It will come as no surprise to you that Canada is a cold place. It came as a surprise to us that Ottowa, our main study destination, is the second coldest capital in the world. Now in extreme climates and circumstances cultures have two choices, to become brutal outposts of “survivalism” or special tribes who take care of each other. I am pleased to report that Canada has been founded on principles which uphold the humanity and equality of all.
What does such a philosophy mean for healthcare? They were two decades ahead of Australia in introducing a fully funded at point of care medical system. This applied equally to primary and tertiary care. They could have rested there. Instead, they were at the forefront of moves to instill quality in healthcare. Now this sort of focus can be driven by clinicians aiming to be evidence based but somewhat clinical in their assessment of the outputs of their work. Canada has taken this quality approach and humanised it.
Patient centred healthcare is an over-riding consideration for so many of the groups we have been meeting. For Accreditation Canada that means revamping accreditation standards to ensure their wording supports care with patients rather than for patients. For the Canadian Patient Safety Institute it means creating patient safety mechanisms which create a global platform for sharing evidence regarding adverse outcomes and putting patients into governance and training mechanisms. But what about those facing up to patients every day? It has meant putting patients at cultural heart of the University of Ottowa Heart Institute and St Elizabeth’s Healthcare. This has led to growth, better patient outcomes and a real search for innovation which makes a difference to patients. Canada has demonstrated a pervasive belief in patient centred care although as both these organisations attested, they still have to ensure they recruit the right staff to retain these values.
Now you could stop there or you could recognise the role of the family in care environments. Both St Elizabeth’s and the Heart Institute have formal mechanisms for engaging family. For example, family members are surveyed regarding the care received in intensive care units as the hospital knows patients are largely unconscious, it is everyone else who is stressed. St Elizabeth’s, who run every type of care apart from primary care, have active engagement models for families. When you are being inducted, they focus on your responsibility to represent the entire organisation to patients and their families as an organisation which hears and responds to patients and their families. They can present case after case where family skill in care, engagement with the care team or reflections to the patient can lead to dramatically changed outcomes for both patients and clinicians.
When you hear organisations talking about their resource allocation process and they list as their first guiding principle that any investment must be focused on delivering for patients not clinicians, you know you have entered an organisation which takes patients very seriously. The patient and family centred home movement in Canada is making the rest of the world take notice. I hope it comes to more health settings in Australia very soon as too many of our patients wonder if they are ever noticed in the massive machinery and emotional exhaustion which often accompanies the delivery of healthcare.
Tracey Johnson, General Manager, Inala Primary Care, AAPM Canada Knowledge Exchange Tour Participant