In order to implement and sustain the changes needed to adapt to evolving needs, decision-makers generally agree that clinical and managerial teams must develop greater ability to carry out improvement or innovation projects in their specific environments.
To follow up on their achievements in evidence-informed change, the managers of the Montérégie health and social services region agreed to try out a new form of support for innovation: the Healthcare and Social Services Management and Governance Experiments Project (LEGG).
Experienced as an incubator of innovation, the LEGG mechanism has made it possible to reconcile management and control roles with that of support for the organizations and for the teams that work towards implementing the necessary changes within them. By instigating and leading interactions that unite decision-makers, researchers and stakeholders who embrace different schemes for action, the LEGG has created a set of dynamics for supporting the change process that is focused on perfecting and carrying out innovations.
The LEGG has focused on three areas of intervention that appear to be essential for carrying out a portfolio of innovative projects and which, together, constitute a mechanism for providing interdisciplinary support:
- Implementation of change in project management, making it possible to design and carry out a change process that is tailored to the realities of the organization in question
- Active mobilization of knowledge by facilitating social processes, promoting the importance of tacit and explicit knowledge and jointly producing knowledge that is useful for achieving the project’s goals
- A course of action focused on the deliberate production of change thanks to a clear direction, the allocation of venture capital, and accountability that is conducive to achieving change and sharing lessons learned.
The LEGG has proven itself to be a systemic mechanism that can support knowledge-informed change. For that reason, the managers in the region have agreed to repeat the initiative.
- The performance of Canada’s primary healthcare (PHC) system lags behind that of other industrialized countries. Well-targeted investments in PHC can improve the health of individuals and populations, which can in turn have a positive impact on macro-economic indicators, such as employment rates, productivity and economic growth.
- There are important gaps in Canadian PHC systems that require improvement. These include accessibility of PHC services, technical quality of care, quality improvement initiatives andpractice organization.
- Various interventions and investments have been shown to enhance the performance of PHC, improve the quality of care and produce economic savings. These include incorporating pharmacists into PHC teams, case-management strategies to enhance chronic disease management, and electronic medical records that include patient recall and provider reminders for preventive care and chronic disease management.
- This report presents the results of four different approaches to evaluate the economic impact of enhancements to PHC: 1. A synthesis of the literature on the macro- and micro-economic effects of good health, with specific relevance to PHC performance. 2. A systematic review of the economic impact of incorporating a pharmacist into a PHC practice. 3. A simulation exercise that evaluates the economic impact of improvements to influenza immunization rates for older adults brought about by provider reminder systems in PHC. 4. A literature review of reductions in burden of illness associated with four specific enhancements to chronic disease management in PHC that produce health benefits. These include PHC improvements that result in improved blood pressure control, enhanced diabetes management, increased uptake of cancer screening and improved continuity of care.
- Three of the four approaches used in the report suggest that improvements to the performance of PHC in Canada would yield economic benefits. Better health outcomes have a positive impacton employment, productivity and economic growth. Simulation results indicate that increasingthe influenza vaccination rate of the elderly population results in cost savings. Improved health outcomes for chronic disease management were linked to cost savings through reductions in hospitalizations, professional visits, emergency room visits and increased productivity; and higher continuity of care was associated with lower resource utilization and reduced healthcare costs. Despite literature that shows a positive health benefit of pharmacist integration in PHC, studies ofthe economic impact are inconclusive.
- There are knowledge gaps and weaknesses in the current structure of Canadian PHC systems.The creation of a National Coordination Body, additional investment to improve Canada’s PHC performance and additional investment in PHC research and evaluation is recommended.