1. Patient Centered, Community Designed, Team Delivered A framework for achieving a high performing Primary Health Care system
Saskatchewan has embarked upon a consultative process to strengthen our primary health care system to better serve the needs of patients, health care providers, and communities.
This process is building on current successes, adapting best practices from other jurisdictions, and engaging all stakeholders.
The strengthening of primary health care represents a fundamental shift in how our health system works.

2. Primary Health Care - Objectives
Develop a draft framework on the approach to strengthening and progressing Primary Heath Care in Saskatchewan.
Engage in consultations with stakeholders to affirm direction of the framework.
Test new models of primary health care delivery while progressing PHC across the province.
The work of strengthening PHC is currently seen as three big initiatives:
The draft framework has been developed.
We are currently affirming the direction of that framework with you here today!
We plan to implement the framework in a “learn by doing” approach by testing new models in a few sites while continuing to progress across the province.

3. Governance Structure for Framework Development
How did we develop the Framework?
A special two-day forum was held in September 2010 in which 50 community leaders, patients, providers, and regional health care authorities developed a new vision and aims for primary health care.
This led to the creation of three working groups which focused on the key areas of primary health care that the Forum said needed to be strengthen: Community Engagement, Interdisciplinary Team Development (focussing on Chronic Disease Prevention and Management), and Physician Engagement. These working groups developed the base concepts for enhancing primary health care and a Core Team reviewed these findings and shaped the draft report: A Framework for Achieving A High Performing Primary Health Care System in Saskatchewan.

4. Saskatchewan’s Vision and Aims for PHC
Primary Health Care is sustainable, offers a superior patient experience and results in an exceptionally healthy Saskatchewan population.
Major Aims
Access
Everyone in Saskatchewan - regardless of location, ethnicity, or ‘underserved’ status - has an identifiable primary health care team that they can access in a convenient and timely fashion.
Patient & Family Experience
A model of patient and family centered care has been implemented to achieve the best possible patient and family experience.
Healthy Population
The primary health care system has contributed to achieving an exceptionally healthy population with individuals supported and empowered to take responsibility for their own good health.
Reliable, Predictable & Sustainable
We are achieving reliable, predictable and sustainable delivery of primary health care.
This is the vision and aims that have been identified for Primary Health Care in SK
You will note the IHI “Triple Aim” – the balance of patient experience, population health and sustainability. We have added an enhanced emphasis on access, which is seen as part of patient experience, but we know it is something that SK people say needs focused attention. 4

5. Framework Recommendations
everyone connected to a PHC Team
services designed with patients & community
culturally responsive system: First Nations & Métis
flexible approach to service design & team composition
coordinated system of family physician practices, RHA managed services & First Nations system
flexible funding, with an accountability framework
Everyone has access to a team – team includes a family physician and helps the patient navigate the rest of the system
Services designed with and for communities and patients to meet their needs
Culturally responsive system and a workforce that reflects the patients
Flexibility in service delivery model design and team composition to meeting the needs of the community and build on their assets and resources
A SYSTEM that includes independent family physicians, RHA services and the federally funded first nations delivery system
Flexible funding with an accountability framework that looks at results

6. The team that delivers service
Each patient/family is a key member of their team.
Each Team includes or is linked to a family physician
Key Functions
Diagnose, Treat and Prescribe
Case Management supports self-management
Navigation and Coordination
Chronic Disease Prevention and Management
Continuous Quality Improvement
Attributes of Team
Multi-skilled Professionals
Practices evidence-based care
Practices collaborative care
Co-location is preferred
After hours access
Representative of the community
Cultural Competence
PHC Team (e.g.)
Healthcare Provider (Physician or NP linked to Physician)
Nurse Case Manager (RN or RPN)
Clerical Staff
With Access to Extended Team Members based on community need
Traditional Healers
Pharmacist
Public Health Nurse
EMT / First Responder
Mental Health Professional
Midwives
Home Care
Community Developer
Specialist Physicians
Other – not exhaustive list
Patient/family are the experts in their own health, which means that patients and families are the centre of the new system. They will share in decision making regarding their own health care needs.
There will be a flexible approach to developing teams and a number of attributes will be considered for developing teams for each patient. Every team must be linked to a physician.

7. Service Delivery Models
Multi-Community Delivery
Single-Community Delivery
Hub and Spoke Delivery
Community A
Community C
Community B
Community A
Cty B
Cty C
Cty D
Cty E
Community A
There are several basic service delivery models for consideration:
A primary health care team in a multi-community delivery system may be made of providers in communities close to each other who work together to serve their collective populations.
2. With a single community delivery models, the primary health care team serves patients and families within one urban, rural, or remote community.
3. With the hub-and-spoke model, a central health care site provides support to 'satellite' sites that are distributed throughout an area in response to community needs
Connection Options
Itinerant
Outreach (Bus)
Virtual

8. How will we do this? Build Long Term Relationships
Increase Patient and Family Self-Reliance
Engage Communities
Engage First Nations and Métis Communities
Enable Primary Health Care Teams to Flourish
Proactive chronic disease prevention & management
Build models that work
Shift focus to promoting health
Transition support
There are a number of building blocks to strengthening PHC:
Long Term Relationships at the Patient and Health Care Provider Level will create numerous benefits such as trust, increased case management capacity, long term attachment to a provider results in better health for the patient. Providers will be better able to develop programs for their patient population….Long term relationships between community leaders and health administrators builds the trust that supports joint problem solving, joint planning and joint decision making.
Increase Patient and Family Self-Reliance by providing them with the information, supports and tools to better manage their own health.
Engage Communities in the Service Model Design.
Engage First Nations and Métis Communities to build a system that provides the best possible care, access to their communities needs and interests.
Enable Primary Health Care Teams to Flourish by:
Allowing teams to design their practices and measure their own results in achieving primary health care’s major aims.
Achieve quality of life and job satisfaction for all team members.
Clarify responsibilities and commitments through agreements that delineate each team member’s role and limitations.
Use community working groups to bring all the stakeholders together periodically to ensure a collaborative approach.
Ensure funding is flexible and encourages team-based care that meets the needs of the community.

9. The Foundation: Primary Health Care
Acute Care
Emergency Care
Urgent Care
Security in EMS
Enhanced primary health care strengths the foundation of our health care system. It focuses on healthy communities, managing chronic diseases, everyday health services and after-hour everyday health services.
This focus pushes upwards to support other health care areas including EMS and urgent care.
Through this new model, we should be able to reduce pressure on emergency care and acute care services.
Healthy Community Focus
Managing Chronic Diseases
Everyday Health Services
After-Hours Everyday Health Services

10. Learn by Doing Stewardship Group Define & Champion Implementation
Indentify & Address Barriers
Lauren Donnelly
Lynn Digney-Davis
Brian Laursen Ministry of Health
Bonnie Brossart Health Quality Council
Phillip Fourie Saskatchewan Medical Association
Marlene Smadu College of Nursing, U of S
Beth Vachon Cypress Regional Health Authority
David Fan Prairie North Regional Health Authority
Sheila Achilles Saskatoon Regional Health Authority
Veronica McKinney Northern Medical Services
Paul Topola Community Representative
Betty Pickering Patient Representative
Alex Campbell Health Canada
Ray Joubert Saskatchewan College of Pharmacists
-Donna Magnusson
Brad Havervold
Andrea Wagner
Margaret Baker
Fay Schuster
Dennis Kendel
Brian Geller
Lisa Clatney Project Team and Resource People
The Test Sites will be overseen by a “Learn by Doing” Advisory Committee. A Tools and Supports Task Team will assist in identifying and developing tools and supports for testing and progressing.
Links will be maintained with other advisory bodies and working groups such as the Mobile Health Services Advisory committee, SUN Gov’t Partnership Table, the Health Canada / FSIN / Ministry of Health Tripartite Table and the SMA Primary Care Committee.
Progressing & Testing
develop tools and supports
test elements such as patient experience and navigation, community engagement, First Nations partnership, chronic disease management, PHC team development
Continue to make progress across all of Saskatchewan
Physician Engagement & Transition
develop instruments and strategies to engage physicians
identify and develop supports for transition to new models
Monitor System-wide Performance
Advise on Spread Strategies 10

11. Learn by Doing
Progressing: Stabilizing Services, Community Engagement, Physician Engagement
Innovating: focus on access and patient experience; team, workflow and space redesign & multi-community models; patient and community input; LEAN methodologies
Approach: Build, evaluate, spread

12. Strategy Deployment
2012/13 start to build a foundation that ensures patients have improved access to primary health care and an exceptional experience.
Chronic disease management will be the additional focus in 2013/14.

13. Check it out!

14. Patient Centred, Community Designed, Team Delivered
A Framework for Achieving a High Performing Primary Health Care System
Pharmacy Coalition on Primary Care Telehealth Session
“How does it affect pharmacists and where do we go from here?”
June 14, 2012
R. J. (Ray) Joubert, Registrar

15. Introduction - Objectives
Reflect on next steps and impact of PHC Re-Design on pharmacists and pharmacy practice
Strategize on becoming involved in the process, roles you can paly on teams and becoming engaged on teams
Identify tools you need

16. Next Steps - Awareness Pharmacists
Are we primary health care providers?
Chronic disease prevention and management (focus )
What is our role? Services?
Other providers and their roles?
Relationships with patients, RHAs, physicians and other providers?
Strengthen/Leverage?

17. Next Steps - Awareness Communities we serve? Service delivery models?
Multi-community
Single-community
Hub and Spoke
Connecting with teams
Colocation
Yes – itinerant?
No – outreach, virtual (technology)

18. Next Steps – Action Discuss internally, employer
Contact RHA Director of PHC
Introduction
Role
Services
Community engagement
Needs and services
Solutions

19. Next Steps – Action Tools? Compensation/funding? PAS role?
Business model – new or leverage current?
SCP Web site
RHA PHC Director contact information
PCPC Roles document
Registers – pharmacies by community/RHA
Link to Framework
Education/training (CPhA ADAPT, Other?)

20. Next Steps - Action Innovation sites – start dialogue with RHAs
Other sites/communities – explore opportunities

21. Part II – Discussion/Questions
How does PHC Re-Design resonate with you?
What opportunities and enablers do you see?
How do you think we should become engaged?
What tools do you need?
For those of you who are engaged, what does it look like?
What solutions do you offer?

22. Part III – Action Plan
Involvement with RHA and community needs and services assessments Solutions to meet those needs?

23. Thank you! Action plans to PCPC c/o SCP
Did this session meet the learning objectives?
Did it meet your expectations?
Travel safely!