Journey to Health Transformation: Partnership to advance needs-based, person-centered primary and acute care services

Background: Access to care is top of mind for everyone. Nova Scotia, a province in eastern Canada is on an expedited journey to world-class health care. Informed by the provincial health strategy, Action for Health, partners across the province, including community are changing primary health care and hospital services.

Approach: Transformation examples in primary health care and hospital services focused on person-centered approaches grounded in community partnerships and assets, quality and safety, analytical and experiential information, and health equity will be shared. Focus is on the health needs of people across the lifespan aligned with the knowledge and competencies of collaborative health teams and the use of technology, process improvements and innovation. For hospital services, we are improving patient journeys from admission to discharge with the introduction of a provincial quality collaborative involving interprofessional teams 24/7 along with codesigning a discharge hub. Along with our care coordination centre, these interventions foster further action and accountability across government departments and with community organizations and services to get people back to the place they call home. In primary health care, we are building team-based models where everyone works to full scope and people needs are matched to the best provider. The teams create collaborative primary health care homes situated within health neighbourhoods, so people have coordinated health and social services. This is all situated within widespread commitment to standardized operational excellence and strategic approaches to health workforce and service planning. To support the significant change across the system, we launched a Leadership Academy and Transformation certification to support the development of leaders. Clinicians, researchers, and leaders across the health system engaged with patients and the public to inform this work through a health system wide public engagement campaign to inform health transformation. Community Health Boards are working with communities to identify health priorities and the public is engaged in local design, implementation and evaluation of health initiatives.

Results: Patient and clinician stories of success as well as health needs data, workforce data and process and outcome measures will be shared. For hospital services, we added inpatient capacity comparable to adding 70 extra beds per year, increased access to care with 28,000 more DI appointments compared to 209-20; 8,000 more CT scans; 8500 more ultrasounds. With increased bed availability, on average we provided inpatient services for ~20 patients more per day compared to last year and reduced transfer time from the ED to inpatient units by 50%. For primary health care, more than 8,000 patients were attached to a primary care provider in the last year; 8% increase in primary care appointments; 5,000 mobile clinic visits; 95,000 pharmacy clinic visits; 48,000 virtual care appointments and the introduction of a health care navigation app with more than 250,000 downloads to date. Positive feedback from Nova Scotians who have used the multiple primary health care options.

Implications: Important learning on multiple, simultaneous, coordinated actions to close the gap in the health workforce and to provide the public with options for clinical services matched to their needs. It is important have quality data, design and feedback processes for public engagement and the need to support health leaders as change agents as well as the utility of technology as an option for health services. The work requires a commitment to system and service partnership, a spirit of possibility, perseverance and the space for teams to learn, fail, adapt and scale innovation. Next steps are to continue with the roll out of success across the health system, continue to learn from patients, families, communities, clinicians and continue to evaluate interventions individually and as they connect for system transformation.