Healthcare Management Forum

Climate change has captured much attention, but it is just one part of a much larger set of massive and rapid global ecological changes. While the United Nations has taken to referring to the “triple planetary crisis” of climate change, biodiversity loss, and pollution, even this does not capture the full extent of human impact upon the Earth—and thus upon human well-being. Canada’s ecological footprint is equivalent to five planets worth of biocapacity, and healthcare’s footprint is probably greater. So while health systems need to become low-carbon or net-zero, they need to go further. If healthcare is to stand by its ethical duty to do no harm, it must become a “One Planet” system. In addition to becoming a net-zero system, healthcare must reduce the consumption of material resources, the use of toxic substances, and production of all forms of waste, and protect and restore nature.

Healthcare governing boards, executives, medical staff, health professionals, and allied staff members should all play a role in devising, promoting, and implementing solutions for climate change mitigation, which must extend beyond the boundaries of their own workplaces and healthcare institutions. Such actions can potentially influence not only healthcare professionals and their patients but also healthcare supply chains and entire communities. Thus, leaders of healthcare organizations can play a vital role in leading by example. The authors herein propose some initiatives for promoting and implementing a culture of sustainability and climate action in medicine.

Planetary health and triple bottom line accounting are concepts healthcare organizations are starting to grapple with. While a few Canadian hospitals are early pioneers in efforts to deliver healthcare with less greenhouse gases, many hospitals struggle with adding a climate lens to their operations. This case study highlights a five year journey at CHEO to roll-out a hospital-wide climate strategy. CHEO has created new reporting structures, revised resource allocation, and launched net-zero targets. This hospital net-zero case study is an illustration of climate actions, given certain contexts, rather than a roadmap. Establishing this hospital-wide strategic pillar—during a global pandemic—has yielded (i) cost savings, (ii) an inspired workforce, and (iii) meaningful greenhouse gas reductions.

Energy benchmarking of Horizon Health Network’s facilities has been the foundation of an energy management system for the health authority that has led to greenhouse gas emission reductions. Benchmarking energy consumption and appropriately understanding the true impact of energy consumption is the first step in setting target greenhouse gas emission reduction. ENERGY STAR® Portfolio Manager® is the benchmarking tool used by Service New Brunswick for all Government of New Brunswick owned buildings, including all 41 owned Horizon healthcare facilities. This web-based tracking tool then produces benchmarks which supports identification of energy conservation opportunities and efficiencies. Progress for energy conservation and efficiency measures can then be monitored and reported. Since 2013, this approach has supported 52,400 metric tonnes reduction in greenhouse gas emission from Horizon facilities.

Personal Protective Equipment (PPE) that was intentionally designed and manufactured as reusable, including gowns, goggles, face shields, and elastomeric respirators, took on a heightened role during the pandemic. Healthcare workers who had access to these products and infrastructure for cleaning and sterilizing them had a greater sense of confidence to undertake their jobs due to an increased sense of personal safety. Using multiple data sources, including a literature review, roundtables, interviews, surveys, and Internet-based research, the project team investigated the impact of disposable PPE and role of reusable PPE during the pandemic in Canada. This research supports the claim that adopting and supporting reusable PPE systems throughout the health sector can, if used appropriately on an ongoing basis, provide continuous access to reusable PPE while also contributing many co-benefits, including lower costs, domestic jobs, and improved environmental performance such as reduced waste and greenhouse gas emissions.

Healthcare decision-makers are becoming increasingly aware that climate change poses significant threats to population health and continued delivery of quality care. Challengingly, responding to climate change requires complex, often expensive, and multi-faceted actions to limit new emissions from worsening climate trajectories, while investing in climate-resilient systems. We present a Climate Resilience Maturity Matrix that brings together both mitigation and adaptation actions into a high-level tool for health leaders, for supporting organizational review, assessment, and decision-making for climate change readiness. This tool is designed to (i) support leaders in Canadian health facilities and regional health authorities in designing mitigation and adaptation roadmaps, (ii) support decision-making for climate change-related strategic planning processes, and (iii) create a high-level overview of organizational readiness. This tool is intended to consolidate key data, provide a clear communication tool, allow for objective rapid baselining, enable system-level gap analysis, facilitate comparability/transparency, and support rapid learning cycles.

Protecting critical building infrastructure and equipment in small, rural eastern Ontario hospitals from intensifying weather patterns is crucial to ensuring continuous, reliable operations—but incredibly challenging. Smaller hospitals face the same climate-driven risks as larger hospitals in urban environments; however, their remote location often means they do not have the same access to resources that are integral to supporting healthcare services and programs. Kemptville District Hospital (KDH) offers first-hand experiences of impacts related to climate change, and how a small, rural healthcare facility rallies to remain agile, ready to respond quickly to weather events to remain a viable community healthcare provider—and a leader. A few contributing factors to climate-induced operational constraints from a facilities management perspective have been highlighted within, including maintaining building infrastructure and equipment, emergency planning with a focus on cybersecurity, policies for change, and the importance of transformational leadership.

Forceful imposition of settler-colonial laws and institutions violate Indigenous rights to self-determination, with profound impacts on health and wellness. As a team of Indigenous and non-Indigenous health leaders working in what’s known colonially as “British Columbia,” our collective work advances the rights and health of Indigenous Peoples (First Nations, Métis, and Inuit) by dismantling Indigenous-specific racism and White supremacy. We envision settler-colonialism as a net composed of hundreds of thousands of “colonial knots” that entangle Indigenous Peoples and prevent sovereignty and self-determination. The net also depicts Indigenous resistance, and the way forward of “untying colonial knots” patiently and persistently every day. We unpack this metaphor of the settler-colonial net and the artwork that inspired it. Our aim is to offer one more tool to Canadian health leaders who are bringing their hands, hearts, and minds to the complex and messy work of arresting White supremacy, Indigenous-specific racism, and settler-colonial harm.

Perceptions of Service Climate in healthcare organizations are important because of their linkages to patient and organizational outcomes. This article presents findings from survey data collected from frontline nurses (n = 275) in Canada who were working in a provincial healthcare system that had recently undergone significant structural changes. The findings indicate that frontline nurses held a neutral view of the Service Climate overall but a strong and negative perception of Managerial Service Practices. The results suggest that some service practices existed in nurses’ working environments; however, improvements could be made in the areas of recognizing and rewarding those who consistently provide high levels of quality service. This has implications for not only continuous quality improvement but also for the patient and staff experience in healthcare.

Building high reliable healthcare systems to reduce avoidable patient harm is a global priority. However, there is variability in the application and understanding of the previously identified High Reliability Organization (HRO) principles to make improvements. We describe specific organizational activities exemplifying the five HRO principles during the planning and go-live periods of the new Electronic Health Record (EHR) system at a multi-site academic health sciences centre in Ontario, Canada. Further, we describe a case example where all five HRO principles were exemplified during EHR implementation. Overall, 23 activities exemplifying organizational anticipation and resiliency were identified. Of the 23 activities, 12 occurred during the preparing for go-live and 11 activities occurred during the go-live periods. This article demonstrates how HRO principles can be used in healthcare to detect and adapt to patient safety threats, in order to prevent avoidable patient harm during large scale change.

There has been widespread criticism of privately owned or operated healthcare organizations in Canada and beyond. However, governments have limited resources to infuse the capital and provide the scale necessary to rapidly address the post-pandemic needs of healthcare systems. Ensuring that healthcare providers regardless of ownership or for-profit or not-for-profit status, provide high quality care and ensure health equity is paramount. Here, we propose the use of a governance for quality model based on the Excellent Care for All Act (2010) developed for public hospitals in Ontario for all healthcare organizations regardless of ownership or profit status, to better align all forms of healthcare providers with quality outcomes and equitable and positive patient experience. We believe that this framework is applicable to healthcare organizations both public and private, for-profit and not-for-profit in Canada, the U.S. and beyond.

Breaking free of pre-existing assumptions to achieve transformative change in care delivery remains challenging. This article presents a care process framework using a rapid task analysis tested with healthcare teams across five communities in British Columbia, Canada, to provide leaders a novel and practical approach to care model development. The study’s goals were to determine if the framework was replicable even though the population care needs differed for each community. The results showed the framework was replicable, informed the care model development, and identified ideal scopes of practice and team composition given the context of care. The framework also captured expert tacit knowledge and decision-making to build capacity given our current workforce challenges. For operational leaders and government agencies, the use of the framework may influence a shift in historical approaches that better aligns health and human resources capacity to population health and service needs.

Now in the post-pandemic era, healthcare employers and leaders must navigate decisions around use of telework arrangements made popular during the COVID-19 pandemic. Among healthcare employees who teleworked during the pandemic, this study investigates preference to continue teleworking post-pandemic and the determinants of this preference. An overwhelming majority (99%) preferred to continue teleworking to some degree and the majority (52%) preferred to telework for all work hours. Healthcare employers should consider that most employees who teleworked during the pandemic prefer to continue teleworking for most or all work hours, and that hybrid work arrangements are especially important for clinical telework employees. In addition to space and resource allocation, management considerations include supports to promote productivity, work-life balance, and effective virtual communication while teleworking to promote positive employee health, recruitment, and retention outcomes.

In early 2023, after three years of pandemic and delayed care, Ontario faced an overwhelming backlog of elective surgical procedures and unacceptable wait times. With hospitals experiencing historic health human resources shortages and critical capacity limitations, disruptive change was required. The Ontario government proposed to address these mounting access-to-care issues by paying for-profit healthcare clinics and surgi-centres to provide insured services, resulting in considerable controversy, much opposition, some praise, and many public protests. Previous experiences with for-profit independent health facilities had generated both complaints and documented problems with their operations. This article examines these concerns against the ethical principles of autonomy, beneficence, non-malfeasance, and justice. While much of this unease can be effectively addressed through collaboration and oversight, the complexity and costs involved in ensuring equity and quality may make it difficult for such facilities to maintain profitability.