The Saskatchewan Health Authority’s (SHA) process of co-design is dramatically different from many other healthcare system approaches because it is community-driven to include patients, their families, Métis and other First Nations people. The First Nations and Métis were previously excluded from healthcare system discussions in Saskatchewan even though they receive nearly 50% of healthcare in Saskatchewan. This new system engages and includes First Nations, Métis and Non-First Nations people.
The SHA collaborated with the Métis and First Nations to develop a healthcare system with a clear vision of how these groups viewed the future of healthcare in their province. The main issues were providing accessibility to care, upholding a commitment of a local treaties and entering into an agreement with the highest degree of ethics.
Historically, the first interactions between Europeans and First Nations occurred when European settlers arrived in Saskatchewan in the 1600s. The European settlers were ill and malnourished. The First Nations people looked after them with care and empathy. From that moment, care became a foundation in First Nations/European relations, and it has been woven through this model.
The Métis and First Nations people believe that health begins at conception; there is a need for care from the beginning to the end of life. This people-centred healthcare model is a visual and self-perpetuating model of care with four parts:
1. Commitment (spirituality)
2. Inspiration (emotion)
3. Who are your partners? (intellectual)
4. What are your actions? (behaviour)
In 2010, there was a shift from system-centred care to patient-centred care in Saskatchewan. This model documents the paradigm shift and implementation process. It fully integrates the Métis/First Nation approach to cyclical conceptions of life and healthcare.
This model has the core values of the co-design at the centre. It represents the commitment from SHA’s board, the CEO and leadership teams to create partnerships within SHA and communities to instill a culture of care.
The SHA’s five values (safety, accountability, respect, collaboration and compassion) are in the inner circle at the centre of the model.
The secondary circle with quadrants represents each year and what will be measured for governance purposes. The respective areas are for meeting standards of care and policy objectives for each respective area.
The third circle is dynamic; the dial represents the four areas the surveys will focus on, and ensures the SHA is maintaining/developing ethical relationships internally and externally. The last circle “System Line Standards” is also dynamic and applied to surveys (for accreditation purposes) as areas of focus. The model functions on a clockwise dial. It is circular as opposed to linear because it is a never-ending and self-perpetuating cycle of survey and assessment. It mimics the human lifecycle, the Métis/First Nation style of thinking, rationalization and overall approach to life. The truth and reconciliation movement also guides the model, and it has helped to redefine the SHA as an organization. Embedded in this model are these key values:
· Physical proof that systems can change (i.e. from a linear model to a circular model)
· Change does not mean indigenizing colonial systems because the spirit cannot be colonized (derived from an emphasis on the spirituality of the treaties)
· Prevention instead of reacting to an illness or a health crisis
· Improved resources to better manage human resources and financial resources by providing tools to care for others before there is a health-related crisis
· All employees had to reapply for different positions to be included and align with the SHA’s new vision and focus
· The people working in and creating the system needed to be part of the paradigm shift. Elders and family/patient counsellors were hired and contributed to the policy development process
· The Knowledge Keeper Council interacts with the board, governance and the SHA
· Métis/First Nations are represented on advisory councils within the SHA
These values enable the SHA to listen to all communities, involve them in ongoing development as well as make the Métis and First Nations visible in the healthcare system. The SHA created a cohesive plan and foundation for patient-centred care, balanced the need for patient first/patient friendly care and committed to being “accreditation ready” for annual accreditations (instead of four-year cycles). The SHA is dedicated to teaching and empowering patient care providers to ensure care is consistent across the province, and believes that patients and families are co-producers of their healthcare experience.
Some of the challenges the SHA faced from jurisdiction and communities include:
· Positive and negative leadership/relationships with Métis/First Nation communities (i.e. a large variation in the quality of relationships across the province)
· Allocating time to build credibility, commitment and trust with multiple partners (80 bands and tribal councils) to discuss how to be active, equal partners
· Understanding the roles and responsibilities of all, and how to involve people
· Politics and intergovernmental relations
Many enabling factors worked together to create a model of care that is a culturally safe environment for healthcare across the province. This model would not be possible without 600 Patient Care Advisors. Patients and families bring their voices, visibility and passion; they are the inspiration behind putting care back into the healthcare system across the province of Saskatchewan.