A healthcare system is consistently searching for ways to improve its services – whether that be through enhancing the quality of care it provides, increasing patient support services or improving patient satisfaction, among other things. This issue focuses greatly on different methods being used and researched to enhance healthcare.

Marcus J. Hollander, Helena Kadlec, Ramsay Hamdi and Angela Tessaro discuss the costs of healthcare in their article "Increasing Value for Money in the Canadian Healthcare System: New Findings on the Contribution of Primary Care Services." This article explores new findings regarding such services, most notably that a patient requiring higher care can reduce healthcare costs by being attached to a primary care practice versus being attached to a hospital. The authors explain that the decrease in the cost of hospital care creates the majority of the cost reduction per patient.

In "Evaluating Nursing Staff Mix in Long-Term Care: A Comprehensive Framework for Decision-Makers," Alice Kennedy discusses a useful evaluation tool for healthcare managers and administrators. Eastern Health, the largest regional integrated health authority in Newfoundland and Labrador, completed a project that assessed the effectiveness of such an evaluation framework, which was created to determine the impact of decisions regarding nursing staff mix on long-term care. The author explains that the tool is helpful when measuring the comprehensive effects of staff-mix changes and for arranging for additional modifications to human resources.

Maintaining quality of care in the face of a healthcare crisis can be difficult, and authors Andrea Frolic, Anna Kata and Peter Kraus discuss a plan for doing just that in their Healthcare Ethics article "Development of a Critical Care Triage Protocol for Pandemic Influenza: Integrating Ethics, Evidence and Effectiveness." The authors share that it is estimated that at the peak of the possible H1N1 pandemic, infected patients will require 170% of the available intensive care unit beds in Ontario and 117% of the available ventilators. The increase in patients needing hospital care combined with the likelihood that healthcare workers will be infected at a rate nearing 50% higher than that in the general population will result in more patients with less staff – a quality-of-care challenge.

Moriah Ellen, Adalsteinn Brown and Rhonda Cockerill. discuss study results in their article "Do Clinical Practice Guidelines Influence Length of Stay in Ontario Acute Care Hospitals?" Using data from acute care hospitals over two years, the authors completed a follow-up study to a systematic review of literature that described the relationship between the use of clinical practice guidelines and patients' length of stay. The results were not consistent, and this article explores possible reasons and limitations, and provides suggestions for further research.

"Overcoming Barriers When Implementing Evidence at the Bedside" discusses an innovative method to assist with knowledge translation at the bedside. Authors Rebecca Anas and Fabrice Brunet propose a problem-solving model that is adaptable to any environment, with a goal for optimal patient outcomes.

Enhancing quality of care doesn't end at healthcare facilities' doors. "Community Networks in Chronic Disease Management," by Diane Pyne, discusses the establishment of programs and services that support those with chronic conditions. Both profit and not-for-profit organizations are being created to address lifestyle choices and other difficult decisions. Such resources are committed to assist healthcare professionals and the public with health promotion.

"Variability in the Surgical Management of Carpal Tunnel Syndrome: Implications for the Effective Use of Healthcare Resources" describes the results of a study on surgeon use of surgical settings and anesthetic techniques for carpal tunnel release surgery. The setting and technique have not been standardized, and authors Amr ElMaraghy and Moira W. Devereaux share how this can impact patient outcomes and administrative healthcare costs.

This issue's case studies discuss improvements on many levels. "Patient Relations ‘Road Show’ at University Health Network," by Terry Gordon, Erika Sedge and Vasiliki Bakas, reviews the reduction in patient complaints after the establishment of the Patient Relations Department of University Health Network and its introduction of a new approach to improving patient/family member experiences.

The case study discussed by Abdool Z. Karim in "Innovative Technology Conserves Resources and Generates Savings: A Case Study from the Sunnybrook Regional Processing Centre" reviews an updated cleaning and decontamination system. Implemented to assist the regional processing centre at Sunnybrook Health Sciences Centre, the system increased cleaning capacity and reduced costs, water, electricity and chemical use, while improving worker safety and morale.

Enjoy another issue of Healthcare Quarterly as we explore different means to enhance our organizations' quality of care and to increase patient satisfaction.

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