Healthcare Management Forum最新文献

Primary care practitioners are optimally positioned to reduce the Greenhouse Gas (GHG) emissions produced by the healthcare system, which pose great risk to the health of people and the environment. This narrative review discusses 19 initiatives that can be implemented into primary care practices to reduce GHG emissions and financial costs through decreasing highly intensive emergency room visits and hospitalizations. This article also summarizes the time it may take for primary care practitioners to embed each of these initiatives into their care delivery. Lastly, this article demonstrates how best practice initiatives in primary care may show a higher GHG reduction than commonly conducted initiatives aimed at reducing GHGs.

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 health leaders who have different points of view, and participate in organizational decision-making.

In response to the increasingly complex ethical issues facing health leaders, the Bioethics Department at The Hospital for Sick Children (a Canadian quaternary care paediatric research institution) was asked by senior leadership to develop a leadership ethics curriculum that would further develop the ability of its institution's leaders to deliberate and make morally defensible decisions in their roles. Insights from an interdisciplinary literature review suggest that the general objectives and structure of leadership ethics teaching remain constant, with specifics changing depending on the organization and intended participants. Implementing findings from an institutional needs assessment, our modular leadership ethics curriculum, which engages participants in asynchronous and synchronous learning, was designed to support (1) understanding of personal and organizational values, (2) recognizing the significance of attending to the ethical dimensions of decisions, (3) familiarity with leadership and organizational expectations, and (4) practicing application of ethical analysis, enhancing abilities and confidence to engage with ethical issues.

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.

This study evaluates mentorship as a practical intervention to address burnout and improve work engagement in healthcare workers at community hospitals. Using a mixed-methods quasi-experimental design, the program included education sessions, mentor-mentee matching, bi-monthly meetings over 6 months, and post-intervention surveys. The primary outcomes, measured with the Maslach Burnout Inventory and UWES-9, showed a significant improvement in Professional Accomplishment (P < 0.05), with favourable but non-significant changes in Emotional Exhaustion and Depersonalization. The program demonstrated feasibility in resource-limited settings, emphasizing its utility for non-academic hospitals. This research provides empirical evidence which highlights the potential role of mentorship as a practical and scalable approach to strengthen workforce well-being in community hospital settings, addressing key challenges exacerbated by the pandemic and limited institutional resources.

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.

Learning health systems are promoted as solutions in Canada to bridge the disconnect between research and care delivery by integrating applied research and evidence supports within healthcare. Patients and clinicians see and experience healthcare system gaps and are therefore uniquely positioned as co-producers and partners in research to advance learning health systems. Practice-based research programs provide point-of-care healthcare professionals with training, mentorship, and nominal seed funding to conduct small research projects in their clinical contexts to address gaps in practice and care. Patient-oriented research engages patients, caregivers, and family with lived experience as partners in the process of identifying gaps, generating knowledge, and applying evidence to inform healthcare delivery. This article describes the benefits gained from unifying patient-oriented research programs in British Columbia, Canada, under a provincial collaboration to standardize practice and advance collective priorities, including the foundation to cultivate and support learning health systems transformation.

Healthcare is a surprisingly large contributor to climate change, responsible for a significant quantity of global Greenhouse Gas (GHG) emissions. Global commitments to achieve "net zero" health systems, including by the federal government in Canada, suggest a growing need to understand and mobilize capacity for GHG emissions estimation across Canada's health sector. Our analysis highlights efforts by public sector healthcare organizations in Canada to estimate an increasingly broad scope of GHG emissions, building on longstanding efforts to report or reduce energy-related emissions from facilities. It also identifies why such efforts will not be sufficient. Developing capacity for routine system-wide greenhouse gas emissions estimation can help Canada's health systems to better understand their progress, including through international comparison. Yet emissions estimation is itself an investment, one that should not displace efforts to reduce the full scope of pollutants from the healthcare enterprise, and to build a truly sustainable health system.

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 health leaders a practical and systematic method to design, implement, and evaluate moral distress interventions, tailoring them to their specific environments.

Trillium Health Partners' (THP's) Regional Ethics Program led a quality improvement project to explicitly address equity, diversity, and inclusion and anti-racism and anti-oppression in its IDEA: Ethical Decision-Making Framework. Various groups, encompassing diverse backgrounds and lived experiences, completed a short survey including demographic and open-ended questions. Survey responses revealed gaps within the IDEA Framework and recommendations for modifications (e.g., editing language to be more accessible and inclusive, placing a greater focus on lived experience). Several themes emerged including explicitness, simplification, and continued learning. This work is of particular interest to health leaders as it aims to expose where bias, power, and privilege exist when addressing ethical dilemmas within healthcare systems. It explicitly addresses implicit bias, discrimination and harassment, reflexivity in care, as well as re-defines and re-imagines ethical principles (e.g., accountability, diversity, inclusivity, justice, relationships, and trust).