Integration as innovation in healthcare systems

Abstract

Healthcare systems in Canada are under pressure and require change-the status quo is no longer fit for purpose, if it ever was. Innovation is often held up as a cure for what ails us, but shiny new things or novel technologies alone have not been enough. This article will explore the concepts of differentiation and integration as being important drivers in the evolution of living organisms, ecosystems, and complex human organizations. The implications of this deep pattern of systems change are essential to understanding the roles of specialization in medicine, and optionality in primary care. Specifically, overspecialization without attention to the principles of healthcare integration can lead to fragmentation of care and worse patient outcomes. Finally, this article will describe some practical examples of system integration as innovation in the form of better public health and care delivery connections, health homes, and community care coordination centres.

Figure 1.

This modified polarity management map depicts the risks and benefits of both differentiation and integration, and why balancing the best of each, while avoiding the worst of each, is the key to system evolution as from deVos.

Figure 2.

The ten key principles for successful health system integration as modified from Suter et al.

Figure 3.

The five components of the healthcare system to be supported by an IMPAC²T Centre. The first (red) is the response to emergent and urgent 9-1-1 calls. This includes the traditional lights and sirens response of ambulances and transport to emergency departments, but not all of these calls require this level of activation and this is where some secondary triage comes in. Some calls may warrant a single paramedic response and assessment followed by non-traditional transport means to the ED, or an integrated urgent care clinic, or healthcare home appointment the next day. Sometimes the needs of the patients may be met safely by integrated virtual care options. The second (yellow) grouping of care coordination would include direct to alternate (non-ED) pathways. This includes direct to specialists or subspecialists clinics, if the patient meets pre-agreed criteria. The third (green) area that a coordination centre could direct calls to, or book appointments with, is the regionally rostered, multidisciplinary Health Home.^,, The fourth (blue) area is supporting care after an ED visit or hospital admission. Home hospital programs have showed some promise in safely reducing hospital admissions.^, Lastly (purple) is the interfacility care coordination role. One-way funnels from the periphery to the central tertiary care centre have been replaced by a network model, where patient and information can travel in both (or many) directions. Sometimes, peer-to-peer virtual care support allows for patients to stay in their home hospitals. Sometimes this helps in pre-transport stabilization and most appropriate vehicle/team and destination decisions.^,