Organizing for impact: Better patient care through enhanced teamwork, transitions

More than 150 health system leaders and providers gathered in Saskatoon October 4 to launch a new strategy aimed at improving care for Saskatchewan patients through better teamwork in hospital and the community, and better transitions between these care settings. Fifteen patient advisors were active participants in the day-long session.

The Connected Care strategy has emerged from the work of the provincial Emergency Department Waits and Patient Flow Initiative, which is mandated to reduce waits in Saskatchewan’s emergency rooms 60 per cent by March 2019. Graham Fast, lead of the Initiative — which is housed at the Health Quality Council — says Connected Care will help align work that is already going on within Saskatchewan’s health care system. 

“Really, this is about leveraging and coordinating the good work around community-based services, the team-based care being done by our rural colleagues, and the work that’s emerged from the Accountable Care Units,” says Fast. “It also follows up on some of the great work we’ve done as a health system over the last couple of years, in understanding the alternate level of care population in our hospitals, and the work that we’re doing at the bedside with interdisciplinary, physician-attended bedside rounding. Connected Care is really just an evolution of the work that’s been going on.”  See more information about Connected Care, alternate level of care (ALC), and interdisciplinary bedside rounding (IDR). 

A number of patients and family members set the stage for the day by sharing stories about how better coordination and communication in their recent care episodes led to better outcomes. Representatives from Saskatoon and Regina shared some of the promising results already being achieved by community care teams, and the new accountable care units. 

Related links

• Overview of The Accountable Care Unit in RQHR
• Accountable Care Unit Pilot (RQHR)
• Accountable Care Unit Five Minute Message (RQHR)
• RQHR’s Accountable Care Unit continues to turn heads
• Patients, Staff and Physicians See Benefits of RQHR’s Accountable Care Pilot Project
• First SIBR-certification for Saskatoon’s Accountable Care Unit
• Creating Connected Care In The Community (Saskatoon)

Participants at the October 4th event expressed excitement about – and a commitment to – the new approach (Links below are to interview clips on YouTube):

Dr. Julie Kryzanowski (Public Health Observatory, Saskatoon Health Region): “What excited me was talking about primary care as the anchor point in the health system. So people seeing their primary care teams as the place that they go to get services and to get connected to other services. And that it helps them navigate the very complex health system.”

Ruth Anne Appl (patient advisor, Saskatoon): “As caregiver for my mother, who had advanced dementia, the connected care is really important. It would have been a great benefit to help support her in her home, seeing that she had the right services until she actually required going into long-term care. So I think connected care is really important for individuals but also for families as well.”

John Ash (Executive Director/Regina Qu’Appelle Health Region): “This is really about redesigning our health care system from the patient’s perspective. It’s really exciting because people are energized about that. It’s all about ‘this is the right thing to do, and we need to put our oars in the water and get going’.”

Dr. Rashad Hansia (Physician Dyad Leader/Regina Qu’Appelle Health Region): “Connected Care means that all of the providers that look after a patient know their patient, know each other, and are able to get information and a shared process in place to better manage the patient. There’s such an enthusiasm, there’s a recognition that we want to work together differently to achieve these better outcomes for our patients collectively whatever part of the health system we belong to.”

Gabe Lafond (Director/Saskatoon Health Region): “What excites me is the amount of energy and the number of people who are excited about the direction we are going and seeing that we’re now focused on a provincial process as opposed to working in silos. There are best practices being shared by regional health authorities that can be replicated across the province and as we move forward into a provincial health authority, we’re going to start thinking and acting as one, which makes it a lot easier from a patient perspective.”

Marjorie Ingjaaldson (Primary health care network director, Regina Qu’Appelle Health Region): “What I think is exciting is that it’s a system level improvement. It’s about understanding that we are a large system and together we have to work to a single goal, and that we all contribute the patient experience, not just the episode in one single location.” 

Carrie Dornstauder (Director of Acute Care Services/Heartland Health Region): “It gives us an opportunity to look at the people we serve. In a rural environment we often miss what’s happening for the patient in the early stages if they’ve gone to tertiary care. When they come to us their needs are very different. This is giving us an opportunity to look at what their needs are and maybe look at re-addressing our services in the community.”