This document discusses medical wait times in Canada. It provides context on wait times as a policy issue and problem. It outlines efforts to address wait times, including the 2004 Health Accord which established benchmarks and funding to reduce waits in key areas by 2007. The 2005 Chaoulli case challenged limits on private insurance and underscored wait times as undermining public support. Provinces then committed to set targets and increase transparency around waits.
The document discusses proposed actions to improve emergency room wait times in Nova Scotia hospitals. It identifies several key issues contributing to long wait times, including a shortage of hospital beds, increased use of emergency rooms by aging patients and alternate level of care (ALC) patients, and government funding cuts. It then proposes several multi-pronged strategies to address wait times by improving patient flow, reducing overcrowding and overuse of emergency rooms, and decreasing the number of ALC patients. Specifically, it suggests implementing triage-driven patient placement, expanding fast-track areas, improving access to diagnostics, and enhancing patient transfers to reduce backlogs in emergency rooms.
This document analyzes wait times in hospital emergency departments. It finds that the average wait time has increased from 46.5 minutes in 2003 to 98.7 minutes in 2013 based on data from 54 hospitals. The goal of the project is to reduce wait times by 50% annually to reach a six sigma quality level. Various factors that influence wait times are examined, including patient urgency, hospital location, and ambulance use. Solutions proposed include implementing a breakthrough team system based on lean manufacturing to streamline workflows and potentially increasing doctor staffing levels. The new process aims to reduce the wait time to 30 minutes or less.
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
This project was done as a pilot project of the Illahee Institute. There were four of us in our Participatory Design class who decided to take it on. We started by doing secondary research to become more familiar with the health care system, followed by primary research interviews with various stakeholders in the system. We went through a lot of work to decide at what level of detail we wanted to define our stakeholders, and then just started in trying to understand the relationships between them. Our final iterations are based on the maps that we made with participants in our workshop. Afterwards, we had the opportunity to share our maps with Wendell Potter and a group of key individuals in the health care system. We were given a positive response and gathered some ideas as to how we could take this project further in the future.
This document discusses a study conducted on patient satisfaction at Eye-Q Super Speciality Eye Hospitals. It found that most patients were satisfied with the hospital's services, staff response, and facilities. It provides recommendations on how Eye-Q can further improve patient satisfaction and reduce waiting times using Six Sigma and PDCA (Plan-Do-Check-Act) methodologies. This includes defining goals, continuously measuring KPIs, analyzing issues, implementing solutions, and controlling processes. The study faced some limitations such as communication barriers and disinterested respondents. Overall, the document emphasizes the importance of measuring and improving patient satisfaction and quality of care.
Patient Satisfaction deals with how patients evaluate the quality of their healthcare experience. It is mainly assessed by conducting Patient Satisfaction Surveys using Healthcare Survey Software to determine the high quality of care, in addition to numerous other dimensions of quality, such as relevance to need, effectiveness, and efficiency.
The document discusses proposed actions to improve emergency room wait times in Nova Scotia hospitals. It identifies several key issues contributing to long wait times, including a shortage of hospital beds, increased use of emergency rooms by aging patients and alternate level of care (ALC) patients, and government funding cuts. It then proposes several multi-pronged strategies to address wait times by improving patient flow, reducing overcrowding and overuse of emergency rooms, and decreasing the number of ALC patients. Specifically, it suggests implementing triage-driven patient placement, expanding fast-track areas, improving access to diagnostics, and enhancing patient transfers to reduce backlogs in emergency rooms.
This document analyzes wait times in hospital emergency departments. It finds that the average wait time has increased from 46.5 minutes in 2003 to 98.7 minutes in 2013 based on data from 54 hospitals. The goal of the project is to reduce wait times by 50% annually to reach a six sigma quality level. Various factors that influence wait times are examined, including patient urgency, hospital location, and ambulance use. Solutions proposed include implementing a breakthrough team system based on lean manufacturing to streamline workflows and potentially increasing doctor staffing levels. The new process aims to reduce the wait time to 30 minutes or less.
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
This project was done as a pilot project of the Illahee Institute. There were four of us in our Participatory Design class who decided to take it on. We started by doing secondary research to become more familiar with the health care system, followed by primary research interviews with various stakeholders in the system. We went through a lot of work to decide at what level of detail we wanted to define our stakeholders, and then just started in trying to understand the relationships between them. Our final iterations are based on the maps that we made with participants in our workshop. Afterwards, we had the opportunity to share our maps with Wendell Potter and a group of key individuals in the health care system. We were given a positive response and gathered some ideas as to how we could take this project further in the future.
This document discusses a study conducted on patient satisfaction at Eye-Q Super Speciality Eye Hospitals. It found that most patients were satisfied with the hospital's services, staff response, and facilities. It provides recommendations on how Eye-Q can further improve patient satisfaction and reduce waiting times using Six Sigma and PDCA (Plan-Do-Check-Act) methodologies. This includes defining goals, continuously measuring KPIs, analyzing issues, implementing solutions, and controlling processes. The study faced some limitations such as communication barriers and disinterested respondents. Overall, the document emphasizes the importance of measuring and improving patient satisfaction and quality of care.
Patient Satisfaction deals with how patients evaluate the quality of their healthcare experience. It is mainly assessed by conducting Patient Satisfaction Surveys using Healthcare Survey Software to determine the high quality of care, in addition to numerous other dimensions of quality, such as relevance to need, effectiveness, and efficiency.
Patient Experience Defined. Patient experience encompasses the range of interactions that patients have with the health care system, including their care from health plans, and from doctors, nurses, and staff in hospitals, physician practices, and other health care facilities.
The document provides a comparison of quality indicators between the 4th and 3rd editions of the NABH standards. It summarizes the key changes made to various quality indicators for monitoring access to care, care of patients, medication management, infection control, CQI processes, and other areas. For most indicators, the definitions and formulas for calculation remain the same between the editions, while some new indicators were added and the frequency of data collection was standardized in the 4th edition.
Lean management is an approach to running an organization that supports continuous improvement. In healthcare, lean management aims to eliminate waste, streamline processes, and improve quality and efficiency. The document outlines several lean tools used in healthcare, including 5S, value stream mapping, and total productive maintenance. It provides examples of how hospitals have implemented lean practices like scheduled equipment calibration, integrated pharmaceutical systems, and grievance management systems. These practices reduced waiting times, errors, and costs while improving patient and employee satisfaction. Overall, lean management helps healthcare organizations improve processes and adapt to changing demands.
This document discusses quality in healthcare. It defines quality and outlines its importance. Quality demands attention to inputs, processes, and delivery of products and services. It also requires doing things right the first time. The document outlines the evolution of quality standards over time. It also discusses key components of a quality system, including quality policy, teamwork, problem solving tools, standardization, design and implementation of quality systems, quality costs and measurements, process control, customer integration, education and training, and quality audits and reviews.
Patient satisfaction is a measure of how content patients are with the healthcare they received. The document lists 8 tools and resources for boosting patient satisfaction, including surveys for dialysis patients, visit-specific instruments, and questionnaires developed by various healthcare organizations. Measuring patient satisfaction through surveys has benefits like helping practices improve performance, increase the quality of care delivered, and fulfill patients which can lead to more referrals.
Outpatient care has evolved significantly over time. It was originally designed to offer only basic minor services, but now encompasses a wide range of treatments, diagnostic tests, and minor surgeries. The outpatient department is the first point of contact between patients and the hospital, and aims to provide quality care through diagnosis, treatment and follow-up in an ambulatory setting. Efficient organization and flow of patients is key to ensuring operational efficiency in the outpatient department.
A presentation, describes basics of Clinical Governance
What do we have in common
as Medical Doctors/Medical
Practitioners?
1. We are technical experts in our fields
2. We are leaders
3. We are managers
4. We are accountable for the patient care and health services
5. We are change agents
6. We are respected highly in the community
7. We are responsive
8. We are good communicators and negotiators
9. We are kind and empathic
10. We are decent and disciplined
Clinical Governance is a strategic framework for the development of high quality healthcare
"A framework through which organizations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish" – NHS, UK
“clinical governance is a way of making sure that everyone who passes through health system is well cared for”
or
System that enable staff to work in the best possible way
+
Staff performing to the highest possible standards
Seven pillars of Clinical Governance
Patient and public involvement (PPI)
Risk management
Staffing and staff management
Education and training
Clinical effectiveness & Research
Using clinical information & IT
Clinical audit
Patient and public involvement
Ensuring services meet the need of the patients
Patient and public feedback is used to improve services
Patients and the public are involved in the development of services and the monitoring of treatment outcomes
Risk management
Complying with protocols
Learning from mistakes and near-misses
Reporting adverse events
Assessing the risks – probability of occurrence, impact
Promoting blame free culture
Staffing and staff management
Appropriate recruitment and management of staff
Ensuring that underperformance is identified and addressed
Encouraging staff retention by motivating and developing staff
Providing good working conditions
Education and Training
Providing appropriate support available to enable staff to be competent in doing their jobs and to develop their skills so that they are up to date
Professional development needs to continue through lifelong learning
Clinical effectiveness & Research
Clinical effectiveness implies ensuring that everything we do is designed to provide the best outcomes for patients
Clinical audit
Clinical audit is a quality improvement cycle that involves measurement of the effectiveness of healthcare against agreed and proven standards for high quality, and taking action to bring practice in line with these standards so as to improve the quality of care and health outcomes
Clinical audit is a systematic process of looking at your practice and asking:
What should we be doing?
Are we doing it?
If not, how can we improve?
This document discusses techniques to maximize efficiency in patient flow in the emergency department. It defines efficiency as the optimal utilization of resources to produce desired outcomes. The goals of improving efficiency are to enhance patient care, satisfaction, and outcomes while reducing costs and stress on staff. Key techniques include expediting the triage process, registering patients simultaneously with initial care, starting IVs and labs early, performing evaluations and tests concurrently rather than sequentially, and flexible staff coordination to speed processes. The overall approach is focused on minimizing time to initial physician exam and making sequential events occur in parallel.
Emergency Department Quality Improvement Transforming the Delivery of CareHealth Catalyst
The document summarizes strategies for transforming emergency care delivery through quality improvement initiatives. It discusses how overcrowding in emergency departments can negatively impact patient outcomes and experience. It recommends taking a data-driven systems approach to improve wait times, throughput, and left without being seen rates. This involves creating an analytics dashboard to provide insights, revising high-impact workflows like triage and registration, and engaging leadership and staff. The document also shares how one health system was able to significantly reduce length of stay and left without being seen rates through such efforts.
The document discusses Joint Commission International (JCI) accreditation. It provides information on what accreditation is, the benefits of accreditation, and an introduction to JCI. Some key points include:
- Accreditation is a voluntary process where an independent entity assesses a healthcare organization against set standards to improve safety and quality.
- Benefits of accreditation include improving public trust, establishing a safe work environment, and creating a culture of continuous learning.
- JCI is a US-based nonprofit that sets international standards for healthcare providers. Over 820 hospitals in 47 countries are JCI-accredited.
- The JCI accreditation process involves surveys to evaluate
The document discusses the Triple Aim initiative in the Edmonton Zone. The Triple Aim is a collaborative with the Institute for Healthcare Improvement that aims to 1) improve population health, 2) improve care experiences, and 3) reduce costs. It focuses on understanding and meeting the needs of those in the top 5% of healthcare costs, including those experiencing homelessness or other social determinants of health issues. Challenges include transitions of care between providers and systems not sharing information well. The initiative uses case management and integrated services to improve outcomes while reducing costs over time for those engaged in the program. Learning includes the importance of permanent supportive housing and other community services for reducing acute care utilization and costs.
The document discusses quality assurance in healthcare, including defining quality, measuring it through indicators, improving quality through approaches like total quality management and continual improvement, and ensuring quality through principles like transparency, evidence-based practice, and accountability. It also addresses important dimensions of quality like safety, effectiveness, efficiency, accessibility, and patient-centeredness.
The presentation describes in brief the patients need, expectations and how to develop the patient care and feedback system to obtain maximum patient satisfaction.
Lean thinking principles were implemented in the emergency department of The Mission Hospital in Durgapur, India to improve patient flow and reduce waste. Key aspects of lean thinking used included value stream mapping to identify non-value adding activities, applying the 5S methodology to organize the workspace, and conducting gemba walks to observe processes firsthand. This led to reductions in patient length of stay, wait times, and overcrowding in the emergency department. Bottlenecks like long wait times for radiology, inpatient teams, and available beds were identified and addressed through lean problem solving techniques. Implementing lean thinking also helped prevent physician burnout by streamlining workflows and reducing clerical burdens.
This document provides an overview of medical audit, including:
- Definitions of medical audit as the retrospective evaluation and analysis of medical records to monitor clinical performance.
- The history of medical audit from ancient codes to its modern establishment in India in 2007 through the National Accreditation Board for Hospitals.
- The purposes of medical audit which include planning improvements, ensuring regulatory standards, and assessing health program effectiveness.
This document discusses patient satisfaction in healthcare. It defines patient satisfaction as an indicator of how well patients are treated. Surveys are commonly used to measure patient satisfaction and provide insights for healthcare providers. Factors that affect patient satisfaction include appropriate care, respect, safety, availability, efficacy, effectiveness, continuity of care, and timeliness. The document provides tips for improving patient satisfaction such as training employees, educating patients, differentiating staff roles, empowering nurses, being flexible, and following up with patients. It distinguishes between patient experience and satisfaction and discusses using question prompt lists to enhance communication and patient participation.
Importance of Measuring Patient SatisfactionZonkaFeedback
Patient Satisfaction is an important metric to measure overall healthcare quality. With the help of Patient Satisfaction Surveys, constant measuring of Patient Satisfaction and improving Patient Experience can be achieved. It is a valuable tool to capture Patient Feedback without much effort.
https://www.zonkafeedback.com/blog/importance-of-measuring-patient-satisfaction
The document discusses patient satisfaction surveys, specifically the HCAHPS survey. It provides context on the objectives and methodology of HCAHPS which include standardizing surveys to allow for hospital comparisons, increasing accountability and incentives for quality improvement, and linking Medicare reimbursements to performance on quality measures including patient experience. It also summarizes what is measured in HCAHPS surveys including composites on communication with nurses and doctors, responsiveness, pain management, communication about medications, discharge information and care transition as well as individual items on cleanliness and quietness.
This document discusses policy issues related to pharmaceutical drugs and innovation in Ontario. It provides an overview of Ontario's past failed pharmaceutical policies, including those aimed at attracting R&D investments and lowering public drug spending. The document then examines recent changes to pharmaceutical policy in Ontario and Canada. Finally, it proposes several "better coverage" and "better innovation" policy options for Ontario to consider, such as using income rather than age for drug benefits eligibility and introducing pay-for-performance schemes for pharmaceutical innovators.
Patient Experience Defined. Patient experience encompasses the range of interactions that patients have with the health care system, including their care from health plans, and from doctors, nurses, and staff in hospitals, physician practices, and other health care facilities.
The document provides a comparison of quality indicators between the 4th and 3rd editions of the NABH standards. It summarizes the key changes made to various quality indicators for monitoring access to care, care of patients, medication management, infection control, CQI processes, and other areas. For most indicators, the definitions and formulas for calculation remain the same between the editions, while some new indicators were added and the frequency of data collection was standardized in the 4th edition.
Lean management is an approach to running an organization that supports continuous improvement. In healthcare, lean management aims to eliminate waste, streamline processes, and improve quality and efficiency. The document outlines several lean tools used in healthcare, including 5S, value stream mapping, and total productive maintenance. It provides examples of how hospitals have implemented lean practices like scheduled equipment calibration, integrated pharmaceutical systems, and grievance management systems. These practices reduced waiting times, errors, and costs while improving patient and employee satisfaction. Overall, lean management helps healthcare organizations improve processes and adapt to changing demands.
This document discusses quality in healthcare. It defines quality and outlines its importance. Quality demands attention to inputs, processes, and delivery of products and services. It also requires doing things right the first time. The document outlines the evolution of quality standards over time. It also discusses key components of a quality system, including quality policy, teamwork, problem solving tools, standardization, design and implementation of quality systems, quality costs and measurements, process control, customer integration, education and training, and quality audits and reviews.
Patient satisfaction is a measure of how content patients are with the healthcare they received. The document lists 8 tools and resources for boosting patient satisfaction, including surveys for dialysis patients, visit-specific instruments, and questionnaires developed by various healthcare organizations. Measuring patient satisfaction through surveys has benefits like helping practices improve performance, increase the quality of care delivered, and fulfill patients which can lead to more referrals.
Outpatient care has evolved significantly over time. It was originally designed to offer only basic minor services, but now encompasses a wide range of treatments, diagnostic tests, and minor surgeries. The outpatient department is the first point of contact between patients and the hospital, and aims to provide quality care through diagnosis, treatment and follow-up in an ambulatory setting. Efficient organization and flow of patients is key to ensuring operational efficiency in the outpatient department.
A presentation, describes basics of Clinical Governance
What do we have in common
as Medical Doctors/Medical
Practitioners?
1. We are technical experts in our fields
2. We are leaders
3. We are managers
4. We are accountable for the patient care and health services
5. We are change agents
6. We are respected highly in the community
7. We are responsive
8. We are good communicators and negotiators
9. We are kind and empathic
10. We are decent and disciplined
Clinical Governance is a strategic framework for the development of high quality healthcare
"A framework through which organizations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish" – NHS, UK
“clinical governance is a way of making sure that everyone who passes through health system is well cared for”
or
System that enable staff to work in the best possible way
+
Staff performing to the highest possible standards
Seven pillars of Clinical Governance
Patient and public involvement (PPI)
Risk management
Staffing and staff management
Education and training
Clinical effectiveness & Research
Using clinical information & IT
Clinical audit
Patient and public involvement
Ensuring services meet the need of the patients
Patient and public feedback is used to improve services
Patients and the public are involved in the development of services and the monitoring of treatment outcomes
Risk management
Complying with protocols
Learning from mistakes and near-misses
Reporting adverse events
Assessing the risks – probability of occurrence, impact
Promoting blame free culture
Staffing and staff management
Appropriate recruitment and management of staff
Ensuring that underperformance is identified and addressed
Encouraging staff retention by motivating and developing staff
Providing good working conditions
Education and Training
Providing appropriate support available to enable staff to be competent in doing their jobs and to develop their skills so that they are up to date
Professional development needs to continue through lifelong learning
Clinical effectiveness & Research
Clinical effectiveness implies ensuring that everything we do is designed to provide the best outcomes for patients
Clinical audit
Clinical audit is a quality improvement cycle that involves measurement of the effectiveness of healthcare against agreed and proven standards for high quality, and taking action to bring practice in line with these standards so as to improve the quality of care and health outcomes
Clinical audit is a systematic process of looking at your practice and asking:
What should we be doing?
Are we doing it?
If not, how can we improve?
This document discusses techniques to maximize efficiency in patient flow in the emergency department. It defines efficiency as the optimal utilization of resources to produce desired outcomes. The goals of improving efficiency are to enhance patient care, satisfaction, and outcomes while reducing costs and stress on staff. Key techniques include expediting the triage process, registering patients simultaneously with initial care, starting IVs and labs early, performing evaluations and tests concurrently rather than sequentially, and flexible staff coordination to speed processes. The overall approach is focused on minimizing time to initial physician exam and making sequential events occur in parallel.
Emergency Department Quality Improvement Transforming the Delivery of CareHealth Catalyst
The document summarizes strategies for transforming emergency care delivery through quality improvement initiatives. It discusses how overcrowding in emergency departments can negatively impact patient outcomes and experience. It recommends taking a data-driven systems approach to improve wait times, throughput, and left without being seen rates. This involves creating an analytics dashboard to provide insights, revising high-impact workflows like triage and registration, and engaging leadership and staff. The document also shares how one health system was able to significantly reduce length of stay and left without being seen rates through such efforts.
The document discusses Joint Commission International (JCI) accreditation. It provides information on what accreditation is, the benefits of accreditation, and an introduction to JCI. Some key points include:
- Accreditation is a voluntary process where an independent entity assesses a healthcare organization against set standards to improve safety and quality.
- Benefits of accreditation include improving public trust, establishing a safe work environment, and creating a culture of continuous learning.
- JCI is a US-based nonprofit that sets international standards for healthcare providers. Over 820 hospitals in 47 countries are JCI-accredited.
- The JCI accreditation process involves surveys to evaluate
The document discusses the Triple Aim initiative in the Edmonton Zone. The Triple Aim is a collaborative with the Institute for Healthcare Improvement that aims to 1) improve population health, 2) improve care experiences, and 3) reduce costs. It focuses on understanding and meeting the needs of those in the top 5% of healthcare costs, including those experiencing homelessness or other social determinants of health issues. Challenges include transitions of care between providers and systems not sharing information well. The initiative uses case management and integrated services to improve outcomes while reducing costs over time for those engaged in the program. Learning includes the importance of permanent supportive housing and other community services for reducing acute care utilization and costs.
The document discusses quality assurance in healthcare, including defining quality, measuring it through indicators, improving quality through approaches like total quality management and continual improvement, and ensuring quality through principles like transparency, evidence-based practice, and accountability. It also addresses important dimensions of quality like safety, effectiveness, efficiency, accessibility, and patient-centeredness.
The presentation describes in brief the patients need, expectations and how to develop the patient care and feedback system to obtain maximum patient satisfaction.
Lean thinking principles were implemented in the emergency department of The Mission Hospital in Durgapur, India to improve patient flow and reduce waste. Key aspects of lean thinking used included value stream mapping to identify non-value adding activities, applying the 5S methodology to organize the workspace, and conducting gemba walks to observe processes firsthand. This led to reductions in patient length of stay, wait times, and overcrowding in the emergency department. Bottlenecks like long wait times for radiology, inpatient teams, and available beds were identified and addressed through lean problem solving techniques. Implementing lean thinking also helped prevent physician burnout by streamlining workflows and reducing clerical burdens.
This document provides an overview of medical audit, including:
- Definitions of medical audit as the retrospective evaluation and analysis of medical records to monitor clinical performance.
- The history of medical audit from ancient codes to its modern establishment in India in 2007 through the National Accreditation Board for Hospitals.
- The purposes of medical audit which include planning improvements, ensuring regulatory standards, and assessing health program effectiveness.
This document discusses patient satisfaction in healthcare. It defines patient satisfaction as an indicator of how well patients are treated. Surveys are commonly used to measure patient satisfaction and provide insights for healthcare providers. Factors that affect patient satisfaction include appropriate care, respect, safety, availability, efficacy, effectiveness, continuity of care, and timeliness. The document provides tips for improving patient satisfaction such as training employees, educating patients, differentiating staff roles, empowering nurses, being flexible, and following up with patients. It distinguishes between patient experience and satisfaction and discusses using question prompt lists to enhance communication and patient participation.
Importance of Measuring Patient SatisfactionZonkaFeedback
Patient Satisfaction is an important metric to measure overall healthcare quality. With the help of Patient Satisfaction Surveys, constant measuring of Patient Satisfaction and improving Patient Experience can be achieved. It is a valuable tool to capture Patient Feedback without much effort.
https://www.zonkafeedback.com/blog/importance-of-measuring-patient-satisfaction
The document discusses patient satisfaction surveys, specifically the HCAHPS survey. It provides context on the objectives and methodology of HCAHPS which include standardizing surveys to allow for hospital comparisons, increasing accountability and incentives for quality improvement, and linking Medicare reimbursements to performance on quality measures including patient experience. It also summarizes what is measured in HCAHPS surveys including composites on communication with nurses and doctors, responsiveness, pain management, communication about medications, discharge information and care transition as well as individual items on cleanliness and quietness.
This document discusses policy issues related to pharmaceutical drugs and innovation in Ontario. It provides an overview of Ontario's past failed pharmaceutical policies, including those aimed at attracting R&D investments and lowering public drug spending. The document then examines recent changes to pharmaceutical policy in Ontario and Canada. Finally, it proposes several "better coverage" and "better innovation" policy options for Ontario to consider, such as using income rather than age for drug benefits eligibility and introducing pay-for-performance schemes for pharmaceutical innovators.
This document summarizes a lecture on Aboriginal health in Canada. It discusses the history of oppression faced by Aboriginal peoples through colonization and policies like residential schools. It outlines the importance of self-determination and ethical partnerships in improving Aboriginal health. The Transformative Change Accord between the First Nations Leadership Council and British Columbia established a 10-year plan to close health gaps in areas like mental health, chronic diseases, health services, and performance tracking.
This document provides an overview of eHealth policy issues in Ontario. It defines eHealth as a consumer-centered model utilizing information and communications technologies to manage health and healthcare. It discusses the creation of eHealth Ontario in 2008 to lead a provincial eHealth strategy, addressing past issues of fragmentation, duplication and lack of coordination in eHealth initiatives. The strategy aims to improve integration of local applications and data sharing across providers through electronic medical records, remote monitoring and ePrescribing applications.
Lecture 1 - Introduction to Canadian Health CareAlexandre Mayer
Tommy Douglas was the Premier of Saskatchewan who introduced North America's first public health insurance plan in 1962, covering all residents for hospital services free of charge. This helped establish the principle of universal public health care that eventually spread across Canada.
Ethics in Pandemics - Basic Principles and Advanced Planning.pptxMike Aref
The document discusses ethics considerations during pandemics and public health emergencies. It begins with a brief history of pandemics and infectious diseases. It then covers various bioethical frameworks and methods of analysis that can be applied to challenges that arise, including principlism, narrative ethics, and casuistry. The document also discusses the differences between clinical ethics and public health ethics. It uses several case examples to demonstrate how different bioethical approaches could be applied to issues like visitor restrictions, goals of care conversations, changing PPE recommendations, and resource allocation. Throughout, it emphasizes the importance of transparency, inclusion, reasonableness and revisiting decisions as more information becomes available.
Empowering Healthcare Leaders: The Business Case for Language Access_10.3.14Douglas Green
Empowering Healthcare Leaders: The Business Case for Language Access provides a framework for calculating total potential encounters with limited English patients, the economic benefit and cost of not providing language access and a frame work to align the economic benefits with organizational goals under the Affordable Care Act.
Right care shared-decision-making-core-clinical-presentation-23-march2011ian.mckinnell
Shared decision making is a process where patients are active partners with clinicians in making healthcare decisions. It is appropriate when there are multiple treatment options and can help patients better manage long-term conditions. Patients want more involvement in their care and choice of treatments. However, shared decision making is not widely practiced. Using decision aids and support can help patients make informed choices that align with their values and preferences, while reducing unnecessary treatment. The NHS aims to make shared decision making the norm so that no decision is made about a patient without their input.
This seminar covered the NHS Resolution's role in supporting members, the latest legal developments on consent, and candour, learning and patient safety.
Leadership austin presentation chenven april 24 2015_ppAnnieAustin
Norman Chenven, founder and CEO of Austin Regional Clinic, presented on healthcare costs and reforms to the Leadership Austin program. Austin Regional Clinic serves over 350,000 patients across 21 locations with 1,750 employees including 335 physicians. Chenven discussed the unsustainable growth of healthcare costs, key provisions and uncertainties of the Affordable Care Act, and strategies to shift payments from fee-for-service to models emphasizing quality and value through accountable care organizations and medical homes.
The document discusses average waiting periods for ENT surgery before and after the introduction of health insurance in Nepal. It finds that the average waiting period increased significantly after health insurance, from 3.43 weeks previously to 19.865 weeks. The increased waiting periods across all ENT units at the study hospital are likely due to more complicated cases being referred from other hospitals after health insurance made tertiary care more accessible. The study recommends strategies to reduce waiting periods like dedicating more operating theater time and expanding insurance coverage to limit access for only aesthetic procedures.
This document provides ethical and legal guidelines for dentists deciding about patients' requests for tooth extraction. It discusses how dentists should consider principles of autonomy, beneficence, non-maleficence and justice. It also describes scenarios where psychological factors may lead to irrational extraction requests, such as dental phobias or body dysmorphic disorder. The document advises that dentists should generally not perform extractions for non-medical reasons, and should consider referring patients for mental health evaluation if the request seems psychologically influenced. Dentists are legally obligated to follow the standard of care and not perform unnecessary or potentially harmful procedures.
The document provides an overview of Ontario's health care system. It discusses how the Ontario government operates under a Westminster system with a Liberal minority government led by Premier Dalton McGuinty. It outlines the roles of the Ministry of Health and Long-Term Care and Local Health Integration Networks in developing health policy and overseeing service delivery. It also describes how physicians and hospitals are major private providers that receive public financing in Ontario's mixed public-private system.
Leadership austin presentation chenven april 24 2015_pdfAnnieAustin
The document discusses healthcare costs and reforms in the United States. It provides an overview of Austin Regional Clinic, including the number of patients, locations, physicians, and specialties. It then discusses various challenges facing the US healthcare system like the costs as a percentage of GDP, the Affordable Care Act, deficits, uninsured Americans, increasing costs, and sustainability issues. Alternative payment models like accountable care organizations and medical homes are presented as ways to better manage costs for high-risk populations through care coordination and preventive care. The challenges of transitioning payments from fee-for-service to these alternative models is also noted.
County Hospital Director of Public Relations and Ethics.docxsdfghj21
The document discusses several ethical issues facing the Director of Public Relations and Ethics at County Hospital including abortion, germline experimentation, randomized clinical research, rationing health care, and organ transplants. The director is tasked with preparing white papers on each topic, drafting questions to guide an ethics committee discussion, and creating press release flyers outlining the hospital's position and rationale on each issue.
This document discusses several ethical issues related to the COVID-19 pandemic. It begins with an overview of ethical decision-making models and frameworks. It then analyzes four clinical ethics cases related to visitor restrictions, goals of care conversations, code status for COVID-19 patients, and mandating the COVID-19 vaccine. For each case, it applies the "four boxes" method of casuistry to analyze the medical indications, patient preferences, quality of life considerations, and contextual features. It concludes with a discussion of resource allocation challenges when demand exceeds supply, such as shortages of staff, drugs, medical equipment and disparities in healthcare access and outcomes.
The document summarizes information about clinical trials and Clinical Trials Ontario (CTO). CTO aims to strengthen Ontario's clinical research capabilities by streamlining ethics reviews and trial agreements. It also works to increase public awareness of clinical trials and encourage participation. The summary describes key aspects of clinical trials such as phases, protocols, approval processes, and considerations for potential participants. Contact information is provided for CTO and the Canadian Cancer Survivor Network.
Project County Hospital Director of Public Relations and Ethics.docxwrite22
The document provides background information on ethical issues facing the director of public relations and ethics at County Hospital. It discusses five topics: abortion, germline experimentation, randomized clinical research, rationing health care, and organ transplants. The director is tasked with preparing white papers on each topic, drafting questions to guide an ethics committee discussion, and creating one-page press release flyers outlining the hospital's position on each issue.
This document describes a quality improvement project to reduce readmissions among uninsured cardiac patients at a large public hospital on the U.S.-Mexico border. The project implemented a protocol to provide uninsured patients with a 30-day supply of essential medications upon discharge. Retrospective data showed high readmission rates and costs prior to the protocol. After implementing the protocol, zero readmissions occurred during the study period. The protocol demonstrated the value of ensuring uninsured patients can access needed medications to improve outcomes and reduce costly readmissions.
Developing a national strategy for research into cancer survivorship in the U...Irish Cancer Society
A presentation given at the Irish Cancer Society's Survivorship Research Day at the Aviva Stadium, Dublin on Thursday, September 20th, 2013.
Developing a national strategy for research into cancer survivorship in the UK - Dr Jim Elliott (UK NCRI)
Operartions research in US Healthcare IndustryPrasant Patro
1. This document describes how operations research (OR) models can help reduce delays in healthcare. It identifies three major sources of delays: emergency department delays, delays for medical appointments, and delays for nursing care.
2. Within emergency department delays, it notes long wait times to see physicians and delays in getting inpatient beds once admitted. For medical appointments, it describes waits of several weeks on average to see primary care physicians. Delays for nursing care can compromise patient safety due to insufficient staffing levels.
3. It argues that healthcare delays remain prevalent because they have not been well measured or reported, hospitals face cost pressures to maximize occupancy, and national shortages of healthcare professionals exacerbate delays. OR models have
This document provides information about hospice care, including statistics on where people die, myths about hospice, eligibility criteria, levels of care under the Medicare hospice benefit, and considerations for choosing a quality hospice provider. It notes that while most people hope to die at home, approximately 50% die in hospitals, but hospice allows three out of four patients to die at home. It aims to educate healthcare professionals about the benefits of hospice to provide timely, quality end-of-life care for terminally ill patients and their families.
Cheshire and Wirral Best Practice event - 8 NovemberInnovation Agency
The document outlines plans for developing integrated care communities across South Cheshire and Vale Royal. Key points include:
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This study surveyed 285 patients across five outpatient clinics to understand their experiences and level of satisfaction. Key findings include:
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إضغ بين إيديكم من أقوى الملازم التي صممتها
ملزمة تشريح الجهاز الهيكلي (نظري 3)
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تتميز هذهِ الملزمة بعِدة مُميزات :
1- مُترجمة ترجمة تُناسب جميع المستويات
2- تحتوي على 78 رسم توضيحي لكل كلمة موجودة بالملزمة (لكل كلمة !!!!)
#فهم_ماكو_درخ
3- دقة الكتابة والصور عالية جداً جداً جداً
4- هُنالك بعض المعلومات تم توضيحها بشكل تفصيلي جداً (تُعتبر لدى الطالب أو الطالبة بإنها معلومات مُبهمة ومع ذلك تم توضيح هذهِ المعلومات المُبهمة بشكل تفصيلي جداً
5- الملزمة تشرح نفسها ب نفسها بس تكلك تعال اقراني
6- تحتوي الملزمة في اول سلايد على خارطة تتضمن جميع تفرُعات معلومات الجهاز الهيكلي المذكورة في هذهِ الملزمة
واخيراً هذهِ الملزمة حلالٌ عليكم وإتمنى منكم إن تدعولي بالخير والصحة والعافية فقط
كل التوفيق زملائي وزميلاتي ، زميلكم محمد الذهبي 💊💊
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1. Policy Issues:
Medical Wait Times
HLTH 405 / Canadian Health Policy
Winter 2012
School of Kinesiology and Health Studies
Course Instructor:
Alex Mayer, MPA
2. Announcement
• Don Drummond speaking at the Queen’s
School of Policy Studies this Thursday
o Rm. 102 at 12pm (noon).
o Presentation on his recommendations to reform
Ontario’s public services.
o Good opportunity to ask tough questions!
4. Topics for today’s lecture:
Policy Issue #3: Medical Wait Times
• Wait times as a policy problem
• Canadian Wait Times in a Global Context
• 2004 Health Accord: Wait Times Strategy
• 2005: The Chaoulli case
• Ontario’s progress: 2005-2011
• Remaining Challenges
5. Wait Times
• A mainstay of universal health care systems
rationed based on medical need rather than
ability to pay.
o Ensures that public health care resources are
being used to their full capacity (i.e.
‚efficiently‛) at all times.
o Imposes a time cost that discourages people
from accessing care for trivial reasons.
6. Wait Times
• Wait times can be measured for all health
care access points, including…
o Access to primary care
o Access to hospital emergency room (ER)
treatment
o Access to surgical and imaging procedures
o Alternative level of care (ALC) placement
o Receipt of home care services
7. Wait Times
• Not problematic so long as…
o Patients are appropriately triaged (i.e. patients
with the most urgent care needs are seen
immediately).
o All patients are seen within time periods
specified by clinical care guidelines, in order to
prevent unnecessary suffering, complications
and mortality.
o Wait times meet the public’s (taxpayers’)
reasonable expectations and do not undermine
public confidence in the health care system.
8. If medical wait times are a
normal part of our system,
why have they been the
subject of so much attention?
9. Wait Times
• Not problematic so long as…
o Patients are appropriately triaged (i.e. patients with the
most urgent care needs are seen immediately).
o All patients are seen within time periods specified by
clinical care guidelines, in order to prevent unnecessary
suffering, complications and mortality.
o Wait times meet the public’s (taxpayers’) reasonable
expectations and do not undermine public confidence in
the health care system.
10. Do Wait Times Worsen
Health Outcomes?
o Coronary artery bypass:
• Between ‘91-’93, 0.4% (n=34) of Ontario patients died while in
the queue. (Naylor et al, 1995)
o Hip replacement:
• Canadian patients experience higher wait times, hospital length
of stay and mortality rates than U.S. patients. However, a
competing risks hazards model shows that wait time is not
significantly associated with mortality. (Carrier et al, 1993;
Ho, Hamilton and Roos, 2000)
o Cancer Surgery:
• Only 2 of 6 studies registered a higher hazards ratios for PSA
recurrence among prostate cancer patients experiencing delays
≥3 months in waiting for surgical treatment. (Saad et al, 2006)
11. Wait Times
• Not problematic so long as…
o Patients are appropriately triaged (i.e. patients with the
most urgent care needs are seen immediately).
o All patients are seen within time periods specified by
clinical care guidelines, in order to prevent unnecessary
suffering, complications and mortality.
o Wait times meet the public’s (taxpayers’) reasonable
expectations and do not undermine public confidence in
the health care system.
12. Wait Times Problem: Access
• In past decade, Canadians have consistently
identified ‘wait times’ as the #1 barrier in accessing
health services.
o For laypeople, wait times are a tangible indicator of
health care quality.
o Canada’s global rankings in this regard easily becomes a
flashpoint for public concern.
15. Wait Times Problem: Access
• Excessive wait times offer an effective line of
attack for private interests that would benefit
from the evolution of a parallel private-payer
health care system in Canada.
"Socialized Medicine" vs "Free Market Medicine" Video
• Whether it’s the ‘grass is always greener’ appeal of
two-tiered care, or the fear of losing what we have to
government mismanagement (overspending,
underinvestment, etc)
Wait times undermine public confidence in the system!
16. Are Canadians Waiting Too Long?
• For a patient, the answer is always yes.
• Medically, however, a patient’s place in line is
determined by the severity and urgency of his/her
case.
o Severity refers to suffering, functional limitations, and risk of
premature death.
o Urgency refers to the extent to which clinical treatment is required
immediately to avoid complications or death, based on the natural
history of the pathology.
17. What the Media Sees
US Anti-Medicare Ad
http://www.youtube.com/watch?v=XwLp2KJCLOQ
18. Fact-Checking the Shona Holmes Case
“Time for a Reality Check on CNN’s ‘Reality Check’
by Julia Mason, The Ottawa Citizen
… I found Holmes’ story both compelling and troubling. So I
decided to check a little further. On the Mayo Clinic’s website,
Shona Holmes is a success story.
But it’s a somewhat different story than the headlines might have
implied. Holmes’ “brain tumor” was actually a Rathke’s Cleft Cyst
on her pituitary gland.”
According to the John Wayne Cancer Centre: “Rathke’s Cleft
Cysts are not true tumors or neoplasms; they are
benign cysts.”
20. Wait Times Problem: Access
Conclusion:
• Whether it’s the ‘grass is always greener’ appeal of
two-tiered care, or the fear of losing what we have
to government mismanagement (overspending,
underinvestment, etc.) and declining quality…
Wait times undermine public confidence in the
system!
23. Solving the Wait Times
Problem
• 2004 Health Accord:
In response to public concern, First Ministers put
wait times front and centre in the 2004 HA.
o Provinces/Territories to come up with medically acceptable wait
times (i.e. ‘benchmarks’) for certain key health services by 2005.
o ‘Five in Five’ plan – provinces to receive additional funding ($5.5B
Wait Time Reduction Fund) to target wait times for 5 key services in
the next 5 years, and to achieve meaningful reductions by 2007.
o Provinces commit to increase % of patients treated within
recommended benchmark period for cancer therapy, heart surgery,
diagnostic imaging, joint replacement and sight restoration.
25. The Chaoulli Case
• 1996: Montreal businessman George Zeliotis waits
1 year for hip replacement surgery. While waiting,
he asks to purchase private insurance to skip the
queue.
• When he learns this isn’t possible, he takes his
case to court.
• He is accompanied by Dr. Chaoulli, who had
previously failed to establish a private hospital in
Quebec that would charge for publicly insured
services.
26. The Chaoulli Case
• The plaintiffs asked the Supreme Court of Canada
to strike down sections of the Quebec Hospital
Insurance Act barring citizens from purchasing
private insurance for publicly financed services.
• The Court agrees that wait times are
‚unreasonably long‛.
• By a 4-3 decision, the Court rules to strike down
the provincial policy (June 2005).
27. The Chaoulli Case
• Asked whether the policy violated the rights of
Canadians to ‚life, liberty and the security of the
person‛, the Court did not come to a majority
decision (3-3, with one abstention).
• Would have raised serious legal (and practical)
questions about the CHA.
29. Solving the Wait Times
Problem
• August 2005
Wait Time Alliance release their final report ‚It’s
About Time‛ that outlines medically acceptable
wait times based on medical consensus and, where
available, research evidence, for the 5 clinical focus
areas (cancer therapy, heart surgery, diagnostic
imaging, joint replacement and cataract surgery).
.
30. Solving the Wait Times
Problem
• Provinces Commit to Set Targets for Wait Time
Benchmarks by 2007
o Early on, different provinces focused on different clinical areas.
o All would publicize benchmarks and wait times on provincial
websites.
o All would report on progress annually.
• In SK, people can visit Saskatchewan Surgical Care
Network website to determine the wait time for
their level of clinical priority.
o E.g. Level 3 surgical patient (out of 6 levels) will know that the
provincial target is to treat 90% of such patients within six weeks.
31. Solving the Wait Times
Problem
• In ON, cardiac patients are assessed according to clinical
guidelines and assigned a maximum recommended wait time of
6 months, depending on seriousness of their condition.
o Targets and Wait times to be found on the Cardiac Network Care of
Ontario website.
o In MB, median wait time for surgery was 2 weeks.
• For oncologist appointment, wait time benchmark in ON is 21
days.
o As of 2005, wait times ranged from 5 - 34 days, depending on the
type of cancer. For 10 out of 12 types of cancer, wait times were
within benchmarks. For lung cancer (24 d) and myeloma (34 d),
wait times exceeded benchmarks.
32. Solving the Wait Times
Problem
Prior to the agreed-upon
2005 Benchmarks, there was
a clear lack of nationwide
standards in reporting wait
times.
e.g. cardiac surgery
34. Solving the Wait Times
Problem
• Today, pan-Canadian standards for measuring waits and
collecting data exist for all focus areas, except for diagnostic
imaging where there are still informational gaps.
35. Solving the Wait Times
Problem
• Today, pan-Canadian standards for measuring waits and
collecting data exist for all focus areas, except for diagnostic
imaging where there are still informational gaps.
o Challenges
• Many imaging facilities are outside of hospital facilities
• Difficult to build consensus on medical urgency
36.
37.
38. Wait Times in Ontario
How has Ontario successfully managed to reduce
wait times in all clinical focus areas?
• Developing data measurement protocols in
accordance with Wait Time Alliance specifications
• Reporting data and sharing results online
Available at:
http://www.health.gov.on.ca/en/public/programs/waittimes/default.aspx
Promotes efficiency, transparency, accountability
39.
40. Wait Times in Ontario
How has Ontario successfully managed to reduce wait times
in all clinical focus areas?
• Pay For Performance program
In Ontario, this involves tying compensation to hospitals’ senior
management to performance (‘Excellent Care for All Act’), which
include setting aggressive goals to meet all Ontario Wait Times
Strategy (OWTS) benchmarks.
“Targets without incentives are not taken seriously”.
UK research shows that pay-for-performance improve worst
areas of performance most quickly.
• Pay 4 Performance video
http://www.youtube.com/watch?v=Q8Wn22I32UQ
41. Wait Times in Ontario
Why pay hospital management to show up to
work, and then pay them a little more to do a good
job? (Shouldn’t they do this anyway?)
‚Targets without incentives are not taken seriously.‛
- Alan Hudson, Lead on Ontario Wait Times Strategy
UK research shows that pay-for-performance improve
worst areas of performance most quickly, especially for
low SES areas.
43. Wait Times in Ontario
• To date, Ontario government has spent $1.5B on funding
additional procedures, system redesign, reducing
bottlenecks, tracking and publicly reporting on progress.
• The result:
44. Wait Times in Ontario
In 2008, Ontario decided to roll ‘emergency room (ER) wait
times’ into the Ontario Wait Times Strategy.
• As of 2010, Ontario hospitals are using CIHI’s Level 1 NACRS database
to report on ER wait times.
• Covers about 90% of the population.
• Tracks time waiting in ER minus the time spent to register/triage a
patient.
45.
46. Wait Times in Ontario
Is pay-for-performance enough?
• Don Drummond’s Feb 2012 report suggests that the best
strategy for reducing ER wait times is to bring FHTs under
the LHINs
o To standardize best practices and offer better quality primary care
for complex cases (e.g. mental health, diabetes management, elder
care, addictions)
o To involve Family Health Teams in LHIN quality improvement plan
o To identify costly patients and fast-track cost-effective interventions
that connect them with community resources that meet their needs
47. Case Study
An 80-year-old woman lives alone, has diabetes,
arthritis, a colostomy from a previous bout with
bowel cancer and is a little forgetful. She has trouble
getting an appointment with her family physician as
the phone system is tiered and confusing (“press 1
for this, 3 for that”). Her daughter who lives far away
gets her an appointment when she visits. The mother
trips on a rug one evening and falls, breaking her
wrist. She cannot get up and is found the next day
by a neighbour and is taken to the ER.
48. Case Study
She gets a cast on her wrist, but feels unable to go
home alone. As a result, she is admitted after
spending 36 hours on a gurney in the ER. Due to a
mixture of pain medications, sleeplessness and
unfamiliarity, the patient gets confused and is
prescribed anti-psychotics. She then gets C. difficile
and is placed in isolation. The daughter is advised
that her mother needs a nursing home (LTC) bed.
49. Case Study
The daughter’s wish for her first choice of
an LTC home and the C. difficile, now complicated
by the patient calling out in the middle of the night,
result in the patient being on a waiting list for weeks.
Eventually the patient gets to the LTC home, where
the cancer returns. The patient is sent back to the
hospital, where she dies.
50. Wait Times in Ontario
What should the next area of focus be…
• Next-day primary care appointments, perhaps?
• Wait for LTC bed? Home care?
• Bariatric surgery? (skyrocketing demand)
“Benchmark”: Medically acceptable wait time, given the severity (stage) and type of illness.“Target”: % of people treated in that specific period of time.
-Today, 8 out 10Cdns are receiving care within benchmarks for focus areasStll room for improvement in knee/hip procedures90% is the ‘realistic’ target; deaths, complications, patients choosing to delay elective procedures for # of reasons, all factors that inflate wait time figures