Using ‘New Power’ to Spark Change

October 30, 2019

By Dr. Jennifer Young, President, Ontario College of Family Physicians

Originally posted on OCFP's website

primary care virtual community word cloud sep 21 2019

This word cloud summarizes the day that over 40 Ontario leaders of primary care spent together on September 21!  We had the honour to share it with Dr. Robert Varnam, a family physician from the UK who has spearheaded some pretty big transformations within family practices and primary care over the last three years.  

With significant support and funding from the National Health Service (NHS), Dr. Varnam has put together a list of 10 high impact actions that free up time of family physicians. The time freed up increases their capacity to serve their patients, to increase their work satisfaction and engage in leadership.

Facilitated by The Change Foundation, our group consisted of representatives from the OCFP, the Section on General and Family Practice, the Association of Family Health Teams of Ontario, the Nurse Practitioners Association of Ontario and primary care clinicians involved in successful innovations in their regions. From the Ministry of Health, Phil Graham (Executive Lead of the Ontario Health Teams) and Nadia Surani (Director of the Primary Health Care Branch) attended for a good portion of the day.

It was great to see everyone come together to constructively talk about the change from an eco-centric, rather than ego-centric, way. In our own practices, we need to think about how we can each connect to our own ecosystems of health in our communities.

Learnings from the UK – “New Power” is Enabling Change

My key takeaway from the successes of the UK work is that there was investment in the support and spread of innovations that were already happening in practices around the country. There were hours of ‘boots on the ground’ engagement BY family physicians WITH family physicians, with thousands of meetings and connections between clinicians. This “New Power” enables changes to be made by the people most affected by them, informed by their own realities. The process was building on strength, enabling existing resources, gathering great ideas and putting them in a format that is practical and accessible for family physicians.  

What’s Next – Putting this New Power into Action

We followed this day with yet another installment of our Primary Care Virtual Community on September 25 where more than 100 people connected online, convened by The Change Foundation. We were demonstrating New Power in action!

old power vs new power

 

The goal of these two events was to come up with our own "High Impact Actions" for Ontario. These actions can be seen to be things that we can do on our own (as are most of the UK 10 High Impact Actions) and changes that require more of a system-level intervention.

Outlined in this chart is what we've come up with - we also welcome your thoughts through this brief survey on where we should prioritize the focus:

Ways to free up your time for care

How the system can better support you to care

  • Integrate EMRs - Either single or intra-operable EMR / EHR systems that can both push and pull required information. We know that lots needs to be done outside of our scope, but are you using your EMR to its best ability, have you looked to peer-to-peer support from OntarioMD?
  • Build the Team within your practice by ensuring all are working to top of their scope. Is your reception enabled to triage, is nursing enabled to manage some patient needs? Is there someone designated in your practice to help with system navigation for patients with more complex needs?
  • Patients as Partners – Involving patients more in the way your practice is run, patient portals, education (within your practice and community based) that foster patient self-care or health literacy. Patients are looking for access to their information to allow more shared decision making and accountability.
  • Building connections to address the social determinants of health and incorporating Social Prescribing – An easy first step is to ask the Poverty screen “Do you have troubles making ends meet at the end of the month” and, as needed, connect your patients to 211.ca or your regional Thehealthline.ca.
  • Alternative Consultation – Such as telephone consultation, virtual care via OTN, eConsult, secure email consultations. Are you connected to OTN?  If not, get your ONE ID and check out how great this service can be – from enabling virtual visits to people with transportation challenges to connecting with hundreds of specialists. 
  • Spread Innovation – Our organizations are working on sharing information about what others are doing. RISE (Rapid-Improvement Support and Exchange) is a go-to location for emerging Ontario Health Teams, providing resources for those interested in integration efforts through OHTs.
  • Practice Facilitation and Change Management – Get your MyPractice Report sent to you, take advantage of Peer-to-Peer facilitation that already exists through OntarioMD.
  • Enhance Personal productivity – What about taking a typing course, or a speed reading course?
  • Organize Primary Care – Be part of your ecosystem! Connecting with your community of family physicians is important. Are your local health care organizations (e.g., hospital, FHTs in the area, CHCs) pitching in to support meetings of family physicians? Besides advocating for support for leaders, we also know that there needs to be administrative support for networks of family physicians to meet.  

 

  • Recognize and Support Primary Continuity (the core team) – This core relationship needs to be recognized in any health transformation as continuity of care allows for best outcomes. Changes that erode this are counter-productive. Access to YOU is important!
  • No patient or practice left behind– Timely access to health care/social care supports such as mental health counselling, social work for all family physicians. This is a message that we have been consistently bringing to the Ministry because it is not acceptable that team-based care is not equitably available.   
  • Clinical Leadership – Ensure that family physicians are at the tables that are talking about health system transformation. Have you joined the meetings in your community about a proposed Ontario Health Team? Do you know who to connect to? We continually reinforce with the government that there be protected time for family physician leadership that is not done off the side of the desk.
  • Navigate and Coordinate – Promote a patient navigator role for those more complex patients within your practices now, and on a system level, we need to recognize the importance of this role in any team-based care.  
  • Streamline and Reduce Admin – Streamline the referral process to tests, specialists, services that need to be available equitably. Central referral processes have been high on the list of priorities within OHTs.   

 

Let’s Connect

Sound overwhelming? Like any change, it is best to start with one small step, something that IS within your control. Be assured that the OCFP is tirelessly speaking up for what makes sense for a practicing family physician and their patients. We want to connect with you, we would love you to connect with us. Visit our website to hear more about our activities and/or join us for the next Primary Care Virtual Community – stay tuned to Twitter/email for updates about the next date. If you are thinking about joining an OHT, check out the OMA map of OHTs, as well as OHT-related resources through our growing online repository and the McMaster Forum’s RISE platform.

Simply put, we can all look inward to see how we alone can improve. And by looking beyond and building the New Power in our own ecosystem – and sharing those learnings with others – can make changes that sustain and grow. Your input to this change matters.

“Hopefully”  yours,
Jennifer

Dr. Jennifer Young
OCFP President