IPCHS. Integrated People-Centred Health Services
May 27, 2016

St. Michael’s Hospital, Department of Family & Community Medicine-Family Health Team

Logo St. Michael's hospital
Region: Americas Engaging and empowering people and communities, Strengthening governance and accountability, Reorienting the model of care, Coordinating services within and across sectors, Creating an enabling environment

The St. Michael’s Hospital Academic Family Health Team (SMHAFHT) is a large, primary care teaching clinic, affiliated with the University of Toronto, and nestled within the downtown core of Toronto. The Family Health Team provides services to the inner-city community of Toronto through 6 clinical sites located conveniently in these neighbourhoods. We serve the poorest communities in Toronto - people who are marginalized, underhoused and with significant health comorbidities who are significantly impacted by many social determinants of health that negatively affect the quality of one’s life, such as poverty, inadequate housing and inequitable access to health and social care services. 

In identifying the significant impact that social determinants of health have on our community, and in consideration of the research which supports the importance of interprofessional (IP) care and education, our department undertook a visioning and planning process to evolve and ‘re-purpose’ the way we deliver care, how we interact with our patients/community and how we train our learners. Our approach was to first consider what we would want to see as optimal primary care in the future. With this in mind, our team consulted broadly with patients, local community agencies, our health providers and administrative staff as well as our academic partners and funders. Top priorities included:

- Improving access to and coordination of health care services and expanding the types of services available, based on identified patient/family/community health and social care needs.

- Supporting integrated care by focusing on a stronger team-based model of care with health providers working to full scopes and skill sets,

- Articulating a comprehensive strategy to address social determinants of health through innovative partnerships with government, non-governmental organizations (community-based agencies) and academic training programs (key system actors)

- Developing an innovative way to train our health professional learners through interprofessional education (IPE) and through the modelling of collaborative behaviour within the team.

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