Everyone wants and deserves excellence in healthcare. The last year has exposed both strengths and fault lines in local and global health and social systems, many of which are long-standing but have been spotlighted by recent events. While some issues are specific to a particular location, many common themes are emerging across countries, three of which I outline in this article. As we move forward to build on our assets and address gaps, there are a broad range of opportunities for consumer engagement, partnership, and leadership in shaping the future of quality and safety in healthcare.
Re-Imagining Models of Care
At its core, healthcare is about people, but the ways that we organize and deliver health services are not always person- or community-centred. Global experiences during the pandemic have reinforced the importance of high-performing public health and primary health care systems, as well as tightly connected and resilient health services, social care, and communities. No one knows this better than individuals whose lives intersect with different services and silos.
Likewise, care cannot be safe if it is not culturally safe. Locally and globally, systemic racism affects many aspects of society, including how different people have been – and will be – affected by the pandemic. Building reciprocal relationships, trust, and respect is a long-term effort. To become more culturally competent organizations, we need culturally competent individuals who are supported by intentional structures and effective processes.
Engagement capable organizations and systems are well-positioned to ensure that service transformations happen with not only for those with lived experience. I encourage you to read my colleague Carol Fancott’s article on this topic in this magazine.
Ways of delivering health services shifted during the pandemic out of necessity, perhaps most notably with dramatic increases in the use of virtual care. In April 2020, virtual care accounted for 35-77% of visits across Australia, Canada, and the United States.
Shifts to virtual care worked well for some, but not all. For example, access to care closer to home or community was generally welcome, while technology limitations affected access for others. In a May 2020 survey, 81-91% of Canadians reported being satisfied with their use of virtual care. That said, over half (57%) said that if they had a choice in the future, they would prefer in-person consultations as the first way to seek a doctor’s advice. The remainder preferred phone (20%), videoconference (14%), or email or texts (8%).
With more growth in virtual care in the early weeks of the pandemic than in the last several years, changes were made quickly because they had to be. Now is the time to decide which of these changes we want to embed and sustain and where we need to adjust or build capacity to more effectively and safely offer virtual care in the future. Consumer voices should inform and influence how we optimize in-person, virtual, and hybrid models of care going forward.
Supporting Essential Care Partners
In the early days of the pandemic, many healthcare organizations introduced blanket visitor restrictions to reduce the risk of disease transmission. Done with best intent, this meant that entry of essential care partners was also restricted in many cases.
Essential care partners are not just visitors. Identified by the patient/resident or substitute decision-maker, these family members or close friends provide important physical, psychological and emotional support. As active partners in care, this can include support in decision making, care coordination, and continuity of care (for example, support for minor medical procedures, feeding, ambulation, cognitive stimulation, hygiene, and medication adherence). The presence of essential care partners benefits patient/resident safety, experience, and outcomes.
Supporting safe re-entry of essential care partners in ways that recognize the important roles that they play will take a collective effort. In Canada, we’ve launched Essential Together based on co-created pragmatic policy guidance. This program now works with policy implementers to re-integrate, welcome and engage essential care partners as part of care teams during COVID-19 and beyond. Teams can access learning bundles with tools and resources, including resources developed by and for essential care partners, as well as peer learning and coaching. A foundation of patient/resident – and family – partnered care will be key to moving forward.
In this article, I’ve highlighted three current challenges shared by many countries around the world for which consumer engagement, partnership, and leadership are vital, but I could have chosen many others. Working together – drawing on the many rich ways of knowing including lived experience – will be important to pursuing the excellence in healthcare that we all seek.
About the author
Dr Jennifer Zelmer is the inaugural President and CEO of Healthcare Excellence Canada, the new organization formed in 2020 through the amalgamation of the Canadian Foundation for Healthcare Improvement and Canadian Patient Safety Institute to achieve safer, higher quality and more coordinated patient-partnered healthcare. She has been a Research Fellow for several years and is also an adjunct faculty member at the University of Victoria, as well as a member of several health-related advisory committees and boards. Dr Zelmer received her PhD and MA in economics from McMaster University and her BSc in health information science from the University of Victoria.
 First Nations Health Managers Association, Canadian Foundation for Healthcare Improvement, Lori Keith. A Journey We Walk Together: Strengthening Indigenous Cultural Competency in Health Organizations. https://www.cfhi-fcass.ca/docs/default-source/itr/tools-and-resources/indigenous-cultural-competency-primer-e.pdf
 Mehrotra A, Bhatia RS, Snoswell CL. Paying for Telemedicine After the Pandemic. JAMA. 2021;325(5):431–432; 2.
 NHS Digital. coronavirus.data.gov.uk.
 Abacus Data and Canadian Medical Association. What Canadians Think About Virtual Care. https://www.cma.ca/sites/default/files/pdf/virtual-care/cma-virtual-care-public-poll-june-2020-e.pdf
 Canadian Foundation for Healthcare Improvement. Evidence Brief: Caregivers as Essential Care Partners. https://www.cfhi-fcass.ca/docs/default-source/itr/tools-and-resources/essential-together/evidence-brief-en.pdf?sfvrsn=103fe5b3_4
 Healthcare Excellence Canada. Essential Together https://www.healthcareexcellence.ca/en/what-we-do/what-we-do-together/essential-together/