Lessons learned: Community engagement critical for better healthcare
Wearing face-shields and masks, we were led up two flights of stairs to a bright, open space in a building many of us had passed countless times and often wondered about its purpose. Here, we would conduct testing for more than 150 participants the following week. Thoughtful and dedicated staff examined optimal ways to offer testing to those living inside and outside the building.
As we left our meeting, we passed eight to ten tents in an adjacent park. That’s when we realized the dimensions of community engagement to which they were referring.
While most were told to stay home during the height of the COVID-19 pandemic, several of us instead ventured outside of our hospital walls. It was the best thing we could have done. Women’s College Hospital, where we have the privilege of working, is situated in the midst of a series of diverse neighbourhoods and close to community organizations, just like many urban hospitals. This proximity is a gift that informs the work we do but often feels disconnected through the divisions of primary care, specialist referrals and general health system navigation.
While COVID-19 has highlighted long-standing systemic disparities through its disproportionate effect on Black and Indigenous individuals as well as newcomers to Canada, it also has created opportunities for action and served as a catalyst to carve out pathways for liaising with the communities we serve. At our organization, opportunities to explore new community partnerships started in late March through our mobile COVID-19 assessment team. For the past five months, we have provided onsite mobile testing in shelters and congregate living settings across Toronto.
The team has explored concepts of community engagement and recognized opportunities to adapt, refine and employ approaches rooted in equity, inclusivity and social justice. These are the lessons learned:
Staff in neighbouring community organizations are as diverse as the populations they serve.
In a time when we need to critically examine whose voices are heard, we recognize that diverse organizations allow for varying perspectives that often directly impact decisions made for the communities they serve. In larger institutions, we have volumes to learn from our neighbouring colleagues to ensure diversity is reflected across all levels and that diverse viewpoints are included in leadership and decision-making.
Our patients are our experts.
We need to recognize and value the multi-sectorial roles patients play in our communities and in neighbouring community organizations. This could play an influential role if we were to realize, value and garner greater perspectives of our patients in the diverse roles they play in our society.
Agility and responsiveness are key attributes in the social service sector – not only in a pandemic but all the time.
Essential workers have been praised throughout the pandemic. Shelter workers make up a significant portion of this work force and have been unsung heroes during the pandemic. To have the ability to multitask between providing individual and group-facing services, team management, sectorial navigation and competing priorities in the face of COVID-19 is awe inspiring. Shelter workers have done all this with tremendous commitment and dedication. There is much from their reflexive and fluid approach that we could adopt in our own institutional roles to the benefit of our patients.
Healthcare is often seen as one entity by the public – we are far from it.
Messaging can be highly confusing between various sectors of the healthcare system including primary care, public health and hospital-based services. The public doesn’t need to know the various divisions of the healthcare sector; it does, however, need messaging that is consistent throughout. It is our responsibility to create a unified voice and be clear and transparent in communications to the public, particularly as we lay foundations to advance community engagement and partnership.
Client-centered care needs to be at the root of all endeavours.
Throughout the pandemic, we have visited 43 community organizations. Each organization consistently centered its approach toward the population it serves. This ranged from scheduling to health literacy. At a time when we all have so many competing priorities and fundamental principles can easily get lost, this steadfast prioritization and tireless advocacy is remarkable and without fail. It is an honest reminder of why we do the work we do.
While we continue to navigate COVID-19, we have been imparted with many grounding lessons that allow for exploration of partnership, advocacy, representation and responsiveness not only within larger healthcare institutions but also across public and private sectors. While these are not novel concepts, they have unveiled an urgency and stark reminder that we must consistently provide patient care with these principles in mind.
Some partitions have been lowered through the privilege of community engagement; it is how we move forward that will determine direct health and policy implications for our community partners, our neighbours and ourselves.
Vanessa Wright is a nurse practitioner at Women’s College Hospital’s Crossroads Refugee Health Clinic and an adjunct lecture at the University of Toronto.