Emergency departments are access points for people experiencing mental health and substance use crises, yet conventional emergency environments and workflows are often poorly aligned with psychiatric crisis care. Dedicated psychiatric emergency and crisis models are increasingly being implemented, including across Canadian hospitals. Drawing on the implementation of the Mental Health Emergency Services Unit at North York General Hospital and relevant literature, this article identifies five leadership lessons: treat environment as clinical infrastructure; bring mental health expertise to the front of the emergency pathway through concurrent care; build mental health capability beyond the specialized unit; integrate community partnerships into the clinical model; and embed evaluation throughout implementation. These lessons emphasize that redesign extends beyond physical capacity to include workforce, workflow, community relationships, and learning systems. Dedicated mental health emergency services should be approached as part of emergency mental health redesign, with implementation shaped by specific local context.
Timely access to Emergency Department (ED) care is a critical health system challenge that cannot be understood solely through ED operations. Existing frameworks for understanding ED wait times have rarely been critically examined collectively. We conducted a critical review of ED wait time frameworks identified through searches of PubMed, Scopus, and Google Scholar. Drawing on synthesis and principles of syndemic theory, we developed a novel framework. Five framework types were identified, which provide limited emphasis on dynamic and potentially reinforcing interactions among factors operating across different levels of the health system. Our proposed framework conceptualizes prolonged ED wait times emerging from interactions between ED management and ED service-utilization pressures within a broader health system context shaping these interactions. Our framework offers health system leaders an integrated lens for identifying interconnected pressures and may support coordination of ED interventions with strategies addressing healthcare-access barriers and system-level constraints.
Telehealth is increasingly supported by connected devices, remote monitoring, Artificial Intelligence (AI), and distributed computing. These tools can extend access and support more responsive care, but their computational and environmental demands are rarely considered alongside clinical and organizational needs. We describe the current Canadian telehealth landscape, including remote care management, virtual visits, patient portals, and remote monitoring, and identify opportunities and gaps for AI integration. We then define Green AI in healthcare and explain how an IoT–fog–cloud architecture can support resource-aware telehealth. For health leaders, Green AI is not only an engineering issue. It affects procurement, infrastructure planning, workforce capacity, clinical workflow, environmental responsibility, and equity. Evaluation should consider clinical performance, resource use, organizational fit, and sustainability. Responsible AI-enabled telehealth requires more than technical performance. A Green AI perspective can help health organizations improve computational efficiency while maintaining patient safety, usable workflows, resilience, and equitable access.
Ontario's Excellent Care for All Act requires hospitals to link executive compensation to quality improvement plan targets. More than 15 years later, this article asks whether the evidence supports that design. A narrative review of Ontario policy documents, Canadian and international research on executive pay and pay-for-performance was conducted, and behavioural science on incentives was analyzed. Pay-at-risk in Ontario is small, largely penalty-only under compensation restraint, and was associated with conservative target-setting. International evidence shows short-lived process gains, little effect on patient outcomes, and predictable gaming. No published evaluation was identified linking the Act's pay-at-risk requirement to patient outcomes. Boards can remain compliant while redesigning the link as a small, shared, multi-year, independently verified component weighted towards patient safety and workforce outcomes. The Healthcare Executive Incentive Framework 2030 sets out domains, weights, governance safeguards, and an evaluation agenda.
To promote the successful integration of Internationally Educated Nurses (IENs) in Nova Scotia, innovative transition to practice programs have been implemented in two sectors of care—acute care hospitals and Long-Term Care (LTC) facilities. These programs use didactic learning, skills and simulation labs, clinical placements, and mentorship to support IENs in building knowledge of system-specific roles, processes and technologies, and confidence enacting entry-level nursing competencies. From 2024-2025, the hospital-based program supported 69 IENs transitioning into registered nurse roles at Nova Scotia Health, and the LTC-based program supported 34 internationally educated registered nurses transitioning into licensed practical nurse roles across employers, fostering effective, timely and positive transition experiences among IENs and employers. Lessons learned include leveraging intersectoral partnerships, integrating multiple interactive learning modalities, ensuring appropriate matching and early exposure to future home units, increasing employer awareness of IEN pathways, ongoing supports and engagement, and supporting cultural competency, inclusivity, and adaptation.
