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Healthcare Management Forum

Don Juzwishin
No abstract text is available yet for this article.
September 13, 2018: Healthcare Management Forum
D Wayne Taylor, Jacqueline J Cahill
Incontinence is not a single disorder but a family of related conditions with different etiologies and treatments; it is a chronic disability that carries an enormous stigma. In few disorder/treatment pairings, there is the need to reinvent care more urgent and clear than in the area of incontinence. Patient-centred care has been realized to improve outcomes, quality of care, and patient satisfaction while concurrently reducing healthcare costs. To improve continence care and move it away from "cleaning up accidents" to a patient-centred care model, in which the disorder is managed to best practice guidelines, does not require investigative or developmental prowess but a simple, concentrated effort to diffuse existing knowledge to close the knowledge gaps, both at the clinical language level for clinical nurses and family physicians, as the gatekeepers to specialist care, and in simplified layperson's language for the healthcare worker, family carer, and person living with incontinence...
September 11, 2018: Healthcare Management Forum
Eileen Florence Pepler, Joy Pridie, Steve Brown
Given the scale and complexity of the challenge of addressing the aging population, increasing demand for complex and integrated care, this article sets out potential opportunities to predict a future without silos, based on international learnings. Examining another country's health and delivery systems, it is interesting to see the similarities and differences, so we offer some reflections applicable to Canada. These models are breaking down the silos. Imagine a setting where you could collaboratively co-design scenarios, debate, refine policy, and predict future population needs...
September 2018: Healthcare Management Forum
David Veitch
Nearly a decade has passed since Alberta folded nine regional health authorities and three government agencies into one province-wide health system: Alberta Health Services (AHS). Deemed a reckless experiment by some at the time, there is now mounting evidence province-wide integration of services across the healthcare continuum is an enabler of improved quality, safety, and financial sustainability. The article highlights specific examples of how AHS is strengthening partnerships, standardizing best practices, and driving innovation, making Alberta a national and international leader in areas such as stroke care and potentially inappropriate use of antipsychotics in long-term care...
September 2018: Healthcare Management Forum
G Ross Baker, Virginia Flintoft, Anne Wojtak, Regis Blais
The increasing complexity of home care services, pressures to discharge patients quicker, and the growing vulnerabilities of home care clients all contribute to adverse events in home care. In this article, home care staff in six programs analyzed 27 fall- and medication-related events. Classification of contributing causes indicates that patient and environmental factors were common in fall events, while organization and management factors along with patient, task, team, and individual factors were common in medication-related events...
September 2018: Healthcare Management Forum
Lisa K Hicks, Patrick O'Brien, Michelle Sholzberg, Nicole Veloce, Anne Trafford, Doug Sinclair
Recent data suggest unnecessary medical testing and treatment is relatively common in Canada. A number of harms to patients can arise as a result of unnecessary tests and treatments. In addition to patient harm, unnecessary tests and treatments add to the cost of medical care. Inspired by the Choosing Wisely campaign, St. Michael's Hospital in Toronto, Ontario, developed a hospital-wide program to address many different forms of overutilization at our hospital. The program prioritizes harm reduction over cost-containment and aims to create sustainable change through grassroots clinician engagement...
September 2018: Healthcare Management Forum
Grant Innes
Emergency care delays are one link in a chain of access blocks that permeate our healthcare system. Community patients blocked in hospitals, in-patients blocked in emergency departments, emergent patients blocked in ambulances. The root cause is failure to define, expect, or manage accountability. The easy response to a heavy patient surge is to block access. This protects programs from care demands that would otherwise mandate innovation, and displaces problems to leaders who cannot solve them-a recipe for perpetual dysfunction...
September 2018: Healthcare Management Forum
David A Petrie, Robert Chad Swanson
After a decade of calls for healthcare transformation, there is a convergence of themes in our general orienting models. The core metaphor of health system as machine (with closed boundaries, linear functions, and controlled predictable outputs) has given way to health as ecosystem (with open boundaries, non-linear functions, multiple interdependencies, and no single locus of control over outcomes). Current developmental psychology theory suggests that people construct their reality, and interact with their world, based on the epistemology (or "action-logic" or "mindset") of their stage of development...
September 2018: Healthcare Management Forum
Gurwinder Kaur Gill, Mary Jane McNally, Vin Berman
Demographics in Canada, and the workplace, are changing. These include population changes due to race, ethnicity, religion/faith, immigration status, gender, sexual identity and orientation, disability, income, educational background, socioeconomic status, and literacy. While this rich diversity can present challenges for patient experiences/outcomes and working environments, it can also present opportunities for positive transformation. For successful transformation to take place, strategies should focus on "Diversity, Equity, and Inclusion" (DEI) versus "diversity" alone and on creating inclusive team environments for positive staff experiences/engagement...
September 2018: Healthcare Management Forum
Nikolija Lukich, Michael Kekewich, Virginia Roth
Each year, many healthcare organizations deal with low influenza immunization rates among staff. Mandatory influenza vaccination programs may be considered in order to address this issue. These types of programs have caused controversy in the past, as staff has argued that they infringe upon their liberties and right to autonomy. However, if viewed from a public health perspective, mandatory vaccination programs are beneficial for both employees and patients and can be justified. When individuals make the decision to work in the medical field, it is assumed that their values align with those of the organization for which they work...
September 2018: Healthcare Management Forum
Samuel G Campbell
No abstract text is available yet for this article.
September 2018: Healthcare Management Forum
Andrew H Travers
Since 1997, Emergency Health Services in Nova Scotia (NS) has evolved from a program providing prehospital care for patients in transport to a system providing integrated healthcare in both traditional (ie, ambulance) and non-traditional settings (eg, patient homes, hospital settings). This article highlights (1) the reorganization of the emergency medical service system design, (2) the strategies enabling efficient operation of this design, and (3) resultant innovations evolving from both system redesign and strategy application...
September 2018: Healthcare Management Forum
Eileen Florence Pepler, Janet Davidson, Douglas McGregor, Keith Poore, Stephen Brown, Joy Pridie
Health systems globally are exploring new models of care to address the increasing demand for palliative, hospice, and end-of-life care. Yet few tools exist at the population level to explore "what if" scenarios and test, in a "cost avoidance environment," the impact of these new care models on policy, workforce, technology, and funding. This article introduces the application of scenario-based "what if" thinking and discrete event simulation in strategic planning for a not-for-profit hospice organization...
July 2018: Healthcare Management Forum
Samir K Sinha, Jocelyn Bennett, Rebecca Ramsden, Joanne Bon, Tyler Chalk
Acute care hospitals are widely recognized as potentially high-risk environments for older adults. In 2010, Mount Sinai Hospital conceived its Acute Care for Elders (ACE) Strategy as a multi-component intervention to improve the care of hospitalized older adults. In order to determine its effectiveness, we conducted a quasi-experimental time series analysis of 12,008 older patients admitted non-electively for acute medical issues over a 6-year period. Despite a 53% increase in annual admissions of older patients between 2009/2010 and 2014/2015, Mount Sinai decreased total lengths of stay and readmissions and reduced the direct cost of care per patient, leading to net savings of CDN$4...
July 2018: Healthcare Management Forum
Mary Boutette, Akos Hoffer, Jennifer Plant, Benoit Robert, Danielle Sinden
The current health system in Ontario is not designed to meet the needs of frail older adults. This is particularly true for older adults hospitalized due to exacerbation of chronic illness or medical crisis. This article describes the Subacute Care Unit for the Frail Elderly (SAFE) program, one which is designed to serve frail older patients who are at risk of deconditioning or disability associated with prolonged hospitalization but who may safely return home or to a retirement home following up to 4 weeks of subacute care in a restorative environment...
July 2018: Healthcare Management Forum
Dan Levitt
Eldercare is a significant challenge globally. The role of health leaders is foremost as agents of the transformational change needed to address the increasing demands for long-term care. This article applies the System Transformation domain of the LEADS leadership capabilities framework to redesign the delivery of care and housing to the aging demographic. A literature review reveals the radical shifts in how programs and services support person-centred care and quality life.
July 2018: Healthcare Management Forum
Darly Dash, George A Heckman, Veronique M Boscart, Andrew P Costa, Jaimie Killingbeck, Josie R d'Avernas
interRAI is a non-profit international consortium of clinicians and scientists who have developed the Minimum Data Set (MDS) 2.0 assessment to systematically identify the health status and care plan of residents in Long-Term Care (LTC). However, LTC staff often fail to realize the clinical utility of this information, viewing it as "data collection for funding purposes" and an administrative task adding to the daily workload. This article reports how one research institute and senior living organization work together to use MDS 2...
July 2018: Healthcare Management Forum
Daniel Kobewka, Alan J Forster
Banking, transportation, and retail have each been transformed by technology enabling on-demand access 24/7 at lower prices. This trend has not yet revolutionized the medical field, but on-line physician services are increasingly common in Canada and have the potential to change the way care is delivered. In this article, we will describe the state of on-line physician services in Canada and outline associated ethical considerations, including autonomy, beneficence, maleficence, and justice. We will suggest steps to mitigate risk so that these services add value for patients and the health system as a whole...
July 2018: Healthcare Management Forum
Marilyn R ElBestawi, Catherine Kohm
Healthcare organizations and governments are exploring new methods to deliver cost-effective, quality care to the frail elderly. Given the projected increase in Canada's elderly population, ensuring that residents receive the right care, at the right time, in the right location is pivotal to this goal. Practical Routine Elder Variants Indicate Early Warning for Emergency Department has been developed as a quality improvement tool. Two pilot studies, one in Ontario and one in British Columbia, have shown promising results...
July 2018: Healthcare Management Forum
Don Carmichael
No abstract text is available yet for this article.
July 2018: Healthcare Management Forum
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