A study by The Institute for Education Research (TIER) at UHN and the Centre for Advancing Collaborative Healthcare & Education (CACHE) explores how health care leaders can balance short-term initiatives with the need for longer-term transformational change.
Primary care in Canada, the backbone of the country's universal health care system, is facing significant challenges. Notably, improving access to primary care remains a top and daunting priority.
Access can be even harder for equity-deserving groups, such as Indigenous peoples, recent immigrants and low-income households.
The nationwide Team Primary Care (TPC) initiative, a funding proposal co-led by the College of Family Physicians of Canada and the Canadian Health Workforce Network, focused on addressing these challenges by promoting interprofessional team-based approaches to comprehensive primary care as a key solution.
In team-based primary care, different types of health care workers, such as family physicians, nurse practitioners and social workers, work collaboratively to provide the right care at the right time and place to those who need it.
TPC was guided by core principles including social accountability, truth and reconciliation, psychological health and safety, equity, diversity, inclusion, accessibility and interprofessionalism.
A key partner in the TPC initiative was CACHE, a strategic collaboration between the University of Toronto (U of T) and the Toronto Academic Health Sciences Network, with UHN as the lead hospital.
CACHE works with local, national and international partners to advance education, practice, research, systems and policy to improve care. As part of TPC, CACHE provided professional development and coaching across the country in an effort to enable emerging and experienced teams to optimize their collaborative practices.
To pursue meaningful change, the team at TIER and CACHE used Principles-Focused Evaluation (PFE) to examine how the TPC principles were interpreted, applied and adapted while delivering on CACHE's commitments to TPC.
Findings from this evaluation indicated that leaders working on health care reform need to balance two competing goals: the need to meet immediate project deadlines while fostering meaningful, long-term change. These competing goals require a delicate balancing act between fast and optimal.
To mitigate this challenge, the study recommends an approach coined "organizational critically reflective practice." This method encourages teams to continuously learn, balance key values, and adapt, continually re-grounding in guiding principles for the work.
This practice involves recognizing knowledge gaps and challenging harmful practices through the following steps:
- Understanding how principles are interpreted by all team members early on;
- Reflecting on current practices and including perspectives that may be overlooked;
- Determining shared goals and regularly reassessing the potential harms of haste during the process.
"We hope that organizations undertaking major health care reforms will use these insights to prioritize early and ongoing critical reflection and learning, ultimately leading to more meaningful and lasting improvements in the health care system," says Dr. Stella Ng, senior author, Director of CACHE, a scientist at TIER and an associate professor at U of T.
The authorship team consists of CACHE team members as well as contributors who joined specifically for the TPC initiative.
This work was supported by Employment and Social Development Canada, the Foundation for Advancing Family Medicine and UHN Foundation.
