Patient Health Homes: What They Are and Why You Deserve One

In this episode, Kyla sits down with Dr Ginger Ruddy, a family physician and consultant with the Saskatchewan Medical Association, to break down what a patient medical home actually is, why the traditional fee-for-service model is holding us back, and what the future of primary care could look like for every person in this province. From Swift Current's same-day access model to the barriers of union integration and funding gaps, this is a frank conversation about the shift that's already underway — and what it will take to get there for everyone.

Also, tune in at the end for another Shift Shout Out where we highlight an innovation from a nurse practitioner in Toronto who is reducing falls in hospitals and long-term care facilities across Canada with her innovative technology.  

Resources

·      Crowfoot Family Practice, Calgary 

·      Advancing Patient Medical Home: Insights from Swift Current 

·      Saskatchewan Medical Association (SMA) — 

·      Innovation Fund 

·      HALO Article (October 2025)

·      UHN Inventor of the Year

·      HALO Website

Transcript

0:13

Hi everyone, welcome to Shift. If you've recently gotten a letter from your family doctor's office saying they're transitioning to a patient medical home, you're not alone. I've had a few friends texting me saying they got this letter and they don't know what it means. And so I felt like it was a question that was probably worth having a conversation about because this model is reshaping how primary care is delivered across Canada. Today I'm joined by Dr. Ginger Ruddy, a family physician in Saskatoon who trained at some of the best medical centers in the U.S., built her understanding of primary care policy at Georgetown, and then after a fateful garden party in Prince Albert, made Saskatchewan her home. She now consults with the Saskatchewan Medical Association on how we transform primary care in this province, and she explains why the old system isn't working and what the new system could look like. We're going to talk about what a patient medical home actually is, why the fee-for-service model creates all the wrong incentives and some examples of what's possible, like when we talk about what's happening in Swift Current and Calgary and what it's going to take to get this care to everyone in the province. So let's get into it. Here's my conversation with Dr. Ruddy. Nice to meet you. I've heard so many things about you. I'm I'm anxious because I'm not a public speaker. Sorry, I'm finding my question list. So I have it. Um and I hope that I can give you answers that are helpful. And if I can't, potentially we could call in some of my more articulate colleagues who may be able to fill in blanks. Sure. And you know what? It's not even the public speaking gig, right? Like it's just I'm gonna ask. It's just a conversation. Yeah, we're just I'm gonna get to know you and I'm gonna learn about patient-centered medical homes. I mean, I know a little bit because I did work on the ED weights and patient flow initiative. And then that was sort of where that started popping up. Like Janet Reynolds was on that team, and that was yeah, that was her thing that we were trying to get pushed through or at least make awareness of it. So, um, but what I why I wanted to do this podcast and find somebody who could talk about it is because I've had a number of friends text me and be like, I got this letter from my doctor's office, and they said they're turning into a patient-centered medical home, and I don't know what that is. So I figured there might be more people that need some more information. And I find my podcast is getting a lot of like non-healthcare people listening who are just sort of interested in the healthcare system. So I thought this would be a good introduction to the concept because it seems to be moving more in that direction all the time. But I just wanted to start with you telling me a little bit of your journey to date and how you kind of got into this role, starting from wherever you feel is relevant. Okay. Um, it's an interesting thing to think about. So I am a family physician currently practicing in Saskatoon. Prior to that, I was in Seattle, Washington in the States for close to 20 years. Yeah. Um, with blips that we'll touch on because they end up being pertinent to the patient's medical home work. And then after undergrad, but prior to deciding I wanted to do medicine, I did some work that was sort of wilderness adventure trips akin to outward bound, but with different equity-deserving groups, adjudicated youth, adult psychiatric patients, individuals with serious medical illness. And so the interesting part about that work that pushed me toward medicine was the fact that almost everyone I talked to had had a really impactful experience of the world of medicine and of doctors. Most of them were not great, or at least those were the ones that they shared in this safe place. And it it made me decide, okay, well, I had thought medicine was completely impossible for me, but that made me decide I would give it a try. And so went and did the prerequisites because my undergrad didn't have anything, then did medicine and um was privileged to train in what is so the Texas Medical Center in Houston, Texas is the biggest medical center in the world. It's got at this point, I think 26 hospitals in walking distance. When I was there, it was 18 or 20. But it was a big concentration of medical research, clinical care, and learning. And it was a great place to learn, but it also highlighted for me the fact that people only end up in the giant medical center when they're not getting the right care first. Um, so much of care that happens in emergency rooms and hospitals can be avoided with good primary care. Um, and then I elected family medicine and moved to Seattle to do that training. And the Pacific Northwest in the U.S. is a place where primary care is better understood than it is in some other parts of the country. So there were really cool training opportunities there. And then I decided to do some research and some additional learning before I went into practice. So I went to Washington, D.C. and at um Georgetown did a program on primary care health policy and then community health center director development. So building some leadership capacity, but also trying to learn about what are the ways that we have to try and improve population health in addition to public health, sort of in the primary care context. Okay. Um, and then I came back and and started caring for patients full-time, which is cool with some teaching responsibilities, like most of us do. And I think the American context gives us so many insights. They um have a larger community of docs providing primary care. It includes pediatricians, it includes internal medicine physicians. Um, some obstetric gynecologists constitute primary care provision there. And so it's a little bit of a different market. But then, of course, the question of health insurance means that access to that care is so altered and so dependent on someone's workplace and their access to insurance services and so forth. One of the one of the cool parts about training there was that as I came up through the system, I learned about the patient-centered medical home, which is what they call patients' medical homes in the US. Okay, that was created in the early 90s by pediatricians providing care to children living with complex medical and mental illness. So they recognized that those children had much better experiences, much better outcomes, as did their families, when it was a team caring for them. So it doesn't matter if your doctor's on vacation, and it doesn't matter if what you need requires social work or nursing or dietitian or pharmacist. All of those people are familiar with your case and your situation and can can make sure that you get the right care from the right person at the right time, which is harder to do in a straight physician-only primary care office. So I got really excited about that and worked in clinics where we had team-based care, which was exciting. And then um I went to a garden party in Prince Albert, um, met a guy, and I like a year and a half later moved to Saskatchewan. Um yeah, it was a fun. It was a fun well, you know, you can't spell paradise without PA. So that's what I'm saying. Yeah. And so ended up up here and having born and raised in Canada, you know, was very, very grateful to be home, um, but wasn't familiar with the medical context because I'd never practiced. Um, and then did some what we call fee for service or private clinic locum. So covering for physicians who are out for various reasons, as well as doing a locum at the academic family medicine unit in Saskatoon, where the residency training program is, and then ended up getting a permanent position at the residency program. So right now I divide my time between them and some on-campus work supporting students, and then some consulting for the SMA around this question of how do we optimize primary care. So that was a really long answer, but no, that's great. That's really good context that we got here. Yes, yes. So, what were your first impressions when you came and started working in primary care in Canada versus your experience in the United States? Well, so in the States, they have co-pay. So even if you have very good insurance, you are either paying per month or per visit to see a doctor to get face-to-face with a healthcare provider. And so that impacts access to care for a huge number of people because if you have the choice between going to the doctor to see if this cold is anything serious or feeding your kids, people are often making those either-or choices, um, which is challenging. So I loved that there wasn't a copay and that people could come when they had a concern. Um, the Canadian system, because it's much more it's a much more straightforward business model. In the US, there are so many layers between the patient and the system that I remember I went to a doctor once for just a GI bug. And every time you go to the doctor in the States, you get what's called an EOB, an explanation of benefits. And it says, this isn't a bill. We're just telling you what we covered for you today. And they explained that my eight minutes with the doctor were billed at $330 US. Um, and it was literally for them to see me and go, Yes, you're throwing up and give me a shop a shoulder supplement. And um, but it's because every physician is supporting at least half a dozen other people's salaries in the organization because there's a marketing department and a billing department and uh an auditing department. And um, and of course, in Canadian medicine, that's not how it works at all. So when I moved here, a physician received $35 for that visit rather than that $330 US. Okay. And about 40% of that goes to overhead, about 40% goes to taxes. So at the beginning, you're taking home about $7 per visit. It made sense to me then why I saw physicians seeing patients so quickly, because you can't keep the lights on at that rate without seeing a lot of patients in a day. And so that part was, I think, disheartening to a degree because I thought, well, I love that everyone has access to care, but I hate that it's done in a way that you really only have six or eight minutes with a patient. Right. You've got to really move through the day to be able to generate enough income to support your practice. Because I think what people don't realize is like in the traditional model of healthcare, GPs are business owners, right? Right. Like they have to rent their space or buy their space, they pay their staff. So they bill the government and the income that they generate then goes to paying for all their supplies, all their staff, all their equipment. It's that's right, right? It's exactly right. Okay. And then, and then when they look at having done all of that, from that $7 that was left over from the visit, physicians are then going, so how would I hire an additional team member, a nurse or a medical dependency counselor, or a diabetic educator? And I think the way that the Canadian model is built, where medical care is covered by Medicare, but the services of a pharmacist or a social worker or a physiotherapist are not covered. What we've created is a situation where patients then come to the person that they know and that is covered to provide the services they need. So you end up with doctors trying to do the work of other professionals that we're not that good at. Like I'm a terrible social worker. I'm a terrible uh pharmacist. And so in trying to move toward a patient's medical home model, we are trying to make sure that the right person is providing that care for patients when that's the care that they actually require. Um, and that that is because it's it's in a situation where we don't have enough doctors, the doctor should really be doing work that only a physician can do and should not be doing work that can be done by another member of the team, right? Um yeah. And so we're trying to move toward that with things like the um transitional payment model that's come in in the last couple of years in our province, or the innovation fund, both of which are aimed at helping physicians move toward this team-based care model, this patient's medical home. Okay. And what does the transitional payment model, how is that different than sort of that business model that is the traditional setup? So, and when we say it's transitional, it's absolutely not where we want to be yet. It is a step on the way to a better payment model. So fee for service physicians who are paid as business owners by the visit are still paid that way. However, the transitional payment model says if you are taking care of a panel of patients longitudinally and you are their doctor, um, then you will also receive a small annual payment per patient that is to help with overhead costs and supplies and all of those pieces. And the reason that that was undertaken is because following the pandemic, um, healthcare was in crisis, and so many physicians were saying, hey, this isn't with the massive increase in costs, this isn't tenable anymore. I'm going to shut my doors. And and having people either reduce the hours of patient care they were offering or retiring early was further worsening our healthcare situation. And so the goal was to put the brakes on it and say, hey, let's make it feasible to stay in practice. Okay. So then where did this idea start to, or when I guess, did this idea of a patient medical home? And I don't know, there's patient center medical home, there's patient medical homes. I don't know what the terminology, health homes, I've also heard. Were there some innovators or pioneers in that space in Saskatchewan that started moving towards that model initially here? My understanding is that, yes. So I got to Saskatchewan in 2018, but my understanding is that 15 and 20 years before that, um, people who are now the leaders of medicine in our province were working toward that and trying to gain a foothold where they could build more of a team-based care model. Okay. Um, and struggled to to achieve that, but had consistently been working towards small incremental changes that would allow us to land on patient medical health care models. And you're right, there are lots of names for it right now, and we don't know what we're gonna end up calling it in Saskatchewan. Um, it will sort of depend on what resonates with patients, what is the right thing. Um, in in Ontario, their family health organizations and 14 other versions, and in other provinces, they have other different names. But the key part is that that team-based care piece. And so there were people over many years who were working toward that. And then I think um in the late 20 teens, um, Dr. Janet Reynolds, who came to Saskatchewan for a period of time and worked, having come out of a patient's medical home in Alberta, did a lot of work to advance the ideas and to spread understanding. And then when she moved back to Alberta, she encouraged me to uh engage with the folks who were working on it here. And so that's when I got to begin to get involved. There's been some tours and visits over to her Calgary clinic, right? Absolutely. Yeah. Yeah. And and the reason why we're aiming for this is for better patient care. Obviously, that's the most important thing. But also what they've learned with that complete implementation at Crowfoot Family Practice, which is where she works in Alberta, is that a physician who has an appropriate team around them providing care for patients can actually be responsible for the care of 30% more people. So it can address this access problem we have really well by creating a highly functional team where people are doing the work that they're trained to do. And then we can have the same number of human resources, but get more patients the care they need. And I should be clear that the transitional payment model, like its name suggests, is only a stopgap to move us toward a place where, like they are at Crowfoot, physicians are paid a blended capitation model where the most significant proportion of the payment is around the number of patients for whom you take responsibility for their global care. Okay. And then there are incentives to make sure that additional services that they also need are also covered. So it's it's a multi-part evolution in primary care that um that is going to be transformational change. It it isn't something small and it's gonna happen over a decade. But I think it will make a difference for all of us in getting care for ourselves and the people we love in our province. Yeah, there's a a quote. I I've got to figure out who says it because I say it all the time and I don't know who says it, but it says, Show me the incentives and I'll show you the outcomes. So it really is about if you're incentivized as a system to move patients through to be able to generate enough money to fund your business, that creates a different model than if you're incentivized to deal with complexity or take more time or you know, refer people to the appropriate care practitioner. Like that's a whole different incentive structure for physicians. Absolutely. And important to know is that in Saskatchewan, whether a doctor takes care of one problem for a patient or 15, it's the same visit. Uh-huh. Which is why they say only one issue per visit. Right. When I moved here, that's what I was told I should do. And I said, Well, but I can't do that. Taking half a day off work, they've arranged child care. Like we have to address as much as we can in this visit. And most physicians do that because they try to be respectful of the patient's time. Yeah. The way that patients respect theirs. But it's it's bad care. Yeah, if you are restricted to returning every time you have a different issue, because of course every issue functions in a way that is um intersecting with all of your other issues, right? You have to provide care. And so by by making it, making the investment in team-based care where the patient gets the amount of time they need, or creating a possibility for way better outcomes where something won't slip through the crack because it wasn't going to be addressed until the visit next week, which means that the patient ends up in the emergency room on a Saturday because their breathing de deteriorated, for example. Right. Yeah. And so, yes, incentivizing the provision of complex care, the recognition that as our population ages, we are having more complex medical pictures and we need a model that recognizes that, you know, sometimes what you need is to sit down with a pharmacist and understand each of your medicines and the impacts they could be having on you. Sometimes you need to sit down with a diabetic educator who's a nurse with extra training who can teach you about managing your own illness or teach your partner about helping you in managing your illness. And um, so the the innovation fund, which is the other big change that I recommended, is a Ministry of Health sponsored initiative where clinics have been able to apply for and then be funded to add additional programs or resources or people in most cases to their clinics. So that if the patient has a question that really needs a five-minute chat with your nurse, they can do that instead of booking a doctor visit. And then the doctor has time to see someone additional that day. Who needs an actual doctor to deal with their issue. Yeah. Yeah. And so, and the idea is because it's called a health home, that these people are housed all under the same roof. So you're calling one place, and then those resources are all together in the same place. And so you go to your doctor's office, but you might see a different kind of provider. Yeah. And the goal is to have that help home be a place where your team knows you. So even if if I'm your physician and I go on vacation, you don't have to worry because you know that the team in place has access to your full medical chart where we're responsible for detailing all of the things that we've talked about and can see what I've suggested as possible next steps, who I've said we may have to consult. And so it doesn't matter, like there, there's so much more continuity because it doesn't depend on having one familiar person who has access to that chart to give you good care. The team can do it. And there was worry initially by both physicians and patients that, hey, am I going to lose that relationship that I have with my physician? But the the data and then our experience so far doesn't suggest that. Rather, a patient feels better cared for. Right. Um, when it's when it's done right, because the patient knows that there's a team of people that's working on making sure they have the best outcomes possible. Yes. Okay. So I always use my two-loops model of change where, you know, an old system is starting to kind of decline or lose its fit for purpose, and then there's a new one emerging. But with that emergence often comes tension or struggle or, you know, pushback or whatever, which I'm also very fascinated in. Because I see this as like, okay, now this is the gold standard. This is the future of primary healthcare. This is where we're going. But yet at the same time, there's like it's Feels like sometimes it's a pulling into that new way of thinking. What have been some of the concerns or the barriers or the mindsets that people have that sort of hold us back from just like letting this rip in our province and reorganizing our entire primary healthcare system into this model? So the biggest issue, as is so frequently the case, is resourcing funding. So right now, we invest a whack ton of our healthcare dollars in tertiary care, in acute care. So the emergency room and the hospital visits. And we have to to get people with serious illness better. And to get to health homes, we have to invest there. And it's challenging to say, I want you to take resources from downstream or from elsewhere and put them into primary care when there's going to be a delay before you see a reduced need for the emergency room or the hospital. Right. And physicians are eager to offer the best care possible, but also can't spontaneously come up with the funds to bring on additional team members. And so what we're working to do is work with the Saskatchewan Health Authority and figure out hey, does this community actually have that resource? Could it be deployed in a way where it was co-located with that primary health care practice, even part-time, so that patients have access to that resource within their health home as opposed to having it be something separate? Because we know that if you're referred to a service, but it's a different location with a person you don't know, then we lose a lot of patients in that transition. Yeah. For, you know, it's why would I go somewhere intimidating where I don't know, or I have to find parking and pay for it, and it's a huge pain. But if I can come to my patient's medical home and get access to those supports and that education, patients engage more completely. And then we get those better outcomes, which mean that they're less likely to have their disease worsen and send them to the emergency room or the hospital. Right. So the benefit is really that relationship and that trust and that, like, these are my people, these are the people that know me. You know, I feel safe with them. And then those care providers feel like they know you as well and can meet you wherever your however your needs change over your health journey. Okay. All right. This is interesting. I think there's a piece that I should mention, which is this that idea about continuity and the benefit that it has for every person getting care is something that isn't super well understood yet here. Yeah. So we are all busy people. And so if someone says to me, Oh, you can dial this phone number and get your problem taken care of, people are going to say, Oh my gosh, I need that because I need this as fast as possible. And there is significant upside to that extreme convenience of what we call episodic care or working with a virtual provider or a walk-in provider. However, we know that when people get care that way, there is increased duplication of services. There's increased test ordering and study ordering, some of which is not necessary, but but which happens because the person providing the care doesn't know you well. Yes. Yeah. And so I think it will be exciting when patients understand, hey, if my own team sees me, I'm going to get the right tests ordered at the right time and I'll have the outcome I want. But also there will be additional funds so that my uncle who needs a hospitalization next month can have that, right? Like it it is better stewardship of resources if we do continuous care longitudinally with a team matched to a person, to a patient. So the things like the innovation fund are almost like bridging, helping people bring in resources, test and try different models, get them used to the idea of what it would look like to work with this other professional and provider in their space, and then build a case for expanding that or spreading those practices across. Absolutely. So every clinic that engages with the innovation fund commits to data gathering, to evaluation, to measurement so that we can learn what difference, if any, it makes to have these additional resources in their clinic. And then over time, the goal is to identify the innovations that work the best for patients with a given profile. Some people have a young, healthy population with lots of pregnancies and new babies and childcare. Other people have an older patient population with complex medical illness. Other people have a population that is living with more mental illness. And so different innovations will work for different clinics. Everyone is still going to be an individual. But as we learn what makes a difference for patients, what makes a difference for access to care, those are the things that we're hoping to be able to scale. And so we've been not only having those clinics commit to evaluating the program and seeing what works and what doesn't, but also offering supports, recognizing these people are no less busy than they were before when they were running full out. Right. And so it makes sense to have experts in program evaluation and assessment who are on tap and available to help them identify opportunities for measurement, opportunities to improve if we're not actually getting the data we need, so that we can then communicate with SHA and ministry and say, hey, it looks like it worked here when we did this. We tried this first, that didn't work. So this is the adjustment we made. These are the outcomes. And then we're hoping to be able to scale. Because when I moved here, people joked to me that we are the land of pilots because we try a lot of cool programs. And the goal here is to move beyond those pilots to scalable interventions that make differences for families. Yes. Yeah. And I have found too, with the pilot project idea, is pilots will get tons of attention, lots of money, lots of resources, lots of support. And then we're like, oh my gosh, that works so good here. Now everybody, you guys go out and do it, but do it without the support, without the reason, without the funding. And then it fails to spread or scale because we didn't give them the attentional support that we did with pilots. So yeah, that's always a challenge. But I think there is a growing understanding that this piloting kind of start stop a project, do a pre-post evaluation, and then just unleash it into the world isn't, doesn't really work that well. Right. And I think one thing that's been helpful in sort of the last five, six years has been we've been working to sort of nudge this along is that we've been consistently supported with folks who have expertise in change management. And that wasn't even a field that I knew existed before I moved to Saskatchewan. It's not something that they cover in medical school. Yeah. And um, having that support and understanding um sort of the predictability of challenges that arise and then approaches to help manage those has been really valuable. And I think the community that we're building of the physicians working with the innovation fund, where they can get together, share ideas, share challenges and how they overcome them has been a powerful piece and will grow as the relationships grow and as the projects grow. Okay. So you guys have built in like a bit of a learning network or a learning community so that people can kind of share what's going well, what's not going well, help each other overcome barriers and and challenges. Exactly. And I think um certainly all physicians are committed to lifelong learning. It's in all of our licensure. But most people, because of the pressures, end up focusing on clinical learning, which makes sense. You want to learn how to improve your patient care. And we have some leadership training, but as it turns out, not necessarily the leadership training to lead a team effectively or um to manage HR challenges when they arise. And so the learning community has built in the change supports, the opportunities to come together for structured learning, but also um on the ground coaching supports when people are moving through implementation and encountering stuff. So it's supported in ways that are, from what I understand, newer in the in these efforts. And it seems to be helping people get traction. Good. One thing I hadn't mentioned that I think may be relevant is that in British Columbia, when they got support to change how they were offering primary care, how they were paying family doctors, it came about because people, patients, citizens of the province started going to their MLAs and saying, hey, we're paying a lot for our health care. We deserve better. Yeah. And that makes sense because, of course, elected officials care about their voters and that that's what motivates them. And my understanding so far is that there isn't sort of a patient advocacy body here in Saskatchewan. But if we want this to take off over time, what we will need is for patients to understand really well what's at stake in terms of quality of care, access to care. Yep. And then start to say to their elected officials, hey, we're paying you. We're giving you a solid tax base. This is what we deserve. This is the care we want. Yeah. Yes. And so that's what we're hoping we can demonstrate to patients is, hey, your care improves if we do it this way. Let's start saying that that's what we need to the people making the decisions. Yeah. And I have to say, my parents live in Suth Kurrent, and they are patients under the patient medical home with Dr. Harrison, Dr. Harrison's practice. The capacity that they're building to be able to take the most valuable thing for them has been to have the same-day access because their physicians have been freed up by having patients seeing other professionals that they do have spaces every day for same-day access. It is such a game changer when your parents are in their late 70s. And that's that's been, and I think the successes that they've experienced in Swift because of the like really consistent um investigative work and efforts of that leadership team have been so motivating for other doctors working to make these changes because they're seeing the outcomes. And that group has been very generous with their expertise that has been so hard-won in sharing it with other folks. And you're right, that if we can maintain the same-day access, that convenience that makes episodic care have appeal, but do it in your medical home, in your health home, that's the win. And the combination of having other providers who can provide care according to the patient's need, but then also some time that is protected to be assigned that day to individuals who need to be seen that day. It's life-changing. Because then you're being seen by someone who knows you, which is entirely different than being seen by someone who has no idea about your history, about your experience, about how you experience illness, right? Because some of us weigh under call stuff. Oh, I'm fine, doctor. Meanwhile, they're having a heart attack. Other folks are pretty sure that that every small experience is life-threatening. And having a physician and a team who knows you means that they can take that into account and say, well, if she's here, she's really not okay because she doesn't come in unless something is falling off of her. So I think it's exciting that we're starting to get um impacts from these changes and then starting to move past that pilot model. This is what Swift is doing to, hey, this is what everyone in Saskatchewan can have access to. So something we could do is if we're experiencing care in a patient medical home that's really good and you're really liking it, you could let your MLA know that this has been a really good experience. Or if you don't have access to that care, you could write them and say, I've heard that there's this model that is working in some places in Saskatchewan. This is the kind of care I would like to get. And I would like to support this moving forward more in the province. Absolutely. If if the people of Saskatchewan are willing to tell elected officials, hey, this is what I want, this is what I'm paying for, um, I think we have the potential to get some real traction. And um our hope in part, because of course we know what's not working because we experience it. Yeah. Our hope is that if patients can begin to see care that works better, then they are going to their elected officials with solutions, right? Hey, what they're doing in Swift has dramatically improved my parents' experience. I want that in Saskatoon. I want Alfred. Yeah. Yeah, amazing. Are you noticing, you know, with any transition or any change, there's often a sense of grief or loss, or, you know, it's hard for people. Are you are you noticing that with physicians, or do you find that there's more of a momentum or a curiosity around exploring what this new model looks like? I think what we see most is maybe anxiety or fear. And I'll explain why. Okay. So in the fee for service model, when you're seeing patients as fast as you possibly can in order to try and help everybody that day, um it is a relief when you have an easy visit. So a patient who comes in for a cold or a urinary tract infection. Um, and and physicians are able to see those patients quickly, take care of them, meet their needs. And it's a little bit of an opportunity to catch up. Yeah. And so um when we talk about everyone working at top of scope, which means handing off some of the different care to another person who's better suited to provide it, physicians worry, oh my gosh, am I going to lose the easy parts of my day where I get to catch my breath and and then just be doing the most difficult parts of the work. And and so there's been fear about that. And I think what's helpful is when they see someplace like Swift where it goes, but if a licensed practical nurse is doing the work that he or she is trained for, and then I don't have to do it, I'm not losing something easy. In fact, our patients are still getting exactly what they need, but I'm able to direct my attention towards something that another patient wouldn't get care for that day unless we had that LPN in place providing that care. So um I think the it's sort of the proof is in the pudding, right? When people begin to see what it looks like to not be harried because in fact you've got people around you collaborating with you to offer care. Um, it doesn't then feel like a loss to have those straightforward visits be handled by someone else. Rather, it feels like a win because you know your patients are getting what they need and you have time to do stuff that was happening at 7, 8, 10 p.m. in the past. Yeah. And then I grew up in a really small town. And I just remember thinking about that poor family doctor that was providing care 24-7, getting called in for emergencies. And then the guilt that they would experience when they would go on a vacation, you know, that they were letting the whole community down. Like that must feel like a lot of pressure and must be hard to unlearn that kind of role that you play in the community to let go and and let other people kind of share in the responsibility of that care. Absolutely. Because I think, yeah, physicians were and and our, especially our rural and regional physicians continue to do all the emergency room work, all the hospital work, all the deliveries. And and in the larger centers, that has been more delicate. People specialize a little bit more. So we have family physicians who do exclusively hospital care or exclusively emergency room care or exclusively clinic care. Um, but it's less common in the city to do it all. And in rural and regional centers, those physicians have been feeling, you're right, independently responsible for the health of their community. And it's a big shift to be supported. And some physicians will see more patients with the time. Some physicians will do advocacy work, some will spend more time with their children when they're young, all of which are wins for all of us. Yeah. Right? Yeah. Um, and so it the goal is to figure out how do we do it in ways that that support patients and also maintain uh sort of a resource use approach that's tenable long-term. Yes. So that because you if you the evidence is pretty good that if you do this part way or do it wrong, it costs more and it doesn't get you benefits. And no one wants to do that, obviously. Yeah. Yeah. Um, so we want to be very deliberate, um, very careful about evaluation so that the things that we scale are the things that make a difference for the people on the ground. I think when we talk about recruitment and retention, the idea has always been, oh, they need more money. They want more money. And I think when you consider what their lifestyle is like in rural and remote areas, that this would offer an opportunity to have a more balanced and better experience as a rural or remote physician, rather than just because sometimes money just isn't enough. Like you want a life, you want support. Yeah. Absolutely. And and that's definitely what we're finding is that um people will for money or for benefits, people will come for a period of time. But when people stay is when the wraparound care optimizers are in place, not when the then the dollar amount is highest. So having uh someone to triage, you know, a nurse who can triage the phone calls that come in and figure out which patient needs to see which professional and how quickly. Um, having a chemical dependency counselor with training specific to substance use so that you can provide the medical care necessary for an individual with that concern, but the individual with specific training in that field can provide the talk therapy and the interactions and the tools that will allow that patient to succeed. That's what makes the work tenable. It's when um it's when everybody gets to do the work they're trained for, and which it turns out if we all do the work we're trained for, patients get what they need when they need it. Um and we're not wasting these resources that we that we invested so heavily to train everybody in. Yeah. And I'm also interested in, like I hear all the things that individuals are doing and practices are doing, and teams are sort of doing to make change. What are the structural policy things that need to be in place to get this to work? So I'm guessing payment structure is one of those. Or is there anything else like regulatory changes or um I don't know, like unionized environments? Like, are there any of those sort of higher-level structural changes that would help support this model expanding? So um, one of the pieces we definitely need to be figuring out and that we haven't optimized yet is the collaboration of physicians and nurse practitioners, especially physicians who are not unionized with um all of the different healthcare providers who are unionized within the SHA. So um with the innovation fund, clinics have the option of hiring someone privately or hiring someone through the SHA. And the the unions are very strong in our province. And so they mean that there are excellent benefits available for individuals within a unionized context. And you can understand, many people say, Well, I'm not going to leave the SHA to work at your clinic. I'm not going to lose my seniority, my benefits. Yes. Um, but then physicians also say, okay, but you know, I work 50, 60, 80 hours a week, and my unionized staff have EDOs every two weeks and have different hours than we have. And so it's a challenge to figure out how to integrate folks who are coming from a different model, but it's not impossible. It's been done. And so figuring out that navigation is really important. And I think of um, like we've we've had successes in this realm. Um, the example that comes to mind is working with the unionized staff who maintain our operating theaters in our hospitals. Um, it took significant negotiation and figuring, but when they figured it out, we were able to open the ORs on the weekends. And now the wait times for knees and hips, those new joints, are going down. So the relationships are strong in this province and the potential to figure out these answers is there. Um, but that's going to be an important piece for this to be optimized. Yeah, I also find unions are often not at the table, right? And they're not integrated, and they're such a huge part of transformation and change. So, how do you kind of uh negotiate and and play with those so that it it's beneficial to the patients and providers? Absolutely. Yeah. And then the other thing I was gonna say is is just human resources. As we know in our province, We can use hundreds more of literally every professional designation of care. And um, our ministry of health has been, you know, working toward this new health human resources strategy, which is exciting. Um, we're seeing a new occupational therapy school, speech language pathology school in our province, which haven't been here before. We're seeing a significant expansion of the medical school by 20 seats per year starting this summer, which will make a huge difference. Now, the pipelines for all of these professions are not short. It's not immediate. Yeah. But we know that it is much more likely that an individual who is from Saskatchewan and has strong ties to Saskatchewan will choose to practice here rather than some individual who comes from another province or another nation. And so optimizing our capacity to grow our own professionals is a big deal. Yeah. And that includes things like having parts of your training or even all of your training be in your home community as opposed to having to come into the centers. People have a partner and children in a smaller community, they may not be willing to move to Saskatoon for six years. And that makes sense. Yeah. Um, and then similarly, working on approaches where when we um invite healthcare professionals from other nations to come here, figuring out how we create the optimal circumstances for them to integrate with the communities that they join, be supported, have culturally relevant resources available so that people don't just come for a couple of years and then leave, but rather put down roots and and build a life. Yes. And so figuring out what does it look like when when we make new folks feel welcome and incorporated and experience that sense of belonging that is what makes all of us choose a place as home. So we have to do that. And I guess um related to that, that takes me back to the sort of educational pipeline. One of the things to think about is that um we are working definitely toward a healthcare um workforce that looks more like the population. So has more individuals from diverse backgrounds, has individuals with diverse abilities, um, and has individuals who maybe grew up in a rural or remote area as opposed to only in urban areas. And patients need to be able to see themselves in their healthcare providers. So, you know, for example, if if one in five Canadians has lived with disability at some point, one in five physicians should have that experience as well because it will improve the care for individuals living with disability. Yeah. Um, but what that means is that health care has to change. So historically, in medical education, um, students were more traditionally from affluent backgrounds where they could live at home and still be sort of taken care of as students. Um, increasingly we have folks who are parents or have had a career already and sometimes are still working to pay for the expense of medical school or have learning differences. And um, all of those things are things that mean that we need to learn how to change education so that all kinds of minds have the capacity and the opportunity to thrive in the educational environment, as opposed to being shunted out and told, well, no, you you don't fit. Everyone fits. If you're willing to do the work, you fit. We have to figure out how to how to create those opportunities to thrive for everyone. So, what's your vision for the future? What do you think primary care will look like here in five to 10 years? What would be your ideal state? Um, I think um one of the few things that I agree on with our premier is that I would love for everyone in Saskatchewan to have a primary care doctor within a few years. I would love everyone to know this is my medical home. This is where my family gets our care. Um, and and when something goes wrong and we need care more urgently, that's where we turn to, not the emergency room. Because we have pretty good evidence that when we can do that, we can really take the pressure off of emergency rooms and off of hospitals because we can mostly keep people healthy and keep them at home, which is where most of us would rather be. Nobody wants to sleep in a hospital overnight unless they really have to, with all those dings and bings and being woken up. So in my dream, we have access to the care that that we need universally. Um, and that's I mean, it's a challenging piece. We have um we have folks who work very far from where they live. We have folks who spend half their time in one community and half their time in another. And so it means an integrated system where if I am in Pine House and then I come to PA, whoever's caring for me in both of those locations, all of them must have access to my full medical chart. Yeah. Um and so the access to a primary care provider and then the integration of medical records so that people offering care to a patient have full information is what's most protective for patients. And so that's that's my dream. Those are the priorities. Yeah. That's the shift. Yeah, I think, you know, the challenging part of change right now is really the shift in mindset from an idea of like hospitals are what we need, you know, more hospitals, more beds, to the idea that, okay, but what if we, what if our measure of success was that you didn't end up in the hospital, that we decreased the amount of times you're in the hospital, that we needed less beds in the hospital because our primary care system was working so well that we were catching people before they were so sick. And not that we'll ever not like be point where we don't need hospitals, but the the idea that that is the measure of a successful healthcare system is that we have more hospitals or more beds, isn't is that it this focus needs to shift. And I think we all have to kind of shift with it. Public providers, governments. Um, but that transition period is a little bit, is a little bit fraught. All the changes and that need to happen with that shifting mindset. Absolutely. And and and part of it is education. So opportunities like this, where patients are are informed about a different model than the one that they're used to and have grown up with. You can be cared for by a team so that it doesn't matter what you need or when you need it, there will be someone who can offer it. And we can offer it in ways that that mean that the resources are going to those upstream interventions, like managing congestive heart failure, managing emphysema rather than rescuing you when something unmanaged goes haywire. Right. And so um, as folks get used to this idea that I can be cared for by a team who are trained to manage all of the different things that I that I live with, uh, hopefully then they start to to request it from our government so that government can say, oh, wait, this is what our patients want. Let's make sure our citizens have the care that that will give them the best experience. Yes. And what have you learned through all of this? Like what's your biggest learning or insight for you personally about doing this transformational change work? I think, wow, so that the team of people involved with this is incredible. And so a fun part of this work for me has been learning from individuals with totally different kinds of expertise. It's understanding how all of those pieces of expertise are essential to change primary care. Because as a primary career, I don't have the IT experience or the understanding of the larger economic models at play, or as I said, the understanding of change management. And so the it's been this lovely sort of uh parallel to the kind of interdisciplinary teams that we're hoping to create because the team doing this is people with all different kinds of expertise and training. Um, and the collaborations are where we make forward strides. So that's been really exciting and really humbling. It's great. Yeah, my favorite thing about being in Saskatchewan is like I told somebody in a meeting last week, like, we have everything we need here. We have such brilliant minds. We have like the Health Quality Council is such a unique player in our system. Um, we've got really good providers, we've got really good doctors, like we've got everything we need. Sometimes we just need the courage to really push something different. And we've done that before with Medicare. And, you know, even the implementation of lean system-wide was a real collective effort where everybody kind of put their hands in the middle and we're like, okay, let's try this, which is something that would be much harder to do in other provinces or areas. And so I always have hope for Saskatchewan that we can be the real innovators and leaders in in transforming care to what it needs to be for the 21st century. Unequivocally. You know, that the the people here and the capacity for innovation, for adaptation is huge. And what has been lovely about moving to Saskatchewan is the fact that it is a completely relationship-based community. Yeah. And it's um, you know, in a giant city where I used to live, people don't need your business more than once. So they'll, you know, do whatever it takes to get your business once, but then there isn't any sort of aftercare to try and maintain that. Whereas every with every industry with which I've interacted in Saskatchewan, all the people working in it have been working together and collaborating over time. And so they behave like people who want to continue to work together. And so the coolest stuff happens because people have relationships, they trust each other, and they say they're willing to take a risk or make a bold suggestion because they have that trust. And so I love the way that everyone behaves as though they're going to see each other again because you will. You will, and you might change jobs, but then you're still gonna see them in another place. Yeah. But it but it creates this very rich ground for trying new things and and sharing ideas in vulnerable ways that allowed those ideas to be built upon and to evolve. So um it's been absolutely eye-opening and so refreshing and a really exciting part of getting to be part of this effort here. Good. Well, thank you so much for doing this with me. I really appreciate you coming with your perspective, you know, coming from the states. I'm sure you've brought in, you know, that's another part of diversity, right? Having people come in from outside and um seeing things in a different light can often be so valuable in a in a system where sometimes we get stuck in our old ways of thinking and and routines and having some fresh perspective is really helpful. And I know leadership is not easy in a healthcare system, especially when you're pushing for change. So thank you for the time and the work and the commitment that you give to our system to make it better. And um, I will encourage all of our listeners to open up dialogue with their care providers and their MLAs to say that this is the kind of care we want, accessible to everybody across the province. Thank you so much for the chance to talk about this exciting work and thank you for everything you're doing to get the word out. Because I think the more of us that are thinking about it, the more innovative ideas we're gonna come up with. And that's right. Yes. Awesome. Thank you so much. Have a great day. You too. Bye-bye. Thanks so much to Dr. Rowdy for taking time out of her very busy schedule to communicate so clearly and articulately the vision of primary care in Saskatchewan. In the last few weeks, I've seen multiple new technologies where virtual care is being offered in the home with all kinds of equipment that can read your temperature, check your ears, listen to your lungs, measure your blood pressure, all from the comfort of your own home, connected to a virtual provider somewhere. And although this technology sounds amazing, we can't forget how valuable our relationships are with those that know and understand us and our context and our communities. So if you're receiving care in a patient medical home and it's working for you, tell your MLA. If you're not, tell them that too. The people making resource decisions respond to their constituents, and this is one area where your voice genuinely may move things. And now it's time for a shift shout-out. This week's shift shout-out goes to Mariana Zubrnich, a nurse practitioner in Toronto General Hospital, who in 2015 was caring for an at-risk patient, someone whose behavior was putting their safety at risk. Traditional interventions were working, and there was no sitter available to keep the patient safe. So she did what great innovators do. She refused to accept the status quo. Mariana worked with the University Health Network's engineering team to build an audiovisual monitoring device that could stream a live feed of the patient into a central observation point. The first attempt was a makeshift device consisting of a camera and speaker on an IV pole donated from the OR and the medical department with monitoring done by nursing summer students. The patient, who she refers to as patient one, was sitting bored in his room waiting for a lung transplant and was excited at the prospect of being involved in the new idea. After he was discharged, he made her promise that she wouldn't stop until every hospital in Canada had access to this. She hasn't stopped. The device became HALO, human-attended live observation, now deployed in 24 hospitals and six long-term care facilities across the country, including a province-wide rollout across Newfoundland Labrador. A research study found a 39% reduction in fall rates across the UHN hospitals after Halo deployment. And in one hospital, falls in high-risk patients were reduced by 75%. At its headquarters in Toronto, HALO now directly employs 27 observation technicians. Each technician is trained by practicing clinicians to intervene in real time and prevent adverse events. This type of proactive support complements on-site care teams and enables them to focus on their core clinical duties. This is what I really love about improvement. The ones closest to the patients are often the ones with the best ideas. And all it takes is a system that will listen and support them in bringing those ideas to life. Congratulations to Mariana, the University Health Network, and the whole Halo team for pushing past status quo thinking and making a meaningful impact on outcomes. If you enjoyed this episode, please subscribe, leave a review, and share it with someone who might be interested in these conversations. Please note our name change. We're now Shift, Conversations on Changing Canadian Healthcare. And you can also find us on Facebook and LinkedIn for episode updates as well. Thanks for listening. This is Shift. See you next time.