A May 2017 Auditor General report on health care noted these root causes of health system dysfunction: fragmented structure of the system; lack of integration of physician services and the services of other care providers; and, the lack of sharing and use of clinical information. Clearly, Alberta has a disjointed health care system that is focused on achieving pre-defined tasks instead of addressing individual patient needs.
Recommendation #1: Adopt a Relational Model of Care
The Health Coalition of Alberta recommends exploring the adoption of a flexible, relationship-based model that is focused on shared decision-making in person-centered care. A task-based, medical model like Alberta’s is focused on diagnosis and treatment of the body with outcomes centered on treatment. A relational model of care focuses on emotional and social needs of each individual with outcomes determined by the patient and supported by the care team. It has been proven as an effective means to reduce costs and improve system performance.
Scotland, with its approach to realistic medicine, and Australia, with its implementation of relational care for dementia patients, are examples of the impact this type of shift can have for improved health outcomes, patient satisfaction, employee engagement and health system savings.
- By shifting care models, Arcare in Australia achieved health outcomes such as a 90% reduction in pressure injuries, 52% reduction in use of PRN psychotropic medication and a 50% reduction in staff turnover. All these achievements translate to system savings.
- In Scotland they started to move towards a realistic medicine approach in 2014-15. The goal is to achieve value-based care by strengthening relationships between patients and health care professionals and reducing harm due to unwarranted variation. The focus is on using shared decision-making to explore what patients want from their health care.
Recommendation #2: Address Care Gaps
Despite reports from the Health Quality Council of Alberta that indicate improvements in access to care, we are still hearing of access to care issues from our members that must be addressed:
- Prevent care gaps when patients move from home to care facilities. Ensure smooth patient transition within AHS zones and silos of care (acute, emergency, rehab, specialists, PCNs, etc.). Improve communication between varied care providers and patients.
- Ensure workforce training is implemented in daily care. Some of our members provide training to ensure unique patient needs are met, e.g. visual impairment. However, they are met with difficulty in delivering sessions and, in some cases, training is not implemented. This workforce training should also include proper and mandated cultural sensitivity training for all health care professionals.
- Increase continuing care spaces for patients with complex care needs. For example, in Edmonton, there are two or three beds that will accept people using a bipap machine to breathe. Members report patients stay in hospital upwards to 90 days while they wait for a long-term care bed.
- Expand the use of patient navigators or case managers. Our members are starting to develop staffing positions to meet the needs of patients who are not able to navigate our complex health care system. A private industry is growing around this new requirement as well, creating improved service for those who can afford it. Case workers or patient navigators are publicly funded in some areas but have been cut in others, despite showing positive results.
Recommendation #3: Reduce system use by supporting primary prevention and public health
Improved population health and a reduction in health inequalities reduce the overall burden of disease, keeping more people healthier longer and away from the health system. A clear commitment to primary prevention and public health strategies is a key component to reducing disease and injury as well as improving longevity and health.
- Ensure robust funding for primary prevention and public health as a way to improve access to care for those who need it while also protecting system sustainability.
Recommendation #4: Ensure Equal Access to Care Across the Province
Although AHS is one health region for all of Alberta, delivery of care remains fragmented and inconsistent from zone to zone.
- Create flexibility of care options to help people stay independent. The Self-Managed Care Program is an example of a move towards system flexibility yet families report the application process is so onerous that they must hire someone to complete the forms. Also, funding is allocated regionally and when it runs out, local support is denied. Some of our members have training guides to help patients through this application process but do not have the resources to promote this service beyond their clientele. This is a perfect example of partnership opportunities between Alberta Health, AHS and patient groups to improve outcomes.
- Secure funding for the palliative care framework. There is currently a patchwork approach to palliative care services in Alberta and access to hospice care is limited, leaving few options beyond hospitals particularly within rural and remote communities. The demand for palliative care and homecare will only increase as the population ages. Additional supports are needed to meet the demand and to ensure equitable, timely and affordable access to palliative care services.
- Access to migraine specialists and allied health care professionals varies greatly between Calgary and Edmonton. Calgary had a multi-disciplinary migraine clinic that was an AHS partnership between neurology and chronic pain. It provided patients with access to a wide variety of health care professionals trained in migraine care, patient education and other services. This partnership was disbanded and patients now have limited care options. However, this model was never implemented in Edmonton or any other region of the province and patient care is disjointed from zone to zone.
The Health Coalition of Alberta wants to engage in a discussion with the Government of Alberta about the impact of adopting a relation-based model of care and how this can improve outcomes in Alberta. We can also facilitate a consultative partnership with our members to address blockages in the health care system, how to eliminate them as well as how to find system improvements that will generate cost savings for all.