Hospital News January 2021

Page 1

Inside: From the CEO’s Desk | Evidence Matters | Safe Medication | Ethics | Careers

January 2021 Edition


Our nurses are not

okay Page 16

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The long road back. In the second wave of the pandemic, the number of daily new cases quickly spiked to alarming and unsustainable levels. A disproportionate number of those infected have been health-care workers. Nurses and their colleagues are experiencing extreme stress and fatigue, and they are burning out. Beating this pandemic is going to be a long road, and nurses, health-care professionals and workers will persevere as best they can. But they are not an unlimited resource. Decades of reports have called for better funding and increases to staffing. When 150 extra hospitalizations threaten to overwhelm the health-care system of an entire province, something is desperately wrong. If we’re going to survive this pandemic and be prepared for future challenges, these longstanding shortcomings must be addressed.

Contents January 2021 Edition


Supporting health care workers


▲ Cover story: Our nurses are not okay: Protecting the mental health of frontline workers


▲ First patient implanted with device to track brain activity



▲ Professional Development and Education

Editor’s Note ....................4 In brief .............................6


From the CEO’s desk .....18 Doctors without Borders .. 38 Ethics .............................40 Safe medication ............41 Long-term care ..............42 Evidence matters ...........46

▲ ICU patient care


Changing Canada’s approach to supporting seniors


▲ Health leadership in 2021


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Primary health care providers have a powerful role to play in helping or hindering responses to the overdose crisis Editor

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ince 2016, over 16,000 people have died in Canada from overdose, a public health crisis made worse by the overlapping coronavirus pandemic that has forced marginalized communities into public health-mandated isolation with less access to health services. It is an unprecedented time bringing into sharp relief society’s health inequities and inadequacies of our current drug policies. To find solutions, Getting to Tomorrow: Ending the Overdose Crisis is a national dialogue project bringing together diverse communities – from politicians, police, people with lived experience, and health care – to find common values and shared purpose so that society can collectively move towards a unified goal: a public health and human rights-based vision for drug policy. The first of 18 dialogues happened recently in New Brunswick and highlighted the important role health care providers play in both helping and hindering


the efforts of people who use drugs navigating two concurrent public health crises. For many, interface with the health system was a challenge. Individuals shared their perspectives and stories about feeling judged and unfairly stereotyped as “drug seeking,” when visiting a doctor or clinic. This dissuaded many from seeking medical treatment in the first place. The sense of stigmatization was so acute for some that the only time they had access to primary care was when they overdosed: “Unless I was going in for an overdose, I didn’t get any other form of health care. It’s always focused on overdoses, otherwise you don’t get treated.” Another common theme was the reluctance of doctors and prescribers to make use of Canada’s relaxed prescribing guidelines for opiate replacement therapy in response to COVID-19. Many people told us that they felt the deeply entrenched negative stereotypes of people who use drugs were preventing doctors from making use of this life-saving intervention. Continued on page 7

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Monthly Focus: Gerontology/Alternate Level of Care/Rehab/ Wound Care/Procurement: Geriatric medicine, aging-related health issues and senior friendly strategies. Best practices in care transitions that improve patient flow through the continuum of care. Rehabilitation techniques for a variety of injuries and diseases. Innovation in the treatment and prevention of wounds.

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First Canadian patient implanted with new device to track brain activity Krembil Brain Institute team is using new technology to read patients’ brains in real time By Heather Sherman ix years ago, 66 year-old Gord Luke was shoveling the driveway of his Wawa, Ontario home when he fell, breaking his hip and his hand. Soon after, Gord noticed a consistent shaking in one of his hands, but chocked it up to the injury. It was Parkinson’s disease, a progressive degenerative neurological condition that can impact a person’s mobility, movement and cognition. “My wife said, ‘you don’t smile like you used to,’” Gord remembers. “But I never thought it was Parkinson’s.” A candidate for Deep Brain Stimulation (DBS) surgery, Gord was referred to Dr. Suneil Kalia, a neurosurgeon and scientist, and Drs Alfonso Fasano and Renato Munhoz, neurologists and Clinician Investigators, with UHN’s Krembil Brain Institute, at Toronto Western Hospital. In October 2020, Gord received surgical implantation of electrodes to stimulate his brain, and a new device that can monitor his brain activity in real time. “This is the first time we can chronically record brain activity,” says Dr. Fasano. “It’s especially helpful for patients with Parkinson’s, because they experience a lot of fluctuations. Sometimes they move well, other times they have excessive movement. The condition really changes by the minute, so knowing why the brain behaves the way it does will give us greater insight into more effective treatments and therapies.” The only way a patient’s medical team would have had access to a patient’s brain activity prior to this, is during the implantation procedure, where electrodes are surgically delivered to targeted areas during awake brain surgery. Now, doctors have the ability to ‘listen’ to the brain, in addition to using electrodes to stimulate those areas to decrease symptoms.


Dr. Alfonso Fasano “It’s kind of like a brain diary,” says Dr. Kalia. “With this technology, we can record brain activity anytime, whether it’s a day after surgery, or whether it’s two to five years after surgery. And that provides clinicians a lot of data that we can react to and optimize the therapy, and potentially further improve the quality of life of our patients.” When Dr. Fasano turns on the device and increases the amount of stimulation, Gord experiences an improvement of movement with the induction of some dyskinesia, or involuntary movements, in his hands and feet. When he decreases the stimulation the right amount, dyskinesia disappears while the beneficial effect on movement remains. At the same time, Dr. Fasano is correlating Gord’s brain waves on a monitor to what he is seeing, in real time. “It’s pretty incredible,” says Dr. Fasano. “I’ve never been able to see this before.” The goal is for Gord to keep a log of activity using a handset, which is connected to the pacemaker-like device in his chest, including when his

Dr. Suneil Kalia symptoms are at their most intense and when he takes his medications. Dr. Kalia and Dr. Fasano can use these crucial data to make adjustments, or improve his therapy. Krembil Brain Institute is one of the top centres for neuromodulation, or brain stimulation, in North America. The team, comprising more than a hundred brain-focused clinicians, researchers, Allied Health Professionals and support staff, does more neuromodulation procedures each year than anywhere else in Canada. “We have many patients like Gord, who come from far distances for appointments,” says Dr. Kalia. “This device will allow our patients to have an even greater role in their care, and more autonomy in their care. Having access to a patient’s brain activity while we’re not with them is a huge benefit for the team and for the patient, when we do see them.” “The brain is very mysterious,” says Dr. Fasano. “We always wonder what’s happening in someone’s brain, more so in a patient with a neurological condition.” He adds: “This device gives us a full picture of brain activity, which

will lead to better outcomes. For us, it’s very exciting.” Right now, the device is being used in patients with Parkinson’s to better understand how abnormal brain signals change over time as the disease progresses. The next generation device will be able to sense a patient’s brain state and automatically make adjustments to therapy. Both Dr. Fasano and Dr. Kalia see huge potential for future applications of this technology with other neurological disorders. “For epilepsy, we would have the capability of detecting seizures before they happen, and potentially, stopping seizures. With other more difficult to treat conditions like depression and OCD, we would have the ability to potentially monitor patients’ mood and changes in their mood, and adjust the therapy accordingly. So the potential is vast and the field is wide open.” Gord is hoping this new technology will help him get back to the wood carving and painting that keeps him busy in retirement. “I’m a little nervous, but excited,” he says. “I’m lookH ing forward to getting back to my life. ■

Heather Sherman is a Senior Public Affairs Advisor at University Health Network.



Ontario hospitals are top drivers of

health research in Canada ineteen of Ontario’s research hospitals have been ranked among the top 40 research hospitals in Canada. The report, Canada’s Top 40 Research Hospitals, 2020, shows that Ontario is home to nearly half of Canada’s top research hospitals and are among the largest drivers of health research in Canada. The rankings are released annually by Research Infosource Inc. and are based on total research spend by institute with investments for each organization coming from a multitude of sources, including philanthropy, government and industry. “Ontario is home to some of Canada’s leading scientific talent, and the Ontario Hospital Association (OHA) congratulates the 19 hospitals recognized for their ongoing investment in research that improves the lives of patients and transforms health care,” says Anthony Dale, President and CEO of the OHA.


ONTARIO HOSPITALS ARE HOME TO MORE THAN 20,000 RESEARCHERS AND RESEARCH SUPPORT STAFF FROM ACROSS CANADA AND AROUND THE WORLD. This year, the Council of Academic Hospitals of Ontario (CAHO) fully integrated into the OHA in recognition of the opportunity to better-serve Ontario’s strong, diverse and evolving hospital sector with a unified voice. In 2019, approximately $1.66 billion was invested in health research at Ontario hospitals helping secure the province’s place as a centre of research excellence. Ontario hospitals are home to more than 20,000 researchers and research support staff from across Canada and around the world.

This year, as the world grapples with one of the most significant health care challenges in a generation, many of the researchers, clinician-scientists and teams from Ontario hospitals have largely pivoted their research to focus on the COVID-19 pandemic. One of the key learnings that’s come from this global crisis is the need to fundamentally strengthen the health research sector in Ontario and Canada. The following Ontario hospitals have been included in this year’s top 40 list. • Baycrest • Bruyère

New approach to manage pain after surgery he pandemic has caused delays for surgeries and anxiety for many patients who don’t want a long hospital stay after surgery. Southlake’s anesthesiologists and orthopaedic surgical teams are finding new ways to help patients who have total knee replacement surgery better manage their pain at home. After surgery, the anesthesiologist inserts a small catheter into the midthigh near the nerve responsible for sensation to the front of the knee. The clinical name for this is an adductor canal catheter (ACC). A small disposable pump continuously delivers local anesthetic keeping the front of the knee anesthetized. Patients can remove the pump themselves a few days after the



procedure when it is no longer needed. In the past, patients would have their total knee replacement surgery without the ACC and use acetaminophen and anti-inflammatories (NSAIDs) as well as stronger opioid medications to manage their pain. With the ACC and local anesthetic pump, patients are able to better manage their pain and reduce the use of these opioids after their surgery. Patients are often able to go home the same day of their surgery, avoiding an overnight stay. Dr. Alim Punja is an anesthesiologist at Southlake and he says, “knee replacements can be a painful experience and our teams are always looking for ways to do things better for our patients. This simple disposable catheter helps patients better manage their

pain, allowing them to do their physiotherapy more easily, and get our patients back to their own home sooner, and with greater comfort.” “Because the demand for this surgery is high and wait times are important to us, getting patients home the same day helps us do more knee replacement surgeries and more importantly gets our patents mobilized faster so they can start their physiotherapy sooner. I’m seeing better outcomes for my patients and they are telling me how grateful they are to have this option available,” says Dr. Patrick Gamble, Orthopaedic Surgeon. Southlake performed more than 560 total knee replacements last year and is proud to share this example of leadH ing-edge care for our patients. ■

• Centre for Addiction and Mental Health • Children’s Hospital of Eastern Ontario • Hamilton Health Sciences • Health Sciences North • Holland Bloorview Kids Rehabilitation Hospital • Hôpital Montfort • Hospital for Sick Children • Kingston Health Sciences Centre • London Health Sciences Centre/St. Joseph’s Health Care London (Lawson) • Ottawa Hospital • Sinai Health • St. Joseph’s Healthcare Hamilton • Sunnybrook Health Sciences Centre • The Royal • Unity Health Toronto • University Health Network (UHN) H • Women’s College Hospital ■

Arthritis patients

see need for mental health care new Arthritis Research Canada study reveals individuals with arthritis have an increased perceived need for mental healthcare in comparison to the general population. The findings specifically revealed that, among individuals with a mental disorder, arthritis is associated with 71 per cent higher odds of having a perceived need for mental healthcare, but a similar odds of receiving support for their mental disorders. “The need for mental healthcare and the probability of receiving various forms of mental health support in individuals with arthritis are underappreciated,” says Alyssa Howren, Continues on page 7



Canadians living with multiple sclerosis find support during COVID-19 s Canadians prepare for the winter months ahead and the COVID-19 pandemic continues to limit day-today activities, those with chronic illnesses like multiple sclerosis (MS) are finding relief and connection through a dedicated social media community and adopting new digital health technology. Canada has one of the highest rates of multiple sclerosis in the world, with an estimated 77,000 Canadians diagnosed with the disease. A recent global survey conducted on behalf of Sanofi Genzyme, the COVID-19 MS Impact Survey, revealed that three in four respondents living with MS felt the pandemic has made them more concerned about their health and well-being, and one in three cited having reduced or no access to the support services they need. The MS One to One® Canada Patient App provides a private online community for Canadians living with MS to connect and support each other. The app became an important tool for patients once restrictions due to the pandemic became widespread, and saw a 35 per cent increase in users since March.


“Right now, in the current climate of a pandemic, going out and socializing with people is difficult or non-existent. Even though the measures put in place are to help us all stay safe and healthy, it can be very difficult to navigate when you have mobility issues,” states Beverly Sudbury who is a member within the MS One to One® Canada Patient App. “Because of this, I have been engaging in more virtual social interactions. The MS One to One® app has become a great way for me to connect with people who understand my disease, my limitations, my concerns, are there to help offer support when I need it and are happy to help celebrate my successes. This has been a key factor in maintaining a healthy mindset during these very difficult times.” The MS One to One® Canada Patient App (available on iOS and Android) offers enhanced support for patients with multiple sclerosis beyond the doctor’s office. The app connects patients with peer-to-peer social support, daily wellness trackers, medication reminders, daily mental health check-ins and access to reliable, expert-driven health inH formation. ■

Arthritis patients Continued from page 6

a research trainee at Arthritis Research Canada. “This is problematic, given the significant burden of mental disorders in people with arthritis.” Despite that burden, there is limited research on how arthritis independently affects an individual’s perceived need and use of mental healthcare in the form of medications, professional services, and non-professional support for emotions, mental health or substance use, as compared to those without arthritis. “This type of research is key to improving quality of care for individuals with arthritis who are struggling with their mental health,” Howren

says. “It will also help us explore the use of mental health support beyond medications, to include psychological treatment, online therapy, self-help groups, and informal support from friends or family.” The study showed that men with arthritis, in particular, had 2.69 times higher odds than men without arthritis in sensing a need for care. “The potential role of traditional masculine norms in symptom recognition and healthcare seeking for mental disorders highlight additional opportunities for improving mental health in individuals with arthritis,” H Howren adds. ■

Primary health care providers Continued from page 4

A PROGRESSIVE APPROACH TO DRUGS ALLOWS INDIVIDUALS TO FIND THE PATH TO WELLNESS WHEN THEY ARE READY AND TURN THEIR LIVES AROUND. Those who had access to it noted how transformative it was. One person emphatically shared how injectable Opioid Agonist Treatment (iOAT) saved her life. She was formerly homeless and given days to live. IOAT allowed her to find physical wellness and stability during the day, which enabled her to secure a job and living wage. It was a powerful testament to the impact that one doctor can have. “Physicians hold that power, so if they can’t open up their mind then it’s a huge barrier to service. Often a primary health care provider is their only resource,” remarked one participant. Individuals also spoke about how service design by its very nature was inaccessible for people who are homeless or struggling with chronic poverty. For example, the health care “appointment” is a standard format followed by millions accessing health care worldwide. But for someone without a phone, computer, or internet, knowing the time of day or even day of week is a significant challenge. This is especially true during COVID-19 when coffee shops--often spaces of refuge for unhoused people-are closed. Appointments are simply not tenable for those who have nothing. “Don’t make appointments, they can’t make appointments. They survived yesterday and they have to make it through today,” remarked one participant. Services must be responsive to the lived realities of those who need them, and that means on-demand treatment and support options that go to clients (outreach) rather than the converse. This was repeatedly mentioned as a solution that would make a big impact on vulnerable communities, especially in rural and remote locations with fewer health resources overall.

There are, however, many positive examples of how health care professionals are making a difference. Doctors Sara Davidson, Mark Tyndall, and Andrea Sereda are all forging new and hopeful paths in health care by embracing opiate replacement therapies and “safe supply.” Changing our view of substance use disorder towards public health principles requires courage like this. A progressive approach to drugs allows individuals to find the path to wellness when they are ready and turn their lives around. Policing and criminalization have failed for over a century and will continue to do so as the country grapples with record overdose deaths at the hands of a toxic and illegal drug supply. To continue down this path is unconscionable. There are many things health care providers can do now to help. • Be compassionate toward people who use drugs. • Avoid stigmatizing language and assumptions about clients. • Keep a blanket and snacks in your office. • Build relationships with social service agencies so clients can be referred easily. • While in hospital and upon discharge, provide new harm reduction equipment as requested. • Talk to your staff about how to best care for people who use drugs. Doctors and health care professionals have an incredible potential for positive change at both an individual and societal level. The actions you take and endorse legitimize the evidence-based public health interventions that need to happen. And when they do, they H will save lives. ■

Peter Kim is a the Strategic Communications Manager at the Canadian Drug Policy Coalition. JANUARY 2021 HOSPITAL NEWS 7


Health care workers have been there for us – now let’s be there for them By Dr. Ann Collins he COVID-19 pandemic continues to put tremendous strain on health care workers. As I write this, there have been more than 450,000 cases across Canada, and more than 13,000 people who contracted the virus have died – a number that includes health care workers. In September, the Canadian Institute for Health Information reported that as of July 23 nearly 20 per cent of people testing positive in Canada for COVID-19 were health care workers, putting our numbers higher than the global average. While this pandemic has exposed the cracks in our health care system, it has also highlighted the lack of supports available for health care workers – on both an individual and system level. Burnout, stress and depression among physicians and medical learners are not new. In 2017, the Canadian Medical Association (CMA) conducted the first-ever national survey on physician health and wellness in Canada. The results showed what we had known anecdotally for many years: many doctors, residents and medical students – one-third, in fact – reported burnout and depression at some point in their career. And while we continue to gather data on this issue, there is no doubt this pandemic is amplifying it. Fortunately, attitudes and awareness about health care worker wellness have started shifting. More and more physicians and other health care professionals are speaking publicly about their personal struggles with wellness, particularly during COVID-19, helping to reduce the stigma and fear that often accompany the issue. The CMA has also made wellness a priority. Through our Wellness Support Line, all physicians, learners and their families now have 24/7 access to tailored mental health services – fill-


ing existing gaps in support across the country. All calls are fielded by counsellors trained to address the specific needs of medical professionals. This summer, we also launched the Wellness Connection, to give physicians and learners free access to physician-led wellness training and peer-support sessions on topics such as stress reduction, mindful parenting, compassion rounds and psychological first aid. This fall, we followed up by launching the Physician Wellness Hub, a first in Canada. Created and curated by the CMA, this national online collection of resources focuses on individual – and system-level change – covering everything from day-to-day strategies physicians and medical learners can use to build resilience, to key factors affecting burnout, to how to start a hospital- or clinic-based wellness program. Even with these supports in place, we know we need more than counselling and resources to change the tide on health care worker wellness. We also need systemic changes to address root causes of burnout. This includes

examining staffing shortages, work hours, personal protective equipment (PPE) supplies and more. Take the issue of PPE. In September, the CMA released a survey showing high levels of concern among physicians when it came to availability and delays in delivery. In fact, 90 per cent of physicians who responded indicated that easy access to a sufficient supply of PPE would help reduce their anxiety around the pandemic. Physicians and other health care workers should not have to worry about getting the basic necessities to do their jobs. At the pandemic’s onset, a lack of coordination among federal, provincial and territorial governments led to inadequate deployment of supplies and equipment, such as PPE. Some health care professionals were faced with the ethical dilemma of being unprotected while treating patients and potentially putting their own families at risk. That added stress can only be dealt with at a system level with effective government policies and by allocating the necessary resources to the health care system.

In November, I presented to the House of Commons’ Standing Committee on Health to discuss the need for these types of system-level interventions with policy-makers. I called on the federal government to create a mental health COVID-19 task force that mobilizes national mental health associations and professionals to support the mental health needs of care providers during and following the resurgence of the pandemic. And I asked the government to increase funding to jurisdictions to enhance access to the existing, but strained, specialized mental health resources for health care providers. Psychological trauma is anticipated to be the longest lasting impact among health care workers in the post-pandemic environment. After they have spent almost a year on the front lines in untenable circumstances, burnout is a grave concern. Health care workers have tirelessly cared for patients. As we start 2021, it is more important than ever that we recognize these incredible sacrifices and ensure they get H the full support they need. ■

Dr. Ann Collins is president of the Canadian Medical Association 8 HOSPITAL NEWS JANUARY 2021

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Markham Stouffville Hospital

forges ahead with COVID-19 research By Lisa Harper any people do not associate their community hospital with conducting large-scale research work. But at Markham Stouffville Hospital (MSH), providing ‘care beyond our walls’ is more than just the vision; it is a self-imposed responsibility to patients, their families and the global community to participate in generating collective knowledge. To that end, while many other hospitals put research on hold during the pandemic, MSH actively sought opportunities to participate in this important work. Since the beginning of the pandemic, MSH has initiated nine COVID-19 related studies, continues to support the hospital’s routine practice of carrying out important oncology studies, all while taking on additional new studies. At MSH, there are currently two clinical trials testing potential treatments for COVID-19 in patients hospitalized with the virus. CONCOR-1 is a trial that involves giving COVID-19 antibodies to infected patients through a transfusion of blood products (COVID-19 convalescent plasma) from donors who have recently recovered from the infection. This trial is being conducted across Canada and the United States and will provide valuable information on COVID-19 convalescent plasma as a potential treatment. The second active trial at MSH – facilitated by CATCO – is the Canadian arm of the World Health Organization’s (WHO) solidarity trial, which evaluates the clinical effect of drugs on patients with COVID-19. This adaptive trial will continue to add or remove drugs as new evidence emerges. Along with these two inpatient trials, MSH is conducting several COVID-19 related research studies with their health care workers. These include a study of health care workers’ mental health by examining the psychological impact of this pandemic


The research team at Markham Stouffville Hospital.

SINCE THE BEGINNING OF THE PANDEMIC, MSH HAS INITIATED NINE COVID-19 RELATED STUDIES, CONTINUES TO SUPPORT THE HOSPITAL’S ROUTINE PRACTICE OF CARRYING OUT IMPORTANT ONCOLOGY STUDIES, ALL WHILE TAKING ON ADDITIONAL NEW STUDIES. on frontline staff, and a serology study looking at the prevalence of CoV-2 antibodies in our health care team. Both studies will provide important information about the health and wellness of our staff during the pandemic that will help us better support them and add to our pandemic preparedness plans for the future. As stated best by Dr. Anthony La Delfa, MSH’s infection prevention and control physician lead: “Despite the challenges faced by community hospitals in developing research programs, we are committed to ensuring our patients receive the highest quality of care at MSH and this includes having access to cutting edge therapies though clinical trials.”

Although MSH has supported research in the past and has significantly grown its research program over the last two years, these are the first hospital-wide clinical trials in the organization’s history. To make this happen, staff had to learn new skills and receive formal research training to support the study work all at a time where there were added pressures associated with responding to the evolving pandemic. This collaborative endeavour included involvement from not only MSH Research Department staff but also the pharmacy, laboratory and blood bank, inpatient clinical leaders, medical day unit, infectious disease clinic, the transformation office and Emergency Department.

It is not surprising that with MSH’s collective honoured to care culture, the research team has embraced the challenge passionately. Katrina Engel is the manager of research at the hospital and has been instrumental in growing the research program including the successful uptake of the COVID-19 studies. Katrina praises her research team and the wider organization for their dedication to the advancement of health care and patient care: “The level of engagement from our staff and physicians has been incredible. They are already extremely busy in their clinical areas and they still find the time to support this important work. It is very inspiring and a testament to what makes MSH special.” MSH’s research team will continue to look for opportunities to do their part to add to the collective knowledge of COVID-19 knowing that the results of the research studies conducted in the hospital will have a lasting impact on health care H and treatment in the future. ■

Lisa Harper, Director of Medical Administration, Planning and Transformation at Markham Stouffville Hospital 10 HOSPITAL NEWS JANUARY 2021


Ontario’s pandemic response By Anthony Dale ast March, as COVID-19 began to rapidly spread across the globe, Ontario hospitals were plunged into a fight that’s been without parallel in our province’s history. The deadly virus overwhelmed hospitals and critical care capacity in jurisdictions across the globe. Under enormous pressure and facing a great deal of uncertainty, hospitals rose to the occasion and became the anchor of Ontario’s pandemic response.


IT IS TIME FOR A SERIOUS NATIONAL DISCUSSION ON STRENGTHENING OUR HEALTH CARE SYSTEM. In the spirit of goodwill and out of a sense of responsibility to the communities they serve, hospitals became the backstop of the health care sector. Not only did hospitals work to uphold their own essential services, they went beyond their traditional roles to provide significant support and expertise across the system, opening up assessment centres, conducting lab testing, and mobilizing to support system partners facing outbreaks. At the height of the first wave, we saw that the system can achieve extraordinary things when we all mobilize around a common cause. By putting the person receiving care at the centre of our work, hospitals freed up capacity and allowed the health care system to focus on what matters most – the safety and well-being of patients. We saw successes when pre-existing relationships and a deep sense of community allowed organizations from different sectors to work together and pool their resources to protect our most vulnerable. But the crisis has also revealed serious vulnerabilities in our system. In some

cases, we saw tragic consequences as a result of a long-term care system that is not equipped to handle outbreaks of this scale or complexity, or well-integrated with the rest of the health care system. The crisis also highlighted the need to rapidly accelerate virtual care, and strengthen public health, primary care, and home and community care. Finally, it raised important questions about how we must prioritize support to vulnerable populations and those with mental health needs. We have learned a great deal during this pandemic, and we are still learning. Chief among these lessons is that the cracks in our system can only be solved by true service integration and increases in capacity across the continuum of care. As the second wave of the pandemic continues, the standby capacity created in hospitals at the onset of the pandemic is gone, and many of Ontario’s large community hospitals and health science centres are full. It’s time for a new and ambitious vision for integrated care. We need to ask hard questions about our failings as a system and implement the changes needed to serve all patients in the months and years ahead. Ontario’s healthcare system, economy and citizens have had to deal with circumstances that were unimaginable a year ago. Now, with Ontario projecting a $38.5B deficit, it is also time for a serious national discussion on strengthening our health care system. The Government of Canada and provincial governments must come together to overhaul our system of transfer payments and to strengthen our country’s ability to fund health services throughout this pandemic and into the future. Ontario cannot return to the same state of austerity. Meaningful change must take place and in building on the unprecedented spirit of cooperation shown during the COVID-19 crisis, the momentum to do so will be unH stoppable. ■

Anthony Dale is President and CEO of The Ontario Hospital Association.




ICU patient care extends beyond the hospital By Dr. Fuchsia Howard s health care professionals, we not only see first-hand the impact of COVID-19 on patients, their families, and our colleagues, we are also seeing the impact on our already overburdened healthcare system – most notably our intensive care units. With our attention focused on treating the 20 per cent of hospitalized patients who develop severe conditions requiring ventilation and care in an intensive care unit (ICU), the pandemic offers an opportunity for meaningful innovation that shifts the focus from simply preventing death to enabling survivors to thrive. A related and welcome outcome of this redirection may be a reduction in the number of patients who return to ICUs and emergency departments for further treatment. While COVID-specific long-term problems are only recently emerg-


ing, recent research has revealed the long-term complications of all critical illnesses. Patients released from ICU shoulder a significant and ongoing burden of disease including cognitive impairment, debilitating muscle aches and pains, lung problems, and crushing anxiety. The successful treatment of a significant number of COVID-related ICU patients has illuminated and magnified a pre-existing gap in the healthcare system – that of critical illness survivorship. The huge advances made in the treatment of life-threatening conditions such as respiratory failure and sepsis has resulted in rapidly increasing numbers of critical illness survivors. Adult Canadians treated in an ICU now outnumber those who receive a new diagnosis of cancer or heart disease. But while more than 80 per cent of ICU patients survive, there is a remark-

able cost that comes with recovery. Up to half of ICU patients suffer from physical, cognitive, and psychological complications called post-intensive care syndrome (PICS). This includes lung impairment, neuromuscular complications, and pain and weaknesses that impair day-to-day life. Symptoms of depression, anxiety and post-traumatic stress disorder are also common, and emulate the same ones found in soldiers returning from combat. Once patients are at home, their family members become caregivers, a cohort known collectively as PICS-Family. These caregivers often have to put their own physical and emotional burdens aside – so much so that the family satisfaction of patients who survive critical illness is significantly lower than family satisfaction of patients who die. This alarming statistic reveals a serious gap in critical illness survivor care.

Survivors soon discover that they are discharged alive, but totally disconnected from their primary and pre-existing care and support networks. Often without a formal personalized plan for their post-treatment care, critical illness survivors are regularly lost in transition from hospital to community care and rarely have access to programs and professionals that have the expertise they need to continue this crucial stage of their recovery. Unfortunately, this leads to hospital readmissions that are both costly to the well-being of survivors and their families, and to the sustainability of the Canadian healthcare system. On average, the daily cost per patient on a general hospital ward is $1,135, and $3,592,

‘Inside-the-box’ technology solves organ and vaccine transportation problem ollowing a fatal car crash, a registered organ donor could save the lives of many patients critically awaiting heart, kidney, liver, lung or pancreas transplantation. Once doctors successfully remove vital organs, they are carefully placed in what are essentially beverage coolers in an attempt to synchronize temperature with the ice cubes also packed within. These are simple organ storage and transportation systems that have seen little change since organ transplants started in the late 1960s. There has to be a better, more effective and safer approach to transport something so incredibly valuable to saving someone’s life. And now there is. A team of researchers from Western University has designed, developed and constructed a new portable temperature regulating device, which can



be used to transport a wide array of temperature-sensitive items including organs, vaccines and pharmaceuticals. This scalable device could also prove invaluable for the restaurant and retail grocery industries with a capacity to effectively deliver items from businesses-to-consumer – at target temperatures – for the entire food supply chain. According to project lead Kamran Siddiqui, a Western Engineering professor, devices currently available in the market (with improper tem-

perature-regulating technologies) can cause deterioration or loss of items, and may have a significant negative impact on human health. “It is 2020 and yet we are still transporting vaccines and organs in devices using primitive cooling methods like ice packs or ice cubes, with no control,” says Siddiqui. Traditional devices are built without controls and have difficulty sustaining a fixed temperature (hot or cold). The new device developed by Siddiqui and Steven Jevnikar, his former graduate student and research assistant at Lawson, can be controlled and maintained at a constant-set point temperature independent of the surrounding temperatures for an extended period of time. The device also has the capability to vary the temperature to different set points for different time durations during transportation. There is also no

need for an external electrical source, and it can also be controlled and monitored remotely. Dr. Alp Sener, a collaborator on the project, is an associate professor at Western’s Schulich School of Medicine & Dentistry and scientist at Lawson, and citywide Chair/Chief in Urology. “Every day, we think about how to improve the lives of our patients,” says Dr. Sener, also a transplant surgeon in the Multi-Organ Transplant Program at London Health Sciences Centre. “Sometimes the answers to our challenges comes from thinking outside of the box, and in this case, a box is exactly what we needed for success.” An expert in mechanical engineering, Siddiqui explains the new device uses ‘phase change materials’ to release and absorb sufficient energy during transport to provide


three times higher, in an ICU. Studies have shown that almost half of ICU survivors are re-hospitalized within a year, with a significant majority readmitted multiple times. Within the first six months, nearly half of those survivors enter the emergency department. It’s clear that critical illness survivorship – and now COVID survivorship – demands immediate attention. ICU survivors living in our communities are in desperate need of support, yet the support they need is not available to them. A comprehensive research-informed clinical program for PICS patients – including a multidisciplinary

team to address complex medical, mental health, and rehabilitation needs – is long overdue. And the tailoring of such programs to survivor-specific needs, including virtual and e-health solutions, are key. As Toronto’s RECOVER program has shown, this is entirely attainable. The program addresses the gaps and challenges seen in transitions from post-ICU and through inpatient rehabilitation to follow-up at home and in the community. There’s an opportunity for rapid healthcare system redesign in Canada and beyond that ultimately improves both patient and family outcomes. A tremendous first step could be combining the research and clinical expertise of the small handful of post-ICU clinics across the country to create an impactful and effective national standard and agenda. Ultimately, COVID could represent a major watershed moment in our healthcare system – so that those who require life-sustaining intervention and therapy not only survive, but H eventually thrive. ■

Fuchsia Howard, PhD, RN is Assistant Professor, Nursing, University of British Columbia.

ate levels of heating and cooling to the stored items to maintain the required temperature. “The need for safe transportation has never been more evident than today as the global COVID-19 pandemic affects all of our lives. Our technology is very promising and has already attracted international interest,” says Siddiqui. Temperature requirements for safe and effective vaccine transport are quite narrow, especially for COVID-19 vaccines currently under development around the world. “Our device may be one of the only options available to meet the strict criteria for worldwide vaccine transport,” says Steven Jevnikar. “It is truly exciting to participate in a project that has this much potential to finally change the current problems facing organ and vaccine transportation, using technology developed right here in London, that will help patients in Canada and

globally,” says Dr. Anthony Jevnikar, professor at Schulich Medicine & Dentistry, scientist at Lawson and the co-director of the Multi-Organ Transplant Program. “During these difficult times of the COVID-19 pandemic, it is crucial to invest in innovative intellectual properties like this device that play such a significant role in protecting people’s health,” says Tamer Mohamed, Business Development Manager, WORLDiscoveries, a technology transfer and business development partnership of Western, Robarts Research Institute and Lawson Health Research Institute. The project arose from collaboration between Western Engineering, the Schulich School of Medicine and Dentistry, the Lawson Health Research Institute and the Multi-Organ Transplant Program. It is supported by NSERC grants, H as well as WORLDiscoveries. ■

Jeff Renaud is the Sr. Media Relations Officer at Western University

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A prescription for a healthy workplace How civility and respect can reduce work-related stress here are times when workplace stress can get the best of us, especially during trying times like these. With the ongoing pandemic and its subsequent changes to our lives, including added social responsibilities, it’s important to remind yourself that everyone in the workplace deserves the same thing as you do: civility and respect. In a respectful workplace, everyone is courteous, caring, and considerate in their interactions with one another, as well as with volunteers, patients and the public. Not only does this lead to greater job satisfaction and a better attitude, civil and respectful workplace behaviours can also positively impact mental health.




It can be normal for some workers to feel job-related stress. While some level of stress can be beneficial, like in situations where you need to focus, constant stress for prolonged periods of time can cause depression, a short temper, job dissatisfaction, and low morale. Thankfully, there are steps that workplaces can take to support the mental health of their workers, which in turn, can help support the mission and values of the workplace. By building a civil and respectful work environment, everyone will start to see tangible benefits take place including improved morale, reduction in sick leave and turnover, and improved teamwork.


Supporting workers by building a civil and respectful workplace can – and should – be done. Here are a few tips to get started.


Provide training and resources on civil and respectful workplace be-

Be courteous, friendly – these actions foster a positive working culture. Find out how co-workers would like to be addressed. Avoid giving people nicknames or pet names as that can be seen as belittling and patronizing. Look for opportunities to include others that you may not generally socialize with by acknowledging their birthday, inviting them to lunch, or asking for their input. Everyone wants to be recognized and have a sense of belonging. It can be very rewarding to bridge social barriers to discover new associations.

PRACTICE HUMILITY haviours such as listening, giving feedback, conflict resolution, anger management, and dealing with difficult customers. It’s also important that staff learn to recognize what constitutes uncivil behaviour and how to address it.


Adopt non-discriminatory language and maintain the confidentiality of employees’ personal information in all communications. Ensure that communications are easy to find and accessible to all by prominently displaying on bulletin boards, in employee handbooks, or online.


Basic respect is the foundation of working relationships. A civil workplace is one where everyone’s input is recognized, valued and where our attention is focused on the conversation at hand. This focus means giving people and meetings your undivided attention. Be sure to turn off your cell phone or any other device that may distract you. If you’re going to be late for a meeting, let the organizer know in advance.


Please… Thank you… Excuse me… I’m sorry are words that you can use regularly to establish civility. Express appreciation to co-workers for their help, avoid interrupting others when they are speaking, and apologize with sincerity if you have mistakenly offended someone. These seemingly small gestures all help to contribute to an overall culture of a respectful workplace.


In an uneasy work environment, it is commonplace for co-workers to not even greet each other. Next time you’re passing a colleague in the hallway or seeing them in the lunchroom, acknowledge them by saying “Hello”. Courtesy is infectious and helps build positive morale.


Humour in the workplace can take many forms and not all of them are appropriate nor appreciated by everyone. Before making a joke, pause to consider your audience. Is the joke at someone else’s expense? Might it be embarrassing or demeaning? If the answer is yes to any of these, then don’t share the joke.

Give others credit when they do a good job. By being modest and raising others, you can contribute to building a culture of generosity and trust, while allowing others to share in the satisfaction of a job well done.


Promote and reinforce respectful leadership behaviour. Provide managers and supervisors with appropriate training and supports, and ensure that they are available, present, and in contact with workers to be able to recognize and resolve issues.


In addition to demonstrating the type of behaviour we expect from others, it is equally important for employers to address situations that affect civility. Create and enforce guidelines and policies detailing expectations, and consequences for inappropriate behaviour. Allow for constructive problem-solving. Manage conflicts in an effective and timely fashion and ensure follow-up with all parties involved. As you move through your day, remember: small, everyday acts of civility, care, and consideration can go a long way to help everyone feel safe, comfortable, and respected at work. ■ H

This article was submitted by The Canadian Centre for Occupational Health and Safety (CCOHS). 14 HOSPITAL NEWS JANUARY 2021


The lost years or a quantum leaps’ next steps:

Health leadership in 2021

By Jaason Geerts he early months of 2021 will define health leadership as it advances. The recent approval and distribution of a vaccine suggests to many that the global crisis is nearly over in a panacea-like manner. Experts, on the other hand, estimate that international herd immunity (resolution) is years away. This gap might encourage people to relax in, or disregard, adherence to public health directives (masks, physical distancing, etc.) prematurely, which could lead to superspread events and further community transmission, which threaten to devastate health systems. Another risk at this stage of the pandemic is slipping into the Waiting it Out (WIO) syndrome: simply plodding along on autopilot until it’s over. This singular focus, bereft of joy or passion, is not sustainable. The longer it persists, the more productivity and mental health decline. The danger of an extended WIO syndrome is that the entire pandemic experience devolves/blurs into “The Lost Years”: a bleak period with little gain but the myopic passage of time. The alternative – thriving in the midst of the pandemic – is demonstrated by the myriad of quantum-leap like advancements in individual and collective resilience, creative innovation, collaboration, distributed leadership, and integrated care. The extent to which organizations can thrive in this context is how the effectiveness of health leadership in 2021 will be distinguished.



This article is informed by ten months’ of international research on leadership during the pandemic by the Canadian College of Health Leaders (CCHL). We also contacted more

than 50 CEO’s of Canadian hospitals, provincial and regional health authorities, and national health organizations. The CEO’s responded to the following questions, which frame our discussion of hospital leadership in the coming year: 1) What is your biggest leadership challenge now? 2) What has been the most remarkable achievement at your organization in the past year? 3) What is your vision for 2021 that inspires you?


Nearly every CEO referenced staff exhaustion and burnout as a pressing current challenge. Even after breaks, people are rarely fully recharged. Ms. Julia Hanigsberg, CEO of Holland Bloorview, the largest children’s rehabilitation hospital in Canada, summarizes the cause well: “We have never faced a time of such uncertainty and volatility without a clear end”. The multitude of competing priorities challenge how to best direct energy: preparing for additional emergencies, maintaining day-to-day operations and caring for staff, patients, families, and communities, managing the non-essential service backlog, and strategic future planning. Concomitantly, as highlighted by Dr. Carr, CEO of the Nova Scotia Health and others, is how to explicity address equity, diversity, and inclusion in our systems. Motivating and enabling staff to perform at their best in this context is a key challenge.


The two most commonly mentioned achievements in the past year were pride in the organizational response to the pandemic and the way in which people collaborated toward a common purpose. A plethora of groups were mentioned, including nurses, frontline staff, environmental services personnel, procurement officers, HR profes-

sionals, positional leaders, and others. Other specific achievements include ensuring availability of providence-wide Personal Protective Equipment (PPE) for all healthcare workers and partners (Dr. Yiu, Alberta Health Services), near-instant pivoting towards virtual care, as demonstrated by the Holland Bloorview Kids Rehabilitation Hospital, who delivered as much virtual care in March than in the previous 10 months combined, and by the Children’s Hospital of Eastern Ontario (CHEO), who launched Canada’s first pediatric virtual emergency department almost overnight. Some organizations opened new wings during the pandemic and Mackenzie Health opened the first new hospital in more than 30 years in the province. Lastly, others were able to advance Strategic Plans (SP’s) (The Royal, Ottawa) and develop new Strategic Plans (Eastern Health, CAMH). To summarize, Dr. Cohn, CEO of Sick Kids, says: “Yes, as challenging as it has been, the teams have also looked for opportunities to leverage this crisis and improve our patient care”.


Although no one would have willed this pandemic, two CEO’s described this as a “once in a lifetime opportunity” to “imagine a fresh start that builds on learnings and allows us to make bold changes” (Dr. Catherine Zahn, CEO of the Centre for Addiction and Mental Health (CAMH). These learnings can be directed toward accelerating key priorities, addressing long-standing systemic challenges and health disparities, strengthening relationships across the continuum of care, and optimizing the integration of patient- and community-centred care.


1. Prepare for the long haul 2. Prioritize health: physical, emo-

tional, and psychological. The longer this pandemic extends, the more important it is to ensure that staff are taking breaks without guilt and that informal and formal supports and backups are in place. 3. Reinforce the North Star and provide islands of certainty in the sea of uncertainty (Dr. Jennifer Zelmer, CEO of the Canadian Foundation for Healthcare Improvement) by reinforcing what will never change: our purpose, values, and vision. 4. Celebrate people’s crisis response achievements, resilience, innovation, and collaboration beyond our walls. 5. Learn intentionally to improve our processes, ourselves, our teams, and our organizations. 6. Re-focus and re-imagine which priorities are most essential… and which are not and should be dropped (Dr. Tom Stewart, CEO of Niagara Health and St. Joseph’s Health System). Next, with a system lens, how can each be most effectively addressed collaboratively? This is the heart of the matter. 7. Inspiring “a spectacular 2021” (Suzanne McGurn, CEO of Canadian Agency for Drugs and Technologies in Health (CADTH)) Despite the many challenges and the toll that they have taken, much has been achieved, including remarkable quantum leaps of advancing integrated care. Overcoming the Waiting it Out syndrome and risking the Lost Years in favour of taking exciting next steps will be a key test of health leadership in the coming months. Thriving in the wake of this storm requires the six steps above, as well as something creative in our current work that inspires and energizes us. That, in 2021, is our New Year’s H wish… and resolution. ■

Jaason Geerts, PhD is the Director of Research and Leadership Development at The Canadian College of Health Leaders.



Our nurses are not okay: Protecting the mental health of frontline hospital workers By Tegan Slot he’s a package wrapped neatly – tied tightly with a piece of string. Don’t ask her how she is – she’s fine. She’s fine because she has to be; she’s fine until she’s not. One more tug on the string that holds her together threatens to completely unravel her. In June, a study by the Canadian Federation of Nurses Unions on mental health disorder symptoms among nurses in Canada reported that 36 per cent of nurses screened positive for major depressive disorder, 29 per cent screened positive for generalized anxiety disorder and clinical burnout, 33 per cent reported having suicidal thoughts and 20 per cent screened positive for PTSD and panic disorders. And that was before the COVID-19 pandemic substantially increased both the mental and physical demands on our frontline healthcare workers. Katelyn* is a clinical care leader and has worked in emergency medicine and trauma units for the past 20 years of her nursing career. She hasn’t stopped in the past nine months, working at a grueling pace to keep up with workload demands. During the pandemic, hospitals are seeing increasing numbers of patients who are without primary care physicians and who no longer have access to the community mental health supports that they were dependent on. The number and type of patients seeking primary care through the hospital has grown – and so has the scope of care that Katelyn provides. Despite increased work demands, increased risk of exposure to a virus with potentially devastating health effects, and a fast-paced environment with ever-evolving provincial guidance on best practices to protect the physical safety of workers, Katelyn has maintained her baseline mental health. It wasn’t until she was required to support a local long-term care home – where a number of staff and residents tested positive for COVID-19 that her mental health shifted. What




changed that she could no longer maintain good mental health? What factors are likely to cause mental-ill health in frontline healthcare workers and how do you know when to step back and seek help? At the height of the first wave of the pandemic, Occupational Health Clinics for Ontario Workers, in collaboration with the Institute for Work and Health, surveyed over 6000 workers on their experiences during the pandemic, with specific focus on mental health. Results show that roughly 43 per cent of respondents who had all their personal protective equipment (PPE) and Infection Prevention and Control (IPAC) needs met reported symptoms of anxiety. When basic needs for protection of physical safety (PPE, IPAC) were not met, prevalence of symptoms of anxiety increased dramatically to over 60 per cent among respondents. Protection of physical safety is only one area that contributes to symptoms of mental ill-health among healthcare workers. Other personal and work-related factors that impact mental wellbeing are: • Heightened stress due to performing multiple roles or lack of role clarity • Caring for patients in an increased state of reactivity

• Increased cognitive demands or mental load • Working outside of professional scope • Change in work hours • Change in work environment • Increased workload and unclear leadership expectations among others • Decreased mental health supports • Anxiety over uncertainty • Being high-risk or caring for highrisk family members • Multiple demands on working parents • Reduced access to childcare • Exposure to domestic violence Workers exposed to any combination of these factors are at risk of experiencing mental ill-health which, according to the Canadian Armed Forces Mental Health Continuum model and the Mental Health Commission of Canada may be evidenced by: • Feelings of fear, uncertainty, panic or anxiety • Sleep disturbances and decreased state of physical health • Increased difficulty with managing symptoms of chronic disease, chronic pain or disability • Difficulty concentrating and becoming easily distracted

• Increased substance use (alcohol, gambling) • Increased social isolation • General changes in feelings and behaviours, such as increased anger, outbursts and suicidal thoughts. What can the workplace do to protect and support the mental health of its workers? Hospital leadership are required to take every precaution reasonable under the circumstances to protect the health and safety of their workers. Traditionally, focus has been on the protection of the physical health and safety of workers. We’re now seeing more understanding, awareness, and focus on the importance of also protecting the psychological health of workers. Most hospitals have a number of supports already in place for the protection of the mental health of their workers. Employee and Family assistance programs, incident reporting systems (both patient and employee), and return to work programs all have elements of psychological support embedded within. Yet, despite existing supports, workers continue to experience anxiety, depression, burnout, panic disorders and suicidal thoughts. So, what comes next? Moving forward, the best starting point is to assess workplace needs. Continued on page 19


Medtronic employees around the world are working together to help health systems navigate the radically DOWHUHG SDQGHPLF ODQGVFDSH E\ RƪHULQJ VKDUHG solutions, resources, and hope. We’re optimizing the use of our virtual care and remote PRQLWRULQJ VROXWLRQV WR KHOS LPSURYH SDWLHQW DQG VWDƪ safety. Our minimally invasive surgical technologies are helping patients recover and return home more quickly. And we’re partnering with hospitals to help improve capacity and patient access within today’s resource constraints, while also helping redesign care delivery systems and processes for tomorrow’s challenges.



Changing the model for case and contact management in public health By Linda Dempster raser Health Authority is the second largest health authority in Canada. We are responsible for the delivery of hospital and community-based health services to over 1.8 million people in 20 diverse communities from Burnaby to Fraser Canyon on the traditional territories of the Coast Salish peoples. Our team of nearly 40,000 staff, medical staff and volunteers is dedicated to serving our patients, families and communities to deliver on our vision: Better health, best in health care. One team that is particularly important for our COVID-19 response is the Population and Public Health Team. This team comprises experts in public health such as Medical Health Officers, Public Health Nurses, Communicable Disease Nurses and Environmental Health Officers, just to name a few. As our cases of COVID-19 across the Fraser Health Region began to rise our Public Health team had to quickly redirect resources from their regular daily functions to focus on case and contact management. When an individual tests positive for COVID-19, it’s vital that quick and thorough follow-up on close contacts is carried out. This is done by public health as case and contact management plays a key role in preventing the spread of the virus. Public health staff help stop the spread of COVID-19 in the community by investigating where an individual may have acquired the virus and preventing further spread. They also investigate clusters of cases to identify potential worksites or businesses that are at higher risk for spread of the virus. That is where the Environmental Health Officers working with community partners such as by-law or local law enforcement to enforce COVID safety plans is key. Traditional case and contact management can be very time consuming and requires expertise in case inves-


Linda Dempster is Vice-President, Patient Experience and Pandemic Response at Fraser Health Authority. tigation. With significant increases in our case counts in the fall we had to quickly re-evaluate how we were managing case and contact management. Clearly we did not want to compromise the value given the importance of reducing the risk of transmission during this pandemic so we had to develop alternative strategies. The overall strategy focused on some key areas: 1. Streamlining case assessments using a risk-based approach 2. Development of a team model for case and contact assessment and notification 3. Leveraging technology

The previous model for case assessments was very detailed and required significant time for case interviews. Upon reviewing the data it was determined that approximately 75 per cent of cases were low risk and would be able to self-isolate and follow public health instructions. We were confident they would abide by the instructions. Based on this assessment we recommended the development of a Contact Tracing Aide role. This role would do the initial case and contact notification as well as the assessment for low risk cases. We also streamlined the case and contact investigation tools. Ap-

proximately 25 per cent of the cases and/or contacts were more vulnerable and we were less confident they would be able to successfully follow public health guidelines without more intense support. These higher risk cases would be referred to an expert hub for more intense case management as well as cluster identification and follow-up. Based on the number of daily cases we developed an algorithm for staffing requirements for contact tracing aides as well as public health expert roles. Starting in mid-September to date we have hired and trained 364 contact tracing aides. The team model for the contact tracing aide role is that they are supervised by a public health nurse. Initially the ratio is approximately one nurse to five contact tracing aides but once the aides became more proficient and comfortable in the role we increased the ratio to one to 10. This has been highly successful and we are keeping up with case and contact management in addition to being more efficient without losing quality of the assessments. Finally, we looked at how we could leverage technology to streamline our systems and provide better support to the public. This included an on-line form for the positive cases to input their contacts so the contact tracers had the information as soon as the positive case received their test results. The positive test result was texted to the case with a link to the online form. Further use of technology is being explored such as auto-texting cases on isolation when isolation is complete. Although not the only initiatives we put in place to better manage our case and contact management these are a few of the changes we made in a very short period of time that increased our efficiency while not compromising the quality or integrity of the case and contact management process in public H health. ■

Linda Dempster, RN, BScN, MA is Vice-President, Patient Experience and Pandemic Response at Fraser Health Authority in British Columbia. 18 HOSPITAL NEWS JANUARY 2021


Frontline workers and mental health Continued from page 16

What type of exposures are workers experiencing? Chronic mental stress? Traumatic mental stress? What are the hospital’s areas of strength and areas of need with respect to psychosocial exposures? Once workplace needs are determined, supporting resources are accessed and implemented. The most successful psychological health and safety programs with the greatest gains have strong leadership commitment, focus on leadership training, support for workers along the full mental health continuum (taking preventative measures to support mental health as opposed to a sole focus on intervention and recovery strategies

once a mental health injury has occurred) and measure key leading and lagging performance indicators to track program successes. Workplaces with a strong psychological health and safety program can expect to see a return on investment of $2.68 for every $1.00 spent after the first three years (Deloitte, 2018,). Having a strong psychological health and safety program in place that effectively supports healthcare workers’ mental health is also in the best interest of providing high quality patient care. Public Services Health and Safety Association (PSHSA) – serving Ontario’s public services workplaces

In addition to workplace resources, frontline workers who are experiencing mental ill-health during the COVID-19 pandemic and beyond may wish to access community resources for mental health through the Mental health Commission of Canada’s Resource Hub. Like Katelyn, thousands of Canadian nurses are grappling with the uncertainty of the pandemic. By augmenting current programming to protect the mental health of healthcare workers, hospital leadership can play a vital role in securing the proverbial string to ensure the package remains tightly bound. H *Katelyn is a pseudonym ■

– has developed and provides consultation on a comprehensive psychological health and safety program to help workplaces identify, assess and control organizational and job-specific psychological factors affecting the mental health of frontline workers. PSHSA’s Psychological Health and Safety program resources include a checklist for employers to use as an initial gap analysis to determine what prevention, intervention and recovery measures are in place, whether they meet organizational needs, and to assist in future program planning, development and implementation for the protection of workers’ mental health (Figure 1).

Figure 1 :Overview of PSHSA’s Psychological Health and Safety program to support the protection of workers’ mental health.

PSYCHOLOGICAL HEALTH AND SAFETY PROGRAM SUMMARY PSHSA’s Psychological Health and Safety Program takes a focused approach to prevention, intervention and recovery designed to support worker well-being and decrease risk of work-related psychological injury/illness.

PREVENTION Leadership Commitment & Participation • • • •

Organizational Commitment PHS Policies & Program Workplace Party Roles & Responsibilities Recognition program for PHS

INTERVENTION Incident Response • Incident response protocol for situations that may affect mental health

Worker Supports • • • • •

Program for pro-active worker well-being Community supports and treatment Employee and Family Assistance Program Psychological Benefits Specialized internal support

Supervisor Response • Supervisors have the knowledge, skills and training to respond to signs and symptoms of mental ill health

Peer Support • Peer supporters with shared workplace experiences are selected and trained • A Peer Support program is developed and communicated to all workplace parties

Risk Management • Hazard Recognition, Assessment and Control for Organizational and Job Specific Psychological Hazards • Procedures and Safe work plans • Workplace Inspections for Psychological Hazards • Incident reporting and investigation process for psychological incidents

Training and Education • General MH Awareness Training (new workers and ongoing) • Job specific MH training • Advanced Mental Health training for workers and supervisors

RECOVERY Post-Incident Response • Self-screening tools are available and communicated to workers • Informal and/or formal Incident debriefing processes are in place

Stay at Work & Return to Work After Injury • Compensation process for mental health injury • Training for all workplace parities on RTW roles and responsibilities • Processes are in place to ensure job demands meet worker capacity

Evaluation and Continual Improvement • PSHSA Psychological Audit Tool

For more information on the Psychological Health and Safety Program, please contact your Consultant or visit

Tegan Slot, R.Kin MSc PhD CRSP is a Health and Safety Consultant at the Public Services Health & Safety Association.



Changes to admission and recovery processes enhance efficiency in Cardiac Short Stay Unit By Madeline Dwyer recent partnership with the Medtronic Integrated Health Solutions (IHS) team and Southlake Regional Health Centre’s Regional Cardiac Care Program has improved patient care and resource utilization, leaving patients happier and staff more confident. Southlake Regional Health Centre (Southlake) in Newmarket is the fourth largest regional cardiac program in Ontario and provides leading-edge innovative procedures for cardiac patients. Until recently, the Cardiac Short Stay Unit (CSSU) workflow was challenged with bottlenecks and bay capacity issues. With growing demand through increased population and disease prevalence on the rise, the program was struggling to accommodate the needs of the community. Through an innovative procurement process, Southlake leveraged the partnership with IHS to review existing processes and improve access for patients. The IHS team is comprised of optimization experts who can assist hospitals and healthcare organizations in improving efficiency, resources, and timely patient care. In June 2019, an IHS-led workshop revealed that the existing workflow in the CSSU could be improved to avoid procedure cancellations and service delays. Jessie Boogaard, Business and Quality Manager of the Southlake Regional Cardiac Care Program says Medtronic and CSSU worked collaboratively to address this problem. “The IHS team made sure to come up with a plan that wasn’t just written on paper, but actually followed through,” explains Jessie. “CSSU staff remained open-minded towards implementing positive change.” The IHS team provided a solution which enabled the department to recover a higher volume of patients within the current physical space, existing budget and staffing resources. IHS played an integral role in facilitating the development and im-


plementation of a successful design for innovative care delivery, meeting the newly identified needs. Sanaz Ghazi, IHS Project Manager, says, “We conducted time studies to clearly understand each step of CSSU’s care delivery and identify areas for improvement. We then brainstormed with key stakeholders, particularly Jessie Boogaard, Cath Lab Manager Leanne Blair, and CSSU charge nurse Rosanne Carnevale, to come up with smart solutions.” One area of focus was the admission process for the CSSU. It was identified that there was opportunity for improved patient flow by modifying the location where admitted patients were waiting for their procedure. Both inpatients and outpatients admitted to the CSSU were assigned to bays to await their upcoming procedure. This approach filled the 15-bay department to capacity early in the day, resulting in an inability to achieve the targeted procedure volume for the day. Medtronic’s solution targeted the outpatient population, which is ap-

proximately 70 per cent of the daily activity. The IHS team suggested that the outpatients be directed to a nearby waiting area, for the period between admission and procedure, instead of being placed in a bay. This simple shift prioritized the use of CSSU bays for the recovery of patients post procedure. Through physician engagement at Southlake and a review of practices at other centres, Medtronic also identified that some ambulatory patients could be recovered sitting up in a comfortable chair. Clinical criteria were developed to ensure appropriate patient selection for this new recovery process. As a result, the Radial Artery Recovery Area was created, which realized additional recovery capacity, accommodating the increase in procedural volume. “We learned that by making these changes, we’d be able to free up about 50 percent of the capacity in the unit, effectively doubling its capacity,” says Morteza Zohrabi, lead IHS Consultant. By shadowing in the CSSU and in the procedural area, the IHS team identified opportunities to streamline

and simplify day-to-day operations. A workflow analysis was completed and tasks that were not necessary to ensure patient safety, patient and staff satisfaction or required for documentation and care purposes, were evaluated and removed from the workflow. Staff identified concerns about how the changes would affect their heavy workload. To assist staff in visualizing the foreseen improvements and bring them onboard, the IHS team developed a simulator using raw hospital data to demonstrate how the proposed changes would enhance the department’s operations. Farbod Abolhassani, Data Analyst on the IHS team, explains, “We built a 3D graphic simulation that looked exactly like the hospital or department. It was essential in engaging Southlake staff in our efforts.” Ms. Ghazi highlights that the commitment from the Southlake team and the transparent approach to change management contributed to the successful implementation of improvement strategies and ultimately superior outcomes for the department. “A year after Southlake implemented the recommended changes, the CSSU hasn’t had to cancel a single procedure because of recovery capacity issues.” Since implementation of the IHS recommendations, staff morale and patient satisfaction have improved. And thanks to focused collaboration, the Interventional Cardiology Program has increased efficiencies, resulting in budget optimization and improved patient access to care. A key learning from the experience is that facilitated change is only successful through meaningful relationships and mutual understanding of goals and objectives. The partnership between Medtronic IHS and the Cardiac Short Stay Unit is built on collaboration transparency and trust, attributes that lead to lasting process improvements and improved outH comes for patients. ■

Madeline Dwyer is a freelance Medical Writer for MedComms Solutions. 20 HOSPITAL NEWS JANUARY 2021


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Connecting work to education is key during COVID-19 and beyond By Larry Rosia OVID-19 has disrupted labour markets unlike anything since the Great Depression. Young people – tomorrow’s workforce – have been especially hard hit by the economic slowdown, with school closures and a transition to remote learning. Youth were also among the hardest hit when employers reduced operations.



Remote work poses a particular challenge for polytechnics, who use work-integrated learning to connect students to real-life experience with the help of engaged employers. Training in the form of practicums, work

DESPITE THE CHALLENGES OF OFFERING HANDS-ON PLACEMENTS DURING A PANDEMIC, RELEVANT EMPLOYMENT EXPERIENCE IS MORE CRITICAL NOW THAN EVER. placements, co-ops and apprenticeships are hallmarks of the polytechnic learning model. Despite the challenges of offering hands-on placements during a pandemic, relevant employment experience is more critical now than ever. When the economy slowed, so did the availability of placements. Yet, the demand for work-ready graduates hasn’t abated. To ensure the pandemic doesn’t leave today’s youth behind,

governments, employers and post-secondary institutions need to find innovative ways to create smooth transitions to an otherwise bumpy labour market.


First, we need to get creative. As it became clear the pandemic would not be short-term, program heads at Saskatchewan Polytechnic sought technological solutions that would enable

remote learning. This meant cook-athome assignments for Culinary Arts students. Virtual slides allowed Medical Laboratory Technologist students to conduct blood cell counts and identify diseases online. We also looked at alternatives to work-integrated learning placements. Students in the Occupational Health and Safety Certificate program were able to complete their practicums with the Saskatchewan Workers’ Compensation Board virtually, using online tools. Because these approaches won’t work for every program, we partnered with Riipen, a technology platform that enables online work-integrated learning. Educators submit collaboration requests in response to projects posted by employers. Once employers

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PROFESSIONAL DEVELOPMENT AND EDUCATION choose with whom they want to work, students are assigned to the project. One such project involved tech start-up Ergonomyx Technologies Canada Inc. of Victoria, B.C. and 26 international students in the Marketing Management class at our Prince Albert Campus. The company produces desks where users can exercise and work simultaneously, tracking progress using web-enabled applications. Unable to work face-to-face, students are interacting with Ergonomyx employees remotely to analyze advertising strategies, sales and target markets, and identify new opportunities. A group of Business Information Systems students used the same platform to connect with the online marketplace, Easy Job Quote for their placement. Students are performing upgrades and adding new functionality to an application where contractors submit bids for home renovation projects posted by homeowners.

ENABLING BOTH VIRTUAL CLASSROOMS AND VIRTUAL WORK PLACEMENTS REQUIRES A SIZABLE UPFRONT INVESTMENT BUT PROMISES LONG-TERM BENEFITS BY CREATING A MORE DIGITALLY ENABLED WORKFORCE. While virtual placements are working in some occupations, apprenticeships in the skilled trades offer a different challenge. Under contract with the Saskatchewan Apprenticeship and Trade Certification Commission, Saskatchewan Polytechnic delivers apprenticeship training for designated trades in the province. One of those trades is Agricultural Equipment Technician – the technicians who set up, diagnose, repair, modify, overhaul and maintain agricultural equipment. Despite the pandemic, we have been able to maintain our apprentice-

ships at Dot Technology Corporation in Pilot Butte, SK. The high-tech manufacturer has garnered worldwide attention for its innovative autonomous agricultural equipment. Apprentices are working onsite using enhanced personal protective equipment, physical distancing and sanitization practices. Following provincial and company-specific health and safety guidelines, apprentices remain employed. Like other polytechnics across Canada, Saskatchewan Polytechnic remains committed to work-integrated learning as a critical component of

the student experience. We need employers to join us in looking for new approaches for current workplace realities. Wage subsidies available through the federal Student Work Placement Program help bridge financial barriers. The federal government can help further by investing in a digital learning infrastructure that includes simulation, augmented and virtual reality and hybrid training options. Enabling both virtual classrooms and virtual work placements requires a sizable upfront investment but promises longterm benefits by creating a more digitally enabled workforce. The return on this investment will be a more adaptable, innovative and resilient labour market. It will create more made-in-Canada talent for employers requiring smart solutions as the economy emerges from shutdown. And ultimately, that means a more competitive, work-ready Canadian H workforce. ■

Dr. Larry Rosia is President & CEO of Saskatchewan Polytechnic and Chair of Polytechnics Canada.

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for COVID Code Blue response By Logan Clow undreds of clinical and non-clinical teams across the province have been training and coordinating their efforts since early March with eSIM (simulation training) as part of Alberta Health Services’ (AHS) response to the COVID-19 pandemic. In September, staff on the Intensive Care Unit (ICU) and Cardiac Care Unit (CCU) at the Queen Elizabeth II Hospital (QEII) in Grande Prairie participated in COVID-19 Code Blue simulation training. Their eSIM training was delivered virtually via Zoom through an innovative program called Virtually-Facilitated Simulation (VFS). “The simulation training covered managing and responding to a


THEIR ESIM TRAINING WAS DELIVERED VIRTUALLY VIA ZOOM THROUGH AN INNOVATIVE PROGRAM CALLED VIRTUALLYFACILITATED SIMULATION (VFS). COVID-positive patient, or suspected COVID positive patient, during a Code Blue, which is a cardiac arrest, or respiratory cardiac arrest,� says Teri Donald, clinical coordinator/clinical

Hosting ďŹ eld placement students to build the workforce your organization needs Field placements are vital learning experiences that get students out of the classroom and into workplaces to apply what they learned. Through each placement they gain the experience employers demand while making meaningful contributions to their host organizations. The Durham College Honours Bachelor of Health Care Technology 0DQDJHPHQW %+&70 UHTXLUHV VWXGHQWV WR FRPSOHWH D KRXU ĆHOG placement between semesters 6 and 7. Students join hospitals, regulatory agencies, Ontario Health, medical device manufacturers, and service groups, among other organizations, where they contribute to real work. Thanks to a holistic management approach to their training, BHCTM students EHJLQ WKHLU ĆHOG SODFHPHQWV KDYLQJ DOUHDG\ OHDUQHG WKH VNLOOV WKH\ QHHG WR VXFFHHG 7KHVH LQFOXGH NQRZLQJ KRZ WR HIIHFWLYHO\ DQG HIĆFLHQWO\ RSWLPL]H the life cycle and value of an organization’s medical equipment at the point of care, as well as having the ability to research emerging technology trends. They are also equipped to evaluate existing medical equipment and work with supervisors and clinical engineers on projects related to equipment DFTXLVLWLRQV LQRSHUDELOLW\ LQVWDOODWLRQV UHQRYDWLRQ PRGLĆFDWLRQV DQG removals. The best way for students to learn what it takes to succeed is to do the work. 7KH VXFFHVV DQG LPSDFW RI D ĆHOG SODFHPHQW GHSHQGV ODUJHO\ RQ WKH KRVW organization that welcomes the student, and the professionals who mentor and supervise them throughout the placement.

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Staff participate in COVID-19 Code Blue simulation training on the Intensive Care Unit at the QEII Hospital in Grande Prairie. nurse educator for the ICU and CCU at the QEII. “The training provided staff an opportunity to practise and learn how to properly protect themselves while also providing safe patient care in those situations. I think our staff worked really well together during the simulations. They communicated effectively and were able to learn from each other and learn together.� Donald adds that COVID-19 Code Blue training is important for staff because the situation requires processes that differ from the usual. “Code Blues are not uncommon during COVID-19. Simulations like this are very helpful for healthcare workers to learn and practise the different processes in a realistic environment,� says Donald. Over five training sessions at the hospital, 25 staff (doctors, registered nurses and respiratory therapists) participated. The final simulation session,

held Sept. 24, saw welcomed participants Registered Nurses Ashley Hagg and Emma Broderick as well as Respiratory Therapist Ghulam Nabi. North Zone eSIM consultants Monika Johnson, Kristin Simard and physician champion, Dr. Sharon Reece, facilitated the hospital’s VFS sessions from remote locations. Prior to the start of the simulation, staff were given an overview of the mock COVID-19 Code Blue scenario ahead. During the exercise, staff used a training mannequin as their patient. As well, they wore the appropriate PPE, and made use of the hospital equipment and supplies they would need in an actual COVID-19 Code Blue. Upon completion of the simulation, the eSIM consultants provided staff with feedback and answered their questions during a debriefing. For more information about eSIM, H visit Insite. â–

Logan Clow works in communications at Alberta Health Services.



Graduates are distinctly qualified to provide appropriate management of an organization’s medical technology policy and strategic objectives. By implementing a holistic and systems approach, the HCTM can effectively and efficiently manage the life cycle of medical technology and harness the greatest value in the delivery of care. Career options include roles in clinical engineering management, capital equipment procurement, medical technology assessment, project management, regulatory compliance and more.




“Patient as Teacher” program recognized at provincial awards ceremony for quality and innovation By Maria Sarrouh ne of the greatest limitations of surgical education is that students only see a snapshot of the impact breast cancer has on patients and their support system. To overcome this barrier in medical education, Dr. Jory Simpson and his team at St. Michael’s Hospital of Unity Health Toronto created the Patient as Teacher program. Through this initiative, survivors are empowered to share their personal stories and lived experiences with undergraduate medical students. “When students come on their surgical rotation, they see a patient in the operating room that they haven’t met before. They probably won’t see them again afterwards,” Dr. Simpson, Surgical Oncologist and Assistant Medical Director of CIBC’s Breast Centre said. “A program like this builds in that gap and creates a whole longitudinal pic-


Dr. Jory Simpson (middle) with Stephanie Mooney and Dr. Ori Rotstein, Vice-President of Research and Innovation at Unity Health Toronto. ture for students to really appreciate SURVIVORS ARE what those patients are going through.” EMPOWERED For their work, Dr. Simpson and his team received this year’s honourable TO SHARE THEIR mention in the Innovation Award catPERSONAL egory at the Cancer Quality Council STORIES AND LIVED of Ontario’s annual ceremony. The EXPERIENCES WITH “Humanism Education in Surgery: A Patient as Teacher Program” was celUNDERGRADUATE ebrated for advancing the quality and MEDICAL STUDENTS. delivery of cancer care in the province. In addition to providing students they are feeling fully supported, and with a chance to connect with patients has been instrumental in the success on a human level, Dr. Simpson, said of the program. the program can help survivors with Since its inception four years ago, the the healing process after a cancer diinitiative has grown from a small pilot agnosis. He acknowledged the courage study to a program that is taught to over of the patient-teachers, and their com200 medical students at the University mitment to the student’s learning. of Toronto by over 30 patient-teach“They find that it’s a way for them ers. Dr. Simpson said he would like to to give back and make a difference for see the program implemented at other the next generation of doctors. It creuniversities. It has been piloted at uniates a feeling for them that their illness versities across Canada, including the can create something positive and that University of British Columbia. they can help other people learn from The program has successfully their own experiences.” moved online since the beginning of He also recognized the efforts of fathe pandemic, with patient-teachers cilitator and patient experience adviguiding medical students through lessor Stephanie Mooney. Mooney works H sons virtually. ■ with the patient-teachers to make sure Maria Sarrouh is a communications intern at Unity Health Toronto.



New tools to help physicians navigate hospital-based practice By Ryan Joyce y the time physicians begin practising, they have many years of education behind them, coupled with knowledge of countless topics in addition to medical care. However, one area not likely to be covered during medical education is how to navigate hospitals – a topic of critical importance for physicians choosing a hospital-based career path. To help address this gap, the Ontario Medical Association – the organization representing Ontario’s 43,000plus physicians, medical students and retired physicians – has developed a series of e-Learning modules to help members better understand the organizational and administrative context


THE ONTARIO MEDICAL ASSOCIATION HAS DEVELOPED A SERIES OF E-LEARNING MODULES TO HELP MEMBERS BETTER UNDERSTAND THE ORGANIZATIONAL AND ADMINISTRATIVE CONTEXT OF PROVIDING CARE IN A HOSPITAL SETTING. of providing care in a hospital setting. Ontario hospitals have a specific governance structure, prescribed by the Public Hospitals Act, and are subject to various other pieces of provincial legislation and hospital-specific bylaws and regulations, all of which apply to physicians. “Hospitals are often large, complex organizations to navigate and challenges may arise that physicians pre-

viously had to learn about on the job,� says Nathalie Assouad, the manager of knowledge translation and implementation at the OMA, whose team was responsible for the development of the modules. “Many challenges may occur, such as confusion around how to effectively escalate concerns within the hospital governance structure or a lack of clarity around processes for retirement. Through these

modules, our goal is to ensure our members are well prepared to effectively navigate situations like these before they arise.� Each module uses plain language to explain concepts relevant to the physician-hospital relationship, examines case studies and provides practical guidance. Each one can be completed within 30 to 60 minutes and is simple to use on a desktop computer, tablet or mobile phone. The following is an overview of the four modules: • Rules provides information relevant to hospital-based practice, including provincial legislation, hospital-based bylaws and hospital-based professional staff rules, regulations and policies. • Governance reviews the governance structure of Ontario hospitals, including key staff roles, supporting

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roles and the function of the Medical Advisory Committee and the Medical Staff Association. It focuses on how to effectively navigate the governance structure to address various issues that may arise, including career, performance and personal experience working in a hospital and concerns about hospital-specific rules, quality of care and patient safety. • Hospital privileges covers physicians’ rights and responsibilities, the appointment and reappointments processes, considerations around resigning, changing or losing privileges and a detailed description of the formal dispute resolution process. • Contracts illustrate how physicians can formally engage in service with the hospital and clarifies the differences between various common contracts and agreements.

These interactive modules were created to address common questions raised by OMA members in the absence of existing educational materials that explain the complexities of working in a hospital from a physician’s perspective. The modules were developed in consultation with hospital-based physicians, the Ontario Hospital Association and the Canadian Medical Protective Association. These self-learning modules have also been certified by the College of Family Physicians of Canada and the Ontario Chapter for up to one Mainpro+ credits. This activity is also an Accredited Self-Assessment Program (section three) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada and approved by the University of Ottawa’s Office of Continuing Professional

Development. Members may claim a maximum of one hour and credits are automatically calculated. “Not only were these modules built with physicians and for physicians, the idea for them also came from physicians,” says Jennifer Gold, the director of legal services and privacy officer at the OMA who was also involved in developing the modules. “The OMA receives questions and requests from its members every day and the idea for this project came from routinely monitoring trends in our inquiries. This highlights the importance of listening and responding to members and the role the OMA plays in responding to the needs of its members.” The Hospital-Based Physician e-Learning Modules are available on the OMA Education Network. Members may access them for free and H complete them anytime. ■

Ryan Joyce is a strategic communications adviser at the Ontario Medical Association.

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Julie Evans, practice director, Provincial Speech-Language Pathology at AHS, and her team worked with AHS Student Placement and the University of Alberta to create placements that would serve both patients and academia, with students allowed to work remotely and virtually.

MCC 360 multi-source feedback program The Practice Enhancement Program for Saskatchewan Physicians (PEPSask) offers physicians in Saskatchewan a quality report of their practice through a practice-based assessment process. They are now using MCC 360 as one feedback component for physicians. Nicole Kopp, Program Assistant at PEPSask, along with her PEP team, has been navigating the inaugural year working with MCC 360 as well as the challenges of rolling out a new program during a pandemic. She explains “MCC 360 has been very easy to use from the early steps of enrolling a physician to retrieving their final report.” “Giving a physician the opportunity to get a direct look at how ‘others’ view their practices and how any feedback may improve the way they practice has been so valuable.” “I believe by implementing MCC 360, it has moved our program forward, increasing our in-office efficiency and streamlining our processes. We’re looking forward to supporting our physicians through MCC 360 as we enroll more physicians into the program.” To learn more about improving your physician team members’ communication, collaboration, and professional skills with MCC 360, visit This multi-source feedback tool gives every doctor an individualized report, 1:1 coaching, and up to 12 CPD credits.


Creativity comes to the forefront of practicums in the age of COVID By Gregory Kennedy racticums are a long-standing tradition within Alberta Health Services (AHS) that benefit students, staff and patients alike, but crafting these vital educational and work experiences during a pandemic called for leaders across disciplines to put their thinking caps into overdrive. “When the world was turned on its ear back in March, many schools stopped placements and pulled their


students away. Typically, March and April are the months for their final placement, and they graduate after that,” says Jacqueline Albers, manager, Provincial Student Placements with Health Professions Strategy & Practice (HPSP). “There was a lot of push around that time to see what else we could do to make sure the students would finish their placements and be able to graduate. Continued on page 32


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Creativity comes to the forefront Between their schools, the regulatory bodies and AHS, we made it work. AHS really pulled together. It was amazing how many people took students, considering the pandemic. Despite the uncertainty, we held firm and created opportunities for students.� Speech-language pathology (SLP), occupational therapy (OT) and nursing were among the first to reach out – looking for ways for students to do placements without having to be in front of a patient.

University of Alberta (U of A) to create placements that would serve both patients and academia, with students allowed to work remotely and virtually. “People with communication needs – who have speech or hearing difficulty – are particularly impacted by the pandemic,� says Evans. “For example, people who are on are on a respirator need support to communicate. So our students helped us to create tools, such as a picture communication board, that pharmacists can use with these patients.

ONE OF THE THINGS WE’VE DONE PROVINCIALLY IS OFFER LEADERSHIP STUDENT-PLACEMENT OPPORTUNITIES – WHERE THE WORK IS VERY VIRTUAL ANYWAYS – SO IT WAS AN EASY TRANSITION. Creative ideas also originated from the office of Julie Evans, practice director, Provincial Speech-Language Pathology, who says her team worked with AHS Student Placement and the

“We prioritized eight really practical, needs-based initiatives for students to develop – and synthesize learning resources for staff to create tools they could use with our patients.

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In all, 21 SLP students were paired with supervisors.� One of them was Spenser Day, a freshly minted SLP, who’s just completed her Masters of Science in Communication Sciences and Disorders at the U of A. “It was so comforting that AHS could accommodate students like myself so quickly,� Day says. “Without a practicum, we faced a lot of uncertainty about our graduation and our careers. It was a huge relief for us. I felt I was being taken care of by my chosen field – and that AHS was willing to help.� Evans adds: “Spenser worked with a group of students on developing a directory of learning resources for staff – putting valuable resources, guidance and information at their fingertips on key topics. This was especially important for those SLPs who were redeployed during the pandemic or addressing changing patient needs.� SLPs play a vital role in the fight against COVID-19, helping people to communicate about their care and to swallow safely again if they have been on a ventilator. “Some SLPs have taken on a diverse range of considerations unique to the circumstances of COVID,� says Day. “For example, caring for patients on mechanical ventilation requires specialized attention to voice care and the upper airway, as well potential impacts to swallowing.� “One of the big things I learned is to appreciate how much work goes into creating these resources and the amount of work it takes not only to keep up with evidence, but how to integrate it into clinical work,� adds Day, who hopes to work with AHS. “We’re all super-appreciative of the hands-on practise and the experience that we got during this project. It was a huge privilege and honour.� Occupational therapists also opened their doors and hearts to welcome student placements, says Carmen Lazorek, practice director, Provincial Occupational Therapy, HPSP. “One of the things we’ve done provincially is offer leadership student-placement opportunities – where the work is very virtual anyways – so it was an easy transition. We allowed

Students have contributed a great deal to Alberta Health Services during their unpaid practicums • For the 12-month period ending March 2019, AHS accommodated 19,240 students who worked 3.2 million hours. For the same period ending March of this year, 22,768 students put in 3.8 million hours, a year-toyear increase of 18 per cent. • While the pandemic has driven practicum numbers down, they remain substantial. For example, from April to July of this year – the spring/summer semester – 2,479 students were still able to work 506,000 hours on their practicums. • Nursing students typically account for the lion’s share – almost three-quarters of students – who gain experience and knowledge through their time with AHS students came to learn about healthcare leadership and occupational therapy leadership through virtual networking and participating in working groups and projects, which is generally done over Skype.â€? “It’s a great opportunity for students to come and learn what we do provincially to support OT practice. We take students on a journey to explore, as well, their own leadership qualities and their leadership styles. This shows them how their practice knowledge and how their own individual approach to occupational therapy will translate into how they can evolve to become leaders in the organization.â€? Lazorek is pleased that some acutecare facilities have been able to think outside the box and take students despite COVID-19, with appropriate safeguards in place. â€?The students were able to jump right in and feel that urgency and that need for them to be there to really support the healthcare system – for both bedside and clinical care,â€? Lazorek says. “Many made sure our patients were feeling OK by helping them to connect virtually with their family and loved ones during times when family members weren’t able to visit.

“Faced with how quickly things had to change as we adapted to pandemic care, our students developed their ability to adapt, to be resilient, to problem-solve in the moment. Students are great at that – supporting us and thinking outside the box and being innovative.” The quality and impact of the student work proved phenomenal, especially at a time when supervisors were under a lot of pressure due to COVID-19, says Evans. “Their spirits were really boosted by the energy, enthusiasm and excellence of the students. They found it a joy to work with these students.” “We’re dedicated to training the next generation,” adds Albers. “We appreciate and see the value of students. “Now we’re encouraging managers and units to take more students to work directly with patients. There’s no better way to learn. When it comes time to hire them in a month or two, they will be ready. They will be so welltrained, they will understand what to do – and how to care for patients in a H pandemic.” ■

During her practicum with Alberta Health Services (AHS), Spenser Day, a University of Alberta grad and freshly minted speech-language pathologist (SLP), researched and created learning resources to support front-line healthcare workers during the pandemic. “It was so comforting that AHS could accommodate students like myself so quickly. (Without a practicum) we faced a lot of uncertainty about our graduation and our careers.”

Gregory Kennedy works in communications at Alberta Health Services.

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Transforming healthcare practice beyond COVID-19 By Elaine Cook he pandemic has challenged healthcare providers in many ways. It has exposed both weaknesses and strengths of individuals, systems and practices. Greek author and poet Archilochus wisely asserted that, “When we are challenged we do not rise to our expectations, we fall to the level of our practice.” Perhaps now, more than ever, we are being challenged to examine our healthcare practices and to consider how we might rise up in ways that are meaningful to our professional practice and the clients we serve.



At Holland Bloorview Kids Rehabilitation Hospital, we have been

working hard at elevating our individual and organizational healthcare practices. Through our commitment to client- and family-integrated care, we have implemented initiatives that have transformed practice clinically and administratively. One program in particular has impacted every discipline in the hospital, as well as staff, clients and families. December 2020 saw the celebration of the first graduating class of our new, nationally accredited Solution-Focused Health Care Coaching (SFHCC) program. A dozen graduates representing doctors, nurses, clinicians, managers and knowledge translation specialists have completed the intensive 12-month program. They are reconstructing and co-constructing how clients/patients and clinicians

experience healthcare, from the inside out. Neuroscience, neuropsychology, cultural psychology and positive psychology have all buttressed our understanding of how individuals process information and how that information influences thoughts, emotion and behaviour. For example, researchers have evidence that suggests words can change our brains in negative and positive ways. This is good news for our program because our solution-focused approach is considered a strategic and dialogic model of communication. Coaches learn strategies and skills to facilitate conversations that amplify as well as reinforce those positive neural pathways by emphasizing client’s strengths and resources. Clients are engaged as the experts of their own

lived experience, while goals and outcomes are co-constructed with clinician-coaches. Dr. Laura Hartman, a researcher and recent graduate, shares: “The evidence- and theory-based approach of the curriculum has guided me beyond a formula for solution-focused conversations towards principles for navigating life situations with a solution-focused approach.” Feasibly, such an approach not only enhances outcomes for clients, but also healthcare providers. Pre-pandemic, healthcare workers experienced high rates of burnout, which have been exacerbated by the on-going stress associated with the working conditions imposed by COVID-19 protocols. Clinicians and healthcare providers trained as SFHCC have responded to COVID-19 constraints with innova-

Are you new to Canada? / Nouvellement arrivé(e) au Canada? Ž LJŽƵ ǁĂŶƚ ƚŽ ŝŵƉƌŽǀĞ LJŽƵƌ ǁŽƌŬƉůĂĐĞ ĐŽŵŵƵŶŝĐĂƟŽŶ ƐŬŝůůƐ͍ PĂƌƟĐŝƉĂƚĞ ŝŶ ĨƌĞĞ KĐĐƵƉĂƟŽŶͲƐƉĞĐŝĮĐ >ĂŶŐƵĂŐĞ dƌĂŝŶŝŶŐ ĐŽƵƌƐĞƐ tŽƌŬƉůĂĐĞ ŽŵŵƵŶŝĐĂƟŽŶ ^ŬŝůůƐ ĨŽƌ ,ĞĂůƚŚ Ăre ͻ ĞŶƚĂů ,LJŐŝĞŶŝƐt ͻ DĞĚŝĐĂů >ĂďŽƌĂƚŽƌLJ dĞĐŚŶŽůŽŐŝƐƚ ͻ DĞĚŝĐĂů ZĂĚŝĂƟŽŶ dĞĐŚŶŽůŽŐŝƐƚ ͻ EƵƌƐĞ ͻ WĞƌƐŽŶĂů ^ƵƉƉŽƌƚ Worker ͻ ^ůĞĞƉ dĞĐŚŶŽůŽŐŝƐt

tŽƌŬƉůĂĐĞ ŽŵŵƵŶŝĐĂƟŽŶ ^ŬŝůůƐ ĨŽƌ /nterproĨĞƐƐŝŽŶĂů ,ĞĂůƚŚ ĂƌĞ dĞĂŵƐ ͻ ŝĞƟƟĂŶ ͻ EƵƌƐĞ ͻ KĐĐƵƉĂƟŽŶĂů dŚĞƌĂƉŝƐƚ ͻ WŚLJƐŝŽƚŚerapiƐt ͻ ^ŽĐŝĂů Worker

&Žƌ ŵŽƌĞ ŝŶĨŽƌŵĂƟŽŶ ǀŝƐŝƚ ŚƩƉƐ͗ͬ​ͬĐŽͲŽƐůƚ͘ŽƌŐ To qualify, you must have training or experience in the ĮĞůĚƐ ůŝƐƚĞĚ ƵŶĚĞƌ each course, be a ƉĞƌŵĂŶĞŶƚ ƌĞƐŝĚĞŶƚ ŽĨ ĂŶĂĚĂ Žƌ Ă ƉƌŽƚĞĐƚĞĚ ƉĞƌƐŽŶ͕ ĂŶĚ LJŽƵƌ ŶŐůŝƐŚ ŵƵƐƚ ďĞ Ăƚ ĂŶ Intermediate level ; ĂŶĂĚŝĂŶ >ĂŶŐƵĂŐĞ ĞŶĐŚŵĂƌŬƐ ϲ ʹ ϴͿ͘


PROFESSIONAL DEVELOPMENT AND EDUCATION tion and resilience. Within weeks of the shutdown, a virtual coaching service for parents and staff was implemented – and is still operating. We are supporting staff transitioning to virtual care through a variety of workshops that facilitate clinicians’ humanistic, solution-focused communication skills.


What makes this 12-month program and training unique is how it is embedded into the daily work schedules and practices of what healthcare providers already do. Learning and placement are seamless and experiential. There are a variety of learning contexts, including formal, informal, self-directed and peer-facilitated. From the very first class, participants learn to contextualize the theory and model to their unique discipline. Amanda Musto, an occupational therapist and recent graduate, describes her experience: “The peer support and discussion embedded within the SFHCC course has been integral in promoting my comfort and confidence to integrate and embed solution-focused coaching into

A Zoom photo of the first graduating class of Holland Bloorview Kids Rehabilitation Hospital’s new nationally accredited Solutions-Focused Health Care Coaching Program. Elaine Cook (top left corner) is the team lead of solution focused practice at Holland Bloorview. my practice. Being able to speak with my peers about practical application in different cases and models helped to

deepen my understanding and imagination to what solution-focused coaching can look like in a healthcare setting.”

External feedback about the SFHCC program has been resoundingly positive. Keith O’Meara, a social worker, counsellor and instructor with the Solution-Focused Brief Therapy program at O.I.S.E., University of Toronto, described our the program as “impressive,” with well developed, detailed curriculum, learning goals and strategies. Dr. Anne Hunt, assistant professor in the department of occupational science and occupational therapy at the University of Toronto, expressed that the solution-focused fundamental module offered to first year students was a great success and opportunity. We have the opportunity, as a result of the novel coronavirus, to do something different, to practice healthcare in ways that care for the healthcare provider as well as clients and families. For more information about the new, novel and certified SFHCC program, or the wide variety of workshops and consulting services that can help to transform your organization, please contact Elaine Cook at ecook@holH ■

Elaine Cook, PhD is the Team Lead, Solution Focused Practice at Holland Bloorview Kids Rehabilitation Hospital.

It truly helped me achieve my professional goal of working for disability policy change within Government. The PhD program is focused on clinical knowledge and skill development; however, I was able to carve out a research program that was multi-disciplinary in approach by using the knowledge I gained in the program to advance my policy development skills. I did this through courses that taught foundational skills in research, such as qualitative and quantitative methodology. Beyond the learnings derived from these courses, though, I had the most amazing supervisor and supervisory committee. My supervisor, Dr. Rebecca Gewurtz, was integral to my academic success, and my bridge to a more advanced professional role post-graduation. The right fit between supervisor and student is absolutely crucial. I had that. Rebecca advised me, guided me, taught me, encouraged me, and believed in me. Often times, Dr. Gewurtz went above and beyond her official role as supervisor to help me stay the course. She and my committee were invested in my success. I am now working as a research advisor with Employment and Social Development Canada. This role would not have been possible had I not completed my PhD, with all the requisite knowledge, skills, and confidence that the program provided me.


Rehabilitation Science Graduate Programs Areas of Research &

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Pamela Lahey, PhD, Rehabilitation Science Graduate Program 2018



When the

simulation labgoes virtual By Gonzalo Blanco, Éric Tassé and Dr. Richard Waldolf t Hôpital Montfort, a francophone academic hospital in Ottawa, research and education are handled by the Institut du savoir Montfort (ISM), the hospital’s knowledge institute. Adapting training to the unique context of the pandemic has presented numerous challenges. The ISM’s training team, consisting of instructors and simulation technicians, has had to demonstrate endless creativity during these unpredictable times. Back in August, when four new simulation instructors required training, the team faced a challenge: how to provide a high-quality, experiential, simulation-based training experience while maintaining physical distancing re-


quirements. To ensure a safe learning environment for staff and learners, the team decided to conduct the session in a synchronized fashion using multiple rooms within our simulation centre. With the help of creativity and technology, the team was able to offer their first simulation training remote-

ly. For the simulation technicians, it is certainly easier to manage the technical equipment, video recordings, mannequins and simulation scenario preparation while physically being on site. During this full-day course, with eleven participants spread out in different rooms, these amazing techni-

cians managed a total of eight cameras, three computers, four applications and numerous video recordings with one member of the pair working remotely. The technicians also had to adapt some of the simulation scenarios since they no longer had access to simulated patients to help bring more realism to the simulations. Éric Tassé, the technician who was working from a remote site, recorded each scenario and broadcast the recordings to the three rooms so that the participants could follow the training in real time. And in case of any unforeseen events, he also helped troubleshoot any technical issues that occurred during the simulations. In order to bring a simulation to life, several applications are neces-


WITH THE HELP OF CREATIVITY AND TECHNOLOGY, THE TEAM WAS ABLE TO OFFER THEIR FIRST SIMULATION TRAINING REMOTELY. sary. Éric supported the instructors by controlling the computers to manage these applications. The other technician, Gonzalo Blanco, was on site for the day and among his many responsibilities was the preparation of the mannequins and some impromptu Oscar-worthy acting performances during the simulation scenarios. “We are very proud of the success achieved by our telesimulation,” explain Éric and Gonzalo. This success allows us to foresee several possibilities for future training sessions.” The development of innovative training activities now includes a concept

that was rarely considered before March 2020: can a version of the activity be offered to remote locations while still providing a similarly rich learning experience as the in-person version? One thing is clear: even once the pandemic is over and we return to a certain normality, the ISM intends to keep this type of training accessible in a virtual format. This option will allow the ISM to achieve its mandate of providing distance training to partners in other regions, including to Francophone partners in regions across Ontario and Canada who cannot travel to H Montfort. ■

Gonzalo Blanco and Éric Tassé are simulation technicians and Dr. Richard Waldolf, MD MMEd CCFP (FPA), is the Simulation Program Director at the Institut du savoir Montfort.

• CCHFM Program developed by CHES • Intended to ensure that Canadian healthcare facilities are managed by competent individuals.

Ensuring Effective Healthcare Facilities Management Leaders Effective leadership of the healthcare facilities management department can be achieved by ensuring certification of all leadership staff. “It’s important our facilities management leadership understand the importance of working in healthcare and all the associated codes and standards that go with it,” says Chuck Donohue, director of facilities management at Hamilton Health Sciences. “Certification ensures the knowledge and experience is available to the organization on a daily basis.” According to CSA standard Z8002-19, Operations and Maintenance of Health Care Facilities, Organizations should make sure healthcare facilities are managed by competent, qualified individuals who have acquired knowledge, skill and judgment through experience and education. The standard also states healthcare facility managers should obtain recognized industry certification in Canadian healthcare facilities management. The Canadian Certified Healthcare Facility Manager (CCHFM) program is designed to test a well-defined body of knowledge representative of professional practice in healthcare facilities management. Developed by the Canadian Healthcare Engineering Society (CHES), the goal now is to make the CCHFM program the standard for healthcare facilities leadership in Canada. I was one of the original recipients of the CCHFM designation and have since encouraged my supervisory team at Hamilton General Hospital to become certified along with all facilities managers with Hamilton Health Sciences. It is an important step in establishing a level of competency across the health network, which is comprised of five hospitals and a cancer centre. “Since we are a multi-site organization, we rely on our facilities management leadership to be independent critical thinkers who can resolve problems at their site quickly and efficiently,” says Kelly Campbell, vice-president of corporate services and capital planning at Hamilton Health Sciences. “Having certified facilities managers would only enhance these qualities.” George Pankiw, P. Eng., is a holder of the CCHFM. He is presently the Facilities Manager at the Hamilton General Site of Hamilton Health Sciences.

• Designed to test a well-defined body of knowledge, representative of professional practice in the discipline of healthcare facilities management.

• Successful completion of a certification examination is an indicator of broad-based knowledge in this field.

HANDBOOK CCHFMHandbook_3DEC2019.pdf (



Overseas opportunities and career development ew applicants to MSF are always told the most challenging aspects of doing humanitarian work also provide the most rewarding and enriching experiences to our fieldworkers, both on a professional and a personal level. Spending nine to 12 months providing lifesaving care to some of the world’s most vulnerable people is a humbling experience, since the needs often outstrip what is possible for healthcare professionals to provide. Many fieldworkers come back with a renewed sense of empathy, which is essential to being a great healthcare provider – something that is true whether someone is a nurse, doctor, pharmacist or any other kind of health worker. But it’s important to note that for international healthcare workers in the humanitarian sector, field assignments are not just a one off but rather often a key part of a long career. In fact, many new applicants are not aware that MSF wants people to stay and grow within the organization and to take on more responsibility as part of that growth. To encourage and enable this type of career development, MSF offers training and career planning to our fieldworkers from their very first assignments onwards. Our internationally hired fieldworkers are often put into situations where they have to go outside of their comfort zones as professionals – whether they are being exposed to new diseases or pathologies, having to adapt to new cultures or living 24 hours a day with the same people they work with. In addition, international fieldworkers often supervise dynamic, multidisciplinary teams in very trying circumstances. Many of our field workers point to these experiences as contributing greatly to making them better and stronger leaders. Juniper Gordon started working with MSF seven years ago as a mobile medical team leader and nursing supervisor and through her experience, ongoing trainings and support from the organization she is now working as


MSF staffer in Kenya a medical coordinator for MSF’s emergency response team. “Working in humanitarian aid gives you a very different perspective on the everyday challenges healthcare workers in many countries face in trying to provide even very basic services on a daily basis,” says Gordon. “I’ve learned to really appreciate how well our healthcare system works in Canada – even though it still has its challenges. Working with MSF I’ve developed skills in cross-cultural communication, diplomacy, setting up health programs and hospitals and managing large teams with various medical backgrounds. The art of flexibility and being able to adapt to changing contexts are invaluable skills I have gained working in humanitarian aid and can be readily applied when working in Canada.” Since 2003, Heather Thomson has been on been on nine field assignments with MSF in seven different countries in sub-Saharan Africa and in Yemen in a variety of roles including

an outreach nurse, a project coordinator and a medical coordinator. “Through my MSF field assignments, I’ve worked with the local medical teams to deliver health care in small remote villages, refugee and internally displaced people camps, and large urban centres with active fighting,” says Thomson. “When I return to Canada, I work as a nurse practitioner in a community health centre in Ottawa. Here I provide primary healthcare to newcomers to Canada, namely refugees, some of whom have come from the very settings where I have been with MSF,” she says. “During clinical encounters with these newcomers, my MSF experience has given me a better understanding of their refugee journey, including a few words in Swahili and Arabic as greetings and medical terms.” “When I share with them that I have visited their country, say Yemen, it has created an instant connection that has helped to develop a therapeutic relationship. I do plan to continue

with MSF field assignments, which have enriched my knowledge and skills as a nurse practitioner in Canada to provide primary healthcare for multicultural Canadians.”


We need people at all levels of our operations, from coordination positions – such as medical coordinators and country directors – to technical advisors in our various headquarters around the world. Professionals who also speak French or Arabic, have some global health experience or backgrounds working in rural and remote northern communities are especially sought after.


To find out more about working for MSF and how the recruitment process works, please visit www.doctorswithH ■

This article was submitted by Doctors Without Borders/Médecins Sans Frontières (MSF). 38 HOSPITAL NEWS JANUARY 2021

Infection Control Risk Assessment



The United Brotherhood of Carpenters’ Infection Control Risk Assessment (ICRA) training teaches healthcare construction protocols that save lives. Our training educates Healthcare Personnel, Construction Professionals and Architects in ICRA best practices that protect patients by working safely during all phases of healthcare facility renovations. Contaminants released during renovation projects can lead to deadly healthcare associated infections. This is why it’s critical for anyone working in a healthcare facility during renovation to have participated in ICRA Training.


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Sexual and reproductive healthcare for refugees By Sarosh Naqvi he subject of comprehensive sexual health education and care, specifically for refugees and migrants, is often overlooked. Some of the specific topics that fall under the domain of sexual health education and care are contraception, sex, pregnancy, and preventive health screenings (e.g., PAP smears and cancer screenings). Given the highly moralized nature of sexual health, however, some healthcare workers may fail to introduce and/ or to adequately address the topic. Additionally, from many cultural perspectives, the subject of sexual health can carry significant stigma with it and/or it may be regarded as taboo. Sexual health is an important aspect of one’s overall health. If patients do not have the opportunity to receive sexual health education and care, then it may lead to, for example, unplanned pregnancies and undetected sexually transmitted infections (STIs). It is often the case that migrants and refugees report never having received sexual health education in their home countries because it was considered taboo. This has resulted in a number of unfortunate consequences. For instance, according to one study, young girls from various countries (including Sudan, Somalia, and Iraq), were not educated about what a period was until their first menstrual cycle. In 2017, Metusela et al. found that refugee and migrant women are at risk of having poor sexual and reproductive health outcomes (e.g. STIs, unplanned pregnancies) because they do not use available services. The study found three reasons that sexual health services are not accessed by this population: 1) minimal knowledge of healthy sexual and reproductive practices and preventive health screenings; 2) physical, geographical, and/or psychological barriers to receiving care; and 3) neg-


IT IS INCUMBENT UPON HEALTHCARE WORKERS TO PROVIDE THOROUGH SEXUAL HEALTH CARE AND EDUCATION FOR MIGRANTS AND REFUGEES. ative sexual and reproductive health results. Negative sexual and reproductive health results can be, for instance, being too anxious to address concerns with healthcare workers, unwanted pregnancies leading to terminations, engaging in risky sexual behaviours because of a lack of sexual health education, and/or avoiding contraception or delaying screenings because of incorrect information. Furthermore, financial and language barriers may influence whether sexual healthcare is sought, especially since Canadian government assistance for refugees and migrants expires after one year, which means that refugees have to pay for services themselves afterwards. It is incumbent upon healthcare workers to provide thorough sexual health care and education for migrants and refugees. Sexual health education and care should be approached in the same way that other bodily ailments are addressed: as a normal part of a person’s life. It may be assumed that refugees or migrants who do not explicitly bring up a sexual health ailment or question do not have concerns, though this may not be the case. In addition to the fact that sexual health may be a particularly stigmatized topic in their country of origin, PTSD from traumatic past experiences may also inhibit patients from bringing up sexual health problems, especially in cases where patients may have been abused by aid workers and/or other trusted individuals. From an ethics perspective, healthcare providers have a duty to ensure

that they are providing benefit to patients and preventing undue harm. Additionally, developing trusting relationships has been shown to influence patient health outcomes. It often takes patients multiple visits in order to feel safe enough to confide in their healthcare provider(s); this needs to be considered when assessing a patient. As such, and insofar some refugees and migrants may be unlikely to broach the topic of sexual health, then healthcare providers may need to take additional time to build trusting relationships and to introduce the topic in a safe and comfortable way. Although healthcare providers have a duty to support each of their patients, taking additional time when working with refugees and migrants in particular may be justified from an equity perspective, particularly given the increased need to build trust and take responsibility for introducing taboo topics. In one recent study, refugees who had lived in Canada for six to nine months participated in focus groups concerning the healthcare that they received. The participants expressed concerns about healthcare providers being dismissive of their ailments and/or slow in providing referrals or prescriptions. These concerns were particularly relevant to women and patients of colour. While there are likely systemic changes that need to occur in order to fully respond to these challenges, it is important that healthcare providers respond to the concerns of patients in a way that ful-

ly takes into account their expressed concerns, especially given their lack of familiarity with our healthcare system and the fact that they may be unable to advocate for themselves based on the norms from their country of origin. Trust-building between migrants and healthcare workers can also be approached by hosting community focus groups. These focus groups can be facilitated by healthcare workers who speak the language of their patients or by enlisting the help of an interpreter. Here, valuable information on where to find resources about various topics can be provided, and sexual and reproductive health education sessions can be offered. Clear and repetitive messaging that addresses the stigma of sexual health needs to be at the forefront of these sessions, making sure that patients are aware that they can speak about their problems without judgement. In short, sexual health education and care for refugees and migrants in Canada needs to be improved. Sexual health can ultimately influence a person’s overall health and well-being, but significant stigma about the topic may prevent refugees and migrants from bringing forward questions and concerns. Consequently, it is important that healthcare providers introduce the topic to refugee and migrant patients in a safe and comfortable way. In order to create a safe space for these patients to express any sexual health concerns, trust needs to be built. Trust-building between healthcare workers and patients can occur by spending more time with patients, enlisting the help of an interpreter, and/or by hosting community focus groups. Ultimately, comprehensive sexual health can be achieved for all refugees and migrants by implementing equitable approaches H to care. ■

Sarosh Naqvi, MSc, is a recent graduate from the London School of Hygiene and Tropical Medicine where she studied Reproductive and Sexual Health Research in Public Health. 40 HOSPITAL NEWS JANUARY 2021


Pharmacovigilance: Committing to safety for Canadians – The case of COVID-19 vaccine By Victoria Bugaj, Jacob Poirier, and Certina Ho e can all agree that the year 2020 can be summarized with one word: unprecedented. The same velocity with which COVID-19 swept throughout the world, medical experts and pharmaceutical industry scientists worked diligently to provide a solution. There has never been more interest, expertise, or upfront investment dedicated to providing the world with a vaccine. In less than one year from the onset of the global pandemic, Canada has approved the first COVID-19 vaccine for use in December 2020.



In today’s society where it can be difficult to identify and verify credible sources of information, it is not surprising that the public perception on the safety of a new drug or a new vaccine may be divided. What everyone may not be fully aware of, however, are the rigorous systems that are in place to ensure the safety of Canadians before and after a drug product or a vaccine is approved. The Clinical Trials Database is managed by Health Canada. It provides a public listing and source of information related to phase I, II and III clinical trials in patients involving human pharmaceutical and biological drug products:

• Phase I clinical trials are usually performed on healthy volunteers to find out the pharmacological actions of and the safety (i.e. side effects) associated with increasing doses of the drug. • Phase II clinical trials are meant to assess the efficacy of the drug in patients with medical conditions to be treated/diagnosed/prevented, and to find out the safety (i.e. side effects) and risks associated with the drug. • Phase III clinical trials are intended to collect additional information to confirm the clinical efficacy and safety under the proposed conditions of use for the drug. In other words, these trials evaluate the drug’s efficacy, safety, and effectiveness (i.e. how well it works) in people. The evaluation of safety and efficacy of a drug product or a vaccine does not stop when the product is approved; in fact, once a drug or a vaccine becomes available in the market, it is constantly being monitored and evaluated for safety. In addition to phase I, II and III clinical trials, what may be lesser known is Phase IV clinical trials: • Phase IV clinical trials are studies performed within the approved indication after the drug has been approved. This is part of post-market surveillance and reflects the combined effort of the pharmaceutical industry and Health Canada

to continuously survey for adverse reactions related to the drug or the vaccine once it is approved. This process ensures every approved drug product or vaccine is continuously monitored for rare adverse events that may not have been captured in previous phases of clinical trials.


Although, the COVID-19 vaccine was developed and approved in less than a year, one must keep in mind that the abundance of resources available for this to occur was unparalleled. As a result, the multiple phases of clinical trials took place simultaneously with Health Canada’s review of the incoming data and evidence. Drug manufacturers are obligated to relay any reported adverse events to Health Canada by performing risk monitoring activities, post-marketing studies and encouraged expedited reporting of possible adverse events associated with their products. For example, as with all drug products, the COVID-19 vaccines are subject to Good Pharmacovigilance Practices (GVP) Guidelines. According to the guidelines, the manufacturer is required to report serious adverse drug reactions (with respect to the drug) to Health Canada within 15 days after receiving or becoming aware of the information. Mandatory reporting

of serious adverse drug reactions and medical device incidents by hospitals to Health Canada is also effective as of December 16, 2019. In addition, under the Health Canada’s Canada Vigilance Program, an online portal is available where anyone can report a side effect to a drug, a vaccine, or a health product. When combining reports from all sources, it allows for the opportunity to identify and highlight potential safety concerns, including those that may have been previously unrecognized. Although the speed at which the COVID-19 vaccines entered the market has been unprecedented, rest assured the safety and reporting standards to which they are upheld are no different than any other drug products or vaccines. In fact, in response to the pandemic, Health Canada made a commitment to increase the monitoring and assessment of any vaccine safety issues via amplified collaboration and data sharing between global health partners, including the World Health Organization. This diligent monitoring of adverse reactions is an ongoing process, which ultimately helps to ensure safe administration of the COVID-19 vaccine for all Canadians. For further information, please refer to the “Vaccines and treatments for COVID-19: Safety after authorization” website at H ■

Victoria Bugaj and Jacob Poirier are PharmD Students at the Leslie Dan Faculty of Pharmacy, University of Toronto; and Certina Ho is an Assistant Professor at the Department of Psychiatry and Leslie Dan Faculty of Pharmacy, University of Toronto.



Spiritual care

promotes employee well-being By Sarah Quadri onnie Jennings is joyfully playing peak-a-boo with her daughter – for the first time in 33 years. It’s a feeling she’s savouring while working from home and caring for her daughter at the same time. But this joy is only a recent development for Jennings, after many long and difficult days, since the pandemic began. “My daughter Sarah is non-verbal and has a disability; she usually attends a day program while I’m at work every day,” says Jennings, an Ontario-based former Personal Support Worker (PSW) turned Service Coordinator at SE Health – a not-for-profit social enterprise and one of Canada’s largest health care organizations specializing in home care. “When the pandemic hit, all of Sarah’s programs stopped; my husband and I were working fulltime and we don’t have help. I have a very strong work ethic and it was extremely hard for me to balance everything – it was a huge adjustment and I felt overwhelmed. I cried every day for three months.” During these trying times, Jennings turned to one of the only places she knew she could – for comfort and support – her employer, where she’s worked for almost 20 years. “I’m not a spiritual person but when I heard about the care services that SE Health is offering, I thought to myself, let’s try this to see if it will help me,” adds Jennings. What Jennings discovered was even more than she hoped for and it helped her to see her situation in a different light. “I found a wonderful woman by the name of Susan Morgan and after responding to me immediately, Susan told me that she has experience living and working with people who have disabilities. Right away, I felt a



Bonnie Jennings with her daughter Sarah.

IN OUR SPIRITUAL CARE ROLES, OUR TEAM IS TRYING TO MODEL THAT; TO ENCOURAGE AWARENESS OF ONE ANOTHER, THE APPRECIATION OF OUR SHARED VULNERABILITY AND TRUST THAT WE ARE STRONGER AND MORE RESILIENT WHEN WE WORK TOGETHER. sense of relief – Susan knows what I’m going through. She was supportive, non-judgmental and kind; she really listened to me and was honest. Susan

also encouraged me to realize that the situation I am experiencing isn’t just about me; it’s about Sarah, too. She helped me to see that Sarah’s routine

also changed and that I needed to be aware of what she may be feeling. Susan earned my trust immediately and when she says she was going to check up on me, she was true to her word.” “I understand that the focus of my role is to be a compassionate and listening presence – to reflect together with those I encounter. Human connection is impactful and can energize us,” says Susan Morgan, Spiritual Care Provider at SE Health. “As individuals, we already have what we need for our journeys, but in times of stress we doubt that. We do our best work when we do it together. In our spiritual care roles, our team is trying to model that; to encourage awareness of one another, the appreciation of our shared vulnerability and trust that we are stronger and more resilient when we work together.” At SE Health, collaborating to promote the health and well-being of its employees and clients is paramount, especially during the pandemic – ensuring everyone is receiving the support they need, no matter what role they have in the organization. As part of that commitment to care, SE Health is proud to be the only home care organization in Canada to offer spiritual care, at no cost, to its employees and clients, in all its service delivery centres, across the country. Since the pandemic began, the shift to virtual spiritual care is having an enormous impact, benefitting many people. “Virtual spiritual care is the cornerstone of SE Health’s commitment to its internal and external communities during COVID-19,” says Nancy Lefebre, Senior Vice President of Knowledge and Practice and Executive Director, Saint Elizabeth Foundation. “The need is greater than ever and our response remains steadfast – a wonderful team of spiritual


care providers, including Susan, who are dedicated to the well-being of our staff and clients, no matter their circumstance. SE Health is proud to be pioneering this vital service in home care.” Last November, the SE Health Spiritual Care Team and the Saint Elizabeth Foundation were honoured to present at the Hospice Palliative Care Ontario (HPCO) Conference about the shift to virtual spiritual care and the impact this program is having across its organization. “Before the pandemic, we offered direct one-on-one support, in-person,” adds Morgan. “Our team members would make visits to wherever the employee or client lives, over weeks, months and even years, depending on the situation.” These visits also included caring for the staff and clients at Journey Home Hospice – an alliance involv-

tario-based PSW who’s enjoyed working at SE Health for the last 14 years. “I am very thankful that I work for a company with heart and support. I always feel valued as an employee and hopefully I will be able to stay at SE Health until my retirement!” Jennings feels the same way. With the support of her amazing colleagues and Morgan, she’s moved from feeling overwhelmed to enjoying every minute she has, working from home while spending time with her daughter. “Some days are better than others, but this time together has bonded us more than ever. If I wasn’t at home, I may have missed the chance to play peak-a-boo with Sarah; I can’t imagine that, I am so grateful.” To read more about the extensive spiritual care services SE Health offers to the wider community, across Canada, please visit H ■

AS NURSES WE DO AN EXCELLENT JOB CARING FOR OTHERS BUT OFTEN DO A LOUSY JOB CARING FOR OURSELVES. ing and staffed by SE Health that improves equitable access to hospice palliative care for Toronto’s homeless community and provides patients with quality health care services and a safe, welcoming and caring environment for their end-of-life journey. “While we can’t support in-person during the pandemic, we still want to be there to offer continuity of care, especially during a crisis like COVID-19,” Morgan adds. When home spiritual care visits halted last March, Morgan and her colleagues seamlessly switched to Microsoft Teams to support staff and clients. During the pandemic this support has expanded, servicing calls from groups and teams across the SE Health

system who are seeking a compassionate, listening ear. “Susan’s words touch all of us and always come at the right time,” says Dawn Chetley, London, Ontario-based Health Services Supervisor at SE Health. “Susan’s messages about the importance of self-care and remaining resilient are critical for our teams to hear especially during the stress and burden of the pandemic. Susan takes the time to review self-calming practices and gives permission for our team members to spend time caring for themselves. As nurses we do an excellent job caring for others but often do a lousy job caring for ourselves.” “My conversations with Susan helped so much,” adds Laura, an On-

Sarah Quadri is Director, Corporate Communications, SE Health.

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New report on aging

calls for makeover of Canada’s approach to supporting seniors By Don Drummond and Duncan Sinclair he challenges of enabling our aging citizens to age well, particularly over the long-term, have become glaringly clear throughout the COVID-19 pandemic. Approximately 80 per cent of deaths from the virus have occurred in those aged 80 or older, waking Canada up to the reality that something has to change. In late November, we released a report titled Ageing Well that calls for a drastic makeover of how Canada approaches support for seniors. In it, we propose a proactive, coordinated, and holistic model of care that considers four primary types of support – health and personal care, housing, lifestyle and social – as vital to ensuring our elderly population can age well.



Canada’s health care model tends to focus on alleviating physical and mental limitations, with housing, lifestyle and social needs coming as secondary if at all. Yet, key to supporting seniors is acknowledging the role that age-inplace options, such as home care that allows seniors to stay and age in their homes and communities, can play in sustaining their health and happiness. Canada is an international outlier when it comes to investing in age-inplace options and the success stories from other countries demand our at-

tention and re-evaluation of our own policy of institutionalization. In Canada, between one-in-nine and one-in-five seniors in long-term care facilities could do well with a home care option, which is often a more appropriate and less expensive path. Many seniors move into long-term care because of frailty and dementia. However, integrating the additional pillars of housing, lifestyle and social needs can prevent or delay the onset of frailty and dementia and lessen their severity. The benefits of age-in-place options are not exclusive to any one age, condition, diagnosis or factor – all seniors deserve this consideration when choosing a care plan. Ultimately, and as the evidence in our report points out, interweaving these additional pillars into the planning and delivery of care is necessary for our elderly population to age happier and healthier.


Our goal in writing the Ageing Well report is to help actualize change. While we all have a role to play in ensuring the well-being of Canada’s seniors, policymakers in government will be responsible for leading the implementation of our policy recommendations. Policy change will also be required to make long-term care homes safe for residents and workers, which will be a significant and expensive shift in the status quo. But we do not ask

policymakers to act alone – they will need to work hand-in-hand with local communities, hospitals, primary caregivers, and other stakeholders in order to effectively drive a transformation in seniors’ support that provides seniors with a quality of life of which we can be proud. There are two mains steps our provincial and federal governments must take – in which relevant stakeholders should seriously engage – to turn the trajectory of our support for seniors around. First is the need to deal with the COVID-19 crisis that has sickened and killed seniors in long-term care facilities across the country. There is both the immediate issue of addressing quality of care issues and now the major economic implications that will come with the post-pandemic reforms expected to take place across long-term care, including its position as a component of Canada’s broader health system. Second, we need to put the issue into the broader context of what seniors truly want: to age-in-place. Many seniors do not want to go into long-term care homes. They want to age in their own homes or in related housing in their communities that enable them to exercise the greatest level of independence they can. We owe it to our elderly population to consider how they would like to live these years of their life, especially if that desire is

beneficial to their health and well-being and makes economic sense. At the government level, the issue of how we can better support seniors – like most policy issues – comes down to costs. Luckily, our report’s proposed approaches can be seen as a “win-win” for government and seniors, wherein where seniors can have what they want, and the government can too. Home care costs between $40 – $100 per day, which jumps to $200-plus per day for long-term care and $1,000-plus per day for those in hospitals receiving care that could be provided elsewhere, including home care. Clearly, age-in-place care does not necessarily lead to increased spending. Rather, it is a different approach to meeting the combined needs of seniors that would see both reduced costs and the betterment of seniors’ lives. As we explain in Ageing Well, there is an obvious problem to address with how support is made available to Canada’s rapidly growing and ageing seniors population. With the stark increase in demand anticipated from the Baby Boomer generation in coming years, we must act now! We must dramatically change our policy direction, recognize the integral role of social, housing, and lifestyle needs in conjunction with health care needs play in a senior’s life, and pay attention to the insights offered by other countries around the world. We’d be foolish not to. The system needs to be revolutionH ized – and we don’t have time to wait. ■

Don Drummond is the Stauffer-Dunning Fellow and Adjunct Professor at the School of Policy Studies at Queen’s University, former Chair for the Commission on the Reform of Ontario’s Public Services and author of the 2012 Drummond Report outlining how Ontario was to tackle debt levels. He is also the former Chief Economist for the TD Bank. Duncan Sinclair, a Member of Order of Canada and of the Canadian Medical Hall of Fame, is internationally recognized for his work in healthcare reform. He was the first non-MD to be Dean of Medicine in Canada, led the creation of North America’s first alternative funding program for academic medicine, and was Chair of Ontario’s Health Services Restructuring Commission from 1996 to 2000. 44 HOSPITAL NEWS JANUARY 2021


New reward tool

helps caregivers maintain their physical and mental health By Arielle Townsend hen her father received a diagnosis of early onset dementia, Sharon did not hesitate to step-in as one of his caregivers. Two years later, she continues to help with everyday tasks like medication reminders, doctor visits and transportation. Yet as a registered nurse, professor, and organizer of a community group called Smart Savvy Seniors, Sharon admits it has been challenging adjusting to the caregiver role and maintaining her own physical and mental health. “There are days when I can manage and others when it is more difficult. I try to eat healthy and exercise, but it’s not always possible,” says Sharon. Sharon’s personal experience reflects a broader narrative. According to a 2018 Statistics Canada report, one in four Canadians over the age of 15 have provided care to a family member or friend with a long-term illness. More than half of the caregivers surveyed in a report by the Change Foundation said they found their role stressful, particularly when balancing caregiving duties with everyday responsibilities. Baycrest@Home, a service for family caregivers, is helping to reverse this trend with a program that combines support, encouragement, and rewards to help caregivers maintain a healthy, balanced lifestyle. With support from the Centre for Aging + Brain Health Innovation’s (CABHI) Spark program, Baycrest@Home will offer reward points to caregivers through the wellness platform BestLifeRewarded (BLR), when they adopt healthy practices, like taking a walk, eating a balanced meal or meditating. Caregivers will also be able to accumulate points by reviewing educational modules on the Baycrest@Home platform. The modules will cover a range of topics, such as how to care for someone living with dementia and how to combat the stigma associated


with the condition. Points can be used towards shopping, entertainment, or food. “Caregivers spend a lot of time taking care of others. This program will also help them take care of themselves,” says Adriana Shnall, Director of Programs, Baycrest@Home. After hearing about the reward program through a community partnership with CABHI, Sharon is excited to begin using it soon. “It’s been a challenging time, but the extra support will make a difference.”


Baycrest@Home’s new platform addresses an important, yet often overlooked phenomenon: caregiver burnout. According to the Change Foundation, family caregivers in Ontario provide approximately 10-30 hours of care per week, often while

working full-time jobs and raising children. Under these conditions, it is common for caregivers to experience higher levels of stress, depression, and health challenges. The opposite is true when adequate support systems are in place. But for people like Ruby Isaac, who currently cares for her husband and elderly parents, avoiding burnout with self-care is easier said than done. “I look after three people. I can’t take care of myself by doing something big, like going away for a weekend,” says Ruby. “But if Baycrest@Home could help me do little things to stay healthy that would be great!” According to Shnall, Baycrest@ Home was created to make health accessible for caregivers like Ruby and Sharon. “Caregivers will say ‘we’re being told to care for ourselves, but we don’t know what that means’. Our resources are designed

to help them adopt healthy lifestyle changes that are realistic and specific to their needs.” Baycrest@Home’s reward program is a step in the right direction for improving the lives of older adults living with dementia and their caregivers, especially during the current health crisis. As COVID-19 continues to amplify the challenges associated with dementia and aging, Baycrest@Home will make it easier for family caregivers to support their loved ones while maintaining their own health and reducing the risk of burnout. With CABHI’s support, Baycrest@ Home is proving that an investment in caregivers is an investment in a brighter future of aging for all. To learn more about Baycrest@Home visit To learn more about the Centre for Aging + Brain Health Innovation visit H ■

Arielle Townsend is the Marketing & Communications Content Specialist at the Centre for Aging + Brain Health Innovation.



Injectable opioid agonists:

An effective option for hard-to-treat opioid use disorder? By Barbara Greenwood Dufour pioid use disorder continues to affect lives and take lives. From 2016 to 2018, there was an estimated 48 per cent increase in overdose deaths in Canada. The Public Health Agency of Canada has reported that since the beginning of the COVID-19 pandemic, the rates of opioid-related harms and deaths has continued to increase. Treatment for opioid use disorder involves the suppression of opioid cravings and control of withdrawal symptoms. This can sometimes be achieved with oral opioid agonists – most commonly methadone and buprenorphine. These two medications are, in fact, opioids themselves. But they’re less likely to cause euphoria, or a “high,” when taken at the prescribed dosage. Oral opioid agonists aren’t effective for everyone, howev-


er. Some people with opioid dependency will keep returning to street opioids despite repeated treatment with methadone or buprenorphine. For these individuals, injectable opioid agonist therapy is a proposed treatment alternative. During injectable opioid agonist therapy, patients inject themselves with either diacetylmorphine (prescription heroin) or hydromorphone under the supervision of a health professional. Like oral opioid agonists, injectable opioid agonists are prescribed as part of a harm reduction strategy of care and are often delivered alongside non-pharmacological therapy such as counselling. But, unlike oral opioid agonists, they do produce the high of illicit opioids. It’s thought that injectable opioid agonists might help people with hard-to-treat opioid use disorder

Help patients get their lives back at West Park West Park Healthcare Centre helps patients get their lives back by providing inpatient, outpatient and outreach services in specialized rehabilitative and complex care after a life-altering illness or injury such as lung disease, amputation, stroke, and traumatic musculoskeletal injuries. By 2023, West Park’s 27-acre site will be transformed into an integrated campus of care, including a new hospital building and additional community supports such as assisted living for persons with disabilities and seniors. This transformation enables the Centre to evolve its rehabilitative programs and strengthen links to community-based services to meet the future healthcare needs of our local community and the province.

stay in treatment and also help reduce the harms of illicit opioid use. The injectable opioid agonists provided as part of the treatment are free from the harmful additives, such as fentanyl, that are sometimes found in street opioids. And, because they’re provided in a treatment facility, timely care can be provided in the event of an overdose. Some have suggested that injectable opioid agonist therapy might also reduce risks to society because having access to these drugs from a treatment facility removes the need to resort to criminal activity to obtain them. To find out what the research can tell us about the effectiveness of injectable opioid agonist treatment for opioid dependence, the health care community turned to CADTH – an independent agency that finds, assesses, and summarizes the research

on drugs, medical devices, tests, and procedures. CADTH found two randomized controlled trials and one systematic review on this topic. One randomized controlled trial looked at injectable diacetylmorphine for treating long-term users of heroin. It concluded that injectable diacetylmorphine, compared with placebo, appears to be effective for controlling heroin cravings and for improving anxiety, anger, emotional excitement, and well-being. The systematic review looked at studies that compared injectable diacetylmorphine with other treatments, such as methadone. This review suggests that injectable diacetylmorphine along with flexible doses of methadone helped chronic users of heroin stay in treatment longer, be less involved in illicit drug use and criminal activity,

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CAREERS have fewer criminal convictions, and be incarcerated less often. But it appeared to offer no better outcomes than methadone and other treatments in terms of adverse event rates and death. The other randomized controlled trial looked at how the two injectable opioid agonist (hydromorphone and diacetylmorphine) therapies compare with one another. This study found that hydromorphone was not inferior to (or was no worse than) diacetylmorphine in terms of physical and psychological health outcomes, retention in treatment, criminal activity, and use of street opioids; but it was more likely to lead to adverse events. Injectable opioid agonist therapy offers people with opioid use dependency a safer option. Therefore, it could certainly reduce some of the harmful

aspects of illicit opioid use. But even though the limited amount of research into the effectiveness of injectable opioid agonists is encouraging, until more evidence becomes available, it’s not yet clear how well the treatment works, how well it works compared with other treatments, or its effectiveness on the long-term outcomes for people with chronic opioid dependency. For more information, you can find CADTH review at injectable-opioid-agonist-treatment-patients-opioid-dependence-review-clinical-and-cost, and for the latest evidence on opioids, visit cadth. ca/opioids. If you’d like to learn more about CADTH, visit, follow us on Twitter @CADTH_ACMTS, or speak to a Liaison Officer in your reH gion: â–

Barbara Greenwood Dufour is a knowledge mobilization officer at CADTH.


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