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Delivering compassionate virtual care in an increasingly digital world
By Miranda Saroli, Knowledge Mobilization and Social Action Coordinator, Access Alliance
In early March of 2020, the announcement came that COVID-19 had become a global pandemic, and businesses and organizations everywhere shut their doors. Determined to prioritize its clients’ needs, Access Alliance took one week and then began incorporating remote healthcare, settlement and other services. However, as time went on, it became clear that this would not be a short-term solution. Access Alliance was prompted to reconsider its model of care delivery from top to bottom, as part of this ‘new reality’. We had taken the leap into a new digital realm of virtual care. But what were the implications for our clients? Our staff? And ultimately, how could we ensure our core values of quality, equity and access still permeated this new hybrid service model?
To better grasp our rapidly changing world of service delivery, and take hold of the reins within our own organizational context, we brought together three experts in the realm of digital health and virtual care to discuss these questions and more. The following video excerpts and discussion highlights took place during the agency’s all staff Annual Corporate Policy Review Day in November 2022. The panel was moderated by Axelle Janczur, Executive Director.
What is Virtual Care?
A good place to start is defining virtual care, before diving into the ethics and implications surrounding it. Ibukun Abejirinde, Scientist and Global Health Researcher at Women’s College Hospital Institute for Health System Solutions and Virtual Care, is a research partner of Access Alliance. Her research focuses on understanding migrants’ experiences of virtual care. Here is Ibukun describing her definition of virtual care:
Ibukun makes her point very clear: patient-centered care is not just about the provision of care, but also about the experience of care. Here she introduces ‘compassion’ as key element of the care experience. Compassion in this context looks like “empathy, respect, a recognition of uniqueness of an individual, and a willingness to enter into a relationship in which not only the knowledge but the intuitions, strengths and emotions of both the patient and the provider can be fully engaged.” If a care experience is not compassionate, it cannot be considered a ‘quality’ patient care interaction, even if that encounter was effective from a clinical perspective. She also makes the important comment that the experience of care is not only about the patient’s experience, but also of the service provider.
Ibukun goes on to say that the element of human interaction embedded within in-person visits have always made a compassionate experience between provider and patient at least possible. However, as we move beyond the traditional brick and mortar model of healthcare towards virtual care, we must re-envision how quality (compassionate) patient care can be delivered without that face-to-face (traditional) contact. So how can we ensure that compassion is baked into the technologies we are using to deliver that care?
“How can care be geographically distant, yet emotionally and humanly present?” – Ibukun Abejirinde
Ethics of Digital Technology in Healthcare
For the most part, healthcare organizations are not developing their own virtual care technology. Large tech companies are, and they are moving fast. When it comes to innovations in healthcare and health system technology, the ethical implications are particularly critical. Jay Shaw, Canada Research Chair in Responsible Innovation at University of Toronto shares that the ethics of digital technology within healthcare covers a broad range: from the micro-level patient-provider interaction all the way to how tech’s capacity to reshape entire healthcare systems. When ‘big tech’ is in the driver’s seat, Jay says, considerations around ethics are not always at the forefront, and this can result in some major ‘missteps’. Here’s Jay sharing an example:
So, considering we are relying on tech to provide virtual care, how can organizations like Access Alliance uphold its commitments around provision of care? In other words, how can we ensure that the virtual services and programs we provide are patient-centered, equitable, and anti-oppressive for our clients and communities? What does equitable virtual care access look like and how can we ensure it for our diverse client populations?
Jay says that building in key questions asked of our clients can help organizations to guarantee that we build a system of care delivery that is right for them. Questions around…
- Access, e.g. do they have stable wifi? A private space?
- Health literacy, e.g. are they able to talk about their health from a distance (as opposed to needing the provider hands on/contact)?
- Digital readiness, e.g. do they know their way around the device?
Considerations within the Settlement Sector
Marco Campana, Immigrant and Refugee Organizations, Digital and Communications Consultant agrees with Jay that we must ask questions of our clients to best understand their needs, before making decisions about which technology to invest in. Marco has done substantial work around virtual care, looking within the immigrant/settlement sector in particular. Here, he talks about the ‘complex dance’ organizations must do when choosing which devices or tools work best to reach our clients, but which also meet privacy regulations.
His final take home message? The ideal model of service delivery is one that is hybrid or blended. “At the end of the day, it is up to the newcomer how they want to access the services, but we can never move away from provision of in-person services.”
Understanding Harm within the World of Virtual Care
When it comes to delivering health care and services to clients, in particular when your clients are newcomers, refugees, immigrants and other structurally marginalized groups, the risk of harm is front and centre. Here, Ibukun discusses the challenges of gauging harm within the world of virtual care, who is implicated, and what harm can look like at three levels: systemic, institutional, and individual.
Ibukun also impresses that harm is on a continuum, where ‘near misses’ in patient safety must also be accounted for and prevented within virtual care. She considers potential early warning signals that would flag harmful virtual care, such as a low rating in compassionate care, literacy levels, distance of the patient from the health facility, access to child care, and other determinants of health. “I believe that all of these things will be linked to how we think about harmful virtual care and what we should do about it.”
When we zoom out and think about how innovations in artificial intelligence are now being used at the system level, we can also see population-level harm, over the longer term. Here is Jay sharing an example:
How Access Alliance is Navigating the World of Virtual Care
The traditional service model of Access Alliance has always been about access. The permanent east (AccessPoint on Danforth) and west (AccessPoint on Jane) locations were established to do exactly that – bring services to where our clients are. Times are changing, but the essence of the Access Model still holds true. The question simply becomes: How can we move forward with adapting care to the meet the complex and unique needs of our diverse populations with an increasingly digital world?
Drawing upon lessons and experiences of staff and management throughout the pandemic and prior, Access Alliance established best practice standards for remote program and service delivery. This set of guidelines, protocols, and updated policies aim to support staff, volunteers, students, and management in ensuring that our organizational standards of quality, access, and equity are built into remote services and programs from the start. As the agency prepares to launch OCEAN, a platform that will allow clients to book appointments online, these standards were a necessary first step.
As the session concludes, Axelle gleans some final closing remarks from the panelists. These wise words are excellent reminders to guide us forward, but they are also helpful in validating how we have always been doing our work.
“Don’t rush. Take the time (to) think about what needs to be put in place. Think about the right ways to relate to your patients, don’t rush as you work to solve some of these problems.” – Jay Shaw
“Good inclusion requires that time… If we’re inclusive, we have to be thoughtful, we have to slow down to think about and factor in the impacts of the technologies we’re using, and it requires a system’s approach – everyone’s perspective, everyone’s voice is there to ensure their safety and security in all of the process…” – Marco Campana
And finally,
“Meet people where they are.” – Ibukun Abejirinde
Resources and further reading: