Mount Sinai Hospital's approach to Ontario's Health System Funding Reform.

In April 2012, the Ontario government introduced Health System Funding Reform (HSFR), a transformational shift in how hospitals are funded. Mount Sinai Hospital recognized that moving from global funding to a "patient-based" model would have substantial operational and clinical implications. Adjusting to the new funding environment was set as a top corporate priority, serving as the strategic basis for re-examining and redesigning operations to further improve both quality and efficiency. Two years into HSFR, this article outlines Mount Sinai Hospital's approach and highlights key lessons learned.

Computer-assisted resilience training to prepare healthcare workers for pandemic influenza: a randomized trial of the optimal dose of training.

BACKGROUND: Working in a hospital during an extraordinary infectious disease outbreak can cause significant stress and contribute to healthcare workers choosing to reduce patient contact. Psychological training of healthcare workers prior to an influenza pandemic may reduce stress-related absenteeism, however, established training methods that change behavior and attitudes are too resource-intensive for widespread use. This study tests the feasibility and effectiveness of a less expensive alternative - an interactive, computer-assisted training course designed to build resilience to the stresses of working during a pandemic. METHODS: A "dose-finding" study compared pre-post changes in three different durations of training. We measured variables that are likely to mediate stress-responses in a pandemic before and after training: confidence in support and training, pandemic-related self-efficacy, coping style and interpersonal problems. RESULTS: 158 hospital workers took the course and were randomly assigned to the short (7 sessions, median cumulative duration 111 minutes), medium (12 sessions, 158 minutes) or long (17 sessions, 223 minutes) version. Using an intention-to-treat analysis, the course was associated with significant improvements in confidence in support and training, pandemic self-efficacy and interpersonal problems. Participants who under-utilized coping via problem-solving or seeking support or over-utilized escape-avoidance experienced improved coping. Comparison of doses showed improved interpersonal problems in the medium and long course but not in the short course. There was a trend towards higher drop-out rates with longer duration of training. CONCLUSIONS: Computer-assisted resilience training in healthcare workers appears to be of significant benefit and merits further study under pandemic conditions. Comparing three "doses" of the course suggested that the medium course was optimal.

Women's satisfaction with the current state of prenatal care for pregnancies complicated by fetal anomalies: a survey of five academic perinatal units in Ontario.

OBJECTIVE: To assess women's satisfaction with the current state of prenatal care for pregnancies complicated by congenital anomalies. METHODS: We conducted a cross-sectional survey of 251 women with pregnancies complicated by congenital anomalies. The women were recruited from five Ontario hospitals (Mount Sinai Hospital in Toronto, Hamilton Health Sciences Centre, St. Joseph's Health Care in London, Kingston General Hospital, and The Ottawa Hospital) at the time of referral. A seven-question, self-administered questionnaire developed by an expert panel was used to collect data from the study subjects about satisfaction with prenatal care at antenatal clinics. The women's level of satisfaction was measured using a 5-point scale (1 = least satisfactory and 5 = most satisfactory). Demographic information and information about women's medical and obstetrical history, and obstetrical knowledge was also collected. Descriptive analyses were performed, and relative risks (RR) were calculated to estimate measures of association. RESULTS: Most of the study subjects (> 90%) had a high level of education and were married or in a common-law relationship, and about 80% came from high-income families. The mean age of the study subjects was 31.4 years. The mean gestational age at the first visit with a doctor or midwife was 8.5 weeks, at first being told of a concern with their pregnancy was 18.6 weeks, and at the first visit with an obstetric specialist in the community was 19.6 weeks. Mean scores for each item of satisfaction measure varied from 4.05 to 4.53, and the mean score for women's overall satisfaction was 29.7 (95% confidence intervals [CI] 28.9-30.4). There was a statistically significant association between women's opinion and knowledge of prenatal testing and their level of satisfaction with prenatal care. Women who had difficulty understanding what a doctor or midwife was telling them were less satisfied with prenatal care than women without such difficulty (RR 3.21; 95% CI 2.14-4.81). Language and ethnic diversity were not associated with the level of satisfaction. CONCLUSION: In Ontario, of women whose pregnancies are complicated by congenital anomalies, those who are less knowledgeable about their pregnancies are more likely to be dissatisfied with their prenatal care. Overall, however, most women are satisfied with their prenatal care.

The fetal alert network: an innovative program of access to care, surveillance, and education for birth defects in Ontario.

Optimal pregnancy outcomes rely on coordinated timely access to appropriate evidence-based clinical care. This is particularly true for pregnant women carrying fetuses diagnosed with birth defects. A systematic approach to prenatal care is ideal, but Ontario has traditionally lagged behind other regions in this regard. In 2004, in response to this challenge, the Fetal Alert Network (FAN) was established with funding support from the Ontario Ministry of Health and Long-Term Care. FAN is composed of five multidisciplinary regional health care teams of nurse coordinators working in close collaboration with primary obstetrical care providers, medical geneticists, specialists in maternal fetal medicine, and pediatric specialists. The teams facilitate access to subspecialists through patient triage and referral, provide outreach education, and act as local experts and change agents to improve care. A key objective is to go beyond a traditional surveillance system to the linkage of service provision with outcomes and effectiveness. FAN's objectives are to ensure optimal health care access and delivery at all levels, to promote coordination and collaboration among providers, to provide timely and accurate information about health system utilization and clinical outcomes, and to educate patients and primary care providers about prenatal diagnosis. Program evaluation is currently underway. Preliminary analyses indicate that achievement of these objectives has resulted in seamless coordinated access to service for the targeted group of patients, as well as enhanced communication among providers; accessible education and information; and precise, accurate, and timely health care data and information.

The nursing human resource planning best practice toolkit: creating a best practice resource for nursing managers.

Evidence of acute nursing shortages in urban hospitals has been surfacing since 2000. Further, new graduate nurses account for more than 50% of total nurse turnover in some hospitals and between 35% and 60% of new graduates change workplace during the first year. Critical to organizational success, first line nurse managers must have the knowledge and skills to ensure the accurate projection of nursing resource requirements and to develop proactive recruitment and retention programs that are effective, promote positive nursing socialization, and provide early exposure to the clinical setting. The Nursing Human Resource Planning Best Practice Toolkit project supported the creation of a network of teaching and community hospitals to develop a best practice toolkit in nursing human resource planning targeted at first line nursing managers. The toolkit includes the development of a framework including the conceptual building blocks of planning tools, manager interventions, retention and recruitment and professional practice models. The development of the toolkit involved conducting a review of the literature for best practices in nursing human resource planning, using a mixed method approach to data collection including a survey and extensive interviews of managers and completing a comprehensive scan of human resource practices in the participating organizations. This paper will provide an overview of the process used to develop the toolkit, a description of the toolkit contents and a reflection on the outcomes of the project.