One home care program for everyone: Bella Coola, British Columbia

Glenda Phillips, Manager, Home & Community Support, Bella Coola General Hospital

In my community, Bella Coola, we have a fully integrated home and community care program situated in a new health centre on-reserve that is used by everyone in the community, whether they are First Nations or not. But it wasn’t always that way.

Bella Coola is a geographically remote community with limited resources. I was the federal health nurse there for years, until I went back to university. When I returned, I was hired by the province to set up home care in the region. I saw that people on-reserve weren’t getting services. There was no structured home and community care program, and no integrated service delivery model between the services offered on-reserve and those offered by the province. We had five long-term care beds in a small community hospital, and no assisted living. Complicating the situation were factors such as budget constraints, nursing shortages, and a lack of clarity around staff roles and responsibilities.  

We wanted to give people equal access to care and the option to remain at home as long as possible—not just in their community but in their own homes. We needed an integrated care program to support this and we wanted to build capacity for culturally sensitive care.  We started the planning by going to the Chief and Council of Nuxalk Nation and saying, “Why don’t we work together and set up a program for everyone?” Then we went out on the road talking to the community, conducting a community needs assessment, and meeting with the many different organizations and government representatives who needed to be consulted.

In the end, we made just one home care program where there had been two (the province’s program and the federal FNIHCC program). There is no new money; we pooled our funding streams to work around budget constraints. And by coming together, we expanded our capacity and flexibility. For instance, there is a four-hour cap on the number of hours of home support we can provide to a client in a day. But if a couple of more hours a day means that the client can stay in the community and in their home, then we provide more hours. It’s good quality care, and it’s cost effective for the system.

Other communities have asked us how they can do similar types of integrated programs. We tell them the standards of care are going to be the same—how you do your assessments, how you clean your tools, how you chart—but how you deliver the care might be a little different because of the culture in your community. You have to know the community. 

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Supporting Métis seniors and families

Wenda Watteyne, Director of Healing and Wellness, and Dr. Storm J. Russell, Senior Policy and Research Analyst, Métis Nation of Ontario

Few Canadians realize that one third of all Aboriginal people in Canada are Métis, and that the Métis population is older compared to other Aboriginal groups. From our research, we know that many of our seniors are experiencing significantly higher rates of chronic disease and other complex conditions compared to non-Métis Ontarians. Métis people also fall under a different legislative and regulatory structure than do other Aboriginal groups, and do not have access to programming supports such as the Non-Insured Health Benefits program that is available to many Aboriginal peoples. Many also live in remote and rural areas, where access to services and supports can be limited. For Métis seniors living on limited incomes, things like transportation to see doctors and specialists, as well as having the means to fill expensive prescriptions, can also serve as barriers to care.  Finally, access to culturally safe care can be a challenge for older Métis citizens.

It is for all these reasons and more that the Métis Nation of Ontario (MNO) provides programs and services at the community level. Situated in 18 Métis communities distributed across the province, MNO community centres serve as important cultural and service hubs that link our Métis citizens to each other, as well as to health services and supports in their local areas. The MNO community centres are especially important in providing our Métis seniors with the kinds of culturally grounded services and supports they need, along with help in accessing medical services. Some of our MNO centres also offer specialist services such as foot care clinics for seniors and other Métis people suffering from diabetes. MNO community centre workers also much in the way of outreach to Métis seniors in need of assistance, visiting their homes to help with things like meal preparation, house maintenance, and other tasks of daily living, while at the same time providing that important cultural connection and support. Through the MNO Community Support Services program we are also able to provide transportation services to help Métis seniors travel to and from their medical appointments.

For the many Métis seniors and other community members who are suffering from significantly higher rates of chronic diseases and conditions, MNO community centres provide a place where they meet with other Métis community members and receive much-needed support and care, and get help in linking to essential services and programs in the broader community. The centres also provide a haven for culturally safe community care. 

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Minding the Gaps in Quality Improvement in Canada

John G. Abbott

John G. Abbott is the CEO of the Health Council of Canada

What can Canada gain by upping its investment to advance the health quality improvement agenda? And, in what areas should it invest?

A lot, in my opinion; and the focus needs to be on increasing the capability and capacity of our system and its leaders to deliver transformative change. 

This week, the Health Council of Canada held a national symposium on quality improvement under the theme: Towards a High-Performing Health Care System: The Role of Canada’s Quality Councils. 

Dr. Ross Baker

Over 200 senior leaders from across the country converged to talk about health system performance measurement and reporting, and building system capacity for quality improvement.  It was clear that there is no ‘one size fits all' when it comes to performance measurement or reporting and each jurisdiction with a quality and/or patient safety organization (there are seven in total) have adopted approaches that are working for them. So what are the gaps in Canada’s current quality improvement approach that need to be closed?

The first gap is the absence of a burning platform for transformative change so that quality improvement is embedded in everything we do in health care. Are health leaders and Canadians themselves convinced that we need to improve the quality of the care being delivered in each hospital, clinic and doctor’s office in this country? The evidence says we need to, but is that enough to make the case?

Panel on Building System Capacity for Quality Improvement

The second gap or challenge is treating QI as an add-on. Shouldn’t our health system encourage all its leaders to begin their day with the question: what have we got to do today to ensure all our activities deliver safe and appropriate care for our patients; and end their day by asking:  how do we know that we achieved this objective? If QI is its own silo, we are not going to achieve transformative change in any setting.

The third gap relates to resources. We need to increase the level of investment in resources to successfully design and manage a QI agenda. We need to train people at the front lines and in the back rooms to think as one, using a common language around performance improvement.  We need to continually support the work of quality councils in this country who in turn are aligning their activities in support of the health systems that they both monitor and engage on quality improvement initiatives.

A fourth gap is not appreciating the magnitude of managing complex system change.

A fifth gap lies in the area of technology and information sharing. We need to leverage the use of today’s technology to collect data and share information about system performance and patient outcomes in a consistent and timely way that can be used by all parts of the system to improve the quality of care.

No one organization or system has all the answers to addressing these gaps. All in all, we need to collaborate within and across organizations and jurisdictions to build capacity and capability in all these areas.  The Health Council’s report on the proceedings of its event will cover these points in greater detail and will be released on December 16, 2013 at www.healthcouncilcanada.ca.

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