Description:
Strategic decision makers in health services organizations face considerable challenges, many of which are associated with their dynamic operating environments. This course introduces contemporary strategic management theories and practices that are used to guide health services organizations through strategic planning cycles. Through selected readings, case studies and case presenters, we critically examine the main concepts of strategic planning and management including strategy formulation, implementation/execution and evaluation; strategic "fit" or alignment; the role of governance; and strategic leadership. In-class exercises focus on applying strategic planning tools. Course assignments afford students opportunities to apply these concepts to their workplaces and to the creation of a new health services organization or initiative.

Objectives:
The overall objective of this course is to provide you with the conceptual tools and the practical skills to enable you to formulate, implement and critically evaluate organizational strategy and to contribute to the underlying strategic planning processes in organizations in which you work.

Upon successful completion of the course, students will be able to:

• Differentiate between the various motivations for developing a strategic plan
• Distinguish among alternative contemporary conceptualizations of strategy
• Identify and relate critical steps in the strategic planning process
• Anticipate and mitigate common barriers to strategy implementation
• Critically analyze the fit between organizational design and strategy
• Explain the essential elements of successful organizational strategies
• Differentiate between the roles of executive and management in strategic planning processes
• Analyze the structure and processes of governance in health care organizations
• Describe the future challenges for strategic planners in health care
• Create a viable strategic plan based upon knowledge of the strategic planning process and critical elements
• Appraise the merits and feasibility of strategic plans
• Critically evaluate a strategic plan using an array of contemporary evaluation tools

• Before starting this course, students should possess a familiarity with the structure and processes of the Canadian health care system and the major activities undertaken in various health care organizations. Those students who feel that their knowledge of health care organizations is limited are urged to read Michael Rachlis and Carol Kushner (1994). Strong Medicine. Toronto: Stoddart Publishing. You are also encouraged to review recent documents on the restructuring of health services in Ontario, such as one of the Health Services Restructuring Commission reports, the Metro Toronto District Health Council Report on Restructuring and/or any of the recent Provincial studies of regionalization and restructuring. The changes in the organizational environment for health care create an important context for understanding the changes in organizational structure, executive and management roles, strategic foci and mechanisms used to execute strategic plans and realize corporate strategic objectives.
  
  
• The material in this course complements some of that in HAD5713H. This is demonstrated in the joint assignment entitled "Improving the Coordination of Health Care Delivery for Specific Needs," which is a joint group assignment for students registered in both HAD5713H and HAD5711H.

Description:
In health care, information is a resource equal in importance to financial and human resources. Epidemiology offers valuable methods for compiling and analyzing data that is crucial for managing health care programs, organizations and systems. Epidemiology is the study of the distribution and determinants of diseases and injuries in populations. Managerial epidemiology, which is the focus of this course, is the application of epidemiological perspectives and methods to health care management.

Although health care managers are developers, collectors, transformers, users and disseminators of information, there has been relatively little discussion about how they can enhance their selection and use of information. Many managers feel overwhelmed by massive amounts of data, much of which provides little assistance in meeting the demands of their jobs. This dilemma becomes more pronounced as provinces attempt to increase the coordination and integration of delivery systems necessitating the coordination and integration of information from a variety of sources within institutions and the community.

The purpose of this course is to explore how managers can identify what they need to know, how they can access the information they need, and how they can use the information they obtain in order to be more effective decision makers. These issues will be examined in relation to the internal processes of individual organizations, the identification and accommodation of population health service needs, and the formulation of provincial and national health policy.

Objectives:
Upon successful completion of the course, students will be able to:

• Identify relevant health and socio-economic information sources to construct specific community and/or population profiles
• Describe:   the relationship between social and environmental characteristics and health needs; how they impact health outcomes; and how this knowldege can be used to inform management and policy decision-making 
• Judge the accessibility, quality, uses and limitations of available health information in supporting effective and efficient management of health care organizations and related government agencies
• Develop a needs assessment for a specific population and geographic area to identify opportunities for and obstacles to the provision of health servies 
• Establish performance criteria for new health or social services programs that impact health outcomes for a specific population
• Recognize the implications of transmissible diseases and environmental risks for population health planning and decision making using epidemiological evidence into clinical, organizational and health policy decision making

• A group project entitled "Improving the Coordination of Health Care Delivery for Specific Needs," which is a joint assignment for HAD5713H and HAD5711H

Description:
The course focuses on the knowledge and skills necessary for healthcare organizations to strategically measure and improve quality and patient safety.  Developing better outcomes at the same (or reduced) costs is a crucial strategic objective for all health care organizations.  While most health care organizations have developed quality review processes and utilization management programs, these often have had limited impact in improving health care.  New skills and ideas have entered healthcare which provide the information, methods and tools for managers and front line staff to improve work, to secure better outcomes for patients, and maintain or reduce the costs of providing services.  These skills and knowledge require that we analyze and improve work processes, and understand and respond to the needs of patients and other customers.  The work in this course will center on understanding the nature of these improvement concepts, developing knowledge about their application in health care organizations, and providing students with an orientation to and experience with basic concepts and principal methods.

Objectives:
Upon successful completion of the course, students will be able to:

• Explain the underlying theoretical framework for continual improvement of health care.
• Explain why quality improvement strategies are critical for health services organizations.
• Describe and give examples of the roles and responsibilities of health services managers, health professionals, and organizational employees for quality improvement and patient safety.
• Apply basic improvement methods and tools for analyzing work processes and for assisting groups in developing remedies for improving these processes
• Explain methods for testing changes and improving work processes 
• Create strategies for developing customer knowledge and assess that knowledge for the design or redesign of healthcare.
• Understand the nature of variation in healthcare and its role in improving quality of care
• Interpret a control chart and be capable of identifying the uses of a control chart
• Explain why analyzing and improving work as a system is critical for effective, safe and efficient care
• Illustrate effective and ineffective strategies for negotiations
• Discuss the effectiveness of different influence strategies in the health care context.
• Analyze the strengths and weaknesses of different approaches and methods for improving the quality of care.

Description:
HAD5723H is the first in a two-course sequence intended to impart to generalist administrators a knowledge of accounting and finance necessary to manage health care organizations. This first course, HAD5723H, focuses on financial and managerial accounting topics. In essence, accounting involves the recording and reporting, in financial terms, of the economic events of an organization. In this course, four broad topic areas are covered: financial accounting, managerial accounting, cost accounting, and budgeting. The second course, HAD5733H, concentrates on corporate finance topics.

Objectives:
Healthcare Accounting is taught in three major sections with the following objectives:

• Financial Accounting:
• The types of financial reports required by organizations and the type of information in those financial statements.
• The theory and foundation of financial accounting and the ‘rules’ for the accumulation and reporting of financial information.
• Key financial performance measures and the interpretation of financial performance.
• Managerial Accounting:
• The concepts and vocabulary in measuring costs, depending on the needs of the decision maker.
• The implications and use of management accounting tools and information for short term and long term decision making.
• Management accounting applications of forecasting, budgeting, and variance analysis.
• Performance Analysis:
• Perform a performance analysis of a chosen health care organization using financial and managerial information from provincial datasets.

Pre-class Individual Quizzes      (1 @ 5%, 3 @ 10% each)	35%
In-class Group Case/Exercise      (4 @ 10% each)	40%
Individual Analysis	15%
Class participation	10%

Description:
The objective of this course is to introduce students to quantitative managerial skills. Increasingly managers face decisions that require reliable information and a clear understanding of their agency's profile. Quantitative managerial skills allow for this information and understanding to be provided; it makes possible better decisions in human resources, marketing, operations, finance, accounting, and other functional areas. Quantitative skills are now an essential tool, and the demand for graduates who can handle managerial quantitative projects continues to grow.

• All learners are required, prior to the start of classes in September,to have a working knowledge of the following topics:

  Measures of central tendency	Normal Distribution
  Measures of dispersion	Distribution of Sample Means
  Frequency distributions	Confidence Intervals
  Percents/skewness	Hypothesis testing for a Single Pop.
  Chi Square test
  Analysis of Variance
  Bivariate linear regression
  Hypothesis testing for differences Between Means
  Hypothesis testing for differences Between Proportions
  Regression analysis
  Regression inference

  
  
• All learners will be required to complete a computer based assignment. Learners will be able to acquire SPSS-PC through a University of Toronto site license. Instruction in SPSS-PC will be provided either during orientation week or during class.
  

Please note: Due to the accelerated nature of this course, most learners will find it helpful to have worked through as much of the required material as they can prior to the first class period.

Description:
This course is designed to teach a basic understanding of the principles of economics as they relate to health care management. The course focuses on health economic and microeconomic concepts underlying the structure of the existing health delivery systems in Canada and other countries. The goal of the course is NOT to train health economists. Rather we seek to provide learners with the opportunities to develop an understanding of and skills in the use of economic concepts and analyses for decision-making. Prior knowledge of economics is not required.

Objectives:

    1. Discuss the usefulness and limitations of economic analysis applied to the health sector
        (and in their day-to-day lives)
    2. Describe the unusual economic characteristics of the health care sector and how they affect the utilization of
        health care
    3. Identify the strengths and weaknesses of cost-benefit, cost-effectiveness and cost-utility analyses and be able to
        apply these evaluation techniques to health programs
    4. Explain the factors that influence the distribution of services and the productivity of providers
 

Evaluation:

Description:
This course focuses on understanding and managing organizational change. Learning to design and carry out effective organizational change is a critical skill for managers in today's turbulent healthcare system. We build upon HAD5711H and HAD5721H, providing an overview of change issues from the restructuring of healthcare organizations, to the improvement of care by healthcare teams. The course includes case studies and guest lectures by leaders and experts in change management. The assignments focus on analyses of cases featuring program and/or organizational change efforts in health care organizations.

Objectives:
Upon completion of the course, students will be able to:

• Analyze the critical skills and knowledge that leaders need to lead change in healthcare organizations
• Assess the factors that influence implementation and performance during and after transformation
• Understand external and internal factors influencing organizational change
• Analyze the usefulness of various change strategies to improve organizational effectiveness
• Identify how organizations need to create a culture that fosters innovation and continual improvement
• Examine strategies for redesigning work in organizations and broader delivery of care
• Understand how organizations need to assess risk and deal with organizational failures
• Analyze how organizational learning contributes to successful organizational performance
• Understand the challenges related to addressing and improving patient safety and high reliability in healthcare organizations

Description:
HAD5733H is the second in a two-course sequence intended to impart to generalist administrators a knowledge of finance and accounting necessary to manage health care organizations. The first course, HAD5723H, focuses on managerial accounting topics. This second course, HAD5733H will concentrate on corporate finance topics. In addition, it will integrate corporate finance and accounting theories, institutional knowledge of health care finance, and applications to specific problems.

Objectives:
The course will be taught in three major sections with the following objectives:

1. Investments (or capital expenditures):
   • Achieving a conceptual understanding of valuation and the effects of project selection, asset acquisition, financing methods and the time value of money;
   • Developing an ability to evaluate the desirability of a project, based on net present value calculations and considerations of non-cash values;
   • Gaining a facility with the use of spreadsheet technology in conducting financial analyses.
2. Financing:
   • Achieving an ability to estimate the cost of various sources of financing, based on projected cash flow
   • Gaining an ability to evaluate leasing versus buying of an asset.
3. Other topics:
• Gaining an understanding of how to develop a strategic long range financial plan
• Gaining an understanding of capital and operations financial planning for a long-term care facilty;
• Gaining and understanding of the financial aspects of public-private partnerships.

Evaluation:

Description:
This is an elective course for students in graduate research programs who wish to gain a better understanding of the commercialization of health research specifically and the knowledge-based economy in general. The course provides an overview of different aspects to research commercialization, including basic and applied research, technology transfer, venture capital, clusters, national innovation systems, and what Canada and other countries are doing to move their economies in this direction. This course will also be available for all students, in particular, business students and science students interested in learning about the business side of their research activities. Students working in public sectors such as research, science, or innovation policy; health policy and management; and education (including universities) may also find the course useful.

Objectives:
Analyze the importance of organizational culture in processes of organizational change.

1. To understand the continuum of research commercialization and the metrics used to assess its efficacy; (what to measure and why).

2. To situate the commercialization continuum within the context of 1) the knowledge-based economy and 2) globalization and from this to gauge national competitiveness; (how to assess whether national policy is robust, relevant).

3. To become familiar with present and emerging issues in the new economy and these in distinction or comparison to a manufacturing- or resource-based economy. Also the components of the new economy and how these can be fostered in political policy making, in particular regarding the uptake of individual components of innovation frameworks; (appropriateness, feasibility, and relevance of components and frameworks).

Description:
This course introduces quantitative methods and their applications to health care decision-making. The use of these methods has recently become an active and growing area of practice and research in contexts including wait list management, patient flow, population demand estimates, health human resource management and the coordination of resources for elective and emergency services. This course is designed to provide health care decision makers with an introduction to several useful quantitative methods that can provide insight and support for complex decisions.

We will cover the following topics:

• Mathematical model formulation
• Linear programming and optimization
• Forecasting
• Queuing theory and simulation modeling
• Project management
• Introduction to decision analysis.

This class is not intended for learners who have a background in operations research.

Objectives:
Completion of this course will allow learners to:

• reconstruct management problems into mathematical models for optimization
• graphically describe the mathematical models to understand the relationship of decision alternatives
• develop Excel spreadsheets to solve mathematical optimization problems
• appraise and justify the value of resource allocation decisions using sensitivity analysis
• interpret retrospective data to predict future states
• develop models using simulation and queuing theory that predict wait times, service demands and resource utilization 
• manage project deadlines using quantitative tools
• display confidence in using quantitative methods to make health care decisions and hold people accountable for making high quality recommendations
• be willing to face quantitative facts even when they are counter-intuitive

Description:
A health administrator needs to understand the legal environment within which management decisions occur. The law is often seen as ambiguous and amorphous.

This course will provide you with an overview of key legal and ethical concepts and their application to the health field. Among the topics to be addressed are an overview of the law and legal process, business organizations, both "profit" and "not-for-profit", litigation, consent and capacity, contracts, medical records, privacy, tenders, product liability and research. Specific ethical concerns and situations will be woven throughout the course. While it is not intended to turn health administrators into lawyers, this course is designed to teach health administrators to spot legal and ethical issues and know when to seek legal assistance.

Objectives:
On completion of the course, it is expected that participants will be able to:

     1. Identify the basic legal systems, analyze their inter-relationships and develop a framework for evaluating problems
         from a legal and ethical perspective 
     2. Analyze key legal issues in various situations arising in the health field
     3. Identify alternatives for resolving legal and ethical issues and analyze which strategies are preferable
     4. Develop a framework for analyzing the difference between legal and ethical issues in the health care setting 
     5. Analyze the business, legal and ethical frameworks which govern both the organizational structures of health care
         institutions and clinical decision-making

Evaluation:

K. Leonard  

Description:
This course provides students with a basic understanding of Information Systems theory. The primary focus is on the development and management of information systems and computer applications. It should be stressed that this is not a course on computers per se – but rather a course that applies computer technology as a means to an end. This end is, hopefully, the competent management of information and decision support systems.

Objectives:
Upon successful completion of the course, students will be able to:

• Explain the underlying framework for information management theory;
• Outline the major roadblocks to building more effective information systems (IS) in healthcare;
• Describe the critical success factors that can facilitate the development and implementation of better IS;
• Analyze strategies for creating innovative solutions and their successful implementation;
• Apply basic continual improvement methods and tools for analyzing work processes for improving IS processes;
• Analyze and describe the strengths and weaknesses of systems and communicate that to the technology community;
• Compare the efficiency and effectiveness of different information systems or platforms to the point of being able to define optimal strategies in healthcare;
• Measure the status of information systems in place today.

Description:
This course analyzes the formation and implementation of public policy through the use of case studies, focused about important theoretical concepts. Students will develop the ability to understand and analyze the processes by which public policies are formed, and the ability to perform comparisons of policy alternatives. Guest lecturers may be used where appropriate to expand upon the process of policy implementation in an informal format.

Cases to be analyzed will be selected from the attached list by the class. With the permission of the instructor, new cases may be added.

Objectives:
Upon successful completion of the course, students will be able to:

• understand and analyze the processes by which public policies are formed and implemented,
• perform comparisons of policy alternatives,
• analyze and discuss case studies in class,
• organize and manage an in-class discussion of a case study, and apply appropriate theoretical concepts to better understand and analyze public policy.

• Introduction to Canadian politics
• Policy formation - including roles of Royal Commissions, task forces, committees, etc.
• Budgetary system
• Policy outputs (including distributive, regulatory, redistributive policies)
• Policy instruments
• Factors influencing policy formation, especially pressure groups and media
• Inter-governmental relations
• Inter-departmental relations; resource allocation within departments
• Policy/Administration tension
• Roles of experts vs/ generalists; administrators vs. politicians
• Role of quasi-independent agencies; regulation.

Description:
"In theory, there is no difference between theory and practice. But, in practice, there is." (Jan L.A. Van de Shepscheut)

To some people, the concept of "marketing" suggests manipulating others to buy something they don’t want or don’t need. In a period of scarce resources, marketing in a health services context has more to do with understanding the audience and communication with it in a way that emphasizes unique and often non-economic qualities. The intent of the marketing effort may range from articulating a compelling case for resources to supporting a change management initiative to identifying and communicating personal strengths in the job market. Whether the audience is patients, staff, stakeholders, or a potential employer, this course provides a foundation from which to analyse the marketing opportunity, develop strategies and tactics and successfully reach the target.

By balancing key elements of the marketing mix (product, place and promotion), strategies to create sustainable differentiation are developed. Branding concepts are considered as a means of building stronger bonds with the potential market. Particular attention is paid to the marketing of services or product/service hybrids to overcome the additional challenges facing intangibles.

Examples are drawn from best practices marketers in well-known consumer fields. Cases provide opportunities to apply marketing concepts to real world problems.

Objectives:
Upon successful completion of this course, students will be able to:
 
     1. Illustrate the differences between a marketing orientation and other strategic approaches to an organization’s
         consumers and stakeholders
     2. Apply measurements used to assess the impact of marketing activities
     3. Predict the sources of bias in marketing research
     4. Describe the major factors influencing the acceptance of innovations
     5. Compare the differences between consumer buying behavior and organizational buying behavior
     6. Analyse markets in order to identify viable segments
     7. Formulate effective positioning strategies
     8. Determine the relationship of a product or service to the product life cycle
     9. Define the unique qualities that contribute to the creation of a strong brand
    10. Prepare solutions for the unique problems facing service brands
    11. Identify the additional challenges of marketing non-profit organizations
    12. Recommend low cost or no cost forms of marketing communications
    13. Develop a formal marketing plan for a health services organization based on strategic analysis and the integration 
         of relevant marketing principles including a workable implementation plan and measurement of outcomes
    14. Formulate differentiation strategies for personal branding

Evaluation:

Description:
The overall objective of this course is to increase learners' appreciation for and skills in managing a diverse workforce in health care. The focus is on creating high quality health care workplaces through strengthening the employment relationship (including union-management relations) taking into account the social, economic and regulatory context within which that relationship is defined.

As health care organizations have decentralized decision-making, many of the traditional HRM functions have become the domain of the manager. In some organizations the human resources management processes are well integrated with overall organizational strategy while in others they are limited to the technical component. Students will be introduced to the basic human resources management functions including selection, training, performance management and management of the collective agreement but, it is not the intent that they will become specialists in these areas. The principal strategic issues which will be addressed include what it means to be a high quality workplace, the changing nature of work and workplace organization including employee engagement as a human resource strategy, the concern with productivity and the measurement of that productivity through performance indicators in a rapidly restructuring system, the impact of new working arrangements on the employer-employee relationship and the creation of learning organizations.

Cases, course readings, role playing and guest lecturers are the approaches used to give learners an opportunity to critically analyze the complexity of the employment relationship.

Objectives:
Upon completion of this course, students will be able to:

1. Demonstrate how managers can create healthy workplaces
2. Compare the differing perspectives managers and employees have of the employment relationship
3. Describe the challenges faced by health care managers in managing a diverse workforce
4. Examine one's perspective related to the concept of fairness and how it can be reflected in HRM practices
5. Compare different ways of involving workers in organizational decision-making processes
6. Evaluate the regulatory context within which human resources management practices are carried out
7. Analyze strategies to link human resources practices to the overall formation and implementation of strategies in health service organizations
8. Describe and explain the unique features of collective bargaining involving health professionals
9. Demonstrate how managers can work within a Collective Agreement
10. Evaluate effectiveness of different approaches in the management of employee performance
11. Distinguish between different approaches to the management of knowledge within the organization

Description:
This course will provide an overview of the current status of program planning and evaluation. Its purpose is to give participants an understanding of the planning and evaluation process, to familiarize them with current program planning and evaluation techniques and to have them develop the skills to apply these techniques to the health and social services sector.

Objectives:
The objectives of the course include:

• Reviewing the role of program planning and evaluation within broader management and policy processes, and discussing the characteristics and nature of these activities,
• Discussing the different types of evaluation, including needs assessments, process and outcome evaluations, from the perspectives of different stakeholders, and
• Developing the skills to apply planning and evaluation concepts to the health and social services sector.

A secondary objective of the course is to provide an opportunity for students to develop expertise in working in groups in an on-line environment.

Description:
Policy-makers across the industrialized world now face converging challenges. These include increasing health care expenditures which after a period of constraint during the mid- and late-1990s, are once again growing steadily; the introduction of new and often more costly medical technologies and drugs; rising public expectations about the right of individuals to access appropriate care on a timely basis; and the multiple, chronic needs of aging populations.

However, there has been less convergence in the pace and direction of policy responses, sometimes even within jurisdictions. While, for example, some countries have experimented with “market-based” reforms aimed at achieving greater “value” through competition, others have adopted cooperative strategies aimed at integrating care across “silos.”

This course, the third of the MHSc. policy courses, compares and analyzes recent health policy trends and issues in Canada, Australia, the UK, New Zealand, Sweden and the Netherlands.

It has two main components. The first, provided on-line, consists of a series of e-modules comparing the organization, governance and financing of health care across these countries, as well as key issues including the public-private mix; health human resources; primary health care; drugs; and public health. The second component, provided in tutorial format, further develops the policy analytic “tool kit” introduced in earlier health policy courses. It uses a conceptual framework focusing on how institutional factors (e.g., the “internal” capacity of the state to make policy) and structural factors (e.g., the political strength of “external” groups and interests to influence policy) shape policy change. Emphasis is placed on the extent to which “lessons learned” from other jurisdictions can be transferred to inform decision-making closer to home.

This graduate course is designed for health professionals and students of health policy who need to “make sense” of health policy in an increasingly globalized environment.

Objectives:

• To document current health policy trends and issues across the industrialized countries;

• To develop further the policy analytic toolkit introduced in HAD 5010 (Canada’s Health System and Health Policy - Part 1) and HAD 5020 (Canada’s Health System and Health Policy - Part 2);

• To apply this toolkit to assess the extent to which trends and issues at a global level can be used to understand and predict policy change more locally.

1.  To increase students' ability to synthesize different pieces of information on competitive forces in the environment to support the development and evaluation of strategy 

2.  Enable students to apply industry and corporate strategic analysis and performance measurement techniques to address common health policy topics through organizing disparate sources of information on an organization's competitive environment

Description:
The overall objective of the practicum is to broaden the student's appreciation for and skills in managing health services organizations by allowing students to evaluate, test and further develop their managerial/policy competencies in a practical setting. Practicum placements are specifically tailored to individual student needs given their past work experience and their specific learning and career objectives. While the student is expected to synthesize and apply the academic knowledge gained in the first two blocks of the Program, the focus of the practicum is on what the student identifies as his/her learning needs. The fieldwork is seen as incremental and developmental, being adaptable to the individual student's needs, and building on their work experience.

Objectives:
Upon successful completion of this course, students will be able to:

• Identify their own learning needs and design a learning contract that will address those needs.
• Complete the activities outlined in the learning contract, as negotiated with their preceptor and faculty advisor.
• Optimize their learning opportunities by regular reflection, both through their learning journal and their discussions with their preceptor and faculty advisor.
• Evaluate their professional strengths and development needs for successful career progression through self-reflection.
• Organize and develop a business plan for a healthcare organization.
• Understand the key components of successful career planning in a healthcare environment.
• Further enhance their organization and delivery of oral presentations.