HealthcarePapers
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This commentary examines the inequitable access to healthcare services that Indigenous peoples in Canada face on a daily basis. It considers not only geographical or physical access but also culturally safe access to healthcare. ⋯ Cultural safety training is recommended, as well as recruitment and retention of Indigenous health professionals. Several recommendations to address physical and geographical access are also recommended, including self-governance and capacity building; enhanced partnerships and collaboration to address jurisdictional issues, particularly for First Nations communities, and a national strategy for access to healthy and affordable food in northern, remote and rural communities.
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Canada's health and social care system is paralyzed by our decentralized federalist governing structure. Public policy change, such as that suggested by Chappell and Hollander, will require a new political paradigm that recognizes the need for a multi-sectoral, co-operative approach to integrated systems of care delivery. The federal government must provide the necessary leadership, and the provinces and territories must show the political will to co-operate if Canada is to embrace the challenges of an aging population.
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An organization can drive quality only through its people. Too often, we relegate quality to a single department or a small group of evangelical leaders but fail to make it everyone's business. Accountability has become a buzzword, and we have translated it into huge agreements with myriads of measures and indicators, all purporting to have something to do with quality. ⋯ As I have said repeatedly, it is as simple as choosing a measure, planning to implement some changes and re-measuring to see if your changes have had any impact. You don't need a national council, or even a provincial one, to make quality happen in the day-to-day operations of every healthcare organization in the country. Rather, you just need to get started.
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This commentary provides perspectives from the nursing profession on the lead article that address professional and regulatory issues and shares insights derived from many years of leading quality enhancement initiatives at policy and clinical levels. The commentary calls attention to a number of successful national and provincial approaches founded on strong leadership, collaboration and consensus building. It also underscores the idea that professional organizations and individual health professionals are important drivers of quality initiatives at the point of care and when overseeing adherence to standards and successful program implementation.
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In 2008, Canada spent $172 billion on healthcare, more than $5,000 for every man, woman and child in the country. Canada has one of the longer life expectancies in the Organisation for Economic Co-operation and Development and relatively low (and declining) amenable mortality rates. This suggests that the healthcare system is having some positive effect; but how well do we know what is "right" and what needs improvement? What do we get for the money we spend on healthcare? This paper proposes that there are some basic issues to address before these value-for-money questions can be answered. What do we value, or what do we want to achieve with our healthcare spending? Are we using inputs such as human resources well to provide services? Are we using services well to promote health? How would we know? The paper ends with a series of challenges to healthcare managers and decision-makers: to re-establish a broad information strategy, to include research as an integral part of healthcare delivery, to develop new data that can tell us something about outcomes of care and to articulate more formally objectives for the healthcare system.