Tag: patients

Addressing the Opioid Crisis with Interprofessional Collaboration

Word cloud of keywords related to spine. muscle and joint pain and the opioid crisis, including: Spine, Muscle & Joint Pain, MSK Pain, Low Back Pain, Manual Therapy, Addiction, Pain Management, Mental Health, Prescriptions, Co-ordinate Care, Collaboration, Interprofessional, Families, Economic Impact

Among its consequences, the COVID-19 pandemic is an unplanned experiment in what it means to have reduced access to care. Sadly, while it’s occurring, Ontarians’ need for care is rising. This increased need is not directly related to COVID-19 but because of it.

Pandemic’s impact on patients

Ontario Medical Association president Dr. Adam Kassam recently advised that due to restrictions during COVID-19’s three deadly waves, “more than one health care service was not performed for every Ontario resident this year.”[1]

This hugely diminished access to care affected primary care, emergency departments, as well as regulated health care professionals, such as chiropractors, registered massage therapists and physiotherapists, who could have provided relief.

As mentioned in my last post, the pandemic’s demands on essential workers and added stress was high, increasing their risk of injury and need for care. Those in labour-intensive roles also had to keep working in less-than-ideal conditions and in moving to makeshift home offices, knowledge workers faced new challenges. These pandemic-driven demands, stress and challenges exacerbated back pain and other spine, muscle, joint and related nervous system or neuromusculoskeletal (nMSK) conditions.

And as musculoskeletal (MSK) conditions and related pain account for the largest share of global disability burden,[2] there’s no doubt reduced access to care impacted many Ontarians with these issues.

In fact, our members have told us of patients who turned to or increased their use of pain management medications to compensate.

Opioid-related deaths increased by more than 75 per cent

Tragically, the fallout of reduced access to health care and other services is notably evident in the number of monthly, opioid-related deaths in Ontario, which rose by 79.2 per cent between February and December 2020.[3]

Some of these fatalities are pandemic related. Others are indicative of the ongoing crisis. For example, almost one third of opioid-related deaths among employed individuals comprised those in the labour-intensive construction industry both before and after the pandemic started.

More than 50 per cent of opioid users have reported back pain

What may come as a surprise to some is that back pain has been reported in more than half of regular opioid users.[4] It’s also one of the most common diagnoses emergency and family physicians cite for prescribing opioids.[5]

And even though many patients are prescribed opioids for pain, a 2016 systematic review and meta-analysis found that opioid medications provide modest, short-term pain relief for people with chronic back pain but evidence of long-term efficacy is lacking.[6] Fortunately, there’s alternatives.

Manual therapy: a medication-free alternative for low back pain

Over the past 10 years, research has demonstrated that treatments chiropractors provide, such as spinal manipulation and therapeutic exercise programs, can relieve low back, neck, shoulder or other MSK pain. Also, the type of care chiropractors provide is now globally recognized as an evidence-based first and second-line approach for low back pain.[7]

In fact, the 2017 Canadian Guideline for Opioid Therapy and Chronic Non-Cancer Pain recommends therapies without medication, such as spinal or joint manipulation and therapeutic exercise, for treating back and neck pain, as well as knee osteoarthritis, fibromyalgia and severe headaches/migraines. Similarly, Health Quality Ontario suggests that making better use of non-medical treatments to manage acute and chronic pain will reduce the number of people who end up using opioids for the long-term.

This means Ontario’s health care system now has a recognized option for treating low back and other spine, muscle and joint pain, aside from opioids. But this option hasn’t been utilized to its full capacity. This shortfall is due in part to the complexity in the public and private pay components it requires to help all patients, including those most vulnerable.

Success of Ontario’s Primary Care Low Back Pain program

For an extended period, Ontario has monitored utilization of the health system with a goal to appropriately move care from acute care settings and emergency departments into the community. So, successive governments focused on strengthening primary care and interprofessional teams as a way of bringing leading practice and efficient health care models to Ontario.

With the knowledge that MSK conditions could be managed in the community, our association advocated with the provincial government to include chiropractic care in the primary care models it was developing at the time.

These efforts led to it funding seven Primary Care Low Back Pain (PCLBP) pilot sites across the province in 2015. Under this model, interprofessional primary care teams were formed to deliver efficient, co-ordinated and integrated care to vulnerable patients with low back pain via MSK experts, such as chiropractors.

Successful outcomes followed and 83 per cent of patients surveyed after receiving MSK care at one PCLBP pilot site said they now rely less on medication, including opioids, to help manage their low back pain.[8] And the PCLBP program continues today.

However, evolution of the community-based model of care has generally seen primary care models focus on disciplines funded by the public health care system – limiting chiropractors’ potential to bring relief to more patients.

OCA’s Opioid and Pain Reduction Collaborative

With the growing awareness of the opioid crisis, there is a desire for all levels of health care professionals, as well as governments to decrease the burden it creates and research what’s causing it. That research reveals significant links to MSK pain and that, for example, these conditions presenting in emergency departments contribute to patients’ initial access to opioids.

So our Board of Directors had the foresight to prioritize the opportunity for chiropractors to help solve the opioid crisis.

Subsequently, we partnered with the Centre for Effective Practice (CEP) to create the evidence-based Opioid and Pain Reduction Collaborative (‘Collaborative’). It’s designed to help chiropractors, or other manual therapists, co-ordinate a plan of care with patients and their prescribing health care professionals toward the end goal of them successfully reducing their opioid use.

Our solution includes the CEP-developed Manual Therapy as an Evidence-Based Referral for Musculoskeletal Pain clinical tool. It’s designed to inform physicians and nurse practitioners with the best available evidence.

Another key part of this solution is a script to help chiropractors start a conversation with a patient about reducing their opioid dependency. Most importantly, this script enables chiropractors to do so while staying within their professional scope of practice. We also offer fillable forms to help chiropractors share care plans with prescribing health care professionals.

Why interprofessional collaboration is imperative

But chiropractors can’t do this on their own. Interprofessional collaboration is imperative because MSK disability that’s related to opioid dependency involves much more than the pain of sitting or standing for long periods of time. It affects all aspects of a patient’s life, including their work, social interactions, family life, mental health and finances.

Spine, muscle and joint experts, such as chiropractors, can target the cause of the MSK pain and connect to affected areas of the patient’s life. Patients, primary care providers, as well as often social workers and other health care professionals, are also essential for the depth and expertise they bring to the complexity of a patient’s situation.

And to achieve the best outcomes, all care team members who the patient wants connected to their care plan should be aware of what’s happening at each stage.

So, as the patient’s mobility improves, it’s important for their care team to understand what the chiropractor’s next steps are in their plan of care. This understanding helps ensure the physician or nurse practitioner reduce their medication at an aligned pace or closely monitors the patient’s medication, if they are taking on a greater amount of exercise.

This close connection among the care team is needed to ensure the patient’s overall goals, such as reducing dependence on opioids, strengthening their mobility or improving their ability to stay at work, are met.

I believe patients also recognize the value of collaboration, as our research has found many are frustrated with the lack of communication and coordination among health professionals who care for them.[9] 

Key challenge: communicating across public and private care disciplines

One of the challenges we face is communicating across disciplines and at the right points in time. As we move into post-pandemic recovery, we know the publicly funded system will be under tremendous pressure to catch up and with enhanced interprofessional communication, chiropractors can help.

So, for example, when a physician refers a patient to a chiropractor or a chiropractor reaches out to them to discuss a patient’s plan of care, it’s important for them to agree on:

  • What the early weeks of care look will look like
  • When they’ll circle back with each other

This is a watershed moment for all of us to come together to change the outcomes for Ontarians who depend on opioids to relieve their MSK pain.

Health care community’s response to OCA’s Collaborative

This urgency coincides with a growing interest among family health team providers to know what’s going on with their patients’ care – whether it’s from a chiropractor or another health care professional outside the publicly funded system.

There’s a recognition that an increasing number of patients choose to see chiropractors or health care professionals who are not within the public pay system.

We’ve heard about an increasing number of family physicians and nurse practitioners asking about chiropractic care and providing information about the kind of care practitioners can deliver outside the bundled care systems. And again, with a focus on interprofessional care, they want to be engaged in these conversations.

Not surprisingly, the CEP clinical tool has been accessed more than 2,500 times since the Collaborative launched in June 2020 and some of our members have cited favourable feedback from physicians they’ve shared it with.

How the Collaborative will help Ontarians and Ontario

This collaborative approach empowers public and private health care professionals to achieve better patient outcomes for many Ontarians.

Once we reach a critical level of adoption, we expect to see more Ontarians moving, healthy and able to be a committed part of our workforce.

If we can provide the best MSK care at the right place, which is often outside hospitals, we’ll also help enable our health system to efficiently address the pandemic’s backlog of patient needs. Then our publicly funded system can devote its resources to priorities, such as cardiac and cancer care, that can’t be delivered elsewhere.

Finally, I think there’s an opportunity to further explore the co-ordination of care between the public and private pay system for evidence-based, well-established pathways of care. And low back pain would be one of those.

We know more than 70 per cent of Ontarians have extended health care benefit coverage through their workplace and the impact MSK conditions indirectly have on employers.[10] I think there’s an opportunity to leverage these benefits for the greater good, in terms of how they’re covered.

How can you help?

We launched the evidence-based Collaborative’s tools to our members in 2020 and are providing additional supports, such as this podcast series, to advance their implementation.

You can help by encouraging prescribing physicians and nurse practitioners to use this CEP tool and apply this approach to collaboratively help solve this opioid crisis.

I welcome your thoughts and feedback.

(Please note, this blog will be taking a break in August so you can enjoy your summer but it will be back in September with a focus on extended health care insights.)

[1] Kassam, A. (2021, July 4). Doctors’ focus on ‘missing patients’ is just first step in leading the pandemic recovery. Toronto Star.

[2] Vos, T., Lim S.S., Abbafati C., et al. (2020). Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. The Lancet, 396:1204–22.

[3] Gomes, T., Murray, R., Kolla, G., Leece, P., Bansal, S., Besharah, J., Cahill, T., Campbell, T., Fritz, A., Munro, C., Toner, L., Watford, J. for Ontario Drug Policy Research Network. (2021) Changing Circumstances Surrounding Opioid-Related Deaths in Ontario during the COVID-19 Pandemic.

[4] Deyo, R.A., Von Korff, M., Duhrkoop, D. (2015). Opioids for low back pain. Thebmj. (350):g6380

[5] Borgundvaag, B., McLeod, S., Khuu, W., Varner, C., Tadrous, M. and Gomes, T. (2018). Opioid prescribing and adverse events in opioid-naive patients treated by emergency physicians versus family physicians: a population-based cohort study. CMAJ Open. 6(1): E110-E117

[6] Shaheed, C.A., Maher, C.G., Williams, K.A., Day, R., McLachlan, A.J. (2016). Efficacy, Tolerability, and Dose-Dependent Effects of Opioid Analgesics for Low Back Pain: A Systematic Review and Meta-analysis. JAMA Intern Med. 176(7):958-968

[7] Foster, N.E., Anema, J.R., Cherkin, D., Chou, R., Cohen, S.P., Gross, D.P., et al. (2018). Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet. 391(10137): 2368–2383.

[8] Primary Care Low Back Pain Pilot Evaluation: Final Report.

[9] Partnership4BetterHealth, OCA Patient and Family Advisory council.

[10] Environics Research, as commissioned by the Ontario Chiropractic Association. (2019). Attitudes of Ontarians Toward Chiropractic Care. 13

5 Ways to Engage Patients and Uncover Invisible Insights

Patient and care coordinator engagingIn my first post, I outlined five features of a patient-focused integrated health care system that I envisioned. The third was a system that: stays informed and measured by evidence from our patients and their families’ voices, as well as data drawn from assessments and social, economic and cultural (SEC) tools, among others.

There is a real opportunity for our health care system leaders to understand what our communities, patients and families consider to be the best quality care they can receive.  Some believe we have this answer in the depth of knowledge, research and clinical evidence that we have and use to guide decision-making. Clearly, patients tell us: we don’t. Clinical data only gives us partial answers.

We need to effectively engage patients, caregivers and families, actively listening to their voices to uncover invisible insights for the rest of the answers. Only then can we fully understand what’s needed to shape a patient-focused system.

In a guest Leadership Lab column I wrote for the Globe and Mail earlier this year, I described ways a leader can engage with their stakeholders to steer their organization through complex change and mitigate risks. We may not have all the answers but when we engage, we bring our team, partners, clients or patients and other stakeholders’ questions, concerns and fears to the surface.

Of all our stakeholders in health care, patients are our priority and it’s important for leaders to continuously engage them, not just during times of change.

Here are five approaches that I found invaluable in my work leading a home and community care organization (Mississauga Halton CCAC):

1. Having meaningful conversations with patients –

If you directly ask a patient what their goals are, they might find them hard to articulate. However, they may enthusiastically express their joy in watching their grandson fine-tune his hockey skills or playing cards with their friends.

A skilled care coordinator starts the patient assessment process by gently having a meaningful conversation with their patient to learn what’s important to them and through this process, subtly uncovers their goals. This conversation also elicits feedback on how the patient wants their care delivered. With this insight, we can form pledges to patients on how they will ‘receive’ care, not just how we deliver it.

In 2015, the Mississauga Halton CCAC launched the award-winning Care Coordination Program of Work to drive consistent quality in our care coordinators’ varied competencies, while providing this essential service.  One competency is communications and we set specific standards and training to help each care coordinator guide these meaningful conversations and effectively engage each patient.

2. Partnering with each patient, their caregiver and family members –

Next to patients themselves, their caregivers and families are in the best position to help care coordinators, service providers and other funded resources understand their specific goals. Actively listening to our patients and partnering with their families helps us deliver on their expectations. And meeting or exceeding a patient’s expectations makes their health care experience that much better.

Patients, caregivers and families want to work with us to make sure their needs or those of their loved ones are met. And when they talk about how care is delivered, their requests are practical. They want to be treated with respect, participate in the conversation and have the opportunity to influence care decisions. To meet these requests, care coordinators work with the patient and often their caregiver or family to co-create a care plan they all agree on.

Based on input from patients and caregivers, our CCAC developed a personalized patient information package called ‘My Story’ to support this process and help patients be confident with their care.

3. Facilitating formal patient engagement forums to inform programs & services –

In 2014, our CCAC established Share Care Council – a structured patient engagement forum of 15 patients, substitute decision-makers and family members. Council members volunteered their time quarterly to provide input into new programs and services, on behalf of our region’s residents.

What I found most interesting is when we asked specific questions about program planning for the future, we didn’t hear “We need more PSWs or more nursing care,” even though we were at the lower end of the funding per capita, per senior resident in our region. Our patients and families understood the constraints of the system. Instead, they told us about their care experience, how it made them feel and how our system design can do better with the resources we do have.

For example, we asked what respite care or caregiver relief means to them. They told us it is temporary care that substitutes for the care provided by their loved ones or family members. It enables their loved one/family member to recharge, so they can continue to provide support. More importantly, they explained how this respite needs to consider how the loved one provided care, by understanding what matters to the patient, such as the way a chair is placed, the specific supports they need for reading or the companionship they seek. Essentially, they want support beyond the clinical care requirements.

Council members showed us the health system is not fractured in their mind. That’s why they find it frustrating when the care they experience falls short. It doesn’t matter whether they are a primary care patient, a hospital patient or a home and community care patient, they are simply a patient – in need, stress or crisis.

Feedback from our council informed many successful initiatives, such as My Story, our Health Links Patient Partnership (HeLPP) program and our award-winning Seamless Transitions, a new approach to help patients transition from hospital to home.

I’m pleased that the Patients First Act requires each expanded LHIN to have a Patient and Family Advisory Committee, like our Share Care Council, to support community engagement. This requirement offers the potential to put patients first by actively using their voice to inform day-to-day planning.

4. Establishing an Ombudsperson office for managing formal complaints –

Complaints are tough and call for intense, specialized interactions. We created an Ombudsperson role and dispute resolution process to address patient complaints that were complex and escalated beyond the care coordinator and their manager.  In a true service culture, point of care teams are supported to resolve issues as soon as possible and as close as possible to the patient and family. However, in the “complexity” of our health system design, “complex” complaints often involve multiple stakeholders across the system. Point of care teams need additional support. This office receives complaints via varied sources – from the patient or caregiver to the Long-Term Care ACTION Line.  The team uses specialized negotiation techniques to focus on the needs of each party with the end goal of achieving the best solution for everyone.

Time and again, we discovered a communications breakdown at the root of an issue. To address it, we needed to ask questions and create opportunities to hear the assumptions behind it. In our information overload world, we can’t assume all input is based on the best or most up-to-date information. We found engaging, even in challenging circumstances, often leads to clarity, prompts dialogue and helps forge solutions.

5. Encouraging broad feedback through formal measurement tools –

Each year, a third-party research firm conducted a Client and Caregiver Experience Evaluation (CCEE) survey of our patients, as well as those at CCACs across Ontario.

This standardized tool invited patients to anonymously answer a series of standard questions about the quality of care they received and how they felt about it.

These provincial comparisons of our local performance gave us a consistent way to assess how well we met patient expectations and opportunities for improvement. For example, through a deep analysis of this information we were able to uncover the need for greater consistency in our communication with patients. As described earlier, this finding led to our investment in the Care Coordination Program of Work and a turning point in satisfaction results with our services.

Through sharing what’s important to them, patients and families will help us as leaders evolve our organizations, make the system adaptable and responsive to their needs, as well as those of the next generation to come.

“It’s far more important to know what person the disease has than the disease the person has” – Hippocrates

What do you think? Can you think of other ways to engage patients and their families?  Can you share an example of how engaging patients helped shape a successful decision or initiative?

3 Hurdles to Dodge in the Patients First Marathon

Patients First Hurdles

Runners' hurdle with Patients First report cover on top.In my last post, I discussed three goals Ontario’s Patients First legislation can potentially realize, if health care leaders effectively leverage Community Care Access Centre (CCAC) assets (people, processes and technology), as well as other organizations’ assets.

On the flipside, I believe health care leaders need to dodge the following risks when implementing Patients First:

1. Working in Silos without a Shared Understanding of Vital Design Principles

We need to work collaboratively, with a shared understanding of the design principles that are essential to a high-functioning, sustainable system.

As I outlined in my last post, we have an opportunity to build stronger connections between primary care providers and community resources. This means designing a system that enables everyone in the circle of care to easily engage with each other in the course of patient care.  For this to succeed, all parts of the system must optimize resources and work collaboratively.  It is contemplated that the LHIN sub-regions will enable this collaboration and integration.

Implementing Health Link helped many patients with complex needs but it also put us precariously close to creating parallel systems to care for those patients. Once this challenge was recognized, changes were made to streamline care and use resources in a more sustainable manner.

This time, as we think about LHIN sub-regions we have an opportunity to step back and identify the shared system design principles that need to be in place, before we move forward.

2. Paying Scant Attention to CCACs’ Proven Culture and Leadership

There’s a risk that in integrating CCACs into the LHINs, health care leaders may pay insufficient attention to proven aspects of the existing home and community care’s culture and leadership. While not perfect, we know that to deliver care in the community, enter people’s homes, work with a diverse, virtually connected workforce and their supports, a unique culture is required. This culture is led by a dual focus on system planning and care delivery operations, which include supporting care coordination, monitoring quality, patient outcomes and service providers’ resource use to ensure those with the greatest need, receive care.

Conversely, LHINs currently require a different type of culture and leadership to meet different mandates, which exclude patient care.

Effectively integrating each organization’s culture and leadership is a huge challenge. CCAC assets (people, process and technology) will be under-leveraged if this part of the expanded LHIN’s mandate receives minimal attention. Focusing on system planning at the expense of leading care delivery, could also mean that one or thousands of patients stay in hospital longer than needed, due to oversight shortfalls. This is far from ideal when systems are constrained.

Understanding the magnitude of the responsibility they are taking on, LHIN board members raised early concerns about potential conflicts for new boards as they communicate their focus after integration. Boards will need support to pay significant attention to their care delivery operations to ensure they set high standards for care quality and oversight.

3. Assuming an Easy, One-Day Transition and Disrupting Vital Processes

Some people may assume integrating two distinct organizations is an easy process with an immediate transformation point, where teams cross over to a new governance structure with new projects. In doing so, they could put the opportunity to leverage existing CCAC assets and progress in peril.

Patients First impacts the expert implementation skills and other strengths within the current CCAC system. These skills include a solid understanding of the current home and community care system and service providers’ performance, plus the leadership to ensure patients/caregivers have quality experiences. It also has the potential to disrupt the support systems developed to manage care in homes and a virtual workforce.  These systems must be adeptly integrated as part of a long-term marathon, not a sprint. This work currently underway in the CCACs includes many strategies that are planned or in motion to continuously improve home care delivery.

There is a significant risk that through integration we will disrupt current culture, process, teams and technology without understanding their value in effectively reorganizing around the LHIN sub-regions. Current initiatives need to be recognized and supported post-integration day to maintain positive traction. It’s critical how attention to that work is prioritized, pre and post-integration.

Fortunately, the MOHLTC has enabled LHIN boards to expand from nine to twelve and has been explicit in requiring directors from CCAC boards to be given consideration. Having this voice of CCAC governance engaged in LHIN planning will help mitigate this risk to patient care disruption but there is an urgency to expand these boards sooner than later.

As with a marathon, we are in the warm up phase. If LHIN boards are expected to plan now for the post-integration transformation agenda, the voice of CCAC governance and leadership at the local level should be reflected in that planning. Ideally, LHINs and CCACs should share and have a continuity plan in place for moving the collective agenda forward post-integration, with ongoing support for strategic home care work in progress.

Patients First is a marathon with a long-term agenda. Ahead of the starting line, it needs CEOs and governance to establish the culture necessary to succeed. This culture requires full engagement of primary care, home and community care, hospitals, LHINs, public health and others to propel it.

My team is ready to move forward toward the long-term goal of a more sustainable, integrated health care system that puts patients at the forefront. Are you?

What do you think? Are there points you’d like to add?  Please share your comments at the bottom of this post.

3 Aspirational Milestones in the Patients First Marathon

Patients First Marathon

Baton with Patients First written on it being passed from one runner's hand to anothers.Change is necessary for sustained and progressive success but it is rarely simple or easy. Such is the case with Patients First, new legislation that the Ontario government’s Ministry of Health and Long-Term Care (MOHLTC) first proposed on December 17, 2015 to improve the accessibility, integration and consistency of patient care across the province. This proposal has since progressed to Bill 41, the Patients First Act, which passed second reading on October 27, 2016. A key part of this legislation calls for integrating Ontario’s 14 Community Care Access Centres (CCACs) into their corresponding Local Health Integration Networks (LHINs).

Since its introduction, Patients First’s proposed design has and continues to evolve. The due diligence to advance this change is also shaping it by shining a light on high performing parts of the current system.

A noteworthy shift is the new context the MOHLTC placed around reintroduction of the legislation. Essentially, the narrative about CCACs has changed to be one about building on the strength of the current home and community care sector. Minister Eric Hoskins has said on numerous occasions: “This is not about fixing a broken system but leveraging the assets within the CCACs for the broader good.”

These assets include people, processes and technology. On the people side, initial integration talks cited the need to have CCAC care coordinators in hospitals and physicians’ offices as a key goal. Digging deeper, many learned that care coordinators have been working in hospitals and connected to physicians’ offices for years. In fact, this practice made it possible for care coordinators to help 210,000 Ontarians transition from hospital to home with a warm hand-off in 2015/16. We all know now this practice is working.

Instead, we need to focus on how to effectively optimize the relationships between care coordinators and so many parts of the system, such as primary care, acute care, working with home care providers, community resources and in patients’ homes. In my first post, Sam’s story demonstrates how our care coordinators use these relationships to help patients, even those with complex health and socioeconomic needs, to stay out of hospital.

The new system can also leverage process and technology assets. The MOHLTC is seeking a dashboard with readily accessible information to help it assess how the home and community care system is functioning, both pre and post-integration. There is now clear recognition that all CCACs use a dashboard, of various levels of sophistication, to provide oversight and inform decisions. Our care coordinators use Insights, an interactive dashboard, for multiple purposes, from planning patient visits to measuring their outcomes. The Ministry can adopt and adapt an existing CCAC dashboard.

This expanded understanding of the capacity to apply CCAC’s, as well as other’s assets, to the system’s greater transformation, opens opportunities for us to achieve several aspirational milestones or goals that put patients first. Here are three goals Patients First can realize, if health care leaders effectively leverage these assets:

Aspirational Milestones or Goals

1. More Engaged Primary Care Providers to Help Patients Achieve their Goals

A great benefit we can realize is having a system that makes it easier for primary care providers (including physicians, nurse practitioners and physician assistants) to interact with the broader community of support services that help patients achieve their goals.  This includes creating stronger connections between primary care and community resources that address a patient’s socioeconomic or cultural needs, as well as publicly funded services.

Through our care coordinators’ experiences, we know how crucially important primary care involvement is to ensure our patients have the best outcomes but it’s not easy for these providers to interact with our current, intricate community care system with its multiple access points.

Patients First legislation contemplates better understanding, planning and support for primary care and a future with expanded roles to complement their practice. These roles will involve primary care providers more closely in the planning for home and community care at the regional, neighborhood and patient level.  For example, this means that a family doctor will know that patients like Yasmin, a single, Urdu-speaking senior, who suffers from depression and diabetes, are connected with a local cultural or faith-based group, as well as home and community services.

2. Inserting the Voice of the Patient and Caregiver in Planning

The new Act sets a requirement for each LHIN to have a Patient and Family Advisory Committee to support community engagement. This offers the potential for LHINs to have and use a greater line of sight about what’s important to patients and families in their day-to-day planning.

All CCACs have experience with patient engagement strategies, and can bring that knowledge of how to involve patients and families into the LHIN’s planning work.

In 2014, we established Share Care Council – a highly structured and successful patient and caregiver advisory forum. It includes 15 patients, substitute decision-makers and family members, who volunteer their time to provide input into new programs and services. Share Care Council applies a carefully defined approach that authentically engages patients and caregivers to elicit their valuable input.

What’s eye opening is Share Care Council members’ responses to questions about how our programs can best meet their needs. We don’t hear “We need more personal support workers (PSWs) or more nursing care.” Instead, they tell us about their care experience, how it made them feel and how our system design can do better. It is less about the technical elements of care and more about the soft touches, social interaction and how these services are delivered that make the difference. For patients like Hilda, it’s having a PSW who knows how to braid her hair and set her up in the chair by the window when she leaves.

Through this requirement, the expanded LHINs can discover that when you carefully engage with patients and families on your journey of continuous quality improvement, their experience can drive development of meaningful programs and changes to care.

3. Organizing Home and Community Care around LHIN Sub-regions

A third advantage is the legislation’s shift to organizing delivery of home and community care around a LHIN sub-region, with consistent, service providers.

Our capacity plan research told us that people’s social, cultural and economic status often varies significantly between our neighbourhoods. So having care providers who are familiar with their patients’ neighborhood and its existing support resources (provincially funded and others) helps ensure successful home and community care delivery.

We also know that having a minimum number of consistent service providers who interact with our teams and patients/families builds strong relationships. Furthermore, this approach helps create high performing teams, whether virtual or in-person, in each patient’s circle of care.

With a goal of being able to identify local resources, numerous CCACs have begun reorganizing their care coordination and service provider teams around these LHIN sub-regions.

In our region, we’ve reorganized patient care around neighborhoods, so that patients, like Betty and Patty, can receive the services they need from consistent providers, who know their community and are located near their home. Organizing services around LHIN sub-regions or neighbourhoods gives service providers a greater connection with the communities where they deliver care.

I believe there’s much to be gained through LHIN sub-region planning but it’s complex work and should be viewed as part of a long-term vision or marathon.

On the flipside, implementing Patients First also poses risks, which I believe health care leaders need to dodge. I will outline three of these risks in my next post.

What do you think? Are there opportunities I’ve missed or points you’d like to add? Please share your comments at the bottom of this post.