I think one of the biggest challenges is that every health care role within the organization sees the service it provides as opposed to seeing the holistic overall view of the experience a patient has within a health care organization. Whether they have a chronic condition or an isolated event brings them into the environment, through their lifetime they are going to deal with a number of different people. You need to look at that holistic view across all of those different health care providers to be able to provide that integrated care.
When you look at it from a business perspective, if you can work with health care providers to allow them to change their focus—and we were able to do this very successfully with both Ontario Shores and Providence Care—that can change their perspective and how they think about the way they work.
We described narratively the same journey of a patient in two different ways. We had it as different roles: “I see these types of patients. I do this as the psychiatrist. I do this as a nurse. I do this.” We asked them to construct what the patient's journey looks like and they couldn't do it. But when we got them to step back and actually see what the experience was like for the patient, then they could do that.
One of the major things that needs to occur is that reorganization of thinking. Certainly the new CIHR initiative on patient-centred research and the SPOR initiative for patient-oriented research are starting to help people to really put the patient at the centre and first, as well as helping a lot with the economic assessment.