Healthcare Management Forum最新文献

This article describes the development, implementation and first-year findings of the Ontario College of Social Workers and Social Service Workers' Equity and Inclusion Data Initiative. This data project was developed to help identify and monitor systemic racism and discrimination within the professions of social work and social service work in Ontario. This initiative was based on the fundamental principle that only what is measured can be effectively understood and improved. College registrants were invited to share their demographic information on a voluntary basis. Data collection launched in the 2024 registration renewal period, with 66.5% response rate in its first year. This is an ongoing large-scale change management initiative, requiring strategic engagements with registrants, clients, government, staff, and other key engagement groups. This workforce project is an innovative example of how demographic data collection can advance equity, diversity, inclusion, and anti-racism efforts in provincial regulation, including healthcare.

Prior research has identified gaps in the ability of hospital systems to efficiently and meaningfully characterize older adults with complex health needs. We recruited community-dwelling older adults presenting to 10 Emergency Departments (EDs) across Ontario, Quebec, and Newfoundland, Canada, from April 2017 to July 2018. We deployed a staged assessment strategy based on the interRAI Acute Care Suite to identify and characterize older adults at high risk of Alternate Level of Care designation. More than 5,700 patients underwent the ED-Screener, 53.3% of whom were not self-reliant. Subsequent focused screening and assessment identified 457 patients, 93.3% of whom were not self-reliant, and who had significant impairments in function, mobility, and cognition, as well as social vulnerability. A staged assessment approach based upon the interRAI Acute Care Suite can efficiently identify older adults with risk factors for Alternative Level of Care designation.

Fragmented healthcare systems worldwide struggle to support patient populations with complex health and social needs. System integration requires a standardized clinical health information system to better care for these populations. This review describes how interRAI systems evolved into powerful solutions to support healthcare system integration. In response to a care quality crisis in long-term care homes in the United States, Congress mandated a standardized Minimum Data Set (MDS) from which multiple outputs were derived to support care planning, care quality, and case-mix assessment. This work drew international attention, leading to the creation of interRAI. Three decades of extensive international research, stakeholder engagement, and implementation have led to the creation of comprehensive cross-sectoral assessment systems for diverse populations, including older adults, mental health patients, and children and youth. InterRAI assessment systems, widely used in Canada and internationally, constitute comprehensive clinical assessment systems capable of supporting health system integration.

InterRAI assessment is required for older people in Aotearoa New Zealand (NZ) to access public aged care services. Paeārahi (Māori health navigators) provide culturally-appropriate, connected healthcare. We investigated the feasibility and acceptability of paeārahi-facilitated Check Up Self Report (CU-SR) completion with older Māori in NZ. Prospective non-randomised, non-comparator intervention study in one NZ health practice with eligible participants (Māori, 55 years or older, community-dwelling, not known to require formal needs assessment). Predefined feasibility and acceptability outcomes were reported using descriptive statistics and thematic analysis. Participants (n = 50, mean 65.3 years, 66% female) felt most CU-SR items were acceptable. Paeārahi-facilitated assessment and care planning were generally acceptable and feasible to undertake and perceived to improve healthcare access. Paeārahi-facilitated CU-SR assessment and care planning is a scalable model utilising a culturally appropriate, non-regulated Indigenous health workforce and an internationally validated assessment with the potential to identify unmet need and address inequities in aged care access.

Shared accountability is widely emphasized in integrated care theory and policy but remains underspecified in practice. This study examined how shared accountability was operationalized and experienced within an Ontario Health Team (OHT) using data from 23 semi-structured interviews with OHT stakeholders. Six interrelated factors that shape shared accountability were identified: perceived organizational identity, clarity of leadership roles and consequences for non-compliance, clarity of partner organizations' roles and consequences for non-compliance, management of goals and interests, trust and psychological safety, and power dynamics. Together, these factors highlight that shared accountability is not merely a matter of assigning roles or measuring outcomes; rather, it is a complex, relational process. These findings offer practical guidance for strengthening shared accountability in integrated care networks.

Integrating research into health service delivery is essential for building an equitable learning health system that values continuous improvement, innovation, and patient-centred care. At the organizational level, evidence shows that research-active hospitals achieve better patient outcomes and experiences, increased staff satisfaction and retention, enhanced operational efficiency, and greater opportunities for innovation and revenue generation. Yet, most Canadian hospitals are community hospitals which lack the infrastructure and organizational supports to conduct research. This article presents a case study of a research institute within a community hospital in Southern Ontario, describing its development, early outcomes, and strategic impact in establishing research as an organizational priority. We also introduce a novel adaptation of the balanced scorecard to guide the implementation and evaluation of research programs in community hospital settings. Reflections from this case highlight patient and organizational benefits, offering practical insights for community hospitals leaders seeking to build research capacity in their organizations.

Older adults living with frailty and multimorbidity interact with multiple care providers and health settings, resulting in fragmented care and information discontinuity. Standardized assessments potentiate integrated care by communicating consistent measures of health information between sectors and providers. We use a pragmatic case example of a theoretical medically complex older adult to illustrate use of interRAI standardized assessments throughout the health journey. The case example represents the assessment findings of a patient accessing care through primary care, the emergency department, home/community care and long-term care. A suite of assessment instruments embedded with decision support algorithms guides nursing care decisions, while a common language and standardized assessment items support effective communication and collaboration among the health team. Successful adoption of integrated and comprehensive assessment tools requires training, engagement, and time to embed processes into practice. interRAI assessments enable integration through a common language, aligning successive assessments across the care continuum.

Personal health information (PHI) sharing through Health Information Exchange (HIE) enhances patient safety in Canada, yet not all provinces and territories voluntarily disclose PHI on safety incidents to federal and pan-Canadian surveillance systems. A frequently cited barrier by healthcare organizations for HIE between different interoperable health databases is patients' and families' concerns for their privacy. This explorative qualitative study examined patients' and families' attitudes toward PHI sharing, including its secondary use in patient safety events. Rather than expressing reluctance, participants described support for HIE when privacy safeguards, such as defined sharing purposes and anonymous formats, were in place. These findings present a significant opportunity for health leaders and data custodians to use the research findings to create a patient-centric framework for the HIE of PHI.

Health leaders are increasingly embracing Artificial Intelligence (AI) to enhance patient care, streamline operations, and support healthcare providers. But are they truly leading an AI-capable organization-one that can harness AI's full potential and long-term value while mitigating its risks? An AI-capable organization possesses the necessary infrastructure, governance, technical expertise, and cultural mindset to effectively develop, deploy, and manage AI systems. It ensures the safe, ethical, and strategic use of AI across its operations, aligning AI adoption with organizational priorities. This article outlines the essential components of an AI-capable organization, provides a framework for assessing AI maturity, and introduces a risk-proportionate approach to building an AI tool pipeline for healthcare delivery. We explore key leadership considerations, including the decision to build or buy AI solutions, and conclude with special considerations, including the rise of Bring Your Own AI and its implications for governance and oversight.

Health innovation involves reducing silos, bringing together interdisciplinary teams, and supporting person-centerd care, particularly for mental well-being. Indigenous youth in Newfoundland and Labrador report having poor mental health, with few options for support in their home communities. How can Integrated Youth Services and traditional modalities of healing support clinical care to improve mental health outcomes for Indigenous Youth?