Critical Success Factors of Street Haven's Residential Addictions Treatment Program for Women.

Street Haven's residential addictions treatment program offers a 90-day residential treatment program to highly vulnerable women who suffer from significant health and social care complexity, including homelessness, experience with gender-based violence, mental illness and chronic diseases. Despite the complexity of the needs of the clients, the program supports recovery, greater housing and enhanced overall well-being for the women it serves. The critical factors contributing to the success of the program include client readiness, pre-treatment programming, group-based programming, evidence-based programming, harm reduction approaches and a whole-person approach. These factors are essential for achieving programming outcomes and continuing the recovery journey post-discharge.

Is public health ready to participate in the transformation of the healthcare system?

The healthcare system in Canada is undergoing significant transformation in response to three major interrelated pressures: the overall burden of illness is rising, patients are getting poor quality of care and healthcare costs are inexorably rising. One idea to guide this change is to transform the primary care system into a community-based primary healthcare (CBPH) system. This paper discusses, in particular, the readiness of public health to participate in the transformation to a CBPH system.

Survival duration among patients with a noncancer diagnosis admitted to a palliative care unit: a retrospective study.

BACKGROUND: Palliative care unit (PCU) beds are a limited resource in Canada, so PCU admission is restricted to patients with a short prognosis. Anecdotally, PCUs further restrict admission of patients with noncancer diagnoses out of fear that they will "oversurvive" and reduce bed availability. This raises concerns that noncancer patients have unequal access to PCU resources. PURPOSE/METHODS: To clarify survival duration of patients with a noncancer diagnosis, we conducted a retrospective review of all admissions to four PCUs in Toronto, Canada, over a 1-year period. We measured associations between demographic data, prognosis, Palliative Performance Score (PPS), length of stay (LOS), and waiting time. RESULTS: We collected data for 1000 patients, of whom 21% had noncancer diagnoses. Noncancer patients were older, with shorter prognoses and lower PPS scores on admission. Noncancer patients had shorter LOS (14 versus 24, p<0.001) than cancer patients and a similar likelihood of being discharged alive to cancer patients. Noncancer patients had a trend to lower LOS across a broad range of demographic, diagnostic, prognostic, and PPS categories. Multivariable analysis showed that LOS was not associated with the diagnosis of cancer (p=0.36). DISCUSSION/CONCLUSION: Noncancer patients have a shorter LOS than cancer patients and a similar likelihood of being discharged alive from a PCU than cancer patients, and the diagnosis of cancer did not correlate with survival in our study population. Our findings demonstrate that noncancer patients are not "oversurviving," and that referring physicians and PCUs should not reject or restrict noncancer referrals out of concern that these patients are having a detrimental impact on PCU bed availability.

Healthcare integration: the study of the toronto central regional hospice palliative care "system" and its integration challenges.

The Ontario Ministry of Health and Long-Term Care's End-of-Life strategy did not result in integrated hospice palliative care (HPC) systems. Consequently, HPC has evolved differently across the 14 local health integration networks. In the Toronto Central Local Health Integration Network, the HPC sector lacks foundational systems integration elements: infrastructure and tools that can ensure optimal access and delivery; centralized data capture and management resources to support delivery and planning; and central planning and performance authority that will further improvements in systems delivery, planning and accountability. The sector has been able to function because of inter-organizational initiatives and system linkage tools.

Infection prevention and control learning preferences of nurses sampled at a teaching hospital.

A pilot study was conducted within the medical-surgical intensive care unit (MSICU) of the Toronto General Hospital site of the University Health Network during the winter/spring (March-June) of 1999 to examine nurses' learning preferences relevant to infection prevention and control (IPAC). The majority of the nurses sampled indicated a preference for face-to-face infection prevention and control education (seminars). Such seminars were preferred on an annual basis by most respondents. Common preferences for paper-based learning formats were observed to be portable flash cards, packages with text and pictures and reference manuals. Such paper-based modalities could be considered in concert with infection control seminars; possibly to serve as easily accessible reminders within hospital units. Although not observed in this study, exploring differences in learning preferences across various demographic characteristics of nurses (e.g., years of experience) could be valuable. It is important to assess the specific IPAC learning needs of nurses before designing educational interventions. Assessing the effectiveness of learning modalities in improving infection control practices is advised. The practicality of nurse participation in various educational initiatives also must be considered, as barriers to nurse participation in continuing education have been noted. Furthermore, organizational commitment to infection prevention/safety should be reinforced through future training opportunities for health care workers (HCWs). Challenges with the application of new technology to educational modalities have been cited, which bears relevance to these findings. These observations are presented in order to inform infection control training of nurses in the post-SARS milieu of health care provision in Canada.

Contract management of Ontario's cancer surgery wait times strategy.

The province of Ontario, as a result of the First Ministers' Meeting, was committed to addressing surgery wait times in Ontario. The Ministry of Health and Long-Term Care's response to this commitment was the Wait Times Strategy (WTS) initiative, which addressed access issues with the aim of positively impacting wait times in cancer surgery. Cancer Care Ontario (CCO) was tasked with managing the cancer surgery WTS. CCO engaged in accountability agreements with Ontario hospitals to provide incremental cancer surgery volumes, in return for one-time funding. Through the use of accountability agreements, CCO was able to tie service volume delivery, quality care initiatives and reporting requirements to funding. Other elements of the cancer surgery WTS implementation included the development of wait times definitions, guidelines and targets; the use of a performance management system; facilitation by existing regional cancer leads and continued development of regional cancer programs. Eight key lessons were learned: (1) baseline volume guarantees are critical to ensuring that wait times are positively impacted; (2) there is a need to create a balance between accountability and systems management; (3) clinical quality initiatives can be tied to funding initiatives; (4) allocations of services should be informed by many factors; (5) regional leadership is key to ensuring that local needs are met; (6) data are invaluable in improving performance; (7) there is regional disparity in service delivery, capacity and resources across the province; and (8) program sustainability is an underlying goal of the WTS for cancer surgery. The implication is that accountability agreements can be leveraged to create sustainable health management systems.

Cancer Care Ontario and integrated cancer programs: portrait of a performance management system and lessons learned.

PURPOSE: A performance management system has been implemented by Cancer Care Ontario (CCO). This system allows for the monitoring and management of 11 integrated cancer programs (ICPs) across the Province of Ontario. The system comprises of four elements: reporting frequency, reporting requirements, review meetings and accountability and continuous improvement activities. CCO and the ICPs have recently completed quarterly performance review exercises for the last two quarters of the fiscal year 2004-2005. The purpose of this paper is to address some of the key lessons learned. DESIGN/METHODOLOGY/APPROACH: The paper provides an outline of the CCO performance management system. FINDINGS: These lessons included: data must be valid and reliable; performance management requires commitments from both parties in the performance review exercises; streamlining performance reporting is beneficial; technology infrastructure which allows for cohesive management of data is vital for a sustainable performance management system; performance indicators need to stand up to scrutiny by both parties; and providing comparative data across the province is valuable. Critical success factors which would help to ensure a successful performance management system include: corporate engagement from various parts of an organization in the review exercises; desire to focus on performance improvement and avoidance of blaming; and strong data management systems. PRACTICAL IMPLICATIONS: The performance management system is a practical and sustainable system that allows for performance improvement of cancer care services. It can be a vital tool to enhance accountability within the health care system. ORIGINALITY/VALUE: The paper demonstrates that the performance management system supports accountability in the cancer care system for Ontario, and reflects the principles of the provincial governments commitment to continuous improvement of healthcare.