DLSPH Blog – Integrating Health Systems because the Future of Health Care is Local

March 23/2018


The DLSPH Blog is a digital platform that will explore issues that impact public health and health systems scholars on a biweekly basis written by Interim Dean Adalsteinn Brown in collaboration with DLSPH faculty, staff and students. For blog ideas, feedback or comments, contact: communications.dlsph@utoronto.ca

The majority of healthy living activities and disease prevention decisions happen outside of the hospital. That’s why health services and policy researchers are forming innovative partnerships with health service providers and managers, public health and community leaders with a shared vision of healthier communities and health system transformation.

Health systems around the world are struggling with the twin pressures of growing disease burden and rising costs. Although the structure and style of response to these pressures vary, there are three common approaches across these efforts:

  1. Moving upstream to focus on health behaviors and community-based health care
  2. Governance structures that integrate care across sectors around the patient
  3. Empowering patients in health care decision-making and self-management

The Dalla Lana School of Public Health is working with local communities to explore new models of care that incorporate one or more of the above approaches. By engaging municipalities, health care planners and providers, public health units, researchers, patients, and others, the DLSPH is developing innovative partnerships that bring together leaders from multiple sectors to improve health in their communities.

Two communities where the School is supporting this work are Barrie and East Toronto. While the issues facing these communities vary greatly, they both take a community engagement approach where researchers are working with local organizations to address real-world problems and drive system-level change:

  • Healthy Barrie is a collaborative that brings together leaders from the community (including the City, public health, primary care, and researchers) to explore how they can align their work to better address complex health issues in the community.
  • The East Toronto Integrated Health Service Delivery Network is an initiative of the Toronto Central Local Health Integration Network (LHIN) to bring together health service providers and health care organizations in East Toronto to explore how local health services could be better coordinated to improve patient care and patient experience.

Barrie is a community with a dynamic mayor who is fully invested in the idea of redesigning the city to support healthy living. In November 2016, the Healthy Barrie project launched as a living laboratory to study, change and improve public health and primary care through city transformation. Healthy Barrie is a partnership between the City of Barrie, the Barrie and Community Family Health Team, the Simcoe-Muskoka District Health Unit, the Family Medicine Teaching Unit at Royal Victoria Hospital, and DLSPH, with a shared goal to affect community change.

The goals of Healthy Barrie are to promote collaboration and multi-sectoral action, address complex issues that go beyond scope and capacity of one single organization, and create opportunities to both drive systems change and learn from the community.

DLSPH researchers are helping Healthy Barrie partners develop shared a vision and action plans that go beyond what any one individual organization could do on its own. This is in response to a growing recognition that complex health issues like chronic disease management, mental health, addictions, and healthy living do not belong to a single organization.

The collaborative has explored multiple facets of city planning including transportation, food and housing to reduce chronic disease, mental health and help citizens incorporate physical activity into their everyday lives. For example, Healthy Barrie is developing plans to tackle physical inactivity through neighborhood design, transit and school interventions.

Closer to home, the Toronto Central LHIN is testing a variety of care integration options in the Toronto East sub-region, which covers the area between the Don Valley and Warden Avenue, from the Beaches up to Eglington. The goal is to improve coordination of health services and create an accessible and seamless, positive patient experience that empowers people to live healthy lives. By shifting from fragmented silos towards a coherent system that addresses the whole picture, patients will be able to navigate between services more easily.

Susan Fitzpatrick, Toronto Central LHIN CEO

Susan Fitzpatrick, Toronto Central LHIN CEO

This will be accomplished through shared accountability agreements that ensure all patients have access to local health care, including primary care and community-based services. The Toronto Central LHIN CEO Susan Fitzpatrick describes this opportunity as one that brings multiple partners to the table to test new incentives and measures of accountability that focus on improving the health outcomes and experience of citizens.  The work is guided by a “one team” or “one system” philosophy.  DLSPH is helping facilitate the process, which is in its early stages, but exciting work is underway in the Toronto East sub-region that leverages grassroots efforts to improve patient awareness, navigation and access to health services across east Toronto.

The value that DLSPH brings to these partnerships is a focused population health, social determinants of health, and health equity lens combined with health system and policy strategy. By developing meaningful local partnerships with municipal governments, community hospitals and local health units, the DLSPH is supporting health system integration and preventing disease by enabling entire communities to lead healthier lives.

– Professor Adalsteinn Brown, Interim Dean, Dalla Lana School of Public Health & Dalla Lana Chair of Public Health Policy, in collaboration with Patrick Feng, Healthy Barrie project manager.