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  Subjects -> HEALTH AND SAFETY (Total: 1283 journals)
    - CIVIL DEFENSE (18 journals)
    - DRUG ABUSE AND ALCOHOLISM (87 journals)
    - HEALTH AND SAFETY (514 journals)
    - HEALTH FACILITIES AND ADMINISTRATION (379 journals)
    - OCCUPATIONAL HEALTH AND SAFETY (106 journals)
    - PHYSICAL FITNESS AND HYGIENE (99 journals)
    - WOMEN'S HEALTH (80 journals)

HEALTH AND SAFETY (514 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: 20)
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: 4)
Afrimedic Journal     Open Access   (Followers: 2)
Air Quality, Atmosphere & Health     Hybrid Journal   (Followers: 3)
AJOB Primary Research     Partially Free   (Followers: 2)
American Journal of Family Therapy     Hybrid Journal   (Followers: 10)
American Journal of Health Economics     Full-text available via subscription   (Followers: 13)
American Journal of Health Education     Hybrid Journal   (Followers: 25)
American Journal of Health Promotion     Hybrid Journal   (Followers: 22)
American Journal of Health Studies     Full-text available via subscription   (Followers: 8)
American Journal of Preventive Medicine     Hybrid Journal   (Followers: 21)
American Journal of Public Health     Full-text available via subscription   (Followers: 179)
American Journal of Public Health Research     Open Access   (Followers: 27)
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: 8)
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  
Archives of Medicine and Health Sciences     Open Access   (Followers: 2)
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: 5)
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: 2)
Australian Indigenous HealthBulletin     Free   (Followers: 6)
Autism & Developmental Language Impairments     Open Access   (Followers: 1)
Behavioral Healthcare     Full-text available via subscription   (Followers: 4)
Best Practices in Mental Health     Full-text available via subscription   (Followers: 6)
Bijzijn     Hybrid Journal   (Followers: 2)
Bijzijn XL     Hybrid Journal   (Followers: 1)
Biomedical Safety & Standards     Full-text available via subscription   (Followers: 9)
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: 15)
Cadernos de Educação, Saúde e Fisioterapia     Open Access   (Followers: 1)
Cadernos Saúde Coletiva     Open Access   (Followers: 1)
Canadian Family Physician     Partially Free   (Followers: 11)
Canadian Journal of Community Mental Health     Full-text available via subscription   (Followers: 10)
Canadian Journal of Human Sexuality     Hybrid Journal   (Followers: 1)
Canadian Journal of Public Health     Full-text available via subscription   (Followers: 18)
Case Reports in Women's Health     Open Access   (Followers: 2)
Case Studies in Fire Safety     Open Access   (Followers: 11)
Central Asian Journal of Global Health     Open Access   (Followers: 2)
Central European Journal of Public Health     Full-text available via subscription   (Followers: 4)
CES Medicina     Open Access  
Child Abuse Research in South Africa     Full-text available via subscription   (Followers: 1)
Child's Nervous System     Hybrid Journal  
Childhood Obesity and Nutrition     Open Access   (Followers: 10)
Children     Open Access   (Followers: 2)
CHRISMED Journal of Health and Research     Open Access  
Christian Journal for Global Health     Open Access  
Ciência & Saúde Coletiva     Open Access   (Followers: 2)
Ciencia y Cuidado     Open Access  
Ciencia, Tecnología y Salud     Open Access  
ClinicoEconomics and Outcomes Research     Open Access   (Followers: 1)
CME     Hybrid Journal   (Followers: 1)
CoDAS     Open Access  
Community Health     Open Access   (Followers: 1)
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: 4)
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: 3)
Epidemiology, Biostatistics and Public Health     Open Access   (Followers: 18)
Ethics, Medicine and Public Health     Full-text available via subscription  
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: 1)
European Medical, Health and Pharmaceutical Journal     Open Access  
Evaluation & the Health Professions     Hybrid Journal   (Followers: 8)
Evidence-based Medicine & Public Health     Open Access   (Followers: 4)
Evidência - Ciência e Biotecnologia - Interdisciplinar     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: 3)
Family Relations     Partially Free   (Followers: 11)
Fatigue : Biomedicine, Health & Behavior     Hybrid Journal   (Followers: 1)
Food and Public Health     Open Access   (Followers: 10)
Frontiers in Public Health     Open Access   (Followers: 8)
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: 4)
Global Health Promotion     Hybrid Journal   (Followers: 15)
Global Journal of Health Science     Open Access   (Followers: 6)
Global Journal of Public Health     Open Access   (Followers: 9)
Global Medical & Health Communication     Open Access  
Globalization and Health     Open Access   (Followers: 5)
Hacia la Promoción de la Salud     Open Access  
Hastings Center Report     Hybrid Journal   (Followers: 7)
HEADline     Hybrid Journal  
Health & Place     Hybrid Journal   (Followers: 14)
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: 9)
Health and Social Work     Hybrid Journal   (Followers: 45)
Health Behavior and Policy Review     Full-text available via subscription   (Followers: 1)
Health Care Analysis     Hybrid Journal   (Followers: 11)
Health Inform     Full-text available via subscription  
Health Information Management Journal     Hybrid Journal   (Followers: 10)
Health Issues     Full-text available via subscription   (Followers: 1)
Health Policy     Hybrid Journal   (Followers: 32)
Health Policy and Technology     Hybrid Journal  
Health Professional Student Journal     Open Access   (Followers: 1)
Health Promotion International     Hybrid Journal   (Followers: 20)
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: 47)
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: 9)
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: 1)
Health Systems     Hybrid Journal   (Followers: 2)
Health Voices     Full-text available via subscription  
Health, Culture and Society     Open Access   (Followers: 10)
Health, Risk & Society     Hybrid Journal   (Followers: 9)
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: 2)
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: 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: 4)
International Journal for Equity in Health     Open Access   (Followers: 7)
International Journal for Quality in Health Care     Hybrid Journal   (Followers: 32)
International Journal of Applied Behavioral Sciences     Open Access   (Followers: 1)
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: 19)
International Journal of Evidence-Based Healthcare     Hybrid Journal   (Followers: 8)
International Journal of Food Safety, Nutrition and Public Health     Hybrid Journal   (Followers: 13)
International Journal of Health & Allied Sciences     Open Access   (Followers: 1)
International Journal of Health Care Quality Assurance     Hybrid Journal   (Followers: 7)
International Journal of Health Geographics     Open Access   (Followers: 6)
International Journal of Health Policy and Management     Open Access   (Followers: 2)
International Journal of Health Professions     Open Access   (Followers: 2)
International Journal of Health Promotion and Education     Hybrid Journal   (Followers: 12)
International Journal of Health Sciences Education     Open Access   (Followers: 2)
International Journal of Health Services     Full-text available via subscription   (Followers: 9)
International Journal of Health Studies     Open Access   (Followers: 3)
International Journal of Health System and Disaster Management     Open Access   (Followers: 2)

        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]
  • 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
       
  • From the Editors
    • Abstract: Anyone who spent the summer in the eastern half of North America will not be surprised to learn that 2016 is on track to be the hottest year ever (Slezak 2016). More than just a physical annoyance, however, climate change "is disrupting national economies and affecting lives, costing people, communities and countries dearly today and even more tomorrow" (United Nations 2016).For this issue of Healthcare Quarterly, we brought together five articles that examine climate change in relation to the healthcare system's environmental burden and efforts to reduce it: as Deanna Fourt and Claudette Poirier stress in their article, healthcare is hugely energy and carbon intensive. Major transformations are needed to address that impact and, as they aptly point out, "healthcare employees have a unique role to play as agents of change" in that work.
      PubDate: Mon, 31 Oct 2016 04:00:00 +000
       
  • Developing Indicators for the Child and Youth Mental Health System in
           Ontario
    • Abstract: When the Government of Ontario launched a comprehensive mental health and addictions strategy, the Institute for Clinical Evaluative Sciences (ICES) was tasked with developing a scorecard for ongoing monitoring of the child and youth mental health system. Using existing administrative and survey-based healthcare and education data, researchers at ICES developed a scorecard consisting of 25 indicators that described at-risk populations, child and youth mental healthcare and relevant outcomes. This scorecard is the first in Canada to report on performance indicators for the child and youth mental health system and provides a model for monitoring child and youth mental health using routinely collected administrative data.
      PubDate: Mon, 31 Oct 2016 04:00:00 +000
       
  • Increasing Rates of Kidney Failure Care in Canada Strains Demand for
           Kidney Donors
    • Abstract: The number of patients with kidney failure is on the rise in Canada, leading to a higher need for dialysis treatment and greater demand for kidney transplants, which have superior patient outcomes and lower healthcare system costs than dialysis treatments. This study examines the incidence and prevalence of kidney failure and renal replacement therapies between 2005 and 2014. The number of patients on dialysis has increased by 31% over this decade. The number of annual kidney transplants performed has also increased along with the waiting list for a kidney transplant, resulting in a persistent 2.5 times gap between patients on a waiting list for a kidney and the number of kidney transplants performed. New programs to increase organ donation to kidney failure patients have led to improvements, but have not been able to close this gap. Continued innovations are needed to preserve kidney function for patients with chronic kidney disease and to promote and increase donation rates in Canada to improve the quality of life and survival of thousands of patients, as well as save hundreds of millions of dollars to healthcare systems in Canada.
      PubDate: Mon, 31 Oct 2016 04:00:00 +000
       
  • In Conversation with Michael Green, President and CEO, Canada Health
           Infoway
    • Abstract: Canada Health Infoway is leading the charge to bring Canada's healthcare system into the twenty-first century. Canada Health Infoway is an independent, federally funded, non-profit organization tasked with accelerating adoption of pan-Canadian digital health solutions. Since 2001, the organization has functioned as a strategic investor, policy advisor and principle architect as Canada and its provinces and territories struggle with the implementation hurdles of digitizing Canada's healthcare system. The rationale for an eMR for Canadians is as simple as it is complex: improved access, improved efficiency of providers, better care and outcomes, better communication and coordination of care, and, ultimately, a system better positioned to deal with the issues of today – chronic disease management, empowered patients, interoperability among providers and population health and surveillance.In 2014, Michael Green was appointed President and CEO, Canada Health Infoway. With an international track record of transforming healthcare through the use of innovative digital health strategies, Michael's mandate was to leverage expertise and experiences gained through his transformation of diagnostic imaging at Agfa to the Canada Health Infoway mandate. With a diploma in Medical Laboratory Sciences from the London Metropolitan University and early days at King's College Hospital in London, his career took him to the C-suite of Agfa Healthcare, Americas Region, where he led that organization's transformation of the imaging industry. Michael received the Queen's Jubilee Medal in 2012 for his contributions to Canada's IT industry, including a three-year term as Board Chair, Information Technology of Canada. Ken Tremblay spoke with Michael this summer.
      PubDate: Mon, 31 Oct 2016 04:00:00 +000
       
  • Healthcare in the Anthropocene: Challenges and Opportunities
    • Abstract: We are entering the Anthropocene. So large is our impact on the planet that Earth scientists suggest our presence will show up in the geologic record far into the future. The global ecological changes we are creating pose a threat to health not only from climate change but from pollution and ecotoxicity, ocean acidification, resource depletion and the loss of biodiversity that threatens a sixth "Great Extinction." These health threats will impose an added burden on the healthcare system, while the ecological changes will force it to adapt to the new realities.The healthcare system contributes to these changes. It is an energy and resource-intensive part of society that also produces large volumes of solid and liquid wastes and air pollutants, some of them quite toxic; the system has a large ecological footprint; yet, at the same time, the system has an ethical duty to do no harm, and thus should be a leader in the transition to a more ecologically sustainable and healthier future.
      PubDate: Mon, 31 Oct 2016 04:00:00 +000
       
  • Canadian Coalition for Green Health Care Leading the Evolution of Green
    • Abstract: Since 2000, a growing contingent of healthcare organizations, individuals and companies have embraced principles and practices of environmental stewardship with a focus on making health service delivery more environmentally sustainable. This article provides an overview of the sector's many successes, drawing upon both Coalition-sponsored initiatives and those initiated by its most engaged and forward-thinking stakeholders, many of whom are original signatories to Canada's Joint Position Statement: Toward an Environmentally Responsible Canadian Health Sector.
      PubDate: Mon, 31 Oct 2016 04:00:00 +000
       
  • Recovering Plastics in a Hospital Can Have Environmental, Social and
           Economic Benefits
    • Abstract: Plastics are omnipresent in today's healthcare facilities. In Quebec, recyclable plastics (the ones with a 1 to 7 number on it, excluding number 6 or styrofoam) represent 7% of all the waste generated by healthcare institutions – 2,907 tonnes each year (Proulx et al. 2009). The vast majority of these plastics are sent to landfill instead of being recycled due to the lack of suitable recycling systems. In collaboration with three Montreal-based hospitals, Synergie Santé Environnement (SSE) conducted an 18-month pilot project to implement a sustainable plastic recycling system with threefold objectives: reduce landfill costs, obtain royalties for the plastics and assure traceability.
      PubDate: Mon, 31 Oct 2016 04:00:00 +000
       
  • Organic Waste Reduction at Hamilton Health Sciences
    • Abstract: Hamilton Health Sciences (HHS) cares for the community in many ways. This includes fulfilling responsibilities as an organization to reduce the environmental impact of healthcare waste that is generated on a daily basis. A significant amount of this is food waste generated by hospital kitchens and cafeterias, and has been identified as a waste stream that could be diverted from landfill. This article explores HHS' journey toward the implementation of a cost effective, environmentally sustainable waste stream management system.
      PubDate: Mon, 31 Oct 2016 04:00:00 +000
       
  • Healthcare and Climate Change: Do No Harm
    • Abstract: The increased frequency of extreme weather events due to climate change can cause casualties and put healthcare delivery at risk. Ironically, healthcare is a significant source of the very greenhouse gas emissions that lead to climate change. The Vancouver Island Health Authority case study shows the value of targets, energy management and innovation in new construction. Efforts have yielded great results to date with $2 million a year saved in utilities, and are nearing the target of reducing emissions by 33% below 2007 levels by 2020.
      PubDate: Mon, 31 Oct 2016 04:00:00 +000
       
  • Searching for Best Direction in Healthcare: Distilling Opportunities,
           Priorities and Responsibilities
    • Abstract: Canada's health and its care are evolving. Evidence from serial Health Care in Canada surveys of the public and health professionals over the last two decades reveal a persistent sense of care quality, despite an aging population, decreasing levels of good and excellent health, increasing prevalence of chronic illnesses; and sub-optimal access to timely and patient-centred care. Stakeholders are, however, somewhat pessimistic and many sense complete rebuilding, or major changes, may be necessary. To improve access, the primary health concern of all Canadians – increasing medical and nursing school enrolment, and requiring professionals to work in teams – have attracted increasingly high support from both the public and professionals. However, physicians' support lags behind that of nursing, pharmacy and administrative colleagues; and, currently, only a minority of patients and professionals are actively involved in team care programs. Another example in which high levels of support may not necessarily translate into priority implementation of promising interventions is the realm of patient-centred care. The public and all professionals report a very high level of general support for care provided in a caring and respectful manner. However, while the public rank it second in implementation priority, following timely access, the majority of professionals rank it only fourth. By contrast, there is remarkable pan-stakeholder concordance around interventions to improve the overall health system, with the majority of public and professional stakeholders rating the creation of national supply systems as their top priority to expedite the clinical and cost efficiency of new treatments. There is a similar pan-stakeholder concordance around priority of responsibility to drive innovations, the top three being: federal/provincial governments; research hospitals/regional health authorities; and the pharmaceutical industry. In summary, Canadians are at a healthcare crossroads. Population health is decreasing, chronic diseases are increasing and desire for timely access to patient-centred, team-delivered and technology-supported care remain top concerns. Despite some disconnects between theoretical support for, and priority to implement, promising innovations, there is universal support to optimize resources to make things better. And there is concordance around the leadership best suited to lead innovation. Things can be better.
      PubDate: Mon, 31 Oct 2016 04:00:00 +000
       
  • Using System Maps to Gain a System Perspective to Improve Outcomes
    • Abstract: Throughout the world, people are living longer, and chronic and degenerative diseases are on the rise (Bloom et al. 2011; National Institute on Aging and WHO 2011; Yach et al. 2004). These factors place great demands on healthcare systems and threaten sustainability. Fundamental changes are needed to improve health outcomes and reduce costs. Changes that affect desired outcomes include aligning and understanding stakeholders' motivations and behaviours as well as gaps in key processes. Through that understanding, when desired outcomes are not achieved, we can answer why. A system perspective provides insight into what changes to make, and system maps are critical tools to help gain that system perspective.
      PubDate: Mon, 31 Oct 2016 04:00:00 +000
       
  • Canadian Cancer Programs Are Struggling to Invest in Development of Future
           Leaders: Results of a Pan-Canadian Survey
    • Abstract: Cancer agencies within Canada operate with a variety of leadership models, assuming that future leaders are identified, developed and supported by institutions other than their own. A literature review, comprehensive survey and structured interviews were conducted to illuminate the perceptions of leadership in Canadian cancer centres. The major finding from the study is the significant gap between the competencies that leaders acknowledge as being important and the lack of development programs for future and current leaders. The study also showed there is agreement on preferred leadership models and the personal traits that identify future leaders worthy of development. Given the current struggles of leadership, the authors suggest that cancer agencies need to strategize how to advance succession planning and leadership development frameworks.
      PubDate: Mon, 31 Oct 2016 04:00:00 +000
       
  • Increasing Primary Care Access Close to Home for Residents of Remote
           Communities in Northern Alberta
    • Abstract: Residents of Canada's rural and remote communities know the challenges associated with accessing consistent healthcare. Alberta Health Services uses telehealth technology to minimize travel for rural and remote residents who require follow-up with specialists, however until recently, telehealth was only used in specialty care. This article describes a pilot project introduced in two remote northern Alberta communities to determine the feasibility and sustainability of using telehealth in the delivery of primary healthcare. Included in the article are descriptions of each phase of the project from seeking stakeholder approval through interpretation of findings and continuation of the project after it was determined successful. Jurisdictions interested in attempting their own telehealth program will be interested in the challenges and successes identified during the process. Although the project was successful, further studies are needed to determine if similar findings could be expected in other communities and populations.
      PubDate: Mon, 31 Oct 2016 04:00:00 +000
       
  • Evaluating Innovations in Home Care for Performance Accountability
    • Abstract: Concerns about rising costs and the sustainability of our healthcare system have led to a drive for innovative solutions and accountability for performance. Integrated Home Care, Calgary Zone, Alberta Health Services went beyond traditional accountability measures to use evaluation methodology to measure the progress of complex innovations to its organization structure and service delivery model. This paper focuses on the first two phases of a three-phase evaluation. The results of the first two phases generated learning about innovation adoption and sustainability, and performance accountability at the program-level of a large publicly funded healthcare organization.
      PubDate: Mon, 31 Oct 2016 04:00:00 +000
       
  • From the Editor
    • Abstract: From the Editor
      PubDate: Fri, 22 Jul 2016 04:00:00 +000
       
  • Epidemiology of Fracture in Adults from Ontario, Canada, with Chronic
           Kidney Disease: An Examination of Fracture Burden Using Administrative
           Health Data
    • Abstract: Fractures are associated with morbidity and mortality. Individuals with chronic kidney disease (CKD) experience bone mineral metabolism changes, which increases fracture risk. Researchers have quantified the epidemiology of fractures in adults with CKD using administrative health databases from Ontario, Canada, held at the Institute for Clinical Evaluative Sciences. Results demonstrated that many individuals with non-transplant CKD sustain fractures, with the risk increasing as kidney function declines. However, fracture risk in kidney transplant recipients was lower than previously described, which suggests recipients may not be a high-risk fracture group. There is a need to test fracture prevention interventions in the CKD population.
      PubDate: Fri, 22 Jul 2016 04:00:00 +000
       
  • Care for Patients with Complex Needs: Canadian Results from the
           Commonwealth Fund 2015 International Health Policy Survey of Primary
           Care Physicians
    • Abstract: Good primary care is essential for the effective management of patients with chronic conditions in the community and to ensure their care is well coordinated with other parts of the system. The Commonwealth Fund 2015 International Health Policy Survey compares the views and experiences of primary care physicians in 11 countries including Canada. The survey found nearly all (98%) primary care doctors across countries treat patients with complex needs in their practice. However, when examining questions on chronic disease management and coordination of care with other providers, Canadian results are mixed compared to the international average, and show variation at the provincial level. Opportunities likely exist to learn from other countries that have a more systematic approach to primary care delivery.
      PubDate: Fri, 22 Jul 2016 04:00:00 +000
       
  • The Challenge Before Us
    • Abstract: The Challenge Before Us
      PubDate: Fri, 22 Jul 2016 04:00:00 +000
       
  • What Gets in the Way of Person-Centred Care for People with
           Multimorbidity? Lessons from Ontario, Canada
    • Abstract: Person-centred care is becoming a key component of quality in health systems worldwide. Although the term can mean different things, it typically entails paying attention to the needs and background of health system users, involving them in decisions that affect their health, assessing their care goals and implementing a coordinated plan of care that aligns with their unique circumstances. The importance of practising a person-centred approach in care delivery dominates policy and research rhetoric worldwide, yet competing goals set by policy planners to save money, eliminate waste and sustain the healthcare system challenge the implementation of such an approach. In this commentary, we begin by exploring the concept of person-centred care and its importance among people who frequently use healthcare, such as those with multimorbidity. We then provide a brief overview of the evolution of Ontario's healthcare system and its emphasis on achieving cost savings. In doing so, we illustrate the implications for health system users, particularly people with multimorbidity, their carers and formal care providers. Finally, we reflect on examples of innovations that are striving to deliver person-centred care, despite a constrained healthcare environment. While a step in the right direction, we conclude that these "one-off" strategies are unsustainable in the absence of supporting policy levers.
      PubDate: Fri, 22 Jul 2016 04:00:00 +000
       
  • Understanding Clinical Complexity the Hard Way: A Primary Care Journey
    • Abstract: Ten years ago, complexity was not a term often used in primary care. In the last decade, however, the population seen in primary care has shifted, posing substantial challenges for both primary care providers and health systems. In this essay, I will document the approaches that evolved in an academic family practice environment to address the challenges posed by complex patients typified by multiple concurrent chronic conditions and social determinants challenges. I will describe the research that lead to the creation, implementation and evaluation of an inter-professional model of care and associated outcomes. I will describe how this work subsequently led to the evolution of clinical models and research projects designed to reframe the discourse around complexity as well as move forward on elaborating new policy, clinical and service delivery innovations. I will conclude with some thoughts about what I see as the major challenges in the short and immediate term for research and practice, drawing on 15 years of practice and research experience with complex populations.
      PubDate: Fri, 22 Jul 2016 04:00:00 +000
       
  • It Takes Two to Tango: Researchers and Decision-Makers Collaborating to
           Implement Practice Changes for Patients with Multimorbidity
    • Abstract: An integrated knowledge translation strategy is a key factor in fostering the implementation of practice changes. Building on a 15-year history of projects that include close collaboration between researchers and decision-makers in the Saguenay region of Quebec (Canada), the authors identify several key elements that resulted in practice changes in primary care and improved outcomes for patients with multimorbidity.
      PubDate: Fri, 22 Jul 2016 04:00:00 +000
       
  • Building Bridges to Integrate Care (BRIDGES): Incubating Health Service
           Innovation across the Continuum of Care for Patients with Multiple Chronic
           Conditions
    • Abstract: Integrating care for people with complex needs is challenging. Indeed, evidence of solutions is mixed, and therefore, well-designed, shared evaluation approaches are needed to create cumulative learning. The Toronto-based Building Bridges to Integrate Care (BRIDGES) collaborative provided resources to refine and test nine new models linking primary, hospital and community care. It used mixed methods, a cross-project meta-evaluation and shared outcome measures. Given the range of skills required to develop effective interventions, a novel incubator was used to test and spread opportunities for system integration that included operational expertise and support for evaluation and process improvement.
      PubDate: Fri, 22 Jul 2016 04:00:00 +000
       
  • A “Simple” Evidence-Based Intervention to Improve Care
           Transitions for Frail Patients with Complex Health Conditions: Why
           Didn’t It Work as Expected?
    • Abstract: The transition from hospital to home is a vulnerable period for patients with complex conditions, who are often frail, at risk for adverse events and unable to navigate a system of poorly coordinated care in the post-discharge period. Care transition interventions are seen as effective care coordinating mechanisms for reducing avoidable adverse events associated with the transition of the patient from the hospital to the home.A study was undertaken to evaluate the effectiveness of a care transition intervention involving a hand-off between a hospital-based care transitions nurse and a community-based rapid response nurse. Two focus groups were held, one involving rapid response nurses and the other involving care transition nurses. Individual interviews were conducted with the managers (n = 2) and executives (n = 2) to identify the factors that facilitated or were barriers to its implementation.Using thematic content analysis, it was found that the effectiveness of transitional coordination efforts was thwarted by ineffective communication, which affected the quality of the underlying relationships between the two teams. Other barriers to achieving the desired outcomes included the following: issues of role clarity, role awareness and acceptance, the adequacy and reinforcement of coordinating mechanisms, the effectiveness of the information exchange protocols and the absence of shared measures of accountability.
      PubDate: Fri, 22 Jul 2016 04:00:00 +000
       
  • Improving Outcomes through Transformational Health and Social Care
           Integration – The Scottish Experience
    • Abstract: The Scottish Parliament recently passed legislation on integrating healthcare and social care to improve the quality and outcomes of care and support for people with multiple and complex needs across Scotland. This ambitious legislation provides a national framework to accelerate progress in person-centred and integrated care and support for the growing number of people who have multiple physical and mental health conditions and complex needs. Additional investment and improvement capacity is helping to commission support and services that are designed and delivered with people in local communities and in partnership with housing, community, voluntary and independent sectors.
      PubDate: Fri, 22 Jul 2016 04:00:00 +000
       
  • In Conversation with Nick Goodwin
    • Abstract: In Conversation with Nick Goodwin
      PubDate: Fri, 22 Jul 2016 04:00:00 +000
       
  • A Health System for Patients with Complex Conditions: Reflections from
           Bridgepoint’s Transformation
    • Abstract: A Health System for Patients with Complex Conditions: Reflections from Bridgepoint’s Transformation
      PubDate: Fri, 22 Jul 2016 04:00:00 +000
       
  • eHealth Advances in Support of People with Complex Care Needs: Case
           Examples from Canada, Scotland and the US
    • Abstract: Information technology (IT) in healthcare, also referred to as eHealth technologies, may offer a promising solution to the provision of better care and support for people who have multiple conditions and complex care needs, and their caregivers. eHealth technologies can include electronic medical records, telemonitoring systems and web-based portals, and mobile health (mHealth) technologies that enable information sharing between providers, patients, clients and their families. IT often acts as an enabler of improved care delivery, rather than being an intervention per se. But how are different countries seeking to leverage adoption of these technologies to support people who have chronic conditions and complex care needs? This article presents three case examples from Ontario (Canada), Scotland and Kaiser Permanente Colorado (United States) to identify how these jurisdictions are currently using technology to address multimorbidity. A SWOT (strengths, weaknesses, opportunities, threats) analysis is presented for each case and a final discussion addresses the future of eHealth for complex care needs. The case reports presented in this manuscript mark the foundational work of the Multi-National eHealth Research Partnership Supporting Complex Chronic Disease and Disability (the eCCDD Network); a CIHR-funded project intended to support the international development and uptake of eHealth tools for people with complex care needs.
      PubDate: Thu, 07 Jul 2016 04:00:00 +000
       
  • Applying Clinical Practice Guidelines to the Complex Patient: Insights for
           Practice and Policy from Stroke Rehabilitation
    • Abstract: In Canada, policy makers are working to align services with the Stroke Rehabilitation Best Practice Recommendations (SRBPR). Complicating the application of clinical practice guidelines (CPGs) is the fact that most strokes occur in the context of other diagnoses. We sought to understand clinicians' use of the CPGs and ascertain how much guidance regarding multimorbidity was available in the SRBPR. Study results indicated that using the recommendations was problematic due to a perceived lack of guidance regarding comorbidities and multimorbidity, and concerns regarding the applicability to "real-life patients." Comorbidities were mentioned in less than half of the recommendations, but no explicit guidance was provided regarding the management of comorbidities. Given the prevalence of multimorbidity in stroke rehabilitation, this clinical context is ideal for development and testing of CPGs that account for multimorbidity and other complexity factors. Results may also suggest limitations to using CPGs in the development of activity-based funding models.
      PubDate: Thu, 07 Jul 2016 04:00:00 +000
       
  • Performance Measurement for People with Multimorbidity and Complex Health
           Needs
    • Abstract: This paper reviews approaches to performance measurement in health systems with particular attention to people with multimorbidity and complex health needs. Performance measurement should be informative and used by multiple stakeholders in order to align performance improvement efforts. System performance measures must allow for macro-system and meso-organization and provider-level reporting, and they should be relevant and important to stakeholders at each level, as well as to patients and all potential care recipients. Measures that assess health outcomes and individuals' experiences with providers, including care planning and coordination of care across providers, are essential to assess value for people with multimorbidity and complex health needs. I suggest that performance measurement for this population should be motivated by the Complexity Framework and organized by the Triple Aim. Based on the care needs and appropriate goals for the health system for this population, applicable measures and suggestions for implementing and using performance measurement systems are identified. Particularly in the case of people with multimorbidity and complex health needs, performance measures must move beyond measures specific to individual encounters to track care for people over time and space. Measures must be rooted in individuals' own needs and goals for care. New systems are required to enable collection and reporting of these measures.
      PubDate: Thu, 07 Jul 2016 04:00:00 +000
       
  • Realizing the Potential of Rehabilitative Care for People with Complex
           Health Conditions: The Time Is Now
    • Abstract: In today's demographic landscape, with its aging population and increasing number of individuals who are living with multiple chronic conditions and comorbidities, the healthcare system is tasked with responding to the needs of medically complex individuals. However, the pressures arising from this emerging demographic are felt not only within the acute care sector at the point of medical crisis but along the entire continuum of the healthcare system. Rehabilitative care plays a key role in that continuum by providing the process through which individuals are engaged in interventions to address their functional (both cognitive and physical) and psychosocial care goals to help them carry on with the business of living.
      PubDate: Thu, 07 Jul 2016 04:00:00 +000
       
  • From the Editors
    • Abstract: From the Editors
      PubDate: Fri, 29 Apr 2016 04:00:00 +000
       
  • Increasing Access to Health Administrative Data with ICES Data & Analytic
           Services
    • Abstract: The Institute for Clinical Evaluative Sciences (ICES) is one of only a few organizations in Ontario permitted to access, link and analyze health administrative data for the purpose of generating evidence to inform decisions in policy and practice. Although ICES is a leading research institute, its access to the data has historically been restricted to scientists with an ICES affiliation. This requirement, designed to meet ICES' data privacy and security obligations, created barriers with respect to the widespread use of Ontario's data assets. In 2014, as part of the government's commitment to the Strategy for Patient-Oriented Research, ICES launched the Data & Analytic Services platform, which is aimed at increasing access to data and analytic services to investigators external to ICES. In making the data widely available to the broader research community, this initiative engages investigators involved in front-line care, stimulates new avenues of research and fosters collaboration that was previously challenging or unfeasible.
      PubDate: Fri, 29 Apr 2016 04:00:00 +000
       
  • Care for Children and Youth with Mental Disorders in Canada
    • Abstract: Care for Children and Youth with Mental Disorders in Canada
      PubDate: Fri, 29 Apr 2016 04:00:00 +000
       
  • In Conversation with Barry Telford
    • Abstract: In Conversation with Barry Telford
      PubDate: Fri, 29 Apr 2016 04:00:00 +000
       
  • The Case for Information Brokering During Major Change: The Experience of
           the Transition Support Office of the McGill University Health Centre
    • Abstract: This paper describes the emergence of an "information brokerage" in the project management office of the McGill University Health Centre (MUHC) in Montreal. This process evolved during unprecedented transformation linked to a redevelopment project. Information brokering became a core function in the MUHC's context of major change. To develop an information brokering model, the paper draws upon the literature on knowledge brokering, applies Daft and Lengel's (1986) seminal framework on information processing in organizations, and builds on the MUHC experience. The paper proposes that knowledge brokering and information brokering are related, yet distinct in content, purpose and structure.
      PubDate: Fri, 29 Apr 2016 04:00:00 +000
       
  • Repeated Diagnostic Imaging Studies in Ontario and the Impact of Health
           Information Exchange Systems
    • Abstract: Health information exchange systems can link the results of diagnostic imaging tests across hospitals and geographic areas. One of the potential benefits of these systems is a reduction in imaging studies ordered by physicians who do not know about or have access to the previous imaging results. We used administrative data from Ontario, Canada (from the year 2013), to measure how frequently the same cross-sectional imaging study is repeated in a patient. Overall, 12.8% of the specified imaging tests were repeated within 90 days. An area of Southwestern Ontario with a health information exchange system for diagnostic imaging tests had a 13% lower rate of repeat cross-sectional imaging compared with the rest of the province (11.2 vs 12.8%, p < 0.01). The use of linked radiology systems may be able to reduce the number of repeated imaging tests and improve patient safety and hospital efficiency.
      PubDate: Fri, 29 Apr 2016 04:00:00 +000
       
  • Process Improvements to Reform Patient Flow in the Emergency Department
    • Abstract: Emergency departments (ED) function to diagnose, stabilize, manage and dispose patients as efficiently as possible. Although problems may be suspected at triage, ED physician input is required at each step of the patient journey through the ED, from diagnosis to disposition. If we want timely diagnosis, appropriate treatment and great outcomes, then ED processes should connect patients and physicians as quickly as possible. This article discusses the key concepts of ED patient flow, value and efficiency. Based on these fundamentals, it describes the significant impact of ED process improvements implemented on measures of ED efficiency at a large community ED in Ontario, Canada.
      PubDate: Fri, 29 Apr 2016 04:00:00 +000
       
  • Lean Transformation of the Eye Clinic at The Hospital for Sick Children:
           Challenging an Implicit Mental Model and Lessons Learned
    • Abstract: Long patient dwell time (i.e., the time between patients arriving and leaving the clinic) has been a long-standing issue in the eye clinic at The Hospital for Sick Children. By applying the Lean principles of eliminating waste and enhancing flow, we achieved a 26% reduction in the mean patient dwell time over an eight-month period. Importantly, the average time a patient spent with healthcare providers (value-added time) increased from 21% to 31%. In this paper, we summarized our experience by illustrating how an implicit mental model (conscious or unconscious conceptual framework from which we understand the world) pervades in the healthcare system based on deeply held but unexamined assumptions that arise from heuristics (general rules of thumb) and biases; how these assumptions can be tested by objective data; and how we can build a new mental model based on objective findings to improve the healthcare system.
      PubDate: Fri, 29 Apr 2016 04:00:00 +000
       
  • Implementing Patient-Oriented Discharge Summaries (PODS): A Multi-site
           Pilot Across Early Adopter Hospitals
    • Abstract: Communication gaps when patients transition from hospital to either home or community can be problematic. Partnership between Toronto Central Local Health Integration Network (TC LHIN) and OpenLab addressed this through the Patient-Oriented Discharge Summaries (PODS) project. From January through March 2015, eight hospital departments across Toronto came together to implement the PODS, a tool previously developed through a co-design process involving patients, caregivers and providers. This paper presents data on how the hospitals came together and the impact of PODS on the patient and provider experience across these hospitals and discusses it implications.
      PubDate: Fri, 29 Apr 2016 04:00:00 +000
       
  • Decentralizing the Team Station: Simulation before Reality as a
           Best-Practice Approach
    • Abstract: The purpose of this article is to share the logistical planning requirements and simulation experience of one Canadian hospital as it prepared its staff for the change from a centralized inpatient unit model to the decentralized design planned for its new community hospital. With the commitment and support of senior leadership, project management resources and clinical leads worked collaboratively to design a decentralized prototype in the form of a pod-style environment in the hospital's current setting. Critical success factors included engaging the right stakeholders, providing an opportunity to test new workflows and technology, creating a strong communication plan and building on lessons learned as subsequent pod prototypes are launched.
      PubDate: Fri, 29 Apr 2016 04:00:00 +000
       
  • Standard of Care in Pediatrics: Integrating Family-Centred Care and Social
           Determinants of Health
    • Abstract: In pediatric healthcare, there is a recognized need to address social determinants of health (SDOH) to positively influence child health and development. In addition, family-centred care (FCC) recognizes the value of the family unit in affecting individual patient experiences of illness and care. However, pediatric healthcare that incorporates principles of FCC and SDOH may be interpreted as calling on clinicians to deviate from or add to practices that form an accepted standard of care. This paper explores the legal and ethical considerations of doing so and describes practical responses to these challenging situations.
      PubDate: Fri, 29 Apr 2016 04:00:00 +000
       
  • Yes, Doctors, You Were Right. The Data Were Wrong: One Organization’s
           Data Quality Journey
    • Abstract: In 2012, publicly released reports indicated that the health outcomes at St. Joseph's Health Centre, Toronto (SJHC), may not be of the same quality when compared with those at peer hospitals. This surprised the leaders within the organization given that SJHC had a sound reputation for quality and patient safety within the sector. As a result, SJHC's senior management and medical leadership identified clinical outcomes and data quality as items to be addressed within its enterprise risk management framework with a focus on the methods by which data were collected, coded and used by clinicians. The following article describes the approach SJHC used to improve the quality of its clinical data and how it changed physician participation in examining data designed to help inform and improve care.
      PubDate: Fri, 29 Apr 2016 04:00:00 +000
       
  • Advancing Interprofessional Collaborative Teams in the Winnipeg Health
           Region
    • Abstract: This project developed an evaluation platform aimed at diagnosing team functioning using evidence-informed, measurable indicators to provide an actionable roadmap to guide teams in improving their interprofessional collaborative team performance. A scoping literature review, stakeholder consultation, survey and focus groups were conducted to inform both the final selection of eight indicators of effective, high-performing teams and the process to assess and evaluate teams against these indicators. The program was piloted with two interprofessional teams in the Winnipeg Health Region. Focus groups and questionnaires were used to evaluate the program.
      PubDate: Fri, 29 Apr 2016 04:00:00 +000
       
  • Bringing Person- and Family-Centred Care Alive in Home, Community and
           Long-Term Care Organizations
    • Abstract: It is now more important than ever for person- and family-centred care (PFCC) to be at the forefront of program and service design and delivery; yet, to date, very little guidance is available to assist home, community and long-term care (LTC) organizations to operationalize this concept and overcome inherent challenges. This article provides a list of practical strategies for healthcare leaders to promote and support a culture shift towards PFCC in their organizations and identifies and addresses five common concerns. The unique opportunities and challenges for practicing PFCC in home, community and LTC settings are also discussed.
      PubDate: Fri, 29 Apr 2016 04:00:00 +000
       
  • Valuable Lessons in How to Transform a Mental Health System
    • Abstract: Valuable Lessons in How to Transform a Mental Health System
      PubDate: Thu, 14 Jan 2016 05:00:00 +000
       
  • Mental Health System Transformation: Drivers for Change. Organizational
           Preparation, Engaging Partners and Outcomes
    • Abstract: St. Joseph's Health Care London (hereafter referred to as St. Joseph's) is a publicly funded hospital that has led mental health (MH) service system transformation in south west Ontario following directives from the Health Services Restructuring Commission (HSRC) (Sinclair 2000). This paper documents how provincial policy; HSRC directives; use of change management activities; organizational planning; and partnerships with other hospitals, community agencies and LHINs drove, shaped and accomplished the transformational change.The transformation included divestment of beds and related ambulatory services to four other hospitals, closure of beds and employment services and the construction of two state-of-the-art facilities. This paper documents the tracking of system performance measures and the outcomes that resulted.
      PubDate: Thu, 14 Jan 2016 05:00:00 +000
       
  • Divestment of Beds and Related Ambulatory Services to Other Communities
           While Maintaining a Patient- and Family-Centred Approach
    • Abstract: Individuals living with serious mental illness who require acute and/or tertiary mental healthcare services represent one of the most complex patient groups in the healthcare service delivery system. Provincial mental health policy has been committed to providing services closer to home and in the community rather than an institution wherever possible for some time. This paper articulates the strategies used by one organization to ensure the successful transfer of beds and related ambulatory services to four separate communities. In addition a case study is also provided to describe in more detail the complex changes that took place in order to accomplish the divestments of beds and related ambulatory services to one of the partner hospitals.
      PubDate: Thu, 14 Jan 2016 05:00:00 +000
       
  • Relentless Incrementalism: Shifting Front-Line Culture from Institutional
           to Recovery Oriented Mental Healthcare
    • Abstract: St. Joseph's Health Care London is a publicly funded hospital that has led mental health service system transformation in south west Ontario following directives from the Health Services Restructuring Commission (HSRC).This paper documents how provincial policy, HSRC directives, organizational planning, research projects, quality initiatives and change management activities drove, shaped and accomplished a cultural shift at the front line to recovery-focused care.Simultaneous to these activities, beds and related ambulatory services were divested to four other hospitals, beds and employment services were closed and two new, state-of-the-art facilities were constructed, adding considerable complexities to achieving cultural change. This paper documents the incremental steps that were taken to achieve that change.
      PubDate: Thu, 14 Jan 2016 05:00:00 +000
       
  • Psychiatrist Health Human Resource Planning – An Essential Component
           of a Hospital-Based Mental Healthcare System Transformation
    • Abstract: The World Health Organization (WHO) defines health human resource planning as "the process of estimating the number of persons and the kinds of knowledge, skills, and attitudes they need to achieve predetermined health targets and ultimately health status objectives" (OHA 2015). Health human resource planning is a critical component of successful organizational and system transformation, and yet little has been written on how to do this for physicians at the local level. This paper will outline a framework for developing and managing key aspects of physician human resource planning related to both the quantity and quality of work within a hospital setting. Using the example of a complex multiphase hospital-based mental health transformation that involved both the reduction and divestment of beds and services, we will outline how we managed the physician human resource aspects to establish the number of psychiatrists needed and the desired attributes of those psychiatrists, and how we helped an existing workforce transition to meet the new expectations. The paper will describe a process for strategically aligning the selection and management of physicians to meet organizational vision and mandate.
      PubDate: Thu, 14 Jan 2016 05:00:00 +000
       
  • Social Determinants of Health: Housing and Income
    • Abstract: Social determinants of health such as housing and income have a large impact on mental health. Community-based initiatives have worked to address access to housing, prevent homelessness and assist people who are homeless with mental health problems. There have been several large research projects to tease out multiple subgroups such as youth and veterans and other individuals experiencing long-term homelessness. The issue of poverty has been addressed by exploring issues related to employment. The use of social enterprises is a promising practice to address issues around poverty, social inclusion and employment. Similarly, the community has worked to move hospital-based employment programs to the community.
      PubDate: Thu, 14 Jan 2016 05:00:00 +000
       
  • Peer Support
    • Abstract: The Mental Health Commission of Canada defines peer support as "a supportive relationship between people who have a lived experience in common … in relation to a mental health challenge or illness … related to their own mental health or that of a loved one" (Sunderland et al. 2013: 11). In Ontario, a key resource for peer support is the Ontario Peer Development Initiative (OPDI), which is an umbrella organization of mental health Consumer/Survivor Initiatives (CSIs) and peer support organizations across the province of Ontario. Member organizations are run by and for people with lived experience of a mental health or addiction issue and provide a wide range of services and activities within their communities. The central tenet of member organizations is the common understanding that people can and do recover with the proper supports in place and that peer support is integral to successful recovery. Nationally, Peer Support Accreditation and Certification Canada has recently been established. The relatively new national organization focuses on training and accrediting peer support workers. This paper focuses on a range of diverse peer support groups and CSIs that operate in London and surrounding areas.
      PubDate: Thu, 14 Jan 2016 05:00:00 +000
       
  • Prevention and Early Intervention Program for Psychoses (PEPP)
    • Abstract: The Prevention and Early Intervention Program for Psychoses (PEPP) was established in 1997 for individuals with first-episode non-affective psychotic disorder. The objectives of PEPP are to improve outcomes for clients by providing a prompt, comprehensive, coordinated and effective treatment program as well as to advance research concerning early intervention for psychotic disorders. This article describes the clinical and research program and the lessons learned.
      PubDate: Thu, 14 Jan 2016 05:00:00 +000
       
  • Early Intervention in Mood and Anxiety Disorders: The First Episode Mood
           and Anxiety Program
    • Abstract: The First Episode Mood and Anxiety Program (FEMAP) was developed for youth with mood and/or anxiety concerns in London, Ontario, to provide early intervention for these disorders, similar to the first-episode psychosis programs across Ontario and Canada. The logic and causal models of the pathway to and through FEMAP are described and inclusion/exclusion criteria are delineated. Results of the process evaluation of the model and preliminary data from a treatment-effectiveness evaluation and ongoing cost-comparison evaluation are provided. Several characteristic quotes from youth utilizing the service are included, as is an overview of utilization statistics. Challenges and lessons learned are conveyed.
      PubDate: Thu, 14 Jan 2016 05:00:00 +000
       
  • The South West Local Health Integration Network Behavioural Supports
           Ontario Experience
    • Abstract: Creating a seamless system of care with improved system and patient outcomes is imperative to the estimated 35,000 older adults living with mental health problems and addictions in the South West Local Health Integration Network. Building on existing investments and those offered through the Behavioural Supports Ontario program, strategies to improve system coordination were put in place, cross-sectoral partnerships were fostered, interdisciplinary teams from across the care continuum were linked, and educational opportunities were promoted. This evolving, co-created system has resulted in a decrease in alternate level of care cases among those with behavioural specialized needs and improved client/family perceptions of care. Also, in fiscal year 2014/15, it provided more than 7,000 care providers with learning opportunities.
      PubDate: Thu, 14 Jan 2016 05:00:00 +000
       
  • Mental Healthcare Delivery in London-Middlesex Ontario – The Next
           Frontier
    • Abstract: The next frontier for mental healthcare delivery will be focused on three facets of innovation, namely structure, process and outcome. The structure innovation will seek to develop new models of care delivery between the two hospitals and with the community. The process innovation will focus on embedding strategies to adopt a recovery and rehabilitation approach to care delivery. Lastly, the outcome innovation will use system wide quality improvement methods to drive breakthrough performance in mental healthcare.
      PubDate: Thu, 14 Jan 2016 05:00:00 +000
       
  • Acknowledgement
    • Abstract: Acknowledgement
      PubDate: Thu, 14 Jan 2016 05:00:00 +000
       
  • Editorial
    • Abstract: Like most issues of our journal, this one is replete with examples of novel efforts to reshape and reinvigorate healthcare policies and practices. A stand-out feature of this issue, however, is the sheer range of professionals – front-line staff, physicians, pharmacists and more – involved in these initiatives.
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
  • What Edmund Wilson Can Teach Us About Health System Transformation
    • Abstract: What Edmund Wilson Can Teach Us About Health System Transformation
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
  • Assessing Primary Healthcare Using pan-Canadian Indicators of Health and
           Health System Performance
    • Abstract: Updated primary healthcare (PHC) indicators are now available for use across Canada. The Canadian Institute for Health Information identified and updated two sets of priority indicators – a policy set to meet the needs of policy makers and a provider set to meet the needs of providers of PHC at the practice and organization levels. A total of 51 indicator definitions were updated to ensure that they are measurable and operational, align with clinical practice guidelines and available data sources and reflect important dimensions of PHC performance in Canada.
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
  • "Avoidable" Emergency Department Transfers from Long-Term Care Homes: A
           Brief Review
    • Abstract: Access to acute care, in particular the ED, will always be an important component of quality care for LTCH residents. Yet increasing evidence suggests that targeting specific care issues for improvement within the LTCH may help to reduce ED transfers. These issues include better access to medical management for common chronic conditions and infections, fall prevention and transitional care activities. However, for any such initiatives to serve the broader policy agenda of reducing avoidable acute care use, ongoing discussions about what we mean by avoidable within the LTCH context are required.
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
  • In Conversation with Chris Eagle
    • Abstract: In Conversation with Chris Eagle
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
  • “If You're Not Keeping Score, You're Just Practising”: A Lean
           Healthcare Program Evaluation Framework
    • Abstract:  "If You're Not Keeping Score, You're Just Practising"*Vince Lombardi, former head coach of the Green Bay PackersLean methods originated with the Toyota Production System developed shortly after World War II (Ohno 1988). Recently, they are finding widespread usage in healthcare. In industry, the primary objective of Lean is to enhance corporate earnings; but in healthcare, Lean seeks to improve patient-centred care and system efficiency (Institute of Medicine 2001). Lean evaluations have tended to be ad hoc, usually focusing on before and after pictures, graphical displays or vignettes. With Lean's widespread adoption in healthcare, a broad and rigorous framework for its evaluation is needed. 
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
  • Building Sector-Wide Bridges to Improve Patient Flow and Care
    • Abstract: Healthcare system transformation relies upon innovative solutions that build sector-wide bridges and challenge conventional thinking to benefit patients and families. Providence Healthcare – a Toronto leader in rehabilitation – is doing this by partnering with the Toronto Central Local Health Integration Network (LHIN), community care access centres and four acute care hospitals to improve system-wide patient flow. This article explains how Providence's Transformation by Design demonstration project was launched and sustained through engaging key stakeholders, and is now demonstrating positive, measurable results on key metrics in patient flow in Toronto.
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
  • Development and Evaluation of a "Working Together" Framework and a Tool
           Kit to Enhance Inter-organizational Relationships in Healthcare
    • Abstract: Healthcare is in a constant state of change and evolution driven by a multitude of complex factors and interactions. Consequently, organizations, teams and individuals in healthcare have to habitually realign their working relationships. Furthermore, research has shown that "working together" relationships fail in the absence of a defined framework. In this research, a novel framework and a tool kit for working together have been developed and evaluated. The framework has a formal process to articulate the intended purpose/outcome, clearly align the type of working relationship with the purpose and identify the barriers and facilitators to working relationships in healthcare.
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
  • Drug Information Systems: Evolution of Benefits with System Maturity
    • Abstract: Benefits from information and communication technology tend to grow over time as system use matures. This study examines pharmacists' experiences with provincial drug information systems (DIS) across Canada. At the time of survey, two provinces had more mature DIS (more than five years) and three provinces had less mature DIS (five years or less).A national online survey of pharmacists was conducted in February 2010. Of the 737 survey responses received, 402 respondents were practising in a province with a DIS. Over 90% of pharmacists using a DIS reported improvements in access to patient information, fraudulent medication use, medication management and drug-related problems. For these benefits, the degree of improvement was similar across provinces. For other benefits, improvements were greater for users of more mature DIS.Some benefits of DIS are realized in the short-term, whereas others take longer to develop. Critical success factors related to implementation, change management and policy alignment may play a role in accelerating realization of long-term benefits.The use of information and communication technology (ICT) in healthcare is evolving rapidly in Canada and around the world. There is a growing body of literature evaluating the results of ICT use, but most studies are short-term. Publications that quantify costs and benefits using empirical evidence over a longer time remain limited (Brown et al. 2008; Shekelle and Goldzweig 2009; Wang et al. 2003). This is especially important since the early phases of implementation can be resource intensive and maximum value may take time to achieve (Brown et al. 2008; Dobrev et al. 2010; McKibbon et al. 2011). This phenomenon is not unique to healthcare and is also observed in technology innovation in other industries, such as manufacturing (Klein and Knight 2005).
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
  • Enhancing Care for Individuals with Mobility Impairments: Lessons Learned
           in the Implementation of a Primary Care–Based Mobility Clinic
    • Abstract: Persons with mobility impairments experience significant barriers to primary healthcare. This study examines key lessons learned, as derived from interviews with referral sources and Centre for Family Medicine Mobility Clinic team members, in the development and implementation of a primary care–based mobility clinic aimed at reducing these barriers, and it reflects on the implications of this model of care on the system of care. Results highlight the importance of accessibility, specialized equipment, promotional activities and management support as well as challenges reflected by system barriers to care. The results of this study have implications for the application of this model of care in other settings.
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
  • Our Patients Expect More (and So Do We): It's Time to Rethink Patient
           Satisfaction
    • Abstract: A current focus of healthcare organizations and legislation requires hospitals to place more importance on patient experience and satisfaction than ever before. Institutional patient satisfaction survey tools yield data that represent approximately 5% of patients and may not represent the typical patient experience. Moreover, our research demonstrates that only 1% of surveyed providers rely on these data as their primary source of patient satisfaction feedback. The low response rate, the delayed timing of the feedback and a lack of usability for clinicians raise questions about the value of these tools to front-line healthcare providers – those most responsible for the patients' experience of care.
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
  • Rapid Dissemination of a Critical Care Protocol Using Basic Information
           Technology Prior to a Rave
    • Abstract: Enterprise-level information technology systems deliver significant quality improvements. Regions with low implementation can leverage basic technology to improve quality and safety. The Division of Critical Care Medicine in Edmonton, Alberta, was able to rapidly develop and disseminate a care protocol for ecstasy (MDMA) intoxication prior to a large public event. Using only email and word processors, the protocol was developed based on recent experience at one site. It was approved by divisional members and then used in another hospital in Edmonton for two patients. Debriefing revealed that the availability of the protocol was instrumental in starting appropriate therapy and preventing death.
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
  • Small Changes Produce Large Gains in Efficiency: A Case Study from Ross
           Memorial Hospital
    • Abstract: Healthcare is now more challenged to provide excellent care, while also increasing efficiency with more limited resources. The recent introduction of Ontario's funding reform challenges hospitals to increase the efficiency of specific procedures by providing funding based on patient volumes. The cataract surgery program at Ross Memorial Hospital, in Lindsay, Ontario, is an example of how a program designed a few years ago with a focus on patient care and efficiency managed to become substantially more efficient by introducing a series of small changes.
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
  • Organ Failure and Treatment in Canada
    • Abstract: Organ Failure and Treatment in Canada
      PubDate: Thu, 01 Jan 1970 00:00:00 +000
       
 
 
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