Faculty of Health Sciences Simon Fraser University

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Faculty of Health SciencesSimon Fraser
University
Non-profit organizations delivering health care
services Executive Directors experiences,
opinions, and needs Rachelle Rebman, Marcy
Cohen, Dr. Craig Janes
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Building Cohesion in Health Care Marcy Cohen,
Jan Taylor, Tim Beachy

• Non-profit organizations delivering health
  care services Executive Directors experiences,
  opinions, and needs

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Introduction

• Procedures

Findings
Conclusion and Recommendations
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Introduction

• Strategy of Inquiry
• Background and relevance to PPH
• Statement of the problem
• The advocacy approach
• Purpose of the study
• The research questions
• Definitions and Delimitations

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Introduction Strategy of Inquiry

• Grounded theory
• The researcher attempts to derive a general,
  abstract theory of a process, action, or
  interaction grounded in the views of the
  participants

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Background and Relevance

• Non-profit organizations are
• Organized
• Private
• Self-governing
• Non-profit-distributing
• Voluntary

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Background and Relevance
180000 non-profit organizations
6.5 million volunteers
5000 health care organizations
3 billion volunteer hours
20-30 billion in volunteer contributions
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Background and Relevance
Non-profit organizations play a key role in all
aspects of the health continuum, including
prevention, promotion, protection, program and
service delivery, and research funding. Public
Health Agency of Canada
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Background and Relevance

• new belief in the efficiencies of competition
• focus on formal bidding processes and short
  term, project based contracts
• requests for proposals are open to for-profit
  organizations
• contracts are non-renewable, subject to
  conditions and audits, revocable

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Introduction Problem Statement

• Provincial government restructuring of health
  care has created some significant challenges for
  non profit health care providers. Health care
  providers are finding it more and more difficult
  to sustain existing services or develop new
  services to meet emergent needs. Across BC,
  non-profit health care providers lack the
  cohesion necessary to promote a strong,
  responsive health care system.

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The Building Cohesion in Health Care Project
was designed to
Introduction Advocacy Approach

• connect community based, non-profit health
  service providers
• to identify common needs
• to find innovative ways to meet those needs

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• my piece of the puzzle

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Introduction Study Purpose

• This qualitative study describes the views of 15
  executive directors of non-profit organizations
  delivering health services in British Columbia.
• The overall purpose of the study was to explore
  the experiences and opinions of the executive
  directors and discover the service needs of the
  non-profit organizations.

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Introduction Research Questions

• What are the experiences of executive directors
  of non-profit organizations that deliver health
  care services in BC?
• What are the opinions of executive directors of
  non-profit organizations that deliver health care
  services in BC?

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Introduction Research Questions

• What services do executive directors say their
  non-profit organizations need?
• What services do executive directors say their
  non-profit organizations do not need?
• What services do executive directors want for
  their organizations?

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Introduction Definitions

• Health Services any service that relates to the
  determinants of health, provided that the
  organization labels the service health related
• Experiences how the organization functions, what
  the organization does, how the organization
  relates to other organizations, clients, and
  communities

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Introduction Definitions

• Opinions beliefs or judgements about
  experiences. Beliefs or judgements about
  non-profit organizations delivering health care
  services in BC. Beliefs or judgements about
  needs
• Needs what the non-profit organization needs to
  thrive or function

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Introduction Delimitations

• Study confined to interviewing Executive
  Directors (12) or senior staff members (3)
• Only non-profit organizations that labelled
  services as health services were included
• Scope limited to qualitative research design
• Exploration confined to three concepts

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Procedures

• Characteristics of qualitative research
• Theory
• Data collection and recording
• Sampling
• Data analysis procedures

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Procedures Qualitative Research
Qualitative inquiry cultivates the most useful
of all human capacitiesthe capacity to
learn from others. Halcolms Law of
Induction
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Procedures Theory

• Data must be allowed to generate propositions
  which keeps a particular framework from becoming
  the container into which the data must be
  poured.
• Lather, 1986, p. 267

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Procedures Data collection

• 15 semi-structured qualitative interviews
• 5 face-to-face interviews
• 10 telephone interviews
• Structured interview guide
• Face-to-face interviews tape-recorded and
  transcribed verbatim
• Telephone interviews recorded with hand written
  notes

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Procedures Sampling

• Purposive sampling moving to snowball sampling
• 4 mental health organizations
• 3 long term care facilities
• 5 community service organizations
• 3 emerging supported housing/supported living
  organizations

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Procedures Data analysis
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Steps to Qualitative Analysis
Procedures Data analysis

• Step One Organizing and Preparing
• Interviews were transcribed from tape recordings
  or hand written notes
• Transcribed interviews were sorted by types of
  services delivered

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Steps to Qualitative Analysis
Procedures Data analysis

• Step Two Noticing Things
• With interviews organized in their service
  groups, read through all the interviews to get a
  general sense of the information and to reflect
  on its overall meaning
• Began to notice things circled phrases and
  words that appeared interesting or pertinent
  open coding

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Steps to Qualitative Analysis
Procedures Data analysis

• Step Three Sorting and Sifting
• After coding three interviews, began to sort and
  shift through codes, looking for types, classes,
  sequences, processes, patterns, or wholes

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Steps to Qualitative Analysis
Procedures Data analysis

• Step Four Thinking about things
• Thought about the patterns I was seeing in the
  data wrote notes to myself and recorded general
  thoughts
• e.g. Even though housing wasnt a question, it
  seems to be coming up a lot. Count how many
  agencies talk about housing

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Steps to Qualitative Analysis
Procedures Data analysis

• Step Five Naming
• Created categories and subcategories that
  explained the data (axial codes)

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Steps to Qualitative Analysis
Procedures Data analysis

• Step Six Categorizing
• Took the coded data and inserted it into the
  categories

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Steps to Qualitative Analysis
Procedures Data analysis

• Step Seven Discovering and Describing
• Coded all my interviews with the previous
  interviews in mind, taking care to notice and
  name new things
• Collected all the emic codes under one category
  and read through them, looking for common themes
  or ideas

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Steps to Qualitative Analysis
Procedures Data analysis

• Step Seven Discovering and Describing
• Found common themes, ideas, concerns, opinions,
  and needs within service types and across service
  types
• Thought about these themes, ideas, concerns,
  opinions, and needs and described them

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Steps to Qualitative Analysis
Procedures Data analysis

• Step Eight Discussion
• Descriptions and themes will be represented in a
  qualitative narrative using quotes to convey the
  findings of the analysis.

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Procedures Data analysis
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Procedures Data analysis

• Protect your analysis by working back and forth
  between the parts and the whole in order not to
  destroy the totality of philosophy as expressed
  by the interviewees
• John Seidel

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Findings

• Domain 1 Relationships with government and
  government funded bodies
• Domain 2 Relationships with clients
• Domain 3 Relationships with other non-profits
• Domain 4 Relationships with communities
• Domain 5 Intra-organizational relationships and
  self-awareness
• Domain 6 Barriers to relationships

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Domain 1 Relationships with Government and
Government Funded Bodies
Not only are we contractors, because thats been
some of the wording that the health authorities
are using with us now, we are partners because we
buy into the whole necessity of these services
and we buy into improving the way that services
are provided and to adding value through adding
other types of services.
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Domain 1 Relationships with Government and
Government Funded Bodies

• Contracts are being turned over every year, but
  really no negotiation.
• The health authority wants to control contract
  terms.

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Domain 1 Relationships with Government and
Government Funded Bodies
Non-profit service providers used to be seen as
partners with the health authorities. The new
health authority attitude is poor and treats
non-profits badly.
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Domain 2 Relationships with clients

• Non-profit organizations are in it for the good
  of people
• Programs are tailor made to meet the persons
  needs...if you need a lot of support, well
  provide a lot, if you need a little, well
  provide a little

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Domain 2 Relationships with clients

• Providing multiple different services allows us
  to care for the whole person
• Not only are the physical needs of a person
  addressed, but also the emotional, relational,
  spiritual, and cultural needs

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Domain 3 Relationships with other non-profits
Networking with other organizations and services
provides clients with well-rounded options and
maximizes community resources We find that
these are our biggest successes when we partner
with other agencies or groups
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Domain 3 Relationships with other non-profits
There are a lot of us who work quite closely
together Developing new services, helping with
donations, sharing goods its a kind of barter
system, sharing services
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Domain 3 Relationships with other non-profits
Sometimes there is competition with other
groups who are also looking for
funding Limited resources and the fight for
money sometimes keep people from sharing
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Domain 3 Relationships with other non-profits
Theres a difference between organizations which
look to trends, find out whos funding what, and
develop programs or services based on funding
probabilities, and organizations which identify
needs and then look for funding to create
programs which answer those needs
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Domain
Domain 4 Relationships with communities
Through close relationships, we are part of the
community The non-profit sector has a much
better grasp on the pulse of the communities they
serve as compared to health regions and other
for-profit organizations
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Domain
Domain 4 Relationships with communities
For non-profit organizations to survive, we
need to be deeply integrated into the
community Volunteers allow non-profit
organizations to continue delivering services in
a financially restraining environment
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Domain
Domain 4 Relationships with communities
Volunteers add an extra component to care and
add extra value Volunteers are essential
because the organization is not funded to provide
everything that defines quality
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Domain
Domain 4 Relationships with communities
And being seen as a value to the community.
Its more than respect really, its an
acknowledgement that theres value to the
services we provide and that we can add value to
every service thats provided in the health care
industry
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Domain 5 Intra-organizational relationships
When the group gets together, we are able to
coordinate care and provide a powerful blend of
services for clients Care providers are all
part of the management team
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Domain 5 Intra-organizational relationships
When people come to us, they dont just get the
services they came for. They also develop
relationships, find support, and become part of
an extended family
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Domain 5 Intra-organizational relationships
Polices and procedures can also be an issue for
non-profit organizations, as many are not
sophisticated enough to think about or develop
policies
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Conclusion and Recommendations

• Interpretation
• Limitations
• Significance of the study
• Expected advocacy effects

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Interpretation

• Non-profit organizations delivering health
  services in British Columbia depend on
  relationships to provide care and ensure service
  capacity.

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Interpretation

• Any advocacy initiatives aimed at non-profit
  organizations must respect the complex interplay
  between these organizations and other entities,
  such as government.

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Interpretation

• Rather than just practical services,
  organizations welcome services that strengthen
  and promote the sector, such as advocacy and
  support for professional development.

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Interpretation

• Taken together, while non-profit organizations
  welcome growth and innovation, any change must be
  sensitive to the relationships on which these
  organizations rely.

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With thanks to...

• Marcy Cohen
• Dr. Craig Janes
• Jan Taylor
• Tim Beachy
• Study interviewees
• The 2005 PPH Cohort