Abstract: Indigenous data governance principles assert that Indigenous communities have a right to data that identifies their people or communities, and a right to determine the use of that data in ways that support Indigenous health and self-determination. Indigenous-driven use of the databases held at the Institute for Clinical Evaluative Sciences (ICES) has resulted in ongoing partnerships between ICES and diverse Indigenous organizations and communities. To respond to this emerging and complex landscape, ICES has established a team whose goal is to support the infrastructure for responding to community-initiated research priorities. ICES works closely with Indigenous partners to develop unique data governance agreements and supports processes, which ensure that ICES scientists must work with Indigenous organizations when conducting research that involves Indigenous peoples. PubDate: Sat, 20 Jan 2018 05:00:00 +000
Abstract: The rise in harms associated with opioids is an issue of increasing public health importance in Canada. The Government of Canada recently reported 2,816 apparent opioid-related deaths across the country in 2016. Recent 2017 data show that deaths involving fentanyl-related opioids have doubled from January to March as compared to the same time period in 2016 (Government of Canada 2017). Additional measures that provide a better understanding of opioid-related harms, such as hospitalizations and emergency department (ED) visits, are a high priority. The objective of this study is to present pan-Canadian data on hospitalizations and ED visits because of opioid poisoning. PubDate: Sat, 20 Jan 2018 05:00:00 +000
Abstract: The philosophy of patient- and family-centred care is widely being adopted in Canada. Critical to this philosophy is the engagement of patients and families as full partners in healthcare. Saskatchewan has successfully adopted a provincial policy that eliminates restrictive visiting hours in hospitals and other healthcare facilities that support partnership with patients and families. This article explains the key role that patient and family advisors played in identifying the need for change and co-creating the implemented Open Family Presence Policy in Saskatchewan. The article outlines the system model, method and audit process that supported the policy implementation. PubDate: Sat, 20 Jan 2018 05:00:00 +000
Abstract: Cancer patients experience a high symptom burden throughout their illness. Quality cancer symptom management has been shown to improve patient quality of life and prevent emergency department use. Cancer Care Ontario introduced standardized symptom screening in Ontario, using the Edmonton Symptom Assessment System (ESAS) to facilitate patient reporting and management of symptoms. However, patient symptom information is not always sufficiently addressed. To address these gaps, patient and family advisors collaborated with clinicians, administrators and health system leaders from across the Province in a Symptom Management Summit to share perspectives and co-design context-specific solutions to improve care in their region. PubDate: Sat, 20 Jan 2018 05:00:00 +000
Abstract: An active offer of French-language health services (FLHS) was introduced in several Canadian provinces to help create an environment that will anticipate the needs of Francophones in their community and will stimulate the demand for services in French. For the active offer to be implemented, changes in how health services are organized and managed at both organizational and system levels must be introduced. In this perspective paper, we identify several success strategies and potential pitfalls with regards to the implementation of the active offer of FLHS primarily at the level of healthcare organization. Our recommendations are based on a recent health services research study exploring reorganization and management strategies for the delivery of the active offer of FLHS in Ontario and insights from a focus group with healthcare administrators conducted as part of this research. We propose a "wrap-around strategy" called organizational health literacy to help reorient organizational culture and improve management and sustainability of the active offer of FLHS. These strategies have relevance for advocates and professionals working to promote an active offer of FLHS, including healthcare administrators, human resource professionals, quality-improvement specialists and others. PubDate: Sat, 20 Jan 2018 05:00:00 +000
Abstract: The expression "shame and blame" has often been used to describe the culture within healthcare when a mistake is made. There has been little exploration, however, on the shame healthcare professionals experience after a mistake. Based on an original grounded theory study on the psychological impact of mistakes on health professionals, this article explores why the healthcare environment is a perfect ecosystem for growing shame, how individuals are coping or not coping with the negative effects of this powerful emotion and what might be done at the system, organizational and team level to mitigate these negative effects. PubDate: Sat, 20 Jan 2018 05:00:00 +000
Abstract: Poor hospital unit culture and staff morale, and dysfunctional multidisciplinary cooperation leads to worse patient safety and satisfaction. The Walk in My Shoes research project aimed to understand how interprofessional job shadowing impacts the attitudes of colleagues. Thirty-three registered nurses at an acute care hospital observed the daily work of social workers. Nurses' attitudes towards social workers were measured by surveys and interviews. Quantitative data indicated a change in nurses' perception of social workers' communication, teamwork and autonomy. Qualitative data indicate that job shadowing helped participants identify personal misperceptions, provided new understanding of roles and gave insight into co-worker job similarities. PubDate: Sat, 20 Jan 2018 05:00:00 +000
Abstract: Patients returning to the community after surgery often experience a disconnect when transitioning from hospital to community home care. Many receive little organized/planned care following discharge sometimes resulting in unplanned expensive care in hospital emergency departments and inpatient readmissions. Trillium Health Partners, a large community/teaching hospital, in partnership with community care provider Saint Elizabeth Health Care, designed and implemented a seamless "bundled care program" for cardiac surgery patients extending from hospitalization to 30 days after discharge. With a risk/gain sharing model, the bundled care program enabled a novel integrated clinical patient care model. This included integrated care coordinators embedded within the hospital team, 24/7 patient phone line, integrated medical records and a tracking board that enabled performance monitoring and improvement. Evaluation results revealed: a 16% reduction in post-operative length of stay; a 38% reduction in readmission rates; and a 13% decrease in total system cost per patient, together with markers of improved patient experience. PubDate: Sat, 20 Jan 2018 05:00:00 +000
Abstract: One of the key challenges to healthcare organizations is the development of relevant and accurate cost information. In this paper, we used time-driven activity-based costing (TDABC) method to calculate the costs of treating individual patients with specific medical conditions over their full cycle of care. We discussed how TDABC provides a critical, systematic and data-driven approach to estimate costs accurately and dynamically, as well as its potential to enable structural and rational cost reduction to bring about a sustainable healthcare system. PubDate: Sat, 20 Jan 2018 05:00:00 +000
Abstract: In 2008, Michael Garron Hospital, transformed its approach to care delivery. The rationale: to improve quality, increase safety and boost patient and staff engagement and satisfaction. The Coordinated Care Team (CCT) model has enabled nurses to not only work to their full scopes of practice within a team of interprofessional providers and unlicensed staff, but also helped create a culture of safety and patient-centredness in a value-driven context. Critics suggest a need for more evaluation and evidence of efficacy. This article provides a rationale, discussion and evaluation of the CCT model based on data curated from implementation to 2016. PubDate: Sat, 20 Jan 2018 05:00:00 +000
Abstract: Antimicrobial stewardship is a key strategy to facilitate judicious antimicrobial use. Software that can amalgamate prescribing and microbiology information in near real-time reporting and track antimicrobial resistance patterns aids timely interventions. This article examines the impact of a clinical surveillance software used to identify patients for prospective audit and feedback rounds by an antimicrobial stewardship team on antibiotic utilization, patient outcomes and workload efficiencies at an acute care community hospital. Results from a general internal medicine unit show statistically significant reductions in the use of broad-spectrum antibiotics and antibiotic expenditures, with no untoward changes in key clinical and patient safety outcomes. PubDate: Sat, 20 Jan 2018 05:00:00 +000
Abstract: Ottawa has a 31-bed palliative care unit (PCU) and two residential adult hospices (total 19 beds). In 2013, we initiated a project to improve the referral and triage processes to these beds. Previously, there were two separate paper-based systems with duplication, inefficiencies, delays and inappropriate patient placements. The multipronged approach included clarifying the respective roles of the PCU and hospices, creating a single referral and triage office and developing an e-platform. We leveraged technology that was available in the public-funded system. This paper describes the development processes, lessons learned, and the final system, referred to as System to Manage Access, Referrals and Triage (SMART). PubDate: Sat, 20 Jan 2018 05:00:00 +000
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