Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Social Work

Faculty/School

Lyle S. Hallman Faculty of Social Work

First Advisor

Dr. Anne Westhues

Advisor Role

Doctoral Advisor

Abstract

Inspired by critical social work practice, this study engages in a discourse analysis of Ontario’s Family Health Team (FHT) model. The purpose for this study is threefold; namely, a) to deepen our understanding of health discourses promoted by Ontario’s FHT model; b) to explore how Ontario’s FHT model compares to Haggerty, Burge, Lévesque, Gass, Pineault, Beaulieu, & Santor’s (2007) conceptual model of PHC; and c) to promote critical reflection in order to help inform decisions on how to improve quality of care and enhance health equity in FHTs. This study is guided using the overarching question: What health care practices and organizational structures are encouraged by the FHT model?

Discourse analysis guides the investigation using Gee’s (2001a) combination of saying, doing, and being. Two data sources inform this study: MOHLTC documents and in-depth interviews with seven policy informants and twenty-nine FHT leaders. Two key findings are presented in this dissertation: foundational PHC attributes shaping FHTs and inadequate performance indicators. Foundational PHC attributes examines and describes the four key PHC attributes that underpin the FHT model. These include: first-contact accessibility, accommodation accessibility, comprehensiveness of services, and interdisciplinary team. The second key finding is inadequate performance indicators and reveals that measures being used to evaluate FHT success are posing challenges to FHT health care practices, FHT structures, and health outcomes. This study demonstrates that performance indicators are inadequate because they are: a) valuing quantity; b) volume is influencing health care practices in FHTs; c) inaccurate measurement is shaping FHT organizations, and d) the volume emphasis is encouraging acuity in health outcomes.

Convocation Year

2013

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