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Jane Roundtable: Returning to Work [Transcript]

Click here for the Jane Roundtable: Returning to Work - A Conversation With Community Members Who Have Done It blog post.

Click here for the Jane Roundtable: Returning to Work - A Conversation With Community Members Who Have Done It chat log.

Ali 0:00

This feels like a throwback for those of you that were part of Allied. I don’t know how many of you joining us were part of that. I actually have quite missed being together with everybody. It was only a few weeks ago. I was wondering if they’re all going to do what we did at allied.

So for those of you joining us, welcome. We’re so glad you could come in this morning to our virtual meeting. We did start thinking it was going to be more of a meeting but then we had to flip it to the old webinar style. So here we are. If you want to, in the chat on the right-hand side there, it’s defaulting to all panellists, but if you want to flip it to all panellists and attendees, we can have a community conversation and it would be great.

While people are just starting to join if you want to let us know where you’re from in the chat and what discipline you are, and maybe what your role is in your practice. We can sort of say good morning. So everyone knows you can flip open chat on the panel as well if you want to see what people are saying.

RMT in Vancouver, Ontario, Hi, Jennifer.

I love this part, you can scroll back up, it will come in very quickly, but good morning everybody.

I’m seeing lots of Canadians.

Everyone’s in such a different stage of reopening, which is one of the things I kind of wanted to mention right at the beginning of how interesting it is. As we’ve been collecting the reopen plans from across the different provinces and across the different states and not only is it different state by state, province by province discipline by discipline, but even associations and colleges are giving different recommendations within the same discipline in the same province or the same state.

So I just want you all to know that if you are finding this slightly confusing, it’s not your fault. And I just said to my team yesterday, everyone’s making stuff up and no one’s ever done this before and that includes our government bodies and our associations. So we’re going to shift over time. I think. So I love that.

We’re just getting together today to talk about how it’s going so far? What has been successful and what do we think is gonna be the story moving forward for the next few weeks? I love this.

I’m going to do a quick intro of everyone that is here joining us this morning. I don’t know what order you’re all in for everyone else but I’m going to go around my order. I always point to people when I’m talking and I know it may not be relevant.

So, starting for me over here on my top left I have Michelle Edmison from North Vancouver. She is a physiotherapist I’ve known for a really long time like forever It feels like. I’m going to say Michelle has been the bridesmaid more often than anyone else I ever know. I’ve never known anyone who’s been a bridesmaid, I think as many times as you. I don’t know if that’s a claim to fame, but you’re a very popular person and lots of people like you enough to put you in their wedding. So I think that’s a good thing I would imagine.

You actually work out of canopy so we’ve worked together, which is the practice that I own in North Vancouver, but I’ve known you for years before that and you’re also always doing new things which I have always appreciated about you. In the closure here, you launched an online movement company. Did it launch during this closure, movement 101?

Michelle 3:57

No, luckily I started in August and got all that uncomfortable stuff done early and it was kind of ready to just push it forwards. So that has been really fun.

Ali 4:10

So a lot of online work and then you returned to in-person practice on Tuesday. So you’ve got a couple of days under your belt and I know you were fully booked as soon as you reopened. I actually think you hadn’t cancelled. So you were just returning to the patients that had already been booked in.

Ali 4:27

Well, welcome. I’m excited to hear your clinical experience this week and working with PPE and how that’s been going with patients.

We have Alice to my right welcome, Alice. Alice is the Director of Customer experience at Myodetox. Would we call it a chain? It’s a group of practices. I suppose it’s a chain. A chain across Canada and the US.

You have a location right now open in LA, there’re locations open In New York, but those were put on pause and then Vancouver, Toronto.

So you’ve been doing a lot of the prep work getting people ready to reopen and so you have a lot to say about that. And then the Vancouver practices opened as well this week. So you have real-time experience.

Then we have Carly and Laura who are here with me. Carly and Laura are coming to us from the Kids Physio Group. If you were part of one of our sessions for allied, they spoke about a really wonderful conversation about leading a team and a values-based organization and I learned a lot from both of you. In fact, I was thinking just this week that I wanted to follow up on just a separate call and be like, Hey tell me more about those templates that you use.

So, Laura, is the clinical CEO, founder, owner of kids physio and Carly is the Director of Operations. So Carly’s been doing all the admin work, getting everything ready and Laura has been working on the understanding of the clinical side and getting the practices ready to go and then the clinics open for patients today this week?

Caryl 6:19

They’re all kind of on different timelines, but this week.

Ali 6:22

Okay, so welcome.

Then I have Zak. Zak is our lone US representative. I’m sorry Zak and you are also our lone male representative. So you’re very outnumbered here this morning.

Zak 6:35

Oh, all good. Happy to be here.

Ali 6:37

Zak is a PT from Boston and you’ve been practicing for two weeks now but closed for six weeks I think before that.

Zak 6:45

Yeah, closed for in-person for six weeks, doing all remote and now in-person the past two weeks.

Ali 6:50

That’s right. And you also are the founder of The LevelUp Initiative, which is an organization I have recently fallen deeply in love with. Very mission-based and very much about the mentorship of new grads. It’s a lot of volunteer-based and it’s connecting existing therapists of all different disciplines with newer grads and then passing on the knowledge of the profession in the clinical sense, right? Was that a good recap? Awesome. So good. So welcome.

That was a lot of people to introduce.

We really appreciated all the questions that you all sent in with your registration. They were so exciting. I think there are a lot of good topics to go through. They are sort of divided into three categories. There is the administrative side of reopening, there was the clinical side of reopening and then how to use Jane or Jane’s features that could aid in both of those things.

So we’re going to go over the pre-sent in questions, but if you do have questions that you want to pop in the chat, we’re also going to be monitoring in there and the Q&A is also available for you.

We have Kasandra here as well, if you’re seeing them on your screen Kassandra is one of the lovely Jane members and she’s going to be trying to answer questions as they pop up as well, if they’re Jane related.

Then Ashleah and Bianca are here as well, just helping manage everything.

Do we want to start with a poll, Bianca? So we’re doing a poll to start here, probably just popped up on your screen about.

Where are you in the process right now? Is your clinic already open? Are you preparing to open or do you have no plans yet to reopen? So if you want to take a second to just let us know in the poll, that should be up on your screen and then we’ll share those results with everybody.

Ali 8:56

For in-person, correct. Yes.

Ali 9:00

In-person specifically, I think is the conversation we’re having. No plans in place as in no firm return date. Not that you’re necessarily closing your practice. Okay, Bianca, do you want to share the results? So that’s sort of that’s interesting. So a lot of you, most of you are preparing to open which is great.

Okay, so we can focus a lot around the prep work and also people can share their stories preparing to open. Okay, great. Let’s get started. So let’s start on the administrative side of things.

So Alice and Carly, I think this is going to be your show primarily, especially on communication and Alice, I’ll let you get started.

If you just wanted to share some of your kind of biggest takeaways from the experience of getting everything ready.

Alice 10:00

Absolutely. So it obviously came together very quickly. We could never have imagined that things would have sped up as quickly as they were, at least in BC, but we had been planning for quite a while.

So we’ve done quite a few things and there were a couple of different major buckets.

So a lot of it was supply procurement, making sure that we had sufficient PPE, and then cleaning chemicals. You know sanitisation, like solvents and things that we would need. So that was kind of number one, because I know right before we closed, getting your hands on anything Lysol or otherwise, antibacterial was really challenging. So one strategy that we employed was to make sure that we had ordered early and ordered bulk. A, to save on costs and B, to make sure. We don’t really know how long this kind of quantities and things will stretch but bigger, might as well front load, have a lot in advance because you can all anticipate that problem. As we all kind of gear back into practice, shortages and things may reoccur again, same thing with all the PPE that we did put in place.

The other one was big on calm. So we wanted to make sure that our clients and our team were really, really aware of a lot of different modalities of all the steps that we were taking. So we took it upon ourselves, we launched a landing page, we’ve got all of the vinyl and clinic signage, designed and printed out, fitted for each location. We’ve put together really comprehensive sort of step by step PDF packets that are customized per clinic that outlines very specifically what we’ve been doing. There’s obviously all of the Jane notifications. We made sure that all of our templates, and the automatic emails get sent out. We actually hosted our own version of town halls where our clients could connect directly with myself and the regional director in each region and ask direct questions. So what we wanted to make sure that we were doing was providing information in a lot of different ways that was most accessible to people in the way that they wanted to hear it.

So those were two of our big priorities as we started to reopen and obviously, it’s still early days, but we wanted people to feel really confident moving into it.

Ali 12:18

Then people asking what people are using for cleaning, and where you’re getting stuff from? I mean a lot of people think what’s practical, where am I supposed to order stuff from? Everything’s sold out and it’s like six weeks to get anything. So how am I supposed to open my practice when I can’t access any of this?

Alice 12:40

So I’ll find it and send it to you Ali to send out later but there’s on Canada Government website, there’s actually a really comprehensive list of all the solvents that are approved for disinfecting and killing. That’s a great reference because when you can’t find one, you might be able to find the other which has definitely been the case. So that’s really, really helpful. I know a lot of them can be damaging to the beds. So we use cardan beds and there’s protective sprays that you can get so if you are using some of the chemicals, because they’re available that may or may not damage the beds, grabbing some of that stuff to protect on the other side is definitely a good idea. Just talking like large scale solves.

We worked with one vendor that we’ve been friends with here in Toronto, Know your Body Best, and they’ve had quite a bit in stock. I can just like name drop though, that one vendor partner, but I do think you know, having a bigger list and like multiple options to work with has been really helpful because we did grab some of one thing, some of the other as quantities were available and that’s kind of like one of the unique challenges found.

Ali 13:54

It is a unique challenge trying to find cleaners that don’t damage beds. Those beds, they’re so difficult to work with. There’s lots of people putting some information in the chat, which I think is helpful. I think that’s great. We can circulate the Canada link, for sure with the recording. So we’ll make a note of that and you said something else about communicating that you’re safe, which I thought was kind of an interesting point.

The town hall was a great idea, just having an open session that all people could come in, kind of chat with you. I’m sure everyone’s been sending out emails and it made me think about cyber and cybersecurity, that they talk about it in two in two ways. One is being secure and one is telling people you’re secure and those are actually two very different jobs, and you have to do both.

So I think people need and I wonder if Carly has something to say about that as well, especially with a pediatric population, and having to communicate to parents that you’re in the safest environment in which they’re bringing their patients is a safe one.

Carly 15:04

Yeah, we can definitely speak to that. Parents are really nervous and reasonably so. So we have really come from the perspective of providing them all the information

Carly 15:37

So we actually love all the Jane features for giving that pre-screen but we are calling all of our clients for their appointments. We haven’t turned on online booking for in-person appointments either. We’re having conversations to really be able to reassure our clients and educate them not only for their own safety but also for the safety of our team. We want to make sure that before people come into our clinic, they really understand these circumstances and also understand that we are doing everything in our power but there still is some risk.

So we are still actively promoting telehealth. Even though our clinics in Vancouver or in BC are open. We are still saying that telehealth is the best option for most people and we’re taking in-person visits really, really slowly. So that we can be as safe as possible.

Ali 16:42

That’s interesting. I wonder, Zak and Michelle, are you still promoting telehealth visits over in person or is it just sort of a return?

Zak 16:53

Yeah, so we’ve definitely been utilizing both and still advocating for telehealth where appropriate. Now that we’re in our third week of being in person and starting to get a good sort of plan and all of the all the hygienic sort of precautions on point, we felt more comfortable starting to ramp up a little bit more, but our staffing is such that we only have two physiotherapists on at once at both of our clinic locations. So there’s no more than six people in here at once, with an aide to help with cleaning everything in between things.

So for our higher risk, we have a screening process we’ve been using. We have still been advocating for remote and telehealth services for that population, but we do work with a big sports population and not having access to the weights and doing stuff remote. Being able to utilize that in person has been really huge and quite fun to get back to.

Ali 18:03

And that’s a reduced capacity in your practices you have.

Zak 18:09

Yeah, we’re only seeing about 50% right now, because we’re also blocking out a full hour for each client, where we were normally doing every 30 minutes to patients and we’re doing one an hour. So it’s, it’s been a good slow process and patients you can tell are starting to become more comfortable with it too, as we continue on.

Ali 18:30

And, Michelle, what’s the demand you’ve seen? I know that I said it earlier that you were fully booked, has that maintained true for the week? They just wanted their in-person treatment.

Michelle 18:47

People, they want it. I want to make sure it’s a really positive experience when they come, so same thing, I’ve rescheduled everyone to a slightly shorter appointment so I have 15 minutes between. I don’t want to be the clinic that has a bad reputation. I don’t want to have any relation to any possibility of that happening.

So I started out wearing everything, gloves, goggles, my face mask, and I’ve cut down now a little bit more but lots of time just to make it positive and have them feel really safe, but they want in. I’ve had a lot of fun with telehealth, but I am a manual therapist. I like to assess and see everything, I like to meet with people. So I’m having fun and it’s been a really positive experience. I don’t have time for telehealth, there’s too much demand for in-person right now.

Ali 19:46

And I liked hearing that you started with the full gear. So you started with goggles, mask and gloves and everything but then after a couple of days of practice, it felt like more than was needed or what was that like? Zak, you’re practicing just in a mask? I think, right?

Zak 20:05

Yeah, we’re just utilizing mask and then if we’re doing manual work, gloves.

Ali 20:11

Interesting. So there’s a lot of people that in the early questions, were asking about massage, like, how do I do a massage? And we don’t have any massage therapists but so are you adjusting your manual practice at all to accommodate the fact that you are trying to have less proximity to your patients?

Zak 20:33

Yeah, if we’re doing like range of motion for any sort of post-ops or things like that, and trying to keep distance with it relatively, but you know, it’s tough. So we’re lucky that a lot of our practices are movement-based so there’s not a massive demand for it in terms of shifting but it’s really what patients are comfortable with too. And you know, it’s definitely an interesting constraint right now.

Ali 21:03

Alice, I know that’s true for my Myodetox too. It’s a lot of manual therapy. Are people changing their shirts between patients? Are they wearing gowns? How much or how much are we doing between patients? When there’s any form of contact?

Alice 21:22

Yeah, so clothing and what we are wearing, we are treating with masks on and actually asking that clients bring in masks as well if they don’t have any, we’ve got some for them. So both people are wearing masks. Therapists, we’ve decided you have your outfit for work and then when you leave, it’s just like a fresh set of clothes that’s worn specifically in the clinic. And, and we right now are kind of because we’re at a lower capacity in the clinics.

We’re changing beds over but the solutions we’re using only take 30 seconds to fully activate. So either we’re alternating beds, letting that stuff kick in fully do what it needs to do for the 10 minutes or the 30 seconds in between and we are doing slightly shorter sessions, as well wrapping them up earlier to provide time for that full cleaning of the bed and then all the touch surfaces around. It’s like a team dependent after a certain extent. So, gloves are widely available, masks are available in certain clinics, certain therapists, and depending on the individual client needs, if they prefer to be treated where the therapist is wearing the face shield or the gown, we’ve got all that stuff available but the standard is just the masks on both parties and then obviously in full time between for cleaning.

Ali 22:49

Michelle, because your patients were already all booked in, you just opted to shorten treatments? Just shorten your inpatient time to include extra cleaning between patients because they already booked in and you couldn’t change this.

Michelle 23:04

Yeah. People were booked for an hour and I shortened to 45. And then if there were shorter ones, I did move them and it worked out. It took a little bit of time, but it’s just so nice to have that for the first week so that I knew if anything came up, I could deal with it then and change and I do recommend it. You don’t need to be a rock star The first time you go back, just everyone’s figuring it out.

Ali 23:34

I think everyone’s just also trying to figure out the financial implications of this and maybe Laura, you can speak to this. When do I ask my patients to bring their own masks? Do I provide masks? There is a financial implication. People are asking, can I charge a COVID fee? People are asking us how do I add a COVID fee to my treatments and I’m like, I don’t know if you can do that. I don’t know how insurance companies are going to respond to you building a COVID fee, but everyone’s kind of trying to figure it out. We’re already at lower capacity. We’re already down obviously, we’ve been closed and what do we do with that? How do we manage the extra costs that come along with all of this?

Carly 24:21

I think it’s safe to say that we can’t manage all of those things and we can’t expect to be managing all of those things. But most importantly, you really need to know who your clients are, and really understand what they’re expecting from you. And so if you’re delivering a really high quality, really safe environment and your clients are expecting that, then absorbing that cost for a temporary period of time, and seeing what your finances look like, over the course of the next month or two, and then perhaps reevaluating six, eight weeks from now and saying okay, This is what the impact has been on our business for us to be able to deliver this level of service to our clients because their comfort level is here. Then, what we have to do in order to meet our financial requirements later. So at this point, we’re absorbing that cost but moving forward, we’re always going to be looking at how does this impact our business long term? And do we have to translate that into some kind of increase in fee but it certainly from my perspective, won’t be a coven fee.

Michelle 25:27


Carly 25:31

We are making a conscious decision right now to invest in building really strong trust with our clients and that is an investment that we are willing to make right now. We actually have 30 minutes between appointments for now. As pediatrics, we have a lot of touchpoints. So it’s a lot of toys to sanitize but we have to wait to air dry. It’s a lot of services. So that’s how we’re operating for the next few weeks. We’re providing PPE to our staff and our clients if they need it again, for now. Our plan is we have our next six to eight weeks that we have all the supplies for. We have a strong plan but we are reevaluating constantly to see what it’s going to look like after that six, eight weeks for our next phase internally of being open.

Ali 26:33

So you’re providing masks currently at no charge. Is that the same for you, Zak and Alice?

Zak 26:43

Yeah, same here. We’re providing it but a lot of patients are bringing them in. We put out that expectation that ideally they’re bringing it but if they don’t, we have plenty for no cost to supply with them.

Ali 26:57

And just single disposable?

Zak 26:59


Ali 27:02

How do we feel about patients wearing their own masks that they’ve made? That’s fine, right? These are not medical grade. It’s not like you’re providing N95 masks to every patient. This is just non-medical grade masks.

Zak 27:17

One of the biggest things actually is that for some patients, they’ll be coming in and some of their masks that they have are so heavy and thick that they’ll actually have a harder time breathing through it if we’re doing some of the exercise space stuff. So we’ll actually give them one of our single-use ones just because they’re a little bit easier to breathe. That’s actually something to think about for some of the more movement-based therapists and practitioners out there. That’s a real issue when you’re working with them and having a monitor how worked up and how out of breath their getting.

Ali 27:55

I’ve just tried to imagine running on a treadmill wearing a mask. I can barely run on a treadmill.

Wearing a mask just sounds good to me. I was thinking about this as my daughter’s been making masks out of socks. So now if I take my kids anywhere, they have to be wearing masks if we go outside, it’s how I feel better as a mother. So I’ve seen people in the chat saying they’re charging $2.

I’ve been thinking about people charging needle fees when they do acupuncture, is this going to be part of one of our new business costs where it’s like you bring your own mask, or we offer them to you for a fee? Which I think is pretty reasonable actually, considering you can bring your own mask and then also thinking about how we have shorts in the office that we just provide and wash. So are we going to be bringing in reusable masks that will become part of our district office supplies. So it’ll be fascinating to see how this evolves over the next little while. So it sounds like everyone’s got just disposable masks, offering them for free. If people don’t come with their own mask is sort of how we’re all managing it currently.

Carly 29:02

One thing I will say about masks is we’ve noticed that in the beginning, lots of people seem to be forgetting. And so in the first couple days of operating, we were a little worried about supply, but we had gotten quite a few. You know, we were just like, oh my goodness, are we gonna run through these really quickly? So as you communicate with your clients, maybe as it feels appropriate to add in extra reminders, you know, just make sure you bring your mask for tomorrow. Just to kind of, attenuate the outflow of them. At least in our first couple of days, we were going through quite a lot.

Ali 29:36

I know in Canada, wearing masks in public has just become a recommended preventative measure where it hadn’t been before and so we’re sending masks to our whole team right now. Just like a new swag item. Like I said, that’s what we’re offering. This is something that people are just gonna start matching them with their bikinis and it’s gonna be a whole thing. Like I think masks is the new fashion statement. So I think it might become, I’m assuming it’ll become more normal, especially as more and more people start doing it.

So maybe that will become less of a problem moving forward. But I’m seeing a lot of people talking about charging and I do agree that especially smaller practices, people working out of their homes, it’s really hard to absorb some of these costs, which I like. Someone has reusable masks as well and they drop it off at a bin and launder them. Yeah. it’s fascinating.

I’m going to let someone else choose their next topic that they want to talk about. People we’re still on to the PPE. Oh, someone’s making their own masks and selling them. Smart. Double up your business when you have no patients. You make the masks you sell them at your front desk. It’s perfect.

Ali 31:04

Okay, did we want to talk about Jane and staggering appointments and your scheduling and how you’ve managed that because it’s not only do we have to stagger appointments with a single therapist, but you have to try and stagger them between therapists and how’s that been working out for you at Myodetox and kids physio?

Laura 31:26

I think I’m gonna let Carly answer this one because she has actually, from an operations perspective, been very deeply connected to all of the various different clinics from a square footage size, to how many practitioners, to are there dividers between rooms, some of our clinics are more open than others. So I’m going to let her talk about how we’ve managed that in our phase one of reopening.

Carly 31:50

Okay, so our phase one of reopening is less than one person per 250 square feet is our maximum capacity and again, these are our own phases. No one told us these rules. We read best practices from across Canada, different colleges, because we were coming up with our procedures before. As everyone in BC knows that BC college came out with their recommendations on Friday, and we’re opening on Tuesday. So that wasn’t enough time. We had come up with all of our procedures before that, and then we meet all the recommendations.

In terms of Jane, we used Jane’s feature to build a 15-minute buffer right into the appointments and although we’re doing a 30 minute in between clients, sometimes a practitioner will go, in person, telehealth, in person and especially just right now during this transition time, and you don’t need 30 minutes if you’re doing a telehealth afterwards.

So we have 15 minutes built in and then we’re adding another 15 minutes break for in-person appointments. And then we just been taking shifts again with Jane and taking appointment types, so some appointment types are in clinic only, some are telehealth only. And then some are a combination of in-clinic and telephone.

So we made a decision based on the staff and the capacity of each of our clinics. Some locations we have room to have three clinicians or four clinicians working independently in totally separate rooms because we have a 3500 square foot clinic and so the shifts look a little bit different at each of our locations. But using that tagging and those built-in breaks or extensions of the shift has worked really well for us so far.

Ali 33:53

I didn’t think about alternating telehealth to in-person to give yourself more time too. That’s actually super interesting because you could prove it, you don’t have to have that buffer time. You don’t have to lose that buffer time as treatable time. If you’re doing it that way, as long as you have admin staff that can help you with the sanitization.

Carly 34:14

The only thing that I could add to the staggering shifts and the break times, we actually have the shift time starting at staggering appointments. So the cascade of the sessions kind of are different as the day goes down. So you know to avoid any kind of clustering and the waiting room lounge lobby, and then also the staff arriving at different times. So just making sure that even in clinics where it’s a bit smaller, you actually aren’t really crossing paths that often, especially around pinch points. It’s like if we had two therapists finishing up their sessions at the same time, people might be crowding in the hallway. So hopefully the 15 minutes is alleviating that and then just making sure that you know with brakes built in that integrity remain. So we’ve been kind of using a lot the viewable function where you can see online which appointments are available, or which sessions are available and making sure that we hold to that and that re-bookings are still holding that staggered flow.

Ali 35:19

I was speaking of people waiting and did we all close our waiting rooms? Everyone’s waiting rooms are completely closed. Yes. And you’re asking people to wait outside in their cars or out in the hallway or outside and is that different for each of your clinics, Zak? Do you have a waiting room with a hallway or how does that work?

Zak 35:44

Yeah, we just have an open concept. So the waiting room merges with the treatment tables, with the gym space. So the way we’re having the full hour treatment slots where even when the next patient comes, we’re still able to keep all social distancing, keep on your 10 people in the space total and they’re not bringing in any family members or anything. So it hasn’t been an issue for us.

Ali 36:10

Definitely harder with pediatrics to send your patient with no family members, just send them in there, they’re gonna be fine.

Carly 36:16

I don’t know how many people actually work with kids but we’ve decorated our doors so wherever the person is going to be waiting we have posters of like, this is the clinician who’s working, these are some fun facts about them, like wait right here for your appointment, but they’re also showing up right before their appointment, which is working great.

Ali 36:35

People know to show up right on time.

This is a little surprise feature that we’ve been recommending. Jane has a QR check-in code, which I don’t know if a lot of people know about it, but patients can self check-in with a QR code, which someone had a QR code on one of our allied talks and I just explained to people that if they open their camera and pointed at the QR code, it will do something and it was like magic. People were just so shocked. So it’s not the newest technology, but it is one of those ones that’s quite impressive when you use it for the first time. So you can print out the QR code which you can find in your Jane settings area, and then if you tape it to your front door, which we’ve had practices do, people can check in from outside the practice. So you know, because it turns green, as arrived on your door or in the hallway, where you have your social distancing tape, so you’ll know that they’ve arrived, even if they’re waiting in their car, and then people are waving them in when they’re ready. So you can prop your front door open. Obviously, you’re trying to minimize doors, or also add automatic hand sanitizer stations, automatic soap dispensers.

I just feel like there’s a billion things. Plexiglas dividers are so much investment. There’s so much financial investment. Right when clinics are all just struggling already for income. That’s the part I’m finding actually just shocking how difficult it is to get back.

If you want more, just search QR code or our patient self check-in in our guide and people are having good experiences with it I’m hearing in the chat. Fantastic. And then people can check-in and you can wave them in.

So it’s funny that hearing that you’re putting other things on your door to try and help ease the anxiety from people who are having to wait outside. That’s a great idea. Reminds me of my kids ballet class. Ballet they’re like, you’re not allowed to watch, you have to leave. No spectators for ballet.

So that’s a good idea putting more information, like educational content as well on your door outside. Yeah, that’s great.

And then lots of changes, obviously to your text reminders, to your emails, to continue to inform patients. I’m curious if anyone’s dealt with a patient that has not wanted to comply, or has just been like, what’s the big deal?

Zak, have you? How did that go?

Zak 39:04

So we have a nice little screening sort of tool that we’re using, like a little algorithm, especially for our patients that are higher at risk with comorbidities, whether it’s diabetic or hypertensive, those are things we’re taking really seriously with why not have them come into the clinic at all. And it’s really only been like one or two patients that are just like, I don’t care. And it’s just one of those things where it’s tough and we’re making sure we’re offering as best as we can to manage things remotely, but it’s just risks that feel very unethical for us to push through there in person. Obviously, I forget who said it, there’s obviously always risk here, but really trying to mitigate it in that population. So that’s been interesting, but mostly well received.

Ali 39:59

I always think like that. So all I’m doing right now is thinking about headlines. So we’re not reopening Jane’s office because all I can think of is the headline of like, new epicentre of COVID, Jane software in North Vancouver. I’m like, let’s just not do that because we don’t have to operate in person but the clinics, we have to operate in person but when you think about it that way as a business person, I think you can stand firm on your policies. You can be like, look no one wants that headline. Like we don’t want that headline, I do not want my clinic to be the epicentre of anything. So let’s just be safe and then I think you can really stand firm behind your policies of PPE or whatever it is that you’re doing. Everyone’s gonna be like what is so stressful. It’s gonna be fine though. It’s gonna, we’re all doing great. And people are wondering about bathrooms. Have you closed your bathrooms? How does that work, Zak?

Zak 41:06

We’ve been getting them deep cleaned every week. So we have a cleaning service coming in to clean our bathrooms once a week and we have one of our aid staff sanitizing them, because we’re using them for people to wash their hands.

Ali 41:25

I know this is what I thought was so funny. So the BC RMT Association just put out all or it was the BC College of massage put out all of their recommendations, and one is that every patient and every practitioner has to wash their hands before and after treatment. And it’s just like, oh my god, like how are we going to do this? I don’t want people going in my bathroom but now the patient has to come in and wash their hands before they can get treated, and after they get treated, which I’m like, is this actually the best flow of patients in the practice? I don’t. We have one shared bathroom so now that one patient is going into a shared bathroom instead of into a treatment room. So how does that work? So I just think people are making stuff up and then trying to figure out the best way to implement it, and does this actually work in real life? No one’s ever done this before. And I like Michelle’s comment about I started like this, and then I’ve kind of adjusted now over the first week of practice. And so Zak, you’ve been practicing the longest in person, what’s the difference? What’s the biggest difference between when you started it now?

Zak 42:34

I would say just the level of comfort from patients. And I mean, as Michelle was saying it, they’re so happy. It’s real for as much as this whole situation obviously stinks in certain aspects, it’s a huge opportunity I think to just because they’re really viewing us as a haven where it’s like, oh, my God, you know, can’t really go do much but they’re able they look forward to much of being able to come in and feel like they have a safe space to move. People are terrified going to the grocery stores, which is even more high risk. This is an 1800 square foot place with six people in it. So, in terms of risk stratification, I think that’s probably the biggest thing is just that patients have really started to become more comfortable with coming in, interacting and adhering to the safety protocols we have in place. It’s just starting to kind of multiply and exponentiate where they’re telling their friends and their family that they’ve had good experiences coming back in. So it’s our third week and our schedule, while we’re only doing 20 to 25 hours a week right now, they’re mostly full with our slots, so it’s been really well received.

Ali 43:48

Zak, I love that mentality. I really appreciate what you said there and I’ve been thinking about this too. I’m like even before this, we had to sanitize between patients like even before that, we were already doing all of these things. So a lot of this isn’t actually new, like we already had to do literally three quarters of this beforehand, because you’re already medical facilities. So this is a little different than, it’s not even though like PPE, I think it is the most extreme visual difference. In reality, you were cleaning your beds between patients already, like all of this, like we’re sanitizing all of your modality equipment, and you’re already using all of this, it is not new. And so I like hearing you say this can be a safe place for people. This is a safe place it was before, but we’re even doing more extreme measures now. You don’t have to be there. It doesn’t have to be that anxiety about coming in for care. And I agree right now, people are desperate for care and disconnection and it’s something that the allied healthcare professionals provide. I think you’re all going to be able to say this is better than any other profession, especially in the medical field history, that sense of care and support. So I love it. I like hearing that it’s good for people to not be afraid to return to in person treatment. We’re already doing most of this anyway and the changes maybe aren’t gonna feel quite so drastic once you start back to practice. So is that sort of the response you’re getting from your therapist, Alice? Are they like, well , great, people really want to come back or just doesn’t feel that different. How’s it going there?

Alice 45:30

Yeah, I think for the most part. I certainly can’t speak for everybody. But you know, therapists are excited to be treating again, and clients are equally as ready to come back. You know, we have been busy the last couple days, and it’s been really positive so far and to the sanitization question, like we have protocols every hour. And so there’s just extra small steps that we’re taking, but it’s not a huge shift in operational priorities or anything. It’s just like a few extras things peppered in here and there. And again, I think people are glad to be able to reconnect again, and just be in the space. I think in general, people are excited to be re engaging in life again, in our own small steps. And so this is just one more thing that’s bringing another sense of, Hey, this is my life and this is my routine and I can at least take charge over this part now again, and so I think that’s really exciting. Overall, really positive.

Ali 46:31

I just saw something in the chat before it disappears. I wanted to mention it because we do have a lot of mental health practitioners using Jane and that are here in this conversation and we don’t have any mental health practitioners on the panel. So I just wanted to add this in. I just saw someone say that they have therapists that are going for walks with their clients and doing their sessions outdoors. That’s brilliant because we know that outdoors, there’s less chance of transmission and anyway, I just thought that was amazing. So great. What a great idea. I think that’s phenomenal. So lots of people say they’re going outdoors. I wonder how much you can do outdoors? Like can you take your clients outside if it’s a nice day and do some stuff outside? Someone’s saying they’re considering putting a tent in their garden? I wonder if I can. Canopy has a courtyard right outside. What if I can put a tent out there? And people can do some of their movement therapy outside? I wonder.

Carly 47:32

Sometimes it’s just an extra consent form.

Ali 47:38

Right! Thank you, Carly. Good points. Extra consent. Okay, I’m going to put one up. I’m going to try to write one that we can circulate consent for outdoor therapy that may or may not be as private. Another question people I’ve had a few times is really about massage with gloves. Are people doing massage with gloves? Is anybody massaging their patients with gloves on?

Michelle 48:04

I’ve been experimenting.

Ali 48:05

Yeah. How’s that going?

Michelle 48:08

So not a massage therapist, but I do a lot of things like shearing techniques and FR and it’s so good for shearing. I have these glowing..

Ali 48:23

So as a clinical tool you’re enjoying it?

Michelle 48:27

You can rip things apart. It’s awesome. There is a little bit of a plus with it. It’s a little harder twirling needles with the gloves on because they’re quite thick gloves and have a texture to them and then I have not been using them today and massage therapists aren’t using them and I believe you don’t have to when we’re touching.

Ali 48:52

Yeah, I’m hearing a lot in the chat about hand washing is enough and actually often gloves are worse right? People don’t use them properly. Actually, I saw someone wearing gloves the other day they were opening their bottle and drinking and I was just like, I don’t think that that’s how that works.

Ali 49:21

And Zak, you have been nodding along there.

Zak 49:25

Yeah, it’s more patient dependent. So I’ll ask what they’re comfortable with. And mix of both for dry needling and massage.

Ali 49:35

Yeah, and if people are saying obviously if it’s oral massage, you wear gloves anyways. Everything that you would have already worn gloves for, you would continue to wear clothes for. The patient choices is an interesting one here, like where do we draw the line or the patient choice with things like PPE? So that’s an interesting conversation and then I guess it’s the same for, do you want to do telehealth or do you want to do in-person? Do you give people the choice on that? How are you? How are you managing the share between telehealth and in person?

Zak 50:07

You know, at least for us, I think Carly was saying this is just really doubling down on the transparency and authentic relationship building with our patients and our community, and just being very upfront about it. Like look, it’s really both of these things can be very effective and ultimately, whatever you’re most comfortable with, let’s roll with that. Unless it’s someone that’s really high at risk, then we’re going to be more firm with and let’s do this remotely. But otherwise, it’s really just been highly based off patient preference and there hasn’t been too many people that are very firm and just wanting remote. So it hasn’t been too much of an issue.

Ali 50:52

Right. And you’re not treating anyone like you said that has comorbidities above a certain age? Like you have a firm no. There’s a firm no at some point.

Zak 51:02

And we’re lucky that a lot of our population is under 50 for who we treat. So we’re lucky, we don’t have to go to that but then it becomes a lot more of a weird ethical space, because I don’t think it should be necessarily a hard no, but it’s just talking about it openly accepting risk on both sides.

Ali 51:25

So have you added a new consent form to your practice?

Zak 51:29

Yes. They have to sign it every time. Every day. Every session, people have to sign it. First thing after they sanitize is do that.

Ali 51:39

And Carly and Alice, you both have the same?

Carly 51:42

So we do an initial pre screening on the phone, either the day before or if it’s like an evening appointment that morning, and then a second pre screen when they come in. So they’re answering all those questions again and they’re also consenting to the increased risks of coming into the clinic.

Alice 52:04

Yep, same here. We have also the consent to increase risk around covid. I think that’s super important to bake that language in somewhere. Just it’s inherent and then the verbal screening when they arrive.

Ali 52:22

I think the consensus to attend a practice in the US is already 20 things you have to consent to. It’s ridiculously long. You’re like Yes, I’m just gonna continue to say yes to all these things. I was thinking COVID screening because we just launched a new COVID screening tool. Have we talked about that yet? No. It launched yesterday or the day before. It’s brand new and it just is sent out before every in person treatment, so it isn’t sent out for telehealth treatments but in person, and you can customize it. We have a default template that’s based on the CDC on the BCD guidelines, so people can sign off on it. This is just going to become the new terms of service. I think it’s good. I understand we all have to do it and it’s gonna make people think but it really it’s an interesting one because people are just gonna like note Oh, you know, if you say yes to that you’re not gonna be allowed to come in? Do you think these are going to be effective? Has anyone ever admitted to something on one of your screenings that you’ve had to say like no, you can’t come in? Not yet.

Zak 53:31

Just over the phone,

Ali 53:32

Where they said, I’ve had a cough, but it’s fine, it’s just allergies or something. And you’re like, no, sorry, can’t come.

Zak 53:36

Or they traveled or they were around people that traveled. And just ask people to wait the 14 day, like self isolation.

Ali 53:47

That’s good. I like that.

Ali 53:50

Okay, we’re coming up on 45 minutes and I’m trying to actually catch questions as they come instead of having an actual question time, and I’m trying to catch them because there’s so many things all coming in at the same time. So we do have another couple of polls. I don’t know if we want to bother asking them. I can’t even remember what they were Bianca? Oh, I did want to know how people are feeling. We should have done a poll at the beginning. How are you feeling about reopening your practice in person and then another one at the end to see if this changed anything about how you’re feeling about it? Can we do that one about how you’re feeling about reopen? I’d like to know that answer.

Ali 54:34

And while we’re waiting for that, people I wonder if you had your employees sign the consent form?

Laura 54:42

We do. Every day,

Alo 54:46
every day before work?

Carly 54:48

Yeah, full pre screen and then they also initial it with the time that they’re leaving the building so that we have really good records of who was there, when, just in case.

Ali 55:01

People are doing log sheets. Hmm. Interesting. People are asking what about if your therapist is in the high risk category? Are we letting high risk therapists return to practice?

Zak 55:19

So that’s a really good question.One of our primary aid staff like an admin. lives with a very at risk population at home. So she’s just been doing all remote. Thankfully, none of our therapists are in that boat but then that becomes a very tough sort of ethical space to navigate.

Ali 55:46

What if you have a therapist that wants to come back, but they’re in the high risk group?

Zak 55:51

Yeah, I mean, it’s tough. I think ultimately has to come to a decision between both parties where this is realistic the new norm for a while. So it’s not like things are changing anytime soon. So I think ultimately it has to be a conversation that people are weighing the risks and doing what they feel is the most appropriate. And sometimes that might be going to do it. I don’t know. I definitely don’t have all the answers.

Carly 56:20

I don’t think at least here legally, we can not allow someone to return.

Ali 56:25

I know. I don’t know how this all works, because it’s a real clash between human rights and workers comp and public safety and all the rules are going to be a little bit different.

Carly 56:38

But I think that we can provide them with as much information as possible and be really clear that although we’re doing everything in our power to mitigate risk, there still is risk associated with coming in. And at least for us, we’re still giving all of our staff the opportunity to do telehealth from home and still treat their clients that way, compensated the same percentage and if that’s what they want to do.

Laura 57:05

And then my suggestion is, if you don’t already have a really trustworthy employment lawyer that you can call to ask these very specific questions to get one.

Ali 57:13

Yeah and in Canada, the CFIB is actually also really helpful. If you don’t know that organization. They’re incredible. The Canadian Federation of Independent Businesses, being a resource to me my entire small business career, and if you don’t know about them, they are wonderful. Okay, we’re at our 45 minute time limit. Did anyone have anything else that they were like burning to ask? Had they really wanted to talk about someone? There were a lot of people asking about where people are getting masks, but I think supply questions is just a tricky one. In general, for everybody. Oh, temperatures, are you taking temperatures? There’s lots of questions about people taking temperatures.

Laura 57:55

We’re planning to, we’re waiting for our infrared thermometers to arrive. But with children, I think it’s just one of those extra precautions that from a parent’s perspective and most parents are going to be happy to hear that we’re doing that. And just because of the touch points in our clinic, we can do everything we can to sanitize but if families know that the child before them and the one that’s coming in after them are being screened for temperature, just one more level, right? It’s, yeah, regardless of whether or not it’s shown to be effective, it’s just something that we’ve chosen to do. And we’re going to make sure that it’s consistent and communicated across all the locations. We’re screening temperature for staff and teams. Right now, we kind of thought the two screens, at least for one, both of them and then verbal, are good for clients. But teams felt really comfortable and they kind of felt safer to come back. I think just because there’s more contact internally or you know, you’re all sharing the same space for your shift at a time. So that was just an agreement among ourselves internally.

Ali 59:07

Someone posted a no touch thermometer in stock in the chat. That’s nice. Thank you. Yeah, you could share your own resources in the chat of where you’re getting things. I started looking at the massage therapy resources here in Canada because the ones in BC or less subscribed so that they have all the same medical. So like Relaxus is actually a national company but they have lots of stuff and stuff. That’s great. Okay, thank you. I’m still trying to see if there’s any last questions but have this recorded so we’ll be circulating the recording and putting it up on Facebook and as a blog post. And I love all the questions. I feel like there’s so many more and the chat is exported with the recording. Yeah, I’ll see if we can circulate the chat. That’s actually a better thing about webinars than it is about meetings. Actually, I don’t know if we can circulate the chat can we?

Ashelah. 1:00:09

It is possible.

Ali 1:00:13

I always promise things and other people have to actually make it happen. It’s really bad.

Ashleah 1:00:16
We’ll include a link to the chat on the blog post, okay.

Ali 1:00:22

Someone wants to do a webinar weekly. You guys all in for that? Let’s keep everyone informed with what’s going on. Yes, weekly. See everyone’s into this idea. So I can get different panel members so that we’re not we’re not all bothering you, you need to go treat your patients. That’s the whole point I think right now and a lot of our RMT’s want one. Okay. Well, thank you so much again for this, this is the worst part because now we all say goodbye. And then we turn off our screens and then you just sit there and you’re empty room by yourself and it feels horrible. And I wish we could not do that. But I don’t think there’s a way to just end this and have all of us still stay here. So everyone that attended thank you for joining us this morning or afternoon. Some people from the UK, I don’t even know what time it is there right now. And to the panelists, thank you for taking an hour of your morning. I so appreciate it. I can see that everyone in the chat is just, I don’t know if you can see it, but they’re very grateful for your time. So, appreciated.

Laura 1:01:24

Thanks for having us.

Ali 1:01:27

I always just let some of the thanks. Oh, someone just said they feel way better now.

Ali 1:01:32

That’s great. I actually feel better now to

Laura 1:01:36

Having heard Zaks last three weeks too. So Zak, thank you so much for sharing. Everybody here who’s just opening up in like the last two days or one day, it’s just really nice. It’s also just nice, like your demeanor and your calmness has, I think a really good lesson for all of us to understand that. We have to tut that on to our clients. Let our clients know that we’re also calm too, so said thanks for that reminder, Zak.

Ali 1:02:02

You should all check out the level up initiative and volunteer to be mentors.

Zak 1:02:05

Yeah, definitely and thank you, Laura. But seriously everyone watching, you do have a lot to look forward to. It was like a little bit nerve-wracking at first but this is kind of the new norm for the next while kind of working on this little battery mood and making it work but it’s a start and people are, just Michelle was saying, like so grateful to be back and I think it’ll be a fun next couple of months to see how it goes.

Ali 1:02:33

That’s a great ending. So we’re gonna end it there. Thanks again, everybody.

Click here for the Jane Roundtable: Returning to Work - A Conversation With Community Members Who Have Done It blog post.

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