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Healthcare Quarterly

Shannon L Sibbald, Andrew F Clark, Jamie A Seabrook, Jason Gilliland
Primary care is the foundation of any high-performing healthcare system. We report a subset of findings that characterize the existing primary care system in southwestern Ontario, Canada, and describe the experiences of primary healthcare providers (PHCPs). Between December 2015 and January 2016, in collaboration with the South West Local Health Integration Network (LHIN), we conducted a mixed-methods research study to gain a better understanding of experiences in providing primary care to support systems planning for primary care...
April 2018: Healthcare Quarterly
Don Flaming, Marie Pinard, Debbie Mallett
Ethical risks are routinely assessed and mitigated in research studies. The same risks can exist in program evaluations and quality improvement initiatives and yet may not be routinely and comprehensively addressed. The authors present a conceptual framework that can help organizations develop comprehensive ethics review processes for non-research knowledge-generating projects (NRKGPs). They provide strategies that can be implemented in three progressive domains and illustrate the framework's application using two examples of health organizations with existing NRKGP ethics review processes...
April 2018: Healthcare Quarterly
Blayne Welk, Lucie Richard, Jennifer Winick-Ng, Salimah Z Shariff, Kristin K Clemens
The use of medications such as glyburide, neuroleptics and benzodiazepines is potentially dangerous in the elderly, as they are linked to adverse drug events such as hypoglycemia and serious falls. We used administrative data from the province of Ontario to determine how often these medications are continued after a patient experiences one of these adverse events. Over a 12-year period, we identified 31,262 patients who had a hospital presentation with hypoglycemia or a fall within three months of starting the previously listed medications...
April 2018: Healthcare Quarterly
Jocelyn Denomme, Deborah Brown, Patsy Cho, Jacques Lee, Meaghan Kinlin, Beth O'Leary, Beth Singleton, Barbara Liu
Low mobility during hospitalization is an under-recognized epidemic leading to adverse outcomes (Brown et al. 2009). The goal of the Mobility Volunteer Program (MVP) is to keep older people as active as possible while in hospital to prevent delirium and loss of strength. Maintaining or improving function from admission to discharge increases the likelihood of patients being able to return home sooner and to their prior level of functioning. The MVP is a valuable component of a multi-pronged corporate strategy to improve rates of mobilization at Sunnybrook Health Sciences Centre...
April 2018: Healthcare Quarterly
Ada Tsang, Ken Wong, David Ryan, Marlene Awad, Barbara Liu
Since 2011, Ontario hospitals have been engaged in the Senior Friendly Hospital (SFH) Strategy led by the Regional Geriatric Program (RGP) of Toronto, in partnership with Ontario's Local Health Integration Networks (LHINs) and the RGPs of Ontario. Using the SFH Framework as a foundation, improvement in Ontario hospitals has been driven by the identification of common priorities, sharing of resources and best practices, and the development of quality indicators. We document this progress through a second environmental scan of hospitals conducted in 2014 that highlights significant advancement in all five domains of the SFH Framework...
April 2018: Healthcare Quarterly
Patricia Sullivan-Taylor, Rachel Frohlich, Anna Greenberg, Michael Beckett
Background: Effective patient relations can improve the patient experience and the safe delivery of care. Recent Ontario policy and legislative changes have increased accountabilities for healthcare organizations and expanded Health Quality Ontario's mandate to measure and report on patient relations. The purpose of this pilot project was to support improved care by validating standardized measures, data submission processes and prototype reporting of patient relations indicators for the hospital, home and community care and long-term care sectors across Ontario...
April 2018: Healthcare Quarterly
Terrence Montague, Bonnie Cochrane, Amédé Gogovor, John Aylen, Lesli Martin, Joanna Nemis-White
The overarching purpose of serial Health Care in Canada (HCIC) surveys of the adult Canadian public and a broad spectrum of healthcare professionals over the past two decades has been the development of an evidence-based map to inform strategic and clinical decisions to improve care and outcomes for Canadians. Recent surveys reveal a growing concern that medicare may require complete rebuilding or major strategic repairs. On the other hand, a majority of stakeholders perceive continuing underlying quality in our clinical care and look forward to both system- and patient-centred initiatives to improve future care...
April 2018: Healthcare Quarterly
Kim Nuernberger, Steve Atkinson, Georgina MacDonald
The next 20 years will see unprecedented growth in Canada's senior population, with higher demands and changing expectations challenging long-term care systems. The Canadian Institute for Health Information (CIHI) linked long-term and acute care data for over 59,000 seniors across six provinces and territories to analyze the pathways and transition patterns of seniors receiving long-term care services. The analysis revealed factors related to residential care entry and identified profiles of seniors admitted into residential care before it may be clinically necessary...
April 2018: Healthcare Quarterly
Yona Lunsky, Robert Balogh, Anna Durbin, Avra Selick, Tiziana Volpe, Elizabeth Lin
Adults with developmental disabilities have increased rates of mental illness and addiction, in addition to being more likely to experience physical health issues. This can lead to high rates of hospital and community-based healthcare. Population-based administrative health data can help in identifying the extent of problems experienced and target areas for policy and practice changes.
April 2018: Healthcare Quarterly
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April 2018: Healthcare Quarterly
José Pereira, Kathy Greene, Lisa Sullivan, Samantha Zinkie Mendis, Nicole Rutkowski, Peter Lawlor, Pamela Grassau
Ottawa has a 31-bed palliative care unit (PCU) and two residential adult hospices (total 19 beds). In 2013, we initiated a project to improve the referral and triage processes to these beds. Previously, there were two separate paper-based systems with duplication, inefficiencies, delays and inappropriate patient placements. The multipronged approach included clarifying the respective roles of the PCU and hospices, creating a single referral and triage office and developing an e-platform. We leveraged technology that was available in the public-funded system...
January 2018: Healthcare Quarterly
Anna Lee, Susan John, Reena Lovinsky
Antimicrobial stewardship is a key strategy to facilitate judicious antimicrobial use. Software that can amalgamate prescribing and microbiology information in near real-time reporting and track antimicrobial resistance patterns aids timely interventions. This article examines the impact of a clinical surveillance software used to identify patients for prospective audit and feedback rounds by an antimicrobial stewardship team on antibiotic utilization, patient outcomes and workload efficiencies at an acute care community hospital...
January 2018: Healthcare Quarterly
Irene Andress, Sharon Navarro, Stephanie Collier, Sarah Coppinger, Priya Herne
In 2008, Michael Garron Hospital, transformed its approach to care delivery. The rationale: to improve quality, increase safety and boost patient and staff engagement and satisfaction. The Coordinated Care Team (CCT) model has enabled nurses to not only work to their full scopes of practice within a team of interprofessional providers and unlicensed staff, but also helped create a culture of safety and patient-centredness in a value-driven context. Critics suggest a need for more evaluation and evidence of efficacy...
January 2018: Healthcare Quarterly
Sanchita Gulati, David During, Jeff Mainland, Agnes M F Wong
One of the key challenges to healthcare organizations is the development of relevant and accurate cost information. In this paper, we used time-driven activity-based costing (TDABC) method to calculate the costs of treating individual patients with specific medical conditions over their full cycle of care. We discussed how TDABC provides a critical, systematic and data-driven approach to estimate costs accurately and dynamically, as well as its potential to enable structural and rational cost reduction to bring about a sustainable healthcare system...
January 2018: Healthcare Quarterly
Patti Cochrane, Michelle DiEmanuele
Patients returning to the community after surgery often experience a disconnect when transitioning from hospital to community home care. Many receive little organized/planned care following discharge sometimes resulting in unplanned expensive care in hospital emergency departments and inpatient readmissions. Trillium Health Partners, a large community/teaching hospital, in partnership with community care provider Saint Elizabeth Health Care, designed and implemented a seamless "bundled care program" for cardiac surgery patients extending from hospitalization to 30 days after discharge...
January 2018: Healthcare Quarterly
Melinda Piechnik, Linda Dempster
Poor hospital unit culture and staff morale, and dysfunctional multidisciplinary cooperation leads to worse patient safety and satisfaction. The Walk in My Shoes research project aimed to understand how interprofessional job shadowing impacts the attitudes of colleagues. Thirty-three registered nurses at an acute care hospital observed the daily work of social workers. Nurses' attitudes towards social workers were measured by surveys and interviews. Quantitative data indicated a change in nurses' perception of social workers' communication, teamwork and autonomy...
January 2018: Healthcare Quarterly
Diane Aubin, Sharla King
The expression "shame and blame" has often been used to describe the culture within healthcare when a mistake is made. There has been little exploration, however, on the shame healthcare professionals experience after a mistake. Based on an original grounded theory study on the psychological impact of mistakes on health professionals, this article explores why the healthcare environment is a perfect ecosystem for growing shame, how individuals are coping or not coping with the negative effects of this powerful emotion and what might be done at the system, organizational and team level to mitigate these negative effects...
January 2018: Healthcare Quarterly
Elina Farmanova, Louise Bouchard, Luc Bonneville
An active offer of French-language health services (FLHS) was introduced in several Canadian provinces to help create an environment that will anticipate the needs of Francophones in their community and will stimulate the demand for services in French. For the active offer to be implemented, changes in how health services are organized and managed at both organizational and system levels must be introduced. In this perspective paper, we identify several success strategies and potential pitfalls with regards to the implementation of the active offer of FLHS primarily at the level of healthcare organization...
January 2018: Healthcare Quarterly
Sean Molloy, Tom McHugh, Heidi Amernic, Wenonah Mahase, Serena Kurkjian, Robert Grossi, Patricia Pottie, Gillian Hurwitz, Esther Green
Cancer patients experience a high symptom burden throughout their illness. Quality cancer symptom management has been shown to improve patient quality of life and prevent emergency department use. Cancer Care Ontario introduced standardized symptom screening in Ontario, using the Edmonton Symptom Assessment System (ESAS) to facilitate patient reporting and management of symptoms. However, patient symptom information is not always sufficiently addressed. To address these gaps, patient and family advisors collaborated with clinicians, administrators and health system leaders from across the Province in a Symptom Management Summit to share perspectives and co-design context-specific solutions to improve care in their region...
January 2018: Healthcare Quarterly
Malori Keller, Jennifer Wright, Serese Selanders, Darlene Dyck
The philosophy of patient- and family-centred care is widely being adopted in Canada. Critical to this philosophy is the engagement of patients and families as full partners in healthcare. Saskatchewan has successfully adopted a provincial policy that eliminates restrictive visiting hours in hospitals and other healthcare facilities that support partnership with patients and families. This article explains the key role that patient and family advisors played in identifying the need for change and co-creating the implemented Open Family Presence Policy in Saskatchewan...
January 2018: Healthcare Quarterly
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