Divisions of Family Practice Provincial Round Table Report June 12, 2013 â€“ June 14, 2013
Over 90 physicians and close to 40 coordinators and executive directors (CoEDs), encompassing 127 communities, participated in the Divisions of Family Practice Provincial Round Table. By the final day, 200 people were in attendance, representing all 32 local divisions and the health authorities. The BC Medical Association (BCMA), the Ministry of Health, the General Practice Services Committee (GPSC), the Physician Data Collaborative (PDC) and the Physician Information Technology Office (PITO) also sent representatives. Feedback from the Round Table indicates that participants felt the forum was informative and useful.
DAY 1 - WEDNESDAY, JUNE 12TH Opening Remarks / Provincial Team Update Day one was based on an agenda built by the CoEDs, and focused on assessment planning and effective evaluation of engagement. Brian Evoy, Executive Lead, Divisions of Family Practice, shared the following: • The provincial team has been working with rural physicians as they create a new division, called the Rural and Remote Division of Family Practice, to address concerns particular to rural and remote communities. • Vantage Point, in partnership with the provincial team, is developing learning plans and content for both physicians who serve on boards and for CoEds. • A number of updates to the website have occurred, including fixing compatibility issues with Internet Explorer 10, redesigning the back-end of the site and creating a linked login feature. • A Community Practice Profile Survey has been developed in consultation with physicians and divisions, with expertise from Ipsos Reid. Two divisions are in the process of sending out the survey (Victoria, Surrey-North Delta). The survey enables local divisions to learn more about family practices in their communities, and provides an opportunity to look at the resulting data from local, regional and provincial perspectives. Workshop 1 – Assessment Planning: A GP for Me Readiness CoEDs had an opportunity to meet and share both the challenges and successes their divisions have experienced in preparation for participating in A GP for Me. CoEDs from the three former prototypes shared their experiences. A set of guiding questions were provided and key responses were collected at the end of the session. Workshop 2 – Four Approaches to Evaluation This session provided CoEDs with four different approaches to evaluation. Representatives from Cowichan Valley, Kootenay Boundary, Surrey-North Delta and South Okanagan Similkameen shared their experiences with evaluation including: the importance of planning for evaluation at the beginning of a project, methodologies and indicators used, pitfalls, successes, and lessons learned. Workshop 3 – Effective Engagement
“I just loved the conference. I am feeling really energized after re-connecting with all the GPs and getting more information as to where the overall program is at.” – Attendee
The workshop began with a condensed refresher of the International Association for Public Participation (IAP2) Model for Engagement used within the health sector throughout the province. Following this, there was an open floor discussion about some of the successful experiences at each level of engagement. Participants then identified why these examples “worked”. Lastly, participants were encouraged to brainstorm and bring forward their own experiences for consideration.
DAY 2 - THURSDAY, JUNE 13TH Opening Remarks Brian Evoy advised attendees that the day was focused on workshops to assist divisions with elements of culture and planning. The themes were based on merging feedback from the November 2012 Round Table, expression of interest responses of March, 2013, A GP for Me activities and Physician Engagement Leader (PEL) contributions. The primary theme identified was “strengthening organizational development”. Sub-themes included culture (planning and assessment), partnership (participation at the Collaborative Services Committee, the Inter-Divisional Strategic Council, Shared Care activities, etc.) and board of director development (structures and processes). The goals for the day were: • building board of director identity and knowing who you are; • building robust engagement with partners with clear intentions; and • getting the results you want from engagements. UpToDate Presentation The presenters explained the features of UpToDate, how to earn College of Family Physicians of Canada Mainpro 1 credits with each clinical search, how to register for mobile access and gain mobile access through IOS, Android and Windows 8 tablet apps in three easy steps. This clinical tool is available to all funded division members at no cost. If any divisions are interested in additional presentations about UpToDate, and the process of registering and gaining mobile access, please contact Nicole.firstname.lastname@example.org. Click here to view the UpToDate PowerPoint presentation. Recruitment Workshop Members of the Recruitment and Retention Steering Committee presented the committee’s work to date on recruitment and retention issues in the province, with an overview of the current and proposed future projects. They engaged participants and asked them to provide input on the development of the Physician Journey Map and insight on the Steering Committee’s proposed Terms of Reference going forward. Click here to view the Recruitment Workshop handout. SESSION ONE: CULTURE & PLANNING Workshop A: Building Board Culture Participants discussed the concept that culture is a combination of values and practice. Many commented that while their division has developed strategic plans, mission, vision and values statements, there was room to improve how these ideas are implemented. As well as discussing values together as a board, participants suggested that there are a number of implied values that people automatically take on when they sign up for the initiative.
DAY 2 CONT... Workshop B: Building an Early Culture of Measurement: Linking A GP for Me Projects with the Triple Aim Attendees participated in a fast-paced introduction to the Institute for Healthcare Improvementâ€™s (IHI) Triple Aim approach, as it relates to building a culture of measurement within their local division. The session shared the structured steps used by IHI in beginning to develop a measurement framework and how that might apply to projects within the A GP for Me initiative. High level quality improvement frameworks, tools, data sources and sample materials were offered to activate early quality improvement thinking as communities engage in Attachment. Click here to view the PowerPoint presentation. Workshop C: Building Board Identity: Culture Inside to Outside Developed in partnership by the provincial divisions team and Vantage Point, this sessionâ€™s objective was to highlight how developing strong board and organizational identity or culture drives successful partnerships with external stakeholders. Through a presentation and small group discussions, participants developed a deeper understanding of why and how their division delivers its mission. This fostered a stronger organizational identity to both inspire their own leadership and support organizational success in external communications in and across partnerships. Click here to view the PowerPoint presentation. Workshop D: Strengthening Your Organization through Effective Member Engagement The workshop focused on the importance of good engagement, especially for member-led organizations, and how it assists members to understand the situation and buy into the solution. It began with a refresher on the IAP2 Model for Engagement which is to inform, consult, involve, collaborate and empower. In practice, effective engagement usually involves communicating, consulting and collaborating. Communication is used when there is a need to inform or educate, such as when factual information is needed to describe a policy and/or the decision has been made and people need to be informed. Communications tools include the use of social marketing, websites, fact sheet mailouts and open houses. Consultation is used when there is a need to gather information/views. It is an opportunity to listen and understand the issue, help shape policy, provide two-way information exchanges, and influence the final outcome. Collaboration is used when we need to talk to each other regarding complex valueladen issues, there is capacity for citizens to shape policy and program decisions and/or there is an opportunity for shared agenda setting and open time frames for deliberation. Techniques include round tables, charrettes, constituent assembly and the Delphi process. Participants of the workshop also shared their experiences and challenges and explored ways to address them. A GP for Me Interactive Plenary The presenters provided an overview of A GP for Me, based on the experiences of the three former prototype divisions. Following the presentation, divisions were invited to participate in an interactive session using guided questions provided by the facilitator. Finally, key points from each group were solicited. Click here to view the PowerPoint presentation.
DAY 2 CONT... Table Talk Presentations: Division Related and Project-based Table talk groups remained seated as presenters rotated. Each presenter had six minutes to describe their initiative and four minutes to answer questions. DIVISION South Island Powell River Vancouver North Shore Nanaimo
Provincial Office Richmond
Victoria HealthMatch BC Siena Consulting Provincial Office UpToDate Physicians Data Collaborative Vantage Point
TOPIC Creating a New Model for Maternity Clinics Better Clarity: A Focus on Framing Fast Facts â€“ Engaging Members and Partners Health Connection: a North Shore High-Needs Clinic An Online Community Resources Database for GPs and MOAs â€“ www.fetchbc.ca Improving Primary Care Home Performance through Assessment, The Coach Approach and the Model of Improvement Learning Resources Tool The British Columbia Pragmatic Trails Collaborative: Quality Improvement Initiatives on a Provincial Scale Speed Dating for practice Coverage Recruitment Ethics Recruitment and Retention Tools and Resources Community Practice Profile Survey: An Introduction to the Tool UpToDate Overview
Guy Chartier Halla Elmobayad
Dr. Dean Brown
Dr. Daniel Bothma Leslie Keenan
Dr. Garry Knoll Dr. Bill Clifford Ryan Kineshanko Olive Godwin Robin Hussen Dr. Scott Garrison
email@example.com firstname.lastname@example.org email@example.com firstname.lastname@example.org email@example.com firstname.lastname@example.org
Dr. Steve Goodchild Alisa Harrison Lawrence Santiago Gayle Farrell
email@example.com firstname.lastname@example.org email@example.com firstname.lastname@example.org
email@example.com Nicole Butner firstname.lastname@example.org Brad Anderson A Visual Representation of Physicians Catherine McGuiness email@example.com Data Collaborative (PDC) Operations firstname.lastname@example.org New Relationship with Divisions of Maria Turnbull Family Practice
Network Within Your Region This was an opportunity for all divisions within the same geographic health region to network with one another.
DAY 3 - FRIDAY, JUNE 14TH Opening Remarks Brian Evoy indicated that the workshop agenda had been designed to strengthen inter-organizational collaboration with appropriate “partner-themed” Table Talks, and to provide a lunchtime networking opportunity in Regional Rooms. He introduced the provincial team and each local division. He also advised attendees of his departure from the provincial team, and his appreciation for the work and dedication of the people in the room. BCMA President’s Remarks Dr. William Cunningham talked about the importance of Divisions in addressing issues of primary care. He spoke about how Divisions improved the morale of physicians and increased their engagement – both with each other and with their communities. He provided examples of how local divisions have addressed long-standing issues in their communities, including where Dr. Cunningham practices. He indicated that he fully supports the spirit of collaboration and partnership, which provides a strong foundation for the work everyone is doing. In acknowledging the changes in leadership, he thanked Dr. Bill Cavers for his work with the GPSC in his position as co-chair, and congratulated him on becoming President-elect of the BCMA. He spoke of the work of Dr. Shelley Ross and acknowledged her new role as co-chair of the GPSC. In addition, he thanked Brian Evoy for helping to make Divisions what it is today. Divisions Evaluation A Divisions staff member introduced the Divisions of Family Practice and A GP for Me Evaluation Framework and Working Group. He described how the Divisions and A GP for Me evaluation frameworks were merged. The toplevel guiding questions were presented, as well as the methodology. He indicated who would be involved during each phase of the evaluation. Click here to view the PowerPoint presentation. Physician Data Collaborative (PDC) The PDC presented a brief overview of the group’s activities since the last Provincial Round Table, including a timeline of significant events, the current state and planned projects. Ongoing projects focused on present Electronic Medical Record (EMR) reporting capabilities, such as the maternal anemia project in Cowichan Valley, chronic obstructive pulmonary disease action planning in South Delta and specialist wait times in Fraser Northwest. More detailed information was presented about examining population health data through EMRs, and the challenges that physicians face to accurately record this data in their own EMRs.
“It provided me an opportunity to see the ‘bigger picture’ of what’s happening within and between the divisions.” – Attendee
DAY 3 CONT... SESSION TWO: ORGANIZATIONAL STRUCTURE/HEALTH/STRENGTH Workshop A: Board Assessment The workshop attendees were compromised of approximately 60 per cent board members and 40 per cent executive directors. This indicated a strong interest from both perspectives to have a robust board assessment in place. The session opened by focusing on the role a board assessment plays in a healthy organization and how it can help ensure a high-functioning team. Further discussion examined how this assessment plays a role in achieving high results within the organization, and supporting the intended culture of the organization. The group was given three examples, with discussion about why boards would need to customize the assessment to reflect their own organization’s needs. Click here to view the Board Assessment handout. Workshop B: Strengthening Financial Stewardship This workshop was structured to provide board members with a deeper understanding of their role as stewards of their division’s financial systems and accountability. Through a presentation and large group discussion, the session clarified the financial stewardship roles of the treasurer, finance committee and paid staff. Participants shared successes and challenges with their peers to provide a relevant context for reviewing and better understanding financial statements and accounting approaches. Click here to view the participant workbook. Workshop C: The Smell of New Blood – Succession Planning as a Way of Life This session focused on the needs of the participants for succession planning within their divisions, first identifying the varying issues that each participant brought forth, then defining the barriers to effective board succession from both an internal (board) and external (potential board candidate) perspective. Time was spent considering obstacles to participation, and strategies were considered to overcome these obstacles – some of which were perceived rather than real obstacles. There was a focus on the need for ongoing efforts to communicate about board work rather than recruitment. Communicating regularly and consistently was viewed as helpful, and should include communication between board members and staff. Workshop D: Performance Management This session was grounded in the perspective that healthy organizations engage in excellent performance management processes. Through a presentation, participants learned about the importance and key components of strong performance management, including ongoing communication, SMART goals (specific, measurable, attainable, realistic and timely), conducting assessments and reviews and understanding how performance management is connected to the strategic plan. With intentional use of experiential exercises, participants actively engaged with the content, and walked away with greater confidence and the ability to succeed in ongoing communication with their team members. Click here to view the PowerPoint presentation.
DAY 3 CONT... Workshop E: Getting the Media to Deliver Your Messages Participants in this interactive session explored strategies for how to get journalists to cover their division’s stories and how to make the most of interview opportunities to publicize messages and achieve objectives. This included a discussion of what makes news and how attendee’s own story ideas might fit into a reporter’s agenda. Through entertaining video clips, participants witnessed how interviews for even seemingly savvy spokespeople can go sideways when they are unprepared. They also had the opportunity to dissect White Rock-South Surrey’s successful media campaign during the launch of A GP for Me. Through role play, attendees explored the basics of key messaging and how to deliver an interview that publicizes their messages. All participants walked away with a sense of how the provincial communications team is available to help with their media relations, as requested. Workshop F: Open Tables Open Table on Change Dr. Bruce Hobson led a group discussion to facilitate the development of questions for the BCMA, Ministry of Health and GPSC to answer. The focus of the discussion was on the recent changes at the GPSC and Divisions executive level, the uncertainty of what these changes may mean to the collaborative process, and how local divisions could affect change and participate in decisions with the GPSC. The discussion culminated in the development of the following core questions: 1. How can we truly work together in a collaborative relationship? 2. How will division family physician leads be involved in PITO/Practice Support Program (PSP) redesign to ensure collaborative planning? (e.g. a Divisions advisory group) 3. Establish process for formal values and commitments going forward. Clarify how this will happen? 4. How can we/divisions participate more in the succession process? (e.g. video polling, Divisions advisory group)
“The last couple of days were fun - lots of little gems to inspire the next moves for us.” – Attendee
DAY 3 CONT... Open Table on the Mental Health Care System Dr. Ralph Jones hosted an open table to discuss how family physicians might better interface with the mental health care system in British Columbia. Several challenges were discussed, and it was agreed that future provincial round tables could consider organizing a session to include FPs, mental health leaders, clinicians and patient advocates. The session could be jointly designed by the participants. 1. All agreed that the communication and integration problems discussed were endemic across the province. 2. There are beacons of hope in projects such as the King Street clinic in Kamloops and Fraser Northwest’s Integrated Family Practice and Mental Health Advisory Committee. 3. Communication is especially deficient in transitions of care, for example from the hospital to the FP’s office, or from a mental health clinic to the FP’s office and vice versa. 4. The solutions may look different in various areas of the province, for example urban suburban and rural areas may need to develop their own appropriate communication and integration approaches. 5. Shared Care was mentioned as a possible solution in some areas; however, it was pointed out that Shared Care has been expensive to apply universally. Furthermore its current distribution may be unequal within the same geographical area, and some participants suggested there was favoritism towards clinics with the space and connections to mental health. 6. Progress will require a sustainable and resourced approach to system redesign in the primary care mentalhealth interface. Partnership Conversation This open forum provided participants with an opportunity to submit questions to a panel comprised of representatives from the BCMA, Ministry of Health and GPSC. Attendees had the opportunity to ask questions of: Allan Seckel, CEO of the BCMA, Dr. William Cunningham, President of the BCMA, Dr. Shelley Ross, co-chair of GPSC, Jonathan Agnew, Executive Director of Practice Support and Quality, GPSC, Dr. William Cavers, former co-chair of GPSC and Kelly McQuillen, co-chair of GPSC and Executive Director of the Primary Health Care and Specialist Services Branch, Ministry of Health. The panel voiced their intent to continue with the collaborative approach. It was agreed that questions that were not able to be addressed before the end of the session would be responded to at a later date. The BCMA, Ministry of Health and GPSC are working to answer the 42 questions (see Appendix A), many of which require a joint response. In general, the questions focused on the following themes: • Commitment to collaboration • PITO • Billing “It is empowering and inspiring to • Physician recruitment know what greater vision you’re a • CSC part of and to hear of colleagues’ • Process for executive lead selection challenges and how they • Planning and future direction overcame them. • GPSC relationship to FPs/Divisions Lunch and Network Within Your Regional Room
So thank you!” – Attendee
This was an opportunity for partners to lunch and network within their region. Each region decided what to discuss.
DAY 3 CONT... Table Talk Presentations: Partnerships Table talk groups remained seated as presenters rotated. Each presenter had six minutes to describe their initiative and four minutes to answer questions. DIVISION Ministry of Health Shared Care Committee Ridge Meadows Vantage Point Integrated Practice Support Initiative
Chilliwack Thompson Region Central Okanagan Fraser Northwest Kootenay Boundary Healthmatch BC
North Shore Nanaimo Burnaby First Nations Health Authority Siena Consulting
Vancouver Coastal Health Authority
TOPIC Patients as Partners: Mental Health Engagement Framework Building Relationships & Improving Quality The Value of Community Stakeholder Partnerships Fostering a Culture of Collaboration Integrated Practice Support Initiative – PITO, PSP and Divisions of Family Practice engaging in collaborative activity to achieve common goals Innovation Project – Chilliwack Healthy Kids Initiative Patient Journey Mapping related to Child and Youth Mental Health Partnerships Advanced Care Planning: Developing a 50 Year Vision for our Community Pain Management Conference Elements of Successful Relationships between HealthMactch BC and Divisions Coastal Family Practice Residency: A Collaborative Success Regional Division Efforts Aimed at Recruiting Family Medicine Residents Elements of a Successful Nurse Practitioner Proposal Let’s Begin the Partnership
Aman Hundal Bethina Abrahams Treena Innes
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Maria Turnbull Sarah Whiteley Liza Kallstrom Jeremy Smith Nick Baldwin Ken Becotte Donna Dixson Dr. Shirley Sze
firstname.lastname@example.org email@example.com firstname.lastname@example.org email@example.com firstname.lastname@example.org email@example.com firstname.lastname@example.org email@example.com
Tristan Smith Dr. Joelle Bradley
Andrew Earnshaw John Mabbott
Dr. Dean Brown
Anneke Rees Rehana Nanjijuma Sarah Williams
firstname.lastname@example.org email@example.com firstname.lastname@example.org
Community Engagement Through Bohdan Zajcew Technology: A Physician Recruitment & Retention Case Study The My Health My Community Survey Jat Sandhu
APPENDIX A Questions submitted by Round Table participants for response by the BCMA/Ministry of Health/GPSC: • •
How can we TRULY work together in a collaborative relationship? How will division family physician leads be involved in PITO/PSP redesign to ensure collaborative planning? (eg. Divisions advisory group) • Establish process for formal values and commitments going forward. Clarify how this will happen? • How can we/divisions participate more in the succession process? (eg. video polling, Divisions advisory group) • Is our funding secure at the provincial level, given the new Liberal austerity based mandate? • Are the GPSC initiatives being evaluated? Could that information be shared? • Why are family doctors limited in the number of codes that can be billed at one visit (fee for visit vs. fee for service)? It appears to be different for specialists? • Could there be a plan to improve dysfunctional division/health authority relationships? • What are the values and principles of collaboration used by both parties in the PMA negotiations? • What do we do with an issue marked as high priority by our members that we have done as much as we can do at our local divisions level? (eg. Chronic Pain Clinic) • How do you deal with the clash of collaboration between people and projects vs. butting up against the system (eg. collaborating at one level, administration in organizations)? Who makes the ultimate decisions? • How will the culture not change, as the leaders set the culture? • How do you maintain the values of collaboration as the people change? • What will the GPSC do to mitigate the risk of backlash (from SSC, BCMA, etc.) as family physicians (FPs) gain power through Divisions? • What concrete steps will the BCMA take to ensure that FPs’ interests are represented in key decision making and policy development? Theoretical support is great – how will this look in reality? • How can the divisions provide meaningful input into Brian Evoy’s replacement? • How can we develop a formal relationship between the GPSC and the SSC? • Can we use innovative approaches/technologies to “weigh in” on the selection process for Brian Evoy’s replacement? (eg. social media) • What do you think will happen now? What do you think things will look like in five years? • What is your process in moving forward and collaborating with divisions? • How do they/we intend to move collaboration into action? What is the process? • Are there any structural changes that need to happen? What is the process for review of these structures towards integration? How do we help/engage in this change? • How do we/they build on our real successes with collaboration and integration in action? • How will you ensure that collaboration is a core competency in leadership? • We were asked by Kelly McQuillen to support the new vision and mandate. Whose are those: Ministry or GPSC? What are they? • Referenced by Shelly Ross to a new work plan developed by GPSC/BCMA. What is it? Will we be able to view it/give input? • What is the hiring process for Divisions executive lead? Will divisions have representation in that? • How will GPSC assess and gather input from the divisions if there is a need for change any of the financial incentives because of fiscal restraints or evidence of a particular incentive failing to meet the desired patient outcomes? • How do divisions ensure that the input is truly representative of their members’ opinions? • What will Divisions, GPSC, BCMA, and the Ministry look like in five to 10 years? • Speak to the suspicion of “ulterior motives” for Divisions? (eg. doing admin work for lower pay – some hidden agenda, detailed to solve Ministry/health authority issues) • How do we build capacity in divisions to meet work we need to do? The community to do this?
APPENDIX A CONT... • • • • • • • • • • • • •
Can the GPSC develop a new billing model that will allow for adequate compensation for physicians to support nurse practitioner’s (NP’s) (physician extenders) caring for patients in our office? How do we de “silo” the incentive monies so we can promote primary care integration to deliver comprehensive services with equitable distribution of monies? Is there an agreement on the values and principles of collaboration between both parties engaging/or a guiding principle in the PMA negotiations? What is going to happen with ongoing EMR funding? Will there be an upper level voice to oversee and manage our EMR vendors in the future to ensure there is continued response to physician needs? (eg. inter-operation ability) What are the risks to be aware of and how do we mitigate to keep work going (attendees at this conference are converted/bought in but it’s the people outside this room)? How do you foresee the future of primary care and Divisions with the changes in leadership level? Are you going to be able to help drive a change to break down the barriers to GP recruitment at all levels? How can the health authority get the right people at the CSC tables (from the FP/Divisions perspective)? How do we create a meaningful interface at the CSC table (eg. should there be a joint strategic planning process)? What responses by the health authority have helped? Would like to see an organizational chart with names of the Practice Support and Quality Department. Would like to see orientation materials, including a list of GPSC members and attendees with affiliations. As you grapple with good stewardship of limited health care dollars – how will you get “emphasis” across the province of FPs on what needs to continue, decrease, or cease to exist? How measurable are the outcomes of incentives and programs the GPSC has created?