Planting, growing, and nurturing networks of care

Dr Trina Larsen Soles

As we begin a new year it is an opportune time for us to focus on new approaches to working together and on the options for improving delivery of medical care in BC. For the gardeners among us, it is time to plant the seeds for the upcoming planting season. And just like them, it is time for us to start cultivating opportunities for working together as a medical profession in the coming year.

The Oxford English Dictionary defines a network as “a group or system of interconnected people or things.” A community is defined as “a group of people living in the same place or having a particular characteristic in common.” Both concepts are integral to the work in BC around networks of care. Networks are developing in different ways at many levels throughout our health care system. 

We strive to deliver comprehensive quality medical care to patients in BC with limited resources and capacity to accomplish this goal. However, this past year practitioners converged to tackle this challenge, and networks and communities of practice are one of the innovative solutions.

One such network is the Child and Youth Mental Health and Substance Use (CYMHSU) Collaborative, supported by the Shared Care Committee, one of the Joint Collaborative Committees, representing a partnership of Doctors of BC and the BC government. The network of over 2600 includes hundreds of physicians joined by numerous community partners including police, school districts, Indigenous groups, community agencies, and those with lived experience, all who have been working toward the common goal of improving the lives of children, youth, and families with mental health and substance use issues in BC.

To date, 64 local action teams and 11 working groups have focused on practical, sustainable solutions that address communication barriers, service-delivery gaps, and coordination of care locally and system-wide. Much of the work of the Collaborative has focused on mitigating the impact of adverse childhood experiences (ACEs) and introducing trauma informed–practice and policy, more recently in collaboration with colleagues in Alberta, who attended an ACEs Summit in Vancouver to share details of their program with 600 attendees.

The BC Patient Safety and Quality Council recently recognized the Collaborative for this outstanding work with a 2018 Quality Award in the Living with Illness category.

I have written before about the GP Oncology Network at the BC Cancer Agency, an ongoing initiative supporting the multidisciplinary network of cancer care in the province. GPs with additional training in oncology help deliver care both at BCCA facilities and at Community Oncology Network clinics. Recently nurse practitioners have been added to this model. The successes of this approach are realized by providers working to the full scope of their professional abilities, team-based care models, respect for complementary skill sets, and good communication among the team.

October saw the launch of the BC Emergency Medicine Network. This virtual network links emergency physicians across the province with each other through a member’s forum that allows for discussion and practice support. A variety of online clinical practice tools are available for members. Still in its infancy, the network has a long-term goal that includes real-time clinical peer-to-peer support through a digital platform. Check out the possibilities on its website, www.bcemergencynetwork.ca, and consider joining if you practise emergency medicine in BC.The Rural Surgical Obstetrical Network is a project supported by the Joint Standing Committee on Rural Issues. It links rural practitioners with enhanced surgical, anesthetic, and obstetrical skills with specialists in larger centres for ongoing clinical and educational support. Strengthening relationships and opportunities to work together are key factors in stabilizing low-volume surgical and obstetrical programs.

Primary care networks are now on the horizon after several years of designing a specific approach for BC. With the implementation of community of practice led and designed patient medical homes and primary care networks, we expect significant progress this year as we tackle primary care access challenges across the province. Team-based care is a key element, but it starts with physicians supporting each other as we work together to address community needs.

All networks rely on specific communities of practice to efficiently and comprehensively address complex patient needs. Our challenge in all these networks is the need for infrastructure support to enable providers to actually do the job. We need to continue to grow relationships between GPs, specialists, and other providers. Health authorities need to include physician expertise in program design to better serve the patient and improve relationships between physicians and administration. Government ministries need to break down the walls between their portfolios to address the needs of patients and communities in a coordinated way. Above all we need to identify, support, and grow the programs that will truly make a difference. We need all partners, including patients and communities, educators, administrators, and providers working together to wrap the care around the patient. These are the ingredients we’ll need to grow the networks of care that will revitalize the health care system in British Columbia.
—Trina Larsen Soles, MD
Doctors of BC President