Visiting the Transgender Person Health Program, Vancouver BC #KPLantern

KPLantern Vancouver BC 52864THE WORDS DON’T FIT THE PICTURE – Click to view on – (City of Vancouver Public Art Registry)

When the Kaiser Permanente Innovation Consultancy (@KPInnovation) undertakes an insight project, it recruits at least two Kaiser Permanente regions + one external “examplar” site outside of Kaiser Permanente.

In the case of KPLantern, field work to understand transgender person care, that site is Vancouver Coastal Health [VCH] (@VCHHealthcare) which serves one million BC residents.

As part of my learning of the design thinking technique, I was fortunate to join the team (of myself and Team Lead and Designer Dana Ragouzeos) to complete our field work there. I’m glad we did.

This is blog post 1 of 2 of our experience.

A lot to see

KPLantern Vancouver BC 52865Our Vancouver Innovation Team – With the experts – Marria Townsend, MD, Gail Knudson, MD (president-elect of WPATH), Vanessa Barron (PHSA), Dana Ragouzeos – Lead Designer, Kaiser Permanente, Kelly Mattheis, MD, John Welch, MD, Ted Eytan, MD (View on

Our host/sponsor was Gail Knudson, MD, MPE, FRCPC (@Gail_Knudson), Clinical Assistant Professor in Psychiatry at University of British Columbia, and also, the President-Elect of WPATH (World Professional Association of Transgender Health – @WPATH). And when I say host, I mean “host.” She personally accompanied us during most of our field work, which is a huge honor, to put it mildly.

Our first two days were spent at BC Children’s Hospital, where the transgender pediatric program is based, and at several VCH clinic sites as well as the Provincial Health Services Authority (@PHSAofBC).

A lot of change yet to come

As described in this YouTube video, 2014 ended with vocal frustration and action on the part of the BC community around transgender person health (and life), along with commitments to improve it.

Programs and services for transgender community to be strenghtened” – This is the statement from the Ministry of Health that was released on October 30, 2014.

The Transgender/Trans* Health Steering Committee was then created (the name “Transgender/Trans*” is intentional, based on feedback from the community) and is actively working in 4 work groups to study gaps and prepare a report for sharing. Their work is posted on the PHSA web site so I won’t attempt to summarize here.

Of special note to me, this is a project that has unprecedented community involvement relative to other projects.

In addition to growing an excellent health program, the people involved are learning how to grow an excellent people involvement program, at all levels of the health system 🙂 . Vanessa Barron from the PHSA was kind enough to share her experience supporting this effort as a relatively new agent / leader in the space.

Pediatrics, Telehealth, Being Part of the Community, Surgery

The pediatric program has been in place since 1998, is based at BC Children’s hospital, and fully manages the care of its patients until age 18. This may includes hormones and surgery, and a transfer of care upon adulthood. We were referred to the “Dutch model,” outlined in this paper, which I’ll review in a future blog post.

We were introduced to the telehealth system by Gail and Margaret Deachman. Through this technology Gail can complete assessments remotely. I had not considered previously a few benefits of this technology in addition to the conventionally appreciated ones (reduced travel, etc): (1) Family can attend with the patient in the telehealth session, enhancing the support, and (2) Patients can have a direct connection to clinicians who are sensitive/aware to trans* issues in places where all medical staff are not yet trained, thus avoiding potentially negative encounters with the health system.

On this day we also met plastic surgeon Cam Bowman, MD and family physician Andrea Szewchuk, MD, who shared their experience with the surgical program (Cam) and being a physician serving the community as part of the community. The amount and level of talent applied to improving health for this population is impressive.

Much to learn, much to do

I found that there are many, many, many (many) ways in which the program here is ahead of the United States in terms of organization, thought, and history. There are also gaps and mutual and differentiated areas of dissatisfaction in comparing our two systems. I and the KPLantern team are really looking forward to the results of the work now underway.

And, the visit confirmed for me that the most innovation in health happens in the places that impact the most special people. Within those places, there’s a special bond between the innovators. I saw it lots of times in the greetings given to each other. We will arrive as a profession when this level of collegiality is replicated everywhere our patients/citizens are served.

In the next post, I’ll review our second day and include the links and resources (of which there are many) that we discovered along the way.

Thanks, Gail, colleagues, VCH, and PHSA for being great teachers to us and great learners as well.

Ted Eytan, MD