Leadership in long-term care is a burgeoning field of research, particularly that which is focused on enabling point of care staff to provide high-quality and responsive healthcare. In this article, we focus on the relatively important role that leadership plays in enabling the conditions for high-quality long-term care. Our methodological approach involved a rapid in-depth ethnography undertaken by an interdisciplinary team across eight public and non-profit long-term care homes in Canada, where we conducted over 1,000 hours of observations and 275 formal and informal interviews with managers, staff, residents, family members and volunteers. Guiding our analysis post hoc is the LEADS in a Caring Environment framework. We mapped key promising leadership practices identified by our analysis and discuss how these can inform the development of leadership standards across staff and management in long-term care.
# Background Community health workers (CHW) are an established workforce in many low- and middle-income countries (LMICs). Some countries with national CHW programs are Brazil, India, Nepal, Ethiopia, Pakistan, Bangladesh, Iran, and Afghanistan. These large-scale CHW programs are often evaluated using data from individual CHWs rather than the program. There is a dearth of quantitative research on national CHW programs using health-related administrative datasets. The purpose of this paper is to describe geographical distribution of CHWs, the volume of their activities, and the relationship of their activities with recorded maternal and neonatal deaths in rural Afghanistan between 2009 and 2012. # Methods This paper is a quantitative analysis of national CHWs program using a large administrative database from the Afghan Ministry of Public Health linked to population census data from Afghanistan. # Results We found that CHWs and the aggregate volume of their activities have increased between 2009 and 2012 in rural Afghanistan. CHWs are not equitably distributed by population size in the 34 provinces of the country. Recorded maternal and neonatal deaths have shown an increase from 2009 to 2011 and a decrease from 2011 to 2012. # Conclusion Large administrative datasets are important data sources for research with a potential to offer valuable lessons for policymakers and health managers. Despite methodological and quality challenges, this study can be used as a baseline for future replications, a point of comparison for future research on national CHW programs for other countries.
The global health workforce crisis, simmering for decades, was brought to a rolling boil by the COVID-19 Pandemic in 2020. With scarce literature, evidence, or best practices to draw from, countries around the world moved to flex their workforces to meet acute challenges of the pandemic, facing demands related to patient volume, patient acuity, and worker vulnerability and absenteeism. One early hypothesis suggested that the acute, short-term pandemic phase would be followed by several waves of resource demands extending over the longer term. However, as the acute phase of the pandemic abated, temporary workforce policies expired and others were repealed with a view of returning to “normal”. The workforce needs of subsequent phases of pandemic effects were largely ignored despite our new equilibrium resting nowhere near our pre-COVID baseline. In this paper, we describe Canada’s early pandemic workforce response. We report the results of an environmental scan of the early workforce strategies adopted in Canada during the first COVID wave of the COVID 19 pandemic. Within a three-part framework for supporting a sustainable health workforce, we describe 470 strategies and policies that aimed to increase the numbers and flexibility of health workers in Canada, and to maximise their continued availability to work. These strategies targeted all types of health workers and roles, enabling changes to the places health work is done, the way in which care is delivered, and the mechanisms by which it is regulated. Telehealth strategies and virtual care were the most prevalent, followed by role expansion, licensure flexibility, mental health supports for workers, and return to practice of retirees. We explore the degree to which these short-term, acute response strategies might be adapted or extended to support the evolving workforce’s long-term needs.
The Mental Health and Substance Use Health (MHSUH) impacts of the COVID-19 pandemic are proving to be significant, complex, and long-lasting. The MHSUH workforce-including psychologists, social workers, psychotherapists, addiction counsellors, and peer support workers as well as psychiatrists, family physicians, and nurses-is the backbone of the response. As health leaders consider how to address long-standing and emerging health workforce challenges, there is an opportunity to move the MHSUH workforce out from the shadows through full inclusion in health workforce planning in Canada. After first examining the roots and consequences of the long-standing exclusion of the MHSUH workforce, this paper presents findings from a recent study showing how the pandemic has compounded MHSUH workforce capacity issues. Priorities for MHSUH workforce action by health leaders include closing regulation gaps, engaging the public and private sectors in coordinated planning, and accelerating data collection through a central health workforce registry.
Title confusion and lack of role clarity pose barriers to the integration of advanced practice nursing roles (i.e., clinical nurse specialist [CNS] and nurse practitioner [NP]). Lack of awareness and understanding about NP and CNS roles among the healthcare team and the public contributes to ambiguous role expectations, confusion about NP and CNS scopes of practice and turf protection. This paper draws on the results of a scoping review of the literature and qualitative key informant interviews conducted for a decision support synthesis commissioned by the Canadian Health Services Research Foundation and the Office of Nursing Policy in Health Canada. The goal of this synthesis was to develop a better understanding of advanced practice nursing roles and the factors that influence their effective development and integration in the Canadian healthcare system. Specific recommendations from interview participants and the literature to enhance title and role clarity included the use of consistent titles for NP and CNS roles; the creation of a vision statement to articulate the role of CNSs and NPs across settings; the use of a systematic planning process to guide role development and implementation; the development of a communication strategy to educate healthcare professionals, the public and employers about the roles; attention to inter-professional team dynamics when introducing these new roles; and addressing inter-professionalism in all health professional education program curricula.
Even though academics are routinely engaged in care activities for their students, colleagues, institutions, and families, care is often overlooked in the culture of academia. This study focuses on how care work affects gender equity in academia, along with work and personal lives of women academics. Through female professors, the study explores the extent, variety, and lived experiences of care practices in academia. Utilizing care and gender theories in an organizational context, we analyzed qualitative interviews with twenty-two female academics from two Canadian universities, purposively selected to represent different disciplines and stages in the academic career trajectory. Regarding their life and health trajectories, our interviewees spontaneously utilized a vocabulary of care to describe their teaching, supervision, and administrative tasks. This acknowledgment of care as an important aspect of academic practice can be helpful in addressing gender inequalities in academia. Specifically, self-care remains a largely overlooked—yet important—category of care theory. Based on our fieldwork, we argue that self-care needs to be more closely and extensively studied to create a more supportive academic work culture.
