Social determinants of access to timely elective surgery in Ontario, Canada: a cross-sectional population level study.

BACKGROUND: Equitable access to surgical care has clinical and policy implications. We assess the association between social disadvantage and wait times for elective surgical procedures in Ontario. METHODS: We conducted a cross-sectional analysis using administrative data sets of adults receiving nonurgent inguinal hernia repair, cholecystectomy, hip arthroplasty, knee arthroplasty, arthroscopy, benign uterine surgery and cataract surgery from April 2013 to December 2019. We assessed the relation between exceeding target wait times and the highest versus lowest quintile of marginalization dimensions by use of generalized estimating equations logistic regression. RESULTS: Of the 1 385 673 procedures included, 174 633 (12.6%) exceeded the target wait time. Adjusted analysis for cataract surgery found significantly increased odds of exceeding wait times for residential instability (adjusted odd ratio [OR] 1.16, 95% confidence interval [CI] 1.11-1.21) and recent immigration (adjusted OR 1.12, 95% CI 1.07-1.18). The highest deprivation quintile was associated with 18% (adjusted OR 1.18, 95% CI 1.12-1.24) and 20% (adjusted OR 1.20, 95% CI 1.12-1.28) increased odds of exceeding wait times for knee and hip arthroplasty, respectively. Residence in areas where higher proportions of residents self-identify as being part of a visible minority group was independently associated with reduced odds of exceeding target wait times for hip arthroplasty (adjusted OR 0.82, 95% CI 0.75-0.91), cholecystectomy (adjusted OR 0.68, 95% CI 0.59-0.79) and hernia repair (adjusted OR 0.65, 95% CI 0.56-0.77) with an opposite effect in benign uterine surgery (adjusted OR 1.28, 95% CI 1.17-1.40). INTERPRETATION: Social disadvantage had a small and inconsistent impact on receiving care within wait time targets. Future research should consider these differences as they relate to resource distribution and the organization of clinical service delivery.

Authentic and ethical leadership during a crisis.

In today's climate and environment, the conventional relationship between caring, economic, and leadership practices may no longer meet the needs of patients, clinicians, providers, or systems. It is asserted that in the current complicated and complex healthcare environment challenged by a multitude of issues, a shift toward human caring values and an ethic of authentic healing relationships is required, especially in light of the current COVID-19 pandemic. The costs of unethical behaviour can be even greater for followers. When we assume the benefits of leadership, we also assume ethical burdens. It is the assertion and experience of the authors that the triangle of ethics and ethical behaviour, followers, and patient outcomes is closely interrelated and affects each other in a very intimate and direct way. Unethical leadership may lead to follower disappointment and distrust, leading to lack of interest and commitment, consequently negatively impacting patient outcomes and organizational effectiveness.

Authentic leadership in healthcare organizations: A study of 14 chief executive officers and 70 direct reports.

There is limited research on authentic leadership in senior leaders of healthcare organizations. The purpose of this study was to investigate authentic leadership from the perspectives of 14 healthcare Chief Executive Officers (CEOs) and 70 senior-level direct reports using the validated Authentic Leadership Questionnaire (ALQ) and one-on-one interviews. CEOs also completed a 20-hour leadership curriculum focusing on authentic leadership. Although CEOs rated themselves higher than their direct reports on the total ALQ, it only approached significance (P = .060). Ratings on the four component parts of the ALQ were also higher, but only one was significant (P = .025) with a trend toward significance on another (P = .61). The CEOs' scores were slightly higher after their self-directed study but only one component was significant (P = .040). Interviews with the CEOs and direct reports underscore how healthcare leadership and authentic leadership specifically is viewed depending on organizational roles.

Aligning career development with organizational goals: working towards the development of a strong and sustainable workforce.

The rapidly changing world of healthcare is faced with many challenges, not the least of which is a diminishing workforce. Healthcare organizations must develop multiple strategies, not only to attract and retain employees, but also to ensure that workers are prepared for continuous change in the workplace, are working at their full scope of practice and are committed to, and accountable for, the provision of high-quality care. There is evidence that by creating a healthier workplace, improved patient care will follow. Aligning Healthy Workplace Initiatives with an organization's strategic goals, corporate culture and vision reinforces their importance within the organization. In this paper, we describe an innovative pilot to assess a career development program, one of multiple Healthy Workplace Initiatives taking place at Providence Care in Kingston, Ontario in support of our three strategic goals. The results of the pilot were very encouraging; subsequent success in obtaining funding from HealthForceOntario has allowed the implementation of a sustainable program of career development within the organization. More work is required to evaluate its long-term effectiveness.

A profile of the structure and impact of nursing management in Canadian hospitals.

The purpose of this study was to describe the profile of nursing leadership structures in Canada and to assess relationships among structures, processes and outcomes pertaining to nurse leaders' work. Data were collected from nurse leaders in 28 academic health centres and 38 community hospitals in 10 Canadian provinces (n = 1,164). The results of this study revealed that the current contingent of nursing leaders in Canada see themselves as an empowered and influential group within their organizations. Despite very large spans of control, nurse leaders at all levels were positive about their work life and confident in their ability to provide effective leadership on nursing affairs within their organizations. Structural and process factors significantly affected nurse manager outcomes at all levels. Senior nurse leaders' work-life factors had a significant effect on middle and first-line managers' perceptions of patient care quality in the organization. Nurse leaders averaged 49 years of age highlighting the need for succession planning.

The relative value of nursing work: a study in progress.

The nursing shortage is likely to continue and, without intervention, may worsen. While retention and recruitment are constantly discussed among nursing leaders, the shortages, particularly in specialty areas, continue. Nurses have frequently stated that they are not valued for their knowledge. Yet many nurses have university degrees, post graduate degrees, specialty certificates and specialty credentials. Nurses seek recognition for what they know and what they do. To date, however, there is no objective method that is used to assess the value of nurses and their work. The study of relative value may provide a method for recognizing nurses' work. The concept of relative value deals with logical operators and facilitates assigning value to a nurse's overall knowledge base and capacity to perform nursing work. Currently, nursing shortages are concentrated in specialty areas. Nurses who work in specialized areas need specialized knowledge in a narrow field of nursing. Specialty nurses are not interchangeable with specialists in other areas or with generalists. A study is in progress to calculate the relative value of nursing work in 15 specialties. The goal is to assess relative value from the point of view of the knowledge base in the specialties and between specialties. In this paper, the research team reports on the background of the study, the study's parameters and its progress to date. Outcomes will include devising a way to recognize nurses' work, developing policies related to retention and recruitment and finding a long-term solution for dealing with the nursing shortage in specialty areas.