S06 E07 Learning Pathway Stage 4: Team Performance and QI

This episode focuses on Stage Four of the learning pathway, emphasizing team performance and quality improvement within primary care settings. The hosts discuss the continuous learning approach as a key element of a healthcare system — which aims to improve patient-centred and team-centred care by applying evidence to practice. Morgan and Sarah explore the concept of quality improvement as an iterative process, emphasizing the importance of starting with a good question and evolving from there. The episode highlights how accepting a trial-and-error style approach may be a culture shift within a clinic. However, in doing so, the practice will improve with each iteration, the roles within the practice will become solidified, and colleagues will become more comfortable utilizing team-based care methods. Practical strategies such as leveraging available resources, engaging with coaching supports, and time-boxing QI cycles are discussed to encourage teams to initiate and sustain quality improvement methods.

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/

Practice Support Program

The Family Practice Services Committee has a robust breadth of resources to help optimize your BC-based practice and delve further into team based care and if you have access to PSP or TBC Coaches, they are wonderful resources if you are thinking about QI in your team. Contact your local PSP team for support.

PSP also offer compensation and MainPRO+ credits for eligible primary care teams participating in PSP services.

Learning Pathway Resources

Check out the  QI Team Member Matrix Worksheet

Through the TeamUp network we are working to advance supports for team based primary care. 

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: Have you got your primary care
team all set up and are working pretty

well, but are you still looking for ways
to strengthen and optimize or improve?

Yeah, me too.

Sarah: Today we're going to talk about
stage four of the learning pathway, team

performance and quality improvement.

Morgan: Sarah, I think a lot of planners
get really excited by the potential

here in primary care and some providers.

Like me get excited too, but I know
quality improvement can be intimidating

for those who haven't done it before.

Sarah: I also think the idea of
performance comes with so much baggage

when we think about evaluation and
assessment and how things are going.

And, I think that can
factor in here as well.

Morgan: For sure.

Sarah: Really, I think it's all about
the idea of continuous learning.

And when we're thinking about quality
improvement, when we're thinking

about team performance, it really is
kind of this continuous learning as

part of a learning healthcare system.

And that's really what the
pathway is designed to support.

Morgan: I think the idea
for me in a way that quality

improvement is much more internal.

So it's bringing evidence into
practice, as a learning system,

like your own practice team.

but thinking about it, how it can impact
you and how you can change and improve

over time, that iterative approach.

certainly I think iteration is
important with evaluation too, but

there's something about this that is.

A bit more patient centered, a bit more
team centered, and you know, it's, focused

on how you can do your work differently.

Sarah: Well, and I think I always
get excited about the why, right?

We know in a continuous learning
system, what we know keeps changing,

and we need to be able to be
responsive to things as they come up.

The environment continues to evolve, the
system is really dynamic, so you need to

kind of have an approach that accounts for
that, and that's what I think continuous

quality improvement really does well.

Morgan: And I think along there, Sarah,
for me, we're going to talk about

evaluation, , I'm going to foreshadow
next episode, , but I think QI can

also be quite a bit more focused on
one area for a particular cycle, and

that might be really relevant for
your practice, for a subset of your

practice, and , you can build from there.

I think, you know, who's involved in
that process will depend on what the

questions are, but generally, you
want to have some buy in from the top.

This sort of learning healthcare
system, QI approach is important

to embed in all the work.

And then the whole team, from patients
through the different members of the

team that may be impacted by a change.

Sarah: It really is a culture shift, the
idea of being okay with trying something

and seeing if it works and then changing
if it doesn't, I think it is absolutely

different way of working and, the kind of
mindset that you can develop as a team.

And I think particularly if you're
moving from one kind of practice to

maybe bringing in some new folks to
maybe growing as a team, like it's a

great opportunity to really intentionally
put some effort into, uh, Building out

a quality improvement mindset, right?

And there's a bunch of resources
that can, , help people do this.

We asked Amy Huff to summarize
the content of this stage.

amie_1_12-20-2023_110634: It's really
around strengthening and sustaining

and optimizing team performance.

the team, could be thinking about
quality improvement or targeting,

uh, specific patient needs
it's, it's a reflection stage.

So, so perhaps you've been working
together for a while and you

want to think about, okay, well,
what's, what's working, what's not.

Sarah: There are a lot of
great resources out there about

supporting quality improvement.

And in BC, a lot of the resources,
from the practice support program

can really be leveraged here.

The coaches are really great at building
out sort of action planning to support

quality improvement, identifying
one key area that you might want to

change and work on and then looping
back and supporting that over time.

Other jurisdictions, have really similar
supports and we'll link to some of

these resources in the show notes.

If you haven't already connected to
whatever kind of coaching supports you

have, in your community, I think this is
a great, reason to, move into this space.

Morgan: It's interesting because, not
having a coach, that's how I started.

Not having that support, it was
us getting excited because a couple

of us went off to the Institute
for Healthcare Improvement, IHI.

we got IHI'd.

we actually went to two different
conferences and then came back and started

sharing some of the work that we did and
tried to inspire it amongst the, team,

back 20 years ago, to make some change and
to start the phrase was pursue perfection.

So not to be perfect, but to pursue
perfection and, try to instill

the sense of urgency in our group.

it's okay.

I think it's, you mentioned earlier,
it's, it's okay, not to have the right

question, it's more important to start.

And then I don't think you're
going to get the right question

until after you've started.

So just start with a pretty good question.

Do a QI cycle, probably by the third
or fourth QI cycle, you'll realize,

oh, this is actually the question we
wanted to ask, but now you've flexed

the muscles and you've got this
idea of, I'm going to make a change.

I'm going to reflect on how it worked.

And then I'm going to make another
change and reflect on how it worked.

Um, And when we started, I will,
I will never forget Sarah, we got

some of the nurses inspired in
this, idea of pursue perfection.

one of the nurses who was
literally counting down the days

to retirement, and she would remind
me regularly how many days it was.

She was excited.

She went off to her, computer and
decided to make signs that said pursue

perfection with an exclamation mark.

And then she increased
the font so big that.

The word perfection couldn't fit
on one line, so it was perfection

with the and on a third line.

And she's like, Oh no,
this is good enough.

We're going to get started.

And she pressed print and printed them
and posted them all over the office.

So we were iterating as we went.

Even at the level of the printer.

And I think that that was, that
kind of made it not only fun, but it

showed us that we were moving forward.

And so we could even improve in our
printing skills, but we were getting

better every time we tried something.

. Now, coming back to the pathway,
Sarah, there's a lot here.

What, what's something that you
wanted to highlight for today?

Sarah: So I think, you know, coming
back to this idea of it can be

really simple things that you can
kind of work with in this space.

And there's the quality improvement
team members matrix is a kind of really

simple resource that is up in the pathway
and it can be a great place to start

thinking about QI and specifically around
kind of the different roles that team

members might play in a QI process.

and I, I love this because it gets away
from the idea that It has to be the leader

role in the team who is initiating,
some sort of quality improvement effort.

And you can think about, okay,
who's sponsoring this process, who's

going to be the, owner, where's
the technical expertise going to

sit, who else do we need to engage?

How are we thinking about, customer
or usually patient experience?

And it's just a simple worksheet
that guides you to really think

through the different roles that
you might have , in a simple process

Morgan: I think this is a great
one to start with because you can

also then, it doesn't have to be
one person who was super keen that

sort of dragging everybody forward.

It can be, that I might be interested in
doing that little bit of technical work.

oh, we need to report out of the EMR.

You know, often that's where I put my hand
up and say, sure, I can help with that.

but I might not be the process owner cause
the particular question might not be all

that relevant for my practice, but I'll,
certainly help in another part of it.

So it's not like the, technical
expertise or thinking about

it from a patient perspective.

Sarah: if you, if you're thinking about
culture change and you're thinking about

sort of small changes across a team.

And we always talk about the importance
of thinking about roles in, this kind of

space, but I think also in, in QI, right?

To take these small projects on to
really think about who's doing what

and then to, time box them, right?

Okay.

We're only, we're trying
this for two weeks.

We're going to see sort of
how it goes and then we'll.

Iterate and come back and, and see if
it's going to keep going or if it's going

to be something completely different,

Morgan: So Sarah, before we wrap up,
I just want to come back to that last

piece you said about time boxing.

Cause we haven't really talked
about that in QI and I think that's

so important in terms of like.

What would I recommend people do
at taking this, matrix forward, but

also taking it with a timeframe.

And if you haven't done a QI cycle
before, start by naming when it's

finished and keep it really short.

And if you have to take a longer
than the whole cycle to figure

out what question you have, then,
you know, you're doing it wrong.

Just Pick one of the first three
questions you come up with and then

do a really short time box because
I think that's where you realize,

okay, now we know how, to do this and
then we can get on to the next one.

I think that's really important.

So don't worry about
getting the right question.

Sarah: Yeah, I know.

And I think it's, it's all about
creating an environment where

it's okay to try things, right?

That, that's really what
the, the motivation is here.

Morgan: Yeah, don't, don't
wait for the right question.

Get started and then
let us know how it goes.

Sarah: As always, you can reach
out to info at teambasecarebc.

ca and let us know what you think.

We're always happy to hear from you.

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.