In recent decades, we have seen dramatic increases in our understanding of disease and our technical capabilities in treating illness and injury. Progress has depended, in part, on greater degrees of specialization with caregivers developing deeper expertise over narrower areas of knowledge. We’ve seen this specialization in medicine, surgery, nursing, physiotherapy and many other disciplines. By some measures, this highly specialized approach to care has improved quality and outcomes but has created considerable challenges in coordinating approaches across specialties and in crafting a holistic approach to meeting the complex needs of many patients. The fragmentation that is the consequence of deep specialization is compounded when specialists work independently.
In Ontario, there are four children’s hospitals with critical care and surgical specialties, about 100 community hospitals, 12,000 family physicians, 1,000 community paediatricians, countless home-care providers, schools, mental health professionals and some rehabilitation hospitals. Depending on the complexity of a patient’s medical needs they may interact with one or many health-care providers. High-quality care depends on effective handoffs and coordination among caregivers who participate in care at different times and in different locations.
Patient and family expectations are also evolving, in part, through their experiences in other aspects of their lives, easily ordering movie tickets, coordinating travel, shopping, and managing finances online. Their experiences with health-care systems are a stark contrast to these consumer-focused industries but ease of access and the degree of coordination is even more important in health care.
In order to create a seamless experience for patients and their families and to provide quality care close to home we need to have a coordinated paediatric health-care system, but who will drive that coordination? In my experience, in most of the world, children’s hospitals play a vital role. That is likely because of the breadth and depth of their expertise, the visibility into the many consequences of fragmentation, and the systems they possess to extend across other domains of the health-care sector. Thinking beyond the advanced care we provide is a very important responsibility for hospitals like ours.
Coordinating care is also important to academic health science centres. The ability to optimally participate in important areas of clinical research and education often depend on following children over time and across health-care encounters and engaging caregivers along a continuum of services into the research and teaching enterprise.
SickKids has been engaging various likeminded partners in an effort to create an alliance that would work towards an integrated health system operating on a regional level. A regional health system would create greater alignment between partners, create consistency in care, decrease the costs of coordinating care and increase our collective impact through the sharing of knowledge and expertise.
As an example of partnerships, SickKids and Hincks-Dellcrest Centre, a community mental health organization, are currently exploring an integration to improve specialized hospital and community-based mental health services for all children, including those with complex mental health needs.
We can also look to an over 10-year-old partnership between SickKids and the emergency department (ED) at Michael Garron Hospital in east Toronto, where one fifth of their ED patients are children. This partnership is building capacity and developing integrated approaches to emergency care outside the walls of SickKids.
Upcoming investments in an integrated health information system will eventually facilitate the continuity of services from SickKids to community hospitals, to children’s treatment centres and to other paediatric care providers. Sharing data through this system will mean that we are able to have one shared view of a patient’s medical situation and of the medication lists that we provide to families. This system is intended to provide a single portal from which hospitals can connect with the rest of the health-care system. Our hope is that this system will be implemented and configured to be a platform on which many parts of the health-care system could rest.
Our success in patient care, research and education depends on relationships with other parts of the system that are seamlessly coordinated. Collaboration has driven our success over the last 140+ years and with the evolution of medicine and the greater expectations of patients and their families, it’s time to accelerate our efforts across the continuum of care to ensure that patients and their families get the timely, highly quality care that they deserve.
