HealthcarePapers
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The two lead articles for this issue by Shamian and El-Jardali and by Clements, Dault and Priest provide an opportunity to consider how two agendas - teamwork in healthcare and the healthy workplace - can be strengthened to gain mutual advancement. Both agendas are in the pan-Canadian Health Human Resource (HHR) strategic plan in Canada and were also identified within the Health Council of Canada's 2005 Annual Report. Strong links have yet to be made related to the teamwork in healthcare agenda and its relationship with the workplace environment. ⋯ It is recommended that those engaged in the research in these two domains dialogue with each other and collectively consider ways in which they could advance the policy directions required to enhance both patient and provider satisfaction in our healthcare system. The teamwork and healthy workplace agendas require thoughtful deliberation between researchers and policy-makers to inform action. This commentary provides an example of how the Ontario government has been able to engage within an evidence-informed process to develop inter-professional care that may ultimately positively impact the teamwork in healthcare agenda and the healthy workplace agenda in the future.
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Physician reimbursement in Canada has been dominated by pay-for-volume which leads to high utilization. The concern is that this does not promote attention to quality issues that are known to affect health services. However, the evidence that pay-for-quality works is weak, despite the logic of the approach. ⋯ Canada offers opportunities to assess the effect of pay-for-performance in several areas. Developing primary care networks are attractive locations to study the effect of pay-for-quality, perhaps even in a randomized trial. Specialized high-volume surgical programs, such as the Alberta arthroplasty pilot project, might be study of pay-for-participation, in a partnership of providers and sponsors.
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Wait times and the wait times agenda are on the Canadian schedule. Although most Canadians support our healthcare system, they are concerned about access. Resolving the wait times agenda might help increase Canadian confidence in the system's ability to provide timely access to care. ⋯ Only a broad-based approach will ultimately succeed in reducing wait times and building a sustainable system. A shift in values needs to take place away from the current emphasis on acute care and toward an inclusive vision of home- and community-based care that puts more emphasis on disease management, chronic care and independent living, if there is ever to be any real progress in the battle. Governments will ultimately be held accountable by Canadian healthcare consumers if they fail to make this important shift.
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Ontario's Wait Time Strategy--a significant change management initiative--is designed to improve access to healthcare services in the public system by reducing the time that adult Ontarians wait for services in five areas by December 2006 (cancer surgery, cardiac revascularization procedures, cataract surgery, hip and knee total joint replacements, and MRI and CT scans). These five are just the beginning of an ongoing process to improve access to, and reduce wait times for, a broad range of healthcare services beyond 2006. Change management initiatives are initially successful because of the significant time, attention and resources that are dedicated to the start-up effort. ⋯ If Ontario is to reduce waits for quality healthcare services over the long term, it must shift from a paradigm where no one--or only a few--are accountable for achieving a particular set of results to one where a wide range of players is accountable for achieving a broad range of results. This includes explicit accountabilities of the public, healthcare providers (including physicians, other healthcare providers, professional associations and regulatory bodies), government and Local Health Integration Networks. Tools required to support these accountabilities include developing leaders, aligning incentives to reinforce what needs to be achieved, and developing information systems to provide the data needed to make decisions, and manage and improve performance.