Conference report on Picking Up the Pace: How to accelerate change in primary healthcare

Montreal, November 2010

Final report (740 KB) 

Main Messages from the Conference

Healthcare must focus on patients
Healthcare providers, organizations and governments must recognize the role patients play in controlling their health journey. This principle must be at the core of healthcare transformation.

Quality is built on trust and teamwork
Quality improvement, innovation and continuity of care depend on open, effective relationships, care teams and communication at all levels.

Flexibility is necessary
A rigid focus on turf, rules and regulations often constrains people and organizations, and limits innovation.

Partnership will serve Canadians
Improving primary care for Canadians requires the sharing of skills, knowledge, innovations and resources.

Measurement is essential
Sound, timely data enable us to test innovations, prove their worth, improve care and be accountable.

It’s time to speak up and reach out
Primary care reform needs a clear and coherent voice to set the agenda, describe the benefits of change and be accountable to the public.

Executive Summary

Countries with strong primary healthcare infrastructure tend to experience better outcomes and efficiency, lower healthcare costs, and higher patient satisfaction. This evidence, paired with Canada’s poor standing in recent international comparisons of primary healthcare, should be a strong impetus for change.  

 “What is really exciting, is when you look across the various sessions, how much innovation is happening across the country. And we take for granted that we share this information on a regular basis, but it takes forums like this one to really do that well. So that’s where CHSRF’s bringing together of the country on topics like this is so critically important.”
Bonnie Brossart, CEO, Health Quality Council, Saskatchewan

At the local level, many improvements have been realized—often thanks to support from the 2000–2006 Health Canada Primary Healthcare Transition Fund. Yet, when it comes to generalizing primary healthcare innovations, Canada has a poor track record.

This is the case despite the fact there is general agreement about the core elements of high-quality primary healthcare: it should be patient-centred—that is, focused on individuals’ needs and expectations; it should integrate all forms of care and be offered by a variety of providers, in interdisciplinary teams; it should be collaborative and co-ordinated. But how can we get there, faster?

In order to help accelerate healthcare transformation, CHSRF launched Picking Up the Pace, a biennial conference. For its inaugural event—Picking Up the Pace: How to accelerate change in primary healthcare—CHSRF established a national steering committee of 23 recognized leaders and experts to provide strategic advice on the conference design. Five regional sub-committees gathered more than 120 effective innovations in primary care from across Canada, from which 47 were selected, grouped under 16 themes (e.g. mental health, hard-to-reach populations, first nations, complex needs). The selection process and all the innovations were summarized in a casebook (PDF), and four innovations were highlighted in video format, available here.

At the event, held November 1 and 2, 2010 in Montreal, 300 senior policy-makers, healthcare managers and clinicians engaged in a dialogue aimed at promoting innovative practices in primary healthcare. The 47 innovations were presented at the conference by the organizations that had implemented them, enabling participants to learn from their experiences and consider how to adapt these practices in their own region.

While the majority of this report explores the themes that emerged from the conference sessions and keynotes, it should be noted that much of the energy and excitement generated by the event came from the opportunity to share successful innovations. Results from a post-conference survey suggest that 84% would attend the conference again, and more than 50% would work to adapt one of the innovations for their region.

Southcentral Foundation’s Nuka Model of Care
Of the many, many words spoken at Picking Up the Pace, four dominated: transformation, flexibility, communication and measurement. Keynote speaker Douglas Eby told the audience that the Alaska Southcentral Foundation began its journey to becoming a model of patient-centred primary care when it undertook a whole-system transformation—from focusing on technical fixes to focusing on individuals. “If you’re going to try to change the health of people longitudinally over time, you need to understand doing health, not healthcare,” he said. (CHSRF has produced a video of the inspiring presentation by keynote speakers, Douglas Eby and Donna Galbreath, available here.)

It was clear in session after session that healthcare is surrounded with rules and limitations—from federalism, to professional tensions, to funding, to governance—yet flexibility is key to transformation. It takes flexibility for different professions to work together as a team. It takes flexibility for physicians to give up control, and accept their position in patient-centred care, as “guests in people’s lives.” It takes flexibility for governments to pay for care that’s delivered by different people, in different ways. But still rigidity is the norm.

Communication, participants agreed, must improve at every level if we’re to achieve primary healthcare reform. Everyone in primary healthcare needs to learn to listen to patients better than in the past. Professionals and administrators must learn to listen to community members on boards. Interdisciplinary teams can’t function without communicating with each other, the patient, and other parts of the system. Governments were urged to find ways to share ideas about primary healthcare reform. And, above all, the conference was told, supporters of reform have to do a better job of communicating with each other, with the public and with politicians if they want their agenda taken seriously. “Can you work toward a coherent voice?” asked keynote speaker Antonia Maioni of McGill University. She told the conference many forces vie to shape public opinion for their own reasons. “Don’t let someone else deliver your message.”

Evaluating Success: Whose job is it, anyway?
Primary healthcare reform is about giving patients high-quality care, and for that, measurement is essential. A quality-improvement project might succeed, but in the absence of data or evaluation, you couldn’t be sure of that, or understand why, or prove that it had. The conference heard how the lack of electronic health records is getting in the way of gathering and analyzing data. Without good data, practitioners can’t see the impact of their care or develop ways to improve its quality. Without evaluation, planners don’t know where to direct funding or how to shape education. Data show the value (or lack thereof) in innovations and it can help win support for them. “If you want more investment and more capability in primary care, you have to make the value proposition,” said keynote speaker Douglas Eby. “The only way you are ever going to do that, is if you can evaluate it and measure it.” 

Picking up the pace of primary care reform will take a dynamic mix of all four factors— transformation, flexibility, communication and measurement. But above all it will take commitment from healthcare providers, organizations, health regions and governments to keep primary care adaptable and responsive to the people it serves: to be open to innovation and help it flourish; to work together, in teams, with respect; and to go beyond simply fixing what we have to transforming primary healthcare into what we know it can be.

Keeping up the pace

System transformation needs to be informed by evidence—evidence that supports quality improvement and demonstrates the value of innovations. Organizations need support to undertake and manage complex change that affects so many different groups—from patients to providers to decision- and policy-makers. Picking Up the Pace is just one way that CHSRF is working to support healthcare transformation.

CHSRF is keeping up the pace through commissioned research on healthcare financing, innovation and transformation. In addition, the Executive Training for Research Application (EXTRA) program continues to train healthcare leaders and their organizations to lead change by creating a culture that values decisions informed by evidence. And perhaps most tangibly, CHSRF is supporting the Northwest Territories in its transformation project to improve the management of chronic diseases. In the coming years, CHSRF will embark on more programs to aid leaders, decision-makers, healthcare providers and patients as they design and implement projects that improve the quality of health services for all.