The development of six regional collaborative care centres is a key component of the clinical services plan released Monday.

But, as the authors note, it will require more than simply developing the infrastructure and getting the staff in place to refresh the Yukon's health care system. It will require a shift in the health care delivery culture.

The regional centres, as envisioned in the report, will provide care to two to four communities in a "hub and spoke” model.

These regional care centres will take a holistic approach to health, integrating social services such as alcohol and drug services, with mental health, health promotion, and medical services led by a nurse practitioner.

"To date, the integration of collaborative services that are patient-centred have not been achieved among professions and families,” the report notes.

"This is achievable through a hub and spoke model structure around regional collaborative care centres.”

The report suggests developing the six regional care centres in Carmacks, to also serve Pelly Crossing, in Carcross to also serve Teslin, in Dawson City, to also serve Old Crow and Mayo, in Haines Junction, to also serve Destruction Bay and Beaver Creek, in Ross River to also serve Faro, and in Watson Lake.

The report includes a master design for collaborative care centres, which calls for a new territorial alcohol and drug services program, noting that service has been "weak” outside of Whitehorse.

It suggests adding two full-time equivalent licensed practical nurses for alcohol and drug services at each regional collaborative care centre.

The master plan also calls for increased services at the rural centres for child abuse treatment, the child development centre, fetal alcohol spectrum disorder, mental health, occupational therapy, palliative care, physiotherapy, social work, and home care nursing.

It recommends creating new positions for a nurse practitioner, health promotion officer, manager, and public health nurse at the regional centres as well.

For each of the six regional centres, the report provides more detailed recommendations for service provision specific to each community's needs.

While upfront costs to establish collaborative care may be high, the authors note it will not only improve the quality of outcomes, but also pare system costs overall in the long run. Those savings, however, can be more difficult to measure than the upfront funding.

But simply fulfilling the staff requirements at each regional centre isn't enough.

Work to develop a culture of teamwork is also needed, and based on the experiences of one Alaskan program, greater involvement of the community may be necessary too.

The Southcentral Foundation is a non-profit health care organization that serves more than 60,000 native people in Alaska through its Nuka System of Care.

The foundation is based out of Anchorage but serves rural populations as well.

The patients of the Nuka system are referred to as customer/owners and take a more active role in health care decision making.

"Before the Nuka System of Care, far too many Alaska Native people believed that they had no control or opportunity for input,” writes Katherine Gottlieb, the foundation's president and CEO, in her 2013 paper The Nuka System of Care: improving health through ownership and relationships.

"The Nuka System of Care is a departure from "beneficiaries” or "patients” serving as mere recipients of tests, diagnoses, and pills. Instead, customer-owners actively share responsibility for the success of the health care system and for their family's health and wellness,” she says.

The system is run by a board of directors comprised of Alaska native customer-owners representing various Alaskan tribes. It also provides different methods for customers to provide freedback.

Gottlieb notes the chief responsibility of each service provider is to develop strong relationships with their customers.

"Relationships provide a better understanding of the context in which a customer lives. As a result, providers are in a better position to understand symptoms, answer questions, have meaningful conversations about risks and benefits, and work with each customer to make better health decisions,” Gottlieb writes.

She continues on to note that relationships across the organization are also necessary.

"Building a culture of trust, based on relationships, encourages shared decisions-making and supports innovation and creativity,” she says.

In order to encourage relationship-building the foundation requires new employees to complete a three-day course that helps new employees understand how their relational styles impact others and how their experiences affect how they build relationships, she explains in the article.

"(The system) works because Southcentral Foundation redesigned the entire health care system based on the wants and wishes of its customer-owners, and, in doing so empowered those receiving the services to share the responsibility,” writes Gottlieb.

In the article, Gottlieb notes that in 1996, only 35 per cent of the local Alaska native population had a designated primary care provider; now, more than 95 per cent are assigned to a collaborative care team.

"Providers know their customers' names, as well as their histories, preferences and family dynamics,” she notes.

Before the Nuka system, there was an average wait of four weeks to schedule an appointment. Now, they can offer same-day access either in person or by phone or email.

The foundation has also seen a 36 per cent reduction in hospital days, a 42 per cent reduction in emergency room and urgent care usage, and a 58 per cent reduction in specialty clinic visits.

Those statistics have been sustained for a decade, says Gottlieb.

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