An Evaluation of In-Person and Online Engagement in Central Newfoundland.

BACKGROUND: This study evaluates the use of in-person focus groups and online engagement within the context of a large public engagement initiative conducted in rural Newfoundland. METHODS: Participants were surveyed about their engagement experience and demographic information. Pre and post key informant interviews were also conducted with organizers of the initiative. RESULTS: Of the 111 participants in the focus groups, 97 (87%) completed evaluation surveys; as did 23 (88%) out of 26 online engagement participants. Overall, focus group participants were positive about their involvement, with 87.4% reporting that they would participate in a similar initiative. Online participation was below expectations and these participants viewed their experience less positively than in-person participants. Organizers viewed the engagement initiative and the combined use of online and in-person engagement positively. CONCLUSIONS: This study presents a real-world example of the use of two methods of engagement. It also highlights the importance of the successful execution of whatever engagement mechanism is selected.

Electronic clinical safety reporting system: a benefits evaluation.

BACKGROUND: Eastern Health, a large health care organization in Newfoundland and Labrador (NL), started a staged implementation of an electronic occurrence reporting system (used interchangeably with "clinical safety reporting system") in 2008, completing Phase One in 2009. The electronic clinical safety reporting system (CSRS) was designed to replace a paper-based system. The CSRS involves reporting on occurrences such as falls, safety/security issues, medication errors, treatment and procedural mishaps, medical equipment malfunctions, and close calls. The electronic system was purchased from a vendor in the United Kingdom that had implemented the system in the United Kingdom and other places, such as British Columbia. The main objective of the new system was to improve the reporting process with the goal of improving clinical safety. The project was funded jointly by Eastern Health and Canada Health Infoway. OBJECTIVE: The objectives of the evaluation were to: (1) assess the CSRS on achieving its stated objectives (particularly, the benefits realized and lessons learned), and (2) identify contributions, if any, that can be made to the emerging field of electronic clinical safety reporting. METHODS: The evaluation involved mixed methods, including extensive stakeholder participation, pre/post comparative study design, and triangulation of data where possible. The data were collected from several sources, such as project documentation, occurrence reporting records, stakeholder workshops, surveys, focus groups, and key informant interviews. RESULTS: The findings provided evidence that frontline staff and managers support the CSRS, identifying both benefits and areas for improvement. Many benefits were realized, such as increases in the number of occurrences reported, in occurrences reported within 48 hours, in occurrences reported by staff other than registered nurses, in close calls reported, and improved timelines for notification. There was also user satisfaction with the tool regarding ease of use, accessibility, and consistency. The implementation process encountered challenges related to customizing the software and the development of the classification system for coding occurrences. This impacted on the ability of the managers to close-out files in a timely fashion. The issues that were identified, and suggestions for improvements to the form itself, were shared with the Project Team as soon as they were noted. Changes were made to the system before the rollout. CONCLUSIONS: There were many benefits realized from the new system that can contribute to improved clinical safety. The participants preferred the electronic system over the paper-based system. The lessons learned during the implementation process resulted in recommendations that informed the rollout of the system in Eastern Health, and in other health care organizations in the province of Newfoundland and Labrador. This study also informed the evaluation of other health organizations in the province, which was completed in 2013.

Referring physicians' perceived benefits of PACS: a regional survey pre- and post-PACS implementation.

Referring physicians in theWestern Health Authority of Newfoundland and Labrador were administered a survey before and after PACS was implemented across all acute sites in the province.The survey had 31.7% and 35.0% response rates, respectively. There was considerable support found for PACS both pre- and post-implementation in the areas of exam access and review, PACS functionality, quality of reports, efficiency, and site-to-site professional consultations.There was limited support that PACS reduced hospital length of stay. Surveys such as the one employed in this study provide an opportunity to measure the perceived benefit and challenges of PACS in a relatively cost effective manner.

Deciding whether to engage the public on health care issues.

Health care decision-makers often face calls for greater public participation or see increasing public engagement as part of their organizational mandate. This article identifies six questions decision-makers must consider when deciding whether to formally engage the public or other stakeholders around a particular health care issue. These questions focus on (1) the clarity of the issue for public engagement, (2) the appropriateness of the issue for public engagement, (3) the extent to which there are viable options, (4) the role for the public, (5) whether the public likely want to be involved and (6) consideration of the expected advantages and disadvantages of public engagement.

Exploring the technology readiness of nursing and medical students at a Canadian University.

Technology readiness is a well-established construct that refers to individuals' ability to embrace and adopt new technology. Given the increasing use of advanced technologies in the delivery of health care, this study uses the Technology Readiness Index (Parasuraman, 2000) to explore the technology readiness of nursing and medical students from the fall 2006 cohort at Memorial University of Newfoundland. The three major findings from this study are that (i) rural nursing students are more insecure with technology than their urban counterparts, (ii) male medical students score higher on innovation than their female counterparts and have a higher overall technology readiness attitude than female medical students, and (iii) medical students who are older than 25 have a negative technology readiness score whereas those under 25 had a positive score. These findings suggest health care professional schools would be well served to implement curricular changes designed to support the needs of rural students, women, and those entering school at a non-traditional age. In addition, patterns such as those observed in this study highlight areas of emphasis for current practitioners as health care organizations develop continuing education offerings for staff.

A framework for involving the public in health care coverage and resource allocation decisions.

Coverage and resource allocation decisions are a very important area for public engagement because of their direct impact on the public's access to care and because the affected services are publicly funded. We present a framework that guides decision-makers through key questions they must address when deciding on, structuring, evaluating and disseminating the results of public engagement exercises, particularly as they relate to coverage and resource allocation decisions. The framework will enable decision-makers to better conduct viable and meaningful citizen engagement around these issues.

Regionalization of health services in Newfoundland and Labrador: perceptions of the planning, implementation and consequences of regional governance.

OBJECTIVES: To describe the context and key drivers for regionalization of one provincial health care system in Canada; to document the original expectations of regionalization on governance and the extent to which these expectations were met; to identify the perceived successes and weaknesses of the process; and to examine the key issues and concerns that warrant further consideration and action in the future. METHODS: Forty-five CEO/senior administrator or senior health department officials in the period 1993-2001 were invited to participate, of whom 35 were interviewed (67% of senior health officials and 85% of CEOs/senior administrators). RESULTS: For the most part, key informants felt that expectations of reform with respect to reduction in the number of boards and integration of services under each board's mandate did occur. However, ongoing financial restraint, failure to include the full range of health services under the regional board mandate (including physician and pharmaceutical services), uncertainty regarding the level of authority the regional boards had for decision-making, and unclear accountability mechanisms between the regional boards and the provincial Ministry of Health limited the extent to which broader expectations related to development of a population health focus, and improved continuity of care for individuals and families was achieved. CONCLUSIONS: Implications for policy-makers were identified in four main areas: alignment between health policy goals and the governance structure; clarification of authority and accountability relationships; clarification of roles and responsibilities among all key actors; and strengthening of mechanisms that support accountability.