What would happen if we asked 500 family doctors, 1000 citizens and 50 health system experts to redesign primary care?
In 2013 and 2014, I was privileged to lead a team that did just that in Canada’s third-largest city, where almost 20% of residents do not have a family doctor. Over 8 months, we brought 350 GPs and health authority staff together to answer a simple question: “what can be done to improve primary care relationships, so that more people can have a family doctor?” What started with a simple question is leading us to a new era in health care.
Using this question as our focus, we held several dialogue sessions that included over 300 family physicians and health authority staff. Through these, we generated 250 pages of data, from which we extracted 22 ideas for making the family doctor’s office more efficient and better connected to the wider health care system in BC. Then we circled back to all 800 local GPs to see which of these interventions were most practical, to create a shorter list of ideas with great promise.
Once we knew what doctors thought would be possible, we asked patients – citizens – what they thought of those ideas. Again using the theme of relationships, over 1000 citizens filled out an online survey to assess the physician-generated ideas. We created a separate process for vulnerable groups (urban Aboriginal families, newcomers, seniors and others) to participate through a dozen in-person kitchen table events.
It would be unfair to promise patients the moon, so we asked them to assess the extent to which the ideas generated by health system experts – including family doctors – would address their needs, and what trade-offs people would make so that everyone could have a family doctor. We found that people were easily able to make actionable recommendations for system change when we used the lens of therapeutic relationships. For example, we found that patients place a high value on everyone having a family doctor, that they want both continuity and convenience, and would much prefer to see or talk with their own doctor’s office instead of going to a walk-in or emergency department. These are all ideas that support health system sustainability.
Through the process, we uncovered clues that will form the foundation for the next era of primary care:
· how seniors and millenials share many preferences in the design of family practice,
· how to best engage citizens and clinicians in co-designing primary care,
· how a culture shift among primary care providers will form the foundation of a primary care system that can enable everyone to have a family doctor
From this work, a few of us have created a new organization to implement the vision of hundreds of family doctors and thousands of patients. The Vancouver Citizens Health Initiative brings patients and providers together to co-create primary care settings through the lens of relationships, and an eye on convenience for citizens and work-life balance for clinicians.
Our sights are set on developing a model of whole-person, collaborative care that is sustainable within fee for service, while doing everything we need primary care to do for patient, provider and community health. Our preliminary business case shows that our primary care clinics can achieve twice the capacity, offer more convenient and timely access, and work upstream, supporting patients to address their social determinants of health. You can check our progress at www.vanchi.ca, or follow us at @VancouverCHI.
It turns out that it’s easier to reimagine primary care than we thought: it starts with listening to what’s important to the people at the centre of the system!