Re-imagining healthcare: the Northwest Territories transitions to an integrated chronic disease management strategy.

With the goal to improve healthcare services and delivery, Stanton Territorial Hospital in the Northwest Territories (NWT) invited the Canadian Health Services Research Foundation (CHSRF) to explore opportunities to collaborate in the redesign and improvement of the health system. This article describes the NWT’s efforts to transform its healthcare delivery to more appropriately care for people living with chronic diseases. It also sets the context for the initial meeting between the NWT and CHSRF and the collaborative journey that continues, with the bringing together of 40 health system managers, policy makers and clinicians, along with CHSRF staff and guest faculty, with a shared vision to redesign care to better meet the needs of people living with chronic diseases in the territory. In the NWT, chronic diseases account for approximately 70% of all deaths and half of all hospital admission days (Northwest Territories Department of Health and Social Services [DHSS] 2011b). As elsewhere, it is understood that healthcare services are not currently meeting population needs. Canadian health systems rank poorly in international comparisons that focus on the delivery of primary care, especially to those with multiple chronic conditions (Schoen et al. 2009). It is also well recognized in Canada that few healthcare systems are patient centred. In a recently commissioned CHSRF synthesis on transformation, professors Ross Baker and Jean-Louis Denis (2011) remarked, “Healthcare systems tend to reproduce their dominant logic and consequently neglect other areas where major care deficits persist.” In another CHSRF-commissioned synthesis on transformation, Professor Denis and colleagues (2011) noted that “a clear vision and a coherent set of strategies are required to transform the system and achieve better alignment between the care offered and the care the population needs today.” Such is the challenge for the NWT. In its recently released 2011–2016 strategic plan, DHSS (2011a) set a priority to “improve the health status of the population” through the development of a culturally appropriate chronic disease management model that tracks system quality outcome measures. With a senior leadership dedicated to improving the health status of its population as a key strategic priority and highly engaged throughout the change management process, the NWT is well positioned to improve healthcare services and delivery through transformation. CHSRF, in partnership with NWT leadership, intends to support the territory through its longer-term vision, to strategically reorient the health system for the benefit of all those living in the territory. We also hope that the lessons we learn here hold value for learning elsewhere.