Healthcare Management Forum最新文献

Climate change is straining Canada's health system. Canada pledged to develop climate-resilient and low-carbon sustainable health systems, with a net zero target. Despite this commitment, progress remains slow and fragmented, with many regions lacking cohesive, evidence-based strategies. While some provinces and health authorities have taken the lead, their efforts are hindered by inadequate investment. Limited data on low-carbon resilient strategies led to a comparative policy analysis of similar health systems to identify solutions. Canada can draw lessons from countries like the United Kingdom and Australia, which have committed to net zero health systems supported by robust national strategies. Australia's approach offers a model for Canada to follow, providing a clear governance structure, accountability mechanisms, and coordinated investments. A similar federal strategy could ensure alignment across provinces and drive transformative change. Without urgent action, Canada risks continued health sector emissions, further system deterioration, and rising health impacts, including preventable deaths.

This article examines how technical terminology in public-facing communication creates epistemic barriers that undermine trust between experts and the public-especially in multilingual, multicultural healthcare systems. It argues that health leaders can foster trust by employing a "code-switching" model within institutions and in patient- or public-facing communications. Code-switching is a linguistic phenomenon in which individuals switch between languages, dialects, or language varieties based on the social context. Recognizing "public-speak" and "medical-speak" as distinct codes would facilitate patient understanding of information relevant to their care and promote trust. Health leaders play a crucial role in ensuring that complex medical information is translated into accessible language, bridging the gap between experts and the public.

Most of what physicians learn in their training when it comes to ethics focuses on the principles related to the doctor-patient relationship: beneficence, non-maleficence, and autonomy. At a system level, this translates into an obligation for physicians to advocate for their patients based on these principles. Advocacy does not necessarily have answers when resources are scarce, and as a result, physicians often find that they are not "at the table" when important decisions are made at the organizational level. I will argue that for physicians to be more effective leaders within their organizations, there needs to be more of a focus on principle of justice within medical training, specifically when it comes to theories around resource allocation and social justice. This will help physicians to more effectively advocate for their patients, have conversations with healthcare leaders who have different points of view, and participate in organizational decision-making.

This article describes the development of an organization-wide intervention to address moral distress in healthcare. A multidisciplinary team, including researchers and organizational partners, used intervention mapping and the theoretical domains framework to create the moral empowerment system for healthcare. This system encompasses a suite of strategies designed for integration into organizations' operations to empower healthcare professionals individually and collectively to address moral events. This suite includes an ethics education program for healthcare professionals, interprofessional teams, and leaders; moral empowerment consultations; reflective debriefings; and mentoring. An implementation and evaluation plan is also presented, highlighting a staged approach that reflects the organizational context. Ultimately, the approach described here offers healthcare leaders a practical and systematic method to design, implement, and evaluate moral distress interventions, tailoring them to their specific environments.

Discrimination against individuals with Mental Health and Substance Use (MHSU) challenges adversely influences healthcare. To address shortcomings of existing anti-stigma interventions, a novel eLearning course on dismantling structural stigma was co-designed, piloted, implemented, and evaluated with diverse partners. The course aimed to foster reflection and evidence-informed approaches to recognize and address structural forms of stigma in healthcare contexts. Participants included self-identified health system leaders, influencers, and healthcare professionals (n = 528). Descriptive statistics and paired t-tests on pre- and post-evaluation data suggest that the course was perceived as relevant and useful for participants while enhancing their knowledge and skills. Overall, a web-based interactive eLearning course designed to improve knowledge, skills, and attitudes about structural stigma while challenging, transforming, and enlightening learners' beliefs and assumptions is an accessible tool with potential to produce sustained educational and practice-based outcomes and improve equity for individuals with MHSU challenges.

Registered Dietitians (RDs) are essential professionals within Canadian Team-Based Primary Care (TBPC). RDs utilize practice competencies to ensure provision of high-quality care while working closely with other TBPC members. To fill in the gaps in the literature, the study's objective was to explore RDs' perception of their contributions to TBPC settings and their educational needs. This will help inform health leaders who manage interdisciplinary teams. A survey was distributed to Canadian TBPC RDs. They (n = 73) reported contributing to nutrition care for various populations, managing a large range of nutrition problems, and using competencies from multiple practice domains. Furthermore, they identified their need to enhance their knowledge about cultural safety within TBPC, as well as their interdisciplinary teams' need to increase their awareness of the dietetic scope of practice. Identifying RDs' contributions, competencies, and learning needs helps inform Canadian health leaders to improve care.

In Canada, the provision of Paediatric Palliative Care (PPC) services faces unique barriers due to a large geography and dispersed service population. This review identifies global challenges and strategies to inform efforts in strengthening Canadian PPC access and delivery. Utilizing a rapid review methodology, two databases were searched for publications between 2014 and 2024. Five hundred and ninety-five studies were imported, and 31 retained. Challenges identified in the literature included (i) uncertainty with team roles and responsibilities, (ii) lack of PPC familiarity, and (iii) navigating fragmented health systems. Recommendations included (i) enhancing education, (ii) streamlining access, and (iii) increasing awareness. Concerted effort between health leaders is essential to implement solutions towards a more integrated care system-one that considers the needs of all children. Prioritizing nationwide awareness, access, and capacity-building will ensure PPC meets the needs of all children and families, regardless of location.

Healthcare systems in Canada are under pressure and require change-the status quo is no longer fit for purpose, if it ever was. Innovation is often held up as a cure for what ails us, but shiny new things or novel technologies alone have not been enough. This article will explore the concepts of differentiation and integration as being important drivers in the evolution of living organisms, ecosystems, and complex human organizations. The implications of this deep pattern of systems change are essential to understanding the roles of specialization in medicine, and optionality in primary care. Specifically, overspecialization without attention to the principles of healthcare integration can lead to fragmentation of care and worse patient outcomes. Finally, this article will describe some practical examples of system integration as innovation in the form of better public health and care delivery connections, health homes, and community care coordination centres.

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.

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 noteworthy.