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March 8, 2019

More effective teamwork, bold advocacy by patients and families key to preventing people from “falling through the cracks”

More effective teamwork, bold advocacy by patients and families key to preventing people from “falling through the cracks”

During a panel discussion following the March 7 public screening of the film “Falling Through the Cracks: Greg’s Story” in Saskatoon, attendees were encouraged to take a proactive role in their own health care and to push the system for better teamwork and communication. The event was hosted by the Health Quality Council (HQC) and the Saskatchewan Health Authority (SHA).

“Falling Through the Cracks” tells the story of Greg Price, an Alberta man who died in May 2012 at age 31 as a result of breakdowns and gaps in his care for a highly treatable form of cancer. The film, which is intended to spark positive change in health care, has been screened more than 150 times in most provinces in Canada and internationally as well. The Price family tours with the film to be part of the frank discussions that follow each screening.

The panel at the Saskatoon screening included Greg Price’s father David and sister Teri; Darlene Dyck, a Patient and Family Advisor; Dr. Mark Wahba, emergency room doctor and physician executive of Integrated Urban Health with the SHA; and, Dr. Dennis Kendel, interim CEO of the Health Quality Council. The panel was moderated by Beth Vachon, Vice President of Quality, Safety, and Strategy with the SHA, and board member of the province’s Health Quality Council.

The Saskatoon screening was one of only a handful to date shown in a public venue, in front of a largely public audience. Most of the other showings have been for health care leaders and providers, and for medical schools and health sciences colleges in Alberta and Ontario. 

Participants in Saskatoon submitted more than 80 questions and comments to the panel  electronically, using slido, an online Q and A and polling platform. Some common themes emerged in the discussion:

What patients can do

Darlene Dyck shared a wealth of practical things that patients and family members can do to be active members of their own health care team: 

  • Never leave an appointment not knowing who to contact if you have problems or questions afterwards, and how to reach that person
  • Learn about your rights as a patient (to have someone present at appointments, to get a second opinion, to initiate a complaint, and to access your health records) and be respectful, clear, and bold in exercising these rights
  • Start a medical binder containing your notes, test results, referral letters, and bring it and update it at every appointment
  • Ask clear questions of your providers and always start with your most pressing concern
  • Keep asking questions until you really understand
  • When you see a provider or accompany a loved one to an appointment, ask “What can I do to keep this process moving along?”

Dr. Mark Wahba suggested patients use Google to learn more about their health problem, and bring this information to their medical appointment.

“As providers, we have a new job in helping patients navigate the information that’s out there now and available to everyone. This is our job now. It’s the reality of the age we live in.”

Dr. Mark Wahba

The role of providers 

Darlene Dyck called on health care providers to recognize that they have two roles: to do their job providing care, and to improve how they do their job. “They need support and commitment from health system leaders to do that second piece.”

Teri Price, Greg’s sister, said she’s encouraged to see that the University of Toronto is looking at how to incorporate this into medical training. “Students are being trained to be physicians and also how to improve the system. Because they have a role to play in this.”

Dr. Dennis Kendel noted that there was no such thing as a “navigator” role back when he was in active practice as a family physician. This new role was created to compensate for the health system’s failure to deliver smooth continuity of care. Family doctors should be playing this role, but to do so, they need to do a better job “connecting the dots for patients” said Dr. Kendel. 

The importance of teamwork

Better teamwork is key, said Greg’s father, David. The challenge, he said, is to understand who is on that team and what goal everyone is working toward. He defines the health care team broadly, to include everyone from the Minister of Health all the way down to the receptionist in a doctor’s office.

Greg’s sister, Teri, echoed that point. “Teamwork is the foundation. Technology is part of the solution, but it’s not enough to simply swap in a new tech solution, without the teamwork. 

“In health care, we work as a team,” said Dr. Mark Wahba. “But we don’t train as a team, and we’re not trained as a team.” He likened it to assembling a hockey team, with a goalie from Prince Albert, forwards from Saskatoon, and defense from Regina, then meeting in Calgary for a game, without ever practising together. “All learners in health sciences need to advocate for interdisciplinary education,” said Dr. Wahba. “It’s in their own best interest, because once they get out of school they need to be a team player.”

Handoffs between team members are critical to safe care, said Darlene Dyck.

“Why can’t we make it so that that once a referral starts, until the next appointment is booked and the patient is aware of this, that referring physician still has the ball. That ball can’t ever get dropped.” 

Darlene Dyck

Axe the fax: Why we don’t yet have a single electronic health record

The physicians on the panel were asked to talk about examples of jurisdictions with good electronic health records. Dr. Kendel cited the unified health record he saw during a study tour to the Kaiser Permanente health system nearly 10 years ago. It included all of a patient’s interactions with primary care, and even generated an automatic email to alert patients when lab test results are available for them to review. Dr. Wahba said that in Sweden, everyone has access to all of their health records.

The barrier to implementing an electronic health record in Saskatchewan, said Dr. Wahba, is that doctors – who work in the system but function as independent contracts – the Ministry of Health, and the SHA all have to agree on one single record. “And right now…they don’t.”