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Background: Patient flow through health services is increasingly recognized as a system issue, yet the flow literature has focused overwhelmingly on localized interventions, with limited examination of system-level causes or remedies. Research suggests that intractable flow problems may reflect a basic misalignment between service offerings and population needs, requiring fundamental system redesign. However, little is known about health systems’ approaches to population–capacity misalignment, and guidance for system redesign remains underdeveloped. Methods: This qualitative study, part of a broader investigation of patient flow in urban Western Canada, explored health-system strategies to address or prevent population–capacity misalignment. We conducted in-depth interviews with a purposive sample of managers in 10 jurisdictions across 4 provinces (N = 300), spanning all healthcare sectors and levels of management. We used the constant comparative method to develop an understanding of relevant strategies and derive principles for system design. Results: All regions showed evidence of pervasive population–capacity misalignment. The most superficial level of response – mutual accommodation (case-by-case problem solving) – was most prevalent; capacity (re)allocation occurred less frequently; population redefinition most rarely. Participants’ insights yielded a general principle: Define populations on the basis of clusters of co-occurring need. However, defining such clusters demands a difficult balance between narrowness/rigidity and breadth/flexibility. Deeper analysis suggested a further principle: Populations that can be divided into homogeneous subgroups experiencing similar needs (eg, surgical patients) are best served by narrow/ rigid models; heterogeneous populations featuring diverse constellations of need (eg, frail older adults) require broad/ flexible models. Conclusion: To remedy population–capacity misalignment, health system planners should determine whether clusters of population need are separable vs. fused, select an appropriate service model for each population, allocate sufficient capacity, and only then promote mutual accommodation to address exceptions. Overreliance on case-by-case solutions to systemic problems ensures the persistence of population–capacity misalignment. [ABSTRACT FROM AUTHOR]

Objectives: Today's supermarket contains hundreds of packaged foods specifically targeted at children. Yet research has shown that children are confused by the various visual messages found on packaged food products. This study explores children's nutrition knowledge with regard to packaged food products, to uncover strengths and difficulties they have in evaluating the healthfulness of these foods. Methods: Focus groups were conducted with children (grades 1-6). Particular attention was paid to the ways children made use of what they know about nutrition when faced with the visual elements and appeals presented on food packaging. Results: Children relied heavily on packages' written and visual aspects--including colour, images, spokes-characters, front-of-package claims--to assess the healthfulness of a food product. These elements interfere with children's ability to make healthy choices when it comes to packaged foods. Conclusions: Choosing healthy packaged foods is challenging for children due to competing sets of knowledge: one pertains to their understanding of visual, associational cues; the other, to translating their understanding of nutrition to packaged foods. Canada's Food Guide, along with the curriculum taught to Canadian children at schools, does not appear to provide children with the tools necessary to navigate a food environment dominated by packaged foods. Key words: Child; nutrition; food labeling; food preferences; nutrition labeling; product labeling, food Objectifs : Les supermarches d'aujourd'hui proposent des centaines d'aliments emballes qui ciblent particulierement les enfants. Or, des etudes ont montre que les enfants sont deconcertes par la grande variete des messages visuels que l'on trouve sur les emballages d'aliments. Nous explorons ici les connaissances nutritionnelles des enfants en ce qui a trait aux aliments emballes pour decouvrir les forces et les difficultes des enfants lorsqu'il s'agit d'evaluer si des aliments sont bons pour la sante. Methode : Nous avons mene des groupes de discussion avec des ecoliers (de la 1e a la 6e annee) en portant une attention particuliere aux facons dont ces enfants utilisent leurs connaissances sur la nutrition quand ils sont confrontes aux elements visuels et aux incitations des emballages d'aliments. Resultats : Les enfants font beaucoup appel aux aspects ecrits et visuels de l'emballage (couleurs, images, personnages porte-parole, allegations sur le devant de l'emballage) pour evaluer si un produit alimentaire est bon ou non pour la sante. Ces elements nuisent a leur capacite de faire des choix sains lorsqu'il est question d'aliments emballes. Conclusion : Il est difficile pour les enfants de choisir des aliments emballes bons pour la sante, car deux jeux de connaissances s'opposent chez eux : l'un a trait a leur comprehension des reperes visuels et associatifs, et l'autre, a l'application de leurs connaissances nutritionnelles aux aliments emballes. Ni le Guide alimentaire canadien, ni les programmes enseignes aux enfants canadiens a l'ecole ne semblent leur donner les outils necessaires pour s'y retrouver dans un environnement alimentaire domine par les produits emballes. Mots cles : enfant; nutrition; etiquetage aliments; preferences alimentaires; etiquetage nutritionnel; etiquetage produits (aliments), Supermarket food products designed to appeal to children frequently feature cartoon images (including characters from popular television shows/movies for children) and/or they promote food by using appeals to fun or [...]

Background: Health care managers face the critical challenge of overcoming divisions among the many groups involved in patient care, a problem intensified when patients must flow across multiple settings. Surprisingly, however, the patient flow literature rarely engages with its intergroup dimension. Purpose: This study explored how managers with responsibility for patient flow understand and approach intergroup divisions and "silo-ing" in health care. Methodology/Approach: We conducted in-depth interviews with 300 purposively sampled senior, middle, and frontline managers across 10 Canadian health jurisdictions. We undertook thematic analysis using sensitizing concepts drawn from the social identity approach. Results : Silos, at multiple levels, were reported in every jurisdiction. The main strategies for ameliorating silos were provision of formal opportunities for staff collaboration, persuasive messages stressing shared values or responsibilities, and structural reorganization to redraw group boundaries. Participants emphasized the benefits of the first two but described structural change as neither necessary nor sufficient for improved collaboration. Conclusion: Silos, though an unavoidable feature of organizational life, can be managed and mitigated. However, a key challenge in redefining groups is that the easiest place to draw boundaries from a social identity perspective may not be the best place from one of system design. Narrowly defined groups forge strong identities more easily, but broader groups facilitate coordination of care by minimizing the number of boundaries patients must traverse. Practice Implications : A thoughtfully designed combination of strategies may help to improve intergroup relations and their impact on flow. It may be ideal to foster a "mosaic" identity that affirms group allegiances at multiple levels. [ABSTRACT FROM AUTHOR]