Sep 14, 2021 by EMPWellness Admin
Today, for a healthcare system to be considered “good,” the system needs to be on a strong primary care system, with practices of family doctors, nurse practitioners and others who serve as the first point of contact for patients.
There are separate ways in which Canada could improve its health care. Expanding public funding for cost-effective treatments, investing in primary care, embracing technology, engaging patients, etc. are some of the ways Canada can improve the quality of health care.
Here we focus primarily on a subset of evidence-based actions at the system level rather than on the actions that individual clinicians or patients can take.
“We generally focus our attention at the national level; Here are 9 factors that can improve the quality of health care in Canada:
1- Expand public funding for treatments proven to be cost-effective
For example, funding psychotherapy for people with depression.
The Canada Health Act has established a legal and regulatory foundation for the funding of “medically necessary” services provided by physicians or in hospitals. Some services, although proven to be effective and provide fair value for money, are not publicly funded. One example is psychotherapy for patients with depression, which is doubles the response rate when added to medication. When patients must bear the cost of their own health care, they forgo important treatments. At the system level, decisions to increase public funding for treatments that are proven to be cost-effective would improve the quality of health care and the health of Canadians.
Conversely, we should eliminate public funding for treatments that are ineffective, such as arthroscopic surgery for knee osteoarthritis. Federal and provincial decision-makers should also consider a recent recommendation to “put in place an ongoing mechanism to define standards for the modernization of the basket of publicly funded services in partnership with the provinces and territories.
2- Invest in primary care
There is still a gap in primary care, and efforts should move beyond payment reform alone to improve this critical area.
The health care systems that were most oriented toward primary care tended to be those that had better outcomes, lower costs, and greater patient satisfaction. They defined primary care as “first-contact, continuous, comprehensive and coordinated care provided to populations undifferentiated by gender, disease or organ system.
3- Use electronic information systems that help doctors work together
Growing evidence speaks to the benefits of health care records that can be accessed by patients and physicians alike.
Most physicians and hospitals in Canada have now transitioned from using paper-based health records to electronic health records.
However, in most provinces and territories, the systems that physicians use in their own offices do not communicate seamlessly with systems used by other health care providers (e.g., paramedics, hospital-based physicians, laboratories and home and community care providers). We need standards for interoperability to ensure these systems work together. We also need a legislative and regulatory framework that maximizes information sharing while also recognizing privacy rights.
4- Engage patients to help determine what services should be offered
Involving patients in decisions about their own health care is now expected within the context of the physician–patient relationship. However, involving patients at the system level in decisions about what services should be offered by a particular organization or the entire health care system, and how, is still the exception rather than the rule.
Involving patients, and the public, increases the legitimacy of decision-making and may improve the quality of the decisions made.
5- Standardize and embed quality-improvement tools, such as guidelines
This will help standardize practice and reduce variability based on clinical knowledge or available resources.
Developing and using guidelines and standards to help patients and clinicians make evidence-based decisions together, in a consistent way, will reduce variations in care and improve the quality of care we provide to Canadians. Using guidelines and standards will be easier for clinicians if system-level decision-makers also facilitate the development of tools, such as standardized order sets, that make it easy for patients and clinicians to pursue an evidence-based course of action. System-level decision-makers can also support initiatives that provide clinicians with data about the quality of care they provide.
Doing so has been proven to improve care; typically, the effects are modest, but sometimes they are dramatic.
6- Improve transparency for patients and the public
Over the past few decades, there has been a revolution in transparency in many spheres of life, driven in part by improvements in computing power and ease of access to the Internet, and in part by changing societal norms. Although the evidence that transparency improves health outcomes remains limited, transparency is at minimum an important mechanism to ensure confidence.
7- Involvement of physicians
Many efforts to improve health care involve physicians too late in the development of the initiative, or superficially, or sometimes not at all. This is true with respect to other health care professionals as well, but physicians have a unique role in the Canadian health care system, given the legal, organizational, and financial arrangements that influence physician practice. In most Canadian hospitals, physicians are not employees and bill provincial health insurance plans directly for the services they provide. Decision-makers at the system level should pay more attention to the relationship between these arrangements and the likelihood that physicians will be involved in improvement efforts.
8- Ensure health education supports high-quality care
Health education curricula in Canada at the undergraduate and postgraduate level receive substantial public funding and most health professions have nationally coordinated curriculum content.
National and provincial education bodies and those that fund health education should support the delivery of high-quality care. This would include training all health care professionals to be capable of a set of core competencies in quality improvement. This competency development should extend throughout the professional career into continuing professional development programs.
9- Support wellness of health care professionals
Ensure the well-being and positive experience of health professionals.
It is impossible to provide high-quality care in an environment where those at the front line of service delivery feel unwell, unsafe or have consistently negative experiences in their work environment.
For this reason, the Institute for Healthcare Improvement in the United States recently emphasized the concept of “joy in work,” and others have similarly articulated a need to expand the Triple Aim —which has included patient experience, population health and costs — to the Quadruple Aim, which would also include the experience of health care providers.
The quality of health care in Canada is good, but not great. Several key actions at the health-system level could go a long way to improving the quality of health care that Canadians receive.
With thoughtful change, we could all benefit from a health care system that provides effective, efficient, timely, equitable, safe, and patient-centered care at every opportunity.
Reference: Improving the quality of health care in Canada, By Irfan A. Dhalla and Joshua Tepper, CMAJ. 2018 Oct 1, doi: 10.1503/cmaj.171045