Building resilience in Canada’s health-care system
Experts say addressing place-specific health-care needs, such as the staff shortages that led to closures of emergency departments in Northern Ontario, requires the engagement of community partners. istock.com
Health crises tend to reveal health inequities and health-care gaps. The COVID-19 pandemic, for example, illustrated the need to make Canada’s health systems more resilient, find a way to efficiently mobilize and integrate new knowledge, and actively engage community partners, especially those representing marginalized and underserved populations.
“Research on health systems plays an important role in identifying opportunities for improving the quality of health and health care,” says Mel Cappe, board chair, Health Research Foundation (HRF) of Innovative Medicines Canada, a non-profit organization that supports and promotes the value of health research in Canada. “Making our health systems more efficient and resilient can help to make a difference in the lives of Canadians as well as enhance our pandemic preparedness going forward.”
From the premise that health outcomes can be improved by creating learning health systems – in which knowledge generation processes are embedded in daily practice to produce continual improvement in care – the HRF supports the work of two leading researchers: Drs. Brianne Wood and Srinivas Murthy.
“Infectious disease outbreaks, such as Ebola in West Africa, measles in the South Pacific and COVID-19 globally, strain health systems; and we’ve seen a difference in outcomes based on the ability to incorporate new knowledge quickly,” says Dr. Murthy, critical care specialist and investigator at the University of British Columbia, who was awarded the HRF chair in Pandemic Preparedness Research. “Our research is looking at the levers, policies and structures that can help to enhance how health systems function.”
“Every decision we make can provide insights on how to improve the care we deliver, whether that’s through novel treatments or devices, assessments and practices, or policy implementation.
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During emerging health threats, clinical care and research are closely linked, since “we constantly need to learn and update what works and what doesn’t as we care for patients and as policy is being implemented,” says Dr. Murthy. “That’s why we need a unified system that continuously evaluates clinical and policy decisions.”
When a health system is more adaptable, this helps to muster a timely response to changing situations, he explains. Yet the Canadian system struggles with numerous challenges, “including limited resources and siloed components preventing a co-ordinated, efficient and thoughtful approach across provinces, regions and different health-system stakeholders.”
Outcomes will be better – for the system as a whole as well as patients – when “knowledge is gathered during clinical care and then used to inform health decisions,” Dr. Murthy suggests. “Every decision we make can provide insights on how to improve the care we deliver, whether that’s through novel treatments or devices, assessments and practices, or policy implementation.”
Enabling such a feedback loop are advances in technology and data systems, he adds. “We have the data; we just need to ensure it’s used – and cared for – in the best and most efficient way.”
“Our goal is to empower individuals, organizations and communities to participate in transforming health systems so they better meet their needs.
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While a co-ordinated approach can bring system-wide improvements, Dr. Wood, associate scientist, Social Accountability and Learning Health Systems at the Northern Ontario School of Medicine University and the Thunder Bay Regional Health Sciences Centre, also sees learning health systems as an effective tool for addressing community-specific challenges.
In major health-care decisions, which tend to be urban-centric and made at provincial or national levels, “voices of smaller communities are often missing. And that means their needs are not being met,” explains Dr. Wood, who was awarded the HRF Health Systems Resilience Fellowship in support of her work to “improve health and health care in rural and remote settings – and specifically in Northern Ontario.”
Consider, for example, a shift to virtual health care in areas where reliable internet access isn’t always available. Or imagine communities “where emergency departments had to close in recent months due to limited staff availability,” she says. “There is an urgency to listen to the challenges faced by rural and remote communities.”
Efforts to identify and address such challenges need to be “place-based and collaborative,” Dr. Wood emphasizes. “We work with health-care providers, health-care decision-makers and community members to not only gain an understanding of their priorities but also engage them in designing solutions that address their specific needs.”
Populations that have long been grappling with health inequities and higher rates of chronic diseases have seen their barriers increase due to the pandemic. In addition to enhancing access to health care, Dr. Wood says community partners advocate for better preventative health services, such as cancer screening.
“Our goal is to empower individuals, organizations and communities to participate in transforming health systems so they better meet their needs. It’s important that our work is community-driven and respectful of Indigenous sovereignty,” she says, adding that understanding the context can then help to translate relevant knowledge into effective programs and interventions.
Insights on how to create learning health systems in rural and remote areas can help to address place-specific needs and improve outcomes for vulnerable populations, but Cappe believes the impact of this research will reach even further – and potentially help to strengthen systems across the country.
For HRF-funded research, “we are looking for impact,” he says. “We support endeavours that promise useful and relevant results that can help to make our health systems more resilient.”
Both Drs. Wood and Murthy aim to do just that: produce “research that makes a tangible difference.”
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For more information, visit www.hrf-frs.com