COLLABORATE ON HEALTH IN BC - Stories of innovation in health care
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Joint Collaborative Committees collaborateonhealthbc.ca
A partnership of Doctors of BC and the BC Government
COLLABORATE
ON HEALTH IN BC
JANUARY 2021
Stories of
innovation in
health care
STORIES OF INNOVATION IN HEALTH CARE 1
Joint Collaborative Committees collaborateonhealthbc.ca
CONTENT WELCOME C
Welcome 3 ollaboration and innovation are at Funding and support from the JSC,
Patient care toolbox expands with 4
the core of what physicians do. A GPSC, and SSC, enables the Rural
virtual care thriving health care system depends Coordination Centre of BC, divisions
on partners – in medicine, government, of family practice, and medical staff
Hospital at Home: Physicians lead 6
the way to bring program to BC
health authorities, communities, health associations, respectively, to take
professions, and many other areas – a grassroots approach to enhance
2,154
COVID-19 and mental health: 8 working together to ensure patients have patient care and improve professional
Advocating for children and youth
access to quality care. satisfaction for doctors in communities
Patients access care closer to home 10 and facilities.
In BC, the Joint Collaborative Committees
Medication risks reduced for seniors 11 (JCC) have been working for nearly 20 Over the past year, it was this strong
doctors engaged in the
Creative approach gets flu shots 12 Health System Redesign years to bring these partners together to foundation of collaboration that
to patients support physician-led work and advocate positioned the JCCs to quickly respond
Community voices heard together 13
on behalf of primary care doctors and to the pandemic and support doctors
specialists. in their time of need. From virtual care
First Nations Virtual Doctor of the Day 14 supports, to introducing temporary
This unique partnership between Doctors fee codes, to supporting physician
Creating easy access to information for 15
palliative care patients and their families
of BC and the BC Government, including health and wellness, the JCCs pivoted
health authorities, allows doctors to follow in response to COVID-19, in addition
Speaking the same language in the ER 16 their passions through research and to continuing the regular work of the
projects, access learning opportunities,
248
Physician workload and patient wait 18 committees.
times reduced with in-practice support and develop leadership skills. The four
JCCs are: The unusual and challenging times we
Collaborating for public health in 19
Northern BC found ourselves in during 2020 sparked
Joint Standing Committee (JSC) on
some unprecedented creativity as well.
Strengthening the circle of care around 20 Rural Issues
doctors attended the This inaugural issue of Collaborate on
patients JCC Pre-Forum Enhances the availability and stability of
Health in BC highlights ways doctors
physician services in rural and remote
Taking care of vulnerable populations 22 used technology to solve problems, how
during COVID-19 areas of BC.
innovation improved patient outcomes,
General Practice Services Committee and why collaboration is at the heart of
(GPSC) the work of the JCCs.
Strengthens full-service family practice
and patient care. We hope you enjoy these stories
describing how your colleagues are
Shared Care Committee (SCC)
making a difference in BC’s health care
Supports family and specialist physician
72
system. You can learn more about the
collaboration for improved coordination
work of the JCCs and how you can get
of care.
involved at www.doctorsofbc.ca.
Specialist Services Committee (SSC)
Engages doctors to collaborate, lead Co-chairs
doctors participated in the quality improvement, and deliver quality Joint Collaborative Committees
BC Physician Integration Program
services.
2 COLLABORATE ON HEALTH IN BC STORIES OF INNOVATION IN HEALTH CARE 3
Joint Collaborative Committees collaborateonhealthbc.ca
PATIENT “We also know patients benefit
from having a doctor who knows
CARE their history, so continuing to
TOOLBOX offer virtual care to my patients
EXPANDS will make it easier for them.”
WITH
VIRTUAL
CARE
N
ew Westminster-based Dr John that extended fees for in-person visits to The practice also continued to see “While it’s not ideal for every situation, “Of course, in-person appointments
Yap remembers the exact date telephone and video appointments. Many some patients in person thanks to ample it’s definitely here to stay,” he said. “It will continue to be vital, particularly for
he and his four colleagues knew who did not have a lot of experience office space and funding for COVID-19 can be very efficient in some cases. We preventative care,” said Dr Yap. “At our
the way they provide care was about to sought much-needed support from the adaptations from the Fraser Northwest also know patients benefit from having practice, we never stopped in-person
change dramatically: Friday, March 13. GPSC’s Doctors Technology Office. Staff Division of Family Practice. The doctors a doctor who knows their history, so care for patients who need physical
provided a suite of online virtual care were able to set up their clinic to safely see continuing to offer virtual care to my examinations. We each spend a day
“We got official word to consider shifting resources that proved invaluable to help non-respiratory patients and those who patients will make it easier for them a week in the office and will see each
to virtual care to help curtail COVID-19,” doctors get up to speed quickly. They
tested negative for COVID-19, including to see doctors from their own patient others’ patients. I look forward to going
said Dr Yap. “The following Monday, also hosted online education and peer-
community patients referred from clinics medical home even when they can’t back to more in-person support but
we showed up to work as usual but support sessions.
as patients started cancelling their that suspended in-person appointments make it to the office.” there’s no question we have a new tool
appointments, we realized we had to “We immediately signed up for secure due to lack of personal protective in our patient care toolbox and that’s a
Patients agree. “It saves a lot of time,” great thing.”
adapt, and quickly.” video-calling accounts but it wasn’t a equipment or safety concerns. All possible
seamless transition,” said Dr Yap. “We said Peggy Tam. “No getting ready, no
or confirmed COVID-19 patients were
Dr Yap is one of thousands of doctors had a lot of tech issues those first weeks. driving, no waiting room. I’m glad we’ve
seen at a dedicated clinic in the area.
around the province who, in response to Also, my practice has a lot of seniors had this option during the pandemic
the pandemic, quickly embraced virtual who aren’t comfortable with technology, At the height of the pandemic, Dr Yap and hope it continues, though there are
care. Doctors were able to pivot with the so the ability to serve patients by phone was seeing approximately 90 per cent of still some things you need to be seen in
timely introduction of new billing codes was important.” his patients virtually. person for.”
Supported by Divisions of Family Practice
and Doctors Technology Office, initiatives of
the General Practice Services Committee.
4 COLLABORATE ON HEALTH IN BC STORIES OF INNOVATION IN HEALTH CARE 5
Joint Collaborative Committees collaborateonhealthbc.ca
HOSPITAL
AT HOME
Physicians Back in Canada, she often thought As agents of change, they had to
lead the way about HaH and in 2019, an opportunity
came up to take action. Her colleague,
challenge some old-standing beliefs. “We
argue that what should define hospital-
to bring program Dr Shauna Tierney, read about a
HaH program for chronic obstructive
level or acute-care is the type of patient
and the type of clinical interventions
to BC pulmonary disease and was inspired. required, rather than adhering to a
definition based on the physical location
“I saw that we could do better for our of the patient.”
patients’ dignity and comfort, and
thought, ’we have a moral imperative to Taking the hospital team and
do this.’” interventions to the patient’s home would
require further support from the Ministry
HaH also had the potential to ease of Health to ensure alignment with the
capacity pressures in hospitals, with BC Hospital Act.
five to 10 per cent of admitted patients
able to meet the clinical criteria for “Even at home, these patients are
management in their homes. admitted and under the responsibility of
V
ictoria hospitalists Dr Elisabeth HaH can provide equivalent or better the hospital.”
Dr Tierney and Dr Crisci quickly joined
“The collaborative
Crisci and Dr Shauna Tierney clinical outcomes, shorter stays, and
forces to develop a HaH program for To their delight, the Ministry was
have been unwavering in higher satisfaction among patients, their interested in doing much more, and in
BC, and needed help to really get their
their pursuit of a new kind of care for
patients. Now, their passion project
caregivers, and health care workers.
effort [with] program off the ground. The JCC, its September 2020, announced that HaH
would be introduced to BC.
frontline
Dr Crisci first saw HaH in action a few programs and partners, stepped up
is about to become a reality with the
years ago while doing fellowship training to help.
BC Government’s launch of Hospital “It has been quite an adventure. It started
at Home (HaH), across the province.
in Australia.
physicians has They included: South Island Medical with two doctors with an idea, and now
been incredible;
They were supported in their journey by “This was not home and community Staff Association and the Health System HaH is one of the priorities for BC’s
the partners of the Joint Collaborative care. It was acute, hospital-level care: IV Redesign program (administered by the health care system,” says Dr Tierney.
Committees (JCCs), who help transform
great ideas developed grassroots level
medications, blood transfusions, oxygen.” something I never Specialist Services Committee), South
Island and Victoria Divisions of Family
“The collaborative effort between the
–in communities and hospitals– into “A hospital is an unsettling environment,
especially for frail and elderly patients,”
thought I’d ever Practice (funded by the General Practice
Ministry, Island Health, and the frontline
doctors has been incredible; something
witness in my
reality. Services Committee); Vancouver Island
she said. “I thought, ‘why can’t we do I never thought I’d ever witness in my
Health Authority, Doctors of BC and the
career,” says Dr Crisci.
career.”
With HaH, acutely ill adult patients who the same in Canada?’ The expertise and Ministry of Health.
are at lower risk and have a predictable therapies that we associate with hospital
Supported by Facility Engagement, “Here we are, side by side, not only
an initiative of the Specialist Services clinical path can get hospital-level care are all portable, and so is the Dr Crisci also benefitted from her
improving patient care but also making
Committee; Divisions of Family Practice, an care from a team of professionals at hospital staff. It is an opportunity to offer enrollment in the UBC Sauder
initiative of the General Practice Services our system more sustainable.”
home, safely and effectively. It has been safer, more patient-centered care for our Leadership Program offered by the
Committee; and the Health System Redesign,
a shared initiative of the Joint Collaborative used for years in Australia and the UK. patients and for less cost. It is the right Specialist Services and Shared Care
Committees. Compared with standard hospitalization, thing to do.” Committees.
6 COLLABORATE ON HEALTH IN BC STORIES OF INNOVATION IN HEALTH CARE 7
Joint Collaborative Committees collaborateonhealthbc.ca
“As physicians we are
just one part of a large
community caring for
COVID-19 T
he implications for the mental and youth mental health across the
health of children and youth, as province, including the BC Pediatric children and youth.
AND
a consequence of the COVID-19 Society, BC School Counsellors
We know that we need to
pandemic, cannot be overestimated. Association, CMHA, FamilySmart,
For those in British Columbia already Foundry, health authorities, and many
MENTAL concerned with the long-term impact
of trauma and adverse childhood
others.
work with all our partners
HEALTH experiences (ACEs), the pandemic
provided an even greater sense of
Discussions centred on challenges
arising from the health care crisis in to ensure that our actions
urgency.
delivering services, actions that would
are coordinated, and that
Advocating for With a comprehensive history of work in
ensure supports are available, and urgent
priorities faced by organizations and how services are reaching those
children and this area, one such group, a Child and to help. Gaps in care were identified.
who need them the most
Youth Mental Health and Substance Use
youth (CYMHSU) Community of Practice (CoP),
“We’ve identified vulnerable populations
such as youth without access to the right now.”
comprised of more than 250 physicians
internet, Indigenous youth, youth with
and partners, was well positioned to
developmental challenges, and youth
mobilize members and ramp up activities
living in situations of neglect and abuse.
to advocate for those at risk.
The CoP advocates for these groups
The CoP’s collaborative efforts to build to receive priority attention and are
relationships between physicians, connecting with organizations that could
government, schools, and community help. We need to address barriers and
partners prior to the pandemic provided blind spots now more than ever.”
a strong foundation to react efficiently to
The CoP has continued to work with
COVID-19.
partners and leaders over the past Leading change to address ACEs in BC
“Because we built relationships in a months to identify areas of concern, raise
relaxed and peaceful time, and broke awareness of mental health risks, and The CYMHSU Community of Increasing awareness and As a result of both initiatives, two
down those silos, we’ve been able educate and inform on preventing and Practice and the work around understanding of the impact of abuse, provincial ACEs Summits have been
addressing ACEs. ACEs are both legacies of the neglect, divorce, domestic violence, and held, drawing more than 1,100
to respond quickly and efficiently to
CYMHSU Collaborative – a large other ACEs on individuals and society attendees in BC to prioritize and build
emerging priorities,” said Dr Matthew
Dr Chow stressed the commitment of the change initiative funded in BC from was integral to the Collaborative’s work. strategies to address ACEs within
Chow, a child and adolescent
CoP to continue working with partners 2013-2017 by the Shared Care The Community of Practice (CoP) every sector of society.
psychiatrist, and one of the founding
during the pandemic and in the future: Committee, a Joint Collaborative continued to build on these efforts by
members of the CoP. Health care priorities focused on
“As physicians we are just one part of Committee of Doctors of BC and creating an ACEs Working Group.
the BC government. embedding ACEs screening and
With children and youth isolated as a a large community caring for children
“With prevention and mitigation of trauma-informed care into practice
result of the pandemic, and families and youth. We know that we need to
During the course of the initiative, ACEs being paramount, our hope is for for maternity care, primary care,
experiencing increased stress, the work with all our partners to ensure that
more than 2,600 people worked to integrated, seamless, trauma-informed, Indigenous communities, and others.
CoP realized the urgent need to assess our actions are coordinated, and that
improve access to timely, integrated and culturally safe care for our citizens
needs for children and youth at risk, and services are reaching those who need
mental health and substance use in BC and beyond,” said Dr Shirley Sze,
determine where they could fall through them the most right now.”
care for children, youth, and families a founder of the Collaborative, and Chair
the cracks.
ACEs resources, including articles in the province. of the ACEs Working Group.
They quickly convened a town hall and webinars, are available at www.
Supported by the Shared Care Committee. meeting of 32 partners involved in child collaborativetoolbox.ca.
8 COLLABORATE ON HEALTH IN BC STORIES OF INNOVATION IN HEALTH CARE 9
Joint Collaborative Committees collaborateonhealthbc.ca
PATIENTS ACCESS CARE MEDICATION RISKS
SPECIALIST SERVICES
COMMITTEE
CLOSER TO HOME REDUCED FOR SENIORS
On Vancouver Island, patients with discusses any issues with the patient’s Polypharmacy has well-known risks— be causing more harm than benefit,
multiple sclerosis (MS) are travelling a neurologist via the telehealth screen, confusion, delirium, falls, and other and how he ranks drugs to develop
lot less for specialized care because of a and provides patients with further negative consequences—that can a medication plan to stop, taper,
new physician-led program. information based on the doctor’s seriously impact a person’s quality of life, or substitute the culprits potentially
remarks. especially those who are elderly or frail. causing adverse reactions and drug
A Victoria-based neurologist and director cascades.
of the Vancouver Island MS Clinic The Nanaimo nurse clinician now A physician in Penticton with extensive
headed the Island Health’s RuralHealth serves as a conduit between patients experience in polypharmacy shares The physician emphasizes the
TeleMS program, funded by the SSC. It and the Victoria clinic’s team of his approach through telling Edna’s importance of collaboration and
uses telehealth technology to connect health professionals including story—a case study of an elderly good communication between
neurologists at the MS clinic in Victoria neurologists, cardiologists, urologists, woman on multiple medications whose the care team, patients, families,
with patients in Nanaimo. physiotherapists, and others. The deteriorating health has meant losing and caregivers around medication
program helped attract a neurologist her independence. The physician likens deprescribing. Frequent, honest
The clinic hired a part-time MS nurse to Nanaimo, and for patients, has his role to a “suspicious detective” as he conversations about goals of care,
clinician to meet in-person with patients reduced the distance to commute by reviews Edna’s medications to determine and the wants and needs of an
in Nanaimo. During a visit, the nurse nearly 156,000 kilometres, reduced if polypharmacy could be responsible for individual for best quality of life, make
performs any necessary tests, faxes driving time by 120,000 minutes, and her decline. He also describes looking the process of deprescribing like
test results to the clinic in Victoria, saved them more than $30,000 in gas. for clues to assess which drugs may “dancing rather than wrestling.”
10 COLLABORATE ON HEALTH IN BC STORIES OF INNOVATION IN HEALTH CARE 11
Joint Collaborative Committees collaborateonhealthbc.ca
CREATIVE APPROACH GETS COMMUNITY VOICES
FLU SHOTS TO PATIENTS HEARD TOGETHER
Joint Standing
Committee on
Rural Issues
Flu season is an annual challenge, and permits to create sidewalk and More than 950 participants signed up to BC is equitable, inclusive, and diverse.
but 2020’s vaccine rollout amid the other outdoor immunization hubs, join virtual discussions with peers and
global COVID-19 pandemic sparked such as the one set up at Bayswater other stakeholders at the BC Rural and They also discussed the power
the creativity and organizational skills Family Practice in Kitsilano. Physicians First Nations Health and Wellness Summit. of building relationships to tackle
of physicians across BC. In Vancouver, worked on the sidewalk adjacent to Held in June, the summit was supported problems together, and the importance
physicians joined forces with partners to four closed-off metered parking spots by the First Nations Health Authority and of having safe places for difficult
meet the immunization demand across to safely immunize patients during a the Rural Coordination Centre of BC, and conversations, translating conversation
the city. Through the Vancouver Division late October weekend. To help meet funded by the JSC. into action, and defining cultural safety.
of Family Practice, member physicians the demand across the city, physicians The summit culminated in
flagged areas such as PPE, clinic space, had the support of more than 100 Across 250 virtual rooms, groups
discussed gaps and advances in rural commitments around the priority
and patient flow; and with partners such UBC medical students. topics, as well as by looking at
as the City of Vancouver and Vancouver and Indigenous health in priority areas
A new vaccine delivery pilot project including virtual care, transportation, team- community governance structures to
Coastal Health, the Division quickly support grassroots solutions, working
identified shared goals. An action plan was also featured as a solution to based care, cultural safety and humility,
obtaining vaccines in a more efficient addictions and overdose, and COVID-19. towards a common understanding
soon followed. around language and shared goals,
way. While still in its proof-of-concept
Working with the city, the Division stage, doctors’ offices across the city Panel conversations discussed the role of and addressing racism to enable
helped physicians organize logistics have signed up for the initiative. academia in ensuring that health care in culturally safe, equitable care.
12 COLLABORATE ON HEALTH IN BC STORIES OF INNOVATION IN HEALTH CARE 13
Joint Collaborative Committees collaborateonhealthbc.ca
FIRST CREATING EASY ACCESS
NATIONS TO INFORMATION
VIRTUAL For palliative care patients and families
DOCTOR OF
THE DAYOF
THE DAY
“Y B
ou can’t replace face-to- Patients appreciate the responsiveness that exists between a provider and eing diagnosed with a life-limiting comprehensive guide to community “One key goal is making patients and
face, the physical space, the and flexibility of the service, from a patient. Perhaps a lack of cultural condition is a challenging and supports and resources in Nelson and families aware of the services available to
interaction, but this really does initial contact with a medical office understanding and appreciation of the emotional time for patients and Trail that physicians can use to support them early on, so they can be prepared,”
help meet a unique need.” assistant, the help with technology, historical context that still exists or has their caregivers. A life-limiting diagnosis patients and their families. says Dr Kerby. “This way, when families
speed of physician call-backs, and help shaped the individual’s experience with means patients will need to access are struggling, they know about the
Dr Kelsey Louie is describing a First “Our community offers resources for
in accessing testing, treatment, and health care. As physicians involved in this many medical, community, and spiritual supports and can access them when
Nations Virtual Doctor of the Day service patients,” says Dr Kerby, “but families
prescriptions. service, we want to ensure a safe space supports to prepare for their palliative they feel the time is right.”
created in March to ensure Indigenous and health care professionals may not
for our patients, where they feel listened care journey, and ensure they are well
people living in BC could readily access Bringing care to patients during the know what is available, so this guide Perhaps most pertinently, the pamphlet
to, and comfortable opening up and cared for and comfortable as their
primary care during the COVID-19 crisis. pandemic is key, but quality of care is helps those supporting patients with a provides information and contact
sharing their feelings.” condition advances. life-limiting illness.”
Dr Louie is a medical officer for the equally or more important. Dr Louie numbers for a wide array of resources
First Nations Health Authority, and an highlights the lack of culturally safe care Issues of access and attachment are Rossland family physician Dr Lilli Kerby available to palliative care patients,
The guide explains that “palliative” not
Indigenous physician providing care as as a significant barrier for Indigenous not limited to rural, remote, and isolated explains, “When patients and families are including BC Palliative Benefits (home
only refers to dying, but to the care
part of the service. people, as significant as the burden of communities. Indigenous people living faced with the prospect of a life-limiting care nurses, palliative medication,
provided over the months or years prior
travel, and limited availability of providers in urban centres are also encouraged to illness, this news can be devastating. Easy and medical supplies) and Federal
The First Nations Virtual Doctor of the to the end of life. Patients and their
and services. connect with the service. access to information allows health care Compassionate Benefits (Employment
families can take comfort in knowing that
Day program enables Indigenous people Insurance benefits paid to people unable
providers to support families in all stages there are many services available to help
in BC without a doctor, or with limited “Unfortunately, some care is not “Statistically about 50 per cent of our to work while providing care or support
of their journey, and for patients and improve patients’ function and quality of
access, to schedule appointments by necessarily being delivered in a safe way, Indigenous community are living away to a family member). Each version of the
families to know that they are not alone.” life throughout this time.
phone or video, seven days a week. In which is adding to issues of attachment. from home, and may be moving around guide also contains a comprehensive
the first three months, more than 400 It’s great that a person has access to and in flux. Consequently it’s more With that in mind, Dr Kerby and a team Patients are also provided with a list of local numbers that patients
patients accessed the service from 32 their family doctor, but if it’s not a healthy difficult to get somebody to agree to take of Kootenay Boundary Division of Family comprehensive list of topics they can call when they need help—from
doctors. All physicians have training or relationship, a patient is not necessarily on care.” Practice doctors created a palliative should discuss with their primary care practical support like personal care
experience in cultural safety and humility, going to want to access that care care information guide. When You Are provider, so that no detail in their care is and medication delivery, to emotional
and 30 per cent are Indigenous. anymore,” he explains. With successful projects such as this Facing a Life-Limiting Diagnosis is a overlooked. support.
one paving the way for virtual care in the
Asked what unsafe care looks like, long term, doctors and patients agree the
Supported by the First Nations Health Dr Louie replies: “Unsafe care benefits can extend past the pandemic,
Authority and the Rural Coordination
Centre of BC, funded by the Joint Standing relates to whether there’s a lack of to address multiple issues relating to
Committee on Rural Issues. acknowledgment of the power dynamic access to quality care. Supported by the Shared Care Committee.
14 COLLABORATE ON HEALTH IN BC STORIES OF INNOVATION IN HEALTH CARE 15
Joint Collaborative Committees collaborateonhealthbc.ca
SPEAKING THE SAME E
mergency room (ER) visits Satisfied patients included a man
are stressful for most people, experiencing deafness with hip pain,
especially those who don’t
“We were able to who ordinarily would have had to explain
LANGUAGE IN THE ER speak the language of the health care
providers. That is the ongoing challenge take an accurate
his symptoms in writing. Instead, within
seconds of being admitted, he was able
history, guide him
at Richmond Hospital’s ER, where to communicate in sign language.
more than half of patients speak mainly
through a focused
Mandarin or Cantonese and interpreters “We were able to take an accurate
are not always available. history, guide him through a focused
COVID-19 infection concerns increase physical exam, physical exam, provide discharge
instructions, and answer his questions,”
this challenge by preventing family
members or friends from escorting
provide discharge said Dr Kwok.
patients into the ER and acting as instructions, IOW affects patient care in three ways:
improved communication, heightened
and answer his
interpreters.
privacy, and patient satisfaction. It
questions.”
For Dr Matthew Kwok, an emergency enables a neutral third party to act as an
physician at the hospital, the drive interpreter, rather than a family member,
to address this challenge is both increasing their privacy. With clear
professional and personal. communication, care can better meet
patient needs, which also means greater
“I came to Canada in fifth grade and provider. Expert medical interpreters – job satisfaction for staff.
remember the struggles of not being able not robots – provide the service. About
to communicate.” This is an especially 200 languages are available, including The device can be more expensive than
important challenge in an emergency 20 Chinese dialects. Patients select the a live interpreter, because it’s priced per-
room where “patients have added language or dialect they’re most familiar minute rather than at a fixed hourly rate,
physical pain and need to be understood with and choose audio or video. Audio is but it’s extremely diverse and always
accurately.” less expensive for the hospital and works available.
like a phone. The video option is better
In searching for a solution, Dr Kwok in certain situations, such as when a “I hope we can keep the technology long
spearheaded a project to determine health care provider needs to show the term,” he concluded. “It’s good, safe
whether a rolling iPad device called interpreter information about a medicine. medical care and it also improves patient
Interpreter on Wheels (IOW) would be satisfaction.”
as effective. His project team included The COVID-19 pandemic provided an
physicians, nurses, the health authority, opportunity to test IOW when patients
provincial language services, and a were unable to bring family members or
Physician Quality Improvement (PQI) friends into the ER. Wiping the iPad after
project manager. use controls infection risk.
Rolled up to the patient, IOW operates Patients now feel that someone in the ER
like a three-way Zoom call between speaks their language, Dr Kwok noted,
patient, interpreter, and health care adding that, “Everyone loved it.”
Supported by the Vancouver Coastal
Health Authority and Physician Quality
Improvement, an initiative of the
Specialist Services Committee.
16 COLLABORATE ON HEALTH IN BC STORIES OF INNOVATION IN HEALTH CARE 17
Joint Collaborative Committees collaborateonhealthbc.ca
“I took a particular interest in harm
reduction because it offered a pragmatic
and dignified care approach to people
most marginalized in our society. It felt
right to me,” he said.
One example of this type of collaboration
is Northern Health’s work with resource
PHYSICIAN WORKLOAD COLLABORATING FOR
development projects such as oil, gas
and mining, to help anticipate and
mitigate health, environmental, and
AND PATIENT WAIT TIMES PUBLIC HEALTH IN community impacts. “We are working
directly with the resource companies and
Reduced with in-practice support NORTHERN BC promoters of these development projects
to better influence their plans. As far as I
know it’s a fairly unique organized effort
to engage with private industry on public
health matters.”
While he enjoys the variety of projects he
D D
r Ruth Demian runs a busy family including completing an electronic template and documents aspects that r Andrew Gray, a medical health is involved in, overdose emergency has
practice with a complex patient medical record (EMR) functionality would be helpful for Dr Demian. During officer in Northern Health chose been the largest part of Dr Gray’s work
panel, including many elderly assessment, organizing a review of team the appointment, the template and his specialty based on a desire to these last few years and his focus when
patients. communication processes and roles,
and identifying measures for planning
EMR clinical decision support trigger
reminders for Dr Demian.
“I took a contribute to the well-being of people in
a variety of ways.
he participated in UBC Sauder Physician
Leadership Program, supported by the
Despite her best efforts to balance her
appointment schedule and workload, she
improvements.
To encourage patients to book their next
particular Upon entering medicine, he found his fit
Specialist Services Committee.
frequently found herself running behind Dr Demian and the team implemented
several changes to clinic workflow
appointment (if needed) before leaving interest in with public health where population-level The goal of his project is eliminating a
harm reduction
and keeping patients waiting. Patients the clinic, the clinic staff implemented statistics and systems thinking aligned barrier to care for people with addictions
were complaining and Dr Demian was related to patient visits. a new follow-up appointment booking with his mathematics background. “I by working to shift hospital policies
leaving the office late each day, spending
at least two hours on paperwork at home
New patients now receive an education
process.
because it offered started looking at policies and social
conditions and it seemed clear it would
from zero tolerance to something more
grounded in patient safety and patient-
a pragmatic
letter explaining that each appointment Dr Demian and her MOA use the
every night. have a bigger impact to change policies centred care. The project is in its early
lasts 10 minutes and covers one to MedAccess appointment schedule for and the circumstances that people were stages, as Dr Gray notes, “systemic
Feeling frustrated and burned-out, and
wanting to serve her patients in a more
two problems. For existing patients,
clinic staff ask the reason for the visit
patient visit bookings, and created a
customized “visit type and preparation”
and dignified living in.” Dr Gray found kindred spirits change takes a long time to happen.”
care approach
in the people working in public health,
timely way, Dr Demian reached out to when booking an appointment. When document for this process. He credits the program with broadening
who were also interested in social
appointments are booked, patient visit
to people most
their regional support coach through the justice and equity. his skills, particularly in listening and
Practice Support Program (PSP). information is clearly documented in the A 10-minute huddle between Dr Demian
influencing change. He learned how to
and her MOA at the end of each day
marginalized in
EMR schedule. Dr Gray’s work with Northern structure a pitch and create compelling
“Having an independent expert—and, enables them to quickly prepare for the Health touches on a wide range
The clinic also created customized visit ways for different audiences to view
our society. It felt
simply, a fresh pair of eyes—was very following workday. of areas including harm reduction;
EMR templates to reflect visit types issues and communicate ideas that
helpful in seeing barriers to the office communicable disease control; resonate. In addition, he learned to
right to me.”
running smoothly,” explains Dr Demian. and support easier documentation and “The system keeps us on track and
completion during the workday. For ensures clinic staff are able to work at environmental health, including air facilitate conversations, to be open to
The PSP coach supported Dr Demian example, the medical office assistant the top of their scope.” quality and drinking water protection; other people’s ideas, and collectively
and the clinic team to work through (MOA)—who now knows the reason for injury and chronic disease prevention; define a problem to find solutions. “It’s
quality improvement activities, each visit— opens a new patient visit and advocacy on climate change not a skill set most physicians get from
mitigation. This often means working their training,” he said of the leadership
with groups outside of the health care program, adding, “it opened my eyes to
system, including local governments, the wealth of ideas all around me and
the education sector, police, NGOs, and gave me a much clearer road map on
Supported by the Practice Support
the private sector. how to make change.”
Program, an initiative of the General Supported by the Specialist Services
Practice Services Committee. Committee.
18 COLLABORATE ON HEALTH IN BC STORIES OF INNOVATION IN HEALTH CARE 19Joint Collaborative Committees collaborateonhealthbc.ca
STRENGTHENING
THE CIRCLE OF CARE
“Hospital and family
AROUND PATIENTS physicians are now
Communication between hospital feeling more like
and community physicians colleagues in the care of
their shared patients.”
I
t’s often difficult to get a snapshot consults, social histories or special With e-notification in place and spreading be faxed and tubed to the wards in the now taking place to develop templates
of a patients entire medical history, care requirements, allergies, and past across the region, physicians turned their old fashioned way. While successful for each EMR and to address the unpaid
even with pieces of information from adverse drug reactions. attention to the next stage of the work – in the moment, the summaries would time physicians spend completing and
Pharmanet, shares Dr Matt Billinghurst, a instituting patient summaries. eventually be buried within the paper- uploading summaries into the new
Victoria-based locum and hospitalist who Before patient summaries could be based charts, with no additional system system.
works at both Royal Jubilee and Victoria introduced, physicians needed a system At the start of the initiative, the patient to flag them.
General hospitals. to alert them when their patients were summaries project saw 40 family The value of connecting physicians to
admitted, discharged, or had died in physicians provide summaries for One hundred more doctors participated share information has resulted in many
“A patient summary helps bridge this gap.” hospital. Developing this e-notification their hospitalized patients via a mix of in the third phase. VIHA arranged for benefits, including a new sense of
system was a challenging but necessary paper and various digital formats. The health authority staff to scan the faxed teamwork.
The Patient Summary Project—a Shared first step. summaries into PowerChart to make
summaries were faxed into individual
Care Committee initiative with the the information part of the electronic “Hospital and family physicians are now
hospital wards or the ED to be manually
Victoria and South Island Divisions of “It required a system change,” recalled medical record. This development was so feeling more like colleagues in the care of
appended to patient charts. While
Family Practice— creates a system to Victoria-based Dr Lisa Veres, who led successful and popular that physicians their shared patients,” says Dr Veres. “It’s
some were used, others were lost or
easily share patient summaries between the work with Dr Laura Phillips. “We went and other health providers across been a big success that’s arisen from this
misplaced.
family physicians and hospitalists to through many people and many layers Vancouver Island began sending in their project.”
inform care when a patient is admitted of medical administration. It became Enough value was realized through summaries— overwhelming the health
to hospital. The summary includes apparent that e-notification wasn’t this phase that 100 more physicians authority staff who were scanning and
information that could be relevant to going to happen unless we formed a participated in the second phase. uploading the documents.
care but is not typically listed on a committee, created a formal project,
patient’s electronic hospital record, received major funding, and had the In phase two, the Vancouver Island In response, VIHA created a web portal
for example: details about past heart power to work with the health authority at Health Authority (VIHA) established a where physicians could upload and
Supported by Divisions of Family Practice attacks or cancer diagnoses, specialist a different level.” central number where summaries could export their own summaries. Work is
and funded by the Shared Care Committee.
20 COLLABORATE ON HEALTH IN BC STORIES OF INNOVATION IN HEALTH CARE 21Joint Collaborative Committees collaborateonhealthbc.ca
“Having access to pandemic
prescribing, including safe supply
guidance, is an integral part of their
TAKING CARE OF VULNERABLE overall care. Ongoing recognition
POPULATIONS DURING of the dual public health crisis is
essential as we plan for our future.”
COVID-19
P
rimary care networks (PCN) have primary care at the shelter and warming access safe supply medication for
enabled the Burnaby Division centres gave people access to COVID opioid use disorder. This was critical as
of Family Practice to implement related care and education. The services contamination in street drug supplies
programs and supports that address the also reduced travel to receive care, increased, placing this population at even
health care needs of both the homeless thus lowering the risk of contracting or greater risk of overdose. The Burnaby
and underhoused population and those spreading COVID during transit. PCN brought in allied team members
who suffer from opioid use disorder. In including social work and counselling
Dr Narang originally offered his services
March of this year, the Burnaby PCNs services for patients who needed
to the PCN in hopes of providing better
acted quickly to respond to the ongoing additional support.
care to homeless and underhoused
COVID-19 crisis, as people in both
people in the community. “I know I make a difference when I offer
groups targeted by these programs and
supports are particularly vulnerable to safe supply to people who just need a
“It has been my privilege to visit the
COVID-19. little help to get back on track.“ added
under-served population in Burnaby
O’Neill.
at warming centres,” says Narang.
PCNs in Burnaby were able to address
“Having access to pandemic prescribing, The need for primary care services in this
the needs of both of these vulnerable
including safe supply guidance, is area continues to increase. The PCN is
groups by utilizing the skills and expertise
an integral part of their overall care. responding by focusing an additional NP
of Dr Birinder Narang, a family physician,
Ongoing recognition of the dual public to continue to work with their community
and Pippin O’Neill, a nurse practitioner
health crisis is essential as we plan for partners and the city to ensure those
(NP). Both Dr Narang and O’Neill were
our future.“ most vulnerable have access to the care
deployed at various facilities throughout
the community such as the Progressive that they need.
Narang and O’Neill not only provided
Housing Emergency shelter or the City patients with immediate primary care,
of Burnaby warming centres. Prior to but could also assess for their pandemic
COVID, there were no regular primary prescribing needs. Through multiple
care services available, and offering clinic outreach locations, patients could
Supported by Divisions of Family Practice,
an initiative of the General Practice
Services Committee.
22 COLLABORATE ON HEALTH IN BC STORIES OF INNOVATION IN HEALTH CARE 23Joint Collaborative Committees
115-1665 W Broadway, Vancouver, BC V6J 5A4
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