HEALTH ACHIEVE SUPPLEMENT See page M1
FOCUS IN THIS ISSUE
TECHNOLOGY IN HEALTHCARE / PATIENT EXPERIENCE:
Evidence Matters ...............................15
Digital health advancements and new technology in healthcare. Programs and initiatives focused on enhancing the patient experience and family centred care.
Nursing Pulse ..................................... 16 From the CEOâ€™s desk ......................... 17 Trends in Transformation...................25 Legal Update ......................................26
NOVEMBER 2016 EDITION | VOLUME 29 | ISSUE 11
Doctors Without Borders ...................30 Careers ............................................... 31
doctors Five doctors that are changing healthcare Story on pages 12 & 13
TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE
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TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE
Mental wellness help line for indigenous peoples
Left untreated, mental illness can be incredibly damaging to individuals and communities, and supports need to be both accessible and culturally appropriate. That is why the Government of Canada is committed to working with First Nations and Inuit leaders, as well as provincial and territorial governments, to provide effective, sustainable and culturally appropriate mental wellness programs and services for First Nations and Inuit. Honourable Jane Philpott, Minister of Health, announced the launch of the national toll-free First Nations and Inuit Hope for Wellness Help Line on October 17th. The Help Line, which started operation on October 1, provides immediate, culturally competent, telephone crisis intervention counselling support for First Nations and Inuit, 24 hours-a-day, seven days-a-week. Counsellors can also work with callers to identify follow-up services they can access. Counselling is available
in English and French and, upon request, in Cree, Ojibway, and Inuktut. “I have been deeply troubled by the many stories I have heard about First Nations and Inuit youth struggling with mental wellness. This Government acknowledges the scope and seriousness of the mental health issues facing many First Nations and Inuit communities across the country, and we are committed to working collaboratively with our partners to address these complex issues. The launch of the First Nations and Inuit Hope for Wellness Help Line is an important step forward and makes culturally safe telephone counselling support available around the clock and across the country, for those who need it, when they need it,” she said. Health Canada will continue to work with Indigenous leaders to develop a long-term plan to address mental health issues being faced by Indigenous H peoples. ■
Quick Facts The new toll-free number for the First Nations and Inuit Hope for Wellness Help Line is 1-855-242-3310. • Indigenous people are at a greater risk of experiencing mental health issues. Suicide is a significant concern in some communities, particularly in the North and in remote areas. • The Help Line is being funded as part of the $69 million announced by the Government of Canada in June 2016 to support crisis response teams, mental wellness teams and increased access to mental health care services. • The Government of Canada provides more than $300 million annually for mental wellness programming for First Nations on reserve and Inuit in Inuit communities.
Revision of the Food Guide part of vision of a healthy Canada Staying healthy is about more than visiting a doctor. It is the result of the choices we make every day. The Government of Canada is taking action to Quick Facts • In Canada, four out of five Canadians risk developing conditions such as cancer, heart disease or Type 2 diabetes; six out of ten adults are overweight and one-third of youth are overweight or obese. • Poor diet is the primary risk factor for obesity and many chronic diseases, and places a significant burden on the health of Canadians and our healthcare system. • The annual economic burden of obesity in Canada is estimated in the billions of dollars.
help Canadians make healthy choices for themselves and their families. On October 24, it was announced that Health Canada has started a process to revise Canada’s Food Guide to reflect the latest scientific evidence on diet and health, and to better support Canadians, in making healthy food choices. The announcement was made at the Canadian Cardiovascular Congress. As part of the Food Guide revision, Health Canada launched a consultation with Canadians, which will run to December 8, to determine how Health Canada can provide better dietary guidance that meets the needs of Canadians. Canadians are being asked to fill out a questionnaire at http://www. foodguideconsultation.ca This revision is part of a multi-year Healthy Eating Strategy. As part of
the Strategy, Health Canada will use every tool at its disposal (legislation, regulation, guidance and education) to create conditions to support healthy eating. In addition to revising Canada’s Food Guide, the Healthy Eating Strategy outlines how Health Canada will achieve the commitments set out in the Prime Minister’s mandate letter to the Minister of Health related to sodium, trans fat, sugars, food colours, marketing to children, and the Nutrition North Program. Health Canada will continue to engage with stakeholders and experts to further refine the strategy as it moves forward. The Healthy Eating Strategy is a component of the vision for a healthy Canada, which focuses on healthy eating, H healthy living and a healthy mind. ■
New Canadian Health Accord
The Canadian Medical Association (CMA) has released its plan for a new Health Accord to give our nation’s healthcare system a much-needed reboot. “Canada’s doctors and the patients we serve have watched and read with growing concern the media reports describing how our political leaders are establishing their opening positions for negotiating a new Health Accord,” said Dr. Granger Avery, CMA President. “Renewing our Canadian healthcare system requires a modern, collaborative approach that builds on existing silos of excellence.” The CMA believes that a new accord is urgently needed so that Canada’s pubwww.hospitalnews.com
licly funded healthcare system – built on and with the health programs funded by each of the 13 provinces and territories – can better meet Canadians’ health needs while providing greater value for money and remaining sustainable. In releasing “Improving the health of all Canadians: A vision for the future”, the CMA has effectively provided a platform of six clear and actionable recommendations that should be part of the 2017 federal/provincial/territorial health accord: • targeted extra funding as a “top-up” to the Canada Health Transfer for provinces and territories with more seniors;
• coverage for highly expensive medication so that Canadians do not experience undue financial hardship if they are sick; • more ﬁnancial support for family caregivers by making tax credits refundable; • a national strategy for palliative and end-of-life care; • a coordinated home care plan so that healthy seniors can continue to live in their homes and get the support they need; and • key infrastructure investments to improve and provide more long-term care H for Canadians who need it. ■
Increased use could lead to significant cost savings
Hiring more physician assistants (PAs) and effectively integrating them into healthcare teams could save the Canadian healthcare system millions in efficiency gains, according to a new report released by The Conference Board of Canada. Canada’s healthcare system cost Canadians $219 billion in 2015, and hospital, drugs and physician services accounted for 60 per cent of this spending. Physician assistants (PAs) could help lower Canada’s healthcare spending, by completing more routine tasks and freeing up physicians’ time. “Faced with increased demand for health services due to an aging population and a rise in chronic disease, governments are looking for ways to innovate and improve the performance and sustainability of the health care system,” said Louis Thériault, Vice-President, Public Policy, The Conference Board of Canada. “Integrating more physician assistants into healthcare teams could help alleviate the increase in demand, decrease wait times, and alleviate H health workforce shortages.” ■
• Canada’s healthcare system cost Canadians $219 billion in 2015, and hospital, drugs and physician services accounted for 60 per cent of this spending. • The number of physician assistants (PAs) in Canada remains very low, but hiring more and properly integrating them into healthcare teams could save the Canadian healthcare system up to $1 billion by the year 2030. Physician assistants (PAs) could help lower Canada’s health care spending, by providing additional hours to physicians to help them complete more routine tasks. Although they are relatively new in Canada, PAs provide safe care to patients in a wide range of practice areas. Manitoba has the longest history integrating PAs, followed by Ontario and New Brunswick. PAs can be an alternative for designated routine medical tasks so physicians can increasingly focus their time on tasks that are more aligned with their specialized skills. If PAs are able to relieve more than 30 per cent of physicians’ time in all practice areas, this could represent $620 million in costs savings for the healthcare system, with greater integration efficiency gains this savings would be even higher. However, even if PAs are only able to substitute for 25 per cent of physicians’ time, some overall cost savings would be realized. NOVEMBER 2016 HOSPITAL NEWS
UPCOMING DEADLINES DECEMBER 2016 ISSUE EDITORIAL NOV 14 ADVERTISING: DISPLAY NOV 25 CAREER NOV 29 MONTHLY FOCUS: Year in Review/Future of Healthcare/Accreditation/ Pharmacology:
Overview of advancements and trends in healthcare in 2016 and a look ahead at 2017. An examination of how hospitals are improving the quality of services through accreditation. The safe and effective use of medications.
JANUARY 2017 ISSUE EDITORIAL NOV 30 ADVERTISING: DISPLAY DEC 16 CAREER DEC 20 MONTHLY FOCUS: Professional Development/ Continuing Medical Education (CME)/ Human Resources: Continuing Medical Education (CME) 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 + PROFESSIONAL DEVELOPMENT SUPPLEMENT
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Canada has more doctors and health specialists –but is that good news? By Livio Di Matteo
he recent negotiations between the Ontario Medical Association and the Ontario Government highlight the complex relationship between physicians and health spending. As important and trusted gatekeepers to the healthcare system, physicians are nevertheless a crucial component of healthcare costs as the total number of physicians, the volume of health services they provide and the cost per service come together. While governments such as Ontario have been focusing on reducing or holding physician fees steady as a cost control measure, healthcare spending is also affected by the overall number of physicians we have and the number of services each provides to their patients. Across the country, provinces are trying to rein in their healthcare spending and rising costs for doctors remains a key concern. Is it the right emphasis? Yes – and no. The Canadian Institute for Health Information (CIHI) released data that shows physicians in Canada were paid a total of $25 billion in gross clinical payments in 2015 – up from $24.1 billion last year, for an increase of 3.7 per cent. This rate of growth is down from nearly six per cent the year before, suggesting that there is some restraint underway. That’s good news from a cost control perspective. We also seem to have more doctors than ever. For Canadians waiting for care, that surely sounds like good news too. For the ninth year in a row, the number of Canadian physicians per capita has grown. We had 82,000 doctors in 2015 – up from 79,905 in 2014. Indeed, Canada has sustained yearly physician increases of more than two per cent since 2007,
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specialists per person should mean better healthcare, right, even if we have to spend more? The problem is, we don’t really know the answer. We don’t have measures in place to evaluate whether increasing the specialist health workforce is always the best investment of our healthcare dollars. Public debate highlights spending and the political tug of war between medical associations and health ministries but missing is any discussion of effectiveness of services and how that can be measured. For example, a campaign from the Canadian Medical Association, Choosing Wisely, suggests there are a number of specialist diagnostic tests and services that may be unnecessary and may even cause unnecessary harm. If spending more on physicians provides greater value for money as measured by improvements in health outcomes, then that is a good thing. On the other hand, if we are spending more money on diagnostic tests and procedures that don’t improve health, then that is not such a good thing. Without appropriate measurement of healthcare outcomes, we cannot know if cost control measures affect the quality of care. It is incumbent on both provincial governments and physicians to work together on evidence based evaluation of the effectiveness of healthcare services. Only then can we know if our money H is well spent. ■ Livio Di Matteo is Professor of Economics at Lakehead University and an expert advisor with Evidence Network. He is co-author (with Colin Busby) of the recently released CD Howe Institute Report, Hold the Applause.
Health care communications
Sarah Quadri Magnotta, Health care communications
Dr. Cory Ross,
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Ontario Hospital Association
HOSPITAL NEWS NOVEMBER 2016
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with increases of more than 4 per cent in 2009 and 2011 and an increase of about 2.6 per cent in 2015. We have gone from an era of perceived physician shortages to one of relatively more abundance. Put another way, total physicians per 100,000 of population have grown from 192 in 2007 to 228 in 2015. At the same time, the average gross payment per physician in 2015 remained virtually unchanged at $339,000 nationally. But looking deeper, there is a worrisome trend. A recent CD Howe Report similarly notes that while there has been a recent decline in real per capita provincial government health spending, total physician costs have continued to rise. But the CD Howe Report points out that spending is also affected by physician composition – particularly specialists. Adding one specialist physician per 1,000 persons was associated with an additional $720 in real per capita provincial health spending – no small amount. Just how big is the increase in the number of specialists? The number of specialists per Canadian has almost doubled since 1981. In 1981, the average number of specialist physicians per 1,000 persons across Canada’s provinces was 0.6 and grew to 1.1 by 2013 – an increase of nearly onehalf a specialist physician per 1,000 persons. This near doubling is therefore associated with a $295 increase in real per capita provincial health spending (1997 dollars) which grew from $1,415 per person in 1981 to a 2015 forecast of $2,447 per person. Again, no insignificant cost. Specialist physician numbers are expected to grow in the future, given increased medical school enrolment. Is this such a bad thing? More health
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TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE
A unique perspective on
cancer pathways By Jil Beardmore nnick Tessier is an Accreditation Assistant on Accreditation Canada’s Client Services team. She was diagnosed with Hodgkin’s lymphoma in 2012 and agreed to share her experience of the cancer care pathway with us. She has a unique perspective on her diagnosis and treatment, given that she works at Accreditation Canada and is familiar with its health care standards. She has a better sense than most people about what the continuum of care should look like. This was the first cancer diagnosis for anyone in Annick’s family. She had a persistent cough, and an x-ray to rule out pneumonia revealed a massive tumour that was impairing her breathing. Annick says she felt very angry when she met the diagnosing physician, like the cancer was his fault. She says he managed it well, was incredibly kind, and explained the diagnostic procedure. After a nurse then told her about her care pathway, she received a package about the diagnostic process and was connected with a social worker.
Client- and family centred care should be the top priority for the cancer unit. Post-diagnosis, a hematologist assumed responsibility for her care and gave her a binder specific to Hodgkin’s lymphoma that explained the coming process, symptoms, and resources (e.g., the wig centre). Annick was also linked to a second, hematology-specific social worker, a nutritionist, and a pivot nurse who she could call on day or night to help her distinguish normal side effects from those requiring medical attention. She began chemo at the Ottawa Cancer Centre after receiving a tour of the facility and an explanation of the process. She says the centre is beautiful, with lots of windows, which really matters when you spend so much time there. It was hard to find a relevant support group because she’s young, but there was always someone checking in to ask if she was okay. She says her nurses were beyond amazing. She particularly appreciated routinely encountering the same care team at her appointments. It made it easier to recognize the nurses and establish a rapport. She wasn’t called in for unnecessary appointments, and that also made a difference. Annick says she felt very involved in her own care, and cited two examples: • She wanted to work, and her care team was very accommodating as long as it was safe for her to be in an office enviwww.hospitalnews.com
ronment (i.e., when her white cell count was high). • After six months of chemo, there was still activity in the tumor. Her hematologist and radiologist advised her to undergo radiation therapy, but she wasn’t sure she wanted to, and said no. When her second scan came back positive, she chose to undergo radiation. The whole care team had respected her decision to wait. What surprised Annick most about the care process was that her support system (e.g., social workers, resources) stays in place for the rest of her life. At a system level, she was quite surprised at how costly cancer medication is, especially for people who don’t have extended drug coverage, which she points out she felt grateful to have. She says there’s an image in your head about cancer, and then there’s the reality. They’re totally different. “It’s odd what you think of when you’re diagnosed,” she says. “I remember immediately wondering how I’d care for my dogs during treatment.” Annick says she had great care, support, and advice, and that it was an advantage to have access to healthcare professionals who could answer questions during treatment and at work. She says she felt very secure about asking questions. She also paid attention to certain processes she knew were important (e.g., medication reconciliation, hand hygiene, patient identifiers). In general, she says, the newer nurses seemed better at quality and safety checks. At the end of the day, she’d check the medication identifiers herself sometimes, just to be certain. What’s more, her sister is a nurse and her care team was very open to her reading Annick’s file and explaining it to her. She did wonder if other patients wanted to know more about their files too, as it gave her a sense of control over her care, and that little bit of control felt great. She says that today, if a client at work asked her about the continuum of care, she’d definitely remind them about the importance of the client’s perspective. As she puts it, “Client- and family centred care should be the top priority for the cancer unit.” It made all the difference in the world to her experience that patients were welcomed. Annick still has a mass – she’ll always have it – but it’s not active. She now sees her hematologist once a year and continues to work full-time at Accreditation Canada, helping healthcare organizations with their quality improvement processes. We’re grateful to Annick for sharing H her story! ■ Jil Beardmore is an Editor at Accreditation Canada. NOVEMBER 2016 HOSPITAL NEWS
TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE
Digital patient flow trackers enhance discharge planning By Anne Kelly
n inpatient units at St. Mary’s General Hospital in Kitchener, discharge planning whiteboards have been replaced with 65-inch touch-screen monitors that track the journey to patient discharge in an interactive and highly-visual way. This innovative solution called stayTrack was designed by Oculys Health Informatics, of Waterloo. It was rolled out at St. Mary’s under a demonstration project which received funding from the Ontario Centres of Excellence, as well as in-kind funding from Oculys. When introducing the technology, St. Mary’s adopted the acronym SISTER (System to Integrate Safe, Timely and Effective Return) in a nod to its founders, the Sisters of St. Joseph of Hamilton. The monitors display information that improves efficiency of daily bullet rounds with interdisciplinary teams by providing comprehensive real-time information. “This information supports the team’s discharge process by having all healthcare providers involved and informed in the patient’s plan of care,” says St. Mary’s Presi-
dent Don Shilton. “It helps, in a very visual way, to pinpoint any bottlenecks so those can be addressed in a timely fashion.” Information appearing on the tracker is pulled automatically from Meditech (i.e. lab and diagnostic imaging results) or entered manually by members of the care team, including physicians, doctors, nurses, therapists, social workers and the CCAC.
The monitors display information that improves efficiency of daily bullet rounds with interdisciplinary teams by providing comprehensive real-time information. The information allows team members to clearly see who has done their part, or still has work to do, in order to move the patient toward the discharge date. Graphic icons, for each patient clearly indicate whether patients require isolation
or a bed alarm, are at risk of falling or unable to have food or fluids by mouth. There are also icons for discharge considerations, such as whether the patient needs CCAC service, requires home oxygen or has been designated Alternative Level of Care.
Other features of the system include:
• Web-based, cloud technology which is accessible by password only on in-house computers or mobile devices such as tablets and smartphones. • Auto alerts sent to members of the care team when information is updated. Patient information is encrypted and protected by the hospital’s firewalls. • A complete picture for physicians so they can initiate discharge while on-site or off-site, including on weekends, when bottlenecks often occur. • Different views on the monitors for patient privacy, which is more private than whiteboards. • Timely, at-a-glance information to help manage patient flow and improve access for patients coming
Sixty-five inch touch-screen monitors help track the patient journey to discharge. from the operating rooms or emergency department. The patient flow tracker is the latest partnership between St. Mary’s and Oculys. In 2012 St. Mary’s became the first hospital in Ontario to launch a realtime online tool that predicts emergency department waits for patients with the least serious medical needs. Ten Ontario hospitals and six in Winnipeg are now using this technology for emergency deH partment wait times. ■ Anne Kelly is Manager of Communications at St. Mary’s General Hospital in Kitchener.
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TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE
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We are proud of the fact that we’ve given back over $140 million since our inception almost 30 years ago. That’s money going back into our healthcare system. As our CEO Peter Flattery (pictured above holding the “R”) prepares for retirement, we know HIROC is stronger than ever, a credit to his dedicated leadership – Thank You Peter!
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NOVEMBER 2016 HOSPITAL NEWS
TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE
CLEAN NUCLEAR POWER. SAFE HOSPITALS.
Cobalt Uses Industrial Cobalt-60 Low Specific Activity (LSA) Cobalt-60 is employed by industry to sterilize medical devices such as sutures, gloves and syringes. It helps sterilize more than 40 per cent of the world’s single-use medical devices. Medical Cobalt High Specific Activity (HSA) Cobalt-60 is used worldwide for cancer treatment and radiation therapy for the treatment of complex brain conditions. One of the technological advancements that will benefit from a stable supply of HSA Cobalt is the Elekta Gamma Knife® surgery, which uses an innovative tool that allows for noninvasive treatment of brain disorders — something that’s very difficult and complex to do through conventional means. This method delivers a single, high dose of radiation to a small and critically located area in the skull, and is preferred for its extreme accuracy, efficiency and outstanding therapeutic response.
Richard Wiens, Nordion’s director of strategic supply, gamma technologies with Mike Rencheck, Bruce Power’s President and CEO.
Partnership ensures stable supply of Gamma Knife Radiosurgery Gamma Knife radiosurgery is a type of radiation therapy used to treat tumours and other abnormalities in the brain. In Gamma Knife radiosurgery, specialized equipment focuses close to 200 tiny beams of radiation on a tumour or other target. Although each beam has very little effect on the brain tissue it passes through, a strong dose of radiation is delivered to the site where all the beams meet. The precision of Gamma Knife radiosurgery results in minimal damage to healthy tissues surrounding the target. In some cases, Gamma Knife radiosurgery may have a lower risk of side effects compared with other types of radiation therapy. Also, Gamma Knife radiosurgery is often a safer option than traditional brain surgery. Gamma Knife radiosurgery is usually a one-time therapy, completed in a single day. HOSPITAL NEWS NOVEMBER 2016
medical grade cobalt ospitals in Canada and throughout the world recently averted a crisis many of us never even knew was looming. But anyone connected to nuclear medicine, whether technician, doctor or patient would have some idea of the impending scarcity of HSA Cobalt, the isotope that makes radiotherapy treatment of complex brain cancer possible. This fall, the partnership announced in 2015 between Bruce Power and Nordion (a long-time supplier of medical grade Cobalt) to produce High Specific Activity (HSA) Cobalt in the four Bruce B reactors reached a milestone as teams began production of what will become a stable supply of HSA for decades to come.
CANADA WORLD’S TOP COBALT PRODUCER
For over 65 years – and for as long as radiotherapy has been a part of cancer treatment – Canada has been a leading
HSA Cobalt-60 cancer treatment has been used for more than 60 years to treat an estimated 35 million patients worldwide. producer of this radioactive isotope. As the nuclear reactor currently responsible for its production nears the end of its lifecycle, the medical community had little in the way of a solution to a problem that will continue to grow as people live longer and more populations present with cancer. That’s why news of the first batch of a new supply of HSA Cobalt-60 going into production this fall was not only a welcome development in Canada’s nuclear
energy industry but also a relief to cancer treatment centres around the world. “Recognizing that in 18 months the NRU reactor will reach its end-of-life, it was critical to find another source of HSA for these life-saving operations,” explains Ian Downie, Nordion’s general manager of gamma technologies. “The HSA Cobalt produced by Bruce Power will help fill this gap.” Indeed, Bruce Power’s CANDU reactors are vastly different than the National Research Universal (NRU) reactors at Chalk River, Ontario, that have been producing HSA for the last 60 years, explains Pierre Pilon, Senior Vice President of the Bruce B reactor. “But we are looking at innovative ways like this to help with isotope production when NRU is shut down. And our engineering teams here have worked very hard to ensure there is absolutely no impact or changes in how we operate and maintain our units,” he says. www.hospitalnews.com
TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE
CLEAN NUCLEAR POWER. SAFE HOSPITALS.
Stereotactic Radiosurgery using Cobalt-60 therapy allows doctors to deliver higher doses of radiation to tumours while limiting damage to the surrounding healthy tissue and organs. For many brain cancers, Cobalt-60 therapy is one of the most precise and advanced forms of radiation treatment available.
TEAMING UP TO FIND A SOLUTION
Nordion and Bruce Power have worked together for years producing Low Specific Activity Cobalt-60 for use in the sterilization of single-use medical devices and implantable devices as well as for food irradiation. In fact, it was this association that provided the basis for the two organizations to collaborate on a solution to address the HSA Cobalt problem. “We were seeing ‘hotter’ LSA Cobalt coming out of Bruce so we looked at how – with some clever engineering – we could get HSA quality Cobalt,” explains Richard Wiens, Nordion’s director of strategic supply, gamma technologies. “If we hadn’t done anything, two-thirds of the world’s supply [of HSA Cobalt-60] would have gone away. Possibly other suppliers could have ramped up supply but there’s no way they could have filled that gap.”
NEED FOR MORE RADIOTHERAPY MACHINES
By some estimates, HSA Cobalt-60 has been instrumental in treating 35 million cancer patients worldwide. It is particularly important for alternative treatments to traditional brain surgery and radiation therapy for the treatment of complex brain conditions through innovative machines like the Elektra Gamma Knife, which allows for the non-invasive, highly precise treatment of brain disorders. The Gamma Knife uses gamma radiation to focus 200 microscopic beams of radiation on a tumour or other target. Although each individual beam has little effect on the brain tissue surrounding the tumour, where the beam intersects, a strong dose of radiation is delivered to the site, minimizing damage to healthy tissue and lowering side effects compared to traditional therapy in some cases. At an event announcing the start of the new HSA supply’s production in October (the first batch is to be ready in early
2019), Dr. Mary Gospodarowicz, clinical department head at Princess Margaret Cancer Centre in Toronto spoke of the need for more radiotherapy equipment. The Gamma Knife and other Cobalt machines, she explained, are an essential part of cancer care. “Much of what we hear about cancer research has to do with advancing our understanding of the molecular and genetic nature of the disease,” she said. “However, advances in technology for the diagnosis and treatment of the disease are equally important to having safer and more effective interventions.” And that is indeed the hope expressed by Mike Rencheck, Bruce Power’s President and CEO who also spoke at the event.
IMPORTANCE OF A RELIABLE COBALT SOURCE
“As a long-time supplier of Cobalt-60, we have long been helping to keep our hospitals safe for our most vulnerable citizens,” he said. “Now, with HSA Cobalt being harvested from our Bruce B reactors, we will have a greater impact on human health across the globe.” Kathryn McGarry, Ontario’s Minister of Natural Resources and Reza Moridi, Minister of Research, Innovation and Science, were also in attendance. While Moridi provided some context to the importance of this announcement for Canada’s nuclear industry, McGarry spoke of her perspective as a former critical care nurse. “I remember many difficult discussions in the intensive care unit with physicians, specialist and family health teams about how we were going to manage when we may be short on nuclear medicine,” she said. “With the partnership between these two Ontario companies announced today, patient can breathe easy knowing they have a secure, reliable source of HSA Cobalt to help families across this province H and beyond with their healthcare needs.” ■
Gamma Technologies For The Medical Industry Gamma is the technology of choice for sterilization by many of the world’s leading medical device manufacturers. Its proven process is safe, reliable and highly effective. Gamma irradiation, produced by Cobalt-60, emits high-energy gamma rays which disrupt living cells by damaging the DNA and other cellular structures. These changes at the molecular level cause death of organisms. Sterilization of single-use medical devices Gamma sterilization is a proven process that’s highly effective at treating single-use medical devices. With the ability to penetrate products while sealed in their final packaging, gamma sterilization economizes the manufacturing and distribution process, while still ensuring full sterility of the product. Sterilization of tissue-based devices Sterilization of tissue-based devices by gamma irradiation is conducted routinely and is gathering momentum in the health care industry. Tissuebased devices come from human donors. There are no living cells in the bone grafts, tendons, ligaments and various other tissues. While not currently required by regulatory standards, tissue banks are choosing to terminally sterilize tissue-based devices with gamma in order to increase patient safety. Sterilization of combination devices A combination device is a medical device combined with a tissue or pharmaceutical or other component that falls within one or more regulatory standards, such as drug-eluting stents. Sterilization can affect drug properties and material properties, so sterilization by gamma irradiation is applied to ensure that the combination device’s sterility and functionality are maintained. Sterilization of implantable devices Implantable devices include orthopedics (i.e. knees), stents, heart valves and more. Metal and polymers present a challenge to some sterilization modalities. Gamma is highly efficient for sterilization of implantable devices; in fact, the highest percentage of sterilization modalities for orthopedics is gamma. Additionally, many implantable devices are high value and therefore depend on a reliable process to ensure quality control and prevent the potential for lost product due to processing faults. Sterilization of pharmaceuticals Sterilization by gamma irradiation is advantageous for a wide range of pharmaceutical products. Due to the high demand in the pharmaceutical industry, gamma has proven itself to be an effective method as indicated by its acceptance in the European Pharmacopeia, and, more recently, drafted into the United States Pharmacopeial Convention. Some of the advantages of gamma over other modalities include high penetration power, isothermal character (small temperature rise) and no residues. It also provides a better assurance of product sterility than aseptic processing and lower validation demands. NOVEMBER 2016 HOSPITAL NEWS
TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE
First “Smart” hospital in Canada By Catalina Guran ackenzie Health is re-visioning its care delivery model to embrace a connected health strategy that utilizes digital communications and the Internet of Healthcare Things (IOHT) to provide quality healthcare both inside and outside the traditional hospital setting. “Our objective is to go beyond simply using technologies to achieve a truly ‘smart’ support service delivery model that is intuitive, patient-centred and highly efficient,” says Richard Tam, Mackenzie Health’s Executive Vice-President and Chief Administrative Officer. Mackenzie Vaughan Hospital, expected to be completed in 2020, will be the first hospital in Canada to feature fully integrated “smart” technology systems and medical devices that can speak directly to one another to maximize information exchange. “The smart hospital vision – applied both at Mackenzie Health’s new Mackenzie Vaughan Hospital as well as at the existing Mackenzie Richmond Hill Hospital – will create a truly connected patient experience inside and outside the hospital setting by utilizing digital communications and the Internet of Healthcare Things to provide quality healthcare delivered through the eyes of the patient,” says Altaf Stationwala, President and CEO, Mackenzie Health.
HOSPITAL NEWS NOVEMBER 2016
Managed ICAT Services (MIS)
In early October 2016, Mackenzie Health announced Compugen as the preferred provider for MIS at the future Mackenzie Vaughan Hospital, to help build and implement its smart hospital vision. Compugen will be working with Mackenzie Health to provide infrastructure and services for the devices, network, security and technology management of the new hospital. Vital to these services will be the provision and support of an integrated platform to enable smart workflows. Under the smart hospital vision, Mackenzie Health plans to develop its own wired and wireless electronic health platform enabled by secured hosting. The smart system will include unified communications (audio/video) between providers and patients and access to patient portals, community provider portals, and home health tools such as integrated private and secure patient electronic records.
Automation of nonclinical hospital services
Through a partnership between the Mackenzie Innovation Institute (Mi) and Sodexo Canada, Mackenzie Health will undertake an exciting new technologydevelopment project that promises to
establish new healthcare industry standards for the delivery of non-clinical support services. Key aspects of this exciting new partnership are to improve how the various IT systems that manage support service delivery communicate with each other and interface with our electronic medical record system to enable smart patient scheduling. Services include: call centre operations, environmental services, patient transport, bio med and physical plant maintenance, central equipment distribution, security and patient food services. “The goal is to get as close as possible to ‘one-touch point’ service fulfillment,” says Richard Tam. “In the future, a single entry by a physician or nurse using the hospital’s patient flow software will trigger multiple service directives that are time stamped, scheduled and seamlessly delivered on
time without any further involvement by the clinician,” he adds. Sodexo Canada is Mackenzie Health’s support services provider. The hospital’s recently established Mi2 dedicates significant resources to achieving its vision of going beyond digital to becoming a truly “smart” hospital. Among these is the first-in- Canada Innovation Unit, an acute care medical unit that has been transformed into a living and breathing laboratory for innovations to help nurses and other inter-professional team members spend more time at the bedside, providing hands-on care. For more information, visit www.mackH enziehealth.ca and www.mi2health.com. ■ Catalina Guran is a Communications and Public Affairs Consultant at Mackenzie Health.
TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE
Colours and critters: Design elements to enhance patient experience By Bernelle Yan he new Teck Acute Care Centre (TACC) currently under construction on the BC Children’s and BC Women’s Hospital + Health Centre campus will incorporate child and adult-friendly and easily recognizable interior design elements such as colours and critters to enhance the patient experience and improve wayfinding. Inspired by the beauty of British Columbia and Yukon’s natural landscape, each floor of the TACC will be represented by a feature of the provincial terrain, from the ocean floor to majestic mountains and sweeping meadows to lush forests. Each unit will also be identified by critters inspired by BC and Yukon’s wildlife and a specific colour to help distinguish it from different areas. “Improved wayfinding can help reduce anxiety for patients and families visiting or staying in the hospital as it gives them an easy tool to find where they are going,” says Arden Krystal, Executive Vice President, Patient and Employee Experience at Provincial Health Services Authority. “Finding your way around a hospital can already be a stressful situation for some, so providing straightforward, clear and simple signage can help remove some of that stress.” The new TACC will incorporate the wildlife and nature inspired visual elements to create a unified look and feel while also
Each unit on the new Teck Acute Care Centre will be identified by critters inspired by BC and Yukon’s wildlife and a specific colour to help distinguish it from different areas.
differentiating between spaces within the hospital. Each floor will have specific colours and critter icons on the walls in the hallways, and upon entry at greeter desks and at care team stations within units, providing a memory cue to guide patients and visitors to a specific area. For example, to locate the Neonatal Intensive Care Unit (NICU) pod a friend or family member is in, visitors can follow the colour purple and corresponding meadow image to level two, and then follow the blue accent colour and rabbit graphic directly to one of the NICU
pods. Additionally, this new visual design will also help to assist BC’s multilingual population navigate their way with ease. “We worked closely with patients, families, care providers, physicians and staff to select the elements, including the colours and critters,” says Eleanor Lee, Chief Project Officer for the BC Children’s and BC Women’s Redevelopment Project. “Their input and feedback has been invaluable and the facility will be greatly enhanced as a result of their involvement.” In addition to wayfinding enhancements,
the new TACC will also feature pieces of art such as murals, sculptures, and framed art, themed rooms, and technology installations. A donor supported initiative led by the BC Children’s Hospital Foundation, the Children’s Healing Experience Project will include interactive technology and unique artwork from artists across Canada. Artwork has shown to help patients recover faster and reduce anxiety and stress for visitors, patients and staff. It will help create a healing environment by offering imagery that creates a positive distraction by telling stories and providing educational information, and will be interactive and engaging for individuals of all ages. Artwork in public areas including ground level and rooftop gardens will also help provide wayfinding landmarks for patients and families. The new TACC is a 640,000-squarefoot facility that will replace aging infrastructure and provide much-needed space for the larger care teams and new technologies required to treat today’s chronic and more complex illnesses. It features eight floors of clinical space, including 231 single patient rooms and 87 outpatient exam rooms. Once it opens in fall 2017, it will be an integral part of BC’s health-care system, providing exceptional specialized care for the most seriously ill children and complex H obstetrical cases. ■ Bernelle Yan is a Communications Officer for the BC Children’s and BC Women’s Redevelopment Project.
NOVEMBER 2016 HOSPITAL NEWS
TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE
Cover story In the future Dr. Wong hopes to develop printable devices as complex as prosthetics.
Dr. Kavanagh’s Ocean Tablet is helping break down communication barriers between patients and their clinicians.
These five doctors are
changing the game By Tamara Mason
anada’s healthcare system is complex and not without its challenges. Physicians and patients alike will tell you that those challenges can be frustrating. Operating on the front lines, physicians are in a unique position to identify solutions to improve the practice experiences of physicians while at the same time enhancing their collective ability to deliver quality care to patients. This is where
Joule™, CMA’s newest subsidiary, comes in to make it easier for physicians to be at their best. In addition to those areas of business brought over from CMA – leadership courses, clinical products and publications – Joule has created an entirely new line of business Joule Innovation, to identify new products and services and a focus on physician-led innovation. Through its innovation council, H2™ Hacking Health
Your one-stop resource for trusted clinical app reviews Visit PracticalApps.ca today
HOSPITAL NEWS NOVEMBER 2016
Design Days and Joule Innovation grants, the company wants to make it easier for CMA members to expand their roles to include “innovator” and “entrepreneur”. “Joule wasn’t created just to help physician innovators bring their ventures to market,” says Lindee David, Joule’s CEO, “but also to ease their journey where possible and to mentor innovation.” A cornerstone of Joule Innovation is its grant program. The first round of Joule Innovation grants was open for only two months for the Canadian Medical Association’s 83,000 plus members. When the process closed on June 23, Joule had received 126 submissions through the Joule app. Over the course of the next two months, 28 were short-listed and through a rigorous review process, five recipients were selected. “We could not have anticipated how well-received our program would be,” says David. “I am absolutely certain that it is a result of us filling a long-standing need among physician members and we are thrilled to fill this gap and thrilled to serve CMA members in this capacity.” On August 20, at the start of its first H2™ Hacking Health Design Day in Vancouver, British Columbia, Joule proudly announced the names of the five recipients sharing $150,000 in grants. Grant funds will allow recipients to take their ventures to a new level with an immense potential to drive change in health and healthcare in Canada but also across the globe.
Family physician, Dr. Kavanagh was awarded a grant to support the development of Ocean Tablet, a patient centric application that reduces the language barriers between physicians and their patients, saving time and lives by automatically translating concise clinical notes into the electronic medical record. To date, the results are impressive. Clinics that use the Ocean Tablet (over 1.5M patient updates so far) report that the time needed for a single appointment can be reduced by as much as 65 per cent, while allowing more time spent face-toface with patients. Digital data entry also allows for more structured patient records
of higher quality, enabling easier data analysis and secured data-sharing for research purposes. “Patient engagement on this level means greater efficiency for clinics, better time management for patients and improved information sharing for research purposes,” claims Dr. Kavanagh.
Dr. Wong, a public health physician, will use the grant she received to develop 3D4MD, which delivers physicians and patients low cost, on-demand 3D printable medical solutions. 3D4MD solves numerous challenges in the healthcare community. First, the printers are low cost and portable and run on solar power which is appealing to those patients in remote areas. Second, because custom medical devices are produced on the spot at the point of use, this eliminates the weeks and months it takes for delivery of the product to clinics. It is also a work-around to the global shortage of skilled workers who can make these custom devices. “My role is to inspire, teach, and empower people to become innovators and use 3D printing to solve big challenges,” says Dr. Wong. “Anybody can be an innovator – it’s about creating technology that’s beneficial and accessible to those around the globe who need it most.”
Radiologist, Dr. Jaremko will use the grant funds to develop CUDL 3D Ultrasound, a cloud-based computer-aided diagnostic tool that is currently under development. Simply put, the goal of the tool will be to provide an on-the-spot diagnosis of a 2D and 3D ultrasound image based on knowledge accumulated from thousands of similar cases. With his expertise and vision, Dr. Jaremko’s goal is to make the CUDL a platform for sharing clinical data securely and applying deep learning networks to radically simplify ultrasound. “Unlike other imaging modalities like CT or MRI, ultrasound is portable and can travel anywhere to remote villages or people’s homes. It’s the 21st century stethoscope,” claims Dr. Jaremko. www.hospitalnews.com
TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE Dr. Jaremko’s CUDL 3D Ultrasound could make universal screening for hip dysplasia easier and more reliable.
Dr. Podolsky hopes his work advances the field of simulation to a level of detail and anatomic accuracy and complexity that has never been seen before.
Dr. Khan’s PenMedic will bring relevant information from across the globe and provide it directly to clinicians right when they need it most.
Simulare Medical Corp
Plastic surgery resident, Dr. Podolsky will use the funds to develop Simulare Medical Corp, a start-up company dedicated to enhancing surgical skills via the development of simulators – starting with a physical cleft palate simulator – towards significantly superior patient safety and outcomes. “The advantage of using simulation as part of physician training is that it allows trainees to learn a complex procedure at their own pace in a low pressure environment. Making mistakes has no direct patient consequences and it enables repetition which in-turn leads to increased proficiency and ultimately better trained surgeons,” claims Dr. Podolsky.
Blue Dot & PanMEDIC
Dr. Khan, a practising infectious diseases clinician, will use the funds towards Blue
Dot and the clinical aid PanMEDIC, a webbased clinical aid for physicians who lack the training or experience to confidently recognize important global infectious diseases. PanMEDIC organizes information on important global infectious disease epidemics around the world as they occur. It concurrently monitors the movements of more than four billion passengers on commercial
flights worldwide every year to anticipate where and when these diseases are mostly likely to spread. Finally, it directs timely educational messages to healthcare providers practising in areas of the world at greatest risk of disease spread, with a goal of enabling early recognition and minimizing the potential for outbreaks.
WANT TO FLEX YOUR INNOVATION MUSCLE? Joule™ knows that physicians play numerous valuable roles in the delivery of care to patients. We also know that physicians are uniquely positioned to identify solutions to common healthcare issues but that innovating can be challenging. For this reason, Joule offers Canadian Medical Association (CMA) members with opportunities to collaborate with other physicians, entrepreneurs and subject matter experts to help physicians hone these skills. In 2017, Joule will hold Joule H2 TM Hacking Health Design Days and other events designed to help physicians progress their ideas – potential health care solutions— so the benefits of those ventures can be realized by physicians and patients in Canada and across the globe.
“We feel that PanMEDIC will be a powerful tool and an important step toward preparedness and infectious disease readiness, not only in Canada but around the world,” says Khan. Joule congratulates all five of its Innovation grant recipients for their successful grant applications. At the same time, we also thank them for reminding all of us that when it comes to physician-led innovation, the possibilities are truly endless. For each grant recipient Joule has published a full-length news story and a short profile video. These can be found on cma.ca in a special web-feature, 16 MDs who made 2016 better for physician-led innovation. ■ H Tamara Mason is the Director, Communications at Joule Inc., a Canadian Medical Association Company.
NOVEMBER 2016 HOSPITAL NEWS
TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE
Patients have their ED aftercare instructions at their fingertips with technology By Andrew Schellenbach r. Guido Alvarez, has been to other emergency departments (ED) in the past and found that the aftercare instructions he received upon discharge were not always clear. This can be expected given the fast-paced nature of any ED and the depth of instructions that patients may receive. Many patients in the ED report feeling overwhelmed and may not be able to focus on instructions while at the hospital. These patients would prefer to review more information when they get home or with family. When Mr. Alvarez arrived at Markham Stouffville Hospital (MSH), he expected to have the same old experience. But this was not the case thanks to a new innovation project being piloted at MSH called Dash MD. Dash MD is the first smartphone app of its kind for ED patients. It provides patients with treatment specific aftercare instructions, helps patients access relevant community care resources, and manage medications, appointments and contacts. Hospitals also receive valuable patient experience feedback through the app. MSH is the first hospital to pilot this innovative technology. Dash MD brings together these important tools that benefit both patients on their recovery journey, and care providers in assisting those for whom they provide care. “This type of app can help take the care I receive to the next level,” says Mr. Alvarez. “The app has a ton of great info – much more than the paper pamphlets could hold.” This is just one example of why healthcare innovation is not just a buzzword at MSH – it is the MSH way of providing care. In addition to learning more about his specific injury, Mr. Alvarez also used the ‘Discover Community Care’ section of the
Kris, a nurse at MSH, explaining how to use the Dash MD application in the ED. app to connect with the appropriate external care provider to aid his recovery. Early analysis shows that the ‘Discover Community Care’ section is the most used feature of Dash MD, followed by use of the ‘To Do’ Checklist, and the ‘Medication and Appointment’ tools. “All patients leave the ED with discharge instructions, follow up plans, and appointments. Patients need to absorb so much information and it is challenging to remember all of it,” says Dr. Andrew Arcand, Chief of Emergency Medicine at MSH. “The app format for discharge instructions enables patients and their family
members quick and easy access to important information wherever and whenever they need it.” “Many people depend on a smart phone as an access point for information so it only makes sense to give patients an app to help with this,” says Dr. Arcand. This is supported by a recent study commissioned by Telus Health and Canada Health Infoway, that found over two thirds of Canadians own a smartphone and nearly nine in 10 Canadians believe that digital health solutions will lead to better care. As part of its strategic plan, MSH is working towards being a leader in health-
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HOSPITAL NEWS NOVEMBER 2016
Dash MD Tools: • Aftercare Instructions – Easy access to instructions available on patients’ smartphones. • “To Do” Checklist – A list of recommended aftercare tasks for each condition listed, created by the MSH clinical team. • Symptoms – Patients can access common symptoms and depending on the severity of their symptoms they will be directed to the appropriate care provider. • Medication Manager – Patients can easily set alerts to manage their medication plan. • Appointment Manager – Patients can input and manage appointment details so that they do not miss appointments. • Discover Community Care – This can help patients get the care they need after leaving the hospital, connecting them with healthcare resources in the community. • Healthcare Contact Manager – Patients can keep track of the healthcare contacts relevant to their recovery care innovation by combining the art of caring with the science of best practice. To meet this goal, MSH has an Office of Innovation with dedicated staff to focus exclusively on innovation. “With greater need to be more efficient, innovation is a necessity,” says May Chang, the Executive Vice President and Chief Administrative Officer responsible for innovation at MSH. “Our communities have asked us to explore new healthcare delivery models. The Office of Innovation will take bold action to deliver results that matter to patients, and influence other hospitals and organizations.” “As a sector, we have no choice but to embrace innovation. For many of us, that can mean moving outside of our comfort zone and accepting new ways of delivering care, while providing tools that our patients need,” says Jo-anne Marr, President and Chief Executive Officer, MSH. The Office of Innovation is fostering a growing culture of innovation. As new partnerships are developed with high-quality health technology companies, MSH can provide patients with options that were not previously available. MSH also supports innovation across the region, and is looking forward to spreading innovations like Dash MD to other hospitals as a member of the Joint Centres for Transformative Healthcare Innovation. The Joint Centres is a collaboration of six hospitals in the GTA working together to share information and successes to improve patient care. Moving forward, the Office of Innovation will conduct more rigorous studies on patient experience and the impact that Dash H MD has on the care the hospital delivers. ■ Andrew Schellenbach is the Innovation Project Manager at Markham Stouffville Hospital. www.hospitalnews.com
Evidence Matters 15
Patients’ views on what matters most When I was pregnant with my second child, a midwife was responsible for my prenatal care. I thought she was marvellous because she did not presume to know my priorities for pregnancy. My midwife asked, listened, and applied her knowledge to my priorities. Rather than overwhelming me with facts, or delivering strict instructions or unwanted advice, my midwife used her wealth of knowledge to address my needs. Experience of Sarah Berglas, Patient Engagement Officer at CADTH. By Sarah Berglas and Tamara Rader s it possible to take this approach – of seeking patients’ priorities and using evidence to address those priorities at an individual level – and apply it at a population level? CADTH – the Canadian Agency on Drugs and Technologies in Health – is working to do just that. CADTH is an independent agency that finds, assesses, and summarizes research on drugs, medical devices, diagnostic tests, and surgical procedures. Using evidence – including patient perspectives and evidence applied to patients’ priorities – CADTH provides advice to help address questions raised by decision-makers across the Canadian healthcare system, including policy makers in ministries of health, regional health authorities, hospitals, and at public drug plans.
Patient voices – heard directly or via published literature – offer valuable insights on the impacts of treatment in the context of living with a chronic condition. To do this, CADTH may start by examining the available research on clinical effectiveness, safety, and cost effectiveness as well as the associated ethical, implementation, and environmental issues. But research on the perspectives and experiences of patients can also be sought and evaluated. How to evaluate this type of research can differ from other types of studies and often involves drawing out new and different ideas from each individual study. These different ideas can then be grouped into themes with each theme helping to identify specific factors that impact how patients and their caregivers experience their illness and treatment. Awareness of these factors can help to support CADTH advice and healthcare decisions. However, the evidence CADTH uses in its work isn’t limited to what has been published in medical journals. Patient groups regularly contribute to the CADTH Common Drug Review and pan-Canadian Oncology Review. Both programs make recommendations to Canada’s provinces and www.hospitalnews.com
territories (except Quebec) or to the federal, provincial, and territorial public drug plans to guide their drug funding decisions. Not all new drugs are publically funded; public drug budgets are not limitless. Showing that the drug works in clinical trials is necessary for the drug to become available in Canada, but is each drug worth its price tag? Will it offer good value for money? Determining value is no easy task. When asked, clinicians, researchers, economists, and patients can have different ideas on what should be considered to determine a drug’s value. In 2010, CADTH began asking Canadian patient groups what treatment outcomes really mattered to patients, prior to the assessment of a drug’s clinical and cost-effectiveness. The insights from the patient groups are included in each drug assessment, and later on, to help CADTH reviewers, committee members, and public drug plans understand the relevance of trial results to the daily lives of patients. From patients, we hear about symptom relief, slower disease progression, and avoiding death. These outcomes are often tracked in clinical trials. However, we also hear insights on avoiding hospitalization, reducing the need for rescue medications, lowering costs for treatment, avoiding dependence upon a caregiver, and having the mental and emotional ability to engage in activities of daily living, and more. Unfortunately, these insights are often not captured in clinical trials. Patient voices – heard directly or via published literature – offer valuable insights on the impacts of treatment in the context of living with a chronic condition. Patients can identify whether the benefits of treatment outweigh the harms of that treatment on other aspects of their lives. With these perspectives as part of the evidence base, both healthcare providers at an individual level, and health policy makers at a population level, can address patient priorities. If you would like more information on patient contributions to CADTH Common Drug Review, pan-Canadian
Oncology Drug Review or our health technology assessments of medical devices, procedures and diagnostic tests, visit: www.cadth.ca/provide-input . And if you’d like to learn more about CADTH, visit www.cadth.ca, follow us on
Twitter: @CADTH_ACMTS, or talk to our Liaison Officer in your region: www. H cadth.ca/contact-us/liaison-officers. ■ Sarah Berglas and Tamara Rader are Patient Engagement Officers at CADTH.
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NOVEMBER 2016 HOSPITAL NEWS
16 Nursing Pulse
New opportunity grows from grief A family tragedy forever changed Lorna Larsen’s life, but it provided her a path to save others from a similar fate By Daniel Punch orna Larsen was in the prime of her nursing career, a manager with two decades of public health experience, when “the sky fell in.” Her 23-year-old daughter, Shanna, was diagnosed with stagefour breast cancer in January 2005, after being repeatedly misdiagnosed. She died just four months later. Nicknamed “Shan” by her family and friends, Shanna was athletic like her mother. She coached children’s figure skating and soccer. She was a talented artist who planned to become a teacher. Losing her turned Larsen’s world upside down. “You work hard to get through the grief, but you never get over the loss,” Larsen says. “Shan’s potential, and the young people she would have influenced along the way, that’s the heartbreak.” But from this devastating loss came an opportunity to protect that potential in countless others. Inspired by her daughter, Larsen founded Team Shan in 2006, a charity that educates young women about their risk for breast cancer. Team Shan helped Larsen through her grief, and set her career off in a whole new direction. Rewind more than three decades to the start of that career in a Thunder Bay high school, where Larsen met with
HOSPITAL NEWS NOVEMBER 2016
a public health nurse during her senior year. Up to that point, she aspired to teach physical education. But speaking to the nurse made her realize a career in nursing would allow her to teach, work with children, and be a part of her community – all priorities for her.
Inspired by her daughter, Larsen founded Team Shan in 2006, a charity that educates young women about their risk for breast cancer.
Larsen graduated from Lakehead University with her nursing degree in 1973 and quickly landed a position with Algoma Public Health. She knew public health was her calling right from the start, and loved visiting families in the rural areas outside Sault Ste. Marie. “It was never dull, and you never knew what would happen when you knocked on the door,” she recalls.
Larsen went on to work in many corners of Ontario, including Kingston, Thunder Bay, Temiskaming and Woodstock. She did family planning, school health, lactation consulting, and taught part-time at Sudbury’s Laurentian University and at the Kingston site of St. Lawrence College. She was seconded by the Ministry of Health and Long-Term Care on a couple of occasions, where she helped develop the provincial Healthy Babies, Healthy Children strategy. She was also a panel member for the Registered Nurses’ Association of Ontario’s (RNAO) 2003 Breastfeeding Best Practice Guidelines (BPG) for Nurses, and was a stakeholder for the Interventions in Postpartum Depression BPG, released in 2005. Shanna’s death that same year made Larsen realize cancer among young adults had never crossed her desk in years as public health manager. The more she spoke to colleagues, the more she found there was a major health promotion gap she could address. “(Team Shan) is a positive outcome to Shanna’s death and a chance to make a difference for others following in her footsteps,” Larsen says. In 2007, Team Shan held its first awareness campaign in southwestern Ontario, using Shan’s story to demonstrate the importance of self care and early detection.
Word spread quickly, and soon Team Shan was giving presentations and providing resources to high schools, post-secondary schools, and community organizations across the country. In 2010, Larsen had Team Shan registered as a national charity, and decided to retire from her role as senior nursing consultant at the ministry of health promotion to focus on the organization and serve as its president. She says she feels Shanna’s presence every day as she makes a difference for young women. Last year, she received a letter from a young woman in Peterborough, who thanked her for saving her life. After finding a lump on her breast, the woman visited her doctor and was told she was “too young” to worry about cancer. The woman told her doctor Shanna’s story and requested more testing. The test showed she had stage-one breast cancer. The early diagnosis meant she was able to have it treated. “Now, she’s gotten on with her life, is teaching full-time, and travelling,” Larsen explains. “And that’s H what it’s all about.” ■ Daniel Punch is a staff writer for the Registered Nurses’ Association of Ontario. This article was originally published in the July/August 2016 issue of Registered Nurse Journal.
HOSPITAL NEWS SPECIAL SUPPLEMENT
Focus on Medec Members Making a Difference in Canadian Healthcare
Canadaâ€™s Medical Technology Companies
MEDEC 2016 — Focus on MEDEC Members Making a Difference in Canadian Healthcare Premier of Ontario, Kathleen Wynne made a keynote speech during the MedTech Conference 2016.
Third annual MEDEC supplement A
t MEDEC we strive to be a collaborative partner, working with our government and healthcare stakeholders on behalf of our members to advocate for a responsive, safe and sustainable healthcare system that is enabled by the use of
medical technology. In this 3rd edition of the MEDEC Medical Technology supplement in Hospital News, we’re pleased to highlight some examples of how we’re putting collaboration into action and creating positive change in Canadian healthcare.
Guiding tomorrow’s innovation
today Founded in cardiovascular care and expanding to other specialties, Philips Volcano products offer integrated solutions that make diagnosis and treatment more efficient, more appropriate and more personal.
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HOSPITAL NEWS NOVEMBER 2016
Brian Lewis, President and CEO of MEDEC. An exciting initiative is currently taking place between MEDEC, Alberta’s Strategic Clinical Networks (SCNs), Alberta Innovates, Health Solutions (AIHS), Alberta Health Services (AHS) and the Institute for Health Economics (IHE) that is making real progress and we’re very pleased that four companies are currently working with the SCNs to address health system challenges through the use of innovative medical technologies. This is a unique and innovative model that brings together multiple health system partners in order to address health system needs and enhance patient care. Improving procurement processes in Canada is a priority of our association and the accomplishments of MEDEC’s Medical Imaging Committee in collaboration with St. Joseph’s Group Purchasing Organization is a real testament to what can be achieved. The leading practice guidance documents that have been developed for site visits and on-site product demonstrations have provided best practice processes that can be utilized in jurisdictions across Canada. Following the appointment of William Charnetski as Ontario’s Chief Health Innovation Strategist in fall 2015, Ontario
has launched a number of initiatives that are aimed at making the province a leading jurisdiction for medical technology innovation. This past summer, Mr. Charnetski launched the first call for applications for two new initiatives: a new $20M Health Innovation Fund and Innovation Brokers. These two initiatives are very exciting and we look forward to continue working with Mr. Charnetski and his office to enhance the medtech environment in Ontario. Collaboration was also on display at the 2016 editions of MEDEC’s MedTech Conference in Toronto and at our standalone Regulatory Conference in Ottawa. Both conferences played host to industry and health and policy leaders from across the country coming together to share best practices, network with peers and discuss solutions to challenges facing innovators. We were very pleased to have a variety of engaging speakers at both conferences, including Ontario Premier Wynne providing a keynote speech during the MedTech Conference – affirming her government’s commitment to ensure that innovations make their way to Ontario patients, while growing the industry in the province. Stay tuned for upcoming announcements about speakers for the 2017 MedTech Conference taking place April 5 & 6th 2017 in Toronto! MEDEC endeavours to be a valued partner in initiatives across the country that seek to collaboratively improve the medtech environment in Canada and we believe that these efforts are leading to an increased recognition by government and healthcare partners across the country of the immense opportunities presented by H the medical technology industry. ■ MEDEC is the national association representing the medical technology industry in Canada. MEDEC members are committed to providing safe and innovative medical technologies that enhance the quality of patient care, improve patient access to healthcare, and help enable the sustainability of our publicly-funded healthcare system. www.hospitalnews.com
Focus on MEDEC Members Making a Difference in Canadian Healthcare — MEDEC 2016
Certainty lives in
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NOVEMBER 2016 HOSPITAL NEWS
MEDEC 2016 — Focus on MEDEC Members Making a Difference in Canadian Healthcare Initial participating technologies 1. Cancer SCN – Philips (Intellispace PACS Enterprise) – An enterprise-wide image distribution solution that brings the power of radiology to the point of care. This solution provides rapid delivery of imaging data and interpretations to referring physicians which allows for expedited treatment decisions and allows clinicians to have rapid access to diagnostic-quality images anywhere, anytime. 2. Cardiovascular Heart and Stroke SCN – Joint Project Between Medtronic and m-Health Solutions Medtronic (CareLink Express) – A healthcare-setting monitoring system that allows remote monitoring of cardiac implanted electronic devices so that patients don’t have to be transported to larger centres for assessment.
to get the best health technologies into our health system very Canadian, at one point or another in their lives, will use the health system. For the most part, we know that we receive the best care possible. Both patients and healthcare providers also know that there are challenges. Having access to new, state-of-the-art technologies could address some of those challenges and mean better health outcomes for their patients. But there are many technologies available and it can be difficult to sort through which products might provide the best improvements to patients or the system. Industry knows that they need to produce effective solutions that provide value for patients, but they don’t always know what the particular issues in health systems are at any given time. What if industry and key members of the health system worked together to identify areas of need and worked towards advancing and adopting technologies to address those needs? The health system would have a much better chance of adopting the right technologies and using them to best assist patients. Alberta Innovates – Health Solutions (AIHS), Alberta Health Services (AHS), the Institute for Health Economics (IHE) and MEDEC have been working together to do just that. This unique collaboration brings together the health system, government, and industry leaders to address the emerging needs of patients in Alberta. This partnership allows the actual needs of Albertans to determine when and how health technologies are adopted into the system.
HOSPITAL NEWS NOVEMBER 2016
Unique partnership between industry leaders and the health system means the right cutting-edge health technologies and innovations are adopted to meet patient needs “The partnership between AIHS, AHS, IHE and MEDEC has the potential to solve specific challenges related various medical conditions and lead to better patient outcomes for Albertans,” says Dr. Blair O’Neill, Associate Chief Medical Officer, Strategic Clinical Networks at Alberta Health Services. Reg Joseph, Vice President, Initiatives & Innovations at Alberta Innovates – Health Solutions understands the potential impact of this kind of approach. “This puts Alberta at the leading edge of health innovation and means that the health system quickly gets the innovative and proven technologies it needs so that Albertans have better care,” he says. The key to this initiative, led by AIHS, is the involvement of AHS’ Strategic Clinical Networks (SCNs). They help identify the needs of the health system for a specific medical condition, which provides MEDEC members and other health technology companies an opportunity to propose solutions for the identified needs. The value of the proposed technologies within Alberta’s healthcare system would then
be tested through demonstration projects. Upon demonstration of this value, the objective would then shift to expand utilization beyond a demonstration project to other patients across Alberta that would benefit from the solution. “This initiative offers a truly unique opportunity for industry to collaborate with our healthcare partners in Alberta, bringing together innovators, clinicians, patients and government to collectively solve challenges facing the health system,” says Brian Lewis, President and CEO of MEDEC. “We’re very pleased to be a part such a progressive initiative that has the potential to provide real value to Albertans.” Collecting data on how specific technologies improve patient outcomes and provide value means that the system would have the necessary evidence to quickly adopt the solution. This gets it into the hands of healthcare providers faster – and gives Albertans the quality of care they deserve.
About Strategic Clinical Networks
Strategic Clinical Networks (SCNs) are the engines for change in the Alberta health system. Teams composed of researchers, physicians, patients and managers work in specific areas of health with the goal of finding new and innovative ways of delivering care that will provide better quality, better outcomes and better value for every Albertan.
About Alberta Innovates, Health Solutions
Alberta Innovates, Health Solutions (AIHS) is the Alberta’s leading health re-
m-Health Solutions (m-CARDS TM – mobile cardiac arrhythmia diagnostic service) – A solution that provides longer duration cardiac monitoring (2/4 weeks or longer), wireless communication, and internet technologies to offer unprecedented centralized diagnostic information and patient management resources to physicians treating patients with arrhythmias. 3. Critical Care SCN – bioMérieux – Use of biomarkers to help diagnose sepsis earlier and help identify the best and most effective antibiotic treatment so that patients use fewer antibiotics and are treated more quickly.
search and innovation organization. AIHS funds top quality, internationally competitive health research and innovation activities to improve the health and wellbeing of Albertans. AIHS provides leadership for Alberta’s health research and innovation enterprise by directing, coordinating, reviewing, funding and supporting research and innovation.
About Alberta Health Services
Alberta Health Services (AHS) is Canada’s first and largest provincewide, fullyintegrated health system, responsible for delivering health services to the over four million people living in Alberta, as well as to some residents of Saskatchewan, B.C. and the Northwest Territories.
About the Institute for Health Economics
The Institute of Health Economics (IHE) is a unique collaborative arrangement among government, academia, and industry. Established in 1995, the IHE is committed to gathering and disseminating evidencebased findings from health economics, health policy, health technology assessment and comparative effectiveness research to H support health policy and practice. ■ www.hospitalnews.com
Focus on MEDEC Members Making a Difference in Canadian Healthcare — MEDEC 2016
Ontario enhancing supports for medical technology innovators ollowing the release of the Ontario Health Innovation Council (OHIC) report in December 2014 to improve the environment for the medical technology industry in Ontario, MEDEC and many others with an interest in healthcare innovation expressed support for the recommendations and the promise they offered to improve the healthcare system, as well as the environment for innovators in the province. Therefore, when the Wynne government committed to implement all six of the report’s recommendations in its 2015 budget, there was immense excitement in the medical technology (medtech) community.
Funding innovative health projects will help transform our healthcare system and improve the patient experience. Since that time, the province has begun implementing the OHIC recommendations, with the first being the appointment of William Charnetski as Ontario’s firstever Chief Health Innovation Strategist. Mr. Charnetski and his office are leading the implementation of the OHIC recommendations and for the first time have provided a central point for medtech innovation within the Ontario government.
Earlier this year, in a speech at the Empire Club of Canada, Mr. Charnetski announced that the province would soon be launching two of the OHIC recommendations: a new $20M Health Technologies Fund and the hiring of Innovation Brokers.
system faster, helping to improve both the quality of care and health outcomes for our patients,” says Dr. Eric Hoskins, Minister of Health and Long-Term Care. Successful applicants will be notified in December 2016 and the medtech community looks forward to the innovations that will benefit patients as a result of this program.
$20M Health Technologies Fund
The goal of the new $20M Health Technologies Fund (HTF) is to support the development of market-ready, made-inOntario health technologies by accelerating prototyping, evaluation and adoption in the Ontario healthcare sector. The fund will support projects that reflect priority areas of the government’s Patients First: Action Plan for Health Care. The first priority area for the HTF is Better Care Closer to Home. It will support home and community care through virtual, digital and mobile healthcare technologies. Initial applications through this multi-stage process were received this summer and interest in the program was very high. The fund’s $20 million will support innovation in our health technology sector. It will help our best and brightest get their products into our healthcare system faster, improve quality of life, increase the sustainability of the health system and support job creation”, says Mr. Charnetski. According to the Ontario Centres of Excellence (the lead agency administering the program), “the HTF fosters partner-
Chief Health Innovation Strategist Mr. William Charnetski addressed the audience at the 2016 MEDEC MedTech Conference. ships between publicly funded healthcare service providers, patients, academia and industry to drive collaboration that improves patient outcomes, adds value to the health system and creates jobs in Ontario.” Applicants were able to apply for funding in one of three project categories: • Prototype • Pre-market evaluation • Early adoption “Funding innovative health projects will help transform our healthcare system and improve the patient experience. With the support of the Office of the Chief Health Innovation Strategist, these health innovations will be adopted by our health care
Medtech innovators often have challenges navigating the healthcare system in order to get their technologies to patients and Innovation Brokers will help remove barriers, so that innovative technologies and processes can be adopted by Ontario’s healthcare system and put to work for the benefit of patients. Innovation Brokers will also work with the Office of the Chief Health Innovation Strategist (OCHIS) to coordinate, integrate and ensure alignment of innovation with health system priorities and the needs of Ontario’s population. Earlier this year, OCHIS issued a Request for Expressions of Interest to establish a list of qualified and interested candidates as the first stage in a two-stage process for filling the Innovation Broker positions and MEDEC looks forward to these individuals working closely with industry and health system stakeholders to improve the adoption of innovation in Ontario. The OCHIS has launched a easy-toaccess link to their homepage at: Ontario. H ca/healthinnovation ■
ONE DAY YOUR PATIENT COULD NEED AN MRI AFTER AGE 65, THE LIKELIHOOD OF NEEDING AN MRI DOUBLES. Òñ" !"äïòñèÌäñäçìäñöøñçèõúèñ÷!'ðìïïìòñÖÛÒèûäðöÝëä÷đöúëüìñ" !!úèïäøñæëèç÷ëèĤõö÷ÖÛÒ conditional pacemaker in Canada. We didn’t stop there. We did the same for our neurostimulator in 2013, our ìñöèõ÷äåïèæäõçìäæðòñì÷òõìñ" !$äñçòøõìðóïäñ÷äåïèæäõçìòùèõ÷èõçèĤåõìïïä÷òõ¤ÒÌÍ¥ìñ" !%Ìòñöøï÷÷ëè conditions of use with your physician. Now, more Canadians with these medical devices can access an MRI. Learn how we’re taking healthcare Further, Together at Medtronic.ca.
NOVEMBER 2016 HOSPITAL NEWS
MEDEC 2016 — Focus on MEDEC Members Making a Difference in Canadian Healthcare
Collaborating to advance best practices in medical imaging equipment acquisition processes atients and clinicians count on advanced medical imaging technologies to help diagnose a wide variety of conditions and the acquisition of these technologies can be some of the biggest decisions to be made by healthcare technology purchasers. MEDEC members recognize the occasional need for prospective purchasers to evaluate products at clinical and/or manufacturing sites, as an important part of the equipment selection process. Ensuring quality site visits and an optimal experience during product demonstrations is of para-
mount importance to MEDEC members, as well as the purchasing organizations. Within that context, MEDEC has been proud to work in partnership with our healthcare partners on initiatives that are aimed at improving transparency and efficiency within the medical imaging procurement process through the development of two medical imaging guidance documents: • Staging an Effective Site Visit Guidance Document • Conducting an Effective On-Site Product Demonstration Guidance Document
Guidance for Staging an Effective Site Visit
In the spring of 2014, MEDEC began developing a Guidance Document that its membership could use when responding to site visit requests by prospective purchasers, and invited St. Joseph’s Health System Group Purchasing Organization (SJHSGPO), as well as other GPOs/SSOs, to provide input. The objectives of this Guidance Document are to: i.) Promote consistent, fair and transparent processes within the vendor community, ii.) Encourage accountability for public funding and optimal allocation of resources, and iii.) Provide guidelines for effective and efficient site visits for all involved parties (i.e., vendors, purchasing organizations, and hospitals). MEDEC was very fortunate to gain the
These guidelines have now been in effect for over a year, and have contributed significantly to improved communication between vendors and the Group Purchasing Organization community support of SJHS-GPO in developing these guidelines, which address such things as ensuring that adequate notice is provided when a site visit is requested, conducting site visits locally whenever possible and limiting the number of purchasing organization representatives that attend the site visit. These guidelines have now been in effect for over a year, and have contributed significantly to improved communication between vendors and the Group Purchasing Organization community.
Guidance for Conducting an Effective On-site Product Demonstration
Following the success of this initial collaboration, MEDEC collaborated with SJHS-GPO again in the spring of 2015 in developing guidance to help the MEDEC membership and prospective purchasers prepare for and conduct effective on-site product demonstrations and evaluations HOSPITAL NEWS NOVEMBER 2016
through a consistent understanding of the key requirements. Included in the guidance document is a “Checklist” to help Demonstration Coordinators execute a successful demonstration process. In addition to providing review and feedback, SJHS-GPO reached out to their member clinicians for input, and successfully piloted the guidelines in a Request for Proposal (RFP) for Diagnostic Imaging equipment, prior to national roll out and implementation. “We are very pleased with the collaboration that we have achieved with SJHSGPO on these initiatives,” says Brian Lewis, President of MEDEC. “Through this collaborative relationship we have an improved process that is better for both vendors and clinicians and has led to greater efficiency, better communication, and increased transparency.” “When we openly engage our suppliers directly in ongoing quality improvement initiatives, we can utilize their extensive expertise and experience to benefit everyone involved, including the patient,” says Jay Ayres, Director of St. Joseph’s Health System, GPO.
Process has led to further collaboration
In the fall of 2015, SJHS-GPO asked MEDEC’s Medical Imaging Committee for input on how they could streamline their RFP equipment specifications for diagnostic imaging equipment, including opportunities to clarify and reduce the number of specifications included in their RFPs. MEDEC’s Medical Imaging Committee provided its perspective, which has helped SJHS-GPO identify redundancies as well as opportunities for clarification within the questions. The next step in their streamlining process will be to engage clinicians within their membership for input. “The collaboration between the St. Joseph’s Health System, GPO team and MEDEC’s Medical Imaging Committee has resulted in a best practice development that we hope can be re-applied in other healthcare jurisdictions to everyone’s benefit,” says Mr. Lewis. “MEDEC is very proud of the Medical Imaging Committee’s work with SJHS-GPO on this initiative.” To view the Guidance documents, please visit: http://www.medec.org/page/ H MIGuidance ■ www.hospitalnews.com
Focus on MEDEC Members Making a Difference in Canadian Healthcare — MEDEC 2016
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NOVEMBER 2016 HOSPITAL NEWS
MEDEC 2016 — Focus on MEDEC Members Making a Difference in Canadian Healthcare
SAVE THE DATE: MEDEC’s 2017 MedTech Conference April 5 and 6th! The annual signature conference of MEDEC and the Canadian medical technology industry will take place on April 5 & 6th, 2017 at the International Centre, 6900 Airport Road, Mississauga, Ontario. MEDEC’s MedTech Conference is Canada’s preeminent information exchange and educational forum focused on medical technology – tackling issues such as the adoption of innovation and opportunities to foster transformation within the healthcare system. Attendees will hear from and engage with high-profile health system leaders and network with colleagues. Previous year’s conferences have hosted dignitaries such as Ministers of Health, Hospital CEOs and other influential thought leaders. This year is shaping up to be no different!
MARK YOUR CALENDAR and plan to join us for MEDEC’s not-to-be-missed annual conference!
Visit www.medec.org/events for more information
HOSPITAL NEWS NOVEMBER 2016
From the CEO's Desk 17
A future of possibilities By Julia Hanigsberg
hen you are a specialty hospital, as we are at Holland Bloorview Kids Rehabilitation Hospital, you spend a lot of time explaining what you do and sometimes it feels like we define ourselves by what we don’t do. We don’t have an emergency department. We don’t do surgery. You get the picture. But if your child has a brain injury, cerebral palsy, autism spectrum disorder, developmental delay or one of more than 1000 other unique diagnoses that have a long term or life-limiting impact, you’ll quickly learn our role in children’s healthcare and the enormous strength and courage of the children and families we serve. And how we do what we do is as important as what we do. We partner in extremely deep and rich ways with children and families to meet their goals in care, therapy, and life. We build on the richness of the child’s life and strengths and help that child and family take who they are and make it the best it can be. Why do we think client and family centred care is the most important thing we do? Let me give you an example.
In a recent national survey conducted by Holland Bloorview Kids Rehabilitation Hospital, 45 per cent of Canadians said that they believe kids with disabilities lead less fulfilling lives than those of typically developing kids. That’s the stigma that our clients and families face each and every day outside our walls. But that doesn’t have to be so. We see joyous kids every day who may not speak, or who use a walker or wheelchair to get around, but they experience friendship and love that comes from being a part of a family. For some kids, fulfillment comes from beginning to communicate with their family through technology specially designed and customized to their needs. It might be becoming more mobile through therapy or prosthetics, less anxious or more adept at social interaction with peers. Or it might come from being able to play music with assistive devices, or from being able to paint or perform in a play. By partnering in care, quality and patient safety with clients and families we are developing the programs, services and approaches that will enable kids with disabil-
Julia Hanigsberg with Holland Bloorview client, Thai, age 10. ities to be appreciated for their strengths and the meaning they bring to their own lives and those who love them rather than being defined by a diagnosis or what they can’t do. Through the partnership of our research family engagement program we are conducting promising research to better understand quality of life as it relates to children and youth with disabilities. We’re exploring areas such as barriers to inclusion, employment and accessibility, friendship and life-skills development, and how all of this contributes to overall satisfaction. So over the next six months as we develop our next strategic plan, we have families and youth at the table and we start with what we hear from families: we need
to make it easier to manage the multiple services, providers and institutions their children interact with. Through research and training we need to lead to enable all elements of our health system to partner more effectively. And we need to explore how we will reduce the barriers put in the way of kids with disabilities outside our walls. Because using a wheelchair doesn’t make you disabled unless someone builds a curb in your path. Listening to our clients and families has led to us challenging the status quo in care, research, and teaching and in the very purH pose of our hospital. ■ Julia Hanigsberg is President and CEO, Holland Bloorview Kids’ Rehabilitation Hospital.
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NOVEMBER 2016 HOSPITAL NEWS
TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE An infographic ic was developed d w after the new patient bookkings team at the e Odette Cancerr Centre identified d a gap in receiv-ing new refer-rals from acute care following g a PIE – People Improving Experiences – meeting.
Improving the patient experience By Alexis Dobranowski
Manager of Activation and Volunteer Services Sarah King (back) with patients and junior kindergarten students from Humbercrest Public School.
Enhancing the patient experience every day By Roxanne Hathway-Baxter t Runnymede Healthcare Centre, patients are more than passive recipients of an identical hospital experience. Staff realize that every patient is unique, and they are committed to designing and implementing patient experience strategies that suit the individual, rather than only adhering to what’s been done in the past. This is part of Runnymede’s “You First” philosophy, one of the four pillars that make up its latest Strategic Plan, Vision 2020: Redefining Possible. Teams are perpetually on the lookout for new programs and initiatives that will help to better the day-to-day lives of the patients during their stay at the hospital. Hospital-wide initiatives are being completed, with a notable example being this year’s expansion of visiting hours, in tandem with the activation department’s continued efforts to implement new patient-centred programs and their use of innovative technologies in therapy.
It is more and more common that many families are increasingly spread farther apart geographically than they would have been before. Children might grow up rarely seeing their grandparents, and grandparents, in turn, not seeing their grandchildren. Not having these interactions can be detrimental for both youth and the elderly, diminishing valuable social development and learning opportunities. In October 2015, intergenerational programming was introduced at Runnymede, which sees junior kindergarten students from Humbercrest Public School socializing with patients and participating in creative group activities. The benefits have been mutual, with the activation team seeing increased engagement from patients and teachers HOSPITAL NEWS NOVEMBER 2016
noticing that many of the students now have greater comfort levels around people with disabilities or those who have difficulties communicating. The program was so popular for everyone involved that it has returned for another year starting in September 2016.
Yoga has become an increasingly popular activity for seniors, and in July 2016, a bi-monthly class was introduced at the hospital. Although the class is operating with a senior-friendly philosophy, it’s open to all patients at Runnymede, regardless of age. The health benefits associated with yoga are immense, from increased flexibility and balance to lowered stress and anxiety levels, all of which are important to those going through therapy at the hospital. It has become a very well-attended program, with over 20 patients taking part in each class.
Technology in the activation program
In many cases, integrating technology into activation therapy has been very beneficial to patients. Devices that many people use on a daily basis can have lots of positive outcomes when used in a therapy setting. For instance, using a tablet to talk to far-away loved ones through video calls can be an incredibly enriching experience for a patient. Moreover, this digital faceto-face contact can be helpful to patients who might have difficulties with verbal communication or who have hearing problems that are exacerbated by the non-visual nature of a traditional phone call. Video calls enhance the experience for not only the patient, but for the loved ones as well, helping to foster a powerful connection even if the individuals cannot be physically in the same room.
Getting visitors can be extremely important to patients and is an integral part of the experience they have at the hospital. Visits from loved ones offer much-needed support and are a building block that helps the patient remain positive throughout their stay. Sometimes visiting hours at hospitals can be restrictive, which can make it difficult for loved ones to fit these visits into their busy and ever-changing schedules. Runnymede has recognized this and in the spring of 2016 chose to implement a new hospital-wide initiative, offering 24-hour visiting hours as part of its ongoing commitment to patient-centred care.
Patient satisfaction surveys completed at Runnymede clearly show that these programs and initiatives being implemented are having a positive effect on the patient experience at the hospital. In 2015, 89.2 per cent of patients reported that they were happy with the overall quality of care, which outranks the peer hospital average of 82.4 per cent. Runnymede, it seems, is on the right track when it comes to patient experience.
There is no one program that is the key to enhancing the patient experience. It takes many. Through the implementation of all these programs and initiatives, Runnymede has worked to secure its place as a centre of excellence, putting a strong emphasis on you first by enhancing the patient experience every day. This is an incredibly important endeavor for Runnymede, and H one that they plan to never stop pursuing. ■ Roxanne Hathway-Baxter is a Communications Specialist at Runnymede Healthcare Centre.
t Sunnybrook, front-line clinical teams and patients have been engaged in focused improvement projects on units and in the clinical area. Several clinical areas have participated in the project, known as People Improving Experiences (PIE), that sees teams meet – over a slice of pie – to develop small, manageable ways to help improve how people access and experience various areas of the hospital. “Our front-line staff and patients have great ideas about changes we can make that may seem small, but can have an immense impact on the patient experience,” says Lynne Downey, an advisor in Sunnybrook’s Office of the Patient Experience. One example of an idea generated and executed through PIE is Hallway Kits. Due to occupancy pressures, patients occasionally find themselves on a bed in a hallway. To help make the best of this situation, a special kit was developed and piloted on B4 to help hallway patients feel more comfortable. The kit includes ‘creature comforts’ such as eyeshades and noise cancelling headphones as well as some toiletries that were donated. “Two other in-patient units have since contacted the Office of the Patient Experience about starting up the Hallway Kits on their units,” Lynne says. At Sunnybrook’s St. John’s Rehab, it was identified during a PIE session that a high number of patients were missing out-patient appointments. Many of the patients have cognitive impairments and the way the schedules were presented on the paper given to patients was confusing. A more patient-friendly schedule was developed and is being piloted to their patients. The new patient bookings team at the Odette Cancer Centre identified a gap in receiving new referrals from acute care. An infographic was developed, posted on Sunnybrook’s intranet and delivered to the Patient Care Managers of the inpatient units. The infographic identified key areas to be included on the referral. The PIE project continues to generate more ways to improve the patient experience. More current projects include reducing noise in the OR, re-examining the information we provide to patient’s who have cancelled surgeries in same day surgery, and revamping information provided H to patients in our drug safety clinic. ■ Alexis Dobranowski is a Communications Advisor at Sunnybrook Health Sciences Centre www.hospitalnews.com
TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE
Solutions that will change the patient experience By David Stoller
he Canadian Centre for Aging and Brain Health Innovation (CC-ABHI) is a solution accelerator for the aging and brain health sector. Its focus is to facilitate the improvement of the patient experience for older adults living with dementia by fostering ground-breaking collaborations among leading global innovators and seniors’ care organizations in North America and around the world. CC-ABHI facilitates the improvement of healthcare outcomes for older adults by providing funding support to leading global innovators and seniors’ care organizations. Through these partnerships, new innovations to the healthcare sector are developed, tested, and ultimately disseminated to the market with an eye to making them available for commercialization and consumption globally. The innovations developed through CC-ABHI’s funding programs are expected to change the patient experience because they will bring together a network of partners with established expertise, resources, and infrastructure who will be able to identify challenges, and develp solutions, in the aging and brain health space. By connecting these partners towards a common goal to improve the design, adoption, and funding of solutions, CC-ABHI will support the dissemination of new and impactful treatments to patients in Canada, and around the world. “CC-ABHI facilitates opportunities for members of the healthcare community to develop and lead health innovation that will enhance and extend brain health and cognitive function,” says Ron Riesenbach, Managing Director of CC-ABHI and VicePresident, Innovation & Chief Technology Officer at Baycrest Health Sciences. “Through innovation and collaboration, and well-rounded funding opportunities, the Centre is helping change the patient experience by helping people age in their setting of choice while maintaining cognitive, emotional, and physical well-being and independence.” CC-ABHI is specifically focused on changing the patient experience for older adults living with dementia by seeking solutions to four health care priorities facing the aging and brain health sector: 1. Reducing unnecessary emergency department visits; 2. Preventing falls; 3. Providing better management of complex health conditions; and/or 4. Improving brain health or cognitive fitness in older adults. To support innovators in the development of these solutions, CC-ABHI has developed four distinct funding programs that are designed to support innovations at various levels of the development cycle: The Spark Program provides funding to point-of-care providers and service staff who have innovative ideas in the field of aging and brain health. The funding provided through this program will help innovators at the point-of-care take an early stage solution with promising scalability to proof-of-concept or prototype. The Industry-Led Program co-invests funding alongside companies who have innovative products or solutions at an advanced stage of development so they can test and validate their innovative products
or solutions and accelerate the pace to commercialization. The Strategic Accelerator Program provides funding to teams of researchers, clinicians, educators and end-users so that they can develop, refine and test their product or solution. The Knowledge Mobilization Program provides funding to eligible clinicians, scientists and/or educators who have scientifically validated knowledge and best practices to share with older adults, family members/caregivers, healthcare providers and health system managers. The
solutions will help disseminate, translate, and/or implement knowledge at the pointof-care. Established in 2015, CC-ABHI is the result of the largest investment in brain health and aging in Canadian history with a total investment of approximately $123.5 million. This unique collaboration of more than 40 leading industry, academic, public sector and not-for-profit partners will bring innovations and solutions to the senior’s healthcare space. The objective is to ease the burden of an aging population by supporting the development of treatments and
solutions that will allow older adults to age more comfortably in the setting of their choice. Furthermore, these new innovations will also support the efforts of healthcare workers and family members who often shoulder the burden of caring for older adults who suffer from cognitive decline. To learn more about CC-ABHI’s funding programs, visit www.ccabhi.com or H email firstname.lastname@example.org. ■ David Stoller is the Sr. Marketing Specialist at The Canadian Centre for Aging and Brain Health Innovation.
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TF: 1.888.223.0448 T: 416.868.3100 www.thomsonrogers.com NOVEMBER 2016 HOSPITAL NEWS
TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE
Elevating patient experience and family centred care By Patti Enright ath towels warm to the touch. A peaceful, contemporary and home-like environment for patients and their families to spend time together while in palliative care. Two private, self-contained suites in the unit, so families can stay close at hand. These were just some of the features highlighted at the grand opening of Providence Healthcare’s new palliative care unit on October 12. The first floor of the two-floor unit includes a dedicated entrance separate from the hospital’s entrance for rehabilitation patients and visitors, allowing for privacy and comfort. The unit also features a play area for children and a business centre; easy access to a peaceful, relaxing outdoor space; and common rooms for socializing with family, pet visiting, music, spiritual needs, entertainment, arts and crafts, computer workspace, television and movie watching. The second floor has comfortable patient rooms, featuring soothing décor; serene spaces with pull out sleeper recliners available for families, with television and music inputs; and new artwork, and floor and wall colours and finishes more in keeping with a contemporary, calming home than a hospital. The improved and relocated unit brings the care experience for patients and families to a new level. One hundred per cent of the $4.5 million project to transform the space in Providence’s palliative care program has been funded by private donors through Providence Healthcare Foundation’s Hope Starts Here campaign, including a $1 million donation received from the Archdiocese of Toronto. The palliative care wing’s
The depth and scope of our work to improve patient care has been professionally rewarding for our staff, and most importantly elevates the care experience our patients and their families receive to a new level.
(above) The children’s play area located on the family and caregiver floor of the new Palliative Care Unit. (right) One of two family guest suites on the family and caregiver floor of the new Palliative Care Unit, for families who want to stay overnight. It contains a bathroom spa, closet and flat screen television. reception area will be named in honour of Michael Power, the first bishop of Toronto. In addition to transforming the physical space in palliative care, over the next year new initiatives being introduced to exceed the expectations of patients and their families include: patient-directed visiting hours; improved wayfinding for patients and visitors coming to the program and other areas of the hospital; and flex-
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ible mealtimes for patients. A blessing of the hands ceremony is being introduced for staff. “Our vision is big and bold,” says Josie Walsh, CEO and President of Providence Healthcare. “We want the people we care for to flourish at Providence and at home.” The strategic direction is three-fold: delivering the best care experience; developing the best community of experts; and, having the best relationships beyond the organization’s walls. An example of an initiative at Providence that integrates these three areas is the Community Referral Pathway that provides Fast Access for Seniors to Community Assess and Restore Services (FAST CARS). The goal of the standardized care path is to stabilize the health of vulnerable frail seniors, and to keep them healthy and safe at home for as long as possible. The pathway helps people flourish at home by bringing together experts, such as Providence’s frailty intervention team and community partners. To support the ‘Best Care Experience’ strategic direction Providence has chosen to pursue Planetree’s Gold Designation in patient-centred care. Planetree is a non-profit group that works with healthcare organizations internationally to improve the patient experience. In September 2015, Providence invited Planetree to conduct focus groups to create a baseline measurement of the patient experience in Providence Hospital. The score is based on 48 criteria under 11 key aspects of holistic, patient-centred care. Over 150 staff, patients and families participated in the focus groups. The summary of the focus group feedback highlighted Providence’s strengths as well as opportunities for improvement.
The results revealed Providence had near perfect scores in the categories of ‘Structures and Functions Necessary for Cultural Change’ and ‘Human Interactions, Independence, Dignity and Choice’. The hospital also scored well in categories of ‘Family Involvement’, ‘Integrative Therapies’ and ‘Healthy Communities’. An example of an area of opportunity was ‘Environment, Architecture and Design’. In this category, participants suggested better wayfinding in Providence Hospital since people were having difficulty finding their way. Ideas for growth included patient and family-directed visiting hours and improving patient access to better understand their medical record. Overall, Providence received a score of 33 out of 48, which would position the organization for a bronze designation. Planetree provided suggestions on how Providence can improve in all areas. The opening of the new palliative care unit marked the implementation of several of these recommendations. “We look forward to seeing the results of the next measurement of our patient experience,” says Walsh. “The depth and scope of our work to improve patient care has been professionally rewarding for our staff, and most importantly elevates the care experience our patients and their families receive to a new level. It is an exciting and fulfilling time for all involved at H Providence.” ■ Patti Enright is the Corporate Communications Manager at Providence Healthcare and Steering Committee Member for the Providence Experience Project. www.hospitalnews.com
TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE
New app helps patients navigate surgical journey for rare cancer By Alica Hall
found something.” It’s been four years since Rick Williamson heard his doctor say those words, but he will never forget the moment. Rick had completed a routine examination of his digestive tract when his doctor asked him to come back in a week for an update. “I was so anxious, I couldn’t wait for an appointment,” he recalls. “Within a few days, I went back to the doctor’s office and I just waited around until he could see me.” Rick sat down in the office and braced himself; he knew it wasn’t good news. His doctor took a piece of paper and drew a crude picture of the small intestine – it was cancer. “I remember just sitting there, trying to process what he was saying,” he says. “I asked him how bad is it and he told me most people are terminal within five years, but you could be gone in less than that.” Cancer of the duodenum is relatively rare. It has few symptoms, which can go unnoticed until the cancer has advanced to a later stage; making it more difficult to treat. Thankfully Rick had an early diagnosis and was a good candidate for a Whipple procedure, the most effective treatment available for this type of cancer. St. Joe’s is just one of 13 hospitals across Ontario that offers this complex surgery to treat cancer of the liver, pancreas and bile ducts.
Within a few weeks, Rick came to St. Joe’s to meet Dr. Shiva Jayaraman, a surgeon who specializes in the Whipple procedure. Rick’s surgery was booked for two weeks after their meeting; the most difficult two weeks of his life. “I couldn’t eat solid food for four months after the surgery, but the hardest part of this experience was getting mentally ready,” he recalls. “You have one meeting with your surgeon and then you’re in the operating room – you don’t really feel prepared.” To ease his fears, Rick tried to search for information online. He found inspiration reading stories of cancer survivors and bloggers, but he still wasn’t sure what to expect in his own journey. As an educator and a surgeon, Dr. Jayaraman knows how difficult it is for patients to find information they can trust. “There’s a lot of medical information out there that is focused on selling services to people,” Dr. Jayaraman says. “The problem we’re facing today isn’t a lack of information, but rather the quality and relevance of what’s available.” This challenge would inspire Dr. Jayaraman to find a solution. He had an idea to develop an app that could provide reliable information about the Whipple procedure for patients and their loved ones. “I’ve always been interested in developing new ways to educate the residents and
Dr. Shiva Jayaraman shows his patient Ann-Marie Ten Hoope how to use the Whipple app. students I work with as well as my patients,” he says. “A free web-based app means anyone can access it, patients can use it to see if they’re on-track in their recovery and caregivers will better understand what’s happening to their loved ones.” Dr. Jayaraman led a team of students, developers and current and former patients for over six months to develop www.whipplepathway.ca. The web-based app walks patients through the surgical journey from beginning to end. Rick financially supported the development of the app. The website launched in April and has already been
visited by thousands of people in the US and Canada. “This is one of the ways, as physicians, we level the playing field. In order to empower patients to become more involved in their healing process we have to educate them about what’s happening in their bodies,” says Dr. Jayaraman. “My goal is to ensure patients have useful, evidence-based information that prepares them for H surgery.” ■ Alica Hall is a Communications Associate at St. Joseph’s Health Centre, Toronto.
NOVEMBER 2016 HOSPITAL NEWS
TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE
Garden enhances patient experience By Ana Gajic
patient with dementia, who is normally in a state of agitation, finds a sense of calm in the simple act of digging up two vegetables in the Bickle Garden. Such moments of therapy and peace were easy to spot this summer in the new garden at Toronto Rehab’s Bickle Centre for Complex Continuing Care, notes Amanda Beales, a Registered Dietitian at Bickle. “It gave the patients something to connect with – a reminder of their own gardens,” says Amanda. “The garden has offered so much positive patient interaction in its first year.”
The new Pupillometer will improve how quickly health professionals can respond to small changes in a patient’s brain activity.
New technology to gauge brain reactivity By Elise Copps he practice of checking a patient’s pupils to determine how well their brain is functioning has existed for over 100 years. A nurse shines a light into the person’s eye and records how his or her pupils react, labeling them “brisk”, “sluggish” or “nonreactive”. It’s an important exam because it can give the healthcare team clues about brain activity and indicate whether urgent surgery might be necessary. But this method is prone to human error. A variety of factors such as the brightness of the flashlight or varying perceptions of pupil size mean that results can be inconsistent. Small changes in reactivity may not be noticed until the brain is already in danger. To take the guesswork out of this process, Hamilton General Hospital (HGH) has adopted a new technology called a Pupillometer. HGH is one of only five hospitals in Canada using this device. It’s manufactured by NeurOptics® and is officially known as the NPi™-200 Pupillometer. The device measures a number of factors including pupil size and reactivity, and can store up to 3,000 measurements in its internal memory bank. That allows trends and changes to be tracked over time. Dr. Draga Jichici, a neurologist at HGH, says it will improve how quickly they can respond to small changes in a patient’s brain activity. “It will allow us to have an objective early warning sign that patients are deteriorating,” he says. “It will give us an opportunity to intervene before it worsens.” Instead of relying on the human eye to gauge reactivity, you point the Pupillometer at each pupil. Using infrared light, it records a video of the pupil and analyzes it to decide how reactive it is. The Pupillometer measures several factors including the speed at which the pupil dilates, its size at HOSPITAL NEWS NOVEMBER 2016
maximum dilation and the delay between the onset of light stimulation and pupil reaction. All of these variables are combined and measured against a normative scale to produce a rating on the Neurological Pupil index™. Instead of using subjecbjech” tive terms like “sluggish” and “brisk,” the Pupillometer’s measurement index gives a rating from 0-5. A score of 3 or greater indicates a normal reaction. 1 or 2 indicates that the pupil is less reactive than normal and a score off 0 means it isn’t respononsive at all. Used alone, each individual score can help the patient’s care team decide id whether h h to stay the course of treatment or attempt a new intervention. Combined over time, they can provide even greater insight. The thousands of scores that are potentially stored in the device can be charted to visualize changes in responsiveness. A clinician using the device can see how pupil size and reactiveness has evolved in recent hours, days or even weeks. The visual map is a clearer indication of small changes that could warrant urgent action, such as surgery to relieve pressure on the brain. The objective scoring system also allows clinicians to identify plateaus over time. If a patient’s pupils consistently score 0, the reality that they are not improving may solidify earlier than if that responsiveness was being measured subjectively by the naked eye. The Pupillometer can also connect to an electronic medical record so the patient’s ratings can be tracked in their chart and viewed alongside other important in-
dicators. The ability to easily track changes based on the numeric rating scale will help clinicians to develop the best plan of action for that patient. In some cases, this could mean the difference between life and death. “The pupil’s changes can preced precede life threatening changes for the patient,” chan says Dr. Jichici. “These say ch changes may indicate th that we need to check the patient more freth qquently, order certain te tests or perform emergency surgery on the ge bra brain.” T The Pupillometer is already in use in the Neurosciences Unit at HGH and is in the process of being introduced to the Care Units. Keih hospital’s h i l’ Intensive I sha Jack is the clinic manager of the Neurosurgery and Neuromodulation Program at HGH and was involved in creating a protocol for ordering the test and phasing in the device. It has become an important tool in making connections between clinical and neurological findings. She says staff has responded well to the technology and feels more confident when performing neurological exams using the Pupillometer rather than the naked eye. “Clinicians appreciate the objectivity the Pupillometer provides,” says Jack. “It allows for more accurate assessments and reporting of changes in the clinical status of the patient. That translates into timely interventions, appropriate clinical decision making and H better outcomes.” ■ Elise Copps works in Public Relations & Communication at Hamilton Health Sciences.
A home-grown effort
Planted this summer, the garden grew thanks to the Bickle Green Team, which received funding from TD Friends of the Environment. It brought Bickle together with the Parkdale neighbourhood organization Greenest City to build a wheelchair accessible, inclusive gardening experience. “This collaboration allowed us to build and enhance our relationships with the community,” says Paula Cripps-McMartin, Clinical Director, Bickle Centre. “We were able to learn and grow together, and now the garden has become a source of comfort and therapy to our patients as well.” This summer, UHN’s first wheelchairaccessible garden offered ingredients for patients honing their cooking skills, a practice terrain for those working on mobility, and a space reminiscent of patients’ own yards at home. “Our garden provided patients an opportunity to reengage in a meaningful life activity that had been put on pause due to illness and/or hospitalization,” says Susan Currie, Occupational Therapist (OT). “Anytime we can make therapy fun, it increases a patient’s motivation and engagement ten-fold.” Susan, who is also the OT Professional Practice Leader for Complex Continuing Care Patient Programs at Bickle, integrated the garden in therapy with patients from the Low Tolerance Long Duration Rehab program and the Complex Continuing Care units. “Given that OT works on helping people engage in activities that they find important, the garden was a perfect fit,” she explains. “Instead of using a table and staring at a wall while working on standing, patients could do the same standing exercises in the garden, in a more interactive environment.” Beyond physical rehabilitation, Amanda says the garden was an excellent “ice breaker to connect with patients” and backdrop for education sessions and nutrition assessments. “We would be walking around the garden, looking at the vegetables growing and all of a sudden a patient would open up to me about their diet struggles, or about how much they loved eating a certain vegetable. It helped me build a rapport with my patients.” Continued on page 26 www.hospitalnews.com
TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE
Brian’s all in.
Brian Cameron likes to win. Be it in the courtroom, or playing poker in his downtime, this hardworking lawyer knows how to keep his cards close to his chest, which may be one reason why he’s at the top of his profession. As a personal injury litigator, Brian gets satisfaction from the opportunity to make a difference in the quality of his client’s lives, especially when they may not yet be aware of the hand that they’ve been dealt. What makes him a good poker player also helps him win cases. “I see myself as a storyteller. I share my client’s life story with the jury so they can see how drastically the defendant has changed their life … and I have a good poker face when I need one.” Brian excels at breaking down legal complexities to their simplest form for his clients. He treats them with a level of dignity and compassion that has contributed to his being recognized as a certified litigation specialist. That kind of passion, commitment and dedication means that Brian’s all in when it counts the most.
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NOVEMBER 2016 HOSPITAL NEWS
TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE
International value-based healthcare report By Yvan Marston
o one disputes that a high functioning healthcare system is one that improves clinical outcomes while lowering costs. But how we get there and whether we are close to implementing one are areas rife with debate. A new report studying health systems around the world is the latest attempt to give the conversation some form. It says Canada is ‘moderately aligned’ with the core components of value-based healthcare, though its implementation remains a few steps from certain. Designed to set a global standard of evaluation and to establish the core components of what it calls “an enabling environment for value-based healthcare,” the 30-page report from The Economist’s Intelligence Unit, released in September, examines the health systems of 25 countries scoring them on a number of key metrics. It defines a value-based healthcare system (VBHC) as one that explicitly prioritizes health outcomes that matter to patients relative to the cost of achieving those outcomes. VBHC is an idea popularized by Michael Porter and Elizabeth Teisberg in their 2006 book Redefining Healthcare, but it has long existed as a focus for health systems worldwide. For the study, researchers sought to determine the level of alignment for each of the 25 countries selected. They organized their enquiry around four key components, namely: Is there an enabling context where policies and institutions champion value
in healthcare? Are outcomes and costs measured? Is there integrated and patientfocused care? And is there an outcomebased payment approach? Value-based approaches, according to the study, are being implemented incrementally and at varying speeds across the world’s healthcare systems. And in some places it is further along than in others. Sweden, for example, emerged as the only country in the report with very high alignment. Not that it has comprehensively implemented a VBHC system, but there are important components already in place. Its healthcare workforce, for example, is largely salaried and therefore not
The study defines a value-based healthcare system as one that explicitly prioritizes health outcomes that matter to patients relative to the cost of achieving those outcomes
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incentivized as they might be in a fee-forservice model. The U.K, whose National Health Service has been experimenting with new team-based healthcare delivery models and forms of payment also scored well and was the only country with high alignment. Canada gets its rating of ‘moderate alignment’ from the fact that it has all four of the key elements, but it only scored ‘high’ on two: having an enabling context and having an outcome-based payment approach. Areas to work on include providing health professionals with training on how to practice in a value-based healthcare setting, and creating a national and provincial level registry where patient reported outcome measures can be more successfully integrated with existing government data.
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Recent evidence suggests Canada has gained ground on the use of interoperable Electronic Health Records. The peer-reviewed journal BMC Medical Informatics and Decision Making reported that healthcare providers in Canada were active users of at least two iEHR components such as accessing diagnostic images and drug information outside of their organization. Twelve months after the initial assessment, that figure jumped by an additional 50 per cent, bringing the number to approximately 139,000. More than 250,000 clinicians from across Canada use at least one component of the iEHR. A second article in the same journal revealed that iEHR users reported improved quality of care and improved access to patient information. “Better data and more data is one key to system improvements and to understanding outcomes,” says Janet Davidson, board chair at the Canadian Institute for Health Information and most recently the deputy minister of Health in Alberta. “There are a lot of data, but is it organized in a way that is easily understood?
Can it be accessed? Is it timely? There’s no point in having access to outcomes that are three years old if your organization is, for example, talking to physicians about performance,” says Davidson. Better information can also contribute to better quality discussions on health spending explains Davidson. “We have the components of a good system but when there’s a suggestion that things should be done differently, the reaction by whatever stakeholder group is impacted is to say: You’re destroying medicare. But it’s the opposite, we’re trying to improve it,” she adds. “Talk is often about costs, because based on the evidence of how much we spend on healthcare there is no reason we cannot have far better outcomes.” While a focus on outcomes seems like an obvious goal, it is not an easy thing to realize in a system that puts volume before value, explains Dr. Gabriela Prada, a Conference Board of Canada health policy expert who has studied health innovation and procurement. “The problem with value is that it can be defined differently by patients, providers and suppliers, but outcomes are what links them all,” says Prada. “People working in healthcare want the best for patients. When you focus on outcomes, rather than cost or volume, the conversation becomes much more collaborative.” Spending more on care is not always effective, as is evidenced by the overuse of some medical tests, Canada’s high rate of caesarian sections and the misuse of antibiotics, but cutting back in service-based areas is complex and often met with skepticism from users. “Procurement is a tangible place to start,” says Prada, explaining that moving the transaction from a cost conversation to one focused on outcome can yield value. She cites the example of a hospital in Norway that bought catheters in the usual manner using key criteria and selecting the lowest cost solution. But patients complained the catheters weren’t comfortable, and providers said they often needed to be replaced. The hospital went back to market with a new procurement process that included a pain test and a one-month trial period for potential solutions. The catheter that was eventually selected was not the cheapest one but the one that would contribute best to outcomes and yield the most value. Pacemakers with longer battery life serve as another example. “These purchasing decisions are made in the context of annual budgets,” Prada says, explaining the challenge. “They aren’t decisions made about the greater value to the system but rather what is of a lower cost today.” “We are currently operating in a system where our ability to measure value is less than our ability to measure cost,” says Prada. “Cost, she explains, is tangible. When you follow a patient through the continuum of care, from acute care to chronic care, measuring outcomes becomes more complicated. But it remains an important focus.” “When you talk about change in a particular healthcare program with hospitals and providers and you talk about it in terms of patient outcomes, people will foH cus on working together,” says Prada. ■ Yvan Marston is a freelance writer in Toronto. www.hospitalnews.com
Trends In Transformation 25
How 10 minutes a day promotes a safety culture By Brenda Kenefick hen the University Health Network (UHN) made improving safety for patients and staff a top priority, the question became how to develop a more robust safety culture. Since a strong safety culture requires strong team engagement, one of the first steps was introducing daily huddles for front line staff. The area manager meets with the interprofessional team for 10 minutes to talk about safety, demonstrating that it is a priority. The safety huddles follow the same format used by senior leaders at each UHN hospital: Look ahead to identify any safety concerns for the next 24 hours, look back and review any incidents from the previous 24 hours, and report back on any action taken to address safety concerns or incidents from the previous day. In the past managers have had an open door policy and staff could report problems whenever they wanted. The move to safety huddles introduces a structured and standardized approach for reporting safety issues. It also reinforces the expectation that staff will report any concerns they have.
Front line huddles
The success of the strategy requires staff to speak up when they identify a safety concern, and it also requires managers to take action when a concern is brought to their attention. Staff are encouraged to adopt a team perspective, to look beyond the scope of their role and to take responsibility for the entire area. â€œI start every huddle by stating our goal of 100 per cent safety for our team, our patients and their families,â€? says Norma Ferrer-Pilarta, Nurse Manager, Toronto General Hospital. â€œSince we started huddling my team is more engaged, and more willing to support each other with shared responsibilities.â€? Managers and unit leadership receive a two-hour training session on how to run the safety huddles, and in particular are taught to do three things. First they make sure to ask every team member, by name, if they have any concerns to report. This ensures team members are not subtlety discouraged from speaking up. Second, managers are trained to respond to every concern reported by saying â€œthank you.â€? Third, they report back to the team on the status of every open issue until it is resolved. â€œWeâ€™ve identified everything from a phone jack that fell off a wall to a serious issue with equipment design,â€? says Norma. â€œSometimes we have a discussion to clarify which team members are responsible for certain tasks, and sometimes I need to work with managers from other departments to address the root cause of an issue.â€? Of course, some problems require organizational changes or investment. These problems must be escalated to a higher level for resolution.
Photo courtesy of UHN
Norma Ferrer-Pilarta, Nurse Manager, Toronto General Hospital, leads her teamâ€™s daily interprofessional safety huddle. managers and directors to complete the cascading communication chain between the front lines and the senior leadership. Every day, after the unit level huddle, directors and their managers develop situational awareness with respect to concerns and incidents. Itâ€™s a structured approach to sharing learnings, to identifying trends and problems that are occurring in multiple areas, and to discussing solutions. â€œWe keep the huddles very tight and focus in on the issues that might need immediate attention or escalation,â€? says Jatinder Bains, Program Manager, Toronto Rehab. â€œHaving the structured time in our day keeps our leadership team
aligned and working together towards safer patient care.â€? The directors then take a summary of the incidents and concerns to the hospital safety huddle. The senior leadership team tracks the number of incidents and concerns every day. Systematic safety concerns can be raised at this level, and the group also reviews any major safety incidents that occurred in the previous 24 hours. This structure creates a direct chain of communication which allows concerns from front line clinicians, support staff and managers to be escalated to senior leaders in a matter of hours and for immediate action to be taken at the appropriate level.
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Decisions can also be quickly communicated back down the chain to inform the team responsible for raising the concern about the outcome. Front line nurses are saying that the huddles are the best thing to happen in 15 years. From an organizational perspective, when safety issues are transparent swift action can be taken to prevent harm to staff, H patients today and patients tomorrow. â– Trends in Transformation profiles people in action, improving health care at the front lines. Brenda Kenefick is Director, Lean Process Improvement at University Health Network.
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Every manager at UHN can escalate an issue to the site level safety huddle by passing it along to their director. Toronto Rehab is piloting a standardized huddle for www.hospitalnews.com
NOVEMBER 2016 HOSPITAL NEWS
26 Legal Update
Should medical assistance in dying be reported to the Coroner? By Michael Watts and Swetha Popuri n June 17, 2016 the federal government passed Bill C-14 on medical assistance in dying (MAID) in response to the Supreme Court’s 2015 decision in Carter v. Canada. As directed by Bill C-14, provincial Ministers of Health have been tasked with implementing MAID through various regulations. In particular, provincial Ministers of Health are required to establish guidelines on the information to be included on death certificates of deceased persons who accessed MAID. The critical question is whether MAID will be identified as the cause of death for these persons, as opposed to their underlying illness, condition or disability. In Ontario, the Ministry of Health and Long-Term Care (MoHLTC) policy on MAID directs physicians to notify the Office of the Coroner (Coroner) following the death of any patients who requested MAID. The Coroner is then required to complete the Medical Certificate of Death for these individuals. In response, the College of Physicians and Surgeons of Ontario (CPSO) created a complementary policy on MAID that instructs physicians to notify the Coroner in MAID-related cases. As to how the Coroner will complete the death certificate in MAID cases, the Chief Coroner for Ontario, Dr. Dirk Huyer has stated the following: As with any coroner’s case, the death certificate will be completed by the investigating coroner based upon the circumstances of the death. In the current legislative
framework, the immediate cause of death will generally be provided as Combined Drug Toxicity, with the underlying condition that led to the MAID request being provided as the Contributing Factor. As prescribed by the Coroners Act, 1990, notification to the Coroner may trigger several serious consequences: the Coroner may take possession of the body, examine the body and make any investigation that is necessary to the public interest. The Coroner’s investigation may include an autopsy and may trigger an inquest. Each investigation is different and subject to the discretion of the Coroner. It is likely, that no advanced notice of the nature and scope of the investigation will be provided to individuals accessing MAID prior to their death. By involving the Coroner in MAIDrelated deaths, the MoHLTC has implicitly taken the position that MAID-related deaths fall within the scope of section 10 of the Coroners Act, 1990. Section 10 of the Coroners Act, 1990 states that the Coroner must be immediately notified by: 10. (1) Every person who has reason to believe that a deceased person died, (f) from any cause other than disease; or (g) under such circumstances as may require investigation However, in a string of decisions released between March and June 2016, prior to Bill C-14 receiving Parliamentary assent, the ONSC consistently found that section 10 of the Coroners Act, 1990 did
not apply to applicants who sought judicial authorization for MAID. In AB v Canada (Attorney General), Justice Perrell accepted the argument that section 10(f) of the Coroners Act, 1990 did not apply to AB as the ultimate or antecedent cause of his death was his advanced-stage lymphoma even though he was seeking MAID. In OP v Canada (Attorney General), Justice Perrell again authorized anyone completing the death certificate for OP to indicate that his cause of death was from his underlying conditions, not MAID. Further, in several decisions, Justice Perrell outright denied that MAID-related deaths constitute circumstances that require an investigation in the public interest and therefore found that section 10(g) of the Coroners Act, 1990 did not apply. Explaining his reasoning, Justice Perrell stated, “put shortly, there is no need to conduct an investigation…pursuant to the Coroners Act either because the information to be gathered by that investigation is already known or because no useful public purpose would be served by gathering the information.” Other Ontario jurists agreed with Justice Perrell and endorsed his analysis of the appropriate characterization of MAID-related deaths and his interpretation of the Coroners Act, 1990. Importantly, Justice Perrell’s interpretation of section 10 of the Coroners Act, 1990 allows a physician to complete the death certificates of their patients seek-
ing MAID without involving the Coroner or triggering the serious consequences described above. To the extent that the Coroner’s involvement interferes with the constitutional right to MAID, Justice Perrell’s statutory interpretation aligns with Charter values and the spirit of the decision in Carter. Now that Bill C-14 has received assent by the Parliament of Canada, the impact of Justice Perrell’s interpretation of the Coroners Act, 1990 and the decisions that preceded June 17, 2016 remains unclear. What is evident is that these decisions are in direct conflict with the interpretation of the Coroners Act, 1990 adopted by the MoHLTC. Moreover, the MoHLTC MAID policy departs from the proposed changes to MAID legislation in other provinces. For example, in Manitoba, Progressive Conservatives have advanced legislative amendments allowing for the underlying condition to be listed as the cause of death in the death certificates of individuals requesting MAID. Hospitals considering implementing policies and procedures on MAID should be aware that the constitutional validity of the MoHLTC MAID policy requiring physicians to notify the Coroner in MAIDrelated cases may be open to challenge in H the future. ■ Michael Watts is a Partner and Swetha Popuri is an Associate in the Toronto office of law firm Osler, Hoskin & Harcourt LLP.
Garden enhances patient experience Continued from page 22
Fruits of their labour
Susan Currie, Occupational Therapist, helped plant the Bickle garden, which then became an environment for therapy for her patients HOSPITAL NEWS NOVEMBER 2016
While some patients practiced walking in the garden and learned about nutrition, others harvested foods that they later used in their cooking program, says Deep Singh, Occupational Therapy Assistant at Bickle Centre. Deep worked with patients who took part in the Kitchen Group – those practicing cooking skills for their return to an independent living space. From herbs to zucchini, the group harvested the garden’s crops, and incorporated them into recipes. “The garden enhanced our group and motivated them to cook,” she says. “Harvesting also helps with fine motor skills – I gave them scissors to cut the leaves we’ll need, for example.” Thanks to the variety of food grown in the garden, the Kitchen Group made colourful salads and healthy snacks such as zucchini and kale chips. Staff who tended to the garden throughout the summer also had a chance to indulge in its harvest. They came together for a group lunch made with some foods from the garden, Amanda says. “We enjoyed the benefits of the garden, just like the patients,” she explains.
Home away from home
Much like the patient with dementia who found solace in picking vegetables, other patients have expressed the comfort the garden provides. For both Susan and Deep, the best memories of the garden come from the joy they saw their patients experience. “My favourite part of working in the garden was having patients reminisce about their own gardens at home,” Susan says. “For some of our Complex Continuing Care patients, home is a very distant memory and thus our gardens brought a little bit of home to them.” Those memories of home, Deep says, encouraged patients in to work harder in Occupational Therapy. “If they are able to garden, to cook, then they know they will be able to be independent at home, and they gain confidence,” Deep explains. Though the harvest is done for the year, the garden will blossom again next year – and Amanda, Deep and Susan all see potential for even more patient involvement in the years to come. “It was definitely a success for our first year,” Susan says, “I am hopeful that our garden project will continue to ‘grow’ with H each year.” ■ Ana Gajic is a Public Affairs Associate at University Health Network. www.hospitalnews.com
TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE
Engaging patients in creating a
new model of care for cataract procedures
By Shawna Davis-Monkman and Lauren Hayes t 84 years old, Violet* was living on her own and struggling to take care of herself. The clouding from her cataracts was so severe she had lost nearly all of her vision. With pre-existing health conditions, Violet was unable to find a doctor willing to perform the outpatient procedure that would replace her cloudy lens with a clear lens to restore her vision. After four years of unsuccessfully navigating the health care system and desperate for help, Violet came to the emergency department at Trillium Health Partners (THP). Within a week, Violet’s first cataract surgery was performed and several weeks later her second surgery had been performed, restoring the vision in both of her eyes and allowing her to regain her independence. Violet says the surgery was life changing, “I live alone and I couldn’t cook, I couldn’t read, I kept falling. It was very hard for me and I had to wait a long time for the surgery.” Cataracts primarily develop through aging and thereby greatly affect seniors, one of the fastest growing and most vulnerable populations.
Surgical removal of a cataract is effective, but with high demand and lack of standardized measures for prioritization, it is not always available in a timely manner for those who need it most. A global leader in ophthalmology, Dr. Ike Ahmed, Division Head of Ophthalmology at THP, says stories like Violet’s are far too common. “In Ontario, the demand for cataract surgery is high and expected to increase as our population ages,” says Dr. Ahmed. “We are rethinking the model of care for cataracts with patients in mind, to create a system that includes the prioritization of patients based on need and appropriateness.” Cataract surgery is the most commonly performed procedure in Ontario, yet costs and wait times vary drastically across the province1. Surgical removal of a cataract is effective, but with high demand and lack of standardized measures for prioritization, it is not always available in a timely manner for those who need it most. Under the current model of care, a patient who is unable to work due to their cataract(s) may be waiting just as long, if not longer, than a patient whose cataract(s) has little impact on their daily life. Dr. Ahmed, along with Institute for Better Health (IBH) Scientist, Dr. Morgan Lim and their team are working to develop an Electronic Cataract Appropriateness and Prioritization System (eCAPS) that would standardize the way patients with cataracts are referred and triaged for surwww.hospitalnews.com
gery. eCAPS would provide physiicians with standardized measurement ntt tools for the assessment of cataract(s)) and act as an electronic interface be-tween the hospital booking system,, the wait time information system m and clinic offices. eCAPS will nott only help identify patients who are appropriate for cataract surgery, but also provide physicians with measurement tools to assess the impacts cataract(s) has on a patient’s quality of life to more appropriately prioritize and schedule patients, ensuring timely access for patients in greatest need of surgery. An expert panel, comprised of ophthalmologists, optometrists and general practitioners, has been engaged to inform the creation of the standardized measurement tools. The panel has expertise in optical care and cataracts; however, they recognize the barriers in truly understanding the he impact cataract(s) have on a patient’s quality of life. Barriers like time constraints, effective communication and power dynamics between patients and providers. To better inform the panel, the research team conducted qualitative interviews with cataract(s) patients and compiled a video that captures diverse patient stories. Patients of different ages, with varied vision loss and social supports, shared their experiences of living with cataract(s) and navigating the healthcare system. The video brings the patient voice into the panel’s decision-making process to help shape a more equitable and patient-centred model of care. “We want patients and experts to be engaged in the design process to ensure we create a new model of care that truly meets the needs of both patients and providers,” says Dr. Lim. “eCAPS will be tested locally in Mississauga first, but if successful, we believe it can be used across Ontario, Canada and even globally, to standardize cataract care and other elective surgeries.” Trillium Health Partners’ Institute for Better Health recognizes that active participation of patients is necessary to develop a new model of care that will result in better practice, better outcomes and better experiences. Violet was able to regain her independence, security and vision through cataract surgery. There are many patients like Violet waiting to receive this life changing surgery. By identifying and prioritizing appropriate surgeries, patients will be given greater access to quality care. *Name has been changed for patient H confidentiality. ■ Shawna Davis-Monkman is a Communications Intern and Lauren Hayes is a Communications Advisor at the Institute for Better Health, Trillium Health Partners.
M I C H E N E R I N S T I T U T E CO N T I N U I N G E D U C AT I O N
Learning for the future
Continuing Education that evolves with our health care system For nearly 60 years, The Michener Institute of Education at UHN has been responding to the educational needs of Ontario’s health care system. Working with experts in their fields, the uniquely designed Continuing Education department at Michener is committed to lifelong learning and making education accessible to a diverse range of individuals with a variety of different needs. Utilizing their combined skills in educational design, online learning delivery and customer service, they have developed cutting-edge courses that are relevant and accessible to busy health care workers caring for our patients. As the incidence of chronic illnesses increases, as the population ages, and as new technologies and concepts emerge, Michener nimbly and creatively responds to the changes in our health care landscape with high quality learning. Michener’s diverse graduate certificates offer health care workers the opportunity to build or maintain skills in areas like leadership, primary and critical care and diabetes education. Options for online or hybrid learning in Continuing Education at Michener means that you can take the next step in your career from anywhere. Michener’s recent integration with the University Health Network in Toronto also creates exciting opportunities for new programs supporting a vast array of health professions. Michener’s Continuing Education programs help graduates reach their professional development goals and meet health care needs across Canada and beyond. Exciting offerings at the Michener Institute of Education at UHN include: • Graduate certificates in Diabetes Educator, Leadership, Quality Management, Intraoperative Neurophysiological Monitoring, Clinical Research, Clinical Management, and Imaging Informatics • Specialty courses in diabetes, and Working With Seniors: A Primer, developed in partnership with Baycrest. • Programs, workshops and seminars in Chiropody, Infection Control, Primary & Critical Care, Radiation Sciences and Medical Laboratory Sciences Interested in preparing yourself for the future of health care? Visit our website to see our online brochure and registration details at michener.ca/ce.
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4 Photos courtesy of Lindsey Donovan Photography
1. Dr. Nick Petropolis is a family physician who rallied health teams to start the Frail Elderly Nurse Practitioner Program. 2. Brandi Newby advocated for a separate neonatal and paediatric dispensary to reduce medication errors. 3. Misty Dawn Stephens helped found the Enterostomal Outpatient Clinic to help patients after bowel damage or surgery. 4. Rejeanne McLean collaborated to raise awareness and funds for a dedicated space for young paediatric patients.
Innovators put the ‘care’ in patient care By Elaine O’Connor
roviding excellent patient experience in healthcare means ensuring patients receive not only highly competent and safe care, but that they feel the “care” in healthcare. That’s Fraser Health’s philosophy and it carries through to the actions of those on the frontlines of the B.C. health authority. Here are a few of the innovative care providers working to improve patient experience in Fraser Health hospitals, residential care facilities and communities. Dr. Nick Petropolis is a family physician who ensures frail, home-bound seniors don’t fall through the cracks. He saw gaps in their access to primary care and rallied teams of nurses and physicians to fill them. This collaboration resulted in the Frail Elderly Nurse Practitioner Program, where health care providers make house calls to residential facilities in Burnaby, New Westminster and the Tri-Cities. He’s also led Fraser Northwest Division’s Residential Care Initiative, ensuring senior residents have access to doctors after hours, and regular medication reviews and check-ups right in their residences every three months, reducing their reliance on emergency rooms. www.hospitalnews.com
As a clinical pharmacy specialist, Surrey Memorial Hospital’s Brandi Newby knew medication errors were more common – and more dangerous – among children, as most dosage data is based on adults. So she advocated for a separate neonatal and paediatric dispensary, and pulled together diverse teams to make it happen.
These care providers were among those recognized for exceptional patient care in the 11th Above & Beyond Awards. It opened in 2014 in the hospital’s neonatal intensive care unit, one of the first of its kind, and she serves as the dispensary’s coordinator. She’s also assisted in building a team of 10 pharmacists and nine pharmacy technicians who serve the hospital’s Maternal Infant Child and Youth programs, improving child medication safety across the board. Misty Dawn Stephens is a wound, ostomy and continence nurse at Burnaby Hospital who’s helped hundreds of pa-
tients cope following bowel damage or surgery. Her personal touch has helped relieve their fears, while her clinical expertise has ensured these vulnerable patients receive the support they need to manage at home. Among her initiatives, she helped found the Enterostomal Outpatient Clinic. Today it’s booked solid, providing pre-op, post-op and discharged patients with holistic care. She also launched a skin tear prevention program, testing wound tapes to reduce patient injury, and has standardized postoperative dressing changes to reduce infection rates. The hospital can be a frightening place for children. The Chilliwack General Hospital Pediatric Observation Team wanted to take away that fear by offering young patients a dedicated space. Pediatrician Dr. Julian Pleydell-Pearce, Clinical Operations Manager Sarah Hyatt and Clinical Nurse Educator Rejeanne McLean collaborated with the emergency department, foundations, and community groups to raise awareness of and funding for the unit. Earlier this year, they achieved their goal with the opening of the Rotary Club of Chilliwack-Fraser Pediatric Observation Centre. The four-bed
unit ensures children brought to emergency get streamlined access to pediatric experts in a bright, child-friendly space, H freeing room in emergency for others. ■ Elaine O’Connor works in communications at Fraser Health in British Columbia.
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Educational & Industry Events To list your event, send information to “firstname.lastname@example.org”. We try to list all events and information but due to space constraints and demand, we cannot guarantee it. To promote your event in a larger, customized format please send enquiries to “email@example.com” Q October 30-November 2, 2016 Critical Care Canada Forum Toronto, Ontario Website: www.criticalcarecanada.com Q November 3-5, 2016 Face-to-Face Course on End-of-Life Care & Medical Assistance in Dying Toronto, Ontario Website: www.cma.ca Q November 7-8, 2016 Patient & Family Centred Care Experience Conference Horizon Health Network, Moncton, NB Website: www.pfccexperience.ca/registration Q November 7-9, 2016 HealthAchieve Toronto, Ontario Website: www.healthachieve.com Q November 27–December 2, 2016 RSNA 2016 McCormick Place, Chicago, United States Website: www.rsna.org Q November 29, 2016 Leading Edge Environments Oakville Trafalgar Memorial Hospital, Oakville Website: www.cchf.net Q December 8–9, 2016 Data Analytics for Healthcare Toronto, Ontario Website: www.strategyinstitute.com Q January 24, 2017 Mobile Healthcare Toronto, Ontario Website: www.strategyinstitute.com Q February 19-23, 2017 2017 HIMSS Annual Conference & Exhibition Orange Country Convention Centre, Orlando FL Website: www.himssconference.org Q March 1-5, 2017 Canadian Critical Care Conference Whistler, British Columbia Website: www.canadiancriticalcare.ca Q March 8-9, 2017 Mobile Healthcare Holiday Inn Toronto Airport, Toronto Website: www.mobilehealthsummit.ca Q April 3-5, 2017 Together We Care Toronto Congress Centre, Toronto Website: www.together-we-care.com Q June 4-7, 2017 eHealth Conference & Tradeshow Toronto, Ontario Website: www.ehealthconference.com
To see even more healthcare industry events, please visit our website www.hospitalnews.com/events HOSPITAL NEWS NOVEMBER 2016
Dr. Edgar Escalante (pictured top row centre) with his MSF surgical colleagues in Yemen.
Doctors without Borders:
Profile of Dr. Edgar Escalante By Claudia Blume ew other surgeons working for Doctor Without Borders/Médecins Sans Frontières (MSF) around the world have as much experience treating war-wounded as Dr. Edgar Escalante from Vancouver. A native of El Salvador, he spent 13 years as head of the orthopaedic department of a hospital in the capital San Salvador during the country’s bloody civil war. After he retired, he moved to Canada because he wanted to live in a calm and peaceful place. But he soon got bored and applied to work with MSF, an organization he first got to know following an earthquake in El Salvador in the 1980s. “I have always wanted to work for a humanitarian organization, but I have been busy raising seven children,” he laughs. “After I retired, my wife encouraged me to follow my dreams.” Dr. Escalante has since spent 20 months working as a surgeon in war zones with MSF, first in Yemen, then in Kunduz hospital in Afghanistan. Three months after he left Kunduz, and already on his next assignment in Jordan, he received the news that the hospital had been destroyed in an airstrike on October 3, 2015. “I was devastated, it was very tough,” he recalls.” I cried for several days. It was one of the worst moments during my time with MSF.” There have been plenty of difficult moments in Jordan too, where he spent 14 months working in Ramtha hospital, an MSF emergency surgical project close to the border with Syria. During most of the time he spent there, the hospital was full of war-wounded who had come across the border from Syria. He and his team initially saw mostly victims of barrel bombings, and later patients with gun shots. Most of them were women and children. One of the patients Dr. Edgar Escalante remembers most vividly is a 19-year old pregnant woman who had been severely wounded in a bomb blast in Syria. “We had to amputate both her legs,” he recalls. “Almost as soon as the operation was over she went into labour, and we had to transfer her to a government hospital to deliver the baby.” The next time he saw her, in a
nearby refugee camp where he regularly went to see his former patients, the young mother was walking towards him on artificial limbs, smiling and holding the baby in her arms. As the hospital’s surgical activity manager he had to make many difficult life and death decisions. Two of his patients with severe brain, chest-and abdomen injuries, as well as multiple fractures, were considered to be hopeless cases by his colleagues, who urged Dr. Escalante to take them off life support. But he insisted to fight for their lives, against all odds. “I am a person who does not easily give up,” he says. “I have a sixth sense.” Both of the patients are now fully conscious and able to walk, and hugged him whenever he saw them at the refugee camp where they now live. At the end of June, things suddenly changed at Ramtha hospital. Following a deadly car bomb attack June 21, Jordan sealed its borders with Syria. More than 75.000 Syrians, most of them women and children, have since been stranded in a desert area called the “Berm” at the border, without access to humanitarian aid. War-wounded are no longer able to cross the border into Jordan to seek treatment. “There are no new cases coming in to Ramtha hospital,” says Dr. Escalante.” We usually had about 45 patients, but in September there were only 10, all of them existing cases.” He says that the newly-opened operating theatre is now unused, and that the medical staff is concerned that they are no longer able to provide assistance to the many Syrians who are in desperate need of medical care. The surgeon recently returned to Canada, and will travel for some well-deserved holiday. But he is already planning his next return to the field with MSF. “It’s still pending,” he says, “but I’m just waiting for MSF to come to me with my next assignment.” After decades of treating patients affected by trauma, Dr. Escalante will continue to H work wherever he is needed most. ■ Claudia Blume is a press officer for Doctors Without Borders. www.hospitalnews.com
TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE
Majority of Canadaâ€™s clinicians using electronic health records
Switch to digital improving quality of care: Users By Dan Strasbourg rowth in the use of interoperable Electronic Health Records (iEHR) by Canadian doctors, nurses, pharmacists and other healthcare professionals is fueling benefits for patients and providers, including improved quality of patient care, according to two articles published this year in the peerreviewed journal BMC Medical Informatics and Decision Making. â€œThe evidence confirms that use of the interoperable Electronic Health Record systems built by the provinces, territories, hospitals and other partners over the past 15 years is delivering patient care benefits and improvements for providers as intended,â€? says Michael Green, President and CEO, Canada Health Infoway (Infoway). According to the article Measuring interoperable EHR adoption and maturity: a Canadian example, 91,235 healthcare professionals in Canada were active users of at least two iEHR components (e.g., access to diagnostic tests and drug information outside of their organization) as of March
31, 2015. Twelve months later, that figure jumped by an additional 50 per cent, bringing the number to approximately 139,000. More than 250,000 clinicians from across Canada use at least one component of the iEHR. Bobby Gheorghiu, Infowayâ€™s Manager of Trending and Performance, who authored the article, says the increased use is expected to continue to rise. â€œAs more and more healthcare professionals use Electronic Health Record systems to access patient information from other institutions, the country moves closer to digital becoming the standard of practice,â€? he says. A second article, The value of connected health information: perceptions of electronic health users in Canada, reveals that iEHR users are reporting improved quality of care and improved access to patient information. Sukirtha Tharmalingam, Infowayâ€™s Manager of Evaluation Methods, isnâ€™t surprised that healthcare providers are notic-
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ing patient benefits as a result of their use of digital health. â€œWhen healthcare professionals use interoperable Electronic Health Records, less time is spent tracking down the information they need to make informed care decisions, which means diagnosis and treatment can proceed at a faster pace, leading to improved quality of care,â€? she says. According to Michael Green, the growing value that has accrued by investing in digital health for clinicians will increase as more patients gain access to digital health tools and capabilities. â€œThe use of the iEHR by Canadian clinicians is beyond the tipping point, and following closely behind are patients and caregivers, who also expect to have the ability to make use of digital health tools and capabilities, as they should,â€? he says. â€œInfoway engages with patients from across Canada through research, patient advocacy groups and our ImagineNation Challenge series, and a common theme we hear
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Electronic health record user adoption landscape
is that Canadians want online patient services to help them manage their health.â€? Infoway aims to further its engagement with patients, as well as healthcare professionals and caregivers through the Better Health Together public education campaign and engagement initiative. As part of these efforts, Infoway, together with its many partners from across Canada, will take part in Digital Health Week from November 14 to 20. Taking part is as simple as joining the conversation on social media by using #thinkdigitalhealth. To learn about other ways to participate in Digital Health Week, H visit www.betterhealthtogether.ca. â– Dan Strasbourg is Director, Media Relations at Canada Health Infoway.
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Please e-mail resumes to firstname.lastname@example.org NOVEMBER 2016 HOSPITAL NEWS
TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE
The Truth Hurts As nurses, we take part in some of the most signiﬁcant events that happen in the span of a lifetime. We see a lot we seldom talk about - moments that stay with us long after a shift has ended. But when the well-being of our patients is threatened, it’s our duty to speak out. Ontario’s healthcare system is falling short. Years of inadequate funding and cuts have left us with fewer RNs per person than any other province. Every time a Registered Nurse is cut, patients lose a skilled professional and a caring advocate. Since 2015, over 1,500 RN positions have been eliminated in Ontario. Our patients deserve the best possible care. As nurses we make a pledge to ensure just that.
HOSPITAL NEWS NOVEMBER 2016
Technology in Healthcare, Patient Experience and Hospital Performance Indicators. Plus: Annual MEDEC Supplement.