How New Governance Shapes Changes in the Long-Term Care Sector in Ontario, Canada 1 (2015)

ABSTRACTThis paper turns to insights of New Governance in order to explain how law was used to promote innovations in health care governance in Canadian province of Ontario between 2004 and 2012. New Governance refers to a family of approaches that are more flexible and less prescriptive. My research includes review of government documents, legislation and other sources in order to identify changes to regulation and governance. I also draw upon interviews with seven organizations in sector, which were conducted as part of a larger project to help contextualize and explain changes in law. I argue that, while formal legal and regulatory apparatus continue to be used to regulate provision of care and treatment, New Governance approaches represent additional processes and procedures to problem-solve challenges in sector. Law is being used to formalize or strengthen these processes and procedures in order to allow long-term care home residents, families, friends, and workers to participate in problem-solving. This increasing emphasis on processes can be understood as an attempt to broaden scope of possible solutions and changes that could be implemented in sector. For future research, I suggest that more attention be paid to interrogating relationships that enable New Governance techniques.Keywords: governance, regulation, experimentalism, long-term care, disability, innovation.IntroductionIn Canada, and around world, public sector managers and their political masters continue to respond to challenges in their respective health care systems. According to Institute of Public Administration of Canada, factors such as an aging population, increasing prevalence of chronic conditions, implementation of new technologies, and introduction of new and costly pharmaceuticals contribute to rising health care costs of provincial and territorial governments (Institute of Public Administration of Canada, 2013: 3). Most frequently, public discourse around health care is related to level and quality of services, and funding for such services. Colleen Flood explains crisis talk in an Ontario context:In end, recurrent political debates are reduced to issues of money, and problems of system are blamed on lack of it. We believe, however, that Ontario crisis in health care, along with similarly situated health care schemes, has more to do with an absence of effective governance (Flood, 2004: 170).One could ask how literature on governance responds to current and future challenges in health care system. By governance, I mean the changing boundaries between public, private and voluntary sectors, and changing role of state (Rhodes, 2012: 33). This paper turns to insights of New Governance in order to explain how law was used to promote innovations in health care governance in Canadian province of Ontario between 2004 and 2012. New Governance consists of a range of processes and practices that are less rigid and less prescriptive: increased participation of non-state actors; public/private collaboration; diversity and competition within market; decentralization; integration of policy domains; noncoerciveness (soft law); adaptability and constant learning; and coordination (Lobel, 2004a and 2012; de Burca and Scott, 2006). There is a shared concern within literature about how New Governance transforms way law is created and administered (Trubek, 2006: 246). For some scholars and policy makers, New Governance is positioned as an ambitious framework for addressing public policy problems, such as occupational safety, discrimination law in workplace, financial regulation, and health care (Lobel, 2004a and 2012; Sturm, 2006a; NeJaime, 2009; Blum, 2007).This paper examines how recent changes to governance of long-term care (LTC) home sector in Ontario-especially participatory processes and procedures enshrined in law- can help meet some of pressing challenges in sector. …