In Crisis? 
Every day in Health Services starts the same: there is a quick huddle of the staff on shift at the end of the hallway to review the day, who is in what exam room, and any issues we need to deal with. Today it doesn’t take long to get to the issues portion: the front desk and medical assistants are already busy trying to get a hold of 20 or so patients that will be impacted by a sick call from one of our doctors who had a packed schedule. There is a nurse and doctor of the day who will take on urgent cases and the rest will be moved to another day if we are able to hopefully reach them. The reality is we know some folks will show up and we will have to figure out what we do when that happens.
The huddle is still boisterous and cheerful and clearly ready to go. They welcome me to join them on various things throughout the day. It’s my goal to have a full experience following all the various practitioners, sitting in on some appointments, and spending some time with the backbone of the whole operation: our medical assistants and administrative staff.
I start my day in what we call the big room, the shared work space where our medical assistants and nurses work from, the hub for the health services team. It is humming. Tuesdays are a busy day with a mix of appointments and commitments including our STI walk-in clinic running through the evening. I had already spent a few hours with Rachel, our STI Coordinator, to see how she approaches a clinic. She starts with reviewing all the results that have come in, arranging follow ups and treatment plans and chasing down reportable STIs (such as syphilis) from public health for treatment and notification.
It is shortly after 9am and I am sitting with Nancy and Maureen, two of our seasoned Medical Assistants (MA) as they work through the tasks in our electronic medical record (EMR). One critical task is helping a young patient who was supposed to see the doc who is away, for a pre-operative form completion, on an urgent referral. This is top priority: staff need to track the family down and find a way to get them seen. Despite everyone having a lot on their plate, they’ll make this happen.
While observing our MA’s and nurses it is clear the huge impact EMR has had on workflow for health care. It is mostly a blessing but sometimes a little bit of a curse too. Tracking tasks and creating referrals creates a great deal of efficiencies and improves checks and balances to prevent missed steps. Everything is carefully monitored; using EChart we can easily access tests and results to ensure that we have the most current information. The downside is that when something happens to the computer system, it is catastrophic to the day and seemingly small glitches like labels that don’t print or stalling of screens creates havoc and redundancy.
I am off to the lab to spend some time with our lab tech, Ingrid, who is also very busy today. She overviews for me the critical details involved in tracking labs and ensuring that the right person is getting the correct tests and accurate results. Her attention to the smallest detail is notable and it is clear she is a master at managing her workflow. Ingrid is also adept at managing patients who may be nervous with the lab work. She confides that she often can be found singing to her patients. I imagine this is a rather unusual service provided at Klinic- but very fitting!
It is interesting to track certain issues through the clinic on this day: as I spend time with our administrative coordinator, I can see her signing off and getting out the referral letters I saw on the MA tasks earlier and trouble-shooting with tech support around the EMR and label printing issues. Again- the details of what happens in a day in Klinic continue to astound me. It is only 11AM.
I am able to spend a bit of time over the lunch hour at our front desk with Cathy and Gerda, two of our long term Klinic staff who keep the front office moving and efficient. As the daughter of a mother who spent most her life operating a very busy front office and switchboard in the child welfare system, I learned young that it is these folks that set the entire tone of your organization. They are the people that both staff and clients see more than any other. When I talk to Cathy about how she approaches her typical day, every statement she makes underlines the importance of treating people with dignity and getting them as much information and support as possible. The front desk staff interacts in person and on the phone with warmth and respect.
Next, I am able to sit in for a couple of appointments with one of our nurse practitioners, Dawn. Our nurse practitioners and our nurses’ work at a very high scope of practice. We strive to ensure our staff can work as autonomously as possible, making the best use of our sometimes tight resources. Dawn’s ease with her clients and longstanding patient relationships is apparent. One of her clients is here with a group home care worker and has several complaints that Dawn moves through with care and concern, while taking every opportunity to talk about healthy behavior changes they have been working on. Though efficient she never appears rushed.
As part of my day I am trying to get a glimpse at all areas of our health services and so I spend some time talking to our Social Workers Angie and Sandra, and our Dietician Lisa. Having access to these types of services in a team environment are a critical component of our care and particularly important with some of our more marginalized clients. We talk about the time and energy spent in helping people apply for different benefits, determining what they are eligible for, looking for housing and services, while also doing general counselling when required. These generalist social work positions allow our other practitioners to focus on their own scope and be more efficient.
Lisa, our dietician, does a significant amount of diabetes education for clients and for anyone in our community and has started a group model for greater efficiency. She talks about the challenges of people living in poverty needing special food diets, filling out forms to try and get them what they need, and the reliance on food banks to get by.
It is now after 4pm and I still have not visited medical records, our nurse of the day, or our MA for the floor. I am starting to panic; I do get to have some conversation with one of our Docs and one of our Nurse Practitioners in between clients (Lisa and Dave) about what they like or find challenging about their work. As always, I am astounded by how congruent the responses are here: the clients are the best part of the work, support us so we can spend our time with the people we serve. Lissa, our floor MA, takes me on a brief tour of her day: putting clients in rooms, moving people through, cleaning and stocking, and frankly making sure everything works. It is like the position of oil greaser- if anything is stuck in the system of the day- Lissa has to fix it!
Finally it is just after 5pm and I have been graciously invited into an appointment with our Medical Director Mike and one of our nurses Gela, who are doing a follow up with a long standing patient who lives in another area group home. The rapport between Mike, Gela and the client is evident of the long standing and respectful relationship, they move through a host of concerns that she has with ease over the course of half an hour. The client and I talk about her love of the area and Klinic. It is a beautiful way to end a long day. As I walk our client out I check in at the front desk. STI clinic is still early on and already we need to give the message that we are full for the night. I chat with Rachel who advises she has a syphilis follow up that can easily take an hour and a half on the schedule.
I end the day with mixed emotions. I am awed at the breadth of what I experienced and our staff experience every day. I am disappointed I did not get to spend more time with folks and know I will need to do a day two at some point. I am reminded of the important role that I have in supporting these amazing people to do their work, so that as many people as possible can get the best possible care.