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Background - Patient's Medical Home and Health Neighbourhood Implementation in Alberta

For almost two decades there has been a growing commitment to transform Alberta’s primary health care system and to optimize its integration within the broader health neighbourhood. Transformation in Alberta began with a handful of clinics, dispersed across the province testing different ways of delivering care to their patients.  At the same time, international evidence continues to emerge demonstrating results that improving quality of care, patient outcomes, and patient satisfaction can be achieved via implementation of the Patient’s Medical Home.

In Alberta, there have been several successful implementation demonstrations of PMH elements, indicating that adoption of the PMH model is possible in our province. In addition, significant uptake of panel identification and preventative screening initiatives validates that spread and scale of PMH work is achievable. 

These successes are the result of clinical teams mobilizing to change the way they deliver care to their patients.  However, most of the improvements have not been organic, but the result of many change agents working tirelessly to promote and support a new way of delivering primary care.  These change agents can be found at all levels of the healthcare system and include:

• Clinic level change agents such as clinic managers, clinical staff, and patients
• The health transformation workforce level – practice facilitators and PMH physician champions supporting clinics to transform
• Enablers of change such as PCN strategic leaders (e.g., PCN Board and Governance Committee members) and PCN staff (e.g., executive directors, PCN communications Personnel, evaluation personnel) typically positions who operate a step or two removed from the clinic level
• System level supports, partner programs and organizations supporting the optimizations of health care delivery

The AMA Accelerating Change Transformation Team (ACTT), and its predecessor organizations[i], , have been supporting structures and roles for primary care reform efforts since 2003 including support to PCN boards, PCN business processes, and clinical process experts.  In 2018, Alberta Health Services (AHS) launched the Primary Health Care Integration Network (PHCIN), a Strategic Clinic Network focused on coordination of services across the health care system.  ACTT is actively partnering with the PHCIN with the focus on the integration of primary and community specialty services. 

As the complexity and scale of implementing PMH and the health neighbourhood increases, the need to organize and optimize supports has also increased. This Blueprint has been created to organize the supports, to identify gaps, and to enable ACTT to continue to optimize the supports.  Its structure was created to be applied to a variety of change agents supporting the implementation of the PMH in the health neighbourhood. 


[i] In 2016 the support programs of Practice Management Program, Towards Optimized Practice, and PCN Program Management Office began work together to better integrate the support and change services offered. These programs officially merged on November 1, 2018 and were renamed Accelerating Change Transformation Team or ACTT.