Recomendations from Study about our Pan Canadian Health Orgs (PCHOs)

[Annette McKinnon]

I skimmed the report and pulled out the areas that seemed relevant to patients and caregivers. It's long and so is this post. Maybe we can make something useful for PAN out of this, but it will take a lot of work.

A review of 8 pan-Canadian healthcare organizations has concluded. It was originally launched by Minister Philpott and completed under Minister Petitpas-Taylor. Included organizations are :

• Canadian Centre on Substance Use and Addiction (CCSA)

• Canadian Agency for Drugs and Technologies in Health (CADTH)

• Canadian Institute for Health Information (CIHI)

• Canadian Foundation for Healthcare Improvement (CFHI)

• Canada Health Infoway (Infoway)

• Canadian Patient Safety Institute (CPSI)

• Canadian Partnership Against Cancer (CPAC)

• Mental Health Commission of Canada (MHCC)

The report recommends how this suite of organizations can better support the needs of the Canadian healthcare moving forward. Some interesting scenarios outlined.
Here is the link:https://www.canada.ca/en/health-canada/services/health-care-system/reports-publications/health-care-system/findings-recommendations-external-review-pan-canadian-health-organization.html

Here are a few excerpts

One part of the platform:
Learning health systems are also an essential foundation for effective health systems of the 21st century. Their goal is patient care that is continuously informed by the meaningful use of data, evidence, and research, with research and practice connected through a continuous feedback loop. This vision requires fully electronic and inter-operable health systems in which data are collected, openly shared, and accessed quickly and efficiently

A commitment to public engagement

The federal government has committed to creating and promoting the expanded use of open data, open information, and open dialogue. That includes a commitment to "accelerate and expand open data initiatives and make government data available digitally, so that Canadians can easily access and use it."

The intent is to allow Canadians across communities and professions to see how evidence informs decision-making, and to increase government transparency and accountability

In partnership with the provinces and territories, can the suite of PCHOs effectively address the current vulnerabilities of Canadian health systems?

Any suite of PCHOs must have the capacity to:

• Support strong pharmaceutical policy (affordability, access, appropriate use)

• Embrace health data and IT for innovation; support learning health systems

• Help the spread and scale of innovation through pan-Canadian collaborative approaches

• Facilitate expanding/reshaping of the basket of services according to need/evidence

• Enable deep patient and public engagement in personal and health system goals

• Assist the development and operation of comprehensive and integrated primary care across Canada

• Encourage reconciliation and accelerate improvements in Indigenous health and wellness

A future defined by tensions

There are tools available to support such decision-making. They include the knowledge that emerges from research and practice; the newer tools of big data and artificial intelligence; critical policy analysis; and democratic inputs about enduring values. Values permeate public policy discourse, and four in particular have been dominant in Canadian discussions about health system reform.

First is the importance of efficiency in the use of public dollars. In publicly funded health systems it is critical that the public trust be maintained by ensuring that when tax dollars are spent on services, administration, and leadership of the health system, they are linked to real impact. Efficient organization of structures and streamlining of functions are key to maintenance of the public trust.

Second, there is ample discussion about the importance of innovation across all sectors of a modern economy. This includes not only the critical technological and scientific innovations that fuel medical advances, but also innovations in service delivery that improve citizens' experiences of public services and improve value for money.

Third is the importance placed on engagement of all stakeholders in complex adaptive systems. The notion that clinicians, citizens, industry, policy makers, and others must come together to solve difficult problems in health care - that change cannot come solely from the top down - is a recurrent theme. New skills, knowledge, and styles of leadership are required to support complex adaptive systems; equipping individuals inside health-care organizations as well as institutions themselves with the tools to get value out of stakeholder engagement is a necessary component of such engagement.

Finally, debates and discussions about Canadian health care frequently come back to the fundamental principle of equity. This value underpins Canadians' pride in their public health-care system and remains central in discussions about health system improvement.

Health leaders around the world are embracing learning health systems (LHS) approaches. Their goal is to create better systems in which patient care is continuously informed by the meaningful use of data, evidence, and research. (This approach aligns with the left-hand side of the WHO model.) In fact, in learning health systems, the relationship between research and practice is redefined as a continuous feedback loop, with learning flowing from the patient's immediate reality to the laboratories where innovative solutions are imagined and tested and, inversely, from the desks and computers of data scientists to the clinical settings where health-care providers identify the options they will discuss with their patients.

A learning health system is "one in which science, informatics, incentives, and culture are aligned for continuous improvement and innovation, with best practices seamlessly embedded in the care process, patients and families active participants in all elements, and new knowledge captured as an integral by-product of the care experience.

IOM 2013. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America

What is particularly exciting today is the ability to leverage big data to exponentially magnify the potential impact on care. In a world inherently constrained by scarcity, data-driven decision-making should be an enabler of better, more timely choices.

Learning health systems augment their data sources to include not only traditional metrics, but also patient-reported metrics (such as patient reported outcomes measures and patient reported experience measures, which are used to support performance measurement and quality improvement) that describe people's experiences of illness and other relevant information on their personal reality, from housing to family relations to education to employment. If our future health systems are to be centred in high-performing primary care, a great deal of data and knowledge will have to concentrate on social contexts of patients.

Finally, debates and discussions about Canadian health care frequently come back to the fundamental principle of equity. This value underpins Canadians' pride in their public health-care system and remains central in discussions about health system improvement.

People-centred

Patients, families, and the public are involved in health-care decision-making at the individual level and engaged in health-service design in their local communities.

Public policy decisions in health care need to be made in meaningful partnership with the public. Efforts in this direction are already occurring in other jurisdictions around the world.

Current models of PPI [patients and public involvement] are too narrow, and few organisations mention empowerment or address equality and diversity in their involvement strategies. These aspects of involvement should receive greater attention, as well as the adoption of models and frameworks that enable power and decision-making to be shared more equitably with patients and the public in designing, planning and co-producing healthcare.

Ocloo and Matthews(2016). BMJ Quality & Safety.

The critical linchpin of patient engagement and empowerment is that the patient is able to access his or her own integrated electronic health record. In addition, there are tailored tools that have been validated at the level of patient care. The science of shared decision-making offers practical tools to help equip people to be active partners in their own care.

At the health-care organization level, institutions are implementing ways to embed people-centred care. Patient and family advisory councils, for example, are seen as an important mechanism to fulfill requirements for improving quality and patient experience. Ongoing research into best practices for patient and public engagement is helping to guide organizations in ways to improve the effectiveness of that engagement. The accreditation of health-care delivery organizations and the world of online reporting about people-centred metrics are other tools to enable people-centred care.

The health systems of the future - and the changes to get to that future - need to be populated with informed, involved, and active participants engaged not only as patients, family members, and caregivers, but as community members and citizens. Citizens must drive changes, co-design services, and help shape policy to improve quality and experiences.

Ultimately, if we want to deliver on the promise to improve the patient experience, all of our organizations are going to have to walk the talk, and that means making patient influence felt system-wide. It is time to elevate the recognition of patient experience as the key driver of system transformation if we are to build a compassionate and sustainable system that serves the health needs of the entire population.

[Alies Maybee]

This report is very important for PAN. It is talking about how healthcare and patient engagement will be in the future in Canada. So what is our role as PAN and as individual advisors in this vision? Never mind the analysis, HOW do we make the necessary changes?

Alies

[Annette McKinnon]

There's an article about this that has appeared in several papers. Here's the link

https://evidencenetwork.ca/making-our-pan-canadian-health-organizations-fit-for-purpose/