Researcher Spotlight: Pam Baxter

Feb 3, 2021
By Guylaine Spencer

Pam Baxter

Leadership in health care has been the focal point of Dr. Pam Baxter’s research for more than 10 years.

“I started out with education as my focus, but unfortunately, there is very little funding for that area,” Baxter says. “I transitioned into interprofessional collaboration, and from there health service delivery with a focus primarily on health leadership.”

Baxter led her first research project during her master’s degree, which she completed at McMaster University. “At that time, I was focused on clinical decision-making in senior level nursing students. We engaged students in simulations of critical clinical situations and observed their responses in order to determine the decisions that they were making and from there we could examine ‘how’ and ‘why'."

After her master’s degree, Baxter went on to complete her PhD. “I was the first to do three consecutive nursing degrees at McMaster,” she notes. “I started in 1996 as an undergraduate and mature student, wife and mother of two. I came in with an RN diploma from Mohawk College and a degree from Wilfrid Laurier University, then I did my BScN, master’s and PhD here. I then went on to become a faculty member. I have been teaching here now for 20 years.”

One of Baxter’s completed research projects involved the examination of organizational leaders’ responses to quality-based procedures (a component of patient-based funding). She explains the project briefly below.

“The patient-based funding (PBF) model was introduced into 91 public hospitals in 2012 and was intended to improve both quality and efficiency within the health care system,” says Baxter. “This funding model represented a shift away from the traditional global budget where hospitals received funding based on their previous year’s budget. Traditional budgeting was not influenced by the quality or type of care provided, but PBF paid hospitals based on the number of patients treated alongside quality and efficiency indicators. This study examined health-care leaders’ initial responses to the implementation of orthopaedic quality-based procedures in 20 hospitals across Ontario. We gathered data from 70 organizational leaders using focus groups and individual interviews. The findings were unique because no one had looked at this type of funding from the leader’s perspective. We found that there was a general perception that quality-based procedures were a good strategy to ensure that services were delivered in a very economical manner. However, we also found that there was a lack of opportunity for some hospitals to be innovative as ‘best practices’ were pre-established in the form of clinical handbooks. Leaders described a general acceptance of PBF and QBPs. However, challenges exist that require further exploration including the need for a strong infrastructure, accurate and timely clinical and financial data, and policies to prevent unintended consequences. The research project was funded by Ontario Health Human Resource Research Network and Canadian Institute for Health Research (CIHR). Findings were published in the Journal of Nursing Management.”

Currently, Baxter is leading a project to examine leaders’ experience with resident-to-resident aggression in long term care homes in ON. “Resident to resident aggression is a growing problem. For this project, we have funding from CIHR and Sigma Theta Tau International Nursing. We will be done by spring 2021,” says Baxter. “In addition, CIHR has funded a large project examining resident-to-resident aggression led by Dr. Lynn McDonald from the University of Toronto and I’m excited to be part of that team as well.”

Baxter enjoys the discovery aspect of research. “I love to hear the stories of participants, and to understand an old topic from a new perspective.” For new researchers, she offers this advice: “Do what you’re passionate about. Find somebody who shares your passion and is well experienced in the area as they can help to open doors and walk with you along the long and winding road of research. Don’t take rejection personally, you’ll see it over and over again in your research career, but the rejections only make the acceptances so much sweeter.”

Baxter is enthusiastic about her current area of research. “Leaders in long term care are the silent heroes,” she says. “We need more nurses to go into leadership at all levels to bring about change in health care. We need more funders to provide opportunities for us to examine the issues that leaders are facing because we’re desperately short of leaders and without leaders, the dire situation in long-term care will not improve. Without these leaders, new policies and new practices are not going to be implemented appropriately and residents, staff and families will pay the consequences”.