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Steven Lewis

Publications and source records attributed to Steven Lewis.

16 recordsLinked to original sources
PubMed2005

An educational intervention to enhance nurse leaders' perceptions of patient safety culture.

OBJECTIVE: To design a training intervention and then test its effect on nurse leaders' perceptions of patient safety culture. STUDY SETTING: Three hundred and fifty-six nurses in clinical leadership roles (nurse managers and educators/CNSs) in two Canadian multi-site teaching hospitals (study and control). STUDY DESIGN: A prospective evaluation of a patient safety training intervention using a quasi-experimental untreated control group design with pretest and posttest. Nurses in clinical leadership roles in the study group were invited to participate in two patient safety workshops over a 6-month period. Individuals in the study and control groups completed surveys measuring patient safety culture and leadership for improvement prior to training and 4 months following the second workshop. EXTRACTION METHODS: Individual nurse clinical leaders were the unit of analysis. Exploratory factor analysis of the safety culture items was conducted; repeated-measures analysis of variance and paired t-tests were used to evaluate the effect of the training intervention on perceived safety culture (three factors). Hierarchical regression analyses looked at the influence of demographics, leadership for improvement, and the training intervention on nurse leaders' perceptions of safety culture. PRINCIPAL FINDINGS: A statistically significant improvement in one of three safety culture measures was shown for the study group (p<.001) and a significant decline was seen on one of the safety culture measures for the control group (p<.05). Leadership support for improvement was found to explain significant amounts of variance in all three patient safety culture measures; workshop attendance explained significant amounts of variance in one of the three safety culture measures. The total R(2) for the three full hierarchical regression models ranged from 0.338 and 0.554. CONCLUSIONS: Sensitively delivered training initiatives for nurse leaders can help to foster a safety culture. Organizational leadership support for improvement is, however, also critical for fostering a culture of safety. Together, training interventions and leadership support may have the most significant impact on patient safety culture.

Adult↗
PubMed2005

Extreme makeover: can we achieve rapid improvement in Canada's healthcare system?

Building upon some key discussion points in the Brown et al. paper, we explore the key elements driving performance measurement and quality improvement strategies in the Veterans Affairs healthcare system in the United States and the national primary-care trusts in England, both of which offer important insights into understanding the factors that affect rapid, large-scale change. In the context of these "extreme makeover" examples, our commentary discusses the currently evolving performance measurement culture in the Canadian primary healthcare reform setting. We specifically highlight the experiences in Saskatchewan, a province that has been acknowledged recently by CIHI as a leader in primary healthcare evaluation. Although Saskatchewan has attempted to overcome the methodological and conceptual challenges in evaluation that Brown et al. outline in their paper, a stable performance measurement culture has yet to emerge and systematically utilize performance measurement reports for purposes of facilitating change. Although there is a growing recognition that measures by themselves will not be able to spur improvement, it is yet to be seen to what extent these performance reports can speak compellingly to policymakers, primary healthcare providers and managers to serve as catalysts to a major leap forward in overall quality improvement.

Evaluation Studies as Topic↗
PubMed2005

Primary healthcare: the all-too-quiet revolution in waiting.

Remodelling the kitchen won't help the house with a weak foundation. The same holds truth in healthcare. We cannot solve quality and access problems or deal effectively with wait times unless primary healthcare the foundation of the system--is solid.

Canada↗
PubMed2005

Moving beyond the cost per quality-adjusted life year: modelling the budgetary impact and clinical outcomes associated with the use of sirolimus-eluting stents.

Restenosis is a major limitation to the long-term success of percutaneous coronary intervention. Drug-eluting stents are the most recent technological advance in restenosis prevention. While they are effective, their use is associated with a significant incremental cost, and a recent economic evaluation performed by the authors suggested that their use is associated with a cost per quality-adjusted life year of $58,721. How should decision-makers react to this value, particularly given that the use of sirolimus-eluting stents appears more attractive in certain patient subgroups, such as those with complex coronary lesions? In the present paper, the authors explore an alternative method of presenting the results of their economic evaluation, rather than the usual cost per quality-adjusted life year rubric, in an attempt to assist decision-makers in deciding whether, and for whom, to fund sirolimus-eluting stents. Several issues that decision-makers and providers may wish to consider when making such funding decisions are discussed.

Blood Vessel Prosthesis Implantation↗
PubMed2004

Regionalization: making sense of the Canadian experience.

This paper revisits the purposes and achievements of regionalization, a decade after its widespread implementation across Canada, and considers to what extent changes in healthcare concepts, emphasis and delivery can reasonably be attributed to it. The authors address four main questions. What, conceptually, is regionalization in healthcare, and what distinguishes it as a structure? How was regionalization intended to contribute to the achievement of the goals for the health system articulated in the 1980s and 1990s? How has regionalization been implemented in Canada, and how have these factors affected its potential to achieve its intended impact? And finally, with the experience gained over the last decade, how might we now (re)design regionalization to better contribute to health system goals? In Canada, regionalization of healthcare has entailed more than devolution and decentralization of services from provincial governments to regional authorities. It included consolidation of authority from local boards and agencies, and some centralization of services. Regionalization was the remedy proposed for the diagnosis of fragmentation and incoherence made by commissions across the country in the 1980s. Regionalization addressed the organizational dimensions of the perceived problems, but provincial governments added goals unrelated to structural change to its mandate. The authors assess the potential impact of regionalization on health system goals and take stock of current Canadian circumstances. Even where regionalization's impact is theoretically high, there are many practical limits to its effect. Although it can facilitate or impede change, in the end the will and actions of provincial governments, providers and other actors in the health system are fundamental to attaining more substantive goals. Many health reform goals require nothing less than a transformation of how society views health, and in the culture of healthcare delivery. Further, the authors argue that the implementation of regionalization in Canada has been limited. Devolution has typically been halting and provisional; there has been little stability; and there have been constraints on the ability to act. These limitations have reduced its potential effect. The authors conclude with proposals for increasing regionalization's contribution to health reform goals. These include a more stable and transparent provincial-RHA relationship, information and measures to better align resources to needs, increased regional-level system integration and changes to organizational culture and practice in the health system.

Canada↗
PubMed2003

Looking back, looking ahead: primary healthcare renewal in Canada.

This year's Health Care in Canada report prepared by the Canadian Institute for Health Information profiles what is changing, and what is not, in Canada's healthcare system, including a selection of findings related to this year's focus topic: primary healthcare.

Canada↗
PubMed2002

Funding the new biologics--public policy issues in drug formulary decision making.

One function of drug formularies is to allow health care providers to exert some control over spending. Decisions about whether to include a given medication in a formulary are based on estimates of its costs and effectiveness, relative to other treatment strategies. These decisions are made from a societal perspective, as opposed to that of individual patients, which sometimes results in conflicts. The clinical response to a medication often varies widely among subjects, which means that a small subgroup of patients might benefit dramatically, while others with the same disease do not. The result would be that a drug might appear not to be cost effective in an economic analysis, even though it is of proven value for some patients. New and innovative medications are assessed according to high standards of cost effectiveness, even though established treatments are wasteful of valuable health care resources. Moreover, quality-adjusted life-years (QALYs) discriminate against certain patient groups, including those with diseases that are associated with a high morbidity but a low mortality. Such patients often incur high indirect costs, including loss of employment income and costs incurred by family caregivers that QALYs do not reflect. Therefore, even though QALYs are transparent and widely applicable, they are not necessarily appropriate in the evaluation of a particular therapeutic intervention. A new paradigm should be developed for evaluating emerging therapies. An example would be a risk-sharing approach, whereby the pharmaceutical industry and public insurers share in the costs and rewards of introducing new treatments. This would have implications for the prices charged for new medications.

Antibodies, Monoclonal↗
PubMed2002

Decoding Mazankowski: a symphony in three movements.

The Mazankowski Report is ingenious in design. It is in fact a report in three movements. It begins with a well-modulated analysis of internal reforms needed to improve the system, generally harmonious with the prescriptions of other national and provincial reports. Its financial analyses are composed in a more ominous minor key. Its defining moment is a jarring ideological crescendo that may turn out to be its legacy in the Canadian healthcare debate.

Alberta↗