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Improving Canadian health care: a lesson from Alberta.


For years, Canada's health care system has been a model of success: a publicly funded, accessible, responsive and professional example of how to do things right. But today, despite total health care expenditures estimated to be $191.6 billion (or about 11.7 per cent of GDP), Canada is falling behind.



"Over the past decade, Canadian health care expenditures have grown much faster than the economy and combined federal-provincial tax revenues," notes Amin Mawani, FCMA, in Can We Get Better for Less: Value for Money in Canadian Health Care.

"Despite significant investment in health care, Canadians do not seem to receive sufficient value from the health care system as it clearly ranks at the bottom among other industrialized countries in terms of value for money spent."

According to Mawani, an associate professor in the Schulich School of Business's Health Industry Management program, Canada in 2008 and 2009 ranked last out of 30 countries in terms of value-for-money spent as reflected in the Euro-Canada Health Consumer Index. In 2010, Canada's ranking moved to 25th place out of 34 countries (excluding the United States). And a scorecard released by the Commonwealth Fund ranked Canada sixth out of six countries on the value-for-money dimension.

But considering how to improve our ranking can seem a daunting task. In an effort to put Canada's current position--and opportunities for improvement--in context, CMA magazine has pulled together the latest comparative statistics, data on key trends and the story of how one province. Alberta, is helping its doctors use data to create efficiencies. We hope our health care snapshot provides you with both insight and inspiration.

How Primary Care Networks are improving Alberta's health care

Over the past five years, many provinces have made efforts to strengthen the primary care system. Alberta did this by introducing a model of muitidisciplinary primary care--tbe Primary Care Network (PCN)--such as the Calgary West Central PCN of which I am executive director.

PCNs are groups of family doctors working together, governed by an agreement between Alberta Health Services (AHS), the Alberta Medical Association and Alberta Health and Wellness. The province now has more than 35 networks representing the majority of the province's family physicians and more than two-thirds of the population.

The PCN in collaboration with various stakeholders develops business plans to address primary care needs to facilitate care within a community or group of communities. PCN funds support activities to achieve objectives of improving access, health promotion, continuity of care and greater use of muitidisciplinary teams.

Through PCNs, a 14-month process improvement program called AIM (Access Improvement Measures) is being used to achieve PCN objectives. The program's goal is to use process improvement to reduce unnecessary patient waits and delays, and redesign clinical care delivery to maximize health access and patient satisfaction.

That goal is accomplished by matching the demand (patient volume) with the supply (physician time and access). Tracking and mapping out the process and identifying improvements to minimize delays result in improved access (i.e., the potential for more patients to be seen), greater cost efficiency and a better patient experience.

How AIM works

Each clinic of the PCN that wishes to be part of the AIM program is assigned a facilitator who works with the clinic's physicians and staff. The key steps for these teams are to

* set improvement goals for access, efficiency and clinical care;

* map the work process to identify areas for change;

* make changes to balance the supply and demand, thereby reducing backlog and queues; and

* measure and monitor to ensure continuous improvement.

AIM'S approach is similar to the ABC storyboard exercise taught in the CMA professional program. It looks at workflows, reduction in delays, rework and redundancy and the elimination of non-value work to make a process more efficient.

Several clinics throughout Alberta have graduated from the AIM program. Feedback from participating physicians has been positive: they now have the required tools to make business improvements. Patients have been responsive as they are now getting timely appointments. Collaborations such as these improve tpiality and reduce costs to the health care system.

RELATED ARTICLE: Health care by the numbers


1 Most Canadian patients receive care from doctors who often work as solo practitioners or in small partnerships. Small practices have difficulty investing in improved technology, quality and cost effectiveness.

23 The Commonwealth Fund found that only 23 per cent of primary care physicians in Canada use electronic medical records (EMR) while 79 per cent or more of primary care physicians in countries such as Australia, the Netherlands, New Zealand and the United Kingdom use such records.

1/3 Canada's primary care system makes poor use of other providers. According to the CHSRF (Canadian Health Services Research Foundation), only one-third of Canadian physicians report routine use of interprofessional teams, despite evidence that interprofessional models have positive effects on providers, patients and processes.

48 In a 2006 study. Canada had one of the lowest rates among seven countries for training primary care physicians in quality improvement methods and tools. The Commonwealth Fund's comparative study found that just 48 per cent of primary care physicians have participated in collaborative quality improvement.

By Robert Adolph, CMA Introduction by John Cooper

Robert Adolph, CMA, PhD, is executive director of one of the largest Primary Care Networks in Alberta. Previously he was chief financial officer at Stanton Territorial Health Authority and chief operating officer at a major radiology group in Calgary.
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Author:Adolph, Robert; Cooper, John
Publication:CMA Magazine (Mississauga)
Geographic Code:1CANA
Date:Jul 1, 2011
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