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  Subjects -> HEALTH AND SAFETY (Total: 1288 journals)
    - CIVIL DEFENSE (18 journals)
    - DRUG ABUSE AND ALCOHOLISM (86 journals)
    - HEALTH AND SAFETY (520 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 (520 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: 22)
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: 5)
Afrimedic Journal     Open Access   (Followers: 2)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 3)
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: 28)
American Journal of Health Promotion     Hybrid Journal   (Followers: 23)
American Journal of Health Studies     Full-text available via subscription   (Followers: 10)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 21)
American Journal of Public Health     Full-text available via subscription   (Followers: 188)
American Journal of Public Health Research     Open Access   (Followers: 28)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 2)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2)
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)
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: 2)
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: 4)
Behavioral Healthcare     Full-text available via subscription   (Followers: 6)
Best Practices in Mental Health     Full-text available via subscription   (Followers: 7)
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: 18)
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: 16)
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: 11)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 1)
Canadian Journal of Public Health     Full-text available via subscription   (Followers: 19)
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: 11)
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: 1)
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: 3)
Education for Health     Open Access   (Followers: 5)
electronic Journal of Health Informatics     Open Access   (Followers: 4)
ElectronicHealthcare     Full-text available via subscription   (Followers: 3)
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  
Environmental Sciences Europe     Open Access   (Followers: 1)
Epidemics     Open Access   (Followers: 4)
Epidemiologic Perspectives & Innovations     Open Access   (Followers: 4)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 19)
Ethics, Medicine and Public Health     Full-text available via subscription   (Followers: 1)
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: 9)
Evidence-based Medicine & Public Health     Open Access   (Followers: 5)
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: 5)
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: 48)
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: 12)
Health Issues     Full-text available via subscription   (Followers: 2)
Health Policy     Hybrid Journal   (Followers: 35)
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: 46)
Health Psychology Research     Open Access   (Followers: 18)
Health Psychology Review     Hybrid Journal   (Followers: 39)
Health Renaissance     Open Access  
Health Research Policy and Systems     Open Access   (Followers: 10)
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: 2)
Health Voices     Full-text available via subscription  
Health, Culture and Society     Open Access   (Followers: 11)
Health, Risk & Society     Hybrid Journal   (Followers: 11)
Healthcare     Open Access   (Followers: 1)
Healthcare in Low-resource Settings     Open Access   (Followers: 1)
Healthcare Quarterly     Full-text available via subscription   (Followers: 8)
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: 10)
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: 6)
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)
International Journal of Health Policy and Management     Open Access   (Followers: 3)
International Journal of Health Professions     Open Access   (Followers: 2)
International Journal of Health Promotion and Education     Hybrid Journal   (Followers: 13)

        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: Anyone who has been following the news recently will have been moved by the sad story of Charlie Gard, a baby in England who suffered from a rare form of mitochondrial disease (Wyatt and Siddique 2017). Charlie's final months and death raised a host of difficult – often painful – questions about medical ethics and end-of-life care. It is particularly apt, therefore, that a number of the articles in this issue of Healthcare Quarterly address both these issues, starting with a new ICES report that sheds light on troubling "gaps" in the provision of end-of-life care across Ontario.
      PubDate: Mon, 31 Jul 2017 04:00:00 +000
       
  • The Delivery of Palliative and End-of-Life Care in Ontario
    • Abstract: Healthcare use in the year prior to death represents a large portion of healthcare spending by older adults. While Canada is considered to have advanced integration of palliative care services within our healthcare system, much of this care is still delivered in hospitals and with varying levels of access according to cause of death trajectory and geography. Results presented in a series of studies from the Institute for Clinical Evaluative Sciences (ICES) unveil gaps in current palliative care delivery and offer directions for future research and policy development.
      PubDate: Mon, 31 Jul 2017 04:00:00 +000
       
  • New Tools for Measuring and Improving Patient Safety in Canadian Hospitals
    • Abstract: The Canadian Institute for Health Information (CIHI) and the Canadian Patient Safety Institute (CPSI) have collaborated on a new measure of patient safety, along with a resource of evidence-informed practices. This measure captures four broad categories of harm in acute care hospitals, consisting of 31 clinical groups selected by clinicians. Analysis showed that harm was experienced in 1 of 18 hospital stays in Canada in 2014–2015 and that no single category accounted for the majority of harmful events. Although CIHI and CPSI continue to work with hospitals and experts to further refine the methodology, the measure and associated Improvement Resource are useful new tools for monitoring and identifying harm, and have the potential to improve patient safety.
      PubDate: Mon, 31 Jul 2017 04:00:00 +000
       
  • In Conversation with Mark Hundert, National Director (Retired), Hay Group
    • Abstract: In Conversation with Mark Hundert, National Director (Retired), Hay Group
      PubDate: Mon, 31 Jul 2017 04:00:00 +000
       
  • Public and Professional Insights on End-of-Life Care: Results of the 2016
           Health Care in Canada Survey
    • Abstract: A new dimension has been added to Canadian Medicare – exemption from prosecution for physicians, nurse practitioners and assistants providing medical assistance in dying for competent and informed adult patients with a grievous and irremediable medical condition causing intolerable physical or psychological suffering, irreversible decline in capabilities and reasonably foreseeable natural death. To define stakeholders' perceptions on all contemporary end-of-life care options, we analyzed data from the 2016 Health Care in Canada Survey comprising representative samples of the adult public (n = 1,500), physicians (n = 102), nurses (n = 102), pharmacists (n = 100), administrators (n = 100) and allied health professionals (n = 100). Among the public, enhanced pain management, hospice/palliative care and home/family care were all supported at, or above, the 80th percentile; medically assisted death was supported by 70%. Among all professionals, hospice/palliative care, pain management and home care garnered >90% support; support for medically assisted death ranged from 58% (physicians) to 79% (allied professionals). In terms of priority to implement available options, medically assisted death was rated first by 46% of the public, overall, and by 69% of the sub-group who strongly supported it, followed by enhanced pain management (45%) and home care (42%). Among professionals, top implementation priorities (range: 57–61%) were: enhanced pain management, hospice/palliative care and home care support. Priority for medically assisted death ranged between 25% and 41%, although among professionals who strongly supported it, it was their top priority (52%). When asked to balance patients' right to access assisted death, versus some professionals' reluctance to provide it, 42% of the public and the majority of professionals thought providers should be allowed to opt out if they referred patients to another willing provider. And many professionals perceive some risk of either legal or regulatory reprisal if they assist in patients' deaths. In summary, there is substantial contemporary support for all components of end-of-life care among all stakeholders. However, non-lethal care modalities remain generally preferred, perhaps, at least in part, because medical professionals have a pervasive concern of going in harm's way by participating in assisted death, or by refusing. Things can be better.
      PubDate: Mon, 31 Jul 2017 04:00:00 +000
       
  • Second Medical Opinions in End-of-Life Disputes in Critical Care: An
           Ethics-Based Approach
    • Abstract: Requests for a second medical opinion (SMO) by patients or substitute decision-makers (SDMs) can arise during end-of-life disputes in critical care. Such disagreements between patients or SDMs1 and physicians often pertain to specific elements of the decision-making process related to withholding or withdrawing of life-sustaining treatments. When these disputes occur in the critical care setting in Canada, practicalities and policy barriers prevent an SDM from obtaining an SMO without support from healthcare providers; moreover, in a majority of these cases the SDM will require the facilitation of a physician who is often the same individual with whom they are in conflict. Institutional and a national society's policy statements propose SMOs as an important component of a conflict resolution process for end-of-life disputes (Bosslet et al. 2015; Singer et al. 2001). However, these policies do not provide specific guidance to physicians on how to fairly consider SMO requests. Given the vulnerable position of patients and their SDMs in the critical care context and in order to promote fairness, physicians should apply consistent standards in deciding whether to facilitate a request for an SMO. To guide physicians' decision-making and inform future policy development, we propose three ethical principles for considering SDM requests for an SMO in critical care at the end of life.
      PubDate: Mon, 31 Jul 2017 04:00:00 +000
       
  • A Survey of Hospital Ethics Structures in Ontario
    • Abstract: In response to the growing recognition of the prevalence of ethical issues in clinical care, hospitals in Canada began forming ethics committees in the 1980s. Studies showed significant growth in the prevalence of ethics committees over the ensuing decade. Although the limited studies available suggest that ethics committees have become very prevalent in Canadian hospitals, hospital ethics services have evolved in recent years to include a wider range of structures. In some cases, these structures may work in conjunction with an ethics committee, but in other cases they may replace ethics committees. They include on-staff ethicists, external ethics consultants, "hub-and-spokes" structures and regional ethics programs. What is not known, however, is how prevalent these other structures are and whether ethics committees continue to function as the main delivery mechanism for ethics services in Canadian hospitals. This paper reports on the results of a survey of hospitals in Ontario to answer those questions.
      PubDate: Mon, 31 Jul 2017 04:00:00 +000
       
  • Persistent and Non-Persistent High-users of Acute Care Resources: A Deeper
           Dive into the Patient and System Factors
    • Abstract: A small population of patients are responsible for the majority of Ontario's acute healthcare costs – high-users of acute care. At our institution, high-users were divided into those who persisted in their high use across more than six months and those who did not. Persistent users were more likely to live alone, have more than three comorbidities, take more than five medications and be admitted for chronic diseases. In a survey of their family physicians, 58% believed no interventions could have prevented readmissions; however, useful strategies such as patient education, surgical rapid access clinics and increased mental health supports were proposed.
      PubDate: Mon, 31 Jul 2017 04:00:00 +000
       
  • Six Change Ideas that Significantly Minimize Alternative Level of Care
           (ALC) Days in Acute Care Hospitals
    • Abstract: A significant issue affecting the healthcare system across Ontario is the number of patients admitted to hospitals that are then subsequently being designated alternate level of care (ALC). In 2016, 14.5% of Ontario in-patient beds were occupied by ALC-designated patients. Contributing to this phenomenon are ethical errors that can affect decision-making around discharge. Since 2012, William Osler Health System has redesigned their discharge process to eliminate ethical errors and align more fully with the Health Care Consent Act (HCCA) and the Public Hospitals Act (PHA). Through quality improvement processes including the use of scripting, education, checklists, mentoring and role clarity, Osler's ALC days are currently the lowest in the province of Ontario. The elimination of such errors also decreased patient confusion and improved the discharge experience.
      PubDate: Mon, 31 Jul 2017 04:00:00 +000
       
  • Leading Practices in Alternate Levels of Care (ALC) Avoidance: A
           Standardized Approach
    • Abstract: Providers across the healthcare system want to provide the right care, in the right place, in a timely manner. Patients listed as alternate level of care (ALC) are often not in the right place to receive the necessary care. In 2014, using a standardized approach, the Toronto Central Community Care Access Centre (CCAC), now Toronto Central Local Health Integration Network (LHIN), set out to reduce the number of ALC beds in hospitals to ensure that more people received the most appropriate level and type of care. Case studies cited in this article will highlight the successes that CCAC and its various partners have realized in developing and implementing strategies.
      PubDate: Mon, 31 Jul 2017 04:00:00 +000
       
  • Conserving Quality of Life through Community Paramedics
    • Abstract: The Economic Value of Community Paramedicine Programs Study was a randomized controlled trial in two Eastern Ontario communities – one urban and one rural – to determine whether community paramedicine services (the intervention through home visits) would have a positive economic impact through influencing self-perceived quality of life and determining a monetized value. A total of 200 clients who were high-users of healthcare services and had one or more of five chronic diseases (congestive heart failure, chronic obstructive pulmonary disease, hypertension, stroke and diabetes) were recruited in early 2015. These participants were randomly assigned to either the intervention group (receiving community paramedicine services for 12 months) or the control group (receiving conventional treatment). Study results suggest that although quality of life scores decreased for all groups, those receiving community paramedicine services demonstrated significantly less reduction in their scores. Suggestions to further increase cost efficiency of this novel service are given.
      PubDate: Mon, 31 Jul 2017 04:00:00 +000
       
  • Medication Incidents Involving Antiepileptic Drugs in Canadian Hospitals:
           A Multi-Incident Analysis
    • Abstract: Medication errors involving antiepileptic drugs (AEDs) are not well studied but have the potential to cause significant harm. We investigated the occurrence of medication incidents in Canadian hospitals that involve AEDs, their severity and contributing factors by analyzing data from two national databases. Our multi-incident analysis revealed that while medication errors were rarely fatal, errors do occur of which some are serious. Medication incidents were most commonly caused by dose omissions, the dose or its frequency being incorrect and the wrong AED being given. Our analysis could augment quality-improvement initiatives by medication safety administrators to reduce AED medication incidents in hospitals.
      PubDate: Mon, 31 Jul 2017 04:00:00 +000
       
  • Sustainable Benefits of a Community Hospital-based Pediatric Asthma Clinic
    • Abstract: In 2011, we reported that our paediatric asthma clinic (PAC) appeared to significantly reduce the burden of paediatric asthma in our community. Supported by these results, the PAC underwent a gradual threefold expansion while maintaining the same model of care. We now report on the outcome of that expansion and demonstrate that our PAC continues to significantly reduce the burden of paediatric asthma in our community. As previously, newly enrolled PAC patients continue to show a 12-month reduction in asthma-related emergency department (ED) visits and admissions exceeding 60% and 80%, respectively. This consistent short-term benefit, coupled with clinic expansion, has contributed to a significant improvement in our rate of paediatric asthma-related ED visits or hospitalizations when compared to other Ontario hospitals.
      PubDate: Mon, 31 Jul 2017 04:00:00 +000
       
  • Strategic Change in Surgical Quality Improvement: The Ottawa Hospital
           Comprehensive Unit-Based Safety Program Experience
    • Abstract: Strategic change principles are widely cited in business and healthcare management literature, but not in the surgical quality improvement literature despite the need for effective change management skills to successfully enable quality improvement projects. The Ottawa Hospital (TOH) Comprehensive Unit-Based Safety Program (CUSP) model within the Division of General Surgery applied strategic change management principles to support the development and implementation of surgical quality improvement initiatives. Using the TOH CUSP experience, we aim to provide insight and a practical example for surgeons seeking to drive quality improvement within their practice environment.
      PubDate: Mon, 31 Jul 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: Patient safety is a topic that is top of mind for the vast majority of healthcare providers, policy-makers and, increasingly, care recipients themselves. In this final 2013 instalment of Healthcare Quarterly, we bring you a cluster of five articles that shed light on patient safety in a variety of forms and locations. In addition, you will find three individual articles on care funding, information management and evaluating mental health services.
      PubDate: Wed, 30 Oct 2013 04:00:00 +000
       
  • Psychological Health and Safety in Canadian Healthcare Settings
    • Abstract: Psychological health and safety are growing priorities in Canadian workplaces, including Canadian healthcare settings. The workplace has a key role to play in promoting mental health. The Canadian Healthcare Association recently adopted a position statement strongly encouraging members and all health stakeholders to adopt and take action to implement the new voluntary standard, outlined in Psychological Health and Safety in the Workplace.
      PubDate: Wed, 30 Oct 2013 04:00:00 +000
       
  • Medication Reconciliation: A Prescription for Safer Care
    • Abstract: Four national healthcare organizations – Accreditation Canada, the Canadian Institute for Health Information, the Canadian Patient Safety Institute and the Institute for Safe Medication Practices Canada – recently collaborated to better understand and share comprehensive information about medication reconciliation in Canada. This article summarizes the key findings of their joint report titled Medication Reconciliation in Canada: Raising the Bar and profiles innovative approaches and tools for healthcare organizations across Canada.
      PubDate: Wed, 30 Oct 2013 04:00:00 +000
       
  • Diabetes in Visible Minority Populations in Ontario
    • Abstract: Most published data on ethnic variations in diabetes care and outcomes come from the United States, and their generalizability to inform clinical care and policy making in Canada is limited. As a result, the Institute for Clinical Evaluative Sciences (ICES) has conducted several studies examining the burden of diabetes for and the quality of care received by visible minority populations in Ontario compared with the general population.
      PubDate: Wed, 30 Oct 2013 04:00:00 +000
       
  • In Conversation with Janet Davidson
    • Abstract: You know when Janet Davidson is in the room. A nationally renowned health executive with more than 30 years of experience in government, voluntary, hospital and community sectors in Alberta, Ontario, Saskatchewan, Manitoba and British Columbia, she recently did two remarkable things: left the C-suite to become a global consultant in healthcare, and returned to Alberta when that province called earlier this year. With a long list of credentials and experiences, and the gratitude of a country as officer of the Order of Canada in 2006, Davidson and her resume are, quite possibly, peerless.When she assumed her role as official administrator of Alberta Health Services (AHS), Davidson was the Canadian Executive of KPMG's Global Healthcare Centre of Excellence. Prior to that, she was president and chief executive of Trillium Health Centre in Mississauga where, with a merger with the Credit Valley Hospital, she helped create the largest community academic hospital in Canada. She is presently a member of board of directors for the Canadian Institute for Health Information (CIHI) and serves as the chair of the CIHI Board's Governance Committee. Until recently, Davidson was a member of the board of the Ontario Institute for Cancer Research, and she is the immediate past chair of the Ontario Hospital Association.Ken Tremblay interviewed her early this fall. Days later, Davidson was appointed as deputy minister of Health for Alberta.
      PubDate: Wed, 30 Oct 2013 04:00:00 +000
       
  • Safety for All: Bringing Together Patient and Employee Safety
    • Abstract: The safety of patients and of employees in healthcare have historically been separately managed and regulated. Despite efforts to reduce injury rates for employees and adverse events for patients, healthcare organizations continue to see less-than-optimal outcomes in both domains. This article challenges readers to consider how the traditional siloed approach to patient and employee safety can lead to duplication of effort, confusion, missed opportunities and unintended consequences. The authors propose that only through integrating patient and employee safety activities and challenging the paradigms that juxtapose the two will healthcare organizations experience sustained and improved safety practice and outcomes.
      PubDate: Wed, 30 Oct 2013 04:00:00 +000
       
  • Engaging Patients and Family Members in Better Hand Hygiene Practices: A
           Teaching Hospital’s Challenge
    • Abstract: It is universally agreed that healthcare workers need to wash their hands in order to help control the spread of hospital-acquired infections. However, we have to be mindful that patients and family members are a significant part of the contamination equation as well. This article details the efforts by University Health Network (UHN) to develop hand hygiene resources for use with patients and family members at all of UHN's sites.
      PubDate: Wed, 30 Oct 2013 04:00:00 +000
       
  • Medication Reconciliation: The Priority That Isn’t
    • Abstract: Medication reconciliation is a crucial step in safe care, but it is often done inconsistently or inadequately, or missed altogether. This can be dangerous and even deadly for patients, and expensive for the system. In this article, the authors discuss the current status of medication reconciliation in Canada, barriers to its implementation and steps healthcare organizations across the country are taking to introduce medication reconciliation. They conclude by outlining ways that provincial and territorial governments could re-energize work on medication reconciliation.
      PubDate: Wed, 30 Oct 2013 04:00:00 +000
       
  • Measuring Quality at a System Level: An Impossible Task' The Toronto
           Central LHIN Experience
    • Abstract: Quality is being measured and reported across healthcare organizations and sectors, but efforts are rarely made to connect the activity in one organization to quality experienced by patients and clients in another part of the healthcare system. This article describes one regional health organization's journey to measuring health quality at a system level. The authors describe a highly consultative and iterative process used to measure quality across the continuum of care, and the challenges experienced in approaching this type of measurement, and they highlight some of the early findings.
      PubDate: Wed, 30 Oct 2013 04:00:00 +000
       
  • Managing Access and Flow through Appropriate Discharge: Preventing Common
           Errors and Improving Processes
    • Abstract: Increased pressure on acute care hospitals to move patients seamlessly through the healthcare system has resulted in more attention to the process of discharging patients, particularly seniors, from hospitals. When alignment with the Health Care Consent Act is lacking, errors can occur in the process. Examples of mistakes by healthcare professionals include these: taking direction from the wrong substitute decision-maker (SDM); taking direction from a family member when the patient is capable; allowing an SDM to make an advance directive on behalf of a patient; being aware of a known prior expressed wish but ignoring that wish when considering a placement plan; waiting for an SDM who is not available, willing and capable instead of proceeding down the hierarchy of decision-makers; or permitting families to propose discharge plans. Such errors have the potential to compromise quality of care, but they also work to prevent timely and appropriate discharge. In order to minimize these common errors in the consent process for placements, we have proposed a checklist to help meet ethical and legal obligations in the discharge process. We suggest the checklist may minimize avoidable conflict and misunderstanding and promote a seamless discharge process.
      PubDate: Wed, 30 Oct 2013 04:00:00 +000
       
  • Activity-Based Funding Model Provides Foundation for Province-wide Best
           Practices in Renal Care
    • Abstract: British Columbia has a unique funding model for renal care in Canada. Patient care is delivered through six health authorities, while funding is administered by the Provincial Renal Agency using an activity-based funding model. The model allocates funding based on a schedule of costs for every element of renal care, excluding physician fees. Accountability, transparency of allocation and tracking of outcomes are key features that ensure successful implementation. The model supports province-wide best practices and equitable care and fosters innovation. Since its introduction, the outpatient renal services budget has grown less than the population, while maintaining or improving clinical outcomes.
      PubDate: Wed, 30 Oct 2013 04:00:00 +000
       
  • Evaluating the Adoption of E-prescribing in Primary Care
    • Abstract: The purpose of this study was to examine the adoption of e-prescribing by primary care physicians in Central Vancouver Island. To accomplish this, a multi-method study design was used to compare the ideal state of e-prescribing (desired e-prescribing features in an electronic medical record [EMR]) with the possible state (what the EMR offers) and current state (what physicians are using in practice).The authors found that recruited physicians are using most of the e-prescribing and EMR features available. However, there are several gaps between the ideal, possible and current states of e-prescribing. The authors address the identified gaps through physician-level, policy-related and technology-related recommendations to improve the adoption, design and development of e-prescribing features.
      PubDate: Wed, 30 Oct 2013 04:00:00 +000
       
  • Pilot Testing of a Questionnaire for the Evaluation of Mental Health
           Services in Family Health Team Clinics in Ontario
    • Abstract: Family health teams (FHTs), regarded today as a premier model of provision of primary care services in North America, were introduced in 2004 to improve traditionally fragmented primary healthcare in Ontario. Physicians and healthcare providers from various disciplines team up under the same roof in FHTs to provide and coordinate care and to ensure adequate access to and continuity of care. Because many Canadians with mental health problems consult family physicians in primary care, routine evaluation of the delivery of primary mental health care services in FHTs is becoming important.The authors' goal was to develop and test an evaluation tool (containing a questionnaire for patients and a questionnaire for providers) for mental health services provided in FHTs with a focus on accessibility, availability, quality, continuity of care and coordination of services. They developed and pilot tested an English-French tailored evaluation instrument in several FHTs in South East, Champlain and North East Local Health Integration Networks across Ontario. A convenience sample of English- and French-speaking healthcare providers and patients using mental health services was recruited. Provider and patient questionnaires were developed and pilot-tested with 12 providers and 10 clients. Patient reviewers rated the patient questionnaire consistently as "good" or "very good." Provider reviewers found the provider questionnaire to be important and timely and the questions to be adequate and interesting.This instrument evaluates, from both the patient and provider perspectives, whether mental health services are structured to meet expectations set for FHTs, and enables healthcare providers, administrators and policy makers to learn about the benefits and the deficiencies of mental health care delivered through these clinics. This instrument can also be used to enhance future research and evaluation of FHTs. Further validation effort will be required to establish its validity and reliability.
      PubDate: Wed, 30 Oct 2013 04:00:00 +000
       
  • Facts-at-a-Glance
    • Abstract: Facts-at-a-Glance
      PubDate: Wed, 30 Oct 2013 04:00:00 +000
       
  • Ross Baker Takes the Lead: Our New Editor-in-Chief
    • Abstract: Ross Baker Takes the Lead: Our New Editor-in-Chief
      PubDate: Thu, 18 Apr 2013 04:00:00 +000
       
  • Highlights of HealthAchieve 2012
    • Abstract: One of the largest and most prestigious healthcare gatherings in North America, HealthAchieve aims to inspire ideas and innovation with over 50 informative and engaging educational sessions along with its award-winning exhibit floor, where close to 300 exhibitors showcase the latest healthcare products, services and technologies.Download the PDF to view the highlights.
      PubDate: Thu, 18 Apr 2013 04:00:00 +000
       
  • Making Sense of Health Rankings
    • Abstract: In an era of increasingly complex medical care and escalating costs, healthcare decision-makers often rely on a broad range of indicators to gauge the health of a population, the quality of hospital care and the performance of healthcare systems. Reports that rank the health of Canadians and Canada's healthcare systems according to these indicators are widely cited in the media. These reports attempt to condense a complicated array of statistics into a relatively simple number, a rank that is used to make international and provincial comparisons. These reports have often been inconsistent. Unlike a familiar economic indicator – the gross domestic product (GDP), which represents a complex entity with a single number calculated according to an internationally agreed-upon methodology – rankings of health and healthcare are not yet standardized or well understood. This article aims to improve readers' understanding of ranking reports. It outlines the components and processes that underlie health rankings and explores why such rankings can be difficult to interpret.
      PubDate: Thu, 18 Apr 2013 04:00:00 +000
       
  • The Burden of Unhealthy Living in Ontario: The Impact of Smoking, Alcohol,
           Diet, Physical Inactivity and Stress on Life Expectancy
    • Abstract: The Burden of Unhealthy Living in Ontario: The Impact of Smoking, Alcohol, Diet, Physical Inactivity and Stress on Life Expectancy
      PubDate: Thu, 18 Apr 2013 04:00:00 +000
       
  • In Conversation with Chris Power
    • Abstract: Capital Health in Halifax, Nova Scotia, is that province's largest healthcare provider, operating nine hospitals and many health centres and community-based programs. With over 12,000 employees, physicians, learners and some 2,000 volunteers, Capital Health serves 400,000 people with an $800-plus million operating budget. It is also the hub for specialist services for the balance of the province and Atlantic Canada. At the helm as president and chief executive officer (CEO) since 2006 is Chris Power, a seasoned executive whose career has spanned 30 years, several provinces and a journey from front-line nursing to the C-suite. Named three times as one of Canada's Top 100 Most Powerful Women in the Public Sector, selected as one of Atlantic Canada's Top 50 CEOs and an award winner for excellence and innovation by her peers, Power offered her insights to HQ's Ken Tremblay earlier this year.
      PubDate: Thu, 18 Apr 2013 04:00:00 +000
       
  • Enhancing Quality and Safety Standards for Older People in Canadian
           Hospitals: A National Collaboration
    • Abstract: In this article, the authors present quality and safety standards for older people in hospital, derived from a national dialogue involving inter-professional experts, key stakeholders and opinion leaders. They report the consensus process and present the standard statements with corresponding operational definitions, along with relevant clinical topics. This work can serve as a platform for service planners, evaluators and policy makers who are endeavouring to ensure that older people receive quality care and service when admitted to a Canadian hospital.
      PubDate: Thu, 18 Apr 2013 04:00:00 +000
       
  • Partnership and Measurement: The Promise, Practice and Theory of a
           Successful Health Social Networking Strategy
    • Abstract: Patient health management (PHM) was launched as a promising paradigm to close care gaps, the inequities between usual and best care, for whole patient populations. PHM's core premise was that interventions of multidisciplinary, community-oriented partnerships that used repeated measurement and feedback of provider practices, clinical and economic outcomes and general communication of relevant health knowledge to all stakeholders would continuously make things better. This article reviews the evolution of PHM from its genesis in a series of casual hospital-based networks to its maturation in a province-wide, community-focused, clustered-lattice social network that facilitated the improved clinical and cost-efficient care and outcomes of whole patient populations. The factors underlying PHM's clinical and cost efficacy, specifically its patient-centric social networking structures and integral measurement and knowledge translation processes, offer continuing promise to optimally manage the care of our increasingly aged patient populations, with their high burden of chronic diseases and disproportionately large care gaps. In an era when patients are demanding and leading change, and governments are struggling fiscally, PHM's clinical efficacy and cost-efficiency are especially resonant. Things can be better.
      PubDate: Thu, 18 Apr 2013 04:00:00 +000
       
  • Developing an Institute of Medicine–Aligned Framework for
           Categorizing Primary Care Indicators for Quality Assessment
    • Abstract: The Institute of Medicine (IOM) framework has been used frequently to assess and monitor quality in secondary and tertiary care, but not in primary care. This article describes and proposes a conceptual framework for categorizing primary care indicators that align with the IOM's six aims for quality in healthcare performance (Safe, Effective, Patient-Centred, Timely, Efficient and Equitable.) Using an iterative process, the authors developed and compared a primary care framework for categorizing indicators in the Quality in Family Practice Book of Tools (QBT) with the IOM aims and other local healthcare systems frameworks (Integrated and Continuous, Appropriate Practice Resources). They also compared, cross-matched and analyzed their QBT categories and indicators with other international primary care assessment tools. And they compared the QBT titles and descriptions of groups of indicators with those published in the international tools.
      PubDate: Thu, 18 Apr 2013 04:00:00 +000
       
  • Facilitating Specialist to Primary Care Transfer with Tools for
           Transition: A Quality of Care Improvement Initiative for Patients with
           Type 2 Diabetes
    • Abstract: The epidemic of diabetes has increased pressure on the whole spectrum of the healthcare system including specialist centres. The authors' own specialist centre at The Ottawa Hospital has 20,000 annual visits for diabetes, 80% of which are follow-up visits. Since it is a tertiary facility, managers, administrators and clinicians would like to increase their ability to see newly referred patients and decrease the number of follow-up visits. In order to discharge appropriate diabetes patients, the authors decided it was essential to strengthen the transition process to decrease both the pressure on the centre and the risk for discontinuity of diabetes care after discharge.
      PubDate: Thu, 18 Apr 2013 04:00:00 +000
       
  • Integrated Care, Information Management and Information Technology in
           Canada: Have We Made Any Progress in the Past 12 Years?
    • Abstract: A dozen years ago, a seminal article was written by Leatt, Pink and Guerriere that boldly stated that Canada did not have integrated healthcare but, rather, a hodgepodge of disconnected parts! The article also stated categorically that Canadian regional health authorities could not provide comprehensive integrated care since they were not responsible for drugs dispensed from retail pharmacies or for medical care provided by physicians. Twelve years later, some progress toward integrated care has been made, though many would argue that it is both inadequate and disappointing – even if Canada's provincial health systems would like to integrate services across an ever-expanding continuum of care to better serve patients.
      PubDate: Thu, 18 Apr 2013 04:00:00 +000
       
  • Social Media in Healthcare: It's So Five Years Ago?
    • Abstract: Not so long ago (2007), sites such as Twitter were relatively free of "spambots" and robotic marketers promoting or demoting brands. Facebook was innocent and not in the business of collecting more than two billion "likes" every day and selling the data. It's a different world today. Five years ago, using social media to engage was innovative. Not so today. In fact, it is questionable that the return on investment of engagement using social media ever lived up to the hype. Despite much attention paid to the role of social media in the United States presidential campaigns of 2008 and 2012, the return on investment of social media in that context is dubious – that is, whether younger people voted in "record numbers" and this translated into a statistically meaningful upswing in voting for this demographic.
      PubDate: Thu, 18 Apr 2013 04:00:00 +000
       
  • Leadership, a Central Ingredient for a Successful Quality Agenda: A
           Qualitative Study of Canadian Leaders' Perspectives
    • Abstract: Quality and safety (QS) teams have emerged as one strategy to improve the quality of care and safety. This article aims to enhance understanding of, and identify implications for, leaders in implementing successful QS teams. Research findings from the authors' study that explored barriers and facilitators of Canadian QS teams highlight the need for delineated leadership and accountability, focused strategic plans, available data, dedicated resources and targeted messaging to engage staff and physicians. While top-down leadership strategies were predominantly reported, developing leaders at all organizational levels was acknowledged as key to sustaining a quality culture and advancing the quality agenda.
      PubDate: Thu, 18 Apr 2013 04:00:00 +000
       
  • Occupational Therapy: Cost-Effective Solutions for Changing Health System
           Needs
    • Abstract: Evidence shows occupational therapy interventions are cost-effective in treating or preventing injury and improving health outcomes in areas such as falls prevention, musculoskeletal injury, stroke rehabilitation, early intervention in developmental disabilities, respiratory rehabilitation and home care. Additional research indicates opportunities for occupational therapy to play an increased role in the management of health outcomes in complex and chronic diseases, pain management, non-pharmaceutical mental health interventions, dementia, end-of-life or palliative care and home care. This article aligns the discussion of health system transformation with literature identifying the cost-effectiveness of occupational therapy in Canada.
      PubDate: Thu, 18 Apr 2013 04:00:00 +000
       
  • Comparative Models of Cervical Cancer Screening in Manitoba
    • Abstract: The laboratory system in Manitoba for routine cervical screening is outdated and costly. We developed a costing framework for the implementation of new cervical cancer screening technology models. The direct healthcare costs in the baseline model, the conventional Papanicolaou smear test, were compared with estimates of two newer technology platforms, liquid-based cytology and human papillomavirus (HPV) testing. The findings revealed that HPV testing as a primary screening model for women aged 30 years and older represented the least-cost strategy. Liquid-based cytology would be used for routine screening of women under 30 years of age and to triage women 30 years and older whose results were HPV positive.
      PubDate: Thu, 18 Apr 2013 04:00:00 +000
       
  • Avoiding "Culture Rejection" in Healthcare Mergers and Acquisitions: How
           New Heights Community Health Centres and York Community Services Minimized
           the Culture Risk when Forming Unison Health and Community Services
    • Abstract: Among the requirements for a successful merger or acquisition are strategic rationale, rigorous due diligence, the right price and revenue and cost synergies. However, bridging the culture gap between organizations is frequently overlooked. The leaders of New Heights Community Health Centres and York Community Services explicitly considered culture in their merger to form Unison Health and Community Services, and they used employee engagement surveys to assess culture in their merger planning and post-merger integration. How Unison Health leaders avoided the risk of culture rejection to achieve a successful merger, and the lessons learned from their experience, is the focus of this article.
      PubDate: Thu, 18 Apr 2013 04:00:00 +000
       
  • Can This Care Be Provided at Home?
    • Abstract: "Can this care be provided at home?" This basic question is a powerful instrument for change in the healthcare system. The fundamental shift required for healthcare is from the current system, where home care is designed to accommodate and respond to pressures in acute care or long-term care, to a system where home care considerations actually drive practice. This article describes how a philosophical change accompanied by the measurement of "system shift indicators" can achieve the move to effective person-centred and home-based healthcare. By changing the approach and the measures for evaluating effectiveness, the health system changes sought by all jurisdictions across Canada and recommended by Drummond for Ontario will be sustainable.
      PubDate: Thu, 18 Apr 2013 04:00:00 +000
       
  • Canada's Health Workforce: A Snapshot
    • Abstract: Canada's Health Workforce: A Snapshot
      PubDate: Thu, 18 Apr 2013 04:00:00 +000
       
  • Editorial
    • Abstract: Editorial
      PubDate: Mon, 29 Oct 2012 04:00:00 +000
       
  • Gambling: A Unique Policy Challenge
    • Abstract: Over the past 15 years, provincial governments across Canada have consistently demonstrated their willingness to expand the availability of gambling (Campbell et al. 2010). Most recently, the Ontario Lottery and Gaming Corporation (OLG) unveiled expansion plans that included eliminating 17 slots-at-race track venues and replacing them with 29 casinos nested more closely to population centres. The singular driving force for expansion is government's quest for non-tax revenue, largely in response to an ideologically based disaffection for tax increases. The trade-off is that, without precedent, government becomes directly involved in providing an activity that knowingly harms the population it is elected to serve. This fact alone demands unique policy consideration in relation to how government implements and manages its gambling agenda (Smith and Rubenstein 2009). Using the current Ontario initiative as a case in point, this article explores several of these considerations.
      PubDate: Mon, 29 Oct 2012 04:00:00 +000
       
  • Quarterly Change
    • Abstract: Quarterly Change
      PubDate: Mon, 29 Oct 2012 04:00:00 +000
       
  • Medication Use among Canadian Seniors
    • Abstract: As they age, many seniors develop a progressively more complex mix of health conditions. Multiple prescription medications are often required to help manage these conditions and control symptoms, with the goal of maintaining seniors' health for as long as possible. This article explores trends in the number and types of medications used by seniors on public drug programs in Canada. Our findings suggest that a high proportion of Canadian seniors are taking several medications, highlighting the need for medication management systems focusing on this population.
      PubDate: Mon, 29 Oct 2012 04:00:00 +000
       
  • The Institute for Clinical Evaluative Sciences: 20 Years and Counting
    • Abstract: The Institute for Clinical Evaluative Sciences: 20 Years and Counting
      PubDate: Mon, 29 Oct 2012 04:00:00 +000
       
  • In Conversation with Howard Waldner
    • Abstract: Providing healthcare services to an island population is a bit different for the Vancouver Island Health Authority (VIHA). With unique geography and demographics, VIHA has its share of the usual healthcare challenges plus scale: 18,000 staff, 1,700 physicians across some 150 facilities and a budget of $1.8 billion.Not usual, though, is VIHA's differential success with chronic disease management, services close to home and senior care and its integrated network of facilities and people who really do work as a system, in every sense of the word. This performance comes as no surprise to Howard Waldner, VIHA's chief executive officer for the past eight years and its current president. Building on his early career in the United Kingdom and a stop in Calgary, Waldner offered his insights to HQ's Ken Tremblay earlier this year. 
      PubDate: Mon, 29 Oct 2012 04:00:00 +000
       
  • Taking the Pulse of Lean Healthcare
    • Abstract: Taking the Pulse of Lean Healthcare
      PubDate: Mon, 29 Oct 2012 04:00:00 +000
       
  • Alberta Health Services: Journey to Accreditation
    • Abstract: In October 2010, Alberta Health Services (AHS) successfully completed phase one of its journey to accreditation, meeting 683 of 774 criteria and earning Accreditation with Condition. AHS entered accreditation during its infancy (18 months, to be exact) in an environment shaped by seismic organizational and structural changes. In this article, the authors share some of the successes, challenges and ongoing opportunities that have emerged during the first years of AHS's accreditation journey, as well as details of the strong collaborative relationship between AHS and Accreditation Canada.
      PubDate: Mon, 29 Oct 2012 04:00:00 +000
       
  • Inter-professional Collaboration as a Health Human Resources Strategy:
           Moving Forward with a Western Provinces Research Agenda
    • Abstract: The current gap in research on inter-professional collaboration and health human resources outcomes is explored by the Western Canadian Interprofessional Health Collaborative (WCIHC). In a recent research planning workshop with the four western provinces, 82 stakeholders from various sectors including health, provincial governments, research and education engaged with WCIHC to consider aligning their respective research agendas relevant to inter-professional collaboration and health human resources. Key research recommendations from a recent knowledge synthesis on inter-professional collaboration and health human resources as well as current provincial health priorities framed the discussions at the workshop. This knowledge exchange has helped to consolidate a shared current understanding of inter-professional education and practice and health workforce planning and management among the participating stakeholders. Ultimately, through a focused research program, a well-aligned approach between sectors to finding health human resources solutions will result in sustainable health systems reform.
      PubDate: Mon, 29 Oct 2012 04:00:00 +000
       
  • An Extra-organizational Mentorship Pilot for Canadian Health Leaders
    • Abstract: There are two sectors in the Canadian health ecosystem: the public sector, composed of hospitals, and the private sector, consisting of suppliers of drugs and services; both are aimed at providing optimal patient care. Currently, both sectors are struggling with the uncertainty and unpredictability plaguing the health environment. A mentoring pilot was aimed at providing solutions for both sectors by strengthening leadership development and accelerating the relationships with organizations from the other sector. The extra-organizational mentoring program included people from Roche Canada (private sector) and hospitals (public sector) whose participants are members of the Canadian College of Health Leaders. An evaluation of the program demonstrated that it was a positive and productive leadership development process for the majority of participants. The mentoring pilot helped advance partnerships based on trust and respect across the two sectors. The pragmatic process and demonstrable success of the program have gained far-reaching attention, and the program has influenced the development of other mentorship initiatives. Extra-organizational mentoring should be encouraged and actively developed with other health organizations.
      PubDate: Mon, 29 Oct 2012 04:00:00 +000
       
  • Hospital-Legal Partnership at Toronto Hospital for Sick Children: The
           First Canadian Experience
    • Abstract: Operating a hospital-legal partnership on a pro bono basis positively impacts patients' families by providing legal assistance for non-medical issues that affect the health of their children and their ability to care for their children. This article describes a formative evaluation of the first hospital-legal partnership in Canada, established at The Hospital for Sick Children in Toronto in 2009, which was carried out through file reviews and interviews with staff, lawyers and family members. The early indications of success of this partnership suggest that its use as a template for similar programs at other Canadian healthcare institutions should be considered.
      PubDate: Mon, 29 Oct 2012 04:00:00 +000
       
  • Understanding the Patients' Perspective of Emotional Support to
           Significantly Improve Overall Patient Satisfaction
    • Abstract: This article presents the results of a research study that laid out important considerations for organizations to improve their patient satisfaction scores. It addresses a dimension of patient satisfaction that appears to garner little attention in healthcare contexts: emotional support. Though the literature strongly suggests that emotional support is correlated to overall patient satisfaction, few organizations have systematically attempted to understand the elements of outstanding emotional support. Research at a community teaching hospital in Ontario has shed light on the essential components of emotional support. In this article, a typology of emotional support is offered. With a better understanding of the components of emotional support, organizations may be able to undertake actions that could potentially improve patient satisfaction scores and, in turn, the overall quality of patient care.
      PubDate: Mon, 29 Oct 2012 04:00:00 +000
       
  • Are the Creation and Maintenance of Databases in Healthcare
           Worthwhile' An Example of a Unique, Population-Based, Radiation
           Therapy Database
    • Abstract: A population-based prospective database targeting 15 key radiation therapy (RT) features was initiated in British Columbia in 1984. This 25-year outcome report assessed the utility of the database and demonstrated that such a database can be used to (1) describe population-based utilization of a health service, (2) inform treatment policy recommendations, (3) inform system planning and resource allocation, (4) audit regional and individual oncology practices, (5) assess whether new observations from randomized trials have been translated into population health gains and (6) produce peer-reviewed publications. Health system managers and researchers could benefit from the development and support of such databases.
      PubDate: Mon, 29 Oct 2012 04:00:00 +000
       
  • Facts-at-a-Glance
    • Abstract: Facts-at-a-Glance
      PubDate: Mon, 29 Oct 2012 04:00:00 +000
       
  • Editorial
    • Abstract: Editorial
      PubDate: Mon, 10 Sep 2012 04:00:00 +000
       
  • Confessions of an MBA Grad: Life in the Real World
    • Abstract: It's a feeling we all remember: crossing the stage on graduation day. You were a somebody, and a new chapter of your life was about to begin. Your degree in hand, you headed to the real world to make your mark. For us, time has moved at warp speed since our MBA convocation in 2010, and this felt like an appropriate "anniversary" to reflect on our first two years as young MBAs working in healthcare.
      PubDate: Mon, 10 Sep 2012 04:00:00 +000
       
  • Old School Thinking Not the Answer to Economic Growth
    • Abstract: The economic slump that the Western world is in will last for a generation unless and until serious changes are made. While we have been through this scenario before, this time it's different. The economy is not expanding – it's flatlining – and the conventional solutions are doing little more than placing us in survival mode.
      PubDate: Mon, 10 Sep 2012 04:00:00 +000
       
  • Quarterly Change
    • Abstract: Quarterly Change
      PubDate: Mon, 10 Sep 2012 04:00:00 +000
       
  • All-Cause Readmission to Acute Care for Cancer Patients
    • Abstract: A recent Canadian Institute for Health Information report on all-cause readmission identified that cancer patients had higher-than-average readmission rates. This study provides further insight on the experience of cancer patients, exploring the risk factors associated with readmission at patient, hospital and community levels. An analysis showed that patient characteristics, including the reason for initial hospitalization, sex, co-morbidity levels, admission through the emergency department and the number of previous acute care admissions, were associated with readmission for cancer patients. In addition, we found that the readmission rate for these patients varied by hospital size and whether the patients lived in rural or urban locations.
      PubDate: Mon, 10 Sep 2012 04:00:00 +000
       
  • All the Right Intentions but Few of the Desired Results: Lessons on Access
           to Primary Care from Ontario's Patient Enrolment Models
    • Abstract: A strong primary care system is consistently associated with better and more equitable health outcomes, higher patient satisfaction and lower costs (Starfield et al. 2005). Access to primary care has proven to be challenging in Canada, leaving it behind many developed countries in timely access and after-hours care, and more dependent than most on the use of emergency departments (Schoen et al. 2007). Canadian jurisdictions have struggled with improving access to primary care, and many have made substantial reforms, the nature of which varies across the country (Hutchison et al. 2011). The common elements of reform include organizing physicians into groups with shared responsibilities, inter-professional teams, electronic health records, changes to physician reimbursement, incentive and bonus payments for certain services, after-hours coverage requirements, and telehealth and teletriage services.
      PubDate: Mon, 10 Sep 2012 04:00:00 +000
       
  • In Conversation with David Levine
    • Abstract: After 10 years at the helm of the Montreal Health Authority, David Levine, no stranger to the politics and challenges of leadership in healthcare, stepped out of the limelight to regroup. A seasoned leader, nationally recognized by peers as a thought leader, Levine's academic training started with civil and biomedical engineering. After his shift to healthcare, his career path included leadership at some of Canada's largest healthcare organizations. Amidst that journey, he served as Quebec's delegate general in New York City and tested the political waters at the provincial level. Never short of commentary and thoughts for improving healthcare in Canada, Levine shared his reflections with Ken Tremblay this past summer.
      PubDate: Mon, 10 Sep 2012 04:00:00 +000
       
  • Ethical Framework for Resource Allocation during a Drug Supply Shortage
    • Abstract: Drug supply shortages are common in health systems due to manufacturing and other delays. Frequently, shortages are successfully addressed through conservation and redistribution efforts, with limited impact on patient care. However, when Sandoz Canada Inc. announced in February 2012 that it was reducing production of a number of generic injectable drugs at its Quebec facility, the scope and magnitude of the drug supply shortage were unprecedented in Canada. The potential for an extreme scarcity of some drugs raised ethical concerns about patient care, including the need to limit access to some health services. In this article, the authors describe the development and implementation of an ethical framework to promote equitable access to drugs and healthcare services in the context of a drug supply shortage within and across health systems.
      PubDate: Mon, 10 Sep 2012 04:00:00 +000
       
  • Voluntary Versus Involuntary Waiting for Joint Replacements: New Alberta
           Wait Times Rules for Hip and Knee Arthroplasties, with Provincial
           Consensus
    • Abstract: Despite various health system improvements across Alberta, the wait times benchmark was not being met for all patients requiring hip or knee arthroplasty. Alberta Health Services Bone and Joint Clinical Network working groups, in collaboration with other provincial organizations, gained consensus on the development and implementation of a set of provincial Wait Times Rules. These rules standardize the definition and measurement of data elements specific to joint replacement and distinguish between voluntary (patient-related) versus involuntary (healthcare system–related) wait times. Collectively, this information will help identify trends in wait times and more accurately show where wait times can be reduced.
      PubDate: Mon, 10 Sep 2012 04:00:00 +000
       
  • Sustaining Walk-In Counselling Services
    • Abstract: Introducing single-session walk-in counselling services in a counselling agency virtually eliminated a lengthy wait list and reduced costly no-shows for scheduled counselling. A pilot study found that client distress decreased significantly following the single session, and a high proportion of clients were "ready for change." The service diverts clients from using hospitals and family doctors/walk-in clinics and toward using community social services. It also enables an earlier return to work and usual activities. The social benefits (reduced hospital use and faster return to work) exceed the cost of the service. This information is helping to make the case for sustaining and expanding these services.
      PubDate: Mon, 10 Sep 2012 04:00:00 +000
       
  • Developing a Physician Engagement Agreement at The Ottawa Hospital: A
           Collaborative Approach
    • Abstract: The Ottawa Hospital (TOH) is focused on providing safe, high-quality care to its patients. TOH has identified physician engagement as a critical factor for improving the quality of care they provide. The physician engagement strategy developed at TOH involved a qualitative inquiry into the impediments and facilitators of engagement. Using concurrent focus groups, researchers collected and analyzed the physicians' perspective regarding engagement. A systematic analysis of the verbal data was used to construct a statement of mutual understanding between the physicians and the hospital (physician engagement agreement). The process of developing this agreement is the focus of this article.
      PubDate: Mon, 10 Sep 2012 04:00:00 +000
       
  • Engaging Instincts to Improve Leadership Performance: A Case Study
    • Abstract: A massive cultural shift in how we work as individuals and teams is taking place. Organizational change and innovation are being driven by widespread global collaboration through social media. With instant access to knowledge and research via the Internet, expertise equated with the holding of information is no longer imbued with prestige and power in the way it once was. This creates a major challenge for leaders; people don't just follow because a leader says so. A leader is valued not so much for being an expert in his or her field but, rather, for his or her ability to inspire, engage and motivate people to take action in service to the objectives of an organization.
      PubDate: Mon, 10 Sep 2012 04:00:00 +000
       
  • Patient Satisfaction after the Redesign of a Chemotherapy Booking Process
    • Abstract: Cancer and chemotherapy can be physically and emotionally challenging for patients and their families (American Cancer Society 2011), a situation that can be worsened by uncertainty about appointment times when patients are placed on a waiting list. Patients frequently need to coordinate transportation, the intake of pre-treatment drugs and travel plans when living in more distant locations. Ambiguity in appointment times is certainly problematic and negatively affects the patient experience. This uncertainty in dates and times of chemotherapy results in a lack of control and a loss of normalcy to life that compounds the quality-of-life impairment associated with the chemotherapy itself (Redeker et al. 2000).
      PubDate: Mon, 10 Sep 2012 04:00:00 +000
       
  • Collateral Impact of a Hospital Outbreak of Clostridium difficile: An
           Unrecognized Surge Event Requiring a System-Level Response
    • Abstract: This paper discusses a unique surge event caused by an outbreak of Clostridium difficile, resulting not from an increase in the demands on the healthcare system but, rather, from a substantial decrease in the capacity to provide care when the medical capacity in the facility was decreased by 50% due to bed closures. Approaches to managing the situation using the staff, stuff and space paradigm are presented as strategies to prevent future adverse medical events.
      PubDate: Mon, 10 Sep 2012 04:00:00 +000
       
  • Facts-at-a-Glance
    • Abstract: Facts-at-a-Glance
      PubDate: Mon, 10 Sep 2012 04:00:00 +000
       
  • How Long Can We Enjoy B-Player Status'
    • Abstract: In the recent edition of Healthcare Papers (http://www.longwoods.com/publications/healthcarepapers/22856, Sutherland and colleagues reflect on their experiences developing a pan-Canadian picture of quality measurement (Sutherland and Leatherman 2010). Their review points out shortcomings, gaps and variations in how we measure and report on the performance of our healthcare system. The picture is not good. It is no better when we consider what the actual data say about the health system performance in Canada. On the basis of this chartbook – which is a useful compendium of quality data from multiple sources – one of us (T.S.) made this case clearly at the Canadian Health Services Research Foundation (CHSRF) CEO Forum in 2010: Canada gets a B grade. In the commentaries that follow, several authors raise – and seem to accept – this B grade.
      PubDate: Fri, 08 Jun 2012 04:00:00 +000
       
  • Quarterly Change
    • Abstract: Quarterly Change
      PubDate: Fri, 08 Jun 2012 04:00:00 +000
       
  • New Mental Health Indicators Provide a Snapshot on Performance of the
           Mental Health System in Canada
    • Abstract: Although the general hospital remains an important place for stabilizing crises, most services for mental illnesses are provided in outpatient/community settings. In the absence of comprehensive data at the community level, data that are routinely collected from general hospitals can provide insights on the performance of mental health services for people living with mental illness or poor mental health. This article describes three new indicators that provide a snapshot on the performance of the mental health system in Canada: self-injury hospitalization rate, 30-day readmission rate for mental illness and percentage of patients with repeat hospitalizations for mental illness. Findings suggest a need for the early detection and treatment of mental illnesses and for optimal transitions between general hospitals and community services.
      PubDate: Fri, 08 Jun 2012 04:00:00 +000
       
  • Do Women Experience the Same Benefits as Men from Implantable Cardioverter
           Defibrillators'
    • Abstract: Do Women Experience the Same Benefits as Men from Implantable Cardioverter Defibrillators'
      PubDate: Fri, 08 Jun 2012 04:00:00 +000
       
  • Data Data Everywhere; But Researchers Dare to Drink
    • Abstract: Data, data everywhere, yet nothing but a gripe. Gripe – characterized by academic chauvinism and pre-Internet era thinking – has been the chorus of some outspoken lawyers and ethicists, government officials and researchers who are terrified of the Big Brother of "Big Data" (Seeman 2012). To be fair, there are legitimate concerns about data mining, in particular the harnessing of data for secondary purposes to improve Canada's healthcare system. It is to this end that Colleen Flood, Canada research chair in health law and policy and editor of Data Data Everywhere, has assembled a sterling group of thought leaders to debate whether folks closer to my way of thinking ("data-access absolutists") or, on the other side (the camp I call the "data-access restrictionists") need to be more nuanced.
      PubDate: Fri, 08 Jun 2012 04:00:00 +000
       
  • In Conversation with Gord Gilman
    • Abstract: In 2008, the New Brunswick government created FacilicorpNB, a separately incorporated public sector company (shared services organization, or SSO) with a mandate to deliver, manage and bring innovative solutions to the supply chain, information technology (IT) and telecommunications, clinical engineering, financial transactions, energy retrofit programs and linen and laundry services for the province's regional health authorities (RHAs). At the helm is Gord Gilman, its inaugural chief executive officer (CEO), its president, and a former assistant deputy minister of health as well as a seasoned public sector executive. Within two years, the 730 employees of FacilicorpNB had generated just under $8 million in annual savings for the government, with a view to becoming self-sustaining. Ken Tremblay spoke with Gord this past fall.
      PubDate: Fri, 08 Jun 2012 04:00:00 +000
       
  • How Employee Engagement Matters for Hospital Performance
    • Abstract: Managers increasingly understand that employee engagement is a prerequisite for high performance. This article examines how job, work environment, management and organizational factors influence levels of engagement among healthcare employees. Original data come from the Ontario Hospital Association–NRC Picker Employee Experience Survey, involving over 10,000 employees in 16 Ontario hospitals. The article provides a clear definition and measure of engagement relevant to healthcare. In addition to identifying the main drivers of engagement, findings shows that a high level of employee engagement is related to retention, patient-centred care, patient safety culture and employees' positive assessments of the quality of care or services provided by their team. Implications of these findings for healthcare leaders are briefly considered.
      PubDate: Fri, 08 Jun 2012 04:00:00 +000
       
  • Citizen Perspectives on the Future of Healthcare
    • Abstract: The Citizen's Reference Panel was created to engage the people of Ontario in a dialogue about the directions for the future sustainability of healthcare. The primary concerns raised during the course of the panellists' deliberations included the need to (1) create a much closer integration of the health system's many providers and institutions, (2) accelerate the deployment of e-health solutions across the health system and (3) continue to focus on improving access to care, especially primary care and expanded community care services to reduce the pressure on institutional care.
      PubDate: Fri, 08 Jun 2012 04:00:00 +000
       
  • Implementing Practice Management Strategies to Improve Patient Care: THE
           EPIC PROJECT
    • Abstract: Healthcare gaps, the difference between usual care and best care, are evident in Canada, particularly with respect to our aging, ailing population. Primary care practitioners are challenged to identify, prevent and close care gaps in their practice environment given the competing demands of informed, litigious patients with complex medical needs, ever-evolving scientific evidence with new treatment recommendations across many disciplines and an enhanced emphasis on quality and accountability in healthcare. Patient-centred health and disease management partnerships using measurement, feedback and communication of practice patterns and outcomes have been shown to narrow care gaps. Practice management strategies such as the use of patient registries and recall systems have also been used to help practitioners better understand, follow and proactively manage populations of patients in their practice. The Enhancing Practice to Improve Care project was initiated to determine the impact of a patient-centred health and disease management partnership using practice management strategies to improve patient care and outcomes for patients with chronic kidney disease (CKD). Forty-four general practices from four regions of British Columbia participated and, indeed, demonstrated that care and outcomes for patients with CKD could be improved via the implementation of practice management strategies in a patient-centred partnership measurement model of health and disease management.
      PubDate: Fri, 08 Jun 2012 04:00:00 +000
       
  • Economic Impact of Delays in Listing Decisions by Provincial Drug Plans
           after a Positive Common Drug Review Recommendation: The Case of a
           Smoking-Cessation Treatment
    • Abstract: Although varenicline (Champix), a smoking-cessation treatment, was recommended for listing by the Common Drug Review (CDR) in 2007, only one CDR-participating drug insurance plan listed it in March 2011 (Saskatchewan). This study estimated the economic impact of delays in the public listing of varenicline in Canada. Using statistical data and peer-reviewed research, social costs and benefits of reimbursing varenicline were estimated. Flows of attempted and successful quitters were projected over a five-year period for three scenarios: immediate listing (2007), one- to four-year listing delays, and no reimbursement. Benefits of public reimbursement of varenicline would have been greatest in the first year ($271 million) and then decreased due to the erosion in smoking prevalence. The current three-year listing delay prevented a projected 17,729 current smokers from quitting, translating into a projected additional lifetime social burden of $700 million. The sizeable opportunity cost of delaying varenicline reimbursement implies broader economic issues for policy makers.
      PubDate: Fri, 08 Jun 2012 04:00:00 +000
       
  • Service Guidelines Based on Resource Utilization Groups Version III for
           Home Care Provide Decision-Making Support for Case Managers
    • Abstract: Increasing costs and budget reductions combined with increasing demand from our growing, aging population support the need to ensure that the scarce resources allocated to home care clients match client needs. This article details how Integrated Home Care for the Calgary Zone of Alberta Health Services considered ethical and economic principles and used data from the Resident Assessment Instrument for Home Care (RAI-HC) and case mix indices from the Resource Utilization Groups Version III for Home Care (RUG-III/HC) to formulate service guidelines. These explicit service guidelines formalize and support individual resource allocation decisions made by case managers and provide a consistent and transparent method of allocating limited resources.
      PubDate: Fri, 08 Jun 2012 04:00:00 +000
       
  • Treatment of End-Stage Organ Failure in Canada
    • Abstract: Treatment of End-Stage Organ Failure in Canada
      PubDate: Fri, 08 Jun 2012 04:00:00 +000
       
  • The Case for an Online Graduate Institute for Chronic Disease Management
           and Prevention
    • Abstract: This article advocates a Canadian online graduate institute for chronic disease management and prevention focused on inter-professional education (IPE) and inter-professional collaboration. Such an institute, with courses offered online, would attract both students and faculty and would help to break down disciplinary barriers. Delivering the education in an online format would eliminate the high capital requirements for infrastructure while opening up the program to potential students across Canada and internationally. Aspiring healthcare practitioners could, together with both patients and other professionals, learn about effective prevention and care of chronic diseases – an increasingly large component of Canada's fiscally challenged healthcare system. By wresting chronic care education out of traditional programs (such as medicine, nursing, social work, occupational therapy, physiotherapy and psychology) housed in traditional universities, the institute would serve an important need and foster true inter-professional care and collaboration. The goal of such an institute would be to improve upon and deliver the best and most effective, collaborative IPE online in a focused institute of higher education whose sole aim would be to address chronic diseases, one of the most costly public health issues facing society today. Our proposed model is based on a case study of the province of Ontario.
      PubDate: Sun, 08 Apr 2012 04:00:00 +000
       
  • Editorial
    • Abstract: "It is now time to set goals for better quality." So say Adalsteinn Brown and Terrence Sullivan in their short, impassioned opinion piece included in this issue of Healthcare Quarterly. Notwithstanding the laborious complexity of achieving an A-player healthcare system for Canada, the seven essays gathered here offer several insights and avenues necessary for such transformation.
      PubDate: Mon, 02 Apr 2012 04:00:00 +000
       
  • Promoting Quality Improvement in Long-Term Care: A multi-site
           collaboration to improve outcomes with pneumonia, falls, bacteriuria and
           behavioural issues in dementia
    • Abstract: The Bridges to Care for Long-Term Care research project aimed to facilitate improvements in outcomes for long-term care residents through the provision of knowledge-to-practice and quality improvement resources by trained facilitators. Point-of-care staff reported improved communication and collaboration, improved use of scope of practice and implementation of best practice knowledge. Overall, participating long-term care homes demonstrated an enhanced capacity for common care issues of the elderly (pneumonia, falls, bacteriuria and behavioural and psychological symptoms of dementia) and the ability to effectively engage in quality improvement processes with efficient and effective use of healthcare resources.
      PubDate: Mon, 02 Apr 2012 04:00:00 +000
       
  • Editorial
    • Abstract: Last night, President Barack Obama delivered his 2012 State of the Union address. While I know the man has his hands full combating deficits and Republicans, what a difference a year makes: hardly a word crossed his lips about the future of healthcare.
      PubDate: Thu, 16 Feb 2012 05:00:00 +000
       
  • Asking the Unaskable – Thinking the Unthinkable
    • Abstract: Posing questions and critically examining the current state of affairs across the spectrum are essential to large-scale quality improvement. The questions we are about to pose are not intended to be gratuitously provocative; they must be addressed to get an accurate assessment of where the system is gridlocked, which interests are aligned or misaligned with a quality agenda and what measures must be taken to move forward. Moreover, the great majority of the questions will come as no surprise to those experienced with the system's dynamics and frustrated by the inability to act.
      PubDate: Thu, 16 Feb 2012 05:00:00 +000
       
  • Quarterly Change
    • Abstract: Quarterly Change
      PubDate: Thu, 16 Feb 2012 05:00:00 +000
       
  • Points of Interest
    • Abstract: Points of Interest
      PubDate: Thu, 16 Feb 2012 05:00:00 +000
       
  • Re-imagining Healthcare: The Northwest Territories Transitions to an
           Integrated Chronic Disease Management Strategy
    • Abstract: With the goal to improve healthcare services and delivery, Stanton Territorial Hospital in the Northwest Territories (NWT) invited the Canadian Health Services Research Foundation (CHSRF) to explore opportunities to collaborate in the redesign and improvement of the health system. This article describes the NWT's efforts to transform its healthcare delivery to more appropriately care for people living with chronic diseases. It also sets the context for the initial meeting between the NWT and CHSRF and the collaborative journey that continues, with the bringing together of 40 health system managers, policy makers and clinicians, along with CHSRF staff and guest faculty, with a shared vision to redesign care to better meet the needs of people living with chronic diseases in the territory.
      PubDate: Thu, 16 Feb 2012 05:00:00 +000
       
  • Cardiac Care Quality Indicators: A New Hospital-Level Quality Improvement
           Initiative for Cardiac Care in Canada
    • Abstract: Health system stakeholders at different levels are focused more than ever on improvements to quality of care. With heart disease continuing to be a top health issue for Canadians, quality improvement initiatives aimed at improving cardiac care are increasingly important. The Cardiac Care Quality Indicators are one such initiative, with the goal of supporting cardiac care centres in their quality improvement efforts by providing comparable facility-level information on a number of cardiac quality outcome indicators. Working together, the Canadian Institute for Health Information and the Cardiac Care Network of Ontario completed the pilot project for this initiative in Ontario and British Columbia in 2010. Based on the success of the pilot, a national expansion of the initiative is currently under way. This article details some of the processes that led to the success of the project and presents some high-level, de-identified results.
      PubDate: Thu, 16 Feb 2012 05:00:00 +000
       
  • Triage: The Unifying First Step of All Emergency Department Care
    • Abstract: Triage: The Unifying First Step of All Emergency Department Care
      PubDate: Thu, 16 Feb 2012 05:00:00 +000
       
  • In Conversation with Tom Closson
    • Abstract: Tom Closson's early career includes deep roots in industrial engineering, with meritorious service and induction into the Engineering Hall of Distinction at the University of Toronto. After Closson received his MBA from York University, his career spanned a national consulting practice, many governance roles with national agencies and corporations, leadership with some of Canada's largest academic facilities, including a regional health authority in British Columbia and, since 2008, president and chief executive officer (CEO) of the Ontario Hospital Association. Earlier this year, Closson announced his retirement plans. For Canada, his departure from the corner office leaves a big leadership gap in healthcare as many see Closson as a strong proponent of health system transformation and the evolving role of hospitals. Ken Tremblay spoke with Closson this winter.
      PubDate: Thu, 16 Feb 2012 05:00:00 +000
       
  • Role of Performance Measurement in a Major Redevelopment Project: The Case
           of the McGill University Health Centre Transition Support Office
    • Abstract: Healthcare is currently in the midst of a construction boom. An increasing number of hospitals are being constructed using the principles of evidence-based design to improve the quality and safety of patient care while at the same maximizing efficiency. As the McGill University Health Centre embarks on a redevelopment journey, performance measurement has been deemed to be a key requirement for monitoring progress toward established objectives. This article discusses the role played by performance measurement in supporting the redevelopment project. Specifically, the importance given to performance measurement, the need for a performance evaluation framework, a description of the framework and the measurement process are presented.
      PubDate: Thu, 16 Feb 2012 05:00:00 +000
       
  • Hospital on a Page: Standardizing Data Presentation to Drive Quality
           Improvement
    • Abstract: Over the past five years, the Credit Valley Hospital (CVH) invested time and financial and human resources into performance measurement systems. In doing so, CVH launched a number of data tools including electronic scorecards and dashboards. However, the processes and accountability structures associated with the tools struggled to gain credibility with clinical and administrative leadership as the performance measurement system was primarily driven by the technology rather than a sound information strategy. Although a corporate-level scorecard was regularly updated, program-related scorecards and other measurement tools were only populated when programs reported to the board, at the time of accreditation or as a result of regulatory requirements. In addition, information contained in data reports was often presented in a manner that did not engage clinical and corporate decision-makers in the key issues of quality, access and sustainability.Following the release of its new strategic plan in 2009, CVH renewed its performance measurement framework and the methods by which it presented data so that the organization's strategic plan could be implemented and measured from the boardroom to the bedside. Long, complex spreadsheets were transformed into strategically designed, easy-to-understand, easy-to-access reports released in a standardized method in terms of format, media, content and timing. The following article describes the method CVH adopted to communicate the organization's performance and the role it played in enhancing the culture of quality and patient safety within the hospital.
      PubDate: Thu, 16 Feb 2012 05:00:00 +000
       
  • Healthcare Cost Containment and Integration of Care in the United States:
           Implications at the Local Level
    • Abstract: As the urgency of healthcare cost containment in the United States increases, this study concerns the impact of this process at the community level in the metropolitan area of Syracuse, New York. It suggests that the responses of the Syracuse hospitals to cost containment have resulted in greater numbers of adult medicine patients. This development has been paralleled by a reduced integration of services with long-term care and ambulatory care providers. As a result, the hospitals have encountered longer stays as well as greater risk of in-patient complications and readmissions for these patients. The study identifies initiatives related to improving integration of care that the Syracuse hospitals are beginning to use to address these issues.
      PubDate: Thu, 16 Feb 2012 05:00:00 +000
       
  • Work Life and Patient Safety Culture in Canadian Healthcare: Connecting
           the Quality Dots Using National Accreditation Results
    • Abstract: Fostering quality work life is paramount to building a strong patient safety culture in healthcare organizations. Data from two patient safety culture and work-life questionnaires used for Accreditation Canada's national program were analyzed. Strong team leadership was reported in that units were doing a good job of identifying, assessing and managing risks to patients. Seventy-one percent of respondents gave their unit a positive overall grade on patient safety, and 79% of respondents felt that they could often do their best-quality work in their job. However, healthcare workers felt that they did not have enough time to do their jobs adequately and indicated that co-workers were cutting corners in patient care in order to save time. This article discusses engaging both senior leadership and the entire organization in the change process, ensuring supervisory support, and using performance measures to focus organizational efforts on key priorities all as improvement strategies relevant to these findings. These strategies can be used by organizations across sectors and jurisdictions and by healthcare leaders to positively affect work life and patient safety.
      PubDate: Thu, 16 Feb 2012 05:00:00 +000
       
  • Annual Performance Appraisal: One Organization's Process and Retrospective
           Analysis of Outcomes
    • Abstract: Performance assessment of personnel is an important component of an organization's quality management program, benefiting the organization, individuals and clients. Performance appraisal is the most common method. This article describes the three-part performance appraisal tool used at the authors' organization, a private inter-professional healthcare agency providing rehabilitation services to clients in the community, and presents the results of a retrospective analysis of the outcomes. Performance appraisals of 13 personnel were randomly selected, representing 39 chart audits and 25 joint client visits. The achievement of mandatory chart audit standards demonstrated 95 ± 7.2% compliance; expected standards showed 96 ± 3.3% compliance. Qualitative findings from the joint visits and interviews showed that therapists enjoyed the process and experience, valued the feedback and appreciated the support they received. Benefits and challenges of the process were identified, resulting in new initiatives being implemented. The authors confirmed that the tool achieves its intended purpose and is relevant in the home care setting.
      PubDate: Thu, 16 Feb 2012 05:00:00 +000
       
  • "I Can't Wait": Advanced Access Decreases Wait Times in Primary Healthcare
    • Abstract: Research has shown that a strong primary healthcare system results in better health outcomes and lower costs (Starfield 1994). A key characteristic of a strong primary healthcare system is access to care. Two elements of a strong healthcare system are accessibility and short wait times for service. In Canada, a shortage of primary healthcare providers is the biggest obstacle to reducing wait times to primary healthcare services; however, timely access to one's primary healthcare provider is also a significant barrier (Howell 2008). Wait times to see primary care physicians are longer for Canadians than for patients in the United States, Australia and the United Kingdom (Bundy et al. 2005; College of Family Physicians of Canada 2006; Sanmartin and Ross 2006). Longer wait times are associated with patient dissatisfaction, poorer individual health outcomes and an increased use of emergency departments and urgent care clinics (Gupta and Denton 2008; Hill and Joonas 2005; Hudec et al. 2010; Valenti and Bookhardt-Murray 2004).
      PubDate: Thu, 16 Feb 2012 05:00:00 +000
       
  • Healthcare Cost Drivers: Where Does the Money Go'
    • Abstract: Best practices, ideas and news in healthcare
      PubDate: Thu, 16 Feb 2012 05:00:00 +000
       
  • Highlights of HealthAchieve 2011
    • Abstract: One of the largest and most prestigious health care gatherings in North
America, HealthAchieve aims to inspire ideas and innovation with over 50
 informative and engaging educational sessions along with its
 award-winning exhibit floor, where close to 300 exhibitors showcase the 
latest health care products, services and technologies. HealthAchieve 
attracts approximately 7,000 health care and business leaders from
 around the world who gather together to learn, build relationships, and
 share best practices. Download the PDF to view the highlights. 
      PubDate: Tue, 07 Feb 2012 05:00:00 +000
       
  • Editorial
    • Abstract: Each issue of Healthcare Quarterly is a full basket of diverse topics and perspectives. At the risk of over-generalizing, however, the contents of our latest edition seem to me to be particularly concerned with the mighty role purposeful planning makes to just about every facet of healthcare excellence.
      PubDate: Mon, 25 Jul 2011 04:00:00 +000
       
  • LHINs at Five Years – What Now'
    • Abstract: Trying to predict the future is always dangerous. At the inception of Ontario's local health integration networks (LHINs), I wrote two pieces for Longwoods – "Local Health Integration Networks: Will 'Made in Ontario' Work'" (Ronson 2006) and a commentary on an article submitted by the LHIN chief executives, "Integrated Health Service Plans: From Planning to Action" (Ronson 2007). Looking back five years, how did I do' And, more importantly, how have LHINs done and where do we go from here'
      PubDate: Mon, 25 Jul 2011 04:00:00 +000
       
  • Awards and Appointments
    • Abstract: Awards and Appointments
      PubDate: Mon, 25 Jul 2011 04:00:00 +000
       
  • Points of Interest
    • Abstract: Points of Interest
      PubDate: Mon, 25 Jul 2011 04:00:00 +000
       
  • Engaging Patients to Improve Healthcare Quality
    • Abstract: Many health services organizations are seeking – and finding – ways to successfully engage patients in all areas of healthcare services, from planning to delivery to evaluation. Including patients in discussions and decisions about their own healthcare may seem like a good and obvious thing to do. However, assessing the success of this approach is complicated as there is little empirical evidence to show whether engaging patients affects the use of services, quality of care or patient satisfaction (Crawford et al. 2002; Nilsen et al. 2006; Simpson and House 2002).
      PubDate: Mon, 25 Jul 2011 04:00:00 +000
       
  • Chronic Conditions More Than Age Drive Health System Use in Canadian
           Seniors
    • Abstract: Which has more impact on health status and the use of healthcare services among seniors: age or the number of chronic conditions' To answer this question, we used responses from the 2008 Canadian Survey of Experiences with Primary Health Care to assess the effect of these two factors on seniors' self-perceived health status, prescription medication use and healthcare service use. We discovered that seniors with at least three chronic conditions were more likely to report poor health, take more prescription medications and use more healthcare services than seniors with two or fewer chronic conditions. The number of chronic conditions is better than age as a predictor of self-reported health status, prescription medication use and healthcare service use by seniors. Seniors with at least three conditions represented 24% of all seniors, but they accounted for 40% of the use of healthcare services. Health policies and programs focused on the prevention and improved management of co-morbidities among seniors could have a significant and positive impact on seniors' health (including self-perceived health status) and their use of healthcare services.
      PubDate: Mon, 25 Jul 2011 04:00:00 +000
       
  • Using Linked Health Administrative Data to Assess the Clinical and
           Healthcare System Impact of Chronic Diseases in Ontario
    • Abstract: The rising incidence and prevalence of chronic diseases is of major global concern (World Health Organization [WHO] 2002). Worldwide, the proportion of overall burden of disease from all causes attributable to non-communicable diseases (NCDs) and mental disorders is expected to increase from 36% in 1990 to 57% in 2020 (WHO 2002). The burden from NCDs, or chronic disease, exceeds that of communicable diseases in all of the six WHO regions except Africa (WHO 2003). This increasing trend has been credited to longer life expectancy due to advances in medical treatment, public health initiatives, social development, demographic shifts and changes in lifestyle and working environments. Thus, chronic disease is a significant burden to patients, families, healthcare providers and healthcare systems.
      PubDate: Mon, 25 Jul 2011 04:00:00 +000
       
  • In Conversation with Maura Davies
    • Abstract: In Conversation with Maura Davies
      PubDate: Mon, 25 Jul 2011 04:00:00 +000
       
  • Improving the Patient Experience through Design
    • Abstract: The Princess Margaret Hospital (PMH), one of the world's leading cancer research hospitals, found itself in an enviable yet challenging situation. The hospital had received a major financial gift to redesign its systemic therapy (chemotherapy daycare and transfusion) facilities. These facilities were both over capacity and in need of improvement, both functionally and aesthetically. PMH's vision was to create a new space and experience that was truly patient centric and world class. To do so, they required a better understanding of what patients experience and what matters most to them. There was universal recognition that achieving this goal would require new thinking and innovative methods.
      PubDate: Mon, 25 Jul 2011 04:00:00 +000
       
  • Chronic Kidney Disease in Canada's First Nations: Results of an Effective
           Cross-Cultural Collaboration
    • Abstract: Chronic kidney disease (CKD) is a serious and growing threat to our First Nations peoples' health. Current evidence indicates more rapid progression of CKD in First Nations populations, leading to markedly increased morbidity and mortality. To address this serious health issue, three First Nations communities, Alderville, Hiawatha and Curve Lake, partnered with the Central East Local Health Integration Network (LHIN), the Peterborough Regional Health Center (PRHC) and local family and specialist physicians.
      PubDate: Mon, 25 Jul 2011 04:00:00 +000
       
  • Attitudes and Behaviours of Hospital Pharmacy Staff toward Near Misses
    • Abstract: Near misses may be early warning signals for errors. The purpose of this study was to examine the attitudes and behaviours of Manitoba hospital pharmacists and technicians toward near misses and reporting.
      PubDate: Mon, 25 Jul 2011 04:00:00 +000
       
  • Barriers to and Incentives for Safety Event Reporting in Emergency
           Departments
    • Abstract: Patient safety events (PSEs) are common in healthcare and may be particularly prevalent in complex care settings such as emergency departments (EDs). Systems for reporting, analyzing, learning from and responding to incidents are promoted as a means to reduce adverse events by facilitating feedback, learning and system change. However, only 4–50% of PSEs are reported. Under-reporting masks the true number of PSEs and may reduce our ability to learn from and prevent repeat events. The goal of this study was to identify barriers that prevent PSE reporting and incentives that encourage reporting.
      PubDate: Mon, 25 Jul 2011 04:00:00 +000
       
  • Enhancing Patient Flow in an Acute Care Hospital: Successful Strategies at
           the Juravinski Hospital
    • Abstract: Publicly funded healthcare institutions are faced with mounting pressure from the increasing burden of chronic illness in an aging population, new and expensive technologies and high public expectations. In Ontario, there is also a legislated requirement that hospitals balance their budgets while achieving or exceeding provincial targets for performance and quality. These competing pressures can be expected to continue and intensify. A 2006 report of the Ontario Health Quality Council emphasized the importance of managing patient flow in the hospital system using operations management concepts such as queuing, smoothing and simulation (Ontario Health Quality Council, 2006). However, the report did not provide specific guidance on how to achieve these improvements.
      PubDate: Mon, 25 Jul 2011 04:00:00 +000
       
  • Using a Quality Improvement Process to Create Measurable Improvement in
           Care Delivery for Acute Stroke
    • Abstract: The introduction of thrombolytic therapy has revolutionized the management of acute ischemic stroke, and it has now been conclusively established that tissue plasminogen activator (t-PA) given within 4.5 hours of stroke onset both limits irreversible ischemic neuronal damage by establishing reperfusion of the penumbra and improves outcomes for patients who have undergone stroke. Clinical trials have demonstrated that in patients who receive t-PA, there is a reduction in disability and a greater chance of having significant recovery (Wardlaw et al. 2009).
      PubDate: Mon, 25 Jul 2011 04:00:00 +000
       
  • Developing Leadership within an Academic Medical Department in Canada: A
           Road Map for Increasing Leadership Span
    • Abstract: Medicine is dependent on strong leaders to advance innovation in the clinical care of patients. In most academic medical streams, there is no explicit system-wide approach for succession planning and leadership development. In late 2009, it was clear to the authors' department that they were at risk of losing high-potential individuals and division heads.
      PubDate: Mon, 25 Jul 2011 04:00:00 +000
       
  • From BPS Guideline to BPS Directive: Has the Hospital Procurement Bar
           Moved'
    • Abstract: There have been an increasing number of concerns regarding procurement practices in the public sector, together with intensive media scrutiny of those practices in the health sector. Yet, notwithstanding those concerns, only Ontario and British Columbia have developed a comprehensive procurement framework to address these issues. (While a review of the British Columbia's procurement requirements is beyond the scope of this article, British Columbia's procurement manual is available electronically [BC Minister of Finance n.d.]. For more detailed information, please also see the BC Purchasing Handbook [BC Government 2010].) However, the way that the procurement regime in Ontario has developed has led to the potential for additional confusion in an area that is already complex, being based on the interaction of common law principles, trade agreements (e.g., the Agreement on Internal Trade) and governmental guidance (e.g., the Management Board of Cabinet procurement directive of July 2009). Specifically, the Ontario Ministry of Finance has issued and replaced in quick succession – over a two-year period – a series of documents seeking to provide guidance as to procurement practices. In April 2009, the Ministry of Finance issued the broader public sector (BPS) Supply Chain Guideline. (For a detailed review of guidelines, please see Understanding the PPP: The BPS Supply Chain Guideline [Beardwood 2010], which contrasts the procurement requirements under the guideline with annex 502.4 to the Agreement on Internal Trade and the Management Board of Cabinet procurement directive [July 2009] at: http://www.fasken.com/understanding-the-ppp/). However, notwithstanding that the guideline was issued in just 2009 and organizations were still in the process of understanding the implications of the guideline on their procurement practices, the guideline has now been replaced by the Broader Public Sector Procurement Directive (Ontario Ministry of Finance 2011), available as of February 1, 2011, on the Ministry of Finance website and effective on April 1, 2011, pursuant to the Broader Public Sector Accountability Act (Government of Ontario 2010).
      PubDate: Mon, 25 Jul 2011 04:00:00 +000
       
  • Health Indicators 2011
    • Abstract: Health Indicators 2011
      PubDate: Mon, 25 Jul 2011 04:00:00 +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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