(This is the eighth in a series of posts from the Settlement Sector & Technology Task Group's final report: From Silos to Solutions: Toward Sustainable and Equitable Hybrid Service Delivery in the Immigrant & Refugee-Serving Sector in Canada. Over the coming days/weeks, I will be extracting thematic sections from the report and posting them as articles to make them more accessible. In each key theme, we provide an introduction, sector perspectives (from interviews and focus groups), a number of useful tools and practices we have found to help guide our recommendations to help the sector and IRCC develop the themes into practice, and then a list of specific recommendations that are relevant to the theme.)
In the first phase of our work, we captured a number of promising practices that SPOs had implemented to adapt to the changing environment regarding the format of service delivery and organizational operation. The pandemic crisis has opened up some new opportunities as digital strategies have expanded to reach more audiences. We see the progress that has been made by SPOs, which strengthen the capacity of program resilience.
In this process, individual settlement practitioners and SPOs have demonstrated creativity, flexibility, agility, and elasticity to create success, strategies, and implications to conquer challenges, difficulties, and toughness in pandemic times. Digital transformation and adopting the hybrid service delivery model can be unique driving forces to encourage and continue institutional resilience in the immigrant and refugee-serving sector.
Interviewees and the literature are clear that the sector needs to both surface innovative and emerging promising practices within the sector, but also learn from ideas, projects and approaches in other sectors. A common question is not only how to identify promising practices, but the processes through which they might become the new standard for service delivery. Within IRCC, the SDI funding stream is a pocket of change and innovation. IRCC can more actively solicit and analyze evidence coming from its innovative SDI funding in order to build the evidence base necessary to move the innovation discussion internally. IRCC should also apply this approach to all funded projects in order to extract learning and to mobilize knowledge both within IRCC and across the sector.
This section explores promising practices and models outside of the immigrant serving sector with a specific focus on innovation, solutions, and implications that other sectors have been implementing to enhance services in their organizations. In particular, we are interested in the evolution of Virtual Care practices in health care.
One community health centre located in Eastern Canada has introduced video interpretation methods in counseling. This solution was invented to better translate clients’ meaning to the counselors if there was an interpreter involved. Through phone counseling, interpreters could not see clients’ faces if clients expressed meaning with body language and gestures. In this context, video counseling could be crucial to enhance language accuracy for the conversation between clients and counselors:
We had to shift services to all virtual, we did have the capacity originally to be able to do phone service. But we had to introduce the video as well. Because of the language barriers, often when clients are describing something, the interpreters will be able to describe it, if we can get that close to actually showing the person, such as I have a huge gash on my head right now, what do I do? So we had to figure out a way to incorporate video interpretation into our sessions…..And we partnered with another agency in Toronto, another community health center to be able to provide that support. We are in the process of now trying to think of how to do this on our own internally, but the capacity is built in. So that support is coming in from a partner that’s in Toronto. (community health centre, interview)
Additionally, this community health centre also utilized a virtual programming model as a tool kit. This virtual programming guide was created by a Canadian company and was customized by the centre for their daily work and practices:
We also came across recently, a company developed a whole virtual programming guide like a toolkit. And we are so happy to find that. So actually part of the sort of culmination of one of our projects and we will be creating something very similar. We will use this tool kit as our basis and then just customize it for our practice. So that at the end of all, this will have it kind of all in one place and have a sort of tool. But I think like they were ahead of the game on that one. And I was really glad that whoever sent it to me that that connection was made, because it shows you what we’ve all been kind of trying to do within little pieces. And they got there and they created something kind of cool. (community health centre, interview)
This participant also addresses how this programming guide was introduced to solve digital inequality issues in different communities:
When I started talking to other groups I heard this term digital equity, which is a bit more of an advocacy term. And so we decided internally, strategically, we're going to use that word, because it really is a new barrier to social determinants of health, and our whole model of care is based on that. So this is just one more we need to start plugging the human right. In this kind of world, you can’t see your doctor, you can’t get your groceries and you can’t order groceries as a senior if you don’t have online capability. You’re facing an inequitable barrier that needs to end. At a service individual level, we’re going to keep doing it. But it’s ridiculous that we’re shopping for tablets and trying to shop for internet plans for people that’s like that, that shouldn’t be the case.(community health centre, interview)
Virtual Care
The virtual care model is an emerging system that focuses on finding the best solution for both clients’ needs as well as practitioners.
Virtual care can be defined as “any interaction between patients and/or members of their circle of care, occurring remotely, using any forms of communication or information technologies, with the aim of facilitating or maximizing the quality and effectiveness of patient care” (Shaw et al., 2018). This breakthrough offers significant opportunities to not only modernize care delivery through interactive services, but also to increase access for those living in rural and remote areas where physicians are not always accessible. A recent report by The Virtual Care Task Force (VCTF) notes that Canada was an early leader in the advancement of virtual care with the works of Dr. Maxwell House of Memorial University of Newfoundland who used telephone technology to offer virtual consultations to remote locations throughout the province in the 1970s (Affleck et al., 2020).
This interest has also been well-represented among Canadians. According to recent polls undertaken by Canada Health Infoway (CHI), 80% of Canadians want access to their medical records as well as other digital health options including e-booking and e-visits. Furthermore, 96% of Canadians believe that using digital health technologies and capabilities is important for the health-care system (Canada Health Infoway). Several questions raised by the settlement sector about digital service delivery seem to be shared by virtual care stakeholders, according to our analysis. Furthermore, as already noted, Canadians' interest in virtual care has validated our need to investigate this field for specific procedures.
One digital health advisor suggests that hybrid service delivery, now somewhat in its infancy, might provide the best of both service worlds, but it must be strategically approached:
Telehealth is not a technology, not a stand-alone service, but rather a clinical tool. It’s a tool available to clinicians to deliver care, just like prescribing medications or referring patients to physical therapy are clinical tools to facilitate the speedy and sustained recovery of patients.
At times telehealth may be a good, appropriate tool and other times it may not. It’s neither a panacea nor is it a modern technology to be shunned. Sticking one’s head in the sand is not going to make telehealth blow over. What is needed is a strategy that guides the effective use of telehealth when appropriate while leaving room and support for the traditional in-person care delivery.
The Empowered Kids Ontario’s Virtual Care Resource Guide is a resource to support organizations in assessing Virtual Care options and implementing Virtual Care services. It includes specific information, templates and resources organized into relevant topics:
Heart and Stroke Foundation of Canada (2020) published a Virtual Healthcare Implementation Toolkit which involves a comprehensive roadmap and detailed checklists for effective and efficient virtual healthcare sessions for both clinicians and service recipients.
It is important to recognize that integrating digital into care processes is an all-in mentality. The Ontario Ministry of Health's "Digital Health by Design" philosophy, an approach to health policy and program design that integrates digital thinking into policymakers' and planners' everyday work, may be one manifestation of this thinking. It necessitates that healthcare professionals ask themselves, "How can we do it with digital?" across care processes and procedures, and consider how to accomplish their objectives through the use of new technologies.
In a comprehensive brief about virtual care in Canada, the authors put forward 10 practical steps which include suggestions such as making digital health practices (i.e., electronic renewals of prescriptions, and on-line scheduling) a part of the accountability agreements for primary-care practices.