In this series, AMS Healthcare addresses the challenges facing healthcare today – particularly in light of the COVID-19 pandemic. The AMS Community promotes compassionate care, development of the leadership needed to realize the promise of technology and the understanding of how our medical history influences the future of our healthcare. A new piece will be posted every Friday on Healthy Debate.
COVID-19 has highlighted the need for all of us to live in a compassionate community.
The pandemic has been devastating for so many individuals and their families. There have been tragic losses despite the heroics of our healthcare workers and other essential staff. Too many of these losses have been made worse when neither the patient nor family were prepared. This has led to more emotional and psychological harm than was necessary. Anxiety levels among caregivers have escalated.
The compassionate community movement begun by Dr. Allan Kellehear incorporates a public health approach to end-of-life issues and promotes the principles of community development. The compassionate community movement is taking hold in Canada (having begun in the United Kingdom, followed by Australia and New Zealand)) and incorporates the Compassionate City Charter.
The charter states “a compassionate community is a community that recognizes that care for one another at times of crisis and loss is not simply a task solely for health and social services but is everyone’s responsibility.” Many compassionate communities have been started by institutions such as hospices, hospitals etc. Others have been started by volunteers (e.g., Compassionate Ottawa) and bring the full force of the non-provider perspective uniquely to their development. This leads to better buy in and the development of more resiliency in the community.
Compassionate communities can work with sectors such as schools, faith groups and workplaces to help the community normalize discussions about dying, death and grieving. Compassionate communities reach those who are vulnerable such as the frail elderly, the isolated, those in poverty. Compassionate communities often focus on providing Advance Care Planning workshops and seminars, a critical tool to help manage and support a patient’s expectations near the end of life. There is evidence that where health provider organizations and community-based initiatives work collaboratively, there can be significant improvements in system performance, potentially reducing emergency room visits and unplanned hospital admissions, reducing provider burnout and increasing providers’ knowledge of community resources.
An observational study on reducing emergency hospital admissions demonstrated a 14 per cent reduction in unplanned admissions and a 21 per cent reduction in costs of unplanned admissions between April 2013 and December 2017 by applying a complex intervention including “patient identification, goal setting and care planning, enhancement of naturally occurring supportive networks and linkage to community resources.” The intervention identified isolated and lonely patients and the community supports needed to help them regain or maintain health and highlighted the critical importance of social wellness and social relationships.
Dr. Julien Abel, a consultant in palliative medicine and the Director of Compassionate Communities U.K. says “Medicine until now has not seen the social relationships domain as part of clinical care. However it is the most effective intervention we have in improving health and well being across populations.”
We can do better moving forward and as we prepare for further waves of the COVID-19 or a new pandemic. COVID-19 has demonstrated that at times physicians are not aware of the community resources that exist and that can be of real help in sending patients back into the community after hospitalization. The bridges between the providers and the community are more critical than ever and need to be understood and promoted. A compassionate community can help healthcare providers meet these challenges and create a mutually beneficial relationship in which providers understand the role of the community and vice versa. Only then will we provide a continuum of care in a way that truly supports the patient and family.
As a family doctor, I have spent my career in a full scope of practice that cares for patients and their families from birth to death. I am now a volunteer with Compassionate Ottawa, working to better integrate the provider expertise with that of the community. I have seen the great strengths of our provider system and am more than ever convinced that we providers can do only so much for our patients – the community can do as much and likely even more. So much care and support takes place in the community that it is not possible to provide comprehensive and full care without the provider and the community working together.
COVID times have forced us to better understand that the health of our communities is not simply a task for health and social services but is the responsibility of all of us. Now is the time and incentive to build your compassionate community.