Faculty of Health Sciences
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The Faculty of Health Sciences (FHSCI) equips students with the tools need to excel in today's rapidly changing health-care sector and engages in research which spans the health-care continuum. Areas of focus in include human health science, health and wellness, exercise science, and rehabilitation.
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Browsing Faculty of Health Sciences by Subject "Accountability"
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Item Approaches to accountability in city of Toronto long-term care homes(2018-12-01) Wyers, Lindsay; Gamble, BrendaWithin the context of healthcare accountability are concepts such as quality and safety of care, resource allocation and the notion of value for money. When understanding accountability, questions such as who is accountable for what and how is accountability demonstrated arise. As the number of stakeholders and funders increase, and in a highly regulated long-term care sector, the answers to these questions increase in complexity. The goal of this study is to examine the approaches to accountability within ten homes that are publicly funded and publicly delivered by the City of Toronto, within a framework of accountability mechanisms including financial oversight, regulations and information, and professionalism. A case study research design, with both document review and semi-structured interviews, was utilized to understand the implications of key variables on the framework to evaluate accountability. The results are based on seven informants from publicly funded and delivered homes in the province of Ontario both from senior management and long-term care home administrators. The dominant mechanisms of accountability found in this research are financial oversight, regulations, and information, while professionalism played a marginal role. Key informants identified the challenges of being accountable to multiple funders, including five LHINs and to the City of Toronto. The increased need to be compliant with legislation requirements, LHIN performance indicators, and ensure high-quality resident care is not consistent with the finite and decreasing resources required to successfully demonstrate accountability to multiple stakeholders.Item Approaches to accountability in the medical laboratory sector in Ontario.(2013-10-01) Bourne, Lavern; Gamble, BrendaPurpose: Greater accountability within the Ontario medical laboratory sector is a high priority and desirable. This sector provides approximately 80% of the objective data for diagnosis, monitoring and treatment. The goal of this study is to determine how accountability is defined, and the advantages and challenges of the approaches used in this sector. Methodology: A case study design based on a mix methods approach incorporating quantitative (i.e., scoping review of documents) and qualitative data (i.e., 20 semi-structured interviews) to examine the approaches to accountability in the medical laboratory sector and the implication of core independent variables on the approaches used. Key stakeholders in the medical laboratory sector were interviewed to determine views on the advantages and challenges of the possible approaches. Results The four approaches to accountability used in the medical laboratory sector are: financial incentives, regulations, information directed towards potential users, reliance on professionalism and stewardship. Regulation is the main approach to accountability in the medical laboratory sector. Ontario Laboratory Accreditation and licensing by the Ontario government is mandatory in all laboratories except those found in physicians’ offices. There were variations in the approaches to accountability based on core independent factors such as: policy goal being pursed, the governance /ownership structures and the goods and services being delivered and their production characteristics. Laboratory services are delivered by public health, hospitals, large community based laboratories and small laboratories often found in physicians’ offices. Key informants identified quality and safety as top priorities regardless of the approach that is used. Concern for costs and resources exists within the sector as a whole. Laboratory results gain much of their value by being embedded within a system of care, in which providers order tests appropriately and are aided in interpreting and acting upon their results. The pre/post analytical stages are just as important as the analytical stage in measuring performance and ensuring validity, reliability and accountability. Conclusion: While the medical laboratory sector is highly regulated, the implementation of additional mechanisms to enhance accountability in the pre/post analytical phases is needed. The importance of this is further highlighted by the advancement of point of care testing at the bedside, the pharmacy and at home which is not fully captured by the accountability mechanisms currently in place. Advances in new technologies such as molecular and genetic testing will also impact future accountability in the medical laboratory sector.Item Patient and physician views of self-testing: blood glucose monitoring(2017-01-01) Iqbal, Sana; Gamble, BrendaMedical laboratories deliver an invaluable healthcare service by providing laboratory results to aid in the diagnosis and monitoring of disease states. Point-of-care testing (POCT), a sub-sector of medical laboratory services, is completed at the patient’s bedside with the goal of providing clinical laboratory results in a very short time frame to assist caregivers in clinical decision making (Ehrmeyer & Laessig, 2007). The technology within this sector of laboratory sciences continues to grow rapidly, making Point-of-Care (POC) tests more accessible for use in a variety of settings, essentially decentralizing laboratory testing. This represents an important shift in healthcare culture as it provides healthcare practitioners and patients alike, the opportunity to perform an ever-growing number of laboratory tests, anywhere and at any time. Through the use of semi-structured interview questions, this qualitative research project utilized a case study informed methodology to understand the role of patient autonomy in self-testing (ST) and the function of accountability as it relates to POCT, when testing occurs in an unregulated environment. Findings suggest that ST and self-care behaviours in diabetes that are autonomously initiated result in positive outcomes, as patients are more likely to be active participants in their own healthcare. The principle of patient autonomy was highlighted in the research by the need to build strong patient/physician relationships in order to facilitate dialogue that promotes informed decision-making, an important aspect of patient care. Patients also felt that participating in ST provided them with a greater sense of control over their health, and that an increased frequency of ST could be seen only in a positive manner, regardless of which self-test was being performed. Conversely, the cost and the possibility of encountering difficulties in the interpretation and troubleshooting of self-test results were seen as negative aspects of ST. Through this research endeavour, the necessity for greater measures of accountability were also made evident, as patients and physicians discussed how self-testing could impact patient care. Short-term and long-term goals are provided as recommendations to strengthen accountability in POCT within unregulated environments.