(OMN1a) Omnibus I: Healthcare Systems and Delivery
Tuesday Jun 18 3:30 pm to 5:00 pm (Eastern Daylight Time)
Trottier Building - ENGTR 2120
Session Code: OMN1a
Session Format: Paper Presentations
Session Language: English
Research Cluster Affiliation: Not Applicable
Session Categories: In-person Session
This panel critically examines health care systems and delivery, focusing on the powerful phenomena of waiting for sexual and reproductive health care, the WHO’s shifting discursive commitment to traditional medicine, a critical look at digital health records in Canadian long-term care facilities, and improving care in rural emergency departments. Tags: Equality and Inequality, Health and Care, Policy
Organizers: Katelin Albert, University of Victoria, Sherry Fox, CSA; Chair: Katelin Albert, University of Victoria
Presentations
Katelin Albert, University of Victoria; Vera Caine, University of Victoria
We all wait throughout our lives, although mostly ordinarily. However, waiting for health care is extraordinary, yet also expected and normalized in health care (Fogarty and Cronin, 2008). Exceptionally long medical wait times are defining characteristics of Canada’s health care system (Kelly, 2022). The median wait time in Canada for medical treatment is 27.4 weeks. This is the longest it has ever been in Canada; it ranges from around 51 days to 271 days, depending on the province and the care required (Moir and Barua, 2022). When people seek care, they wait: for appointments, diagnosis, specialist care, results, surgery, and answers. As a social phenomenon, waiting is not neutral – it shapes the lives of those accessing care, is imbued with power, inequality, structural violence (Anderson, 2014), and is filled with expectations and responsibilities that are gendered, normative, and cultural (Dewart et al., 2021). It is also relational, with other people and institutions, shaping the social organization of many aspects and domains of life. When people wait, they are in a complicated state of stasis, suspension, but also active waiting. Those waiting may imagine future possibilities, consider who and what they are waiting for, and are living in precarity where their lives are marked by suspension (Llewellyn and Higgs, 2021). Despite the centrality of waiting in health care, it is an underexplored aspect of research (Dewart et al., 2021). In this paper, we explore the phenomenon of waiting for health care. Bringing together diverse interdisciplinary literatures on waiting and insights from our own research, we i) provide an overview of what we know about experiences of waiting for health care, and ii) offer our thoughts on some theoretical and methodological considerations for future research in this area.
Nadine Ijaz, Carleton University
Traditional medicine (TM) refers to the wide range of Indigenous, ethnomedical and otherwise non-biomedical therapeutic systems and practices in use worldwide. In 1976, the World Health Organization (WHO) established the first working group to advance TM’s inclusion within national health systems. By 1978, the WHO’s Alma Ata Declaration on primary health care called for inclusion of TM practitioners in health systems, a call renewed and extended thirty years later, in the WHO’s 2018 Declaration of Astana, which further emphasized the value of TM knowledges. Other key TM-related WHO documents include two TM Strategies (2002-2005, and 2014-2023), the Beijing Declaration (2008), and the Gujarat Declaration (2023). These documents address a range of complex TM-related issues, including the integration of safe, effective TM into national health systems, scientific evidence pertaining to safety and effectiveness, governance of TM practitioners, practices and products, traditional/Indigenous knowledge protection, and the logistics of ‘integrating’ TM into national health systems. Despite its ongoing expressed interest in advancing TM’s inclusion within health systems over almost five decades, the WHO’s investment in the field has been relatively minor, compared to other areas of political commitment. In 2022, however, the WHO announced it would establish a major Global TM Centre in India, and in 2023, held its first Global Summit on TM. Taken together, these material investments appear to signal an increased political investment in TM on the WHO’s part. In light of the WHO’s recently-increased material investment in the TM field, this study aims to evaluate possible shifts in the ways in which the WHO’s political narratives surrounding the TM field may be concurrently shifting. Using an intertextual, critical discourse analysis approach, the authors analyze key narratives evident across an exhaustive compilation of TM-related public statements delivered by the WHO’s Directors-General (DG) Margaret Chan and Tedros Adhanom Ghebreyesus, over the last fifteen years. Notably, whereas just two public TM-related statements were made by DG Chan over the period 2008 – 2015, DG Ghebreyesus made four such statements in 2022 and 2023 alone, signaling a sudden, recent and notably-increased degree of attention to the TM field by the WHO highest political actors. The TM-related discourses evident within Chan’s two speeches are substantially consistent over time, as are Ghebreyesus’s four statements. However, key similarities as well as important differences exist between the two DGs’ public statements. Aligned with discourses expressed within the two WHO’s TM Strategies, both DGs’ statements recognize the long histories of many TM systems and practices, their cultural importance, and their major role in community-based primary health care, especially in global South settings. Both DGs furthermore affirm the potential advantages of TM’s increased inclusion within national health systems, the unique contributions of both biomedicine and TM to quality, equitable and people-centred health care, and recognize the strong demand for non-biomedical therapeutics worldwide. Chan’s statements uniquely point to possible reasons for such demand, including the lack of available biomedical care in some settings, and peoples’ pursuit of alternatives to biomedicine’s reductive, depersonalized therapeutics. Chan’s speeches, at odds with Gebreyesus’s, strongly emphasize the limits and possible dangers of TM in some contexts, as well as the inadequacy of the related scientific evidence base and quality assurance mechanisms. Gebreyesus’s remarks take a less cautionary tone, strongly emphasizing in positive historical terms TM’s ‘enormous contributions’ to the development of key biomedical therapeutics, and pointing to TM’s ‘enormous potential’ for advancing human health. Echoing the 2018 Declaration of Astana’s calls for the inclusion of traditional as well as biomedical knowledges in primary health care, his remarks decry the widespread stigmatization and dismissal of TM as ‘unscientific,’ calling for health systems to ‘bring together ancient wisdom and modern science in the pursuit of health for all’. Echoing the Gujarat Declaration, these narratives emphasize TM’s potential role in advancing planetary health and the importance of benefit-sharing with knowledge holders. Gebreyesus’s comments foreground the WHO’s active commitment to advancing the scientific evidence base to inform the governance and health systems integration of ‘safe, cost-effective and equitable’ TM therapeutics. Overall, important shifts are evident between the two WHO DGs’ public narratives regarding TM, affirming an increased political commitment at WHO to actively invest in advancing TM’s inclusion within health systems worldwide.
Non-presenting author: Daniel Gallego-Perez, University of North Carolina
Krystle Shore, University of Waterloo
The COVID-19 pandemic exposed serious inadequacies within Canada’s long-term care (LTC) system, including poor infection control, communication gaps, staffing and supply shortages, and overall low standards of care. Federal and provincial governments have since directed considerable funding toward these issues, citing innovative healthcare technologies as a key response measure. Health informatics literature also suggests ‘smart’ technologies—like electronic health records (EHR) software integrated with operations management tools and clinical machine learning—can improve LTC efficiency and resident well-being. However, it is unclear whether such outcomes are empirically confirmed. Further, extant research focusing on the promises of technology in healthcare administration tends to ignore important social contexts that shape how the technology is used in practice. Research that does account for how integrated EHRs are used by frontline LTC staff, though sparse, suggests person-centered care practices are tempered by the impersonal, burdensome, and often dysfunctional elements of the software. More generally, the rationales supporting innovative technology as a solution to public crises often rest on false pretenses and prioritize economic interests over public good. Given these concerns and the increasing adoption of integrated EHR software in the wake of identified deficiencies in Canadian LTC, it is crucial to examine whether this technology truly addresses LTC needs or whether it reflects other, discursive interests. This presentation outlines the methodological and analytical approach employed in a qualitative, multi-phased study of the rationales driving the implementation of integrated EHR software in Canadian LTC and whether adoption of the technology aligns with LTC staff needs. Phase one of the described study focuses on how private vendors market EHR software to LTC facilities and aims to identify the assumptions and vested interests embedded within these vendor rationales. Phase two of the study seeks to understand how frontline LTC staff perceive of and use the technology. Foucauldian discourse analysis is then employed to compare phase one and phase two findings to identify any disconnects between how EHR software is framed through marketing discourse and how the technology operates in practical LTC contexts. As such, this project aims to identify whether integrated EHR software responds to frontline LTC staff needs as well as the broader social, cultural, and political forces that situate innovative technologies as a solution to crises in Canadian healthcare administration (e.g., neoliberal imaginaries that situate technology as a more ‘cost-effective’ solution in health administration). The number of Canadians aged 75 or older will more than double between 2017 and 2037. If identified LTC deficiencies are left unadressed they will compound over time as Canadas population ages. Digital healthcare administration technologies like integrated EHR software carry a potential to improve LTC, though research is needed to substantiate whether this potential translates into practice. The project described here seeks to identify whether integrated EHR software responds to the needs and perspectives of frontline care staff in a post-pandemic era, thereby evaluating the technology to enhance healthcare delivery for Canadas rapidly growing elderly population. In describing the methodological and analytical apporach used in this study, I advocate for research to address critical gaps in our understanding of how smart healthcare administration technologies are rationalized as a solution to public health crises, whether these technologies and the rationales underpinning them align with practical healthcare needs, and the broader socio-political forces that condition them.
Nahid Rahimipour Anaraki, Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland
The implementation of effective quality improvement eHealth interventions in emergency departments (EDs) is challenging. Prior research has identified barriers and facilitators to the implementation of such interventions in the ED (i.e., management strategies, availability of key resources, the obvious need for change, etc.). However, prior research has often overlooked how to develop strategies to address these factors when implementing large-scale interventions in EDs. This study identifies a set of management strategies to guide the implementation of SurgeCon, an eHealth quality improvement program, in the dynamic environment of two rural and two urban EDs in Newfoundland and Labrador, Canada. SurgeCon aims to improve ED wait times and ED efficiency while ensuring high-quality patient care and enhancing clearer communication among healthcare providers. The implementation of SurgeCon involved changes throughout the ED, including: the installation of eHealth system, organizational restructuring, and the establishment of a patient-centered environment. We utilized semi-structured, in-depth interviews with 33 healthcare providers (e.g., physicians, nurses, managers), discussions with the implementation team involved throughout the implementation of SurgeCon in the four EDs and in the implementation at a pilot site, and structured observations of the EDs. An interpretive description approach was utilized to analyze the data. A set of seven management strategies to overcome barriers and leverage facilitators emerged from our analysis. 1- Train staff to cultivate engagement in the intervention. The SurgeCon implementation team developed a 4-hour FLOW Course to foster a holistic approach —an interactive simulation module to provide practical insights into connecting software to process improvement, an eHealth platform module to familiarize staff with the digital whiteboard application, and a patient centeredness module to reinforce core values related to patient care. 2- Appoint and train a dedicated frontline champion by ED management to act as a crucial liaison between staff and the implementation team, ensuring effective communication and ongoing support. 3- Continuously measure and report performance to improve the operational efficiency of EDs by offering meaningful data. Prominently displaying department-level data in the ED and providing individual performance reports to physicians, focusing on key performance indicators (KPIs) such as time to physician initial assessment (PIA), length of stay (LOS), and the rate of patients leaving without being seen (LWBS). However, post-COVID staffing shortages prompted changes in reporting protocols, as KPIs do not reflect staffing allocations and are inappropriately assuming ideal operating conditions. Providing individual physicians with performance reports may not offer a fair assessment in the presence of staff shortages, leading the implementation team to opt for aggregated department-level reports. The primary goal is to boost physician motivation to use SurgeCon. 4- Highlight successes. To motivate physicians, the research team highlighted the success of SurgeCons implementation in the pilot site, presenting it as a model for other sites. 5- Encourage engagement in the intervention. Executing interventions is a collaborative effort requiring dedication from all members. To encourage engagement, compensation, including full payment for attendance, travel, and meals, was provided for participation in training sessions and interviews. Additionally, refreshments in the form of snacks and beverages were offered at every training session. 6- Assign a clinical or non-clinical staff member to manually enter department-level data into SurgeCons cloud-based application to assess the level of busyness in the ED based on patient demand and availability of resources. The SurgeCon score that is calculated once an algorithm has analyzed all the inputted data provides a set of actions the ED team can carry out to improve patient flow. The data entry process takes less than a minute and collects information related to the number of patients, the level of acuity assigned to those patients, the number of patients with special care requirements, bed availability, staff shortages, among other relevant variables. 7- Employ demand and capacity analysis to optimize staffing models. The information collected through SurgeCon’s eHealth platform can be used to advocate for improved staffing levels during peak times of the day and week. This could come in the form of double physician coverage, the addition of a nurse practitioner to the team, or an increase in the number of registered nurses. This study expands upon current knowledge providing comprehensive management strategies to overcome obstacles and leverage facilitators when implementing quality improvement eHealth interventions in the ED.
Non-presenting authors: Holly Etchegary, Memorial University ; Meghraj Mukhopadhyay, Memorial University; Jennifer Jewer, Memorial University; Christopher Patey, Memorial University; Paul Norman, Eastern Health, Carbonear Institute for Rural Reach and Innovation by the Sea, Carbonear General Hospital; Oliver Hurley, Centre for Rural Health Studies, Faculty of Medicine, Memorial University; Shabnam Asghari, Centre for Rural Health Studies, Faculty of Medicine, Memorial University