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In this special episode of TeamUP!, Morgan and Sarah host a roundtable discussion with friends of the Innovation Support Unit to talk about the past, present, and future of Primary Care change in British Columbia.
The guests are both optimistic for the future and a bit sad as context of the episode’s conversation: the ISU, a unit that began eight years ago to strengthen and support Team-Based Primary Care in British Columbia, is wrapping up its core work with the BC government.
Throughout the episode, guests Angela Wignall, Valerie St. John, Christie Newton, Carolyn Canfield, and Andrew Earnshaw, discuss highlights of BC’s primary care strategy, new compensation models, relationship building and team development, collaboration challenges, and foundational needs.
This will be the last planned episode for TeamUP! Sarah and Morgan are not yet sure where they will turn there podcasting eye to next, but they do not want their microphones to go to waste, if there is an audience wanting to hear from them.
Please enjoy this episode, and thank you for being a part of the TeamUP! community!
Creators and Guests
Host
Morgan Price
Host
Sarah Fletcher
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: Sarah, we've got a
special episode of Team Up today.
This is one that we've wanted
to do for some time now.
Sarah: Yeah, that's right Morgan.
you and I hosted a round table talk with
some of our friends of the ISU people that
we've collaborated with and who really are
experts in their fields, who have intimate
knowledge and understanding of the primary
healthcare system in bc and we're so
lucky to get to work with these folks.
Morgan: And in this conversation we
reflected on some of the changes in
primary care and BC since the ISU started.
It's a little reflection of the
past, where we are today in 2026
and where we might go in the future.
Sarah: And, you know, I was worried
when we sent the invitations out.
That would be impossible to
find a time that would work for
all of these amazing leaders.
but we were able to find
time pretty quickly.
And that really speaks to how
generous and collaborative all
these folks are in this episode.
you'll hear from Angela Al, who's a
nurse and who is also the CEO of the
nurses and nurse practitioners of bc.
There's Valerie St.
John, the executive director of the
BC Association of Community Health
Centers, also known as B Catch.
Morgan: And we have Christy Newton in the
episode who's, another friend of the pod.
And she's the associate, vice
President of Health for UBC, and
she's been doing collaborative health
education for two decades or more.
And andrew Earnshaw also joined us.
He's the executive director
from the Division of Family
Practice in Koo Boundary.
And they've always been a vanguard of
pushing the boundaries of primary care,
both in the division and in primary
care networks in BC and at the IU.
We've been lucky to work with
them throughout the years.
Sarah: And last, but certainly
not least, is Carolyn Canfield.
She has been an ISU team member
really since almost the beginning,
about seven years ago now.
And among her many titles, she's
an adjunct professor in the
Department of Family Practice.
She's also a self-described citizen
patient disruptor, and she's really
been kind of the patient voice of
reason in so much of our, of our
work over the last eight years.
Morgan: As you'll hear in the
episode, and Sarah, this is an
important episode for us, for another
reason, not just the people that
are here as part of the round table.
but some of our audience may
know, but many may not that
the IU is coming to a close.
It's been over eight years of
engaging with teams and communities
as well as planners and leaders.
And, our funding is running
out at the end of this year.
So Sarah, you know, I, I'm
getting a little choked.
I didn't think we'd have this kind of
life in reach of the ISU when we started
to design it way back in 2017 as a
little project, and yet here we are.
Sarah: Right.
We were like, oh, it'll be a year or two.
we'll focus on team-based care
for a bit, and then we will
figure out the next thing.
And I think it's just
been an amazing journey.
this conversation is
really a way to bring, uh.
Some of the great minds and voices in
BC healthcare space together to reflect
on where things have been, where they're
going, what the future might look like
for primary care, and to reflect on the
healthcare system in general and, and
team-based care where things are at.
this episode is meant to be a
sendoff from us to the community
and to those who listen to team up.
Morgan: Yes, and everyone in this
episode has been a collaborator, a
partner, and a friend of the ISU.
We're really glad to have the opportunity
to bring everyone together like this,
and I hope the audience enjoys this.
So let's kick off by
going backwards in time.
eight years ago was an interesting time
in BC Christie, you and I were chatting
about something called an innovation
support unit, and when we were co-heads
in the Department of Family Practice and
Carolyn, it was around the time that we
were getting you your, faculty position.
And lo and behold, in the background,
the ministry was developing
a strategy on primary care.
and so all those things were kind
of coalescing around the same time.
And so to sort of think about that,
history and the BC primary care strategy,
one of the questions we could start with
is what were some of the big impacts from
that strategy over the last eight years?
Is there a highlight you wanna
bring forward of, of, change
over the last eight years
Angela: I am.
I'm very happy to start
with something.
I am Angela
Al.
I am the Chief Executive Officer of
the Nurses and Nurse Practitioners
of British Columbia, or N-N-P-B-C,
which is the Provincial Association
representing all nurses in British
Columbia.
And I'm a proud registered nurse myself.
Something that we saw in the nursing world
shift tremendously was the opportunity
to introduce a new compensation model
for nurse practitioners and primary care.
And that really opened up the floodgates
for the opportunity for nPS to be
employed in primary care networks
in a way that they had never had
the opportunity to be employed
in those areas before.
And as a direct result of
that strategy, we've gone from, simply
having nurse practitioners and nurses
employed in primary care through health
authorities to having hundreds of
nurse practitioners now employed in
PCNs.
and that's opened up attachment
to thousands of patients in BC and
really expanded the idea of who is
and can be a provider of primary care
in the province.
Morgan: Angela, that's,
that's a really good insight
that I guess I wasn't
quite as aware of because.
I've worked with nurse practitioners
through the community health
centers, and Kool-Aid specifically
for longer than the strategy.
but from a outside of
Kool-Aid or outside of
CHCs, I guess there, there's
been a, a big shift that way.
And I I know it
systematically, but I don't,
didn't get quite the, the connection.
Yeah.
Angela: Yeah.
Blew open compensation opportunities
that allowed us to do creative things.
Morgan: And Val, I wonder if,
that change has impacted other
community health centers that
are connected to B catch.
Valerie: Yeah.
Thanks Morgan.
So I'm Val St.
John.
I'm the
Executive director of the BC Association
of Community Health Centers, or as
Morgan just said, B catch for short.
yeah, I, I, I mean definitely
when you look at team-based
care, which, you know, has many
definitions currently in our system.
and, and selfishly looking at the
CHC sector, the implementation of, of
the nurse practitioner role and the
understanding of the n nurse practitioner
role, coming, into view I think helped
very much, the delivery of primary care
and the support for team-based care.
definitely in the community health center
sector, in particular where there has
been, you know, very often with, the
numbers of different compensation models
and the move away from fee for service
for physicians and looking into the
salaried space, in particular, which is
what CHCs attempt to do, it, it's allowed
for that different construct of team
and the, um, different implementation
more broadly of team-based care.
you know, going into other aspects where
the lack of an understanding of scope
of practice is very often a challenge
for implementing team-based care.
We're not quite there yet, I don't think.
Right.
But I, but I think, you know, and I know
we'll talk a little bit in the future
about, you know, what's next right?
In terms of focus and supports
and those kinds of things.
And, and certainly I'll chime in
in that regard, but I think, that
conversation with the implementation
of nurse practitioners really
started to highlight the, the scope
of practice conversations that need
to continue and, and be clarified.
Christie: Can I jump in there?
Morgan: Yeah.
Christie, please do.
Christie: Christie Newton, associate Vice
President Health, I have been involved in,
promoting, collaborative health education.
To support team-based care to really
prepare health professional learners
to be, ready to work in teams.
since 2004, I think I started that push.
and so it's hard for me to jump in
with what's happened since 2017.
although I have to say, having built
in 2006 a team-based care model.
On UBC campus with a nurse practitioner
and a family physician, and a
clinical pharmacist and a midwife,
and ot, occupational therapy and
physiotherapy, and then over a year,
so having faculty and learners of
all of those professions and then.
Over a year having each one of them
except for clinical pharmacy 'cause
they were cross appointed with
the Department of Family Practice.
have to step out of the clinic because of
compensation models, academic policies,
provincial health, delivery policies.
So now with the opportunity again on
UBC campus, with the opening of the
gateway building and the team-based
care teaching clinic there, the things
like altered compensation models,
things like a shift in academic policy.
to allow for clinical education,
to, teach across professions.
Those are the types of things and the
buy-in across the health sectors that
this is actually some the direction to go.
so you know, they talk about a
tipping point, they talk about flow.
They think we've come to that point where.
The Pentagram Partnership Plus, has
decided to co-own the transformation
of the healthcare system and is pushing
the envelope on all of these things
that were previously barriers, to this.
whether it's, from 2017 or not,
I think having, the ISU and That
rigor of evaluation, I think is,
has been really important too.
Carolyn: I think I'd like to, to jump in.
so I'm Carolyn Canfield.
I'm an adjunct professor in the
Department of Family Practice.
and I've been connected to the
ISUA, part of the ISU team, as a
kind of, Citizen patient disruptor,
to get different ways of thinking.
Sarah: That is Carolyn's
actual title in our
Carolyn: great.
And I'm also I've, I, so Morgan, you
were saying that I came onto faculty?
Yes.
You, you were arranging to, to confirm
that reappointment in 2017, but, it was
actually 2014 that, I was an honorary
lecturer, so I've been involved as
Christie was alluding to education.
I've been involved in teaching in the
undergraduate medical program and,
nursing school here at, at UBC Vancouver.
And, My patient perspective has
always brought, the lens of trust
in relational care, longitudinal,
relational care, and, and the topic of
trust, trust building and sustaining,
And understanding where the gaps can
be and where betrayal and harm can
arise, has always been a mantra for me.
And so I've been talking about, team-based
care for a long while, telling the
students that this is the environment
they're gonna be working in, but it's
been kind of a hope and a prayer.
and I think that something that has
changed remarkably over the last
eight years is, The, the level of
sophistication and understanding that
we have because of the Is u's approach.
I was, delighted and excited
about the team mapping approach.
it's patient centered explicitly and
the imagination and development of
personas to really push, the challenges
and the challenges are about the
teams who are in these workshops
relating to each other over the issues.
And of course, that builds trust
as well among the participants.
So it's been an iterative, process to
develop the sophistication that, has
been about discovery as, as Christie
was saying, To find the reality behind
the language that we've used for
so long, about primary care teams.
Yeah, primary care teams.
I can point to all the
different practitioners.
Well, how do they relate?
How do they relate to me as a patient?
How do they relate to each other?
And then how do they relate to, the
health authority and the oversight
and governance and fee schedules?
And, you know, that, that, administrative
context and policy context.
it's been really exciting for
me to see that progress from,
yeah, we're all in this together.
Yeah.
It's all about teams and trust to
something much more sophisticated.
and the way the ISU has gone about
this has been really interesting to me.
It's been, a wonderful,
form fits function.
Because I can see within the
dynamics of, the team, the ISU,
team, how much development of
relational trust and collective
understanding of how we work as a team.
and The intentionality of sustaining
teamwork, understanding what the
elements are and where's the flex,
where's the flexibility, where
are the limits to flexibility?
how can we accomplish goals efficiently
and sustain trust throughout the
lifecycle of a project and beyond?
So I really feel privileged to have
seen how the, ISU has, modeled,
really refreshing, practice.
Of team-based, project work, team-based,
a team-based unit, literally.
and I think that knowledge, it's
really important that that knowledge be
maintained through each of us, I guess
is as we go onto our next incarnation,
our next, our next projects, there is
good documentation of the, the work with
practitioners, clinicians policy, the
evaluation work, the patient partners
who have been a part of this, all the way
through, that's well documented, but I,
I wouldn't want to lose the documentation
of how the ISU has evolved as a a working.
Team.
its expansion and adaptation of
skills, the amount of learning within,
individuals on the team, how much
they've contributed to each other in,
um, understanding our healthcare system,
understanding how to work, and how to
innovate, how to, apply imagination
to, issues that arise within a project.
So I'll stop there.
I mean, there's lots more to say, but,
uh,
Morgan: I'm gonna ignore
all the compliments,
Carolyn: well, I, I think it's important,
I think it's
important not to ignore the compliments,
and that's what I'm saying, you know,
it's not about, oh boy, aren't we good?
It's about, this is,
important learning to share.
And I, you know, I'm, as Christie knows,
I've, I've been involved with the, uh,
gateway clinic and looking at how are.
teaching and learning teams going to roll
out, and I would hope that some of the
practices that of the ISU in working as a
team could be applied within the faculty
at, at Gateway, in the way that the
faculty needs to also be collaborative.
Morgan: I think you're right.
That, and, and that's definitely
a piece we don't wanna lose.
one thing that, that you mentioned earlier
that I, I want to explore is that idea of
relationship centered care within a team.
it has been a, tenant of mine that I
think teams actually can support that
and improve relationship centered care.
And yet one of the pushbacks from my
colleagues is don't wanna have a team
because it's going to, it's gonna water
down my relationship with my patients.
I'm the longitudinal provider.
And I'm curious what people's
thoughts are about that.
'cause I know it's possible to improve
the relationship centeredness of care
with a team member or with team members.
I don't know if anybody
has a, has a reaction
Carolyn: WI,
I'd like to jump in with just with, I
don't know, a qualifier, maybe it's a, you
know, a fist punch, in the air that, that.
the relationship to me, the relationship
based care is owned by the patient.
Morgan: Mm.
Angela: Yeah, I would echo that.
Christie: I was just
gonna say the same thing.
I echo that in my practice as well.
The, the patient is the one that
identifies the person in the
clinic that they have the strongest
relationship with, and I can tell
you that that's often not me as the.
family physician, that it, may actually
be that they more consistently relate
to my medical office assistant or my
receptionist who they speak to frequently,
and who they feel, understands when
things are urgent or when things
can wait and, and things like that.
So, I completely agree, Carolyn.
The nice thing about, and this is
something that would never have
happened at the, in 2017, with the
building of the team at the Gateway
Center, we are fortunate to have
four weeks of team development,
specifically to train the team.
To work collaboratively and to model what
we will ultimately be trying to teach.
recognizing we're not gonna get it
perfect and it is gonna take time to
develop, but at least we have time,
which is an important concept for
transforming the entire system that
investment has not been made in the past.
And finally there's a recognition that
just putting people together doesn't
form a team and doesn't generate the
healthcare efficiencies that we're hoping
to achieve through team-based care.
and that it's not intuitive.
and so, that is definitely
a change, that there is this
recognition and resources are being.
Put forward to support team
development before the expected
team functioning to be perfect.
Valerie: So I can certainly
jump in a bit on that.
And, and just say a couple of things.
So
working with the ISU,
to sort of riff off what
Carolyn was saying around,
the tools and supports and, and
how the team at the ISU showed up
that work put.
you know, community health center
evaluation on the map for us, right?
Because we didn't have the skillsets to
go into that deep, dark hole, and yet we
knew we needed to go into that deep dark
hole to be able to talk about the value
proposition of, of you
know, this particular model.
And so working with, the ISU team,
on what I call phase one of our
evaluation strategy, brought us a
framework for evaluation, brought
us the, the tools and the reporting
capabilities to talk about attachment.
And third, third next
available appointment.
And, and the more recent team-based
care, assessments and gave the CHCs that
were in the pilots for these, evaluation
items, dashboards to start to form,
you know, their, their QI supports.
And we wouldn't have been able
to do that without the ISU.
Jumping in with us to, to make that real.
And now we have the opportunity to
build on that and to, to continue
to get a bit more sophisticated
as, as government in essence starts
to do a bit more primary care
evaluation right across, the province.
And so for us, there is great gratitude
in a sense of looming fear that we won't,
no, we'll no longer have the ISU in its
current form to support sort of what
we had planned to be our next stages.
because it's, really critical work.
And then the, you know, the
second aspect I'd like to talk
about, I'm not a clinician in
any way, shape or form, right?
I work with the community health
centers across the province and
lots of partner organizations and.
Without fail the, the practitioners in
the CHC model say that they gravitated
to the model and stay retained by the
model because of the team-based care,
even though there hasn't
been that focused support.
to start up right.
Team-based care and maintain and
sustain it because it is, you know,
it's one of the things that the
folks love of the model and the
patient's love of the model, but it's
hard going on very much their own.
And so Christie, what you're saying
about Gateway now, providing that
opportunity for not only that recognition
that it, takes a fair bit of support
to set this thing up and then to
sustain it is very welcome news for
me and it will be very welcome news
for the community health centers.
And so, you know, very happy to, to
participate in that space because
it's, it's absolutely a gotta do for
the sustainment of team-based care
and to attract more folks into it.
Right to retain more folks
in, in that, way of being.
because at the end of the day, it
only benefits the patient, while
it's benefiting the practitioners.
So, you know, very excited about
what comes next in that space.
Very sad that the ISU isn't, in its
current form, going to help us to
navigate through that, deep, deep,
dark hole that is the evaluation.
Right?
Because, you know, that too is
scary work,
Sarah: Hmm.
One, one of the things I'd love to
jump off that you just mentioned,
Val, is you said patients love it.
Like patients love the team-based care.
And I'm just wondering if you kinda
look back over sort of the evolution of
team-based care over the past kind of
eight years, what do you think has had
like the biggest impact for patients?
What's sort of your, your highlight
Valerie: So I think, you know,
based, based on, what I hear.
And I can only comment
on five and a half years.
But you know, it's, it's been
a very similar journey through
those five and a half years.
I think they like the access, right?
I think it's that availability to
have access to the conversation
they need to have, with a
particular practitioner, right?
and not be limited to 15 minutes.
You got one issue, ready, set, go, right?
Because that's what the compensation
model, um, sort of created for,
you know, for, for the doctors.
Morgan: That last part I think
is really key because culturally,
the different team members are
different, both professional
culture and and personal culture.
And that makes it for a richness.
And there's this, my, my comment that I
made earlier about just sort of watering
down the relationship centeredness.
There's that sense of
a zero sum game, right?
If I, if you take half of
the relationship away, then I
lose half of the relationship.
But it's not that it,
it's not a zero sum game.
Christie: it just changes the
relationship.
Morgan: it changes and it, it,
it, it enriches it.
Angela: Yeah, that piece around culture
Morgan, I, you know, I think I have
to pick up on, because when you, when
you said that about that, you know, it
will water down my relationship with a
patient as a nurse, my first, feeling
was to put my arms around you and say,
oh my goodness, you are suffering.
If you think you are carrying
all this responsibility, you poor
individual let me help you talk
about that and take care of that.
Such a nurse.
But I think the other part of it is that,
you know, there are members of the team
who have never not worked in a team.
Right.
And I think it's interesting to think
about the different disciplinary
boundaries that we put around ourselves.
So, you know, as a nurse, nursing
has always worked in teams.
We don't work anywhere, alone, ever.
And when I think about the history
and the culture of nursing, you
know, we come from, thousands of
years of women's work in community.
And so that work is never alone.
We are never doing that in isolation.
And I think sometimes when I, you
know, have had conversations with
you Morgan, or with other physician
colleagues, I have wondered about the
suffering that it must, what it must
be like to feel solely responsible for
something to such an extreme degree.
And I have curiosities around the
disciplinary background that cultivates
that kind of worldview because it is.
palpably different from the worldview
that we hold in my discipline.
And I think one of the
joys of intersecting with
U-B-C-I-C-U for the first time.
Was coming into a room with you, Morgan,
and with you Sarah, and realizing
that you know, to be Canadiana, I
was among kindred spirits because we
wanted to talk about the history and
we wanted to talk about the philosophy
and all of these pieces that underpin
the systems and the structures that
we are inhabiting together today.
And I see that in also how you have
built your team at U-B-C-I-S-U,
which is extraordinarily unique.
It is rare to have an evaluation team
or a creative team or an innovation
team that's comprised of doctors and
patients and advocates and historians.
You've created a pocket where you
can be truly transdisciplinary in
looking at some of these challenges.
And I think that gets
to that culture piece.
You are modeling it and you are reminding
us that we need to pay attention to it.
Morgan: that was definitely
part of the plan was to.
To see how it worked, because if
we were gonna teach something, we
had to have lived something too.
Angela: Hmm.
Morgan: And that was,
that's very intentional.
And I think now as, we look at the
sort of the diaspora of some of the
learnings, that was a conversation
we had just this morning of how
do we want to promote each of us
to feel empowered to share some of the
things that worked wherever we land next.
Carolyn: I'd like to, to go back
to, this idea of the zero sum.
of relational trust.
and I guess also, you know, thinking
about that, that, psychological isolation
of the single, the lone, primary care
practitioner, that Angela referenced.
and I think, you know, when we think
about, how is it that patients see the
team, as being different from, Having
a single primary care practitioner,
well, on the patient's side.
the health condition never leaves.
So the concern is always there and
it's multifaceted because we all
have complicated personalities and
complicated lives, and it's lots of
aspects of our health is contextual.
you know, how do I feel
when I'm with my kids?
How do I feel when I'm at work?
How do I feel when I'm called
on to do more than I feel I can.
With the health limitations that I have.
So there's this huge well of potential
for relational trust within the patient.
And it's multifaceted.
and the relationship is, with a
member of a primary care team.
It's partly formed around
the scope of practice.
It's also formed around personality.
It's formed around available
time, and it's progressive.
It, it evolves.
Those relationships don't, you
know, it's not the snapshot of
the first, the first time you meet
with a new member of the team.
that's just the beginning.
And it doesn't mean you drop the
relationship you have with the other
members of the team that you've
spent time with or the history.
and in fact.
By seeing there are multiple people with
particular viewpoints interested in me,
interested in my wellbeing, in this facet
of my, my health concern and, the work
that I'm doing to improve my wellbeing.
That's very additive.
but to contrast it with a single
family practitioner making a referral
that's episodic, or likely episodic,
the referral is to a specialist.
There's, narrow scope of practice.
There is not an expectation
of a long-term, relationship,
or an embrace of complexity.
actually that, the generalist is
my family doctor, home base, but
I'm with the orthopedic surgeon
because of, of this injury, because
of, this, specific need I have.
And I don't expect, and I don't want
to have a long-term relationship
with the orthopedic surgeon.
you know, I want this to
be a fix and it's over.
And then I'm back to, my
focus with, my ongoing health
with my family practitioner.
So with the team, there's a sense that.
the metaphor that I oftentimes use is,
the importance to a patient of knowing
that not so much that they're gonna
be fixed by our healthcare system, but
they are going to be a company there,
there's going to be a traveling with
the patient along their life course and
not being abandoned, you know, feeling
as though they are accompanied so.
The team expands that beautifully
And even as, different practitioners,
roll through a, a team over time,
the composition of the team changes.
The fact of having team-based
care when it's successful.
You know, I guess that's the assumption
I'm making, when it's actually working,
is that it extends the scope of that
traveling with that being accompanied.
and that enables patients to cope
with all the screw ups, all the
complexities, all the, the difficulties
that are always gonna be there.
They're always going to be, gaps that
open up and, and challenges, to overcome.
When, you know, you've got, not just
one person, but multiple people who are
committed to traveling with you, that
doesn't feel so isolating and so daunting.
even with really big screw ups or
really complicated medical issues.
Morgan: And I think that different
team members can travel with in
different ways, in different places,
Absolutely.
Yeah.
Absolutely.
And for the audience, I just have to say
that if anyone's worried about me as a
solo family doctor with all this on my
shoulders, 25 years ago, I decided that
was not for me gonna work in teams, and
I've worked in teams ever since and,
and it was the best choice I ever made.
So, yeah.
Valerie: Thank God.
Christie: I I graduated from residency,
and the very next day started in a
team-based care teaching practice,
and I have never experienced
solo fp even group FP practice.
I just can't understand it.
Morgan: yeah.
Valerie: There you go.
Morgan: Yeah.
Sarah: Well, I guess we've spent a
little bit of time kind of thinking about
the, the sort of last eight years, the
past and kind of where we've come from.
And I'm wondering now about moving us
to sort of thinking about where things
are at date, and what do you think, like
what do you think is helping different
kinds of clinicians working in teams?
And Angela, I'm thinking specifically
about like the, the new kind of
primary care nursing roles that we've
seen sort of come into play through
the primary care networks and, and,
all, all of the different roles in
the primary care networks really.
But, what do you think what's
helping clinicians in that space?
Angela: Well, I really have appreciated
the opportunity to work with U-B-C-I-S-U
and with, health Quality bc Yeah, I'd
be remiss if I didn't mention HQ BBC's
work as well in advancing tools for
helping, understanding the breadth of
the nursing family within primary care.
So I'm thinking of our work
together on Nurse Compass and
in so many other places as well.
without harping on the
same the opportunity to be
employed in primary care is.
Different for nurses than it is
elsewhere perhaps in the team.
And so the, the opportunity to open
up programs like the nursing practice
funding model with the government of BC
and the supporting program at N-M-P-B-C,
the nursing initiatives for primary
care that has enabled the integration
of RNs and LPNs into primary care teams
that are either not-for-profit run or
physician or nurse practitioner led
in a way that we haven't seen before.
And that is, you know, really quite new
within the last year, the provincial
opening up of that opportunity.
And what we continue to hear from the
nurses e employed within those models
is that they, they wanna be there,
they wanna be working in those clinics,
they wanna be working with those teams.
And there remains challenges both in
terms of structure, but also in terms of
understanding of how to be an employer.
I, I'm not sure that many folks who go
out to set up a primary care practice
think of themselves as setting, you
know, controls on practice for a nurse.
They're like, what, what is that?
How do I do that?
I need help with that.
So the infrastructure that goes
underneath, enabling the breadth of
the nursing team within primary care is
something that we're still working on.
We are still building as a province.
We're not there yet.
But to see hundreds of nurses
in those environments, expanding
care is really extraordinary.
And also hearing from other members
of the care team, like physicians,
like social workers, like dieticians
who are also in the spaces.
Hearing the richness of what opening
the team up brings to their practice,
the relief it brings to them, as well as
they're carrying so much responsibility
and that sense of keenness about
the public discourse, about lack
of access and the quality of care.
Having colleagues that can step
in and support with a really
broad scope of practice is
emancipatory in those settings.
And I think that's a key part that
we don't talk about quite enough.
My job at N-M-P-V-C is to enable
providers so that nurses as
providers can care for patients.
That's our through line to the patient,
but at the end of the day, retaining
those providers, as Val said, you
know, making the conditions where
their work is seamless and they are
well cared for while they do the work,
no matter what discipline, no matter
what their designation or profession,
that has to be a focus so that we
can deliver that care for patients.
And so, relieving stress increasing the
capacity of the team, it does it, it
achieves those goals as well as expanding
access and attachment for patients.
Morgan: Thank you, Angela.
I'm gonna take this
moment to welcome Andrew,
Sarah: maybe we can start
with getting you to introduce
yourself
Andrew: my name is Andrew Shaw.
I am the executive director of division
of Family Practice in Kmi Boundaries.
Southeast corner of the
province is the traditional
territory, the the and peoples.
I'm also the executive director of a
small little community health center
style nonprofit that runs some small
clinic services to kind of filling
gaps where health authority services
and private physician services
aren't able to tread prima health.
So those are my two
engagements in this space.
In terms of my role in team-based
care, our region was a really early
champion of team-based care as
a solution to the shortages, the
supply shortages in primary care.
we had team-based care pilots happening
before there was such a thing called PCN.
And then we were one of the first
groups to really warmly embrace PCN.
And throughout that.
Entire journey.
We really did our absolute most
within the constraints that we had
to adopt all of the leading practice
for successful team-based care.
So our team members are, for the
most part, entirely co-located
in patient medical homes.
And we have done as much work as we could,
again, within the constraints that we
face to kind of build those teams in a
way that they would be delivering real
value in the primary care ecosystem.
Morgan: Well, thank you Andrew.
Definitely.
You've got lots to add and lots
of experience that's different to
everybody else on this, conversation,
which is great to have your
perspective and, and your history.
We were just sort of talking
about what are some of the.
the.
benefits.
But how about I shift and say after
the PCN primary Care strategy for the
last eight years, what's been harder
from your perspective than you thought?
What, what was surprisingly hard?
There's lots of hard stuff that's been
happening, but what, what maybe stood out
as a, I didn't expect this part to be hard
if Christie has to look up at the sky.
It's a good question.
I know it.
Christie: It's a really good question.
So can I.
just say that, cause you
asked what's happening today
Morgan: Yeah.
Christie: and we've got examples
of, all the great things that
are actually happening today,
there are multiple models.
Of team-based care developing, not
just PCN but CHCs and municipalities
developing different ways to work to
ensure that they have team-based care
opportunities in their communities.
There were the team-based primary
care learning centers that were
spread across the province.
And so.
I, I really do think we're starting
to get into the flow, right?
People are catching on and they're
looking at their local resources
and their contexts and trying
to figure, figure things out.
And great examples are developing.
What I'm finding hard, I guess then is.
While we're doing that, and I am
busy every day developing the new
team-based care teaching clinic on UBC
campus in the gateway building I lose
touch with all of the other things
and I risk reinventing the wheel.
So I find the hard part, for
example, is I can't stay connected
to Angela and Val and, you know,
learn from what they've been doing.
And it, it becomes
challenging to stay connected.
The other hard part, I think, is that.
The system is still designed to make
us competitive versus collaborative.
and what I mean by that is, especially in
a time when there's scarcity of resources,
we are all competing for a very small pot.
Actually no pot right now we're, we're
now forced to compete for survival.
And I, you know, that's not,
you know, something I say
lightly, especially to the ISU.
and so I, I think that's hard.
While we've all got
it and we're all
doing great
things, staying connected
and truly trying to
collaborate to move the.
system forward is hard.
Angela: I think Christie raises a really
important point there around you know, how
we view the resources and it's something
that, you know, I've had a number of
conversations about in the last few weeks.
In particular, when we talk about the
resources, I think, you know, it's
important for us to remember too, and to
have conversations about the reality that.
What we're talking about is care that
the province of British Columbia is
required to provide to British Colombians.
And so we're not competing for resources.
We're all working within a system that's
designed to meet that requirement.
And when the system pits
us against each other for.
The purpose of, pretending that these
resources are scarce or that this care
isn't needed or that, you know, expanding
to meet the actual need of British
Colombians is somehow out of the budget.
I think we need to collectively respond
to that assertion quite strongly as a
community and say, no, this is actually
the full responsibility of, this province
and we all have a space within it.
So it's not about nurse practitioners
taking dollars from doctors or doctors
taking dollars from social workers.
it's about funding the
care that's required.
And I hope that, conversations about
that get to continue regardless of
the venue because it's, I think it's
an important piece of the puzzle.
Morgan: So how do we
shift that conversation?
How do we change it to be that more
collaborative, patient centered
view or system centered view
into providing care for people?
Valerie: Well, I, I know I,
I spend a lot of my time.
Identifying a dot, trying to connect
the dots and the people under the
dots who are holding the dots.
So that we ideally break out of silos
that we may intentionally have found
ourselves in.
So that we can collaborate and, and
go into those sort of economies of
scale and efficiencies of thought
and delivery and, and funding.
And I think more and more the
onus is on leaders to do that.
'cause it's, seems to be hard to
do at, the top level of the system.
And so I think we continue to do
our collaborations of the willing
And be a bit more aware that this
is how system change happens, right?
If, we have those conversations, if we
bring in other folks that we're aware of
who, tell two friends and so on, right?
I think, I think, we can do that.
I think a number of us around the screen
are doing that, and I think we, we expand
our, our circles and our partnerships and
continue to do that so that ultimately the
silos start to lose their walls, right?
Because there's, there's more of us either
knocking at those doors or, participating.
but I think it's a conscious effort
to do it at, this sort of operations
or, you know, we're at strategic
levels ourselves, but I think it's
something that we have to take on if
we wanna be part of transformation.
So we, you know, we need to be
the change we wanna see, right?
So invite the folks.
That you know of who are doing the
work that, that you're involved in
to talk about it and to share it
and who else is out there doing,
similar or adjacent, work that kind
of makes sense to collaborate around.
Carolyn: One, thing that that concerns
me, if I can riff off that Val, is
that, when resources are scarce and
people feel pressed to accomplish what
they know they have to accomplish it
can be very challenging to create the
safe spaces that collaborators need.
And, and that's something that
I worry about in, going forward.
There are real shortages and real
pressures, but there are also imagined
stresses and a priority that has to
kind of overcome that is allowing for
the safe spaces to actually express
misgivings or hesitations or challenge
them assumptions and to, to feel as.
though that's going to be welcomed
and that it's a part of progress.
It's a part of moving ahead.
Angela: I think that's something that's
really been exemplified in the ISU.
It's, you know, when I was preparing
my notes for today, one thing I wrote
in big capital letters was humility.
And I, have experienced such profound
intellectual, cultural humility in the
team at U-B-C-I-S-U in the willingness
to consider different perspectives.
And I think that that's, again,
you know, I'm repeating myself, but
mentoring the way for the rest of us.
Because Carolyn, to your point,
that it is, there's a humility
that's needed that we can't solve
this from our silos, as Val said.
And we can't solve this from
our entrenched positions.
We have to enter into the space
of creating solutions with
a high degree of humility.
and that's a teaching that definitely
I've witnessed and been part of
through the work with U-B-C-I-S-U.
Morgan: And there's also this need
in that context to then have some
of those difficult conversations
transparently Not to avoid them.
And I think,
I think of ney boundary and some of
the difficult conversations that we've
been able to witness and be a part
of that I, I remember Andrew thinking
about the idea of episodic care for
many versus high quality longitudinal
care for those who were attached.
And, and that was a conversation that
not all communities are willing to
have, but need to, and you embrace
that as a community to, to explore.
And it, it obviously didn't start
from sort of ground zero and
have that tough conversation.
You built the culture to
have that conversation.
But, an effective community
level decision and, exploration
of the topic was had.
Andrew: Yeah, we've had a lot of
success flow from those conversations
in terms of our, you know, strategic
commitments to prioritize equity in
that context and, and, and using.
Uncomfortable language for
clinicians, like good enough
care as a goal to achieve equity.
I love that you're bringing me
back to that, those gatherings.
That was probably three or
four years ago when we did
that.
your last question is how do we do
it in your, in your previous question
was, you know, what's been hard?
And, and I know that my answer's
kind of the same for, for both of
them, and I just wanted to put.
Into the room complete and utter
agreement with what everyone has just
said around collaboration and how to
make it work and how difficult it is,
but it's the only answer forward, But,
but I have a bit of a, contrary opinion
when I think about what's been heard.
Because if you don't have
to, then why would you?
And when I think about what's been
hard, it, like, it's like if you
have to move into this collaborative
governance, collaborative space.
it's an inevitable handicap.
And if it's the nature of the
ecosystem you're in, then you
bring the art and science of those
skills to the table, and you do it.
And you do it well as the rest
of you have just spoken to.
But if you're designing a system
where you don't have to do that,
where you can actually have people be
truly members of each other's teams,
why would you flick the handicap?
Of the requirement to manage this thing
collaboratively for, the rest of time.
It just doesn't make any sense at all.
And to me, that's one of my.
Greatest frustrations.
You know, I, I think we've knocked
collaboration out of the park here.
I'm proud of the work
that we've done here.
What a waste to have to do it when
we didn't have to in the first place.
So I, I just think that's
an important thing to frame.
It's more of a policy answer to your
original question about what's been
difficult and what could be otherwise.
But I think as we move forward, we should.
that's a compromise that was made in the
system that I would fight much more hard,
get much more vociferously against it.
With what I know now about how much
more work it's been to have multiple
employers and multiple backgrounds
and multiple collective agreements,
and like I could just go on and on and
on, like it's just a tax on patients.
It's a massive
reduction in quality and
quantity of care to patients.
So we ought to have the
courage to look at our systems
and, and stop paying that tax.
We don't have to do it.
Valerie: So I'm, really curious building
on that, Andrew on what, system review
means and what the outcomes will be.
Clearly that's where we are
and have been for a while.
And optimization is the word of the day.
Right.
Or possibly the year or the budget,
and I, think there hasn't been
enough Gotta dos to your point.
Absolutely.
So we implement primary care
networks for an example, but there
wasn't a series of gotta dos.
Right.
And now there's a series of.
92 different ways of doing things related
to each PCN 'cause the, the folks had to
start from scratch right in, PCN land.
And that is nuts in my humble opinion.
And so, and I worked in government
and I understand that the philosophy
is steering and rowing, right?
So government steers with policy and
the folks who deliver and design row,
And I honestly don't buy into that.
I don't buy into it anymore
because it, it costs the system
and the patients too much.
So in the future, and as a result of
the various reviews that are going in
and around in, our health system, I'm
hoping there'll be more, gotta do.
And a little bit more guidance
through policy and through tools,
if nothing else, Don't make us
create something 92 times over
'cause
it's just really hard for the folks who
are, who are having to do that, right?
Let's figure out, there's best practices
in healthcare for a reason, right
There there's a lot of evidence and
there's a lot of research invested and
there's all that kind of good stuff
across, the hundreds of years that,
you know, healthcare has been a thing.
So let's, let's actually have some
more gotta dos that are written in
policy and more tools and more supports
so that it's easier to do a lot of
this setup and a lot of operations.
And, and then let's focus our,
our time and our energy and,
and the additional investment.
On innovation on top of all of that.
And I'm getting old and I have to say
that, innovation on no foundation is
probably the hardest work you ever try
to do or transformation on no foundation.
it's hard work and I'm not gonna say
anything Sarah, so you have to bleep me.
But, you know, I'm feeling it.
that's my hope for the future.
More supports, more firm policy,
more structures that, create the
foundation so that we can get
this optimization sorted in the
delivery space where it makes sense.
And then spend the dollars on
innovation and spend the energy,
on innovation to support and, and
continue to iterate that foundation.
'cause things keep.
Right.
But yeah, so that's, that's kind of where
I am and that's my hope for the future.
And what comes out of all of the,
you know, evaluation and reviews
that are, are currently underway.
Morgan: So maybe Val, what I'll
do is I will build off that and
use this as an opportunity for the
last question around the table.
' ' what is that For each of you?
What is that foundational piece that you
can think of that stands out as something
that we could remind our colleagues
in policy to put in place in the near
future that will help and then allow for
that, focus on innovation in the future.
But what are those foundational
piece that you think is missing
that could be put in place?
Not too far in the future.
Christie: How about attachment
to a clinic, not an MRP?
Morgan: Excellent.
I think I have a meeting on Friday.
Valerie: Indeed we do.
Morgan: That's low
christie-newton_1_02-04-2026_160539:
It's a low hanging fruit.
Valerie: Let's pick.
Let's pluck that Apple.
Yes.
Morgan: Yeah.
Are there other thoughts
around foundational pieces?
I think attachment is an important piece.
Absolutely.
Angela: I think evaluation of
population and actual health
outcomes is absolutely critical.
And we have done, you know, we talked
about the last eight years, I would
like to see data that tells us how
we've changed the health of communities.
We don't have it.
We need it.
So if we're pouring our energy and our
dollars into systems and structures that
we either need to optimize or abandon,
we need to know how they're working.
And we don't know that
Morgan: Yeah.
Carolyn: Yeah, I, I have a
qualitative concern here.
I guess I've lived in rural areas
for most of my life not now,
but up until a few years ago.
And and I really respect the way in
which small, isolated communities.
Identify what has to be done
to achieve an objective.
And the niceties of job descriptions
and budgets and a lot of other
things go by the side in order to
work together and accomplish things.
And so What I would like to see is and
Andrew's a good embodiment of this what
I would like to see is an understanding
of what that adaptive energy sees as
the barriers identifies as the must dos.
I'm working around a lot of rural
practitioners now in research projects
that are designed to enable communities
to design the kind of, team-based care
assisted by technology and whatever
else insight we can we can muster.
And in order to accomplish that,
everybody's giving quite a bit.
You know, they're flexing quite a bit.
and I think we need to, you know, what
we say a lot in in this rural context
is that rural BC will be teaching
the urban areas how to do this.
Because there is this, culture
of creativity and necessity
partly because of isolation.
So, I would like to see the ministry, but
also other kinds of oversight and, and
authority to respect and actually focus on
the recommendations from smaller centers
that have, walked down this pathways.
I think there's some real wisdom there.
and there's some clarity in what the
barriers are, what the necessities are.
So I don't know, Andrew, if you'd like
to respond to that with some practical
experience of your own, but I do feel
strongly that when we measure impact
of team-based care, for example.
There's a tendency to, disregard the
cultural, the qualitative, the, you know,
retention, the, you know, some of the,
the sort of broader, longer term factors
that mean the world to those communities.
Andrew: I feel cheated being put
on the spot like that 'cause I
really wanted to talk about was
one EMR as the solution to, to
Carolyn: I'm for that too.
Andrew: No, I complete, utter agreement.
I mean, what would my friendly amendment,
dear comment, be an observation
that in those communities while.
The structure of the hierarchy
that exists to run healthcare
systems in those places looks kind
of like it does in urban places.
In reality, a lot of
oversight is a long way away.
And so there's a level of agency And
autonomy that's made possible in rural
communities by scale and by just the,
the simple re reality that you end up
with a manager overseas, 10 rural sites.
Well, you know how much.
Attention they're giving to it.
And so the people on the ground are
able just to make things work that's
right for patients and right for
them as team members that work with
each other, shoulder to shoulder.
not what a MR believe it?
or not, but that That was when you
first asked the question, I was
like, oh, co-location Of course.
You know?
You know, so if you're talking
to someone about team-based care.
I would say like, for God's sakes,
do not take away this resource
that you've invested in team.
It's incredibly foundational to like
name one high performing primary
healthcare system that does not have
a very high performing primary care
system that's rooted in team-based
care, in clinic, team-based care.
But, but that's the big failing
is we've made this consequential
investment and an enormous
percentage of it is landing in hubs.
is landing in something that
looks an awful lot to me, like
a home health officer or mental
health and substance use office.
and surprise, surprise, the
patient encounters are really
low in all those places, right?
So, and this is the threat
that Christie was speaking to.
You know, we're now in this kind
of like fear zone that we've
gotta like save what we've got.
And a lot of this, a lot of it
doesn't look very high performing.
And that's 'cause.
They just miss that basic benchmark
of people need to be shoulder to
shoulder, human to human meeting each
other's needs on a regular basis.
And we have that in rural, that,
that's why those sites are so amazing.
Like you go to CUSP and the docs are
still rounding in the hospital like every
morning, and then they meet with the
health authority staff in that space.
at least two, at least two times a week.
And then shoulder rub, you
know, all every single day.
So, I mean, that's what makes it work.
Morgan: Yeah.
And that's definitely a
foundational piece, isn't it?
That the co-location is a
huge piece of that foundation.
Val, you triggered this conversation.
Did you have a, foundational
piece, a specific example?
Valerie: Oh, I'm feeling a sense of blame.
Morgan: No, I, I love this.
This is great.
I love this conversation.
Valerie: oh gosh.
I'm curious about diving into
the compensation models that
we talked a little bit about at
the beginning as foundational, because
I think they are going back to my
HRL, our negotiation days, right?
I mean, you, we behave to a
certain degree and are motivated
based on, some of the stuff that
comes out of compensation models.
It's, we're humans and we like to survive
and we like to eat and feed our families.
Makes total sense.
a review and a revisit of how tricky
our compensation models are and what
they're really motivating in addition to
what they're costing, and then looking
through the lens of team-based care.
Right, because we don't have that at
this point, we don't have a compensation
model that really truly considers
all the aspects of team a scare.
And I think that would be enabling.
I know it's a tall order, but I think
it's transformational and, and is,
you know, ultimately foundational, the
health system is, you know, the most
expensive system for a reason, right?
And they're not all bad reasons, right?
They're, they're reasonable reasons.
But maybe, maybe it's time to, to
actually, think about compensation
from a philosophical and
pragmatic approach, both combined.
Christie: It will make.
Team-based care in the province.
If we don't address it, and you know,
I said I, I went from graduating
to immediately into team-based
care model and they've all been
compensated the compensation models
that were completely different.
Then community-based practices
where you're trying to rig together
different compensation pieces.
And that's one thing that we're going to
evaluate at the new gateway team-based
care teaching clinic is a salaried model.
and how does that work?
And can I add the foundational
piece as well is educating.
So I, I really do think that part
of our role within team-based
care service delivery is actually
providing practice education as well.
'Cause there's such a steep
learning curve right now, and
there's the risk that continues of.
You're trained in a silo, you get
out, or sometimes you're trained
a little bit in a team-based care
environment, but when you get out, you
don't find it or a sustainable model.
And, and you fall back into the
sort of independent or parallel
play, which is often, whoa.
our policy makers are looking
at as team-based care.
They may be co-located multiple
health professions, but they're
still working in parallel.
There's this lack of interdependence
and role clarity under standing
scopes and role overlap.
That just doesn't happen.
And so again, the, the, what
was that optimization those
efficiencies aren't gained.
so I would like to add that, that
we really need to invest in ensuring
that we're educating in these models
of team-based care.
Morgan: This is a broad set of foundations
from equity to community learning
from our, rural colleagues to single
EMR, evaluation, compensation, all
those things, all very important and
probably each of us have experienced
or know people who've experienced
the challenges of each of those gaps.
And I think maybe that is a great
place to wrap up this conversation
Well, Sarah, I thought that pulled
together a lot of interesting threads
for BC and probably for others
working in primary care outside of bc.
Sarah: Yeah, and I think, you know,
a key reflection for me here is that
we're really lucky in BC to have so
many innovative folks in leadership
working together to try to continuously
develop and improve primary care.
And we're just so lucky to
have gotten to work with them.
Right.
I'm really appreciative that when we
reached out to plan for this conversation,
everyone we talk to is keen to participate
and fit this into their busy schedules.
And I really think that says a lot.
Morgan: I agree.
And the diversity around the
table was really great too.
It wasn't just academics talking with us.
It wasn't just community
folks talking with us.
There was a whole range and you know,
there is this really good, passionate.
Set of people at all the different
levels across BC Primary care,
trying to make things better.
We talked to some of them today, but
throughout the whole series we've
talked to people at different levels
from, patients, family doctors,
nurse practitioners, nurses and
allied health providers of all sorts.
And I think if we can support the people
in the front lines and those doing the
planning and create the capacity in the
system, they'll keep doing more good work.
Sarah: And you know, what we know is
that particularly when we have, you know,
these real human resource challenges
and when the system is stretched,
creating capacity and providing support
to allow frontline providers to work
together better, and it's going to
continue to be really important.
anything that facilitates enhancing system
resilience, and I know I keep coming back
to this idea, you know, really supporting
patients with navigation, supporting
teams, supporting providers, and really
thinking of patients as part of that team,
so that everyone's able to work together.
That's just gonna continue
to be so important.
Morgan: Yeah.
And I think that rises
the tide for everybody.
It helps everybody have that capacity.
and maybe that's a good place
to wrap up this episode.
and this is the, the end of a phase
for the Is U'S work with the ministry.
And we're not quite sure what the next
steps are gonna be for the podcast.
We've covered a lot of grand, Sarah
over several seasons, and you know, I'm
actually not even sure exactly where
we would go next for a new season.
So maybe this is a good place to pause.
Sarah: I guess instead of saying, you
know, tune in for our next episode and
leaving people hanging, we really thought
it would be good to close off this chapter
and end with, you know, an encouragement
to, to keep teaming up and keep doing
the great work that we know so many
folks are out there doing on the ground.
So thank you for listening.
Morgan: Thank you everybody.