Reflections on a recent presentation by Alberta’s Deputy Minister of Health, Dr. Carl Amrhein

carl-amrhein-talkSeveral members of the IMAGINE Citizen Steering Committee have had the opportunity to attend or listen in on a recent presentation by Dr. Carl Amrhein, Deputy Minister of Alberta Health. The presentation was held at the O’Brien Institute for Public Health and was titled Health System Transformation in Alberta.

Each time we have the opportunity to participate in and reflect on discussions about Alberta’s health system it helps us think more deeply about the kinds of change required in our health care system, and about how IMAGINE can be an effective catalyst for positive change. We believe Dr. Amrhein raised a number of important themes. Here are some of the highlights:

The Deputy Minister spoke about the positive benefits he believes Albertans would experience from a reformed primary health care system. These included access to our own health information and active participation in service planning that would result in service design and delivery that meets the needs of the community. We were pleased to see both of these benefits highlighted, as they are well aligned with IMAGINE’s priorities.

Regarding this first benefit, we feel strongly that patients need access to their own health information, if they are to be active partners in their own health and healthcare. This means we need to move forward quickly with the development of an electronic health record that includes a patient portal, through which patients can access their medical information and contribute to their health record. As we travel the province listening to Albertans this continues to be identified as a high priority.

IMAGINE also strongly believes that citizens must be actively engaged in shaping the design of our future health system, if we are develop a system that works for Albertans. As much as we applaud this benefit, however, we would like to see the language shift from vague and token promises to “engage citizens”, to language that recognizes the centrality of citizen-patient involvement. This is needed if we are to move from thinking that experts can design a good health care system ‘for’ people, to thinking that recognizes that design our future healthcare system must happen ‘with’ people. Using language like co-design and co-production, which is being increasingly used internationally to describe processes where patients and health professionals work together to design services and systems that work, would better demonstrate this shift in thinking.

In the past few weeks we have been reminded by two highly respected individuals of the centrality of citizen voice and its important role in system change. Chris Power, CEO of Canadian Patient Safety Institute) said to us this week,

“Patients and families are an integral part of healthcare system. I am a firm believer that their voice and desire for change will be what drives transformation in the system, today and in the future.”

And in a very recent publication from last week by Don Berwick – the ‘grandfather’ behind the ‘IHI Triple Aim’ (which the Deputy Minister has expanded to the quadruple aim) wrote,

“The more patients and families become empowered, shaping their care, the better that care becomes and the lower the costs. Clinicians and those who train them should learn how to ask less “What is the matter with you?” and more “What matters to you?” ‘Coproduction, co-design, and person centered care’ are among the new watchwords and professionals and those who train them should master those ideas and embrace the transfer of control over people’s lives to the people. That includes paying special attention to the needs of the poor, the disadvantaged, and the marginalized, and firmly defending health care as a universal human right.” (from Berwick, D. Era 3 for Medicine and Health Care.  JAMA, April 5, 2016, pg.1330)

The Deputy Minister also outlined some essential characteristics of our future healthcare system. These were:

  • Community services that are integrated to support overall health;
  • Services that are aligned with population needs, and;
  • Care provided closer to home and community.

IMAGINE supports these essential characteristics. We are convinced that a strong primary care system, which includes care provided by family physicians working with many other healthcare and related professionals, is the foundation of a good health system.

It is very good news that Alberta Health is committed to these broad themes that will support a renewed health system that is patient and family centred. We believe any future discussion about the future of health care in Alberta needs to include citizen-patients as active partners. The kind of transformative change Dr. Amrhein is describing will not be realized by health professional ‘experts’ alone. We need to bring together the expertise of both patients and families using the healthcare system, the healthcare providers working in the system, and key insights and innovations from research and promising practices to build a better system for all Albertans.