Don Juzwishin

Acceptance of Global Positioning System (GPS) Technology Among Dementia Clients and Family Caregivers

ABSTRACT The purpose of this study was to examine the acceptance of Global Positioning System (GPS) used to help people with dementia, who are at risk for wandering in their communities. We used a mixed methods research approach that included use logs, pre and post paper-based questionnaires, and focus groups. Forty-five client-caregiver pairs (dyads) were included to use one of the GPS devices for an average of 5.8 months over a 1-year period. GPS acceptance was high; dyads were likely to continue using the GPS. According to the participants, the GPS provided caregivers peace of mind and reduced anxiety in dyads when clients got lost.

Procurement change in Canada: an opportunity for improving system performance.

The Canadian healthcare system is undergoing restructuring of how goods and services are purchased. A conference “Navigating Hospital and Health System Procurement” was organized by MEDEC and the Canadian College of Health Leaders to examine the issues. This paper describes the implications and opportunities these changes present for healthcare policy, regulation, practice, and the supplier marketplace.

Cultivating excellence in leadership: wicked problems and virtues.

Introduction Previous reflections on healthcare leadership ethics have pointed to the ways in which the LEADS in a Caring Environment leadership capability framework reflects the Canadian College of Health Leaders (CCHL) Code of Ethics. They have also discussed the potential for this framework to provide guidance on strong ethical behaviours and professional competencies. The framework provides today’s health leaders with a tool to help them think about and act in ways that will help during turbulent times of transformation and change. Leaders must think issues through and be prepared to act based on their personal ethical framework; this takes courage, resolve, and commitment. Good governance and effective leadership also require transparency and honesty in decision making, and trustworthiness and attentiveness to the moral climate of your colleagues. How might leaders foster the development of these capacities personally and in their staff? How might leaders maintain and strengthen these capacities and behaviours in times of turbulence? In this article, we explore the leadership capacities and behaviours expressed in the LEADS Framework and ways a virtue approach in ethics might assist leaders striving to address the “wicked problems” encountered in complex and rapidly transforming health systems. Some concluding remarks on how to support the development of virtues in leadership are provided.

Mentoring a health technology assessment initiative in Kazakhstan.

OBJECTIVES The aim of this study was to assist in the development of a health technology assessment (HTA) program for the Ministry of Health (MOH) of the Republic of Kazakhstan METHODS Mentoring of an initial HTA program in Kazakhstan was provided by the Canadian Society for International Health (CSIH) by means of a partnership with the Kazakhstan MOH. HTA materials, courses, and one-on-one support for the preparation of a series of initial HTA reports by MOH HTA staff were provided by a seven-member CSIH team over a 2.5-year project. RESULTS Guidance documents on HTA and institutional strengthening were prepared in response to an extensive set of deliverables developed by the MOH and the World Bank. Introductory and train-the-trainer workshops in HTA and economic evaluation were provided for MOH staff members, experts from Kazakhstan research institutes and physicians. Five short HTA reports were successfully developed by staff in the Ministrys HTA Unit with assistance from the CSIH team. Challenges that may be relevant to other emerging HTA programs included lack of familiarity with some essential underlying concepts, organization culture, and limited time for MOH staff to do HTA work. CONCLUSIONS The project helped to define the need for HTA and mentored MOH staff in taking the first steps to establish a program to support health policy decision making in Kazakhstan. This experience offers practical lessons for other emerging HTA programs, although these should be tailored to the specific context.

Ethical Management in Health Services Administration: A Sequel:

It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to heaven, we were all going direct the other way-in short, the period was so far like the present period, that some of its noisiest authorities insisted on its being received, for good or for evil, in the superlative degree of comparison only. ––Charles Dickens, A Tale of Two Cities

Case Study: Assessing Laparoscopic Cholecystectomy: The GVHS Experience

This article describes the experience at the Greater Victoria Hospital Society of assessing the appropriateness of introducing laparoscopic cholecystectomy (lap chole) within the framework of an established technology assessment process. Lap chole promised to deliver cost savings; however, these could only be realized by capitalizing on the reduced length of stay by removing the surgical beds from service. A cautionary note is raised as to whether the increased use of lap chole in the population is appropriate.

Quality of Care and Utilization Management: Contemporary Tools and Strategies

An effective Quality-Utilization Management Program requires a contemporary and clinically relevant information system. Involvement of the medical staff and support of hospital personnel are critical to implement such a program. Equally important is the commitment of government and community representatives to address hospital quality and utilization issues in the context of the full range of community services. Outlining the background leading to the inception of a Quality-Utilization Management Program in a multi-hospital system, the authors also present the rationale for selecting a concurrent and retrospective review system.

Innovation and commercialization in public health care systems: a review of challenges and opportunities in Canada

License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Innovation and Entrepreneurship in Health 2015:2 69–80 Innovation and Entrepreneurship in Health Dovepress

The emergence of precision therapeutics New challenges and opportunities for Canada’s health leaders

In the era of personalized and precision medicine, the approach to healthcare is quickly changing. Genetic and other molecular information are being increasingly demanded by clinicians and expected by patients for prevention, screening, diagnosis, prognosis, health promotion, and treatment of an increasing number of conditions. As a result of these developments, Canadian health leaders must understand and be prepared to lead the necessary changes associated with these disruptive technologies. This article focuses on precision therapeutics but also provides background on the concepts and terminology related to personalized and precision medicine and explores Canadian health leadership and system issues that may pose barriers to their implementation. The article is intended to inspire, educate, and mobilize Canadian health leaders to initiate dialogue around the transformative changes necessary to ready the healthcare system to realize the benefits of precision therapeutics.

Economic evaluations of eHealth technologies: A systematic review

Background Innovations in eHealth technologies have the potential to help older adults live independently, maintain their quality of life, and to reduce their health system dependency and health care expenditure. The objective of this study was to systematically review and appraise the quality of cost-effectiveness or utility studies assessing eHealth technologies in study populations involving older adults. Methods We systematically searched multiple databases (MEDLINE, EMBASE, CINAHL, NHS EED, and PsycINFO) for peer-reviewed studies published in English from 2000 to 2016 that examined cost-effectiveness (or utility) of eHealth technologies. The reporting quality of included studies was appraised using the Consolidated Health Economic Evaluation Reporting Standards statement. Results Eleven full text articles met the inclusion criteria representing public and private health care systems. eHealth technologies evaluated by these studies includes computerized decision support system, a web-based physical activity intervention, internet-delivered cognitive behavioral therapy, telecare, and telehealth. Overall, the reporting quality of the studies included in the review was varied. Most studies demonstrated efficacy and cost-effectiveness of an intervention using a randomized control trial and statistical modeling, respectively. This review found limited information on the feasibility of adopting these technologies based on economic and organizational factors. Conclusions This review identified few economic evaluations of eHealth technologies that included older adults. The quality of the current evidence is limited and further research is warranted to clearly demonstrate the long-term cost-effectiveness of eHealth technologies from the health care system and societal perspectives.