Healthcare Management Forum

This article examines the Ontario Ministry of Health policy response to persistent rural health challenges over the last 5 decades. Rural health policy responses are grouped into policy “paradigms” for purposes of this high-level analysis. Key policies are assessed in terms of progress, limitations, and lessons learned for policy-makers and rural health leaders.

Two small hospital corporations in neighbouring communities came together with a shared interest in collectively delivering as much care as close to home as possible across their collective geography. While external factors created a sense of urgency for the collaboration, trust-building, communication, and a shared focus on patient care have built a foundation for success without the need to change legal structure.

The urgency for reforming our health systems to improve health outcomes and service pathways is pressing and must be championed by leaders. Coalitions of the willing must be created to lead this movement. The All Nations Health Partners in Kenora, Ontario, have formed to lead health system reform in the Kenora Health District and are doing so in the spirit of Reconciliation in Action. All nations and organizations working together to reduce health disparities and improve health outcomes for all people.

Sexual assault against transgender (trans) persons is a complex public health issue requiring the coordinated effort of multiple sectors to address. In response to a global call to improve health equity for persons of diverse gender identities, leaders across health and social service sectors need to enhance collaboration to champion trans-affirming care for sexual assault survivors. In collaboration with Egale Canada Human Rights Trust and the Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, we have undertaken the development of an intersectoral network to connect trans-positive community organizations with hospital-based violence treatment centres to improve support services for trans survivors across Ontario. Guided by the Lifecycle Model for network development outlined by the National Collaborating Centre for Methods and Tools, we describe our approach to planning the intersectoral network, including key insights learned thus far and the potential of the network moving forward.

Interprofessional Education (IPE) has been recognized on an international and national level as an effective method of preparing health professionals for practice while also improving health system outcomes. In particular, recent research highlights that geriatric IPE initiatives can be mutually beneficial both to learners and older adults in rural communities. Despite this trend, IPE initiatives continue to produce mixed results. Although some scholars have acknowledged that IPE initiatives need to consider the complexity of healthcare contexts, there is a dearth of research that considers the diversity of rural communities or rural older adult health. This paper proposes that leveraging contextually sensitive rural gerontological health research marks a next step in IPE development.

This article describes the Rural Physician Peer Review Program (RPPR©) developed by the Texas A&M Rural and Community Health Institute and presents it as an example of a program that could be implemented in rural Canada as an effective means of continuing professional development (CPD) for rural Canadian physicians. RPPR© post review survey responses from 574 physician participants across rural Texas indicate that they are highly satisfied with RPPR© and that their competency in medical knowledge and patient care improves as a result of participation. A pilot project with two to four northern Ontario hospitals would enable RPPR© to be modified to ensure applicability and feasibility in the northern Ontario context to create an RPPR© “North.” New and innovative approaches to CPD for rural northern physicians need to be continually explored to decrease professional isolation, improve recruitment and retention, and ultimately improve the quality and safety of healthcare in rural areas.

Clinical Practice Guidelines (CPGs) provide evidence-based recommendations for Healthcare Providers (HCPs) to utilize when making patient care decisions. Rural providers face challenges in the provision of evidence-based care, including the use of guidelines. The aim of this article is to explore the complexities of providing healthcare in rural areas. This article will focus on a specific aspect of rural maternity care with well-established CPGs, the prevention of Rhesus D factor alloimmunization. An applied health research approach, interpretive description, utilized semistructured interviews with HCPs across the vast geographic region of northern British Columbia. The study found that HCPs are aware of guidelines but face various barriers during implementation. In order to implement guidelines within practice, rural HCPs adapt processes to overcome local barriers. These process adaptations need to be identified and shared across a large health authority with a complex geography and healthcare system to ensure quality of care.

Medication Reconciliation (MedRec) is a proven method of optimizing pharmacotherapy and decreasing incidence of Adverse Drug Events (ADEs); however, consistent and correct execution is often a challenge in the setting of outpatient oncology. Ambulatory chemotherapy patients are particularly susceptible to polypharmacy and ADEs and their medication management is often complicated due to gaps in communication between an increased volume of non-co-located, multidisciplinary, healthcare providers. Acknowledging these challenges, Winchester District Memorial Hospital (WDMH) led an initiative to create an ambulatory chemotherapy MedRec process using behavioural change approaches. Prior to the intervention, ambulatory chemotherapy MedRec at WDMH was conducted informally via an “open-loop” process. Through an iterative quality improvement process which involved understanding and communicating failure points in the transmission of patients’ medication information directly with the frontline medical staff, a practical and sustainable “closed-loop” system evolved, which improved rates to 97.8% overall completion post-intervention.

Canadian hospitals participate in provincial and national procurement processes to help reduce healthcare costs. This allows for redirection of funds to direct patient care, along with creating networks, integrating services, and improving innovative solutions. To be competitive, vendors offer creative solutions and provide free or low-cost supplies to hospitals with the hope that patients will continue to purchase those items when discharged. What is not always factored into the procurement decision-making processes is the potential financial impact of the supplies required for patients when discharged from hospital services and other ethical implications of accepting free/reduced-cost supplies. This column provides some guidance for health leaders in this respect.