The Taber Integrated Primary Care Project - Turning Vision into Reality

Key Implications for Decision Makers

In response to widespread calls for healthcare reform, integrated primary healthcare systems are quickly becoming the new model of choice for practitioners. Integration can do a lot to improve our healthcare system. This study outlines some of the tools and evidence that can be used to implement changes.

  • Integrating services should not be done by imposing authoritarian solutions. Professionals should be brought together to work in teams and develop new ways to deliver healthcare services. Everyone involved in the change must develop relationships that allow for information sharing and building trust.

  • Making improved patient care the primary value means healthcare professionals will be more supportive. However, distrust of management must still be addressed, and there must be incentives for professionals to accept the change. These incentives can be based on workload, lifestyle, finances, or professionalism.

  • Change that gives power to non-physicians is more likely to succeed when physicians have a say in how much power will be shifted and how the shift will be done.

  • Patient satisfaction does not suffer when doctors and other healthcare professionals present change in a positive fashion.

  • Successful integration leads to increased job satisfaction among healthcare workers, improved patient service, improved population health, and less inefficient use of the healthcare system.

Executive Summary

Primary care reform has recently moved to the top of the healthcare policy agenda, highlighted by the recent first ministers' accord that promised $16 billion over five years to study ways to reform and emphasize primary care. Yet there is only limited evidence showing the value of this reform. The Taber Integrated Primary Care Project provides an opportunity to better understand reform's effects and benefits.

Mostly positive changes emerged from the three-year project, and there is strong support for the initiative and its continuing evolution. A positive self-assessment and recent resource commitments indicate a level of success that appears to justify expanding the project to other areas.

From a health-system perspective, the most important question of interest to the people who run the health system and make policy decisions is whether the project led to improved quality of care and better health outcomes. Our findings show that:

  • healthcare workers reported that the quality of services in Taber is improving;

  • use of physician, hospital, and laboratory services is becoming more efficient;

  • residents are adopting healthier lifestyles and using fewer health services; and

  • satisfaction with healthcare services tends to be high, and it remained high throughout the project's changes.

From the perspective of healthcare providers, there are still opportunities to improve satisfaction with work styles and lifestyles through a primary-care renewal project. While most workers said the primary healthcare system was improving and their satisfaction with professional practice had improved, they were also working harder than before without the anticipated lifestyle gains, and their expectations of how the changes would improve their jobs were not met.

During the project, some process issues were identified that provide critical lessons for jurisdictions that are considering similar changes: Taber had a strong health system to begin with, the town's physicians were willing to change, there was broad support from other healthcare workers, there were clearly identified champions, and the health region was willing to innovate and be supportive.

Implementation was made easier by the shared value of enhancing patient care, structural changes such as having professionals work together at the same site, allowing physicians to retain control of the changes and their timing, incentives including short-term financial gains, careful attention to protecting business interests, good communications, and externally established deadlines.

It would have been easier to implement these changes if there were a clear process for negotiation, external stakeholders were committed to the primary value of improving patient care, there was clarity regarding local versus regional authority, trust was established with all affected workers, there was full agreement regarding expectations, values, and objectives, and all professionals gained equally.

By analysing the changes from an organizational perspective, the team identified changes in professional identity, leadership, power shifting, trust in the organization, stress in the workplace, organizational culture and structure, and integration. Healthcare managers are encouraged to apply organization theory when making system changes of this nature.

The rural nature of Taber means the project's results may be applicable to similar settings where entire populations and the majority of healthcare services are included in such primary healthcare initiatives. Some elements may be applicable to larger urban settings where services may be offered in a competitive environment and populations are not defined based on their residence.

Some of the specific changes associated with the project, as well as the detailed research studies, can be accessed through the project's web site at www.uleth.ca/man/taberresearch/.

The research was done using a combination of research methods ranging from personal interviews and community surveys to large administrative database analysis. Research teams were based at the universities of Lethbridge and Alberta and within the Chinook Health Region.