Accountability in the Home and Community Care Sector in Ontario
Bibliographic record
Abstract
This research seeks to identify what accountability frameworks were in place for the home and community care sector in the Canadian province of Ontario, how home and community care agencies in Ontario responded to accountability demands attached to government service funding (specifically through Community Care Access Centre (CCAC) contracts and Local Health Integration Network (LHIN) Multi-Service Accountability Agreements (MSAAs) and what, if any, effect accountability frameworks had on service delivery. \nThis study uses a multi-phase parallel mixed methods approach. First, an environmental scan and document analysis was conducted to identify accountability frameworks and identify key characteristics of accountability demands. Next, 114 home and community care agencies in Ontario were surveyed and 20 key informant interviews were conducted with executives from 13 home and community care agencies, two CCACs and two LHINs. Data from these different methods were combined in the analysis phase.\nHome and community care agencies face multiple accountability requirements from a variety of stakeholders. We found that government agencies relied most heavily on regulatory and expenditure policy instruments to hold home and community care organizations to account. Organizational size and financial dependence were significantly related to organizational compliance to accountability demands attached to CCAC contracts and MSAAs. In addition to the theorized potential organizational responses to external demands (compliance, compromise, avoidance and defiance), this study found that organizations engaged in internal modification where internal practices are changed to meet accountability requirements. Smaller, more poorly resourced organizations that were highly dependent on LHINs or CCACs were more likely to internally modify organizational practice to meet accountability demands. Although MSAAs and CCAC contracts supported a quality culture amongst organizations, internal organizational changes, such as redirecting time towards reporting requirements and away from care, and cutting innovative practices and programs, were reported to have a negative impact on the quality of service delivery. \nGovernment reliance on contract-based accountability for funded home and community care services, while politically advantageous, has the potential to seriously and negatively affect the quality of home and community services delivered. Policy makers need to carefully consider the potential impact on quality of service delivery when developing and implementing accountability policy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.004 |
| Science and technology studies | 0.011 | 0.003 |
| Scholarly communication | 0.004 | 0.001 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".