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Background: Electronic health records are becoming increasingly common in the health care industry. Although information technology (IT) poses many benefits to improving health care and ease of access to information, there are also security and privacy risks. Educating health care providers is necessary to ensure proper use of health information systems and IT and reduce undesirable outcomes. Objective: This study evaluated employees’ awareness and perceptions of the effectiveness of two IT educational training modules within a large publicly funded health care system in Canada. Method: Semi-structured interviews and focus groups included a variety of professional roles within the organisation. Participants also completed a brief demographic data sheet. With the consent of participants, all interviews and focus groups were audio recorded. Thematic analysis and descriptive statistics were used to evaluate the effectiveness of the IT security training modules. Results: Five main themes emerged: (i) awareness of the IT training modules, (ii) the content of modules, (iii) staff perceptions about differences between IT security and privacy issues, (iv) common breaches of IT security and privacy, and (v) challenges and barriers to completing the training program. Overall, nonclinical staff were more likely to be aware of the training modules than were clinical staff. We found e-learning was a feasible way to educate a large number of employees. However, health care providers required a module on IT security and privacy that was relatable and applicable to their specific roles. Conclusion: Strategies to improve staff education and mitigate against IT security and privacy risks are discussed. Future research should focus on integrating health IT competencies into the educational programs for health care professionals.

Internationally Educated Health Professionals (IEHPs) constitute a major health care workforce in Canada. Interprofessional education is particularly important for IEHPs to integrate into the Canadian health care system. We designed an online interprofessional education curriculum for IEHPs. The curriculum is designed to cover the six interprofessional competency domains defined in the Canadian Interprofessional Health Collaborative National Interprofessional Competency Framework. In this article, we are presenting findings from the pilot testing of the curriculum with a cohort of IEHPs and educators.We conducted surveys and interviews with IEHPs and educators from four provinces (British Columbia, Alberta, Saskatchewan, and Manitoba). We aimed to include seven healthcare professionals: licensed practical nurses, registered nurses, registered psychiatric nurses, pharmacists, physicians, occupational therapists, and physical therapists. We also used a pre- post- self-assessment tool and a set of reflective questions to measure the effectiveness of the curriculum.Thirty IEHPs and five educators reviewed the online curriculum and participated in this evaluation. Postintervention confidence scores for all items under the role clarification and patient-centered care domains increased significantly (P =0.01) after module completion. The scores also increased for most questions in team functioning, collaborative leadership, and communication domains. The postassessment scores increased for only half of the questions in conflict management domains. Participants agreed with the appropriateness of the content in terms of language, scenarios, and cultural aspects covered in the online curriculum on interprofessional education.The content of the curriculum improved IEHPs' understanding of interprofessional collaboration in Canada. The interprofessional curriculum is a creative and useful resource to improve collaborative practice among internationally educated health professionals in Canada.

Shortages with resources and inefficiencies with orthopedic services in Canada create opportunities for alternative staffing models and ways to use existing resources. Physician assistants (PAs) are a common provider used in specialty orthopedic services in the United States; however, Canada has limited experience with PAs. As part of a larger demonstration project, Alberta Health Services (AHS) implemented 1 PA position in an upper-extremity surgical program in Alberta, Canada, to demonstrate the role in 4 areas: preoperative, operative, postoperative and follow-up care.A mixed-methods evaluation was conducted using semi-structured interviews (Preoperatively, the PA prioritizes patient referrals for surgery and redirects patients to alternative care. In the second year with the PA in place, there was an increase in total new patients seen (113%). Postoperatively, the PA attended rounds on 5 surgeons' patients and handled follow-up care activities. Health care providers and patients reported that the PA provided excellent care. Findings from the operating room showed that the preparation time was greater than expected (38.6%), whereas the surgeon time (20.6%) and postsurgery time (37.2%) was less than expected.After 24 months the PA has become a valuable member of the health care team and works across the continuum of orthopedic care. The PA delivers quality care and improves system efficiencies.Le manque de ressources et les inefficacités des services d'orthopédie au Canada créent des possibilités pour de nouveaux modèles de dotation et de mise à contribution des ressources existantes. Aux États-Unis, les adjoints au médecin sont des fournisseurs de soins courants dans les services spécialisés d'orthopédie comparativement au Canada qui en fait une utilisation limitée. Dans le cadre d'un grand projet de démonstration, Alberta Health Services (AHS) a créé un poste d'adjoint au médecin dans un programme de chirurgie des membres supérieurs en Alberta, au Canada, afin de démontrer le rôle de l'adjoint au médecin à 4 étapes des soins : préopératoire, opératoire, postopératoire et suivi.Une évaluation avec méthodes mixtes a été effectuée au moyen d'entrevues semi-structurées (À l'étape préopératoire, l'adjoint au médecin a établi la priorité des patients référés en chirurgie et redirigé les patients vers d'autres soins. Lors de la deuxième année de l'adjoint au médecin, nous avons observé une augmentation du nombre de nouveaux patients accueillis (113 %). À l'étape postopératoire, l'adjoint au médecin a participé aux tournées auprès des patients de 5 chirurgiens et s'est occupé des activités liées aux soins de suivi. Les fournisseurs de soins et les patients ont signalé l'excellence des soins de l'adjoint au médecin. Les résultats de la salle d'opération ont révélé un temps de préparation plus élevé que prévu (38,6 %), alors que le temps de chirurgie (20,6 %) et le temps postchirurgical (37,2 %) étaient inférieurs aux prévisions.Après 24 mois, l'adjoint au médecin est devenu un membre valorisé de l'équipe de soins qui travaille à toutes les étapes du continuum des soins orthopédiques. L'adjoint au médecin fournit des soins de qualité et améliore l'efficacité du système.

Discrepancy in the supply-demand relationship for critical care services precipitates a strain on ICU capacity. Strain can lead to suboptimal quality of care and burnout among providers and contribute to inefficient health resource utilization. We engaged interprofessional healthcare providers to explore their perceptions of the sources, impact, and strategies to manage capacity strain.Qualitative study using a conventional thematic analysis.Nine ICUs across Alberta, Canada.Nineteen focus groups (n = 122 participants).None.Participants' perspectives on strain on ICU capacity and its perceived impact on providers, families, and patient care were explored. Participants defined "capacity strain" as a discrepancy between the availability of ICU beds, providers, and ICU resources (supply) and the need to admit and provide care for critically ill patients (demand). Four interrelated themes of contributors to strain were characterized (each with subthemes): patient/family related, provider related, resource related, and health system related. Patient/family-related subthemes were "increasing patient complexity/acuity," along with patient-provider communication issues ("paucity of advance care planning and goals-of-care designation," "mismatches between patient/family and provider expectations," and "timeliness of end-of-life care planning"). Provider-related factor subthemes were nursing workforce related ("nurse attrition," "inexperienced workforce," "limited mentoring opportunities," and "high patient-to-nurse ratios") and physician related ("frequent turnover/handover" and "variations in care plan"). Resource-related subthemes were "reduced service capability after hours" and "physical bed shortages." Health system-related subthemes were "variable ICU utilization," "preferential "bed" priority for other services," and "high ward bed occupancy." Participants perceived that strain had negative implications for patients ("reduced quality and safety of care" and "disrupted opportunities for patient- and family-centered care"), providers ("increased workload," "moral distress," and "burnout"), and the health system ("unnecessary, excessive, and inefficient resource utilization").Engagement with frontline critical care providers is essential for understanding their experiences and perspectives regarding strained capacity and for the development of sustainable strategies for improvement.

Objective The objective of this environmental scan was to identify Western Canadian interprofessional education (IPE) resources that currently exist for internationally educated health professionals (IEHPs). Methodology A web-based search was conducted to identify learning resources meeting defined inclusion criteria with a particular focus on the resources available in the Western Canadian provinces. Information was extracted using a standardized template, and we contacted IEHP programs for additional information if necessary. Members of the research team reviewed preliminary findings, identified missing information from their respective provinces, and contacted organizations to fill in any gaps. Results The scan identified 26 learning resources for IEHPs in Western Canadian provinces and 15 in other provinces focused on support for IEHPs to meet their profession-specific licensing requirements and to acquire knowledge and competencies relevant to working in the Canadian health care system. Most learning resources, such as those found in bridging programs for IEHPs, included an orientation to the Canadian health care system, components of cultural competence, and at least one aspect of interprofessional competence (eg, communication skills). None of the 41 learning resources provided comprehensive training for IEHPs to cover the six interprofessional competency domains defined in the Canadian Interprofessional Health Collaborative (CIHC) National Interprofessional Competency Framework. Conclusion The IEHPs learning resources in Western Canada do not cover all of the interprofessional competencies. This review points to the value of developing a comprehensive IPE curriculum, based on the six domains identified in the CIHC National Interprofessional Competency Framework.

Background Alberta’s Primary Care Networks, introduced in 2003, use a team-based approach to meet the mandate to improve timely access to primary health care services. Yet, not much is known about the factors that influence how teams work in PCNs. Methods and Results We conducted individual and group interviews with 14 Primary Care Network teams, physicians, managers, and other staff to understand these factors. Using a socioecological model we found that the most salient issues for the interprofessional teams at the external level was physician remuneration. Organizationally the main issues were co-location, the need for an interoperable electronic health record, visionary leadership and educational supports. At the team level, accountability, relationships and communication were valued. Conclusions Using the socioecological model allowed us to understand the critical issues that influence team functioning within Alberta. We suggest that the model be used to design interventions that are relevant and feasible to all the stakeholders including front line providers.

Background: Despite far reaching support for integrated care, conceptualizing and measuring integrated care remains challenging. This knowledge synthesis aimed to identify indicator domains and tools to measure progress towards integrated care. Methods: We used an established framework and a Delphi survey with integration experts to identify relevant measurement domains. For each domain, we searched and reviewed the literature for relevant tools. Findings: From 7,133 abstracts, we retrieved 114 unique tools. We found many quality tools to measure care coordination, patient engagement and team effectiveness/performance. In contrast, there were few tools in the domains of performance measurement and information systems, alignment of organizational goals and resource allocation. The search yielded 12 tools that measure overall integration or three or more indicator domains. Discussion: Our findings highlight a continued gap in tools to measure foundational components that support integrated care. In the absence of such targeted tools, “overall integration” tools may be useful for a broad assessment of the overall state of a system. Conclusions: Continued progress towards integrated care depends on our ability to evaluate the success of strategies across different levels and context. This study has identified 114 tools that measure integrated care across 16 domains, supporting efforts towards a unified measurement framework.

This study examined organizational factors influencing the functioning of inter-professional teams in select primary care networks (PCNs) in Alberta. Seven PCNs participated, each identifying two teams to be interviewed. The study used an exploratory qualitative approach to collect information from 118 physicians, managers and other clinical and non-clinical staff. Organizational factors affecting these teams included leadership and workplace culture, physical infrastructure, information technology infrastructure, organizational supports and employment models. The authors offer organizational strategies that enhance inter-professional team functioning based on interviewee recommendations and the existing literature. Further research is needed to link the strategies to measureable outcomes.

Introduction: Ten key principles have been identified to facilitate successful health systems integration. The principles include: 1) comprehensive services, 2) patient focus, 3) geographic coverage and rostering, 4) standardized care delivery through interprofessional teams, 5) performance management, 6) information technology, 7) organizational culture and leadership, 8) physician integration, 9) governance structure, and 10) financial management. To our knowledge, there is little research on patients/user’ perceptions on the concept of integration. This unique perspective will assist in identifying the relevancy of the principles for patients and users as well as influence recommendations for which indicators should be prioritized for measurement and further research. Methods: As a part of a larger study to identify indicators and tools for measuring health systems integration, three focus groups were conducted with 17 patients/users of the system in three regions (British Columbia and Alberta, Canada, and Rio Grande do Sul, Brazil). Each focus group targeted a different population to capture a variety of perspectives. In British Columbia participants were from rural communities, in Alberta from a large urban setting and in Rio Grande do Sul participants represented the community Health Councils in the City of Porto Alegre. Participants were provided with a list and descriptions of the 10 integration principles. At the end of the session they were asked to prioritize the principles. Both quantitative and qualitative analysis of the data were completed. A virtual meeting was held to discuss similarities and differences in themes. Key sections of data from Brazil was translated into English to be included in our final analysis. Results: The highest priority principles for integration in Canada were patient focus, comprehensive services across the care continuum, and standardized care delivery through interprofessional teams. In Canada, focus groups participants felt the system was still provider and International Journal of Integrated Care – Volume 15, 17 Nov – URN:NBN:NL:UI:10-1-117317 – http://www.ijic.org 3 rd World Congress on Integrated Care, Mexico City, Mexico, 19-21 November, 2015 system focused; while in Brazil the Family Health Strategy was highlighted as a proposal for patient-focused care. Canadian participants considered lack of continuity across the continuum of care was a risk for patients not accessing services in a timely or appropriate manner. In Brazil, integration between health systems was considered necessary, although current initiatives were insufficient and lacked continuity. Discussion: These results provide an in-depth understanding of patient/user perspectives on integration. The principles of patient focus, comprehensive services across the care continuum, and standardized care delivery through interprofessional teams are a priority for this group and provide a foundation for integrated health systems. Conclusion: According to participants the highest priority principles of integration in Canada and Brazil were patient focus and comprehensive services across the care continuum. Team: This collaborative Canadian and Brazilian project includes researchers and knowledgeusers with expertise in health systems policy and planning, systematic reviews, and library ciences. Health systems integration is a priority in both countries. The partnership builds on commonalities such as: publicly funded health systems; comparable funding priorities; and similar geography with large urban centres and rural communities. Conducting collaborative research in these two countries will increase the international applicability of the results. Conference abstract Spanish Introduccion: Diez principios clave han sido identificados para facilitar la exitosa integracion de los sistemas de salud. Los principios son: 1) servicios integrales, 2) enfoque paciente, 3) la cobertura geografica y de turnos, 4) la prestacion de asistencia normalizada a traves de equipos interprofesionales, 5) la gestion del rendimiento, 6) tecnologia de la informacion, 7) la cultura organizacional y liderazgo, 8) medicos en integracion, 9) la estructura de gobierno, y 10) gestion financiera. Hasta donde sabemos, hay poca investigacion sobre las percepciones de los paciente y usuario 'en el concepto de integracion. Esta perspectiva unica ayudara a identificar la relevancia de los principios para los pacientes y usuarios, asi como recomendaciones de influencia para que los indicadores deben ser priorizados para la medicion y una mayor investigacion. Metodos: Como parte de un estudio mas amplio para identificar los indicadores y herramientas para medir la integracion de sistemas de salud, tres grupos focales se llevaron a cabo con 17 pacientes / usuarios del sistema en tres regiones (Columbia Britanica y Alberta, Canada; y Rio Grande do Sul, Brasil). Cada grupo de enfoque dirigido a una poblacion diferente para capturar una variedad de perspectivas. En British Columbia los participantes eran de las comunidades rurales, en Alberta de un entorno urbano grande y en Rio Grande do Sul participantes representaron a la comunidad de los Consejos de Salud de la ciudad de Porto Alegre. Los participantes se les proporciono una lista y descripciones de los 10 principios de integracion. Al final de la sesion se les pidio que dar prioridad a los principios. Se completaron Tanto el analisis cuantitativo y cualitativo de los datos. Un encuentro virtual se llevo a cabo para discutir las similitudes y diferencias en los temas. Secciones clave de los datos procedentes de Brasil fue traducido al Ingles que se incluiran en el analisis final. Resultados: Los principios de mayor prioridad para la integracion en Canada eran enfoque paciente, servicios integrales en todo el continuo de la atencion y la prestacion de atencion estandarizada a traves de equipos interprofesionales. En Canada, los grupos focal de participantes consideraron el sistema seguia siendo proveedor y un sistema centrado; mientras que en Brasil la Estrategia Salud de la Familia se destaco como una propuesta para la atencion centrada en el paciente. Participantes canadienses consideran la falta de continuidad a traves de la continuidad de la atencion era un riesgo para los pacientes no acceden a los servicios en el momento oportuno o conveniente. En Brasil, se considero necesaria la integracion entre los sistemas de salud, a pesar de las iniciativas actuales eran insuficientes y carecen de continuidad. Discusion: Estos resultados proporcionan una comprension en profundidad de las perspectivas del paciente/usuario en la integracion. Los principios de la atencion del paciente, servicios integrales en todo el continuo de la atencion y la prestacion de atencion estandarizada a traves de equipos interprofesionales son una prioridad para este grupo y proporcionan una base para los sistemas de salud integrados. International Journal of Integrated Care – Volume 15, 17 Nov – URN:NBN:NL:UI:10-1-117317 – http://www.ijic.org 3 rd World Congress on Integrated Care, Mexico City, Mexico, 19-21 November, 2015 Conclusion: De acuerdo a los participantes los principios de mayor prioridad de la integracion en Canada y Brasil eran enfocados en pacientes y servicios integrales en todo el continuo cuidado. Equipo: Este proyecto de colaboracion canadiense y brasileno incluye investigadores del conocimiento de los usuarios con experiencia en la politica de los sistemas de salud y la planificacion, revisiones sistematicas, y las ciencias de la biblioteca. Integracion de sistemas de salud es una prioridad en ambos paises. La asociacion se basa en elementos comunes, tales como: sistemas de salud financiados con fondos publicos; prioridades de financiamiento comparables; y la geografia similar con los grandes centros urbanos y comunidades rurales. La realizacion de la investigacion colaborativa en estos dos paises aumentara la aplicabilidad internacional de los resultados.

Background: Health systems integration continues to be an important mechanism to enhance quality of care and improve health outcomes. In a prior study (Suter et al, 2009), we identified 10 key principles that need to be considered for successful health systems integration. The principles include: 1) comprehensive services, 2) patient focus, 3) geographic coverage and rostering, 4) standardized care delivery through interprofessional teams, 5) performance management, 6) information technology, 7) organizational culture and leadership, 8) physician integration, 9) governance structure, and 10) financial management. There is evidence that organizations that pay attention to these areas achieve a higher level of integration. However, measuring progress towards integration in these areas is not easy because appropriately tested indicators and tools are missing. 3 World Congress on Integrated Care, Mexico City, Mexico, 19-21 November, 2015 International Journal of Integrated Care – Volume 15, 17 Nov – URN:NBN:NL:UI:10-1-117309 – http://www.ijic.org The goal of this study is to identify indicators and tools for measuring health systems integration. Our primary research question is how can we measure health systems integration? More specifically, two sub-questions are addressed: 1) What are appropriate indicators for each of the 10 key integration principles described above? and 2) What measurement tools are used to measure these indicators? The findings from this knowledge synthesis will assist health systems planners and managers to evaluate progress made towards integrating health systems. Approach: We first identified appropriate indicators for each of the 10 key principles for successful integration. Using a modified Delphi approach, a panel of integration experts, knowledge-users and providers (n=39) were invited to provide feedback on the indicators and decide on the most relevant and important indicators. Three rounds of Delphi with 17 participants were used to come to an agreement. For each of the indicators we then conducted a systematic search for tools to measure the indicator. The following databases were searched: Medline, EMBASE, CINAHL, ABI Inform, and Business Source Premier, LILACS and SciELO. For each measurement tool, information on the reliability and validity was extracted (if reported), the context in which the tool was used and potential challenges with using the tool. Findings: Delphi panel members initially received a list of 22 indicators and had the opportunity to propose additional indicators. After three Delphi rounds, the panel reached consensus on 16 indicators across 9 principles. No agreement was reached for indicators for Principle 9 (governance structure). We found a high number of articles for some indicators (e.g., coordinated care transition, intersectoral collaboration). For these indicators we found several measurement tools, mainly in the form of questionnaires; many of them were well tested and validated. For other indicators, the literature was sparse and only a few tools or no tools were found; some of the indicators were best measured by administrative health data or other data sources. We will present a summary of tools and appropriate measures for each of the indicators including recommendations on how to use them. In addition, gaps in measurement tools for indicators will be highlighted and imitations will be discussed. Team: This is a collaborative project between Canadian and Brazilian researchers and knowledge users with expertise in health systems policy and planning, systematic reviews, and library sciences. This partnership was specifically chosen as both countries have: publicly funded health systems; comparable funding priorities; and similar geography of large urban centres and rural communities. Furthermore, health systems integration is a priority in both countries. Having team members from two countries increases the applicability of the tools to different contexts. Conference abstract Spanish Antecedentes: la integracion de sistemas de salud sigue siendo un mecanismo importante para mejorar la calidad de la atencion y mejorar los resultados de salud. En un estudio previo (Suter et al, 2009), se identificaron 10 principios clave que deben tenerse en cuenta para la integracion de los sistemas de salud exitosos. Los principios son: 1) servicios integrados, 2) enfoque del paciente, 3) la cobertura geografica y de turnos, 4) la prestacion de asistencia normalizada a traves de equipos interprofesionales, 5) la gestion del rendimiento, 6) tecnologia de la informacion, 7) la cultura organizacional y liderazgo, 8) medico integrado, 9) la estructura de gobierno, y 10) gestion financiera. Existe evidencia de que las organizaciones que prestan atencion a estas areas a alcanzar un mayor nivel de integracion. Sin embargo, medir el progreso hacia la integracion en estas areas no es facil porque faltan los indicadores y herramientas adecuadamente probados. El objetivo de este estudio es identificar los indicadores y herramientas para medir la integracion de sistemas de salud. Nuestra pregunta de investigacion principal es ?como podemos medir la integracion de los sistemas de salud? Mas especificamente, dos sub-preguntas se abordan: 1) ?Cuales son los indicadores apropiados para cada uno de los 10 principios de integracion clave descritos anteriormente? y 2) ?Que herramientas de medicion se utilizan para medir estos indicadores? Los resultados de esta sintesis de conocimientos ayudaran a los planificadores y administradores de los sistemas de salud para evaluar los progresos realizados hacia la integracion de los sistemas de salud. 3 World Congress on Integrated Care, Mexico City, Mexico, 19-21 November, 2015 International Journal of Integrated Care – Volume 15, 17 Nov – URN:NBN:NL:UI:10-1-117309 – http://www.ijic.org Enfoque: En primer lugar, identificamos indicadores apropiados para cada uno de los 10 principios fundamentales para una integracion exitosa. Utilizando un enfoque de Delphi modificado, un panel de expertos en integracion, conocimiento de los usuarios y los proveedores (n = 39) fueron invitados a proporcionar informacion sobre los indicadores y decidir sobre los indicadores mas relevantes e importantes. Tres rondas de Delphi con 17 participantes se utilizaron para llegar a un acuerdo. Para cada uno de los indicadores luego se realizo una busqueda sistematica de herramientas para medir el indicador. Las siguientes bases de datos: Medline, EMBASE, CINAHL, ABI Inform, y Business Source Premier, LILACS y SciELO. Para cada herramienta de medicion, se extrajo informacion sobre la fiabilidad y validez (si informo), el contexto en el que se utilizo la herramienta y desafios potenciales con el uso de las herramientas. Hallazgos: los miembros del panel Delphi recibieron inicialmente una lista de 22 indicadores y tuvo la oportunidad de proponer indicadores adicionales. Despues de tres rondas, el panel Delphi llego a un consenso sobre 16 indicadores en 9 principios. No se llego a un acuerdo para los indicadores de los 9 Principios (estructura de gobierno). Encontramos un gran numero de articulos para algunos indicadores (por ejemplo, la transicion de cuidado coordinado, colaboracion intersectorial). Para estos indicadores encontramos varias herramientas de medicion, sobre todo en forma de cuestionarios; muchos de ellos fueron bien probados y validados. Para otros indicadores, la literatura era escasa y se encuentran solo unas pocas herramientas o sin ninguna; algunos de los indicadores se midieron mejor con los datos de salud administrativas u otras fuentes de datos. Vamos a presentar un resumen de las herramientas y las medidas adecuadas para cada uno de los indicadores que incluyen recomendaciones sobre la forma de utilizarlos. Ademas, las lagunas en los instrumentos de medicion de indicadores seran resaltados y se discutiran las imitaciones. Equipo: Este es un proyecto de colaboracion entre investigadores canadienses, brasilenos y usuarios de conocimiento con experiencia en la politica de los sistemas de salud y la planificacion, revisiones sistematicas, y las ciencias de la biblioteca. Esta asociacion fue elegida especificamente ya que ambos paises tienen: los sistemas de salud financiados con fondos publicos; prioridades de financiamiento comparables; y la geografia similar de los grandes centros urbanos y comunidades rurales. Por otra parte, la integracion de los sistemas de salud son una prioridad en ambos paises. Tener los miembros del equipo de dos paises aumenta la aplicabilidad de las herramientas en diferentes contextos.

Healthcare organisations are starting to implement collaborative practice to increase the quality of patient care. However, operationalising and measuring progress towards collaborative practice has proven to be difficult. Various interprofessional competency frameworks have been developed that outline essential collaborative practice competencies for healthcare providers. If these competencies were enacted to their fullest, collaborative practice would be at its best. This article examines collaborative practice in six acute care units across Alberta using the Canadian Interprofessional Health Collaborative (CIHC) competency framework (CIHC, 2010 ). The framework entails the six competencies of patient-centred care, communication, role clarification, conflict resolution, team functioning and collaborative leadership (CIHC, 2010 ). We conducted a secondary analysis of interviews with 113 healthcare providers from different professions, which were conducted as part of a quality improvement study. We found positive examples of communication and patient-centred care supported by unit structures and processes (e.g. rapid rounds and collaborative plan of care). Some gaps in collaborative practice were found for role clarification and collaborative leadership. Conflict resolution and team functioning were not well operationalised on these units. Strategies are presented to enhance each competency domain in order to fully enact collaborative practice. Using the CIHC competency framework to examine collaborative practice was useful for identifying strength and areas needing improvement.

Introduction: The importance of integration across the continuum of care is not limited to the health care sector. Coordinating client care between sectors and including supportive services such as education and social services is considered an essential part of building a fully integrated health system. Building on previous integration research, this study is a part of a comprehensive systematic review focused on identifying indicator and measures of the key principles of integration. We identified 16 indicator domains through a modified Delphi process using an expert panel of policy-makers, decision-makers, providers, and researchers. Intersectoral collaboration was identified as one of two indicator domains for the first principle of successful health systems integration, Comprehensive Services across the Continuum of Care. Methods: Search terms were generated for intersectoral collaboration to identify tools in the peer-reviewed and targeted gray literature. Tools were identified through a rigorous review process including abstract review, relevancy ratings, identifying additional articles in reference lists, quality ratings, and extraction. To avoid duplication of tools, only “tool development” articles were included in data extraction. If an article was found which used but did not develop an appropriate tool, the original article reporting the development and testing of the tool was identified and data was extracted from this source only. Notable exceptions included articles where the original tool was modified to measure intersectoral collaboration. Results: A review of 650 abstracts identified 14 tools which measure intersectoral collaboration. Most of the tools were questionnaires or checklists and were created or tested in a health care setting or with health related outcomes. The tools collected information from organizations in different sectors in a number of differed ways. Distributing a questionnaire or checklist to multiple organizations to measure the perceived level of mutual collaboration was the most common way. Network analysis was also used and one tool measured intersectoral collaboration as a quadrant using a balanced scorecard approach. The variables identified to measure intersectoral collaboration include identifying “high and low structure” between partnering organizations; a low level of connectivity represented “cooperation and coordination” and a high level of connectivity represented “collaboration and consolidation”. Other variables included looking at social networks, assessing interagency linkages, measuring the depth of integration in a model of human services integration, and system integration and change. All the tools came from medium-high to high quality empirical papers where in most cases the tools were tested and the psychometric properties were reported. Only one tool came from the gray literature. Discussion: Only a small number of tools have been identified, but the diversity among these tools was substantial. Ranging from simple questionnaires to complicated network analyses a number of options were found to capture ways to measure these intersectoral relationships. Some tools not only measured intersectoral collaboration but also provided a blueprint for how to use and build collaborative relationships across health care sectors and the community. For instance, Browne’s Human Services Network Integration model and measure highlights the model and how integration between sectors can be facilitated and measured. This study has a number of strengths and limitations. The review is strengthened by its thorough methodological approach. The fact that intersectoral collaboration is one indicator domain which is a part of the larger, comprehensive knowledge synthesis allows the results to contribute to the greater picture of healthcare integration. The size of the knowledge synthesis is a strength and a limitation. Given the size of the knowledge synthesis and the breadth of the topic areas, it is possible that articles and tools may have been missed despite extensive search and review strategies. Conclusion: A lot of emphasis has been put on the importance of integrated health care systems; however, there are few ways to identify and measure indicators and outcomes related to health services integration. It is not only important to identify key dimensions or principles of integrated care but also to be able to measure progress towards these integrated systems. Intersectoral collaboration is an important indicator domain contributing to building and sustaining health care integration. Valid and reliable tools to measure collaboration are essential. As such, this knowledge synthesis provides a number of appropriate tools for users including researchers, policy- and decision-makers, and providers across a wide range of health care systems. In this study we focused on measuring the presence but not the impact of intersectoral collaboration; this is an area we hope to investigate in future research.

Introduction: Health systems integration is a cornerstone for health system reform enhancing quality of care and health outcomes. Health systems planners invest significant resources to create fully integrated health systems. However, impacts of these efforts are difficult to determine due to the lack of well-defined indicators and tools to measure progress towards integration. The goal of this study was to identify indicator domains and measurements tools to evaluate health system integration. Methods: This international knowledge synthesis utilized a modified seven-stage scoping review approach across three sites: Rio Grande do Sul, Brazil, and Alberta and British Columbia, Canada. The knowledge synthesis built on previous work of two principle investigators (NO, ES) identifying 10 key principles for integration. A group of knowledge-users were included in discussions to validate the research questions. A panel of experts, policy and decision-makers, and providers participated in a modified Delphi process to identify relevant and important indicator domains for each principle. Three rounds of Delphi surveys were completed in English and Portuguese. Potential tools and measures for each indicator domain were identified using inclusion/exclusion criteria applied to peer-reviewed and targeted grey literature sources. Relevancy and quality were assessed using standardized tools. Data are being extracted, collated, and summarized with a final report to be completed summarizing all significant tools and measures. Results: The Delphi process identified 16 indicator domains for nine of the ten principles. Domains included: coordinated transitions across the continuum of care; coordinated care across sectors; patient/family involvement in care planning; primary care network structures in place; team effectiveness; shared clinical pathways across the continuum of care; individualization of care pathways for patients with co-morbidities; performance measurement indicators and tools in place; clinical outcomes measured; data (e.g., administrative, performance, clinical) tracked and shared with stakeholders; shared information systems across sectors; shared patient electronic charts accessible to patients; data used for service planning; organizational goals and objectives aligned across sectors; physician integration within care teams; and goals and objectives supported by funding and human resources. No agreement was achieved by the Delphi participants on indicator domains for principle 9, governance structure. To capture tools or measures related to two or more domains an eleventh principle, overall integration, was added. To date we have reviewed over 5500 abstracts across the 16 indicator domains. Over 115 tools have been identified for such domains as transitions in care, patient focus, intersectoral collaboration, and the use of shared clinical pathways. Where tools were not appropriate, measurement approaches and gaps in evaluation strategies have been identified. Once the literature review has been completed in its entirety we anticipate a comprehensive set of tools and measures for the indicator domains of the principles of health systems integration. Discussion: Availability of high quality tools and measurement approaches for indicator domains varies. Some domains are more developed, such as coordinated transitions, where a large number of high quality tools have been identified. For other domains, there is a need to develop high quality tools. Tools of medium or low quality require refinement through further validity and reliability testing to assess their potential to measure domains of integration. For domains where tools were not located approaches to measure these domains require further development. For Principle 9, governance structure, the relevance of the principle to health system integration needs to be examined. Strengths of the study include the use of the Delphi process to identify indicator domains for each of the principles by stakeholders and the thorough systematic review process conducted for each domain. Several challenges were also experienced. The Delphi process used an online survey approach; synchronous or asynchronous discussion between participants was not completed. The identification of appropriate search terms for some domains was challenging due to the variation of terms and conceptualizations used in the integration literature. Multiple searches were required to ensure the focus of the search terms were appropriate for each domain. Conclusion: This knowledge synthesis is the first of its kind to provide a comprehensive set of tools and measures to evaluate health systems integration. The tools to measure indicator domains of integration and overall integration will provide beneficial information to policy-makers, decision-makers, and providers across a variety of health care systems internationally. Key areas for future research include: testing of tools and measures to ensure high quality tools to measure all aspects of integration; the development of further tools to measure less developed aspects of integration; and translation and validity testing of tools in different languages.

Objectives To review the effectiveness of financial and nonfinancial incentives for improving the benefits (recruitment, retention, job satisfaction, absenteeism, turnover, intent to leave) of human resource strategies in health care. Methods Overview of 33 reviews published from 2000 to 2012 summarized the effectiveness of incentives for improving human resource outcomes in health care (such as job satisfaction, turnover rates, recruitment, and retention) that met the inclusion criteria and were assessed by at least two research members using the Assessment of Multiple Systematic Reviews quality assessment tool. Of those, 13 reviews met the quality criteria and were included in the overview. Information was extracted on a description of the review, the incentives considered, and their impact on human resource outcomes. The information on the relationship between incentives and outcomes was assessed and synthesized. Results While financial compensation is the best-recognized approach within an incentives package, there is evidence that health care practitioners respond positively to incentives linked to the quality of the working environments including opportunities for professional development, improved work life balance, interprofessional collaboration, and professional autonomy. There is less evidence that workload factors such as job demand, restructured staffing models, re-engineered work designs, ward practices, employment status, or staff skill mix have an impact on human resource outcomes. Conclusions Overall, evidence of effective strategies for improving outcomes is mixed. While financial incentives play a key role in enhancing outcomes, they need to be considered as only one strategy within an incentives package. There is stronger evidence that improving the work place environment and instituting mechanisms for work-life balance need to be part of an overall strategy to improve outcomes for health care practitioners.

An outcome evaluation was conducted to obtain psychiatric inpatients' perspectives on acute care mental health treatment and services. The applicability of diagnostic categories based on affective, non-affective, and schizoaffective disorder were considered in the predictability of responses to treatment regimens and the related services provided in an inpatient psychiatric unit. A multidimensional approach was used to survey patients, which included the DAI-30, the BMQ, the SERVQUAL, and the CSQ-8. Overall, findings indicate that inpatient satisfaction could be improved with tailoring treatment to suit their respective symptoms. Furthermore, this exploratory study demonstrates some preliminary support for the inclusion of patients with a diagnosis of schizoaffective disorder as a separate group toward improving acute mental health care while hospitalized.

The current gap in research on inter-professional collaboration and health human resources outcomes is explored by the Western Canadian Interprofessional Health Collaborative (WCIHC). In a recent research planning workshop with the four western provinces, 82 stakeholders from various sectors including health, provincial governments, research and education engaged with WCIHC to consider aligning their respective research agendas relevant to inter-professional collaboration and health human resources. Key research recommendations from a recent knowledge synthesis on inter-professional collaboration and health human resources as well as current provincial health priorities framed the discussions at the workshop. This knowledge exchange has helped to consolidate a shared current understanding of inter-professional education and practice and health workforce planning and management among the participating stakeholders. Ultimately, through a focused research program, a well-aligned approach between sectors to finding health human resources solutions will result in sustainable health systems reform.