bluuebunny/crossref_metadata_2025 huggingface dataset:
Making Customer—Service a Priority in Health Care Organizations
Authors: O'Hagan Joshua , Persaud David
Published: July 2010

Improving customer-service in health care organizations has been linked to better patient care, satisfied staff, a reduction in preventable medical errors, fewer malpractice lawsuits and improved revenue. However, it has been observed that there is sometimes a gap between the level of customer-service provided by health care organizations and their clients' expectations. This paper integrates, synthesizes and extends theory and practice from existing literature to provide health care organizations with strategies for closing this gap. Methods are also outlined for creating, implementing and evaluating an organizational plan for improving customer-service.
Structured or Unstructured Personnel Interviews?
Authors: Azarpazhooh Amir , Ryding William H. , Leake James L.
Published: July 2010

The challenge for health care managers is finding, hiring and retaining appropriately qualified and motivated employees. One useful method of gaining information about and insight into a candidate is interviewing, which can be classified as structured, unstructured or semi-structured. The disadvantages of unstructured interviews are reviewed; ways to enhance the psychometric properties of interviews by adding structure are reviewed and summarized; and the possible reasons for underutilization of structured interviews are explored.
Implementing Information Technology to Improve Workplace Health: A Web-Based Information Needs Assessment of Managers in Fraser Health, British Columbia
Authors: Sandhu Jag S. , Anderson Keith , Keen Dave , Yassi Annalee
Published: July 2010

A web-based questionnaire-survey was administered primarily to determine what information is useful to managers in Fraser Health, of British Columbia to support decision-making for workplace health and safety. The results indicated that managers prefer electronic quarterly reports, with targets, goals, and historical trends rated as “very important.” Over 85.7% “agree” that if information was readily available in the “most beneficial” format, they would be able to improve workplace health. Recommendations include that managers be presented with clear and concise workplace health reports that facilitate analysis for decision-making.
Advancing the Population Health Agenda
Authors: Davidson Alan
Published: July 2010

Using the case of the B.C. Interior Health Authority, the paper teases out some of the bases for practical success and failure in advancing population health in a regionalized health system.
Lessons Learned: The Implementation of an Alternative Funding Plan at SCO Health Service in Ottawa
Authors: Sarre-McGregor Deborah , Knoefel Frank-D.
Published: July 2010

Physicians of SCO Health Service in Ottawa recently entered into an Alternative Funding Plan agreement with the Ministry for Health and Long-Term Care in Ontario. The plan provides agreed monthly funding to the SCOHS Academic Medical Organization in return for medical services. Funds are then paid to physician Practice Plans for services provided. The plan almost entirely eliminates fee-for-service billing, and also provides funding for teaching and research activities. The process of establishing the plan has provided some insights that might be useful to organizations undertaking the same process. Some of these insights are shared in this paper.
The Creation of a Research Forum: An Attempt to Get the CEO's Attention
Authors: Lowe-Lauri Malcolm
Published: July 2010

This paper reports on the experience of U.K.'s King College Hospital's NHS CEO's Research Forum and Network and explores the next steps in making this a tool accessible to a broader audience of healthcare decision-makers.
La création d'un forum de recherche : Une tentative pour attirer l'attention des premiers dirigeants
Authors: Lowe-Lauri Malcolm
Published: July 2010

Cet article fait état de l'expérience du King's College Hospital's NHS CEO's Research Forum and Network du Royaume-Uni et se penche sur les prochaines étapes visant à rendre cet outil accessible à un plus grand nombre de preneurs de décisions en soins de santé.
Passing the Baton — Toward Making a Case for a Canadian Centre for Health Leadership
Authors: Tholl William G. , MacLaren Monika , Tcheremenska-Greenhill Alexandra , Adams Owen
Published: July 2010

This paper demonstrates that the average tenure of current senior leaders in the health sector has declined sharply over the last three decades, and is substantially shorter than that of leaders in the private and public arenas. It offers potential reasons for this downward trend, and sets out the broad parameters for a Canadian Centre for Health Leadership, which could help better identify, develop, support, and celebrate leadership in health and healthcare in Canada.
Finding the Right Balance between Evidence for Judgment and Evidence for Quality Improvement
Authors: Chan Benjamin T.B.
Published: July 2010

“Evidence for judgment” asks whether healthcare practitioners did what they were supposed to do. “Evidence for improvement” asks whether quality is improving due to the deliberate efforts of managers and care providers The former describes the gap between optimal and actual care, examines peer-to-peer comparisons, is retrospective and often measured only at a single point in time, and identifies problems but not necessarily solutions. Knowledge tends to flow from researchers to practitioners, and knowledge transfer mechanisms are unclear. Evidence for improvement is prospective, focuses on comparisons to self over time, uses longitudinal data, and includes evidence on “how” to improve. Knowledge transfer mechanisms are built into quality improvement projects. Both types of evidence have their role; evidence for judgment helps system leaders identify priorities for improvement, whereas evidence for improvement helps leaders assess whether their implementation strategies have been successful. Currently, however, evidence for judgment predominates. Funding mechanisms, data systems, measurement tools, publication guidelines, and health professional training programs will need to be modified if we want more evidence for improvement.
Stakeholder Engagement and Public Policy Evaluation: Factors Contributing to the Development and Implementation of a Regional Network for Geriatric Care
Authors: Glover Catherine , Hillier Loretta M. , Gutmanis Iris
Published: July 2010

The development and implementation of a regional network that provides universally accessible and consistent services to the frail elderly living in Southwestern Ontario is described. Through continuous stakeholder engagement, clear network goals were identified and operationalized. Stakeholder commitment to the integration of expertise and specialized services, to evidence-based public policy and to iterative evaluation cycles were key to network success.
Engagement des intervenants et évaluation de la politique publique: Facteurs contribuant au développement et à la mise en œuvre d'un réseau régional de soins gériatriques
Authors: Glover Catherine , Hillier Loretta M. , Gutmanis Iris
Published: July 2010

Le développement et la mise en œuvre d'un réseau régional qui assure la prestation de services universels et uniformes aux personnes âgées fragiles vivant dans le sud-ouest de l'Ontario sont décrits. Grâce à l'engagement continu des intervenants, on a défini et opérationnalisé des objectifs de réseau clairs. L'engagement des intervenants envers l'intégration de l'expertise et des services spécialisés, une politique publique fondée sur des données probantes et les cycles d'évaluation itératifs ont été des facteurs de succès clés du réseau.
Disease Management in Canada: Surmounting Barriers to Adoption
Authors: Gallant Christopher R. , MacKinnon Neil J. , Sprague Denise A.
Published: July 2010

Disease Management (DM) programs are used to optimize economic outcomes and improve patient outcomes. Despite this, relative to the United States, Canadian health care organizations have been slow to adopt them. The objective of this article is to examine the concept of DM programs, the existing evidence to support their use and the barriers to their adoption in Canada. Several solutions aimed at overcoming the barriers to DM in Canada are proposed.
Workforce Deployment — A Critical Organizational Competency
Authors: Harms Roxanne
Published: July 2010

Staff scheduling has historically been embedded within hospital operations, often defined by each new manager of a unit or program, and notably absent from the organization's practice and standards infrastructure and accountabilities of the executive team. Silvestro and Silvestro contend that “there is a need to recognize that hospital performance relies critically on the competence and effectiveness of roster planning activities, and that these activities are therefore of strategic importance.”1 This article highlights the importance of including staff scheduling — or workforce deployment — in health care organizations' long-term strategic solutions to cope with the deepening workforce shortage (which is likely to hit harder than ever as the economy begins to recover). Viewing workforce deployment as a key organizational competency is a critical success factor for health care in the next decade, and the Workforce Deployment Maturity Model© is discussed as a framework to enable organizations to measure their current capabilities, identify priorities and set goals for increasing organizational competency using a methodical and deliberate approach.
Le déploiement de la main—d'œuvre — Une compétence organisationnelle capitale
Authors: Harms Roxanne
Published: July 2010

L'établissement des horaires du personnel a toujours été intégré à l'exploitation des hôpitaux, est souvent défini par chaque nouveau gestionnaire d'une unité ou d'un programme et est remarquablement absent de l'infrastructure des pratiques et des normes de l'équipe ainsi que de l'obligation de rendre compte. Silvestro et Silvestro soutiennent la nécessité d'admettre que le rendement d'un hôpital dépend largement de la compétence et de l'efficacité des activités de planification des horaires, qui sont d'une grande portée stratégique.1 Le présent article fait ressortir l'importance d'inclure l'établissement des horaires du personnel, ou déploiement de la main-d'œuvre, dans les solutions stratégiques à long terme des organisations de santé pour affronter la pénurie grandissante de main-d'œuvre (susceptible de frapper plus fort que jamais lorsque l'économie reprendra). Il est essentiel de percevoir le déploiement de la main-d'œuvre comme une compétence organisationnelle, et c'est un facteur de succès capital pour le milieu de la santé au cours de la prochaine décennie. Par ailleurs, le Workforce Deployment Maturity Model© (modèle de stabilisation de déploiement de la main-d'œuvre) peut constituer un cadre pour permettre aux organisations de mesurer leurs effectifs courants, de déterminer les priorités et d'établir des objectifs pour accroître la compétence organisationnelle au moyen d'une démarche méthodique et délibérée.
An Innovative Approach to Goal Setting and Reporting in a Complex Organization
Authors: Escaf Marnie , McGrath Petrina , Costello Judy
Published: July 2010

Managing multiple priorities and achieving sustainable outcomes is a challenge for leaders across health care organizations. One academic health science centre set about to address this challenge through the development of an innovative annual goal and objectives process that aligned every unit/department around organizational priorities. The results have enabled exceptional outcomes for individuals, teams, patients/families and the organization as a whole.
From a Project to Transformation: How “Going against the Flow” Led to Improved Access and Patient Flow in an Academic Hospital
Authors: Alikhan L. Miin , Howard Robert J. , Bowry Richard
Published: July 2010

A results-driven approach to optimizing patient flow, grounded on quality improvement, change management and organizational learning principles, is described. Tactics included collaborative governance, performance management, rapid process improvements and implementation toolkits. Results included an 83.1% decrease in emergent volumes waiting for greater than 24 hours and a 49.1% improvement in emergency department length of stay for admitted patients. There were no adverse outcomes on other key indicators. Sustainability remains the challenge but early results are encouraging.
Towards a Collaborative Model of Care
Authors: Campbell Brad , Fryers Marla , Devitt Rob , Vestal Kathy
Published: July 2010

The current crisis in Canada's health care system calls for transformational change in the way we deliver care. The Collaborative Model of Care is not a new concept, but has not been implemented in Canadian acute care hospitals until recently. Toronto East General Hospital developed and piloted a collaborative care model on three acute units and initial results are promising in terms of improved patient safety, patient satisfaction, job satisfaction and improved use of resources.
Mobilizing toward Regional Accreditation
Authors: O'Neill Mary Lou
Published: July 2010

In January 1999, the Eastern Regional Health Board began planning for a Regional Accreditation scheduled in November 1999. This would be the first time that our two programs (Addiction Services and Public Health), and two of the nine acute care facilities in our Region would be accredited.

This article describes a regional accreditation planning process. It suggests the resources required for such a project, suggests a workable time line, and indicates a communication strategy.

Mobilizing over 1000 staff, physicians, and the communities toward Regional accreditation was a challenge for the Steering Team. Defining a plan of action with defined time lines proved helpful; defining team chairs who were flexible and positive was vital, and engaging the communities in our review was rewarding. Informing the public was completed using strategies borrowed from our Newfoundland counterparts (an accreditation mural and a regular newsletter), and our own creative strategies such as “Sharing Day” and engaging community health board involvement on accreditation teams.

The project development was initiated by a steering committee, and spanned 21 teams. Both a communication and education plan were important in keeping the board, staff, physicians and residents of the Region informed.
Resource Allocation in Integrated Delivery Systems and Healthcare Networks: A Proposed Framework to Guide Ethical Thinking
Authors: MacDonald Melanie
Published: July 2010

Drawing on a management perspective and the literature, this article suggests an ethical framework to be used at the meso or community level of resource allocation in a Canadian setting. The suggested framework enlarges on the program-level framework developed by Meslin et al primarily by building in stakeholder inclusiveness and public accountability, both of which are essential to resource allocation at the population-based level.
Navigating Ambulatory Referral: A Standardized Process
Authors: McDonald Nancy , Pinard Marie , Richardson Fran
Published: July 2010

Significant funding and structure changes to healthcare in Ontario in the mid-90's led The Hospital for Sick Children in Toronto to examine patient referral processes. In an effort to streamline access and encourage more appropriate referrals, the hospital tested and implemented three major changes. This article outlines these changes using the PDSA (Plan, Do, Study, Act) improvement framework and summarizes the results from this project.
Tonsillectomy Rates for Manitoba Children: Temporal and Spatial Variations
Authors: Brownell Marni
Published: July 2010

This study compared tonsillectomy rates for Manitoba children across geographic regions and over time. Shortly after the publication of clinical guidelines for tonsillectomy, provincial rates of this procedure dropped by over 25% between 1994/95 and 1996/97. By 1998/99, rates for non-Winnipeg children had increased to pre-guideline levels, whereas the rates for Winnipeg children remained lower. Significant regional variation existed in all years examined, suggesting that quality of care remains an issue for this procedure.
Assessing the Performance of Rural Hospitals
Authors: Martens Patricia J. , Stewart David K. , Mitchell Lori , Black Charlyn
Published: July 2010

This study developed population-based and hospital-based indicators to examine the performance of Manitoba's 68 rural hospitals. Analyses of the indicators revealed considerable differences in the populations served and their use of rural hospital services. Hospital type was also an important factor for performance. The rural hospital indicators would be useful to hospital planners and regional policy makers for comparison purposes and for highlighting issues that need to be addressed.
Comparing Apples to Apples: The Relative Financial Performance of Manitoba's Acute Care Hospitals
Authors: Watson Diane , Finlayson Greg , Jacobs Philip
Published: July 2010

This paper presents comparative financial ratios that can be adopted by health system administrators and policy analysts to begin to evaluate the performance of acute care hospitals. We combined financial, statistical and clinical information for 73 acute care hospitals in Manitoba for fiscal 1997/98 to calculate 15 indicators of financial performance. Our findings suggest that there is variability between hospital types in their average costs per weighted case, cost structure and financial performance.
The Relative Cost of Inpatient Care in Manitoba's Largest Hospitals
Authors: Finlayson Greg , Watson Diane , Jacobs Philip
Published: July 2010

Comparative information from 1991/92 to 1997/98 regarding an indicator of the relative financial performance of teaching, urban community and major rural hospitals in Manitoba is presented. Results suggest that the acuity and complexity of patients in teaching and urban community hospitals was similar in 1997/98, and that teaching facilities had higher inpatient care costs in all time periods, even after accounting for differences in case-mix, physician remuneration, capital expenditures and the direct costs of teaching programs.
Seasonal Patterns of Hospital Use in Winnipeg: Implications for Managing Winter Bed Crises
Authors: Menec Verena H. , Roos Noralou P. , MacWilliam Leonard
Published: July 2010

This study examined whether Winnipeg hospitals experience predictable “high-volume periods” in order to determine whether hospital overcrowding might be anticipated and, therefore, avoided. We found that high-volume periods among medical patients occurred during all but one year between 1987 and 1998. Most high-volume periods occurred during influenza seasons. Preventing such recurrent bed pressures requires a multi-faceted approach, involving preventive efforts to reduce hospital admissions (influenza vaccination) and alternatives to managing the hospital system.
Romanow, Kirby and Courchene: Canada's Health System — A Moral or a Business Enterprise?
Authors: Davidson Alan
Published: July 2010

This paper examines Thomas Courchene's argument that Senator Kirby was closer to the truth than Commissioner Romanow when Kirby argued that Canada's healthcare system is only sustainable though introducing more private investment. The paper finds that Romanow's position, and indeed the nature of Canada's healthcare system, have been misrepresented by those seeking a larger private market share. The paper concludes the balance of evidence supports Romanow, not Kirby.
Setting Priorities and Allocating Resources in Regional Health Authorities: A Report from Two Pilot Exercises Using Program Budgeting and Marginal Analysis
Authors: Mitton Craig , Donaldson Cam , Halma Lisa , Gall Nadine
Published: July 2010

A significant mandate of Canadian regional health authorities is to set priorities and allocate resources within a limited funding envelope. Program budgeting and marginal analysis is a priority-setting framework used in the health sector. This article discusses the application of the framework in two regional health authorities in Alberta. The framework was demonstrated to be effective in aiding decision makers to set priorities, and wider application of the framework in these health authorities is planned.
Slaying the Dragon of Protectionism: Lessons Learned on the Journey to Health Services Integration
Authors: Elson Steve
Published: July 2010

This article describes what the Queen's University Care Delivery Network project, a multidisciplinary, applied research project, learned about facilitating clinically focused integrated service delivery. Lessons learned include the importance of teamwork, resources, skills, planning, communication, leadership, education and ongoing commitment to ensure successful outcomes. It was also learned that people are prepared to change and collaborate to improve the process and outcome of patient care.
Ambulatory Health Centres (Part 1): A Typology
Authors: Rodriguez Rosario , Champagne François , Contandriopoulos André-Pierre
Published: July 2010

The authors examine the possible forms that an ambulatory care centre associated with a university hospital system — created through a merger of several independent hospitals — might assume. Part 1 describes potential models; part 2 estimates the plausible performance of each of these potential models using the Parsonian approach to social systems.
Integrating Admission and Discharge Services: Evaluation Results, Challenges and Directions
Authors: Hadjistavropoulos Heather D. , Lawson Karen , Peters Cathy , Asmundson Gordon J. G. , Boisvert Jennifer A.
Published: July 2010

This article documents an evaluation of a health district organizational change aimed at improving admission and discharge services. To this end, diverse staff from across the continuum of care were integrated and focused on facilitating, evaluating and coordinating timely and appropriate service access. Quantitative and qualitative methods were used to examine the impact of the change on stakeholders. Results revealed improvements in admission and discharge over a short period, but also illustrated challenges faced during implementation and areas for program development.
Éliminer le spectre du protectionnisme: Leçons tirées de l'intégration des services de santé
Authors: Elson Steve
Published: July 2010

Le présent article décrit les leçons tirées du projet de réseau de prestation de soins de l'Université Queen's, un projet multidisciplinaire de recherche appliquée portant sur l'intégration de la prestation de services cliniques. On a pu évaluer l'importance que revêtent le travail d'équipe, les ressources et les aptitudes, la planification, la communication, le leadership, la sensibilisation et un engagement soutenu pour veiller au succès des efforts d'intégration. On a également pu constater que les gens sont prêts à changer et à collaborer afin d'améliorer le processus et l'issue des soins aux patients.
What are the Initial Perceptions of Multidisciplinary Personnel New to Integrated Care Pathway Development?
Authors: Hadjistavropoulos Heather , Pierce Tanya Dunn , Biem H. Jay , Franko Joanne
Published: July 2010

Initial perceptions of programmatic shifts are important to gauge if organizational change is to be successful. We used qualitative methods to understand the perceptions of multidisciplinary team members who were responsible for developing integrated care pathways for chronic heart disease in an attempt to improve continuity of care. Members viewed continuity of care as problematic and perceived ICPs as a template for increasing knowledge and enhancing communication. Numerous barriers to ICP use were noted. Information collected in this study may assist others who are developing integrated care pathways.
Going Provincial: Preceptoring and Mentoring Revisited in the Health Sciences. Part II — The Evaluation
Authors: Mitchell Carol , Sawatzky-Girling Brenda
Published: July 2010

Part I of this two part series, which was published in the Spring 2003 issue of Healthcare Management FORUM, described the Preceptor & Mentor Initiative for Health Sciences in BC, a provincial strategy to facilitate preceptoring and mentoring. Activities included creation of an educational web site and a UBC Continuing Studies preceptor course, and provincial workshops on preceptoring and mentoring. The purpose of this second article is to outline the philosophy, framework, results and interpretation of the Preceptor & Mentor Initiative's evaluation component.
Mesurer certains éléments du rendement des conseils de santé décentralisés: des patients de Nouvelle-Écosse qui voyagent plus que nécessaire pour obtenir des soins hospitaliers
Authors: Hanlon Neil T.
Published: July 2010

Cet article présente un ensemble d'indicateurs de rendement mesurant le succès des conseils de santé décentralisés à fournir des services hospitaliers secondaires aux résidants de leurs juridictions. L'étude repose sur l'analyse des données sur les sorties d'hôpital en Nouvelle-Écosse de 1992–1993 à 1999–2000. Bien que la plupart des résidants de Nouvelle-Écosse obtiennent cette catégorie de soins dans leur propre district, de grands écarts ont persisté dans le temps quant à l'engagement des hôpitaux envers les résidants de leur propre district.
Consolidation of Surgical Services within a Health Region: A Case Study
Authors: Triska Olive H. , Trepanier Kathy , Evans Judith , Bear Robert , Hamilton Stewart M. , Ness Kathleen , Saunders L. Duncan
Published: July 2010

This article is an historical case study of the effects of consolidating surgical services in Alberta's Capital Health Authority from 1994 to 2001. The consolidation resulted in the region's two largest hospitals offering primarily high intensity inpatient surgical care, while three other hospitals offered low-intensity day surgery and short-stay procedures only. Over time, refinements of the initial model were required. Lessons learned from the initiative are also presented.
Gestion du savoir en santé: De quoi s'agit-il? Comment la mesurer?
Authors: MacDonald Melanie
Published: July 2010

Bien que le savoir existe dans toutes les organisations de soins de santé, il demeure souvent coincé dans des silos ou sur la touche, sans être utilisé à son potentiel maximal ni cibler des résultats stratégiques. Afin de faciliter l'élaboration de connaissances valables au plan stratégique, cet article décrit sept dimensions d'accumulation des connaissances permettant de créer un puissant levier de gestion du savoir au sein d'une organisation. En outre, l'article aide les lecteurs à composer avec la responsabilisation en suggérant des résultats stratégiques issus de la gestion du savoir. L'accent a été mis sur les indicateurs précurseurs permettant de suivre les progrès et de mesurer le succès de la gestion du savoir.
A Practical Approach to Understanding Risk of Institutionalization in Two Canadian Cities: The Regina Risk Indicator Tool
Authors: Gillis Liz , Parsons Louise , Neville Susan , Stein Glenda
Published: July 2010

Appropriate utilization of long-term care resources is critical to sustainability. This article reports on the evaluation of the Regina Risk Indicator Tool conducted by the Calgary Health Region in 2000, including an overview of the tool evaluation and a summary of RRIT development within the Regina Health District. The RRIT has provided value to Calgary and Regina in matching client needs with appropriate community- and facility-based services.
Hospital Psychology in Canada: Issues and Strategies
Authors: Nicholson Ian R. , Velikonja Diana , Bisnaire Lise
Published: July 2010

Psychology has long been an important component of the services provided in Canadian hospitals. Most major centres' interdisciplinary teams include a number of psychologists. Nonetheless, recent restructurings have resulted in substantial negative consequences to hospital psychology staff and to their accessibility by patients. This article outlines the impact of recent changes on the recruitment and retention of hospital psychologists and offers recommendations for organizational changes to assist in overcoming these problems.
Implementation of a New Central Intake System in Community Care
Authors: Mohr Gloria , Bourne Deb
Published: July 2010

This article identifies how the Central Intake process for the community healthcare programs within one Interior Health health services area was restructured to provide clinical screening for all referrals. The process involved complex project management to ensure the respective input from acute, residential and community care programs. The result was the development of a much more effective, clinically led intake system providing more appropriate referrals within and beyond the community programs.
Comprendre la reddition de compte dans le système de santé canadien
Authors: Penney Christine
Published: July 2010

Au fur et à mesure que le secteur public en général et plus particulièrement le secteur de la santé traversent des périodes de réforme à travers le monde occidental afin de trouver des systèmes qui fonctionnent mieux et qui coûtent moins cher, l'obligation de rendre compte revêt de plus en plus d'importance pour les décideurs. Au Canada, les commissions les plus récentes qui ont étudié les soins de santé, dirigées par Romanow et Kirby, soulignent la nécessité d'améliorer la reddition de comptes au sein du système de santé canadien. Et pourtant, même si la reddition de comptes est un concept de longue date intégré à l'administration publique et à la gouvernance du système de santé, sa signification et son application soulèvent de nombreux problèmes. Le présent article vise à résumer les constatations faites à l'occasion de la rédaction d'une dissertation de doctorat cherchant à clarifier le concept d'obligation de rendre compte et de reddition de comptes dans le domaine de la santé, et à examiner les questions relatives à l'amélioration de la reddition de comptes dans le système de santé au Canada.
Building a Culture of Ethics: The Capital Health Ethics Support Model
Authors: Simpson Christy , Kirby Jeffrey , Davies Maura
Published: July 2010

This article describes a new model for ethics support for Capital Health (a health region in Nova Scotia). With its emphasis on building a culture of ethics, many innovative elements are integral to this model and its future success. Particular emphasis is on organizational healthcare ethics and meaningful participation. Concerns about volunteer burden, urban and rural ethics needs, and varying exposure to prior ethics support will also be met by this model.
A Palette of Desired Leadership Competencies: Painting the Picture for Successful Regionalization
Authors: Hall Lee
Published: July 2010

Regionalization is occurring across the country in an attempt to improve accessibility and services to populations with increased expectations and significant budget pressures. A successful reorganization requires strong and effective leadership, equipped with an array of knowledge, skills and abilities known as competencies. The model of leadership competencies presented in this article will become an essential tool for organizations in their pursuit of leaders to implement and drive successful change. This leadership competency model, discussed within a framework of change management process, will ensure that essential steps of change are followed and provide organizations with a blueprint for success. Is your organization ready?
The Costs of Safeguarding Privacy: One Research Organization's Experience
Authors: Slaughter Pamela M. , Leman Kevin , McGill Peggy , Varney Carolynne
Published: July 2010

While academic health research has always observed strict vigilance in the guardianship of the rich information found in health databases, new legislation faced by all organizations ups the ante even higher. Research organizations like the Institute for Clinical Evaluative Sciences are delving into even more rigorous policies to keep sensitive information secure while preserving the value that dedicated research provides. The costs of implementing privacy protections are of great concern to Canadian researchers. This report discusses basic costs associated with privacy practices undertaken at the Institute.
Le leadership est-il une solution?
Authors: Wong Jocelyne , Modrow Robert
Published: July 2010

Un leadership solide est nécessaire afin de pouvoir réformer le système de santé de manière responsable et transparente. Cet article examine le contexte des programmes de développement du leadership et les conditions menant à leur succès, tel que mesuré par l'efficacité des résultats observés. L'article comprend un examen sur l'évaluation du rendement du leadership dans la perspective du processus de rétroaction à 360 degrés. Compte tenu du climat qui prévaut à l'heure actuelle dans les soins de santé, il faut faire preuve de prudence dans la mise en place de programmes de formation en leadership et du processus de rétroaction à 360 degrés.
Preventing and Resolving Ethical Conflicts: More Help for Policy Makers
Authors: Ells Carolyn
Published: July 2010

Institutional policy makers have a useful resource in the “Joint Statement on Preventing and Resolving Ethical Conflicts Involving Healthcare Providers and Persons Receiving Care”. Yet, some aspects of the joint statement pose challenges for institutional policy development and merit further reflection. With the aim of clarifying and augmenting the recommendations in the joint statement, this paper gives additional guidance on the issues of benefit, power imbalance, and legitimate decisional authority.
A Pilot Study on Home Visiting in Aspen Community Care Services
Authors: Kipp Jean , Killick Linda , Kipp Walter
Published: July 2010

The aim of this study was to test a questionnaire for more detailed management information of a community care program in rural Alberta. A total of 24 community care clients and 486 home visits to these clients were assessed. The Client Homebound Score (CHS) and the Case Management Intensity Score (CMIS) were positively associated with time spent on home visits. These scores would be useful indicators for improved resource-based planning of home visiting.
The 360° Feedback® Process: A Tool for Continuous Board Improvement
Authors: Cordeiro Lili , Newman Lisa
Published: July 2010

To remain accountable to stakeholders, healthcare governing boards need meaningful and actionable feedback on their performance. In 1998, the Board of Governors of West Park Hospital (now West Park Healthcare Centre) used the 360° feedback® technique for the first time to gather feedback from a range of stakeholders. Board members found the technology accessible and the process valuable. They are using the individual results to improve individual performance, and have developed work plans to address areas for continued board development.
Rebâtir une culture organisationnelle après une fusion
Authors: Trimnell Jean , Butterill Dale , Skinner Wayne , Golyea Gaby , Yue-Chan Louisa , MacFarlane Dianne
Published: July 2010

On reconnaît de plus en plus la culture d'entreprise comme étant un déterminant important de l'efficacité organisationnelle. Le présent article décrit la façon proactive avec laquelle le Centre de toxicomanie et de santé mentale (CTSM) a rebâti sa culture après une fusion forcée. Les effets à long terme de cet effort restent à suivre; toutefois, l'engagement semble solide envers les idées véhiculées dans la Déclaration de culture souhaitée, énoncé élaboré par un groupe de travail composé de membres du personnel et approuvé par le Conseil d'administration du Centre.
Redefining Leadership Responsibilities following Organizational Redesign
Authors: Miller Pat , Worth Barb , Barton Debbie , Tonkin Marita
Published: July 2010

A redefinition of leadership roles was necessitated by the adoption of program management, which accompanied the merger of two large academic hospitals, each of which consisted of two sites. Directors of professional departments were removed when staff were deployed to programs. Program directors were selected to manage the new programs, and profession leaders were identified to monitor standards of practice. The roles and accountabilities of the new program and profession leaders needed to be clarified for incumbents and other hospital staff. This article describes the process undertaken to clarify those responsibilities. The resulting Guide outlines 14 specific and collaborative responsibilities of program and profession leaders. Plans for review and future development of the Guide are discussed.
Prioritizing Resource Allocation for Clinical Enhancement: A Participative Methodology
Authors: Jarvi Kristine
Published: July 2010

The allocation of hospital funding for new and expanded clinical programs can be a difficult but most important task to deal with during the development of the operating plan (budget). Like many other hospitals, York Central Hospital has struggled with this task each year. In order to address this challenge, the hospital has successfully designed and implemented a prioritization process that includes a standardized program proposal and peer evaluation. The process is grounded in the hospital's vision and strategic directions and built on a culture of evidence-based practice.
Healthcare: The New Economy's Last Frontier?
Authors: Stuart Neil
Published: July 2010

The New Economy is transforming large parts of the business world and the public sector. New Internet technologies are being used to increase efficiency and add value. But the most distinctive contribution of the Internet is the added reach that it is giving to producers and service providers who had previously been confined by geography and by travel time and costs. Now they are able to connect with much larger markets and reach more communities and do so with a much greater immediacy. The Internet is also facilitating much more responsive and tailored services/products. This is giving rise to new and expanded demand, as these Internet-enabled services become more attractive to buyers/consumers.
Improving Outcomes in Rehabilitation
Authors: Knoefel Frank D.
Published: July 2010

This article addresses the issue of measurement in a geriatric rehabilitation program (GRP). The Sisters of Charity of Ottawa Health Service Geriatric Rehabilitation Program was found to have a long length of stay relative to peer programs. Therefore, a number of processes were adopted, over 15 months, to improve outcomes. The results of these interventions produced a net improvement in patient outcome including a threefold increase in rate of patient improvement and a corresponding increase in cost efficiency.
The Organizational Structure of Intensive Care Units and its Influence on Patient Outcomes
Authors: Kutsogiannis D.J. , Hague C. , Triska O.H. , Johnston R.G. , Noseworthy T.
Published: July 2010

Despite the growing body of knowledge on the theory of organization, the application of such theory to the organization of intensive care units is in its infancy. Our knowledge about the influence of ICU organization on patient outcomes is limited. Development of instruments to measure ICU organization, and their implementation in studies of new therapies and technologies, will assist in demonstrating the effect of various models of ICU organization on the provision of clinical care.
The Realities of Synthesizing and Disseminating Research Evidence
Authors: Lau Francis , Hebert Marilynne
Published: July 2010

This article describes the results of a 15-month pilot project to determine whether producers and users of organizations' research findings can synthesize and disseminate evidence collaboratively. The findings of the project suggest that the collaborative approach is a feasible but costly endeavor owing to differences in need, expertise, experience and context. Funding agencies should consider alternative ways to build sustainable partnerships and to address the cultural and political contexts of organizations involved with the synthesis and dissemination of evidence.
Application of an Impact of Restructuring Scale to the Healthcare Sphere
Authors: Greenglass Esther R. , Burke Ronald J.
Published: July 2010

Job loss and job insecurity are frequently associated with today's widespread restructuring and downsizing of the workplace. The authors have developed an Impact of Restructuring Scale that quantifies the effects of restructuring in the healthcare sphere. The scale documents the effects of the resulting cutbacks, hospita mergers and hospital closings on two areas: quality of healthcare services and effects on staff. The study described in this article applies the scale to the healthcare sphere as reported in a sample of 1,363 nurses employed in hospitals that were being restructured. The nurses returned a self-report questionnaire in which they reported their reactions on a variety of measures designed to assess extent of restructuring initiatives, stressors, hospital support, job satisfaction and distress. Results showed that predictors of the impact of restructuring on nurses include restructuring initiatives undertaken by the hospital, deterioration of hospital facilities and services, work stressors (e.g., workload, bumping, use of generic workers) and social support. Hospital restructuring was also associated with lower job security, diminished job satisfaction and increase in depression, anxiety and somatization.
Federal Governance in Emergency Management in Canada: Quo Vadis?
Authors: Caro Denis H. J. , Angelis Demetrios
Published: July 2010

Emergency management has become a focus of scientific study on how to better understand the hazards that shape our natural and constructed environments in order to establish standards for a safer world. It comprises the body of knowledge, policy and practice associated with humanitarian responses to both natural and technological disasters and emergencies. Its objective is to decrease the vulnerability of Canadian communities through improved access to emergency services, information, education and empowerment. In this article, we explore several important emergency management issues concerned with information support that require an examination of the basic tenets of emergency governance in Canada.
Project Management: An Essential Tool for Implementing Integrated Information Technology in Healthcare
Authors: Chittick Paul K. , Persaud D. David
Published: July 2010

Implementing organizational change can be a difficult process. Managers continue to search for innovative methods to implement improvement initiatives. Project management, a framework that has been used to successfully guide project implementation in several business sectors, is now also being employed in healthcare to implement large-scale change. This article provides healthcare managers with an overview of project management and a description of how it can be used to implement integrated health information systems successfully.
Evaluating an Alternative Funding Plan
Authors: Anderson M. , Cosby J.
Published: July 2010

There have been increasing levels of interest shown across Canada in the potential application of alternative funding arrangements for academic health science centres. This article outlines the approach, and some preliminary results, of the alternative funding plan evaluation at Queen's University. Following a discussion of the AFP itself, the article describes the first phase of the evaluation process. Several studies nearing completion are outlined, as are other pieces of research that will be conducted before the AFP is renegotiated in 1999. Finally, the authors provide a brief discussion of the organizational and methodological issues that emerge when evaluating an AFP.
Surviving Change: One District Health Board's Experience
Authors: Borody J. , Gieni K.J.
Published: July 2010

This qualitative evaluation examines critical steps the Moose Jaw-Thunder Creek District Health Board initiated to address health reform; in particular, the adoption of a governance philosophy, restructuring of services, development of a comprehensive planning process, and implementation of a communication strategy. The outcome has been a yearly health plan that maintains quality health services; provides opportunities for service growth, client-centred health delivery and increased accountability through defined outcomes; and ensures that the Board ends the year with a balanced budget.
How to Move Things around a Hospital: Transport Logistics at St. Michael's
Authors: Yau Angelina , Zorn Renate , McLaughlin Joan
Published: July 2010

Ongoing fiscal restraint challenges hospitals to focus their resources primarily on core services. Support services receive much less attention. This article describes the experience of Toronto's St. Michael's Hospital when it re-engineered its transport logistics by consolidating centralized support services into a logistics department and creating new roles and processes to enhance patient care.
Efficacité de l'utilisation des lits de soins aigus à Terre-Neuve et au Labrador
Authors: Doyle Michael , Barrett Brendan J. , McDonald Jackie , McGrath Jerry , Parfrey Patrick S.
Published: July 2010

L'efficacité des services d'un hôpital est étroitement liée aux niveaux d'utilisation et à la durée de l'hospitalisation. Dans cette étude, nous avons cherché à déterminer si, à Terre-Neuve, la mauvaise utilisation des lits était liée à de l'inefficacité ou à un mauvais accès à d'autres services. Pour assurer le suivi de l'efficacité, nous avons aussi comparé les données de l'Institut canadien d'information sur la santé (ICIS) à celles de notre sondage pour voir si elles fournissent de l'information semblable. Nous avons présenté la durée incongrue des soins aigus en modifiant un peu le Protocole d'évaluation de la congruité (PEC). À partir de la banque de données de l'ICIS, nous avons aussi étudié la durée moyenne d'hospitalisation (DMH) pour chaque service des établissements de soins aigus de chaque province pour la période allant de 1993–1994 à 1995–1996.

L'admission à l'hôpital était incongrue dans 14,2 pour cent des 2 007 cas. Sur 14 194 jours de soins, 22,8 pour cent des jours étaient incongrus; on aurait pu éviter cela en grande partie (16,4 pour cent) en utilisant mieux les ressources disponibles. De ces jours, 49,2 pour cent étaient liés aux fonctions médicales. Dans toute la province, la DMH est passée de 5,7 jours en 1993–1994 à 5,39 jours en 1995–1996; elle demeure toutefois de 10,5 pour cent plus élevée que la moyenne nationale. À l'échelle nationale, les données de l'ICIS sur la DMH dans chaque service correspondent au pourcentage de jours incongrus par service (r=0,57). On utilise trop de lits parce qu'on ne se sert pas adéquatement des services disponibles. En fait, les médecins pourraient faire baisser presque de moitié le total des jours d'hospitalisation incongrus. Les données de l'ICIS sur la durée d'hospitalisation pourraient servir à cerner les services ou les médecins sur lesquels concentrer une intervention.
Efficiency of Institutional Long Term Care and Annual Demands for Placement
Authors: O'Reilly Darla , Parfrey Patrick S. , Barrett Brendan , McDonald Jackie
Published: July 2010

The objective of this study was to determine the efficiency of and annual demands for institutional long term care placement in the St. John's region. The study population comprised all applicants assessed for institutional long term care through the Community Health St. John's Region Single Entry System in 1995–96. The outcome measures used for the study included estimates of client resource utilization employing the RUGs III and Alberta Resident Classification System; hospital beds occupied; time to placement; and annual demands on long term care.

The study concludes that objective criteria for admission to supervised care and nursing home care may help reduce the number of inappropriate placements (thus maximizing the use of existing nursing home beds) and decrease annual demands. Investment in alternatives to nursing home care for those with modest disability is suggested.