The Department of Health (Health) is continuously working to renew and advance health care across the territory to meet the needs of Nunavummiut.
Health commissioned Health Intelligence Inc. to produce the Model of Care Report (Report) in 2017, following the Office of the Auditor General’s (OAG) recommendation that Health improve how it delivers services and that it regularly checks to ensure services are meeting community needs.
The term Model of Care generally refers to having the right mix of clinicians, support staff, and paraprofessionals working as a team to provide the best care possible for each patient and community. It takes into consideration the unique circumstances of a health system, the resources available, referral services, available technology and equipment, and the community’s needs and capacity.close
Health commissioned the Report to provide a full picture of how a Model of Care should look in Nunavut. To provide this full picture, Health sought more detailed recommendations from the consultant to provide the guidance needed to provide better health care for Nunavummiut.close
Since commissioning the Report in 2017, Health has focused and will continue to focus on enhancing Nunavut’s health care system. Despite ongoing capacity and resource challenges, Health has used the draft Report ¬– alongside other resources, such as community expertise, the subject matter experts, and new technologies – to inform decision-making as system-wide initiatives are developed.
As this Report focuses its review solely on community health centres, Health, in its commitment to deliver safe quality care, is using a holistic approach that also captures regional centres, physician services, out-of-territory care, as well as cultural considerations, such as Inuit employment, training, and overall community development opportunities.
The Report provides recommendations in the following areas:
- Primary health care.
- Community engagement and ownership.
- Organization structure, authority and decision-making.
- Quality of care and patient safety.
- Skilled and stable workforce.
- Digital healthcare services.
- Medical travel.
Other Canadian jurisdictions are struggling with regional and provincial health authority structures. The regional health authority structure came about in the provinces to shift care from hospital/acute care services to community, prevention and promotion services. It was intended to create efficiencies by standardizing care and eliminating administrative duplication, and to prevent and/or manage diseases to avoid progression. In Nunavut, services have historically been set up at the community level, and the standardization and efficiencies are not an issue that can be resolved through health authority structures.
The Department of Health has completed or is establishing the following initiatives to enhance health care services to Nunavummiut:
Health System Standardization:
- Establishing and standardizing baseline services across the continuum of care, such as screening programs for cancer and diabetes, and standardizing chronic disease management.
- Health is committed to supporting the role of Community Health and Wellness Committees (CHWCs) in identifying and addressing wellness needs at the community level and continues to work directly with CHWCs in implementing their Community Wellness Plans.
- Development of community-specific service plans will be considered as the clinical management teams determine how best to deliver screening, diagnosis and treatment services across each community.
- Health is working towards establishing the Health Information Unit (HIU), similar to that of other jurisdictions. The HIU collects data and provides information and analysis to inform decision-making and address community priorities. This would allow Health to examine results to enhance and improve care.
- Establishment of a territorial service utilization and monitoring group that oversees the appropriateness, access, quality, safety, effectiveness, and efficiency of the services provided across the territory and out-of-territory.
- Monitor medical travel and use the data to improve access to services. This is part of the territorial service utilization and monitoring group.
- Refine the organizational structure to better serve the functions of the health system as it evolves.
- Streamline management duties, accountabilities, and communication.
- Point-of-Care Testing (lab tests) pilot is underway. The project aims to provide additional training, skills, and knowledge for Inuit employees to perform laboratory procedures at the community level.
- The Basic Radiological Technician (BRT) program is underway. It provides Inuit Health staff with the skills and knowledge to perform specialized x-ray procedures in all Nunavut community health centres and at Qikiqtani General Hospital (QGH).
- The Educational Upgrade Program (EUP) supports capacity building and creates career advancement for Inuit Health employees. The EUP is a tiered education program that advances from Grade 12 to college certificates and diplomas, to bachelor’s degrees and beyond.
- Health offers a one-year mentorship program to Nunavut Arctic College (NAC) nursing graduates. Following successful completion of the one-year mentorship, and successful completion of the national nursing registration exam, graduates can apply and interview for nursing competitions.
- Health’s Paraprofessionals Project focuses on hiring Inuit staff in each community as a top priority of its Mental Health and Addictions (MHA) program. The Project provides an opportunity for training and growth for advanced employment through career laddering. MHA paraprofessionals improve consistency and standardization of care and provide culturally-appropriate mental health services across the territory.
- The Continuous Quality Improvement Unit has been established to reduce patient safety incidents. New policies and protocols are in place, and a new electronic incident management system is being implemented across all communities.
- Improved case management through the territorial service utilization and monitoring group.
- Health recognizes the importance of technology and new innovations to provide health care closer to home. Health now has the capacity to complete CT Coronary Angiography at QGH. A CT Coronary angiogram is an imaging test that looks at the arteries that supply blood to the heart and in some cases can detect serious heart disease before symptoms are presented.
- The expansion of MEDITECH throughout the territory continues, as does the use of telehealth.
Implementing a Model of Care takes time: The Report recognizes that health system changes take time and are part of an ongoing process that will take place over years.
The Report recognizes service delivery in Nunavut has its challenges, including:
- changes in the utilization demands and expectations of the public.
- ongoing fiscal and resource constraints.
- an aging population.
- increasing prevalence of chronic disease.
- inefficiencies in internal processes that are outside of Health’s control.
- the vast geographical coverage.
The Report offers suggestions for consideration and is not intended to be prescriptive. The Report provides a framework for dialogue and is a resource for future planning. The information in the Report may be used to inform future initiatives, innovations, and pilot projects. It may also be used to support the development of accountability frameworks, and associated system metrics. The Report offers a review of community health centres, but does not provide a review of the health system as a whole:
Health recognizes that a well-functioning health system requires a system-wide and holistic approach. While the Report is a resource for future planning, its primary focus is on community health centres. The Report does not provide considerations for other areas such as regional health centres, out-of-territory care, and specialist and physician services. The Report does not offer considerations for Inuit employment and workforce development. Health believes that efforts to modernize the health system must also consider these additional areas. The Report outlines areas of strength and areas of opportunity
The Report identifies areas of strengths and opportunity in community health centres at the time the Report was drafted. The areas to be addressed are comparable to those in other jurisdictions (e.g. diversification of clinical workforce; standardizing clinical and administrative processes; providing adequate support for health centre staff, etc.).