Building Blocks to Sustainable Rural Maternity Care: Toward a Systems Approach to Service Planning.

This qualitative study aimed to understand, document and analyze system supports needed to sustain rural maternity care in communities without local access to Caesarean section. In-depth interviews and focus groups with 58 healthcare providers and administrators from rural British Columbia were conducted in 2017/2018. Themes from the data led to the development of five systems interventions necessary to stabilize local maternity care: (1) building nursing confidence; (2) supporting interprofessional teams; (3) efficient transport to referral sites; (4) clear inclusion criteria for local deliveries; and (5) enhanced relationships with referral centres.

Finding Primary Care-Repurposing Physician Registration Data to Generate a Regionally Accurate List of Primary Care Clinics: Development and Validation of an Open-Source Algorithm.

BACKGROUND: Some Canadians have limited access to longitudinal primary care, despite its known advantages for population health. Current initiatives to transform primary care aim to increase access to team-based primary care clinics. However, many regions lack a reliable method to enumerate clinics, limiting estimates of clinical capacity and ongoing access gaps. A region-based complete clinic list is needed to effectively describe clinic characteristics and to compare primary care outcomes at the clinic level. OBJECTIVE: The objective of this study is to show how publicly available data sources, including the provincial physician license registry, can be used to generate a verifiable, region-wide list of primary care clinics in British Columbia, Canada, using a process named the Clinic List Algorithm (CLA). METHODS: The CLA has 10 steps: (1) collect data sets, (2) develop clinic inclusion and exclusion criteria, (3) process data sets, (4) consolidate data sets, (5) transform from list of physicians to initial list of clinics, (6) add additional metadata, (7) create working lists, (8) verify working lists, (9) consolidate working lists, and (10) adjust processing steps based on learnings. RESULTS: The College of Physicians and Surgeons of British Columbia Registry contained 13,726 physicians, at 2915 unique addresses, 6942 (50.58%) of whom were family physicians (FPs) licensed to practice in British Columbia. The CLA identified 1239 addresses where primary care was delivered by 4262 (61.39%) FPs. Of the included addresses, 84.50% (n=1047) were in urban locations, and there was a median of 2 (IQR 2-4, range 1-23) FPs at each unique address. CONCLUSIONS: The CLA provides a region-wide description of primary care clinics that improves on simple counts of primary care providers or self-report lists. It identifies the number and location of primary care clinics and excludes primary care providers who are likely not providing community-based primary care. Such information may be useful for estimates of capacity of primary care, as well as for policy planning and research in regions engaged in primary care evaluation or transformation.

Key drivers of social accountability in nine Canadian medical schools.

A social accountability mandate for Canadian medical schools formally emerged in Canada with changes to accreditation standards in 2015. However, how social accountability is defined and operationalized within medical schools has transpired independently. Key enablers of social accountability in Canadian medical schools have been largely unexplored. This paper is the first of a two part series that seeks to explore drivers of social accountability in a sample of Canadian medical schools. Nine key drivers of social accountability emerged from the data including a unified vision, committed leadership, accreditation standards, champions of social accountability, authentic community engagement, community-based learning opportunities, a supportive organizational and governance structure, diversity within medical schools, and measurement of progress and outcomes. This is the first study of its kind to examine what is driving social accountability across Canadian medical schools. An appreciative inquiry approach highlights areas of progress for future work to focus and build upon. This paper presents the findings from part one of the study - exploring the themes emerging from key informant interviews with senior leaders. A second paper will dive into the broader perspectives of faculty, staff and students, to explore more fully the varying perspectives of social accountability within colleges.

Exploring social accountability in Canadian medical schools: broader perspectives.

This article was migrated. The article was marked as recommended. This article is the second of a two-part series in a study that explores key drivers of social accountability in Canada's medical schools and offers examples of social accountability in action. The study gathered perspectives from medical school staff, students and faculty through focus group discussions, using an appreciative inquiry approach. Drivers of social accountability emerging from the focus groups largely corroborate what was discovered in the first part of the series during key informant interviews with senior leaders. These include the importance of accreditation, leadership, vision and mandate, and community engagement among others, and highlight the key role champions play in driving social accountability. This study builds on the first article in the series by recognizing leadership as an important driver for social accountability, but highlighting how leadership alone is not enough. The broader range of perspectives gathered through the focus group discussions uncovered the importance of social accountability 'champions' at all levels: formal leadership, faculty, student and staff. Focus group discussions also uncovered an additional key driver that was not found in key informant interviews - cultural humility, with participants noting that action towards social accountability requires shifts not only in organizational structure, but also organizational culture, to foster real, lasting change. This study demonstrates the utility of an appreciative inquiry approach for understanding how complex systems like medical education institutions are innovatively tackling challenges around health equity. The richness of the themes that emerged consistently across focus group sessions and key informant interviews support the utility of the approach in furthering our understanding as to what is working to drive social accountability in some Canadian medical schools.