Healthcare Management Forum最新文献

Recent advancements in the field of Artificial Intelligence (AI) provide promising applications of this technology with the aim of solving complex healthcare challenges. These include optimizing operational efficiencies, supporting clinical administrative functions, and improving care outcomes. Numerous AI models are validated in research settings but few make their way into useful applications due to challenges associated with implementation and adoption. In this article, we describe some of these challenges, along with the need for a facilitating entity to safely translate AI systems into practical use. The authors propose a new AI governance framework to enable healthcare organizations with a mechanism to implement and adopt AI systems.

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.

Digital health programs continue to be implemented within Canadian health systems at a steady pace. The effectiveness of digital health initiatives has been rigorously analyzed, with both benefits and drawbacks extensively commented on. While the discussion about digital health continues, both positive and negative perspectives of it are approaching saturation in their themes. Accepting that digital health is here to stay post-pandemic, the focus should shift to strategies and supports needed to avoid the fragmentation of care through digital health implementation. This short article poses three questions which policy-makers and decision-makers should explore as part of a level-setting exercise with involved stakeholders at the outset of a digital health program's consideration. An implementation team should design the digital health program to have equity as its foundational focus, conduct value-based evaluations, and position the program in a learning health system framework to guard against the fragmentation of care.

Canadian Institute for Health Information (CIHI) is looking to modernize and adopt new ways of working. This incudes the use of new technology, including the application of Artificial Intelligence (AI). To begin in a purposeful manner, the organization developed an AI strategy which was informed through feedback from key stakeholders and partners, from its staff and from a review of international research. The research informed several ways AI could add value to CIHI's internal operations and to the external role CIHI could play in advancing responsible AI adoption in health systems across Canada. This article describes the strategy development process and the areas of focus within the strategy.

The ageing global population is posing a significant challenge to healthcare systems worldwide. Healthcare needs have become more complex and the demand for services is ever increasing. Identification of frailty at the front door of hospitals can prompt comprehensive geriatric assessment and streamline patients to the most suitable clinical area. The United Kingdom has set a priority to develop front door services given the pressure on the National Health Service. A British Geriatrics Society survey has demonstrated that the majority of frailty assessments occur in the emergency department using the Clinical Frailty Scale. This survey prompted the creation of the setting up services guide and its key principles using a collaboration of experience from across the country. Understanding the systems that already exist and creating a network to enable a flow of care towards community teams is crucial to the successful provision of modern frailty attuned care.

This article explores the concept of medical silos, particularly within hospital systems, and examines their deeper roots in social identity and the fiduciary duty of care of healthcare providers. While traditional perspectives focus on informational and communication barriers, this analysis highlights how professional identity and moral obligations contribute to the persistence of silos. Social identity theory reveals that strong in-group affiliations, formed during medical training and specialization, fosters collaboration within groups but also create divisions between them. Similarly, the fiduciary duty of care, central to ethical medical practice, may inadvertently reinforce silo boundaries in resource-limited environments. By emphasizing the role of centralized leadership, the article proposes that health system managers and leaders, with the broadest possible duty of care, must take action to dismantle these barriers. Recommendations include re-evaluating policies for patient transitions and fostering integrated care pathways to improve overall system flow, rather than simply balancing the agendas of stakeholders within their silos.

Paramedics and Palliative Care is an example of a promising practice ("pilot") that underwent successful spread and scale across Canada. Through the support of two pan-Canadian health organizations and concurrent evolution of the profession of paramedicine, this innovation has become integrated into practice. Evaluation of the innovation sites showed positive impact in all elements of the Quintuple Aim, and data from the expansion sites mirrors this success. Paramedic comfort and confidence is improved. Patient and family satisfaction is high. Quality indicators such as time spent at home, and home deaths, improved after program launch. There are time and cost savings with the program in place. The framework that enabled this spread and scale is presented and elaborated, to support further uptake of this innovation and provide a blueprint for successful expansion of other promising practices to support healthcare improvement across Canada.

Public servants are central in helping Canadians navigate public health crises. Before, during, and after the COVID-19 pandemic, these professionals have been essential to implementing widespread government interventions, sometimes amid significant public scrutiny. These experiences highlight the delicate balance public health officials maintain in a democracy: providing expert advice to cabinet to define the public good and implementing decisions to help preserve public health. Notwithstanding varying scopes for autonomous decision-making, chief medical officers of health aid elected officials in weighing tradeoffs in the pursuit of communal objectives, not by dictating them but by enabling informed decision-making. In recent years, there have been calls for public health officials to substitute their judgement for that of elected officials in issuing directives. This article explores the role of public health officials as public servants and the perils of these officials misunderstanding their roles which may undermine the effectiveness and legitimacy of policy decisions.

OurNotes is a movement that advocates for patient engagement by encouraging patients to contribute to their care through a pre-visit note, where they can comment on their health progress and prioritize topics for discussion with their clinicians. To date, pre-visit notes have been implemented in primary and acute care settings internationally, and their reception has generally been positive. However, their use in Canada and in mental health settings is limited. To address this gap, we conducted semi-structured interviews with 26 mental health clinicians, patients, and care partners. Barriers, facilitators, and recommendations to implementing pre-visit notes in Canadian mental health settings were identified. Overall, clinicians, patients, and care partners had positive perceptions towards pre-visit notes, indicating that they may serve as an innovative model for improving patient engagement and satisfaction in mental health settings. The barriers and facilitators identified, provide guidance for mental health organizations considering the implementation of pre-visit notes.

The Canadian healthcare landscape is characterized by its ambitious pursuit of innovation in response to challenges such as resource limitations and system restructuring. However, meaningful innovations cannot be sustained without leadership that empowers a patient-first integrated model of care. This article will explore the transformative changes of CIUSSS Centre Ouest de l'Île de Montréal directed to implanting the pillars of a value-based health system. We showcase our "Hospital-at-Home" program as an example to highlight the critical role of leadership in setting our vision of "Care Everywhere," empowering our healthcare workforce, and in ensuring successful implementation and sustainment. Our manuscript aims to provide insights into the leadership strategies that have underpinned these achievements, focusing on how these innovations have anticipated emerging healthcare demands, and highlighting a sustainable model for health leaders and policy-makers who are addressing similar challenges.