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Background: Despite the suggested benefits of shared decision-making (SDM), its implementation in policy and practice has been slow and inconsistent. Use of complex adaptive systems (CAS) theory may provide understanding of how healthcare system factors influence implementation of SDM. Methods: Using the example of choice of mode of birth after a previous caesarean section, in-depth, semi-structured interviews were conducted with patients, providers, and decision makers in British Columbia, Canada, to explore the system characteristics and processes that influence implementation of SDM. Implementation and knowledge translation principles guided study design, and constructionist grounded theory informed iterative data collection and analysis. Findings: Analysis of interviews (n=58) revealed that patients formed early preferences for mode of delivery (after the primary caesarean) through careful deliberation of social risks and benefits. Physicians acted as information providers of clinical risks and benefits, while decision makers revealed concerns related to liability and patient safety. These concerns stemmed from perceptions of limited access to surgical resources, which had resulted from budget constraints. Discussion and conclusions: To facilitate the effective implementation of SDM in policy and practice it may be critical to initiate SDM once patients become aware of their healthcare options, assist patients to address the social risks that influence their preferences, manage perceptions of risk related to patient safety and litigation among physicians, and enhance access to healthcare resources.

We explored enablers and mechanisms of optimal team function within rural hospital teams, and the impact of these factors on health service sustainability in British Columbia. The data were drawn from interviews and focus groups with healthcare providers and administrators (n = 169) who participated in the Rural Surgical Obstetrical Networks (RSON) initiative to support low-volume rural surgical and obstetrical services in British Columbia, Canada. The 5-year programme (2018–2022) provided evidence-based system interventions across eight rural sites with the objective of providing sustainable, quality health services to meet population needs. To explore the impact of RSON interventions on local team function, we performed a scoping review, to assess the current literature surrounding enablers of effective rural hospital teamwork. Through inductive thematic analysis of interview data, we identified five enablers of good team function at RSON sites, including emphasis on local leadership, shared direction, commitment to sustainability, respect and solidarity among colleagues, and meaningful communication. The RSON project led to a shift in team culture in participating sites, improved team function, and contributed to improved clinical processes and patient outcomes. The findings have implications for rural health policy and practice in British Columbia and other jurisdictions with similar health service delivery models and geographic contexts. [ABSTRACT FROM AUTHOR]

OVERVIEW The precipitous attrition of small-volume surgical programs in rural Canada over the past 2 decades has led to the need for rural residents to travel for even the most [...], Our professional organizations have prepared this paper as part of an integrated, multidisciplinary plan to ensure the availability of well-trained practitioner teams to sustain safe, effective and high-quality rural surgical and operative delivery services. Without these robust local (or nearby) surgical services, sustaining rural maternity care is much more difficult. This paper describes the "network model" as a health human resources solution to meet the surgical needs, including operative delivery, of rural residents; outlines necessary policy directions for achieving this solution; and poses a series of enabling recommendations. Nos organisations professionnelles ont prepare cet article dans le cadre d&apos;un plan multidisciplinaire integre visant a assurer la disponibilite d&apos;equipes soignantes bien formees pour offrir des services obstetricaux interventionnels et chirurgicaux securitaires, efficaces et de grande qualite en milieu rural. Sans de tels solides services chirurgicaux locaux (ou de proximite), il est beaucoup plus difficile d&apos;assurer les soins obstetricaux en milieu rural. Cet article decrit le << modele en reseau >> comme une solution au chapitre des ressources humaines en sante pour repondre aux besoins chirurgicaux des populations rurales, y compris pour les services obstetricaux interventionnels. On y decrit aussi les orientations politiques necessaires a l&apos;application de cette solution et on formule une serie de recommandations preparatoires.

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Before the COVID-19 pandemic, researchers identified factors that influence physician practice in rural and remote locations. This body of research continues to be important in informing ongoing physician shortages in rural and remote communities across Canada. However, the pandemic appears to have changed physician workforce preferences, especially among those who shifted to telemedicine. This commentary discusses the investigation of post-pandemic workforce preferences among rural and remote physicians as a contemporary research priority and offers initial research directions for this work. [ABSTRACT FROM AUTHOR]

INTRODUCTION Rural maternity services are being discontinued in British Columbia and across rural Canada, often because of the loss of local surgical services. (1) Without immediate access to operative backup, [...], Introduction: A substantial number of small surgical services in rural Canada have been discontinued in the past 15 years because of difficulties recruiting and retaining practitioners, health care restructuring and a lack of a coherent evidence base regarding the safety of small services. The objective of this study was to examine the safety of small perinatal surgical services. Methods: We accessed perinatal data for singleton births that occurred in British Columbia between Apr. 1, 2000, and Mar. 31, 2007. We defined hospital service levels, population catchment areas surrounding each hospital and the postal codes linked to those catchment areas. Births were linked with specific catchment areas and amalgamated by service level. We made comparisons among service strata populations and adjusted for potentially confounding characteristics. Results: A total of 87 294 births occurred during the study period. The births were distributed across 6 strata of services, which ranged from no local maternity services to services supported by obstetricians. Fifteen catchment areas were served by general practitioners with enhanced surgical skills (GPESSs), and 9174 births were included from this obstetric service level. Outcomes for surgical services provided by GPs compared favourably to those provided by obstetricians. Conclusion: Our results suggest that small surgical services supported by GPESSs are a safe health services model to meet the needs of rural women and families. Introduction: Plusieurs raisons expliquent la fermeture d'un nombre substantiel de petits services chirurgicaux en milieu rural ces 15 dernieres annees au Canada: difficulte a recruter et a fideliser les medecins, restructuration des soins de sante et manque de preuves coherentes a l'appui de la securite de ces services de petite taille. L'objectif de cette etude etait de verifier la securite des services chirurgicaux perinataux de petite taille. Methodes: Nous avons accede aux donnees perinatales concernant les naissances simples survenues en Colombie-Britannique entre le 1er avril 2000 et le 31 mars 2007. Nous avons defini les niveaux de services hospitaliers, delimite les bassins de populations entourant chaque hopital et identifie les codes postaux correspondants. Les naissances ont ete assorties aux differents bassins de population, puis amalgamees par niveau de services. Nous avons procede a des comparaisons entre les populations par niveau de services, puis effectue les ajustements necessaires pour tenir compte de variables de confusion potentielles. Resultats: En tout, 87 294 naissances ont eu lieu au cours de la periode de l'etude. Les naissances ont ete distribuees entre 6 niveaux de services allant de <> a <>. Quinze des bassins de populations etaient desservis par des omnipraticiens ayant des competences chirurgicales avancees et 9174 naissances ont ete assorties a ce niveau de services obstetricaux. Au plan des resultats, les services chirurgicaux fournis par les omnipraticiens se sont compares favorablement aux services offerts par les obstetriciens. Conclusion: Nos resultats donnent a penser que les petits services chirurgicaux assures par des omnipraticiens ayant des competences chirurgicales avancees constituent un modele de services de sante securitaire pour repondre aux besoins des femmes et des familles des milieux ruraux.

Introduction: Between 2000 and 2004, 17 small rural maternity care services in British Columbia (BC) closed or were placed under moratoria. This paper explores the experiences of care providers in [...]