BackgroundOrganizational-level leadership competencies are critical for the development and governance of resilient public health systems that can endure and thrive in an ever-evolving economic, social, and political context.AnalysisA mixed-methods research study identified 20 organizational leadership competencies for public health in Canada, across eight domains, including: systems thinking (e.g., leaders are able to adapt, are nimble, and innovate), policy development/implementation/evaluation (e.g., leaders engage multiple actors in policy) and resource stewardship (e.g., leaders develop a resource allocation strategy that balances efficiency and equity).Policy OptionsRecommendation: Governments across Canada should undertake legislative and regulatory efforts to implement organizational-level leadership competencies in public health organizations to strengthen system-level governance. Status quo: Without a systemic approach, some organizations will continue to undertake actions that strengthen their governance, while others will not. This could exacerbate inequities in population health outcomes and organizational performance.ConclusionStrengthening organizational leadership competencies is critical for the effective and equitable governance of public health organizations in Canada. Failure to do so could undermine their resilience in a resource-constrained and changing context.

Objective:Research is lacking that explores the transitions in mental health care of graduating postsecondary students. This mixed methods study aims to understand emerging adults' experiences in accessing mental health support over the period from pre - to post-undergraduate graduation.Methods:Survey data were collected from 586 undergraduate students in Canada to assess post-graduation expectations. Eighteen of these participants were interviewed post-graduation to reflect on their transition experiences. Data were weaved through integration and meta-inferences were generated using joint displays.Results:Graduates indicated finding online mental health services/information post-graduation unhelpful. Informal supports (e.g. friends, family) remain key sources and acted as facilitators to accessing formal services. Financial concerns and limited accessibility of free services were leading barriers. Students who anticipated being unlikely to access community services after graduation, if needed, were more likely to report not knowing where or how to access services.Discussion:These findings highlight that while informal supports remain critical, graduates face persistent financial and structural barriers that hinder access to formal services. Addressing affordability and improving awareness of available resources are necessary strategies to support emerging adults in accessing the support they need.

ObjectiveThis study aimed to better understand the mental health experiences of students as they prepared to transition out of university.ParticipantsParticipants included 18 recently graduated students from a Canadian university.MethodsVirtual one-on-one semi-structured qualitative interviews were conducted and analyzed following the protocol for content analysis and using QSR NVivo.ResultsFour main themes were identified, including: distress and feelings of doubt, the importance of connections, the impact of the COVID-19 pandemic, and experiences with mental health service use. Participants discussed feeling pressured to succeed and a fear of failure, uncertainty and unpreparedness for next steps, the importance of connections to peers and professors, a lack of motivation and feeling 'unfinished' due to the COVID-19 pandemic response, and the need for flexible and accessible mental health services to address immediate and longer-term needs.ConclusionResults have implications for better support of students as they prepare for graduation.

Although health research in Canada is primarily conducted in academic hospitals, most patients receive their care in community hospitals. The benefits of increasing research capacity in community hospitals include improved study recruitment, increased generalizability of results, broader patient access to novel therapies, better patient outcomes, enhanced staff satisfaction, and improved organizational efficiency. Nevertheless, building research programs in community hospitals remains challenging because of a lack of support and expertise. To address this gap, we developed a toolkit to help community hospital professionals build and sustain their community hospital research programs. The toolkit was developed by the Canadian Community Intensive Care Unit Research Network (CCIRNet), a group of clinician-researchers and research staff from community hospitals across Canada who have experience building community hospital research programs. Feedback from a concurrent qualitative study of Canadian community critical care professionals informed the toolkit’s design. The CCIRNet toolkit outlines five stages of community hospital clinical research program development: 1) building a research team and gaining support, 2) developing a new research program, 3) choosing a first research study, 4) getting the study up and running, and 5) sustaining a research program. Feedback from qualitative interviews emphasized the need for a step-by-step approach, frequently asked questions, and essential resources. Accordingly, each stage is structured in a question-and-answer format and includes relevant resources for each section. The CCIRNet toolkit is a practical resource for establishing research programs in community hospitals. The toolkit may increase research participation and support clinical research capacity building in community hospitals.

In Canada, academic hospitals are the principal drivers of research and medical education, while community hospitals provide patient care to a majority of the population. Benefits of increasing community hospital research include improved patient outcomes and access to research, enhanced staff satisfaction and retention and increased research efficiency and generalizability. While the resources required to build Canadian community hospital research capacity have been identified, strategies for strengthening organizational research culture in these settings are not well defined. This study aimed to understand how research culture is experienced and shaped in Canadian community hospitals to provide strategies for strengthening research culture in these settings. This qualitative descriptive study, as part of a larger study, explored the underlying dimensions of research culture. Participants were purposefully sampled and included healthcare providers, research staff or hospital administrators from community hospitals across Canada, with non-existent, emerging or established research programs. Data were collected via virtual semi-structured interviews and a demographic questionnaire. Interview transcripts were analyzed using reflexive thematic analysis and Schein’s Model of Organizational Culture as a sensitizing framework. Demographic data were analyzed using descriptive statistics. A total of 38 participants from 20 Canadian community hospitals described their experiences of research culture illustrating three key themes. As community hospital research programs matured, participants described a shift in research culture whereby research became more embedded in “the way things are done” within the community hospital. Recommended strategies to achieve an embedded culture of research involve: communications; relationship building; mentorship, training and education opportunities; selecting locally relevant studies; and systems-level support. A top-down approach to embedding research culture was contrasted with a bottom-up approach. This study described the underlying dimensions of community hospital research culture and targeted strategies for strengthening research culture at different levels of research program maturity. Community hospitals without pre-existing research infrastructure were able to foster a culture of research from the bottom-up by emphasizing the value of embedding research in clinical practice. Although challenging, fostering a culture of research from the bottom-up may be necessary to propel research forward and initiate the process to build research capacity within a community hospital.

Introduction: As the social prescribing movement grows in Canada, there is a need to understand whether students (a) are aware of this concept and (b) think it is important. Objectives: The aim of this study was to examine student perceptions and awareness of social prescribing in a Canadian university. Methods: This study was conducted at Brock University. Data collection took place between March and June of 2023. Eligibility criteria included (a) being a student at Brock University and (b) being able to read and write English. Participants completed an online survey. Quantitative data analysis consisted of basic mathematical computations. Qualitative data analysis consisted of qualitative content analysis. Results: Most participants (138/183, 75.4%) had never heard about social prescribing before. Once they were told what social prescribing is, the vast majority of participants thought that it seemed like a useful way to support health and well-being (121/126, 96.0%), felt that offering it on campus would be beneficial (129/130, 99.2%), believed that it is relevant to future health care professionals (121/128, 94.5%), thought that it should be part of the curriculum for health sciences programs (118/128, 92.2%), and expressed that they would be willing to follow their physician’s advice if they were to suggest social prescribing at an appointment (119/126, 94.4%). Conclusion/Discussion: Given the lack of awareness about social prescribing and the positive perceptions about this concept among the student body, Canadian post-secondary institutions are encouraged to (a) integrate this concept into the curriculum for health sciences programs and (b) offer social prescribing on campus.

Community hospitals account for 90

Background The COVID-19 pandemic continues to demonstrate the risks and profound health impacts that result from infectious disease emergencies. Emergency preparedness has been defined as the knowledge, capacity and organizational systems that governments, response and recovery organizations, communities and individuals develop to anticipate, respond to, or recover from emergencies. This scoping review explored recent literature on priority areas and indicators for public health emergency preparedness (PHEP) with a focus on infectious disease emergencies. Methods Using scoping review methodology, a comprehensive search was conducted for indexed and grey literature with a focus on records published from 2017 to 2020 onward, respectively. Records were included if they: (a) described PHEP, (b) focused on an infectious emergency, and (c) were published in an Organization for Economic Co-operation and Development country. An evidence-based all-hazards Resilience Framework for PHEP consisting of 11 elements was used as a reference point to identify additional areas of preparedness that have emerged in recent publications. The findings were analyzed deductively and summarized thematically. Results The included publications largely aligned with the 11 elements of the all-hazards Resilience Framework for PHEP. In particular, the elements related to collaborative networks, community engagement, risk analysis and communication were frequently observed across the publications included in this review. Ten emergent themes were identified that expand on the Resilience Framework for PHEP specific to infectious diseases. Planning to mitigate inequities was a key finding of this review, it was the most frequently identified emergent theme. Additional emergent themes were: research and evidence-informed decision making, building vaccination capacity, building laboratory and diagnostic system capacity, building infection prevention and control capacity, financial investment in infrastructure, health system capacity, climate and environmental health, public health legislation and phases of preparedness. Conclusion The themes from this review contribute to the evolving understanding of critical public health emergency preparedness actions. The themes expand on the 11 elements outlined in the Resilience Framework for PHEP, specifically relevant to pandemics and infectious disease emergencies. Further research will be important to validate these findings, and expand understanding of how refinements to PHEP frameworks and indicators can support public health practice.

Previous research has examined postsecondary student mental health and transitions into university. However, research focused on the transition out of university is lacking. Challenges may be experienced differently among population subgroups. We examined the mental health and support access of university students approaching graduation and differences by various social positions. Survey data were collected from final-year undergraduate students that had registered to graduate at a Canadian university in 2021 and 2022. Chi-square and linear regression models analyzed relationships between sociodemographic characteristics and mental health outcomes. Open-ended questions assessed barriers to accessing support and desired supports. Sexual/gender diverse students reported greater depressive symptoms than cisgender heterosexual students. Students without stressful childhood or current financial situations had lower depression and anxiety scores than their peers that experienced stressful financial situations, respectively. Formal support was more commonly accessed off-campus than on-campus in the past year. Differences in past-year support access were found by gender/sexuality, financial stress, age and race/ethnicity. Availability/scheduling was the most reported barrier to accessing campus-based services. Financial concerns were a common challenge and area for desired support. Implementing developmentally specific mental health support catering to the demands of this life period is necessary.

Background: Over the past two decades, the demands placed on modern paramedic systems has changed. Paramedic services can no longer continue to operate on a traditional response model where more ambulances are deployed to meet the rising demand of patients calling for their health needs. Recent research has explored system design in paramedicine and its relationship with organizational performance. Two subsequent paramedic systems have been identified with one, the Professionally Autonomous paramedic system, being linked to higher performance. Yet, how to operationalize this model for system modernization continues to be a gap in practice. Objective: To provide health leaders and policy makers with a framework from which to drive paramedic system modernization. Methods: This study uses the Knowledge to Action framework to develop an implementation plan for systems that seek to modernize their service delivery model toward that of a Professionally Autonomous paramedic system. Results: A detailed plan of the steps required to undertake system transformation are outlined. Whilst this framework outlines the components required for system modernization, it does not propose an in-depth outline of each of the steps required to achieve each component. Rather, end users are encouraged to develop individual implementation plans tailored to the local context using the comprehensive tools outlined within. Conclusion: This knowledge to action framework provides health leaders and policy makers with a uniform roadmap for paramedic system modernization intended to improve health (clinical) outcomes as well as health system outcomes through the Professional Autonomous paramedicine model. (c) 2023 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

BackgroundUse of telemedicine for healthcare delivery in the emergency department can increase access to specialized care for pediatric patients without direct access to a children's hospital. Currently, telemedicine is underused in this setting. ObjectivesThis pilot research project aimed to evaluate the perceived effectiveness of a telemedicine program in delivering care to critically ill pediatric patients in the emergency department by exploring the experiences of parents/caregivers and physicians. MethodsSequential explanatory mixed methods were employed, in which quantitative methods of inquiry were followed by qualitative methods. Data were collected through a post-used survey for physicians, followed by semi-structured interviews with physicians and parents/guardians of children treated through the program. Descriptive statistics were used to analyze the survey data. Reflexive thematic analysis was used to analyze interview data. ResultsThe findings describe positive perceptions of telemedicine for emergency department pediatric care, as well as barriers and facilitators to its use. The research also discusses implications for practice and recommendations for overcoming barriers and supporting facilitators when implementing telemedicine programming. ConclusionThe findings suggest that a telemedicine program has utility and acceptance among parents/caregivers and physicians for the treatment of critically ill pediatric patients in the emergency department. Benefits recognized and valued by both parents/caregivers and physicians include rapid connection to sub-specialized care and enhanced communication between remote and local physicians. Sample size and response rate are key limitations of the study.

Objective: The objective of this study was to determine the factors that increase the odds of long-stay delayed discharge in alternate level of care (ALC) patients using data collected from the Ontario Wait Time Information System (WTIS) database.Design: Retrospective cohort study utilizing data from Niagara Health's WTIS database. WTIS includes individuals admitted to any of the Niagara Health sites that have been designated as ALC.Setting and Participants: Sample consisted of 16,429 ALC patients who received care in Niagara Health hospitals from September 2014 to September 2019 and were recorded in the WTIS database.Methods: ALC designation of 30 or more days was used as the threshold fora long-stay delayed discharge. This study used binary logistic regression modeling to analyze sex, age, admission source, and discharge destination as well needs/barriers requirements to assess the likelihood of a long-stay delayed discharge among acute care (AC) and post-acute care (PAC) patients given the presence of each variable. Sample sizes calculations and receiver operating characteristic curves were used to verify the validity of the regression model.Results: Overall, 10.2% of the sample were considered long-stay ALC patients. Both AC and PAC long-stay ALC patients were more likely to be male [OR = 1.23, (1.06-1.43); OR = 1.28, (1.03-1.60)] and have a discharge destination of a long-term care bed [OR = 28.68, (22.83-36.04); OR = 6.22, (4.75-8.15)]. AC patients had bariatric [OR = 7.16, (3.45-14.83)], behavioral [OR = 1.89, (1.22-2.91)], infection (isolation) [OR = 2.31, (1.63-3.28)], and feeding [OR = 6.38, (1.82-22.30)] barriers hindering discharge. PAC patients had no significant barriers hindering patient discharge.Conclusions and Implications: Shifting the focus from ALC patient designation to short-vs long-stay ALC patients allowed this study to focus on the subset of patients that are disproportionately affecting delayed discharges. Understanding the importance of specialized patient requirements in addition to clinical factors can help hospitals become more prepared in preventing delayed discharges.(c) 2023 AMDA -The Society for Post-Acute and Long-Term Care Medicine.

A case study using mixed methods that critically appraises the implementation of a mental health policy in higher education in the absence of evidence to inform the policy using an exemplar case from one mid-sized post-secondary institution was the motivation for this research. Explanation building was used to iteratively analyse data on rival explanations of the implementation of the fall break policy. Analyses from the surveys revealed that overall, only 36.9 per cent of students perceived an increase in workload before the break and only 29.6 per cent of students perceived an increase in workload after the break. However, the focus groups and professor interviews revealed that the timing of the fall break had an impact on how students and professors experienced the break and their perceptions on its impact on student mental health. If baseline data regarding the implementation of the fall break would have been collected prior to its implementation, we could have possibly avoided the implementation issues that arose. While this research provides an exemplar case of a fall break policy at one post-secondary institution, the policy learning is universal.

The mental wellness of university students can be critical for their success. In an attempt to minimize stress for students, many universities have implemented a policy for a fall break with limited evidence to support its intended outcomes. This case study offers a critical appraisal of the formation of the fall break policy at one medium sized comprehensive university using qualitative and quantitative forms of evidence triangulated from (1) University Student Union survey, (2) document analysis and; (3) informant interview. The lack of uniformity on how the fall break is labelled, the timing of the break and its evaluation emerged as design flaws in the creation stage that perhaps, could have been mitigated if faculty and student voices were included in policy creation decisions.

BACKGROUND:The COVID-19 pandemic generated a growing interest in and need for evidence-based tools to facilitate the implementation of emergency management strategies within public health practice. Quality improvement (QI) is a key framework and philosophy to guide organizational emergency response efforts; however, the nature and extent to which it has been used in public health settings during the COVID-19 pandemic remains unclear. METHODS:We conducted a scoping review of literature published January 2020 - February 2021 and focused on the topic of QI at public health agencies during the COVID-19 pandemic. The search was conducted using four bibliographic databases, in addition to a supplementary grey literature search through custom Google search engines and targeted website search methods. Of the 1,878 peer-reviewed articles assessed, 15 records met the inclusion criteria. An additional 11 relevant records were identified during the grey literature search, for a total of 26 records included in the scoping review. RESULTS:Records were organized into five topics: 1) collaborative problem solving and analysis with stakeholders; 2) supporting learning and capacity building in QI; 3) learning from past emergencies; 4) implementing QI methods during COVID-19; and 5) evaluating performance using frameworks/indicators. CONCLUSIONS:The literature indicates that QI-oriented activities are occurring at the organizational and program levels to enhance COVID-19 response. To optimize the benefits that QI approaches and methodologies may offer, it is important for public health agencies to focus on both widespread integration of QI as part of an organization's management philosophy and culture, as well as project level activities at all stages of the emergency management cycle.

Public health responses to the COVID-19 pandemic, such as business restrictions, social distancing and lockdowns, had social and economic impacts on individuals and communities. Caremongering Facebook groups spread across Canada to support vulnerable individuals by providing a forum for sharing information and offering assistance. We sought to understand the specific impacts of Caremongering groups on individuals 1 year after the pandemic began. We used a convergent parallel mixed-methods approach that included semi-structured interviews with group moderators from 16 Caremongering groups and survey data from 165 group members. We used a constant comparative approach for thematic analysis of interview transcripts and open-ended text responses to the survey. We used source theme tables as joint displays to integrate interview and survey findings. Our results revealed five major themes: providing food, sharing information, supporting health and wellness, acquiring goods and services (non-food), and connecting communities. Respondents of our survey tended to be 35-65 years of age range, but reported helping adults of all ages. Our findings illustrate the potential of using a social media platform to connect with others and provide and access support. The Caremongering initiative demonstrates a community-driven, social media solution to issues such as isolation, loneliness and community health promotion.

Attempting to support student mental health, many Canadian universities have implemented a fall break with the assumption it would be helpful in alleviating students’ stress and anxiety. However, there is no baseline data regarding stress level or mental illness burden of students to understand its effectiveness. Using case study methodology with mixed methods, this research sought to appraise, given a lack of baseline data, the impact of a fall break on student mental health. While the surveys revealed that students overwhelmingly liked the break and perceived it to reduce their school related stress, the focus groups revealed key insights into understanding stress and coping among university students about how students like to de-stress that have practical implications for any policy aimed at promoting students’ mental wellness. This research offers practical policy suggestions to help post-secondary institutions determine whether a fall break week can be effective in addressing students’ stress and anxiety.

Background Clinical guidelines suggest that routine assessment, treatment, and prevention of pain, agitation, and delirium (PAD) is essential to improving patient outcomes as delirium is associated with increased mortality and morbidity. Despite the well-established improvements on patient outcomes, adherence to PAD guidelines is poor in community intensive care units (ICU). This quality improvement (QI) project aims to evaluate the impact of a multifaceted and multidisciplinary intervention on PAD management in a Canadian community ICU and to describe the experience of a Canadian community hospital in conducting a QI project.Methods A ten-member PAD advisory committee was formed to develop and implement the intervention. The intervention consisted of a multidisciplinary rounds script, poster, interviews, visual reminders, educational modules, pamphlet and video. The 4-week intervention targeted nurses, family members, physicians, and the multidisciplinary team. An uncontrolled, before-and-after study methodology was used. Adherence to PAD assessment guidelines by nurses was measured over a 6-week pre-intervention and over a 6-week post-intervention periods.Results Data on 430 and 406 patient-days (PD) were available for analysis during the pre- and post- intervention periods, respectively. The intervention did not improve the proportion of PD with guideline compliance to the assessment of pain (23.4% vs. 22.4%, p=0.80), agitation (42.9% vs. 38.9%, p=0.28), nor delirium (35.2% vs. 29.6%, p=0.10) by nurses.Discussion The implementation of a multifaceted and multidisciplinary intervention on PAD assessment did not result in significant improvements in guideline adherence in a community ICU. Barriers to knowledge translation are apparent at multiple levels including the personal level (low completion rates on educational modules), interventional level (under-collection of data), and organisational level (coinciding with hospital accreditation education). Our next steps include reintroduction of education modules using organisation approved platforms, updating existing ICU policy, updating admission order sets, and conducting audit and feedback.

Background Implementation of quality improvement (QI) practices varies considerably among public health units (PHUs) in Ontario. With the emphasis on continuous quality improvement (CQI) in the revised Ontario Public Health Standards (OPHS), there is a need to understand the level of QI maturity in Ontario's PHUs. The objective of this research was to establish a baseline understanding of QI maturity in Ontario's PHUs. Methods The QI Maturity Tool - Modified Ontario Version was used to assess the state of QI maturity in 34 PHUs across Ontario. QI maturity was assessed through 23 questions across three dimensions: QI Organizational Culture; QI Capacity and Competency; and QI Perceived Value. QI maturity scores were classified into five stages: Beginning; Emerging; Progressing; Achieving; and Excelling. QI maturity scores were calculated for each of the 34 participating PHUs to determine their stage of QI maturity. Each PHU's score was then used to determine the provincial average for QI maturity. Participants were also asked to answer three questions related to core CQI organizational structures. Results Across the 34 PHUs, 3503 staff participated in the survey. A review of individual PHU scores indicates that Ontario's PHUs are at varying stages of QI maturity. The average QI maturity score of 4.94 for the 34 participating PHUs places the provincial average in the "Emerging" stage of QI maturity. By QI dimensions, the participating PHUs scored in the "Emerging" stage for QI Organizational Culture (5.09), the "Beginning" stage for QI Competency and Capacity (4.58), and the "Achieving" stage for QI Perceived Value (6.00). Conclusion There is an urgent need for Ontario's PHUs to progress to higher stages of QI maturity. Participants place a high value on QI, but collectively are at less "mature" stages of QI in relation to QI organizational culture and the competency and capacity to engage in QI activities. PHUs should leverage the value that staff place on QI to foster the development of a culture of QI and provide staff with relevant knowledge and skills to engage in QI activities.

Work-integrated learning (WIL) is an expanding practice in Canadian non-clinical health-related undergraduate programs. WIL participants frequently encounter failure experiences, yet there is limited literature exploring how students overcome failure and how instructors can support this process. This study aimed to understand how students overcome and learn from failure experiences in a non-clinical undergraduate health-related WIL program. Using a constructivist grounded theory approach, in-depth interviews were conducted with 10 previous students from an established WIL program. Iterative cycles of data analysis and constant comparison generated a theoretical explanation highlighting how students overcome failure by renegotiating their expectations through 1) experiencing and managing the wave of emotion, 2) modifying expectations of self and others, 3) redefining success and moving forward, and 4) building flexibility of expectations. This research presents failure as a tool for learning and a steppingstone toward success. Findings inform a pedagogical framework to optimize student learning from failure.