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Making hospitals innovative: Macro-level policy to sustain micro-innovations in healthcare. 让医院创新:维持医疗保健微观创新的宏观政策。
Q3 Medicine Pub Date : 2024-11-01 Epub Date: 2024-08-16 DOI: 10.1177/08404704241273965
Khalil B Ramadi, Saakshi More, Anshuman Shaji

Successful innovation clusters are notoriously difficult to establish, and many attempts fail. How can we go about designing such systems reliably? We describe how ecosystems can be strengthened through grassroots bottom-up efforts that empower user and community innovation, as opposed to economic policies that dictate innovation. Specifically focusing on the healthcare industry, we advocate that community hospitals which constitute 90% of all hospitals in Canada are the ideal setting for such community innovation efforts. We investigated the distribution of innovation output from hospitals over the past 13 years and found a decrease in predominance of major teaching hospitals, supporting the potential role for community hospitals in this space. We categorize different types of innovations and recommend institutional policies that can sustain bottom-up, micro-level efforts. Such policies could improve and enhance the development of micro-innovations and the creation of health innovation clusters.

成功的创新集群很难建立,许多尝试都以失败告终。我们如何才能可靠地设计出这样的系统?我们介绍了如何通过基层自下而上的努力来加强生态系统,从而增强用户和社区的创新能力,而不是通过经济政策来左右创新。我们特别关注医疗保健行业,主张占加拿大医院总数 90% 的社区医院是开展此类社区创新工作的理想场所。我们调查了过去 13 年中医院创新产出的分布情况,发现大型教学医院的主导地位有所下降,这支持了社区医院在这一领域的潜在作用。我们对不同类型的创新进行了分类,并提出了能够维持自下而上的微观努力的制度政策建议。这些政策可以改善和加强微观创新的发展和卫生创新集群的创建。
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引用次数: 0
Artificial intelligence research in Canadian hospitals: The development of metropolitan competencies. 加拿大医院的人工智能研究:大都市能力的发展。
Q3 Medicine Pub Date : 2024-11-01 Epub Date: 2024-08-22 DOI: 10.1177/08404704241271218
Pierre Pelletier, Aldo Geuna, Daniel Souza

This study explores the deployment of Artificial Intelligence (AI) in Canadian hospitals from 2000 to 2021, focusing on metropolitan areas. We investigate how local public and private research ecosystems and links to national and international AI hubs influence the adoption of AI in healthcare. Our analysis shows that AI research outputs from public institutions have a significant impact on AI competences in hospitals. In addition, collaborations between hospitals are critical to the successful integration of AI. Metropolitan areas such as Toronto, Montreal, and Vancouver are leading the way in AI deployment. These findings highlight the importance of local AI research capabilities and international hospital collaborations and provide guidance to policy-makers and health leaders to drive the diffusion of AI technology in healthcare.

本研究探讨了 2000 年至 2021 年加拿大医院的人工智能(AI)部署情况,重点关注大都市地区。我们调查了当地公共和私营研究生态系统以及与国内和国际人工智能中心的联系如何影响医疗保健领域采用人工智能。我们的分析表明,公共机构的人工智能研究成果对医院的人工智能能力有重大影响。此外,医院之间的合作对于成功整合人工智能至关重要。多伦多、蒙特利尔和温哥华等大都市地区在人工智能部署方面处于领先地位。这些发现凸显了本地人工智能研究能力和国际医院合作的重要性,并为政策制定者和卫生领导者提供了指导,以推动人工智能技术在医疗保健领域的推广。
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引用次数: 0
Getting better at getting better: Advancing quality and safety in healthcare. 在 "变得更好 "中 "变得更好":提高医疗质量和安全。
Q3 Medicine Pub Date : 2024-11-01 Epub Date: 2024-08-29 DOI: 10.1177/08404704241271164
Jennifer Zelmer

Scaling the innovative models of care, policies, practices, and technologies that deliver true value requires deliberate, focused effort. We need to simultaneously apply practical strategies that enable change agents to drive meaningful, sustainable impact to address particular challenges that a health system is facing, alongside implementing proven, evidence-informed approaches that broadly strengthen health system foundations. Both approaches matter; it's not about choosing between them. Rather, we need to respond to the health system's specific and immediate needs, while also growing culture, capacity, systems, and tools that enable transformation in quality and safety.

推广具有真正价值的创新医疗模式、政策、实践和技术需要深思熟虑、集中精力。我们需要同时采用切实可行的战略,使变革推动者能够推动有意义的、可持续的影响,以应对卫生系统面临的特殊挑战,同时实施经过验证的、有实证依据的方法,以广泛加强卫生系统的基础。这两种方法都很重要,而不是在两者之间做出选择。相反,我们需要应对卫生系统的具体和迫切需求,同时还要发展文化、能力、系统和工具,以实现质量和安全方面的转型。
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引用次数: 0
Ethical challenges in healthcare innovation: A leadership perspective. 医疗创新中的道德挑战:领导力视角。
Q3 Medicine Pub Date : 2024-11-01 Epub Date: 2024-08-19 DOI: 10.1177/08404704241273997
Renate Ilse

Innovation is essential for advancing and sustaining healthcare systems, particularly in hospitals. While innovation offers solutions to challenges such as chronic disease management, access to care, and patient safety, it also introduces significant ethical dilemmas for health leaders. This column explores the broad ethical issues associated with healthcare innovation, focusing on resource allocation, support for diverse healthcare professions, equitable access to care, and the emphasis on technology-based innovations. It highlights the complexities of funding innovation through government, private sector, universities, donors, and the unpaid work of healthcare providers. The column also addresses the disparities in innovation support across different professions and the potential for innovation to exacerbate healthcare inequities. Potential solutions are proposed, including the establishment of interdisciplinary councils, dedicated innovation funds, and public-private partnerships. By prioritizing ethical leadership and balanced innovation strategies, health leaders can ensure that advancements benefit all stakeholders, fostering a more equitable and sustainable healthcare system in Canada.

创新对于推进和维持医疗系统,尤其是医院的医疗系统至关重要。虽然创新为慢性病管理、获得医疗服务和患者安全等挑战提供了解决方案,但它也为医疗领导者带来了重大的伦理难题。本专栏探讨了与医疗创新相关的广泛伦理问题,重点关注资源分配、对不同医疗专业的支持、公平获得医疗服务以及对技术创新的重视。专栏强调了通过政府、私营部门、大学、捐助者以及医疗服务提供者的无偿工作为创新提供资金的复杂性。专栏还讨论了不同专业在创新支持方面的差异,以及创新加剧医疗保健不平等的可能性。文章提出了潜在的解决方案,包括建立跨学科委员会、专项创新基金和公私合作伙伴关系。通过优先考虑道德领导力和平衡的创新战略,卫生领导者可以确保进步惠及所有利益相关者,促进加拿大医疗保健系统更加公平和可持续发展。
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引用次数: 0
HCA PIECESTM Care Coach Program: Peer to peer approach to promote person-centred care in long-term care. HCA PIECESTM 护理教练计划:在长期护理中推广以人为本的护理方法。
Q3 Medicine Pub Date : 2024-10-28 DOI: 10.1177/08404704241290777
Jae Yon Jones, Amanda Leddy, Gloria Real

In Long-Term Care (LTC) settings, the potentially inappropriate use of antipsychotics for behavioural and psychological symptoms of dementia is a persistent issue, with high rates despite limited benefit and serious risk. Best practice is a non-pharmacological, person-centred approach to care, though this can be challenging in LTC settings. To help address this gap, we developed the PIECESTM HCA Care Coach Program and described its implementation and outcomes observed at 13 LTC homes. This program empowers Health Care aides with training, tools, and processes to practice the principles of person-centred care and provide peer mentorship to the care team. After 1 year, we found declining antipsychotics use (by 4.4%) and positive indicators of improved staff experience and improved resident quality of life. The Care Coach Program can be adapted and spread to a variety of LTC settings to help reduce potentially inappropriate antipsychotic use and better support people living with dementia.

在长期护理(LTC)机构中,抗精神病药物可能会被不恰当地用于治疗痴呆症的行为和心理症状,这是一个长期存在的问题,尽管疗效有限,但使用率却很高,而且存在严重风险。最佳做法是采用非药物、以人为本的护理方法,但这在长期护理中心环境中具有挑战性。为了弥补这一不足,我们开发了 PIECESTM HCA 护理教练计划,并介绍了该计划的实施情况以及在 13 家 LTC 养老院观察到的结果。该计划通过培训、工具和流程赋予健康护理助理实践以人为本的护理原则的能力,并为护理团队提供同伴指导。一年后,我们发现抗精神病药物的使用量有所下降(减少了 4.4%),员工的工作经验得到了改善,居民的生活质量也得到了提高。护理教练计划可以在各种长期护理中心进行调整和推广,以帮助减少可能不适当的抗精神病药物使用,更好地为痴呆症患者提供支持。
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引用次数: 0
Long term care-acute system integration and transformation: Innovations in models of care. 长期护理-急诊系统整合与转型:护理模式的创新。
Q3 Medicine Pub Date : 2024-10-27 DOI: 10.1177/08404704241293316
Beatrise Edelstein, Denise Scott, Kathleen Kirk

The article discusses innovations in integrating Long-Term Care (LTC) and acute systems, focusing on Humber River Health's (HRH) model. Older adults in LTC homes are vulnerable to avoidable Emergency Department (ED) visits due to frailty and medical complexity. HRH developed an integrated care model centred on LTC Remote Monitoring (RM) with LTC partners, leveraging nurse-led care models, digital tools, and virtual care hub to reduce avoidable ED transfers. Key components include the PREVIEW-ED© tool for early detection of clinical deterioration, LTC+ Hub and LTC++ Diagnostic Imaging and Transportation, supporting improved access to healthcare services. The program aligns with the Quintuple Aim, emphasizing patient and provider experiences, population health, cost reduction, and health equity. Results show significant reductions in ED visits, hospital lengths of stay, and associated costs, while enhancing resident and provider experiences. The LTC RM model is positioned as a scalable solution for system transformation in integrated care.

文章讨论了整合长期护理(LTC)和急诊系统的创新方法,重点介绍了亨伯河健康中心(HRH)的模式。由于体弱多病和医疗复杂性,住在长期护理院的老年人很容易出现可避免的急诊就诊(ED)情况。Humber River Health 与 LTC 合作伙伴共同开发了以 LTC 远程监控(RM)为中心的综合护理模式,利用护士主导的护理模式、数字工具和虚拟护理中心来减少可避免的急诊室转院。其主要组成部分包括用于早期发现临床病情恶化的 PREVIEW-ED© 工具、LTC+ Hub 和 LTC++ 诊断成像及交通,支持改善医疗保健服务的获取。该计划符合 "五重目标"(Quintuple Aim),强调患者和医疗服务提供者的体验、人口健康、降低成本和健康公平。结果表明,急诊室就诊率、住院时间和相关费用大幅减少,同时提升了居民和医疗服务提供者的体验。LTC RM 模式被定位为综合护理系统转型的可扩展解决方案。
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引用次数: 0
The Integrated Care Team: A primary care based-approach to support older adults with complex health needs. 综合护理小组:以初级保健为基础,为有复杂健康需求的老年人提供支持。
Q3 Medicine Pub Date : 2024-10-22 DOI: 10.1177/08404704241293051
George A Heckman, Sarah Gimbel, Chantelle Mensink, Brittany Kroetsch, Aaron Jones, Anooshah Nasim, Melissa Northwood, Jacobi Elliott, Adam Morrison

Many older adults have complex needs and experience high rates of acute care use and institutionalization. Comprehensive Geriatric Assessment (CGA) is a specialized multidimensional interprofessional intervention to prevent such outcomes, but access to CGA in the community is limited. The Integrated Care Team (ICT) is a proactive case-finding intervention to support older adults with complex needs in primary care. The ICT provides nurse practitioner-led shared-care supported by a pharmacist, family physician, and geriatrician. Patients undergo a CGA, and a person-centred plan of care is implemented. We conducted a mixed-methods evaluation of the ICT. Patients were 81 ± 9.2 years old, 71% were women. Patients had a high burden of dementia and multimorbidity and received 12.8 ± 5.8 prescriptions daily. The ICT improved prescribing and reduced emergency department visits by 49.5% (P = 0.0001). Patients, care partners, and referring physicians reported high satisfaction with care. The ICT is currently being expanded to support additional primary care providers.

许多老年人有复杂的需求,使用急症护理和住进养老院的比例很高。老年病综合评估(CGA)是一种专门的多维度跨专业干预措施,旨在预防此类结果的发生,但在社区获得 CGA 的机会有限。综合护理团队(ICT)是一种积极主动的病例查找干预措施,旨在为有复杂需求的老年人提供初级保健支持。ICT 提供以执业护士为主导的共享护理,并由药剂师、家庭医生和老年病学专家提供支持。患者接受 CGA 检查,并实施以人为本的护理计划。我们采用混合方法对 ICT 进行了评估。患者年龄为(81±9.2)岁,71%为女性。患者的痴呆症和多病负担较重,每天需要开 12.8 ± 5.8 个处方。信息和通信技术改善了处方情况,并将急诊就诊率降低了 49.5%(P = 0.0001)。患者、护理伙伴和转诊医生对护理服务的满意度很高。目前,ICT 正在进行扩展,以支持更多的初级保健提供者。
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引用次数: 0
Attendance, Wellness, and Engagement: The AWE Model of Workplace Satisfaction. 出勤、健康和参与:工作场所满意度 AWE 模型。
Q3 Medicine Pub Date : 2024-10-13 DOI: 10.1177/08404704241289095
Loren Tisdelle

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.

工作场所满意度的出勤、健康和参与(AWE)模式是一种创新方法,旨在促进员工队伍的可持续发展、健康和参与。路易-布赖尔养老院和医院实施的 AWE 模式概括了一项人员战略,旨在营造一个支持性和充实的工作环境。提高出勤率的方法是承认缺勤,同时提供全面的支持系统,以解决医护人员面临的个人挑战。通过提高资源利用率、提供现场医疗服务和培养社会团体以提高整体健康水平,强调了健康要素。此外,员工参与的特点还包括员工表彰仪式、社区建设活动和庆祝活动。重要的是,本文提出了一个令人信服的观点,即 AWE 模式对减少缺勤、提高员工满意度和转变组织文化产生了积极影响。在医疗机构领导者努力应对劳动力挑战的过程中,AWE 模式可作为一个务实的框架,为员工营造一个健康和投入工作的环境。
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引用次数: 0
A new patient navigation model of care to support older adults in transitions of care: Key considerations for implementation for policy-makers and health system leaders. 支持老年人护理过渡的新患者导航护理模式:供政策制定者和医疗系统领导者参考的实施要点。
Q3 Medicine Pub Date : 2024-10-06 DOI: 10.1177/08404704241288458
Grace Liu, Kristina Kokorelias, Amanda Knoepfli, Tracey DasGupta, Naomi Ziegler, Emma Elliot, Sara J T Guilcher, Sander L Hitzig

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.

2019 年,加拿大安大略省的一家大型都市医院引入了患者导航(PN)护理模式,以支持老年人的护理过渡。患者导航员是一名社区社会工作者或 "社区过渡领导",被纳入医院的护理团队,协助制定出院计划,并为老年人、其家人和/或护理伙伴提供长达 90 天的后续护理。PN 计划最初为急症患者提供支持,后来扩展到急诊科和重新激活护理中心。在这项队列回顾性观察研究中,我们通过分析患者导航员收集的临床笔记,描述了新的患者导航员护理模式。这篇文章为有意实施这种新型 PN 模式以改善医院环境中的护理过渡的医疗领导者提供了初步见解。资金由 SLAIGHT 家庭基金会提供。
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引用次数: 0
Art of leadership and science of implementation for sustainable impact of organizational model of care. 领导的艺术和实施的科学,促进组织关怀模式的可持续影响。
Q3 Medicine Pub Date : 2024-09-04 DOI: 10.1177/08404704241271235
Kaiyan Fu, Sarah Tam Lee

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.

在医疗危机和大流行病的双重影响下,东南欧医疗集团在过去十年的护理模式实验基础上,进行了组织变革,将创新模式付诸实践。这一模式被命名为 "H.O.P.E. MODEL™ of Care--家庭、机会、人、赋权"。护理模式的创新设计和实施以健康服务研究实施综合促进行动(i-PARiHS)框架为指导。我们的历程彰显了领导的艺术和实施的科学,从而对卓越护理和医疗系统转型产生可持续的影响。我们的实施经验还产生了以下启示:强化基础、实践操作化、量力而行、技术助力实践,以及所有道路都通向 H.O.P.E。
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引用次数: 0
期刊
Healthcare Management Forum
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