By Dr. Cathy Scrimshaw
How do we, as community practitioners, care and support our complex patients in the best way possible, while ensuring that we can address both health and social care? How do we change the way we work to make it more sustainable, supportive, and effective?
Why Even Ask These Questions?
We are in the middle of a lengthy pandemic which has glaringly exposed the inequities of the health and social care systems. We are seeing a drug poisoning crisis resulting in over four deaths a day in Alberta. We are dealing with a tsunami of mental health issues in our patients. We have difficulty sustaining our practices. We are realizing the work that needs to be done in reconciliation and recognizing the truth of systemic racism that occurs in our health, social, and education systems. We are facing the realities and health implications of climate change. As health care workers, we are burnt out, stressed, and depressed. These “wicked” problems need complex and transformative solutions – how can we even start looking for a remedy?
Constructive Disruption and Transformation
Let’s consider constructive disruption – a possible way to leverage existing programs, ideas, and technologies, to transform a flawed system. What is constructive disruption? Constructive disruption is the act of productively challenging inherited wisdom or structure. It supports innovation by opening up the space to replace what we have with what we might imagine.
There are so many barriers to change and especially now, it is even more challenging. But what if we left those barriers behind, to look at what we have learned during the pandemic and imagine a new transformed system. What could we consider?
What If – Virtual Opportunities
What if we got rid of the structural urbanism of conventional medical and health professional education? What if we used our experience of virtual education in the pandemic, to provide health professional education where people are living? The disciplines could share some courses and have a separate appropriate curriculum, leverage local hospitals, clinics, pharmacies, social services, and NGO’s for in-person training. This would allow those in rural, remote, and Indigenous communities to stay in their homes with their support systems for most of their education. It would allow for development of interdisciplinary education opportunities and shared care models in education, and train people that are likely to stay and work in these areas.
What If – Community Collaboration
What if we, as primary care providers, worked with groups like “Boots on the Ground” an Edmonton based harm reduction group that provides resources and supplies to people who are unstably housed or homeless? We could provide better care by benefitting from the transferred trust from the people working in the community and focus on non-judgment and minimizing barriers. To take it further, we could function as a community hub of social and health care, with co-located services.
What if we looked at the successful community-based addiction programs in northern Ontario and on the Kainai First Nation, and learned from those ideas and successes to inform and constructively disrupt addiction programs in other communities in Alberta?
What If – Reallocate, Restructure, and Revise
What if we were allocated resources to manage complex chronic and concurrent conditions in community within a “hospital without walls”? What if, to do this, we had a primary care/community care funding allocation, like acute care systems have? What if we staffed community practices like we do operating rooms and acute care, with interdisciplinary teams embedded in health and social care hubs either virtually or physically? These hubs could manage complex patients where they are at, using virtual care, home monitoring devices, and in-person visits either in home or in clinic as needed.
What If – Data Integration
What if we integrated GIS data, social determinants of health data, infectious disease dashboards, and drug poisoning maps into dashboards for our panels to help direct resources where they are needed most within local geographic areas and patient panels? What if we could integrate an early warning system for outbreaks of COVID-19 and other infectious diseases using wastewater mapping integrated into our EMR, identifying our high-risk patients?
Applying and Inspiring
All these ideas use services, resources, and existing technologies, but would disrupt the way we practice – in a good way. Balancing the technology, the importance of trusted relationships, integrating social care and peer supports, into the medical neighbourhood and medical home could transform health care. Some of these are massive undertakings. Some of these could make small changes in our practices and workplaces. All of these could have big impact.
So, how do we encourage and inspire these changes? Lois Kelly, one of the two instigators of the Rebels at Work blog, did a great talk about being “Brave Hearted Rebels in Health Care”.
Her sage advice was to:
- Do it together. Find your likeminded individuals and work to a common goal. Convincing 10% of your team, organization, or system will have great impact.
- Remember conflict is inevitable with change. Approach it with “Ted Lasso like” curiosity, not judgement (the Ted Lasso comment is mine not Ms. Kelly’s!)
- Self-care is important: Know when to quit. She reports when no one has your back, when your values are not shared, when relationships are fraying, you may need to step away.
Despite the ongoing pandemic and the difficult political situation, doctors and nurses, pharmacists and social workers, patient advocates, researchers, and individuals with lived experiences, have been continuing to fill gaps and focus on solutions to some of the most difficult problems in health. We can leverage all of these lessons learned, work arounds, experiences, research, and have significant transformative change.
As Winston Churchill said, “Never waste a crisis”. We are at a critical juncture in primary care, in family medicine within the medical home and the medical neighbourhood. Can we find a way to amplify the change we need to provide compassionate care in community, supported with technology, and people trained to use innovation and best practices? Can we think beyond the status quo to a different way of work? I think we can be a group of “bravehearted rebels” in constructive disruption to move health and social care forward.
Let’s continue this discussion – join us on November 25, at 7:30 PM and meet some constructive disruptors!
“Being a Bravehearted Rebel in Health Care:
1. Find your rebel wild pack
2. Turn to curiosity amid conflict
3. Know when to quit
4. Make it safe
5. Appreciate strengths and differences and finally,
BE NOT AFRAID.”
– Lois Kelly, Brave Hearted Rebels in Health Care