In Bella Bella, a remote island community off the Central Coast of British Columbia, home to about 1,400 people, healthcare is shaped as much by geography and history as it is by clinical need. Located on the reserve of the Heiltsuk Nation and accessible only by air or water, the hospital and clinic serve not only Bella Bella, but neighbouring coastal communities as well. Care is delivered by a small, dedicated team working in a context where distance, weather and continuity all matter. 

For Dr. Adam Sandell, who worked in Bella Bella for more than four years, the work was unlike anything he had experienced before. 

“Canada is unusual in that this kind of medicine still exists,” he reflected. “Because of the geography, you’re doing full-scope care in a way that stopped happening in many high-income countries decades ago. It’s challenging, but deeply fulfilling.” 

Like many rural and remote settings, the healthcare team in Bella Bella was made up of people with different roles, rhythms, and realities. Physicians flew in for shifts, while clinic and administrative staff were based in the community year-round. Over time, it became clear that although everyone was working toward the same goal, they often felt like two separate teams. 

At the same time, the clinic was experiencing change, as many rural teams do. Rather than responding reactively, the team decided to pause and invest in how they worked together. That decision led them to the Quality Team Coaching for Rural BC (QTC4RBC) program, an initiative led by the Rural Coordination Centre of BC that supports rural and remote healthcare teams to strengthen relationships, clarify shared goals and improve how they work together. 

Quality Team Coaching is a six-month program that includes a full-day, in-person workshop and a series of facilitated online sessions. For the Bella Bella team, which included seven medical staff and eight administrative staff, the full day in-person workshop became a turning point. 

Held in the Heiltsuk Big House, the workshop took place in a space rich with cultural meaning. For facilitator Dr. Rahul Gupta, that setting mattered deeply. 

“To be invited into that space told me there were already strong relationships and trust,” Rahul said. “It created a container where people could show up differently, with more care and intention.” 

The day focused on slowing down and practising something that many teams struggle to make time for: honest conversation. Participants were invited to talk about what was working, what felt hard, and how they experienced one another as colleagues. The approach was intentionally non-hierarchical, allowing voices from across the team to be heard. 

“It gave us time and safety to practise having difficult conversations,” Adam reflected. “People saw that they could do that, and that good things could come out of it.” 

Over the following months, the online sessions built on that foundation. Small changes began to take hold, including culturally grounded practices such as using a talking stick during discussions, an adjustment that helped some team members feel more comfortable speaking and being heard. 

One of the most tangible outcomes of the coaching was a shift in how the team related to one another day to day. The clinic began holding regular check-ins at the beginning and end of each week, creating space to talk not only about work, but about life beyond it. 

“We now meet together just to check in as humans,” Adam said. “How was your weekend? How are you feeling about the week ahead? It changes everything.” 

Those practices helped dissolve the sense of separation between clinical and administrative roles. Physicians began attending meetings more consistently, and conversations became more participatory and grounded. 

“When I walked into the clinic office, it felt like walking in with colleagues,” Adam said. “That wasn’t always the case before.” 

Over time, the strengthened relationships began to show up in other ways. New ideas emerged, including conversations about involving an Indigenous Elder in the clinic to provide culturally grounded support, an initiative that may not have surfaced without the increased trust, cohesion and communication within the team. 

Adam noticed meaningful ripple effects from quality team coaching. Recruitment improved, with new staff describing the clinic as a supportive and welcoming place to work. With more stable staffing, workloads became more manageable, giving team members greater capacity to show up fully for patients. 

“When things are good, people have more energy,” Adam said. “They have the headspace to pay attention, to be present. That matters for care.” 

The coaching also supported the team through transition. As Adam and a colleague prepared to step away from their roles as joint medical directors, the changes were discussed openly with the full team, reducing disruption and supporting a smoother transition. 

Looking back, Adam acknowledges that committing to team coaching felt like a risk—of time, vulnerability, and uncertainty. But it’s one he would encourage other rural healthcare teams to consider. 

“You don’t always know what the benefit will be,” he said. “You might discover strengths you didn’t realize you had, or that the problem isn’t what you thought it was. But the investment is small, and the potential benefits are significant.” 

For Rahul, the experience in Bella Bella reinforced the importance of leadership, humility, and willingness to sit with discomfort. He said the coaching highlighted how effective leadership within the Bella Bella clinic depended on compassionate boundaries and mutual respect between the medical and administrative teams. 

“When leaders are open to being challenged and genuinely curious, that creates the conditions for real change,” he said. “From there, teams can begin to care for one another in ways that support the people they serve.” 

In a community where relationships are central to care, the Bella Bella team’s experience shows what is possible when rural healthcare teams are given time, space and support to work as one team. 

To learn more about the Quality Team Coaching for Rural BC, an RCCbc program funded by the Joint Standing Committee on Rural Issues, and how to get your team involved, visit https://rccbc.ca/initiatives/qtc4rbc/.