Team Up! Team-based primary and community care in action

In this episode Morgan and Sarah dive into the role of the Medical Office Assistant in primary care teams. From team culture curator, to scheduling master, to on-boarder for new team members, and patient connector, MOAs are often the ‘glue’ that can hold teams together. In this episode we have the opportunity to hear from a number of MOAs, as well other other providers working in a range of clinic settings about how the MOA role is uniquely positioned to understand clinic and team capacity as well as the patient experience.
When you are thinking about how MOAs support team based care and what you can do in a team to really utilize the skills of the MOA team members here are three things to think about:
  1. Engage MOAs in planning and decision making in the team
  2. Create processes that really utilize the MOA’s unique position as a connector to patients and providers
  3. And as always, create opportunities for teams to work together on how they want to work together
A huge thank-you to all of our wonderful guests for this season! In this episode you heard from:
  • Ava Mundy: Ava is a Medical Office Assistant and a coach with the Practice Support Program, where she has been very involved in supporting the Primary Care Network on the Sunshine Coast.
  • Shania Sholtz: Shania is a Medical Office Assistant in a maternity and pediatric-focussed primary care clinic in Victoria.
  • 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 is also engaged in a number of national and international research projects that range in focus from patient engagement in care, to system resilience, to patient safety.
  • Caycee LaViolette: Caycee is a Social Worker who supports patients across the Sunshine Coast Primary Care Network.
  • Eliza Henshaw: Eliza has practiced for 14 years as a primary care Nurse Practitioner across a populations ranging from refugees to complex populations in urban environments in Vancouver. She has been part of a number of interdisciplinary teams, and is currently joining a new clinic within the North Shore Primary Care Network, which is a partnership between Midwives and Nurse Practitioners.
  • Erin Berukoff: Erin is a Nurse Practitioner in a Patient Medical Home clinic, where she works with a team of fee-for-service physicians and has her own panel of patients. Erin’s team includes an RN and a Social Worker, that they share with another clinic, as well as 3 MOAs.
  • Spencer Newell: Spence is a Registered Nurse works at both the the Kelowna Urgent and Primary Care Center and the West Kelowna Urgent and Primary Care Center.
  • Kelvin Bei: Kelvin is a Nurse Practitioner who works with a Community Health Centre in Vancouver, serving a diverse population that includes a large number of immigrants and refugees, as well as people who are at risk for homelessness, people struggling with mental health and substance use, and those with precarious status.
Resources and Links :
  • For more information on the ‘Bread and Roses’ metaphor Sarah and Morgan reference throughout this season check out Heath, I., & Montori, V. M. (2023). Responding to the crisis of care. BMJ, 380.
  • To learn more about team-based care and the transformation of primary care in BC check out Teambasedcarebc.caand TeamUp community of practice (webinars and of course this podcast series).

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.

Morgan: Are you thinking about the
administrative support that's needed to

keep a primary care team running smoothly?

Are you wondering what MOAs do and
how to better support MOA engagement

in team-based primary care?

Yeah, me too.

Sarah: When you walk into a
primary care clinic, who's the

first person you see often?

It's the medical office assistant.

Morgan: That's right.

So today we're gonna talk about the
MOA and their role in primary care

Sarah: teams.

And they play such a central
role in, in nearly every team,

you know, big, big or small.

And I think MOA roles get more
important as a primary care team grows.

In the office, everything
flows through that MOA role.

Ava: So when I'm in my MOA role, I am
mostly doing reception, front desk,

navigating patients, helping connect
them with the appropriate resources,

scheduling, answering questions, etc.

Sarah: That was Ava Mundy.

And Ava is a bit unique.

She's a part-time MOA and
a part-time PSP coach.

So in our conversation, which we'll
hear snippets from throughout this

episode, she really focused on the
range of roles that MOA can take on in

a team, as well as her own experiences.

Morgan: So, Sarah, before we
dive in, let's summarize some

of the things that MOAs do.

I mean, we've already mentioned
they're the first point of

contact for patients, both on the
phone, but also, in the office.

And so with that, they often set
the tone of the clinic and the team.

Sarah: And that idea of, setting
the team culture, setting the

tone is just so important.

I know one of the clinics we worked
in recently, we went in, and the

whole office was like super decorated
I think for Valentine's Day.

And, the providers were talking
about how great it was to come in in

the morning and, There'd been this
change overnight that they didn't

know was gonna happen, and MOAs were
in the corner laughing about it.

But those kind of things
are just so important.

And you know, while they're setting
that culture, they're also managing the

capacity of a team at any given time.

Morgan: Yeah, any MOA will tell you,
the changing capacity of the team as

we change our schedules and suddenly
we have to adjust because of a meeting

or we're not available for a half day.

there's a lot of management there.

And they also, beyond that though, can
take on some clinical support roles.

They can room patients, they can take
some initial histories and screenings

with some tools and take some vitals.

There's a lot that they
can do that way as well.

Sarah: And really I think we, we
heard this a number of times as we've

been talking to different people
in different roles across teams is

MOAs are often the glue that holds
a lot of clinical teams together.

It can be really easy to think about the
MOA role in a little bit of a limited way.

In what's really historically a
very hierarchical system, I feel

like the role of the medical office
assistant often gets of overlooked.

Morgan: Which is a shame because they
are so important and we think about

the tone or seeing patients before or
after an encounter with the provider.

But as you move into a team, the
MOAs more and more become the

glue across the team as well.

And, we are as providers often going
into rooms and working one-on-one with a

patient, but the MOAs are out and about,
between the encounters and they're able

to talk to different members of the team
when they're between other encounters.

So they're, they'll be able to connect
and this has happened for me many times.

I'll be flagged that one of my patients
is seeing a nurse down the hallway.

And I didn't realize they were even in
the schedule, but it's an opportunity

for me then to pop in and say hello.

And it's a huge piece of maintaining
a relationship with a patient, not to

provide any additional medical care,
but just to be connected in, and that

kind of sixth sense awareness of how
the team is working and where people are

and where patients are is one of those
really important parts that the MOA does.

And it changes a lot when you have a team.

Sarah: Well, and I know that I've
already shared a number of stories

of my own experiences with my
MOA, I walk in, she knows my kids.

She's known them from,
the day they were born.

They're now seven and 10.

She knows that they're on baseball teams.

And I love visiting with
her before my appointments.

And, you know, it's really interesting
because when I think about my own

perspective of the role of an
MOA you know, before getting into

all this work, fairly limited.

But whenever you talk
to a provider, I think.

Morgan: Mm-hmm.

Sarah: They're really quick to emphasize
the value that the MOA adds to the team.

So maybe it's my kind of outsider
hat here that I lean toward this

idea of MOAs being undervalued.

But I think also, they get left out of
decision making tables a lot of times.

Morgan: which is a shame because for
all the reasons that we've talked about

already, they really do need to be there.

They are part of the team and you know,
we've seen that a couple times where we

plan to do some team building and the
MOAs aren't invited to the table to have

the conversation and it's such a shame.

So we try to always advocate for that.

It's interesting as a patient, you
see the front facing part of the

MOA's job, but there's so much more
that an MOA does in the office.

And I think it's important if there's
any patients listening to this just to

help understand the general scope is a
lot broader for an office assistant than

just Being on the phone, or being in the
front desk, although that's a part of

it, and that may be a part of one or two
people's jobs, there's a lot more that

the, uh, assistants do across the clinic.

Sarah: And we connected with Shania, an
MOA who works in a larger team practice

with a number of MOAs, who work together
to support the clinic and she gave us

a great explanation of how their team
works and sort of divides up those roles.

Shania: oh my goodness.

We do lots.

So, we also do the cleaning
of the instruments.

We stock up the rooms every day.

I think at least once a month we do
like a big, deep clean of those rooms.

we're pretty much hands on for that doctor
whenever they need it, we have to call

the lab for health records or we have to
fax off for consults, we follow up and

go through the consultation lists we're
constantly updating lists so working as a

team to ensure that the day-to-day tasks
get done in appropriate timeframes, right?

Morgan: So I like how Shania's
Clinic has set up the team of MOAs

with a bunch of different stations,
with different areas of focus.

I think that keeps the interest in the
different parts of the work high and

for them on different days, they fill
different aspects of the whole role.

in her clinic stations one and two
are the front, and , that's the first

point of contact with patients, that's
rooming patients and stuff like that.

And then station two also gets
to do things like managing

the dreaded fax machine.

Sarah: Because even though it's
2023, faxing is still a thing.

Morgan: Hey, Ontario's got a five year
plan to reduce the number of faxes.

but also for Shania, they've got stations
three and four which focus more on,

, dealing with patients over the phone,
managing the records and things like that.

And, we do something similar at
our community health center, a

slightly different breakdown, but
then there's some , that manage a

lot of the referrals as a focus.

And they get to know all the other offices
and the wait times and who to talk to

and how to get people in quicker when
they need to and all that sort of thing.

So there's a lot of relationship
building in the community that

MOAs do with other clinics.

Sarah: you know, it's pretty common
in, larger clinics to see sort

of the division of MOA roles into
front of house, back of house.

But it also may be a really interesting
thing for a smaller teams to

think about, even if you just have
one person, filling the MOA role

I think that can be an interesting
way to get people thinking about

how the team could work differently.

Morgan: Yeah, sarah, I think
that's important because it

surfaces a lot of the work.

And if you're thinking of changing
your team, growing it, moving

into another location, that's an
opportunity to then think about.

How do those tasks get divided up?

And there might be a much more efficient,
or, sustainable or better way of

working when there's two people and
you're not all doing the same things.

Experienced teams can do that really well.

Shania: often I think people just
feel that MOAs are just there to

help the doctor, but not really
like, realize like we are alongside

them like every step of the way.

Like everything that you're feeling, we
communicate that with your physician.

We are part of that team.

You're the doctor's patients,
but you're also our patients, so

you're important to us as well.

That's why we're part of the team.

Sarah: And I think as the first point
of contact, MOAs also hold a lot

of the relationship with patients.

Carolyn: the, medical office
assistant, she knows me by name.

She's always got a
happy tone in her voice.

I feel that she's my advocate
within the healthcare team.

Sarah: Carolyn Canfield, our patient
advocate and ISU scholar often highlights

the role of the MOA as the first point of
contact, and that holder of relationship.

The MOA also has insights
into a patient's life.

After speaking with Carolyn, I
started thinking about the role

of the MOA as the culture curator
or connector, which is something

that, I hadn't thought about before.

Morgan: Yeah, I think MOAs , as
you have that relationship with

a patient, you can really help
promote the new members of the team.

as a physician, I'll do that too, but
something very different when you're a

patient sitting in the waiting room.

And the team at the front
go, oh, it's so good.

You're gonna be able to see
the social worker today.

Cayce: I don't know if I've put emphasis
on that relationship with MOAs, and I

don't think it gets talked about enough
when we talk about primary care networks.

But those MOAs are, not only are
they essential to the functioning

of a family practice, but , they
are like the lifeblood, right?

The MOAs build the culture of that clinic,
both physically by how they decorate

it, socially by their personalities.

But they also have their finger
on the pulse of which patients are

the most in need, and they get to
know those patients really well.

And there's no way that I could
do this job without having

been accepted by the MOA team.

If they didn't want me
here, it would never work.

Sarah: That was Cayce Laviolette.

And Morgan this was fun.

We had the opportunity to speak with
Cayce, a social worker, as well as

Ava Mundy, who, I introduced earlier.

And Cayce and Ava worked together, , an
integrated team with Cayce as the

social worker, and then with Ava's
coaching hat she was really involved

in integrating Cayce into their primary
care network, and without kind of any

sort of prompting, they both spoke to the
value of each other's roles on the team.

Ava: we knew it was really important
to give the physicians an opportunity

to ask questions before they started
sending referrals to him and knew it was

also really important for him to have
the opportunity to share with them his

understanding of his role and scope.

So we did schedule a Zoom meeting.

Where he was able to talk about his role
and what the referral process was going

to look like and give the physicians
the opportunity to ask any questions.

Morgan: Ava also talked about, the
creation of, charting templates

and figuring out how the different
kinds of providers wanted to

communicate with each other.

And with the new additions to the
team, this is really important.

And it's a great example, of, the kind
of things that MOAs can often take on,

to help the team work better together.

Sarah: the emphasis that was placed on,
MOAs as problem solvers was something that

I'd maybe spent less time thinking about.

Problem solving for both patients
and for other providers on the team.

Morgan: It's constant.

there's always something to work on.

Ava: My job sometimes involves a lot of
mystery solving, a lot of investigating.

I think people don't realize how often
calls come in from patients asking

questions about something unrelated to
the clinic functions or asking a very,

very open-ended question where they don't
really know what they're looking for.

Morgan: I mean, also just knowing
the other resources in the

community, who to connect with.

And I think that becomes a really
important piece because patients may not

share with, a provider, but will disclose
something in the waiting room before

or after a visit, and, a more casual
suggestion might be heard and people

can connect to other community resources.

Ava: It can be really impactful
for patients and patient care when

we do know about other programs
and resources in the community.

for example volunteer drivers or art
programs or hiking groups or those

kinds of things, that aren't medical
care, but that can be really impactful

Morgan: and one thing the MOAs
have is a really good handle

on the capacity of the clinic.

At any given time they're seeing running
too fast, how full the waiting room is,

how many phone calls are coming in, and
a lot of that input into the clinic isn't

always felt by the providers, cuz once
your day sheet is full, it's full and

you'll hear a little bit about, oh well,
you know, it took me forever to get in

to see you, but you don't have that,
immediate sense of how the team is working

together, or not, and how much demand
is coming through the phones and such.

Sarah: And, you know, one of the things
I think that Ava highlighted as well

as, as Shania, was the ability to kind
of juggle things and squeeze people in,

, when they really needed to see somebody.

You know, she gave a great example
of someone calling at the end

of the day, being able to move
somebody around and really feeling

that sense of accomplishment when
you're able to get a patient seen.

Ava: being able to either, go
a little bit above and beyond,

that feels really good when it
would've been easier and simpler to

say, sorry, we're full for today.

So it, it does feel good when I'm able
to really help smooth that transition

and help navigate patients and help
them access resources that they need.

Sarah: Across all the team members
we connected with, the MOA role

was something that almost everyone
returned to when we asked about,

tell me a story about how another
role really has supported your team.

those stories just kept
coming out again and again.

In preparation for this season,
I had the chance to connect with

three nurse practitioners in kind
of a panel style conversation.

Eliza: Primary care can be incredibly
chaotic and at the opposite end of the

spectrum from chaos is structure and
MOA's create a lot of the structure

that can create a day that actually
flows and is safer for everybody.

Just by the way they're booking
the appointments in managing the

scheduling, triaging the phone calls.

So I think that MOA practice
directly informs quality

of care and safety of care.

MOAs can also increase the level
of caring in the clinic and really

impact the culture because they
touch and interface with everyone.

And some of the MOAs that I've
worked with in busy clinics, add so

much to the resilience of the team

Morgan: eliza Henshaw is one of those
NPs and the relationship that Eliza

highlights here, between managing
clinic capacity and supporting

quality and safety, is something
that I think often gets overlooked.

Sarah: That's so true.

And you know, in the same conversation,
Erin talked about kind of the three

MOAs that she works with in her clinic
as really the backbone of primary care.

Another kind of interesting
way to frame the MOA role.

And then the medical anthropologist
and me got excited and started thinking

about mapping out all the roles onto a
body and like who would fit into what

parts and what would this look like.

But I won't go down,
this rabbit hole now.

beyond sort of this first point of
contact and advocate for the patient,

Erin added a new perspective here.

Erin: so they're there to support
the patients, but they're also

there to support us as providers.

They're a huge asset to making
change in the workplace as well.

And making sure that the workflows
and or how things are done in the

office are very patient centered.

For example, in our community, we've
had a hard time getting timely ECGs.

And so, one of the MOAs, she's
actually the lead MOA, and she did

some research and found that we
could purchase our own ECG machine.

And she brought this forward and
brought to the team and we were

able to then provide these ECGs
for our patients in a timely manner

Morgan: So this support of
clinic function and keeping the

patient centered is so important.

We always come back to it ourselves.

The MOA is often closest to that
patient-centered perspective, from

a personal perspective , and knows
more maybe about people's lives

outside of the medical encounter.

Coming back to my own experience in
our team, the MOAs are often seeing

patients who come in and access a
whole range of different services

without appointments for many things.

And they see people, some of them multiple
times a week, and it might just be a

hello or just, , just an observation,
but they start to understand the ebbs and

flows of people's life , and how it may
connect in with our clinic in different

ways, so MOAs have a very unique and
important view into people's lives.

Sarah: And it's not just in
community health centers, that

this kind of role is seen.

Spence Newell is an RN, with
an Urgent & Primary Care Centre.

Spence: our team leads and our MOAs as
well, are wonderful about completing

taxi vouchers, and arranging for
taxis for patients who come in and,

you know, they don't have a way
back home or anything like that.

Or we want to get them to the hospital,
but they might not need an ambulance,

but they're not gonna go because they
can't afford anything to get there.

So those little things, they're
things that you really take for

granted until you need it and then
you go, oh my gosh, I'm so happy that

person knows how to do that, and had
that information readily available.

Sarah: He's right.

Sometimes the administrative side of care
does get overlooked or taken for granted.

Kelvin: Our MOA team saves lives.

I think that's the thing where each role
of each team member, like the recall

for someone's pap if there's a list,
cervical cancer screening, without that,

we would've missed a cervical cancer.

Or their hypertension care, their
chronic disease management without

the MOAs helping us going through the
list of our EMRs or recalling people.

And so those are the things that
-MOAs do lifesaving work full stop.

Morgan: Kelvin is an NP working in a
different CHC and he's totally right.

Every role in the primary care team is
working to support patient-centered care.

and this does save lives.

Sarah: So if a new MOA is
joining a team, what can you do?

This is a question that we asked
the medical office assistants

that we talked to and we heard
a number of recommendations.

Ava: I would say, don't underestimate
the role and the importance of a

really good MOA as part of a team
and don't underestimate the value of

having them in the room when you're
making decisions and brainstorming

because MOAs are the frontline.

And that it's so valuable for MOAs
to have a good understanding of the

scope and the role of other team
members because they are the ones

speaking directly with patients.

They're the ones who can help with
patient education about different

resources and team members and roles.

Morgan: So thinking about
it as MOAs are glue.

Our first call to action is
really creating opportunities to

engage the MOAs in team building,
planning, decision making related

to how the team works together.

Sarah: And I think the next call to
action has to do with recognition.

Recognize the connector role that MOAs
can play in a team and create processes

that specifically utilize this role.

Morgan: And the final suggestion,
I think is something that's more

generalizable across the whole team.

And it's key to creating any high
functioning team, which is creating

the opportunities for teams to work
together on how they wanna work together.

And if you've been part of Team
Up and you've listened to us

before, you know we say that.

Ava: Take the time to sit down
and get to know each other

and plan things out together.

Definitely don't just assume that you
know each other's scope and that you

know how you're going to work together

Sarah: And what that does is
really build the team trust.

That's just essential for good
team communication and functioning.

Shania: If something's bothering
you that's communicating, if there's

something that needs to be done
differently, let's write it down and

bring it up on the next team huddle.

There's always room for improvement.

I think in order for things to work well,
like in life in general, you have to have

a good team and you have to communicate.

Sarah: So to kind of recap, when
you're thinking about how MOAs support

team-based care and what you can do in
a team to really utilize their skills,

here are three things to think about.

Number one, engage MOAs in planning
and decision making in a team.

Morgan: Create and promote processes that
build the MOA's position as that connector

for both patients and team members.

Sarah: And then lastly, as always,
create opportunities for teams to work

together on how they wanna work together.

Morgan: Thanks for listening
to this episode of Team Up.

Over this season, we'll be diving
in a bit to all the different

roles in primary care teams.

Sarah: And if you have suggestions,
we'd love to hear from you.

Reach out to and let
us know what you think of the podcast, and

if you have any ideas for future episodes.

Thanks so much, and tune in next week.