Abstract
The articles in this edition of Healthcare Management Forum represent a select response to a wide range of challenges facing global spending in healthcare systems that have been exacerbated by the COVID-19 pandemic. Many countries are at the early stages of emerging from the second and third waves, and in some cases the fourth wave. The recovery from the pandemic raises a new set of challenges and opportunities for healthcare policy-makers and leaders.
A long-time advocate of using explicit approaches to priority setting in healthcare decision and policy making, Mitton and his co-authors address the challenges of prioritization in the midst of and emerging from a global pandemic. They describe how decision-makers during the first and second waves of the pandemic were constrained in their decisions because of the urgency in response to public safety and the uncertainty surrounding the virus and how rapidly it spread. A new set of dynamics are now at play as health systems address how to catch up on delayed interventions. The authors provide us with a description of the trade-offs that will be necessary, in a constrained fiscal environment, as well as identifying the tools that health leaders can use to aide in priority setting and resource allocation decisions. Leaders will be well served by these tools as they embark on this complex and politically charged landscape. Being open, explicit and transparent about how priorities are established, and decisions made will provide the best foundation for ensuring that the public interest is best served.
Telemedicine, although it has been around for two decades, witnessed a very rapid and unprecedented diffusion during the pandemic. In her article, Malas and her co-authors ask a very practical question: will telemedicine thrive as an effective tool after COVID-19? Telemedicine filled an essential gap in the need to provide healthcare during a time when physical contact was restricted. They use the case study approach to describe the use and challenges of telemedicine before the pandemic and compare its use during the pandemic. Many barriers were overcome in order to expedite access to care. The authors caution us to not assume that because barriers have been removed to facilitate the use of telemedicine during the pandemic that this will necessarily be the case in the future. They also provide us with advice on how and what steps need to be taken to ensure that the quality in the application of telemedicine in the future provides the very best care to our patients.
The extraordinary expenditures of countries to their citizens and businesses during the pandemic have been essential in order to incentivize appropriate public health behaviours and to minimize the negative financial impact on the interruption to income and revenue streams. In Canada, the funding and provision of healthcare to Canadians is primarily the responsibility of the provinces, however, the federal government exercises its federal spending power to contribute to that cost. The emergency spending during the pandemic has put a strain on the fiscal capacity of the federal and provincial governments. This will undoubtedly raise issues of whether restraint is necessary during the recovery phase of the economy. In her article, Miller puts forward the argument that it is essential for Canada to support investments that support population health and health equity. Health leaders can play an instrumental role in supporting a healthy recovery from the pandemic.
Johnson and her colleagues bring attention to the serious issue of social isolation of immigrant and refugee seniors that have come into sharp focus during the COVID-19 pandemic. The authors argue that the pandemic starkly pointed out the vulnerability of seniors to the social, psychological and physical issues which resulted. Health leaders have a responsibility to develop resilient processes, programs and policies to ensure that these tragedies do not occur in the future. This is particularly a concern as Canada is expected to introduce as many as 400,000 immigrants to the country each year in the next three years in order to counter the declining population. This trend is not likely to be diminished in the foreseeable future. Unlike other seniors, refugee and immigrant seniors arrive from different countries, cultures, familial customs, living arrangements and languages. Johnson and her co-authors identify program and service issues and opportunities coupled with conceptualization and measurement challenges that will need to be addressed by health leaders to create settings that will reduce social isolation with a strong equity and determinants of health perspective.
Leadership in healthcare is a complex and challenging task during ordinary times, during a pandemic, it is magnified many folds because of the new emerging issues often times with conflicting goals and influences. In recent years, it has been recognized that the emotional intelligence of leaders can have an important impact on how effectively they function. Cabell and his co-authors explore and analyze the effectiveness of the Feagin Leadership Program as a means of teaching leadership skills and emotional intelligence to medical trainees. The results of the study emphasize the importance of a strong understanding of emotional intelligence and team work to achieve effective functioning. The study also identified gaps that need to be addressed such as negation and conflict management.
Swan and his colleagues, in their case study of an addiction and mental health services organization, provide us with a glimpse into the challenges associated with an organization dealing with governance, financial, leadership and program delivery turbulence over a six-year period. With a turnover of six CEOs, staff downsizing, loss of knowledge and skills coupled with several revisions to the administrative model the approach to stabilizing the organization was daunting. Swan and colleagues illustrate how they used various organization and leadership strategies and tools, including the CCHL LEADS framework and approach, to bring order to a chaotic setting. The case study validates the observation that negative experiences can be as informative and valuable as the positive ones.
Szelest and her co-authors describe how prescribing appropriate available pharmacotherapies for Alcohol Use Disorder (AUD) can have a positive impact for patients and for the healthcare system. In this retrospective quality improvement study, the impact of education sessions coupled with counselling pharmacotherapies are shown to be effective in positive outcomes for AUD treatment and reducing demands on the healthcare system.
New knowledge about effective health leadership and the successful functioning of organizations depends on a broad range of research findings. Sibbald and her co-authors make a strong case for the value of the case study methodology in health services research and its application to health leadership. They argue for use of the case study method because it can document, illustrate, and examine complex relationships, contexts and the dynamics of systems as they evolve. The authors provide guidance to leaders, decision-makers and policy-makers on how to engage in and critically appraise and apply a case study design to a project they might undertake, for example, undertaking their CCHL Fellowship. Using the case study approach to build bridges and new knowledge will not only improve the quality of the case study approach but also the lessons in the application of that knowledge.
Footnotes
Don Juzwishin, BA, MHSA, PhD, FCCHL, is the former director of Health Technology Assessment and Innovation for Alberta Health Services. He holds adjunct associate professor positions at the Universities of Alberta, Calgary, and Victoria. He is a co-lead of the National Centers of Excellence AGEWELL initiative which strives to create real-world solutions that will make a meaningful impact on the lives of Canadian seniors and caregivers.