Building a regional, integrated model of cardiovascular care

One of the things that has always amazed me about the discussion around health care transformation is this: no matter what the forum or venue, no matter who the discussants are or whom they represent, and no matter what “angle” the discussion is coming from or slanted towards, there is agreement.

We all agree on what needs to be done. You heard it here, first.

At national meetings I’ve attended, great ideas are met with murmurs of assent, smiles and nodding heads around the room. Heads that belong to physicians, nurses, and other health care professionals. Heads that belong to hospital and community directors, managers and CEOs. Heads that belong to Ministry of Health people. Heads that belong to policy thinkers, policy makers, and political figures. And heads that belong to patients – those heads nod with the most enthusiasm of all.

It’s quite remarkable, I think, that an issue that is as complex as Canadian health care transformation can lead to the creation of such a unifying force made up of a group of such diverse people. But time and again, I have seen these discussions bring out the very best in people. The seasoned, the “political”; even the jaded and the cynical; they all talk about doing “what is right” and they seem to be, at a conceptual level at least, united in their end-state vision.

It is exactly this sense of goodwill and sense of common purpose that have created the driving force behind the development of the Southeast Local Health Integration Network’s (SE LHIN’s) Cardiovascular Clinical Services Roadmap. It has been a learning experience for me, serving as the Clinical Lead for the project, not so much because the individual pieces of what we are trying to do are novel or difficult, but because the bringing together of all these components into a truly regional, integrated model of intraprofessional care has been such an enriching experience, with more “a-ha!” moments than I can count.

Partnerships are key. Not just aligned synergies. True partnerships. Taking the time to understand the barriers that every partner faces from their siloed vantage points. Listening. Showing respect and establishing trust. Embracing the complexity of our interconnectedness as a strength, not shying away from it as a perceived liability. Not being afraid to make mistakes, or to say something really crazy. And getting to know each other, as people. Embracing the human relationship part of all this discussion.

When the trust, respect, and broad-mindedness were established, all heads started nodding at our planning tables, too. Suddenly, the solution belonged to everyone.

“We need to do this.”

“It’s the right thing to do.”

“It’s no longer whether we need to make this happen. It’s, ‘How are we going to make this happen?'”

Against what seemed like impossible odds, the plan was developed, finalized and endorsed. Seven hospitals. CCACs. The primary care community. CEOs, CNOs, docs, LHIN people, everyone. Unanimity.

Now, we are at the implementation planning stage. With regional family health teams enthusiastically at the table, we’re preparing the implementation of Phase 1 – a regional network of heart function clinics that are embedded in primary care settings around the region. We have family physicians excitedly talking about how we will reduce Emergency Department recidivism. We have NPs telling powerful stories of how intensive outpatient followup prevents progression to that tipping point that leads patients, in desperation, to present to an Emergency Department in acute pulmonary edema. We have cardiologists and internists who believe in, and are championing, primary care-based models. And administrative directors and managers saying, “We will just have to find a way to make it work.”

It is inspiring. It really is. I have seen the the best in people. All the idealistic sentiments we all had as naive young  students who wanted to change the world (remember that?). It’s all been on display during this process.

The formula is simple. It feels good to do the right thing. To be enabled to do the right thing.

Barriers fall when the vision is clear and shared; when focus is on the patient and the patient experience rather than on the institutions serving them, and when there is a commitment to a culture of respect, trust and transparency.

It sounds so simple. It isn’t. But it’s worth the effort.

We’re on our way here in Southeastern Ontario!

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