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  Subjects -> HEALTH AND SAFETY (Total: 1291 journals)
    - CIVIL DEFENSE (18 journals)
    - DRUG ABUSE AND ALCOHOLISM (86 journals)
    - HEALTH AND SAFETY (523 journals)
    - HEALTH FACILITIES AND ADMINISTRATION (377 journals)
    - OCCUPATIONAL HEALTH AND SAFETY (105 journals)
    - PHYSICAL FITNESS AND HYGIENE (101 journals)
    - WOMEN'S HEALTH (81 journals)

HEALTH AND SAFETY (523 journals)                  1 2 3 | Last

Showing 1 - 200 of 203 Journals sorted alphabetically
16 de Abril     Open Access  
A Life in the Day     Hybrid Journal   (Followers: 9)
Acta Informatica Medica     Open Access   (Followers: 1)
Acta Scientiarum. Health Sciences     Open Access  
Adultspan Journal     Hybrid Journal  
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10)
Advances in Public Health     Open Access   (Followers: 23)
African Health Sciences     Open Access   (Followers: 2)
African Journal for Physical, Health Education, Recreation and Dance     Full-text available via subscription   (Followers: 6)
African Journal of Health Professions Education     Open Access   (Followers: 6)
Afrimedic Journal     Open Access   (Followers: 2)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 4)
AJOB Primary Research     Partially Free   (Followers: 3)
American Journal of Family Therapy     Hybrid Journal   (Followers: 11)
American Journal of Health Economics     Full-text available via subscription   (Followers: 12)
American Journal of Health Education     Hybrid Journal   (Followers: 30)
American Journal of Health Promotion     Hybrid Journal   (Followers: 23)
American Journal of Health Sciences     Open Access   (Followers: 6)
American Journal of Health Studies     Full-text available via subscription   (Followers: 10)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 24)
American Journal of Public Health     Full-text available via subscription   (Followers: 199)
American Journal of Public Health Research     Open Access   (Followers: 29)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 2)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4)
Annali dell'Istituto Superiore di Sanità     Open Access  
Annals of Global Health     Open Access   (Followers: 9)
Annals of Health Law     Open Access   (Followers: 3)
Annals of Tropical Medicine and Public Health     Open Access   (Followers: 15)
Applied Biosafety     Hybrid Journal  
Applied Research In Health And Social Sciences : Interface And Interaction     Open Access   (Followers: 1)
Archive of Community Health     Open Access  
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Arquivos de Ciências da Saúde     Open Access  
Asia Pacific Journal of Counselling and Psychotherapy     Hybrid Journal   (Followers: 8)
Asia Pacific Journal of Health Management     Full-text available via subscription   (Followers: 3)
Asia-Pacific Journal of Public Health     Hybrid Journal   (Followers: 8)
Asian Journal of Gambling Issues and Public Health     Open Access   (Followers: 3)
Association of Schools of Allied Health Professions     Full-text available via subscription   (Followers: 6)
Atención Primaria     Open Access   (Followers: 1)
Australasian Journal of Paramedicine     Open Access   (Followers: 2)
Australian Advanced Aesthetics     Full-text available via subscription   (Followers: 4)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Indigenous HealthBulletin     Free   (Followers: 6)
Autism & Developmental Language Impairments     Open Access   (Followers: 5)
Behavioral Healthcare     Full-text available via subscription   (Followers: 6)
Best Practices in Mental Health     Full-text available via subscription   (Followers: 8)
Bijzijn     Hybrid Journal   (Followers: 2)
Bijzijn XL     Hybrid Journal   (Followers: 1)
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 8)
BLDE University Journal of Health Sciences     Open Access  
BMC Oral Health     Open Access   (Followers: 5)
BMC Pregnancy and Childbirth     Open Access   (Followers: 19)
BMJ Simulation & Technology Enhanced Learning     Full-text available via subscription   (Followers: 7)
Brazilian Journal of Medicine and Human Health     Open Access  
Buletin Penelitian Kesehatan     Open Access   (Followers: 2)
Buletin Penelitian Sistem Kesehatan     Open Access  
Bulletin of the World Health Organization     Open Access   (Followers: 17)
Cadernos de Educação, Saúde e Fisioterapia     Open Access   (Followers: 1)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Canadian Family Physician     Partially Free   (Followers: 12)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 12)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 1)
Canadian Journal of Public Health     Full-text available via subscription   (Followers: 20)
Case Reports in Women's Health     Open Access   (Followers: 3)
Case Studies in Fire Safety     Open Access   (Followers: 12)
Central Asian Journal of Global Health     Open Access   (Followers: 2)
Central European Journal of Public Health     Full-text available via subscription   (Followers: 4)
CES Medicina     Open Access  
Child Abuse Research in South Africa     Full-text available via subscription   (Followers: 1)
Child's Nervous System     Hybrid Journal  
Childhood Obesity and Nutrition     Open Access   (Followers: 10)
Children     Open Access   (Followers: 2)
CHRISMED Journal of Health and Research     Open Access  
Christian Journal for Global Health     Open Access  
Ciência & Saúde Coletiva     Open Access   (Followers: 2)
Ciencia y Cuidado     Open Access  
Ciencia, Tecnología y Salud     Open Access  
ClinicoEconomics and Outcomes Research     Open Access   (Followers: 2)
CME     Hybrid Journal   (Followers: 1)
CoDAS     Open Access  
Community Health     Open Access   (Followers: 2)
Conflict and Health     Open Access   (Followers: 8)
Curare     Open Access  
Current Opinion in Behavioral Sciences     Hybrid Journal   (Followers: 3)
Day Surgery Australia     Full-text available via subscription   (Followers: 2)
Digital Health     Open Access  
Dramatherapy     Hybrid Journal   (Followers: 2)
Drogues, santé et société     Full-text available via subscription  
Duazary     Open Access   (Followers: 1)
Early Childhood Research Quarterly     Hybrid Journal   (Followers: 13)
East African Journal of Public Health     Full-text available via subscription   (Followers: 3)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 16)
EcoHealth     Hybrid Journal   (Followers: 4)
Education for Health     Open Access   (Followers: 5)
electronic Journal of Health Informatics     Open Access   (Followers: 6)
ElectronicHealthcare     Full-text available via subscription   (Followers: 4)
Elsevier Ergonomics Book Series     Full-text available via subscription   (Followers: 5)
Emergency Services SA     Full-text available via subscription   (Followers: 2)
Ensaios e Ciência: Ciências Biológicas, Agrárias e da Saúde     Open Access  
Environmental Disease     Open Access   (Followers: 2)
Environmental Sciences Europe     Open Access   (Followers: 2)
Epidemics     Open Access   (Followers: 4)
Epidemiologic Perspectives & Innovations     Open Access   (Followers: 5)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 20)
Ethics, Medicine and Public Health     Full-text available via subscription   (Followers: 2)
Ethiopian Journal of Health Development     Open Access   (Followers: 8)
Ethiopian Journal of Health Sciences     Open Access   (Followers: 7)
Ethnicity & Health     Hybrid Journal   (Followers: 13)
European Journal of Investigation in Health, Psychology and Education     Open Access   (Followers: 2)
European Medical, Health and Pharmaceutical Journal     Open Access  
Evaluation & the Health Professions     Hybrid Journal   (Followers: 10)
Evidence-based Medicine & Public Health     Open Access   (Followers: 6)
Evidência - Ciência e Biotecnologia - Interdisciplinar     Open Access  
Expressa Extensão     Open Access  
Face à face     Open Access   (Followers: 1)
Families, Systems, & Health     Full-text available via subscription   (Followers: 8)
Family & Community Health     Partially Free   (Followers: 12)
Family Medicine and Community Health     Open Access   (Followers: 6)
Family Relations     Partially Free   (Followers: 11)
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 1)
Food and Public Health     Open Access   (Followers: 11)
Frontiers in Public Health     Open Access   (Followers: 7)
Gaceta Sanitaria     Open Access   (Followers: 3)
Galen Medical Journal     Open Access  
Geospatial Health     Open Access  
Gesundheitsökonomie & Qualitätsmanagement     Hybrid Journal   (Followers: 11)
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Global Health : Science and Practice     Open Access   (Followers: 5)
Global Health Promotion     Hybrid Journal   (Followers: 16)
Global Journal of Health Science     Open Access   (Followers: 9)
Global Journal of Public Health     Open Access   (Followers: 12)
Global Medical & Health Communication     Open Access   (Followers: 1)
Globalization and Health     Open Access   (Followers: 5)
Hacia la Promoción de la Salud     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 3)
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 15)
Health & Justice     Open Access   (Followers: 5)
Health : An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine     Hybrid Journal   (Followers: 7)
Health and Human Rights     Free   (Followers: 8)
Health and Social Care Chaplaincy     Hybrid Journal   (Followers: 7)
Health and Social Work     Hybrid Journal   (Followers: 49)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 1)
Health Care Analysis     Hybrid Journal   (Followers: 14)
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 15)
Health Issues     Full-text available via subscription   (Followers: 2)
Health Policy     Hybrid Journal   (Followers: 36)
Health Policy and Technology     Hybrid Journal   (Followers: 1)
Health Professional Student Journal     Open Access   (Followers: 1)
Health Promotion International     Hybrid Journal   (Followers: 21)
Health Promotion Journal of Australia : Official Journal of Australian Association of Health Promotion Professionals     Full-text available via subscription   (Followers: 10)
Health Promotion Practice     Hybrid Journal   (Followers: 15)
Health Prospect     Open Access   (Followers: 1)
Health Psychology     Full-text available via subscription   (Followers: 48)
Health Psychology Research     Open Access   (Followers: 18)
Health Psychology Review     Hybrid Journal   (Followers: 40)
Health Renaissance     Open Access  
Health Research Policy and Systems     Open Access   (Followers: 11)
Health SA Gesondheid     Open Access   (Followers: 2)
Health Science Reports     Open Access  
Health Sciences and Disease     Open Access   (Followers: 2)
Health Services Insights     Open Access   (Followers: 2)
Health Systems     Hybrid Journal   (Followers: 3)
Health Voices     Full-text available via subscription  
Health, Culture and Society     Open Access   (Followers: 12)
Health, Risk & Society     Hybrid Journal   (Followers: 12)
Healthcare     Open Access   (Followers: 1)
Healthcare in Low-resource Settings     Open Access   (Followers: 1)
Healthcare Quarterly     Full-text available via subscription   (Followers: 8)
Healthy-Mu Journal     Open Access  
HERD : Health Environments Research & Design Journal     Full-text available via subscription  
Highland Medical Research Journal     Full-text available via subscription  
Hispanic Health Care International     Full-text available via subscription  
HIV & AIDS Review     Full-text available via subscription   (Followers: 11)
Home Health Care Services Quarterly     Hybrid Journal   (Followers: 5)
Hong Kong Journal of Social Work, The     Hybrid Journal   (Followers: 2)
Hospitals & Health Networks     Free   (Followers: 4)
IEEE Journal of Translational Engineering in Health and Medicine     Open Access   (Followers: 3)
IMTU Medical Journal     Full-text available via subscription  
Indian Journal of Health Sciences     Open Access   (Followers: 2)
Indonesian Journal for Health Sciences     Open Access   (Followers: 1)
Inmanencia. Revista del Hospital Interzonal General de Agudos (HIGA) Eva Perón     Open Access  
Innovative Journal of Medical and Health Sciences     Open Access  
Institute for Security Studies Papers     Full-text available via subscription   (Followers: 5)
interactive Journal of Medical Research     Open Access  
International Health     Hybrid Journal   (Followers: 5)
International Journal for Equity in Health     Open Access   (Followers: 7)
International Journal for Quality in Health Care     Hybrid Journal   (Followers: 33)
International Journal of Applied Behavioral Sciences     Open Access   (Followers: 2)
International Journal of Behavioural and Healthcare Research     Hybrid Journal   (Followers: 7)
International Journal of Circumpolar Health     Open Access   (Followers: 1)
International Journal of Community Medicine and Public Health     Open Access   (Followers: 5)
International Journal of E-Health and Medical Communications     Full-text available via subscription   (Followers: 2)
International Journal of Environmental Research and Public Health     Open Access   (Followers: 20)
International Journal of Evidence-Based Healthcare     Hybrid Journal   (Followers: 8)
International Journal of Food Safety, Nutrition and Public Health     Hybrid Journal   (Followers: 16)
International Journal of Health & Allied Sciences     Open Access   (Followers: 3)
International Journal of Health Care Quality Assurance     Hybrid Journal   (Followers: 9)
International Journal of Health Geographics     Open Access   (Followers: 6)

        1 2 3 | Last

Journal Cover Healthcare Quarterly
  [SJR: 0.192]   [H-I: 25]   [8 followers]  Follow
    
   Full-text available via subscription Subscription journal
   ISSN (Print) 1710-2774
   Published by Longwoods Publishing Homepage  [7 journals]
  • From the Editors
    • Abstract: From the Editors
      PubDate: Mon, 13 Nov 2017 05:00:00 +000
       
  • Ethnic Differences in Mental Health and Race-Based Data Collection
    • Abstract: There is strong evidence of ethnic disparities in chronic medical conditions, such as diabetes and cardiovascular diseases; however, less is known about ethnic differences in mental illness and health service utilization. Previous studies have shown that Asians are more likely to avoid or delay seeking help for their mental illness. We conducted a population-based study using Ontario health administrative data to examine ethnic differences in mental illness severity at hospital presentation. We found that Chinese and South Asian psychiatric patients were significantly more likely to be involuntarily admitted and exhibited more aggressive behaviours and psychotic symptoms compared to the general population. Our study highlights the need to better understand how individual, family and health-system factors contribute to the observed ethnic disparities. This paper also describes the current status of ethnicity and race-based data collection in Ontario and the benefits of routinely collecting more ethnicity data in our healthcare system to ensure equitable healthcare access and outcomes for all Ontarians.
      PubDate: Mon, 13 Nov 2017 05:00:00 +000
       
  • Unnecessary Care in Canada
    • Abstract: Unnecessary Care in Canada
      PubDate: Mon, 13 Nov 2017 05:00:00 +000
       
  • Physician Remuneration for Remote Consults: An Overview of Approaches
           across Canada
    • Abstract: While lengthy waits for medical specialists remains a persistent problem across Canada, remote consult presents a strategy to address this issue. Connecting primary healthcare providers to specialists via electronic (eConsult) or telephone consult enables care providers to deliver appropriate, speciality-informed care for their patients in the primary care setting, reducing the time spent waiting for specialists and potentially preventing unnecessary referrals to specialty care. These remote consult models are the focus of a new pan-Canadian quality improvement collaborative delivered by the Canadian Foundation for Healthcare Improvement in partnership with Canada Health Infoway, the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada. Successful implementation of remote consult services requires alignment of remuneration for physicians. This article presents an overview of compensation arrangements across Canada for remote (telephone or electronic) and select in-person consults. It also shares key messages for payers and providers to inform future direction in this area.
      PubDate: Mon, 13 Nov 2017 05:00:00 +000
       
  • The Ted Freedman Award for Innovation in Education 2017
    • Abstract: The Ted Freedman Award for Innovation in Education 2017
      PubDate: Mon, 13 Nov 2017 05:00:00 +000
       
  • A Model for Developing Clinical Analytics Capacity: Closing the Loops on
           Outcomes to Optimize Quality
    • Abstract: Closed Loop Analytics© is receiving growing interest in healthcare as a term referring to information technology, local data and clinical analytics working together to generate evidence for improvement. The Closed Loop Analytics model consists of three loops corresponding to the decision-making levels of an organization and the associated data within each loop – Patients, Protocols, and Populations. The authors propose that each of these levels should utilize the same ecosystem of electronic health record (EHR) and enterprise data warehouse (EDW) enabled data, in a closed-loop fashion, with that data being repackaged and delivered to suit the analytic and decision support needs of each level, in support of better outcomes.
      PubDate: Mon, 13 Nov 2017 05:00:00 +000
       
  • Clinical Documentation in an Era of Increasing Transparency: The Impact of
           Electronic Portals on Care
    • Abstract: Electronic health records (EHRs) and consumer health portals have implications for improving the quality and cost-effectiveness of healthcare and make it much easier for patients and families to access health information in a timely and convenient manner. However, the accessibility of information afforded by EHRs and health portals changes the dynamic of control over health information in very significant ways. Institutions and their clinicians have typically been the caretakers of these documents; therefore, the introduction of portals represents a major cultural shift in healthcare. The efforts of both clinicians and patients are needed to effectively make this shift, as the implementation of new technology is uniquely challenging within a healthcare setting. An interactive workshop was facilitated to understand clinicians' perceived challenges of this shift with a specific focus on the implications of increased transparency and patients' increased access to health information.
      PubDate: Mon, 13 Nov 2017 05:00:00 +000
       
  • Partnering with Patients: The Toronto Central LHIN Telehomecare Experience
    • Abstract: Chronic obstructive pulmonary disease (COPD) and heart failure are responsible for significant healthcare costs in Ontario. One program developed to improve the management of these conditions is Telehomecare, which provides six months of health status monitoring and patient self-management education at no cost to participating COPD and heart failure patients. The Toronto Central Local Health Integration Network (LHIN; formerly the Toronto Central Community Care Access Centre), an early participant, enrolled over 3,000 Telehomecare patients between 2012 and 2016. Research shows that the program reduces emergency department visits and hospital admissions, improves patient confidence and self-management skills and is associated with high patient satisfaction. Program improvements and expansion are ongoing.
      PubDate: Mon, 13 Nov 2017 05:00:00 +000
       
  • Using Mobile Apps to Communicate Vaccination Records: A City-wide
           Evaluation with A National Immunization App, Maternal Child Registry and
           Public Health Authorities
    • Abstract: Medicine is experiencing a paradigm shift, where patients are increasingly involved in the management of their health data. We created a mobile app which permitted parental reporting of immunization status to public health authorities. We describe app use as a proxy for feasibility and acceptability as well as data utility for public health surveillance. The evaluation period ran from April 27, 2015, to April 18, 2017, during which time 2,653 unique children's records were transmitted, containing 36,105 vaccinations. Our findings suggest that mobile immunization reporting is feasible and may be an acceptable complement to existing reporting methods. Measures of data utility suggest that mobile reporting could enable more accurate assessments of vaccine coverage.
      PubDate: Mon, 13 Nov 2017 05:00:00 +000
       
  • Interprofessional Education for Internationally Educated Health
           Professionals: Pathways to Licensure
    • Abstract: In response to the shortage of healthcare professionals, the Canadian government has supported two innovative health workforce planning strategies: interprofessional education for interprofessional collaboration and recruiting internationally educated health professionals (IEHPs). Interprofessional collaboration is increasingly expected by Canadian-educated healthcare professionals; IEHPs must also be oriented to this practice model. An environmental scan and iterative assessments and evaluations informed the development of an online interprofessional competency toolkit aimed at training and assessing interprofessional collaboration for IEHPs. This paper outlines the complex licensure pathways for seven healthcare professions and confirms "collaboration" is a required competency, further validating the need for the toolkit.
      PubDate: Mon, 13 Nov 2017 05:00:00 +000
       
  • Improving Care Experiences, Efficiencies and Quality of Care for Seniors
           in Alberta
    • Abstract: Improving Care Experiences, Efficiencies and Quality of Care for Seniors in Alberta Forum was held to explore the current challenges and opportunities in seniors' care. A diverse group of 53 attendees, representing a cross section of healthcare organizations, front-line healthcare providers, researchers and patients, participated in facilitative, small group discussions to share and propose solutions to barriers to coordinating and integrating care for the senior population across the continuum within the Edmonton zone, to comment on a standardized assessment that may inform integrated care and support planning and to outline steps towards health information continuity.
      PubDate: Mon, 13 Nov 2017 05:00:00 +000
       
  • Code Grey: Stained Surgical Instruments and Their Impact on One Canadian
           Health Authority
    • Abstract: In 2016, NL's largest RHA was faced with serious challenges stemming from the discovery of stained surgical instruments at its two largest hospitals. This discovery prompted a series of postponed surgeries, an extensive internal mobilization of labour and the purchase of millions of dollars of new equipment. In tackling these challenges, the organization not only acquired a better understanding of its surgical tools, but it also gained renewed appreciation for the resilience of its human resources. By describing this incident and the lessons learned, we hope to offer insight to providers in similar circumstances.
      PubDate: Mon, 13 Nov 2017 05:00:00 +000
       
  • Coding Accuracy for Outpatient Ophthalmic Surgery: St. Joseph’s
           Healthcare Hamilton
    • Abstract: Coding accuracy is an important factor in ensuring hospitals receive adequate reimbursement from the government for healthcare services rendered. A retrospective review of 100 charts, the purpose of this study was to determine the degree of coding accuracy from the surgeon perspective, for outpatient procedures performed for ophthalmic services at St. Joseph's Healthcare Hamilton from July to December 2016. Using ICD-10-CA, Canadian Classification of Health Interventions, Quality-Based Procedures criteria where applicable, and the 3M Coding and Reimbursement system, this paper reveals three primary sources of coding errors and presents recommendations to increase accuracy of reimbursement for the benefit of both the Ministry of Health and hospital organizations.
      PubDate: Mon, 13 Nov 2017 05:00:00 +000
       
  • Going Beyond the 9-1-1 Call – What BC Emergency Health Services is
           doing to Improve Timely Access to Emergency Care
    • Abstract: British Columbia Emergency Health Services (BCEHS) uses an internationally recognized Medical Priority Dispatch System to assign appropriate responses to 9-1-1 calls based on patients' clinical acuity. In 2015, 71% of Omega calls (classified as calls involving low acuity injuries) were assigned an ambulance. To better meet patients' needs, BCEHS collaborated with HealthLink BC's Nursing Services (HLBC NS) to audit over 2,000 calls. Based on the results, three Plan, Do, Study, Act (PDSA) cycles were implemented, yielding a 35% decrease in ambulances assigned and a 173% increase in referrals to HLBC NS to provide more suitable support. Ultimately, the interventions allowed these ambulances to be reallocated to more critical patients.
      PubDate: Mon, 13 Nov 2017 05:00:00 +000
       
  • Monitoring Receptivity to Online Health Messages by Tracking Daily Web
           Traffic Engagement Patterns: A Review of More than 13 Million US Web
           Exposures over 1,235 Days
    • Abstract: Reaching the recipient of online health messages is necessary to Web-based health promotion applications. To measure willingness to adhere to a health-related Web message, we explored the frequency with which more than 13 million Web users ignored or opted to receive a random inbound message. The findings suggest declining curiosity among Web users about online messages, and that certain days may be more propitious than others for communicating with users. This approach can be modified to gather more granular insights into how messages, including timing and design features, can be tailored to promote improved public health messaging.
      PubDate: Thu, 26 Oct 2017 04:00:00 +000
       
  • From the Editors
    • Abstract: From the Editors
      PubDate: Fri, 28 Apr 2017 04:00:00 +000
       
  • Gender, Sex and Traumatic Brain Injury: Transformative Science to Optimize
           Patient Outcomes
    • Abstract: This paper presents highlights from a program of research addressing sex and gender among persons with traumatic brain injury (TBI) relevant to the Canadian context. Epidemiological trends based on health administrative data are examined, and their implications for policy and practice are considered. Further, the authors discuss the need to proactively address TBI in marginalized populations and in the workplace, two areas that have not received widespread attention.
      PubDate: Fri, 28 Apr 2017 04:00:00 +000
       
  • Improving Health System Efficiency: Perspectives of Decision-Makers
    • Abstract: While improving health system efficiency, or value for money, is a priority in Canada, there is little information about optimal approaches for improvement in the Canadian context. Through interviews with senior health system decision-makers from two provinces, this study conducted by the Canadian Institute for Health Information identified the following five main themes along with actions that can be taken to improve health system efficiency in Canada: performance monitoring for accountability and decision-making, system-level integration in governance and care delivery, partnerships outside the health sector to improve population health, physician engagement and remuneration and flexible funding. Future work could apply this framework to assess and compare progress towards health system efficiency in other jurisdictions.
      PubDate: Fri, 28 Apr 2017 04:00:00 +000
       
  • Healthcare for the Aging Citizen and the Aging Citizen for Healthcare:
           Involving Patient Advisors in Elder-Friendly Care Improvement
    • Abstract: With an aging population and a healthcare system that is overly reliant on providing expensive and sometimes problematic hospital-based care for older Canadians, driving improvements that promote elder-friendly care has never been more critical. The Acute Care for Elders (ACE) Strategy at Toronto's Mount Sinai Hospital is the focus of a pan-Canadian collaborative delivered by the Canadian Foundation for Healthcare Improvement in partnership with the Canadian Frailty Network. The intent is to spread the ACE Strategy's elder-friendly models of care and practices to 18 participating healthcare delivery organizations. A key element of the ACE Collaborative is the inclusion of patient advisors as members of the 18 teams. This article considers the development of elder-friendly care models and practices, with lessons for patient advisors and organizations on the necessary skill-mix, as well as lessons for providers and managers on ways to more effectively engage patient advisors in health system improvement to better serve an aging population.
      PubDate: Fri, 28 Apr 2017 04:00:00 +000
       
  • In Conversation with Leslee Thompson
    • Abstract: In healthcare, no organization was as synonymous with quality and safety as Accreditation Canada, an independent agency established in 1958 to verify and certify that healthcare service providers met process and outcome standards at national and even international levels. In Canada, some 1,000 organizations across 7,000 sites turned to Accreditation Canada for their compliance verification with current and emerging practices and outcomes. In early 2017, feedback from stakeholders drove a bold new direction for users where HSO specializes in the development of best-in-class standards and their assessment while its affiliate, Accreditation Canada, plans and provides accreditation services to Canadian and international clients.Arriving in February 2016, President and CEO, Leslee Thompson, started her career as a critical care nurse, has an MBA from Western, a Master's degree in health administration from the University of Toronto and is a certified Corporate Director. She has a long and successful track record in the C-suite where she honed her leadership skills in some of Canada's most prestigious academic centres. Combined with business acumen gained from the front lines and boardrooms of the private sector, Leslee's many contributions to her profession and best practices in healthcare position her uniquely to lead HSO and Accreditation Canada, here and abroad. In 2012, Leslee received the Facing Cancer Together Award of Honour for her work empowering women with cancer. HQ's Ken Tremblay caught up with her this spring.
      PubDate: Fri, 28 Apr 2017 04:00:00 +000
       
  • Regulation in Whose Interest? A Review of Private Profits versus Public
           Policy: The Pharmaceutical Industry and the Canadian State
    • Abstract: Regulation in Whose Interest? A Review of Private Profits versus Public Policy: The Pharmaceutical Industry and the Canadian State
      PubDate: Fri, 28 Apr 2017 04:00:00 +000
       
  • The Case for Quality Improvement
    • Abstract: Healthcare systems around the world are facing increasing public and government scrutiny, financial pressures and challenges from growing complexity. There is a need to accelerate the pace of change, and improve the quality of care while reducing cost. These changes must centre on improving care and increasing accountability for quality in the system. But how do we achieve this goal?
      PubDate: Fri, 28 Apr 2017 04:00:00 +000
       
  • Early Rehabilitation for Patients with Hip Fractures: Spreading Change
           Across the System
    • Abstract: Evidence suggests that patients with hip fractures should begin rehabilitation no later than six days following surgery. The reality is often far different. In an initiative led by the Greater Toronto Area (GTA) Rehab Network, acute care and rehab/complex continuing care hospitals across the GTA have implemented a new early referral process to aid transition of patients from acute care to inpatient rehabilitation as early as possible to improve their outcomes. Two of the participating acute care hospitals have now surpassed the six-day target and two others are within range. The initiative also provides useful learnings to guide other cross-sector change and spread initiatives.
      PubDate: Fri, 28 Apr 2017 04:00:00 +000
       
  • BOOMR: Better Coordinated Cross-Sectoral Medication Reconciliation
           for Residential Care
    • Abstract: There is evidence that medication errors often arise during the transition of residents from acute care to long-term care (LTC) homes due to lapses in communication and documentation. Better Coordinated Cross-Sectoral Medication Reconciliation (BOOMR) is an integrated practice change improving medication safety during patient transitions through the health system. Our Medication Reconciliation (MedRec) redesign improved patient engagement using “the patient's story,” increased quality of information, workflow efficiency and reduced unnecessary medications. Using progressive initiatives, we showed cost savings to the system proving value for quality with sustainable results since January 2015.
      PubDate: Fri, 28 Apr 2017 04:00:00 +000
       
  • The PoET (Prevention of Error-based Transfers) Project
    • Abstract: The PoET (Prevention of Error-based Transfers) Project is one of the Ethics Quality Improvement Projects (EQIPs) taking place at William Osler Health System. This specific project is designed to reduce transfers from long-term care to hospital that are caused by legal and ethical errors related to consent, capacity and substitute decision-making. The project is currently operating in eight long-term care homes in the Central West Local Health Integration Network and has seen a 56% reduction in multiple transfers before death in hospital.
      PubDate: Fri, 28 Apr 2017 04:00:00 +000
       
  • Optimizing Transitions of Care – Hospital to Community
    • Abstract: Discharging patients from the hospital is a complex process, and preventing avoidable readmissions has the potential to improve both the quality of life for patients and the financial sustainability of the healthcare system (Alper et al. 2016). Improving the discharge process is one method to mitigate readmission to the hospital. Historically, St. Thomas Elgin General Hospital (STEGH) consistently experienced higher-than-expected readmission rates, and only 41% of discharge summaries were sent from the hospital to the community primary care within 48 hours. In addition, the overall percentage of patients attending a follow-up appointment with a primary care physician within seven days of discharge from hospital was lower than the provincial average. Through engagement with primary care providers (PCPs) and clinical associates (CAs) and with the use of standard work and monitoring organizational metrics, STEGH has achieved significant improvements.
      PubDate: Fri, 28 Apr 2017 04:00:00 +000
       
  • Patient-Centred Care in Canada: Key Components and the Path Forward
    • Abstract: Canadians' health and its care continue to evolve. Chronic diseases affect more than 50% of our aging population, but the majority of public and professional stakeholders retain a sense of care quality. An emergent issue, however, is generating an increasingly wide debate. It is the concept of patient-centred care, including its definition of key components, and efficacy. To advance the evidence base, the 2013–2014 and 2016 Health Care in Canada (HCIC) surveys measured pan-stakeholder levels of support and implementation priorities for frequently proposed components of patient centricity in healthcare. The public's highest rated component was timely access to care, followed by perceived respect and caring in its delivery, with decisions made in partnership among patients and professional providers, and within a basic belief that care should be based on patients' needs versus their ability to pay. Health professionals' levels of support for key components largely overlapped the public's levels of support for key components, with an additional accent on care influenced by an evidence base and expert opinion. In terms of priority to actually implement enhanced patient-centred care options, timely access was universally dominant among all stakeholders. Caring, respectful care, also retained high implementation priority among both the public and professionals, as did care decisions made in partnership, and, among professionals, care driven by research and expert opinion. Low priorities, for both the public and professionals, were the actual measurements of patient-centred care delivery and its impact on outcomes. In summary, there is remarkable concordance among all stakeholders in terms of favoured interventions to enhance patient-centred care, namely, timely access, caring, partnering and communicative delivery of evidence-based care. Unfortunately, the lack of contemporary imperative around the value of measuring and reporting actual use and outcomes of favoured interventions means uncertainty of their efficacy will persist for the foreseeable future. Things can be better.
      PubDate: Fri, 28 Apr 2017 04:00:00 +000
       
  • Listening to Improve: Transforming Patient Relations Measurement and
           Reporting in Ontario
    • Abstract: Effective patient relations are important to improve patient experience and deliver better care. Policy and legislative changes in Ontario have increased accountabilities for patient relations and expanded Health Quality Ontario (HQO)'s mandate. In response, HQO collaborated with patients, health sector organizations, associations and the Ministry of Health and Long-Term Care to co-design a patient relations measurement and reporting approach. Informed by an environmental scan, broad consultations, a multi-sector survey and a provincial advisory group, the approach includes standardized patient relations indicators to support measurement and public reporting across the hospital, home and long-term care sectors. Pilot testing with 29 sites across three sectors will inform province-wide implementation.
      PubDate: Fri, 28 Apr 2017 04:00:00 +000
       
  • Improving Patient Engagement and Satisfaction: Lessons from a
           Patient-Driven Care Initiative in a Community-Based Hospital
    • Abstract: Lack of collaboration and alignment between members of the healthcare team interfere with the patient-centred care approach.The Patient-Driven Care Project was initiated in 2012. This model sought to advance a system of care that is patient-driven, family-centred and provider-guided to improve the value to patients and give them more control on their health journey.The evaluation revealed that the efforts should focus on sustainability and continuation of support and encouragement of hospital colleagues to ensure each patient and family experience is based on caring communication at every interaction with them.
      PubDate: Fri, 28 Apr 2017 04:00:00 +000
       
  • Integrating Engagement and Improvement Work in a Pediatric Hospital
    • Abstract: Although geared towards a common goal – improved patient-centred care – quality improvement strategies and patient engagement-focused approaches are often developed and conducted in silos. The lack of integration may lead, on the one hand, to the uptake of patient suggestions that do not always take into consideration implications for the delivery of quality care and, on the other hand, to inadequate understanding of patient views required to create optimal services.The Children's Hospital of Eastern Ontario (CHEO)'s action plans to address gaps in patient engagement and quality improvement, two of its priority areas, were initially carried out in isolation of each other. While implementing a key patient engagement initiative using an experience-based co-design approach, Lean process improvement tools were used to plan and implement projects to improve patient, family and staff experiences of care.Preliminary assessments of this project revealed that the integration of these two approaches is feasible and that it was well received by both staff and families. There is important synergy to be found between patient engagement and quality improvement that needs to be leveraged by organizational structures and processes to fulfill the commitments inherent in both fields.
      PubDate: Fri, 28 Apr 2017 04:00:00 +000
       
  • The Effect of Language on Hospital Inpatient Length of Stay
    • Abstract: As one of the most ethnically diverse countries in the world, Canada is faced with numerous challenges in addressing disparities affecting its healthcare system. One barrier to care is limited English proficiency (LEP). Using electronic medical records, this retrospective study examined the impact of LEP on inpatient length of stay (LOS) in an acute care community hospital. We found that patients in our sample population with LEP had a shorter inpatient LOS by 0.36 days compared with English-proficient (EP) patients. In this paper, we discuss possible contributing factors, potential impact on patient care and experience and considerations for future research.
      PubDate: Fri, 28 Apr 2017 04:00:00 +000
       
  • St. Michael’s Improvement Program – A Collaborative Approach to
           Sustainable Cost Savings
    • Abstract: In response to a challenging financial environment and increasing patient demand, St. Michael's Hospital needed to find long-term sustainable solutions to continue to provide high-quality patient care and invest in key priorities. By conducting Operational Reviews in focused areas, the hospital achieved $7.4 million of in-year savings in the first year, found standardizations, process efficiencies and direct cost savings that positioned itself for success in future funding models. Initiatives were grounded in evidence and relied heavily on the effective execution by the leadership, front-line staff and physicians. As organizations face similar challenges, this journey can provide key learnings.
      PubDate: Fri, 28 Apr 2017 04:00:00 +000
       
  • Editorial
    • Abstract: Editorial
      PubDate: Fri, 27 Jan 2017 05:00:00 +000
       
  • Pediatric Insulin Pump Therapy: Reflecting on the First 10 Years of a
           Universal Funding Program in Ontario
    • Abstract: We evaluated the universal funding program for pediatric insulin pumps in Ontario by examining the dynamics underlying patterns of pump use and adverse events using population-based health administrative data available at the Institute for Clinical Evaluative Sciences (ICES), supplemented by other data. We found that (1) pump use has increased steadily since 2006 with variation across centres and disparity in use by socioeconomic status; (2) pump discontinuation is uncommon; (3) physicians value pump therapy in numerous ways that provide important insights into patterns of uptake; and (4) the safety profile of pump therapy is, in general, very good; however, individuals of lower socioeconomic status are at an increased risk of acute diabetes complications, most frequently diabetic ketoacidosis. This comprehensive mixed-methods evaluation reveals the need to understand and intervene to reduce social disparities in the use and adverse outcomes of technologies used for diabetes management.
      PubDate: Fri, 27 Jan 2017 05:00:00 +000
       
  • A Snapshot of Advance Directives in Long-Term Care: How Often Is "Do Not"
           Done?
    • Abstract: Advance directives allow individuals and their families or legal guardians to communicate preferences for interventions and treatments in the event that these individuals are no longer able to make decisions for themselves. This study examines how often do-not-hospitalize (DNH) and do-not-resuscitate (DNR) directives were recorded for residents in 982 reporting Canadian long-term care facilities between 2009–2010 and 2011–2012 and, to the extent possible, whether these directives were followed in acute care settings. It found that three-quarters of long-term care residents had a directive not to resuscitate and that these directives appeared to be well followed across the continuum; only 1 in 2,500 residents with a DNR received resuscitation in hospital. Fewer residents – 1 in 5 – had a directive not to hospitalize, and about 1 in 14 (7%) of these residents was admitted to hospital. The data are unable to determine whether patients or their families provided consent for these hospitalizations at the time of a decision to transfer. Close to half of hospitalizations among residents with a DNH directive were from potentially preventable causes, such as injuries or infections. Although hospital transfers from long-term care decreased over the study period, hospitalizations could be further reduced with the enhancement of palliative care services in long-term care settings.
      PubDate: Fri, 27 Jan 2017 05:00:00 +000
       
  • Open Innovation Prizes and Challenges: Learnings from the ImagineNation
           Series
    • Abstract: Open Innovation Prizes and Challenges: Learnings from the ImagineNation Series
      PubDate: Fri, 27 Jan 2017 05:00:00 +000
       
  • Principles for Health System Capacity Planning: Insights for Healthcare
           Leaders
    • Abstract: Jurisdictions across Canada and around the world face the challenge of planning high-performing and sustainable health systems in response to growing healthcare demands. In this paper, we report on the process of developing principles for health system capacity planning by the Ministry of Health and Long-Term Care in Ontario. Integrating the results of a literature review on health system planning and a symposium with representatives from local health integration networks, we describe the following six principles in detail: (1) develop an aspirational vision, (2) establish clear leadership, (3) commit to stakeholder engagement, (4) engage patients and the public, (5) build analytics infrastructure and (6) revise policy when necessary.
      PubDate: Fri, 27 Jan 2017 05:00:00 +000
       
  • Comparing the Health of Canadian Hospitals: Paying Attention to the Mix of
           Planned and Unplanned Admissions
    • Abstract: Canadian hospitals are being placed under increasing scrutiny for both performance and safety in some cases with a threat of financial consequences for failure. However, there are no accepted standards for comparing the relative context in which hospitals must operate; the unstated assumption being that all are starting from the same place and have equal opportunities for success. A "healthy hospital" should be able to meet the needs of its community with a mix of both planned (scheduled) and unplanned (emergency) services. The proportion of admissions that are planned has been falling in most Canadian hospitals and unplanned admissions have been rising, creating an unhealthy state with added costs. Canadian Institute for Health Information's databases give us a way to monitor these changes, but it is not routinely done. Making this information more available would help to identify hospitals most in need of support.
      PubDate: Fri, 27 Jan 2017 05:00:00 +000
       
  • How Appropriate Is All This Data Sharing? Building Consensus Around What
           We Need to Know About Shared Electronic Health Records in Extended Circles
           of Care
    • Abstract: Background: The bulk of healthcare spending is on individuals who have complex needs related to age, income, chronic disease and mental illness. Care involves many different professions, and interoperable electronic health records (EHRs) are increasingly essential.Objectives: The objective of this paper is to describe the use of a nominal group technique (NGT) to develop a stakeholder-centred research agenda for clinical interoperability in extended circles of care that include social supports.Methods: We held a day-long meeting with 30 stakeholders, including primary care providers, social supports, patient representatives, health region managers, technology experts, health organizations and experts in privacy, law and ethics. Participants considered, "What research needs to be done to better understand how EHRs should be shared across large healthcare teams that include social supports?" Following sensitizing presentations from researchers and participants, we used an NGT to generate and rank research questions on a 9-point Likert scale. We retained research questions that had a mean score of at least 6.5/9 by at least 70% of the participants over two rounds of consensus-building.Results: Participants identified and ranked 57 research questions. Five items achieved consensus, related to 1) the impact of information sharing on care team outcomes, 2) data quality/accuracy, 3) cost/benefit, 4) what processes use what data and 5) regulation/legislation.Conclusion: Healthcare reforms are increasingly focused on systems that integrate and coordinate multidisciplinary care, facilitated by EHRs. Research prioritization will ensure common concerns and barriers are addressed and resolved.
      PubDate: Fri, 27 Jan 2017 05:00:00 +000
       
  • The Development of a Quality Management Framework for Evaluating Medical
           Device Reprocessing Practice in Healthcare Facilities
    • Abstract: There is increasing awareness of the importance of medical device reprocessing (MDR) for the provision of safe patient care. Although industry service standards are available to guide MDR practices, there remains a lack of published key performance indicators (KPIs) and targets that are necessary to evaluate MDR quality for feedback and improvement. This article outlines the development of an initial framework that builds on established guidelines and includes service standards, KPIs and targets for evaluating MDR operations. This framework can support healthcare facilities in strengthening existing practices and enables a platform for collaboration towards better MDR performance management.
      PubDate: Fri, 27 Jan 2017 05:00:00 +000
       
  • Key Advantages of a Targeted Incident Reporting System for Severe and
           Critical Clostridium difficile Infection Incidents
    • Abstract: There is little guidance on how to design and implement an incident reporting system (IRS) targeted at one of the most common types of adverse events in hospitals: hospital-associated infections. In this article, we describe an IRS for severe and critical Clostridium difficile infection incidents and highlight its key advantages.
      PubDate: Fri, 27 Jan 2017 05:00:00 +000
       
  • Emergency Department Use: Influence of Connection to a Family Physician on
           ED Use and Attempts to Avoid Presentation
    • Abstract: Some low-acuity emergency department (ED) presentations are potentially avoidable with improved primary care access. The majority of ED patients (74.4%) in this study had a family physician, but the frequency of visits varied substantially. The variable frequency of patients' visits to these providers calls into question the validity of linkage assumptions. Several sociodemographic factors were associated with having a family physician, including female sex, being married/common law, race (Caucasian), being employed over the previous 12 months and having received a flu shot in the past year. These factors need to be explored further.
      PubDate: Fri, 27 Jan 2017 05:00:00 +000
       
  • Primary Care Collaborative Memory Clinics: Building Capacity for Optimized
           Dementia Care
    • Abstract: Increasingly, primary care collaborative memory clinics (PCCMCs) are being established to build capacity for person-centred dementia care. This paper reflects on the significance of PCCMCs within the system of care for older adults, supported with data from ongoing evaluation studies. Results highlight timelier access to assessment with a high proportion of patients being managed in primary care within a person-centred approach to care. Enhancing primary care capacity for dementia care with interprofessional and collaborative care will strengthen the system's ability to respond to increasing demands for service and mitigate the growth of wait times to access geriatric specialist assessment.
      PubDate: Fri, 27 Jan 2017 05:00:00 +000
       
  • Lessons Learned from an Advanced Access Trial Within a Canadian Armed
           Forces Primary Care Clinic
    • Abstract: Accessibility is a key element of an effective primary care system. Literature has outlined that primary care practices have successfully employed an advanced access scheduler to improve accessibility to booked appointments and consequently enhance patient experience and outcomes. In 2015, a Canadian Armed Forces (CAF) primary care facility in Ottawa trialed an advanced access scheduler. Based on the unique characteristics of a CAF medical clinic and the patient population, this trial produced six critical lessons, which include maintenance of a stable base of clinicians, correcting rostering mismatches, eliminating appointment backlogs, acquiring required information systems, improved understanding of patient demand and communicating changes effectively. These lessons may be utilized by similar organizations to successfully integrate an advanced access scheduler within their primary care facilities.
      PubDate: Fri, 27 Jan 2017 05:00:00 +000
       
  • Implementation of Behavioural Supports Ontario (BSO): An Evaluation of
           Three Models of Care
    • Abstract: Behavioural Supports Ontario (BSO) was launched to enhance the healthcare services for Ontario's seniors, their caregivers and families living and coping with responsive behaviours associated with dementia and other neurological conditions. The implementation of the program varied across and within the local health integration networks (LHINs). By 2015, there were three BSO models operating within the long-term care (LTC) home sector: in-home BSO teams, a mobile team that serves multiple LTC homes within a sub-area of a LHIN and a LHIN-wide mobile team that provides services to all homes. A survey was undertaken to identify the differences among the BSO models of care in relation to care planning, collaboration and team building and home-level resident outcomes. We found that three years after implementation, LTC staff reported that the in-home BSO model out-performs the mobile team across all key measures. There is a role for mobile teams to provide expertise and sharing of best practices across the regions, but future policy and funding should focus on supporting the development of in-home BSO teams.
      PubDate: Fri, 27 Jan 2017 05:00:00 +000
       
  • Longitudinal Evaluation of a Parent and School Team-Mediated Workshop
           Intervention for Reducing Challenging Behaviours in Children with Autism
           Spectrum Disorder
    • Abstract: Children with autism spectrum disorder often develop persistent challenging behaviours. A previous study in this journal (Reynolds et al. 2011) reported effective implementation of strategies immediately following involvement in a comprehensive positive behaviour support workshop for parents/school personnel. The current study assessed long-term efficacy more than six months after workshop completion. Parent and school behaviour scores suggested maintained improvement in child behaviour. Parent responses to a verbal questionnaire revealed important perceptions of what made workshop participation beneficial. This study provides evidence for long-term benefits from this innovative approach for caregivers working with children with challenging behaviours.
      PubDate: Fri, 27 Jan 2017 05:00:00 +000
       
  • Editorial
    • Abstract: Like most issues of our journal, this one is replete with examples of novel efforts to reshape and reinvigorate healthcare policies and practices. A stand-out feature of this issue, however, is the sheer range of professionals – front-line staff, physicians, pharmacists and more – involved in these initiatives.
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
  • What Edmund Wilson Can Teach Us About Health System Transformation
    • Abstract: What Edmund Wilson Can Teach Us About Health System Transformation
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
  • Assessing Primary Healthcare Using pan-Canadian Indicators of Health and
           Health System Performance
    • Abstract: Updated primary healthcare (PHC) indicators are now available for use across Canada. The Canadian Institute for Health Information identified and updated two sets of priority indicators – a policy set to meet the needs of policy makers and a provider set to meet the needs of providers of PHC at the practice and organization levels. A total of 51 indicator definitions were updated to ensure that they are measurable and operational, align with clinical practice guidelines and available data sources and reflect important dimensions of PHC performance in Canada.
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
  • "Avoidable" Emergency Department Transfers from Long-Term Care Homes: A
           Brief Review
    • Abstract: Access to acute care, in particular the ED, will always be an important component of quality care for LTCH residents. Yet increasing evidence suggests that targeting specific care issues for improvement within the LTCH may help to reduce ED transfers. These issues include better access to medical management for common chronic conditions and infections, fall prevention and transitional care activities. However, for any such initiatives to serve the broader policy agenda of reducing avoidable acute care use, ongoing discussions about what we mean by avoidable within the LTCH context are required.
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
  • In Conversation with Chris Eagle
    • Abstract: In Conversation with Chris Eagle
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
  • “If You're Not Keeping Score, You're Just Practising”: A Lean
           Healthcare Program Evaluation Framework
    • Abstract:  "If You're Not Keeping Score, You're Just Practising"*Vince Lombardi, former head coach of the Green Bay PackersLean methods originated with the Toyota Production System developed shortly after World War II (Ohno 1988). Recently, they are finding widespread usage in healthcare. In industry, the primary objective of Lean is to enhance corporate earnings; but in healthcare, Lean seeks to improve patient-centred care and system efficiency (Institute of Medicine 2001). Lean evaluations have tended to be ad hoc, usually focusing on before and after pictures, graphical displays or vignettes. With Lean's widespread adoption in healthcare, a broad and rigorous framework for its evaluation is needed. 
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
  • Building Sector-Wide Bridges to Improve Patient Flow and Care
    • Abstract: Healthcare system transformation relies upon innovative solutions that build sector-wide bridges and challenge conventional thinking to benefit patients and families. Providence Healthcare – a Toronto leader in rehabilitation – is doing this by partnering with the Toronto Central Local Health Integration Network (LHIN), community care access centres and four acute care hospitals to improve system-wide patient flow. This article explains how Providence's Transformation by Design demonstration project was launched and sustained through engaging key stakeholders, and is now demonstrating positive, measurable results on key metrics in patient flow in Toronto.
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
  • Development and Evaluation of a "Working Together" Framework and a Tool
           Kit to Enhance Inter-organizational Relationships in Healthcare
    • Abstract: Healthcare is in a constant state of change and evolution driven by a multitude of complex factors and interactions. Consequently, organizations, teams and individuals in healthcare have to habitually realign their working relationships. Furthermore, research has shown that "working together" relationships fail in the absence of a defined framework. In this research, a novel framework and a tool kit for working together have been developed and evaluated. The framework has a formal process to articulate the intended purpose/outcome, clearly align the type of working relationship with the purpose and identify the barriers and facilitators to working relationships in healthcare.
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
  • Drug Information Systems: Evolution of Benefits with System Maturity
    • Abstract: Benefits from information and communication technology tend to grow over time as system use matures. This study examines pharmacists' experiences with provincial drug information systems (DIS) across Canada. At the time of survey, two provinces had more mature DIS (more than five years) and three provinces had less mature DIS (five years or less).A national online survey of pharmacists was conducted in February 2010. Of the 737 survey responses received, 402 respondents were practising in a province with a DIS. Over 90% of pharmacists using a DIS reported improvements in access to patient information, fraudulent medication use, medication management and drug-related problems. For these benefits, the degree of improvement was similar across provinces. For other benefits, improvements were greater for users of more mature DIS.Some benefits of DIS are realized in the short-term, whereas others take longer to develop. Critical success factors related to implementation, change management and policy alignment may play a role in accelerating realization of long-term benefits.The use of information and communication technology (ICT) in healthcare is evolving rapidly in Canada and around the world. There is a growing body of literature evaluating the results of ICT use, but most studies are short-term. Publications that quantify costs and benefits using empirical evidence over a longer time remain limited (Brown et al. 2008; Shekelle and Goldzweig 2009; Wang et al. 2003). This is especially important since the early phases of implementation can be resource intensive and maximum value may take time to achieve (Brown et al. 2008; Dobrev et al. 2010; McKibbon et al. 2011). This phenomenon is not unique to healthcare and is also observed in technology innovation in other industries, such as manufacturing (Klein and Knight 2005).
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
  • Enhancing Care for Individuals with Mobility Impairments: Lessons Learned
           in the Implementation of a Primary Care–Based Mobility Clinic
    • Abstract: Persons with mobility impairments experience significant barriers to primary healthcare. This study examines key lessons learned, as derived from interviews with referral sources and Centre for Family Medicine Mobility Clinic team members, in the development and implementation of a primary care–based mobility clinic aimed at reducing these barriers, and it reflects on the implications of this model of care on the system of care. Results highlight the importance of accessibility, specialized equipment, promotional activities and management support as well as challenges reflected by system barriers to care. The results of this study have implications for the application of this model of care in other settings.
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
  • Our Patients Expect More (and So Do We): It's Time to Rethink Patient
           Satisfaction
    • Abstract: A current focus of healthcare organizations and legislation requires hospitals to place more importance on patient experience and satisfaction than ever before. Institutional patient satisfaction survey tools yield data that represent approximately 5% of patients and may not represent the typical patient experience. Moreover, our research demonstrates that only 1% of surveyed providers rely on these data as their primary source of patient satisfaction feedback. The low response rate, the delayed timing of the feedback and a lack of usability for clinicians raise questions about the value of these tools to front-line healthcare providers – those most responsible for the patients' experience of care.
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
  • Rapid Dissemination of a Critical Care Protocol Using Basic Information
           Technology Prior to a Rave
    • Abstract: Enterprise-level information technology systems deliver significant quality improvements. Regions with low implementation can leverage basic technology to improve quality and safety. The Division of Critical Care Medicine in Edmonton, Alberta, was able to rapidly develop and disseminate a care protocol for ecstasy (MDMA) intoxication prior to a large public event. Using only email and word processors, the protocol was developed based on recent experience at one site. It was approved by divisional members and then used in another hospital in Edmonton for two patients. Debriefing revealed that the availability of the protocol was instrumental in starting appropriate therapy and preventing death.
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
  • Small Changes Produce Large Gains in Efficiency: A Case Study from Ross
           Memorial Hospital
    • Abstract: Healthcare is now more challenged to provide excellent care, while also increasing efficiency with more limited resources. The recent introduction of Ontario's funding reform challenges hospitals to increase the efficiency of specific procedures by providing funding based on patient volumes. The cataract surgery program at Ross Memorial Hospital, in Lindsay, Ontario, is an example of how a program designed a few years ago with a focus on patient care and efficiency managed to become substantially more efficient by introducing a series of small changes.
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
  • Organ Failure and Treatment in Canada
    • Abstract: Organ Failure and Treatment in Canada
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
 
 
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