Pub Date : 2025-08-13DOI: 10.1016/j.ssmhs.2025.100119
Johanna Thomas-Maude , Sharon McLennan
In mid-2021, Fiji recorded one of the highest rates of COVID-19-related deaths in the world, amidst a rapidly disintegrating health care system. This scoping review examines Fijian health system responses to the COVID-19 pandemic, exploring both the vulnerabilities and adaptive strategies that emerged during the crisis. Using a systematic search strategy to identify studies relating to how the Fijian health system responded to the COVID-19 pandemic, and what insights could be drawn about adaptive practices and resilience in this context, 71 papers were included. The findings demonstrate that while Fiji experienced significant workforce shortages, infrastructure constraints, and disruptions to routine healthcare, the pandemic response was also characterised by rapid policy adaptations, innovative use of some digital technologies, and strong community-led initiatives. However, challenges with public trust and culturally inclusive governance remain key areas for consideration. By applying a health system resilience framework that explores the tangible and intangible dimensions of health systems, this review offers insights relevant both for Fiji and the region. Strengthening local capacity, investing in sustainable infrastructure, and embedding Indigenous and other local knowledge in public health strategies are crucial steps toward building resilient Pacific health systems and preparing for future crises.
{"title":"Health system resilience in the Pacific: A scoping review of Fiji’s COVID-19 response","authors":"Johanna Thomas-Maude , Sharon McLennan","doi":"10.1016/j.ssmhs.2025.100119","DOIUrl":"10.1016/j.ssmhs.2025.100119","url":null,"abstract":"<div><div>In mid-2021, Fiji recorded one of the highest rates of COVID-19-related deaths in the world, amidst a rapidly disintegrating health care system. This scoping review examines Fijian health system responses to the COVID-19 pandemic, exploring both the vulnerabilities and adaptive strategies that emerged during the crisis. Using a systematic search strategy to identify studies relating to how the Fijian health system responded to the COVID-19 pandemic, and what insights could be drawn about adaptive practices and resilience in this context, 71 papers were included. The findings demonstrate that while Fiji experienced significant workforce shortages, infrastructure constraints, and disruptions to routine healthcare, the pandemic response was also characterised by rapid policy adaptations, innovative use of some digital technologies, and strong community-led initiatives. However, challenges with public trust and culturally inclusive governance remain key areas for consideration. By applying a health system resilience framework that explores the tangible and intangible dimensions of health systems, this review offers insights relevant both for Fiji and the region. Strengthening local capacity, investing in sustainable infrastructure, and embedding Indigenous and other local knowledge in public health strategies are crucial steps toward building resilient Pacific health systems and preparing for future crises.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100119"},"PeriodicalIF":0.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144841049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Learning Health System (LHS) aims to improve healthcare by using continuous data analysis to create equitable, patient-centered, and cost-effective care. Evaluating LHS success is challenging due to real-world variability in execution and implementation and absence of clear metrics. We conducted an international jurisdictional scan to highlight common evaluation approaches, indicators, outcomes, challenges, and assumptions related to establishing counterfactuals in LHS evaluation. Evaluation outputs were categorized into four types: description, lessons learned, efficacy, and effectiveness. Frequencies and thematic analysis were used to describe LHSs, their evaluations, indicators of change, and lessons learned. 45 papers describing 44 LHSs were included. 30 papers shared lessons on LHS progress, 14 reported on efficacy during scaling, and none reported on effectiveness of sustained systems. Ingredients perceived to contribute to a successful LHS included engagement of key individuals, establishment of a LHS culture, data considerations, and contextual factors. Future evaluations should consider LHS maturity, utilize counterfactuals, and prioritize equity. Evaluating and addressing these gaps can fuel LHS effectiveness and ensure that diverse needs of patients and providers are met. Ultimately, structured and more standardized evaluation efforts could foster a culture of continuous learning and improvement, enabling health systems to better enhance population health outcomes and deliver high-quality, equitable care.
{"title":"Evaluating learning health systems: a jurisdictional scan","authors":"Balpreet Panesar , Carly Whitmore , Shelley Vanderhout , Marissa Bird","doi":"10.1016/j.ssmhs.2025.100117","DOIUrl":"10.1016/j.ssmhs.2025.100117","url":null,"abstract":"<div><div>The Learning Health System (LHS) aims to improve healthcare by using continuous data analysis to create equitable, patient-centered, and cost-effective care. Evaluating LHS success is challenging due to real-world variability in execution and implementation and absence of clear metrics. We conducted an international jurisdictional scan to highlight common evaluation approaches, indicators, outcomes, challenges, and assumptions related to establishing counterfactuals in LHS evaluation. Evaluation outputs were categorized into four types: description, lessons learned, efficacy, and effectiveness. Frequencies and thematic analysis were used to describe LHSs, their evaluations, indicators of change, and lessons learned. 45 papers describing 44 LHSs were included. 30 papers shared lessons on LHS progress, 14 reported on efficacy during scaling, and none reported on effectiveness of sustained systems. Ingredients perceived to contribute to a successful LHS included engagement of key individuals, establishment of a LHS culture, data considerations, and contextual factors. Future evaluations should consider LHS maturity, utilize counterfactuals, and prioritize equity. Evaluating and addressing these gaps can fuel LHS effectiveness and ensure that diverse needs of patients and providers are met. Ultimately, structured and more standardized evaluation efforts could foster a culture of continuous learning and improvement, enabling health systems to better enhance population health outcomes and deliver high-quality, equitable care.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100117"},"PeriodicalIF":0.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144866276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Information continuity, where information follows service users across the healthcare system, is an element of continuity of care and is essential for safe and quality care. Information continuity depends on the information practices of both care professionals and service users, such as seeking and sharing information. This paper aims to provide insights into the information practices of care professionals across health, mental health, and social care services in Australia’s mental healthcare system, and how they balance service user privacy with information continuity. Fourteen care professionals were interviewed about seeking and sharing information to provide care for service users. Interviews were analysed inductively and deductively utilising the literature on information continuity, information practices and contextual privacy. Five themes and 14 sub-themes emerged. The lack of a shared information context across different care settings shaped the information practices of care professionals and acted as a barrier to information continuity. Care professionals pieced together information about service users from various sources to understand their needs and to manage risk. Information shared with other care professionals was curated based on a range of factors including, service user consent, risk management and the perceived sensitivity of the information being shared. This study provides new insights into the information practices of care professionals that contribute to information continuity in the mental healthcare system. The findings suggest that ongoing efforts to improve information sharing infrastructure, such as through the adoption of electronic health records, should occur alongside efforts to build relationships and shared information sharing expectations.
{"title":"Bridging the gap: How information sharing practices across health, mental health and social care services shape information continuity in the Australian mental healthcare system","authors":"Timothy Charles Kariotis , Megan Prictor , Kathleen Gray , Shanton Chang","doi":"10.1016/j.ssmhs.2025.100118","DOIUrl":"10.1016/j.ssmhs.2025.100118","url":null,"abstract":"<div><div>Information continuity, where information follows service users across the healthcare system, is an element of continuity of care and is essential for safe and quality care. Information continuity depends on the information practices of both care professionals and service users, such as seeking and sharing information. This paper aims to provide insights into the information practices of care professionals across health, mental health, and social care services in Australia’s mental healthcare system, and how they balance service user privacy with information continuity. Fourteen care professionals were interviewed about seeking and sharing information to provide care for service users. Interviews were analysed inductively and deductively utilising the literature on information continuity, information practices and contextual privacy. Five themes and 14 sub-themes emerged. The lack of a shared information context across different care settings shaped the information practices of care professionals and acted as a barrier to information continuity. Care professionals pieced together information about service users from various sources to understand their needs and to manage risk. Information shared with other care professionals was curated based on a range of factors including, service user consent, risk management and the perceived sensitivity of the information being shared. This study provides new insights into the information practices of care professionals that contribute to information continuity in the mental healthcare system. The findings suggest that ongoing efforts to improve information sharing infrastructure, such as through the adoption of electronic health records, should occur alongside efforts to build relationships and shared information sharing expectations.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100118"},"PeriodicalIF":0.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144880317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-12DOI: 10.1016/j.ssmhs.2025.100115
Francesco Andrea Causio , Ciro Pappalardo , Salvatore Palazzo , Chiara Barneschi , Francesca Aurora Sacchi , Alice Ravizza , Davide Golinelli
Western healthcare systems face escalating pressures from chronic disease prevalence, aging populations, increasing healthcare demands, and rising costs. Artificial Intelligence (AI) solutions offer transformative potential by enhancing clinical decision-making and healthcare management, optimizing resource allocation, improving patient outcomes, and accelerating innovation. However, the integration of AI into healthcare raises unresolved questions regarding transparency, algorithmic accountability, legal liability, and data governance, highlighting significant systemic risks. The regulatory frameworks adopted by the European Union (EU) and the United States (US) differ significantly, shaped by contrasting legal traditions and policy objectives. This paper critically examines these divergent regulatory approaches, focusing on the recent Healthy Technology Act 2025 proposal in the US, which would enable AI to prescribe medications autonomously. We discuss legal, ethical, and educational challenges arising from this regulatory divergence, ultimately providing insights and recommendations for policymakers, healthcare organizations, and technology developers.
{"title":"AI prescription systems automation: Regulatory and educational challenges in the USA and Europe","authors":"Francesco Andrea Causio , Ciro Pappalardo , Salvatore Palazzo , Chiara Barneschi , Francesca Aurora Sacchi , Alice Ravizza , Davide Golinelli","doi":"10.1016/j.ssmhs.2025.100115","DOIUrl":"10.1016/j.ssmhs.2025.100115","url":null,"abstract":"<div><div>Western healthcare systems face escalating pressures from chronic disease prevalence, aging populations, increasing healthcare demands, and rising costs. Artificial Intelligence (AI) solutions offer transformative potential by enhancing clinical decision-making and healthcare management, optimizing resource allocation, improving patient outcomes, and accelerating innovation. However, the integration of AI into healthcare raises unresolved questions regarding transparency, algorithmic accountability, legal liability, and data governance, highlighting significant systemic risks. The regulatory frameworks adopted by the European Union (EU) and the United States (US) differ significantly, shaped by contrasting legal traditions and policy objectives. This paper critically examines these divergent regulatory approaches, focusing on the recent Healthy Technology Act 2025 proposal in the US, which would enable AI to prescribe medications autonomously. We discuss legal, ethical, and educational challenges arising from this regulatory divergence, ultimately providing insights and recommendations for policymakers, healthcare organizations, and technology developers.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100115"},"PeriodicalIF":0.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144904057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
While health systems increasingly recognize the critical role that patient and caregiver feedback plays in person-centered care, patients and caregivers often experience barriers to voicing their ideas, suggestions, and concerns. The aim of this narrative synthesis is to identify within the literature organizational behaviours and contextual factors that have been shown to help facilitate patient and caregiver voicing (expressing ideas, opinions, or suggestions to improve individual, group, or organizational functioning) in hospital settings and develop a conceptual framework of these enablers.
Search methods
A narrative synthesis review of the literature was conducted. A systematic search across three databases generated 14,273 records, and 10,129 once duplicates were removed. Following full-text review and application of the inclusion criteria, 89 articles were included in the synthesis.
Search results
The results from this narrative synthesis identify practice and organizational factors that, when implemented together, may enable patient and caregiver voice in inpatient hospital settings. The organizational behaviours and interventions described include creating spaces to elicit patient and caregiver voice, using communication practices that support voice, and showing care for the full person. Enabling factors identified were having an organizational commitment to person-centered practice, supportive work processes and organizational policies, patient personal resources and voicing preferences, and staff motivation, orientation to care, and skills.
Discussion and conclusions
There is an opportunity to improve patient and caregiver voicing during care episodes to advance the provision of person-centered care in healthcare organizations. Drawing from the literature, we propose a conceptual framework that reflects the conditions needed to support patient and caregiver voicing in hospital settings.
{"title":"Facilitating patient and caregiver voicing in hospital settings: A narrative synthesis of the literature and conceptual framework","authors":"Emily Cordeaux , Isra Amsdr , Alysha Bartsch , John Easton , Meena Andiappan , Lesley Gotlib Conn , Kerry Kuluski","doi":"10.1016/j.ssmhs.2025.100116","DOIUrl":"10.1016/j.ssmhs.2025.100116","url":null,"abstract":"<div><h3>Purpose</h3><div>While health systems increasingly recognize the critical role that patient and caregiver feedback plays in person-centered care, patients and caregivers often experience barriers to voicing their ideas, suggestions, and concerns. The aim of this narrative synthesis is to identify within the literature organizational behaviours and contextual factors that have been shown to help facilitate patient and caregiver voicing (expressing ideas, opinions, or suggestions to improve individual, group, or organizational functioning) in hospital settings and develop a conceptual framework of these enablers.</div></div><div><h3>Search methods</h3><div>A narrative synthesis review of the literature was conducted. A systematic search across three databases generated 14,273 records, and 10,129 once duplicates were removed. Following full-text review and application of the inclusion criteria, 89 articles were included in the synthesis.</div></div><div><h3>Search results</h3><div>The results from this narrative synthesis identify practice and organizational factors that, when implemented together, may enable patient and caregiver voice in inpatient hospital settings. The organizational behaviours and interventions described include creating spaces to elicit patient and caregiver voice, using communication practices that support voice, and showing care for the full person. Enabling factors identified were having an organizational commitment to person-centered practice, supportive work processes and organizational policies, patient personal resources and voicing preferences, and staff motivation, orientation to care, and skills.</div></div><div><h3>Discussion and conclusions</h3><div>There is an opportunity to improve patient and caregiver voicing during care episodes to advance the provision of person-centered care in healthcare organizations. Drawing from the literature, we propose a conceptual framework that reflects the conditions needed to support patient and caregiver voicing in hospital settings.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100116"},"PeriodicalIF":0.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-24DOI: 10.1016/j.ssmhs.2025.100113
Rajinder Sonia Singh , Dana P. Brunson , Monica M. Matthieu , JoAnn E. Kirchner , Michael R. Kauth , Jillian C. Shipherd , Sarah E. Valentine , Sara J. Landes
Lesbian, gay, bisexual, trans-identifying, queer (LGBTQ+) veterans experience health and health care disparities. Health care organizations play a critical role in supporting recipients of care, particularly for underserved communities, such as LGBTQ+ patients. To improve health and reduce health care disparities for LGBTQ+ veterans, the Veterans Health Administration (VHA) in the United States (U.S.) created the LGBTQ+ Health Program, a national program that includes local coordinators called the LGBTQ+ Veteran Care Coordinator (VCC) Program. The LGBTQ+ VCC Program was established through VA policy and illustrates one example of how policy implementation can push forward health equity for marginalized populations. We conducted a process program evaluation of the LGBTQ+ VCC Program (launched in 2016) to assess the barriers and facilitators of the program as well as provide recommendations and tools to assist in program implementation. Guided by the Consolidated Framework for Implementation Research and enhanced by two health equity domains, we collected data from local coordinators (n = 172) and regional network leads (n = 15) from January–March 2022. Qualitative data were collected through focus groups and individual interviews with local coordinators (n = 41), former local coordinators (n = 3), and regional network leads (n = 6) from July–December 2022. A mixed-methods design was used for triangulation, analyzing quantitative data using descriptive statistics and qualitative data using template analysis. Findings indicate local coordinators and network leads value their work. They struggle navigating the VHA system including difficulty engaging local and network leadership as well as navigating interpersonal situations with staff and veterans. Although local coordinators and network leads are dedicated to the VCC program mission, systemic changes are necessary. Based on local coordinator and network lead feedback, it would be beneficial for health care facility and network leadership to increase their awareness of LGBTQ+ health policy and create systems of accountability related to program implementation.
{"title":"Improving health care through the U.S. Veterans Health Administration’s nationwide LGBTQ+ Veteran Care Coordinator Program","authors":"Rajinder Sonia Singh , Dana P. Brunson , Monica M. Matthieu , JoAnn E. Kirchner , Michael R. Kauth , Jillian C. Shipherd , Sarah E. Valentine , Sara J. Landes","doi":"10.1016/j.ssmhs.2025.100113","DOIUrl":"10.1016/j.ssmhs.2025.100113","url":null,"abstract":"<div><div>Lesbian, gay, bisexual, trans-identifying, queer (LGBTQ+) veterans experience health and health care disparities. Health care organizations play a critical role in supporting recipients of care, particularly for underserved communities, such as LGBTQ+ patients. To improve health and reduce health care disparities for LGBTQ+ veterans, the Veterans Health Administration (VHA) in the United States (U.S.) created the LGBTQ+ Health Program, a national program that includes local coordinators called the LGBTQ+ Veteran Care Coordinator (VCC) Program. The LGBTQ+ VCC Program was established through VA policy and illustrates one example of how policy implementation can push forward health equity for marginalized populations. We conducted a process program evaluation of the LGBTQ+ VCC Program (launched in 2016) to assess the barriers and facilitators of the program as well as provide recommendations and tools to assist in program implementation. Guided by the Consolidated Framework for Implementation Research and enhanced by two health equity domains, we collected data from local coordinators (n = 172) and regional network leads (n = 15) from January–March 2022. Qualitative data were collected through focus groups and individual interviews with local coordinators (n = 41), former local coordinators (n = 3), and regional network leads (n = 6) from July–December 2022. A mixed-methods design was used for triangulation, analyzing quantitative data using descriptive statistics and qualitative data using template analysis. Findings indicate local coordinators and network leads value their work. They struggle navigating the VHA system including difficulty engaging local and network leadership as well as navigating interpersonal situations with staff and veterans. Although local coordinators and network leads are dedicated to the VCC program mission, systemic changes are necessary. Based on local coordinator and network lead feedback, it would be beneficial for health care facility and network leadership to increase their awareness of LGBTQ+ health policy and create systems of accountability related to program implementation.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100113"},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144739381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-22DOI: 10.1016/j.ssmhs.2025.100112
Jacob Goffnett , Jarrod Call , Jeff Ciak , Em Medina , Kelly L. Clary , Rob Ventura , Simran Sidhu
Purpose
To create a framework of inclusive healthcare for transgender and gender-diverse patients comprising environmental, interpersonal, and intrapsychic factors.
Background
Transgender and gender-diverse individuals face significant barriers to accessing competent and affirming healthcare in the United States (U.S.), contributing to higher rates of behavioral health issues. Research has largely focused on interpersonal factors affecting access leaving environmental factors—shown to reduce anxiety and improve comfort—underexplored.
Methods
We conducted focus group interviews with 13 transgender and gender-diverse participants (M = 23 years old) in the U.S., utilizing a semi-structured guide and photo elicitation. Participants shared their healthcare experiences, discussing preferences and dislikes while reflecting on images of healthcare environments.
Results
Inclusive healthcare comprises environmental and interpersonal factors that enhance intrapsychic feelings of privacy, agency, comfort, and gender affirmation. Key environmental features include spacious, private layouts and culturally relevant symbols, while interpersonal factors highlight the importance of culturally competent care. Participants noted that inconsistencies between environments and interactions served as unique stressors.
Conclusions
To improve healthcare for transgender and gender-diverse patients, providers should emphasize privacy, agency, comfort, and gender validation through thoughtful environmental design that complement affirming interpersonal practices. Further research is necessary to validate these findings across diverse samples.
{"title":"Conceptualizing trans-inclusive healthcare in the United States: Environmental and interpersonal factors of healthcare provision","authors":"Jacob Goffnett , Jarrod Call , Jeff Ciak , Em Medina , Kelly L. Clary , Rob Ventura , Simran Sidhu","doi":"10.1016/j.ssmhs.2025.100112","DOIUrl":"10.1016/j.ssmhs.2025.100112","url":null,"abstract":"<div><h3>Purpose</h3><div>To create a framework of inclusive healthcare for transgender and gender-diverse patients comprising environmental, interpersonal, and intrapsychic factors.</div></div><div><h3>Background</h3><div>Transgender and gender-diverse individuals face significant barriers to accessing competent and affirming healthcare in the United States (U.S.), contributing to higher rates of behavioral health issues. Research has largely focused on interpersonal factors affecting access leaving environmental factors—shown to reduce anxiety and improve comfort—underexplored.</div></div><div><h3>Methods</h3><div>We conducted focus group interviews with 13 transgender and gender-diverse participants (M = 23 years old) in the U.S., utilizing a semi-structured guide and photo elicitation. Participants shared their healthcare experiences, discussing preferences and dislikes while reflecting on images of healthcare environments.</div></div><div><h3>Results</h3><div>Inclusive healthcare comprises environmental and interpersonal factors that enhance intrapsychic feelings of privacy, agency, comfort, and gender affirmation. Key environmental features include spacious, private layouts and culturally relevant symbols, while interpersonal factors highlight the importance of culturally competent care. Participants noted that inconsistencies between environments and interactions served as unique stressors.</div></div><div><h3>Conclusions</h3><div>To improve healthcare for transgender and gender-diverse patients, providers should emphasize privacy, agency, comfort, and gender validation through thoughtful environmental design that complement affirming interpersonal practices. Further research is necessary to validate these findings across diverse samples.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100112"},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144694691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-18DOI: 10.1016/j.ssmhs.2025.100108
Patrick Chiu , Natalie J. Thiessen , Damilola Iduye , Samantha Louie-Poon , Janice Y. Kung , Kathleen Leslie
Background
Racism remains pervasive in healthcare systems, driving inequalities for racialized healthcare professionals and clients. The role of health practitioner regulators is to protect the public; however, their actions or inactions may also perpetuate racism. Though there is increasing recognition of regulators’ role in addressing racism, there is currently no synthesized understanding of existing knowledge on this topic.
Methods
A scoping review following JBI guidelines explored the literature on racism and health practitioner regulation. Six databases were searched: Ovid MEDLINE, Ovid Embase, CINAHL, Scopus, Web of Science Core Collection, and ProQuest Dissertations and Theses Citation Index. Leading global regulatory organizations were searched for grey literature.
Findings
Fifty-four sources were included in the review, with 57 % categorized as scholarly literature and 43 % as grey literature. While underdeveloped, this scholarship has grown consistently since 2020. Sources were predominantly from the United Kingdom and the United States, followed by Canada, Australia, and New Zealand. Racism and/or racial discrimination can be manifested and perpetuated within regulators’ organizational practices, complaints and conduct processes, licensure requirements, practice standards or guidelines, education program approval or accreditation processes, and continuing competence programs. Health practitioner regulators can create anti-racist healthcare systems by addressing their organizational governance structures and processes and attending to their core regulatory functions.
Conclusions
While progress has been made toward anti-racist health practitioner regulation, further critical analysis and empirical evidence are needed to inform effective strategies. Clarifying concepts, collecting race-based data, partnering with racialized groups, and integrating anti-racism into regulatory performance frameworks can drive impactful reforms.
背景：在医疗保健系统中，种族主义仍然普遍存在，造成了种族化的医疗保健专业人员和客户的不平等。卫生从业者监管机构的作用是保护公众；然而，他们的作为或不作为也可能使种族主义永久化。尽管越来越多的人认识到监管机构在解决种族主义方面的作用，但目前对这一主题的现有知识还没有综合的理解。方法根据JBI指南进行范围审查，探讨有关种族主义和卫生从业人员监管的文献。检索了6个数据库：Ovid MEDLINE、Ovid Embase、CINAHL、Scopus、Web of Science Core Collection和ProQuest disserds and Theses Citation Index。我们搜索了全球领先的监管机构的灰色文献。研究结果综述中包括54个来源，其中57 %归类为学术文献，43 %归类为灰色文献。虽然不发达，但自2020年以来，该奖学金一直在增长。来源主要来自英国和美国，其次是加拿大、澳大利亚和新西兰。种族主义和/或种族歧视可以在监管机构的组织实践、投诉和行为流程、许可要求、实践标准或指南、教育项目批准或认证流程以及持续能力项目中表现出来并持续存在。医疗从业者监管机构可以通过解决其组织治理结构和流程并参与其核心监管职能来创建反种族主义的医疗保健系统。结论：虽然在反种族主义卫生从业人员监管方面取得了进展，但需要进一步的批判性分析和经验证据来为有效的战略提供信息。澄清概念，收集基于种族的数据，与种族化的群体合作，以及将反种族主义纳入监管绩效框架，可以推动有影响力的改革。
{"title":"Health practitioner regulation and anti-racism: A scoping review","authors":"Patrick Chiu , Natalie J. Thiessen , Damilola Iduye , Samantha Louie-Poon , Janice Y. Kung , Kathleen Leslie","doi":"10.1016/j.ssmhs.2025.100108","DOIUrl":"10.1016/j.ssmhs.2025.100108","url":null,"abstract":"<div><h3>Background</h3><div>Racism remains pervasive in healthcare systems, driving inequalities for racialized healthcare professionals and clients. The role of health practitioner regulators is to protect the public; however, their actions or inactions may also perpetuate racism. Though there is increasing recognition of regulators’ role in addressing racism, there is currently no synthesized understanding of existing knowledge on this topic.</div></div><div><h3>Methods</h3><div>A scoping review following JBI guidelines explored the literature on racism and health practitioner regulation. Six databases were searched: Ovid MEDLINE, Ovid Embase, CINAHL, Scopus, Web of Science Core Collection, and ProQuest Dissertations and Theses Citation Index. Leading global regulatory organizations were searched for grey literature.</div></div><div><h3>Findings</h3><div>Fifty-four sources were included in the review, with 57 % categorized as scholarly literature and 43 % as grey literature. While underdeveloped, this scholarship has grown consistently since 2020. Sources were predominantly from the United Kingdom and the United States, followed by Canada, Australia, and New Zealand. Racism and/or racial discrimination can be manifested and perpetuated within regulators’ organizational practices, complaints and conduct processes, licensure requirements, practice standards or guidelines, education program approval or accreditation processes, and continuing competence programs. Health practitioner regulators can create anti-racist healthcare systems by addressing their organizational governance structures and processes and attending to their core regulatory functions.</div></div><div><h3>Conclusions</h3><div>While progress has been made toward anti-racist health practitioner regulation, further critical analysis and empirical evidence are needed to inform effective strategies. Clarifying concepts, collecting race-based data, partnering with racialized groups, and integrating anti-racism into regulatory performance frameworks can drive impactful reforms.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100108"},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145094923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-18DOI: 10.1016/j.ssmhs.2025.100109
Stephanie Montesanti , Emily Fleming , Joyla Furlano , Erynne Sjoblom , Richard T. Oster , Pamela Roach , Amrita Roy , Lindsay Crowshoe Lynden
The capacity of primary health care (PHC) systems to provide high-quality, culturally safe care for Indigenous Peoples depends on strong and sustainable system infrastructure—including physical facilities, human resources, information systems, administrative supports, and equipment. This rapid qualitative policy study examined how PHC infrastructure is funded and resourced for Indigenous populations in Alberta and Ontario, comparing experiences from both provinces. Fourteen semi-structured interviews with key policy actors in both provinces were conducted, which informed the development of policy event timelines and enabled access to relevant provincial policy documents. The findings revealed that despite distinct provincial approaches, both juridictions face structural and juridictional barriers that hinder sustainable PHC delivery. Participants emphasized that salary-based payment models for physicians can support recruitment and rentention within First Nation and Métis communities, but alone are insufficient to address longstanding infrastructure gaps . Key barriers include geographic isolation, inadequate clinical space and technology, and limited clinical resources, which hinder PHC delivery, especially in remote and smaller communities. We identified funding inequities as a continuing barrier across both provinces, particularly concerning limited support for physician travel to rural and remote areas. The study also highlights how partnerships between First Nations and PHC organizationscan mitigate infrastructure gaps when clinical resources are shared. Physician goodwill emerged as a key factor in improving access to PHC in remote regions, highlighting their commitment to go beyond contractual obligations and funding limitations to provide necessary services in Indigenous communities. The study highlights critical opportunities for policy reform, including expanded funding for system infrastructure, population-based funding, increased support for physician travel, and the recognition of Indigenous self-determination in health care planning.
{"title":"Navigating policy and infrastructure inequities in Indigenous primary health care: A qualitative comparative policy analysis of Alberta and Ontario","authors":"Stephanie Montesanti , Emily Fleming , Joyla Furlano , Erynne Sjoblom , Richard T. Oster , Pamela Roach , Amrita Roy , Lindsay Crowshoe Lynden","doi":"10.1016/j.ssmhs.2025.100109","DOIUrl":"10.1016/j.ssmhs.2025.100109","url":null,"abstract":"<div><div>The capacity of primary health care (PHC) systems to provide high-quality, culturally safe care for Indigenous Peoples depends on strong and sustainable system infrastructure—including physical facilities, human resources, information systems, administrative supports, and equipment. This rapid qualitative policy study examined how PHC infrastructure is funded and resourced for Indigenous populations in Alberta and Ontario, comparing experiences from both provinces. Fourteen semi-structured interviews with key policy actors in both provinces were conducted, which informed the development of policy event timelines and enabled access to relevant provincial policy documents. The findings revealed that despite distinct provincial approaches, both juridictions face structural and juridictional barriers that hinder sustainable PHC delivery. Participants emphasized that salary-based payment models for physicians can support recruitment and rentention within First Nation and Métis communities, but alone are insufficient to address longstanding infrastructure gaps . Key barriers include geographic isolation, inadequate clinical space and technology, and limited clinical resources, which hinder PHC delivery, especially in remote and smaller communities. We identified funding inequities as a continuing barrier across both provinces, particularly concerning limited support for physician travel to rural and remote areas. The study also highlights how partnerships between First Nations and PHC organizationscan mitigate infrastructure gaps when clinical resources are shared. Physician goodwill emerged as a key factor in improving access to PHC in remote regions, highlighting their commitment to go beyond contractual obligations and funding limitations to provide necessary services in Indigenous communities. The study highlights critical opportunities for policy reform, including expanded funding for system infrastructure, population-based funding, increased support for physician travel, and the recognition of Indigenous self-determination in health care planning.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100109"},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-18DOI: 10.1016/j.ssmhs.2025.100110
Gerald Bloom , Lewis Husain , Minghui Ren
Recent decisions by the US Government signal a need for major changes to the way global health is organised. As the contribution of development assistance to financing health services falls, there is a need to ensure that national strategies are respected and that countries have access to affordable drugs and a variety of health-related technologies. Leaders of aid-recipient countries, the traditional donors and large middle-income countries will need to take joint responsibility for making this possible. Despite a context of global competition and contestation, there is a lot of agreement on key global health objectives, so that it could be an important arena for establishing more inclusive governance. This will involve changes to current institutional arrangements. These changes are likely to take place in a piecemeal manner, whereby new approaches for tackling a problem will be tested at a relatively small scale before agreements are reached for more ambitious reforms and the capacity to implement them is built. The transition that is needed will be difficult and will take time. However, it is important that it succeed, in order to make effective responses to major health threats possible and to ensure progress towards universal access to effective health care.
{"title":"Global health governance in transition: A time for new leadership, new ideas, new partnerships","authors":"Gerald Bloom , Lewis Husain , Minghui Ren","doi":"10.1016/j.ssmhs.2025.100110","DOIUrl":"10.1016/j.ssmhs.2025.100110","url":null,"abstract":"<div><div>Recent decisions by the US Government signal a need for major changes to the way global health is organised. As the contribution of development assistance to financing health services falls, there is a need to ensure that national strategies are respected and that countries have access to affordable drugs and a variety of health-related technologies. Leaders of aid-recipient countries, the traditional donors and large middle-income countries will need to take joint responsibility for making this possible. Despite a context of global competition and contestation, there is a lot of agreement on key global health objectives, so that it could be an important arena for establishing more inclusive governance. This will involve changes to current institutional arrangements. These changes are likely to take place in a piecemeal manner, whereby new approaches for tackling a problem will be tested at a relatively small scale before agreements are reached for more ambitious reforms and the capacity to implement them is built. The transition that is needed will be difficult and will take time. However, it is important that it succeed, in order to make effective responses to major health threats possible and to ensure progress towards universal access to effective health care.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100110"},"PeriodicalIF":0.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144694692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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