Steven Lewis

• Professor (Associate) at Simon Fraser University

In Canada the majority of deaths from the COVID-19 pandemic have occurred in nursing homes. This has exposed a major weakness in Canadian health care policy and funding that leaves thousands of vulnerable people at risk. This article explores the politics underlying this state of affairs and the choices that face the country in the future.

One of the glaring gaps in Canada's universal healthcare system is the low level of public financing of prescription drugs-42.7% of total spending in 2018. At the federal level there is renewed interest in moving towards universal coverage, supported by a recently commissioned report on how to achieve it. It will take superb political navigation to...

In February 2018, 4 fans at a hockey game in Chicago yelled "basketball!" at a black hockey player for the opposing team, the Washington Capitals. Was the taunt racist? Was the decision to expel the fans immediately and ban them from all future United Center events just? This essay explores the issues in the context of time (when a decision had to...

Overview of the context within which the Health Transition Fund (1997-2001) was established and a distillation of key outcomes and insights from the 140 projects.

Acute hospitals are the largest single component of health care budgets. Only a small percentage of the population encounters acute inpatient care in any given year, but these are the sites for the most intensive (and most expensive) care provided in the health care system. Anyone who is admitted to acute care will also use other parts of the healt...

Canadian healthcare has learned a lot about failure; it is less clear that it has learned from it. Our system performs poorly on most indicators compared to our international peers. We continue to define failure narrowly and hence as a relatively rare phenom-enon, which both comforts the status quo and douses the burning platform essential to large...

Nursing is everywhere in healthcare and at all levels, and is among other things numerically dominant. Yet it arguably plays a less prominent role in charting the future course of the system than it should. As in any complex system, power matters in health, and the history of healthcare and gender relations explains a good deal of why nursing's inf...

The failings of the Canadian health care system suggest that a public system narrowly focused on care by hospitals and physicians will perform poorly and that even massive spending increases won't solve problems without policy, structural, funding, and payment reforms.

Primary medical care is changing-more female providers, desire for better work-life balance, and increasing availability of walk-in clinics have altered service delivery. There is no uniform physician practice style, and understanding service availability and delivery requires analysis of family physicians' practice patterns, rather than just physi...

Patient-reported outcome measures (PROMs) are assessments of health status from the patient's perspective. The systematic and routine collection and use of PROMs in healthcare settings adds value in several ways, including quality improvement and service evaluation. We address the issue of instrument selection for use in primary and/or community se...

http://policyoptions.irpp.org/issues/building-a-brighter-future/lewis/

Contemporary healthcare is a sobering spectacle. It costs a lot and doesn't deliver much at the margins. But even if deep and open-minded reflection and analysis were to propose a reboot, the odds are very long against it. It is next to impossible to alter deeply entrenched patterns and entitlements. It will take nothing less than a collective comm...

Context: An evidence base that addresses issues of complexity and context is urgently needed for large-system transformation (LST) and health care reform. Fundamental conceptual and methodological challenges also must be addressed. The Saskatchewan Ministry of Health in Canada requested a six-month synthesis project to guide four major policy deve...

The text and slides from the Mowafaghian Lecture, an event sponsored by the Children’s Health Policy Centre at Simon Fraser University, Burnaby, British Columbia on May 23, 2012.

Health services research (HSR) is commonly conceived as an applied discipline whose success is defined by its tangible impact on policy, practice or both. In Canada there has been a concerted effort to engage decision-makers in informing the research agenda. While it is admirable to aspire to practical utility, the HSR community has no control over...

McGrail and colleagues have made a strong case for embedding PROMs into the everyday healthcare system. This commentary focuses on translating their argument into policy and practice. PROMs can no longer be considered a "nice to have"; they are core elements of a patient-centred, quality-oriented healthcare system. Putting PROMs at the centre of th...

Health services research (HSR) is conceived as an applied discipline and studies are expected to be useful. Yet some of the most justly famous and important HSR has no tangible short-term impact. This raises the question of what constitutes 'useful' and whether it is possible to predict which studies will influence policy or practice. Attribution i...

There is an extensive body of literature on health system quality reporting that has yet to be characterized. Scoping is a novel methodology for systematically assessing the breadth of a body of literature in a particular research area. Our objectives were to showcase the scoping review methodology in the review of health system quality reporting,...

Reference Database. This file contains the references selected from the scoping review of the literature pertaining to health system report cards. The file contains tabs that are labeled according to the categories listed in Figures 1 and 2, and the references are organized under these categories. We list an identification number, first author and...

Traditional health care is fragmented, marred by quality and safety defects, with a failure to provide evidence-based care, and huge and unjustifiable variations in practice. There is abundant evidence that traditional means of delivering health care are obsolete. Concerns are deepening about persistent and widening gaps in health status that healt...

The provision of preventive services and continuity of care are important aspects of long-term care (LTC). A proposed quality indicator of such care is the rate of hospitalizations due to ambulatory care sensitive conditions (ACSCs). As the ACSC approach to identifying potentially avoidable hospitalizations (PAH) was developed for younger community...

Some populations targeted in survey research can be hard to reach, either because of lack of contact information, or non-existent databases to inform sampling. Here, we present a methodological "case-report" of the yield of a multi-step survey study assessing views on health care among American emigres to Canada, a hard-to-reach population. To samp...

Hurley et al. document the rise of care provided by workers' compensation boards (WCBs) in Canada and suggest that they potentially represent the "proverbial canaries in the coal mine) for the publicly funded healthcare system. Given WCBs' potential draw on similar resources and their ability to purchase services through incentive-based funding, so...

Canada's apparent capacity to reform its health system is inversely proportionate to the volume of high-quality reports that document its need to do so. One of the principal causes of this inertia is our unusual preoccupation with the financial sustainability of the public system, despite compelling evidence that this is a fundamental misdiagnosis....

The authors undertook this qualitative study as part of a larger evaluation of the effect of eight clinical practice guidelines issued by an arm's-length government agency in a Canadian province. Using Orlandi and colleagues' version of the Rogers diffusion of innovation model as a framework, the authors mapped doctors' views on implementation of c...

Evidence-based medicine (EBM) and evidence-based decision-making (EBDM) were intended to revolutionize health care and health policy. Thus far they have not. A great deal of research has demonstrated the persistent ubiquity of error in health care, wide and unjustifiable variations in practice and the minimal impact of decision aids such as clinica...

There are no reported head-to-head comparative assessments of health care in any two countries by people who have experienced both. We sought to report the experiences and views of Americans living in Canada who have used both health care systems as adults. We surveyed a sample of Americans living in Canada. We used 5 communication strategies to ob...

Although the study of research utilization is not new, there has been increased emphasis on the topic over the recent past. Science push models that are researcher driven and controlled and demand pull models emphasizing users/decision-maker interests have largely been abandoned in favour of more interactive models that emphasize linkages between r...

This paper summarizes findings of a comprehensive, systematic review of the peer-reviewed and grey literature on performance measurement according to each stage of the performance measurement process--conceptualization, selection and development, data collection, and reporting and use. It also outlines implications for practice. Six hundred sixty-f...

Performance measurement is touted as an important mechanism for organizational accountability in industrialized countries. This paper describes a systematic review of business and health performance measurement literature to inform a research agenda on healthcare performance measurement. A search of the peer-reviewed business and healthcare literat...

In a narrow and bitter 4–3 decision, the Supreme Court of Canada in the Chaoulli1 decision struck down Quebec laws prohibiting the sale of private health insurance on the basis that they violate Quebec’s Charter of Human Rights and Freedoms. Three of the four judges in the majority also found that the provisions, in light of wait times in the publi...

The Supreme Court decision of June 9, 2005, clarifies the political choice facing organized medicine in Canada.1 Many of Canada's doctors are strong and eloquent supporters of single-tier health care. Many are not, and never have been. A mere decade ago, at the CMA's annual General Council meeting, a motion declaring that citizens “must have the ri...

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...

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...

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...

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.

his is the season of licensed excess, of endless parties, of cash-register orchestras chiming the Allelujah Chorus. In the health care sys- tems of the world's richest nations, Christmas comes year round. An appealing notion, at first glance: the world would surely be a better place if good will and largesse were permanent contagions. But alongside...

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 wh...

The treatment of ST-segment elevation myocardial infarction has undergone profound changes since the bedrest era of the 1960s. Most recently, the use of percutaneous coronary intervention (PCI) has been shown to be superior to thrombolysis. However, to be effective, PCI must be done as soon as possible after MI. Patients in large urban areas of Can...

Until now, we have had little systematic knowledge of the medical imaging landscape in Canada. An overview of recent trends and emerging issues is essential to sound decision-making at all levels.

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.