Sara A Kreindler

• DPhil
• Chair at University of Manitoba

Background: Satire shows significant potential to engage audiences and effectively translate knowledge on politically-charged issues, yet applications to health-policy research are rare. Methods: We present the qualitative component of a mixed-methods study evaluating the reception of a research-based digital musical satirizing health-system dysfu...

Lorsque la COVID-19 a frappé, l’expression « Ça va bien aller » (All in this together) est devenue un cri de ralliement; pourtant, au cours de la pandémie, le discours public s’est irrémédiablement polarisé. Pour comprendre ce renversement, notre étude qualitative examine le déploiement et la réception publique du discours « Ça va bien aller » (All...

Background Older adults are at high risk of developing delirium in the emergency department (ED); however, it is under-recognized in routine clinical care. Lack of detection and treatment is associated with poor outcomes, such as mortality. Performance measures (PMs) are needed to identify variations in quality care to help guide improvement strate...

Background Despite growing evidence of the potential of arts-based modalities to translate knowledge and spark discussion on complex issues, applications to health policy are rare. This study explored the potential of a research-based theatrical video to increase public capacity and motivation to engage with the complex issues that make Emergency D...

Background Older adults are at high risk of developing delirium in the emergency department (ED); however, it is under-recognized in routine clinical care. Lack of detection and treatment is associated with poor outcomes, such as mortality. Performance measures (PMs) are needed to identify variations in quality care to help guide improvement strate...

Introduction Older adults are at high risk of developing delirium in the emergency department (ED). Delirium associated with an ED visit is independently linked to poorer outcomes such as increased length of hospital stay and mortality. Performance measures (PMs) are needed to identify variations in the quality of delirium care to help focus improv...

Rationale: Older adults are at high risk of developing delirium in the emergency department (ED); however, it is often missed or undertreated. Improving ED delirium care is challenging in part due to a lack of standards to guide best practice. Clinical practice guidelines (CPGs) translate evidence into recommendations to improve practice. Aim: T...

Background Up to 35% of older adults present to the emergency department (ED) with delirium or develop the condition during their ED stay. Delirium associated with an ED visit is independently linked to poorer outcomes such as loss of independence, increased length of hospital stay, and mortality. Improving the quality of delirium care for older ED...

Background Up to 35% of older adults present to the emergency department (ED) with delirium or develop the condition during their ED stay. Delirium associated with an ED visit is independently linked to poorer outcomes such as loss of independence, increased length of hospital stay, and mortality. Improving the quality of delirium care for older ED...

Introduction: Acute care hospitals often inadequately prepare older adults to transition back to the community. Interventions that seek to improve this transition process are usually evaluated using healthcare use outcomes (e.g., hospital re-visit rates) only, and do not gather provider and patient perspectives about strategies to better integrate...

Background Research co-production is an umbrella term used to describe research users and researchers working together to generate knowledge. Research co-production is used to create knowledge that is relevant to current challenges and to increase uptake of that knowledge into practice, programs, products, and/or policy. Yet, rigorous theories and...

Background Research co-production is an umbrella term used to describe research users and researchers working together to generate knowledge. Research co-production is used to create knowledge that is relevant to current challenges and to increase uptake of that knowledge into practice, programs, products, and/or policy. Yet, rigorous theories and...

Purpose: Interventions to hasten patient discharge continue to proliferate despite evidence that they may be achieving diminishing returns. To better understand what such interventions can be expected to accomplish, the authors aim to critically examine their underlying program theory. Design/methodology/approach: Within a broader study on patie...

Purpose: This paper reports the quantitative component of a mixed-methods study of patient flow in the 10 urban health regions/zones of Western Canada. We assessed whether jurisdictions differed meaningfully in their emergency flow performance, defined as mean emergency department length of stay (ED LOS). Methods: We used hierarchical linear mod...

Access to a regular primary care provider is essential to quality care. In Canada, where 15% of patients are unattached (i.e., without a regular provider), centralized waiting lists (CWLs) help attach patients to a primary care provider (family physician or nurse practitioner). Previous studies reveal mechanisms needed for CWLs to work, but focus m...

Background: Patient flow through health services is increasingly recognized as a system issue, yet the flow literature has focused overwhelmingly on localized interventions, with limited examination of system-level causes or remedies. Research suggests that intractable flow problems may reflect a basic misalignment between service offerings and po...

Units providing transitional, subacute, or restorative care represent a common intervention to facilitate patient flow and improve outcomes for lower acuity (often older) inpatients; however, little is known about Canadian health systems’ experiences with such “transition units.” This comparative case study of diverse units in four health regions (...

Background Several of the many emergency department (ED) interventions intended to address the complex problem of (over)crowding are based on the principle of streaming : directing different groups of patients to different processes of care. Although the theoretical basis of streaming is robust, evidence on the effectiveness of these interventions...

Background: Health care managers face the critical challenge of overcoming divisions among the many groups involved in patient care, a problem intensified when patients must flow across multiple settings. Surprisingly, however, the patient flow literature rarely engages with its intergroup dimension. Purpose: This study explored how managers wit...

In publicly funded health systems, reform efforts have proliferated to adapt to increasingly complex demands. In Canada, prior research (Lazar et al ., 2013, Paradigm Freeze: Why is it so Hard to Reform Health Care in Canada? , McGill-Queen's Press) found that reforms at the end of the 20th century failed to change the fundamentals of the Canadian...

While most health systems have implemented interventions to manage situations in which patient demand exceeds capacity, little is known about the long-term sustainability or effectiveness of such interventions. A large multi-jurisdictional study on patient flow in Western Canada provided the opportunity to explore experiences with overcapacity mana...

Context Many health systems have centralized waiting lists (CWLs), but there is limited evidence on CWL effectiveness and how to design and implement them. Aim To understand how CWLs’ design and implementation influence their use and effect on access to healthcare. Methods We conducted a realist review (n = 21 articles), extracting context-interv...

According to Iverson and colleagues’ thoughtful analysis, decisions to decentralize or regionalize surgical services must take into account contextual realities that may impede the safe execution of certain delivery models in lowand middle-income countries (LMICs), and should be governed by procedure-related considerations (specifically, volume, pa...

Bowen et al offer a sobering look at the reality of research partnerships from the decision-maker perspective. Health leaders who had actively engaged in such partnerships continued to describe research as irrelevant and unhelpful – just the problem that partnered research was intended to solve. This commentary further examines the many barriers th...

Objective: To understand family physicians' perceptions of Manitoba's strategies for primary care renewal or reform (PCR). Design: Qualitative substudy of an explanatory case study. Setting: Rural and urban Manitoba. Participants: A total of 60 family physicians (31 fee-for-service physicians, 26 alternate-funded physicians, and 3 physicians...

Primary care reform cannot succeed without substantive change on the part of providers. In Canada, these are mostly fee-for-service physicians, who tend to regard themselves as independent professionals and not under managerial sway. Hence, policymakers must balance two conflicting imperatives: ensuring the acceptability of renewal efforts to these...

This paper proposes a general model, based on what is known about the nature of (complex) systems, of how systems—in particular, health care systems—respond to attempted change. Inferences are drawn from a critical literature review and reinterpretation of two primary studies. The two fundamental system‐change approaches are “stipulation” and “stim...

Canada has the lowest rate of attachment to primary care providers among OECD countries, which makes access and continuity of care problematic. To address this important issue, seven Canadian provinces have implemented centralized waiting lists (CWLs) for unattached patients in primary care. Introduced at different times, no two provinces' CWLs are...

Purpose Healthcare policymakers and managers struggle to engage private physicians, who tend to view themselves as independent of the system, in new models of primary care. The purpose of this paper is to examine this issue through a social identity lens. Design/methodology/approach Through in-depth interviews with 33 decision-makers and 31 fee-...

Background Integrated knowledge translation (IKT) flows from the premise that knowledge co-produced with decision-makers is more likely to inform subsequent decisions. However, evaluations of manager/policy-maker-focused IKT often concentrate on intermediate outcomes, stopping short of assessing whether research findings have contributed to identif...

Introduction Centralized waiting lists (CWLs) are one solution to reduce the problematic number of patients without a regular primary care provider. This article describes different models of CWLs for unattached patients implemented in seven Canadian provinces and identifies common issues in the implementation of these CWLs. Methods Logic models o...

Introduction: Centralized waiting lists (CWLs) are one solution to reduce the problematic number of patients without a regular primary care provider. This article describes different models of CWLs for unattached patients implemented in seven Canadian provinces and identifies common issues in the implementation of these CWLs. Methods: Logic models...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The proposed review will address the following questions: What impact does consolidating surgical services through an "acute care surgery" model have on patients, staff, and resources? What are the impacts of each of four (or more) variants of the acute care sur...

Most health care organizations engage in formal and informal planning, yet their improvement initiatives may remain disjointed and reactive. Research on organizational decision‐making has found that the “discovery” approach (seek and assess multiple options before selecting one) outperforms “idea imposition” (identify 1 option, then gather informat...

Background: Timely access to orthopedic trauma surgery is essential for optimal outcomes. Regionalization of some types of surgery has shown positive effects on access, timeliness and outcomes. We investigated how the consolidation of orthopedic surgery in 1 Canadian health region affected patients requiring hip fracture surgery. Methods: We ret...

Background Health systems in many jurisdictions struggle to reduce Emergency Department congestion and improve patient flow across the continuum of care. Flow is often described as a systemic issue requiring a “system approach”; however, the implications of this idea remain poorly understood. Focusing on a Canadian regional health system whose flow...

Background Having a regular primary care provider (i.e., family physician or nurse practitioner) is widely considered to be a prerequisite for obtaining healthcare that is timely, accessible, continuous, comprehensive, and well-coordinated with other parts of the healthcare system. Yet, 4.6 million Canadians, approximately 15% of Canada’s populatio...

Background: Although well-established principles exist for improving the timeliness and efficiency of care, many organisations struggle to achieve more than small-scale, localised gains. Where care processes are complex and include segments under different groups' control, the elegant solutions promised by improvement methodologies remain elusive....

Purpose – Patient involvement in the design and improvement of health services is increasingly recognized as an essential part of patient-centred care. Yet little research, and no measurement tool, has addressed the organizational impacts of such involvement. The paper aims to discuss these issues. Design/methodology/approach – The authors develop...

Prolonged emergency department (ED) stays make a disproportionate contribution to ED overcrowding, but the factors associated with longer stays have not been systematically reviewed. To identify the patient characteristics associated with ED length of stay (LOS) and ascertain whether a predictive model existed. This rapid systematic review included...

This paper presents the findings of a systematic search and review examining the acceptability of e-mental health services for children, adolescents, and young adults and their parents and healthcare providers. Multiple databases were searched and abstracts were screened to determine if they met study inclusion criteria. Findings from included stud...

Given all the available knowledge about effective implementation, why do many organizations continue to have—or appear to have—an implementation problem? Analysis of a 7-year corpus of reports by a Canadian health region's “embedded” research and evaluation unit sought to discover the source of the region's intractable difficulty implementing impro...

The majority of internet-based anxiety and depression intervention studies have targeted adults. An increasing number of studies of children, youth, and young adults have been conducted, but the evidence on effectiveness has not been synthesized. The objective of this research is to systematically review the most recent findings in this area and ca...

Recognition of the importance and difficulty of engaging physicians in organisational change has sparked an explosion of literature. The social identity approach, by considering engagement in terms of underlying group identifications and intergroup dynamics, may provide a framework for choosing among the plethora of proposed engagement techniques....

The consolidation of acute care surgery (ACS) services at 3 of 6 hospitals in a Canadian health region sought to alleviate a relative shortage of surgeons able to take emergency call. We examined how this affected patient access and outcomes. Using the generalized linear model and statistical process control, we analyzed ACS-related episodes that o...

Background Despite widespread belief in the importance of patient-centred care, it remains difficult to create a system in which all groups work together for the good of the patient. Part of the problem may be that the issue of patient-centred care itself can be used to prosecute intergroup conflict.Objective This qualitative study of texts examine...

The implementation of accountable care organizations (ACOs), a new health care payment and delivery model designed to improve care and lower costs, is proceeding rapidly. We build on our experience tracking early ACOs to identify the major factors-such as contract characteristics; structure, capabilities, and activities; and local context-that woul...

This cross-site comparison of the early experience of four provider organizations participating in the Brookings-Dartmouth Accountable Care Organization Collaborative identifies factors that sites perceived as enablers of successful ACO formation and performance. The four pilots varied in size, with between 7,000 and 50,000 attributed patients and...

Context: It is widely hoped that accountable care organizations (ACOs) will improve health care quality and reduce costs by fostering integration among diverse provider groups. But how do implementers actually envision integration, and what will integration mean in terms of managing the many social identities that ACOs bring together? Methods: U...

One of health care's foremost challenges is the achievement of integration and collaboration among the groups providing care. Yet this fundamentally group-related issue is typically discussed in terms of interpersonal relations or operational issues, not group processes. We conducted a systematic search for literature offering a group-based analysi...

This is the protocol for a review and there is no abstract. The proposed review will address the following questions: What impact does consolidating surgical services through an “acute care surgery” model have on patients, staff, and resources? • What are the impacts of each of four (or more) variants of the acute care surgery model? • What effects...

This synthesis seeks to assess and explain the effectiveness of policy interventions to reduce elective wait times or lists. PubMed, EMBASE, EconLit, and grey literature were systematically searched for relevant studies and reviews. Strategies with the strongest evidence base include paying for activity, buying capacity locally and setting targets...

Although housing is widely recognized as a crucial issue for people with severe and persistent mental illness, there is much to learn about the ongoing housing experiences of this group of people. Using secondary data, this study examined the housing histories of 65 assertive community treatment (ACT) clients from 2 years prior until up to 7 years...

The idea of including patient perspectives in health-services planning and evaluation is increasingly embraced by Canadian health authorities. This article argues that the validity of a particular method is not simply a matter of its scientific rigour; rather, it depends on what one considers to be the meaning and purpose of patient involvement. Pe...

Indicators are increasingly being used to monitor and evaluate health system performance. However, although indicators can provide valuable information, they also have limitations. The benefits of indicators are vitiated when they are seriously flawed (unreliable, invalid or easily "gamed"), selected before the right question has been posed or used...

The healthcare system desperately needs to invest in more evaluation in order to answer fundamental questions: Why are we seeing these results? Which interventions will result in improvement? How can we best implement evidence-informed changes? Indicators can be valuable in promoting questions; they cannot be relied on to provide answers. Unfortuna...

Nobody wants the health care system to be characterized by long, involuntary waits for treatment. Both a strong theoretical rationale and a growing number of case studies support approaches that address the root cause of long waits-usually a poorly designed system, rather than an absolute lack of capacity. This structured review of both peer-review...

There is emerging consensus that the growing problem of chronic disease demands major health system changes, as envisioned in the Chronic Care Model (original and expanded). Yet implementation research has documented the pitfalls of trying to implement the whole model at once; it is more effective to focus on one highly important change at a time....

The study of right-wing authoritarianism (RWA) and Social Dominance Orientation (SDO) as predictors of prejudice has represented an attempt to explain group dynamics in terms of individual traits. In contrast, I argue that the individual tendencies that predict prejudice are actually a product of group dynamics. This article critiques personality a...