With good reason, an emphasis on partnering to address the health system’s thorny issues endures. After all, if health care organizations work together and, as a result, perform better; patients benefit, communities benefit, the system benefits, and so on. Everyone stands to win from a collaborative that solves a common problem. But too often, it’s easy to forget that partnerships are a means, not an end.
When hospitals and Community Care Access Centres (CCACs) form alliances, which we should be doing willingly and often, we need to first think long and hard about the kind of relationship we are ready to build: strategic partnerships must produce results that create value for the patient, which is the only goal that really matters.
Central CCAC’s most pressing issues – including growing needs and expectations, balanced with finite resources – are shared with our hospitals. So are many of the metrics against which our performance is measured and that we know generate value: equity of access and service; quality; helping people navigate the health system and; providing leading practice, person-centred care.
It’s become a mantra that the future of health care is in the community. But that paradigm shift will only work if both hospitals and CCACs enable each other to do what each does best. While hospitals are an indispensable part of the system, and offer patients care that no one else does, they are also expensive. It costs about $450 a day for hospital alternative level of care (ALC), compared to only $45 a day for a CCAC long-stay patient with higher needs.
CCACs have to find ways to develop capacity in the community to care for sicker people so we can take patients home when they no longer need acute care. And hospitals have to embrace a level of accountability around care in the community. My challenge to my colleagues is – how do we start seeing people as “our” patients, not yours and mine. That lens changes the dialogue and leads to more constructive and innovative thinking.
The symbiotic connection between hospitals and CCACs presents unique opportunities. Let’s consider how we can bring our resources to bear collectively to solve problems. When we provide a similar service targeting a system goal, why not share the service? Or think about secondments and joint staff instead of competing for resources to serve the same population?
Together, we could also expand on what’s already working in the system. Take Central CCAC’s clinics, which are an efficient and cost-effective way of delivering quality services. To fully optimize clinics, and as a result prevent emergency department visits for example, we might enhance the model with additional, integrated services in partnership with our hospitals’ specialists and clinicians.
We tend to first think of all the reasons why these types of partnerships would be difficult to execute. But if an idea is the best path to provide value, control costs and support efficiencies, we need to come together to figure it out.
The home and community care sector is complex and fragmented, even for those with the expertise to grasp who does what. Legislative requirements can make it difficult for organizations to implement new ways of delivering services. And self-interest is always going to play a role.
As leaders – and I would include governing entities – we have a responsibility to understand the issues and to break down these barriers that inhibit more innovative, strategic partnerships.
Admittedly, this is not easy work. It takes a lot of effort to successfully partner. We have to be out building relationships and letting go of preconceived notions. We have to be listening hard. And we have to fully comprehend the concerns and priorities of others we may work with – and in so doing, find ways to address the respective needs of both partners.
After many years as a senior executive in the hospital sector, I joined the Central CCAC in August 2014. As I’ve connected with stakeholders, I’ve signaled a new approach by asking “how can we work together to better serve patients?”
I consider meaningful engagement to be the secret sauce in strong relationships, because involving others in both the why, and the how, fosters a sense of ownership. So from a hospital’s perspective, if we say, “here’s what the CCAC is going to do about ALC,” there’s an imbalance of accountability and an allowance for finger pointing – instead we have to create skin in the game for both sides.
Here are two examples. Central CCAC recently launched our first system partner satisfaction survey to give us a baseline confidence rating for evaluation. We also collaborated with hospitals on an improvement dashboard, identifying a handful of key performance metrics we will track and measure over time.
To increase access, which is a system priority and an important measure of quality, Central CCAC is focusing on two Wildly Important Goals. One is to streamline our core service, to increase the direct contact care coordinators have with patients and to help people navigate the health system. The other is to increase the number of people who have access to personal support by this end of this fiscal year.
That sets the bar high but, with strategic hospital partnerships, I believe we will get there. More importantly, we need to try. Personal support is the backbone of the home and community sector and we don’t want people to wait for this essential service. The government has also recognized this issue and its impacts, recently setting a new five-day wait time target for nursing and personal support home visits.
As a health care organization, what matters most is making sure people have access to the care they need, when and where they need it. To reach that goal, hospitals and CCACs must show leadership in moving beyond self-interest. We have to consider many possibilities, then focus on a few important shared priorities. And we need to have a different conversation with one another, based on trust, reciprocity and confidence in what we can achieve through more strategic partnerships.