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Over the last decade, second victim phenomenon (SVP) has been identified as a serious issue for healthcare workers (HCWs). Results from a 2018 survey of Canadian HCWs demonstrated that the majority of those who responded had experienced SVP and indicated that there was a lack of support in the workplace. The overall objectives of this paper are to a) heighten the awareness about SVP and its impact on HCWs and 2) to recommend an organizational/systems approach to support HCWs as second victims. This will be accomplished by first defining SVP and its relationship to patient safety. We will apply a health geography framework which incorporates the concepts of location, place, human interaction, movement and region to demonstrate the variability across care settings and the need for a systems approach to support HCWs. A human geography approaches to SVP would allow policymakers, leadership teams and managers within a health care setting to uniquely tailor their support systems to their individual contexts, which in turn will create a workplace culture of safety that builds on the organization's unique qualities. [ABSTRACT FROM AUTHOR]

Abstract Background Recruiting and retaining health professions remains a high priority for health system planners. Different employment sectors may vary in their appeal to providers. We used the concepts of inflow and stickiness to assess the relative attractiveness of sectors for physical therapists (PTs) in Ontario, Canada. Inflow was defined as the percentage of PTs working in a sector who were not there the previous year. Stickiness was defined as the transition probability that a physical therapist will remain in a given employment sector year-to-year. Methods A longitudinal dataset of registered PTs in Ontario (1999-2007) was created, and primary employment sector was categorized as ‘hospital’, ‘community’, ‘long term care’ (LTC) or ‘other.’ Inflow and stickiness values were then calculated for each sector, and trends were analyzed. Results There were 5003 PTs in 1999, which grew to 6064 by 2007, representing a 21.2% absolute growth. Inflow grew across all sectors, but the LTC sector had the highest inflow of 32.0%. PTs practicing in hospitals had the highest stickiness, with 87.4% of those who worked in this sector remaining year-to-year. The community and other employment sectors had stickiness values of 78.2% and 86.8% respectively, while the LTC sector had the lowest stickiness of 73.4%. Conclusion Among all employment sectors, LTC had highest inflow but lowest stickiness. Given expected increases in demand for services, understanding provider transitional probabilities and employment preferences may provide a useful policy and planning tool in developing a sustainable health human resource base across all employment sectors.

Health Care Aides (HCAs) provide up to 80% of the direct care to older Canadians living in long term care facilities, or in their homes. They are an understudied workforce, and calls for health human resources strategies relating to these workers are, we feel, precipitous. First, we need a better understanding of the nature and scope of their work, and of the factors that shape it. Here, we discuss the evolving role of HCAs and the factors that impact how and where they work. The work of HCAs includes role-required behaviors, an increasing array of delegated acts, and extra-role behaviors like emotional support. Role boundaries, particularly instances where some workers over-invest in care beyond expected levels, are identified as one of the biggest concerns among employers of HCAs in the current cost-containment environment. A number of factors significantly impact what these workers do and where they work, including market-level differences, job mobility, and work structure. In Canada, entry into this 'profession' is increasingly constrained to the Home and Community Care sector, while market-level and work structure differences constrain job mobility to transitions of only the most experienced workers, to the long-term care sector. We note that this is in direct opposition to recent policy initiatives designed to encourage aging at home. Work structure influences what these workers do, and how they work; many HCAs work for three or four different agencies in order to sustain themselves and their families. Expectations with regard to HCA preparation have changed over the past decade in Canada, and training is emerging as a high priority health human resource issue. An increasing emphasis on improving quality of care and measuring performance, and on integrated team-based care delivery, has considerable implications for worker training. New models of care delivery foreshadow a need for management and leadership expertise - these workers have not historically been prepared for leadership roles. We conclude with a brief discussion of the next steps necessary to generating evidence necessary to informing a health human resource strategy relating to the provision of care to older Canadians. [ABSTRACT FROM AUTHOR]

The debate about the sustainability of Canada's health care model has focussed on updating what services should be publicly funded. Full public coverage is only guaranteed for services delivered in hospitals or by physicians. Many reports have recommended expanding public coverage to include community-based services. A national survey of 2,523 policy elites demonstrated that implementation of this policy direction will be difficult. The inability to implement policy that supports publicly financing community-based services could result in a shift of the delivery of care from the formal sector to the informal sector. Moreover, a shift of this nature will undoubtedly result in a higher reliance on the unpaid work of women caregivers. Consequently, there is a need to explore the impact that economic and social restructuring has on the well-being of women caregivers within both the formal and informal sectors. [ABSTRACT FROM AUTHOR]

Interprofessional collaborative practice is a key requirement for the successful implementation of integrated healthcare models. Current interprofessional education opportunities seldom include medical laboratory technologists who oversee the production of data that informs the diagnosis, treatment, and monitoring of patients. Errors in the laboratory process mostly occur in the pre-analytical and post-analytical phases, which both involve the need for collaboration between medical laboratory technologists and other healthcare providers. In this article, we introduce and describe an innovative work-integrated virtual learning experience that provides technologists with the opportunity to fully participate in interprofessional education.

Given that there are limited evidence-informed non-pharmacological interventions to treat behavioural and psychological symptoms of dementia, a specialized psychiatric hospital partnered with an academic university to create a clinical demonstration unit (CDU) - a learning health systems (LHS) model to advance dementia care. In this paper, we identify five key enablers that led to the successful creation of the CDU, its achievements and challenges encountered. The paper provides learnings for other healthcare providers who are considering initiating an LHS model within their setting to advance patient care., (Copyright © 2022 Longwoods Publishing.)

Interprofessional collaboration (IPC) supports the delivery of quality and safe healthcare. The acquisition of interprofessional competencies both pre-licensure and post-licensure are key to implementing this approach in the healthcare workplace. This report documents the development and implementation of a simulation intervention to support interprofessional education (IPE) in the undergraduate classroom for pre-licensure learners. The learning activity framework includes an exposure phase (e.g., didactic classroom instruction) and an immersion phase (e.g., simulation intervention and debriefing). Details on the debriefing process are included as it is key to achieving the learning objectives. The three learning activity pilot tests (n=150) revealed that learners recognized that interprofessional competencies were an important asset to support IPC. The pilot tests identified the need for further development in order for students to make a connection with the mastery phase (i.e., clinical placement). The next steps will include the development and incorporation of formative tools to assess learners' progress, as well as a plan to evaluate the learning activity that will connect all three phases (exposure, immersion, and mastery) of the learning framework., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Gamble et al.)

As the participants in the Canada Health Act, Version 2.0 conference made clear, there is a strong case to be made that this key piece of legislation no longer captures some key challenges to managing health care in Canada. Particular issues include 'portability' across provincial/territorial boundaries, and the definition of insured services. However, the CHA is not a barrier to reform; it acts as a floor, rather than a ceiling. Health reform may thus require a combination of new legislation to set conditions for which new services should be insured, and developing mechanisms to identify priorities, ensure appropriateness, and improve efficiency, which are unlikely to be addressed through overarching legislation. The CHA should thus be maintained, recognizing that it is necessary, but not sufficient.

Registered respiratory therapists (RRTs) aid in the diagnosis and treatment of respiratory illness and cardiopulmonary disorders, conditions that are increasingly being managed in settings other than the hospital sector. However, analysis of a longitudinal data set of Ontario's RRTs (2,903) from 1996 to 2007 demonstrates that the majority of RRTs work full-time in the hospital sector, where retention is high. Despite a policy direction encouraging the shift of the site of care from the hospital sector to the community/home, this has had little impact on where RRTs work, raising the question of who is providing respiratory services in the community.

The Canada Health Act requires that provincial insurance plans provide universal coverage without co-payments for all "medically necessary" services delivered by hospitals and doctors, but allows care delivered by other providers in other locations to fall outside of the boundaries of Medicare. Discussion about the sustainability of medicare at both the national and provincial levels has called for the revisiting of these boundaries. The M-THAC (Medicare to Home and Community) Research Unit attempted to clarify the areas of consensus and controversy as to what key stakeholders thought should be "in" or "out" of Medicare. Using a non-experimental, cross-sectional design, a self-administered survey (in both English and French, constructed in consultation with our partners) was distributed between January and April 2002 to policy elites of key stakeholder groups. The results are based on 2,523 responses. Much of the current "debate" is mired in discussing issues where consensus already exists. We found strong support for in-hospital care. However, there is considerable resistance, across all groups, to full funding for similar services in private clinics or in the home, and almost no support for full funding for non-medical home-based services. The vision of many policy elites remains heavily linked to the current system of guaranteed public funding only for acute care in hospitals or by physicians. Successful reform will need to address, rather than assume, a broader view of healthcare.

The Canada Health Act requires that provincial insurance plans provide universal coverage without co-payments for all "medically necessary" services delivered by hospitals and doctors, but allows care delivered by other providers in other locations to fall outside of the boundaries of Medicare. Discussion about the sustainability of medicare at both the national and provincial levels has called for the revisiting of these boundaries. The M-THAC (Medicare to Home and Community) Research Unit attempted to clarify the areas of consensus and controversy as to what key stakeholders thought should be "in" or "out" of Medicare. Using a non-experimental, cross-sectional design, a self-administered survey (in both English and French, constructed in consultation with our partners) was distributed between January and April 2002 to policy elites of key stakeholder groups. The results are based on 2,523 responses. Much of the current "debate" is mired in discussing issues where consensus already exists. We found strong support for in-hospital care. However, there is considerable resistance, across all groups, to full funding for similar services in private clinics or in the home, and almost no support for full funding for non-medical home-based services. The vision of many policy elites remains heavily linked to the current system of guaranteed public funding only for acute care in hospitals or by physicians. Successful reform will need to address, rather than assume, a broader view of healthcare.