Peter Varga talks about how technology can unlock capacity, enhance care delivery, and optimize performance in the Canadian health sector

By Peter Varga, RN, BScN, MHSc (health admin) 

When it comes to healthcare spending, Canada has always made a strong commitment to our public healthcare system. Out of 38 OECD countries, Canada spends more on healthcare as a percentage of GDP than every other country except the United States. Canada’s federal government is even poised to further increase healthcare funding, following a recent proposal to add $46.2 billion in new spending over 10 years.

Yet despite this, Canada’s ranking in healthcare system performance falls behind most of the other high-income countries, according to a 2021 Commonwealth Fund report. The study considered five measures, including access to care, care processes, administrative efficiency, equity, and healthcare outcomes.  While many Canadians take great pride in our healthcare system, there is room for improvements.

In the March edition of Healthcare Management Forum, we explore strategies healthcare leaders can pursue to close the gap between healthcare spending and healthcare performance. We also consider the future of healthcare in Canada, examining the role of digital solutions and partnerships with technology vendors in building greater capacity in our health systems.

Over the past few years, many clinicians have incorporated technology (such as virtual care platforms) into how they deliver care, and many patients have been using technology to access health services and exert greater control over their own care. While change had already been underway, the COVID-19 pandemic accelerated this transformation.

The pandemic created an urgent need to shift to new paradigms of care as health systems had to adapt quickly to rapidly changing circumstances. Adopting innovative solutions often has a transformational impact. New technologies can enable better communication, collaboration, and coordination, both within individual care settings and across the care continuum.

Against this background, we ask the question: how can healthcare leaders continue to capitalize on the momentum generated by the pandemic? Keeping in mind the key measures for healthcare system performance, we see a few opportunities for healthcare leaders to consider. These include:

• Supporting clinicians with the technology that best serves their day to day needs at the point of care, thereby optimizing care delivery.
• Assessing and addressing “technological debt,” which can impact an organization’s performance and efficiency.
• Moving to a population health approach that emphasizes wellness, disease prevention, early detection, and mitigation, while acknowledging equity to address populations who may not have the opportunity to utilize technology, and/or those who do not have access to the internet or technology that would enable these benefits.
   

Looking toward the future, we examine how we can build greater capacity in health systems, while also expanding capabilities. We focus on three key areas:

1. Procurement: As hospitals have an obligation to adhere to very detailed procurement guidelines, there is an opportunity to refine the procurement process by adopting a value-based procurement model that will help ensure new investments align with the needs of clinicians and patients.

• Partnerships: Long-term, strategic partnerships with technology providers that have relevant expertise will help healthcare organizations share risk, improve clinical services, quality of care, and patient outcomes.

• Platform solutions: Transitioning from legacy systems to modern digital solutions will bring many benefits, including increased flexibility, cost savings, improved user experiences, and enhanced security. Examples include digital platform solutions with cloud computing, Software as a Service (SaaS) solutions, Internet of Things (IoT) platforms, and Artificial Intelligence (AI).

When it comes to adopting digital health innovations and integrating them within existing frameworks, partnering with a technology vendor can make the process easier. Embarking upon a digital transformation is a significant undertaking, but the benefits for patients, clinicians and the healthcare sector are immeasurable.

Peter Varga is a Registered Nurse and the Chief Transformation Officer at HealthHub Solutions, Canada’s leading provider of bedside patient engagement technology. Read Peter’s full article here.

The full March edition can be found here: https://journals.sagepub.com/home/hmf

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Maria Mathews wants us to think about the key roles for primary care physicians during a pandemic

There’s a Wayne Gretzky quote that’s often cited in strategic planning texts: “Skate to where you think the puck will be”.  Our paper, “The Roles of Family Physicians During a Pandemic”, outlines what health system planners, as well as individual family physicians, need to anticipate for future pandemics.  The COVID-19 pandemic, along with other outbreaks before it, have highlighted the critical need to have a health workforce that is prepared and enabled to carry out pandemic response roles.   

Back in February 2020, my family physician colleagues were anxiously waiting for directions from the local public health unit about the growing number of COVID-19 cases.  In the days before the pandemic was declared, public health had notified family physicians to screen patients presenting with flu-like symptoms for recent travel from high-risk locations and encouraged them to complete N95 mask fittings and volunteer to help at local hospitals as needed.  But what exactly were family physicians expected to do?  Many family physicians dusted off outdated PPE, in storage from the H1N1 outbreak, and realized that they, their staff, and patients would be unprotected if infected patients arrived at their practices.  Colleagues, who recalled experiences from the SARS outbreak, asked “have we not learned anything from SARS? Where is the pandemic plan for primary care?”

Similar conversations were happening in family practices across the country.  With research and clinical colleagues from Nova Scotia, Newfoundland and Labrador, British Columbia and Ontario, we scrambled to obtain funding from the Canadian Institutes of Health Research to document the stages of the pandemic response, family physicians’ roles, and the resources (e.g., policies, supplies, infrastructure) in each province that have supported (or hindered) family physicians in carrying out their pandemic roles.  We were fortunate to interview physicians in 2020 and 2021, when memories were still fresh, and changes in the day-to-day operations were rapidly adopted and evolving.  Two-plus years in retrospect, many recollections of the uncertainty and anxiety of the first, hectic months of the pandemic have grown hazy, and the practice-based adaptations seem more routine and familiar.        

Our paper describes the different stages of a pandemic response and the roles of family physicians in each stage.  While many of the roles, such as screening and testing patients, may seem self-evident, the infrastructure needed to support these activities require thought-out system and practice-based supports (e.g., access to appropriate personal protective equipment, access to testing kits or mass testing sites, professional development).  Others, such as adopting virtual care may become part of routine primary care after COVID-19.  Notably, these roles are in addition to the provision of routine primary care, which may become more complex during a pandemic.  For example, modulating referrals to services in other healthcare sectors, requires family physicians to care for patients without usual specialist or diagnostic supports.    

The variation in COVID-19 cases and pandemic response plans across regions has allowed us to examine different ways that family physician roles have been implemented and supported – while still identifying a core set of roles across regions. The regional variations also allow system planners to compare experiences and identify wise practices for future pandemic plans.   

The COVID-19 pandemic, along with other outbreaks before it, have highlighted the critical need to have a health workforce that is prepared and enabled to carry out pandemic response roles.  Developing a pandemic plan for primary care is essential to ensure that family physicians can meet the needs of patients and assist pandemic response in other healthcare sectors.

Maria Mathews, PhD, is a Professor in the Schulich School of Medicine & Dentistry at the University of Western Ontario. She is the lead author of this article which appears in the January 2023 edition of Healthcare Management Forum.

Why getting sex, gender and sexual orientation information right, matters

By Karen L. Courtney & Kelly Davison

Using the name and pronouns that a patient asks you to use is, in no small measure, a very important relational gesture. It means that clinicians have taken the time to read and understand this information about the patient. It means that someone has taken the time to ask the patient about their name, gender identity and pronouns at some point along their care journey. And it means that someone has documented this information in the correct fields in the electronic health record for other members of the care team to use-so they can avoid harming the patient by using a name or pronoun that shouldn’t be used, or by making assumptions about gender identity and anatomy. The quality of the therapeutic relationship and the quality of care provided depends on showing respect for persons for who they are. 

But it also means much more. It also means that the people who have built the information system that has been implemented have designed it in such a way that it promotes person-centred care. It means that vendors, governments, standards organizations and health authorities that fund and regulate these initiatives recognize the role of information structures in quality care processes; that inequities in health are produced by barriers to quality care. It means that healthcare leaders have championed both the big and the small changes within their organizations to make it happen. It means they have dedicated time, energy, and resources to improvement. 

Gender, sex and sexual orientation (GSSO) information practices affect every single person who accesses healthcare services. Historically, the terms sex and gender have been conflated, and represented as a binary structure, upon which all care interactions and care decisions were based. This remains the case in many information systems. Modernization will likely result in greater precision for clinical services and for evaluating program or policy outcomes.

Our existing systems assume that sex, anatomy and hormones are unchanging over the human lifespan whereas this likely not the case for most clients. In the long term, the inclusion of anatomic, organ and hormone inventories within the digital health systems will allow clinicians and decision support systems to link relevant clinical information to preventive care, interpretation of diagnostic tests, and treatment planning. But many organizations may need to take intermediate steps to modernize their current digital health systems. How these changes are undertaken are important.

In the November edition of Healthcare Management Forum, we examine the ethical challenges for healthcare leaders as they modernize GSSO information in digital health systems. We suggest that the ethical principles found in the Canadian College of Health Leaders’ Code of Ethics and the International Medical Informatics Association Code of Ethics are relevant for understanding the impact that technical and clinical information practice changes can have on clients.

The status quo for GSSO information has led to inappropriate care and client harm and avoidance of the healthcare system.  Modernization is necessary. Health leaders need to champion thoughtful engagement with clients and family advisory groups on the intermediate and long term changes needed.

Dr. Karen Courtney, RN, PhD is an Associate Professor in the School of Health Information Science at the University of Victoria.   Kelly Davison, RN, MSN, MN is a doctoral student in the School of Health Information Science at the University of Victoria.  Both are co-chairs along with Dr. Francis Lau of the Canada Health Infoway Sex and Gender Working Group.