Background Migrants and refugees experience a higher prevalence of mental disorders than host populations, and language discordance undermines care from help-seeking through diagnosis, adherence and outcomes. The WHO Refugee and Migrant Health: Global Competency Standards for Health Workers set broad behavioural expectations for individual health workers but do not operationalise language-discordant care, leaving clinicians and administrators without measurable standards. Objective To develop an international, consensus-based competency framework for healthcare professionals working in language-discordant mental health care, paired with a priority-versus-feasibility gap analysis to direct policy investment. Methods We conducted an international modified e-Delphi study between May and October 2025, reported in accordance with the ACCORD and CONFERD-HP guidelines. Evidence-derived items, organised into five domains and stratified for healthcare providers and administrators, were rated for priority and feasibility; consensus required at least 75% "Mandatory" agreement. Results In Round 1, 101 experts from 24 countries participated; 51 (50.5%) completed Round 2 with non-differential attrition, and 16 ratified borderline items in Round 3. Seventy-six items reached consensus across People-Centred Care (19), Communication (27), Collaboration (6), Evidence-Informed Practice (7) and Personal Conduct (17). The widest gaps fell in systemic, infrastructure-dependent competencies, including 24-hour interpreter access and interpreter-coincident scheduling (mean gap 29.6 percentage points; 33 items >30 points). Conclusions This first international competency framework defines the reciprocal behaviours clinicians and administrators must meet in language-discordant (mental) health care. Paired with a gap analysis, it offers a behaviourally specific basis for training and accreditation and shows where policy investment is most needed.
BACKGROUND:The Centre for Healthcare Innovation in Singapore has developed an Innovation Cycle framework that has served as a catalyst for successful healthcare innovation implementations across Singapore's healthcare system. OBJECTIVE:This article presents the CHI Innovation Cycle-a structured framework designed to guide clinicians and administrators through the macro stages of planning, implementing, and improving healthcare productivity and innovation initiatives, underpinned by iterative Plan-Do-Study-Act (PDSA) cycles. METHODS:The framework encompasses three interconnected areas of innovation in a hospital-broadly categorised as Care and Process Redesign, Technology, and Job Redesign-that are conceptually linked to work iteratively rather than in isolation. Five healthcare innovation projects implemented at Tan Tock Seng Hospital were analysed to demonstrate the framework's application and effectiveness. RESULTS:Analysis of the five projects revealed the framework's application and effectiveness. Projects demonstrated enhanced scalability and sustained impact when following the complete cycle. It also looks ahead to the evolution of the Innovation Cycle as the foundation for driving systems transformation in achieving better value, health, social integration, and sustainability in the Singapore healthcare system. CONCLUSIONS:The CHI Innovation Cycle framework effectively transforms organisational innovation culture by promoting integrated thinking across care processes, technology adoption, and workforce development.
Background Participation in out-of-home activities (OoHA) is hypothesised to enhance the physical, emotional, and social development of children with disabilities, as well as their health-related quality of life (HRQoL). However, longitudinal evidence in the Australian context remains limited. Objective To examine the long-term association between OoHA participation and HRQoL among children with disabilities using a population-based longitudinal dataset. Methods Data were drawn from eight waves (2004–2018) of the Longitudinal Study of Australian Children, comprising 2,480 unique children with disabilities (3,694 children-wave observations). HRQoL was measured using the Paediatric Quality of Life Inventory instrument. OoHA was defined as participation in community activities, including movie or sporting events, playgrounds or swimming pools, concert or museum visits, visiting libraries, or religious services. Panel regression (random-effects) model was employed, controlling for child and family-level covariates. Results OoHA participation was significantly associated with higher overall HRQoL (β=3.43, 95% CI:[1.27,5.59], p=0.002). More specifically, significant positive associations were observed for the physical (β=4.52, 95% CI:[1.81,7.23], p=0.001), social (β=4.12, 95% CI:[1.05,7.19], p=0.009), and school (β=4.03, 95% CI:[0.92,7.13], p=0.011) domains. A graded association was evident, with overall HRQoL scores increasing from 1 activity (β=3.12, 95% CI:[0.77,5.46], p=0.009) to 2–3 activities (β=3.34, 95% CI:[1.15,5.54], p=0.003) and to 4–5 activities (β=4.41, 95% CI:[2.06,6.76], p<0.001). Conclusions Diverse OoHA participation was associated with higher HRQoL among children with disabilities. Targeted funding should expand equitable access to inclusive programs across all regions and socioeconomic groups, supported by formal partnerships among schools, local governments, and disability service providers.
BACKGROUND:Public-private workforce dynamics, including dual practice and movement between public and private sectors, are widespread in European health systems. In small countries they interact with thin professional pools, concentrated services and constrained administrative capacity to produce disproportionate system effects; evidence for the twelve Member States of the WHO Small Countries Initiative (SCI) is limited. OBJECTIVE:To describe the shape, drivers, perceived impacts and governance of these dynamics across SCI Member States and identify priorities for cooperative action. METHODS:We analysed responses to a cross-sectional consultation conducted ahead of the SCI Ministerial Meeting (Riga, 2026). Ten of twelve Member States responded through nominated ministerial officials. Descriptive frequencies were combined with thematic synthesis of open-text responses. RESULTS:Employment structures are heterogeneous: four of ten responding Member States describe predominantly public systems with limited dual practice, while the remainder describe public-private dynamics as structural rather than marginal. Where dual practice is substantial, it concentrates among medical specialists (9). Salary is the dominant driver (8). Five of ten reported disproportionate service-delivery effects when small numbers of professionals depart. Respondents cluster into four profiles - pre-authorisation, public-dominant, restrictive and data-deficit; priorities converge on governance of simultaneous employment, public-private collaboration for surge capacity, and minimum data and monitoring systems. CONCLUSIONS:Public-private workforce dynamics in SCI Member States require responses calibrated to four typological profiles. Governance, collaboration and data form a coherent policy architecture with retention as a cross-cutting concern; regional cooperation is a fit-for-purpose response to the shared constraints identified.
The Medical Training (Prioritisation) Act 2026 provides preferential access to specialty training for UK and Irish medical graduates, graduates from certain European countries, and some internationally qualified doctors with specified immigration status. The policy has been introduced in response to the considerable pressure on specialty training: in 2025, 40,965 unique medical applicants applied in rounds 1 and 2 for 12,833 positions, as compared with 22,248 applicants applying for 11,579 positions in 2021. This article contends that while prioritisation redistributes access to limited training opportunities, it does not address the fundamental constraint on training capacity. To make this case, the article first examines the selection environment and the Act's equity aspects, then examines training capacity and workforce dependency, and finally considers what is needed for sustainable expansion and alternative pathways to progression. Recent evidence from the GMC also indicates that UK graduates still receive considerably more offers for postgraduate training than do non-UK graduates. The Act does not prevent internationally trained doctors from working in non-training roles or from pursuing other paths to become specialists. The central concern is therefore differential access to structured career progression. A lasting solution needs both prioritisation and more funding for training places, investment in educators and placements, and the creation of reliable alternative routes for career advancement.
BACKGROUND:In geriatric long-term care settings, safety is a well-established organizational goal, with measures in place to prevent physical injury and psychological harm to residents. However, no study has yet to use official Ministry of Health inspection data to systematically examine whether, and to what extent, these safety goals are achieved in Israeli geriatric long-term care facilities. OBJECTIVE:Identify safety violations in geriatric care facilities and determine whether there is a gap between written safety regulations and documented practices. METHODS:A qualitative content thematic analysis was conducted on 126 audit reports conducted in Israel's geriatric homes between the years 2023 and 2025, selected through sequential analysis until thematic saturation was reached. RESULTS:The thematic analysis of safety inspection reports from geriatric care facilities identified safety violations organized into five major themes of recurring safety concerns: (1) physical environment hazards, including faulty infrastructure, temperature extremes, and sanitation failures; (2) medication management failures, encompassing protocol non-adherence and storage/identification errors; (3) clinical care safety risks, including infection control lapses, fall hazards, pressure ulcer mismanagement, and treatment protocol violations; (4) inappropriate use of physical restraints; and (5) emergency response deficiencies. Despite clear, well-established safety protocols designed to protect residents, it appears that the guidelines are not consistently or effectively enforced. CONCLUSION:The documented safety failures represent preventable, and in some cases recurrent, risks of harm to elderly residents that point to the need for targeted improvements in resources, staffing, regulatory enforcement, and accountability in geriatric care facilities.
Background Canada’s official bilingualism aims to ensure equitable access to health services in English and French, yet official-language minority populations continue to face barriers to care. Objective To examine how provincial and territorial health profession regulatory authorities collect and publicly report official-language data, how practices vary across jurisdictions and professions, and how they have changed since 2017. Methods A mixed-methods environmental scan combined a follow-up survey of registrars with an updated review of publicly available registry information. Data were collected in summer 2024 across Canada’s ten provinces and three territories for seven regulated health professions and compared descriptively with findings from 2017. Results In 2017, 48 of 89 regulatory authorities (54%) reported collecting official-language data from registrants and 22 (25%) made these data publicly available. In 2024, 43 of 83 authorities (52%) collected such data and 21 (25%) reported them publicly. Because the sampling frames differed and fewer authorities were included in 2024, changes in absolute numbers should be interpreted cautiously. Authorities regulating medicine, psychology and pharmacy were most likely to collect and disclose language data. Misinterpretation of privacy legislation and the absence of mandatory reporting requirements remained important barriers. Jurisdictions with minimum data standards, notably Ontario, demonstrated more consistent practices. Conclusions The collection and public reporting of official-language data by Canadian health profession regulatory authorities have changed little since 2017. Standardised minimum requirements are needed to support equitable access to care and evidence-informed health workforce planning for official-language minority populations.
Background Telehealth can reduce barriers to allied health care, but consumer preferences remain underexplored. Because allied health involves discipline-specific assessment and therapeutic techniques, findings from medical telehealth may not generalise. Objective To investigate consumer preferences for telehealth in Australian allied health services. Methods An online discrete choice experiment was conducted with 1,001 participants drawn from an Australian consumer panel, with recruitment quotas ensuring adequate representation of culturally and linguistically diverse (CALD) (n = 194, 19.4%) and rural participants (n = 285, 28.7%). Participants completed hypothetical choices in two allied health clinical frames (physiotherapy and psychology). Attributes and levels were developed through literature review, focus groups, and consumer and expert input. Data were analysed using conditional logit and latent class models, with subgroup analyses by rurality and CALD. Results In-person or hybrid models were preferred. Telehealth preference improved with reliability, though technical issues penalised. Timeliness and cost drove uptake, while long waits and high fees reduced use. Rural participants were more sensitive to delays and technical problems; CALD participants were more cost-sensitive but accepting of reliable telehealth. Patterns were similar across physiotherapy and psychology, physiotherapy valued punctuality and psychology valued structured follow-up. Latent class analysis identified three groups: traditionalist and cost-sensitive (47.2%), cost-tolerant generalists (27.4%), and time- and travel-sensitive users (25.4%). Conclusion Reliable, affordable telehealth can be an attractive option for allied health care, although preferences vary. Policies that support affordability, cultural responsiveness, and quality standards, while enabling mixed delivery models, are critical to meeting consumers’ diverse needs and circumstances.
BACKGROUND:A mental health lens has historically been used to describe suicide and its prevention, however increasing research evidence and policy advice indicates that collaboration between multiple government agencies, service sectors and communities would more appropriately address the underlying drivers of distress. This has contributed to growing support internationally for a whole-of-government approach to suicide prevention, but there are varied descriptions of how this is applied. OBJECTIVE:This paper identifies mechanisms for whole-of-government action, as written into Australian suicide prevention policies and provides a narrative review of existing governance structures and potential future actions. METHODS:Nineteen suicide prevention policy documents were identified via an online search of government and other websites. Document analysis was used to assess whole-of-government arrangements between levels of government (vertical), across government portfolios (horizontal), and between departments at different levels of government (mixed). RESULTS:All nine Australian jurisdictions had between one and four policy documents guiding suicide prevention. While extracts referencing whole-of-government mechanisms were relatively sparse (N = 91), all documents included examples of one or more whole-of-government mechanisms (horizontal = 34%, vertical = 25% and mixed = 41%). The most common mechanism function was joint oversight and collaboration, with joint funding arrangements, policy linkages, formal agreements, and legislation less common. CONCLUSIONS:Despite variations across jurisdictions, there is evidence that contemporary Australian suicide prevention policies include arrangements to facilitate whole-of-government action. However, strengthened arrangements between governments and across portfolios are needed to advance suicide prevention as a whole-of-government priority.
Background An ageing population, rising chronic disease and workforce shortages challenge Singapore’s healthcare system. To meet these challenges, healthcare professional (HCP) leaders are needed to drive policy transformation, generate knowledge and build strategic networks. These skills are best developed through practice and application, reinforced through experiential learning. Objectives Our paper presents the concept, delivery and outcomes of the NHG Health and the Centre for Healthcare Innovation (CHI)’s systematic development of leaders, achieved through four Fellowship programmes and initiatives - Management Fellowship (MF); CHI Fellowship (CHI-F), NHG Health-LKC Medicine Clinician Scientist Fellowship (CSF) and Centre for Healthcare and Innovation - Future Leaders and Young Innovators Guild (CHI-FLYING). Methods MF develops HCPs into potential executive leaders, honing strategic planning skills through organisation-wide projects and senior mentorship. CSF builds clinician-scientists by integrating PhD training with domain specialisation. CHI-F prepares HCPs to lead healthcare transformation by exposing them to emerging healthcare priorities. CHI-FLYING fosters cross-sector collaboration, connecting young leaders through platforms such as interprofessional hackathons and engagements. Results Over 250 young leaders benefited from these initiatives. Feedback has been positive, appreciating hands-on, project-based learning that enables participants to rethink, reorganise and drive change in their setting. Conclusion NHG Health and CHI’s programmes play a pivotal role in shaping future healthcare leaders for Singapore, equipping them with the key skills such as critical thinking, strategic vision, and resourcefulness required to lead the future health systems. At NHG Health, these skills are honed firsthand through a blend of experiential learning and their culmination projects.
Background Many female-specific health services in Canada are delivered by obstetrician-gynecologists and family physicians. However, little is known about how patterns of care delivery, physician workforce supply, and patient characteristics have changed over time, limiting evidence-informed workforce and health system planning. Objective To examine long-term trends in outpatient women's health service delivery, physician workforce supply, and patient characteristics in Alberta and identify implications for workforce planning, access, and health system reform. Methods This population-based cohort study used linked administrative health data from Alberta between 1994 and 2020 to analyze outpatient visits for female-specific health services to obstetrician-gynecologists or family medicine physicians. We estimated temporal trends in visit rates by health complaint, physician characteristics, and patient reproductive life stage (reproductive, perimenopausal, or postmenopausal), and comorbidities. Results Over a 26-year period, >2 million females accessed care from 416 obstetrician-gynecologists and 7,658 family medicine physicians. While the number of obstetrician-gynecologists and family medicine physicians per 1000 females increased (from 0.11 to 0.15 and 2.21 to 2.57, respectively), the average number of visits per physician per 1000 females declined (from 291 to 250 and 834 to 625, respectively). The nature and volume of visits varied by life stage. Physician and patient demographics shifted with more women physicians, patients with multimorbidity, and a U-shaped relationship between neighbourhood income and specialist utilization. Conclusion Findings suggest that physician supply alone may provide an incomplete picture of the resources required to meet women's health care needs. Future workforce planning efforts may benefit from considering changes in patient complexity, patterns of care delivery across physician types, and potential inequities in access to specialty services.
Background Indigenous health workforce reform in Canada remains shaped by colonial jurisdictional fragmentation, Indigenous-specific racism, and underinvestment. Although cultural safety initiatives and recruitment supports have expanded, reforms remain uneven and poorly coordinated. Objective To compare recent Indigenous health workforce policy instruments in Canada and identify persistent gaps and policy directions for distinctions-based, culturally rooted reform. Methods We conducted a structured narrative policy review of publicly available legislation, strategies, and professional/regulatory standards. Three cases were selected for their emphasis on Indigenous governance and cultural safety: British Columbia’s Declaration on the Rights of Indigenous Peoples Act (DRIPA) Action Plan (2022–2027), Québec’s Bill 32 establishing a cultural safety approach (2024), and Nunavut’s Inuit Employment Plan (2024–2034). Analysis was organized across five dimensions of Indigenous governance and self-determination; cultural safety and anti-racism expectations; recruitment, retention, and mentorship; sustainable financing; and education/regulatory redesign. Results Across cases, workforce-related instruments show emerging policy attention to Indigenous authority and cultural safety expectations, including co-development requirements and system-wide standards. However, implementation and accountability mechanisms remain inconsistent, financing is commonly short-term and fragmented, and accountability for measurable workforce equity varies across jurisdictions. These gaps constrain recruitment, retention, and leadership progression and limit sustained workforce infrastructure. Comparative insights from Aotearoa New Zealand, Australia, and the United States highlight the value of national coordination, measurable targets, and sustained investment. Conclusion Canada would benefit from an Indigenous-led, distinctions-based workforce framework with measurable targets, transparent accountability, and renewable Indigenous-governed financing aligned with cultural safety and anti-racism requirements.
Background Internationally educated health professionals (IEHPs), including internationally educated nurses (IENs), are central to addressing global and Canadian health workforce shortages. Canada faces a projected shortfall of over 117,000 nurses by 2030, increasing reliance on IEN recruitment and retention strategies. This paper synthesizes evidence from a nationally funded nursing workforce policy review, a targeted scan of IEN and IEHP reforms, and a Nova Scotian case study to inform policy directions. Methods A layered analysis was adopted to integrate findings across the three evidence streams. (1) An analysis of national and international nursing workforce policy reforms and strategies including an umbrella review, comparative policy analysis, and expert insights (2) A targeted scan of provincial, national, and international IEHP policies and strategies; and (3) A Nova Scotian case study drawing on expert insights and learnings from provincial implementation. Results Five key domains emerged. First, licensure and education pathways are being expedited in Canada, while international exemplars emphasize structured bridging and adaptation. Second, practice readiness and retention supports are expanding but remain uneven. Third, equity and inclusion are inconsistently operationalized. Fourth, first-voice leadership is critical to ensuring policies reflect IEN lived experience. Fifth, effective integration depends on intersectoral alignment across immigration, regulation, and settlement systems. Conclusions Canada has made progress in expanding entry pathways and supports for IENs and IEHPs, but reforms remain fragmented and uneven across provinces. A pan-Canadian IEN/IEHP implementation strategy with embedded evaluation is seen as essential to inform cross learning opportunities and key policies.
