Healthcare Management Forum最新文献

This article focuses on the implementation of interRAI instruments at a national health system level. It is based on a narrative review undertaken by the authors from several interRAI member countries. Implementation experiences from several countries and searches of PubMed and other databases, grey literature sources, policy reports, and the interRAI repository, identified practical insights and recommendations relevant for health system implementation. Key considerations are outlined. These include policy and legal considerations, resourcing considerations, training and education considerations, and data considerations.

Improving aged care quality is a global priority. Effective monitoring and evaluation systems are the mechanism through which this priority can be realized. The interRAI consortium offers an integrated clinical information system that spans multiple care settings to support quality improvement in clinical care, meeting policy, industry, and recipient needs. However, the economic value of implementing these systems remains unknown, complicated by challenges in monetizing relevant costs and benefits. Using Campbell and Brown's cost-benefit methodology, we present a flexible framework to evaluate the cost-benefit of implementing interRAI as a minimum dataset for aged care, focused on the cost-benefit domain of care quality. Our framework provides a comprehensive foundation for cost-benefit analysis of interRAI implementation. It presents an informative starting-point for high-level decision-makers to reliably estimate the value of implementing integrated clinical information systems at multiple levels.

This multiple case study explored how Long-Term Care (LTC) teams in Ontario, Canada, manage informational continuity when older adults transition from community-based care to LTC. Five LTC homes, varying in size and rurality, participated, with 20 professionals interviewed across various roles, including nursing, medicine, rehabilitation, and administration. LTC providers emphasized the importance of comprehensive, accurate, and up-to-date biopsychosocial information to support effective care. However, information transferred from community and hospital sources was often incomplete or outdated. To address gaps, LTC staff sought additional details from electronic health records, families, care coordinators, and hospitalists. Their ability to obtain missing information was influenced by organizational capacity, physician's practice location, power dynamics between providers, availability of family caregiver support, and access to electronic health records. A stronger primary/hospital-LTC collaboration, incentives for informational continuity, and a specific staff managing transition information and activities could optimize the LTC transition information exchange process.

Health leaders must consider various solutions to alleviate the healthcare management burden within Canadian hospitals. Increased access and rapidity of Infectious Diseases (IDs) testing via multiplex Point-of-Care Tests (POCTs) is an example. Twenty-four interviews assessed the facilitators and barriers to implementing such tests in the inpatient hospital setting in Quebec, Ontario, and British Columbia. The perspective of health leaders, including provincial laboratory officials, medical and laboratory directors, POCT managers, physicians, and nurses, revealed the following major themes as being relevant to the sustainable adoption and implementation of a multiplex POCT for IDs: (1) current diagnostic methods and experience with POCTs; (2) disease burden and level of health system integration affecting a hospital; (3) the management capacity of hospitals; and (4) the anticipated impact on healthcare management efficiency. The study provides structure for health leaders to evaluate and plan for necessary organizational transformation for adopting multiplex POCTs.

Personal Support Workers (PSWs) are essential to Ontario's healthcare system. In 2021, the Health and Supportive Care Providers Oversight Authority Act (HSCPOA) established a regulatory body to protect the public, register PSWs, standardize education and competencies, and foster greater public confidence in the profession. In response, a large community hospital launched a transformational change initiative with three key components: (1) support PSWs in achieving registration, (2) enhancing PSW knowledge and skills through evidence-informed competency-based education program and simulation learning, and (3) facilitating sustainable change in the organization. Using the ADKAR Model, this initiative resulted in 98% of PSWs successfully completing registration with HSCPOA. Additionally, 97.5% of participants reported improved communication skills for managing complex situations, applying skills learned in simulated clinical scenarios. This initiative highlights the importance of aligning organizational priorities with standards of practice and demonstrates how structured change management can enhance workforce readiness and promote patient safety.

This study explored the perspectives of trauma patients, their families/proxies, and healthcare providers to understand how a dedicated inpatient Trauma Consult Service (TCS) supports high-quality, coordinated care and to identify opportunities for improvement. Over 26 months, a mixed-methods survey collected ratings across five domains of care quality along with open-ended feedback. Responses were analyzed descriptively and inductively to identify themes. Feedback across respondent groups was consistently positive, highlighting three main themes: optimized system, skilled team, and patient-centred care. The TCS was perceived as enhancing continuity, collaboration, and overall care quality. These findings suggest that dedicated consultative services can strengthen coordination and support patient recovery and satisfaction in complex inpatient settings.

Burnout among healthcare workers in Canada remains a critical challenge with implications for workforce retention, patient safety, and system sustainability. Traditional responses have often emphasized individual coping strategies rather than structural change. This article argues that Artificial Intelligence (AI) might offer new opportunities to address some of the organizational drivers of burnout. We outline three domains where AI may provide value: (1) enhancing the measurement and understanding of burnout, (2) strengthening workforce planning and operational decision-making, and (3) mitigating workplace risks through process redesign and automation. By shifting attention from "fixing workers" to "fixing work," AI might be part of the "solution" to support healthier, more sustainable healthcare environments.

Despite the relatively high turnover rates and increasing demand for homecare, little is known about the costs of turnover for homecare employers. To create effective policies to reduce turnover and associated costs, employers require an understanding of what factors contribute to the costs of turnover. Building upon existing models from labour economic and human resources theories, we worked with subject matter experts from a large homecare employer organization to co-design the first known homecare cost of turnover model. The resulting model accounts for sector-specific cost differences and can be used to estimate the costs of homecare worker turnover. As homecare continues to face high workforce instability, clear estimates of the cost of turnover can guide organizations and decision-makers in the evidence-based design of retention policies and programs to the benefit of homecare workers, funders, those seeking homecare, and the broader health and social care system.

Artificial intelligence for health holds enormous transformative potential. It has already proven successful in enhancing patient outcomes, facilitating the duties of professional caregivers, and their organizations. Its potential applications in the field of healthcare architecture are similarly being explored. This article discusses the role and function of generative artificial intelligence with respect to the professionals who work in close collaboration with healthcare organizational clients and their direct-care constituencies in decision framing the planning, design, construction, and management of healthcare facilities. Opportunities and challenges associated with generative artificial intelligence in the facility procurement process are discussed, including the role of ethics and societal responsibility at this critical juncture.

Healthcare Providers (HCPs) serving Rural, Remote, First Nations, and other Indigenous (RRFNI) communities face unique challenges in delivering longitudinal care due to geographic isolation. The Real-Time Virtual Support Services (RTVS) network aims to improve equitable access to healthcare and provide collegial support for HCPs in RRFNI communities across British Columbia. The objective of this study was to understand HCPs' experiences with RTVS and identify improvement areas. Data were collected through semi-structured interviews with HCPs that were recorded, transcribed, and openly coded. Twenty HCPs using RTVS were interviewed during 2022-2023. The constant comparative method was used to develop themes. Themes focused on RTVS's benefits and outcomes including increased clinical confidence, reduced provider anxiety, respectful and collegial support, reduced administrative burden, and recruitment and retention support. Challenges included occasional service disruptions and limited Wi-Fi availability. These findings provide in-depth and contextualized feedback informing the development of RTVS.