PARTNERS IN CARE. Project Scope Document

Transcription

1 PARTNERS IN CARE A Shared Care Initiative PROJECT CHARTER Project Scope Document September, 2011

2 Table of Contents 1. Executive Summary 2. Project Scope Document Introduction 2.1. Purpose 2.2. Document Change Control 2.3. Consultations 3. Project Overview 3.1. Background 3.2. Summary 3.3. Goals, Objectives and Outcomes 3.4. Scope 3.5. Timeline 3.6. Initial milestones 3.7. Key Deliverables 3.8. Budget 4. Project Approach 4.1. Process Methodology 4.2. Governance & Relationship Model 4.3. Human Resource Plan 4.4. Communications 4.5. SWOT analysis 4.6. Key Project Risks 5. Project Evaluation 6. Acronyms 7. Appendices A. Estimated Budget Details 2

3 1. Executive Summary The members of the South Island Division of Family Practice (SIDFP) identified the need to improve linkages between family physicians (FP) and specialists (SP) as one of their key priorities. Improving these linkages would enhance the relationship between family physicians and specialist physicians and be fundamental to the delivery of effective health care, especially for the most complex patient populations. The desire to enhance these relationships and strengthen linkages resulted in the creation of the South Island Division Partners in Care project, a Shared Care initiative. The project will leverage a number of transformational projects already underway in other Divisions as a means to strengthen relationships, foster mutual trust, respect, and share knowledge of each physician s expertise and responsibilities. Under this proposed initiative, activities will be undertaken that will serve as building blocks to create system improvements for improved patient care, optimize service delivery, and improve patient experience and physician professional satisfaction. Five key factors were used to select the activities that form the scope of this project. These are the: 1. ability to leverage existing successes with only minor adaptation to meet SIDFP s local needs; 2. contributes to the effective and efficient flow of patients between primary and specialist care; 3. improves patient experience and physician professional satisfaction; 4. engages key stakeholders in specific activities; and 5. ability to be achievable and measurable. The activities to be undertaken for this initiative are: Leveraging and potentially expanding on the Provincial Shared Care Committee s Partners in Care Referral Program. Expansion may include exploring the introduction and testing of an e-referral system, pooled referrals and promoting the broader adoption of expedited and other types of consultations. Conducting concurrent activities such as: A Engagement event bringing together FP and SPs, potentially co-hosted with the Victoria Division; Delivering a number of Learning and Knowledge Transfer events. These will include informational sessions following each specialty engagement and general knowledge sharing opportunities. Partnering with the Victoria Division and VIHA s Practice Support Program team to expand their System of Care prototype for patients with COPD across the SIDFP. Exploring the feasibility of implementing a blog feature on the South Island Division website to not only track the progress of the initiative but encourage knowledge sharing on shared care practices, challenges, victories and lessons learned. Conducting a feasibility study on the local adaptation of the Providence Health Care Rapid Access to Consultative Expertise Program. 3

4 The guiding principles for these activities are that they: are patient centered; ensure that other physicians not involved in working groups are consulted about changes that will impact their practices and resources; and achieve optimal care by designing a FP/SP dynamic that enables the patient to get the right treatment. The activities are aimed at improving: communication, knowledge transfer and relationships between specialists and family physicians; patient care by ensuring practices are accessible and coordinated and provide continuity of care; access to specialists for consultations; capacity of specialists; and capacity of family physicians to manage care, when appropriate, within their setting Desired outcomes of these activities are: the patient s journey is seamless with appropriate and timely access to specialist care; patients can better manage their own care with fewer unnecessary medical and/or diagnostic interventions; duplication of effort and utilization of resources are reduced; the frustrations of patients and physicians are reduced; and specialists capacity is increased. The Process: The process used throughout this initiative is the Institute of Healthcare Improvement (IHI) model of improvement which utilizes a collaborative stakeholder approach to implementing and measuring change. It includes two components: Plan Do Study Act cycles A tool for prototyping change (see section 4.1 for details) Triple Aim An evaluation tool The initiative will be undertaken over an month period. Timelines are highly dependent on the participation levels of both family physicians and specialists and the type of the relationship that develops with the Victoria Division*. *Note to reader: At the writing of this report the Victoria Division was in its early formative stage which may affect their ability and capacity to engage with the SIDFP around this initiative. Awareness and information sharing between the South Island and Victoria Divisions will help facilitate future cross-division collaboration and engagement. 4

5 2. Scope Document Introduction 2.1 Purpose This document defines the project scope of this initiative and serves four purposes. It is a: 1. living document that defines the scope, objectives, assumptions, risks and overall approach for the work to be completed; 2. business case to secure funding through the Shared Care Committee for activities not funded through other sources; 3. single point of reference and will be revised to reflect changes in the scope as assumptions are validated or disproved or if changes are required as a result of surveys, PDSA cycles or the evaluation process; and 4. knowledge management tool. 2.2 Document change control Document Revision History Date Version Author Brief Description of Change Darlene Letendre Initial draft completed Darlene Letendre Addition of SWOT analysis Darlene Letendre Addition of Appendix A - estimated budget details Darlene Letendre Revised version based on Andrew Hume s review Darlene Letendre Revised following review by Drs. Fretz and Pocock and additional discussions with Andrew Page Project Summary, 2 nd paragraph Addition of Note: It is critical that prototyping exercises consider the EMR in design and implementation Page 13 Added for each speciality engaged following Standard Referral Template Page 15 Add Governance and Relational Model Graphic Page 16 Simplified language in Purpose section Page Budget Adjusted amount from to accommodate cost of Division staff support and meeting participation Changed term from Dine and Learn to Learning and Knowledge transfer throughout the document Change Meet and Greet to Engagement 5

6 2.3 Consultations Building on the recommendations of the South Island Division s members, the direction and scope of this project evolved through consultations with the following individuals. Business Area Name Role South Island Division of Family Practice Andrew Hume SIDFP Board Members Division Coordinator Project Sponsor Family Physicians Dr. Michele Fretz Physician Champion Dr. Jeff Pocock Physician Champion MOHs/BCMA Clay Barber Provincial Shared Care Committee Lead Vancouver Island Health Authority Val Tregillus Alana McCabe Nichola Manning Kevin Brown Jean McKinnon Executive Director, Primary Care GPSC Regional Support Team Lead Executive Director, Medical Services Division Director, Community Healthcare and Resource Directory (CHARD) Manager, Primary Health Care, Regional Support Program South Okanagan Division Terrie Crawford Division Coordinator Division of Family Sarah Whiteley Physician Engagement Leader Practice Society of Specialists and Surgeons of BC Providence Health Care Rapid Access to Consultative Expertise Program (RACE) Victoria Division of Family Practice Physicians Information Technology Office (PITO) VIHA (Telephone advice line) Andrea Elvidge Future consultations Margot Wilson Dr. Robert Levy Dr. Garey Mazowita Valerie Ehasoo Rob Hughes Dr. Brian Weinerman Executive Director (Sept 7, 2011) Director Physician Lead Physician Lead Physician Lead Contact Relationship Manager for South Island Executive Medical Director Pharmacy, Diagnostics and Community Hospitals 6

7 3. Project Overview 3.1 Background Divisions of Family Practice are groups of physicians organized at the local or regional level who work to address common health care goals. They are designed to improve patient care, increase family physicians influence on health care delivery and policy, and provide professional satisfaction for physicians. Each Division of Family Practice works in partnership with its health authority, the General Practice Services Committee (GPSC) and the Ministry of Health Services (MoHS). Together, they identify gaps that exist in patient care in a Division s community and develop solutions to meet each community s needs. An information and planning event, sponsored by the South Island Division of Family Practice (SIDFP), was held in November The members who attended the event identified a number of priorities. One of the key priority areas was improving linkages between FP and SP which lead to this Partners in Care project, a shared care initiative. The core work of this project is made possible through the Shared Care Committee (SCC), which is working closely with the GPSC and the Specialist Services Committee (SSC) to support both FP and SP. Dedicated funding is committed to March 31, 2012 under the current Physician Master Agreement (PMA). Approved SCC Projects with implementation dates beyond this date, continue to have access to the allocated funding for the duration of the project. Other project initiatives are made possible through the Practice Support Program and the Community Healthcare and Resource Directory (CHARD) - initiatives of the GPSC supported SSC. Intentionally left blank 7

8 3.2 Project Summary The core initiative proposed for this project involves leveraging and potentially expanding on the Provincial Shared Care Committee s Partners in Care Referral Program. Through a physician-led structured collaboration of family physicians (FP) and specialists (SP), working groups will assess/take stock of current practices, identify areas for improvement that will increase the capacity and access to specialist, improve the capacity of family physician to manage care when needs are within their scope of practice, improve communication, knowledge transfer by improving the flow of information between FP, SP and patients. Processes and protocols will be established for referrals, consults, care plans and patient self-management mechanisms and may include exploring the introduction and testing of an e-referral system. This initiative will initially include: rheumatology, gastroenterology, dermatology, psychiatry, general surgery, orthopaedics and cardiology. Other specialties may join throughout the project. Note: It is critical that prototyping exercises consider the EMR as part of design and implementation. The project also includes leveraging other transformational initiatives in place in other Divisions and a number of complementary activities that serve as building blocks to enable knowledge transfer and relationship building. Delivering a number Learning and Knowledge Transfer events. These events are aimed at: - increasing awareness throughout the project and encouraging participation and adoption of tools, processes etc. These would include FPs and MOAs. - facilitating knowledge transfer with interested specialty groups and/or community stakeholders to strengthen relationships - soliciting feedback The initial events will include: - Partnering with CHARD to deliver information and training sessions. Initial pilot scheduled for October 5, 2011 with similar follow-up events over the next 6-9 months building on the success of the pilot. - an engagement event bringing Family and Specialist physicians together - potentially co-hosted with the Victoria Division in the early spring. Partnering with the Victoria Division and VIHA s Practice Support Program (PSP) team to expand their System of Care prototype for patients with COPD across the South Island Division. Following an initial discussion with VIHA s PSP manager, it is recommended a timeline of early spring 2012 to roll out the expansion. Conducting a feasibility study on the local adaptation of the Providence Health Care Rapid Access to Consultative Expertise Program.; and Exploring the feasibility of implementing a communications strategy including a blog feature on the South Island Division website to not only track the progress of the initiative but encourage knowledge sharing on shared care practices, challenges, victories and lessons learned. 8

9 3.3 Project goals, objectives and outcomes No. Goals Objectives Outcomes Improved physician experience Improved mutual support More efficient communications between SP and FP for urgent issues Improve communication, knowledge transfer and relationship between specialists and family physicians Improve practices that provide quality patient care that is accessible, coordinated and provides continuity of care Improve specialists access and capacity Improve flow of information between SP, FP and patient: referrals, consults, care plans, medication management and end of life care Create and foster an environment where SP and FP are actively participating Strengthen the link between SP and FP Improve SP knowledge of the scope of FP Clarify roles, processes and protocols in providing shared care Develop seamless processes for providing care between physicians Develop integrated care plans where appropriate SP and FP communicating when required to provide timely and appropriate care to patients Patients receive the right care at the right time by the right provider Development of integrated care plans to support collaboration and continuity of care between providers and patients where appropriate Increased access to services Improved quality and appropriateness of referrals Increased access to service Improved physician experience 4. Improve capacity of FP to manage care, when appropriate within their setting FP receiving decision support for referral decisions FP receiving needed information to provide up to date care for patients Consult to SP from FP using up to date guidelines and assessments 5. Include patient voice in project and redesign To provide an avenue for patients to engage in project Patients included in components of project Where specific data is not available to measure success, improvement will be evaluated using tools such as: Physician/MOA surveys Physician discussion groups e-polling tools at physician events Patient satisfaction surveys 9

10 3.4 Project scope # Activities in Scope Activities out of Scope 1 Referral processes and practices between Family and Specialist Physicians. Including exploring the introduction and testing of an e-referral system and pooled referrals. 2 Consultative processes and practices between Family and Specialist Physicians. Including broader adoption of expedited and other types of consultations. 3 Communication patterns and channels between Family and Specialist Physicians. 4. Care Planning processes and practices between Family and Specialist Physicians. 5. Member surveys, newsletters and Learning and Knowledge Transfer events. May include the implementation of a blog feature on the Division s website 6 An Engagement event for family physicians and local specialists in early Spring Partnering with the Victoria Division and VIHA s Practice Support Program team to expand their System of Care prototype for patients with COPD across the South Island Division. 8 Conducting a feasibility study on the local adaptation of the Providence Health Care Rapid Access to Consultative Expertise Program. To be populated after the development of the detailed work plan. 10

11 3.5 Timeline The term of this project is months beginning with approvals from the Board, South Island Division and Provincial Shared Care Committee. The anticipated start date is November 1, Initial 90 day work plan - Subject to obtaining funding approval: Develop detailed work plan within the first 30 days; Set up Steering and Advisory Committees and hold kick off meetings; Develop Terms of Reference and obtain Committee approval; Survey Physicians and MOAs to identify potential participation levels and create an inventory of members with special interests etc.; Hold an information sharing event including MOAs to increase awareness of the project and encourage participation in the roll out of new tools and processes; Pilot a dine and learn to increase awareness and utilization of CHARD. Tentatively scheduled for October, 2011; Initiate an informal working group engaging a rheumatologist to trial the approach, draft engagement criteria, level of administrative support required etc. The objective is to develop a flexible structured model for future specialist engagement initiatives. Includes but not limited to: a. Inventory of templates developed by other initiatives such as: SCC Partners in Care Referral Program, PSP System of Care prototype for patients with COPD, South Okanagan Division etc. b. List of tools and processes working groups might consider focusing on. For example: - Standard referral form - Telephone advice protocols - Urgent/expedited consultation protocols - Care plans including re-referral criteria - Knowledge transfer opportunities - Development of baseline measures & what success looks like - Patient self-management mechanisms Implement project management support tools, recruit project support staff such a facilitator, evaluator and administrative support and secure meeting facilities; and Identification and cultivation of partnerships with other stakeholders that play a role in the success of this project. 11

12 3.6 Initial Milestones # Project Milestone 1 Develop Project Scope Development/Proposal Description Expected Date Overview of project scope and estimated budget Aug 31, Obtain Board approval Present proposal Sept 21, Obtain funding from SCC Present proposal and estimated budget Oct Pilot event on CHARD 5 Communicate project to members 7 8 Survey members Hold MOA information 9 Develop Project Management Team Form Steering Committee Form Advisory Committee Launch informal Working Group with rheumatology 13 Develop working groups and schedule sessions with other specialties Physician engagement Completion of physician surveys Engagement Event 17 Initiate expansion of PSP System of Care for COPD patients Present evolution of Directory, provide training and promote utilization Present proposal, promote engagement, advice of survey To solicit participants, obtain feedback on issues, special interests Communicate, promote project, solicit engagement, identify best channel for ongoing communication Hire Facilitator, Evaluator and Administrative Assistant Confirm Steering Committee with representation from Specialists, Family Practice, VIHA/MOHS/SCC Confirm Advisory Committee with representation from Specialists, Family Practice, VIHA/MoHS, Patient Voices and Society of Specialists and Surgeons of BC To trial approach, develop generic engagement criteria, assess administrative support required. Will be used as example at physician engagement events Obtain participates for each identified specialty group, prioritize engagement and schedule meetings Promote and communicate with SP & FP the focus of project. Physician surveys are developed and sent to physicians to solicit feedback about area of focus to assist the advisory group plan the actions required to improve the processes Relationship building initiative between Family and Specialist Physicians Work with PSP to trial COPD System of Care across Division Oct 5, 2011 Oct 26, 2011 Nov 2011 Nov/Dec 2011 Nov/Dec 2011 Dec 2011 Dec 2011 Dec 2011 Jan/Feb 2012 To be done prior to the start of each topic area To be done prior to the start of each topic area Spring 2012 Spring

13 3.7 Key Deliverables 1. Tools and associated processes that strengthen the flow of the patient between Family and Specialist physicians such as: Standard referral templates (for each specialty engaged) (Telephone) advice protocols Urgent consultation mechanisms Care plans and re-referral criteria Patient self-management mechanisms 2. Documented processes that improve the quality and appropriateness of referrals 3. Processes that improve communication and understanding of roles between Specialists and Family Physicians through knowledge transfer and relationship building activities. 4. A 25% increase in local Specialists practice specific information on CHARD 3.9 Budget The SCC has allocated up to $3 million at provincial level to support this collaboration. This budget only includes the portion of this project that will be funded by the SCC. The projected budget is. This amount includes a contingency fund in anticipation of an increase in membership by approx 1/3 and potential partnership opportunities with the Victoria Division. It is understood that these funds will be transferred to the South Island Division of Family Practice to administer. A separate account will be established for this project. Monthly financial reporting will be presented for review at scheduled Steering Committee meetings. See detailed budget estimate in Appendix A. Physician Remuneration Physicians will be compensated for their time in accordance with SIDFP compensation guidelines and within the provisions set forth in the BCMA Master Agreement. 13

14 4 Project Approach 4.1 Process Methodology The process used throughout this project will be the Institute of Healthcare Improvement (IHI) model of improvement. It is a stakeholder collaborative approach to implementing and measuring change. The model includes two components: 1. PDSA cycles A tool for prototyping change Changes will be tested in the physicians work setting and reviewed to identify what worked? What didn t? What needs to be modified? Cycling through this process until the change is ready to spread. The four stages of the PDSA cycle: Plan - the change to be tested or implemented Do - carry out the test or change Study - data before and after the change and reflect on what was learned Act - plan the next change cycle or full implementation Aim/outcome and target population Measures/Indicator Process changes/activities/inventions What have others done? What hunches do we have? What can we learn as we go along? 2. Triple Aim An evaluation tool Improving the health of the defined population, Enhancing the patient care experience (including quality, access and reliability), and, Reducing or at least controlling the per capita cost of care. The three components of Triple Aim are interconnected - a change in one component can affect the other two. 14

15 4.2 Project Governance & Relationship Model 15

16 Steering Committee Advisory Committee Working Group Goals Purpose Members To maximize the potential for success of this initiative through coordinated, strategic, implementation of the shared care initiative by maintaining an active effective steering committee that provides oversight, promotion, and support of the project. Strategic oversight and leadership Set priorities and addresses strategic issues Promotes project to stakeholders Provides support to reduce barriers and risks Physician Representation Specialist Lead Family Practice Lead Partners VIHA MoHS SCC Society of Specialists Support Division Coordinator Project Coordinator Facilitator Admin assistant To develop, trial and implement processes and protocols between specialists and family physicians to improve access to specialists and co-ordinate and enhance the continuity of care between disciplines to improve care for patients with complex chronic care needs. Provides day to day leadership Champions and ensures physician engagement in process Advises on tools and process development, implementation and evaluation Manages project risks and ensures outcomes are achieved Physician Representation Specialists Family Practice Physicians Partners VIHA MoHS SCC Society of Specialists Patient Representation Patient representatives from the Patient Voices Network Support Project Coordinator Facilitator Admin assistant To develop, trial and implement processes and protocols between specialists and family physicians to improve access to specialists and co-ordinate and enhance the continuity of care between disciplines to improve care for patients with complex chronic care needs. Develops, trials and implements processes to be tested Champions project and encourage colleagues to participate Engages in revisions based on PDSA cycles Participates in knowledge transfer events Physician Representation Specialists Family Practice Physicians MOA (FP and SP) Partners (Optional) VIHA Support Project Coordinator Admin assistant 16

17 4.2 Human Resource Plan i. Project Management Support A Project Coordinator, Facilitator, Administrative Assistant and an External Evaluator will be providing support for this project. Details about their roles are included in the chart below. ii) Roles and responsibilities Role Responsibilities Project Sponsor works with the project management team MOHs/BCMA Shared Care Committee helps with project matters such as funding, scope clarification, progress monitoring, and influencing others in order to benefit the project champions project receives reports from Project Coordinator monitors progress and responds to issues Project Coordinator Under the direction of the Division Coordinator provides: day to day executive responsibility for the project lead for developing project structure, scope and plan initiates stakeholder communication primary liaison to sponsor and other stakeholders manages the delivery of project outcomes & responsible for project status works closely with specialist, FP champions and IH reps planning work, allocating resources,defining tasks assigning responsibility,monitoring quality and performance supporting PDSA cycles responsible for identifying issues & risks to Steering Committee Admin Assistant arranges bookings for meetings and events takes minutes, composes correspondence, reports, briefing notes, and a variety of documents creates, edits and formats templates and documents for trials and implementation Evaluator develop an evaluation plan and related tools required if requested assist with the write up of the submission for the Research Ethics Board collect and analyze data provide feedback and recommendations to Division Coordinator, Project Coordinator and Steering Committee after each improvement cycle. prepare and submit final evaluation report 17

18 Role Responsibilities Specialist Lead advocate and promote the benefits of pursuing this project and encourage physician engagement seeks project support from management and other organisational leaders FP Lead advocate and promote the benefits of pursuing this project and encourage physician engagement seeks project support from management and other organisational leaders VIHA Reps various reps participating at the various levels of the project to assist with process development and systems change reviewing and commenting on impact of suggested changes involved in trials and evaluating suggested changes Steering Committee provide strategic oversight and leadership for project planning, implementation and evaluation communicate project updates to various stakeholders develop and Approve Project Scope Document approve communication plan and roll out champion, lead and encourage progress for collaborative project Advisory Committee champion, lead and encourage progress for collaborative project advise on the tools and process development, implementation and evaluation provide day to day leadership for project planning communicate project updates to various stakeholders ensure physician engagement in the process provide advice on the communication plan and roll out ensure quality and safety elements are embedded in the project Patient Representatives add patient perspectives to discussions in advisory committee and working groups 4.4 Communications Meeting agendas and minutes will be communicated primarily through . Minutes will be distributed to formal participants (members of Steering and Advisory Committees) as well as a broader cohort of interested physicians, administrative leads, and other key stakeholders. Progress will be communicated through the Division newsletter, website and physician engagement and information events. 18

19 INTERNAL EXTERNAL Partners in Care 4.5 SWOT Analysis Key Strengths Top Five Factors Key Weaknesses Project was identified as one of the members key priorities Strong board support 2 physician champions to initiate specialist referral improvement activities Project designed to provide flexibility if course change is required and to ensure continuous forward momentum Access to strong skills within Division administration and support at the Provincial Division level Key Opportunities Division is just developing and has a number of identified priorities that will compete from the same resource pool Level of Family Physician participation due to competing demands on their time is unknown. Impacts directly on: Template/process development activities PDSA trials Spread activities Governance structure Lack of dedicated meeting venue and geographic distribution of members Full scope of administrative resources and information technology support required is unknown at this time. Many outcome aspects of the project cannot be measured quantitatively. Key Threats Potential for partnering with the Victoria Division Strong support network in place: PSP CHARD SCC MoHS Other Divisions have previously received funding for similar projects Prototypes in place and ample templates to leverage Minimal funding required for System of Care expansion and CHARD activities Victoria Division priorities unknown may be competing from the same specialist resource pool as South Island. Unknown level of Specialist participation due to competing demands on their time. Impacts directly on: Template/process development activities PDSA trials Spread activities Governance structure Master Agreement Negotiations risk of future funding to ensure long term sustainability of continued improvement initiatives Low take up by local specialist on CHARD Potential lack of VIHA /PSP resources to spread COPD prototype 19

20 4.6 Key Project Risks A risk register will be developed as part of the development of a detailed work plan. The register will be maintained throughout the project. Risk Description Probability Impact Risk Response Description 1 Physician Engagement The majority of physicians MEDIUM MAJOR are at full capacity and there are a number of competing initiatives requiring their participation. Need to actively communicate and promote project and progress Identify a pool of FPs that are interested in participating Align FPs that have special interests to a corresponding change / improvement strategy. 3 Scope creep MEDIUM MEDIUM Reviewing requests and updating progress monthly in steering committee meetings to identify if within scope. If out of scope develop a list of future initiatives or refer to potential avenues to be addressed. 4 Spreading Changes MEDIUM MAJOR develop strategies and communicate changes with those not involved in working groups but impacted by the changes Formally engage MOAs to assist in promotion and adoption of tools. 20

21 5 Project Evaluation The evaluation of the project will be conducted by an external evaluator/consultant. The evaluation will follow the Institute of Healthcare Improvement s Triple Aim approach and will align with the PDSA cycles of the project in order to provide feedback to inform the development of the project. Due to the nature of the project and its continual evolution throughout the evaluation, each phase informs the evaluation phase of the next one. Intentionally left blank 21

22 6 Acronyms Acronym CHARD Definition Community Healthcare and Resource Directory A project operated by HealthLink BC. Provides general practitioners other healthcare professionals with information about health-related services, organizations, locations and practitioners. EMR/EHR Electronic Medical Record/ Electronic Health Record FP GPSC IHI MOA MoHS PVN A computerized medical record that may include medical history, medication lists, lab results, etc. Family Physician or Family Practice Physician The General Practice Services Committee Institute for Healthcare Improvement Medical Office Assistant Ministry of Health Services Patient Voices Network. PSP SIDFP SP VIHA A network of patients who help change the primary care system in BC through being active in patient advisory committees, speaking to decision makers, attending conferences etc Practice Support Program Helps doctors and their staff to make changes in their practices (in partnership with General Practice Services Committee, BC Medical Association and Ministry of Health). South Island Division of Family Practice Specialist Physician Vancouver Island Health Authority 22