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Integrating recovery-oriented mental health and addictions services directed by clients. 整合以康复为导向的心理健康和成瘾服务,由客户--患者指导。
Q3 Medicine Pub Date : 2024-07-01 Epub Date: 2024-01-31 DOI: 10.1177/08404704231223131
Victoria Huehn

This article focuses on the planning, process, and outcomes of integrating multiple services into a system that is based on the client's journey. It demonstrates the incorporation of the client voice and shared decision-making throughout the process. This article provides guidance for leaders looking for ways to engage clients in the planning process. The discussion describes the process used by Frontenac Community Mental Health and Addiction Services to implement a client designed and centred, functionally integrated substance use and mental health service using the Mental Health Commission of Canada's recovery-oriented strategy. The reality is that although integrated services are evidence based best practices, in only rare cases has this translated into practice. Key messages are that the client voice and direction can be used successfully in designing an integrated mental health and substance use system.

本文重点介绍了将多种服务整合到一个基于病人/客户旅程的系统中的规划、过程和结果。文章展示了在整个过程中客户的声音和共同决策的融入。本文为领导者寻找让客户/患者参与规划过程的方法提供了指导。文章描述了弗朗蒂娜克社区心理健康与成瘾服务机构(Frontenac Community Mental Health and Addiction Services)采用加拿大心理健康委员会以康复为导向的策略,实施了一项由客户设计、以客户为中心的药物使用与心理健康功能整合服务的过程。现实情况是,尽管综合服务是以证据为基础的最佳做法,但只有在极少数情况下才会付诸实践。关键信息是,在设计心理健康和药物使用综合系统时,可以成功利用客户/患者的声音和方向。
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引用次数: 0
Patient-oriented research: An essential driver of learning health system capacity development. 以患者为导向的研究:学习型卫生系统能力发展的重要推动力。
Q3 Medicine Pub Date : 2024-07-01 Epub Date: 2024-03-21 DOI: 10.1177/08404704241235601
Heather Strosher, Taylor Hainstock, Sharon Karsten, Barbara Whyte, Christopher Hauschildt, Tara McMillan, Uta Sboto-Frankenstein, Cindy Trytten

Canada's health system faces a lag in implementing high-quality evidence and research-driven innovation into service delivery, while demonstrating accountability and benefit to the public. To address these challenges, Patient-Oriented Research (POR) builds teams that engage researchers, healthcare providers, decision-makers, and most importantly, patients (people with lived and living experience) in the process of generating and applying evidence to inform health services and decision-making. A Learning Health System (LHS) systematically integrates external evidence with internal data and experience and puts that knowledge into practice in a continuous cycle. Using a POR/LHS example from a BC health authority, we describe nine enablers required to support LHS capacity development. The LHS case study, Walk With Me, addresses a health system high-priority topic: the toxic drug crisis. Understanding the value of learning health systems, along with the enablers required to support and implement them, will empower health leaders to champion and orchestrate positive change.

加拿大的医疗系统在提供服务过程中实施高质量的证据和以研究为导向的创新方面面临着滞后问题,同时还要向公众展示责任和利益。为了应对这些挑战,"以患者为导向的研究"(POR)建立了一个团队,让研究人员、医疗服务提供者、决策者,最重要的是让患者(有生活经验的人)参与到生成和应用证据的过程中,为医疗服务和决策提供依据。学习型医疗系统(LHS)系统地将外部证据与内部数据和经验相结合,并在持续的循环中将知识付诸实践。我们以不列颠哥伦比亚省一家卫生机构的 POR/LHS 为例,介绍了支持 LHS 能力发展所需的九个推动因素。LHS 案例研究 "与我同行 "涉及卫生系统的一个高度优先主题:有毒药物危机。了解长效机制的价值,以及支持和实施长效机制所需的推动因素,将增强卫生领导者倡导和协调积极变革的能力。
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引用次数: 0
Benefits, facilitators, and barriers of electronic medical records implementation in outpatient settings: A scoping review. 在门诊环境中实施电子病历的益处、促进因素和障碍:范围综述。
Q3 Medicine Pub Date : 2024-07-01 Epub Date: 2024-01-20 DOI: 10.1177/08404704231224070
Hamidreza Kavandi, Zeina Al Awar, Mirou Jaana

This scoping review examined the breadth and depth of evidence on Electronic Medical Record (EMR) implementation benefits in outpatient settings. Following PRISMA guidelines for scoping reviews, five databases were searched, and 24 studies were retained and reviewed. Benefits, facilitators, and barriers to EMR implementation were extracted. Direct benefits included improved communication/reporting, work efficiency, care process, healthcare outcomes, safety, and patient-centredness of care. Indirect benefits were improved financial performance and increased data accessibility, staff satisfaction, and decision-support usage. Barriers included time and financial constraints; design/technical issues; limited information technology resources, skills, and infrastructure capacity; increased workload and reduced efficiency during implementation; incompatibility of existing systems and local regulations; and resistance from healthcare professionals. Facilitators included training, change management, user-friendliness and alignment with workflow, user experience with EMRs, top management support, and sufficient resources. More rigorous, systematic research is needed, using relevant frameworks to inform healthcare policies and guide EMR projects in outpatient areas.

本范围界定综述研究了门诊环境中电子病历(EMR)实施效益的证据广度和深度。按照范围界定审查的 PRISMA 指南,对五个数据库进行了检索,保留并审查了 24 项研究。提取了实施 EMR 的益处、促进因素和障碍。直接效益包括改善沟通/报告、工作效率、护理流程、医疗成果、安全性和以患者为中心的护理。间接效益包括财务业绩的改善、数据可获取性的提高、员工满意度的提高以及决策支持的使用。障碍包括时间和资金限制;设计/技术问题;信息技术资源、技能和基础设施能力有限;实施过程中工作量增加、效率降低;现有系统与当地法规不兼容;以及医疗保健专业人员的抵制。促进因素包括培训、变革管理、用户友好性和与工作流程的一致性、用户使用电子病历的经验、高层管理人员的支持以及充足的资源。需要进行更严格、更系统的研究,利用相关框架为医疗保健政策提供信息,并指导门诊区域的电子病历项目。
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引用次数: 0
Innovative nursing employment initiatives to strengthen and sustain the health workforce in Canada. 创新的护理就业举措,以加强和维持加拿大的医疗队伍。
Q3 Medicine Pub Date : 2024-07-01 Epub Date: 2024-02-19 DOI: 10.1177/08404704241232668
Andrea Baumann, Victoria Smith, Mary Crea-Arsenio

Health systems worldwide are at a critical juncture due to an increasing demand for health services and a diminishing pool of health human resources. While COVID-19 exacerbated nursing deficits, the need to strengthen and sustain the health workforce in Canada was evident decades prior and supported by numerous studies that warned of significant shortages. Post pandemic, building health system capacity has become paramount. This article examines innovative nursing employment initiatives in Canada. It provides a snapshot of federal, provincial and territorial approaches, with a particular focus on Internationally Educated Nurses (IENs) due to burgeoning interest in and competition for their skills and services. However, recognizing that health human resource planning is a persistent challenge, further initiatives are suggested. These include complementary policy development to improve retention and policy frameworks that support proactive long-term strategies to address the cyclical shortage of nurses.

由于对医疗服务的需求不断增加,而医疗人力资源却在不断减少,全球医疗系统正处于一个关键时刻。虽然 COVID-19 加剧了护理人员的短缺,但加强和维持加拿大医疗卫生人员队伍的必要性在几十年前就已显现,并得到了许多警告严重短缺的研究的支持。大流行过后,建设卫生系统的能力变得至关重要。本文探讨了加拿大创新性的护理就业举措。它简要介绍了联邦、省和地区的做法,并特别关注受过国际教育的护士 (IENs),因为人们对她们的技能和服务兴趣浓厚,竞争激烈。然而,认识到卫生人力资源规划是一项长期挑战,建议采取进一步的举措。这些举措包括制定补充政策,以改善护士留用情况,并制定政策框架,支持积极主动的长期战略,以解决周期性护士短缺问题。
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引用次数: 0
A Message from the Guest Editor. 特邀编辑的致辞
Q3 Medicine Pub Date : 2024-07-01 Epub Date: 2024-03-30 DOI: 10.1177/08404704241242912
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引用次数: 0
Relational skill training for patient engagement and the creation of a trauma-informed critical care. 患者参与的关系技能培训和创伤知情重症监护的创建。
Q3 Medicine Pub Date : 2024-07-01 Epub Date: 2023-11-18 DOI: 10.1177/08404704231215461
Laura Istanboulian, Tasneem Master, Christine Devine, Lorrie Hamilton

Patients and families in critical care have a high likelihood of previous and re-experienced trauma. Unaddressed, physical, and psychological impacts of these traumas can worsen outcomes for patients and families. A trauma-informed care approach has been proposed for critical care; however, training programs do not include relational competencies or de-escalation techniques, risking the re-traumatization of patients and families in critical care and negatively impacting clinicians. This article describes a strategy that can be adopted by critical care teams towards the creation of a trauma-informed critical care unit including the use of a framework for relational training. Principles of relationship management and de-escalation are discussed with the use of a fictional exemplar scenario. Key messages include a call to action for relational training for care teams to enhance skilled relational engagement of patients and families. This article also highlights the foundational importance of policies supporting a trauma-informed approach in critical care.

重症监护的患者和家属有很高的可能性以前和再次经历创伤。这些创伤对身体和心理的影响尚未得到解决,可能会使患者和家属的预后恶化。一种创伤知情的护理方法已被提议用于重症监护;然而,培训计划不包括关系能力或降级技术,有可能使危重病患者和家属再次受到创伤,并对临床医生产生负面影响。本文描述了一种策略,可以被重症监护团队采用,以创建一个创伤知情的重症监护病房,包括使用关系培训框架。使用虚构的范例场景讨论关系管理和降级的原则。关键信息包括呼吁采取行动,对护理团队进行关系培训,以加强患者和家属熟练的关系参与。本文还强调了在重症监护中支持创伤知情方法的政策的基础重要性。
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引用次数: 0
Recommendations for supporting healthcare workers' psychological well-being: Lessons learned during the COVID-19 pandemic. 支持医护人员心理健康的建议:在 COVID-19 大流行期间吸取的经验教训。
Q3 Medicine Pub Date : 2024-07-01 Epub Date: 2024-01-30 DOI: 10.1177/08404704241226693
Melissa B Korman, Lisa Di Prospero, Tracey DasGupta, Mark Sinyor, Samantha J Anthony, Monika Kastner, Janet Ellis, Rosalie Steinberg, Robert Maunder

Healthcare workers are at risk of adverse mental health outcomes due to occupational stress. Many organizations introduced initiatives to proactively support staff's psychological well-being in the face of the COVID-19 pandemic. One example is the STEADY wellness program, which was implemented in a large trauma centre in Toronto, Canada. Program implementors engaged teams in peer support sessions, psychoeducation workshops, critical incident stress debriefing, and community-building initiatives. As part of a project designed to illuminate the experiences of STEADY program implementors, this article describes recommendations for future hospital wellness programs. Participants described the importance of having the hospital and its leaders engage in supporting staff's psychological well-being. They recommended ways of doing so (e.g., incorporating conversations about wellness in staff onboarding and routine meetings), along with ways to increase program uptake and sustainability (e.g., using technology to increase accessibility). Results may be useful in future efforts to bolster hospital wellness programming.

医护人员有可能因职业压力而导致不良的心理健康后果。面对 COVID-19 大流行,许多组织都推出了积极支持员工心理健康的措施。加拿大多伦多一家大型创伤中心实施的 "STEADY 健康计划 "就是一例。计划实施者让团队参与同伴支持会议、心理教育研讨会、突发事件压力汇报和社区建设活动。作为旨在阐明 STEADY 计划实施者经验的项目的一部分,本文介绍了对未来医院健康计划的建议。参与者认为,让医院及其领导参与支持员工的心理健康非常重要。他们推荐了这样做的方法(例如,在员工入职培训和例行会议中加入有关健康的对话),以及提高项目吸收率和可持续性的方法(例如,利用技术提高可及性)。研究结果可能对今后加强医院健康计划的工作有所帮助。
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引用次数: 0
Charting the future of patient care: A strategic leadership guide to harnessing the potential of artificial intelligence. 描绘病人护理的未来:利用人工智能潜力的战略领导力指南。
Q3 Medicine Pub Date : 2024-07-01 Epub Date: 2024-03-05 DOI: 10.1177/08404704241235893
Marie Ennis-O'Connor, William T O'Connor

Artificial Intelligence (AI) applications have the potential to revolutionize conventional healthcare practices, creating a more efficient and patient-centred approach with improved outcomes. This guide discuses eighteen AI-based applications in clinical decision-making, precision medicine, operational efficiency, and predictive analytics, including a real-world example of AI's role in public health during the early stages of the COVID-19 pandemic. Additionally, we address ethical questions, transparency, data privacy, bias, consent, accountability, and liability, and the strategic measures that must be taken to align AI with ethical principles, legal frameworks, legacy information technology systems, and employee skills and knowledge. We emphasize the importance of informed and strategic approaches to harness AI's potential and manage its challenges. Moreover, this guide underscores the importance of evaluating and integrating new skills and competencies to navigate and use AI-based technologies in healthcare management, such as technological literacy, long-term strategic vision, change management skills, ethical decision-making, and alignment with patient needs.

人工智能(AI)应用有可能彻底改变传统的医疗保健实践,创造出一种更高效、以患者为中心的方法,从而改善医疗效果。本指南讨论了 18 种基于人工智能的临床决策、精准医疗、运营效率和预测分析应用,包括在 COVID-19 大流行早期阶段人工智能在公共卫生领域发挥作用的真实案例。此外,我们还讨论了伦理问题、透明度、数据隐私、偏见、同意、问责制和责任,以及必须采取的战略措施,以使人工智能与伦理原则、法律框架、传统信息技术系统以及员工技能和知识保持一致。我们强调必须采取知情的战略性方法来利用人工智能的潜力并应对其挑战。此外,本指南还强调了评估和整合新技能与能力的重要性,以便在医疗保健管理中引导和使用基于人工智能的技术,如技术素养、长期战略愿景、变革管理技能、道德决策以及与患者需求保持一致。
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引用次数: 0
Ethical patient engagement in healthcare governance. 患者参与医疗治理的道德规范。
Q3 Medicine Pub Date : 2024-07-01 Epub Date: 2024-05-03 DOI: 10.1177/08404704241251898
Treena Klassen

Health leaders are faced with a lack of public trust in healthcare governance. This waning trust relationship was further solidified through the pandemic. Improving the relationship between health organizations and the community/citizens/patient partners is a moral imperative of which ethical governance is a significant factor. This article will structure the ethical analysis of patient partners in governance through reviewing who we are, how we function, and what we do on governance boards. Taking an ethical approach will enable the promise of the value and impact of the patient partner to be actualized. Ethical governance that recognizes the significant contributions and value of engaged patient partners can be achieved and may be one of the significant levers required to transform healthcare.

医疗卫生领导者面临着公众对医疗卫生管理缺乏信任的问题。大流行病进一步巩固了这种日渐式微的信任关系。改善医疗机构与社区/公民/患者伙伴之间的关系是一项道义责任,而伦理治理则是其中的一个重要因素。本文将通过回顾我们是谁,我们如何运作,以及我们在治理委员会中做了什么,对治理中的患者合作伙伴进行伦理分析。采取合乎伦理的方法将使患者合作伙伴的价值和影响得以实现。承认患者合作伙伴的重大贡献和价值的伦理治理是可以实现的,而且可能是改变医疗保健所需的重要杠杆之一。
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引用次数: 0
An end to the "muffin meeting": Conceptualizing power and navigating tokenism in patient engagement for health leaders. 结束 "松饼会议":健康领导者在患者参与过程中的权力概念化与象征性导航。
Q3 Medicine Pub Date : 2024-07-01 Epub Date: 2024-03-29 DOI: 10.1177/08404704241239862
Steven Slowka

Patient engagement is emerging as a priority for Canadian health leaders. Alongside the proliferation of patient engagement efforts in healthcare organizations and networks, awareness that tokenism can potentially occur within such efforts, as well as strategies to mitigate it, are gaining increased attention. While many actions associated with more tokenistic forms of patient engagement have been identified, this article posits there is a need to pay critical attention to the concept and role of power in enabling these actions in the first place. Of particular importance is how power and knowledge work to shape healthcare organizations and can create unequal relations with the patients they seek to engage. Drawing on the literature, this article serves as a theoretical roadmap for health leaders to think critically about power, as well as a set of prompts that can be used to reflexively consider their role in navigating power dynamics in the context of patient engagement efforts. This article contends that building awareness of power is a critical step for health leaders and organizations and that navigating power differences is a necessary leadership competency for engaging patients in decision-making throughout all stages of healthcare improvement and organizational change efforts.

患者参与正在成为加拿大医疗领导者的首要任务。伴随着医疗机构和网络中患者参与工作的激增,人们越来越注意到在这些工作中可能会出现象征性的行为,以及减少这种行为的策略。虽然已经发现了许多与更多象征性的患者参与形式相关的行为,但本文认为,首先有必要对促成这些行为的权力概念和作用给予高度关注。尤为重要的是,权力和知识是如何塑造医疗机构的,并与医疗机构寻求参与的患者之间形成不平等的关系。本文以文献为基础,为医疗机构领导者批判性地思考权力问题提供了一个理论路线图,并提供了一系列提示,可用于反思他们在患者参与工作中驾驭权力动态的角色。本文认为,建立权力意识是医疗领导者和组织的关键步骤,在医疗改善和组织变革的各个阶段,引导权力差异是让患者参与决策的必要领导能力。
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引用次数: 0
期刊
Healthcare Management Forum
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