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Doctors without borders: Reflections from troubled waters FOCUS IN THIS ISSUE

PROFESSIONAL DEVELOPMENT/ CONTINUING MEDICAL EDUCATION/ HUMAN RESOURCES:

Canada's Health Care Newspaper JAN. 2016 | VOLUME 29 ISSUE 1 | www.hospitalnews.com

Continuing Medical Education for health care professionals. Human resource programs implemented to manage stress in the workplace and attract and retain health care staff. Health and safety issues for health care professionals. Quality work environment initiatives and outcomes.

The discovery of the CEA antigen

INSIDE Ethics .................................................. 10 Evidence Matters ...............................13 From the CEO's desk.......................... 17 Legal Update ......................................20 Nursing Pulse ..................................... 21

Taming workplace

incivility Story on page 14

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Letter to the Editor

Re: Rethinking opioid use (December issue) y name is Chris Cull and I am in long-term recovery after a seven-year opioid addiction and dependency. Unlike and not unlike a lot of Canadians, I didn’t start down the path of opioid abuse through a prescription. When I was 22 years old, my father, after a roughly sixyear battle with Huntington’s Disease, succeeded in taking his own life. The result of that incident was pure devastation. In retrospect, I was not maturely nor emotionally developed enough at the time to manage the loss productively, so I turned to Percocets which I got off the streets to try and numb out my pain. That then escalated into using five 80mg Oxycontins a day, over a two year span that eventually saw me lose my house, my girlfriend and over six figures in cash. I decided to enter a harm reduction program, which took five years from beginning to end, to beat my opioid dependency. Finally free from addiction, I set the biggest challenge for myself I could think of: To ride my bicycle across Canada and film a documentary with the goal of bringing awareness around this growing health concern and show how prevalent the prescription drug crisis has become. What I found was troubling to say the least. I stopped and walked around in every town I passed through to talk to the local community about prescription drug abuse. The phrase I heard most often was, ‘You’ll find a lot of that around here.’ And when you start to hear that in every city, in every province, across the entire country, it begins to raise questions as to why this is occurring and what we can do about it. I was given the opportunity to interview many people across the country who have been affected by the prescription drug abuse epidemic; abuse commonly began through legitimate dosage of prescribed opioids for pain and, of course, recreational use. Some of the stories I encountered include an 18-year-old girl from Regina, Saskatchewan, who developed a physical dependency in high school at the age of 16 after being prescribed Oxycontin due to a hairline fracture in her pinky finger. Another unforgettable story I encountered was that of an elderly woman in Northern Ontario who was

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After battling his own opioid addiction, Chris Cullen bicycled across Canada while filming a documentary to raise awareness of what he believes is a prescription drug crisis. prescribed opioids for chronic pain, who eventually became physically dependent, then began doctor shopping so she could sell her prescriptions to supplement her income as well as feed her addiction. Stories like these exist everywhere across the country and with an estimated 432,000 Canadians currently dependent on either heroin and/or opioid painkillers, the time has come where we need to at minimum mitigate this problem. How to do that with such a complex problem to solve is difficult; there are so many different variables and dynamics that play into it. I am not a doctor nor a medical professional of any kind, but after studying the broad scale of the problem and looking at it objectively, I have a few thoughts, using sensible logic, as what to work on. I believe that awareness, education, prevention and treatment working collectively with medical professionals, academics, government, and the general public is where we can improve.

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The first step to solving any problem is recognizing there is one, which is where awareness comes into play. As a person who has felt the stigma associated with being addicted to and dependent on prescription painkillers, I understand how difficult it can be to seek help. But I encourage everyone who has been touched by this crisis to speak out and share their story so we can make it easier for those in the future to seek help without the overwhelming feeling of shame.

An estimated 432,000 Canadians currently dependent on either heroin and/or opioid painkillers. By doing so, we shine a spotlight on the crisis and show how prevalent it is. Education on opioids is the most important factor in this entire equation as it plays a vital role in both prevention and treatment. Both the physician and patient need to have a clear understanding of the potential for harm that comes with prescribing opioids. This is particularly important with chronic pain where sustained opioid use develops into a quick tolerance to the drug, leading to higher dosages and/ or physical dependency. If all parties involved are educated on the potential for harm with opioids and even being educated on non-drug therapies for certain pain states, then the potential for prevention is much higher. The one thing I found in my travels that is severely lacking is adequate resources for treatment, especially in rural areas. Whether it be harm reduction, counselling or meetings, the lack of resources pertaining to opioids in specific areas is

appalling. One way to help improve access to treatment would be to encourage and support rural GPs to play a role in their communities by offering treatment for opioid dependence. If we can give everyone the tools they require to fix the problem, we can significantly lower the alarming statistics. With the right support and resources, people suffering from opioid dependence can move on from addiction and live in recovery. One amazing resource I am proud to align myself with in my personal mission to help provide Canadians with access to the opioid addiction services they need is ORbeOK.ca. The site is one of the first and most comprehensive websites for Canadians suffering from opioid dependency. ORbeOK.ca offers educational resources on what opioid dependence is, how to recognize if you or someone you love is becoming dependent, community news as well as where to go to get the medical and emotional help you need. That being said, I understand everything involving the opioid epidemic is much easier said than done and it will take time. But I am confident it can be done. This is by no means a “how to” note as there are many more pieces to the puzzle than I have highlighted – it is simply a call to action. As mentioned, there are so many different variables to the equation and it is not a black and white issue. Understanding that, we need to find a balance within the spectrum of everything the opioid epidemic entails and take a new approach to it. If we all do our part – whether it is physicians, pharmacists, academics, government, industry or the general public – we all have our own part to play in this and if we can change it now, we can look forward to a brighter future tomorrow. Sincerely, Chris Cull www.hospitalnews.com


In Brief

Canadians still wait more than 18 weeks for surgery The median wait time for Canadians seeking medically necessary surgery or other therapeutic treatment remains stagnant for the third consecutive year, finds a new study by the Fraser Institute. The study, an annual survey of physicians from across the country, reports a median wait time of 18.3 weeks, up slightly from 18.2 weeks in 2014. In 1993, the wait time was just 9.3 weeks. The study examines the total wait time faced by patients across 12 medical specialities from referral by a general practitioner (ie: a family doctor) to consultation with a specialist, and subsequent receipt of treatment. “These protracted wait times are not the result of insufficient spending but because of poor policy. In fact, it’s possible to reduce wait times without higher spending or abandoning universality. The key is to better understand the health policy experiences of other more successful universal health care systems around the developed world,� says Bacchus Barua, senior economist at the Fraser Institute’s

Centre for Health Policy Studies and author of Waiting Your Turn: Wait Times for Health Care in Canada, 2015 Report. On a provincial basis, Saskatchewan now has the shortest waits in the country at 13.6 weeks, a dramatic turnaround from 2011 when it was among the country’s longest wait times (29.0 weeks). It’s followed by Ontario (14.2 weeks), Quebec (16.4 weeks), and Manitoba (19.4 weeks), which has also decreased wait times since its 2013 high of 25.9 weeks. For the third consecutive year, British Columbia recorded an increase in wait times with its median wait now sitting at 22.4 weeks. Meanwhile, the Atlantic provinces face the longest median wait times: Prince Edward Island (43.1 weeks) followed closely by New Brunswick (42.8 weeks) and Newfoundland and Labrador (42.7 weeks). However, the number of survey responses in Atlantic Canada were lower than other provinces which may result in reported median wait times being higher or lower than those actually experienced.

Among the various specialities, the longest referral-to-treatment wait times exist for patients requiring orthopaedic surgery – the treatment of ailments related to bones, joints, and muscles – at 35.7 weeks and neurosurgery (27.6 weeks), surgery performed on the nervous system. In fact, patients requiring such treatments can expect to wait over 15 weeks to just get a consultation with a specialist after getting a referral from their family doctor. “These wait times for medically necessary treatment in Canada are not simply minor inconveniences. They can result in pain and suffering for patients, contribute to lost productivity at work, decreased quality of life, and in the worst cases, disability and death,â€? Barua says. On a somewhat better note, patients face much shorter referral-to-treatment wait times, relative to other treatments, for radiation oncology (4.1 weeks) and medical oncology (4.5 weeks) – specialties involved in the treatment H of cancer. â–

Wait time alliance report card reveals Important lessons for next Health Accord The Wait Time Alliance’s (WTA) tenth national report card shows that, despite encouraging signs that wait times for the initial five areas identified in the 2004 Health Accord are being reduced, progress to reduce waits for other medical procedures and treatments is spotty across the country. “The upcoming work between the federal and provincial and territorial governments on a new Health Accord for Canada is a great opportunity for our elected leaders to create a new national vision for our health care system,� says Dr. Chris Simpson, chair of the WTA. “The WTA report card shows that Canadians need action to reduce waits beyond the initial five areas identified in the 2004 Health Accord.� As in previous years, the 2015 WTA report card found that Canadians are still waiting too long for care and that significant variation exists among some provinces; timely access is often still affected

by where you live, and often, how old you are. Key findings in the 2015 report card include: •Nationally, the picture of timely access has not changed significantly over the past year. Those provinces who did well in 2014 continue to be the best in 2015 – Saskatchewan, Ontario and Newfoundland and Labrador; •The number of provinces reporting Emergency Department wait times continues to grow. PEI and BC are the latest to do so in approximate real time – updated every five minutes; •On the primary care front – PEI now reports on wait time to access a family physician – the first province to do so; •New in 2015, the report card draws special attention to the issue of timely access to care for elderly Canadians and also looks at wait times for those populations falling under federal jurisdiction (First Nations, refugees, veterans, Canadian Forces

and inmates in federal prisons). “If we are going to reduce wait times across the system on a sustained basis, we must better integrate areas such as primary care, mental health services, home care, long-term care and palliative care,â€? adds Dr. Simpson. “Shortages in these areas all too often lead to more people, particularly seniors, spending more time in hospital when they could and should be getting care elsewhere.â€? The WTA report cited the current lack of suitable living arrangements for seniors, such as supportive residential care models and long-term care beds, as having a huge impact on our health care system. Many senior patients are left waiting in acute care hospital beds until more appropriate care can be arranged. As a result, hospitals simply run out of beds and become overcrowded, leading to longer wait times in the emergency room and for tests H and surgeries. â–

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Women attend less than half of cardiac rehab sessions Even with cardiac rehab (CR) programs tailored to their needs, women heart patients miss more than half of the sessions prescribed to them, according to a joint study by York University and the University Health Network (UHN). “However, they may adhere more to a CR program and benefit from it, if they are able to make their own choice on which model of program they attend,â€? says Professor Sherry L Grace in the Faculty of Health at York U. “Participating in a cardiac rehab program greatly reduces death and hospitalization, as well as helps in improving the quality of life for heart patients,â€? says Grace, who is also a senior scientist at the UHN. “Unfortunately, many patients do not use these proven services, and women are much less likely than men to access them, and to fully participate once they do.â€? To test what might improve female heart patients’ adherence to cardiac rehab, Grace and her colleagues compared women’s participation in one of the three program models offered. Study participants were randomly assigned to in a mixed-sex (co-ed) program, women’s only program or home-based program model. The researchers recruited women from six cardiac care facilities in Ontario and referred them to one of these three most-commonly available CR models. The study, CR4HER, published in Mayo Clinic Proceedings, assessed adherence to the program as well as improvements in exercise capacity, which is strongly linked to better survival. The researchers found that women only attended just over half of the 24 sessions offered, regardless of the model they were assigned to. However, the participants achieved significant improvements in their exercise capacity. “The results suggest that women should be encouraged to participate in cardiac rehab, offering them the program model of their choice,â€? says Liz Midence, lead author and PhD candidate at York U. “We should inform women of the benefits of cardiac rehab and use all the tools at our disposal to promote their full participation.â€? Midence notes that women might have limitations such as taking time off from caregiving responsibilities and access to transportation. “They may be more likely to fully participate in a home-based program, where they can be supported by the cardiac rehab staff by phone at a convenient time for them, to make the changes they need to H manage their heart condition.â€? â–

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Guest Editorial

UPCOMING DEADLINES FEBRUARY 2016 ISSUE EDITORIAL JAN 8 ADVERTISING: DISPLAY JAN 22 CAREER JAN 26 MONTHLY FOCUS: Facilities Management and Design/ Health Technology/Greening Healthcare/Infection Control:

Innovative and efficient health care design, the greening of healthcare and facilities management. An update on the impact of information technology on health care delivery. Advancements in infection control. + INFECTION CONTROL SUPPLEMENT

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Geriatric medicine, aging-related health issues and senior friendly strategies. Best practices in care transitions that improve patient flow through the continuum of care. Programs and advancements designed to keep patients at home. Care in rural and remote settings: enablers, barriers and approaches. Rehabilitation techniques for a variety of injuries and diseases. + LONG TERM CARE SUPPLEMENT

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Don’t hurt me. Heal me.

Be nice to me By Dr. Peter Pisters hose nine words describe what every patient who enters a hospital expects from their care teams. And we all know that, try as we might, people do come to harm in ways that can be prevented. Hospital acquired infections, injuries from falls, bed sores, and medication errors are examples of preventable harm that occur every day in healthcare organizations. In a video we produced for our Annual General Meeting last June we described how dangerous all hospitals are and underlined the need to have frank discussions about our need to improve. We cannot change what we don’t measure and acknowledge. A significant component of this change is that we need to approach preventable harm as an opportunity to learn and fine tune the system. Frank and supportive discussions need to take place on how we must change so that no patient is hurt as a result of a hospitalization. I lead University Health Network – a health care system that includes acute care hospitals, rehabilitation facilities, and long-term care. In our health system, a community of nearly 20,000 care providers and volunteers work together to provide world class clinical care, innovative research and technology solutions to health problems, and education for 7,000 students a year in a variety of health disciplines. Our community is now committed to use our talent, expertise and resources to reduce and eventually eliminate preventable harm for the patients we serve. As a part of a structured transformation process, we have conducted a Speak Up for Safety survey that was carried out across the entire system. This safety survey tool has been used in healthcare organizations across North America and allows us to benchmark our safety cul-

T

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HOSPITAL NEWS JANUARY 2016

ture against hundreds of other hospitals and health systems and to monitor safety culture over time as we undergo our safety transformation. The response rate to our survey was extraordinary. Two of our hospitals achieved a 100 per cent response rate, with an overall response of 74 per cent at UHN. This is unequivocal evidence of the engagement of our organization around the commitment that we have made to our patients and the community that we serve.

In high reliability industries safety is a core value and employees are supported and trained to spot problems before they happen and take immediate action For critical insights on improving safety, we are looking to other industries that have made extraordinary safety improvements over the past 30 years. These industries include aviation, nuclear power, and chemical manufacturing – industries that have a relative complexity of the work environment similar to healthcare and where reliability and resilience have been hard wired into the workforce. Collectively, these industries have adopted practices known as high reliability. In high reliability industries safety is a core value and employees are supported and trained to spot problems before they happen and take immediate action. The lessons learned from success in other industries are applicable to healthcare. Two of the most important critical success factors in safety transformation are the presence of a CEO, who sees themselves as the Chief Safety Officer,

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GRAPHIC DESIGNERS

ANGEL EVANGELISTA CAROLINE PAPINEAU NICK MCGRAW RENATA VALZ JEFF CHARD ARUN PRASHAD ALICESA LAROCQUE KATHLEEN WALKER STEPHANIE GIAMMARCO BILLING AND RECEIVABLES

MATTHEW PICCOTTI PHIL GIAMMARCO

Dr. Peter Pisters is President & CEO, University Health Network. Follow him on twitter @ppisters

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

and constant engagement of the Board. Indeed, we have commitment from myself and the UHN Board to aggressively pursue this safety transformation. Our journey to improve safety will not be easy, nor will it be quick. And so, we have collaborated on this with peer hospitals including the Hospital for Sick Children, Sinai Health System, and Women’s College Hospital. This collaboration will help accelerate progress by allowing us to share approaches, resources and tools designed to make our hospitals safer for our patients and staff. Patients and staff will be part of a common safety culture that extends across our organizations. Safety is an implicit expectation that Ontarians have of our hospitals. For those who would like to read more about High Reliability Organizations I recommend two books – Why Hospitals Should Fly by J.D. Nance and Managing the Unexpected by Karl Weick and Karen Sutcliffe of the University of Michigan. The first is written in novel form and imagines what it would be like to work in a hospital that has adopted the principles of high reliability organizations. The second book is a seminal work that outlines the principles in more detail. We work with caring, concerned and dedicated people who want the best outcomes for their patients. By working together, speaking up for safety, and supporting our workforce to change practice and behavior, we can transform our organizations become stronger and more resilient over time. We hope that our efforts may precipitate a safety transformation that extends across the entire H health care sector in Canada. ■

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PROFESSIONAL DEVELOPMENT/CONTINUING MEDICAL EDUCATION/HUMAN RESOURCES

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Fostering a sense of community By Marie Sanderson ncil London spends his days at Sunnybrook assisting with audio-visual requests for the hospital’s 10,000 staff, volunteers and physicians. Every Wednesday evening, he hits the basketball court and blows off some steam for a couple of hours. What’s different about his basketball team? Ancil is sinking hoops with other Sunnybrook employees from across the hospital.

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The program’s overarching goal is to ensure staff are coming to work in the best possible mental and physical condition. Photo credit: Doug Nichoslon

“We’re literally an interdisciplinary team,” says Ancil, audio-visual technician at Sunnybrook, with a laugh. “The team is a mix of staff providing frontline care, support staff and everything in between. Thanks to the basketball team, I’ve built amazing friendships with people across the hospital that I would have likely never met under normal circumstances.” The basketball team is just one of several sports teams formed as a result of Sun-

Sunnybrook’s basketball team takes a short break from the court for a photo. Ancil London is pictured standing in the second row, far right. nybrook’s Quality of Work and Life Program. The program’s overarching goal is to ensure staff are coming to work in the best possible mental and physical condition. “Over the last few years, we’ve focused on building teams at work to develop, more and more, our sense of community,” explains Marilyn Reddick, Vice President of Human Resources, Organizational De-

velopment and Leadership at Sunnybrook. “Forming basketball, soccer, volleyball and hockey teams at the hospital has created a sense of fun, allowing staff to play together and keep stress in check.” Sports teams are not the only focus of the Quality of Work and Life Program. There are other wellness programs, including yoga, pilates and Zumba classes, as well

as onsite fitness centres at two of the hospital’s campuses. Another element includes fostering a family-friendly environment, with an on-site daycare at Sunnybrook’s largest campus and opportunities for flexible work schedules. The hospital strives to attract and retain staff with families, and was named as one of Canada’s Top FamilyFriendly Employers for several years in a row. And of course recognition and celebration are an important part of the program, with opportunities for development for all roles across the hospital. “By supporting life-long learning and career development through courses, financial assistance for education, and a culture where we are all teachers and learners, we are ensuring that you can live and grow your career at Sunnybrook,” says Reddick. “We want to ensure our staff are happy, challenged and rewarded for the hard work that they put in everyday.” For Ancil, the experience of bonding with fellow staff has helped contribute to his satisfaction at work. “I look forward to coming to work every day,” says Ancil. “It often feels like the people I work with are more than just colleagues, H they’re teammates.” ■ Marie Sanderson works in Communications and Stakeholder Relations at Sunnybrook Health Sciences Centre.

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JANUARY 2016 HOSPITAL NEWS


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Focus

PROFESSIONAL DEVELOPMENT/CONTINUING MEDICAL EDUCATION/HUMAN RESOURCES

Doctors without Borders:

Reflections from troubled waters By Dr. Simon Bryant hen Italy’s “Mare Nostrum� maritime SAR (search-andrescue) operation was terminated in November 2014, only a few Italian Coast Guard and passing merchant vessels remained as rescue resources for the deadliest refugee route in the world, the central Mediterranean from Libya to Italy. The resulting carnage was as terrible as it was preventable, with almost 1800 people perishing by the end of April 2015, while attempting to reach Europe in overcrowded, unseaworthy craft. Of course maritime SAR is only a band-aid solution to a tiny part of the overall situation. There are currently 60 million people worldwide, or 1 in 120, displaced from their homes by statesponsored violence, climate change effects such as drought and floods, repression, coldly-calculated terrorism, and crimes against humanity. The flow of

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Dr. Simon Bryant assists refugees rescued from the Mediterranean.

“irregular migrantsâ€? in 2015 is a global issue that is straining the European capacity to accept them. But in 2014 over 150,000 had attempted the central Mediterranean crossing, and in early 2015 there was no significant rescue capacity on hand. True to form, MSF (MĂŠdecins Sans Frontières/Doctors Without Borders) had already decided to intervene, having had projects in many of these refugees’ countries of origin since years prior. The two per cent mortality rate on the central Mediterranean migrant route was also impossible to ignore. MSF’s Amsterdam office therefore negotiated a partnership with MOAS (Migrant Offshore Aid Station), to rescue and provide medical and humanitarian care for these “boat peopleâ€?. MSF also intended to gather testimonies when possible and advocate for adequate SAR resources. Continued on page 7

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Focus

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Troubled waters

Continued from page 6

This would be the first-ever ship-based MSF project, on a 40-meter fishing boat adapted for SAR work, the Phoenix. This was also my first-ever MSF project, full of surprises despite an excellent preparation. Within 24 hours of setting sail on May 2nd we’d rescued 369 children, women, and men from one sinking wooden boat. After a long midnight pause to assist another 109 from an inflatable raft onto a nearby oil tanker, we headed north to Italy. In 28 repetitions of the same basic procedure over the summer of 2015, always according to the instructions of the Maritime Rescue Coordination Centre in Rome, we plucked 6,985 people from grossly overcrowded and unseaworthy wooden boats and inflatable rafts. I learned much about the “migration crisis”, MSF, SAR techniques, and humanity. The beneficiaries weren’t so much seeking a dream-future in Europe as fleeing an ongoing nightmare featuring war-related violence (e.g. in Syria and South Sudan), summary imprisonment and extortion (e.g. in Libya), systematic repression, military conscription and forced labour (e.g. in Eritrea), rape, widespread chronic poverty and unemployment, and terrorist atrocities. They came from a surprising number of countries. Many from Pakistan, Bangladesh, and the Philippines had worked in Libya for years before the utter collapse of civil order there forced them into the dangerous sea-crossing attempt. All those I encountered had no safe, legal way to apply for asylum, or even to return to their distant homes.

Over the summer of 2015 we plucked 6,985 people from grossly overcrowded and unseaworthy wooden boats and inflatable rafts. We diagnosed and treated conditions ranging from minor injuries to fatal carbon monoxide poisoning. Skin abscesses and scabies were commonplace, due to unhygienic conditions in transit and in detention in Libya. People were universally exhausted and for the first several hours aboard would often sleep soundly on the metal deck, often only to later report that it was the best rest they’d had in months, or even years. Seasickness was the rule rather than the exception, and late effects of torture and trauma were not uncommon. After encountering cases of hypertensive emergency and testicular torsion I thought no presentation would surprise me. I was truly astonished, therefore, to encounter a sick hemodialysis patient among those rescued. She’d had no treatments for three weeks since deciding to gamble her very last funds on the risky sea-passage, and was in trouble with shortness of breath, peripheral edema, and ominously tall peaked T-waves and dysrhythmia showing on our cardiac monitor. Intravenous calcium gluconate soothed her heart rhythm, followed by her helicopter evacuation to definitive care in Italy, which did much the same for mine. www.hospitalnews.com

Aging is not a challenge - it is a journey and we embrace it, learn from it and innovate to enhance how it is and will be experienced.

Certain persistent memories remind me of priorities:

On the sobering, darker side: fifty-two corpses tangled below deck in one wooden boat, victims of carbon monoxide and global indifference; one survivor of that incident, whom we intubated and transported to an eventual demise despite intensive care in Italy; and a helicopter crew searching the sea on August 5th, after 200 drowned when a wooden boat capsized. These dead people felt they had no other viable option. You and I, in their shoes, would have reached the same very unfortunate conclusion. On the inspiring, brighter side: in May 2015 the European Union effectively reinstated the rescue resources of the summer of 2014, and many lives were consequently saved; a man with a broken knee healed at ninety degrees of flexion, after a truck accident in the Sahara that killed 23 others, was assisted by his companions for months. Whenever I’d catch his eye he’d flash a wide smile accompanied by an enthusiastic “thumbs-up” gesture. Another rescuee had spent months in summary detention in Libya, having no money to bribe himself out, and no relatives to forward any. He was slow to respond, had the bilateral lower-limb edema of the severely protein-malnourished, a hemoglobin level about one-third of normal, and a look of death about him. His compatriots passing through that place raised the cash to bail him out, onto the tragic boat from which we rescued them all. Since my return home from the Mediterranean a few weeks ago there have been terrible killings in Beirut, Paris, and elsewhere, underscoring the urgent need for humanity, and not violence, to prevail. In the summer of 2015 our team on the Phoenix disembarked in Europe 6,877 women and men, and 108 clearly blameless persons below the age of five. I sincerely hope those children mature to enable a more humane world than H exists today. ■ Simon Bryant is a physician from Canmore, Alberta.

Migrant deaths in the Mediterranean by month 2014

2015

1400 1200

800 from Sunday 19 April

1000 800 600 400 200 0

Jan

Feb

Mar

Apr May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Source: IOM

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JANUARY 2016 HOSPITAL NEWS


8

Focus

PROFESSIONAL DEVELOPMENT/CONTINUING ONTINUING MEDICAL EDUCATION/HUMAN RESOURCES

Dealing with

workplace fatigue

By Henrietta Van hulle atigue in the workplace is an emerging health and safety issue that requires increased understanding of its impact and prevention. With its mandate to improve safety in the Ontario workplace, the Public Services Health and Safety Association (PSHSA) is taking major steps to improve how fatigue will be prevented and handled in the workplace. A link between fatigue and impacts on work performance has been shown and increasingly health care professionals are also taking steps to prevent and address fatigue as part of creating healthy work environments. Research has shown that more than 20 per cent of all serious incidents and negative patient outcomes are fatigue-related. Numerous factors may cause fatigue to develop including heavy patient load, shift work and a field that is always changing and evolving for nursing professionals. In addition stress from reduced budgets, staff scheduling and a slowing economy all go towards adding to an already stressful workplace. The organization itself suffers when its staff are subjected to fatigue which may result in increased absenteeism, turnover, and increasing Workers’ Compensation costs. This could also result in conflict between management and workers which only adds to the overall dysfunction and challenges. The recent classification of shift work as ‘probably carcinogenic to humans’ by the International Agency for Research on Cancer (IARC) and the 2013 research in Occupational & Environmental Medicine indicating that breast cancer risks are doubled for female long term night shift workers makes this a critical health issue to address. In nursing, when workers experience fatigue, it can cause lack of concentra-

F

tion which can lead to reduced situational awareness (SA) – the constant state of knowing what’s going on in your immediate environment, why it is happening and what is likely to happen next. Fatigue can also contribute to stress which may lead to poor decision-making and unintentional medical errors. In some situations fatigue can be addressed by getting sufficient sleep or leaving a stressful work environment; however, continuing a poor sleeping routine or not coping with the workplace environment will continue to contribute to ongoing chronic fatigue.

Research has shown that more than 20 per cent of all serious incidents and negative patient outcomes are fatigue-related.

The results of a joint CNA/RNAO national research study (2010) of more than 7000 RNs representing all sectors of health care indicated that: • Nurses working 12.5 hours or longer are found to be three times more likely to make an error. • Of the 7,000 nurses polled, 80 per cent feel tired after work. • Of the 7,000 polled, 55 per cent feel they are “almost always” tired at work. • On average, nurses work more than 40 hours a week. • During a 28-day study, every nurse involved worked at least one overtime shift.

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Acceptance and Commitment to Living and Dying Workshop January 31, 2016 (Sunday-full day) Conducted by Dr. Jane Smith-Eivemark, DMin

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HOSPITAL NEWS JANUARY 2016

• Two out of three nurses work 10 or more overtime shifts in 28 days. Implementing fatigue management strategies has had a positive impact in other sectors. Developing effective interventions relevant for the health care and community service sector is crucial. The Public Services Health and Safety Association is delving into the causes and consequences of fatigue across various sectors. We are looking to develop strategies to build awareness, address and mitigate fatigue which is emerging more as a workplace issue. As pointed out in the RNAO Best Practice Guideline “Preventing and Mitigating Nurse Fatigue in Health Care” a multipronged approach is needed with strategies from External/ System partners (like PSHSA), workplaces and individuals. Last month PSHSA announced it is providing leading work-related injuries researcher, Lora Cavuoto with Fatigue Science Readibands, a wearable wrist-worn technology that monitors sleep, activity and fatigue. The goal is to gather datadriven research to understand the impact of fatigue and implement innovative solutions to prevent it as a workplace hazard. Studies have shown that fatigue is about four times more likely to contribute to workplace impairment than drugs or alcohol, and a fatigued worker is at 70 per cent greater risk of accident than a nonfatigued worker. “We know that fatigue in the workplace is a major health and safety issue,” says Glenn Cullen, VP Corporate Programs and Product Development, PSHSA. “We need to learn how to prevent fatigue in the workplace and new technology like Fatigue Science Readibands will help us develop effective Fatigue Risk Management Programs. We are aiming to develop ways to intervene before fatigue becomes a risk to the health and safety of workers and control the hazard once it has been identified.” PSHSA is supplying researcher Cavuoto with Fatigue Science Readibands that provide 24/7 measurement of sleep patterns and mental fatigue. Wearing the Read-

ibands, study participants will be asked to perform a set of tasks, with participants’ natural variation in sleep-related fatigue and work-load factored in to the experiment. With this data, Cavuoto will be able to estimate fatigue based on work schedule, sleep and work conditions, and test these findings in a real-life scenario. The research will evaluate the interaction of sleep-based fatigue and workload in targeted industries that utilize shifts such as health care and emergency services. It will also evaluate fatigue mitigating interventions for the purpose of improving program effectiveness in the workplace. “Today, we have little understanding of when and how fatigue intervention should be implemented,” says lead researcher Lora Cavuoto. “This research partnership with PSHSA will allow us to build first-of-itskind fatigue interventions and customize them for particular industries, like healthcare, fire departments, police and mining to name a few.” Managing fatigue is key for maintaining a culture of quality and patient safety within our healthcare system. To reduce the damaging effects of that fatigue presents, workers must address the core issues and develop coping mechanisms. One should be aware of the root causes, symptoms and effects on body, mind and performance. The PSHSA fatigue study is scheduled to begin in early 2016. As a result of the study and learnings, PSHSA is looking forward to providing products and services to assist the workforce in Ontario with addressing this pervasive issue. Public Services Health & Safety Association (PSHSA) works with Ontario’s public sector workers and employers, providing occupational health and safety training, resources and consulting to reduce workplace risks and prevent workplace injuries H and illnesses. ■ Henrietta Van hulle is Executive Director, Health & Community Services, Public Services Health & Safety Association. www.hospitalnews.com


PROFESSIONAL DEVELOPMENT/CONTINUING MEDICAL EDUCATION/HUMAN RESOURCES

Focus

9

Runnymede’s Values In Action Award display brings recognition to the forefront

Promoting a positive workplace By Alison Terpenning

ecognition can make all the difference in promoting a quality work environment. With both the Long Service and Values in Action Awards, Runnymede Healthcare Centre recognizes the remarkable contributions of staff that ensure a positive experience for the hospital’s patients and fellow team members. The Long Service Awards recognize those staff members that have raised the bar with their commitment to Runnymede. Recognizing commitments of five, 10, 15, 20 and more years of commitment, these outstanding staff members contribute their years of knowledge and share this experience with everyone they work with. Margaret Tobin, whose 29 year commitment was recognized in 2015, says that “working at Runnymede is like being part of a community. All the years that I’ve spent here have allowed me to understand the hospital, and the unique needs of Runnymede’s patients. Being recognized for this experience makes me feel really appreciated.” The Long Service Awards also share the tight-knit community that has sprung up amongst staff at Runnymede Healthcare Centre. “Seeing their colleagues recognized for their long-standing contributions to Runnymede is inspiring to those working towards longer service milestones as well as new hires,” says Director of Human Resources Richard Mendonca. The Values in Action Awards continue to be an important part of recognizing staff members’ exceptional contributions towards making Runnymede Healthcare Centre a great place to work. These awards were established in 2012 and have since acknowledged the ways that recipients have exemplified Runnymede’s ICARE Values in the areas of Integrity, Compassion, Accountability, Respect and Excellence. The Values in Action Awards serve to recognize those staff members who have gone above and beyond the call of duty in their job performance, but there have been additional outcomes in the workplace culture since Runnymede began handing out www.hospitalnews.com

R

these awards. Chief Planning & Communications Officer Sharleen Ahmed explains that “since implementing the Values in Action Awards, there has been an increase in awareness of Runnymede’s values as we all work to incorporate those into our daily work. These values can be seen in action when someone offers a supportive ear to a patient; they take on extra work to make sure an event goes off without a hitch, or any of the many ways that people here contribute to making Runnymede an outstanding hospital and a special place to work.”

“We know from experience that sharing our appreciation for our team members brings everyone closer together and improves the overall workplace environment.” For Administrative Assistant Justyna Slazyk, receiving a Values in Action award in 2015 meant a lot more than just having a certificate to put on the wall. “Being nominated by my peers and recognized by the Awards committee felt like a big deal to me. Feeling recognized not just by my manager but other people that I work with made me feel motivated to work even harder.” “We know from experience that sharing our appreciation for our team members brings everyone closer together and improves the overall workplace environment,” says Ahmed. “These awards give everyone a chance to recognize some of our most dedicated staff and in turn, to strive further to bring Runnymede’s values to everything we do.” It’s not just staff that are being awarded. Runnymede’s positive workplace has been recognized by several industry awards, including receiving the Quality Healthcare Workplace Award (QHWA) three years running, as well as Exemplary Standing

from Accreditation Canada. The hospital has received a Leading Practice award from Accreditation Canada, which recognizes their commitment to promoting a culture of wellness and work-life balance. In October 2014 Runnymede embarked on a new strategic planning process and their dedication to staff is an integral part of the ambitious, five-year strategic plan, Vision 2020: Redefining Possible. The plan outlines Runnymede’s bold new vision, transforming healthcare together, and acts as a roadmap to achieving the hospital’s new strategic directions: You first; Lead innovation; Access and support; and Supporting transformation. You first is an important commitment. It reflects the hospital’s goal of putting

patients at the centre of decision-making processes in addition to ensuring that staff have the support the need to deliver an outstanding patient experience and enhance their own practice as a member of the Runnymede team. Runnymede recognizes that an investment in staff will foster a culture of clinical excellence, curiosity and innovation which are essential components of the hospital’s strategic directions and will pay dividends for patients now and in the future and ensure ongoing quality H improvement. ■ Alison Terpenning is a Communications Specialist at Runnymede Healthcare Centre.

Ontario Shores’ 5th Annual Mental Health Conference

Research, Recovery and Quality in Mental Health Tuesday, March 1 and Wednesday, March 2, 2016

This two-day conference will focus on new research in mental health and exploring issues in mental health care quality and promising quality improvement initiatives.

Featured Speaker:

Mark Henick Mental Health Advocate

Keynote speakers: Dr. Sandy Simpson, Dr. Ian Dawe, Nicholas Watters and Lee Fairclough.

For more information and registration details, visit: ontarioshores.ca/research. JANUARY 2016 HOSPITAL NEWS


10 Ethics

Ethics and HR practice:

Are two taxi chits good enough? By Kevin Reel

still recall the first time I received an email announcing a colleague was ‘no longer with the organization effective immediately’. I assumed there had been some egregious conduct leading to an immediate dismissal. I had never before encountered this ‘industry standard’ when firing a member of staff. When I spoke with other colleagues about it, I then found out there was no misconduct at all – there was a service redesign and someone’s post was deleted.

I

The odd relief I felt about the nature of the incident soon gave way to a creeping sense of dismay – why did this happen this way? Apparently it is the industry standard in much of Canada. It was not something I had known in the UK, at least not in the public sector. It has continued to happen with some regularity. Sometimes I lose colleagues with whom I have worked closely; on occasion I have even seen the signs of it coming where service changes or performance issues might be behind it. I have had friends

and family members experience it as well. It has sometimes seemed an appropriate change, but it has never felt right, for various reasons. First of all, there is the impact this practice can have on the person at its centre. Some people might see it coming; a few might even feel it is a welcome relief (as is suggested by some of the advice on the internet from HR consulting agencies). I have seen some friends struggle with profound depression and anxiety, loss of self-esteem and increasing hopelessness

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HOSPITAL NEWS JANUARY 2016

after being ‘walked out’. In discussions with them, it is typically the process more than the result that is the source of their distress. Those infamous taxi chits often become the central joking point – the recognition that the process might cause such deep upset that it is considered ‘caring’ (or less than negligent?) to offer a taxi ride home and then another when you come to fetch your belongings on another day. Such caring might be an effort in certain industries. In an industry like healthcare it amounts to little. Surely we can do better given what we know of the way human interactions happen? The other reasons I feel this practice is often morally wrong are to do with the enduring damage to the organization itself, and the effects it has on the remaining staff. While much of the commentary one can find on various websites about this recommended practice centers on avoiding harm to the organization, it seems (from my limited experience) that many of the concerns identified are rarely addressed. Yes, the legal ramifications are typically front and centre. The lingering sense of dismay and distrust across the organization are left to fester. The stories of dismissal become part of a folklore that is shared for years – among old and new staff. Ultimately, it would seem to me that the primary ethical problem is the absurd shift in status it confers upon a person. One moment you may be entrusted with the health, well-being and confidential personal health information of thousands of people. Ten seconds from now, after the uttering of a few key words, you are persona non grata. You may even be a licensed healthcare professional, but you are so unworthy of trust you must be removed immediately. (I do not include here any situations of egregious conduct – only those where someone is no longer required or wanted for lesser reasons). The convenience of this practice speaks to its popularity. The lack of imagination associated with it is glaring – especially in healthcare, where values are purported to play an important role in the way hospitals work. These values typically include such laudable aims as respect, compassion, caring, teamwork, trust, communication, excellence and innovation. It escapes me how these are applied in those situations where an employee is subjected to taxi chit termination. Perhaps there is evidence that this is clearly the best practice – in all the situations where it is applied. Or perhaps we are applying the tactic in a manner akin to off-label prescribing – convinced by someone selling the idea that it is a wise practice here, too. I for one would hope that the values we espouse in our work with our patients and our colleagues might suggest some alternative ways of caring about people when hard decisions are taken. That humane and innovative institutional character we show the world in our mission statements and the like ought to govern our sense of an appropriate inwardH looking countenance as well. ■ Kevin Reel is an Assistant Professor in the Department of Occupational Science and Occupational Therapy at the University of Toronto. www.hospitalnews.com


INSIDE

SPECIAL PROFESSIONAL DEVELOPMENT SUPPLEMENT See page P1

PROFESSIONAL DEVELOPMENT/CONTINUING MEDICAL EDUCATION/HUMAN RESOURCES

Focus 11

This is Part 1 of our 3 Part Series on

Effective working relationships between hospitals and physicians

Effective working relationships between hospitals and physicians:

Themes from the literature he Ontario health care system is in a period of significant transformational change. In order to continue driving the shared objective of a high-performing, integrated and sustainable health care system, a positive relationship between hospitals and physicians at all levels is critical. The enhancement of the partnership between hospitals and physicians will result in greater levels of satisfaction and engagement on the part of physicians working within robust and high-performing hospitals, which will improve both patient care and patient safety.

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It is essential to create administrative structures and collaborative approaches to problemsolving that facilitate more effective engagement of physicians in all aspects of hospital operations. The importance of these relationships and their impact on the sector prompted the Ontario Hospital Association (OHA) to identify hospital-physician relations as one of its three areas of thought leadership. Working collaboratively with other health system stakeholders such as the Ontario Medical Association (OMA), the OHA has set objectives that will: • Identify cultural and structural barriers to the improvement of relationships; • Develop strategies to champion innovative models to engage physicians in hospital leadership; and • Improve hospital-physician alignment to enhance patient care and patient safety. Currently, there is limited data regarding the current status of hospital-physician relationships in Canada. To better understand the issue, the OHA conducted a comprehensive review of the literature which explored: • Attitudes of physicians and hospital www.hospitalnews.com

management towards a better alignment of purposes; • Factors affecting hospital-physician relationships; and • Strategies to enhance the alignment between physicians and hospital management. The literature review canvassed Canadian, American and international research. While the nature of the legal relationship between physicians and hospitals varies across jurisdictions (i.e., employer-employee, independent contractor, or other models), the research highlights consistent themes that influence the working relationship between physicians and hospital management. The research also provides some insight into successful strategies for enhancing physician engagement; however, local solutions may need to be tailored to individual circumstances and working environments. Additional research focused within Ontario will be helpful to better understand the strategies that hospital management and physicians are currently using to foster effective relationships. To this end, the OHA has been conducting member surveys and informational interviews with selected physician leaders and hospital management to determine the current state of hospital-physician relationships in Ontario, and to ascertain barriers and relevant best practices from a provincial perspective. Following the review, seven considerations for leaders to reflect upon to successfully foster and maintain positive relationships emerged: 1. Supporting a culture of trust, respect and collaboration. The foundation for building constructive and collaborative relationships is to create a culture of trust and respect among hospital boards, administrative leaders and physicians. To do that, it is important to understand and address the underlying characteristics and values important to physicians, (autonomy, time restrictions, and different styles of decision-making). Ultimately, there must be a shared commitment that promotes management’s understanding of what physicians require to pro-

vide quality patient care, and physicians’ understanding of hospital governance, management and government/legislative requirements 2. Creating shared purpose and values among hospital boards, administration and physicians. Creating a shared purpose (mission, vision and values) with active participation by all stakeholders promotes ownership of a common agenda for all stakeholders and helps to ensure that work is driven by a shared platform of consensus and commitment to common objectives. Roles, responsibilities and accountabilities should be clearly articulated and mutually respected. 3. Communicating effectively. Effective communication among hospital boards, management and physicians is critical in creating a culture of trust. Given that physicians value evidence-based data, investing in information technology can provide physicians with meaningful data to facilitate their understanding of and involvement in hospital issues. Equally important is the need to provide timely opportunities to openly discuss sensitive issues. 4. Providing support and education to develop management skills for physicians.

An environment that identifies and supports physician leaders, and provides opportunities for individual and collective leadership growth, should be developed. Physicians taking on leadership roles benefit from training in key areas such as change management, finance and leadership development. 5. Enhancing organizational structures and processes to support and encourage clinical leadership. It is essential to create administrative structures and collaborative approaches to problem-solving that facilitate more effective engagement of physicians in all aspects of hospital operations. Administrative decision-making should be evidence-based, impact-sensitive, outcome-oriented, fair, transparent, and timely. 6. Encouraging and empowering physicians to take leadership roles in the design, implementation and evaluation of a broad range of hospital and system initiatives. Relationships are enhanced where physicians participate in decision-making at all levels of the organization, and are provided with meaningful opportunities to participate in the design, implementation and evaluation of hospital initiatives. Continued on page 19

Perspectives on Communication Competency

ANNUAL SYMPOSIUM

Explore the relationships, challenges and opportunities in communication competency and practical language skills for professional practice, with international experts from: • • • •

Medical education Applied linguistics Health care practice Professional regulation

February 23, 2016 MaRS Collaboration Centre Toronto, Canada

www.perspectives2016.com JANUARY 2016 HOSPITAL NEWS


INSIDE

SPECIAL PROFESSIONAL DEVELOPMENT SUPPLEMENT See page P1

PROFESSIONAL DEVELOPMENT/CONTINUING MEDICAL EDUCATION/HUMAN RESOURCES

12 Focus

Improving psychological health and safety in the health sector By Susan Anderson, Jennifer Kitts, Sandra Koppert and Ed Mantler ill is exhausted. She and her partner, Paul, are struggling with childcare because of her shiftwork. Paul is unexpectedly – and hopefully only temporarily – unemployed. Jill’s arm is still sore and stiff, days after a patient struck her, and now there is that little bit of anxiety every time she approaches a patient to deliver care. Between the pressures at home and work, sometimes she feels like she’s on auto-pilot. Jill is really distracted and hoping that Paul finds employment soon.

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Health sector workers are 1.5 times more likely to be off work due to illness or disability than people in all other sectors. Andrew is a new manager at his facility and is just back to work after taking a week off to get his parents moved from another province into an assisted living arrangement in the town where he lives. His teen-aged son is starting to get into trouble at school; he’s had two calls from the Principal just this week. Today, two of his staff called in sick; one just went off on short term disability. He’s not sure how he’s going to balance home, his parents and his new position. He’s not feeling himself at all. Do either of these scenarios seem familiar to you? Maybe you know a “Jill” or an

Many health care workers report that tiredness, exhaustion, or sleep deprivation negatively affects the care they deliver. “Andrew”? A person’s mental health can be affected by everyday life and stressors, including those experienced in the workplace. Chances are that you, or someone you work with, is struggling and may have

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a mental health problem or illness; 1 in 5 Canadians do. Workplaces are central to our lives; many of us spend more time with our colleagues than we do our families. Many Canadian workers report rising stress levels, increasing work pressures, and challenges balancing competing work and family demands. In fact, in any given week, 500,000 Canadians won’t go to work due to mental illness. Today, 30 per cent of disability claims and 70 per cent of disability costs are attributed to mental health related situations. Between $2.97 and $11 Billion per year could be saved by creating psychologically safer and healthier workplaces. The picture isn’t pretty and we know that things can be even more challenging in the health sector: • Health sector workers are 1.5 times more likely to be off work due to illness or disability than people in all other sectors. • Over 40 per cent of Canadian physicians report that they are in the advanced stages of burnout – a critical condition for Canadian nurses and other health care workers. • Stress, anxiety, depression, burnout and substance misuse are work-related conditions reported by Canadian healthcare workers. • Many health care workers report that tiredness, exhaustion, or sleep deprivation negatively affects the care they deliver. An organizational culture that puts employees’ psychological health and safety on a level playing field with physical health

and safety will cultivate engaged, supported and more satisfied employees along with safer and more effective patient care. Research suggests that integrating patient and employee safety can lead to better safety practice and outcomes. While the issue of workplace mental health isn’t unique to Canada, one solution is – the National Standard of Canada for Psychological Health and Safety in the Workplace (Standard). The first of its kind in the world, the Standard is a set of guidelines, tools and resources for an organization to focus on promoting employees’ psychological health and preventing psychological harm due to workplace factors. Following the launch of the Standard in 2013, many Canadian organizations of all sizes and sectors have answered the call to commit to building a mentally healthy workplace by implementing the Standard, in whole or in part. For example, HealthCareCAN, a national organization representing hospitals and health care organizations, released a position statement strongly encouraging its Members and all health system stakeholders to adopt the Standard. A catalyst for our continued work and building on the momentum of the policy, the Mental Health Commission of Canada (MHCC) and HealthCareCAN have been working in partnership to advance workplace mental health in the health sector and to increase uptake of the Standard in hospitals and healthcare organizations across the country, including a series of cohosted roundtables across Canada. The Mental Health Commission of Canada (MHCC) is also carrying out a case study project, which is tracking over 40 organizations in the private and public sectors as they implement the Standard. Of the participating organizations, 18 are in the health care sector, comprising the largest sector represented in the study. HealthCareCAN and MHCC have commissioned research involving an in-depth analysis of the 18 health sector organizations to identify promising or unique factors (barriers or enablers) related to implementing the Standard. Findings from this research will be shared and will provide insight into and motivation for other hospitals and healthcare organizations to start their journey implementing the Standard. Watch for more details in future issues of Hospital News as our work unfolds in 2016. To learn more about MHCC’s and HealthCareCAN’s efforts and next steps, visit http://www.healthcarecan.ca For more information on the Standard and its implementation guide, and to download both for free, visit www.mentalH healthcommission.ca ■ Susan Anderson is Senior Policy Analyst and Jennifer Kitts, Director, Policy and Strategy, at HealthCareCAN. Sandra Koppert is Program Manager, Prevention and Promotion Initiatives and Ed Mantler is Vice President, Programs and Priorities at Mental Health Commission of Canada. www.hospitalnews.com


THE 14TH ANNUAL

Development & Education

SUPPLEMENT

www.hospitalnews.com

JANUARY 2016 HOSPITAL NEWS


P2

Professional Development and Education

First Simulation Centre devoted to training mental health care professionals opens By Sandeep Dhaliwal On November 30, 2015, the Centre for Addiction and Mental Health (CAMH) and the recently established Medical Psychiatry Alliance (MPA) celebrated the launch of a unique mental health training centre to help health professionals care for patients with complex mental health needs more effectively. Called the Simulation Centre, the new education hub is located at CAMH and will provide a safe learning environment for students, trainees, and health professionals to explore their clinical practice and test new approaches to treating combined physical and mental illness. While simulation training has been well-established in physical health specialties such as surgery and anesthesiology, the new Simulation Centre at CAMH is the first of its kind in Canada to focus primarily on mental healthcare. “There’s not enough opportunity to rehearse aspects of learning before you actually confront it with your patients and clients,” says Dr. Ivan Silver, Vice President, CAMH Education. “It’s a missing ingredient in mental health – we do a lot of learning on the job, but we need better ways to prepare clinicians before they actually need to use a skill in practice.” The Simulation Centre is supported by the Medical Psychiatry Alliance, a collaborative partnership between CAMH, the

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At the official opening of the Simulation Centre at CAMH. From left to right: Dr. Ivan Silver, Vice President, CAMH Education; Dr. Catherine Zahn, President and CEO,CAMH; Dr. Benoit Mulsant, Executive Director, Medical Psychiatry Alliance; and Dr. Trevor Young, Dean, Faculty of Medicine, University of Toronto. University of Toronto (U of T), the Hospital for Sick Children and Trillium Health Partners, with the goal of transforming mental healthcare in Ontario. The new training centre supports the MPA’s man-

date to transform the delivery of mental health services for patients suffering from both physical and mental illnesses. In Ontario, 1.3 million people suffer from combined physical and mental health illnesses. In many cases, treatment of these patients fails because health care professionals are trained to focus on either physical or mental illness but not both at the same time. As a result, physical symptoms with a mental health origin can often go unaddressed.

Called the Simulation Centre, the new education hub is located at CAMH and will provide a safe learning environment for students, trainees, and health professionals to explore their clinical practice and test new approaches to treating combined physical and mental illness. To meet the challenge of treating people with complex mental and physical health care needs, the MPA is creating a new model of integrated care that includes a new approach to the education of health care professionals. The Simulation Centre at CAMH will train health care staff using the new model of care. Dr. Benoit Mulsant, MPA Executive Director and Chair of the Department of Psychiatry at the U of T, says it’s his hope “that in the years to come, we will have trained our health professionals to integrate mental and physical care so that it becomes the norm to do in our health care system.” In addition to hands-on mental health training available within the Simulation Centre, the MPA is rolling out other continuing education initiatives in the coming year to help health professionals care for this population of patients. In collaboration HOSPITAL NEWS JANUARY 2016

with Trillium Health Partners and U of T, the MPA plans to offer a medical psychiatry certificate program to equip current health professionals already working in their respective fields with the skills and resources needed to better treat patients suffering with both mental and physical illnesses. The MPA is already transforming curriculum in U of T’s Undergraduate Medical Education program so that future health leaders will be better equipped to care for patients in a more integrated health care model. “If we want to teach innovative models of care, we need new tools andapproaches,” says Dr. Mulsant. Established in January 2014 through a $60 million grant, the MPA has a six-year mandate. During this time, the MPA aims to: • Improve quality of life and increase life expectancy for those with serious, simultaneous mental and physical illnesses, while reducing the burden of illness on families, the healthcare system and society • Create a new model of clinical care to support patients with both mental and physical issues • Teach current and future health professionals how to prevent, diagnose and treat mental and physical illness within a novel integrated care model • Deepen our understanding of the interaction between body and brain regarding co-morbid mental and physical illnesses. For more information, please visit www. H medpsychalliance.ca. ■ Sandeep Dhaliwal is a Senior Communications Advisor with the Medical Psychiatry Alliance (MPA). Supported by The Centre for Addiction and Mental Health (CAMH), The Hospital for Sick Children, Trillium Health Partners and the University of Toronto (U of T) in conjunction with the Ministry of Health and Long-Term Care and an extraordinarily generous donor, the MPA is dedicated to transforming the delivery of mental health services for patients who suffer from physical and psychiatric illness or medically unexplained symptoms. www.hospitalnews.com


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Teaching quality improvement in residency education Dr. Roger Wong reveals what the launch of his new e-book means for medical educators and residents across Canada By Kerry Blackadar hen it comes to making improvements in the health care arena, Dr. Roger Wong, Associate Dean of Postgraduate Medical Education at the University of British Columbia, knows medical residents have a key role to play. But what’s the best way to equip the next generation of medical practitioners with the skills and knowledge needed to improve clinical processes and patient care over the course of their training and medical career? A recently released e-book, Teaching Quality Improvement in Residency Education, sheds light on teaching quality improvement (or QI) in the health care setting, a topic that has garnered increased attention from postgraduate medical education programs across the country in recent years.

W

The user-friendly publication, which offers practical tips and tools for teaching (and assessing) QI competencies, represents a culmination of years of medical education research by Dr. Wong. Developed in partnership with the Royal College, the new resource was officially unveiled during the 2015 International Conference on Residency Education, which was held in Vancouver last fall. We recently sat down with Dr. Wong to find out where his passion for teaching QI began, and what his e-publication means for medical educators and residents across Canada.

When did the idea for this e-publication emerge?

Years ago, before my time as the Associate Dean of Postgraduate Medical Education at UBC, I served as the associate

As the HIM profession evolves, so does the program The Health Information Management profession is one of constant change. The Centre for Distance Education offers a dynamic HIM program that recognizes the needs of both industry and the students. Last year was the introduction of the Mock National Certification Exam to assist CD-ED students in their preparation for this intense exam credentialing HIM professionals. This was exceptionally well received, and students were thankful for this opportunity to practice for the exam. The Mock NCE was then expanded to be offered at a minimal cost to HIM students from any HIM program. The uptake and positive response indicates that this is a valued resource for all HIM students in Canada. With the success of this first “learn it online now” project, CD-ED has expanded their LION professional and personal development offerings to now include a Classifications module. In this self-directed module, enrollees progress from an introduction to the 2 primary classification systems used in Canada (ICD10CA and CCI) to applying the codes to real records while adhering to national standards at www.learnitonlinenow.com In recognition of the diversity of students, and their life experiences, CD-ED is planning for the 2016 implementation of a part-time option that will allow the students to take 3 years to complete the HIM program. This will allow those students who are balancing work life and their personal life to now also take on a challenging academic program and be successful. We are so pleased for and proud of Dr. Shapoor Shayegani. Dr. Shayegani is the first and only Canadian who holds the prestigious title of IHTSDO Consultant Terminologist (http://www.ihtsdo.org/participate/consultant-terminologist-program). This is a fabulous recognition of Shapoor’s expertise, and we are privileged to have him as an instructor with the CD-ED Health Information Management Program.

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Dr. Roger Wong. program director of the Internal Medicine Residency program. At that point in time, the topic of quality improvement was beginning to gain a lot of attention in the medical community, and there was certainly a strong appetite at UBC to develop a QI curriculum to teach residents. So I decided to take on the task. Back then, very little had been written about the subject of teaching and assessing QI competencies, so I knew taking on the project would be challenging, and offer an opportunity to be quite innovative. After implementing the new QI curriculum within the UBC environment, my colleagues and I began to share our thoughts and experience with medical educators from across the country. By 2007, I had received national recognition for my work, earning the Royal College’s Donald Richards Wilson Award, which recognizes those who have demonstrated excellence in integrating the CanMEDS roles into a Royal College training program. Our QI curriculum continued to catch the attention of a lot of people – including the Royal College’s Dr. Jason Frank, Director of Specialty Education, Strategy and Standards, who recommended that I partner with the Royal College to write a book about teaching QI to residents. Not one to turn down an opportunity, I agreed and worked with the Royal College to develop the e-book. Looking back, although it was a lot of work, I’m so glad I took on the project – I had the opportunity to meet and work with a very talented pool of people from both within the Royal College, as well as the UBC environment.

What can readers expect to take away from your book?

While many people recognize the importance of continuous improvement in the quality of care delivered in healthcare and in medicine, a lot of times, what they may not realize is how essential it is to teach our up-and-coming physicians and surgeons about QI – it’s a skillset and competency that must be taught like any other. The intention of this book is to provide a user-friendly guide for medical educators

looking to develop and implement a QI curriculum. The publication covers everything from setting learning objectives to assessing competencies and curriculum evaluations (at the foundational and advanced level). Readers will walk away with a host of tips, lessons learned, and assessment tools that they can download and modify to meet their specific program needs. Another big feature of this book is that it is very resident focused and looks at how trainees can be engaged and inspired to get involved in the important work of quality improvement in the health care setting. At the 2015 International Conference on Residency Education (ICRE), where the new CanMEDS framework was launched, the book was positioned as one of the tools that can help residency programs implement competency-based curriculum.

Why are you passionate about this topic?

As a medical educator, I have the pleasure of meeting and working closely with residents. And over the years, many have come to me with stories and examples of processes in clinical settings that they feel are not working as effectively or efficiently as they could be. At first, they feel quite discouraged about what impact they can make ‘as just residents’ – but after being exposed to the QI curriculum, and learning about some of the methodology and tools at their disposal, I see a huge change in their outlook – they feel empowered. By teaching future doctors how to do quality improvement work, we are empowering them with tools to make a change for the better of healthcare, and their patients. So, for me, QI is really a fundamental skillset that makes a huge impact, and being able to publish and share what I’ve learned about QI with other medical educators and residents is very exciting. Copies of Dr. Wong’s e-book, Teaching Quality Improvement in Residency Education, are available on the Royal College’s H website. ■ Kerry Blackadar is a Communications Coordinator, Faculty of Medicine, The University of British Columbia. www.hospitalnews.com


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Professional Development and Education

It’s Your Education Grab a Front Row Seat Ever dozed through a monotone lecture in a dusty lecture hall? No more. Education should be engaging, interactive, and facilitated by industry thought leaders. You’ll want to get a front row seat for these programs. The Ontario Hospital Association (OHA) offers 50+ certificate courses to help health care professionals acquire the knowledge and skills necessary to face the challenges of today’s health care climate. These programs help more than 1,400 professionals from the industry, including front-line staff, human resources, emerging leaders and more.

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Advance Elder-Care in your organization, Join the ACE Collaborative. The Canadian Foundation for Healthcare Improvement (CFHI), in partnership with the Technology Evaluation in the Elderly Network (TVN), is inviting applications from healthcare delivery organizations to participate in a quality improvement collaborative focused on spreading innovative elder-friendly care practices. Too often in Canadian healthcare, promising innovations remain isolated pockets of excellence. Any organization working to improve patient care, health outcomes and value-for-money should ask: “What’s out there that works?” The Acute Care for Elders (or ACE) collaborative will support participating healthcare delivery organizations across Canada and internationally with the implementation, evaluation and spread of proven evidence-informed elder-friendly care practices. The ACE collaborative responds to what those working in healthcare across Canada and internationally are telling us they need in order to kick-start sustainable improvement at the service delivery level: seed funding, an evidence-based program and coaching to support the implementation of specific elder-friendly practices. Benefits of Joining the Collaborative • Up to $40,000 in seed funding to implement the initiative • CFHI collaborative support with the implementation, evaluation and spread of proven evidence-informed elder-friendly care practices • Peer-to-peer networking and exchange among the entire cohort • Monthly team educational webinars • Support for performance measurement and evaluation • An in-person workshop to foster cross-team learning and sharing • Access to a network of expert faculty coaches, including Dr. Samir Sinha and his team who have led the ACE Strategy at Mount Sinai • Individual coaching to ensure a rapid pace for testing change and troubleshoot, as needed • Access to online learning tools and activities • Award winning strategy recognized by Accreditation Canada as leading practices. For more information on joining the ACE collaborative, visit cfhi-fcass.ca/ACE. Deadline for application is February 1st, 2016.

Great Minds Meet Here Welcome to Your Next OHA Conference Think of the last time you felt truly inspired. Imagine if you could multiply that productive energy by 100. Or even 1000. There’s nothing more invigorating than a room bursting with great ideas and energy for change. The Ontario Hospital Association’s (OHA) conferences are designed with this in mind. Built by members and for members, our conferences offer participants an opportunity to share leading practices and information about industry-wide issues and trends.

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JANUARY 2016 HOSPITAL NEWS


P10 Professional Development and Education

Anaesthesiologists advance medical education in Canada By Niki O’Brien n September, three anaesthesiologists from the University of Ottawa were awarded a World Federation Of Societies of Anaesthesiologists (WFSA) Innovation Award for the creation of online tools to support a competency-based anaesthesiologist residency programme. Dr. Christopher Hudson, Dr. Viren Naik and Dr. Emma J. Stodel designed the learner driven programme in response to the evolving needs of graduate medical education and 21st century healthcare. “Calls for reform in how physicians are trained have been longstanding,” explains Dr. Emma Stodel, “In many of the current systems, programs define the successful completion of training based on the length of time a trainee is in a program, assuming that trainees will develop the required competencies to practice after a predetermined amount of time.” “However, the restrictions around resident duty hours, pressure to reduce costs associated with resident training, and the need for improved accountability for patient safety, have led many countries to consider a competency-based approach to medical education.” Rather than focusing on the length

I

Dr. Naik teaching in simulation. of time a resident is in training, as is the case with existing programs, the new tools focus on attaining specific competencies required of an anaesthesiologist to ensure positive patient outcomes. “The online tools identify the abilities

EDUCATION AT THE INTERSECTION OF HEALTH, BUSINESS, AND TECHNOLOGY

People become healthcare professionals to help make people better. The DeGroote School of Business at McMaster University is working hard to make healthcare better by helping health professionals and administrators attain the leadership and management skills they need to deliver care more effectively. The healthcare sector is burdened by business processes designed by clinicians and technology designed for business processes – not patients. Healthcare management sits at the intersection of health, business, and technology and the DeGroote School is able to draw on McMaster’s faculties of Engineering and Health Sciences to provide a truly interdisciplinary approach to health management. The variety of health management programs available at the DeGroote School means that there is something for everyone in the health sector. In addition to the well-known MBA specialization in Health Services Management, the School offers an MSc in eHealth, and Masters in Health Management, a PhD in health policy and a suite of health-specific leadership and development programs for healthcare executives. Coming soon: The DeGroote School of Business will be adding a Health Management area of study to its existing Business PhD program. This new area of study will also be offered on a part-time basis allowing health management professionals earn a doctorate without interrupting their careers.

For more information about all of DeGroote’s programs, visit www.DeGrooteSchool.ca/ programs HOSPITAL NEWS JANUARY 2016

required of the physician and then design the curriculum to support the achievement of them. This paradigm defies the assumption that competence to practice as a fully rounded physician is achieved based on time spent on rotations and instead requires residents to demonstrate the competencies deemed necessary for patient care,” Dr. Stodel explains. For some trainees, this may require more time than the typical programs, while others may be able to accelerate their training and enter the workforce earlier or engage in further specialized training. One key component of the program is the Clinical Case Assessment Tool (CCAT), an online resident-driven assessment used throughout the program. “The resident’s self-assessment is shared with the staff who assess performance on a behaviourally anchored scale ranging from “Staff had to do” to “Staff did not need to be there” and documents their assessment based on what was done well, what needs to be improved, and next steps for learning,” Stodel explains. The tool increases face-to-face feedback to residents and allows data to be easily analyzed and interpreted for learning, research, and quality improvement purposes. Another element of the program is a series of learning cases, completed by residents during the ‘Core of Discipline’ stage of their program starting seven months into their training. The learning cases are designed to replace traditional academic half-days. Unlike academic half-days, Drs. Hudson, Naik and Stodel’s learning cases are linked to the module the resident is in so residents learn topics most relevant to them at the time. The learning cases are based on the format of the Royal College of Physicians Surgeons Canada (RCPSC) oral examinations. Residents are provided with a case scenario followed by questions to direct their learning and selected resources. They are then expected to spend time engaged in self-directed learning for each case, followed by a meeting with a staff anaesthesi-

ologist to discuss the case and are assessed against an expected level of competence. “By reviewing the topic before interacting with staff, the staff-resident discussions can be at a more advanced level, mirroring a ’flipped classroom’,” according to Stodel. Learning cases are delivered through a custom-built electronic system that stores and manages access to cases, tracks completion, and documents assessment. Data from this system will be automatically fed into in-training evaluation reports (ITERs) so evaluators know whether module requirements have been satisfied, as well as to a central dashboard that will provide a summary of resident progress. Five months into the new program anecdotal comments from staff indicate that the program residents are more skilled and more confident than residents from the traditional program at this stage of training. “The biggest impact we have seen since the introduction of the above tools is the engagement from the faculty. Utilizing the electronic CCAT, the faculty are feeling empowered to provide more specific and detailed learning assessments. Anonymous survey results suggest that the culture change related to CBD methodology has improved the quality of their assessments,” says Dr. Stodel. As the WFSA Innovation Awards encourage and support innovation in anaesthesiology that has had, or is likely to have, a positive impact on surgical patient outcomes, the creators’ intention is to share the electronic tools they developed with other departments and institutions across Canada was looked upon very favourably. “Innovation in the field is a large part of improving standards in anaesthesia care globally. Recognizing and rewarding innovation is good for medical staff and patients and will have a positive impact on future generations,” adds Julian GoreH Booth, Chief Executive of the WFSA. ■ Niki O’Brien is a Communications Officer at The World Federation Of Societies of Anaesthesiologists. www.hospitalnews.com


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JANUARY 2016 HOSPITAL NEWS


SPECIAL PROFESSIONAL DEVELOPMENT SUPPLEMENT P12 Professional Development and Education Hospital News Delivered To Your Inbox!

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If you’re a health care professional, you’ll agree: there just aren’t enough hours in the day. Today’s fast-paced world leaves little time for traditional classroom learning. Yet, modern technology affords health care professionals the convenience of staying current with the latest issues and trends, from the comfort of home or workplace.

Effective committees can assist employers in reducing the risk of occupational illness and injury

The Ontario Hospital Association (OHA), a leading industry authority, offers more than 60 broadcasts per year on a variety of health-related topics. With live broadcast programming, it’s more convenient than ever to excel in your career.

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The Public Services Health and Safety Association is an approved training provider and all trainers are specialized in the hazards of the health and community services sector. There are a variety of delivery options for Part 1 and Part 2 Certification Training and both courses can be bundled for extra savings. Training is available across Ontario. If you complete training before the new standard takes effect on March 1, 2016, you will be certified for life and can take your refresher training on your own terms. Call 1-877-250-7444 or book at pshsa.ca/jhsc. Talk to one of our consultants in your area today and get more for your health and safety budget.

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HOSPITAL NEWS JANUARY 2016

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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.

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 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,

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.

The JHSC Standard is Changing. Learn More: pshsa.ca/jhsc

Bundle Cert 1 & 2 and save. Call 1-877-250-7444 to register and talk to a Regional Consultant. www.hospitalnews.com

JANUARY 2016 HOSPITAL NEWS


SPECIAL PROFESSIONAL DEVELOPMENT SUPPLEMENT P14 Professional Development and Education

Online e-learning

Courses for cancer screening and Aboriginal cancer care By Erin MacFarlane earning and development is important in any industry, but it’s particularly crucial for health care professionals to continuously enhance their knowledge on key topics. That’s why Cancer Care Ontario has launched an e-learning platform for the health care community. Available at elearning.cancercare.on.ca, the accredited online courses are free of charge and can be accessed by clinical and administrative staff across the province anytime, from anywhere. The courses are accredited for MainproM1 credits by the College of Family Physicians of Canada (CFPC) and the Ontario Chapter and focus on Cancer Screening and Aboriginal Relationship and Cultural Competency courses. They were developed based on discussions with experts and an expressed interest in building knowledge in these specific areas. “Offering online courses ensures that we’re able to reach all health care providers across Ontario, regardless of their geo-

L

graphic location,” says Dr. Suzanne Strasberg, Provincial Primary Care Lead, Cancer Care Ontario. “The courses give doctors, nurses and health care administrators the chance to increase their understanding of Ontario’s organized cancer screening programs and guidelines as well as key issues faced by Aboriginal Ontarians. Ultimately, this contributes to an improved patient experience and better quality of care.” Cancer Care Ontario is offering four cancer screening courses to help primary care providers better understand Ontario’s guidelines for breast, cervical and colorectal screening, including limitations and benefits. Each course takes about 30 minutes and is accredited for 0.5 Mainpro-M1 credits. Nine Aboriginal Relationship and Cultural Competency courses are designed to enhance knowledge of First Nations, Inuit and Métis history, culture and the health landscape to improve patient experience and person-centred care. The courses are geared to health care providers, professionals, administrators and others working with First Nations, Inuit and Métis com-

munities. Eight of the courses take about 60 minutes and each is accredited for 1.0 Mainpro-M1 credits, and one course takes about 30 minutes to complete and is accredited for 0.5 Mainpro-M1 credits. “What we often hear in the communi-

Cancer Care Ontario is offering four cancer screening courses to help primary care providers better understand Ontario’s guidelines for breast, cervical and colorectal screening, including limitations and benefits. ties we work with is that there’s a desire to create a greater understanding of the unique needs of First Nations, Inuit and Métis people,” says Alethea Kewayosh, Director, Aboriginal Cancer Control, Cancer Care Ontario. “One of the priorities in our Aboriginal Cancer Strategy is to continue

building productive relationships and educate healthcare professionals about the distinct needs of these communities. Our hope is that these Aboriginal Relationship and Cultural Competency courses will help enhance the healthcare experience for many First Nations, Inuit and Métis cancer patients and caregivers across the province.” In September, Cancer Care Ontario launched the third Aboriginal Cancer Strategy (ACS); a four year plan that guides how the organization works together with partners to improve the performance of the cancer system for First Nations, Inuit and Métis people. ACS III is a direct deliverable of the Ontario Cancer Plan IV and reflects the shared priorities of Cancer Care Ontario, the Regional Cancer Programs and First Nations, Inuit and Métis communities. Healthcare professionals can visit elearning.cancercare.on.ca to learn more about Cancer Care Ontario’s online H e-learning courses and register today. ■ Erin MacFarlane is a Communications Advisor, Cancer Care Ontario.

WE MADE ROOM FOR EDUCATION. WILL YOU? Tight budgets. Hectic schedules. High travel costs. When it comes to continuing education for busy professionals, there are plenty of challenges and not enough solutions. Until now.

TAKE A VIRTUAL TOUR oha.com/educationcentre

To make education more accessible, the Ontario Hospital Association (OHA) has recently launched a state-of-the-art Education Centre, a 12,000 square foot facility located in downtown Toronto. Employing a sophisticated suite of broadcast technology, the Education Centre allows the 55,000+ health care professionals who attend our programs annually to participate virtually from any location.

HOSPITAL NEWS JANUARY 2016

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Professional Development and Education P15 PROGRAMME D’ACCÈS AUX SERVICES DE SANTÉ POUR LES IMMIGRANTS

PASSI Pour mieux performer sur le marché du travail

Celebrating 10 Years of Governance Excellence

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ÊTES-VOUS UN PROFESSIONNEL &'.#5#06Ǻ(14/ǺDZ.ŦǺ64#0)'4ş! PASSI vise à vous offrir une formation spécialisée ainsi qu’une assistance pour faciliter votre intégration sur le marché du travail ontarien dans votre domaine d’expertise. For the past 10 years, the Governance Centre of Excellence (GCE) has supported health care and not-for-profit boards with education programs and thought leadership tools and resources.

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Ů d’occasions de réseautage » Visites en entreprise » Conférences » Rencontres Ů de possibilité de stage avec des travailleurs.

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parcoursfrancophone@collegelacite.ca 613 742-2475 | 1 800 267-2483, poste 2475

During this milestone year, we’d like to thank our supporters and invite you to celebrate this occasion with us! Sign up for a chance to win one of many great prizes, including: •

$100 Starbucks Gift Cards

$100 Oliver & Bonacini Gift Cards

Keurig 2.0 K400 Brewing System

To sign up, visit thegce.ca/subscribe

Inspire and change lives. Apply now for one of our Health and Wellness Studies programs. Several of our programs are offered in both the fall and winter or in a compressed format, and all of our full-time programs feature field placement components and practical labs for hands-on learning. ( ( ( ( ( ( (

Esthetician Food and Nutrition Management (fall/winter) Healthcare Environmental Services Management Pharmacy Technician (fall/winter) Massage Therapy (fall/winter – compressed) Fitness and Health Promotion (fall/winter – compressed) Workplace Wellness and Health Promotion (fall – two sites)

Continuing Education programs: ( Reflexology ( Athletic Taping (for Registered Massage Therapists) ( Medical Esthetics for Nurses

For more information on any of our offerings, please visit centennialcollege.ca/community-health or call 416 289-5000 x 8068.

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See where experience takes you. JANUARY 2016 HOSPITAL NEWS


P16 Professional Development and Education

Engaging Belief and Practice

Spiritual Care CPE/PCE Training Chaplaincy & Ethics Social Justice Focus Inter–Religious Dialogue

Master of Pastoral Studies 2 yr Program – 20 courses Streams in Spiritual Care and Social Ministries for Christians, Muslims, Buddhists and others (CRPO Stream forthcoming)

Multi-Religious Approaches to Spiritual Care at Emmanuel College

Do you have a passion for social justice? Are you interested in exploring matters of religious practice and belief, and gaining expertise in spiritual care and counselling? Do you have a vision for holistic care? The Master of Pastoral Studies (MPS) program at Emmanuel College offers students the opportunity to gain skills in spiritual care, theological analysis and approaches to mental health and well-being. The MPS has a number of streams in spiritual care and social ministries for Christians, Muslims, Buddhists and others. With an emphasis on inter-religious dialogue, this professional master’s degree prepares students for careers in the non-proďŹ t sector and in a variety of settings such as hospitals, prisons and educational institutions. Graduates can also be certiďŹ ed with the Canadian Association for Spiritual Care (CASC). The MPS provides a wealth of opportunities for those from different religious backgrounds who wish to integrate belief and practice. Emmanuel College also offers a Diploma in Buddhist Mindfulness & Mental Health, and an Applied Buddhist Studies Initiative (ABSI) starts January 2016 in collaboration with the Buddhist Education Foundation of Canada. The MPS: Muslim Studies program is an initiative that stems from Emmanuel College’s goal to foster dialogue between Muslims and Christians, and others within the larger community. Emmanuel College continues to work on developing a stream to coordinate with the new College of Registered Psychotherapists of Ontario. Emmanuel College Principal Mark Toulouse writes, “These programs naturally emerge out of the College’s vision which recognizes that concepts of justice, goodness and love are larger than any one particular religion or tradition can fully deďŹ ne by itself.â€? These programs emphasizing spiritual care in a variety of religious traditions are the ďŹ rst of their kind in Canada.

Diploma in Buddhist Mindfulness & Mental Health Part–time Program – 6 courses

Emmanuel College is a theological college of Victoria University in the University of Toronto. Emmanuel provides an education characterized by rigorous theological inquiry, contextual analysis, commitment to justice, and inclusive practice.

www.emmanuel.utoronto.ca

www.emmanuel.utoronto.ca

OSGOODE PROFESSIONAL DEVELOPMENT CONTINUING LEGAL EDUCATION

Osgoode Professional Development (a division of Osgoode Hall Law School at York University), provides lifelong learning programs for lawyers and other professionals, including those working in the health care sector. We have a diverse range of programs ‒ from one hour to 5 days ‒ developed by and for health professionals. Whether you’re looking to get an update on recent developments or develop a solid foundation with one of our intensive FHUWLoFDWHSURJUDPVOsgoodePD’s experienced faculty of leading health and legal experts will equip you with the knowledge, strategies and practical skills you need to advance your career.

What past attendees have said: “The information in this course should be mandatory in all health care training programs� Janice Janz, RN, University Health Network – Toronto Western Hospital 7KH2VJRRGH&HUWLoFDWHLQ+HDOWK/DZ

“Well organized. Dynamic and knowledgeable presenters. I would recommend this to all health professionals and legal counsel who work in liability, risk management and patient safety.� Deborah Perry, Risk Management Consultant, Eastern Health 7KH2VJRRGH&HUWLoFDWHLQ&OLQLFDO5LVN1HJOLJHQFHDQG&ODLPV 0DQDJHPHQWLQ+HDOWK&DUH

“This was a very informative education session. My charting ZLOOEHQHoWJUHDWO\IURPDWWHQGLQJWKLVFRXUVHy Dawn Bunnett, Belleville Nurse Practitioner 'RFXPHQWDWLRQDQG&KDUWLQJIRU1XUVHV

Learn more: osgoodepd.ca/HNhealthlaw HOSPITAL NEWS JANUARY 2016

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Professional Development and Education P17

Part-Time Studies in Human Services Opens Doors

PART-TIME CERTIFICATES

Humber’s School of Social and Community Services is dedicated to delivering more than education. Pathways are available that allow full- and part-time students to reach their academic and career goals. Do you want to help change lives? Programs and courses offered in Human Services give you a chance to make a difference in your community. Certificates in Crisis Intervention and Counselling, Case Management, Psychosocial Rehabilitation and Children’s Mental Health are featured on the continuing education platform. Whether it is to upgrade skills or add to existing ones, individuals can take courses towards these certificates on a part-time basis. Part-time studies offers a great way to try out a new career path while working. Understanding the importance of flexibility in helping students pursue their academic goals, the school provides classes during times that are convenient for people juggling work and life responsibilities. With ever-increasing online learning options, students can study from virtually anywhere. Part-time courses could help you advance your career through the acquisition of new skills. Your employer may even offer tuition reimbursement for your continuing education. With over 200 part-time courses, Humber’s School of Social and Community Services offers the critical courses to learn what is needed in today’s world. Program topics range from Settlement Counsellor to Managing in the VAW (Violence Against Women) Sector to Child Welfare and Forensic Practice. Course offerings include Responding to Abuse, Suicide Prevention, Urban Sociology, Physical Aging, Wellness and Promotion of Abilities among many others. Promises Derek Stockley, Dean of the School of Social and Community Services, “We are dedicated to delivering more than an education - we are changing lives.� Visit us at communityservices.humber.ca/ce to find out more.

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Make Plans, Not Resolutions Take Charge of Your Education This Year The health care industry is complex and ever-changing, and the beginning of each year provides a perfect opportunity to evaluate your career. The Ontario Hospital Association (OHA) is committed to providing premium tools and training for busy health care professionals, offering flexible education opportunities, such as: • Virtual and blended learning sessions let you attend in-person or from the comfort of workplace or home • Over 50 certiďŹ cate programs provide practical workplace applications

• Online training modules offer a convenient and affordable way to train staff • New Education Catalogue allows you to view all programs at-a-glance

• Online certiďŹ cate courses provide a cost-effective and easily accessible training option

LEARN MORE oha.com/catalogue

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JANUARY 2016 HOSPITAL NEWS


P18 Professional Development and Education

George Brown College helps dental assistant progress to a new level When Faye Fu decided to go to George Brown College to upgrade her dental assistant skills, it wasn’t about increasing her salary or competing with her colleagues – it was about self-betterment. “I took the courses for my personal interest. It was for me – I felt no pressure to do it,” says Faye. With medical practices, technology and dental office needs constantly evolving, Faye wanted to improve her skillset. George Brown’s Dental Assistant Level II Upgrade Certificate proved to be the right program for Faye. “I trust George Brown. It is a highstandard community college,” says Faye. “The times work so well because it is every other Saturday and Sunday. I don’t have to skip my work, it doesn’t bother my job and I still can have weekends to do my stuff.” Faye found the courses to be a perfect combination of hands-on patient work and dental office reality – with the teacher walking students through clinical sessions and building up their dental theory, skills and confidence.

It has been a pleasure to serve you in 2015, and we look forward to serving you in the future.

Happy New Year! From all of us at Hospital News!

Faye Fu

Taking the upgrade certificate not only helped Faye pass the National Dental Assisting Examining Board (NDAEB) exam – it has allowed her to smoothly adapt to more challenging tasks at the dental office where she works. Above all, the courses helped Faye reach her personal goal of self-development. “The certificate has opened me up to many more opportunities … What I do now is more advanced and I can do more intra-orally,” she explains. “It’s a good challenge, to learn something new and go ahead. Honestly, it was wonderful.”

To learn more about the Dental Assistant Level II Upgrade Certificate, visit coned.georgebrown.ca/health.

Professional development opportunities for health professionals Continuing Education at George Brown College George Brown College has a range of certificates that are geared to health professionals and offered on a part-time basis through Continuing Education. Courses for these certificates start this January: t%FOUBM"TTJTUBOU-FWFM**6QHSBEF t)FBMUIBOE/VUSJUJPO t)FBMUI1SPNPUJPO t)FBMUI3FDPSET t)FBMUI4FSWJDFT.BOBHFNFOU

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For more information, contact us at 416-415-5000, ext. 2126, or cecommunity@georgebrown.ca.

HOSPITAL NEWS JANUARY 2016

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Professional Development and Education P19

St. Michael’s doctor develops skills test for surgical residents By Greg Winson technical exam for colorectal surgery fellows piloted by a St. Michael’s physician could lead to a paradigm shift in certification for all surgical fellows. Surgical residents are currently assessed on their knowledge through written exams and for their judgment through oral exams. However, there is no formal assessment of technical skill at the time of certification. Dr. Sandra de Montbrun, a colorectal surgeon, has been working with the American Society of Colon and Rectal Surgeons to develop a technical skills exam for the purpose of certification in the United States. “This is the first time that any North American surgical society has moved forward with developing a technical skills exam with the purpose of certification for high stakes assessment,” says Dr. de Montbrun. Implementing this sort of test could lead to improved patient outcomes. “If we can identify the residents who show deficiencies in technical skill and remediate them during their training, there is a potential impact on patient care,” she adds. The technical exam takes place in a surgical skills lab setting and is made up

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of eight different technical skill tasks. The students are observed by an examiner who evaluates their performance. She has led three pilot studies to prove the validity of the technical exam. The first study, held at the University of Toronto in 2011, compared general surgery residents to colorectal residents. “We found there was a difference in their performance, giving some initial evidence of validity to the test,” says Dr. de Montbrun. The results from the second pilot study suggested that this exam identifies technical deficiencies in people who would otherwise go on to be certified with the current board certification process. For 2014, the Colorectal Objective Structured Assessment of Technical Skill, or COSATS, exam became a mandatory component for certification for the American Board of Colon and Rectal Surgery. It was the first time in North America that a technical skills exam was a required component for certification. “The purpose of the exam was to collect data on the exam itself,” says Dr. de Montbrun. “Candidates were not assigned a pass/fail status, but we had to administer it to the entire cohort of people to get an idea of what the data would look like with the entire group of examinees taking their board exam.” The results of this most

Dr. Sandra de Montbrun evaluates a surgical fellow in the Allan Waters Family Simulation Centre skills laboratory. recent pilot have been submitted for publication. There is no timetable for the COSATS exam to become a permanent component of The American Board of Colon and Rectal Surgery exam. At the same time, the American College of Surgeons is inter-

Photo by Katie Cooper

ested in moving forward with a technical exam for general surgery training in the United States. The Royal College of Physicians and Surgeons of Canada does not yet have plans to incorporate the COSATS into H Canadian certification. ■

JANUARY 2016 HOSPITAL NEWS


P20 Professional Development and Education

Sunnybrook Simulation Centre welcomes patients to help train medical students By Alexis Dobranowski here’s an extra set of eyes and ears providing a unique perspective to students in the Sunnybrook Canadian Simulation Centre: a patient. The new initiative has a patient volunteer participating in a simulation scenario for third-year medical students on anesthesia rotation. The patient volunteer interjects during the simulation in order to help students articulate why an x-ray wouldn’t be required in this situation. She then shares her own story about a surgical experience and also provides feedback to the students. The first volunteer, Ruth Milikin, says she’s delighted to be taking part. “There’s so much anxiety that comes with being a patient,” she says. “I’m reminding the students to take a moment to reassure the patient, answer questions, and be open with the time line – even just that can help. Giving a sense to the patient that you know their history, having a kindly disposition and listening. Really, that’s number one: listening.” Medical student Ali Damji said he hopes having patients involved in training becomes a standard. “This is real-time feedback. We don’t often – or ever – sit with a patient and get feedback on how we are doing,” Ali says. “By involving a patient in our simulation session, we are reminded this is a person.

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Third-year medical student Ali Damji receives feedback from patient Ruth Milikin after a simulation session. This is their life. This is their family member and they might be scared or upset.” Ruth helped remind him that even explaining why he may only have two minutes to talk can help allay a patient’s fears. It’s something he will try to communicate better with patients in the future, he says. “Some of the most fantastic teachers are our patients,” Ali adds.

Empower Yourself and Your Staff with Online Training Modules From Accessible Customer Service Standards to Wound Care and more, the Ontario Hospital Association’s (OHA) range of online modules will enable you to train yourself and your staff efficiently and within budget. These online training modules empower participants through self-paced independent learning. The interactive modules enrich the learning experience, while program quizzes assess and enhance students’ knowledge. A variety of learning styles are addressed through text, audio, video and instructive activities.

“Patients need a voice and this is an effective way to do it. I’m honoured to have the opportunity to be involved in this, and have a positive impact on the future of medicine.” Involving patients in education activities is one of several ways Sunnybrook is creating meaningful opportunities for engaging patients and families in the unique activities of an

Photo credit: Doug Nicholson

Academic Health Sciences Centre – research, education, patient care, and administration. “By engaging patients and families in all aspects of Sunnybrook, we can gain powerful insight and use that to improve the experiences for all of our patients,” says VP, H Communications Craig DuHamel. ■ Alexis Dobranowski works in communications at Sunnybrook Health Sciences Centre.

CFHI Inviting Applications from Organizations to Build Capacity, Enhance Leadership, Deliver Improvement

The Canadian Foundation for Healthcare Improvement is calling for motivated organizations to apply to EXTRA: Executive Training Program, the only bilingual, pan-Canadian improvement fellowship in Canada. The 14-month program builds leadership and organizational capacity to achieve breakthrough, sustainable innovations that achieve better care, better health and better value. Teams of three to four leaders, from one or more organizations, work collaboratively to design, implement and evaluate an evidence-informed improvement project addressing a pressing clinical, organizational, regional or provincial/territorial challenge. EXTRA is grounded in the complex reality of leading and managing in today’s health and healthcare environments. Teams work with CFHI faculty and coaches to tackle healthcare challenges such as addressing the needs of a target population; designing a new product, process or service; improving an existing process or service; spreading a promising practice; and -developing a framework or infrastructure for improved governance, management or quality. Since its launch in 2004, the EXTRA Program has supported more than 300 healthcare professionals from 120 organizations across Canada.

LEARN MORE oha.com/onlinemodules

EXTRA’s 2016 cohort will comprise up to ten organizations to take part in the program, beginning in April 2016. This year, CFHI is encouraging applications from, and will create space for, up to three organizations focusing on palliative care.

Learn more about the program and how to apply by February 15, 2016 at cfhi-fcass/EXTRA.

HOSPITAL NEWS JANUARY 2016

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Professional Development and Education P21

The best way to care for her may be to participate in this collaborative. Apply now to the ACE collaborative.

The Acute Care for Elders (ACE) Collaborative is funding innovative, new ways to provide care for older Canadians. Join and beneďŹ t from support.

Deadline February 1st, 2016 cfhi-fcass.ca/ACE

CFHI is a not-for-proďŹ t organization funded by the Government of Canada.

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JANUARY 2016 HOSPITAL NEWS


P22 Professional Development and Education

Centre for People Development supports hospital staff By Calyn Pettit earning has always been central to work and life at Hamilton Health Sciences. Supporting and developing our people is a key part of our strategic plan – to engage, enable and empower our people to deliver on our mission of providing excellent healthcare for the people and communities we serve and to advance healthcare through education and research. The Hamilton Health Sciences Centre for People Development is making a significant contribution to achieving this objective by providing staff and physicians at Hamilton Health Sciences with formal learning opportunities to help them grow and enhance their leadership ability. At Hamilton Health Sciences we believe in the notion of a leader in every chair. Leadership is not a title, it is a being: regardless of the role we all lead. “Our staff and physician engagement surveys have underscored how much our staff and physicians value development opportunities. The Centre for People Development, which opened in May, 2015, was built with extensive stakeholder consultation. It was designed to provide learning opportunities that strengthen our people’s ability, individually and collectively, to perform with great ability and care with great

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compassion. We live in an ambiguous and changing world, we must continue to grow, develop, think differently and be agile and adaptableâ€?, says Andrew Doppler, Vice President, Human Resources. Offering learning and development opportunities to staff, formal leaders and physicians, the centre offers a wide range of programming in leadership, quality and performance, compassion and resilience and team performance. Some programs include Mindfulness Based Stress Reduction, Personal Power and Resilience, Leading Organizational Change and Team Simulation Based Learning focused on important clinical priorities such as early detection of sepsis. The Centre is unique from other providers of formal development, as it incorporates the following: • facilitators who are recognized experts in their field and also appreciate the challenges of the health care environment • learning that is practical, blended and focused on adult learning principles • treats the learner as a “whole beingâ€? • a learning environment where new learning can be practiced/applied immediately in people’s operating context • the opportunity to network with other health care professionals across disciplines and roles • a curriculum that reflects strategic and operational goals of the organization

Danielle Fry, occupational therapist at McMaster Children’s Hospital, is one of more than 11,000 Hamilton Health Sciences staff who now have access to specialized, unique professional development programming through the hospital’s Centre for People Development. Courses are also open to non-HHS employees.

• a curriculum that reflects what our people say they need and want The Centre reflects the very latest thinking on what separates high performing leaders (formal and informal) from average leaders. “Leaders want to get better in the here and now, not to be judged against a competency map or be sold an abstract theory about what leadership should look like‌ Leadership development is more about application than theoryâ€? (Warner, 2015). Evaluations strongly indicate that the

Hamilton Health Sciences Centre for People Development is delivering this type of learning, offering relevant, engaging programming that directly translates into enhanced performance. For more information please contact Kathryn Adams, Organizational Development Specialist, Hamilton Health SciH ences. â– Calyn Pettit works in Public Relations & Communications at Hamilton Health Sciences.

Welcome to the online health care career destination for employers and job seekers. Employers Post jobs and connect with the industry’s best and brightest. Job Seekers Create an account, sign up for job DOHUWVDQGĆQG\RXUFDUHHULQKHDOWK care today!

healthscapejobs.ca: A Destination for Health Care Careers

HOSPITAL NEWS JANUARY 2016

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Professional Development and Education P23

Broaden Your Nursing Horizons with Durham College’s Mental Health Nursing Program ,Q DQ\ JLYHQ \HDU RQH LQ ÀYH &DQDGLDQV H[SHULHQFH D PHQWDO KHDOWK RU DGGLFWLRQ SUREOHPDQGDOPRVWDWKLUGRI &DQDGLDQVZKRVHHNPHQWDOKHDOWKFDUHUHSRUWWKDW WKHLUQHHGVDUHXQPHWRUSDUWLDOO\PHW *LYHQWKHVHVWDWLVWLFVOLFHQVHGUHJLVWHUHGQXUVHVDQGUHJLVWHUHGSUDFWLFDOQXUVHV 51 531 QHHGWRSRVVHVVWKHNQRZOHGJHUHTXLUHGWRWUHDWSDWLHQWVVXIIHULQJIURPPHQWDO KHDOWK LVVXHV 'XUKDP &ROOHJH¡V 0HQWDO +HDOWK 1XUVLQJ SURJUDP SURYLGHV QXUVHV RSHUDWLQJRQWKHIURQWOLQHVZLWKWKHWUDLQLQJWKH\QHHGWREHVXFFHVVIXOLQWKHLUÀHOG 7KH SURJUDP EDVHG RQ WKH 6WDQGDUGV IRU 0HQWDO +HDOWK 1XUVLQJ LQ &DQDGD SUHSDUHV51531VZLWKWKHRUHWLFDONQRZOHGJHDQGKDQGVRQFOLQLFDOSUDFWLFHDQG LVDVVRFLDWHGZLWKWKH2QWDULR6KRUHV&HQWUHIRU0HQWDO+HDOWK6HUYLFHVLQ:KLWE\ 2QWDVLWVWUDLQLQJSDUWQHUDQGFXUULFXOXPFROODERUDWRU $UHDVRI VWXG\ZKLFKDUHFRPSOHWHGRQOLQHFRQVLVWRI ÀYHWKHRU\FRXUVHVKRZHYHU VWXGHQWV PD\ FKRRVH WKH ,QWHUSURIHVVLRQDO 3V\FKRJHULDWULF %HVW 3UDFWLFHV HOHFWLYH ZKLFKLVRIIHUHGDVDQLQFODVVFRXUVHDW2QWDULR6KRUHV7KHSURJUDPDOVRLQFOXGHV DFOLQLFDOFRPSRQHQW8SRQFRPSOHWLRQJUDGXDWHVZLOOEHJUDQWHGDPHQWDOKHDOWK FHUWLÀFDWHLQGLFDWLQJWKH\DUHHTXLSSHGZLWKWKHVNLOOVQHFHVVDU\WRDVVHVVSURYLGH LQWHUYHQWLRQVDQGDGYRFDWHIRUPHQWDOKHDOWKFOLHQWVLQDYDULHW\RI LQVWLWXWLRQDODQG FRPPXQLW\VHWWLQJV 7KRVHSUDFWLFLQJLQWKHKHDOWKFDUHVHFWRUQHHGWRHQVXUHWKH\FDQPHHWWKHQHHGVRI  WKRVHVHHNLQJKHOS8SJUDGLQJDQGH[SDQGLQJ\RXUVNLOOVHWLVWKHÀUVWVWHSWRZDUGV DLGLQJWKRVHZKRVXIIHUIURPPHQWDOKHDOWKSUREOHPV

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Stress, Anxiety, and Depression Special Seminar To Be Held Insomnia, obesity, and diabetes are the consequences of excessive stress. 7KH VFLHQWLĂ€FDOO\EDVHG VL[KRXU VHPLQDU ´6WUHVV $Q[LHW\ DQG 'HSUHVVLRQÂľ H[DPLQHV WKH FDXVHV RI DQG WUHDWPHQWV IRU VWUHVVEDVHG GLVRUGHUV 7KH VHPLQDU examines how stress affects the brain and predisposes patients toward cardiovascular disease, dementia, and hormonal disorders. 7KHVHPLQDUH[DPLQHVZK\VWUHVVLVDNLOOHURI UHVLGHQWVRI 1RUWK$PHULFD It shows how stress can affect memory and learning. The seminar presents ideas for the management of stress and examines how stress LV UHODWHG WR YLVLWV WR D GHQWDO RIĂ€FH 7KH VHPLQDU H[DPLQHV WKH UROH RI  VWUHVV LQ marriage, sex, and suicide. It covers medications used to treat stress. 7KHVHPLQDUZLOOEHSUHVHQWHGE\RQHRI 1RUWK$PHULFD¡VOHDGLQJSV\FKRORJLVWV'U 0LFKDHO+RZDUG 3K'  The seminar will be presented three times in the Ontario Province: Wed., May 11, 2016, Best Western Lamplighter Inn, 591 Wellington Road South, London, Ontario; Thu., May 12, 2016, Radisson Hotel, 55 Halcrown Place, Toronto, Ontario; and Fri., 0D\&RXUW\DUG7RURQWR1(0DUNKDP:RRGELQH$YHQXH0DUNKDP 2QWDULR2QHDFKGDWHWKHVHPLQDUWLPHVZLOOEH$0WR30 7KH VHPLQDU LV VSRQVRUHG E\ WKH %LRPHG &RUSRUDWLRQ 1RUWK $PHULFD¡V ODUJHVW provider of live seminars for health professionals. Biomed neither solicits nor receives any gifts or grants from any entity.

To obtain more information about the seminar, please contact Biomed, 3219 Yonge Street, Suite 228, Toronto, Ontario M4N 2L3. 9LVLW%LRPHG·V:HEVLWHDWZZZELRPHGJOREDOFRP 7HOHSKRQH WROOIUHH RU   )D[  (PDLOLQIR#ELRFRUSFRP

Careers in health-care Get the qualiďŹ cations you need to further your career in these areas: • Advanced Wound Care • Child Development Practioner • Children’s Mental Health • Dementia Studies – Multidiscipline • Diabetes Worker/ Educator • Food Service Worker • Foot Care Advanced and Diabetes • Gerontology • Hospital Nursing Unit Clerk

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CONTINUING EDUCATION WWW.DURHAMCOLLEGE.CA/CONED www.hospitalnews.com

JANUARY 2016 HOSPITAL NEWS


P24 Professional Development and Education BIOMED PRESENTS...

STRESS, ANXIETY, & DEPRESSION A Seminar for Health Professionals TUITION $109.00 (CANADIAN)

Instructor:

Michael E. Howard, Ph.D.

The seminar registration period is from 7:45 AM to 8:15 AM. The seminar will begin at 8:30 AM. A lunch (on own) break will take place from 11:30 AM to 12:20 PM. The course will adjourn at 3:30 PM, when course compleWLRQFHUWL¿FDWHVZLOOEHGLVWULEXWHG Registration: 7:45 AM – 8:30 AM Morning Lecture: 8:30 AM – 10:00 AM z The Three Brains. Pathways for Stress, Anxiety, and Depression. z Brain Adaptation and Genetics. How Early Adverse Experiences and Genes Affect the Risk for Stress. z Sympathetic and Parasympathetic: The Automatic Yin and Yang of Stress. z Stress and Stressors: Does the World Stress Us or Do We Stress Ourselves? z Stress and Life: Has Chronic Stress Become the Biggest Killer of North Americans? z Why Zebras Don’t Get Ulcers: The Upside and Downside of the Thinking Brain. Mid-Morning Lecture: 10:00 AM – 11:30 AM z The Brain Structures of Stress: Hypothalamus; Pituitary Gland; Sensory and Frontal Cortex; Amygdala; and the Hippocampus. z Men, Women, and Stress. Important Gender Differences in the Stress Response. z How Chronic Stress Creates Two Opposing and Dangerous Conditions: ,QÀDPPDWLRQDQG,PPXQRVXSSUHVVLRQ3RVWWUDXPDWLF6WUHVV'LVRUGHU 376'  z Chronic Stress and Life-Threatening Diseases: Cardiovascular Disease, Diabetes, Autoimmune Disorders, and Alzheimer’s Disease. z The Obesity Epidemic: Does Chronic Stress Create Big Waistlines? z Stress, Marriage, and Immunity: Is Marriage Healthier for Men or Women? z Sleep Disturbance: $0DMRU&DXVHRI,QÀDPPDWLRQDQG6WUHVV5HODWHG'LVHDVH" Lunch: 11:30 AM – 12:20 PM Afternoon Lecture: 12:20 PM – 2:00 PM z Brain and Body Aging. Does Chronic Stress Accelerate Aging and Shorten Lives? z Memory, Learning, and Stress. How Stress Causes Forgetfulness. Chronic Stress and Brain Damage. Hypochondria: When Fear of Being Sick Becomes an Illness. z The Basics of Stress Management. z Achieving Tranquility. The Magic of Mindfulness Meditation. z Dental Management of Patient Stress. Distractions, Control, and Expectations. Getting a Root Canal and Catching a Cold. Are They Related? z Major Anxiety Disorders: Causes; Symptoms; and Treatments. z Anxiety Medications: SSRI’s; SNRI’s; Benzodiazepines; Buspirone; Tetracyclics; Tricyclics; Propranolol and Prazosin; The Role of Morphine. Mid-Afternoon Lecture: 2:00 PM – 3:20 PM z Dental Anxiety: How Prevalent? Dental Use of Eugenol and Olfactory-Induced Anxiety. z Stress and the Biology of Depression. Stress Hormones and Neurotransmitters. z Depression, Sex, and Suicide. Do Antidepressants Raise the Risk? z Seasonal Affective Disorder (SAD). Does Light Therapy Really Work? z Bipolar Disorder: When Depression Is Not Really Depression. Mania Vs. Hypomania. z Treatment of Bipolar Disorder: Can This Be Cured? Evaluation, Questions, and Answers: 3:20 PM – 3:30 PM

6 CONTACT HOURS / www.biomedglobal.com

MEETING TIMES & LOCATIONS LONDON, ON

TORONTO, ON

Wed., May 11, 2016 8:30 AM to 3:30 PM Best Western Lamplighter Inn 591 Wellington Road South London, ON

Fri., May 13, 2016 8:30 AM to 3:30 PM Courtyard Toronto NE Markham 7095 Woodbine Avenue Markham, ON

CHEQUES: $109.00 (CANADIAN) with pre-registration. $134.00 (CANADIAN) at the door if space remains. CREDIT CARDS: Most credit-card charges will be processed in Canadian dollars. Some charges will be in U.S. dollars at the prevailing exchange rate. Note: some Canadian banks may add a small service charge for using a credit card. The tuition includes all applicable Canadian taxes. At the seminar, participants will receive a complete course syllabus. Tuition payment receipt will also be available at the seminar.

ACCREDITATION 7KLVSURJUDPLVGHVLJQHGWRSURYLGHQXUVHVZLWKWKHODWHVWVFLHQWL¿FDQG clinical information and to upgrade their professional skills. Numerous registered nurses in Canada and the United States have completed these courses. This activity is co-provided with INR. Institute for Natural Resources (INR) is an approved provider of continuing nursing education by the Virginia Nurses Association, an accredited approver by the American Nurses’ Credentialing Center’s Commission on Accreditation.

PHARMACISTS

Pharmacists successfully completing this course will receive FRXUVHFRPSOHWLRQFHUWLÂżFDWHV%LRPHGLVDFFUHGLWHGE\WKH$FFUHGLWDtion Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. The ACPE universal activity number (UAN) for this course is 0212-9999-16-002-L01-P. This is a knowledge-based CPE activity.

DIETITIANS

CPE Accredited Provider

Biomed, under Provider Number BI001, is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RD’s) and dietetic technicians, registered (DTR’s) will receive 6 hours worth of continuing professional education units (CPEU’s) for completion of this program/materials. Continuing Professional Education Provider Accreditation does not constitute endorsement by CDR of a provider, program, or materials. CDR is the credentialing agency for the Academy of Nutrition and Dietetics (AND).

PSYCHOLOGISTS &RXUVHFRPSOHWLRQFHUWLÂżFDWHVZLOOEHGLVWULEXWHGWRSV\FKRORJLVWV completing this program. This activity is co-provided with INR. INR is approved by the American Psychological Association to sponsor continuing education for psychologists. INR maintains responsibility for this program and its content.

SOCIAL WORKERS

This activity is co-provided with INR. Social Workers completing this SURJUDPZLOOUHFHLYHFRXUVHFRPSOHWLRQFHUWLÂżFDWHV7KLVSURJUDPLVDSSURYHG by the National Association of Social Workers (Provider #886502971-1419) for 6 social work continuing education contact hours.

Dr. Michael E. Howard (Ph.D.) is a full-time psychologist-lecturer for INR. 'U+RZDUGLVDERDUGFHUWLÂżHGFOLQLFDOQHXURSV\FKRORJLVWDQGKHDOWKSV\FKRORJLVW who is an internationally-recognized authority on brain-behavior relationships, traumatic brain injury, dementia, stroke, psychiatric disorders, aging, forensic neuro-psychology, and rehabilitation. During his 30-year career, Dr. Howard has been on the faculty of three medical schools, headed three neuro-psychology departments, and directed treatment programs for individuals with brain injury, dementia, addiction, chronic pain, psychiatric disorders, and other disabilities. Biomed reserves the right to change instructors without prior notice. Every instructor is either a compensated employee or independent contractor of Biomed.

LEARNING OBJECTIVES

1) 2) 3) 4) 5) 6) 7) 8)

Participants completing this course will be able to: describe the structure and function of neurons, glia, neurotransmitters, and brain regions. explain how the brain produces and is affected by stress, anxiety, and depression. determine the major differences between acute stress and chronic stress. explain the proposed new criteria for diagnosing anxiety disorders and major depressive disorder. outline the symptoms and treatments for the major anxiety disorders, including dental anxiety. list the differences and similarities between major depressive disorder and bipolar disorder. describe how the information in this course can be utilized to improve patient care and patient outcomes. describe, for this course, the implications for dentistry, mental health, nursing, and other healthcare professions.

SPONSOR %LRPHGLVDVFLHQWL¿FRUJDQL]DWLRQGHGLFDWHGWRUHVHDUFKDQGHGXFDWLRQLQVFLHQFH and medicine. Since 1994, Biomed has been giving educational seminars to Canadian health-care professionals. Biomed neither solicits nor receives gifts or grants from any entity. 6SHFL¿FDOO\%LRPHGWDNHVQRIXQGVIURPSKDUPDFHXWLFDOIRRGRULQVXUDQFHFRPSDQLHV Biomed has no ties to any commercial organizations and sells no products of any kind, except educational materials. Neither Biomed nor any Biomed instructor has a PDWHULDORURWKHU¿QDQFLDOUHODWLRQVKLSZLWKDQ\KHDOWKFDUHUHODWHGEXVLQHVVRUDQ\ other entity which has products or services that may be discussed in the program. Biomed does not solicit or receive any gifts from any source and has no connection with any religious or political entities. Biomed’s telephone number is: (925) 602-6140. Biomed’s fax number is: (925) 363-7798. Biomed’s website is, www.biomedglobal.com. Biomed’s corporate headquarters’ address is: Biomed, P.O. Box 5727, Concord, CA 94524-0727, USA. Biomed’s GST Number is: 89506 2842.

There are four ways to register: Online: www.biomedglobal.com By mail: Complete and return the Registration Form below. By phone: Register toll-free with Visa, MasterCard, American ExpressÂŽ, or DiscoverÂŽ by calling

1-888-724-6633. By fax:

(This number is for registrations only.) Fax a copy of your completed registration form— including Visa, MasterCard, American ExpressŽ, or DiscoverŽ Number—to (925) 687-0860.

For information about seminars in other provinces, please call 1-877-246-6336 or (925) 602-6140.

REGISTRATION INFORMATION Individuals registering by Visa, MasterCard, American ExpressŽ, or DiscoverŽ will be charged at the prevailing exchange rate. If the credit card account is with a Canadian bank, the USA tuition will be converted into the equivalent amount in Canadian dollars (approximately $109.00) and will appear on the customer’s bill as such. The rate of exchange used will be the one prevailing at the time of the transaction. Please register early and arrive before the scheduled start time. Space is limited. Attendees requiring special accommodation must advise Biomed in writing at least 50 days in advance and provide proof of disability. Registrations are subject to cancellation after the scheduled start time. A transfer at no cost can be made from one seminar location to another if space is available. Registrants cancelling up to 72 hours before a seminar will receive a tuition refund less a $35.00 (CANADIAN) administrative fee or, if requested, a full-value voucher, good for one year, for a future seminar. Other cancellation requests will only be honored with a voucher. Cancellation or voucher requests must be made in writing. If a seminar cannot be held for reasons beyond the control of the sponsor (e.g., acts of God), the registrant will receive free admission to a rescheduled seminar or a full-value voucher, good for one year, for a future seminar. A $35.00 (CANADIAN) service charge applies to each returned cheque. Nonpayment of full tuition may, at the sponsor’s option, result in cancellation of CE credits issued. $IHHZLOOEHFKDUJHGIRUWKHLVVXDQFHRIDGXSOLFDWHFHUWL¿FDWH)HHV subject to change without notice.

REGISTRATION FORM Wed., May 11, 2016 (London, ON) Thu., May 12, 2016 (Toronto, ON)

Fri., May 13, 2016 (Markham, ON)

For information about seminars in other provinces, please call 1-877-246-6336 or (925) 602-6140

Please print: Name: Profession: Home Address: Professional License #: City: Province: Postal Code: Lic. Exp. Date: Home Phone: ( ) Work Phone: ( ) Employer: Please enclose full payment with registration form. Check method of payment. E-Mail: QHHGHGIRUFRQÂżUPDWLRQ UHFHLSW

Check for $109.00 (CANADIAN) (Make payable to BIOMED GENERAL) Charge the equivalent of $109.00 (CANADIAN) to my Visa MasterCard American ExpressÂŽ DiscoverÂŽ Most credit-card charges will be processed in Canadian dollars. Some charges will be in U.S. dollars at the prevailing exchange rate.

Card Number: Signature:

(enter all raised numbers)

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HOW TO REGISTER

INSTRUCTOR

NURSES (RNs, RPNs, & LPNs)



TUITION:

MARKHAM, ON

Thu., May 12, 2016 8:30 AM to 3:30 PM Radisson Hotel 55 Hallcrown Place Toronto, ON

Please return form to:

BIOMED

Suite 228 3219 Yonge Street Toronto, Ontario M4N 2L3 TOLL-FREE: 1-877-246-6336 TEL: (925) 602-6140 FAX: (925) 687-0860

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HOSPITAL NEWS JANUARY 2016

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Evidence Matters 13

True or False?

There is fast, fun, and free CME from CADTH and CMAJ By Dr. Janice Mann

he number of new health technologies – medications, medical devices, procedures, and diagnostic tests – that become available each year in Canada is staggering. At the same time, new evidence on existing health technologies is constantly emerging. It is next to impossible for busy health care providers to stay abreast of all the new evidence and developments in diagnosing, treating, and managing their patients’ care. That’s why having quick access to reliable evidence and information to use in practice is so important and why organizations such as CADTH – the Canadian Agency for Drugs and Technologies in Health – are here to help. CADTH is an independent health technology assessment (HTA) agency offering synthesized and critically appraised evidence on drugs, medical devices, diagnostics, and procedures that is both reliable and timely. Our HTA work provides the evidence piece to the many decision-making puzzles faced by health care providers in their daily practice. Our evidence, together with a health care providers’ clinical experience, clinical judgment, and knowledge of their patients and the local context they live in can result in better outcomes for patients and the Canadian health care system.

T

www.hospitalnews.com

And there are many ways that health care providers can access our evidence to use in clinical practice. Our website provides free access to all our reports, recommendations, and practice tools. And each month in Hospital News we feature evidence from one or a few of our recent reports in our Evidence Matters column.

Why not grab your smartphone, tablet, or laptop and take a few moments to test your knowledge with the CMAJ true-or-false quizzes from CADTH at www.cmaj.ca But often busy clinicians have only a minute or two to spare. Is that enough time for you to find new evidence to use in clinical practice? CADTH and CMAJ think it is – and it’s as simple as a true-or-false quiz. On the homepage of CMAJ, a new, peer-reviewed true-or-false quiz based on a recent CADTH report is regularly fea-

tured. These quizzes bust clinical myths and provide evidence-based information on new or controversial topics. And they are very simple to use. After reading the short statement about a practice-relevant topic, you can vote on whether you believe the statement to be true or false. You can see how your answer compares with others who have voted – with the percentages of true and false votes. You can then “check your answer” and learn why the statement was true or false with a brief explanation. The original CADTH report on which the quiz is based is can always be accessed by the provided link. Some popular topics for the quizzes have included: sexually transmitted infection testing in young women, self-monitoring of blood glucose in patients with type 2 diabetes, probiotics for the prevention and treatment of gastrointestinal disorders, ASA and oral anticoagulants for stroke prevention, treatments for obstructive sleep apnea; and treatments for constipation. Since CMAJ launched the true-or-false quizzes in March 2013, they have been accessed by thousands of health care providers. And depending on the topic, the percentage of correct answers can vary widely – from 85 per cent who correctly identified that all sexually active women under

the age of 25 should be screened for chlamydia, to less than 30 per cent who correctly answered quiz questions on monitoring of blood glucose in patients with type 2 diabetes. True or false? Is there fast, fun, and free CME available to health care providers in Canada? The answer is true. Knowing the latest evidence can help with making important decisions in Canadian health care. Why not grab your smartphone, tablet, or laptop and take a few moments to test your knowledge with the CMAJ true-orfalse quizzes from CADTH at www.cmaj. ca. And if you have more than a minute or two, the archives of the CMAJ true-or-false quizzes are available at www.cmaj.ca/site/ misc/poll_archives.xhtml, and offer over 30 quizzes from CADTH, as well as quizzes from Choosing Wisely Canada and the Canadian Task Force on Preventive Health Care (CTFPHC). If you would like to learn more about CADTH and the evidence it has to offer to help guide health care decisions in Canada, please visit www.cadth.ca, follow us on Twitter: @CADTH_ACMTS, or talk to our Liaison Officer in your region: www. H cadth.ca/contact-us/liaison-officers. ■ Dr. Janice Mann, Bsc, MD is a Knowledge Mobilization Officer at CADTH.

JANUARY 2016 HOSPITAL NEWS


COMING IN FEBRUARY 2016

14 Focus

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PROFESSIONAL DEVELOPMENT/CONTINUING MEDICAL EDUCATION/HUMAN RESOURCES

Cover story

Taming workplace incivility By Sharone Bar-David aria’s husband, Tony, is about to go through a serious medical procedure. While Tony is being prepped, the couple overhears a nurse make a belittling comment to the co-worker who is tending to him. The affected co-worker is clearly upset and distracted. Her attempt to draw a blood sample misses. She apologizes and tries again unsuccessfully. This situation adds to the stress that Tony and Maria already feel. They become wary of the hospital staff. Recounting their experience to family and friends, they spread word of the upsetting event. Hospital administration, managers, team leads and Human Resources professionals tend to underestimate the farreaching impact of situations like this that take place between hospital personnel. Known as workplace incivility, these lowintensity, seemingly insignificant words or actions that show lack of regard for others’ feelings manifest in many forms: belittling comments such as what Maria and Tony witnessed, gossip, exclusion, dismissive gestures (eye rolling, lip sounds), skipping greetings, silent treatment, and rude use of mobile devices. In hospitals, many people complain about colleagues who communicate with one another in a foreign language that is not understood by their co-workers, who in turn are left feeling excluded and upset.

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HOSPITAL NEWS JANUARY 2016

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per cent of people who participatted in the 17-industry study abovee admitted to researchers that theyy took out their frustration on a customer or client after an incivility event. That’s one out of four people—nothing to sneeze at. Uncivil behaviour among hospital personnel will inevitably spill over into the interface with patients. Hospital employees who are distracted by colleagues’ incivility make mistakes, take longer breaks, forget information, and offer no creative solutions when that’s what is needed. Or, as happened to Maria and Tony, when team members are uncivil with each other, patients who witness the behaviour will feel worry, anxiety, and mistrust. Other times, staff members who are used to treating each other discourteously will inadvertently deal with a patient in the same manner or will refer to patients behind their backs in derogatory ways.  

Incivility is not as trivial as seems at first glance. In fact, it sends malignant tentacles into vital organizational organs and ends up bleeding into the quality of care itself. As humans, we all engage in some forms of incivility, but realizing its effects should give anyone who cares about healthcare reason to pause. Exposure to incivility affects motivation. Research from across 17 industries shows that 48 per cent of respondents who were asked about their reaction to a workplace incident where they were treated in an uncivil manner reported that they purposely lowered their work effort. It also affects people’s ability to do their jobs: 80 per cent of respondents said that they lost time worrying, and 66 per cent reported that their performance declined following an incivility incident. Collaboration and teamwork are also compromised. A training simulation of NICU teams found the experience of incivility reduced the amount of information sharing and help seeking between team members, which led to poor team diagnostic and procedural performance. Research based on more than 400 health professionals has found that having an uncivil colleague or supervisor exacerbates mental and physical health problems associated with overwork and not having enough control over one’s work. Using a sample of employees from five Canadian hospitals, research found the more incivility employees experience, the less satisfied and less committed they are to their job. And then there’s the direct effect on patients and their families. Twenty-five

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The real-life effects of incivility

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It is no secret that many hospitals struggle with persistent incivility issues. “Incivility is an ongoing challenge in the health care sector. Some hospitals are beginning to recognize that civility is critical to patient care and to maintaining excellence,� says Emma Pavlov, Executive Vice President, HR and OD at University Health Network and Program Director of the Masters Certificate in Healthcare Management at the Schulich Executive Education Centre. When daily work involves life and death, attention to relationships is often trumped by attention to the task at hand. Ever-present stress triggers discourteous behaviour. A hierarchical structure compounded by the fact that physicians are not employees of the institution can result in a lack of consistent consequences. As jobs are performed with tight physical proximity and high role-interdependence, there is little time or space to check oneself before resorting to poor behaviour. Managers who manage large groups can’t stay on top of incivility. Rotating charge nurses who, after their turn in a leadership position return to work with peers, find it challenging to deal effectively with incivility, especially of the chronic kind. A multitude of stakeholders contributes to the pressure, which leads to rudeness. And finally, multicultural health care environments where the stronger bonds that naturally connect people of the same background can result in cliques and fractures along cultural lines.

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Paths to solutions

Taming workplace incivility requires a thoughtful, multipronged approach. Indeed, many hospitals are already putting this matter on their agenda in commendable ways, thereby ensuring patients’ paths are not impacted negatively by the undesirable and unnecessary damage that incivility leaves in its wake. Adds Pavlov, “UHN has invested significant effort putting in place a host of measures to increase leaders’ and staff capacity and confidence to deal with situations early on. This is an ongoing effort for us



and d other h hospitals, h i l and d one that h is i well ll worth the investment.� Consistent good modeling by those in leadership is an imperative – leaders need to examine their own behaviour and tame their bad habits. A manager might convince herself that he absolutely must be reachable at all times but fails to see that staff experience his BlackBerry addiction as disrespectful. Modeling is not about being utterly flawless but rather about authentically striving to do better, owning up to slips, being open to feedback, and doing things differently next time. Having a shared understanding across the board as to what comprises incivility is crucial too. In many hospitals, all too often people say “she bullied me� or “he’s a bully� to describe a situation in which they experience even a minor instance of being treated with disrespect. However, the term “bullying� should be reserved to rare and serious situations; it refers to the repetitive mistreatment over time of a person by one or more others. Continued on page 15 www.hospitalnews.com


PROFESSIONAL DEVELOPMENT/CONTINUING MEDICAL EDUCATION/HUMAN RESOURCES

Focus 15

Workplace incivility Continued from page 14

However, in most cases the problem behaviour qualifies as incivility rather than bullying. Clearing the rampant confusion around the distinctions between incivility and other forms of bad behaviour can go a long way toward desirable change. This can be accomplished with clear policies, effective training, ongoing dialogue, and the provision of learning tools and strategies. At UHN, says Pavlov, “we have made significant efforts to change the conversation from one that is about bullying to one that is more accurately focused on incivility and disrespect.” The next order of business is to empower staff and leaders at all levels to shift from being bystanders to becoming “upstanders.” Bystanders’ silence condones bad behaviour and contributes to the distress of the person who is subject to it. When Tammy witnesses Charisa speaking rudely to Rodney of the environmental staff and says nothing, an opportunity for correction and learning is missed. Charisa assumes her behaviour is acceptable and will repeat it in the future, Rodney’s work will be compromised by his upset and worry (possibly leading to missing contaminated surfaces), and Tammy will for hours feel bad for having betrayed her personal integrity. Meanwhile, patients who interact with the three professionals are sure to note the lack of focus and poor demeanour. Everyone in this scenario would have benefited if Tammy had been an upstander – someone who takes positive action even if he or she is alone in doing so. Tackling the underlying beliefs that shape the work environment is another

www.hospitalnews.com

Research from across 17 industries shows that 48 per cent of respondents who were asked about their reaction to a workplace incident where they were treated in an uncivil manner reported that they purposely lowered their work effort.

Physical violence

A Severity Continuum Bullying Harassment Incivility

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BAR-DAVID

CONSULTING

www.sharonbardavid.com Clearing the rampant confusion around the distinctions between incivility and other forms of bad behaviour can go a long way toward desirable change. ©SharoneBar-David 2009

key path. Much of the incivility in hospitals is nurtured and even fueled by potent core notions that go unnoticed and unquestioned. These notions are sometimes shared overtly; however, they often percolate under the surface, accepted as truth without anyone ever stopping to question them or examine their negative effects more closely.

Common examples of such beliefs that are prevalent in healthcare include: in our high-pressure environment, it’s okay to skip the niceties; people shouldn’t be so sensitive – if you want to enter the kitchen you have to tolerate the heat; no one can hold doctors accountable for abrasive conduct; we’re like a family here – we don’t have to watch every word we

say to each other; it’s okay to let loose by speaking one’s mother tongue with a colleague even if others don’t understand it; the best way to release steam when you’re frustrated with someone is to vent about them to another colleague. When the group you belong to (a team, a division or even the entire hospital) buys into such beliefs, its members accept conduct that they otherwise would not. It is as if everyone has blinders on, preventing them from seeing uncivil behavior for what it is. Finally, addressing instances where incivility has become chronic is a mustdo. On many teams, poor interpersonal conduct has become a built-in feature. Other times, the chronic bad behaviour of one or two people has a negative effect on an entire group. When leaders fail to address these situations effectively, it sends a strong condoning message. This in turn has a ripple effect, discouraging those who want to do better and inadvertently giving rise to similar bad behaviour by others who perceive that there are no meaningful consequences. As complex and challenging as it may be, hospitals need to take charge of incivility in a visible and decisive way to ensure that their commitment to excellence H in patient care is upheld. ■ Sharone Bar-David is author of Trust Your Canary: Every Leader’s Guide to Taming Workplace Incivility and president at Bar-David Consulting, a firm specializing in creating civil work environments.

JANUARY 2016 HOSPITAL NEWS


16 Focus

PROFESSIONAL DEVELOPMENT/CONTINUING MEDICAL EDUCATION/HUMAN RESOURCES

Canada’s gift to the world: The discovery of the Carcinoembryonic Antigen (CEA) By Sandra Sciangula

major preoccupation for cancer researchers in the early 1960’s was the search for a specific biomarker, material or molecule, that would distinguish tumour cells from regular cells – in essence, a way to identify cancer through a simple blood test. “Numerous attempts had been made, but none had been successful. The common wisdom at the time was that such a marker would not be found,” says Dr. Phil Gold, the Douglas G. Cameron professor of Medicine at McGill University, the first director of the Goodman Cancer Centre, current Executive Director for the Research Institute of the McGill University Health Centre and former chair of the McGill Department of Medicine. “For myself and my then PhD supervisor Dr. Samuel Freedman, it sounded like a challenge we were happy to accept.” After completing his first year of residency at the Montreal General Hospital (MGH) Dr. Gold worked on his PhD in the laboratory of Dr. Freedman, who was the director of the Division of Allergy at the MGH and subsequently dean of medicine at McGill University. In 1965 they published their discovery of the carcinoembryonic antigen (CEA), which is produced during the growth of the bowel. Subsequent studies led to the development of the CEA blood test – the first blood test approved, internationally, for the detection and management of human cancer. A lot has changed in the past five decades, but the CEA test remains the most frequently used blood test in oncology around the world today. This breakthrough discovery by the two researchers, made over 50 years ago, is a true gift from Canada to the world. Dr. Gold shares some of his memories of the ground breaking discovery. The research utilized a few new and unique ideas: “We employed immunologic technologies, which had not been used in cancer research at that time,” he recalls. “We focused on rabbits because they are good producers of antibodies, and we used colon tumours because they grow differently from other tumours making it easier to compare the tumour tissue with normal tissue, which was taken from the same individual.”

A

The discovery of CEA was significant because it was the first time that a tumour biomarker had been clearly demonstrated to exist, even though very small amounts of CEA were also present in normal tissue. Drs. Gold and Freedman exposed newborn rabbits to samples of normal tissue of the human colon, to make them immunologically tolerant to these tissues. Later, they injected the rabbits with cancer cells from the same donor. The rabbits responded to the molecule in the cancer tissue. This identified the cancer molecule, which was subsequently found in human embryonic digestive organs, as well as in cancer, leading to the designation of CEA. HOSPITAL NEWS JANUARY 2016

(above) Dr. Phil Gold and Dr. David Thomson pictured here in 1971, published the CEA blood test together. (right) Dr. Phil Gold in 1970 at the University Medical Clinic Labs at the Montreal General Hospital. “The discovery of CEA was significant because it was the first time that a tumour biomarker had been clearly demonstrated to exist, even though very small amounts of CEA were also present in normal tissue,” explains Dr. Gold. “Therefore, we were able to establish a blood test that allowed us to examine the blood samples of individuals with a variety of different conditions to see if this would be helpful in the diagnosis, management, and treatment of cancer patients.” The CEA test is the standard against which other human tumour markers are measured. It is presently the most common blood test for cancer, with an apparent market value of well over a billion dollars annually to the pharmaceutical industry. Various cancer organizations across the world have established that the blood test for CEA is instrumental in predicting the future outcome and in monitoring the management of the disease in patients with colon cancer. This discovery has helped shape the modern era of cancer immunology and tumour markers. Making such an impactful discovery informed the trajectory of Dr. Gold’s career, “The immediate result of having discovered CEA was the excitement of suddenly having a large group of international collaborators with whom to work which led to a rapid expansion of data on CEA.” He continues, “I’m certain that the CEA phenomenon was a significant factor in allowing me to initiate the McGill (now Goodman) Cancer Centre, and to the take on the post of Physician-in-

Chief at the MGH, and Chair of the Department of Medicine at McGill. These opportunities allowed me to pay back all that the university and hospital had done for me.” Dr. Gold’s distinguished career has earned him an induction into the Canadian Medical Hall of Fame, an appointment as an Officer of l’Ordre National du Québec, as well as a Companion of the Order of Canada, amongst other coveted awards. When asked about the future of cancer, Dr. Gold is optimistic. “I have no

doubt that a variety of cures for cancer will be forthcoming. Indeed, many are already in place and such conditions as Hodgkin’s disease and Chronic Myelogenous Leukemia are now virtually curable,” he says. “In addition, many other common cancers such as those of the bowel, breast, and even lung, are now being treated with H ever increasing success.” ■ Sandra Sciangula works in Public Affairs & Strategic Planning at McGill University Health Centre. www.hospitalnews.com


From the CEO's Desk 17

Enhancing lives: Transforming care By Daniel Levac

appy new year Hospital News readers! 2016 will bring about much change for Bruyère Continuing Care as January signals the start of both a New Year and new leadership for Bruyère. For readers not familiar with Bruyère, we are located in Ottawa, ON, and pride ourselves in providing evidence-based care to the vulnerable and medically complex, with a focus on people who require integrated seniors health, sub-acute care and palliative care.

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Aging is not a challenge – it is a journey and we embrace it, learn from it and innovate to enhance how it is and will be experienced. As I begin my new role as President and CEO on January 9, 2016, I want to thank Bernie Blais for his leadership at Bruyère over the last 3 1/2 years as he retires from a 45-year career in healthcare. He has been a great mentor and collaborator. After eight years as Bruyère’s Chief Financial Officer and one year as Chief Operating Officer, I have a great depth of understanding of the challenges and op-

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portunities presented to Bruyère. We have established strong partnerships with other providers within our region to ensure effective transitions for people which is a key element to ensure the future success of the health system. The mission and values set out 170 years ago as led by 27-year-old Sister Élisabeth Bruyère is part of our DNA. This commitment to respecting the rich traditions the organization was built on while investing in research and academics is why I am so proud and excited to be the new president of Bruyère. Working with our colleagues in the region and provincially – we will support each other and enhance health care in our community. We recognize the urgency is great – with a rapidly aging population and with the prevalence of chronic conditions on the rise, we will need to be prepared to support those who may need our care and services in one way or another. Bruyère is not satisfied by status quo. Instead we are passionate about improvement and ensuring that the next generation has a better health system and better health outcomes than currently being experienced. We are also interested in training the future leaders of tomorrow and providing exposure to all of the other areas in our health system. Our number one goal is to help people home. Bruyère is rising to a higher standard of customer service, delivering a ‘human ser-

Daniel Levac vice.’ The patient experience begins and ends with people. Our strong reputation in the community has allowed Bruyère to not only impact change within its facilities but has allowed it to help other organizations fill important health needs in our community – such as hospice care. In this spirit, our leadership team is relentless in their pursuit of quality improvement initiatives and streamlining regional processes between our health care partners in the region and to build efficiencies for

our community. Bruyère is committed to enhancing lives and transforming care. Our vision complements that of our partners and policy makers at all levels – federal, provincial and municipal – which ensures that we are always maximizing opportunities. Together, we envision and are planning to bring the best minds, evidence and practice to our community ensuring that seniors and those with complex conditions remain healthy and independent. Our vision also sees a program of distinction in brain health. Care will be provided to patients and will be in an ideal situation to carry out the clinical research that will lead to better diagnosis, better care and ultimately prevention. At Bruyère, planning for and responding to the needs of our aging and medically complex populations is central to our mission. Aging is not a challenge - it is a journey and we embrace it, learn from it and innovate to enhance how it is and will be experienced. Building on the legacy by Bernie Blais, we will continue to be bold, courageous and revolutionary. We are grateful for the ongoing support of this generous community, our partners and our dedicated team. Together we will continue to be a cornerstone in the regionH al health care community. ■ Daniel Levac is President and CEO, Bruyère Continuing Care.

JANUARY 2016 HOSPITAL NEWS


18 Focus

PROFESSIONAL DEVELOPMENT/CONTINUING MEDICAL EDUCATION/HUMAN RESOURCES

Creating a staff engagement ‘game’ By Donna Danyluk athleen Farr has a dilemma. The registered nurse at Barrie’s Royal Victoria Regional Health Centre (RVH) has just been assigned to an extremely anxious elderly patient who does not speak English. Needing a little assistance with the situation, she immediately turns to the coworker to her right, shares what she thinks she should do to help the patient and then asks for her colleague’s opinion. Except Farr is not actually caring for the patient. She is participating in a staff-engagement activity known at RVH as Mission Possible. For over a year the health centre has used gamification to embed its mission, vision and values and advance its patientfocused strategy, enabling staff to discuss how they can live the corporation’s values despite challenging work and personal situations. Mission Possible was developed inhouse by RVH’s Corporate Communications team and designed as a colourful and interactive board game to sustain the health centre’s MY CARE philosophy, particularly the values of Work Together, Respect All, Think Big, Own It and Care. “This unique activity engages staff in an innovative and fun way, prompting thoughtful, frank conversations and brainstorming solutions,” says Suzanne Legue,

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Royal Victoria Regional Health Centre’s (RVH) Respiratory unit staff participate in an innovative staff-engagement activity called Mission Possible. It was developed in-house by RVH’s Corporate Communications team and designed as a colourful and interactive board game. vice-president, Strategy, Communications and Stakeholder Relations. “The tool enables participants to connect the dots between our values, employees’ behaviour and RVH’s strategy in a way that sitting in a meeting never could. Significant research shows that when your employees and physicians are engaged, the patient experience and outcomes improve. Sim-

ply put – higher engagement means better patient care.” Mission Possible, which resembles a typical board game, guides participants through a series of real-life professional and personal challenges. Clear instructions and an intuitive design means the 20-minute activity can be completed without a facilitator, although ideally, a

SickKids is one of Canada’s Top 100 Employers! By Rebecca Skinner he Hospital for Sick Children (SickKids) is proud to have been named one of Canada’s Top 100 Employers for 2016 by Mediacorp Canada Inc. This is the fourth time in the last five years SickKids has received this award. SickKids was chosen from applicants from across Canada. Employers of any size may apply for the award, whether private or public sector. Applications are assessed against those of peer organizations based on the following eight criteria: physical workplace; work atmosphere & social; health, financial & family benefits; vacation & time off; employee communications; performance management; training & skills development; and community involvement. “The reason SickKids is such an incredible place to work is because of our staff and volunteers,” says Dr. Michael Apkon, SickKids President and CEO. “SickKids is a collaborative team environment that truly relies on the compassion, dedication and innovation of our employees.” SickKids’ investment in ongoing staff training and development was cited as a winning combination. Staff are provided with a wide range of online and in-class learning opportunities to augment their on-the-job learning and development experiences. This includes tuition subsidies through the hospital’s staff continuing professional development fund for courses, workshops or conferences related to an employee’s role. SickKids also hosts over 100 conferences each

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HOSPITAL NEWS JANUARY 2016

year and offers a variety of in-house educational programs such as KidTALKs, live discussions led by SickKids experts. “We’ve worked hard to make sure we are supporting employees in a number of ways,” says Susan O’Dowd, Vice-President of Human Resources at SickKids. “We’re delighted to be recognized for this as a top employer in Canada.” SickKids’ commitment to creating a healthy work environment through its wellness program was also noted as one of the reasons the hospital was honoured. SickKids offers employee subsidized memberships to its onsite fitness facilities, including instructor-led classes in boot camp, Pilates and yoga. The nomination also highlighted other aspects of SickKids’ wellness program including its Employee Assistance Program, weekly seated massage therapy, walking and running clubs, meditation/ reflection rooms and onsite facilities, including employee shower facilities and bike lockers.

The hospital’s physical environment also impressed the Mediacorp judges and was given a grade of A. SickKids’ newest building, the Peter Gilgan Centre for Research and Learning, opened in 2013 and offers 21 storeys of state-of-the-art laboratories and learning facilities. The campus’ year-round farmers’ market, open concept hospital atrium and outdoor patios were also highlighted in the nomination as notable features. “From wellness initiatives to employee assistance programs to education and training opportunities, we want to make sure staff find meaning and value in their work and continue to provide the best for our patients and families,” says O’Dowd. The Top 100 Employers were announced on Nov. 9 in a special editorial feature in The Globe and Mail, and are listed on Canada’s Top 100 Employers’ H website. ■ Rebecca Skinner is a Communications & Marketing Officer, The Hospital for Sick Children (SickKids).

department leader is on-hand to promote team-building. The goal is a lively and robust discussion about how values can be applied to real-life situations and challenges. “It is a great game. There are good scenarios which inspired great discussions. All the scenarios we selected during play have all happened to me in a workplace,” Kathleen Farr, RN, Dialysis. A 2014 report by Technology Advice found that 54 per cent of employees would be much more likely to perform a task if it had game elements. In fact, gamification is quickly becoming a highly effective training tool; applying gaming designs and concepts to learning scenarios in order to make them more engaging and entertaining for the learner. All new RVH hires participate in the activity during orientation while existing staff participate in a team Mission Possible session annually. The results have been remarkable. In a 2014 employee survey, 68 per cent of staff said they remember the health centre’s vision and apply it to their work day. Within six months of launching Mission Possible, another survey revealed that number had jumped to 83 per cent. “Mission Possible is extremely fun and a great team building exercise,” says Kim Roberts, administrative assistant, RVH cancer centre. “The game is excellent and it covers all the RVH values.” RVH president and CEO Janice Skot notes, RVH’s values were developed through significant staff consultation and reflect the personal values the health centre’s employees hold most dear. “We know that in the busy, challenging world of healthcare, if employee’s dayto-day behaviours default to their values – their True North – we can consistently put patients first and successfully execute our strategy. That is why using innovative strategies, such as Mission Possible, to hardwire these values into the day-to-day work habits of staff is so very important. It’s important for them and ultimately to H the patients who will benefit.” ■ Donna Danyluk is with the Corporate Communications department at Royal Victoria Regional Health Centre in Barrie www.hospitalnews.com


PROFESSIONAL DEVELOPMENT/CONTINUING MEDICAL EDUCATION/HUMAN RESOURCES

Focus 19

Professional development through humanitarian work By Owen Campbell s a recruiter for Doctors Without Borders Canada/Médecins Sans Frontières (MSF), I am often asked by first-time medical fieldworkers what professional challenges they will face during their assignments overseas, and what impact their experience with MSF will have on their career development. I truly believe that the most challenging aspects of doing humanitarian work also provide the most rewarding and enriching experiences to our fieldworkers, both on a professional and a personal level. I have spoken to hundreds of health care workers who have gone on field assignments with MSF, and here is what they found most rewarding in terms of their career development:

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Returning to Canada invigorated, and as better health care professionals

Spending nine to 12 months providing vital lifesaving care to some of the world’s most vulnerable people is a humbling experience, since the needs often outstrip what is possible for health care professionals to provide. Many fieldworkers come back with a renewed sense of empathy, which is essential to being a great health care provider – something that is true whether someone is a nurse, doctor, pharmacist or any other kind of health worker.

Acquiring new skills, knowledge and experience

Our fieldworkers are often put into situations where they have to go outside of their comfort zones as professionals – whether they are being exposed to new diseases or pathologies, having to adapt to new cultures or living 24-hours-a-day with the same people they work with.

Gaining leadership skills

International fieldworkers often have managerial responsibilities, and are called upon to supervise dynamic, multidisciplinary teams in very trying circumstances. Many of our recruits point to these experiences as contributing greatly to making them better and stronger leaders.

Possibilities of career growth within MSF

Many people are not aware that MSF wants people to stay and grow within the organization, and to take on more responsibility. To help us do that, MSF offers training and career planning to our fieldworkers from their very first assignments onwards. We need people at all levels of our operations, from coordination positions – such

Effective working relationships Continued from page 11

7. Setting clear and measurable objectives, as well as performance expectations. Goal-setting with annual objectives and performance reviews should be developed for physicians participating in management, in a process similar to the evaluation of hospital leaders. In setting such goals, it is imperative to outline role descriptions, responsibilities, expectations, and lines of accountability.

Conclusion

While there are opportunities for further research with respect to organizational strategies used to achieve alignment between hospitals and physicians, a number of conclusions can be drawn from this literature review. Though many structural and cultural aspects of an organization contribute to creating an effective working relationship between hospitals and physicians, this article highlights the key themes prevalent in the research, regardwww.hospitalnews.com

less of hospital size, type and geographic location. The information gleaned from the OHA’s member surveys and informational interviews should provide additional insight to how organizations can be more successful in achieving alignment. The hospital-physician relationship will benefit from further exploration, and lessons may be learned from other sectors that have successfully transformed organizational cultures in an effort to improve quality, patient experience, performance, and staff engagement. The OHA will continue to work with key stakeholders to gather leading practices in this area and share them with physicians and hospital management across the province. Stay tuned for the next article in this series, coming in the February issue: Part 2: A Practical Approach to Enhancing the H Relationship. ■

as medical coordinators and country directors – to technical advisers in our various headquarters around the world. We have Canadians involved in every part of the organization, from medics on their first overseas assignments to the office of the MSF International President – a role currently filled by our very own Dr. Joanne Liu, from Montreal!

Who does MSF need?

I know that the readership for Hospital News is quite varied, so let me share with you what types of health care professionals we are currently looking for: We need physicians, nurses, pharmacists, midwives and

YOU

administrators – and accountants too! For the complete list, check out our website at www.msf.ca and click on “Work with Us.” Professionals who also speak French or Arabic, have some global health experience or backgrounds working in rural and remote northern communities are especially sought after. To get more information, see videos, read testimonials and apply, go to MSF.ca. If you have specific questions you can write H to me at applications@msf.ca ■ Owen Campbell, a former MSF fieldworker, is the manager of recruitment for MSF Canada.

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This article was submitted by The Ontario Hospital Association. JANUARY 2016 HOSPITAL NEWS


20 Legal Update

Ontario’s new patient ombudsman By Michael Watts, Jeff Murray and David Solomon n December 10, 2015, Ontario announced Christine Elliott as the province’s first Patient Ombudsman. It is anticipated her appointment will come into effect on July 1, 2016, concurrently with amendments to the Excellent Care for All Act setting out the role’s functions and powers. Many stakeholders are concerned, however, that the amendments to the Act fall short, because the Patient Ombudsman will not be as independent or empowered as the Ontario Ombudsman. While Health Minister Eric Hoskins has stated that the Patient Ombudsman will be free to criticize the government “as she sees fit,” she will be an employee of the Ontario Health Quality Council (OHQC) who can be terminated for cause, and will report to

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Minister Hoskins (whereas the Ontario Ombudsman is an officer of, and reports to, the Legislative Assembly). Stakeholders are also concerned that the Act does not empower the Patient Ombudsman to investigate for-profit health sector organizations, such as retirement homes or private clinics that receive public funds, nor does it allow expressly her to investigate systemic issues affecting the industry. Regardless of these concerns, health sector organizations need to amend their existing complaint policies before July 1, 2016 to address possible Patient Ombudsman investigations, and to ensure that those policies are robust and effective to help avoid investigations in the first place and demonstrate that adequate investiga-

tions occurred where complaints to the Patient Ombudsman are (inevitably) made. The Patient Ombudsman will be responsible for responding to complaints from patients, substitute decision-makers, and caregivers regarding care provided by public hospitals, community care access centres (CCACs), and long-term care facilities. Other organizations that receive public funds will not fall within the Patient Ombudsman’s jurisdiction (unless and until prescribed by the Minister). The Patient Ombudsman will work with all parties to resolve the complaint, unless (a) the complaint relates to a matter that is within the jurisdiction of another person or body or is the subject of a proceeding, (b) the subject matter of the complaint is trivial, (c) the complaint is frivolous or

LiveWell program connects

hospital staff to wellness resources in “real time”

vexatious, (d) the complaint is not made in good faith, (e) the patient, former patient, caregiver or other prescribed person has not sought to resolve the complaint directly with the health sector organization; or (f) the patient, former patient, caregiver or other prescribed person does not have a sufficient personal interest in the subject matter of the complaint. These exemptions will shield a wide swath of matters from investigation, and underscores why hospitals must have robust and effective complaint resolution mechanisms in place. Under the Act, “proceeding” includes a proceeding held in, before or under the rules of a court, a tribunal (including a hospital’s board of directors, when sitting as a tribunal under the Statutory Powers Procedure Act), a commission, a justice of the peace, a coroner, a specified regulatory committee, or an arbitrator or a mediator. This exemption also bars any investigation of matters falling within the jurisdiction of the Health Professions Appeal and Review Board or the Health Services Appeal and Review Board, or existing labour and employment dispute resolution mechanisms.

By Ania Basiukiewicz ealth care workers are devoted to providing safe, high-quality care to their patients, and oftentimes, this can come at the expense of their own well-being. Hospital staff face a range of unique risks to their health and well-being on the job: they may be at increased risk of suffering from burnout or exhaustion, stress and fatigue, as well as higher rates of violence and client aggression. A healthy and supportive workplace can make all the difference. Trillium Health Partners is making a variety of health and wellness activities easily accessible to its staff to support a healthy workplace. In 2012, Trillium Health Partners launched the LiveWell program, a multi-faceted platform offering a variety of exercise classes such as Zoomba, Pilates and Yoga, walking and running groups and access to a gym. The LiveWell program offers wellness events throughout the year, including movie nights featuring movies such as Roko Belic’s Happy, and monthly webinars focused on monthly wellness and stress management topics like Goal Setting for Personal and Professional Success , Impact of Shift Work on Mind and Body, or Coping with ‘Compassion Stress’. LiveWell also offers special initiatives throughout the year, like October’s Healthy Workplace Month, which boasts a 98 per cent satisfaction rate from participating staff. “Putting patients first is what our nurses, physicians, and other health care professionals at Trillium Health Partners do. But it’s just as important to be aware and attentive to your own needs so that you can continue to be able to help, and heal others,” says Nicole Stibbe, Manager, Employee Health, Safety and Wellness at Trillium Health Partners. The Connection Cart is a popular part of the hospital’s LiveWell program. It’s a large push cart stocked with an array of hot beverages and snacks, along with wellness resources. It travels be-

Many stakeholders are concerned, however, that the amendments to the Act fall short, because the Patient Ombudsman will not be as independent or empowered as the Ontario Ombudsman.

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HOSPITAL NEWS JANUARY 2016

Trillium Health Partners staff taking a moment of self-care with LiveWell travelling Connection Cart tween Trillium Health Partners’ three sites offering a healthy break, snacks, information about wellness resources and printed schedules for a varied menu of wellness activities. Employee Health, Safety and Wellness staff take the Connection Cart to Trillium Health Partners’ clinical and corporate departments several times throughout each month, paying special attention to programs in the hospital where stress or workload levels might be especially high, and organizing targeted resources as appropriate to their specific situations. “The idea behind Connection Cart is to have your ear to the ground, being responsive to what staff in the organization might be going through at any given time, whether it’s supporting staff dealing with the loss of a patient following a Code Pink, or helping staff to manage stress through an intense project. It’s designed to connect with our staff’s wellness needs in real time,” says Ivian Tchakarova, Wellness Specialist at Trillium Health Partners. “It’s also an opportunity

for our staff to pause, reflect and have an unexpected moment of self-care.” The LiveWell program also includes a mobile mini-massage program, laughter yoga, and lessons in stress management techniques such as Emotional Freedom Technique (EFT) tapping. “LiveWell exercise classes helped me get stronger, fitter and calmer,” says Maxine Benjamin, Physiotherapy Assistant, Surgery at Trillium Health Partners. “The boost in energy levels is amazing. Having the classes at the hospital is very convenient and makes it easier to get to the classes after work. The classes are also provided to us free of charge, and that is a wonderful incentive to attend.” Over the past year, there were 714 wellness events offered through the Trillium Health Partners’ LiveWell Program, with a strong attendance of more than H 10,653 participants. ■ Ania Basiukiewicz is a Communications Advisor at Trillium Health Partners.

In resolving complaints, the Patient Ombudsman will have the power to investigate, including investigations undertaken on her own initiative. Any caregiver, patient or former patient, or officer, employee, director, shareholder or members of health care organization may be summoned by the Patient Ombudsman to provide information under oath or produce documents relating to the investigation. The Patient Ombudsman will also have the power to enter any health sector organization, but only with the organization’s consent or a search warrant. Following an investigation, the Patient Ombudsman will be able to make recommendations to the health sector organization. The Patient Ombudsman will also report to the Minister on her activities and recommendations at least annually, will provide periodic reports to local health integration networks (LHINs) on her activities and recommendations, and will make all reports publicly available. While there is little doubt that the creation of the Patient Ombudsman is an improvement from Ontario being the only province in Canada not to have a patient ombudsman, it remains to be seen whether she will have the ability to effect meaningful change to Ontario’s healthcare industry, or whether she will meet Ontarians’ H expectations. ■ Michael Watts is a Partner, Jeffrey Murray and David Solomon are Associates in the Toronto office of Osler, Hoskin & Harcourt LLP. www.hospitalnews.com


Nursing Pulse 21

RNs on campus help students By Victoria Alarcon

n a typical day at the campus recreation and wellness centre at Durham College, RN Teresa Engelage and her four nursing colleagues and two physicians will assess 100 to 120 students for health issues ranging from allergies to mental health challenges. “We’re like their family doctor when they’re going to school… (we) offer them long-term solutions and continuous care,” the seasoned campus health nurse says, adding that she always finds time to sit down with students to explain some of the school resources available to them. “Nurses are an integral part of the overall health and culture of an academic institution,” says Lindsey Thomas, a former campus health nurse and current professor for the school of health and community services at Durham. “We are there to provide care… when they are in need of medical or psychological interventions,” Thomas says, adding that campus RNs are also “…a comforting person to talk to when in need of any health advice and support.” Looking to give the role more recognition, Engelage and Thomas launched the Ontario Campus Health Nursing Association (OCHNA), an interest group of the Registered Nurses’ Association of Ontario (RNAO), in February 2015. With 22 members to date, OCHNA has a mandate to promote campus health nurses and the work they do for students. “This group was formed to not only advocate for the importance of our role within academic institutions and as advocates for our student pop-

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ulation, but to also act as a support system for the RNs who practise in this environment,” says Thomas, who, in partnership with Engelage, co-chairs the group. Engelage and Thomas believe that through this new interest group, and with the support of RNAO, they will also be able to tackle one of the biggest issues affecting students: mental health. According to a U.S-Canada study, one-in-four students who visit an on-campus health centre for a routine medical problem shows signs of depression, and many of those students report they have considered suicide.

According to a U.S-Canada study, one-in-four students who visit an on-campus health centre for a routine medical problem shows signs of depression, and many of those students report they have considered suicide. In 2012, Ryerson University’s centre for student development and counseling reported a 200 per cent increase in demand from students in crisis situations such as suicide. University of Toronto campus RN Rovina Girn points out that campus health nurses are the frontline when it comes to

this issue. During a time in their lives when they are moving away from home and finding their independence, it is important they have someone to confide in and guide them, she says. “During the busy times (like exam season), at least a couple times a day, a student may be feeling suicidal or stressed out and they have no support,” says Girn. They may be “…able to find a connection with the nurse,” whose scope of practice includes scanning for suicidal thoughts and determining whether follow-up is needed with a counsellor or if the student needs to go to the hospital. Christine Philbrick, director of research for OCHNA, says mental healthcare a top priority for the interest group, and so is advocating for changes to certain campus policies. “We’d like to continue to improve on policies related to mental health, discrimination and harassment,” she says, “Our goal is to make our campuses a better learning environment for students and to enhance their personal health,” she explains, suggesting they would also like to explore policies that prohibit the use of tobacco on campus. The group is also looking to share best practices between campus health nurses so they can enhance the care they provide to students. To make these aspirations a reality, the group hosted its first member meeting in November. They focused on goals for the coming year, and the resolution(s) they hope to bring forward at RNAO’s annual general meeting next spring. The team is

already thinking about putting forward a resolution that will encourage universities and colleges to continue funding roles for RNs and RPNs on campus. Although their work is sometimes overlooked, Engelage says she is proud and happy to be a campus RN at Durham College. “I recently got a letter from a student who wrote… ‘I was seen by the nurse today and she spoke to me like I mattered, and that I was normal. She didn’t speak down to me or make me feel like I was inferior.’” Engelage remembers the student well, and explains that she was having suicidal thoughts during her visit. The young woman was eventually sent to the hospital, and Engelage was truly touched to receive the note of gratitude. This story “… really speaks to our nurses and how they understand what these young people need,” Engelage says. “We need to realize how important nurses are in the health centres, and talk (to our politicians) about how important it is to have these health centres – and RNs – on campus.” With OCHNA still in its infancy, Engelage, Thomas, Philbrick and Girn, along with other members of the group, are working hard to reach out to more RNs, NPs, and nursing students working in academic settings. Their goal: to become the leading voice for campus health nurses in H Ontario. ■ Victoria Alarcon is editorial assistant for the Registered Nurses’ Association of Ontario.

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22 Careers

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WHAT ARE NURSES SAYING…

“Being considered as one of the applicants for the Crytzer England Group was one of the highlights of my career thus far. I was impressed by how organized the job fair was. I was also enthused by the acknowledgements that Crytzer England Group received from employers and top US healthcare institutions with prestigious backgrounds. I was honored to receive offers from these employers. Crytzer England Group takes pride in seeking the best nurses. If you have that passion and drive to pursue a better future, then Crytzer England Group will take you to where you deserve.” Marvin P., BSN, RN – Newmarket, ON

“I decided to finally pursue the big change I was looking for in my life and my career and thanks to you all it actually happened. I traveled to your interview expo in Washington DC and was beyond impressed by what happened during those three days. Working with Crytzer England just made everything so easy! The community tour and hospital tour were so helpful and having it all arranged by your group was the icing on the cake. Once I accepted the position, I was once again so grateful to have you and Kim, help me navigate the licensing and TN visa process in order to move from Canada to DC. Sincere Thanks.” Leyna S., BSN, RN – Victoria, BC

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Health Care Technology 23

Imaging technology developed at Lawson By Laura Goncalves cientists at Lawson Health Research Institute, in collaboration with Ceresensa Inc., have produced the first commercial imaging product available in the world for PET/MRI scanners. The novel PET-transparent MRI head coil provides unparalleled images to advance the study, diagnosis and treatment of a wide range of diseases. Lawson installed Canada’s first whole body PET/MRI scanner at St.Joseph’s Hospital, part of St. Joseph’s Health Care London, in 2012. This hybrid imaging scanner combines magnetic resonance imaging (MRI) and positron emission tomography (PET) into one powerful and simultaneous whole-body system, with substantial and innovative results. Patient diagnosis is faster and overall information available from the scan is better and more detailed. “With only 50-60 PET/MRI scanners installed worldwide, Lawson’s Imaging program has made significant early contributions to this young technology and pioneering system,â€? says Dr. Jean ThĂŠberge, Lawson Imaging Scientist and Physicist in Diagnostic Imaging at St. Joseph’s.

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The novel PET-transparent MRI head coil provides unparalleled images to advance the study, diagnosis and treatment of a wide range of diseases. During scans, a coil is positioned around the head. The coil contains several elements, called channels, which detect the MRI signals being emitted. No gamma rays are used in standard MRI and so the components are not designed to avoid absorbing this radiation. For PET images,

A close up of the PETtransparent MRI head coil. Adam Farag, Scientific Director and co-founder of Ceresensa (left) and Dr. Jean ThĂŠberge, Lawson Imaging Scientist collaborated in creating the first commercial imaging product in the world for PET/MRI scanners. participants are injected with a radioactive material which emits gamma rays. The problem is that in a hybrid PET/MRI scanner, the PET gamma rays are absorbed by the MRI head coil, resulting in a loss in the quality of data at the level used for research. “Our challenge was to create a MRI head coil with 32 channels for research-grade scans that would be transparent to gamma rays,â€? explains Adam Farag, Scientific Director and co-founder of Ceresensa. Together, Dr. ThĂŠberge and Farag arrived at a design that solved the problem, making possible advanced and highly effective neuroimaging with both MRI and PET. This was done through significant changes to the geometry of the existing coil and, thanks to the wide array of imaging equipment at Lawson, careful testing and selection of materials. With PET-friendly geometry and PET-friendly materials, the result is simultaneous acquisition of images and information from both the PET and MRI scans –

giving a more complete picture of the area being studied. The coil is so transparent to the PET process that it can be used without correction for attenuation. Attenuation is any reduction in the strength of a signal leading to image noise, artifacts or distortion that may decreases the scan’s accuracy. “The number of gamma rays lost due to attenuation within the coil is less than two per cent, a figure that is not matched by any other published designs,� notes Farag. For research in the areas of neuropsychiatry and neurodegenerative diseases, the scan provides a more complete set of brain markers that can be studied – all from a single exam. In clinical settings, the high degree of transparency of the coil paired with a PET/MRI scan greatly increases the effectiveness and accuracy of the information provided to physicians as part of a patient’s diagnosis and treatment. Work is underway for the development of coils for other parts of the

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body, including the heart and prostate. “Simultaneous PET/MRI has changed what we can dream of for brain imaging research and clinical applications,â€? says Dr. ThĂŠberge. “PET/MRI has proven to deliver uncompromised quality compared to standalone PET or MRI scanners. Our brain imaging coil extends this quality to advanced neuroimaging applications, attracting neuroscientists previously specialized in only PET or MRI. This opens up considerable possibilities for coll aboration and synergy.â€? At Lawson, the coil will be used for research in schizophrenia and depressive disorders, Alzheimer’s Disease and FrontoTemporal Dementia, and the study of brain damage resulting from chronic dialysis. The PET-transparent MRI head coil, and its design and implementation, are the subH ject of a provisional patent (USA). â– Laura Goncalves works in Communications & External Relations at Lawson Health Research Institute.

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JANUARY 2016 HOSPITAL NEWS


PROFESSIONAL DEVELOPMENT/CONTINUING MEDICAL EDUCATION/HUMAN RESOURCES

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1. S.S. Huang, R. Datta, R. Platt, Archives of Internal Medicine, 2006. 2. B. Koll, American Journal of Infection Control, June 2009.

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Hospital News 2016 January Edition  

Professional Development, Continuing Medical Education (CME) and Human Resources. *Special Supplement: Professional Development

Hospital News 2016 January Edition  

Professional Development, Continuing Medical Education (CME) and Human Resources. *Special Supplement: Professional Development