MEMORIAL PRESENTS
A Dialogue on Social Innovation:
Regional Approach to Governance in Health, Education,
Municipal Government and Economic Development
Presentation
Dr Stephen Tomblin
Joan Dawe 
Panel
Dr. David Dibbon  Kelly Vodden
MEMORIAL PRESENTS
Managing Change Through Regionalization:
Lessons from Newfoundland and Labrador
Dr. Stephen Tomblin
Department of Political Science and Faculty of
Community Medicine
Memorial University of Newfoundland
October 6, 2005
Managing Change Through Regionalization:
Lessons from Newfoundland and Labrador
•
Focus on regionalization
reform in four policy
fields:
1.
2.
3.
4.
Education
Health Care
Economic Development
Municipal Government
•
1.
2.
3.
OUTLINE:
What is regionalization?
Why regionalize?
Examples from
Newfoundland and
Labrador
4. Similarities across policy
fields
5. Differences across policy
fields
6. Policy lessons
What is regionalization?
• About delivery and decision making for programs and
services at “regional” level
 For this discussion: about regions within the province
• Innovation / change driven by idea that old ideas,
institutions, processes are out of touch and must be
replaced:
 incrementally over time
or
 quickly through a “big bang”
Regionalization not necessarily
Decentralization
• Irony that centralization and consolidation of power
can and does often occur with regionalization
• The number of opportunities for citizen participation
have actually been curtailed through the
centralization of various services delivered by boards
or authorities (School Boards; REDBs, RIHAs)
 Explains some of the resistance to regionalization
Why Regionalize?
Policy goals to:
•
reduce costs
•
respond better to the needs of local populations
•
increase local control over decision-making
•
coordinate and integrate services
•
achieve efficiencies in resource allocation
•
improve access to services
•
manage institutions effectively
•
increase accountability
•
achieve improved outcomes
Why Regionalization?
Democracy and Citizen Participation
• devolution of powers by provincial governments
 potential to allow lay persons opportunities to participate in
decision-making and tailor decisions to the specific needs of
local communities
• citizen participation can be problematic:
 requires specialized knowledge that most citizens do not
possess
 creating more voices and diversity makes it more difficult to build
common vision for the province
 regionalization experiments may work at cross-purposes
 may be ploy for avoiding blame for cutting public services
 rural communities lack capacity and volunteers
 lack of capacity can result in cynicism and apathy
Why Regionalization?
Appointment vs. Election
• Appointed bodies are much more common than elected
 allows the provincial government to exercise more control over
the process of regionalization
 provides opportunity to ensure there is a balanced approach to
representation and key stakeholders are involved in the process
 allows government to reward friends
• Main disadvantage with appointed boards is the lack of
legitimacy and accountability to citizens’ interests
 stakeholders may (through their actions in the process)
undermine reforms and defend the status quo
 where elections do occur (eg. school boards in NL), turnout and
interest are low
 Health Authority elections in other provinces have not generated
much citizen interest either
Building new forms of innovation is
never a smooth process
Requires:
• Mobilizing a new vision
• Leadership
• Mobilizing a coalition and public support around the new
regime
• Finding the means to tackle and rethink old ways of
doing things
• Getting the new vision institutionalized
 either bring in or replace old institutions and interests
Lessons from Newfoundland and Labrador:
Regionalization and Education
• Education reform driven by two factors:
 adapting to the needs of a “post-industrial” society
 reduce or eliminate the power of the churches to control the
education system
• New vision from two Royal Commission documents: Building On
Our Strengths and Education for Self-Reliance (1986)
 upgrade “human capital” with training that was scientific and
entrepreneurial
 education viewed as a key to economic development
• Royal Commission Report, Our Children, Our Future (1990-92)
focused on the delivery and organization of education in NL
 stated that “the denominational system in its present form
creates divisiveness and is an impediment to social cohesion.”
Regionalization and Education:
Not a Smooth Process
• Negotiations between the province and churches were
launched in 1992
• Agreement could not be reached
• Government decided to seek public approval to amend
Term 17 via referendum
• 1995 referendum called for government to retain
denominational education but to allow for the reduction
in the number of school boards from 27 to 10
 majority of voters (55%) endorsed the amendment
 boards would be elected
• However, new amendment was confusing as it permitted
both uni-denominational and inter-denominational
schools.
Regionalization and Education: “Big Bang”
• 1997 second referendum to remove all denominational
control over education in NL
 turnout of 53%, 73% of voters approved amendment to Term 17
• 2004: further consolidation in the number of school
boards from 11 into five
 Rationale based on declining enrolments and attempts to create
administrative and managerial efficiencies
 However, new regional entities were larger and no public input
was sought by government
(new Eastern School Board has 127 schools with approximately
44,000 students distributed across the Avalon, Bonavista and
Burin peninsulas)
Regionalization and
Economic Development
• Fall 1990: process leading to the province’s first strategic economic
plan began with Economic Recovery Commission (ERC)
 15 public meetings, 15 formal presentation meetings, five regional
roundtables, a pan-provincial roundtable and 261 written submissions
 key feature of the Strategic Economic Plan was plan to establish 17
economic zones across Newfoundland and Labrador
• Jan. 1995: Report of the Task Force on Community Economic
Development
 Equal federal – provincial and community organization representation
on Task Force
 Call for Regional Economic Development Boards (REDBs) in 18 (later
20) economic zones
 Federal and Provincial adoption of recommendations
 REDBs not appointed by government
 Strategic Economic Plans to establish shared priorities for development
Why the creation of economic zones?
•
•
•
•
•
•
•
each region is better able to participate in and respond
to opportunities for economic growth
better coordination and integration of economic
planning
citizen input in developing economic plans for each
zone
joint projects can be undertaken by zonal communities
major centres in each zone will have infrastructure
improved to attract new services and investments
greater regionalization of government administration
the unique characteristics of each region will be easier
to identify and will be better understood
Regionalization of Health Care
• 1990: comprehensive health restructuring began
 Wells government established a Resource Committee to review
the state of the health system; included key stakeholders
 National Health Ministers conference, regionalization emerged
as a potential solution to combat escalating hospital costs
(everywhere but Ontario).
• province adopted several strategies for combating rising
expenditures:




regionalization
focus on the population health model
integrated approach to health care delivery
shift from hospital to community level care.
Regionalization of Health Care
• Advantages associated with regionalization:
 reduction in costs due to economies of scale
 increases in quality of care, due to improved potential to attract
specialists
 greater justification for specialized administrative services
(increased capacity), such as data handling, and in-service
education
• Disadvantages of regionalized health system:
 diminished community involvement
 potential for closing institutions in rural and remote areas
 possible decline in employment
Regionalization of Health Care
• March, 1993: Report on the Reduction of
Hospital Boards
 consultations held across the province
 ten recommendations for government; most were
formally adopted
 14 regional health authorities established: two
integrated authorities, four community health boards,
six institutional boards and two boards overseeing
nursing homes and the NL Cancer Centre
 appointed boards
Regionalization and
Municipal Government
• amalgamation debate due to small population that is highly
dispersed
 most municipalities still consist of small communities that are
isolated from one another
• 1997 Task Force on Regionalization
 conducted interviews and seminars with municipal officials and
the public throughout the province
 need for regionalization and the sharing of services
 However, the public was not very supportive: “overwhelming
response was one of ‘go away, leave us alone, we’re already
doing the best we can to share with our neighbours.’”
Regionalization and Municipal Government
• One example of regional cooperation is the Avalon
Waste project
 ambitious effort with the goal of merging 43 disposal sites into
one location
 new waste site would cover the Avalon peninsula up to
Clarenville
Similarities and Differences in Reforms
Across Policy Fields
Similarities
1.
2.
3.
4.
5.
Reducing costs for services
Reducing levels of management and administration for
services
Achieving efficiencies through centralization
Claims of responding better to local and community
needs
Improvements in services provided and access
Similarities and Differences in Reforms Across
Policy Fields
Key Differences
1.
Frameworks, Concepts and Objectives relied upon to
define vision and strategies:


2.
3.
4.
equity (health needs-based)
efficiency- based vision more dominant in economic
development field
Selection of members for regional boards: in NL, most
are appointed, not elected
Consultations: regionalization has been established
with varying degrees of public input
Success of reforms: in health, positive perception but
in education, municipal government more challenges
and constraints
Policy Lessons
Points to Consider:
• Regionalization adopted during times of crisis, whether
fiscal, social or political
• Ideas for reform came from external and internal sources
• Requires public buy-in or support
• Regionalization absolves responsibility for government to
make the hard decisions but allows a more communitybased approach to problem definition and solution.
Policy Lessons
• Regionalization adopted in some cases without
widespread public input and consultation
• Lack of meaningful community participation
• Little policy learning across regional systems
• More recently, regionalization imposed from top down,
from centre to periphery in education and health
MEMORIAL PRESENTS
A Dialogue on Social Innovation:
Regional approaches to governance in health, education,
municipal government and economic development
Joan Dawe
Chair
Eastern Regional Integrated Health Authority
October 6, 2005
New Directions for Health and
Community Services
• September 10th, 2004 press release announcing
restructuring:
– “Creating fewer, more accountable health authorities is
a necessary step in renewing our health and community
services system and meeting client needs. Fewer regions
mean less administration and more opportunity for
collaboration. Integrated boards will have the ability to
focus on the full continuum of care, from community
care to acute care and long-term care, resulting in better
service for clients.” Minister of Health and Community
Services
Four New
RIHA
Population
•
•
•
•
Eastern 295,000
Central 100,926
Western 82,034
Labrador 40,516
Eastern Health - Organization
Former Boards:
•
•
•
•
•
Avalon Health Care Institutions Board
Health & Community Services - Eastern
Health & Community Services - St. John’s
Health Care Corporation of St. John’s
Newfoundland Cancer Treatment and Research
Foundation
• Peninsulas Health Care Corporation
• St. John’s Nursing Home Board
Mandate
• Broadest Level
1. Service
2. Education
3. Research
Regional Mandate
– Full continuum of community, institutional acute and long term
care
Provincial Mandate
– Adult tertiary care
– Child specialty services
– Cancer care
– Genetics program
– Mental Health
Eastern Health - Organization
•
•
•
•
•
18 member (volunteer) appointed Board
$850 m. operating budget
12,000 employees
27 health care facilities
30 community offices
Population Health
 Key concept and approach for program and policy development
aimed at improving the health of the population.








Elements:
Addresses the determinants of health and their interaction;
Base decisions on evidence;
Increase upstream investments;
Apply multiple strategies;
Collaborate across sectors and levels;
Employ mechanisms for public involvement;
Demonstrate accountability for health outcomes.
Challenges
• Creating new organizational culture.
• Maintaining stability throughout reorganization.
• Very large geographic area.
• Urban / Rural issues.
• Competing demands for services and infrastructure –community /
institutional acute care / long term care.
• Human and fiscal resources.
Opportunities
 Promote population health approach
 Achieve better balance between promoting health / preventing illness /
care and treatment
 Build an integrated, seamless health and community services system
 Improve access to services
 Address gaps through reallocation of resources
 Avoid unnecessary duplication of services.
Governance
Legislation:
Regional Health Authorities Act
(proposed)
Transparency and Accountability Act
Policy Governance Model
(assent Dec. 16, 2004)
MEMORIAL PRESENTS
A Dialogue on Social Innovation:
Regional approaches to governance in health, education,
municipal government and economic development
Dr. David Dibbon
Faculty of Education
Memorial University of Newfoundland
October 6, 2005
Newfoundland and Labrador School
Districts 2004-2005
Labrador
•Schools 16
•Pupils 4,505
•Teachers 343.3
Conseil
scolaire
francophone
•Schools 5
•Pupils 193
•Teachers 31.8
Nova Central
•Schools 75
•Pupils 14,741
•Teachers 1,099.5
Eastern
Western
•Schools 82
•Pupils 14,742
•Teachers 1,159.1
•
•
•
Schools 125
Pupils 45,258
Teachers 3,000.7
Regionalization in Education
Though pupil enrolment numbers have
been declining, the number of school
board districts and administration staff
has remained constant. We will reduce
the number of school boards by
September of this year from eleven to
five, for an anticipated savings of about
$6 million annually (Budget 2004).
Governance in an era of mandated
change
You can’t mandate what matters, but
Mandates can work if they are supported
Regionalization means
many changes masquerading as
a single change
The Impact of Regionalization
•
•
•
•
•
On the education system
On district office
School administrators
Teachers
Students
District Office Administration
140
120
2004-2005
100
1997-1998
80
1994-1995
60
40
20
0
Directors
Assist. Dir.
SEO/REO
Prog. Spec.
Regionalization
 Myths
– Big is better
– More efficient = more
effective
– It is possible to do
more with less
– Downsizing to
prosperity
– Shared vision
 Realities
–
–
–
–
–
Era of fiscal restraint
Top down model of DM
Loss of capacity
De-professionalizing
Rational is not always best
 Opportunities
– New model of governance
– To adequately resource the
system
– To involve the community
It is only when responsibility for
education is shared by the
community can education ever be
reformed ( Dewey 1952).
MEMORIAL PRESENTS
A Dialogue on Social Innovation:
Regional approaches to governance in health, education,
municipal government and economic development
Kelly Vodden
Dept. of Geography,
Center for Sustainable Community Development
Simon Fraser University
October 6, 2005
1995
1. Strategic economic
planning
2. Coordinating
business support
3. Supporting
communities and
organizations
4. Coordinating social
and economic
initiatives
5. Public education and
participation
1998
• SSP implementation
•coordinated approach
to social and economic
development
• building and
supporting community
involvement, action
and partnerships
• input into policy and
decision-making
2005
• focal point for
partnerships with
government
• rural voice
• support for
communities and
regions
• develop regional
approaches that link
economic, social,
cultural and
environmental issues
RED Boards
Rural Secretariat
• social and economic
initiatives relating to RED
• coordination of local (and
senior government) efforts
SSP
• government-region-community
partnership around social and
economic development
•coordination of government
efforts/policy and local/regional
efforts
• “develop regional approaches
which effectively link
economic, social, cultural and
environmental issues”
• coordination of government
efforts/policy (and
local/regional efforts)
Relationships??
Layers of Regionalization
– Multi-level Governance
Municipalities
Economic Sub-Zones
(RDAs, municipal collaboration, EAS)
Economic Zones
Rural Secretariat Regions
SSP Regions
Newfoundland and Labrador
Atlantic Canada
Cross-border/North Atlantic
Options for Municipal Cooperation
• Status quo
• Service sharing arrangements
• Amalgamation
• Regional government
Issues for consideration
• Tensions - place-based vs. functional regions
• Change and stability
• Boundary creep – adding vs. replacing layers
• Planning temporal, vertical and horizontal
linkages
• The reality of resource limitations – efficiency and
accountability, but not at the cost of
effectiveness
MEMORIAL PRESENTS
A Dialogue on Social Innovation:
Regional Approach to Governance in Health, Education,
Municipal Government and Economic Development
Question and Answer Period