Lately in conversation about healthcare industries, you'll hear individuals discuss the need for continued improvements - not only regarding patient access to healthcare but also pertaining to improved funding and research as our population grows and ages. This issue of Healthcare Quarterly focuses on enhancing healthcare systems. Murray Martin and Cliff Nordal describe the two-tiered approach by private/public healthcare systems that have emerged in Australia and New Zealand in their article "A Visit Down Under: Our Journey to Improve Canada's Healthcare System." Motivated by Canada's increasing fascination with private healthcare, these two authors targeted a range of private and public healthcare organizations to examine the operational impact and resulting system benefits.

In "Creating Sustained Improvements in Patient Access and Flow: Experiences from Three Ontario Healthcare Institutions," Hugh MacLeod, Bob Bell, Ken Deane and Carolyn Baker explore the "front door" to our healthcare system - the emergency department (ED) - noting the importance of improved access and flow in the ED despite challenges created by a rising demand and acuity. This report examines the recent effort by several Ontario hospitals to improve ED functions and describes the promising results.

A companion case study focuses on the North York General Hospital's efforts to transform its services by examining strategy and leadership. Bonnie Adamson and Susan Kowlek report on this hospital's cultural transformation efforts after the outbreak of severe acute respiratory syndrome led to improvements in both the ED and general internal medicine. "Strategy, Leadership and Change: The North York General Hospital Transformation Journey" provides an interesting case that displays why the organization's new approach will enable sustained improvements over time.

This issue's Perspective provides a fascinating report focusing on the funding and delivery of healthcare to Aboriginal populations. C.W. Ashton and Denise Duffie-Ashton report on the improvements made in New Zealand's and Australia's resource accounting principles. Such principles served to highlight best management practices, improve long-term resource planning and enhance performance measurement. This review provides an interesting insight into what Canada's healthcare system can learn from these two countries.  

In Ideas at Work, Katie Lundon, Rachel Shupak, Lorraine Sunstrum-Mann, Debbie Galet and Rayfel Schneider explore the Advanced Clinician Practitioner in Arthritis Care program - a competency-based educational program created in 2005. Through the collaboration of St. Michael's Hospital and the Hospital for Sick Children in Toronto, experienced physical and occupational therapists are provided the opportunity to explore an expanded scope of practice. The goal is to provide optimal, timely and appropriate delivery of healthcare to patients.

Anne-Marie Broemeling, Diane E. Watson and Farrah Prebtani explore the management of chronic health conditions as Canada's aging population continues to increase. Chronic conditions are already a daily reality for approximately nine million Canadians, and this number is expected to rise. Prevention and management of chronic conditions are the focus of the Health Council of Canada in its effort to promote discussion of the changes that will be necessary to improve health outcomes for Canadians.

As improved access to healthcare is a popular topic, this issue's Longwoods Review addresses the challenges for healthcare leaders created by the heightened public demand for access improvements. Some challenges include political pressure for shorter wait times, a stretched workforce, overused equipment and facilities and an aging population. Each of these challenges forces healthcare leaders to integrate new management approaches. Jonathan Patrick and Martin L. Puterman highlight the benefits that can be achieved by applying operations research methods to healthcare management in "Reducing Wait Times through Operations Research: Optimizing the Use of Surge Capacity."

All in all, enhancing healthcare models and patient access to treatment is a controversial topic, and there are many factors to consider - as is evidenced by this issue's fascinating articles.

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