DEVOLVING AUTHORITY FOR HEALTH-CARE IN CANADA PROVINCES .3. MOTIVATIONS, ATTITUDES AND APPROACHES OF BOARD MEMBERS

Objective: To obtain information from the members of the boards oi dev olved health care authorities on their motivations, attitudes and appr oaches, to evaluate their relative orientations to the expectations of provincial governments, local providers and community members, and to evaluate the influence of members being employees in health care or s ocial services and being willing to stand for election. Design: Mail s urvey conducted in cooperation with the devolved authorities during th e summer of 1995. Setting: Three provinces (Alberta, Saskatchewan and Prince Edward Island) with established boards and 2 provinces (British Columbia and Nova Scotia) with immature boards. Participants: All 791 members of the boards of devolved authorities in the 5 provinces, of whom 514 (65%) responded. Outcome measures: Respondents' declared moti vations, levels of confidence in board performance and attitudes towar d accountability; differences between members who were willing to run for election to boards and others and differences between members who were employees in health care or social services and others. Results: The main motivations of board members were an interest in health care and a desire to be part of decision-making, and their main concern was inadequacy of data for decision-making. Almost all (93%) felt that th ey made good decisions, and 69% thought that they made better decision s than those previously made by the provincial government. Most (72%) felt that they were accountable to all of the local citizens, although nearly 30% stated that they represented the interests of a specific g eographic area or group. Attitudes toward their provincial governments were polarized, with half agreeing and half disagreeing that provinci al rules restrict the board members. The board members who were employ ed in health care and social services and those who were willing to st and for election did not differ substantially from their counterparts, although potential electoral candidates were less likely than others to feel accountable to provincial-level constituencies (such as taxpay ers and the minister of health) and more likely to represent the inter ests of a specific geographic area or group. Only a modest number of d ifferences were found among members from different provinces. Conclusi ons: Board members' strong feelings of accountability to and represent ation of local citizens could counteract the structural influences lea ding board members to favour the interests of provincial governments a nd providers.