June 25, 2025 • 39 mins
Hot on the heels of "Let's Talk Access" episode, Karen chats with the practice team from Halifax's Mentor Clinic. In what Karen calls, "a two-fer," Drs. John Ross and Shauna Archibald and Nurse Practitioner Theresa Hubley discuss what it's like to work at, and care for patients in, Nova Scotia's first Health Home.
They discuss how through creating a healthier work environment for staff, they have more time to promote wellness and not just treat illness.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Hi, everybody. I have a gang here today and we
are here to talk about health homes and a particular health
home that's been operating in the North End of the city of
Halifax for the past, jeez, yearand a half at least, I guess.
So coming around for 18 months. And the inspiration behind the
(00:20):
Mentor clinic is Doctor John Ross.
Hi, John, how are you today? Hey, Karen, good to see you.
That's good. Good to see you too.
I saw you running down the street the other day, actually.
So I'm literally running. And we have also Doctor Shawna
Archibald, who's a physician at the Mentor Clinic, and we have
(00:41):
Teresa Hubley and Teresa is a nurse practitioner and she's
been practicing for about 12 years both in Ontario and in
Nova Scotia. So welcome to the three of you.
And I'm excited to learn what you've been up to now.
I've been there kind of when it was in fledgling stages, so very
(01:01):
early days. So I'm probably overdue for a
visit. So you're going to have to paint
a bit of a picture for me and for for all of us today.
So let's start with understanding a little bit about
what you're doing at the mentor clinic.
So you call it mentor. There has to be a reason for the
name. And then what's going on at the
mentor? What's your?
(01:22):
What's your model, John? What are we about?
So, so mentor clinic is that theword mentor sounds like teaching
or guiding. And so we thought, well, we'd
like to be able to help guide patients in their primary care
and health journey. We think that patients are going
to guide us, which they are. We want to be a teaching
(01:42):
facility where we're going to teach, you know, future
providers to be there too. So to the mentor clinic to seem
like a kind of a nice, nice name.
It is I, I like it too. I mean, mentors got a good
connotation. So, so you had the idea what,
what was the genesis of the idea?
What took you to up in the NorthEnd?
(02:03):
Like what, what was the, what was the, what was the
progression? I mean, it's a bit of a change
from an ER physician. It was so.
What's it? What's it all about, Alfie?
I I could occupy the sure, the passion hour and then the 17
right. So I'll shut up, John.
So yeah, the health home is it doesn't really have a specific,
(02:25):
you know, term or, or a bunch ofdescriptions yet.
It's kind of something that is being developed here in the, in
the province. There are other places called
medical homes or health homes oraround the country that all have
kind of various patients. So we're, we're going to, we're,
we're kind of figuring this out together.
This is a project with NS Healthfully funded by, by, by you and
the government. And it's really, it's in and we
(02:47):
started off as a test and try project.
And you, I think very wisely thought, well, we need to get
out there and let's do a, a mobile primary care.
So that's what kind of where we started as a mobile primary care
clinic going primarily into the Western zone with a very, very
small team. But we were, we were, we were
moving the markers. And but it also validated that
(03:08):
the need, I think that the, the larger team we wanted, we knew
that more doctors aren't going to be coming in great numbers in
our province, just like they're not going to be coming in any
other province. And so if we're only waiting to
recruit more people, we're goingto be waiting forever.
We needed to take more people that are out there providing
elements of primary care and putput them together as a
(03:29):
collaborative, well functioning team, people who can support
Shawna and and Teresa as, as youknow, core medical providers.
But but there's so many other things that keep people healthy.
So the the health home is a place where people will be are
attached to the clinic, not necessary to a specific.
(03:50):
Provider not necessarily to Doctor John Ross or Doctor
Shauna Archibald or nurse practitioner Hubley, right?
So they're patient of the clinic.
They're a patient of the clinic,they're likely to see that
person most often, but they may well be also seeing other
members of the, of the team and,and if, if Shauna or Teresa or
(04:13):
our other family doctor and our other 4 nurse practitioners.
Oh. You have 4, so 5 all.
Together 1. Amazing, guys.
That's great. Yeah, I'm happy to hear that.
So if one of those is goes on a vacation or is away for whatever
reason, it doesn't mean that you're now, you know, blocked
off until they get back. It means that you're, you're,
you can come in the next day, the same day and see the, the
(04:34):
clinician that's going to be very aware of your, your, your
current health problems because we all share the same EMR
electronic medical record. Yeah, let's just maybe talk
about that. So that is, that's a key.
That is, that is a key, it's a key enabler for, for being able
to share what's happening with that particular person and also
prevent that routine that you that you get usually in the
(04:56):
system where you see somebody and then the next person asks
the same questions over and overagain.
And and and you know is this tire same and and inappropriate
so. This person has the ability to
well. I think it does it and you know,
you kind of have a lower expectation that, you know, they
don't know me. I I got to start all over again
and that doesn't happen in this in this.
(05:16):
Well, I think that's great. So those are two distinctions, I
guess. Now I want to turn to Shauna.
Shauna, you were a solo practitioner.
I can't believe it really in this day and age, hard to think
that somebody gets out of medical school and actually
decides to hang up their shinglethemselves and and go go for it.
But but you did that and then eventually found your way to the
(05:39):
mentor clinic. So, so tell me a little bit
about, you know, how, how did that all happen?
You came out of medical school, you did your thing and then you
have changed gears a little bit.Maybe tell us your path?
So I don't think you'll be most of the family physicians
listening to this won't be surprised to hear that we most
(05:59):
of us have been working all along in solo practices.
So I just, I had that expectation that this is what I
was going to be doing. And in fact, it was, it was
really overwhelming. To your point, I remember taking
over a practice, established practice of someone who'd been
there again, in solo practice, just sharing space with a, you
know, administrator for 17 years, being, you know, all
(06:23):
things to all people. And I thought, OK, I'm just
going to need to, you know, fillsome big boots pretty quickly.
And so off I went, you know, andI am enthusiastic, hard working,
smart, willing to bring everything I had to the role
people, you know, were happy in general with, you know, with the
(06:44):
care. But I soon realized that this
was not something that I was going to be able to sustain
because the hard work was not translating into people actually
being healthier. And there was just more and more
and more and more. And this is the situation that,
you know, as I say this, I'm sure it's resonating with a lot
(07:06):
of the family physicians who arecurrently work in HRM.
And so it when this opportunity to consider a different model
came along, it only made sense to me that being part of a
collaborative clinic was going to allow me to actually sustain
what I needed to do, which was, you know, diagnose, treat,
(07:27):
manage, help people with their health and help them to actually
be healthier and happier. So that was that was how I
started from. Being.
From being overwhelmed to thinking, OK, I need to do this,
I want to do this. I spent eight years and then two
more years in residency getting ready to work as a family
(07:50):
doctor, helping people with their health to be healthier,
and I was not going to let that dream go.
The right niche. I think it's interesting because
I, I, I, I dare say the general public, including patients,
don't realize that in a smaller office, you're the, you're the
(08:10):
Internet person, you're the Microsoft 365 person, you're the
phone person. And of course you go to medical
school or law school in my case,they certainly don't.
Those are courses that you take and yes, you can hire people to
do it, but that's money. And also if you're contracting,
(08:32):
that takes time. It takes time for the IT guy to
get there and fix it all up or the phone guy and, and you know,
you, you don't have the time. So it's very stressful.
It's scary. And I don't know if that's
partially what you experienced, but that would make me like very
stressed out. Yes, exactly.
So that business part. The business side of it.
(08:52):
We have the most amazing organized administrative and
management team. At the Mentor.
And we just know that when we get there, we're going to have
everything we need to manage ourday and we can just take it from
there. I think that's great.
You know one thing we we never talked about where the physical
space is. So where Where is the physical
space of mentor Clinic? Ground level Gladstone St. and
(09:14):
again, after a number of years moving around to many different
locations, fantastic accessibility that has to be #1
and bright. And we're working on making it
welcoming and the flow to be safe and organized to respect
people's confidentiality. So we're growing.
Watch out. We're taking over the entire
(09:36):
floor. And you have a million square
feet next to you of a park of Richmond yard.
So I don't see your population base shrinking anytime soon.
So it's quite a change from whatyou started in practice to to
where you are now. So that's great.
So we'll we'll come back to whatyou're doing now.
(09:57):
And I just want to turn to Teresa.
So the snapshot, Teresa, you didsome time spend some time you
spent some time in on in Ontarioand then you moved like back to
Nova Scotia or to Nova Scotia. Moved to Nova Scotia.
Nice, so So what was your path and your choices?
(10:20):
So I was working at a family health team in Ontario, which
is, for anyone who hasn't been to one, typically a
collaborative, quite a collaborative site.
We have a lot of the same providers that we have in our
current health home, but all under the same roof.
And when I moved here, I was a member of different health
teams, but while we shared the same roof, it we didn't
(10:40):
necessarily share a lot of the patients or have the same level
of supports in those teams. So I really like the opportunity
here to work collaboratively with all of the extra
interdisciplinary team members. And to Shawna's point, that
feedback loop as a provider is really, really helpful.
Yes, you can send your patient out to see a dietitian or the
(11:03):
pharmacist in the community, buthow often do you get a letter
back that explains what happened?
And in this instance, she can just come to my doorway and tell
me, hey, guess what, this patient you sent me, we made
huge strides and now her A1C hasdropped three points and all
because of dietary changes. Yay for us.
It's it's fantastic. Yay for the team, it is
(11:24):
fantastic and you can celebrate together along with the patient
instead of waiting. Absolutely.
That's great. Now, Teresa, just before we
really dive into a few other elements, metrics, who runs the
show on the metrics in this, in this, in this?
Group I wear another hat. I'm the director of Quality at
(11:48):
our clinic. At the clinic.
At the clinic and I have some experience doing some quality
improvement stuff in Ontario because that that's big there
that those metrics are tied to funding there.
So here, you know, as a collaborative group in this
health home, we wanted to show what we're doing makes it.
Matters exactly so patient outcomes.
Patient outcomes access. So for example, I track our
(12:10):
third next available appointment.
When Shawna and Jill joined us, you know their third next
available appointment wasn't fantastic.
Well, what does that mean now? Just break it.
Down. Can you call us on that?
Table. So let's, let's just just just
just work with me here. So explain exactly what that
means, because there could be people here who have no idea
(12:30):
what we're talking about. Same day, next day, third day,
7th day, six weeks. So, so you call your doctor
because you have, you need a Medrefill, for example, and they
say, sure, you can come in in six weeks, but I'm out already.
I, I need it now. So that access point is really
(12:51):
important. Or for something urgent, you
know, maybe you have a sore throat and you want to be seen
for a strep throat. Or maybe you have a new
pregnancy and you want to be seen by your doctor for the new
pregnancy. And you're told as a patient,
yeah, you can come in in six weeks or however long 8 weeks or
longer. It can be stressful on the
(13:12):
patient. So the 3rd next available
appointment takes into account that that position or nurse
practitioner might have a cancellation that offered, you
know, oh, I have an opening today.
But really the third next available is more predictive of
their availability to their patients.
So let me understand this. Is this a principle that the
(13:33):
clinic has adopted as a path forward or?
We're trying to make it our access open as open as.
Part of your rule, yes. Yeah.
So when Sean and Jill joined us,third next available access, 3rd
next available appointment was probably in excess of 3 1/2
weeks approximately. And we've dropped that
(13:56):
consistently to about 7 days. So how did, how did, how did you
get that down? We have team based Care now, so
that person who sprained their ankle for example, they can be
seen by the physiotherapist instead of Shawna who might say
you need to go see the physiotherapist.
So that's that extra appointmentstep that maybe doesn't need to
(14:16):
be there. And it's a lot of efficiency in
the sense that, you know, you wait just say, just say six
weeks to see your family physician and family physician
says, well, that's great. You have a sprained ankle, you
need to go see the physio. So that's another X period of
time. So it's it's really is a true
compression of time, which. Right.
(14:37):
And everybody leads to a better outcome for the individual.
Seeing the right provider at theright time as well.
So maybe they need to see a pharmacist first, maybe our
nurses. So they do a lot of the
immunizations. Shauna was previously doing
those immunizations A a nurse iscapable of doing those
immunizations and that opens up an appointment for.
Her yeah, pap smears. But but the other thing I think
(14:59):
it's also just talking worth talking about is is the duty
clinician role, yes, in terms of, you know, cutting back that
that third available. So we have same day access at
our clinic. All of our physicians and nurse
practitioners take a turn each week as as some collaborative
teams do, doing urgent same day appointments.
And that has really allowed all of the patients of the clinic to
(15:20):
be able to access care when theyneed it as opposed to attending
a walk in or emerge when it's something we can solve and we do
know them. Now And, and, and so just going
back to the metrics, so you run that part of the operation
through you keep tabs on on that, so to speak.
And I'm sure you all look at it.We do, yeah.
So I want to come back to. But if I can just to interrupt
(15:42):
just for a second, but but I think one of the other
challenges we we encountered early on is that there aren't a
lot of metrics that are used by the system currently.
And so we've been, we've had to make up our.
Own. Yeah.
We've had to devise both clinic performance.
We want to look internally, how are we doing?
And that comes to surveys and other things, but also the
numbers that we're coming up with, we think are important
(16:04):
from, for, from a system point of view.
And so we want to share this andsay, you know what, I think
everyone should be looking at these numbers.
And we, we got to figure out howwe extract it from the EMR, from
the electronic medical record. And that often means using it
the same way uniformly across everybody.
So whatever you put in, you got to be able to get at.
So that's been a big project, making sure everyone's using the
(16:26):
EMR the exact same way and then try.
To do that across the. Province.
Well, exactly. That's right.
It's a huge, it's a huge change.It's a big.
Change but but necessary so thatyou know you're looking at
apples and apples. Right.
It's if you know, if you don't do it, then you then you're just
blind. Yeah, exactly.
So I'm interested in the culturea little bit.
(16:48):
You know, I think culture, something I'm very conscious of
because of course, Nova Scotia Health is one of the, it's the
largest employer in the provinceand it was a coming together of
Regional Health authorities, if you can believe it, 10 years
ago. And you know, certainly for me
(17:08):
when I first experienced going around the province, very, very
different cultures. Now you know, we're moving to A1
team team, but that does take time and it will never be fully
A1 team team and and I don't think it should be, but but I
just recognize how important culture is and culture being
(17:30):
attached to the leader, but alsoto the vision, to the mission,
to the values. So I'd like to hear, you know,
your thoughts around that John and and team.
Yeah. I mean, I think going back to NS
Health, I mean, we've divided itup into four zones, which I
think has been helpful in terms of maybe some micro, some micro
macro cultures that have that are able to kind of do their own
(17:51):
thing. So that that's been helpful.
But I mean, I think the, the keything for us was we have been
fortunate to be able to interview and and hire people
based on fit. And so, you know, here's here's
the philosophy that we're tryingto go with.
We, we not only want to be a clinic that deals with the usual
(18:13):
chronic disease management, which is sort of the, the, you
know, the general mantra out there.
And, and I get it, there's a need, but we wanted to also go
upstream and be willing to challenge our patients,
challenge ourselves in terms of how do we try and keep people
healthier? How do we promote a, a better
awareness of the one's own body and all the things that, that
(18:35):
are required? And so you know, that that's a,
that's a certain kind of mindset.
And, and, and so we've been fortunate to, to basically put
together a team of people who, who all are, are, we're all
rowing in the same direction, which is great.
And, and we have a, a, a non hierarchical arrangement.
We were, I think in some ways fortunate, and this is no
offense to Shauna, but we, we started off as mostly an NP
(18:57):
centric, nurse practitioner centric clinic.
It was, it was them first and then the doctors were added
next. It's kind of a, you know, we
backed into that in, in some ways.
And, and so that's been important.
We, we meet as a whole group andthe, the administration group is
there the, you know, all the, the, the supporting the, the
actors, the the dietitian and, and exercise physiologists.
(19:19):
We're all in the same room talking about patients and
processes. And so we process problem solved
together. I think trying to keep this as
non hierarchical and as broad based and also respecting that
the dietitian and social worker bring huge and others, but they
bring a lot to the clinic. I, I, I've, I've also sort of
said, you know, if I made my, myideal clinic, I would start off
(19:43):
with a social worker, a dietitian and a clinical
exercise physiologist as the core, not the usual doctor nurse
combo. And why do you?
Say that, John, why? Why do you say that?
So I find this really interesting, right?
And I'm sure you have thoughts on this.
I don't know about you folks andyou can certainly.
Wait, I I'd add them. Yes, but you know, think about
it. You're an ER, you're an ER doc,
(20:03):
right? You're an ER doc.
This is your life. I'm, I'm, I'm an ER doc now.
I'm not. I mean, you are of course, but
you're doing something very different and you have the
opportunity to recruit that's fitting into a particular set of
values and so forth, as you've just described.
So, you know, how do you get to that place where you say the
(20:27):
first people I would choose if Iwas starting from scratch again
would be this particular clinician and this particular
clinician? Yeah, you're speaking to a
weirdo as and I know you know that, so.
Well, we're all a touch and a little bit touched.
So as an emergency physician foralmost 30 years, I was a, a
reactive disease care specialist, you know, my, my job
(20:49):
is to show up and whatever comesin the door, they're going to be
sick people and they're going tobe injured people.
And that is, that's that, right.I didn't really practice care
for health healthcare for reallyany of my practice.
I mean, I, you know, occasionally I would say you
should stop smoking. You should, you know, exercise
more, you should change your diet.
But, but that doesn't, that's not effective.
(21:09):
But most of my time was spent reacting to disease as it was
already presenting. And towards the end of my time,
I was just struggling because I was getting busier and busier.
The wait times are getting worseand worse.
We're putting all sorts of things in.
But, but you know what? We're not winning the game
because folks are out there in the world facing all the
stresses and strains of life andgetting sick.
(21:31):
And so we needed to, we need to play a different game.
And part of that is putting moreof a, of a, of a, of an onus
and, and attention to those who can help us understand whatever
I fuel myself with put inside mybody.
You know, as a dietitian, it that's important news, right?
You know, and all the society tells us to buy a bunch of bunch
of junkies sort of stuff. But really, you know, you got to
(21:54):
choose the right fuel. You got to move your body 'cause
we were designed, we got an incredible machine.
And unless we use it, we lose it.
And the social worker, I mean, again, life is stressful and
it's crazy. And so those three to me are
kind of core people that get theget the foundation right.
And then if things you get a little bit sick, great, Shauna
(22:14):
and and Teresa and colleagues are there to help.
So the Wellness. Repair you.
The Wellness and then the. Foundation.
So thoughts, thoughts on that, Shauna?
Like, is that something that talks to you or, you know, do
you? Have a different.
Or do you have a different approach?
100% and I just wanted to weigh in to your point about the
culture. Yeah, it is, as John says, a
(22:35):
secret of our success at Mentor Clinic because we respect each
other. We spend time together as a
team, team building. So this is how we understand
each other in terms of the scopeof our practice and the
expertise. And you're absolutely right,
those determinants of health arewhere it begins.
(22:55):
And we keep talking about healthand we call ourselves Nova
Scotia Health. And this finally, since I've
been working at this practice, this clinic feels like we are
helping people to actually be healthier.
And, and to John's point, it's because they can live healthier.
So when they live healthier, moving well, eating right, and
(23:16):
having the supports for these inevitable stresses that come
along, guess what? They have less acute illness and
they're chronic diseases if theyhappen to have them because, you
know, things happen, they're much better managed.
And not only that, the patients feel empowered.
So in terms of the culture, patients feel more positive
(23:38):
about their own situation and their ability to control it.
And they know that we've got their back in a serious way
because it's not just what theirdoctor can do for them, it's
these other things that they're able to access if and when that
time comes, when they need thoseservices, when their health
declines. I think it's really important so
they have agency, they have control.
(24:00):
I mean, this is what people want.
They just don't necessarily knowhow to go about achieving it.
Exactly. And they need that ongoing
support, as John was saying, 100.
Percent Doctor Google doesn't solve everything, and fact can
make it even scarier. From time to time.
Yeah. And Teresa, what actually
brought you to Nova Scotia? Was it this clinic or you?
(24:23):
You. No.
So that's another story. Is it?
It's a different story, OK, It'sa different story.
But you found your way to mentor.
Yeah. And and do you have any
additional comment on culture orany aspects of the operation
from your perspective? I think the culture like these
guys have mentioned, you know, it takes time to build.
(24:44):
So all the people listening, youknow, it's scary opening up your
practice. Change is hard.
It is. It's hard.
It's hard for for any provider to join a new team and then just
openly trust other individuals. Hard for you?
I mean a little bit, but I've worked in big teams before.
(25:04):
And you're probably an early adopter, which is another, you
know, can be good or bad depending on the situation.
Teresa. Thought huge experience to this,
to our community. She has been immensely helpful
in terms of helping us figure out what the priorities are,
where you know, where are we, where are we going?
Absolutely. It's easier for me to jump 2
(25:25):
feet in because I've I've seen it work and I know it works.
But you know, for someone like Shawna who's practiced and has
all these patients, these, these, this is what she's
dedicated her life to. And I understand the resistance
to, you know, well, but I know Ican do it and I know my patient
are, are you going to do it as well as I can?
So we have to honor that and take time to build that trust
(25:49):
with with our providers. And as we have new providers
join the team. Like I've never worked with this
exercise physiologist before. I don't know what she's capable
of doing. So learning each other's roles
was great and we spend time every three months doing some
rounds on our patients and we can use each other and, and
bounce ideas off each other. Like I have this patient and I,
(26:12):
I'm just struggling with this question because they, they have
all these complex factors and what do you think I should do?
And it's nice to have, you know,a social worker in there and
being like, Hey, did you know this program exists?
What No and it's just more resources and then it it helps
with. The ready, though, I think
that's the other key. It's it's at the ready, Yeah.
So it's there's no waiting. I don't have to wait six months
(26:34):
to hear that. Answer exactly, which I really
think people, you know, teammates and the patient really
appreciates. It's very comforting, yeah, that
you have the level of expertise in in your own office.
And the access, Karen, to your point, that's the biggest crisis
in healthcare right now is access.
So we have that. Access, which I think is great.
So, you know, I hope that there will be a number of family
(26:58):
physicians listening to this. We'll make sure that we try to
get it out as best we can. But I think for you, Shawna, you
know, what would your biggest message be to a family physician
who perhaps is in the same spot that you found yourself before
you join Mentor Or you know what, what would you like them
(27:19):
to understand about your new life?
Again, it's you're not hearing it here for the first time.
We keep hearing even within the circles of family medicine
across the country. Find yourself a health home.
We providers need health homes just as much as patients need
them because again, it allows usto function in a way that we can
(27:44):
be inspired to provide better care.
We can be supported in providingthe best care.
And previously, as I, you know, mentioned with your first
question, we found that we were working just as hard as ever and
following the guidelines, but weweren't achieving the outcomes.
And both patients and myself as a provider, we're feeling less
(28:09):
and less engaged in the process,less, less agency in the
process. And as you know, access just
keeps continuing to deteriorate.So things would fall on me even
more than before. But here I we have the
supportive team and and yes, to Teresa's point, embrace the
(28:31):
roles of the other providers. I always understood that healthy
nutrition was going to lead to better outcomes for both, you
know, acute and chronic disease management.
And I would do my best. Well, again, having access to
someone who not only has the time to do this, but it's their
whole career and their expertise.
(28:53):
I continue to be amazed by the skills and, and abilities of
these other providers to, to, todo their roles.
And I welcome that. No one ever said that the
physician had to be the leader in the in the top of the
pyramid. To John's point, we sort of
(29:15):
breeze in and out in different, you know, aspects of people's
lives. But actually they do the living
and the support can come from anywhere as long as it's there.
I think that's a great answer. I think, you know, I hope that
there are folks that are hearingthat and maybe start to think
about what it could mean for them and maybe stick around a
(29:38):
little bit longer, whether it's part time, full time, some kind
of time. And I guess a question for you,
John. You know, if somebody out there
was interested in seeing what itwas all about, I'm sure you'd be
more than happy to give them a little inside baseball and.
Drop drop in we my emails available.
(30:00):
They're mentorclinic.ca is on the website.
You can find out how to get where we are and you can love to
to give some tours and, and, andhave a chat.
You can come to one of our Thursday afternoon meetings and
see the whole team just kind of exchanging about stuff.
I think that would be great, andwe'll make sure that we put that
in the notes for the podcast. So I'm going to give the last
(30:20):
word to you, Doctor Ross. You know, this is quite an
odyssey. It's been quite a change.
I love the metrics. Of course, I love the data, love
the idea of collaboration and working in a team.
I mean, I, I personally come from a professional services
background where it was always team and when you had a problem,
(30:42):
you walked down the hall and youfound the person that could help
you. So I, I get that, but if you
haven't had that experience, then it's a real change.
I don't know how I would have done otherwise.
So that's, but that's just, you know, my own personal experience
in the workforce. So, so you know, sum it up for
us. OK, I'm going to, I'm going to
(31:03):
say I'm going to repeat. Change is hard.
Change is continuing to be hard.It's this is, you know what
we're, it's hard, period. And then that's why many people
don't either try it or they giveup because it's hard.
So I'm happy to admit that, you know, we've been talking about
very positive sort of things, but I think I wanted to give
(31:25):
some evidence based to that, that we have been doing
anonymous surveys with our staff.
We've been doing anonymous surveys with our patients,
getting feedback on the good, the bad and the ugly of how are,
how is it going in terms of a staff experience?
How's it going in terms of a, ofa patient experience?
And you know, there's been good constructive suggestions,
absolutely as balanced feedback.But you know, there's I'm, I'm,
(31:51):
I'm, I pinch myself over the honeymoon that continues.
I mean, people are just really positive about how this is
going. I mean, and there are
unsolicited statements like from, you know, people who you
wouldn't otherwise guess that this would come from them saying
my, my, my, my sense of well-being, my general overall
health has improved my attitude towards whatever I'm feeling
(32:11):
more engaged in, blah, blah, blah.
I mean, it's just, and Teresa can probably give you more
details around those specifics. But, but again, I've just been,
it's been very heartening to know that although we we can
kind of feel positive in Kumbayaabout all this, there is some
there is a real on the ground level that supports that.
You know what, we're doing the right thing.
(32:32):
This is a no brainer design. The specifics of the team, you
know, will be variable dependingon which community you're
talking about. I don't think, you know, we
don't have to have the magic ratio of of people, But but this
team based care I think has beenso super supportive to the
providers as someone who was saying and the patients are
feeling like they're they're being listened to.
(32:52):
I think that's key the but, but it does actually 'cause me to
ask 1 slightly provocative question and not, not
provocative to this table, but just a general which is, you
know, it does get said once in awhile, particularly it's
(33:15):
reported. And I'm talking nationally, not
just in Nova Scotia. You know that the goal has to be
a provider for every Canadian. Let's just go there.
Provider, meaning either a nursepractitioner or a family
physician. Now this is a little bit
(33:35):
different from that, but not notfully.
And I, I think it's really important to maybe drive that
home. So, you know, when you hear that
kind of a comment, what what, what's your reaction?
Don't start. Oh, yeah.
Damn. So the patient first of all, who
gets signed on to our clinic is,is as we said, a member of the
(33:55):
clinic, but they are currently so and they're either going to
be with a nurse practitioner primarily, although again shared
amongst a few or, or, or the physician is we have some
physicians that are physician istaking some of the patients.
So, so it's still an attachment thing that's still a bit of a
legacy. I think what we're going to end
(34:16):
up doing is dividing up into kind of a a more micro team
base. Will there be a doc nurse
practitioners and a nurse that would be your kind of go to like
the the the blue team and the green team?
Exactly right. So that if if the doctor isn't
isn't available or there that day and that was the person you
tended to see more often, you'restill going to see you're going
to see someone. It's going to be the nurse
practitioner, but it's the person you're going to see more
(34:39):
often as a smaller little group.Then if you were just sort of
coming into a clinic that had 10providers and it was kind of
like, oh, you know, 1 of 10 is going to see me.
That's that's a bit too broad. So I think there is out there
both the providers want to see the continuity of care too.
They, they don't want to be shift workers.
No, no, So I, so I think, you know, I, I, I this is, this is
(34:59):
absolutely people again are finding like, wow, I didn't know
that I didn't have to not, you know, I didn't have to see the
doctor. The same person every every
time. A little bit of this is
education I. Know it's a big piece.
It's a change management processagain.
For for. For the public.
The public. So comments Teresa, Because
you've seen it in two provinces.It's nice to be familiar with
(35:21):
the provider and it's nice as a patient to have that person have
that knowledge of you and your healthcare and your family and
your situation. But there needs to be a balance.
So if Shawna wants to go on vacation, she should be able to
do that without worrying that who's going to look after my
patients and her patients shouldn't have to worry that who
(35:44):
am I going to see? So, you know, attaching to one
person puts a lot of pressure onthat one person.
And yes, you could have urgent things.
Oh, my colleague will cover for me in this urgent situation.
But that's short term. That's not long term.
What if Shawna wants to take twoweeks instead of one week?
Or a trip of a lifetime. She wants to go to Australia.
(36:06):
What if she needs to go away from?
Or what if someone gets sick or,you know, has a life event that
that takes them out of the the workplace for a little bit
longer? You don't want those patients
feeling orphan. Do you want them feeling like
you know what this person's not here, but I can still see
someone who knows me and knows my history and can provide the
(36:26):
care that I need in that person's absence.
And the provider has that security that they don't have to
worry their their patients will be looked after I.
Think that's really what? There's also been the benefit
though, too, that an alternate set of eyes on someone.
If we, we've got lots of examples where someone said,
(36:47):
hey, do you know, what did you think about blah, blah, blah.
Or maybe do you think it's time to for this kind of test and you
think, yeah, you're right. I'm just kind of completely out
of mind. So, so there's been a, there's
been a real, I think benefit in that cross pollination of, of,
of ideas. Excellent.
Any final party. Yeah.
I would just like to say, you know, just as again to other
(37:07):
family physicians thinking of something like this, it is just
really freeing in terms of increasing your capacity to to
be attached to patients so you wouldn't feel as overwhelmed by
your roster because you're not the one who's everything and
anything to everyone of those 2000 patients.
For example, on my roster now I know that I that there are nurse
(37:31):
practitioners available to see them on days when I'm not there
and still diagnose and prescribethat there are family practice
nurses who are more than capable, oftentimes helping
people meet their diabetes outcomes better than me
connecting them to, they can connect them straight to the
dietitian if they feel it's appropriate.
And for example, the well baby care they can provide a lot of
(37:55):
the, the well checks, the routine assessments, the
developmental screens. And then instead of spending
half an hour or 40 minutes as the NPS would with those visits,
I can spend 15. Theresa May spend 20.
But we can focus that time reviewing everything, making
sure that, you know, we're happywith the overall way things are
(38:16):
developing with the child and their growth.
And inevitably when the parents have questions, which may very
well require someone, you know, with that diagnostic capacity,
we have our full attention to beable to focus on those instead
of because the routine metrics have already been obtained.
So it's just a win, win for everybody, but again, including
(38:38):
the providers to increase capacity to be able to take on
more patients in the clinic. And you're probably aware we've
been able to take more patients in the clinic.
And and keep it coming. Ongoing keep.
This coming, Teresa, I want to see those metrics.
Keep it coming. No, I'm teasing.
I think. Look, you, you, you're doing
exactly what we've been envisaging, you know, having
(39:01):
teams where each individual can work to the top of their scope.
I mean, that's really what we where we have to go and it's
exactly what you just described.So I'm, I'm so happy that the
three of you were able to join today.
It may spur more conversation. I hope it does.
I think a lot of it is educational in nature where we
need to take Nova Scotians. We'll see what kind of response
(39:22):
we get and we'll make sure amongst the four of us we send
it, you know, far and wide so that if, if people want a Part
2, they can have a Part 2. And if they want a tour, they
can have a tour. If they want to talk to a member
of the team, they can get a better snapshot.
So I really appreciate your timeand what you're doing.
Nice to meet you, Shawna. Nice to meet you, Teresa.
(39:43):
Keep the good times coming. Thanks.
Thanks for. Thanks for the opportunity.
Hi, everybody. I have a gang here today and we
are here to talk about health homes and a particular health
home that's been operating in the North End of the city of
Halifax for the past, jeez, yearand a half at least, I guess.
So coming around for 18 months. And the inspiration behind the
(00:20):
Mentor clinic is Doctor John Ross.
Hi, John, how are you today? Hey, Karen, good to see you.
That's good. Good to see you too.
I saw you running down the street the other day, actually.
So I'm literally running. And we have also Doctor Shawna
Archibald, who's a physician at the Mentor Clinic, and we have
(00:41):
Teresa Hubley and Teresa is a nurse practitioner and she's
been practicing for about 12 years both in Ontario and in
Nova Scotia. So welcome to the three of you.
And I'm excited to learn what you've been up to now.
I've been there kind of when it was in fledgling stages, so very
(01:01):
early days. So I'm probably overdue for a
visit. So you're going to have to paint
a bit of a picture for me and for for all of us today.
So let's start with understanding a little bit about
what you're doing at the mentor clinic.
So you call it mentor. There has to be a reason for the
name. And then what's going on at the
mentor? What's your?
(01:22):
What's your model, John? What are we about?
So, so mentor clinic is that theword mentor sounds like teaching
or guiding. And so we thought, well, we'd
like to be able to help guide patients in their primary care
and health journey. We think that patients are going
to guide us, which they are. We want to be a teaching
(01:42):
facility where we're going to teach, you know, future
providers to be there too. So to the mentor clinic to seem
like a kind of a nice, nice name.
It is I, I like it too. I mean, mentors got a good
connotation. So, so you had the idea what,
what was the genesis of the idea?
What took you to up in the NorthEnd?
(02:03):
Like what, what was the, what was the, what was the
progression? I mean, it's a bit of a change
from an ER physician. It was so.
What's it? What's it all about, Alfie?
I I could occupy the sure, the passion hour and then the 17
right. So I'll shut up, John.
So yeah, the health home is it doesn't really have a specific,
(02:25):
you know, term or, or a bunch ofdescriptions yet.
It's kind of something that is being developed here in the, in
the province. There are other places called
medical homes or health homes oraround the country that all have
kind of various patients. So we're, we're going to, we're,
we're kind of figuring this out together.
This is a project with NS Healthfully funded by, by, by you and
the government. And it's really, it's in and we
(02:47):
started off as a test and try project.
And you, I think very wisely thought, well, we need to get
out there and let's do a, a mobile primary care.
So that's what kind of where we started as a mobile primary care
clinic going primarily into the Western zone with a very, very
small team. But we were, we were, we were
moving the markers. And but it also validated that
(03:08):
the need, I think that the, the larger team we wanted, we knew
that more doctors aren't going to be coming in great numbers in
our province, just like they're not going to be coming in any
other province. And so if we're only waiting to
recruit more people, we're goingto be waiting forever.
We needed to take more people that are out there providing
elements of primary care and putput them together as a
(03:29):
collaborative, well functioning team, people who can support
Shawna and and Teresa as, as youknow, core medical providers.
But but there's so many other things that keep people healthy.
So the the health home is a place where people will be are
attached to the clinic, not necessary to a specific.
(03:50):
Provider not necessarily to Doctor John Ross or Doctor
Shauna Archibald or nurse practitioner Hubley, right?
So they're patient of the clinic.
They're a patient of the clinic,they're likely to see that
person most often, but they may well be also seeing other
members of the, of the team and,and if, if Shauna or Teresa or
(04:13):
our other family doctor and our other 4 nurse practitioners.
Oh. You have 4, so 5 all.
Together 1. Amazing, guys.
That's great. Yeah, I'm happy to hear that.
So if one of those is goes on a vacation or is away for whatever
reason, it doesn't mean that you're now, you know, blocked
off until they get back. It means that you're, you're,
you can come in the next day, the same day and see the, the
(04:34):
clinician that's going to be very aware of your, your, your
current health problems because we all share the same EMR
electronic medical record. Yeah, let's just maybe talk
about that. So that is, that's a key.
That is, that is a key, it's a key enabler for, for being able
to share what's happening with that particular person and also
prevent that routine that you that you get usually in the
(04:56):
system where you see somebody and then the next person asks
the same questions over and overagain.
And and and you know is this tire same and and inappropriate
so. This person has the ability to
well. I think it does it and you know,
you kind of have a lower expectation that, you know, they
don't know me. I I got to start all over again
and that doesn't happen in this in this.
(05:16):
Well, I think that's great. So those are two distinctions, I
guess. Now I want to turn to Shauna.
Shauna, you were a solo practitioner.
I can't believe it really in this day and age, hard to think
that somebody gets out of medical school and actually
decides to hang up their shinglethemselves and and go go for it.
But but you did that and then eventually found your way to the
(05:39):
mentor clinic. So, so tell me a little bit
about, you know, how, how did that all happen?
You came out of medical school, you did your thing and then you
have changed gears a little bit.Maybe tell us your path?
So I don't think you'll be most of the family physicians
listening to this won't be surprised to hear that we most
(05:59):
of us have been working all along in solo practices.
So I just, I had that expectation that this is what I
was going to be doing. And in fact, it was, it was
really overwhelming. To your point, I remember taking
over a practice, established practice of someone who'd been
there again, in solo practice, just sharing space with a, you
know, administrator for 17 years, being, you know, all
(06:23):
things to all people. And I thought, OK, I'm just
going to need to, you know, fillsome big boots pretty quickly.
And so off I went, you know, andI am enthusiastic, hard working,
smart, willing to bring everything I had to the role
people, you know, were happy in general with, you know, with the
(06:44):
care. But I soon realized that this
was not something that I was going to be able to sustain
because the hard work was not translating into people actually
being healthier. And there was just more and more
and more and more. And this is the situation that,
you know, as I say this, I'm sure it's resonating with a lot
(07:06):
of the family physicians who arecurrently work in HRM.
And so it when this opportunity to consider a different model
came along, it only made sense to me that being part of a
collaborative clinic was going to allow me to actually sustain
what I needed to do, which was, you know, diagnose, treat,
(07:27):
manage, help people with their health and help them to actually
be healthier and happier. So that was that was how I
started from. Being.
From being overwhelmed to thinking, OK, I need to do this,
I want to do this. I spent eight years and then two
more years in residency getting ready to work as a family
(07:50):
doctor, helping people with their health to be healthier,
and I was not going to let that dream go.
The right niche. I think it's interesting because
I, I, I, I dare say the general public, including patients,
don't realize that in a smaller office, you're the, you're the
(08:10):
Internet person, you're the Microsoft 365 person, you're the
phone person. And of course you go to medical
school or law school in my case,they certainly don't.
Those are courses that you take and yes, you can hire people to
do it, but that's money. And also if you're contracting,
(08:32):
that takes time. It takes time for the IT guy to
get there and fix it all up or the phone guy and, and you know,
you, you don't have the time. So it's very stressful.
It's scary. And I don't know if that's
partially what you experienced, but that would make me like very
stressed out. Yes, exactly.
So that business part. The business side of it.
(08:52):
We have the most amazing organized administrative and
management team. At the Mentor.
And we just know that when we get there, we're going to have
everything we need to manage ourday and we can just take it from
there. I think that's great.
You know one thing we we never talked about where the physical
space is. So where Where is the physical
space of mentor Clinic? Ground level Gladstone St. and
(09:14):
again, after a number of years moving around to many different
locations, fantastic accessibility that has to be #1
and bright. And we're working on making it
welcoming and the flow to be safe and organized to respect
people's confidentiality. So we're growing.
Watch out. We're taking over the entire
(09:36):
floor. And you have a million square
feet next to you of a park of Richmond yard.
So I don't see your population base shrinking anytime soon.
So it's quite a change from whatyou started in practice to to
where you are now. So that's great.
So we'll we'll come back to whatyou're doing now.
(09:57):
And I just want to turn to Teresa.
So the snapshot, Teresa, you didsome time spend some time you
spent some time in on in Ontarioand then you moved like back to
Nova Scotia or to Nova Scotia. Moved to Nova Scotia.
Nice, so So what was your path and your choices?
(10:20):
So I was working at a family health team in Ontario, which
is, for anyone who hasn't been to one, typically a
collaborative, quite a collaborative site.
We have a lot of the same providers that we have in our
current health home, but all under the same roof.
And when I moved here, I was a member of different health
teams, but while we shared the same roof, it we didn't
(10:40):
necessarily share a lot of the patients or have the same level
of supports in those teams. So I really like the opportunity
here to work collaboratively with all of the extra
interdisciplinary team members. And to Shawna's point, that
feedback loop as a provider is really, really helpful.
Yes, you can send your patient out to see a dietitian or the
(11:03):
pharmacist in the community, buthow often do you get a letter
back that explains what happened?
And in this instance, she can just come to my doorway and tell
me, hey, guess what, this patient you sent me, we made
huge strides and now her A1C hasdropped three points and all
because of dietary changes. Yay for us.
It's it's fantastic. Yay for the team, it is
(11:24):
fantastic and you can celebrate together along with the patient
instead of waiting. Absolutely.
That's great. Now, Teresa, just before we
really dive into a few other elements, metrics, who runs the
show on the metrics in this, in this, in this?
Group I wear another hat. I'm the director of Quality at
(11:48):
our clinic. At the clinic.
At the clinic and I have some experience doing some quality
improvement stuff in Ontario because that that's big there
that those metrics are tied to funding there.
So here, you know, as a collaborative group in this
health home, we wanted to show what we're doing makes it.
Matters exactly so patient outcomes.
Patient outcomes access. So for example, I track our
(12:10):
third next available appointment.
When Shawna and Jill joined us, you know their third next
available appointment wasn't fantastic.
Well, what does that mean now? Just break it.
Down. Can you call us on that?
Table. So let's, let's just just just
just work with me here. So explain exactly what that
means, because there could be people here who have no idea
(12:30):
what we're talking about. Same day, next day, third day,
7th day, six weeks. So, so you call your doctor
because you have, you need a Medrefill, for example, and they
say, sure, you can come in in six weeks, but I'm out already.
I, I need it now. So that access point is really
(12:51):
important. Or for something urgent, you
know, maybe you have a sore throat and you want to be seen
for a strep throat. Or maybe you have a new
pregnancy and you want to be seen by your doctor for the new
pregnancy. And you're told as a patient,
yeah, you can come in in six weeks or however long 8 weeks or
longer. It can be stressful on the
(13:12):
patient. So the 3rd next available
appointment takes into account that that position or nurse
practitioner might have a cancellation that offered, you
know, oh, I have an opening today.
But really the third next available is more predictive of
their availability to their patients.
So let me understand this. Is this a principle that the
(13:33):
clinic has adopted as a path forward or?
We're trying to make it our access open as open as.
Part of your rule, yes. Yeah.
So when Sean and Jill joined us,third next available access, 3rd
next available appointment was probably in excess of 3 1/2
weeks approximately. And we've dropped that
(13:56):
consistently to about 7 days. So how did, how did, how did you
get that down? We have team based Care now, so
that person who sprained their ankle for example, they can be
seen by the physiotherapist instead of Shawna who might say
you need to go see the physiotherapist.
So that's that extra appointmentstep that maybe doesn't need to
(14:16):
be there. And it's a lot of efficiency in
the sense that, you know, you wait just say, just say six
weeks to see your family physician and family physician
says, well, that's great. You have a sprained ankle, you
need to go see the physio. So that's another X period of
time. So it's it's really is a true
compression of time, which. Right.
(14:37):
And everybody leads to a better outcome for the individual.
Seeing the right provider at theright time as well.
So maybe they need to see a pharmacist first, maybe our
nurses. So they do a lot of the
immunizations. Shauna was previously doing
those immunizations A a nurse iscapable of doing those
immunizations and that opens up an appointment for.
Her yeah, pap smears. But but the other thing I think
(14:59):
it's also just talking worth talking about is is the duty
clinician role, yes, in terms of, you know, cutting back that
that third available. So we have same day access at
our clinic. All of our physicians and nurse
practitioners take a turn each week as as some collaborative
teams do, doing urgent same day appointments.
And that has really allowed all of the patients of the clinic to
(15:20):
be able to access care when theyneed it as opposed to attending
a walk in or emerge when it's something we can solve and we do
know them. Now And, and, and so just going
back to the metrics, so you run that part of the operation
through you keep tabs on on that, so to speak.
And I'm sure you all look at it.We do, yeah.
So I want to come back to. But if I can just to interrupt
(15:42):
just for a second, but but I think one of the other
challenges we we encountered early on is that there aren't a
lot of metrics that are used by the system currently.
And so we've been, we've had to make up our.
Own. Yeah.
We've had to devise both clinic performance.
We want to look internally, how are we doing?
And that comes to surveys and other things, but also the
numbers that we're coming up with, we think are important
(16:04):
from, for, from a system point of view.
And so we want to share this andsay, you know what, I think
everyone should be looking at these numbers.
And we, we got to figure out howwe extract it from the EMR, from
the electronic medical record. And that often means using it
the same way uniformly across everybody.
So whatever you put in, you got to be able to get at.
So that's been a big project, making sure everyone's using the
(16:26):
EMR the exact same way and then try.
To do that across the. Province.
Well, exactly. That's right.
It's a huge, it's a huge change.It's a big.
Change but but necessary so thatyou know you're looking at
apples and apples. Right.
It's if you know, if you don't do it, then you then you're just
blind. Yeah, exactly.
So I'm interested in the culturea little bit.
(16:48):
You know, I think culture, something I'm very conscious of
because of course, Nova Scotia Health is one of the, it's the
largest employer in the provinceand it was a coming together of
Regional Health authorities, if you can believe it, 10 years
ago. And you know, certainly for me
(17:08):
when I first experienced going around the province, very, very
different cultures. Now you know, we're moving to A1
team team, but that does take time and it will never be fully
A1 team team and and I don't think it should be, but but I
just recognize how important culture is and culture being
(17:30):
attached to the leader, but alsoto the vision, to the mission,
to the values. So I'd like to hear, you know,
your thoughts around that John and and team.
Yeah. I mean, I think going back to NS
Health, I mean, we've divided itup into four zones, which I
think has been helpful in terms of maybe some micro, some micro
macro cultures that have that are able to kind of do their own
(17:51):
thing. So that that's been helpful.
But I mean, I think the, the keything for us was we have been
fortunate to be able to interview and and hire people
based on fit. And so, you know, here's here's
the philosophy that we're tryingto go with.
We, we not only want to be a clinic that deals with the usual
(18:13):
chronic disease management, which is sort of the, the, you
know, the general mantra out there.
And, and I get it, there's a need, but we wanted to also go
upstream and be willing to challenge our patients,
challenge ourselves in terms of how do we try and keep people
healthier? How do we promote a, a better
awareness of the one's own body and all the things that, that
(18:35):
are required? And so you know, that that's a,
that's a certain kind of mindset.
And, and, and so we've been fortunate to, to basically put
together a team of people who, who all are, are, we're all
rowing in the same direction, which is great.
And, and we have a, a, a non hierarchical arrangement.
We were, I think in some ways fortunate, and this is no
offense to Shauna, but we, we started off as mostly an NP
(18:57):
centric, nurse practitioner centric clinic.
It was, it was them first and then the doctors were added
next. It's kind of a, you know, we
backed into that in, in some ways.
And, and so that's been important.
We, we meet as a whole group andthe, the administration group is
there the, you know, all the, the, the supporting the, the
actors, the the dietitian and, and exercise physiologists.
(19:19):
We're all in the same room talking about patients and
processes. And so we process problem solved
together. I think trying to keep this as
non hierarchical and as broad based and also respecting that
the dietitian and social worker bring huge and others, but they
bring a lot to the clinic. I, I, I've, I've also sort of
said, you know, if I made my, myideal clinic, I would start off
(19:43):
with a social worker, a dietitian and a clinical
exercise physiologist as the core, not the usual doctor nurse
combo. And why do you?
Say that, John, why? Why do you say that?
So I find this really interesting, right?
And I'm sure you have thoughts on this.
I don't know about you folks andyou can certainly.
Wait, I I'd add them. Yes, but you know, think about
it. You're an ER, you're an ER doc,
(20:03):
right? You're an ER doc.
This is your life. I'm, I'm, I'm an ER doc now.
I'm not. I mean, you are of course, but
you're doing something very different and you have the
opportunity to recruit that's fitting into a particular set of
values and so forth, as you've just described.
So, you know, how do you get to that place where you say the
(20:27):
first people I would choose if Iwas starting from scratch again
would be this particular clinician and this particular
clinician? Yeah, you're speaking to a
weirdo as and I know you know that, so.
Well, we're all a touch and a little bit touched.
So as an emergency physician foralmost 30 years, I was a, a
reactive disease care specialist, you know, my, my job
(20:49):
is to show up and whatever comesin the door, they're going to be
sick people and they're going tobe injured people.
And that is, that's that, right.I didn't really practice care
for health healthcare for reallyany of my practice.
I mean, I, you know, occasionally I would say you
should stop smoking. You should, you know, exercise
more, you should change your diet.
But, but that doesn't, that's not effective.
(21:09):
But most of my time was spent reacting to disease as it was
already presenting. And towards the end of my time,
I was just struggling because I was getting busier and busier.
The wait times are getting worseand worse.
We're putting all sorts of things in.
But, but you know what? We're not winning the game
because folks are out there in the world facing all the
stresses and strains of life andgetting sick.
(21:31):
And so we needed to, we need to play a different game.
And part of that is putting moreof a, of a, of a, of an onus
and, and attention to those who can help us understand whatever
I fuel myself with put inside mybody.
You know, as a dietitian, it that's important news, right?
You know, and all the society tells us to buy a bunch of bunch
of junkies sort of stuff. But really, you know, you got to
(21:54):
choose the right fuel. You got to move your body 'cause
we were designed, we got an incredible machine.
And unless we use it, we lose it.
And the social worker, I mean, again, life is stressful and
it's crazy. And so those three to me are
kind of core people that get theget the foundation right.
And then if things you get a little bit sick, great, Shauna
(22:14):
and and Teresa and colleagues are there to help.
So the Wellness. Repair you.
The Wellness and then the. Foundation.
So thoughts, thoughts on that, Shauna?
Like, is that something that talks to you or, you know, do
you? Have a different.
Or do you have a different approach?
100% and I just wanted to weigh in to your point about the
culture. Yeah, it is, as John says, a
(22:35):
secret of our success at Mentor Clinic because we respect each
other. We spend time together as a
team, team building. So this is how we understand
each other in terms of the scopeof our practice and the
expertise. And you're absolutely right,
those determinants of health arewhere it begins.
(22:55):
And we keep talking about healthand we call ourselves Nova
Scotia Health. And this finally, since I've
been working at this practice, this clinic feels like we are
helping people to actually be healthier.
And, and to John's point, it's because they can live healthier.
So when they live healthier, moving well, eating right, and
(23:16):
having the supports for these inevitable stresses that come
along, guess what? They have less acute illness and
they're chronic diseases if theyhappen to have them because, you
know, things happen, they're much better managed.
And not only that, the patients feel empowered.
So in terms of the culture, patients feel more positive
(23:38):
about their own situation and their ability to control it.
And they know that we've got their back in a serious way
because it's not just what theirdoctor can do for them, it's
these other things that they're able to access if and when that
time comes, when they need thoseservices, when their health
declines. I think it's really important so
they have agency, they have control.
(24:00):
I mean, this is what people want.
They just don't necessarily knowhow to go about achieving it.
Exactly. And they need that ongoing
support, as John was saying, 100.
Percent Doctor Google doesn't solve everything, and fact can
make it even scarier. From time to time.
Yeah. And Teresa, what actually
brought you to Nova Scotia? Was it this clinic or you?
(24:23):
You. No.
So that's another story. Is it?
It's a different story, OK, It'sa different story.
But you found your way to mentor.
Yeah. And and do you have any
additional comment on culture orany aspects of the operation
from your perspective? I think the culture like these
guys have mentioned, you know, it takes time to build.
(24:44):
So all the people listening, youknow, it's scary opening up your
practice. Change is hard.
It is. It's hard.
It's hard for for any provider to join a new team and then just
openly trust other individuals. Hard for you?
I mean a little bit, but I've worked in big teams before.
(25:04):
And you're probably an early adopter, which is another, you
know, can be good or bad depending on the situation.
Teresa. Thought huge experience to this,
to our community. She has been immensely helpful
in terms of helping us figure out what the priorities are,
where you know, where are we, where are we going?
Absolutely. It's easier for me to jump 2
(25:25):
feet in because I've I've seen it work and I know it works.
But you know, for someone like Shawna who's practiced and has
all these patients, these, these, this is what she's
dedicated her life to. And I understand the resistance
to, you know, well, but I know Ican do it and I know my patient
are, are you going to do it as well as I can?
So we have to honor that and take time to build that trust
(25:49):
with with our providers. And as we have new providers
join the team. Like I've never worked with this
exercise physiologist before. I don't know what she's capable
of doing. So learning each other's roles
was great and we spend time every three months doing some
rounds on our patients and we can use each other and, and
bounce ideas off each other. Like I have this patient and I,
(26:12):
I'm just struggling with this question because they, they have
all these complex factors and what do you think I should do?
And it's nice to have, you know,a social worker in there and
being like, Hey, did you know this program exists?
What No and it's just more resources and then it it helps
with. The ready, though, I think
that's the other key. It's it's at the ready, Yeah.
So it's there's no waiting. I don't have to wait six months
(26:34):
to hear that. Answer exactly, which I really
think people, you know, teammates and the patient really
appreciates. It's very comforting, yeah, that
you have the level of expertise in in your own office.
And the access, Karen, to your point, that's the biggest crisis
in healthcare right now is access.
So we have that. Access, which I think is great.
So, you know, I hope that there will be a number of family
(26:58):
physicians listening to this. We'll make sure that we try to
get it out as best we can. But I think for you, Shawna, you
know, what would your biggest message be to a family physician
who perhaps is in the same spot that you found yourself before
you join Mentor Or you know what, what would you like them
(27:19):
to understand about your new life?
Again, it's you're not hearing it here for the first time.
We keep hearing even within the circles of family medicine
across the country. Find yourself a health home.
We providers need health homes just as much as patients need
them because again, it allows usto function in a way that we can
(27:44):
be inspired to provide better care.
We can be supported in providingthe best care.
And previously, as I, you know, mentioned with your first
question, we found that we were working just as hard as ever and
following the guidelines, but weweren't achieving the outcomes.
And both patients and myself as a provider, we're feeling less
(28:09):
and less engaged in the process,less, less agency in the
process. And as you know, access just
keeps continuing to deteriorate.So things would fall on me even
more than before. But here I we have the
supportive team and and yes, to Teresa's point, embrace the
(28:31):
roles of the other providers. I always understood that healthy
nutrition was going to lead to better outcomes for both, you
know, acute and chronic disease management.
And I would do my best. Well, again, having access to
someone who not only has the time to do this, but it's their
whole career and their expertise.
(28:53):
I continue to be amazed by the skills and, and abilities of
these other providers to, to, todo their roles.
And I welcome that. No one ever said that the
physician had to be the leader in the in the top of the
pyramid. To John's point, we sort of
(29:15):
breeze in and out in different, you know, aspects of people's
lives. But actually they do the living
and the support can come from anywhere as long as it's there.
I think that's a great answer. I think, you know, I hope that
there are folks that are hearingthat and maybe start to think
about what it could mean for them and maybe stick around a
(29:38):
little bit longer, whether it's part time, full time, some kind
of time. And I guess a question for you,
John. You know, if somebody out there
was interested in seeing what itwas all about, I'm sure you'd be
more than happy to give them a little inside baseball and.
Drop drop in we my emails available.
(30:00):
They're mentorclinic.ca is on the website.
You can find out how to get where we are and you can love to
to give some tours and, and, andhave a chat.
You can come to one of our Thursday afternoon meetings and
see the whole team just kind of exchanging about stuff.
I think that would be great, andwe'll make sure that we put that
in the notes for the podcast. So I'm going to give the last
(30:20):
word to you, Doctor Ross. You know, this is quite an
odyssey. It's been quite a change.
I love the metrics. Of course, I love the data, love
the idea of collaboration and working in a team.
I mean, I, I personally come from a professional services
background where it was always team and when you had a problem,
(30:42):
you walked down the hall and youfound the person that could help
you. So I, I get that, but if you
haven't had that experience, then it's a real change.
I don't know how I would have done otherwise.
So that's, but that's just, you know, my own personal experience
in the workforce. So, so you know, sum it up for
us. OK, I'm going to, I'm going to
(31:03):
say I'm going to repeat. Change is hard.
Change is continuing to be hard.It's this is, you know what
we're, it's hard, period. And then that's why many people
don't either try it or they giveup because it's hard.
So I'm happy to admit that, you know, we've been talking about
very positive sort of things, but I think I wanted to give
(31:25):
some evidence based to that, that we have been doing
anonymous surveys with our staff.
We've been doing anonymous surveys with our patients,
getting feedback on the good, the bad and the ugly of how are,
how is it going in terms of a staff experience?
How's it going in terms of a, ofa patient experience?
And you know, there's been good constructive suggestions,
absolutely as balanced feedback.But you know, there's I'm, I'm,
(31:51):
I'm, I pinch myself over the honeymoon that continues.
I mean, people are just really positive about how this is
going. I mean, and there are
unsolicited statements like from, you know, people who you
wouldn't otherwise guess that this would come from them saying
my, my, my, my sense of well-being, my general overall
health has improved my attitude towards whatever I'm feeling
(32:11):
more engaged in, blah, blah, blah.
I mean, it's just, and Teresa can probably give you more
details around those specifics. But, but again, I've just been,
it's been very heartening to know that although we we can
kind of feel positive in Kumbayaabout all this, there is some
there is a real on the ground level that supports that.
You know what, we're doing the right thing.
(32:32):
This is a no brainer design. The specifics of the team, you
know, will be variable dependingon which community you're
talking about. I don't think, you know, we
don't have to have the magic ratio of of people, But but this
team based care I think has beenso super supportive to the
providers as someone who was saying and the patients are
feeling like they're they're being listened to.
(32:52):
I think that's key the but, but it does actually 'cause me to
ask 1 slightly provocative question and not, not
provocative to this table, but just a general which is, you
know, it does get said once in awhile, particularly it's
(33:15):
reported. And I'm talking nationally, not
just in Nova Scotia. You know that the goal has to be
a provider for every Canadian. Let's just go there.
Provider, meaning either a nursepractitioner or a family
physician. Now this is a little bit
(33:35):
different from that, but not notfully.
And I, I think it's really important to maybe drive that
home. So, you know, when you hear that
kind of a comment, what what, what's your reaction?
Don't start. Oh, yeah.
Damn. So the patient first of all, who
gets signed on to our clinic is,is as we said, a member of the
(33:55):
clinic, but they are currently so and they're either going to
be with a nurse practitioner primarily, although again shared
amongst a few or, or, or the physician is we have some
physicians that are physician istaking some of the patients.
So, so it's still an attachment thing that's still a bit of a
legacy. I think what we're going to end
(34:16):
up doing is dividing up into kind of a a more micro team
base. Will there be a doc nurse
practitioners and a nurse that would be your kind of go to like
the the the blue team and the green team?
Exactly right. So that if if the doctor isn't
isn't available or there that day and that was the person you
tended to see more often, you'restill going to see you're going
to see someone. It's going to be the nurse
practitioner, but it's the person you're going to see more
(34:39):
often as a smaller little group.Then if you were just sort of
coming into a clinic that had 10providers and it was kind of
like, oh, you know, 1 of 10 is going to see me.
That's that's a bit too broad. So I think there is out there
both the providers want to see the continuity of care too.
They, they don't want to be shift workers.
No, no, So I, so I think, you know, I, I, I this is, this is
(34:59):
absolutely people again are finding like, wow, I didn't know
that I didn't have to not, you know, I didn't have to see the
doctor. The same person every every
time. A little bit of this is
education I. Know it's a big piece.
It's a change management processagain.
For for. For the public.
The public. So comments Teresa, Because
you've seen it in two provinces.It's nice to be familiar with
(35:21):
the provider and it's nice as a patient to have that person have
that knowledge of you and your healthcare and your family and
your situation. But there needs to be a balance.
So if Shawna wants to go on vacation, she should be able to
do that without worrying that who's going to look after my
patients and her patients shouldn't have to worry that who
(35:44):
am I going to see? So, you know, attaching to one
person puts a lot of pressure onthat one person.
And yes, you could have urgent things.
Oh, my colleague will cover for me in this urgent situation.
But that's short term. That's not long term.
What if Shawna wants to take twoweeks instead of one week?
Or a trip of a lifetime. She wants to go to Australia.
(36:06):
What if she needs to go away from?
Or what if someone gets sick or,you know, has a life event that
that takes them out of the the workplace for a little bit
longer? You don't want those patients
feeling orphan. Do you want them feeling like
you know what this person's not here, but I can still see
someone who knows me and knows my history and can provide the
(36:26):
care that I need in that person's absence.
And the provider has that security that they don't have to
worry their their patients will be looked after I.
Think that's really what? There's also been the benefit
though, too, that an alternate set of eyes on someone.
If we, we've got lots of examples where someone said,
(36:47):
hey, do you know, what did you think about blah, blah, blah.
Or maybe do you think it's time to for this kind of test and you
think, yeah, you're right. I'm just kind of completely out
of mind. So, so there's been a, there's
been a real, I think benefit in that cross pollination of, of,
of ideas. Excellent.
Any final party. Yeah.
I would just like to say, you know, just as again to other
(37:07):
family physicians thinking of something like this, it is just
really freeing in terms of increasing your capacity to to
be attached to patients so you wouldn't feel as overwhelmed by
your roster because you're not the one who's everything and
anything to everyone of those 2000 patients.
For example, on my roster now I know that I that there are nurse
(37:31):
practitioners available to see them on days when I'm not there
and still diagnose and prescribethat there are family practice
nurses who are more than capable, oftentimes helping
people meet their diabetes outcomes better than me
connecting them to, they can connect them straight to the
dietitian if they feel it's appropriate.
And for example, the well baby care they can provide a lot of
(37:55):
the, the well checks, the routine assessments, the
developmental screens. And then instead of spending
half an hour or 40 minutes as the NPS would with those visits,
I can spend 15. Theresa May spend 20.
But we can focus that time reviewing everything, making
sure that, you know, we're happywith the overall way things are
(38:16):
developing with the child and their growth.
And inevitably when the parents have questions, which may very
well require someone, you know, with that diagnostic capacity,
we have our full attention to beable to focus on those instead
of because the routine metrics have already been obtained.
So it's just a win, win for everybody, but again, including
(38:38):
the providers to increase capacity to be able to take on
more patients in the clinic. And you're probably aware we've
been able to take more patients in the clinic.
And and keep it coming. Ongoing keep.
This coming, Teresa, I want to see those metrics.
Keep it coming. No, I'm teasing.
I think. Look, you, you, you're doing
exactly what we've been envisaging, you know, having
(39:01):
teams where each individual can work to the top of their scope.
I mean, that's really what we where we have to go and it's
exactly what you just described.So I'm, I'm so happy that the
three of you were able to join today.
It may spur more conversation. I hope it does.
I think a lot of it is educational in nature where we
need to take Nova Scotians. We'll see what kind of response
(39:22):
we get and we'll make sure amongst the four of us we send
it, you know, far and wide so that if, if people want a Part
2, they can have a Part 2. And if they want a tour, they
can have a tour. If they want to talk to a member
of the team, they can get a better snapshot.
So I really appreciate your timeand what you're doing.
Nice to meet you, Shawna. Nice to meet you, Teresa.
(39:43):
Keep the good times coming. Thanks.
Thanks for. Thanks for the opportunity.
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