Vancouver Division of Family Practice
In 2009, think: act consulting led a process to incorporate the Vancouver Division of Family Practice. In 2013, the Division asked think: act to chart and navigate a path towards a massive system improvement, that would enable 25,000 more people to have a family doctor.
We helped build a vision for engaging 400 family physicians and thousands of citizens in a dialogue that would generate a plan for increasing the number of people who have a family doctor, without making the doctors work harder or longer hours.
See our case study for how we did it!
Doctors of BC
think: act consulting was given the challenge of incorporating non-profit societies for family physicians as part of a new innovative approach to engaging GPs in improving primary care. Most participants had never been on a non-profit board and were cautious about the potential impact on their work-life balance. Think: act consulting developed and templated a process that required two meetings of 1.5 hours long to establish each society, develop governance documents and a member recruitment strategy. Using this approach, over 85% of BC's family doctors became part of a Division within two years.
With the number of Divisions expanding quickly, there was a need for a provincial infrastructure to support their development, evaluation and their work in improving local health care systems, not to mention the tricky work of building and supporting a culture of collaboration. Think: act consulting defined the needed set of activities, divided the work into coherent roles and identified the systems and processes that would make it possible to expand, support and sustain a growing grassroots physician movement for change.
Finally, those who know BC are aware that the population is spread across a huge geographic area, and developing Divisions that have the critical mass to be functional entities is just not financially feasible. Kyle worked with the growing internal team to identify how small communities and rural and isolated groups could participate in this big project, within a given provincial funding envelope. We mapped out a process for involving groups of doctors who were spread widely, to become effective agents for health system improvement.
Aboriginal and First Nations Health and Wellness
Between 2009 and 2010, think: act consulting helped First Nations and Aboriginal leaders to ensure that the issue of HIV and AIDS as it affects Aborigial and First Nations people in BC, would remain a high priority. Think: act consulting was engaged to support a group of leaders of organizations serving BC's Aboriginal and First Nations communities in relation to HIV and AIDS. The group named themselves after a recently-held provincial meeting on the future of supports for the communities: Renewing Our Response. think: act helped the Renewing Our Response (ROR) group to develop a compelling case for new directions, funding and attention to the issues facing Aboriginanl and First Nations people affected by HIV and AIDS. We helped link the group with the First Nations Health Council (now the First Nations Health Authority) to ensure that the country's first Aboriginal Health Authority would continue to hold the issue high. We also engaged the Ministry of Health, provincial health authorities, and other provincial groups to chart a course for concerted action on HIV and AIDS in Aboriginal communities.
Innovative Clinical Models
Primary Medical Care
In 2013, think: act consulting led a team of consultants to give shape to and evaluate an idea for a first-generation clinical innovation that will increase the capacity of the primary care system in Surrey and North Delta. The project was called "G8" and started with surfacing the best ideas from a committee that included a doctor, the local organization of doctors (Division of Family Practice), and the health authority. Once we surfaced the best ideas, we developed a "straw model" and then generated a financial plan and analysis so we could see if the model would work. At the same time, we met with health authority staff, hospitalists and family physicians to generate elements of this new group practice with an integrated and interdisciplinary model of primary care. We wrapped up our project with a Business Case that the Division used to seek funding for the establishment of the clinic as part of their approach to increasing access to a GP in Surrey and North Delta, BC.
The model we shaped, costed and assessed included some great bells and whistles:
- Integrative group practice primary care with 4 experienced physicians (with existing panels), and 4 new physicians (with no panels) sharing office space and staff;
- Most current approaches to scheduling (Advanced Access) and group visits, resulting in increased access and quality of care for urgent and chronic issues;
- Extended hours of operation with emergent care component for both attached and unattached patients (who will be offered a place on the practice’s panel);
- Shared after hours call and hospital call provision;
- Shared coverage for patients when one GP is away from the clinic;
- Shared registered nurse to support non-physician clinical functions and coordinate chronic care programs and follow-up;
- Health authority and community resources available on a referral-out and flow-in basis to enable interdisciplinary care and ensure that patients with chronic conditions receive holistic and integrated care.
Dental Care for marginalized children and families
In the late 1990's, parents in Vancouver's inner city identified that children were not able to access dental treatment. A quick look at the statistics showed that over 60% of kindergarten students had untreated cavities that were big enough to see with the naked eye. Kyle Pearce build and led a group of 25 health advocates, parents, dentists, Ministry officials and school principals to figure out what could be done. After two years of research and trying different approaches, the group opened the Strathcona Community Dental Clinic, which used a social enterprise model to address the dental needs of Vancouver's children and their families. Thirteen years on, the clinic is an essential part of the neighbourhood and the struggle to address the most common chronic disease of childhood.
Elements of the model:
- Non-profit governance and charitable status allows the clinic to generate revenues as a business while accessing donations and other funding sources;
- Services are provided in 4 languages to address the needs of a diverse population;
- Special outreach to seniors, many of whom are new to Canada and are responsible for child minding while parents are working;
- Fixed rate payment for dentists ensures consistency of the rotation, and provides reasonable compensation for dentists who have more lucrative practices elsewhere;
- All staff are paid, enabling children and families to build relationships with staff.
The SCDC is one of the few community-accountable dental clinics that has been in the black since its third year of operations. It continues to fund dental care for families falling in the cracks and is looking for opportunities for expansion to other communities.
City of Vancouver
Immigrant Investor Opportunities
Think: act consulting was asked to explore and identify a role for the City of Vancouver in provincial and federal immigration policy. The City was hoping to improve the attractiveness of investing in Vancouver's inner city areas, including historic Chinatown and the Downtown Eastside (also know as "the poorest postal code in Canada"). think: act spoke with policy and business experts and realized that while there was an opportunity for the City to advocate for changes to the existing policy, the solution was far from simple, with numerous problems with oversight and accountability in the Immigrant Investor Program (the program has since been cancelled). The work of think:act consulting enabled the City to reframe the issue (impact of immigrant investors on the economy as opposed to housing proces) for internal discussion and assess a policy opportunity and ultimately dodge several potential problems.
Neighbourhood Integrated Services Teams
With the emergence of new mapping technology through the City's 311 system, Vancouver started exploring how its internationally recognized approach to service integration, called Neighbourhood Integrated Services Teams, could evolve to be more proactive. The challenges we explored included the resources needed to see the full development of data capabilities, the need for staff to see the usefulness of a new role, and the training needed to move responsive teams to pro-active teams. Once the City full in implements its data collection and mapping capabilities, it has a roadmap for changing the Teams to take full advantage of their place-based focus and ability to integrate data, predictions and action.