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Dr. Joshua Tepper

Change at the Frontlines of Healthcare

“The only constant is change”, a quote attributed to the Greek philosopher Heraclitus, feels particularly true in healthcare.

Healthcare systems around the world seem to be in an almost constant state of change.

There are many reasons for these constant cycles of change including rising costs, evolving states of disease, shifting demographics, technological transformations and fluctuating political perspectives. Most changes in health care that we hear about are large scale and centrally driven with a reliance on political and policy levers –often accompanied by significant infusion or redaction of resources. While this type of change will certainly continue, is this the only way to change healthcare?

This year three Canadian provinces are also trying a different approach. It draws its spirit from the belief that individuals can make a significant difference and that those closest to the front lines of care often have their fingers on the pulse (sometimes literally) of what is needed to make health care better.

On November 17th, British Columbia, Alberta and Ontario are joining a global, grass roots movement called Change Day. Started in 2013 in the National Health Service (NHS) in England, Change Day has now spread to at least 15 countries.

The title is actually a misnomer as the initiative is not confined to a single day. For 2-3 months leading up to Change Day health care professionals, patients, family members and health leaders make personal pledges that they then action to improve care in small ways. The pledges are typically prominently posted in their organizations and shared on social media platforms.

Change Day itself is more of an opportunity to recognize and celebrate the pledges that have been made. Following the day of celebration, activities associated with pledges continue as does the sharing of learnings to further spread improvement.

Across Canada more than 12,000 pledges have been made to date representing every part of the health care system with some single pledges representing the commitment of dozens or even hundreds of people.

The pledges collectively aim to improve all six dimensions of quality: safe, effective, efficient, patient-centered, timely and equitable.

In British Columbia pledges included:

  • *Identifying oneself using pronouns that will help people who do not identify with their visible gender feel safe to tell their story;
  • Creating a “Message of Hope Album” where clients in substance dependency centers can leave an inspirational message of their recovery for those that follow;
  • Participating in cultural training;

In Alberta, pledges included:

  • Using digital & video storytelling workshops to empower patient voices in healthcare;
  • Never stopping questioning the status quo and why every child in Alberta does not currently have the opportunity to be healthy;
  • Acknowledging at least one good deed, action or positive quality observed in colleagues each day.

In Ontario, pledges included:

  • Completing a sign language course to provide better care to deaf/hearing impaired patients.
  • In another hospital, a group of receptionists joined with the communications department to visit all 4 hospital campuses to promote understanding of the importance of introducing yourself to help patients and families feel more comfortable.
  • A group of personal support workers in one long term care home pledged to learn the life story of one of the residents each week.

Skeptics may reasonably ask: Does Change Day work and how will we know? It’s a fair question and strong empirical data is hard to come by. There are some examples where a local pledge has gone literally global such as the “My Name is” movement that originated in the National Health Services by a physician who became ill and as a patient experienced the common occurrence of health providers not introducing themselves when entering the room. On return to active practice she pledged to always begin by telling patients who she was and why she was there. This example has now spread globally to countries including Canada.

Not all pledges will have that kind of reach or impact and measurable improvements in health due to Change Day pledges may be hard to quantify. It is helpful perspective to recall that a few months after the original Change Day in the U.K. in 2013, Dr. Damian Roland wrote that “healthcare is an environment where 'change' can be an overused and a moral sapping word. While there is much work to be done on demonstrating direct patient benefit … Change Day has demonstrated the passion for improvement is alive and that change is possible.”

With 12,000 pledges and counting, the same passion for improvement is clearly present in Canada.


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