What I Like About RIFS: 5 Things AHS and AMA Learned From the Reducing the Impact of Financial Strain Project

“The really important problems facing society – poverty, conflict, crime and so on – cannot be tackled by any single organization acting alone. The issues have ramifications for so many aspects of society that they are inherently multi-organizational. Collaboration is thus essential if there is to be hope of alleviating these problems.”     - Chris Huxham, 1996

The Plan

In 2018, AHS Population and Public Health (PPPH) and Primary Health Care (PHC) programs along with the Alberta Medical Association’s Accelerating Change Transformation Team (ACTT) were presented with a rare opportunity – a project that addressed the complexity of addressing the social determinants of health in a tangible way with both primary care and communities with an explicit focus on meaningful collaboration.

Clinical teams and their networks would be well connected with their community’s agencies and partners; aware of the community needs, and adjusting services based on these needs. At the community level, multi-sectoral teams would be formed or strengthened to build on community assets and strengths and develop novel solutions by working together.

The Reducing the Impact of Financial Strain (RIFS) project tested ways that helped mobilize teams to work together across Alberta Health Services Zones, Primary Care Networks, primary care clinics (“medical home”) and community serving organizations.

4 years later, the provincial team realize how critical this explicit focus on collaboration was.  What we learned about collaboration and partnership are transferable to other collaborative effort between Provincial programs, Zones, PCNs and communities. 

The Outcomes

Engage stakeholders early around a common vision

We learned about the importance of building relationships, understanding of the big picture, and how all the pieces fit together enhances the collaborative process and leads to more effective work processes and outcomes.

We took deliberate action such as hosting collaborative forums, sharing knowledge throughout the project, and responding to expressed needs of the site teams instead of prescribing what they should do.

If given the opportunity to do it all over again, we would take more time with all stakeholders to establish and co-designed a shared vision earlier on.

Plan multi-stakeholder, sector work jointly, with a mindset of collaboration

Pulling new teams together across organizations and AHS divisions sometimes led to a murky definition of roles, responsibilities, and reporting structure.

Ongoing conversations with team members, project leads, community partners and staff managers, helped clarify roles and responsibilities, which evolved based on skills, strengths and needs of the community.

The team continually worked toward a culture of respect and trust, effective communication and sharing power but it takes time to establish this, integrating work early was key.

Clinical interventions for social determinants of health require community collaboration outside of the traditional health care system

Screening for financial strain alone isn’t enough and can often feel overwhelming for patients and healthcare workers. Addressing financial strain in a holistic way often falls outside of health care's traditional scope of practice.

To address the needs that screening identified, Primary Care Networks worked with multi-sectoral community teams to create relationships with community members and organizations. These teams provided a venue for collective problem solving and led to more local support options, stronger coordination and system navigation.

Teams strived to act together on financial strain issues relevant for their communities, resulting in greater shared learning around the social determinants of health

Work with community multi-sectoral teams to co-design interventions based on local priorities

Community partners understand local context, experiences and opportunities. The Alberta Healthy Communities Approach guided community processes to determine shared action — building on local strengths and assets, infused with human centred design.

Engaging existing multi-sectoral teams accelerated opportunities to co-design action.

Engaging community networks from the start ensure goals and opportunities are led and sustained by communities in partnership with supportive and responsive teams.

Be responsive to emerging needs and adapt

Complex interventions will inevitably result in unanticipated twists and turns.

The many changes in environment presented teams with opportunities to adapt and respond (e.g., COVID-19, travel restrictions, staff losses at PCNs and community organizations). Teams were creative and adapted with local innovations and processes.

Leadership was flexible with local funding allocation and evaluation measurement.

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