What are Canadians seeking in the client experience?

What are Canadians seeking in the client experience?What are Canadians seeking in the client experience?

How Can Health Professionals Embrace Patients, Clients How Can Health Professionals Embrace Patients, Clients and Families?and Families?

Dr. Judith Shamian

President & CEO

VON Canada

WHIN Symposium

May 22nd, 2008

Richmond, BC

What do Canadians Want?What do Canadians Want?

• Equitable and timely access to reliable service

• Effective treatments and high quality care (safety)

• Partnerships - involvement in decision-making

• Support for family & friend caregivers

• Flexibility and choice

• Information & support for self-care

• Seamless, integrated care

• Emotional support and respect

• Live, heal, and age ‘at home’

What do Canadians Want?What do Canadians Want?

• What initiatives would you support to improve the health system? more home and community care programs: 80% electronic patient records: 60% more use of non-physician health providers: 59% allowing the delivery of publicly covered services

to be contracted out: 51% paying to promote wellness and prevent disease,

even if this means higher costs in the short term: 51%

– Health Care in Canada Survey 2006

What do Canadians Want and Need?What do Canadians Want and Need?

Increase in demand for home care Aging population

• 4.3 million Canadians are 65 or older (Statistics Canada)

Re-structuring of health care system Technology Increased consumer demand

• Between 1996 and 2046, the number of people needing home care is expected to double (CHCA, 2004)

• 53% of Canadians prefer to recover at home (Health Care in Canada Survey, 2006).

• Similar findings for end-of-life care.

Canadians Have a Health Care System That Canadians Have a Health Care System That is….is….

• Fragmented Little coordination between providers or across

sectors

• Inequitable Access to care and services is not consistent

across the country. Access is dependant on many things, such as geography, income (e.g. user fees), eligibility criteria, language, etc.

• Reactive and illness-based Reactive system that is good at treating illness

but does a poor job at prevention and management (e.g. chronic disease)

• Acute-care focused Hospitals are very well-resourced in

comparison to other sectors of health care.

• Hierarchical, provider-centred

Hierarchy of the Health Care SystemHierarchy of the Health Care System

• Often very little communication from top to bottom

• Clients and their families left feeling disengaged

DoctorsDoctors

NursesNurses

Allied Health ProfessionalsAllied Health Professionals

Unregulated Health Professionals/Volunteers

Unregulated Health Professionals/Volunteers

VolunteersVolunteers

Patients/ClientsPatients/Clients

Families/CaregiversFamilies/Caregivers

Interprofessional CollaborationInterprofessional Collaboration

• Work is being done across the country, in both education and practice settings to create a cultural shift and encourage interprofessional collaboration.

Interprofessional Network of BC (In-BC)

Institute of Interprofessional Health Sciences Education

• The majority of work being done is targeted at health professionals.

• Clients are involved in projects, but their level of involvement varies according to the project.

DoctorsDoctors

NursesNurses

Allied Health ProfessionalsAllied Health Professionals

Unregulated Health Professionals/Volunteers

Unregulated Health Professionals/Volunteers

VolunteersVolunteers

Patients/ClientsPatients/Clients

Families/CaregiversFamilies/Caregivers

Patient-Centred CarePatient-Centred Care

• In some areas of the country, patients and their families are starting to be included as part of the care team. For example:

• Seamless Care - An Interprofessional Education Project for Innovative Team Based Transition Care (Dalhousie University)

• “Student teams from medicine, nursing, pharmacy, and dentistry/dental hygiene are helping patients develop the skills and knowledge necessary to manage their illness – in consultation with the health care team – as they transition from acute care to home or continuing care settings.” (Project Website)

DoctorsDoctors

NursesNurses

Allied Health ProfessionalsAllied Health Professionals

Unregulated Health Professionals/Volunteers

Unregulated Health Professionals/Volunteers

VolunteersVolunteers

Patients/ClientsPatients/Clients

Families/CaregiversFamilies/Caregivers

There are Gaps Between There are Gaps Between What We KnowWhat We Know and and What We DoWhat We Do……

We say that we…

• Deliver client & family-centred care

• Work with patients as equal partners in care

• Make evidence-based decisions

• Deliver integrated seamless care

• Want right person, right place, right time

…but we don’t…

• Develop providers’ skills

• Help them develop confidence/skills

• Have easy access to evidence at Point of Care

• Bridge barriers between sectors

• Provide appropriate funding mechanisms

Why Interprofessional Collaboration and Why Interprofessional Collaboration and Patient-Centred Practice?Patient-Centred Practice?

• It is what Canadians want

• Improves: patient outcomes access to care and services patient safety and communications among

providers efficiency of the system recruitment and retention of HHR

(Adapted from Health Canada)

Self Managed CareSelf Managed Care

Wagner EH. Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice. 1998;1(1):2-4.

Canadians Want Self Managed CareCanadians Want Self Managed Care

• Should Canadians take responsibility for their own health? Canadians should take care of their own health,

prevent illnesses and injuries, and by lead a healthy lifestyle: 85%

Canadians should work in partnership with healthcare providers to manage their health care: 79%

Canadians who live a healthy lifestyle should be rewarded, for example by tax incentives: 50%

– Health Care in Canada Survey 2006

Chronic Disease = Noncommunicable DiseaseChronic Disease = Noncommunicable Disease

• The global burden of noncommunicable diseases continues to grow; tackling it constitutes one of the major challenges for development in the twenty-first century. Noncommunicable diseases, principally cardiovascular diseases, diabetes, cancers, and chronic respiratory diseases, caused an estimated 35 million deaths in 2005.

– DRAFT ACTION PLAN FOR THE GLOBAL STRATEGY FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES, 2008

WHO Department of Chronic Disease and Health Promotion

• PROMOTE Promote healthy living (better diet,

more physical activity and tobacco cessation) and healthy societies, especially for the poor and those living in disadvantaged populations.

• PREVENT Prevent premature deaths and avoid

unnecessary disability due to chronic diseases. The solutions exist now, and many are simple, cheap and cost effective.

• TREAT Treat chronic diseases effectively,

using latest available knowledge. Make treatment available to all, especially those in the poorest settings.

• CARE Help provide appropriate care by

facilitating equitable and good quality health care for major chronic diseases.

1. Stay@Home with VON1. Stay@Home with VONChronic Disease – Self Managed CareChronic Disease – Self Managed Care

Support for Self-ManagementCDSMP classes, Activity, Nutrition screening, Disease Specific Education

Clinical Information SystemsTelehome Monitoring

Self-Management PortalElectronic Record

Delivery System Design& Decision Support

System NavigationAdvocacy

Case ManagementInterdisciplinary engagement

Stay @ Home’s Case Management and Stay @ Home’s Case Management and System Navigation System Navigation

IdentificationIdentification

Care Planning & TxCare Planning & Tx

Primary Care/FHT/PCI/Family Doctor

Care Coordination and Case Management – Assessment, referral, liaison with health care community

Patient Monitoring - Pro-active calls to client for assessment, care planning, follow up

Education – provide Phone education/resource and portal access.

System Navigation. – Resources guidance and routine care calls, referral, long term follow up. Portal for Client Information – Connectivity to patient information from an integrated primary, secondary, etc. sources

Interventions – timely support, Nursing assessments, Nutrition /Education , Medication Therapy, CDSMP classes Community Support – Meals Programs, Transportation, Visiting companions, Respite etc.

Care Coordination and Case Management – Assessment, referral, liaison with health care community

Patient Monitoring - Pro-active calls to client for assessment, care planning, follow up

Education – provide Phone education/resource and portal access.

System Navigation. – Resources guidance and routine care calls, referral, long term follow up. Portal for Client Information – Connectivity to patient information from an integrated primary, secondary, etc. sources

Interventions – timely support, Nursing assessments, Nutrition /Education , Medication Therapy, CDSMP classes Community Support – Meals Programs, Transportation, Visiting companions, Respite etc.

Continuing Care/VON

Case Management

Care Coordination

Case Management

Care Coordination

AssessmentAssessment

Advocacy & referralAdvocacy & referral

Self-Care Portal

Delivery SystemDesign

& Decision Support

Chronic Disease Self-Management ClassesChronic Disease Self-Management Classes

First class January–February 2008 with 15 participants “…the first week, I met someone and that’s what made me go

back. She had the same diagnosis as me and felt no one was paying attention to her either. It’s so good to find someone from my planet because sometimes you feel like a total idiot complaining about pain that can’t seem to be fixed.”

“Things changed in little bits and pieces during the program. I listened to the voice in me that I hadn’t been paying attention to by listening to others in the room. I realized I had to stop thinking about how I got here and start thinking about how I get out. I needed to take back the control I had given away to everyone else.”

“It’s like being active again.”

2. Self-Managed Care2. Self-Managed CareAging at HomeAging at Home

• Seniors Managing Independent Living Easily (SMILE) Part of Aging at Home Strategy (Ontario Ministry of

Health and Long-term Care) The model is designed to maximize local access to

services through multiple access portals at points in the system where people traditionally seek care or have contact with their community, as well as assistance with service navigation, if wanted or needed.

More importantly, it provides seniors with the choice of self-managing services through traditional and non-traditional service providers, and/or of selecting care from traditional community support agencies.

Betty – SMILE ParticipantBetty – SMILE Participant

• Betty is 91 and lives in a house that overlooks Picton Harbour. It has a front porch, a balcony and a deck at the back. The deck is where she likes to be in the summer, because it looks out on her flower garden.

• These days, she’s only able to putter around in the garden. “I hire someone to take care of the heavy gardening work,” explains Betty. She also likes to knit, and shows us a blue shrug that she is making for one of the residents of a nearby nursing home. “It helps to keep them warm,” she says.

• Betty can’t do as much as she used to, so she pays her neighbour, Bob, to do maintenance work in and around the house. Because she doesn’t own a car, he sometimes drives her to appointments or her nephew does, and she covers their gas.

• Last year, Betty was diagnosed with cancer and now needs to go to Kingston General Hospital for treatment. She says that the Cancer Society covers her transportation, but she is on her own for other appointments. “So that’s difficult,” she adds.

• Betty is proud to have reached 90 and to be living at home still. “There are a few of us on this street who are in our 90s and still living in our own homes,” says Betty. “It’s a real milestone.”

Why Self-Managed Care?Why Self-Managed Care?

• The SMILE program will make it possible for more seniors who are frail and elderly, and most at risk of premature institutionalization, to receive help with activities that are essential to daily living, so they can remain in their homes.

• Because dignity is a matter of choice, SMILE will offer them options – in managing their care, in selecting services, in choosing who comes into their home and when.

Why Self-Managed Care?Why Self-Managed Care?

• Canadians want control over their chronic illness

• 16 million Canadians live with chronic illness

• 80% of adults over age 65 have a chronic disease

• 25% of Aboriginal people over age 45 have diabetes

• Chronic Disease is responsible for 60% of hospitalizations 70% of all deaths in Canada 2/3 of medical admissions via emergency departments 80% of family doctor visits 60-80% of total medical costs

Source: Rapoport, J. et al Chronic Diseases in Canada, 2004 in CDM for the SIMS partnership. Phase 2 – CDM Program Design. CDM working group, April 12, 2006.

Why Self-Managed Care?Why Self-Managed Care?Lifestyle Changes Reduce Health Care CostsLifestyle Changes Reduce Health Care Costs

3. Family/Caregiver Engagement and 3. Family/Caregiver Engagement and Support Support

2.85 million Canadians are caregivers

Caregivers in Canada provide more than 2 billion hours of caregiving, saving the health care system an estimated $5 billion per year

Predominantly female (77%), typically older

Male caregivers also play an important role

Emerging trend of teen and young adult caregivers

Many are employed outside the home

DoctorsDoctors

NursesNurses

Allied Health ProfessionalsAllied Health Professionals

Unregulated Health Professionals/Volunteers

Unregulated Health Professionals/Volunteers

VolunteersVolunteers

Patients/ClientsPatients/Clients

Families/CaregiversFamilies/Caregivers

Who is Providing Care in the Community?Who is Providing Care in the Community?

47,012

7,284,200

2,850,000

Total Number of Paid Providers*

Volunteers**

Caregivers***

sources:

*Canadian Home Care Human Resources Sector Study, 2003

** National Population Health Survey, (NPHS), 1996

*** Statistics Canada, General Social Survey, 1996

What caregivers need?What caregivers need?

“Caregivers need to be informed regarding what support is

available to them not only to support the family member but also to meet their own needs. This information is not readily

evident, you really have to dig for it or the list of helpful

organizations is so long you don’t know where to look; it needs to be organized such that you can contact the organization quickly.

There is so much searching required… it is a real challenge.”

Caregiver, VON Canada Learning to Listen – Listening to Learn Project participant, 2003.

What caregivers need:

Easy to understand information about caregiving – health, financial, emotional information

Access to respite information and opportunities for themselves

Connection with the health care system

Purpose of the portalPurpose of the portal

The Caregiver Connect provides caregivers with information, resources and supports they need

• to care for themselves;

• to provide better quality care to their family members and/or friends; and

• to connect and share with other caregivers.

Who will Benefit from thisWho will Benefit from this PortalPortal??

Caregivers• access to information • a space to learn, share and seek support for themselves• reduces the feeling of isolation

Care recipients• will improve care from their informed and supported

caregiver

Health professionals• access to up to date community specific information

The health care system• caregivers save the system an estimated $5B a year• they need to be supported to be sustained in their work

Caregiver Portal Communities of Practice (CoP) are distributed groups of people who share a common concern and sense of purpose about the care of a family member or friend. The concept of community binds them together

The Caregiver Portal will serve as the virtual meeting place for these Communities of Practice

Caregivers will connect online with peers and other experts via the Caregiver Portal CoP

Building a Community Building a Community of Practiceof Practice

Caregiver Portal Caregiver Portal Community of PracticeCommunity of Practice

Care Recipient

Health CareProvider

Caregiving network

Family/Friend

Caregiver

Other Caregivers

OtherHealth Care

Professionals

a circle of caring

Concluding RemarksConcluding Remarks

• Approaches to health care must include patients and their families in meaningful ways – for the benefit of patients and caregivers – as well as the health care system. Patient and caregiver engagement improves

health outcomes and overall well-being. There are not enough resources (HHR, beds,

money, etc.) to provide comprehensive care and support to everyone if we continue with our current acute-care focused approach. There is no other option, luckily it happens to be the ‘right thing’ to do!

Concluding RemarksConcluding Remarks

• Time to move from rhetoric to action: Philosophy must be embedded across sectors

and vertically throughout work settings (i.e. frontline management).

All approaches, policies, programs and services must centre on the needs of clients and their families. Mechanisms must be put in place – along with targets and incentives – to make sure that progress is made.

Collective accountability

Health professionals have a moral and professional obligation to embrace patients, clients and

families.

Thank youThank you

[email protected]

www.von.ca