GRANT’S DESI ACHIEVER
AN INNOVATIVE APPROACH TO PATIENT CARE
Dr Tara Kiran, Fidani Chair in Improvement and Innovation, University of Toronto.
By SHAGORIKA EASWAR
Dr Tara Kiran opted for family medicine over seemingly more glamorous specializations because “family medicine is grounded in the community over the life of a patient”.
The Fidani Chair in Improvement and Innovation at the University of Toronto and Vice-Chair of Quality and Innovation at the Department of Family and Community Medicine, Dr Kiran practices family medicine at the St. Michael’s Hospital Academic Family Health Team.
“I am passionate about trying to improve the primary care system in Canada and the world,” she says. “I am focused on social and policy innovation in my work. If we want everyone to have access, we have to think differently, do things differently.
“Traditionally, we see the model of one family doctor and a medical secretary bringing care to patients. What if we were to bring in more healthcare professionals into the team, keeping in mind the communities they serve?”
Dr Kiran is not talking about one’s family physician’s referrals to a specialist if needed, but about bringing in dieticians, social workers – people whose training is complementary to that of the physician’s, to work together in collaboration.
She herself works in such a team, but that is the exception, not the norm.
“We have nurses, nurse practitioners, pharmacists, dieticians, and income security health promoters. As family doctors, we get to know our patients in the context of their families and community, and become more attuned to their individual circumstances and needs.”
She investigates how changes in the healthcare system impact the most vulnerable. She develops and tests solutions to make healthcare more inclusive and more effective.
Under her leadership, her team collected and reported more than 20 indicators of quality and made significant improvements in a number of areas, making it easier for patients to get a timely appointment and more people started receiving recommended cancer screening. Recent initiatives include trying to improve care for people facing stigma in society such as those who are dependent on opioid medications and those with Hepatitis C.
She and her team have also studied the impact of financial incentives on diabetes care and cancer screening and found that the introduction of these incentives for family doctors has had minimal to no impact.
“Research suggests that most people who had family doctors were getting screened anyway. The ones who were getting left out didn’t have a family doctor. Now there are new pathways to screening for many cancers without a family doctor, but no one is telling the patients.”
More recently, she is focusing her efforts on quality improvement research initiatives to improve patient experience including access to care and reducing care disparities.
Her research has shown that income, gender, race, length of time in Canada and the communities patients live in impact access.
“Primary care is the front door to healthcare, but more than 6.5 million people in Canada don’t have a family physician or access to a nurse practitioner.
“There have been many studies over decades that show that despite universal medicare, we still see inequities in health and health access. People in low income are unlikely to have a family physician or get cancer screening. There are many reasons for this, many interacting issues, with some confluence with poverty, competing priorities being just one factor. When you have to work double shifts to put food on the table, you are unlikely to take time out for a screening. People who have suffered trauma fear tests and diagnoses. Newcomers find it hard to navigate language and cultural barriers. In a healthcare system where maybe not everything is abundant, and you’re jostling to get to the front of the line, some may lack resources to advocate for themselves.
“I try to take an equity lens in all my work to understand differences in health and healthcare for vulnerable population groups. To identify health issues in communities and workshop solutions that would help remove some of the barriers we find.”
To this end Dr Kiran launched OurCare, a national, public engagement initiative to co-create the blueprint for a stronger, more equitable primary care system in Canada – a blueprint that can be used by government to inform and enact reforms, and by professional organizations and the public to advocate for change.
It is the largest such exercise in primary care in Canada, with national surveys, citizenship panels, roundtables with Indigenous youth, and panels on newcomer health in different languages, etc. They heard a lot of recommendations from those directly affected.
From Indigenous youth they heard the importance of self determination, the desire to be empowered and given the resources to take charge of their heath.
Newcomers across the country shared their surprise at first learning that dental care – or the cost of an ambulance ride – were not covered. They had assumed everything was free. They wanted more clarity and information to be readily available. They also recounted their experiences of racism and discrimination within the healthcare system, and how that impacts whether they seek care at all.
Their final report brought consistent themes across the country to the attention of physicians as a vision forward..
“A lot of the work I am doing now involves working with senior leaders in governments and the community to make it a reality.”
Many physicians don’t want to practise in rural areas for a variety of reasons. Dr Kiran wasn’t one such.
After completing her family medicine residency at McMaster University in 2004, she worked as a locum in Indigenous communities in northern Ontario and in community health centres in urban Toronto.
She practised at the Regent Park Community Health Centre from 2006 to 2010 before joining St. Michael’s in 2011.
Those years helped her see the important role family doctors play. “I saw my mentors in rural areas taking leadership in improving population health,” she notes. “Regent Park is dense, urban and distinct. The community health centre there was embedded in the larger community in the true sense of the word. Their strategic envisioning and co-led initiatives led to the setting up of Pathways to Education which provides key support to ensure that youth from the community who complete high school continue on to post-secondary programs and become actively engaged in their career development.”
“Have the courage to try new things.” Dr Tara Kiran, extreme left, with her team.
Dr Kiran has held a number of local and provincial leadership roles and received a number of prestigious awards for her research.
She is frequently quoted in the media on issues of public health and was often in the news during the pandemic, fighting misinformation about vaccines and for her advocacy for marginalized and under-served communities.
Today, though the frenzy may appear to have dissipated somewhat, conspiracy theories abound. Where do we find information we can trust?
“I would suggest looking for websites run by medical organizations,” she says.
“The Canadian Medical Association has a new website, www.cma.ca, Healthcare for Real. The Society for Obstetrics and Gynaecologists has a number of wonderful websites helping in reproductive planning and safe facts. Canadian Paediatric Society and Sick Kids are great for questions on kids’ health. I often refer my patients to the Mayo Clinic site. Basically, it’s okay to use Google, but from there navigate to reputable sites.
“Be wary of social media feeds that disproportionately distribute controversial material. Hateful speech gets more ‘likes’ and they are not incentivised to give links to reliable information.”
Dr Kiran’s father came to Canada in the 1970s with a scholarship at the University of Saskatchewan and her mother followed a year later, to study at the same university.
From there, they moved to Toronto where she was born.
The Indian diaspora helped them feel at home, and many in the larger community were kind and friendly.
One in particular, supported her father, helped him figure out how things worked in Canada, helped him integrate and introduced him to fun experiences.
The story of how her father got conned into buying a coat enroute Canada also made it into family lore.
This was his first journey outside India and with no internet at the time and also no one he knew here who would have shared information, he didn’t really know what to expect.
On a layover in Hong Kong, someone approached him saying he would need a warm winter coat as he was going to a cold country.
“He sold dad a ‘wonderful warm coat’ made of corduroy, and you can imagine how warm that kept him.!” she says with a laugh.
“Where food is concerned, dad loved milk and eggs, so he was good. Mom was initially a vegetarian and she must have found it challenging.”
Dr Kiran is married to Dr Irfan Dhalla, an internist at St Michael’s Hospital. It’s still early years for their children, Anousha, 17; Nikhil, 14; and Mihir, 11, to have decided on career paths, but she says Nikhil is the one who most frequently says he wants to be a physician.
Hard work and perseverance go a long way in achieving success, she tells those who see a role model in her.
“Know who you are and your values, and bring that to the work you do. Show up in an authentic way.
“Observe and listen, understand the culture and society. Look for where you can make any contribution in areas where a need is not being met.
“Have the courage to try new things, putting yourself in situations where you might feel vulnerable. That can be hard, but immigrants try so many new things without even consciously being aware of doing so.
“And don’t lose your sense of adventure and fun. That will help you see challenges in a different light, to enjoy the journey and not just focus on the destination.”
For her, making an impact in people’s lives is very special.
“And when I publish something that resonates with a wider group and moves things in a new direction, I find that very rewarding. I enjoy variety in my workday and in family medicine, I get to see a wide range of people. There’s never a dull day!”
More info at OurCare.ca.
Find a family doctor at www.ourcare.ca/find-a-family-doctor.
• Grant’s is proud to present this series about people who are making a difference in the community. Represented by PMA Canada (www.pmacanada.com).
