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I never intended to become a scientist. My career developed on the basis of chance happenings, repeated failure, the willingness to take risks and the acceptance and provision of mentoring. My career has included periods of difficulty and shifted back and forth between academic health centers and universities in Canada. Although I have been amply recognized for my successes, my greatest learning has come from my failures. My greatest satisfaction has been in the development, evaluation and dissemination of interventions. The combination of intellectual stimulation and emotional gratification has meant a rewarding career. [ABSTRACT FROM AUTHOR]

This paper is an examination of the methodological and theoretical perspectives of a study with an inquiry focus on the experiences and perspectives of staff who worked at an injectable opiate assisted (iOAT) clinic. Twenty-two staff members, including nurses, social workers, and peer support workers, were interviewed. The goal of the study was to uncover how the clinic staff provided care to the clients who attend the clinic, their perspectives on how the clinic program impacted both them and their clients, and their experiences with the program itself. This interpretive descriptive study was underpinned by critical social theory. Thematic analysis was undertaken to identify recurring, converging, and contradictory patterns of interaction, key concepts and emerging themes. In this paper we examine and discuss how the relationship between critical social theory and interpretive description enhanced the study. Examples from the study are presented to provide insight into the relationship. [ABSTRACT FROM AUTHOR]

Statelessness in Canada is an emerging site of inquiry with recent investigations into its causes and consequences, focusing on legislative and policy analyses and the lived experiences of stateless persons. Yet, health care experiences generally and access to mental and physical health care in particular remain under-researched. This study attempts to bridge this gap by examining how statelessness impacts physical health, mental health, access to health care services, and overall well-being. To answer these questions, we conducted semi-structured interviews with stateless or formerly stateless persons to understand their views and experiences. The study reports on negative health outcomes in four broad areas: The limited ability of stateless persons (SPs) to access health care. Mental health challenges. The failure to treat health issues until they have reached a dangerous point and the reliance on self-care strategies. The negative impact of lack of status on four social determinants of health: employment, education, housing, and food security. From these findings, the paper makes three arguments: Legal Status is a key determinant of health and lack of status leads to negative health outcomes. SPs heavily depend upon others for their life-needs, which can lead to exploitation and encourage forms of adaptive and negotiated agency. SPs in Canada experience a physical and mental liminality [a condition of uncertainty]. The paper concludes that Canada should recognize stateless individuals either as stateless or as Canadian nationals, and should implement a context-tailored institutional response to statelessness. [ABSTRACT FROM AUTHOR]

Objectives: Indigenous youth who identify themselves as First Nations, Métis or Inuit living in Canada between the ages of 12-25 experience higher rates of depression and suicide than non-Indigenous youth. Using narrative review, this paper provides a critical analysis of the scholarly literature to explore the current delivery and accessibility of mental health services among Indigenous youth and suggests areas for improvements in system recovery. Research Design and Methods: The narrative review selected papers from databases including Google Scholar, PubMed, APA PsychInfo, and Indigenous Peoples Atlas of Canada to capture literature from several academic disciplines between August 2020 to May 2022. Data was then synthesized to deliver broad perspectives on this topic. Results: Three categories describe how the accessibility of mental health services for Indigenous youth is impacted by (1) research, (2) current mental health practice, and (3) the location of care services. The medicalization of mental health services, and its emphasis on individual causation and intervention, grounded this discussion. Intersectionality and cultural safety offered a counterpoint to medicalization since these ideas encourage the consideration of social, political, economic, and historical forces. These concepts inform possibilities for change at the micro, mezzo, and macro system levels to address this growing issue. Conclusion: Future implications for improving mental health services and mental health recovery among Indigenous youth include advancing research and implementing innovative solutions that promote intersectionality and culturally safe care across multiple system levels. [ABSTRACT FROM AUTHOR]

COVID-19 poses serious challenges to the health and safety of childcare providers, and these challenges were particularly acute in early 2022 during the first Omicron wave when vaccines were not available for children. Childcare providers work in environments where the recommended methods to minimize COVID-19 infection were often not possible to implement: children could not wear masks for extended periods and were not able to maintain physical distance. Under these pressures, Canada's already-fragile childcare sector was strained, caregivers struggled, and existing deficiencies were exacerbated. As part of a larger quality assurance and improvement project examining the impacts of the pandemic on childcare in the Canadian prairie province of Manitoba, this paper reports on qualitative findings to make public health and policy recommendations for the childcare sector. Data were voluntarily provided by a sample of childcare providers between January 6–13, 2022. A thematic analysis of open-text responses was performed, finding: an urgent need for health and safety resources; a need for sustained support and guidelines; and an absence of value and respect. We also identified an emergent theme of gratitude, which was reflected by an overwhelming number of thanks to the project team for listening to the voices of childcare providers. We draw on our qualitative analysis to propose measures to improve public health and safety, funding, and infrastructure, as well as to underscore the importance of systematic data collection and evaluation to protect and support the essential childcare workforce through the COVID-19 pandemic and into the future. [ABSTRACT FROM AUTHOR]

In Canada, public insurance for physician and hospital services, without cost-sharing, is provided to all residents. Outpatient prescription drug coverage, however, is provided through a patchwork system of public and private plans, often with substantial cost-sharing, which leaves many underinsured or uninsured. We conducted a systematic review to examine the association of drug insurance and cost-sharing with drug use, health services use, and health in Canada. We searched 4 electronic databases, 2 grey literature databases, 5 specialty journals, and 2 working paper repositories. At least 2 reviewers independently screened articles for inclusion, extracted characteristics, and assessed risk of bias. The expansion of drug insurance was associated with increases in drug use, individuals who reported drug insurance generally reported higher drug use, and increases in and higher levels of drug cost-sharing were associated with lower drug use. Although a number of studies found statistically significant associations between drug insurance or cost-sharing and health services use, the magnitudes of these associations were generally fairly small. Among 5 studies that examined the association of drug insurance and cost-sharing with health outcomes, 1 found a statistically significant and clinically meaningful association. We did not find that socioeconomic status or sex were effect modifiers; there was some evidence that health modified the association between drug insurance and cost-sharing and drug use. Increased cost-sharing is likely to reduce drug use. Universal pharmacare without cost-sharing may reduce inequities because it would likely increase drug use among lower-income populations relative to higher-income populations. • There is a gap in the literature pertaining to the effects of drug insurance and cost-sharing in a Canadian context. • We conducted a systematic review of Canadian studies and found that there was consistent evidence that the expansion of drug insurance was associated with meaningful increases in drug use, that individuals who reported drug insurance coverage generally reported higher drug use relative to those who reported no coverage, and that increases in and higher levels of drug cost-sharing were associated with lower use. • Universal pharmacare without cost-sharing may reduce inequities in access to essential drugs. [ABSTRACT FROM AUTHOR]

This paper reports on recommendations made by Métis women, two-spirit, and gender diverse people for improving access to health and social services in Victoria, British Columbia. Expanding on research conducted in Toronto, Ontario, this study applied a conversational interview method to further explore and understand experiences of self-identifying Métis women, two-spirit, and gender diverse people (n = 24) who access health and social services in Victoria. Participants provided wholistic and practical recommendations for improving access to health and social services, including (1) warm and inviting service spaces, (2) Métis-specific cultural safety training, (3) Indigenous specific clinic, (4) wholistic or integrative service delivery, and (5) non-judgemental service providers. This research demonstrates that Métis women, two-spirit and gender diverse community members hold practical solutions for improving access to health and social services for the larger Métis community. [ABSTRACT FROM AUTHOR]

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This paper is concerned with the impact of medical inadmissibility provisions in Canada's immigration law on applicants with disabilities. The paper draws on key informant interviews, policy analysis, and Ministry of Immigration data on medical inadmissibility findings. We follow the lead of recent mobilities scholarship to examine how the immigration system is enacted, reproduced, and contested over time. From this perspective, we see that recent court challenges to the statutory provisions have created additional procedural space for applicants to contest findings of inadmissibility. However, the legitimacy of excessive demand as a basis for exclusion remains firmly in place, while recent immigration policy changes signal an intensification of measures to limit the social reproductive costs of immigration. Les personnes handicapées, l'inadmissibilité pour motifs sanitaires et la politique d'immigration sélective Cet article s'intéresse aux effets des dispositions de la législation canadienne en matière d'immigration relatives à l'inadmissibilité pour motifs sanitaires des candidats ayant une incapacité. L'article se fonde sur des entretiens auprès d'informateurs clés, des analyses politiques et des données du ministère sur les décisions d'inadmissibilité pour motifs sanitaires. Les recherches récentes portant sur la mobilité forment le point de départ d'une exploration du mode de fonctionnement du système d'immigration, sa reproduction et sa remise en question au fil du temps. Vues sous cet angle, les contestations actuelles des dispositions légales devant les tribunaux ont permis de dégager un espace de procédure supplémentaire pour les candidats afin de contester les verdicts d'inadmissibilité. Cependant, la légitimité de la demande excessive en tant que motif d'interdiction perdure, tandis que les changements récents apportés à la politique d'immigration annoncent une intensification des mesures visant à limiter les coÛts sociaux de l'immigration. [ABSTRACT FROM AUTHOR]

Aim: This paper explores the potential for incorporating big data in nursing regulators' decision‐making and policy development. Big data, commonly described as the extensive volume of information that individuals and agencies generate daily, is a concept familiar to the business community but is only beginning to be explored by the public sector. Background: Using insights gained from a recent research project, the College and Association of Registered Nurses of Alberta, in Canada is creating an organizational culture of data‐driven decision‐making throughout its regulatory and professional functions. The goal is to enable the organization to respond quickly and profoundly to nursing issues in a rapidly changing healthcare environment. Sources of evidence: The evidence includes a review of the Learning from Experience: Improving the Process of Internationally Educated Nurses' Applications for Registration (LFE) research project (2011–2016), combined with a literature review on data‐driven decision‐making within nursing and healthcare settings, and the incorporation of big data in the private and public sectors, primarily in North America. Discussion: This paper discusses experience and, more broadly, how data can enhance the rigour and integrity of nursing and health policy. Conclusion: Nursing regulatory bodies have access to extensive data, and the opportunity to use these data to inform decision‐making and policy development by investing in how it is captured, analysed and incorporated into decision‐making processes. Implications for Nursing and Health Policy: Understanding and using big data is a critical part of developing relevant, sound and credible policy. Rigorous collection and analysis of big data supports the integrity of the evidence used by nurse regulators in developing nursing and health policy. [ABSTRACT FROM AUTHOR]

Market-based migrant intermediaries play an important role in skilled migration. Skilled workers, especially in regulated professions such as nursing, face increasingly complex testing and credential assessment systems. 'Regimes of skill' control and filter membership to these professions by reproducing already existing power imbalances in the global regulation of skilled labour. This paper examines these processes in the case of Indian trained nurses who use educational brokers to enrol in Canadian post-graduate programmes with the intention of practising in the Canadian health care system. The study elaborates on the 'regime of skill' in nursing, revealing its maintenance through interactional and transnational connections between intermediaries, educators and regulators in terms of codifying and translating skills and competencies between jurisdictions with different cultural and professional histories and norms of nursing. Findings reveal that intermediaries operate transnationally in a symbiotic manner with more powerful actors in order to exploit regimes of skill and expand their market share. [ABSTRACT FROM AUTHOR]

National responses to COVID-19 depend in part on national health care financing arrangements. Yet the pandemic itself has not only strained system capacity, it has – through subsequent economic shocks – strained revenue sources that prop up these arrangements. In federal countries, fiscal pressures are particularly pronounced. As this paper argues, however, federal health financing regimes differ in ways that are shaping the agenda for post-pandemic reforms. The analysis, which focuses on health care financing in three federal countries (Canada, the United States, and Mexico), explores the current and potential future impact of COVID-19 on existing policy legacies. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to analyze patterns of health services utilization – visits to family practitioner and visits to an emergency room – by recent immigrants (those who have lived in Canada for less than ten years) and “established” immigrants (those who have resided in Canada for ten years or longer) relative to their Canadian-born counterparts. Design/methodology/approach – The 2009/2010 files of the Canadian Community Health Survey were used for the analysis. A logit model was used to analyze utilization while a zero-inflated negative binomial model was used to measure the intensity of health services utilization. Findings – Results suggest that relative to native-born Canadians, recent immigrants are more likely to visit an emergency room and are less likely to visit a family/general practitioner. The opposite effect is observed for “established” immigrants. In terms of intensity of use, native-born Canadians are more likely to use physicians’ services intensively compared with either recent or established immigrants. Originality/value – The paper’s findings suggest that provincial governments in Canada will need to focus effort to ensure that recent immigrants have access to a family/general practitioner. This will be necessary given the recent primary care reform initiatives introduced across Canada that emphasize the physician as the first point-of-contact with the health system. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to describe the process of transformation in the Northern Health region of British Columbia (BC), Canada, based on a new relationship between governments of BC, Canada, and First Nations. Design/methodology/approach - Written from the perspective of four key participants in the transformation process, this paper highlights the ways in which partnership has been integral to the transformation of health service delivery to First Nations communities in Northern BC. Findings - In sharing their experiences with health system transformation through partnership, the authors of this paper hope to contribute to a growing set of promising practices as indigenous health service organizations take a greater role in health service provision, and non-indigenous health service organizations improve their understanding of and relationships with indigenous communities. Originality/value - This paper outlines a unique and leading edge transformation in health service delivery, told from the perspectives of key partners involved in the transformation process. [ABSTRACT FROM AUTHOR]

Evidence-informed health policy making (EIHP) is becoming a necessary means to achieving health system reform. Although Canada has a rich and well documented history in the field of evidence-basedmedicine, a concerted effort to capture Canada's efforts to support EIHP in particular has yet to be realized. This paper reports on the development of EIHP in Canada, including promising approaches being used to support the use of evidence in policy making about complex health systems issues. In light of Canada's contributions, this paper suggests that scholars in Canada will continue engaging in the field of EIHP through further study of interventions underway, as well as by sharing knowledge within and beyond Canada's borders about approaches that support EIHP. [ABSTRACT FROM AUTHOR]

Multi-sectoral, interdisciplinary health research is increasingly recognizing integrated knowledge translation (iKT) as essential. It is characterized by diverse research partnerships, and iterative knowledge engagement, translation processes and democratized knowledge production. This paper reviews the methodological complexity and decision-making of a large iKT project called Seniors - Adding Life to Years (SALTY), designed to generate evidence to improve late life in long-term care (LTC) settings across Canada. We discuss our approach to iKT by reviewing iterative processes of team development and knowledge engagement within the LTC sector. We conclude with a brief discussion of the important opportunities, challenges, and implications these processes have for LTC research, and the sector more broadly. [ABSTRACT FROM AUTHOR]

Background: Historically transgender adults have experienced barriers in accessing primary care services. In Ontario, Canada, health care for transgender adults is accessed through primary care; however, a limited number of practitioners provide care, and patients are often waiting and/or traveling great distances to receive care. The purpose of this protocol is to understand how primary care is implemented and delivered for transgender adults. The paper presents how the case study method can be applied to explore implementation of health services delivery for the transgender population in primary care. Methods: Case study methodology will be used to explore this phenomenon in different primary care contexts. Normalization Process Theory is used as a guide. Three cases known to provide transgender primary care and represent different Ontario primary care models have been identified. Comparing transgender care implementation and delivery across different models is vital to understanding how care provision to this population can be supported. Qualitative interviews will be conducted. Participants will also complete the NoMAD (NOrmalization MeAsure Development) survey, a tool measuring implementation processes. The tool will be modified to explore the implementation of primary care services for transgender individuals. Documentary evidence will be collected. Cross-case synthesis will be completed to compare the cases. Discussion: Findings will provide an Ontario perspective on the implementation and delivery of primary care for transgender adults in different primary care models. Results may be applicable to other primary care settings in Canada and other nations with similar systems. Barriers and facilitators in delivery and implementation will be identified. Providing an understanding and increasing awareness of the implementation and delivery of primary care may help to reduce the invisibility and disparities transgender individuals experience when accessing primary care services. Understanding delivery of care could allow care providers to implement primary care services for transgender individuals, improving access to health care for this vulnerable population. [ABSTRACT FROM AUTHOR]

In May 2012, the Canadian Association of Geographers (CAG) annual meeting in Waterloo, Ontario, attracted strong attendance by scholars whose research explores the geographies of health and health care. The CAG's Geography of Health and Health Care Specialty Group organized 14 special paper sessions spanning three consecutive days and involving 53 presenters; 24 health-focused papers were also given in other sessions throughout the CAG meeting, for a total of 77 presenters. In this viewpoint, we draw upon the diverse geographies of health and health care scholarship presented at this meeting to provide a snapshot of some current research themes in Canadian health geography. Five interrelated themes were identified, namely: 1) aging, disability, and chronic disease; (2) environmental determinants and health; (3) accessing health and health-promoting services; (4) diversity and intersecting positions; and (5) research methods and frameworks. We believe that identifying themes from the 2012 CAG annual meeting provides insight regarding what issues, topics, methods, and frameworks are inspiring Canadian health geographers, while also serving as a baseline for comparison of future trends and directions for future research. [ABSTRACT FROM AUTHOR]

The consequences of parallel paper and electronic medical records (EMR) and their impact on informational continuity are examined. An interdisciplinary team conducted a multi-site, ethnographic field study and retrospective documentation review from January 2010 to December 2010. Three case studies from the sample of older patients with hip fractures who were transitioning across care settings were selected for examination. Analysis of data from interviews with care providers in each setting, field observation notes, and reviews of medical records yielded two themes. First, the lack of interoperability between electronic information systems has complicated, not eased providers’ ability to communicate with others. Second, rather than transforming the system, digital records have sustained health care’s ‘culture of documentation’. While some information is more accessible and communications streamlined, parallel paper and electronic systems have added to front line providers’ burden, not lessened it. Implementation of truly interoperable electronic health information systems need to be expedited to improve care continuity for patients with complex health-care needs, such as older patients with hip fractures. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to present a case study of a healthcare service redesign. Before 1998, five community hospitals in Winnipeg each managed their intensive care units (ICUs) independently, providing virtually no access to patients in rural and remote regions of the province of Manitoba; and two tertiary university affiliated hospitals were left with insufficient intensive care beds to service the rest of the provincial population in addition to their tertiary service responsibilities. The authors resolved to create a city-wide integrated critical care services model, in order to improve patient access, quality of care and cost effectiveness. Design/methodology/approach – A population demand analysis was performed and service objectives were defined. A gap analysis became the basis of an integrated service model design and an implementation plan was formulated. Findings – Beds were redistributed among community hospital ICUs to match available nursing resources. A credentialing process was developed to establish medical competency for attending physicians. A central bed registry and a referral triage system were implemented, to ensure that any Manitoban requiring an ICU admission acquired an appropriate bed in a timely manner. A regional computerized critical care database was introduced to all ICUs. The total number of beds was reduced from 92 to 84 and total occupancy fell from 65 to 58. The new model was entirely funded from bed reductions. Originality/value – This paper describes the integration of a group of hospital-based ICUs into a regional service delivery model developed to meet the needs of a provincial population. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to describe the processes and results of implementing and evaluating the Releasing Time to Care™ (RTC™) model in a 45-bed Neurosciences unit in a tertiary care hospital in Saskatchewan province of western Canada. Design/methodology/approach – Organizational restructuring in healthcare systems has impacted the ability of clinical registered nurses (CRNs) in participation and in influencing the decision making that affect the delivery and outcomes of patient-centered care. At the same time, CRNs' work has intensified because of increases in patient acuity, technological advances, complexity of care provided to patient families and communities, in addition to the intensifying demands put on by an aging population and dwindling resources. The work reported in this paper shows that significant improvements have been made based on the current needs and the change is forever imminent. Establishing solid people connections and networking opportunities proved valuable for current and future exchange of information and knowledge translation. Findings – Model implementation resulted in positive narrative and empirical data including: improved patient safety, staff engagement, leadership opportunities and an affirmative shift in organizational culture. Improved patient safety was evidenced by a reduction in falls and decreased medication errors. Originality/value – The paper focuses on including the clinical nurse in organizational and system change towards improving patient-centered quality care. Neurosciences 6300 at Royal University Hospital (RUH) in Saskatoon, was viewed as an RTC™ champion and one of the first to implement and complete the 11-module toolkit. [ABSTRACT FROM AUTHOR]

Background: Providing efficient and effective aged care services is one of the greatest public policy concerns currently facing governments. Increasing the integration of care services has the potential to provide many benefits including increased access, promoting greater efficiency, and improving care outcomes. There is little research, however, investigating how integrated aged care can be successfully achieved. The PRISMA (Program of Research to Integrate Services for the Maintenance of Autonomy) project, from Quebec, Canada, is one of the most systematic and sustained bodies of research investigating the translation and outcomes of an integrated care policy into practice. The PRISMA research program has run since 1988, yet there has been no independent systematic review of this work to draw out the lessons learnt. Methods: Narrative review of all literature emanating from the PRISMA project between 1988 and 2012. Researchers accessed an online list of all published papers from the program website. The reference lists of papers were hand searched to identify additional literature. Finally, Medline, Pubmed, EMBASE and Google Scholar indexing databases were searched using key terms and author names. Results were extracted into specially designed spread sheets for analysis. Results: Forty-five journal articles and two books authored or co-authored by the PRISMA team were identified. Research was primarily concerned with: the design, development and validation of screening and assessment tools; and results generated from their application. Both quasi-experimental and cross sectional analytic designs were used extensively. Contextually appropriate expert opinion was obtained using variations on the Delphi Method. Literature analysis revealed the structures, processes and outcomes which underpinned the implementation. PRISMA provides evidence that integrating care for older persons is beneficial to individuals through reducing incidence of functional decline and handicap levels, and improving feelings of empowerment and satisfaction with care provided. The research also demonstrated benefits to the health system, including a more appropriate use of emergency rooms, and decreased consultations with medical specialists. Discussion: Reviewing the body of research reveals the importance of both designing programs with an eye to local context, and building in flexibility allowing the program to be adapted to changing circumstances. Creating partnerships between policy designers, project implementers, and academic teams is an important element in achieving these goals. Partnerships are also valuable for achieving effective monitoring and evaluation, and support to 'evidence-based' policy-making processes. Despite a shared electronic health record being a key component of the service model, there was an under-investigation of the impact this technology on facilitating and enabling integration and the outcomes achieved. Conclusions: PRISMA provides evidence of the benefits that can arise from integrating care for older persons, particularly in terms of increased feelings of personal empowerment, and improved client satisfaction with the care provided. Taken alongside other integrated care experiments, PRISMA provides further evidentiary support to policy-makers pursuing integrated care programs. The scale and scope of the research body highlights the long-term and complex nature of program evaluations, but underscores the benefits of evaluation, review and subsequent adaptation of programs. The role of information technology in supporting integration of services is likely to substantially expand in the future and the potential this technology offers should be investigated and harnessed. [ABSTRACT FROM AUTHOR]

Health policies have played significant roles in attaining good achievements in population health improvement. This paper chronologically reviews and analyzes health-related parliamentary actions and law enactments in Canada. It indicates that the salient feature of the Canadian health system is that it is publicly financed with a single-payer, but privately run. The Canadian health system is based upon five founding principles: care must be universal (covering everyone), portable (among all provinces) , comprehensive (covering all medically necessary services), accessible (without barriers to access like user fees), and publicly administered (by the government). This paper pays special attention to what and how China can learn from Canada and what should be avoided against failures of Canadian healdi system, and how it might provide a new. health policy base for China's current health reform. [ABSTRACT FROM AUTHOR]

Floating Catchment Area (FCA) methods are a popular tool to investigate accessibility to public facilities, in particular health care services. FCA approaches are attractive because, unlike other accessibility measures, they take into account the potential for congestion of facilities. This is done by 1) considering the population within the catchment area of a facility to calculate a variable that measures level of service, and then 2) aggregating the level of service by population centers subject to catchment area constraints. In this paper we discuss an effect of FCA approaches, an artifact that we term demand and level of service inflation. These artifacts are present in previous implementations of FCA methods. We argue that inflation makes interpretation of estimates of accessibility difficult, which has possible deleterious consequences for decision making. Next, we propose a simple and intuitive approach to proportionally allocate demandand and level of service in FCA calculations. The approach is based on a standardization of the impedance matrix, similar to approaches popular in the spatial statistics and econometrics literature. The result is a more intiuitive measure of accessibility that 1) provides a local version of the provider-to-population ratio; and 2) preserves the level of demand and the level of supply in a system. We illustrate the relevant issues with some examples, and then empirically by means of a case study of accessibility to family physicians in the Hamilton Census Metropolitan Area (CMA), in Ontario, Canada. Results indicate that demand and supply inflation/deflation affect the interpretation of accessibility analysis using existing FCA methods, and that the proposed adjustment can lead to more intuitive results. [ABSTRACT FROM AUTHOR]

This paper aims to contribute to a better understanding of multilevel governance processes. We do so by focusing on the in-depth examination of the institutional changes recently implemented in the Quebec health care delivery system that require a close collaboration between interdependent actors acting at various levels of governance. Our three research questions are: (1) How does multi-level governance emerge in a pluralist institutuional context? (2) How do multi-level governance processes shape the adaptive capacity of the organization to its environment? (3) How does institutional context influence these multi-governance processes?Our empirical investigation is inspired by the theory of complexity which invites us to pay attention to three processes: self-organization, eco-self organization and co-evolution. This study shows that the effectiveness of multi-level governance processes do not only go through the implementation of instruments aiming at aligning the action of lower government levels with the objectives of the upper levels as suggested by numerous existing works. More precisely, it suggests that more distributed and coordinated processes favor a more homogenous form of adaptation (Miller and Page, 2007) taking into account the interdependence between stakeholders. [ABSTRACT FROM AUTHOR]

The right to healthcare is a socio-economic right. It is positive in the sense that governments need to provide resources and set the priorities for individuals to be able to exercise it. The provision of healthcare within complex political entities such as the European Union (EU) and Canada is divided between different actors, namely the federal government and provinces in the case of Canada, and European institutions and Member States in the case of the EU. The paper analyses the EU and Canadian legal frameworks and attempts to determine the right balance of power between the centre and the constituent parts in order to facilitate the exercise of the right to healthcare. [ABSTRACT FROM AUTHOR]

A diversity assessment measures an organization's progress in increasing diversity and inclusiveness. As part of a larger study, this paper examines and analyses the application of the Diversity Audit Tool (DAT) to the Canadian Financial Services sector to the status of women's representation within the workforce. The DAT assesses policies and practices to increase diversity and inclusiveness not only on human resource functions but also how diversity can be integrated throughout the organization's value chain. As an exceptionally adaptable and flexible tool, the DAT has been previously applied to education, health care, police services, and information and communications technology (ICT) sectors; it is generalizable enough to examine diversity initiatives across a number of groups as well as to focus on a single one, as it does in this study. This paper begins with a discussion of the current status of female workers within this sector and identifies a number of barriers that prevent full workforce participation and inclusiveness. The DAT is systematically applied to the financial services sector (reproduced in Appendix 1) and the findings are discussed, examining six key areas: leadership and governance, human resource practices; quality of life and organizational culture; measuring and tracking diversity; integrating or mainstreaming diversity across the value chain; and developing the pipeline. Finally, these findings will be discussed and conclusions will be made. [ABSTRACT FROM AUTHOR]

Purpose - This paper aims to describe Caribbean traditional medicine and to consider whether and how it could be integrated into health systems in Canada.Design/methodology/approach - This paper employs a literature review and synthesis.Findings - Caribbean traditional healing takes a variety of forms reflecting the diversity of histories of the people of the Caribbean. A number of arguments including quality, equity, cost, and social climate will be important factors in facilitating or hindering the expansion of these complementary therapies. However, linking an expansion of therapies to other policy imperatives such as developing stronger communities and expansion of trade may make success more likely.Research limitations/implications - This is a narrative and document review. It is an argument which aims to produce discussion rather than empirical research.Practical implications - Taking a discursive narrative approach to difficult policy issues may help in considering strategies for promoting change.Originality/value - This is the first study which has attempted to consider traditional Caribbean medicine in the Canadian context. It is also the first to consider the strategies for convincing health systems to adopt this form of complementary medicine. [ABSTRACT FROM AUTHOR]

In addition to facing barriers to health care and experiencing poor health status, immigrants to Canada and Sweden tend to have more negative birth outcomes than the native-born population, including low birth weight and perinatal mortality rates. Explored through interviews with health care professionals, including midwives, nurse practitioners, social workers and obstetrician gynaecologists, this paper evaluates their experiences in providing prenatal care to immigrants in Hamilton, Ontario, Canada. Results reveal the complexity of delivering care to immigrants, particularly with respect to expectations surrounding language, culture and type and professionalism of care. The paper concludes by discussing future research options and implications for the delivery of prenatal care to this population. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to undertake an examination of the Local Health Integration Network (LHIN) Health Policy proposal. This policy established a decentralized approach to health system management in the province of Ontario, Canada by creating 14 crown agencies, LHINs.Design/methodology/approach This policy is examined against the five policy stages of the Stages Model: agenda setting, formulation, legitimation, implementation and evaluation. The examination was based on a review of grey literature, including key government reports and briefs.Findings This policy did not follow the Stages Model sequentially: the policy was implemented while it was still undergoing its legitimacy phase. Formal reviews were undertaken following implementation and found areas for improvement: poor integration amongst all the LHINs; poor patient navigation persists; LHINs lack the capacity and competency to engage in regional capacity planning; and planning and integration is not centered around patient needs. As a result, a decade after the introduction of LHINs, the Ontario HealthCare System has not achieved systems improvement when measured against accepted government indicators of performance.Originality/value This integration policy highlights the context and evolution of Ontario’s healthcare system governance in the past decade and contributes to the body of knowledge on the impact of regionalization on health systems and patient care. [ABSTRACT FROM AUTHOR]

Much of the existing research literature on the health of immigrant populations does not address the health care experiences of refugees, even though they likely experience unique and different health care needs relative to economic or family class immigrants. The objective of this paper is to explore the systemic barriers to health care access experienced by Canada’s refugee populations. The paper focuses on understanding these challenges as expressed by health and social service providers at the local level in Hamilton, Ontario. Data from interviews illustrate the impact of these systemic barriers for both refugees and providers. The paper examines issues of interpretation/language, cultural competency, health care coverage, isolation, poverty, and transportation in terms of health care and availability of services. [ABSTRACT FROM PUBLISHER]

Canada is internationally known for its universal healthcare system. Like other nations, Canada's publicly funded healthcare system struggles with challenges related to escalating costs, complexity of care and sustainability. The Canadian Health Services Research Foundation (CHSRF), through its flagship programmes — Capacity for Applied and Developmental Research and Evaluation (CADRE) and Executive Training for Research Application (EXTRA) — strives to meet those challenges by improving the capacity of researchers and decision makers to make evidence-informed health service decisions. This paper showcases the significant strides being made by the programmes in adapting the linkage and exchange approach, through national-level data and narrative accounts from key stakeholders. The paper concludes with remarks on potential future directions for CADRE and EXTRA, and their alignment with CHSRF's strategic priorities. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to exemplify the evolving applications of balanced scorecard and strategy map in the healthcare sector. This paper seeks to describe a number of innovative approaches adopted by healthcare organizations and health systems in their implementation of Kaplan and Norton's strategy map and balanced scorecard. Although strategy map and balanced scorecard are useful strategic management tools, policy makers and decision makers should be well-informed about implementation issues and challenges of their adoption in healthcare organizations and health systems. Design/methodology/approach - The paper is based on a literature review of the applications of strategy map and balanced scorecard in healthcare organizations and health systems. Also publications of the Ministry of Health and Long-Term Care and its agencies are examined to assess the strategic priorities and plans for Ontario's health system. Findings - From the literature review and case studies cited, an increasing use of strategy map and balanced scorecard was found in the healthcare sector. The implementation is both unique and innovative. Moreover, strategy map and balanced scorecard are effective communication and strategic management tools in aligning and integrating the strategic goals of various levels within the health system. Practical implications - The paper gives an account of the different implementation approaches of strategy map and balanced scorecard in the healthcare sector; thereby providing policy makers and decision makers with choices on how to implement the strategic management tool in their organizations. Originality/value - The literature review and case studies described here highlight the value and applications of strategy map and balanced scorecard in the healthcare sector. [ABSTRACT FROM AUTHOR]

Cultural impacts on health experiences and behaviours are profound in the area of reproductive health and family planning. Explored through interviews with family planning healthcare professionals, this paper evaluates their experiences in providing family planning and reproductive healthcare to immigrants in the Greater Toronto and Hamilton area of Ontario, Canada. Results reveal the complexity of delivering care to members of this group, particularly when dealing with language barriers, situations when professional and non-professional interpreters are used, and instances where healthcare professionals realize that they themselves have misconceptions and misunderstandings about other cultures. The paper concludes by discussing future research options and implications for the delivery of reproductive health family planning services to this population. [ABSTRACT FROM AUTHOR]

This paper overviews the emergence of medical/health geography in Canada. The paper discusses the key questions that Canadian health geographers have explored in the past two decades, how these enquiries have featured in the field and how they contribute to the wider discourse of human geography. It also addresses questions on emerging themes and where Canadian health geography will go in the years ahead. With shifting health landscapes in terms of changes in social, political and physical environments, and changes in health care restructuring, Canadian health geographers are entering a new phase of research, teaching and policy. The complexity of the questions that health geographers seek to address means it is necessary to continue to highlight the policy implications of their findings. Health geographers need to emphasize the public agenda through interdisciplinary research and by continuing to work with geographers in other subfields. [ABSTRACT FROM AUTHOR]

This paper seeks to examine how immigrants in a multicultural society access and utilize culturally- and linguistically-diverse family physicians. It focuses on Mainland Chinese (MLC) immigrants – the most important source of immigrants to Canada since 1996 – in the Toronto Census Metropolitan Area (CMA), Canada. Specifically, the paper aims to explore the choice between Chinese-speaking and non-Chinese-speaking family physicians by MLC immigrants and to determine the underlying reasons for MLC immigrants use of ethnically- and linguistically-matched family physicians. A wide range of data are analyzed including survey and focus group data, physician data from the College of Physicians and Surgeons of Ontario (CPSO) and geo-referenced 2001 Canadian Census data. A mixed-method approach is employed combining quantitative analysis of survey data and Census data, spatial analysis of patient travel behaviour based on the survey and qualitative analysis based on focus groups. The paper reveals an overwhelming preference among MLC survey respondents for Chinese-speaking family physicians regardless of study areas and socioeconomic and demographic status. The focus groups suggest that language, culture and ethnicity are intertwined in a complex way to influence the choice of health care providers and health management strategies in the host society. The paper yields important policy implications for identifying health professional shortage areas for culturally-diverse populations, addressing issues related to foreign-trained physicians and enhancing primary care delivery relevant for immigrant populations. [Copyright &y& Elsevier]

Objectives. To examine if Aboriginal health research conducted within the field of social sciences reflects the population and geographic diversity of the Aboriginal population. Study Design. Review. Methods. We searched the Web of Science Social Science Citation Index, the Arts and Humanities Citation Index and Scholars Portal for the time period 1995-2005 using search terms to reflect different names used to refer to Canada's Aboriginal peoples. Citations that did not focus on health or Canada were eliminated. Each paper was coded according to 7 broad categories: Aboriginal identity group; geography; age; health status; health determinants; health services; and methods. Results. Based on the 96 papers reviewed, the results show an under-representation of Métis and urban Aboriginal peoples. Most of the papers are on health status and non-medical determinants of health, with a particular focus on chronic conditions and life-style behaviours. Only 6 papers examined traditional approaches to healing and/or access to traditional healers/medicines. A small number involved the use of community-based research methods. Conclusions. Further research is required to address gaps in the current body of literature. Community-based research studies are necessary to address gaps that are most relevant to Aboriginal peoples. [ABSTRACT FROM AUTHOR]

This paper combines multiple cross-sections of data drawn from the National Population Health Survey and Canadian Community Health Survey to confirm the existence of the ‘healthy immigrant effect’, specifically that immigrants are in relatively better health on arrival in Canada compared to native-born Canadians, and that immigrant health converges with years in Canada to native-born levels. The paper finds robust evidence that the healthy immigrant effect is present for the incidence of chronic conditions for both men and women, and results in relatively slow convergence to native-born levels. There is only weak evidence in terms of self-assessed health status. The inclusion of controls for region of origin and year of arrival does not account for the observed effects, although region of origin is an important determinants of immigrant health. The paper then considers some alternative explanations for the observed differences, and support is found for the idea that the healthy immigrant effect reflects convergence in physical health rather than convergence in screening and detection of existing health problems. [Copyright &y& Elsevier]

Difficult health care encounters often do not translate into expressions of dissatisfaction with care. This paper focuses on the ‘non-expression’ of dissatisfaction with care in the accounts of 12 people in Canada who provided care to a relative or friend who died of breast cancer.The analysis foregrounded in this paper began from the observation that as difficult health care experiences were elaborated, speakers located health professionals’ actions in relation to various situational factors, including the fact of a (cancer) death and conditions of constraint in the health system. Set alongside these two realities, expressions of dissatisfaction tended to be disarmed. Results of this study suggest that the cost of articulating dissatisfaction with care is high where the cared-for person has died, and the perceived value of focusing on difficult experiences is low. Further, respondents in this study took the specificity of the situation and the setting into account in formulating beliefs about the care outcomes for which health professionals could be held responsible. When conditions in the health system and the disease process of advanced cancer were positioned in talk as ‘ultimate limits’ on health professionals’ actions, perceived lapses in care were excused. [Copyright &y& Elsevier]

The paper examines levels and determinants of trust in a health care system and in key actors in the health policy community. Talcott Parsons theorizes that the sharing of common values is a necessary condition for interpersonal trust to exist; this paper tests that notion at the level of systemic (institutional) trust. The paper reports findings of a 1999 survey of 493 randomly selected residents of Calgary, Alberta, Canada. It uses multiple regression analysis to identify the determinants of three different types of trust—generalized systemic trust, fiduciary trust, and generalized trust in particular actors’ input to health system changes. Among the numerous independent variables, special attention is devoted to the degree of congruence or incongruence between the importance which respondents attach to one of the values enunciated in the Canada Health Act—namely, ‘accessibility’ (equal access to quality health care)—and the importance which respondents believe is attached to that value by the Regional Health Authority and by the Premier of the province. Both value importance and value congruence on equal accessibility are found to be important factors explaining variation in all three types of trust. In explaining levels of trust in the Premier on the issue of health care system reform, congruence on equal accessibility proved to be even more important than such factors as political partisanship, political cynicism, and personal experience as a patient in the health care system. Findings also suggest that there is an emotional component to systemic trust. [Copyright &y& Elsevier]

Healthcare professionals use the genre of case presentation to communicate among themselves the salient patient information during treatment and management. In case presentation, many uncertainties surface, regarding, e.g., the reliability of patient reports, the sensitivity of laboratory tests, and the boundaries of scientific knowledge. The management and portrayal of uncertainty is a critical aspect of professional discourse. This paper documents the rhetorical features of certainty and uncertainty in novice case presentations, considering their pragmatic and problematic implications for students’ professional socialization.This study was conducted during the third-year inpatient clerkship at a tertiary care, pediatric hospital in hospital in Canada. Data collection included: (1) non-participant observations of 19 student case presentations involving 11 student and 10 faculty participants, and (2) individual interviews with 11 students and 10 faculty participants. A grounded theory approach informed data collection and analysis.Five thematic categories emerged, two of which this paper considers in detail: “Thinking as a Student” and “Thinking as a Doctor”. Within these categories, the management and portrayal of uncertainty was a recurrent issue. Teachers modeled central features of a “professional rhetoric of uncertainty”, managing uncertainty of six origins: limits of individual knowledge, limits of evidence, limitless possibility, limits of patient''s/parent''s account, limits of professional agreement, and limits of scientific knowledge. By contrast, students demonstrated a “novice rhetoric of uncertainty”, represented by their focus on responding to personal knowledge deficits through the strategies of acknowledgement, argument, and deflection. Some students moved towards the professional rhetoric of uncertainty, suggesting not only advances in communication, but also shifts in attitude towards patients and colleagues, that were interpreted as indications that this rhetoric shapes professional identity and interactions. [Copyright &y& Elsevier]

This paper documents the experiences of Two-Spirit people, both within society generally and in the context of health and health care. Findings of a national qualitative research study on gay, lesbian, bisexual, and Two-Spirit people's health care are reported with particular attention placed upon Two-Spirit people's notions of identity and community, the meaning of health, and the experience of health care barriers within and outside of Aboriginal communities. Currently, the body of academic research on health and health care access largely excludes gay, lesbian, bisexual, and transgendered/transsexual people (glbt). The smaller growing body of research on glbt health has little reference to Two-Spirit people. This paper attempts to redress these glaring absences. [ABSTRACT FROM AUTHOR]

Background The development and approval of both targeted and immune therapies for patients with advanced non-small cell lung cancer (nsclc) has significantly improved patient survival rates and quality of life. Biomarker testing for patients newly diagnosed with nsclc, as well as for patients progressing after treatment with epidermal growth factor receptor (EGFR) inhibitors, is the standard of care in Canada and many parts of the world. Methods A group of thoracic oncology experts in the field of thoracic oncology met to describe the standard for biomarker testing for lung cancer in the Canadian context, focusing on evidence-based recommendations for standardof- care testing for EGFR, anaplastic lymphoma kinase (ALK), ROS1, BRAF V600 and programmed death-ligand (PDL1) at the time of diagnosis of advanced disease and EGFR T790M upon progression. As well, additional exploratory molecules and targets are likely to impact future patient care, including MET exon 14 skipping mutations and whole gene amplification, RET translocations, HER2 (ERBB2) mutations, NTRK, RAS (KRAS and NRAS), as well as TP53. Results The standard of care must include the incorporation of testing for novel biomarkers as they become available, as it will be difficult for national guidelines to keep pace with technological advances in this area. Conclusions Canadian patients with nsclc should be treated equally; the minimum standard of care is defined in this paper. [ABSTRACT FROM AUTHOR]

In this paper, we test the hypothesis that health technology assessment units located in hospitals tend to be more optimistic toward technologies that are currently in use in their organization than technologies that are not. The data include 108 health technologies assessed in 87 full-scale health technology assessment reports produced by the four main local health technology assessment units in Quebec (Canada) on behalf of decision makers from the same facility. We found that 58 (53.7 percent) of the 108 technologies were currently in use within the hospital during their assessment. Based on the assessors' interpretation of the scientific evidence regarding the efficacy of the technologies, 67.3 percent of the technologies that were in use in the hospital during the evaluation were effective (56 percent for those that were not currently being used), but the difference is not statistically significant (chi-square 1.38; p = 0.24). Controlling for the efficacy judgment, the type of technologies (i.e. preventive, diagnostic, therapeutic or organizational), the number of technologies assessed in the report and the assessment unit, we found that the technologies that were currently in use in the facility during the evaluation were 62 percent more likely to be recommended favorably by the assessment unit than the technologies that were not currently being used (RR = 1.62; 95 percent CI = 1.06–1.88). This suggests that the local health technology units that were examined in the study tended to be more optimistic toward technologies that were currently in use in their hospital at the time of the evaluation. [ABSTRACT FROM AUTHOR]

This paper will describe the Disabled Women's Network (DAWN) in Canada, its origins, its significance, and its effective contributions to public awareness and social policy. DAWN was conceived as a result of the realization that the disabled community and its advocates lacked gender awareness or sensitivity, while the women's movement had a blind spot regarding women with disabilities. The paper will consider the topic against the background of disability statistics, the health care system in Canada and from a perspective of needs, risks and tasks of women in general and women with disabilities in particular. [ABSTRACT FROM AUTHOR]

Medical tourism is the practice of traveling across international borders with the intention of accessing medical care, paid for out-of-pocket. This practice has implications for preferential access to medical care for Canadians both through inbound and outbound medical tourism. In this paper, we identify four patterns of medical tourism with implications for preferential access to care by Canadians: (1) Inbound medical tourism to Canada's public hospitals; (2) Inbound medical tourism to a First Nations reserve; (3) Canadian patients opting to go abroad for medical tourism; and (4) Canadian patients traveling abroad with a Canadian surgeon. These patterns of medical tourism affect preferential access to health care by Canadians by circumventing domestic regulation of care, creating jurisdictional tensions over the provision of health care, and undermining solidarity with the Canadian health system. [ABSTRACT FROM AUTHOR]