop regional approaches which effectively link economic, social, cultural and environmental issues”

• coordination of government efforts/policy (and local/regional efforts)

RED Boards

• social and economic initiatives relating to RED

• coordination of local (and senior government) efforts

Relationships??

SSP

• government-region-community partnership around social and economic development

•coordination of government efforts/policy and local/regional efforts

Layers of Regionalization– Multi-level Governance

Cross-border/North Atlantic

Atlantic Canada

SSP Regions

Newfoundland and Labrador

Rural Secretariat Regions

Economic Zones

Municipalities

Economic Sub-Zones (RDAs, municipal collaboration, EAS)

Options for Municipal Cooperation

• Status quo

• Service sharing arrangements

• Amalgamation

• Regional government

Issues for consideration

• Tensions - place-based vs. functional regions

• Change and stability

• Boundary creep – adding vs. replacing layers

• Planning temporal, vertical and horizontal linkages

• The reality of resource limitations – efficiency and accountability, but not at the cost of effectiveness

A Dialogue on Social Innovation:Regional Approach to Governance in Health, Education,

Municipal Government and Economic Development

Question and Answer Period

MEMORIAL PRESENTS