bluuebunny/crossref_metadata_2025 huggingface dataset:
Petitions, Public Opinion and Hospital Restructuring in Kitchener-Waterloo
Authors: Goyder John
Published: July 2010

A survey was collected in 1996–97 in which, early in the petition-gathering process by the Save Our Hospital Campaign to prevent the closing of St. Mary's Hospital in Kitchener, Ontario, known petition signers and a general cross-section of the public were sampled. The survey data demonstrated that signers of the “Save St. Mary's” petition did indeed have strong views about local health issues. The general public and the petition signers were differentiated not so much by personal health experiences or amount of contact with hospitals as by general concern among petitioners about the erosion of health care together with a conviction that the public should have a strong voice in health care decision making.
Pétitions, opinion publique et restructuration des hôpitaux à Kitchener-Waterloo
Authors: Goyder John
Published: July 2010

Un sondage a été effectué en 1996-1997, peu de temps après qu'une pétition ait été lancée dans le cadre de la campagne Save Our Hospital qui visait à empêcher la fermeture de l'hôpital St. Mary's de Kitchener (Ontario); à l'occasion du sondage, des signataires connus de la pétition ainsi qu'un ensemble représentatif de citoyens ont été interrogés. Les données du sondage démontrent que les signataires de la pétition Save St. Mary's avaient des idées bien arrêtées quant aux services locaux de santé. Le grand public et les signataires de la pétition ne se différenciaient pas tant par leurs expériences personnelles au plan de la santé ou par leurs contacts avec les hôpitaux, mais plutôt par l'inquiétude généralisée observée au sein des signataires quant à l'érosion du système de santé et la conviction que le public devrait avoir une forte représentation dans la prise de décision en matière de santé.
Determinants of Job Stress and Job Satisfaction among Supervisory and Non-Supervisory Employees in a Large Canadian Teaching Hospital
Authors: Brown J.A. , Woodward C.A. , Shannon H.S. , Cunningham C.E. , Lendrum B. , McIntosh J. , Rosenbloom D.
Published: July 2010

This article explores the extent to which hospital workers at a large teaching hospital at different managerial/supervisory levels (designated and non-designated supervisors, and non-supervisory staff), experienced job stress and job satisfaction prior to the re-engineering of hospital services.

For all groups, increased levels of job demands were associated with higher levels of stress. Lower levels of decision latitude were associated with increased job stress for designated supervisors. Increasing levels of decision latitude were associated with both job stress and satisfaction for the other two groups. Co-worker support and teamwork contributed to increased job satisfaction for all groups.
Regionalization and Hospital Utilization: Alberta 1991/2-1996/7
Authors: Saunders L. Duncan , Bay Kyung S. , Alibhai Arif A.
Published: July 2010

Background:

In February 1994 Alberta Health announced a three-year business plan for the radical restructuring of the health care system in Alberta. The business plan outlined large reductions in funding for acute hospital care spending and the establishment of 17 Regional Health Authorities (RHAs).

Objectives:

The objectives of this study are to describe for the period 1991/2 to 1996/7: Trends in overall acute hospital utilization by Alberta residents and residents of each of the 17 RHAs. Trends in the provision of acute hospital services by each of the 17 RHAs and the Alberta Cancer Board. Trends in the transfer of patients between RHAs.

Results:

Between 1991/2 and 1996/7, the age-sex standardized separation rate, the age-sex standardized average length of stay, and age-sex standardized hospital days rate for Alberta residents fell by 25.6%, 18.7%, and 39.5% respectively. The age-standardized hospital days rate fell in all 17 RHAs. The total number of separations (Alberta residents and non-residents) from Alberta acute care facilities fell by 19.6% while the average care intensity for all separations from Alberta acute care facilities rose by 8.7%. The ratio of the highest to lowest average RHA care intensity remained between 1.7 and 1.9 during the study period. RHA self-su flciency indices increased dramatically in one RHA and remained largely unchanged in the remaining RHAs. RHA import indices decreased for most RHAs.

Conclusions:

Large reductions in the use of acute hospital services have occurred in Alberta during the period of major health care restructuring. Further research is needed to examine shifts in services to other sectors and to assess the impact of these reductions on patient outcomes.
Where Do We Go from Here?
Authors: McLellan Tena , Petricic Jane , Grant Susan
Published: July 2010

This article describes the transition support program that Ottawa's Salvation Army Grace Hospital developed for its staff leading up to the hospital's closure scheduled for the fall of 1999. The closure followed on the recommendation of the Ontario Health Services Restructuring Commission that the hospital's obstetrics and gynaecology programs be moved to the Queensway-Carleton Hospital. The hospital was further directed to move its other programs to the Ottawa Hospital.
Manners: “Well, No One Would Mistake him for Richard the Lionhearted.”
Authors: Evans Bob
Published: July 2010

Bad manners and shin kicking have been evident in the job market since Adam departed The Garden in search of greater challenges
LES BONNES MANIÈRES
Authors: Evans Bob
Published: July 2010

Les mauvaises manières et le tir en rase-mottes sont manifestes sur le marché du travail depuis qu'Adam a quitté le paradis terrestre en quête de nouveaux défis.
New Patent for Innovative Tool to Evaluate Healthcare System
Authors:   McCartney Consultants Ltd.
Published: July 2010

Richmond Hill, January 27, 1999 — Patent no. 2,209,266 issued to McCartney Consultants Ltd. is a “method for optimizing healthcare provider performance, forecasting healthcare resource consumption, optimizing healthcare resource allocation, and computing projected healthcare budgets which allocate human and physical resources”.
The Use of Computer Simulation as a Strategic Decision-Making Tool: A Case Study of an Emergency Department Application
Authors: Edmonds Mark I. , O'Connor H. Michael
Published: July 2010

Computer simulation is a recognized decision support tool, one which has been used in many Healthcare applications. Simulation offers the benefit of constructing and analyzing multiple “what if” scenarios without disrupting patient care or incurring significant cost. This article describes the successful use of computer simulation in the evaluation of multiple restructuring options in the emergency departments of a health sciences centre. Healthcare executives require timely and meaningful information to assist with strategic choices, and computer simulation can play a significant role in decision support.
Is There Room for Managed Care in Canada? A Preliminary Inquiry of Physicians
Authors: Taylor D. Wayne , Ng San
Published: July 2010

Managed care, which is becoming increasingly prevalent in the United States, is virtually absent in Canada. Yet managed care, if implemented judiciously, has the potential to provide comprehensive, high quality care while containing spiraling healthcare expenditures. Managed care is also the foundation of integrated Health systems, which have been widely discussed during the pdst few years. Then why has Canada been so slow to accept managed care? Since physicians have a great deal of influence on how healthcare is ultimately delivered, a group of Ontario physicians was surveyed to determine their perceptions of managed care. It was found that physicians were knowledgeable about the cost-containment capabilities of managed care but had misperceptions about managed care with respect to quality of patient care, preventive services and necessary medical care. Education and further research are recommended so that any debate about managed care, integrated systems or alternative physician payment can be meaningful, objective, beneficial and accurate.
Creating an Elder-Friendly Hospital
Authors: Parke Belinda , Stevenson Lynn
Published: July 2010

Older adults comprise the majority of people receiving hospital services in many regions of our country today. Current literature is fraught with stories of how risky hospitalization can be for an older adult. Even with the best intentions, being in hospital can set up a cascade of events for older adults and their families that result in longer lengths of stay and functional disability.

In a climate of fiscal restraint, competing priorities and public pressure, meeting the challenges of hospitalization for this population is not an easy task. As the number of older adults in acute care rises and the average length of stay continues to decrease, it is necessary for acute care hospitals to rethink their views of caring for older adults; fundamental shifts are required. The purpose of this paper is to describe the “Elder Friendly Hospital” (EFH) concept and explain the strategies taken by the Capital Health Region in Victoria British Columbia.
A Unique Role: The Peer Mentor on the Spinal Cord Team at G.F. Strong Rehab Centre
Authors: Young Jenny M. , Lawrence Walter , Quick Peter
Published: July 2010

The peer mentor is a full time paid staff member of the G. F. Strong Rehab Centre Spinal Cord Program. To qualify for the position, an individual with a high lesion spinal cord injury must live a self-managed life in the community. The peer mentor's role bridges professional, lay, and client perspectives, and is a voice for both clients and staff unlike any other team member. This report focuses on the peer mentor's facilitation of communication between clients and staff and on two initiatives that promote clients' perspectives.
Acute Care Has an Innovative Approach to the Bed Crisis!
Authors: Goulard Debbie , Simpson Cindy
Published: July 2010

The regionalization of healthcare in Alberta has been instrumental in changing the way we deliver healthcare to the population. In Calgary, the restructuring involved the closing of three acute care hospitals and a significant reduction in beds per capita, This reduction in inpatient beds behooved Senior Management in acute care to be innovative and responsive to the utilization of existing resources. The Department of Patient Transition Services was conceived with a mandate to provide assistance and support in utilization management and discharge planning, administrative coordination, system support and integration support. The evolution of this unique department is described.
Challenges in Providing Comprehensive and Coordinated Care to HIV/AIDS Patients: A Canadian Perspective
Authors: Tsasis Peter
Published: July 2010

This article focuses our attention on the means by which healthcare is provided to HIV-infected patients who require comprehensive and coordinated care to address the variety of changing and challenging needs presented by the acquired immunodeficiency syndrome (AIDS). Improved clinical management of HIV infection over the past decade, with antiretroviral agents, protease inhibitors and prophylactic therapies against opportunistic infections has transformed HIV infection from an acute to a chronic illness. Many individuals with AIDS are now living longer with more chronic conditions. Concomitant with the transformation of HIV infection from an acute to a chronic illness comes the challenge to provide effective, humane and economical care to patients with chronic conditions that continue to reside in the community, within a healthcare delivery system that has evolved to treat patients with acute diseases.
An Access to Care Center as a Learning Organization
Authors: Parris Urica
Published: July 2010

The Durham Access to Care (DATC) is one of the new streamlined vehicles for the delivery of integrated home-based and community-based health services across Ontario. Management and staff in this change transition have undertaken to become a learning organization. To implement this visionary process leadership qualities and style is key. This article gives a brief account of DATC and its move to becoming a learning organization and the author's observational reflections of an effective leadership style.
Méthode de répartition des coûts unitaires et des coûts hospitaliers
Authors: St-Hilaire Carole , Crépeau Paul K.
Published: July 2010

La recherche de l'efficience a favorisé la publication d'un nombre important de travaux d'évaluation dans le domaine des établissements de santé. Certains d'entre eux adoptent une approche méthodologique qui semble, à première vue, critiquable en ce qui concerne la répartition des frais généraux ou de soutien au. centres d'activités de l'établissement. L'objectif du présent article est de vérifier, à partir de données réelles d'utilisation des ressources hospitalières, si le choix d'une méthode de répartition affecte significativement les coûts unitaires découlant de cette consommation de ressources. Les résultats obtenus à partir de notre échantillon suggèrent qu'il n'existe aucune relation statistiquement significative entre les méthodes utilisées et les coûts unitaires ainsi produits.
Use of an ER Audit to Build Recommendations for Improving Quality of Care: Part I: Initial Audit and Recommendations
Authors: Hadjistavropoulos Heather , Clark Jennifer , Hardenne Denise , Lochbaum Bobbi , Larrivee Diane
Published: July 2010

This paper documents a complete audit of the Regina Health District's Emergency rooms. The issues examined were triage, non-urgent visits, waiting times, and information management. The results, presented in the two studies following, describe the initial audit and recommendations, as well as the follow-up research and subsequent recommendations. Our findings demonstrate how an audit can effectively monitor the functioning of the Emergency Room (ER) and provide data essential to continuous quality improvement.
Use of an ER Audit to Build Recommendations for Improving Quality of Care: Part II: Follow-up to an ER Study
Authors: Hadjistavropoulos Heather , Clark Jennifer , Hardenne Denise , Lochbaum Bobbi , Larrivee Diane
Published: July 2010

Two years after presentation of recommendations to improve the quality and efficiency of the Emergency Room (ER), we systematically examined changes in the ER with respect to volumes, triage status, and waiting times. We also interviewed 10 key informants about their perceptions of the level of implementation of the recommendations. The results suggested that while some progress had been made, there was still considerable room for improvement and further recommendations were needed. The study highlights the importance of the follow-up process and the need for ongoing quality improvement in the ER.
Potholes in the Information Highway: The Use of Health Service Utilization Data by Alberta Health Care Managers
Authors: Casebeer Ann , Johnson David
Published: July 2010

Reviews and consultations with regional health authority decision makers have indicated that both data quality and access can limit effective use of health services information when assessing outcomes, planning changes, testing solutions and making decisions. To further a more system-wide understanding of these data utilization issues, we asked senior managers, board members and information analysts in Alberta regional health authorities (n=111) about the availability of, organizational supports for and barriers to the use of health service utilization data. Eighty percent of respondents stated that the lack of data impeded problem resolution, and 83 percent of managers stated that health service data alerted them to new problems. Examples of useful data related to good standardization and linkage of data sets, or to capacity for valid comparison and trending. Given the limitations highlighted in relation to meeting even the simplest needs of standardization, linkage, comparison and trending, Alberta health care managers indicate frustration in trying to use health service data as currently construed and distributed, particularly within their current frameworks and fast-paced timelines for decision making.
Réductions au sein du système hospitalier — Un processus de restructuration
Authors: Baumann Andrea , O'Brien-Pallas Linda , Deber Raisa , Donner Gail , Semogas Dyanne , Silverman Barbara
Published: July 2010

Pour tenter de maintenir une situation financière viable, les hôpitaux ont entrepris d'importantes restructurations. Cet article présente une étude qui a porté sur des stratégies innovatrices de réduction utilisées par 20 hôpitaux de soins actifs en Ontario. L'équipe de recherche a examiné les plans d'exploitation des hôpitaux et a analysé les résultats d'entrevues sur le processus de réduction menées auprès d'administrateurs et d'employés. Les résultats n'ont montré aucune uniformité quant à l'approche à la réduction. Bien que de nombreux administrateurs aient exprimé le besoin d'une approche en collaboration, la réduction a été typiquement orientée de haut en bas et a été perçue très différemment par le personnel et les administrateurs. Les auteurs suggèrent des façons d'améliorer les tentatives de restructuration et posent quelques questions pour orienter les recherches ultérieures.
In Search of Informed Input: A Systematic Approach to Involving the Public in Community Decision Making
Authors: Abelson Julia , Lomas Jonathan
Published: July 2010

Given the task of distributing scarce resources, decision makers are faced with the question of how to involve an increasingly threatened and disenfranchised public in decisions affecting their communities. This article introduces a systematic approach to public involvement in community decision-making and identifies key elements in the design of institutionally driven public participation exercises. Examples are drawn from the health care system restructuring experiences of three Ontario communities.
Revolutionary versus Evolutionary Change: The Experience of a University Hospital Department of Psychiatry
Authors: Rook Marilyn , Shulman Kenneth I.
Published: July 2010

In the spring of 1991, the Department of Psychiatry at Sunnybrook Health Science Centre chose to undergo a major reorganization in an attempt to better meet the needs of patients as well as the academic and research requirements of the University of Toronto. This brief report describes the circumstances leading up to the decision to make a “revolutionary” change, the department's experiences during the period of radical change and the impacts of the change process.
Identification of Best Practices in the Delivery of Patient Food Services through Public/Private Sector Partnerships
Authors: Marshall Lori
Published: July 2010

This article describes the evolution of public/private sector partnership in patient food service delivery and identifies skills required by executives to manage partnerships effectively, features that may be generalized to other areas; and the importance of labour relations. Site visits conducted across Canada demonstrate that when partners understand each other's objectives, commit to providing strong leadership, and create meaningful labour relations and communications strategies, partnerships can be successful.
Les meilleures pratiques pour la prestation de services diététiques aux patients par le biais de partenariats entre les secteurs public et privé
Authors: Marshall Lori
Published: July 2010

Cet article décrit l'évolution du partenariat entre les secteurs public et privé dans le domaine des services diététiques aux patients et précise les compétences dont les dirigeants ont besoin pour gérer ces partenariats efficacement, caractéristiques qui peuvent s'appliquer à d'autres domaines, et l'importance du facteur relations de travail. Des visites sur les lieux à travers le pays démontrent que les partenariats peuvent être couronnés de succès lorsque les partenaires comprennent leurs objectifs mutuels, s'engagent à assurer une direction claire et créent des relations de travail et des stratégies de communication efficaces.
Integrated Systems to Reduce Length of Stay for Knee and Hip Joint Replacement Surgeries
Authors: Woo Tina , Bramwell Marion , Greenwood Beverley , Gow Shirley , Ackerman-Rainville Rosemary , Corradetti Patricia , Wood Susan , Moreland Julie
Published: July 2010

To reduce length of stay while maintaining quality of care, St. Joseph's Hospital, Hamilton, ON implemented a care path with three discharge options. Two of these discharge options were early discharge to integrated community services. Patients meeting early discharge criteria are discharged home five days post-operatively with follow-up by home care nursing and physiotherapy. Otherwise, patients are discharged on day four to a multi-disciplinary rehabilitation unit at a separate facility. Patients requiring acute medical services for complications or co-morbidity stay in the acute care hospital. A prospective cohort evaluation showed no difference in complications and similar functional outcomes for the three discharge options.
Principes d'équité organisationnelle et changements de grande envergure: la gestion de programme
Authors: Persaud D. David , Narine Lutchmie
Published: July 2010

Plusieurs des obstacles à la mise en œuvre de changements de grande envergure dans les organisations de soins de santé semblent liés à un manque d'attention au changement humain qui doit survenir. Un des éléments de cette dimension humaine souvent négligé par les agents du changement est le rôle que la perception d'équité joue dans la mise en œuvre de changements organisationnels de grande envergure. Le présent article utilise l'adoption de la gestion de programme (conception organisationnelle qui a été adoptée par de nombreux établissements de soins de santé au Canada) à titre d'exemple de changement organisationnel de grande envergure pour démontrer l'importance que revêtent les principes d'équité procédurale et interactionnelle afin de faciliter la mise en œuvre de changements organisationnels.
Initiating Regional Quality Management
Authors: O'Neill Mary Lou , Gunn Ethel , Wylde Brenda
Published: July 2010

In June 1999, the Eastern Regional Health Board began to structure a regional quality management program that included quality, satisfaction and risk management initiatives. A regional plan for our two programs (Addiction Services and Public Health) and nine acute care facilities was needed. All had internal quality programs in place, at varying levels of maturity. Synthesis into a regional quality management plan was required. This article describes how one region planned and implemented this task over 10 months. Suggestions are included relating to required resources, a workable timeline and a communication strategy.
Un modèle de soins de longue durée dans un contexte de soins régionaux
Authors: Fulton Thomas R. , Penney B. Christine , Taft Alice
Published: July 2010

Le modèle épisodique de soins aigus qui accapare la majeure partie du financement de la santé ne répond pas aux besoins d'une société qui doit composer avec un fardeau de plus en plus lourd de maladies chroniques. Le présent exposé décrit l'application et l'évaluation préliminaire d'un modèle de soins de longue durée élaboré dans un milieu de soins dirigés aux États-Unis dans un contexte de soins régionalisés au Canada. Ce modèle vise les objectifs stratégiques suivants: responsabiliser les clients en leur fournissant un environnement remanié de services qui favorise l'autogestion; appuyer les pourvoyeurs de soins par l'élaboration de systèmes d'information clinique et d'aide à la décision; et structurer les ressources, les politiques et l'organisation des soins de façon à appuyer une clientèle avisée et active ainsi qu'une équipe soignante proactive.
Hypertensive Patients and Their General Practitioners
Authors: Cree Marilyn , Roos Noralou , Yang Qian , Carriere K.C.
Published: July 2010

This study examined the relative contribution of hypertensive patients and their physicians in selecting total annual physician visit frequencies and made regional comparisons between two Canadian cities. We found that the frequency of physician visits was primarily influenced by physician referrals and physician practice patterns, which accounted for about 80 percent of the total explainable variance in physician visits. The relative contribution of other available patient and physician characteristics in determining visit frequency was rather small.
Healthcare Quality in an International Setting
Authors: Fabrey Lawrence J. , Koff Sondra Z. , Maronde Janet L. , Perez Edgardo L.
Published: July 2010

This report discusses the process used by the Healthcare Quality Certification Board to internationalize its certification program. With some modifications this methodology can be utilized to define the role of any healthcare professional and to legitimize, create or restructure a certification program that assesses competency in a particular healthcare field. This process and the importance of quality management are related to today's cataclysmic healthcare environment which challenges efforts to confront cost and access.
Citizen Participation in the Reform of Health Care Policy: A Case Example
Authors: MacFarlane Dianne
Published: July 2010

The trend toward greater citizen participation in health care policy reform has its roots in the consumerism of the 1960s. This era witnessed the beginning of a dispersion of power in health care and an increase in the number and variety of stakeholders involved in the policy development process. Using the reform of Ontario's long-term care policy as a case example, this paper offers observations about the benefits and challenges of participative policy-making. Despite the challenges and the paucity of hard evidence pointing to benefits, the author concludes that broad citizen participation in health care policy reform is a desirable goal. However, the capacity for genuine collaboration remains underdeveloped and requires more systematic refinement.
Partners in Health: A Case Study of a Comprehensive Disability Management Program
Authors: Caulfield Catherine
Published: July 2010

When absenteeism threatened to raise health care costs and affect the quality of care at Tillsonburg District Memorial Hospital, a multidisciplinary team came together to develop a strategic response. The hospital seized the opportunity to initiate the “Partners in Health” program, an innovative and collaborative disability management program designed to improve its response to the health issues of all its staff. This paper describes how the program was developed and outlines its comprehensive approach. Partners in Health has proven to be extremely successful at increasing attendance awareness, improving work accommodation and/or rehabilitation after illness or injury, and reducing costs associated with health and lost-time claims. Partners in Health was recognized with the 1995 Health Care Quality Team Award sponsored by the Canadian College of Health Service Executives and 3M.
The Effects of Teamwork on Staff Perception of Empowerment and Job Satisfaction
Authors: Kutzscher Lia I. T. , Sabiston Jean Anne , Laschinger Heather K. Spence , Nish Margaret
Published: July 2010

Rosabeth Moss Kanter's1 model of organizational empowerment was used to examine the effects of a multidisciplinary teamwork project initiated in preparation for a 1995 Canadian Council on Health Services Accreditation survey. Kanter1 maintains that work structures such as teams foster opportunities to learn and grow, provide access to information, support and resources, empower employees, and result in increased work satisfaction and effectiveness. Staff who participated on multidisciplinary teams to prepare for the accreditation survey (n = 210) and a random sample of staff who did not participate on the teams (n = 348) were surveyed to ascertain their perceptions of work-related empowerment and job satisfaction. Consistent with Kanter's propositions, members participating on teams had higher empowerment scores and perceived access to empowerment structures to be more important than members not participating on these teams. Overall, perceived access to empowerment structures was found to be significantly lower than perceived importance of access to the empowerment structures. The results of this study support the use of multidisciplinary teams as one work redesign strategy for enhancing work effectiveness in the health care environment.
Selecting Clinical Outcome Indicators for Monitoring Quality of Care
Authors: Barnsley Jan , Lemieux-Charles Louise , Baker G. Ross
Published: July 2010

Clinical outcome indicators are used to identify opportunities for improvement in patient care processes. This paper focuses on issues specific to the selection of clinical outcome indicators for use in assessing performance within and between hospitals. The issues and examples are based on the experiences of a university research team that worked in collaboration with a group of teaching hospitals to develop and monitor clinical outcome indicators. Four sets of issues are discussed: the intended use, and end users of indicator information; aspects of indicator validity; data quality; and dissemination and use of indicator information. Recommendations are made that apply to individual hospitals, groups of hospitals and health care systems.
Sélection des paramètres de résultats cliniques pour le contrôle de la qualité des soins
Authors: Barnsley Jan , Lemieux-Charles Louise , Baker G. Ross
Published: July 2010

On utilise les paramètres d'évolution clinique pour identifier les possibilitiés d'amélioration des processus de soins du patient. Cet article traite de questions particulières au choix de ces paramètres d'évolution clinique pour l'évolution du rendement au sein des hôpitaux et entre eux. Les questions et les exemples proviennent d'expériences faites par une équipe de recherche universitaire qui a travaillé, en collaboration avec un groupe d'hôpitaux universitaires, à l'élaboration et au contrôle des paramètres d'évolution clinique. Quatre sujets sont abordés dans cet article: l'utilisation prévue de l'information provenant des paramètres et les personnes à qui elle est destinée; certains aspects de la vialdité des paramètres; la qualité des données; et la diffusion et l'utilisation de l'information provenant des paramètres. Des recommandations sont faites aux hôpitaux individuels, aux groupes d'hôpitaux et aux organismes de soins de santé.
Assessing Health Service Needs: Tools for Health Planning
Authors: Brazil Kevin , Anderson Malcolm
Published: July 2010

As fiscal pressures mount, health-planning and decision-making at smaller geographics scales must be more effective. Involving local constituents in needs assessments, it is believed, would lead to better identification and serving of regional demands and needs for health services. This article examines needs assessment as a tool to determine a community's service needs and establish priorities for the creation of programs. Various approaches used in needs assessments are described, including survey methods, structured groups and geographic information systems.
A Decision-Making Aid for Long-Term Care Waiting List Policies: Modelling First-Come, First-Served vs. Needs-Based Criteria
Authors: Burkell Jacquelyn , Wright Alison , Hoffmaster Barry , Webb Kathleen
Published: July 2010

A chronic care hospital in London, Ontario, was faced with the question of whether to continue to admit applicants on a first-come, first-served basis, or to implement a needs-based admission criterion. To provide information relevant to this decision, a simple computer modelling technique was used to model the waiting list under both policies. Analysis of the results indicated substantial variability in the need for care demonstrated by waiting list applicants, and individual placement priority under the two schemes. Descriptions of individuals affected by the proposed change in policy provided additional information. The information provided by the waiting list analysis contributed to the decision-making process about waiting list policy. The method used is applicable to waiting list management decisions in other institutions.
Identifying an Appropriate Case Mix Measure for Chronic Care: Evidence from an Ontario Pilot Study
Authors: Hirdes John P. , Botz Charles A. , Kozak Jean , Lepp Virginia
Published: July 2010

With the move toward rate-based funding for chronic care hospitals, a case mix measure that describes chronic care patients in a valid and reliable manner is needed. A pilot study was done in Ontario to evaluate the effectiveness of three classification systems that have been implemented elsewhere. It was recommended that work continue on the basis that Ontario will implement the Resource Utilization Groups (RUG-III) system for activity measurement and funding of chronic care patients.
Marketers Don't Wear Plaid: Marketing and Health Care Administration in the Canadian Context
Authors: Rigby John M. , Backman Allen M.
Published: July 2010

Marketing has a bad reputation among Canadian health managers, even though marketing solutions may address many of their problems. This article provides an overview of current understandings of marketing and how they may be applied to health care situations. Marketing should be considered an ongoing process. This is particularly helpful if we understand the root task of health managers as creating and promoting exchanges — with governments, physicians, nurses, other health workers and client groups. Exchanges that are desirable to the health care community will more likely occur if the true costs and benefits of health services are analyzed, understood and imaginatively communicated. The public constantly evaluates the health system. Constant evaluation implies a need for marketing directed internally at staff and those within the health system, and externally at constituents outside the system. Properly understood and practised, marketing can be part of the innovative solutions health care managers develop and apply as they deal with the difficult challenges facing them in Canada's current health care environment.
Public-Private Management Partnerships in the Canadian Environment: Options for Medical Imaging
Authors: Uddin Zahava , Bear Robert A.
Published: July 2010

Health services restructuring demands that hospitals consider innovative ways of providing patient care, including services within the clinical support departments such as medical imaging, diagnostic laboratories and pharmacy. This Brief Report describes the result of work carried out at St. Michael's Hospital to explore options for public-private management partnerships within the Department of Medical Imaging. Various partnership models and opportunities for cost containment, revenue generation and strategic positioning are discussed.
Partnerships between Self-Help Networks and Health Care Facilities: The Case of the Bayview Support Network
Authors: Gray Ross , Greenberg Marlene , McBurney Terry , Douglas Mary Sue
Published: July 2010

This article discusses the role of patients and their families as peer support providers to other patients, and as decision makers within organizations. We use as a model the Bayview Support Network, a self-help network at the Toronto-Sunnybrook Regional Cancer Centre. We review the benefits of partnership, costs, limitations and risks. A list of features that contribute to effective partnerships is also provided.
La gestion des systèmes de prestation intégrée de soins de santé: Satisfaire aux exigences relatives aux responsabilités
Authors: Leatt Peggy , Leggatt Sandra G.
Published: July 2010

Plusieurs gouvernements provinciaux canadiens examinent des moyens d'intégrer davantage les services de santé en vue d'améliorer les soins fournis, tout en maintenant les coûts à leur niveau actuel ou en les réduisant. Des systèmes de prestation intégrée de soins de santé voient le jour présentement aux États-Unis, en Grande-Bretagne et dans d'autres pays d'Europe. Ces systèmes visent à fournir, à une population cible déterminée et selon un mode de financement par capitation, un éventail complet de soins de santé.

Dans l'article qui suit, les auteures explorent les questions liées aux responsabilités de gestion dans un système de prestation intégrée (SPI). Elles examinent des modèles possibles de gestion et présentent les facteurs qui influent sur le choix d'un modèle pour un SPI. En 1987, Ewell affirmait que les conseils d'administration étaient le maillon le plus faible des systèmes de prestation intégrée de soins de santé aux États-Unis. Il laissait entendre qu'en portant attention à la gestion, dès le début de l'établissement des modèles de SPI au Canada, il pourrait être possible de les rendre plus efficaces.
Functional Independence Training Program: An Example of a Sub-Acute Care Model for Patients following Primary Joint Replacement
Authors: MacLeod A.M. , Huber J. , Gollish J.D.
Published: July 2010

The Orthopaedic and Arthritic Hospital is a specialty institution dedicated to the provision of elective reconstructive orthopaedic surgery and rehabilitation to individuals with musculoskeletal disorders. This facility is the largest volume joint replacement centre in Canada, performing over 1,000 hip and knee replacement/revision procedures annually. In 1995, the hospital established a Functional Independence Training (FIT) program — a seven-day reactivation program for patients following primary joint replacement. The program aims to promote early independence, improve functional level and return patients to normal activity as quickly and cost-effectively as possible. The program has received positive patient feedback and has demonstrated the potential to save the health care system approximately $479,655 annually through the reduction of 1,453 acute and rehabilitation hospital inpatient days, based on the hospital's annual primary joint replacement caseload.
Programme de formation à l'autonomie fonctionnelle: Modèle de soins subaigus aux patients ayant subi un remplacement d'articulation primaire
Authors: MacLeod A.M. , Huber J. , Gollish J.D.
Published: July 2010

L'Hôpital Orthopaedic and Arthritic Hospital est un établissement spécialisé en reconstructions électives et en réadaptation des personnes souffrant de troubles locomoteurs. On y effectue le plus grand volume de remplacement d'articulations au Canada: on y réalise en effet plus de 1 000 interventions chirurgicales de remplacement ou de mise à jour par année. En 1995, cet hôpital a mis sur pied un programme de formation à l'autonomie fonctionnelle ( Functional Independence Training Program, ou FIT), Il s'agit d'un programme de réadaptation de sept jours à l'intention des patients qui ont subi une intervention de remplacement d'une articulation. Ce programme a pour objectif de rendre leur autonomie aux patients, d'améliorer leur niveau de fonctionnement et de les ramener à une activité normale aussi rapidement et de façon aussi rentable que possible. Les patients s'en disent satisfaits. En ce qui a trait au système de santé, ce programme a produit, entre autres, une économie d'environ 479 655 $ par année en réduisant de 1 453 le nombre de jours d'hospitalisation (suivant le nombre de cas de remplacement d'articulations primaires que I'hôpital traite en un an). Modèle bien établi et réussi de soins subaigus, ce programme adhère à la philosophie de la Commission de restructuration des services de santé ( Health Services Restructuring Commission), selon laquelle il est nécessaire de « fournir les bons services dans un contexte approprié, ce qui entraînera la prestation de soins meilleurs et plus appropriés et de meilleurs résultats au plan de la santé, à un coût plus adéquat.»1
Resource Intensity Weights™ and Canadian Hospital Costs: Some Preliminary Data
Authors: Poole Barbara , Robinson Shawn , MacKinnon Murray
Published: July 2010

Different types of inpatients “consume” differing amounts of hospital resources, and it is important to be able to measure these differences in resource consumption, An equitable methodology for funding hospitals must take into account differences in case mix between facilities. An ability to examine these differences in case mix and resource utilization allows hospitals to focus efforts to improve efficiency. A standardized methodology for measuring resource consumption is critical to funding and resource allocation both at a global and organizational level. This study was undertaken to determine whether or not the Canadian system for measuring resource consumption, Canadian Institute for Health Information (CIHI) RIWs™, was reflective of the relative cost differences between inpatient cases at the Greater Victoria Hospital Society (GVHS) and to identify RIWs with a significant difference in comparison to GVHS cost weights.

A regression analysis was performed on the more than 30,000 inpatient cost profile records from the GVHS 1995–96 cost and patient activity data. The scope of the analysis was restricted to the 424 Case Mix Groups (CMGs) that had a minimum composition of five patient profiles. Comparisons of GVHS cost weights to CIHI RIWs yielded mostly positive results. With the noted exception of about 20 CMGs, there was a high correlation between the CIHI RIW and the GVHS actual cost weights. Hence, the GVHS cost weights can be viewed with confidence as representative of the relative cost differences between typical RIW value CMGs and actual costs.
Best Laid Plans: Effective Implementation of Re-Engineering Recommendations
Authors: Zorn Renate , Yau Angelina
Published: July 2010

Continuing pressures on health care funding have led most hospitals to undertake re-engineering and restructuring projects to reduce operating expenses. Unfortunately, savings often turn out to be less than anticipated, as the projects falter in the implementation stage. As part of a two-year process improvement and expense reduction project, Toronto's St. Michael's Hospital developed an aggressive and comprehensive implementation process to ensure that it met its savings targets and maintained its financial viability. This article outlines the Hospital's implementation strategy and reviews the project's major challenges and key success factors.
Redesigning Services to Meet Client Needs: The Gage Transition to Independent Living
Authors: Parent Michelle Dixon , Thompson Gail G. , Forma Laura , Self Hazel
Published: July 2010

The Gage Transition to Independent Living, offered by Toronto's West Park Hospital, helps physically disabled adults acquire the skills necessary for living independently in the community. Although the program's goal has remained constant, its structure has changed considerably. In response to client feedback and community trends, the program has replaced its original institutional framework with a community-based one. This article traces how those involved changed the program to meet client needs, and describes what they learned in the process.
Recommendations for Managing Hospital Closure
Authors: van der Wal Rena , Bouthillette France , Havlovic Stephen J.
Published: July 2010

An acute care hospital was closed by the British Columbia Ministry of Health in 1993. A research study was conducted to investigate the ways closure of the hospital affected hospital employees and to identify ways to facilitate the closure/reorganization process. Unstructured interviews were conducted with 25 employees around the time of closure and six months after the closure. In the category Living with Closure, six themes arose from the qualitative analysis. They related to (1) provision of information; (2) effect of closure on the working environment and colleagues; (3) perceived stress; (4) recognition of one's worth; (5) provision of support services; and (6) the process of having a new job. The authors offer recommendations stemming from the analysis, which are intended to assist others planning for future hospital reorganizations or closures.
Applying Activity-Based Costing in Long Term Care
Authors: Wodchis Walter P.
Published: July 2010

As greater numbers of the elderly use health services, and as health care costs climb, effective financial tracking is essential. Cost management in health care can benefit if costs are linked to the care activities where they are incurred. Activity-based costing (ABC) provides a useful approach. The framework aligns costs (inputs), through activities (process), to outputs and outcomes. It allocates costs based on client care needs rather than management structure. The ABC framework was tested in a residential care facility and in supportive housing apartments. The results demonstrate the feasibility and advantages of ABC for long term care agencies, including community-based care.
The Experience of Clients and Informal Caregivers with Community Health Care Services
Authors: Greaves Gaye , Lewis Phyllis
Published: July 2010

Persistent changes in long term care policy reform in Ontario prompted one home care program to undertake a multifaceted study to evaluate the effects of those changes. This article describes the qualitative component of the study examining perceptions of clients (persons with disabilities; adults over 80 and under 80 years of age) and of informal caregivers concerning their satisfaction with services and the impact of service delivery on their quality of life.

Responses and descriptions of relevant perceptions and experiences varied with category of participant. Study findings revealed that satisfaction with services and concomitant quality of life depended upon the quality of communication with service providers.
The Last Critical Care Bed in Western Canada
Authors: Bear Robert A. , Frame Grant , Weatherill Sheila
Published: July 2010

This Brief Report provides an assessment of various factors contributing to the widely publicized emergency department overflow and bed availability crisis that occurred last spring in Edmonton area's Capital Health Region. We were able to divide the factors contributing to the crisis into those of a general nature, those related specifically to health care restructuring, and factors related even more specifically to the nature of Capital Health's Integrated Delivery System. Strategies that we have developed to deal with each of these factors are described.