S07 E08 Shared Visits CAN Create Capacity in Teams

In episode eight of TeamUP!, we learn about the benefits of shared visits with a primary care provider and a nurse.

Morgan and Sarah discuss how these shared visits can enhance team capacity, improve care for complex illnesses, foster team building, and create immediate capacity in the moment. With insights from nurses, the episode highlights the importance of synchronized care plans, trust-building, and efficient multitasking, all while encouraging you to incorporate a shared visit in your practice to fully understand the benefits.

Special Thanks

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Throughout this season you’ll hear from several amazing nurses:

• Angela Wignall is a Registered Nurse who has worked in perinatal health and public health. Since recording this episode Angela has been promoted to the CEO of the Nurses and Nurse Practitioners of BC from her position as Senior Executive Director. Angela is also a board member at the Canadian Nurses Association.
• Diana Boateng is a Registered Nurse and is working on her dual master’s degree in nursing and health informatics. In her Masters, she is a co-op student working with the Innovation Support Unit. Her background is mostly in acute care but she has been interested in exploring what it means to be a nurse in primary care.
• Hannah Roy works as a Registered Nurse in primary care and urgent primary care. She has certified practice in STI management and is completing her Masters degree to be a nurse practitioner.
• Jamie Duteil is a Registered Nurse and the Health System Improvement Director at Health Quality BC. She has managed urgent primary care centres and acute care centres.
• Kacey Wall is a Registered Nurse and a diabetes educator, she has worked in primary care networks and is a team member of the Innovation Support Unit.
• Nikki Kafal is a Registered Nurse and has spent her career working in emergency and critical care settings. She is completing a dual master degree in nursing and health informatics and joins the Innovation Support Unit as a co-op student.

What is Team Up! Team-based primary and community care in action?

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.

Sarah: Are you interested
in team based primary care?

Are you curious how shared visits
with a primary care provider and a

nurse can increase your capacity?

Yeah, me too.

Okay, Morgan.

So we touched on shared visits
in a previous episode, and you

seemed pretty keen on these and
said that they can create capacity,

but they take up more time.

Two providers in the room at once.

how does that create capacity?

Morgan: Well, Sarah, for you and
for the audience, I think that,

that might feel counterintuitive,
but I think I can convince you that

shared visits can be a good thing.

not for every single visit, obviously,
but when you use them strategically,

shared visits, where both the primary care
provider and a nurse are working together

with a patient, can be really effective.

Sarah: I think I can see how
they can be higher quality for

the patient, two brains and all.

but I know our busy primary care
teams are going to need to know

more about efficiency as well.

Morgan: Yeah.

And I think I can do both today.

keep asking me about efficiency
along the way if it's not obvious.

And today I'll give you and the
audience three ways that I think shared

visits can build capacity in the team.

So for the first one, I want to
talk about improving care for

patients with complex illnesses.

Kacey's going to introduce
this, and Kacey's an RN who

works with us at the ISU.

Kacey: It was helpful because, of
the complexity, the doctor and I had

different questions that we wanted to ask.

So And having the caregiver
present for that allowed

everyone to be on the same page.

Electronic charting only gets you so far.

There can be little nuances that
are missed in electronic charting.

Having that conversation in real
time, Really provides a deeper

context of what's going on, and I
think that's where the real value in

a shared appointment can come from

Morgan: So for Kacey, the
benefits are felt in the common

understanding of the plan.

The next steps for the care of the patient
are going to be more synchronized, and

that actually means, Sarah, less effort
later on in communicating about that plan.

Sarah: And I'm guessing the patient hears
the same thing from both of you as well.

Morgan: Well, yes and no.

Sarah: Yes and no.

That sounds like both and.

I'm not a both and person.

Morgan: no, no, I know, I know.

How about yes and more?

So, yes, the patient and, and or
caregiver, of course, hears a consistent

message and we're all there together
hearing the same thing, but no or

more, because, what you're hearing are
different perspectives from the two

different care providers at the same time.

So, I might explain something in one way,
and the nurse that I'm working with might

explain it in a slightly different way.

It's still the same thing, but the
context and the way of explaining is

slightly different, and the way of
listening is slightly different, so I

think we get to a deeper understanding
across everybody at the same time.

And I think that ultimately
improves follow through.

Kacey: the biggest value is
seeing that real true TeamUProach

is, Hey, I'm not in this alone.

I actually, I have a doctor
that's looking out for me.

I have a nurse that's looking out for me.

They're listening to what I need
and they're on the same page.

there's no question about, oh,
well, the doctor said this and

the nurse said something else.

It really gives that continuity
of message and that, confidence

that I'm in good hands.

Sarah: So you're building understanding,
and that also means more capacity, as

the patient is a team member and really
engaged in their own care in this way.

Morgan: So, yes, Sarah,
Both quality and capacity.

There's better alignment
and, the patient understands.

So there's potentially better adherence
and potentially fewer follow up visits

with either the nurse or the primary
care provider with the patient.

Sarah: So I can really see
the value for those complex

illness cases with a patient.

What's your second capacity reason?

Morgan: Well, Sarah, this is team up.

And so this one's not a surprise.

I think that shared
visits are team building.

And especially when you're starting out.

You know, you can build that
teamwork faster by working

together in shared visits.

Here's Jamie.

Jamie's a former ICU nurse who's managed
a UPCC and is now a director at HQPC and

she knows about working closely together.

Jamie: to me, that's the best thing that
could happen because you're starting

to work together and communicate,
and you're starting to respect each

other's, style communication, how they
approach patients, you're breaking down

the, power distance that might exist.

You're connecting as people with a
common goal of supporting patients.

Sarah: So you can communicate better.

Morgan: and you're building
trust between each other sooner.

And so your future work across many other
patients becomes more fluid and effective.

Sarah: I can really see how this
kind of early work can really

help create future capacity.

You know, there'd be less miscommunication
when you knew each other, and,

this would all be thanks to working
together more closely at the beginning.

Morgan: Yeah, exactly.

Now, I don't want to belabor this,
but I do think it's super important.

Hannah, the nurse that I work with on
Thursdays, we've worked quite a bit.

Only for a few months together
now, but we've also thought about

how we want to work together.

There was a moment last week where we had
a pretty intense patient and, in order

to sort of work and navigate through
it, we actually had to use hand signals.

And it was effective because
we knew how each of us work.

Sarah: And I can really see how,
Thinking about how you want to work

together, spending that time to maybe
talk about some hand signals if things

are getting escalated early on, would
just really help down the line when

you think about streamlining things.

And this kind of ties really well
actually, to this idea of more visits.

You asked me to keep,
keep coming back to that.

You know, we've talked about
complex visits and team building.

So what's the third
way to create capacity?

Morgan: So, Sarah, the third way
is that shared visits, when used,

again, strategically, can actually
create some capacity in the moment.

Sarah: How do you create capacity in the
moment when you're both with one patient?

Morgan: So there are a couple ways.

Together you could be speeding up
a process, by working together.

Two sets of hands are faster than one.

Sarah: I can see that definitely
would improve care and capacity.

Morgan: Yep, absolutely, you can
address multiple issues at once.

So sort of a multitasking with
the patient in the same visit.

Sarah: Can you give me an example of that?

Morgan: Yeah, so Hannah
and I often do this.

particularly around wound care.

Here's Hannah,

Hannah: we share the appointment to
say, you know, is this an infection?

Is this a stable wound?

Do we need to refer to a specialist,
For patients to have two medical

providers in a room together,
it can be more reassuring.

because we do have different specialties.

For example, you might be
prescribing antibiotics.

I know we've talked before and I've
asked, well, why did you prescribe

that one over another antibiotic?

Morgan SM7b-MixPre: right.

Hannah: wounds can be really
scary for people to see.

they can be really graphic,
they can be very painful.

So to have two people actively listening
to someone at once, I feel like it's

really validating for the person.

And then there's a lot of
collaboration that's also going on.

Between the three parties, what's working,
what's not working, how can we assist,

whether it's like, pharmacological
interventions or dressing changes,

and I've learned a lot too, you
know, when I used to see cellulitis,

I used to jump and say, uh, we need
antibiotic stat, and now I'm like,

oh, some legs are always going to be
red and earthemic, and kind of knowing

the cardinal signs, in a population
that does get lots of infections, we

don't want to go to the extreme of
over prescribing or under prescribing.

There's this fine line.

Morgan: Hannah reminded me how valuable
this can be when we do outreach.

There are benefits to immediate care
for the person, and then, you know, we

often do this, say, for a, a shared visit
for a patient with an infected wound.

Sarah: Okay, so I can definitely
see how that's better quality care.

Morgan: Yeah, and we can also do this with
two different things that are unrelated.

So, I can address a different issue
completely while Hannah's doing

a dressing change, for example.

I can pop in, ask a couple questions,
let's say about a medication renewal,

and then pop out and carry on.

Sarah: So this pop in pop out
idea, a shared visit doesn't

have to be for the full visit.

I can see that creating some capacity
too, both for you and for the patients.

Morgan: the patient doesn't have
to have two separate visits,

but they get their needs met.

now sometimes I'll, I'll do that and just
talk to the patient as Hannah's doing

the dressing change, and, This can help
Hannah by me distracting the patient but

also helps me get to know the patient
a little bit better and the patient get

to know me a little bit better and that
builds capacity in the long run as well.

Sarah: Okay, so I think
you've won me over.

There is value in the shared visit.

and you flag some great examples,
I think, of where shared visits can

help build capacity, not just quality.

Morgan: Yeah, I think so, Sarah.

Sarah: So one last question.

You recommended shared visits when people
are just starting to work together.

Do you also recommend them, you
know, even after you've been

working together for a while?

Morgan: I do.

There's real value when you start working
together for sure and I think it's

easier to start, when you have capacity
to do shared visits from the beginning.

But I, think they shouldn't
just be used at the beginning

when you're starting to team up.

I think they can be really helpful
for select patients at inflection

points in someone's care.

Those complex care moments where everybody
does need to get on the same page.

or times when you need to
provide support to your teammate.

Sarah: guess if you need to get
support from your team mate as well,

I can see how normalizing group visits
could really help in this space.

Morgan: Yeah, absolutely.

Getting that support.

It's a, a two way street.

So, to reach out to the audience, if
you haven't done a shared visit yet,

the next time you're together at the
clinic, look over your day sheets and

decide who you're going to see together
and then try it, see how it works out.

You'll find that I think shared
visits, when they're useful,

can be incredibly valuable.

Sarah: Great, and I think that
might be a good place to wrap up

this episode on shared visits.

You've won me over and we're good to go.

We'll see you next time on TeamUP.

Morgan: Thanks for listening, and if
you have any specific questions or topic

suggestions, please email us at isu.

familymed.

ubc.

ca

Sarah: 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: we'll see you in
the next episode of team up.