Point of Care Integration

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OUTSTANDING CARE EVERY PERSON, EVERY DAY

• Point of Care Integration
• Driving Transformation
• BRIDGES Conference 2014
• Thursday March 27th, 2014

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A Debate About Reform and Which Road is Best
Steadfast Despite Political Context
Structural Reform?
Layered On?
Point of Care Functional Integration
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Point of Care Integration
Building inter sectorial, inter-organizational,
inter-professional teams at the point of care
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One Client One Team

• A Perspective On Lessons Learned From A Regional
  Partner

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Flip Our Thinking
Ground The Approach
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Delivering integrated care requires integrated
action within 3 key domains
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3
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At home, in the community
Acute, CCC or Rehab
When necessary, the transition
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Multiple Integration Initiatives

• Aim One client, One team

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Point of Care Integration
Virtual Ward
Kids with Medical Complexity
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Point of Care Integration
Palliative Care
ICCP Older Adults
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Point of Care Integration and Alignment with
BRIDGES

• Integrated Home Based Primary Care
• (IHBPC)

IMPACT Plus
Integrated Community Care Team (ICCT)
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Stop, Take Stock and Reflect

• Principals to Guide Integration

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Deliberately being openDeliberately responding
differently
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I meet with my ICCP care coordinator every two
weeks or so She speaks with my doctor. This is
the first time the doctor ever came to my home.
Client
The Coordinator works with other professionals
to collect information, so I just have one person
to contact. It saves me time. Primary Care
Physician
Point of Care
The cross-sector care we now provide is
improving the patient experience - as witnessed
by shorter lengths of stay and improved patient
satisfaction scores within these patient groups.
Acute Care Partner
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Incremental Build
Maturity Reached Over Time
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Walk a Mile or Two
How can we work together differently? What do I
need to do differently?
How can we understand and experience different
perspectives? How can we all work together on
what is most important to the client/family?
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Opposing NotionsTensions
Integrated Solutions
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Need For Scientific Evidence And Outcomes With
Quality Improvement Frameworks For Complex And
Disruptive Change Processes

• Balance

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Demonstrating Value Less Talk And More Delivery
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Do not wait for complex solutions
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There is no script
Lead Through Ambiguity
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Relationship Will Determine Success
Trust Will Determine Success Safe Shared
Accountability
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Leadership Leaderful
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Lift Up, Look out
and Honour the Past
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Thank You
Jodeme Goldhar Lead, Health System Integration
for Complex Populations and Primary Care