Ask an Expert

 

A feature presented by Longwoods™ Publishing in collaboration with a pool of leading experts in the design and management of healthcare organizations. Ask your question at the bottom of this page.

What kind of apps and/or shortcuts does CIHI.CA make available.

CIHI makes a range of apps available to individuals and organizations that have accounts with the organization. You will find the complete list here: http://www.cihi.ca/CIHI-ext-portal/internet/EN/ApplicationIndex/applicationindex/applications_index_main


Dianne Foster Kent, Editorial Director, Longwoods

how to develop project manager reengineering process for hospital admission department

Try this: goto Longwoods.com and put your question into the website's search bar. There is a good chance you will get some useful ideas.


The Publisher

Where can the public obtain transparent metrics illustrating the number of administrators compared to the number of beds versus the number of nurses to number of beds and/or number of doctors to number of beds? The rationale behind the question: There are too many administrators in healthcare. There are more administrative offices than there are patient rooms. That is a huge problem because administrators keep getting added while front line services are continually cut. Administrators have nicer offices than patients do beds. Administrators are served better food than patients eat. There are more administrators in healthcare than there are doctors. We need money to address the front lines, not the backlines. Slim the backlines, put more funding on the front lines. This question is aimed at identifying a metric that compared the # of admin to the # of frontline workers.

Try some of these papers . . . http://bit.ly/VbYk5s


publisher@Longwoods.com

What do you mean the publisher is doing "due diligence"?

Over the second half of this, the summer of 2012, Longwoods will be asking some questions.

We are the second most popular health sciences web site in Canada. So what are we doing right? More importantly what should we improve and what are we doing wrong?

Popularity is a global scale and we can all participate. See. www.alexa.com. Our national medical association (CMAJ) leads the pack followed by Longwoods and then the usually significant foundations, institutes and associations all with additional and parallel streams of revenue. A seemingly small ranking group can be found hiding deep in the overheads of a university or academic hospital.

Poring over internet traffic numbers may feel like a victory lap, but there’s much more to understanding whether or not the publications are sustainable with the new business models that have evolved over the last decade.

What is the value and productivity of our regular and freelance staff and our committed editors-in-chief and their editorial advisors? Are our products the best they can be? How good are our journals, web assets and learning programs? How committed are our authors and faculty?

Do we know the quality of our markets? How committed are our readers and institutional subscribers? What do they really think?

How good are we at making our content and programs available and accessible to our core markets and secondary markets.

How well do our pricing models work and what will come of them? How do we relate to federal, provincial, pan Canadian and private funding organizations including our institutional clients? How committed are they?

How do we benchmark with our peer organizations? Consider our performance and compare our figures to those of similar publishing companies?

This cursory audit may motivate us to do nothing or it may tell us to re-invent ourselves. We will look to see if scholarly publishing is to become an elite responsibility for deep institutional pockets hiding costs in their padded overheads. Or does it require philanthropy? (PLoS alone was the beneficiary $10,000,000 to establish an open access scholarly website and both the Milbank and HealthAffairs are propped up by foundations that pay no tax.)

Or something else. Anyone willing to participate should contact the publisher at ahart@longwoods.com


Anton Hart is the publisher at Longwoods.com

What is an "essay" and what is a "white paper"?

About Essays and White Papers (again) An essay is a short literary composition on a single subject, usually presenting a personal point of view. Longwoods evaluates an essay based on the author’s reputation and the essay’s value proposition.

A white paper is an authoritative report or guide that helps solve a problem – usually from a corporate or government point of view. The white paper is seen as a reflection of the presenting organization – generally known as its brand and reputation. Longwoods evaluates a white paper based on that reputation and the white paper's value proposition.

Both essays and white papers generally bypass the scholarly publication evaluation which includes reviews by individuals with earned academic kudos or abstract accomplishments. However, individuals with suitable knowledge and more pragmatic reputations may be asked for their advice.

For more information contact ahart@longwoods.com.

July 9, 2012


Anton Hart, Publisher of Longwoods Publishing Corporation and Longwoods.com

How much does it cost to launch and publish a scholarly journal?

Here are three examples of scholarly journals with related financial data that are available online. They are: the highly regarded Milbank Quarterly, the Public Library of Science (PLoS), now ten years old and reportedly the largest scholarly journal in the world, and Health Affairs, the target journal for any scholar with ambition and often considered as the most prestigious scholarly publication covering health sciences.


PLoS
The Public Library of Science launched PLoS with a $9,000,000 grant from the Gordon and Betty Moore Foundation Dec. 17, 2002 [See: http://www.moore.org/grant.aspx?id=1054 + http://www.moore.org/newsitem.aspx?id=524. PLoS received an additional grant for on-going support in May 2006, $1,000,000, also from the Gordon and Betty Moore Foundation. There appears to be an undetermined amount of funding directed their way as part of various large grants from the Gordon and Betty Moore Foundation. See: http://www.moore.org/search.aspx and search for PLoS. The editor of PLoS, for example, appears to be brought in to support/advise certain projects. This may not be inappropriate but it does create an opportunity to channel indirect and additional funding to the PLoS initiative. Note that the Gordon and Betty Moore Foundation is a $5 billion fund established by the founder of INTEL.
The Milbank Quarterly
Published for more than eighty years, The Milbank Quarterly features peer-reviewed original research, policy review, and analysis from academics, clinicians, and policymakers. According to the Institute for Scientific Information, the Quarterly has either led or been in the top three for “impact factor” (based on citations of published articles) of fifty-six journals in Health Policy & Services and of seventy-one journals in Health Care Sciences & Services since 2003. The Quarterly’s multidisciplinary approach and commitment to applying the best empirical research to practical policymaking offer in-depth assessments of the social, economic, historical, legal, and ethical dimensions of health and health care policy. (source: http://www.milbank.org/publications/the-milbank-quarterly).
Form 990 for the Milbank Foundation (calendar year 2010) shows that publication administration costs to the Foundation were $428,692. Income from Milbank Quarterly and books was $119,587 (http://www.eri-nonprofit-salaries.com/index.cfm?FuseAction=NPO.Form990&EIN=135562282&Year=2012) Other costs were, presumably, covered by the Foundation.
HealthAffairs
Project HOPE owns and publishes Health Affairs, the leading journal of health policy and thought research. The peer-reviewed journal appears monthly in print with additional daily online web exclusive materials. Published since 1981, The Washington Post has called Health Affairs the bible of health policy. Susan Dentzer, formerly head of PBS NewsHour’s health unit, serves as Editor-in-Chief. All papers undergo external peer review and are authored by leading academics from fields that intersect with health policy such as economics, public health, sociology, political science, medicine and nursing , to name a few. Government policymakers and health industry decision makers from the U.S. and around the glove also write for and read the publication and its website. Health Affairs is available via subscription and every article the journal has ever published is available online at www.healthaffairs.org. All abstracts, tables of contents and many articles are available for free online. The journal is also free to online readers from the lowest income nations. From Form 990 [Return: Organization Exempt from Income Tax.] you can find: Expenses $7,913,535; Revenue $2,082,940 -- the two key financial indicators for Health Affairs. The difference coming from Project Hope. (In 2011 and 2010 Project Hope received $47M and $38M in donated materials from the pharma sector.) [This is available at: http://www.projecthope.org/assets/documents/Project-HOPE-2010-IRS-990-Form.pdf]


Sources
http://www.moore.org/grant.aspx?id=1054
http://www.moore.org/newsitem.aspx?id=524.
http://www.moore.org/search.aspx
http://www.milbank.org/publications/the-milbank-quarterly
http://www.projecthope.org/assets/documents/Project-HOPE-2010-IRS-990-Form.pdf

Interpreting the Personal Health Information Protection Act

A reader asks:

I attended a conference in May, in which eHealth Ontario presented and they advised hospitals, that they should be prepared  (January 1. 2012) for a flood of requests, regarding copies of health records. No one seemed to know what they were talking about. They really didn’t want to go into details, because they said that they were waiting for the bill to pass any day now. After reading Hansard I believe under the Bill 173, Better Tomorrow for Ontario Act, which seems to be a Budget Measures Bill, they substituted Section 1, Schedule 15.

Committee members also discussed copies of hospital emails, handwritten notes, accountability for all Hospitals and the level of care. Did the floodgates open with Section 1, Schedule 15? Would appreciate your opinion of the substitution.

The Response from the Assistant Commissioner (Access)
Office of the Information and Privacy Commissioner of Ontario

Thank you for your email dated June 22, 2011 addressed to Dr. Ann Cavoukian in which you forwarded a question from a reader in relation to statements made by eHealth Ontario at a conference in May 2011 and in relation to Bill 173, the Better Tomorrow for Ontario Act (Budget Measures), 2011. Your email was forwarded to me for response.

As health information custodians under Ontario’s Personal Health Information Protection Act, hospitals have been responsible for providing individuals with access to their own health data – their records of personal health information, since November 1, 2004.  But the general records of hospitals (non-personally identifying information), have not, in the past, fallen under our freedom of information laws.  That will change next year.

As of January 1, 2012, hospitals will also be included, having been designated as institutions under the Freedom of Information and Protection of Privacy Act (FIPPA).  Upon this date, individuals will have the right to request access to a broader range of general records held by hospitals, that came into their custody or control on or after January 1, 2007.  This includes records relating to the administrative and operational functions and financial decisions of hospitals.  Requests by individuals for access to their own records of personal health information, however, will continue to be governed by the Personal Health Information Protection Act, as before. As such, hospitals should not receive an increase in requests for personal health information. It is the new area of general records (such as policy-related information, administrative records, etc.) that will be opened up.
 
The right of access under the FIPPA is subject to a number of exemptions and exclusions, some of which are specifically applicable to hospitals. An example of an exemption specifically applicable to hospitals is that set out in section 1 of Schedule 15 to the Better Tomorrow for Ontario Act (Budget Measures), 2011, referred to in the email from your reader.  This section amends the FIPPA to permit a hospital to refuse to provide access to “information provided in confidence to, or records prepared with the expectation of confidentiality by, a hospital committee to assess or evaluate the quality of health care and directly related programs and services provided by a hospital, if the assessment or evaluation is for the purpose of improving that care and the programs and services.”  As the oversight body for FIPPA, we are confident that we will be able to ensure that this exemption is only applied to records in the appropriate circumstances.

If you would like to discuss the application of FIPPA to hospitals or the exemptions and exclusions from the right of access further, please do not hesitate to contact me at (416) 326-3906 or by email at Brian.Beamish@ipc.on.ca. Your readers can get further information at www.ipc.on.ca or by contacting info@ipc.on.ca.


Regards,
Brian Beamish
Assistant Commissioner (Access)
Office of the Information and Privacy Commissioner of Ontario

Where do I get more information on the number of patients who die every year from errors made by doctors and nurses

Statistics on Healthcare Quality and Patient Safety Problems – Errors & Harm http://www.leanblog.org/2009/08/statistics-on-healthcare-quality-and/ via @MarkGraban


@MarkGraban

While there may not be a single best model for integrated health care at the community level, what services might be most beneficial to consolidate in a central geographic location?

Integrated health systems are considered part of the solution to the challenge of sustaining Canada's healthcare system. This systematic literature review was undertaken to guide decision-makers and others to plan for and implement integrated health systems. This review identified 10 universal principles of successfully integrated healthcare systems that may be used by decision-makers to assist with integration efforts. These principles define key areas for restructuring and allow organizational flexibility and adaptation to local context. The literature does not contain a one-size-fits-all model or process for successful integration, nor is there a firm empirical foundation for specific integration strategies and processes.


Ten Key Principles for Successful Health Systems Integration Esther Suter, Nelly D. Oelke, Carol E. Adair and Gail D. Armitage Healthcare Quarterly, 13(Sp) 2009: 16-23 For more information click here.

Can gender difference in cardiac intervention rates after acute myocardial infarction be explained by age difference?

(...) there is currently no gender bias in key cardiac interventions after AMI in Manitoba, and suggest that similar analyses in other jurisdictions may reveal similar findings. Lower procedure rates for females were completely explained by their older age profile compared to male AMI patients, because intervention rates drop sharply with age for both males and females.
These results are important for clinicians and policy makers, as they show that while the age of the patient plays a role in post-AMI intervention decisions, the sex of the patient does not. The equal treatment of male and female AMI patients shown in our study may reflect a changing reality in clinical practice, as almost all other recent studies that adequately controlled for age also revealed non-significant or marginal sex differences. Bypass surgery may be the exception and requires additional research. Furthermore, demonstrating equality in rates of treatment after AMI does not address other issues regarding gender differences in heart disease, including possible differences in risk factors, presentation, diagnosis, patient preferences and effectiveness of various treatments.


Age Difference Explains Gender Difference in Cardiac Intervention Rates After Acute Myocardial Infarction
Randall R. Fransoo, Patricia J. Martens, The Need to Know Team, Heather J. Prior, Elaine Burland, Dan Château and Alan Katz
For more information: click here.

We want to improve our website to better enable consumers to be effective users of health information. How should we assess the quality of existing health information sites on the Web so that we have examples to consider?

Principles set forth by the Health Improvement Institute include:

1. Transparency regarding: identity of the website, ownership, privacy (and threats to its invasion).
2. Ease-of-use for: Finding/navigating contents on website, comprehending contents (clarity of writing, basic reading level), printing contents of interest, and serving consumers with special needs.
3. Meticulous in distinguishing advertising/selling from education/information
4. Disclosure regarding: authors’ credentials (especially for clinical information), process for selecting and editing contents. Resulting content should be: accurate, complete, objective, balanced, well-organized, not muddled, and referenced.
5. Current, frequently updated.
6. Useful to consumer needs and responsive to feedback

Consumers instinctively trust websites that meet the above criteria. Web rankings indicate that the most visited health information sites in North America (e.g. WebMD) are those that meet the above criteria and have the seal of approval from the Health on the Net Foundation (HONcode) and contain the URAC accreditation. Leading health information websites that meet these criteria may be found at: http://www.hii.org/.


Neil Seeman, JD, MPH is a Managing Consultant in the health care practice at IBM Global Business Services and Adjunct Professor of health services management at Ryerson University. E-mail: neil@ca.ibm.com

Please cite some examples of legal cases that have affected (or haven't) affected the right of healthcare for Canadians.

There may have been a time when it was realistic to believe the best medical treatment available for all medical treatment required could be provided under our public healthcare system. However, the reality is that it has proven not possible to provide this level of care under our public healthcare system. Modern medical technology and science continue to make available treatments that cost beyond the resources that the public healthcare system is able or willing to provide.

Resource allocation must be taken into consideration in determining whether a medical treatment is appropriate to be included as a service provided under our public healthcare system. Difficult choices have to be made that can cause a great deal of anxiety and concern. The challenge to a healthcare system committed to providing universal access is how best to allocate the resources available. Resource allocation in the delivery of healthcare gives rise to the fundamental issue as to whether there is a right to healthcare recognized in law. For more information: click here.


Rino A. Stradiotto, QC, LSM, Member emeritus of Borden Ladner Gervais LLP

Is Canada prepared to manage a pandemic threat from the perspective of response capacity and having in place adequate systems of governance?

The outbreak of SARS in 2003 exposed some of the limitations of this country's abilities in this regard, both from the perspective of response capacity and having in place adequate systems of governance. Considerable progress has been made since SARS to address these limitations, including increased investment in public health and strengthening of public health relationships across the country (Public Health Agency of Canada 2006). However, a remaining concern is the adequacy of existing federal legislation in this area and, in particular, the powers the federal government has at its disposal to respond to a public health emergency confined within the borders of one province. For more details visit here.


Kumanan Wilson, MD, MSc, FRCP(C), Associate Professor, Faculty of Medicine, Department of Health Policy, Management and Evaluation, University of Toronto and Research Associate, Institute of Intergovernmental Relations, Queen's University.

Correspondence may be addressed to: Kumanan.Wilson@uhn.on.ca

What are some perspectives, strategies and behaviours that are required by healthcare leaders to successfully implement complex change within the system?

Leadership is cited as a critical success factor in virtually every publication on complex change. What is not as frequently described are the perspectives, strategies and behaviours that are required to effectively lead initiatives involving multiple independent entities in complex systems.
One key finding was that successful leaders were able to command and let go of control at the same time. These leaders did not work to find a balance. Instead, they used the tension in the polarity between these two extremes to deliver meaningful results on an ongoing basis. For more information click here.


Sharon King, BMath, the lead researcher on this project, is the president of Starfield Consulting. Starfield's expertise is in helping healthcare organizations develop and implement strategies to quickly create sustainable change.
Larry Peterson, BEng, DRel, is the co-author of Bridging Boundaries - Lessons from Leaders and a study researcher. Peterson is a Starfield Consulting senior associate.

How is the 'sharing' of system governance and management responsibilities evolving in Ontario?

In Ontario, in contrast to other provinces, has no history of sharing system governance. Like the relationship between RHAs and ministries of health, LHINs and the MOHLTC will share responsibility for health system planning; one from a regional perspective and the other from a provincial one. Since there is a significant interdependence between the two this can be expected to generate on-going tension between the two system governing organizations. For more information click here.


Steve Elson is Director, Integrated Strategic Alliances & Networks, London Health Science Centre and St. Joseph's Healthcare, London. He can be reached at steve.elson@lhsc.on.ca.

 

 

 

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