Healthcare Management Forum最新文献

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.

The healthcare system in Canada is overwhelmed and requires reform. Good discharge communication is a cornerstone of patient safety and quality care. In the Emergency Department (ED), good discharge communications means that patients leave with a clear understanding of their health condition, and the steps they need to take to continue their recovery at home. The fragmented nature of communication in the ED coupled with long wait times and high noise levels pose significant risks to the continuity of information exchange. Additional communication barriers arise for many patients due to a lack of control, language differences, low health literacy, and feelings of fear and uncertainty. Multiple interventions have been evaluated to improve ED discharge communication, but further work is needed to engage all end users in a theory-based approach. Addressing challenges related to successful discharge communication requires a multifaceted approach that includes improving institutional policies, adopting innovative co-designed interventions, and leveraging technology.

The Attendance, Wellness, and Engagement (AWE) Model of Workplace Satisfaction is an innovative approach to promoting a sustainable, healthy, and engaged workforce. Implemented at Louis Brier Home and Hospital, the AWE Model encapsulates a people strategy aimed at nurturing a supportive and fulfilling work environment. Attendance promotion is accomplished by acknowledging absences while providing a comprehensive support system to address personal challenges faced by healthcare workers. The wellness component is underscored by increasing resource utilization, offering on-site health services, and cultivating social groups to enhance holistic well-being. Additionally, engagement is characterized by staff recognition rituals, community-building initiatives, and celebratory events. Importantly, this article presents a compelling position that the AWE Model creates a positive impact on reducing absenteeism, enhancing staff satisfaction, and transforming organizational culture. As health leaders grapple with workforce challenges, the AWE Model serves as a pragmatic framework to cultivate environments where employees regularly attend work healthy and engaged.

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.

A Patient Navigation (PN) model of care was introduced in a large metropolitan hospital in Ontario (Canada) to support transitions in care for older adults in 2019. The patient navigator is a community social worker or "community transitional lead" embedded in the hospital's in care teams to assist with discharge planning and provide follow-up care to older adults, their families, and/or care partners for up to 90 days. Initially, the PN program supported acute care patients and has since expanded in the Emergency Department and Reactivation Care Centre. In this cohort retrospective observational study, we described the new PN model of care by analyzing the clinical notes collected by the patient navigator. This article provides preliminary insights for health leaders who are interested in implementing this novel PN model to improve transitions of care in a hospital setting. Funding was provided by the SLAIGHT Family Foundation.

Principles-focused evaluation reflects on the change process itself through examination of its underlying principles. The Centre for Advancing Collaborative Healthcare & Education (CACHE) worked to build interprofessional education programs and tools that attended to the Team Primary Care (TPC) principles. Our internally directed principles-focused evaluation, presented here, asks how CACHE adhered to these principles in the programs and tools it delivered to the TPC project. The article's main contribution is the creation of a new concept, organizational critically reflective practice, which describes an approach health leaders can use to mitigate the limitations of short-term initiatives while pursuing transformational change. We propose specific tools and steps that will help health leaders attempting to enact organizational critically reflective practice.

Necessitated by the healthcare crisis and exacerbated by the pandemic, and building on model of care experimentation over the last decade, SE Health executed on an organizational change to bring the innovative model to life. This model is titled H.O.P.E. MODEL™ of Care-Home, Opportunity, People, Empowerment. The innovation in model of care design and implementation is guided by the Integrated-Promoting Action on Research Implementation in Health Services (i-PARiHS) framework. Our journey highlights the art of leadership and science of implementation for sustainable impact on care excellence and health system transformation. This implementation experience has also generated the following insights: reinforce the foundation, operationalizing practice, what gets measured gets done, technology enabling practice, and all roads lead to H.O.P.E.

This article presents the development of the Equity, Diversity, Inclusivity, and Accessibility (EDIA) Cross-Cutting Theme Project within the Team Primary Care (TPC) initiative, aimed at addressing systemic inequities through innovative educational strategies. Grounded in the social accountability of health professions framework, this project aims to equip primary care teams with the knowledge, skills, and attitudes necessary to promote health equity. The EDIA Integrated Educational Experience (IEE) model includes a self-assessment tool, digital learning space, and national mentorship network, providing a comprehensive approach for primary care teams to promote health equity. The IEE model utilizes a layered micro, meso, and macro approach to support cultural transformation within highly complex healthcare environments. Key lessons learned involve trust- and relationship-building processes to help dismantle historical silos and encourage open dialogue. Future efforts focus on implementation, ensuring adaptability, scalability, and sustainability, positioning the model as a catalyst for equitable primary care delivery.

Canada has been unique in the modern era for limiting midwives from providing sexual health and perinatal care to families. Prohibitions on midwifery practice were finally lifted in Prince Edward Island in 2024, yet midwives' scope of practice continues to be restricted in most jurisdictions. The Canadian Midwifery Regulators Council recently recommended midwives should be able to practice their full scope. Our midwifery pilot project, located in the city of Victoria, British Columbia, implemented this recommendation in 2023-2024. Below we demonstrate the benefits of integrating midwifery into a primary healthcare clinic and the continued challenges midwives and their teams face in securing salaried employment long-term. We focus on the specialized cultural and clinical skillset that Indigenous registered midwives in particular bring to primary care, and the life-saving outcomes that can occur for youth clients if interprofessional collaboration and cooperation are well-established.

In March 2020, as the COVID-19 cases began to rise in Ontario, Canada, the central role of Occupational Health and Safety (OHS) to ensure the well-being of hospital workforce became highly visible. While Ontario's hospitals concentrated efforts to meet each challenging and uncertain wave stressing the system, it was apparent that there is a lack of consistency in best practices and policy response across the healthcare sector. Additionally, the unprecedented pressure on healthcare workforce as they attempted to meet the pandemic's new surging demands resulted in workforce shortages and increased levels of burnout, making it difficult to engage, support, and retain the staff necessary for delivering highest quality of services. The Toronto Academic Health Science Network (TAHSN), a dynamic consortium of 14 healthcare organizations, established a collaborative to implement an integrated effort and align on structure, processes, and standards that will increase strength and defensibility of TAHSN programs. To foster community building, identify areas of common concern, and co-create practices during and beyond the COVID-19 pandemic, a structured network of 14 OHS directors across the healthcare organizations was established. This article discusses the origin of the TAHSN collaborative, the thriving community vision for partnership, and the case study methodology used to combine capabilities to showcase innovation and excellence in care together.