The worldwide burden of cancer warrants more effective and efficient cancer care management strategies (World Health Organization, 2003). Model of ambulatory care, in particular, has tremendous implications on patient and administrative outcomes (Knight, 2007; Lynch, Marcone & Kagan, 2007; Moore, Johnson, Fortner & Houts, 2008). Nevertheless, little is known about the pattern of practices and the clinic operations in this setting. As part of the hospital's ambulatory redesign program, this survey aims to: a) review and describe existing models of ambulatory care employed by key national and international cancer centres; b) identify models or elements within the models that are appropriate to be adopted for best practice.
Semi-structured interviews with 10 senior management members at 10 centres (N = 10) were conducted. Participants were asked to describe: a) model of ambulatory care employed by their institution (e.g., scope and model of ambulatory nursing practice); and b) strategies used to manage common patient care related issues in their institutions. Interviews were recorded and analyzed according to the objectives of this survey.
A majority of cancer centres employed models of care similar to the existing Hospital model of ambulatory care and are encountering similar challenges in care delivery. Therefore, it was not deemed appropriate to adopt any models from participating centres.
It is crucial for administrators to report and share best practices to ensure high-quality care. The survey of current practice did not yield sufficient data to adequately support the implementation of any specific models at the hospital's ambulatory care settings. Nevertheless, findings from the present review support the principles proposed for the new hospital model of ambulatory care.
An in-depth analysis of organizational risk management in healthcare, and in particular the concepts of Enterprise Risk Management (ERM), has identified a 5-part model that can be used by Canadian healthcare leaders as an evidence-supported approach to successful organizational risk management. The Model for Organizational Risk Management, termed "the Model," has been developed as a basis for linking the components of an ERM Framework into a Canadian health organization to overcome the barriers that commonly disrupt strategic risk management. The Model addresses how an ERM Framework can fit within an existing health organization by building off and enhancing existing processes and resources to ensure familiarity, acceptance, and sustainability of the risk management program. By approaching the Model in a stepwise fashion (based on individual organizational context), healthcare leaders are provided with a road map from which to advance their own organizational risk management program.
Prior to the early 1980s, two Winnipeg hospitals provided hemodialysis for all patients in Manitoba with chronic renal failure. Because no other hemodialysis centres existed, families were forced to relocate to the city. Because of these factors, the Manitoba Renal Failure Advisory Committee proposed the development of an outreach hemodialysis program. Under the auspices of the Health Sciences Centre in Winnipeg, this outreach program has evolved into the current Manitoba Local Centre Dialysis Program. Hemodialysis services are now available in an additional seven health care centres throughout Manitoba and northwestern Ontario. This program has benefited many and in some instances, families previously separated by distances of up to 500 miles have been reunited. Creativity has been one of the most essential ingredients in the evolution of this unique program.
Carrying out critical business functions without interruption requires a resilient and robust business continuity framework. By embedding an industry-standard incident management system within its business continuity structure, the Bank of Canada strengthened its response plan by enabling timely response to incidents while maintaining a strong focus on business continuity. A total programme approach, integrating the two disciplines, provided for enhanced recovery capabilities. While the value of an effective and efficient response organisation is clear, as demonstrated by emergency events around the world, incident response structures based on normal operating hierarchy can experience unique challenges. The internationally-recognised Incident Command System (ICS) model addresses these issues and reflects the five primary incident management functions, each contributing to the overall strength and effectiveness of the response organisation. The paper focuses on the Bank of Canada's successful implementation of the ICS model as its incident management and continuity of operations programmes evolved to reflect current best practices.