bluuebunny/crossref_metadata_2025 huggingface dataset:
A Framework for Involving the Public in Health Care Coverage and Resource Allocation Decisions
Authors: Chafe Roger , Neville Doreen , Rathwell Thomas , Deber Raisa
Published: July 2010

Coverage and resource allocation decisions are a very important area for public engagement because of their direct impact on the public's access to care and because the affected services are publicly funded. We present a framework that guides decision-makers through key questions they must address when deciding on, structuring, evaluating and disseminating the results of public engagement exercises, particularly as they relate to coverage and resource allocation decisions. The framework will enable decision-makers to better conduct viable and meaningful citizen engagement around these issues.
Public Engagement and the Changing Face of Health System Planning
Authors: Grant John , Sears Nancy A. , Born Karen
Published: July 2010

This paper examines the impact of the emerging citizens' assembly model of public engagement on health system planning and management. The characteristics that distinguish this model from more traditional approaches such as surveys and town hall meetings are elaborated using the case study of the recent Citizens' Regional Health Assembly. The paper concludes by suggesting the possibility of a new type of relationship between health system decision-makers, providers and the community.
Building Organizational Capacity for Change
Authors: Heslin Kathleen , Marr Jo-Anne
Published: July 2010

This paper describes strategies to enhance organizational capacity through a large-scale role redesign initiative. Innovation for change strategies were used as the framework to guide the change. Project management processes were used. Assessment of need was based on characteristics of the patient population, service access, staff preferences and opportunities for enhancement identified through patient feedback. Twenty-one roles were reviewed, ten new roles created, seven revised and four consolidated. Transition support and sustainability processes and structures were implemented.
Mise en œuvre de la technologie de l'information en vue d'améliorer la santé en milieu de travail: une évaluation par le Web des besoins d'information des gestionnaires de la Fraser Health Authority, en Colombie-Britannique
Authors: Sandhu Jag S. , Anderson Keith , Keen Dave , Yassi Annalee
Published: July 2010

Un questionnaire d'enquête par le Web a été administré principalement en vue de déterminer l'information qui était utile aux gestionnaires de la Fraser Health Authority, de Colombie-Britannique, à l'appui de la prise de décisions relative à la santé et la sécurité en milieu de travail. Les résultats ont indiqué que les gestionnaires préfèrent des rapports trimestriels électroniques, avec des cibles, des objectifs et des tendances historiques évalués comme « très importants ». Plus de 85,7 % « sont d'accord » que si l'information était facilement disponible dans le format « le plus avantageux », ils seraient en mesure d'améliorer la santé en milieu de travail. Il est recommandé, entre autres, que les gestionnaires obtiennent des rapports sur la santé en milieu de travail qui sont clairs et précis, tout en facilitant l'analyse aux fins de la prise de décisions.
Beyond Knowledge Transfer: A Model of Knowledge Integration in a Clinical Setting
Authors: Gauthier Nicole , Ellis Kathy , Bol Nancy , Stolee Paul
Published: July 2010

Current conceptualizations of knowledge transfer reinforce the notion of a linear process between researchers and clinicians, who are seen as operating separately with different agenda. This paper uses a case study to illustrate a dynamic model of knowledge integration involving integrated and interdependent relationships among researchers, clinicians, and decision-makers. We believe the principles of this model are more likely to lead to effective use of research evidence in clinical practice.
Linking Research, Policy, and Action: Evidence-Based Complementary and Alternative Medicine
Authors: Wong Vivian Taam , Feichau Pang
Published: July 2010

Complementary and Alternative Medicine (CAM) is highly prevalent worldwide, resulting in legislation to regulate the providers and the products accompanied by enhancement of educational and research programs in many countries.

Evidence-based Medicine (EBM), an effective approach for making healthcare decisions, can be equally applied to CAM, using innovative research methodology. When using Chinese Medicine (CM) as a proxy for CAM, the challenge is to develop a scientific model that could create a common platform of dialogue between CM and Western Medicine (WM), based on shared interpretation of CM syndromes, the pluralistic diagnostic logic, and multi-dimensional treatment approach.

To facilitate the above, Hong Kong has implemented CM practitioner registration, transitional trade licensing, and control of proprietary CM. The Hospital Authority has created a modern delivery model by introducing an application system in CM pharmacy and clinical management, which could be used as research and audit tools.
How Can We Synthesize Qualitative and Quantitative Evidence for Healthcare Policy-Makers and Managers?
Authors: Pope Catherine , Mays Nicholas , Popay Jennie
Published: July 2010

Interest in synthesizing the findings of qualitative and quantitative evidence is increasing in response to the complex questions being asked by healthcare managers and policy-makers. There is a wealth of evidence available from many sources — both formal research and non-research based (e.g., expert opinion, stakeholder, and user views). Synthesis offers the opportunity to integrate diverse forms of evidence into a whole. We categorize the current approaches to the synthesis of qualitative and quantitative evidence into four broad groups: narrative, qualitative, quantitative, and Bayesian. Many of the methods for synthesis are emergent; some have been used to integrate primary data; few have a long history of application to healthcare. In the healthcare context, synthesis methods are less well developed than methods such as systematic review. Nonetheless, synthesis has the potential to provide knowledge and decision support to healthcare policy-makers and managers.
Adverse Events in Older Patients Admitted to Acute Care: A Preliminary Cost Description
Authors: Ackroyd-Stolarz Stacy , Guernsey Judith Read , MacKinnon Neil J. , Kovacs George
Published: July 2010

The financial costs associated with Adverse Events (AEs) for older patients (≥65 years) in Canadian hospitals are unknown. The objective of this paper is to describe and compare costs between patients who experienced an AE and those who did not during an acute hospital admission to a tertiary care facility Patients with an AE had twice the hospital length of stay (20.2 versus 9.8 days, p < 0.00001), resulting in 1,400 extra days at a cost of approximately $7,500/patient.
Mobilisation En Vue De L'Agrément Régional
Authors: O'Neill Mary Lou
Published: July 2010

En janvier 1999, le Conseil de santé régional de l'est (Eastern Regional Health Board) commençait à planifier son agrément régional prévu pour novembre 1999. Il s'agirait d'un premier agrément pour nos deux programmes (Services de lutte contre la toxicomanie et Santé publique: Addiction Services et Public Health) et pour deux des neuf établissements de soins de courte durée de la région.

Cet article décrit le processus de planification de l'agrément régional. Il énumère les ressources voulues pour un tel projet, propose un calendrier d'exécution raisonnable et suggère une stratégie de communication.

Mobiliser plus de 1000 employés et médecins ainsi que les collectivités en vue de l'agrément régional s'est avéré un défi de taille pour le Comité d'orientation. L'élaboration d'un plan d'action prévoyant des échéances précises a été utile; la nomination de présidents d'équipes conciliants et positifs a été essentielle, et consulter les collectivités dans le cours du processus a été enrichissant. L'information du public s'est faite grâce à des stratégies empruntées à nos homologues de Terre-Neuve (une murale d'agrément et un bulletin publié régulièrement), ainsi que par l'adoption de stratégies de notre cru, comme la Journée du partage, et enfin par le biais de la participation des conseils communautaires de santé dans nos équipes d'agrément.

La mise sur pied du projet a été confiée à un comité d'orientation et a mené à la création de 21 équipes. Des plans de communication et de sensibilisation ont constitué des outils importants afin d'informer le Conseil d'administration, le personnel, les médecins et les habitants de la région.
Integrated Health Information Systems Based on the RAI/MDS Series of Instruments
Authors: Hirdes John P. , Fries Brant E. , Morris John N. , Steel Knight , Mor Vince , Frijters Dinnus , LaBine Steve , Schalm Corinne , Stones Michael J. , Teare Gary , Smith Trevor , Marhaba Mounir , Pérez Edgardo , Jónsson Palmi
Published: July 2010

There is a growing need for an integrated health information system to be used in community, institutional and hospital based settings. For example, changes in the structure, process and venues of service delivery mean that individuals with similar needs may be cared for in a variety of different settings. Moreover, as people make transitions from one sector of the healthcare system to another, there is a need for comparable information to ensure continuity of care and reduced assessment burden. The RAI/MDS series of assessment instruments comprise an integrated health information system because they have consistent terminology, common core items, and a common conceptual basis in a clinical approach that emphasizes the identification of functional problems.
Results of Implementation of a Contemporary Model for Ambulance Diversions in an Integrated Healthcare Delivery System
Authors: Anderson Erin , Riddle Kent , Bear Robert
Published: July 2010

This brief report contains a description of a contemporary, coordinated new system for ambulance diversions, which was implemented in Edmonton area's Capital Health Region in January 1999. The development of this new system was precipitated by the combination of increasing pressures within the acute care system especially being felt within our emergency departments, and mounting evidence that the existing system for ambulance diversions was ineffectual in providing temporary relief of these pressures. The nature of the previous and the new system are compared and contrasted, and data are included to demonstrate that the new system has led to marked reductions in the number of ambulance diversions experienced regionally.
Evaluation of Communication Surrounding the Implementation of the Resident Assessment Instrument
Authors: Brunton Bev , Rook Marilyn
Published: July 2010

Two outcomes of the introduction of the Resident Assessment Instrument at Sunnybrook Health Sciences Centre in 1996 were (1) a communication plan and (2) patient unit RAI communication centres. This article describes a survey that was used to evaluate the effectiveness of the plan and centres in implementing the RAI. Staff identified the InfoRAInbow Newsletter as the most useful communication strategy. Satisfaction with communication about the RAI implementation was only 57 percent. Further investigation of this level of satisfaction is required. This result may be attributed to the “choices” staff make as to whether or not to read information, or to environmental factors that occurred at the time of the survey's completion. Future directions for improving the RAI Communication Plan should focus on environmental factors that may impede communication of information, especially information that affects integration of the RAI into the clinical care system.
Health Service Use in the Winnipeg Regional Health Authority: Variations across Areas in Relation to Health and Socioeconomic Status
Authors: Frohlich Norman , Fransoo Randy , Roos Noralou
Published: July 2010

The use of healthcare services in Winnipeg is examined to determine whether groups who appear to have a higher need for medical care actually get more care. Despite universal coverage, considerable variation in service use rates exists. Most of the basic healthcare services are provided in accordance with need as measured by premature mortality rates. Nevertheless, visits to specialist physicians, a variety of high profile procedures, and screening and preventative services appear not to be provided in accordance with need.
Long Stay Patients in Winnipeg Acute Care Hospitals
Authors: Kozyrskyj Anita , De Coster Carolyn , St John Philip
Published: July 2010

Risk factors for long-stays (more than 30 days) in Winnipeg hospitals were identified, including sociodemographic, illness, and system characteristics. The largest determinant of length of stay was discharge destination; discharge to a nursing home increased length of stay by 173% and 89% for medical and surgical patients, respectively. Hospital of stay also made a big difference for patients discharged to nursing homes. Only 13% of long-stay patients were discharged to a nursing home; 52% were discharged home. Other factors which were associated with an extended length of stay included: hospitalization for stroke, cognitive impairment, rehabilitation therapy, PEG tube insertion, and inhospital fall.
Trends in Health and Healthcare Utilization in Manitoba
Authors: Lix Lisa M. , Newburn-Cook Christine V. , Roos Noralou P. , Derksen Shelley
Published: July 2010

Trends in health status and healthcare utilization were examined for regions of Manitoba from 1985 to 2000. While the provincial premature mortality rate decreased, the difference between the northern and southern regions increased. Hospital admissions remained stable despite major bed closures and an aging population; a decrease in hospital days per capita was observed in all regions. Physician contact rates also remained constant despite a 40% increase in the number of seniors.
Patients Hospitalized for Medical Conditions in Winnipeg, Canada: Appropriateness and Level of Care
Authors: Bruce Sharon , DeCoster Carolyn , Trumble-Waddell Jan , Burchill Charles
Published: July 2010

A medical record review of patients hospitalized for medical conditions in Winnipeg, Canada during 1998/99 was completed using InterQual utilization review instruments. On admission, 95% of patients required the services provided in an acute care facility. Fifty-eight percent of days in hospital following the day of admission required an acute care setting, and 42% required an alternate level of care. Our results suggest there is room for treating more acute patients within the existing system.
Beyond Partnering: Creating the Healthcare Community
Authors: Amaratunga Carol , Hockney Judith
Published: July 2010

Growing stress on the healthcare system has encouraged policy makers and care providers to reconsider the current system. While universal access must be maintained, the authors argue that greater recognition of the differences in the health needs of Canada's diverse communities should shape service delivery. The creation of “healthcare communities” based on targeted research and stakeholder advice is more efficient and cost-effective than a standardized model based on population aggregates.
Le syndrome du survivant: comparaison des perceptions des administrateurs, des gestionnaires, du personnel de soins infirmiers et des médecins durant la restructuration des hôpitaux en Ontario
Authors: Lees Martin , Steeves William
Published: July 2010

Lors d'une restructuration organisationnelle, les dirigeants doivent tenir compte des inquiétudes des employés à défaut de quoi de nombreuses conséquences négatives pourraient se manifester au sein des «survivants». Cet article fournit des considérations importantes à l'intention des administrateurs, des gestionnaires et des planificateurs au sujet des gens qui sont demeurés en poste durant la restructuration des hôpitaux ontariens. Selon nos constatations, qui sont valables pour la plupart des organisations qui envisagent ou qui traversent une restructuration, il est nécessaire de gérer le changement de façon proactive, y compris l'application de stratégies d'intervention personnalisées, afin de venir en aide aux «survivants».
La recherche au service des dirigeants de la santé
Authors: Lomas Jonathan
Published: July 2010

Dans ce numéro de FORUM, le Collège a le plaisir de vous proposer un texte rédigé par un éditorialiste invité, Jonathan Lomas. M. Lomas est directeur exécutif de la Fondation canadienne de la recherche sur les services de santé (FCRSS). Étant donné les liens étroits qui existent entre le Collège canadien des directeurs de services de santé (CCDSS) et la FCRSS, dont le mandat consiste à favoriser l'intégration de le recherche à l'intention des décideurs, il ne fait aucun doute qu'il s'agit-là d'une collaboration gagnante. Nous présenterons d'autres éditoriaux du genre dans les numéros à venir.
Reflections from an Early Careerist
Authors: Down Annette
Published: July 2010

In this edition of FORUM, the College is pleased to feature a guest editorial from Annette Down, current recipient of the 2002–2003 Fellowship in Health Services Management. More than half way through the Fellowship, Annette shares some of her take home messages from the experiences she has had so far. Annette would like readers to know she will be looking for a job in September.
National Guidelines for Rehabilitation Staffing Levels: A Literature Review
Authors: Erlendson Patricia , Modrow Robert
Published: July 2010

Canadian rehabilitation staffing guidelines do not exist; consequently, significant service-level differences are found. This article reviews methods of determining rehabilitation staffing and presents factors to consider in developing staffing guidelines. Skill mix, service intensity, patient diagnosis and cost of care should drive staffing benchmarks.
Toward Standard Definitions for Waiting Times
Authors: Sanmartin Claudia A. ,   Steering Committee of the Western Canada Waiting List Project, Noseworthy Tom , Barer Morris L. , Black Charlyn , Donnelly Lauren , Levy Isra , Lewis Steven , McGurran John , Sheps Sam , Taylor Mark C. , Thomson Darrell , Young Barbara
Published: July 2010

There are no standard or universally accepted definitions of waiting times for a broad range of health services and procedures. The Western Canada Waiting List Project, like other similar projects, has recognized the need to establish such standard definitions to improve the accuracy and comparability of waiting time information across procedures and jurisdictions and of information provided to patients. This article proposes standard definitions of waiting times for surgery and magnetic resonance imaging.
Knowledge Management in Healthcare: What Does it Involve? How is it Measured?
Authors: MacDonald Melanie
Published: July 2010

While knowledge exists in all healthcare organizations, it often remains in silos or on the sidelines, neither used to its maximum potential nor purposefully focused on strategic results. In order to facilitate the development of strategically valuable knowledge, this article outlines seven knowledge-building dimensions that create a solid knowledge-management lever within the organization. Additionally, the article helps readers to come to grips with accountability by suggesting strategic outcomes for knowledge management. A particular focus is on lead or forward-looking indicators that track the progress and success of knowledge management.
Action Research: A Hospital Responds to Domestic Violence
Authors: Mason Robin A.
Published: July 2010

Using action-research methods and the principles of community development, a small working group initiated an organization-wide process to sensitize the Sunnybrook and Women's College hospital community to the relationship between violence and women's health. In this article, we explore the process by which the initiative was successfully introduced into the newly merged hospital. We describe critical factors for the initiative's success and offer some suggestions on how to maximize opportunities for organizational change.
Global Burden of Disease: Huge Inequities in the Health Status in Developing and Developed Countries
Authors: Sentes Kyla , Kipp Walter
Published: July 2010

This paper outlines the Global Burden of Disease study which was conducted for the 1993 World Bank Development Report. The study revealed huge differences in premature death and disability in the world regions examined; sub-Saharan Africa and India had the highest burden of disease. This paper also examines how the large differences in burden of disease between developed and developing countries can be explained by economic factors, highlighting research findings that suggest egalitarian societies are likely to have better health status than countries with capitalistic, market-based economies. This study then examines the efforts of the Global Forum for Health Research to create an integrated approach to global health policy formulation, using global burden of disease data, and concludes with the assertion that adopting such an approach nationally would also assist developed countries like Canada in better dealing with future health challenges.
Healing from Within: Internal Marketing
Authors: Backman Allen
Published: July 2010

This is the third submission of our new regular feature, the “Members' Speak Out” column. It has been designed to enhance and stimulate dialogue amongst our members and ultimately ignite the fires of debate. We encourage you to respond to these columns and let your voice be heard.
The Patient Connection: Improving Call Bell Response at Cambridge Memorial Hospital
Authors: Cardoso Gloria , Martin Nancy
Published: July 2010

This paper describes interventions to reduce call bell response time and concomitantly substantially increase patient satisfaction. Examination of the relationship between actual and perceived call bell response and patient satisfaction is explored, highlighting the complexity of this relationship. Given the highly accountable nature of patient satisfaction as measured through the Hospital Report Series and the importance of prompt call bell response to patients, call bell response is an excellent opportunity for hospitals to explore.
Réforme de l'hôpital en France: les problèmes (et parfois les solutions) semblent les même partout
Authors: Bilodeau Michel
Published: July 2010

Le système hospitalier français est en crise. Sa situation ressemble à celle des hôpitaux canadiens. À l'automne 2002, le ministre de la santé de France a annoncé une réforme en profondeur, nommée Hôpital 2007, annonce suivie d'une vaste consultation de tous les intervenants. Malgré certaines modifications suite à ces consultations, les principes de base de la réforme demeurent et leur mise en œuvre commence en 2004 pour se poursuivre pendant les cinq prochaines années. Certains aspects de cette réforme permettent d'intéressantes comparaisons avec la situation canadienne.
Change Readiness for SAP in the Canadian Healthcare System
Authors: O'Neill Mary Lou , Downer Pauline
Published: July 2010

The study described in this article was designed to assess the change readiness for e-business cost management systems (particularly SAP) within the Canadian healthcare system. Previous studies and experts suggest that change readiness is an important variable in the application of e-business cost management system implementation. One hundred and fifty-four chief executive officers within the Canadian healthcare system were surveyed. The response rate was 25.9 percent.

The survey included a demographic sheet, which supported a better understanding of the profile of Canadian healthcare CEOs, their operational budget responsibilities, and their feelings toward e-business cost management systems. A change readiness instrument reviewed CEOs' change readiness scores in relation to four independent variables (implementation of an e-business cost management system, healthcare restructuring, budget size and tenure of the CEO). There was a significant difference between change readiness scores and the implementation of an e-business cost management system. Given the small sample size (n=40), findings are limited. However the study offers more information on this issue than is found in the Canadian healthcare literature to date.
Hospital Reform in France: Problems (and Sometimes Solutions) Look Much like Ours
Authors: Bilodeau Michel
Published: July 2010

The French hospital system is in a state of crisis, its woes not much different from what Canadian hospitals experience. In the fall of 2002, the French Minister of Health announced a major reform called Hospital 2007, and initiated a wide-ranging consultation of all stakeholders. Although these consultations resulted in some minor changes to the plan, the basic principles of the reform have remained. Their implementation has begun and will continue for the next five years. Some aspects of this reform allow us to make interesting comparisons with the Canadian situation.
Understanding Accountability in the Canadian Health System
Authors: Penney Christine
Published: July 2010

As the public sector in general and the health sector in particular undergo reform throughout the Western world to find systems that work better and cost less, the phenomenon of accountability becomes increasingly important to policy makers. In Canada, the most recent healthcare commissions, conducted by Romanow and Kirby, point to the need for improved accountability within the Canadian health system. Yet, although accountability is an ancient concept embedded in public administration and health system governance, its meaning is confused and its implementation is fraught with issues. This article aims to summarize the findings of a doctoral dissertation that was undertaken to clarify the concept of accountability within the health field, and to examine the issues related to improving health system accountability in Canada.
Variations in the Use of Emergency Departments in Alberta's Capital Health Region 1998–2000
Authors: Saunders L. Duncan , Alibhai Arif , Ness Kathleen , Estey Angela , Bear Robert
Published: July 2010

The objectives of this study were to describe the utilization of emergency departments in the Capital Health region, Alberta, between 1998 and 2000, and temporal variations in emergency department utilization by month, day of week, and time of day in 2000. Between 1998 and 2000, the annual number of visits to emergency departments in the region increased by six percent. The mean length of stay, median length of stay and the number of patients who left without being seen increased by six minutes, eight minutes, and 4,442 patients respectively. Variations in the number of visits, mean and median lengths of stay, and numbers of patients who left without being seen by month, day of week, and time of day were modest except for patients who left without being seen. Service pressures in Capital Health emergency departments continue to exist. Temporal variations in service pressures were small. Causes of emergency department pressures are multiple and interrelated. Therefore, system-wide changes should be considered in addressing emergency department pressures.
Combien de chirurgiens faut-il dans chaque province et comment établir ces chiffres?
Authors: Roos Noralou P. , Fransoo Randy
Published: July 2010

L'étude a comparé le nombre de chirurgiens de chaque province de trois spécialités (ophtalmologie, orthopédie et chirurgie thoracique et cardiologie) avec les taux d'interventions clés (cataracte, remplacement du genou et de la hanche, et pontage aortocoronarien) que les habitants subissent. Nous avons trouvé peu ou pas de lien entre le nombre de chirurgiens et les taux d'interventions subies par les habitants. Nous concluons donc que le nombre de chirurgiens spécialisés ne constitue pas une mesure pertinente pour la planification des ressources en soins de la santé.
Rebuilding Organizational Culture in the Wake of a Merger
Authors: Trimnell Jean , Butterill Dale , Skinner Wayne , Golyea Gaby , Yue-Chan Louisa , MacFarlane Dianne
Published: July 2010

More and more, corporate culture is being recognized as an important determinant of organizational effectiveness. This article describes how the Centre for Addiction and Mental Health proactively focused on rebuilding its culture after a mandated merger. The long-term effects of this effort need to be monitored. However, commitment is strong to the ideas articulated in the Statement of Desired Culture that was developed by a staff task force and approved by the Centre's Board.
Impact of Restructuring Scale: An Instrument to Measure Effects of Hospital Restructuring
Authors: Greenglass Esther R. , Burke Ronald J.
Published: July 2010

As restructuring and downsizing occur throughout the workplace, many individuals are either losing their jobs or experiencing job insecurity. The study of downsizing is particularly important within the healthcare system where hospital mergers and closings, and severe cutbacks, have dramatically reduced healthcare services. Since nurses are the largest group employed by hospitals, they are the most likely to be affected by recent cutbacks. All this leads to the conclusion that a measure of the impact of restructuring is needed. This study reports on the Impact of Restructuring Scale — a new scale containing acceptable psychometric properties — that quantifies the effects of restructuring on organizations and individuals. The scale was applied to a sample of 1,363 nurses employed in hospitals undergoing restructuring and downsizing. The nurses returned a self-report questionnaire in which they reported their reactions to hospital restructuring and to specific job stressors.
Améliorations des résultats en réadaptation
Authors: Knoefel Frank D.
Published: July 2010

Cet article traite de la question de la mesure d'un programme de réadaptation gériatrique. On a constaté que le programme de réadaptation gériatrique du Service de santé des Sœurs de la Charité d'Ottawa présentait des séjours plus longs comparativement à d'autres programmes analogues. Un certain nombre de processus ont donc été adoptés sur une période de 15 mois afin d'améliorer les résultats obtenus. Ces interventions ont généré une nette amélioration au plan des résultats pour les patients, y compris une amélioration par un facteur de trois du taux d'amélioration des patients et une augmentation correspondante du rapport coût-efficacité.
Public-Private Partnerships in Healthcare: Criteria for Success
Authors: Monaghan Barry J. , Malek Anne-Marie , Simson Helen
Published: July 2010

Public-private partnerships present opportunities for healthcare providers to meet the dual challenges of shrinking public funding and increasing demand for care. Partnering with private sector organizations can provide new sources of capital, expertise and technology. Successful partnerships require specific skills and strategies. This article describes a pilot study that explored the literature and the experiences of participants in a small sample of interviews to compile a set of criteria for successful public-private healthcare partnerships.
A Journey to Create a New Patient-Record System
Authors: Greene Anne-Marie , Henhoeffer Christine , Merkens Barbara J.
Published: July 2010

In fundamentally redesigning its patient-record system, West Park focused on the patient's story, streamlined the many chart forms, and integrated the documentation with a new care model that would bring the disciplines in closer collaboration. We involved stakeholders in the redesign process at every step, relying on leadership and collaboration throughout the organization. We sought to fit the new system to the organization — to “West Park it”, and we continue to refine the new charting forms.
Managing Patient Length of Stay Better Using an Appropriateness Tool
Authors: Kaplow M. , Charest S. , Mayo N. , Benaroya S.
Published: July 2010

A multidisciplinary group from two medical floors at the Royal Victoria Hospital chose the Managed Care Appropriateness Program (MCAP) to evaluate the appropriateness of the days of stay for their patients. Of 100 charts of consecutive patients examined by the nurse reviewer (comprising 1,095 patient days), 33 percent of the days were deemed inappropriate. The reasons for each of these inappropriate days were documented, and strategies were implemented to address the issues. The major outcome of the study was a change in the culture of the health professionals to a more positive approach to defining and carrying out efficient patient care.
Managing Change in the Context of Health Reform: Lessons from Alberta
Authors: Casebeer Ann L. , Hannah Kathryn J.
Published: July 2010

A qualitative field study of health system reform in Alberta was undertaken to identify, describe, compare and contrast the processes of change management adopted and implemented as a result of legislated health policy shift. Chairs and chief executives of the new regional health authorities and provincial leaders managing the change processes within Alberta's health care system were interviewed. Components of change strategies important to the structure, process and impact of the health policy shift to a regionalized system of care were identified and analyzed. Stakeholders involved in managing change inside Alberta's health care system were able to consistently identify a range of issues important to beginning and sustaining health policy shift. These issues and insights did not come from the literature, but rather from experience. To test and share this experience further, it will be important to study more consciously the management of change in relation to expected outcomes. With so many natural experiments altering health care systems across Canada and beyond, a window of opportunity exists for researching both the quality and quantity of such change, comparing and sharing findings over time and, eventually, linking process to outcome.
The Efficiency of Acute Care Bed Utilization in Newfoundland and Labrador
Authors: Doyle Michael , Barrett Brendan J. , McDonald Jackie , McGrath Jerry , Parfrey Patrick S.
Published: July 2010

Hospital efficiency is closely related to utilization levels and length of stay. This study determined whether inappropriate bed utilization in Newfoundland was related to inefficiency or inadequate access to alternative services. It also compared Canadian Institute for Health Information (CIHI) data to our survey to determine whether they provide comparable information for monitoring efficiency. Inappropriate acute care days were identified using a modified Appropriateness Evaluation Protocol. Average length of stay (ALOS) by service for each of the province's acute care institutions was also reviewed from 1993–94 to 1995–96 using the CIHI database.

Hospital admissions were inappropriate in 14.2 percent of 2,007 cases. Of the 14,194 days of care, 22.8 percent were inappropriate, with most (16.4 percent) being avoidable with better use of existing resources. Of the inappropriate days, 49.2 percent related to physicians' functions. The provincial ALOS fell from 5.70 days in 1993–94 to 5.39 days in 1995–96, but remains 10.5 percent above the national average. CIHI national data for ALOS by service correlated with the percent of inappropriate days by service (r=0.57). Excess bed utilization remains because of the inappropriate use of existing services, and almost half of the total inappropriate days in hospital could be influenced by physicians. CIHI data on LOS can be used to target services or physicians for focused intervention.
Using the Balanced Scorecard to Align Strategy and Performance in Long Term Care
Authors: MacDonald Melanie
Published: July 2010

The Sisters of Charity of Ottawa Health Service (SCOHS) is a Canadian health care corporation that has adapted Kaplan and Norton's balanced scorecard to enhance strategic management and measurement in a multisite health care facility comprising long term care, continuing complex care, rehabilitative services, palliative care and ambulatory care. This article discusses how the SCOHS has incorporated the following principles into the balanced scorecard: demonstration of cause and effect; inclusion of outcomes and performance drivers; linkage to fiscal and utilization indicators; and integration of the mission and values of the organization. Examples of corporate level outcomes and performance measures are provided in the form of lead and lag indicators.
Continuous Quality Improvement: Status of Canadian Health Care Organizations
Authors: Murphy Tracy , Grimes Kelly , Snasdell-Taylor Barbara
Published: July 2010

The Canadian Council on Health Services Accreditation (CCHSA) surveyed its client groups to determine how involved they had become in continuous quality improvement (CQI) activities. This was a follow up to a 1992 survey.

Most of the participating organizations indicated they had adopted a CQI philosophy. A major factor influencing this decision was the use of the CCHSA's client-centred standards.

This article outlines the gains organizations have realized by implementing CQI, and the extent to which organizations have implemented CQI principles, methods and tools. The information from this survey has been used to develop the accreditation program for the year 2000 — “The AIM Project: Achieving Improved Measurement.”
UN MODÈLE PRATIQUE DE PRIORISATION AU PASSAGE À L'AN 2000 DES ÉQUIPEMENTS HOSPITALIERS
Authors: Pagé Michel
Published: July 2010

Cet article fournit un modèle simple qui permettrait de décider de la priorité et de l'ordre des démarches de résolution de problèmes que soulève le passage à l'an 2000 des équipements hospitaliers micro-programmée ou informatisés. Les raisons de la priorisation sont formulées; des niveaux de priorité sont suggérés; et, la distinction entre risques et priorité est rappelée. Ce modèle lie l'influence de paramètres tels l'interactivité et la complexité systémique; les risques pour la sécurité et les opérations; et, les impacts pour l'institution. La priorisation permet ainsi de fournir des critères d'ordonnancement qui permettront de vérifier le plus grand nombre possible d'équipements, et de structurer plus efficacement la phase des actions correctrices (remplacement, modification, acquisition, etc.).

Cette manière cohérente d'aborder le problème permet d'anticiper les étapes de la gestion des risques, l'élaboration d'un plan de contingence, et, de s'assurer de la contribution de responsables institutionnels aux compétences multidisciplinaires dont les rôles, les responsabilités et les degrés d'imputabilité seraient ainsi mieux identifiés.
Health Reform and Technological Change: Shifting Hospitalization Patterns for Four Procedures in Manitoba
Authors: Soodeen Ruth-Ann , Roos Leslie L. , Peterson Sandra
Published: July 2010

This study used Manitoba data from 1991 to 1996 to assess the effects of health reforms and technological advances on hospitalization patterns, patient mortality, and readmission rates. Cholecystectomy and hernia repair served as indicators of response to both new technology and health reforms, while appendectomy and hysterectomy helped gauge the impact of health reforms alone. Neither the introduction of new technology (i.e. laparoscopy) nor the health reform initiatives (i.e. shorter hospital stays) adversely affected surgical volumes, postsurgical mortality, or postsurgical readmissions.
Predictors of Job Stress and Satisfaction among Hospital Workers during Re-Engineering: Differences by Extent of Supervisory Responsibilities
Authors: Woodward Christel A. , Shannon Harry S. , Lendrum Bonnie , Brown Judy , McIntosh John , Cunningham Charles
Published: July 2010

After two years of rapid organizational change within a large teaching hospital, 83 percent of workers remained employed there. Among these “survivors,” job satisfaction decreased and job stress increased regardless of whether they were employed in a supervisory position. This article examines the predictors of job satisfaction and job stress for managers, for people who indicated that they supervised others but were not managers, and for workers. There are areas of commonality in predictors across these groups, as well as some differences by level of supervisory responsibility. Examining and modifying job characteristics associated with high stress could result in healthier hospital work environments.
Clinical Practice Guidelines: The Need for Improved Implementation Strategies
Authors: Randall Glen , Taylor D. Wayne
Published: July 2010

Although substantial resources have been spent developing clinical practice guidelines, little effort has been made to evaluate the effectiveness of their implementation. In the absence of effective implementation, CPGs will have minimal impact on changing behaviours. This article critically reviews the literature and identifies a number of reasons why these guidelines have not been implemented successfully. If CPGs are to have a positive impact upon clinical behaviour and practice, then more aggressive and positive implementation strategies are indicated. Five key ingredients for successful implementation of quality CPGs are identified and recommended.
The Creation of Strategic Alliances: The Experience of the London Health Sciences Centre and Southwestern Ontario
Authors: Adamson Bonnie J. , Crook Gail F. , Girotti Murray , MacLean Neil F.
Published: July 2010

This article describes the framework and strategies that the London Health Sciences Centre has developed to foster trusting and collaborative relationships with its regional partners in Southwestern Ontario. A four-phase approach was used to identify, implement and evaluate system-wide opportunities to improve the integration of clinical care in Southwestern Ontario. Specific case studies are illustrated that used this framework to improve both access to patient services and length of stay, while positively affecting operating resources.
Downsizing in the Hospital System: A Restructuring Process
Authors: Baumann Andrea , O'Brien-Pallas Linda , Debet Raisa , Donner Gail , Semogas Dyanne , Silverman Barbara
Published: July 2010

In an effort to maintain fiscal viability, hospitals have been undergoing major restructuring. This article reports on a study that examined innovative downsizing strategies used by 20 acute care hospitals in Ontario. The study team reviewed hospital operating plans and analysed the results of interviews conducted with administrators and employees about the downsizing process. Results revealed no uniformity of approach to downsizing. Although many administrators expressed the need for a cooperative approach, downsizing was typically conducted in a top down fashion, and was perceived very differently by staff and administrators. The authors suggest ways to improve restructuring efforts and put forward questions to guide future research.
Potential Savings Involved in the Purchase of Low-Cost, High-Volume Medical Commodities as Established from a Community Hospital Survey
Authors: Ng San W. , Esmail Rosmin , Sibbald William J. , Doig Gordon S.
Published: July 2010

Health technology refers to the instruments, equipment, drugs and procedures used in health care delivery, as well as the organizations supporting it. Health technology assessment, which is the process of conducting investigations to establish the criteria for efficacious, effective and efficient patient care, is becoming increasingly important in an era of diminishing resources. This survey of 39 community hospitals in southwestern Ontario found that improved purchasing strategies can result in substantial cost savings which can in turn be used to improve patient care. The study shows that optimizing the price of basic hospital commodities could save an average community hospital as much as $625,000 per year.
Reminding and Monitoring: New Uses of Administrative Data for Preventive Care
Authors: Roos Leslie L. , Fedson David S. , Roberts Janice D. , Cohen Marsha M.
Published: July 2010

This article illustrates how administrative data can be used to improve population health in an environment of fiscal constraint. In our universal single-payer health system, health care providers submit standardized data. This allows provinces to create health information utilities that generate population-based data that can be used for research and health care delivery. Although more study is needed to determine the cost-effectiveness of using such data to raise the rates of primary and secondary prevention, it appears that appropriately designed information systems could improve population health with relatively little additional cost.
Human Health Resources: Issues concerning the Number, Distribution, Mix and Role of Physicians in the Canadian Health Care System
Authors: Colohan Desmond P.
Published: July 2010

This article focuses on key health policy issues related to physician health resources. Using the 1991 Barer/Stoddart report, Toward Integrating Medical Resource Policies for Canada, as the starting point for discussion, the author examines such issues as the number and geographic distribution of physicians, reimbursement, licensing standards, specialty mix and scope of practice. The article concludes with recommendations for future directions in public policy.
Information Systems for Healthcare: Why We Haven't Had More Success
Authors: Leonard Kevin
Published: July 2010

Over the last number of years, I have often been asked: “Why haven't we had more success in implementing Information Technology (IT) in Healthcare?” Unfortunately, there is no simple answer to this question. The answer is usually heavily dependent on several factors that “define” the specific implementation in question — consequently, the answer is one comprised of a number of interrelated factors or components. In order to facilitate this answer process, this paper attempts to identify these individual answer components. At the very least, this will help simplify the process of answering future questions by referring to the components outlined herein. At most, in addition to providing a reference compendium for others, it will assist in increasing the solution implementation success rate by exploring the problem definition in detail: The first step in solving a problem is to have it fully articulated.
Working to Promote and Maintain a Safe and Secure Environment in a Hospital Setting
Authors: Langill George , Ralph Michael , Ware Mary Lou
Published: July 2010

This article examines how one hospital developed an approach to creating a safer and more secure environment for staff and patients. A cross-functional task group promoted a review of existing practices and processes related to the issue of violence in the workplace. The task group made recommendations for improving prevention, response, and the reporting of violent incidents. Results to date indicate that this approach is working to meet the goal of a safer and more secure environment.
Exploring a Chronic Care Model in a Regional Healthcare Context
Authors: Fulton Thomas R. , Penney B. Christine , Taft Alice
Published: July 2010

The episodic acute care model of service delivery that consumes the majority of healthcare funding is inadequate to meet the needs of a society experiencing an increasing burden of chronic illness. This article describes, in a regional Canadian healthcare context, the application and preliminary evaluation of a model of chronic care delivery developed in a managed care environment in the United States. The strategic goals of this model are to empower clients by providing a redesigned service delivery environment that supports self-management; support care providers by developing clinical information systems and decision supports; and align community resources, policies and organization of care to support an informed, activated client and a proactive practice team.
Tuberculosis in the Eastern European Countries and the Former USSR
Authors: Kipp Walter
Published: July 2010

This article provides a situational analysis of the increasing trends in the tuberculosis case notification in Eastern Europe and the former USSR. In the Russian Federation, one main reason for the spread of tuberculosis is the insufficient funding of TB control measures which were very costly in the past and which cannot be sustained due to the current economic problems. The author also describes his own experience as technical advisor to a TB control program in western Siberia.