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T - New Perspectives From E-Scan

Marriage of Accreditation Canada and a Culture of Best Practice Can Advance Service Delivery Improved standards of care require that frontline clinicians inform accreditation, with consideration given to practice gaps, evidence, impact (outcomes), feasibility and other factors. The work of the SCI Knowledge Mobilization Network (SCI KMN) - a national, networked community of practice consisting of a wide spectrum of stakeholders, at six participating rehabilitation centres across Alberta, Ontario and Québec - incorporates rigorous methods of consensus prioritization, with implementation of science innovations, to ensure buy-in for chosen best practices. Choices made via the SCI KMN consensus process are, at times, unexpected because of real-life factors considered by frontline staff.   For example, while an intervention may have ample high-level evidence, other factors may not resonate with the clinicians and patients that would implicate a best practice (cost benefit ratio, training and equipment for the intervention, etc.).  Ongoing, three-way conversations are an urgent priority among funders (health ministries, NGOs, etc.), regulators (Accreditation Canada (AC), and healthcare organizations) and healthcare targets (SCI KMN that represents frontline clinicians, patients, healthcare administrators and others).   As a first step, AC and SCI KMN need to share knowledge immediately.  The second step is to produce a briefing note, co-authored by AC and SCI KMN, for funders’ consideration. The third step is a tripartite meeting, to map out priorities, for improving health outcomes. The latter would include funding for SCI KMN’s expansion to incorporate the nine remaining rehabilitation centres and other pressing initiatives. This is a necessary, relatively inexpensive approach to standardize rehabilitation best practices, across Canada. Recipient stakeholders with a voice to inform accreditation standards, and funders to ensure that support barriers are overcome, can result in national buy-in for high-level, AC-monitored best practices. Careful Attention to Implementation of “Extenders” with Specialty or Advanced Practice Training is Required Within the current healthcare system, there is a move afoot to introduce physician, nursing, physical and occupational therapy “extenders” to provide a cost-effective means of increasing the volume of individual patients assessed and served in specific settings. For example, in Ontario and Alberta there are now established physician assistant training programs, intended to enhance the volume and complexity of issues of individuals served by a physician, through provision of collaborative care in a setting where delegation is feasible. In other settings, kinesiologists or physiotherapy assistants are used to extend the activities of physical therapists, and seating technicians for occupational therapists. While introduction of extenders is, in general, a rational move, it will be critically important for the SCI community to advocate for use of “extenders” with appropriate knowledge, skills and training to manage complex SCI patients. The importance of this issue should not be underestimated. Strategic partnerships with local colleges and universities are recommended to ensure appropriate training and clinical competence in SCI Care, as the models of care expand over time. 206 CAPTURING CAPACITY IN CANADIAN SCI REHABILITATION


T - New Perspectives From E-Scan
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