Description:
The Canadian health care system (Medicare) remains a top policy issue and a key-defining characteristic of Canadian identity. There continues to be strong public and political support for Medicare’s guiding principles: universality, comprehensiveness, accessibility, public administration and portability.

Yet, as recent federal and provincial reports on health care have emphasized, Medicare faces tremendous challenges. An aging and increasingly diverse population, new diseases, new and more costly medical technologies, as well as changing values and expectations have generated rising and more complex demands. There is an increasing emphasis on community-based health promotion and social support in contrast to more traditional care in hospitals and institutional settings. Individuals and communities are demanding a greater role in decisions about their health and the use of scarce health resources at the same time as the pressures of globalization begin to constrain the capacity of governments to implement domestic policy solutions. In spite of billions of new health care dollars, public concerns about long waits for care in Canada continue to fuel debate about the “sustainability” of publicly funded health care and the need for commercial health care options.

HAD5011 (and HAD5010, its counterpart for students in the professional stream) is the first of two courses which develop and apply a policy analysis “tool kit” to critically analyze key issues and trends in Canada’s health care system and health policy. Course sections examine the current state of health care in Canada, the public-private mix, the influence of powerful interest groups, and the shift toward home and community care, paying particular attention to the ideas, interests, and institutions which have shaped the Canadian health care system in the past and continue to shape its future.

HAD5010/5011 is designed for health professionals and students of health policy who need to "make sense" of a rapidly changing and increasingly politicized health care environment in which "evidence" is often only one, but rarely the most important factor driving change. HAD5011 is directed towards students in research streams (MSc/PhD) who must demonstrate strong analytical skills and a more developed mastery of the research literature.

• identify and discuss major elements of Canada's health care system
• describe key issues and trends in health care delivery and health policy
• demonstrate a developed understanding of basic tools for policy analysis
• apply these tools to analyze critically current issues and trends in Canada's health care system

• a basic understanding of the major elements of Canada's health care system
• an awareness of major trends and issues
• a developed ability to read and use course materials and other sources to research and write graduate-level, analytic assignments
• developed English language (reading and writing) abilities.

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Description:
This course is the second in a series of health policy courses and is appropriate for students who have already completed an introductory course. We explore contexts, processes and theories relevant to health policy studies, accompanied by exploration of topical health policy issues in Canada. The course is offered in conjunction with HAD5020H – a 5-session course for professional Master’s students that is taught through lectures and panel discussions. In addition to these sessions, HAD5021H students will participate in weekly seminars to discuss and debate an interdisciplinary body of scholarship relevant to health policy studies, drawing from political science, organizational sociology and related disciplines.

NB. This course is required for PhD students in the policy stream, to prepare for health policy comprehensive examinations.

• Health policy studies as a distinct field of study
• Theories, concepts and frameworks in public policy studies
• Institutionalist theories relevant to health policy studies

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The course will use an interactive format and will integrate didactic presenatations, case examples and application of the material in independent project work.  Learning will take place through various modalities including lectures, small group exercises and full class discussions.  The course instructors' experience and work in mental health and addictions health services research and consulting will be augmented by the expertise of guests from different health areas who will bring their experience as producers, users or brokers of knowledge.  Students will be responsible for leading the discussion on the course readings.

• To develop core knowledge of knowledge transfer and exchange issues, concepts, models and methods
• To understand the uses of knowledge transfer and exchange in research, policy making, management and clinical practice
• To learn how to apply knowledge transfer theory and practice to student research
• To learn techniques to help in the measurement and evaluation of knowledge transfer and exchange

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Description:
This is an elective for students in graduate research programs who wish to gain a better understanding of performance measurement in health care and the methods available to develop performance measurement systems and specific indicators of performance. The course will provide an overview of different models for performance measurement, indicator development strategies and a discussion of issues specific to several stakeholder groups. This course will also be available for all students enrolled in the Ontario Training Centre Collaborative Program in Health Services and Policy Research, and will directly address both research and policy competency components. Students working in other public sectors, such as education, may also find the course useful.

1. To understand performance measurement frameworks and models that are currently available across the health care system (what to measure and why).
2. To describe several different methods for identifying, selecting and validating specific types of performance measures (how to measure - soundness, relevance).
3. To become familiar with emerging issues in the calculation, reporting, and uptake of individual components of performance measurement frameworks by varying stakeholder groups (appropriateness, feasibility, and relevance of measures and frameworks). 

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Description:
One of the aims of knowledge translation is to ensure that research findings, synthesized into "evidence-based knowledge," are taken up in practice; that is, used to change behaviour. Research funding agencies in Canada have put increasing emphasis on the use of research results in the practice of policy makers, managers, and practitioners. For example, "knowledge translation" is a focus of the Canadian Institutes of Health Research (CIHR), the Canadian Health Services Research Foundation (CHSRF) refers to "knowledge exchange," and the Social Sciences and Humanities Research Council (SSHRC) has used the term "knowledge mobilization." But what counts as knowledge? How is it translated, exchanged, taken up, or used? What role do practice and context play? Academic disciplines can vary markedly in their approaches to these questions depending on their theoretical lenses

The goal of this course is to highlight relationships and conflicts between different conceptual and theoretical approaches to knowledge translation. These include, for example, diffusion of innovation, science- or knowledge- push and user-pull models, evidence-based practice, and social marketing. We will compare and contrast knowledge translation with information behaviour theories and information use in context. To open a window on the theoretical underpinnings of the research, we will compare metaphors, definitions, language, and assumptions. We will also explore the linkages with several topics related to knowledge translation, including continuing professional development, quality improvement, organizational learning, and knowledge management.

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

1. explain and compare various theories and conceptual frameworks related to knowledge translation/transfer/exchange
2. understand the linkages between knowledge translation and other related topics such as information behaviour, quality improvement, and organizational learning
3. critically analyze assumptions underlying the approaches taken in research related to knowledge translation/transfer/exchange
   

Evaluation:

All assignments are individual assignments. Letter grades will be assigned.

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• To introduce learners to different types of economic evaluations.
• To acquaint learners with the approaches and viewpoints that applied health economists bring to health services research.
• To apply economic evaluation techniques to important contemporary issues in Canadian health services research and decision-making.

Description:
This course will provide learners with a comprehensive working knowledge of implementation science. Also known as knowledge translation, this subject focuses on the use of tools and strategies to enhance research utilization by clinicians, managers and policy-makers through understanding of the complex factors that can influence health professional practice and outcomes. This knowledge is relevant to guideline implementers, continuing education planners, practicing clinicians, health care managers, and health services researchers. The course will review how educational, social, patient, organizational, incentive and embedded approaches and interventions can be applied to close the gap between best evidence and practice.

• Explain the meaning of implementation science/knowledge translation

• Identify and explain various theories underlying implementation science/knowledge translation

• Describe the influence of multiple factors on the utilization of knowledge, practice and technology

• Discuss the applicability of various knowledge translation strategies

• Design a quality improvement program or research study involving a knowledge translation approach or intervention

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• To introduce learners to regression as a technique for creating cost-effectiveness estimates.
• To introduce learners to regression as a technique for handling uncertainty in cost-effectiveness analysis.
• To acquaint learners with advanced techniques from regression that can be applied to cost-effectiveness analysis.

Description:
This course will help students to understand and take an informed view about broad health care policy issues. It will introduce important ethical and economic theories relevant and apply them to health care policy decision making, implementation and evaluation. The chief objective is to equip students with sufficient knowledge and confidence in applying it to participate in discussions and debates in the formulation, implementation and evaluation of contemporary health care policy. Participants will be encouraged to explore the interactions between normative and positive approaches, and between quantitative and qualitative approaches, to health care policy. In class, students will develop critical analytical skills, and will be encouraged to indentify the organizational and managerial implications of (contentious) policy issues, and to anticipate the real world implications of implementing policy change.

• detect bunk (bad arguments, special pleading, careless theory, spurious empirics, …)
• identify and search out materials that are relevant in assessing the merits (or otherwise) of a contentious ‘case’
• evaluate evidence for its technical quality, completeness and relevance
• integrate empirical evidence with value judgments and other kinds of judgment
• summarize the principal issues entailed in a debate
• define key concepts with rigour
• understand key theories thoroughly
• give an even-handed account of the pros and cons of a ‘case’
• reach conclusions (including the conclusion that there is no conclusion)
• criticize an argument stoutly (but without giving offence)
• defend an argument stoutly (but without giving offence)
• identify the organizational and managerial implications of a debated issue and develop a 'can do' approach to implementing ideas

HSR1001H or any other introductory level qualitative methods course at the graduate level.
Note:  Instructor permission required. No auditors. 50% of places reserved for OTC students.

Description:
This course will provide intermediate level instruction in the use of qualitative methods in health services research, clinical research, and policy research and is intended as part of a suite of qualitative methodology courses available to IHPME students.  Students who are in the initial stages of designing and conducting their thesis research will be exposed to intense instruction related to issues in field research, including: study design; data collection; analysis; and writing. Students will be expected to come to class prepared to actively engage in group discussions and to discuss their own thesis work.  Students who complete this course will be able to begin conducting qualitative research.

Objectives:

After completing this course, students will:

• Be able to choose and apply the various philosophical foundations, traditions, and methods grouped under the rubric of "qualitative research" and appreciate the complexity of doing qualitative research
• Have experience with and able to apply the main techniques used for gathering qualitative data
• Have experience with and be able to apply the different analytic strategies used in qualitative research, including coding and development of themes
• Have experience with and be able to write up the results of a qualitative study

• To introduce participants to theoretical and empirical research conducted internationally in health economics.
• To acquaint participants with major public policy issues in the field of health that have attracted the attention of health economists.
• To develop analytic skills so that participants will be able to read and critically evaluate theoretical and policy research in health economics.

1. To provide students with an understanding of key conceptual and methodological issues related to assessing the validity of measures used in health services research.
• At the end of the course, the students should be able to assess the validity of measures used in health services research and to apply the principles of validation to the measures used in their own research.
  
2. To provide students with an overview of issues related to the validity of observational designs in health services research.
• At the end of the course, the students should be able to assess the validity of studies that use observational methods and to apply principles for designing valid observational studies to their research.

Prerequisite:
Prerequisites include an understanding of basic research design and statistics including regression techniques. Knowledge and experience with clinical patient care as well as familiarity with existing data sources are an asset, but are not prerequisites for the course.

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• 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.

Students should be familiar with such basic concepts as:

• 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:
Health systems must attempt to align supply and demand within a context of constrained resources, a growing private sector, increased presence of multinational institutions, and interdependent international economies. Low and middle-income countries must often deal with like childhood and infectious diseases, and simultaneously address the rise of chronic disease due to an aging population and increasing urbanization. Organizations in these areas are pioneering frugal innovations to address growing needs with limited means. There is increasing interest in using evidence-informed decision making within health systems to improve accountability, assess performance and ensure value on investment. Health reform strategies include introducing universal health insurance, decentralization, and regulating the private sector.  Understanding the impact of these efforts requires frameworks to evaluate the performance of health systems and institutions. Health services research offers an approach to analyzing health systems and organizations’ structures and processes to improve the quality and efficiency of the services they provide. Studying health services management in low and middle-income settings fosters a broad and innovative perspective on health service delivery, policy and research.

• To provide an introduction to the global context, international organizations and developing-country health systems;
• To facilitate the application of health service research to international health issues;
• To learn about important issues related to the management of health services in low and middle income country settings;
• To develop analytical skills focused on equity and performance measurement; and
• To allow for an in-depth investigation into an area of health services management of your choice.

• To introduce priority setting (resource allocation) and different approaches and perspectives to priority setting, including traditional disciplinary perspectives. 
• To examine different ethical issues in priority setting and introduce 'accountability for reasonableness' as a priority setting framework for health care institutions
• To examine the most recent cutting-edge research and/or practice improvements.
• To develop and present a case study of priority setting in learner's own context

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Description:
This course is designed to prepare students in the following areas: analysis of variance for one-way and multiway data for fixed, mixed and random effects; repeated measures analysis of variance; analysis of covariance; linear and multiple regression; logistic regression factor analysis; and structural equation modeling (introduction).

• Demonstrate an understanding  (both conceptual and practical) of the analysis approaches covered  in this course;
• Identify appropriate analysis approach(es) to address specific research questions;
• Identify appropriate analysis approach(es) to use with data that has already been collected;
• Use of the computer program SPSS for data management, statistical exploration and analysis, and understanding and explaining results;
• Present analysis results in APA format.

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Description:
This seminar introduces dominant theories developed to pursue the study of organizations. This is a survey course intended to assist students in becoming conversant with contemporary frameworks for analyzing organizations at the meso and macro levels. The seminar offers students an opportunity to familiarize themselves with the dominant theories in organizational behaviour that are pertinent to the study of issues in the health services organizations including organizational learning, innovation and knowledge utilization, organization design, interorganizational relationships, decision making, team performance, and organizational performance. The last two sessions are allocated to student presentations, where students present a research idea and related research question(s) that are motivated using theory reviewed in the course.

Objectives:

1. Conversance with dominant theories of organizational behaviour and their relevance to the study of issues in health services organizations;
2. Ability to critically analyze a research article that uses as its theoretical framework one of the theories discussed in seminar;
3. Ability to develop a viable research question(s) that is motivated and explored using one or more of the theories discussed in seminar
   
   

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Description:
This seminar course is for doctoral and advanced masters students who are using qualitative approaches in their dissertation/thesis research. While working on material from their own research or for their proposals, students will explore a range of topics such as:

• The epistemological assumptions underlying their methodologies (such as grounded theory, discourse analysis, ethnography, for example).
• Will/does your methods description match what you actually do and produce?
• Understanding the implications of methodology and methods choices
• Reflexivity and reflection – what do these terms imply for you as researcher?
• Managing data (e.g., transcription challenges, using qualitative analysis software)
• Analysis (e.g., memoing and writing; mapping concepts and relationships with diagrams)
• Theorizing: interplay between theory and analysis; building theory.
• The qualitative dissertation.

Part of Essentials of Qualitative Research (EQR) Course Series.
 

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

1. Explain and compare the theoretical and conceptual underpinnings of various qualitative methodologies;
2. Understand the linkages between methodologies and methods choices;
3. Critically analyze approaches used in qualitative health services research.
   

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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. This course is targeted at research stream students.
 

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.

• Draw upon and integrate the research theories and methods used in  a variety of disciplines to define a research question and plan a health services research project;
• Develop a conceptual framework for a research study and use it as the basis for a study design;
• Understand the application of quantitative and qualitative methods used in health services research;
• Demonstrate the analytic skills required to critically read and evaluate the health services research literature;
• Develop and defend a research question, conceptual framework and methodology that addresses an important health services research question.

• Class facilitation
• Literature review
• Development of conceptual framework
• Poster presenting study justification, conceptual framework, study design, and study methods

Evaluation - Winter Term (HAD7001H-S4):

• Class facilitation
• Critical appraisal of a research paper
• Draft research proposal (paper & presentation)

1. To ensure familiarity and understanding of health care/health services research conceptual frameworks and methodologies.
2. To be able to evaluate and critique a research conceptual framework and research methodology.
3. To be able to select and apply an appropriate research conceptual framework and methodology to any health services research question.

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1. Undertake a comprehensive review of the key concepts and theories from the management and organizational sciences literature which have been applied, or have viable application potential, to management in the health services industry,
2. Identify and critically analyze the strengths and weakness of varying research traditions in health services management research,
3. Critically assess the strengths and weaknesses of varying methodologies used to study managerial and organizational issues in health services management and the general organizational literature, and
4. Prepare the student to formulate and clearly articulate relevant, topical research questions and to develop viable research designs/plans by which to pursue them.

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Description:
The health policy comprehensive course is the capstone course in the series of 3 health policy courses for PhD students in IHPME. The comprehensive course is primarily intended to capture the 'breadth' dimension of the field, and to complement the 'depth' expected in the thesis. This is not a 'taught' course. Students are expected to lead discussion of the readings with the course instructor serving as a resource for the class.

The comprehensive course also provides students with the opportunity to participate in HAD5774H, "Comparative Health Care Systems" – a 5-session course for professional Master’s students. The study of comparative policy throws local health system characteristics into sharp relief, and is an opportune way to become more familiar with health policy issues in Canada, and concepts and theories in health policy studies.

The comprehensive examination provides the opportunity for students to demonstrate their competence in the field of health policy. Specifically, the student is expected to demonstrate:

• A comprehensive understanding of the conceptual and theoretical issues relevant to health policy (including appropriate citations to the literature covered)
• A developed ability to apply these concepts and theories to topical issues in health policy
• An ability to present ideas clearly and cogently

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Description:
This course is designed to provide an introduction to econometric methods. That is, the basic principles of model development and testing that underlie much of applied health economics and health services research. The starting point is the fact that a great number of possible data generating processes yield very similar looking data series. The course deals with how to determine which data generating process, from among the range of possible ones, has actually generated the data you are working with. To that end, the course deals with application of statistical tests and procedures in the context of distinguishing between models. It is therefore assumed that students have a basic training in statistics.

Description:
This seminar course is designed for graduate students in the Institute of Health Policy, Management and Evaluation and perhaps other students at the University of Toronto who have an interest in examining the use of economic concepts as they apply to real health care problems in a hospitalized setting, i.e. the front line (see Incorporating Economic Reality Into Medical Education: Sessions, Samuel Y., MD, JD; Detsky, Allan S., MD, PhD. (JAMA, September 15, 2010-Vol 304, No.11). The course will consist of seven core sections that illustrate health care problems and the use of economic thinking in solving those problems. Micro economic theory will be used as a platform. Students will be expected to participate in all of the sessions and to take one patient or administrative scenario and work it up as an economic problem. They will use this conceptual framework to develop both a paper and an oral presentation. Grade will be determined by class participation, oral and written presentations. All sessions will be run by a single faculty member, Allan Detsky (M.D., Ph.D. Economics), Professor of Health Policy, Management and Evaluation, and Medicine.  

Description:
The growing focus on learning and accountability in Canada and internationally has resulted in an increasing need for evaluation approaches to understand and assess if policies work, how they work, and what can be done in planning and implementing policies to make them work.  Given the complexity of some of the health policies, the designs and approaches required to evaluate some of the policies need to go beyond standard clinical trials and often will involve the evaluator working with the policymakers and program planners right at the formulation of the policy and program. This class will focus on an evaluation of a variety of complex policy and programmatic interventions, all of which have the ambition of improving health outcomes.

Topics to be covered in this class include: the role of program theory and why we need to think theoretically about complex interventions; types of evaluation approaches and how they respond to complexity (approaches will include realist evaluation and developmental evaluation); types of threats to validity in evaluation design including internal and external validity ; varieties of evaluation design including experimental and quasi-experimental designs; and the relationships between program theory, threats to validity and evaluation design. 

Objective:
At the end of the course, for a given intervention, students will be able to design and execute an evaluation that includes consideration of key evaluation questions; is appropriate to the program theory of the intervention; addresses key threats to design validity; and addresses policymaker and practitioner perspectives.

Description:
This course will provide an introduction to the use of qualitative methods in health services research, clinical research, and policy research.  Students will be introduced to philosophical foundations, qualitative approaches and methods, and discover their utility for framing and answering health services research questions.  Single modules will be devoted to philosophical foundations, qualitative approaches, data collection, study design, research ethics, and critical appraisal.  Students will be expected to come to class prepared to actively engage in group discussions.  Students who complete this course will have built a solid foundation in their understanding of qualitative methods, but should not expect to conduct high quality research without further study and practice.

This is a seminar course. Each student will be responsible for presenting the readings for one class. Topic selection will occur during the first class.

• Understand the heterogeneity of philosophical foundations, approaches, and methods grouped under the rubric of “qualitative research” and appreciate the complexity of doing qualitative research
• Be familiar with the main techniques used for gathering qualitative data
• Be familiar with the different analytic strategies used in qualitative research
• Be familiar with the concept of critical appraisal in qualitative research
• Develop skills in writing a qualitative protocol for a research project, including submission for ethical approval

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Description:
In most western countries, contemporary health care is spatially dispersed and/or technologically mediated. Rapidly evolving technological and clinical advances together with fiscal challenges continue to transform how and where health care is provided and received. These developments have philosophical, social, psychological, political, clinical and scientific implications that remain to be fully understood. In this course, we grapple with a subset of these implications by focusing on the significance of the concept of "place" in health care scholarship.

Reflecting the goals of the HCTP Program, the course draws from the health and social sciences, the humanities and the arts. Using exemplars as points of departure, seminars are led by professors and post doctoral fellows from different disciplines/professions. Dominant lines of scholarship are reviewed to illuminate current approaches to the student of four predominant places where health care currently occurs: hospitals/long-term care facilities; homes; neighbourhoods/ communities; and cyberspace. Films, internet sites and field trips augment traditional educational resources. The course aims to foster the development of innovative approaches to research and scholarship in a supportive but challenging transdisciplinary milieu. Insights are gained through respectful dissent and communication ruptures as well as through consensus building and the acquisition of new knowledge.

1. understand how health care settings and sites are conceptualized, represented and/or studied by humanists, social scientists and health professionals;
2. be able to frame pertinent issues about the relationships among health care settings, technologies, and the well-being of providers and/or recipients;
3. have the skills needed to use different types of knowledge to engage in place sensitive health care scholarship;
4. understand the challenges and rewards associated with transdisciplinary approaches to health care scholarship.

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Description:
This course is designed to expose trainees to knowledge translation issues in the area of home and community care.  Participants produce a quarterly digest for decisions makers involved in planning health service provision in the community. Participants select policy and program relevant research and translate it into an accessible format for decision makers.  The course is designed to teach academic trainees how to disseminate research findings to a broad audience of policy decision makers.  Over 70 international and Canadian journals from several disciplines are reviewed.

Evaluation: 
There are four components to the evaluation: first, participants will attend and engage in active discussion demonstrating knowledge and understanding of the articles for potential inclusion in the quarterly digest (20%); second, participants will select, discuss and write articles for potential inclusion in each quarterly issue (20%); third, participants will produce a headline, summary and structured abstract as 1st or 2nd reviewer for each issue of the digest (20%); and finally, each participant will take on the editorial leadership for at least one issue of the digest (40%).

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