Insights February 2019

Go Big, and Go Home

Shirlee Sharkey


The world is in motion. People’s needs and expectations are constantly evolving with changes in society – yet the healthcare system, for all of its strengths, has not kept pace with advances in design and technology. Whether it’s a number to call, an app for self-management, post-acute or ongoing home care, people benefit from personalized options.

We have an amazing opportunity to keep people in their own homes, but research shows that we routinely underestimate their potential for independence.

As noted in the first interim report from the Premier’s Council on Improving Healthcare and Ending Hallway Medicine, the largest driver of cumulative ALC days in Ontario is patients waiting to be discharged to long-term care (59 per cent) (Government of Ontario 2019). This frequently leads to conversations about system capacity and the need for more beds. However, merely adding more beds to the system may be an overly simplistic and costly approach. It turns out, the pathway to long-term care is often contingent on where seniors are assessed, and who conducts the assessment. Recent studies by the Canadian Institute for Health Information and SE Research have revealed that between 30 and 50 per cent of those entering long-term care could be cared for at home with appropriate support (Bender and Holyoke 2018) (CIHI 2017).

What was perhaps more surprising though, is the biggest factor influencing seniors’ admission to long-term care – more than cognitive impairment, living alone or wandering behaviour – was being assessed in a hospital setting (CIHI 2017).

Often, the issues are complex but the solutions are not.

In Glasgow, Scotland, for example, they were able to significantly alter the healthcare trajectory when they stopped assessing people’s need for long-term care during their hospital stay. Instead, patients were assessed after spending time at residential-style transitional facilities. As a result, 70 per cent more people went back home, and delayed transfers from hospital to long-term care decreased by 60 per cent (Fooks et al. 2018).

Last year, I had the opportunity to visit Denmark, a country that has nearly eliminated institutional long-term care by empowering patients and enabling elderly independence. Less than 10 per cent of seniors aged 65+ receive care in an institutional setting, and I was impressed to see how the Danes have designed and built their entire healthcare system – from highly specialized hospitals to primary care and home care – around the needs of patients.

With the changes afoot in Ontario, we have taken a bold first step to find creative and practical solutions to our challenge of hallway healthcare.

The starting point is not about having all the answers, but having confidence that we can get there through better communication, collaboration and design processes. With a vision to create a renewed, connected and sustainable healthcare system that is centred on patient needs, we have been armed with a blueprint, strong guiding principles and the requisite flexibility to integrate and customize care for people and communities.

The road has been paved; now the opportunity is ours.

About the Author(s)

Shirlee Sharkey is the CEO of SE Health. @ShirleeSharkey


Bender, D. and P. Holyoke. 2018. “Why Some Patients Who Do Not Need Hospitalization Cannot Leave: A Case Study of Reviews in 6 Canadian Hospitals.” Healthcare Management Forum, 31(4): 121–125. doi:10.1177/0840470418755408. <>

Canadian Institute for Health Information (CIHI). 2017. “Seniors in Transition: Exploring Pathways Across the Care Continuum.” Retrieved February 26, 2019. <>

Fooks, C., J. Goldhar, W.P. Wodchis, G.R. Baker and J. Coutts. 2018. “Integrating Care in Scotland.” Healthcare Quarterly, 21(3): 37-41, doi:10.12927/hcq.2018.25702.

Government of Ontario. 2019. “Hallway Healthcare: A System Under Strain.” Retrieved February 20, 2019.<


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