Healthcare Management Forum

This article explores how living with complex mental health conditions can serve as a valuable asset in health leadership. It uses the author’s personal journey after receiving a borderline personality disorder diagnosis before beginning a career in healthcare, and her decision to disclose her diagnosis despite the risks to her career. This decision was made in part due to her belief that personal disclosure could combat stigma, encourage understanding, and be an asset to her career rather than a detriment. The author reflects on reframing her disorder as a source of leadership strength rather than weakness. This article encourages other health leaders to lead by example, normalize discussions about mental health, and embrace the innovative ideas of individuals with lived experiences. Ultimately, this article serves as a call to action for reducing stigma surrounding borderline personality disorder and other mental health challenges, fostering inclusivity, and promoting authenticity in the workplace.

Our Canadian multi-site academic health sciences centre uses a standardized process to review critical patient safety incidents and develop recommendations to prevent incident reoccurrence. We recognized an opportunity to enhance recommendation development by integrating the Hierarchy of Intervention Effectiveness (HIE), a human factors framework, into the incident review process. This project aimed to increase the proportion of system-focused recommendations from critical incident reviews from 16 to 30% over 16 months. A multi-intervention strategy included (1) standardizing the incident analysis review template; (2) earmarking time for recommendation development during reviews; (3) providing participants with just-in-time education and tools; and (4) initiating HIE-based recommendation classification during incident reviews. Statistical process control p-Chart analysis showed an increase in system-focused recommendations from 16 to 30% over 16 months. The HIE promotes system-level change to prevent critical incidents, which other organizations may benefit from incorporating in their patient safety reviews.

Burnout and fatigue are significant challenges in healthcare, especially within our surgical services. Our remote location, frequent leadership turnover, chronic understaffing, and misalignment between operating room hours and community needs have led to excessive overtime, exhaustion, and sick leave. A sustainability plan was co-developed with stakeholders. The plan addresses human factors through department stabilization, expanded operating hours, increased baseline staffing, and training via a partnership with the Association of periOperative Registered Nurse perioperative certification program. The plan was assessed using a project analysis approach. Our objective is to demonstrate how institutional support and partnerships can reduce burnout and fatigue in surgical services. This article offers practical lessons for health leaders and other professionals seeking sustainable solutions. Six-month review showed a substantial decrease in overtime among operating room nurses and a reduction in agency nurse use. Leveraging institutional supports supported a more sustainable work-life balance and reduced burnout.

In healthcare settings, frustrating and confusing product and system designs can lead to use errors that can negatively impact patient safety. Usability testing is an established and widely used human factors evaluation method which can be employed to assess ease of use. In a usability test, participants complete simulated tasks using a product or system, and insights gained from their interactions are used to inform design changes. COVID-19, cost savings, and reduced travel have driven the expansion of remote usability beyond more traditional in-person testing. Two project examples are used to showcase how remote usability testing can be applied to both a dynamic web-based patient safety reporting system and a static clinical cognitive aid. Next, the benefits and pitfalls of remote usability testing, and when the method can be utilized effectively, are examined. Finally, strategies for using videoconferencing platforms to successfully evaluate various healthcare products and systems are shared.

Remote Patient Monitoring (RPM) technologies, including blood pressure monitor, pulse oximeter, thermometer, scale, and tablet, allow eligible patients to monitor and share their vitals with their healthcare team from the comfort of their home. When procuring new RPM devices, human factors specialists sought feedback from patients and clinicians using the RPM devices and conducted usability testing with patient advisors to inform the purchasing decision. Usability testing is a validated human factors technique that evaluates the ease of use and safety of medical devices and equipment. A device that is easy to use can increase patient adherence to reporting their vitals, reduce stress for the patient, and increase the pool of patients who can use the devices easily at home. Lessons learned on how to incorporate usability testing into the procurement cycle, and the value of involving end-users in patient facing medical device evaluations will be provided.

Electronic Health Record (EHR) systems can help to improve patient safety by reducing common errors, but they can also introduce new safety risks associated with the technology itself. The application of Human Factor (HF) methods in an EHR implementation project is critical to identify usability issues early and optimize the build to ensure safety, efficiency, and alignment with clinical workflows. Despite the benefits, inclusion of HF evaluations can have time and resource costs which must be accounted for in the overall project plans and timelines. Based on our experiences with a large-scale EHR implementation project, this article outlines recommendations on how to incorporate HF evaluation methods into EHR design. Over the 7-year roll-out, the HF team had the opportunity to engage with over 400 clinical end users in 30 usability evaluations across the EHR project, which yielded over 2,000 recommendations for improvement to address usability issues.

There is a growing trend to conduct simulation-based mock-up evaluations as part of the process to design healthcare facilities. Health Quality Alberta (HQA) has published a framework to provide guidance for organizations wanting to integrate this evaluation methodology into their healthcare facility design process. Several national and international hospital design standards recommend using the framework. Simulation-based mock-up evaluations of various rooms (client rooms, washrooms, medication rooms, and dialysis stations) planned for a new complex continuing care facility were conducted. Healthcare delivery organizations CapitalCare, Alberta Health Services, and HQA conducted the evaluations collaboratively. The evaluations were intended to inform design modifications to enhance client and staff safety for the unique cohorts to be served at this continuing care centre. Observational assessments and staff/client engagement informed evidence-based recommendations that were incorporated into the planned design of the facility.

Quality mental healthcare delivery in Canada continues to face challenges in consistency and effectiveness. To address these gaps and respond to the evolving mental health landscape post-COVID, HealthCareCAN and the Mental Health Commission of Canada revised the Quality Mental Healthcare Framework (QMHCF) and developed an implementation toolkit. A multi-phase approach was used, including an environmental scan, key informant interviews, and consultations with people with lived and living experience to refine the framework and inform implementation strategies. The QMHCF identifies eight core dimensions of quality, emphasizing care as equitable, trauma-informed, recovery-oriented, evidence-based, integrated, stigma-free and inclusive, appropriate, and delivered in a positive work-life environment. The implementation toolkit includes practical guidance, case studies, and evaluation tools to support adoption. Both the revised framework and toolkit provide healthcare organizations with evidence-informed resources to enhance the delivery of mental health services across diverse care settings in Canada.

Since its legalization in 2016, Medical Assistance in Dying (MAiD) in Canada has undergone significant development, yet the roles of Unregulated Support Providers (USPs) remain largely overlooked in research and policy discussions. This study investigates the experiences of and challenges faced by USPs supporting patients choosing MAiD in Canada. We conducted semi-structured interviews with 19 USPs across Canada, recruited via purposive sampling. Thematic analysis was employed to explore experiences and identify patterns of service provision, collaboration, and barriers to care. USPs offer emotional, educational, and logistical support to patients and families navigating MAiD-related decisions. Despite their contributions, they face barriers, such as financial inaccessibility and lack of formal recognition. Participants advocated for greater integration into the formal healthcare system and regulation to enhance accountability, accessibility, and patient safety. USPs can play an important yet overlooked role in MAiD. Their formal recognition could enhance psychosocial care for patients.

This is a case study about University Health Network (UHN) and West Park (WP) Healthcare Centre’s merger in April 2024, marking a significant milestone in organizational transformation. As part of this integration, Occupational Health departments at both organizations were unified into a single team. Data collection, process mapping, and gap analysis were employed to conduct current-state assessments, which identified key differences in organizational structure, database systems, technology platforms, and operational processes. By addressing these gaps, the team clarified roles, centralized infrastructure, aligned policies, and standardized workflows. Four key domains were targeted for integration: organizational structure, database systems, technology platforms, and operational processes. Challenges in change management, resource allocation, and training were addressed strategically. This integration approach improved multidisciplinary communications, standardized protocols, reduced manually intensive administrative workload, and enhanced safety, emphasizing project scoping, cross-functional collaboration, and innovative solutions for operational excellence.

Psychological safety—the belief that one can speak up or report concerns without fear of retribution or humiliation—is a foundational element of highly reliable healthcare teams. While every industry and team can benefit from psychological safety, in healthcare, it is not just a “nice-to-have”—it can be life-saving. In the high-risk, emotionally charged context of cancer care, its importance is magnified. Oncology is one of the many extra high stress and high-stakes areas of medicine and patient care. There is also benefit from establishing a psychologically safe culture in these very well-known areas of healthcare, and that is they can serve as a model and beacon for other areas in healthcare. Conversely, a bad culture in a highly visible area can encourage bad behaviour elsewhere. Yet, while often framed as a quality or cultural issue, psychological safety is also an ethical imperative. Leaders in healthcare have a moral responsibility to cultivate environments where team members feel safe to raise concerns, challenge unsafe practices, and contribute to system learning. This article explores the ethical dimensions of psychological safety, how human factors influence speaking up, and how leadership practices can advance or inhibit a culture of safety. Drawing from safety science, organizational ethics, and the author’s experience in oncology safety leadership, the argument is made that fostering psychological safety is not simply best practice—it is a moral obligation grounded in justice, trust, and the prevention of harm.