Hospital News 2015 November Edition by Hospital News

First TAVI procedure on pregnant patient

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TECHNOLOGY IN HEALTHCARE/ PATIENT EXPERIENCE/HOSPITAL PERFORMANCE INDICATORS

Canada's Health Care Newspaper NOV. 2015 | VOLUME 28 ISSUE 11 | www.hospitalnews.com

INSIDE Evidence Matters ............................... 10 Ethics .................................................. 17

Digital health advancements and new technology in healthcare. Programs and initiatives focused on enhancing the patient experience and family centred care. An examination of health system performance based on hospital performance indicators.

Data Pulse ..........................................18 From the CEOâ&#x20AC;&#x2122;s desk ......................... 24 Legal Update ......................................28 Nursing Pulse .....................................35

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World’s first TAVI procedure on pregnant patient By Calyn Pettit or just a moment, put yourself in Sarah Sayle’s shoes. You’re a busy mom of two even busier girls, both under the age of two. Juggling the daily demands of an infant and a toddler, you learn there’s one more on the way. This time, a baby boy. Life’s about to get a whole lot busier. Is your head already spinning? Few can relate, let alone imagine life with three little ones under three. Still, Sarah and her husband are prepared to take it all in stride.

A transcatheter aortic valve implantation (TAVI) procedure is where a new valve is inserted into the heart via an incision made in the groin. Suddenly, a second wave of news strikes: Sarah, 29, who was born with a congenital heart defect, needs to have heart surgery. Her aortic valve has given out under the physical stress of pregnancy. “I didn’t know what was going to happen,” says her husband. “She went for a doctor’s appointment in the morning, was supposed to be back by noon and instead was admitted to hospital.” Sarah needed to make a decision right away. She had three options: wait until her baby was born to have open-heart surgery, risking death for both her and/or her unborn child in the meantime; terminate the pregnancy and proceed with open-heart surgery; or undergo a specialized valve replacement while pregnant – something that had never been done before. Sarah’s decision was clear. At sixteen weeks pregnant, she underwent a transcatheter aortic valve implantation (TAVI) procedure, where a new valve is inserted into the heart via an incision made in the groin. For TAVI patients, the physical stress and recovery of the surgery is minimized – the best option for those who are too frail or in unique situations such as Sarah’s. “Our main goal was to save Sarah’s life,” says Dr. Rich Whitlock, cardiac surgeon at Hamilton General Hospital. Although Dr. Whitlock and his team were confident that TAVI was the best option for Sarah, it took careful planning and collaboration between both the cardiac

On Sept. 22, 2015 Sarah Sayles and her husband welcomed baby Peter, who was just sixteen weeks gestation when his mother underwent a specialized aortic valve replacement – the first case of its kind in the world. and obstetrics teams to ensure a smooth journey for both mom and baby. “Everyone was constantly checking in on me,” says Sarah. “My obstetrician even visited me in recovery at the General to make sure everything was okay.” Sarah recovered well from her surgery. On Sept. 22, Sarah and her family welcomed a healthy baby boy, Peter, weighing 7lbs 12oz. He spent his first few days being closely monitored by staff and physicians in the neonatal intensive care unit at McMaster Children’s Hospital before heading home to meet his two big sisters. “Sarah’s case is something you read about in a textbook,” says Dr. Michelle Morais, obstetrician at McMaster University Medical Centre who helped to deliver baby Peter. “You maybe see it once or twice in a career.”

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Dr. Morais says other health care teams will read about and learn from Sarah’s case, a world first not only due to her pregnancy, but also her age – she’s the youngest TAVI patient to date. The learnings shared between the two teams are invaluable for future TAVI and other cases. Together, they’ve exemplified the epitome of collabo-

ration and interdisciplinary care, and the positive outcomes for both Sarah and baby Peter are proof. “It was perfect,” says Dr. Whitlock. “It H was a textbook case.” ■ Calyn Pettit is a Public Relations Specialist at Hamilton Health Sciences.

Moving to the forefront of health care technology By Stefanie Kreibe t Mackenzie Health, patients are at the heart of everything we do. As a regional health care provider serving a population of more than half a million people across York Region and beyond, Mackenzie Health is evolving its IT infrastructure to benefit both the existing Mackenzie Richmond Hill Hospital as well as the new Mackenzie Vaughan Hospital expected to be completed in 2019. Recently, the organization introduced ICAT Healthcare, a strategy that will see Mackenzie Health propel its information, communications, and automation technology (ICAT) systems to a leadership position within the health care industry over the next four years. Nationally recognized for its commitment to safety, quality patient care and innovation, Mackenzie Health works with health care, technology and academic partners to constantly evolve and

adapt to keep current with best practice and technology changes. “ICAT Healthcare serves as a key pillar in helping Mackenzie Health achieve its vision to create a world-class health experience for its patients by providing our staff and physicians with world-class technologies to enable that care,” says Richard Tam, Executive Vice President and Chief Administrative Officer at Mackenzie Health.

New first-in-Canada hospital portable data centre

The recent addition of Mackenzie Health’s state-of-the-art, portable data centre, puts Mackenzie Health at the forefront of health care IT infrastructure as the first health care organization in Canada to acquire this kind of technology. Mackenzie Health is among the first of only a handful of health care organizations across North America to do so. Continued on page 6 www.hospitalnews.com

Insomnia ranks 2nd after cold as most common health complaint

Half of people internationally say they have had a cough or cold in the last 12 months and over a quarter report suffering from insomnia or problems sleeping. These are findings from a recent GfK online survey that asked over 27,000 people in 22 countries which health conditions from a given list they had experienced in the past 12 months. The possible conditions asked about included items such as skin conditions, allergies, vomiting or diarrhea, diabetes or pre-diabetes and high cholesterol or blood pressure. But, internationally, the top five most common conditions that people say they have experienced in the past 12 months are a cold (which was bundled with a cough, sore throat, up-

per respiratory infection, flu or influenza and was reported by 51 per cent), problems sleeping (27 per cent), muscle or joint pain due to injury or over exertion (25 per cent), weight problems (21 per cent) and migraines or severe headaches (21 per cent). Looking at the breakdown between men and women, there are some clear gender differences. For almost all the conditions listed, women have higher percentages saying they have experienced these in the last 12 months than men. Both genders report a cold or cough as being the most common complaint (53 per cent of women and 49 per cent of men), but, for women, the next most

common complaint is insomnia (32 per cent), while, for men, it is a tie-breaker between muscle or joint pain due to overexertion or injury, and insomnia (both standing at 24 per cent). There is also a difference in what items make it into the top five for each gender. For women, migraine or severe headache is their third most common complaint, but does not feature in menâ&#x20AC;&#x2122;s top five list (reported by 27 per cent of women and 15 per cent of men). And for men, heartburn or acid reflux is their fourth most common complaint, but does not feature in the womenâ&#x20AC;&#x2122;s top five list â&#x20AC;&#x201C; even though more women than men report having experienced it over the last year (19 per cent of H men and 21 per cent of women). â&#x2013;

Use of restraints in Ontarioâ&#x20AC;&#x2122;s long-term care homes has been cut in half The Ontario Long Term Care Association welcomed the release of Health Quality Ontarioâ&#x20AC;&#x2122;s (HQO) annual report on the health system, Measuring Up, calling it an opportunity to celebrate quality improvement efforts in Ontarioâ&#x20AC;&#x2122;s long-term care homes and highlighting the need to provide additional support to homes to expand their efforts. Long-term care homes showed either improvement or relative stability on three key measures of care, including restraint usage, falls, and new or worsening pressure ulcers. â&#x20AC;&#x153;Homes have either held steady or improved during a time of intense change, when new residents have become increasingly medically complex and with a higher rate of dementia,â&#x20AC;? says Candace Chartier, RN, CEO of the Ontario Long Term Care Association. â&#x20AC;&#x153;These results demonstrate that long-term care homes are successfully creating a culture of person-centred care and quality improvement.â&#x20AC;?

Chartier noted that restraint use in particular has dropped from 16.1 to 7.4 per cent in just four years (2010/11 to 2014/15). â&#x20AC;&#x153;The decrease in restraint use benefits our residents tremendously, both in their health and quality of life.â&#x20AC;? The Association pointed to data which demonstrates the increasing needs of seniors in long-term care homes. Seniors who come to long-term care are at a much more advanced stage of physical and cognitive decline than they were in the past. The vast majority (93 per cent) of residents have two or more chronic health conditions; 62 per cent of residents live with Alzheimerâ&#x20AC;&#x2122;s or another form of dementia; and 46 per cent display some level of aggressive behavior related to their dementia or mental health. To help support the increasing needs of residents, the Association has renewed calls to government to imple-

ment recommendations to strengthen the quality of care homes are providing to approximately 100,000 seniors every year. The Association is calling for immediate action to continue to improve seniorsâ&#x20AC;&#x2122; care in Ontario, including: â&#x20AC;˘ Implementing a plan to modernize every long-term care home in Ontario that has been classified as outdated by the province â&#x20AC;&#x201C; increasing the quality of care to the 35,000 seniors who live in these homes. â&#x20AC;˘ Providing the necessary funding to ensure that long-term care home operators can hire the staff required to care for the growing needs of our aging population. â&#x20AC;˘ Establishing dedicated dementia and mental health support teams in every home, ensuring the safety and comfort of the more than 65,000 seniors living in long-term care homes with H Alzheimerâ&#x20AC;&#x2122;s and other dementias. â&#x2013;

In Brief

Federal panel studies U.S. approach to physician assisted dying The Expert Panel on Options for a Legislative Response to Carter v. Canada has returned from its fact-finding trip to Portland, Oregon, where it learned how assisted dying, which has been legal there for nearly 20 years, is practiced. During their three-day visit, Dr. Harvey Max Chochinov, Chair of the Panel, BenoĂŽt Pelletier and Catherine Frazee met with nine individuals and organizations to discuss the implementation and operation of assisted dying in Oregon. Panel members engaged in discussions with the co-author of Oregonâ&#x20AC;&#x2122;s Death with Dignity Act, as well as with experts from the medical profession and disability rights organizations. The Panelâ&#x20AC;&#x2122;s fact-finding mission concluded with an exchange of ideas with Dr. Linda Ganzini, a prominent researcher in geriatric mental health, end-of-life care, and palliative care for the terminally ill. â&#x20AC;&#x153;We were impressed by the discussions we had with experts from a range of disciplines,â&#x20AC;? says Dr. Harvey Max Chochinov, Chair of the External Panel on Options for a Legislative Response to Carter v Canada. â&#x20AC;&#x153;The insight they provided has given us a more thorough understanding of Oregonâ&#x20AC;&#x2122;s Act. These consultations are of great importance to the Panelâ&#x20AC;&#x2122;s work in developing effective options for the government to consider when developing well-crafted laws for Canadians.â&#x20AC;? The Oregon mission was a follow up to the Panelâ&#x20AC;&#x2122;s previous study of physicianassisted dying in three European countries â&#x20AC;&#x201C; Belgium, The Netherlands, and Switzerland. Both are part of a larger program of consultation that includes a national online consultation with Canadians (www. externalpanel.ca), meetings with expert groups and individuals, and in-person consultations set to resume immediately following the federal election. Canadians are encouraged to provide their insights to the Panel on how physicianassisted dying can be implemented in CanH ada at: www.externalpanel.ca/issuebook/. â&#x2013;

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What I didn’t learn in medical school

Sometimes doctors can’t fix what makes their patients sick in the first place By Vivian Tam with Elizabeth Lee-Ford Jones

began medical school optimistic about what becoming a physician meant I could do for my future patients. Naively, I presumed my career would involve treating patients’ illnesses so they could return to lead full and fulfilling lives. Yet for the one in seven Canadians living in poverty, it is often difficult for doctors to achieve this goal. Take Christina, a 64-year old woman with diabetes, who came to me with new-onset numbness in her fingers and toes (a serious and progressive consequence of poorly controlled diabetes). As she struggled to leave on her walker, her prescription fell out of her purse. When I retrieved it for her, she mentioned that it hardly mattered because she would not have enough money to purchase the medication anyway. Then there was Andrew, a 36-year old man who had been physically assaulted while panhandling. He had a prosthetic hip from a work accident that had left him with a pronounced limp, a chronic disability and no job. While I could screen Andrew for fractures and neurologic deficits, I could do nothing for his unemployment or his inability to find safe shelter at night. These are but two of many encounters I have had that starkly contrast the values of social medicine I have learned in medical school. What good is it to treat illness if we can only send our patients back to the conditions that helped make them sick to begin with?

ADVISORY BOARD Cindy Woods,

Senior Communications Officer The Scarborough Hospital,

Barb Mildon,

RN, PHD, CHE , CCHN(C) VP Professional Practice & Research & CNE, Ontario Shores Centre for Mental Health Sciences

610 Applewood Crescent, Suite 401 Vaughan Ontario L4K 0E3 TEL. 905.532.2600|FAX 1.888.546.6189

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Healthcare is just a small part of what determines our well-being. In fact, our health is strongly influenced by factors such as income, our working environment and affordable housing, over which neither patients nor medical doctors have much control. This is why Canada needs better public policy that safeguards the global health of all Canadians. As the ninth richest country in the world, we have managed to ignore the erosion of social assistance and the rise in income inequality that has taken place over the last decades. While we are one of the countries consistently spending the most on healthcare, we don’t do a very good job of providing a social safety net for the growing numbers of Canadians who are living paycheck to paycheck or are under or unemployed. We are also one of the few OECD countries without a national housing and homelessness strategy, which the United Nations Committee on Economic, Social and Cultural Rights considers a “national emergency.” For a nation that once prided itself on being ranked “the best country in which to live,” we have a lot to do before warranting the title once again. It does not have to be this way. Public policy decisions, including those that determine the allocation of tax revenue, strongly influence health outcomes. These decisions need to be critically reexamined, particularly when most Canadians have demonstrated their support for policies that improve conditions for the most vulnerable.

Helen Reilly,

Publicist Health-Care Communications

Jane Adams,

President Brainstorm Communications & Creations

Bobbi Greenberg,

Health care communications

Sarah Quadri Magnotta, Health care communications

GRAPHIC DESIGNERS

ANGEL EVANGELISTA CAROLINE PAPINEAU NICK MCGRAW RENATA VALZ JEFF CHARD ARUN PRASHAD ALICESA LAROCQUE KATHLEEN WALKER STEPHANIE GIAMMARCO ACCOUNTING ANALYSTS

MATTHEW PICCOTTI PHIL GIAMMARCO

Vivian Tam is a second year medical student at the Michael G. Degroote School of Medicine at McMaster University and Elizabeth Lee-Ford Jones is an expert advisor with EvidenceNetwork.ca, andProfessor of Paediatrics at The Hospital for Sick Children and the University of Toronto.

Dr. Cory Ross,

B.A., MS.C., DC, CSM (OXON), MBA, CHE Dean, Health Sciences and Community Services, George Brown College, Toronto, ON

Akilah Dressekie,

Ontario Hospital Association

David Brazeau

Director, Public Affairs, Community Relations and Telecommunications Rouge Valley Health System

In 2009, a Nanos research poll reported that most Canadians strongly supported the public health system and strengthening publicly funded healthcare. In 2014, a poll by the Broadbent Institute found that 77 per cent of Canadians recognize the widening income gap as a serious issue for the country, while 71 per cent believe this gap undermines Canadian values. The same poll found that most Canadians are in favor of increasing taxes to fund public programs that will reduce the impacts of income inequality. This means that Canadians are far ahead of their governments in supporting solutions to close the gap between the rich and poor, and, often at the same time, the healthy and unhealthy. Canada’s current public policies could better meet both the health needs and social values of its citizens. As a soon-to-be physician I hope to practice medicine in a nation where income is not an obstacle to good health, and where polices and legislation are accountable to Canadians’ priority of H health for all. ■

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Health care technology Continued from page 2

Currently used by technology giants such as Microsoft, Google and high security military installations, the data centre ‘future proofs’ Mackenzie Health to be able to adopt a wide range of new and emerging technologies. It will also support the work of Mackenzie Health’s Innovation Unit and as well as enable the organization’s medical electronic record adoption to go from EMRAM 3 to EMRAM 7 in just two years. The new data centre also helps Mackenzie Health to set the stage for future innovation that will see the Mackenzie Richmond Hill and Mackenzie Vaughan Hospitals become a truly ‘smart hospital’. This means having digital technologies that have interconnectivity between systems so that they share information to better support clinicians to care for their patients. “A key aspect of our ICAT Healthcare strategy is to introduce the majority of new technologies at Mackenzie Richmond Hill Hospital well in advance of the opening of the new Mackenzie Vaughan Hospital,” says Mackenzie Health President and CEO Altaf Stationwala. “By incorporating these technologies into their practices today, they will be well versed in the latest technologies when the future Mackenzie Vaughan Hospital opens. This approach will also enable both hospitals to share some of the most advanced technologies to enhance patient care delivery and safety creating a truly ‘smart hospital’,” adds Stationwala.

Celebrating the launch of Mackenzie Health’s ICAT Healthcare.

Preparing for tomorrow, today

In 2019, Mackenzie Health will complete construction of the new Mackenzie Vaughan Hospital and will continue to operate Mackenzie Richmond Hill Hospital. In preparation for this significant addition, in 2014, Mackenzie Health launched its Innovation Unit project and has been working with a variety of partners to refine and advance the project, which is a living laboratory for health care technologies. A first in Canada, Mackenzie Health’s is Innovation Unit is an acute care medical unit where health care innovations are developed, evaluated and adopted, with the goal to have other patient care units at Mackenzie Richmond Hill Hospital, as well as the new Mackenzie Vaughan Hospital adopt those most successful.

The introduction of Mackenzie Health’s ICAT Healthcare strategy, supported by its first-in-Canada, state-of-the-art data centre, will provide technology solutions that enhance patient care through world-class technological solutions. Supported with accurate and consistent patient information across a multitude of devices, ICAT Healthcare will help Mackenzie Health incorporate easy to use systems ultimately enhancing patient care delivery and safety.

Mobile Way finding App and much more

ICAT Healthcare also enables Mackenzie Health to support a variety of exciting new technologies such as a new first-in-Canada GPS Mobile Way finding App and electronic kiosk system and a Bring Your Own Device program to enable staff and physicians to receive

secure Mackenzie Health email on their personal smart phones, tablets and computers. These new technologies are being developed now, to prepare for the future of healthcare at Mackenzie Health. Going forward, the ICAT Healthcare strategy will enable our staff and physicians to enjoy: • more time at the bedside to care for their patients; • better communication and tools at their fingertips; • faster response times; and • reduced human error incidence, through the use of technology. ICAT Healthcare will also help to create an exceptional care experience for patients by: • integrating care delivery customized to individual patient needs; • enhancing bed-side care as clinicians can better interact with patients with the technology; and • enhancing communications for patients with special needs such as built-in language translation services and touch screen technology for patients with limited mobility. The impact on the delivery of care at Mackenzie Health will be pervasive. It may also help to establish new standards across the health care industry including: • immediate access to clinical data anytime, anyplace across the organization; and • the development of clinical decision support tools to further improve safety and quality of care, shorten length of stay, and reduce readmission to H hospital. ■ Stefanie Kreibe is a Communications and Public Affairs Consultant at Mackenzie Health.

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“Our partnership with the Public Services Health & Safety Association allows for JHSC training that is focused on the health & safety issues that our hospitals see. It is relevant training and PSHSA knows how to connect with our JHSC members to keep them engaged.” Steve Jamieson Safety Manager, Health, Safety and Wellness Hamilton Health Sciences

PSHSA sat down with Steve to discuss what makes a good JHSC and how PSHSA has built a successful partnership with Hamilton Health Sciences:

Q: How long have you worked with the Public Services

Q: What are emerging health and safety issues that

Health and Safety Association as your Health and Safety training partner? How is it a good ﬁt?

the JHSC are faced with and how does PSHSA assist?

A: Hamilton Health Sciences (HHS) originally worked with OSACH in the early 2000s and have enlisted JHSC Certiﬁcation training services of PSHSA since 2012. The service that PSHSA provides is excellent. A highly valued characteristic of the training is that it is delivered from PSHSA staff who have relevant health care experience and are able to connect with our members. We continue to hear from our members how in tune their staff are to our environment and are able to share relevant examples. It creates a great learning atmosphere.

Q: What is important for a good JHSC training program? How does PSHSA deliver?

A: PSHSA’s certiﬁcation program provides all JHSC members with a clear understanding of the OHSA, including how they ﬁt in supporting the organization’s health and safety program and ways they can make an impact in supporting workers’ concerns. The different methods used to deliver the training keeps the members interested and engaged.

A: As PSHSA is funded by the Ministry of Labour, they are consistently involved in discussions related to emerging health & safety issues and implementation plans of new legislation. Within the training sessions offered to us, PSHSA staff provide opportunities for us to discuss and better understand new issues that workers are raising to our Committee members. Through these discussions, our members gain tools to better assist them in identifying health and safety issues and methods to support our workers. Q: What sets PSHSA apart from other training vendors? How can we do better? A: PSHSA’s knowledge of health care settings and focused training geared to our challenges is the difference for us. They tailor the training to include our practices and processes which greatly helps everyone understand their role. Our members immediately are engaged in the training offered as PSHSA staff have practical experience within our settings which provides insight to the challenges our hospitals see.

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TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE/HOSPITAL PERFORMANCE INDICATORS

Digital health for consumers the next major step

By Dan Strasbourg

he benefits associated with the use of digital health, such as improved patient outcomes, efficiencies and improved access to care, are becoming a core part of day-to-day hospital care. Now is the time to focus on extending these efficiencies and benefits to patients, which is one of the biggest developments in the digital health revolution. According to Michael Green, President and CEO of Canada Health Infoway, providing Canadians with their health information and digital tools to help them be informed, engaged members of their own care team is transforming healthcare.

“Information is critical to quality care, whether patients are in hospital or managing their conditions themselves at home,” says Green. “The vast majority of Canadians want secure access to online patient services, and never before has Canada been better positioned to do that.” Access to an online patient portal helped cancer survivor Judith Morley and her family manage her care and treatment, and she thinks every Canadian should have access to digital health. “Digital health greatly improves the patient experience,” says Morley. “Whether you’re waiting to learn how your cancer treatment is progressing or you’re book-

Empower Patients. Empower Health Care Teams. Patients are demanding more involvement in their own health care. Doctors, pharmacists and other health care providers are challenged to work collaboratively to deliver quality services to their patients. How do we make sure that both patients and health care providers have the information they need, when they need it? By putting in place robust information technology tools to connect all providers at every point of care. RelayHealth does this.

Provides eﬃcient care coordination across settings and time frames t t

The right data to the right person at the right time Information shared on a common, secure, communication platform Patient data exchange between primary, community, acute and ambulatory care

Enables patients to become engaged participants in their care t

Patient messaging to care team on a common platform

RelayHealth is an easily implemented web-based solution to eﬃciently and securely provide clinicians and patients with a common view of the patient’s medical record. RelayHealth will accelerate Ontario’s Health Links strategy Ideally suited for the successful operation of Health Links, RelayHealth oﬀers secure collaboration among patients and all their healthcare providers, including physicians, laboratories and hospitals, wherever they are located. Enabling Patient Access The implementation of RelayHealth in your institution may lead to reductions in: t Time from primary care referral to specialist consultation t Number of 30-day re-admissions to hospital t Number of avoidable ED visits for patients with conditions best managed elsewhere t Time from referral to home care visit t Unnecessary admissions to hospitals To learn more about RelayHealth, visit us at HealthAchieve booth # 1606 or visit www.relayhealth.ca

HOSPITAL NEWS NOVEMBER 2015

ing your child’s medical appointment, who wouldn’t rather have the ability to do those things online, quickly and securely?” Judith is in good company. Patient portals are already providing Canadians with access to their health information such as initiatives at Toronto’s Holland Bloorview and Sunnybrook Health Sciences Centre, the Children’s Hospital of Eastern Ontario in Ottawa, and Nova Scotia’s patient portal project. Green points to e-booking and viewing lab test results as examples of areas in which there should be immediate expanded access. The vast majority of Canadians want to be able to do these things. Between six and 10 per cent of Canadians are able to. “Leveraging these untapped opportunities to support patient-centered care through consumer access to digital health tools and capabilities is the current focus in Canada’s digital health journey,” adds Green. He also points out that Canada, in particular, is a country where the expansion of consumer-oriented digital health makes a great deal of sense. “We are among the highest users of the internet in the world,” says Green. “Canadians go online to shop, to read or watch the news, to bank, and to communicate with friends. And research is showing that they know digital health makes health care easier and more convenient, and they want access for themselves.” The economic case for digital health is also clear, particularly when one considers the value that electronic healthcare has already brought about. Since 2007, digital solutions such as telehealth, drug and diagnostic imaging systems and physician electronic medical records have resulted in an estimated $13 billion in access, quality and productivity benefits for Canadians. The Medical Post recently convened an expert panel to discuss the state of electronic technology in healthcare. The comparison was made between health care today and the banking industry 15 years ago. Back then, many banking executives were concentrating their efforts on providing services through ATMs, assuming that this was what customers really wanted. It turned out, of course, that what customers also wanted was the freedom and flexibility to take control of all their own banking themselves, online. That consumer desire for control and involvement is ex-

Judith Morley. actly what Michael Green says health care planners should be thinking about. “Together with our partners, Infoway has spent the last 14 years working to improve the health of Canadians by accelerating the development, adoption and effective use of digital health solutions,” he says. “As a country, we have made extraordinary progress and we find ourselves in the enviable position of being able to enhance the patient experience by improving outcomes and reducing the amount of time required to renew prescriptions, book appointments or manage illnesses.” Access to the portal provided Judith and her family with online access to her medical information. Despite the stress and confusion of the multiple tests, appointments and treatments that her cancer required, they were able to use the portal to review her information and progress securely from home. It also helped keep them in contact with members of her care team who provided clarification or answered questions as needed. “In hindsight, digital health gave my family hope at a time when I was overcome with anger and grief, and was unable to grasp what was happening to me, let alone focus on the value of digital health,” says Morley. “Today, I am cancer-free. While I haven’t looked back since conquering my battle with cancer, I am grateful that the H experience led me to digital health.” ■ Dan Strasbourg is Director, Media Relations Canada Health Infoway. www.hospitalnews.com

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10 Evidence Matters

Testing for Helicobacter pylori: Can stool provide the answer? By Kasia Kaluzny elicobacter pylori is a troublemaking bacterium that infects the stomach and can cause indigestion, stomach ulcers and, in rare cases, stomach cancer. H. pylori can be treated with antibiotics, but an accurate diagnosis of infection is important before starting treatment. Once the course of antibiotics is complete, a followup test is needed to make sure the H. pylori are history. There are several different tests for H. pylori, and choosing the most appropriate test depends on the patient’s age and symptoms. For example, patients with symptoms of cancer will need an endoscopy – a camera in a tube inserted through their throat into the stomach – but other patients could be tested with less invasive methods. These methods include blood tests, urea breath tests, or stool tests. The stool tests are called stool antigen tests because they look for H. pylori antigens (bits of the H. pylori bacteria that stimulate our immune system). Many experts consider urea breath testing to be the best non-invasive test for H. pylori, but it requires special equipment and is not readily accessible in rural and remote locations. In some areas of Canada, doctors and other health care providers use stool testing as the first option, saving patients the time and money it takes to travel outside their communities. However, this practice is not consistent across the country – many patients are still referred to larger city clinics or hospitals for urea breath testing. To clear up some of the uncertainty about which test to choose, CADTH reviewed the evidence on H. pylori stool antigen tests to find out how accurate they are compared to other tests. CADTH is an

There are several different tests for H. pylori, and choosing the most appropriate test depends on the patient’s age and symptoms.

independent agency that finds and summarizes the research on drugs, medical devices, and procedures.

CADTH review

For this project, CADTH found more than 200 publications in a literature search for publications between January 2009 and December 2014. Researchers narrowed down the list to 24 reports that were the most relevant. Of these, one report was a clinical practice guideline document, two were economic reports, and 21 were diagnostic studies – 15 of which were for initial testing for suspected H. pylori infection and six of which were for follow-up testing after treatment. Taking a look at all this research, CADTH found that many (but not all) of the stool antigen tests had good diagnostic sensitivity and specificity. In other words, many of the stool tests were good at correctly identifying people who had H. pylori (good sensitivity) and good at identifying those people who did not have H. pylori (good specificity).

Which type of stool antigen test is best?

There are several commercially available stool antigen tests for H. pylori that use either monoclonal or polyclonal antibodies. Monoclonal antibodies are more specific to H. pylori but more expensive to produce, while polyclonal antibodies are less specific but less expensive. With both types of tests, the antibody recognizes the H. pylori antigen, and this reaction causes the positive sample to turn a different colour. Some of the tests can be performed in the doctor’s office, with results available in a few minutes, but others need to be sent out to a lab. The CADTH review showed that, generally, the monoclonal antibody tests performed better – the results from these tests were close to or just as accurate as the results from urea breath testing or endoscopy. Some of the polyclonal tests also performed well, but some showed lower sensitivity. In particular, the stool tests that worked the best for initial diagnosis were:

• Testmate pylori antigen [TPAg EIA] (a lab-based test using monoclonal antibodies) • Premier Platinum HpSA Plus (a labbased test using monoclonal antibodies) • Amplified IDEIA Hp StAR (a lab-based test using monoclonal antibodies) • EZ-STEP H. pylori (a lab-based test using polyclonal antibodies) • Atlas H. pylori antigen (an in-office test using monoclonal antibodies) The stool tests that performed the best for follow-up were: • Testmate rapid pylori antigen [Rapid TPAg] (an office-based test using monoclonal antibodies) • Testmate pylori antigen EIA [TPAg EIA](a lab-based test using monoclonal antibodies) • Amplified IDEIA Hp StAR (a lab-based test using monoclonal antibodies) • HpSA ELISA II (a lab-based test using monoclonal antibodies) • RAPID Hp StAR (an in-office test using monoclonal antibodies) • ImmunoCard STAT! HpSA (an inoffice test using monoclonal antibodies) The clinical guideline document included in the CADTH review aligned well with these findings because it recommends choosing a stool antigen test that is laboratory-based, validated, and with monoclonal antibodies. This test could be used reliably for the initial diagnosis and for the follow-up testing after antibiotic treatment. The two economic reports included in the review examined only specific situations, but they did find the stool antigen tests to be cost-effective in these situations, meaning they provided good value for money.

Who can benefit

These results are encouraging for rural and remote patients and their health care providers. There are also implications for developing countries and health care centres – in Canada or abroad – that want to provide less invasive testing options that could potentially offer cost-savings. To learn more about CADTH, visit www.cadth.ca, follow us on Twitter: @ CADTH_ACMTS, or talk to our Liaison Officer in your region: www.cadth.ca/conH tact-us/liaison-officers. ■ Kasia Kaluzny, MSc, is a Knowledge Mobilization Officer, CADTH. HOSPITAL NEWS NOVEMBER 2015

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Co-designing home care with clients and their families By Pamela Stoikopoulos

ncorporating the insights, ideas and feedback of patients and their family members in the design and delivery of health services has been crucial to providing patient-centred care in many hospitals for the last several years. In home care, the notion of clients (patients) and their families as “co-designers” of quality improvement initiatives and direct care services is relatively new, and one that VHA Home HealthCare (VHA)–an Ontario-based, not-for-profit, charitable organization in its 90th year – is determined to apply. In 2013, VHA began paving the way to incorporate the Client and Family Voice into everything it does. The community model VHA developed is largely based on Britain’s National Health Service’s (NHS) transformative “nothing about me without me” philosophy and research, which empower patients and their families to help direct their own care needs. “This model is so exciting,” notes VHA Vice President of Client Services and Chair of the Client and Family Voice Steering Committee, Barbara Cawley, “because it takes clientcentred care a step further so clients and their family members are true partners in designing and developing VHA services and how we deliver them.” Before creating its own community care-based model, VHA met with hospitals identified as being ahead of the curve in this area, including Holland Bloorview Kids Rehabilitation Hospital and North York General Hospital. “They really helped to steer us in the right direction,” Cawley says. “Based on their advice we determined how to approach the implementation of the Client and Family Voice strategically. They also provided ideas about the nuts and bolts of recruitment – for identifying both Client and Family Voice partners and projects that would greatly benefit from client and/or family input.” She adds that while insights were extremely helpful, there were some unique challenges VHA had to work out for itself. “We don’t have a ‘building’ in the same way

Client and Family Voice helps VHA better reflect the needs of its home care clients and the loved ones who support them. that a hospital does. Our workers and our clients and families are in their home so we knew we’d have a greater challenge with recruiting them for projects. We can’t just walk down to their room to see if they’d be interested in joining,” Cawley says. “Getting the word out amongst our more than 2,000 staff and service providers – so that they understand what we’re doing and how they can support us – was also something we had to consider carefully.” Though it is still relatively early days for the initiative, there have already been several successes that signal VHA is headed in a positive, more inclusive direction. One of the most exciting is the creation of a Client and Carer Advisory Council. Two-thirds of the members are VHA clients or caregiv-

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The community model VHA developed is largely based on Britain’s National Health Service’s (NHS) transformative “nothing about me without me” philosophy and research, which empower patients and their families to help direct their own care needs. ers who are receiving or have received services from VHA. The council’s vision is to “act as the voice of the client in planning, developing or evaluating services.” Since its inception in 2014, the team has been involved in: reviewing and making recommendations on VHA’s quality improvement initiatives; advising staff on education to improve the client experience; and sharing personal stories and home care experiences with our board and leadership team, amongst many other activities. Outside of the council, client and family partners at VHA have also been involved in various capacities, including: • Discussing their experiences as a client or caregiver during staff education sessions; • Providing feedback to Human Resources on hiring; • Offering insights and ideas on the design and content of a client and family newsletter;

• Sharing their experiences with the rehab equipment/Assistive Devices Program (ADP) processes; • Nominating staff and service providers for VHA’s newly minted Client Choice Awards. The application of client and family partnering to home care is starting to see a lot of interest from other community care agencies, especially after VHA’s presentations on the topic at the Canadian Home Care Conference in Banff and Accreditation Canada’s conference in Vancouver, both held last year. “People were definitely keen to learn more about our experience,” notes Cawley, “especially since client and family involvement will be part of the next wave of accreditation criteria for home care organizations.” VHA has also begun to pay the knowledge forward by advising other home care organizations on starting their own Client and Family Voice initiatives. Recruitment of clients and family members is also climbing as VHA’s “roadshow” rolls out and an organizational culture shift takes hold. “Our progress wouldn’t have been possible without all the support we received from North York General Hospital and Holland Bloorview Kids Rehabilitation Hospital,” says Cawley. “Though it’s nice to be perceived as innovators, it’s an innovation we need to actively share and support. The more we promote this, the more positive impact it will have on all home care clients H – and that’s what’s most important.” ■ Pamela Stoikopoulos is Communications Manager at VHA Home HealthCare. www.hospitalnews.com

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Breaking down the silos

Susan Bradbury, RPN, (left) measures patient Janet Gayle’s lung function using a spirometer. Gayle was a participant in the COPD clinic, part of the Living Well program offered at Rouge Valley Health System.

Changing the way programs think and patients are seen is improving the patient experience at St. Joseph’s Hospital in London.

Living Well education program S helps keep COPD patients out of hospital

By Dahlia Reich

By Jane Kitchen

program at Rouge Valley Health System (RVHS) is helping to keep patients with chronic obstructive pulmonary disease (COPD) out of hospital. RVHS offers an education and selfmanagement clinic on COPD for outpatients as part of its Living Well chronic disease education program that also includes clinics for asthma, osteoporosis, arthritis, chronic pain, hypertension, and smoking cessation. The COPD clinic was started in March 2013, based on a module from the Ontario Lung Association and input from the RVHS respirology team. COPD is a chronic disease that limits airflow to and from the lungs, causing shortness of breath and other breathing problems. The Canadian Institute of Health Information (CIHI) states that COPD now accounts for the highest rate of hospital admission among major chronic illnesses in Canada. Further, hospital readmissions are higher among COPD patients than any other chronic illness. Rouge Valley’s COPD clinic, which teaches patients self-management of their condition, is helping to bring these rates down. “The goal of this clinic is for patients to

move towards a comprehensive and proactive approach to chronic disease prevention and management. Patients can learn techniques that allow them a much better quality of life while living with their condition. With triggers under control, emergency visits and the subsequent readmissions can decrease,” says Amber Curry, manager, inpatient surgery, ambulatory care unit, pre-admit and fracture clinic, RVHS. Most of the participants who come to the education clinic are on a cycle of emergency department visits and/or being readmitted to hospital. Staff and physicians refer these patients to Susan Bradbury, a registered practical nurse who runs the Living Well program. She visits patients while in hospital to inform them about the COPD clinic and the benefits of learning to manage the condition successfully. The majority of these patients attend, sometimes with family members who wish to learn how to help their loved ones. The clinic has proven to be life-changing, helping patients to break the cycle of continual hospital visits. Since September 2014, only one out of 82 patients was readmitted to hospital for a COPD exacer-

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bation within 30 days after completing the COPD program, and only six were readmitted within 90 days. Janet Gayle is one of those COPD clinic graduates who has learned how to get her breathing under control and has not needed to go back to the hospital. “Before I went to the clinic, I was having trouble breathing when I was doing anything. Every time I got a cold, it would go straight to my lungs, and I’d be hospitalized,” says Gayle. An asthma sufferer for over 30 years, she was diagnosed with COPD in November of 2012. She lived a restricted life, not able to do housework or climb the stairs without gasping for breath. Sometimes fragrances and perfumes that her co-workers wore would prompt an attack, or she could not go to her son’s hockey games because the cold air in the arena would make it difficult to breathe. Even enjoying herself out with friends was hard, as laughing would bring on a coughing fit. By participating in the clinic, Gayle learned the best way to get oxygen into her compromised lungs. She also learned how to manage environmental triggers and her medications. And, in the two years since she finished clinic, she has not needed to go to the emergency department. Rouge Valley respirologist Dr. George Philteos, who is involved in the COPD program, says: “I have been very pleased with the feedback I have received from patients. They have a better understanding of their disease and have learned valuable coping strategies that impact their quality of life.” Gayle agrees. “You can live with your COPD, and you can have a fulfilling life, but have to know how. Now I know how. I credit the COPD clinic,” says Gayle. For more information, call Rouge Valley’s Living Well program at 905-683-2320 ext. 1182 or go to www.rougevalley.ca/livH ingwell. ■ Jane Kitchen is Communications Specialist at Rouge Valley Health System.

heila Lucas had her first open heart surgery to repair a faulty mitral valve at age 21. Twenty years later, she underwent a second surgery, and now, at 64, is likely facing another heart operation. To ensure she’s in the best shape possible, Sheila was referred to the Cardiac Rehabilitation and Secondary Prevention (CRSP) Program at St. Joseph’s Hospital in London. There, she would find care and support that extended beyond the program and address health care needs she didn’t know she had. Designed for individuals with known heart disease, the six-month CRSP program is a safe and effective way to overcome some of the physical and psychological complications of heart disease, limit the risk of developing more heart trouble, and assist in the return to an active social or work life after a heart event. For Sheila the program was an opportunity to improve her fitness level and reduce the strain on her heart. Tragically, her husband recently died suddenly, three months after being diagnosed with cancer. She was beginning the program in a vulnerable state, physically and emotionally. “I was way overweight and my heart was bad. I couldn’t breathe. I couldn’t walk. My ankles were swollen. I couldn’t bend over to do my shoes up. I couldn’t go from the parking lot into the grocery store without feeling like I was dying. I couldn’t do anything,” says Shiela. During the initial comprehensive assessment at the CRSP program, the news got worse. Sheila also had type 2 diabetes. “It was a shock. I was overwhelmed as it was – this was another blow.” But working with the interdisciplinary cardiac rehab team, which includes physicians, kinesiolgists, psychologists, dietitians, nurses, and others, Sheila slowly began making progress. For the diabetes, she was enrolled in a class at the Diabetes Education Centre, also at St. Joseph’s Hospital. Sheila’s care experience is part of a focus on integrated chronic disease management at St. Joseph’s Hospital, which is changing the ways programs think and patients are seen. For the most part, hospital programs have care delivery models divided by disease-specific silos, explains Mary Mueller, Director, Medicine Services at St. Joseph’s. Continued on page 15 www.hospitalnews.com

TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE/HOSPITAL PERFORMANCE INDICATORS

Focus 15

Designed for individuals with known heart disease, the six-month CRSP program is a safe and effective way to overcome some of the physical and psychological complications of heart disease, limit the risk of developing more heart trouble, and assist in the return to an active social or work life after a heart event.

Breaking down the silos Continued from page 14

For example, at St. Joseph’s Hospital there is the Centre for Diabetes, Endocrinology and Metabolism and CRSP. Traditionally, there has been little or no integration or coordination of care between these two programs even though their patients share common risk factors. To break down the silos, a plan has been developed at St. Joseph’s to bring programs together in the care of patients with chronic diseases. First up was creating new care pathways for diabetes care and cardiac rehabilitation. Looking at identified risk factors seen in patients in both programs, a coordinated, collaborative care model was developed to optimize the care and service for these patients. It begins with a comprehensive medical assessment for all patients entering CRSP. This starts the ball rolling to systematically detect and address all vascular health risk factors and behaviours. For patients presenting in CRSP with diabetes or pre-diabetes it means they are now referred to the appropriate diabetes services specific to their needs – Diabetes Education Centre, Diabetes, Endocrinology and Metabolism Clinics, or Primary

Care Diabetes Support Program – all part of St. Joseph’s. Since March 30, 2015, 53 cardiac rehab patients have been referred to diabetes services. More importantly, 74 per cent did not know they had diabetes and are now being offered care for that condition. As well, new diabetes patients at St. Joseph’s now receive exercise education within the Diabetes Education Centre and routine screening for referral to cardiac rehab’s exercise programming. If eligible, they are offered enrollment into a six-month program. Exercise is a key component in care for type 2 diabetes patients yet many don’t get enough physical activity. Since July 2015, 23 out of 33 diabetes patients were found to be eligible for the exercise program and 70 per cent accepted enrollment. “Bringing programs together in this way is very exciting work that we are slowly expanding across St. Joseph’s Hospital,” says Karen Perkin, Vice President, Patient Care, and Chief Nurse Executive. “Essentially, we are combining our services in the best way possible around the needs of the patient.”

Sheila Lucas works on improving her heart health with registered kinesiologist Shannon DeLuca at the Cardiac Rehabilitation and Secondary Prevention Program at St. Joseph’s Hospital in London. For Sheila, the focus on integrated care has been life changing. Her weight is on the downswing, her stamina, heart health and emotional wellbeing are on the upswing, and her understanding of what she needs to do to regain her health is empowering. “I don’t know what I would have done

without St. Joseph’s,” says Sheila. “I was such a mess physically and emotionally. St. Joseph’s has been a true blessing. Everyone has been so encouraging. They keep me H motivated.” ■ Dahlia Reich works in Communications & Public Affairs at St. Joseph’s Health Care, London.

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TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE/HOSPITAL PERFORMANCE INDICATORS

“Patients are entitled to receive care based on the best scientific evidence and should receive the same quality of care regardless of geographic location. Telemedicine can remove the barrier of distance and ensure critically ill patients receive the right care, at the right time, in the right place.”

Dr. Derek Manchuk, Medical Lead for VCC Unit at Health Sciences North (HSN) in Sudbury and Medical Lead for Critical Care, North East Local Health Integration Network (NE LHIN) confers on Virtual Critical Care consult with Diane Whalen, Registered Nurse, Virtual Critical Care team at HSN.

Virtual critical care model wins provincial health award By Dan Lessard

new approach to providing critical care in Canada, pioneered in Northeastern Ontario has won a provincial award for health care innovation. The Virtual Critical Care (VCC) Unit is this year’s recipient of the Minister’s Medal Honouring Excellence in Health Quality and Safety, presented by Health Quality Ontario. Launched in May of 2014, VCC is the first critical care model of its kind in Canada. Based at Health Sciences North/Horizon Santé-Nord (HSN) in Greater Sudbury, Virtual Critical Care received startup funding through the North East Local Health Integration Network (NE LHIN) and uses a special software program created by the Ontario Telemedicine Network (OTN).

Virtual Critical Care uses the latest in videoconferencing technology and electronic medical records sharing to connect HSN with smaller Critical Care units and Emergency Departments at 22 other hospitals across Northeastern Ontario. Under the VCC model, a team of Intensive Care Unit (ICU) physicians, specially trained nurses and ICU respiratory therapists based at HSN are available for around-the-clock consultations for critically ill patients at participating hospitals. Other allied health professionals such as dietitians and pharmacists are also available for consultation during scheduled hours. The goal of VCC is to enhance the diagnosis and treatment of critically ill patients across Northeastern Ontario, and potentially avoid the transfer of patients

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out of their local hospitals, away from their families and support systems. Since being launched in May of 2014, VCC has been used for 227 patients, with an additional 355 follow-up visits, for a total of more than 19,362 VCC care minutes. Thanks to VCC, 80 patients avoided a medical transfer by air ambulance, at approximate savings of $1,360,000 to the health care system. “The Virtual Critical Care Unit has been a major advance in the care of critically ill patients in our region and represents the future of acute care medicine. The ability to instantly bring the HSN Critical Care team to the bedside of patients across the region has been remarkable,” says Dr. Derek Manchuk, Medical Lead for the VCC and Critical Care Lead for the NE LHIN. “Our partner hospitals, the NE LHIN, Ontario Telemedicine Network, Criticall, and the Ministry of Health have all come together with us to make this new program a reality. I’m very proud of this ‘made in Northern Ontario’ program that was the first of its kind in Canada.” “Patients are entitled to receive care based on the best scientific evidence and should receive the same quality of care regardless of geographic location.Telemedicine can remove the barrier of distance and ensure critically ill patients receive the right care, at the right time, in the right place, by the right provider. It is very humbling to work with such a large group of special people so fully invested in the success of the NELHIN Virtual Critical Care program. Kudos for a job very well done,” adds Renee Fillier, Virtual Critical Care H Nurse Clinician at HSN. ■ Dan Lessard is a Media and Public Relations Officer, Health Sciences North.

Hospitals in Northeastern Ontario that are part of the Virtual Critical Care Unit: • Blind River (Blind River District Health Centre) • Chapleau (Services de Santé de Chapleau Health ServicesChapleau General Hospital) • Cochrane (MICS Group of Health Services - Lady Minto Hospital) • Elliot Lake (St. Joseph’s General Hospital) • Englehart (Englehart and District Hospital Inc.) • Espanola (Espanola Regional Hospital and Health Centre) • Hearst (Hôpital Notre-Dame Hospital) • Hornepayne (Hornepayne Community Hospital) • Iroquois Falls (MICS Group of Health Services - Anson General Hospital) • Kapuskasing (Sensenbrenner Hospital) • Kirkland Lake (Kirkland and District Hospital) • Little Current (Manitoulin Health Centre) • Matheson (MICS Group of Health Services - Bingham Memorial Hospital) • Mattawa (Hôpital de Mattawa General Hospital) • Mindemoya (Manitoulin Health Centre) • New Liskeard (Temiskaming Hospital) • North Bay (North Bay Regional Health Centre) • Parry Sound (West Parry Sound Health Centre) • Smooth Rock Falls (Hôpital de Smooth Rock Falls Hospital) • Sturgeon Falls (West Nipissing General Hospital) • Sudbury (Health Sciences North) • Timmins (Timmins and District Hospital) • Wawa (Lady Dunn Health Centre www.hospitalnews.com

(Re-)humanizing the datadriven world of healthcare

Ethics 17

By Jonathan Breslin

embers of the public would be pleased to know that our hospitals expend significant resources (financial and human) on quality improvement. Reports like the Institute of Medicine’s ground-breaking 1999 report, To Err is Human, have made those who work in healthcare painfully aware of just how much work is needed to improve the quality of the care provided. Many hospitals have quality improvement departments, or at least people on staff who are trained in quality improvement methodologies. More recently there has been a movement towards creating cultures of quality improvement in organizations, to encourage and empower employees and physicians to lead quality improvement efforts right at the point of clinical care. This is obviously a good thing. A natural question that follows is, “How do we know if we are successful at actually improving quality?” The obvious answer is to find ways of measuring it. Thus we have quality and performance indicators: wait times data, infection rates, falls rates, critical incident data, and an endless list of acronyms like ALC, HSMR, EDLOS, and so on.

The more time we spend focused on data and indicators the more disconnected we become from the people represented by those indicators. Senior leaders and Board governors devote countless hours to monitoring and discussing their hospital’s performance on each of the indicators, typically via a balanced scorecard: a document that contains a dizzying array of numbers and trend indicators, such as arrows pointing in different directions and colour codes (green is good, red is not good). Hospitals are now held both publicly and fiscally accountable for their performance – certain indicators are publicly reportable, and hospitals (as well as individual senior executives) can be penalized financially for not meeting certain targets. In theory, all of this is a good thing. But there is a drawback to the emphasis on data and indicators in the health care world: it de-humanizes what is at its heart a very human endeavour – the provision of care to people in need. Even the part of quality that is more inherently human – the patient experience – gets reduced to indicators on a balanced scorecard, by tracking data related to complaints or concerns, for example. The problem is the more time we spend focused on data and indicators the more disconnected we become from the people represented by those indicators. Patients lose their individuality, their human-ness, and instead become faceless numbers in a spreadsheet and balanced scorecard. The tangible risk here is that we are psychologically less motivated by data than we are by individual stories. As Mother Theresa once said, “If I look at the mass I will never act. If I look at the one, I will.” www.hospitalnews.com

Many leaders in healthcare have begun to recognize this and have introduced various strategies to re-humanize health care quality. For example, I have heard of hospitals that begin Board meetings with the sharing of a patient story to set the tone from the beginning that the hospital’s work is about the people it serves. There is also a new movement in hospitals to create Patient and Family Advisory Councils (PFACs) to

integrate the patient perspective into hospital planning and decision making, and there is great potential for these councils to further re-humanize healthcare. If utilized properly these PFACs can help us see everything we do through the eyes of our patients, from building and renovating our facilities to developing policies. I recently read that Thunder Bay Regional Health Sciences Centre has even taken the step

of inviting one of their PFAC members to join their Quality of Care Committee. What better way to re-humanize the hospital quality agenda than to have an actual patient or patient’s family member sitting at H the Quality table? ■ Jonathan Breslin, PhD is an Ethicist at Southlake Regional Health Centre and Mackenzie Health.

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NOVEMBER 2015 HOSPITAL NEWS

18 Data Pulse

Putting the focus on patients CIHIâ&#x20AC;&#x2122;s pan-Canadian approach to capturing the patient perspective: PREMs and PROMs By Kira Leeb and Greg Webster ow many Canadians had a good experience from the care they were provided? How often did doctors and nurses listen carefully to the patient? Are patients providing input into their care pathway? Did the treatment improve the patientâ&#x20AC;&#x2122;s health and achieve its desired outcome? These are important questions to ask because understanding the patientâ&#x20AC;&#x2122;s view on health service delivery and their perspective on their health status is an essential component of patient-centred care and quality improvement. While patient reported experience measures (PREMs) capture the patientâ&#x20AC;&#x2122;s view on health service delivery (e.g., communication with nurses and doctors, staff responsiveness, discharge and care coordination), patient reported outcome measures (PROMs) provide the patientâ&#x20AC;&#x2122;s perspective on their health status (e.g., symptoms, functioning, mental health). PREMs and PROMs are complementary and are meant to be used together to capture a more complete picture of the patient journey. There has been an increased recognition of the importance of the patientâ&#x20AC;&#x2122;s perspective in supporting a patient-centered approach to providing quality healthcare. In Canada, the availability of standardized patient-reported information has been lim-

ited. Health service providers, administrators and policy-makers have indicated a desire and need for comparable patient-reported measures to better understand and improve quality of care as well as service delivery and outcomes. In response to this need, the Canadian Institute for Health Information (CIHI) has led the development of a pan-Canadian approach for the collection of PREMs for inpatient care and is working closely with jurisdictions across Canada to understand the need to measure patient experience across other sectors. CIHI is also working with several collaborators to lead and facilitate a common approach for PROMs collection and reporting across Canada.

Developing the Canadian Patient Experiences Survey Inpatient Care (CPESIC) and Canadian Patient Experiences Reporting System (CPERS)

In 2011, CIHI was approached by several jurisdictions to lead the development of a standardized PREMs survey for inpatient care as there was no other pan-Canadian survey tool to capture patient experience information.

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CIHI, in conjunction with the Inter-Jurisdictional Patient Satisfaction Group and survey research experts, applied rigorous survey and testing methodology to develop the CPES-IC. National organizations such as Accreditation Canada, the Canadian Patient Safety Institute and the Change Foundation also provided input into the development process. The Canadian Patient Experiences Survey â&#x20AC;&#x201C; Inpatient Care (CPES-IC) includes questions from the American Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. HCAHPS was chosen as the base survey as it is a rigorous tool widely used in the United States for over 10 years, already adopted in a few Canadian jurisdictions and will allow for international comparisons. The CPES-IC is administered post-discharge and touches on a number of patient experience themes, some of which include: â&#x20AC;˘ admission and discharge processes; â&#x20AC;˘ communication with nurses and doctors; â&#x20AC;˘ responsiveness of staff; and â&#x20AC;˘ coordination of care. CIHI built a survey collection database in spring 2014 to house patient experience survey data and as of spring 2015, the system is available to receive CPES-IC data

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About CIHI CIHI is an independent, not-forprofit organization that provides essential information on Canadaâ&#x20AC;&#x2122;s health system and the health of Canadians. CIHI is viewed as a leader in developing standards for data collection and reporting, and provides comparative reports and information to jurisdictions and federal organizations, such as Health Canada, to support policy and health system decisionmaking. With 30 data holdings, CIHI collects a wealth of clinical and administrative data from various clinical areas and sectors of care.

from participating jurisdictions. Together the CPES-IC and CPERS standardizes the collection of patient experience information, ensures the comparability of data from participating organizations and ensures the minimum necessary data elements required for comparative reporting and analysis.

Next Steps for PREMs at CIHI

Implementation of the CPES-IC has already begun in Alberta and Manitoba and CIHI is providing support to additional jurisdictions interested in adopting the CPES-IC. In the near future, CIHI will be providing measures/results back to participating jurisdictions. These reports along with nationally comparative PREMs information will further enrich existing health data to support improvements at the facility and system level. CIHI is working closely with jurisdictions across Canada to understand the need to measure patient experience across other sectors. For a copy of the public domain survey and for more information on the CPES-IC and CPERS, please visit www. cihi.ca/prems.

PROMs

In the past year, CIHI has also developed a new program of work focused on PROMs. Similar to PREMs, stakeholders have indicated a desire for CIHI to provide leadership and guide the development of a common approach to PROMs across Canada. Following an environmental scan of the Canadian and international PROMs landscape in 2014 which revealed variations in existing local and regional PROMs programs, CIHI hosted a pan-Canadian PROMs forum in February 2015 to discuss opportunities to develop a common approach to PROMs in Canada, including common tools and coordinated administration and reporting. Continued on page 20 www.hospitalnews.com

HOSPITAL NEWS SPECIAL SUPPLEMENT

MEDTECH Focus on MEDEC members making a difference in Canadian Healthcare

Canadaâ&#x20AC;&#x2122;s Medical Technology Companies

MEDEC 2015 — Focus on MEDEC Members Making a Difference in Canadian Healthcare

A letter from MEDEC President n behalf of our association, welcome to the second Hospital News MEDEC MedTech Insert. We’re pleased to once again have this opportunity to share news about exciting initiatives involving the medical technology industry that are improving patient care, increasing health system sustainability while highlighting examples of our valued partnerships with the health care community. While the health care system continues to face immense challenges such as a rapidly aging population and constrained resources, this has also led to an increased recognition that collectively we need to do things differently in order to meet these challenges and ensure the sustainability of our health care system. Within this context, we often hear the term health care innovation being referenced. While it can often mean different things to different people, I think it ultimately means something that’s better for patients and better for the health care system. Our industry strives to be a partner in the drive to bring about health care innovation within Canada’s health care system. Medical technology is not just innovative because new and exciting technologies are being developed every day, but because of the unique value offered by many of these technologies – enabling better care for patients, while improving sustainability of the system. While achieving adoption of new medical technologies into Canada’s health care system continues to be very challenging compared to other countries, we believe that medical technology’s value in Canada is increasingly being recognized and governments/health care providers are interested in seeking solutions. Within this context on innovation, a number of important advancements have taken place as of late. Examples include: • Ontario Government implementing all Ontario Health Innovation Council (OHIC) Recommendations – In the province’s spring budget it was announced that the Wynne government would be adopting the transformative recommendations put forth by the Ontario Health Innovation Council (OHIC). While some progress has so far been made towards implementation, the recent appointment of William Charnetski as the province’s first-ever Chief Health Innovation Strategist is a catalyst to make the Council’s full recommendations a reality. The recommendations seek to make Ontario a leading centre not only for new and innovative health technology, but also for bringing that technology to market both in Ontario and around the world. • Advisory Panel on Healthcare Innovation released its report to the government – This federally appointed panel chaired by Dr. David Naylor presented wide ranging recommendations to the previous government this past July in their 164-page report. While the report tackled a variety of aspects of healthcare in Canada, there were many recommendations put forth by the panel that, if implemented, would improve the environment for the adoption of medical technologies in Canada. Examples include making changes to Canada’s regulatory requirements and implementing measures to integrate ser-

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HOSPITAL NEWS FEBRUARY 2015

vices and create shared budgets in healthcare, which the panel suggests may address some of the frustrations of innovators and industry stakeholders seeking greater clarity about purchasing decisions. • Alberta Strategic Clinical Networks (SCNs) as Pathway for Innovations – The SCNs were established to be the engines of innovation in Alberta’s health care system and they offer a unique environment where networks of health care professionals and researchers that are passionate about specific areas of health are driving innovations within their specialty areas. MEDEC has been collaborating closely with the SCNs to establish them as potential pathways for innovative technologies to make their way to patients. Please see page M7 in this insert for more details about this collaboration. These are just a few examples of the increasing recognition of the opportunities presented by medical technology and the willingness from a diverse array of health care partners that are seeking to collaborate for the benefit of patients and the system. As the health system adapts to better serve patient needs, MEDEC is constantly seeking to ensure that our association and industry is being responsive to the needs of the system as well.

Medical technology is not just innovative because new and exciting technologies are being developed every day, but because of the unique value offered by many of these technologies – enabling better care for patients, while improving sustainability of the system.

One example of adapting to meet health system needs is through MEDEC’s recent establishment of a Hospital to Home committee in order for us to constructively build relationships and collaborate within this increasingly important segment of healthcare. Opportunities for transformation within this area of healthcare are abundant, given the almost universal move towards this type of care, in conjunction with the fact that advanced new technologies are being introduced every day that contribute to patients being able receive care in their own their own homes or in a community setting. We greatly value our many partnerships with our health system partners and we look forward to continue and build upon these relationships in order to improve patient care, as well as the health H care system. ■ Brian Lewis is President and CEO of MEDEC. www.hospitalnews.com

Focus on MEDEC Members Making a Difference in Canadian Healthcare â&#x20AC;&#x201D; MEDEC 2015

INNOVATING )25 PATIENTS AND PROVIDERS 7RJHWKHU ZH ZLOO FROODERUDWH ZLWK KHDOWK V\VWHPV DQG SURYLGHUV WR KHOS LPSURYH KHDOWKFDUHuWR JHW WKH ULJKW WUHDWPHQW WR WKH ULJKW SDWLHQW DW WKH ULJKW WLPH LQ &DQDGD DQG DURXQG WKH ZRUOG /HDUQ PRUH DW PHGWURQLF FD

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FEBRUARY 2015 HOSPITAL NEWS

MEDEC 2015 — Focus on MEDEC Members Making a Difference in Canadian Healthcare

Alberta sets the stage for innovation n 2012, Alberta Health Services launched Strategic Clinical Networks (SCNs) to be “the engines of innovation in the province’s health care system”. The SCNs consist of networks of health care professionals and researchers that are passionate about specific areas of health and are driving innovations within their specialty area – aiming to deliver better care and better value for every Albertan. Last June, the SCNs and MEDEC hosted an introduction day. The plan was to establish an actionable framework for a needs based approach to the adoption of innovative medical technologies. It brought together a diverse group of stakeholders, including Alberta Health Services (AHS), Alberta Innovation and Advanced Education, the Institute of Health Economics, TEC Edmonton Health Accelerator, and BioAlberta. “We wanted broad representation at the table, because Alberta is on the cusp of developing a new market dynamic,” says Robert Rauscher, VP Western Canada for MEDEC. “We got an agreement among key players for a framework on how to move this forward.” The stakeholders’ integral role resulted in 13 key recommendations structured around five themes. Six months later, the findings are beginning to bear fruit, with the SCNs focusing on what’s actionable, and leading from there. “We are targeting three main areas, initially, for proof of concept,” says Dr. Blair O’Neill, medical lead for the SCNs. “In order to focus our efforts and in response

to where industry feels there may be early synergies, a few SCNs were suggested to lead. First, the Cardiovascular Health and Stroke Network will bring a focus on arrhythmia management devices. On the stroke side, it will explore unmet needs around improving therapies for endovascular intervention. For instance, we need improved embolic protection devices for carotid stents, and better technologies for

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acute stroke intervention, including better imaging, brain protection-cooling devices, and pharmacology. This way we can increase the window where patients can benefit from interventions that will reduce the damage caused by stroke.” Dr. O’Neill says that the second and third pilot SCNs, Surgery and Critical Care, will be asked to develop a list of gaps or unmet needs in patient care that could be addressed by innovation. “Within Critical Care, we know remote monitoring technologies can help expand expertise in rural Alberta,” he says. “It can predict patients who are deteriorating earlier to help achieve better outcomes.” This is how innovation occurs – by listening to the real requirements of the experts in the field. In Albert’s case, momentum is being built from the June findings, leveraging the province’s unique levers. “MEDEC asked us to come up with the ideas,” says Dr. O’Neill. “By presenting them to industry, we can find something that’s already been worked on, or that industry can examine because there’s a business case.” And in Alberta, by having everyone on the same page, and working on a consensus basis, device manufacturers assure their market relevance. That means listening to who’s buying. “An example is Glenrose Rehabilitation Hospital in Edmonton, which has a fairly sophisticated reverse trade show,” says Dr. O’Neill. “They present to the medical device industry, along with venture capitalists and other partners listening. The best ideas are developed.” The ongoing process is iterative. The SCNs will learn from round one, and apply that knowledge to round two. With proven solutions brought to the table, and the right buy-in, innovation becomes more than an abstract idea. “We are rolling out something that’s practical,” says Rauscher from MEDEC. “It’s a good approach for developing a mechanism that allows adoption of new innovation, placing it within an applied research context.” One of the mandates of Alberta’s SCNs is that they must introduce innovative new technologies to improve healthcare. They are also acutely aware of funding

constraints, and the challenges related to mothballing older technologies. This is critical given the gaps in the system. In a zero sum game, older low value technologies must be retired to make room for newer, higher value technologies. It is why the approach taken by MEDEC and the other stakeholders in Alberta is so necessary. Decisions are made with input from those who know the medicine, the patient requirements and, yes, the costs – particularly when addressing inefficiencies.

This is how innovation occurs – by listening to the real requirements of the experts in the field Alberta’s SCNs also have access to experts at the University of Calgary and the University of Alberta. It can often take more evidence to decommission something than to bring in a new technology, and the link to academia builds a longterm knowledge base. “After the first three networks, we’ll have learned something,” says Dr. O’Neill. “Then we’ll go to round two and pick several more SCNs.” As it stands, of the thousands of medical devices brought into play each year, a relatively small percentage are truly disruptive. Those that are can improve outcomes, but can also create discord. All of this is happening within the context of a cost-constrained system. “We are doing this in a zero sum game,” says Dr. O’Neill. “We have to look at we have been doing, and eliminate those things that haven’t been delivering a lot of value to patients.” The good news, of course, is that Alberta’s SCNs have stakeholders across the board. That puts them in an excellent position to make the right decisions, to be a leader in healthcare transformation for years to come, and in the continued pursuit of quality patient care better achieved through the adoption of relevant medical H technologies. ■ www.hospitalnews.com

MEDEC

Focus on MEDEC members making a difference in Canadian Healthcare

Focus on MEDEC Members Making a Difference in Canadian Healthcare â&#x20AC;&#x201D; MEDEC 2015

Discover IntelliSpace Cardiovascular http://www.2.forms.healthcare.philips.com/CA_intellispacecardiovascular www.hospitalnews.com

FEBRUARY 2015 HOSPITAL NEWS

MEDEC

Focus on MEDEC members making a difference in Canadian Healthcare

MEDEC 2015 â&#x20AC;&#x201D; Focus on MEDEC Members Making a Difference in Canadian Healthcare ADVERTORIAL

Alternatives to the Acute Care Hospital Sector for Womenâ&#x20AC;&#x2122;s Health Interventions The Importance of Ambulatory Gynaecological Clinics

Ambulatory Gynaecological Clinics

It is clear that many gynaecological procedures that are currently performed in the operating room are well-suited to be performed in an ambulatory clinic setting. Indeed, among the many advantages of an ambulatory setting are decreased anaesthetic risks, speedier patient recovery, improved postoperative pain control and reduced costs. The tremendous interest â&#x20AC;&#x201C; both globally and in Canada â&#x20AC;&#x201C; to develop and establish ambulatory gynaecologic clinics bodes well for womenâ&#x20AC;&#x2122;s health.

Abnormal Uterine Bleeding and Endometrial Ablation

Abnormal uterine bleeding is a common problem in women: 41,000 hysterectomies are performed in Canada each year, 25% of which are for the diagnosis of abnormal uterine bleeding. However, there are a number of less invasive interventions for abnormal uterine bleeding, including ablation. When these interventions are utilized, recovery time is briefer and women return to their activities of daily living more TXLFNO\ DV ZHOO D VLJQLÂż FDQW UHGXFWLRQ LQ K\VWHUHF tomy rates (up to 40%) may result.1 Global endometrial ablation is a surgical procedure that was developed to lighten or discontinue menstrual periods; it offers a speedier, safer and simpler alternative to hysterectomy. Endometrial ablation is performed vaginally, frequently with only local anaesthesia and with no external excisions.

Key Data: Endometrial Ablation

The NovaSureÂŽ endometrial ablation procedure is safe and comfortable in either the operating room or clinic setting. Indeed, NovaSureÂŽ is a proven technology, with >2.5 million procedures performed to date. The NovaSureÂŽ system uses radiofrequency energy to destroy or ablate the endometrium of the uterus; ablation takes only 90â&#x20AC;&#x201C;120 seconds to complete, and is well-tolerated in the ambulatory setting.2 At the Regina General Hospital Womenâ&#x20AC;&#x2122;s Health Centre, at 6- and 9-month follow-up, >90% of women reported that they are pleased with the outcome, and fully twothirds report that they are no longer menstruating.

'U $GROI *DOOLQDW DVVHVVHG WKH VDIHW\ HIÂż FDF\ DQG durability of the NovaSureÂŽ endometrial ablation system 5 years after the procedure had been performed in women with severe menorrhagia secondary to dysfunctional uterine bleeding.3 In this study of 107 patients, no intra- or postoperative complications were observed. At 5-year follow-up, amenorrhea was reported and successful reduction of bleeding was achieved in 75% and 98% of patients, respectively. The author concluded that the NovaSureÂŽ system is safe and effective in women with severe menorrhagia and dysfunctional uterine bleeding.

Key Recommendations: Endometrial Ablation and Ambulatory Gynaecology Clinics

The provision of outpatient gynaecological procedures has been proposed for many years. In 2002, the Ontario Womenâ&#x20AC;&#x2122;s Health Council recommended the development of ambulatory sites around the province for investigation and management of abnormal uterine bleeding.4 The Councilâ&#x20AC;&#x2122;s task force recommended that minimally invasive surgical options (e.g. endometrial ablation) were an important, but underutilized, therapy for abnormal uterine bleeding in Ontario. In 2006, the Ontario Endometrial Ablation Guideline ([SHUW 3DQHO UHFRPPHQGHG WKDW VSHFLÂż F DPEXODWRU\ sites for the investigation and treatment of dysfunctional uterine bleeding be developed, utilizing the protocol of endometrial ablation.5 In 2013, the Society of Obstetricians and Gynaecologists of Canada published guidelines entitled Abnormal Bleeding in Pre-Menopausal Women.6 A key recommendation is as follows: â&#x20AC;&#x153;Non-hysteroscopic ablation techniques offer similar patient satisfaction results, with fewer risks of complications and less anaesthetic requirement than traditional hysteroscopic ablation.â&#x20AC;? In 2015, the Society of Obstetricians and Gynaecologists of Canada published guidelines entitled Endometrial Ablation in the Management of Abnormal Uterine Bleeding.7 The guidelines included the following statement: â&#x20AC;&#x153;The use of local anaesthetic

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and blocks, oral analgesia, and conscious sedation allows for the provision of non-resectoscopic endometrial ablation in lower resource-intense environments, including regulated non-hospital settings.â&#x20AC;? The 2015 guidelines further noted, â&#x20AC;&#x153;Endometrial ablation performed in a hospital-based procedure room or a free-standing surgical centre, rather than an operating room, offers the advantages of a patient-centred environment, easier scheduling and reduced costs per case.â&#x20AC;?7

.H\ %HQHÂż WV Ambulatory Gynaecology Clinics

Table 1 RXWOLQHV WKH EHQHÂż WV RI DPEXODWRU\ J\QDHFR logical clinics for patients and the healthcare system. Figure 1 depicts the â&#x20AC;&#x153;iron triangleâ&#x20AC;? of healthcare.8 The principle behind the concept of the iron triangle is that there are 3 complementary healthcare issues: access, quality and cost containment. In a perfect world, all 3 can be achieved in balance without compromising any individual component. Ambulatory gynaecological clinics achieve this by delivering high-quality care and providing excellent access to much-needed services, at a reduced cost.

Summary

Moving gynaecological procedures to an accredited ambulatory clinic is safe and cost-effective, and provides optimal clinical outcomes. Furthermore, ambulatory clinics provide a quality work environment for all employees (i.e. doctors, nurses and allied staff). This type of clinic also augments work volume without affecting patient safety, while reducing the role of hysterectomy in the management of abnormal uterine bleeding. Ambulatory care clinicians have been compelled to develop opportunities to improve operational performances and cost, while enhancing the quality of care delivered to patients. Much is expected of these healthcare professionals, and they deliver! For further information, please email info-canada@ hologic.com. ÂŠHologic Canada Ltd., 2015

Figure 1. The iron triangle of healthcare

Improved access to care

Efficiency/Cost containment

Relaxed and patient-centred approach to surgical and postoperative care Less invasive procedures Faster recovery and return to normal function +HDOWKFDUH V\VWHP EHQHÂż WV

Delivery of excellent service Reduction in procedure wait time (IÂż FLHQF\ DQG FRVW HIIHFWLYHQHVV High-quality specialized care

High-quality care

Patient access

References: 1. Fergusson RJ, et al. Cochrane Database Syst Rev. 2013;11:CD000329. 2. Hologic website. NovaSureÂŽ Endometrial Ablation. Available at: http://www.hologic.com. 3. Gallinat A. J Reprod Med. 2007;52:467â&#x20AC;&#x201C;472. 4. Stewart D, et al. Toronto, ON: Ontario Womenâ&#x20AC;&#x2122;s Health Council; 2002. 5. Health Quality Ontario. Ont Health Technol Assess Ser. 2004;4:1â&#x20AC;&#x201C;89. 6. Singh S, et al. J Obstet Gynaecol Can. 2013;35:473â&#x20AC;&#x201C;479. 7. Laberge P, et al. J Obstet Gynaecol Can. 2015;37:362â&#x20AC;&#x201C;376. 8. Kissick W. Medicineâ&#x20AC;&#x2122;s Dilemmas. New Haven, CT: Yale University Press; 1994.

HOSPITAL NEWS FEBRUARY 2015

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MEDEC

Focus on MEDEC members making a difference in Canadian Healthcare

Focus on MEDEC Members Making a Difference in Canadian Healthcare — MEDEC 2015

MEDEC Code of Conduct: Demonstrating Commitment to Ethical Business Practices The MEDEC Code of Conduct, which has recently been updated for 2015, is a valuable tool for supporting ethical business practices and socially responsible industry conduct, in light of the important relationship between member companies and health care professionals in meeting the healthcare needs of patients. “We know that our members are committed to conducting their businesses in alignment with accepted ethical practices, and the Code formalizes these practices by providing MEDEC Code of Conduct Certification” says Brian Lewis, MEDEC President and CEO. “Additionally, Code certification recognizes the increased expectation we are seeing for life science vendors, such as our members, to be aligned with a code of ethical practices.” Stephan Ekmekjian, Chair of MEDEC’s Code of Conduct Committee and Health Care Compliance Officer with Johnson & Johnson Canada, recently attended the APEC Business Ethics for SMEs Forum in Manilla. Mr. Ekmekjian was a facilitator and moderator at the event and he has been invited to join the long-standing APEC mentor group as MEDEC representative.

Best practices in interactions with health care providers R epresentatives of medical device companies are often required to enter hospitals and other health care facilities for many different reasons, including: training health care professionals on the safe and effective use of devices, demonstrating new and advanced technologies that can improve patient outcomes and increase system sustainability, or servicing vitally important medical equipment like an MRI. The members of MEDEC operate in the Canadian health care system in partnership with the medical community based on the strong foundation of the industry’s (MEDEC’s) Code of Conduct and are deeply committed to patient safety. MEDEC understands the desire by some health care institutions to implement credentialing requirements in order to coordinate admission to certain areas of their facilities by suppliers and external contractors. In Canada, the process of collecting and storing data for any credentialing system is influenced by a number of laws in the areas of privacy and human rights. These legal considerations, as well as the awareness of issues involving the vendor credentialing experience in the U.S., led to the effort to establish a vendor credentialing standard in Canada.

The situation in the US

The vendor credentialing cost implications on the U.S. health care system have been staggering – primarily due to the inconsistency in credentialing requirements across health care facilities. Vendor credentialing has added nearly $1 billion in costs to the health care system in the U.S. and many companies have had to hire internal staff in order to track and manage all of the differing training, background checks and health and safety requirements in order to become credentialed. www.hospitalnews.com

MEDEC understands the desire by some health care institutions to implement credentialing requirements in order to coordinate admission to certain areas of their facilities by suppliers and external contractors

Additional challenges are created by the various differences in timelines required for each of the credentialing requirements (some ask for annual updates, others biannual etc.). This lack of consistency has burdened the U.S. healthcare system with considerable and avoidable costs and caused significant confusion that has led to a loss of focus towards everyone’s shared objective of ensuring that patients receive the best possible care.

The HSCN national standard for vendor credentialing

With a keen understanding of the challenges faced in the US and with Canadian privacy and human rights laws in mind, in 2012 the Healthcare Supply Chain Network (HSCN), a Canadian association comprised of health care provider and supplier professionals (hospital representatives, shared services and group purchasing organizations and industry representatives), developed a Canadian National Standard for Vendor Credentialing. MEDEC has fully endorsed the HSCN National Standard for Vendor Credentialing in Canada. It’s an efficient, effective, and reasonable solution that allows for health care providers who have adopted the standard to log onto a

password protected website in order to view attestations by vendor companies who have completed the requirements of the Standard, which include elements that deal with a variety of things such as immunizations and training.

The HSCN national standard:

• Creates consistency • Avoids the excessive and unnecessary duplication and resulting costs experienced in the U.S. • Addresses Canadian legal issues that form barriers for vendors to meet their credentialing requirements • Is adaptable – by virtue of HSCN’s position and its membership from the provincial and territorial health care provider community and vendors, it is a perfect forum for the evolution of the standard if laws and practices changeover time The HSCN Standard has also been implemented by Health Shared Service British Columbia (HSSBC), which covers all health care providers in the province and it’s been recently been recognized by Québec’s Ministry of Health and Social Services as the acceptable standard for Québec health care facilities to rely upon if credentialing is deemed necessary (as of January 1st, 2016). The Standard provides consistency and ensures that the privacy and human rights of supplier representatives are respected, while allowing Canadian health care organizations to achieve their credentialing objectives without overburdening the system with unnecessary costs. It is for these reasons that MEDEC fully endorses the HSCN National Standard for Vendor Credentialing. For more information about the HSCN National Standard for Vendor Credentialing, please visit: http://www. H hscn.org/national-standard.aspx ■

Changes in 2015 Code MEDEC’s restated code expands into important new areas, including the following. • On-site Product Demonstrations and the need for documentation between the health care organization and company to outline the purpose, duration, equipment and scope of the demonstration. • Site Visits which are necessary to evaluate products. Whenever possible, site visits should occur in Canada. Companies should fund expenses only for attendees with a bona fide professional interest in the equipment. • Third Party Intermediaries (TPIs). Reminder that each company is responsible to train TPIs on various foreign and local anti-bribery and health care compliance policies, including training on the company’s own internal compliance program. • Greater Clarity and Addition of Glossary – The MEDEC Code of Conduct Committee amended sections of the document to provide greater clarity and added a glossary so that there is common understanding of the terms being referenced. These code updates were made to reflect the changing expectations within business and health care environments. The principles of the code, which is a “living” document, are regularly updated. Originally developed by MEDEC member companies in 2005, it was updated in December 2009, September 2012 and April 2015 by the MEDEC Code of Conduct Committee. “There is growing recognition about the need for codes of ethics around the world,” says Stephan Ekmekjian, Chair, MEDEC Code of Conduct Committee, who recently represented the association at the AsiaPacific Economic Cooperation (APEC) Business Ethics for SMEs Forum. “In the APEC region, for example, the number of such codes has soared from 33 in 2012 to 65, representing 19,000 firms, including 13,000 small and medium-sized enterprises, in the medical device and biopharmaceutical sectors. I take pride in MEDEC leading the way in Canada with our code to safeguard our members’ business relationships with health care professionals, affirm legitimate business practices and, ultimately, enhance patient care.” FEBRUARY 2015 HOSPITAL NEWS

MEDEC

Focus on MEDEC members making a difference in Canadian Healthcare

MEDEC 2015 â&#x20AC;&#x201D; Focus on MEDEC Members Making a Difference in Canadian Healthcare

Streamlining research ethics review for clinical trials in Ontario E

arlier this year, Clinical Trials Ontario (CTO) rolled out the CTO Streamlined Research Ethics Review System, a highlyefficient approach to research ethics review that reduces the time and effort involved in launching multi-centre clinical trials. The new CTO Streamlined System allows any single CTO Qualified research ethics board (REB) in Ontario to provide ethics review and oversight for multiple research sites participating in the same clinical trial. This means, for example, that a trial with 10 participating sites no longer has to go through 10 separate REB reviews for the same study protocol. The first industry-sponsored global multi-centre clinical trial to use the CTO Streamlined System received provincewide ethics approval of the study protocol in Ontario in just two months from the time of submission.

The CTO Streamlined System by the Numbers

Since its launch, there has been significant uptake by the clinical research community as sites and sponsors come on board to use the CTO Streamlined System. â&#x20AC;˘ 18 studies â&#x20AC;&#x201C; eight of which are industry-funded â&#x20AC;&#x201C; are already using CTO Stream, the web-based platform for coordinating research ethics reviews

More than 3,200 clinical trials are underway in Ontario at any given time. that features document management and communication between multiple institutions and REBs. â&#x20AC;˘ 11 REBs are CTO QualiďŹ ed. These REBs have undergone an external review

TOSHIBA celebrates its 100th anniversary in the healthcare business. Throughout our 100-year history in the medical device business, Toshiba has responded to our customersâ&#x20AC;&#x2122; needs by providing a wide range of high-value solutions. These efforts have made us the top company in our business segment in Japan and have given us an expanding global presence in over 135 countries around the globe. 'HOLYHULQJ PDQ\ -DSDQÂˇV DQG ZRUOGÂˇV Ă&#x20AC; UVWV ZH KDYH DOZD\V EHHQ FRPPLWWHG WR GHYHORSLQJ VROXWLRQV WKDW KHOS LPSURYH FOLQLFDO ZRUNĂ RZ DQG DGYDQFH patient outcomes and patientsâ&#x20AC;&#x2122; quality of life. From corporate programs to the wide range of product features that protect patients and healthcare providers, we have made safety a top priority in everything we do. While always strictly adhering to our companyâ&#x20AC;&#x2122;s well-known tradition of excellence and quality, we will continue to respond to changes in the industry and the needs of our customers, and pursue our mutual goal of improving healthcare delivery. Our products and our company will remain dedicated to our â&#x20AC;&#x153;Made for Lifeâ&#x201E;˘â&#x20AC;? philosophy.

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of policies and procedures and meet a high quality and transparent standard for governance, membership, operations and procedures. They can provide ethical review and oversight of multi-centre clinical research on behalf of participating research sites across Ontario. â&#x20AC;˘ 44 research sites have already signed on to participate in the CTO Streamlined System. What used to take months can now take days. Instead of each research site submitting a full research ethics review application to their local REB a process that can take up to six months, a participating site can join an approved protocol in just days. With a user-friendly interface and common REB application forms, the CTO Streamlined System harmonizes processes and reduces the time and administrative burden involved in multi-centre clinical trials in Ontario. â&#x20AC;&#x153;The new CTO Streamlined System significantly enhances the clinical trials environment in Ontario, while supporting the highest ethical and quality standards,â&#x20AC;? says Susan Marlin, President and CEO of CTO. â&#x20AC;&#x153;Stakeholders are recognizing the importance of this new approach, which was conceived, designed and built by the clinical trials and research ethics communities in Ontario.â&#x20AC;? In June 2015, the CTO Streamlined System was highlighted in Ontarioâ&#x20AC;&#x2122;s 2015 Burden Reduction Report as one of 28 initiatives across government that are â&#x20AC;&#x153;modernizing services and making it easier for businesses to succeed.â&#x20AC;? Building on the success of the CTO Streamlined System, CTO is working on other streamlining measures, such as processes to support efficient contract review for multi-centre clinical research. CTO is also committed to increasing public and participant engagement in clinical trials and promoting Ontarioâ&#x20AC;&#x2122;s clinical trials strengths. A stakeholder-led organization established with support from the Government of Ontario, CTOâ&#x20AC;&#x2122;s vision is to make On-

Photo by Mark Ridout, courtesy of Clinical Trials Ontario.

Benefits of the CTO Streamlined Research Ethics Review System â&#x20AC;˘ Reduces the costs and improves the speed of conducting multi-centre clinical trials in Ontario. â&#x20AC;˘ Enhances efficiency while supporting high-quality ethical reviews. â&#x20AC;˘ Leverages the excellent research ethics review and administration capacity across Ontarioâ&#x20AC;&#x2122;s institutions. â&#x20AC;˘ Eases the overall burden on investigators and saves time by moving to a single ethics review, instead of multiple ethics reviews for the same clinical research. â&#x20AC;˘ Provides a supportive and complementary approach to conducting multi-site studies, both investigator-initiated and industrysponsored. â&#x20AC;˘ Enables special expertise built up by individual REBs to be accessed more readily. tario a preferred location for global clinical trials, while maintaining the highest ethical standards for participant protection. To learn more, visit www.ctontario.ca

Attend a Free CTO Informational Webinar

Researchers, REB staff, REB operations personnel, industry sponsors and institution representatives are invited to join the more than 400 people who have attended CTOâ&#x20AC;&#x2122;s informational webinars to learn how they can take advantage of the CTO Streamlined System. Webinars are free to attend and are currently ongoing. Register for free at www. ctontario.ca/webinars. Please contact CTO at streamline@ ctontario.ca for more information about the CTO Streamlined Research Ethics Review System or to request a live demo of H CTO Stream. â&#x2013; www.hospitalnews.com

Focus on MEDEC Members Making a Difference in Canadian Healthcare — MEDEC 2015

Paving the way for improvements to Ontario’s MedTech environment O

n Sept. 10, Ontario’s Ministry of Health and Long-Term Care announced that the Wynne government had appointed William Charnetski as the province’s firstever Chief Health Innovation Strategist. While Mr. Charnetski’s responsibilities in this role will be wide-ranging, he will ultimately ‘champion Ontario’s health technology innovation sector’.

Mr. Charnetski’s appointment paves the way for the remaining OHIC recommendations to be implemented The creation of an Office of the Chief Health Innovation Strategist was a recommendation of the Ontario Health Innovation Council (OHIC), whose report was presented to the Ontario government in December 2014 and received full validation through the government’s commitment in their 2015 Budget to implement all of six of the report’s recommendations. MEDEC strongly believes that the recommendations provided in the OHIC report have the potential to positively transform the way in which the medtech industry operates in Ontario and Mr. Charnetski’s appointment paves the way for the remaining OHIC recommendations to be implemented.

The remaining six recommendations in the report are: • Establishing a new $20-million Health Technology Innovation Evaluation Fund to support made-in-Ontario technologies • Using newly created Innovation Broker positions to connect innovators and researchers with opportunities in the health care system

• Streamlining the adoption of health care innovations across the health system • Shifting to procurement practices that focus on outcomes, such as fewer hospital readmissions and the long-term value of medical devices • Investing in the assessment of emerging innovative health technologies to get those products to market faster

Mr. Charnetski takes on this role having worked as a senior executive in the private sector for a number of years. Prior to that, he practiced law and held roles working in government. MEDEC congratulates Mr. Charnetski for being chosen in this distinguished role and we look forward to fostering a highly collaborative relationship with him and his H office going forward. ■

We aim to maximize the quality, safety, and efﬁciency of medical care, supporting clinical practice with reliable quality products and innovative, cutting-edge technologies. Toshiba: A Focused Perspective in Diagnostic Imaging www.toshiba-medical.ca U LT R A S O U N D

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MRI

X - R AY

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FEBRUARY 2015 HOSPITAL NEWS

M10 MEDEC 2015 — Focus on MEDEC Members Making a Difference in Canadian Healthcare

Product data synchronization

Improving health system sustainability and increasing patient safety round the world, the medical device industry and many leading health care providers have chosen the Global Data Synchronization Network (GDSN) and its GDSN-certified data pools as the systems of choice for the secure, accurate global electronic communication of supply chain data. These suppliers and providers recognize the benefits of the efficiencies and enhanced patient safety offered by the GDSN-certified system, and are committed to its implementation. The GDSN is built around the GS1 System of Standards including the GS1 Global Registry, GDSN certified Data Pools, the GS1 Data Quality Framework and GS1 Global Product Classification, which, when combined, provide a powerful environment for secure and continuous synchronization of accurate data . The objective of the GDSN is to provide an assured, secure, seamless, point-to-point information exchange between manufacturer, distributor and health care provider. The GS1 Global System of Standards ensures a single solution that provides the highest level of accuracy and data integrity for the global health care world. Ongoing collaboration between providers and suppliers has resulted in significant development of the GDSN system to optimally meet health care provider requirements. As an example, a collaborative of five of the largest health care providers in the U.S. called the Healthcare Transformation Group have made tremendous progress by working hand-in-hand with the medical device industry to implement GS1 standards through GDSN-certified data pools. In addition, on the global stage this collaboration toward the ongoing development and uptake of the GDSN is exemplified through the GS1 Healthcare Global GDSN Implementation Work Group. This group, which consists of GDSN-

certified data pool operators, medical device company logistics professionals and others, was assembled in order to discuss and determine such things as the required product attributes for medical devices in order to meet global and country-specific requirements. While there is industry-wide recognition for the benefits that health care data standards can provide both clinically and operationally, data standards utilization is still very low in Canadian healthcare at this point in time. However, implementation plans are now beginning to take shape in some provinces. For example, the province of Quebec has indicated that they are moving towards the adoption of the GDSN for medical device product data. Another example is an exciting new initiative taking place in Alberta known as the Canadian Healthcare Medical Device Standards Project.

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The goal of the Canadian Healthcare Medical Device Standards Project is to showcase the value of GS1 standards implementation in terms of the patient quality and safety improvements and that can be gained by implementing product data standards through the GDSN and enhanced health system efficiencies derived from data synchronization and ecommerce transactions. At the conclusion of the project, the participants will deliver a simplified, sustainable and global model for standards implementation that others in the industry can utilize. This project’s participants are Alberta Health Services, Baxter Corporation, Cardinal Health Canada, Canadian Hospital Specialties Ltd., Cook Medical Canada, Medtronic , Johnson & Johnson Medical Products Inc. and MEDEC. The project will be executed in two phases: • Data synchronization: Create a sustainable, efficient model for sharing product data via GDSN-certified data pools between participating supplier/distributor stakeholders and Alberta Health Services. • e-Commerce: Subsequently utilize GS1 data attributes in electronic data interchange (EDI) order transactions between participating supplier/distributor stakeholders and Alberta Health Services. “The ability for all stakeholders in the health care supply chain to utilize global data standards holds tremendous potential for improving the safety of our patients and the operational effectiveness of our industry,” says Jitendra Prasad, chief program officer, Contracting, Procurement and Supply Management, Alberta Health Services (AHS). “The only way we can develop a model for sharing and transacting data that benefits everyone is to work collaboratively together. At AHS, we are proud of the role we are playing to create such a model that others in the industry can learn and benefit from.” GHX, a software and services company and GDSN-certified data pool provider will manage the project amongst all the stakeholders, and document and publish the findings of the group’s success in a white paper that details the value derived from implementing GS1 standards from the perspective of provider, supplier and distributor organizations. The paper will be

GDSN usage by the numbers

965,351

Registered Medical Device GTINs (Global Trade Identification Numbers – unique products or services)

36,126

Registered data sources (suppliers) GDSN-certified Data Pools – There are three Canadian-based GDSN-certified data pool providers: Commport Communications, GHX Canada and GS1 Canada. Data recipients looking to utilize the GDSN can choose any data pool, with many based in countries all over the world. One of the benefits of the GDSN is that companies that operate globally only have to be a part one data pool in order to utilize the GDSN around the world. For a list data pools, visit: http:// www.gs1.org/docs/gdsn/gdsn_ certified_data_pools.pdf made available to the health care industry so that other providers and suppliers can replicate this model within their own trading partner relationships. “We have assembled a group of stakeholders in Canada who are serious about demonstrating the value of fully implementing GS1 standards and are willing to showcase this proof of concept in their own organizations to accelerate industrywide adoption,” says Nils Clausen, AVP Supplier Sales, GHX North America. “All parties are committed to working collaboratively together to achieve successful outcomes that will benefit not only their organizations but healthcare as a whole, including the patients they serve.” As supporters of GS1 Standards in healthcare implemented through the GDSN, MEDEC is pleased to be a supporting partner of this project and we are excited about the prospects of increasing adoption of the GDSN in healthcare H across Canada. ■ www.hospitalnews.com

Focus on MEDEC Members Making a Difference in Canadian Healthcare — MEDEC 2015 M11

Proven Results

Outstanding results from the market-leading global endometrial ablation system:

NovaSure Endometrial Ablation: a safe, comfortable procedure in the operating room or clinic setting ®

• Average 90-second treatment time • 73% of patients in the pivotal trial received IV or local sedation • 93% patient satisfaction in pivotal trial 1

• Post-procedural pain and cramping rates: – Over 97% of patients experienced no procedural pain at less than 24 hours to 2 weeks

avoidance of hysterectomy at 5 years 3

9 out of 10

patients return to normal levels of bleeding or lower

For more information, contact info-canada@hologic.com

REFERENCES: 1. Cooper J, Gimpelson R, Laberge P et al. A randomized, multicenter trial of safety and efﬁcacy of the Novasure System in the treatment of menorrhagia. J Am Assoc Gynecol Laparosc. 2002;9:418-428 2. NovaSure Instructions for Use 3. Gallinat A. An impedance-controlled system for endometrial ablation: Five-year follow up on 107 patients. J Reprod Med. 2007; 52:467-472 ©2015 Hologic, Inc. Printed in USA. Hologic, NovaSure and The Science of Sure are trademarks or registered trademarks of Hologic, Inc. and/or its subsidiaries in the United States and/or other countries. This information is intended for medical professionals in the U.S. and other markets and is not intended as a product solicitation or promotion where such activities are prohibited. Because Hologic materials are distributed through websites, eBroadcasts and tradeshows, it is not always possible to control where such materials appear. For speciﬁc information on what products are available for sale in a particular country, please contact your local Hologic representative or write to info-canada@hologic.com.

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FEBRUARY 2015 HOSPITAL NEWS

M12 MEDEC 2015 — Focus on MEDEC Members Making a Difference in Canadian Healthcare

SAVE THE DATE: MEDEC’s 2016 MedTech Conference April 26 and 27! The annual signature conference of MEDEC and the Canadian medtech industry will take place on April 26th and 27, 2016 at the Sheraton Toronto Airport Hotel & Conference Centre, 801 Dixon Road, Toronto. MEDEC’s MedTech Conference is Canada’s preeminent information exchange and educational forum for the medical technology industry – tackling issues such as innovation and change within the healthcare system. Attendees will hear from and engage with high-profile health system leaders and network with colleagues. Previous year’s conferences have hosted dignitaries such as Ministers of Health, Hospital CEOs and other influential thought leaders and this year is shaping up to be no different!

Registration information

coming soon

MARK YOUR CALENDAR and plan to join us for MEDEC’s not-to-be-missed annual conference!

Sign up for conference updates via email at dgates@medec.org with the subject line Medtech Conference. HOSPITAL NEWS FEBRUARY 2015

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TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE/HOSPITAL PERFORMANCE INDICATORS

Focus 19

The use of personal health information in clinical care:

Finding the right balance By Alice Melcov

n the clinical care setting, a patient’s personal health information (PHI) is a powerful catalyst for optimizing healthcare outcomes. When utilized appropriately, it can have a critical role to play in enhancing the quality of care that a patient receives. Recent regulatory and legislative developments have aimed to enhance protections around the collection, use and disclosure of PHI in the clinical context; however, these advancements have been centered on the concept of enhancing legislative compliance through disciplinary measures. Much of the focus of these developments has been on the punitive aims of the Personal Health Information Protection Act (PHIPA) – the primary piece of legislation governing PHI – and in particular, has sought to advance legislative compliance by emphasizing the legal consequences for breaching patient privacy. Undoubtedly, PHI is among the most sensitive types of information. Patients are entitled to expect that their confidential details will not be inadvertently or purposefully disclosed without proper authorization – and that those who do

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so will be disciplined and/or sanctioned appropriately. Yet, PHIPA, like many other pieces of legislation, has multiple purposes. Apart from its punitive rationale, focused on deterring unwanted conduct, the legislation

Patients are entitled to expect that their confidential details will not be inadvertently or purposefully disclosed without proper authorization – and that those who do so will be disciplined and/or sanctioned appropriately. also seeks to create a framework to facilitate the effective provision of healthcare. In this regard, it recognizes the importance of disclosure of PHI to clinical care, and aims to provide secure parameters within which PHI can be freely exchanged between patients and clinicians, and also within a patient’s circle of care.

This more positive aim of the legislation corresponds to how PHI is used to advance clinical care. A patient who knows that his or her PHI will remain confidential is more likely to be forthcoming about sensitive medical details. In turn, this may give clinicians a more complete medical history, allowing them to implement the most appropriate care plan. As part of the privacy compliance framework, PHIPA envisions clinicians (or health information custodians generally) to be key players in safeguarding PHI – knowing that they may rely on patient’s full and frank disclosure of PHI as an important tool in diagnosis and treatment advice. When considering the collection, use and disclosure of PHI in clinical care, a proper balance must be struck between the various purposes of PHIPA. Overemphasizing the punitive aims of the legislation risks creating a climate of fear around how to appropriately use and disclose PHI – particularly for clinicians. On the other hand, in focusing only on the importance of facilitating the flow of PHI, one may overlook the clinical and practical significance of the deterrent aims of the legislation. An ideal approach to the

conversation around privacy compliance is one where the negative consequences for breaching privacy are equally voiced and heard alongside more encouraging, positive-based rationales. In striking the right balance, it is also important to consider the broader institutional context. The use, disclosure and collection of PHI does not occur within an operational vacuum – paper charts, electronic information systems and institutional policies (as they relate to IT) are all vehicles that are used to enable (or sometimes prevent) access and disclosure of PHI. These operational aspects may come with their own limitations and resource challenges. Accounting for these operational factors is also a significant part of the privacy compliance picture, given the practical daily workflow implications. Additionally, in the compliance environment, the role of relevant stakeholders has to be considered. For example, the Ontario Information and Privacy Commissioner plays an important role in ensuring that individual health care providers and health care institutions are accountable for meeting legislative requirements. Continued on page 20

NOVEMBER 2015 HOSPITAL NEWS

20 Focus

TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE/HOSPITAL PERFORMANCE INDICATORS

Clients and families at the centre of care

By Jil Beardmore

ealth care organizations across Canada are putting an increasing emphasis on involving clients and families in health care. They’re doing this with individuals (i.e., involving clients and families more in care plans) and by consulting more broadly with clients and families when implementing new programs or policies. This increased participation has improved health care outcomes and client satisfaction, and has encouraged more organizations to focus on client- and family-centred care (CFCC) in Canada and internationally. At Accreditation Canada we are helping to lead this shift through our Qmentum accreditation program. We made significant revisions to Qmentum to strengthen its CFCC focus across the care continuum. The new requirements are expected to permeate an organization’s culture, promoting collaboration among clients, families, and providers in all aspects of all service design, delivery, and evaluation. Through collaboration with our CFCC pan-Canadian Advisory Committee (which had equal representation from patients, families, and service providers), the wording and requirements in the standards were modified to reflect a focus on CFCC, and will start being evaluated by Accreditation Canada surveyors during on-site surveys in January 2016.

Where to begin?

We created a webcast for our clients who need an introduction or a refresher around implementing CFCC throughout their organization. For many organizations, focusing on CFCC is par for the course, while for others, it is entirely new. No matter where they are in the process of implementing CFCC, the changes in our standards support health care and social services organizations in embedding this approach throughout their organization, from direct care providers through to governance and leadership. While these requirements represent a significant shift in philosophy and culture for some organizations, the need for this change was clear.

CFCC and Leading Practices

Also beginning in January 2016, CFCC will be strengthened in the Leading Practice submission process. There will be a stronger focus on how the patient is involved in Leading Practices and organizations will need to describe this aspect more fully. Examples of client and family involvement: • Clients and families participate as stakeholders from the onset of a Leading Practice to inform both the project and implementation process.

For example, organizations could seek CFCC input from advisory groups, focus groups, formal surveys, or informal day-today feedback. • Clients and families participate in evaluating the Leading Practice to inform future changes and improvements. • Through CFCC feedback, organizations use the experiences of clients and families as a basis to develop the Leading Practice. • Organizations use ideas brought forward by clients and families to improve care processes. To help you understand what a CFCCfocused Leading Practice looks like, we have included two excellent examples below: Leading Practice: Social media and the patient experience at Sunnybrook Sunnybrook Health Sciences Centre was an early adopter of social media, which it uses to engage patients and their families. It uses outlets like Facebook and Twitter to stay connected to patients, gather feedback, and respond to patients’ needs and inquiries. Social media channels help staff listen to and communicate with patients, and provide health tips and facts, including prevention information, surgery explanations, and afterillness care tips. With over 27,000 followers on Twitter and over 11,000 Facebook friends, Sunnybrook is now a public platform for questions and feedback throughout the continuum of care. Patients and families can easily engage with the hospital at any hour of any day and receive a swift response. Leading Practice: photoVOICE at the North Bay Regional Health Centre (NBRHC)

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The NBRHC uses a highly interactive program called photoVOICE to help its inpatients express themselves through photography. They participate in a program that concludes with a public exhibit that gives voice to their experiences. It’s a way to encourage inpatients to share their stories, and for the staff who work with them on a daily basis to get to know them better. Many of the inpatients struggle with illnesses like bipolar disorder, schizophrenia, depression, and Alzheimer’s disease and often have difficulty communicating. This program helps them find a way to share their stories, in part, so staff can better understand how to participate in their recovery. The program has been incredibly effective on both fronts, empowering inpatients and helping staff get to know them. Jil Beardmore is a writer/editor at Accreditation Canada.

Data pulse Continued from page 18

The CIHI PROMs Forum was attended by senior policy-makers from federal/ provincial/territorial governments, senior health system decision-makers, international guests as well as selected clinicians and senior researchers actively involved in using PROMs. A PROMs background document and the PROMs Forum summary are available at: www.cihi.ca/proms.

There has been an increased recognition of the importance of the patient’s perspective in supporting a patientcentered approach to providing quality healthcare. Building on the input obtained at the PROMs Forum, CIHI launched a panCanadian PROMs advisory committee to support collaboration and inform decisions on PROMs surveys and approaches for data collection and reporting. PROMs demonstration projects and working groups for two priority clinical areas (hip and knee arthroplasty and renal care) are now underway. CIHI will continue to engage in activities to support the availability of comparable PROMs data to Canadians. For more information on CIHI’s PROMs H program of work, visit www.cihi.ca/proms. ■ Kira Leeb is Director, Health System Performmance at The Canadian Institute for Health Information and Greg Webster is Director, Acute and Ambulatory Care Information, Canadian Institute for Health Information.

Finding the right balance Continued from page 19

It also has an educational mandate in creating awareness about rights and obligations under PHIPA. Provincial regulatory colleges that govern regulated health professionals also inform the compliance environment – through both disciplinary and educative authority. The functions performed by these external bodies also shape the overall context for privacy compliance. A robust dialogue about privacy compliance acknowledges that there are no easy solutions. The dynamics around the use of PHI in clinical care are complex – and finding the right balance between often competing considerations presents both clinical and operational challenges. Moreover, the privacy compliance framework is one that requires a nuanced approach – accounting for the interplay between enforcement and clinical care rationales. A thorough awareness of the various factors at work (and understanding that there is no one-size-fits-all approach for any particular setting) is arguably the best startH ing point to striking that balance. ■ Alice Melcov is a Legal and Policy Advisor with the Ontario Hospital Association. The views expressed in this article are solely those of the author, and do not represent the position or policies of the Ontario Hospital Association. www.hospitalnews.com

TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE/HOSPITAL PERFORMANCE INDICATORS

Focus 21

FAMILY PRESENCE

REDUCESAND GETS READMISSIONSKARL TO HIS

DAUGHTER’S GRADUATION.

Patients. Families. Healthcare Providers. Family presence improves patient experience and outcomes.

Take the pledge at

cfhi-fcass.ca/BetterTogether CFHI is a not-for-proﬁt organization funded by the Government of Canada.

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NOVEMBER 2015 HOSPITAL NEWS

22 Focus

TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE/HOSPITAL PERFORMANCE INDICATORS

Cover story

Where will the next generation of hospital CEOs come from? By Yvan Marston

ospital boards appoint leaders but it is the health care system that builds them. Some may bring experience from the broader public sector or academia, but an Ontario Hospital Association (OHA) survey conducted this spring found the average CEO had 28 years of health care experience – most of which came from working in Ontario. And given their ages, should these leaders choose to retire at 60, the system could lose almost half in the next three years. Succession planning and developing leaders has been on many hospital board agendas for some time and was identified as a key issue by the OHA five years ago. Since then, much work has been done to address the issue. But for a health system facing frozen budgets, resource shortages, and the first drop in this country’s registered nurses in almost 20 years, what is the current state of the talent development pipeline? The next system leaders may be poised to take on the rigours of transformation, but where will the following generation come from? “Three or four times a year I’ve had medical students approach me wanting to know how best to position themselves for leadership. And they hadn’t even graduated yet,” says Dr. Barry McLellan, CEO of Sunnybrook Health Sciences Centre. “I think it’s a very good sign.” McLellan, like many of his colleagues, is heartened by the optimism and ambition he is seeing in this young cohort of medical and other health care professionals. But system transformation will require more than optimism and ambition. To cultivate system leaders, some hospitals are engaging in important talent development work to identify and build leadership capacity within the system. In some ways, there is a sense of urgency behind this work because the system will see a demographic shift that threatens to deliver a double impact. Not only will healthcare see the same wave of retiring boomers that is threatening to disrupt other sectors, but the demand for health services is also set to rise as the population ages. Essentially, a large contingent of health care workers will leave their offices, operating rooms and patient bedsides, and become the clients. “I don’t have a sense that we’re ready for that demographic bulge or what’s going to happen on the consumer side with this aging cohort,” says Ray Racette, president and CEO of the Canadian College of Health Leaders, an organization focused nationally on identifying, developing and supporting leadership in healthcare. Despite the work he is seeing in health care leadership development and the relative stability he is seeing in Ontario hospital leadership, Racette says it’s important to pay attention to this shift. “It’s a time to be a little nervous,” he says. The growing complexity of the leadership role and an aging cohort has some ob-

HOSPITAL NEWS NOVEMBER 2015

Photo courtesy of MediaSource-Doug Nicholson.

Dr. McLellan, CEO, Sunnybrook Health Sciences Centre at one of the hospital’s leadership development sessions. servers also worrying about the short-term future of the system’s current leaders. As the retirement wave washes through industries and sectors, a significant exit of these leaders, specifically hospital CEOs, could cause further disruption for a system in the midst of transformation.

Large- and mediumsized hospitals are more likely to have a robust leadership development system at work, but all hospitals have the opportunity for staff to understand and even participate in the development of care in the community. The OHA’s current demographic figures on this province’s hospital CEOs say that half fall into the 52-to-59-year-old age bracket. And the rate of retirement is accelerating – from four per cent in 2012 to 11 per cent in 2014. Seeing more senior leaders considering retirement begs the question: Are there enough in-line who are ready to replace them? The most likely source of CEOs, it seems, is another hospital’s senior team. The OHA survey found that 60 per cent of the responding CEOs had been senior ex-

ecutives before taking on their role. But a look at the OHA’s 2014 HR Benchmarking survey found that the external job fill rate was significantly higher than the internal job fill rate when it came to CEO and senior hospital executive positions. In short, most CEOs appear to come from senior levels and from other hospitals. External candidates are more common for hospitals in large urban markets like Toronto, as was the case for Sarah Downey, President and CEO at Toronto East General Hospital. Downey took the reins of this community hospital in April of this year, having been an executive vice president at The Centre for Addiction and Mental Health (CAMH) and a vice president at the University Health Network before that. “I think there are a lot of highly qualified candidates out there who are ready to make that shift,” she says of the CEO candidate pool. When she was contacted in 2014 to gauge her interest in leading a hospital, there were eight CEO searches across Canada underway at the time. Barbara Nixon is not surprised by these numbers. A partner in the executive search firm Promeus, she says her team has worked on three CEO searches in the last 18 months, is currently working with Thunder Bay Regional Health Sciences Centre and Thunder Bay Regional Research Institute to find its new top executive, and is potentially involved in two other CEO searches. Nixon thinks health care organizations have more work to do to improve succession. “They are getting better at it, and

people are recognizing it’s important, but I would say that over the last decade it’s not something the health system has focused on,” she says, explaining that most recruiting firms encourage a search that includes internal candidates but that hospital boards tend to want an external search to ensure that there has been a competitive process. “We’re at an interesting juncture in terms of not only getting the right talent and the right skills but also making sure [senior managers] want the job,” says Nixon. While many senior leaders tend to come from other hospitals to take on a CEO role, boards are also careful to assess and develop internal talent. And if they want to maintain a current strategic direction, it can be even preferable. When Bluewater Health’s president and CEO Sue Denomy announced her plans to leave in 2015, an internal candidate was deemed important for continuity. Vice president of operations and chief operating officer Mike Lapaine was interviewed and selected by the board and will take on the CEO role in January of next year. “The decision to hire an internal candidate over an external one really depends on the situation of the organization at the time,” says Lapaine, citing the importance of a senior executive’s pre-existing relationships with external health care partners in the community as an important factor. Sue Denomy says this is one of the key traits for successful CEOs in the current health climate. Continued on page 23 www.hospitalnews.com

TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE/HOSPITAL PERFORMANCE INDICATORS

Focus 23

Hospital CEOs Continued from page 22

â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s not enough to go the traditional route of being an accountant to manager of a department, to director and VP. The skill set needed now is one that understands broad performance such as utilization rates and understanding the impact of the hospital within the community,â&#x20AC;? she says, adding that with system change, itâ&#x20AC;&#x2122;s important for CEOs to be able to understand what is best for the community rather than what is simply best for the hospital. This type of broader approach to leadership thinking is at the heart of most leadership training. Bluewaterâ&#x20AC;&#x2122;s own formalized leadership training is in its third year and it partnered with Lambton College to launch a Board of Governorâ&#x20AC;&#x2122;s certificate program for leaders. But future leadership, Denomy offers, should also be understood in the hiring processes at levels below senior executives. â&#x20AC;&#x153;You should be recruiting with the notion that you want to keep them and advance them. Rather than hiring for a single position, consider whatâ&#x20AC;&#x2122;s ahead and what opportunities they could grow into,â&#x20AC;? she says. Large-and-medium-sized hospitals are more likely to have a robust leadership development system at work, but all hospitals have the opportunity for staff to understand and even participate in the development of care in the community. Sunnybrookâ&#x20AC;&#x2122;s senior team is part of a number of processes outside the hospital, from Health Links to LHINs to ministry of health projects; it works to find new ways to provide care outside the hospital, explains CEO, Dr. Barry McLellan.

To cultivate system leaders, some hospitals are engaging in important talent development work to identify and build leadership capacity within the system. He sees the next generation of senior leaders not only as assets to the hospital, but as stewards of the health system itself. â&#x20AC;&#x153;They need to be system leaders and spend more time on issues like how best to provide primary care, and how community care can, frankly, prevent people from coming to hospitals and help them to get out of hospitals sooner,â&#x20AC;? he says. Itâ&#x20AC;&#x2122;s a team-based approach but where the team is beyond the hospital walls so that the skill is not only in partnering, but also in having a lens on the needs of the patients and how a system can deliver that, he explains. While healthcare has some learning to do in the area of leadership development, Sunnybrook stands among those taking matters into its own hands. The hospitalâ&#x20AC;&#x2122;s Leadership Development Institute works with U of Tâ&#x20AC;&#x2122;s Rotman School www.hospitalnews.com

Bluewater Health CEO Sue Denomy at an onsite Knowledge Exchange. of Management and York Universityâ&#x20AC;&#x2122;s Schulich School to deliver leadership programming for middle and senior managers, and initiatives such as its strategic workforce planning retreat, tackles succession planning and allows managers to discuss emerging leaders and their development. Itâ&#x20AC;&#x2122;s an environment where leadership is seen as a shared resource. â&#x20AC;&#x153;Weâ&#x20AC;&#x2122;re growing talent and we have leaders growing within the organization, but if individuals benefit from our leadership training and go off to work for another hospital in a more senior leadership position, thatâ&#x20AC;&#x2122;s great for the system,â&#x20AC;? says McLellan. Southlake Regional Health Centreâ&#x20AC;&#x2122;s president and CEO Dr. Dave Williams holds a similar perspective on the importance of taking a broader view on building leadership capacity because, as he puts it, the big changes in healthcare are going to occur at a system level. â&#x20AC;&#x153;We can support emerging leaders by decreasing the competitive aspect and placing a greater importance on collaboration,â&#x20AC;? he says. Southlake is one of the six GTA and York Region hospitals that make up The Joint Centres for Transformative Healthcare Innovation, which served to formalize the knowledge sharing in which these hospitals were already engaged. Designed to share innovative ways to improve patient care and increase efficiency, itâ&#x20AC;&#x2122;s a collaborative unlike any in the province. And it serves as a means for partners to identify talent in various organizations. â&#x20AC;&#x153;If you are developing a leader and theyâ&#x20AC;&#x2122;re good but they donâ&#x20AC;&#x2122;t have the opportunity to move up, you run the risk that they will find a job elsewhere. In that case, what theyâ&#x20AC;&#x2122;re doing is bringing your organizationâ&#x20AC;&#x2122;s best practices to a new organization. And thatâ&#x20AC;&#x2122;s immensely powerful,â&#x20AC;? he explains. Williams sees consumer expectation as the next big force of change in healthcare. If the goal of the system is to maintain wellness and meet needs, then leaders have to understand not only how to work with families and patients, but how to work with other providers and institutions to deliver better care. Thatâ&#x20AC;&#x2122;s why the notion of building leaders for the system is so important, says Wil-

liams, because it cuts to the heart of the matter. â&#x20AC;&#x153;Not everyone who needs healthcare goes to a hospital.â&#x20AC;? As a broad approach to system leadership takes root, the OHAâ&#x20AC;&#x2122;s president and CEO, Anthony Dale, points out that the current hospital leadership has been driving change in a number of ways. â&#x20AC;&#x153;Ontarioâ&#x20AC;&#x2122;s fiscal challenges have generated new ways about thinking about health system transformation, and hospital leaders have been at the centre of this

innovation, driving forward with quality improvements, such as integrated funding models for post-acute care, funding reform and health hubs,â&#x20AC;? explains Dale. â&#x20AC;&#x153;Thanks to this leadership, hospitals are becoming more efficient and providing better quality H of care for patients.â&#x20AC;? â&#x2013; Yvan Marston is a Toronto-based communications writer who has helped to develop several reports on health human resources.

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NOVEMBER 2015 HOSPITAL NEWS

24 From the CEO's Desk

Making our patients our partners By Robert Biron

odayâ&#x20AC;&#x2122;s health care system can be characterized as one that is under enormous strain given our demographic and economic realities. The changes underway in Ontario are nothing short of daunting and the stakes couldnâ&#x20AC;&#x2122;t be higher. At the heart of this transformation is a desire to sustain our cherished system that is anchored on the principle of universality, while we also pursue improved service access for our communities and better quality of care for our patients. There is no doubt that to achieve these lofty goals, our system will need to adapt in so many ways â&#x20AC;&#x201C; deploying new medical technologies, leveraging electronic health records, integrating our providers to remove the silos within the system, and embracing a more holistic approach to health and wellness, to name a few. I believe that one particular strategy holds the most promise in leading this health system transformation â&#x20AC;&#x201C; the relationship and approach we take as providers with our patients, their families, and caregivers. There is a growing body of research and evidence on the links between the patient experience and clinical safety and health outcomes, as well as improvements in satisfaction and system cost effectiveness. Other jurisdictions have long recognized the importance of engaging patients when redesigning their health care system. For example, in 2004, the British Design Council noted: â&#x20AC;&#x153;The biggest untapped resources in the health system are not doctors but users (of the service). We need systems that allow people and patients to be recognised as producers and participants, not just receivers of systemsâ&#x20AC;Ś At the heart of the approach users will pay a far larger role in helping to identify needs, propose solutions, test them out and implement them, together.â&#x20AC;? The British National Health Serviceâ&#x20AC;&#x2122;s Institute for Innovation and Improvement embraced this approach and defined five

Robert Biron â&#x20AC;&#x2DC;core principlesâ&#x20AC;&#x2122; of experience-based codesign in a health care context: â&#x20AC;˘ A partnership between patients, staff, and carers; â&#x20AC;˘ An emphasis on experience rather than attitude or opinion; â&#x20AC;˘ Narrative and storytelling approach to identify â&#x20AC;&#x2DC;touch pointsâ&#x20AC;&#x2122;; â&#x20AC;˘ An emphasis on the co-design of services; â&#x20AC;˘ Systematic evaluation of improvements and benefits. In short, redesigning services is seen as a shared activity between providers and their patients, families, and caregivers. Itâ&#x20AC;&#x2122;s a partnership approach that requires direct user and provider participation in a faceto-face collaborative venture to co-design services. The focus is shifted to one of designing experiences as opposed to systems or processes, thereby requiring new methods, such as narrative-based approaches and in-depth observation. A patient-centred philosophy to care represents a paradigm shift for our health care system, and it also means a cultural shift at the institutional level. At the sys-

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tem level in Ontario, this transformation is not only recognized as essential, but itâ&#x20AC;&#x2122;s well underway. The Ministry of Health and Long-Term Care has set the stage and expectations through their action plan, â&#x20AC;&#x153;Patients First: Action Plan for Health Care,â&#x20AC;? which is â&#x20AC;&#x153;designed to deliver on one clear promise â&#x20AC;&#x201C; to put people and patients first by improving their health care experience and health outcomes.â&#x20AC;? In addition, Health Quality Ontario has identified the patient experience as a top priority with dedicated resources to support providers and patients to implement leading practices. New regulations further enhance the involvement of patients and provider responsiveness to their needs, such as patient participation in preparing the hospitalâ&#x20AC;&#x2122;s annual Quality Improvement Plans. At the institutional level, there are numerous organizations in the province that have led the way â&#x20AC;&#x201C; shout outs go to Kingston General Hospital for their comprehensive patient engagement strategy, including their Patient and Family Advisory Councils, and the groundbreaking Northumberland PATH (Partners Advancing Transitions in Healthcare) project sponsored by The Change Foundation, among others. At The Scarborough Hospital, we have a longstanding history of understanding and adapting to the needs of one of Canadaâ&#x20AC;&#x2122;s most diverse populations. We were one of the first hospitals in Ontario â&#x20AC;&#x201C; over 20 years ago â&#x20AC;&#x201C; to dedicate a department and a director focused on diversity, to meet the needs of our changing community and patient profile. In 2009, we took our actions a step further, embedding the patient experience in the core of our new mission statement, â&#x20AC;&#x153;To provide an outstanding care experience that meets the unique needs of each and every patient.â&#x20AC;? Over the years, this mission has become a passion and an intrinsic way in which we operate. Itâ&#x20AC;&#x2122;s clear our team has a strong foundation to guide this journey of transformation and further evolve our culture of

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patient engagement. Our approach at The Scarborough Hospital is multi-faceted and touches the organization at all levels â&#x20AC;&#x201C; at the top through our Board governance, at the program/service level in planning and design activities, and at the front-line where the interface between staff and patients matters most. At the governance level, earlier this year our Board of Directors approved a new strategic plan, and â&#x20AC;&#x153;Patients as Partnersâ&#x20AC;? was identified as one of four new strategic directions for the organization. We wish to engage patients and families in a meaningful way to enhance their experience, promote shared care, and improve quality of care.

There is a growing body of research and evidence on the links between the patient experience and clinical safety and health outcomes, as well as improvements in satisfaction and system cost effectiveness. As well, our hospital recently transitioned its community council to one with an expanded mandate that now includes the â&#x20AC;&#x2DC;patient voice.â&#x20AC;&#x2122; The Community and Patient Advisory Council will provide guidance on overarching patient engagement activities and reports directly to the Board of Directors. In addition, the Quality and Safety Committee of the Board is focused on how to best monitor and measure our success in achieving better outcomes from these patient engagement activities. At the patient program/service level, The Scarborough Hospital adopted Lean quality improvement methods a number of years ago, which have demonstrated success in improving care outcomes and operating efficiencies. A core principle of Lean is to engage those who perform the work â&#x20AC;&#x201C; namely, the front-line staff â&#x20AC;&#x201C; in designing better solutions to remove waste in their processes and focus on adding value to our patients. We have extended these Lean activities to include patients and caregivers to co-design our processes and take into account their experiences. At the front-line level, an enhanced model of interprofessional care, based on key patient-centred principles, is being developed with a goal of learning with, from and about each other (providers and patients) to develop better perspectives. Other deliverables being pursued that engage patients and caregivers span the organization: the development of shared care plans; change of shift reports at the patient bedside; a review of the hospitalâ&#x20AC;&#x2122;s visitor policy; patient involvement in new staff orientation; and, improvement in hospital way finding; to name a few. From international best practice research, to what weâ&#x20AC;&#x2122;ve learned right here in our own hospital, itâ&#x20AC;&#x2122;s clear that collaboration with our patients and families will lead to better care experiences, improved quality outcomes, and a more efficient health care system overall. While this journey may not always be smooth, itâ&#x20AC;&#x2122;s worthy of H our collective energy and commitment. â&#x2013; Robert Biron is President and CEO, The Scarborough Hospital. www.hospitalnews.com

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TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE/HOSPITAL PERFORMANCE INDICATORS

Focus 25

‘Eat in a Seat’ Innovative program helps

seniors in ED get home faster

By Ania Basiukiewicz esearch shows that many seniors admitted to hospital emergency departments experience a significant decline in functional ability, which can extend their hospital stay and create additional complications. As a result, they often need additional help to regain their independence before they can return home safely. At Trillium Health Partners, over half of all patients admitted via the emergency department (ED) are 65 years of age or older. Christine Dias, Trillium Health Partners’ Clinical Nurse Specialist in Geriatric Emergency Management, knew there had to be a simple solution that could help elderly patients remain more mobile during their hospital stay, helping them go home faster. “When thinking of this problem, I knew the solution had to fit a busy emergency department – it needed to be a simple, fast, and an easy fit for ED nurses to work with,” says Christine Dias. “So, I came up with Eat in a Seat – a simple way for elderly patients who are medically able to do so, to get up and eat at least one meal per day while seated in a chair.”

www.hospitalnews.com

Eat in a Seat empowers elderly adult patients to retain more of their functional abilities by eating at least one meal a day in a seated position, helping them retain key functional abilities such as balance, mobility, or independence with self-care activities, and improving the overall patient experience. In the first three months of the program operating at Trillium Health Partners’ Mississauga Hospital, the number of seniors admitted to the ED who were up in a chair for breakfast went from two per cent since its inception in March 2015, to a remarkable 63.8 per cent this past June. This was due in part to the overwhelmingly positive response Eat in a Seat received from the ED nurses, most of whom Christine was able to personally train as part of Trillium Health Partners’ annual skills day this year. “Eat in a Seat is easy to implement because it is the same treatment for every patient, allowing us to assess them and their mobility needs,” says Nancy Gilchrist, Emergency Department Nurse, Trillium Health Partners. “It promotes healthy eating and cognitive stimulation for our patients, and patients really enjoy getting

Christine Dias, Clinical Nurse Specialist developed the Eat in a Seat Program for patients like Florence Muirhead who are medically able to get up and eat at least one meal per day seated in a chair. out of bed and sitting in a chair to eat – it makes them feel better. They smile when their food arrives and their families comment on how wonderful it is to see them out of bed. I find it encourages them to be more independent.” Patient Florence Muirhead agrees. “It’s so much more comfortable and enjoyable not to have to eat in your hospital bed,” she says. “It just feels so much better.”

Eat in a Seat is currently running as a pilot program at the Emergency Department of Trillium Health Partners’ Mississauga Hospital site, and is being considered for broader adoption across its other H sites and program areas. ■ Ania Basiukiewicz is a Communications Advisor at Trillium Health Partners.

NOVEMBER 2015 HOSPITAL NEWS

NEXT ISSUE – On Stands December 1st

December Focus on Year in Review, Future of Healthcare, Accreditation and Pharmacology

26 Focus

TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE/HOSPITAL PERFORMANCE INDICATORS

First Canadian hospital to win prestigious award

By Sanaz Riahi

t’s been a remarkable 12 months at Ontario Shores Centre for Mental Health Sciences (Ontario Shores). Since being recognized by Healthcare Information and Management Systems Society (HIMSS) for achieving Stage 7 in the Electronic Medical Record Adoption Model (EMRAM) in October, 2014, there has been a steady stream of celebrations. Becoming the first hospital in Canada and the first mental health hospital in the world to achieve the HIMSS Analytics EMRAM Stage 7 Award has proven to be a hallmark achievement for our organization. More recently, Ontario Shores was named a 2015 recipient of the HIMSS Nicholas E. Davies Enterprise Award for Excellence, which recognizes the outstanding achievement of using health information technology to substantially improve patient outcomes while achieving return on investment. We are the first hospital in Canada and one of 77 organizations in the world to receive this prestigious recognition. Awards and recognition is wonderful. The attention we have received as a result of these accomplishments not only enhances the reputation of our organization, but also instills a greater sense of pride in our patients, staff, family members and the community. As proud as we are of our accomplishments, we’ve enjoyed the journey much more. Ultimately within our organization, achieving Stage 7 or any other achievement must result in providing an answer to one simple question. What does this mean for the care being provided at Ontario Shores? As the Director of Professional Practice and Clinical Information, it is important for me to highlight that achieving Stage 7 and earning the Davies Award was not about the awards themselves but rather about the principles this designation promotes: patient safety and quality of care. Our transformation advanced a culture of adoption with our electronic medical record (EMR), where we are not just ‘dumping’ data into the EMR but in fact using the information towards enhancing patient safety and the quality of mental health care we provide at Ontario Shores. An example of such quality is the widespread use of our computerized physician order entry (CPOE), where prescriptions are no longer handwritten or transcribed.

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Our transformation advanced a culture of adoption with our electronic medical record (EMR), where we are not just ‘dumping’ data into the EMR but in fact using the information towards enhancing patient safety and the quality of mental health care we provide at Ontario Shores.

At Ontario Shores our fully integrated EMR is allowing us to use information to enhance patient safety and the quality of mental health care. Our excellent and engaged team of physicians truly appreciates the safety concerns related to non-CPOE order entry. Our CPOE rates have been greater than 90 per cent (currently 94 per cent) for over a year, demonstrating the positive impact the EMR has on practice. Before having an electronic medical record, we would not have been able to effectively determine any of this information and promote patient safety in this domain. Similarly, our nurses who are dedicated to patient safety, have been adhering to best practices related to medication administration by ensuring that at minimum, 95 per cent of the time or greater, medications are being scanned into the electronic Medi-

cation Administration Record prior to administration. In addition, from a quality of care lens, we have leveraged data analytics to support the implementation and adherence to our Clinical Practice Guidelines in the assessment and treatment of schizophrenia and metabolic monitoring. For example, we have seen a 27 per cent increase in adherence to metabolic monitoring for people on antipsychotics and almost a 20 cent decrease in the percentage of patients on multiple antipsychotics, which all align with evidence-based practices recommended in the Clinical Practice Guidelines. The use of the EMR has been integral to this process, as it has provided

us with the ability to transform the clinical team’s day-to-day documentation into clinical dashboards available to our providers and clinical leadership teams, informing them of key information about adherence and outcomes related to our Clinical Practice Guidelines. These are just a few examples of how we, at Ontario Shores, are advancing exemplary mental health care while leveraging the EMR as an enabler. Today, in our paperless clinical environment, our EMR system supports enhanced patient safety, improves the delivery and quality of mental health care, and uses standardized clinical documentation in an environment which is efficient, secure and collaborative. We look forward to continuing to build on our work thus far and advance the care being provided at Ontario Shores to our patients H and families. ■ Sanaz Riahi is Director of Professional Practice and Clinical Information at Ontario Shores Centre for Mental Health Sciences.

From labs to lives:

Innovation improves quality of life of Canadians By Claire Samuleson round-breaking technological advancements and innovative treatments and therapies enhance a patient’s experience in a hospital setting, prevent exposure to illness, and improve health outcomes and quality of life. From coast to coast, Canada’s health research community is dedicated to promoting innovation, facilitating inquiry, and integrating research into practice. A pivotal study led by researchers at Fraser Health and Vancouver Coastal Health aims to improve the reproductive health of immigrant women who may have been exposed to dangerous contaminants including heavy metals and environmental toxins. Researchers believe that women could potentially be exposed to such contaminants through imported powders, candies, cosmetics, occupations such as metal work, welding or furniture refinishing, glazed cookware or those made of copper or bronze, or diet. The study will test these women’s contaminant level and teach them how to re-

duce their exposures and concentrations if they are too high. This is especially useful information for women who intend to become pregnant, as materials such as lead and mercury are known to be transmitted from pregnant mothers to their fetuses, affecting fetal development and growth. In Ottawa, Hôpital Montfort has developed a sleep clinic that includes a sleep laboratory at the cutting edge of technology dedicated to the diagnosis, evaluation and treatment of sleep disorders, including sleep apnea, a serious disorder that causes your breathing to stop repeatedly while you sleep. These breathing pauses or “apneas” usually last 10 to 30 seconds and can occur many times throughout the night. For sufferers, sleep apnea is like being shoved in the shoulder all night long. Every time you stop breathing, it gives you a little shove just to get you going again. Other symptoms include headache, acid reflux, snoring and sweating throughout the night. Sleep apnea is also associated with a two-fold increase in risk of developing

cardiovascular diseases. To better understand this association, researchers from the Institut de recherche de l’Hôpital Montfort (IRHM) explore how obstructive sleep apnea may disrupt blood lipids clearance, a potential culprit favoring cardiovascular disease development in these patients. The researchers are also investigating a cutting edge non-pharmacological intervention involving a combination of educational, cognitive, and behavioural interventions in chronic insomnia patients in a study supported by the Canadian Institutes of Health Research. This study is also looking to improve access to health services for Francophones living in minority communities by offering these interventions through videoconference or telemedicine. Hôpital Montfort’s ground-breaking sleep laboratory and the IRHM researchers are working together to offer Canadians the treatment they need for a much needed good night’s sleep and improve their quality of life. Continued on page 27 www.hospitalnews.com

TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE/HOSPITAL PERFORMANCE INDICATORS

Focus 27

Expanding capacity without adding resources By Morteza Zohrabi

ospitals are constantly tasked with the challenge of increasing internal capacity without compromising existing budgets or the patient experience. To that end, many have turned to Lean and Six Sigma training as a collaborative means to seek out bottlenecks and streamline processes for the greater good. In June 2014, Integrated Health Solutions, a division of Medtronic, embarked on a project with William Osler Health System’s (Osler) Diabetes Education Centre at Brampton Civic Hospital, focused on freeing up capacity to meet growing patient demand. Osler’s Diabetes Education Centre provides essential educational and nursing services to help individuals and their families understand, control and manage diabetes. It offers various categories of services: nursing and dietitian support for Type 2 diabetes patients; counselling and insulin management for Type 1 diabetes patients; gestational diabetes management for pregnant women; and paediatric diabetes support. One interesting anomaly of note is that Peel Region has one of the highest prevalence rates of diabetes in Canada, 10 per cent versus the national average of just over five per cent, placing significant demand on the Diabetes Education Centre. Among other issues, the Diabetes Education Centre was experiencing a 45 per cent no-show and cancellation rate, taking time away from other patient visits and leading to longer wait times. Integrated Health Solutions worked with the Osler Diabetes Education Centre to tailor a solution that would increase the number of new patient visits and capacity for classes, as well as decrease the number of no-shows. The first step was to conduct a five-day formal Six Sigma training workshop for project teams comprised of dietitians, nurses and administrative staff.

The first step in the Integrated Health Solutions process was to conduct a fiveday formal Six Sigma training workshop for project teams comprised of dietitians, nurses and administrative staff. Over that time, the teams worked together to review processes, find bottlenecks within the system, and develop solutions. A key element involved mapping the value stream of the process from the patient’s perspective, assessing what worked/ what did not, how long each step took, and its inherent value. This mapping exercise is considered to be one of the strongest tools in Lean training.

A key element involved mapping the value stream of the process from the patient’s perspective, assessing what worked/ what did not, how long each step took, and its inherent value.

From labs to lives Continued from page 26

Researchers and physicians at Vitalité Health Network and Horizon Health Network in New Brunswick have partnered on a project aimed at ending the use of sliding scales to determine insulin therapy for diabetes. Evidence shows that the sliding scale approach in which regular insulin is given only in response to particularly high blood glucose levels can lead to erratic glucose control, resulting in patient risk and longer hospital stays. Researchers wish to enable the adoption of novel treatments including a nutritional insulin regimen based on individualized treatments and a collaborative model of care. About one in 10 residents of New Brunswick live with diabetes. About 20 per cent of all hospitalized patients have diabetes, but use almost 30 per cent of beds in the province. Developing better protocols for glycemic management will result in better www.hospitalnews.com

health outcomes for patients living with diabetes and ultimately health care sustainability in New Brunswick and across the country. In Prince Edward Island, clinician scientists are leading a study aimed at eradicating hepatitis C. Newly approved oral medications have proven cure rates of 90 to 97 per cent and minimal side effects. Previous generations of hepatitis C medications were given intravenously over long periods of time, with side effects including pain, fatigue and low blood counts. The next challenge is dissemination – getting these medications to everyone who’s infected in order to wipe out the virus in the H population as a whole. ■ Claire Samuelson, MA is a Policy Analyst, Research and Innovation at HealthCareCAN.

Following the five-day engagement, Integrated Health Solutions then worked with the team to develop an action plan outlining tasks and requirements. The program’s clinical services manager followed up on every action item to ensure the deadlines were met. This was facilitated through daily performance huddles for dietitians, nurses and administrative staff. Key action items included streamlining the medical reporting systems by merging three databases into one. This initiative alone saved over 2,300 working hours and allowed staff members to focus less on administration and more on interacting with patients. Another significant outcome was reducing redundancy by eliminating a 25 per cent overlap in what dietitians and

nurses were covering during patient sessions. This move reduced session times by 25 per cent with no negative impact on training or the perceived patient experience. Overall, the outcomes have been exceptional. New patient visits per full-time employee have increased by 33 per cent; gestational diabetes management capacity has increased by 20 per cent; and impaired glucose tolerance class capacity has seen a 45 per cent improvement. In addition, the no-show rate has been reduced from 45 to less than five per cent, allowing for more patient interactions with no additional time investment. Lastly, streamlining paperwork has saved 2,600 hours of team time annually; while data redundancy has been reduced by 60 per cent. To ensure a sustainable process, the entire project team earned their Lean Six Sigma Yellow Belts. This has provided the Diabetes Education Centre with the internal capacity to continue managing similar projects and enabled it to be much more effective in improving internal capacity on an ongoing basis. Perhaps the most important takeaway from this is that all of these outcomes were achieved while maintaining patient satisfaction rates and service delivery. Medtronic Integrated Health Systems was pleased to be a key community partner to Osler and looks forward to partnering with other health care providers to help address H the needs of their communities. ■ Morteza Zohrabi, MD is a Lean Sigma Black Master Belt and Integrated Health Solutions Lead Consultant at Medtronic Canada.

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28 Legal Update

Supplier relationships can be a weak link in privacy and data security chain By Simon Hodgett

n today’s complex technology environment there are doubts across many sectors as to whether there is enough focus on supplier relationships and in the context of cybersecurity. Healthcare is no exception. Hospitals and other health care facilities hold vital data about their patients, staff, and medical practices. These institutions are high value targets for unscrupulous theft of data. Add to this the increasing number of connected or electronically tagged medical devices entering the health system, and the result is a rich field for criminal organizations, disgruntled insiders and others bent on mischief to penetrate and disrupt health-related systems. An institution’s focus on cybersecurity must extend beyond locking down and monitoring its internal systems and information practices. Some of the largest data breaches, including in health care, have occurred in connection with suppliers providing services to the enterprise, not a failure of internal practices and policies. Some of these suppliers were not technology suppliers at all, but rather suppliers of non-technology related products and services who had incidental access to systems. Extending safe data practices from internal practice to suppliers involves focusing on pre-contract diligence, contract terms and attentive contract compliance management throughout the supplier relationship. In health care systems, data security is also governed by legislation protecting personal health information. Such legislation recognizes the importance of suppliers in the protection of personal information. For example the Personal Health Information Protection Act (Ontario) deals specifically with the responsibility of agents and service providers with respect to personal health information, and regulations to the Health Information Act (Alberta) set out general provisions that must be included in an agreement with an “information manager”. While bearing these legislative requirements in mind, agreements with suppliers should be generally based on best practices and direct the supplier to take practical steps that will help prevent breaches and, if a breach occurs, bring the supplier into the process to solve or reduce the impact of the breach. The following are proactive steps that health care institutions should take to manage these risks. Knowing the environment. First it is important to have a full appreciation of what data and systems are vital to the operation of the institution or represent a privacy or patient safety risk. The mapping of these data categories allows for risk management with respect to how such data is used internally and if, when, and how it is accessed by a third party supplier. The institution should have an inventory of suppliers and associated supplier contracts, as well as a corresponding ranking or rating of the cybersecurity risk associated with the services provided under each supplier contract. Knowing where high risk data, systems, and suppliers reside helps direct focus to the areas requiring most attention in an environment where resources for these activities are inevitably limited.

HOSPITAL NEWS NOVEMBER 2015

Knowing the supplier. When the decision is made that a significant data set or system is to be made accessible to a supplier, the institution should, either through a request for proposal process or other fact finding process, diligently investigate the promises and actual practices of the supplier with respect to cybersecurity.

Some of the largest data breaches, including in health care, have occurred in connection with suppliers providing services to the enterprise, not a failure of internal practices and policies. Such investigation can include security questionnaires, site visits, review of supplier policies, review of security controls, and available third party audits of security practices. Contracting for compliance. Informed by the knowledge gained through the “due diligence process”, the contract with the supplier should include certain key provisions such as the following:

• an obligation to comply with relevant institution policies (e.g. physical security, requirements for connecting to systems, terms restricting access to and removal of data, and encryption requirements); • an obligation for the supplier to comply with its own policies (which have been disclosed during the due diligence process); • an obligation to comply with laws, specifically those laws in the institution’s jurisdiction applicable to privacy of personal health information; • reference to relevant external standards, such as the ISO/IEC 27000 series of standards; • personnel related terms, such as background checks and training; • restrictions on subcontracting to ensure data and responsibility remains with the party the institution has vetted, unless agreed to otherwise; • threat monitoring and penetration testing practices; • provisions allowing audits by the institution and obligating the supplier to maintain its ongoing program of audits by third parties (e.g. annual audits of controls); • restrictions on use of data (even if anonymized) and obligations to return or destroy data at conclusion of contract; and

• obligations to promptly notify the institution of data breaches or unauthorized access of data. Monitoring compliance. Ensuring that promises made by suppliers with respect to cybersecurity are actually carried out is vital. The institution should ensure that as part of the inventory of supplier contracts discussed above and following the entering into of new agreements with suppliers, there is a clear understanding of the tools available to promote compliance with the cybersecurity requirements. Appropriate personnel should be required to ensure that reporting, monitoring, and audit tools in the contracts are actually exercised with reasonable frequency, especially with respect to supplier contracts that touch high risk or high value systems or data. Cybersecurity-related risk is not a temporary risk faced by health care institutions or other sectors of society, but instead, a permanent feature of risk management. Strong internal polices and controls are essential and extending the same significant level of scrutiny and rigor applied internally to supplier relationships is another important eleH ment in any risk reduction strategy. ■ Simon Hodgett is a Partner in the Technology Group at Osler and a member of the firm’s Health Industry Group.

An Operative Approach to

Health IT Implementation By Nurallah Rahim

nformation technology (IT) advancements in healthcare have presented many opportunities and challenges as clinical leaders seek the best road to wise and impactful investments that will have the greatest benefit to patient care. Whether it’s a large-scale electronic health record, or a specialty clinical information system, the ability to align operational and clinical objectives is no easy feat. These complexities were top of mind when The Scarborough Hospital (TSH) implemented a new perioperative IT solution for the hospital’s operating rooms (ORs) in 2013. This project was part of the organization’s ongoing commitment to support quality improvement initiatives and increase the use of LEAN health care processes. Our goal was to choose the best perioperative IT solution that would help us improve performance and reduce our supply and equipment costs. With 12 OR suites, eight procedure rooms, plus an eye centre with two ORs, all spanning the hospital’s two campuses, implementation of this new solution did not come without its share of challenges. Critical to the selection process was the ability of any new perioperative IT solution to interface with both TSH’s MEDITECH electronic health record and Novari patient access systems. Following

a comprehensive Request for Proposal process, TSH chose Surgical Information Systems (SIS) as their perioperative IT solution. SIS was chosen for its ability to satisfy both the hospital’s clinical objectives, as well as how easily it could interface with our existing IT systems. Features such as intelligent surgical scheduling, nursing documentation automation, perioperative-focused analytics, training programs, and in-room and

mobile communications, allowed us to enhance the overall quality of our OR operations. The Surgery program devised an accelerated plan to implement the SIS system within six months. This included a core team of three staff members working alongside educators. Computer training rooms were set aside to educate nurses on the new standardized workflows. This strategy eased the transition process and hastened adoption of the new system. Capturing data and viewing dynamic, near real-time dashboards enabled TSH to improve purchasing decisions, better manage room blocking and utilization, and increase productivity. Within the first year of implementation, TSH increased the number of early or on-time surgery completions by 35 per cent and increased room turnovers completed in less than five minutes by almost 150 per cent. Staff are now able to identify key areas of process improvement on an ongoing basis by having data at their fingertips. The thoughtful, strategic deployment of the SIS perioperative IT solution allowed TSH to be more efficient, as well as improve the care experience for patients H and families. ■ Nurallah Rahim, RN, BScN, MHA, is Director of Surgical Services at the Scarborough Hospital in Scarborough, Ontario. www.hospitalnews.com

Focus 29

TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE/HOSPITAL PERFORMANCE INDICATORS

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Managing pain when preparing patients for air transport

INSIDE Data Pulse .............. ............................ 11 Ethics .............. ............................ ........ 14 Legal Update ............................ ..........19 Evidence Matters ............................ ... 27 Nursing Pulse ............................ .........28 From the CEO's desk.......................... 31 Careers .............. ............................ .....39

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NOVEMBER 2015 HOSPITAL NEWS

30 Focus

TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE/HOSPITAL PERFORMANCE INDICATORS

Community care in ACTion

St. Joseph’s Assertive Community Treatment teams are on the go, providing care and support to individuals living with persistent mental illness wherever they may be. By Renee Sweeney

t’s 8 am and a team of 11 clinicians is gathering to discuss the needs of the nearly 100 individuals they serve in the community, just as they do each week day morning. These health care professionals are part of ACT 3, one of seven community mental health teams across Southwestern Ontario managed by St. Joseph’s Health Care London. But the office is rarely where you will find these dedicated teams. ACT stands for “Assertive Community Treatment” – a team approach that has been well documented as an effective model of community care for those living with severe and persistent mental illness. The teams are mobile, inter-professional and provide treatment, rehabilitation and support services to clients within community settings. “We like to think of ourselves as a hospital on wheels,” says ACT 3 coordinator Joseph Morgan. “We go to the client wherever they are, whether it’s their home, a shelter or drop-in centre…even if they are currently without a place to live. We provide care anywhere.” ACT teams work together with the client and other community providers to be-

Social worker Susanne Goudswaard, left, visits with ACT 3 client Tobi over coffee each week to discuss and monitor how she’s doing with daily tasks, overall functioning and to intervene should she be experiencing difficulties. Providing side-by-side assistance with daily tasks is also a part of a comprehensive rehabilitation plan for all ACT clients. come collaborative partners in the client’s recovery, explains Morgan. “The reality is, some individuals may have to cope with a mental illness for the long-term, often for a lifetime. We treat our clients with dignity and help them gain the skills they need to better manage their illnesses and their lives. We aim to inspire hope and encourage our clients to stay connected with us and their families to continue treatment that will allow them to live independently in the community. We constantly advocate for their needs and are non-judgmental with the choices they make.”

ACT team members are social workers, occupational therapists, nurses and psychiatrists. Depending on individual need, they provide medication support; addiction intervention, monitor physical health and mental functioning, assist with daily living skills, encourage positive lifestyle changes and seek appropriate community resources for their clients. “First and foremost we work to improve the quality of our client’s everyday lives, which is especially important for those who have limited financial means, family support or housing options,” says Morgan.

By building relationships with clients, the ACT model also helps reduce hospital admissions, visits to emergency rooms and crisis scenarios for those with mental illness. For those who do require hospital readmittance, the aim is a reduced average length of stay. “This kind of support,” says Morgan, “makes a huge difference to a great many H people in our community.” ■ Renee Sweeney is a Communications Consultant at St. Joseph’s Health Care London.

New policy streamlines patient safety By Maryanne Matthews

hunder Bay Regional Health Sciences Centre (TBRHSC) has launched Alert 99, a new policy that addresses the immediate care of any person who requires medical attention or has experienced a collapse and/or trauma within the Health Sciences Centre building. If a person has collapsed in a non-clinical area of the Health Sciences Centre but is responsive, able to communicate and answer questions, an Alert 99 is called. If that same person has experienced an injury, Alert 99 Trauma is called. Both alerts have specified response teams that are trained to address the incident safely and efficiently. “Safety is always our priority here at the Health Sciences Centre and this policy helps to ensure the wellbeing of every person who comes through our doors,” says Jennifer Masiak, Lead for Emergency Planning and Enterprise Risk Management, TBRHSC. Alert 99 encompasses the whole spectrum of incidents from minor slips and falls, to more serious collapses resulting in trauma. It is different from a Code Blue, which is used in cases of cardiac arrest.

HOSPITAL NEWS NOVEMBER 2015

Jennifer Masiak, Lead for Emergency Planning and Enterprise Risk Management, Kerry Posselwhite, Clinical Nurse Specialist for Emergency and Trauma Services, and Kendra Walt, Interprofessional Educator, RN, are just a few of the dedicated health professionals from TBRHSC who helped develop and implement Alert 99. “We developed Alert 99 to address collapses or incidences requiring care within non-clinical areas of the hospital,” explains Kerry Posselwhite, Clinical Nurse Specialist for Emergency and Trauma Ser-

vices, TBRHSC. “Rather than calling an unnecessary Code Blue, we wanted to ensure that we were responding in the best way possible, with the most appropriate resources.”

After creating a new hospital wide policy, the next challenge becomes making everyone aware of it – which is not an easy task considering the Health Sciences Centre has nearly 3,000 employees and hundreds of volunteers. “This project was unprecedented for us given the level of awareness that was required by everyone in the hospital,” explains Kendra Walt, Interprofessional Educator, RN, TBRHSC. “Responding personnel such as nurses, security guards, and respiratory therapists were given formal training. The rest of the staff and volunteers were given information packages.” Since the policy was launched on June 29th, four or five calls have been made and all of them have gone very smoothly. “Feedback has been nothing but positive,” says Walt. “Alert 99 has been especially helpful for staff and volunteers who would not normally have received frontline response training. Everyone is happy to now have clear directions on what to do should someone collapse and they can confidently be a part of ensuring safety H within the Health Sciences Centre.” ■

Maryanne Matthews is a Communications Officer at Thunder Bay Regional Health Sciences Centre. www.hospitalnews.com

TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE/HOSPITAL PERFORMANCE INDICATORS

Focus 31

Sunnybrook reaches out to its

virtual community

By Marie Sanderson

ow does a hospital, with patients from across Ontario, initiate a dialogue with patients and families, both during their hospital stay and beyond? For Sunnybrook, the answer was as simple as looking online.

Sunnybrook has asked its virtual community to weigh in on issues such as whether or not the hospital should build shelters for smokers, to asking people their opinion on redesigning the main entranceway to its busiest campus. With a strong social media presence, Sunnybrook began to reach out to patients and their families online. The hospital’s 26,000 Twitter followers and others were invited to offer their opinion on a variety of issues impacting the patient experience at Sunnybrook. A special section of the website, www.sunnybrook.ca/engagement,

www.hospitalnews.com

has been dedicated as the hospital’s virtual town hall. The issue of caller ID, and whether or not the hospital should have ‘Sunnybrook’ identified as an incoming caller, was an ideal engagement issue. Due to a sense of privacy, calls from the hospital appeared as ‘Unknown Name’, which made sense when caller ID was first introduced on home phones. The logic was to maintain a patient’s privacy in a home where other members of the household may be unaware the person was a patient at the hospital. With the mass proliferation of cellphones in the past few years, people began ignoring calls from an ‘Unknown Name’ and as a result were missing information such as clinic appointment times. To settle the issue, Sunnybrook took to its online community and asked a simple question: “Are you happy with the call appearing as ‘unknown’ or would you prefer to know the call is coming from Sunnybrook Hospital?” Over 85 per cent of respondents said they would prefer to know the call is appearing from Sunnybrook. Based on this feedback, calls are now identified as “Sunnybrook Hospital”. “Reaching out online seemed to make the most sense for our organization,” says

Patient Sally Nicholson visits a recent engagement topic at www.sunnybrook.ca/ engagement from the comfort of her front porch. Photo credit: Media Source). Craig DuHamel, Vice President Communications and Stakeholder Relations at Sunnybrook. “About 65 per cent of our patients live outside of Toronto and it seemed unreasonable to ask them to come in for a meeting. This way, they can engage on a topic on their own time, from the comfort of their own home.” Sunnybrook has asked its virtual community to weigh in on issues such as whether or not the hospital should build shelters for smokers, to asking people their opinion on redesigning the main entranceway to its busiest campus. Feedback from the online engagement is provided to those areas internally who

will benefit most from the information. The results are also shared with the Senior Leadership Team, who use the information collected to help inform decisions. “Patients appreciate us asking their opinions, and it’s quick and easy to enter the debate,” says Sivan Keren Young, Manager of Sunnybrook’s web communications team. “This is our modern-day virtual town hall and we’re getting tanH gible results from putting patients first.” ■ Marie Sanderson works in Communications and Stakeholder Relations at Sunnybrook Health Sciences Centre.

NOVEMBER 2015 HOSPITAL NEWS

32 Focus

TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE/HOSPITAL PERFORMANCE INDICATORS

Improving care for elderly patients By Maryanne Matthews ne year since its launch, Hospital Elder Life Program (HELP) of the Thunder Bay Regional Health Sciences Centre (TBRHSC) has a lot to celebrate. “The HELP program is primarily known as a delirium prevention program, but is also known for maintaining cognitive and physical functioning, maximizing independence at discharge, reducing hospital stays, and reducing readmission rates,” explains Kelsey Lecappelain, HELP Coordinator, TBRHSC. Delirium is a sudden onset of confusion and can be brought on by a number of factors that are assigned with lengthy hospital stays. “In our first year on our pilot unit, The HELP Program has shown success in reducing average elderly hospital stays from 12 to 7 days, reducing delirium rates from 10 per cent down to one per cent, reducing the number of senior patients discharged to long-term care from 10 to one per cent, and preventing mental and functional decline in older patients while maintaining their dignity and respect,” says Lecappelain. A registered, comprehensive program of care for hospitalized older patients, HELP was designed to prevent delirium and functional decline during hospitalization. Using a team of well-trained volunteers, it helps elderly patients to be more functional and independent when discharged from hospital.

Patients enrolled in HELP receive daily visits from dedicated, well-trained volunteers who help reduce delirium and improve the overall experience of TBRHSC’s senior patients. Over 400 senior patients have been enrolled in the program to date. Patients receive daily visits from volunteers who provide therapeutic activities and games, walking or exercise, and help with feeding. In the past year, HELP volunteers have collectively provided over 1,600 hours of quality time with patients. “HELP is an important program, providing meaningful and cost-effective care that speaks loudly to TBRHSC’s Seniors Health initiative, which is a Strategic Di-

rection identified in TBRHSC’s Strategic Plan 2020. It also provides a constructive, concrete experience to prepare families, communities, and our health care system for our aging society,” says Lecappelain. The need for senior care in the community is growing rapidly and the HELP program has been crucial in maintaining the highest level of personal attention and support that is valued by TBRHSC patients and their families. “The volunteers were there when I

needed to talk. HELP is an excellent program and I am very happy it’s being implemented,” stated a previous HELP patient. “This is a great program for my mother,” said another patient’s family member. “The volunteers are friendly and great for my mother’s morale. Our family is extremely satisfied.” Lecappelain also notes that patients and families aren’t the only ones benefiting from HELP. TBRHSC staff is also happy to have the program on their units. “We have received really positive feedback from staff, stating that their patients have been happier, they enjoy the interaction, and their cognitions have improved thanks to the HELP program,” she says. TBRHSC is always looking for more volunteers to provide support and companionship for patients enrolled in the HELP program – particularly those who are available for daytime shifts. If you are over 18 and interested in becoming a HELP volunteer, please contact Volunteer Services at 684-6267 to learn more. The HELP program will be featured in the CBC series “Keeping Canada Alive”, which will give viewers an unprecedented look at the health care system and the powerful emotional stories that take place within it. “Keeping Canada Alive” airs Sundays at 9 p.m./9:30 NT starting Oct. 4 on CBC. It can also be viewed online at H www.cbc.ca/keepingcanadaalive ■ MaryAnne Matthews is a Communications Officer at Thunder Bay Regional Health Sciences Centre.

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INSIDE

.....12 ............................ 3 desk .........................1 ... 14 ............................ Evidence Matters .......... 17 ............................ Legal Update

Safe Medication From the CEO’s

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TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE/HOSPITAL PERFORMANCE INDICATORS

St. Paul’s Hospital

implants next generation defibrillator By Justin Karasick

other hand, uses electrodes placed just under the skin (in the extrathoracic space) and not in the heart, leaving the heart and veins untouched. The device delivers a shock across the chest wall with the heart positioned in between. Mike McLellan, a sporting goods wholesaler from Squamish, was the first patient in BC to receive a S-ICD. The 44-year old father of three has not only fully recovered from surgery, but completed a grueling, four-day, 650 kilometer bike ride just a few months after having the device implanted. “The S-ICD will only fire if it detects that I need it,” says McLellan. “I kind of look at it like a lifejacket. It’s always listening to my heart and it can differentiate between exercise and a medical issue.” The S-ICD provides defibrillation therapy for the treatment of life-threatening ventricular tachyarrhythmias. It is a promising new device because the absence of an intracardiac lead means the need for complicated surgeries to extract failed leads is avoided. This complication occurs in about one in 200 patients every year. “To be the age that I am, relatively young for heart issues, it allows you to not be at risk for that invasive lead removal or lead extraction with traditional ICDs,” says McLellan. Nearly 1,000 conventional defibrillators are implanted in patients around the prov-

INSIDE

t delivers a life-saving shock to the heart without ever actually touching it. Doctors at St. Paul’s Hospital, in collaboration with Cardiac Services BC and a group of physicians from around the province, have taken a step towards revolutionizing the care of people with cardiac arrhythmias in British Columbia by implanting the first ever subcutaneous implantable cardioverter defibrillator (S-ICD) in BC. “One of the biggest challenges we face with implantable defibrillators is the invasiveness of the procedure,” says Dr. Jamil Bashir, cardiac surgeon and director of the laser lead extraction program at St. Paul’s. “This new device is a paradigm shift that allows us to shock the heart without having to place a wire in the blood vessels. Because the heart and blood vessels are untouched, the potential for blood vessel injury is eliminated, the potential for system infection is reduced and the patient’s vein access is preserved for the future.” The primary purpose of the device is to monitor the patient’s heartbeat and deliver a potentially life-saving shock that disrupts a fast heart rhythm and resets the heart. Conventional ICDs, which involve a lead being placed in the veins of the upper chest, are connected directly to the heart. This feature is required for many patients who receive an ICD, and remains the standard of care in BC. The S-ICD, on the

One of the biggest challenges we face with implantable defibrillators is the invasiveness of the procedure. This new device is a paradigm shift that allows us to shock the heart without having to place a wire in the blood vessels.

Mike McLellan of Squamish was the first person to have an S-ICD, or sub-cutaneous implanted cardio defibrillator, installed at St. Paul’s Hospital in Vancouver. He recently completed a four-day, 650 Km bike ride, only months after the operation. ince per year for protection against potentially fatal arrhythmias. In addition to the defibrillation feature of an ICD, many patients also require longer term pacing. At this time, the S-ICD is currently unable to provide this therapy but may eventually be suitable for patients with other types of heart disease. Since the first procedure, St. Paul’s Hospital, in collaboration with Cardiac Ser-

vices BC and a provincial physician review panel, has implanted 18 more S-ICDs into patients. The implant team has been led by Dr. Bashir, cardiac surgeon and director of laser lead extraction program at St. H Paul’s. ■ Justin Karasick is Director, Communications & Public Affairs at Providence Health Care.

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TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE/HOSPITAL PERFORMANCE INDICATORS

How technology in healthcare can support the community By May-Lin Poon

nce upon a time, there was a simple way to gather healthrelated information: Visit your family doctor or local medical facility, go to your local public library, contact a community agency or medical establishment or ask friends and family for help. In more recent times, it became the norm to search “Professor Google” for details about any and every topic under the sun. The problem was, however, that this method of gathering information would pull up just that – “everything under the sun” – and it was often difficult to find details that were locally-based, and relevant to the person who was searching. Whether one was looking for the availability of a family doctor or medical clinic close-by, or trying to find out information about community supports or agencies, the vast scope of data available via Google and similar search engines was daunting, to say the least. While Google was indeed a considerably easier way to search information, the challenge was that the search engine provided an almost infinite number of possibilities – making it difficult and often time-consuming for those who needed information quickly and efficiently. In the area of healthcare in particular, time and specificity was often of the essence, as information that was being searched was often done so with an immediate or pressing need as the catalyst. A sudden illness, a diagnosis required for those strange set of symptoms, or an urgent need for a community agency or support system that would provide respite or homecare for an elderly senior – these were all events that would require detailed information that was both correct, and often specific regarding location. For example, those searching for details on how to find a Personal Support Worker (PSW) to care for their aging parent, or a new Canadian looking for resources close to home would need to be able to determine online sources that would directly meet their needs - a task that wasn’t easy in the almost infinite rage of information on the web. Technology had provided the tools to search for this information online, but there were still challenges to be overcome: • Senior citizens and the elderly were often not able to access online information, due to lack of resources, an understanding of the Internet or lack of awareness that details could be found online • New Canadians faced limitations in finding required information due to language barriers, lack of access to resources or being unaware of where to start in their search for support • New parents who are limited in their ability to get out of the house, or who do not have an existing support system in place to provide help during the early days of parenthood • All of the above who may require the services of a medical professional, a family doctor, a community support agency and more With these facts in mind, two particular health care-related organizations that catered to these specific groups recog-

HOSPITAL NEWS NOVEMBER 2015

nized the challenges faced by so many in the community. With the goal of providing simple solutions to the problems that existed, the Toronto Central Community Care Access Centre (CCAC) created a dedicated site that acted as a “one-stop shop” of resources for the community. The site – TorontoCentralHealthline.ca – takes away the challenges that face those who are looking for information on larger search engines by providing all relevant resources, information and content on one dedicated site. The website allows visitors to search information by specific postal code, allowing them to hone in on resources, services and information that is close to home. The site also provides a portal that offers detailed information that is categorized by topic, including Mental Health, End of Life Care, People With Disabilities and more. In addition, it has dedicated sub-pages that are catered to New Canadians, Caregivers and Mental Health and Addiction. Continued on page 35

Ensuring outstanding patient experience By Steve Erwin

indsor Regional Hospital (WRH) is always seeking out new opportunities and possibilities to improve the patient experience. This fall, the hospital was given the opportunity to lead by example and educate other hospitals throughout North America on some of the successful strategies it has put in place to help ensure an outstanding experience for patients. Five hospital programs were presented and on display at the Mayo Clinic Delivery Science Summit, which was held September 16-18, 2015, in Rochester, Minnesota. Selected among hundreds of applicants, the poster presentations by WRH involved: ‘From Boardroom to Bedside: Engaging the Entire Organization in Patient Safety & Quality’’ which is about efforts to ensure knowledge about WRH’s 14 corporate quality indicators was effectively communicated to those who provide care at the bedside. ‘Lean On Me: Practical Strategies for Improving Patient Satisfaction Through Improved Emotional Support’ which focuses on WRH’s efforts to provide emotional support to patients, including a number of programs for patients designed and developed by the Patient Experience Task Force. ‘Right Place, Right Time, Right Care: Short Stay Medical Unit Improves Patient Flow’ which is about efforts to improve the transition of patients from the Emergency Department to in-patient beds so that patients requiring a bed aren’t left waiting in the ED. ‘Concierge Program: Improving Patient Satisfaction Through Enhanced Interaction’ which is about offering a variety of services to patients and family members while waiting for treatment or during their hospital stay.

Rheem McLennan, WRH volunteer, standing beside a poster for the WRH “WellCome Mat” program at a Mayo Clinic conference. ‘WellCome Mat: Strategies for Helping Patients Feel WellCome’ which is about improving the emotional support we provide to our patients through a unique hospital orientation program that is provided to newly admitted patients on medical units. “We are proud that our programs to improve the quality of care we provide and the patient experience they need are being recognized and shared with leaders throughout the continent,” says David Musyj, WRH President and CEO. “The programs are a true reflection of our continuing vision to provide Outstanding Care – No Exceptions!” In 2012, WRH was informed it was the first Canadian hospital to make clinical quality-of-care presentations at an international conference held at the Mayo Clinic, a non-profit world leader in medical care, research and education. The conference was attended by hundreds of health care and related professionals, including clinicians, scientists, administrative leaders, policymakers and IT professionals. The conference focused on ways to enhance the patient experience, improve health outcomes and manage the cost of care. Current research and concrete examples were presented, providing

tools for practice implementation, policy change and further research. Presentations emerged from a variety of institutions and across many disciplines, including health economics, qualitative research, systems engineering, clinical statistics, implementation science, sociology and clinical informatics. In addition to being able to promote its own patient experience concepts, WRH representatives who attended the conference were also given the opportunity to hear from leaders throughout the continent on many aspects of enhancing the patient experience, improving population health and managing the total cost of care. “It was an opportunity to learn about methods used to understand how patients experience their care by capturing events in ways that are respectful of patients and clinically useful,” says Lisa Landry, a member of WRH’s board of directors who joined frontline staff at the conference. One session Landry found engaging centered on a discussion of the important role of clinical preventive services in improving population health, highlighting its cost effectiveness. A variety of approaches to developing sustainable health care systems were described, all of which connect to local community resources in order to address underlying determinants of health. The WRH programs displayed in a poster exhibit depicted a variety of initiatives whose goals were centered on improvement of patient throughput, satisfaction, safety and post-operative care. The WellCome Mat program received great accolades from the many patient care providers that walked the poster displays throughout the conference. Once again, WRH has something to be proud H of,” Landry adds. ■ Steve Erwin is Manager, Corporate Communications at Windsor Regional Hospital. www.hospitalnews.com

Nursing Pulse 35

From nursing Educational to policing, & Industry Events and back again To list your event, send information to “events@hospitalnews.com”.

By Jill Scarrow

s a police officer in Hamilton, Ingrid Boiago saw hundreds of cases of elder abuse. She found one woman covered with lice head-to-toe, dehydrated, and emaciated. Her toenails had grown under her feet, and she was confused because her daughter had given her too much medication. Today, that woman is a resident at Dundurn Place Care Centre, the Hamilton long-term care facility where Boiago is now clinical director of nursing. It’s a job that allows her to weave her nursing and policing skills together. She investigates complaints at the home, and says her background in law enforcement in Hamilton – where many Dundurn residents have spent most of their lives – has given her unique insight into the poverty and poor health many of them faced.

After two decades in law enforcement, Hamilton RN returns to the career she’s always loved. Boiago graduated from Hamilton’s Mohawk College as an RN in 1980, but spent the last 20 years on the Hamilton Police Service, including four years investigating crimes against seniors. Her career has been full of serendipitous twists. After university, she wanted to be a doctor. But when she didn’t get into medical school, her father suggested she try nursing. By the time she graduated, she’d found her passion in psychiatric nursing. “I love figuring out why people do and say the things they do,” she says. After nursing school, Boiago worked on an acute psychiatric ward. She met doctors interested in forensics, and began working with them in local jails to determine if inmates were mentally fit to stand trial. She faced violent murderers and pedophiles, but was never fearful; she was fascinated. She began assisting her psychiatrist colleagues with their research and was working on a tool to predict if a criminal would reoffend when her career took an unexpected turn. She called the Hamilton police looking for statistics, and they offered her a job. At the time, the force was looking to get into behavioural sciences, including

forensic psychiatry, and they thought her background was a perfect fit. She decided to apply, and was hired. Then in her late30s, she spent 16 weeks at police college alongside men in their 20s running, marching, and having her bed inspected every morning. “We had to do nursing corners, so I made everyone’s bed,” she recalls. Boiago joined the force in 1994 and spent time on patrol, worked on domestic and sexual assault cases, and in the fraud office. She always maintained her nursing license, and when she joined the Crimes Against Seniors/Senior Support Unit in 2010, she approached her work with a nursing lens. She would help people find housing if needed, or connect them with community agencies. Other officers didn’t understand why she bothered, but she couldn’t ignore her desire to improve health. Having a nurse on the force proved helpful when her colleagues noticed some seniors had trouble living independently. In 2011, she became certified to assess adults to determine their ability to make their own decisions about their property and personal care, a position only open to regulated health providers. “Any doors that have been opened have been because of my nursing,” she says. “It’s part of who I am, and what’s shaped me. In hindsight, it made me a much better police officer.” Last year, Boiago decided to go back to healthcare. She was about to be moved off the seniors’ unit and back to patrolling the streets. “I’m almost 60 and I didn’t think I could go back to chasing kids and stolen cars,” she says. She decided to apply for a nurse educator position at Dundurn. She got the job and then, a few months later, the clinical director position opened up, so she applied for that too. “I feel like I’ve finally found my place,” she says, suggesting it’s because of the different jobs she’s done. “I feel more rounded in terms of having all those experiH ences. Who knows what I’ll do next.” ■ Jill Scarrow is a freelance writer in Burlington, Ontario. This article was Originally published in the May/ June 2015 issue of Registered Nurse Journal, the flagship publication of the Registered Nurses’ Association of Ontario (RNAO).

Technology in healthcare Continued from page 34

For health care professionals and community agencies, the site provides a portal that can be pulled up on the spot, while patients or clients are present, allowing for immediate information sharing. Realizing the need for easy online access to information about healthcare, the Province of Ontario also implemented a resource to assist Ontarians who were looking for a family doctor. Health Care Connect puts those in need of physician in touch with a doctor or nurse practitioner within their area. Similar to The Healthline, the site uses postal code www.hospitalnews.com

and location-based information to find a practitioner who is close to the requester’s home. To date, 80 per cent of those who use the program have been successful in finding a doctor or nurse practitioner through the site. For more information, visit the Ministry of Health and Longterm Care at http://www.ontario.ca/page/find-family-doctor-or-nurseH practitioner ■ May-Lin Poon is the Manager of Client Services, Information & Referral, at the Toronto Central Community Care Access Centre.

We try to list all events and information but due to space constraints and demand, we cannot guarantee it. To promote your event in a larger, customized format please send enquiries to “advertising@hospitalnews.com”

Q November 2-4, 2015 Health Achieve 2015 Metro Toronto Convention Centre, Ontario Website: www.healthachieve.com Q November 5-7, 2015 12th National Respiratory Care & Education Conference Niagara Falls, Ontario Website: www.cfhi-fcass.ca. Q November 16-19, 2015 World Forum for Medicine Duesseldorf, Germany Website: www.medica-tradefair.com Q November 17-18, 2015 Rx&D Annual General Meeting Hyatt Regency, Montreal Website: www.canadapharma.org Q November 23-25, 2015 This is Long Term Care 2015 Toronto, Ontario Website: www.oltca.com Q November 29- December 4, 2015 RSNA Annual Meeting 2015 McCormick Place, Chicago, United States Website: www.rsna.org Q December 1–2, 2015 Data Analytics for Healthcare International Plaza Hotel Toronto, Ontario Website: www.healthdatasummit.com Q December 1, 2015 Health Canada: Financial Models and Fiscal Incentives in Health and Health Care InterContintental Toronto Centre Hotel, Ontario Website: www.conferenceboard.ca Q January 26-27, 2016 12th Annual Mobile Healthcare Toronto, Ontario Website: www.mobilehealthsummitdata.com Q March 1-5, 2016 13th Annual Critical Care Conference Whistler, British Columbia Website: www.canadiancriticalcare.ca Q April 16-19, 2016 The Canadian Conference on Medical Education Fairmont The Queen Elizabeth, Montreal Website: www.mededconference.ca Q April 17-19, 2016 Putting the Pieces Together – Collaborating for Quality Hospice Palliative Care in Ontario The Sheraton Parkway and Convention Centre, Richmond Hill Website: www.hpco.ca Q June 5-7, 2016 Annual OACCAC Conference Westin Harbour Castle Hotel, Toronto Website: www.oaccac.com

To see even more healthcare industry events, please visit our website www.hospitalnews.com/events NOVEMBER 2015 HOSPITAL NEWS

36 Focus

TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE/HOSPITAL PERFORMANCE INDICATORS

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