Healthcare Quarterly

Healthcare Quarterly 10(4) September 2007 : 0-0.doi:10.12927/hcq.2007.19325
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Ten Top Tens

Abstract

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Top Tens

Top Ten Best-Read Papers on Medicare

1. Public and Private Places in Canadian Healthcare
Raisa Deber
Healthcare Quarterly, 1(2) 1997: 28-31
Link

2. Consumer Perspectives on Healthcare Reform
Hy Eliasoph and Caroline Rafferty
Healthcare Quarterly, 1(2) 1997: 8-15
Link

3. Private Health Services in Canada: The Potential, The Politics and The Propaganda
Jim Saunders
Healthcare Quarterly, 1(2) 1997: 16-23
Link

4. Patients' Bill of Rights
Carolyn Shushelski
Healthcare Quarterly, 3(1) 1999: 50-53
Link

5. First Ministers' Meeting Communiqué on Health: Provincial Health Reform Joined by Federal Health Dollars
Michael B. Decter
Healthcare Quarterly 4(1) 2000: 20-23
Link

6. The Future of Healthcare in Canada
Peggy Leatt
Healthcare Quarterly, 5(1) 2001: 20-23
Link

7. Strangulation or Rationalization? Costs and Access in Canadian Hospitals
Morris L. Barer, Steven G. Morgan and Robert G. Evans
Longwoods Review, 1(4) 2003
Link

8. Variations of Gray: The Ethics of Public-Private Partnerships in the Delivery of Uninsured Services for Canadian Hospitals
Penelope Hutchison
Healthcare Quarterly, 6(3) 2003: 39-45
Link

9. Steering and Rowing in Healthcare: The Devolution Option
Colleen M. Flood and Duncan G. Sinclair
Healthcare Quarterly, 8(1) 2005: 54-59
Link

10. The Chaoulli Case: A Two-Tier Magna Carta?
Gregory P. Marchildon
Healthcare Quarterly, 8(4) 2005: 49-52
Link


Top Ten Health Policy Mistakes Since Medicare

1. Moving too late and too timidly on a national pharmaceutical strategy, and overvaluing the presence of having a branch-plant R & D presence in Canada
(see: New Zealand).

2. Giving doctors too much power in setting fee schedules and determining the relative incomes of family practitioners and specialists (see: cataractologists vs. geriatricians).

3. Allowing the College of Dental Surgeons to kill off the school-based Children's Dental Health program in Saskatchewan - one of the most successful primary health care programs in Canadian history.

4. Allowing professions to increase their entry-to-practice credentials without producing evidence that doing so would improve the system, and basing scope of practice on credentials rather than demonstrated competencies.

5. Failure to build a Canada-wide, comprehensive health information system useful at the clinical, managerial
and governance levels to enhance quality, efficiency,
and accountability.

6. Retaining fee-for-service remuneration beyond its useful life span.

7. Failure to translate demonstration projects into system-wide policy (see: primary health care stuck in neutral).

8. Failure to develop a cooperative framework that unites the federal and provincial/territorial governments and aligns goals, funding, and accountability.

9. Governments have ceded too much of the policy agenda and discourse to interest groups.

10. Governments have been too aggressive in telling regional health authorities how to do their work and not aggressive enough in setting goals, and developing incentives to accelerate improved performance.

- Steven Lewis, Saskatchewan


10 Most Often Used Search Words or Phrases

1. healthcare

2. hospital

3. hospital business services

4. how to be a leader

5. management

6. policy

7. practice

8. quality

9. safety

10. workplace


Top 10 Reasons to Improve Health Promotion, Disease Prevention and Chronic Disease Management in Canada

1. The burden of chronic conditions on Canadians, the healthcare system and our economy is enormous.

2. The World Health Organization estimates at least one-third of all disease burdens are caused by tobacco, blood pressure problems, alcohol, cholesterol levels and obesity.

3. The World Health Organization has determined that the impact of many risk factors can be reversed quickly, most benefits will accrue within a decade and even modest changes in risk factor levels can bring about large improvements.

4. The economic burden attributed to physical inactivity and obesity has been estimated to be in the billions of dollars per year. Close to half of Canadians are not active enough and more and more Canadians are obese.

5. About 1 in 3 Canadians report having at least 1 chronic condition and more than one-third of people in this group have multiple long-term health problems.

6. Chronic conditions are generally more common with increasing age, within certain populations (Aboriginal people) and among those with low income.

7. The quality of chronic illness care could be improved as less than half of Canadians with diabetes, for example, get all the laboratory test and procedures that experts recommend.

8. Underuse, overuse and inappropriate use of medications are ongoing concerns, and prescribing practices can vary widely across the country. Too few people with diabetes, for example, receive medications that are effective at preventing cardiovascular problems and more than half of people with diabetes have poor heart health.

9. Modest life-style changes - like losing four kilograms over three to six years - have been shown to dramatically delay or prevent the onset of diseases such as diabetes in high risk populations.

10. We owe it to our parents, our neighbours and our children.

- Health Council of Canada


Ten Most Frequently Downloaded Papers from Healthcare Quarterly

1. Local Health Integration Networks: Will "Made in Ontario" Work?
John Ronson
Healthcare Quarterly, 9(1) 2006: 46-49
Posted on-line on: 2/3/2006

2. Acute Care Hospital Strategic Priorities: Perceptions of Challenges, Control, Competition and Collaboration in Ontario's Evolving Healthcare System
Adalsteinn D. Brown et al.
Healthcare Quarterly, 8(3) 2005: 36-47
Posted on-line: 8/27/2006

3. Full-Time or Part-Time Work in Nursing: Preferences, Tradeoffs and Choices
Jennifer Blythe, Andrea Baumann, Isik Zeytinoglu, Margaret Denton and Ann Higgins
Healthcare Quarterly, 8(3) 2005: 69-77
Posted on-line: 8/27/2006

4. A Healthcare Revolution: Quebec's New Model of Healthcare
David Levine
Healthcare Quarterly, 8(4) 2005: 38-46
Posted on-line: 10/25/2005

5. The Economic Impact of Nurse Staffing Decisions: Time to Turn Down Another Road?
Linda O'Brien-Pallas, Donna Thomson,
Chris Alksnis and Shirliana Bruce
Healthcare Quarterly, 4(3) 2001: 42-50
Posted on-line: 8/27/2005

6. Nursing Shortages: Workplace Environments Are Essential to the Solution
Heather F. Clarke, Heather Spence Laschinger, Phyllis Giovannetti, Judith Shamian, Donna Thomson
and Ann Tourangeau
Healthcare Quarterly, 4(4) 2001: 50-58
Posted on-line: 8/30/2005

7. Strategic Management System in a Healthcare Setting - Moving from Strategy to Results
Rob Devitt, Wolf Klassen and Julian Martalog
Healthcare Quarterly, 8(4) 2005: 58-65
Posted on-line: 10/25/2005

8. Are Physician Executive Pay-for-Performance Programs the Future of Physician Leader Compensation in Canada?
Frank Vounasis and Isser L. Dubinsky
Healthcare Quarterly, 8(4) 2005: 86-90
Posted on-line: 10/25/2005

9. Making Canadian Healthcare Facilities 100% Smoke-Free: A National Trend Emerges
Dan Parle, Shannon Parker and Dan Steeves
Healthcare Quarterly, 8(4) 2005: 53-57
Posted on-line: 10/25/2005

10. A Public/Private Partnership: The Royal Ottawa Hospital Experience
David Laird and George Langill
Healthcare Quarterly, 8(4) 2005: 70-79
Posted on-line: 10/25/2005


Ten Reasons Why Private Healthcare Will Save the System

10. The wealthy patients will be out of the way, leaving more space in ERs for the middle-class and poor citizens

9. Canada will save healthcare costs because neonatal death rates will increase to third world (or U.S. inner city) status, saving us the costs of neonatal care

8. The economy will benefit as richer doctors buy more stuff, or take more exotic vacations.

7. Physicians will get richer quicker, with their entitlement to education continuing to be borne by the public sector.

6. Public healthcare will be able to obtain old equipment at bargain prices from private facilities when they buy up-to-date models

5. Student doctors and nurses will get really good training at working without proper equipment and supplies in the public hospitals

4. There will be fewer and fewer doctors and nurses in the public system as employment in the private system grows, thus reducing public healthcare costs. This in turn will reduce capacity, which ultimately reduces demand (as people give up or die)

3. There will be lower public post-secondary costs as fewer students will be enrolled in medical and nursing schools (because of limitations in public sector student placements due to staff shortages).

2. There will be lower post-secondary costs as fewer students will be enrolled in medical and nursing schools because private facilities don't want to burden themselves or the crème de la crème with the "problem" and costs of having to teach all students in order to educate the next generation

1. There will be no need for universal coverage, saving the economy significant dollars, as there will be no point in universal healthcare if there is no longer universal access, and fewer and fewer trained staff. In fact, maybe eventually there will be no need for any healthcare, as the private sector won't take on the costs to train new staff, and the public sector won't have the capacity to train because new professionals flock to the higher wages and benefits in the private sector and are not available to mentor students.

- Anonymous


Top 10 Reasons for Not Washing Hands

1. I'm a doctor

2. Germs? What germs? I don't see any germs!

3. There was no sink or soap or paper towel in a two step radius

4. No one was watching me

5. I only washed a little old lady

6. I used gloves, that's enough right?

7. I washed them 10 minutes ago

8. My boss didn't wash his/her hands

9. But I am sure I did, I always wash them

10. I had my flu shot.

- Sara Holland, Infection Control Practitioner
Capital Health, Edmonton


Top Ten Reasons Why Researchers Don't Want To Involve Decision Makers In Research

1. After a couple of meetings, most researchers realize that the apparently cushy world of management is just too complicated and complex for linear rational brains.

2. The theory never works in management practice.

3. There is no management practice amenable to good theory.

4. "Working with them is fine. We just can't co-author papers - my management collaborators are always making light of important scientific terminology for peer reviewed papers. For example,

When I write …They edit this in plain language to mean …
Correct within an order of magnitude. Wrong.
This is commonly understood. We couldn't locate the original references.
This study synthesizes previous work. We were uninspired by the real research agenda.
It is evident from the findings. Our conclusion is not contradicted by the findings.

5. 'My three-year research programs outlast every deputy minister of health and CEO I have ever tried to partner with. Oh well, at least the new ones never notice the important scientific evolution of methods and approach over time."

6. The only time they are able to meet with us is at 7:30 … a.m.!

7. "We were only interested in the right answer, it had nothing to do with feasibility or acceptability or politics or anything related to context."

8. It takes longer than our funding award to agree to the real, policy-relevant, context-specific research question."

9. "Do you really expect me to boil down 117 pages of data, description and analysis (not to mention scintillating prose) into one page of bullet points … double-spaced? Besides, there's a diagram on page 110 that explains everything quite succinctly."

10. In reality, none of those people look like the managers on Grey's Anatomy or House.


Ten Most Often Cited Papers from Longwoods Library

1. Making Patients Safer! Reducing Error in Canadian Healthcare
G. Ross Baker and Peter Norton
HealthcarePapers 2001

2. The Economic Impact of Nurse Staffing Decisions: Time to Turn Down Another Road?
Linda O'Brien-Pallas, Donna Thomson, Chris Alksnis and Shirliana Bruce
Healthcare Quarterly 2001

3. Home Care: It's Time for a Canadian Model
Margaret MacAdam
HealthcarePapers 2000

4. Nursing Shortages: Workplace Environments Are Essential to the Solution
Heather F. Clarke, Heather Spence Laschinger, Phyllis Giovannetti, Judith Shamian, Donna Thomson and Ann Tourangeau
HealthcarePapers 2001

5. Voices from the Trenches: Nurses' Experiences of Hospital Restructuring in Ontario
H. K. Spence Laschinger, J. A. Sabiston, J. Finegan, and J. Shamian
Nursing Leadership 2001

6. Healthcare Restructuring: The Impact of Job Change
A. Baumann, P. Giovannetti, L. O'Brien-Pallas, C. Mallette, R. Deber, J. Blythe, J. Hibberd and A. DiCenso
Nursing Leadership 2001

7. Using Research to Inform Healthcare Managers' And Policy Makers' Questions: From Summative to Interpretive Synthesis
Jonathan Lomas
Healthcare Policy 2005

8. Working Within and Beyond the Cochrane Collaboration to Make Systematic Reviews More Useful to Healthcare Managers and Policy Makers
John N. Lavis, Huw T.O. Davies, Russell L. Gruen, Kieran Walshe and Cynthia M. Farquhar
Healthcare Policy 2006

9. Practice Patterns Of Acute Care Nurse Practitioners
S. Sidani, S. Irvine, H. Porter, L. O'Brien-Pallas, B. Simpson, L. McGillis Hall, L. Nagel, J. Graydon, A. DiCenso and D. Redelmeir
Nursing Leadership 2000

10. Predictors of Nurse Managers' Health in Canadian Restructured Healthcare Settings
Dr. Heather K. Spence Laschinger, Joan Almost, Nancy Purdy and Julia Kim
Nursing Leadership 2004


Patient Safety

1 . In 2005, one in 10 adults with health problems in Canada reported receiving the wrong medication or wrong dose during the past two years. In 2002, one in 10 adults, and one in 12 children, contracted a nosocomial infection while in an acute care hospital;

2. Between April 2003 and March 2006, one in 141 babies born in hospitals outside of Quebec experienced birth trauma, such as injuries to a baby's scalp and nervous system or skull fractures; this represents more than 1,700 cases yearly.

3. One in 21 mothers giving birth by vaginal delivery experiences obstetrical traumas, such as third- or fourth-degree perineal lacerations, lacerations of the cervix, vaginal wall or sulcus, or injury to the bladder or urethra. Between April 2003 and March 2006, there were, on average, more than 9,100 reported obstetric traumas in Canadian hospitals outside of Quebec each year.

4. 3.6 out of every 1,000 patients in Canadian hospitals (outside of Quebec and parts of Manitoba) experience a pulmonary embolism, which occurs when a blood clot or globule of fat or tissue travels through the veins and into the lung. It usually originates in a vein in the leg, when it is known as deep vein thrombosis.

5. The risk of pulmonary embolism or deep vein thrombosis generally increases with age, with patients 60 and over at higher risk than younger patients. However, the rate among children 4 and under is statistically significantly higher compared to that for older children up to 17 years of age.

6. Foreign objects left in after a surgical procedure are less common than many other adverse events, affecting about one in 3,000 surgical patients in Canadian hospitals outside of Quebec and parts of Manitoba. This still represents more than 200 cases per year between April 2003 and March 2006.

7. Previous studies show that obese patients are at higher risk of having a foreign object, such as a sponge or surgical instrument, left behind after surgery. Other higher risk groups include patients who undergo emergency operations, have an unexpected change in operation or have a change in nursing or surgical staff during a procedure. Patients aged 17 and under are at a lower risk than adults.

8. In 2003, adverse blood transfusion events in Canada were reported in about one in 4,100 cases.

9. In a survey conducted in 2006, 8% of primary care doctors reported that patients had received the wrong drug or dose, or had preventable drug interactions in the last 12 months. In 2005, 18% of nurses surveyed reported that patients in their care had occasionally or frequently received the wrong medication or dose in the previous year.

10. In 2006, 10% of Canadian primary care physicians reported routinely receiving computerized alerts about potential drug interactions or dose problems. (Another 31% said that they received this information using a manual system.) Canada's 10% compares with 23% in the United States, 40% in Germany and 80% or more in Australia, New Zealand, the Netherlands and the United Kingdom.

These factoids were compiled from Patient Safety in Canada, a recent analysis from the Canadian Institute for Health Information (CIHI), and come from a variety of sources. The full analysis can be found on CIHI's website at www.cihi.ca.

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