Ten years after first implementing Primary Health Care – a globally adopted patient- and caregiver-first model of care – a regional government wasn't seeing the expected improvements in health outcomes or lift in patient and caregiver satisfaction. Ownership for the model still rested squarely on the region, when in fact a basic tenet of Primary Health Care is ownership by all stakeholders, and in particular patients, providers, and local communities. No one else was stepping up to take responsibility beyond their own immediate concerns, and the latest patient survey was showing a step back in satisfaction, after ten years, rather than progress.
The government decided to undertake five Syntegrations aimed at aligning and mobilizing crucial stakeholder groups around a revitalized rollout of Primary Health Care and overcoming existing distrust and disconnection amongst them. Four of the five Syntegrations focused on critical aspects of Primary Health Care – Physician Engagement, Community Engagement, Chronic Disease Prevention and Management, and First Nations Care – and the fifth Syntegration pulled the output from each of the others together into one coherent strategy and established specific short- and medium-term outcomes and measures for the resulting set of initiatives.
As an example of the important progress that was made and results that were achieved, in the Community Engagement Syntegration, mayors of towns and small cities, together with practitioners and government representatives, determined that 'poaching' of healthcare practitioners between towns had to stop, and that instead communities needed to work in concert to attract resources into the entire region and share them effectively. Everyone involved came to realize how to work together for the greater good and that the Primary Health Care model was a key to being able to establish hub-and-spoke models for connecting and sharing practitioners amongst rural and remote populations. For this to work, all parties needed to buy in: community leaders, healthcare providers and government.
The First Nations Syntegration – focused on optimizing care for First Nations populations – started with skepticism about the government's willingness to undertake genuine change. The conversations that ensued, however, full of heart-breaking stories about system failures that had and were continuing to do harm, laid a new foundation of understanding and trust between the First Nations communities, government leaders, and other healthcare stakeholders.
The five Syntegrations led to a strategy for Primary Health Care that was not radically different from its predecessor ten years ago—the real difference was that this time, the approach was co-developed and co-owned by the right variety of stakeholders across the region. When the new strategy was officially launched and rolled out across the region, it wasn't just government ministers who were standing on stage to present it. This time, representatives from the medical associations, nurse practitioners, town mayors, and private physicians joined government ministers in introducing the new plan.
A senior government health director commented that she used to be the face of the Primary Health Care model, but now it is co-owned by many other faces, all of whom had a role in developing the model. After a decade of stalled progress, the region finally started to see substantial improvements along many primary health care indices.
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