Healthcare Management Forum最新文献

Just as healthcare organizations must carefully consider how to incorporate Artificial Intelligence (AI) into patient-facing apps and messaging, so must they also think about how to ethically introduce AI into the workplace. Unreasonable expectations, lack of training, insufficient AI tool maintenance, and other barriers to effective use of AI create significant challenges for leaders that can lead to lower productivity, less effectiveness at work, reduced satisfaction, and burnout. A thoughtful, measured approach to AI design and implementation that incorporates practices supporting user comfort and satisfaction is key to achieving success with AI in the workplace.

Digital health interventions are complex, involving the interactions of organizations, people, workflows, and technology. Adaptability is needed in both implementation and evaluation strategies to meet the needs of organizations, clinicians, patients, and researchers. The Digital Bridge project aims to co-design, implement, and evaluate a digitally enabled care transition intervention for older adults with complex needs. We encountered varying ability of partners to engage at different times, alongside changes in technology infrastructure, vendor, and healthcare services offered including unanticipated emergence of other care transition interventions. Through collaboration with health system partners, implementation and evaluation strategies were adapted. In evaluating digital health interventions, adaptability and flexibility in implementation strategies and evaluation methods are needed to meet the real-world need of delivering digital health interventions at scale. The Learning Health System Action Framework may offer insights as to how to address these tensions.

Rural, remote, and Indigenous communities in British Columbia (BC) tend to have lower access to healthcare providers and poorer health outcomes-an inequality that the COVID-19 pandemic has exacerbated. In response, Real-Time Virtual Support (RTVS) pathways were developed to advance equitable access to care for patients and provide peer support to physicians working in underserved communities. This study aimed to describe the perspectives of Virtual Physicians (VPs) who delivered the RTVS services. Forty-five RTVS VPs engaged in 30-minute semi-structured interviews about their experiences and perspectives delivering RTVS. Three themes emerged: (1) RTVS's contributions to VPs' personal and professional development; (2) impacts on communities; and (3) considerations for the availability and expansion. VPs identified incremental expansion and attaining funding stability as critical next steps for virtual healthcare in BC. This evidence informed RTVS program evaluation and may provide learnings relevant to other jurisdictions.

High-performing physicians are an essential attribute of quality health services and public safety. Inaccessibility to quality health data by health providers can lead to individual, population, or health system harm suggesting a relationship between health data and the delivery of high-performing health programs and services. Yet the characteristics of health data have not been considered as a factor that may impact physician performance. There is evidence that limitations in health data access, quality, and effective and appropriate use can impair the capacity of physicians to provide high-quality clinical health services and use secondary health data to generate beneficial insights. Failure to acknowledge and mitigate health data factors can potentially hinder efforts to promote patient safety, reduce physician burnout, and address broader healthcare inefficiencies including a lack of interoperability. Efforts to enhance physician performance and safeguard public well-being must include a proactive approach to improving health data access, quality, and user literacy.

This article addresses how the dynamic, interdisciplinary, and non-linear nature of health information technology implementations require a workforce equipped with both technical competencies and an understanding of the relationships between healthcare system components. The article identifies key workforce preparation strategies including ongoing education and training for certificates or degrees through universities, professional associations, or health information technology vendors, tuition reimbursement, title changes, paid time off, and increased pay or bonuses. Helping employees to understand how their work is integrated into the overall healthcare data ecosystem creates a more efficient and effective health information technology implementation. As an example, we highlight how to prepare employees to consider clinical knowledge organization systems and standards, and how they ensure data accuracy and interoperability for data exchange of newly implemented health information systems and related artificial intelligence tools.

The purpose of this study was to provide an update on patients', clinicians', and health administrators' experiences and perspectives on opportunities, barriers, and priorities for virtual care to inform health policy and planning as virtual care programs continue to mature and develop. Three surveys were developed and distributed in Saskatchewan, Canada. Quantitative data were analyzed using descriptive statistics and chi-squared tests, and free-text responses were analyzed using thematic analysis. Chronic disease management and mental health disorders were identified as highly suitable for virtual care. Health administrators underscored cost savings and improved patient access as key advantages, though they lacked consistent frameworks to assess virtual care effectiveness. Key barriers included digital literacy, technology constraints, and compensation models not aligned with virtual service provision. Participants called for greater infrastructure investment, technical support, and integrated electronic platforms. These insights may inform policy and practice to strengthen virtual health delivery and support health equity.

Access to Hepatitis C (HCV) treatment requires a specialist referral in Manitoba, Canada, with specialist availability posing barriers to HCV care. This work assessed the impact of eConsult, an electronic platform that enables Primary Care Providers (PCPs) to access specialist advice, potentially reducing face-to-face patient visits. This single case study was conducted at Nine Circles Community Health Centre in Winnipeg. Charts of individuals referred via traditional pathways (Dec. 2016-Dec. 2017) and eConsult (Dec. 2017 - Dec. 2019) were reviewed, and stakeholder interviews were conducted with PCPs and an HCV specialist. Compared to traditional referrals, eConsult patients were more likely to link to specialist care (100% vs. 69%, P = 0.026) and complete HCV treatment (79% vs. 36%, P = 0.049). The use of eConsult may improve access to HCV care in Manitoba, with outcomes shaped by system agility, adaptability across contexts, and the altruism of healthcare providers who support its use.

Primary care practitioners are optimally positioned to reduce the Greenhouse Gas (GHG) emissions produced by the healthcare system, which pose great risk to the health of people and the environment. This narrative review discusses 19 initiatives that can be implemented into primary care practices to reduce GHG emissions and financial costs through decreasing highly intensive emergency room visits and hospitalizations. This article also summarizes the time it may take for primary care practitioners to embed each of these initiatives into their care delivery. Lastly, this article demonstrates how best practice initiatives in primary care may show a higher GHG reduction than commonly conducted initiatives aimed at reducing GHGs.

Most of what physicians learn in their training when it comes to ethics focuses on the principles related to the doctor-patient relationship: beneficence, non-maleficence, and autonomy. At a system level, this translates into an obligation for physicians to advocate for their patients based on these principles. Advocacy does not necessarily have answers when resources are scarce, and as a result, physicians often find that they are not "at the table" when important decisions are made at the organizational level. I will argue that for physicians to be more effective leaders within their organizations, there needs to be more of a focus on principle of justice within medical training, specifically when it comes to theories around resource allocation and social justice. This will help physicians to more effectively advocate for their patients, have conversations with health leaders who have different points of view, and participate in organizational decision-making.