Posted on Mar 30, 2023
West Coast Gynecology and Perinatal Care and Full Circle Family Practice provides full women’s health services through a single-entry model, with specialists, family doctors and multi-disciplinary providers working together to increase access to the appropriate provider working to their full scope of practice.
Victoria obstetrician Dr William Kim MacDonald is leading the work to create a team-based home for women's health where patients get faster access to coordinated action, and feel connected and well-cared for by a team of providers through life-changing journeys.
Dr MacDonald reflects on childhood home visits from his family doctor. "The sense of being cared for; having somebody who was invested in my well-being provided a lot of confidence," he said.
He notes that with today's pressures, doctors and patients are disconnected from each other, and don't always have strong and consistent relationships that support a patient's well-being – and also contribute to the joy of a physician's job.
"How can we work together more collaboratively to maintain clinical excellence, while creating better connections with our patients – somewhere that feels a bit like home, where they're cared for and have continuity of care?" - Dr MacDonald
Dr MacDonald talked to OB/GYN, family physician, and allied health care colleagues about exploring a team care model. At the time, Dr MacDonald and four OBGYN physicians worked in traditional independent practices in a shared space.
An opportunity to buy and renovate the space provided the impetus to work together more collaboratively. Three family physicians who support maternity care and women's health joined them.
WATCH VIDEO: Dr Kim MacDonald - Building team care for women's health
Accessing SSC supports to build out the model
Having been involved in Facility Engagement, Dr MacDonald accessed the Specialist Services Committee's funding programs, guidance, and mentorship to support development of a collaborative team care approach.
“Much of this change falls under the realm of business, accounting services or legal expertise. Often physicians lack this knowledge. SSC understood and connected me to other people and resources.”
He was able to adopt models and draw on other physicians' experiences from the SSC's first-entry pooled referral system (Enhanced Access), as well as the integration of allied health providers, primarily nurses, into the clinical setting. He is also involved in the SSC's Specialists Team Care Collaborative (STCC).
"We've been now able to get seven OBGYN ins and four family doctors, three nurses, a midwife, and our group of MOAs, all together on the same page to move this clinic forward." - Dr MacDonald
Creating a model for team care
As one aspect of the team care model in the clinic, family physicians see some of the general women’s health concerns they are trained to handle, leaving the OB/GYN physicians more time to care for the complex needs of patients.
Other team-based approaches include a new early pregnancy assessment clinic for complicated pregnancies, a central pooled referral system, and a rapid access clinic for urgent-care needs.
When a referral comes in, a nurse or midwife makes the first intake contact, assesses next steps, and gets everything organized before the appointment – setting expectations for the patient, and saving time at the appointment. The patient also then has a contact point, and confidence that something is happening.
Tying it all together is a central Enterprise EMR to support sharing information between team members. "It is the anchor for our team-based work," he notes.
"If a patient's clinical course changes, they have somewhere to reach out to, instead of just waiting for a referral and fumbling without knowing when they will be seen." Dr MacDonald
Improving access and experiences
Better division of labour among the providers allows for a better use of everyone’s time and results in lower wait-times for patients, quicker access to care, increased comprehensive care, and overall satisfaction for both the patients and providers.
Dr MacDonald notes that initial feedback from the patients about the experience is positive.
"Patients feel like they have a home where they're cared for. Someone is paying attention to them and meeting their needs. They are able to get a hold of somebody. All of these things that make them feel like you belong somewhere," he says. "That energizes me."
"If you're all on the same page, you're encouraging each other to work to full scope of practice. It's a very positive work environment. I think that flows to the patients. It keeps everybody working, they're happy." - Dr MacDonald
Clinic and model features and services
- implementation of a first available intake system
- rapid access gynecology clinic
- general gynecology clinic
- family medicine well women clinic (PAP testing, contraception, etc.)
- sexual health clinic
- early pregnancy assessment clinic
- early pregnancy loss clinic
- preconception counseling clinic
WATCH VIDEO: Dr Kim MacDonald - Building team care for women's health
