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Article: A Canadian Rural Living Lab Hospital: Implementing solutions for improving rural emergency care.

Fleet, Richard

2020 Volume 7, Issue 1, Page(s) 15–21

Abstract: Introduction: More than 6 million Canadians live in rural areas (approximately 20% of the population) and emergency services are a critical safety net for them.: Objectives: We want to create, in Baie-Saint-Paul (rural emergency department, Québec, ... ...

Abstract	Introduction: More than 6 million Canadians live in rural areas (approximately 20% of the population) and emergency services are a critical safety net for them. Objectives: We want to create, in Baie-Saint-Paul (rural emergency department, Québec, Canada), an experimental milieu where all stakeholders develop, implement and evaluate solutions to address the problems that beset their environment. Method: The Living Lab will rely on the quadruple aim approach to improve health system performance and will use a multimethod approach based on the philosophy of open and user-driven innovation. Three pilot projects will be implemented (quality of work life programme, computed tomography implementation study and telemedicine in ambulances). Other possible solutions will be evaluated and prioritised ( Conclusion: We are confident that this Living Lab will contribute to saving lives, will improve the quality of work life for rural healthcare professionals, and will inspire similar innovation internationally.
Language	English
Publishing date	2020-02-25
Publishing country	England
Document type	Journal Article
ZDB-ID	3016427-8
ISSN	2514-6653 ; 2514-6645
ISSN (online)	2514-6653
ISSN	2514-6645
DOI	10.7861/fhj.2019-0067
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Article ; Online: Barriers and Facilitators to Point-of-Care Ultrasound Use in Rural Australia.

Arnold, Annie C / Fleet, Richard / Lim, David

International journal of environmental research and public health

2023 Volume 20, Issue 10

Abstract: This study explores the barriers and facilitators to point-of-care ultrasound (POCUS) use and adoption in rural healthcare since POCUS is a useful resource for rural clinicians to overcome the challenges associated with limited on-site clinical support, ... ...

Abstract	This study explores the barriers and facilitators to point-of-care ultrasound (POCUS) use and adoption in rural healthcare since POCUS is a useful resource for rural clinicians to overcome the challenges associated with limited on-site clinical support, such as limited diagnostic imaging services and infrastructure. A qualitative descriptive study was employed, interviews with ten rural clinicians were conducted, and the data were analysed using the Walt and Gilson health policy framework to guide interpretation. Barriers include a lack of standardised training requirements, the cost of the devices and challenges recouping the costs of purchase and training, difficulty with the maintenance of skills, and a lack of an effective method to achieve quality assurance. Coupling POCUS with telemedicine could address the issues of the maintenance of skills and quality assurance to facilitate increased POCUS use, leading to positive patient safety and social and economic implications.
MeSH term(s)	Humans ; Point-of-Care Systems ; Ultrasonography/methods ; Point-of-Care Testing ; Telemedicine ; Australia
Language	English
Publishing date	2023-05-14
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph20105821
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Article ; Online: On creativity and innovation: getting into the minds of creative giants at Family Medicine Forum.

Fleet, Richard

Canadian family physician Medecin de famille canadien

2014 Volume 60, Issue 10, Page(s) 950–951

MeSH term(s)	Canada ; Creativity ; Humans ; Research Personnel/psychology ; Societies, Medical
Language	French
Publishing date	2014-10-14
Publishing country	Canada
Document type	Journal Article
ZDB-ID	603565-6
ISSN	1715-5258 ; 0008-350X
ISSN (online)	1715-5258
ISSN	0008-350X
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Article ; Online: Rethinking the organizational culture of the health system to address burnout.

Sinan, Kouadio Ibrahime / Tremblay, Marie-Philippe / Tounkara, Fatoumata Korika / Fleet, Richard

Psychiatry and clinical neurosciences

2022 Volume 76, Issue 8, Page(s) 404–405

MeSH term(s)	Burnout, Professional/prevention & control ; Burnout, Psychological ; Humans ; Job Satisfaction ; Organizational Culture
Language	English
Publishing date	2022-06-04
Publishing country	Australia
Document type	Letter
ZDB-ID	1292906-2
ISSN	1440-1819 ; 1323-1316
ISSN (online)	1440-1819
ISSN	1323-1316
DOI	10.1111/pcn.13371
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Article ; Online: A case for mandatory ultrasound training for rural general practitioners: a commentary.

Arnold, Annie C / Fleet, Richard / Lim, David

Rural and remote health

2021 Volume 21, Issue 3, Page(s) 6328

Abstract: Context: Point-of-care ultrasound is a rapidly evolving technology that enables rapid diagnostic imaging to be performed at a patient's bedside, reducing time to diagnosis and minimising the need for patient transfers. This has significant applications ... ...

Abstract	Context: Point-of-care ultrasound is a rapidly evolving technology that enables rapid diagnostic imaging to be performed at a patient's bedside, reducing time to diagnosis and minimising the need for patient transfers. This has significant applications for rural emergency and general practice, and could potentially prevent unnecessary transfers of patients from rural communities to more urban centres for the purpose of diagnostic imaging, reducing costs and preventing disruption to patients' lives. Meta-analyses on point-of-care ultrasound have reported extremely high sensitivity and specificity when detecting lung pathology, and the potential applications of the technology are substantial. A significant application of the technology is in the care of rural paediatric patients, where acute lower respiratory pathology is the most common cause of preventable deaths, hospitalisations, and emergency medical retrievals from remote communities for children under five. Issues: Although widely available, point-of-care ultrasound technology is not widely utilised in Australian emergency departments and general practices. Issues with comprehensive training, maintenance of skills, upskilling and quality assurance programs prevent physicians from feeling confident when utilising the technology. In Canada, point-of-care ultrasound training is part of the core competency training in the Royal College of Physicians of Canada emergency medicine fellowship program. Point-of-care ultrasound is widely used in rural practice, although lack of training, funding, maintenance of skills and quality assurance were still listed as barriers to use. Lessons learned: Point-of-care ultrasound is a highly sensitive and specific technology with wide potential applications. Issues with quality control and maintenance of skills are preventing widespread use. Coupling point-of-care ultrasound with telemedicine could help increase the usability and accessibility of the technology by reducing the issues associated with maintenance of skills and quality assurance.
MeSH term(s)	Australia ; Child ; General Practitioners ; Humans ; Rural Health Services ; Rural Population ; Ultrasonography
Language	English
Publishing date	2021-07-09
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2105620-1
ISSN	1445-6354 ; 1445-6354
ISSN (online)	1445-6354
ISSN	1445-6354
DOI	10.22605/RRH6328
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Article ; Online: Is it time for a CT scanner in every Canadian rural hospital?

Fleet, Richard / Brochu, Philippe / Blanchard, Pierre-Gilles

CJEM

2021 Volume 23, Issue 5, Page(s) 579–580

MeSH term(s)	Canada ; Hospitals, Rural ; Humans ; Rural Health Services ; Tomography Scanners, X-Ray Computed ; Tomography, X-Ray Computed
Language	English
Publishing date	2021-09-07
Publishing country	England
Document type	Editorial ; Comment
ISSN	1481-8043
ISSN (online)	1481-8043
DOI	10.1007/s43678-021-00197-6
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Article: Integrating environmental considerations in digital health technology assessment and procurement: Stakeholders' perspectives.

Alami, Hassane / Rivard, Lysanne / Lehoux, Pascale / Ag Ahmed, Mohamed Ali / Fortin, Jean-Paul / Fleet, Richard

Digital health

2023 Volume 9, Page(s) 20552076231219113

Abstract: Background: Digital health technologies (DHTs) are promoted as means to reduce the environmental impact of healthcare systems. However, a growing literature is shedding light on the highly polluting nature of the digital industry and how it exacerbates ... ...

Abstract	Background: Digital health technologies (DHTs) are promoted as means to reduce the environmental impact of healthcare systems. However, a growing literature is shedding light on the highly polluting nature of the digital industry and how it exacerbates health inequalities. Thus, the environmental footprint of DHTs should be considered when assessing their overall value to healthcare systems. The objectives of this article are to: (1) explore stakeholders' perspectives on integrating the environmental impacts of DHTs in assessment and procurement practices; (2) identify the factors enabling or constraining the operationalisation of such a change; and (3) encourage a constructive dialogue on how environmental issues fit within healthcare systems' push for more DHTs. Methods: Semi-structured interviews were conducted with 29 stakeholders involved in DHTs in a large Canadian academic healthcare centre. Data were collected and analysed through a mixed deductive-inductive process using a framework derived from diffusion of innovations theories. Results: The integration of the environmental impact of DHTs in assessment and procurement is contingent upon key micro-meso-macrosystemic factors that either enable or constrain changes in practices and processes. Innovation (micro) factors include stakeholders' recognition of the environmental issue and the extent to which it is feasible for them to address the environmental impact of DHTs. Organisational (meso) factors include the organisation's culture, leadership, policies, and practices, as well as the expertise and professional skillsets available. Finally, external (macro) factors include political and regulatory (e.g., national strategy, laws, standards, norms), economic (e.g., business models, public procurement), and professional and scientific factors (e.g., evidence, methodologies, clinical guidelines). Conclusion: Considering the environmental impact of DHTs depends on micro-meso-macrosystemic factors involving a variety of stakeholders and levels of governance, sometimes with divergent or even antagonistic objectives and expectations. It highlights the importance of better understanding the complexity inherent in the environmental shift in healthcare.
Language	English
Publishing date	2023-12-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2819396-9
ISSN	2055-2076
ISSN	2055-2076
DOI	10.1177/20552076231219113
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Article: The 'wrong pocket' problem as a barrier to the integration of telehealth in health organisations and systems.

Alami, Hassane / Shaw, Sara E / Fortin, Jean-Paul / Savoldelli, Mathilde / Fleet, Richard / Têtu, Bernard

Digital health

2023 Volume 9, Page(s) 20552076231169835

Abstract: The COVID-19 pandemic has accelerated the deployment of telehealth services in many countries around the world. It also revealed many barriers and challenges to the use of digital health technologies in health organisations and systems that have ... ...

Abstract	The COVID-19 pandemic has accelerated the deployment of telehealth services in many countries around the world. It also revealed many barriers and challenges to the use of digital health technologies in health organisations and systems that have persisted for decades. One of these barriers is what is known as the 'wrong pocket' problem - where an organisation or sector makes expenditures and investments to address a given problem, but the benefits (return on investment) are captured by another organisation or sector (the wrong pocket). This problem is the origin of many difficulties in public policies and programmes (e.g. education, environment, justice and public health), especially in terms of sustainability and scaling-up of technology and innovation. In this essay/perspective, we address the wrong pocket problem in the context of a major telehealth project in Canada. We show how the problem of sharing investments and expenses, as well as the redistribution of economies among the different stakeholders involved, may have threatened the sustainability and scaling-up of this project, even though it has demonstrated the clinical utility and contributed to improving the health of populations. In conclusion, the wrong pocket problem may be decisive in the reduced take-up, and potential failure, of certain telehealth programmes and policies. It is not enough for a telehealth service to be clinically relevant and 'efficient', it must also be mutually beneficial to the various stakeholders involved, particularly in terms of the equitable sharing of costs and benefits (return on investment) associated with the implementation of this new service model. Finally, the wrong pocket concept offers a helpful lens for studying the success, sustainability, and scale-up of digital transformations in health organisations and systems. This needs to be considered in future research and evaluations in the field.
Language	English
Publishing date	2023-04-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	2819396-9
ISSN	2055-2076
ISSN	2055-2076
DOI	10.1177/20552076231169835
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Article ; Online: A Canadian consensus-based list of urgent and specialized in-hospital trauma care interventions to assess the accuracy of prehospital trauma triage protocols: a modified Delphi study.

Mercier, Éric / Nadeau, Alexandra / Le Sage, Natalie / Moore, Lynne / Malo, Christian / Blanchard, Pierre-Gilles / Fleet, Richard / Émond, Marcel

Canadian journal of surgery. Journal canadien de chirurgie

2023 Volume 66, Issue 2, Page(s) E181–E188

Abstract: Background: Injury severity scales have traditionally been used to assess the performance of prehospital trauma triage protocols, but they correlate weakly with the urgent needs of specialized trauma care interventions. This study aimed to develop a ... ...

Abstract	Background: Injury severity scales have traditionally been used to assess the performance of prehospital trauma triage protocols, but they correlate weakly with the urgent needs of specialized trauma care interventions. This study aimed to develop a list of in-hospital urgent and specialized trauma care interventions that require direct transport to the highest-level trauma centre within the catchment area. Methods: Based on a list of potential participants we obtained using data on training, experience, geographic location, affiliations and role within key trauma organizations, we recruited multidisciplinary trauma experts (including prehospital, emergency, surgery and intensive care clinicians, epidemiologists and clinician/decision-makers) from across Canada to complete a 3-round modified Delphi survey. We conducted a literature review of the criteria used to define urgent and specialized trauma care, and included all diagnostic and therapeutic interventions presented in previously published studies in the list of interventions to present to the panellists. The final list was determined by our advisory committee, 5 clinicians with experience in trauma care. Participants were asked to rate their level of agreement for potentially including the 38 items as urgent and specialized trauma care interventions on a 9-point Likert scale. Interventions were retained if more than 67% of participants moderately or strongly agreed (7-9 on the Likert scale). Interventions that did not reach consensus were presented again in the subsequent round. Results: Twenty-three panellists were recruited. The response rate was 91%, 96% and 83% for the 3 rounds. After the Delphi process, 30 of the 38 interventions, including endotracheal intubation, blood product administration and angioembolization, and abdominal, thoracic, neurosurgical, spinal and/or orthopedic operations (excluding hip or limb surgery, and toe or finger amputation), were selected. Hospital admission to the intensive care unit and/or for observation of brain, spinal, thoracic or abdominal injuries were also retained. Conclusion: We developed a Canadian consensus-based list of urgent and specialized in-hospital trauma care interventions requiring direct transportation to a major trauma centre. This list should help standardize assessments of current protocols and derive new triage tools.
MeSH term(s)	Humans ; Canada ; Consensus ; Delphi Technique ; Emergency Medical Services ; Hospitals ; Triage
Language	English
Publishing date	2023-03-31
Publishing country	Canada
Document type	Journal Article ; Review
ZDB-ID	410651-9
ISSN	1488-2310 ; 0008-428X
ISSN (online)	1488-2310
ISSN	0008-428X
DOI	10.1503/cjs.019920
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Article ; Online: Through the big top: An exploratory study of circus-based artistic knowledge translation in rural healthcare services, Québec, Canada.

Théberge, Julie / Smithman, Mélanie Ann / Turgeon-Pelchat, Catherine / Tounkara, Fatoumata Korika / Richard, Véronique / Aubertin, Patrice / Léonard, Patrick / Alami, Hassane / Singhroy, Diane / Fleet, Richard

PloS one

2024 Volume 19, Issue 4, Page(s) e0302022

Abstract: Background: The conventional methods and strategies used for knowledge translation (KT) in academic research often fall short in effectively reaching stakeholders, such as citizens, practitioners, and decision makers, especially concerning complex ... ...

Abstract	Background: The conventional methods and strategies used for knowledge translation (KT) in academic research often fall short in effectively reaching stakeholders, such as citizens, practitioners, and decision makers, especially concerning complex healthcare issues. In response, a growing number of scholars have been embracing arts-based knowledge translation (ABKT) to target a more diverse audience with varying backgrounds and expectations. Despite the increased interest, utilization, and literature on arts-based knowledge translation over the past three decades, no studies have directly compared traditional knowledge translation with arts-based knowledge translation methods. Thus, our study aimed to evaluate and compare the impact of an arts-based knowledge translation intervention-a circus show-with two traditional knowledge translation interventions (webinar and research report) in terms of awareness, accessibility, engagement, advocacy/policy influence, and enjoyment. Methods: To conduct this exploratory convergent mixed method study, we randomly assigned 162 participants to one of the three interventions. All three knowledge translation methods were used to translate the same research project: "Rural Emergency 360: Mobilization of decision-makers, healthcare professionals, patients, and citizens to improve healthcare and services in Quebec's rural emergency departments (UR360)." Results: The findings revealed that the circus show outperformed the webinar and research report in terms of accessibility and enjoyment, while being equally effective in raising awareness, increasing engagement, and influencing advocacy/policy. Each intervention strategy demonstrates its unique array of strengths and weaknesses, with the circus show catering to a diverse audience, while the webinar and research report target more informed participants. These outcomes underscore the innovative and inclusive attributes of Arts-Based Knowledge translation, showcasing its capacity to facilitate researchers' engagement with a wider array of stakeholders across diverse contexts. Conclusion: As a relevant first step and a complementary asset, arts-based knowledge translation holds immense potential in increasing awareness and mobilization around crucial health issues.
MeSH term(s)	Humans ; Quebec ; Translational Science, Biomedical ; Delivery of Health Care ; Canada ; Emergency Service, Hospital
Language	English
Publishing date	2024-04-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0302022
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