Our approach to Healthcare
People face barriers to being able to access healthcare. These can include housing, education, income, access to health benefits, and preferred language. Access operates through an equity lens looking at the various barriers that people face and developing ways to address them. Our Non-insured Walkin Clinic is an example of how we continue to address barriers that affect peoples ability to access healthcare.
Joe is a 59-year old male who moved to Canada in hopes of achieving financial security. He had no major health complaints and had not visited a healthcare professional in several years. However, one day he visited the Non-Insured Walkin Clinic (NIWIC) after experiencing shortness of breath and chest pain for three weeks. He was diagnosed with pericardial effusion, which was reducing his heart function. With the assistance of an interpreter, the NIWIC advised him to go to the nearest ER. However, Joe chose not to visit the ER for fear of hospital bills.
The NIWIC’s consulting physician stressed to Joe the severity of his illness and wrote an advocacy letter on his behalf explaining the need for emergency care and a payment plan. Joe finally agreed to visit the emergency department. Joe was admitted immediately upon arriving to the ER and the doctors agreed that surgery was necessary. However, the hospital requested confirmation of payment before they initiated treatment. Because Joe was unable to provide this and appeared relatively healthy, they suggested postponing treatment until he could afford it. Subsequently, NIWIC managers began to liaise with administrators at Toronto hospitals and ultimately found a hospital willing to perform the surgery immediately. Nevertheless, there was a three-week delay between the date surgery was recommended and performed.
As soon as Joe presented to the NIWIC, a high-risk referral was made to a CHC, to connect Joe to a primary care provider (PCP) within three weeks. The first CHC where Joe was referred to declined Joe as a client due to financial constraints in serving uninsured clients, shortages of PCPs, and long wait-lists. Joe was eventually accepted by another CHC to obtain a family doctor, diabetes nurse, diabetes dietician and settlement worker two weeks after his heart surgery and days after his discharge from the hospital. He has continued to visit this CHC for the past year. Joe’s settlement worker managed to help lower his overall hospital bill as well as his expected monthly payments for a few months while he took time off work to recover from his procedure.
Health Equity Project
In 2017/18, Access Alliance Multicultural Health and Community Services led the Building Capacity for Equity-Informed Planning and Evaluation (Health Equity) Project in partnership with the Alliance for Healthier Communities and seven Champion community health centres, located throughout Ontario. The overarching aim of this project was to build organizational level knowledge, commitment and capacity to routinely use a health equity framework and evidence geared at overcoming systemic inequities in healthcare access, healthcare quality and health outcomes.
Each Champion had a unique work plan based on identified needs and their baseline capacity around equity-informed planning and evaluation. They received training and coaching support to execute this work plan over the course of the project cycle, a capacity-building intervention which also enabled them to build leadership and an institutional commitment towards health equity, drive their equity agenda forward, and strengthen partnerships and forge new ones.
Although the project is officially completed, the goal is to sustain momentum by moving beyond the level of the individual organization (its culture and practices), towards creating a shared vision and best practices at the sector or cross-sector level. This will help to create a foundation for promoting the uptake of an equity framework among decision makers such as HQO, the Ministry, and the LHINs.
The products of the Health Equity Project are housed online (see the Alliance for Healthier Communities project page), and are geared towards supporting community health centres and social service agencies to:
- Improve knowledge, skills and attitudes among regarding equity informed planning and evaluation, including capacity to routinely collect relevant socio-demographic indicators and conduct disaggregated, intersectional analysis to understand and overcome health disparities that exist within or between client populations
- Enhance available resources regarding evidence informed planning and evaluation
- Promote the use of an organizational framework to establish and operationalize a commitment towards health equity
regional workshops delivered by Champions to partners around their unique learnings
organizations reached by this project, through active knowledge mobilization at regional workshops, planning tables, conferences, etc.
training sessions delivered to Champions, partners, and other interested members
established sector commitment of the Provincial Performance Management Committee (PMC) of the Alliance for Healthier Communities, to facilitating a “Community of Practice” where they will look at operationalizing health equity informed practices with a focus on quality improvement, and support on-going knowledge sharing for the project Champions and interested members.
Volunteer-Led Cooking Program
Providing a nourishing meal to the participants of the LGBTQ+ Newcomer program was greatly appreciated by participants but the costs were not sustainable and were inequitable when compared to other programs at Access Alliance. It was costing $120/week to feed approx. 40 participants and this put pressure on the Community Health Worker LGBTQ+ Newcomer Programs to fundraise to maintain this type of meal.
To address this problem, a PDSA was developed and tested based on the model of the Community Dining Program: Would the LGBTQ+ Newcomer program be able to continue to eat a healthy meal while reducing costs through the development of a volunteer led cooking program?
The PDSA was successful and this program currently engages LGBTQ+ newcomers to cook dinner for program participants of the Weekly LGBTQ+ Newcomer Workshop at APOD at a significantly reduced cost – $70/week. The program has an added benefit of engaging participants as volunteers, providing capacity building opportunities. It also provides opportunities for clients to cook foods from their own country to share with the program. The food is always healthy and is rich in whole grains, protein and vegetables.
Since completing the full cycle the following improvements have been made:
We have 2 volunteers that are not program participants taking the lead on this initiative in order to provide consistency with limited staff resources. A student also offers support during placement months.
We have developed a training procedure for new program participants that are volunteering to orient them to safe food handling, meal preparation and respecting the rules of the shared kitchen space. This training is delivered at the commencement of the program each week.
The group has been formalized as a NOD group separate from the Weekly LGBTQ+ Newcomer Group and we are engaging 6-10 participants on a weekly basis.
The food for the Pride event this year was mostly prepared by participants.
One volunteer, Ken Olson, won the June Callwood Award for Volunteerism from the Provincial Government for his efforts in leading this program.
This process has saved Access Alliance over $2,500
In order to achieve the target, we implemented a number of interventions for all new clients in October 2016, including:
- The registration process for new clients was changed in a couple of ways (e.g. on the form, there was the addition of required sign-off by staff collecting data and staff entering data into NOD); this was communicated to the secretary and service provider teams by the ED about the change management and the expectation of 100% completeness for all new client registration forms.
- Training was held for staff on cultural competency, and on the purpose and importance of data collection.
- We also used a staff incentive model to encourage the process, where staff were praised and received ‘Golden Mouse’ awards.
The result was that by the end December 2017, we reached 83% completeness.
In this case, an evidence-informed intervention made a significant change. Also, an equity lens was applied in that there was a team approach of relevant staff from all levels, representing an inclusive model of work. Everyone had the opportunity to identify the flaws and contribute to the process of improvement.