Healthcare Management Forum最新文献

This article showcases the high-quality, standardized, and national labour force and health-related data that can be leveraged for effective health workforce planning. It also underscores the importance of interoperability, the ability to integrate and harmonize data from multiple sources to optimize health workforce analysis. Using three case studies drawing on five Statistics Canada data sources, it examines persistent shortages of nurses and personal support workers and the impact of increased workload on their stress during the COVID-19 pandemic. This article also outlines how Statistics Canada data can inform planning by identifying unmet labour demand, work-related stress, and untapped labour resources, such as internationally educated healthcare professionals. It aims to guide health leaders in accessing and leveraging Statistics Canada data, including but not limited to those outlined here, to strategically address workforce and policy challenges in the health sector using an evidence-based approach.

The role that a government can or should play in a public health crisis or in the health of the public can only be understood by considering how it has defined its role in the past and the impacts that has caused. While many might assume that government-led public health has been net beneficial and universal in its intents and approaches across the population of Canada, the history of Indian healthcare tells a different story. We are a trio of Cree-Anishnaabe, Dene/Métis, and Hul'q'umi'num' physician leaders who believe that the role of governments in the health of the public, including during crisis, should be to protect and advance the health of all. In our experiences during the COVID-19 pandemic, we witnessed settler governments uphold historical public health paradigms that undermined the inherent rights of First Nations, Inuit and Métis Peoples. We also witnessed pockets of transformation where rights-based frameworks and anti-racist approaches were implemented that resulted in better outcomes for First Nations and Métis Peoples. We believe that for settler governments to protect and advance health for all, assumptions of exhaustive and benevolent jurisdiction over Indigenous Peoples and lands must be dismantled to create new, unfamiliar, co-governance models.

Despite most Canadians preferring to die at home, over 50% die in hospitals, a setting often discordant with patient-centered end-of-life care and environmentally harmful. This article argues that healthcare policies unintentionally "nudge" patients and providers towards the medicalization of death, contributing to low-value care and significant greenhouse gas emissions. We analyze how inaccessibility to primary and palliative care, default "full code" status, overspecialization, and inadequate home-care supports perpetuate hospital deaths. Using an illustrative case, we demonstrate how these policies influence care trajectories from outpatient to hospital admission and disposition planning. Our aim is to highlight these underrecognized downstream effects to inform health leaders about opportunities to improve end-of-life care quality, align with patient preferences, and secondarily, benefit planetary health.

Governments in Canada and elsewhere play a very significant role in shaping the health of populations, but the main ways in which they do so are largely hidden because they lie outside of the health sector and are thus under-leveraged. Neoliberal economic and social policy has eroded upstream determinants of health, with profound consequences for health equity. The current polycrisis-a predictable outcome of neoliberalism-provides an opportunity to re-imagine a role for governments in supporting the public's health. Anchored in a broad version of public health, I consider three levels where we, as a community of health professionals, could start to envision such a version of government, focusing primarily on federal government: (1) public spending; (2) overall orientation of government vis-à-vis the well-being of the population; and (3) the broader political economic paradigm and its dynamics of power. Collectively, these offer opportunity to learn from our past while expanding our imaginations for the future. Such a vision will require the support, and the humility, of healthcare leaders.

Protecting the public is a key role of all levels of government in Canada. This role takes many forms. During a public health emergency, preparation, timely and evidence-based decisions, considering the unique needs of vulnerable populations, and balancing between action taken to protect the public while being cognizant of the impact of such actions on the longer-term well-being of the public, particularly equity-deserving groups, is critical. This article reflects on some of our historical failures in public health to protect the public in Canada, the lessons learned, how these impacted our experience during COVID-19, and how the related framework for optimizing our work can protect the public in future events.

Public health leaders and programs have played an important role in Alberta's response to major health events, including COVID-19. We discuss how the Alberta provincial government has exerted increasing control over public health functions in the province, and how this played out over the course of the pandemic and beyond. Given the significant role that the social determinants of health play in shaping the health of the population, we also discuss how successive governments have approached policy and investment in public health. Using our experiences, we discuss a more effective role for government in a public health crisis, and in the health of the public more broadly. We advocate for a Health in All Policies approach to government decision-making and a move towards focusing on evidence rather than ideology.

Poised to receive vital administrative personal health information to serve its role as New Brunswick's seminal research data centre, DataNB (previously NB-IRDT) inadvertently drew attention to a well-established but unsanctioned use of the New Brunswick public health insurance (Medicare) number. DataNB's 2014 request to access the NB Medicare number for research purposes also highlighted its use as a unique identifier for the provincial Moose Draw for hunting licenses, disclosure not granted in legislation. With newfound scrutiny being exercised on the appropriate disclosure and use of personal health information, DataNB's need to access the Medicare number for linking personal administrative data was halted by provincial authorities. In response, provincial government officers and DataNB staff collaborated to develop and introduce legislative mechanisms that would create an authorized Medicare number use for data matching to support research on a wide range of subjects including the recruitment and retention of healthcare professionals in NB.

In Ontario, pregnant people can choose to seek care from an obstetrician, family physician, or midwife. This study aimed to determine whether Ontario's Champlain Region displayed the levels of access to the full range of maternity care providers required to afford pregnant people the opportunity to exercise choice of provider. Drawing on data from a census survey of midwifery practice groups, the CIHI National Physician Database, and BORN Ontario, the Enhanced Two-Step Floating Catchment Area Method was adapted to calculate provider-specific accessibility scores for communities across the region. The resulting maps revealed inequities in the distribution of access across the region, differences in relative access across provider groups, and underserviced communities with minimal access to any provider group. This study presents a new approach to mapping alignment between maternity care workforce capacity and pregnant people's needs, and illustrates that additional action is required to equitably support access and choice.