Healthcare Management Forum最新文献

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?

With an anticipated increase in breast screening volume, provincial healthcare systems and health leaders must identify innovative technologies and care pathways that can alleviate the burden of an already resource-constrained healthcare system. The solution explored here utilizes vacuum-assisted technology that is clinically equivalent and a more cost-effective alternative care pathway, as successfully demonstrated in many other countries. This article reviews the clinical efficacy of Vacuum-Assisted Biopsy (VAB) and Vacuum-Assisted Excision (VAE) and calculates the potential Canadian direct cost savings by implementing VAE for the management of benign and high-risk breast lesions in place of Surgical Diagnostic Excision (SDE): calculated to be $1,607,769 to $11,341,107 (2025 CAD) annually in Canada, or $2,208 (2025 CAD) per-patient procedural savings from avoiding SDEs. Additional non-quantifiable patient benefits are also explored: avoiding unnecessary surgery; preventing the associated anxiety and time off work; and greater patient autonomy over their diagnosis journey, helping maintain their quality of life. Finally, barriers to adoption are identified, and an Implementation Leadership Action Plan is proposed, to help support the successful integration of this practice shift. The plan includes procedural reimbursement and policy changes, and multidisciplinary engagement targeting radiology, surgery, and pathology stakeholders.

Physician Assistants (PAs) are increasingly recognized as part of the solution to addressing Canada's primary care shortage. This study reports findings from a national survey of 386 Canadian PAs with primary care experience. Respondents described delivering a broad scope of care, including direct patient management, teaching, mentorship, and quality improvement across settings such as elderly care, mental health, Indigenous health, refugee health, and rural communities. Most PAs reported high confidence in core competencies and effective integration into interprofessional teams. Despite this, systemic barriers persist including inadequate funding, role ambiguity, and resistance from other providers. Many PAs (71%) expressed job satisfaction, and 75% would recommend primary care practice. The study highlights opportunities to improve PA utilization and access to care through policy reform, better funding models, and expanded educational supports. These insights are valuable for policy-makers, administrators, and educators aiming to strengthen primary care delivery and PA role optimization.

Adverse Drug Events (ADEs) are unintended and harmful events related to medication use. Many ADEs recur because patients are unintentionally re-exposed to medications that previously caused harm. To help address this, we designed ActionADE, an interoperable Health Information Technology (HIT) that allows clinicians to communicate ADEs across health sectors. We completed ethnographic workplace observations and a systematic review to inform design. After piloting, we integrated ActionADE with the provincial medication dispensing database to alert pharmacists when patients seek to fill a prescription for the same or a same-class drug as one that previously caused harm. Co-design, application of clinically meaningful field labels and data standards, and integration with other health information systems were critical to ActionADE's functionality and use. However, health system decision-makers need to proactively plan for how to spread and scale pilot project in the HIT ecosystem to ensure public benefit from successful innovation.

Community hospitals represent 90% of Canadian hospitals, yet many lack the necessary infrastructure to conduct health research. This shortfall limits patient access to research studies, reduces study efficiency, and decreases the generalizability of study results. Previous work from our group identified an increase in publications from Ontario's large community hospitals between 2013 and 2022. However, data from other Canadian provinces is lacking. This bibliometric analysis identified indexed publications from authors affiliated with Canada's 544 community hospitals between 2018 and 2023. Among 13,689 publications, 12,472 unique articles were identified. Most were primary research articles (67%), with only 5% being clinical trials. Ontario's community hospitals had the highest number of publications (n = 7,925), followed by Alberta (n = 2,086) and Quebec (n = 1,480). Of Canada's 544 community hospitals, only 42% were affiliated with one or more publications from 2018 to 2023, highlighting the need to strengthen Canadian community hospital research capacity at a systems level.

OurNotes is a movement that advocates for patient engagement by encouraging patients to contribute to their care through a pre-visit note, where they can comment on their health progress and prioritize topics for discussion with their clinicians. To date, pre-visit notes have been implemented in primary and acute care settings internationally, and their reception has generally been positive. However, their use in Canada and in mental health settings is limited. To address this gap, we conducted semi-structured interviews with 26 mental health clinicians, patients, and care partners. Barriers, facilitators, and recommendations to implementing pre-visit notes in Canadian mental health settings were identified. Overall, clinicians, patients, and care partners had positive perceptions towards pre-visit notes, indicating that they may serve as an innovative model for improving patient engagement and satisfaction in mental health settings. The barriers and facilitators identified, provide guidance for mental health organizations considering the implementation of pre-visit notes.

Canadian healthcare systems require profound transformations to enhance patient experience, improve population health, reduce costs, and improve the work life of healthcare providers. Learning Health Systems (LHSs) are an approach for undertaking this transformation in an effective, efficient, and sustainable manner with digital technologies as a key enabler for change. However, the successful implementation of a LHS brings with it challenging and potentially risky changes to clinical practices and operations. Simulation modelling is an advanced analytics technique particularly well-suited for informing decision-making and planning prior to and during the transformation of complex systems such as LHSs. Yet, despite the use and demonstrated benefits of simulation modelling in many different industries including healthcare, its application in the context of LHSs has received limited attention. In this article, we discuss how simulation modelling can be leveraged to support better-informed, lower-risk decisions and innovation in LHSs.

Health literacy is important from two perspectives: the individuals (personal health literacy) and the organizations providing information and services (organizational health literacy). While research has addressed digitalization in healthcare and associated barriers and enablers in personal health literacy (e.g., digital health literacy), these developments have not been paraleled in organizational health literacy. In this article, we proposed an augmented definition of organizational health literacy and conducted a gap analysis of the Health Literacy Universal Precautions Toolkit to expand it for digital health. Important advancements, specifically for virtual care, have been made, yet a broader approach must be adopted for all digital health technology. We proposed a series of modifications to emphasize the importance of digital health in organizational health literacy. Organizations must equitably enable individuals to understand and use digital information and services. In this monograph, we describe the current informatics gap and the required competencies, policies, and infrastructure to close the gap.

Wait times for elective surgical procedures in publicly funded healthcare systems impede patient well-being and resource efficiency. Patients with gallstone disease requiring semi-urgent intervention are often treated via inpatient emergency pathways due to limited elective surgery access. This study aimed to evaluate the rationale and cost-effectiveness of providing timely outpatient semi-urgent cholecystectomy. We retrospectively reviewed 512 patients with urgent biliary disease (excluding cholecystitis) who underwent surgery between July 2019 and December 2022. The primary outcome was time from booking to operating room; the secondary was the estimated cost of prolonged hospital stays. Patients waited an average of 26.45 hours; 19.1% waited 48 hours or longer, and 6.2% waited 72 hours or more. The associated cost was $405,785 over 40 months. Implementing semi-urgent surgical resources could reduce costs, improve efficiency, and enhance patient quality of life. Future work should involve stakeholders to address barriers and facilitators in Canada.