Technology to Practice: A Three Part Series. Part 1: Dynamics and Challenges in Community Care

Together with Anthony Divalentino, the talented and exceptionally bright Executive Director of the Central Brampton Family Health Team, we are bringing forth a three-part series on implementing technology in community practices.  We hope this will combine the experiences of both the clinical and administrative sides of care, talking about the issues and helping solve problems in practice.  We both believe that technology is not a panacea to all the woes of our day, but rather, if brought in thoughtfully can help clinics and clinicians operate more smoothly, dynamically and with greater joy.  This is the ultimate goal! Of course, you may disagree so please do comment!!

Thanks for the read.

Darren and Anthony.

The Dynamics and Challenges in Community Care

Community clinics face a unique set of challenges. One of the most pressing issues is the relentless rise in operating costs against stagnant revenue streams. Adding to this is the continual pressure to find staff to replace those who have left or to increase capacity in this post-pandemic world of work. Certain medical administrative positions are especially hard to keep filled and have high turnover. Low and static wages, combined with a lack of extended benefits, make these positions difficult to staff. This problem is not going away anytime soon because we can’t afford it. Workloads in clinics are increasing daily due to numerous system pressures. Our population, unevenly distributed throughout the province, is growing rapidly due to urban growth. There are never enough people to serve the needs in the busiest clinics, and there is always more demand. To make matters worse, the health system tends to download more responsibilities onto primary care practices, leading to a massive increase in administrative stress. Long wait times for specialist appointments and procedures mean primary care is required to manage complex cases for extended periods. Ensuring compliance with standards in areas like electronic medical records, privacy and confidentiality, and data collection is complex and requires large institutional resources to handle. However, most community clinics lack such resources, leading to clinical staff time and expertise being misapplied to non-core-competency jobs.

Community Healthcare vs. Traditional Businesses

In many sectors, a growing labor force is often a signal of strength, prosperity, and asset growth. This workforce expansion can enhance the value of a business, contributing to its scale, spread, and long-term success. However, most of the community healthcare sector operates under different dynamics. The term ‘administrative burden’ frequently arises from an inability to endlessly accommodate administrative demands. Most community healthcare clinics, unlike traditional businesses, are not designed to be sold or to generate profit in the same way. This fundamental difference means that any investment in the labor force or other key areas needs to have an almost immediate payoff, as there is no future sale to recoup costs or generate a return on investment. Growing administration does not correspond with revenue growth to offset or support the administrative expansion. In fact, staff are a cost center to most practices.

In community healthcare, we often focus on immediate and short-term planning due to the lack of asset growth. Most organizations are preoccupied with addressing current and near-future challenges, with only a few able to plan and invest for the long term.

The challenge is even more pronounced for doctors and nurses who bear the brunt of these administrative tasks when staff are stretched thin. More admin work often strains resources without a corresponding increase in revenue. As management, we must view administrative tasks not as a burden but as opportunities to find innovative ways to inform, manage, and improve these processes. Additionally, these clinics need access to sufficient implementation support to effectively integrate new systems into practice.

Specialized compliance officers and expert management available in larger institutions are not available to most community-based clinics. These clinics must be accountable for data interoperability, privacy and confidentiality, risk management, and a host of other domains that are not necessarily within the team’s core skills. As administrative burdens increase, it takes more personnel to maintain the same level of service, straining already tight budgets. There has to be a release valve other than “hire more staff.” The status quo can’t be an option because hiring more people as demands rise is not feasible with stagnant revenues. With each passing day, the pressures pile up until the clinic backbone buckles. So, how can this be changed?

Innovative Administrative Management

We are writing this together from the perspectives of the executive director of a large suburban family health team and a primary care physician who deeply understands health technology and its potential for use and misuse. We approached it this way because, like the material we discuss throughout, no matter how good the idea is, it requires a team effort. In community-based healthcare, the best idea can’t be implemented without a diverse skill set and sufficient implementation support. The best administrative team can’t progress an inch without ensuring clinical objectives and standards are achieved. There are so many tools available that there isn’t enough time for community clinics to be aware of all of them, let alone implement, troubleshoot, and coordinate among various members of medium to large clinics. But modern tools are required to bring a modern service experience. It’s not the only thing required, but it must be part of the program. For this to happen, community clinics need expertise and support beyond what EMR vendors and generalized IT companies offer.

From our perspective, processes and technology can be implemented to make accessing services more convenient, workflows simpler, and the experience of accessing and being employed in primary care better. There are ways to improve the patient experience and outcomes and ensure sustainability, especially as we balance the demands for access with continuity and quality. Without additional revenue or funding, innovative approaches are required to propel the service experience in community healthcare to a level similar to other service-based industries. This blog series aims to explore how leveraging technology can help ensure sustainability in community clinics and how we can prepare for future technological advancements to reinforce and expand the capabilities of the people delivering community healthcare.

Our effort in no way suggests that technology is a fix-all, magic bullet. It is not. It must be part of the discussion to provide levers that offer mechanical advantage where needed as our population ages and grows. We focus on tools, but most importantly, how tools help people. We hope you engage with us as we look at technologies and processes that are becoming increasingly relevant in areas such as how patients can access medical appointments, engage with our providers and clinics, and how our healthcare providers can be equipped with the best information and modern tools. Areas ripe for enhancement need awareness brought to them, and opportunities that may be around the corner need to be highlighted. The marketplace is in a place where we must all adopt a “ready-position” posture as we explore what is out there for us and you. Most importantly, we will explore what benefits deploying these tools and processes into our community-based clinics can yield.