The Senior Citizens’ Consumer Alliance for Long-Term Care’s report on the Ontario New Democratic government’s health care reforms, released in July, documents what many people suspected: the much-needed reforms are mismanaged and dangerously close to chaos.
The report compares the present crisis to the failed attempt in the seventies to move psychiatric care out of institutions and into communities by closing 1,000 beds. Patients were left with inadequate community services, resulting in many homeless and jailed former patients. The alliance fears seniors – the biggest users of health services – could fall victim to reforms in the same way.
According to many health care reformers, Bob Rae’s government seems to have lost control of the issue, resulting in massive job losses and a worrying breakdown in services.
The NDP’s health care document “Goals and Strategic Priorities” reads like a wish list for progressive health care reformers, ranging from disease prevention programmes to improved access to health care for minorities, natives and women. To many, the debate isn’t over these goals but how they are achieved and what the government’s true motives are. Under pressure from big business and its lobby groups, the NDP is desperate to save money where it can, and as Ontario Health Minister Francis Lankin says, “not disrupt or destroy business confidence.”
Emily Phillips, president of the Registered Nurses’ Association of Ontario, is blunt: “The NDP’s plans sound good on paper, but they can’t give a budget or direct plan on how they hope to carry out reforms. They are going about things backward. They cut hospital beds and lay off staff without having community health care services ready.”
The national trend in health care is to deinstitutionalize and bring services to homes and communities. It is hoped that emphasizing prevention and healthy living will significantly reduce the need for hospitals, expensive drugs, surgery and high-tech equipment. The NDP has pledged to spend $647 million to reform long-term care services by 1997 – creating services that will allow seniors to stay in their own homes.
Problem is, the NDP has embarked on radical down-sizing of hospitals – closing beds and laying off thousands of health care workers – right now. Lankin claims that in the worst-case scenario, layoffs this year wouldn’t exceed 2,000, but the Ontario Hospital Association claims 14,000 jobs are in jeopardy. Phillips believes it will be hard to estimate job loss: “It is hard to even record the number of nursing jobs lost, because for every full-time job cut many part-time and relief positions go with it.”
Chaos will result when people who depend on hospitals have nowhere to turn but the inadequate community health care services, which are uneven and narrowly focussed. To make things worse, the same funding restrictions placed on hospitals have also hit the services that are supposed to save the day.
“I haven’t heard of any change in the quality of care. It is just too early,” says Phillips about the effect of layoffs on hospitals. “Right now the nurses are picking up the slack, but soon they will burn out. I don’t feel confident this government has the management skills to do this. I’d like to see a plan in place before moving people into the community.”
Training for laid-off hospital workers will have to come from the $160-million allocated for retraining workers laid off by cities, universities and school boards – all of whom are coping with record-low budget increases.
In February, Lankin appealed to hospitals to do everything in their power to make layoffs painless and to trim doctors and administrators first. But the NDP has yet to pass legislation that would bind hospital boards to make the right cuts. The boards operate at arm’s length from government and continue to make unnecessary decisions, ignoring the NDP’s moral pleas.
Rosanna Pellizzari, a member of the Medical Reform Group and chair of the Ontario Association of Health Centres, wants better community accountability for hospitals before they lay off staff and cut services: “Sometimes it makes sense to bring people to hospitals. Planning must be at the community level and open and democratic. Health care workers, who are mostly women, should not be scapegoated for financial problems. Doctors and management should go first. Physicians experience very little unemployment.”
Carol Kushner, co-author of the book Second Opinion, which evaluates the country’s medical system, sees chaos resulting from the conflicting agendas of governments and health care reformers: “Will the tremendous contradictions of institutions be transferred to the community? The federal government is rapidly draining money from medicare while provincial governments are having a hard time. This hasn’t produced extra funds for re-allocating services to the community – which was recommended by reformers. You have to ask: who is going to fall through the cracks?”
In 2001 I was hired to project manage and deliver a Child Health Web Portal for the prestigious Great Ormond Street Children’s Hospital NHS Trust (GOSH)/Institute of Child Health (ICH) based in London, UK.
The project was intended to lead on innovation at the institutions and in the wider National Health Service (NHS) and was delivered in three phases. Screen grabs can be viewed below:
From the start, the project begged the question: Could we take a complex (and complicated) mandate and successfully achieve it in just two years? All under great public and media scrutiny (London being a world centre for media)? And how do you innovate for the 21st century in a major health care institution and build on its already high reputation?
Britain’s best-loved children’s hospital and charity, Great Ormond Street Hospital for Children NHS Trust (GOSH), contracted me to lead a two-year project to modernise the hospital’s web presence and take its brand into the 21st century. GOSH is both Britain’s first children’s hospital and a pioneering child health institution (along with its partner the Institute for Child Health). The hospital’s outstanding reputation meant the project was carried out under intense public, media and professional scrutiny, and required a keen awareness of new media developments and the needs of the hospital’s patients, their families and the public. It drew on an extensive public consultation and the NHS Modernisation Plan and the Information for Health strategy – which had identified strong demand for services and information to be made available online – to develop this innovative online offering. The NHS had also set the goal of having 25 per cent of all its services accessible via the web.
From the start, the project represented a new phase in how the institutions communicated. An announcement in PR Week in April 2001 acknowledged this, declaring the role will deal “with what is increasingly becoming an important part of the press office and the hospital”. Prior to beginning the two-year project in 2001, the existing website was an amateurish affair and not suitable for an internationally renowned centre for paediatric treatment, training and research.
The UK had become out of step with wider web developments at that time and had to do a lot of catching up. But there was a ready audience for better web content already established in the country. By 2001, data showed 3 million children in the UK were using the Internet and 33 million UK citizens could access it through work, school or home.
By 2001, the Internet offered an estimated 100,000 health-related websites (most based in the United States, leaving a gap for high-quality information based on UK research and experience). Trust was key and this was a crucial part of the content strategy that was developed.
As lead staff member for the website, I was in charge of recruiting and managing staff and suppliers, liaising with stakeholders inside and outside the organisations, planning work and seeking opportunities and partnerships.
The project was developed in three, distinct phases. Screen grabs from these phases are available for download and evaluation. They also include web traffic statistics. This unique snapshot of a complex project as it unfolded, should prove useful for other e-health practitioners.
As an innovator, the project became a catalyst for numerous online and offline initiatives across the institutions. The website made enormous strides, winning a number of national and international awards and leapfrogging to become one of the best NHS-linked sites in the UK. Areas radically improved included the design and navigation, patient information for families, press office, and the development and launch of the award-winning children’s website.
Each stage was transparently communicated and accompanied by high-profile publicity campaigns: a necessity because the hospital relies heavily on public trust and funding to function.
The first phase involved getting buy-in on a new design vision, assembling a team, extensive work on migrating the very large legacy website into the new template, and exciting colleagues on the potential of the new child health portal vision. It was launched in September 2001.
Ask Dr Jane Collins, a regular column written by the Chief Executive Dr. Jane Collins for The Times newspaper, was one of the more popular features of the child health portal. The portal was also directly connected to the NHS Direct service with its extensive online health encyclopedia.
As another example, the hospital’s 150th birthday celebration on 14th February 2002, attended by Her Majesty the Queen (and celebrities, including Madonna), was accompanied by an online interactive history prepared by the project and was used to inform the wider public about the child health portal.
Phase two involved the launching of new content developed by some of the world’s top child health experts and scientists, substantial new resources for sick children and their families, an online awareness-raising campaign to drive traffic to the health portal as a trusted and reliable resource, plus a wider media campaign. Based on user experience testing and user feedback, changes were made to the design and content structure to make the portal more user-friendly and to follow best practice in web design at that time.
The overall child health portal also gave birth to a highly successful new resource, the award-winning Children First website in May 2002. This resource was a year in development and was calibrated by age to provide relevant resources to guide children through the hospital experience. It used high-quality animation and partnered with BBCi and BBC Science to create resources that would resonate with children and youth. It included high-profile elements such as the Write4GOSH children’s writing prize, attracting entries from around the world, with winners receiving prizes from Cherie Booth QC, Dannii Minogue and children’s writer Jacqueline Wilson.
Children First attracted an average of 700,000 visitors each month with over 800 children in its first year contributing to the site. It addressed a gap in the online marketplace for health resources written for children rather than for their parents and families. It also gave birth to its own project: The Virtual Children’s Hospital (VCH). Funded by the PPP Foundation in August 2002, it worked with a team of psychologists to meet the social, psychological and information needs of ill children.
In March 2003 the Commission for Health Improvement (CHI) in its review and assessment found, in answer to the question “What, if anything, did CHI find that the rest of the NHS can learn from?” at the hospital, it was the child health portal, because “The trust’s website has different sections for children and families as well as for health professionals. The website also has sections for children of different ages and a broad range of information leaflets is available to download. The website has 3.5 million hits per month.”
In 2003, the UK’s Guardian newspaper called the Children First website one of the “three most admired websites in the UK public and voluntary sectors,” and a UK government assessment called the overall GOSH child health web portal a role model for the NHS. Children First also won the prestigious Cable and Wireless Childnet Award that year as well. And was short-listed for the New Stateman’s New Media Awards.
In 2006, The Times of London called Children First the Top Child Health Website in its Wellbeing on the Web: The Best Portals survey (November 11, 2006).
Phase three saw online traffic growing at a steady clip, the portal gaining accolades, awards and positive reviews; it also helped the hospital to gain the highest rating in a government review (5*), and Children First was awarded significant further funding so it could expand its resources. The award-winning team also re-developed thewww.gosh.org charity website (one of the highest profile charity brands in the UK) and launched it in 2003 as well.
2001: Initial design vision articulated and team assembled. First phase of content creation and ‘soft launch’ of portal in September 2001. Begin experiments with new graphic design, including an online interactive Christmas advent calendar with health tips.
2002: Launch new content during the hospital’s 150th anniversary celebrations; begin development work on Children First content. Partnering with BBCi and BBC Science to improve quality of child and youth resources. Significant new content is launched throughout the year as the portal sees month-on-month growth in web traffic. Awarding of further funding for Children First and the Virtual Children’s Hospital.
2003: Winning of Childnet Award; launch of new GOSH Charity website. Record web traffic to the website.
“As a parent, I recognise how important it is to help your child understand all that they can about their stay in hospital and their care and treatment. Time spent in hospital can often be a very frightening experience. Making sure that your child has helpful, easy to read information will make a significant difference to their time in hospital.
I am sure that this website will prove very useful for children and their families.” Prime Minister Tony Blair, May 2002
“A highly attractive website written by and with children at Britain’s biggest specialist hospital for children. The site is carefully segmented for different age groups and provides a powerful platform on which children can reach out from the confines of their hospital wards, share their experiences and learn about a range of medical issues as well as have access to fun interactive resources.” Childnet Award 2003
“I am glad you mentioned the web site. If you can access it and haven’t recently please have a look. It has vastly improved and both David Latchman and I (it is a joint site with ICH) are very pleased.” Dr Jane Collins, Chief Exec’s Corner, Roundabout newsletter, February 2002
“I never thought that GOSHKids would be so valuable to the hospital or, more importantly, to children and young people attending the hospital or simply interested in health matters. I think that this reflects my age, though!
“Many of us over 30, even if we use the internet ourselves, are surprised how much children and young people use it both as a source of information and for entertainment.
“Even quite young children are using it routinely now and as an increasing number of families have access to it, either at home and/or at school or work, presumably more and more will do so.
“There are over 42,000 hits per day (1,260,000 a month) on our GOSHKids website already. Of course, part of the success of the website is down to its design and content. I would like to take this opportunity to congratulate Gary Loach, David South and the whole team who have worked so hard to make it successful.” Dr Jane Collins, Chief Exec’s Corner, Roundabout newsletter, June 2003
“The GOSH/ICH web site to date has been a notable success. Not only has it met a majority of its objectives as delineated in the PIN report of 2000 and achieved recognition as ‘exemplary’ among NHS resources, but it has also generated a number of spin-off projects, including Children First (as a successor to GOSHKids) and The Virtual Children’s Hospital.
“It has moved from providing a poor representation of the organisations, to above average for corporate web resources, and compares highly favourably with those of other NHS sites and departments. The most notable success lies in the resource it now provided for the public, especially GOSHKids.
“In a context in which less than 25% of all projects realise even 50% of their benefits, the satisfaction of 75% of the original objectives set out in the PIN report must rank as a significant achievement.” Website Project Audit by Passmasters Limited, 17 April 2003
“Great Ormond Street Hospital has launched this health site targeted specifically at childen, with a separate version aimed at young teenagers. The site aims to give young ‘uns information about health, illness and treatment in an easily digestable, non-threatening manner.” Internet Magazine, July 2002
“… it’s a good site and not just for those about to go into the hospital.” New Media Age, 20 June 2002
“The project was instrumental in pulling together a number of key strategies (including the NHS’s Modernisation Plan, and its Information for Health Strategy), and acting as a catalyst for numerous online and offline initiatives. Critical to these strategies is the need to provide information and services online and in an accessible way. The aim has not only been about serving the specific needs of the institutions, but also to become a broader child health portal.
“The website in 2001 was an amateurish affair and a disgrace to an internationally renowned centre for paediatric treatment, training and research. Run largely from the Research Office it was focused on one particular audience, uninspiring in design, reactive in updating and made little use of the potential of the internet. We needed someone to take it forward …
“David [South] was lead staff member for the website, recruiting and managing staff and suppliers, liaising with stakeholders inside and outside the organisations, planning work and seeking opportunities and partnerships. It is fair to say that the site made enormous strides under his leadership, winning a number of national and international awards, and leapfrogging to become one of the best NHS-linked sites in the UK.
“A number of areas were drastically improved, including design and navigation, patient information for families, press material, and the award-winning children’s site, which is now an international project with many different partners. David [South] project managed many projects in this time including linked sites for London IDEAS Genetics Knowledge Park, and the hospital charity site …” Stephen Cox, Chief Press Officer, Great Ormond Street Hospital for Children NHS Trust and the Institute of Child Health
took public consultation and consultant’s report and crafted and developed a strategy to implement the GOSH Child Health Web Portal
assembled team across two institutions
set clear milestones and brought project management methodology previously deployed with the United Nations
led on teaching new ways of project management for results
took GOSH brand forward for the digital age
advised colleagues on digital publishing and design
awarded additional funding
role model for NHS and government/charity sector. Awarded five stars in government review
launched major milestones with well-known figures, including Her Majesty the Queen, Madonna, and pop stars
significant media coverage of project
attracted funding not only for the GOSH Child Health Portal but also for other projects at the institutions
grew web traffic month-on-month, becoming one of the top online child health resources
website cited in many other resources. One of the goals of the project was to increase access to high-quality child health resources and to have them cited in books etc.
The Great Ormond Street Hospital Manual of Children’s Nursing Practices by Susan Macqueen, Elizabeth Bruce and Faith Gibson, John Wiley & Sons, 2012
Help! My Child’s in Hospital by Becky Wauchope, Marbec Family Trust, 2012
Oxford Desk Reference: Nephrology by Jonathan Barratt, Peter Topham and Kevin P.G. Harris, Oxford University Press, 2008
“There is increasing interest in young people’s participation in the design and delivery of health services. But young people’s views are not consistently sought or acknowledged, and they are still often marginalised in healthcare encounters. Drawing on original research and a diverse range of practice examples, Brady explores the potential for inclusive and diverse approaches to young people’s participation in health services from the perspectives of young people, health professionals and other practitioners. She presents a practical new framework, embedded in children’s rights, that shows how young people’s participation can be integrated into services in ways that are meaningful, effective and sustainable.”
In November/December 2000 I worked in Kyiv/Kiev, Ukraine for the United Nations mission on the strategic re-launch of the mission website as a portal, whilst also advising the UN Resident Coordinator/UNDP Resident Representative Douglas Gardner on communications strategy. It was an extraordinary experience on many levels. It was a time when the Internet was fast evolving and required quick thinking and an ability to innovate; it was also a key moment in Ukraine’s history.
But despite those dangers and clear threats from the government of the time, there was a flourishing and inventive Internet and digital economy. The magazine Internet UA (whose editor I enjoyed meeting) gave a great overview of the scene in Ukraine and its creativity. Just as now, the creation of Internet stars who can exploit the medium (in this case sexy videos: a very large online market today) was driving viewers and subscribers. But there was also a vibrant online news media, blogging, commerce and gaming presence as well.
According to ain.ua, the Ukrainian digital economy today is ” … ‘local’ only just figuratively speaking. Ukrainian startups are initially focused on international markets. Product companies are included into international industry ratings. Outsourcing works with clients from all over the world. Global players enter Ukrainian market, opening R&D offices, acquiring and investing into local companies. There are no boundaries.”
It is easy to take digital freedoms for granted now but there was great resistance at the time and, unlike today, many governments were openly hostile to digital technology, online communications and e-commerce.
The UN itself was evolving and embracing the communications and design revolution being driven by digital change. This was the first “dot.com” boom, which had begun in 1997. I had played a key role in pioneering online content for Mongolia (1997-1999) and could bring this experience to Ukraine. In particular, I launched an award-winning web portal for the UN Mongolia mission in 1997 (www.un-mongolia.mn) and also the country’s first web magazine, Ger.
Key content created and launched on the UN Ukraine portal included critical information on the HIV/AIDS crisis in Ukraine, UN Ukraine’s first online magazine to explore perceptions of volunteering and NGOs in the post-communist period, and content preparing for the visit of the UN Secretary-General Kofi Annan, by showing how Ukraine was engaging with global development priorities, for example the eight Millennium Development Goals (MDGs), and bringing together UN agencies and entities into a cohesive web and “One UN” experience.
The power of the Internet and the digital economy to engage people, especially the young, despite living in a country with significant political repression of free speech and even physical intimidation and murder, stuck with me. This work also contributed to laying the foundations for Ukraine’s growing freedoms and greater engagement with Europe.
Southern Innovator was initially launched in 2011 with the goal of – hopefully – inspiring others (just as we had been so inspired by the innovators we contacted and met). The magazine seeks to profile stories, trends, ideas, innovations and innovators overlooked by other media. The magazine grew from the monthly e-newsletter Development Challenges, South-South Solutions published by the United Nations Office for South-South Cooperation (UNOSSC) since 2006. A selection of books and papers citing stories from the magazine are featured below to aid researchers, in particular those interested in health and human development and the role of innovators in international development.
“Innovation is critical to growth and development in Africa. In the context of a continent characterized by fast growing economies as well as an array of socioeconomic challenges, such as high levels of poverty and inequality, innovation in Africa must be understood in an encompassing manner. Africa needs to support the emergence of its own Silicon Valleys, but it must also foster the invention and adoption of cleaner technologies that limit respiratory illnesses, deforestation and combat climate change. This book contains a number of analytical case studies that examine the nature and origins of emerging high-end innovation hubs in Africa. These “hubs” or ecosystems are both understudied and little known inside and outside the continent. With this analysis, the book highlights and draws lessons from some of the most promising and successful innovation cases in Africa today, exploring the key factors driving their successful emergence, growth and future prospects. Relevant for scholars, policymakers, and business leaders, the book provides both inspiration and useful policy advice that can inform strategies and concrete measures to speed up the pace of innovation in Africa today.”
“Research on gated communities is moving away from the hard concept of a ‘gated community’ to the more fluid one of urban gating. The latter allows communities to be viewed through a new lens of soft boundaries, modern communication and networks of influence.
The book, written by an international team of experts, builds on the research of Bagaeen and Uduku’s previous edited publication, Gated Communities (Routledge 2010) and relates recent events to trends in urban research, showing how the discussion has moved from privatised to newly collectivised spaces, which have been the focal point for events such as the Occupy London movement and the Arab Spring.
Communities are now more mobilised and connected than ever, and Beyond Gated Communities shows how neighbourhoods can become part of a global network beyond their own gates. With chapters on Australia, Canada, Europe, South America, Asia, Africa and the Middle East, this is a truly international resource for scholars and students of urban studies interested in this dynamic, growing area of research.”
“The economic, political and social situation in Chile shows a country in transition. Some observers anticipate a broad “reboot” of the nation. While Chile is still seen by many as an example of progress in South America and of developmental potential in the global South, it faces a complex political constellation, particularly in the aftermath of the re-election of Michelle Bachelet. Many wonder how social and institutional innovations can be incepted without interrupting the country’s remarkable success over the past decades.
This book provides an interdisciplinary analysis of Chile’s situation and perspectives. In particular, it addresses the questions:
What is Chile’s real socio-political situation behind the curtains, irrespective of simplifications?
What are the nation’s main opportunities and problems?
What future strategies will be concretely applicable to improve social balance and mitigate ideological divisions?
The result is a provocative examination of a nation in search of identity and its role on the global stage.
Roland Benedikter, Dr., is Research Scholar at the Orfalea Center for Global and International Studies, University of California, Santa Barbara, Senior Research Scholar of the Council on Hemispheric Affairs Washington D.C., Trustee of the Toynbee Prize Foundation Boston and Full Member of the Club of Rome.
Katja Siepmann, MA, is Senior Research Fellow of the Council on Hemispheric Affairs Washington D.C., Member of the German Council on Foreign Relations, and Lecturer at the Faculty of Interdisciplinary Cultural Sciences of the European University Frankfurt/Oder.
The volume features a Foreword by Ned Strong, Executive Director of the David Rockefeller Center for Latin American Studies, Harvard University, and a Preface by Larry Birns, Director of the Council on Hemispheric Affairs, Washington D.C., and Former Senior Public Affairs Officer of the United Nations’ Economic Commission for Latin America (Santiago, Chile).”
“A Sociological Approach to Health Determinants investigates how the social works in determining health and health inequity. Taking a global perspective, the book shines a light on how experiences of health, illness and health care are shaped by a variety of complex social dynamics. Informed primarily by sociology, the book engages with the WHO’s social determinants of health approach and draws on contributions from history, political economy and policy analysis to examine issues such as class, gender, ethnicity and indigeneity, and the impact they have on health. A Sociological Approach to Health Determinants is a comprehensive resource that provides a new perspective on the influence of social structures on health, and how our understanding of the social can ensure improved health outcomes for people all over the globe. Toni Schofield is Associate Professor at the University of Sydney. She specialises in research and teaching in sociology, and public policy and administration.”
New Directions in Children’s and Adolescents’ Information Behavior Research edited by Dania Bilal and Jamshid Beheshti (Emerald Group Publishing: 2014)”This book comprises innovative research on the information behavior of various age groups. It also looks at special populations such as ethnic minorities, indigenous peoples, and users with disabilities. The book presents research and reflections on designing systems that help the new generation cope with a complex knowledge society.
Economy Reports for APEC Economies on demographics, policies & ICT applications for people with Special Needs (Seniors and People with Disabilities), Asia-Pacific Economic Cooperation, APEC Telecommunications and Information Working Group, January 2013
If you would like hard copies of the magazine for distribution, then please contact the United Nations Office for South-South Cooperation: Website:http://ssc.undp.org/content/ssc.html. If you would like to either sponsor an issue of Southern Innovator or place an advertisement in the magazine, then please contact email@example.com.