Over the past decade, the need for healthcare delivery systems to identify and address patient safety issues has been propelled to the forefront. A Canadian survey, for example, demonstrated patient safety to be a major concern of frontline nurses (Nicklin & McVeety 2002). Three crucial patient safety elements, current knowledge, resources, and context of care have been identified by the World Health Organization (WHO 2009). To develop strategies to respond to the scope and mandate of the WHO report within the Canadian context, a pan-Canadian academic-policy partnership has been established.
This newly formed Pan-Canadian Partnership, the Queen's Joanna Briggs Collaboration for Patient Safety (referred throughout as "QJBC" or "the Partnership"), includes the Queen's University School of Nursing, Accreditation Canada, the Canadian Patient Safety Institute (CPSI), the Canadian Institutes of Health Research, and is supported by an active and committed advisory council representing over 10 national organizations representing all sectors of the health continuum, including patients/families advocacy groups, professional associations, and other bodies. This unique partnership is designed to provide timely, focused support from academia to the front line of patient safety. QJBC has adopted an "integrated knowledge translation" approach to identify and respond to patient safety priorities and to ensure active engagement with stakeholders in producing and using available knowledge. Synthesis of evidence and guideline adaptation methodologies are employed to access quantitative and qualitative evidence relevant to pertinent patient safety questions and subsequently, to respond to issues of feasibility, meaningfulness, appropriateness/acceptability, and effectiveness.
This paper describes the conceptual grounding of the Partnership, its proposed methods, and its plan for action. It is hoped that our journey may provide some guidance to others as they develop patient safety models within their own arenas.
The diffusion and adoption of information technology innovations (e.g. mobile information technology) in healthcare organizations involves a dynamic process of change with multiple stakeholders with competing interests, varying commitments, and conflicting values. Nevertheless, the extant literature on mobile information technology diffusion and adoption has predominantly focused on organizations and individuals as the unit of analysis, with little emphasis on the environment in which healthcare organizations are embedded. We propose the social worlds approach as a promising theoretical lens for dealing with this limitation together with reports from a case study of a mobile information technology innovation in elderly home care in Denmark including both the sociopolitical and organizational levels in the analysis. Using the notions of social worlds, trajectories, and boundary objects enables us to show how mobile information technology innovation in Danish home care can facilitate negotiation and collaboration across different social worlds in one setting while becoming a source of tension and conflicts in others. The trajectory of mobile information technology adoption was shaped by influential stakeholders in the Danish home care sector. Boundary objects across multiple social worlds legitimized the adoption, but the use arrangement afforded by the new technology interfered with important aspects of home care practices, creating resistance among the healthcare personnel.
Studies have shown that physicians are subject to high stress levels that can lead to mental health problems. Ophthalmologists are facing particularly high pressures because of shortages in their number and lack of resources. This study describes the state of mental health of Quebec's ophthalmologists and identifies certain elements of their work environment and personal lives that may contribute to problems.
This cross-sectional study uses self-report questionnaires, including validated instruments, as well as instruments created for the study. A total of 133 out of 266 Quebec's ophthalmologists participated in the study.
More than 35% of ophthalmologists reported high levels of burnout and psychological distress. The 5 main occupational stressors were growth in demand for services (49.2%), shortage of ophthalmologists (48.1%), amount of work to be done (45.4%), budgetary pressures (44.6%), and repeated training of new work teams (41.9%). Self-acceleration is the defensive strategy used most often to deal with work overload. Nearly half (47.4%) reported having problems reconciling work and personal life. The mean scores indicate that ophthalmologists received little recognition from administration.
Work overload and systemic organizational deficiencies are burdening ophthalmologists in Quebec. They constantly work harder to preserve their professional ideals, but they receive little recognition from the administration. The levels of distress observed in this context point to the need for the authorities to take action to improve practice conditions. The situation is urgent because population aging has already begun to cause a sharp increase in demand, and younger physicians appear to be suffering most from work overload and burnout.
Canada is a high-income country with a population of 33 million people. Its economic performance has been solid despite the recession that began in 2008. Life expectancy in Canada continues to rise and is high compared with most OECD countries; however, infant and maternal mortality rates tend to be worse than in countries such as Australia, France and Sweden. About 70% of total health expenditure comes from the general tax revenues of the federal, provincial and territorial governments. Most public revenues for health are used to provide universal medicare (medically necessary hospital and physician services that are free at the point of service for residents) and to subsidise the costs of outpatient prescription drugs and long-term care. Health care costs continue to grow at a faster rate than the economy and government revenue, largely driven by spending on prescription drugs. In the last five years, however, growth rates in pharmaceutical spending have been matched by hospital spending and overtaken by physician spending, mainly due to increased provider remuneration. The governance, organization and delivery of health services is highly decentralized, with the provinces and territories responsible for administering medicare and planning health services. In the last ten years there have been no major pan-Canadian health reform initiatives but individual provinces and territories have focused on reorganizing or fine tuning their regional health systems and improving the quality, timeliness and patient experience of primary, acute and chronic care. The medicare system has been effective in providing Canadians with financial protection against hospital and physician costs. However, the narrow scope of services covered under medicare has produced important gaps in coverage and equitable access may be a challenge in these areas.
Governments in Canada have committed $5.5 billion to shorten waiting lists. There is little information about changes in waiting lists over time except the perception that they are getting longer.
Monthly data from the Misericordia Cataract Waiting List Program from 2000 to 2006 were used to examine changes in the length of the waiting list per surgeon over time. The data were analyzed to see whether changes in the length of a surgeon's list from month to month appeared to influence his or her threshold for booking surgery.
The overall length of the waiting lists decreased during the study period. Individual surgeons' lists fluctuated markedly. Surgeons were not found to adjust their threshold for booking surgery to maintain the length of their lists.
Committing extra resources to shorten waiting lists is successful. Surgeons do not appear to be manipulating their threshold for booking surgery to maintain the length of their waiting list. Individual surgeons' waiting list lengths are surprisingly dynamic. More study is needed on the variation in length of waiting lists and the longitudinal change over time if all patients are to receive their surgery within recommended benchmark wait times.
Focuses on the critical role played by professionals in the management of healthcare institutions in the UK and Canada. Using empirical data, examines the structural models of clinical management, the roles of clinical managers and their relationships with colleague professionals. Compares the approaches taken in the UK and Canada, and explores issues of context, history and relative power. Questions the extent to which professionals are losing autonomy to other professions and management. In particular examines whether the sharing of power inter-professionally may lead to greater, overall collective professional autonomy. Develops themes of the contextual influences on the process of change, and whether professionals are more effectively managed by internal or external processes of control.