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A podcast that brings together primary care providers, healthcare planners, patients, innovators and others to talk about the changes that are happening in primary care in British Columbia.
Morgan: Are you working with a team and
looking for new ways to work together?
Are you looking for innovative ways to
improve cognitive care across your team?
Yeah, me too.
Sarah, we're getting into stage three
of the pathway for team based care.
This is where the team is
really developing and starting
to gel as a team, isn't it?
Sarah: Right.
So in this stage, , team members
are already working together.
They're getting to know each other.
And they're kind of starting to
establish new ways of interacting.
Really, I think a key piece here is
thinking about, you know, not just who's
doing what, but also how are we sharing
leadership decision making and maybe
working a little bit differently to
really, draw in kind of team strengths.
Morgan: And Sarah, when you get into that
kind of shared leadership or distributed
authority that you need to have a lot
of trust in who you're working with.
So I think that's, that's
a part of this, isn't it?
It's that understanding about who
you're working with, knowing them
and, and having that trust for the
shared leadership to be effective.
Sarah: Exactly.
Morgan: Yeah.
And at this stage, I think also.
And this is my bias, but you're going to
start thinking about continuity as well.
It's not just here's a task
for somebody else to do and I'm
going to get the answer back.
But now thinking about if there is
that shared leadership, that shared
care that's really happening, how do
you ensure continuity across the team?
And that's particularly true if
you're growing up in a larger team.
Sarah: And Morgan, I know this
is a passion area for you.
You've done a lot of work
Morgan: It is.
Yeah.
Sarah: if we think about one of
the main concerns that we've heard
when we think about team based care
and how patients are understanding
what's happening in this space, both
patients and provider concern actually.
is really this idea that team based care
is going to decrease continuity of care
because all of a sudden as a provider You
might not have as close a relationship
with The patient that you're seeing
all the time the patient now has a team
rather than one person that they're
connecting with There's a lot of concern
here about you know, does this mean that
I'm gonna have less continuity of care?
Morgan: And it, doesn't
mean that if you do it well.
And I think understanding the
different kinds of continuity then
helps you understand how to do it.
but also for a patient who, who as part
of the relationship needs to feel part
of the team and connected, understanding
how relationship continuity happens
across a team is also really important.
So, if I can get a little academic, I
think of continuity myself in four ways.
And the first one is about information.
So, you know, the classic thing here
really is, do we all have access to the
same record if we're part of a team?
Are we able to see the same information
or is, are there barriers to that?
And if, if that continuity is broken, that
makes it hard to see what's happening.
Second one's a little different.
And, that's more about
management continuity.
And some people think of this as care
plans, so we all have, okay, this is our
protocol, we're going to run the protocol.
it's partly that, but it's
also, why are we here, and
what's our philosophy for work?
Sarah: Right.
Morgan: So that purpose of, like,
are we taking a harm reduction
approach, for example, in my practice?
If one of us is not taking a harm
reduction approach, it's very hard
to be consistent in our management.
one person, a patient sees one
member of the team and versus
another, that can be tricky.
So you have to have that sort of
general philosophical alignment,
Sarah: I'm guessing that, you know,
the management continuity could also
be really tricky when you think about
how a patient's needs might evolve
over time and how that, could change
over time and needing to really loop
back to that idea of, okay, do we all
have the same framing for our work?
Do we all have that same philosophy?
Does that management continuity continue
even when the team changes and adjusts,
Morgan: And sometimes the, the, goal
of different parts of care shift.
So having the informational
continuity helps with the management.
So it kind of builds on it.
So you can say, we're changing the plan
and there's a way to share that plan.
Sarah: and that's So
interesting because I think when I,
kind of think about continuity, all I
really think about is the relational
continuity side, which I think
Morgan: as a patient, that's,
yeah, and sometimes you think,
well, it's a given, isn't it?
That everyone has the information.
I think , that's a lot of it.
I remember my mom years ago
saying, well, the hospital
didn't have my doctor's records.
And I said, well, mom, where did
the doctor write the records?
So in the paper.
And then, and where does
the paper go afterwards?
On the shell.
Oh, right.
It goes on the shelf, so
obviously nobody has access to it.
Now, with electronic records, it's
a little bit different, but still.
relational continuity, though,
coming back to that, I think it's
about getting that connection so
people understand being, connected.
The patient knows who they're talking
to, so that small teams are actually
really good for this, because you build
a relationship, patient to team members.
I think with a team, too, You actually
can spend a bit more time as a, family
doctor or any team member, you can spend
more time getting to know the patient
Understanding what matters to them.
Sarah: And actually, there's
a tool for that, isn't there?
HQBC, Health Quality BC, has a great
resource, that's built out around asking
patients explicitly, what matters to you?
And I think we're going to
come back to that later today.
Morgan: Yeah, absolutely.
I think that's an important thing
to think about and it definitely
helps build relational continuity.
I'm almost done my academic piece.
Let me do one more type of continuity.
And this is my, my favorite one.
Cause this is part of what I learned
through my own work is this idea of,
what I call inter provider relationships.
So the, relationships between
team members across the team and
this inter provider connectedness
really is about how much we trust.
So coming back to that idea of trust.
How much we trust each other and how
closely we work together means we're
more likely to share all the other
pieces, and patients really feel that.
they just, they get that sense,
and, and also it's not so much,
you know, I want you to see one
of our nurses about such and such.
It's actually, you know what, I want
you to see Ann, and let's go down,
down the hallway and just double
check with Ann, or, you know, it,
it becomes so much more personal.
And then there is that personal attention
that is felt by the patient, so that
builds that relational continuity as well.
So that last part, I think, when you
think about how the team provides that
continuity, becomes really important.
And it happens across team members.
Sarah: And, you know, as you're
saying this, I'm thinking, Morgan,
you know, so many, so much of the
pathway that's been designed is
really to support this Interprovider
connectedness, build this trust and
then kind of extend that interprovider
connectedness to the relational
continuity and include the patient.
Right.
So really thinking about, all
of these stages of the pathway,
the getting started, the team
building, the team development.
And then as you move ahead, you know,
thinking about quality improvement
and what do you want to do better?
So much of that, I think, yeah.
It really needs that kind of
foundation of trust to work well.
Morgan: Yeah.
Absolutely.
Sarah: And I think
patients feel this, right?
They see when a team works well together,
they, they, they can tell when, something
is, is, you know, well supported.
Morgan: Yeah.
Absolutely.
Even if it's not directly with them,
one thing I've noticed is if, Sam, I'm
walking a patient out of, out of a visit
out to the waiting room and one of the
other team members is walking a patient
in the other direction, you know, just
even, acknowledging the, the nurse that's
going the other direction, patients see
that and they see how connected we are.
And that makes a big difference as
opposed to sort of cold and clinical,
don't know who that is, kind of.
walking the other
direction down the hallway.
So patients definitely pick it up.
Sarah: And it's, I mean, I know
I always come back to this, but
it's that culture piece, right?
That team culture.
How do you, how do you build that out?
Morgan: Yeah.
Sarah: Thinking about kind of this
team development stage that we're now.
And in the pathway, and you know, what
jumped out to me when we think about an
interesting activity, I really wanted
to come back to the what matters to
you, resources that have been included
here you can think that they're
really sort of not as team focused.
It really is more about how a provider is
connecting with a patient individually.
But I think it's one of those pieces.
If you can bring that back
into the philosophy of how
you're all working together.
and make it so that, you know, across the
team, everyone is really reflecting on
this question of, what matters to you to
keep care sort of patient centered and
to keep patients engaged in the team.
I just think there's a lot of, great
kind of team development that can
happen through the use of, of that tool.
Morgan: Yeah, I think so.
Now this, we're going to put some
links down to the, what matters to
you tool down below in the show notes.
And what I like about this
tool is I agree with you.
It, it comes back to that
question of how do we keep the
relational continuity going?
it's a very easy thing to also implement.
And I like that.
It makes you think in a patient centered
manner and it's something that all
the team members can do from the front
staff to nursing team members to nurse
practitioners family doctors Any team
member can take this approach and it
it really does help shift our thinking.
Sarah: And I mean, as far as an
example , of the kind of questions
and resources that are in this kind
of host of, tools, there's a series
of, checklists that you can work
through and we'll post the links below.
But one of the things is, before
an appointment and a checklist
of things to make sure, has
been communicated to a patient.
And when we were building out the,
the idea for this episode, I thought,
Oh, like I, that would be great
if I got a, before the appointment
sort of check in with my provider.
I don't, I don't get that at all.
But then I realized, no, actually,
if I think about how in the team that
I'm part of, my, the team works, it's
not the primary care provider who
reaches out to me, but it's the MOA.
and I absolutely do get all of those
things that are in that checklist.
But through, through the MOA, reaching out
to me and, and confirming, demonstrating
the flexibility and scheduling,
setting out what can be expected.
Am I connecting, over a phone
or is there a kind of virtual
platform that we're using?
and I realized, Oh, I do get everything
in this checklist, but I immediately
had jumped to, Oh, my provider doesn't
connect with me at all about this.
Morgan: Right.
Sarah: So I just think it's a
really, interesting reframe when
you think about the team and how
can the team fit into, these sort
of what matters to you questions.
Morgan: I think that's a really good
point and it might be helpful to share
that approach with the patients in your
practice so people understand, oh yeah,
we're all working together, as a team.
And so the things that the MOA might
be asking, I'm going to know about.
And, that extends the relationship
across team members for the person.
the simple idea of just asking somebody
in a visit what matters to you or what's
important for you right now or, you
know, what, what are you worried about?
Simple questions like that can change
the conversation so dramatically.
somebody comes in, you know, I
work in a shelter as, as people
have listened to this now.
it might be for a medication refill
is what I, what I'm initially
understood as the question, but then
as we start to talk, you know, , what
is it that's, , important for you
right now that I can help with?
And it might be something unsurprisingly
to do with housing or, finances.
And some of those things
are out of my scope.
but because I'm connected into a team,
I'll say, you know, what I'll do is I
will talk to one of the social workers
here or the client support worker here.
And and just help to advocate a little
bit, and even if it's a, a little bit
of advocate, you know, that, that could
be important for, for a patient to hear
that that's happening, and if I don't
ask the question what's important,
I don't, I don't know that that's
what they really want to know about.
a classic example is, something
that I think is completely benign.
It might be, a sprained ankle
or it might be a cough, but
somebody thinks it's cancer.
And if you don't ask and then all
of a sudden like, well, do you
think I'm going to die from this?
And you know, wait, wait, it's.
All you have is, you know,
it's just a sprained ankle.
There's nothing that, and, but for
some part of their history there's a
reason they think that, and then you
can unpack that and reassure them.
and so those things are important
little questions that really
suddenly change the conversation
and then change the relationship.
Sarah: And I think so, really learning
what matters to a patient I think
is just so important throughout
their sort of care journey.
And there's a lot of questions on
people's plates and that's when I
think these kind of checklist sort of
tools can at least be a good prompt
to, to review and, and think about.
One other thing that kind of comes to
mind here is if this kind of resource
is of interest to you, and if you
specifically have a nursing role on
your team, we actually did some work
at the beginning of the pandemic times,
about, uh, our end virtual visit tool,
very similar to the, what matters to
you tools, kind of checklists when
you think about how you're connecting
as a team and with your patients.
Morgan: Yeah, I think those are
excellent things to start looking at.
you know, the other thing in terms of the,
relational continuity and thinking about
how your team is structured, I think the
team let is, is something that I often
come back to is if you have a, if you have
a large clinic, and a potentially a large
team or a large group of members that are
potentially working together in different
ways, trying Shrink down into smaller
teams that work more consistently with
a panel of patients, obviously there's
going to be some shifts on certain days
or when people are available or certain
skills, but if you generally try to have
a smaller collaborative group, patients
are going to feel that continuity.
They're going to feel more listened to
across a smaller team than if it's just,
different people every single time.
And that goes for all the different roles.
So I think that that's one
thing to structure your team.
The other thing that I'll, I'll
highlight as a possible thing to try
to implement if you have a team is just
communicating with your patients about
how you're communicating across the team.
and it can be as simple as I'm
writing a note here so that,
that, your nurse will know, you
know, or Ann will know next week.
I've written something specially for
Roz here and the patient will realize
that you're communicating even if it's
asynchronously through the EMR note.
Sarah: And I think the,
the side benefit is.
Your patient is being reminded of
these other people that are on their
team and what their names are
and that you're working together
and all of those questions.
I think it can be really concerning
for folks when all of a sudden they
don't have maybe their one provider
that they're going to see all the time.
All of those concerns get mediated by the
fact that you're really open about how
you're connecting and communicating, which
is one of the biggest areas of feedback
that we heard when we reached out to
patients about, you know what they need
To be better supported in team based care,
I guess before we wrap up, I'm looking at
this kind of stage three of the pathway
and thinking about the other sort of
really interesting tools in this space.
there's a relational continuity
change package that has been
highlighted in the learning pathway.
This comes from Alberta and does some
really interesting sort of resource
linking, identifying actions and tools for
teams, to try out when they're thinking
about different aspects of continuity.
. Some of it is really Alberta, specific
and we are going to be working on
building out some more of these resources.
So this is another kind of check this
space, uh, note for, for our listeners,
come back to this and, and check
in and we'll continue to update it.
to wrap up, what do you think Morgan
is an action to try in practice?
Morgan: I'm going to keep it super
simple and very actionable, and
that is, as you're writing up your
care plan, just tell patients how
you're sharing them across your team.
I think any team can just start
to embed that into their practice
very simply, and it's a nice
way to wrap up a visit as well.
Sarah: Great.
Well, and while doing that, you're,
you're developing your team here.
You're moving forward kind
of through this journey.
So invite you also to check out some
of the other resources in stage three.
We've highlighted a couple here,
but there's so much more, and
thanks so much for listening.
If you've heard anything that's really
interesting today, if you have feedback
for us, we'd love to hear from you.
Reach out to info at teambasedcarebc.
ca.
The Innovation Support Unit is a
distributed multidisciplinary team.
We work mostly remotely from communities
across the Lower Mainland and
Vancouver Island in British Columbia.
Morgan: Sarah and I are both recording
from our offices in the territories
of the Lekwungen speaking peoples, the
Songhees and Esquimalt First Nations.
Sarah: And recognizing the colonial
history and the ongoing impacts of
colonization and healthcare systems
and in Indigenous communities in
Canada and around the world, as we
move through the season, we'll work
to bring an equity lens to this work.
And we really encourage you, our
listener, to reflect on your past,
present, and future participation.
On the indigenous lands
where you are situated.
Morgan: Thanks for listening.