Recalibrating healthcare to create a more equitable post-pandemic work environment

The COVID-19 pandemic has accelerated the need for flexible arrangements, including asynchronous work and working from home. These arrangements may be necessary to comply with public health directives and are manageable when few other options exist. It can be difficult to lead in an environment when team members have divergent core working hours and are not available for collaboration. This can be compounded by the perception of inequitable treatment of employee needs or preferences by management, which can further strain team dynamics. As the pandemic eases, it may be difficult for all employees to revert to a fully on-site arrangement; some may be unable and others unwilling. Leaders will need to consider ethical issues in reaching organizational goals in this new reality. Equity, diversity, and inclusion principles will be critical when balancing the needs of the individual and the team. Supportive arrangements and a culture of inclusion will be key to retaining top talent.

Visit restrictions highlight crucial role of family members in long-term care: The British Columbia experience

The COVID-19 pandemic has created much-needed attention on long-term care in Canada. Public exposure of life in long-term care has generated tremendous public support for improvements that to a large extent focus on staffing and ageing infrastructure. However, the impact of visit restrictions on long-term care residents during the pandemic highlights the need for changes to how long-term care has traditionally viewed the role and value of family members. The Office of the Seniors Advocate of British Columbia published a report Staying Apart to Stay Safe that highlighted the impact of visit restrictions from the perspective of over 13,000 residents and family members directly affected. The results provide compelling evidence of the need for health leaders to re-evaluate current practice and embrace a more holistic role for family members of residents in long-term care.

Leadership for quality in long-term care

Leadership in long-term care is a burgeoning field of research, particularly that which is focused on enabling point of care staff to provide high-quality and responsive healthcare. In this article, we focus on the relatively important role that leadership plays in enabling the conditions for high-quality long-term care. Our methodological approach involved a rapid in-depth ethnography undertaken by an interdisciplinary team across eight public and non-profit long-term care homes in Canada, where we conducted over 1,000 hours of observations and 275 formal and informal interviews with managers, staff, residents, family members and volunteers. Guiding our analysis post hoc is the LEADS in a Caring Environment framework. We mapped key promising leadership practices identified by our analysis and discuss how these can inform the development of leadership standards across staff and management in long-term care.

Advanced Robotics as a Support in Healthcare Organizational Response. A COVID-19 Pandemic case

The use of robotics is becoming widespread in healthcare. However, little is known about how robotics can affect the relationship with patients in epidemic emergency response or how it impacts clinicians in their organization and work. As a hospital responding to the consequences of the COVID-19 pandemic “ASST dei Sette Laghi” (A7L) in Varese, Italy, had to react quickly to protect its staff from infection while coping with high budgetary pressure as prices of Personal Protection Equipment (PPE) increased rapidly. In response, it introduced six semi-autonomous robots to mediate interactions between staff and patients. Thanks to the cooperation of multiple departments, A7L implemented the solution in less than 10 weeks. It reduced risks to staff and outlay for PPE. However, the characteristics of the robots affected their perception by healthcare staff. This case study reviews critical issues faced by A7L in introducing these devices and recommendations for the path forward.

Transforming the hospital-style nursing home to a centre for living

COVID-19 has put a spotlight on the senior living sector. Transformational change is needed to address the challenges of an institutional model of long-term care. This article makes recommendations applying the Systems Transformation domain of the LEADS leadership capabilities framework to change the way older persons experience the ageing journey by creating a small home model of living. A literature review reinforces the spotlight on the capital investment needed to reinvent the nursing home into a centre for living.

Home health monitoring during the COVID pandemic: Results from a feasibility study in Alberta primary care

The expansive geography of Central Alberta presents many barriers to optimal care, including limited resources and access issues. In response to the COVID-19 pandemic, primary care networks (PCNs) within Central Alberta partnered with a technology provider to rapidly implement home health monitoring (HHM) for patients with chronic diseases. In the 37 patients evaluated in phase 1 (90 days), diabetes was most common (73%), followed by hypertension (38%), chronic obstructive pulmonary disease (27%), and heart failure (11%). Overall, patients were comfortable using the HHM technology, and >60% reported improved quality of life after follow-up. Patients also made fewer visits to their family physician/emergency department compared with the pre-enrolment period. In January 2021, the HHM initiative was expanded to a larger patient cohort (phase 2; n = 500). Interim results for 90 patients from eight PCNs up to the end of May 2021 show similar findings to phase 1.

Community-informed, integrated, and coordinated care through a community-level model: A narrative synthesis on community hubs

We identify the core services included in a community hub model of care to improve the understanding of this model for health system leaders, decision-makers in community-based organizations, and primary healthcare clinicians. We searched Medline, PubMed, CINAHL, Scopus, Web of Science, and Google from 2000 to 2020 to synthesize original research on community hubs. Eighteen sources were assessed for quality and narratively synthesized (n = 18). Our analysis found 4 streams related to the service delivery in a community hub model of care: (1) Chronic disease management; (2) mental health and addictions; (3) family and reproductive health; and (4) seniors. The specific services within these streams were dependent upon the needs of the community, as a community hub model of care responds and adapts to evolving needs. Our findings inform the work of health leaders tasked with implementing system-level transformations towards community-informed models of care.

Public health leadership: Competencies to guide practice

In 2013, the Community Health Nurses of Canada in partnership with the Canadian Institute of Public Health Inspectors and the Manitoba Public Health Managers Network received funding from the Public Health Agency of Canada to develop a set of interdisciplinary leadership competencies for seven public health disciplines. The Leadership Competencies for Public Health Practice in Canada project comprised a multimethod research approach that included a scoping literature review, on-line survey, webinar-based focus groups, and a modified Delphi process. The 49 leadership competencies for public health practice were organized according to the LEADS Canada capabilities. The leadership competencies extend the core public health competencies and discipline-specific competencies and reflect foundational values of public health. The leadership competencies can be applied to professional development pathways, mentoring programs, and performance appraisals to advance public health practice. How these competencies have been enacted by public health leaders during the COVID-19 pandemic is discussed.

A new era of health leadership

Traditional models of health leadership are characterized by top-down structures dependent on hierarchy – which emerged historically from military models. With supporting evidence, many of today’s leaders are now working hard to shift their organizations to models of empowered teams and servant leadership with the hopes of inciting a broader cultural shift. The concern is that these early signs of progress could unravel due to the many challenges now exacerbated by COVID-19 and its implications. One such example is fostering respect and civility (i.e. the pillars of empowerment and servant leadership) which is placed at risk during times of change and crisis – more so during a pandemic when command-and-control structures are deemed necessary. The evolution of modern health leadership must be implemented with plans for mitigating related risks. Ultimately, the behaviours that are tolerated during times of stress are what become the value system of any organization.