Service models and input
Hybrid on-site
Virtual physician is working alongside an in-person physician and an in-person team. This model is intended to support workload by dividing Most Responsible Provider responsibilities between providers based on acuity and capacity.
Driver/problem to solve:
- Long waitlists
- Patients leaving without being seen
- Service interruptions due to physician shortages or reduced capacity of existing on-site physician
Data indicators:
- Emergency Department wait times
- Percentage of patients waiting longer than target wait times
- Stratified Emergency Department volumes based on Canadian Triage and Acuity Scale triage categorization
- Left Without Being Seen rate
- Time until physician assessment
- Emergency Department occupancy level
- Patient and provider satisfaction
Escalation:
Hybrid on-call
Virtual physician is working alongside an in-person physician and an in-person team. This model is intended to support workload by dividing Most Responsible Provider responsibilities between providers based on acuity and capacity.
Driver/problem to solve:
- Long waitlists
- Patients leaving without being seen
- Service interruptions due to physician shortages or reduced capacity of existing on-site physician
Data indicators:
- Emergency Department wait times
- Percentage of patients waiting longer than target wait times
- Stratified Emergency Department volumes based on Canadian Triage and Acuity Scale triage categorization
- Left Without Being Seen rate
- Time until physician assessment
- Emergency Department occupancy level
- Patient and provider satisfaction
Escalation:
Fully virtual
A virtual physician is the sole physician delivering care alongside an in-person team, with escalations to hands-on physician care to another hospital with in-person physician coverage.
This model requires an airway protection and/or high acuity management escalation plan via nursing rural/remote certification, advanced care paramedic, respiratory therapist and/or ambulance bypass.
Driver/problem to solve:
- Service interruptions due to physician shortage
- Proactive overnight coverage
Data indicators:
- Physician full-time employee availability versus. service demand
- Number of shifts unfilled
- Emergency Department closure hours
- Provider burnout rates or satisfaction
Escalation:
- On-site airway protection provided by non-physician, as outlined in description
Understanding the lived experiences of patients, families, and clinicians is central to shaping a Hybrid Model of Care that is responsive, respectful, and effective. Throughout this initiative, we’ve engaged in meaningful conversations to learn what matters most to those receiving and delivering care.
What information helps patients feel ready before seeing a virtual physician
- Process of how patients are assigned to see a virtual physician
- The consent process and right to refuse
- Privacy and patient rights
- Information should be available both in the community and hospital, including:
- Social media, community centre and library boards, and brochures and posters at doctor’s offices and walk-in clinics
- Posters about virtual/remote physicians in the hospital, FAQ brochures, conversations with nurses about virtual care, interaction with a remote physician
What makes a virtual care encounter via HMOC successful
Feeling informed and prepared
- Clear information about how and why they are assigned to a virtual physician
- Understanding their right to give or refuse consent
- Knowing their privacy and rights are protected
- Seeing posters or brochures in the hospital and community
- Having a conversation with a nurse before the virtual visit
Feeling confident in the provider
- The physician is prepared and has reviewed the patient’s chart
- The physician listens actively and communicates clearly
- The nurse present helps the patient feel supported and comfortable
Feeling comfortable with the technology
- The video and audio are clear and easy to adjust
- The platform is simple to use, with no technical barriers
- The connection is strong, with no delays or disruptions
Feeling safe and respected
- The virtual visit takes place in a private, secure setting
- The environment is calm and comfortable
- The provider takes time to:
- Address patient and family concerns
- Explain the treatment plan
- Explain follow-up after discharge
What supports a positive experience
- Patients and caregivers expect the physician to have the necessary knowledge and skills
- The physician is expected to review the patient’s chart before the virtual visit to demonstrate preparedness
Communication and bedside manner:
- The physician actively listens to both the patient and caregiver
- The nurse present with the patient plays a key role in helping the patient feel comfortable
Technical quality and usability:
- Video quality enables the patient to clearly see the physician
- Audio volume is adjustable and easy to hear
- The platform is intuitive and free of technical barriers
- Strong connectivity ensures smooth interaction without lag or disruptions
Privacy and comfort:
- The virtual encounter is held in a private and secure setting
- The environment is physically and emotionally comfortable for the patient
- "The majority of in-person providers have found the experience to be quite smooth and the workload division equitable, there are a couple of doctors that are more hesitant but adjusting to the workflows"
- Interior Health Physician - "Virtual care has great potential to alleviate pressures within our health authority, but it requires thoughtful refinement in both system processes and resource allocation."
- Interior Health Physician
To guide change management across diverse teams and settings, we’ve adopted the ADKAR framework - focusing on Awareness, Desire, Knowledge, Ability, and Reinforcement. This framework helps us support individuals and teams as they transition to hybrid care delivery.
