有明确越来越多的证据表明，医疗参与为实现患者护理的创新和改进做出了重要贡献。在过去的四年中，Cowichan领导团队及其医师合作伙伴已经认识到这一点，并共同努力在山谷中建立了迎合这一挑战的文化。这种参与和文化转变的旅程不仅得到了质量改进，参与活动，领导力发展，教育和培训的投资，而且还受到导致所需状态的治理安排的支持。
有效地整合了医师参与的临床和行政组成部分，呼吁强大的医师领导和参与治理角色，这通过整个岛屿卫生行政领导者经常与医疗领导者配对的地区的Dyad领导模式得到了增强。beplay全站App
通过关注医师和管理员之间的联合决策和结盟策略，Cowichan展示了与临床整合的统一护理交付模型，该模型还为将医师和管理员汇集在一起，并基于以下论点，即医疗参与不应是可选的额外额外的论点，而是任何健康组织和系统文化的组成部分。
This commitment to improving collaboration has been facilitated in many ways including ensuring that all physicians working in the area have forums to be heard and that they are informed as to how to navigate the system to allow them to contribute to the planning and decision making within the area. These contributions have been provided through a variety of channels including the Collaborative Services Committee (CSC), the CDH Quality and Operations Committee, the Cowichan Valley Quality and Operations Council, the development of the Physician Human Resource Planning Committee, the Local Medical Advisory Council and the Health Authority Medical Advisory Council.
确定质量改进的医师冠军，整个Cowichan都努力通过关键发展的质量改进愿景，例如快速进入和出院单位（RADU），重症监护外展团队（CCOT），社区的快速响应医生和住宅护理姑息护理服务的倡议（RCI）建立和发展。
其他改进包括：
- implementation of the electronic Best Possible Medication History (eBPMH) in the CDH Emergency Department
- 实施更多OB计划
- 选择主要关节置换患者的同一天出院
- 成功地在急诊室实施中风协议
- 手术室和外科服务的空前效率
这些改进的实践示例为提供高价值绩效的工作提供了证据，从而改善了卓越的运营，降低了差异，最大化可靠性并为利益相关者带来最大的价值。
At a shared care engagement event recently held in Cowichan, these examples were outlined by Dr. Graham Blackburn as part of his presentation to highlight how the area can adapt the principles of highly reliable organisations to drive operating cost reductions and higher output, while maintaining the high safety environment demanded by healthcare environments. Together with Brenda Aguiar, Quality and Safety Lead for Geography 3, Dr. Blackburn explained that the key to a highly reliable organization’s performance is to conduct consistent, sustainable and low error operations based on informed, high quality decision making and controls and that collaboration and engagement between physicians and administrators is necessary for this to be executed successfully. As Dr. Graham Blackburn put it, "Getting to know each other and understanding how we can best work together will help us provide reliable, high quality health care."
活动结束后，鲍勃·安德森（Bob Anderson）博士说：“我希望我们所有人将来都能有更多这样的活动。我认为我们所有人都可以很好地工作，以至于我们忽略了CDH上演变的全面服务功能。多么的团队！！”
此外，尽管Jan Malherbe博士将是第一个承认自己不是一个值得渴望的人，但他还发现订婚会议非常愉快。
"The sessions were unique in that we had various levels of care providers in one place, sitting together shoulder to shoulder, all speaking to the same topic of how we can improve patient care. There’s a great deal of value in the perspectives of so many people with vastly different experiences," says Dr. Malherbe. "Every day on the wards, I see these same people and witness their commitment to our patients, but there isn’t time for deep engagement. After brainstorming with them at the sessions there is now a recognition that we were all part of the same process. It’s absolutely brilliant."
Throughout the four-year journey to improve collaboration and build relationships based on trust, the Cowichan Valley has recognized that a key principle in alignment has been "separate togetherness" in which physicians and administrators have maintained their own autonomy as separate groups but simultaneously united around a common purpose of driving up standards of quality care and provision of service delivery. This shared vision, common purpose and trust is what is hoped will lead the Cowichan Valley to continue its pursuit of operational excellence, and a coveted spot as one of the best places to work on Vancouver Island for both physicians and administrators alike.
区域主任艾玛·詹姆斯（Emma James）和地区医疗总监米歇尔·韦泽尔（Michelle Weizel）博士都承认：“科琴地区很幸运有一群致力于和敬业的医生，他们处理将运营策略与能量和热情保持一致的工作，并真正致力于真正致力于改善组织和总体实现我们的地区目标。”
