Noseworthy Tom, Wasylak Tracy, O'Neill Blair J
Professor, Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, AB.
Vice President, Strategic Clinical Networks & Clinical Care Pathways, Alberta Health Services, Edmonton, AB.
Healthc Pap. 2016;15(3):49-54.
Verma and Bhatia make a compelling case for the Triple Aim to promote health system innovation and sustainability. We concur. Moreover, the authors offer a useful categorization of policies and actions to advance the Triple Aim under the "classic functions" of financing, stewardship and resource generation (Verma and Bhatia 2016). The argument is tendered that provincial governments should embrace the Triple Aim in the absence of federal government leadership, noting that, by international standards, we are at best mediocre and, more realistically, fighting for the bottom in comparative, annual cross-country surveys. Ignoring federal government participation in Medicare and resorting solely to provincial leadership seems to make sense for the purposes of this discourse; but, it makes no sense at all if we are attempting to achieve high performance in Canada's non-system (Canada Health Action: Building on the Legacy 1997; Commission on the Future of Health Care in Canada 2002; Lewis 2015). As for enlisting provincial governments, we heartily agree. A great deal can be accomplished by the Council of the Federation of Canadian Premiers. But, the entire basis for this philosophy and the reference paper itself assumes a top-down approach to policy and practice. That is what we are trying to change in Alberta and we next discuss. Bottom-up clinically led change, driven by measurement and evidence, has to meet with the top-down approach being presented and widely practiced. While true for each category of financing, stewardship and resource generation, in no place is this truer than what is described and included in "health system stewardship." This commentary draws from Verma and Bhatia (2016) and demonstrates how Alberta, through the use of Strategic Clinical Networks (SCNs), is responding to the Triple Aim. We offer three examples of provincially scaled innovations, each representing one or more arms of the Triple Aim.
韦尔马和巴蒂亚提出了令人信服的理由，支持以“三重目标”促进卫生系统的创新与可持续发展。我们表示赞同。此外，作者依据融资、管理和资源生成这一“经典功能”，对推进“三重目标”的政策与行动进行了有益的分类（韦尔马和巴蒂亚，2016年）。文中指出，在缺乏联邦政府领导的情况下，省级政府应接纳“三重目标”，并提到，按照国际标准，我们充其量处于中等水平，而更实际的情况是，在年度跨国比较调查中我们在垫底竞争。在此次论述中，忽视联邦政府在医疗保险中的参与，仅依靠省级政府的领导似乎有其道理；但如果我们试图在加拿大的非系统性体系中实现高效运作，这就完全行不通了（《加拿大卫生行动：继承传统》，1997年；加拿大医疗保健未来委员会，2002年；刘易斯，2015年）。至于争取省级政府的支持，我们由衷赞同。加拿大省长联合会理事会能够成就很多事情。但是，这一理念的整个基础以及参考文献本身都假定了一种自上而下的政策与实践方法。这正是我们在艾伯塔省试图改变的，接下来我们将进行讨论。由测量和证据驱动的、自下而上的临床主导变革，必须与目前广泛推行的自上而下的方法相结合。虽然这适用于融资、管理和资源生成的每一个类别，但在“卫生系统管理”的描述和内容中体现得最为明显。本评论借鉴了韦尔马和巴蒂亚（2016年）的观点，并展示了艾伯塔省如何通过战略临床网络（SCN）来响应“三重目标”。我们提供了三个省级规模创新的例子，每个例子都代表了“三重目标”的一个或多个方面。
