Of Big and Small Swings: Toward a Hybrid View of Healthcare Systems Governance.

International exchange training in genetic counseling is increasing, but research examining these experiences is lacking. In this study 309 genetic counseling students and genetic counselors completed an anonymous survey investigating six major research questions: (1) How prevalent are international genetic counseling experiences? (2) What types are pursued and why? (3) What supports and barriers exist? 3) What are the demographic characteristics of individuals accruing international experience? (5) Does international experience promote professional development? and (6) Do genetic counseling students and professionals perceive international experiences as beneficial? Most respondents were Caucasian females born in one of 25 countries. The most prevalent experiences involved either clinical observation or clinical training. Common motivations for pursuing international experience were personal growth, exposure to a different healthcare system, and travel opportunities. Outcomes included professionally-relevant experience and personal growth. Barriers included finances, limited availability of opportunities, and for those without international experience, family responsibilities. Additional findings, practice and training implications, and research recommendations are provided.


 
 
 This paper explores intersectionality of oppression and social agency in refugee narratives of four female teachers from Yugoslavia who immigrated to Ontario and Quebec between 1994 and 1998. These narratives reveal a number of systemic barriers participants encountered in their new country, such as lack of coordination between immigra- tion and settlement services, lack of information about the teacher recertification process, systemic ignorance towards international teaching credentials and experiences, and a number of settlement practices that pushed the partici- pating women teachers to the margins of the Canadian educational system. In addition to reporting a number of systemic barriers to teaching, these women also revealed self-imposed psychological and culturally constructed barriers to settlement such as personal perceptions of having limited language competencies, of being “too old” to continue education, and of remaining permanent outsiders to Canadian ways of being. Women also discussed their choices and priorities in terms of their personal and professional lives and the ways in which these preferences facilitated and/or hindered their integration in the Canadian education system and society. The paper challenges the master narrative of refugeehood in Canada by exposing the ways in which race, class, gender, age, ethnicity, and professional identity, in addition to refugeehood, shape the oppression and the privilege of refugee women in the Canadian context. 
 
 

Significant challenges are associated with the availability of and access to treatments for rare diseases. In this issue, Sirrs et al. (2023) frame challenges in terms of evidence, economics and ethics and describe how they manifest in the Canadian context. This short response paper argues that although interesting initiatives exist internationally to deal with some of these challenges, a plug-and-play approach will not suffice given the particularities of the Canadian system. Rather than seeking international lessons on how to deal with Canadian challenges, the emerging interdisciplinary framework of social pharmaceutical innovation is advanced here as a whole-systems approach that stands to address interconnected components of the rare disease ecosystem, and in doing so, a made-in-Canada approach is advocated for.

Integrated Business Modelling for Developing Digital Internationalising Firms in NigeriaThis research explores integrated business modelling, international entrepreneurship and internationalisation business development aspects of digital firms in Nigeria.This combination of perspectives is a new line of research in Nigeria.Specifically, the research examines: 1) the international entrepreneurial characteristics of digital firms; 2) how digital internationalisation patterns emerge; 3) current developments in the digital economy and their influences on the development and internationalisation activities of digital firms in Nigeria; 4) business model characteristics of digital firms, and 5) the challenges faced by digital firms in their internationalisation activities.Theoretically, the research integrates pertinent ideas from the international entrepreneurship, digital internationalisation, and business model literature, to develop a conceptual framework for the research.The existing models from these fields tend to be oriented towards developing international business and engaging in international markets generally, and so may be not suitable for digital internationalising firms.Building on the conceptual framework, the research therefore developed an integrated business template (IBMT) for Nigerian digital internationalising firms.This is the first research to explore the research objectives to this depth.The research adopts a qualitative and case study research methodology to explore the associated research questions and objectives.This methodology consists of critical review of key constructs associated with the research, construction of suitable interview questions related to the gaps in knowledge and research objectives.These questions supported the interview of founders and senior of five selected digital internationalising firms in Nigeria.This primary data is complemented by secondary data from related websites.This is the first research to explore the research objectives to this depth.The main findings from the research are as follows.Nigerian firms use: a hybrid approach which combines online and offline customer engagement strategies; data-driven decision making (big data analytics, for example); multifaceted platforms and third-party internationalisation to localise their offerings; in addition to strategies explored in the literature such as founders' international experience, international market awareness and orientation.The research generates new knowledge and understanding about the development and internationalisation of these firms within the Nigerian context related business modelling, international entrepreneurship, and internationalisation research themes.Theoretically, the revised conceptual framework and resulting IBMT will support continuing work in this important area of research.Practically, the IBMT can be applied to other subunits of the selected case study firms, other emerging digital firms in Nigeria and Africa, and across different sectors, since the subunits explored in the thesis are mainly e-commerce and eplatform business lines.Methodologically, the approach adopted in the research can be replicated in the above contexts.The insights from the findings can also support effective government policies towards enhancing the development of digital firms, especially by creating enabling digital economy environment for their growth.Internationalisation Template for Digital Firms (ITDF).These templates integrate ideas from the literature on international entrepreneurship and business modelling.They will enhance the development of such digital firms by entrepreneurs in Nigeria and Africa.The notes below provide further perspectives on the growth of internet penetration in Nigeria and Africa, which supports the development of digital internationalising firms.According to McKinsey & Company, the internet will add about US$300 billion to Africa's GDP by 2025.This is because of the above-mentioned increasing mobile and broadband penetration in developing countries compared to developed countries (World Bank, 2009).Nigeria has 48.8 percent internet penetration as of 2017 (Fawcett, 2015; Internet World Stats, 2017).The high mobile and internet penetration is because reductions in mobile data and broadband tariffs have made mobile phones and broadband access more affordable.Consequently, Nigeria, Rwanda, Uganda and Ghana have experienced high growth in internet penetration from the period 2000-2013 (Banga & te Velde., 2018).However, developing countries like Nigeria still have a need for wider access to internet services across the populations.The digital economy also needs to add more value to the economies than obtain in developed countries.For example, internet-related technologies and activities contributed about 1.5% of Nigerian GDP, and internet retailing value was about US$ 4 billion in 2013.Compared to a base population of 180 million Nigerians, about 93 million mobile users accessed the internet from their devices in 2015 (International Trade Centre, 2015).According to McKinsey & Company, internet penetration in Africa is expected to reach 50% by 2025, and Africa will account for 1 billion out of 50 billion devices projected to be connected globally by 2020 (Liquide Telecom).Increased access to internet will have great effect how on the people in Africa live and work and transform the way firms operate and deliver their offerings to customers (Liquide Telecom).In Nigeria, mobile phone services were introduced in 2001 and the market has grown rapidly since then, with connectivity reaching over 83 million subscribers, equivalent of 45% of the population as of 2015 (GSMA, 2015)."Mobile services are driving digital inclusion and supporting socioeconomic development in Nigeria" (GSMA, 2015, p.4), by enabling individuals and businesses in Nigeria to benefit from the exchange of information, goods and services online. Structure of the thesisThe thesis is structured into eight chapters as shown in Table 1.1.This first chapter is the introduction and the summary of the thesis.It explains and summarises the research background, aim of the research, research questions and objectives, justification for the research focus, the methodology, and the contributions to knowledge.Table 1.

Early childhood education and care is, again, a focus of debate in Quebec, Canada. Government-subsidized childcare programs are being cut and the province's plan to open prekindergartens for children in impoverished areas is being met with contention. Invariably, the focus of the debate is on the children's needs, the parents’ needs and society's needs. The educator is rarely mentioned. In this paper, I focus on the early childhood educator's subjective experiences (Chang-Kredl 2013) in a social system that undervalues their work as maternal, endorsing Grumet's (1988) close attention to women's internal experiences as a means of generating social change in education. I compare the social positioning of early childhood educators, in a Canadian context, with the representation of abjected maternal figures in a children's film, namely the split mothers in Coraline (2009). The argument for such a comparison is made through theories of maternal thinking (Ruddick 1995; Mullin 2009) and feminist readings of psychoanalytic theories related to the abject and the monstrous-feminine (Kristeva 1982; Creed 1993).

The article examines key aspects shaping women’s health in the social dimension. The authors emphasize the relevance of analyzing social determinants of health, particularly their impact on women’s quality of life and wellbeing. The issue addressed stems from the need for a deeper understanding of gender aspects in healthcare and their role in forming effective social policy. The study analyzes research on gender differences in health, economic and social factors influencing its levels. Among the highlighted factors are studies on gender inequality, working conditions, income levels, social isolation, and access to resources. The article reviews Canada’s experience as a country with extensive research on the social aspects of citizens’ health. At the same time, it highlights the lack of similar studies in the Ukrainian context. Several unresolved issues are identified, including: how changes in gender roles and structural inequality affect women’s health; how international experience can be adapted to Ukrainian realities; and which material indicators should be considered for monitoring women’s health. The main purpose of the study is to identify social factors affecting women’s health and to develop recommendations for implementing gender-sensitive approaches into Ukraine’s healthcare system to improve women’s well-being through the integration of social and gender perspectives into health policy. The research methodology is based on a literature review, content analysis of academic works, a comparison of international and national experiences, and an interpretation of existing socio-economic indicators. The findings indicate that gender inequality, social isolation, unemployment, and unequal access to resources are key factors determining women’s health quality. The conclusions highlight the importance of integrating a gender perspective into the formulation of the country’s social and healthcare policies. Future research perspectives are linked to the need for developing tools to monitor women’s social health in Ukrainian society and adapting best practices from international experience.

Safety culture has been shown to affect patient safety in healthcare. While the United States and United Kingdom have studied the dimensions that reflect patient safety culture in family practice settings, to date, this has not been done in Canada. Differences in the healthcare systems between these countries and Canada may affect the dimensions found to be relevant here. Thus, it is important to identify and compare the dimensions from the United States and the United Kingdom in a Canadian context. The objectives of this study were to explore the dimensions of patient safety culture that relate to family practice in Canada and to determine if differences and similarities exist between dimensions found in Canada and those found in previous studies undertaken in the United States and the United Kingdom. A qualitative study was undertaken applying thematic analysis using focus groups with family practice offices and supplementary key stakeholders. Analysis of the data indicated that most of the dimensions from the United States and United Kingdom are appropriate in our Canadian context. Exceptions included owner/managing partner/leadership support for patient safety, job satisfaction and overall perceptions of patient safety and quality. Two unique dimensions were identified in the Canadian context: disclosure and accepting responsibility for errors. Based on this early work, it is important to consider differences in care settings when understanding dimensions of patient safety culture. We suggest that additional research in family practice settings is critical to further understand the influence of context on patient safety culture.

<p dir="ltr">Immigration has long been a key contributor to Canadian population growth, economic prosperity, and social vitality and innovation. Economically, the benefit of the ‘brain gain’ — the acquisition of knowledge workers from the rest of the world has given Canada significant advantages by attracting global talents to not only fill the labour shortages, but also contribute to advancing human capital, innovation, and global exchange.</p><p dir="ltr">However, internationally trained professionals often face significant challenges after immigrating to Canada, such as a lack of Canadian work experience, inadequate social and professional networks, and difficulty in obtaining foreign credential recognition for professional licensing and certification. In the planning profession, an accredited planning degree is critical to obtain a full membership with the governing body in order to practice as a Registered Professional Planner in Canada.</p><p dir="ltr">Despite the fact that internationally trained planning professionals (ITPPs) can bring us a wealth of planning knowledge and experience from global planning practices, it has become imperative to provide them with the needed skills and hands-on training to transition and advance their planning careers in the Canadian context. Accredited planning schools can play a pivotal role in creating career-focused curriculum and programs to pave a pathway to success for highly qualified ITPPs. At the School of Urban and Regional Planning, Toronto Metropolitan University, our accredited Master of Planning (MPl) in Urban Development program<a href="https://ontarioplanners.ca/blog/planning-exchange/april-en/pathways-to-success-building-support-infrastructures-for-internationally-trained-planning-professio#_ftn1" target="_blank"><sup>[1]</sup></a> provides an accelerated stream that recognizes international education and experiences and supports ITPPs to obtain much needed training, skills development, and networking opportunities.</p><p dir="ltr">I had the great pleasure working with three ITPPs who recently graduated from our MPl accelerated stream program. I spoke with them about their life stories and professional experiences and aspirations, and found their perspectives shed light on how planning schools can play an important role in developing support infrastructures along with the commitment and investment from employers and accrediting and regulatory professional bodies. The following are the highlights of their backgrounds and responses to four interview questions.</p>

<p dir="ltr">Immigration has long been a key contributor to Canadian population growth, economic prosperity, and social vitality and innovation. Economically, the benefit of the ‘brain gain’ — the acquisition of knowledge workers from the rest of the world has given Canada significant advantages by attracting global talents to not only fill the labour shortages, but also contribute to advancing human capital, innovation, and global exchange.</p><p dir="ltr">However, internationally trained professionals often face significant challenges after immigrating to Canada, such as a lack of Canadian work experience, inadequate social and professional networks, and difficulty in obtaining foreign credential recognition for professional licensing and certification. In the planning profession, an accredited planning degree is critical to obtain a full membership with the governing body in order to practice as a Registered Professional Planner in Canada.</p><p dir="ltr">Despite the fact that internationally trained planning professionals (ITPPs) can bring us a wealth of planning knowledge and experience from global planning practices, it has become imperative to provide them with the needed skills and hands-on training to transition and advance their planning careers in the Canadian context. Accredited planning schools can play a pivotal role in creating career-focused curriculum and programs to pave a pathway to success for highly qualified ITPPs. At the School of Urban and Regional Planning, Toronto Metropolitan University, our accredited Master of Planning (MPl) in Urban Development program<a href="https://ontarioplanners.ca/blog/planning-exchange/april-en/pathways-to-success-building-support-infrastructures-for-internationally-trained-planning-professio#_ftn1" target="_blank"><sup>[1]</sup></a> provides an accelerated stream that recognizes international education and experiences and supports ITPPs to obtain much needed training, skills development, and networking opportunities.</p><p dir="ltr">I had the great pleasure working with three ITPPs who recently graduated from our MPl accelerated stream program. I spoke with them about their life stories and professional experiences and aspirations, and found their perspectives shed light on how planning schools can play an important role in developing support infrastructures along with the commitment and investment from employers and accrediting and regulatory professional bodies. The following are the highlights of their backgrounds and responses to four interview questions.</p>

The purpose of this article is to discuss the challenges and rewards of developing and nurturing an international clinical psychiatric mental health advanced nursing practice exchange between the Netherlands and the United States. Since 1997, Rotterdam University of Applied Sciences in the Netherlands has been participating in international clinical experiences for their psychiatric mental health (PMH) advanced practice nursing students. The international experience is mandatory prior to graduation and is the first of its kind in Europe to mandate such a unique experience. This study sample included eight Dutch PMH advanced practice nursing students enrolled in a full-time master's in advanced nursing practice program. The descriptive study included reflective reports and one-on-one discussions over a 3-year period. With proper planning, an international nursing experience provides a unique opportunity for nurses to think beyond their own culture and healthcare system. Solving problems together through different perspectives creates opportunities for creative solutions. International partnerships within PMH advanced practice nursing promotes sharing of knowledge and solutions as patients and diseases have no border.

Background. The efficiency of healthcare organization activity should be improved and measured using new techniques, as the healthcare system has widely applied advanced technologies and optimized the workflow of all medical facilities. The methodology of data envelopment analysis (DEA) is one of the fast-evolving approaches to assessing the performance of healthcare organizations. The article examines Russian and international experience in applying the DEA method, which can be used for assessing the performance of Moscow public healthcare organizations. Purpose. To study the basics of DEA and the experience of its use for assessing the efficiency of healthcare organizations in Russia and abroad, and to consider its potential implementation in the Moscow healthcare system. Materials and methods. The publications were selected using the PRISMA guidelines. A complex of modern general scientific methods of cognition was also used: system and structural approach, analytical method, comparison, and generalization. Results. The practice of using the DEA method in Russian regions and abroad was analyzed. The main advantages and disadvantages of DEA, as well as the main parameters used in constructing the model of efficiency measurement for healthcare organizations, were categorized. The prerequisites for using the DEA method to assess the efficiency of Moscow healthcare organizations were identified.

The adoption of Standardized Structured Reporting (SSR) in pathology offers significant potential to improve data consistency, completeness, and interoperability. This study combines quantitative data from an online survey of Belgian pathologists with qualitative insights from focus group interviews to identify key factors influencing SSR implementation. Survey results demonstrate strong support for SSR, particularly in enhancing report uniformity, completeness, and efficiency, especially in multidisciplinary teams and for secondary data use. Despite these advantages, participants identified several challenges, including the integration of SSR with existing IT systems, financial constraints, resistance to change, and legal and regulatory barriers. Focus group interviews reinforced these findings, emphasizing the need for collaboration, technological innovation, and governmental support. Effective strategies for overcoming these barriers include securing funding, providing comprehensive training, improving IT infrastructure, and advocating for supportive legal frameworks. A hybrid approach, balancing centralized standardization with local customization and drawing on international experiences, seems to offer the most promise for successfully integrating SSR into pathology practice.

The article addresses the relevant scientific and practical issue of developing innovative approaches to forecasting in enterprise financial management in the context of economic digital transformation. The necessity of using intelligent forecasting tools based on modern technologies of artificial intelligence, machine learning, big data analytics, and neural networks is substantiated. The main advantages of implementing such tools are identified, including increased accuracy and speed of financial analysis, enhanced adaptability of strategic planning, and reduced subjectivity in decision-making processes. The study systematizes key models of intelligent forecasting: ARIMA, GARCH, LSTM, CNN, decision trees, clustering algorithms, hybrid approaches, and fuzzy logic. Practical examples of their application in financial management are provided, including cash flow forecasting, investment attractiveness evaluation, risk analysis, enterprise development scenario modeling, and fraud detection. It is shown that intelligent technologies play a leading role in building flexible and resilient financial management systems capable of self-learning, self-regulation, and dynamic restructuring under uncertainty. At the same time, the main limitations of implementing intelligent systems in enterprise financial operations are outlined: high requirements for the quality and structure of input data, complexity of interpreting forecast results, shortage of qualified personnel, and the need for significant computational resources. The study emphasizes the importance of developing appropriate digital infrastructure, organizational transformation, and interdisciplinary cooperation for the successful integration of such tools. International experience in the application of intelligent forecasting by leading companies in digital transformation is generalized. A classification of major categories of forecasting tools by functional purpose is proposed, and practical recommendations for their adaptation to the Ukrainian context are developed. The results obtained can be used as an analytical and methodological basis for modernizing enterprise financial management systems under the new economic reality.

The key tools for managing innovative projects in startups and their impact on sustainability and growth of companies have been studied. The global experience has been analyzed, including the ecosystems of the US, Poland, France, the UAE, and Saudi Arabia. A study has been conducted among Russian startups. Based on the study of 78 domestic startup projects of various stages of maturity and industry affiliation, key factors for project management methodologies successful implementation have been identified. Empirical evidence shows significant differences in the effectiveness of classical Agile techniques and their adapted hybrid modifications. Hybrid approaches (Scrumban et al.) demonstrate 23–27% higher implementation rates in Russian conditions compared to canonical Agile practices. Special attention has been paid to the regional ecosystems analysis. The Republic of Tatarstan has a concentration of 34.6% of the total number of student startups with a 17% success rate, which is significantly higher than the national average according to data from 2022 until 2024. The study results include an algorithm for choosing a management strategy depending on the innovation type, a matrix for assessing the resources importance for various innovation models, a project management systems classification, and analytical data from a survey of Russian startups. The practical significance of the study lies in developing an adapted system of recommendations for managing startup projects, considering both international experience and the Russian specifics of conducting innovation activities. The results obtained can be used when forming regional startup support programs and developing educational programs in the innovation management sphere.

This study examines incentive payment schemes in primary care and their impact on healthcare effectiveness and equity. We analyze four principal remuneration models: Fee-for-Service, Capitation Financing, Pay-for-Performance (P4P), and hybrid approaches. Kazakhstan introduced capitation financing with P4P elements in 2009. Our analysis identifies three fundamental paradoxes in this system. First, weak risk-adjustment mechanisms chronically underfund facilities serving vulnerable populations. Second, payment delays undermine financing predictability and create financial instability. Third, incentives for selective patient enrollment contradict universal health coverage goals. The P4P component shows additional weaknesses: questionable quality indicators, inadequate outcome attribution, and poor integration across care levels. Based on international experience (Kyrgyzstan, Uzbekistan, United States), we propose four optimization strategies: strengthening risk-adjustment models; refining P4P mechanisms with emphasis on equity and provider support; eliminating payment delays; and developing comprehensive motivation frameworks that combine adequate base salaries and fair capitation rates with non-financial incentives such as professional development and improved working conditions. Our findings show that financial mechanisms without broader systemic support generate counterproductive incentives. These results inform remuneration policy development, primary care quality improvement, and healthcare expenditure optimization.