Abstract
Background: Planning of healthcare systems has traditionally been top-down, focused more on illness care rather than health and wellbeing, and retentive of control. Locally, nationally and globally this approach no longer meets the needs of individuals and populations. Comments of healthcare systems being in crisis or no longer sustainable are ubiquitous. Rather than perpetuate “doing more of the same, and hoping for different results”, at the broadest system level, we sought to radically change our approach to healthcare using integrated care principles.
Approach: Using many of the pillars of integrated care, as well as an assed-based community development approach, we sought to identify what was of importance to achieve health and wellbeing for individuals, groups and communities. We also were cognizant of the need to understand how services should be organised and who should be the organizer. Finally, as we started the work, we realized that individuals and groups whom we considered as “recipients” of care, particularly in terms of achieving equity, also had a role as community assets. This work was carried out through interviews with over 200 groups and communities, with themes and roles being identified and grouped.
Results: Interviews spanned the entities which we considered as being involved in integrated care: the volunteer sector (both service providing and peer/condition specific), municipalities, portfolios within our health system, caregivers, individuals with medical conditions or subject to inequities, government departments, primary care, and others. In these interviews there was strong support for the component pillars of integrated care. Many entities (caregivers, municipalities) were shocked to realize the importance of their efforts in promoting health and wellbeing. Without exception, all groups indicated strong willingness to work collaboratively. From the health system perspective, we developed an awareness of the capacity of many groups to support integrated care and we translated this into ongoing relationships. At an individual level, people developed an understanding of the importance of social factors and community in health. They also shared what was important to them to have health and wellness, and commonly this was different from what the historical health system saw as being important. Moreover, we humbly learned that all individuals and groups had talents and could be considered a resource. For example, individuals experiencing homelessness were often the best source of support and resource for others in the same condition. From a service-based approach, we carried out a monetization exercise using published data and found that resources external to the health system, calculated at $26 billion, equated to the total health system budget of $26 billion.
Implication: Pillar 1 of Integrated Care – common vision – seems to be the key factor in facilitating care. With this common vision, all the other pillars of integrated care seem to fall into place. Understanding is needed from all regarding the roles and abilities of the various sectors and individuals. Importantly, the historical health system has to be comfortable in ceding control and working as an equal partner, or even having citizens lead priority-setting and ways of doing.