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Comprehensive redesign of a rehabilitation program at Runnymede Healthcare Centre. 全面重新设计 Runnymede 医疗保健中心的康复计划。
Q3 Medicine Pub Date : 2024-11-07 DOI: 10.1177/08404704241294220
Karimah Alidina, Phuntsok Namgyal, Joanna Armatys, Kerry-Ann Flowers

The redesign of the rehabilitation program at Runnymede Healthcare Centre (RHC) was designed to enhance patient care, staff satisfaction, and rehabilitation capacity. Aligned with RHC's strategic vision to become a centre of excellence for ageing and wellness, the initiative introduced a range of initiatives such as group therapy models, specific, measurable, achievable, relevant and time-bound rehabilitation goals, and enhanced leadership practices under the healthy engagement of older adults in rehabilitation therapy philosophy. Evaluation was integral to the initiative, with patient satisfaction, staff engagement, and key performance indicators continuously measured. Patient satisfaction scores, operational efficiency metrics, and staff engagement scores improved considerably. This project exemplifies how structured change management and embedded evaluation can lead to sustained improvements in patient care, staff experience, and rehabilitation outcomes.

Runnymede 医疗保健中心(RHC)康复项目的重新设计旨在提高患者护理水平、员工满意度和康复能力。根据 RHC 成为卓越的老龄化与健康中心的战略愿景,该计划引入了一系列举措,如小组治疗模式、具体、可衡量、可实现、相关且有时限的康复目标,以及在老年人健康参与康复治疗理念下加强领导力的做法。评估是该举措不可或缺的一部分,对患者满意度、员工参与度和关键绩效指标进行持续衡量。患者满意度得分、运营效率指标和员工参与度得分都有了显著提高。该项目充分体现了结构化变革管理和嵌入式评估如何能够持续改善患者护理、员工体验和康复效果。
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引用次数: 0
Determining skill mix and optimal multidisciplinary team composition: A scoping review. 确定技能组合和最佳多学科团队组成:范围审查。
Q3 Medicine Pub Date : 2024-11-05 DOI: 10.1177/08404704241293095
Donna Meadows, Joanne Maclaren, Alec Morton, Darcy Ross

Holistic care models aligned to population care needs are needed to help leaders shed pre-existing mindsets when determining skill mix and Multidisciplinary Team (MDT) composition. Using a PRISMA flowchart, a narrow eligibility criterion, and a research question, this scoping review resulted in 9 frameworks/models published between January 2000 and September 2023. Analysis showed common methodological elements such as a population needs-based approach, a systematic process, engagement, three or more professions reporting task or competency level analysis, change advocacy, and reliance on population and workforce supply data. Key system enablers were sponsorship, access to population needs-based and workforce supply data, a learning management system for MDT development, and health human resource policies and governance to drive health system redesign to distribute an equitable workforce. This scoping review offers health leaders and policy-makers options and next-step considerations to inspire fresh thinking for making evidence-informed decisions about skill mix and MDT composition.

在确定技能组合和多学科团队(MDT)组成时,需要与人群护理需求相一致的整体护理模式来帮助领导者摆脱既有思维模式。通过使用 PRISMA 流程图、严格的资格标准和研究问题,本次范围界定综述筛选出了 2000 年 1 月至 2023 年 9 月间发表的 9 个框架/模型。分析表明了共同的方法要素,如基于人口需求的方法、系统化流程、参与、三个或更多专业报告任务或能力水平分析、变革倡导以及对人口和劳动力供应数据的依赖。关键的系统促进因素包括赞助、获取基于人口需求和劳动力供应的数据、用于 MDT 发展的学习管理系统,以及推动卫生系统重新设计以分配公平劳动力的卫生人力资源政策和治理。本范围界定综述为卫生领导者和政策制定者提供了选择方案和下一步考虑因素,以启发新思维,从而就技能组合和多学科小组的组成做出有实证依据的决策。
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引用次数: 0
Exploring the impact of a clinical extern program on readiness to practice. 探索临床实习计划对实习准备的影响。
Q3 Medicine Pub Date : 2024-11-04 DOI: 10.1177/08404704241293050
Charissa Cordon, Dianne Norman, Alison Fox-Robichaud, Joanna Pierazzo, Natasha Marzilli, Marium Alvi, Charlotte Blakely, Mary Anne Aliazon

The COVID-19 pandemic created an increased demand for healthcare professionals across all healthcare sectors globally. Attrition, retirement, delayed graduations, and sick leaves resulted in an inadequate supply of knowledgeable, skilled, and experienced nurses to care for hospitalized patients and help address hospital capacity pressures. In response to this health human resource crisis in Canada, the Ontario Ministry of Health offered hospitals funding to support the employment of Clinical Externs (CEs), that is, students in nursing, respiratory therapy, physiotherapy, occupational therapy medicine, and paramedicine, hired to work as unregulated staff, alongside an inter-professional team. This mixed-methods study evaluated the CE program that was implemented in one large academic hospital. The primary aim was to identify the outcomes of the clinical extern program from the perspectives of CEs, CE coordinators, and clinical leaders. Findings indicate the clinical extern program reinforces student confidence and supports their transition to formal nursing and respiratory therapy roles.

COVID-19 大流行导致全球所有医疗保健部门对医疗保健专业人员的需求增加。自然减员、退休、延迟毕业和病假导致知识丰富、技术娴熟、经验丰富的护士供应不足,无法照顾住院病人,也无法帮助解决医院的容量压力。为应对加拿大的这一卫生人力资源危机,安大略省卫生部为医院提供资金,支持医院聘用临床实习生(CEs),即护理、呼吸治疗、物理治疗、职业治疗医学和辅助医疗专业的学生,作为不受监管的工作人员,与跨专业团队一起工作。这项混合方法研究对一家大型学术医院实施的 CE 计划进行了评估。主要目的是从临床外聘医师、临床外聘医师协调员和临床领导者的角度来确定临床外聘医师项目的成果。研究结果表明,临床实习生项目增强了学生的信心,并支持他们向正式的护理和呼吸治疗角色过渡。
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引用次数: 0
One Health in two countries: The politics of transdisciplinary healthcare collaboration in Canada and the United States. 一个健康在两个国家:加拿大和美国的跨学科医疗合作政治。
Q3 Medicine Pub Date : 2024-11-01 Epub Date: 2024-08-19 DOI: 10.1177/08404704241271316
Andrew Schrank

The One Health perspective highlights the potential synergies between the human, animal, and environmental health sciences, especially in an era of budget shortfalls, climate change, and emerging infectious diseases of zoonotic origin. Canadian physicians and veterinarians arguably lay the foundation of One Health in the late 19th century, when they pioneered the study of "comparative medicine" in Montreal, but they fell into disciplinary silos before World War I to the lasting detriment of the Canadian population. This article explores both the advantages and impediments to cross-disciplinary healthcare collaboration in Canada, highlighting the country's vast size, sparse population, and political decentralization in particular, and offers a number of policy recommendations that would allow the country to reclaim its rightful role as a leader in the One Health movement.

一体健康 "观点强调了人类、动物和环境健康科学之间的潜在协同作用,尤其是在预算短缺、气候变化和新出现的人畜共患传染病的时代。加拿大医生和兽医在 19 世纪末在蒙特利尔率先开展了 "比较医学 "研究,可以说为 "一体健康 "奠定了基础,但他们在第一次世界大战前陷入了学科孤岛,对加拿大人民造成了持久的伤害。本文探讨了加拿大开展跨学科医疗合作的优势和障碍,特别强调了加拿大幅员辽阔、人口稀少和政治权力分散的特点,并提出了一系列政策建议,使加拿大能够在 "一体健康 "运动中重新发挥其应有的领导作用。
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引用次数: 0
Do national innovation projects shape citizens' public health behaviours? 国家创新项目会影响公民的公共卫生行为吗?
Q3 Medicine Pub Date : 2024-11-01 Epub Date: 2024-08-09 DOI: 10.1177/08404704241271159
Ben Ansell, Martin W Bauer, Jane Gingrich, Jack Stilgoe

This article investigates whether, in the context of rising nationalism, drawing attention to national innovation strategies influences public health behaviours, particularly vaccine uptake. It draws on an original two-wave panel study of United Kingdom (UK) respondents during the COVID pandemic. The survey included an experimental design, which primed respondents with a nationalist framing of COVID-19 vaccines, drawing attention to the UK's role in developing the AstraZeneca vaccine and in rapid approval and roll out of other vaccines. Our results show no significant impact of nationalist framing on vaccine willingness, even among those with nationalist or science-skeptical views. These findings suggest public health authorities should be cautious with nationalist framing, as it may be ineffective or counterproductive.

本文研究了在民族主义抬头的背景下,关注国家创新战略是否会影响公共卫生行为,尤其是疫苗接种。文章借鉴了在 COVID 大流行期间对英国受访者进行的原创性两波面板研究。调查采用了实验设计,向受访者灌输了关于 COVID-19 疫苗的民族主义框架,让他们注意到英国在开发阿斯利康疫苗以及快速批准和推广其他疫苗方面所发挥的作用。我们的研究结果表明,民族主义框架对疫苗接种意愿并无明显影响,即使在那些持有民族主义或科学怀疑论观点的受访者中也是如此。这些研究结果表明,公共卫生机构应谨慎对待民族主义框架,因为它可能无效或适得其反。
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引用次数: 0
Learning from the United States' experience: Private equity and financing healthcare in Canada. 学习美国的经验:加拿大的私募股权和医疗融资。
Q3 Medicine Pub Date : 2024-11-01 Epub Date: 2024-08-02 DOI: 10.1177/08404704241268414
Maryann Feldman, Martin Kenney

Private Equity (PE) investment in healthcare has grown substantially in recent years, raising alarm about its impact on patient care, healthcare professionals, and the overall integrity of the healthcare system. The influx of PE investments into healthcare has sparked debates regarding profit-driven motives, cost-cutting measures, and potential risks to patient safety and access to essential services. This article examines the extent and possible impacts of private equity in Canadian healthcare using data from a proprietary database. Drawing upon evidence from academic studies in the United States, this article provides evidence on the adverse impacts on the quality of care, the deterioration in working conditions, and degradation of the healthcare system. It provides suggestions to limit the predatory impacts of PE investment.

近年来,私募股权投资(PE)在医疗保健领域的投资大幅增长,引起了人们对其对患者护理、医疗保健专业人员以及医疗保健系统整体完整性的影响的警惕。私募股权投资大量涌入医疗保健领域,引发了有关利润驱动动机、成本削减措施以及对患者安全和获得基本服务的潜在风险的争论。本文利用一个专有数据库中的数据,研究了私募股权投资在加拿大医疗保健领域的程度和可能产生的影响。本文借鉴了美国学术研究的证据,提供了对医疗质量、工作条件恶化和医疗系统退化的不利影响的证据。本文提出了限制私募股权投资掠夺性影响的建议。
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引用次数: 0
Adoption of assistive technologies in long-term care homes: What the pandemic has taught us. 在长期护理院中采用辅助技术:大流行给我们的启示。
Q3 Medicine Pub Date : 2024-11-01 Epub Date: 2024-08-14 DOI: 10.1177/08404704241271274
Goldie Nejat, Amos Zehavi, Cristina Getson, Hila Shoef-Kollwitz

COVID-19 increased the use of technology in everyday life and highlighted critical applications for assistive technologies. This comparative research study explores how assistive technologies, including socially assistive robots, can be adopted by long-term care homes to mitigate the lasting effects of the pandemic. In particular, we investigated the types of assistive technologies used by long-term care facilities to help with the care of older residents and for what tasks. Furthermore, we identified barriers to adoption and proposed policy measures that encourage technology adoption.

COVID-19 增加了技术在日常生活中的应用,并强调了辅助技术的关键应用。这项比较研究探讨了长期护理机构如何采用辅助技术(包括社交辅助机器人)来减轻大流行病的持久影响。特别是,我们调查了长期护理机构用于帮助护理老年居民的辅助技术的类型和任务。此外,我们还确定了采用技术的障碍,并提出了鼓励采用技术的政策措施。
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引用次数: 0
Addressing unmet need for primary care in Canada. 解决加拿大初级保健需求得不到满足的问题。
Q3 Medicine Pub Date : 2024-11-01 Epub Date: 2024-08-09 DOI: 10.1177/08404704241271141
Richard H Glazier

Primary care is the key health system strategy for improving health, enhancing patient and clinician experience, saving money, and promoting equity. Once a pioneer in primary care, Canada now fails to provide access to millions of people. This crisis is widely recognized, but policy responses are varied and mostly incremental and piecemeal. The goal of providing primary care to everyone seems unrealistic and elusive in Canada, yet it has long been attained in many other countries. Without an explicit policy goal of primary care for all, most likely on a geographic basis, Canada will continue to underinvest and underperform in primary care, with ramifications that include rapidly escalating costs, emergency department and hospital overcrowding and a growing and inequitable burden of preventable suffering. A commitment to work towards this goal is needed now to ensure that Canadians have access to high-quality well-organized care for everyone.

初级医疗是医疗系统改善健康状况、提升患者和临床医生体验、节约资金以及促进公平的关键战略。加拿大曾经是初级医疗的先驱,但现在却无法为数百万人提供服务。人们普遍认识到了这一危机,但政策应对措施各不相同,大多是渐进式和零敲碎打的。在加拿大,为所有人提供初级医疗服务的目标似乎并不现实,也难以实现,但在许多其他国家,这一目标早已实现。如果没有明确的全民初级医疗的政策目标(很可能以地域为基础),加拿大将继续在初级医疗方面投资不足、表现不佳,其后果包括成本迅速攀升、急诊科和医院人满为患,以及可预防的痛苦负担日益加重且不公平。现在就需要承诺努力实现这一目标,以确保加拿大人人人都能获得组织良好的高质量医疗服务。
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引用次数: 0
Do high drug prices fund pharmaceutical innovation? 高昂的药价能否为医药创新提供资金?
Q3 Medicine Pub Date : 2024-11-01 Epub Date: 2024-08-12 DOI: 10.1177/08404704241271237
William Lazonick, Öner Tulum

Pharmaceutical companies claim that they need high drug prices to generate sufficient profits to invest in innovation. While this claim can be valid in principle, it is contradicted by the extent to which "Big Pharma" companies in the United States (US) distribute profits to shareholders in the form of cash dividends and stock buybacks. For 2013-2022, the 14 US-based pharmaceutical companies in the S&P 500 Index paid out 54% of net income as dividends and another 51% as buybacks. Incentivizing senior corporate executives to allocate resources in this financialized manner is, as we document, their stock-based compensation. In effect, these companies use high stock prices to boost stock yields at the expense of investing in innovation and compensating workers and taxpayers who make value-creating contributions to the corporation. Given the prominence of US-based pharmaceutical corporations in Canada, we explain how their financialization results in high Canadian drug prices and underinvestment in pharmaceutical research and development in Canada.

制药公司声称,它们需要高药价来创造足够的利润,以投资创新。虽然这种说法在原则上可以成立,但美国 "大制药 "公司以现金分红和股票回购的形式向股东分配利润的程度却与此相矛盾。2013-2022 年,标准普尔 500 指数中的 14 家美国制药公司将净收入的 54% 用作股息,51% 用作股票回购。正如我们记录的那样,激励公司高级管理人员以这种金融化方式分配资源的是他们的股票薪酬。实际上,这些公司利用高股价来提高股票收益率,而牺牲了对创新的投资以及对为公司创造价值的工人和纳税人的补偿。鉴于美国制药公司在加拿大的突出地位,我们解释了它们的金融化是如何导致加拿大药品价格居高不下以及加拿大药品研发投资不足的。
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引用次数: 0
Innovating for impact: Standards and assessments as a catalyst for safer, integrated, people-centred care. 创新产生影响:标准和评估是更安全、综合、以人为本的护理的催化剂。
Q3 Medicine Pub Date : 2024-11-01 Epub Date: 2024-08-01 DOI: 10.1177/08404704241268565
Kaye Phillips, Leslee Thompson

In today's evolving healthcare landscape, leaders must innovate and collaborate to ensure safe, accessible, and high-quality care. Addressing complex issues like climate change, workforce resiliency crises, and the erosion of public trust, alongside equity and inclusive services, is critical. This article offers insights into the role of quality standards and assessment programs as catalysts for innovation and future collective impact. Using examples from Health Standards Organization and Accreditation Canada, it illustrates how these levers of change enable leaders to improve patient and workforce safety, advance integrated care, and strengthen the health of communities. Embracing people-centred and evidence-informed solutions to enable new mindsets and ways of working lays the foundation for sustainable, resilient learning health systems.

在当今不断变化的医疗保健环境中,领导者必须进行创新和合作,以确保提供安全、便捷和高质量的医疗保健服务。解决气候变化、劳动力恢复危机、公众信任度下降等复杂问题,以及公平和包容性服务至关重要。本文就质量标准和评估计划作为创新和未来集体影响的催化剂所发挥的作用发表了见解。文章以加拿大卫生标准组织和认证机构为例,说明了这些变革杠杆如何帮助领导者改善患者和员工的安全、推进综合护理并增强社区健康。采用以人为本、以证据为依据的解决方案来实现新的思维方式和工作方式,为可持续的、有弹性的学习型医疗系统奠定了基础。
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引用次数: 0
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Healthcare Management Forum
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