Living Well Integrative Health Center

2176 Windsor Street, Halifax, Nova Scotia, Canada. (902) 406-1500

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Important Concepts in Collaborative Transformation

I am grateful for CBC's public forum tonight which enabled me to speak on behalf of all of you who are courageous, strong, gentle and fiercely passionate. Thank you for family, my patients and my dear colleagues. Sharing some:Important conceptualizations about Collaborative Care. I am happy if you share, kindly put my name to it. My kids need to know this is why I work so hard too and that meaningful change is possible.! Let us cultivate a collaborative disposition and a culture of health and well-being regardless of disease state. Let compassion be our currency for care. Love Maria 

Important conceptualizations in transformation to a collaborative model of primary HC provision:


1.      “Collaboration/integration is a process NOT an endpoint”. It is a way of being, working and functioning that necessitates working together. Another way of saying this iscollaboration is a verb not a noun”. The Webster dictionary defines it "as a purposeful relationship in which all party strategically choose to cooperate in order to achieve shared or overlapping objectives”. In this circumstance there are many shared objectives of which the most important is better patient care. Collaboration as a process is constantly changing, evolving and is responsive to various changing factors in the healthcare landscape.


2.      Collaboration is conciliation i.e. "the unity of knowledge". Where is the unity and where are the sources of knowledge derived? “The process by which we derive information and knowledge for the transformation must be a culmination of multidisciplinary and interdisciplinary research”.


3.      “Collaboration requires engagement on every level”. Global, government, policy, practice, organizations, institutions, administrations, researchers, teachers, providers, patients, and communities, etc.


4.      “Learning to transition to collaborative care is an adaptive process that has both technical and adaptive challenges. A technical approach to an adaptive process doesn't work. The approach itself must be integrative” (in this sense integrating adaptive as well as technical solutions).


5.      “Collaborative practices must be patient-centred AND population centered. Collaboration requires continual adaptation and change to varying individual as well as community and population variables. This, to some extent, this reflects how patient centered care is envisioned and supported in the community (beyond the walls of a practice) and how communities can foster healthy practices in individuals belonging to larger groups.”


6.      “Patients must be consulted in the process of formation of collaborative care otherwise the process itself is not patient centered and risks falling short of needs. Collaboration grows collaboration. Including patient voice in the process of transformation demonstrates authenticity, consistency and continuity in considering what is truly conducive to patient centered care. There are no existing patient interest groups for primary care provision”.


7.      “Collaborative care exists within a larger landscape and must also consider global trends and economies, agencies, organizational and institutional interests, government and policy formation, societal pressures, cultural shifts, technological advances and innovation, financial and fiscal restraints, availability of professional resources and the environment”.


8.      “Collaborative practice is dynamic and should be intelligent, informed, proactive, purposeful, innovative, flexible, optimistic, responsive, responsible, stable and resilient.” The word conciliation refers to the coming together of meaning and derives from the Latin word COM meaning “together” and Sileans meaning “jumping” or “resilient. Success is not possible without failure. With resilience, we grow from failure. It acts as a built in mechanism to provide information about what works and what doesn’t work. Resilience is necessary.


9.      “Stronger collaborative practices are formed when the providers involved are respected for having knowledge, expertise, and experience, and opportunities are made to give voice to their vision. The ‘lived work experience’ holds some validity and credibility. Providers need to be permitted some degree of autonomy and choice over what they experientially know is a good fit for them. ‘Prescribing’ partners and practices don’t work”.


10.  “Collaborative relationships are highly reliant on communication and inherently require some form of leadership. In a strong collaborative practice there needs to be some agreement upon the style of leadership that is conducive to the provider-centered components of care as well as the overall collaborative structure and set up”.Transitioning to collaboration and integration requires leaders, champions, trailblazers and risk takers. Tasks and roles should be defined by skills and not by disciplines.


11.  Primary care embraces the value of providing continuous care throughout the lifespan. Although this is ideally a component of the training and subspecializing is discouraged, not one provider can be all to everyone at all stages of life. This is why a collaborative model suits lifespan care. Multiple providers with varying expertise collectively meet needs through shared roles and responsibilities. This type of set up honors intellectual liberty and engenders enriched care by nurturing and investing in the interests and aptitudes of the providers”.One wouldn’t want a family physician with expertise in geriatrics providing ongoing prenatal care. Tasks and roles should be defined by skills and not by discipline”.


12.  Collaboration requires structure to ensure efficiency, effective use of resources, to encourage innovative ways to deliver care and in an effort to ensure patient care is enhanced. Structure is a value adding component to collaborative care”. This includes (not exclusively) EMR, administration and access, assessment, evaluation and feedback, programming and training. This speaks to the necessity for collaboration to include some formal processes and procedures.


13.  Communication is the foundational practice necessary for a seamless transition to collaboration and integration. It is it is also the foundation of ongoing practice. Communication is the language of collaboration”.  There should be opportunity for both formal and informal communication in a collaborative model of care. Formal communication occurs through shared charting or EMR, assessments and regular meetings. There are well established tools to assist in the process. Informal communication promotes strong interpersonal relationships and recognizes limitations inherent in formal communication practices. Informal communication includes practices such as brainstorming, problem solving as well as the “Warm” handover. “Both formal and informal communication serves to enhance patient care and working relationships in a collaborative practice”.


14.  “Collaborative care is best envisioned as holistic and integrative. Integrative care fits into a ‘wellness’ model of health.  Health is not merely defined as the absence of illness and disease but also by the subjective experience of being and living well. A wellness model fosters healthy practices that both prevent disease and promote wellness in addition to treating illness. Holistic care is a value adding practice and considers the whole person, their families, relationships, work, culture, community and traditions.  It necessitates patient engagement and further strengthens relationships between patients and providers by positioning them as the center of the collaboration. A wellness model of care is truly a patient-centered care. No person wants to be defined or remembered for what ailed them”.

A wellness-based model is one that considers the whole person. It is a strengths-based model that embraces the bio –psychosocial approach to care and places value and credibility on prevention, some medicines, as well as non-medicinal approaches to care including diet, exercise, socializing, social support, one’s environment, faith, culture, sense of purpose, meaning, and value, and emphasizes the positive role of active care. It seeks to educate, build skills, capacity and foster resilience, which is both protective and therapeutic. It places the patient at the center of their care emphasizing choice and aligning with being patient-centered, an important pillar of the collaborative care model.

The reality is that our system is not well, nor is it serving the needs of patients or providers. This creates barriers to accessing and providing care. An over-reliance on evidence based medicine has replaced common sense and has discouraged and creates artificial divisions where there should be integration and interdisciplinary collaboration. It has also contributed to a culture where there is more emphasis on numbers and outcomes rather than the whole person. There is lack of consideration for the qualitative experience of what is supposed to be a healing interaction and relationship between provider and patient. There is a growing body of evidence that demonstrates empathetic exchange or compassionate care has significant positive health outcomes and this is not factored into the existing model.


15.  A collaborative care model is only as healthy, functional and happy as the people that work and function within it. This speaks to the importance of physicians and health care provider’s health. This must consider their needs and the importance of a work-life balance as well as the need to be engaged in healthy practices themselves. Providers must be heavily encouraged to self-care, be mindful and responsive to their changing needs, to establish a sense of safety, security and stability as well to ensure that they are deriving from their work role a sense of meaning, purpose and mastery. Providers need care and need to take care.


16.   “Collaboration is reliant on healthy relationships. Compassion is the currency of relationships. We are social beings and our brains are social organs. We have the capacity to learn and grow together. Because of our social nature, our success will be defined by our ability to honor the role of relationships and the importance of regard for our deep seated need to connect and belong. By virtue of these qualities and values, the collaborative model of care holds the potential and promise of being able to establish the healthiest forms of working relationships if the process of forming them is itself compassionate and considers our humanity”.


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