title: Transforming Regions into High-Performing Health Systems Toward the Triple Aim of Better Health, Better Care and Better Value for Canadians.
abstract: A study on the impact of regionalization on the Triple Aim of Better Health, Better Care and Better Value across Canada in 2015 identified major findings including: (a) with regard to the Triple Aim, the Canadian situation is better than before but variable and partial, and Canada continues to underperform compared with other industrialized countries, especially in primary healthcare where it matters most; (b) provinces are converging toward a two-level health system (provincial/regional); (c) optimal size of regions is probably around 350,000-500,000 population; d) citizen and physician engagement remains weak. A realistic and attainable vision for high-performing regional health systems is presented together with a way forward, including seven areas for improvement: 1. Manage the integrated regionalized health systems as results-driven health programs; 2. Strengthen wellness promotion, public health and intersectoral action for health; 3. Ensure timely access to personalized primary healthcare/family health and to proximity services; 4. Involve physicians in clinical governance and leadership, and partner with them in accountability for results including the required changes in physician remuneration; 5. Engage citizens in shaping their own health destiny and their health system; 6. Strengthen health information systems, accelerate the deployment of electronic health records and ensure their interoperability with health information systems; 7. Foster a culture of excellence and continuous quality improvement. We propose a turning point for Canada, from Paradigm Freeze to Paradigm Shift: from hospital-centric episodic care toward evidence-informed population-based primary and community care with modern family health teams, ensuring integrated and coordinated care along the continuum, especially for high users. We suggest goals and targets for 2020 and time-bound federal/provincial/regional working groups toward reaching the identified goals and targets and placing Canada on a rapid path toward the Triple Aim.
authors.affiliation: CCFP, FRCPC, FCFP, Medical Advisor, Clinical Governance, Institut national d'excellence en santé et en services sociaux (INESSS), Director of Global Health Programs, Department of Family Medicine, McGill University, Montréal, QC.
authors.forename: Yves
authors.initials: Y
authors.lastname: Bergevin
authors.affiliation: Clinical Research Assistant, Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, QC.
authors.forename: Bettina
authors.initials: B
authors.lastname: Habib
authors.affiliation: Improvement Analyst, Canadian Foundation for Healthcare Improvement, Ottawa, ON.
authors.forename: Keesa
authors.initials: K
authors.lastname: Elicksen-Jensen
authors.affiliation: Vice-President, Canadian Foundation for Healthcare Improvement, Ottawa, ON.
authors.forename: Stephen
authors.initials: S
authors.lastname: Samis
authors.affiliation: Jean Rochon, MD, LL.L, DrPH, Medical Advisor, Institut national de santé publique du Québec (INSPQ), Emeritus Professor, Université Laval, Associate Professor, Université de Montréal, Montréal, QC.
authors.forename: Jean
authors.initials: J
authors.lastname: Rochon
authors.affiliation: Jean-Louis Denis, PhD, Professor, Canada Research Chair in Health Systems Governance and Transformation, École nationale d'administration publique (ENAP), Montréal, QC.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Denis
authors.affiliation: Vice-President - Science and Clinical Governance, Institut national d'excellence en santé et en services sociaux (INESSS), President of the Canadian Association of Health Services and Policy Research (CAHSPR), Clinical assistant professor, École de santé publique de l'Université de Montréal, Associate professor, Université de Sherbrooke and McGill University, Montréal, QC.
authors.forename: Denis
authors.initials: D
authors.lastname: Roy
mesh_terms: D002170:Canada; D003256:Community Participation / Q000379:methods; D018166:Health Care Reform / Q000458:organization & administration*; D006293:Health Promotion / Q000458:organization & administration; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D007256:Information Systems / Q000458:organization & administration; D007857:Leadership; D015279:Organizational Culture; D058996:Quality Improvement / Q000458:organization & administration; D011787:Quality of Health Care / Q000458:organization & administration*; D012040:Regional Health Planning / Q000458:organization & administration*; D013222:State Medicine / Q000458:organization & administration*; D018511:Systems Integration; D013997:Time Factors