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Shifting paradigms

A physician’s learning of the Touchpoints approach helps nurture parent-child relationships

As a family physician working in a maternity clinic in Comox, Dr Theresa Wilson observes families interacting with each other and sometimes witnesses the frustrations related to adapting to a child’s development. This is an experience not unfamiliar to her during some of her visits with families with young children.

“All parents want to do well by their child, and all parents have strengths,” says Dr Wilson, who credits Touchpoints for her understanding that relationships are the foundation for development. 

Dr Wilson first learned about Touchpoints and attended the initial training when it was brought to the Comox Valley by the Pathways to Healing Partnership and a public health nursing coordinator.

Touchpoints is a framework that guides practitioners to intentionally build on relationships between physicians and parents and their families, and between parents and their young children.

Dr Wilson explains that using the Touchpoints guiding principles is a culturally responsive approach to care as it can help practitioners recognize and understand the differences of patients before and during a visit –meeting patients where they are at. Physicians can use the child’s behavior to learn more about where the family is at, and how they are coping with a new developmental change or challenge.  The Touchpoints principles also helps physicians observe interactions for strengths.

“You’re doing what you’re doing, just better. We are genuinely changing how we see people by becoming more self-aware,” says Dr Wilson.

Physicians can shift conversations between parents and children from what is not working to what is working well. Through reflection and practice, physicians work alongside families during predictable periods of disorganization or regression as a child learns or acquires a new skill or milestone.

“I can help parents to see that it’s okay that their child's development fluctuates when the child is working on a learning a new skill,” says Dr Wilson. “I can help normalize the ups-and-down.”

Strengthening the parent-child relationship

Dr Wilson recalls a time when she was with a patient who had just delivered her child. The patient’s partner had rushed into the patient room, missing the birth by eight minutes. Recognizing that the father was disappointed, Dr Wilson was able to help reframe the experience.

“I had seen the baby turn its head to look at the father when he came into the room,” shares Dr Wilson. “So I pointed that out to the father, who hadn’t seen it. I was able to use the language of the baby and narrate its behavior.”

By focusing on the positive aspects of the situation, Dr Wilson transformed how the interaction was remembered by the family.

Reducing physician burnout

By using the Touchpoints approach with patients, doctors can help reduce their own stress and feelings of burnout.

Before a patient visit, Dr Wilson reviews the area of development, looking for what might be seen or expected during the visit and reflecting on potential Touchpoints assumptions and guidelines. With that preparation, she feels grounded and ready for difficult issues that may come up during the interaction.

“My patients have commented about how they appreciate the extra time I’m spending with them, but that’s not the case,” says Dr Wilson. “My visit times have not changed.”

In 2018, Dr Wilson became a registered Touchpoints trainer in BC with the support of the Shared Care Committee (SSC) and Comox Valley Division of Family Practice.

Supported by the Physician Engagement Society of Comox and Courtney, which is funded by the Facility Engagement Initiative, the interactive training is offered to doctors through the Comox Valley Child Development Association (CVCDA). For more information, contact the CVCDA.

Watch the video below to learn more about Touchpoints from a panel of multidisciplinary health practitioners in BC.

The webinar is presented by the Shared Care Committee –one of four Joint Collaborative Committees that represent a partnership of Doctors of BC and BC Government– and the CVCDA.

Simulating emergencies bring invaluable results

In situ simulation helps save the life of a two-week old newborn

Any hospital’s Emergency Department (ED) has seen life-threatening drama and life-saving results – often it is preparation that makes the difference. Dr Matt Carere, an ED doctor at the Victoria General Hospital knows well the importance of being prepared.

During the past year or so, he along with Dr Donovan MacDonald, an emergency medicine resident doing a Fellowship in simulation training, with the support of ED Department Heads Drs Paul Collela and Gavin Jones, and help from the South Island Medical Staff Association's Facility Engagement Initiative funding have brought “in situ simulation” training to the hospital’s ED.

This training allows ED staff and relevant specialties to work, learn and reinforce their skills together in their clinical environment. It also helps identify hazards and deficiencies within clinical systems, the environment and the health team. This is unlike the traditional simulation training conducted at teaching hospitals.

From simulation to real life

A recent in situ simulation helped save the life of a two-week old newborn. Dr Carere, “there is nothing more daunting than having a two-week old premature baby in profound shock and peri-arrest come in. And nothing more satisfying than being able to work in the most efficient way possible to save her because we had just run a simulation a week previously that yielded a number of critical changes to our approach.” 

Over the last year, one to two simulations were held each month, involving not only Emergency Department physicians, but also Pediatric Intensive Care docs, PICU and NICU nurses, pediatricians, hematopathologists, anesthesiologists, adult intensivists, respiratory therapists, ECG and lab technicians, as well as more than 40 different emergency department nurses.

Dr Carere notes, “getting them to come in and give us their input on how we can improve our practices in the ED is invaluable. This doesn’t happen without complete buy in from everyone. In fact, we have a group of nurses who volunteer for these nursing education days. They’re getting examined under a microscope by us and they are all for it.”

“There is nothing more daunting than having a two-week old premature baby in profound shock and peri-arrest come in. And nothing more satisfying than being able to work in the most efficient way possible to save her because we had just run a simulation a week previously that yielded a number of critical changes to our approach.

Each scenario is attended by a clinical nurse educator to summarize the scenario and lessons learned to ensure any insights or needed actions are given to all ED staff. The group also film each simulation so that those not able to attend on the day can still learn from the experience. Dr Carere states, “It’s humbling because I’m in these rooms with all these talented doctors and nurses and every time I personally am learning so much.”

Due to COVID, some practices have been made more complicated. With in situ simulations, even the smallest barriers can be revealed to have a huge impact. For example, a recent simulation involved a cardiac arrest with a suspected COVID patient. One doctor discovered administering CPR in full PPE with glasses, googles and face mask left him unable to see as his glasses continually fogged up.

The South Island Medical Staff Association's FEI funding funding has been inestimable in allowing this work to happen. Feedback has been universally positive from staff to the hospital administration. Dr Carere is working to help make in situ simulation become a natural part of the hospital’s culture.



Maintaining physician wellness during Covid-19 and beyond

Maintaining physician wellness during Covid-19 and beyond

Doctors are working hard to provide the best care for their patients during the COVID-19 pandemic. These unprecedented times add stress and anxiety to physicians and frontline workers who may already feel burned out.

“I think most of us are just feeling tired,” shares Dr Laura Kelly, department head of Emergency Medicine at Ridge Meadows Hospital. “I'm seeing a fair amount of covert fatigue not just in doctors, but in all health care workers. A lot of people are exhausted.”

Dr Kelly and her colleague Dr Connie Ruffo, a White Rock hospitalist, recognized that doctors were potentially facing their own health crisis.

It’s why the doctors spearheaded swift efforts to prioritize the well-being of themselves and their colleagues through the Fraser Health Physician Wellness Committee, which is co-chaired by Drs Kelly and Ruffo.

As part of its work, the committee declared November as Physician Wellness Month in Fraser Health to keep health and well-being top of mind for all medical staff.

Also, the third annual Physician Wellness Forum held in November pivoted to accommodate pandemic restrictions, changing from an in-person event to a series of virtual workshops throughout the month.

Dr Kelly observed that the virtual sessions tried to accommodate both community- and hospital-based physician schedules, making it easier for doctors and medical staff to pop-in to the two-hour sessions at the end of workdays.

More than 100 doctors and medical staff joined weekly workshops to reflect on how to strengthen their personal wellbeing and of their colleagues. Topics included sources of wellness support, including community wellness teams, energy management, peer support, and compassionate leadership.

The forum is sponsored by the Fraser Health Authority and regional medical staff associations and divisions of family practice, and received funding for the first two years from Facility Engagement, an initiative of the Specialist Services Committee.

“The work we are doing for physician wellbeing highlights how vital Facility Engagement is in supporting physician partnerships with health authorities to nurture system change.”

Collaborating for cultural change

Dr Kelly notes that a doctor’s wellness is more than just caring for personal health through exercise, nutrition, or yoga. It’s also about connecting with peers to support one another. It is also about doctors engaging with the health care system to create changes that reduce the risk of burnout by improving efficiency and effectively delivering patient care.

For more than 15 years, Drs Kelly and Ruffo have been championing a shift in the culture of wellness at the grassroot level. They have been working with their peers, along with local and regional partners including MSAs, divisions, and Fraser Health. Together, these groups are fostering more peer-to-peer conversations, modelling compassionate leadership, reducing stigmas, and creating safe spaces.

In recent years, Drs Kelly and Ruffo have been working with colleagues and health care partners to develop a regional wellness strategy, visions and mission –a first of its kind in BC.

Recalling how she and Dr Ruffo got started, Dr Kelly says they modelled peer support by reaching out to colleagues who were distressed, sad or acting out, and fostered collegiality by hosting wellness activities where there were conversations about suicide, addiction, burnout, and how to look after a patient who's also a doctor.

Dr Kelly’s advice to other doctors is to do for themself and their colleagues as they would for their patients.

“It's just a matter of saying ‘I'm here. How are you? or I'm noticing this; how can I help?’”  

Dr Kelly says that simply taking the time to truly listen and hear a colleague is what peer support is about.

“If you have people in each community that are modelling peer support, then they are seen as advocates for their colleagues,” says Dr Kelly. “And then we have real movement in the culture shift that we're trying to make –that physicians are valued and supported.”

From the ER: Love is Also Contagious

From the ER: Love is Also Contagious

From the ER: Love is Also ContagiousThese are challenging times in BC, and staying positive is more important than ever.

That’s why emergency physician Dr Linda Johannson took action to try to uplift her own spirits, and of her colleagues. 

“Everyone was feeling stressed and real fears about what was to come,” says Dr Johannson. “I didn’t realize how deeply it [the Covid-19 pandemic] all was affecting me until one night on shift when I snapped at a nurse, something that is very out of character for me.  She snapped back, also out of character for her, and we had a terrible shift together.”

After apologizing to the nurse and reflecting, Dr Johannson realized that everyone was feeling anxious, and this was affecting how they treat each other.

She acknowledged she wasn’t doing okay, and attended an online meditation session. The facilitator mentioned that a colleagues’ display of an anxious, fearful attitude is contagious and can spread to the whole team, and the reverse is also true.

This sparked the idea for the “Love is Also Contagious” campaign. 

“I wanted a way to remind people that, because of the fear we are all experiencing, our behaviour may not be consistent with the way we know each other to be,” says dr Johannson. “We can recognize that in each other and in ourselves, offer forgiveness, and choose to behave in a loving way rather than react to the stress that is going on.” 

Dr Johannson shared the campaign idea to spread love, not fear, as an attitude at work with her colleagues. With their overwhelming encouragement and funding from Facility Engagement, an initiative of the Specialist Services Committee,  Dr Johannson started to work on the campaign.

She asked a friend who is a graphic designer to morph an image of the coronavirus into a heart. They turned this friendly image into buttons and stickers and a downloadable window sign.

In full support of the campaign, the Kootenay Lakes Hospital (KLH) administration sent a facility-wide email introducing the campaign and encouraging staff to wear the image as a visual reminder to act from a place of love.

Keeping the momentum going, Dr Johannson regularly distributes “Love is Also Contagious” pins and stickers around the hospital during different shifts. 

“I can really feel the positive energy when I show up with my bag to hand out some love,” says Dr Johannson. “It’s been a lot of fun, and a side benefit has been that I feel much more positive about weathering this storm, both individually and as part of a top-notch team in KLH Emergency.”

Help spread the love. Download the “Love is Also Contagious” window sign. 

Cultural Connections:

Collaborating for Healing in Health Care

In early 2020, Tla-o-qui-aht First Nation community members led a group of Tofino health care professionals through a cultural ceremony where they experienced traditional healing practices first-hand. Together, they wanted to explore how these practices and stronger cultural connections might blend with medical care to support people who experience trauma and pain. 

Tla-o-qui-aht First Nation healer Nora Martin and cultural worker Chris Seitcher led the ceremony, which included Tla-o-qui-aht members, physicians, nurses, X-ray and laboratory technicians, and a firefighter.

Martin explains that traditional cleansing ceremonies have been used by her ancestors for generations and continue today. “We carry trauma around with us, and sometimes never deal with it,” she explains. “In our community, if there is a serious incident or death, we do these kinds of ceremonies for community members right away. It makes a big difference.”

Those benefits caught the attention of Tofino primary care and emergency room physician Dr. Luke Williston. He had seen for himself how traditional cultural practices helped a group of patients who were struggling to deal with trauma and experiencing substance use that required frequent treatment in hospital. 

“A First Nations Cultural Worker came to the hospital to do a cleansing ceremony for some patients,” he says. “We didn’t see any of those patients for more than a year after. When I would see them in the community, I could see they were doing better. That is hard to ignore."

“While our current medical therapies are good, they do not always hit true with everyone.”

He observes that traditional practices help people reconnect with their identity, community and culture. “That, in turn, can give them more of an anchor and focus, so they can keep on track longer.”


Williston wanted to learn more. With funding from Facility Engagement and the Rural and Remote Division of Family Practice, he connected with Martin and Seitcher to explore how they could work together to introduce health care colleagues to traditional practices, and over time, create a more connected healing community.

Chris Seitcher has worked in the helping field for many years, including as a care aid with Island Health, and for elders in the Tla-o-qui-aht Nation. He runs a weekly men’s group, which he describes as being a supportive, safe space for community members to share stories, history, traumas, and emotions. Traditional chanting and singing are also incorporated to help change the energy.

“This is how we deal with our trauma, our suffering, our pain,” he explains. “When we have safe space and support where we can share things that are happening inside—things we don’t usually talk about—then things start to slowly change.”

Williston feels that health care workers can also benefit from some of these approaches. “We get exposed to a lot of trauma at the hospital all day,” he says. “We all need to find healing for ourselves.”


A collaborative plan unfolded. Martin and Seitcher arranged to hold a traditional cultural ceremony  that was recorded on video. It incorporated a talking circle, breathing exercises, and drumming and singing led by Hayden Seitcher, also of the Tla-o-qui-aht First Nation.

Pools were set up at Načiks (Clayoquot Heritage Museum at Monks Point in Tofino) for the group to experience cold water cleansing.

 “Any time there was trauma in the community, or family, grief, or loss, we would bring members to the river or ocean to do a cleansing,” explains Martin. “Cold water rebalances us: it refocuses negative energy…to help clear the mind.”

The ceremony was an insightful learning experience for the guests. “It is quite different from our usual kind of medical work—a much slower pace,” says participant Dr. Pam Frazee. “A different part of your brain is working—your emotions are more present.”


Over time, the aim of those involved is to introduce traditional healing practices more widely with health care professionals, ambulance crews, firefighters, the coast guard, and police officers—all of whom are exposed to emotional and physical trauma—and to create stronger cultural connections among patients, health care, and emergency professionals.

“These providers work in First Nations communities and may not have that connection yet,” says Williston, who sees benefits of making traditional, non-medical interventions more available to health professionals. He suggests that paramedics, for example, could introduce some of the techniques that help reduce a patient’s anxiety before getting to the hospital. 

Additionally, cultural workers could be integrated into the hospital to perform ceremonies for sick patients and those who are soon to be discharged. “That surrounding care might help [patients] stay better, longer,” says Williston. 

Seitcher also sees many benefits to blending in traditional practices. “Culture is always around us,” he says. “Culture means connection. We can bring our culture to the hospital and create a safe space to connect and work through some tough issues.”

Martin, reflecting on her first time working with the medical community, says she is pleased to see the openness to new ways and new learning.

It supports an aim of the First Nations Health Authority and BC’s health care system to have First Nations communities and members work in partnership with doctors and health care professionals to support people’s health, wellness and care. 

“We have a lot to offer,” she says. We can help each other out – instead of living and working in isolation – and provide more services to many more people.”

Watch: Traditional Cleansing Ceremony>



This project was supported by Facility Engagement, a Specialist Services Committee (SSC) Initiative, and the Rural and Remote Division of Family Practice, an Initiative of the General Practice Services Committee (GPSC). The SSC and GPSC are Joint Collaborative Committees of the Government of BC and Doctors of BC.


Physicians Lead the Way to Hospital at Home

Physicians Lead the Way to Hospital at Home

Victoria Hospitalists Dr. Elisabeth Crisci and Dr. Shauna Tierney have been unwavering in their pursuit of a new kind of care for patients. Now, their passion project is about to become a reality with the BC Government’s launch of Hospital at Home across the province.

With Hospital at Home (HaH), acutely ill adult patients who are at lower risk and have a predictable clinical path can get hospital-level care from a team of professionals at home, safely and effectively. The model has been used for years in countries like Australia and the UK.

Extensive studies, including three Cochrane reviews (Ref 1), show that HaH provides equivalent or better clinical outcomes than standard hospitalization. Length of stay tends to be shorter and there is a higher level of satisfaction amongst patients, their caregivers and healthcare workers. It also shields patients from some of the complications associated with a brick and mortar hospital stay.

Dr. Crisci first saw HaH in action several years ago while doing fellowship training in Australia.  “This was not home and community care. It was acute, hospital-level care: IV medications, blood transfusions, oxygen. There is no doubt in my mind that those patients, if they were back in Canada, would need to be on a hospital ward.”

“A hospital is an unsettling environment, especially for frail and elderly patients,” she says. “I thought, ‘why can’t we do the same in Canada?’ The expertise and therapies that we associate with hospital care are all portable, and so is the hospital staff.”

“It is an opportunity to offer safer, more patient-centered care for our patients and for less cost. It is the right thing to do.”

Back in Canada, she often thought about the HaH model. Then, in 2019, an opportunity came up to take action. Her Hospitalist colleague, Dr. Shauna Tierney, was reading about a HaH program for COPD and was inspired. 

“I saw that we could do better for our patients’ dignity and comfort, and thought, “we have a moral imperative to do this." - Dr. Shauna Tierney

Dr. Tierney reached out to Island Health and her Hospitalist colleagues to see what could be done. Dr. Crisci was ready. “We knew that we needed to join forces to make this happen.”

Left: Dr Elisabeth Crisci.  Right: Dr Shauna Tierney

Collaboration moves the vision forward

The two physicians would need help to develop a HaH program for BC– including the buy-in and support of the Island Health, South Island Hospitalists, the Divisions of Family Practice, and eventually, the Ministry of Health. Funding from Health System Redesign and Facility Engagement made that possible.  

“Over the past year we worked relentlessly to get the level of engagement this project requires, while developing our own HaH program for B.C.” says Dr. Tierney.  It meant that they had to become agents of change, inspire others to think outside of the box, and challenge some old-standing beliefs about how hospital-care can be delivered.  

“The same old thinking will always give you the same old results,” says Dr. Crisci.  “We argue that what should define hospital-level or acute-care is the type of patient and the type of clinical interventions required, rather that adhering to a definition based on the physical location of the patient.”

Taking the hospital team and interventions to the patient's home would require further support, which they sought from the BC Ministry of Health. “We don’t want this to be just another community-based service,” says Dr. Crisci.

“We want a true substitute to a standard hospital admission. For this to be possible, we have to ensure that these patients fall under the governance of the provincial Hospital Act. This means that even if at home, these patients are admitted and under the responsibility of the hospital.”

To their delight, the Ministry was interested in doing much more with HaH, and in September 2020, announced that BC would introduce the model to Victoria, and then spread it across the province.  In part, HaH can help with the government’s COVID-19 planning by freeing up some acute care capacity.

Next steps

While there are details to iron out to pilot HaH at Victoria General Hospital and eventually scale to other hospitals, a full-time project team is in place to take the work over the finish line.  The doctors are continuing as medical leads.

They note that experienced physicians on the ground are uniquely positioned to bring innovative ideas such as this to the fore. But they could not have done it alone. It took everyone’s help to make their vision a reality.

“It has been quite an adventure. It started with two physicians with an idea, and now HaH is one of the priorities for BC’s health care system,” says Dr. Tierney.
“The collaborative effort between the Ministry, Island Health and the front-line physicians has been incredible; something I never thought I’d ever witness in my career,” agrees Dr. Crisci. “Here we are, side-by-side, to not only improve the care of patients but also working to make our system a bit more sustainable.”    

"I can’t wait to see that first patient’s face when I can say, “you get to go home, and I will come to see you at home.” - Dr. Elisabeth Crisci

Funding for physician engagement in the HaH project was provided by Health System Redesign (HSR), an initiative of the Joint Collaborative Committees (JCCs) – a partnership of Doctors of BC and the Government of BC – and the South Island Medical Staff Association, funded through the South Island Facility Engagement Society and Specialist Services Committee (one of the four JCCs).

See the South Island MSA website for background, rollout and BC Government plans for Hospital at Home>   


Ref 1: Cochrane Reviews







What's happening

Engaging Physicians to Improve BC Health Care

"Facility Engagement in Action" highlights a few examples of the hundreds of successful activities across BC that are making a difference.   Read it here >

2020 Facility Engagement (FE) Evaluation Survey

2020 Facility Engagement (FE) Evaluation Survey

Facility Engagement is currently undertaking province-wide evaluation. Physicians/medical staff and health authority stakeholders are invited to take our survey to help us evaluate the value and impact of the FEI.  Click here to participate by August 31!

Coronavirus (COVID-19) Updates

Facility Engagement: What is changing?

What is changing?
A lot has changed in the four years since the Specialist Services Committee launched Facility Engagement across BC to strengthen meaningful physician involvement in health authority decision-making. 
  • Across BC’s acute care facilities and programs, 72 Medical Staff Associations (MSAs) in 6 health authorities have galvanized more than 4,300 physicians to participate in 2600+ Facility Engagement activities. (Updated to February 2020).
  • A combination of new structures, funding, physician leadership, and administrative supports are enabling MSAs and their physician members to improve engagement and teamwork among colleagues and with health authorities, in ways that were not possible in the past.
  • The UBC evaluation of Facility Engagement to March 2019 found that medical staff and health authority leaders think that participation in the initiative is worthwhile.

With all of this activity  – and a lot of hard work  – a sense of optimism is fueling a growing culture of engagement across BC, with renewed teamwork and positive experiences reported by many of those involved.

Big themes: Foundation for change

“This is an exercise in relationships – setting a foundation that allows us to grow as an organization, as people, as a team, as partners in care.” – Dr. Harsh Hundal,  Executive Medical Director Physician Engagement & Resource Planning, Interior Health

  • Physician-to-physician communication and relationships are improving as a key step for MSAs to build a strong foundation for engagement and a medical staff voice. Physicians are connecting and meeting across sites and regions – for the first time ever in some cases – to get to know and support each other, discuss priorities and work on projects that strengthen their hospital, patient care, and personal well-being. 

  • Communication with health authorities is improving. At many sites, MSA working groups and physician members are regularly meeting and establishing collaborative processes with health authority administrators and leaders to discuss respective priorities, and to work on projects together. 

  • Physician wellness has also surfaced as a priority, with MSAs across BC initiating activities that aim to reduce the risk of burnout and support physicians to provide patient care in a healthier way.  Some MSAs are now starting to elevate these efforts to an organizational, regional and system level to look at potential improvements that can reduce the risk of burnout. (Doctors of BC is further working on this priority through the Physician Burdens engagement and policy development process.)

  • ​With the new 2019 Physician Master Agreement, Facility Engagement is also officially supporting medical staff engagement in the implementation of electronic health records, starting with Lower Mainland hospitals that are adopting the Cerner syste

Moving Forward

There is more work to be done to achieve sustained change, and further evaluation of the Facility Engagement Initiative will to measure its ongoing impact. Meanwhile, both physicians and health authority partners from many parts of the province report they are making headway to build trust and to make decisions together that impact their hospitals, programs, work culture and patient services.  Stay tuned as this great work continues to unfold!

Read examples and successes >