Governing the Primary Healthcare Home


If healthcare is to be “people-centered”, as it must be, every Canadian will have to have a primary healthcare home, a place where s/he is known and can confidently seek help with problems large and small that bear on his or her health, broadly defined. It doesn’t take much imagination to generate an image of such a home. Take the old-fashioned family physician’s office, add a number of others so its services cover a broader spectrum and are available 24/7 – more physicians, some nurse practitioners, nurses, home care providers, a pharmacist, physio- and occupational therapist or two, a dietitian, psychologist, social worker, and some office staff – and you have it. The family health teams that have been developing both spontaneously and with government support since the dawn of the 21st century form a pretty good nucleus. Community Health Centres (CHCs) have been in place longer and are all but there, particularly in relation to their governance/leadership by Boards of Directors drawn from the populations they serve.

Hospitals, another provider of public healthcare services, have been led by community Boards for many years; they still are in some Provinces. In others their governance is by publicly appointed Regional Health Authorities. The prime function of governance is to ensure that the organization operates in accordance with a clearly defined set of values toward the achievement of a specified mission and within the framework of an agreed-upon strategic plan. But it is also a fundamental principle that the organization concerned should be intimately connected to the community it serves, that it is kept aware of the community’s or region’s particular cultural characteristics and needs, and, most importantly, has through the members of its Board of Directors, a ready channel of person-to-person, non-bureaucratic communication with patients, families, and the community as a whole. The goal of making healthcare services people-centered requires many changes to the current ‘system’ but none is more important to the establishment of primary healthcare homes than giving people a voice in the leadership of the teams that provide them with primary medical, home and community care.

Although public governance is well-accepted in hospitals, Canada’s system of primary medical care provision has been for a long time one of public funding for private provision of services —most doctor’s offices function as small businesses. Physicians have traditionally seen their main accountability as being to their patients. The idea of being governed publicly is a relatively new one for doctors, but the addition of other doctors, nurses, and other publicly (and conceivably some privately-funded) providers to the team makes the need for visible answerability to the community more pressing.

How should that answerability be best achieved? The answer to that key question is best found in the partnership between each primary health team’s professional members, its physicians, nurses, and other providers and those members it serves, patients and families who have registered with the team or perhaps even with more than one such team in a defined region. A one-size-fits-all prescription for primary care with its mandate expanded to include home and community care is almost certainly unable to meet optimally the needs of Canadian communities and of teams in all their diversity. But if primary healthcare services are to be genuinely people-centered, the teams that provide them should be governed by the people they serve.

Authored by members of the Queen’s Health Policy Council:

Don Drummond
Chris Simpson
Duncan G. Sinclair
David Walker
Ruth Wilson

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