Pereira José, Contant Jocelyne, Barton Gwen, Klinger Christopher
Champlain Hospice Palliative Care Program, 69 Primrose Avenue, Annex C, Saint-Vincent Hospital, Ottawa, Ontario, K1R 6M1, Canada.
Division of Palliative Care, Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.
BMC Palliat Care. 2016 Jul 26;15:65. doi: 10.1186/s12904-016-0131-6.
Regionalization promotes planning and coordination of services across settings and providers to meet population needs. Despite the potential advantages of regionalization, no regional hospice palliative care program existed in Ontario, Canada, as of 2010. This paper describes the process and early results of the development of the first regional hospice palliative care program in Ontario. The various activities and processes undertaken and the formal agreements, policies and documents are described.
A participative approach, started in April 2009, was used. It brought together over 26 health service providers, including residential hospices, a palliative care unit, community and hospital specialist consultation teams, hospitals, community health and social service agencies (including nursing), individual health professionals, volunteers, patients and families. An extensive stakeholder and community vetting process was undertaken that included work groups (to explore key areas such as home care, the hospital sector, hospice and palliative care unit beds, provision of care in rural settings, e-health and education), a steering committee and input from over 320 individuals via e-mail and town-halls. A Transitional Leadership Group was elected to steer the implementation of the Regional Program over the summer of 2010. This group established the by-laws and details regarding the governance structure of the Regional Program, including its role, responsibilities, reporting structures and initial performance indicators that the Local Health Integration Network (LHIN) approved.
The Regional Program was formally established in November 2010 with a competency-based Board of 14 elected members to oversee the program. Early work involved establishing standards and performance indicators for the different sectors and settings in the region, and identifying key clinical needs such as the establishment of more residential hospice capacity in Ottawa and a rural framework to ensure access for citizens in rural and remote regions. Challenges encountered are explored as are the process enablers and facilitators. The paper views the development and implementation process from the perspectives of several frameworks and models related to change management.
Following on several initial achievements, the long term success of the Regional Program will depend on consolidating the early gains and demonstrating changes based on key measurable outcomes.
区域化有助于跨机构和提供者进行服务规划与协调，以满足民众需求。尽管区域化具有潜在优势，但截至2010年，加拿大安大略省尚无区域临终关怀与姑息治疗项目。本文描述了安大略省首个区域临终关怀与姑息治疗项目的发展过程及早期成果。文中阐述了所开展的各类活动与流程以及正式协议、政策和文件。
采用始于2009年4月的参与式方法。该方法汇聚了26家以上的卫生服务提供者，包括临终关怀院、姑息治疗病房、社区及医院专科咨询团队、医院、社区卫生与社会服务机构（包括护理机构）、个体卫生专业人员、志愿者、患者及家属。开展了广泛的利益相关者及社区审查过程，包括工作组（探讨家庭护理、医院部门、临终关怀与姑息治疗病房床位、农村地区护理提供、电子健康与教育等关键领域）、指导委员会以及通过电子邮件和市政厅会议收集的320多人的意见。2010年夏季选举产生了一个过渡领导小组，以指导区域项目的实施。该小组制定了区域项目治理结构的附则和细节，包括其作用、职责、报告结构以及地方卫生整合网络（LHIN）批准的初始绩效指标。
区域项目于2010年11月正式成立，由一个基于能力的、由14名当选成员组成的委员会监督该项目。早期工作包括为该地区不同部门和机构制定标准和绩效指标，以及确定关键临床需求，如在渥太华建立更多临终关怀院床位以及建立农村框架以确保农村和偏远地区居民能够获得服务。探讨了所遇到的挑战以及促进变革的因素和推动者。本文从与变革管理相关的几个框架和模型的角度审视了发展与实施过程。
在取得若干初步成就之后，区域项目的长期成功将取决于巩固早期成果并根据关键可衡量结果展示变革。
