Healthcare Management Forum最新文献

Equitable and effective service and policy decisions require reliable evidence-based information; interRAI assessments offer objective data across broad health determinants for multiple purposes. This article aims to highlight selected embedded scales and algorithms and illustrate their prevalence across settings using Canadian data. Ten measures are described along with examples of subsequent use in predicting outcomes, adverse events, and resource utilization across diverse populations and jurisdictions. Prevalence rates for nine scales and algorithms were available across home and community care, Long Term Care (LTC), and inpatient settings. Higher rates of disability in function and cognition were seen in LTC and CCC, whereas palliative care has highest prevalence of health instability. Overlaps in key areas suggest the need to provide targeted services irrespective of setting. Overall, this article highlights the potential of scales and algorithms to capture key clinical information across the broader health determinants while minimizing assessment burden.

Canada's federal structure is the institutional reality informing our system of public health. While there are advantages to this decentralization, it can also lead to fragmentation and inefficiencies. Calls for stronger federal leadership or better collaboration between jurisdictions are common, but they do not directly address the question of why there has been so little progress in moving in either of these directions. Through the lens of six key public health functions, this article describes contextual realities and disparate interests of the jurisdictions. These underpin a dynamic for public health decision-making in which rational decisions can lead to suboptimal outcomes collectively. Understanding the dynamics of federalism underlying public health in Canada can help us to identify and address barriers to a more effective public health system.

To support health system transformation, efforts are underway to implement multi-professional, population needs-based health workforce planning in the province of Nova Scotia. The purpose of this article is to report on these efforts as well as successes and challenges encountered to date. Implementation has progressed furthest in the COVID-19 response and continuing care sectors, with similar efforts underway in primary care and mental health and addictions. Key enablers of needs-based health workforce planning in Nova Scotia include the availability of robust data on workforce supply and collaborative relationships between health system partners. The main challenges with implementing needs-based health workforce planning in Nova Scotia are the absence of provincial-level clinical service planning or standardized levels of service provision, and a lack of systematic collection of data to measure provider workload or health service outcomes.

To make good decisions, health leaders need information about their communities and the health workforce available to meet their needs. Raw data and indicators of population needs and workforce capacity must be transformed into usable intelligence that can support decision-making. Using the case study of integrated primary care workforce planning in Toronto, we outline our workforce planning framework, and with a focus on workforce analysis, describe the inputs and outputs that are needed for planning, key steps in the conversion of data to intelligence, and the impact of the approach. Raw data flow from data partners through a planning model into a six-step workforce analysis that renders the results of data analysis, modelling, synthesis and visualization relevant, and accessible to planners and decision-makers. We highlight important challenges and considerations related to data standardization, comprehensiveness, granularity, accessibility, and timeliness, and envision a system that more effectively supports workforce planning and decision-making.

The use of population-based data sources can offer healthcare planners and organizations insights on whether the health workforce reflects the sociodemographic diversity of the population it is meant to serve. However, sources outside the traditional boundaries of the healthcare system are typically underused in assessing health workforce imbalances to inform planning. This article offers a guide for health leaders on using national census data to monitor health workforce imbalances by geography, gender, and other equity-oriented characteristics. A case study illustrates how census data can provide standardized quantitative information on the oral health workforce, using various dissemination tools (online census tabulators and full census databanks) and methods (including linkages with other sources for enhanced cohort and ecological analyses). We also address practical issues such as the value of fostering academic partnerships to help navigate the analytics competencies and other requirements for using census products to support decisions.

Eight years ago, we were part of a team of authors who wrote about challenges facing public health at that time, indicating threats to public health that also threatened the health of the population and the sustainability of the healthcare system. Eight years later, the issues we discussed remain. In this article, we reflect on what "public health" is, its challenges, and its role both within and beyond the healthcare sector. In particular, we focus on the challenges of downgrading public health within governments and health authorities, of limiting the independence of public health officials, and of limiting public health's scope by combining it with primary and community care. We conclude with the role of public health in wider society and on what could be gained both within and beyond the health sector from a strong public health system that is oriented around a well-being society.

Indigenous Peoples have unique legislative considerations as employees that may have implications for researchers and health workforce leaders. This article aims to contextualize workforce surveys from an Indigenous employee perspective (What), identify legislation and taxation considerations for health workforce leaders regarding Indigenous employees (So What), and share organizational measurement tools and promising practices (Now What).

Advancements in health workforce research depend on access to timely, detailed, and practically oriented data. Yet researchers in this field often encounter barriers to data access, which impacts the research that we are able to conduct. In this article, we share insights as researchers who have studied health workforces through a range of data sources accessed across traditional academic and embedded scientist roles. We concentrate on unique opportunities and limitations from two experiences: (1) use of Statistics Canada surveys as part of university-based studies and (2) health organization administrative data as embedded homecare scientists at VHA Home HealthCare. Collectively, these complementary data sources contribute to providing a more comprehensive advancement of our understanding of personal support workers in Canada. We hope that sharing insights from these experiences provides inspiration and guidance to others who want to pursue a similar path in health workforce research.

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.

This article outlines the key functions and practices of government in addressing a public health crisis. Governments are responsible for planning and coordinating, resourcing and responding, and revising and evaluating. These three core functions are supported by cross-cutting practices in governance, accountability, and communication. Health leaders are advised to ensure that their organizational emergency plans intersect with those of government, and that they have processes to work with public health, government, and other partners to support robust responses to health crises.