Hospital standardized mortality ratio is a useful burning platform.

Hospital Standardized Mortality Ratio (HSMR) is an important indicator of hospital performance that can be immediately used by quality improvement teams. As described by Penfold et al., the indicator is not perfect. However, it does serve as a useful measure that is readily understood by healthcare professionals and the public. Engaging hospital staff in quality improvement work can be challenging and requires understandable quality measures. The Canadian Institute for Healthcare Information deserves our thanks for making this indicator available.

Applying a prism: the spectrum of a sustainable healthcare system.

Initiatives aimed at reducing wait times for surgical and diagnostic procedures and comprehensive chronic disease management programs focus, respectively, on the supply and demand aspects of access to healthcare. Addressing either in isolation can have a salutary health effect for segments of the population and produce system improvement. Approaching healthcare access issues even more broadly, in the context of population health and with a patient-centred perspective, carries the promise of sustainability, the potential for superior health outcomes across a continuum of patient care and the possibility of enhanced system competency through true integration of multiple sectors. A model for comprehensive access to health services includes a plan for a network of primary care providers, appropriate capacity and flow efficiency for the provision of unplanned (emergency) services, operationalization of wait times initiatives to sustain planned services (most surgeries and diagnostic procedures) and a strategy for decreasing demand for care by engaging primary and community care capabilities and a robust chronic disease management strategy.

Gender bias in hospital leadership: a qualitative study on the experiences of women CEOs.

Purpose The purpose of this paper is to examine the experiences of gender bias among women hospital CEOs and explore to what these female leaders attribute their success within a male-dominated hospital executive leadership milieu. Design/methodology/approach This qualitative study involved 12 women hospital CEOs from across Ontario, Canada. Purposeful sampling techniques and in-depth qualitative interview methods were used to facilitate discussion around experiences of gender and leadership. Findings Responses fell into two groups: the first group represented the statement "Gender inequality is alive and well". The second group reflected the statement "Gender inequity is not significant, did not happen to me, and things are better now". This group contained a sub-group with no consciousness of systemic discrimination and that claimed having no gendered experiences in their leadership journey. The first group described gender issues in various contexts, from the individual to the systemic. The second group was ambivalent about gender as a factor impacting leadership trajectories. Originality/value Representations of women's leadership have become detached from feminism, with major consequences for women. This study reveals how difficult it is for some women CEOs to identify gender bias. The subtle everyday norms and practices within the workplace make it difficult to name and explain gender bias explicitly and may explain the challenges in understanding how it might affect a woman's career path.

Establishing a comprehensive continuum from an evidentiary base to policy development for health technologies: the Ontario experience.

OBJECTIVES: The aim of this study was to describe a comprehensive continuum that has developed in Ontario between government and key stakeholder groups, including hospitals, physicians, academic institutions, clinical epidemiologists, health economists, industry, and bioethicists to achieve evidence-based recommendations for policy development. METHODS: The various components of the comprehensive model that has evolved to develop an evidentiary platform for policy development are summarized, and the flow between these components is described. RESULTS: The development of the Ontario Health Technology Advisory Committee (OHTAC) and associated programs demonstrate the need to go beyond the traditional steps taken within most health technology assessment paradigms. These components include pragmatic postmarketing studies, human factors, and safety analyses, and formalized interactions with a broad spectrum of potential end-users of each technology, experts, and industry. Thesecomponents, taken together with an expanded systematic review to include a range of economic analyses, and societal impacts augment the traditional systematic review processes. This approach has been found to be important in assisting decision making and has resulted in an 81 percent conversion from evidence to policy consideration for eighty-three technologies that had been assessed at the time this article was submitted. CONCLUSIONS: The comprehensive model, centered around OHTAC, has added important new dimensions to health policy by improving its relevance to decision makers and providing an accountable and transparent basis for government to invest appropriately in health technologies. This study could also form a basis for further research into appropriate methodologies and outcome measurements as they relate to each component of this approach.

Processes of care: comparison between nurse practitioners and physician residents in acute care.

The purpose of this study was to compare the processes of care (performance of role functions, provision of comprehensive care, coordination of services) of acute care nurse practitioners (ACNPs) and physician residents (PRs) assigned to various medical and surgical programs in acute care settings. A cross-sectional comparative design was used. ACNPs (n = 31) and PRs (n = 10) completed the study questionnaire within two weeks of consenting. Patients who received ACNP care (n = 320) and those who received PR care (n = 46) completed the questionnaire within one week of discharge. The results indicate that ACNPs engaged in management and informal coordination activities more than PRs did, while PRs engaged in more formal coordination activities compared to ACNPs. ACNPs encouraged more patient participation in care and provided more patient education than PRs. These findings, which reflect differences in the processes used by ACNPs and PRs to provide care to patients, could influence the quality and cost outcomes expected of these two groups of healthcare providers.

Achieving clinical improvement: an interdisciplinary intervention.

This study evaluates whether training health care teams in continuous quality improvement methods results in improvements in the care of and outcomes for patients. Nine of the 25 teams who participated in the study were successful in improving the care/outcomes for patients. Successful teams were more effective at problem solving, engaged in more functional group interactions, and were more likely to have physician participation.

Practice parameter: temporal lobe and localized neocortical resections for epilepsy.

PURPOSE: To examine evidence for effectiveness of anteromesial temporal lobe and localized neocortical resections for disabling complex partial seizures. METHODS: Systemic review and analysis of the literature since 1990. RESULTS: One intention-to-treat Class I randomized controlled trial of surgery for mesial temporal lobe epilepsy found that 58% of patients randomized to be evaluated for surgical therapy (64% of those who received surgery) were free of disabling seizures and 10 to 15% were unimproved at the end of 1 year, compared with 8% free of disabling seizures in the group randomized to continued medical therapy. There was a significant improvement in quantitative quality-of-life scores and a trend toward better social function at the end of 1 year for patients in the surgical group, no surgical mortality, and infrequent morbidity. Twenty-four Class IV series of temporal lobe resections yielded essentially identical results. There are similar Class IV results for localized neocortical resections; no Class I or II studies are available. CONCLUSIONS: A single Class I study and 24 Class IV studies indicate that the benefits of anteromesial temporal lobe resection for disabling complex partial seizures is greater than continued treatment with antiepileptic drugs, and the risks are at least comparable. For patients who are compromised by such seizures, referral to an epilepsy surgery center should be strongly considered. Further studies are needed to determine if neocortical seizures benefit from surgery, and whether early surgical intervention should be the treatment of choice for certain surgically remediable epileptic syndromes.

Establishing a comprehensive continuum from an evidentiary base to policy development for health technologies: the Ontario experience

Objectives: The aim of this study was to describe a comprehensive continuum that has developed in Ontario between government and key stakeholder groups, including hospitals, physicians, academic intitutions, clinical epidemiologists, health economists, industry and bioethicists to achieve evidence-based recommendations for policy development. Methods: The various components of the comprehensive model that has evolved to develop an evidentiary platform for policy development are summarized, and the flow between these components is described. Results: The development of the Ontario Health Technology Advisory Committee (OHTAC) and associated programs demonstrate the need to go beyond the traditional steps taken within most health technology assessment paradigms. These components include pragmatic postmaketing studies, human factors, and safety analyses, and formalized interactions with a broad spectrum of potential end-users of each technology, experts, and industry. These components, takne together with and expanded systematic review to include a range of economic analyses, and societal impacts augment the traditional systematic review processes. This approach has been found to be important in assisting decision making and has resulted in an 81 percent conversion from evidence to policy consideration for eighty-three technologies that had been assessed at the time this article was submitted. Conclusions: The comprehensive model, centered around OHTAC, has added important new dimensions to health policy by improving its relevance to decision makers and providing an accountable and transparent basis for government to invest appropriately in health technologies. This study could also form a basis for further research into appropriate methodologies and outcome measurements as they relate to each component of this approach.(AU)