Long before collaborative-health centres became a trend, the model was thriving in Halifax’s north end.
The idea started in 1971 and has since evolved into a community hub.
“There was no health facility in this part of the woods,” said Dr. Anne Houstoun, who has worked at the North End Community Health Centre for 32 years. “So the community got together and rallied, that’s how this one came about.”
The facility is governed by a board, and the health-care workers don’t have to deal with administrative duties. Because it’s a multi-functional health centre, it receives funding from the Nova Scotia Health Authority and charitable donations.
The clinic at the centre, which has a goal of seeing 6,750 patients a year, doesn’t depend solely on the seven family doctors who work there part time. The team includes nurses, a social worker and a nutritionist. Their mandate isn’t just to treat patients, but to educate and advocate for their needs.
“To me it’s the best health-care model,” Houstoun said.
The clinic is one of the success stories CBC Nova Scotia is examining as part of an in-depth look this month at the province’s doctor shortage.
Dr. Anne Houstoun, who has been working at the clinic for 32 years, said it thrives because all the health-care workers are considered equals. (Brian MacKay/CBC)
Instead of being compensated through fee-for-service, physicians on staff are paid a salary, which encourages them to take the time that’s needed with each patient.
“We happen to work in an area that has low socio-economic, so there’s social challenges and other challenges,” Houstoun said. “But this model would work anywhere.”
When Nova Scotia started training nurse practitioners, the North End Community Health Centre added two part-time positions to their roster. Marilyn Rutherford, who was in the second graduating class, started 13 years ago.
“It’s actually my dream job,” she said. Rutherford’s scope of work includes ordering X-rays, ultrasounds and prescribing medication.
“I used to do outpost nursing, so I got a good feel for working independently but also collaboratively because physicians were at a distance. So this was kind of the next transition for me, and we have a very collaborative team here.”
Doctors work as part of a team at the health centre. (Brian MacKay/CBC)
Rutherford’s work isn’t just limited to the building. One day a week, her job is outreach. With the help physicians, she compiles a list of patients who have difficulty leaving their homes and does wellness checks.
While the province deals with its doctor shortage, Rutherford thinks more nurse practitioners could help.
“I see how well it works here,” she said. “I can’t speak for all types of practices but I think this kind of collaborative model works very well.”
The staff at the clinic work under the philosophy that there is no hierarchy among the team.
“That’s a very key element whenever we’re hiring, that you have to be on board with that,” said Houstoun. “All the health-care providers have their own expertise and this egalitarian model, and that works very well.”
The health-care workers have regular meetings to discuss cases. They share notes and files.
A doctor, for instance, might be focused on a patient’s high blood pressure and have “no clue as to what the problem was.” But a nurse might know more about the patient’s extended family and the stresses in their life.
“It gives us a much broader source of information to understand our actual patient population,” said Houstoun.
After thriving for decades, she said it’s clear that their collaboration is one that works.
“I think it’s a model if you look at broader health care, I think it’s an excellent model that serves all kinds of needs, no matter what the population is.”
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