Of Silos and Systems: The Issue of Regionalizing Health Care

Simpson, Scot H.

doi:10.4212/cjhp.v64i4.1033

Cited by 13 publications

(15 citation statements)

References 6 publications

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“…The survival of some rural hospitals is threatened by physician and nurse shortages; the survival of others is affected by budget cuts or efforts at regionalizing or centralizing care. 2,15,16 The extent of these service alterations has not been documented.…”

Section: Ré Sumémentioning

confidence: 99%

Comparison of access to services in rural emergency departments in Quebec and British Columbia

Fleet

Audette

Marcoux

et al. 2014

CJEM

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Introduction: Although emergency departments (EDs) in Canada's rural areas serve approximately 20% of the population, a serious problem in access to health care services has emerged. Objective: The objective of this project was to compare access to support services in rural EDs between British Columbia and Quebec. Methods: Rural EDs were identified through the Canadian Healthcare Association's Guide to Canadian Healthcare Facilities. We selected hospitals with 24/7 ED physician coverage and hospitalization beds that were located in rural communities (using the rural and small town definition from Statistics Canada). Data were collected from ministries of health, local health authorities, and ED statistics. A telephone interview was administered to collect denominative user data statistics and determine the status of services. Results: British Columbia has more rural EDs (n 5 34) than Quebec (n 5 26). EDs in Quebec have higher volumes (19,310 versus 7,793 annual visits). With respect to support services, 81% of Quebec rural EDs have a 24/7 on-call general surgeon compared to 12% for British Columbia. Nearly 75% of Quebec rural EDs have 24/7 access to computed tomography versus only 3% for British Columbia. Rural EDs in Quebec are also supported by a greater proportion of intensive care units (88% versus 15%); however, British Columbia appears to have more medevac aircraft/helicopters than Quebec. Conclusions: The results suggest that major differences exist in access to support services in rural EDs in British Columbia and Quebec. A nationwide study is justified to address this issue of variability in rural and remote health service delivery and its impact on interfacility transfers and patient outcomes.

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Section: Ré Sumémentioning

confidence: 99%

Comparison of access to services in rural emergency departments in Quebec and British Columbia

Fleet

Audette

Marcoux

et al. 2014

CJEM

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“…The goal of intra- and inter-sectoral collaboration was often compromised by a wide-spread fragmentation of services and services operating in silos, a finding well described in the literature [ 38 39 ]. Ultimately such barriers had the potential to affect client outcomes.…”

Section: Resultsmentioning

confidence: 99%

Care Coordination for Vulnerable Families in the Sydney Local Health District: What Works for Whom, under What Circumstances, and Why?

Eastwood¹,

Dewhurst²,

Hansen³

et al. 2020

International Journal of Integrated Care

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Introduction: Healthy Homes and Neighbourhoods (HHAN), an integrated care programme in the Sydney Local Health District (SLHD), seeks to address the needs of disadvantaged families through care coordination, as one of its components. This research aims to determine for whom, when and why the care coordination component of HHAN works, and establish the reported outcomes for clients, service-providers and partner organisations. Methods: Critical realist methodology was utilised to undertake a qualitative evaluation of the impact of care coordination. Purposive sampling was used to select a total of 37 participants for interview, including consumers, service-providers and key stakeholders. Thematic analysis was undertaken to derive the major modes of intervention of HHAN, and data representing these elements was coded and summarised under contexts, mechanisms and outcomes. Results: Analysis indicates that care coordination has a positive impact on clients' sense of independence, self-awareness and outlook on life. Trust and favourable interpersonal relations were identified as major underlying mechanisms for a successful client-provider working relationship. The identified modes of intervention facilitating positive consumer outcomes included accessibility, flexibility and service navigation. Persistent siloes in health and systemic resistance to collaboration was seen to hinder effective care delivery. Conclusions: This study suggests that a care coordination model may be effective in engaging disadvantaged families in healthcare, assist them in navigating the health system and can lead to beneficial health and social outcomes. Successful implementation of care coordination requires flexible programme design and experienced and skilful clinicians to fulfil the care coordinator role. There is a need to appreciate the negative impact that the complex and siloed health system can have on disadvantaged families.

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“…Firstly, under contexts of a siloed, complex health system, mechanisms that built connections between services -including communication and motivation to collaborate -produced positive outcomes such as improved collaboration and a foundation of integration between HHAN and other services, ultimately improving engagement with clients. The silo-working of services is well known, especially in health systems [59,60]. Due to the complexity of the health system, resources, boundaries, privacy legislation can cause problems with collaboration.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the complexity of the health system, resources, boundaries, privacy legislation can cause problems with collaboration. To combat this, information sharing via a service integration model has been shown to improve accessibility to services for clients [59,61,62]. Hence, HHAN drew services to communicate with each other to reduce this silo-working culture, by encouraging formal and informal interactions.…”

Section: Discussionmentioning

confidence: 99%

Refining Program Theory for a Place-Based Integrated Care Initiative in Sydney, Australia

Eastwood

Barmaky

Hansen

et al. 2020

International Journal of Integrated Care

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Background Introduction Savic and colleagues have described integrated care as a "holistic care model" that encompasses individual medical, physical and mental health needs, and includes social issues and environment [1]. Place-based interventions (PBIs) are initiatives that use complex partnership networks to implement multiple-component interventions aimed at changing the social and physical environment within a targeted location. Such an approach to integrated care creates a coordinated approach between multiple healthcare providers such as primary care, social services and hospitals, and supports community services. The PBI approach both connects and aligns the different sectors and organisations [2]. Effective integrated care strategies for primary-secondary interface include factors such as communication and information exchange, interdisciplinary teamwork and shared care guidelines and pathways [3]. Integrated care is thus founded on the interconnectedness between social and health issues of an individual and communities. There are many approaches to the design and implementation of integrated care. A co-location model, through PBIs, is one of them. PBIs co-locate different services and activities such as legal, health, social and housing within the same physical space. The extant literature supports the PBI approach for several reasons. Firstly, it is local physical and social

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Of Silos and Systems: The Issue of Regionalizing Health Care

Cited by 13 publications

References 6 publications

Comparison of access to services in rural emergency departments in Quebec and British Columbia

Comparison of access to services in rural emergency departments in Quebec and British Columbia

Care Coordination for Vulnerable Families in the Sydney Local Health District: What Works for Whom, under What Circumstances, and Why?

Refining Program Theory for a Place-Based Integrated Care Initiative in Sydney, Australia

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