Integration. Along with sustainability, it’s a common buzzword for discussion and debate in health care circles. But what, exactly, do we mean by integration? And more importantly, how do we do it?
I participated in Wednesday’s symposium on integrated care
in my role as vice-chair of the Health Council of Canada. But I also listened to the presentations – both from keynote speakers and front-line providers – with the perspective of someone who has operated a hospital and a health region.
I thought Dr. Dennis Kodner
set the stage perfectly at the beginning of the day by providing his insight into the key success factors and potential pitfalls of integration. He made some pointed comments about the need for courage, which is all too true: there are many barriers for people who are trying to implement patient-centred integration, including inertia, professional and organizational “tribalism”, misaligned policies, regulation and financing, and the differences in the roles and clinical philosophies across providers and sectors. (And that’s just to start.)
One of Dr. Kodner’s quotes should be above the desk of every health manager (and health minister): It’s not about fitting people into the model – it’s about finding a model that meets the needs of the people. There were continuing conversations about this throughout the day, including the importance of patient and community input in developing integrated care models that work for them. We shouldn’t assume we know.
Dr. Kodner’s presentation was followed by a panel discussion on promising solutions for achieving integrated care, with presentations on interprofessional teams, increased patient and community engagement, and the role of case managers, a topic which seemed of particular interest to the audience. Dr. Charles Wright, the panel moderator and a fellow councillor, concluded the discussion by reminding us that some common components of successful integrated systems – such as interprofessional teams, expanding the scope of practice, and physician payment reform – require firm political action, which can be a challenge since some of these changes can be “politically distasteful”. I appreciated Dr. Wright’s frank comments. We need to speak more openly about these challenges and how to resolve them. We also need courageous action from politicians as well as providers.
Throughout the day, I particularly enjoyed the many presentations about integration
by front-line providers. They told us about innovative programs and strategies that are making improvements in areas such as transitions of care, communication between providers, access to care, and patient engagement. But great front-line efforts in integration need more support from health leaders and governments. We need to be willing to tackle physician compensation and scope of practice issues, speed adoption of electronic health records, and revise policies that are blocking their progress. Jurisdictions that move quickly in these areas will be able to provide better care. Those that don’t will still be stuck in the same place 10 years from now.
Finally, the keynote presentation by The Honourable Fred Horne, Alberta’s Minister of Health, earned him accolades from the audience: “The best presentation I’ve ever heard from a Minister of Health.” Mr. Horne described the three provincial priorities for health –– primary health care, continuing care, and mental health ––adding that reforms are guided by an overarching philosophy: to stop doing things in the hospital that they know they can do in the community. In the question period, several participants asked about Alberta’s decision to eliminate regional health authorities in favour of one large organization, Alberta Health Services. Mr. Horne said the reasons for this included a desire to be able to uniformly implement any policy issue across the province, to standardize, and to achieve better cost savings. There appears to be significant interest in Alberta’s approach and how their reforms will unfold. We were pleased that the Minister was able to join us as this is Alberta’s first year as a member of the Health Council of Canada.
I was inspired by the ideas I heard at the symposium and only wish it had been possible to attend all the presentations. I encourage you to read the descriptions of the innovative practices in the symposium program
, view the corresponding presentations
, and bookmark the Health Council’s Health Innovation Portal
as an ongoing source of ideas. We can avoid duplication and speed each other’s efforts by sharing what’s working.
By Murray Ramsden
, Councillor, Health Council of Canada