Healthcare Management Forum

With an anticipated increase in breast screening volume, provincial healthcare systems and health leaders must identify innovative technologies and care pathways that can alleviate the burden of an already resource-constrained healthcare system. The solution explored here utilizes vacuum-assisted technology that is clinically equivalent and a more cost-effective alternative care pathway, as successfully demonstrated in many other countries. This article reviews the clinical efficacy of Vacuum-Assisted Biopsy (VAB) and Vacuum-Assisted Excision (VAE) and calculates the potential Canadian direct cost savings by implementing VAE for the management of benign and high-risk breast lesions in place of Surgical Diagnostic Excision (SDE): calculated to be $1,607,769 to $11,341,107 (2025 CAD) annually in Canada, or $2,208 (2025 CAD) per-patient procedural savings from avoiding SDEs. Additional non-quantifiable patient benefits are also explored: avoiding unnecessary surgery; preventing the associated anxiety and time off work; and greater patient autonomy over their diagnosis journey, helping maintain their quality of life. Finally, barriers to adoption are identified, and an Implementation Leadership Action Plan is proposed, to help support the successful integration of this practice shift. The plan includes procedural reimbursement and policy changes, and multidisciplinary engagement targeting radiology, surgery, and pathology stakeholders.

Adverse Drug Events (ADEs) are unintended and harmful events related to medication use. Many ADEs recur because patients are unintentionally re-exposed to medications that previously caused harm. To help address this, we designed ActionADE, an interoperable Health Information Technology (HIT) that allows clinicians to communicate ADEs across health sectors. We completed ethnographic workplace observations and a systematic review to inform design. After piloting, we integrated ActionADE with the provincial medication dispensing database to alert pharmacists when patients seek to fill a prescription for the same or a same-class drug as one that previously caused harm. Co-design, application of clinically meaningful field labels and data standards, and integration with other health information systems were critical to ActionADE’s functionality and use. However, health system decision-makers need to proactively plan for how to spread and scale pilot project in the HIT ecosystem to ensure public benefit from successful innovation.

High-performing physicians are an essential attribute of quality health services and public safety. Inaccessibility to quality health data by health providers can lead to individual, population, or health system harm suggesting a relationship between health data and the delivery of high-performing health programs and services. Yet the characteristics of health data have not been considered as a factor that may impact physician performance. There is evidence that limitations in health data access, quality, and effective and appropriate use can impair the capacity of physicians to provide high-quality clinical health services and use secondary health data to generate beneficial insights. Failure to acknowledge and mitigate health data factors can potentially hinder efforts to promote patient safety, reduce physician burnout, and address broader healthcare inefficiencies including a lack of interoperability. Efforts to enhance physician performance and safeguard public well-being must include a proactive approach to improving health data access, quality, and user literacy.

OurNotes is a movement that advocates for patient engagement by encouraging patients to contribute to their care through a pre-visit note, where they can comment on their health progress and prioritize topics for discussion with their clinicians. To date, pre-visit notes have been implemented in primary and acute care settings internationally, and their reception has generally been positive. However, their use in Canada and in mental health settings is limited. To address this gap, we conducted semi-structured interviews with 26 mental health clinicians, patients, and care partners. Barriers, facilitators, and recommendations to implementing pre-visit notes in Canadian mental health settings were identified. Overall, clinicians, patients, and care partners had positive perceptions towards pre-visit notes, indicating that they may serve as an innovative model for improving patient engagement and satisfaction in mental health settings. The barriers and facilitators identified, provide guidance for mental health organizations considering the implementation of pre-visit notes.

Health literacy is important from two perspectives: the individuals (personal health literacy) and the organizations providing information and services (organizational health literacy). While research has addressed digitalization in healthcare and associated barriers and enablers in personal health literacy (e.g., digital health literacy), these developments have not been paraleled in organizational health literacy. In this article, we proposed an augmented definition of organizational health literacy and conducted a gap analysis of the Health Literacy Universal Precautions Toolkit to expand it for digital health. Important advancements, specifically for virtual care, have been made, yet a broader approach must be adopted for all digital health technology. We proposed a series of modifications to emphasize the importance of digital health in organizational health literacy. Organizations must equitably enable individuals to understand and use digital information and services. In this monograph, we describe the current informatics gap and the required competencies, policies, and infrastructure to close the gap.

Community hospitals represent 90% of Canadian hospitals, yet many lack the necessary infrastructure to conduct health research. This shortfall limits patient access to research studies, reduces study efficiency, and decreases the generalizability of study results. Previous work from our group identified an increase in publications from Ontario’s large community hospitals between 2013 and 2022. However, data from other Canadian provinces is lacking. This bibliometric analysis identified indexed publications from authors affiliated with Canada’s 544 community hospitals between 2018 and 2023. Among 13,689 publications, 12,472 unique articles were identified. Most were primary research articles (67%), with only 5% being clinical trials. Ontario’s community hospitals had the highest number of publications (n = 7,925), followed by Alberta (n = 2,086) and Quebec (n = 1,480). Of Canada’s 544 community hospitals, only 42% were affiliated with one or more publications from 2018 to 2023, highlighting the need to strengthen Canadian community hospital research capacity at a systems level.

Physician Assistants (PAs) are increasingly recognized as part of the solution to addressing Canada’s primary care shortage. This study reports findings from a national survey of 386 Canadian PAs with primary care experience. Respondents described delivering a broad scope of care, including direct patient management, teaching, mentorship, and quality improvement across settings such as elderly care, mental health, Indigenous health, refugee health, and rural communities. Most PAs reported high confidence in core competencies and effective integration into interprofessional teams. Despite this, systemic barriers persist including inadequate funding, role ambiguity, and resistance from other providers. Many PAs (71%) expressed job satisfaction, and 75% would recommend primary care practice. The study highlights opportunities to improve PA utilization and access to care through policy reform, better funding models, and expanded educational supports. These insights are valuable for policy-makers, administrators, and educators aiming to strengthen primary care delivery and PA role optimization.

Access to Hepatitis C (HCV) treatment requires a specialist referral in Manitoba, Canada, with specialist availability posing barriers to HCV care. This work assessed the impact of eConsult, an electronic platform that enables Primary Care Providers (PCPs) to access specialist advice, potentially reducing face-to-face patient visits. This single case study was conducted at Nine Circles Community Health Centre in Winnipeg. Charts of individuals referred via traditional pathways (Dec. 2016-Dec. 2017) and eConsult (Dec. 2017 - Dec. 2019) were reviewed, and stakeholder interviews were conducted with PCPs and an HCV specialist. Compared to traditional referrals, eConsult patients were more likely to link to specialist care (100% vs. 69%, P = 0.026) and complete HCV treatment (79% vs. 36%, P = 0.049). The use of eConsult may improve access to HCV care in Manitoba, with outcomes shaped by system agility, adaptability across contexts, and the altruism of healthcare providers who support its use.

Canadian healthcare systems require profound transformations to enhance patient experience, improve population health, reduce costs, and improve the work life of healthcare providers. Learning Health Systems (LHSs) are an approach for undertaking this transformation in an effective, efficient, and sustainable manner with digital technologies as a key enabler for change. However, the successful implementation of a LHS brings with it challenging and potentially risky changes to clinical practices and operations. Simulation modelling is an advanced analytics technique particularly well-suited for informing decision-making and planning prior to and during the transformation of complex systems such as LHSs. Yet, despite the use and demonstrated benefits of simulation modelling in many different industries including healthcare, its application in the context of LHSs has received limited attention. In this article, we discuss how simulation modelling can be leveraged to support better-informed, lower-risk decisions and innovation in LHSs.

Wait times for elective surgical procedures in publicly funded healthcare systems impede patient well-being and resource efficiency. Patients with gallstone disease requiring semi-urgent intervention are often treated via inpatient emergency pathways due to limited elective surgery access. This study aimed to evaluate the rationale and cost-effectiveness of providing timely outpatient semi-urgent cholecystectomy. We retrospectively reviewed 512 patients with urgent biliary disease (excluding cholecystitis) who underwent surgery between July 2019 and December 2022. The primary outcome was time from booking to operating room; the secondary was the estimated cost of prolonged hospital stays. Patients waited an average of 26.45 hours; 19.1% waited 48 hours or longer, and 6.2% waited 72 hours or more. The associated cost was $405,785 over 40 months. Implementing semi-urgent surgical resources could reduce costs, improve efficiency, and enhance patient quality of life. Future work should involve stakeholders to address barriers and facilitators in Canada.

Rural, remote, and Indigenous communities in British Columbia (BC) tend to have lower access to healthcare providers and poorer health outcomes—an inequality that the COVID-19 pandemic has exacerbated. In response, Real-Time Virtual Support (RTVS) pathways were developed to advance equitable access to care for patients and provide peer support to physicians working in underserved communities. This study aimed to describe the perspectives of Virtual Physicians (VPs) who delivered the RTVS services. Forty-five RTVS VPs engaged in 30-minute semi-structured interviews about their experiences and perspectives delivering RTVS. Three themes emerged: (1) RTVS’s contributions to VPs’ personal and professional development; (2) impacts on communities; and (3) considerations for the availability and expansion. VPs identified incremental expansion and attaining funding stability as critical next steps for virtual healthcare in BC. This evidence informed RTVS program evaluation and may provide learnings relevant to other jurisdictions.

This article addresses how the dynamic, interdisciplinary, and non-linear nature of health information technology implementations require a workforce equipped with both technical competencies and an understanding of the relationships between healthcare system components. The article identifies key workforce preparation strategies including ongoing education and training for certificates or degrees through universities, professional associations, or health information technology vendors, tuition reimbursement, title changes, paid time off, and increased pay or bonuses. Helping employees to understand how their work is integrated into the overall healthcare data ecosystem creates a more efficient and effective health information technology implementation. As an example, we highlight how to prepare employees to consider clinical knowledge organization systems and standards, and how they ensure data accuracy and interoperability for data exchange of newly implemented health information systems and related artificial intelligence tools.

The purpose of this study was to provide an update on patients’, clinicians’, and health administrators’ experiences and perspectives on opportunities, barriers, and priorities for virtual care to inform health policy and planning as virtual care programs continue to mature and develop. Three surveys were developed and distributed in Saskatchewan, Canada. Quantitative data were analyzed using descriptive statistics and chi-squared tests, and free-text responses were analyzed using thematic analysis. Chronic disease management and mental health disorders were identified as highly suitable for virtual care. Health administrators underscored cost savings and improved patient access as key advantages, though they lacked consistent frameworks to assess virtual care effectiveness. Key barriers included digital literacy, technology constraints, and compensation models not aligned with virtual service provision. Participants called for greater infrastructure investment, technical support, and integrated electronic platforms. These insights may inform policy and practice to strengthen virtual health delivery and support health equity.

Digital health interventions are complex, involving the interactions of organizations, people, workflows, and technology. Adaptability is needed in both implementation and evaluation strategies to meet the needs of organizations, clinicians, patients, and researchers. The Digital Bridge project aims to co-design, implement, and evaluate a digitally enabled care transition intervention for older adults with complex needs. We encountered varying ability of partners to engage at different times, alongside changes in technology infrastructure, vendor, and healthcare services offered including unanticipated emergence of other care transition interventions. Through collaboration with health system partners, implementation and evaluation strategies were adapted. In evaluating digital health interventions, adaptability and flexibility in implementation strategies and evaluation methods are needed to meet the real-world need of delivering digital health interventions at scale. The Learning Health System Action Framework may offer insights as to how to address these tensions.

Just as healthcare organizations must carefully consider how to incorporate Artificial Intelligence (AI) into patient-facing apps and messaging, so must they also think about how to ethically introduce AI into the workplace. Unreasonable expectations, lack of training, insufficient AI tool maintenance, and other barriers to effective use of AI create significant challenges for leaders that can lead to lower productivity, less effectiveness at work, reduced satisfaction, and burnout. A thoughtful, measured approach to AI design and implementation that incorporates practices supporting user comfort and satisfaction is key to achieving success with AI in the workplace.