Health systems across Canada are increasingly focused on the gaps and discontinuity in care that contribute to ongoing problems for so many people, particularly those who are chronically ill or otherwise vulnerable. It is generally acknowledged that the system needs to be more integrated, with seamless services and better coordination all around. The question of the best way to achieve integration, however, remains open.
In search of answers, The Change Foundation, an Ontario-based independent health policy think tank, felt it would be timely to review and discuss how other jurisdictions are handling efforts to integrate care. Together with partners from the University of Toronto – the Institute of Health Policy, Management and Evaluation, the Health System Performance Research Network and the Dalla Lana School of Public Health – it launched a series of discussions on effective approaches to integrating care in late 2017 to glean insights that might help improve healthcare in Canada.
Three speakers took part in the series: Chris Ham, chief executive of the London-based King’s Fund think tank; Geoff Huggins, director for health and social care integration in Scotland; and Helen Bevan, chief transformation officer of England’s National Health Service. Common ideas echoed through their talks and the lessons they offered will likely resonate across Canada as well.
All three speakers said a shift toward integrating healthcare is almost always triggered by a crisis of quality, sustainability or both. They all advised focusing on services rather than trying to overhaul institutions. But unlike in recent decades, when crises led to pressure to standardize care, Ham, Huggins and Bevan called for focusing on local solutions because success will come from letting front-line workers develop new ways to care for the people and communities they know, not from centralized planning. And they all said successful change is based, above all, on good relationships, trust and altruism.
Perhaps that is the most important lesson of all for Canadian providers looking to integrate care – forget the myriad divisions of healthcare, within and among institutions and provinces and professions and patients – be honest and work together for the good of patients, caregivers, the public, providers and the system as a whole.
The series begins with Chris Ham’s presentation looking at international examples of integrating care. Watch for commentaries from Geoff Huggins discussing integrating care in Scotland later in 2018 and Helen Bevan’s thoughts on bringing integrated care to the National Health Service (NHS) in England in early winter 2019.