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Introduction: Integrated youth services (IYS) presents a unique opportunity to adopt social prescribing (SP) strategies within the IYS service model by developing and leveraging a highly connected multidisciplinary network of clinical and community-based service providers to tackle health inequities and enhance service access and outcomes for youth. This paper outlines a case study of Youth Wellness Hubs Ontario (YWHO), Canada, a collective of youth-serving organizations integrated and networked, and operating as a learning health system implementing SP services. The main study objective was to document how YWHO hubs engage in social prescribing through service provision., Methods: We adopted an embedded case study approach. Data were collected from youth (n = 6361) aged between 12 and 25 years who were seeking services at a YWHO hub. Descriptive analyses, including frequencies across categories, were generated from service data, including reason for visit, needs addressed and service provided., Results: A comparative analysis of services requested and provided found that youth across visits to YWHO hubs were engaging with multiple services and service providers, with a wide range of health, mental health and social support needs being addressed., Conclusion: YWHO implements SP services that aim to improve mental health resilience by supporting the vocational, educational and socialization needs of young people accessing IYS through YWHO hubs., Competing Interests: The authors declare there are no conflicts of interest.

Nurses in Lebanon are poorly prepared to provide palliative care (PC), and practice in this area is poorly documented. This qualitative descriptive study aimed to understand the reality of nursing practice in PC, with terminally ill cancer patients, within an interdisciplinary team. A simple case study was conducted with eleven nurses, three families, an interdisciplinary team, and national experts in PC. Data analysis, carried out with triangulation of both methods and sources, highlighted a humanist relationship characterized by caring, transcending the five central emerging themes : the perception of PC as a means of offering a better quality of life, comprehensive patient care, interdisciplinarity, spirituality, and family support during PC. The results could provide empirical foundations to guide the development of PC nursing practice in the country.

Social inequalities in health and access to care remain significant in France. Cultural and socioeconomic dimensions of health inequalities are often studied, but gender-specific behaviors and local dynamics are rarely investigated. This article aims to examine the role of municipal representatives, public health policies and local communities in unequal access to prevention for men and women. We analyze the relationship between gender, space and health through the case study of health promotion in the town of Gennevilliers (Paris region). We rely on data from over six months of field work based on semi-structured interviews with elected officials, health professionals, social field and civil society actors as well as archival consultations and field observations. We show that the town of Gennevilliers, by the age of the inclusion of health in local policies, the dynamism of the associative network and local players or the number of innovative actions, is a relevant and inspiring example for analyzing the obstacles and means of health interventions. But, this article also demonstrates that the promotion of preventive health, rooted in long-term and complex territorial dynamics, can also contribute to the strengthening of gender roles and differences between men and women. Finally, this study pinpoints the need for an approach integrating both gender and territorial questions in the analysis as well as the development of health promotion campaigns.

Objectives: The Main dans la main initiative relies on collaboration between child protection and hospital-based social workers to help substance-abusing expectant mothers maximize their chances of caring for their newborn. The article describes the positive outcomes of this initiative for the women, based on the experiences and perception of the participants and social workers involved., Method: A case study was conducted with 21 participants using three data sources: 1) a semi-structured interview with the mothers at two points in time; 2) a semi-structured interview with social workers; and 3) the tools of the initiative. The data were analyzed based on content condensation and data presentation., Results: A majority of participants experienced changes in their various spheres of life: personal (positive changes in substance-abuse habits), parental (improved self-confidence as a parent, reduced stress due to the fear of losing custody of their newborn), and social/relational (improved relationships with social support network and support services)., Conclusion: The results confirm the relevance and potential for change of a short intervention model during the perinatal period based on inter-professional collaboration with substance-abusing expectant mothers. Further research is needed to validate the hypothesis on the effectiveness of this initiative.

The aim of this study was to investigate the effects of the national HIV/AIDS control programme on district hospitals in Cameroon. A multiple case study was conducted in two district hospitals- one public and one faith-based. Data were collected by document review, semi-structured interviews and observation of managerial processes and health care delivery. Programme interventions result in a series of positive and negative effects on the functioning of district hospitals and local health systems. High input and support of staff skills were observed for antiretroviral therapy and the management of opportunistic infections. However, the impact of the programme on the stewardship function is problematic. The low implication of district management teams in the implementation of HIV /AIDS activities reduces their structural capacity to run the local health systems. Programme and health system managers failed to take advantage of opportunities to develop synergies between the HIV/AIDS programme and local health systems. The HIV/AIDS programme weakens the systemic and structural capacity of local health systems. Managers of both programmes and general health systems should analyse and adapt their interventions in order to effective' strengthen health systems. One of the research questions is to understand why health system stakeholders do not seize opportunities to develop synergies between programmes and the general system and to strengthen health systems.

Background: Mental health is a public health priority among chronic diseases in France and the United States. Although there is room for progress in France, the experience of Intermountain Healthcare (IH), Utah, in the United States can provide convincing experimental data., Aim: To identify the lessons learned from IH clinical integration of mental health specialists in primary care practices called "Mental Health Integration" (MHI) which might be useful in France., Methods: This research is based on qualitative analysis of data derived from collaborative work with IH experts, literature searches, and item queries on the 3 objectives of the Triple Aim of the Institute for Healthcare Improvement (IHI)., Results: The MHI programme was developed to achieve IHI T riple, Aim: improving user satisfaction; improving access of care and the health of the population; reducing health care costs per capita. By integrating mental health specialists within a multidisciplinary team headed by primary care physicians and working under the same roof with care managers and support staff, the MHI model enhances the process of the Chronic Care Model. Furthermore MHI has become the foundation for team-based care centered on the patient and theirfamily over the continuum of care by offering a global and structured evidenced-based care process. Prevention and integration of specialized care have been developed. Users and their families are co-responsible for their health. Discussion: Evaluation is systematic and based on specific indicators. The efficiency and clinical and organizational effectiveness created generate savings for health insurance as well as improved access to care and health equality.

Objective: This study was designed to analyse the adaptive strategies used by primary care professionals to provide more adapted and continuous services to patients with more than one chronic disease., Methods: A qualitative case study was conducted in a primary care structure (GMF in Québec). Data were derived from two sources: semi-structured interviews and documents. Based on our thematic analysis of data, we illustrate the adaptive processes at play., Results: Our analysis identified the challenges raised by the increased prevalence of patients with more than one chronic disease and how they influence adaptive strategic initiatives from professionals at the following levels: (1) the patients themselves, (2) the professional-patient relationship, (3) the relationships between professionals of the GMF (4) the relationships between the GMF and other healthcare organizations. The description of these phenomena illustrates the dynamic emergence ofa network form of organization., Conclusion: This phenomenon leads to transformation of the core of the healthcare production system. A deeper understanding of its emergence, impacts and management is necessary.

This article demonstrates how enterprise intelligence systems can be used to improve operational efficiency in hospitals. Enterprise intelligence systems mine raw data from disparate systems and transform the data into actionable information, which when used appropriately, support streamlined processes, optimize resources, and positively affect staff efficiency and the quality of patient care. Case studies on the implementation of McKesson Performance Visibility and Capacity Planner enterprise intelligence solutions at the Southlake Regional Health Centre and Lions Gate and Richmond Hospitals are provided.

In 2011, the Toronto East General Hospital (TEGH) began its journey towards developing a culture of continuous improvement. TEGH evolved to an organization-wide improvement system through a commitment to fiscal responsibility, practical innovation, team-based performance management, and daily management systems. This culture enabled the TEGH to achieve the lowest Emergency Department wait times for admitted patients in its local health integration network and reduce length of stay for patients with chronic obstructive pulmonary disease by 46%.

This article examines the way that non-clinical support services are provided in healthcare settings through outsourcing partnerships. The integrated support services model and benefits to patient experience and safety as well as organizational efficiency and effectiveness are explored through an examination of services at a busy urban community hospital.

For more than 60 years, the French Comprehensive Cancer Centers participate in public hospital service and are exclusively dedicated to the fight against cancer. This article returns on their history, their model, their group strategy with the creation of UNICANCER, their place in French cancer research and treatments today, their contribution to the cancer plans and the challenges and issues they will face in the next 10 years.

As the Canadian population ages, it becomes increasingly important for hospitals to address and implement programs and policies that ensure elderly patients are receiving the right care in the right place at the right time. Despite the vast majority of elderly patients being healthier than ever, it is important to recognize the rapid deconditioning that occurs when they are admitted to an acute care hospital. Although it is recognized that children need to be treated differently, we fail to recognize the same is true for older adults. The Enhanced Activation Program was conceptualized during consultation with community partners while discussing the aging at home strategy. It was during these consultations that gaps in service for the frail elderly were identified and the Enhanced Activation Program was developed.

St. Joseph's Healthcare Hamilton (SJHH) supports a grassroots green team, called Environmental Vision and Action (EVA). Since the creation of EVA, a healthy balance between corporate projects led by corporate leaders and grassroots initiatives led by informal leaders has resulted in many successful environmental initiatives. Over a relatively short period of time, environmental successes at SJHH have included waste diversion programs, energy efficiency and reduction initiatives, alternative commuting programs, green purchasing practices, clinical and pharmacy greening and increased staff engagement and awareness. Knowledge of social movements theory helped EVA leaders to understand the internal processes of a grassroots movement and helped to guide it. Social movements theory may also have broader applicability in health care by understanding the passionate engagement that people bring to a common cause and how to evolve sources of opposition into engines for positive change. After early successes, as the limitations of a grassroots movement began to surface, the EVA team revived the concept of evolving the grassroots green program into a corporate program for environmental stewardship. It is hard to quantify the importance of allowing our staff, physicians, volunteers and patients to engage in changes that they feel passionately about. However, at SJHH, the transformation of a group of people unsatisfied with the organization's environmental performance into an 'engine for change' has led to a rapid improvement in environmental stewardship at SJHH that is now regarded as a success.

The development and implementation of a regional network that provides universally accessible and consistent services to the frail elderly living in Southwestern Ontario is described. Through continuous stakeholder engagement, clear network goals were identified and operationalized. Stakeholder commitment to the integration of expertise and specialized services, to evidence-based public policy and to iterative evaluation cycles were key to network success.

Francophone Canadians living in a context where French is a minority language have poor access to health services in their native language. To remedy this situation, the Canadian Government has adopted a networking model inspired from the strategy "Towards Unity For Health" (TUFH) elaborated by the World Health Organization (WHO). This model, used since 2001, has given rise to a large number of partnership networks covering the entire regions where minority Francophones live. In this model five key stakeholders in health are being involved: health professionals, communities, managers of health care institutions, educational institutions and governments. The Canadian Federal Government, in close collaboration with communities, directed the project through two non-for-profit agencies: the Sociéte Santé en Français (SSF) and the Consortium National de Formation en Santé (CNFS), sharing a common vision and aiming at improving access to health services and hence health status of minority Francophones. The networking following the TUFH model created a lot of opportunities as well as many challenges to overcome.

The main constraint to improving access to health services of quality in rural areas is to attract qualified health personnel in these areas. A fifteen years experience in rural health in Mali has shown that it is possible to develop community medicine practices in an African context that do integrate individual care and public health activities. The policy of decentralization of health services encouraged local communities and municipalities to recruit rural doctors themselves. An initiative of rural doctors materialized with this event as they founded a national association and adhere to the principles of a Charter to provide quality health care at an affordable cost. A mechanism of quality improvement was established with the participation of several partners: a professional association, a funding non-governmental organization, and groups of academic staff and health managers. This paper describes the evolution of the rural doctors' experience, its philosophy, conditions that made it successful, constraints it had to overcome and the attitude of partners. It highlights the potential of health care personnel in Africa to provide primary health care well beyond traditional programs on prevalent diseases and to respond to both urgent individual needs and pressing public health requirements.

Doctors of the World France (Médecins du Monde, MdM) is an international humanitarian aid NGO working to support access to health care to vulnerable populations of the world excluded from these services. MdM has fixed two strategies to "cure and give witness," especially in light of the flagrant injustices lived by the populations they work with. Based on the need to improve the situation of these populations, and using the Anglo-Saxon model, the association wanted to take their strategy one step further by progressively developing advocacy actions in partnership with other organizations. This case study shows the different success obtained through advocacy actions in two campaigns: one against the World Bank's promotion of health systems' privatization in 1993 and another one for the increase in training of health care workers in the Southern hemisphere in 2006.

In today's competitive, fast-changing world of healthcare, organizations cannot tolerate ineffective leadership over the long term if they are to remain successful. It is very common for leadership teams to come together and immediately begin to do business...at least to attempt to do what each team member believes the group's business should be. Unfortunately, each person probably has a different idea of what the team's business should be, and how they should go about conducting it. This is a certain recipe for ineffectiveness. The following case study examines how the executive team in a health sciences college approached the development of an effective leadership team, and discusses the importance of process to achieving the desired outcomes. The process so described can be used with any leadership team, but it should always be customized to suit the unique needs and desires of each team.

Equity is an essential health promotion concept and must be included at the heart of public health policy making. However, equity, which can also be referred to as social justice, is a polysemic and contextual term which definition must stem from the discourse and values of the society where the policies are implemented. Using a case study from Burkina Faso, we try to show that the non-acknowledgement of the local concept of social justice in the policy making process partly explains the resulting policies' relative failure to achieve social justice. Data collection methods vary (individual and group interviews, concept mapping, participant observation, document analyses) and there are qualitative and quantitative analyses. The four groups of actors who generally participate in the policy making process participated in the data collection. With no intention to generalise the results to the entire country, the results show that mass social mobilisation for justice is egalitarian in type. Health or social inequalities are understood by individuals as facts which we cannot act upon, while the inequalities to access care are qualified as unjust, and it is possible to intervene to reduce them if incentive measures to this effect are taken. We also observed a certain social difficulty to conceive sub-groups of population and fierce will to not destabilise social peace, which can be provoked when looking for justice for the impoverished sectors of the population. This research allows better understanding about the emic aspect of equity and seems to confirm the importance of taking into account local values, especially social justice, when determining public policy.

Objective: Sustained health promotion programmes in the workplace (HPPW) continues to be a public health challenge. This article presents an evaluation of the implementation and sustainability of such programmes in private blue-collar companies in Quebec to shed light on issues specific to this type of setting., Method: A multiple case (4 sites), longitudinal (7 years) and interpretive study method was used. The interpretation framework considered that the implementation and sustainability of HPPW in companies are the result of organizational learning in health promotion, determined by the strategies of individuals in a position of control who shape the decisional processes related to these programmes., Results: After seven years of observation, two of the four sites had continued their HPPW, although these programmes were no longer applied within these companies. The health promotion organizational learning processes in both sites were defined according to targeted organizational purposes set by the decision-makers who supported HPPW. However, these gains were largely lost when HPPW were no longer retained as a component of their organizational development strategy., Discussion: The organizational conditions that are conducive to HPPW are difficult to put together and sustain in companies like those in our study. Businesses implement these programmes mainly for the organizational benefits they expect to reap in the short term, whereas improvement in the health of workers in the longer term is not a priority.

A multidisciplinary group from two medical floors at the Royal Victoria Hospital chose the Managed Care Appropriateness Program (MCAP) to evaluate the appropriateness of the days of stay for their patients. Of 100 charts of consecutive patients examined by the nurse reviewer (comprising 1,095 patient days), 33 percent of the days were deemed inappropriate. The reasons for each of these inappropriate days were documented, and strategies were implemented to address the issues. The major outcome of the study was a change in the culture of the health professionals to a more positive approach to defining and carrying out efficient patient care.