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SOC 222 > History of Medicine, Medicalization & Doctors - (up to 252) > Flashcards

History of Medicine, Medicalization & Doctors - (up to 252) Flashcards

1
Q

earliest type of society

A

hunting & gathering band

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2
Q

hunting & gathering band

A

small society

30-50 people:

adults & children less than 100 people

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3
Q

Describe early society (hunting&gathering band)

A

society of equality

  • no rich or poor b/c no possessions
  • Nomadic

Had a CHIEF that formalized decisions of the tribe Gender equality

gender division of labor

had medicine women

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4
Q

Gender Inequality taught by?

A

“white man”

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5
Q

How does early hunter gather society relate to healthcare?

A

healthcare became women’s work b/c it evolved as an extension of women’s 2 basic roles

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6
Q

womens B

A

1) childcare
2) gathering

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7
Q

Describe womens 2 basic roles and how they relate to healthcare

A

1) childcare: involves HC, picked up skills, human biology became women’s domain, begins with childbirth
2) gathering - plants

medicine came from herbs & plants (an extension of cooking)

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8
Q

How was the Human Body viewed differently by

a) Modern Male Medicine
b) Tribal Societies

A

a) mechanical model of human body
b) balance of nature - more holistic

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9
Q

Describe Tribal Societies view of the human body

A

strong sense of ecology

people were a part of nature

had to maintain balance of nature

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10
Q

Describe the importance of the Balance of Nature to Tribal Societies & its relationship to HC

A

if screwed up the people would suffer eventually nature was understood in spiritual terms so HC was about getting in touch with spirit world

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11
Q

Deity

A

Goddess - idea of nature as a whole

supernatural being that is the embodiment of **nature **

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12
Q

Why is the Deity female?

A

Deity had created the world & women are givers of life

therefore it is only logical that she is female

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13
Q

Central Concept of Healthcare in Tribal Societies

Healthy vs. Sick

A

Balance

sick = out of balance with goddess

healing = restoring balance

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14
Q

In Tribal Societies, HC was tied closely to?

A

**Spiritualism **→ became religion

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15
Q

Describe the role of the Medicine Women

A

doctor + spiritual leader (priestess)

  • expert on herbal medicine & healthcare
  • interpreted goddess’s wishes
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16
Q

Did men play a role in HC?

A

yes → Shaman (witch doctor)

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17
Q

Shaman

  • roles
A

male “witch doctor”

  • led men into rituals & prayers before war/hunting = - boosted social solidarity (unity)
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18
Q

What caused the change of societies from HUNTER-GATHERER to AGRICULTURAL

A

couldn’t feed increasing popn

developed agriculture

**- ** allowed popn to expand b/c it allowed for storable wealth

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19
Q

Where did Agriculture begin?

A

in Middle East & Africa

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20
Q

Problems with Agricultural society

A

led to

  • social inequality
  • class inequality
  • gender inequality
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21
Q

How did the shift to Agricultural society lead to social inequality?

A

agricultural society developed into slave empires

**- **prisoners of war became slaves

rise of CLASS INEQUALITY + aristocracy (military) > peasants > slaves

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22
Q

How did the shift to Agricultural society bring about gender inequality?

A

increasing importance of army increased the importance of men

  • men took over priestesses

replaced by male priest

men took over HC

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23
Q

After shift to Agricultural Society, men took over (3)

A
  1. Politics
  2. HC
  3. economics
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24
Q

Health in Ancient Greece

A

healing = women’s work

Hyglia - greek goddess of healing

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25
Q

Over time Greek society become more?

A

militaristic

**Hyglia **→ Apollo (male god)

male medicine dominated female medicine

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26
Q

Hippocrates

A

ancient greek physician

  • made Hippocratic Oath

saw his techniques as restoring balance

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27
Q

Hippocratic Oath

A

religious oath

**- **do not harm

  • do not betray patients trust
  • contains prohibitions about sexual contact with patients (the fact that this clause was introduced shows it was meant for men)
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28
Q

The main goal of Hippocrates

A

to seperate medicine & religion for the first time

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29
Q

Greek Physicians made significant advances in…

A

anatomy & medicine

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30
Q

The significant advances made by Greek Physicians were brought together by? when?

A

Galen → 2nd Century

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31
Q

Galen

A

summarized what others had learned before him

  • published an anatomy text in **2nd Century AD - **

developed model of human body

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32
Q

Galens model of the human body

A

body is composed of specialized organs each performing specific functions & working together

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33
Q

Galen’s text was the authority on human anatomy until late 16th century despite..

A

never having dissected a human cadaver

-based on dissection of apes & pigs

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34
Q

Early Christianity & human dissection

A

4th Century: Catholic Church forbade human dissection & anatomical examinations

  • believed people were resurrected on judgement day and this could not occur if body was cut into pieces
  • remained this way throughout Medieval Europe
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35
Q

After Greece & Rome Collapsed in 4th Century…What happened to the progress of science & medicine?

A

science & medicine came to a halt

Church decreed that health was determined by spiritual things (not physical)

- tied to religion once again

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36
Q

Male medicine after collapse of Greece & Rome

A

beyond prayer, reduced to military medicine

- bandage wounds & pray they live

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37
Q

Age of Feudalism

A

quiet resurgence of female medicine

  • every village came to have medicine women (old religion of goddess never really died out)
  • acted as midwife, healer (herbal meds) & spiritual leader
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38
Q

16th Century: Europe

A

feudalism → CAPITALISM

religion threatened by rise of science

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39
Q

16th Century: Italy

A

Renaissance - rebirth of knowledge before Middle Ages

  • tried to resurrect scientific approach

Galileo defied Church with his astronomical revelations which undermined Church’s teaching

  • was forced to recant
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40
Q

Leonardo Davinci

A

one of the first to defy Church’s ban on human dissection

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41
Q

(2) things that Challenged the Church in 16th Century

A

science

Prodestantism

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42
Q

Germany - Martin Luther

A

German Preacher

said Catholic Church had fallen away from path of Christ b/c they were all about wealth & power

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43
Q

How did the Church maintain its Authority?

A

found a Scapegoat that only the Church could save Europe from (pushed womans status down)

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44
Q

How did the Church use a scapegoat to maintain its Authority?

A

began witch hunts lasted through 16th & 17th Century (200+ years)

witches = medicine women

  • were believed to be in league with the devil
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45
Q

The Inquisition

A

reign of terror

  • went from town to town & tortured/burned at stake/killed witches

~100,000 to 1 million killed

mostly peasant women

  • blamed womens for societies problems
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46
Q

What was the beginning of Society blaming women for everything?

A

Eve → blamed for taking the forbidden fruit

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47
Q

How long did the Catholic Church remain as the primary authority in Europe?

A

over 200 years after beginning of witch hunts

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48
Q

Mid-18th Century: ____Revolution

A

Industrial Revolution

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49
Q

Industrial Revolution

A

people began to leave villages for big cities

  • witch hunts died out
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50
Q

Since 1960’s: Resurgence of _____

A

Wicca → religion

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51
Q

In the late 16th/17th Century, what emerged again?

A

Male medicine

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52
Q

What kind of new healthcare emerged from 17th Century onward?

A

male dominated

  • increasingly based on science not spirituality chemical meds replaced herbal
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53
Q

How did the shift from **Agricultural to Industrial **affect HC?

A

more industrial type of HC

  • based on dif model of health & human body
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54
Q

Industrial society → model of human body

A

Rene Descartes

rediscovered & updated Galen’s model → MECHANICAL model of body

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55
Q

Mechanical Model of Human Body

A

human body is like a machine

simple parts with simple functions

  • could be taken apart & put back together
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56
Q

Basis of modern surgery (2)

A

cuts‘n’ chemicals (surgery & pharmaceuticals)

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57
Q

Descartes model lead to?

A

new approach of medicine → called Allopathic Medicine

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58
Q

Allopathic Medicine

A

based on isolating specific problem & dealing with it

aka specific aetiology

  • more intrusive

widely accepted bc it showed results

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59
Q

Allopathic Medicine lead to?

A

specialization → localized pathology

**- **opposite of female **holistic approach **

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60
Q

Men → specialize /compartmentalize where as women…

A

Women → look at human body as a whole

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61
Q

Mechanical model lead to new medical technology such as?

A

microscope

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62
Q

the microscope lead to the rise of (2)

A

vaccination (18th Century) - Edward Jenner

germs/other microorganisms (19th Century) - Louis Pasteur

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63
Q

Modern Medicine

A

isolate from environment

  • away from psychological support
  • objective

ignores social context

**- ** downplays role of emotional support

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64
Q

Female vs. Male

A

care vs. cure

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65
Q

What types of problems do

a) men’s approach
b) women’s approach work best for?

A

a) acute
b) chronic

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66
Q

Historical Development of Modern Healthcare (sociological approach)

A

born not just from technological advancements but from social struggle between different groups that had different ideas of how it should be run

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67
Q

18th & 19th Century- Power struggle

A

Homeopathy vs. Mechanical Model

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68
Q

Barber-surgeons

A

through 17th & 18th Century

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69
Q

How did Academics gradually transform Modern Medicine?

A

**12th Century- Bologna **

North Italy Universities → defied ban on human dissection

  • gradually brought science & medicine together
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70
Q

Francis Bacon

A

Founded Royal Society in 17th Century Britian - promoted development of all empirical sciences including anatomy

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71
Q

With the help of the Royal Society, what was formed?

A

Guild of Surgeons (18th Century)

  • not just barbers
  • surgeons given more respect
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72
Q

Ivan Illach

A

1970s

one of the 1st to question role of doctors

  • found that mortality rates declined long before introduction of drugs & scientific techniques (although antibiotics were 1st developed in 1920s, over 90% of decline of disease rate had happened before antibiotics were available in 1940s/50s)
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73
Q

Ivan Illach & Iatrogenesis

  • (3) sorts of **Iatrogenesis **
A
  • argues that contemporary medicine is iatrogenic - **creates disease & illness even as it provides medical assistance

**1) Clinical - **pain/sickness/death result from provision of medical care (unneccessary procedures, Thalidomide)

**2) Social - **health policies reinforce industrial organization which generates dependancy & ill health

**3) Structural - **loss of individual autonomy & creation of dependancy

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74
Q

(2) things really improved peoples health:

A

improvements in

1) nutrition - world trade

sanitation - sewers

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75
Q

When French & British came to Canada.. early physicians were?

A

ship doctors

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76
Q

War between France & Britian

A

Britian took over Fur Trade from France but only **after 100 years **in 1763

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77
Q

Military Medicine

A

particular type of medicine based on anatomy & surgery b/c it was mostly about sewing up military wounds

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78
Q

Doctors referred to as…

A

sawbones

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79
Q

Inhalation Anesthesia

A

not invented until 1840s

  • didn’t become widely used in 1850s
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80
Q

Antisepsis

A

keeping surgical conditions clean/sterile

  • not introduced until 1880s
  • followed germ theory by **louis pasteur (860s) **
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81
Q

Joseph Lister

A

British Surgeon

  • one of the first to introduce antisepsis into his surgery
  • found 1/2 of his surviving patients died of post-operative infections

**- ** read Pasteur’s work on Germ Theory & started sterilizing instruments with carbolic acid to kill germs

  • decreased post-operative death to 15%
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82
Q

Medical treatments used by 19th century doctors

A

still based on Galens idea but influenced by years of military medicine

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83
Q

Military medicine pushed Galen’s model to the extreme & developed ?

A

Heroic Therapy

**Galens model - **balance

**Military Mind - **if a little was good, alot was better

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84
Q

Heroic Therapy

A

based on principle of huge intervention

blood-letting

blistering

purging

vomiting

tonics

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85
Q

Blood-letting

A
  • based on theory that if you let some blood out of body that it would heal person
  • cut veins or used leeches
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86
Q

Blistering

A

believed to remove/suck poison from body

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87
Q

Purging

A

clearing bowels by giving patient a diarrhetic (causes diarrhea) - calomel & mercurous chloride

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88
Q

Vomiting

A

induced by giving an emetic - tartar (tartar ate of antinomy)

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89
Q

Tonics

A

made from compounds of arsenic or opium

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90
Q

Licensing system - late 18th & 19th Century

A

Canadian government tried to introduce new legislation to restrict medical practice to only physicians

→ licensing system: only licensed physicians allowed to practice medicine

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91
Q

First Medical School in Canada

A

was established in 1824 in Montreal

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92
Q

Monopolies in Canada

A

Fur Trade → Royal Charter gave monopoly to Hudson Bay Company → monopoly on fur trade given by king of England

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93
Q

Why did Canadian State support Doctors so strongly?

A

it is believed that it is because doctors are good for peoples health

but the real reason is because they were always a tight-knit elite group so because of their high social position they were given monopoly

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94
Q

Characteristics of Doctors in 18th Century

A

only male

all went to medical school (wealthy bc they could afford it)

  • family/social ties to political/economic leaders of Canada or wealthy/influential people in Britian
  • mostly military doctors
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95
Q

Military were respected & had high prestige because?

A

Canada has started with century of warfare

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96
Q

course of medicine was determined by?

A

by power struggle between different groups trying to establish themselves as healthcare providers

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97
Q

1830s

- (2) new brands of medicine came to Canada from?

A

1) USA
2) Germany

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98
Q

1) USA

A

ecclecticism/herbalism

founded by Samuel Thomson

  • New England Farmer rediscovered techniques of women’s traditional herbal med.
  • argued that conventional med = disaster & techniques of orthodox med. = “instruments of death”

advocated for herbal meds, steam baths & bed rest

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99
Q

2) Germany

A

**homeopathy: **German Doc- Samuel Hahnemann - rejected heroic therapy

  • like cures like

also rediscovered herbal medicine

  • argued drugs should be given in microscopic doses (anything harmful in large doses would promote good health in small microscopic doses) - however he did not use inoculation, used herbal medicine (Echinacea)
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100
Q

Similarities between Samuel Thomson & Samuel Hahnmann

A

both rejected Heroic therapy

  • emphasized bed rest

rediscovered herbal meds

both aided in popularity increase of eclecticism & homeopathy that pressured gov. to license them in 1860s

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101
Q

1869

A

conventional doctors formed General Medical Council

**- **eclectics & homeopaths invited to join → over 200 licensed to practice but they had to go to medical school first

eclectics agreed → became absorbed into regular med. & ceased to exist

homeopaths rejected - quit council & continued to practice

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102
Q

how did Confederation change Homeopathy?

A

modern Canada was born

  • *federal** government introduced
  • better able to enforce licensing system
  • homeopaths driven underground in late 19th century
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103
Q

Resurgence of homeopathy in the…

A

early 20th century

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104
Q

Another group of men challenged Canadian physicians for control of HC

A

→ American Doctors

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105
Q

How was the USA different from Canada with respect to medical practice?

A

no old boys network

no pressure on gov to provide monopoly

- turned to private sector

  • private med. schools tuition = relatively cheap entry virtually unrestricted

had far more docs

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106
Q

Why did American Doctors look to Canada for a place to practice?

A

less competition

  • USA had more doctors
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107
Q

How did the Canadian doctors deal with US doctors coming to Canada?

A

public campaign → against influx of American Doctors (called yankee loafers)

late 19th century → law passed that only docs with Canadian degrees could practice

late 1880s → every province had this legislation

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108
Q

length of medical school in

a) USA
b) Canada

A

a) 2 years
b) 5 years

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109
Q

3rd World Countries → how did they challenge that you needed years of medical school

A

developed 6 month courses → to train paramedics could handle 70-80% of what doctors can

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110
Q

1980s/90s → recession

A

pressure to develop cheaper HC

→ nurse practitioners by 2010

→ just over 1,600 nurse practitioners in Canada

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111
Q

1910 - Flexner Report

A

responsible for creation of modern scientific medicine

  • “the document that helped change modern medicine from quackery to responsible practice”
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112
Q

Abraham Flexner

A

schoolmaster

→ commissioned by Carnegie foundation of NY to conduct study on medical education

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113
Q

**Abraham Flexner **→ concluded that?

A

medical education = absolute disaster,

all medical schools should be shut down immediately

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114
Q

How many universities did Flexner give seal of approval to?

A

5 - Harvard, Mcgill, U of Toronto & 2 others in USA

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115
Q

What were Flexners recommendations? (3)

A
  • shut down majority of medical schools
  • rather than private medical schools, medicine should be taught exclusively at universities at graduate level by full-time qualified faculty
  • should have access to lab, research & hospital facilities (to connect medical education to medical practice)
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116
Q

Flexner managed to persuade both US & Canadian governments as well as the Carnegie & Rockafeller families to put a lot of money into reforming medical schools. What made his argument so persuasive?

A

the coming of WW1 (1914-1919) which introduced conscription

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117
Q

Explain how the coming of WW1 made Flexners argument so persuasive

A

many men who were conscripted failed medical exam meaning they were unfit for military service which forced gov. to change attitude & finally recognize HC was inadequate - beginning with medical education

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118
Q

The Flexner Report changed (2) major things

A

1) structure of medical education
2) medicine in general

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119
Q

How did the Flexner Report impact the USA?

A
  • med schools either shut down or affiliated with universities
  • outlawed other forms of medicine
  • stricter regulations for medical care
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120
Q

How did the Flexner Report impact Canada?

A

had less impact on the structure but larger impact on CONTENT

  • standards improved (research, HC, education)
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121
Q

What is the time period that genuinely scientific/effective healthcare began in North America?

A

1910s & 20s

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122
Q

When did the chance of patients being helped by doctors rise above 50%?

A

after Flexner Report

in particular, huge change from integration of practical HC with universities which led to research

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123
Q

Pharmaceuticals → CHEMOTHERAPY REVOLUTION

A

1920s

→ 1st time effective chemical drugs were invented - variety of antibiotics developed that greatly improved health standards,

especially after becoming widely available in late 1940s/50s

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124
Q

Importance of

a) Alexander Fleming
b) Bantings & Best

A

a) discovered penicillin
b) discovered insulin in 1922

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125
Q

Chemotherapy Revolution lead to introduction of?

A

series of MIRACLE DRUGS

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126
Q

Miracle Drugs

A

drugs that could cure so-called incurable diseases

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127
Q

Miracle Drugs helped improve the public’s view of doctors in what way?

A

led public to genuinely respect & want to go to doctors

  • increased demand for doctors
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128
Q

How did rural areas concerns change after the Chemotherapy Revolution?

A

rural areas were concerned about the absence of doctors in their areas

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129
Q

difference between the 19th & 20th Century in the publics demand for doctors

A

19th → gov tried to force people to go

20th → public demanded more access to doctors

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130
Q

What was the governments response to the public demand for doctors?

A

Medicare

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131
Q

Which province led the way for Canada in respect to Medicare?

A

Saskatchewan

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132
Q

How did SK lead the way for Canada (with medicare)?

A

SK is the most agricultural province

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133
Q

What dramatic change in HC was pioneered by SK?

A

change from individual-based system to a system based on gov. paying doctors for medical treatments

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134
Q

What (2) things resulting from SK being the most agricultural province contributed to the introduction of MEDICARE?

A

1) full of small rural communities where few doctors wanted to live/work
2) province of farming communities

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135
Q

Explain how SK being a province:

1) full of small rural communities where few doctors wanted to live/work… contributed to creation of medicare

A

most of SK served by horse & buggy doctors so they only visited each town every few weeks/months

  • the ill had to wait or travel
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136
Q

Explain how SK being a

2) province of farming communities … contributed to creation of medicare

A

traditional farming community spirit of Mutual Aid

  • neighbours helping each other (collectivity)
  • when they felt they needed to attract more docs, introduced MUNICIPAL DOCTOR PLAN
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137
Q

MUNICIPAL DOCTOR PLAN

A

allowed towns/municipalities to pay doctor annual fee to provide medical services (benefited doctors b/c they had guaranteed income)

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138
Q

Explain the problem of default rates?

A

doctors fees raised but many people were too poor to pay

  • rise in default rates was a problem in the 20s
  • even worse in the 30s because of US stock market crash (great depression)
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139
Q

How was the problem of default rates solved by intro of medicare?

A

guaranteed income for doctors in troubled time - paid collectively through taxes through municipality

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140
Q

Now in historical context, what can be seen as the first step in the Healthcare Revolution?

A

Municipal Doctor Plan

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141
Q

Sarnia - 1914

A

pilot project of Municipal Doctor Plan

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142
Q

the Municipal Doctor Plan was backed up by?

A

passing of Rural Municipality Act in 1916

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143
Q

Rural Municipality Act in 1916

A
  • allowed all SK townships for 1st time to levy tax on citizens specifically to set up fund to pay for doctor
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144
Q

1917 - Union Hospital Act

A

expanded idea because it allowed several townships to combine into health districts so together they could afford to maintain hospital

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145
Q

Hospitals were built partly for the purpose of?

A

attracting doctors

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146
Q

Once these acts were passed…

A

Municipal Doctor Plan spread across SK & continued until late 40s after WWII

(by this time ~200 SK towns used MDP & also spread to neighbouring towns of MB & AB)

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147
Q

How did the change from municipal to provincial government occur for funding of HC?

A

MDP spread swiftly across SK & neighbouring provinces (smaller scale)

  • more demands that funding & organization of HC should be funded by provincial level
  • demanded intro of PUBLIC HEALTH INSURANCE
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148
Q

What was the obstacle to public health insurance?

A

none of the leading politicians wanted it b/c they declared it was “socialized medicine” & it was a stepping stone to turning Canada into socialist & then communist country

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149
Q

How did SK overcome politicians who did not want public health insurance?

A

established new political party → Co-operative Commonwealth Federation (CCF)

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150
Q

Co-operative Commonwealth Federation (CCF)

A

left wing party

  • demanded major changes in gov. policy most of which involved intro of welfare state
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151
Q

the CCF argued that…

A

Canadian government should take responsibility for well-being of Canadians through introduction of measures such as unemployment insurance**, higher **pensions**, **social security** & **universal government funded HC

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152
Q

1944

A

CCF won provincial election & formed provincial government under leadership of Tommy Douglas (introduced medicare to Canada)

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153
Q

CCF popularity

A

grew slowly at first in the 30s but more quickly in late 30s/early 40s

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154
Q

When did the CCF win the provincial election?

A

in 1944 under leadership of Tommy Douglas

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155
Q

Tommy Douglas

A

premier of SK from 1944-1961 deserves title of Father of Modern Medicare - universal medical care was his #1 priority

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156
Q

What led Tommy Douglas to his life-time commitment for providing universal healthcare?

A

as a child, suffered from osteomyelitis - disease of the bone

  • couldnt afford series of operations needed to save his leg
  • one orthopedic surgeon said he would perform operations for free if he could use it for experience for other medical students
  • made TD realize many other Canadians may not be this lucky
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157
Q

1945

A

CCF introduced free medical care for the poorest people (pensioners & unemployed)

  • free mental health care
  • free polio treatment
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158
Q

1946

A

CCF introduced first district-wide medical insurance program

- pilot program in Swift Current

159
Q

1947

A

Introduced the Hospital Insurance Plan

- intended to provide gov-paid hospital care to everyone in SK

  • by end of 1947: already guaranteed of 90% of SK had access to state-funded hospital services
160
Q

Throughout 1950s, what made TD the most popular premier in SK?

A

these HC measures & other welfare state measures

161
Q

The growing popularity of the CCF & their principles of HC pressured federal politicians to..

A

take these HC measures & expand them to the federal level

162
Q

Who was in power (federal) by the end of WWII?

A

Liberals under Mackenzie King

163
Q

What did the Liberals introduce for the 1st time that raised their popularity?

A

introduced welfare state policy at federal level

(the established pairing of Tories & Liberals was under threat)

164
Q

1948

A

Federal Gov. began program in giving hospital construction grants to provinces

165
Q

The 1950s saw the… than any other comparable period

A

fastest growth in hospital construction

166
Q

What became the centerpieces of modern HC?

A

hospitals

167
Q

1958

A

Fed. Gov. passed Hospital Insurance & Diagnostic Services Act

168
Q

Hospital Insurance & Diagnostic Services Act - 1958

A

modelled on SK Hospital Insurance Plan

  • made hospital services freely available nation-wide
169
Q

What led to the creation of the Hospital Insurance & Diagnostic Services Act in 1958?

A

the success of SK hospital plan & resultant public pressure to expand

170
Q

1959

A

TD announced CCF would be introducing Prepaid Medical Care (Medicare)

171
Q

the purpose of Prepaid Medical Care (Medicare)

A

to expand government funding from just paying for hospitals to all authorized medical services

effectively cutting all financial ties between doctor & patient

172
Q

Although the public was keen on the idea of Medicare, doctors were not. Why?

A

they were not able to raise their fees b/c they were taken out of free market & gov became their only client

173
Q

Medicare put the government in the position of ____ which would allow them to?

A

monopsonist - one who is a single buyer for product/ service of many sellers this would allow them to lower fees

174
Q

**1960 - **Provincial Election was all about?

A

those against and those for Medicare practically a referendum on HC

175
Q

What stance did the SK Medical Association have?

A

backed up by all right wing conservatives

mounted visious propaganda campaign against Tommy Douglas

  • called TD a **communist, fascist **
176
Q

Despite the SK Med Association’s attempts against Medicare…

A

Tommy Douglas was still reelected

177
Q

1961

A

introduced SK Medical Insurance Act which put medicare into practice in SK

178
Q

Tommy Douglas’s last act as premier

A

the SK MEDICAL INSURANCE ACT

179
Q

in 1961, TD resigned as premier and the CCF..

A

formed alliance with Trade Unions of the Canadian Labor Congress (umbrella organization of unions) - - - CCF became the **NDP **

180
Q

In 1962, when Medicare was introduced…

A

most SK doctors went on strike & suspended everything but emergency services (1st doc strike in Canada)

CCF stood firm & after 3 weeks, strike ended & doctors reached a sort of compromise with the government

181
Q

SK government gave doctors the option to opt-out & still bill individually. However this option died out because…

A

public would rather government pay for HC services

182
Q

by ___ over ___% of doctors were sending their bills directly to insurance commission

A

**1967 → **95%

183
Q

by 1967, over 95% of SK doctors were sending their bills directly to insurance commission, which means that..

A

SK established Medicare in the course of the 60s and was the 1st province to do so

184
Q

CCF became the?

A

NDP

185
Q

At the federal level, the NDP continued to press for?

A

overhaul of Canada’s HC system

186
Q

After continued pressure from NDP to change our HC system…

A

the Federal gov. established a Royal Commision to look into it (**Hall Report) **

187
Q

1964 - Hall Report looked at?

A

both public & private health insurance in Canada

188
Q

The Hall Report (1964) revealed that..?

A

private health insurance had existed for over 25 years

** **but only 50% of Canadians were covered & much of that coverage was inadequate

189
Q

After the findings outlined in the Hall Report, What did the federal government do?

A

Lester B. Pearson (Liberal PM) announced his gov. would introduce cost-sharing scheme

190
Q

cost-sharing scheme

A

federal gov paid 1/2 of prov. medical care program if they met the criteria of universal access

191
Q

1966

A

Medical Care Act - cost-sharing to provinces & brought Medicare to Canada as a whole

192
Q

Which provinces initially qualified for this cost-sharing proposal?

A

SK & BC all other prov. govs were right wing & opposed

193
Q

How did all the other provinces agree to Medicare?

A

SK & BC started recieving millions of dollars & other provinces wanted to get in on this

194
Q

by the end of 1970..

A

every province had introduced a universal medical insurance plan

195
Q

Although initially most doctors opposed Medicare, it gained their support for (2) reasons

A

1) doctors realized they couldnt win
2) quickly learned that their fear of gov. lowering their fees was unfounded

196
Q

Despite doctors worries of their fees being lowered, throughout the late 60s/early 70s…

A

doctors fees increased

197
Q

by mid-1970s, doctors average income was how many times the national average income?

A

5.5x

198
Q

between 1968 & 1978, the # of doctors increased by..

A

50% which is the largest single decade expansion in Canadian history

199
Q

Greatest expansion of government spending on HC

A

late 60s/early 70s

200
Q

The public supported the increase in gov. spending in HC as long as…

A

economy was in a boom period & there was plenty of $ to pay for HC

201
Q

However, the public’s view on increased HC spending changed in 1973 because?

A

Arabs countries formed OPEC (Organization of Petroleum Exporting Countries)

  • nearly quadrupled price of oil which increased cost of everything
  • profits fell & more businesses were going bankrupt
202
Q

This period of low wealth in Canada is known as?

A

the Great Recession - late 70s

203
Q

Age of Cutbacks

A

(70s) following the Great Recession

- new laws introduced to cut back on costs

204
Q

What act was established in 1977?

A

Established Programs Financing Act

205
Q

1977 - Established Programs Financing Act

A

changed basic principle of Medicare from cost-sharing to block funding

  • lump sum barely 1/2 of what federal funding had been the previous year, meaning provinces had to pay 3/4
206
Q

Since the change to block funding (global budgeting) Medicare has grown to be the …

A

largest single item on provincial budgets

207
Q

as of 2011, ___% of all provincial budgets was for Medicare

A

42%

208
Q

In order for provinces to pay for Medicare, the 1977 act also allowed them to..

A

raise taxes & introduce user fees on non-essential HC services (private room, tv/phone)

209
Q

Controversial method used by provinces to cut costs

A

doctors accepted lower fees & in exchange they were given the ability to extra-bill patients directly

210
Q

Extra-billing by 1980

A

Ontario & Alberta - over 1/3 of patients being extra billed Federal gov put a stop to this

211
Q

in 1984

A

Canada Health Act

212
Q

Canada Health Act- 1984

A

still the primary legal basis for HC in Canada

  • eliminated extra-billing indirectly
  • decided it was contrary to principles of Medicare
213
Q

how did the Canada Health Act indirectly eliminate extra-billing?

A

every dollar province saved from extra-billing would be lost from federal funding

214
Q

What was the problem with eliminating extra-billing?

A

doctors unhappy

215
Q

When Ontario implemented act at start of 1986…

A

led to 2nd doctors strike in Canadian history but quickly ended after only 3 weeks

216
Q

Who was in power during the 2nd doctors strike in 1986?

A

Conservaties under power of Brian Mulroney

217
Q

With the doctors defeated, the conservative gov. quickly moved to restrict…

A

growth in HC spending

218
Q

The conservative gov. restricted federal spending on HC in __, ___ and in ____ …

A

1986, 1989, and in 1990 - straight freeze on HC spending for foreseeable future

219
Q

While the Conservativeswere in office from1984 to 1992, they cut ___ ___ dollars from HC budget

A

30 billion

220
Q

as a result of this 30 billion $$ budget cut…

A

beds, wards & even hospitals shut down

221
Q

between 1986-1995…

A

of public hospitals fell by 15% # of hospital beds fell by 11%

222
Q

1993 - Political Party in Power

A

Liberals took over under Jean Chretien

223
Q

How did the Liberals change things in 1993?

A

found new way to introduce more cutbacks to HC & social programs in general

224
Q

1995 - changes to Transfer payments

A

Liberals put together Federal Transfer Payments for health, education & welfare into lump sum - Canada Health & Social Transfer (CHST)

225
Q

(2) advantaged of the CHST for the Fed. Gov.

A

1) cut total amount of $ going to provinces
2) deflected public attention to provinces

226
Q

How long did the CHST last?

A

Until 2003

227
Q

Since 2003, HC funding from Federal Government comes from?

A

Canada Health Transfer (CHT)

228
Q

between 1995 & 2003

A

cutbacks led to more closures of bed, wards & hospitals (Plains hospital in Regina closed in 1988)

229
Q

Also introduced other problems for HC system

A

staff shortages

de-insuring of med. services

lengthening of waiting lists across Canada

230
Q

most serious problem with the cutbacks introduced

A

hospitals turned away patients

  • even emergency patients
  • ambulances shuttled form hospital to hospital to find somewhere for patient
  • people died in ambulance
231
Q

1999 - consequences of cutbacks

A

patients died due to lack of beds/wards/hospitals in North Battleford, Yorkton & Prince Albert

232
Q

The cutbacks and resultant deaths led to?

A

This situation led to mounting public outrage/outcry

233
Q

When economy finally improved in __/___ __ …

A

mid/late 90s → provincial politicians began to demand more money from ottawa

234
Q

Premier’s Summits - all premiers agreed to…

A

demand more $$ for social programs in general & HC in particular

235
Q

1997

A

Turning point - under pressure from politicians federal gov. finally agreed to put more $$ into HC - 1.5 billion dollars

236
Q

1999 & 2000 - Funding for HC

A

further increases in federal funding announced

237
Q

By the time the CHST was broken up in 2003, how much had HC spending reached?

A

almost 20 billion dollars

238
Q

2003 - GDP spent on HC

A

9.46% of GDP was spent on HC

239
Q

in 2003, 9.46% of GDP was allocated to HC … how does this compare to 1992?

A

less than in 1992 - which was before liberal cutbacks but after conservative cutbacks

240
Q

2003 also saw report delivered by …

A

Royal Commission - headed by former SK premier - Roy Romanow

241
Q

Romanow Commission concluded that?

A

concluded that HC in Canada still needed major infusion of $$

242
Q

2004 - HC funding

A

Premiers help special HC conference which demanded an increase in HC funding from fed. gov.

243
Q

As a result of the 2004 special HC conference…

A

Fed. Gov. committed 41.3$ billion dollars for HC over next 10 years

244
Q

2006 - Political Party in Power

A

Stephen Harper & Conservatives elected - only had minority

245
Q

2011 - Political Party in Power

A

Harper obtained majority gov.

246
Q

One of the first things Harper did once he obtained a majority government was…

A

cut 36 billion from Canada Health Transfer to save money (real motive is believed to be because he wanted to open up possibility of private HC companies)

247
Q

Harper’s cutbacks put a lot of pressure on ___ & ___ __

A

politicians & HC workers

doctors & nurses told to do more with less

  • expected to treat more patients in less time with

resources

248
Q

Inevitable result of this pressure on doctors

A

rise in physical & mental exhaustion which adversely affect their health & job performance (& indirectly affects the health of the public)

249
Q

Occupation in crisis

A

Nurses

250
Q

Impact of cutbacks on Doctors vs. Nurses

A

doctors have always been a relatively privileged group

  • still had to work harder (reported increased stress) but incomes have remained high

Nurses have received the most pressure yet earn the same as national avg income

251
Q

in 2012, average annual income of:

a) GPs
b) specialists

A

a) 180k
b) 350k

252
Q

History of nursing begins with?

A

Florence Nightingale

253
Q

Florence Nightingale - background before Crimean war

A

born into relatively wealthy family in 1820 - strong-willed woman - despite her familys strong objections to working as a nurse, she studied HC anyways - became director of nursing home in England where she transformed it into an efficient little hospital

254
Q

Nightingale effectively transformed nursing from… into…?

A

FROM occupation restricted to untrained nuns/charity workers INTO genuine occupation requiring vocational education

255
Q

Nightingale is famous for her work in? (years?)

A

the Crimean War (1853-1856)

256
Q

What was the nickname Nightingale earned in the Crimean war? For what reason?

A

Lady with the Lamp - for her nightly rounds of checkin on patients with her lamp

257
Q

When Nightingale and her group of nurses first arrived in Crimea, how were they recieved?

A

met with hostility from doctors there (doctors were obsessed about maintaining control/a monopoly over HC)

258
Q

How did Nightingale respond to the doctors hostility? (3 pts)

A

reassured them that nurses were not competition and were strictly there to obey the doctors orders & do women’s work (cooking & cleaning)

259
Q

How did Nightingale make a difference by cooking & cleaning in the Crimean War (1853-1856)?

A

by taking over cooking & cleaning, she was able to introduce proper standards of nutrition & sanitation which was previously ignored by male doctors - mortality rates declined sharply

260
Q

One famous case where Nightingale helped improve sanitation

A

persuaded military officers to go upstream & found dead horse spewing bacteria - convinced them to move it

261
Q

Florence Nightingale -After Crimean War

A

took heavy toll on her, was ill & bed-ridden most of her life - became public heroine & used her fame to write about nursing, engage in political activism & organizational work that laid the foundation for modern nurse training

262
Q

Nursing - occupation for women

A

virtually only paid occupation for women - therefore it was very attractive for those who wanted an education & career (middle-class womeN)

263
Q

First Nursing School in Canada

A

St.Catharines - established in 1874 in Ontario - based on Nightingales model of nursing

264
Q

of nursing schools in Canada in… a) 1900 b) by 1909 c) by 1930

A

a) 20 b) 170 c) 220

265
Q

The first 30 years of the 20th Century were known as the period that..

A

saw the greatest expansion in nursing

266
Q

Impact of the Flexner Report on Nursing

A

following the recommendations of the Flexner report, the **first university degree program in nursing was established in 1919 at UBC **

267
Q

1900s: # of nurses vs doctors

A

200 nurses compared to 5,000 doctors

268
Q

1930: # of nurses vs doctors

A

30,000 nurses compared to 10,000

269
Q

After 1930, what happened to the rate of growth of nursing?

A

declined

270
Q

Despite the decline in the rate of growth of nursing after 1930, Throughout the 20th Century…

A

nursing maintained average annual increase of 50% - compared to less than 10% for doctors

271
Q

By 2006, How many registered nurses in Canada? What % were women?

A

320,000 94% women

272
Q

Nurses made up __ of all HC providers becoming the…

A

2/3 single largest profession in Canada

273
Q

In economic terms, the expansion of nursing allowed…

A

Canadian women to get back into the labor market from which they had been virtually squeezed out of by late 19th century

274
Q

Routes for Economic Independance for women in early 20th century? (2)

A

1) Inheritance 2) nursing

275
Q

Despite being the only route to independance (apart from inheritance) for women, there were still drawbacks/limitations..

A

hard road to travel only gave limited form of independance

276
Q

Although Nightingale herself was strong & independent, her teaching methods demanded…

A

strict obediance to male doctors

277
Q

Argument about Nightingale’s teaching methods

A

some say she did a disservice to women but may have been the only way to be accepted & overcome the hostility of male doctors

278
Q

Only way that nursing could be accepted by doctors was if…

A

they defined themselves as an AUXILLARY OCCUPATION to that of doctors (a supplementary occupation)

279
Q

The general attitude about nursing by male doctors

A

women were still doing women’s work, just in a hospital setting - which was acceptable to male docs at the time

280
Q

Connection b/w Patriarchal relations that existed in Victorian family/society & HC

A

the patriarchal relations that existed in Victorian society/family (era: 1837-1901) were reproduced within the hospital

281
Q

The Patriarchal (male-dominated gender) relations that existed in Victorian society/family were reproduced within hospital, creating…

A

a new gender division of labor in HC

282
Q

Men providing cuts & chemicals (surgery & drugs) & women providing nutrition & sanitation was a reasonable division of labor. However, the problem was..

A

men ended up taking most of the money & power but the women did most of the work - particularly nursing students

283
Q

Early 20th Century - nursing students

A
  • treated like slave laborers - work consisted of hard manual labor (washing floors/windows, changing beds, cooking) - forced to work 12-16 hours/day in hospital WITHOUT pay - only received training, room and board
284
Q

When did Nursing students get paid? How much compared to average male wage?

A

Only after they had graduated & recieved their Nursing Diploma - only 1/2 of average male wage

285
Q

Nursing students training consisted of..

A

mostly on-the-job training which consisted of working hard while being supervised by small permanent staff of grad nurses - no time for actual study/theory

286
Q

How long to finish a Nursing Degree in the early 20th century?

A

2-3 years

287
Q

How did the hospitals benefit from nursing students in the late early 20th century?

A

provided hospitals with rotating pool of cheap labor

288
Q

After graduation, where would nurses work?

A

some worked as private nurses but increasings #s found jobs in hospitals

289
Q

The explosive growth of nursing schools was greatly motivated by?

A

the desire of hospital administrators & doctors to have cheap labor

290
Q

What effect did permanent nursing staff have on hospitals?

A

no more cheap labor - less motivation for growth of nursing profession

291
Q

How did nursing change hospitals in early 20th Century compared to 19th century?

A

19th century - hospitals were places people only went to die 20th - changed hospitals into hygienic centers of care & recovery which changed public image of hospitals

292
Q

Nursing made major contribution to…

A

medical profession & doctors reputation yet still they were heavily exploited - paid virtually nothing for a lot of work

293
Q

As the # of nurses rose, they begin to..

A

fight for their rights

294
Q

Nurses realized the only way to get better wages & working conditions was through (2)?

A

self-organization & collective action

295
Q

1908

A

Canadians Nurses established Canadian National Association of Trained Nurses (CNATN)

296
Q

1924

A

reorganization CNATN and renamed as Canadian Nurses Assocation

297
Q

Canadian Nurses Association

A

still remains main organization that represents nurses interests today

298
Q

First goal of CNATN in 1908

A

establish provincial registries of qualified nurses -only these nurses could practice nursing

299
Q

1910

A

began to set up registries & nurses became known as RNs

300
Q

Through the process of registering nurses.. the nursing profession tried to…

A

gain monopoly on role of assistant caregiver but never been as successful as doctors in achieving a monopoly

301
Q

By WW2 (1939-1945) ..Nurses

A

organized enough to gain some concessions - gained 8 hour day

302
Q

1950 - nurses income

A

nurses pay was 60% of avg national income

303
Q

by 1980 - nurses income

A

risen to avg national income - mostly due to pressure from nurses

304
Q

In addition to pushing for better wages & working conditions, Nurses also demanded?

A

real education and not just on-the-job training

305
Q

1964 - Nursing

A

Hall report - Royal commission looking into HC delivered report that was critical of nursing education in Canada

306
Q

The Hall Report of 1964 recommended what change to nursing?

A

seperation of nursing training from hospital demands for nursing services (nursing education should be seperate from training)

307
Q

How did the government respond to the Royal Commission’s recommendations of seperating nursing education from training?

A

in late 60s/early 70s → nursing education moved away from hospital schools into newly created diploma programs in universities

308
Q

Nursing ___ & ___ significantly improved after the government responded to the Royal Commissions recommendations.

A

skills & standards

309
Q

What other change did the government make other than to nursing education?

A

changed immigration policy to attract more nurses

310
Q

As a result of he change in Canadian immigration policy…

A

over 20,000 nurses immigrated to Canada - mostly from Britain

311
Q

Britain’s NHS

A

Britain’s National Health Service/System (NHS) was more advanced & developed than Canada’s HC system

312
Q

NHS - impact on Canadian HC

A

Canadian government deliberately tried to upgrade nursing standards & increase # of nurses

313
Q

The government’s attempts to upgrade nursing standards & increase # of nurses by changing immigration laws was part of..

A

overall policy of Canada to establish Medicare by copying Britain’s NHS

314
Q

Time period that saw considerable expansion in # of nurses

A

1960s & 1870s

315
Q

The expansion in the # of nurses in 60s & 70s was accompanied by..

A

a growing division of labor

316
Q

Nursing saw an increase in (3) things

A

1) specialization 2) fragmentation 3) hierarchization

317
Q

Nursing began to generate its own __ ___

A

auxilliary occupations (therapists, dieticians, orderlies, technicians)

318
Q

specialization of nursing

A

some nurses took more education to upgrade their qualifications & specialize in one area of nursing - realized pay only increased marginally (still 3/4 of nurses are general duty nurses)

319
Q

While there were some changes in nursing, more changes changes occured where?

A

at bottom of occupational ladder- auxiliary occupations

320
Q

How did hospital administrator try to cut nurses wage bill after they had just gotten their wages increased?

A

replaced many nurses with registered nursing assistants (1970s) - when RNAs got organized & pushed for higher wages, they were replaced with nursing attendants (1980s)

321
Q

The replacement of nurses with registered nursing assistants & then nursings attendants demonstrates…

A

class struggle in action which is seen in any area of the economy - cycle that is built into capitalism

322
Q

Despite all these changes to the Nursing field, what remained constant? How?

A

Ongoing feminization of HC system - by 1990s, 2/3 of HC system workers were nurses (90% women) nearly 80% of all HC workers = women

323
Q

Despite the increasing proportion of women in the HC system..

A

women’s influence & power has not grown in proportion to their #s

324
Q

in the late 80s/90s, how were hospital bills broken down?

A

into thirds 1/3 for doctors 1/3 for nurses 1/3 for administrative & support staff

325
Q

Nursing expanded greatly in 60s & 70s, but in 80s & 90s, there was a major increase in..

A

administrative staff

326
Q

(2) reasons for the major increase in administrative staff in hospitals

A

1) certain support services were removed from nursing & subcontracted to private companies 2) growth & change in kind of hospital administrators

327
Q

80s → certain support services removed from nursing

A

hotel services (cooking, cleaning, laundry, catering) were no longer nurses responsibility & hospitals subcontracted these to private companies

328
Q

What was the beginning of privatization of HC

A

subcontracting private companies for hotel services

329
Q

Growth & change in in kind of hospital administrators

A

in 5 years (1981-86), # of HC administrators grew by over 2/3s - hospitals began to hire administrators outside of HC field - mostly managers from private sector who had an education in management & not HC

330
Q

Before the 80s, who were hospital administrators?

A

mostly doctors or other HC workers that had climbed administrative ladder internally

331
Q

by 1993.. HC administrators characteristics

A

1/3 of HC administrators had NO HC experience - mostly men - business degree/experience in management

332
Q

Changes in control/influence due to the new kind of hospital administrators

A

doctors lost control of hospitals - womens influence decline

333
Q

How did these new hospital administrators view their job & how did this affect working in the hospital?

A

saw their job as the same kind they had in private sector - pressure workers work as hard as possible

334
Q

Why did most of pressure from hospital administrators fall on nurses?

A

doctors were still seen as relatively privileged group, middle-class professionals who deserved to not be pushed as hard

335
Q

Managerial structure emerged in hospitals

A

private administrators > doctors > nurses & auxiliaries

336
Q

To the hospital administrators, nurses were seen as..

A

the working class of the HC system which management has always pushed to work harder

337
Q

How did Hospital administrators push nurses to work harder??

A

through the process of deskilling

338
Q

deskilling

A

breaking down jobs into simple tasks so highly paid experts can be replaced with less-skilled cheaper workers

339
Q

(2) advantages of deskilling for management

A

1) increased control over workforce 2) saves $$ by decreased wage bill

340
Q

Deskilling - first noted in academic terms by..

A

Chares Babbaged in early 19th Century →known as Babbage Principle

341
Q

Other terms for deskilling

A

late 19th century → Fordism (Henry Ford) early 20th→ Taylorism (named after Frederick Taylor who invented time & motion studies & scientific management) late 20th→ Mcdonaldization

342
Q

Terms for Deskilling within the field of HC

A

Managerial Ideology Case-mix grouping Total Quality Management

343
Q

Why should TQM be called Totalitarian Quality Management?

A

because it introduces total control over nurses work

344
Q

What were nurses told that TQM do?

A
  • provide greater autonomy - make jobs easier by improving job efficiency - hep assess staffing needs
345
Q

What did TQM actually do?

A

breaks down nursing into specific jobs & assigning specific amounts of time for each task (based on polls asking nurses how much time they needed for each) - allowed administration to cut amount of time allowed for each job to force nurses to work harder/faster & save money by not hiring more nurses

346
Q

Negative consequences of TQM

A

TQM was taken from factory work where assembly lines can be standardized to improve efficiency - However, people are not machines & HC cannot be standarized because it wouldnt account for personal differences

347
Q

How does the standardization of HC by TQM affect nursing care how?

A

left nurses without enough time so that they were constantly falling behind on tasks - made decision making difficult b/c they had less time to make possibly life-or-death choices

348
Q

Quality of Care given by nurses after TQM introduced

A

of mistakes increased # of people harmed increased because they did not have enough time

349
Q

TQM’s attempt to standardize HC ad negative effects on…

A

the patients & the nurses

350
Q

Study by Canadian Institute for Health Information (2004) - main finding

A

over 5 million CDNs reported they or member of their family had been harmed by medical errors in hospital

351
Q

Study by Canadian Institute for Health Information (2004) statistics given (5)

A
  • 1 in 9 reported receiving incorrect medication/dosage - 1/9 adults & 1/11 children contracted infection - 1/81 newborns suffered birth trauma - 1/~1000 seniors suffer hip fracture - 1/~7000 reported having foreign object left inside them after procedure
352
Q

TQM treats nurses as if they were?

A

interchangeable components on assembly line

353
Q

How has TQM resulted in a lack of continuity of HC?

A

different nurses do different jobs on same patient → unable to learn patients overall health situation so nurses can’t treat patients like individual with individual needs

354
Q

TQM is the ultimate extension of? & denial of?

A

extension of male mechanical model & denial of traditional holistic female approach to HC

355
Q

TQM turned the continuous process of care into?

A

series of compartmentalized cures that were about seeing to a patients minimum needs

356
Q

TQM also eliminated..

A

subjective side of HC - part of nurses work called emotional labor

357
Q

Explain how private sector administrators view HC & how that is reflected in their management.

A

administrators deal with balance sheets, numbers & money - the comfort that nurses provided is invisible & seen as a waste of time that must be eliminated to increase speed, efficiency & decrease cost

358
Q

How does TQM treat a) nurses b) patients

A

a) as if they were uneducated unskilled labourers who have to be told what/how/when to do things b) treats patients in a standardized manner

359
Q

In Sociological Terms, professionals want control over their own __ __

A

labor process

360
Q

TQM has greatly increased level of ___ that nurses experience from their jobs

A

alienation

361
Q

How has TQM affected quality of care given by nurses? How has this affected hospital in last 30 years?

A

has forced them to do their jobs badly bc they do not have enough time or resources - health sanitation & nutrition levels declined over last 30 years

362
Q

In general, how has TQM affected nurses?

A
  • decrease in quality of care (more mistakes etc) - behind in work - decreased morale - blame themselves - increased physical & mental stress - rise in work-related injuries & illness
363
Q

By the late 1990s, as a result of TQM, nursing has become known as..

A

the sickest profession in Canada

364
Q

Nursing - Sickest Profession in Canada - Example

A

1997 - sick leave avg CDN = 1 week nurses = weeks

365
Q

Nurse Burnout

A

in 1990s, as a result of TQM - many nurses quit because they couldn’t take the pressure

366
Q

Why is the phenomenon known as Nurse Burnout only happening in the later 20th Century?

A

in the late 19th/early 20th Century, nursing was really the only acceptable & paid job for women

367
Q

2000 - Canadian Nurses Association study found..

A

~ 1/3 nurse graduates left canadian nursing within 5 years of graduating - 20% quit altogether - 10% went to USA to work in private sector (paid more)

368
Q

What decade saw a sharp decline in the # of applicants & graduates of nursing schools?

A

1990s

369
Q

Nurses graduated in Canada in 1999 vs. 2000

A

1999 - ~9000 2000- <5000

370
Q

How did Nurses try to fight back against the increasing stress put on them? (3)

A

in late 1980s, Nurses Union proclaimed TQM was endangering patients life through pressure putting on nurses Provincial Nurses Unions took a stand on SAFETY TO PRACTICE issues - went on strike

371
Q

First Wave of Nursing Strike

A

bc they were being completely ignored, wave of nursing strikes swept across Canada in late 80s/early 90s

372
Q

late 80s/early 90s Nursing Strikes

A

1988- SK & BC 1989 - BC & Quebec 1991 - Manitoba (longest strike)

373
Q

What was the result of the Nursing strikes?

A

a professional responsibility clause was added to nurses contracts that established channels for nurses to express their grievances

374
Q

Second wave of nursing strikes - when?

A

late 90s/early 2000s 1999- SK

375
Q

How did SK government respond to SK nurses going on strike

A

NDP gov met nurses w/ great hostility despite being party of the working class - ready to enact back to work legislation - used courts to threaten unions with fines & leaders with prison time

376
Q

Throughout the 2000s, nurses have been ___, ___ & ____

A

overstressed over-supervises over-worked

377
Q

2003 Statistics - Nurses Overtime

A

CDN nurses worked over a quarter million overtime hours in a week - equivalent to work of 7,000 full-time jobs a year

378
Q

2005 - Study on Ontario Nurses - findings

A

58% of nurses & 66% of junior nurses experiencing symptoms of nurse burnout 1 in 3 nurses under 30 plan to quit 1 in 3 over 50 plan to retire early

379
Q

2005 Study on Ontario Nurses - Symptoms of nurse-burnout - reasons for symptoms of nurse-burnout? (3)

A
  • depression, emotional/physical exhaustion, physical illness & growing cynicism of job 1) work overload 2) lack of fairness in workplace 3) lack of empowerment (increasing supervision & not in control)
380
Q

How does TQM put more pressure on nurses to quit?

A

their job involves making life-or-death decisions - mistakes increasing because of lack of resources/time/people - worries nurses b/c patient life & health is compromised

381
Q

How has SK addressed this issue of nurse burnout?

A

In 2012, Premier Brad Wall announced that SK will once again lead way for Canada in improving HC (just like TD did) → 1st province to introduce LEAN Management

382
Q

LEAN Management in SK

A

in 2012, SK government signed 4 year contract with Seattle-based company John Black & Associates - pay 40 million over 4 years to teach LEAN management techniques in over 1,000 HC facilities

383
Q

Origin of LEAN

A

Japan

384
Q

Sensei (meaning)

A

one who has gone this way before voice of experience teacher

385
Q

How did the public view LEAN?

A

initially well until 2014 - was criticized for 40 million $ price rage - Cam Broten of NDP called lean a “cult”

386
Q

How has SK Premier defended Lean & its 40 million dollar cost?

A

says that LEAN management has already more than paid for itself - by eliminating waste & improving efficiency, has saved 35 million in blood services, 16 mill in design of new hospitals in Saskatoon & Moosejaw & million more in 100s of small savings in HC facilities all across province

387
Q

How was lean created?

A

Toyota automobile corp. - the term was coined by American Analyst John Krafcik who wrote article about Toyota in 1988 - introduced idea of LEAN to the west

388
Q

Toyota - History

A

founded in 1930s as small family business -has since grown to be the 5th largest corporation

389
Q

The Toyota Way - History & Basis

A

based its production on assembly line techniques pioneered by Henry Ford In USA - concerned with efficiency & elimination of waste by standardized & simplified production process - an extension of Fordism & based on Taylorism (time & motion studies) - Flow System -production should flow smoothly - no bottle necks of unused resources - aka Just in Time system - each person finished their part of job just in time for next person to take over - dont need lots of backup inventory (save $$) -

390
Q

The Toyota Way Philosphy (6) points

A
  • managerial philosophy - established culture where everyone is committed to looking for ways to improve process - regular meetings to look for ways to do things better -emphasizes teamwork, mutual respect bw management & employees & constantly improving - decisions made by reaching consensus
391
Q

How does the Toyota Way differ from standard manager-worker relationships

A

management regularly consults workers & gets feedback - workers are involved in the decision-making process & their opinions are respected - makes them feel like it is their company so they want to be more efficient & finds ways to do job better

392
Q

What does Toyota literature say is the primary reason behind their time-saving techniques?

A

these time-saving techniques are by-products of the positive attitude,teamwork, mutual respect & culture of improving workforce

393
Q

Why is the Toyota Way unsuccessful for many companies over the longterm?

A

most managers dont think & dont want to think this way - they beleive that managers should give orders & workers should obey (top-down manner) - rather than set up meetings, they hire Sensei’s to tell workers what to do which makes workers angry, decreases morale & makes workers less engaged

SOC 222 (13 decks)

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