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The reality of robots

Special Series: Creating a high performance work culture



Canada's Health Care Newspaper FEB. 2014 | VOLUME 27 ISSUE 2 |

INSIDE Nursing Pulse .....................................23

Innovative and efficient health-care design, the greening of health-care, and facility management. An update on the impact of information technology on health-care delivery including electronic health-care records. Trends, issues and achievements in the field of Clinical Informatics.

From the CEO's desk.......................... 27 Data Pulse ..........................................29 Evidence Matters ............................... 31 Careers ...............................................38

Robotic surgery Is it safe? Story on page 8






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In Brief

Medical journals could increase transparency by removing ads Pharmaceutical ads could easily be removed from general medical journals by increasing subscription rates, according to an international study published in PLOS ONE. York University health policy professor Joel Lexchin, one of the co-authors of the study and a Toronto emergency physician, says he would willingly pay a little extra for the journals to get rid of the ads, whose poor quality information appears next to high-quality, peer-reviewed articles. The study, which looked at advertisements in six general medical journals in Canada, the United States, and the United Kingdom, included researchers from Canada, the U.K. and the U.S. The two Canadian journals studied–the Canadian Medical Association Journal and Canadian Family Physician–contained five times more advertisements than the American and British journals in the study. Lexchin co-authored earlier research that shows pharmaceutical promotion may cause doctors to prescribe more expensive or less appropriate drugs, and do it more often. “Drug advertisements in medical journals do not lead to better prescribing and often result in worse prescribing,” he says. “We estimate that for $40 more per year, Canadian doctors could read the Canadian Medical Association Journal without ads. H I think it would be worth it.” ■

Cost of aging A 2013 national survey just released by LifestageCare™ provides detailed statistics on the consumer costs of a range of specific home care and home health care services, retirement and assisted living residences, nursing homes and adult day care across Canada. In all, 1,638 service providers were surveyed for LifestageCare's 4th annual national report on The Costs of Canadian Long Term Care for the elderly. The survey finds that Ottawa is the most expensive major city for Canadians paying for private retirement homes or assisted living care, followed closely by Toronto. Montreal and Winnipeg are the least expensive major city locations for these categories of care. On a provincial basis, median prices are highest in Ontario. On the other hand, privately paid residential care was found to be least expensive in British H Columbia and Manitoba. ■

Top 10 List


New and emerging health technologies

Of the countless innovative technologies emerging on the health care horizon, which ones truly hold the greatest promise of improving the lives of patients and the Canadian health care systems? It's a challenging question, and one that inspired the creation of the Canadian Network for Environmental Scanning in Health (CNESH). CNESH is now inviting the community at large to help it find the answers. "Our first major initiative will be a Top 10 list of new and emerging health

technologies that may have the potential to transform the delivery of healthcare," says Professor Ron Goeree, chair of CNESH and director of the Programs for Assessment of Technology in Health (PATH) Research Institute at McMaster University. The nomination form for the Top 10 list is available online at Nominators will be asked to provide the name and manufacturer of the technology they recommend for the list. Nominators will also be asked to provide supporting documentation

such as clinical trials and other information that can explain why and how a particular technology may be a game changer. Clinical effectiveness, patient survival, quality of life impact, safety, or costs to the health care system are elements that the nominating committee will consider in finalizing the Top 10 list. The term "health technologies" refers to medical and dental devices, diagnostics and procedures, as well as drugs–anything that can be described as a "health H intervention." ■

Canadians want palliative and end-of-life care support Nearly every Canadian believes that hospice palliative and end-of-life care are critical and should be available to anyone in need, but most do not know what services are available - or how to access them. A new Harris/Decima survey reveals that while the vast majority of Canadians support hospice palliative care, and integrating services as early as possible for people who are critically ill or aging, there remain many barriers to connecting people with those programs and services across the country. The Harris/Decima survey was conducted for The Way Forward, a three year nation-wide initiative that is working with healthcare professionals and governments to integrate high quality hospice palliative care earlier into the ongoing care of Canadians with serious life-limiting illness. The Harris/Decima survey identified five main findings: 1. There is nearly unanimous support among Canadians for hospice palliative care (96%) 2. Most Canadians (87%) believe that a palliative approach to care should be available early on in the course of a disease and most (94%) believe it should include all of their care providers 3. Nearly all Canadians (93%) believe

palliative care services should be available in the setting of their choice (home, longterm care, etc.) but less than half (49%) are aware they can access these services outside of a hospital 4. Although nearly all Canadians (96%) believe it is important to have a conversa-

tion with loved ones about their wishes for care, not many (34%) have actually had a discussion 5. The majority of Canadians (73%) would like to get more information from their doctors so that they can plan and beH gin these important conversations ■

‘Love hormone’ carries unexpected side effect The love hormone, the monogamy hormone, the cuddle hormone, the trust-me drug: oxytocin has many nicknames. That’s because this naturally occurring human hormone has recently been shown to help people with autism and schizophrenia overcome social deficits. As a result, some psychologists are keen to prescribe oxytocin off-label, in order to treat mild social unease in those who don’t suffer from a diagnosed disorder. Not such a good idea, say researchers from Concordia University’s Centre for Research in Human Devel-

opment. Their recent study, published in the American Psychological Association’s journal Emotion, study shows that, in healthy young adults, too much oxytocin can actually result in oversensitivity to emotions in others. Ultimately, oxytocin has solid potential to help those with diagnosed mental disorders overcome social deficits, such as autism, but the potential social benefits of oxytocin in most people may be countered by unintended negative consequences, like being too sensitive to emotional H cues in everyday life. ■




UPCOMING DEADLINES MARCH 2014 ISSUE EDITORIAL FEB. 7 ADVERTISING: DISPLAY FEB. 21 | CAREER FEB. 25 MONTHLY FOCUS: Pain Control/ Rheumatology/ Complementary Health/ Health Promotion: Pain management interventions. Developments in the management of rheumatic diseases. Advancements in complementary treatment approaches to various diseases and conditions. Innovative health promotion programs that focus on disease prevention.

APRIL 2014 ISSUE EDITORIAL MARCH 7 ADVERTISING: DISPLAY MARCH 28 | CAREER APRIL 1 MONTHLY FOCUS: Gerontology/Palliative Care/Home Care/Rural and Remote: Geriatric medicine and aging-related health issues. Innovative approaches to home care and palliative care delivery. Care in rural and remote settings: enablers, barriers and approaches.


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Technology abounds –

time to embrace it Hardly a day goes by that we don’t hear about some type of new technology. Newer and smarter smartphones, wearable glasses that serve as a computer, adjusting the temperature in your home while at work–the possibilities are endless. As a consumer who enjoys the convenience of newer and better technology, I have also come to realize and accept that I am a bit of a stick in the mud, technologically speaking. While the ’techies’ count down the minutes to the release of a new operating system (OS) on their mobile device, I am the one who doesn’t download the new OS until it’s absolutely necessary. I am a creature of habit. I have everything organized to my liking and don’t want to get used to a new operating system. I like the old one just fine. It doesn’t matter that the new system will improve the performance of my device, or simplify things even further, making my chaotic life a little easier - I still resist the change. So it comes as no surprise to me that the biggest challenge of digitalizing our health care system is adoption - getting clinicians to transform their practices into digital ones. I can’t say I blame them. Technology can be daunting. Imagine a family doctor who has run their own practice for 30 years. It ’s like a well-oiled machine. Enter electronic records - which will completely change their practice. Being three years away from retirement, they may think, what’s the point? The transition of Canada’s health care system to a digital one has been long, going back more than a decade. Several scandals have plagued provincial and federal governments assigned to oversee this transition and many Canadians are left wondering what the hold-up is. According to Canada Health Info-

way, only 7600 clinicians used EHRs across Canada in 2006. By 2012 that number had risen to 45,000 users. An increase of more than 500 per cent–so progress is being made. Yet, Canada lags behind all G7 nations in the adoption of EHRs. Many countries have universal EHR adoption–The Netherlands and Australia have since 2007. In the 2013 National Physician Survey 61.8 per cent of physicians reported using electronic records. Of those who do use electronic records, 56.2 per cent reported the quality of patient care better or much better and 30 per cent reported no change. Forty-two per cent reported productivity has (greatly) increased since implementation of electronic records and 31 per cent reported it as the same. A surprising 13.3 per cent claim productivity has actually decreased. From this survey it seems the general consensus among physicians is that adopting electronic records can enhance patient care but not always. And for some, it has actually decreased productivity. No wonder adoption of electronic records has been a challenge. Part of the problem is that while in theory, electronic records will save money, improve efficiency and enhance patient care, the reality is that in Canada we aren’t there yet. A crucial component of the impact electronic records can have is dependent on health information exchange–or the ability to exchange health information electronically between hospitals and health care facilities. What is the point of having an electronic record if only your primary care doctor can access it? If these records aren’t accessible to a patient’s whole care team, we aren’t reaping all the benefits this new technology has to offer. When a patient shows up unconscious at an ER and a simple scan of

their health card can bring up their health history and alert caregivers to allergies etc., then we will really begin to see exactly what these records have to offer. Until we have a system where these records can be shared across the care continuum, we can only hypothesize as to their potential. The slow progress that has been made, the wasted taxpayer dollars and the many blunders along our digitalization journey could be partly responsible for the hesitation of some physicians to adopt electronic records. Government needs to provide more incentive for physicians to adopt them–and have a plan in place to ensure that every Canadian patient will reap the benefits, soon. As we turn our focus to technology and innovation in this issue, I am reminded that technology isn’t just about making our life convenient, it can often mean the difference between life and death. This month’s cover story examines the safety of robotic assisted surgery and addresses some of the negative press in the US. Another company, Ekso Bionics has developed a wearable robot that enables individuals with lower extremity paralysis or weakness to stand up and walk (page 10). Another company has developed an early warning system that digitally evaluates seven vital signs to help clinicians identify children who are clinically deteriorating to help prevent unnecessary code blues (28). Technology is moving forward at a rapid pace, and Hospital News wants to keep you informed on recent updates and advancements so starting in March we will be including a Healthcare Technology section in every issue. For those of us resistant to the constant change technology brings, it’s time to embrace it. Especially in healthH care where it can save lives. ■ Kristie Jones, Editor

ADVISORY BOARD Jonathan E. Prousky,

BPHE, B.SC., N.D., FRSH Chief Naturopathic Medical Officer The Canadian College Of Naturopathic Medicine North York, ON

Cindy Woods,

Barb Mildon,

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

Senior Communications Officer The Scarborough Hospital, Scarborough, ON

Helen Reilly,

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










Publicist Health-Care Communications Toronto, ON



Jane Adams,

President Brainstorm Communications & Creations Toronto, ON

Bobbi Greenberg,

Manager, Media and Public Relations. Mississauga Halton Community Care Access Centre

Dr. Cory Ross,

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

Akilah Dressekie,

Senior Communications Specialist Rouge Valley Health System

Hospital News is published for hospital health-care professionals, patients, visitors and students. It is available free of charge from distribution racks in hospitals in Ontario. Bulk subscriptions are available for hospitals outside Ontario. The statements, opinions and viewpoints made or expressed by the writers do not necessarily represent the opinions and views of Hospital News, or the publishers. Hospital News and Members of the Advisory Board assume no responsibility or liability for claims, statements, opinions or views, written or reported by its contributing writers, including product or service information that is advertised. Changes of address, notices, subscriptions orders and undeliverable address notifications. Subscription rate in Canada for single copies is $29.40 per year. Send enquiries to: Canadian Publications mail sales product agreement number 40065412.




Evolving role of health

information management professional By Fiona Hill-Hinrichs


s the e-health record gets rolled out across Canada, the role of the certified health information management (HIM®) professional is evolving and becoming increasingly important in ensuring our health information is protected, and properly managed; contributing to the best care of the patient. In 2013, the Canadian Health Information Management Association (CHIMA) released their report, Transforming Health Information Management: The Evolution of the HIM Professional, which outlines a strategic plan to educate and prepare HIM professionals for the electronic future.

The benefits of an electronic health record are vast. This innovation will reduce health care costs, improve patient care and improve efficiencies. “There’s a lot of information out there about the electronic health record, but little information about the human resources needed to effectively manage and implement the EHR,” says Gail Crook, CEO and Registrar of CHIMA. “CHIMA has been vigilantly working with our partners to ensure our workforce is ready, however, the process of rolling out the EHR has been slow and we find we’re in limbo. HIMs are currently working with paper, hybrid and the electronic record to adapt to the slow pace of progress.” The Workforce Transformation project maps the evolution of the HIM profession into new roles. This project characterized future roles and functions of HIM professionals and focused on two main areas: the development of eHealth competency profiles; and the definition and development of new HIM roles separated into eight categories of HIM functions. The future roles will continue to be defined based on the requirements for meaningful

tion management within any health care organization. In addition to transforming the workforce, in 2013, CHIMA was challenged by stakeholders across Canada to develop the Canadian HIM lifecycle. HIM lifecycle management goes beyond the lifecycle of the traditional paper record, though it is built on the long-standing international standards for records management. With the move from a paper-based environment to an electronic environment, HIM practice now focuses on the content of the health record and the information it contains, whether the information is contained in one record or many repositories that link to form a complete picture of care for a given individual. CHIMA expects to release the HIM lifecycle document in mid 2014. “One of the most challenging aspects of the ehealth record will be to digitally collect clinical documentation. The reams and reams of progress notes, consultations, and nursing notes that are usually part of the paper record, would require multidisciplinary consultation to put them into a natural language captured in an electronic format,” explains Crook. “This will be a huge amount of work and collaboration. The HIM professional will be instrumental in working through this with the clinical staff.” The benefits of an electronic health record are vast. This innovation will reduce health care costs, improve patient care and improve efficiencies. As the health care environment in Canada undergoes this significant transformation, CHIMA is addressing the evolving skills and training needs with our partners and is prepared to ensure the financial and patient care benefits of the EHR are realized. For more information about the CHIMA report and for detailed descriptions of the new HIM roles and the advisory council’s recommendations, please review the report H at ■ Fiona Hill-Hinrichs is the Director of Marketing and Communications at CHIMA. FEBRUARY 2014 HOSPITAL NEWS




Digital Health Challenge offers up to $1 million in rewards By Dan Strasbourg


linicians who use digital health to connect with their patients and peers, as well as those implementing digital health solutions into their practices, are being encouraged to take part in the e-Connect Impact Challenge. Funded by Canada Health Infoway (Infoway), the Challenge has up to $1 million available to reward team achievements. "If patients are attending appointments virtually, or requesting prescription refills and renewals electronically, we want to hear from you," says Richard Alvarez, President and CEO, Canada Health Infoway. "If you're using digital health to request patient services from another clinician or exchanging clinical reports with peers electronically, we encourage you to join the Challenge." According to a recent Harris/Decima survey commissioned by Infoway, 96 per cent of Canadians think it's important that the health care system make use of digital health tools and capabilities, and 89 per cent feel it is important that they personally have full advantage of digital health tools and capabilities. These findings support the most recent Challenge in the Infoway ImagineNation Challenges series. Currently underway, the e-Connect Impact Challenge rewards teams of health providers that are using, or increasing the adoption of, digital health solutions to improve patient care and experiences.

The e-Connect Impact Challenge rewards teams of health providers that are using, or increasing the adoption of, digital health solutions. “The vast majority of Canadians think it's important that the health care system make use of digital health tools," adds Alvarez. "The e-Connect Impact Challenge encourages clinicians to share how they are using these tools to help accelerate their use among their patients and peers." The e-Connect Impact Challenge will recognize and reward teams of health providers that are using and increasing the adoption of digital health solutions to im-

prove patient care and experience in four areas: •e-Visits: e-Visits offer patients access to a private, secure and digital, two-way interaction with their health care provider from their home. •e-Requests for Prescription Renewals or Refills: Electronic requests by patients for the renewal or refilling of their prescription medication, sent to a regulated health care provider.

•e-Requests for Services: Electronic requisitions from one regulated health care provider to another for the purpose of requesting health care services on behalf of a patient. •e-Reports of Services: Reports containing patient health information generated, transmitted, and received electronically, sent from one health care provider to another for the purposes of aiding in the care of a patient. The e-Connect Challenge is part of the Infoway ImagineNation Challenges initiative launched in 2011 with a vision to inspire, provoke, and promote innovation in health and health care in Canada. To date, thousands of Canadians, including consumers, clinicians, and health and business leaders have become involved in one of the five Challenges that Infoway has launched over the past three years. The Challenges have been a catalyst for innovation and have provided an opportunity to showcase these innovations and the teams behind them so that others can learn from their experiences. “I look forward to the innovative submissions that will come in as part of the e-Connect Challenge, which is open until March 2015,” Alvarez adds . Learn more at www.imaginenationchalH ■ Dan Strasbourg is Director, Media Relations at Canada Health Infoway.

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Sunnybrook helps balance

Ontario’s electricity grid By Laura Berndt


unnybrook Health Sciences Centre is participating in an innovative new smart grid program and helping Ontario’s electricity grid to keep to the lights on. Sunnybrook has teamed up with ENBALA Power Networks to provide realtime regulation service, known as Grid Balance®, to the Ontario electricity grid.

Through participation in the program Sunnybrook is contributing to the overall reliability of the Ontario power grid Traditional demand response programs require an electricity customer to curtail their energy use for hours at a time, which is not something that is easily achievable for a hospital. Participation in Grid Balance® requires real-time power draw adjustments for only short periods of time (usually less than 15 minutes). This makes it easy for hospital facilities to participate because shifting when the power is used does not affect the cooling capacity provided or how much total energy is used. Grid Balance® helps to match Ontario's

Sunnybrook staff members stand by the hospital's chiller during an open house total electricity generation with Ontario's total electricity demand on a second by second basis, keeping it in balance. Since electricity is not traditionally stored, it is very important that the amount of electricity generated in each moment correctly match the demand loads. As we introduce more variability into our province's

power generation by connecting more solar and wind power (which are intermittent sources of power), keeping the grid in balance becomes more difficult and more important. ENBALA has connected a network of large electricity consumers to provide Grid Balance® to the Ontario electricity grid.

Through the use of their innovative smart grid technology platform, GOFlex™, ENBALA can intelligently manage the flexibility of electricity loads in response to real-time needs of the electricity grid. The result is a more reliable, sustainable and often cheaper method of regulation service. Sunnybrook is one of the inaugural large electricity users participating in the program and the first in the health care sector. Sunnybrook has five large air conditioning chillers that are connected to ENABALA's Ontario Grid Balance Network. There is flexibility in when and how power is used for these machines by adjusting the temperature of the cold water that is produced, all the while keeping hospital spaces within ordinary comfortable temperatures. Through participation in the program Sunnybrook is contributing to the overall reliability of the Ontario power grid and generating a new revenue stream to help sustain the hospital’s services. Sunnybrook expects to receive $15,000 – $30,000 annually for participating. This cost free initiative is one of the outcomes of the Smart Energy Actions Program the hospital H launched in early 2013. ■ Laura Berndt is Manager of Energy & Sustainability at Sunnybrook Health Sciences Centre.







Is robotic surgery safe? Continued from cover

By Dr.Christopher Schlachta


f you surf the internet or watch late night television, you are no doubt aware of the close scrutiny robotic surgery is under. Medical experts from reputable institutions have come forward decrying the lack of evidence of clinical effectiveness and added costs of robotic surgery. Legal firms across the USA are actively seeking clients allegedly injured during robotic surgery to initiate class action lawsuits. While Canadian surgeons are not different from American surgeons in that they are motivated by the same desire, first and foremost, to provide safe and effective care for their patients, it is important to understand the very distinct drivers behind adoption of robotic surgery in Canada and the USA and similarly to separate myth from fact in terms of the evidence concerning safety, clinical effectiveness and costs. Given the for-profit health system in the USA, exciting new medical technologies are increasingly leveraged by hospitals to attract more business. The commercial nature of the system has led to reports that surgeons are being coerced by hospital administration to use da Vinci and concern of errors being made fueled the litigious faction into action. A closer look indicates that there is no specific concern about the inherent safety of the da Vinci surgical system, but rather the inadequate training of the surgeons employing this technology. In Canada, we have a publicly-funded system with rationing of fixed health care resources. If a hospital acquires da Vinci technology in Canada it is at the behest of its surgeons who see this technology as an import investment in patient care. This has almost exclusively been made possible by the generosity of the donor communities. The absence of a commercial benefit to such technologies for Canadian health care providers creates a significantly different (and less controversial) dynamic here surrounding new medical technologies adopted by hospital surgeons. In both countries, the introduction of robotics is the latest in a continuum of care focused on improving the quality and safety of surgery through advances in technology. The evolution of minimally invasive surgery has allowed surgeons to harness the benefits of computer-assisted technologies to perform therapeutic interventions without the need for large incisions. This reduces pain and suffering and some complications. The current scrutiny surrounding the introduction and expansion of robotic surgery is understandable – even healthy. It follows from a similar introduction of a disruptive technologic advance some thirty years ago that was new to the surgical community – laparoscopic “key-hole” surgery. Prior to this new procedure, a patient needing their gallbladder removed faced a painful abdominal incision accompanied by tubes, drains and a week or more in hospital. Today, with laparoscopic surgery, HOSPITAL NEWS FEBRUARY 2014

Dr. Christopher Schlachta is Medical Director, Canadian Surgical Technologies and Advanced Robotics (CSTAR) at London Health Sciences Centre more than 80 per cent of gallbladder surgery is ambulatory care. There is a cautionary tale to be heeded. Despite best efforts of surgeons to adapt, complication rates rose during the initial learning curve in the push to adopt this “key-hole” approach which promised such tremendous benefits for patients. Understandably, accusations that this technology was being pushed by industry with inadequate surgeon training were prevalent. In fact, the introduction of laparoscopic cholecystectomy was once called ‘the biggest unaudited free-for-all in the history of surgery’.

The current scrutiny surrounding the introduction and expansion of robotic surgery is understandable – even healthy Despite those early concerns, laparoscopic gallbladder surgery has become the standard of care and heralded the modern era of minimally invasive surgery. Today, various body cavity procedures from cardiac bypass to rectal cancer surgery can be performed with a minimally invasive approach. No one serious about providing quality care would turn the clock back now. Robotic surgery carries the promise of advancing these technologic benefits even further. The da Vinci system provides enhanced instrument dexterity and offers full visual depth perception as compared to simple laparoscopic instruments. Surgeons who have embraced da Vinci do so in anticipation that it will lead to the next quality advance in patient care. In 1999, the London Health Sciences Centre (LHSC) cardiac surgery team performed the world’s first closed-chest, off-pump, beating heart, coronary artery bypass surgery using the Zeus robot (Computer Motion). In 2003, the first da Vinci Surgical Systems (Intuitive Surgical) were

put into service in Montreal Quebec and London Ontario. That year, 42 da Vinci procedures were performed at these two sites in Canada. By 2013, the 18 Canadian centres performing da Vinci surgery pushed that cumulative volume to over 10,000 cases. Lessons from past adoption of new technologies inform our very rigorous approach to introducing this technology, including structured assessment of cost and patient outcomes. The most commonly performed da Vinci procedure in Canada is radical prostatectomy, while hysterectomy is the fastest growing. Data as to the effectiveness of this unquestionably expensive technology is slow to come and occasionally conflicting. The Canadian Agency for Drugs and Technologies in Health (CADTH) performed a health technology assessment of robotic surgery to evaluate clinical and cost. In a review of 95 published articles on robotic surgery it was concluded that while the available data was of low quality, robotic surgery seemed to be generally associated with shorter hospital stay and reduced need for blood transfusions at the expense of longer operating time. The economic analysis demonstrated that the higher cost associated with robotic surgery is partially offset by reduction in hospital stay. Da Vinci surgery in Ontario is now the subject of a review by the Ontario Health Technology Advisory Committee of Health Quality Ontario. Specifically with regard to the learning curve, it is key to consider what is the best comparator for robotic surgery. Published evidence, including our own laboratory research, suggests for a surgeon trained in open surgery, as compared to learning the laparoscopic approach, the learning curve for being able to offer patients a minimally invasive alternative is attenuated when da Vinci is employed. Surgeons can learn to use da Vinci faster than laparoscopic surgery. In addition, the data does not support the negative outcomes being alleged in the media surrounding robotic surgery. A recent systematic review and meta-analysis of 34 peer-review studies comprising over

4,000 patients having robotic-assisted total hysterectomy versus open or laparoscopic surgery found the robotic approach was associated with a lower rate of complications. A study of a large administrative database looking at nearly 10,000 women having hysterectomy for benign disease found no differences in complications. In appropriately trained hands the da Vinci surgical system is safe. By learning from the past, we have taken steps to ensure appropriate training precedes adoption of new approaches. At LHSC and St. Joseph’s Health Care London, since 2005 the Protocol and Guidelines for Robotic Surgery Innovation have been in effect. These guidelines lay out specific training criteria for surgeons wishing to adopt da Vinci technology and mandate clear disclosure requirements for obtaining informed consent from patients undergoing these procedures. In addition, every surgeon performing da Vinci surgery in London is tracking the outcomes of their cases and participating in a critical review of clinical and cost effectiveness of this technology. It is through this program that surgeons in London have reported 11 national and world firsts with da Vinci technology. As true leaders in robotic surgery innovation surgeons in London have also contributed to the safe introduction of this technology in other centres by acting as proctors and by having the Canadian Surgical Technologies and Advanced Robotics (CSTAR) program at LHSC designated the Canadian training centre for da Vinci surgery by Intuitive Surgical. While questions still remain to be answered about the clinical and cost effectiveness of the current prevalent robotic surgery system, we are proud of the approach we have implemented for the introduction of this promising technology and will continue to evaluate its ongoing role H in the Canadian health care system. ■ Dr. Christopher Schlachta is Medical Director, Canadian Surgical Technologies and Advanced Robotics (CSTAR) at London Health Sciences Centre.




Greening Health Care: Energy efficiency and sustainability By Brian Dundas


anada-wide, hospitals spend approximately $750 million a year on utilities. Relative to other costs of healthcare, this may seem like small potatoes. Yet, Greening Health Care’s (GHC) member hospitals are proving that pursuing energy efficiency not only saves money and demonstrates leadership, but also helps instill the principle of high performance into all aspects of hospital operations. For 10 years, Greening Health Care has been providing a strategic, systematic approach to benchmarking performance, targeting potential savings, identifying the best measures and delivering results. The program gives facility managers the tools they need to take control of their buildings using GHC's data-driven, performance based methodology. GHC's methods allow you to see precisely where your optimal savings can be found. Whether you are looking to save money, improve operational efficiency, undertake a retrofit or renewal project, or build a new hospital, Greening Health Care provides the information, standards, and peer-network to help get the best performance out of your facilities. There are currently 51 hospitals participating the Greening Health Care and the program is available to hospitals across Canada. Almost every hospital in Canada has three things in common–deteriorating infrastructure, minimal capital availability,

and severe pressure on operating budgets. The good news is their large, untapped financial asset in potential utility cost savings. Our studies have shown that about $250 million of the nation-wide utility expenditure is wasted. Ten years of data-sharing and benchmarking through GHC have shown that some hospitals are already quite efficient while others can save 50 per cent or more of their energy and water use, utility expenditures, and greenhouse gas emissions.

methodology developed through Greening Health Care is now providing the metrics, best practices and tools for leading hospitals across the country to quantify and deliver the full potential of each facility. The approach is readily applied to every hospital in Canada, supporting a systematic, multiyear effort to deliver and verify the savings. Many provincial agencies, electric utilities and gas companies are ready to provide financial incentives and technical support to help hospitals take action and achieve their savings potential. All that is needed now is for hospitals to find out how they compare, quantify their energy and cost savings potential, and get on with planning and implementing the necessary operational improvements and capital measures. Of course, The Greening Health Care approach is about more than benchmarking and performance-based energy management. Members also value the opportunities for networking, recognition, and celebration. To date, two GHC member hospital corporations have been awarded the Greening Health Care Leadership Award for sector-leading sustainability ethos and performance: Trillium Health Partners (2012) and West Park Healthcare (2011). West Park Healthcare committed itself to aggressive energy management way back in the 1980’s, then built on that commitment by broadening its sustainability lens to the point where their wide–ranging

Our studies have shown that about $250 million of the nation-wide utility expenditure is wasted. Our members have learned that in most cases savings can be achieved quite easily, often through smart operational and controls changes that require no capital outlay. All that’s required is first to know what your savings potential is, then a facilities staff eager to take control of their building and finally making the business case for senior level support. Greening Health Care provides the means to help you do all three. The health care sector has generally done a good job of benchmarking performance and cost indicators–with the glaring exception of utility consumption. The

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Brian Dundas stakeholder–supported sustainability program is engrained in the culture. The Trillium model is a bit different, but equally powerful. They have adopted ISO (14001), managing their drive to sustainability and efficiency through a formal environmental management system that ensures efficiencies are constantly assessed and addressed through continual improvement. Both have leveraged energy conservation to improve their overall corporate efficiencies. Anchoring your facility in sustainability is all about greater efficiency, cost savings, and happier engaged staff. Greening Health Care can help any health care facility in Canada take charge of their facilities, learn how they are performing, and inform and track real progress over time. Visit for more H information. ■ Brian Dundas is the Manager of Greening Health Care program at Toronto and Region Conservation.

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10 Focus


The reality of robots By Allison Sojka


Through the use of their Robotic Suit, Ekso has helped individuals take over a million steps that would not have otherwise been possible.

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obotic technologies in the field of neuro-rehabilitation are increasingly associated with improved patient outcomes. While the technology certainly aids the patient in learning how to walk again, perhaps a significant contribution to the process has gone unrecognized. The technology also has the potential to augment the work of the physical therapist in ways that might otherwise be impractical at best and impossible at worst. A recent example is the surge in adoption of robotic exoskeletons used to rehabilitate patients following a stroke, spinal cord or traumatic brain injury. Rehabilitation after a stroke or spinal cord injury (SCI) can be grueling and expensive. According to the Canadian Heart and Stroke Foundation, stroke patients spend more than 639,000 days in acute care and 4.5 million days in residential care facilities, totaling $3.6 billion on an annual basis. Spinal Cord Injury Canada reports there are more than 86,000 people living with SCI in Canada—with an estimated 4,300 new cases each year, also resulting in an annual price tag of $3.6 billion. Worst of all, the gap between the hope and reality of rehabilitation for patients often times can’t be bridged. But that may soon change with new robotic tools to augment health care providers’ rehabilitative arsenal. The International Collaboration On Repair Discoveries (ICORD) will shortly be ushering in a new chapter in neurorehabilitation research with their recent acquisition of the Ekso™ robotic exoskeleton. ICORD is an interdisciplinary research centre at the University of British Columbia and the Vancouver Coastal Health Research Institute focused on SCI and looking for more effective means of functional recovery and improved quality of life after SCI. There will soon be a new face of rehabilitation with robotic exoskeletal suits helping humans (patients and therapists alike) do the work to walk again. Ekso, a wearable robot designed by the Richmond, California-based company Ekso Bionics™, enables individuals with lower extremity paralysis or weakness to stand up and walk over ground with a natural, full weight-bearing, reciprocal gait. Walking is achieved by the user’s weight shifts to activate sensors in the device which in turn initiate steps. Batterypowered motors drive the legs, replacing as much–or as little–of the patient’s deficient neuromuscular function as is required to achieve ambulation. “Ekso is an exciting technology for us because it provides us with a strategy to investigate the overall health benefits of getting patients with complete SCI up and walking again, including the possibility of relieving the many associated secondary complications of SCI,” says Tania Lam, PhD, Principal Investigator at ICORD and an Associate Professor in the School of Kinesiology at the University of British Columbia. “The addition of the Variable Assist feature also opens up whole new re-

search opportunities for investigating new gait training strategies for incomplete SCI patients. It helps to relieve some of the physical burden of doing over-ground gait training for patients while enhancing the physical therapist’s ability to conduct the rehab session. The therapist can focus on the quality of the stepping pattern without having to worry about maintaining the patient’s correct posture or supporting them. Everyone can focus on the actual act of walking.” As a principal investigator at ICORD, Dr. Lam is continuously looking for ways to improve gait training. “We are very interested in pursuing research comparing over-ground gait training with the Ekso to current gait training strategies, such as body-weight supported treadmill training. Over-ground walking requires you to propel the body forward, not just stay in one place, which is what you get with a treadmill. The Ekso brings us closer to real-life walking contexts of going from Point A to Point B, supporting the foundation of actual walking, which requires integration with balance and postural control.”

Ekso, a wearable robot designed by the Richmond, Californiabased company Ekso Bionics™, enables individuals with lower extremity paralysis or weakness to stand up and walk over ground with a natural, full weightbearing, reciprocal gait.

Dr. Lam says, “We’re at the beginning stages but we’re very excited about the possibilities this new platform could provide. We also look forward to continued advances in the technology which could allow people to practice more skilled walking tasks, like walking up stairs or stepping over objects, that more closely align with real-world situations people encounter.” Ekso’s innovative, task-based platform is designed as a practical and efficient means for physical therapists to help patients produce proper bio-mechanical alignments while re-learning proper gait patterns and weight shifts, and to achieve higher step dosage than what might be possible with traditional over ground gait training methods. This means therapists who may otherwise have opted to “pass” on gait training with the most acute patients to focus on smaller, more achievable rehabilitation goals now have a practical option to get them up and walking over ground under as much of their own power as possible. Continued on page 11


Reality of robots Continued from page 10

For patients further along in their recovery, it allows therapists to provide a more personalized and progressive care plan. Aside from the clinical benefits, the latest version of Ekso also hosts practical benefits to clinics, making it easy to integrate into their practice and provide rehabilitation to a wide variety of patients in a single day. The device takes up no more floor space than a patient sitting in a chair and the detachable batteries can be charged from a standard wall outlet. While the technology accommodates a vast spectrum of patient sizes and clinical presentations, adjustments between patients can be done in less than five minutes. The type of rehab a patient receives can have dramatic impacts on the time to recovery and the per cent of recovery. Typically, physical therapists have the resources to utilize gait-training techniques, such as parallel bars or KAFOs, but these can be impractical for the patient as well as the staff. Conversely, body weight-supported treadmills can be complicated to install and set up, take up considerably more floor space, and don’t necessarily require patients to engage in the therapy, therefore slowing the rehabilitation trajectory. All that’s required is a robotic suit, no larger than an actual person, instead of a team of trained specialists, expensive infrastructures built to house past robotic rehab systems, and special electrical requirements. The patient merely straps the robotic suit over his clothing and begins

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Photo by Lowell McPhail/ICORD

Mustafa Hasan poses with the Ekso Suit after a training session with Drs. Lam (left) and Chisholm at The International Collaboration On Repair Discoveries (ICORD). to walk. This enables individuals with lower body weakness to achieve mobility, strength, or endurance not otherwise possible. “Ekso is filling a gap in the rehabilitation continuum, so we’re looking forward to uncovering how this can be used most effectively in the care plan. The possibilities are exciting,” Dr. Lam says. "Companies have been building robots as a solution for paralysis for well over a decade,” says Ekso Bionics CEO Nathan Harding. “The one thing we’ve come to realize is that the difference between a cool prototype and a viable product is huge. No one needs technology for the sake of technology.” With the Ekso bionic suit, the company has developed a meaningful therapeutic robot that is both sophisticated and user-


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friendly. Adds Harding, “It’s designed to work within the constraints of a real health care setting, and we feel it marks the beginning of a new chapter for both patients and practitioners. The goal was to design something that could help therapists get their patients walking on day one and yet help them progress along a rehabilitation program. It was important too that it was easy and efficient for therapists to use with a wide variety of patients.” While ICORD is the first facility in western Canada with an Ekso, there are more than 40 systems placed in North America, Europe and South Africa. ICORD will initially use the bionic suit to conduct research studies in people with SCI. The wearable robot uses force and motion sensors to monitor the patient’s

Focus 11

gestures and motion, and uses this information to intelligently interpret the intent and strength of the patient and translate it into appropriate action. It allows patients to walk in a straight line, stand from a sitting position, stand for an extended period of time, or sit down from a standing position. These seemingly simple acts might also be applied to a much broader patient population unlocking an entirely new approach to patient care, which could dramatically reduce health care costs and enhance lives. In addition to helping those with some level of paralysis, the Ekso bionic suit could also provide benefits by getting patients who’ve been hospitalized up and out of bed sooner. Early ambulation may be directly tied to reduction in risk of deep vein thrombosis and even hospital-acquired pneumonia. In essence, this rehabilitative tool could get patients home faster and keep them healthier. That obviously translates to reduced health care costs. The reality of leveraging therapeutic robotics to help deliver an affordable and effective health care system has never been closer. “To get people safely up and mobile could reduce secondary medical complications during the acute care phase but also over the lifetime of the patient,” Dr. Lam explains. “Many of the secondary complications that arise over the long term come from patients sitting all the time.” With the rise of obesity, an aging population and chronic health conditions, mobility aided by robotic exoskeletons could be a defining driver of mental, physical and even H financial health. ■ Allison Sojka is the Director, Marketing Communications at Ekso Bionics.

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12 Focus


Waste management is

green management By Michele Lawton

healthcare and for making CKHA a leader in the industry, she received the OHAâ&#x20AC;&#x2122;s Individual Leadership Award. This accolade, which goes to someone nominated by their peers, â&#x20AC;&#x153;recognizes a hospital employee who has made an outstanding individual contribution to reducing their hospitalâ&#x20AC;&#x2122;s environmental impact and inspiring the hospital to go greenâ&#x20AC;?. Carrie continues to be recognized for her ongoing commitment to green healthcare and for making CKHA a leader in the industry.


rogressing steadily on a wellgrounded path, Chatham-Kent Health Alliance (CKHA) continues to lead in sustainable waste management and green health care programs. Since the formation of CKHA`s Green Team in 2005, CKHAâ&#x20AC;&#x2122;s dedicated green practices have recevied local, provincial and national recognition. In the past seven years, they have received a Clean Air Award from the National Air Filtration Association (NAFA) where they were recognized for efforts put in place for best practice maintenance and surpassing normal standards; earned provincial recognition for leadership to protect the future health of the environment with the Ontario Hospital Association`s (OHA) Pollution Prevention Award; and received two, Waste Management Awards from the OHA`s Green Health Care Awards (2011 and 2013) as well as an Individual Leadership Award in 2013. Knowing waste management is an enormous and costly side effect of daily hospital operations, CKHA was ahead of the curve many years ago in organizing the Green Team to help improve and reduce hospital waste within its facility. Through this teamâ&#x20AC;&#x2122;s leadership and commitment, they have been able to divert extraordinary amounts of waste from the landfill and lead the way in green health care programs. They have made a positive impact on handling waste management for their organization and partners, continuing to lead as environmental stewards. CKHA is the Best Practise Spotlight for being the first facility in Canada to implement the reusable pharmaceutical waste containers. The organization also created an implementation plan for reusable sharp smart containers, developed an instrument tray wrap recycling program, and rolled out an initiative for inpatient room recycling (and these are just a few examples). The Green Team is always looking at new ideas. They are currently considering partnering with a company who is working with the Recycling Council of Ontario (RCO) where CKHA could be the first hospital test site for a Green Certification program. If successful, this program will eventually be rolled out to other hospitals.

CKHA is the Best Practise Spotlight for being the first facility in Canada to implement the reusable pharmaceutical waste containers.

Recycled ecycle ed materials are collected via small plastic containers for delicate surgical items, ems clear plastic bags for gauze dressings and other lighter supplies and heavier, heavie larger supplies ones are gathered in bags and put in Operation Green garbage bins in strategic areas of both campuses. With CKHAâ&#x20AC;&#x2122;s Return to Vendor program, packaging from purchased products is returned to the vendor for disposal or recycling which reduces the hospitalâ&#x20AC;&#x2122;s costs for disposal and encourages reduced packaging of materials. CKHAâ&#x20AC;&#x2122;s expanded partnerships for recycling diverts plastics that are normally not accepted for recycling. Led by the Housekeeping Team, CKHA Waste Management program partners with other health care facilities in a program called, Operation Green. Operation Green has diverted supplies from landfill by re-

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directing items (that would normally be disposed) to third world countries. Educating and empowering the staff and public to get involved with green initiatives has been one of CKHAâ&#x20AC;&#x2122;s greatest strengths, through their Environmental Expos, departmental challenges, and Energy Matters web site Alliance staff, community members and partners in healthcare are encouraged to be involved by participating and conceptualizing new ways to collect recyclable products. â&#x20AC;&#x153;Working with our partners, including the Canadian Coalition for Green Health Care (CCGHC) and sharing information and programs with other health care facilities regionally, provincially and nationally is the key to greening the health care industry,â&#x20AC;? says Beth Hall, Director of Support Services. â&#x20AC;&#x153;It's absolutely imperative that hospitals become aware of green healthcare and its importance. That's part of our goal. If we can help other facilities implement our program that just pushes us to find new and innovative ways to improve our programs.â&#x20AC;? To initiate, organize and implement these initiatives, it takes a green-savvy staff member who has the insight and perseverance to see it through and make change. Carrie Sophonow, CKHAâ&#x20AC;&#x2122;s Manager of Housekeeping has spearheaded many of these initiatives. Her contributions to CKHA becoming a greener hospital have not gone unnoticed. With her ongoing commitment to green

Some of Carrieâ&#x20AC;&#x2122;s contributions include serving as Chair of CKHAâ&#x20AC;&#x2122;s Green Team, a small, volunteer group within the hospital. The primary task of this team is to lead CKHAâ&#x20AC;&#x2122;s Environmental Stewardship Program. Under her leadership, the Green Team has achieved extraordinary success over the years such as the IV Over-Pouch Recycling Initiative with Baxter, reusable pharmaceutical waste containers, fully expanded recycling program, Operation Green Project, Scrap Metal Recycling, Surgical Instrument Tray Wrap Recycling Project, Reusable Sharp Smart Containers and the Annual Educational Environmental Expo. She has also led the CKHA â&#x20AC;&#x153;Sharpsmart Programâ&#x20AC;? and the installation of a Solutions Recycling Unit. The â&#x20AC;&#x153;Sharpsmart Programâ&#x20AC;?â&#x20AC;&#x201C;an initiative which replaced disposable sharps containers with reusable onesâ&#x20AC;&#x201C;is responsible for ultimately redirecting plastic from the landfill each year. She has organized the Erie St. Clair LHIN Environmental Services group where she leads the group to standardize processes, combine resources and share her environmental projects, many of which have been implemented across the Erie St. Clair Local Health Integrated Network (LHIN) and with peer hospitals across the province. As well, Carrie was instrumental in CKHA being the recipient of national, provincial and community awards for green health care initiatives such as the national Canadian Healthcare Engineering Society Wayne McClellan Award of Excellence, the provincial Ontario Hospital Association Waste Management Award (2011 and 2013) and in 2012, the Chatham-Kent Chamber of Commerce Environmental Leadership Award 2011. Through teaching and coaching, Carrie continues to encourage, mentor and inspire staff and students to take a positive environmental stand. â&#x20AC;&#x153;We have an incredible team of people who, with Carrieâ&#x20AC;&#x2122;s leadership, continue to demonstrate that CKHA is an exceptional community hospital that continues to set the standard for environmental stewardship,â&#x20AC;? reflects Hall. â&#x20AC;&#x153;CKHA was also one of five finalists, out of 90 organizations, for the Green H Hospital of the Year Award,â&#x20AC;? she adds. â&#x2013; Michele Lawton, Communications Specialist at Chatham-Kent Health Alliance.


Focus 13

New energy conservation initiative By Kent Waddington


he Canadian Coalition for Green Health Care and strategic partner, the Ontario Chapter of the Canadian Healthcare Engineering Society, together with technical partner, ICF Marbek, have a new energy conservation initiative officially launching in 2014. Funded by the Ontario Power Authority (OPA), the initiative is part of provincewide capability-building aimed at providing resources directly to electricity customers through sector-based organizations. Over the past five months, the project team consulted extensively with health care stakeholders and energy management colleagues across Ontario to ensure it crafted all necessary elements into what is now known as the HealthCare Energy Leaders Ontario (HELO) initiative. With the framework now complete, Account Managers are being hired and deployed across the province to provide onsite energy reduction assistance to eligible Ontario health care facilities. Speaking for the Coalition, Executive Director Linda Varangu states, “The opportunity for conservation and demand management within the hospital sector is vast and we feel that our goal is in perfect alignment with the OPA’s: to have health care facilities realize energy savings as soon as possible, and assist in inciting a change in business culture from one of consumption to that of conservation and demand management.”

JJ Knott, will help the Coalition lead the energy efficiency activities on behalf of the Coalition and CHES Ontario. Electricity comprises approximately 30 per cent of energy used in the sector. However, the relatively high cost of electricity demands over half of a typical energy budget. Natural gas and other heating fuels comprise the remainder. Research by partner ICF Marbek suggests hospitals in Ontario’s 14 Local Health Integration Networks (LHINs) have the potential to reduce electricity consumption by approximately eight per cent with even higher savings achievable for natural gas. Ray Racette, President of the Canadian College of Health Leaders explains, "Financial challenges are the most pressing

issues facing Canada’s health system and hospital CEOs. With limited new money coming to healthcare, it makes sense that we strive to find savings wherever we can. The HELO program can help our health care organizations realize savings in facility operating costs, thereby freeing up valuable funds for the delivery of patient care." Under the HELO initiative, health care facilities operating in Ontario, including hospitals, long-term care facilities, and community health centres are eligible for different types of service with some restrictions. Hospitals already receiving funding for an embedded energy manager through their local electric utility are ineligible, as are municipally funded long-term care homes since they are served by other electricity-saving programs available in Ontario. All participants have access to Basic Support which includes guidance on accessing electric utility incentives, project implementation advice, educational webinars and e-newsletters, as well as access to online tools and resources. Those sites qualifying for Custom Support are eligible to receive assistance identifying energy efficiency opportunities, support developing the business case for projects, and help with implementation. Depending on participant needs, specific services may include a free walk-through audit, assistance with utility data analysis and energy performance benchmarking or support accessing incentives and funding. JJ Knott, past President of CHES Na-


tional, and Director, Plant Operations at Norfolk General Hospital in Simcoe, Ontario has been hired to help the Coalition lead the delivery of energy efficiency activities. “As energy efficiency lead on this project, I am simply ecstatic about its launch,” says Knott, “and am thankful that Norfolk General Hospital sees the value in such a project and has agreed to allow me to work with the team that is overseeing delivery of the HELO initiative.” What does all this mean for those involved in health care facility and energy management? An initiative developed from the inside out by a team intimate with the challenges and opportunities faced each day in a health care setting that are here to help. “After many long months of planning, we’ve finally been able to make it happen,” says Coalition Chair, Kady Cowan. “This project dovetails nicely with many other projects the Coalition has brought to the sector such as the new Canadian Green Health Care Revolving Fund to help finance energy efficiency projects; our EcoAction project with Environment Canada to help the sector.” To learn more about participating in this new Ontario health care initiative, visit: or contact Kent Waddington–kent@greenhealthcare. H ca 1-888-589-HELO (4356) ■ Kent Waddington is Communications Director at The Canadian Coalition for Green Health Care.

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14 Focus


Creating a high performance work culture Six ways Windsor Regional Hospital is doing it By Yvan Marston

Windsor Regional Hospital CEO David Musyj focuses on fostering transparency as a way to build organizational trust. He may be best known for handing out his personal contact information to staff and patients, inviting them to contact him directly to discuss any issue.




three-part series a in le tic ar t rs fi e th is This ls approach internal ita sp ho w ho g in in am ex ls function best when communications. Hospitaengaged. A well their employees are fully ntribute to efficiency co organized building can mes from a well but true effectiveness co e not only willing to organized culture. And on ange This installment ch change, but wanting to Regional Hospital or ds in W k or w e th at s look nsparency to build tra on ng si cu fo ne do s ha organizational trust.


indsor Regional Hospital’s intercom system, like that of any other hospital, squawks constantly. Short sharps bursts fire off first names, instructions and room numbers to fill the halls with the kind of background noise that is typical in a busy care environment. But at 9:00 and again at 12:00 you will hear 18 seconds of ‘Lean on Me’. And some days, seemingly at random during regular hours, you may also hear 18 seconds of Brahms’s Lullaby. “The lullaby means a baby was born. And if it’s played twice, that means twins,” says Ron Foster, the hospital’s VP of communications. Music can connect a web of thoughts and emotions, and in this organization, it also connects trust. “We use ‘Lean on me’ to remind staff of the emotional side of providing care. It’s a triggering mechanism,” explains Foster, adding that while staff satisfaction scores are high, it is important to deploy tactics that continually reinforce a positive atmosphere, one in which you can build trust. Windsor’s focus is on fostering transparency as a way of building trust. The hospital’s outspoken CEO David Musyj (pronounced ‘moo-shay’) likes to stick his neck out every so often, exposing himself to potential criticism and even personal attack by handing out his home phone number and direct email address for employees to connect with an idea or a complaint, or for patients to discuss their quality of care. Building a culture of trust is the foundation for good engagement strategies. Employees want to feel socially safe when changes are put upon them. If they function on a social perimeter, they are less likely to adapt to change, never mind contribute to it. But a big wide trusting space can create a climate where change is not as threatening. And if it is not threatening, staff won’t be defensive and will contribute positively. Here are six things Windsor Regional is doing to strengthen its culture of trust:

1. Reach out to get good feedback When Musyj took over in 2007, Windsor had only balanced its budget twice in 14 years and clinical results were also “not the greatest” recalls the 40-something CEO. A former lawyer, he joined the hospital in 2000 as VP of corporate services and was made chief executive officer in 2007 when his predecessor retired. “I couldn’t understand why we were struggling. Clearly everyone wanted to do a good job and be recognized as good caregivers,” says Musyj. To find the answers he asked employees if he could interview them. Willing candidates were given a list of questions asking HOSPITAL NEWS FEBRUARY 2014

what was being done well versus not well (see sidebar) to prepare their ideas. Most, recalls Musyj, showed up with pages of typewritten notes. It is perhaps a testament to Musyj’s disarming character that some of these faceto-face interviews yielded honest expressions of dissatisfaction–which were useful. “When staff tell me they are embarrassed about where they work, that’s the key to this. I don’t want them to be punching a clock. There’s so much more here than that. I want to provide that opportunity because when staff satisfaction goes up, patient satisfaction goes up,” he says. Over 200 employees were interviewed in a three-month period in 2007, and the same method was again brought into play this past fall to manage the current realignment that has seen Windsor Regional become responsible for the Hotel-Dieu Grace Hospital, now known as the Ouellette site. And to align the entire organization, the hospital sends the same five questions annually to its board, to members of its medical advisory committee and to union executives. “If I’m getting generally the same responses from everybody, it means we are all moving in the same direction,” says Musyj.

2. Provide direct access to decision makers Musyj is perhaps best known as the hospital CEO who hands out his personal contact information telling both patients and employees to call him up and discuss any issue. Every patient who enters the hospital gets a letter outlining the facility’s vision and letting them know how they can recognize an employee for outstanding care or contact him directly by email, cellphone and even home number if they have an issue. There has been surprisingly little abuse since he began the practice in 2011, and Musyj tends to get two to three phone calls from patients each day and upwards of 20 from staff. One has to be mindful of the organizational structure when providing this kind of access, advises Musyj, explaining that you should be clear that you can’t step in and resolve an issue directly. “If I start jumping to conclusions and trumping my managers’ decisions, I’ll end up running this place by myself,” he adds. Mainly, this type of access serves as a clearing mechanism to resolve small problems before they develop into larger ones. (It is also likely to encourage better employee performance given that their boss is very easily accessible to dissatisfied clients.) Continued on page 15

Focus 15


high performance work culture Continued from page 14 3. Be a partner and not a â&#x20AC;&#x2DC;parentâ&#x20AC;&#x2122; Guelph-based engagement consultant Brady Wilson draws a distinction between engagement and energy when looking at employee relations. You can be engaged and do your job, he says, but if you feel drained at the end of the day, you will not be able to consistently bring energy to your work. â&#x20AC;&#x153;And that can be demoralizing because we all want energy for other aspects of our lives,â&#x20AC;? says Wilson, whose firm Juice Inc. has consulted with health care organizations across North America. One way to boost energy is to give employees control to resolve conflict as much as to design systems. Itâ&#x20AC;&#x2122;s what he refers to as partnering rather than parenting. Windsor took the partnering approach when it sought to resolve a persistent user problem: Eight per cent of the population the hospital served was consuming 50 per cent of its resources. The hospital had funding to create a dedicated short-stay medical unit that could quickly accept these high-use patients from the ER to care for them in a unit designed for a maximum 72-hour stay. But what would that unit look like and how would it function? â&#x20AC;&#x153;We brought all the staff together, the nurses, physicians, lab techs, housekeeping, medical imaging and we said: Hereâ&#x20AC;&#x2122;s the concept. Hereâ&#x20AC;&#x2122;s how many beds we have money for. Now you guys design the unit,â&#x20AC;? says Musyj of a January 2013 meeting he had to initiate the project. The unit was designed for patients with chronic conditions like urinary tract infections, pneumonia, or heart failure complications, as well as for patients who make multiple visits to the ER. Staff mapped out the patient journey from the moment they arrived at the ER to their move to the short stay unit right through to discharge. And it was operational by July that same year. Partnering to foster this type of ownership in a project creates a bias towards success, says Musyj. â&#x20AC;&#x153;It works and whatever doesnâ&#x20AC;&#x2122;t work gets addressed as a hurdle, not a wall, because this is their unit.â&#x20AC;?

4. Win your employeesâ&#x20AC;&#x2122;shoes Inspired by an episode of Undercover Boss he caught while channel surfing one evening, Musyj adapted the idea to his needs and set up a job shadowing program. He pasted the television showâ&#x20AC;&#x2122;s logo onto an internal email for effect and told employees across the organization that he was ready to don scrubs and get to work learning their jobs and to contact him to set up a time. â&#x20AC;&#x153;I had done rounding â&#x20AC;&#x201C; walking around in a suit and tie with an entourage asking questions â&#x20AC;&#x201C; but I felt it wasnâ&#x20AC;&#x2122;t getting us to where we wanted to be,â&#x20AC;? he says. Now he regularly accepts invitations to work with employees. Typically requiring a half-day, Musyj has tried his hand at everything from assisting nurses in the operatory, working in food services and portering patients, to changing beds, sweeping floors and cleaning toilets. Besides experiencing the pride employees take in performing each task, which is an indication of how they perceive themselves as valuable contributors to a larger system, Musyj says he learns about small efficiencies.

The 5 questions Windsor Regional Hospital asks its employees, board members, medical advisory committee members and union executives. â&#x20AC;˘What are we DOING WELL as an organization? â&#x20AC;˘What are we NOT DOING WELL? â&#x20AC;˘What must we START doing? â&#x20AC;˘What must we STOP doing? â&#x20AC;˘What GENERAL ADVICE do you have for me?

As part of his Undercover Boss initiative, Windsor CEO David Musyj joins dietary helper Kevin Cassetta in preparing food for patients. â&#x20AC;&#x153;You come across a lot of good ideas. I often tell them: You can ask for that to be changed,â&#x20AC;? he says, adding that again, like handing out your phone number, giving employees direct access to you does not mean you can ignore the formal feedback loop. â&#x20AC;&#x153;Always be careful to involve the employeeâ&#x20AC;&#x2122;s immediate manager,â&#x20AC;? he cautions.

5. Recognize and reward ideas with action Under Musyj, Windsor Regionalâ&#x20AC;&#x2122;s strategic planning process in 2008 brought frontline staffers, physicians and volunteers to the table and all players continue to be involved in strategy. It is in this inclusive culture that a staff meeting yielded the idea of Genius Lab, an intranet portal by which employees could easily submit ideas that could be quickly implemented. â&#x20AC;&#x153;Employee engagement initiatives have a shelf life,â&#x20AC;? says Brady Wilson. â&#x20AC;&#x153;Hospitals do engagement surveys and then pick the low hanging fruit to work on. Then, after a few years, over half the employees will indicate in a follow up survey that they donâ&#x20AC;&#x2122;t expect meaningful outcomes as a result of this survey.â&#x20AC;? By putting ideas into action quickly it reinforces the culture of change. Of course surveys, staff meetings and interactions with peers still constitute some channels for innovation, but having a formal mechanism that can give an individual the power to change a small process can have a lasting effect. â&#x20AC;&#x153;We now have received over 1,000 recommendations and implemented hundreds of them, â&#x20AC;&#x153; says Musyj, adding that they are often simple ideas that have a big impact, like putting handwashing stations in the elevators because it is the one place hospital employees will most assuredly stand still for a few seconds. â&#x20AC;&#x153;The CEO would never have figured that out. That takes frontline staff knowledge,â&#x20AC;? says Musyj. He is also in favour of rewarding engagement through exposure. Two years ago the hospital was invited to present innovations such as its 15-minute Monday Morning Huddles (which track 14 key indicators to stay ahead of monthly and quarterly trends rather than have to react to them) at the Mayo Clinicâ&#x20AC;&#x2122;s Quality Expo in Rochester New York. Windsor regional sent its staff to present and Musyj promoted this fact internally.

6. Takes measures to avoid drift Measurement is part of the change, says Musyj, invoking the adage that what gets measured gets done. â&#x20AC;&#x153;You need measurements in place to ensure you are on track,â&#x20AC;?

he says, explaining that change should look like a market index chart with lots of little ups and downs but a general upwards trend. If itâ&#x20AC;&#x2122;s trending downwards, thatâ&#x20AC;&#x2122;s drift. Step back and look at the big picture. The idea, he explains, is to stay ahead of negative trends because if you are operating at capacity, any little change can really throw you off. â&#x20AC;&#x153;But if you can get ahead of this, it can be really enjoyable... even fun.â&#x20AC;? Windsor Regional Hospitalâ&#x20AC;&#x2122;s culture of transparency enables a core component of employee engagement, namely, to ensure that their employeesâ&#x20AC;&#x2122; work is meaningful and that what they are doing is making a difference to the organization as much as to patients. But it is also about being part of an organization that is widely recognized for its good work.

â&#x20AC;&#x153;When youâ&#x20AC;&#x2122;re walking around the community and someone asks where you work, you can say you work at Windsor Regional Hospital and the discussion is a good one,â&#x20AC;? says Musyj. â&#x20AC;&#x153;I think more hospitals are realizing that this has to be their focus. Focus on this and the finances will take care of H themselves.â&#x20AC;? â&#x2013; Yvan Marston is a health care communications writer based in Toronto. But change doesnâ&#x20AC;&#x2122;t always stick. So what do you do when you see it falter? In the seriesâ&#x20AC;&#x2122; next installment we look at Kingston General Hospitalâ&#x20AC;&#x2122;s approach to addressing its dip in handwashing rates.

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16 Focus


Staff lead recycling improvements By Lindsay Smylie Smith


Amputee Terry Lewis walks in the ‘countryside’ as he works on his balance skills on the CAREN (Computer-Assisted Rehabilitation Environment)-the only clinical virtual reality simulator of its kind in Western Canada-at Glenrose Rehabilitation Hospital in Edmonton.

Photo Dale MacMillan

A new leg to stand on By Gregory Kennedy


fter losing a leg to infection, Terry Lewis found himself having to learn to walk again at 43. But he has two powerful allies in his corner–his one-year-old granddaughter, Cortlyn, who inspires him as she learns right along with him, and Alberta Health Services. “The people at Glenrose Rehabilitation Hospital have given me my life back,” says the Hinton man, who now walks 10 kilometres a day as he builds strength and endurance. “I’m looking forward to getting out into the woods again for some hunting this fall.” Lewis’s newfound vertical confidence stems from his participation in virtualreality research now being conducted at the Glenrose, where amputees learning to walk with a prosthetic leg are gaining the skills to do so thanks to sessions on the CAREN (Computer-Assisted Rehabilitation Environment)-the only clinical virtual reality simulator of its kind in Western Canada. Patients at this AHS facility are getting care specific to their challenges as they help University of Alberta researchers devise new approaches to therapy. “We’re looking at what a person with a single prosthesis usually does when they’re thrown off-balance,” says Dr. Jacqueline Hebert, Medical Lead, Adult Amputee Program at the Glenrose, as well as associate professor, Division of Physical Medicine and Rehab in the Faculty of Medicine & Dentistry at the U of A. “On the CAREN, we can actually study the biomechanics of how they’re walking, what their balance reactions are, then look at that and help them train better for the real world.” CAREN’s twin-treadmill platform, motion hydraulics and circular surround screen can be programmed by therapists to deliver a rehab program precisely tailored to each amputee’s needs. Sensors placed on patients are tracked by overhead cameras to give objective feedback and measure progress on gait, stride, speed, weight-shift, balance and more. A patient becomes part of the simuHOSPITAL NEWS FEBRUARY 2014

lated environment, interacts with it and changes it through their body movements. “We’re developing an assessment tool on the CAREN system that can be used to determine how amputee gait and balance are affected, and whether we can change this with therapy or other interventions,” says Dr. Hebert. “This tool also may allow us to compare other therapies that may be more accessible to people without access to a CAREN system.”

Sensors placed on patients are tracked by overhead cameras to give objective feedback and measure progress on gait, stride, speed, weight-shift, balance and more. As part of a national collaboration, Dr. Hebert’s research partners include lead co-investigators Dr. Edward Lemaire and Emily Sinitski of The Ottawa Hospital Rehabilitation Centre, where Canada’s only other clinical CAREN system is located. At the Glenrose, patients walk through virtual reality scenarios to build skill and confidence. “We can have the CAREN system in a self-pace mode, so patients can walk as fast as they’re comfortable walking,” says Dr. Hebert. “And then they suddenly have to go up inclines, or down inclines, or over ramps–and then we can simulate a bumpy surface where it’s like walking over rock, as the platform jolts them and bounces them around. That’s something that we can’t do in therapy on a level ground surface. And here, it’s safer than having them do it in the real world.” Says Lewis: “If it wasn’t for the Glenrose and this research, I wouldn’t be able to do what I’m doing now. I think it’s fabulous. You’re hooked to a harness, so you’re not afraid to fall. When you come out, you

still have the confidence that you can do it without falling. It’s helped me with my balance.” To date, 16 single-limb amputees have taken part in the national study, with more sessions and subjects expected next month. Helping amputees with lower-limb trauma also promises better rehab for military veterans wounded in action, says Dr. Hebert. Gordon Wilson, Chair of the Glenrose Rehabilitation Hospital Foundation, says the CAREN system is one of the many interventions that keep the Glenrose at the forefront of rehabilitative care and is an example of what the Glenrose Foundation makes possible. “Our foundation exists to support the outstanding work done by the hospital and its exemplary team of physicians and staff. This includes Dr. Hebert’s research, which is instrumental in our continuous pursuit of care improvements that allow patients to positively shape their quality of life,” says Wilson. Funding for CAREN came from the Government of Canada ($1.5 million) and the Government of Alberta ($250,000). Through the Courage Campaign, the Glenrose Rehabilitation Hospital Foundation also raised more than $4.5 million, which led to the 2011 opening of the Building Trades of Alberta Courage Centre and the creation of the Courage In Motion (CIM) Centre, which houses the CAREN system. Alberta Health Services provides the clinicians, facilities and logistical support to ensure the system will reach its full potential. The CAREN at the Glenrose is the result of the hospital’s partnership with the Department of National Defence. It can be used to rehabilitate Canadian Forces personnel and civilians with physical injuries, such as amputations, Parkinson’s disease, stroke, brain injuries, spinal cord injuries and cerebral palsy, as well as psychiatric disorders such as phobias and post-traumatic H stress disorder. ■ Gregory Kennedy is a Senior Writer / Communications Advisor at Alberta Health Services.

taff at the North Bay Regional Health Centre (NBRHC) have been recycling for over a decade-but the hospital’s Go Green Committee knew they could do better. “We were very proud of the fact our hospital has been recycling pretty successfully in most of our departments,” explains Kari Loach, NBRHC’s Go Green Committee Chair. “But we also identified some opportunities to expand our recycling program and include more,” Loach says. NBRHC’s Go Green Committee is a multi-disciplinary committee that meets on a regular basis to identify, evaluate and recommend green/eco-friendly initiatives and improvements for the facility. The committee came up with the idea of a Recycling Matrix to improve recycling at the facility. Loach says the committee recognized that one of the challenges to recycling at work was helping staff understand exactly what could be recycled. “We had to educate people about the everyday items at work that we are capable of recycling–it’s definitely a shift from household recycling. We focused specifically on hospital waste.” The committee created posters using real pictures of everyday items at the hospital that could be recycled, and included information about exceptions and preparation. Loach says members of the committee posted close to 150 copies of the posters in all areas of the hospital, and went unit to unit educating staff. “The feedback we received was great,” she says. “Staff were surprised at the amount of items they were throwing out on a daily basis that could actually be recycled.” Another change around the same time was the shift from small recycling bins on the units to larger ‘totes’. The totes were much larger, and because of an arrangement with the company providing them, staff didn’t need to separate the recyclables. Loach says they trialed these recycling totes in some of the high volume areas and saw incredible results. “Our Renal unit is a real success story. They used to have 14 bags of garbage in a 24 hour period. After introducing the totes, and some education through the Recycling Matrix, they were able to reduce that number to two bags and two large recycling totes in 24 hours,” Loach says. The majority of the recycling on the Renal unit is acid bath jugs that are used on the dialysis machines. The NBRHC Go Green Committee has identified a number of other initiatives they will be working toward in 2014. ■ H Lindsay Smylie Smith is a Public Relations Specialist at The North Bay Regional Health Centre.

The Go Green Committee identifies green initiatives.


Focus 17

St. Mary’s Hospital in British Columbia is one of the greenest hospitals in North America.

St.Mary’s Hospital designed to “cause health” By Tye Farrow

The greenest hospital

Carbon neutral means removing at least as much carbon dioxide from the atmosphere as we put in. This is done by using energy conservation measures that reduce the emission of greenhouse gases from burning oil, coal or gas. In addition to a high-performance building envelope, the project includes 125 boreholes, each 250 feet deep to provide zero-carbon energy for heating and cooling for the building distributed through radiant slabs. A 19-kilowatt photovoltaic array provides electricity, the largest of its type of building in British Columbia. Patients look out over a green roof, which, along with white roofs, reduces solar heat gain. Passive design strategies, such as the use of solar shading and operable windows, allow for natural ventilation. Lighting is equipped with occupancy sensors, and exhaust air recovery ventilation. As a result, the project is on target to achieve a 40per cent energy savings when compared to other LEED Gold certified hospitals. In a study conducted by the Center for Maximum Potential Building Systems reported in Healthcare Design magazine, “the average capital cost green premium for 13 sample hospitals greater than 100,000 square feet…was less than one per cent, while the smaller hospitals reported an average capital cost green premium of 2.1 percent.” The Sechelt donated the land for the hospital nearly 50 years ago on land that was once part of a residential school. It is significant that a place of health has arisen to help people alleviate memories of that bleak era, to see brighter days on the Sunshine Coast. St. Mary’s Hospital, Sechelt, British Columbia, was designed by Farrow Partnership Architects in association with H Perkins+Will Vancouver ■

St. Mary’s Hospital was designed with the goal of becoming the greenest hospital in Canada as well as North America’s first newly built carbon-neutral hospital.

Tye Farrow is a senior partner at the Toronto-based firm Farrow Partnership Architects.


t. Mary’s Hospital, in Sechelt, British Columbia was conceived as a long-term asset to the community in terms of both conservation of resources and its positive effect on patients, staff and families. Arguably the greenest hospital in North America, it raises the bar by becoming a “heath asset” with the power to “cause health.” In recent years, expectations for environmental impact have been reset from passive to active sustainability through the Living Building Challenge. The Challenge initiative promotes design and planning that is net-zero in terms of energy consumption, water and waste production, use of nontoxic, sustainably-sourced materials, as well being as beautiful and inspiring to humans. Emphasis on green issues has thus been expanded to include awareness for how physical surroundings affect our state of mind. Similarly, healthcare is entering an era of greater expectations than merely to “do no harm.” Architects can lead the movement to actively cause health rather than cope with disease through design that makes a holistic, meaningful contribution to people as well as the environment.

A health-centric world view The design approach for St. Mary’s builds on a health-centric view of the world, rather than a disease-centric perspective. The disease-centric view can be defined as focusing on human deficiencies and gaps, which casts patients in the role of passive recipients of services. The health-centric view sees human assets and capabilities – regardless of the patient’s diagnosis – with everyone engaged in leveraging these assets to optimize health. Optimizing health in a hospital setting requires more than a shiny, new facility.

St. Mary’s has indoor porches for patients. St. Mary’s embodies health-centric design with its vibrant space that connects people spiritually and physically. Members of the local Sechelt Indian Band played an important role in the design process by advising on the most meaningful and enduring elements of native tradition to incorporate. The light-filled lobby serves as the new face of St. Mary’s, marking the main entrance and connecting the new and existing portions of the hospital. This space creates a public room and gathering place where community members can socialize as well as discuss their most serious concerns. The lobby area is animated by a spectacular Sechelt Nation mural that spans the entire 70-foot-long lobby. This mural, originally conceived by the design team as an integral element of the hospital experience, was developed and created by First Nation artist Shain Jackson of Spirit

Works Ltd. In addition to on-site respite gardens, patient rooms have large operable windows that maximize spectacular views of the Strait of Georgia. The quality of daylight and views makes people feel better. When you have a long view out, it creates a meditative moment. You can take a breath, look outward to the enduring qualities of nature. The design team set out to reflect indigenous themes and take advantage of the site’s natural beauty. Inspired by the cedar bent-box, which is unique to the coastal First Nations, in this concept it holds our most precious possession – our health.


18 Focus


The grass is green in British Columbia.

Even in winter. By Tasleem Juma


rom winter to summer and back, Fraser Health (FH) was completely carbon neutral in 2012. Fraser Health administers 12 acute care hospitals, has 22,000 staff, and serves a population of 1.6 million across the lower mainland of British Columbia. In addition, the health authority administers 149 buildings, which entail roughly 700,000 square meters of health care related facility space. Fraser Health annually consumes 86 GwH of electricity and 570 GJ of natural gas. All of those facilities, operations, and energy usage have been deemed carbon neutral for three straight years, dating back to 2010. But this story started well before 2010. It was in 2007 that Sustainability Manager, Glen Garrick, envisioned an organizationwide effort to reduce its environmental impact. According to Glen, “I once worked in Africa for a medical NGO. I had an epiphany one day while disposing of medical waste. I realized that we were good at

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helping patients that came in the door but we gave very little, if any thought to the amount of waste and garbage we produced. How this impacted the environment and subsequently human health was given even less consideration. The community around our facilities constantly had power outages but we didn’t give any thought to the amount of energy we would drain from the power grid, much less reducing it.” “Coming to Vancouver and working in healthcare, I realized that was not just a Third World problem. Even here in Canada, we have occasionally sent the wrong waste to the wrong location. With energy usage, we used what we wanted with disregard to concepts like waste, or even the carbon impact it had on the environment. It was then that I committed myself to being a part of the solution and started a program called GreenCare,” Glen adds. It was in 2008 that Sustainability Manager, Ruth Abramson, envisioned direct oneon-one engagement with staff around energy and environmental conservation. She

Glen Garrick i k and d Ruth R th Abramson Ab have h been b working ki g tto reduce d th the carbon, b and environmental footprint of Fraser Health and other British Columbia health care organizations. From these efforts the Green Care Community website was born. devised a program called Green+Leaders to provide staff with direct support in making energy and environmental sustainability changes in their work spaces. In 2010, these Sustainability Managers, along with three Energy Managers, came together under Fraser Health, to establish an Energy and Environmental Sustainability team. This team has been working to reduce the carbon, and environmental footprint of Fraser Health and other British Columbia health care organizations since. “At a high level our strategy is actually pretty simple. We engage staff for behavioural and cultural change, and we work tirelessly to improve the mechanical elements in our facilities to be as energy efficient as possible. However, in the end, no organization the size of ours is going to be carbon neutral on its own,” explains Glen. Thus was born the online “GreenCare Community” website. The site would enable leaders to reach out to all internal and external stakeholders in energy and environmental sustainability. Internally over 3,700 employees have registered to be a part of the community. They’ve formed groups around “Energy Conservation”, “Walk, Bike, Ride”, “Healthy Land and Food”, “Recycling Renewal”, and even a group on designing facilities, called “LEED” (Leadership in Energy and Environmental Design) and “LBC” (Living Building Challenge). Within these groups, staff collaborate, share, and take away best practices and solutions to improve health care’s energy and environmental sustainability. The Energy Conservation group is run by the Energy Management team. Beyond the social engagement with staff around behavioural change, mechanically, the Fraser Health Energy Management team has been able to reduce Fraser Health’s energy consumption by six per cent since 2009/2010. This has been accomplished through lighting retrofits, lighting control

upgrades, boiler upgrades, kitchen appliance upgrades, and much more. The GreenCare Community also reaches out to external stakeholders. It provides valuable insight into their team’s strategic framework, programs, and resources. According to Glen, “The utilities out here are a fantastic support. BC Hydro has offered us a lot of resources and funding for energy improvements. FortisBC, our natural gas supplier, has also offered us support and funding, which included the funds to build the GreenCare Community website. Without them, we simply wouldn’t have that level of social engagement.” Other key stakeholders noted by Glen were Sodexo, Aramark, TransLink and the HUB. “It’s about being financial, health, social and environmental stewards. We’ll always work hard to reduce our carbon footprint but in the areas where it’s impossible to zero that footprint through conservation and reduction, we’ll take steps to offset that footprint through the investment in alternative power such as solar and geo-exchange, the purchase of green power from wind turbines in northern BC, and the purchase of carbon offsets when necessary,” says Glen. The health care sector faces a lot of challenges with improving services while reducing costs. In a lot of cases, taking responsibility for environmental stewardship is an after-thought or lost in internal challenges with time and funding. Fraser Health’s Energy and Environmental Sustainability team is proving that through collaborations and commitments, the grass of environmental stewardship can be just as green in winter as it is in the summer. For more information on the GreenCare Community and the work being done by Fraser Health and its health care partners across British Columbia visit www.bcgreenH ■ *with files from Glen Garrick Tasleem Juma is a Senior Consultant, Public Affairs at Fraser Health.

Focus 19


Your EMR is in place–now what? By: Dr. Chris Hobson


he health care system is constantly changing and at present, health information technology solutions are at the heart of a major shift in Canada. The use of an electronic medical record (EMR) is no longer a new concept; it has made its mark on our health care system and is now an essential part of the day-to-day life of clinicians. Advanced EMR platforms have led to improved care and facilitated the shift from an acute care focus to a patientcentric model. Now that many of the technology systems are in place there are steps our health care leaders should be taking to make the most of their EMR investments. A fundamental goal of health care system reform is to have a fully integrated and connected system. Continuity of information across settings is a critical component to support that goal and forms the basis of most e-Health strategic plans in Canada. Two out of five Canadians have at least one chronic disease and this issue comes at a cost of $68 billion a year in health care spending. The need for easily accessible complete information including an up-

to-date care plan, problem list and medication list wherever the patient is seen is key to improving the management of any chronic condition. When empowered with such complete patient information, health care professionals are able to avoid duplication of services, improve patient safety and control costs while at the same time ensuring patients receive the best evidence-based coordinated care. Health care practitioners across all points of care such as acute, community, long-term and palliative care all need to be able to access accurate, trustworthy, complete patient information seamlessly. When we consider where we’re headed in the EMR arena, integration and care coordination could be the most valuable operational areas for the Canadian health care system.

Achieving provincial EHR success In some provinces, such as Alberta, Saskatchewan, New Brunswick and Newfoundland and Labrador, province-wide EHR solutions are currently implemented

to connect software such as EMRs, lab and radiology systems and patient portals. With that said there are still a few provinces that have yet to take steps in this direction. The hesitation likely stems from a number of challenges. For one, physicians across Canada have different backgrounds and varying levels of experience with complex technology, and not everyone is on board with the aims and objectives of using EMRs or EHRs. To change this mindset, the value of the technology derived by other clinicians in similar settings must be articulated. Second, to reduce the initial technical and cost barriers to EMR adoption, there are simple technology solutions such as the web-based EMR “lite” that integrates and leverages existing provincial EHR captured information. Continued on page 38

Dr. Chris Hobson

NOMINATE A NURSING HERO! Hospital News’ 9th Annual Nursing Hero Awards COMMITMENT  DEDICATION COMPASSION  LEADERSHIP Look around you. Have you been inspired, encouraged or empowered by an employee or a colleague? Have you or your loved one been touched by the care and compassion of an outstanding nurse? Do you know a nurse who has gone above and beyond the call of duty? Now is your chance to acknowledge and recognize the nursing heroes in your facility or community. Hospital News will once again salute nursing heroes through our annual National Nursing Week (May 12th to 18th) contest. We hope you will share your stories with us so that we can highlight the exceptional work that our nurses are doing and how they touch our lives. Nominations can be submitted by patients or patients’ family members, colleagues or managers. Please submit by April 15th and make sure that your entry contains the following information:  Full name of the nurse  Facility where he/she worked at the time  Your contact information  Your nursing hero story

nual 9th AnSING UR


Please email submissions to or mail to: Hospital News, 610 Applewood Crescent, Suite 401 Vaughan, ON, L4K 0E3




20 Focus


An innovative continence care solution technology electronically tracks voiding pattern data into actionable, evidence-based reports.

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Innovative technology provides evidence-based continence planning By Barb Tate


roviding residents with the highest quality of care and managing the many competing priorities that make up the daily routine can challenge even the most seasoned caregivers. Most will attest to the fact that traditional methods for continence management can be time-consuming and due to their manual nature may not be carried out consistently. The team of researchers at SCA, the maker of TENA personal care products, have dedicated over three years to the design, testing and introduction into the market of TENA Identifi, an innovative continence care solution technology that represents a shift in continence care planning and resident care in both acute and long-term-care facilities across Canada and around the globe. It integrates an innovative logging device with TENA Identifi’s Sensor Wear to electronically track voiding patterns in real-time, graphically converting voiding pattern data into actionable, evidencebased reports. TENA Identifi is a first for our industry and it marks a revolution in how caregivers are able to deliver improved quality of life for residents. Breakthroughs in continence planning are made possible through advances in technology and access to uncompromised research data. Over a 72-hour assessment period, highly absorbent TENA Identifi Sensor Wear replaces traditional continence protection. These disposable products measure urine voids through safely integrated thin, thread-like sensors. A silent, reusable TENA Identifi logger attached to the Sensor Wear measures the voiding volume at each product change, providing a good base for the most appropriate product selection based on individualized needs. The information is automatically transmitted to a private, secure server where it is automatically converted into a voiding assessment report, establishing a pattern and identifying the individual’s unique needs, without relying upon manual recordings. In a busy environment, manual data en-

try tracking can be challenging. This tool provides caregivers with an individualized assessment that is more accurate than what they currently rely upon. The most innovative products are those that reduce time from a caregiver’s maxed out routine, are easy to incorporate into that routine and eliminate the guess work. The voiding assessment report is easy to use and helps caregivers select toileting times and choose the right products based on absorbency to prevent leakage and potential skin irritation– which means increased dignity and comfort for the individual. A product is only as successful as the reviews it gets when put to the test in a reallife setting. In recently conducted trials, the product tested well and feedback was positive. Undertaken in two Ontario longterm-care facilities, professional caregivers had the opportunity to observe resident care outcomes after temporarily integrating the new system into their continence assessment procedures. The results of the trials confirmed that the TENA Identifi system is comfortable and easily integrated into care routines without any disruption. Apart from improving the resident’s quality of care and continence planning, directors of care at participating facilities also indicated staff morale increased with exposure to the new system. Health care professionals indicated that the tool empowered them to make decisions with more authority and confidence and provided them with a resource to do their job more effectively. Continence care planning need not be a challenging or complicated process for either the individual or the caregiver. With access to the most innovative products currently available, there is an increased opportunity for caregivers to greatly improve the care they provide, as well as facilitate the critical work of caregivers in both acute and long-term-care facilities H across Canada. ■ Barb Tate is Vice President, Sales for SCA in Canada.

Focus 21


Building a hospital through the eyes of a patient By Catalina Guran

Stage 3 of the Mackenzie Vaughan Hospital Projects will be completed in 2014. Construction is expected to begin in 2015 and the hospital is on target to open to care for patients and families in 2019.


n 2019, residents of Southwest York Region will have a new hospital, the first to be built in the area in 50 years. The new hospital will be designed through a very unique perspective-it will be a hospital designed through the eyes of the patient. With five years until the expected opening, Mackenzie Health has launched a comprehensive strategy to create a patientcentered organization that will also create a world-class health experience at both Mackenzie Richmond Hill Hospital and the future Mackenzie Vaughan Hospital.

Lean thinking For the past four years, Mackenzie Health has been on a Lean transformation journey. The transformation strategy has a major focus on long-term sustainability, building process improvement capacity using a Lean philosophy and implementing Lean methodology in target areas. “Lean thinking” has been instrumental in achieving strategic improvements in the areas of quality, cost, access and patient satisfaction. This experience has proven to be highly valuable in improving care and efficiency of current operations, and equally valuable in the planning of the new Mackenzie Vaughan Hospital. The Lean-led approach to the facility design is based on the following core principles: • Design based on the voice of the patients, staff and organization; • Engage and empower those who work in the processes to redesign their work flows and participate in all user groups; • Design work processes that ensure safety and quality and support access to care; and • Determine work processes based on the Eight Flows of Healthcare.

Focusing on the patient In support of the Lean-led design, Mackenzie Health completed a detailed process design from the perspective of the patient during the summer of 2013. The work began using a 2P (process preparation) approach. This meant bringing together staff who “touch the work,” leaders, patients and their families to collaborate on the best way to deliver health care services in the future. Feedback from patients and families helped the team confirm the Patient Hierarchy of Needs, which includes the following: Safety; Quality of Care; Access to Care; Respect and Empathy; Privacy/Confidentiality; and Communication. These criteria then drove the development of the Patient Journeys 1. Obstetrics 2. Emergency 3. Outpatient Surgery/Procedure 4. Inpatient Surgery 5. Inpatient Medicine 6. Critical Care 7. Pediatrics 8. Mental Health

During 2P sessions, Mackenzie Health inter-professional teams work collaboratively to develop the best way to deliver health care services in the future. future design to deliver the best possible care and patient experience. The Mackenzie Health Process Improvement team led the organization through eight different patient journeys in separate 2P events. By the end of each event, each team created a detailed patient journey optimized for patient safety, quality of care and patient experience. When the Planning, Design and Compliance (PDC) team joined the project in the Fall of 2013, they participated in follow-up events with the staff for each of the eight 2P Patient Journeys. These oneday events reviewed the optimized patient flow processes, as well as the design of the micro-environment (i.e. space where care is delivered) and the macro-environment (i.e. space immediately connected that supports the micro-environment such as storage and retrieval of supplies, equipment and communication devices).

Patient-centered hospital The Mackenzie Health team’s experience, knowledge and input align with significant consultations with its community and have been key to the design process. With input from hundreds of staff, physicians and thousands of community members, Mackenzie Health’s Project Team and external consultants are working to create the “Project Specific Output Specifications” (PSOS). These specifications will describe the standards and the performance requirements to which the new hospital will be built and operate. Through investigation of best practices, learnings from recent development projects, expert advice, internal discussions and initiatives, Mackenzie Health has developed a framework to guide the development and implementation of Mackenzie Vaughan Hospital. The intent of the framework is to provide the structure to support the project vision of creating a facility that supports exceptional quality of care, personalized and compassionate service, coordinated, timely and efficient access to services.

Creating a world-class health experience To meet the growing health care needs of the people of Richmond Hill, Vaughan and surrounding communities, and to realize its vision ‘to create a world-class health care experience,’ Mackenzie Health has designed an exciting new two-hospital model of care. This includes the contin-

ued enhancement of services at Mackenzie Richmond Hill Hospital and the building of the future Mackenzie Vaughan Hospital. It also includes a comprehensive network of community-based services across Southwest York Region and beyond. Planning for the enhancement and expansion of services, including the building of the new Mackenzie Vaughan Hospital, began in 2009 and will continue through to the opening of the new hospital in 2019. With an official project approval provided by the Ministry of Health and Long-Term Care in 2011, the project has a government funding commitment of $58 million to complete the planning and tendering process. For more information on Mackenzie Health and the Mackenzie Vaughan Hospital project, please visit www.mackenH ■ Catalina Guran is a Communications and Public Affairs Consultant at Mackenzie Health.

The Eight (8) Flows of Healthcare: 1. Flow of Patients: Focus on the patient experience and bring services to the patient to minimize patient waiting and walking. 2. Flow of Visitors: Eliminate unnecessary walking, asking and searching for visitors. 3. Flow of Providers: Ensure the right person with the right skills is doing the right task at the right time, and that staff spend as much of their time as possible with their patients by reducing unnecessary activities. 4. Flow of Medications: Medications should be located as close to the patient as possible. 5. Flow of Supplies: The most frequently used supplies should be located as close to the patient as possible. 6. Flow of Information: Handle information only once, with one way to request and receive it. 7. Flow of Equipment: Store equipment as close to the patient as possible, and portable equipment should be considered to promote flexibility and efficiency. 8. Flow of Continuous Improvement: Space and equipment should be flexible to changes in demand, patient type and process design.

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22 Focus


Commitment to patient and planet centred care Volunteer stewards help develop the garden from seed and maintain the garden as it grows. The harvest is used in the ELLICSR kitchen to teach cancer survivors how to cook healthy meals.

By Lisa Vanlint


niversity Health Network has been proudly green for almost 15 years. Led by the Energy and Environment department, we breathe life into the motto "UHN: Committed to Patient and Planet Centered Care". We've won awards for our groundbreaking programs, including two at OHA HealthAchieve Green Health Care Awards in both the Energy and Water categories. We put concern for the environment right into how we care for and treat patients. Here's just some of what we do: Energy Awareness Program – With our TLC – Care to Conserve energy management program, UHN combines raising awareness, changing behaviors and installing more efficient equipment to save energy. Projects include LED lights, energy efficient chillers, a cool roof and a green roof. Our most important element is staff uptake, with over 100 volunteer energy experts spreading energy efficient words and actions. Green Team – With only six staff to help 15,000 colleagues, we would be nowhere without our Green Team. Well over 600 dedicated staff volunteer a little time to help green their departments. Departments with green teams recycle better, conserve more energy and have fun doing it! Medical Equipment Donations – Working with Operation Green and other

KDC – The Krembil Discovery Tower, a world-class research centre, was built with Leadership in Energy and Environmental Design (LEED) Certification Standards in mind. LEED is the gold standard in measuring human and environmental health.

UHN's Energy & EnvironmentTeam(l-r): Songyang Hu, Chad Berndt, Lisa Vanlint, Kady Cowan, Ed Rubinstein, Mike Kurz organizations, we collect surplus medical equipment and supplies to give to developing communities that need them. Recycling & Composting – We have a long running and successful recycling and composting program that saves over a third of our waste from landfill. And with separated recycling, like paper/cardboard vs. cans/bottles, we save money too. That's green environmentally and financially. eWaste – In healthcare and everywhere, we're seeing more electronic waste like computers, medical equipment, printers, toner and batteries. We have several programs to recycle it ethically, so that future generations aren't stepping over a mountain of old cartridges.

Clean commuting – UHN's staff is a small city in itself, with around 15,000 staff. More than 2,500 of our people use the TTC VIP program. The Bicycle User Group, plus our many bike parking zones, all encourage our 1,500 cyclists. And our carpool-matching program connects staff to share a ride. Green Cleaning and Maintenance Products – UHN uses more and more ecocertified green alternative, which helps protect our staff, patients and visitors from toxic chemicals. UHN Food Garden – A groundbreaking (pun intended) 'Seed to Feed' experience for UHN staff and members of the cancer survivorship programs at ELLICSR.

NATIONAL NURSING WEEK 9th Annual Supplement The May 2014 issue of Hospital News will be celebrating National Nursing Week in Canada (May 12th – 18th) with a special pull-out feature showcasing our “Nursing Heroes” contest winners as well as highlighting outstanding leadership and stories from the nursing frontlines!

ADVERTISERS: Don’t miss this opportunity to celebrate and acknowledge the outstanding contributions of our hard working nurses with your own THANK YOU ad!

Talkin' Trash with UHN – Our blog featuring free-range, organic ideas from around UHN http://talkintrashwithuhn. com/. We now get social on Twitter & Facebook too. All of these programs and projects are possible because UHN invests the resources to make it so. In turn, the Energy & Environment programs make UHN more efficient, saving far more resources. Starting with Ed Rubinstein, our Manager, our team has grown from 1 person to 6 in the last 15 years. We bring a lot to the table for our 15,000 colleagues. Energy project managers work with specific sites to make our buildings more efficient behind the scenes. Energy stewards work with staff in front of the scenes to educate and help positive behavior changes. From top down to bottom up, all 15,000 of us work towards a H common green goal. ■ Lisa Vanlint is an Energy Steward at University Health Network in Toronto.


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Nursing Pulse 23

The body mechanic By Kimberley Kearsey


anet Klok’s experience with back injury is probably more extreme than most nurses will ever face. She’s experienced bullying, fights with the Workplace Safety and Insurance Board (WSIB), two lay-off notices, and arbitration through her union. Her story may not reflect the norm, but it’s one that illustrates just how much your life can change when you twist awkwardly to help a patient. It was a Sunday at 4 a.m. on the neurosurgical floor of the hospital where Klok was filling in as a member of the float team. As the veteran RN (with 20 years of experience) finished up her rounds, she heard an unusual sound down the hall. She entered a room where she found a woman, groggy from her meds, grasping her walker and heading for the bathroom. As Klok stood at the foot of the bed, she noticed the woman attempting to squat to relieve herself. She grabbed her by the arm to pull her back up. “I’ve turned a 500-pound patient by myself, so I know how to move,” Klok says, adding the woman began pulling in the opposite direction. “She just caught me off guard.” Klok twisted to reach the call bell, a motion that strained her neck and injured her lower back in one fell swoop. She struggled to hold the woman up for at least five minutes, waiting for colleagues to arrive. The now 51-year-old mother of four knows that’s what did her in. Four years after that injury, WSIB has now deemed Klok’s neck a permanent impairment. She’s still fighting to have her lower back injury recognized as equally problematic.

Although research points to a need for better policies to protect nurses from back injury, the onus is often on RNs to watch their everyday movements and motions that may lead to long-term pain. “I was not going to go to emerg,” she recalls of that night in 2009. Her colleagues convinced her to have the injury checked out, and she says “it’s been a nightmare ever since.” That’s primarily because she feels she’s had very little support from her employer, and suffered severe stress as a result of bullying by a manager at work. Klok was on sick leave immediately following the injury, then stress leave a few months later. She was laid off during her stress leave, and only this September resumed her role thanks to help from her union. “I didn’t do anything wrong,” she says. “I did my job and got hurt…and I didn’t deserve to be treated the way I was treated.” Klok admits she knew nothing about her rights when she injured her back. And she’s not alone. “I’ve actually become a bit of an advocate and resource for other nurses who are injured and have no idea what to do,” she says. Klok is currently doing her

Ono was a new grad working in acute care when she first hurt her back in the 60s. Young and naïve, she entered a patient’s room and decided not to turn on the light and wake the gentleman in bed. She went to pull a lever to adjust his position, and yanked the wrong one, pulling her back out instead. She continued to work, and when a large gentleman later grabbed her arm to pull himself up, she collapsed on the floor and couldn’t stand up. Ono believes the onus is on the nurse “…to think all the time.” The first question she asks herself in any situation is ‘how am I going to do this with the least amount of stress on my back?’ “I used to have a head nurse who would say, ‘if you think with your head, you’ll save your feet,’” Ono recalls. She’s altered that motto: “If you think with your head, you will H save your back.” ■ master’s degree, and suggests the lack of knowledge among nurses could stem from the lack of research on the subject. One comprehensive study that looked at the issue is the now eight-year-old National Survey of the Work and Health of Nurses. Conducted by Statistics Canada in 2005-2006, it found one in 10 nurses reported occasional or frequent injury on the job in the year before the survey. And about 37 per cent reported they had experienced pain serious enough to prevent them from carrying out their normal daily activities. A more recent systematic review of 89 existing studies on the correlation between nursing and lower back pain, conducted by nursing researchers at the University of British Columbia and published in the International Journal of Occupational and Environmental Health (September 2013), found a clear link between nursing duties and lower back pain. That link is sufficient scientific justification for reversing the burden of proof placed on injured nurses, researchers wrote, suggesting “…sufficient evidence exists … to warrant new policies.” Although these are important research findings, they don’t quite get to the heart of what Klok and others suggest is a bigger issue: an acceptance of back injury as commonplace in the profession. Klok considered simply working through her pain, and says many of her colleagues would do the same. She wonders if that attitude can be linked back to nurses’ training days, and the implied message she remembers from nursing school: if you’re injured, “suck it up.” That message to students may not be as prevalent today, thanks in part to educators like Anne Marie Lozinski, a clinical tutor at McMaster University in Hamilton who teaches good body mechanics (proper body movement that helps to prevent injury). Lozinski, who sustained a back injury in 2004, admits that injury is sometimes not preventable, because it’s an unexpected movement on the part of the patient. But, more often, it’s about understanding patients’ limitations. “You can underestimate how much assistance they need,” she explains. If colleagues are busy, “…You think ‘I can do

it myself,’ and then…you’re stuck, holding someone who’s not able to bear their weight.” Lozinski admits that when she injured her back, she had just come off an evening shift, and returned to work for a day shift less than eight hours later. She says the muscles that should have engaged to protect her back were fatigued from overuse and lack of rest. York region public health RN Patricia

Kimberley Kearsey is managing editor for the Registered Nurses’ Association of Ontario (RNAO), which represents registered nurses wherever they practise in Ontario. Since 1925, it has advocated for healthy public policy, promoted excellence in nursing practice, increased nurses' contribution to shaping the health-care system, and influenced decisions that affect nurses and the public they serve. To find out more about the association’s work, visit


24 Focus


High-rise research lab will promote discoveries in

children’s health By Donald Schmitt


here are not many medical research facilities in the world that reach upwards for excellence. The vital work of finding better outcomes for children's health is often performed in buildings where labs are dark and outmoded. If a research building could inspire and energize research activity, if labs can be flexible to adapt to needs as yet unknown, if collaborative space can facilitate interdisciplinary exchange-could medical discovery be made more effective? This is what The Hospital for Sick Children sought for the new Peter Gilgan Centre for Research and Learning.

At 21 stories, this highrise lab is the largest child health research tower in the world and among the largest laboratories in the high-rise form. The hospital’s 2000 research and support staff had previously been dispersed across six buildings in downtown Toronto. To bring them together for the first time represented an opportunity to create a collaborative environment as well as heighten public awareness with a new gateway building to the SickKids campus. An integrated team of architects, engineers and, most importantly, the SickKids research group led by Dr. Janet Rossant realized this vision. At 21 stories, this high-rise lab is the largest child health research tower in the world and among the largest laboratories in the high-rise form. Labs are complex structures that require elaborate mechanical systems for air exchange, fume-hood venting, and contaminant-free environments. Design solutions were interwoven with a mandate to make this building highly sustainable and energy efficient. To overcome the silo culture inherent in

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An interior shot of the high-rise research lab. the elevator connections of tall buildings, the research floors are clustered around six neighbourhoods where principal investigators and their research teams from various disciplines work side by side. Each neighbourhood is formed by two-and three-storey open and collegial collaborative spaces. These striking curvilinear forms extend like bay windows beyond the building and have low iron glass to achieve a crystalline transparency from the street and offer extraordinary views of the skyline. Connected by stairs, these working lounges have kitchenettes and white boards and serve as gathering points where scientists, clinicians and students can share information and fuel innovation. Our design of the labs is configured for maximum flexibility to accommodate diverse research needs now and in the future. Modular mobile benching converts from wet lab to dry lab as research demand requires. Support spaces are located in the core for permanent facilities such as lab sinks and fume-hoods, freeing up the open floor space and perimeter for a light-filled work environment. Dr. Rossant puts this collaborative workspace in perspective. “Scientists and researchers from different disciplines who normally wouldn’t rub shoulders can now interact. Not only will cell biologists, computer scientists and geneticists work side by side in the labs, researchers will also meet over coffee in the neighbourhoods’ open, light-filled atriums. Those spontane-

ous meetings present incredible opportunities to share information and promote new discoveries in children’s health.” An abundance of natural daylight is just one element that puts this green laboratory on track for LEED Gold certification for sustainable design. Fully 80 per cent of the tower’s high performance glazed enclosure is covered in a horizontal graduated ceramic frit for thermal control that maximizes daylight harvesting. Natural light penetrates to over 90 per cent of the program areas. The subtle colour palette of the building’s glass spandrel creates a signature identity for the Hospital on the city skyline. The first three floors of The Gilgan Centre house the Learning Institute with conference and education facilities. Stateof-the-art teleconferencing and distance learning technologies allow information exchange to connect across the SickKids campus and around the world. The concourse is publically accessible and has a smart auditorium that seats 250 people. A pedestrian link connects The Gilgan Centre with the Elizabeth St. wing of the Hospital. The highly visible Learning Institute serves to connect the Hospital and its research activity with the city. It demystifies research into children’s health by putting education and collaboration on view. The building itself, which was funded in large part by the generous support of donors and which was completed nine per cent under budget, reinforces the Hospi-

tal’s important role. “Discoveries made here will impact not just SickKids patients and families, but child health locally, nationally and around the world,” adds H Dr. Rossant. ■ Donald Schmitt is Principal, Diamond Schmitt Architects.

The new Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children.


Focus 25

Outlook is sunny for cloud in healthcare By Aldo Gallone


ealthcare is all about harnessing information to make the best medical decisions for patients. What are the symptoms? What does the latest medical literature tell us about a patientâ&#x20AC;&#x2122;s condition and treatment options? What have other patients responded to? Those questions can only be answered provided todayâ&#x20AC;&#x2122;s health care professionals have immediate access to information, when and where they need it. Enter cloud computing, a means to access information and software applications from remote data centres via the Internet, rather than directly from an onsite computer or mainframe. Increasingly, clinicians are leveraging cloud computing technology â&#x20AC;&#x201C; often from mobile devices â&#x20AC;&#x201C; as a means to quickly access and share data and knowledge. Boston Childrenâ&#x20AC;&#x2122;s Hospital provides the most recent example, as the pediatric medical centre recently announced the worldâ&#x20AC;&#x2122;s first Cloud-based global education technology platform, OPENPediatrics, to transform how pediatric medicine is taught and practiced around the world. OPENPediatrics will improve the exchange of medical knowledge on the care of critically ill children no matter where they live, and help train medical professionals by using an interactive, digital and social learning experience, with content provided by Boston Childrenâ&#x20AC;&#x2122;s Hospital and other international expert clinicians.

a strategic and tactical enabler for timely and effective IT enabled health services for Canadians. They also see the operational efficiencies gained as having financial gains that can be directly applied to front line clinical service delivery. The report quotes Infowayâ&#x20AC;&#x2122;s lead consulting firm Booze Allan as estimating â&#x20AC;&#x153;cost savings for operating a government services data centre in the Cloud was as much as two-thirds lower than maintaining a traditional in-house data centre.â&#x20AC;? The report goes on to say â&#x20AC;&#x153;the health care sector in Canada should give serious consideration to the use of cloud technologies and deployment models for the delivery of their health IT systems.â&#x20AC;?

Much of Cloudâ&#x20AC;&#x2122;s value proposition is derived from the fact that in healthcare, two other technological trends intersect with Cloud. The first is mobility. Doctors and nurses can use smart phones and tablets at a patientâ&#x20AC;&#x2122;s bedside much more easily than they can use a laptop on a cart. And, applications that simplify medical tasks like writing prescriptions can connect with cloud-based electronic health records to alert doctors when a new prescription interacts with an existing medication. The second intersecting technology trend is â&#x20AC;&#x153;Big Dataâ&#x20AC;? analytics, which involves leveraging advanced computing power to make sense of massive amounts of health care data with such precision that

individualized treatments are determined based on a patientâ&#x20AC;&#x2122;s specific symptoms, medical history and genetic profile. With an aging population and mounting pressure to improve quality outcomes for patients, itâ&#x20AC;&#x2122;s increasingly imperative for health care providers to uncover the information and evidence they need, when they need it, to deliver cost-effective and quality care. Whether at a patientâ&#x20AC;&#x2122;s bedside or giving advice from across the globe, doctors need to be able to unlock the power of information in life-or-death decisions, and Cloud technology is a key enabler to make H that happen. â&#x2013; Aldo Gallone is the Director of Cloud Computing at IBM Canada.

â&#x20AC;&#x153; Focus on the things you can do, not ZKDW\RXFDQĂ&#x2013;WDQG\RXZLOOĂ&#x;QG just like I did, that life is fantastic.â&#x20AC;? â&#x20AC;&#x201C; Danny McCoy

The health care sector in Canada should give serious consideration to the use of cloud technologies Medical personnel in 74 countries around the world are using the platform to access simulations, video seminars and illustrations to, for example, learn how to use a pediatric ventilator. The benefit of Cloud, particularly in under-developed nations, is that it overcomes the need to invest in or build technology infrastructure. But the benefits of Cloud are not limited to under-developed nations. In the US, the University of Pittsburgh Medical Center uses private cloud technology to store patient information more efficiently, process all the information in a patientâ&#x20AC;&#x2122;s medical records and images and better tailor treatments for each patient. Their cloud-based system enables doctors to compare symptoms to case studies of previous patients, which may result in two different courses of treatment for two patients of the same diagnosis. Similarly, oncologists at New Yorkâ&#x20AC;&#x2122;s Memorial Sloan-Kettering Cancer Center are accessing information delivered via the cloud on mobile devices to help design treatment plans for cancer patients. MSK oncologists located anywhere can remotely access detailed information about treatment options based on continuously updated research-information that will help them decide how best to care for an individual patient. Here at home, the promise of cloud is well-documented. Canada Health Infoway released a position paper in October 2012 detailing how leaders see Cloud as

Danny McCoy was rendered a paraplegic in a terrible car accident at the age of 43. Before the accident he was an avid sailor. After the accident, Danny became one of the top ranked competitive disabled sailors in the world. Heâ&#x20AC;&#x2122;s also the founder of the Disabled Sailing Association of Ontario and one of the sportâ&#x20AC;&#x2122;s foremost international ambassadors. Thomson, Rogers is a proud supporter of The Disabled Sailing Association of Ontario. We are honoured to have represented Danny McCoy in his lawsuit and to count Danny as a friend and one of the many everyday heroes we have been able to help.

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26 Focus


Greening healthcare: How one hospital is making sustainability a top priority By Sabrina Jeria


ealth and the environment are closely connected: you cannot have healthy people without a healthy environment. There are hundreds of hospitals in Ontario, all of which consume significant amounts of energy, create waste and emit various pollutants. To protect the environment and the health of the province’s citizens, the health care sector needs to incorporate more environmentally-friendly practices into the delivery of care. One organization that has demonstrated its commitment to being a responsible corporate citizen is Runnymede Healthcare Centre. In April 2012, the hospital became a member of Greening Health Care. This innovative, federal program supports health care facilities working together to lower energy costs and raise environmental performance, while improving patient care. Since joining the program, Runnymede has made numerous operational changes to its 180,000 square foot, 200-bed facility. In particular, the hospital has come up with inventive and cost-effective solutions to better manage waste, reduce energy use and conserve water.

Waste management In November 2012, the hospital launched Runnymede Recycles to better manage waste and divert recyclables from landfills. To encourage on-site participation, recycling stations comprised of 3-stream receptacles that separate general waste from paper, cans and bottles were placed on every floor of the hospital and in the cafeteria. But since you can recycle more than just paper and plastic, Runnymede went on to collaborate with its vendors and began recycling batteries through Stericycle, wooden skids through Pallet Canada and grease through Rothsay, all of which contributes to environmental preservation by providing a safe disposal alternative to landfills and incineration. Further, the hospital purchases ecofriendly products, such as refillable wipes, recycled paper, and reusable microfiber cloths and mops that have reduced chemical use by 92 per cent. To date, Runnymede has achieved a 72 per cent capture rate of recyclables and diverted over 11 metric


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(l-r) Freudenberg Filtration Technologies’ Peter Graham and Kevin Leach present the 2013 NAFA Clean Air Award to Runnymede Healthcare Centre’s Archie Arshad and Connie Dejak. tonnes of waste from landfills. This is equal to saving 210 trees and 39 cubic metres of landfill space.

Energy reduction To maximize energy use at the facility, a number of feasible no-cost and low-cost solutions were implemented. From something as simple as replacing fluorescent light bulbs with LED lights equipped with motion sensor technology, the hospital has seen significant energy and cost savings. Fan system schedules were adjusted to align with occupancy times in offices and patient rooms, which resulted in a savings of nearly

60,000 kWh of energy. Pressures on the steam system were also adjusted, leading to a savings of approximately $3,000/year in gas, and space temperatures were increased from 13 to 18-degrees Celsius, lowering the hospital’s gas use by 18.2 per cent in 2012 from the previous year. To remain fiscally responsible, when it comes to higher cost projects, the hospital continues to focus on those that yield a return on investment in less than three years. For instance, Runnymede spent $25,000 on an air conditioning optimization initiative that provided a $20,000 incentive cheque from Toronto Hydro for making the

improvement. This enables the hospital to not only conserve energy, but also save money that can be reinvested in patient care. An ongoing partnership with a Toronto Hydro Roving Energy Manager ensures Runnymede will continue to manage energy use and cut costs in years to come. Through big changes, small tweaks, education and leadership, Runnymede has lessened its environmental impact, cut operating costs and improved the health of the community. The hospital’s green efforts were recently celebrated with a number of awards. In May 2013, Runnymede received the Greening Health Care 5% Club Award from the Toronto and Region Conservation Authority for lowering total energy use by more than 5 per cent. In September 2013, the hospital became one of only 29 organizations in North America to receive the National Air Filtration Association (NAFA) Clean Air Award for demonstrating air filtration and maintenance best practices. Additionally, the hospital received incentive cheques from Enbridge for gas savings and from Toronto Hydro for saving over 34,000 kWh of electricity during the last fiscal year as part of the Ontario Power Authority’s saveONenergy program. Runnymede was also named one of five finalists for the Ontario Hospital Association’s (OHA) Green Hospital of the Year Award that recognizes hospitals that demonstrate excellence in reducing the impact the health care industry has on the H environment. ■ Sabrina Jeria is a Communications Associate at Runnymede Healthcare Centre.

Innovative St. Joe’s physician ramping up hospital recycling efforts By Lauren Pelley


typical surgery produces lots of bags, filled with everything from gloves to plastic packaging to a separate bag stream of biohazardous waste. Most of the general garbage produced by hospital operating rooms heads to landfills, but one Toronto physician is striving to change that. “You have to protect the earth for our future generations,” says Dr. Ali Abbass, an anesthesiologist who introduced a new recycling program at St. Joseph’s Health Centre with the goal of making a difference locally within the communities we serve. His first simple but effective idea – going from clear to blue bags for recyclable materials – is already making a difference in boosting operating room recycling efforts. Now, this innovative physician is tackling an even bigger challenge: recycling medical Polyvinyl chloride (PVC) such as intravenous bags and oxygen delivery devices, (masks and nasal prongs). PVC, is a common, recyclable plastic used in various materials from sewage piping to clothing. Typically, medical PVC is sent to the landfill, but Dr. Abbass’ plan aims to recycle it instead.

Dr. Ali Abbass, an anesthesiologist from St. Joseph’s Health Centre, Toronto introduced a new recycling program. “In my opinion, Dr. Abbass' effort in finding solutions to reduce the damage done to the environment in the course of providing care to patients embodies the innovative spirit at St. Joe’s,” says Ruby Brown, Interim Vice President of

Transition & Support Services. “With support from hospital staff and vendors, the disposed PVC bags gathered at St. Joe’s will be used to manufacture auto parts.” Continued on page 28

From the CEO's Desk 27

Delivering the future – Bruyère is There By Bernie Blais


s the CEO of one of Canada’s largest health care organizations of its kind, the opportunity to lead Bruyère Continuing Care and make a difference in the lives of our aging Canadians, is one of the most important and impactful elements of my entire career. The Sisters of Charity left us a strong legacy of caring, compassion and social justice for those most in need. As the champion of aging Canadians and those requiring continuing care, it’s clear what our mission is. Bruyère is a Catholic academic continuing care organization committed to improving the quality of life and independence of our patients, residents, tenants and clients. I intend on continuing to steer our organization in the direction always intended by our founder, Mother Élisabeth Bruyère.

Being in service to others means having a greater awareness of our responsibility to stretch our social conscience As you know, the most dramatic population shift in Canada’s history has just begun. Experts all agree that the current health care system needs to be recalibrated to ensure that everyone receives the right care, at the right place, at the right time. Serving this demographic is our passion and our commitment for over 167 years. During this time, we have evolved to meet the needs of the seniors in the community, and in 2013-14 we continued to evolve once again. Enter the Bruyère Village and the Ruddy-Shenkman Hospice. The Bruyère Village innovation provides seniors with a continuum of housing and services along the banks of the Ottawa River and is focused on creating a community within a community. Divided into independent and assisted-living phases, this unique living arrangement was not possible without the help of multiple partners. There is an urgent need for hospice palliative care beds in Ottawa. In response to this, John Ruddy and William Shenkman made a collective $1million donation towards the build of a 10-bed residential hospice. This is the largest private donation to a hospice in Ottawa and among the largest donations ever made to hospice in Canadian history. Bruyere is helping to lead a partnership with the Hospice Care Ottawa team to make this dream a reality. Although we are not directly responsible for this service, we believe that we are socially responsible to help build a better continuum of care to serve our community’s needs.

Bruyère also recognizes that technology is transforming healthcare. Therefore Bruyère is in the process of implementing an electronic patient record (EPR) in partnership with six other hospitals in the Ottawa-area. The multi-year phased EPR project entitled, CHAMP or Champlain Association of MEDITECH Partners, will provide another platform for the partners to continue on the path of improving patient care and integrated services by providing secure access to just in time legible patient information not just within a single care facility, but for those patients requiring access to multiple health service providers. The EPR embeds tools to support decision making, thus reducing clinical errors and increasing quality of patient care. Being in service to others means having a greater awareness of our responsibility to stretch our social conscience. At Bruyère, we understand that in order for people to be served -especially those at risk -we need not do it alone. Our partnerships with the Champlain Community Care Access Centre (CCAC), Hospice Care Ottawa, and our affiliation with the University of Ottawa, ensures Bruyère is progressive in looking to the future of health care programs, technological advancements, research and innovation and community service needs. As technology transforms health care delivery we also use Helpline, e-consultation and TeleHealth to connect with our

Bernie Blais is President and CEO, Bruyère Continuing Care patients in rural areas or those who have mobility challenges to ensure they receive access to health-care. Bruyère’s Research Institute (BRI) is advancing Bruyere’s overall mission with the introduction of more than 15 projects focused on long-term care systems and services – a direct result of our new Centre for Learning, Research and Innovation in Long-Term Care. BRI is running more than 60 innovative studies aimed at integrating innovation into promising clinical practices to enhance primary and palliative care. BRI’s talented scientists are focused on research related to cognition and mobility ensuring the older adults that we serve can effectively transition from hospital care to

At some point, everyone can use a hand.

the community. Our number one goal is to get people home. The compassionate caring from volunteers, the innovation to look into research to uncover health care possibilities, and the dedication of Bruyère employees to deliver “Kind, Safe, Care” to every patient and resident they encounter–is why I’m so proud to be their leader. “The best way to predict the future is to invent it” – together. I look forward to steering us on this journey and there is no place I would rather be in the world than H at Bruyère. ■ Bernie Blais is President and CEO, Bruyère Continuing Care.

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28 Focus


St. Joe’s physician

Continued from page 26 It’s a project already in motion at hospitals in Australia, Dr. Abbass notes, but St. Joe’s would likely be one of the first hospitals in Canada to implement this kind of recycling program. The key aspect of making it work, he believes, is educating hospital staff – and making the process simple for them. That’s what led to the success and sustainability of our blue bag system in our operating rooms last year. Trash and recycling bags were both clear before blue bags became the norm in ORs, meaning it was easy for busy OR staff to mix them up. “One dirty pair of gloves… if (they’re) thrown into the recycling hamper, now it’s all contaminated and it goes in the garbage,” explains Dr. Abbass. Now, clear bags indicate garbage, and blue indicates recycling-a simple visual swap that encourages easy recycling. Dr. Abbass’ blue bag program and the upcoming PVC recycling program are examples of positive change amid an extremely wasteful industry. The Canadian health care sector contributes one per cent of the country’s total solid waste, according to a 2001 study by Western University published last year by the Canadian Medical Association – and up to one-third of the waste that comes from hospitals is generated by their operating rooms. Surgery necessitates sterile packaging and many items are single use, so the large amount of waste makes sense. With 35 to 40 surgical cases per day in our operating rooms, we’re generating hundreds of bags of waste every day at St. Joe’s. Thanks to our simple recycling program, more recyclable materials are actually getting to their destination now, rather than winding up in landfill.

The Canadian health care sector contributes one per cent of the country’s total solid waste, according to a 2001 study by Western University Dr. Abbass says we’re currently producing one or two bags of recycling per case – which means there are roughly 56 bags of recyclable product coming from our ORs every day. Our next steps are to build on the success we’ve seen in the OR and roll the blue bag program out across the entire Health Centre. We are also exploring ways to launch our PVC recycling program. It’s a marked difference from the way things were before, but Dr. Abbass says our hospital – and others across Canada – still have a long way to go when it comes to being environmentally friendly, which in turns helps the patients we work so hard to protect as a community Health Centre. “Contributing to a green environment is really an extension of the whole wellness model that health is based on,” adds Brown. “Without prevention and promotion, we will continue to have the upstream problems of living conditions that make people sick. This is all part and parH cel of having a healthy environment.” ■ Lauren Pelley is a Jr. Associate in the communications department at St. Joseph’s Health Centre in Toronto. HOSPITAL NEWS FEBRUARY 2014

The Bedside Paediatric Early Warning System was developed to help clinicians identify children who are clinically deteriorating.

New early warning system

helps prevent unexpected code blues in pediatric patients By Rajesh Sharma


nfortunately, the harrowing scene of doctors and nurses running with crash carts to a child’s bedside after an ‘unexpected’ code blue is a familiar one to most hospital workers. In 2002 Dr. Christopher Parshuram, a physician and safety scientist in the Department of Critical Care Medicine at The Hospital for Sick Children (SickKids) recognized that in most cases it was possible to identify children well before the immediate call for help was made. With the help of Kristen Middaugh, a paediatric intensive care nurse, he began careful research to see which vital signs could be relied upon to provide early identification of clinical deterioration in children. “Through our research, and with the collaboration of 300 health care professionals and data from 5000 patients, the Bedside Paediatric Early Warning System (BedsidePEWS™) was developed to help clinicians identify children who are clinically deteriorating, allowing medical teams the time they need to intervene and prevent the need for immediate assistance from a resuscitation team,” explains Dr. Parshuram. In 2009, they published their results in Critical Care highlighting the development and initial validation of the Bedside Paediatric Early Warning System (BedsidePEWS™). In Critical Care 2011, they published evidence that BedsidePEWS™ can improve outcomes. Recognizing the need for appropriate dissemination of BedsidePEWS™, and the requirement to develop a robust electronic form, SickKids and MaRS Innovation collaborated to establish Bedside Clinical Systems (BCS). The program digitally logs, charts, and evaluates seven vital sign items that are part of routine clinical assessments and then summarizes them into a single score. From the BedsidePEWS™ score, care providers can better match the level of care with the patient's required needs, thereby improving patient outcomes and reducing

the number of urgent calls, code blue incidents, and related deaths. “Identifying at-risk patients is significant since approximately 5,000 children in North America experience a code blue event each year, from which too many children die or sustain neurological deficit. BedsidePEWS™ hopes to improve outcomes for these patients and their families,” says Dr. Parshuram. Hospitals benefit from the program through improved quality and safety in care delivery, improved communication among clinical team members, and reduced costs as a result of lowering the number of code blue events and minimizing transfers to a paediatric intensive care unit between and within hospitals.

Identifying at-risk patients is significant since approximately 5,000 children in North America experience a code blue event each year BedsidePEWS™ is currently being used in a Canadian, US, and New Zealand hospital. Unlike other systems, BedsidePEWS™ can be used on all pediatric patients regardless of their condition. It is the only FDA cleared system that demonstrates the strength of science and technology which were validated through a fiveyear clinical study. Nurses who have used BedsidePEWS™ as a system of care note an elevation in their critical thinking skills. Through continued use of the system, nurses can recognize the score trends that are acceptable for specific patient populations and when their patient's score falls out of that predictable trend, they understand the need to immediately take action to ensure that a patient's condition does not deteriorate. A nurse might determine that they need to call for additional help and involve colleagues or other teams which can be in-

timidating at times in environments where staff are stressed and overworked. It can be especially intimidating for clinicians when monitoring patients for cardiopulmonary issues, as they must rely on vital signs and intuition to support their decision to call for help or else wait for obvious signs of deterioration, which is often too late for the patient. Before using this system nurses often talked about a ‘gut feeling’ they had that a patient was at-risk for deterioration. With BedsidePEWS™, nurses now have a tool that helps objectify their clinical assessment and confidently communicate their concern. Physicians have noted that the system helps to foster teamwork as the system creates a shared language for nurses and physicians that helps them identify patients that are deteriorating and plan how best to use their resources. With increasing international interest in BedsidePEWS™ BCS is planning to take the system to any hospital that provides inpatient care for children. At King's College Hospital in London, UK, the nurses have the found that the system improves the continuity of care for patients when they are transferred to the recovery areas from inpatient wards. With recovery staff that are not necessarily trained in paediatrics, Kings College staff find the program’s agespecific charts invaluable. For hospitals without electronic charting systems, BCS offers a paper documentation solution so hospitals can improve paediatric care immediately as they eventually transition to an electronic solution. Both the Stollery Children’s Hospital in Alberta and a Children’s Hospital in New Zealand have implemented the paper BedsidePEWS™ solution. For more info visit: www.bedsideclinical. H com ■ Rajesh Sharma is president & chief marketing officer at Bedside Clinical Systems. He can be reached at

Data Pulse 2 29

Leaving the hospital against medical advice: who’s leaving, why, and how to stop it By Kathleen Morris


ach year, thousands of patients leave Canadian hospitals against the advice of their care team. Many of these patients will be readmitted within a month. Many more visit the emergency department (ER) within a week of discharging themselves from the hospital. The impact of this cycle of admission and re-admission is significant and poses an ethical dilemma for caregivers. It affects everything from patient outcomes to a hospital’s bottom line. But who exactly is leaving the hospital early, and why? Can we identify those who are most at risk? And can we prevent it from happening?

In 2011-2012, there were 25,137 inpatient admissions across Canada and 58,756 ER visits in Ontario and Alberta alone, that ended with patients leaving against medical advice. This represents more than 1 per cent of all admissions.

A recent report from the Canadian Institute for Health Information (CIHI) – Leaving Against Medical Advice: Characteristics Associated With Self-Discharge – begins to answer these questions by providing a fresh perspective on the magnitude of the issue across Canada. CIHI’s report uses data provided by Canadian acute care hospitals to examine the extent of the issue for both inpatient and ER settings. It focuses on those who left inpatient care and the ER at acute care hospitals against medical advice, rather than patients who left the ER without triage or medical assessment. The data reveals the types and characteristics of patients who leave against medical advice, and explores the many adverse effects on patients themselves and across the system. The report also examines the role that hospitals and communities play. Based on the data, CIHI’s report offers some strategies to minimize the negative effects of patients who leave against medical advice, and to manage and prevent the risk.

Who’s leaving The following shared characteristics were found among patients who leave against medical advice: •They were typically younger males •Many had histories of leaving against medical advice •Mental health or substance use problems were common diagnoses •They were most likely to be homeless or live in low-income neighbourhoods

Why they’re leaving Research suggests that patients who leave against medical advice do so based on their perceptions of the quality of care they receive at the hospital. •From the perspective of these patients, “quality of care” could go beyond the actual healthcare they receive to include how long they have to wait to be seen, along with how effectively (or not) their health care providers communicate with them. •These patients’ perceptions could be affected by their mental and emotional state, which may be compounded by significant mental health or substance abuse issues. •For patients who visit the ER, wait times and perceived overcrowding were factors in decisions to leave. •Hospital type, size and location had little effect on whether or not people left against medical advice.

The impacts Patients who leave hospitals earlier than recommended by their physicians and care teams are at greater risk of serious health problems, including death. The situation creates an ethical dilemma for health care providers, who must balance patients’ wishes to leave with ensuring they receive the most appropriate care. And given the recent increased focus on improving communication among care providers, experts have also expressed concern about the professional – and in some cases legal – responsibility that may arise from patients leaving against medical advice. Many of these patients are repeat users of hospital care: CIHI’s data shows that patients who self-discharge, as compared to patients with routine discharges, had considerably more admissions and readmissions to acute inpatient care, as well as more visits to the ER, regardless of their underlying conditions. Because acute care hospitals are the most expensive setting within the health care system, it is becoming increasingly important to strengthen efforts to reduce unnecessary admissions and readmissions

•Improving oving follow-up follow up care and commucommu nication across different care settings between providers, both formal and informal. More research is needed to explore strategies to reduce the rate of patients who leave hospital against medical advice. But for now, the information in CIHI’s report will enable a better understanding of the breadth, depth and importance of this issue in the Canadian health care system. This information can be used to inform

decision-making, individdecision making help identify the in uals who can be most supported through targeted interventions and innovative solutions, and ultimately reduce the number–and the impact–of people who leave H against medical advice. ■ Kathleen Morris is Director, Health System Analysis and Emerging Issues, Canadian Institute for Health Information.

Strategies and solutions What can we interpret from these findings? And how can this data be used to make a difference? Placing greater emphasis on providing true patient-centered care will go a long way toward reducing the number of people who leave against medical advice. This could include: •Explaining to patients the expected course of care and plans for individualized follow-up •Helping patients understand what’s involved in all aspects of their care–for example, the amount of time needed for laboratory and diagnostic tests while in the ER •Informing patients of the risks associated with early discharge •Communicating effectively with patients and their families to help understand why patients choose to self-discharge, and targeting counselling appropriately

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30 Focus


One organization’s commitment to

sustainability By Deanna Fourt


sland Health provides health care to more than 765,000 people on Vancouver Island, the islands of the Georgia Strait, communities north of Powell River and south of Rivers Inlet and is committed to sustainability. While Island Health’s key priority is providing excellent care, we are also dedicated to reducing our environmental impact, energy consumption and waste. Being committed to sustainability not only reduces our operating costs, it also helps ensure Vancouver Island remains a vibrant, beautiful and healthy place to live. Throughout the organization, there are many examples of our commitment to sustainability. Below are a few of these: •The Energy Efficiency and Conservation department (EEC) was created in 2011 in part to ensure the organization achieves carbon neutrality through Green House Gas (GHG) reporting and the purchase of offsets. •The organization also has a strategic energy management plan for reducing GHG emissions and it provides a roadmap for meeting and exceeding provincially legislated GHG reduction targets. •To ensure that Island Health can expand its services while limiting GHG emissions, all new construction is built to LEED Gold standards and enrolled in BC Hydro’s New Construction Program. •In addition to reduced energy costs, the benefit of Island Heath’s energy management program includes securing substantial funding from external sources, mainly: BC Hydro and FortisBC. At present, these external funding agencies have committed to provide over $670,000, on projects worth nearly $10,000,000. In the prior two fiscal years, we received a total of $5.4 million in external funding on projects worth $11.7 million in addition to over $2 million from Public Sector Energy Conservation Agreement funding. Many of Island Health’s successes can be attributed to strong partnerships with BC Hydro, FortisBC and the Climate Action Secretariat. In addition to providing incentives for capital projects, BC Hydro has been instrumental in developing an energy program at Island Health. The utility has co-funded two Energy Manager positions as well as provided funding for Energy Studies, recommissioning programs and workplace conservation awareness programs. FortisBC has also provided support to the program by funding three Energy Specialist positions as well as custom energy studies. In 2012, Island Health was recognized by BC Hydro as a Power Smart Leader, the highest level of recognition possible from BC Hydro and was also ranked #1 on its Top 10 list of Power Smart Partners in 2013. Island Health was awarded the Canadian College of Health Leader’s Energy and Environmental Stewardship Award in 2013. This recognition came with a $2,000 prize to be donated to a select charity. The EEC team decided to donate this prize to the West Coast General Hospital FoundaHOSPITAL NEWS FEBRUARY 2014

Solar installation at Victoria General Hospital. This technology allows VGH to reduce its natural gas demand and decrease its GHG emissions. tion in Port Alberni, BC in recognition of the enthusiasm of that facility’s Green Team. Through a variety of technical projects ranging from, but not exclusive to, boiler plant upgrades, lighting overhauls, site wide air balancing projects and heat recovery systems, Island Health’s EEC team has helped curb the bite of rising utility costs, while the organization continued to expand services. Projects completed in 2013 resulted in 2.75GWh of annual electrical energy savings. This is worth nearly $200,000 off our utility bills.

Since the start of the Green Island Health program, more staff are reporting turning off lights, monitors and considering sustainability at work compared to prior years •The new Nanaimo Regional General Hospital Emergency Wing in Nanaimo, BC is a LEED Gold targeted building and employs a number of technological features which help to ensure it operates with minimal impact. A key energy saving measure is the implementation of a heat recovery chiller which provides necessary cooling to regions of the building while also collecting and distributing heat, maximizing its efficiency and reducing our carbon footprint. A fairly unique feature is a thermal labyrinth, which is used to temper incoming outdoor air. The labyrinth took advantage of the ability to move the outdoor air through a long plenum in the basement of the facility. •Island Health’s newest building, Oceanside Health Care Centre in Parksville, BC, also a LEED Gold targeted building, has a unique and effective method of conserving

space heating and cooling which therefore reduces its electricity use and carbon footprint. This facility employs Thermenex technology (Thermal Energy Exchange); the first of its kind on Vancouver Island, BC. The intent of this technology is to ensure that thermal energy or cooling that is not needed in one part of the building is transferred to another part of the building that needs it, rather than producing new thermal energy or cooling, hence reducing energy input to the building. BC Hydro supported this facility’s construction and provided funding through its Commercial New Construction program to help make our energy and carbon reduction goals a reality. •West Coast General Hospital, Port Alberni BC, once one of Island Health’s most energy intensive buildings, saved approximately 3700 GJ of natural gas during 2013 compared to 2012 through the implementation of energy efficiency measures along with excellent cooperation, leadership and planning from Facilities Maintenance and Operations. These energy savings added up to $59,000 in avoided utility costs. •For many of Island Health’s sites, the EEC team has developed energy targets which are reviewed with Facilities Directors, Managers, Supervisors, and staff regularly to ensure Island Health is on the right track to maximizing energy efficiency. To engage employees in more sustainable practices at work on a broad scale, the Energy Efficiency and Conservation department created the Green Champion program. This program is modeled after the highly successful Green + Leaders program implemented in the Lower Mainland Health Authorities facilities. The program enables staff to roll out energy campaigns in their departments, attend regular meetings to discuss sustainability, help coordinate educational events, and enable their peers to act more sustainably. Currently, Island Health has six Green Champion sites where there is support

from a range of departments, including but not limited to housekeeping, maintenance and operations, clinical departments, and food services. The Green Champions can make a significant difference by changing their peers’ attitudes towards energy efficiency and sustainability. At Trillium Lodge, Parksville BC, since the inception of the Green Champion program, there has been a sustained decrease in electrical demand by 20 per cent. These results were possible due to great leadership from Facilities and Maintenance staff and a strong, active and cohesive group of Green Champions. Green Champions and the EEC team put on large campaigns aimed at reducing electricity and natural gas use, water waste and paper waste. The campaigns have ranged from interdepartmental staff driven initiatives, travelling educational tours from the Energy Team and large events held in cafeterias which help us reach hundreds of staff at our Green sites. Island Health staff, local media, and community leaders such as the Mayor of Port Alberni, BC and Deputy Mayor of Parksville, BC have all attended Island Health green events and recognize that Island Health staff can play an integral role on reducing our impact. Through the annual Green Survey, we have found, since the start of the Green Island Health program, more staff are reporting turning off lights, monitors and considering sustainability at work compared to prior years. Green Champions continue to emerge throughout the organization and all do their part to reduce waste and energy consumption. It is with the help of Island Health’s 18,000 employees that Island Health will continue to be a leader in sustainability and carbon H neutrality. ■ Deanna Fourt is the Director of Energy Efficiency and Conservation at The Vancouver Island Health Authority.

Evidence Matters 31

Treatment options for Multiple Sclerosis By Andrea Tiwari


ultiple Sclerosis (MS) is a chronic and often disabling disease that attacks the central nervous system and causes symptoms like numbness, difficulty walking, blurred vision, fatigue, memory problems, and more. Canada has the fifth highest worldwide prevalence of MS, affecting 240 out of every 100,000 people. Relapsing-remitting MS (RRMS) is the most common type of MS, affecting 85 to 90 per cent of patients. In RRMS, symptoms appear and then partially or completely fade away and the frequency of relapse is highly variable. The goal of treating RRMS is to lessen the frequency of relapses and potentially delay the progression of physical disability. For many years, there were only a handful of drugs available in Canada to treat RRMS and they were all given by intramuscular or subcutaneous injection. But recently, several new therapies have been approved by Health Canada, including three drugs that can be taken orally and one drug given through intravenous infusion. These new therapies are changing the landscape of MS treatment in Canada.

What does the evidence show? When new drugs come on the market, one of the first questions patients, physicians, and health care decision makers ask is how the new drugs compare to the older drugs. To help them answer this question and guide their decisions, itâ&#x20AC;&#x2122;s important

At a Glanceâ&#x20AC;&#x201C;MS Drugs in Canada Name Interferon beta-1a (Avonex or Rebif) Interferon beta-1b (Betaseron or Extavia) Glatiramer acetate (Copaxone) Natalizumab (Tysabri) Alemtuzumab (Lemtrada) Fingolimod (Gilenya) Dimethyl fumarate (Tecfidera) Teriflunomide (Aubagio) that reliable sources of evidence-based information are available to help them understand the comparative benefits, harms, and costs. CADTH (Canadian Agency for Drugs and Technologies in Health)â&#x20AC;&#x201C;an independent, not-for-profit producer and broker of health technology assessmentsâ&#x20AC;&#x201C;recently published a comprehensive study, with recommendations, comparing the clinical effectiveness and cost-effectiveness of existing treatments and newly available treatments for RRMS. CADTHâ&#x20AC;&#x2122;s review found that, compared to no treatment, all of the drugs reduced the average number of relapses a patient will have in a year (known as the annualized relapse rate or ARR). Specifically, compared with no treatment, ARR was reduced by approximately 70 per cent for natalizumab or alemtuzumab, 50 per cent

How drug is administered Injection Injection Injection Infusion Infusion Oral Oral Oral

for fingolimod or dimethyl fumarate, and 30 per cent for interferons, glatiramer acetate or teriflunomide. However, patients, physicians, and health care decision makers need to consider more than just the clinical effectiveness of a new drug. Cost-effectiveness is another important consideration. The annual cost of some of the new drugs is double the cost of existing drugs. CADTHâ&#x20AC;&#x2122;s analysis shows that interferon beta-1b and glatiramer acetate have clinically meaningful effects on the ARR and are the most cost-effective initial therapies. And because all drugs have some form of side effect, it is important to consider the adverse events associated with a drug when choosing a treatment. For example, fingolimod may not be suitable for patients with a history of certain heart conditions and, for certain patients, natalizumab may

be associated with a potentially fatal brain infection.

What does CADTH recommend? Below are the key messages from CADTHâ&#x20AC;&#x2122;s recommendations for drug therapies for RRMS: â&#x20AC;˘For patients newly diagnosed with RRMS, start with glatiramer acetate (Copaxone) or interferon beta-1b (Betaseron or Extavia). â&#x20AC;˘For patients who do not respond to or are unable to take one of the recommended initial drugs, switch to the other recommended drug. â&#x20AC;˘For patients who do not respond to or are unable to take both glatiramer acetate (Copaxone) or interferon beta-1b (Betaseron or Extavia), choose one of dimethyl fumarate (Tecfidera), fingolimod (Gilenya), and natalizumab (Tysabri), based on safety and cost considerations. â&#x20AC;˘Combination therapy should not be usedâ&#x20AC;&#x201C;the review showed no clinical advantage of combination therapy over monotherapy. It is important to note that at the time these recommendations were made, alemtuzumab (Lemtrada) and teriflunomide (Aubagio) were not yet approved by Health Canada for the treatment of RRMS. The recommendations were restricted to treatments that were approved for RRMS in Canada at the time of the report. To read more on drug therapies for H RRMS, visit â&#x2013; Andrea Tiwari is a CADTH Knowledge Mobilization Officer.




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32 Focus


Copper coatings

could reduce infections, kill superbugs and cut costs

By Whitney Slightham


n an effort to drive down infection rates, hospitals are always looking for new ways to minimize the spread of bacteria. Last year, one hospital evaluated a promising new antimicrobial tool: copper alloy coatings. Recently tested in Toronto General Hospital, Aereus Shield, a thermally sprayed metal coating, was shown to reduce bacterial burden by two-thirds on patient touch surfaces. Led by Dr. Allison McGeer and Dr. Michael Gardam, infectious disease consultants at Mount Sinai Hospital and University Health Network, the 265-day clinical trial compared bacterial load on copper coated surfaces versus plastic touch surfaces. The study took place in the hospital’s busy outpatient waiting room. Half of the plastic patient chair arms were coated with copper. Researchers swabbed the copper arms and control plastic arms to identify the strains and amount of bacteria on each surface. Despite regular cleaning, the median bacterial colony count was 66 per cent lower in Aereus Shield samples. Furthermore, no superbugs, including MRSA, VRE and Enterobacteriaceae; were identified on the copper coating. University Health Network presented the trial’s impressive results at the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) in Nov. 2013. McGeer, anticipated these findings. “Copper is the only substance that we know persistently kills bacteria on contact,” says McGeer. “Our study confirmed that, like solid copper, copper alloy coatings have persistent antimicrobial activity and could be valuable in health care settings.” If copper is such an effective antimicrobial, one can’t help but wonder: “Why isn’t it used more often?” Facing tight budgets, hospital procurement officials are hesitant to purchase solid copper equipment for three simple reasons: it’s expensive, difficult to manufacture and tarnishes over time–until now. Designed by University of Toronto researchers to overcome these challenges, the silver-coloured copper coating is durable, non-tarnishing, and cost-effective to apply. “Hand-washing and regular cleaning are important aspects of infection prevention and control, but copper coatings present an opportunity to kill bacteria before transmission can take place,” explains Dr. Karim Keshavjee, medical director, Aereus Technologies. “Copper has the potential to save lives while saving hospitals money in the long run.” Hospital-acquired infections are not only life threatening, but also pose serious economic challenges. Unfortunately, patients who acquire infections often require longer stays, extra treatments, more medication and lab testing, more frequent nursing, and greater physician attention. These extra needs not only inconvenience the patient, but also tie up scarce medical resources. A US study funded by the United HOSPITAL NEWS FEBRUARY 2014

A hospital bed receives thermally sprayed copper coating, Aereus Shield. States’ Department of Defense found that by reducing bio-burden in patient areas, copper surfaces have been shown to reduce hospital-acquired infections by 58 per cent. The two-year study evaluated intensive care units in three hospitals across the US. In each room, six frequently-touched surfaces were replaced with copper: bed rails, over-bed tray tables, chairs, data devices, IV poles and call buttons. Health economists predict that if a hospital retrofitted these six items with copper, the hospital would reduce infections by at least 20 per cent, saving the hospital $520,000 each year in risk-aversion. Based on the longer lifespan, increased durability and reduced manufacturing costs of coatings, hospitals can expect to

see even greater returns with this emerging copper technology. Since the coating hit the market in late 2013, manufacturers and hospitals alike have been eager to conduct more research with the incoming antimicrobial technology. Southlake Regional Health Centre in Newmarket recently became the newest owner of Aereus Shield-coated Techlem stretchers. With copper-coated handles, grips, railings and IV poles, Southlake employees and patients will both benefit from less exposure to bacteria. Located in Burlington, the coating manufacturer, Aereus Technologies, has partnered with other Canadian organizations to conduct ongoing clinical research and development. Together, the group of manufacturers, researchers, infection

control experts and equipment distributors has formed a healthcare coalition: the Canadian Healthcare Association for the Reduction of Infections (CHAIR). The coalition aims to measure the impact that emerging antimicrobial technologies, such as UV light and copper alloy coatings, have on infection rates. As bacteria continue to gain resistance to antibiotics, Canadian hospital research initiatives have shown that one of the most powerful antimicrobial weapons is a naturally occurring element: copper. For more information visit www.aereH ■ Whitney Slightham is Aereus Technologies’ communications director.

Eco-efforts lead Lakeridge Health to Green Hospital Award By Jessica Verge


s a community hospital, Lakeridge Health’s duty goes beyond providing the best possible patient care. It also means making a positive impact on the local environment. It’s that eco-mindset which led Lakeridge Health to be named Green Hospital of the Year by the Ontario Hospital Association, an award voted on by health care staff. “We’ve taken some amazing strides to save energy and reduce our environmental impact,” says Kevin Empey, CEO and President of Lakeridge Health. “Being named Green Hospital of the Year has been an incredible honour.” While green efforts, both big and small, happen every day at Lakeridge Health, there were three main areas of focus that led to the win: energy conser-

vation, waste reduction and pollution prevention.

Energy conservation In 2012, Lakeridge Health launched an energy retrofit project aimed at reducing the hospital’s environmental footprint. “A major success has been the installation of rooftop solar panels,” says Neil Clarke, Director of Engineering and Infrastructure. “We’re now producing green energy at three of our hospital sites. Another important focus has been the replacement of outdated technology with high-efficiency alternatives. More than 24,000 lighting tubes have been updated and exterior lighting has been switched to LED. Chillers have been replaced with eco-friendly Freon models and new

boilers eliminate the use of steam. Also in the works is a 1.6 megawatt co-generation plant. To support these strides, Lakeridge Health has improved building controls for all systems and uses a web application to track gas and hydro use and identify anomalies in real time.

Waste reduction “Waste management is a challenge, but it’s one Lakeridge Health is facing head on,” says Helen Gibson, Director of Patient Care Support Services. “We’re offering staff, patients and visitors more ways to recycle, reduce and reuse.” This past summer, a waste audit was conducted to find out exactly what makes up Lakeridge Health’s waste and what can be done to reduce it. Continued on page 34


Focus 33

Looking ahead to mobility management:

The next wave in hospitals By Michael Murphy


n the world of healthcare, IT security is always top of mind. As hospitals continue to embrace a BYOD environment, incorporate more devices and enable hospital staff to access real-time patient data via virtualization solutions, the real challenge is how to ensure patient information is protected and remains private. Best practices and governance policies can be implemented and enforced, but there will always be errors made or users that are risk-takers, finding a work-around to get what they need done on the device. To assist IT in developing and managing policies, Mobile Device Management (MDM) solutions are helping organizations and hospital networks manage the influx of devices, both personal and corporate owned. In 2012, Gartner saw license revenue run to $784 million worldwide and it is expected to rise to over $1.6 billion in 2014. The growth around MDM indicates a demand for increased management of devices. And, as hospitals have some of the strictest guidelines around protecting information, the security MDM provides can help the health care industry move forward with future mobility initiatives.

Getting started with MDM A MDM system will help optimize the functionality and security of mobile com-

munications, while minimizing costs. Long-standing functions of most MDM platforms include the ability to remotely wipe a device if it is lost or stolen; secure Wi-Fi and VPN settings to ensure data exchanges are not compromised; and more recently, multi-device support.

Mobile Device Management (MDM) solutions are helping organizations and hospital networks While MDM is a way to increase security measures, it also helps create a richer user experience. Previously, if a device needed to be remotely wiped, everything on the device would be removed. Now, most MDM systems can delete information selectively, in what is called a sandbox approach, partitioning apps and programs in the device so personal information, pictures and videos are not lost. It’s also possible to control the use of applications on devices, especially in a BYOD setting, as users can potentially download everything from Angry Birds to the latest game for their kids. MDM systems can detect when an app is downloaded, so the applications on the device are scanned,

and prevented from accessing sensitive patient data. For a physician, it’s likely that the device is going to be with them all the time, so it’s reasonable to provide access to personal email, social networking websites and other apps. For other devices that are hospital owned, restricting access to certain apps and downloads can be done. Along with the various security functions, MDM systems have also made inroads in tracking vital stats of each device, such as its usage pattern, applications installed, phone number and carrier. This creates efficiencies in how the device is managed. For example, IT can view devices that need software upgrades, and can push those updates out to the various devices securely when needed.

Moving beyond MDM There are many benefits to using MDM in a hospital environment. But hospitals will only truly move towards greater mobility and integration when this is part of a broader Enterprise Mobility Management (EMM) solution. EMM is a holistic approach to an organizations’ mobility strategy that focuses on the delivery of virtualized desktops, applications and shared data from the data centre or cloud to any device from anywhere, while still maintaining control of the end device through MDM. EMM platforms can be customized to

the hospital’s unique requirements. From a user’s perspective, a physician wants the freedom to obtain electronic medical records and other important applications from any device, at any time. Virtualization will provide this type of availability and sync to the network, allowing users to have instant access to information that is approved by the IT department. As result, users are able to provide a better diagnosis to their patients. In fact, many hospitals are securely leveraging Citrix virtualization solutions to exclusively deliver Patient Health Information (PHI). All the necessary applications can be accessed via any device, with no information actually residing on the device. As hospitals become further integrated through various health care networks and share EMRs with one another, MDM can provide hospital networks with that added layer of security to manage various types of devices with ease. But, it is the versatility of an EMM solution that should be considered for long term strategy as we move towards a truly mobile hospital environment H in 2014 and beyond. ■ Michael Murphy is the vice-president and country manager of Citrix, a global company that enables mobile work styles, allowing people to work and collaborate from anywhere.


34 Focus


Lakeridge Health Continued from page 32

The audit found that 42.3 per cent of Lakeridge Health waste is being recycled. To increase this amount, the hospital started an electronic waste recycling program and offers recycling opportunities to the public with conveniently located drop boxes for alkaline battery recycling. Lakeridge Health aims to make it easier than ever for staff to go green: •The number of recycling bins available have increased; •Reusable totes have replaced cardboard boxes for in-house distribution; •Departments are encouraged to purchase printers able to print double-sided; •Kitchen waste is composted; •And staff are encouraged to re-use whenever possible, whether it’s choosing reusable lunch containers or making use of scrap paper for notes.

Pollution prevention Lakeridge Health is dedicated to making a positive impact on the environment by using eco-friendly cleaning agents. In 2012, the hospital introduced the lotus PRO non-chemical cleaning process for all non-clinical areas to reduce the amount of pollution going into our water treatment facilities. This system infuses ozone into tap water to turn it into a chemical-free sanitizing agent. It kills germs but is harmless to people. Another green cleaner used at Lakeridge Health in our clinical areas is Accelerated Hydrogen Peroxide, a disinfectant that is a blend of commonly used safe ingredients mixed with low levels of hydrogen peroxide.

Eco-friendly cleaning methods aren’t just better for the environment, they’re safer for the staff using them and the patients and visitors they are protecting “These eco-friendly cleaning methods aren’t just better for the environment” says Gibson. “They’re safer for the staff using them and the patients and visitors they are protecting.” Lakeridge Health’s green efforts have resulted in a huge payoff. The energy retrofit project has reduced greenhouse gas emissions by 2,077 tonnes – mequal to the energy produced by 310 homes. Not only has this been a successful money-saving effort, but it has significantly reduced Lakeridge Health’s environmental footprint. Similarly, the e-waste recycling program diverted 6.5 metric tonnes of electric waste from landfills last year. “It takes the effort of everyone at Lakeridge Health to become a green hospital, from the departments who work tirelessly to develop eco-friendly initiatives, to the staff member who chooses to recycle their waste,” says Empey. “Together, we earned H this title, and together we’ll keep it.” ■ Jessica Verge is a Communications Officer at Lakeridge Health in Oshawa. HOSPITAL NEWS FEBRUARY 2014

Re-imagining care by design By Megan Bieksa

an a health care facility’s architecture positively affect patient outcomes? Can a health care campus’ design help transform the way that mental health and addiction are perceived, prevented and treated? When St. Joseph’s Healthcare Hamilton set out to re-imagine medical and mental health care with the development and opening of their new West 5th Campus facility, they turned these questions into statements. After ten years of visioning, design and construction, St. Joseph’s Healthcare Hamilton’s research, analysis, community engagement and planning has led up to the opening of the new facility in this month. But how does a hospital break down barriers to holistic care for the mind, body and soul with blueprints and planning? How does an integrated medical and mental health facility begin to abolish the stigma often association with mental illness with bricks, mortar and spirit? The answer to this has always been at the core of St. Joseph’s Healthcare Hamilton’s beliefs and values: through research and innovation, and a deep commitment to compassionate, patient-centred care. To begin, St. Joseph’s Healthcare Hamilton’s redevelopment team scanned far and wide to study the best facilities in Europe and North America, then rigorously planned to bring the best attributes to life. “The new facility was designed to promote hope and healing with a holistic, patient-centred approach to design throughout,” says Dr. Joseph Ferencz, interim Chief of Psychiatry at St. Joseph’s Healthcare Hamilton. “Early in the research and planning stages, we engaged our patients, our community and our staff to develop the blueprints for a facility that would foster a whole new approach to medical and mental health care.” As a result of this research and engagement, natural light shines into over 70 per cent of the building’s 855,325 square feet. The views from patient room windows have been optimized with the sight of 16 courtyards throughout the facility grounds. Indoor therapeutic spaces in the form of a gymnasium, fitness centre, games room and café are accessed by way of a bright, expansive galleria. Outdoor recreation spaces include a soccer field, baseball diamond, tennis court and lush walking trails. Every patient has his or her own private room with an ensuite washroom, with


access gained via individual key card for comfort and convenience. Freedom of movement and safety has been balanced throughout the facility. The transition points of the facility are activated via individual patient room keycards, allowing patients greater access. Skills development has been integrated into the facility with the addition of multiple community teaching kitchens and self-contained, modern apartment units. Diagnostic Imaging services are available on site and include a new MRI that will serve patients within the hospital as well as outpatients from the broader HamiltonNiagara-Haldimand-Brant LHIN.

How does a hospital break down barriers to holistic care for the mind, body and soul with blueprints and planning? As a whole, the new centre’s design and layout features are poised to help holistically heal and inspire the mind, body and spirit of all who walk through its doors. When St. Joseph’s Healthcare Hamilton enlisted the help of their patient and family advisors in the planning and evaluation of the layout of programs and services within the building, they gained valuable, albeit surprising insight. “When we engaged our patients and their families to help us define what they would most like to see at our West 5th Campus, the answer surprised us,” says Jodi Younger, Director of Mental Health and Addiction Services at SJHH. “Our patients and families asked for mental health and addiction research to be made visible and brought to the forefront as a priority. They saw this as a sign of hope for a brighter future.” This integral feedback inspired the full integration of clinical, academic and research spaces within the facility. The locations of all research units are aligned with corresponding clinical areas. Programs like Mood Disorders, Seniors Mental Health, Forensic Psychiatry, and Schizophrenia all have research units that are clearly labeled and layered between inpatient and outpatient settings. At the West 5th Campus, St.

Joseph’s Healthcare Hamilton will continue to fulfill its role as an academic health sciences centre, and the home of McMaster University’s Department of Psychiatry and Behavioural Neurosciences. Not only were the above-mentioned programs positioned for high visibility, they were also placed in the facility for optimum accessibility. Driven by patient and family feedback, SJHH positioned the building itself close to the street and more physically open to our community. Outpatient programs that receive the most traffic now face the street on Level 0, with easy access on foot and via public transit. Another strategic layout choice includes placing mental health inpatient programs for seniors on street level, accessible from the main entrance. When the new hospital is fully operational, the next phase of important research begins: measuring the success of the facility’s design. St. Joseph’s has launched a Redevelopment Evaluation Project involving patients, families, staff, physicians, volunteer and learners from all programs to test a simple hypothesis: that a newly built, specially designed mental health facility will improve quality of care and safe care, lead to better patient outcomes and increase work-life satisfaction. “Part of renewing the promise of the best possible healthcare includes asking how we can improve what we do through challenging ourselves and generating new knowledge to help our patients,” says Dr. David Higgins, President, St. Joseph’s Healthcare Hamilton. “The new West 5th Campus embodies our mission of discovery and improved care through research and education – Re-imagining care with our patients at the centre.” Achievement for the opening of the new St. Joseph’s Healthcare Hamilton’s West 5th Campus will not be judged solely on positive patient outcomes within its walls alone, but will be felt in the communities within the region it serves. True success for the facility will include a regional transformation of the way mental health and addiction is perceived. Patients will move into St. Joseph’s Healthcare Hamilton’s West 5th Campus in early February. Visit www. for H more information. ■ Megan Bieksa is Senior Specialist, Media & Strategic Issues at St. Joseph’s Healthcare Hamilton.


Focus 35

New technology can help

help control pests By Alice Sinia


ealth facilities rely on the latest technologies to make a difference for their patients and their bottom lines. As new technology comes along–and it’s always evolving–hospitals and health facilities can improve operations, increase productivity and save money. But technology advances in the health care industry expand beyond what can be used in patient and operating rooms. The pest management industry offers several recent innovations that can benefit your facility as well. Much like new health care technology, new pest management tools can track, manage and monitor pest activity with the goals of being more effective and efficient. The results speak for themselves.

Pheromones With pheromone traps, you can also use pests’ own biology against them. Pheromone traps use natural scents produced by insects to communicate with each other. The chemical communication which is highly specific to insects can be sex attractant, used to attract males of the same species, or can be an aggregate pheromone,

used to attract both males and females. Either way, they are a tool to lure pests in and trap them without posing any ple. health threats to people. These traps are also reffective for monitoring pests, as you can use them to detect the presence or absence of specific pests in your facility. This monitoring can give you insight and feedback on the effectiveness of your pest management program, serving ng as a vital tool to helpp in your decision making. g.

Ultrasonic deterrence While ultrasonic technology isn’t new, even in the pest management industry, the technology has improved immensely over the past few years. Ultrasonic devices emit a sound undetectable by humans but tailor-made for rodents. The sound pressure and frequency drive

rats and mice away and supplement traditional, mechanical rodent controls and outdoor baiting. By creating a buffer of so sound around your facility in addition to exteri exterior baiting using tam tamper-proof bait sta stations, the battle aagainst rodents ccan be kept outside.

Electronic E monitoring m Forget a long pa paper trail or a thick file when it thic comes to keeping up come with ppests. Electronic scanning an and reporting devices can keep tr track of pest activity, hot spots and even treatments. Barcodes on different traps and monitoring stations can be scanned, which generates data on the number and kinds of pests caught in different areas inside your hospital. These reports are completely customizable on a web-based program and are al-

ways available. Over time, you can use the reports to measure overall pest activities, trends and related issues. These reports are also available for audits and inspections.

Insect light traps Designed to capture flying insects, it is one of the most effective tools to monitor and control flies. The technology has drastically improved over the years and is available in a variety of sizes based on your facilities’ need. Many of these technologies can blend seamlessly into your Integrated Pest Management (IPM) plan, a proactive approach that focuses on limiting access to the elements pests need to survive through sanitation and facility maintenance measures. Work with a pest management provider to set up a custom IPM plan with these technologies to help manage pests at your H facility. ■ Alice Sinia, Ph.D. is Resident Entomologist–Regulatory/Lab Services for Orkin Canada. For more information, email Alice Sinia at or visit

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36 Focus


Barrie’s Royal Vic doubles its size and raises the bar in Ontario By Janice Skot


he January 2014 opening of the 10th operating suite at Barrie, Ontario’s Royal Victoria Regional Health Centre (RVH) was a big day. It marked the successful completion of an historic $450 million expansion project, which doubled the size of the facility and transformed healthcare in Central Ontario. RVH has a history of reinventing itself. From humble beginnings as the Barrie General Hospital, a four-bed ‘cottage hospital’ built in1891, the hospital has been located on four different sites throughout the city, growing progressively larger with each move to meet the demands of what would become one of Canada’s fastest growing communities. A new facility was built on the current hospital site in 1997, yet within a decade, the region’s explosive population growth saw RVH once again bursting at the seams. The expansion project was given the green light by the provincial government in 2005 and in 2010 we opened the expansion which grew the facility to one million square-feet, adding 101 new inpatient beds. Regional services include a dedicated respiratory unit, cardiac renal unit and cardiac care unit. The most notable regional addition is the new Simcoe Muskoka Regional Cancer Centre which brings comprehensive cancer care, including radiation therapy, to the region.

Outstanding support Royal Victoria Regional Health Centre’s expansion was one of the largest capital infrastructure projects in the history of Simcoe Muskoka. Recognizing that half of RVH patients come from outside the City of Barrie and that an expanded facility would become an even more valuable

Royal Victoria Regional Health Centre’s (RVH) President and CEO Janice Skot tours the Laboratory with Dr. Russell Price, RVH’s chief of pathology and clinical director of laboratory medicine. regional resource, local municipalities enthusiastically invested in our ambitious expansion. Together, Simcoe County and the District of Muskoka contributed $23 million, while the City of Barrie invested a remarkable $52.5 million. At the time, this was the largest contribution by a municipal government to a hospital infrastructure project in Ontario. Community partners were equally generous. Through the tireless efforts of the RVH Foundation, the ‘I Believe’ capital campaign raised an additional $36.5 million from service clubs, businesses, organizations, and individuals throughout the region with more than 33,500 individual gifts in all. Our remarkable 1,000-volun-

teer strong Auxiliary kicked-off the campaign with a $5 million pledge, fulfilled in just three years. “RVH’s total ‘local share’ of funding reached $112 million, sending a clear signal to the provincial government that the RVH expansion had enormous support throughout the region,” explains Hilary Rodrigues, RVH vice president, chief financial officer. “It also meant RVH did not have to borrow a penny to complete the expansion, putting us in a very enviable position.”

Recruiting challenge Recruiting 600 additional skilled employees and 35 physicians in a tight health care labour market – all within a one-year period – required an equally remarkable effort. As capable as it is, RVH’s modest Human Resources team wouldn’t have been able to support this volume. To address the short-term recruitment challenge, RVH partnered with Boston-based Profiles International, part of the Talent Insight Group, to recruit potential candidates and do the initial screening, enabling RVH to focus on interviewing the very best candidates. The result was astounding–600 new hires from 19,000 applications.

RVH introduced one of the first Total Laboratory Automation (TLA) systems in Canada which was part of the new equipment installed in the health centre’s recent expansion. “The health professional job market is very tight, especially for those hard-tofind, specialized positions,” says David Coward, vice president and chief human resources officer at RVH. “We realized that our needs would outstrip the local candidate pool, so we turned to provincial, naHOSPITAL NEWS FEBRUARY 2014

tional and even international recruitment to fill these roles.” Considerable time was then spent orienting new staff to ensure that when the carefully staged, safe transition into the expansion began, they were familiar with the space, systems, equipment, culture and expectations. Innovation continues to be a high priority for RVH and the expansion included $70 million in advanced equipment and leading-edge technology, including: •Nearly $20 million in the latest imaging equipment, resulting in the most advanced imaging department in the region. Some of the equipment is typically found only in teaching hospitals, including two interventional radiology suites. •RVH was one of the first hospitals in the country to implement the Robotic Intravenous Automation System (RIVA), which automates the preparation of chemotherapy medication. The RIVA unit ensures each of the very complex, patient-specific doses is prepared safely and accurately in a sterile, controlled environment. The unit also eliminates repetitive, manual processes, while avoiding staff exposure to potentially toxic chemicals. •RVH introduced one of the first fully automated laboratories in Canada. The 65-foot-long, automated track routes lab specimens to the appropriate analyzers, performs all the necessary laboratory processes and allows technologists to monitor and verify lab results more efficiently – all without the samples being touched after loading. •Two additional ‘Smart Operating Rooms’ were built as part of expansion, bringing the total number of suites to 10. These “operating rooms of the future” are fully integrated, high-definition, voice-controlled and feature touch-screen technology. The technology enables patient images to be accessed during surgery or transmitted from the operating room to other specialists or a physician working in another Smart OR, for real-time consultation. Surgeries can also be transmitted to classrooms allowing RVH to further its commitment to teaching and research. With the bricks and mortar in place, RVH has cast its attention toward the future. After getting feedback from over 3,000 people across Simcoe Muskoka, we introduced a bold new strategic plan. Called MY CARE, it is based on a philosophy that every patient has a right to expect the safest care and the best possible experience in our health centre. The plan also identifies key clinical priorities for the future, including introducing a child and youth mental health inpatient unit; an advanced cardiac program; and specialized gynecology cancer services for women throughout Central and Northern Ontario. When the original RVH opened in 1897, the Northern Advance newspaper wrote, “Barrie has indeed much to be proud of in possessing one of the prettiest and most up-to-date hospitals in Canada.” That obH servation still holds true 117 years later. ■ Janice Skot has been the President and CEO of Royal Victoria Regional since 2004.


Bedside test for rapid detection of early pregnancy now available in Canada By Lisa Green


To list your event, send information to “”.

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 “”

Q Feb 7–9, 2014 Canadian Pain Society – Education SIG – Pain Refresher Eaton Chelsea Hotel, Toronto Website: Q Feb 8–11, 2014 Canadian Digestive Diseases Week – Fairmont Royal York Hotel, Toronto Website: Q Feb 23–27, 2014 HIMSS14 Annual Conference & Exhibition, Orlando, Florida Website: Q Feb 27–28, 2014 National Patient Relations Conference – Metro Toronto Convention Centre Website:

Ultimately, when making the decision between utilizing lab or point of care testing, hospitals must weigh their specific needs against the potential benefits

Educational & Industry Events Q Feb 1–5, 2014 CSHP 45th Professional Practice Conference Sheraton Centre Toronto Hotel Website:

very day, Canadian doctors and nurses see patients with a vast array of medical issues arrive in their emergency rooms, often experiencing high patient volume. Managing the flow of patients efficiently is a key driver of quality care, safety, patient satisfaction and financial performance. As a nurse, my goal is to ensure that all tests are completed and results are obtained prior to a physician assessing a patient. The doctor can then perform a history and physical exam, order the required treatment and make the decision to admit or discharge, and move on to care for the next patient.

Health care professionals have an additional challenge when presented with a female patient of childbearing years and pregnancy status is unknown or in question (if she is unsure of when her last menstrual cycle occurred). Whether the patient needs care for an accident or an illness, in order to avoid potentially harming an unborn child, a pregnancy test must be completed before decisions can be made about the use of diagnostic imaging, surgery, medication, and admission or discharge. To determine pregnancy status, a hospital may perform various tests to detect a patient’s hCG (“pregnancy hormone”) levels, including blood (quantitative and qualitative) and urine analysis. While quantitative testing is currently considered to be the most accurate, qualitative testing simply detects the presence of the hCG hormone in blood and it can be difficult for a patient to urinate at will. Although traditional testing methods are effective in detecting pregnancy, they require the participation of a lab, which may take 60 to 90 minutes (or more) to produce accurate results, whereas point of care tests can help deliver results sooner. It has been shown that point of care testing can produce lab-quality results while dramatically reducing turn-around time. Hospitals will soon be able to use Abbott’s handheld device to run the new i-STAT -hCG test, which is currently the only in vitro diagnostic point of care whole blood test for the early detection of pregnancy that produces lab-quality results within 10 minutes. With the sample drawn and labeled at the patient’s bedside, the health care provider uses the i-STAT handheld device to scan the operator, specimen and cartridge barcodes. The operator then fills

Focus 37

Q Feb 28th, 2014 Interdisciplinary Trauma Conference presented by University of Toronto, St. Michael’s Hospital, Sick Kids Hospital and Sunnybrook Health Sciences Centre BMO Institute of Learning, Toronto Website: Q March 11–12, 2014 The National Forum on Patient Experience West Hyatt Regency Hotel, Vancouver Website: In the ER, time can be critical. If a female patient is of childbearing years and pregnancy status is unknown or in question, completing a pregnancy test to detect her hCG (“pregnancy hormone”) levels can help doctors make appropriate treatment decisions. the cartridge and inserts it into the device for analysis, and results are communicated to the patient’s electronic medical record for the physician’s review. All hospitals want to provide patientcentered care and measure patient satisfaction. Research suggests that as wait times increase, a patient’s perception of care declines. A decrease in wait times can also positively impact the “left without being seen” rate, thereby reducing the risk of a patient leaving the hospital without knowing the status of his or her condition. Ultimately, when making the decision between utilizing lab or point of care testing, hospitals must weigh their specific needs against the potential benefits. Implementing point of care testing may be associated with improved efficiencies (such as reduced wait times and increased patient intake) and reduced risks associated with delayed care, in addition to improved patient satisfaction. By taking a systematic approach and implementing changes-such as point of care testing – it is possible to make a permanent improvement in patient H care. ■ Lisa Green, RN, ENC(C) is Unit Manager, Emergency Department, Critical Care Program at Ross Memorial Hospital in Kawartha Lakes, Ontario.

Q April 1–2, 2014 National Patient Relations Conference – Hyatt Regency, Vancouver Website: Q April 10–11, 2014 National Telemedicine Conference – Metro Toronto Convention Centre Website: Q April 27–29, 2014 Hospice Palliative Care Ontario (HPCO) 2014 Annual Conference Sheraton Parkway Toronto North Hotel & Conference Centre Richmond Hill, Ontario Website: Q May 20–23, 2014 &DQDGLDQ3DLQ6RFLHW\WK$QQXDO6FLHQWLÀF0HHWLQJ Quebec Convention Centre, Quebec City Website: Q May 29–30, 2014 e-Medication Management Conference – Metro Toronto Convention Centre Website: Q May 29–June 1, 2014 CAMRT Annual General Conference – Shaw Conference Centre, Edmonton Website: Q June 2–3, 2014 2014 National Health Leadership Conference, Banff, Alberta Website: Q June 12–13, 2014 Emergency Department Management Conference Metro Toronto Convention Centre Website: Q June 25–28, 2014 The Canadian Paediatric Society 91st Annual Conference Montreal, Quebec Website: To see even more healthcare industry events, please visit our website FEBRUARY 2014 HOSPITAL NEWS

38 Focus


Your EMR is in placeâ&#x20AC;&#x201C; now what? Continued from page 19

This approach offers most of the functionality of a traditional EMR system and requires minimal technology input by the provider. There are two essential components that need to be in place in order to derive the best value from a provincial EHR as well as from the individually owned EMR systems. These two essential components are an integration engine (to assemble the data from across multiple systems) and a clinical portal to provide a webbased view of all that data. An integration engine should â&#x20AC;&#x153;just work,â&#x20AC;? meaning that it is a piece of technology that operates in the background to reliably pull data from systems and transfer it to other systems with minimum fuss. It should be quick to install, fast to configure and simple to deploy. It needs to understand the wide variety and nature of clinical data, and understand how to transfer clinical data across systems deployed across a province.

â&#x20AC;&#x153;EMRâ&#x20AC;? vs â&#x20AC;&#x153;EHR:â&#x20AC;? An EMR (Electronic Medical Record) is a computer system that generally serves to support use by doctors and nurses as they work in a clinic or a hospital. It is built on the needs of a single clinical provider unit or organization such as a single hospital or a primary care practice. They are often referenced as â&#x20AC;&#x153;provider centricâ&#x20AC;? or â&#x20AC;&#x153;facility centricâ&#x20AC;? applications because their goal is to support providers as they work in clinics. An EHR (Electronic Health Record) is a computer system that serves to provide complete information about a patient drawn from multiple underlying sources of information, including EMRs, laboratory radiology and documentation systems. Typically it is implemented across a province, providing complete information to providers about the patient, drawn from all care settings they have attended. They are referred to as being â&#x20AC;&#x153;patient centricâ&#x20AC;? as the patient is very clearly at the center of the system.

With the volume of disparate information that health care facilities deal with on a daily basis, an integration engine is one of the fastest, easiest and most valuable ways to streamline health care processes and integrate communities. The clinical portal should act as an open, universal platform that can provide all types of patient information in one place. A good clinical portal should also be able to provide single-view access to all pertinent information whether that information is stored or retained solely in another system like a radiology PACS system. As we move toward creating a more patient-centric environment where patients are more involved in their care, the right technology needs to be in place. A patient portal that leverages the same views available to clinicians in the pro-

vider portal ensures clear communication between all members of the care team including the patient.

The ROI of an EMR EMRs have become an integral part of healthcare today because they meet the needs of clinicians for improved quality and efficiency in care delivery. However, many EMRs are functioning as standalone systems meaning they are not yet delivering to clinicians the maximum benefit they could provide if their EMRs are connected with the rest of the health care system. Using an EMR and an integration engine allows the connection of key components of the care process like e-referrals, medication reconciliation, lab reports, clinical pathways, disease management and so much more. Achieving real-time connectivity from any system

to any system, streamlines processes, reduces operational costs, and increases network reliability and visibility. So, when you ask yourself the question â&#x20AC;&#x153;My EMR is in place-now what?â&#x20AC;? the answers are clear-integration and care coordination. Canadian healthcare jurisdictions are well on the way to full deployment of provincial EHRs, so health care practitioners should strongly endorse the strategy in their local regions and push for full implementation as soon as practically possible. For more information, visit www.oriH â&#x2013; Dr. Chris Hobson, MD MBA is the Chief Medical Officer with Orion Health and a primary care practitioner and internist certified in health care informatics.

The Central Community Care Access Centres (CCAC) encompasses North York, York Region and South Simcoe area and is one of fourteen CCACs across the province. These publicly funded healthcare agencies are dedicated to enhancing the health, quality of life and independence of individuals in our communities by offering a single point of access to home and community services. Each year, over 600,000 Ontarians count on their local CCACs to help them navigate the complexities of the health care system and access quality care and support. As part of a system wide initiative to strengthen connections across the health continuum, the Central CCAC is hiring 3 Nurse Practitioners to provide enhanced leadership, navigation and support to complex palliative clients within Central catchment area.

Nurse Practitioner If you are a Nurse Practitioner, and if you share the same passion for outstanding care in our communities, we want you to join our Team! As an integral member of the Integrated Palliative Home Care Program, you will provide holistic patient care to complex palliative clients, provide care connections for our clients in the community, and develop a shared care partnership with primary care partners. Working across the health care system, the Nurse Practitioner provides expert clinical palliative leadership to support seamless, integrated care delivery. You will also be involved in all domains of advanced practice nursing, including acting as a key resource for Care Coordinators, service providers, nursing and physician colleagues, and participating in educational initiatives. As a Nurse Practitioner, you will go beyond addressing the needs of palliative clients with stable and predictable needs; you will also serve a population of clients with complex medical, physical, cognitive and psychosocial conditions. 4XDOLÂżFDWLRQV â&#x20AC;˘ Current registration with the College of Nurses of Ontario in the Extended Class; graduate of a Nurse Practitioner 3URJUDPZLWK%6F1 &DQDGLDQ1 XUVLQJ$VVRFLDWLRQ&HUWLÂżFDWLRQLQ+RVSLFH3DOOLDWLYH&DUHRUUHOHYDQWVSHFLDOW\ FHUWLÂżFDWLRQ â&#x20AC;˘ Continuing education in palliative care is essential as well as minimum of two years of experience preferably in a community setting and in Palliative Care Nursing. â&#x20AC;˘ Demonstrated advanced knowledge in consultation and ethical decision-making and ability to apply theory and evidence to advance clinical practice and outcomes. â&#x20AC;˘ Excellent interpersonal and communications skills to communicate with clients and family members. â&#x20AC;˘ Valid driverâ&#x20AC;&#x2122;s license and access to a vehicle. +RZWR$SSO\ Please submit your resume and cover letter to For more information on this role, please contact Cecilia Tam at 416.237.1500 x 222 or at


Working Environment


905-569-7595/877-569-7595 info@campkodiak

The Central CCAC is a GTA Top Employer! Competitive salary! &RPSUHKHQVLYHEHQHÂżWVDQGFRQWLQXLQJHGXFDWLRQLQLWLDWLYHV Committed to a culture that values diversity and inclusion!




Focus 39

Located in the heart of Toronto, the largest and most culturally diverse city in the country, Ryerson University is committed to diversity, equity and inclusion. The University is known for innovative programs built on the integration of theoretical and practically oriented learning. Our undergraduate and graduate programs are distinguished by a professionally focused curriculum and strong emphasis on excellence in teaching, research and creative activities. Ryerson is also a leader in adult learning, with the largest university-based continuing education school in Canada.



We are seeking an ambitious, highly motivated, organized and results-driven sales + marketing coordinator with a solid understanding of marketing concepts, access to a reliable vehicle, and a min. of 3 years of experience in the homecare field.

needed to work for busy nursing Agency in long-term care facilities. Experience in LTC facilities and reliable transportation an asset. Company offers flexible schedule and excellent rate of pay according to experience in LTC settings.

The person will be accountable for the support, coordination and execution of various marketing campaigns.

needed for after hour on-call week nights and on weekends, Good command of English, communicating skills, computer literate and able to work under pressure an asset.

Send resume to:

Send resume to:

Join today!


The Department invites applications from outstanding candidates for a tenure-track faculty position, at the Assistant or Associate Professor level, effective July 1, 2014, subject to the final budgetary approval. The focus of this search is in the fields of Radiation Physics, Radiation Oncology Physics and any other related areas. The successful candidates must possess an earned doctorate in Medical Physics, Physics or a related field, and demonstrate excellence in research and teaching. The Department of Physics offers an undergraduate degree in Medical Physics and master’s and doctoral degrees in the field of Biomedical Physics with an Option in Medical Physics accredited by the Commission on Accreditation of Medical Physics (CAMPEP). The Department has 16 full-time faculty members, 7 post-doctoral fellows, 36 graduate students, and 8 staff members. The Department has a core group of scientists who have secured substantial external peer-reviewed funding for cutting-edge research in Medical and Biomedical Physics. Our faculty members collaborate extensively with the surrounding biomedical community in what the City of Toronto has designated as the Discovery District, home to 7 world-renowned hospitals and more than 30 specialized medical and related sciences centres. More information on the Department can be found at

This position falls under the Ryerson Faculty Association ( jurisdiction. For details on the Ryerson Faculty Association Agreement and the University’s RFA Benefits Summary, please visit and benefits/benefits_by_group/rfa/index.html.

CARE Centre provides support to internationally educated nurses. We can help you enter the nursing profession in Ontario. Join CARE and receive: • Professional workshops and events • Observational Job-Shadowing • Exam Preparation • Networking

Free Information Sessions:


Interested candidates should submit a current CV, and statements of proposed research directions and teaching interest, online via our Faculty Recruitment Portal at cfm?posting_id=501358. Please note that applications have to be made electronically. All reference letters should be sent by the referees to the attention of Tess Sy, Administrative Assistant, at Confidential inquiries can be directed to Dr. A. Pejovic-Milic, Department Chair, at Review of applications begins on March 1, 2014. Although applications will be accepted until the position is filled, only those received by the review date will be guaranteed full consideration.

Use your nursing skills! Pass registration exams! Work in Ontario!

• Individual case management support • Create a plan for your success • Nursing Readiness Assessment • Nursing-specific language courses


Funded by

Ryerson University is strongly committed to fostering diversity within our community. We welcome those who would contribute to the further diversification of our faculty and its scholarship, including, but not limited to, women, visible minorities, Aboriginal people, persons with disabilities, and persons of any sexual orientation or gender identity. All qualified candidates are encouraged to apply, but applications from Canadians and permanent residents will be given priority.


40 Focus


New Improvement Workshop

Better Care for your Highest Users: How to Become a Chronically Well Champion and Still Manage Costs

Five-part online workshop features independent study and webinar sessions. Runs: February 19 to April 14, 2014 CFHI experts France Laframboise and Jean Mireault will introduce you to a data-driven approach designed to improve care and optimize resource use for patients identified as a system’s “highest users.” In one community, ED visits dropped by 72%, hospital admissions decreased by 83% and inpatient days were reduced by 80%.

France Laframboise

Jean Mireault

RN, IMHL, CFHI EXTRA fellow, Assistant Director of Clinical Services at MediaMed Technologies (MMT)

MD, M.Sc, Chairman of the Board and VP Clinical Affairs of MMT

The Canadian Foundation for Healthcare Improvement is a not-for-profit organization funded through an agreement with the Government of Canada.


For information or to register visit:

February 2014 Edition  

Focus on Facilities Management and Design, Health Technology, Greening Health Care.

February 2014 Edition  

Focus on Facilities Management and Design, Health Technology, Greening Health Care.