Considerations for adapting digital competencies and training approaches to the public health workforce: an interpretive description of practitioners' perspectives in Canada.

Background: Widespread digital transformation necessitates developing digital competencies for public health practice. Given work in 2024 to update Canada's public health core competencies, there are opportunities to consider digital competencies. In our previous research, we identified digital competency and training recommendations within the literature.

A comparative analysis of supply chain factors impacting COVID-19 vaccine security in high-income countries (HICs) and low-income and middle-income countries (LMICs).

Introduction: The COVID-19 pandemic focused attention on the importance of vaccine security to national security. Demand for vaccines far exceeded supply when the first COVID-19 vaccines were released. Growing data suggest a non-perfect correlation among vaccine development, production, purchases, deliveries and vaccination rates.

Digital Competencies and Training Approaches to Enhance the Capacity of Practitioners to Support the Digital Transformation of Public Health: Rapid Review of Current Recommendations.

Background: The COVID-19 pandemic highlighted gaps in the public health workforce's capacity to deploy digital technologies while upholding ethical, social justice, and health equity principles. Existing public health competency frameworks have not been updated to reflect the prominent role digital technologies play in contemporary public health, and public health training institutions are seeking to integrate digital technologies in their curricula.

Objective: As a first step in a multiphase study exploring recommendations for updates to public health competency frameworks within the Canadian public health context, we conducted a rapid review of literature aiming to identify recommendations for digital competencies, training approaches, and inter- or transdisciplinary partnerships that can enhance public health practitioners' capacity to support the digital transformation of public health.

Shifting gears: Creating equity informed leaders for effective learning health systems.

Leadership is vital to a well-functioning and effective health system. This importance was underscored during the COVID-19 pandemic. As disparities in infection and mortality rates became pronounced, greater calls for equity-informed healthcare emerged.

Fairness for Whom? Learning Health Systems' Approach to Equity in Healthcare.

Many healthcare systems use "equity" as a catch-all term to underscore their commitment to delivering care matching users' needs. Despite its ubiquity, it is often haphazardly used and applied to care and improvement efforts. As the learning health systems (LHSs) approach gains prominence, LHS researchers have sought to embed equity into their work while navigating systems with differing views of equity.

Institutional boundaries and the challenges of aligning science advice and policy dynamics: the UK and Canada in the time of COVID-19.

This comparison of institutions of science advice during COVID-19 between the Westminster systems of England/UK and Ontario/Canada focuses on the role of science in informing public policy in two central components of the response to the pandemic: the adoption of non-pharmaceutical interventions (NPIs) and the procuring of vaccines. It compares and contrasts established and purpose-built bodies with varying degrees of independence from the political executive, and shows how each attempted to manage the tensions between scientific and governmental logics of accountability as they negotiated the boundary between science and policy. It uses the comparison to suggest potential lessons about the relative merits and drawbacks of different institutional arrangements for science advice to governments in an emergency.

Saying and doing are different things: a scoping review on how health equity is conceptualized when considering healthcare system performance.

Introduction: Ensuring healthcare systems provide equitable, high quality care is critical to their users' overall health and wellbeing. Typically, systems use various performance frameworks and related indicators to monitor and improve healthcare. Although these frameworks usually include equity, the extent that equity is reflected in these measurements remains unclear.

Aligning goals of for-profit, not-for-profit, and public healthcare organizations by governing for quality: A model for change in the U.S. and other jurisdictions.

There has been widespread criticism of privately owned or operated healthcare organizations in Canada and beyond. However, governments have limited resources to infuse the capital and provide the scale necessary to rapidly address the post-pandemic needs of healthcare systems. Ensuring that healthcare providers regardless of ownership or for-profit or not-for-profit status, provide high quality care and ensure health equity is paramount.

Addressing Health-Related Quality of Life Among Children With Multiple Sclerosis.

Background: Children with the chronic disease multiple sclerosis (MS) report lower health-related quality of life (HRQOL) compared with children who experience transient illness. The relationship between an MS diagnosis and the HRQOL of affected children is mediated by parental HRQOL. Interventions to improve the HRQOL of children with MS should, therefore, include parents of affected children.

Family health conditions and parental occupational status modify the relationship between pediatric-onset multiple sclerosis and parental health-related quality of life.

Background: The health-related quality of life (HRQoL) of children with multiple sclerosis (MS) is mediated by the HRQoL of their parents. Understanding factors that modify the relationship between the child's MS diagnosis and parental HRQoL would inform interventions to improve the HRQoL of both parents and children living with MS.

Objective: We evaluated whether the association between an MS diagnosis during childhood and parental HRQoL is modified by the presence of a family health condition or low socioeconomic position (SEP).

How Do We Build the Human Capital for a True Learning Healthcare System?

Our healthcare systems depend on human capital for effectiveness. The Canadian Institutes of Health Research - Institute of Health Services and Policy Research has prioritized building capacity for "solution-oriented research and evidence-informed health care system transformation" (CIHR IHSPR 2021a: 20) as a core strategic direction. In this commentary, we articulate strategies for positioning PhD-trained scientists at the forefront of this transformation, including refreshing a competency framework that outlines the skill set required for maximum impact, exploring opportunities to expand embedded research career pathways and considering new ways to support the evolution of learning health systems.

The determinants of effective inter-organization information sharing in the health capital planning process.

This qualitative study examines the determinants of effective inter-organization information sharing in the Health Capital Planning process (the process), primarily in the final stage of the process which focuses on the review of final expenses and release of a holdback. Using thematic analysis and building off a scoping review that was conducted in preparation for this study, we provide a framework for effective information sharing during the process. We interviewed 17 leaders from the Government of Ontario and hospitals across the province.

The health-related quality of life of children with multiple sclerosis is mediated by the health-related quality of life of their parents.

Background: We previously found that children with the chronic disease multiple sclerosis (MS) reported lower health-related quality of life (HRQoL) when compared to children who experienced the transient illness termed monophasic acquired demyelinating syndromes (monoADS). Parents of children with MS also reported lower HRQoL.

Objectives: We evaluated whether parental HRQoL mediated the relationship between the diagnosis of MS and the HRQoL of affected children.

Ontario's COVID-19 Modelling Consensus Table: mobilizing scientific expertise to support pandemic response.

Setting: COVID-19 has highlighted the need for credible epidemiological models to inform pandemic policy. Traditional mechanisms of commissioning research are ill-suited to guide policy during a rapidly evolving pandemic. At the same time, contracting with a single centre of expertise has been criticized for failing to reflect challenges inherent in specific modelling approaches.

Effects of hospital funding reform on wait times for hip fracture surgery: a population-based interrupted time-series analysis.

Background: Health care funding reforms are being used worldwide to improve system performance but may invoke unintended consequences. We assessed the effects of introducing a targeted hospital funding model, based on fixed price and volume, for hip fractures. We hypothesized the policy change was associated with reduction in wait times for hip fracture surgery, increase in wait times for non-hip fracture surgery, and increase in the incidence of after-hours hip fracture surgery.

Divergent notions of "quality" in healthcare policy implementation: a framing perspective.

Purpose: This paper examines how "quality" was framed in the design and implementation of a policy to reform hospital funding and associated care delivery. The aims of the study were: (1) To describe how government policy-makers who designed the policy and managers and clinicians who implemented the policy framed the concept of "quality" and (2) To explore how frames of quality and the framing process may have influenced policy implementation.

Design/methodology/approach: The authors conducted a secondary analysis of data from a qualitative case study involving semi-structured interviews with 45 purposefully selected key informants involved in the design and implementation of the quality-based procedures policy in Ontario, Canada.

Association between the regional variation in premature mortality and immigration in Ontario, Canada.

Objectives: Health region differences in immigration patterns and premature mortality rates exist in Ontario, Canada. This study used linked population-based databases to describe the regional proportion of immigrants in the context of provincial health region variation in premature mortality.

Methods: We analyzed all adult premature deaths in Ontario from 1992 to 2012 using linked population files, Canadian census, and death registry databases.

Are we prepared? The development of performance indicators for public health emergency preparedness using a modified Delphi approach.

Background: Disasters and emergencies from infectious diseases, extreme weather and anthropogenic events are increasingly common. While risks vary for different communities, disaster and emergency preparedness is recognized as essential for all nation-states. Evidence to inform measurement of preparedness is lacking.

Out of sync: a Shared Mental Models perspective on policy implementation in healthcare.

The impact of policy ambiguity on implementation is a perennial concern in policy circles. The degree of ambiguity of policy goals and the means to achieve them influences the likelihood that a policy will be uniformly understood and implemented across implementation sites. We argue that the application of institutional and organisational theories to policy implementation must be supplemented by a socio-cognitive lens in which stakeholders' interpretations of policy are investigated and compared.

Exploring Mentorship as a Strategy to Build Capacity and Optimize the Embedded Scientist Workforce.

Background: Mentorship plays a significant role in career development in academic and applied settings, but little is documented about its role in the experiential learning of academic trainees embedded in health system organizations. The experiences of the first cohort of Canada's Health System Impact (HSI) Fellowship program can provide insights into how mentorship in this innovative type of training can work.

Objectives: To understand the mentorship strategies that were used and to explore fellows' and supervisors' perspectives and experiences on the effectiveness and value of those strategies.

Developing Competencies for Health System Impact: Early Lessons Learned from the Health System Impact Fellows.

Background: The Health System Impact (HSI) Fellowship program provides highly qualified post-doctoral fellows studying health services and policy research (HSPR) with opportunities for experiential learning, enriched core competency development and mentorship from senior-level leaders within health system organizations. Its overall aim is to prepare post-doctoral fellows with the research and professional skills, experiences and networks to make meaningful and impactful contributions in careers in academic and applied health system settings.

Objective: This study examined whether this HSI Fellowship program has contributed to the development of enriched core competencies in HSPR.

Training for Health System Improvement: Emerging Lessons from Canadian and US Approaches to Embedded Fellowships.

The benefits of supporting experiential learning for improved health and societal outcomes have been recognized in many countries. A number of funding organizations have developed competitive funding opportunities to support experiential learning in health system organizations outside of the traditional university setting. AcademyHealth in the US is an early innovator that pioneered the Delivery System Science Fellowship (DSSF) and inspired Canada's creation of the Health System Impact (HSI) Fellowship program.

Training for Impact: PhD Modernization as a Key Resource for Learning Health Systems.

The Institute of Medicine (IOM) has articulated a vision of a learning health system (LHS) as one that provides the best care at lower costs and that constantly, systematically and seamlessly improves based on data and evidence (IOM 2013). The IOM identifies the four foundational characteristics of an LHS as the real-time use of data and informatics to capture the care experience, patient-clinician partnerships, incentives aligned for value and a leadership-instilled culture of learning (IOM 2013). Although much policy research and commentary has focused on informatics and incentives, relatively less has focused on the critical question of creating a culture of learning in these systems.