Engagement-capable environments enable strategies and processes supporting patient engagement. However, research using this framework has not fully explored how leaders can help to shape organizational cultures that sust...Engagement-capable environments enable strategies and processes supporting patient engagement. However, research using this framework has not fully explored how leaders can help to shape organizational cultures that sustain engagement over time, even during crises such as the COVID-19 pandemic. Using interviews and documents from the Holland Bloorview Kids Rehabilitation Hospital in Toronto, ON, prior to and after the pandemic, we examine the maturation of their engagement practices and culture to illustrate how a supportive culture developed and shaped their responses to this crisis. Further exploration of such dynamics could inform leaders designing engagement strategies with greater impact and sustainment.
Patient and caregiver engagement is a core component of high-quality healthcare systems. The COVID-19 pandemic revealed to us the fragility of patient and family engagement that was not as firmly rooted in the health sys...Patient and caregiver engagement is a core component of high-quality healthcare systems. The COVID-19 pandemic revealed to us the fragility of patient and family engagement that was not as firmly rooted in the health system as expected. In this paper, we reflect on case examples from healthcare organizations across Canada where pivots and adaptations were made to patient engagement activities. We share core enablers of engagement in times of high system stress, drawing on illustrative examples. We then synthesize key learnings in relation to existing literature and conclude with reflective questions as we orient the work of engagement into the future.
We are honoured to bring this special edition to you and hope that it will resonate with and cause you to think and rethink what it means to engage people as they intersect with the healthcare system. Being co-editors of...We are honoured to bring this special edition to you and hope that it will resonate with and cause you to think and rethink what it means to engage people as they intersect with the healthcare system. Being co-editors of this special edition has provided us with a unique opportunity to learn from the lived and professional experiences of people actively working to develop and nurture engagement-capable environments (ECE). Individually, and in partnership as co-editors, we bring a profound belief in the importance of ECEs as they affect the lives, health and healthcare of individuals, families and communities.
Healthc Pap
· 2024 Jan · PMID 38482661
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This series of papers explores the concept of essential digital health for the underserved. Several cross-cutting themes are highlighted in this paper, for example: (1) harmonizing journeys of different patient groups to...This series of papers explores the concept of essential digital health for the underserved. Several cross-cutting themes are highlighted in this paper, for example: (1) harmonizing journeys of different patient groups to understand diverse perspectives; (2) engaging health professionals in interoperability, change management and health human resource capacity building; (3) ensuring harmonization of micro, meso and macro levels of health services delivery; and (4) integrating evaluation iteratively to enable continuous improvement and learning. Adopting a learning health system (LHS) approach facilitates iterative growth and evolution, incorporating concepts from the software industry, as well as participatory processes such as failing forward, developing ecosystems for collaboration and engagement of stakeholders. The example of HealthLink BC's 811 as a digital front door is used to demonstrate how an LHS approach can enable meaningful system change. We welcome further dialogues and discussion on existing and emerging examples of health system implementation approaches that can help our Canadian health systems move continuously and progressively closer toward the ultimate goal of Health for All (WHO 2023).
Cressman S, Abejirinde IO, Assali J
… +8 more, Dennis MB, Maybee A, Strom M, Ho K, Ardern CL, Sayani A, Markham R, Bhattacharyya O
Healthc Pap
· 2024 Jan · PMID 38482660
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Learning health systems (LHSs) embed social accountability into everyday workflows and can inform how governments build bridges across the digital health divide. They shape partnerships using rapid cycles of data-driven...Learning health systems (LHSs) embed social accountability into everyday workflows and can inform how governments build bridges across the digital health divide. They shape partnerships using rapid cycles of data-driven learning to respond to patients' calls to action for equity from digital health. Adopting the LHS approach involves re-distributing power, which is likely to be met with resistance. We use the LHS example of British Columbia's 811 services to highlight how infrastructure was created to provide care and answer questions about access to digital health, outcomes from it and the financial impact passed on to patients. In the concluding section, we offer an accountability framework that facilitates partnerships in making digital health more equitable.
Ardern CL, Haagaard A, MacPherson M
… +5 more, Nadigel J, Kasaai B, Cressman S, Cordeiro J, Ho K
Healthc Pap
· 2024 Jan · PMID 38482659
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In this paper, we explore what is needed to generate quality research to guide evidence-informed digital health policy and call the Canadian community of patients, clinicians, policy (decision) makers and researchers to...In this paper, we explore what is needed to generate quality research to guide evidence-informed digital health policy and call the Canadian community of patients, clinicians, policy (decision) makers and researchers to action in setting digital health research priorities for supporting underserved communities. Using specific examples, we describe how evidence is produced and implemented to guide digital health policy. We study how research environments must change to reflect and include the communities for whom the policy is intended. Our goal is to guide how future evidence reaches policy makers to help them shape healthcare services and how these services are delivered to underserved communities in Canada. Understanding the pathways through which evidence can make a difference to equitable and sustainable digital health policy is vital for guiding the types of research that attract priority resources.
Forsyth A, Chapman A, Malovec S
… +4 more, Tatto M, Matsusaka MA, Cordeiro J, Mak M
Healthc Pap
· 2024 Jan · PMID 38482658
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Having the right information at the right time and at the fingertips of the right individuals is not just a necessity for a well-functioning healthcare system but it is also the difference between life and death for Cana...Having the right information at the right time and at the fingertips of the right individuals is not just a necessity for a well-functioning healthcare system but it is also the difference between life and death for Canadians. It is particularly critical to enable improved access to and quality of care for equity-deserving individuals because these data eliminate blind spots for clinicians, policy makers and system planners. The COVID-19 pandemic put a spotlight on the health data challenges that exist across Canada and the tangible impact those have on the healthcare system's ability to meet the needs of underserved populations. It sparked unified urgency at the federal and provincial/territorial levels to build a learning health system powered by connected health data for clinical care, patient access, care organization operations, health system use and population/public health. Person-centric data content standards will lie at the foundation of Canada's learning health system, enabling the creation and exchange of data.
Affleck E, Sutherland E, Lindeman C
… +7 more, Golonka R, Price T, Murphy T, Williamson T, Chapman A, Layton A, Fraser C
Healthc Pap
· 2024 Jan · PMID 38482657
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Comprehensive health data interoperability is recognized as an essential element of high-functioning and accountable health service. Canada is lagging in health data interoperability compared to international comparators...Comprehensive health data interoperability is recognized as an essential element of high-functioning and accountable health service. Canada is lagging in health data interoperability compared to international comparators, and lacks a comprehensive approach to human factor interoperability, defined as system-level relationships that impact the capacity of health sector stakeholders to adopt harmonized health data standards and technology. Without addressing these system-level relationships, the adoption of harmonized health data standards and technology will be obstructed and Canadians will be underserved. The proposed health data interoperability framework articulates the factors that Canada needs to address to optimize health data design to support quality health programs and services.
Lauscher HN, Sing CK, Strong C
… +6 more, Palepu A, Jaswal J, Fürstenburg D, Oelke ND, Pearce PK, Ho K
Healthc Pap
· 2024 Jan · PMID 38482656
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In this paper, we describe current pressures on health human resources (HHRs) in the Canadian context and related factors that impact equity-deserving communities/populations. We explore issues of HHR challenges in rural...In this paper, we describe current pressures on health human resources (HHRs) in the Canadian context and related factors that impact equity-deserving communities/populations. We explore issues of HHR challenges in rural, remote and urban underserved contexts and explore the associated benefits and challenges of incorporating digital health (DH). We present examples and evidence of integrating hybrid models of care as a means of supporting HHRs via DH in the publicly funded health system.
Mah J, Pawlovich J, Aldred T
… +12 more, Graham S, Markham R, Williams K, Woollard B, Grogan J, Taylor D, Oelke ND, James A, Stewart M, Cressman S, Hogan A, Harper D
Healthc Pap
· 2024 Jan · PMID 38482655
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The healthcare crisis across unceded First Nations' territories in rural, remote and Indigenous communities in British Columbia (BC) is marked by persistent barriers to accessing care and support close to home. This comm...The healthcare crisis across unceded First Nations' territories in rural, remote and Indigenous communities in British Columbia (BC) is marked by persistent barriers to accessing care and support close to home. This commentary describes an exceptional story of how technology, trusted partnerships and relationships came together to create an innovative suite of virtual care programs called "Real-Time Virtual Support" (RTVS). We describe key approaches, learnings and future considerations to improve the equity of healthcare delivery for rural, remote and First Nations communities. The key lessons include the following: (1) moving beyond a biomedical model - the collaboration framework for health service design incorporated First Nations' perspective on health and wellness; (2) relational work is the work - the RTVS collaboration was grounded in building connections and relationships to prioritize cultivating trust in the partnership over specific outputs; and (3) aligning to the core values of co-creation - working from a commitment to do things differently and applying an inclusive approach of engagement to integrate perspectives across different sectors and interest groups.
Healthc Pap
· 2024 Jan · PMID 38482654
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Publisher ↗
Digital health and virtual care (DH/VC) interventions have been rapidly transforming healthcare systems, offering enormous potential to bridge gaps in healthcare access and deliver person-centred interventions to equity-...Digital health and virtual care (DH/VC) interventions have been rapidly transforming healthcare systems, offering enormous potential to bridge gaps in healthcare access and deliver person-centred interventions to equity-deserving populations. Working in partnership with patients, caregivers and communities to meaningfully integrate lived experience perspectives into DH/VC interventions can help ensure that diverse needs are met. In this commentary, we propose a consolidated set of principles for co-designing equity-informed DH/VC interventions. We also identify how these principles can be leveraged through resources and opportunities offered by Healthcare Excellence Canada and others.
Healthc Pap
· 2024 Jan · PMID 38482653
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Publisher ↗
The World Health Organization envisions achieving "Health for All," to strive for equitable access to important health information and services to attain wellness (WHO 2023a). The COVID-19 pandemic reshaped the Canadian...The World Health Organization envisions achieving "Health for All," to strive for equitable access to important health information and services to attain wellness (WHO 2023a). The COVID-19 pandemic reshaped the Canadian health system toward increasing digital health services, which improved access for some but underserved others. Integrating digital health into holistic health services delivery deserves careful consideration. This paper introduces the concept of "essential digital health for the underserved," by first defining the terms "digital health," "essential" and "underserved." Then, we share a summary of a discussion at a May 2023 conference with stakeholders, including patients, caregivers, health professionals, health policy makers, private sectors and health researchers. A series of papers follow to explore how digital health can help chart a responsible course for the future of essential digital health in Canada. In this post-pandemic era - with a health human resources shortage through attrition and retirement, an increased health service demand from patients and a greater strain on our recovering economy - innovative solutions need to be implemented to strengthen our Canadian health system.
Rawson and Adams (2023) are certainly entitled to express their views about the lead and response articles by Sirrs et al. (2023a; 2023b). Their entitlement comes with a responsibility to accurately and comprehensively s...Rawson and Adams (2023) are certainly entitled to express their views about the lead and response articles by Sirrs et al. (2023a; 2023b). Their entitlement comes with a responsibility to accurately and comprehensively state their conflicts of interest (COI) so that readers can assess whether their arguments may be influenced by other interests.
A refusal to consider the experiences of Black, Afro-Indigenous and Indigenous Peoples in healthcare settings has predated the global COVID-19 pandemic. The history and development of medicine are founded on anti-Black r...A refusal to consider the experiences of Black, Afro-Indigenous and Indigenous Peoples in healthcare settings has predated the global COVID-19 pandemic. The history and development of medicine are founded on anti-Black racism and, as a result, systemic anti-Black racism is a feature of healthcare settings and the delivery of services. Globally, anti-Blackness is a barrier to meaningful and substantively effective health equity and, yet, contemporary practices of equity and inclusion do not effectively address anti-Black racism. Focusing on the needs of Black and Indigenous Peoples would create equitable healthcare that would serve everyone's needs.
In this issue, Dryden (2023) disrupts the myth of neutrality in healthcare and outlines the importance of naming anti-Black racism in order to dismantle it. In this commentary, I take up Dryden's (2023) call to study the...In this issue, Dryden (2023) disrupts the myth of neutrality in healthcare and outlines the importance of naming anti-Black racism in order to dismantle it. In this commentary, I take up Dryden's (2023) call to study the relationship between colonialism, anti-Blackness and healthcare. I utilize historical and present-day examples that uncover the roots of settler colonialism and slavery within North American healthcare systems. Finally, I explore how dispossessed communities have resisted medical violence. I call on healthcare workers to fight for non-reformist reforms, uplift self-determining care and engage in resistance toward liberatory futures.
Dryden (2023) highlights how the COVID-19 pandemic anchored on anti-Black racism within the Canadian healthcare system to cause disproportionate suffering and death among Black people. We extend this argument by situatin...Dryden (2023) highlights how the COVID-19 pandemic anchored on anti-Black racism within the Canadian healthcare system to cause disproportionate suffering and death among Black people. We extend this argument by situating both COVID-19 and healthcare within broader racialized landscapes- the weather of anti-Blackness in the US - and argue that from sports and education to healthcare, Black bodies are weathering precisely because of intentional interconnected systems of oppression grounded in white supremacy, racial capitalism and patriarchy. Because oppression does not exist in a vacuum, health equity and liberation require us to engender new lexicons that decisively expose racism to (1) evaluate data differently, relationally and more critically through different disciplinary lenses and (2) centre the liberation of those at the intersection of multiple systems of oppression, such as Black women; Black queer and transgender people; Black people with disabilities; and unhoused, unemployed, uninsured and incarcerated Black people.
Racial inequities exacerbated by the COVID-19 pandemic highlight how systemic anti-Black racism negatively impacts health. Anti-Black racism pervades the healthcare system, ranging from race-based corrections embedded in...Racial inequities exacerbated by the COVID-19 pandemic highlight how systemic anti-Black racism negatively impacts health. Anti-Black racism pervades the healthcare system, ranging from race-based corrections embedded in clinical algorithms to bias among healthcare providers. Systemic racism takes a physiological toll, causing illness and early mortality among Black people in the US and sending ripple effects across Black communities. The erasure of Black history is a common tool of racism that serves to impede progress toward racial justice. Structural changes, such as policies and laws that centre the lived experiences of Black people and directly address anti-Blackness racism, are essential for achieving health equity.
In response to the arguments put forward by Dryden (2023), this paper discusses the disproportionate toll of the COVID-19 pandemic on racially marginalized communities - particularly, Black healthcare workers. There were...In response to the arguments put forward by Dryden (2023), this paper discusses the disproportionate toll of the COVID-19 pandemic on racially marginalized communities - particularly, Black healthcare workers. There were numerous reports in the media that Black people were being treated poorly by healthcare providers and that Black healthcare workers felt poorly protected compared to their white counterparts. This paper argues that the National Health Service has been maintained through a system of racial capitalism. The author proposes that to address racial health inequity a more in-depth understanding of our shared colonial history is required.
This is a reflection from three Black South African doctors - two women and a man. We studied at the institution that we are currently working in, which is a former white university that was not permitted to train Black...This is a reflection from three Black South African doctors - two women and a man. We studied at the institution that we are currently working in, which is a former white university that was not permitted to train Black medical students by the apartheid government. We experienced the segregation in healthcare and witnessed how our communities did not have access to it. The COVID-19 pandemic unearthed major challenges and asymmetries, particularly for the Black race and poor countries. For countries such as South Africa, it brought back memories of the apartheid past with the history of segregation and discrimination.
Despite notions of colour-blindness and denials of widespread systemic racism, anti-Black racism remains inherent in the political, economic, educational and healthcare systems in Europe. We use the Netherlands as a case...Despite notions of colour-blindness and denials of widespread systemic racism, anti-Black racism remains inherent in the political, economic, educational and healthcare systems in Europe. We use the Netherlands as a case study to explore some of these mechanisms. Here, we discuss how a focus on cultural deficiency and the denial of racism allows the bearers of inequality and inequity to be blamed for their own disenfranchisement. Nonetheless, scholars in the Netherlands continue to show how everyday racism is negatively impacting marginalized people's lives and their access to the social determinants of health and well-being in society.