“Ms. Eve Adams, Member of Parliament for Mississauga-Brampton South,…  today announced support to the Canadian Home Care Association for the development of a policy planning and evaluation tool, called the Home Care Policy Lens.
…
“The Home Care Policy Lens project will help achieve the Canadian Home Care Association’s vision of an integrated system that provides accessible, responsive services which enable people to safely stay in their homes with dignity and independence and quality of life” confirmed Nadine Henningsen, Executive Director, Canadian Home Care Association.

Delivered by the provinces and territories, home care programming provides an array of health and social services which enable clients with various health and functional limitations to live at home, rather than in a hospital or a long-term care facility.”  … continues on the site

More on this – Policy lens to focus integration of home care under development – 26 January 2012 CMAJ 

“In a bid to reduce confusion and disparities in the planning of home care policies across the country, the Canadian Home Care Association (CHCA) is drafting a national framework to outline the role of home care within the health care system.”

… continues on the site

Full text 

Commentary on this from HealthEdition
“LPNs outpace RNs in nursing growth

Over the 2006 to 2010 period the number of licensed practical nurses grew 3.6 times faster than the number of registered nurses, a report from the Canadian Institute for Health Information this week has revealed.”  … continues

by Professor Bryant Stokes AM
ISBN: 978-1-921841-04-0

“Summary

At a time when hospitals are under pressure to improve quality and make productivity savings, they need to find tools to support them. Service-line management (SLM) and service-line reporting (SLR) offer one approach. Service-line management is a system in which a hospital trust is divided into specialist clinical areas that are then managed, by clinicians, as distinct operational units. SLM enables clinicians and managers to plan service activities, set objectives and targets, monitor financial and operational activity and manage performance. Service-line reporting provides the necessary data on financial performance, activity, quality and staffing.

Service-line management: Can it improve quality and efficiency? presents the findings from a series of interviews with staff at seven NHS trusts that are using SLM or SLR, revealing how they are implementing this approach and identifying what helps and what hinders this way of working.

The paper outlines a number of important issues for trusts to consider when introducing SLM.”

… continues on the site

“When a nation or region prepares for public health emergencies such as a pandemic influenza, a large-scale earthquake, or any major disaster scenario in which the health system may be destroyed or stressed to its limits, it is important to describe how standards of care would change due to shortages of critical resources. Crisis standards of care can be defined as the level of health and medical care capable of being delivered during a catastrophic event. Nations and regions need a robust system to provide information to those who are involved in catastrophic events.

At the 17th World Congress on Disaster and Emergency Medicine, held May 31-June 3, 2011, in Beijing, the IOM Forum on Medical and Public Health Preparedness sponsored a session that focused on the promise of and challenges to integrating crisis standards of care principles into international disaster response plans. This document summarizes the workshop.”

“What GAO Found
National Quality Forum (NQF) has made progress on projects under its contract activities, as of August 2011. Specifically, NQF has completed or made progress on 60 of 63 projects. For example, NQF has completed projects to endorse measures related to various topics, including nursing homes. However, for more than half of the projects, NQF did not meet or did not expect to meet the initial time frames approved by HHS.”  … continues

“GAO recommends HHS: (1) use all monitoring tools required under the contract to help address NQF’s performance, (2) complete testing of retooled measures, and (3) comprehensively plan for its quality measurement needs. HHS neither agreed nor disagreed with these recommendations.”

“To celebrate Research4Life’s 10th anniversary in 2011, we launched a user experience competition. We asked users to share with us how HINARI, AGORA or OARE has improved their work, life and community. In total we received some 60 entries from countries in all five continents. This impressive array of inspiring testimonies revealed a wealth of positive impacts brought about by Research4Life. This book celebrates the stories behind some of these competition entries.

This illuminating series of case studies provides insights into how access to the results of peer-reviewed research from Research4Life publisher partners is benefiting the health, well-being, and economic and social development of communities in the developing world, as well as contributing to greater environmental health and awareness.”

… continues on the site

by The Association of Breast Surgery, the British Association of Plastic and Reconstructive Aesthetic Surgeons, the British Association of Aesthetic Plastic Surgeons, the Federation of Surgical Speciality Associations and the Royal College of Surgeons

Media release
“Authoritative new professional and patient guidance for all women who have received a PIP breast implant has been released today (Tuesday, 17 Jan 2012) by the professional bodies representing surgeons. The new guidance provides patients with practical advice on what to expect and their rights, indicates to GPs where to refer different groups of patient and advises surgeons on treatment. The guidance goes beyond current government advice aimed at patients with symptoms to give additional practical advice for the majority of patients who do not. Key points include:”

… continues on the site

“This document is the initial issue of the Joint Plan of works to be undertaken by the Department of Health Informatics Directorate (DHID) and Intellect. The objective of the Joint Plan is to foster the right conditions to enable a healthy and vibrant healthcare IT market for the benefit of NHS organisations, the IT supplier community and patients and public alike.

This joint plan has been developed by discussions held between DHID Head of Industry Liaison, and Intellect Health Programme Manager, and updated to reflect input received from the wider stakeholder community following a consultation period ending 30th November 2011.”
…
“The objective of the joint plan is to foster the right conditions to enable a healthy and vibrant healthcare IT market within England for the benefit of Patients and the Public, as well as the NHS and Adult Social Care staff who care for them.”

Media report on this from HealthTech Wire and the Guardian

by Malcolm Williams, Tamara Dubowitz, Dawn Jacobson, Kristin J. Leuschner, Lisa Miyashiro, Elizabeth D. Steiner, Margaret M. Weden

“To determine whether the services they provide are meeting population needs, local health departments (LHDs) use a variety of formal and informal assessments, including community health assessments and communitywide health-improvement plans. Despite these efforts, the services do not always meet the needs, for a variety of reasons, including competing funding priorities, political mandates, and natural shifts in population makeup and health concerns. Geographic information system (GIS) mapping software provides a promising tool to enhance priority-setting and resource allocation for LHDs by displaying complex geospatial information in an integrated and visual way, enabling staff to compare the geographic distribution of population health in a community (i.e., where services are needed) with the geographic distribution of LHD programs and expenditures (i.e., where services are provided). Using such an approach, LHDs can identify gaps between program services and community health needs. This report presents findings from interviews with 65 staff at four LHDs and three case studies to test potential solutions for how maps can be used to address the gaps between public health needs and LHD services. It describes options for accessing easy-to-use, no-cost GIS data and tools and suggests ways in which LHDs can integrate new GIS approaches into their activities.”

Available in:  English (PDF), 2.3 MB
By Sonja Kahlmeier, Nick Cavill, Hywell Dinsdale, Harry Rutter, Thomas Götschi, Charlie Foster, Paul Kelly, Dushy Clarke, Pekka Oja, Richard Fordham, Dave Stone and Francesca Racioppi      39 pages     ISBN 978 92 890 0251 6

“The promotion of cycling and walking for everyday physical activity not only promotes health but can also have positive effects on the environment.

This booklet summarizes the tools and guidance developed to facilitate this shift: the methodology for the economic assessment of transport infrastructure and policies in relation to the health effects of walking and cycling; systematic reviews of the economic and health literature; and guidance on applying the health economic assessment tools and the principles underlying it.

This methodology and user guide will be of key interest to professionals at both national and local levels: transport planners, traffic engineers, and special interest groups working on transport, walking, cycling or the environment, as well as health economists, physical activity experts and health promotion experts.”

“Chicago –The American Medical Association (AMA) released three online educational tutorials today to help physician practices better implement health information technology (health IT).

“Physician practices may need to redesign and reorganize their office routines so that they can successfully and efficiently adopt health IT,” said AMA President Peter W. Carmel, M.D. “The AMA created these tutorials to help physicians understand how to best implement new technologies, such as ePrescribing, into their practices.”

This series of short video tutorials feature downloadable tools and best practices about health IT for physician practices. The tutorials will provide physicians with guidance on how they might better use health IT in their practices.

The three tutorials cover ePrescribing, pre-visit planning and point-of-care documentation. The first tutorial explains the value of ePrescribing and the quality, safety, and efficiency of ePrescribing compared to handwritten prescriptions. The tutorial also allows physicians to identify opportunities for medication management improvement while enhancing physician and patient convenience.

The pre-visit planning tutorial will help physician practices to establish a pre-visit planning structure that provides full patient information to the physician before the patient arrives. This can create new efficiencies that will allow more time for patient-physician interaction and shorter patient wait times. The point-of-care documentation tutorial addresses decisions regarding the type of hardware used during an office visit. The tutorial also helps physician practices understand the type and format of information that should be entered during a visit.

These activities have been certified for AMA PRA Category 1 Credit™. To view the tutorials, visit www.ama-cmeonline.com/health_it_workflow.”

Text taken from an email alert from the Institute of Medicine

“As obesity continues to diminish the quality of people’s lives and raise health care costs, the Institute of Medicine is pleased to join HBO, the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), the Michael & Susan Dell Foundation, and Kaiser Permanente in developing “The Weight of the Nation,” a new national campaign tackling the obesity crisis.

The Weight of the Nation will shed new light on the facts and myths of this urgent public health issue and explore how obesity is impacting our nation and the health care system. This multipronged project will feature a series of four documentary films, a three-part HBO Family series, 14 bonus short films, a social media campaign, a companion book, and a nationwide community-based outreach campaign. The four-part documentary series — which HBO announced will air May 14 and 15 — and other facets of the initiative were developed with expert input from IOM as well as CDC and NIH.”

Author: Alan Painter, Policy Horizons Canada

Document Type: Issue Brief

“There is currently an opportunity to work with the research community within and outside the federal government to increase the benefits flowing from research funded by the federal government and its partners.

Several recent federal commitments support increasing access to research results:

•The 2007 Federal S&T Strategy included a commitment to increase accountability to Canadians by improving measurement and reporting on the impacts of federal expenditures on research. A follow-up study concluded that it would be useful to have externally-funded researchers report impacts as a matter of course.
•The federal academic research granting agencies adopted as a guiding principle in 2010 that publicly funded research should be as accessible as possible in order to maximize the economic, social, cultural and health benefits for Canadians.
•The March 2011 Open Government announcement included a commitment to making government information easier to find and more accessible for Canadians.

The Canadian research community is exploring news ways of making its research results available to other researchers, Canadians generally and the world at large.2 A 2011 synthesis paper funded by the Social Sciences and Humanities Research Council as part of its support for research in digital economy offers a broad vision of how to renovate the research process and describes Canadian innovations in digital academic publication.3 The paper also provides examples of how the federal granting agencies are developing policies and programming that support open access to the results of research. Similar discussions and initiatives are underway in other countries: see, for example, discussions on the London School of Economics blog (LSE)4, “Impact of Social Sciences”.

Researchers led by John Houghton from Australia have been exploring the costs and benefits of alternative approaches to publishing research results. Various approaches have been systematically compared to the status quo for the cases of the UK, the Netherlands, Denmark, Germany, and the US. To ensure that meaningful comparisons could be made, all of the approaches explored included the peer review, certification, and quality control functions necessary for formal scholarly publishing.

… continues on the site

Full text of the report 

“HEART UK, the Cholesterol Charity, has today called on all NHS Trusts to offer cardiac rehabilitation services to patients more vigorously following the launch of a report highlighting the shocking inequalities in treatment after a heart attack in England.

The cardiac rehabilitation report, entitled ‘After the event: getting care right for patients after a heart attack’, found that 2,100 patients across England are not being offered cardiac rehabilitation despite the clear benefits of the service in improving patient experience and outcomes from the disease.

HEART UK Chief Executive Jules Payne said: “It is encouraging that many patients are offered cardiac rehabilitation after they have had a heart attack but the variation in uptake across the country is unacceptable. Action is needed on both a national and local level to ensure that all patients are offered this service to help them to recover and return to normal life as soon as possible after their heart attack.”

… continues on the site

“Members of the public and all interested parties are invited to make submissions on the Draft Pricing Framework, released on 16 January 2012 by the Independent Hospital Pricing Authority (IHPA).

IHPA was established in December 2011 to determine the National Efficient Price (NEP) for public hospital services.

The Draft Pricing Framework is a key strategic document for the newly formed Authority. It will guide the Authority in setting a NEP for public hospital services, including the determination of:

The principles to be used by the Authority in determining the NEP
The scope of public hospital services eligible for Commonwealth Government activity based funding under the National Health Reform Agreement
The criteria for services to be funded by blocks grants
The methodology to be used to price services that are provided to private patients in public hospitals

Submissions gathered in this public consultation process will be used to help inform IHPA’s final Pricing Framework.”

Media release 

Extract:

“There are “real and present” risks to the independence of the voluntary sector, with support for disadvantaged groups under particular threat, warns the Panel on the Independence of the Voluntary Sector in the first of five annual assessments published today, pointing to the Work Programme as an important example.

Threats to the three aspects of voluntary sector independence – of purpose, voice and action – have existed for some time, says the Panel, but have been considerably heightened by cuts in public spending and other income, and the way in which contracts are awarded. This means that some organisations have to choose between closure and agreeing to sub-optimal delivery. 2012 will be a crucial year, the Panel’s assessment says.

The Panel, which has created a Barometer to measure voluntary sector independence, points to six major challenges:

The effects of a contract model which favours large, often private sector, organisations and can be unnecessarily restrictive
The inability of the voluntary sector to influence service design and delivery or funding models
The blurring of boundaries between public, for profit and voluntary sectors, which may mask important differences and dilute independence
Pressure for self-censorship, with some organisations fearful of using their voice
Pressure on independent governance, as trustees seek to balance survival and independence
Regulation and safeguards for independence that may not be sufficiently robust.”

Media release 

“The Australian Government is seeking public opinion on the draft Ten Year Roadmap for National Mental Health Reform (PDF 2156 KB) (the Roadmap) via an online survey. The Roadmap is a key component of the Australian Government’s Delivering National Mental Health Reform Package of the 2011-12 Budget, and the draft has been developed with states and territories, informed by input from mental health experts, including mental health consumers and carers. The survey will be available from 16 January 2012 until 7pm AEDST 1 February 2012.”

“The WHO Growth Chart Training Program is an evidence-based, self-learning package designed for primary care and public health practitioners. It has been developed through a collaboration led by Dietitians of Canada and includes the Canadian Paediatric Society, the College of Family Physicians of Canada, Community Health Nurses of Canada, National Aboriginal Health Organization, Canadian Obesity Network and NutriSTEP®. Reviewer reference groups from each professional collaborating organization, as well as provincial/territorial representatives responsible for implementation of the WHO Growth Charts within their jurisdictions, helped to shape this training program.

THERE IS NO FEE for this program. Dietitians of Canada gratefully acknowledges funding for this project made possible through a contribution from the Public Health Agency of Canada (PHAC). The views expressed in the training package do not necessarily represent the views of PHAC.

There are 5 modules in the training package, each with the following features:

•An automated power point video with voice over instruction
•Evidence-based practice guidance
•Case scenarios and/or reflective practice questions to facilitate application of the module content to practice
•Pre-and post self-scoring knowledge evaluation
•Self-scoring “pop” quizzes throughout each module
•References and resources for further study
•A personal certificate of completion of each module
•Opportunity to provide feedback on the module
Each module takes approximately 45-60 minutes to complete at a time, place and pace convenient for you. While it is recommended that you use all of the training modules in sequence, the package is designed so that you can select those modules that you feel are most relevant to your learning needs.”

Module 1 – Introduction to the WHO Growth Charts
Module 2 – Monitoring Growth: Measurements and Calculations
Module 3 – Interpreting the WHO Growth Charts
Module 4 – Childhood Obesity
Module 5 – Counselling to Promote Healthy Growth and Development

“In June 2011, the Department of Health issued a Call for Evidence and Ideas about how the adoption and diffusion of innovations can be accelerated across the NHS. This was part of the NHS Chief Executive‘s Review of Innovation in the NHS. This report is a summary of the responses submitted to the Call for Evidence which was carried out by the Young Foundation on behalf of the Department of Health.”

by Gagnon, Marie-Pierre

“Key messages
■Health technology assessment (HTA) is a multidisciplinary area of applied research that produces high quality information about health technologies—drugs, medical technologies and health interventions. The HTA produces recommendations on whether a health technology should be considered, funded and adopted into practice. The goal is to use the research and recommendations from the HTA to inform decisions that will improve quality and cost-effectiveness of healthcare.
■In Canada, there are several well-established agencies at the national and provincial levels that successfully perform HTA. More and more, however, HTA units are being implemented in a local/ hospital-based setting, based on a growing awareness that the local context needs to be taken into account when assessing health technologies.
■Four different models for performing local/hospital-based HTA have been identified and are currently in use world-wide: the ambassador model; mini-HTA; internal committee; and HTA unit. Each has its own strengths and weaknesses. There is insufficient evidence available to adequately assess which of these models would be the best for Canadian hospitals.
■Research shows that local/hospital-based HTA may influence decision-making. There are reports from isolated experiences related to local/hospital-based HTA on hospital decisions and budgets, as well as positive perceptions from managers and clinicians.
■It is difficult to evaluate the overall impacts of HTA on the various levels of healthcare delivery, largely because most hospital-based HTA experiences are recent and there is a paucity of data. Further research is necessary to explore the conditions under which local/hospital-based HTA results and recommendations can have an impact on hospital policies, clinical decisions and quality of patient care.
■The potential exists to share expertise and methodologies between local/hospital-based HTA units. However, there are challenges in directly transferring research knowledge from one organization to another, given the specificity of the context from hospital to hospital.”

by  Mable, Ann L.; Marriott, John

“The key findings for decision-makers on the current state of Canadian primary healthcare (PHC) policies, and the perceptions thereof, offer insights for renewed direction and action.

■All jurisdictions have maintained some focus on PHC policy. Although the extent and complexity of PHC application varies, the glass is half-full, not half-empty.
■The combined information that can be found about PHC at the federal, provincial and territorial levels provides a foundation of PHC policy direction that could be built upon for a more cohesive PHC strategy across Canada.
■The many links between current PHC activity and work done under prior national initiatives confirm the continuity and legitimacy of direction that, in turn, strengthen the foundations for current PHC reform.
■The system would benefit from renewal of an overarching framework for PHC reform across Canada to provide guidance and a reference point for aligning with principles and objectives and understanding progress.
■Different PHC delivery models, elements and capacity building—many showing considerable innovation—have emerged in jurisdictions across Canada. Their successes should be showcased and problems addressed from a high level to recognize good work and relieve pressures on the ground.
■Given the diverse activity under way and issues of clarity about and between primary healthcare and primary care, there is a perception by key informants of a lack of coherence in reform across Canada.
■Continued tensions between old and new ways of care delivery are affecting PHC reform progress at all levels and require resolution if reform is to achieve desired goals.
■Despite good work under way, the situation is not well served by the unsatisfactory state of data, lack of interoperable information systems and insufficient available research across the country.”

by Brasset-Latulippe, Anne; Verma, Jennifer; Mulvale, Gillian; Barclay, Kevin

“It is estimated that nearly 16 million Canadians, almost every other one of us, is living with a chronic condition. There are approximately nine million Canadians living with at least one of seven “high-impact, high-prevalence” chronic illnesses. As the population ages so does the increase in prevalence with a majority of Canadian seniors over the age of 65 reporting at least one chronic illness. Chronic illnesses have become a serious economic burden, with total direct medical costs and indirect productivity losses surpassing $93 billion a year. The importance of addressing these costs cannot be overstated. Even more staggering is the number of lives claimed by chronic illnesses–nearly three quarters of all deaths in Canada arise from only four types of chronic disease.iv Our international ranking when it comes to addressing chronic care delivery in primary care is no better–Canada ranked last out of seven countries.

Publicly-funded healthcare in Canada was largely designed to treat acute episodes of illness, not chronic conditions. Public health insurance plans, collectively referred to as medicare, primarily cover medically necessary hospital and physician services. Overall, the healthcare system in Canada is comprised of 14 healthcare systems – 10 provincial, three territorial and one federal. A recent assessment by the Canadian Academy of Health Sciences reported major gaps between the current functioning of the healthcare system and the needs of patients with chronic diseases. Simply put, healthcare in this country was not designed to meet the care needs of those living with a chronic condition, let alone of those living with multiple chronic conditions.

A more active and organized response for the management of chronic diseases in Canada is needed…”

by Brasset-Latulippe, Anne; Verma, Jennifer; Mulvale, Gillian; Barclay, Kevin

“Healthcare in Canada is decentralized into 14 health systems—13 provinces and territories and the Federal Government. Each of these involves a mixture of urban, rural and remote settings, all facing competing priorities and constrained budgets. A recent analysis shows that health spending is rising faster than the rate of economic growth.i In this context, along with the approaching expiry of the 10-Year Plan to Strengthen Health Care (2004), the Canadian Health Services Research Foundation (CHSRF) recognizes that this is a critical time to examine questions of health system sustainability, accessibility, quality and responsiveness.

As such, CHSRF undertook an environmental scan to explore the shared values and principles, goals and key health policy issues across provinces and territories. The scan used a framework analysis approach,ii examining strategic planning documents for the period of 2008-2011 that were available during the analysis—February-March 2011. At the same time, CHSRF consulted with senior policy-makers across provinces and territories in ministries of health, intergovernmental affairs and finance. This summary presents key findings from the framework analysis and face-to-face meetings.”

KT casebook Volume 2 2011

“This Casebook, the second in a series produced by Alberta Innovates – Health Solutions, showcases knowledge translation activities of the Interdisciplinary Team Grant program. The program was launched in 2008 to support research addressing complex health problems. Co-funded by Alberta Health and Wellness and Alberta Innovates – Health Solutions, the program provides $50 million over fi ve years for 10 teams. The teams are interdisciplinary and multi institutional and include nearly 600 researchers and 160 trainees, and support 147 international collaborations. Research activities of the teams cover the spectrum of basic biomedical, clinical, health services, and population health research and all encompass an integrated KT approach.

The teams have already made notable gains on all measures of knowledge translation”

… continues

QIPP Right Care Team: Muir Gray, Simon Swift, Mehrunisha Suleman East Midlands SHA: Nigel Beasley, Donna Hakes and Malcolm Qualie London SHA: Andy Mitchell, Sue Dutch
Edited by:Edited by: Mehrunisha Suleman

Executive Summary

“The aim of this report has been to make recommendations for consideration by the NHS Operations Board with regard to effective commissioning of elective surgical procedures. The work was commissioned by Professor Sir Bruce Keogh, NHS Medical Director, following widespread expressions of concern from professional bodies that approaches based on lists of procedures deemed to be of ‘limited effectiveness’, ‘lowvalue’ or requiring a ‘threshold’ result in inequitable patterns of service delivery. The evidence base for such approaches are not thought to be sufficiently robust, and in many cases procedures with well‐established evidence of effectiveness, such as cataracts or arthroplasty, have been included.

The paper draws on discussions held between clinicians and commissioners in two SHAs (London and East Midlands). It establishes principles of  ommissioning which support fully informed shared‐decision making that takes into consideration patients individual circumstances, and ensures that they receive appropriate interventions by suitably skilled individuals in line with widely agreed, nationally endorsed pathways of care. It emphasizes the importance of the care pathways rather than individual procedures, and the requirement for audit of points on the pathway against set standards.”

Full text online 

“In 2010, the IOM released a report that found that, among other things, data not being reported by sex had slowed progress in women’s health. The number of women participating in clinical trials has increased over the last two decades, though they are still underrepresented. Even when women are included in these trials, however, the results are often not analyzed separately by sex.

On August 30, 2011, the IOM’s Board on Population Health and Public Health Practice hosted a workshop to address the recommendation in Women’s Health Research: Progress, Pitfalls, and Promise that journals should adopt a guideline that, where appropriate, articles report the outcomes of clinical trials report on men and women separately. The workshop focus went beyond clinical trials, to look at sex-specific reporting in all types of scientific research. Speakers at the workshop discussed the need for sex-specific reporting, potential barriers to such reporting, as well as what must be done to report sex-specific results. This document summarizes the workshop.”

Discussion Paper by Genevieve Howse
ISBN 978-1-921889-17-2

“This paper explains the options available for Australian governments to articulate and allocate responsibilities for the health and health care of Aboriginal and Torres Strait Islander people in an enduring, reliable form. It was commissioned by the Lowitja Institute – Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research in response to widespread recognition of problems in the policy and administrative arrangements for health and health care for Australia’s First Peoples, including lack of clarity about the responsibilities of governments at various levels.”

“Context: Policymakers seeking to introduce expensive national eHealth programs would be advised to study lessons from elsewhere. But these lessons are unclear, partly because a paradigm war (controlled experiment versus interpretive case study) is raging. England’s $20.6 billion National Programme for Information Technology (NPfIT) ran from 2003 to 2010, but its overall success was limited. Although case study evaluations were published, policymakers appeared to overlook many of their recommendations and persisted with some of the NPfIT’s most criticized components and implementation methods.

Methods: In this reflective analysis, illustrated by a case fragment from the NPfIT, we apply ideas from Ludwig Wittgenstein’s postanalytic philosophy to justify the place of the “n of 1” case study and consider why those in charge of national eHealth programs appear reluctant to learn from such studies.

Findings: National eHealth programs unfold as they do partly because no one fully understands what is going on. They fail when this lack of understanding becomes critical to the programs’ mission. Detailed analyses of the fortunes of individual programs, articulated in such a way as to illuminate the contextualized talk and action (“language games”) of multiple stakeholders, offer unique and important insights. Such accounts, portrayals rather than models, deliver neither statistical generalization (as with experiments) nor theoretical generalization (as with multisite case comparisons or realist evaluations). But they do provide the facility for heuristic generalization (i.e., to achieve a clearer understanding of what is going on), thereby enabling more productive debate about eHealth programs’ complex, interdependent social practices. A national eHealth program is best conceptualized not as a blueprint and implementation plan for a state-of-the-art technical system but as a series of overlapping, conflicting, and mutually misunderstood language games that combine to produce a situation of ambiguity, paradox, incompleteness, and confusion. But going beyond technical “solutions” and engaging with these language games would clash with the bounded rationality that policymakers typically employ to make their eHealth programs manageable. This may explain their limited and contained response to the nuanced messages of in-depth case study reports.

Conclusion: The complexity of contemporary health care, combined with the multiple stakeholders in large technology initiatives, means that national eHealth programs require considerably more thinking through than has sometimes occurred. We need fewer grand plans and more learning communities. The onus, therefore, is on academics to develop ways of drawing judiciously on the richness of case studies to inform and influence eHealth policy, which necessarily occurs in a simplified decision environment.”

“The NHS is facing a period of financial constraint, with providers charged with delivering four per cent efficiency savings per year up until 2015. While this can be seen as an opportunity to stimulate NHS providers to think differently about how they work to deliver services and to extract the necessary efficiencies, the scale of the challenge is unprecedented.

Against this backdrop, the Nuffield Trust commissioned a study into the factors known to impact on hospital efficiency. The resulting report, Can NHS hospitals do more with less?, by Jeremy Hurst and Sally Williams, draws on a review of UK and international research studies and a survey of senior managers and clinicians at NHS trusts.

The report contains recommendations on how hospitals can increase efficiency. It identifies the key determinants of technical efficiency in hospitals, which include: leadership, management and staff engagement; technology adoption; hospital operational processes; staff productivity; and the external policy environment.”

… continues

Media release: New Guidelines to Control Group A Streptococcal (GAS) Infections in UK Hospitals Launched – 10 January 2012

“The Health Protection Agency (HPA) together with the group A streptococcal (GAS) Working Group* has today launched new guidelines for the investigation, control and prevention of GAS infection in acute healthcare settings, including maternity units, in the UK.”   … continues

… continues

This publication is designed to assist NHS boards and audit committees as they review and continually reassess their system of governance, risk management and internal control to ensure that it remains effective and ‘fit for purpose’ in providing them with the assurance they require.
ISBN 978-1-904624-60-8

About this:  New approach to education and training published 

“The policy framework for a new approach to workforce planning and the education and training of the health workforce is published today.

It puts employers and professionals in the driving seat and gives them the national support they need to identify and anticipate the key workforce challenges, and to be flexible and responsive in planning and developing their workforce. The Department of Health believes these provider-led arrangements offer the best assurance for future-proofing the way the health and public health workforce is developed.

Liberating the NHS: Developing the Healthcare Workforce builds on responses to earlier public consultations and the advice of the NHS Future Forum.

There are two central planks to the new system – Health Education England (HEE) and the Local Education and Training Boards (LETBs).”

… continues on the site

“On December 14, 2011, the Centers for Medicare & Medicaid Services (CMS) awarded $218 million to 26 State, regional and national hospital system organizations to serve as Hospital Engagement Networks.  The contracts were part of the Partnership for Patients, a nationwide public-private collaboration sponsored by the U.S. Department of Health and Human Services (HHS), to keep patients from being harmed while in the hospital and heal without complication once they are discharged.

The Hospital Engagement Networks’ will be funded as part of the $500 million Partnership for Patients initiative from the Centers for Medicare & Medicaid Services Innovation Center.  The Center was established by the Affordable Care Act to identify and develop promising new models of care delivery to reduce costs and increase quality.”

News release

AHRQ = US Agency for Healthcare Research and Quality
 
“This guide presents step-by-step instructions that can be used by hospitals in planning and implementing patient flow improvement strategies to ease emergency department crowding.

Contents
Acknowledgments
Executive Summary
Section 1. The Need to Address Emergency Department Crowding
Section 2. Forming a Patient Flow Team
Section 3. Measuring Emergency Department Performance
Section 4. Identifying Strategies
Section 5. Preparing to Launch
Section 6. Facilitating Change and Anticipating Challenges
Section 7. Sharing Results
References
Appendix A: Guide to Online Resources Successfully Used by Hospitals to Improve Patient Flow
Appendix B: Implementation Plan Template
Appendix C: Example Implementation Plan
Appendix D: Additional Readings”

McHugh, M., Van Dyke, K., McClelland M., Moss D. Improving Patient Flow and Reducing Emergency Department Crowding: A Guide for Hospitals. (Prepared by the Health Research & Educational Trust, an affiliate of the American Hospital Association, under contract 290-200-600022, Task Order No. 6). AHRQ Publication No. 11(12)-0094, October 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/ptflow/

Clostridium difficile Infections: Diagnosis, Treatment, and Prevention. Clinician Summary – AHRQ – 19 December 2011

Treating and Preventing C-diff Infections: A Review of the Research for Adults and Their Caregivers. Consumer Summary – AHRQ – 19 December 2011

Clostridium difficile Infections: Diagnosis, Treatment, and Prevention – CME Activity

Clostridium difficile Infections: Diagnosis, Treatment, and Prevention – Slides

Lorincz CY, Drazen E, Sokol PE, Neerukonda KV, Metzger J, Toepp MC, Maul L, Classen DC, Wynia MK.
Research in Ambulatory Patient Safety 2000–2010: A 10-Year Review. American Medical Association,
Chicago IL 2011.

Alcohol guidelines inquiry site 

Media release 9 January 2012

Media release

Department of Health [England] statement on breast implants and response to expert group report – 6 January 2012

“The focus of the work programme of the National Imaging Clinical Advisory Group (NICAG) led by Professor Erika Denton, National Clinical Director for Imaging is to improve the quality of services, and enhance the patient experience and outcomes.

This document will contribute towards the wider work around how routine seven day working could be introduced successfully across the NHS.”

“Summary

Hospital incident reporting systems captured only an estimated 14 percent of the patient harm events experienced by Medicare beneficiaries. Hospitals investigated those reported events that they considered most likely to lead to quality and safety improvements and made few policy or practice changes as a result of reported events. Hospital administrators classified the remaining events (86 percent) as either events that staff did not perceive as reportable (61 percent) or as events that staff commonly report but did not report in this case (25 percent).

As a condition of participation in the Medicare program, Federal regulations require that hospitals develop and maintain a Quality Assessment and Performance Improvement (QAPI) program. To satisfy QAPI requirements, hospitals must “track medical errors and adverse patient events, analyze their causes, and implement preventive actions and mechanisms that include feedback and learning throughout the hospital.” To standardize hospital event reporting, AHRQ developed a set of event definitions and incident reporting tools known as the Common Formats. We requested and reviewed incident reports from hospitals regarding patient harm events. We had previously identified these events from a nationally representative sample of Medicare beneficiaries discharged in October 2008.

All of the hospitals we reviewed had incident reporting systems designed to capture events; hospital administrators we interviewed indicated that they rely heavily on the systems to identify problems. Hospital accreditors reported that they do not investigate event collection methods, such as incident reporting systems, unless evidence of a problem emerges through the survey process.

Because hospitals rely on incident reporting systems to track and analyze events, improving the usefulness of these systems is critical to hospitals’ efforts to improve patient safety.

Therefore, we recommend that AHRQ and CMS collaborate to create and promote a list of potentially reportable events for hospitals to use. We further recommend that CMS provide guidance to accreditors regarding their assessments of hospital efforts to track and analyze events. CMS should also suggest that surveyors evaluate the information collected by hospitals using AHRQ’s Common Formats. Additionally, CMS should scrutinize survey standards for assessing hospital compliance with the requirement to track and analyze events and reinforce assessment of incident reporting systems as a key tool to improve event tracking.”

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“The Chronic Disease Control Division is responsible for the development, implementation and evaluation of provincial policies and programs related to chronic disease prevention and management in Newfoundland and Labrador. Improving Health Together: A Policy Framework for Chronic Disease Prevention and Management in Newfoundland and Labrador  sets the direction for action by all partners including government, community groups, employers, the health system, and individuals.”

“Health Minister Don McMorris released Saskatchewan’s Health Human Resources Plan on December 21, 2011. 

The guide will inform health workforce strategies and policies of the province, health regions, educational institutes and other stakeholders over the next 10 years.

The plan focuses on four key goals for the health workforce: patient- and family-centred care providers; collaborative, interprofessional practices; positive, productive and safe workplaces; and a sufficient number and mix of health care providers.”

“Formal accreditation procedures and standards are the primary means for ensuring the IAPT workforce is capable of delivering NICE approved therapies appropriately and effectively. Advice has been produced which identifies the relevant professional bodies involved in the accreditation of IAPT approved therapies and summarises their accreditation requirements.

The advice is intended primarily for commissioners of either psychological therapy services or education and training programmes. It should be read in conjunction with the ‘Guidance for Commissioning IAPT Training 2011/12 – 2014/15′ (available at http://www.iapt.nhs.uk/workforce/iapt-education-training-and-development/) which outlines the role of Multi Professional Education and Training (MPET) funding in relation to IAPT. The information should also be of use to HEIs and individual practitioners and therapists. Similarly, mental health charities and individual patients or clients might also find the information helpful in identifying therapists who have been trained on an IAPT commissioned course and whether they have joined a voluntary register indicating the nature of their training and possibly, in some cases, fitness to practice.”

Start: Jan 6, 2012 End: Mar 30, 2012 Results Published: Jun 30, 2012

“Consultation summary:
 
The General Medical Council (GMC) is proposing new arrangements for recognising and approving trainers and in particular:

a.  named educational supervisors
b.  named clinical supervisors
c.  lead coordinators of undergraduate training
d.  doctors responsible for overseeing students’ educational progress.

We will use our existing standards structured into seven areas. Local education providers such as hospitals and general practices would use the seven areas to show how they identify, train and appraise these trainers. Postgraduate deaneries and medical schools would then use that information to show the GMC what local arrangements are in place to meet our standards.

Why the consultation should matter to you”

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“The current legal status of assisted dying is inadequate and incoherent…”

ISBN   978-1-906693-92-3

“The Commission on Assisted Dying, launched in November 2010, was set up to consider whether the current legal and policy approach to assisted dying in England and Wales is fit for purpose. In addition to evaluating the strengths and weaknesses of the legal status quo, the Commission also set out to explore the question of what a framework for assisted dying might look like, if such a system were to be implemented in the UK, and what approach might be most acceptable to health and social care professionals and to the general public.

The Commission, chaired by Lord Falconer, includes members with expertise in law, medicine, social care, mental health, palliative care, theology, disability and policing. The Commission engaged in a wide-ranging inquiry into the subject, including a public call for evidence which received over 1,200 responses, public evidence hearings, international research visits, and original and commissioned research on the issues surrounding assisted dying.

In this report, the Commission concludes that the current legal status of assisted suicide is inadequate and incoherent. While the current legal regime can be distressing for the people affected and their families, it is also unclear for health and social care staff, and lays a deeply challenging burden on police and prosecutors, which could be eased by a new statutory framework. A proposed legal framework for assisted dying is laid out in detail in the report, including strict criteria to define who might be eligible to receive assistance and robust safeguards to prevent abuse of any new law.

Based on the evidence received, the Commission considers that substantial improvements to health and social care services would be needed in parallel with changes to the law to permit assisted dying. It proposes that the role of any future assisted dying legislation must be to provide all people with access to high quality end of life care and protect potentially vulnerable people from any form of social pressure to end their lives, at the same time as providing people with greater choice and control regarding how and when they die.”

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“The Royal College of Nursing has said that assaults on nursing staff are completely unacceptable, as new survey findings show that over 60 per cent of nurses working in the community have been subjected to abuse in the past two years.”

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“An initial Joint Plan from the Department of Health Informatics Directorate and industry body Intellect is supporting efforts to create the best conditions for the healthcare IT market to flourish. (Published: 05 January 2012)

This new partnership with Intellect, which represents IT suppliers, was announced on 22 September 2011. A draft Joint Plan, setting out objectives, principles, key initiatives and workstreams, was later published for consultation in November 2011.

Now the first version of the plan has been agreed, incorporating feedback from stakeholders. This is available alongside raw data on systems and services in use within the NHS.”

“Why should major breast surgery be an inpatient procedure?

• It’s a relatively short operation
• Low post operative pain
• Patients can mobilise, eat anddrink early
• Rare post operative events
• Patients want to return to normal life as quickly as possible.

In 2007, NHS Improvement Transforming Inpatient Care Programme as part of the Cancer Reform Strategy (2007) and recently the Improving Cancer Outcomes Strategy (2011) redesigned the breast care surgical pathway (excluding reconstruction) with the working hypothesis that:
“Streamlining of the breast surgical pathway could reduce length of stay by 50% and release 25% of unnecessary bed days for 80% of major breast surgery (excluding reconstruction).” “

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