Healthcare Management Forum最新文献

Healthcare delivery exposes care providers and leaders to suffering, loss, moral dilemmas, conflicts, and overwhelm. The cumulative effects of workplace stress and trauma have organizational impacts (turnover, cynicism, and conflict), personal impacts (burnout, mental illness, and traumatic stress), and patient care impacts (reduced empathy, poor communication, and errors). Organizations have attempted to address these issues largely through individual wellness offerings. A systematic approach is needed to create environmental conditions that support people to remain resilient, engaged, and compassionately connected in the face of constant trauma exposure. This article describes an ecological model for developing and sustaining resilience based in neuro and social science. It includes practical strategies to reshape leaders' understanding, perspectives, and competencies to enhance systemic well-being.

People have infinite needs, including illness prevention, wellness, self-care, practical support, and quality of life. This article describes community-based, informal care programs that help people identify their needs, set goals, and organize networks of care to address their needs holistically in a way that can also significantly reduce healthcare costs. Approaches can be customized for primary care, home and community, hospice, and other care sectors to facilitate low-cost, high impact adoption. We provide a blueprint for programs that integrate informal and formal care across social, physical, and mental health domains as a key part of healthcare system transformation.

With an ageing population, there is an increasing need to focus on the care of older adults, particularly those who are more medically complex. Frail older adults are more likely to require care from multiple providers across multiple settings. It is well recognized that the current Canadian healthcare system is not well-designed for this complex population. To address the health system challenges, healthcare leaders are rapidly developing and implementing programs to better support the ageing population. Unfortunately, this often means that organizations are implementing and scaling health and social care programs with limited evidence or understanding of the specific context in which it was implemented. Drawing on regional experiences, this article will explore challenges and offer solutions related to the implementation, spread, and scale of healthcare programs for older adults.

Staff burnout, a pervasive and persistent issue in the Canadian primary care environment, demands urgent and immediate attention. The managerial response to this problem has been largely reactive, especially in the post-COVID era. The need for proactive approaches to equip health leaders to detect early signs of burnout in healthcare workers and intervene effectively is more pressing than ever. Health leaders are beginning to acknowledge the significant role that trauma plays in impacting workers' propensity to experience burnout, leading to the growing recognition of trauma-informed best practices in healthcare management. This article will introduce the CARES model, a leadership competency framework that underscores the connections between leadership competencies and employee-leader engagement to detect early signs of burnout in primary care workers. The model, along with the proposed CARES toolkit, strongly emphasizes trauma-informed best practices and will enable health managers to better proactively prevent burnout through appropriate, empathetic, and efficient interventions.

Health leaders are increasingly interested in harnessing Artificial Intelligence (AI) to remotely conduct virtual triage for Emergency Department (ED) patients. This study explores equity considerations and patient attitudes to virtual triage in a Canadian ED. A cross-sectional study surveyed 150 ED patients, with 32 additional patients interviewed in-depth. Descriptive statistics and qualitative descriptive methodology were employed. 84.7% of patients would consider virtual triage. 71.3% were comfortable following advice to seek alternate care, including their General Practitioner or virtual ED. Approximately 38.2% of patients >60 years would require assistance using virtual triage, with confidence in using technology to direct care decreasing with age. Thematic analysis revealed five key themes: value of decision support; care access expectations; technological literacy demographics; trust in AI; and confidentiality. In conclusion, virtual triage is a viable and promising tool if barriers to technological literacy are addressed, and tools are endorsed by health providers and patients.

The redesign of the rehabilitation program at Runnymede Healthcare Centre (RHC) was designed to enhance patient care, staff satisfaction, and rehabilitation capacity. Aligned with RHC's strategic vision to become a centre of excellence for ageing and wellness, the initiative introduced a range of initiatives such as group therapy models, specific, measurable, achievable, relevant and time-bound rehabilitation goals, and enhanced leadership practices under the healthy engagement of older adults in rehabilitation therapy philosophy. Evaluation was integral to the initiative, with patient satisfaction, staff engagement, and key performance indicators continuously measured. Patient satisfaction scores, operational efficiency metrics, and staff engagement scores improved considerably. This project exemplifies how structured change management and embedded evaluation can lead to sustained improvements in patient care, staff experience, and rehabilitation outcomes.

The purpose of this article is to assess whether COVID-19 shaped Canadians' preferred settings of dying. We compared data collected using the same survey from two independent but comparable sets of panel respondents, prior to and after the onset of the pandemic. A vignette methodology was used to assess preferences for dying in each of four settings: home, acute/intensive care, palliative care, and long-term residential care. Although preferences for dying at home, in acute/intensive care and palliative care units did not change, preferences for dying in nursing homes significantly declined. In the pandemic's first and second waves, the spread of knowledge about problems of poor care, visitation restrictions, and fears of contagion in Canadian long-term residential care may have shaped public perceptions of and preferences for dying these settings. If this change persists, it may influence advance care planning decisions. That preferences for dying at home did not shift is, however, noteworthy.

Holistic care models aligned to population care needs are needed to help leaders shed pre-existing mindsets when determining skill mix and Multidisciplinary Team (MDT) composition. Using a PRISMA flowchart, a narrow eligibility criterion, and a research question, this scoping review resulted in 9 frameworks/models published between January 2000 and September 2023. Analysis showed common methodological elements such as a population needs-based approach, a systematic process, engagement, three or more professions reporting task or competency level analysis, change advocacy, and reliance on population and workforce supply data. Key system enablers were sponsorship, access to population needs-based and workforce supply data, a learning management system for MDT development, and health human resource policies and governance to drive health system redesign to distribute an equitable workforce. This scoping review offers health leaders and policy-makers options and next-step considerations to inspire fresh thinking for making evidence-informed decisions about skill mix and MDT composition.

The COVID-19 pandemic created an increased demand for healthcare professionals across all healthcare sectors globally. Attrition, retirement, delayed graduations, and sick leaves resulted in an inadequate supply of knowledgeable, skilled, and experienced nurses to care for hospitalized patients and help address hospital capacity pressures. In response to this health human resource crisis in Canada, the Ontario Ministry of Health offered hospitals funding to support the employment of Clinical Externs (CEs), that is, students in nursing, respiratory therapy, physiotherapy, occupational therapy medicine, and paramedicine, hired to work as unregulated staff, alongside an inter-professional team. This mixed-methods study evaluated the CE program that was implemented in one large academic hospital. The primary aim was to identify the outcomes of the clinical extern program from the perspectives of CEs, CE coordinators, and clinical leaders. Findings indicate the clinical extern program reinforces student confidence and supports their transition to formal nursing and respiratory therapy roles.

This scoping review of gender and healthcare leadership synthesized the barriers and facilitators at multiple levels employing a framework that integrates a specific focus on the concept of care. The 71 sources identified focus predominantly on barriers to women's leadership at the individual and team level and, to a lesser extent, at the organizational and system level. Facilitators tend to be presented as recommended actions than evaluated interventions. Healthcare leadership tends to ignore the gendered context of care elevating leaders who are least likely to provide such care. Where personal caregiving circumstances are considered, they are individualized, reflecting the literature in general. More critical analysis is needed to focus on women's experiences and how their gender can predetermine their success in achieving and being in leadership positions. Healthcare leadership researchers are encouraged to include gender and care-focused analyses and interventions to address the under-representation of women in healthcare leadership.