Model of Care Project - press release

I received this press release in my email inbox this afternoon and thought I should share it here. The Model of Care Project referenced in the release represents an effort to promote collaborative practice and interprofessional care in the PEI health system.

For Immediate Release
June 17, 2009

The Department of Health Begins Work on a Province-wide Model of Care

CHARLOTTETOWN, PEI -- Over eighty people from across the provincial health system came together recently to form the Model of Care Design Team and to begin work on improving the ways in which health care is organized and delivered on Prince Edward Island.

“The results of the 2008 review of our health system indicate that we need to work together as an integrated health system to continue to provide quality health care for all Islanders,” said Premier Robert Ghiz. “The Model of Care Design Team is making an important contribution in achieving the Government’s vision of One Island Community, One Island Future, One Island Health System.”

Similar to other jurisdictions, Prince Edward Island’s health system faces human resource shortages, increasing demands for services and rising health care costs. The work of the Model of Care Design Team involves the creation of a “made in Prince Edward Island” solution that address these challenges.

Specifically, the Model of Care Design Team will look at clarifying the roles of Island health care providers and support staff, and improving the interactions between these roles so that all members of the health care team are empowered to work to their full potential.

“We know that our most valuable health resources are the people working within the health care system. The Model of Care Project will ensure that the effort they put forth produces optimal results across the system,” said Minister of Health, Doug Currie. “We need to find ways to operate as a team and to create opportunities to leverage the collective skills and talent of our team.”

In a display of the Government’s support for the project, Premier Ghiz, Minister Currie and Provincial Treasurer Wes Sheridan visited the team on the second day of their three-day planning session. “As a government, we recognize the importance of listening to those who work within our health care system,” said Minister Sheridan. “I was certainly impressed with the energy and enthusiasm of those involved in the Model of Care project, and have every confidence that their recommendations will enhance the way health care is delivered to all Islanders.”

Model of Care Design Team members come from across the province and represent a wide range of health care skills and perspectives, including physicians, nurses, support staff and associations.

In addition to ensuring that our health system can continue to deliver high quality care sustainably, a redesigned model of care will empower health care providers to work collaboratively to the full potential of their abilities and training. Research supports that an effective model of care can improve both the quality of care and the quality of work life for health care providers.

The Design Team will reconvene this month to continue this important work, and detailed planning will take place over the summer for the implementation of the redesigned model.

BACKGROUNDER

In November 2008, the results of the Corpus Sanchez (CSI) Health System Review were released. Hundreds of Island health care providers, public citizens and stakeholders participated in this review, contributing to the sustainability of the health system and the improved health services for all Islanders.

The Government of Prince Edward Island has endorsed the report’s general direction of One Island Health System. Extensive investigation, review and planning are now underway across the health system to determine which solutions will work best for Prince Edward Island. This is the work of the Department of Health’s Integrated Health System Project.

The Integrated Health System project will concentrate on operational improvements and service realignment. The goals are to improve health outcomes, enhance access and refocus the emphasis of the care delivery system on primary health care and services that can appropriately and safely be provided locally.

The Model of Care Project, referred to officially as the Collaborative Care Team Project, is looking into the ways in which health care providers and support staff can operate as a team. The redesigned model of care within One Island Health System will be centered on patient needs and will strive to make the best use of the system’s skills and expertise. The model will ensure that the most appropriate member of the health care team can provide the most appropriate service at the most appropriate time and place.

The Prince Edward Island Department of Health employs over 2000 health care providers, including physicians, registered nurses, licensed practical nurses, resident care workers and allied health professionals. The 2008 review of the health system reveals that the existing care delivery system is limiting the capacity of these care providers to work to the fullest extent of their abilities.

Opportunities for improvement exist in staffing models, work processes, and the use of information and supporting technology. National research and best practices show that Model of Care strategies are being used to reduce health system barriers by creating and supporting interdisciplinary, collaborative care delivery environments.

The Model of Care Project is just one of the initiatives underway in the effort to achieve One Island Health System. More information on this and the Integrated Health System Project can be obtained through the Project Management Office at healthinput@gov.pe.ca or

(902) 368-5810.

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Exemplary Care: Registered Nurses and Licensed Practical Nurses Working Together

The Association of Registered Nurses of PEI, the Licensed Practical Nurses Association of PEI, and the PEI Health Sector Council today announced the release of Exemplary Care: Registered Nurses and Licensed Practical Nurses Working Together. This publication highlights the guiding principles shared among RNs and LPNs and clarifies some of the key differences between RNs and LPNs in clinical practice. The discussion and examples presented in the report reflect the practice of typical nurses and is intended to promote an understanding of:

• the scope of practice of each group,
• the practice expectations when both groups work together, and
• the contributions that both groups bring to the care setting.

Having a full understanding of the different health care contributions of RNs and LPNs will enhance and improve the process of collaboration and effective decision-making in the clinical setting.

RNs and LPNs are two health professions that work very closely together. This document represents an important milestone in fostering mutual knowledge-sharing and increased collaboration between the two professions to relieve some of the tremendous human resource pressures on the health system and create an exemplary health care workplace. A more efficient, collaborative nursing practice benefits all of us – nurses, other allied health professionals, and clients of the health system. An efficient, collaborative nursing practice enhances our ability to recruit and retain nurses and leads to better utilization of human resources and, consequently, savings in financial resources.

I hope you get a chance to read and comment on this document.

Cheers,
Mark

Teams in Action: Primary Health Care Teams for Canadians

Last week the Health Council of Canada released a report on health teams in Canada called Teams in Action: Primary Health Care Teams for Canadians. The report was released exclusively as an e-document to limit paper use and save some trees in the process. The HCC asked if I would post a link to the report here and I am happy to oblige, especially considering its focus on Collaborative Practice, one of our favourite topics at the Health Sector Council.

The Teams in Action report profiles many of the public health benefits of collaborative practice in health care, what makes a collaborative health team and efforts to encourage the formation of health teams, and the extent of access to health teams across Canada. Although the report is not health human resource specific, it does make note of the human resource benefits of collaborative practice, including increased job satisfaction and greater knowledge and skill-sharing among health professionals in a collaborative practice setting. In addition to the main report, the HCC has also released backgrounders and supplementary reports specific to each Canadian jurisdiction, including Prince Edward Island. Check out the other site-specific documents here.

Have a look at the report, spread it around, and post your thoughts here. And I promise, the PEI Health Sector Council is not a branch of the Health Council of Canada, despite appearances from the last number of posts!

Cheers,

Mark

Prince Edward Island's Intergrated Palliative Care Program

This post originally featured a video profile of PEI's Integrated Palliative Care Program that was produced by the Health Council of Canada. I've since removed that video as it is somewhat out-of-date and doesn't reflect the current reality of palliative care in PEI. The video can still be viewed on the Health Council of Canada's website if you're curious, but I feel it is important to stay current with these posts. I will have more to say about palliative care and collaborative practice on PEI in the future.

Cheers,
Mark

Best Practices in Interprofessional Care Case Study

This Health Council of Canada video presents a brief case study of a successful collaborative practice facility in Twillingate, a small community of about 2,500 people on the northeast shore of Newfoundland. The chronic disease care team described in the video exhibits qualities that I think we can consider best practices in collaborative care – namely, that collaborative care is a team-based approach where practitioners from different occupations and levels of the health system come together to discuss an individual client’s case. The approach is client-centred, includes the patient as a team-member, and promotes the sharing of knowledge between disciplines. Seems like a no-brainer, I know. That collaborative care is a somewhat revolutionary health care delivery model may be a revelation to some, but the degree of collaboration exhibited by the chronic disease team in Twillingate is not the norm. However, collaborative practice facilities and teams are becoming more prevalent. We have good examples on PEI which I will be profiling in future blog posts. Stay tuned!

Embedding of this video is disabled, so you'll have to link directly to Youtube to view it. Sorry about the extra step!

http://www.youtube.com/watch?v=PADGp1I34is&feature=channel

A Family Health Team model

The article below describes a community’s response to pressures affecting its health human resources and its ability to deliver effective, quality health care. Many of the issues raised in the article are ones that we share in PEI – physician recruitment challenges, shifting demographics among the medical profession whereby more medical school graduates are choosing to specialize rather than enter family medicine, physician retirement, and so on.... Granted, there have been some good news stories, including some recent success recruiting physicians, but the times are changing and recruitment is just one piece of the puzzle.

The article outlines the development of an interprofessional, team-based health delivery system for the Peterborough region of Ontario, adhering to the ideals of collaborative, patient-centred care outlined in one of my previous blog posts. The Peterborough region currently has five interprofessional family health teams (two in the city of Peterborough), consisting of family doctors, nurse practitioners, receptionists (yes...they are an integral part of the health team concept), registered nurses, dietitians, social workers and so on. In 2008 the Peterborough Regional Health Centre was opened with the intention of expanding the interprofessional care concept to include outpatient services and bring specialist physicians into the mix.

It’s an interesting concept and one that appears to be working. Fourteen thousand people have been taken off the waiting list for a family doctor in the Peterborough region in the last two years and wait times have decreased. We have family health teams on PEI and I’m not sure how they compare to those in Peterborough, but the two jurisdictions are strikingly similar. Peterborough and Prince Edward Island are almost exactly equivalent in population (139,818 in PEI as of 2008 vs. 133,080 in Peterborough as of 2006). Both jurisdictions are also largely rural and comparable in overall area and population density (23.9 people per square kilometre in PEI vs. 35 per square kilometre in Peterborough).

I think it’s something that bears watching. If successful, some of the concepts that drive the Peterborough model might be worth adopting on PEI. For one thing, I’m curious to know how many people the Peterborough health teams count as patients compared to PEI teams. I’ll keep you posted if I find out. What are your thoughts?

The Perfect Storm

How a community calmed the rough waters of health care
By Gordon Gibb

You’ll have to forgive Dr. Don Harterre for choosing a winged warthog as his office mascot. The diminutive porker suspended above his desk serves as a delicious metaphor in view of recent success implementing family health teams in Peterborough, Ont., — something one local physician predicted would only happen "when pigs fly."

In Peterborough, an idyllic city of 75,000 located 90 minutes northeast of Toronto, health care is something people love to talk about these days.

Little wonder. The sprawling, state-of-the-art Peterborough Regional Health Centre (PRHC) is slated to open in June, consolidating two outdated hospitals into one meticulously planned facility. The Peterborough Clinic has just moved into a new building adjacent to the PRHC, with its orphaned facility downtown tagged to house expanded vascular health services. Five family health teams are flourishing. And upwards of 14,000 people have come off the waiting list for a family doctor in the past two years.

read the rest of the article here...

The Expanding Health Team - Nurse Practitioners

The health sector is changing, not only in PEI and Canada but worldwide, and with good reason. Why?

There is no other option.

One of the most startling statistics I read in the Corpus Sanchez report was the rate at which the cost of the health system is growing relative to the provincial treasury. Based on that report, by 2013 our health system will consume all new incremental revenue, meaning the spending of every other department will have to be frozen in order to pay for increases in the health budget. By 2014, only five years from now, other departments will have to reduce spending to pay for health care cost increases. It’s a sobering statistic....

As we move toward a primary care model – community-based, preventive, continuous and integrated care with a focus on interprofessional collaboration – we have to find new, more efficient ways of accessing the health system to avoid the grim situation described above. One way of doing that is to make better use of the health team.

Nurse practitioners are a central part of the health team. According to a recent CBC report, nurse practitioners can see from 60 to 70 percent of patients that would normally see a family doctor. That is a significant burden removed from the family doctor and also a much more cost-effective way of accessing the health system. After all, a nurse practitioner exerts a much lighter burden on the province’s pocketbook than a doctor.

The article at this link is from a Newfoundland perspective, but is also relevant to PEI and presents a good example of how nurse practitioners can help ease demands and pressures on the health system.

Mark

What is ‘Collaborative Practice’ anyway?

Collaborative practice, interprofessional care, interdisciplinary care...these are phrases that get kicked around a lot in health literature, conferences and board meetings. The PEIHSC held a forum in May 2008 called the ‘Collaborative Practice forum’, so you would think that when the new Executive Director at the PEIHSC called me into his office to talk about our next year of activities and asked if I could define collaborative practice that I could give a pretty good answer, right? Well, I found myself stumbling to come up with a clear definition of how collaborative practice and interprofessional care differs from how the majority of health facilities currently operate.

I went back to an article I wrote on this subject in one of our newsletters where I quoted a definition of collaborative practice by Carol P. Herbert. She defines collaborative practice in her article “Changing the culture: interprofessional education for collaborative patient-centred practice in Canada” as “the continuous interaction of two or more professionals or disciplines, organized into a common effort, to solve or explore common issues with the best possible participation of the patient.” But what makes a practice truly collaborative, and how does that definition distinguish a collaborative practice from any other practice?

At its core, interprofessional care has to do with breaking down walls and making a shift from autonomy to interdependency. Individuals engaged in collaborative practice are mutually dependant on each other and are aware of each others’ expertise. Power is shared among team members, including the patient. Making this shift might mean the actual removal of physical walls and changing a practice into an open concept space with minimal or zero private office space. It will certainly mean instituting practices that promote collaboration and the sharing of information – multidisciplinary rounds for example, where the practitioners in a collaborative practice facility meet to discuss and recommend steps for a particular client’s care, often with the participation of that client.

James and I recently met with two individuals who were instrumental in setting up a collaborative practice facility here in Charlottetown. Something about the facility that struck both of us as a defining characteristic of interprofessional care was the adoption of a horizontal communication structure. Adopting a philosophy of horizontal communication blurs the lines between roles, removes traditional boundaries and promotes the deliberate exchange of knowledge, skills and expertise.

Getting back to Carol Herbert’s definition of collaborative practice, I think that three of the key concepts in that definition are “continuous interaction”, “organization” and “patient participation.” I’m sure that almost any health worker would agree that they interact with other health professionals to solve and explore common issues for their patients. Continuous interprofessional interaction that is organized by means of institutional policies and models of care, which includes the client as a contributing member of the team is what really distinguishes interprofessional care.Of course, that’s just my opinion. We’d like to hear yours.

Cheers,
Mark