Category: Social Work in Health Care

Former Deputy Minister, Dr. Bob Bell talks about the relevance and role of LHIN’s, in the context of potential axing as a cost saving measure.

From District Health Councils to the LHIN’s our decades struggles on how to manage health governance continues.  The 10 minute discussion on CBC is worth a listen.

 Show host graphic

Ottawa Morning with Robyn Bresnahan

 In defense of the LHIN

Jan 18, 2019

The CBC has learned province is putting Ontario’s fourteen regional health agencies on the chopping block. Bob Bell, former deputy minister of health and long-term care, is with us.

Federal efforts to “consider” bridging national: research, practice, policy, in Health Care

While the report by Drs. Danielle Martin and Pierre-Gerlier Forest plays down the actual answers to the problems of  the lack of coherence in national organizations to advance and change health care, their efforts to advocate for cohesion by framing the efforts for these evidence developing organizations as a suite is “refreshing.”  Clearly the devil is in the details but its important that the federal government places itself as having a critical role in contributing to research, practice, policy in Canadian health care.

The suite is listed here, in chronological order of founding:

  • Canadian Centre on Substance Use and Addiction (CCSA)
  • Canadian Agency for Drugs and Technologies in Health (CADTH)
  • Canadian Institute for Health Information (CIHI)
  • Canadian Foundation for Healthcare Improvement (CFHI)
  • Canada Health Infoway (Infoway)
  • Canadian Patient Safety Institute (CPSI)
  • Canadian Partnership Against Cancer (CPAC)
  • Mental Health Commission of Canada (MHCC)

… The PCHOs are self-governed, non-profit organizations. Although the federal government provides the majority of their funding, they operate as arm’s-length bodies. They were set up between 1988 and 2007 to respond to disparate health policy issues affecting the country. …

“Fit for Purpose: Findings and Recommendations of the External Review of the Pan-Canadian Health Organizations – Summary Report”

… A vision for 21st century health systems

The terms of reference for this review made it clear that there is a pressing need for the PCHOs to help citizens, providers, administrators, and policy makers address the vulnerabilities of today’s health systems. These vulnerabilities include issues related to fragmented and inadequate pharmaceutical policy; the need for robust health data governance and digital infrastructure; the desire to scale-up successful health innovations; the need to modernize the basket of publicly funded services to promote equity; the critical importance of strong primary care systems across the country; the need for more meaningful patient and public engagement in health care; and the imperative of working in partnership with Indigenous organizations and communities to improve Indigenous health outcomes.

But beyond the vulnerabilities of today, a successful PCHO suite must be designed to support the emergence of health systems of the future across Canada. Therefore, before recommending a future set of PCHOs, we endeavoured to understand what these 21st century systems will look like. A consensus vision emerged both across the country and in Canada’s international commitments. It is clear that Canada’s future health systems must be shaped by federal government partnership with the provinces and territories, as well as with Indigenous partners. The need to balance local and regional priorities against the need for a shared architecture and framework across Canada’s health systems will be ongoing. But there is also a set of global trends and an emerging international consensus that will set the broader context for health system reform.

The World Health Organization’s model of Integrated, People-Centred Health Services, endorsed by countries the world over – including Canada – is presented as the framework to guide Canada to 21st century health care. It puts people at the centre of the health system and promotes care that is universal, equitable, and integrated. The framework emphasizes a seamless connection to other sectors, notably those focused on the social determinants of health. This framework also promotes providing a continuum of care that requires high-performing primary care.

Learning health systems are also an essential foundation for effective health systems of the 21st century. Their goal is patient care that is continuously informed by the meaningful use of data, evidence, and research, with research and practice connected through a continuous feedback loop. This vision requires fully electronic and inter-operable health systems in which data are collected, openly shared, and accessed quickly and efficiently. …

See the report here


When a progressive model of community based care looses its values, in the name of VALUE

British experience shared by Alex Fox, with the impacts of the  use of “lowest bidder” on client community based care.

… This was not what was envisaged by disabled people and their families who developed personalisation, which was the idea that people would plan the most effective care and support when they were in control of an individual planning process which started with what a good life looked like, not with a list of low-cost services. Planning creatively in this way enables people to make best use of their own capacity and of the family and community resources available to them. That also usually results in the most independence and lowest overall cost to the state, whereas narrow price-focused processes bring missed opportunities for independence, or lead to family care breaking down. But instead of people planning a life, and then choosing the support they need to live it, care providers now compete for the individual, and an algorithm makes the choice. …

see the article here

Survey “Hospital Discharge for Patients Experiencing Homelessness.”

From the  Community Workspace on Homelessness – “an interactive space for communities and by communities!”

Profile image for Canadian Observatory on Homelessness.

If you are a professional whose work relates to homelessness, please consider completing this anonymous 3-minute survey titled, “Hospital Discharge for Patients Experiencing Homelessness.” This research is being conducted by Dr. Kristy Buccieri, Assistant Professor at Trent University, to better understand professional opinions on discharge planning for patients experiencing homelessness. For further information, please contact


Shifting health care focus to include, “care givers”

From the Change Foundation

“Our health care system is dependent on unpaid caregivers. And the reality is that these caregivers are often not recognized or respected for the role they play. At best, there is an inconsistent approach to family caregivers. In many cases, they are not even considered as key members of the care team.”
The Change Foundation
Out of the Shadows and Into the Circle

The Change Foundation’s new strategic plan, Out of the Shadows and Into the Circle, builds on past work focused on improving experiences for patients and family caregivers as they move across Ontario’s healthcare system. Although many ideas and trends were evident during our previous work, there was one consistent theme: the vital, yet often unrecognized, role of informal or family caregivers in the system. We are committing to shining a light on this area. Based on what we know already, we believe that valuing and recognizing family caregivers as integral members of the health care team should be an urgent focus for our health system.

Download Out of the Shadows and Into the Circle.

Our strategic goal: to improve the experience of family caregivers as they help their family members transition through and interact with Ontario’s health and community care systems.

Research tells us that most Ontarians have been or will be a family caregiver at some point. Twenty-nine percent of the provincial population – or 3.3 million people – provide some form of support, assistance, care or enrichment to a family member or friend. Both women (53%) and men (47%) in Ontario take on caregiving roles.

We believe, that by recognizing, facilitating and supporting the role of the family caregivers, we can improve patient experience, coordinate care more effectively and create an environment in which the highest quality health care can be delivered. This plan was developed with input, insight, and ideas from over 100 people, including our Strategic Plan Renewal Working Group, our Sounding Board and TCF’s citizen’s panel, PANORAMA.

Our agenda will evolve and flesh out in the first year, The Change Foundation will focus on listening and learning to better understand the family caregiver experience as part of the patient experience and to identify promising models or initiatives for effective and collaborative engagement between family caregivers and providers. This exploratory work will help us scope out and identify our specific projects and policy work that will be the focus in the remaining years of the strategic plan.

15 % of the population is elderly
29 % of Ontarians provide some form of caregiving support
48 % of family caregivers are looking after parents or in-laws
30 % of caregivers are part of the “sandwich generation” of Ontarians provide some form of caregiving support

Key work:


We will use the framework to illustrate how the focus of the Foundation fits within the big picture and the important work of other organizations. This will help us identify where our focused contribution will have the biggest impact.


We will ask: who they are, what they need, who is helping them and how they are helped, what are common challenges for all family caregivers, what are unique challenges for sub-groups of family caregivers.


We want to learn more about the challenges that family caregivers encounter when they interact with providers and the health and community care systems and in particular, we want to learn more about the issues facing diverse and multicultural families. We will also engage with providers to understand their frustrations with the status quo.


We will develop an engagement plan to best listen and learn family caregivers, patients, providers and system representatives as we further define and implement our strategic plan.


We will undertake a systematic review of the literature and informally published reports and documents to learn more about innovative initiatives within Ontario and in other jurisdictions where providers and organizations are collaborating with family caregivers and patients for mutual benefits. We will use this reconnaissance to shape and identify our priority initiatives.


We will also monitor efforts in other jurisdictions to join-up and better integrate health and community care given how this integration can help to improve the experience of family caregivers and patients.

Read our new strategic plan.

Resource to consider evidence informed approaches to “the work” of health care

This … dare I say pithy focus through articles on our health system attempts to bridge academic writing to the worlds of both patients and the front line.  The search for better practices continues!

Why We Need More Canadian Health Policy in the Media is our fourth in a series of eBooks, bringing together opinion-based commentaries on pressing Canadian health policy issues from Evidence Network’s more than 80 Canadian and international academic experts. Why do we do this? To make sure the evidence matters.Why We Need More Canadian Health Policy in the Media


(BTW, you have to dig a bit to find the pdf rather than links to the other sites where you can download)

Paper explores service users views of the Social Model of Disability in Mental Health

British paper “exploring the views of mental services users/survivors and disabled people about how they felt mental health issues were understood in society and how they themselves understood them” 

From Mental Illness to a Social Model of Madness and Distress.

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… While divided about the social model of disability, most service users who took part in the project feel that social approaches to mental health, which take account of the whole person and wider societal issues affecting them, are the most helpful. Some feel that such social approaches need to be incorporated more widely in medical practice. Service users value an holistic or combined approach which takes account of both the individual and their social circumstances. Findings highlighted the complexity of service users’ views, their reluctance to impose monolithic interpretations on their feelings and experience and desire to take account of both personal and social issues. While some service users value some medical interventions, they draw a distinction between that and a narrow medical model and overreliance on medication.

While seeing benefits to be gained from social approaches to mental health, particularly for members of black and minority ethnic communities, they also see practical obstacles in their way. Most service users involved in the project strongly support the idea of developing discussion about social approaches to mental health issues, particularly among service users/survivors. Some feel that progress is already beginning to be made and that there is more preparedness to think in such ways among some mental health professionals. …

See the paper here: