Healthcare Management Forum最新文献

This article presents how the Registered Nurses' Association of Ontario developed the People-Centred Care, 3^rd edition best practice guideline and describes its use in advancing patient advocacy by implementing the three guiding principles, two evidence-based recommendations and five good practice statements. Furthermore, the guideline equips leaders and organizations with implementation tips to promote patient autonomy, address systemic barriers, and foster inclusive, advocacy-driven care. We emphasize leadership's role in fostering cultures of engagement, collaboration, and empowerment. This is a critical tool for organizations, leaders, and providers seeking to embed patient advocacy within practice and policy. It underscores the transformative potential of leadership-driven advocacy in advancing people-centred care and ensuring health systems prioritize the voices, needs, and experiences of those they serve.

This article focuses on the implementation of interRAI instruments at a national health system level. It is based on a narrative review undertaken by the authors from several interRAI member countries. Implementation experiences from several countries and searches of PubMed and other databases, grey literature sources, policy reports, and the interRAI repository, identified practical insights and recommendations relevant for health system implementation. Key considerations are outlined. These include policy and legal considerations, resourcing considerations, training and education considerations, and data considerations.

This article aimed to examine the philosophy of Artificial Intelligence (AI) in healthcare and present a novel framework that could bridge philosophy, ethics, and leadership to promote the responsible and human-centered integration of AI. Moving beyond efficiency and innovation, it explored the deeper philosophical, moral, and human dimensions of AI's evolving role in care delivery. The proposed framework incorporated teleology, ontology, epistemology, axiology, and ethics to provide a structured foundation for guiding AI development, implementation, and governance through purpose, knowledge, values, and moral action. Grounded in these principles, it highlights the leadership approaches that foster accountability, organizational readiness, and ethical stewardship in AI adoption. These insights informed the development of a framework designed to align AI with human values and to promote compassionate, ethical, and sustainable applications that enhance healthcare outcomes while preserving the essence of human care.

Healthcare organizations face accelerating digital transformation, yet sustainable change depends on empowering the people at the centre of care. This article presents a human-centred change management approach that positions clinical leaders as effective advocates for innovation. Drawing on experience within a large integrated health system, we explore how inclusion and agency mitigate resistance and foster adoption. Two digital use cases-a nurse handoff tool and a scheduling and staffing platform-illustrate how co-authorship in design and implementation builds a sense of ownership and advocacy. By embedding representation and control into change processes, organizations not only improve adoption but cultivate a culture in which clinicians champion transformation. This approach reframes change management as a strategic lever for advocacy, aligning digital innovation with patient-centred values and frontline realities.

Improving aged care quality is a global priority. Effective monitoring and evaluation systems are the mechanism through which this priority can be realized. The interRAI consortium offers an integrated clinical information system that spans multiple care settings to support quality improvement in clinical care, meeting policy, industry, and recipient needs. However, the economic value of implementing these systems remains unknown, complicated by challenges in monetizing relevant costs and benefits. Using Campbell and Brown's cost-benefit methodology, we present a flexible framework to evaluate the cost-benefit of implementing interRAI as a minimum dataset for aged care, focused on the cost-benefit domain of care quality. Our framework provides a comprehensive foundation for cost-benefit analysis of interRAI implementation. It presents an informative starting-point for high-level decision-makers to reliably estimate the value of implementing integrated clinical information systems at multiple levels.

There are rich data available from assessments like the interRAI Mental Health that may not be shared with patients in usable ways. We outline a co-design process as an example for health system providers interested in developing platforms for sharing interRAI information with care recipients. Persons with lived experience (current and past service users) identified design specifications for summaries of interRAI data over a series of co-design workshops, including visual and text representations of clinical information as well as processes for sharing summaries with patients. Graphic and text considerations were identified in workshops, including icons associated with key clinical issues and nuanced text summaries of assessment outputs and implications. Participants noted that persons in inpatient care should review this information once stable, and with assistance of a peer support specialist. This work affirms that it is not only desirable, but entirely achievable from an organizational perspective to prioritize and integrate patient voices in the design and use of clinical information.

InterRAI instruments consist of clinical information systems able to support integrated care. Through a scoping review, we describe how interRAI instruments are used: (1) as interventions (implementation category) and (2) to evaluate interventions (efficacy category) in older adults. In accordance with the PRISMA-ScR framework, we searched 6 databases and conducted dual-independent screening, with conflicts resolved by a third reviewer. Data extraction followed an identical procedure. The review yielded 64 manuscripts, including 43 and 21 categorized as studies of efficacy or implementation, respectively. Findings indicate that interRAI systems are consistently utilized to evaluate or enhance participant-centred outcomes across diverse healthcare settings in 17 countries, with a particular emphasis on home and long-term care. InterRAI is a versatile system with the potential to form the foundation of an integrated clinical information system. This review provides a basis for future research testing novel intervention strategies with interRAI systems.

Team-based primary care involving a pharmacist provides many benefits, including improved patient outcomes, increased efficiency, and enhanced patient and clinician satisfaction. This article reports findings from a provincial survey to describe primary care network administrators' experiences during integration of pharmacists into interprofessional team in primary care networks, and to describe the facilitators and barriers of team-based care. Health service administrators reported an overall high degree of satisfaction with their experiences collaborating with the program team and with pharmacists in a developing team-based primary care model. Barriers to team-based care included lack of integrated electronic medical record preventing efficient access and sharing of patient information/communication, lack of role clarity and scope of practice among team members, and lack of co-location precluding relationship building, timely care, and optimization of the team. These barriers should be addressed to optimize the effectiveness and efficiency of the team as the model of primary care continues to evolve.

Data from routine interRAI assessments can inform healthcare decisions at individual, organizational, and system levels. A well-designed, sustainable education strategy for all target audiences is essential to support both implementation and ongoing use of interRAI systems. Instructional design strategies and considerations for developing an educational program are described, as well as specific delivery suggestions for three audiences: (1) interRAI assessors who complete accurate assessments or coordinate them within teams; (2) clinicians who utilize interRAI assessment outcomes without conducting the assessments themselves; and (3) end users such as administrators, officials, and researchers who use interRAI data for management, governance, service delivery, performance measurement, policy, and research.

The objective of this article is to examine the interRAI system for developing digital solutions. As an organization, interRAI provides all the necessary tools for digitalization of interRAI assessments and applications to create an integrated information system for decision support. The organization's model for developing software is to license software vendors in a competitive market. Thus, service providers should carefully consider required and desired features and functionality of software as these will determine how well the interRAI system will work in daily practices. The eight features presented in this article offer general guidelines for procurement agencies and software developers.