Abstract
The COVID-19 pandemic has had a devastating impact on virtually every global jurisdiction including lives lost, economic hardships, social isolation, and limited access to health and social services, to name just a few. The pandemic has illustrated the profound limitations of current health systems, which have had to adapt and shift their ways of working to rapidly respond to the dramatic surge in demand for care as the pandemic continues to unfold. A number of opportunities for learning are now evident, and must be harnessed to ensure that Canadian healthcare systems have the capacity, are sustainable, agile, and able to rapidly respond, and proactively manage, the demands for healthcare services to support the health of Canadians.
Seven papers in this edition report on the findings of empirical case studies that document the capacity to respond to the pandemic, with particular focus on supply chain leadership, data and infrastructure, that were critical to the response in the early waves of the pandemic in each of the seven provinces – British Columbia, Alberta, Manitoba, Ontario, Quebec, Nova Scotia and Newfoundland and Labrador. Three additional papers in this edition profile the leadership strategies and care delivery approaches that must be considered to further advance healthcare services that are equitable, collaborative, and designed to meet the unique needs of every Canadian. A number of key insights from this unique collection of papers offer health leaders an impressive range of strategic opportunities to strengthen health system performance in Canada.
In the Quebec case study, Beaulieu et al. define four key features of supply chain infrastructure and processes that destabilised provincial efforts to procure Personal Protective Equipment (PPE) during the first wave of the pandemic. This paper documents the multiple and long-standing limitations of supply chain infrastructure and practices that are common to almost every provincial and territorial health system in Canada. The foundational features of health supply chain and the leadership strategies employed to manage supply destabilisation varied widely across the seven provinces and inform a way forward to advance and strengthen supply chain resilience in Canada.
Leadership structure, roles, and collaboration were found to be strategic assets that contributed to provincial capacity to respond to the pandemic. A distributed, or decentralized, leadership strategy is described in the Ontario case study, characterized by a complex leadership structure with multiple and very diverse leadership tables informing management decisions. Supply chain leadership varied widely across Ontario regions and sectors (e.g., hospitals, community agencies, public health). Ontario confronted the first wave of the pandemic with a ‘hospital-first’ strategy, which prioritized supply chain resources to hospitals in anticipation of the demands for hospital care in the early waves of the pandemic. This paper documents key lessons learned in Ontario, highlighting the importance of decision-making structures and accountabilities that need to mobilize a wide range of expertise to inform decisions, and in particular the need for supply chain expertise at provincial decision-making tables.
Leadership role clarity and centralization of leadership decision making emerged as a critical factor associated with effective management of the early waves of the pandemic in Nova Scotia. The Nova Scotia case documents the value of supply chain centralization to manage pandemic sourcing, procurement, and coordination of supply chain teams to build capacity to respond to severe product shortages. Supply chain data and digital tools, developed during the first wave of the pandemic informed supply chain decisions and processes, that enabled Nova Scotia to develop a proactive approach to support all healthcare organizations, leveraging a coordinated supply chain strategy. The Nova Scotia case demonstrates the importance of integrating healthcare supply chain expertise into decision-making processes at the provincial level.
Engagement of local business leaders enabled supply chain capacity building and opened up access to global supply chain networks in the Newfoundland and Labrador case study. In this province, an integrated leadership structure was already well established, and served as a strategic asset able to support Newfoundland and Labrador’s pandemic response. The highly integrated leadership approach to pandemic management was inclusive of all health organizations, which prioritized equity in the distribution of resources to every health organization in the province (e.g., hospitals, long-term care, community agencies). Collaborative partnerships with businesses across the province mobilized access to global supply chain networks to source critical products such as N95 masks, gowns, and gloves. A coalition between health leaders and a taskforce of business leaders in NL (TaskForceNL) was instrumental in the sourcing of necessary PPE to support health organizations, while domestic manufacturing of PPE was also a highly successful outcome of this coalition with the business community. This case highlights the value and impact of collaborative partnerships, afforded by a highly integrated provincial leadership strategy to ensure healthcare supply processes were equitable, and supply chain expertise assumed a critical role at provincial decision-making tables.
In the British Columbia case study, Zhang et al. describe a well-established emergency management infrastructure, which offered a strong leadership platform with established experience in managing crises such as provincial wildfires. The critical importance of early and proactive decision making was crucial in supporting the pandemic response across the province. In addition,
Adaptive, collaborative and dynamic leadership strategies were described by Metge et al. in the Manitoba case study, highlighting the evolution of pandemic response strategies that successfully avoided significant shortages of PPE in this province. The leadership approach in Manitoba was able to achieve the development of a ‘digital network’ to mobilize health system and supply chain data to inform leadership decisions. A rudimentary provincial ERP system that combined seven ERP systems under one data platform, made it possible for teams to design and mobilize digital intelligence tools to track, analyze, and display supply chain data across the province. Manitoba was also able to leverage this data to inform domestic production of critical supplies – such as reusable gowns and testing swabs by local manufacturers to overcome critical product shortages.
The strategic importance of digitally enabled supply chain infrastructure was best illustrated by the Alberta case study. Alberta was unique to all other provinces, due to its provincial digital infrastructure, which enabled a robust pandemic response informed by supply chain data
Three additional papers in this issue offer important evidence and insights into strategies to further strengthen care delivery approaches to better serve Canadians’ health needs.
Equitable access to health services is profiled in the study by Hiscock et al. which documents the barriers that continue to be experienced by Indigenous people across Canada. The use of Indigenous Patient Navigators (IPNs) is presented as a strategy to support navigation of the healthcare system to reduce barriers and support culturally safe care for Indigenous patients and their families. Indigenous Patient Navigators provide the support needed by Indigenous people for understanding and navigating care and treatment plans, but they are also essential for patient advocacy, honouring Indigenous culture and values. Hiscock and co-authors describe the wide variation in the number, roles, and range of healthcare facilities that IPNs are operating in, with some IPNs operating within more narrow healthcare programs such as cancer care or diabetes care. Opportunities to improve and strengthen equitable care delivery for Indigenous people are highlighted as a strategy to strengthen equitable healthcare services that are well-positioned to meet the unique cultural needs of Indigenous people in Canada.
Community-based care delivery is described in the paper by Manis and co-authors. This paper describes the value of the community hub model of care, in building community connections and community-informed service delivery. Four streams associated with a community hub model of care are profiled, including chronic disease management, mental health and addictions, family and reproductive health, and seniors’ care delivery approaches guided by citizen governance. Community needs are considered central in decision making in these care approaches. This paper profiles opportunities to strengthen community-informed, integrated, and coordinated community care models that support the health and social care needs of communities, guided and informed by the communities these models are designed to serve.
The value of collaboration is a pervasive theme evident across all of the papers in this issue. The paper by Morassei and co-authors documents the gap in evidence and knowledge of collaborative frameworks to support the development of interprofessional collaboration in the hospital sector. A framework for interprofessional team collaboration in an Ontario hospital setting is proposed, which defines the six core competencies of collaboration: shared decision-making, interprofessional values and ethics, role clarification, communication, interprofessional conflict resolution, and reflection, each of which have associated definitions and behaviours. As Canadian health systems advance and strengthen their capacity and ability to respond to patient care demands, collaboration will undoubtedly be a central feature of care delivery well into the future.
Canada is at a crossroads, faced with profound challenges in performance and sustainability of the healthcare system, managing unprecedented demands for healthcare services now and well into the future. These papers offer an evidence-based approach to advancing and strengthening the foundational features of health system leadership, new models of equitable care delivery, and digitally-enabled supply chain infrastructure that creates transparency and flow of data to every citizen and every provider team, to enable data-driven decision making that can build and strengthen the confidence of every Canadian to support and guide their journey to health, wellness, and quality of life.
Footnotes
Dr. Anne Snowdon is a Professor of Strategy and Entrepreneurship at the Odette School of Business, University of Windsor, the Vice Chair of the Board of the Directors for Alberta Innovates, member of the Health Futures Council of Arizona State University (ASU), and the Chief Scientific Research Officer for HIMSS. She leads an extensive program of research on healthcare supply chain and Digital Health, and is an Adjunct Faculty at the Department of Computer Science at the University of Windsor.