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Leading the way in enhancing patient experience FOCUS IN THIS ISSUE

VOLUNTEER PROGRAMS AND FUNDRAISING/PATIENT EXPERIENCE:

Canada's Health Care Newspaper

The vital role of volunteers in health-care delivery. Innovative approaches to fundraising. Programs and initiatives focused on enhancing the patient experience.

NOV. 2013 | VOLUME 26 ISSUE 11 | www.hospitalnews.com

Run with me TBay: More than an Urbanathlon

INSIDE Evidence Matters ...............................11 Patient Safety .....................................13 From the CEO's desk..........................20 Nursing Pulse .....................................25 Careers ...............................................35

A life or death decision By Jonathan Breslin, PhD ay Carter, Gloria Taylor, Dr. Donald Low, and Hassan Rasouli – all names of Canadians who have made headlines recently for being at the forefront of high profile challenges to our current legal landscape regarding end-of-life issues. Kay Carter (through her family) and Gloria Taylor were the lead plaintiffs in the recent challenge to the Canadian law prohibiting assisted suicide, which will most likely be the first assisted suicide case to be heard by the Supreme Court of Canada since the Sue Rodriguez case twenty years ago. Ms. Carter died in 2010 after seeking assisted suicide in Switzerland; Ms. Taylor died of complications from her condition about a year ago. Dr. Donald Low, who was central to helping Toronto through the SARS crisis, made headlines for a video he filmed eight days before he died from a brain tumour, in which he made an impassioned plea for Canadians to reconsider their opposition to assisted suicide. Hassan Rasouli is the patient at the center of the case in which the Supreme Court of Canada just affirmed that physicians must obtain consent to withdraw life-sustaining treatment. Although the two issues are very different, the ethical thread that runs through both is the battle for control over life and death decisions. Continued on page 14

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Dr. Donald Low filmed a YouTube video eight days before his death making an impassioned plea for Canadians to reconsider their opposition to assisted suicide.

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In Brief

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Survey reveals

Canadians want access to digital health tools Ninety-six per cent of Canadians think it's important that the health care system make use of digital health tools and capabilities, and 89 per cent feel it is important that they personally have full advantage of digital health tools and capabilities, according to a new survey by Harris/Decima, released by Canada Health Infoway (Infoway). Other key findings from the report include: •86 per cent of Canadians agree that digital health will provide health information to a care team in an emergency situation •86 per cent of Canadians believe it is important that their doctors use electronic medical records •90 per cent of Canadians who access their own health information online deH scribe the experience as positive ■

Survey flags a lack of patient care resources and workforce planning New data released from the 2013 National Physician Survey (NPS) show that physicians are concerned over gaps in our health care system that may be adversely affecting patient care. Access to key health care resources, the impact of Canada's aging population and workforce planning issues are posing significant challenges for Canada's doctors. The survey found that the leading concerns among physicians include the insufficient availability of hospital beds, access to publicly-funded physiotherapists, and advanced diagnostic imaging tools. Among key findings of the 2013 NPS is the fact that physicians continue to work an average of 54 hours a week providing direct patient care, research, teaching and administration. Most average an additional 110 hours per month providing on-call services in addition to regular practice hours. The NPS data also highlight the fact that as Canada's population ages, care requirements are also shifting. Fifty nine percent of geriatric medicine specialists reported a major increase in the need for their H services over the past two years. ■

Accreditation Canada

report identifies opportunities to improve safety in care transitions In its annual Canadian Health Accreditation report "Safety in Canadian health care organizations: A focus on transitions in care and Required Organizational Practices", Accreditation Canada turns the lens on care transitions – handovers at shift changes, patient transfers, discharges and referrals – in Canadian health care organizations, and finds opportunities for improvement. In 2012, 277 health care organizations across the country were as-

sessed by Accreditation Canada surveyors, including physicians, nurses, pharmacists and therapists, using the rigorous Qmentum program. Results indicate that participating health care organizations achieved a high level of compliance with standards related to coordinating services across the continuum of care. However, there was a drop in compliance with follow-up to evaluate the ef-

New online tools support optimal treatment decisions at point of care Health care providers have access to new tools that support the latest recommendations to guide care for people living with diabetes. at the 16th annual Canadian Diabetes Association and Canadian Society of Endocrinology and Metabolism Professional Conference and Annual Meetings, health care experts are presenting new tools that will assist colleagues with implementing the 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada (Guidelines). The Guidelines is a 212-page, 38-chapter, evidenced-based resource that is recognized internationally and sets the gold standard for diabetes care and management. An expert committee of physicians, certified diabetes educators, and Canadian Diabetes Association staff refined the information into five major themes. These include: Screening & Diagnosis; Blood Glucose (sugar) Lowering (in-patient and out-patient); Vascular Protection; Self-

Management Education; and Team Care & Organizing Diabetes Care. at the 16th annual Canadian Diabetes Association and Canadian Society of Endocrinology and Metabolism Professional Conference and Annual Meetings, health care experts are presenting new tools that will assist colleagues with implementing the 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada (Guidelines). The importance of the Guidelines is highlighted by the fact that diabetes rates in Canada have doubled over the past decade, with one in every three Canadians projected to have either diabetes or prediabetes by 2020. If not managed properly, diabetes can lead to significant secondary complications, such as heart disease, stroke, blindness, kidney failure and limb amputations. The new Guidelines tools are crucial for both the medical community and the growing number of Canadians H living with diabetes. ■

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fectiveness of those transitions. The data also reveals that while efforts to improve medication reconciliation – a significant component in care transitions – are increasing (compliance rates were up 11 per cent to 71 per cent at admission and up 12 per cent to 62 per cent at transfer/ discharge over the previous year), the relatively low compliance rate remains an area that organizations should continue to H focus on. ■

Cardiac rehab programs can result in huge gains for recovery in stroke patients Stroke patients who participate in a cardiac rehabilitation program for six months make rapid gains in how far and fast they can walk, the use of weakened limbs and their ability to sit and stand, according to a study presented at the Canadian Stroke Congress. On average, participants saw a 21per cent improvement in the strength and range of motion of weakened limbs; a 19-per-cent improvement in walking speed; and a 16-per-cent improvement in the distance they could walk. Cardiac rehabilitation incorporates exercise training (aerobic and resistance/strength training), nutrition counseling, risk factor counseling and management (lipids, blood pressure, diabetes, weight management, smoking cessation and psychosocial management,) delivered by an interprofessional health care team. All of the 120 patients who participated in the study H saw improved recovery. ■

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Through the eyes

of a patient I recently attended the patient experience summit in Toronto. Over two days speakers from across Canada shared case studies, experiences and different ways to focus on and enhance the patient experience. Our health care system is transforming in many ways, one of them being that the focus is shifting from the institution (hospital) to the patient – where it should be. I was surprised to learn that this was the first Patient Experience Summit of its kind – then was pleasantly surprised to hear that the venue had to be changed to accommodate the larger than expected number of registrants. This is a good sign for patients – a clear message that they matter. In his opening remarks, Summit Chair, Vaughan Glover, President of the Canadian Association for People-Centred Health summed the patient experience up in one sentence – People want the care back in healthcare. And when it comes to patient experience it’s really that simple. Reducing wait times, easing transitions home, increasing transparency –these are all initiatives that put the patient first and help put the care back in healthcare. Leslee Thompson’s (President and CEO of Kingston General Hospital) opening address confirmed just how seriously many hospitals are taking patient experience. “Kingston General Hospital made a declaration that every single decision that would affect patient care would be made with a patient at the table.” It’s a courageous declaration, but it makes perfect sense. Who better than a patient to represent the interests of patients at the decision-making table? There is no better critic or impetus for change than a patient who can speak from experience. The Patient Experience Summit provided trailblazers of the patient experience movement like Thunder Bay

Regional Health Sciences Centre and Kingston General Hospital to share their successes and help other hospitals enhance patient experience. Some successes are the result of initiatives that are large in scope and organization wide – like the declaration made at Kingston General Hospital. And some are as simple as providing an estimated wait time for people in the emergency department; or giving them pagers so they don’t have to sit in the waiting room and can go to the washroom or get a drink.

75 per cent of responses to Hospital News’ online poll are in favour of legalizing assisted suicide in Canada – our highest response rate ever. Enhancing the patient experience can be as simple as having Radio Flyer wagons to bring pediatric patients up to surgery (pg 8) to ease their anxiety and distract them; or installing an interactive wall in the waiting room at a children’s hospital to make waiting for the doctor fun (pg 13). This month Hospital News also focuses on the patient experience and steps health care facilities are taking to enhance it. As a health care consumer, I am encouraged by these initiatives, no matter how small. What is becoming clear is that the patient should and needs to be considered in every aspect of healthcare… from construction of new facilities (BC Women and Children’s Redevelopment Plan pg. 7) to discharge (VHA Home Care’s Parent Relief Program pg. 21).

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Dr. Vaughan Glover advocates for a person-centric system transformation and lists where he sees an increasingly informed and empowered people driving our health systems and hospitals in particular in his article (pg. 16). What’s becoming clear as the patient experience movement gains momentum is that people are starting to listen. This month’s cover story ‘A life or death decision’ examines end-of-life care and issues surrounding assisted suicide. During end-of-life care the focus of care should solely be on the patient experience. Nothing else matters. Dr. Donald Low, who led Toronto through the SARS crisis in 2003, made an impassioned plea in a YouTube Video for Canadians to rethink their opposition to assisted suicide. The video is powerful – and has ignited a new dialogue on the merits of assisted suicide. While this column will not address the pros and cons of that issue, I can say that assisted suicide is really at the heart of the patient experience. If and when this issue is addressed in the Canadian legal system – decisionmakers need to have patients at the table and look at the issue not only as politicians, lawyers and lawmakers but as patients. There was a time not so long ago when the patient experience would have been considered an extravagance our strapped health system could ill afford. What we didn’t understand then (or ignored) is that focusing on the patient experience can increase efficiencies, decrease costs and improve outcomes. It’s a win-win situation. It’s time we start evaluating the performance of hospitals not only through budgets and quantity of procedures etc., but through the eyes of the people who matter most, the H patients. ■

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

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VOLUNTEER PROGRAMS AND FUNDRAISING/PATIENT EXPERIENCE

Pet therapy volunteers offer different approach to connecting with patients By Lauren Pelley and Michelle Tadique

olunteers play an integral role in patient care and customer service at St. Joseph’s Health Centre, with 250 volunteers from the community dedicating their time in giving back. Volunteers come from all walks of life, including a couple of special volunteers who walk on four legs. Elska and Buddy, our two therapy dogs in the Volunteer Pet Therapy Program, tour the halls of the Health Centre visiting patients in various departments. "It's really gratifying to walk into a room and see a patient who is not really responding, (and then) when I come in with Elska – a smile lights up their face," says her owner, Barbara Haire. "It's really great to see the impact that she has on them." Whether she's wagging her tail while getting petted by a patient, or sashaying down the hallway like a supermodel, Elska is hard to miss in the halls of St. Joe's. Barbara first had the idea to make the almost three-year-old Shetland sheepdog a therapy dog after seeing her mom's experience with a canine companion. Her mother suffered from Alzheimer's, and her own Sheltie was amazing at calming her down. "When I got (Elska), she seemed to have a personality – she just loves to greet people," says Barbara. "She loves to say 'hi' to everybody that she meets."

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HOSPITAL NEWS NOVEMBER 2013

Elska, one of St. Joe’s therapy dogs, joins her owner, volunteer Barbara Haire, in visiting a patient. She's also a loving dog, as her name suggests. "Elska" actually means "love" in the Icelandic language. "My mother's family was Icelandic, and it was a word that I knew as a little kid and it seemed to apply to her so perfectly," says Barbara. Being a therapy dog at St. Joe's has given Elska the chance to get petted even more than usual – and the experience has been a rewarding one for Barbara, too. "I just believe that it's very important to give back to the communities we live in," she says.

Susan Bertoldi, Manager of Volunteer Services at St. Joe’s adds that, “Elska is a dog with great intuition and is so people-focused, it’s incredible.” With a growing interest in a pet therapy program from patients, families and staff, Elska is the first dog we have welcomed to our growing team. This fall, St. Joe’s also welcomed Buddy, a Portuguese water dog and her owner, volunteer Carolina Lorenz to the program. “Research has shown that pet therapy helps to lower blood pressure and ease anx-

iety for patients, and brings them a sense of calmness,” says Bertoldi. The program is one way our organization is helping to improve our patients’ experience while they are in our hospital, she adds. “It’s a very generous thing that our volunteers do, to share their pet in this way. They are giving their time as well as sharing the companionship of their animal and that’s a huge gift to share,” says Bertoldi. Our volunteer programs are support resources for our visitors and patients to help them navigate the hospital, locate a loved one that is here for care, or escorting people to and from appointments. “We are so fortunate to have so many volunteers, who are committed to St. Joe’s and our Mission and Values, who want to participate in their community and see St. Joe’s as that place where they can give back,” says Bertoldi. Earlier this year, our video featuring Elska received international attention, when St. Joe’s was honoured with an Award of Distinction in the 2013 Videographer Awards, a United States-based competition that had 1,500 applicants. To watch the video, visit our St. Joe’s YouTube channel at www.youtube.com/stH joeshealthcentre ■ Lauren Pelley is a Junior Associate and Michelle Tadique is a Communications Associate at St. Joseph’s Health Centre, Toronto.

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Patient needs drive construction of new acute care centre in Vancouver By Melanie Barnes f you were building a new hospital, how would it look? Beyond the physical structure, are there more efficient or patient-friendly ways to move patients, families, staff, physicians, suppliers and services through the hospital? What changes could be made at the department level to deliver even better patient care? These are the tough questions the teams BC Children’s Hospital and BC Women’s Hospital & Health Centre in Vancouver, British Columbia, needed answered to support the construction of a new Acute Care Centre (ACC) and the redevelopment of existing services. The solution–a first in Canada–a process called Integrated Facility Design (IFD). Over the course of one week a month for six months, from January to July, 2012, hundreds of clinicians, physicians, patients and families traded their usual attire and regular routines for a 140,000 square foot warehouse, work gloves, and the opportunity to shape the delivery of care in the new ACC. Eight foot high cardboard walls brought two dimensional drawings to life and helped teams understand their physical space. Guests walked through full size mock-ups of each floor of the new ACC to review, test and improve how patients, providers, suppliers and services flow through their areas.

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The IFD process meant providers were collaborating with patients and families right from the get go, to learn what would work best, instead of making decisions first, then asking for input” “Incorporating our first-hand experience in the design will ensure that the new hospital’s design works in the real world and not just on paper,” says Dr. Eleanor Reimer, Pediatric Anesthesiologist at BC Children’s Hospital. She adds: “The IFD process gave providers and family representatives the opportunity to test floor plans and flows and to make changes to the design based on their own experience working and staying in clinical settings. Susan Greig, BC Children’s Hospital Partners in Care Family Liaison could not agree more. She felt: “The IFD process meant providers were collaborating with patients and families right from the get go, to learn what would work best, instead of making decisions first, then asking for our input.” During IFD event weeks, the hours were long, the work was physical and the pace was intense. However, patient needs drove decisions, and teams worked hard to break down barriers and to find the best way to provide even better care to patients and families. All of the hard work paid off. Recently, BC Children’s and BC Women’s, both agencies of the Provincial Health Services www.hospitalnews.com

The cardboard mock up is used to test the flow of patients, clinicians, medications, supplies, equipment and information. Authority, were honoured with a 2013 Excellence in Health Care Award for the innovative IFD process from the Health Employer’s Association of BC (HEABC). As a result of the IFD process, the ACC’s new design will be even more patient and family focused; it will incorporate access to nature and have single patient rooms with enough space for families to stay with their child during treatment. These improvements are expected to shorten the length of stay in hospital, reduce post-discharge complications, and enable care providers to spend even more time focussed on direct patient care. When complete, in 2018, the new ACC will include Inpatient Units, an Emergency Department, Medical Imaging and Procedural Suites, Hematology/Oncology and Pediatric Intensive Care for BC Children’s Hospital. It will also include a High Risk Labour and Delivery Suite and a new Neonatal Intensive Care Unit for BC Women’s Hospital & Health Centre. The new $682-million Redevelopment Project which includes construction of a new ACC, a public-private partnership, will be built to LEED Gold standards,

ensuring that the building provides a healthy and ecologically sustainable environment for patients, visitors and staff. For more information about the BC Children’s and BC Women’s Hospital ReH development Project visit www.newcw.ca. ■

Melanie Barnes is a Director with the BC Children’s and BC Women’s Redevelopment Project. She was part of the team that led the 2012-2013 Integrated Facility Design process.

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Leading the way in enhancing patient experience By Bonnie Nicholas

our years after adopting the Patient and Family Centred Care model and making it a cornerstone of our strategic plan, the Patient Family Advisors at Thunder Bay Regional Health Sciences Centre (TBRHSC) are still involved in every aspect of the hospital. It’s become a part of the culture here. Patient and Family Centred Care (or PFCC) is the provision of care that is respectful of, and responsive to, individual patient and family preferences, needs and values, and ensures that patient values guide all clinical decisions. Patient Family Advisors are volunteers who have experienced care at TBRHSC within the preceding two years and want to be involved in improving the experience of other patients and families. We now have 100 Patient Family Advisors, or PFAs, who are involved in everything we do, from program planning, policy and procedure development, hiring practices, teaching our new employees and learners to strategic planning, board quality and all of our program and service councils. We have changed our culture, the way we think and the way we work, in order to provide patients and families with the best possible care. After receiving the Leading Practice award in Patient and Family Centred Care, from Accreditation Canada, the Gold Standard in healthcare, in 2011, Keith Taylor, volunteer co-chair of the PFA Advisory Council, later asked the team what made us the best in Canada in PFCC. They said nowhere else had they

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Patient Family Advisor, 13-year-old Connor Ferguson, drew on his own experiences to help improve patient care. One idea he worked on was getting Radio Flyer wagons to make going up to surgery more fun for children. Pictured here are Ethan and Emily Erickson. seen patients so integrated in the day-today operations of the hospital. Now Accreditation Canada has asked Keith Taylor and I to partner with them to help develop their Client and Family Centred Care guidelines. Since 2011 we

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have also received a lot of calls, e-mails, visits and invitations from hospitals around the world asking us to assist them in their own journey toward patient and family centred care. I’m always happy to share information about our own PFCC history, terms of reference for a PFA Council and PFCC leadership. This year a few of our PFAs were asked to talk about the role of the PFA with Bluewater Health. Afterward, they agreed to stay in contact as mentors for new recruits. Their Patient Advocate told me she would never have dreamed of saying she wants 100 PFAs if it hadn’t been for Thunder Bay. We’ve been doing a lot of work to diversify our membership, in terms of culture and age, in order to better reflect our patient population. The youngest PFA is 13 years old. He was nine when he started and we have PFAs in their 80s. A new recruitment brochure was recently developed by an Aboriginal placement student with the goal of attracting more Aboriginal PFAs. We are always listening to our patients and families and they are driving very real change. Thanks to their input, we have seen changes to the visiting hours policy and the development of a family tour for children scheduled for surgery, for example, and we have seen how these partnerships are improving patient experience. More recently, the hospital identified gaps when patients leave the hospital to return to their home environment. It became clear that a plan of understanding was necessary to ensure that discharged patients clearly understand their plan of care.

In response, we launched a post-discharge callback trial, calling patients at home to check in and see if they understood their care plan and were adhering to it, and, if not, why not. The information collected as a result of that trial was used to develop a patient discharge summary form. It includes questions to help patients become active participants in their care, regardless of which healthcare provider they’re dealing with: What is my main problem? What do I need to do? Why is it important for me to do this? We know that when patients become active participants in their healthcare, recovery is quicker and readmissions decrease. PFAs were integral in the design of that form, making sure it contained the information they felt patients needed. The trial form went back to the PFAs several times. We wanted to know if it was meeting patients’ needs. We are still the only hospital in Canada to have been recognized with a Leading Practice award from Accreditation Canada for our adoption of PFCC. And while that is an honour, PFCC isn’t about gaining recognition. It is about the very best kind of healthcare. It is about caring together, to create the best experience for the patient, every time. It is about being H Healthy Together. ■ Bonnie Nicholas, is Co-chair, PFA Advisory Council, Patient and Family Centred Care Lead & Patient Advocate at Thunder Bay Regional Health Sciences Centre. www.hospitalnews.com


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Patient engagement through technology By Chris Cashwell

hat we see increasingly is that engaged patients have better outcomes.” That statement may seem intuitive and grounded in common sense, but it is a paradigm shift in healthcare. The statement wasn’t just made by anyone, but by Kevin Tabb, MD, President and CEO of Beth Israel Deaconess Medical Center in Boston, MA. The need to empower the patient and give them a voice in their care is critical as we move as an industry from “volume” of patients to the “value” we place on the outcomes of patients. How does the health care industry tackle such a daunting challenge? One way is through technology. Patients and loved ones do not enter an episode of care leaving their expectations of technology and connectivity behind. Today over 80 per cent of adults have cellphones and 60 per cent of those are smartphones. Doctors and clinicians routinely access reference material on their mobile devices and patients have access to their medical records through a patient portal or direct access to part of their electronic medical record. The question is how to tie all of the technology options, apps, and expectations together to get the best patient experience possible and the highest clinical outcomes possible.

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One recent study gave nearly 15,000 patients access to their electronic medical records and more than 77 per cent of patients reported they felt more in control of their care One way is to invest in a patient engagement platform. This technology adds value and ties together the touch points that drive improved patient engagement. Whether it is simple entertainment or a review at bedside of a complex scan, the ability to deliver the right information at the right time is key to meeting the patient’s needs. Patient engagement technology brings together an enterprise wide software solution that connects patients to the “outside” world as well as to important information about their hospital stay and more importantly about their discharge and post discharge requirements. Lincor Solutions, is one of the companies that provide a complete hardware and software solution to help hospitals achieve better outcomes and better patient engagement. Dr. Eddie Simpser, CMO, of St Mary’s Hospital for Children in New York, NY explains how interactive patient technology brings value to his hospital. “The device and software functions like a tablet computer and TV that lets patients not only choose their entertainment, but also interact with the real world to improve the quality of their hospital experience. At the same time, our staff uses it to access the EMR, chart at the bedside and educate patients. We find it brings a very high value to the hospital.” Solutions like these have many advantages over a simple television in a hospital room or clinic. The interactive platform allows the hospital to give the patient access to important items such as patient education about their condition, instructions about their medications, and planwww.hospitalnews.com

ning around discharge and follow up post discharge. All of these actions can be automated and monitored to proactively help the clinicians monitor where the patient and family are in the understanding of their condition and care plan. As part of a comprehensive care plan, patient engagement can clearly reduce readmission risks, medication errors, and begin to predict which patients need more resources to assure the highest possible outcome. One recent study gave nearly 15,000 patients access to their electronic medical record and more than 77 per cent of patients reported they felt more in control of their

care and 60 per cent reported doing a better job of taking their medications because of the access. Another area patient engagement technology creates a better experience is the automation of many manual processes related to a patient’s stay. This drives up the efficiency of the clinical staff and addresses the concerns or requests the patient has during their stay. For example, a patient can access their customized dietary and menu options based on their condition and order their food directly from the dietary system. If a patient needs a “comfort item” such as a glass of water, ice, or an adjustment to their

room, they can “order” those items directly to the support staff and not have to ask a nurse to send in the request. Engaged patients matter. It’s good for outcomes and it’s good for business. Using technology to improve the experience of the patient and the interaction with the physician, drives better outcomes and lowers cost. The next time your organization focuses on ways to improve patient engagement, include a patient engagement technology solution to help drive your H success. ■ Chris Cashwell is the SVP, Strategy and Marketing at Lincor Solutions.

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CSMLS saves you money: ͻĐĐĞƐƐƚŽŐƌĂŶƚƐĂŶĚƐĐŚŽůĂƌƐŚŝƉƐ ͻ>ŽǁĞƌƌĂƚĞƐĨŽƌ>KEĐŽŶĨĞƌĞŶĐĞ ͻŝƐĐŽƵŶƚƐƚŚƌŽƵŐŚĸŶŝƚLJWƌŽŐƌĂŵƐ ;ƉůĞĂƐĞǀŝƐŝƚŽƵƌǁĞďƐŝƚĞĨŽƌĂůŝƐƚŽĨĐƵƌƌĞŶƚƉĂƌƚŶĞƌƐͿ

CSMLS keeps you connected: ͻŝͲǁĞĞŬůLJeNEWS ͻYƵĂƌƚĞƌůLJCanadian Journal of Medical Laboratory Science ;ũD>^ͿƉƵďůŝĐĂƟŽŶ ͻŽŵŵƵŶŝƟĞƐŽŶůŝŶĞĚŝƐĐƵƐƐŝŽŶĨŽƌƵŵ

^D>^ĂůƐŽŽīĞƌƐ͗ ͻĚǀŽĐĂĐLJĨŽƌƚŚĞƉƌŽĨĞƐƐŝŽŶĨŽĐƵƐĞĚŽŶƚŚĞŐŽǀĞƌŶŵĞŶƚ ĂŶĚƚŚĞŐĞŶĞƌĂůƉƵďůŝĐ͘ ͻĐĐĞƐƐƚŽůĂďŽƌĂƚŽƌLJƐƚĂŶĚĂƌĚƐĂŶĚŽƚŚĞƌƌĞĨĞƌĞŶĐĞ ŵĂƚĞƌŝĂů ͻƵĂůŵĞŵďĞƌƐŚŝƉǁŝƚŚƚŚĞ/ŶƚĞƌŶĂƟŽŶĂů&ĞĚĞƌĂƟŽŶ ŽĨŝŽůŽŐŝĐĂů>ĂďŽƌĂƚŽƌLJ^ĐŝĞŶĐĞƐ;/&>^Ϳ

www.csmls.org NOVEMBER 2013 HOSPITAL NEWS


10 Focus

VOLUNTEER PROGRAMS AND FUNDRAISING/PATIENT EXPERIENCE

Urgent follow-up clinic for crisis enhances mental health support By Amanda Monaghan ssessing and treating mental health issues in patients who come in through the emergency department (ED) requires flexible, timely and efficient care. It also involves a great deal of compassion. North York General (NYGH) has taken an innovative approach to patients with mental health issues in the ED with its Urgent Follow-Up Clinic. Started in March 2012, the Clinic was developed to address mental health crisis stabilization in the ED. Today, the clinic works with patients and their family members to provide rapid mental health crisis stabilization, and follow a collaborative process for individualized crisis stabilization, and transition to community resources for ongoing treatment. “By using protocols based on the Registered Nurses’ Association of Ontario’s (RNAO) best practice guidelines and a holistic approach to care, the clinic has eased the pressures on the outpatient clinics, and inpatient and partial hospitalization admissions,” says Fern Quint, RN, BA, Emergency Psychiatric Consult Team, NYGH. A process for approaching and treating patients has been developed which is simple and mindful of the time sensitivity of these cases. A crisis nurse will contact

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HOSPITAL NEWS NOVEMBER 2013

the patient the day after their visit to the ED to arrange an initial assessment. The initial visit is two hours in length, where the patient will be assessed, create a crisis plan with the nurse, and discuss diagnostic clarification and treatment recommendations with a psychiatrist.

Crises may be triggered by a number of scenarios such as relationship disputes, trauma-related issues, or social poverty and lack of knowledge of resources. Up to five further follow-up visits are scheduled with the psychiatrist for medication review or further diagnostic evaluation, and with the crisis nurse for psychotherapy, discharge planning and linkage to community resources. An example of mental health presentations seen in the Clinic include anxiety and autistic spectrum disorders, mood disorders (mainly depression), and ADHD. Crises may be triggered by a number of scenarios such as relationship disputes, trauma-related issues, or social poverty and lack of knowledge of resources. Crises can also result from an undiag-

nosed mental health disorder. A patient may be referred to the Clinic for one issue, but after the assessment, underlying issues may be uncovered. An example would be a patient who is referred for anxiety but assessment reveals a diagnosis of ADHD. “Being thorough and keeping an openmind are essential parts of the assessment to ensure that we can target the primary and related issues contributing to the crisis presentation,” says Dr. Ian Weinroth, Outpatient Psychiatrist, NYGH. “Ensuring correct diagnosis is crucial to the patient’s safety and their treatment plan.” In addition to their work in the ED, the Clinic partners with the Hospital’s Centre for Complex Diabetes Care (CCDC), and Cardiac Rehab program. The Clinic provides the CCDC with consultations to their patients with identified mental health issues requiring timely psychiatric intervention. In the Cardiac Rehab program, patients are offered two educational sessions during the 16 week duration, facilitated by Fern Quint, to discuss optimal mental health. “The program aims to improve patient’s physical health as well as their mental health and wellness. We focus on having them exercise their bodies, and Fern helps them to understand why they need to exercise their minds,” says Nancy

Cohen, Coordinator, Cardiac Education Program, NYGH. In the short time the Clinic has been operating, the success can be seen in the recovery of the patients. “The care I received was compassionate and immensely beneficial,” says a former patient of the clinic. “I feel much better than I did when in crisis and am now connected to resources in our community for longer term therapy. Ms. Fern Quint and Dr. Ian Weinroth are extraordinary medical professionals and I give them my most sincere gratitude for how they have helped me.” The Clinic shares the success of the program, and their model of care, in medical journals and at national conferences. Their innovative mentorship program for the Emergency Psychiatric Consultation Team (EPCT) was recently published in the July/August edition of RNAO’s Registered Nurse’s Journal, and the team facilitated a “How to Session” titled, Creating an Urgent Follow Up Clinic for Crisis Management: From Conception and Design to Successful Outcomes, at the National Mental Health Nurses Conference H in October in Kelowna, BC. ■ Amanda Monaghan is a Communications Coordinator at North York General.

www.hospitalnews.com


Evidence Matters 11

Preventing strokes in your patients with atrial fibrillation:

What’s the evidence? By Dr. Janice Mann trial fibrillation (AFib or AF) is the most common abnormal heart rhythm, affecting an estimated one to two per cent of our population – that’s 350,000 Canadians living with AF. Its incidence increases with age, so numbers are likely to increase as our population continues to age. AF can lead to serious complications. It increases the risk of stroke by three to five times; an estimated 20 per cent of all strokes are caused by AF. Medications called antithrombotic drugs help to prevent stroke, but also increase the risk of serious bleeding. There are two types of antithrombotic drugs used to prevent stroke in people with nonvalvular AF: •anticoagulant drugs such as warfarin (Coumadin); and a newer class of oral anticoaulant drugs, called NOACs, which includes dabigatran (Pradaxa), rivaroxaban (Xarelto), and apixaban (Eliquis) •antiplatelet drugs such as acetylsalicylic acid (ASA, Aspirin) and clopidogrel (Plavix). Warfarin has been the mainstay of therapy for more than 60 years. It is effective in preventing strokes in patients with AF, but there are some challenges with warfarin therapy: diet restrictions, drug and food

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interactions, the need for regular international normalized ratio (INR) monitoring, and frequent dosing changes. The newer drugs, NOACs, are given in fixed doses so routine blood tests and dose adjustments are not needed; however, these drugs are costly, long-term safety data and clinical experience is lacking, and unlike warfarin, there is no reversal agent in the event of a serious bleed. Antiplatelet drugs are less effective than warfarin and the NOACs, but are sometimes used for patients considered to have a low risk of stroke. Given the changing landscape of available drug options for the prevention of stroke in patients with AF, the Canadian Agency for Drugs and Technologies in Health (CADTH) undertook systematic reviews of the scientific evidence for these drugs as well as an economic analysis.

The results:

•Compared with warfarin, the added benefit of NOACs in preventing stroke in patients with AF is small. The estimated number of patients who would avoid a stroke or other blood clot if treated with a new drug rather than warfarin was less than 10 people for every 1,000 patients treated per year. •Bleeding risks for patients treated with the newer drugs compared with warfa-

rin were similar overall, with a modest decrease in intracranial bleeding and a small increase in gastrointestinal bleeding. •While warfarin can be reversed with vitamin K, there is no reversal agent or proven management strategy if bleeding occurs with the new drugs. •The newer drugs were significantly more costly even when the cost of INR monitoring with warfarin was factored in, and the cost-effectiveness of the newer drugs was uncertain. •Compared with anticoagulant drugs, people on antiplatelet drugs experience more strokes without any reduction in bleeding risk. Even though antiplatelet drugs are inexpensive, they are not costeffective because the cost of treating additional strokes and bleeding events must be factored in. An expert committee made recommendations based on CADTH’s systematic reviews and economic analysis to guide policy and clinical decisions.

The bottom line:

•Warfarin is the recommended first-line therapy for preventing stroke in patients with atrial fibrillation. •NOACs are a second-line option for some patients with non-valvular atrial fibrillation who are not doing well on warfarin.

•If a new oral anticoagulant is prescribed, patients must be monitored. •For people who are able to use an anticoagulant, anticoagulant drugs should be used in preference to antiplatelet drugs.

Improving warfarin management:

A structured plan of care can help to improve warfarin management in any care setting. This includes regularly scheduled patient follow-up, monitoring for adherence and side effects, regular INR monitoring, dose adjustments based on INR results using a dosing tool or nomogram, ongoing patient education, involving other health professionals in patient care and education, and engaging caregivers to ensure adherence to treatment and regular follow-up. For more evidence-based reports, tools, and other information from CADTH on the prevention of stroke in patients with AF, please visit www.cadth. ca/clots. If you would like more information about CADTH, the AF project, or other topics we’re working on please visit www. H cadth.ca. ■ Dr. Janice Mann is a Knowledge Mobilization Officer at The Canadian Agency for Drugs and Technologies in Health.

NOVEMBER 2013 HOSPITAL NEWS


12 Focus

VOLUNTEER PROGRAMS AND FUNDRAISING/PATIENT EXPERIENCE

In the photoVoice group, Athena shared the darkest part of her addiction, capturing a moment in her life she felt lost – when her son was taken from her.

Her moment of recovery was captured by a full colour photograph representing her and her son – where she felt found.

The power of a picture:

Enhancing the patient experience with photoVoice By Renée Baker

any of you have heard the saying, “a picture is worth a thousand words”. What if that picture meant even more? Athena, a patient at the North Bay Regional Health Centre (NBHRC) participated in a group called photoVoice. The focus of this photoVoice group was addiction. Athena was only 15 years old when she gave birth to her son. After only eight short months, he was taken away from her. As any parent can imagine, this was the beginning of a very long, painful road. First came depression, then the addiction to alcohol and drugs. After years of struggling with depression and addiction, things escalated and she was convicted of a crime, which ultimately led her to the Mental Health and the Law Division of the NBHRC. Mental Health and the Law provides specialized mental health services to both

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inpatient and outpatients within the criminal justice system and people with a serious mental illness who are involved with the legal system. For those who are found unfit to stand trial or not criminally responsible, treatment and rehabilitation is individualized, focused on recovery and community reintegration and provided by a multidisciplinary team. Athena has been an inpatient of this service for 18 months. During her journey to wellness, Athena was able to participate in a photoVoice group offered to NBRHC patients twice yearly. “Often individuals suffering from a mental illness may not be able to adequately tell their story in words,” says Tamara Dube Clarke, photoVoice facilitator. “Through photoVoice our patients are able to capture and communicate a message in a way that empathetically engages people.” In this particular photoVoice: Focus on Addictions, participants gave insight into

the darkness they faced, how they conceptualize their circumstances and their hopes for the future. Participants met as a group for 10 weeks, where they discussed the photographs they had taken, developed narratives for the photos and shared amongst each other the pain and joy they experienced during their journey. An important component of the photoVoice group is the public display, aimed to educate and bring awareness to members of the community, family, friends, caregivers and policy makers. Athena’s message is clear. She shared the darkest part of her addiction, capturing a moment in her life she felt lost. The black and white photograph she took was of an empty stroller. The narrative is “because of my addiction, my son was taken from me. I lost a piece of my heart.” Her moment of recovery was captured by a full colour photograph representing her and her son, who is now 8 years old. She described the photograph as “Found”. Because of my recovery, I am reconnecting with my son, receiving and giving unconditional love. I found a piece of my heart.” For Athena, these photographs are worth much more than a thousand words. They have cost her time with her son, but they are worth everything; being reunited her son, the hope for a brighter future and a commitment to living sober. “This group has made me realize that my son is what I am doing this for,” says Athena. “It has taught me how powerful reconnection is, and how hard I will work to change and maintain my health.” Athena is currently working with her team of care givers to become well. The hope is that she will be discharged in the near future, reunited with her son and be able to care for herself and him. This program, photoVoice has been a part of the patient experience at NBRHC since 2008. Over 75 participants have had an opportu-

nity to share with us, the community, family and friends the very real and powerful experiences of what living with a mental illness really means. A documentary exists for each of the photoVoice groups the NBRHC has conducted and they are available on the NBRHC youtube channel. For more information on how to conduct a photoVoice group in your hospital, please contact Tamara Dube Clarke at H NBRHC. ■ Renée Baker is a Public Relations Specialist at North Bay Regional Health Centre.

Athena participated in a PhotoVoice group.

HOSPITAL NEWS NOVEMBER 2013

www.hospitalnews.com


Patient Safety 13

The power of the patient story

By Hugh MacLeod

hen it comes to healthcare, everybody has a story to tell. It could be about a really positive experience where excellent care was provided and everything ran on time, or it could be a negative experience that didn’t go the way you expected. It could also be an anecdote about the quality of the hospital food or a quirky roommate. While some have happy endings, others do not. Sadly, some will never be told because of a patient safety incident that was unnecessary and the patient didn’t survive. Other times, it is their families who are left to tell the story.

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ScreenPlay is a brightly-coloured, pressure-sensitive floor that allows children to create large projections on a floor-to-ceiling screen by standing, sitting and wheeling on the hundred tiles that make up the unique floor. It’s a cool blend of technology and art that lets kids of all ability levels play in the waiting room.

The fun is in the

waiting room By Claire Florentin

aiting in a doctor's office or hospital for a medical appointment can be a stressful experience. How can a health care facility make the waiting process more enjoyable and inclusive for all children? Researchers in the Bloorview Research Institute at Holland Bloorview Kids Rehabilitation Hospital have answered the call with ScreenPlay.

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An interactive waiting room

Launched last year and funded by the Canadian Institutes of Health Research (CIHR), ScreenPlay is the innovative answer from Dr. Elaine Biddiss, scientist in the Bloorview Research Institute and her team. Their goal was to create a waiting room installation that would provide all children with the opportunity to create and control their environment, regardless of their disability. "ScreenPlay is a unique installation designed to give waiting children and their families the opportunity to engage together in a calming play experience that is safe and accessible for people of all abilities,” says Dr. Biddiss. “It’s a collaborative effort that aims to understand and meet the needs of waiting children in a hospital environment." ScreenPlay came to life as a brightly-coloured, pressure-sensitive floor that allows children to create large projections on a floor-to-ceiling screen by standing, sitting and wheeling on the hundred tiles that make up the unique floor. Children of all abilities have the opportunity to participate in low-intensity exploration and creativity, easing the transition from waiting room to appointment. Children can create collective images by playing on the floor with others, which helps to encourage socialization and collaborative learning. ScreenPlay responds both to motion and stillness. The longer a child stays in one spot on the floor, the bigger their projection can become. As a result, children with limited mobility can generate dynamic responses though slow movements. On the other hand, active, able-bodied children www.hospitalnews.com

wanting to create bigger projections learn the value of slower, purposeful movements. Researchers and clinicians worked with engineers and students from OCAD University who helped develop the system and design the projected images. “What is special about this project is the multi-disciplinary collaboration,” says Amy McPherson, a scientist in the Bloorview Research Institute and a member of the ScreenPlay research team. “Clinicians and researchers worked together to identify the needs for an interactive waiting room, and we brought in design students to help us make the projections beautiful. To develop a waiting room that served such a diverse group of clients, we needed as many perspectives as possible!” A year after the official launch, the interactive installation is now an integral part of the hospital. Kids use ScreenPlay regularly while waiting for their appointments. CIHR, the original funder of ScreenPlay, has responded to the project’s success with continuing support. Initially funding a 3-year grant from 2011 – 2013, CIHR has now extending funding through 2016. Dr. Biddiss and her team conducted a data gathering phase with over 300 participants to understand ScreenPlay’s impact on the waiting process. They closed the recruitment phase of the research project at the end of May and are now analyzing the data provided by their large participant group. Looking to the future, scientists want to explore ways to integrate ScreenPlay more effectively. In addition to providing clients with an engaging way to spend time in the waiting room, it may become an important communication vehicle. The team is also looking to involve kids in designing new images for the display. To learn more about the ScreenPlay waiting room installation, contact Dr. Elaine Biddiss at EBiddiss@hollandbloorH view.ca. ■ Claire Florentin is a Communications Associate at Holland Bloorview Kids Rehabilitation Hospital.

Patients for Patient Safety Canada’s more than 60 members ensure that health care organizations and systems include the perspective of patients and their families when making decisions and planning For better or for worse, this is the patient experience – a collection of stories highlighting the good, the bad and the ugly, in our health care system. We are motivated by the latter. They are the stories that give you goose bumps. The stories that can level a room and remind everyone of the importance of health care improvement. For some, these stories become a powerful tool. They are the foundation of a crusade to put the patient voice back in healthcare and to ensure that others don’t feel the harm and suffering they experienced, when it could have been prevented. These brave men and women belong to a group called Patients for Patient Safety Canada. They are patients and family members who have suffered unspeakable grief, loss and heartache.

What’s so amazing about them is their ability to actually speak about it and turn their tragedies into something positive. Everyone who has ever heard one of these stories can attest to their power. Patients for Patient Safety Canada’s more than 60 members ensure that health care organizations and systems include the perspective of patients and their families when making decisions and planning safety and quality improvement initiatives. Every prospective member goes through an interview process to ensure they are at a stage in their healing where they can work with the system to improve patient safety. Patients for Patient Safety Canada is not a support group. Members avoid terms like “negligence” and “incompetence,” and do not assign blame. Many members have shared their personal stories through videos broadcast during Canada’s Virtual Forum on Patient Safety and Quality Improvement. These narratives reinforce the importance of including the voice of patients and their families in patient safety discussions. Members participate in conferences on patient safety as keynote speakers, panel members, or poster presenters. They also participate in the development of patient safety resources and serve on various committees and working groups. The importance of this group can’t be overstated. To experience the hardships they have and come out the other end willing to work with the system to better it for the benefit of future patients is nothing short of remarkable. There is no greater stakeholder in the effort to improve patient safety than patients and their families. To learn more about Patients for Patient Safety Canada or the possibility of becoming a member, visit www.paH tientsforpatientsafety.ca. ■ Hugh MacLeod is the CEO of the Canadian Patient Safety Institute.

Buddhist Psychology Retreat Finding Peace within the Storm For all Health and Helping Professionals

Fo ore informram tion call

705.749.6 145

January 9 -11, 2014 The Ecology Retreat Centre, Hockley Rd. (West of Airport Rd.) Two days of stepping back and exploring meditation, self care and therapeutic understanding and working from a Buddhist Psychological perspective. There will be an intermingling of theory with practice including periods of silence and meditation, as well as study and learning in an interactive workshop environment.

Details and registration at:

Presenter

Don Ferren Ph.d, C Psych., Buddhist

Or Email

www.cast-canada.ca info@cast-canada.ca ...come and sit together

NOVEMBER 2013 HOSPITAL NEWS


14 Focus

Life or Death Continued from cover

These stories are very compelling. When there is someone in front of us who is suffering, or has an illness that will bring suffering, the issue can seem simple. They’re going to die soon anyway, so why not give them the control over the timing and manner of that death? Isn’t it cruel and inhumane to refuse them that control? Is there really any ethical difference between allowing a patient to refuse CPR, or to withdraw a life-sustaining feeding tube, or providing high doses of opiates that may hasten death, and assisted suicide? It is for these reasons that opinion polls consistently show that the majority of Canadians support assisted suicide. So why is there such reluctance to change the law on the matter? It is an interesting feature of human psychology that we find individual stories more compelling and persuasive than aggregate data. As the famous quote goes, “One death is a tragedy; one million is a statistic.” I don’t know how anyone can watch Dr. Low’s video, in which he shared his fear of dying what he considered to be an undignified death, and think, “No, sorry, you should have to endure such a death.” However, public policy can’t be driven by individual stories; with issues like assisted suicide the Supreme Court must consider the broader societal implications of the practice. There are a number of concerns that have been raised about the societal implications. Some fear that it will erode our general commitment to the value of life, which can lead us down the dreaded slippery slope. We might start by allowing terminally ill people under very strict criteria to seek assisted suicide but inevitably, so the argument goes, we will relax those conditions and end up with widespread assisted suicide. Others fear that allowing assisted suicide may have a negative impact on funding for palliative care and hospice, and may even be used as a way to conserve health care resources. Another societal implication, mentioned by the Supreme Court of Canada in 1993, is the concern about the impact on vulnerable patients near the end-of-life – that patients may be coerced into assisted suicide, or may seek assisted suicide prematurely. This latter risk, I believe, is the main remaining stumbling block preventing the legalization of assisted suicide in Canada. What is different now from when the Supreme Court last examined the issue in 1993 is that we now have 20 years of evidence from other jurisdictions that have

VOLUNTEER PROGRAMS AND FUNDRAISING/PATIENT EXPERIENCE legalized assisted suicide: three states in the U.S., The Netherlands, Belgium, Switzerland, and Luxembourg. Last year, B.C. Supreme Court Justice Lynn Smith ruled that while the evidence shows that some risk exists, that risk can be managed through carefully designed and well-monitored safeguards. Would the safeguards be perfect? Of course not, no set of safeguards could be. There might be people who get talked into seeking assisted suicide, and the media have reported on

Dr. Donald Low with his wife Maureen Taylor. stories of patients from other jurisdictions who requested assisted suicide only to find out they were misdiagnosed or their prognosis was inaccurate. But these uncertainties are inherent in the practice of medicine and are no different from the risks associated with the status quo. People could commit suicide now without help, despite being misdiagnosed. Decisions are made in hospitals every day to withhold or withdraw treatment based on diagnoses and prognoses that could turn out to be inaccurate or incorrect.

It is an interesting feature of human psychology that we find individual stories more compelling and persuasive than aggregate data. While the B.C. Court of Appeal overturned the B.C. Supreme Court’s ruling in a 2-1 vote, they did suggest a compromise solution should the Supreme Court of Canada decide to revisit the 1993 decision. That compromise would be to maintain the legal prohibition on assisted

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HOSPITAL NEWS NOVEMBER 2013

suicide but introduce a “constitutional exemption” that would allow people who meet very specific criteria to petition the courts for access to assisted suicide on a case-by-case basis. Though it is impossible to predict what the Supreme Court might do if they revisit the issue, the compromise offered by the B.C. Court of Appeal appears to be a very reasonable way to strike a balance between protection of the vulnerable and respect for the autonomy and dignity of dying patients.

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Hassan Rasouli’s story reflects the theme of control over life and death decisions but in a very different way. Mr. Rasouli has been on life support at Sunnybrook Health Sciences Centre since 2010, when he contracted bacterial meningitis as a complication of brain surgery. He was initially diagnosed as persistently vegetative but his condition has since been upgraded to minimally conscious. His physicians had proposed withdrawing life-sustaining treatment to his wife but she (with the support of their children) insisted that such treatment continue for two reasons: 1) their religious beliefs forbid removal of life-sustaining treatment; and 2) they weren’t confident in the diagnosis because they believed he responded to them. These sorts of disagreements happen on a daily basis in ICUs across Ontario. Most of the time they are successfully resolved internally through communication and negotiation. When that doesn’t work, however, the mechanism that is available to physicians is to apply to the Consent and Capacity Board (CCB) on the grounds that the substitute decision maker (SDM) is not adhering to their legal obligations. Mr. Rasouli’s physicians believed that continued life-sustaining treatment was not in his best interests because it would only serve to maintain him in a state in which he had no reasonable chance of a meaningful recovery. Their job, they argued, is to use their expertise and technology to benefit patients while minimizing harm – that is after all the primary ethical responsibility of every physician. In other words, they claimed that forcing them to keep Mr. Rasouli alive given his diagnosis and prognosis is actually forcing them to practice unethical medicine. Moreover, they believed that they should not be required to obtain consent from the substitute decision maker to withdraw treatment under these circumstances. So instead of going to the CCB they went directly to Ontario Superior Court and ended up appealing the case all the way to the Supreme Court of Canada. In a 5-2 judgment the Supreme Court maintained that physicians must obtain

consent to withdraw life-sustaining treatment. Since this case focused on very specific legal arguments, and did not address the broader issue, the narrowly-focused judgment was likely disappointing to many who were hoping the Supremes would tackle it for the first time in Canadian history. Others have applauded the ruling, calling it a victory for patients’ rights and religious freedom. They would argue, correctly, that disputes over the appropriateness of life-sustaining treatment are value judgments about what ‘benefit’ means and which benefits are worth pursuing given the harms and costs involved. Their conclusion is that when such value judgments arise, the patient’s values should always take priority. Allowing physicians to unilaterally withdraw life-sustaining treatment would be even worse than paternalism – it would allow physicians to supplant the patient’s values with their own. The reality is that our HCCA and the CCB processes are designed around precisely this conclusion; our consent legislation and legal dispute resolution mechanism are very well suited to protecting the interests of individual patients. And that may also be their most serious flaw, for two reasons. First, these disputes never arise between health care providers and cognitively intact patients; they are always disputes between health care providers and substitute decision makers, who (often) claim to be speaking on behalf of the patient. If the SDM can make a convincing argument at a CCB hearing that the patient would want continued treatment, physicians have no grounds upon which to challenge that argument (unless the patient expressed contrary wishes to members of the health care team while capable). The SDM does not have to provide any tangible evidence to support their argument, such as a written advance directive. The second reason why the extreme patient-centredness of our legislation may be its most serious flaw is that there is no room to factor societal interests into the equation via consideration of the resource impact of keeping patients like Mr. Rasouli alive. This is a touchy subject in Canadian healthcare because we don’t like to think about costs when we’re talking about such sensitive issues for fear we might be perceived as putting a price on someone’s life. But I’m not sure how much longer we can continue to have the luxury of avoiding the discussion. Tens of millions of dollars have been cut from hospital budgets across Ontario over the past several years; and given our rapidly aging population there is every reason to believe our health care resources will only come under increasing strain in the future. While the cost of maintaining a single patient like Mr. Rasouli is barely a drop in the bucket of Ontario health care expenditures, the fact is that health care resources in Canada are communal resources. It may be time that we all started to think more like a community about how those resources are used. One thing all these stories have in common is that they provide catalysts for conversation. These are conversations that must take place – both at the societal level about practices like assisted suicide and use of communal health care resources, and at the individual and familial level about the kind of death we want or don’t H want for ourselves. ■ Jonathan Breslin is an independent ethics consultant and educator and an Assistant Professor in the Institute of Health Policy, Management and Evaluation at The University of Toronto. www.hospitalnews.com


VOLUNTEER PROGRAMS AND FUNDRAISING/PATIENT EXPERIENCE

Focus 15

Volunteer led program improves accessibility for patients By Krista Luxton very Friday morning for the past three years, 90-year-old Bill Pfaff arrived at The Scarborough Hospital (TSH) for his cancer treatments. At 8 a.m. sharp, his cab would pull up at the hospital entrance and Bill would slowly go through his routine: check in at Patient Registration, walk to the elevator, ride to the first floor, attend his appointment, return to the ground floor, stop at Tim Hortons and stand in line for his doubledouble and timbits, then return to his awaiting taxi.

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CAVA helps patients and their loved ones navigate the hospital and generally make their visit a little easier and a lot friendlier That was until Bill met Atta. Atta Mohammed, TSH volunteer, is part of an innovative new program â&#x20AC;&#x201C; Call Ahead for Volunteer Assistance (CAVA) â&#x20AC;&#x201C; which helps patients and their loved ones navigate the hospital and generally make their visit a little easier and a lot friendlier. CAVA, developed by the hospitalâ&#x20AC;&#x2122;s Volunteer Services Program, is available for anyone planning to visit TSH, but specifically geared towards those living with accessibility challenges. It provides a 24-hour

answering service, which patients or loved ones can call the day before their scheduled appointment to â&#x20AC;&#x153;reserveâ&#x20AC;? a volunteer who will meet them at their most convenient entrance. â&#x20AC;&#x153;The messages are checked every morning and a confirmation call is returned so patients know someone will be there for them,â&#x20AC;? explains Debbie Vandenberg, Manager, Volunteer Services. â&#x20AC;&#x153;We piloted the program throughout the summer, and the response has been overwhelmingly positive. Itâ&#x20AC;&#x2122;s amazing what a big difference a little guidance and a smile can make.â&#x20AC;? These days, every Friday, Atta is ready and waiting outside at five minutes to 8 a.m. â&#x20AC;&#x201C; with a wheelchair â&#x20AC;&#x201C; for Billâ&#x20AC;&#x2122;s arrival. â&#x20AC;&#x153;He even goes out of his way to get me a good one,â&#x20AC;? says Bill. â&#x20AC;&#x153;They donâ&#x20AC;&#x2122;t make them any better than Atta.â&#x20AC;? Atta wheels Bill everywhere he needs to go and often keeps him company during his chemotherapy treatments, swapping stories about Billâ&#x20AC;&#x2122;s old hockey days and his time in the airforce, and Attaâ&#x20AC;&#x2122;s family. On the way out, Atta even stands in line to order Billâ&#x20AC;&#x2122;s weekly double-double and timbits. â&#x20AC;&#x153;The greatest thing is the appreciation from our patients,â&#x20AC;? says Atta. â&#x20AC;&#x153;The program started slow, but itâ&#x20AC;&#x2122;s such a nice thing and we have seen an increase in the number of users.â&#x20AC;? Atta adds that often patients can be unsteady following certain appointments, and having someone who knows the ins and outs of the hospital, as volunteers always

Atta Mohammed, Volunteer at The Scarborough Hospital, meets Bill Pfaff, patient, every Friday morning to bring him to his appointment as part of the hospitalâ&#x20AC;&#x2122;s innovative new Call Ahead for Volunteer Assistance program. do, puts their mind at ease and they can focus on feeling better. â&#x20AC;&#x153;Everyone was always very nice,â&#x20AC;? says Bill. â&#x20AC;&#x153;But the staff have their assignments, so itâ&#x20AC;&#x2122;s excellent to have people like Atta who can help us find our way or make it easier to get to where we need to go.â&#x20AC;? CAVA volunteers are currently on staff Monday to Friday, 8 a.m. to 4 p.m., but as the program gains popularity, Volunteer Services is hoping to extend availability into the evenings and weekends. Currently, the program offers some off-hour flexibility if patients wish to arrange a time. â&#x20AC;&#x153;We want to start training people and

help to avoid some confusion for patients and visitors,â&#x20AC;? says Atta. â&#x20AC;&#x153;The people we have helped so far have been so thankful to just have someone there. Itâ&#x20AC;&#x2122;s amazing.â&#x20AC;? He adds that even with the program in place, volunteers always have their eyes and ears open for people in the hospital who seem lost or confused. As they help the person find their way, they also pass along a CAVA business card to promote the program so more patients can utilize H this unique service. â&#x2013; Krista Luxton is a Communications Officer at The Scarborough Hospital.

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VOLUNTEER PROGRAMS AND FUNDRAISING/PATIENT EXPERIENCE

16 Focus

Volunteer connects to Canada through the eyes of patients By Donna Danyluk hen Olga Joukova slips on her cheery blue volunteer vest and walks the halls at Royal Victoria Regional Health Centre (RVH) she sees more than patients in rooms – she sees stories. A Russian immigrant, Joukova discovered volunteering at Barrie’s RVH was a wonderful way to connect to her new country. “I spent 14 years as a stay-at-home mom. With limited English and living in a new country it was very hard for me to connect and learn about this society,” says Joukova. “Volunteering at RVH has given me the opportunity to truly understand this country through the stories the patients share with me. Every time I’m here I learn something new about Canada and what living here is – and was – really like.” Even the concept of volunteering was strange and foreign to Joukova. “Volunteering is something new to me. In Russia it is not popular like here.” She learned about volunteering when her daughter, Alissa, entered high school and had to accumulate volunteer hours to graduate. “That’s when I thought, ‘Why am I here at home and not volunteering?’ I decided to go to RVH because it is a big place and there would be many opportunities for me.” And she was right. Last year RVH’s Blue Brigade, as they are affectionately known, contributed more than 120,000 hours in 75 different areas of the health centre. They escort patients to their destinations; assist in the beautiful, newly-opened Victoria’s Gift Shop; play bingo with patients in the Rehabilitation Inpatient Unit and everything in between and beyond. “We are very fortunate to be able to boast about our 850 volunteers who touch lives every day in so many different ways,” says Valerie Bennett, director of Volunteer Resources. “Our volunteers are ambassadors who provide the human touch to our patients, their families and the staff at RVH. Volunteers commit at least one year of their time and are placed in areas that suit their interests and backgrounds. They impact us all and RVH is a better place because of them.”

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Olga Joukova, a Russian immigrant, discovered volunteering at RVH was a wonderful way to connect to her new country. She connected to the culture of the country by listening to stories from patients like William Haire, 90, from Barrie. Ninety-year-old William Haire will attest to that. He’s just come back from a lovely walk around the RVH campus with Joukova. It was the first time Haire has been out in a while and today’s walk was a sign his health is improving. In fact, Haire enjoyed himself so much he was almost late for lunch – almost. Equally impressed was his son Steve Haire. “From a family point of view it is incredible that other members of our community step up to the plate to help and take care of patients with these acts of kindness,” says Haire. “Olga has lifted Dad’s spirits. She listens to his stories, which I have heard a hundred times, and that’s great too.” Haire’s nurse, Laine Venner, RPN, noticed the difference in her senior patient as well. “I can see he’s so bright right now,” says Venner. “Volunteers are invaluable. I have four other patients to care for and there

Last year RVH’s Blue Brigade, as they are affectionately known, contributed more than 120,000 hours in 75 different areas of the healthcentre is no way I could leave the floor to go for a walk with Mr. Haire, but I know it’s so helpful to his recovery.” Joukova cherishes the chance to interact with patients, while improving her English. In fact, her experience at RVH has got her thinking. “I was a flight attendant in Russia, and now I’m thinking I would like to become a nurse. They do such an important job helping people and I think I’d like to be a part of that.” In the meantime, it’s back to Mr. Haire’s room. He knows a few words of Russian so he and Joukova are going to have a chat

in her mother tongue. “Talking to the patients has taught me to be kinder, more patient and calm. They have changed me – in a good way.” RVH Volunteers are also members of the RVH Auxiliary which raises funds for patient care. Café Royale and Victoria’s Gift Shop are businesses owned and operated by the RVH Auxiliary. They are major fundraising sources for the Auxiliary and over the past 10 years they have earned more than $3,000,000. “The Auxiliary relies on these two businesses and their staff and volunteers to enable us to make such significant contributions to improve patient care at RVH,” says Wayne Hubbard, president of the H RVH Auxiliary. ■ Donna Danyluk is with the Corporate Communications department at Royal Victoria Regional Health Centre (RVH) in Barrie.

Hospitals and the paradigm shift to a person-centred model By Vaughan Glover n 2005 I published my book ‘Journey to Wellness – Designing a people-centred health system for Canadians’ and launched the Canadian Association for People-Centred Health. The same year, Paul Wallace of Kaiser Permanente predicted we were in the midst of the greatest paradigm shift in health information and power, in the history of mankind – this being the shift in power

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from the provider to the people. He also predicted this shift would affect virtually every stakeholder in healthcare. Thus far the majority of hospitals and health care institutions around the world have essentially maintained the status quo of the provider and institutionally-centred paradigm, but this is beginning to change at a rapid pace. It is time to advance our thinking, with urgency, to an understanding of the role these vital institutions will play as people assume greater control of their own

health. Putting the needs of the people first in healthcare is happening whether we like it or not, and it is the right thing to do. Failure to do so is jeopardizing the efficiency of our institutions, outcomes they achieve, and quality of care. It is time to take off our institutionallycentred hats, move out of a silo mentality, and put some critical thinking to work with the single objective of determining how we can make this happen with the least amount of stress and upheaval. Continued on page 17 www.hospitalnews.com


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Paradigm shift model Continued from page 16

Using my 40 years of health care experience, designing a person-centric care model, and 20 years of writing, speaking and advocating for person-centric system transformation, the following is a list of where I see an increasingly informed and empowered people driving our health systems and hospitals in particular. As I travel around the globe, there is growing consensus that each of these statements is no longer a dream. Each of these things is happening now in innovative centres around the world. This is what the people are demanding and asking for more of, and I think we should listen. â&#x20AC;˘ People want the care back in healthcare. With access to information and technology, healthcare is becoming totally transparent. People will know their options and choose to be supported where they have a trusting relationship and feel understood. The Doctor as God model is disappearing. â&#x20AC;˘There will be a conscious and rapid shift of care delivery from within institutions to home and community, for many financial and system design reasons. When people bear a greater financial role in their healthcare as is happening increasingly in Canada, and are able to access information seamlessly, they will realize what an expensive ($2500â&#x20AC;&#x201C;$5000 per day) but valuable and cherished resource hospitals are. They will then begin to respect them more and understand that these are specialized support units, not a catch all for all health issues. If we donâ&#x20AC;&#x2122;t use them respectfully, they will not be available for those who truly need them. It must be stated that the primary force driving people out of hospitals and back to home and the community is that this is where people feel safe and want to be.

jor investments to serve their customers in terms of healthcare. â&#x20AC;˘Chronic care is driving system design and care models and moving it out of institutions and into home and community. Over 70 per cent of health expenditures are for chronic care and most chronic care does not have to be done in a hospital or even a primary care centre. Technology enabling home monitoring, communications, etc. are enabling rapid shifts in this context. â&#x20AC;˘Driven by system reform and legislation in various parts of the world, person centric cloud-based technology is making it possible to bring all provider and institutionally-centred, electronic health records together, putting it in the hands of the people so they can access and share their health information. This will enable teams in the community to provide care and sup-

Focus 17

port that in the past could only have been done in a single hospital/ institution, for the primary reason that the hospital and doctors office was where the information was stored. â&#x20AC;˘Very exciting health system apps and technology managed on mobile devices and supported by health coaches and cloudbased technology is drastically reducing the need for physical visits to the hospitals for tests like, ECG, Dopplerâ&#x20AC;&#x2122;s, Blood Pressure, etc â&#x20AC;˘In addition to these myriad of devices and Apps and a key theme in Dr. Topolâ&#x20AC;&#x2122;s book â&#x20AC;&#x2DC;The Creative Destruction of Medicineâ&#x20AC;&#x2122;, genomics and proteomics are enabling dramatic changes to how we diagnose and treat illness and disease at a personal level, fundamentally changing the way care is administered and funded, and the design of

the hospital. Truly personalized care based on genetic factors is becoming a reality. When viewed in aggregate, I think you would have to agree that a person centric approach to care, enabled by proper utilization of the technology that is already available with realignment of the providersâ&#x20AC;&#x2122; role to their full scope of practice, and delivering care where the people most want to be cared for, is dramatically changing the role of hospitals. The hospital and system leaders must be innovative in managing the journey from where we are now to a truly person-centred H model for care and support. â&#x2013; Dr. Vaughan Glover is the CEO of the Canadian Association for People Centred Health. He can be reached at vglover@capch.ca

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There will be a conscious and rapid shift of care delivery from within institutions to home and community, for many financial and system design reasons. â&#x20AC;˘Virtually all hospital design and new construction based on the hospitals as the centre of care should be stopped and rethought. As is happening in the UK, and elsewhere, all design should be based on major hospitals as specialized acute and emergency care centres with communitybased poly-centres to serve the people closer to home. Decisions must be based on where things are going in future, and what is best for the people, rather than where things have been and what was perceived to be best for the institutions. â&#x20AC;˘Emergency Care: As much as 80 per cent of the emergency visits that are now done in hospitals, will be managed outside the hospital by primary health care teams, including Physician Assistants, Nurse Practitioners, Nurses, health coaches and allied health professionals. These teams will be located in malls, pharmacies, community centres and locations where parking is free and people actually want to go for many reasons. This is already happening around the world and it is time to catch up. We see Loblaw in Canada, Walgreens in the US, and other retailers announcing mawww.hospitalnews.com

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

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18 Focus

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Health Innovation Collaborative seeks to enhance patient experience By Judy Steed s the demographic tsunami bears down, health care professionals, policy makers and institutions face daunting prospects: severe gridlock, potential bankruptcy – or significant change to business as usual. Is it possible to improve best practices while enhancing the patient experience and system efficiencies in a time of duress? This is the challenge the Green Shield Canada Foundation (GSCF) has embraced. GSCF’s Health Innovation Collaborative (HIC) was launched last June with a $3 million investment over three years in five major partners: St. Michael's Hospital -Virtual Ward; SPRINT Senior Care – HouseCalls; Bridgepoint Active Healthcare – Health Gateway; Centre for Global eHealth Innovation – Health eConcierge; Alzheimer Society of Toronto- Dementia Care Training Program. HIC’s partners are dedicated to improving care for seniors with complex, chronic conditions, while focusing on best practices. The goals are clear: to reduce emergency department visits, improve care at home, develop the skills of caregivers and PSWs, and increase access to online resources, enabling effective navigation of the system. Canada’s only national not-for-profit health and dental benefits specialist, Green Shield Canada (GSC) was created

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HOSPITAL NEWS NOVEMBER 2013

by pharmacists in 1957. Its foundation was established in 1992 to act as a catalyst, supporting innovation leading to big-picture change. Certainly the need has never been greater. With the population of seniors expected to double in the next 20 years, “We know that older adults in general – and those with complex issues in particular – drive health care costs as they tend to use more expensive and intensive types of services, particularly in acute care settings,” Dr. Samir Sinha, director of geriatrics at Mt. Sinai Hospital, wrote in his report, Living Longer, Living Well, for the Ontario government. “Indeed, while accounting for only 14.6 per cent of our current population, nearly half of our health care spending occurs on their behalf. While some warn against ‘apocalyptic demography,’ few jurisdictions have grasped the complexity of illnesses… or the difficulties that this aging demographic will pose for our health, social, and community care delivery systems as they currently exist.” How could they change in practical terms? That question drove GSCF to explore whether breaking down silos and increasing collaboration could make a difference. After extensive research, Sarah Saso, the Executive Director of the Foundation, came up with the HIC framework and chose the five innovators who share her mission. Third party evaluation began this fall, to identify HIC’s strengths, measure

impact on clients, quality of care, system functioning – and the possibility of replication elsewhere. Already, Pat can attest to the benefits of collaboration. At the age of 81, disabled by rheumatoid arthritis, Pat rarely leaves her apartment. “I received dreadful care from my family doctor,” she says. Too many professionals “don’t want to have anything to do with seniors.”

Is it possible to improve best practices while enhancing the patient experience and system efficiencies in a time of duress? The breakthrough came when she found SPRINT, which sent an occupational therapist (OT) to see her. “The OT hooked me up with House Calls, which is wonderful.” Now she has home visits from a doctor or nurse practitioner, a social worker, hairdresser and foot care specialist. PSWs from the CCAC visit three times a week, “and I get all the care I need.” Her daughter Wendy Irons is a PSW. Wendy appreciates Health Gateway’s vetted online resources, and the future promise of the Health eConcierge, which will reach a broader range of websites. And if her mother is admitted to hospital again, Wendy hopes Pat will come under the care

of Virtual Ward, to manage the transition back home. “It’s the basis of holistic care – that all parts of the system interconnect,” Wendy says. “When Mom has hard days, her caregivers communicate with each other. It’s astonishing. Most patients don’t get the full story told. But Mom’s story gets shared and she gets the care she needs.” As for HIC’s partners, they’re deepening their interaction, with SPRINT’s PSWs taking the Alzheimer Society’s Online Dementia Training. The Health eConcierge team, working with the Inclusive Design Research Centre at OCADU, is sharing findings with Bridgepoint’s Health Gateway, in their mission to reconfigure digital systems designed for diversity. House Calls professionals routinely connect with St. Michael’s Virtual Ward, sharing electronic files on older patients, often enabling them to be diverted from hospital admissions. “The GSCF strategy is designed to build community capacity, strengthen public policy and advance knowledge in the health care field to ensure long-term change as well as to address urgent needs,” says Sarah Saso. “By supporting HIC, we hope this is first step in building a new collaborative patient centred model of care for patients and H their caregivers.” ■ Judy Steed is a veteran journalist recipient of four National Newspaper Award citations and author of four books.

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Focus 19

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20 From the CEO's Desk

Preventing hospital readmissions can’t be a solo mission By Marilyn Emery

hen a patient is unexpectedly back in hospital, or in an emergency department, soon after being discharged, it’s an indicator that some aspect of his or her recovery is not going according to plan. In Canada, the Canadian Institute for Health Information (CIHI) reports that 8.5 per cent of patients discharged from hospital are readmitted within 30 days. Nine per cent of discharged patients visit an emergency department within seven days – and almost one-third of those emergency visits result in readmission. Medical patients have the highest readmission rate and account for almost two-thirds of readmissions – significantly more than surgical or obstetrical patients. Chronic illnesses such as COPD and heart failure are among the most common conditions associated with unplanned readmissions, and patients with co-morbidities are more likely to be readmitted. Many of these incidents are unavoidable. However, CIHI reports that published studies have found rates of preventable readmissions ranging from nine per cent to 59 per cent. Even at the lower estimates, reducing hospital readmissions can deliver better patient outcomes, improve patient’s quality of life and spare patients and their families the disruption of a second hospitalization, and it saves the healthcare system considerable costs. This is why Women’s College Hospital

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(WCH) – Canada’s leading academic ambulatory hospital and a world leader in the health of women – is focused on developing ambulatory models of care that help reduce emergency department visits and readmissions. It’s our mission to be the hospital that keeps people out of hospital. This means providing solutions that improve the health system as a whole. The role of ambulatory medicine in preventing readmissions includes establishing innovative models of care for medically complex patients, enabling more effective care transitions, and building a system of integrated care in the community. When approaching gaps in care, it’s important to not merely identify them, but to understand them. For example, we know that older adults are high users of emergency departments, but researchers at Women’s College Research Institute are probing the underlying reasons for that. They have discovered there are contributing issues, such as vulnerable transitions like moving patients from hospitals to long-term care facilities, and high-risk groups like older women with little family support. This research provides specific targets that enable us to apply more specific – and effective – solutions. Often, building those solutions means building healthcare partnerships. Even the most comprehensive plan for care after discharge may not succeed without accessible services in the community and effective

At some point, everyone can use a hand.

transitions to ambulatory treatment and primary care. Optimum patient outcomes often depend upon coordinated care and collaboration from multiple providers, multiple services and multiple levels of healthcare delivery. Those types of collaborations and partnerships are at the core of everything we do at WCH, and are a cornerstone of the WCH Institute for Health System Solutions and Virtual Care (WIHV). Launched in June 2013, WIHV is designed to address some of the biggest emerging issues in healthcare, including avoidable emergency department visits, hospital readmissions, and improved care transitions. WIHV acts as an innovation laboratory to design and test new ways of delivering higher quality healthcare more efficiently, and then scale-up these processes so they can be widely implemented. But WIHV doesn’t work alone. Its programs are targeting preventable readmissions through partnerships with healthcare players ranging from providers to industry. For example, working with St. Michael’s Hospital, the University Health Network (UHN), Sunnybrook Health Sciences Centre and Toronto Central Community Care Access Centre (TC CCAC), WCH operates the Medical Virtual Ward. For patients who have recently been discharged, but are at high risk of readmission, it offers some of the best features of hospital care – fast access to specialists, personalized follow-up

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Marilyn Emery is the President and CEO of Women’s College Hospital. treatments and highly coordinated healthcare – after the patient has gone home. The Centre for Addiction and Mental Health (CAMH) and TC CCAC are working with us to provide a similar model for patients discharged from inpatient psychiatric care. Among this group, readmission rates are higher than one in 10. The program addresses the transitional needs of these patients and targets modifiable risk factors for re-hospitalization, such as difficulties with medication management. Another example is Bridges SCOPE (Seamless Care to Optimize the Patient Experience) which is providing a group of 25 solo-practice, community-based family doctors with specific services at WCH, UHN and the TC CCAC to help them manage their complex medical patients. The aim is to avert exacerbations of chronic illness that often result in an ED visit or hospitalization. On the surgery side, surgeons at WCH have worked with QoC Health Inc., a technology company focused on patient healthcare, to test a mobile app that enables them to monitor their post-surgical patients remotely. Using the app, patients send daily reports and photos of their incision sites. Their surgeon uses this information to catch complications such as infection (the most common reason for hospital readmission after surgery) before they escalate. Effective partnerships are crucial to these programs. Strong and diverse alliances will also be the key to ensuring that the solutions developed and evaluated at WIHV do not just benefit patients at Women’s College, but are applicable across the healthcare system and across the country. Challenges like preventable readmissions and ED visits affect all hospitals, and the healthcare system as a whole. They won’t be solved in a silo, or by a single facility, or even by a single level of healthcare delivery. Only by working in collaboration can we create and implement tangible solutions. The work we’re doing today, together with our health sector partners, is a fundamental shift in how hospitals can deliver superior, coordinated care outside the traditional boundaries of our individual organizations. It presents the greatest opportunity in decades for us to transform our health system and to enable sustainable H and truly integrated care. ■ Marilyn Emery is the President and CEO of Women’s College Hospital. www.hospitalnews.com


VOLUNTEER PROGRAMS AND FUNDRAISING/PATIENT EXPERIENCE

Focus 21

Volunteers support at-risk families beyond the delivery room By Pamela Stoikopoulos

s any new mom or dad will tell you, parenting can be challenging at the best of times. But if you’re a new parent who is also coping with your own severe illness, managing multiples or a special needs child with little outside help, or struggling with post-partum depression, the journey can feel isolating and downright overwhelming. For a number of parents in Scarborough, however, the road is a lot less lonely these days thanks to VHA Home HealthCare’s (VHA) unique Parent Relief Volunteer Program (PRVP) – a volunteer-based service, funded by both the United Way and VHA – that offers moms and dads a vital break from the demands of parenting.

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In several cases the moms were suffering from post-partum depression, exhaustion and loneliness either because their families lived very far away and they had no support here in Canada, or because their husbands worked 24/7 just to make ends meet “The program is really about helping families avoid a crisis situation,” notes VHA Volunteer Co-ordinator Roseanna Wirt, who designed and now runs the program. “Many of our clients are at risk of or suffering from post-partum depression,” adds Wirt. “They leave the hospital unprepared to deal with the situation and usually have little or no family help. The lack of supports can make a challenging situation seem impossible.” Such was the case for Samira, who spiraled into a depression after the birth of her second child. Alone (her partner currently lives abroad for work) with two young children in a new country, Samira didn’t know where to turn. “I was depressed, alone and I don’t have family… it was a very bad situation,” says Samira. The hospital social worker and her local Children’s Aid initially referred her to VHA’s Parent Relief Program, which provides families with up to 30 hours of help from a Personal Support Worker. Once this service concluded, she was referred to the Program’s volunteer-based “cousin.” Launched in 2006, the PRVP serves families in Scarborough’s “priority neighbourhoods” and offers referred families three hours of volunteer support per week for up to four months. Volunteers are matched with families based on needs, language, availability, etc. Samira is clearly moved by the relationship she’s developed with her volunteer helper, Beverly Douthright, a high school teacher by day, over the last several months. “She (Beverly) is always talking www.hospitalnews.com

very nice to me like my very close sister or my mom. She always gives me the best advice… If I didn’t have her I would be very depressed and wouldn’t have energy for my kids. Beverly helped me with everything – she’s perfect!” But the families aren’t the only ones who benefit from the experience. “I thought it would be great to be able to assist families who needed support but never realized what a blessing they would be to me too,” notes Beverly, Samira’s volunteer. “Samira recently told me that both she and her boys eagerly await my Saturday morning visit... Mom (Samira) looks forward to having someone to bounce ideas off of... She sometimes does not feel she understands exactly how things work in Canada and she loves to be able to talk things over with me.” Over the last several years Beverly has helped several families, each with unique needs and challenges. “I’ve had the pleasure of working with many delightful families including: three with twins; a single mom family with three kids under the age of four and most recently Samira. In several cases the moms were suffering post-partum depression, exhaustion and loneliness either because their families lived very far away and they had no support here in Canada, or because their husbands worked 24/7 just to make ends meet.” Beverly adds, “The family that most sticks out in my memory though is the one I worked with for four months last year. A newly bereaved husband of two sweet girls, who lost his wife just after his youngest daughter was born.” “The reasons for volunteering are as diverse as the people we serve,” says Wirt. “Many are looking to give back to the community while some view volunteering as an opportunity to gain valuable Canadian work experience.” Students, she notes, often get the chance to put academic theory into action while others see it as a great way to improve their English skills. Volunteers are further supported through a broad range of materials – including information on children’s developmental stages, activity ideas and communication tips – and through monthly training meetings. VHA’s Parent Relief Volunteer Program is clearly an invaluable service to the at-risk Scarborough communities it serves. “It seems to me to be such a simple thing to be able to spend just three hours a week playing with kids, talking with moms, providing basic life advice and a bit of encouragement to families who just need to feel and believe that someone cares,” says Beverly. For more information on VHA Home HealthCare’s Parent Relief Volunteer Program contact Roseanna Wirt a rwirt@ H vha.ca or 416 489-2500 ext 4327. ■ Pamela Stoikopoulos is the Communications Manager at VHA Home HealthCare.

Trusted advisor, caregiver and friend: Parent Relief Volunteer Program volunteers wear many hats in their support of families at-risk.

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NOVEMBER 2013 HOSPITAL NEWS


VOLUNTEER PROGRAMS AND FUNDRAISING/PATIENT EXPERIENCE

22 Focus

Jai Kawale has been a swim program volunteer for the past year.

Volunteers share their talents and help kids with special needs By Kathy Foisey olland Bloorview Kids Rehabilitation Hospital is Canada’s largest children’s rehabilitation teaching hospital fully affiliated with the University of Toronto. Holland Bloorview provides programs and services to kids with special needs to help them reach their highest goals while having fun at the same time.

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We place volunteers in many programs across the organization.They get a chance to help out in the programs that need it the most. Some of the more common placement areas include: recreation and therapy programs; transitions and lifeskills programs; research; nursing inpatient support programs and child development programs.

In these unique placements, volunteers often work one-on-one with kids and help enhance programs, while offering support to the kids who might need a little more attention. Volunteers are placed according to their skills and interests putting their passion into action. Every hour of dedicated volunteer service allows Holland Bloorview to provide the best service possible to our families and clients. Because of volunteers, employees are able to offer individualized support which positively makes a difference to a child’s progress. We realize that our passionate volunteers are essential to smooth running programs and to providing the best possible experiences for our clients. When we ask our volunteers at Holland Bloorview why they are so committed, they tell us that it’s a wonderful way to stay connected to the community, it’s rewarding, but ultimately they do it for the kids. We asked a couple of volunteers about why they keep coming back, here are their stories.

Louise Ferrari’s story Therapeutic Playroom Volunteer – 10 years

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HOSPITAL NEWS NOVEMBER 2013

I have been volunteering in the therapeutic playroom for over 10 years and I love my weekly visits with the kids. I get to help with their therapy and support the staff in therapeutic playroom programs. The kids are a pleasure to be around, the staff are wonderful. It’s amazing to see how the kids respond to the therapeutic play programs. I have seen kids who we didn’t think would ever walk, take steps. They would not have been able to do this without this kind of play therapy. I am glad to be a part of something so wonderful. Working alongside, so many knowledgeable, enthusiastic, and kind people makes it even better. In my daily life, I run a restaurant, find time for my family and grandkids and to visit the kids at Holland Bloorview. I do this because I can and it’s important to me to offer a helping hand to those who need it.

Louise Ferrari has been a therapeutic playroom volunteer for more than 10 years.

Jai Kawale’s story: Swim program volunteer – 1 year

I volunteer in the pool one day a week and make time between family, school and soccer commitments. Volunteering adds fulfillment to my life, I believe that we all have something to offer to someone else. I help the instructors and therapists provide one-on-one help to the kids who need extra attention and this really makes a difference. There is one girl who comes to mind who was having a hard time paying attention and listening in a group. After a couple of weeks working one-onone with her in that group, her skills really improved. This made a huge difference in how quickly she learned skills to keep up with the group. The great thing about being in the pool is that it’s play time and we have a lot of fun. It doesn’t feel like a volunteer job at all. At Holland Bloorview, our families and clients benefit greatly from having dedicated volunteers. We would like to extend a big thank you to all the volunteers, including our family, youth and child leaders past and present that make a difference in the H lives of the children we serve. ■ Kathy Foisey is a Communications Associate at Holland Bloorview Kids Rehabilitation Hospital. www.hospitalnews.com


VOLUNTEER PROGRAMS AND FUNDRAISING/PATIENT EXPERIENCE

Focus 23

Think differently, Act differently, get different results By Suzette Strong, MA, CFRE ospitals come in all shapes and sizes; trauma, rehabilitation, specialized, general, regional, teaching or community based; yet delivering safe, high-quality patient care remains at the heart of every mission. Within a health care system and an environment that continues to change, there is something else they have in common. More than ever, hospitals rely on support from their foundations to drive innovation and enable growth. A total of $2.4 billion in fundraising revenues was reported in 2010 in support of Canadian hospitals alone (according to T3010 filings). Since 2008, the focus for the Markham Stouffville Hospital Foundation (MSHF) is its $50 Million Campaign for Expansion. The first phase of this redevelopment project was the opening of a brand new 385,000-square-foot building in March 2013. The ongoing and final phase involves extensive renovations to the original building scheduled for completion in August 2014. Thanks to our generous donors, we recently surpassed the $45 million mark and remain on target to reach our goal at the same time as the hospital’s completion. This last $5 million is critical to the success of the capital campaign; however, our commitment to innovative approaches for fundraising is vital to ensure our sustainable future. Our mandate is simple, sustainable revenue generation for today and tomorrow, and our priorities are clear: •Build on the success of getting single donations of $10,000 and more pledged over time, something referred to as leadership giving; •Expand the donor base through broader community outreach to identify leadership donors of the future; •Create valued experiences because engaged donors keep giving and give more. While many fundraising organizations’ mandates are similar, the difference between success and failure is execution. Fundraising innovation means different things to different organizations and depends on the maturity and mix of programs. At MSHF, we’re thinking differently about the needs of the hospital, our community, our volunteers and our donors. And we are doing things differently. Broadly speaking, our community is made up of donors and prospective donors who are segmented further by the size of their donation and how they give. Leadership donors are usually a result of one-to-one relationships, whereas annual and monthly donors contribute smaller amounts on a regular basis, often in response to event participation or a mailed solicitation. Staff and volunteer resources are built to support this approach. Our recent strategic planning process challenged us to define and think differently about our core business: revenue generation and community engagement.

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www.hospitalnews.com

We evaluated all of our programs and activities to determine which category they fit into the best – it couldn’t be both. This led to a new perspective about our community which we now segment based on specific demographics, each group with a unique value proposition that helps us take a targeted approach in our communications, engagement strategies and relationship building. We also identified the programs and activities that were working well, not so well and in some cases, not at all. This also enabled us to consider the target audiences we were reaching out to (or not) and prioritize the importance of doing so. We are also developing and prioritizing new programs and initiatives and changing our organizational structure to support our core business of revenue generation and community engagement. Doing things differently also means making tough decisions about what not to do. It is no longer reasonable to assume that the past is a key indicator of what the future brings. It is easy to keep doing what you’ve done before because it’s comfortable and nice to be good at all things. It is a much greater challenge, and more strategic, to identify fewer areas where you want to excel. This means going down the road less travelled. In today’s world of rapid and digital communications, we are in a constant state of evolution. Being strategic and innovative requires us to be agile. It is essential to continuously validate your programs and initiatives to ensure they are taking you in the right direction and, if not, adapt. The traditional approach to planning is adapting, it’s dynamic and more about thinking strategically. MSHF is about to make history with the completion of the largest fundraising capital campaign in our community, however, our greatest success will be defined by what happens next, how we get there and ultimately whether our hospital can continue to rely on our revenue generation and community engagement to drive innovation and enable growth. While the system and environment continues to change and our innovative approaches to fundraising continue to evolve, both the hospital and its partner foundation must continue to celebrate our greatest strength – the caring and compassionate people who deliver outstanding care at Markham Stouffville Hospital. It is their dedication to excellence that our continued success relies on to inspire and earn the generous support of every H member of our community. ■

Markham Stouffvile Hospital Foundation CEO Suzette Strong with volunteers Khalid Usman, MSHF Board Chair and Sanjeev Agnihotri who volunteers with the hospital.

Suzette Strong was appointed CEO, Markham Stouffville Hospital Foundation, in 2007 to lead the fundraising campaign in support of the hospital’s expansion and extensive renovations. NOVEMBER 2013 HOSPITAL NEWS


24 Focus

VOLUNTEER PROGRAMS AND FUNDRAISING/PATIENT EXPERIENCE

A personal plea Educational for enabling patient & Industry Events engagement 7ROLVW\RXUHYHQWVHQGLQIRUPDWLRQWR´HYHQWV#KRVSLWDOQHZVFRP¾

We try to list all events and information but due to space constraints and demand, we cannot guarantee it. To promote your event in a larger, customized format please send enquiries to â&#x20AC;&#x153;advertising@hospitalnews.comâ&#x20AC;?

Q Oct 31- Nov 3, 2013 Canadian Hospice Palliative Care Conference Ottawa Westin Hotel, Ottawa Website: www.chpca.net Q Nov 3-6, 2013 FutureMed San Diego, California Website: www.futuremed2020.com Q Nov 4-6, 2013 OHA HealthAchieve 2013 Metro Toronto Convention Centre, Toronto Website: www.healthachieve.com Q Nov 28-29, 2013 National Correctional Services Healthcare Conference Ottawa Convention Centre Website: www.healthcareconferences.ca Q Dec 1-6, 2013 7KHWK6FLHQWLĂ&#x20AC;F$VVHPEO\DQG$QQXDO0HHWLQJRIWKH5DGLRORJLFDO 6RFLHW\RI1RUWK$PHULFD McCormick Place, Chicago Website: www.rsna.org Q Dec 2-3, 2013 1DWLRQDO2SHUDWLQJ5RRP0DQDJHPHQW&RQIHUHQFH +\DWW5HJHQF\9DQFRXYHU Website: www.healthcareconferences.ca Q Dec 3-4, 2013 Data Analytics for Healthcare The Old Mill Inn, Toronto Website: www.healthdatasummit.com Q Jan 28-29, 2014 WK$QQXDO0RELOH+HDOWKFDUH Eaton Chelsea Hotel, Toronto Website: www.mobilehealthsummit.ca Q Jan 29-30, 2014 Activity Based Funding Conference Metro Toronto Convention Centre, Toronto Website: www.healthcareconferences.ca Q Jan 30-Feb 1, 2014 2014 Better Breathing Conference Toronto Marriott Downtown Eaton Centre Website: www.on.lung.ca Q Feb 1-5, 2014 CSHP 45th Professional Practice Conference Sheraton Centre Toronto Hotel Website: www.cshp.ca Q Feb 23-27, 2014 +,066$QQXDO&RQIHUHQFH ([KLELWLRQ Orlando, Florida Website: www.himssconference.org Q Feb 27-28, 2014 1DWLRQDO3DWLHQW5HODWLRQV&RQIHUHQFH Metro Toronto Convention Centre Website: www.healthcareconferences.ca Q May 29-June 1, 2014 &$057$QQXDO*HQHUDO&RQIHUHQFH Shaw Conference Centre, Edmonton Website: www.camrt.ca

To see even more healthcare industry events, please visit our website www.hospitalnews.com/events HOSPITAL NEWS NOVEMBER 2013

By Dave Mosher was recently asked to speak at a patient-experience forum. As a director for RelayHealth, a care coordination and patient engagement solution and as the chair of ITAC Health (Information Technology Association of Canada), I am quite adept at discussing technology that will enhance the patient experience. However, it is my role as a father, with a child with special needs that provides me with insight and passion that can only be cultivated through personal experience. I have a lovely 11 year old daughter, Victoria, who has been challenged with several serious medical issues since early childhood. Caring for her has given my wife and me an appreciation of how the patient experience varies from within the acute care setting to the community. In Victoriaâ&#x20AC;&#x2122;s first year, we almost lost her. After contracting a simple cold, she began to experience difficulty breathing, which resulted in a coma. Perplexed, the doctors at the Hospital for Sick Children explored many possibilities to explain her sudden degeneration. After much testing and consultation, the diagnosis was Mitochondrial Disease, a metabolic illness which affects the bodyâ&#x20AC;&#x2122;s ability to convert food into energy efficiently. This disease renders my child vulnerable to all illnesses, as the assault on her system is much more significant than a battle with a common cold. All the staff and medical professionals at the hospital were exceptional. They were knowledgeable and empathetic and gave us light in our hours of darkness. After spending several years recovering from her metabolic episode, Victoria began missing some key developmental milestones. Not knowing whether this new set of symptoms was related to her metabolic illness, we consulted with our paediatrician and our hospital specialists and she was diagnosed with autism. Again, the care Victoria received was outstanding and our patient experience was positive. Due to Victoriaâ&#x20AC;&#x2122;s complex conditions, we have multiple caregivers in various facilities and at home. The challenge is that her care providers do not share information well and they have no way to securely communicate with each other. For example, Victoriaâ&#x20AC;&#x2122;s complex care plan is routinely faxed between her providers and rarely does the clinician we are seeing have the latest version. In addition, there is no method for her home care nurse to contact her metabolic specialist or her paediatrician. Keeping all her caregivers in sync is our familyâ&#x20AC;&#x2122;s responsibility. Unfortunately, we are not provided with the tools we need to manage the care for our daughter even though it would make it considerably easier for her care team. Ideally, there would be a system in place that allows her care team and I to access the same health record summary. It should include her complex care plan, her illness management plan and allow us to track

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Dave Mosher with his daughter, Victoria. her vitals and make them available to her team. In addition, we would like to have the ability to securely message her care team instead of placing numerous calls and being frustrated by our inability to connect. Also, there are times when her specialists need to communicate with each other and we are tired of being the go-between. In short, it is time that our health system invested in solutions that improved the patient experience across the continuum. McKesson Canada has been delivering such a project in Nova Scotia, using RelayHealth, which is demonstrating the benefits of a patient-centred approach. Amongst numerous other elements, their global health care strategy provides patients with access to their personal health record, which includes lab results and will also include data from their family doctor. Patients can now securely message their doctors to make appointments or ask clinical questions. The project began with 30 doctors in Halifax and was made available to patients within a few months of the project starting because of the simplicity of implementation. The patient response has been tremendous. More than 4,000 patients signed up in the first nine months which is much higher than anticipated. Clearly, there is a large pent-up demand for patients to actively manage their own care. Here in Ontario, I am always very impressed at the level of care we receive from the talented clinicians that care for my daughter. There is no doubt, that as a Canadian system we have made huge strides in patient-centred care within the walls of the hospital. The problem is that more and more care is delivered in the community, and as a system we have not made the investments needed to empower patients and caregivers to provide the best care possible. Rather than mega-IT projects, which has been the norm, it is time for the health system to make smaller, targeted investments that have a measurable benefit to H patients. â&#x2013; Dave Mosher is the Director, RelayHealth, McKesson Canada. www.hospitalnews.com


Nursing Pulse 25

Volunteer RNs at RNAO see equal parts â&#x20AC;&#x2DC;giveâ&#x20AC;&#x2122; and â&#x20AC;&#x2DC;getâ&#x20AC;&#x2122; By Melissa Di Costanzo

mily Monaco, Joyce Tsui, Christina Moldovan and Cathie Gernaey are executive network officers (ENO) for their chapters or interest groups within the Registered Nursesâ&#x20AC;&#x2122; Association of Ontario (RNAO). They are among the more than 300 ENOs who play an instrumental role in advancing nursing and health issues at the local and specialty level. Discover what led them to the role, and the lessons theyâ&#x20AC;&#x2122;ve applied to their working lives.

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Emily Monaco â&#x20AC;&#x201C; Policy and political action officer, Sioux Lookout chapter

Emily Monaco decided to become more politically active when she became aware of RNAOâ&#x20AC;&#x2122;s advocacy work. The obstetrics RN at the Meno Ya Win Health Centre applied to become policy and political action officer (PPAO) for the associationâ&#x20AC;&#x2122;s Sioux Lookout chapter about a year ago. â&#x20AC;&#x153;Seeingâ&#x20AC;Śa force like RNAO and how much (it) does and can do in terms of health advocacyâ&#x20AC;Śmotivated me,â&#x20AC;? she explains, adding that, in the north, â&#x20AC;&#x153;itâ&#x20AC;&#x2122;s harder to get issues brought forward and recognized as prioritiesâ&#x20AC;? due to geographic distances, smaller population sizes and diverse needs. Monaco admits she was intimidated by the role at first, but has since gained valuable insight into politics, the role of an MPP, and how to build a rapport with politicians. She now knows how to prepare for meetings with decision-makers, and the value of participating in advocacy events such as Queenâ&#x20AC;&#x2122;s Park on the Road and Take Your MPP to Work, two of RNAOâ&#x20AC;&#x2122;s signature political events. She was involved in both with Kenora-Rainy River MPP Sarah Campbell, and says: â&#x20AC;&#x153;It was a privilege to get (Campbellâ&#x20AC;&#x2122;s) insight on the issuesâ&#x20AC;Ś it gave us a sense of what she was doingâ&#x20AC;Ś to addressâ&#x20AC;Ś affordable housing.â&#x20AC;? Inspired to apply what sheâ&#x20AC;&#x2122;s learned as an ENO, Monaco joined forces last winter with two other nurses to speak to teenagers at a local high school about parenting (there are many young mothers in the area, Monaco explains). Finding opportunities to join forces and create and foster connections with other health-care providers and organizations was something she learned. â&#x20AC;&#x153;Thereâ&#x20AC;&#x2122;s a lot of potential to form new relationships and collaborate,â&#x20AC;? she says. â&#x20AC;&#x153;Being an ENO has given me more motivation and more confidence to promote health and nursing within my community.â&#x20AC;? Thanks to her experience as an ENO, she now has a better sense of nursesâ&#x20AC;&#x2122; ability to have a positive impact on health and healthy work environments, she says. When it comes to volunteering with the chapter and getting involved, Monaco says â&#x20AC;&#x153;just do it if you feel any inclination.â&#x20AC;?

Joyce Tsui and Christina Moldovan â&#x20AC;&#x201C; Membership officers, Nursing Research Interest Group

Joyce Tsui and Christina Moldovan were classmates at Torontoâ&#x20AC;&#x2122;s Ryerson University. They both had the same goal: a masterâ&#x20AC;&#x2122;s degree in nursing. Now, the pair www.hospitalnews.com

have found themselves pursuing another objective together, except this time, the focus is on recruitment of RNAO members. Tsui and Moldovan are membership ENOs for RNAOâ&#x20AC;&#x2122;s Nursing Research Interest Group (NRIG). Theyâ&#x20AC;&#x2122;ve shared the role for two years. Together, they have created postcards to attract new nurses to the group, called former members, and spearheaded a campaign to honour longstanding NRIG RNs. Tsui and Moldovan say they took on the role because they want to give back to their professional association. â&#x20AC;&#x153;All of the great benefits and learning we gain (through RNAO) inspires (us) to get others involved,â&#x20AC;? says Moldovan. â&#x20AC;&#x153;Without our professional association, we would not be where we are today,â&#x20AC;? Tsui adds. â&#x20AC;&#x153;As a member, you are contributing to that growth and development within the nursing profession.â&#x20AC;? â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s so empowering to be able to share the passion of nursing,â&#x20AC;? Moldovan says, adding the role has helped her develop her communication and leadership skills. Tsui says it has forced her to come out of her shell: â&#x20AC;&#x153;Iâ&#x20AC;&#x2122;m a shy person, so this helps me open up. Iâ&#x20AC;&#x2122;ve learned how to connect with people.â&#x20AC;? â&#x20AC;&#x153;You have to be passionateâ&#x20AC;Ś to bring othersâ&#x20AC;&#x2122; passion forward,â&#x20AC;? Moldovan suggests. Both Tsui and Moldovan were mentored by Nancy Purdy and Veronique Boscart, chair and past chair of NRIG, respectively. â&#x20AC;&#x153;Great role models make me want to do this work, be involved and make a difference,â&#x20AC;? says Tsui. â&#x20AC;&#x153;Iâ&#x20AC;&#x2122;ve gained so much through RNAO, so itâ&#x20AC;&#x2122;s just a tiny way for me to give back.â&#x20AC;?

Cathie Gernaey â&#x20AC;&#x201C; Communications officer, Middlesex-Elgin chapter

Twenty years ago, there were very few nursing jobs in Ontario, so Cathie Gernaey began applying for work south of the border. Landing a position in Michigan, she spent over a decade practising in acute care for an American hospital and developed a â&#x20AC;&#x153;great appreciation for Canadian nurses and Canadian nursing.â&#x20AC;? Gernaey returned to Canada in 2004. At that time, she made it a personal goal to ensure ev-

eryone knows just how much value RNs add to the health-care system. She defends nurses when a negative news story surfaces, and has gone to elementary schools to discuss nursing roles and responsibilities. Gernaey is communications officer for RNAOâ&#x20AC;&#x2122;s Middlesex-Elgin chapter. Itâ&#x20AC;&#x2122;s a role she says allows her to promote the value of the profession and to learn more about RNsâ&#x20AC;&#x2122; different levels of expertise. â&#x20AC;&#x153;(Communications) is an area Iâ&#x20AC;&#x2122;ve never

really delved into,â&#x20AC;? she explains. â&#x20AC;&#x153;I do a lot of speaking, lecturingâ&#x20AC;Ś(but) Iâ&#x20AC;&#x2122;ve never really done anything (like) press releases.â&#x20AC;? Gernaey now drafts the chapterâ&#x20AC;&#x2122;s newsletter and drums up media interest when the group hosts events. She writes media releases and advisories, and pitches story ideas to local journalists. Fostering relationships with the media, she admits, isnâ&#x20AC;&#x2122;t always easy. As an ENO, Gernaeyâ&#x20AC;&#x2122;s been able to keep colleagues informed about exciting activities they might not otherwise hear about. Earlier this year, the chapter took part in a Habitat for Humanity build. On build day, four of Gernaeyâ&#x20AC;&#x2122;s co-workers showed up to help raise awareness of the need for a national housing strategy. â&#x20AC;&#x153;If I hadnâ&#x20AC;&#x2122;t been promoting itâ&#x20AC;Śthey might not have heard about it or paid attention,â&#x20AC;? she says. Gernaeyâ&#x20AC;&#x2122;s advice for new volunteers is to persevere, despite the challenges of relationship building with journalists. Above all, have fun and â&#x20AC;&#x153;keep H your mind open,â&#x20AC;? she says. â&#x2013; Melissa Di Costanzo is staff writer for RNAO. This is an excerpt from a feature published in the September/October 2013 issue of Registered Nurse Journal, RNAOâ&#x20AC;&#x2DC;s bi-monthly magazine.

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NOVEMBER 2013 HOSPITAL NEWS


VOLUNTEER PROGRAMS AND FUNDRAISING/PATIENT EXPERIENCE

26 Focus

Run with me TBay: More than an Urbanathlon By Heather Vita

he first thing you notice when meeting Jay Tysoski is how you feel like you’ve known him for a long time, when, in reality, you’ve just met him. He’s outgoing, personable and makes you feel at ease right away. As he’d say, “I’m a lot like my Mom.” It’s a fitting tribute, as Jay’s Mom, Susan, passed away in August 2010 from a rare endocrine cancer, yet her spirit lives on through him. “She was an amazing person who seemed to know everyone,” said Jay. “She was kind, caring and always looking out for others to make sure they were OK.” Upon her passing, Jay was understandably overcome with grief. But he decided not to submit to it – instead he decided to help support others, much like his Mom had always done. And so, ‘Run with Me TBay’ was born – a fundraiser for the Northern Cancer Fund of the Thunder Bay Regional Health Sciences Foundation. In order to raise funds, Jay challenged himself to run in his first ever Men’s Health Urbanathlon in Chicago – a grueling, eleven-mile endurance race featuring city landmarks and ten urban obstacles. Friends, family, and members of the Thunder Bay community realized the significant challenge that Jay had taken on and pledged him in anticipation of race day. That first year, Jay recalls thinking about his Mom when he was racing, especially in the tough moments. “She couldn’t quit when she was going through her chemo, she always fought hard,” he said. “I’d remember that and get the drive to keep going.” He fondly recalls crossing over the finish line in 2011 – and feeling an incredible sense of achievement. “You have no idea

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From left: 2012 Chicago Men’s Health Urbanathlon finishers: Jay Tysoski, Kris Evans and Kyle Baysarowich. In the three years since Jay began the ‘Run with Me Tbay’ fundraiser, a total of $11,707.23 has been raised for the Northern Cancer Fund of the Thunder Bay Regional Health Sciences Foundation to support Exceptional Cancer Care in Northwestern Ontario. what you can do until you try,” he said. “When I thought up the name ‘Run with Me TBay’, it was really strategic – I wanted to encourage everyone to try something that they think they could never do – you may surprise yourself with what’s possible.” What he didn’t know that first year was that two of his best friends, Kris Evans and Kyle Baysarowich, would join him in running the Urbanathlon in 2012 and raise even more money for the Northern Cancer Fund. “Watching those two guys cross the fin-

ish line and being there for them as they completed the Urbanathlon challenge was definitely the highlight of the race for me in 2012,” said Jay. “I can’t tell you how much it meant to me to have them racing with me.” Needless to say, with three men running the Urbanathlon in 2012, fundraising efforts were tripled, and, in just two shorts years, ‘Run with Me TBay’, raised over $7,000 for the Northern Cancer Fund. Funds from 2011 were directed to the Northern Cancer Fund in memory of

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Jay’s mother Susan, while in 2012 funds were specifically directed to the WE-Can program – a 10 week Wellness and Exercise program for individuals living with Cancer. “My Mom was a very active person and since our fundraising efforts were associated with a very physical activity, I wanted money raised to go to a program that would help others feel better by being active,” said Jay. “I know when I’m training, I feel better mentally and physically and I know it’s important for cancer patients to stay active for those same reasons.” “We’re extremely grateful to Jay and all the supporters of ‘Run with Me TBay’ for dedicating the funds to the Northern Cancer Fund to support our Cancer Centre,” said Joanne Lacourciere, Program Director, Regional Cancer Care. “Our goal is to provide Exceptional Cancer Care and these funds are helping us accomplish that.” While Jay, Kris and Kyle were unable to participate in the 2013 Men’s Health Urbanathlon for a variety of personal reasons, they continued their fundraising legacy with a ‘Run with Me Tbay’ golf tournament, held in September. This year, $4,625 was raised to support the Patient Navigation Desk in the Garden of Hope at the Regional Cancer Centre in Thunder Bay. “It was important to all of us that patients feel welcomed when they enter the Cancer Centre,” said Jay. “This was a perfect opportunity to ensure that we can provide that extra level of support in what can be a very overwhelming experience.” As for plans for 2014? “We’ve all agreed that we’re on board 100 per cent for next year!” said Jay. Supporters can follow ‘Run with Me TBay’ on Facebook at facebook.com/runH withmetbay ■ Heather Vita is the Manager, Marketing and Communications at Thunder Bay Regional Health Sciences Foundation.

HOSPITAL NEWS NOVEMBER 2013

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Enriching Volunteers get seniors involved patient experience E with volunteers By Kendra Stephenson

very Tuesday morning Patricia Jose and Rosamund Claire Moore of the Volunteers Involving Seniors in Activities (VISA) program flip through a binder at the Geriatrics Unit nursing station at St. Michael’s Hospital. The binder lists the names of patients in the unit who want a visit from a volunteer, with comments about their interests and how best to approach them. “Sometimes when we come in the nurses warn us that a patient isn’t very happy, but we always check in anyways,” says Jose. “Most of the time they recognize my face and are genuinely happy to see me.” The VISA program was launched at St. Michael’s in 2012 by volunteers and two staff members in the Geriatrics Unit. The program focuses on social visits and activities with older patients as part of the patient’s therapy and to prevent delirium, a form of acute confusion that can be brought on by isolation and detachment during a hospital stay. Delirium is a common issue in elderly patients who are hospitalized. Disruption in routine, unfamiliar surroundings and lack of regular social contact can result in acute confusion and disorientation, or delirium. “When I was first in the hospital I was confused and disoriented, going off on tangents when I spoke,” says Helen Hutchinson, one of the first Canadian women in television and a patient in the Geriatrics Unit. “Nothing is familiar and you start to blame yourself for being confused.” Hutchinson became a patient after a fall and subsequent head injury. Usually a very sharp and active senior, she found she was confused and had trouble focusing for the first few days in the hospital. The VISA volunteers began to drop by for a visit after rounds, at first to make sure Hutchinson had everything she needed, then to chat and listen to her incredible life stories. She now greets Jose and Moore like old friends,

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By Michael Westman ifestyle adjustments can be difficult for patients and families as they adapt to being in hospital to receive care for chronic conditions. Over 90 per cent of Runnymede Healthcare Centre’s patients are over the age of 65, many of whom experience a range of cognitive impairments and physical disabilities that may lead to feelings of frustration, isolation and stress. With quality care and safety as a top priority, Runnymede is dedicated to creating the best possible experience for patients during their hospital stay. Volunteers are a crucial component of the team at Runnymede because they provide assistance to hospital staff in non-clinical, support roles. Activation therapy is another area that adds to the patient experience by collaborating with hospital departments and the community to provide more than 50 programs and activities for patients. With programs and services like these, Runnymede continues to make remarkable advancements to enrich the lives of patients. “We couldn’t do it without our volunteers. They give generously of their time, talent and skills to support the interprofessional team in the delivery of key patient programs,” says Volunteer Services and Reception Manager May Cass. “In return, volunteers are given the opportunity to develop new skills and relationships while contributing to their community.” After completing training and orientation, volunteers are seen throughout the hospital – wearing blue vests with a volunteer ID badge – offering assistance to a variety of departments and areas, from administration to infection control. While volunteers do not replace the roles of professional staff, their presence is a valuable asset as they interact and build relationships with patients. Offering a unique experience fosters patient satisfaction and volunteers do this through a number of programs including: friendly visiting, activation therapy, mealtime assistance and accompanying patient out-trips to Blue Jays games, shopping malls and the Art Gallery of Ontario. Pet visits are also offered through volunteer services, as interaction with animals is believed to have a positive effect on patients. An exciting new volunteer program at the hospital utilizes iPads to offer patients e-books and news online. Runnymede’s activation therapists design and implement therapeutic programs to meet the diverse social, emotional, physical, intellectual, spiritual and creative needs of each patient, while catering to a wide variety of hobbies and interests. Continued on page 32

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Patricia Jose, left, Helen Hutchinson, centre, and Rosamund Claire Moore, right share a comedic moment during a VISA visit. Photo by Katie Cooper, Medical Media, St. Michael’s Hospital.

Delirium is a common issue in elderly patients who are hospitalized. Disruption in routine, unfamiliar surroundings and lack of regular social contact can result in acute confusion and disorientation slipping easily into conversation about her travel plans in the next few months that include Chile, Florida and Los Angeles. “The volunteers visiting and chatting has been wonderful – there’s someone to talk to when you’re here for a long time,” says Hutchinson. “It has helped me focus and become myself again, especially after a fall where I had a head injury.” The VISA initiative was adapted from

the Hospital Elder Life Program, an American program developed for older patients who have been hospitalized. Similar programs have been proven to shorten hospital stays, increase cognition and generally improve patient mood and happiness. The volunteers make social visits and do activities with patients, ranging from 30 minutes to two hours. They try to engage seniors in purposeful conversation, reminisce or play games. One volunteer even helped a patient write her memoirs over the summer. The patient had started the story of her life but the contents were lost in a fire. The volunteer visited her three times a week to listen to her stories and help with the dictation. Together, they filled multiple binders with her memoirs, despite the patient’s hospitalization and limited mobility. “Many patients have routines and things they like to do when they’re at home, like keep a diary or a journal,” says Jose. “We had one patient who loved poetry so we brought in some poems and she recited them from memory to me for hours at a time. It was fantastic.” Volunteers converse and interact with patients about their lives and memories to keep their minds grounded in the present and stave off delirium. The program purchased an iPad for patients to communicate and interact beyond the hospital walls, which has been hugely popular with tech savvy seniors. “Even with all the available activities, I find that most patients just want to talk or have someone to listen,” says Moore, a VISA volunteer. “I have patients asking when I’ll be back next or planning for the next time. I think they very much look forward to it because it’s a bit of normalcy.” The program has received positive feedback from staff, relatives and patients. The program includes family education, where volunteers coach relatives on how to prevent delirium using VISA activities and conversation. “I feel that I’m doing something good for these patients, even though I’m often just listening,” says Moore. “I help to pass a few hours in the day or I’m a human connection for someone. We help a patient to also be a H person.” ■ Kendra Stephenson is a Communications Intern at St. Michael’s Hospital.

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Volunteer helps prepare brothers and sisters-to-be By Jessica Verge t’s a Saturday morning at Lakeridge Health Oshawa and volunteer Jeanne Frolick is waiting to welcome a new group of youngsters to a quiet room on the third floor, just down the hall from the birthing suite. It’s an area of the hospital the families of these little ones will soon come to know as they’re all awaiting the arrival of a new brother or sister. For the past 15 years, Jeanne has been leading the Kangaroo Kapers Sibling Preparation Class at Lakeridge Health, which helps kids aged two to six, get ready for a new addition to the family. One Saturday per month, the 85-year-old retired elementary school teacher and principal returns to the head of the class to lead little ones through a series of activities that will teach them how to help their parents care for the new baby and aims to ease any anxiety they may be facing. “We want the little ones that come to the program to accept the new family member that’s coming very soon,” says Jeanne. With the help of fellow volunteer Laurie Bell, Jeanne teaches the children, who have each arrived with a doll or stuffed animal, how to hold a newborn baby and how to diaper the baby. After Jeanne leads them in a song – “Mommy Loves the Baby and She Loves Me Too” – and lets them choose a new hat that baby can wear home from the hospital, Laurie reads “Franklin’s Baby Sister” to the group and takes children and parents on a tour of the birthing suite, topping it off with a popsicle and a bag of goodies. On one particular Saturday, Jeanne welcomes 2-year-old Brooklyn Pigeau to the class. She’s the third child in her family to take Kangaroo Kapers. Her mom, Kelly, sees it as a great way to introduce little

I

YOU

By Nikki Hegarty hile many volunteer programs centre around local areas and require long term commitment, this October the World Parkinson Congress was a great example of bringing together volunteers from around the world to support a unique event over four days, all within the impressive surrounds of the Palais des Congrès, Montreal. The World Parkinson Congress (WPC) is the only international meeting of its kind, bringing together the entire spectrum of Parkinson’s disease – researchers, clinicians, people with Parkinson’s, allied health professionals and care partners. Designed to be inspiring and rejuvenating, the WPC allows people with Parkinson’s the world over, to meet and share their experiences and is an opportunity for scientists working on basic science in the lab to meet the people who will ultimately benefit from their efforts. As the WPC is run by a charitable organization, the work of volunteers is vital to its success. The team behind the WPC engaged volunteers from around the world; establishing a number of committees, including the newly launched WPC ‘Buddies’ program. This year, a call for volunteers was made to support the delivery of the congress. Those who volunteered were asked to commit to five hours a day and the response was fantastic, with volunteers signing up from as far afield as New Zealand and Switzerland, as well as many Canadians, both from Montreal and across the country. One local volunteer who has left a lasting legacy is Lucie Lachance, clinical nurse specialist at the Movement Disorder Clinic at the McGill University Health Centre. Lachance delivered awareness training for service staff including airport workers, taxi drivers, bus drivers, Palais des Congrès team members, hotel, and restaurant staff. More than 1,000 of the 3,300 WPC attendees were people with Parkinson’s, so it was especially important to make sure that local staff and businesses understood this condition and could offer great service and understanding of their needs, helping ensure attendees could gain the full benefits of the congress, within a supportive and positive environment. Another unique element of the volunteer group was that it included many people with Parkinson’s, who were ideally placed to understand the needs of attendees. One such volunteer was Cherry Vogt Ward, who had travelled all the way from Switzerland.

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Jeanne and one of her young students, Ashton. ones to the idea of welcoming a brother or sister. “It’s a good program for all ages. They can adjust to having a new baby in the house, learning how to help and care for it and hold it,” she says, adding that the song reinforces the message she’s trying to spread at home. “Yes, there’s going to be a new little person but it doesn’t mean that mommy loves you any less.” Shannon Bourke, who brought 3-yearold Anderson to Kangaroo Kapers, agrees. “I just thought it was a great thing, a good introduction for him becoming a big brother.” Jeanne was a volunteer in the paediatric department when she was approached

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to lead the Kangaroo Kapers class in the late 1990s. With a lifelong passion for teaching children, Jeanne couldn’t resist. Her favourite part is drawing children out of their shells and it’s something she’s become known for.

The Kangaroo Kapers Sibling Preparation Class at Lakeridge Health, which helps kids aged two to six, get ready for a new addition to the family “Many children come to the class quiet and afraid to leave mom and dad’s side,” says Kim Moran, Patient Care Manager of the Maternal Newborn program. “Within that short hour, even the shyest child will be found leaning on Jeanne’s knee, enjoying her full attention as they chatter about a toy or pet or holiday.” “Some of them come and they’re very shy and timid at the start but by the time it’s over, we’ve made good friends,” says Jeanne, whose knack for working with little ones was recently featured on CTV Toronto’s Lifetime segment. Jeanne’s dedication to volunteering at Lakeridge Health, and her love of little ones and learning, is what keeps the Kangaroo Kapers program going. “Jeanne is the powerhouse behind the Kangaroo Kapers program,” says Kim. “Her overwhelming love for children and ability to speak and listen to even the littlest ones endears her to parents and children alike. Jeanne’s greatest gift is that she knows the importance of kindness and silliness to children.” Families can register for Lakeridge Health’s Kangaroo Kapers class online at www.welovebabies.ca, under Classes and Tours, or by calling 905-576-8711 ext. H 3495. ■ Jessica Verge is a Communications Officer at Lakeridge Health.

HOSPITAL NEWS NOVEMBER 2013

Volunteers make World Parkinson Congress a tremendous success

Continued on page 31 www.hospitalnews.com


VOLUNTEER PROGRAMS AND FUNDRAISING/PATIENT EXPERIENCE

Focus 31

Volunteer’s small gestures

forever remembered By Calyn Pettit n Christmas Day in 2012, Lorraine Ruffo received the worst kind of news: she had stage four brain cancer. A surgery on New Year’s Eve at Juravinski Hospital & Cancer Centre (JHCC) removed the aggressive tumour from her head, but her prognosis remained unclear. Not knowing whether she had months or years worth of life left ahead of her, Lorraine describes the days and weeks that followed as one of the most difficult times of her life. It was during this time that she met the person she calls her “angel”. “They told me I would lose my hair from the radiation treatment,” says Lorraine. “I had always admired the scarf headdress that Muslim women wear, and thought maybe I could find one for myself.” Lorraine recalls sitting in her hospi-

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Any act of kindness from a volunteer, whether it’s a smile or a friendly conversation, creates a ripple effect tal bed at Juravinski Hospital wondering where she could find a head scarf to wear once she began to lose her hair. Just moments later Sabrin Abbas, a student volunteer at JHCC, walked into Lorraine’s room to deliver a cup of ice water. As a woman of Muslim faith, Sabrin was wearing a traditional head scarf. Right away, Lorraine asked Sabrin where she could find a scarf of her own. The women chatted for some time, and their conversation evolved into what Lorraine calls a “beautiful exchange” of culture, faith and friendship.

“She was a shining light,” says Lorraine. Lorraine was delighted when Sabrin returned to see her just three days later, and was touched when she realized that Sabrin had come bearing the gift of three beautiful head scarves that she had purchased especially for Lorraine. “It was extraordinary,” says Lorraine. “It was such a blessing to find that kind of caring in a young woman.” Sabrin presented the scarves to Lorraine and showed her how to wear them. Together, the women laughed and cried and shared more about their respective religious views, about life, and about hope. Sabrin continued to visit Lorraine in the weeks that followed. “To me, it was a simple gesture,” says Sabrin of her gift to Lorraine. “I remembered when she first told me that she was going to lose her hair, and I didn’t want her to feel insecure.” Sabrin, 18, has volunteered with Hamilton Health Sciences since 2009, when she completed a 40-hour placement as a requirement for high school. When her placement ended, she knew she wanted to stick around. Eventually, Sabrin was volunteering at JHCC three times per week and was given the role of team captain, having the responsibility of training new student volunteers. In her volunteer role, Sabrin greets patients and families in the emergency department, and she circulates the book cart and distributes water to patients on the rehabilitation ward. “It makes my day, putting a smile on someone’s face,” says Sabrin. “It’s more than just bringing a cup of water. Patients trust us, and it motivates me to help them as much as I can.” Liz Deluca, coordinator in the volunteer resources department at JHCC says the small actions of volunteers can have

Sabrin Abbas, volunteer at Juravinski Hospital & Cancer Centre, says it’s the trust that patients place in her and the opportunity to put smiles on their faces that motivates her to volunteer. a significant impact. “Any act of kindness from a volunteer, whether it’s a smile or a friendly conversation, creates a ripple effect,” says Liz. “And it comes back to them tenfold, every time.” In February, Lorraine was discharged from hospital. “When I returned home, my husband and I sat down with each other,” recalls Lorraine. “We remembered our 55 years together, and how we had laughed more than we cried. In a way, my cancer was a blessing in disguise. It reminded us of how blessed we were.” Shortly after, Lorraine’s husband passed away due to illness. Although she may never recover from her cancer and the loss of her husband still weighs heavy, she finds comfort in her “wonderful family” and continually recounts her blessings, one of them being Sabrin. “I have a photo of Sabrin and I together framed in my home. I look at it often,” says H Lorraine. “I’ll never forget her.” ■ Calyn Pettit is a public relations specialist at Hamilton Health Sciences.

Barry Grennan of Move4Parkinsons with CherryVogt Ward, a volunteer at the conference who is living with Parkinson’s Disease.

World Parkinson Congress Continued from page 30

Cherry described her time volunteering at the WPC as “a superb experience” which really added to her enjoyment of the congress, she also spoke about how it helped her “to [get to] know people much closer, really it was like a family,” an important aspect when travelling so far from home. The volunteer group also included a number of students; including Danielle Murray, a second year researcher in the Neuroscience program at the University of British Columbia. Danielle described the program as “a good way to get to know the community and really fantastic to get to know people.” She found that she made connections with others in her field and with people with Parkinson’s, that she never would have met otherwise. The volunteer program, while an amazing experience for those involved, also had huge benefits for those attending. Volunteer coordinator, Paul DeRoos commented on how the approximately 100 volunteers, “provided a link www.hospitalnews.com

between conference organizers, the event team and conference participants.” Mags Mullarney who has Parkinson’s herself and is founder of Irish charity Move4Parkinson’s, travelled to Montreal with a group of twenty people. For Mags, the volunteers were a significant part of her WPC experience. “The volunteers were just amazing. Anywhere we looked you would see an orange t-shirt and someone smiling and ready to answer questions, offer directions or just say hi! Travelling with such a big group it was really important to us that everyone was looked after and knowing there was so much support available made it easy for us to relax and just enjoy the congress and soak up all of the knowledge and H experience on offer.” ■ Nikki Hegarty is a member of the WPC2013 communications committee and Board member of Move4Parkinson's, she lives and works in Ireland. NOVEMBER 2013 HOSPITAL NEWS


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VOLUNTEER PROGRAMS AND FUNDRAISING/PATIENT EXPERIENCE

Enriching patient experience Continued from page 28 The staff set unique goals for each patient and implement care plans that are tailored to each patient’s current level of abilities. Collaboration with other clinical areas at the hospital provides unique opportunities for additional programming e.g., collaboration with speech language pathology to provide weekly music therapy sessions. Promoting the use of language through movement and musical activities, this innovative program is aimed at patients with communication impairments, who require language stimulation, or who are at risk of social isolation and would benefit from a group setting. Dorothy is a caregiver whose husband has been a Runnymede patient for over two years. When he first arrived at the hospital, it took some time to become accustomed to new people and a change in environment. After taking part in Runnymede’s activation therapy programs, the staff and his family have noticed a remarkable change in his demeanor. “He has opened up completely,” Dorothy says. “He has adapted well to being at the hospital and is friendly with

all of the staff. I appreciate what Runnymede is doing for their patients and I feel blessed that we have come to this hospital.” Runnymede’s mandate is to continue to raise the standard of high quality care as the hospital continues to grow and expand. To guide the hospital in this process and assess their current performance, they conduct an annual patient satisfaction survey, which also surveys each patient’s most frequent visitor and has highlighted the great work of the hospital to date. In 2013 patient satisfaction with the overall quality of care was an outstanding 83 per cent. In addition, the patients’ most frequent visitors rated the overall quality of care as 96 per cent. These results confirm Runnymede’s commitment to enhancing the patient experience and the overall quality of care. The hospital continues to make adjustments so that patients are able to live exceptional lives while having an experience H that can brighten their day. ■ Michael Westman is a Communications Assistant at Runnymede Healthcare Centre.

Runnymede’s volunteers assist during activation therapy programs, such as arts and crafts.

HOSPITAL NEWS NOVEMBER 2013

Patients can keep their Emergency Department Transfer Packages on the fridge.

Partnership ensures patients a

smooth ride

By Aleem Bhanji

hen Elsa* dials 911, not only does she know that help is on its way, but she knows where the Toronto Emergency Medical Services (EMS) Paramedics will take her and that her primary care doctor and Toronto Central CCAC care coordinator will be notified immediately. Elsa is part of an initiative created by Toronto Central CCAC and Toronto EMS that also involves acute and primary care. The Emergency Department (ED) Transfer Package and Community Agency Notification (CAN) Program places patient safety front and centre, and ensures that individuals with multiple complex health conditions are supported and their needs communicated accurately as they transition through the health care system. Research increasingly indicates that patients are at higher risk of medical errors and other adverse events during situations in which responsibility for care is being transferred from one care provider to another. These risks can be reduced through better coordination of care and increasing access to patient information for the provider who is taking over care of the patient. A medical transfer package is one example of how to ensure that necessary patient information follows the patient. Elsa has Chronic Obstructive Pulmonary Disease (COPD) and diabetes, and lives with her husband who also has multiple health concerns. Previously, during an acute episode, she would be taken to the first available hospital. It meant different hospitals and doctors, answering many questions on each occasion, increasing her anxiety and disorientation. Sometimes her family doctor and Toronto Central CCAC care coordinator didn’t even know she’d been to hospital. But this new partnership has changed all that. Elsa and her husband are assigned to one nearby hospital, and the ED Transfer Package includes the important information EMS Paramedics and emergency department staff need in the first two hours of caring for a patient. The Community Agency Notification (CAN) program ensures that one phone call by a Paramedic will automatically inform the client’s care team members whether or not the patient is transferred to hospital. The heart of the ED Transfer Package is a single Patient Information Sheet, which includes important medical information, medications, ‘Do Not Resuscitate’ (DNR)

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status, cognitive status, communication and behavioural considerations, and special devices used by the patient. The information sheet was developed by Toronto EMS and Toronto Central CCAC in consultation with emergency department staff, pharmacists, patients and caregivers. The information sheet is kept in a clear plastic bag with DNR orders, if any. Patients are encouraged to keep their medications in the bag too, so that Paramedics will have everything easily accessible if they need to transfer the patient to hospital. Paramedics are trained to look for the transfer package inside the front door or on the refrigerator. Elsa and her husband keep their transfer packages on the fridge. A large sticker on their front door alerts EMS to look for the packages. Bright stickers on their health cards also alert paramedics or hospital staff (if they were to make their own way to hospital) to their participation in the program. The second crucial part of the program, the Community Agency Notification (CAN) program, requires one phone call to be made by the EMS Paramedics or hospital staff. They leave a message on the CAN hotline with the patient’s name, CAN ID number, and the hospital receiving the patient. If the patient is not being taken to hospital, the reason is given. The notification line automatically forwards the message via email or phone to everyone on the patient’s contact list, including the Toronto Central CCAC care coordinator, the Toronto EMS project coordinator, and the patient’s primary care provider. This allows them to follow up and even consult directly with hospital staff. The ED Transfer Package and CAN Program demonstrate the benefits of integrated care to both patients and our health care system. Improved communication ensures accurate information is passed on in a timely way, improving patient safety and quality of life. Patients (and families) are more comfortable staying at home longer, delaying the need for long-term care. Calls to EMS and demand on emergency departH ments are reduced. *(not her real name) ■ Aleem Bhanji is Project Manager for the Health System Integration for Complex Populations and Primary Care at the Toronto Central Community Care Access Centre www.hospitalnews.com


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Focus 33

Ironman meet Ironman: Improving the experience for kids at cancer centre By Kathy Leblanc superhero visited the London Regional Cancer Program (LRCP) at London Health Sciences Centre (LHSC) recently. Actually, make that two superheroes. When Carter Robbins was diagnosed with a stage three Anaplastic Ependymoma brain tumour at the age of four, it was clear he would have a tough battle to fight. Five surgeries, a round of chemotherapy and 33 sessions of radiation later, Carter had not only fought a winning battle, but had also earned himself a nickname from his surgeon – “Iron Man”.

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Recognizing that the cancer centre was designed for an adult population, without many child-friendly features, the team set out to do what they could to change that “Carter has always been known for his easy-going nature, and his ability to go through any test or treatment without much complaint or fuss at all,” says mom Jeannette. “In fact, he has never once needed to be sedated for any of his MRIs or radiation treatments. He just reminds himself that he’s Iron Man, and does whatever the doctors need him to do.”

Carter Robbins, a patient at London Health Sciences Centre rings the ceremonial gong along with his superhero Iron Man after his final radiation treatment. After a two-year period free from cancer, Carter – now seven – recently suffered a recurrence of his tumour, and his superhero strength kicked in once again. Staff at the LRCP were so impressed by their “little Iron Man”, that they arranged for Carter’s

favourite superhero to surprise him after his final radiation treatment. Together the two Ironmen – big and little – sounded the ceremonial gong that each radiation patient rings when their treatments come to an end. Carter also had the opportu-

The sound of hope: Ringing bell signifies end of treatment for cancer patients By Nanci Corrigan hen Lauren Scott was diagnosed with breast cancer, she heard from friends who were also going through their own cancer journeys about a bell that patients would ring following their final treatment. They told her about how meaningful the tradition was to each patient. Lauren decided that she wanted to experience that feeling for herself – and so she, her friends and family donated a bell to the Cancer Centre of Southeastern Ontario at KGH in July of 2010. Today, the sound of a ringing bell within the Centre signifies a milestone for cancer patients, and a new sense of hope for the future. The tradition of ringing a bell to signify the end of treatment has its roots in the U.S. Navy. Rear Admiral Irve Le Moyne, a cancer patient in Houston Texas, installed a bell at the MD Anderson Radiation Treatment Centre in 1996. Inspired by the military’s tradition of ringing a bell to symbolize that a job has been completed, Le Moyne donated a bell to the centre with the inscription: “Ring this bell/Three

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Lauren Scott stands beside the bell she donated. times well/Its toll to clearly say/My treatment’s done/This course is run/And I am on my way!” Today, the bells are a common addition to cancer treatment centres, as well as variations on the theme – MD Anderson also has a gong for patients who complete their treatment at the Proton Therapy Centre. At Lennox & Addington County Hospital, the new chemotherapy treatment

suite that opened a year ago includes a bell as well, a sound that is music to Chief Nursing Officer Tracy Kent-Hills’ ears. “It’s fabulous to be able to offer chemotherapy treatments in our community, and to have our own bell to celebrate the end of treatment,” she says. “In our first year alone, we’ve had the pleasure of hearing that sound over 20 times.” Lauren was the first to ring her bell, even before it was installed. Her young son held it for her while she celebrated the end of her chemotherapy treatments. Once it was installed she added her own inscription, which reads: “Symbol of Courage, Sound of Hope, Celebration of Life". Today, Lauren sees the bell when she goes for follow-up tests, and says that people often send her photos of patients ringing the bell. She says that for her, it’s a beautiful sound. “I’m always hoping to hear it when I go to the Centre,” she says. “For me, it’s the sound of hope H and joy.” ■ Nanci Corrigan is a Communications Strategist with the South East Regional Cancer Program.

nity to show his hero the radiation mask (painted in Iron Man colours) that he wore throughout his 30 treatments. London Health Sciences Centre’s vision is Exceptional Experiences, Extraordinary People, Engaging Partnerships and the paediatric radiation therapy team at LRCP has embraced the idea of ensuring an enhanced patient experience, particularly for their youngest patients. Recognizing that the cancer centre was designed for an adult population, without many childfriendly features, the team set out to do what they could to change that. They began taking some of the fear out of radiation masks, used to treat head and neck cancers, by painting them to resemble young patients’ favourite superheroes or movie characters. They created countdown calendars on which each child – and even siblings in some cases – mark each successful treatment with a fun sticker of their choice, helping them to understand how many more treatments they still have to go. Toys were purchased as ‘congratulations’ gifts for each child upon completion of their therapy. The team’s next undertaking is turning a standard exam room into a fun, welcoming room for kids. “It’s important to our staff that our young patients leave LRCP with some good memories – even happy memories – of their time here,” says LHSC Radiation Therapist Kelly Ackerman. “We try to ensure that their visits are not just about the treatment, but also recognize the special and unique personalities of each child. When we learned about Carter’s nickname, we knew that helping him channel his inner Iron Man would make his treatments easier and more pleasant. We hope that having his favourite superhero here to celebrate the end of his radiation sessions will put a smile on his face.” Remarks Jeannette, “We can’t thank the team at the London Regional Cancer Program and the Pediatric Medical Day Unit and Art Therapy Department at Children’s Hospital enough for the kindness they’ve shown to Carter. His care has been exceptional, and this surprise visit by Iron Man is one more example of how far above H and beyond they’ve gone for him.” ■ Kathy Leblanc is a Communications Consultant at London Health Sciences Centre.

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34 Focus

VOLUNTEER PROGRAMS AND FUNDRAISING/PATIENT EXPERIENCE

New student volunteer research program at

Southlake By Cheryl Genereaux ate Sinclair, a 3rd year Biomedical Science student at the University of Waterloo, contributed over 350 hours of her time last summer working with Southlake Regional Health Centreâ&#x20AC;&#x2122;s research department. Sinclair was part of a new project, Side by Side, an innovative partnership between two departments â&#x20AC;&#x201C; the Research Institute and the Community Resources Department. When Pat Clifford, Director of Research, Janet Jeffery, Research Scientist, and Lee

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As Southlake further develops its research culture, there will continue to be opportunities for volunteers to support clinicians in the implementation of important research studies

Ann Crilley, Project Lead, approached the Community Resources Department with the idea to involve university student volunteers and community volunteers in the fast-paced Research Department, the result was Side by Side. â&#x20AC;&#x153;Where they saw a need, we saw an opportunity,â&#x20AC;? says Cheryl Genereaux, Volunteer Specialist, Community Resources. In short order, an advertisement went online and within a week, there was an overwhelming response from eager students and members of the community looking to add valuable experience to their resumes or to simply give back. In the end, last summer 19 undergraduate and graduate students along with community members donated almost 1000 hours of their time. â&#x20AC;&#x153;Their hard work, enthusiasm, and results underscored the value of Side by Side,â&#x20AC;? adds Genereaux. Kate Sinclair saw Side by Side as an amazing opportunity to gain experience and knowledge. She assisted with several projects including developing an interactive nutrition blog for cancer patients receiving treatment at the Stronach Regional Cancer Centre at Southlake. The blog al-

From left: Michelle Fedele, Registered Dietitian, Kate Sinclair, Side by Side research volunteer, Jacqueline Hornick, Registered Dietitian and Janet Jeffery, Research Scientist. lows patients to ask nutrition-based questions to Michelle Fedele and Jacqueline Hornick, two of the hospitalâ&#x20AC;&#x2122;s registered dietitians. Additionally, Sinclair worked with Paula Roberts, RN, who was conducting a study to measure frailty and quality of life in patients who are referred for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). She also worked alongside Alyson McQueen, Manager of ER, in a study exploring ways to prevent nosocomial infections in patients undergoing cardiac surgery. The importance of patient advocacy in every aspect of healthcare, including preventive medicine, patient education, and emotional support, is something Sinclair will take with her throughout her career. She learned new skills, many of which she felt she would never have found in a textbook. â&#x20AC;&#x153;I am motivated by the experience Iâ&#x20AC;&#x2122;ve been given,â&#x20AC;? she says.

The program also had tremendous benefit for Southlake. â&#x20AC;&#x153;The role these volunteers played in each project was critical,â&#x20AC;? says Pat Clifford. â&#x20AC;&#x153;None would have moved forward without the volunteer contribution.â&#x20AC;? As Southlake further develops its research culture, there will continue to be opportunities for volunteers to support clinicians in the implementation of important research studies. In fact, as a result of this very successful pilot, the program has become permanent, and will see volunteers in Southlakeâ&#x20AC;&#x2122;s Research Department, working alongside research scientists from York University and the University of H Ontario Institute of Technology. â&#x2013; Cheryl Genereaux is a Volunteer Specialist at Southlake Regional Health Centre.

â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s my pleasure to say â&#x20AC;&#x2DC;thank you.â&#x20AC;&#x2122; Your knowledge DQGFRQĂ&#x20AC;GHQFHJXLGHGXVWKURXJKDOOWKHWLPH<RX ZHUHOLNHWKHOLJKWDQGWKHKRSHLQWKHGDUNHVSHFLDOO\ LQWKHĂ&#x20AC;UVWFRXSOHRI\HDUV,DPJODGLWLVRYHUVXFFHVVIXOO\7KDQN\RXÂľ â&#x20AC;&#x201C; A.W.

HOSPITAL NEWS NOVEMBER 2013

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VOLUNTEER PROGRAMS AND FUNDRAISING/PATIENT EXPERIENCE

Focus 35

Volunteer landscape changing ore than 13.3 million Canadians volunteer more than 2.1 billion hours annually, according to the Canada Survey of Giving, Volunteering and Participating. This group accounts for 47 per cent of the population aged 15 or older, each person volunteering an average of 156 hours per year. Of this incredible percentage, Statistics Canada highlights that six per cent volunteer for organizations supporting health issues. This makes healthcare one of the top five types of organizations Canadians volunteer to support – two per cent of which were hospitals specifically. Volunteers play a vital role in the operations and functions of hospitals. From assisting with administrative tasks or recreational programs, offering friendly visits or outings with patients or providing support to families in waiting rooms, volunteer contributions are extensive. Valuing Volunteers: An Economic Evaluation of the Net Benefits of Hospital Volunteers highlights that aside from providing staff with extra support in nonmedical services, volunteers help hospitals maintain a personal touch, reducing anxiety and feelings of vulnerability and contributing to the comfort and happiness of patients, families and visitors. As hospitals are dealing with a num-

M

ber of changing realities, including aging populations, higher costs and efforts to digitize healthcare, the support of hospital volunteers is even more critical. However, alongside changes in the health care field, a number of transitions have occurred in the volunteer landscape in Canada. In order for the support services of volunteers to be best leveraged, hospitals should explore the changing landscape and its implications on volunteer engagement. Shifting demographics have implications for volunteer recruitment at hospitals. Statistics Canada reveals the highest volunteer rate (58 per cent) is among youth aged 15-24. Young Canadians are shaping the volunteer landscape and the health care field. However, while they have the highest volunteer rate, they contribute fewer hours per year than those aged 35 plus. The pan-Canadian research, Bridging the Gap: Enriching the Volunteer Experience to Build a Better Future for our Communities has highlighted a shift amongst volunteers towards a preference for short-term volunteering, over long-term commitment with organizations. This may pose some challenges for roles that benefit from long-term relationship building such as palliative care or rehabilitation. In recruiting volunteers, hospitals will want to consider ways they can design short-term roles.

Careers

Hospitals can also look to resources on Volunteer Canada’s website on youth engagement in order to adapt to a younger volunteer base. Approximately one in five Canadians is now born outside of Canada. According to Statistics Canada, immigration now accounts for close to 70 per cent of population growth. Hospitals have the opportunity to tap into the rich skills and cultural competencies of newcomers. Volunteer engagement strategies should include policies and practices regarding diversity and inclusion. Resources such as Building Blocks for Engaging Newcomer Volunteers have been designed to offer key insight around creating welcoming organizations. Many of today’s volunteers are well educated and are citing a desire to apply professional or technological skills in their roles. When recruiting, conducting follow-ups or evaluations, volunteer managers should take time to learn about volunteers’ motivations and desires to apply skills. Hospital volunteer retention levels will benefit if volunteers goals and objectives are being met through skills-based volunteering. In order to adapt to the changing volunteer landscape, organizations in the healthcare field and hospitals across Canada have been adopting the Canadian Code for Volunteer Involvement. Revised in 2012, the

Code has been designed to reflect today’s volunteer realities and meet the needs of organizations of all sizes. It provides a framework for discussion and decisionmaking within organizations and promotes meaningful volunteer involvement that meets the needs of both the organization and its volunteers. To accompany the Code, the online Code Audit will become available to Volunteer Canada members this fall, and will help organizations assess and analyze the way they are currently involving volunteers. There have been excellent examples of volunteer engagement across the sector. To recognize volunteers during the 2013 National Volunteer Week, the Montréal Children’s Hospital dedicated their employee newsletter to their volunteers and created a Thank You website. Organizations are acknowledging the vast benefits of developing strong volunteer programs, with effective recruitment, screening, training, supervision and recognition. By adapting to the changing volunteer landscape, hospitals will have the opportunity to be champions in supporting a culture and structure that values the vital role and significant H impact of volunteer involvement. ■ This article was submitted by Volunteer Canada.

DEADLINE FOR DECEMBER 2013 ISSUE: NOVEMBER 26, 2013

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36 Focus

HOSPITAL NEWS NOVEMBER 2013

VOLUNTEER PROGRAMS AND FUNDRAISING/PATIENT EXPERIENCE

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Hospital News November 2013 Edition  

Focus on Patient Experience, Volunteer Programs and Fundraising.

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