Curiosity about Primary Health Care Redesign in Saskatchewan

Curiosity is an interesting thing ... I don't know how you ended up here and I don't know when or where you will be going after this. Well I don't even know what this is ...

What I do know is that you were curious and I only have a few minutes to get your attention. Some of you might say that I only have 140 characters. Well, I say that I have until I land in Denver or until I run out of battery power (I started this blog as a note on my iPad on my way back by air from the IHI meeting in Orlando, Florida and then copied it into this blog.)

I heard an interesting story this week about a shoe shining guy who was shouting out small phrases to passers by. When he was asked what he was doing he said that he had 3 seconds to connect to somebody. (implying that if he does not connect with that person, he would not be able to shine their shoes ...)

If you are still reading this then it means that I still have your attention and it did not take 3 seconds to connect. I do know that if I don't give you what you are looking for, you will be leaving soon.

Now here comes the interesting thing: I want you to stay for only as long as you feel comfortable with what you see, because you can start right now to do something that you feel passionate about.

I am passionate about redesigning primary health care in Saskatchewan as one of the ways to reform the Saskatchewan health care system. I plan to use this page to showcase stories of people like Dr Kishore Visvanathan and organizations who are transforming health care in Saskatchewan. I am not much of a writer, blogger, facebooker or tweeter, but I know that there are others that do these things well that will lead you here. Hopefully you will look at the Saskatchewan stories and do something in your world or share your stories with all of those in Saskatchewan who are making a difference in transforming the Saskatchewan health care system.

So all I ask of you is that next time that we meet in person or connect in cyberspace, please tell me how curious you were, what you are doing in your world and how long it took for us to connect ...

So here is my story ...

I am a family physician in Yorkton, Saskatchewan. I came to Canada in 1999 to do locums (temporary replacements for 3 months for other physicians who went on vacation ). At the end of the 3 months I decided to stay in Yorkton, Saskatchewan, Canada. This lead me on a journey during which I constantly tried to improve the way I practise. I soon realized that there were a lot more than just my practice that had to change. Changes were needed in my health region (Sunrise Health Region).  As I got more involved, I became my health regions primary care representative for the (Saskatchewan Medical Association or SMA).  I then realized that it was not only in my practice or health region - we needed to improve health care delivery for the province.

As time went on I became involved with more SMA work and ended up on the board of the SMA and currently I am serving a term as president of the SMA for 2011/2012. This gave me the opportunity to have input on a provincial level on matters that influence my daily practice.  It also gave me exposure to quality improvement conferences like IHI and Inspire.  I was one of 16 physicians that were sponsored by a group effort of  the Saskatchewan Medical Association, Ministry of Health, Health Quality Council and the College of Physicians and Surgeons of Saskatchewan .  There were others from Saskatchewan too - to make up a total delegation of about 40 people from Saskatchewan.).

I have been working on moving my own practice from the solo practice that I took over to a multi-disciplinary team based group practice. This is another story which I will write about later.

For now, I just want to write about the exciting period of time that we are experiencing in Saskatchewan. We have a provincial government that tells us that they believe in physician leadership to be a major contributor to the transformation of health care in Saskatchewan.  We have a medical association (SMA) that is actively involved in primary care reform as outlined in their primary care framework.  We have the Health Quality of Saskatchewan (HQC) that have been spearheading the quality improvement agenda for the province.  We also have dedicated individuals from many different health care organizations who want to work together for a better solution for the province.  I believe the tipping point is near where we are going to witness the transformation of a mediocre provincial health care system to a health care system that others would want to duplicate.  As Malcolm Gladwell said in his book, The Tipping Point: "The tipping point is that magic moment when an idea, trend or social behaviour crosses a threshold, tips, and spreads like wildfire." ...

Currently the main focus for Minister of Health, honourable Don McMorris and especially his deputy Minister of Health, Mr Dan Florizone is the Saskatchewan Surgical Initiative. (SSI). The Saskatchewan Surgical Initiative is striving to improve surgical patients' care experience and ensure that by 2014, all patients have the option of receiving their surgery within three months.

The SSI is looking at the whole patient experience from before they see their primary care provider until after surgery is completed. Several projects came from this initiative, for example - The Specialist Directory and Primary Health Care Redesign.  These initiatives all came as a result of the Patient First Review which was a report on what patients wanted from the Saskatchewan Health Care System.

I am passionate about Primary Care Redesign and this journey started towards the end of 2010 when the ministry of health got Syntegrity to facilitate discussions between a number of Saskatchewan stakeholders about the future of Primary Health Care in the province. The sessions were divided into different groups that addressed issues on Physician Engagement, Chronic Disease Management, Community Engagement and First Nations.

I attended the Physician Engagement sessions and found the process very productive. Syntegrity facilitated discussions between patients, physicians, nurses, other health care providers, health regions, community representatives, First Nations representatives and more.

During one of these sessions in a small group discussion I had an "Aha" moment and was so excited that I literally jumped up and grabbed the pen out of the surprised facilitators hand and drew a graph that looked something like this:

The vertical axis represents the level of support from the health region and ministry and the horizontal axis represents the number of desirable elements that physicians have implemented in their practises.

So the desirable factors that I am talking about on the horizontal axis are these:

So what I meant was that every physician practice in the province is somewhere on the horizontal axis. The more desirable factors they have in place the more to the right they are on the graph. The support for these practices from the health regions and ministry should increase as they move more to the right. In this model it confirms that every practise in Saskatchewan is part of Primary Health Care delivery. They are all just at different milestones on the journey. So far I have received a lot of support for this model from physicians, some of the ministry health officials and other stakeholders in the province. This is in stark contrast to what the previous model looked like between 2003 and present. In the old model only the "approved" primary health care sites received support. So that graph from the past would look something like this :

In both graphs the red box indicates which practices get support from their health regions or the ministry.

So to summarize - all I ask of the health regions and the ministry is to see how they can enable physician practices to implement more desirable elements into their practices. All I ask of physicians is to look at their own practices and see how many desirable elements they have implemented in their practices and if they are somewhere on the left of the graph then I challenge them to see if they can move to the right on the graph.  This way the transformation in primary care will move along all over the province and not only in a few primary care sites.

So whether you are from a health region, the ministry or whether you are a health care provider I am asking you the question: In the transformation of the health care system in Saskatchewan, are you an enabler or an obstacle ....