Healthcare quarterly (Toronto, Ont.)最新文献

Patient safety provides an important foundation for high-quality care. Research in Canada and elsewhere has identified substantial levels of harm in hospitals and other settings; these results spurred the development and spread of safety practices, along with strategies to strengthen organizational training, incident reporting and analysis and a host of resources intended to reduce the burden of harm. Yet, despite these efforts, 20 years after the publication of the Canadian Adverse Event study (Baker et al. 2004) and other studies, many leaders believe progress in patient safety has stalled (NEJM Catalyst 2023). Indeed, some recent studies indicate that the levels of harm have increased. One notable study by David Bates and colleagues (2023), building on approaches used in earlier studies, identified at least one adverse event in 23.6% of a random sample of patients in Massachusetts hospitals in 2018. Among 978 events, 22.7% were judged preventable and one-third required at least substantial intervention or prolonged recovery.

The long-standing systemic inequities highlighted during the COVID-19 pandemic and current events of social injustice have underscored the importance for health system leaders to develop or strengthen their competencies related to equity, diversity and inclusion. Inclusive leadership values different perspectives across organizational hierarchies. It reduces psychological distress and improves the performance of individuals and teams in health settings. Through semi-structured interviews, we explored the inclusive leadership experiences of five health system leaders. This study offers initial insights by unpacking inclusive leadership as a competency, identifying barriers and enablers and providing advice for current and future health system leaders.

Healthcare administrators steer their organizations' strategic direction with an emphasis on quality, value and efficiency, aiming to improve patient outcomes and ensure operational sustainability. Artificial intelligence (AI) has become a transformative force in healthcare in the past decade, with Canadian health systems and research institutions investing in AI solutions to address critical healthcare challenges. This primer delivers a fundamental guide to essential AI concepts in healthcare and provides practical guidance to prepare organizations for AI readiness.

Throughout the COVID-19 pandemic, delivery of care was exceedingly difficult for hospital healthcare teams. This analysis presents a high-level look at the available pan-Canadian data on hospital staffing - including sick time, overtime and agency use - and potential impacts on patient harm in acute care hospitals. In 2021-2022, nurses and other healthcare providers working in hospital in-patient units across Canada logged significantly more overtime and sick-time hours compared with the previous year, equating to a shortfall of almost 14,000 full-time positions. Concurrently, the pan-Canadian rate of unintentional hospital harm increased to 6% compared with pre-pandemic numbers. The Hospital Harm Improvement Resource (HEC 2023a) links harm measurement and improvement efforts by providing evidence-informed practices to support patient safety improvement efforts.

Ontario Health Teams (OHTs), models of integrated care, are responsible for measuring and improving patient experience. However, routine collection of patient-reported data has not been fully realized, presenting a significant system-wide gap. We conducted a pilot study to implement routine collection of patient-reported data in the Frontenac, Lennox and Addington (FLA) OHT. Each clinic integrated the survey, which captured encounter experience, health and well-being and demographics into their workflow. During the five-month pilot, over 1,200 patients shared their experiences. Clinics reported that the data were valuable for ongoing quality improvement, boosting staff morale and providing a voice to patients. Each site needed flexibility for deployment and to ensure that they captured data relevant to their practice needs. A balance is needed to meet differing needs at each level of the system, requiring cross-sectoral commitment for integrated care systems to truly understand the patient experience and health of the population.

Across Canada, pressures related to staffing, burnout and funding continue to affect healthcare organizations and systems. These pressures impact the quality of care Canadians receive, most notably access to care. Evidence indicates that patients are more likely to suffer from preventable harm during periods of hospital overcrowding and, indeed, very recent data from the Canadian Institute for Health Information suggest that rates of preventable harm have increased modestly in Canadian hospitals. A key lever that can have a positive impact on patient safety culture and contribute to fewer preventable adverse events at an institutional level is systematic formal case reviews. This article describes a large healthcare organization's approach to systematically reviewing serious harm events. An evaluation of both quantitative and qualitative metrics suggests that Unity Health Toronto's critical incident review process has been effective at building a resilient patient safety culture that stood up to the challenges of the COVID-19 pandemic and continues to have a positive impact on patient safety at Unity Health Toronto.

To champion an unremarkable health system means pursuing results within a corridor of "decent enough" results that do not merit concern, thereby offering a baseline for system improvement and allowing for the identification of surprising data that may surface in future monitoring. Pursuing such unremarkability in healthcare maximizes the health and welfare of everyone and can support quality improvement across all institutions.

The Bridge-to-Home program was launched as a 16-month collaborative from 2018 to 2020 to improve care transitions out of hospital using a patient engagement-focused quality improvement (QI) initiative. Teams that participated in the collaborative were able to implement elements of the patient-oriented care transitions bundle, improve experience of care transitions and increase capacity for patient engagement for both patient partners and providers. In this article, we highlight three case studies of teams in different types of organizations with different levels of patient engagement maturation. Key enablers and barriers are identified with a specific lens on engagement efforts to co-produce changes in the processes and experience of care. These cases illustrate that providing support for patient engagement when leading a QI initiative is mutually reinforcing, where patient engagement and QI support and strengthen each other, resulting in increased success of the quality initiative and increased capacity for patient engagement.

It will take years before we can understand and measure the full toll that the COVID-19 pandemic has taken on our health systems. Of the many reverberations from the pandemic, one of the most concerning implications is an increase in the rates of preventable harm. Four years of unprecedented demand on healthcare services combined with health human resource shortages and clinician burnout have pushed our systems to the brink - and are impacting our capacity to improve or even maintain standards of care.

Sex and gender may play a role in the association between occupational experiences and the mental health (MH) of defence and public safety personnel. This report summarizes the findings of three studies exploring sex-based differences in MH service use between Veterans and non-Veterans in Ontario. Female Veterans had significantly higher rates of MH-related physician visits, emergency department visits and hospitalizations compared to female non-Veterans. These findings impart useful information for individuals or organizations with the ability to influence healthcare policy, planning and delivery for the Canadian defence and public safety sectors.