Healthcare Quarterly

Healthcare Quarterly 13(Sp) October 2009 : 1-1.doi:10.12927/hcq.2009.21090

If health systems in Canada are going to tackle the challenges they are facing, for example, growing and aging populations and an increasing burden of chronic disease, new ways of connecting services and service providers need to be found.

In Alberta, the establishment of Alberta Health Services (AHS) in May 2008 created an opportunity to review what had been and could be achieved in integrating health services to improve the quality and outcomes of health services delivered within the province. With a renewed focus on the patient and organizational goals of quality, access and sustainability, AHS set out to encapsulate the integration experiences from previous regional/provincial health service organizations within Alberta.

Integrating services is a necessary part of improving patient care and efficiently using scarce resources. Integration as a focus of study has been evolving in Canada. By commissioning this special edition, AHS wanted to contribute to a growing body of knowledge regarding integrating health services and integrated care.

But how to define integration? While we are challenged by a lack of one common definition, there are relative agreements on what integration is not. Patients' and their families experiences in healthcare are often characterized by fragmentation, duplication and system or care gaps. What readers will see in this special edition is that integration is a framework – a lens that can be systematically applied to better link patients/clients, healthcare providers and services. Informing this framework are a number of foundational tools and progressive approaches: creating an operational definition (Kodner; Suter et al.); critical roles for information management (Protti) and knowledge management (Scott et al.); new roles for healthcare leaders as "change leaders" (Silversin) within modified governance structures (Smyth); and the importance of using rigorous improvement methodologies (Murray).

Then, what about the how – how can complex healthcare systems effectively undertake new ways of delivering services that result in a better patient/client experience, improved clinical outcomes and results on investment? Readers will also find in this special edition a wealth of experiential knowledge that demonstrates some of the challenges and successes in integrating health services. Examples are provided related to improving access and organizing the care continuum through a number of initiatives: integrated stroke and cardiac care; exploration of various clinician roles, for example, a pharmacist-managed clinic; a systems approach to chronic disease management and prevention; and a community-based approach to medication reconciliation.

Collectively capturing and sharing the key learnings from healthcare leaders and practitioners directly involved in this work not only helped to advance our organizational knowledge about what works and doesn't work. It also helped to break down the "integration silos" that often result from taking on very targeted quality improvement initiatives, thereby preventing missed opportunities for a broader spread of proven methods and innovative solutions.

This edition brings together a mosaic of voices that will hopefully stimulate broader and ongoing conversations with clinicians, researchers, administrators and patients to improve the healthcare system within Canada and beyond. The opinions herein are those of the authors and researchers cited.

We hope you enjoy this special edition on healthcare system integration and find it helpful in your own quests to improve the quality of healthcare services for the patients/clients you serve. As AHS continues to evolve as a renewed provincial healthcare organization, we will surely be adding to our integration journey! Stay tuned!

About the Author(s)

Dr. Jodi Abbott
Quality Performance Improvement

Michele Zielinski
Executive Director
Clinical Practice Improvement


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