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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: Do you want to know how
your primary care team is doing?
Are you considering what
changes might benefit your team?
Yeah, me too.
We're now in the last stage of the
learning pathway, team evaluation.
Sarah: But the pathway is a circle.
The last stage or, you know, at any point.
Morgan: Yes.
Yes.
I think, I think evaluation can
be valuable at so many times.
Evaluation of the team and how
the team is doing is an important
part of the journey any time.
And this ties back, as you said, to
all the other stages that we've already
talked about through this season.
Team readiness and service design, team
building, team development, QI, all that.
Sarah: And I think, you know,
evaluation might sound scary, but
it can really help a team, you know,
build on areas for improvement, set
kind of QI or patient care goals.
And Amy describes this fifth stage
of the learning pathway really well.
amie_1_12-20-2023_110634: we've lined
it up in a bit of a linear way, thinking
about those teams that might be starting
from, the ground up, but you can, you
can hop over to the evaluation stage
at any point in your team based care
journey, because thinking, having the
end in mind can also help shape your
team goals and, and vision and purpose.
So, evaluation is just.
that?
How can our team start to measure
our success and how can we improve?
how do we look at, patient
and provider satisfaction?
are we including patients and
families in our evaluation processes?
Are we including the team
members in these processes?
Sarah: And again, you know, I think I
already jumped in with this, but Amy
makes an important point here that I
think we just need to keep coming back to.
The pathway is a circle for a
Morgan: Mm hmm.
Sarah: It's a process.
It's continuous.
And, while we're talking about evaluation
as the last stage, it really is
important to think of it as something
that you start doing at any point.
Morgan: Yeah, Sarah, I think, you know,
I've, I've been doing evaluation and
in practice and with other practices
for decades now, I'm curious from your
perspective, how do you distinguish QI?
And evaluation, because the way I often
roll there, there's such a spectrum
for quality improvement to formative
evaluation or action oriented evaluation
to more fulsome or summative evaluation.
How do you make that
distinction or do you?
Sarah: Well, so, and I'm probably
not the best person to ask here
because I think what I like is
really any kind of action oriented
QI . To me, that's all evaluation.
And those sort of, maybe I think of QI
sometimes as smaller, shorter term and
more, more nimble than larger evaluation
where you typically have, you know, a set
of metrics that you're, you're looking at.
And often, I think, particularly
in primary care, when I think about
the sort of big E evaluation, it's,
you know, what are the metrics that
we need to track over time to think
about big picture improvement.
And usually the evaluation instructions
or direction are coming from above,
whereas I think of quality improvement
as being sort of that kind of goal.
quicker, more responsive, on
the ground, work with the team.
Morgan: Yeah, I agree with you.
I think that QI feels a bit more
internal, so I'm doing it for myself,
I know, or we're doing it for ourselves
and it can be a bit more focused.
So, it's not a whole giant,
like, let's figure out all this.
Yeah, but it can be something
very small and very tangible.
it's a bit of a gray zone cause
sometimes those things will get shared.
We've done X number of QI cycles
this year and that, but often the,
the impetus for evaluation can be a
little bit more external, can't it?
It can be like, we need to do this because
our funders require this or, you know,
we need to align with others to compare.
And so I think.
Evaluation can be a little bit more
external, but for me, there's, there's
a very blurred line between the two.
One, one of my favorite, little
evaluations inside of, our clinic
was when we wanted to see what
our impact was on Emerge visits.
This is a, as a big thing for us
both internally and part of our
reason for being is to support,
a population honestly, are in
and out of emerge quite a bit.
And so we wanted to see
how we were impacting.
eMERGE visits and, you know, in the
spirit of smaller evaluation, we had
to find ways that were feasible to do
the evaluation without getting access
to data from the hospital, which
for us here proved to be difficult.
So we had a student work with us
to take all the paper copies of
eMERGE reports that got back to us.
So we already had them locally
and for an entire year, just
track those onto a calendar.
And we were able to see and then show
to our funders the days and the weekends
that we were closed, especially on
a long weekend, where we were closed
for three days instead of a normal
weekend where we're only closed for one.
How the Emerge visits spiked and that was
an incredibly powerful piece of evaluation
that we did that was not massive.
It wasn't particularly.
You know, expensive to do, but
incredibly important to show the value.
Now, it didn't show how our team
was working, but it showed the value
of our team in terms of, resource
utilization across the health system.
Sarah: Well, and I think, we know that
in BC and, across Canada, we haven't
really had a clear evaluation plan
for, team based care and primary care.
And I think.
so often evaluation gets hung up on the
idea of we need to have a clear plan
before we can start doing things right.
but there's also a lot of great
work that's happening in this space.
Communities are coming up with
their own evaluation plans.
Clinics are doing, you know,
quality improvement projects.
communities and clinics are kind of
developing their own tools and resources.
And we're really hoping to,
support and help this space.
Morgan: Yeah, I think compared to QI,
there is value in trying to align Some of
the indicators, and similarly to what I
said last week, you can spend more time
planning than actually doing evaluation.
And I think there is a balance there too.
And sometimes it's better to get out
and evaluate with things that are
pretty good and then, learn through
that about what's relevant and what
you can do with that information.
Both.
within your own practice and then
within your community or your
neighborhood, your region or system.
And we've been working on this.
We're certainly helping the Ministry
of Health in British Columbia to
adapt and develop some tools to
support the assessment of a number of
different components of our framework.
So team function being one, provider
experience, patient experience,
people be familiar with those.
and also capacity access and attachment.
And we've been working with our,
provincial TBC advisory group with
some task groups to help confirm that
these are the right areas to, evaluate.
Sarah: So what's going to be
happening in this space, Morgan?
Morgan: So we're starting
kind of iteratively.
We're going to, uh, run a clinic
evaluation with 15 clinics, and that
will be getting a report and some
surveys of both providers and patients,
and then pulling all that together
into a workshop for the clinic.
And that's the part that I really like
is it's idea of not just thanks for
your data, but, but here's something
that we found that was interesting
and it might be interesting for you.
So, a clinic that can participate
will actually be able to get
feedback so it can spill into
their own QI process afterwards.
And then those 15 clinics we
will summarize anonymously and
share more provincially through
another provincial level workshop.
We're going to iterate that too, Sarah.
So we're going to actually do at least
one more cycle with another 15 clinics.
So 30 clinics total across the
province with this idea of how are
these more mature teams working?
What is the provider's experience?
How do patients feel it's working
for them and how is that potentially
impacting their ability to provide greater
capacity or access for their patients?
Sarah: I'm just so excited to
see sort of what comes out of
these pilot sets of evaluations.
And then also we'll be sharing
the tools that are developed
and, thinking about sort of an
evaluation toolkit, down the line.
And that'll be all shared
on teambasedcarebc.
ca and in this learning pathway as well.
So really, I think there'll be
a lot of, a lot of change in
this space over the next year.
Morgan: Absolutely.
And there's, we're not the only ones.
There's a lot of other people
that are working on this too.
Sarah, what do we want to highlight now
while these tools are being developed,
there's already in the pathway.
Sarah: there's a couple things I think.
First would be there's a really simple
measurement plan worksheet, that
you can access through the pathway.
It's a simple table, that can help
identify kind of what measures to
collect, when to measure, how to measure,
how to analyze and display results.
And I think the, big motivator is
the idea that you don't want to let
data collection and questions about
data collection, Install the actual
project, start collecting at the
outset and the idea of the worksheet
is you can go back to it and you can
change things, if, you know, you're
learning as you go and some of the data
collection plans, change a little bit.
Morgan: I think that's a good point.
I think that, is different
ways of collecting data.
And sometimes the small ones are.
Almost as good, and yet
they're much more feasible.
So to think about, you know,
what's, what's the most feasible
way we could, measure this, is a
really important question to ask.
Especially if you don't have a
lot of capacity in in your group.
we've been really lucky in our clinic
because , We have evaluation as part of
our team, in part because we do research
projects and we can piggyback on that.
But a lot of groups don't have that.
so the other thing that I'd
suggest, Sarah, is just to
go back to where we started.
And this is a circle.
So to come back to the team
effectiveness tool and see how
the team has changed over time.
And that can be a
Sarah: I love the circle.
It's like we planned this.
Morgan: as if we planned it.
And perhaps that's a good place for us to
wrap up actually for the season because
this finishes the pathway, doesn't it?
Sarah: It does.
Well, and, you know, it's a journey.
It's not something that finishes.
Morgan: Please come back to episode one
of season six and start all over again.
but no, in seriousness, thanks
for listening to season six
and, keep checking back.
We will update our show notes if
there's anything critical there or
look to the pathway on teambasecarebc.
ca because that's where the resources
are going to be updated, for this work.
Sarah: and I think do keep checking
back because our plans are to, really
make the pathway a dynamic space.
If you're working on something that you
think should be added to the pathway,
please do reach out and let us know.
We're always happy to add more materials
here, and it's been a really great
collaborative effort between a whole
bunch of different folks who've been
involved in the team based care advisory
and the kind of learning task groups
that were set up as a result of this.
So it's going to be a space
that continues to evolve.
Morgan: to foreshadow a little bit,
we're excited about next season of the
Team Up podcast where we're going to
talk about nursing in primary care.
There's a lot of work happening right
now to build sort of core teams or
small teams which are primary care
providers, so family doctor or nurse
practitioner with a nurse and MOA.
So we're going to focus on that team.
Sarah: And we don't want
to give too much away here,
right?
But we're going to be taking a
couple weeks off, and then we'll
be launching the next season soon.
So stay tuned.
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 to
season six, and we'll see you
in the next episode of team up.