Across the Canadian healthcare landscape there is a prevalent theme: change is coming.

Some of these emerging transformations were recently highlighted by Jennifer Zelmer, President and CEO of the Canadian Foundation for Healthcare Improvement (CFHI) during a virtual Breakfast with the Chiefs hosted by Longwoods.

“It has never been clearer that how we live, learn, work, shop and play affect our health,” said Zelmer, “and the COVID-19 pandemic is forcing a shift in the way we deliver healthcare.”

As the head of CFHI, a not-for-profit that focuses identifying, spreading and scaling proven healthcare innovations, Zelmer has known for a long time that change is needed: “The last few weeks have shown us that widespread change in Canada’s health sectors is not only possible, but it can happen fast.”

Partnering with patients

One area of possible change is for healthcare organizations to partner with patients and community.

“In times of crisis, this philosophy continues to hold true even if the ways it’s implemented will change. This is an area where we absolutely need to double down,” she said.

The notion of “family presence policies” is an area of focus because of its significance for patients’ wellbeing both mentally and physically.

“But the doors slammed shut in March. Blanket visitor restrictions were implemented across Canada to reduce transmission of the virus and to conserve the limited supply of personal protective equipment,” she said.

While these policies were introduced with the best intent, extended restrictions also bring their own risks and, in some cases, significant moral distress.

“Studies show that the presence of essential family partners in care decreases anxiety during procedures, improves medication adherence, and helps maintain cognitive function in older adults. It can also reduce re-admission and some family members provide significant hands-on help,” noted Zelmer.

As the pandemic evolves, organizations and jurisdictions are now beginning to revisit their family visiting policies.

CFHI also recently convened a rapid response advisory group. Their report will focus on seven steps to guide policy, including having patients and family caregiver partners at the table for reviews.

Expanding home care services

The second area of possible change is expanding home care services.

“The pandemic has not affected us all equally,” she said.

Zelmer highlighted a report that indicated how physical distancing and travel restrictions can be triggering for people coping with historical trauma.

In another study that Zelmer referenced, it showed that eight out of 10 Canadians said safe and appropriate healthcare should be provided in the community where patients live and can be supported in homes.

“Think about how much easier it would be right now if you could access care closer to home in the community and reduce the need for medical travel,” she said. “Or if everyone was linked to a regular care team and had access to high quality services virtually or physically when needed.”

Secured video health visits with healthcare professionals is also important to Canadians. Data from Infoway indicated that, last year, 80 to 90 per cent of healthcare visits were in person, but that’s been halved during the pandemic.

“So, the questions become: how do we sustain the gains that have been made and what additional steps are needed to ensure that virtual care isn’t just happening but optimized?” she said.

It’s not solely technology that’s going to change healthcare, but instead there needs to be a fundamental change in the delivery of care. One example is a hybrid system that includes both in-person primary care and virtual specialist care.  

“We’re not aiming for care just closer to home and in the community but reducing future needs for in-person care.”

Senior care

The last area of change Zelmer touched on was senior care.

In Canada, eight out of 10 senior deaths are attributed to those in congregate settings. That’s the highest rate by the countries studied in the International Long-Term Care Policy Network.

“Long-term care homes were hard-hit by COVID-19, and data along with reports from the press, the Canadian Armed Forces and other sources have highlighted the pandemic’s absolutely devastating effects in these homes,” she said.

To better understand what happened and best next steps, Zelmer said CFHI has been in discussions with all stakeholders.  

“If 60 per cent of your staff become infected – which happened in some long-term care homes – it’s just not realistic that a home will be able to manage an outbreak on its own. Every home should know where to turn to for help and have surge capacity arrangements in place,” she said.

“We’ve seen that the pandemic has brought significant and rapid change in domains where there’s been a push for transformation for some time. We need to be open and honest about what hasn’t worked well, but we also need to identify, sustain and scale the best innovations that emerged.”