It has been an extremely interesting month (where did that time go already) learning about how our healthcare system in Alberta works and where some improvements could be made.
I am currently volunteering for Covenant Health, St. Mary’s Hospital in Camrose, Alberta, consulting with the hospital by looking for ways to improve the care that is delivered at the site.
I am partially in charge of bringing what Collaborative Practice, Family & Patient Centered care and innovation to our delivery of care at St. Mary’s.
Collaborative practice is essentially when “multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, caregivers and communities to deliver the highest quality of care across settings” (WHO, 2010). The idea is that if you bring multiple different disciplines, backgrounds and experiences together as a team that is responsible for patient care, the team will come up with more comprehensive, advanced, “outside the box” solutions to complex medical issues in contrast to one doctor with one idea of care providing for a patient. Collaborative practice aims to reduce the strain on individual practitioners (especially nurses and physicians) and allow for a team to be collectively responsible for the patient’s well-being. It involves a large amount of what is called interprofessional education (IPE) to educate different health care disciplines on what all the other health care discipline’s are “allowed to do” or otherwise known as their scope of practice. For example, did you know that pharmacists are able to prescribe some medication? The same goes for Nurse Practitioners (NP’s). NP’s have a scope of practice that is quite a bit different than a Registered Nurse (RN), and are able to direct patient care, prescribe medication and diagnose illnesses.
The thing is, most professionals that are not physicians (nurses, therapists, pharmacists etc.) are actually unaware of the full extent of what care they are trained (and legally allowed) to provide, never mind understanding what the full scope of practice of another health care professional is. Once you really start looking at the training and the scope of practice each professional is able to provide, there is a surprising amount of overlap between what each professional is able to do. Collaborative practice pools these resources and scopes of practice together to efficiently provide care by anyone who is allowed and competent, instead of handing everything off to the doctor because they know they make the calls. Collaborative practice is about empowering individuals to work to their full scope of practice and discouraging just handing the work off to someone else, and working together to provide the best patient care.
Our healthcare system in Alberta today is largely, and unfortunately, a “Band-Aid” system. Often only the symptoms of illness are treated because the doctors, nurses and all other staff are terribly overworked and trying to care for many patients at once. Collaborative practice aims to give team based care to allow for diverse medical opinions and allow for time to get to the root cause of illness.
I’ll give you some (theoretical) examples on what healthcare can sometimes look like, and what I have envisioned healthcare COULD be like with collaborative practice.
In today’s healthcare system: An individual came into the Emergency Department (ED) suffering from a myocardial infarction (heart attack). Typically this patient would be seen by emergency doctors and nurses with some medical interventions and possible prescriptions involved. The patient would be then sent home and told to follow up with their family doctor. However, the patient is not able to get an appointment with his family physician until weeks later. Because the patient was not educated about the possible causes of their heart attack, the patient continued to smoke, drink and eat high fat foods profusely, making the medication he was given by the ED doctor ineffective. Just over two weeks later, the patient lands back in Emergency because of further complications from the heart attack, and the cycle repeats itself.
If Collaborative Practice was engrained into our healthcare system, this patient’s story may be a little different. Let’s say, again that a patient where to visit Emergency due to a heart attack. This time, the patient would be seen by the doctor and nurses to immediately deal with the emergency at had. Once the patient has stabilized, the Emergency doctor would fill in the rest of his team about the patient, their heart attack and possible causes and patient history. This team could consist of a pharmacist, nurse, dietitian, exercise specialist, occupational therapist and social worker. All of these individuals would bring in their expertise to evaluate the patient’s overall health and well-being. These individuals could evaluate their diet and educate them about healthy eating choices AND sign them up for a healthy cooking class, review their prescriptions, educate about exercise and figure out if there is a social program to give them a hand up.
The idea is that this patient receives 360 degree care, not just for their immediate problem, but to ensure that they are well overall and prevent them from coming back to the Emergency department. We know that here in Alberta, a visit to Emergency costs a minimum of six times more than a visit to a family doctor. Collaborative practice could potentially mean better outcomes for patients, increased job satisfaction for healthcare workers and possible cost savings. At the end of the day, hospitals, doctors, nurses etcetera all exist because patients exist. There is no reason why we should not provide the best care possible and keep people at home with their families instead of in hospitals (where there is evidence of a dramatic risk increase of acquiring an infection while in hospital, why subject people to this for problems that should have been looked at earlier).
However, Collaborative practice cannot occur without the support of Family & Patient centered care and innovation. As I said earlier, the only reason that healthcare exists is because patients exist. Everyone is different, and have different needs to be cared for compassionately and successfully. This is why we are focusing at putting both the patient and respecting the role of the family in care at the center of our attention. We need to listen and actively engage how the patient and family feel about their care, as they know the patient best. Innovation is required to create a system where interdisciplinary healthcare teams are supported, celebrated and expected. Right now in healthcare disciplines, there seems to exist “silos”, where doctors are their own entity, nurses do their own thing etcetera. Innovation in this sense does not require new technology, it requires a new way of thinking, and creating a way of “being” where the culture in healthcare changed from “doctor’s orders” to “what do you think about this patient, their care and their overall well-being”.
We are starting small. We plan to launch a pilot project within individual units and clinics here at St. Mary’s and constantly monitor our progress. Alberta Health Services is planning a similar initiative called COACT, but we feel that we are capable of going beyond that. Healthcare is sick…. let’s treat the root causes and not the symptoms.
Collaborative Practices/Leadership Associate to Cherylyn Antymniuk, Site Administrator
Covenant Health, St. Mary’s Camrose
@JCRohloff on Twitter