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Abstract: From the Editors PubDate: Tue, 30 Apr 2024 04:00:00 +000
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Abstract: Sex and gender may play a role in the association between occupational experiences and the mental health (MH) of defence and public safety personnel. This report summarizes the findings of three studies exploring sex-based differences in MH service use between Veterans and non-Veterans in Ontario. Female Veterans had significantly higher rates of MH-related physician visits, emergency department visits and hospitalizations compared to female non-Veterans. These findings impart useful information for individuals or organizations with the ability to influence healthcare policy, planning and delivery for the Canadian defence and public safety sectors. PubDate: Tue, 30 Apr 2024 04:00:00 +000
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Abstract: Throughout the COVID-19 pandemic, delivery of care was exceedingly difficult for hospital healthcare teams. This analysis presents a high-level look at the available pan-Canadian data on hospital staffing – including sick time, overtime and agency use – and potential impacts on patient harm in acute care hospitals. In 2021–2022, nurses and other healthcare providers working in hospital in-patient units across Canada logged significantly more overtime and sick-time hours compared with the previous year, equating to a shortfall of almost 14,000 full-time positions. Concurrently, the pan-Canadian rate of unintentional hospital harm increased to 6% compared with pre-pandemic numbers. The Hospital Harm Improvement Resource (HEC 2023a) links harm measurement and improvement efforts by providing evidence-informed practices to support patient safety improvement efforts. PubDate: Tue, 30 Apr 2024 04:00:00 +000
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Abstract: To champion an unremarkable health system means pursuing results within a corridor of “decent enough” results that do not merit concern, thereby offering a baseline for system improvement and allowing for the identification of surprising data that may surface in future monitoring. Pursuing such unremarkability in healthcare maximizes the health and welfare of everyone and can support quality improvement across all institutions. PubDate: Tue, 30 Apr 2024 04:00:00 +000
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Abstract: Twenty years after the publication of the Canadian Adverse Events Study, the incidence of patient safety events remains an important challenge in Canadian healthcare. Human resource issues dominate current strategic plans, but these issues need to be linked to renewed efforts to assure safer care. PubDate: Tue, 30 Apr 2024 04:00:00 +000
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Abstract: Across Canada, pressures related to staffing, burnout and funding continue to affect healthcare organizations and systems. These pressures impact the quality of care Canadians receive, most notably access to care. Evidence indicates that patients are more likely to suffer from preventable harm during periods of hospital overcrowding and, indeed, very recent data from the Canadian Institute for Health Information suggest that rates of preventable harm have increased modestly in Canadian hospitals. A key lever that can have a positive impact on patient safety culture and contribute to fewer preventable adverse events at an institutional level is systematic formal case reviews. This article describes a large healthcare organization's approach to systematically reviewing serious harm events. An evaluation of both quantitative and qualitative metrics suggests that Unity Health Toronto's critical incident review process has been effective at building a resilient patient safety culture that stood up to the challenges of the COVID-19 pandemic and continues to have a positive impact on patient safety at Unity Health Toronto. PubDate: Tue, 30 Apr 2024 04:00:00 +000
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Abstract: Healthcare administrators steer their organizations' strategic direction with an emphasis on quality, value and efficiency, aiming to improve patient outcomes and ensure operational sustainability. Artificial intelligence (AI) has become a transformative force in healthcare in the past decade, with Canadian health systems and research institutions investing in AI solutions to address critical healthcare challenges. This primer delivers a fundamental guide to essential AI concepts in healthcare and provides practical guidance to prepare organizations for AI readiness. PubDate: Tue, 30 Apr 2024 04:00:00 +000
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Abstract: The long-standing systemic inequities highlighted during the COVID-19 pandemic and current events of social injustice have underscored the importance for health system leaders to develop or strengthen their competencies related to equity, diversity and inclusion. Inclusive leadership values different perspectives across organizational hierarchies. It reduces psychological distress and improves the performance of individuals and teams in health settings. Through semi-structured interviews, we explored the inclusive leadership experiences of five health system leaders. This study offers initial insights by unpacking inclusive leadership as a competency, identifying barriers and enablers and providing advice for current and future health system leaders. PubDate: Tue, 30 Apr 2024 04:00:00 +000
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Abstract: The Bridge-to-Home program was launched as a 16-month collaborative from 2018 to 2020 to improve care transitions out of hospital using a patient engagement–focused quality improvement (QI) initiative. Teams that participated in the collaborative were able to implement elements of the patient-oriented care transitions bundle, improve experience of care transitions and increase capacity for patient engagement for both patient partners and providers. In this article, we highlight three case studies of teams in different types of organizations with different levels of patient engagement maturation. Key enablers and barriers are identified with a specific lens on engagement efforts to co-produce changes in the processes and experience of care. These cases illustrate that providing support for patient engagement when leading a QI initiative is mutually reinforcing, where patient engagement and QI support and strengthen each other, resulting in increased success of the quality initiative and increased capacity for patient engagement. PubDate: Tue, 30 Apr 2024 04:00:00 +000
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Abstract: We reflect on the paper from Hahn-Goldberg et al. (2024) who shared key learnings from a pan-Canadian quality improvement (QI) and patient engagement care transition initiative called Bridge-to-Home. In considering the approach and outcomes presented in their paper, we have generated reflections and practical suggestions on how to amplify engagement work even further: (1) patient engagement and QI are about relationships; (2) seamlessly implementing complex interventions across siloed organizations continues to be a challenge, which engagement alone cannot solve; (3) it is time for a paradigm shift; (4) QI is about human behaviour change and is inherently messy; and (5) embedding fulsome evaluation of engagement is essential. PubDate: Tue, 30 Apr 2024 04:00:00 +000
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Abstract: Ontario Health Teams (OHTs), models of integrated care, are responsible for measuring and improving patient experience. However, routine collection of patient-reported data has not been fully realized, presenting a significant system-wide gap. We conducted a pilot study to implement routine collection of patient-reported data in the Frontenac, Lennox and Addington (FLA) OHT. Each clinic integrated the survey, which captured encounter experience, health and well-being and demographics into their workflow. During the five-month pilot, over 1,200 patients shared their experiences. Clinics reported that the data were valuable for ongoing quality improvement, boosting staff morale and providing a voice to patients. Each site needed flexibility for deployment and to ensure that they captured data relevant to their practice needs. A balance is needed to meet differing needs at each level of the system, requiring cross-sectoral commitment for integrated care systems to truly understand the patient experience and health of the population. PubDate: Tue, 30 Apr 2024 04:00:00 +000
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Abstract: From the Editors PubDate: Wed, 31 Jan 2024 05:00:00 +000
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Abstract: There is growing recognition of the importance of patient, public and community engagement in health research, which has not been used widely in analyzing health administrative datasets. In Ontario, health data are stewarded by ICES, whose strategic decision making is guided by a diverse Public Advisory Council (PAC). In a first foray into publicly led projects, the ICES PAC undertook an analysis project on mental health and addiction health service use. Public members guided the project through all stages of research. This generated critical lessons for ICES on improving participation, collaboration and trust. PubDate: Wed, 31 Jan 2024 05:00:00 +000
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Abstract: Joint replacements are among the most effective and most frequently performed surgeries in Canada. Patient-reported outcome measures (PROMs) are measurement instruments completed by patients about aspects of their health status, including pain and function. PROMs data from three provinces show that approximately nine in 10 patients report higher PROM scores after joint replacement surgery. These data can help identify factors that lead to better care and opportunities to further understand what contributes to a patient's perception of surgical success. Expanding the collection of PROMs to more patients and more provinces is needed to help healthcare planners and clinicians understand these important outcomes. PubDate: Wed, 31 Jan 2024 05:00:00 +000
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Abstract: The integration of artificial intelligence (AI) offers the promise of developing open-source frameworks and tools that incorporate social and behavioural determinants of health data, thereby fostering an empirical understanding of the causal factors behind patient complaints. Through comprehensive complaint capture and analysis, “Ombuds AI” has the potential to realize the vision of delivering equitable, high-quality and sustainable healthcare. PubDate: Wed, 31 Jan 2024 05:00:00 +000
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Abstract: The future of quality is personal. Health Quality 5.0 moves people-centred, integrated health and social care systems to the forefront of our post-COVID-19 agenda – and that cannot happen without addressing our global workforce crisis. Building back a stronger, healthier workforce is the first of the five big challenges we address in our special series. Starting with the global health workforce crisis is fitting, given it is the most fundamental and formidable barrier to health and quality today. As we put the pieces of the Health Quality 5.0 puzzle together, a picture of a more resilient health system will emerge and a new leadership agenda to get there will take shape. PubDate: Wed, 31 Jan 2024 05:00:00 +000
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Abstract: Parents of children with medical complexities (CMCs) report significant challenges affecting their financial, emotional and social well-being in relation to caring for their child's medical needs. The Complex Care Navigator Program was designed to provide social, emotional and economic support to parents of CMCs. This paper describes the results and outcomes of the program and the challenges experienced during the evaluation process. Overall, results suggest that the program had a positive impact on the parents' psychosocial functioning and social connections. The results demonstrate the importance of providing early screening, psychosocial intervention and peer support. PubDate: Wed, 31 Jan 2024 05:00:00 +000
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Abstract: People-centred care is foundational to healthcare excellence. One urban Canadian long-term care residence recently participated in an initiative titled “Improving the Care Conference Experience” to engage residents and families in annual care conferences. The Institute for Healthcare Improvement introduced “care bundles” to group evidence-based practices within standard processes. For this initiative, one health region's Experience in Care team co-developed, implemented and evaluated an “experience bundle” for inclusive care conferences with key stakeholders including residents, family members, direct care providers and leadership. Our ongoing goal is to collaboratively create a culture shift from “doing to/for” to “doing with.” PubDate: Wed, 31 Jan 2024 05:00:00 +000
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Abstract: Through an ambitious change management initiative titled “No One Waits (NOW),” Bluewater Health leaders enlisted staff to take ownership of reducing wait times by identifying barriers to transitions within the hospital and to the community. The approach shifted the hospital's culture to overcome those impediments and succeed in reducing wait times dramatically, including compared with peers. Meanwhile, overall patient experience ratings improved and staff trust increased. These changes have been maintained over several years and have resulted in better management of patient volumes during the COVID-19 pandemic and the current health human resources crisis. PubDate: Wed, 31 Jan 2024 05:00:00 +000
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Abstract: Vulnerable populations such as low-income older adults in social housing suffer from poor quality of life and are impacted by chronic diseases. These populations are also high users of emergency services, which contribute to high healthcare costs. Community-based, patient-centred interventions, such as community paramedicine (CP) programs, can address the healthcare gaps for these underserved populations. Community Paramedicine at Clinic (CP@clinic) is an innovative, evidence-based, chronic disease prevention/management program that improves patient health and quality of life, connects them with health and community services, preserves healthcare resources and yields cost savings for the emergency care system. The program also works with other community organizations, facilitating interprofessional engagement and supporting other disciplines in providing care. Known barriers to implementing CP programs highlight the importance of standard practices and training as exemplified by the CP@clinic program. PubDate: Wed, 31 Jan 2024 05:00:00 +000
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Abstract: Language expressed in online forums can highlight which pro-vaccination messages intensify vaccine skepticism and which messages resonate with different populations. This study examined Reddit (an online discussion forum) to analyze what anonymous Canadians disclosed about their rationales for getting vaccinated against COVID-19 during the height of the pandemic. The investigation examined 266 Canadian subreddits (sub-forums on specific topics on Reddit) and evaluated 79 English-language phrases that people commonly use on Reddit to express the reason(s) why they (or someone close to them) chose to get vaccinated/boosted for COVID-19. The findings suggest that machine-learning techniques hold out the promise of a real-time approach toward public health messaging via an iterative Plan-Do-Study-Act cycle. PubDate: Wed, 31 Jan 2024 05:00:00 +000
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Abstract: Vincent Lam, the author of the best-selling novels Bloodletting & Miraculous Cures (Lam 2006) and The Headmaster's Wager (Lam 2012), recently spoke with the editors of Healthcare Quarterly (HQ), Neil Stuart and Anne Wojtak, about his new novel On the Ravine (Lam 2023). The novel explores the nuances of substance abuse and its impacts on patients and the people in their lives. PubDate: Wed, 31 Jan 2024 05:00:00 +000
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