Strengthening Health Workforce through Indigenous Care

Dr. Stephanie Montesanti

On July 11, 2024, the Canadian Institutes of Health Research (CIHR) announced a significant $11.6 million investment to strengthen Canada's health workforce, as part of a broader $47 million federal initiative. Among the funded projects is one led by Stephanie Montesanti from the School of Public Health at the University of Alberta, focused on improving clinical care for Indigenous Peoples in Alberta's primary care networks (PCNs).

Montesanti, along with her team Lynden (Lindsay) Crowshoe, Val Austen Wiebe, and Esther Tailfeathers, received the CIHR Strengthening the Health Workforce for System Transformation – Implementation Science Team Grant, receiving $750,000 in funding. Their project introduces an Indigenous Hub-and-Spoke Model of Care in PCNs, addressing the unique health challenges faced by Indigenous patients, often complicated by social, cultural, and environmental factors.

"The project is really intended to support clinical care for Indigenous patients within primary healthcare settings," says Montesanti. The Indigenous Support Hub will be a shared resource for healthcare providers in PCNs, offering support on social, cultural, and systemic factors affecting Indigenous Peoples health. Indigenous support workers will participate in virtual case conferencing and collaborative learning with clinicians to provide guidance and advice on best practice care for Indigenous patients.

Roles of Indigenous support workers include hospital liaison workers, patient navigators, and mental health navigators, bringing Indigenous knowledge and expertise to support Indigenous patients. Montesanti emphasizes, "They have an intuitive understanding of the person's lived experience and how social and cultural environments shape health and well-being."

The project involves a patient-centred, collaborative learning model using a ‘Hub-and-Spoke’ structure. The Indigenous Support Hub connects with PCNs via videoconferencing for case-based learning and skill building, enhancing local Indigenous patient care. The hub will include Indigenous support workers, a social worker, and a trained social scientist, integrating best practices and evidence for other hub members.

"PCNs will connect with the Indigenous Support Hub using an intake process," Montesanti explains. An intake worker will review the requests to determine the best support worker to initiate case-based learning with the  PCN team, providing a space for collaborative learning and mentorship for clinicians.

Montesanti's team will utilize implementation science and learning health system thinking to support the implementation of the Indigenous Support Hub.. They will engage researchers, policy-makers, professionals, and Indigenous patients to integrate research and evidence-based practices into the Indigenous Support Hub's implementation. The team will also form a Research Advisory Committee and a Professional Advisory Committee to encourage collaboration and capacity-building.

This three-year project begins with formative research and relationship-building in the first year, followed by the implementation of the hub model in the second year, and evaluation in the third year. The Indigenous support hub model aims to improve access for Indigenous patients, support clinicians in understanding social and cultural dynamics, and prevent further harm through a deeper understanding of Indigenous experiences within the healthcare system.

Montesanti highlights the importance of this initiative, "It touches on so many things in terms of improving cultural safety for Indigenous patients and ensuring they are accessing the right supports they need." The project addresses the current primary care crisis in Alberta, where increasing administrative burdens challenge primary care clinicians' ability to manage the complexity of issues experienced by Indigenous patients. 

The federal government plans to invest nearly $200 billion over the next decade to improve healthcare in Canada, including CIHR's largest investment in health workforce research. This funding aligns with themes identified by the Canadian Academy of Health Sciences, aiming to improve retention and recruitment practices, support physician mobility, and strengthen the health workforce, ultimately influencing policy and practice nationwide. 

Montesanti and her team's innovative approach to Indigenous healthcare in Alberta demonstrates the transformative potential of targeted research and collaboration. This CIHR investment marks a significant step toward a stronger, more resilient healthcare workforce capable of meeting the diverse needs of Canadians.