S06 E04 Learning Pathway Stage 2: Building Relationships

Morgan and Sarah continue their discussion on Stage 2 of the Learning Pathway for Primary Care Teams. This episode is focused on Team Building, and specifically, seeing Patients as Team Members. The hosts make a point that patients are essential team members, and understanding the patient perspective when transitioning to team based care is important. If a practice is moving to team based care, patients likely won’t know what to expect, and may even be worried that their standard of care is lowering. Morgan and Sarah highlight the importance of exploring methods of communication to help explain this new care model. Furthermore, the discussion emphasizes how small communication changes in everyday practice can have a significant influence and help patients feel more supported. Finally, practical suggestions are made to help healthcare establishments in manifesting their teams via checklists, orientation activities for new patients, posters, and website representation.

Special thanks to Amie Hough, a Leader in Health System Improvement for Primary and Community Care with Health Quality BC, and one of the creators of the learning pathway, who we will be hearing from throughout the season.

Links and Resources

For more information on the Team Based Care Learning Pathway check out https://teambasedcarebc.ca/team-based-care-pathway/

To get started check out the culture change toolbox and the “Questions to consider before getting started” on P 12 of the toolbox.

Read over the AHRQ White Paper discussed in this episode “Creating patient Centred Team Based Care” (2016). This includes a great list of strategies for providing patient centred team based care (p. 7-19)

Check out the activities laid out in the Patient Centred Teams “Setting the Stage” handout

Past Podcast Episodes that may be of interest:

• TeamUp podcast: S05 E02 Patients as team members
• Explore more of the resources in Stage 2 of the Team Based Care Learning Pathway.

Through the TeamUp network we are working to advance supports for team based primary care. Please reach out to info@teambasedcarebc.ca if you would like to learn more!

Stage 2 of the Learning Pathway for Primary Care Teams is focused on Team Building. In this episode of Team Up, Sarah and Morgan focus on a key element within this stage: the importance of building relationships within a team. We explore the value of returning to shared purpose and shared goals as a tool to support effective team building and collaboration. We also provide practical tips and discuss some of the great resources that are highlighted in the Team Building Stage of the Team Based Care Learning Pathway.

Special thanks to Amie Hough, a Leader in Health System Improvement for Primary and Community Care with Health Quality BC, and one of the creators of the learning pathway, who we will be hearing from throughout the season.

Links and Resources

• For more information on the Team Based Care Learning Pathway check out https://teambasedcarebc.ca/team-based-care-pathway/
• For more information about shared purpose and some the resources we highlight in this episode check out the Shared Purpose Facilitation Guide
• Take a look at this template for Team Agreements and this collection of resources focused on Team Huddles, all resources that are connected to the Learning Pathway.

Past Podcast Episodes that may be of interest:

• TeamUp Webinar Feb 17 2022: Skill Building for Teams- Huddles
• TeamUp Podcast: S03 E03: Distributed Teams and Team Huddles
• TeamUp Podcast: S01 E07: Practical Tools for Virtual Team Based Care

Explore more of the resources in Stage 2 of the Team Based Care Learning Pathway.

Through the TeamUp network we are working to advance supports for team based primary care. Please reach out to info@teambasedcarebc.ca if you would like to learn more!

In this episode, Morgan and Sarah continue their discussion of the first stage of the learning pathway: Where to start with team based care. Our hosts focus on the importance of thinking about both service design and team readiness when transitioning to team-based care in primary care clinics. They emphasize the need to consider the existing services in the community when designing or redesigning a team. Sarah and Morgan also highlight a number of resources available for primary care teams in the first stage of the learning pathway, highlighting the Team Readiness Checklist as something for listeners to try out in practice.

Special thanks to Amie Hough, a Leader in Health System Improvement for Primary and Community Care with Health Quality BC, and one of the creators of the learning pathway, who we will be hearing from throughout the season.

Links and Resources

• For more information on the Team Based Care Learning Pathway check out https://teambasedcarebc.ca/team-based-care-pathway/
• For more information about Team Mapping, a tool to support teams working together on how they want to work together, in a patient centred way take a look at the following resources:
• Team Mapping MIROVERSE toolkit
• Price M, Bellwood P, Hill TT, Fletcher S. Team Mapping: A Novel Method to Help Community Primary Healthcare Practices Transition to Team-Based Care. Healthc Q. 2020 Jan;22(4):33-39. doi: 10.12927/hcq.2020.26086. PMID: 32073389.

Past Podcast Episodes that may be of interest:

• S03 E07: A Quick intro to Team Mapping
• S03 E09: Clearer Roles in Distributed Primary Care Teams

For links to the job descriptions and role material described in this episode explore stage 1 of the team based care learning pathway

• Role Descriptions
• Sample RN posting

Find the Team Readiness checklist here to try it out in practice

Through the TeamUp network we are working to advance supports for team based primary care. Please reach out to info@teambasedcarebc.ca if you would like to learn more!

https://teambasedcarebc.ca/team-based-care-pathway/where-to-start-with-team-based-care/

In this episode, Morgan and Sarah introduce the first stage of the Team Based Care Learning Pathway and focus on the importance of getting to know your patients. Morgan and Sarah explore two ideas related to getting to know patients,

1. Utilizing EMR data for demographic insights and chronic condition trends and
2. Conducting patient surveys to uncover needs.

Special thanks to Amie Hough, a Leader in Health System Improvement for Primary and Community Care with Health Quality BC, and one of the creators of the learning pathway, who we will be hearing from throughout the season.

Links and Resources

For more information on the Team Based Care Learning Pathway check out https://teambasedcarebc.ca/team-based-care-pathway/

Here are a few of the highlighted patient experience survey tools from a recent review by the ISU:

• Patient-Perceptions of Team Effectiveness (PTE) questionnaire (43 item survey- Canadian)
• Kilpatrick K, Tchouaket É, Paquette L, Guillemette C, Jabbour M, Desmeules F, Landry V, Fernandez N. Measuring patient and family perceptions of team processes and outcomes in healthcare teams: questionnaire development and psychometric evaluation. BMC Health Serv Res. 2019 Jan 6;19(1):9. doi: 10.1186/s12913-018-3808-0. PMID: 30612571; PMCID: PMC6322340.
• (Demonstrates strong reliability and validity in assessing healthcare team functioning, covers critical dimensions of integrated care such as role clarity, boundary work, perceptions of team effectiveness, and outcome of care. It is easy to administer and aligns well with the primary care context)
• **Patient Reported Indicators Survey (PaRIS) (121 item survey that can be broken up into sections- International)**
• Slawomirski, L., van den Berg, M., & Karmakar-Hore, S. (2018). Patient-Reported indicator survey (Paris): aligning practice and policy for better health outcomes. World Medical Journal, 64(3), 8-14.
• The Innovation Support Unit is currently working on a comprehensive review of patient surveys to recommend a survey for use as part of the TBC evaluation. Watch this space for updates!

Through the TeamUp network we are working to advance supports for team based primary care. Please reach out to info@teambasedcarebc.ca if you would like to learn more!

https://teambasedcarebc.ca/team-based-care-pathway/where-to-start-with-team-based-care/

In this episode, Morgan and Sarah introduce Season 6 of Team Up and discuss the new team-based care pathway. They highlight the motivation behind creating the pathway and how the pathway will structure the season. The episode also includes a tangible takeaway for listeners, as Morgan and Sarah suggest trying out the team effectiveness tool available on the teambasedcarebc.ca website as a place to start!

Special thanks to Amie Hough, a Leader in Health System Improvement for Primary and Community Care with Health Quality BC, and one of the creators of the learning pathway, who we will be hearing from throughout the season.

Links and Resources

For more information on the Team Based Care Learning Pathway check out https://teambasedcarebc.ca/team-based-care-pathway/

The Team Effectiveness Tool is a short, multiple-choice assessment that gathers information about your team’s values, communication, roles, and existing supports to help guide your learning on team-based care. https://teambasedcarebc.ca/team-effectiveness-tool/

Through the TeamUp network we are working to advance supports for team based primary care. Please reach out to info@teambasedcarebc.ca if you would like to learn more!

The transition to a post-pandemic world has drawn increased attention to the tensions, pressures and capacity challenges that are experienced by health care providers and patients in primary care systems around the world. In the face of these challenges, in British Columbia, policy makers, funders, providers, and patients are working through another transition- the transition to team based primary care. The Innovation Support Unit, in the Department of Family Practice at the University of British Columbia, has been working to develop a series of implementation supports for communities, teams, providers and patients engaged in this transformation of Primary Care. Designed to accelerate planning and implementation, the mapping methods support inclusive, patient-centred and equity focused discussion and decsion-making.

This podcast episode tells the story of the evolution and iteration of the mapping tools and supports that have been co-developed by the ISU and communities across BC engaged in the implementation of team based care in primary care.

Drawing on the experiences of the ISU team as well as community interviews, the episode highlights the challenges, opportunities and potential new directions in the transition spaces of primary care transformation. Please see the resources below for more information about the primary care supports highlighted in this story.

Thanks to our guests!

Megan Sloan is the manager of the Qathet Primary Care Network, the regional district that surrounds the city of Powell River. Over the last 13 years, Megan has very engaged with the local community of physicians and nurse practitioners in Qathet and has taken on a variety of roles supporting primary care practices and planning.

Leslie Keenan: is the Executive Director of the South Island Division of Family Practice. Leslie has a long history of supporting primary care in communities, prior to her time with South Island she was the ED of the Nanaimo Division of family practice.

Amanda Frazer is the Strategic Lead of Primary Care Implementation Supports with the Innovation Support Unit. We are so grateful she was able to join us from her maternity leave! Amanda is passionate about the intersection between community engagement and system change. Prior to joining the ISU Amanda worked with the Campbell River Division of Family Practice.

Aleah Ross is the Primary and Community Care Mapping Lead with the Innovation Support Unit and is currently a PhD student at the University of Victoria in clinical psychology.

Morgan Price is the director of the ISU. He is an Associate Professor at UBC and affiliate faculty at UVic Division of Medical Sciences, Computer Science, and Health Information Science. Morgan is a family physician and practices in a Community Health Centre where he provides team-based care to underserved populations in the inner-city in Victoria. His research is in health systems change and clinical information system design and adoption.

Resources

For more information about Team Mapping:

• Read Team Mapping: A Novel Method to Help Primary Care Teams in Transition
• visit teammapping.ca
• check out our MIROVERSE template at https://miro.com/miroverse/team-mapping/

For more information about PACC mapping:

• Read Primary and Community Care Mapping: Helping Communities Collaboratively Plan Health Services in a Patient-Centred Manner
• please check out our MIROVERSE template at https://miro.com/miroverse/isu-pacc-mapping/

You may also be interested in checking out some of the material related to TEAL organizations through the Re-Inventing Organizations WIKI based on the work of Fredrick LaLoux.

If you would like to learn more about the ISU or if you have any ideas for future podcasts please email isu@familymed.ubc.ca

It’s the end of Season five! In this wrap-up episode Morgan and Sarah reflect on the variety of roles that were showcased this season, share some season highlights and key recommendations for action and give a with a sneak peak at what’s to come- first a break, then SEASON 6!

Exciting plans are already in the works for Season 6, which will be focused on PRIMARY CARE CLINIC STORIES and (spoiler alert!) may include more in-person conversations and in-the-field reflections! Reach out to isu@familymed.ubc.caif you know of a clinic whose team story should be shared!

Thanks to our Guests and to the ISU Team

No guests this episode but a huge thank you to all the wonderful people who connected with us this season. Thanks to the over 30 providers who helped us create season five - we are so grateful to everyone who agreed to talk with our team!

Special thanks goes out our amazing ISU team who were behind the scenes making this season a reality! Thanks to Josephine Lam and Erza Mjekiqi who both jumped in to interviews, reviewing transcripts and coordinating and connecting with guests and special thanks to Tlell Elviss who did all that AND joined our script writing and production team!

Resources

If you are interested in learning about resources and supports available to primary care teams, try out the new Team Effectiveness Tool , part of www.teambasedcarebc.ca

As we take a break over the next few months take a listen to some our favourite episodes of Season 5 or spend some time listening to our earlier seasons!

In this episode Morgan and Sarah explore the Physician role in Primary Care. Physicians are the foundation of the primary care system and support cradle to grave care for a wide range of patient needs in a variety of care models. They provide care in rural and urban settings, in clinical settings that range from UPCCs to community health centres and FNPCIs. Team-based care is an opportunity for physicians to practice with the support of other healthcare professionals which can impact their wellbeing and adaptive capacity. We hear from physicians who practice in different settings about what they do, how TBC has impacted their wellbeing, and

The key takeaways from this episode include:

1. Family Physician roles can vary considerably depending on the model of care. This impacts how they connect, in person or virtually, with a team.
2. Second, teams can enhance the adaptive capacity of the overall primary care system which in turn can enhance the wellbeing of family doctors.
3. The best place to start is to just start! Take a small step towards team based care by hiring a single role, doing a few shifts with a primary care team in your area, or start working with the team already in your clinic slightly differently.

Guests:

A huge thank-you to our guests from this episode for sharing their knowledge and experience with us. In this episode you heard from:

• Terri Aldred: Dr. Aldred is Carrier from the Tl'azt'en territory located north of Fort St. James. She is a member of the Lysiloo (Frog) Clan. Dr Aldred is the medical director for primary care for BC’s First Nations Health Authority, the site director for the UBC Indigenous family medicine program, a clinical instructor with UBC and UNBC, a family physician for the Carrier Sekani Family Services primary care team, which serves 12 communities in north-central BC, and the Indigenous lead for the Rural Coordination Centre of BC.
• Daphne Green: Dr. Green is a family doctor who works with a team of professionals at the Kelowna Urgent and Primary Care Centre.
• Rahul Gupta: Dr. Gupta work as an integrative medical physician, professional coach, trauma-sensitive mindfulness instructor, and advocate for physician wellness. He is currently a coaching consultant for the Physician Health Program of BC, a clinical Assistant Professor for the Department of Family Medicine, UBC, and a facilitator for Quality Team Coaching for Rural BC.
• Dana Hubler: Dr. Hubler is a Family Physician with the FNHA, the UBC Rural CPD Medical Director and Physician Advisor with the Physician Quality Improvement Island Health program.
• Anne Nguyen: Dr. Nguyen is a Victoria Primary Care and Addiction Medicine physician who worked for a number of years with Victoria Cool Aid Society. She also works for Doctors of BC as the Physician Lead for the Physician Health Program.
• Christie Newton: Dr. Christie Newton as Associate Vice-President, Health, pro tem, an associate professor and the Associate Head, Education and Engagement in the Department of Family Practice in the Faculty of Medicine. In this role, she is working on a province-wide project funded by the Ministry of Health, aimed at supporting the design and evaluation of teaching within team-based models of care embedded in Primary Care Network communities. She is also the Medical Director of the UBC Health Clinic.
• Carolyn Canfield: Carolyn is the ISU’s in house patient-disruptor and adjunct faculty member in the Department of Family Practice at UBC. Carolyn is very involved in the Department of Family Practice and shares her expertise by teaching medical residents about patient experience and engagement. She also teaches in the undergraduate medical program, serves on the medical school admissions subcommittee and contributes on a number of provincial, national and international project teams on topics ranging from partnership evaluation to understanding systems resilience to advance patient safety.

Resources and Links :

• To learn more about the Centre for Resilience in Healthcare visit: https://www.uis.no/en/research/share-centre-for-resilience-in-healthcare. Some of their recent publications include:
  • Lyng, Hilda Bø, Carl Macrae, Veslemøy Guise, Cecilie Haraldseid-Driftland, Birte Fagerdal, Lene Schibevaag, Janne Gro Alsvik, and Siri Wiig. “Exploring the Nature of Adaptive Capacity for Resilience in Healthcare across Different Healthcare Contexts; a Metasynthesis of Narratives.” Applied Ergonomics 104 (October 2022): 103810. https://doi.org/10.1016/j.apergo.2022.103810.
  • Lyng, Hilda Bø, Carl Macrae, Veslemøy Guise, Cecilie Haraldseid-Driftland, Birte Fagerdal, Lene Schibevaag, and Siri Wiig. “Capacities for Resilience in Healthcare; a Qualitative Study across Different Healthcare Contexts.” BMC Health Services Research 22, no. 1 (December 2022): 474. https://doi.org/10.1186/s12913-022-07887-6.
  • Fagerdal, Birte, Hilda Bø Lyng, Veslemøy Guise, Janet E. Anderson, Petter Lave Thornam, and Siri Wiig. “Exploring the Role of Leaders in Enabling Adaptive Capacity in Hospital Teams – a Multiple Case Study.” BMC Health Services Research 22, no. 1 (December 2022): 908. https://doi.org/10.1186/s12913-022-08296-5.
• To learn more about the Quality Team Coaching for Rural BC program: https://rccbc.ca/initiatives/qtc4rbc/.
• To learn more about the Physician Wellbeing Program visit: https://www.physicianhealth.com/
• To assess the effectiveness of your team, try the new Team Effectiveness Tool on the Team-based Care BC website: https://teambasedcarebc.ca/team-effectiveness-tool/#gf_6
• To dig into a whole bunch of team-based care resources see: https://teambasedcarebc.ca/
• If you are interested in listening to Season 2, the episodes on resilience you can find that here: https://teamuppod.com/season-2/

Who doesn’t like Unicorns? Join Sarah and Morgan as they talk about primary care unicorns- or unique roles that are being tested in primary care- and the potential for extending the boundaries of how we think about primary care teams. In this episode we highlight the stories of BC’s one (and only) kinesiologist currently working in a primary care team as well as learning about the potential of adding genetic counselling to primary care teams to support patients with mental health concerns in primary care.

Thank you to our Guests!

• Carmela de Gracia Patten: Carmela is the first kinesiologist in the province hired to work in Primary Care. Based in northern BC, Carmela is a team member with the Change Program, a lifestyle intervention program focused on metabolic syndrome (people with type 2 or pre-diabetes)
• Jehaninne Austen: Jehaninne is a neuropsychiatric geneticist and a genetic counselor. They are a professor at the University of British Columbia.
• Prescilla Carrion: Prescilla is a senior research genetic counsellor and clinical associate professor in the UBC Department of Psychiatry and was the genetic counsellor for the Cool Aid Community Health Centre team as part of the GenCOUNSEL research project.

Resources

• If you would like to learn more about CHANGE BC and the engagement of kinesiologists in Primary Care in BC check out the Team UP webinar: CHANGE BC and Team Based Care: a rural experience and visit the Change BC website.
• To read more about the impact of embedding psychiatric genetic counselling in primary care visit: https://blog.invitae.com/real-stories-prescilla-c-2b8475b29e8f.
• To see the impact of psychiatric genetic counselling on a client, Prescilla recommends watching this video: https://youtu.be/gKX1MAggeX0?t=3321
• And coming soon: Carrion PB, Austin J, Elliott AM. A genetic counselor's reflections on lessons learned, challenges, and successes experienced during a one-year pilot integration in a primary care clinic. Public Health Genomics. 2023 Jun 12:1. doi: 10.1159/000530683. Epub ahead of print. PMID: 37307802.
• Slomp C, Morris E, GenCOUNSEL Study, Price M, Elliott, AM, and Austin JA. The stepwise process of integrating a genetic counselor into primary care. Eur J Hum Genet. 2022; DOI: 10.1038/s41431-022-01063-4.

In this episode Morgan and Sarah explore Indigenous Advocate and Indigenous liaison roles in Primary Care. Indigenous Liaisons and Advocates work across the primary care system to support Indigenous people in accessing care. This can also include supporting system transformation towards more culturally safe care, providing education to healthcare colleagues, and working alongside Indigenous Nations, elders, and community to design care for local needs. We will hear from two people who work in advocacy and liaison roles about what they do, how they work, and what they enjoy about working in primary care.

The key takeaways from this episode include:

1. Indigenous support roles might span the whole system of care and are responsive to the unique needs of each community and Nation they serve - they won’t ever look the same and that’s a good thing!
2. The approaches, decisions, and changes to care must be guided by community, elders and Indigenous people.
3. Care practice between Indigenous support roles and patients needs to: be grounded in relational care, have a deep understanding of history, take careful consideration of space, and allow the process to unfold with Indigenous patients setting the pace.

Guests:

A huge thank-you to our guests from this episode for sharing their knowledge and experience with us. In this episode you heard from:

• Reina Thurmer: Reina was born and raised in Whitehorse, Yukon, and she is a member of the Wikwemikong First Nation on her mother’s side and German on her father’s side. When interviewed for this episode, she held the role of Indigenous Wellness Advocate with the Comox Valley PCN, working on the K’ómoks First Nation supporting patients in receiving culturally appropriate care from family doctors, nurse practitioners and other healthcare team members. She has since left that role and started med school!
• Gracie Kelly: Gracie’s family roots are with the Soowahlie/Xaxlip First Nations and she is a Cultural Safety and Humility facilitator, an educator, enjoys sharing traditional teachings and is an advocate of supporting Indigenous communities. Gracie works with the Chilliwack Division of Family Practice, a non-profit society that represents Family Physicians in Chilliwack, Agassiz, Seabird Island and Hope. Their members provide primary care services from Chilliwack to Boothroyd and strive to improve health care services for patients by supporting an engaged and collegial medical community.

Resources and Links :

• To learn more about Gracie’s work with the Chilliwack Division of Family Practice have a look at the PDF they have created for Cultural Safety and Humility
• Cultural Safety and Humility Brochure.pdf
• and visit: https://divisionsbc.ca/chilliwack/sharing-cultural-safety-and-humility.
• To learn more about the breadth of work being done in the First Nations Health Authority see: https://www.fnha.ca/what-we-do. For more information about their work on cultural safety and humility across the healthcare system see: https://www.fnha.ca/wellness/wellness-and-the-first-nations-health-authority/cultural-safety-and-humility
• To learn more about pronunciation of First Nations in BC see the First Nations Pronunciation Guide: https://www.first-nations.info/pronunciation-guide-nations-british-columbia.html and https://www2.gov.bc.ca/assets/gov/british-columbians-our-governments/indigenous-people/aboriginal-peoples-documents/a_guide_to_pronunciation_of_bc_first_nations_-_oct_29_2018.pdf
• In Plain Sight Report on Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care: https://engage.gov.bc.ca/app/uploads/sites/613/2020/11/In-Plain-Sight-Summary-Report.pdf
• To read more about the Chilliwack & Fraser Health Rural Primary Care Centre: https://www.fraserhealth.ca/Service-Directory/Locations/Chilliwack/chilliwack-and-fraser-health-rural-primary-care-centre-momiyelhtelaxwt.