Case Example

Case Example #1

The public health nurse works as part of a team at the local health centre in a small Aboriginal community. The primary care provider in this small community notices an increase in ear infections among infants. These babies are all bottle fed and well above their optimal weight percentile for their age.

Knowing that breast feeding can be a protective factor, the primary care provider brings her concern about few babies being breast fed to the monthly team meeting. Births occur in a baby friendly hospital in a neighbouring community about 100 km. away.

The public health nurse confirms that few babies are still breast fed when seen for their two month immunization. When she asks mothers what made them give up breastfeeding, they say that their babies were fussy and they feared that they weren’t getting enough breast milk. There seems to be a lack of support for breastfeeding in the community.

They decide to collaborate and meet with the local health and wellness committee to share their concerns, and inform about the importance of breastfeeding. An additional important strategy was to engage the community, in particular, the older respected women of the community, to design and develop a community-driven plan to increase the length of time infants are breastfeed in the community.

Related: Shared Values, Beliefs and Attitude 
 Related: Effective Communication
 Related: Collaborative Approaches to Programs and Service Delivery
Related: Strategic Coordination and Communication Mechanisms between Partners

Case Example #2

Health Quality Ontario (HQO) is an independent government agency, created under the Commitment to the Future of Medicare Act on September 12, 2005.

On June 8, 2010, the Excellent Care for All Act was passed in the legislature expanding Health Quality Ontario’s role and mandate. The functions of Health Quality Ontario are:

• To monitor and report to the people of Ontario on access to publicly funded health services; health human resources in publicly funded health services; consumer and population health status; and health system outcomes;
• To support continuous quality improvement;
• To promote health care that is supported by the best available scientific evidence;
• Making recommendations to health care organizations and other entities on standards of care in the health system, respecting clinical practice guidelines and protocols;
• Ensuring recommendations include the Government of Ontario’s provision of funding for health care services and medical devices.

Visit to explore more information on the Excellent Care for All Act, 2010,
Visit to explore more information on Health Quality Ontario.

Source: Excellent Care for All Act, 2010. Health Quality Ontario, 2013.

Systemic level decision-making framework
One example of the use of a decision-making framework in Ontario is seen by the Ontario Health Technology Advisory Committee (OHTAC). This is a subcommittee of the Health Quality Ontario (HQO) Board. The committee makes recommendations about the “uptake, diffusion, distribution, or removal of health interventions in Ontario” (Retrieved from:http://www.hqontario.ca/evidence/evidence-process/about-the-ontario-health-technology-advisory-committee). Their recommendations are guided by a decision determinants framework, which provides criteria. These include clinical benefits offered by a health intervention, value for money, societal and ethical considerations, and economic and organizational feasibility. This framework is currently under review. To explore more information on this decision-making framework.

Case Example #3

Another example of a decision-making tool in action is Ontario’s Ministry of Health and Long-Term Care Health Equity Impact Assessment (HEIA) Tool.This tool provides a framework for intersectoral decision making. The workbook introduction provides the following description:

“Health Equity Impact Assessment (HEIA) has broad application and is intended for use by organizations and health service providers who have an impact on the health of Ontarians. Thus, HEIA is not only intended for use by organizations across the Ontario health care system, such as the Ministry of Health and Long-Term Care (MOHLTC), Local Health Integration Networks (LHINs), Public Health Units (PHUs), and health service providers; but also by organizations outside the health care system whose work can have an impact on health outcomes.”

Ministry of Health and Long-Term Care, 2012, Health Equity Impact Assessment Workbook, p. 7 www.health.gov.on.ca/en/pro/programs/heia/docs/workbook.pdf