It is always an organization's desire to improve and make adjustments to enhance services provided to others; the healthcare industry is no different. This issue of Healthcare Quarterly explores new methods for working smarter, improving methodologies and enhancing healthcare quality. Here are some highlights from this issue.

Evaluating organizations for ways to improve and change is ever important in today's economy, where we are often asked to do more with less. "Leading Lean: A Canadian Healthcare Leader's Guide" analyzes Lean methodologies and discusses approaches to working smarter as a company. Benjamin Fine, Brian Golden, Rosemary Hannam and Dante Morra report on a study of five Canadian healthcare providers that have implemented Lean. Success stories are shared, and potential obstacles are analyzed for ways they may be overcome in order to provide a better value for healthcare investments.

Jane Coutts and Jennifer Thornhill analyze whether or not two funding models will enhance Canadian healthcare quality. "Pay for performance" and "service-based funding" are two methods becoming increasingly popular internationally and that are certain to have a larger role in Canada in years to come. The reality of these methods caused the Canadian Health Services Research Foundation to organize its third annual CEO Forum, in February 2009, where this topic was discussed in depth.

A fascinating article by Marcus J. Hollander reports on end-of-life care in "Costs of End-of-Life Care: Findings from the Province of Saskatchewan." Studies were conducted on each of the four western provinces (British Columbia, Alberta, Saskatchewan and Manitoba); Saskatchewan focused its analysis on healthcare costs in the two years before death. This article summarizes data on healthcare costs for persons who died in Saskatchewan in 2003-2004.

"Facilitating Innovation in the Clinical Setting: A Pathway for Operationalizing Accountability" describes the pathway developed for managing the introduction of innovative procedures in surgery. A team at The Hospital for Sick Children, in Toronto, Ontario, created this policy-entrenched method that adheres to both ethical and legal standards. A way to manage new methods while preserving the intent of the innovator is much needed in today's industry, and Randi Zlotnick Shaul, Maria McDonald and Jacob C. Langer explore this management technique thoroughly.

As we become more deeply rooted in the economic downturn, resource equity is increasingly important for those providing healthcare services. Vivian Stieda and Barb Colvin analyze the inequalities existing in health information resources across Alberta using data from a survey conducted by SEARCH Custom, Health Knowledge Network and Inter-Regional Research and Evaluation Network. The survey provides empirical evidence as to the nature of existing gaps, and results will be used to support the vision of equitably funded health information for healthcare practitioners in Alberta.

Daune MacGregor, Sandra Parker, Sharon MacMillan, Irene Blais, Eugene Wong, Chris J. Robertson and Cindy Bruce-Barrett provide an interesting review of the Ambulatory Referral Management system (ARMs) in "Innovation in Managing the Referral Process at a Canadian Pediatric Hospital." This web-based system works to improve access to care by enabling the electronic routing for submission, review, triage and management of all outpatient referrals. This article shares how ARMs has informed how processes can be improved to increase access to care.Alice B. Aiken, Mark M. Harrison and John Hope also examine how to improve access to care. They examine the role of the advanced practice physiotherapist (APP) in outpatient orthopedic clinics. APPs have been used in Ontario for five years, and their role is to improve patient access to timely surgical care by reducing wait times for hip and knee replacement surgeries. "Role of the Advanced Practice Physiotherapist in Decreasing Surgical Wait Times" provides an examination of the APP role.

Finally, the accreditation process - often seen as one of the most effective ways to assess and improve an organization - is evaluated. Wendy Nicklin, Gilles Lanteigne and Paula Greco discuss the first year of implementing Accreditation Canada's Qmentum accreditation program, including progress made and challenges encountered, as well as a brief examination of what lies ahead.

Further information on Qmentum is also provided in "New Accreditation Program: University Health Network's Experience with Qmentum," by Anita Tepfers, Christa Hruska, Justin Stone and Jane Moser. This article describes UHN's experience executing Qmentum, as well as lessons learned by the multi-site organization.

I hope you enjoy this issue of Healthcare Quarterly and gain valuable insight into ways to further strengthen your own organization.

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