Navigating The Health Care System

By Susan Sainsbury RN on April 29, 2014

Navigating the Health Care System

Primary care is the foundation of our health care system. The first line of contact patients and their families have with the health care system is usually through their doctor, nurse, or other medical professional. Patients may subsequently be referred by the primary provider for specialized care at a hospital, a rehabilitation facility or a long-term care facility. Alternately, health care services may be prescribed within a patient’s home. These specialized services can include nursing care, home care,physiotherapy and home-making services for people requiring assistance with daily living activities and wish to remain independent. The patient’s needs are assessed by case managers, and services are coordinated to provide continuity of care.

As a registered nurse, working in hospitals and in the community, I have discovered first-hand how frustrating it can be for patients to navigate the health care system. Over

many years I have learned that a family doctor’s referral does not necessarily expedite the process as designed. As Director of Care for Living Assistance Services, an

agency that specializes in providing home care to seniors, my job is to ensure our clients receive the timely assistance they deserve.


Seniors may find it difficult to navigate the health-care system especially if they live alone. In Ontario, after a patient is discharged from a hospital, the discharge planner or social worker will organize access to home care through the Community Care Access Centre (CCAC). The CCAC will conduct an interview to assess the patient’s needs.

It is important to know that the home care services provided by CCAC are typically short-term and often restricted to a limited number of hours per week. Seniors may need to supplement this care with private or family caregivers.


In health-care, as in life, the more knowledgeable you are about the system, the better off you are in terms of navigating it and maximizing results. My best advice to patients in dealing with the system as efficiently as possible is four-fold:


Information: Currently, healthcare agencies and the government provide a great deal of information on the internet to help guide and accelerate the process of navigating the system. Patients, especially seniors, may utilize the Internet but the importance of asking healthcare professionals the right questions should not be underestimated as this can usually accelerate the process of obtaining the right care, at the right place

and at the right time. Information is power only if used wisely.


Advocacy: Become your own advocate or identify individuals who can be your advocates. A significant portion of my job entails acting as an advocate on behalf of our clients. I have observed that at times, family members are so overwhelmed with the emotional and physical aspect of providing care to a loved one that, they simply do not have the energy to advocate on the loved one’s behalf. Family and/or patients should also enlist their doctor’s support and make him/her an advocate because he/she is a navigator and gatekeeper of various elements of the healthcare system. You should never feel shy or guilty about asking your doctor what to expect from tests or specialists and what will happen next.


Self Management: Self management will help you control your own patient care

experience. For example, if you are being referred to a specialist, ask your doctor when the referral letter was sent and if it’s possible to obtain a copy. This will allow you to fol-

low up with the specialist to make sure your appointment is booked. It will also eliminate the risk of your referral becoming lost, as sometimes happens. In addition, self management is useful when dealing with a complex system such as a hospital. For ex-

ample, instead of waiting for the result of an ultrasound or x-ray and then having a blood test, you can enquire, “Could I get the blood test done while I am waiting for the ultra sound?” Self management of chronic diseases will also help you understand the disease in a thorough and thoughtful way. Seek out information and become an active participant in your own care.


Networking: Networking will help you discover information and gain access to services. Make a list of family, friends and acquaintances who work in health care just in case

you might need their help or advice.


Remember that there are things you can do to improve your own medical journey or that of your friends and/or family. Understanding the shortfalls, complexities and nuances of our health care system will help you navigate it effectively.








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By Susan Sainsbury RN| April 29, 2014
Categories:  Care Giving

About the Author

Susan Sainsbury RN

Susan Sainsbury RN

Susan Sainsbury, RN is the Director of Care at Living Assistance Services

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