'We are going to have that breakthrough': Karima Velji on reimagining health care

Karima Velji, Ontario’s chief of nursing and professional practice (CNPP) and assistant deputy minister, wants to reimagine – and ultimately reinvent – models of health care so that they meet the needs of the population now and in the future.

When thinking about the nursing workforce, the alumna of the University of Toronto’s Lawrence S. Bloomberg Faculty of Nursing stresses that a human health resource strategy that focuses on more than retention and recruitment must be considered as part of a shifting model of care.

She says it is the only way to solve the current issues facing the health-care system.

“I’ve always believed that complex problems require complex solutions, and you can’t cultivate those solutions in an office or a board room – they need to be developed in collaboration with the people you are trying to impact,” says Velji, who was recently appointed Ontario’s CNPP and assistant deputy minister. 

A seasoned nursing leader who previously worked as a senior executive in several academic health science centres, Velji says it was important that her role as CNPP be more than just a figurehead. She needed to be able to make an active difference at the health system level – something she has been committed to doing throughout her career.

Velji is an avid supporter of patient and family partnerships in co-designing care solutions. In her previous role, she led the creation of a new team-based integrated model of care for psychotherapy in two large regions in Ontario – one of the first to be publicly funded. It embedded mental health practitioners (nurses, occupational therapists, social workers, etc.,) within primary care practices, including those that supported Indigenous and racialized communities. It was one of the few times, Velji says, they were able to see this marriage between primary care and mental health, solving an upstream issue with wait times and providing care directly to those in need sooner.

“That holistic approach, where the patient experience is good, outcomes are positive, the system improves and financial stewardship is sound, is truly magical,” says Velji. “People are happy when their care is co-designed.”

Building robust relationships – not only with patient partners but also point-of-care health care team members – is something Velji continues to advocate for. Tapping into the wisdom and credibility of nurses and heath-care professionals is instrumental in bringing healthy public policy to the table, she says. It is also, she adds, an opportunity to resituate care solutions around the needs of the population, which is what “nurses do best.”

“Nurses go into the profession to care for people. We are the largest in numbers and the highest holder of public trust,” says Velji. “We are embedded in all sectors of health care on a 24-7 basis. Our nursing workforce is one of the most educated in history, and there is a real opportunity here to have nurses lead change.”

Velji is under no illusion that change will be easy. In fact, some of her ideas around new models of nursing care seek to reimagine where nurses need to focus their knowledge and skills in the health-care system. For example, she says it is important to prioritize nurses’ presence in the community dealing with upstream health issues in the population to avoid emergency room visits in the first place. “These are changes that require more than just increasing staffing levels, they require us to think outside of the box.”

Velji says home care, long-term care and the mental health sector are all in dire need of nursing knowledge and skills as direct care providers. These are areas where new policy, appropriate compensation for nurses and acknowledgement of leadership and expertise must be addressed in order for the profession to embrace these areas in higher numbers.

“We don’t have a choice – we need to be in community spaces, taking charge of the health of the population on a continuous basis,” says Velji.

When she immigrated from Tanzania, one of the many aspects that drew Velji and her family to consider Canada was its health-care and education systems. But as she became a nurse and progressed through her leadership roles, she couldn’t believe the types of problems in care provision that she encountered.

“I could not find a primary care provider for my adult son and his family and I knew how to navigate the system. Imagine then what it is like for so many, including newcomers, to try and find basic primary care,” she says.

Nurse practitioners, Velji says, could solve the lack of primary care providers where almost one in 10 individuals in the community do not have access to a primary care practitioner. This would also benefit the mental health care sector as well.

“I’ve worked in mental health and addictions,” says Velji, “and I’ve seen how we make patients wait and wait for care and services, resorting to emergency room support at their most dire time.”

Velji does not shy away from saying that the health system and the nursing workforce is challenged; many of the current concerns within nursing have been on the horizon well before the COVID19 pandemic. But what continues to motivate Velji is a fundamental desire to make a difference and to give a voice to those who otherwise would not have one.

Velji credits her time as a student at U of T in both the master of nursing and PhD programs and the nurse practitioner program, as well as in her role as an adjunct lecturer, in helping her develop an ability to see a problem from multiple viewpoints, and to let the evidence inform the way forward.

“U of T has been instrumental in creating knowledge in the health human resource space, and I think it remains well poised for us to continue to study the models of care we need for tomorrow. We have the scholarly capacity here to show us the way forward,” says Velji.

Velji is unshakeable in her belief that nurse leaders will reimagine health care and practice because they are uniquely prepared to do so. Yes, the shortage needs to fixed urgently, but so too does the way in which the system provides care, she says.

“We are going to have that breakthrough and find a solution for health care because the population needs us. Our first duty is to the people we serve, and we cannot lose sight of that.”