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Abstract: After two years of turmoil, the pandemic seems to be waning. The light at the end of a two-year-long tunnel is getting brighter. Spring is coming – although slowly in some parts of the country. Children are back in school. We are able to socialize and travel again with fewer and fewer restrictions. Tragic events, such as the war in Ukraine and the challenges of climate change notwithstanding, there is a sense of hopefulness in the air. PubDate: Wed, 27 Apr 2022 04:00:00 +000
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Please help us test our new pre-print finding feature by giving the pre-print link a rating. A 5 star rating indicates the linked pre-print has the exact same content as the published article.
Abstract: The Ted Freedman Award for Innovation in Education 2021 PubDate: Wed, 27 Apr 2022 04:00:00 +000
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Abstract: There has been considerable growth in the development of machine learning algorithms for clinical applications. The authors survey recent machine learning models developed with the use of large health administrative databases at ICES and highlight three areas of ongoing development that are particularly important for health system applications. PubDate: Wed, 27 Apr 2022 04:00:00 +000
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Abstract: Healthcare workers are the foundation that keep our healthcare systems running. The recent COVID-19 pandemic has placed unprecedented demands on Canada's health workforce. The Canadian Institute for Health Information has compiled data and information to help inform how the pandemic has impacted healthcare workers and the care Canadians received.This article deliberates on the many challenges of the pandemic, such as safety and access to personal protective equipment, faced by healthcare workers along with its impact on health workers and the healthcare system. The article also shares how the system responded to protect the health workforce and boost capacity by expanding provider roles and adapting new ways of delivering services, including quickly adapting to virtual care. PubDate: Wed, 27 Apr 2022 04:00:00 +000
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Abstract: Increasing awareness of the extent of preventable harm from healthcare has led to efforts to improve patient safety through a variety of efforts, including legislation. Extending legal privilege to quality and safety reviews leads to further harm for many patients, families and healthcare providers. The intentional isolation, silencing and exclusion after the incident undermines trust, prevents learning and impedes an opportunity to heal and recover for all those directly involved. Our case study examines Section 51 of British Columbia's Evidence Act (1996) and concludes that amending this legislation is an urgent and necessary step toward trauma-informed care. PubDate: Wed, 27 Apr 2022 04:00:00 +000
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Abstract: Boards are a powerful resource in overseeing our health system. This resource is limited in the amount of available time; therefore, boards should be as productive as possible. Boards should focus their energy on tangible, measurable results. Using natural language processing tools and quantitative outcome measures allows us to measure the impact of board focus. This analysis finds no significant relationship between a higher focus on finance or quality as measured by the board minutes and organizational performance in finance or quality. Boards focus much more on finance than quality or any other focus area with no substantive difference in outcomes. The study indicates that, at least in Ontario, boards may need to revise their approach and allocation of time to these topics. PubDate: Wed, 27 Apr 2022 04:00:00 +000
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Abstract: Commentary: Is Your Organization Providing Quality Care' PubDate: Wed, 27 Apr 2022 04:00:00 +000
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Abstract: Eastern Health (EH) is the most populous of four Regional Health Authorities in Newfoundland and Labrador. In 2017, EH realized the potential impact that healthcare innovation could have on improving patient care, its outcomes as well as provincial economic development. This paper describes EH's innovation journey with "vested contracting," a relatively rare approach in Canada, for its procurement of management services for support activities, such as housekeeping, laundry, patient/resident food services, retail food services and portering. Through individual interviews with EH executives, directors and the successful vendor, this paper describes the system changes needed to accommodate "vested contracting," the burden associated with learning and changing the procurement process and lessons learned. PubDate: Wed, 27 Apr 2022 04:00:00 +000
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Abstract: Granting minors with online access to their personal health information (PHI) is a complex policy and implementation issue, requiring a balance of rapid changes in adolescent maturity and autonomy, adolescent need for privacy and confidentiality and care responsibilities of custodians and providers. There are currently no standard legislation or policies that enable access; however, most implementations use the age of majority or the mature minor doctrine as an approach – each with its own limitations. This paper highlights key legislative and implementation insights for organizations seeking to enable adolescents with online access to their PHI, calling for leadership to address this issue. PubDate: Wed, 27 Apr 2022 04:00:00 +000
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Abstract: The healthcare system is complex and requires effective leaders who can navigate team, organizational and system dynamics. The objectives of this study were to explore competencies required to lead emerging healthcare challenges and identify strategies for developing successful leaders. Semi-structured interviews were conducted with 12 healthcare leaders from the government, hospitals and in consulting. This study unpacks competencies such as communication and change management and draws attention to the significance of emotional intelligence and working with data that have not traditionally been identified as key competencies. These findings can inform curriculum and modernization initiatives in healthcare leadership programs. PubDate: Wed, 27 Apr 2022 04:00:00 +000
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Abstract: Modernized primary care systems are founded in holistic team-based care. Many models exist in the world. However, to overcome the challenges of various physician funding models and to scale resources across the highly populated urban/suburban areas, a different approach is needed. A new integrated primary care centre, CarePoint Health, was designed to solve these remaining gaps. This paper outlines the evaluation of the model after one year in operation, highlighting critical success factors for any future centre: design, team unity and culture of learning. Recommendations for the next steps include the development of a standard blueprint, dedicated funding and a single oversight body for the creation of new centres across the province. PubDate: Wed, 27 Apr 2022 04:00:00 +000
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Abstract: Hospitals had to create new practices, training programs and roles due to the COVID-19 pandemic. An urban community hospital enacted written policies to cross-train nurses for supporting patients in an intensive care setting.This paper shares the planning, implementation, evaluation and revision of a support nurse training for a team-based intensive care unit model. Learning evaluations show that tailoring the education to the type of nurse is received more positively than a general skills training session. Leaders are encouraged to ensure that teams have role clarity and practice supports to be successful. PubDate: Wed, 27 Apr 2022 04:00:00 +000
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Abstract: This special edition of Healthcare Quarterly (HQ) has been developed through a novel partnership between the Ontario Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit (OSSU) and Longwoods Publishing. The concept for this edition emerged from an alignment of interests between the partners. OSSU's mandate is to support patient-oriented health and health services research in Ontario and to facilitate the uptake of research evidence to improve health policy and decision making. HQ's mission is to recognize, nurture and champion excellence in the Canadian healthcare system by sharing leading practices in health services delivery and policy development. As we look toward the future of healthcare and health system transformation, leading practices will be increasingly defined by the degree to which they are designed and implemented in full partnership with patients and caregivers. This perspective, shared by both OSSU and Longwoods, is at the heart of this publication. PubDate: Fri, 15 Apr 2022 04:00:00 +000
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Abstract: Patient partnerships require adequate planning, support and funding to mobilize knowledge and accelerate impact. We outline the themes and foreground ways in which the Engaging Multi-stakeholders for Patient Oriented-research Wider Effects and Reach teams have advanced patient-oriented research in Ontario. PubDate: Fri, 15 Apr 2022 04:00:00 +000
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Abstract: While it is recognized that research priorities should reflect and integrate the perspectives and needs of patients along with those of health professionals and researchers, it remains challenging to actualize such priorities into tangible research projects. Targeted dissemination is required to catalyze research on these priorities. To create awareness of and inspire action toward actualizing the top 10 retinoblastoma research priorities in Canada, Canadian Retinoblastoma Research Advisory Board (CRRAB) members developed a wide range of dissemination tools and processes. These resources, co-produced with patients, were instrumental to CRRAB sharing the top 10 priorities internationally to mobilize action toward solving them. Key Points The Canadian Retinoblastoma Research Advisory Board (CRRAB) serves to facilitate involvement of patients in all aspects of retinoblastoma research. One of the first initiatives of CRRAB was to jointly determine the top 10 retinoblastoma research priorities in Canada. To increase awareness of and inspire action toward solving the top 10 retinoblastoma research priorities, CRRAB members developed and implemented a wide range of dissemination tools and processes. The dissemination tools were used to reach key researchers, as well as members of the public, and they continue to be utilized through the CRRAB website. PubDate: Fri, 15 Apr 2022 04:00:00 +000
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Abstract: Our original patient-oriented research project identified the top 10 priorities for pediatric chronic pain research and care in Canada from the perspective of people with lived experience (patients), their family members and healthcare professionals through a modified James Lind Alliance Priority Setting Partnership. We undertook subsequent knowledge translation activities with youth, families, healthcare professionals, decision makers and researchers to (1) generate awareness and interest in the top 10 priorities and our partnership process, (2) facilitate collaborative dialogue and open innovation and (3) integrate and adopt the top 10 priorities into stakeholder activities. This paper describes our knowledge translation activities, outcomes and impact. Key Points Partnership with youth with chronic pain and parents led to a greater impact of knowledge translation activities. A focus on knowledge translation and patient partnership enabled our work to move beyond knowledge sharing to behaviour and policy change. Challenges in patient engagement and knowledge translation were overcome through inclusion of multiple youth and parent partners. PubDate: Fri, 15 Apr 2022 04:00:00 +000
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Abstract: Poor access to care is a top patient-oriented research priority for youth with chronic pain in Canada, and the COVID-19 pandemic has exacerbated these concerns. Our patient-oriented project team engaged with marginalized and racialized youth with chronic pain (Black youth with sickle cell disease, Indigenous youth and youth with complex medical needs) and their families to ensure that best practice recommendations for virtual care are inclusive and equitable. Input provided through virtual round-table discussions improved recommendations for leveraging, implementing and selecting best platforms for virtual care for youth with chronic pain and identified new gaps for future research, practice and policy change. Key Points Partnership is key to equitable, diverse and inclusive engagement, particularly when engaging with populations or population groups that are marginalized. Virtual activities both facilitated and hindered equitable, diverse, inclusive and accessible engagement. Patient engagement offered an opportunity to critically expand on and refine learnings from the scientific literature – in this case, on a rapidly emerging widespread need for virtual care for pain during the COVID-19 pandemic. PubDate: Fri, 15 Apr 2022 04:00:00 +000
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Abstract: This article describes the methods, successes and challenges of engaging parents while studying the impacts of COVID-19 on healthy children and families. Parent partners in a Parent and Clinician Team (PACT) informed study aims, supported feasibility and recommended changes to enhance participation. PACT members stated that they felt a sense of connectedness and purpose by contributing to COVID-19 research. Engagement increased by parents acquiring new roles, attending more frequent meetings and co-creating alternative methods of engagement. Recruiting new PACT members was challenging, likely due to limited time and resources available to parents of young children during a pandemic. PubDate: Fri, 15 Apr 2022 04:00:00 +000
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Abstract: Background: The aim of this project was to engage with patient partners to translate knowledge about the decision aids and develop a scaling-up strategy for wider effects and reach.Method: This project was guided by the World Health Organization and IDEAS (Integrate, Design, Assess and Share) frameworks for design thinking (e.g., ideating creative strategies), dissemination (e.g., sharing locally and widely) and scalability.Results: We engaged 132 stakeholders in six webinars, had 321 total page views of the decision aids and conducted 16 interviews to determine revisions to the design of the decision aids before scalability.Conclusion: Patient-partner collaborations assisted with design thinking, dissemination and scalability. PubDate: Fri, 15 Apr 2022 04:00:00 +000
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Abstract: Background: Health technology has increasingly moved toward adopting a "user-centred design" approach to include the user/patient throughout the innovation and design process; however, few studies have evaluated the patient's experience of such an engagement.Objective: The aim of this study was to explore the role of patient engagement (PE) within e-health innovation research.Method: Using qualitative descriptive methodology, semi-structured interviews were conducted with eight participants (patient partners and research/development team members).Findings: Key themes were centred on enablers of, challenges to and methods of improving PE.Conclusion: PE must be prioritized from study conception, explicitly programmed into study conduct and valued by integrating patient partner input. PubDate: Fri, 15 Apr 2022 04:00:00 +000
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Abstract: In this commentary, we reflect on our experience of co-designing an intervention to address challenges due to delayed hospital discharge (known as alternate level of care in Canada). Through a series of focus groups and co-design sessions, we identified common challenges with delayed discharge (including a lack of services while waiting for discharge and poor communication with the care team). In co-designing service improvements, we (1) amplified the voices of patients and caregivers, which helped them feel unified in their experience and (2) developed tools that aim to improve patient, caregiver and provider experiences. In this commentary, we reflect on these impacts along with the key lessons learned. PubDate: Fri, 15 Apr 2022 04:00:00 +000
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Abstract: A lack of mental health literacy may impact youths' ability to advocate for themselves as they seek to access and navigate the mental healthcare system. Recognizing this, members of the National Youth Action Council at the Centre for Addiction and Mental Health in Toronto, ON, developed the Youth Wellness Quest resource. This health literacy resource informs youth of possible available services, increasing their capacity to make informed mental healthcare decisions. The youth-led process of creating this resource, from development to dissemination, is described within this paper, showcasing how youth can lead the development of tools designed for youth. PubDate: Fri, 15 Apr 2022 04:00:00 +000
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Abstract: Peer-to-peer recruitment efforts are important in generating interest and participation of patients as partners in research but difficult to sustain when face-to-face interactions are limited. The Retinoblastoma Research and You! booklet, co-developed by patients, researchers and health professionals, serves as a guide for patient engagement in research while retaining an element of personalization. The Retinoblastoma Research and You! booklet was developed through two virtual workshops to iterate and finalize the booklet design and content. The booklet outlines how individual patients' lived experiences and skills can influence retinoblastoma research and highlights real-world examples of patient-partnered research activities at different stages of the research process. PubDate: Fri, 15 Apr 2022 04:00:00 +000
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Abstract: Kidney transplantation gives many patients with kidney failure a longer and healthier life. Unfortunately, some transplant-eligible patients will never receive one. In this paper, we describe how patients and researchers collaborated on new strategies and programs to enhance access to kidney transplantation and living kidney donation. These efforts led to the creation of the Transplant Ambassador Program (TAP). TAP is a patient-led program that helps connect patients who have kidney failure to individuals who have successfully received a kidney transplant or donated a kidney. We also detail barriers, facilitators and lessons learned from engaging patients in research. PubDate: Fri, 15 Apr 2022 04:00:00 +000
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Abstract: AbstractEngaging patients as partners in the design and execution of early-phase clinical trials offers a unique opportunity to ensure patient perspectives are considered. Here we describe our experience partnering with four individuals with lived experience of blood cancer to co-develop documents and services to support participants of an early-phase trial. Through regular team meetings, patient partners co-developed a visual informed consent document and a non-technical summary of the informed consent document to facilitate participant understanding of trial procedures. Overall, patient partners highlighted important trial components that would not have been identified without their input. PubDate: Fri, 15 Apr 2022 04:00:00 +000
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Abstract: Building on a study to develop core outcome sets for children with rare inherited metabolic diseases, the purpose of this workshop was to inform the design of longitudinal pediatric registries that support registry-based clinical trials. This workshop was co-designed by two patient/family partner investigators and attended by two family advisors who received preparatory training. Patient partners and advisors recommended integrating the collection of registry data into everyday life and highlighted the importance of transparent communication and attention to the issue of integration of patient-reported data into clinical care. We propose a need to explore strategies for engaging patients in post-project knowledge translation. PubDate: Fri, 15 Apr 2022 04:00:00 +000
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Abstract: Equity-Mobilizing Partnerships in Community (EMPaCT) is a novel approach to patient engagement that centres diverse lived experiences and promotes equity-oriented and inclusive partnerships. As an independent community table, EMPaCT is made up primarily of patients/diverse members of community. Researchers and other decision makers come to this table with their projects to learn how to make their project more inclusive and equitable. In this paper, we detail how we used participatory co-design to define, build and grow EMPaCT as an innovative and scalable patient partnership model that promotes bottom-up action for health equity. PubDate: Fri, 15 Apr 2022 04:00:00 +000
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Abstract: First Nations in Ontario are building capacity to leverage health services data in Ontario to provide robust, First Nations–driven health evidence. Beyond providing evidence, population health research processes must involve diverse First Nations' perspectives, collective capacity building and translation of research findings into action through integrated and community engaged knowledge translation and exchange (KTE) approaches. Suggested ways include integrating stories and traditional knowledge, prioritizing gatherings and establishing an enduring commitment to action. To effectively support First Nations' self-determination and sovereignty, First Nations' principles of ownership, control, access and possession (OCAP®) in research could be expanded to include "action" (OCAPA). PubDate: Fri, 15 Apr 2022 04:00:00 +000
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Abstract: This project involved patients with intellectual and developmental disabilities and a family caregiver as advisors on a knowledge translation (KT) effort on healthcare communication. The project demonstrated that with the right supports, patient and family advisors can effectively share their experiences and add a powerful voice to KT activities. Lessons learned included the importance of being creative, responsive and flexible to support the advisors, of recognizing their expertise and of building capacity in multiple advisors to allow for diverse voices and greater flexibility. This work requires adequate time and funding, which needs to be factored into planning. PubDate: Fri, 15 Apr 2022 04:00:00 +000
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Abstract: From the perspective of patient partners, the Ontario SPOR SUPPORT Unit Engaging Multi-stakeholders for Patient Oriented-research Wider Effects and Reach Awards have facilitated successful patient-partnered research projects, which, in turn, have led to an evolution in patient partnerships and engagement strategies. The 15 projects profiled in this special issue point to the beneficial impacts of patient-partnered research. PubDate: Fri, 15 Apr 2022 04:00:00 +000
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Abstract: Patient-engaged research requires strong patient and applied partnerships to realize innovative knowledge mobilization. Demonstrating impact and sustainability, advancing health equity, evaluating engagement and incorporating flexibility are key ingredients to advance engagement science. PubDate: Fri, 15 Apr 2022 04:00:00 +000
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Abstract: From the Editors PubDate: Fri, 28 Jan 2022 05:00:00 +000
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Abstract: Homelessness is a significant social issue within Canada but is difficult to quantify at the population level. In this paper, we discuss the development and use of a case ascertainment algorithm that identifies people experiencing homelessness through health administrative data. We highlight the appropriateness of various uses of this method given its key strengths and limitations. Finally, we discuss plans to improve this methodology and broaden its use through the addition of linkable administrative data from non-health sectors, such as emergency shelters and social services organizations. PubDate: Fri, 28 Jan 2022 05:00:00 +000
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Abstract: In 2020, health systems across Canada responded to the COVID-19 pandemic by making rapid changes to reduce the risk of exposure for patients and staff and to allocate resources toward the treatment of COVID-19 patients. This included postponing surgical and diagnostic procedures. Data collected by the Canadian Institute for Health Information show that these interventions resulted in longer wait times across all provinces in April–September 2020 for scheduled surgical procedures, such as hip and knee replacements and cataract surgeries. The impact on wait times for cancer surgeries and diagnostic imaging varied by type of procedure and jurisdiction, while the wait times for hip fracture repair and radiation therapy were not impacted. Subsequent waves of the COVID-19 pandemic added to the initial backlog of procedures, and it will take time to assess the long-term impact of surgical and diagnostic imaging delays on patient outcomes and wait times. PubDate: Fri, 28 Jan 2022 05:00:00 +000
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Abstract: Eastern Health (EH), the most populous region of the four Newfoundland and Labrador (NL) Regional Health Authorities, has been advancing innovation to improve patient care, health outcomes and provincial economic development. This paper describes how EH engaged with the provincial Department of Finance to estimate the direct, indirect and induced economic impacts on provincial gross domestic product, employment and employment income from innovation-related activities. The modelling demonstrated significant economic benefits in both 2019 and 2020. There was a large increase in 2020 due to pandemic-related personal protective equipment manufacturing opportunities. The number of well-paying jobs created also increased. Local healthcare innovation was stimulated by EH's Living Lab, Health Innovation Team and increased coordination between vendor partners, Memorial University, the NL Centre for Health Information and government funding agencies. PubDate: Fri, 28 Jan 2022 05:00:00 +000
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Abstract: Healthcare institutions have been searching for ways to increase the value they deliver to patients and to society. Innovation is an effective way to boost this value, and procurement strategies are key to bringing innovation into healthcare organizations. However, hospitals are one of the most challenging organizations to implement innovations. Thus, this research highlights some lessons learned and the best practices of a healthcare organization in Denmark that has successfully implemented the value-based procurement approach. PubDate: Fri, 28 Jan 2022 05:00:00 +000
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Abstract: The Ontario Ministry of Health funded a reintegration unit to transition hospitalized patients who no longer required acute care to alternate level of care (ALC), such as long-term care. In its first year, 102 (3.5%) patients of the hospital's waiting-for-ALC population were transferred, with 37.3% transferred on the day of ALC readiness. The reintegration unit reduced direct hospital costs by $861,000. Using case costing, we modelled optimized scenarios including all transfers on the day of ALC readiness and increased transfers to the reintegration unit; this helped reduce avoided direct costs by $2.3–$5.4 million. Acute-care bed capacity could have increased by 11%. We outline strategies to optimize future performance of the reintegration unit. PubDate: Fri, 28 Jan 2022 05:00:00 +000
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Abstract: The pediatric demand for medical cannabis has been increasing. This has necessitated the need to develop hospital statements and policies at the Children's Hospital of Eastern Ontario (CHEO) to provide clinicians and administrators with recommendations for working with patients and caregivers seeking the use of prescribed or non-prescribed cannabis. Through a structured working group, two hospital position statements and policies on the pediatric use of medical and non-prescribed cannabis were developed for patients served at CHEO. In highlighting the procedural framework and position statements, these policies provide valuable recommendations and resources to other hospitals seeking to develop similar administrative action. In a changing medical landscape, best practices and policies are needed for hospital administrators on the patient use of medical and non-prescribed cannabis. The authors highlight recent policy work and position statements from CHEO, providing a valuable reference to all pediatric and adult hospitals. PubDate: Fri, 28 Jan 2022 05:00:00 +000
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Abstract: The digital health landscape is rapidly evolving with regard to how society accesses and interacts with digital information and technologies. With a largely commercial marketplace, there are growing concerns that users are not fully informed about how their data are used. Canadian privacy legislation is currently undergoing modernization to improve the transparency of commercial information handling practices through the introduction of meaningful consent. This paper reports on workshops held across Canada, exploring the implications of meaningful consent in a digital health context. Recommendations focus on measures to promote transparency, improve digital literacy and foster public trust in digital health innovations. PubDate: Fri, 28 Jan 2022 05:00:00 +000
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Abstract: While the importance of physician involvement in organizational quality and safety (Q&S) activities has been well established, a paucity of information exists on tangible supports needed to effectively execute this role. Interviews with 13 MD Q&S leads uncovered common enablers, including valuing Q&S work academically, hiring skilled collaborators, ensuring appropriate power and authority to advance Q&S initiatives, facilitating connections, emphasizing culture change and strong action by leadership. To operationalize these enablers and drive quality innovation, organizations should prioritize the identification and appointment of MD Q&S leads for each department/division and facilitate their assembly as a formal physician Q&S committee. PubDate: Fri, 28 Jan 2022 05:00:00 +000
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Abstract: Workplace violence is a common safety concern for hospital staff. The Behaviour Safety Risk Communication and Care Planning program identifies, manages and cares for patients at risk of exhibiting unsafe behaviours. This paper reports on a mixed-methods evaluation consisting of staff surveys, focus groups and open forums, screening audits, patient interviews and assessment of effectiveness measures at five hospital sites. Staff perceptions about safety risk imposed by a patient's behaviour significantly improved after this program was implemented. Opportunities exist to improve staff adherence to screening processes and communication with patients. This study provides insight for teams implementing similar interventions. PubDate: Fri, 28 Jan 2022 05:00:00 +000
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Abstract: The healthcare system has undergone a transformational shift toward people-centred care (PCC), and healthcare leaders are accountable for enabling this culture change. This paper describes the University Health Network's journey of using a person-centred approach for cultural transformation, reflecting on (a) the leadership elements required to build and sustain a culture of PCC; (b) the importance of establishing a Patient Declaration of Values, which is a framework for patient care; and (c) how this culture led our approach during the COVID-19 pandemic. PubDate: Fri, 28 Jan 2022 05:00:00 +000
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