(OMN1a) Omnibus I: Healthcare Systems and Delivery

This panel critically examines health care systems and delivery, focusing on the powerful phenomena of waiting for sexual and reproductive health care, the WHO’s shifting discursive commitment to traditional medicine, a critical look at digital health records in Canadian long-term care facilities, and improving care in rural emergency departments. Tags: Égalité et Inégalité, Politique, Santé et soin

Organizers: Katelin Albert, University of Victoria, Sherry Fox, CSA; Chair: Katelin Albert, University of Victoria

Presentations

Katelin Albert, University of Victoria; Vera Caine, University of Victoria

Waiting for health care: Some theoretical and methodological considerations for exploring the phenomenon of waiting

We all wait throughout our lives, although mostly ordinarily. However, waiting for health care is extraordinary, yet also expected and normalized in health care (Fogarty and Cronin, 2008). Exceptionally long medical wait times are defining characteristics of Canada’s health care system (Kelly, 2022). The median wait time in Canada for medical treatment is 27.4 weeks. This is the longest it has ever been in Canada; it ranges from around 51 days to 271 days, depending on the province and the care required (Moir and Barua, 2022). When people seek care, they wait: for appointments, diagnosis, specialist care, results, surgery, and answers. As a social phenomenon, waiting is not neutral – it shapes the lives of those accessing care, is imbued with power, inequality, structural violence (Anderson, 2014), and is filled with expectations and responsibilities that are gendered, normative, and cultural (Dewart et al., 2021). It is also relational, with other people and institutions, shaping the social organization of many aspects and domains of life. When people wait, they are in a complicated state of stasis, suspension, but also active waiting. Those waiting may imagine future possibilities, consider who and what they are waiting for, and are living in precarity where their lives are marked by suspension (Llewellyn and Higgs, 2021). Despite the centrality of waiting in health care, it is an underexplored aspect of research (Dewart et al., 2021). In this paper, we explore the phenomenon of waiting for health care. Bringing together diverse interdisciplinary literatures on waiting and insights from our own research, we i) provide an overview of what we know about experiences of waiting for health care, and ii) offer our thoughts on some theoretical and methodological considerations for future research in this area.

Krystle Shore, University of Waterloo

Examining the adoption of electronic health records software in Canadian long-term care: For what and for whom?

The COVID-19 pandemic exposed serious inadequacies within Canada’s long-term care (LTC) system, including poor infection control, communication gaps, staffing and supply shortages, and overall low standards of care. Federal and provincial governments have since directed considerable funding toward these issues, citing innovative healthcare technologies as a key response measure. Health informatics literature also suggests ‘smart’ technologies—like electronic health records (EHR) software integrated with operations management tools and clinical machine learning—can improve LTC efficiency and resident well-being. However, it is unclear whether such outcomes are empirically confirmed. Further, extant research focusing on the promises of technology in healthcare administration tends to ignore important social contexts that shape how the technology is used in practice. Research that does account for how integrated EHRs are used by frontline LTC staff, though sparse, suggests person-centered care practices are tempered by the impersonal, burdensome, and often dysfunctional elements of the software. More generally, the rationales supporting innovative technology as a solution to public crises often rest on false pretenses and prioritize economic interests over public good. Given these concerns and the increasing adoption of integrated EHR software in the wake of identified deficiencies in Canadian LTC, it is crucial to examine whether this technology truly addresses LTC needs or whether it reflects other, discursive interests. This presentation outlines the methodological and analytical approach employed in a qualitative, multi-phased study of the rationales driving the implementation of integrated EHR software in Canadian LTC and whether adoption of the technology aligns with LTC staff needs. Phase one of the described study focuses on how private vendors market EHR software to LTC facilities and aims to identify the assumptions and vested interests embedded within these vendor rationales. Phase two of the study seeks to understand how frontline LTC staff perceive of and use the technology. Foucauldian discourse analysis is then employed to compare phase one and phase two findings to identify any disconnects between how EHR software is framed through marketing discourse and how the technology operates in practical LTC contexts. As such, this project aims to identify whether integrated EHR software responds to frontline LTC staff needs as well as the broader social, cultural, and political forces that situate innovative technologies as a solution to crises in Canadian healthcare administration (e.g., neoliberal imaginaries that situate technology as a more ‘cost-effective’ solution in health administration). The number of Canadians aged 75 or older will more than double between 2017 and 2037. If identified LTC deficiencies are left unadressed they will compound over time as Canadas population ages. Digital healthcare administration technologies like integrated EHR software carry a potential to improve LTC, though research is needed to substantiate whether this potential translates into practice. The project described here seeks to identify whether integrated EHR software responds to the needs and perspectives of frontline care staff in a post-pandemic era, thereby evaluating the technology to enhance healthcare delivery for Canadas rapidly growing elderly population. In describing the methodological and analytical apporach used in this study, I advocate for research to address critical gaps in our understanding of how smart healthcare administration technologies are rationalized as a solution to public health crises, whether these technologies and the rationales underpinning them align with practical healthcare needs, and the broader socio-political forces that condition them.

Kimberly Seida, Egale Canada

Queering mental health supports in Canada: Developing a training program for service providers

A robust evidence base has confirmed the presence of socioeconomic and health inequities among 2SLGBTQI people in Canada due to exclusion, discrimination, and a lack of affirming healthcare (Bettergarcia et al., 2021). The COVID-19 pandemic has exacerbated these inequities, disproportionately impacting numerous social determinants of mental health for 2SLGBTQI individuals, including access to primary and mental healthcare, housing, food, and employment (Seida, 2023). Alongside these deepened disparities wrought by the pandemic, the last few years have been characterized by troublesome rises in gender-based and anti-2SLGBTQI violence (Women and Gender Equality Canada, 2022). In the current context of national anti-2SLGBTQI movements and rhetoric, 2SLGBTQI people are being systematically marginalized and excluded from Canadian mental health care and social services. To address these challenges, Egale Canada’s researchers and instructional designers co-developed a cost-free and self-led virtual training program for mental health and social service providers across Canada. The bilingual training program is based on research conducted between 2021 - 2022, which included a national survey ( N = 304) and virtual focus groups ( N = 61) with 2SLGBTQI service seekers as well as queer and allied service providers, giving participants a space to share their experiences regarding the pandemic’s wide-ranging impacts on mental health and well-being. Queer and allied service providers similarly shared the challenges they faced in delivering inclusive care for 2SLGBTQI people during the pandemic. The training is entirely rooted in the experiences, challenges, and priorities for change shared by research participants. The Queering Mental Health Supports in Canada training is a four-module interactive program incorporating both service recipients’ and providers’ experiences. Specifically, it builds on the needs identified by service providers in earlier phrases of the research, including: strategies on how to provide safer, more affirming care and services; incorporating rural and remote experiences; using socio-ecological and intersectional modalities; adapting to more virtual care provision; and responding to the needs of 2SLGBTQI service providers (e.g., burnout prevention). The first module reviews content from the “Inclusion 101” trainings Egale already provides. The second module puts forward the theoretical foundations of the training program: social determinants of mental health, intersectionality, minority stress, and trauma-informed care. The intent is to move beyond biomedical, individualistic, and westernized understandings of mental health to wholistically address 2SLGBTQI mental health disparities. The third module aims to create safer mental health care with a focus on cultural safety, anti-oppression, and neurodiversity-affirming care. In the final module, learners will explore how the field responded to pandemic-related challenges by adopting alternate strategies and modes of delivery, and how to dismantle financial, proximity, and physical barriers to care. Egale’s training challenges existing frameworks of “cultural sensitivity” or “cultural competency”, which risk reducing safe and appropriate care to a finite set of practices or knowledge canons which, if applied, will result in better healthcare experiences and decreased disparities. Instead, it invites learners to focus on approaching care through the lens of cultural humility, an approach which places the service seeker at the centre and which understands provider and organizational improvement and growth as ongoing processes. Going beyond the typical risk discourses which only serve to pathologize and further marginalize 2SLGBTQI care and service seekers, our training highlights the strengths and resilience of 2SLGBTQI people in their efforts to navigate and optimize their healthcare, health, and well-being. Our training also builds on the adaptive approaches already being employed by 2SLGBTQI and allied service providers to provide a roadmap for new learners. Incorporating both provider and seeker perspectives in the same training is key to mapping out collaborative approaches to improve health care delivery and to maximize learners’ application and integration of the training. Egale Canada’s training serves as a critical intervention to support the health and well-being of 2SLGBTQI communities. Addressing key training and knowledge gaps among frontline service providers, managers, and decision-makers 2SLGBTQI communities’ health and healthcare needs is urgent within a shifting sociopolitical landscape increasingly marred by anti-2SLGBTQI behaviours, discourse, and legislation.

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Non-presenting author: Krista Ceccolini, Egale Canada