Leadership for success in transforming medical abortion policy in Canada
Autoři:
Brigid Dineley aff001; Sarah Munro aff001; Wendy V. Norman aff003
Působiště autorů:
Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
aff001; Centre for Health Evaluation and Outcome Sciences (CHÉOS), Vancouver, Canada
aff002; Department of Family Practice, University of British Columbia, Vancouver, Canada
aff003; Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, England
aff004
Vyšlo v časopise:
PLoS ONE 15(1)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0227216
Souhrn
Objectives
Mifepristone was approved for use in medical abortion by Health Canada in 2015. Approval was accompanied by regulations that prohibited pharmacist dispensing of the medication. Reproductive health advocates in Canada recognized this regulation would limit access to medical abortion and successfully worked to have this regulation removed in 2017. The purpose of this study was to assess the leadership involved in changing these regulations so that the success may be replicated by other groups advocating for health policy change.
Methods
This study involved a mixed methods instrumental design in the context of British Columbia, Canada. Our data collection included: a) interviews with seven key individuals, representing the organizations that worked in concert for change to Canadian mifepristone regulations, and b) document analysis of press articles, correspondence, briefing notes, and meeting minutes. We conducted a thematic analysis of transcripts of audio-recorded interviews. We identified strengths and weaknesses of the team dynamic using the Develop Coalitions, Achieve Results and Systems Transformation domains of the LEADS Framework.
Results
Our analysis of participant interviews indicates that autonomy, shared values, and clarity in communication were integral to the success of the group’s work. Analysis using the LEADS Framework showed that individuals possessed many of the capabilities identified as being necessary for successful health policy leadership. A lack of post-project assessment was identified as a possible limitation and could be incorporated in future work to strengthen dynamics especially when a desired outcome is not achieved. Document analysis provided a clear time-line of the work completed and suggested that strong communication between team members was another key to success.
Conclusions
The results of our analysis of the interviews and documents provide valuable insight into the workings of a successful group committed to a common goal. The existing collegial and trusting relationships between key stakeholders allowed for interdisciplinary collaboration, rapid mobilization, and identification of issues that facilitated successful Canadian global-first deregulation of mifepristone dispensing.
Klíčová slova:
Allied health care professionals – Canada – Drug regulation – Health care policy – Health systems strengthening – Pharmacists – Physicians – Termination of pregnancy
Zdroje
1. Dickson RGB, Beetz J, Estey W, McIntyre W, Lamer A, Wilson B. La Forest G V. R. v. Morgentaler—SCC Cases (Lexum). 1988. Available: https://scc-csc.lexum.com/scc-csc/scc-csc/en/item/288/index.do
2. Shaw D, Norman W V. When there are no abortion laws: A case study of Canada. Best Pract Res Clin Obstet Gynaecol. 2019 [cited 14 Oct 2019]. doi: 10.1016/J.BPOBGYN.2019.05.010
3. Colekessian A. UN human rights body slams Canada for failure to ensure access to abortion, affordable contraception | Action Canada for Sexual Health and Rights. In: November [Internet]. 2016 [cited 14 Oct 2019]. Available: https://www.actioncanadashr.org/about-us/media/2016-11-21-un-human-rights-body-slams-canada-failure-ensure-access-abortion-affordable-contraception
4. Norman W V., Guilbert ER, Okpaleke C, Hayden AS, Lichtenberg ES, Paul M, et al. Abortion health services in Canada Results of a 2012 national survey. Can Fam Physician. 2016;62: e209–e217. 28192276
5. Sethna C, Doull M. Far from home? A pilot study tracking women’s journeys to a Canadian abortion clinic. J Obstet Gynaecol Can. 2007;29: 640–7. Available: http://www.ncbi.nlm.nih.gov/pubmed/17714617 doi: 10.1016/s1701-2163(16)32560-9 17714617
6. Sethna C, Doull M. Spatial disparities and travel to freestanding abortion clinics in Canada. Womens Stud Int Forum. 2013;38: 52–62. doi: 10.1016/J.WSIF.2013.02.001
7. Norman W V, Soon JA. Requiring physicians to dispense mifepristone: an unnecessary limit on safety and access to medical abortion. CMAJ. 2016;188: E429–E430. doi: 10.1503/cmaj.160581 27754893
8. Costescu D, Guilbert E, Bernardin J, Black A, Dunn S, Fitzsimmons B, et al. Medical Abortion. J Obstet Gynaecol Canada. 2016;38: 366–389. doi: 10.1016/j.jogc.2016.01.002
9. Health Canada. Regulatory Decision Summary: Mifegymiso. Ottawa, ON; 2015.
10. Gold M, Chong E. If we can do it for misoprostol, why not for mifepristone? The case for taking mifepristone out of the office in medical abortion. Contraception. 2015;92: 194–196. doi: 10.1016/j.contraception.2015.06.011 26093187
11. Dawson AJ, Nicolls R, Bateson D, Doab A, Estoesta J, Brassil A, et al. Medical termination of pregnancy in general practice in Australia: a descriptive-interpretive qualitative study. Reprod Health. 2017;14: 39. doi: 10.1186/s12978-017-0303-8 28288649
12. College of Physicians and Surgeons of British Columbia. Professional Standards and Guidelines: Dispensing and Sale of Pharmaceuticals by Physicians and Surgeon of British Columbia. Vancouver; 2009.
13. College of Pharmacists of British Columbia. Health Professionals Act. Part 1: Community Pharmacy Standards of Practice. Vancouver; 2016.
14. LEADS Collaborative. Health Leadership Capabilities Framework. 2010.
15. Dickson G, Van Aerde J. Enabling physicians to lead: Canada’s LEADS framework. Leadersh Heal Serv. 2018;31: 183–194. doi: 10.1108/LHS-12-2017-0077
16. Gifford W, Graham ID, Ehrhart MG, Davies BL, Aarons GA. Ottawa Model of Implementation Leadership and Implementation Leadership Scale: mapping concepts for developing and evaluating theory-based leadership interventions. J Healthc Leadersh. 2017;9: 15–23. doi: 10.2147/JHL.S125558 29355212
17. Norman W V, Munro S, Brooks M, Devane C, Guilbert E, Renner R, et al. Could implementation of mifepristone address Canada’s urban–rural abortion access disparity: a mixed-methods implementation study protocol. BMJ Open. 2019;9: e028443. doi: 10.1136/bmjopen-2018-028443 31005943
18. Munro S, Dineley B, Davies C, Norman W V. 6TH BC Women’s and CART Meeting: Contraception & Abortion in BC: Experience Guiding Research Guiding Care.
19. Dineley B, Oetter H. Personal Correspondence. 2019.
20. Kirkey S. Home abortion pill about to hit market in Canada, but has already garnered criticism. National Post. 19 Apr 2016.
21. Board OCE. No Title. Ottawa Citizen. 20 Apr 2016.
22. Picard A. Abortion pill’s sexist regulations deny women true reproductive choice. The Globe and Mail. 16 May 2016.
23. Oetter H. Registrar’s message—prescribing Mifegymiso will require clear and concise communication between physicians, patients and pharmacists | College of Physicians and Surgeons of British Columbia. Coll Connect. 2016;4. Available: https://www.cpsbc.ca/for-physicians/college-connector/2016-V04-06/01
24. Grant K. B.C. regulators plan to let pharmacists distribute abortion pills. The Globe and Mail. 17 Oct 2016.
25. Health Canada. Mifegymiso Canadian Distribution and Administration Porgram. 2017.
26. LEADS Collaborative. Develop Coalitions Executive Summary. 2010.
27. LEADS Collaborative. Achieve Results Executive Summary. 2010.
28. LEADS Collaborative. Systems Transformation Executive Summary. 2010.
29. Academy A. Plan,Do, Study, ACt PDSA cycles and the model for improvement.
30. BC Women’s Hospital. Vision, Mission, Values. [cited 2 Aug 2019]. Available: http://www.bcwomens.ca/about/who-we-are/vision-mission-values
31. Overton A, Lowry A. Conflict Management: Difficult Conversations with Difficult People. Clin Colon Rectal Surg. 2013;26: 259–264. doi: 10.1055/s-0033-1356728 24436688
32. Watt A. Project Management. BC Open Textbook Project; 2012. Available: https://opentextbc.ca/projectmanagement/
33. Policy JD-I of H, Evaluation M and, 2013 undefined. Exploring the dynamics of physician engagement and leadership for health system improvement prospects for Canadian. cahspr.ca. [cited 2 Aug 2019]. Available: https://cahspr.ca/web/uploads/conference/2014-02-14_Exploring_the_Dynamics_of_Physician_Engagement.pdf
34. Agendas Kingdon J., Alternatives and Public Policies. 2nd ed. New York, NY: Pearson; 2003.
35. Guilbert E., Wagner M-S., Munro S., Wilcox ES., Devane C., Dunn S., Soon J., Norman W. La pilule abortive au Québec en 2019 –Pourquoi n’est-elle pas plus accessible? Rapport de recherche de la CART-MIFE-Study. Quebec; 2019.
36. Berer M. Reconceptualizing safe abortion and abortion services in the age of abortion pills: A discussion paper. Best Pract Res Clin Obstet Gynaecol. 2019 [cited 14 Oct 2019]. doi: 10.1016/j.bpobgyn.2019.07.012
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