Podcast

Doctors Manitoba

September 12, 2022

Trina Larsen, Director of Planning and Physician Health at Doctors Manitoba, discusses their three-year Communities of Practice Pilot Program. Trina and her team have developed physician-led, evidence-informed action plans for systemic change.

The program addresses the broad, institutional issues that drive physician burnout and distress. Small pilot hubs give doctors a voice and provide them with avenues for informal peer support in otherwise isolated, remote communities.

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This episode is available in English only

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How Communities of Practice Support Communities of Wellness

Trina Larsen, Director, Planning and Physician Health, Doctors Manitoba

Healthy systems can support a variety of people. In an unhealthy system, however, even the healthy struggle to thrive. At Doctors Manitoba, our goal is to give every physician the support they need to deliver exceptional care. That support begins with working towards a health care system that is as healthy as possible to allow physicians to flourish and, in turn, provide the best care they can.

Our three-year Communities of Practice pilot program explores the interconnectedness of system and physician wellness, supports dynamic relationship building and encourages collaborative learning.

doctor with laptop during a virtual meeting with other doctors

Our three pilot hubs bring together physicians, administrators, and other key stakeholders into groups of eight to 13 members, who focus on learning about the challenges physicians are facing in their regions. The groups then leverage this new knowledge to develop grassroots-driven and evidence-informed action plans that can drive systemic change, rather than interventions solely intended for individual physicians.

By organizing our Communities of Practice in this way, we recognize that a major driver of physician burnout and distress are institutional factors and seek to address these broader system issues.

In addition to the plans created within these groups, physicians have told us that they have found these hubs to be a refuge where they can count on having informal peer support from their colleagues. Hub members report feeling connected, understood, and valued.

This connection is critical, as our project focused on rural and northern Manitoba, where isolation is a common issue. They may be the lone physician in a particular community, or they may be separated by a geographic boundary from other physicians. We know that there is important knowledge everywhere, and we wanted to facilitate collaboration through connection, to help build awareness about how the regional health authorities can support physician health both locally and potentially across the country.

The three pilot hubs have currently just finished developing their action plans. Some of the proposed actions can be implemented right away, others might take a year or two. Doctors Manitoba is committed to supporting the regions and monitoring their progress to ensure the action plans deliver results.

Among many other insights, this process has reminded us that physicians are also valued decision makers. They have thoughtful, creative, and well-informed views. Physicians are used to being experts in their fields. And so, to come together to learn about something new and gaining expertise in that new field or topic, has a significant impact. As champions of change, they can initiate a powerful ripple effect about how we think about physician wellness, the impact on our communities and the health care system overall.

Physician health has never been more important. Across the country, health care systems are going through many changes and facing unprecedented challenges. Being able to develop and sustain a strong workforce where doctors are also included in key conversations and invited to the table to influence health policy is critical.

Systemic change requires time, creativity, and commitment to doing the work, but it doesn't always have to cost a lot of money to move the needle. At Doctors Manitoba, we are committed to continuing this work, and we are grateful for the support of the Canadian Medical Association, MD Financial Management and Scotiabank.

The Canadian Medical Association (CMA), MD Financial Management Inc. (MD) and Scotiabank together are firmly committed to supporting the medical profession and advancing health in Canada. As proof of this commitment, Scotiabank, in collaboration with the CMA and MD, is investing $115 million over 10 years to support physicians and the communities they serve across Canada.

TRANSCRIPT

Welcome to Physicians First – a podcast series that explores unique and home-grown wellness initiatives that are impacting the lives – and livelihoods – of Canada’s physicians. In this series, we’ll introduce you to the people creating customized solutions that improve physician health and wellness and strengthen the medical profession – whether through coaching programs, peer support groups or leadership training sessions. And you’ll hear how these initiatives are making a difference to physicians.

The Canadian Medical Association, MD Financial Management and Scotiabank together are firmly committed to putting physicians first, supporting the medical profession and advancing health in Canada. As proof of this commitment, and in collaboration with the Canadian Medical Association, and MD Financial Management, Scotiabank is investing $115 million over 10 years to support physicians and the communities they serve across Canada. This podcast is just one of many initiatives. Physicians First is hosted by Dr. Caroline Gérin-Lajoie, a psychiatrist and physician wellness expert.

Dr. Caroline Gérin-Lajoie: Welcome. I'm Dr. Caroline Gérin-Lajoie, a psychiatrist and wellness expert, and host of Physicians First, a podcast exploring important topics related to supporting physician wellness. Today, I'm pleased to welcome Trina Larsen from Doctors Manitoba. Trina is a director focused on planning and physician health on the Doctors Manitoba Physician Health and Wellness Team.

By way of introduction to the organization, the purpose of Doctors Manitoba is to give every physician the support they need to deliver exceptional care to Manitobans. Today, Trina is here to discuss Doctors Manitoba and their Communities of Practice initiative and the impact of health system wellness on the health and wellbeing of physicians.

Trina, welcome.

Trina Larsen: Happy to be here. Thank you.

Dr. Caroline Gérin-Lajoie: Trina, let's begin with a short overview of the work Doctors Manitoba does. And can you tell us how the organization advocates on behalf of the province's physicians?

Trina Larsen: Sure, Caroline. So, Doctors Manitoba is the professional association for physicians and medical learners in Manitoba, and we believe in a healthier future for everyone in our province and that physicians and learners can contribute to that. So, we work on our members’ behalf to advocate, to provide a united voice for the profession and to help build a better system where physicians can deliver the best possible care to Manitobans. We also work to try and improve health policy, to influence health policies, so that patients have better access to physicians across the province.

And we regularly connect with a variety of different partners from our provincial government to the regional health authorities and other organizations to ensure that physicians voices are heard and they have a meaningful impact on decision making.

Dr. Caroline Gérin-Lajoie: Trina, I know that you and Doctors Manitoba believe in the critical importance of addressing physician wellness at the system level. Can you talk a bit about why a focus on system-level change is so important?

Trina Larsen: The reality is, is that health systems can support a variety of people; in an unhealthy system, even well people are not going to thrive. So, it's important for health care in Manitoba that the system is as healthy as it can be so that physicians and learners can do their best and therefore provide the best care for Manitobans.

Dr. Caroline Gérin-Lajoie: Around the same time, I think there were changes in health care in Manitoba. Can you tell us a little bit more about that?

Trina Larsen: Certainly. I joined Doctors Manitoba in 2019 and there were two converging things happening. One, there was, I think, a change in the literature. Much of what was done by the CMA and their national physician survey, where we had Canadian data that talked about the importance of system-level change and the impact on physician health. At the same time, in our very own province, there was restructuring happening within the health system and that was having a direct impact on physicians and perhaps their ability to provide care. Through the literature and the evidence that was being put forward, we know that a focus on individuals physician resilience is not enough to have a sustainable and long-lasting impact on improving the health of physicians.

We know that it's important that healthy environments create healthy workplaces, create a healthy team and a healthy physician to deliver the best care they can.

Dr. Caroline Gérin-Lajoie: So, let's explore the idea of relationship building. Doctors Manitoba is involved in a three-year pilot project focused on a Community of Practice approach. Can you tell us how these Communities of Practice are inspiring change?

Trina Larsen: Sure. In Manitoba, our province is split up into five different health care regions. Each of those regions has a CEO, salaried physicians, fee-for-service physicians, etc. The whole gamut. Our thought was, wouldn't it be great if somehow, they're all learning together and then actually collaborating to figure out plans to address at least some of the barriers to physician wellness.

So that's where we started, looking for ways to bring physicians together and to facilitate action-oriented discussions that could ladder up to recommendations for system-level change. The three-year pilot project we’re running utilizes a Community of Practice approach that brings together physicians, administrators, and other key stakeholders, including Doctors Manitoba into the three pilot hubs. Each of the Community of Practice hubs has about eight to 13 members.

The hubs now are focused on learning about the issue together, discovering through some surveys and research that was done in their own areas, actually, what's happening in their own backyard or home regions, and then discovering more about what challenges physicians are actually facing. The groups are then taking this research and new knowledge and are trying to design programs and interventions and services to help the physicians in their community directly. And this is the key. The primary focus is on the development of grassroots-driven and informed action plans that can drive system change.

And what we're seeing is that sometimes positive change is about a mindset and about just doing something a little bit differently or engaging physicians in decision making and discussions so their voices can be heard.

And interestingly, in addition to these plans with the groups, there's also a lot of literature about positive physician leadership being a protective factor for challenges like burnout. So, the process itself is having a protective factor on physicians as well as those action plans and they end up with an end product produced that's going to be extremely helpful.

Dr. Caroline Gérin-Lajoie: So, it's exciting that this model goes beyond just sharing or peer support. This is really bringing the group to action and to solutions.

Trina Larsen: Yes. And focused on system-level interventions rather than interventions solely for individual physicians and resilience.

Dr. Caroline Gérin-Lajoie: Doctors Manitoba is really highlighting the importance of physicians being able to connect with their colleagues. How does that support your goal of increasing physician wellness?

Trina Larsen: The project has many different goals that we're trying to achieve, but one of them was also to improve connections and the individual physician hub of the people participating in the project. So, what is interesting about the project is we planned it before the pandemic and then the pandemic happened.

So, by the physicians coming together every two months to work on the project activities, they actually found themselves being able to connect with the colleagues that were a part of the project in a way that was not happening before. So, they've made new connections with physicians they may not know, strengthened connections with the people in the group, and had an opportunity to talk about what was impacting them on a personal level during the pandemic, but also how that influences what's going to happen in the project.

Our project is focused in rural and northern Manitoba, so by nature, some of these physicians already may feel isolated. They may be the lone physician in a particular community or may be separated by a geographic boundary from other physicians. We know that there's important knowledge everywhere, and we want to support the conversations that build awareness about how the regional health authorities can support physician health both here at home and also across the country.

So, receiving the funding from the CMA, from MD Financial Management and Scotiabank really enabled Doctors Manitoba to work in a way that has never done in the past, to try and be a catalyst for positive change and to engage physicians from a variety of different backgrounds in a project that is going to have a direct impact on not only their home communities, but the whole province and potentially the country. So, we're very excited.

Dr. Caroline Gérin-Lajoie: Trina, was it challenging to have physicians share with each other?

Trina Larsen: I think it was difficult to have physicians share and be vulnerable, but also to do it virtually. All of our meetings had to occur virtually, which was not ever something that was anticipated when the project was developed. So, we were learning, they were learning, but one of the other benefits with having our project manager involved is she quickly became an expert in all things virtual and was able to actually support the physicians. And what we found is that people started to share personal thoughts during the meetings. They also started to connect outside of the meetings, and they really found the Community of Practice hubs as a bit of a refuge where they knew they could count on having an understanding that peer connection, informal peer support from their colleagues where they would feel understood and valued.

So, it brought together physicians in a way that we didn't expect, but certainly we documented the benefits of that and are hoping to be able to replicate that and being able to go on this journey with them, learn about virtually how to best engage, has been very helpful for us.

Dr. Caroline Gérin-Lajoie: And I'm curious to hear if you find that the Community of Practice model and the virtual approach was helpful to diminish the fear of stigma that we know many physicians have about taking that risk of sharing wellness issues.

Trina Larsen: I think it absolutely helped to contribute to that. Within each of our Community of Practice hubs, we have a physician champion, and so they're meant to assist our project manager, but also to be that physician leadership voice for the rest of the physicians. So, each of our physician champions has a commitment to physician health. They have an understanding of it. Some of them have a lived experience, so they were able to share their thoughts and perspective and create a safe environment for the other physicians to share. The other thing that having a virtual component did is it leveled the playing field about disparities with geography or difficulties in people attending meetings, or if they have child care issues at home and things like that.

Physicians were able to participate in whatever environment they felt comfortable. In one of the hubs where we have our Community of Practice going, it's a very large geographic area separated by a large lake, and originally the project was meant to be in-person on one side because it would have been too difficult for people to travel. But, because of the virtual aspect of the project, people from all around the region were able to participate. So, that's been a very unexpected but helpful benefit of the program.

Dr. Caroline Gérin-Lajoie: How has funding helped facilitate the Community of Practice pilot?

Trina Larsen: Well, to be quite frank, we just simply would not have been able to do any of this work without the generous support of the CMA, Scotiabank and MD Financial. I think we were an early project to receive funding, so we appreciate the funders, you know, taking a chance and funding this three-year initiative.

Doctors Manitoba is a small organization. We have primarily focused on supporting the economic wellbeing of our members, so this was our first big attempt to try and have an impact on physician health. And so, to have the infrastructure funding to hire staff to do the work – really all of this comes from a human resource strength and complement that we need people to do this work.

Physicians are very busy, so to have a project manager support all of the physicians involved was paramount and the project simply could not have happened if the funding wasn't there.

Dr. Caroline Gérin-Lajoie: And were there also opportunities within that funding to support some physicians to access leadership training?

Trina Larsen: Absolutely. So that has been a very interesting part of the project, is that the physicians have learned the linkages between physician health, maybe in a very traditional or historical context about wellness in general. They've learned about the impact of system change and what healthy systems look like. And they've also learned that excellence in physician leadership can actually be a protective factor related to burnout. And especially during these difficult times during the pandemic, when physicians and physician leaders have gone so far beyond what has ever been expected of them, we need to have healthy leaders so that they can support their entire teams.

So, many of the physicians who have been engaged in the Community of Practice hubs have taken on this role, which was not expected for them. They've gotten additional education and learning and are now trying to branch out and be more influential, whether it's in formal leadership or informal leadership in the spheres of control that they have and to influence decision making. And they've all become advocates of system-level change related to physician health.

Dr. Caroline Gérin-Lajoie: So where does the Community of Practice pilot take you now?

Trina Larsen: Well, as I mentioned, our three practice hubs have just finished developing their action plans. And so, I cannot overstate the importance of having a physician-led action plan that has been endorsed by the senior leadership of each of these three regional health authorities.

So, there should be no surprises. So, if workflow efficiencies is an action plan, the CEO has already signed off that this is going to happen. If formal peer support for physicians is on the action plan, it's already been approved that it's going to happen. So, we have a variety of different plans throughout the three regions. They'll be starting to implement them over the summer and in the fall.

Some of them are quick and will be able to be implemented right away. Others might take a year or two but Doctors Manitoba has made a commitment to continue to support the project and the three hubs after the funding ceases. And we will continue to do that so that we can ensure that all of this work that's gone in to developing these action plans comes to fruition.

Dr. Caroline Gérin-Lajoie: And so, Trina, what have you learned about physician wellness through this process?

Trina Larsen: I think some of the main things that we've learned are that engaging with physicians in this particular way has not really been done before, to our particular knowledge. I think physicians are decision makers. They have the answers. Physicians are used to being experts in their fields. And so to come together to learn about something new, which perhaps takes a certain amount of vulnerability, but then to become the experts in that field and to champion things, we know there's a ripple effect that's happening based on what they've learned and what they're working on. We also know that we've done a rigorous evaluation of how we established the Community of Practice hubs. We certainly have a good sense of the things that we absolutely need to do to replicate the things that perhaps could be changed. We want to work with our partners to scale it to other areas of the country as well, where this could be a benefit. We are so pleased of the relationships that have been enhanced with our regional health authorities and the senior leadership there.

Physician health has never been more important in the world than it is right now, and that is no different in Manitoba. Our health system is still going through restructuring and changes, so to be able to have a strong physician workforce where physicians are also included in decision making and at tables to help influence direction about health policy is critical.

Dr. Caroline Gérin-Lajoie: And is there anything that you've learned in terms of system change?

Trina Larsen: As it turns out, system change doesn't actually always have to cost a lot of money for people to do the things a little bit differently. It takes time, creativity and a commitment to doing the work. And at Doctors Manitoba, we're absolutely committed to continuing doing this work.

Dr. Caroline Gérin-Lajoie: Those are very inspiring words, Trina.

Trina Larsen: Thank you.

Dr. Caroline Gérin-Lajoie: Is there anything else today that you'd like to share about your experience? In this project on Communities of Practice in Manitoba?

Trina Larsen: Well, just to say that it's actually been transformative for our entire organization as well, because we've also been able to do further education with our staff. We've taken a physician health lens and approach to all of the work that we do and, you know, to follow through on our mission of strengthening, supporting the whole physician, we are looking at physicians and learners from that holistic perspective. And so this project has been a real catalyst for us to do that work.

Dr. Caroline Gérin-Lajoie: Well, thank you very much, Trina, for an important and invigorating conversation. We look forward to learning about what comes next and how the interventions inspired by this process contribute to the health and wellness of Manitoba's physician community.

Trina Larsen is a director focused on planning and physician health on the Doctors Manitoba Physician Health and Wellness Team. And thanks to our listeners for joining us.

I'm Dr. Caroline Gérin-Lajoie, your host. And this is the Physician's First podcast.

You’ve been listening to Physicians First.

The Canadian Medical Association, MD Financial Management and Scotiabank are firmly committed to putting physicians first, supporting the medical profession and advancing health in Canada. As proof of this commitment, and in collaboration with the Canadian Medical Association and MD Financial Management, Scotiabank is investing $115 million over 10 years to support physicians, including the funding for the wellness initiative discussed in today’s podcast.

For more information, visit cma.ca/physiciansfirst.

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