This is the Healthcare System, We Don’t Manage Housing
So it has taken us a while, but now we all seem to be on the same page: our healthcare system needs to focus on Health Improvement, not only on Illness Management. To do this, we need to blur the lines between social services, primary, acute and post-acute care and the social determinants, in particular housing.
When I first became a Local Health Integration Network CEO, I was struck in a visceral way by the direct and obvious implications of housing challenges on our healthcare system. It was no longer an abstract concept about the social determinants of health that felt like an amorphous intellectual notion I could never get my arms around. This was the in my face here is the real issue stuff.
When I pursued housing, the response from most stakeholders was multiple variations of “this is the healthcare system, we don’t manage housing.” Of course this seems counterintuitive given we literally have sectors within the healthcare system labelled by housing options: long-term care, support housing, and assisted-living. And, I can guarantee, Lakeridge Health is not the only group of hospitals in the system with patients who also call their hospital - “home.”
Bill 74, The People’s Health Care Act, 2019 focuses on best health for our population, as are a growing number of leaders across the system. Better Population Health is the central point of the Institute for Health Improvement’s Triple Aim. The Triple Aim brings together the elements of Population Health, Individual Experience of Care and Reducing the Per Capita Cost of healthcare. When combined with a fourth element - Provider Wellness - we see the healthcare system locally, provincially and nationally headed in this direction. It is something that we have been talking about and now it appears its time has really come.
In addition with Bill 74, perhaps we truly have our local mandate to look beyond our limits (which are largely self-imposed), funding barriers, and traditional self-definitions, to approach services holistically – social, health or otherwise – to integrate around the person, collectively presenting ourselves as one system regardless of funding models, regulatory gaps and occasional legislative misalignment.
In Ontario, we have been trying different approaches to health system integration for several years now, with well-documented middling success. While I certainly do not have all the answers, here are a few of the things I have learned along the way that truly matter.
- Trust. Cliché or not, if there is no trust among the partners, it will be nearly impossible to get anything truly meaningful done
- Size - although only sometimes. It matters particularly - and this cannot be emphasized enough - when considering issues of risk management and mitigation. It also matters in other ways such as volumes for scale. It does not matter for governance. Do not mix up financial risk, gain-sharing and governance.
- Cross continuum/multi-sector. When the partners span the continuum of services that a person needs to stay healthy, the work is compelling and easy for all stakeholders to understand and to support.
- Transparency -particularly if trust is less than complete. In one partnership I was involved in, we had a single CFO overseeing all of our respective financials. This was a key enabler beyond all others.
- Culture. Organizations have different cultures. This needs to be acknowledged and respected. Assimilation rarely works, although what often emerges is a new and unifying culture.
- The person. When in doubt, and I am often in doubt, go back to what is most important for the person being supported – the right answer, no matter how uncomfortable it is, comes from putting the person first.
The much-heralded tsunami of aging is arriving, the old way of doing things is not holding up well under the pressure, and our government is asking us to think differently. As a system, we seem to be at a watershed moment. With a focus on the health of our population, and creating a unified system of care, we can move to a new lasting solution.
About the Author(s)Matthew Anderson is President & CEO of Lakeridge Health
Abhi Mukherjee wrote:
Posted 2019/04/04 at 01:35 PM EDT
Thank you Matt - good points. I am very encouraged that we are moving in the right direction - away from a hospital-centric acute/ episodic treatment to a broader health & wellness model. I hope this will mature with time to a prevention and wellness care model (with housing and all other social determinants of health factored in).
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