Hospital or home? Given the choice, most of us would rather stay close to what we know, in our communities, as long as we could receive comparable medical care and support.

Those who run our healthcare system agree. They know that the traditional acute care-focused model is not financially sustainable, or often appropriate, especially under the strain of a rapidly aging population and with more people living longer with chronic conditions. Patients receiving care in hospitals run a greater risk of contracting hospital-borne infections. Good community-based care can prevent the need to go to hospital and can help patients leave sooner. Community-based healthcare is not only attractive to patients and system administrators; increasingly, it's the way of the future.

"Community-based healthcare is not only attractive to patients and system administrators; increasingly, it’s the way of the future."

BRIAN GOLDEN
Executive Director, Collaborative For Health Sector Strategy

Government is responding by putting more emphasis on the community healthcare sector. Enhanced investment has come with that. Funding for homecare has more than doubled in Ontario, as have the number of Ontarians receiving it. Work is underway to increase access and investment in community-based mental health and addiction services. Better coordinated and integrated healthcare, closer to people's homes, is a central principle in Ontario's Ministry of Health's Patients First philosophy, making home the preferred acute care discharge option for elderly patients, instead of long term care.

Many community agencies have done an impressive job of providing -- sometimes pioneering -- badly-needed services, tailored to the needs of their clients, on tight budgets. Punjabi Community Health Services, a small, 25-year-old agency in Ontario's Peel region, was among those leading the way in mental health, addiction and geriatric services with its development 15 years ago of a holistic family-centered, rather than individual-centered, model of care.

However, the redefined and evolving role for community-based healthcare brings more intense demands for increased service delivery, evidence-based accountability, transparency and collaboration. Community-based organizations are more than eager to meet the challenge, but we have not done enough to prepare their leadership. This is not only unfair to community health leaders, it's poor business practice when it comes to ensuring that additional investment in the sector is used to its fullest advantage.

Brian Golden also teaches Health Leadership: Achieving Your Potential

Many community sector healthcare leaders get to their roles after serving in frontline professional positions, such as social workers and nurses. Rarely have they received formal training in leadership, management or financial strategy skills. They seldom get the chance to step back and reflect on current processes, what works and how things could be done differently. Many are too busy meeting the needs of their clients, being accountable to a diverse group of funders and putting out the bush fires typical of small organizations to devote much time or money towards a "nice to have," rather than a standard leadership support, similar to what many leaders in the acute care sector have access to.

This becomes critical when we accept that our future healthcare system will be one that must provide more value -- that is, more and better care for the dollars we spend. It cannot be treated as an either/or trade-off, or a call to make staff, commonly paid less than their hospital counterparts, work harder. Instead, it means delivering services differently and leaders with the vision to see what is possible. Technology might be harnessed so that a rural homecare nurse checks in with a client via Skype instead of always driving to see them. Volunteers and even clients can be mobilized for peer-to-peer mental health support.

A well-developed leader can create the conditions for value-adding opportunities such as strategic partnerships and service consolidation. But to advance these, the leader needs negotiating, governance and relationship management skills. Likewise, in the community care sector, which depends too often on overworked staff and volunteer goodwill, no leader can afford to lead change with a big stick; that's not what professionals respond to, nor should it be. The leader's job must be to provide a compelling vision for change that motivates those within the organization to welcome it and want to get on board.

We have the opportunity to deliver better care, more tailored to the needs of patients, where they have asked for it: close to home. But this will take a reconceptualization of what health and community-based care are and can look like. That cannot happen without the full participation, creativity and unique insight of community health leaders. To do this, they must be supported, with the same access to leadership development, appropriate to their needs, as acute care leaders receive.

Yet the opportunities remain limited. When Rotman recently held its Community Health Leadership Program, generously supported by philanthropist Bill Downe, few of the 35 executives attending had ever had the opportunity to share and learn about leadership challenges experienced at other community agencies like theirs. We are thankful so many talented and hard working people have committed to working in the community sector. It's time to do our part and support their dedication by providing them with the leadership tools they need to help us sustain a quality healthcare system well into the 21st century.

Brian Golden is the Vice-Dean of Professional Programs; the Sandra Rotman Chair in Health Sector Strategy at the University of Toronto and The University Health Network (joint appointment Faculty of Medicine); Professor of Strategic Management at Rotman; and Executive Director for Collaborative For Health Sector Strategy. Brian's conducts research and teaches in the areas of strategic change and implementation, health system integration and funding, governance, organizational strategy and leadership. He also teaches in numerous Rotman Executive Programs including the Advanced Health Leadership Program, Community Health Leadership Program, UHN-Rotman Leadership Development Program and customized programs for organizations. For more information visit: www.rotmanexecutive.com/healthleadership.