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Aim A discussion on how informatics knowledge and competencies can enable nursing to instantiate transition to integrated models of care. Background Costs of traditional models of care are no longer sustainable consequent to the spiralling incidence and costs of chronic illness. The international community looks towards technology-enabled solutions to support a shift towards integrated patient-centred models of care. Design Discussion paper. Data sources A search of the literature was performed dating from 2000-2015 and a purposeful data sample based on relevance to building the discussion was included. Discussion The holistic perspective of nursing knowledge can support and advance integrated healthcare models. Informatics skills are key for the profession to play a leadership role in design, implementation and operation of next generation health care. However, evidence suggests that nursing engagement with informatics strategic development for healthcare provision is currently variable. Implications for nursing A statistically significant need exists to progress health care towards integrated models of care. Strategic and tactical plans that are robustly pragmatic with nursing insights and expertise are an essential component to achieve effective healthcare provision. To avoid exclusion in the discourse dominated by management and technology experts, nursing leaders must develop and actively promote the advancement of nursing informatics skills. For knowledge in nursing practice to flourish in contemporary health care, nurse leaders will need to incorporate informatics for optimal translation and interpretation. Conclusion Defined nursing leadership roles informed by informatics are essential to generate concrete solutions sustaining nursing practice in integrated care models. [ABSTRACT FROM AUTHOR]

Medical Education 2011: : 95-106 One hundred years after the Flexner report remade medical education in North America, many countries are reviewing the purpose and organisation of medical education. In Canada, a national study is being undertaken to define important issues and challenges for the future of medical education. The objectives of this paper are to describe the process of conducting an empirical environmental scan at a national level, and to present the research findings of this scan. Thirty national key informant interviews were conducted, transcribed and coded to identify key themes. Interview data were triangulated with data sourced from 34 commissioned literature reviews and a series of national focus groups. Ten key issues or priorities were identified and used to generate detailed review papers used by the Association of Faculties of Medicine of Canada to create a blueprint for the evolution of medical education. The new priorities have major implications for areas ranging from admissions, curriculum content, educational process and the need to articulate the purpose and responsibilities of medical schools in society. This research provides a case study of how an empirical research approach can be used to identify and validate priorities for changes in medical education at a national level. This approach may be of interest in other countries. [ABSTRACT FROM AUTHOR]

Background: Processes of the patient and public involvement (PPI) in health research shifted quickly during 2020. Faced with large‐scale issues, such as the COVID‐19 pandemic, the need to adapt processes of PPI to uphold commitments to nurturing the practice of 'nothing about us without us' in research has been urgent and profound. We describe how processes of PPI in research on patient‐oriented methods of knowledge translation and implementation science were adapted by four teams in a Canadian setting. Methods: As part of an ongoing quality improvement self‐study to enhance PPI within these teams, team members shared their experiences of PPI in the context of this pivotal year during interviews and facilitated discussions. Drawing on these experiences, we outline challenges and reflections for adapting processes of PPI in health research on methods in times of urgency, conflict and fast‐moving change. Discussion: Our reflections offer insight into common issues encountered across teams that may be amplified during times of rapid change, including handling change and uncertainty, sustaining relationship‐building and hearing differing perspectives in processes of PPI. Conclusion: These learnings present an opportunity to help others active in or planning patient‐oriented methods research to reflect on the changing nature of PPI and how to adapt PPI processes in response to turbulent situations in the future. Patient and Public Contributions: The key reflections presented draw heavily from perspectives shared by eight patient and public partners in interviews and facilitated discussions (the conduct and analysis of data in the quality improvement self‐study). [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to test the validity of a set of best practice principles for managing transformational organizational change by applying them to a specific change initiative in the media. It also aims to examine whether prescriptions for effective change leadership (traditionally confined to single leaders) apply to a situation and organization where there are three distinct leader roles. Design/methodology/approach – The paper takes the form of a case study of a major change initiative undertaken at a leading Canadian newspaper. Findings – The paper shows that multiple, relatively autonomous leaders can lead a successful and unified change given specific organizational and environmental conditions. It also concludes that the generally accepted best practice of change leadership does not necessarily apply to a newspaper environment and posits that, in certain circumstances, a major change initiative can succeed despite running counter to the prevalent prescriptions in the literature. Research limitations/implications – The conclusions drawn may be limited to organizations in the news media or those with similar organizational structures. Practical implications – The paper suggests shortcoming of existing normative leadership theories, seeks to explain why this is the case, and makes numerous suggestions for further study. Originality/value – The paper challenges orthodox assumptions and theories about leader roles and necessary qualities in leaders in successful organizational change. It extends understanding of change processes in the news media, which is under-studied. It also suggests the applicability, but also relative insufficiency, of existing change theory as pertains to the media industry. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to provide details on how the Capital Projects Division within Alberta Infrastructure, in the provincial government of Alberta, started its journey to excellence by following Excellence Canada's framework. The framework focusses on systematic approach to excellence and widespread implementation in the organization. This paper provides comprehensive information on the division's processes, trends and impending changes for leadership that demonstrates quality and commitment of business excellence through quality improvements based on experience. Design/methodology/approach - In partnership with Excellence Canada, Capital Projects Division of Alberta government embarked on a journey to excellence using the Progressive Excellence Program® framework for quality. Equally important, the division explored ways it can invest wisely in innovative ideas that will reshape the current organization and prepare staff for a very exciting future. That meant using the most comprehensive approach to review existing processes and strive for efficient and innovative ideas for continuous improvement over the longer term. Findings - First, incorporating quality in the workplace is about the journey, not the destination, so leadership plays a vital role in its success. Second, the strategies on how to achieve quality primarily originate from the people within the organization. A key to achieving quality is to provide a framework for these ideas and strategies to emerge. Originality/value - This paper focuses on the perseverance and leadership required in the development of a framework to support and encourage quality in the organization. [ABSTRACT FROM AUTHOR]

Introduction: Discussions of integrated care have ranged in focus from large-scale health system transformations, to discrete interventions intended to enhance local continuity of care. Beyond these variations in scale and focus, literature on integrated care has used a variety of conceptual frameworks to explain various activities and elements necessary to achieve integrated care. Existing frameworks have helped to advance research and practice; yet the complexity of changing practice required to achieve integrated care across the policy, organizational, and clinical levels complicates efforts to represent or implement these innovations in straightforward ways. Aims Objectives Theory or Methods: In this paper, we present a novel strategy for conceptualizing integrated care as developing through a series of milestones observable at the organizational level. Based on analysis of four integrated care organizational case studies in Canada and New Zealand, we outline how this approach to conceptualizing integrated care both resolves the tension of crossing the macro, meso, and micro levels of analysis, and generates new practical insights to guide policy and practice. Methods consist of qualitative interviews, observation, and document analysis across cases, and qualitative data were analyzed temporally to identify milestones as indicated by participants over time. Highlights or Results or Key Findings: We define a milestone as the occurrence of a salient event that is perceived by respondents to facilitate or disrupt efforts towards the development of integrated care. We synthesize these events at the organizational level, suggesting that the organizational level of analysis is the most appropriate level to represent the significance of these milestones. Our analysis identified six categories of milestone: (1) Strategic relational milestones, referring to building relationships between stakeholders. (2) Strategic process change milestones, referring to efforts to improve quality in practice. (3) Structural (intra-organizational) milestones, referring to changes in organizational structure. (4) Structural (inter-organizational) milestones, referring to changes in the legal, operational, or leadership structures that facilitate relationships between organizations. (5) Environmental milestones, referring to changes in the social or natural environment. (6) Political milestones, referring to changes in the control and allocation of resources. Conclusions: Our results generate a new conceptual framework for understanding the achievement of integrated care as occurring through a series of milestones. This approach enhances the focus on achieving integrated care "in the wild", in the actual environments in which leaders, clinicians, policymakers, patients, and caregivers work to implement integrated care. Implications for applicability/transferability sustainability and limitations: Our model emphasizes two practical points. First, that there is no single series of sequential steps that must be taken to achieve integrated care. Second, that policy efforts to support integrated care ought to encourage organizations and their collaborators to work toward milestones that facilitate the development of integrated care. [ABSTRACT FROM AUTHOR]

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This paper provides an overview of transition strategy, focusing specifically on the Chinese business world, where the common practice is for founders to pass their companies on to their children, the younger generation. This paper describes how Chinese businesses are invariably adopting the western-style management practice of instituting the various offices of chairman, chief executive officer, president, etc. primarily because the children of those founding fathers have been mostly sent to the USA, the UK and Canada to receive higher education. This paper concludes that these second-generation operating managers have essentially transformed their business environments with great success, modernizing the Asian business community as a whole and competing effectively with the western world. [ABSTRACT FROM AUTHOR]

Aim: To evaluate effectiveness of specific policy and practice changes to the process of registration for internationally educated nurses. Background: Little research exists to inform registration policy for internationally educated health professionals. Introduction: Internationally educated nurse employment can help address nursing shortages. Regulators assess competencies for equivalency to Canadian‐educated nurses, but differences in health systems, education and practice create challenges. Methods: The study setting was a Canadian province. We used a mixed methods approach, with a pre–post‐quasi‐experimental design and a qualitative evaluation. Previous analysis of relationships between applicant variables, registration outcomes and timelines informed changes to our registration process. Implementation of these changes composes the intervention. Comparisons between pre‐ and post‐implementation exemplar subgroups and timeline analyses were conducted using descriptive statistics, univariate analysis and non‐parametric tests. Data were collected from complete application files before (n = 426) and after (n = 287) implementation of the intervention. Interviews, focus groups and consultations were completed with various stakeholders. Findings: The time between steps in the process was significantly reduced following implementation. Stakeholders reported an increase in perceived efficiency, transparency and use of evidence. Discussion: Results indicated that initial impacts of the policy changes streamlined the process for applicants and staff. Conclusion: Maintaining a consistent and systematic review of an organization's data coupled with implementation of findings to effect policy and practice change may have an important impact on regulatory policy. Implications for Nursing Policy: These findings represent the beginning of an international policy conversation. Policy changes based on organizational data can underlie major process improvement initiatives. Ongoing nursing shortages across the globe and increasing mobility of nurses make it important to have efficient and transparent regulatory policy informed by evidence. [ABSTRACT FROM AUTHOR]

Purpose - The paper's aim is to analyze changes in the relative importance of Canada as a supplier for its home markets; and, the rising importance of China versus other Canadian trading partners. Design/methodology/approach The market overlap measure (MOM) statistic, developed by Sawchuk and Yerger is used to analyze the Canadian home market shares for Canada and every other nation with sales in the Canadian market for each of 61 different NAIC sectors (56 at the four-digit NAIC level and five at the three-digit NAIC level). Findings The USA remains the most important foreign supplier to Canadian markets with a weighted average 23.6 percent market share as of 2003 (Canadian-based production having a 63.0 percent market share), US market share, however, has been declining by nearly a percentage point per year since 2000. Approximately, half of the lost US' market share has been captured by Canadian-based firms and approximateIy a quarter has been captured by Chinese production. China's growth in Canadian market share places it second behind only the USA in terms of Canadian-based farms' home market competitive exposure. Research limitations/implications - The work does not include an analysis of service sector trade flows due to inadequate data. Practical implications The MOM statistic is shown to be a useful diagnostic tool for analyzing the level of, trends in, and industries driving the competitive exposure a nation's firms have on sales in a specified market. Originality/value The MOM statistic is shown to yield better insights regarding the actual degree of competitive exposure than does the more commonly used similarity indices such as Finger-Kreinen. [ABSTRACT FROM AUTHOR]

Background: Intensive upper extremity training (IUET) has demonstrated efficacy in clinical and functioning outcomes in children with hemiplegia. However, implementation in the clinical context requires novel service models and knowledge translation. Aims: To map implementation of IUET in Canada, to identify factors associated with the implementation and best practices for implementation. Methods: Mixed-methods design; descriptive statistics, chi-square tests. Individual phone interviews and focus groups with purposeful sampling. Thematic analysis; telephone surveys with managers of 31 pediatric rehabilitation centers across Canada. Four focus groups across Canada and one in the Netherlands. Results: Implementation of IUET group interventions is limited in Canada (7/31). Barriers included beliefs and values related to evidence-based practice, opportunities for continuing education, researchers-clinicians partnerships, access to scientific literature, and the presence of a champion. Pressure from parents and media presenting IUET as a novel and effective therapy, support and flexibility of families, having the critical mass of clients and a managerial willingness to accommodate new ideas and restructure service provision were some facilitators. Conclusions: Uptake of the evidence requires many steps described in the knowledge translation cycle. Factors identified in the study could be considered in most clinical settings to facilitate the uptake of research evidence for IUET. [ABSTRACT FROM AUTHOR]

Family-centered approaches offer significant promise regarding the enhancement of child and family safety. Child protection workers find value in working alongside families, whereas families appreciate having a voice in decision-making processes. The introduction of Family Group Conferencing (FGC) in New Zealand in 1989 prompted the exploration of family partnership options internationally. This study, focusing on Ontario, Canada, examines the expansion of FGC from a local pilot in 1998 to a current province-wide initiative. The internal and external factors that have promoted and inhibited change were investigated. Interviews and a focus group were used to elicit the perspectives of Alternative Dispute managers and key informants. Participants concluded that the FGC program has been successful as a result of multilevel and multipronged change efforts. However, the long-term viability remains in question, primarily because of unstable funding and uneven buy-in, on provincial levels and within child welfare agencies. To ensure sustainability current strengths should be built upon, employing the same intentional, strategic planning that characterized the introduction of FGC into the province. The Ontario experience provides pointers for interested parties wishing to embed FGC and other family-centered approaches in daily child welfare practice. [ABSTRACT FROM PUBLISHER]

Background: An interoperable electronic health record is a secure consolidated record of an individual's health history and care, designed to facilitate authorized information sharing across the care continuum.  Each Canadian province and territory has implemented such a system and for all, measuring adoption is essential to understanding progress and optimizing use in order to realize intended benefits.Results: About 250,000 health professionals-approximately half of Canada's anticipated potential physician, nurse, pharmacist, and administrative users-indicated that they electronically access data, such as those found in provincial/territorial lab or drug information systems, in 2015.  Trends suggest further growth as maturity of use increases.Conclusions: There is strong interest in health information exchange through the iEHR in Canada, and continued growth in adoption is expected. Central to managing the evolution of digital health is access to robust data about who is using solutions, how they are used, where and when.  Stakeholders such as government, program leads, and health system administrators must critically assess progress and achievement of benefits, to inform future strategic and operational decisions. [ABSTRACT FROM AUTHOR]

Background Ongoing challenges to healthcare integration point toward the need to move beyond structural and process issues. While we know what needs to be done to achieve integrated care, there is little that informs us as to how. Specifically, we need to understand how diverse organizations and professionals develop shared knowledge and beliefs - that is, we need to generate knowledge about normative integration. We present a cognitive perspective on integration, based on shared mental model theory, that may enhance our understanding and ability to measure and influence normative integration. Purpose To validate and improve the Mental Models of Integrated Care (MMIC) Framework, which outlines important knowledge and beliefs whose convergence or divergence across stakeholder groups may influence inter-professional and inter-organizational relations. Methods We used a two-stage web-based modified Delphi process to test the MMIC Framework against expert opinion using a random sample of participants from Canada's National Symposium on Integrated Care. Respondents were asked to rate the framework's clarity, comprehensiveness, usefulness, and importance using seven-point ordinal scales. Spaces for open comments were provided. Descriptive statistics were used to describe the structured responses, while open comments were coded and categorized using thematic analysis. The Kruskall-Wallis test was used to examine cross-group agreement by level of integration experience, current workplace, and current role. Results In the first round, 90 individuals responded (52% response rate), representing a wide range of professional roles and organization types from across the continuum of care. The majority of respondents are from the province of Ontario. In the second round, 68 individuals responded (75.6% response rate). The quantitative and qualitative feedback from experts was used to revise the framework. The re-named "Integration Mindsets Framework" consists of a Strategy Mental Model and a Relationships Mental Model, comprising a total of nineteen content areas. Conclusions The Integration Mindsets Framework draws the attention of researchers and practitioners to how various stakeholders think about and conceptualize integration. A cognitive approach to understanding and measuring normative integration complements dominant cultural approaches and allows for more fine-grained analyses. The framework can be used by managers and leaders to facilitate the interpretation, planning, implementation, management and evaluation of integration initiatives. [ABSTRACT FROM AUTHOR]

Background: The health care sector has a significant role to play in fostering equity in the context of widening global social and health inequities. The purpose of this paper is to illustrate the process and impacts of implementing an organizational-level health equity intervention aimed at enhancing capacity to provide equity-oriented health care. Methods: The theoretically-informed and evidence-based intervention known as 'EQUIP' included educational components for staff, and the integration of three key dimensions of equity-oriented care: cultural safety, trauma- and violence-informed care, and tailoring to context. The intervention was implemented at four Canadian primary health care clinics committed to serving marginalized populations including people living in poverty, those facing homelessness, and people living with high levels of trauma, including Indigenous peoples, recent immigrants and refugees. A mixed methods design was used to examine the impacts of the intervention on the clinics' organizational processes and priorities, and on staff. Results: Engagement with the EQUIP intervention prompted increased awareness and confidence related to equity-oriented health care among staff. Importantly, the EQUIP intervention surfaced tensions that mirrored those in the wider community, including those related to racism, the impacts of violence and trauma, and substance use issues. Surfacing these tensions was disruptive but led to focused organizational strategies, for example: working to address structural and interpersonal racism; improving waiting room environments; and changing organizational policies and practices to support harm reduction. The impact of the intervention was enhanced by involving staff from all job categories, developing narratives about the socio-historical context of the communities and populations served, and feeding data back to the clinics about key health issues in the patient population (e.g., levels of depression, trauma symptoms, and chronic pain). However, in line with critiques of complex interventions, EQUIP may not have been maximally disruptive. Organizational characteristics (e.g., funding and leadership) and characteristics of intervention delivery (e.g., timeframe and who delivered the intervention components) shaped the process and impact. Conclusions: This analysis suggests that organizations should anticipate and plan for various types of disruptions, while maximizing opportunities for ownership of the intervention by those within the organization. Our findings further suggest that equity-oriented interventions be paced for intense delivery over a relatively short time frame, be evaluated, particularly with data that can be made available on an ongoing basis, and explicitly include a harm reduction lens. [ABSTRACT FROM AUTHOR]

This article analyzes how leadership affects resistance to change in projects. Using Dulewicz and Higgs' (2005) leadership framework in the context of the Canadian Public Service, types of resistance and factors influencing them were listed, leading to the identification of competence areas for the project manager. It was found that an engaging leadership style, developed through proper training, effectively reduced resistance to change. Other factors, such as the inclusion of affected people in the decisions, as well as a formal project management methodology, were instrumental in reducing resistance. Finally, upper management support was identified to be a mandatory success factor. [ABSTRACT FROM AUTHOR]

While there is a growing amount of research that calls for extensive school reform in Canada, I am more interested in research on the effectiveness of current teacher education and the documented inability of universities to arm student teachers with the necessary knowledge and expertise to not only survive but excel in a complex yet interesting and dynamic school setting. My argument is that due to outdated teacher education programs, new teachers are unprepared for a teaching profession that is becoming increasingly complex. My research question is thus: How can teacher education programs be reformed to better prepare new teachers for a demanding and complicated profession? To shed some light on the issue and to propose some answers, the current statistics on teacher retention in Canada will be introduced. I will then explain why school environments today are considered more complex than ever and illuminate the need for reforms in teacher education to prepare preservice teachers for diverse school contexts and a wide array of responsibilities other than instructor. Subsequently, I will highlight two approaches to teacher education-the technical/rational approach and the inquiry approach-and argue that the former, a linear process of acquiring content knowledge and conveying subject matter in a brief practicum, should be abandoned in favour of the inquiry approach, which allows for greater creativity, malleability, and development on the part of the prospective teacher. Lastly, several studies that explore the benefits of inquiry-oriented preparation programs in teacher education will be presented and the implications for future research will be discussed. [ABSTRACT FROM AUTHOR]

The focus of this article is on the contribution made by the project management office (PMO) to organizational performance. It explores the particular case of a PMO dedicated to a major organizational transformation within a Canadian university hospital. The national government has asked hospitals to provide strict control over their budgets through implementing strong governance mechanisms. How can PMO performance be assessed within this context? Perception of two different groups has been analyzed within a competing values framework, allowing for a combination of four different performance conceptions. Results show certain similarities in the barriers to PMO performance but, most importantly, they reveal that between the two groups a paradox exists regarding what is valued in PMO performance. Results bring empirical evidence of the application of the competing values framework to the health care sector, but also to a wide variety of industries, public or private. [ABSTRACT FROM AUTHOR]

Purpose: To identify facilitators and barriers to service reorganization, how they evolved and interacted to influence change during the implementation of a new service delivery model of paediatric rehabilitation. Methods: Over 3 years, different stakeholders responded to SWOT questionnaires ( n = 139) and participated in focus groups ( n = 19) and telephone interviews ( n = 13). A framework based on socio constructivist theories made sense of the data. Results: Facilitators related to the programme's structure (e.g. funding), the actors (e.g. willingness to test the new service model) and the change management process (e.g. participative approach). Some initial facilitators became barriers (e.g. leadership lacked at the end), while other barriers emerged (e.g. lack of tools). Understanding factor interactions requires examining the multiple actors' intentions, actions and consequences and their relations with structural elements. Conclusions: Analysing facilitators and barriers helped better understand the change processes, but this must be followed by concrete actions to successfully implement new paediatric rehabilitation models. [ABSTRACT FROM AUTHOR]

Purpose – To analyze lower level employees' retrospective views of their experience with organizational changes introduced by management; to provide a typology of change responses based on employees' interpretations. Design/methodology/approach – Canadian bank employees' accounts of their experience with change were obtained in interviews and analyzed using established guidelines for qualitative data analysis. A typology of change responses (acceptance, resigned compliance, avoidance/opposition, and ambivalence) was derived from the data. Links are made to the literature on readiness for, compliance with and resistance to, change, and to the literatures on framing and on identity as they inform responses to change. Findings – Among others, the findings indicate: that changes that are compatible with employees' role identity or that are viewed as enhancing organizational identity tend to be easily embraced; the extensive prevalence of the ‘resigned compliance’ response; that lack of participation in change decisions may be a common expectation among employees of large bureaucratic organizations that seek uniformity across widely dispersed geographic units; and opposition to change may be functional from an organizational standpoint. Research limitations/implications – Several research implications are outlined including the need for theories to consider that change has been ubiquitous and that its pervasiveness can place its legitimacy beyond questioning. Research limitation includes the fact that the study focused on change survivors and did not have access to employees who had willingly left, or were asked to leave the organization as changes were being implemented. Practical implications – The study provides an understanding of the dynamics that underlie different responses to change. Understanding such dynamics is essential for the performance of the change agent role. Originality/value – Unlike much of the extant literature that tends to focus on the managerial view of change and on managerial framing, this study contributes the lower level employee perspective on, and framing of, change. In contrast with other studies of change that attend to a specific change situation, this article focuses on experiences with multiple changes and on the general view of change held by participants. The study also addresses a gap in the literature, as empirical studies have failed to tie responses to change to identity dynamics. [ABSTRACT FROM AUTHOR]

Systematic differences in the determinants of firm failure between firms that fail early in their life and those that fail after having successfully negotiated the early liabilities of newness and adolescence are identified. Analysis of data from 339 Canadian corporate bankruptcies suggests that failure among younger firms may be attributable to deficiencies in managerial knowledge and financial management abilities failure among older firms, on the other hand, may be attributable to an inability to adapt to environmental change. [ABSTRACT FROM AUTHOR]