Healthcare Management Forum最新文献

Data and evaluation have become integral to efforts aimed at transforming organizational cultures. This is true in Diversity, Equity, and Inclusion (DEI), where organizations are assessing their employee make-up and the impact of their programs and services on systematically marginalized communities. This article presents a case study of a self-identification and workplace experience survey that was the first of its kind at the Provincial Health Services Authority in British Columbia. With a 30.7% response rate, we share an overview of the survey, lessons learned, and recommendations for other healthcare institutions embarking on their DEI journey. Key takeaways include engaging leaders early and allowing adequate time and resources for planning and executing the survey. Confidentiality is a crucial element to ensure that everyone feels confident to take the survey. Ultimately, adequate implementation of actions from survey results will build trust among staff and advance DEI priorities in organizations.

This article examines the role of health leaders in the early stages of a community response to address health and homelessness in London, Ontario. Specifically, we explore how leaders from large healthcare-providing organizations have influenced the dynamics of the entire community response. We argue that the high level of engagement from health leaders has been a key ingredient in the early successes of the new approach in London, in part because it validated the reframing of homelessness as a healthcare issue-importantly, changing perceptions about who shares the responsibility to address it.

In recent primary care policy, collaboration is often understood as an outcome, such as the delivery of team-based care or an integrated health system. This outcome-based understanding of collaboration in policy has proven challenging to achieve in practice. This article introduces the concepts of constructing boundaries and boundary objects used in other disciplines, to support our understanding of collaboration by observing the collaborative process. Multiple methods, such as semi-structured interviews, discourse analysis, and member-checking, were used to compare primary care collaborations across three distinct time periods during the onset of COVID-19 within Interior British Columbia. Data analysis revealed the changing nature of boundaries and boundary objects, providing insights into the collaborative process. Through the exploration of boundaries and boundary objects, this article provides a way to approach collaboration in practice differently. By better understanding the process of collaboration, this research could potentially improve collaborative outcomes.

The purpose of this study was to investigate how the COVID-19 pandemic's inaugural wave impacted the professional autonomy of family physicians in Canada. This study highlights how family physician's resilience enabled them to overcome the many challenges they faced to provide health services to patients and has enabled them to rebuild their sense of purpose and duty of care. Four themes were found to summarize physician experiences: (1) loss of clinical autonomy and control; (2) abandonment and neglect by the health system; (3) a fear of patients "falling through the cracks" and moral injury; and (4) building resilience to support duty of care in family practice. These results highlight the emergence of resilience among family physicians to restore professional autonomy in family practice, overcoming moral injury in order to fulfil their "duty of care" to their patients. Physicians believe the health system's crisis preparedness efforts need to be dedicated to protecting the autonomy of practicing physicians to maintain the continuity of quality patient care in future health crises.

Canada is experiencing an unprecedented primary care crisis, with 6.5 million Canadians reporting lacking a family physician, including 31% of the Quebec population. To address this problem, the province of Quebec implemented Primary Care Access Points (GAPs) to help unattached patients navigate and access primary care services while awaiting attachment. We aimed to examine the determinants associated with unattached patients receiving a medical appointment compared to another service through the GAP. Cross-sectional data (n = 13,291) from two GAPs were collected (June 2022 to March 2023). Multivariable logistic regression was carried out. Being younger, calling for an acute health problem, medication renewal or to have administrative documentation filled, having a physical or mental health problem, and using GAP A (compared to GAP B) were associated with an increased likelihood of receiving a medical appointment. This study is the first to document the characteristics of patients using the GAP and their needs.

Emergency Departments (EDs) have faced mounting pressures in recent years as greater volumes of patients seek care, many with increasingly complex clinical and social needs. However, the potential contributions of rehabilitation professionals to help alleviate these pressures in the ED are not well understood or leveraged. To address this knowledge gap, the authors conducted a literature review of rehabilitation models of care and the impact of rehabilitation professionals in the ED, as well as an environmental scan to understand rehabilitation models of care across two large regions in Ontario. This article outlines these findings, as well as future opportunities related to leading care and patient flow practices based on rehabilitation models in the ED.

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.