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Health-system arrangements

 

The first draft of the sub-taxonomy focused on health-system arrangements is provided below. We will continue to refine this sub-taxonomy in the coming days based on input already received. Once the second draft has been finalized, please send suggestions for how to improve it further to forum@mcmaster.ca.

Broad decisions Specific decisions Available options
Approach to population-health management for COVID-19 and for those whose care is disrupted by COVID-19 Segmenting the population into groups with shared health and social needs See sub-taxonomy in the introduction
  Re-designing care pathways and in-reach and out-reach services Out-reach to those at high risk
  Addressing barriers to implementation of pathways and services   
  Addressing cultural safety in the implementation of pathways and services
 
  Maintaining gains made in population-health management (e.g., population segmentation, virtual care) and spreading and scaling them
 
Delivery arrangements
Service planning for COVID-19 prevention Changing emergency-medical service procedures (ambulances, paramedics)
 
  Re-locating hospital-based ambulatory clinics, cancer treatments, etc.
 
  Limiting access to health facilities
Paid caregivers, unpaid caregivers, and family members
  Changing hospital-discharge procedures
 
  Changing long-term care procedures
 
  Changing home and community care procedures
 
Service planning for COVID-19 treatment
Scaling up/down testing capacity
 
  Scaling up/down emergency-room capacity
 
  Scaling up/down ICU capacity
 
  Scaling up/down post-ICU recovery capacity (e.g., hospital beds)
 
  Scaling up/down palliative-care capacity
Home and community care, primary care, hospital care, long-term care
  Scaling up/down COVID-19 sequelae-management capacity
 
  Scaling up/down capacity to manage the pandemic-related impacts on health more generally (e.g., mental health and addictions)
 
  Surge-management models
 
  Triage protocols
 
  Infection prevention and control measures in health facilities
 
  Death certification
 
  Handling dead bodies
Morgue procedures, funeral home procedures, burial procedures
Service planning for the ongoing management of other conditions
Changing acute care surgery and trauma-care procedures
 
  Changing cancer-treatment procedures
 
  Delaying return visits, elective procedures, etc.
Includes dental care
Infrastructure planning and resource allocation
Personal protective equipment (under shortage conditions), including N95 respirators for health workers
Production, allocation, usage, conservation, re-use (includes de-contamination), and re-purposing (see REP#6 for full sub-taxonomy)
  Ventilators for sick COVID-19 patients
 
  Medications and other technologies (under shortage conditions due to disrupted supply chains)
 
  Remote monitoring
 
  Virtual visits
Telephone, text, online platforms (e.g., Zoom), telehealth
Workforce planning (including workforce shortages management) and development
Recruitment  Retired health workers, internationally trained health workers, current medical and nursing students 
  Role extensions
 
  Training in new procedures
 
  Replacements when sick
 
  Movement-control strategies
 
  Supports to unpaid caregivers
Respite care, training, financial support
  Volunteer engagement to support vulnerable populations
 
  Self-management supports
 
Service planning for ‘return to normal’ Sequencing of services re-starting, by sector, conditions, treatments (including diagnostics), and populations
 
  Wait-lists management
 
Financial arrangements
Financing health services
   
Funding organizations 
   
Remunerating providers
New or adjusted fee codes for virtual care
 
  Income replacement when virtual care is not possible (at the same scale)
 
Purchasing products and services
Bulk purchasing
 
Governance arrangements (who can make what decisions)
Consumer and stakeholder involvement
   
Professional authority
Licensure changes to accommodate out-of-jurisdiction or retired health workers
 
Commercial authority
Technology approvals, public-private partnerships
 
Organizational authority
Limits of number of staff sent in
 
Policy authority
Federal versus provincial
 
  Adhering to the International Health Regulations