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www.hospitalnews.com JANUARY 2017 EDITION | VOLUME 30 | ISSUE 1
Continuing Medical Education for health care professionals. Human resource programs implemented to manage stress in the workplace and attract and retain health care staff. Health and safety issues for health care professionals. Quality work environment initiatives and outcomes.
INSIDE Trends in Transformation..................... 5 Nursing Pulse ..................................... 10 From the CEO's desk..........................15 Evidence Matters ...............................18 Legal Update ......................................19 Careers ...............................................19
Nasal spray flu vaccine Why is it still offered in Canada? Story on page 8
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CPS encourages physicians to “choose wisely” when treating children and youth The Canadian Paediatric Society (CPS) released a list of specific tests, treatments and procedures that are commonly ordered but not always necessary as part of Choosing Wisely Canada. The list identifies five targeted, evidence-based recommendations that can support conversations between patients and clinicians about what care is really necessary. The CPS list makes the following five recommendations: • Don’t routinely use acid blockers or motility agents for the treatment of gastroesophageal reflux in infants. • Don’t perform screening panels (IgE tests) for food allergies without previous consideration of the pertinent medical history. • Don’t administer psychostimulant medications to preschool children with Attention Deficit Disorder (ADD), but
offer parent-administered behavioural therapy. • Don’t routinely do a throat swab when children present with a sore throat if they have a cough, rhinitis, or hoarseness as they almost certainly have viral pharyngitis. • Don’t recommend the use of cough and cold remedies in children under six years of age. “As health professionals, we can help improve care by talking with patients about what procedures are really necessary and beneficial to their health,” says Dr. Isabelle Chevalier, member of the CPS Board of Directors and project lead. “Our recommendations are intended to help patients and clinicians start important conversations about treatment options and make wise choices about their health.” “Conversations about what care pa-
tients truly need is a shared responsibility among all members of the health care team,” adds Wendy Levinson, MD OC, Chair and Co-Founder of Choosing Wisely Canada. “The CPS’s Choosing Wisely Canada list will help paediatricians across the country engage their patients in a dialogue about what care is best for them, and what we can do to reduce waste and overuse in our healthcare system.” With the release of these new lists, the campaign will have covered more than 175 tests and treatments that the medical professional society partners say are overused and inappropriate, and that clinicians and patients should discuss. To learn more about Choosing Wisely Canada and to view the complete lists and additional detail about the recommendations and evidence supporting them, visit www.ChoosH ingWiselyCanada.org. ■
Nutrition quick facts In Canada, four out of ﬁve Canadians risk developing conditions such as cancer, heart disease or Type 2 diabetes; six out of ten adults are overweight and one-third of youth are overweight or obese. These food label changes are being made after two years of consultations with consumers and stakeholders. During the consultations, the majority of respondents told Health Canada that improvements are needed to both how and what information is provided on food labels to reflect the latest science and allow consumers to easily compare products when shopping. As part of the Healthy Eating Strategy, Health Canada has already completed a first set of consultations on revisions to Canada’s Food Guide, and is currently consulting with Canadians on a proposal to introduce front-of-package labelling on foods that are high in sugars, sodium and saturated fat. It is also consulting on a proposal to ban the use of industrial trans fat in foods. Canadians can participate in H both consultations until January 13. ■
Many Ontarians aren’t getting screened for cancer The number of people newly diagnosed with cancer in Ontario has increased over the last two decades and will continue to rise, largely due to an aging population. Certain cancers can be prevented or detected earlier by regular screening, but according to a new report released by Cancer Care Ontario, many eligible Ontarians aren’t up to date with their screening tests. “Effective cancer screening programs are crucial to reducing the impact of cancer,” says Dr. Linda Rabeneck, Vice-President, Prevention and Cancer Control, Cancer Care Ontario. “Research has shown that family doctors can influence their patients’ participation in cancer screening, which is why we encourage all healthcare provid-
ers to speak to their patients about getting screened.” There are a number of geographic and socio-demographic characteristics associated with being overdue for cancer screening, including age, male sex, low neighbourhood income and not being registered with a family doctor. The findings in this report will be used to inform evidencebased and locally relevant strategies to strengthen cancer screening in Ontario. Key report findings are: • Participation in breast cancer screening has remained stable at 65 per cent of eligible women since 2011–2012. The proportion of women screened within the Ontario Breast Screening Program has
Changes to the Nutrition Facts table and list of ingredients on packaged foods Making science-based nutrition information easier to understand is one way to empower Canadians to make healthier food choices. The Canadian government recently announced amendments to the Food and Drug Regulations to make the Nutrition Facts table and list of ingredients on packaged foods easier for Canadians to use and understand. This is the next step in Health Canada’s Healthy Eating Strategy, which was announced by the Minister this past fall with the launch of the revision of Canada’s Food Guide. Included in the labelling amendments are changes to the regulation of serving sizes to make comparing similar food products easier. A simple rule of thumb, 5% is a little, 15% is a lot, has also been added to the Nutrition Facts Table to help Canadians use the percent daily value (% DV) to better understand the nutritional composition of a single product or to better compare www.hospitalnews.com
two food products. More information on sugars will also be made available, including a % DV for total sugars in the Nutrition Facts table, and the grouping together of sugar-based ingredients under the name “sugars” in the list of ingredients. In addition, all food colours will be declared by their common name rather than the generic term “colour” and the list of ingredients and allergen information will be easier to read. A new health claim will also be allowed on fruits and vegetables, informing Canadians about the health benefits of these foods. The food industry has until 2021 to make these changes. This timeline for implementation will align with other labelling changes proposed under the Healthy Eating Strategy including front of pack labelling as well as some label modernization measures being proposed by the H Canadian Food Inspection Agency. ■
continued to increase, up to 78 per cent in 2013–2014. • Participation in cervical cancer screening has declined from 2009-2011 (68 per cent) to 2012–2014 (63 per cent). • Retention in the OCSP has also declined, from 81 per cent among women screened in 2010 to 72 per cent among women screened in 2011. These decreases may be related to changes in screening guidelines which extended the recommended screening interval from annually to once every three years. • Older women were less likely than
younger women to return for a subsequent Pap test. Retention was lowest in the oldest age group (women ages 60 to 66) at 68 per cent. • The proportion of eligible Ontarians who are overdue for colorectal cancer screening has continued to improve (decline) from 50 per cent in 2008 to 40 per cent in 2014. We are transitioning to a new screening test for colorectal cancer for average risk individuals (the fecal immunochemical test), which we anticipate will improve screening H participation. ■
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Wait times worsen:
It’s time to innovate By John Sinclair he recent edition of the annual report on wait times from the Fraser Institute once again raised the topic of wait times ever so briefly to the attention of Canadians. In summary, the report’s findings declared that wait times are worse than ever. As has been the case with past reports, a number of healthcare professionals, academics and administrators across the country rightly claimed that the methodology used by the Fraser Institute to collect its data left a great deal to be desired, and would certainly not have passed muster with a serious peer review process. While the data collection methodology falls well short of scientific standards, the issue of wait times for various surgical procedures and diagnostic imaging is real, and may be worsening. The Canadian Institute for Health Informatics (CIHI), a national organization tasked with collecting healthcare data, reports what many Canadians already know: that wait times are a fact of our healthcare system. So the credibility of the recent Fraser Institute report aside, wait times are real and are likely worsening again. Like myself, you might wonder if Canada is alone in this regard. Living next to the United States, we often fail to look globally at the state of affairs in other western industrialized countries and instead compare ourselves exclusively to our cousins south of the border. Unfortunately, this single comparison is too simplistic. While it is true that, generally speaking, wait times are not an issue in the U.S.A., they have other daunting challenges pertaining to access to care, with many Americans (usually the disadvantaged) having little-to-no insurance, and therefore little-to-no access to healthcare. The Affordable Care Act enacted by the Obama administration was designed to address this issue. The recent presidential election has now put the
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The OECD drew up a list of approaches countries such as the United Kingdom, France, Germany, Australia, New Zealand, among others, have tried. They then ranked the effectiveness of each of the items on the list as weak, medium or strong. For example, it turns out that simply increasing funding in the public sector was tried in six of the 13 countries, with a resultant weak and temporary impact on wait times. Changing how physicians and hospitals are paid had a much greater impact than on simply throwing more money at the problem. In 2004 the Federal government allocated 5.5 billion dollars to help the provinces reduce wait times over a 10-year period ending in 2014. Improvements, if any, were marginal and seemingly temporary. Increasing patient choice to include a wider list of providers along with improved wait list management actually had a greater impact than temporarily increasing expenditures. In order to have a full grasp of wait times,
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effective wait list management is a very important concept to understand. In most parts of the country, it’s not your surgeon or a hospital physician who decides when you will be scheduled for elective (non-emergency) surgery – it’s a medical secretary in a surgeon’s office, or a scheduling clerk at the hospital. Imagine the task of having dozens (or often hundreds) of patients waiting for surgery and then subsequently having to pick which patient gets scheduled. Keep in mind that some patients are more urgent than others, and that some who were less urgent become more urgent over time. In many surgical ofﬁces, management of wait lists happens on paper charts in paper file folders. All the while, innovative wait list management, eReferral and central intake software has been designed and built in Canada, and successfully implemented in many parts of the country. Such software acts like air traffic control, tracking each patient as they are referred, wait for surgery and, in some cases, wait to be discharged from acute care hospitals to alternative level of care facilities. The software makes it intuitively easy for whomever is managing a wait list to pick the right patient at the right time. Innovation like this is not expensive, and uses real-time information to improve wait times. Experience has shown that wait times can only be improved by introducing a series of systematic changes such as patient wait time guarantees backed by penalties, better wait list management, central intake and modified funding models. The time has come to retire the fax machines, move to the use of innovative software systems, and bring air traffic control style management to H wait times. ■ John Sinclair CPHIMS-CA, is the President of Novari Health and is a Certified Professional in Health Information Management Systems.
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Dr. Cory Ross,
B.A., MS.C., DC, CSM (OXON), MBA, CHE Dean, Health Sciences and Community Services, George Brown College, Toronto, ON
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HOSPITAL NEWS JANUARY 2017
Wait times are real and are likely worsening again.
ANGEL EVANGELISTA ARUN PRASHAD ALICESA LAROCQUE KATHLEEN WALKER STEPHANIE GIAMMARCO
progress made by the Affordable Care Act in immediate jeopardy. So if we can’t realistically compare ourselves to the Americans, how do we stack up against other similar countries? The Organization for Economic Cooperation and Development (OECD) looked at this a few years ago and – you guessed it – Canada was, and almost certainly still is, a poor performer when it comes to access to care. So Fraser Institute report aside we have a lot of work to do in this area.
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Trends in Transformation
Cutting waste and getting lean in an emergency department By Carly Baxter oming face-to-face with some pretty grim statistics about its Belleville Emergency Department performance, leaders at Quinte Health Care (QHC) knew things had to change. So, they enlisted the help of a Lean Transformation professional to coach staff in eliminating waste and improving processes not just in the emergency department, but throughout the entire organization. Quinte Health Care (QHC), located in south/central Ontario, is an integrated system of four hospitals, providing health services to nearly 170,000 people in the region. QHC Belleville General Hospital’s emergency department (ED) performance was particularly worrisome with one of the highest Left Without Being Seen (LWBS) rates in Ontario. In April 2016, more than 75 staff from all hospital areas participated in a Value Stream Analysis (VSA) exercise to identify key improvement opportunities. The VSA focused on improving the patient journey for Chronic Obstructive Pulmonary Disorder (COPD) patients from the time they enter the ED, throughout their inpatient stay, until time of discharge. With the input of front line staff, QHC’s transformation journey was dubbed “Grassroots Transformation,” and adheres to the notion that change comes from the bottom up. “This journey is about engaging front line staff and physicians to own and change the process in which they deliver care,” says Jeff Hohenkerk, Vice President, QHC. “We’re here to support them and break down barriers.”
Getting to the crux of the conundrum
QHC’s first Kaizen event, which is an intense four-day improvement event, was a “5S.” Front line staff and physicians spent four days completely clearing out and reorganizing medical supplies in patient rooms, storage rooms and on supply carts in the QHC Belleville Emergency Department. The term “5S” stands for Sort, Set in order, Shine, Standardize, Sustain. This event resulted in the implementation of a Kanban system – which provides a visual signal that stock needs to be replenished. This allows staff to have what supplies they need, where and when they need them, reducing time and physical steps wasted searching for them – equating to more time spent on direct patient care. The next ED-related Kaizen event in October was meant to focus on Nursing Standard Work, however, it quickly became apparent that better departmental flow must first be established. “We first had to create structure within the department,” says Viviane Meehan, QHC Process Improvement Coordinator. “Nursing was everywhere. In order to allow for very good Standard Work, you need the foundation of good structure. Then you can build on top of that.” www.hospitalnews.com
In April 2016, more than 75 staff from all hospital areas participated in a Value Stream Analysis (VSA) exercise to identify key improvement opportunities.
Photo courtesy of Quinte Health Care
The simple act of placing coloured tape on the floor to lead patients to their appropriate zone has improved patient flow in Quinte Health Care’s Belleville Emergency Department. One big change to the structure was moving triage into the waiting room, close to the entrance of the ED. This new setup allows the triage nurse to have a line of sight to the patients waiting, allowing her/him to watch for changes in patient condition. Another change was the creation of three geographic zones. As patients are processed in triage, they are assigned to the Red Zone (for acute patients), the Yellow Zone (for sub-acute patients) or the Green Zone (for ambulatory patients). Once assigned a zone, patients follow the coloured tape (red, yellow or green) on the floor to their appropriate zone within the actual ED. They are no longer spending long hours waiting in the waiting room, but rather are within the emergency department, waiting to be taken to a room for assessment/treatment. These changes have already received positive feedback from staff and patients. “The lines on the floor are good. It’s really easy to find your way – just follow the line,” says patient Minnie Verburg. “And I like being redirected right into the ED rather than waiting out in the waiting area. Communication has improved too. While I was waiting, a nurse came over and explained that two ambulances had just come in, so the wait would be a bit longer. That wouldn’t have happened before. Communication is important.” “Front line staff are now looking at how things are done from a different per-
spective – the patient perspective,” says Beverly Shepherd, an ED nurse and Grassroots Transformation Coach. “We’re bringing patients into the department so they can see how hard we’re working and we can see their pain and frustration as they wait.” The few changes put into practice so far have already improved the emergency department’s LWBS numbers. In two months, the average daily LWBS rate dropped from 6.8 per cent to 5.8 per cent. And QHC is confident those numbers will continue to improve. Similarly, due to these changes and other Grassroots Transformation initia-
tives, once a patient is assigned a bed, they are moving from the ED to inpatient units much faster. What used to take fourplus hours, now only takes about one hour, with the future goal of 30 minutes. This too improves flow in the ED. QHC will continue its Grassroots Transformation over the next two years, with the goal of developing a culture of constant improvement for the H organization. ■ Carly Baxter is a Communications Consultant at Quinte Health Care Corporation.
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Improved service in a healthier workplace:
The little hospital that could By Paul Crookall n 2004, Michael Garron Hospital (formerly, Toronto East General Hospital) celebrated 75 years as a community teaching hospital. They faced a turbulent, challenging environment, with increasing demand, rising costs, decreased funding, external scrutiny and workplace safety concerns. And they were just emerging from supervision by the Province. The management team, led by previous CEO Rob Devitt, decided that a fundamen-
The Michael Garron Hospital (formerly Toronto East General Hospital)
• A full service community teaching hospital • Specialties in thoracic, neo-natal and child care, and continuing care/rehab • Founded 1929, centred in a multi-cultural part of Toronto, near Coxwell and Danforth • 473 beds; 70,000 Emergency Room visits per year; an outpatient program • 2,500 staff, 400 physicians, 500 volunteers
tal course change was needed. The leadership team wanted: “To put a new dot on the horizon and get aligned to reach it.” They chose Excellence Canada’s framework because it seemed like a natural fit. The process was similar to what they would have to go through with accreditation; it was quite aligning, it augmented and strengthened their approach, of integrating wellness and service. The team decided on a dual focus: (1) improving patient care and (2) improving staff job satisfaction. “You can’t have one without the other,” says Devitt. Both would be achieved through better management: improved service while reducing costs and creating a healthier workplace. They decided to use a management framework developed by Excellence Canada: Quality and the Healthy Workplace. It is a progressive model, with four levels, and the impact was obvious – people could soon see the difference. In 2008, management launched its first Mental Health Strategic plan. This added a focus on work/life balance, enhanced physical well-being, and training in emotional intelligence and workplace violence prevention. By 2010, they had achieved national recognition with the gold Canada Awards for Excellence for the Quality and Healthy Workplace Standard.
They became an early leader in reducing workplace violence. In 2013, with the release of the new National Standard of Canada for Psychological Health and Safety in the Workplace, the Mental Health Commission of Canada (MHCC) recognized MGH as an early adopter and industry leader. They have become a poster child for the Commission. In a 2016 report, the MHCC noted: “MGH’s overall staff engagement scores have significantly increased, placing them as the leading community hospital in nine of 11 engagement categories…they believe their staff engagement score improvements have been a significant driver in improving their patient satisfaction and overall quality metrics.” Some of the impacts the hospital has achieved (2009–2015): • A steady focus on the psychological health and safety of staff was maintained. • There has been a steady year over year two per cent increase in employee engagement. • Overall healthcare costs were reduced by seven per cent • Absenteeism is down to 6.55 days per year from 10.66 • Emergency Department wait times have been cut in half
• Patient satisfactions scores are up, to 92 per cent from 85 per cent, from 2011 to 2015; and clinical metrics have improved, for example, mortality is reduced, and sepsis is reduced How was all this achieved? Christine Devine, Wellness Specialist, observed: “The Excellence Canada framework supporting overall business performance and principles of excellence is thoroughly aligned with our Patient-Centred Care Model and strategic success factors. Each factor is related to a principle within the framework, as illustrated in our Strategic Plan.” To help embed mental health, the CEO signs a Statement of Commitment each year, to protect the psychological health and safety of staff. Champions have been given responsibility. Policies have been created and implemented. The keys are: • Lead in a positive way • Make psychological health and safety a part of decision making • Engage workers • Identify and address psychologically unsafe practices and workplaces • Ensure staff members are responsible for protecting each other’s psychological health and safety by adhering to the Code of Conduct and related policies.
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“Quality and value are inextricably linked. We have been on our journey to achieve excellence and develop and sustain a culture focusing on quality, wellness, and continuous improvement for many years. Partnering with Excellence Canada to use their frameworks for Excellence, Innovation and Wellness, and for Mental Health at Work, has helped embed our mission, vision, values, strategic success factors, and philosophy of wellness in everything we do. Healthy staff provides better patient-centred care.” Christine Devine, Wellness Specialist The hospital routinely carries out workplace violence risk assessments; physical and psychological hazard assessments; and verification against the workplace safety checklist. There is an online reporting system with immediate feedback. Critical incident reports are analyzed and an action plan developed and followed up. SMART goals are tracked. The staff engagement survey is conducted quarterly. WSIB claims are followed up, and the Manulife Health Benefits Diagnostic is used to identify areas needing attention. Leaders are equipped to support a healthy workplace through management training programs, coaching skills development and the provision of a ‘mental health toolkit.’ All staff members receive mandatory mental health training, including an emotional intelligence program. “Wellness is tailored to the needs of our staff,” Devine says. “We track the effectiveness of programs and initiatives through trend data, including progress on the 13 psychosocial risk factors in the National Standard. We also use the Ontario Hospital Association benchmarks to compare within our industry.” The hospital participates in national programs and campaigns, including Bell’s “Let’s Talk,” and Mental Health Week.
The newly renamed Michael Garron Hospital continues to build on the Excellence Canada program as it works to fully implement the National Standard of Canada for Psychological Health and Safety in the Workplace.
About Excellence Canada
Michael Garron Hospital staff accepting Excellence Canada’s Mental Health at Work®Award of Excellence at the platinum level, October 29, 2015. Patient Involvement. Engagement extends to patients. Each team designs a patient-centred care plan focused on relationships among the hospital staff, patient, patient family and colleagues. “Patient stories” provide frontline caregivers with the opportunity to learn more about the people they serve. It’s not all soft relationships. Process management and risk assessment are key. Work processes are continuously assessed for their impact on mental health. Feedback happens in daily “huddles,” weekly “check-ins” and annual appraisals.
Staff members need to be supported as they give care to patients. The hospital uses an ergonomist and an organizational psychologist, and an Improvement Team. The Future. The hospital is currently in growth mode, thanks in part to the largest one-time donation to a Canadian community hospital – $50M from the Garron family, to increase the focus on research and bedside services, as well as a new strategic direction under the guidance of new President and CEO Sarah Downey.
Excellence Canada is an independent, not-for-profit corporation that is committed to advancing organizational excellence across Canada. Since 1992, Excellence Canada has helped thousands of organizations become cultures of continuous quality improvement and world-class role models, through its Excellence, Innovation and Wellness® Standard and its four-level progressive methodology. As a national authority on Quality, Healthy Workplace®, and Mental Health at Work®, Excellence Canada provides excellence frameworks, standards, and independent verification and certification to organizations of all sizes in all sectors. It is also the custodian and adjudicator of the Canada Awards for Excellence program, of which the Patron is the Governor General of H Canada. ■ Paul Crookall is executive director, National Capital Region, for Excellence Canada.
JANUARY 2017 HOSPITAL NEWS
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Nasal spray flu vaccine Why is it still offered in Canada? By Dr. Samira Mubareka s healthcare providers, we know that the best protection against the influenza virus is to get the flu shot. For children, there are two options for influenza vaccination: the intranasal live attenuated vaccine (the nasal spray) or the inactivated vaccine (the shot). However, deciding which method to use in children has recently become more confusing. The Centers for Disease Control and Prevention (CDC) in the U.S. announced that, based on the data they had collected, the nasal spray was not effective last flu season. As a result, many parents have been asking their health care providers whether they should be giving the nasal spray flu vaccine to their children. So, why are we still offering the nasal spray flu vaccine in Canada? And how should we respond when parents inevitably ask why we aren’t following the U.S.’s lead in only offering the needle this year?
Flu strains change
First, it’s important to mention that researchers continue looking at vaccine effectiveness every year, and that the findings from Canadian data are different from the U.S. Using data from previous flu seasons, researchers work hard to predict which flu strain will be most prominent during the next flu season, months in advance. This means there may be yearto-year variation in how well the vaccine and circulating flu virus strains match. Still, significant protection against getting the flu is provided even during years where the vaccine isn’t a perfect match. Because the flu strain you’re being protected against is constantly changing, you should get the flu vaccine every year, and you should encourage your patients to do the same. Inﬂuenza can cause serious illness and death, particularly among the elderly, very young children, pregnant women and those with chronic medical conditions. As such, the flu vaccine is universally recommended in Canada.
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The intranasal live attenuated vaccine. It bears repeating that not everyone can get the flu vaccine, including babies younger than six months old (who are too young to receive it), making it essential that people who spend time with these vulnerable groups get the flu shot – including moms of infants.
Differences in data
Canada isn’t the only country that continues to recommend the nasal spray. In fact, the U.S. is one of only a few countries that are not recommending it this flu season. The difference comes down to different findings in studies conducted on either side of the border. In the data
that’s been collected in Canada and other countries, such as Finland and the United Kingdom, we haven’t seen the low level of effectiveness of the nasal spray that American studies have found. In fact, a recent Canadian study showed no difference between the two types of vaccine in terms of protection from influenza. While we can’t ignore the U.S. data, we must also keep our own data in mind. Though it can be difficult to understand how one country can make a recommendation that differs from another, the fact remains that the evidence was not strong enough for Canada to remove its recommendation of the nasal spray.
What should parents do?
Deciding between the nasal spray or flu shot can be difficult, particularly for a parent who has to make a decision about which to give to their child. Speak with your family physician about which vaccine method is best for your child. In addition to getting the vaccine, parents and children should be reminded of other ways to prevent the spread of the flu. It’s important to clean hands before and after using the washroom or handling food, covering coughs and sneezes with tissue (and disposing of the tissue immediately in the garbage) and then cleaning your hands. Practice healthy habits to keep the immune system strong, like having a balanced diet and getting enough sleep, and stay home from work, daycare or school when sick. These are all good habits to adopt, and will increase your chances of staying healthy through the flu season. I made sure my own children were vaccinated this year, one way or another. While one of my kids got the flu shot, the other got the nasal spray – he simply wouldn’t do it any other way. Sometimes, the decision comes down to how your child reacts to needles! As a parent, I’ll be keeping a closer eye on new data about the effectiveness of the nasal spray versus the shot. However, the most important thing is that my kids H received an influenza vaccine this year. ■ Dr. Samira Mubareka is a microbiologist and infectious diseases consultant at Sunnybrook Health Sciences Centre.
Five misconceptions about the flu There are many misconceptions about the flu, even among those of us who work in healthcare. Here are five of the top flu misconceptions you may hear people talk about this season: 1. “It’s really just a bad cold” The flu is not just a bad cold. Generally, people who have come down with the flu will say they’ve been “hit” with the flu – and that’s no exaggeration. Knowing the difference can make all the difference for everyone. Fever and chills are common flu symptoms, along with severe muscle pain and weakness. A sore throat, chest congestion and persistent cough are also signs that you’re suffering from the flu, not just a cold. 2. “I don’t need the vaccine. I never get the flu. Even if I were to get it, I’d get through it.” Chances are this individual, if healthy and hit with the virus, would likely recover with no complications. They would also likely spend time with family, relatives and friends – social circles that include the two most flu-vulnerable groups: very old and very young, and in some families, pregnant women. Transmission from an infected individual can cause serious complications and result in hospitalization for these vulnerable groups.
3. “I’ve got too much work. I’ve got to come in. And besides… it’s just a bad cold.” (see #1) Good work ethic is admirable and important, but the health of an individual and those around him/her is also important. Have a co-worker who’s got chills/high fever? Aches and pains? Persistent cough? It’s best to advise this individual to head home. 4. “I’ve heard of people getting the flu from the vaccine” The flu vaccine contains killed strains of the virus. People often associate the vaccine with a slight chill, sore arm, and not feeling 100 per cent. That’s not because they are coming down with the flu; it’s because they are experiencing an immune response. And that’s a good thing. The sore arm, however, is from the needle – and for those with a quiet fear of needles, there is the needlefree nasal spray vaccine option. This option contains live virus, so is not recommended for older or very young individuals, or individuals with pre-ex-
isting medical conditions or weakened immunity. No one can get the flu from the vaccine. But an individual can still get the flu even after getting the vaccine. However, evidence shows that being armed with the vaccine results in a less severe hit, should you get the flu. 5. “The flu vaccine doesn’t work anyway” Every year, the vaccine covers three strains of the flu virus: an H1N1 strain, an H3N2 strain and an influenza B strain. The nasal spray vaccine contains an additional influenza B strain. The influenza strains in this year’s vaccine have been updated to reflect what has been circulating over the last year. Don’t discount the flu vaccine based on what happened the previous year. The flu vaccine still provides, on average, 60 per cent protection against the flu. Think of it as a 60 per cent discount taken off the flu’s contagiousness – to you! www.hospitalnews.com
PROFESSIONAL DEVELOPMENT/CONTINUING MEDICAL EDUCATION/HUMAN RESOURCES
Building positive workplace cultures and addressing disruptive behaviours By Dr. Gordon Wallace uilding a culture of respect in any healthcare setting is critically important. A stable, collegial and productive workplace leads to safer medical care and positive outcomes for patients. It also results in better job satisfaction among healthcare providers, and higher rates of employee retention. However, establishing a respectful work environment is not always easy. In particular, disruptive behaviour on the part of physicians can undermine the healthcare setting, put patients at risk, and jeopardize a healthcare institution’s reputation. Nearly 73 per cent of respondents to the Canadian Association of Internes and Residents 2012 National Resident Survey reported experiencing inappropriate behaviour by others that made them feel diminished during their residency. Half of all respondents experienced this behaviour from physicians or nursing staff. The most commonly cited behaviours were yelling, shaming and condescension. According to a study in the Annals of Internal Medicine, approximately five per cent of practising physicians engage in recurrent disruptive behaviour. A comprehensive analysis of the Canadian Medical Protective Association’s closed cases of disruptive physician behaviour found that incidents of disruptive behaviour represented five per cent of all medical regulatory authority (College) cases, and five per cent of all hospital cases that the association dealt with. The majority of these cases ended up with unfavourable outcomes for the physicians involved, including communication and anger management courses, written or verbal admonishments, suspensions and practice limitations.
Nearly 73 per cent of respondents to the Canadian Association of Internes and Residents 2012 National Resident Survey reported experiencing inappropriate behaviour by others that made them feel diminished during their residency. Fortunately, the healthcare community is collectively working to eliminate disruptive behaviour in hospitals and other healthcare environments – recognizing the negative impacts that this conduct has on patient safety and staff. Key to successfully addressing disruptive behaviour is to first recognize that it is occurring. A widely used definition of disruptive behaviour is: “Any inappropriate conduct, whether in actions or in words, that interferes with or has the potential to interfere with quality healthcare delivery.” Examples of disruptive behaviour to be on the lookout for include: www.hospitalnews.com
1. Inappropriate words 2. Abusive language 3. Yelling and screaming 4. Shaming of other staff 5. Outbursts of anger 6. Throwing of medical instruments 7. Threats of unwarranted physical force Disruptive behaviour is rarely an isolated incident. At times, disruptive behaviour can be subtle. Instances of subtle disruptive beaviour include refusing to work cooperatively with others; being chronically late for meetings, scheduled appointments and surgeries; and paying more attention to e-mail than to discussions during meetings. Beyond showing a lack of respect for other people’s time and work, this type of behaviour prevents the proper functioning of the workplace and can put patients at risk. If left unchecked, disruptive behaviour on the part of physicians, and others, often worsens and can have short and longterm consequences. Healthcare providers working in a disruptive environment do not communicate effectively and may perform poorly in their jobs. Over the long-term, disruptive behaviour can lead to ineffective care, harm to patients and poor clinical outcomes. Providers subjected to a disruptive work environment may also become distracted, stressed, and suffer negative impacts on their personal health and relationships. Legislation and regulations are helping to raise awareness about disruptive behaviour. In every province and territory, legislation is now in place to address violence, harassment and safety in the workplace. In addition, many provinces have legislation that requires hospitals to report to Colleges any and all cases of physician suspensions or privilege restrictions due to misconduct. This is helping to foster a zero tolerance environment in healthcare for beaviour that is considered to be harmful to staff morale and patient safety. At CMPA, we feel strongly that disruptive physician behaviour requires a collaborative and tiered response from institutions. Healthcare institutions are well positioned to address these matters
in-house given their knowledge of the situation, the workplace and the individuals involved. An adversarial process at the College level should be avoided in favour of a step-by-step approach that includes early identification, proactive intervention, workplace assessment and remediation. Given their position, experience and influence, physician leaders have an important role to play in addressing disruptive behaviour on the part of their colleagues and subordinates. Doctors with formal leadership roles, such as chiefs of staff and department heads, can address disruptive behaviour in healthcare institutions by setting clear expectations, modeling exemplary behaviour, and emphasizing positive values and behaviours. Physician leaders should also set clear
expectations for professional conduct among residents and faculty, including consequences for non-compliance. Complaints about disruptive behaviour should be investigated and addressed promptly through a process that is transparent, fair and consistent. A single unprofessional incident may be subject to an informal intervention such as a “coffee conversation” with a colleague. If the behaviour recurs, or a pattern develops, a documented intervention with the physician’s supervisor would be appropriate. A persistent pattern of disruptive behaviour that is unresponsive to lower level interventions may require escalation to a higher authority, with further documentation and an action plan put in place. Finally, failure to respond to the authority intervention could lead to disciplinary action and sanctions. Taking steps to address disruptive physician behaviour is not always easy. But it is necessary to build a respectful and collegial workplace that puts patient safety first. The CMPA will continue to work with physician leaders, healthcare institutions and other stakeholders to enhance civility in the workplace. Physicians and other hospital leaders are encouraged to develop transparent policies and procedures that incorporate a graduated and fair approach to addressing disruptive behaviour. Patience and due process are important for all involved. Finally, do not forget the emotional impact that disruptive behaviour can have on staff, physicians and hospital leaders. Ensure that the necessary supports are in H place to enhance resilience. ■ Dr. Gordon Wallace is Managing Director of Safe Medical Care at the Canadian Medical Protective Association.
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JANUARY 2017 HOSPITAL NEWS
10 Nursing Pulse
Nurses in the courtroom
Whether acting as juror or witness at a coroner’s inquest, nurses play a vital role in the analysis of evidence and creation of recommendations that help build stronger health and social systems. By Kimberley Kearsey ike hundreds of other Ontarians summoned by the Ministry of the Attorney General for jury selection, RN Laura Jackson wasn’t quite sure what to expect when she arrived at Toronto’s Superior Court of Justice in the fall of 2015. She never gave much thought to being selected as a juror, nor did she know much about the troubled life and tragic death of a little girl named Katelynn Sampson. Over the next five months, as one of five jurors at a coroner’s inquest into the young girl’s murder, Jackson would put her life on hold to examine how the girl slipped through the cracks and died in 2008. “It had such a huge impact on my life,” the mental health nurse says of her role as a juror, and her introduction to Sampson. “I think the ﬁrst day in court we heard the 911 tape... a few days in, we heard from the forensic pathologist and saw the images of Katelynn. Seven years old and she had about 70 wounds on her body. Those images are still in my head.” Sampson’s biological mother, who struggled with addiction, signed an informal agreement in 2007 to hand over legal guardianship of her daughter to her friends Donna Irving and Warren Johnson. The pair would later plead guilty to beating her to death, and are now in prison. Irving called the Children’s Aid Society asking to have the girl removed from their care just months before her death. Because Irving is half-Anishinabe, her call was passed along to Native Child and Family Services, creating another layer between Sampson and the support systems she needed to help her. The warning signs leading up to that call – and following it – were glaring. Worried school officials called Children’s Aid, but no action was taken. The recommendations of a coroner’s inquest can lead to important modifications in policy and legislation, and Jackson is hopeful that will happen with at least some of the 173 recommendations she helped to develop when the Sampson inquest wrapped up in April 2016. Advocating for children is the central lesson the 38-year-old RN says she’s taken away from her experience as a juror. In fact, it is the basis for the jury’s first and most important recommendation known as Katelynn’s Principle; the notion that every child be seen, heard and respected when it comes to any and all decisions about their care. “This (inquest) was a huge chunk of my life,” Jackson says. “And it was not easy. We got close to 400 exhibits… there were 13,000 pages of disclosure… we had to sit through days and days of evidence.” She says they set a record for the amount of time it took to deliberate, but reflects back that there was no way they could have combed through all of the information in less time. “It had a huge impact on all of us and we wanted to get through it, but we also wanted to do it right. We had to make sure we understood everything.” The experience was emotionally exhausting, Jackson adds, but “I’m glad I did it.”
HOSPITAL NEWS JANUARY 2017
“I think I’m a better clinician because of this experience,” she adds. As an RN, Jackson understands accountability and knows the skill that goes into assessing people in need. That “… was absolutely useful,” she says, but stops short of suggesting her expertise had any direct bearing on the jury’s recommendations, since those were based entirely on the evidence presented in court. “You have to go through the inquest process with that neutrality,” she explains. You have to “go in with an open mind and let the evidence speak.”
Even though an inquest isn’t about laying blame… you always have staff who are second-guessing themselves and feeling a whole gamut of emotions. It is a difficult time for everyone. The role Jackson played in the Sampson inquest is unique because her nursing background wasn’t a factor in her selection as a juror. Nursing background and skill comes into play far more often when RNs are involved in inquests as witnesses. This happens if the death of a patient is being investigated, and if the nurses involved in that patient’s care have information that will help in the investigation. “If you have knowledge of (the circumstances surrounding a death), you can be subpoenaed to attend,” explains Tim Hannigan, a lawyer for the Registered Nurses’ Association of Ontario (RNAO) who has helped its members through the inquest process. Although the roles of juror and witness are equally important to the legal process, the latter is often associated with far more pressure and anxiety around what it means on a professional level. “Anyone getting pulled into something like this is understandably nervous about it, and what the implications of it might be,” explains Hannigan. He eases some of that concern by clarifying a coroner’s inquest is not de-
signed to lay blame. “It should not have a result that nurse A or nurse B is responsible,” he says. In fact: “If the jury were to try to assign blame, the coroner would not accept that.” Dig a bit deeper and Hannigan does warn nurses that there may be implications from an inquest that affect them down the road. “Depending on how the evidence unfolds, there may be red flags raised about the behaviour of certain people involved. From the perspective of, say, a family…if they have a civil suit…(the evidence given at an inquest) may mean they double their focus on a particular person. (The inquest) may influence how the civil suit proceeds.” Hannigan’s advice to nurses in this regard: “Approach everything as if it’s as serious as something that could be the focus of a coroner’s inquest. Always document as if you are one day going to be on the stand testifying about it.” Wendy Fucile, RNAO past president and a nursing instructor at Trent University, has been in a number of leadership roles in the acute care setting and has provided testimony at several inquests. “I think coroner’s inquests are an incredibly important part of our system. It’s a privilege – maybe a bit scary, but still a privilege – to be able to be part of trying to make it better.” That said, some inquests are harder than others, Fucile admits. Looking back to the 90s, when she was a witness at an inquest into the death of an elderly patient in Peterborough, Fucile recalls “… it was… as is every inquest I’ve been to…an incredibly sad moment. You have family that has lost someone. You have a life that is gone. Even though an inquest isn’t about laying blame… you always have staff who are second-guessing themselves and feeling a whole gamut of emotions. It is a difﬁcult time for everyone.” Fucile has discussed her experience at inquests with first-year nursing students who are often shocked that a nurse can be called upon to testify. It’s important that they realize this is a real possibility for any RN, she says. It’s also important that the nursing perspective has been heard during legal proceedings. Fucile was called upon as president of RNAO to provide testimo-
ny at the investigation into the 2005 death of Jeffrey James, a patient at Toronto’s Centre for Addiction and Mental Health. James was restrained for five days and died after being released from those restraints. RNAO requested standing at the inquest in 2008 because of the significance the investigation had to the nursing profession in a broad sense. With its system expertise, and its well-established and internationally respected process around the development of best practice guidelines, RNAO felt it could come forward and suggest there were systemic issues of staffing, especially around continuity of care and caregiver. In addition, RNAO wanted to suggest it could source evidence and create a tool that could be used to improve the safety of patients. “I think the degree to which you feel heard is the degree to which you see the recommendations (of the jury) acted on,” Fucile adds. “Any recommendation is just words on paper until someone does something with it.” There is always a fear that the jury’s recommendations may end up on a shelf, collecting dust. That was the hardest thing about the inquest process for Jackson. During the Katelynn Sampson inquest, recommendations made in 2014 by the jury examining the death of Jeffrey Baldwin were presented as evidence. Baldwin was another child who slipped through the cracks and died at the hands of his caregivers. “We know several recommendations just sat there,” Jackson laments. “We haven’t seen any changes.” “I hope people pay attention,” she adds for the sake of another Jeffrey or Katelynn. “I hope these agencies actually step up to the plate. They’ve made some changes, but a lot of the (recommendations touch on) things they still need to do.” The hardest part to accept is that they might not do anything, Jackson says, acknowledging the jury’s recommendations are not H binding. ■ Kimberley Kearsey is managing editor/ communications project manager for RNAO. This article was originally published in the September/October 2016 issue of Registered Nurse Journal. www.hospitalnews.com
THE 15TH ANNUAL
Professional Development & Education
Professional Development and Education
Sunnybrookâ€™s critical care obstetrics education program earns kudos By Marie Sanderson he Women & Babies Program at Sunnybrook Health Sciences Centre knew change was coming. It was 2008 and plans were underway to move the hospitalâ€™s Women & Babies Program, including a high-risk obstetrics program and level 3 Neonatal Intensive Care Unit, from its downtown Toronto location to the organizationâ€™s Bayview campus. The transition meant a shift to caring for more medically complex obstetrics patients also receiving treatment from Sunnybrookâ€™s brain sciences, cancer, heart, trauma and critical care areas. Recognizing the change in the patient population that would accompany the move of services in 2010, program leadership identified and planned opportunities for critical care education within the program. A critical care education program existed at George Brown College for intensive care unit nursing staff. Eight birthing unit nurses enrolled in this program to enhance their expert obstetrical knowledge. â€œI completed the course feeling confident I could meet the needs of patients and their families,â€? says Leigh Andrews, Advanced Practice Nurse in Sunnybrookâ€™s Women & Babies Program. â€œMembers of the team can now care for a pregnant
Members of the obstetrical nursing team at Sunnybrook who completed advanced critical care education to support care for the hospitalâ€™s complex patients.â€? woman who also has cardiac or renal disease, or a woman receiving treatment for cancer.â€? The education program has been cited as a leading practice in a new report, â€œObstetrics Services in Canada: Advanc-
Schulich School of Business injects healthy dose of real-world expertise into its MBA Healthcare Specialization Canadaâ€™s growing healthcare industry expected to account for $4.3-trillion by 2030
Three things in Canadian life are certain: Death, taxes and a future of rapid healthcare sector expansion due to one of the fastest-aging populations in the Western world. The healthcare industry currently accounts for over $219-billion (or $6,000 for every Canadian), with private and public spending in this industry projected to reach $4.3-trillion by 2030. This is in contrast to other sectors that may experience slower growth or even decline. Such accelerating growth will create unprecedented opportunities for advancement for those currently working in the healthcare industry or those just entering the industry, as long as they have the right managerial credentials, said Joseph Mapa, Executive Director of the MBA Health Industry Management Program at Schulich School of Business at Torontoâ€™s York University. â€œThis is an ideal time for health industry practitioners and professionals to invest further in their human capital as we prepare for tremendous future challenges and opportunities,â€? said Mapa, who is also CEO of Sinai Health Foundation and past and founding President and CEO of Sinai Health System, formed after the amalgamation of Mount Sinai Hospital, Bridgepoint Active Healthcare, Lunenfeld Tanenbaum Research Institute and Circle of Care, a home care organization. â€œThe healthcare industry has never been so in need of highly specialized business leaders to drive innovation, creative thinking and change as the healthcare landscape evolves to meet the challenges of demographic and systemic changes,â€? said Mapa. Thatâ€™s why so many part-time and full-time MBA students have enrolled in Schulichâ€™s Health Industry Management Program (HIMP) since its launch in 2004, he said. Mapa works closely with Program Director Amin Mawani, Associate Professor and Graduate Diploma Coordinator, in helping to shape the strategic direction of the HIMP program. Mapa has also served as an Executive-in-Residence, adjunct professor, mentor and executive advisor to the program and Schulichâ€™s Career Development Centre. The Health Industry Management Program (HIMP) builds on Schulichâ€™s established strength in management fundamentals, delivering an industry-focused curriculum, intellectual content and career-based development. The goal of HIMP is to enable students to leverage their learnings in pursuing exciting career opportunities and growth in this dynamic sector. 'UDZQIURPPDQ\GLVFLSOLQHV6FKXOLFKÂśV+,03IDFXOW\DUHH[SHUWVLQWKHLUÂżHOGVDQGSOD\ leading roles in the private and hospital sectors as CEOs, entrepreneurs and consultants; LQWKHSXEOLFVHFWRUDVSROLF\DGYLVRUVDQGHFRQRPLVWVDQGLQWKHQRWIRUSURÂżWVHFWRUDV consultants, board members and administrators. Graduates of Schulichâ€™s MBA HIMP work in a variety of progressive roles such as program managers, directors, analysts, planners and consultants in the government, private and public healthcare sectors. Core HIMP courses include: Business of Healthcare; Strategy in Healthcare; Economics of Healthcare; and Entrepreuneurship and Innovation in Healthcare.
HOSPITAL NEWS January 2017
ing Quality and Strengthening Safetyâ€?, co-authored by Accreditation Canada, Health Insurance Reciprocal of Canada, Canadian Medical Protective Association and Salus Global Corporation. The overarching goal of the program was to establish an innovative model of care for critically ill women with co-morbidities in the perinatal period. â€œA driving force was the desire to maintain the proximity of each woman with her baby or babies,â€? explains Dr. Jo Watson, Operations Director for the Women & Babies Program, who oversaw the development of the education program. â€œHistorically, an acutely ill woman would be moved to the intensive care unit or transferred offsite, with their baby or babies remaining in the postpartum unit under the care of their partner and family.â€?
The overarching goal of the program was to establish an innovative model of care for critically ill women with co-morbidities in the perinatal period. Program leadership, including Monica Nicholson, Patient Care Manager, consulted with universities and colleges, in addition to networking internally within Sunnybrook to determine the best approach for ensuring staff were prepared to care for pregnant women with complex medical conditions. A partnership with George Brown College was formed to ensure a relevant and unique curriculum for the hospitalâ€™s nurses. To date, 37 staff, including nurses and educators, have completed the program at George Brown College. This innovative model of care minimizes multiple transfers to different units, decreasing the potential for knowledge translation errors and enhancing patient safety.
Photo: Kevin Van Paassen
â€œDay-to-day obstetrical nursing now involves interprofessional case conferences and drawing upon those with expertise in critical care, mental health and cancer,â€? says Leigh Andrews. â€œIâ€™ve seen firsthand the boosted morale among staff who have taken ownership of creating a safe environment for our patients and families.â€? Formal surveying found 100 per cent of nurses who completed the critical care course changed their nursing practice. The nurses also reported higher confidence, improved critical thinking and decreased anxiety when caring for critically ill patients. Leigh recalls a woman, 28 weeks pregnant, who presented in triage with a fever. Both mother and baby were declining quickly, with an eventual diagnosis of meningitis and septic shock, and the baby was delivered by emergency Caesarian section. During her eight days in the cardiovascular intensive care unit, under induced coma for five days, the patient was seen by an interprofessional team including obstetrical nurses working alongside neurology and critical care to ensure breastfeeding support and postpartum care. â€œA poignant moment was witnessed by the entire team from several areas of clinical focus. The mother was in a decreased state of consciousness and the baby was placed on her skin-to-skin,â€? says Leigh Andrews. â€œHer arm automatically came up around her baby and her vital signs settled.â€? This case, and many others, spurred the hospital to create an innovative corporate policy to facilitate mothers and babies staying together, as well as a policy on supporting breastfeeding for women who are hospitalized and acutely ill. â€œThis recognition by Accreditation Canada for the development of a formal process enabling an interprofessional team to care for complex patients is extremely gratifying,â€? adds Dr. Jo Watson. â€œSunnybrook will continue to develop innovative practice to enhance the care and manageH ment of critically ill obstetrics patients.â€? â– www.hospitalnews.com
Professional Development and Education
Reimagine Your Career in the Dynamic Healthcare Sector
The Schulich Health Industry Management Program (HIMP) is an industry-focused MBA specialization at Canada’s top-ranked business school. The program focuses on the public and private healthcare sector, as well as innovation and entrepreneurship, delivering real-world applications and a solid base of understanding of this highly complex industry. Schulich’s Health Industry program provides the robust training, networking opportunities and career development that will deliver on the healthcare sector’s burgeoning need for highly-specialized management practitioners.
To learn more, contact: Amin Mawani, Program Director: email@example.com Joseph Mapa, Executive Director: firstname.lastname@example.org
schulich.yorku.ca /mba /himp
Canada’s Top-Ranked Business School Schulich MBA: #1 IN CANADA (The Economist, Forbes, CNN Expansión, América Economía, eFinancialCareers.com) #1 IN THE WORLD (Corporate Knights) Kellogg-Schulich Executive MBA: #1 IN CANADA (Financial Times, The Economist ) #5 IN THE WORLD ( The Economist )
Global Reach. Innovative Programs. Diverse Perspectives.
January 2017 HOSPITAL NEWS
Professional Development and Education
Unique medicine and horsemanship workshop By Jennifer Garland
“Whenever doctors are interacting with a patient, doing uncomfortable invasive things or having to impart bad news, we really need to have the patient’s trust. This is exactly the point of the work with horses, because the handlers need to use gentle, non-verbal cues to persuade the horse what to do. The horse gains the trust and becomes a willing partner. This is exactly what we need patients to do – to join us in the healing effort rather than being afraid of what we are doing to them. With patients, like with horses, it is up to the doctor to figure out what works best with each.” – Dr. Allan Hamilton, Professor of Neurosurgery, University of Arizona orking with horses in equine experiential learning programs are becoming increasingly effective for individuals who’ve experienced trauma, compassion fatigue or who are seeking greater mental health and wellness. But can a horse help those of us in healthcare become better healers? A unique program called Medicine and Horsemanship offered by The Mane Intent is based on the premise that horses can help healthcare professionals improve their communication skills and ultimately, their relationships with patients and their
families and other healthcare professionals. Reconnecting healthcare professionals with their empathy for others is the overarching goal of this program, helping people to adopt a whole-minded approach to medical care. Horses are fantastic teachers and natural coaches. When we work in partnership with them, they simply reflect back to us any self-limiting perceptions, while helping us close the gap between how we actually present ourselves to others and how we think we are being. This is a unique experiential learning opportunity and offers up
a profound way to change the delivery of healthcare and to help change the world for patients and their families. By working with a variety of horses, both hands on and at a distance, participants learn about boundaries, leadership and teamwork; they tune into emotions, intuition and body language. They also learn to make decisions with greater clarity and compassion. The Mane Intent offers a variety of health and wellness workshops, individual and team effectiveness coaching and leadership development working in partnership with horses as natural coaches at a farm 90 minutes north east of Toronto. Open to medical students, resident physicians, physicians, nurses, and allied health professionals including paramedics, the Medicine and Horsemanship Workshop is a unique opportunity for healthcare students and practitioners to develop greater awareness of the subtleties of selfpresentation and communication necessary for the provider-patient relationships and other professional interactions. All exercises with the horses are completed on the ground and are guided by a professionally certified coach and experienced facilitators. No previous horse experience is required.
The Medicine and Horsemanship Program is built on the founding principles of The Manual of Medicine and Horsemanship by Dr. Beverley Kane of Stanford School of Medicine. This concept of bringing together Medicine and Horsemanship began at the University of Arizona in 2001. It was conceived and taught by Professor of Neurosurgery, owner of Rancho Bosque, and Parelli Natural Horsemanship practitioner, Allan Hamilton, M.D. Workshop participants work with the horses at The Mane Intent, with a shared focus on: • Becoming aware of the subtleties of verbal and non-verbal communication
Redeﬁning Health Care:
CY LI PO LT H EA H N O E GU O AL DI A |F all 20 16 Iss ue I
A Dialogue on Health Policy
A New Source for Health Policy Debate The Ontario Hospital Association (OHA) has launched a new health policy journal, Redefining Health Care: A Dialogue on Health Policy. This biannual publication will provide in-depth perspectives and analysis on the issues, trends, research and best practices in health care and systems improvements. The first issue, available from the OHA now, is focused on the theme of health system restructuring and the creation of new models of care. As a starting point for analysis, the OHA commissioned a research paper by Dr. Ross Baker and Dr. Renata Axler of the University of Toronto to determine what elements make up a high-performing health care system. What are other leading health care systems from around the world doing to drive high performance? How do patients define high performance? This anchor article answers these questions and provides a framework for planning and assessing structural change.
The Ontario Hospital Association’s health policy journal Designed to support our hospitals and partners, this biannual publication will provide in-depth perspectives and analysis of the issues, trends, research, and best practices in health care.
HOSPITAL NEWS January 2017
The publication also takes an in-depth look at the Patients First Act with a feature interview with Dr. Bob Bell, Deputy Minister of Health and Long-Term Care, as well as commentary from Dr. Gregory Marchildon, Ontario Research Chair in Health System Design at the University of Toronto. Other articles examine the benefits of integrated care models, including rural health hubs as well as bundled payments. Finally, this issue includes case studies from many of our members, including the Centre for Addiction and Mental Health (CAMH), Manitouwadge General Hospital, and St. Mary’s General Hospital. Moving forward, the next two issues will examine hospital-physician relationships and patient- and family-centred care. If you would like to contribute to the publication, or if you would like to receive a hard copy, please contact email@example.com.
Visit www.oha.com/journal to view the ﬁrst issue.
Professional Development and Education â€˘ Improving attention, mindfulness and focusing abilities â€˘ Becoming aware of congruency of intention versus behaviour â€˘ Identifying and respecting boundaries in ourselves and others â€˘ Recognizing the nature of projection and transference â€˘ Developing conďŹ dence in decision-making and ultimately, â€˘ Enhancing the doctor-patient relationship â€œAs a physician who has spent many years with them, I know that working with horses in a structured learning environment opens doors to self-awareness, and can teach us much about life. The Medicine and Horsemanship Program teaches an approach that will improve interpersonal skills, communication, leadership and teamwork â€“ skills that arenâ€™t always part of the formal curriculum for new doctors and other healthcare providers. This program helps the healthcare provider improve the doctor-patient relationship by emphasizing compassion and respect, to the benefit of the provider, the patient and their families,â€? says Dr Bob Henderson, Trent Hills Family Health Team; former physician representative, Trent Hills Physician Recruitment and Retention Committee; and Larkin Health Professional Educational Award Recipient (2011). The Mane Intent has previously partnered with the Trent Hills Physician Recruitment Committee and Campbellford Memorial Hospital to offer the Medicine and Horsemanship Workshop to physicians and health service providers in Northumberland County.
â€œThis workshop taught me an incredible amount both professionally and personally. This program will change how I look at each patient and challenge at work,â€? says Sarah, Paramedic, Medicine and Horsemanship Workshop Participant. This workshop is intended to help healthcare providers hone their awareness of the subtleties of communication necessary for successful patient-provider relationships. Because health sciences often focus on intellectual proficiency over other forms of intelligence, some healthcare
providers have not finely developed the emotional intelligence and/or empathic sensitivity required for successful patientprovider interactions. Horsemanship requires an appreciation of the non-verbal messages that we give to others. It requires patience, gentleness, self-confidence and sensitivity. Horses are large prey animals whose very survival has depended on becoming attuned to their surroundings. Horses reflect back to us the signals and intentions of which we arenâ€™t even aware at times.
For more information on the Medicine and Horsemanship Workshop, please contact: Jennifer Garland at firstname.lastname@example.org or visit the web site at www. themaneintent.ca For participating physicians, Medicine & Horsemanship Course qualifies for CME credits under: http:// H www.cfpc.ca/Mainpro_M2/ â– Jennifer Garland is the Owner/Program Director of The Mane Intent, offering Wellness Workshops and Effectiveness Coaching. She provides consulting support to health care sector clients as President, The Cactus Group.
FOOT CARE ACADEMY is raising the standard of professional health care delivery in Canada. Working abreast with other educational institutes and groups across the country, we provide courses needed, to registered nurses and registered practical nurses and allied health staff based on clinical practice guidelines. Our entire course includes infection control practices, and the health information protection act; ethics, values and principles are some key elements health care providers need to show in their daily practices. BASIC ADVANCED AND DIABETIC FOOT CARE COURSE
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Become a CDE or, maintain your CDE designation Course Code: DE102 Course Duration: January 15, 2017 (09:00-17:00) Cost: $599 plus tax Based on CDAâ€™s Clinical Practice Guidelines (2013)
We offer various comprehensive professional development programs ranging from 1 to 5 days, depending on the course. We are proud to offer the most in-depth and involved training currently available for health care providers, onsite our Pickering location or, at various long term care facilities throughout Ontario. Our reasonably priced program fees include the cost of textbook, ZRUNERRNDQGHTXLSPHQW(DFK)RRW&DUH$FDGHP\JUDGXDWHHDUQVDFHUWLĆ“FDWHXSRQVXFFHVVIXO completion of the desired course. Foot Care Academy training programs are recognized by the department of Veterans Affairs Canada, the Canadian Association of Vascular Nursing and the Canadian Association of Foot Care Nurses. In addition to our education program, we also maintain up-to-date clinical guidelines on various policies including infection prevention and control as well as the health information privacy act. PROGRAM INFORMATION 1. DIABETES EDUCATOR PROGRAM (PRIMER) This course is Based on Canadian Diabetes Associationâ€™s Clinical Practice Guidelines(2013), a one day course (Sundays), LW SUHSDUHV WKH KHDOWK FDUH SURYLGHU WR VLW WKH &HUWLĆ“HG 'LDEHWHV (GXFDWRU ([DP LQ 0D\ Participants include Nurses Physiotherapists, Registered Dietitians, Social workers, Occupational Therapists and other health care professionals. 2. PRINCIPLES OF WOUND CARE MANAGEMENT A three day course (three consecutive Saturdays), for health care professionals interested in learning how to prevent, manage and treat various kinds of wounds based on clinical practice guidelines as per Canadian Association of Wound Care. 3. BASIC ADVANCED AND DIABETIC FOOT CARE7KLVGD\FRXUVH0RQGD\)ULGD\ LVRIIHUHG weekly to Registered Practical Nurses and Registered Nurses, includes Ankle Brachial Index measurement and best practice guidelines for Infection Prevention and control. Theoretical and practical exercises are included.
FOR MORE INFORMATION Visit our website at: www.footcareacademy.ca Phone: 905-839-0080 Address: 210-1550 Kingston Road, Pickering ON, L1V 1C3
ĆŠĆĽĆžĆšĆŹĆžĆŻĆ˘ĆŹĆ˘ĆĆŽĆŹĆšĆ WWW.FOOTCAREACADEMY.CA Ć&#x;Ć¨ĆŤĆŚĆ¨ĆŤĆžĆ˘Ć§Ć&#x;Ć¨ĆŤĆŚĆšĆĆ˘Ć¨Ć§ĆĆĄĆšĆ§Ć¤ĆŹ www.hospitalnews.com
January 2017 HOSPITAL NEWS
Professional Development and Education
Portal to HIV education resources Gateway to latest clinical research and practices By Caroline Dobuzinskis he website for the Clinical Education and Training Program at the BC Centre for Excellence in HIV/AIDS (BC-CfE) was created in 2014 to provide educational information regarding HIV to clinicians and healthcare professionals. Since its launch, it has received accolades and served to provide both online and inperson training to hundreds of healthcare providers, community members and patients across Canada. The site has a wealth of free tools and information for both patients and their caregivers, including updates in HIV treatment, guidelines and research. For the use of patients and their families, there are lists of resources and community-based supports in British Columbia, searchable by region. A major goal of the Clinical Education and Training program is to increase the number of healthcare providers in British Columbia â€“ and nationwide â€“ who have the specialized training to help meet the unique needs of patients living with HIV. This will, in turn, lead to increased retention in care and better health outcomes for individuals living with HIV. By ensuring patients are accessing treatment, the health and longevity of people living with HIV can be improved while reducing the chances of HIV transmission. This is the
Dr. Silvia Guillemi (left), with a medical resident, assisting a patient. concept behind the Treatment as PreventionÂŽ strategy, which serves as the foundation for the BC-CfE Clinical Education and Training Program. The program helps to meet patients where they are by expanding access to
state-of-the-art care within their own communities. A range of training is offered to healthcare professionals, allied health professionals, community frontline workers and health science students throughout British Columbia and Canada.
A major goal of the Clinical Education and Training program is to increase the number of healthcare providers in British Columbia â€” and nationwide â€” who have the specialized training to help meet the unique needs of patients living with HIV
&GUCHHCKTGUGPUCPVČ•Ĺ&#x;Đ› Au Canada depuis septembre 2014, je comptais me trouver un emploi rapidement dans le domaine de la santĂŠ, surtout grĂ˘ce Ă mes nombreuses CPPČ•GUFĹŚGZRČ•TKGPEGGPVCPVSWĹŚKPĆ’TOKGTRWKUIGUVKQPPCKTG.CVČŽEJGUĹŚGUV CXČ•TČ•GRNWUNQWTFGČŒUWTOQPVGTĹ&#x;CRTČ”URNWUKGWTUTGHWULGUWKUVQODČ• FCPUNGFČ•EQWTCIGOGPVGVPGUCXCKURNWUXGTUSWKOGVQWTPGT 7PLQWTEĹŚGUVWPCOKSWKCXCKVXČ•EWFGUFKHĆ’EWNVČ•UUKOKNCKTGUSWKOĹŚCRCTNČ• FĹŚWPRTQITCOOGRQWTNGURTQHGUUKQPPGNUHQTOČ•UČŒNĹŚČ•VTCPIGTFCPUNG FQOCKPGFGNCUCPVČ•KEKOČ–OGČŒ1VVCYC#RTČ”UCXQKTEQOOWPKSWČ•CXGE GWZOCXKGCEJCPIČ•
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For example, physicians and other healthcare professionals can access a full range of online free-of-charge courses developed by BC-CfE experts â€“ targeted to physicians, nurse practitioners, allied healthcare professionals and others. The online course, â€œWorking Together: Interprofessional Care in HIV,â€? provides an introduction to providing interdisciplinary care and support for people living with HIV. This course is targeted at diverse teams of clinicians, nurses, community workers and allied healthcare professionals. â€œHIV Diagnosis and Managementâ€? offers comprehensive and evidence-based knowledge about the diagnosis and management of HIV/AIDS. This course was recently updated in September 2016 and certified by the College of Family Physicians of Canada (CFPC) for 10 Self-Learning Mainpro+ certified credits. In addition, the website hosts recorded videos of various educational events, ranging from biweekly clinical rounds for hospital staff to public lectures featuring speakers working in the field of HIV/AIDS from various health, research and medical disciplines. Regular webinars, conducted in partnership with Positive Living B.C, are
broadcast live and offer opportunities for care providers and community members in remote rural regions to access information about HIV and to interact with BC-CfE experts from afar. For physicians, the BC-CfE Clinical Education website provides a link to the University of British Columbia Department of Family Practice R3 Enhanced Skills program in HIV /AIDS. The program offers a variety of clinical placements for three months. Preceptees get in-person, handson experience in providing primary and specialized care to HIV positive patients. The accredited Intensive Preceptorship Program offered by the BC-CfE supports the professional growth and development of primary care practitioners within British Columbia. The multi-modular training program consists of an online course, clinical placements and a three-month mentorship. The program was developed in 2011, and has since trained more than 57 family physicians and 19 nurse practitioners from across the province. This has led to a significant impact on the number of patients seen by those physicians and on the health outcomes of their patients. The Intensive Preceptorship Program was recognized in 2016, with the CFPC Continuing Professional Development Award for providing an exceptional learning experience to practicing CFPC members. â€œThe BC-CfE is providing a pathway to accessible resources, educational programs and information on the treatment of those with HIV,â€? says Dr. Silvia Guillemi, Director of the BC-CfE Clinical Education and Training Program and assistant medical director at the Immunodeficiency Clinic (IDC) at St. Paulâ€™s Hospital. Visit the Clinical Education website today: http://education.cfenet.ubc.ca/. For more information about any of the Clinical Education programs at the BC Centre for Excellence in HIV/AIDS, please contact H us at Education@cfenet.ubc.ca. â– Caroline Dobuzinskis is a Communications Coordinator at The BC Centre for Excellence in HIV/AIDS. www.hospitalnews.com
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January 2017 HOSPITAL NEWS
Professional Development and Education
Getting serious with serious games in health professionals’ education By Gilda Salomone ames have always been played in all cultures to amuse and distract. If you’ve ever played a quiz game like Jeopardy, you have experienced the emotional thrill of getting answers right and doing so before your opponents. Time goes by quickly, and you become completely immersed in the activity. Although all games have rules and involve competition, not all are designed solely for entertaining. When games have an educational purpose, they are called serious games. The use of games as learning tools is growing in environments such as defense, engineering, politics and healthcare. Dr. Jeff Wiseman, an Internal Medicine physician at the Royal Victoria Hospital of the McGill University Health Centre (RVH-MUHC), assistant professor of Medicine at McGill University and core member of the McGill Centre for Medical Education, is currently developing a serious medical smartphone-based game called The Deteriorating Patient with the aim of helping medical students learn how to stabilize severely ill patients when on call. He gives us the nitty-gritty on serious games and their applications in medical education.
What are the benefits of using games for educational purposes?
Serious games can be a powerful tool to engage students. We are emotional people, and competition is filled with emotion. That’s why playing a game for many human beings is so exciting. It’s that thrill of just barely being able to meet a challenge and triumphing over adversity that many, not all, human beings enjoy. We become so involved in an activity that nothing else seems to matter.
Are there disadvantages to serious games?
Serious games should not be used carelessly: they can take time to develop and may lead to unintended negative learning outcomes such as learning how to win the game rather than learning how to be a better health professional. We have to choose a precise educational problem for which there is no other similarly effective teaching method. We also have to ensure this problem can be successfully transformed into a serious game. Many developers want to develop a game first and foremost without asking themselves the question ‘Why do I need this game?’
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How can serious games be used to teach medical students and residents?
Serious games can be excellent training tools. They can help students prepare for emergency situations, for example. A patient’s health can deteriorate quickly, so we need to take action fast, many times with incomplete information. These stressful situations are challenging to learn and involve mental and emotional aspects. Students can practice thinking through emergencies with dolls and real equipment at the McGill Medical Simulation Centre. That’s effective, but also expensive and time consuming. Serious games, on the other hand, promise to achieve similar learning outcomes, with the benefit of being cost effective and easy to implement, particularly for less experienced learners. This would free up the Simulation Centre for use by more experienced learners. You use a simulation called the Deteriorating Patient in a course called ERRAD (Early Recognition of and Response to Acute Deterioration), given to fourth-year medical students about to become residents. How does this simulation work? A simulation is a representation of a real-life situation: people take on roles, perform tasks and face the consequences of their decisions and actions. In the De-
Is a simulation a serious game?
A simulation becomes a serious simulation game if one adds to it the elements of competition, rules and a visible measurable goal. An example of this is “SimWars”, a competition where teams attempt to solve the same simulation scenario with the goal of saving a life fastest and with the best outcome, as judged by a panel of experts. You are developing the Deteriorating Patient smartphone app. Why? The main reason is, again, educational. With an app, students can practice on their own on a patient’s case over and over
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HOSPITAL NEWS January 2017
teriorating Patient simulation, I tell my students ‘Imagine you are the physician on first call during the night shift on an inpatient ward. You are called by the ward nurse because “Mr. Smith looks terrible, with a blood pressure of 80/60.” What do you do?’ Students have to take a series of steps to treat the patient as successfully and as quickly as possible. If you make mistakes, the patient can worsen and even die. As a tutor, I adjust the game according to learners’ level, coach them and record every action for debriefing. The idea is to offer students a safe, relevant challenge in a way that’s supportive, inspiring and mutually trusting.
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Professional Development and Education again until they get things right and save the patient’s life. Results are then analyzed by a tutor who gives students feedback on their recorded performances. That’s called deliberate practice with feedback. My students suggested we go further and add a scoreboard and develop an online community. I’m working in collaboration with experts in Educational Psychology, Learner’s Emotions and Computer Science and hope to be able to fully implement the app into the ERRAD course by 2017. Once the app works for medical students, we’d like to use it to teach nurses. The idea is to transform the Deteriorating Patient app into an interprofessional educational tool.
highly adaptive. We also hope to discover more about how students’ emotions can help or hinder learning.
You are also a researcher at the Research Institute of the MUHC (RI-MUHC). Can the Deteriorating Patient app be used as a research tool?
We hope to get educational psychological data on adaptive expertise and learners’ emotions. Doctors have to develop two types of expertise: reproductive expertise – where you do something over and over again to a high degree of precision, and adaptive expertise – where you have to come up with quick, optimal solutions for problems that are constantly evolving. Almost all of the research in medical expertise has been in reproductive expertise. By conducting research related to adaptive expertise, we can better understand how people learn from cases that change dynamically over time and what makes them
You’ve been involved in medical education for more than 30 years. What drew you to this area?
As a physician, I can personally look after 20, 30 patients on a ward. But as an educator, I magnify the effect of my knowledge and experience by teaching many other health professionals to care for far greater numbers of patients. Medical education is one of the “basic sciences” of health professional education, just like bio-
Above: “Serious games can be excellent medical training tools,” says MUHC physician and educator Dr. Jeff Wiseman. Left: Dr. Wiseman is transforming a simulation used in the classroom into a smartphone-based app called Deteriorating Patient. chemistry, anatomy and physiology. Education is a critical enabler of the translation of basic research into clinical practice. Like fresh water education is essential, but easily taken for granted. In terms of return on society’s investment, education gives you a
“big bang for the buck.” Derek Bok, a former president of Harvard University, once said ‘If you think education is expensive, H try ignorance.’” ■ Gilda Salomone is a Communications Officer at The McGill University Health Centre.
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January 2017 HOSPITAL NEWS
P10 Professional Development and Education
The key to addressing changing patient needs By Michael Oreskovich ngoing nursing education is the key to ensuring that clinical staff continues to keep up with increasing patient demands at Runnymede Healthcare Centre. According to Ontario’s Action Plan for Seniors, in 2017 people over the age of 65 will outnumber children under age 15 in the province for the first time. As one would expect, older patients require more support from the healthcare system and are likely to have more complex needs compared to other age groups. This represents an unprecedented challenge to healthcare organizations across the country. Specializing in rehabilitation and medically complex care, Runnymede is profoundly affected by the shift in patient demographics and complexity. The majority of its patients are over the age of 75 and in 2015/16, its patient complexity was ranked second highest in the Toronto Central Local Health Integration Network (TC LHIN). “Continuing education is essential for us to meet the increasingly complex needs of our patients,” says Runnymede’s VP of Patient Care, Chief Nursing Executive and Chief Privacy Executive, Raj Sewda. “We saw our RPNs (registered practical nurses) as a vital resource with
Runnymede supports its nursing staff with continuing education so they can work to their full scope of practice and meet the needs of increasingly complex patients. great potential to enhance the quality of our patient care, so we invested in them with education to help them work to their full scope of practice.”
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Mental Health Nursing certificate program In any given year, one in five Canadians experience a mental health or addiction problem and almost a third of Canadians who seek mental health care report that their needs are unmet or partially met. Given these statistics licensed registered nurses and registered practical nurses (RN/ RPN) need to possess the knowledge required to treat patients suffering from mental health issues. Durham College’s Mental Health Nursing certificate program provides front line nurses with the training they need to be successful in their field. The program, based on the Standards for Mental Health Nursing in Canada, prepares RN/RPNs with theoretical knowledge and hands-on clinical practice, and is associated with the Ontario Shores Centre for Mental Health Services in Whitby, Ont., as its training partner and curriculum collaborator. Areas of study, which are completed online, consist of five theory courses, however students may choose the Interprofessional Psychogeriatric Best Practices elective which is offered as an in-class course at Ontario Shores. The program also includes a clinical component. Upon completion, graduates will be granted a mental health certificate indicating they are equipped with the skills necessary to assess, provide interventions and advocate for mental health clients in a variety of institutional and community settings. Those practicing in the healthcare sector need to ensure they can meet the needs of those seeking help. Upgrading and expanding your skill set is the first step towards aiding those with mental health illness.
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HOSPITAL NEWS January 2017
Both RPNs and registered nurses (RNs) learn from the same body of healthcare knowledge, but RNs study for a longer period of time. Because of this, RNs provide independent care for the more complex, high-risk patients and guide colleagues in building their capacity and expertise. When RPNs are trained to work to their full scope of practice, they are more independent when providing care to lesscomplex patients. In turn, this increases the time that both RPNs and RNs can spend providing independent patient care, therefore enhancing the patient experience and increasing the effectiveness of service delivery.
When RPNs are trained to work to their full scope of practice, they are more independent when providing care to lesscomplex patients. To further invest in patient care, Runnymede introduced a new position to coordinate the activities of all clinical educators, and she hit the ground running. “Surveys were conducted with RPNs to establish a baseline for their learning needs, and then we worked together to tailor our educational tools to meet those needs,” says Kim Deroo, manager, professional practice and education. Training consisted of online modules, hands-on workshops, speaker sessions and also included one-on-one mentorship from the hospital’s team of clinical educators. Skill sets of RPNs were noticeably expanded as demonstrated by enhanced
technical expertise including: initiation of intravenous (i.v.) therapy, performing tracheostomy care and peripherally inserted central catheter (PICC) line care. They also enhanced their skills pertaining to clinical assessments and interpretation of diagnostic results. “Another outcome we witnessed is enhanced critical thinking abilities for these nurses, which really benefits everyone and adds to the overall quality of collaboration with other members of the clinical team,” says Deroo. “Today, I’m really proud to say our RPNs work to their full scope of practice, rely much less on guidance from their RN colleagues, and spend more time providing care for our patients.” In addition, the education has also improved the staff experience for the hospital’s RPNs. “Many of them told me that before receiving our nursing education, they didn’t fully realize the potential they had as healthcare professionals,” says Deroo. “Now our RPNs take more pride and ownership in what they do, and really appreciate the special investment that the hospital has made in their careers.” Runnymede supports its “you first” strategic direction by empowering staff to perform at the peak of their abilities. Continuing nursing education addresses this priority and contributes to an outstanding patient experience. “Healthcare needs of our patients and the local community are increasing in volume and complexity, and we’re working as efficiently as possible to continue to meet this challenge,” says Sewda. “Supporting RPNs with ongoing nursing education so they can work to their full scope of practice is an example of how we support our staff in the delivery of high-quality care and become more reH sponsive to patients’ needs.” ■ Michael Oreskovich is a Communications Specialist at Runnymede Healthcare Centre.
Professional Development and Education P11
Everything I needed to know about leadership, I learned as an operating room nurse By Helena Hutton s a young operating room nurse, a mentor of mine once asked me a very simple question: Why do operating room nurses wear surgical masks? I was always quite keen to contribute, so I launched into an explanation of how these masks serve a dual purpose. First, they help protect patients and the surgical environment from contaminants carried by healthcare providers. Second, the masks protect healthcare providers from being exposed to bodily fluids or other infectious materials. I then capped off my answer with a detailed description of regulatory requirements and industry best practices.
So often it’s the simplest lessons that are the most poignant, like listen first.
Knowing I had nailed the answer, I waited eagerly for a nugget of praise. My mentor just smiled and I knew that although technically correct, I was about to be taught a powerful leadership lesson.
She explained that the real reason that operating room nurses, especially those in a leadership role, cover their mouths with surgical masks is to remind them to always listen first and talk later. This turned out to be one of the best pieces of advice I’ve ever received. Not only did it help guide my 17-year career in operating room nursing, it also helped prepare me for my senior leadership roles in healthcare. Right now, I have the privilege of serving as Executive Vice-President and Chief Operating Officer of Southlake Regional Health Centre in Newmarket. As an administrator, my day-to-day responsibilities starkly contrast from my days scrubbing in as an operating room nurse. However, I am proud to say that many of the things I needed to know about leadership, I learned during my time as an operating room nurse. So often it’s the simplest lessons that are the most poignant, like listen first. Often, formal leaders do most of the talking, advising and directing. But I’ve found that one of the most effective ways to lead is by listening. We must really listen to our patients and families, our staff and our volunteers. Only then can we truly understand their needs and concerns, and serve them best. Early in my career, I also learned that the very best operating rooms can only deliver excellence in patient care if everyone is working as a team. No one can work in
Helena Hutton a silo. Everyone from the surgeon, surgical assistant, anaesthesiologist, as well as the nurses must work together. The most highperforming healthcare organizations are those who work toward a shared objective and truly value contributions at all levels. Similarly, leadership should be about enabling teams at the front line to provide the best possible patient care. Leadership can – and should – be demonstrated from every level of an organization. As leaders, we should be empowering our staff to speak up if they have an idea that could improve
the way we do things. Effective leadership is also knowing when to follow others. In fact, this is something we believe in so strongly at Southlake Regional Health Centre that we recently made Speak Up one of our core values. In doing so, we are making a commitment to recognize, uphold and improve service excellence across the organization. Over the years, I have always admired operating room nurse’s ability to innovate, problem solve and embrace change. And, all this has to be done in a highstress, time-sensitive environment. An operating room is not the place to crumble under pressure. Challenges must be faced head-on, and approached with creativity and flexibility. These are traits that any good leader must use on a daily basis. To this day, I still remember scrubbing in to my first procedure as a nursing student working in the operating room at the University Hospital in London. It was a major abdominal surgery, and I still recall the faces of everyone huddled around the table. I loved the teamwork, intensity and relentless commitment to excellence. I knew right away that this was the job for me. What I didn’t know, was that the lessons I learned in that operating room would prepare me for the leadership role H I’m grateful to have now. ■ Helena is the Executive Vice-President & Chief Operating Officer of Southlake Regional Health Centre.
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January 2017 HOSPITAL NEWS
P12 Professional Development and Education
An interdisciplinary team rehearses a breech birth using the new SimMom mannequin during an OB-GYN education day in the Allan Waters Family Simulation Centre. Photo by Katherine Cooper, Medical Medic Centre.
SimMom brings simulation closer to reality By Kelly O’Brien team of six healthcare professionals wheels a distressed mother into an operating room. Her baby is breech and the delivery is difficult. But when the team members hear the baby cry and confirm the mother is stable, relief washes over their faces. In the midst of all the action, it’s easy to forget the mother is a mannequin.
Excellence in Education
SimMom is just one of the simulation mannequins used in the Simulation Centre. Others include SimMan, SimBaby, and the Harvey cardiopulmonary simulator mannequin.
The Governance Centre of Excellence (GCE) offers annual educational programs on a variety of hot topics and foundational governance practices. In the form of larger multi-speaker conferences, small classroom-style certiﬁcate courses and online modules and webcasts, the GCE is focused on improving governance by providing boards with the practical, evidence-informed education, tools and resources they need at every stage of the trustee lifecycle. Learn more at www.thegce.ca/education
HOSPITAL NEWS January 2017
SimMom is a high-fidelity, or highly realistic, computerized mannequin that simulates five different childbirth scenarios, including breech birth. It is one of the most realistic models available: it can talk, has a pulse and has flexible joints that allow it to move as a real woman would. The mannequin was recently purchased by the Allan Waters Family Simulation Centre and the Department of Obstetrics and Gynecology to improve educational, quality improvement and other simulations. Dr. Michael Geary, chief of Obstetrics and Gynecology at St. Michael’s, says improving simulation was one of his main goals when he arrived two years ago.
“It’s possible to effectively recreate emergency scenarios using role play, but the value SimMom’s heightened reality adds is huge,” he says. SimMom was purchased in combination with low-fidelity, or less realistic, pregnant mom and baby simulators. Dr. Geary said this combination allows for comprehensive skills development days, such as those hosted by the More OB (Managing Obstetric Risk Efficiently in OB) program. Dr. Tatiana Freire-Lizama, a perinatologist and the More OB site co-lead at St Michael’s, said SimMom helps participants fully suspend disbelief to make the most of the development days. “You can actually help her pick up her legs like you would a real patient, and she feels a lot like a real person,” Dr. FreireLizama says. “People buy in a lot more when things are highly realistic.” But the mannequin itself is just one piece of the puzzle. “The tools are constantly improving, but creating an effective simulation is really about combining the features of the mannequin with the principles, information and scenarios we develop through the More OB program,” says Dr. Freire-Lizama. Dr. Geary, Dr. Freire-Lizama and Sharon Adams, a registered nurse and More OB site co-lead, said that one of the most valuable things about SimMom is that the simulations create an opportunity for people from different professional areas to come together and improve team processes. “There’s no point in having people who are individually great, but can’t work together,” says Dr. Geary. “Working together in these simulated situations improves moH rale, communication and team spirit.” ■ Kelly O’Brien works in communications at St. Michael’s Hospital. www.hospitalnews.com
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Are you new to Canada? / Nouveau au Canada? Do you want to improve your workplace communication skills? Participate in free Occupation-specific Language Training courses Workplace Communication Skills for Health Care • • • • • •
Workplace Communication Skills for Interprofessional Health Care Teams
dental hygienist • dietitian medical laboratory technologist • nurse medical radiation technologist • occupational therapist nurse • physiotherapist personal support worker • social worker sleep technologist Visit http://www.co-oslt.org for more information Pour de plus amples renseignements sur les formations francophones consultez : http://www.lacitedesaffaires.com/service-immigrants/flap.htm
To qualify, you must have training or experience in the fields listed under each course above. Also, you must be a permanent resident of Canada or protected person and your English/French must be at an intermediate level (Canadian Language Benchmark 6 – 8 for courses delivered In English or Niveaux de compétence linguistique canadiens 6 – 8 for courses delivered in French).
REVITALIZED DIPLOMA IN HEALTH CARE MANAGEMENT Engage. Inform. Inspire. Our health care system is complex and ever changing, which is why the OHA is committed to enhancing our educational offerings to meet the challenges faced by today’s health care professionals.
This new program will engage, inform and inspire health care professionals across the system. Learn more oha.com/diploma
The revitalized Diploma in Health Care Management is an 8-course program covering all essential topic areas of health care management, blending both theoretical and practical approaches in an interactive and engaging format. With each course ranging from one to three days, participants have up to ﬁve years to complete all eight courses.
January 2017 HOSPITAL NEWS
P14 Professional Development and Education
New program for healthcare providers integrates training in mental and physical healthcare n Ontario, over 1.3 million people experience mental illness and physical illness at the same time, and there is increasing evidence suggesting the need to integrate care for mental and physical health conditions, as they can often be interrelated. Healthcare providers often see patients in their daily practice who have increasingly complex co-existing mental and physical healthcare needs, but do not always have the most effective tools or training to best support them. Although there has been a growing focus to improve education for healthcare providers in this area, there remains a significant need for capacity building for frontline healthcare providers, including primary care and hospital teams, to improve care at this critical interface of mental and physical health. In order to better bridge the current education gap, Trillium Health Partners is offering a new continuing education program: the Medical Psychiatry Collaborative Care Certificate (MP3C). Initially launched in the Mississauga community, the program is being designed to equip healthcare providers from all disciplines with the tools and resources to better integrate mental and physical healthcare with
Medical Psychiatry Collaborative Care Certificate Education Session in Progress at Trillium Health Partners’ Mississauga Hospital. their patients. The Medical Psychiatry Collaborative Care Certificate is supported by the Medical Psychiatry Alliance (MPA), a collaborative partnership between Trillium
M I C H E N E R I N S T I T U T E CO N T I N U I N G E D U C AT I O N
Learning for the future
Continuing Education that evolves with our health care system For nearly 60 years, The Michener Institute of Education at UHN has been responding to the educational needs of Ontario’s health care system. Working with experts in their fields, the uniquely designed Continuing Education department at Michener is committed to lifelong learning and making education accessible to a diverse range of individuals with a variety of different needs. Utilizing their combined skills in educational design, online learning delivery and customer service, they have developed cutting-edge courses that are relevant and accessible to busy health care workers caring for our patients. As the incidence of chronic illnesses increase, as the population ages, and as new technologies and concepts emerge, Michener nimbly and creatively responds to the changes in our health care landscape with high quality learning. There are many benefits to accelerating your career with Continuing Education at Michener. Having options for online or hybrid learning means that we cater to different learning styles, and that you can take the next step in your career from the comfort of your home – anywhere in Canada or even the world. Our collection of graduate certificates offers health care workers opportunities for enhanced practice in areas like leadership, laboratory quality management, and diabetes education. Of note, Michener’s recent integration with the University Health Network in Toronto also creates exciting opportunities for new programs that will benefit learning for numerous health professions. Exciting offerings at the Michener Institute of Education at UHN include: • Graduate certificates in Diabetes Educator, Leadership, Quality Management, Intraoperative Neurophysiological Monitoring, Clinical Research, Clinical Management, and Imaging Informatics • Specialty courses in diabetes, and Working With Seniors: A Primer, developed in partnership with Baycrest. • Programs, workshops and seminars in Chiropody, Infection Control, Primary & Critical Care, Radiation Sciences and Medical Laboratory Sciences Interested in preparing yourself for the future of health care? Visit our website to see our online brochure and registration details at michener.ca/ce.
HOSPITAL NEWS January 2017
Health Partners, The Centre for Addiction and Mental Health (CAMH), The Hospital for Sick Children (SickKids), and the University of Toronto. The MPA is dedicated to transforming care for Ontarians living with co-existing mental and physical health conditions. “The focus ofour program is to ensure the right education and training tools are available to healthcare providers to treat the mind and body together. We need to help patients and their families to recover from both mental and physical illnesses with one plan of care and a unified approach,” says Dr. Alison Freeland, Vice President, Quality, Education and Patient Relations, Trillium Health Partners. In its initial phase, the Medical Psychiatry Collaborative Care Certificate includes three modules: • Bridging the Gap between Mental and Physical Health • Evidence and Models for Integrated Collaborative Care • Patients and Families as Partners in Integrated Collaborative Care Additional modules are planned in 2017 that will include focusing on quality improvement and best practices in team based, integrated care environments, along with skills and tools to facilitate and improve caring for patients with specific co-occurring mental and physical health needs. Teachers consist of a variety of experienced healthcare providers and community members, including Nurse Practitioners, Psychiatrists, Social Workers, Education Specialists, Family Physicians, as well as patients and family members who bring their perspectives and experience to the learners. “The goal of the Medical Psychiatry Collaborative Care Certificate is to provide training that will help healthcare providers care for patients who too often fall through the cracks of a healthcare system where mental and physical healthcare is typically
addressed separately, rather than together. What is remarkable about this training is the alignment of quality improvement, interprofessional education, and inclusion of patients as partners, helping participants implement more integrated mental and physical healthcare in their own practices,” says Dr. Sanjeev Sockalingam, Director of Curriculum Renewal, Medical Psychiatry Alliance, and Director of Continuing Practice and Professional Development, University of Toronto. Andrea Lamarre, a former Trillium Health Partners’ patient whose own experience with the healthcare system has prompted her to do further research on patient experience in her professional life, has signed up as a co-teacher for the Patients and Families as Partners in Integrated Collaborative Care module of the Medical Psychiatry Collaborative Care Certificate. “Part of my teaching includes reminding healthcare providers that being aware of how you as a person can impact care delivery for patients who are often vulnerable and may have experienced trauma in their lives – this helps put a human face on their diagnosis. What’s most groundbreaking about this education program for me is how my perspective as a patient was valued as equal to that of any other expert involved in the training,” she says. Since launching in September of 2016, the Medical Psychiatry Collaborative Care Certificate program had over 250 registrations and it keeps growing. In these early stages, participants are encouraged to contribute to the development and refinement of course offerings. As this work progresses, the program will be continuing consultations with current and future participants to understand the education gaps and requirements for integrated collaborative care across Ontario, with the hope of broadening the offering to more communities around the province. For more information, please visit H www.medpsychalliance.ca. ■ www.hospitalnews.com
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M I C H E N E R I N S T I T U T E CO N T I N U I N G E D U C AT I O N
Learning for the future See our brochure for full course listings
Graduate Certificate Programs Enhance your skills and prepare for new job opportunities with our popular graduate certificate programs. Diabetes Educator Clinical Management Imaging Informatics Leadership in Health Care Lab Quality Management Clinical Research Intraoperative Neurophysiological Monitoring
Online course delivery offers flexible learning designed to fit your busy schedule. Visit our website for more information about registration, and about other speciality courses and workshops offered at Michener. 222 St. Patrick Street | Toronto, Ontario | M5T 1V4 | www.hospitalnews.com
email@example.com January 2017 HOSPITAL NEWS
P16 Professional Development and Education
Bringing a climate change resiliency mentoring program to healthcare By Kent Waddington hanks to a $199,100 grant from the Ontario Trillium Foundation (OTF), the Canadian Coalition for Green Health Care, and partner health organization, University Health Network (UHN), is offering Canada’s first climate change resiliency mentoring program to Ontario’s health services sector. Together with UHN, the Coalition team is developing climate change resiliency best practices for healthcare facilities, which will integrate with and expand the Coalition’s Climate Change Resiliency Toolkit. Under the new initiative, collaborative learning groups will be established to train healthcare site facilitators to use the Toolkit at their sites and help organizations become more aware of their preparedness level for climate change incidents that might negatively impact their ability to deliver care during a disaster. Opportunities will also be explored to embed resiliency practices into existing healthcare priorities such as emergency planning and insurance. The Coalition’s mentoring partner, UHN, is no stranger to climate change leadership, having been the only Canadian hospital to win international Global Green and Healthy Hospitals awards presented during the 2016 UN Climate Summit in Paris. The mentoring program will help facilitate a greater understanding and use
Connecting Top-Quality Professionals with Premier Career Opportunities healthscapejobs.ca is a valuable service that helps our member organizations – and the broader health care community – with recruitment efforts and job searching.
For Job Seekers
Reach like-minded professionals and attract top talent by showcasing your current health care career opportunities to a broad network of health care professionals.
Get Started in 4 Easy Steps: 1. Visit healthscapejobs.ca 2. Create a job seeker account 3. Sign up for job alerts 4. Find your dream job!
For more information, please contact firstname.lastname@example.org
of the Coalition’s Health Care Climate Change Resiliency Toolkit to promote responsible resource stewardship within the health services sector. It will also serve to empower more individuals to reduce the negative impacts their health care organizations have on our environment while increasing infrastructure resiliency and abilities to cope with increases in health risks. Through facilitated discussions and expert advice, program participants will be much better prepared to undertake facility assessment and resiliency actions. Participation is FREE to organizations wishing to assess their facility’s resilience to climate change but space is limited. Participants will have exclusive access to peer mentoring, and take part in educational webinars, networking conference calls and will develop their skills as climate change resiliency champions in their organization. Participants will also have an opportunity to contribute to the national healthcare climate change resiliency conversation and be recognized for green leadership within their community. Program benefits are valued at approximately $15,000. If you are interested in increasing your facility’s climate change resiliency by increasing your knowledge of climaterelated risks and learning how careful planning now can help prepare your organization for the worst case weather scenario, contact the Coalition from the website at: http://greenhealthcare.ca/ H climate-change/mentoring ■
Education Opportunities for Today’s Health Care Professional Beyond the Classroom, Into the World Education can take many forms and exist beyond the traditional classroom setting. That’s why the Ontario Hospital Association (OHA) prides itself on embracing complementary education delivery models, including hybrid and blended learning sessions, certiﬁcate programs, online certiﬁcate courses and training modules. Topics are timely and relevant for today’s health care professional: • • • •
Clinical Communications Data/Analytics Finance/HSFR
• Hospital-Physician Relations • Health Human Resources
• • • •
Leadership Legislative Updates Mental Health Patient Safety/Risk
• Quality • Skills-Based • System Reconﬁguration
Learn more oha.com/education
HOSPITAL NEWS January 2017
Professional Development and Education P17
Gender equity in medicine Q&A with Dr. Sharon Straus, Director of the Knowledge Translation Program By Geoff Koehler r. Sharon Straus is director of the Knowledge Translation Program at the Li Ka Shing Knowledge Institute and deputy physician-in-chief of St. Michael’s Hospital. She’s leading a research project assessing gender equity in medicine and research at St. Michael’s and the University of Toronto.
Q. Is there gender equity in medicine and research? No, there’s not. At Canadian universities, women have outnumbered men for more than 20 years in undergraduate and graduate levels. But that trend doesn’t continue for more senior levels of academia. The higher the university rank, the lower the proportion of women. At St. Michael’s, 62 of our 206 research scientists are women. More than twice as many men as women are clinician scientists. Q. Why do these gaps exist? Unconscious bias is a contributing factor. How many of us, for example, have laughed at jokes about men being reluctant to ask for directions? Having biases doesn’t mean we’re bad people. Everyone is susceptible to unconscious stereotyping but it’s important to be aware of our biases so we can make efforts to minimize their influence.
Q. What needs to be done to bridge the gender divide? We need to detect unconscious gender bias. Take the Harvard Implicit Association Test (http://bit.ly/genderequitytest) and see how you do. Institutional structures also contribute to the discrepancy. We need a formal mentorship program for our scientists. Role modeling by women scientists helps encourage trainees to consider this pathway. Inviting more women to present at research or grand rounds would create more opportunities. We need to standardize recruitment processes to ensure searches are equitable and transparent. Women need to be represented on search committees and all committee members, women included, need to be aware of potential for unconscious bias.
ate strategies that we believe will bring a better balance. Q. Who is the female scientist in history you most admire? Rosalind Franklin is the person I admire most from history. Her X-ray studies contributed to the understanding of DNA’s double-helix structure but she passed away before the Nobel Prize was awarded for this work. As for active scientists, I really admire Dr. Deb Cook, who is a terrific researcher at McMaster University. Her work has impacted care worldwide and she’s an amazing mentor and a fantastic role H model. ■
Q. Is St. Michael’s making progress toward gender equity? We’re talking about this issue, which is a good sign. I’ve had the full support of the hospital’s research leadership and Department of Medicine in our work to close this gap but I don’t believe we’ll be “there” until our faculty reflects our training pool. It’s important to have women in leadership roles and Dr. Patricia O’Campo joined the Research Leadership Committee in April. The research institute will monitor recruitment and retention and will implement and evalu-
CONTINUING EDUCATION AT YOUR FINGERTIPS Keep current with our Professional Development Programs New courses added since your last visit.
Visit our Canadian Guidelines on Parkinson’s Disease portal and earn CME credits. Find out more about how we can help you serve your patients with Parkinson’s. www.ParkinsonClinicalGuidelines.ca email@example.com 1.800.565.3000 ext 3320 www.hospitalnews.com
January 2017 HOSPITAL NEWS
P18 Professional Development and Education
Northern exposure By Claudia Blume ost of Sein Youn’s work experience as a nurse has been in remote northern communities in British Columbia, such as Port Simpson, Kitkatla, Telegraph Creek and Anahim Lake. Her work at nursing stations in these communities entails a wide range of responsibilities: emergency and primary healthcare, health promotion and community capacity building. For much of the time, she and her colleagues are left to their own devices. Doctors only come to the communities for a few days each month, and are available for phone consultations the rest of the time. In 2015, Youn applied to work overseas for Doctors Without Borders/ Médecins Sans Frontières (MSF), and eventually went to Pakistan on her first assignment. She found that there were a lot of similarities to her work in the Canadian North. “Both jobs involve great responsibility and a lot of autonomy, and in both settings I had extensive protocols and guidelines to help my practice,” she says. Juniper Gordon, another nurse with extensive experience in northern BC, has also worked overseas with MSF since
2013. Among the similarities she found is that nurses in both contexts often have to make do with limited resources, and that access to higher levels of care can be challenging. “You need to be quite flexible when working in either setting. Things rarely go as planned and you have to roll with it,” she says. She adds that both contexts involve working in isolated areas, which means mainly socializing with work colleagues. In addition, access to internet and TV is often limited. “You have to get pretty comfortable with your own company and be able to manage the stress of living in isolation,” she says. Gordon points out that her northern experience has also taught her how to manage stressful situations and cope with a high workload in the places she has worked in with MSF, such as South Sudan, Jordan and Myanmar. Dr. AnneMarie Pegg first started her medical career as a community health nurse in Fort Simpson in the Northwest Territories, and later moved from nursing to medicine. She spent part of her medical training in remote northern areas and has for the past few years divided her time between practising medicine in Yellowknife
Juniper Gordon has worked with MSF in South Sudan, Jordan and Myanmar. and going on assignments overseas with MSF. Since 2008, she has been working in humanitarian projects around the world, from Haiti to Syria. She says that what humanitarians and medical staff in northern Canada have in common is not only flexibility but also professional courage. “It’s like going outside your comfort zone in order to practice,” she says. “I am not talking about cowboy-style medicine. But if you are part of a small team, in either context, you need to be prepared to face situations you have perhaps only seen once or twice before.” While there are many similarities, some aspects working with MSF are quite differ-
ent from the northern Canadian experience. “The context and the kind of injuries and illnesses you see when working with MSF are quite different,” says Gordon. Another difference is that contracts with MSF are often longer, a minimum of six months, and that the salary is lower. For many nurses, the main difference is that working with MSF involves a stronger management role compared to the more hands-on-work in Canada. “As a northern nurse I would be in charge of the clinic’s daily activities, and of managing two to five colleagues. In Pakistan I had to manage two departments with 25 to 30 staff,” says Youn. “And as the
NEW YEAR, NEW LEAN Introducing the OHA’s Partnership with KPMG We’re committed to providing ﬁrst-class educational programs and resources – and we’ve recently partnered with KPMG, a Canadian leader in delivering health care advisory services. What does it mean? You get to enjoy a new, robust offering of programs to advance your Quality Improvement initiatives and Lean implementation efforts. Some of these include:
• • • • •
HOSPITAL NEWS January 2017
White Belt Yellow Belt Green Belt Executive Green Belt Black Belt
Plus, you’ll have a chance to win a $1000 OHA Education Scholarship, applicable to any Lean program(s) of your choice!
Learn More oha.com/lean
Professional Development and Education P19
Above Left: Sein Youn went to Pakistoan on her assignment with M.S.F. Above Right: Dr. Anne Marie Pegg in Syria.
The organization is looking for medical staff with a broad mix of experience, ideally with a specialization in neonatology or pediatric intensive care, ER and trauma. Bilingual candidates are preferred.
medical team leader, I also had to manage the supplies for an entire hospital!” This is one of the reasons why many medical staff alternate between working with MSF and practising in Canada. “My work with MSF is now mainly management, so I don’t get so much hands-on clinical nursing experience at times. It’s nice to be able to come home and keep up my nursing skills,” says Gordon. Many medical aid workers say that the management skills they have gained overseas make them better nurses and doctors back home. “I can now better support my patients and the communities I work in,”
says Gordon. “When I am mentoring new nurses, I can better support them in managing the challenges of working in isolated settings with limited resources. Ultimately, I think my MSF experience has taught me the importance of taking the time to ask questions and to listen to people’s stories.” Owen Campbell, field human resources manager for MSF Canada, says that nurses and doctors with work experience in Canada’s north make ideal humanitarian aid workers, and are in high demand by the organization. “We see a definite positive relationship between the quality of the work done in the field and prior experience work-
ing in remote, northern communities.” The organization is looking for medical staff with a broad mix of experience, ideally with a specialization in neonatology or pediatric intensive care, ER and trauma. Bilingual candidates are preferred. Campbell says the organization is recruiting on an on-going basis and that there are opportunities for a long-term career with MSF, with professional development opportunities and the possibility to take on leaderH ship roles. ■ By Claudia Blume is press officer for Doctors Without Borders/ Médecins Sans Frontières (MSF) Canada).
November 6 & 7, 2017 Metro Toronto Convention Centre, South Building, Toronto ON healthachieve.com
FOOD, DRUGS, & ALCOHOL Are there addictions to such foods as ice cream and cake? What can science tell us about addictions to drugs (like heroin), alcohol, and tobacco? The scientifically-based six-hour course, “Understanding Addictions,” is designed to bring the health professional up to date on the causes and treatments for addictions. The course will cover the role of the brain in addictions. The seminar will be presented by two of North America’s leading scientists: Dr. Laura Pawlak (Ph.D., R.D. emerita) and Dr. Michael Howard (Ph.D.).
Mark Your Calendars and Save the Date! HealthAchieve is evolving once again and preparing for another amazing event. Mark your calendars, save the date and register for HealthAchieve 2017 today. Early bird rates now available for this spectacular two-day event scheduled for November 6 & 7, 2017.
Register today at healthachieve.com/registration
The seminar will be presented 6 times in Alberta Provence i Wed., Apr. 26, 2017, Radisson Hotel, 4520 - 76th Ave., Edmonton, Alberta; i Thu., Apr. 27, 2017, Radisson Hotel, 6500 - 67th St., Red Deer, Alberta; i Fri., Apr. 28, 2017, Clarion Hotel, 2120 - 16th Ave., NE, Calgary, Alberta; i Wed., May 10, 2017, Radisson Hotel, 4520 - 76th Ave., Edmonton, Alberta; i Thu., May 11, 2017, Radisson Hotel, 6500 - 67th St., Red Deer, Alberta; and i Fri., May 12, 2017, Clarion Hotel, 2120 - 16th Ave., NE, Calgary, Alberta. On each date the seminar times will be 8:30 AM to 3:30 PM
Dr. Pawlak will give the presentations in April. Dr. Howard will give the presentations in May. “Understanding Addictions” will examine the reward and pleasure system of the brain. The course will cover acute and chronic pain in dentistry and any addictions associated with pain-killers used in dentistry. The course will examine behavioral addictions related to shopping, video games, and smart phones. It will cover teenagers and addictive drugs. The seminar is sponsored by the Biomed Corporation, North America’s largest provider of live seminars for health professionals. Biomed neither solicits nor receives any gifts or grants from any entity. To obtain more information, please contact Biomed, Suite 877, 101-1001 West Broadway, Vancouver, British Columbia V6H 4E4 Visit Biomed’s Website www.biomedglobal.com 1.877.246.6336 (TOLL-FREE) OR 925.602.6140 FAX 925.363.7798 EMAIL firstname.lastname@example.org
January 2017 HOSPITAL NEWS
P20 Professional Development and Education BIOMED PRESENTS...
UNDERSTANDING ADDICTIONS: )22''58*6 $/&2+2/ A Seminar for Health Professionals TUITION $109.00 (CANADIAN)
The seminar registration period is from 7:45 AM to 8:15 AM. The seminar will begin at 8:30 AM. A lunch (on own) break will take place from 11:30 AM to 12:20 PM. The course will adjourn at 3:30 PM, when course compleWLRQFHUWLÂżFDWHVZLOOEHGLVWULEXWHG Registration: 7:45 AM â€“ 8:30 AM Morning Lecture: 8:30 AM â€“ 10:00 AM â€˘ Addiction and Brain Function: Perception, Thinking, Emotions, and Memory. Â‡ 'HÂżQLQJWKH7HUPVTolerance, Physiologic Dependence, Psychological Dependence, Addiction, and Pseudo-Addiction. â€˘ The Reward and Pleasure System of the Brain: Dopamine. How Activation of The Nucleus Accumbens Contributes to Addictions. â€˘ Key Elements of Addiction: Reward, Tolerance, Cravings, Loss of Control, and Continued Abuse. Mid-Morning Lecture: 10:00 AM â€“ 11:30 AM â€˘ Time, Tolerance, and Changes in Behavior: Distinguishing Normal Tolerance from Aberrant Behavior. â€˘ Hyperpalatable Foods and Addiction: The Siren Song of Sweet, Fat, and Salt. â€˘ The Five Types of Overeating. Why Food Addiction Undermines Dieting. Effective Treatments for Food Addiction. â€˘ Caffeine: Is it Addictive? Energy Drinks and Toxicity. Caffeine Withdrawal. â€˘ Understanding Addictive Drugs: Agonists and Antagonists. Lunch: 11:30 AM â€“ 12:20 PM Afternoon Lecture: 12:20 PM â€“ 2:00 PM â€˘ The Hidden Dangers of Alcohol: Intoxication, Alcohol Poisoning on College Campuses, Functional Alcoholism in the Workplace. â€˘ Opioid Addiction: Recognizing the Signs, Reducing the Risks. â€˘ The Dental Patient With Acute and Chronic Pain: Reducing the Risk of Drug Diversion, Misuse, and Addiction. â€˘ Dealing with the Double-Edged Sword: Helping Patients with Chronic Pain and Substance Use Disorder. â€˘ Smoking and Nicotine: Helping Patients to Quit. Nicotine Replacement, Varenicline, and Bupropion; Behavior Therapy, Vaccines, and Hypnosis. â€˘ The Vulnerable Years: Teenagers and Drug Addiction. Mid-Afternoon Lecture: 2:00 PM â€“ 3:20 PM â€˘ Gateway Drugs of Abuse: Nicotine, Alcohol, and Marijuana. â€˘ Marijuana and the Brain: Medical Marijuana. Smoking vs. Ingestion. Consequences of Legalization. â€˘ Cocaine, â€œCrack,â€? and Heroin: New Patterns of Use. Treatment Options. â€˘ Stimulants and Sedatives: Amphetamines, MDMA, and Ecstasy. â€œDesignerâ€? Methamphetamines. Ketamine as a New Date-Rape Drug. â€˘ Hallucinogens: LSD, Mescaline, and Psilocybin. Clinical Consequences and Complications. â€˘ Behavioral Addictions: Gambling, Shopping, Video Games, Internet Pornography, Smart Phones, and Tablets. Evaluation, Questions, and Answers: 3:20 PM â€“ 3:30 PM 6 CONTACT HOURS / www.biomedglobal.com
MEETING TIMES & LOCATIONS EDMONTON, AB Wed., April 26, 2017 8:30 AM to 3:30 PM Radisson Hotel 4520 76th Avenue Edmonton, AB TUITION:
RED DEER, AB Thu., April 27, 2017 8:30 AM to 3:30 PM Radisson Hotel 6500 67th Street Red Deer, AB
CALGARY, AB Fri., April 28, 2017 8:30 AM to 3:30 PM Clarion Hotel 2120 - 16th Avenue NE Calgary, AB
EDMONTON, AB Wed., May 10, 2017 8:30 AM to 3:30 PM Radisson Hotel 4520 76th Avenue Edmonton, AB
RED DEER, AB Thu., May 11, 2017 8:30 AM to 3:30 PM Radisson Hotel 6500 67th Street Red Deer, AB
CALGARY, AB Fri., May 12, 2017 8:30 AM to 3:30 PM Clarion Hotel 2120 - 16th Avenue NE Calgary, AB
CHEQUES: $109.00 (CANADIAN) with pre-registration. $134.00 (CANADIAN) at the door if space remains. CREDIT CARDS: Most credit-card charges will be processed in Canadian dollars. Some charges will be in U.S. dollars at the prevailing exchange rate. Note: some Canadian banks may add a small service charge for using a credit card. The tuition includes all applicable Canadian taxes. At the seminar, participants will receive a complete course syllabus. Tuition payment receipt will also be available at the seminar.
ACCREDITATION NURSES (RNs, RPNs, & LPNs) 7KLVSURJUDPLVGHVLJQHGWRSURYLGHQXUVHVZLWKWKHODWHVWVFLHQWLÂżFDQG clinical information and to upgrade their professional skills. Numerous registered nurses in Canada and the United States have completed these courses. This activity is co-provided with INR. Institute for Natural Resources (INR) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Centerâ€™s Commission on Accreditation.
PHARMACISTS & PHARMACY TECHNICIANS $OEHUWDOLFHQVHG SKDUPDFLVWV VXFFHVVIXOO\ ÂżQLVKLQJ WKLV FRXUVH ZLOOUHFHLYHFRXUVHFRPSOHWLRQFHUWLÂżFDWHV%LRPHGLVDQDFFUHGLWHG provider through the American Council on Pharmaceutical Education. The ACPE universal activity numbers (UAN) are 0212-9999-17-001-L01-P and 0212-9999-17-001-L01-T. This is a knowledge-based CPE activity.
Biomed, under Provider Number BI001, is a Continuing Accredited Provider Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RDâ€™s) and dietetic technicians, registered (DTRâ€™s) will receive 6 hours worth of continuing professional education units (CPEUâ€™s) for completion of this program/materials. Continuing Professional Education Provider Accreditation does not constitute endorsement by CDR of a provider, program, or materials. CDR is the credentialing agency for the Academy of Nutrition and Dietetics. This course has Activity Number 126190 and Suggested Learning Codes: 3000, 4040, 5350.
This activity is co-provided with INR. Social Workers completing this SURJUDPZLOOUHFHLYHFRXUVHFRPSOHWLRQFHUWLÂżFDWHV$SSOLFDWLRQIRUDSSURYDORI this course has been made to the ASWB for 6 hours of credit.
Biomed General is approved by the Canadian Psychological Association to offer continuing education for psychologists. Biomed General maintains responsibility for the program.
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Participants completing this course will be able to: describe the main brain functions that contribute to addictive behavior. explain the major ways that addiction changes the brains of addicts. describe how drugs mimic and alter neurotransmitters which provoke the psychological effects of addiction. explain the difference between drug dependence, tolerance, and addiction. describe the clinical consequences of addiction to food, opioids, street drugs, and alcohol. list and compare the major treatment options for legal and illegal drug addictions. describe how the information in this course can be utilized to improve patient care and patient outcomes. describe, for this course, the implications for dentistry, mental health, and other health professions.
SPONSOR %LRPHGLVDVFLHQWLÂżFRUJDQL]DWLRQGHGLFDWHGWRUHVHDUFKDQGHGXFDWLRQLQVFLHQFH and medicine. Since 1994, Biomed has been giving educational seminars to Canadian health-care professionals. Biomed neither solicits nor receives gifts or grants from any entity. 6SHFLÂżFDOO\%LRPHGWDNHVQRIXQGVIURPSKDUPDFHXWLFDOIRRGRULQVXUDQFHFRPSDQLHV Biomed has no ties to any commercial organizations and sells no products of any kind, except educational materials. Neither Biomed nor any Biomed instructor has a PDWHULDORURWKHUÂżQDQFLDOUHODWLRQVKLSZLWKDQ\KHDOWKFDUHUHODWHGEXVLQHVVRUDQ\ other entity which has products or services that may be discussed in the program. Biomed does not solicit or receive any gifts from any source and has no connection with any religious or political entities. Biomedâ€™s telephone number is: (925) 602-6140. Biomedâ€™s fax number is: (925) 363-7798. Biomedâ€™s website is, www.biomedglobal.com. Biomedâ€™s corporate headquartersâ€™ address is: Biomed, P.O. Box 5727, Concord, CA 94524-0727, USA. Biomedâ€™s GST Number is: 89506 2842.
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INSTRUCTORS Dr. Laura Pawlak (Ph.D., M.S., R.D.) (emerita) is a full-time biochemist-lecturer for INR. Dr. Pawlak undertook her graduate studies in biochemistry at the University of ,OOLQRLVZKHUHVKHUHFHLYHGKHUPDVWHUVDQGGRFWRUDOGHJUHHV$XWKRURIVFLHQWLÂżF publications and many academic books, she conducted her postdoctoral research in biochemistry at the University of California San Francisco Medical Center. Dr. Michael E. Howard (Ph.D.) is a full-time psychologist-lecturer for INR. Dr. +RZDUGLVDERDUGFHUWLÂżHGFOLQLFDOQHXURSV\FKRORJLVWDQGKHDOWKSV\FKRORJLVWZKR is an internationally-recognized authority on brain-behavior relationships, traumatic brain injury, dementia, stroke, psychiatric disorders, aging, forensic neuro-psychology, and rehabilitation. Biomed reserves the right to change instructors without prior notice. Every instructor is either a compensated employee or independent contractor of Biomed.
HOSPITAL NEWS January 2017
PROFESSIONAL DEVELOPMENT/CONTINUING MEDICAL EDUCATION/HUMAN RESOURCES
Investing in people to achieve their full potential By Catalina Guran ackenzie Health recognizes and believes that their great people serve as the most valuable asset and critical resource to organizational success. Core to achieving success is valuing, engaging and empowering its people. “Investing in our employees, physicians and volunteers through engagement and healthy workplace initiatives enables our people to reach their potential, which translates into an improved patient and family experience at the hospital,” says Stav D’Andrea, Chief Human Resources Officer at Mackenzie Health.
Learning and wellness academy
• Career Wellness – Empowers people to be engaged, feel valued, find satisfaction and be connected to Mackenzie Health. Through its Kudos Recognition Program, Mackenzie Health celebrates its people, including individuals and teams, who go above and beyond to create the best possible experience for patients, co-workers and other members of the community.
Workplace Engagement Advisory Council
In response to feedback received from employees, physicians and volunteers through engagement and culture surveys, Mackenzie Health recently established a
Workplace Engagement Advisory Council. “To foster an engaged workplace culture, the Council is another means to hear the employee, physician and volunteer perspectives across all levels of the organization in a timely and structured way that gets results,” says D’Andrea. The 23 council members from across all levels of the organization serve as ambassadors for their respective teams and Mackenzie Health’s values. The Council also represents an excellent opportunity to obtain feedback from a diverse perspective on initiatives that are being planned, as well as provide suggestions for improvement on a variety of workplace programs
and services, including wellness, workplace experience, recruitment, transformational change and much more. Time is reserved on its agenda each month for project leaders to attend, engage the Council and hear from a diverse front-line perspective. “An empowered and engaged workplace is the foundation for a positive and healthy culture at Mackenzie Health and our ability to deliver world-class healthcare,” says H Altaf Stationwala. ■ Catalina Guran is a Communications and Public Affairs Consultant at Mackenzie Health.
To help its people achieve their potential, Mackenzie Health developed and implemented a Learning and Wellness Academy which offers a multi-faceted and blended approach to learning, including learning and wellness opportunities, learning moments and eLearning modules. The various options and approaches to learning provide individuals with tools and skills to further their personal and professional development. Additional opportunities open to employees, physicians and volunteers include lunch ‘n learns, speaker series’ and bulletins consisting of impactful articles and tips to support ongoing learning.
The Pursuit of Wellness
An initiative for all employees, physicians and volunteers at Mackenzie Health, the Pursuit of Wellness program provides tools, information and support to set out on a journey to a happier and healthier self. “As Mackenzie Health grows into a two-hospital organization, we are committed to the continued pursuit of wellness of our staff members through physical, emotional, social, spiritual and career supports,” says Altaf Stationwala, Mackenzie Health’s President and CEO. “A direct outcome of our 2015 Culture Survey, the Wellness Program will feature events, programs and education on topics from nutrition and fitness to stress management and relaxation techniques,” adds D’Andrea. Staff members will have the opportunity to customize their own wellness journey based on their needs and goals by choosing to take part in a variety of programs and events designed to enhance professional skills, manage stress, make healthier choices and create a better work-life balance. The Pursuit of Wellness program will aim to enhance personal wellbeing for all aspects of life including: • Physical Wellness – Activities aimed to support physical wellness including walking, taking the stairs or just getting up from the desk to stretch, which can have enormous benefits for overall health, as well as mood, stress levels and productivity. • Emotional Wellness – Taking care of one’s emotional needs through programs like mindfulness, meditation, stress management and relaxation techniques, which can help boost confidence, manage stress and improve resiliency. • Social Wellness – Fosters a sense of belonging to the Mackenzie Health team and community and provides opportunities for positive social networking with coworkers. • Spiritual Wellness – Focuses on celebrating significant cultural holidays and helps people discover meaning and purpose in life, exemplifies values and creates an inclusive environment. www.hospitalnews.com
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PROFESSIONAL DEVELOPMENT/CONTINUING MEDICAL EDUCATION/HUMAN RESOURCES
Unlocking the formula for physician involvement How NBRHC created an innovative medical leadership structure through quality improvement initiatives
“The reason physicians get frustrated with administration and don’t want to participate is because we ask them to be sequestered for hours at a time [for meetings.”
By Lindsay Smylie Smith hen Paul Heinrich took on the role as President and CEO of the North Bay Regional Health Centre (NBRHC) in 2012, one of the first challenges he learned of came to him from the Chief of Staff at the time, Dr. Joseph Madden. Dr. Madden appealed to Heinrich to change up the existing physician leadership structure which, in Dr. Madden’s opinion, wasn’t working. Dr. Madden described a very informal structure, without clear roles and responsibilities and no real ownership – so most issues still ended up on the Chief of Staff’s desk. “Basically whoever drew the short straw was given the role. It wasn’t a sought after position,” Heinrich recalls, and he was looking to change that thinking. NBRHC as an organization was still in its infancy when Heinrich took over as CEO – born in 2011 from the amalgamation of the regional specialized mental health hospital and the district community hospital – and when he arrived the Health Centre was still working within two very separate cultures. “The initial layout of the medical leadership model actually had a Chief of Staff and Deputy Chief of Staff,” Heinrich says. Changing the organizational structure with the doctors and for the doctors was a natural progression of the unity Heinrich was looking to bring to the entire organization.
Don’t waste the doctors’ time
Kristen Vaughan is the Physician Engagement Quality Coordinator at the
(l-r) Dr. Joseph Madden, Pediatrician and former NBRHC Chief of Staff; Dr. Donald Fung, Anaesthesiologist and NBHRC Chief of Staff Paul Heinrich, NBRHC President and CEO; and Dr. Kevin Gagne, Anaesthesiologist and NBRHC Medical Director of Surgical Services meet to review the Continuous Quality Improvement Board located in the Chief of Staff office. Health Centre, and says the Medical Leadership model at NBRHC has come a long way since Heinrich and Dr. Madden spoke back in 2012. “When we decided to look at our model, it was important to us to first talk to our docs and find out from them what they needed to be successful,” Vaughan says. They quickly discovered through these consultations what would end up being the formula for NBRHC’s success. Heinrich summarizes it like this ‘don’t waste the doctors’ time.’ “The reason physicians get frustrated with administration and don’t want to participate is because we ask them to be sequestered for hours at a time [for meetings],” Heinrich explains.
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At the same time the hospital was changing the physician leadership structure, they were also rolling out the new quality management system across the organization – branded internally as More Time to Care (MT2C). MT2C actively involves patients, staff, physicians and volunteers in system transformation and quality improvement. “We started out looking to improve the process for physicians – but as a whole, the organization has now become more efficient at planning for quality improvement initiatives. Now we don’t waste anyone’s time!” Heinrich jokes. An added benefit of these efficiencies are a higher quality of care and an organizational savings of $25M in annual operating costs. The organization’s physician leadership structure now has three year terms – up from the previous one year term; clear definition of roles, responsibilities and accountabilities; and dedicated administrative time. “The dedicated admin time required an incremental investment,” Heinrich says, “but has paid off with engaged physicians.” The time allows the doctors to step away from their clinical practice up to one day a week for dedicated administrative time and access to office space adjacent to the other administrative offices. Some of the other changes include the move to a single Chief of Staff, presently Dr. Donald Fung, who has been in the top medical leadership role since the move to the new structure. Under his leadership, NBRHC has re-defined the medical departments; focused on physician involvement in continuous quality improvement, and promoted physician leadership and mentorship opportunities – especially for quality improvement initiatives.
Engaging physicians early
Dr. Kevin Gagne is an Anaesthesiologist and currently serves as Medical Director of Surgical Services. After arriving in North Bay in 2006, Dr. Gagne recalls being asked early on to take on a leadership role within his service.
He agrees that at that time it was seen to most as a burden, or an annoyance. “To most people it just looked like more meetings after work and listening to complaints,” Dr. Gagne says. Whereas most people in the role were ‘burdened’ with the role for a year and then gratefully handed it off to someone else, Dr. Gagne continued in the role for three years. After taking a few years off when he started his family, he then opted to return to the role. By this time, the new physician leadership model and MT2C was in place at the Health Centre. He says he appreciates how the roles and responsibilities are very clear in the new model. Dr. Gagne credits the success of the changes to Heinrich’s foresight to solicit input from the organization’s doctors early in the process. “It all happened at the right time,” Dr. Gagne says. “Having Paul as the CEO invest in the whole quality improvement philosophy and then bringing along the physicians at the exact time was imperative. You can’t induce major change at a hospital, benchmarking or otherwise, unless the docs are a part of it.” Dr. Gagne suspects that without all of the quality improvement processes and business management tools the organization has adopted, his role as Medical Director of Surgical Services wouldn’t be as gratifying. “I think it would be more frustrating. Now with metrics and targets, knowing how to use data, organize meetings – we are comparing apples to apples. I think the structure gives more of a voice to the physicians who are privileged here.” Heinrich notes that since the changes, NBRHC’s physicians have significant influence and participation in planning, quality improvement and resource management. “We work as a team while building leadership capacity in physicians within our organization,” Heinrich says. “We’ve built leadership for today, and are building H leadership for tomorrow.” ■ Lindsay Smylie Smith is a Communications Specialist at North Bay Regional Health Centre. www.hospitalnews.com
PROFESSIONAL DEVELOPMENT/CONTINUING MEDICAL EDUCATION/HUMAN RESOURCES
Investing in our people – psychological health, safety and wellness By Kristi Lalonde ith one-third of our lives spent at work, it’s important to feel safe, encouraged and supported while we’re there. For about 15 years now, Waypoint has supported employee wellness with a variety of initiatives, but the addition of the psychological health and safety component started to take shape in the last few years. The correlation between happy, engaged employees and excellent patient care is direct and undeniable, making the decision to adopt the National Standard of Canada for Psychological Health and Safety in the Workplace in 2015, and allocate the appropriate resources to develop a comprehensive program, an easy one for us. So many initiatives that aligned with the standards were already in place, including trauma support, an employee and family assistance program, mental health first aid and lifestyle management and fitness opportunities. Developing the program was just a matter of tying them all together and filling in the gaps. The hospital’s three year plan began in the summer of 2015 and includes policy development, a committee involving all stakeholders and a staff survey to help determine priorities. Along the way, we launched some major awareness campaigns including self-care
Anti-bullying and civility in the workplace promotions that had Waypoint staff awash in a sea of pink to show their support. promotion during mental health week and anti-bullying and civility in the workplace promotions that had Waypoint staff awash in a sea of pink to show their support. Once we got the results of the Guarding Minds@Work survey, we were able to drill down on our strength areas and identify where improvements were needed. With the committee structure in place and terms of reference drafted, the plan really started to come together. The first psychosocial factor we focused on is civility and respect in the workplace. According to Guarding Minds@Work,
organizations characterized by civility and respect create a positive atmosphere marked by high spirits and work satisfaction. This allows people to enjoy the environment, whether they are staff, clients or customers. Three recommendations under this theme were brought forward and relate to better management of breaks for clinical staff, clear communication standards for teams to ensure 24/7 information flow and topic consistency across the hospital, and guidelines to ensure feedback and accountability.
With October being healthy workplace month, the fall was filled with initiatives and targeted education in the name of getting civility and respect on the agenda. Our leaders attended mandatory education on bullying and harassment and enhancing work relations and were also offered a “Let’s Talk about Mental Health” session where they gathered with their peers to work through mockscenarios with the support of communications and health and safety staff. In addition, conversation kits were distributed across the hospital that included helpful tips for leaders on how to spark the conversation at their team meetings. An entire week of career/retirement planning workshops, a session on how to support someone with depression and a webinar about coping strategies for parents with children struggling with a mental, neurodevelopmental, or behavioural challenges were also on offer for all staff. And this is only the beginning. Work is well underway on psychological protection, which is the next psychosocial factor we are focused on. This is a long-term commitment for Waypoint and although we’ve come a long way, there’s still work H to be done. ■ Kristi Lalonde is Communications . Officer at Waypoint
Next ISSUE! FEBRUARY 2017 EDITION Annual Healthcare Infection Control Supplement
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Improving health and safety of hospital workers By Cindy Moser ncorporating practices and policies that help prevent injuries and disabilities among workers is essential to maintaining a healthy hospital workforce. However, knowing what practices and policies are actually going to make a difference is challenging. That’s where research from the Institute for Work & Health (IWH) can help. As an independent, not-for-profit Canadian research organization, the Torontobased IWH promotes the use of evidence among work-health professionals. It develops research-backed resources in two main areas: (1) workplace injury prevention and (2) recovery and return to work. Here is a quick look at recent research from the Institute – and the practical advice it gives rise to.
1. Add peer coaching to patient lift programs to reduce injuries
Adding a peer-coaching component to a patient lift program can result in a large drop in injuries related to patient handling – at a small net cost to the system, an IWH study found. This finding is based on an economic analysis of a peer-coaching program introduced in British Columbia across 15 longterm care facilities between 2006 and 2011. The facilities introduced peer coaching after finding the installation of ceiling lifts alone did not lead to their wide use. Although more than 90 per cent of the staff had been trained to use ceiling lifts, many went back to their old ways after a few months. With the peer-coaching program, designated care aides received training both on using the lifts and on getting others interested in using the lifts. They were then given one day a week to work side by side with other care aides, encouraging them, listening to their complaints and reservations, and showing them ways to make their jobs easier and safer. The peer coaching program led to a 34 per cent reduction in injury rates during the program time period – and a 56 per cent drop after the program was over. This further reduction showed that the benefits of reduced injuries lasted even after the program ended, reflecting the new skills gained as a result of the coaching. The total cost of the program was $894,000, and it delivered $748,000 in benefits. In other words, 84 cents was saved for every dollar spent on the program – representing a modest net cost to the system. “The challenge is that all the costs are borne by the long-term care facilities, and the savings largely go to the insurer or workers’ compensation agency,” says Dr. Emile Tompa, labour economist and senior scientist at IWH who led the study. “As a result, the right incentives need to be set up for health care organizations to support such a program.”
2. Coordinate management of operations and safety management to do better at both
Employers sometimes argue that focusing on occupational health and safety (OHS) compromises operational effectiveness. It’s the “trade-off” argument, which says organizations can choose to excel at operations or OHS, but not both. HOSPITAL NEWS JANUARY 2017
However, a recent study of nearly 200 organizations in Ontario found no evidence of a trade-off. Instead, it found that organizations focusing on both operations and OHS through “joint management system” (JMS) practices achieve the same operational outcomes (i.e. better cost, quality, delivery and flexibility outcomes) as organizations that emphasize operations over safety. What’s more, they also achieve many of the same OHS outcomes (e.g. fewer lost-time claims) as organizations that emphasize safety over operations. In essence, employers that adopt a JMS approach, which allows for the coordinated management of both operations and safety, do significantly better across the board compared to those that don’t. “The research provides empirical evidence supporting the integration of safety into operations, an idea that has been promoted by some OHS professionals based on their first-hand experience,” says Dr. Lynda Robson, one of two IWH scientists on the study research team.
hazards and the presence of three types of protection: (1) workplace policies and procedures; (2) worker awareness of OHS hazards, rights and responsibilities; and (3) worker empowerment to participate in injury prevention. The tool considers workers to be vulnerable to injury and illness when they’re exposed to hazards at work and inadequate protection in at least one of the three areas. “The underlying idea of the tool is that workers are vulnerable only if they’re exposed to hazards, but vulnerability is more than just being exposed to hazards alone,” says Dr. Peter Smith, an IWH senior scientist and the lead researcher on the team that developed the measure. “Hazards are an intrinsic part of the work in many industries and occupations. It’s when workers are exposed to hazards and also lack one of these other types of protection that they become vulnerable.” To download the measure, go to: www. iwh.on.ca/ohs-vulnerability-measure
3. Consider workplace-based resistance training to help prevent upper extremity MSDs
5. Prepare for challenges in returning employees with psychological injuries
Strong evidence suggests that implementing workplace-based resistance training can help prevent and manage musculoskeletal disorders (MSDs) of the upper extremity, which includes the neck, shoulder, arm, elbow, wrist and hand. Resistance training refers to exercises that cause the muscles to contract against an external resistance (e.g. dumbbells, rubber exercise tubing, own body weight, etc.) with the expectation of increases in muscle strength, tone, mass and/or endurance. This is the key finding of a systematic review recently conducted by IWH. The review team emphasizes that strong research evidence such as this is only part of evidence-based practice, which also incorporates the knowledge and experience of practitioners (e.g. occupational health and safety professionals) and end users (e.g. workers). “We are not saying that workplaces should rush to implement resistance training,” says Emma Irvin, head of IWH’s systematic review program and one of the lead investigators of this project. “However, we are suggesting that OHS practitioners consider it in their arsenal of prevention practices when it comes to upper extremity MSDs.” The review also found moderate evidence that stretching exercise programs (including yoga), workstation forearm supports and vibration feedback on computer mouse use have a positive effect on preventing and managing MSDs of the upper extremity.
4. Assess worker vulnerability to injury to help tailor prevention programs
A new evidence-based tool from IWH measures the extent to which workers may be vulnerable to increased risk of workrelated injury and illness. Called the OHS Vulnerability Measure, the tool can be used to identify and address OHS program weaknesses in order to prevent injury and illness. The 27-item questionnaire asks respondents about their exposure to workplace
People who file workers’ compensation claims for psychological injuries are less likely to be offered modified work and less likely to go back to work than those who file claims for musculoskeletal disorders (MSDs). This is according to an Australian-based research project that included two IWH senior scientists on its team. The study found psychological claimants: • are less sure about returning to their previous jobs; • are less likely to be contacted by their workplace’s return-to-work (RTW) coordinator; • are less likely to be offered and to accept modified duties; • face more negative reactions in response to the injury from supervisors and coworkers; and • experience more stressful interactions with healthcare providers, RTW coordinators and claims agents. According to Dr. Smith, one of the IWH senior scientists involved in the study, the results suggest workplaces don’t really know what to do when someone has a mental health injury. This needs to be addressed, he adds, given the growing consensus that work conditions can play a role in the development and exacerbation of mental health issues. “Regardless of the system under which chronic and acute psychological injuries are compensated, we need to start thinking about whether we need different return-to-work strategies for psychological injuries,” says Smith.
6. Consider screening for depressive symptoms in first six months post work injury
Depressive symptoms are common in the first year after people have been injured at work, and the first six months appear to be particularly important to an injured worker’s future mental health, an IWH study finds. According to the study, about half of injured workers feel many symptoms of depression at some point during the year after their injury. For most injured workers, depressive symptoms do improve over the
course of the year. However, the course of depressive symptoms in the first six months seems to be an important indicator of how well injured workers will likely feel by the year’s end. In other words, levels of depressive symptoms appear to stabilize at six months. “Our findings suggest that the first six months after a workplace injury are particularly important to an injured worker’s future mental health,” says IWH research associate Nancy Carnide, the author of the study. “This six-month period may be a window of opportunity to screen for symptoms of depression, and to provide the necessary support to those who need it, in order to prevent mental health problems in the future.”
7. Turn to existing benefits and accommodation programs to support workers with arthritis
A recent IWH study about workplace supports for people with arthritis suggests that many affected workers don’t feel they need frequent help. However, when they do need help, the study also finds that the benefits and accommodations needed – ranging from extended health benefits to flexible working hours – are often already being offered by employers. Workers who are able to access these supports often report better outcomes at work, which can mean less job disruption, greater ability to concentrate on tasks and fewer changes to work hours. “Our study suggests that providing benefits and accommodations to workers improves work participation,” says Dr. Monique Gignac, an IWH senior scientist and lead author of the study. “It also suggests that providing such support is unlikely to drain company resources.” There are things employers can do to help, and they’re not things that employers have to design from scratch, says Gignac. A lot of these things are policies or practices that companies are doing for other employees, especially as people age and start to have health problems. “What we’re finding is they can make a difference for people H with arthritis as well,” she adds. ■ Cindy Moser is a Communications Manager at The Institute for Work & Health STAY TUNED FOR MORE PRACTICAL FINDINGS The Institute for Work & Health has a number of projects on the go that will likely yield research findings of practical benefit to hospital workplaces. For example, IWH researchers are studying the implementation of workplace violence legislation in Ontario’s acute healthcare sector, the incidence of work-related aggression and violence in Canada, and the role of healthcare providers in the workers’ compensation system and return-to-work process, among others. To ensure you learn of these findings as soon as they become available, you can sign up for the Institute’s monthly e-alert, IWH News: www.iwh.on.ca/e-alerts www.hospitalnews.com
From the CEO's Desk 15
More innovation, more compassion, more heart:
Bringing mental and physical healthcare under one roof By Cathy Szabo n just a few months, Providence Care will begin delivering patient care in our brand new hospital. Our new building is leading-edge in many ways: it provides access to outdoor spaces on every level, all inpatients will have private rooms, and the technology incorporated throughout the facility will make it easier to communicate in real-time. Designed with the theme of ‘At the Water’s Edge,’ Providence Care Hospital draws in natural light to every space, and offers spectacular views of Lake Ontario. But what has me excited most is a principle Providence Care has applied to this redevelopment project from the start: No matter what diagnosis an individual has, they will have access to all support and services. Why do I say this? It is because Providence Care Hospital will be among the first publicly-funded hospitals in North America to fully integrate long-term mental healthcare with physical rehabilitation and complex care. For years, psychiatric care has been delivered in stand-alone institutions and hos-
pitals. Here in Kingston, it was 1859 when the Rockwood Asylum was established on the lakefront. While the early days of care at Rockwood and similar institutions across Ontario would shock us now, over time we have made remarkable reforms in how mental healthcare is delivered. As we worked with architects to design the building, we insisted that patients and their families have a say in what the hospital should look and feel like. Our frontline staff have also been active participants throughout the redevelopment process. Several innovations have been inspired by patient and staff involvement. We had long conversations over several weeks about whether the windows in patient rooms needed to be operable or not. It was a challenge because having windows that can open and shut can interfere with building heating and cooling systems. But we listened to the experts – our clients and our staff – and that led to the installation of window vents in each of the 270 inpatient bedrooms. This was important in particular to the people representing our mental health programs, who voiced the recovery and healing benefits of
not only the fresh air, but things like the sounds of children playing in the park or smells of freshly cut grass. Providence Care has a group of ‘Experience Advisors’ who are past patients and family members. They sit on committees to offer their perspectives and input. One of our advisors has been passionate about ensuring the new hospital is welcoming to children – even though our clinical programs serve adults. As a former client of mental health services herself, she points out the importance of being able to feel comfortable having your family visit during an inpatient stay. In April, when we move our hospital programs from our two current sites into the single, brand new Providence Care Hospital, we will be celebrating. By bringing together mental and physical health under one roof, we are saying that no matter what type of care you need – we want to give you the best care. More innovation, more compassion and more heart, at Providence Care H Hospital. ■ Cathy Szabo is President and CEO, Providence Health.
Providence Care Hospital includes: • 270 private inpatient rooms • A therapy pool, gymnasium and walking track • One main entrance, for all clients, visitors and staff • Dining rooms and social spaces on each unit • Natural light, colours and art through the building
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Effective working relationships between hospitals and physicians: This is Part 3 of our 3 Part Series on T Effective working
his is the third article of the series the Ontario Hospital Association (OHA) has published on the topic of hospital-physician relationships. The first article in this series, “Key Themes from the Literature” highlighted seven considerations to successfully foster and maintain positive relationships between hospitals and physicians. The second, “A Practical Approach to Enhancing the Relationship” provided strategies and guidance on developing and nurturing an effective hospital-physician relationship. Over the past year, the OHA has been consulting with hospitals across the province to better understand the current landscape in Ontario as it relates to hospital-physician relationships, both from a quantitative and qualitative perspective.
Results of online survey
In April 2015, the OHA conducted an online survey to evaluate the current state of physician relationships within Ontario hospitals and the strategies that hospitals and physicians were using to strengthen their relationship. The survey was sent to hospital Board Chairs, Chief Executive Officers (CEOs), Chiefs of Staff, Vice-Presidents of Medical Affairs, Department Chiefs and Medical Staff Association (MSA) Presidents to gain an understanding of the organizational structures and processes being used to foster effective hospital-physician relationships. Forty-eight per cent of Ontario hospitals responded to the survey (69 hospitals, 98 responses), and represented a variety of hospital types. Responses at each of these hospitals were provided by a variety of leaders. The chart below illustrates the common job titles of respondents to the survey. Respondents were divided into three groups, based on the individual respondents’ role within the hospital: (1) Corporate Leadership (e.g., Board, CEO, n = 27); (2) Senior Leadership (e.g., Chief of Staff, Vice President – Medical, n = 28); and (3) Clinical Leadership (e.g., staff physician, Chief Operating Officer, Chief Quality Officer, n = 43). Analysis of responses by respondent group illuminated a number of statistically significant differences in average responses between groups.
Corporate Leadership and Senior Leadership
Corporate Leadership and Senior Leadership groups responded differently when asked if their hospital promotes trust. Where Corporate Leadership had an average response of 3.97, Senior Leadership had an average response of 3.71; the difference was found to be statistically significant. Corporate Leadership and Clinical Leadership groups differed in their average re-
sponses to the statements on six of ten cultural aspects: 1) Hospital recognizes and values input of physicians; 2) Hospital welcomes innovative ideas and supports fresh approaches; 3) Hospital promotes trust, favours openness and transparency; 4) Hospital provides education and leadership training for physicians; 5) Hospital provides timely and accurate data to physicians to enable appropriate decisions; and, 6) Hospital use rewards and recognition strategies to acknowledge efforts by physicians. The differences in responses suggest that these groups may not be aligned in their views on cultural aspects that support positive hospital-physician working relationships. Further work may be required to explore these areas to ensure that the goals and priorities of “on the ground” leadership, often provided by physician leaders, are in alignment with the overall vision for the hospital.
Senior Leadership and Clinical Leadership
Senior Leadership and Clinical Leadership were the more closely aligned groups upon comparison. These groups only provided statistically significant yet different responses on one structural aspect: “Physicians actively involved at the board level”. The average response of Senior Leadership on this item was 3.5, where the Clinical Leadership response was lower, at 3.46. This difference suggests that physicians may not perceive their involvement as sufficient at the board level, or that physician involvement at the board level may not be communicated effectively to clinical staff. The survey also identified a number of common issues that generally impact the relationship with hospital management: financial resources; culture; leadership structure and processes; and information management. Resources (i.e. physician time and funding) were also highlighted as a major challenge by physician leaders during
the interviews, as was the need to develop strong physician leaders through leadership training.
Results of Informational Interviews
The majority of CEOs and physician leaders (e.g., Chief of Staff, Vice PresidentMedical) interviewed describe the relationship between their hospital and physician leaders as ‘good’ to ‘very good/excellent’ (15 of 17 CEOs interviewed and 9 of 11 physician leaders interviewed). Many indicated that there has been steady incremental growth in engagement and collaboration. Respect, trust and open communication were often noted as key ingredients for a positive relationship. The remaining CEOs and physician leaders, however, indicated that the current relationship is a ‘work in progress’ or ‘strained’, largely attributed to lack of engagement, poor communication, and lack of trust, which they are working to overcome through more open and transparent communication, and structured engagement of physician leaders. Interviewees were asked to identify the top three enablers of an effective relationship between hospital and physician leaders. The most commonly noted enablers were: • Physician Engagement: To engage physicians at all levels and as early as possible in the change process, give them formal roles so they are part of the change process, build trust, have meaningful engagement, transparency and respect; • Leadership Development: Provide leadership development, recognizing that strong physician leadership goes a long way to enabling the work of the hospital, provide physicians with the skills and supports for team-based problem solving, and recruit the right individuals; • Inter-professional Team Approach: Provide an inter-professional team approach to patient care and leadership (also called shared leadership), programmatic management, dyad teams and clinical leadership teams; • Shared Decision-Making: Ensure physi-
relationships between hospitals and physicians
cians h have meaningful f l involvement l and d influence on process, outcomes and accountability, that they feel listened to and encouraged to suggest innovative ideas; and • Engaged Hospital Leaders: Promote attendance and involvement of the CEO and hospital leadership at all levels of physician groups, have an open door policy and hospital leadership that is very responsive. The most common barriers to developing effective hospital-physician relationships were identified by hospital and physician leaders as: • Physician availability and time; multiple work-life demands; • Physician payment/income models/status as independent contractors; • Tensions between the OMA and the Ministry of Health and Long-term Care (MOHLTC); • Generational barriers/ “old school” attitudes/slow leadership turnover; and, • Challenges with recruiting and retaining physicians who are strong leaders. Some leaders shared that they are actively working to improve what can be a somewhat tenuous relationship. These conversations have reinforced that there is no “one-size fits all” approach to hospitalphysician relationships, although embracing the common enablers highlighted in the literature, survey and interviews appears to be a shared approach among hospitals with positive relationships. Another common observation during interviews was the ongoing work required to maintain and foster effective hospital-physician relationships. Leaders shared that these relationships require constant attention to improve and strengthen the connection between hospitals and their physicians. As the demands on the health care system continue to grow, it will become increasingly important for hospitals and physicians to navigate through the changes as partners with shared goals and expectations in order to deliver high-quality, effective and efficient patient care. Continued on page 17
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Continued from page 16 The OHA is in the process of better understanding the strategies used by hospital management and physicians to foster effective relationships. To support this work, the survey, literature review, and consultations have illuminated the broader industry trends, current work in Ontario, and future areas of exploration to support these relationships from a provincial perspective. The opinions of hospital CEOs and physician leaders interviewed did complement the findings of the OHA’s literature review and survey in a number of key areas. These included identifying the most important factors fostering positive hospital-physician relationships are a culture of trust, respect, engagement; formal roles and leadership development; shared values; and accountability and performance management. The surveys and interviews suggest that further areas have potential in improving hospital-physician alignment, including creating a standard template outlining physician leadership roles, responsibilities and accountabilities; creating an onboarding program for physician leaders; facilitating more consistency across the province in the development of physician leaders; and, increasing collaborative provincial system discussions between hospital and physician leaders. The OHA looks forward to supporting our members and collaborating with system stakeholders to explore opportunities and develop resources to support hospitals and physicians as they build, maintain and grow H this partnership. ■ This article was submitted by The Ontario Hospital Association (OHA); the voice of Ontario’s public hospitals.
Putting an end to the “name, blame, shame”
approach to error in healthcare
By Kathryn Perrier hen things go wrong in healthcare, it’s easy to ‘name, blame, and shame.’ But it actually takes bravery and vulnerability for a team to share their experiences in making changes to improve patient safety when an error has occurred. At Southlake Regional Health Centre, interprofessional teams are working together to speak up when it comes to situations where things have not gone as planned in order to promote a culture of safety. Interprofessional practice is putting patients first, by bringing together members of the healthcare team to collaborate, share and learn from each other. An example of this practice includes Artichoke Rounds which is now recognized as a Leading Canadian Practice by Accreditation Canada. Artichoke Rounds – a catchy name for a creative platform that encourages interprofessional teams to share learning and speak up for safety. This practice is an innovative way to achieve positive results at a minimal cost. Together, the team is working to create the “ultimate patient experience” as part of Southlake’s strategic plan.
“It’s about peeling back the layers of interprofessional processes, to get to the “heart” of the matter,” says Lorna Bain, the coordinator of Interprofessional Collaboration and Education at Southlake. “The Rounds offer a safe and encouraging environment of discussion for teams and frontline staff to talk about and hear stories everyone can learn from.” By sharing experiences and patient stories, it can shed light on possible gaps occurring in other areas of the hospital. “Since we initiated the Artichoke Rounds, staff who have been involved have spoken of the shift in culture,” says Dr. Wulffhart, Physician Leader, Regional Cardiac Care Program and Director of Medical Education. “They’ve become more comfortable with speaking up, and encouraging others around them to do the same.” Artichoke Rounds serve as an arena to lessen moral distress and alleviate compassion fatigue often experienced by front line staff. It promotes safety as system causes are explored and improvement strategies are shared. The Rounds are only one example of initiatives Southlake has implemented to improve the quality of services at the hos-
Lorna Bain and Dr. Zaev Wulffhart, the founders of Artichoke Rounds. pital. Back in March, Southlake achieved Accreditation Canada’s top ranking of Exemplary Standing. “We were thrilled to learn that we have achieved this designation from Accreditation Canada,” says Dr. Dave Williams, President and CEO at Southlake. “Each day, our talented people demonstrate their passion for delivering safe, quality care to our patients. We all share in the pride of this success.” As a learning organization striving for high reliability, Artichoke Rounds’ goal is to raise the bar on quality by reaching frontline staff across programs to gain input, learn from errors, and not repeat H them. ■ Kathryn Perrier is a Strategic Communications Consultant at Southlake Regional Health Centre.
JANUARY 2017 HOSPITAL NEWS
18 Evidence Matters
Educational burning question: & Industry Events A Do non-antibiotic preventive treatments To list your event, send information to “email@example.com”.
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 “firstname.lastname@example.org” Q January 23–April 3, 2017 Advanced Ostomy Care and Management University of Toronto, Faculty of Nursing Toronto, Ontario Website: www.bloomberg.nursing.utoronto.ca Q January 28-29, 2017 NCLEX-RN Exam Prep Course University of Toronto, Faculty of Nursing Toronto, Ontario Website: www.bloomberg.nursing.utoronto.ca Q January 31-February 1, 2017 IoT, Big Data Healthcare Summit Western Canada Vancouver, British Columbia Website: www.iotevents.ca Q February 21, 2017 Virtual Healthcare & Telemedicine: Managemnet of Legal Risks Toronto, Ontario Website: www.osgoodepd.ca Q February 19-23, 2017 2017 HIMSS Annual Conference & Exhibition Orange Country Convention Centre, Orlando FL Website: www.himssconference.org Q March 1-5, 2017 Canadian Critical Care Conference Whistler, British Columbia Website: www.canadiancriticalcare.ca Q March 8-9, 2017 Mobile Healthcare Holiday Inn Toronto Airport, Toronto Website: www.mobilehealthsummit.ca Q March 21-22, 2017 Industrial Autonomous Vehicles Summit Calgary, Alberta www.iotevents.ca Q April 3-5, 2017 Together We Care Toronto Congress Centre, Toronto Website: www.together-we-care.com Q April 23-25, 2017 Hospice Palliative Care Ontario Conference Richmond Hill, Ontario Website: www.hpco.ca/conference Q April 26-27, 2017 Healthy Canada Conference 2017: Access to Affordable Medicines Old Mill, Toronto Website: www.cchl-ccls.ca Q June 4-7, 2017 eHealth Conference & Tradeshow Toronto, Ontario Website: www.ehealthconference.com Q June 12-13, 2017 National Health Leadership Conference Westin Bayshore, Vancouver BC Website: www.nhlc-cnls.ca To see even more healthcare industry events, please visit our website www.hospitalnews.com/events HOSPITAL NEWS JANUARY 2017
for urinary tract infections work? By Barbara Greenwood Dufour
rinary tract infections (UTIs) are the second most common infection of the human body. Certain medical conditions, such as bladder dysfunctions and urologic anatomical abnormalities, increase one’s risk of developing a UTI, as does being a resident of a long-term care facility or using a urinary catheter. However, healthy women are also at an increased risk. According to US statistics, of the general healthy female population, approximately 50 per cent will experience at least one UTI in their lifetime, and up to half of women who develop a UTI will have a recurrence within a year. For postmenopausal women, particularly those with an estrogen deficiency, that risk is even higher.
Concerns regarding antimicrobial resistance, the potential impact on the human microbiome, as well as the related side effects and cost of antibiotics have led to an interest in non-antibiotic UTI prevention strategies. Antibiotics are commonly used for the treatment of UTIs, and they’ve also been used as a preventive measure for populations at an increased risk of recurrent UTIs. However, concerns regarding antimicrobial resistance, the potential impact on the human microbiome, as well as the related side effects and cost of antibiotics have led to an interest in non-antibiotic UTI prevention strategies. Two such alternatives are topical estrogen (e.g., vaginal estrogen suppositories, cream, tablets, and extended-release inserts) and cranberry products (e.g., cranberry juice, extract, and capsules). Topical estrogen deals directly with the issue of estrogen deficiency. The idea behind this treatment is that, since decreased estrogen can change the vaginal flora and make it more susceptible to bacteria, adding estrogen can normalize the flora and reduce the risk of a UTI. Cranberries have been used to address urological health issues for hundreds of years. It’s thought that a group of compounds found in cranberries, called proanthocyanidins, can stop antibiotic-susceptible and resistant strains of bacteria from adhering to the cells of the urinary tract, thereby preventing an infection. To find out what the evidence says about the effectiveness of topical estrogen and cranberry products for preventing UTIs, CADTH – an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures – looked for the available evidence on the topic. Two systematic reviews on topical estrogen prophylaxis in women
were identified. For cranberry product prophylaxis, three systematic reviews, two of which also included meta-analyses; eight randomized controlled trials; and five nonrandomized studies were identified. Both systematic reviews that looked at topical estrogen for UTI prophylaxis in women found evidence to support its effectiveness. One of the reviews, which examined studies involving menopause patients, concluded that vaginal estrogen reduces the incidence of UTI. The other, which examined evidence pertaining to community dwelling, post-menopausal women, identified two studies that reported a statistically significant reduction in UTI incidence associated with vaginal estrogen prophylaxis. Neither review reported any adverse effects from this treatment. One of the systematic reviews with a meta-analysis that looked at cranberry products found them to be potentially effective in women with recurrent UTIs and in children, and another systematic review that looked specifically at a pediatric population also found evidence of effectiveness in children. In seven of the eight randomized controlled trials and in all five of the non-randomized studies, statistically significant reductions in UTIs were reported in a variety of patient subpopulations, such as post-gynecological surgery patients and elderly long-term care residents at a high risk of developing UTIs. The other systematic review with a meta-analysis, however, concluded that cranberry products are no more effective than placebo or no treatment for women with recurrent UTIs, children, and a variety of additional subpopulations. The conflicting findings of this systematic review compared with the others could be due to variations in the patient populations and in the types of cranberry products examined in the studies. There were no reports of any significant adverse events specific to this intervention. The literature CADTH identified on topical estrogen for UTI prevention consistently supports its effectiveness in women. Regarding cranberry products, much of the literature suggests such products could be an effective for preventing UTIs in certain at-risk subpopulations, but more evidence is needed. However, given that cranberry products are so readily available and there appear to be no significant risks in using them, they might be a non-antibiotic treatment option to consider. If you’d like to learn more about the evidence on topical estrogen and cranberry products for preventing UTIs, or about CADTH and the evidence we offer to help guide health care decisions in Canada, visit www.cadth.ca, follow us on Twitter @CADTH_ACMTS, or talk to a Liaison Officer in your region: www.cadth. H ca/contact-us/liaison-officers. ■ Barbara Greenwood Dufour is a Knowledge Mobilization Officer at CADTH. www.hospitalnews.com
Legal Update 19
Hospital physician appointment and appeal process prejudices patient care By Michael Watts and Swetha Popuri he Ontario Public Hospitals Act (“PHA”) entitles physicians to apply on an annual basis for appointment or reappointment to exercise privileges at a hospital. If the hospital decides: against appointing or reappointing a physician, or if the hospital revokes, suspends or cancels a physician’s appointment, or to substantially alters a physician’s privileges, the physician’s rights to due process under the PHA and by-law are triggered. Under the PHA, a physician’s rights to due process include, but are not limited to: 1. a meeting before the medical advisory committee; 2. a hospital board hearing, 3. an automatic right to appeal any board decision to the Health Professions Appeal and Review Board (“HPARB”); and 4. an automatic right to appeal any HPARB decision to the Superior Court of Justice. The Auditor General in its 2016 Annual Report (“2016 Report”) observed that a physician’s comprehensive rights to due process have prejudiced patient care in Ontario: “Hospital decision-making on patient care has been negatively impacted by the physician appointment and appeal process. We noted some instances where hospitals were not able to resolve human resources issues with physicians quickly because of the comprehensive legal process that the hospitals are required to follow under the Public Hospital Act. In some cases, longstanding disputes over physicians’ hospital privileges have consumed considerable
hospital administration and board time that could be better spent on patient care issues.” [p.432] The Auditor General recommended that the Ministry of Health and LongTerm Care (MOHLTC) review the PHA provisions on physician appointment and appeal. While we strongly agree with the Auditor General’s comments above, we believe the suggested solution ignores a key contributing factor to the resources required to manage disputes relating to physician appointment and privileges: the legal assistance afforded to all Canadian physicians through the taxpayer-funded Canadian Medical Protective Association (“CMPA”). Physicians represented by CMPA-appointed counsel receive the most fulsome representation possible from the commencement of their dispute with the hospital to the final appeal without any accountability or contribution to the legal fees incurred in the dispute. Faced with the above “legal deterrent” strategy, the hospital’s oversight of physician performance in hospitals has suffered because historically hospitals lost their willingness to dedicate the resources (i.e. time, Chief Executive Officer, Chief of Staff, Department Chiefs, volunteer board of directors) required to hold physician accountable for performance that was not acceptable. As a result, hospitals developed cultures that tolerated performance issues that were, in our view, three deviations from the norm; performance that simply would not be tolerated from any employee working in a hospital. The findings in the Dupont/Daniel Coroner Inquest provides an extreme example of the extent that the above PHA process can have on the cul-
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ture of a hospital where a physician’s right to practice supersedes patient’s or staff’s safety concerns. “Relevant behaviour issues and complaints were not identified during Dr. Daniel’s re-appointment process at the hospital. There were multiple complaints from the nurses regarding Dr. Daniel’s disruptive behaviour starting in 2000 which included damage to equipment, fracture of a nurse’s left ring finger, verbal abuse, unprofessional behaviour in front of patients and refusal to work with a specific nurse. Medical staff by-laws should support a culture that does not tolerate physician disruptive behaviour and make it easy to address concerns and ensure timely resolution of the issues.” The Dupont/Daniel inquest led to amendments to the Occupational Health and Safety Act (Ontario) that enforced zero tolerance for workplace violence and harassment and, in addition, greater transparency for quality of care in hospitals including the reporting of critical incidents and the recent introduction of the Patient Ombudsman. While these legislative changes has motivated hospitals to more actively manage physician performance, the prohibitive cost of physician-hospital disputes persists. The 2016 Report noted that the number of hospital proceedings involving physicians increased 87 per cent in 10 years from 285 cases in 2006 to 533 in 2015. As cited in the report, a single proceeding cost one hospital $800,000 – the equivalent of two in-patient acute beds. We emphasize that not only did taxpayers pay for these disputes through public hospital funding, but also through taxpayer contributions
to the CMPA-driven legal defence that generated these hospital costs. In fact, the 2016 Report quoted that from 2013 to 2016, taxpayers have paid $567 million for CMPA coverage of Ontario physicians. In our view, there are three possible solutions to the above-noted issues going forward: 1. amend the PHA to streamline the process for physician appointments/ reappointments and appeals; 2. amend the Physicians Services Agreements so that physicians are accountable for a percentage of the legal fees paid to their CMPA-assigned counsel; and/or 3. develop hospital board rules compliant with the Statutory Powers Procedure Act (Ontario) (“SPPA”) to ensure that physician-hospital proceedings are managed in a “just, expeditious and cost effective” manner. While it’s open to hospitals to implement the third of these solutions immediately and without legislative amendment, to our knowledge, no Ontario hospital has thus far adopted SPPA-compliant board rules. Perhaps now, in response to the Auditor General’s findings, hospitals will finally develop board rules to effectively safeguard the judicially-recognized “primary purpose” of the PHA – ensuring patient safety in the provision of hospital services (Soremekun v. University Health Network, 2004 CanLII 11892 (ON SCDC)), while balancing the need to securing not only a “just” proceeding but one that is equally H “expeditious” and “cost effective”. ■ Michael Watts is a Partner and Swetha Popuri is an Associate in the Toronto office of law firm Osler, Hoskin & Harcourt LLP.
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