Healthcare Management Forum最新文献

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.

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.