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Saving lives and alleviating suffering with Médecins Sans Frontières FOCUS IN THIS ISSUE


Canada's Health Care Newspaper JAN. 2014 | VOLUME 27 ISSUE 1 |

New roles and training for health-care professionals. Human resource programs implemented to manage stress in the workplace and attract and retain health-care staff. Health and safety issues for health-care professionals. Quality Work Environment initiatives and outcomes.

Special Professional Development Supplement INSIDE Evidence Matters ................................. 8 Nursing Pulse ..................................... 10 From the CEO's desk.......................... 16 Ethics ..................................................19 Careers ...............................................19

Aging Tsunami Why we need to rethink the way we deliver hospital care for elders

By Dr. Samir Sinha lthough aging is inevitable, the proportion of the population entering ‘old age’ has never been greater. As the boomers start turning 65 this year, this demographic imperative will continue well into the future, doubling in the


next two decades. While it is proper to recognize that aging is a triumph, rather than a disease, we need to also acknowledge that the aging of our society will place unprecedented pressure on Canada’s health care system. The growing numbers of older adults

are driving health costs in Canada. Older adults also use more expensive types of health services, particularly in the acute care setting. Indeed, while people aged 65 and older account for 14.4 per cent of the population they consume nearly half of our pub-

lic spending on healthcare. However, what complicates things further is the well-documented but underappreciated heterogeneity of the older population and the impact that this has on health care use. Continued on page 9

Be their link to living safely at home. Join our team of skilled Care Coordinators

Be the health professional clients can rely on to understand and evaluate their unique situation, connecting them with the care and services they need to continue enjoying life at home – with dignity and independence. RNs, MSWs, OTs, PTs, RDs and SLPs are invited to apply. For details, locations and staff videos, and to apply for a Care Coordinator, Nursing or other role, visit Most Community Care Access Centres of Ontario are governed by the requirements of the French Language Services Act. We provide services in French and encourage applications from bilingual candidates.

We are committed to accommodating people with disabilities as part of our hiring process. If you have any special requirements during the recruitment process, please advise Human Resources.




Patient experience training brings

‘Heart’ to Rouge Valley By Akilah Dressekie kind word, a smile, or a listening ear can make all the difference in turning a potentially difficult hospital experience, into a positive one. Thanks to a new, enhanced patient experience training program, all 3,500 of Rouge Valley Health System’s (RVHS) staff, physicians and volunteers are learning to take their already strong customer service skills to the next level. The program is called Communicate with Heart and was developed by the world-renowned Cleveland Clinic. To date, RVHS has focused on two sections of the program: •START With Heart – This part of the program provides patient-focused customer service training focused on practical skills and tools staff can use as a behavioural standard for all patient and family interactions; and •Respond with Heart – This section of the program focuses on effective conflict resolution, and teaches the skills needed to make that possible. Staff members are given the tools they need to effectively address the patient’s concerns, preventing escalations. The program empowers staff to communicate with their colleagues, patients, and families in a caring and compassionate manner.


START stands for: •Smile and greet warmly; •Tell your name, role and what to expect; •Active listening and assist; •Rapport and relationship building; and •Thank the person. The interactive workshops bring staff from all areas across the hospital together to learn and practice the skills in small groups, using actual situations, role-playing, and group discussion. The START With Heart customer service training workshops ran from May to November, with nearly all staff, physicians and volunteers at Rouge Valley receiving the training. The Respond With Heart training is expected to run from January to June. More than 30 Rouge Valley staff members have been trained by Cleveland Clinic representatives to deliver the workshops. While the Communicate With Heart program was designed by the Cleveland Clinic for their own workforce, it has been modified to reflect Rouge Valley’s Patient Declaration of Values and Strategic Plantwo key directives that articulate the hospital’s commitment on how care is delivered, and how patients are to be treated at Rouge Valley.

Many health care facilities may not consider offering customer service training for staff. But organizational learning manager Bill Hamilton explains that making excellent customer service the standard only enhances the patient experience. “The service you receive from a health care facility is more than just the technical aspects; it’s also about the hospital experience. It’s not just what you say, but how you say it. It’s not just what you do, but how you do it,” he explains. “When people come to the hospital, they’re often stressed and anxious. They are more sensitive to how they’re treated, so it’s important that we show them empathy and respect.” As one former patient put it, “before I care how much you know, I need to know how much you care.” In all, it is expected to take between 12 to 18 months to fully launch the program and train all staff, physicians and volunteers. It is also part of a five-year sustainability plan to ensure that behaviours taught in the program are being recognized, while areas identified for improvement can receive coaching. Rouge Valley took the opportunity to make START With Heart the theme of its recent annual Patient Appreciation Day. On that day, leaders throughout the hospital spoke to approximately 250 patients to get their direct feedback on how well hospital staff members were doing in implementing the START With Heart behaviours.

Not only do patients and their families benefit from a positive hospital experience, but staff, physicians and volunteers can also feel reassured that the care they are givingbeyond their expert training-has made all the difference to someone undergoing a seH rious medical procedure or receiving care. ■

Akilah Dressekie is the Senior Communications Specialist at Rouge Valley Health System. Five things you can do to demonstrate empathy to a patient. 1. Focus – Focus on the person, and eliminate all the distraction around you. 2. Listen – Listen for the facts and emotions. 3. Paraphrase – Repeat what the person says to confirm that you heard the details of what they said. 4. Acknowledge their emotions – Pick up on what their emotions are. By saying something like, “You seem a little upset,” you can show your customer that you are paying attention. 5. Ask what you can do – Find out exactly what they need you to do to provide the right solution.

You’re in good hands. We’ll be there for you.

OPSEU hospital workers across Ontario wish you a healthy and happy holiday season! HOSPITAL NEWS JANUARY 2014



In Brief


Eve ed... r wonde

✓ How to make infection rates into more than a number at a staff meeting? ✓ What key communication technique outweighs all others in its ability to deliver immediate results? ✓ How to move staff from being merely engaged to being totally energized ✓ How to give employees ownership over their engagement? ✓ How employee decisionmaking helps to lower attrition? In our new three-part series starting in February, writer Yvan Marston examines communications’ challenges and solutions across several hospitals outlining case studies, best practices and featuring interviews with CEOS, engagement experts and communications managers.

Don’t Miss Out!

Meningococcal Serogroup B

Health Canada approves first vaccine Health Canada has approved Bexsero* (Multicomponent Meningococcal B Vaccine [recombinant, adsorbed]) for use in individuals from two months through 17 years of age. Bexsero* is the first broad coverage vaccine to help protect against meningococcal serogroup B (MenB) disease, including infants, toddlers and adolescents who are at the greatest risk of infection. MenB infection is the leading cause of meningococcal disease across Canada, particularly in infants. Although rare, this

disease is feared as it affects healthy people rapidly and without warning. Meningococcal disease can cause significant mortality in 24-48 hours and early symptoms can often resemble the flu, making this disease initially misdiagnosed in its early stages. About 10 per cent to 14 per cent of people who contract the disease will die despite appropriate treatment. Up to 20 per cent of survivors may suffer from devastating, life-long disabilities such as neurological disabilities, hearing loss or limb

Top Canadian Cancer Society

research stories of 2013 The Canadian Cancer Society announced its list of 2013's top research stories today, highlighting important discoveries with the promise to change cancer forever. The 2013 list includes: •Designing cancer-fighting viruses that are even more effective at killing cancer cells while leaving normal cells unharmed. •Identifying the cancer cells which spread from the lungs to the brain, which could provide new targets for drugs to block the spread of these cells. •Developing a toolkit to collect and use information on cancer-causing substances in the workplace to help reduce exposure to dangerous substances. •Asking a simple question to help restore

Dementia biggest health challenge facing our generation

Alzheimer's Disease International (ADI) has announced that the number of people living with dementia worldwide in 2013 is now estimated at 44 million (estimated at 35 million in 2010), reaching 76 million in 2030 (66 million) and 135 million by 2050 (115 million). The Policy Brief entitled 'The Global Impact of Dementia 2013-2050' reports a staggering 17 per cent increase in global estimates of people living with dementia, compared to the original ADI estimates in the 2009 World Alzheimer's Report. Although high income countries like all those in G8 have borne the brunt of the dementia epidemic, the disease is a


global phenomenon. In the next few decades the global burden of the disease will shift inexorably to low and middle income countries with 71 per cent of those with dementia living in lower and middle-income countries by 2050. Most governments are woefully unprepared for the dementia epidemic with only 13 countries implementing a national dementia plan. All governments should initiate a national dialogue regarding future provision and financing of long term care. There is an urgent need for a collaborative, global action plan for governments, industry and non-profit organisaH tions like Alzheimer associations. ■

dignity to terminally ill cancer patients. "Scientists funded by the Canadian Cancer Society are making tremendous progress against cancer. Each December, when we look back on the year that was, it's a challenge to select the top research achievements because all the work is excellent. With this list, we're highlighting outstanding research that is dramatically expanding our cancer knowledge; how to prevent it, treat it better and move beyond it," says Dr Sian Bevan, Director of H Research, Canadian Cancer Society. ■

loss. Prevention through vaccination is considered the best control strategy against an aggressive disease that leaves H little time for intervention. ■

Introducing food allergens to baby

Babies who are at high-risk of developing a food allergy can be exposed to potential food allergens as early as 6 months of age, according to a joint statement by the Canadian Paediatric Society (CPS) and Canadian Society of Allergy and Clinical Immunology (CSACI). "Delaying dietary exposure to potential allergens like peanuts, fish or eggs will not reduce your child's risk of developing a food allergy," said Dr. Edmond Chan, paediatric allergist and co-author of the statement. "However, once a new food is introduced, it is important to continue to offer it regularly to maintain your child's tolerance." Babies are considered at high risk of developing a food allergy if they have a parent or sibling with an allergic condition, such as atopic dermatitis, a food allergy, asthma or allergic rhinitis. The statement says that while these foods can be introduced to high-risk babies, the decision about when should be individualized and based on the parents' comfort level. The CPS advises parents who are unsure to talk to their physician. Food allergies affect approximately 7 per cent of Canadians. Some research suggests food allergy in babies is increasing, affecting over 10 H per cent of one-year-olds. ■

.YV\W)LULÄ[Z for part-time and casual hospital employees and all hospital retirees


We now have a plan for everyone . . .





Guest Editorial

UPCOMING DEADLINES FEBRUARY 2014 ISSUE EDITORIAL JANUARY 10 ADVERTISING: DISPLAY JANUARY 24 | CAREER JANUARY 28 MONTHLY FOCUS: Facilities Management and Design/ Health Technology/Greening Health Care: Innovative and efficient health-care design, the greening of health-care, and facility management. An update on the impact of information technology on health-care delivery including electronic health-care records. Trends, issues and achievements in the field of Clinical Informatics.

MARCH 2014 ISSUE EDITORIAL FEBRUARY 13 ADVERTISING: DISPLAY FEBRUARY 21 | CAREER FEBRUARY 25 MONTHLY FOCUS: Pain Control/ Rheumatology/ Complementary Health/Health Promotion: Pain management interventions. Developments in the management of rheumatic diseases. Advancements in complementary treatment approaches to various diseases and conditions. Innovative health promotion programs that focus on disease prevention.


Hospital News is provided at no cost in hospitals. When you visit our advertisers, please mention you saw their ads in Hospital News.

Healthy physicians equals

healthy patients By Dr. Louis Hugo Francescutti

he tragic death of a medical resident just before the start of the recent Canadian Conference on Physician Health in Calgary provided a powerful reminder of why the Canadian Medical Association feels it is so important to acknowledge the importance of maintaining the health of doctors and helping our colleagues in need. A large part of maintaining that health involves reconnecting with each other, supporting each other and striving to be happy in both our professional and personal lives. My colleague Dr. Derek Puddester, director of Canadian Physician Health Institute perhaps put it best in opening the two-day meeting when he stated: “Remember you are in a room of support. This is our house, this is our community, this is our tribe. We support each other because that is what we do best.” That message is one that continued throughout the incredibly rich series of presentations given during the conference. I had the honour of closing the event and I reminded my colleagues that we have been given a unique opportunity to make sure the health of the population at large is as good as it can be-in part by making sure we stay healthy ourselves. In the past two decades, there has been a growing recognition of the need to address mental health issues and problems of addiction that can afflict physicians. While physicians in general practice what they preach and strive to maintain good physician and mental health, the unique challenges facing doctors means suicide continues to be much more common among physicians than other professionals. As one of my predecessors as president of the CMA Dr. Ruth Collins-Nakai noted, despite the strong network of physician health programs across


ADVISORY BOARD Jonathan E. Prousky,

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

Cindy Woods,

Canada, access to the resources of these programs is variable and many doctors remain unaware of the help that is available to them. The theme of this year’s Canadian Conference on Physician Health was “harnessing wisdom across generations to promote physician health.” Much of the discussion focused on enhancing physician health in the medical education system and examining intergenerational perspectives to improve physician health and the workplace culture. Dr. Kevin Busche, a neurologist at the University of Calgary, explored as he talked about the four different generations working in medicine right now and the different expectations and strengths each group brings to the profession. Harnessing the synergies between these generations can make us all healthier. Hospital-based physicians could relate well to two of the other major focuses of discussions at this year’s meeting-how to deal with disruptive colleagues and the implications of the new digital technologies that are pervasive in the practice of medicine today. Understanding and managing disruptive behavior by physicians throughout the career cycle was addressed by three expert physicians associated with the Canadian Medical Protective Association (CMPA). The representatives provided advice on how all parts of a health care institution can work to address this issue. The CMPA has also recently carried out extensive work to better understand the complex mental health issues that can underlie such behavior and how best to manage it. Delegates at the meeting were almost evenly divided about whether digital connectivity has a positive or negative impact on physician health. A lively and often humorous debate on the topic did not sway delegates as electronic voting showed 52 per cent of audience mem-

Barb Mildon,

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

Senior Communications Officer The Scarborough Hospital, Scarborough, ON

Helen Reilly,

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










Publicist Health-Care Communications Toronto, ON



bers felt digital connectivity had a negative impact on health both at the start and end of the debate. Opening plenary speaker psychiatrist Dr. Michael Myers noted mobile devices and email can make it difficult for some physicians to retain a balance between work and home life. He talked of some doctors who get up during the night and are unable to go back to bed because they get caught up checking emails, tweets etc. The debate on the issue featured CMA past-president Dr. Anna Reid, UBC health technology expert Dr. Kendall Ho, resident Dr. David Ward and medical student Joshua Bezanson. Discussion was wide-ranging and included references to the Borg from Star Trek and a digression on the evils of using mobile devices while driving. Throughout the debate, chaired by Calgary’s Dr. David Topps, audience members were polled on their attitudes towards and use of digital technologies. While 61 per cent of the audience felt it was always inappropriate to use mobile devices while dining with family or friends, there was still a significant minority who admitted to always having their mobile in the bedroom while sleeping (35%). In my closing remarks I noted that while most of us love what we do, few Canadian doctors love the health care system in which they work. We must change that so we can ensure the system is supporting keeping patients as healthy as possible. The conference was presented by the Canadian Physician Health Institute and co-hosted with the Alberta Medical Association (AMA) and the AMA PhyH sician and Family Support Program. ■ Dr. Louis Hugo Francescutti is the President, Canadian Medical Association.

Jane Adams,

President Brainstorm Communications & Creations Toronto, ON

Bobbi Greenberg,

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

Dr. Cory Ross,

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

Akilah Dressekie,

Senior Communications Specialist Rouge Valley Health System

Hospital News is published for hospital health-care professionals, patients, visitors and students. It is available free of charge from distribution racks in hospitals in Ontario. Bulk subscriptions are available for hospitals outside Ontario. The statements, opinions and viewpoints made or expressed by the writers do not necessarily represent the opinions and views of Hospital News, or the publishers. Hospital News and Members of the Advisory Board assume no responsibility or liability for claims, statements, opinions or views, written or reported by its contributing writers, including product or service information that is advertised. Changes of address, notices, subscriptions orders and undeliverable address notifications. Subscription rate in Canada for single copies is $39.00 per year. Send enquiries to: Canadian Publications mail sales product agreement number 40065412.




Mental wellness: An excellent healthy workplace investment By Christine Devine and Diana Hooper

ver a decade ago, the leaders at Toronto East General Hospital (TEGH) identified that a healthy workplace with engaged employees was critical to achieving its long-term goals and providing top notch care for its patients. As a result, TEGH developed a staff wellness program as one of its healthy workplace priorities. A formal program was launched in 2004 with a focus on physical wellness and workplace safety. Since then, the hospital has supported the expansion of the program to accommodate needs specific to the organization and its employees. Program development has been influenced by staff who have always been encouraged to bring forward ideas and concerns concerning workplace wellness and work-life balance. Given that mental health disorders are among the most frequently claimed illnesses for all employees, and that people in caring professions are particularly vulnerable to personal burnout, compassion fatigue and second victim syndrome, TEGH pro-actively identified the importance of expanding the program to include support for mental wellness.


Mental health disorders are among the most frequently claimed illnesses for all employees, and that people in caring professions are particularly vulnerable to personal burnout, compassion fatigue and second victim syndrome “We made the decision to allocate resources to a comprehensive mental wellness program for our staff and have never looked back. The correlation between happy, engaged employees and excellent patient care is direct and undeniable and therefore clearly a benefit to the organization,” says Nancy Casselman, Director, Human Resources, Organizational Quality, Safety & Wellness. In 2008, the first Mental Wellness Strategic Plan was developed, focusing on three strategic priorities to promote mental wellness. A major review and rewrite of the plan took place in 2012 to coincide and align with the recommendations of the Mental Health Commission of Canada’s new national standard, “Psychological Health and Safety in the Workplace-prevention, promotion and guidance to staged implementation”. This plan outlines a number of specific and measurable goals the organization will monitor regularly. Highlights from the Plan include: • Employee training in Emotional Intelligence

A team from Toronto East General Hospital receiving the Silver Award of Excellence at the Excellence Canada Gala in October. Photo credit: Gary Roork. for Work & Life: A program that helps staff learn about managing their emotions in key relationships and teaches the importance of active listening and recognizing the value that each individual brings to a team. This is a mandatory four-hour course for all staff during orientation and a full two-day course for new leaders. • Psychological health and safety training for managers and supervisors: Recognizing the impact that managers have on the day-today operations of their team, and the key role they play in recognizing and/or influencing behavior, TEGH identified the need for a program that would equip leaders with the knowledge and support they need to recognize and provide support for employees experiencing mental health issues. Mandatory for all leaders, the program includes: 1) A Manager Toolkit for Psychological Health and Safety, which outlines ways to combat stigma in the workplace and promote inclusive behaviours to create an environment of awareness, support and safety; and 2) A mandatory Mental Health Awareness course, consisting of face-to-face training and an iLearn course. • Second Victim Syndrome: Caring for our own: This peer support program is currently being piloted to respond to the pervasive occurrence in healthcare that occurs when a caregiver is traumatized because of an unanticipated patient adverse event. This support project is designed to help alleviate a caregiver’s trauma, increase self-awareness to promote self-care and provide appropriate resources through convenient and confidential channels. Tactics include mandatory breaks for atrisk staff, enhanced Emotional Intelligence programming and the creation of an online resource bank. Developing a comprehensive program takes time, commitment and resources, but there are many steps that can be taken early on in one’s journey that don’t require a lot of time or resource commitment. TEGH, for example, as part of an anti-stigma campaign, began with partici-

pating in national campaigns like Mental Health Week and Bell Let’s Talk Day to raise awareness and encourage dialogue about mental wellness within the organization. The hospital also partnered with its EAP provider to create and offer an annual Self Care Series of Lunch n Learns, a forum which allowed employees to have open discussion about such topics as Seasonal Affective Disorder (SAD), Care for the Caregiver and Burn Out. TEGH is confident that its investment in employee wellness and mental wellness has been successful and has led to improved employee engagement. This year’s staff engagement results were the best ever

recorded. Employees responded favourably to questions designed to measure their ability to contribute and feel valued and the hospital received its highest scores ever for being a good or excellent place to work. In addition, long-term disability (LTD) claims, psychological LTD claims and employee absentee days have all been trending downward. TEGH’s efforts to promote mental wellness in the workplace have not gone unnoticed. The hospital received a Silver Award of Excellence for meeting the requirements of Excellence Canada’s Progressive Excellence Program®-Mental Health at Work® levels 2 and 3; the only hospital and one of only three organizations in Canada to be awarded at this level. TEGH was also selected by the Mental Health Commission of Canada (MHCC) to participate in a promotional video highlighting its commitment to psychological health and safety in the workplace and wellness programming that considers the holistic needs of employees. The video will be released in January 2014 on TEGH’s YouTube channel and posted on the MHCC’s website. Keeping in mind its commitment to developing and supporting a holistic wellness program that addresses the mind, body and spirit, Toronto East General Hospital will continue to focus on mental wellness as an important component, confident that it will not only lead to increased employee engagement, but will continue to positiveH ly impact patient care. ■ Christine Devine is a Wellness Coordinator and Diana Hooper is a Coordinator in Corporate Communication, Planning & Partnerships at Toronto East General Hospital.





Saving lives and alleviating suffering with

Médecins Sans Frontières By Dr. Raghu Venugopal

he devastating typhoon Haiyan in the Philippines. Decades-long war in the Congo. Southeast Asia’s disastrous Tsunami. Kenya’s vast refugee camps. Haiti’s cholera epidemic. HIV and TB devastating southern Africa. Such calamities are in the news. And they have perhaps been on your mind. What can you personally do to reduce such largescale human suffering? How can getting involved in humanitarian medical assistance change your career and life? Médecins Sans Frontières/Doctors Without Borders (MSF) deploys qualified Canadian health care professionals to provide medical assistance to victims of conflict, disaster, disease outbreak and health care exclusion around the world. As a Canadian emergency physician, MSF is the toughest job I have ever loved. I was inspired to join after learning of MSF’s efficient and effective action in the world’s most difficult places to live and work. These include eastern Chad where I worked in 2013 while taking leave from my usual job in Toronto. The 45-degree weather, distance from my fiancé and workload in Chad was difficult, but I loved my local colleagues and believed in our efforts to provide aid to the rural poor. I joined MSF be-



MSF team speaks with a victim of typhoon Haiyan in the Philippines. cause I was struck by the motivation of Canadians like Dr. James Orbinski (who accepted the 1999 Nobel Prize on behalf of MSF) to bear witness of the plight of our patients and advocate for human survival, one patient at a time. The dual role of providing bedside medical care and speaking out about what we encounter is central to MSF’s mission. For the past 43 years of MSF’s existence, nurses, surgeons, doctors, midwives, psychologists, pharmacists, laboratory technicians, anesthetists, and epidemiologists have given assistance to populations in danger regardless of race,

religion, gender or political affiliation. Crucial to our work are non-medical professionals such as team coordinators and logisticians. These experts allow MSF medical staff to focus on patient care. While many missions are planned weeks in advance, the call to action can occur quickly for large-scale emergencies such as the Philippines’ typhoon Haiyan. Canadian nurse Martine Bouchard was called by MSF on November 12th and left to the field the same night. In Martine’s blog ( she speaks about how much she has learned during her time in the field

about courage, resilience, and strengthby the Filipino population itself. While Canadian medical professionals give their passion, solidarity and skills in many of the more than 70 countries around the world MSF is working in, they receive much in return. We learn from our patients about hope in the face of great uncertainty, dignity in the midst of losing everything, and perseverance in the midst of seemingly insurmountable challenges. These experiences are lived in small villages, massive refugee camps and dilapidated hospitals which we refurbish. Our work often lies deep in the jungle, in urban war-zones and at isolated, insecure military front-lines. There is usually no running water and no modern conveniences where we work. Those aiming to work with MSF should have experience being outside their normal comfort-zone. As a professional and as a person, working with MSF will change your life. You will gain a deep appreciation of the reality faced by the world’s poor, forgotten and mired in crisis. Canadians choose to work for MSF because they realize they can make a difference in the lives of their fellow humans facing immeasurable suffering in places like war-torn Syria, malaria-ridden Central African Republic and Sub-Saharan Africa where malnutrition kills thousands of children each year. Continued on page 7




Saving lives Continued from page 6

Our more than 30,000 staff-the majority of who are locally hired-realize that the needs of their families are also the needs of all families. These include medicine when they are sick, security for their loved ones, clean water to drink, enough food to eat and a roof over their head. The beneficiaries MSF serves often do not have any of these basic necessities. To address this reality, last year we treated about 276,000 children for malnutrition, performed 8.3 million ambulatory consultations, performed 78,000 surgeries, treated 1.6 million persons for malaria, 284,000 patients for HIV with antiretrovirals, and assisted 185,000 births. MSF provides shelter, water, pots and pans, food, vaccinations and blankets when needed. Of central importance, MSF aid workers recognize the humanity in all persons. They believe that solidarity with those suffering is achieved by living and working side by side with beneficiaries in their affected community and not from a farflung metropolitan city. Our staff choose to work with MSF because our non-governmental organization is independentboth financially and politically. Of the 944 million Euros we spend annually to aid those in crisis, 90 per cent of our funds come from private individual donors and not from institutions or governments. Our neutrality is also our strength. Not choosing sides in a conflict and providing care based on need allows us to often work on both sides of an armed conflict. When I worked in the Central African Republic, I recall transferring by road a woman with a ruptured ectopic pregnancy through the night across government and rebel front lines. Our medical legitimacy and record of serving all those in need were our “helmets” and “bullet-proof vests.” Armed actors on both sides of the front-line let us pass unharmed. Canadian medical personnel working with MSF: This could be you! MSF is actively looking for: •OR and ER staff: Surgeons, anesthesiologists, OR nurses and ER doctors •Doctors & nurses with experience in maternity care and pediatrics •Knowledge of French or Arabic is an asset 253 Canadian aid workers worked for MSF in 2013. These include: •30 doctors •17 anesthesiologists + surgeons •55 nurses As a doctor, my career in Canada has been enriched during my MSF missions. I remember learning how to perform a lumbar puncture with a child sitting upright from a nurse in Burundi-a more successful method than the patient lying down as I had learned in Canada. I have also learned how to innovate based on the local resources available. Nurses in eastern Congo taught me how to keep insulin cool by creating a village-based “refrigerator” by placing one pot in another pot separated by moist sand and then buried in the ground. Working with MSF has exposed me to medical conditions I had only read about in textbooks. Sadly, I have seen many diseases in their advanced end-stage, owing to the lack of access to healthcare. Yet, as a doctor, there is no shortage of

Dr. Raghu Venugopal examines a baby while working with MSF in the Central African Republic. ful work and our patients are universally grateful. Utilizing accepted protocols and essential drugs, it is not difficult to save many lives and alleviate much suffering. As a doctor and as a person, this is deeply rewarding. Even when a patient is lost, our patient’s families are extremely grateful we tried. I remember the mother of a child who died under my care. She could not thank me enough for trying. She said no one else would even touch her child. My MSF experience has made me grateful for our life and resources in Canada. Working mostly in central Africa, my teams and I had curfews and many necessarily strict security rules. I have often longed for the freedom we as Canadians are accustomed to enjoying-such as taking a walk at night in the cool air. Although MSF has excellent medical and material resources needed in order to carry-out life-saving work, there are limitations to what we can do. Hemodialysis, intensive care, advanced surgical procedures and other resources are often impossible in the locations where MSF works. I remember seeing a man dying from renal failure in Congo with a physical finding called “uremic frost”-like a fine white dust-covering his entire body. These situations I have not seen in Canada, and make me grateful for what our Canadian health care system can provide our population. Canadians join MSF to save lives and alleviate suffering in acute and chronic crises. Some of these emergencies can languish for decades and be largely forgotten by the rest of the world. Some contexts where we work may also be risky for the field worker. My colleagues in Congo performing mobile clinics were sometimes stopped by armed rebels. In two instances, they suffered non-life-threatening injuries including a gunshot injury to the foot and being punched in the face and pulled out of a car window by the hair. These were isolated circumstances but highlight the security risks of working overseas and the need for careful security precautionswhich MSF takes seriously. Risks to fieldworkers also include illnesses brought

about by the basic living conditions in the field. We ensure all field workers are in good medical condition and are vaccinated, and we have robust plans in place to care for staff if they fall ill. Bearing in mind the risks of working overseas, MSF staff choose to go to the field because they realize the perils faced by the population living there-is far greater than the risks faced by the foreign aid worker. Working for MSF can be the right choice for qualified Canadian medical professionals looking to make a tangible difference to patients living in danger and crisis. We seek those who are outstanding team players, flexible and passionate about aiding those in need. We seek Canadians who can bear witness to the situation of

their patients and advocate for their needs when they return to their home society. “Bon courage” as we say in the field if you choose this challenging and rewarding endeavor. For more information about working for MSF and recruitment events around H Canada please visit: ■ Raghu Venugopal has worked with MSF in Burundi, Central African Republic, Democratic Republic of Congo and Chad. He is a former Board Director of MSF-Canada. He is an Assistant Professor of Medicine at the University of Toronto and an Attending Emergency Physician at the University Health Network in Toronto, Ontario

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Evidence Matters

Does anyone know why? By Sarah Berglas

ometimes it is a patient who asks the question. Other times it is a student or new members of staff. Or maybe, in a moment of reflection, you ask yourself, why do we do that? Questions like: Why are patients with a mental illnesswho are not confined to bed-required to wear pyjamas in hospital? Why must gloves be worn when administering immunizations to patients? Will they really offer protection in the event of a needle stick injury? Other times, it is the promise of a new device or procedure that excites some members of staff, but has others raising eyebrows. Are antimicrobial sutures necessary for every surgery? Should antiseptic solutions be used to clean all wounds, or does tap water, or saline, work just as well? In an age of evidence-informed medicine, there are many resources available to help you. Health technology assessment agencies, such as The Canadian Agency for Drugs and Technologies in Health (CADTH), exist to evaluate drugs, devices, diagnostics and procedures and provide advice. CADTH has a Rapid Response Service which allows participating hospitals, long-term care facilities or health authorities to request a rapid search for evidence, and a critical appraisal of that evidence, for use when making decisions. Importantly, the questions asked, and evi-


dence found, is published within a short report and is available to everyone, without charge. Currently CADTH has 2073 reports posted to with 20 or so new reports, added each month. Let’s return to the questions raised earlier.

The Canadian Agency for Drugs and Technologies in Health (CADTH), exists to evaluate drugs, devices, diagnostics and procedures and provide advice Why are patients with a mental illness required to wear pyjamas in hospital? This was a question inspired by a patient and families group, who felt that pyjamas added to the degradation of receiving help within an inpatient setting. As it turns out, CADTH found no clinical evidence to support the need for adult psychiatric patients to wear hospital pyjamas, instead of their own clothes. After a six month incident-free trial, the hospital reversed their long standing policy and allowed patients to wear their own clothes, if they so desired.

Should gloves be worn when administering immunizations to patients? No randomized controlled trials, nor trials of any other type, were found to evaluate the benefit of wearing gloves to reduce the likelihood of blood-borne pathogen transmission in the event of a needle stick, during routine immunizations. In other words, it is not known if wearing gloves will help prevent infection in this setting. Instead, those creating hospital policies can be guided by other factors, with the knowledge that they are not going against the evidence. Are antimicrobial sutures necessary for every surgery? Surgical site infections can also result from wound contamination, with the sutures used to close the wound being one potential source of contamination. Synthetic, absorbable sutures coated with triclosan, a broad spectrum antiseptic agent, are available for use in Canada. So, how well do they work in preventing surgical site infections? Using a predefined methodology, CADTH found and critically appraised one systematic review and two randomized controlled trials. As compared with uncoated sutures, benefit of using triclosan-coated sutures was seen in abdominal surgery, colorectal surgery, and in leg wound closure. However, no benefit was seen in cardiac surgery or breast surgery, as compared to uncoated sutures.

Should antiseptic solutions be used to clean wounds, or does tap water, or saline, work just as well? Wound cleansing with normal saline doesn’t damage tissue or cause sensitization. It doesn’t alter the normal bacterial flora of the skin or interfere with the normal healing process. Tap water is quickly, cheaply, and easily accessed. Multiple antiseptic solutions are also available. CADTH identified, and critically appraised, one systematic review and two evidence-based guidelines to answer this request. Based on a meta-analysis of three small trials, the risk of infection was 37 per cent lower with tap water compared to saline in adults with acute wounds. For children, a meta-analysis of two small trials showed no difference in infection rate between the use of tap water or saline. A similar result was found for adults with chronic non-sutured wounds, in another study. No evidence was found to compare the benefit of antiseptic solutions. In addition to CADTH, evidence is readily accessible from other health technology assessment agencies, such as INESS, HTAI and PATH in Canada, NICE in the UK and AHRQ in the US. Take advantage of these resources to help answer your questions using critically appraised H evidence. ■Sarah Berglas is a Knowledge Mobilization Officer at CADTH.




â&#x20AC;&#x153;Canadians deserve the best legal representation and highest standard of healthcare available to them. $W+LPHOIDUE3URV]DQVNL//3ZHĂ&#x20AC;JKWIRU\RXUULJKWV WRVHFXUHWKHSURIHVVLRQDOFDUHDQGIXOOFRPSHQVDWLRQ \RXGHVHUYHâ&#x20AC;? David Himelfarb

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Aging Tsunami Continued from Cover

For example, in examining hospitalization patterns among the elderly, a number of longitudinal studies have consistently demonstrated that only a small proportion of older adults are actually high users of hospital services. Currently, provincial governments are faced with managing resources in the face of an economic downturn. This puts pressures on health system administrators at the regional and provincial levels to consolidate services with the explicit agenda of reducing health care costs. In such an atmosphere, the opportunity for innovation in health service delivery becomes limited to simply ‘doing the same with less’. With annual per capita growth rates in acute care costs increasing the fastest for older adults and given that this growth rate is expected to continually increase, it is imperative that we increasingly focus our efforts around developing new costeffective models that are also able to meet the complex needs of older patients. Our main problem is that while the patients have changed, our systems have not. Our current hospital care model was developed decades ago when the average age of Canadians was 27 and most adults tended to not live past 65 or be living with chronic illnesses, and usually only had one active problem that brought them to hospital. While things still function well for younger patients like this, it is increasingly being recognized that our current model that focuses on treating one issue at a time often disadvantages older adults who often present with many active chronic health problems. As our current system’s greatest users, we are increasingly coming to understand how our traditional models of care also put many older patients particularly at risk for adverse complications such as falls, delirium, drug-interactions, functional decline, and death. What is most concerning is that few have come to appreciate that much of these adverse outcomes are preventable.

People aged 65 and older account for 14.4 per cent of the population they consume nearly half of our public spending on healthcare Studies have demonstrated how the implementation of focused models of care that consider the unique needs of older patients can improve overall care outcomes while at the same time reducing lengths of stay, admissions, readmissions, and inappropriate resource utilization-thereby improving the overall capacity and efficiency of the system. However, implementing innovative models of care that challenge deeply ingrained traditional ways of providing care has proved to be a significant challenge. Nevertheless, more than at any other point in the history of Canada has there ever been such an urgent imperative, with significant social and economic implications, that will require us to develop comprehensive evidence-based care strategies to improve the care of older adults in need of acute care.

Dr. Sinha visiting one of his house call patients, at her home in Toronto. Photo Credit: Dr. Mark Nowaczynski Acknowledging the need for reforms in community-based care, older adults will still require hospitalization even under the best of circumstances. In response to the challenge of addressing the complexities of caring for older adults in acute care settings and across the continuum of care, Mount Sinai Hospital in Toronto embarked on a different approach to develop an innovative and comprehensive Acute Care for Elders (ACE) Strategy that puts the needs of older patients and their families first. As the first major acute care academic health sciences centre in Canada to make geriatrics a core strategic priority, Mount Sinai, implemented a series of evidenceinformed but tailored interventions and linked them to create a more seamless, integrated delivery-model spanning the continuum of care. This strategy is further enabled by an interprofessional, team-based approach to care as well as technological innovations with a focus on maintaining the independence of older adults in our community for as long as possible. While this may sound logical and obvios, despite the fact that the 14.4 per cent of our population that is 65 years and older accounts for 58 per cent of inpatient bed days, few hospitals across the country have made their needs a core strategic priority. It’s a smart move given that 60 per cent of current hospital expenditures are directed to the older population, and that even small improvements in the way we care for them can have important health, social and economic benefits. Indeed, since launching our strategy three years ago, Mount Sinai has seen a 31 per cent increase in the number of admitted older adults it serves on an annual basis. In that time, our strategy has allowed us to reduce our average total

length of stay per patient by more than 28 per cent, our average ALC days by18 per cent, and our readmissions by 13 per cent which has allowed us to reduce our overall beds in operation by five per cent. Our patients are now more likely to go directly home, and are more satisfied with our care. Despite the increase in patient volumes, our approach which required minimal financial investments, but rather a different approach to the way we work, has also reduced our direct costs of care per patient by 31 per cent and our overall care costs by more than $6.26 million in 2012/13 alone. While these results are exemplary, and have positioned our hospital as a national leader in elder care, our ability to do it with minimal financial investments should give other hospitals across Canada that ability to deliver similar results too.

Could the elderly bankrupt Canada? Absolutely. However, by viewing our current challenges as opportunities to transform our dated models of caring for older adults, we can help ensure that the greater efficiency and capacity that will be needed can be sustained within the existing public system and financing structures to meet current and future demands for hospital care by all H Canadians.■ Dr. Samir K. Sinha is the Director of Geriatrics for Mount Sinai and the University Health Network Hospitals in Toronto, and is the Provincial Lead of Ontario’s Seniors Strategy.The content in this article was originally written for Health Care Papers Vol. 11 No. 1 and has been modified and updated for Hospital News.

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10 Nursing Pulse

Declining number of RNs means a weakened health care system By Marion Zych and Kim Jarvi ore than 1,500 registered nurses (RN) and nursing students have followed the lead of their professional association and emailed letters of concern to Premier Kathleen Wynne, the provinceâ&#x20AC;&#x2122;s minister of health, opposition leaders, and opposition health critics about Ontarioâ&#x20AC;&#x2122;s declining RN-to-population ratio, which has been falling steadily since 2009. There


are 6.99 RNs/1,000 people in Ontario, compared to the national average of 8.3 RNs/1,000 people. Given this troubling shortfall of almost 16 per cent, the Registered Nurses' Association of Ontario (RNAO) says the provincial government needs to hire more RNs if it is to live up to its promises of a transformed health care system that meets the diverse care needs of Ontarians.

Job openings have dried up as RN employment has stagnated, the association says, which may help to explain why almost 6,000 Ontario RNs are working in nursing outside of the province. More than 3,000 of them work south of the border. The health ministry's much vaunted action plan and its promise â&#x20AC;&#x2DC;to provide the right care, at the right time, in the right placeâ&#x20AC;&#x2122; simply canâ&#x20AC;&#x2122;t be realized if Ontario's

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

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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RN-to-population ratio continues to decline. "Too many RNs across this province are experiencing excessive workloads, and job openings for new grads have dried up," says Rhonda Seidman-Carlson, president of RNAO. According to the associationâ&#x20AC;&#x2122;s calculations, 12.9 per cent of newly registered RNs were unemployed in 2012. A further 4.1 per cent were working outside of nursing. Seidman-Carlson argues â&#x20AC;&#x153;this is alarming and wasteful.â&#x20AC;? In their November letter to Premier Wynne, Seidman-Carlson and RNAO CEO Doris Grinspun wrote â&#x20AC;&#x153;â&#x20AC;Śwe know from the 1990s that when new nursing graduates are unable to find work, they move away-especially to the U.S. Once they move away, it is very difficult to bring them back, even if there are jobs available. Most have put down roots in their new communities. Ontario invests substantially in educating its nurses, and other jurisdictions like the U.S. are only too glad to take them because of the quality of the education and close equivalence of Canadian credentials to American credentials.â&#x20AC;? The province took years to recover after the fiasco of the exodus in the 1990s, RNAOâ&#x20AC;&#x2122;s president adds, noting it is shameful â&#x20AC;&#x153;â&#x20AC;Śto educate RNs and then fail to create meaningful opportunities for them to work in their chosen profession. The evidence that links hours of RN care with better quality patient outcomes and system performance is conclusive.â&#x20AC;? Based on RN-to-population ratios from the Canadian Institute for Health Information (CIHI), Ontario needs to hire 17,600 nurses to catch up with the rest of the country. RNAO has called for 9,000 more RN positions by 2015 to start that process. â&#x20AC;&#x153;RNs play a pivotal role when it comes to delivering healthcare in this province. A system without enough RNs who have the knowledge and skills to deal with patients with complex care needs, and to help those requiring expert care in the community, is doomed to fail,â&#x20AC;? says Grinspun. â&#x20AC;&#x153;How can the province deliver on its promise to improve access to primary care and home care, and live up to its pledge to lower chronic disease rates such as childhood obesity and combat smoking without more RNs?â&#x20AC;? In its letter to Premier Wynne, RNAO requested an urgent meeting to discuss the magnitude of the gap that has opened up between Ontario and the rest of the country. â&#x20AC;&#x153;Not acting now will endanger the H public,â&#x20AC;? Grinspun says. â&#x2013; Marion Zych is director of communications for RNAO. Kim Jarvi is the associationâ&#x20AC;&#x2122;s senior economist. RNAO represents registered nurses wherever they practise in Ontario. Since 1925, it has advocated for healthy public policy, promoted excellence in nursing practice, increased nurses' contribution to shaping the health-care system, and influenced decisions that affect nurses and the public they serve. To find out more about the associationâ&#x20AC;&#x2122;s work, go to


Professional Development & Education




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designed for frontline staff By Tania Haas

first-of-its-kind, five-part multimedia book series created by two of Mount Sinaiâ&#x20AC;&#x2122;s own is helping clinicians bridge the gap for patients with mental health issues. Psychotherapy Essentials to Go (WW Norton, 2013) is a series of interactive educational tools for frontline health care workers treating patients with mental health conditions. The seriesâ&#x20AC;&#x2122; editors, Drs. Paula Ravitz, Director, Mount Sinai Hospital Psychotherapy Institute and Morgan Firestone Psychotherapy Chair at the University of Toronto, and Robert Maunder, Mount Sinai Psychiatrist and Head of Research in the Department of Psychiatry, wanted to create a resource that took established psychotherapy research off the shelves and into the front pockets of primary health care providers, community health workers and mental health specialists. â&#x20AC;&#x153;In this series, weâ&#x20AC;&#x2122;ve put complex ideas into plain language. It is an approach that resonates with learners who have lots of expertise along with those who are new to psychotherapy, regardless of their professional discipline,â&#x20AC;? says Dr. Ravitz. â&#x20AC;&#x153;The tools in the books are all supported by evidence. We are trying to help patients with common mental disorders to become more resilient, feel better, and


manage the stresses of life through psychotherapy.â&#x20AC;? Each title includes lesson plans, case studies, role play transcripts and a DVD with captioned demonstrations of therapeutic techniques to help integrate guidelines into patient care. Each case-based learning module enhances a clinicianâ&#x20AC;&#x2122;s ability to help treat anxiety, depression, emotion dysregulation and concurrent substance abuse disorders. â&#x20AC;&#x153;One of the biggest issues in mental health revolves around access to resources,â&#x20AC;? says Dr. Mark Fefergrad, Head, Cognitive Behavioural Therapy, Sunnybrook Health Sciences Centre and co-author of Psychotherapy Essentials to Go: Cognitive Behavioral Therapy for Depression. He says that while many evidence-based psychotherapeutic interventions have been incorporated into national treatment guidelines, not enough mental health professionals are trained in these modalities. As a result, there are substantial wait times in most centres across Canada. In fact, the series launched on the heels of a study that highlighted the growing need for mental health care in the country. In September 2013, Statistics Canada reported that 20 per cent of Canadians reported getting no help for mental health

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Professional Development and Education


care in the past year, while 16 per cent said their needs were only partly met. Overall, one in six Canadians believed they needed mental healthcare in the past year. Furthermore, counselling was mentioned as the highest unmet mental health need. â&#x20AC;&#x153;These books are intended to help ameliorate this problem,â&#x20AC;? says Dr. Fefergrad, who is also Director of Postgraduate Medical Education, Assistant Professor, Department of Psychiatry, University of Toronto. â&#x20AC;&#x153;The book series represents a wonderful example of using an evidence-based teaching tool to disseminate evidence-based treatments. The users of the books can then provide effective treatments to people suffering from mental illness across the country.â&#x20AC;?

A first-of-its-kind, five-part multimedia book series created by two of Mount Sinaiâ&#x20AC;&#x2122;s own is helping clinicians bridge the gap for patients with mental health issues. Drs. Maunder and Ravitz agree that the books are another way to support health care training and continuing education so the best care is provided to patients in both urban and under-serviced rural areas. Some of the materials have already been used by health care workers in community mental health clinics in Northern Ontario (funded by the Ontario Ministry of Health), where the books helped improve access to professional development for mental health providers. They also helped foster collaboration between mental health

Psychotherapy Essentials to Go contributors, (front row, L to R) Wayne Skinner, Dr. Mark Fefergrad, Carolynne Cooper (back row, L to R) Shelley McMain, Drs. Priya Watson, Paula Ravitz and Bob Maunder. experts and front-line community mental health services through an interprofessional knowledge exchange program. Feedback from the Northern Ontario focus groups has been overwhelmingly positive. Participants reported an improved sense of self-efficacy in their professional roles and the confidence in acquiring new skills to expand their therapeutic repertoire.

New Opportunities Knock

Other participants said the work-based small-group learning format fostered cohesion and collegiality with their colleagues. The books are also being adapted and used in Ethiopia as part of a global mental health project for improving patient outcomes in low- and middle-income countries. The Psychotherapy Essentials To-Go series is available online or at bookstores

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Professional Development and Education


The role of the Nurse Practitioner By Claudia Mariano hile many people believe Nurse Practitioners (NPs) are relatively new to the Ontario health care scene, they have been providing exemplary care to patients for over 40 years. As this year marks the fortieth anniversary of the Nurse Practitioners’ Association of Ontario (NPAO), it’s fitting to look back and remember where we came from and where we are now. The seventies were a time of great need in Ontario in terms of access to healthcare. Many northern and remote areas struggled to find physicians. NPs were already integrated in the American health care system at that time, and were known to be highly effective at improving access for vulnerable patients and improving health outcomes. Using the model of the NP as a physician replacement, the role of the NP in Ontario was enabled to expand the scope of practice of Registered Nurses to provide care in these remote and under-serviced communities, as well as in pediatric intensive care units. The first educational program for NPs was established in Ontario soon after and continued until 1983, with approximately 250 NPs graduating from the program. As a result of the increased number of seats made available in medical schools in the seventies, the physician shortage which


initially spawned the NP role was no longer relevant, and the NP program was closed in 1983. However, those NP graduates continued to work in the role, quietly providing the advanced nursing care patients needed.

The NP role represents a return to the roots of nursing care, and while not a replacement for the medical model, is ideally suited to break down the barrier of access to healthcare across all sectors. In 1993, then Minister of Health Ruth Grier announced a significant strategy for primary health care reform. She herself received primary healthcare from one of the initial group of 250 Nurse Practitioners at a local community health centre, and was aware of the impact NPs could have. In 1995, the NP university program was re-established, followed in 1998 by the Expanded Nursing Service for Patients Act , which gave NPs access to three additional controlled acts – communicating a diagnosis, ordering from a list of drugs, and ordering certain lab-

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placement for the medical model, is ideally suited to break down the barrier of access to healthcare across all sectors. As organized healthcare became more dominated by a model which did not fully support the nursing role, patients lost the benefit of the evolution of nursing knowledge and research. Fortunately, we are coming full circle with the NP role, by enabling Nurse Practitioners to practice to the full extent of their nursing knowledge, skill, and judgement and supporting professional development with a variety of educational opportunities. As a result, patients in all practice settings are working with NPs to maintain their health, and manage and treat their health conditions. Patients are not only receiving information on medications and diagnostics testing, but are also benefitting from advanced nursing knowledge regarding behavioural and emotional responses to health and illness and ongoing, individualized support in the context of their lives. For more information on the evolution of the Nurse Practitioner role and education program in Ontario, you can view NPAO’s 40th anniversary video on You H Tube. ■ Claudia Mariano NP-PHC, MSc, CDE is a previous NPAO Board member and Past President. She currently works at the West Durham Family Health Team in Pickering.

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oratory tests, xrays, and ultrasounds. As more NPs entered the workforce, they were able to act as preceptors for NP students, thereby enabling socialization into this advanced nursing role. As the impact of NP practice began to spread across the province, changes to legislation and regulation continued to facilitate the full scope of practice. Most recently, legislative changes have enabled NPs to admit, treat, and discharge patients from hospital. Patients have also benefitted from the removal of a list-based approach to the ordering of laboratory tests, and are awaiting final proclamation of the legislation which removes the barrier of ordering diagnostic tests from a specified list. From that initial group of 250 NPs, Ontario now boasts over 2300 NPs, representing two thirds of all NPs in Canada. In order to prepare experienced Registered Nurses for the NP role, the NP education programs focus on those aspects of advanced NP practice which are in addition to those gained in the baccalaureate nursing programs. Following successful completion of a Primary Health Care, Adult, or Pediatric NP program RNs are required by the College of Nurses of Ontario (CNO) to pass the provincial NP registration exam. The NP role represents a return to the roots of nursing care, and while not a re-

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

Professional Development and Education




Professional Development and Education

Why eLearning?

Exploring training options for health care organizations By Mathew Kennedy or health care organizations, training staff is a routine procedure. It’s necessary to remain up to date with current processes, procedures or technology in order to ensure the best possible care for clients and patients. Many hospitals and health care organizations employ a large number of staff, and while community and home care organizations may employ fewer professionals, they are often dispersed across a large geographic area. How do you go about ensuring they are adequately trained, without spending a fortune? Over the past several years, more and more health care organizations have been turning to eLearning for their training needs. As the benefits become more and more apparent, even the most traditional educators are now identifying eLearning as a viable training option. If you’re still unsure about the validity of eLearning in today’s training environment, it’s time to see what you’ve been missing.


Learn at your own pace

We’ve all been in classrooms with a facilitator who runs through content extremely fast or excruciatingly slow. Unfortunately,

there’s not much we can do about it except hold on tight or down that extra cup of coffee. With the understanding that everyone learns at different speeds and in different ways, eLearning offers the freedom to learn at your own pace. Users are able to pause modules or revisit previously viewed pages to let teaching points sink in. Even more, most eLearning courses are now built with a function known as ‘bookmarking’, which affords learners the luxury of exiting a course and returning right to the point they left off on their next visit. This is especially convenient for health care professionals with long hours and large workloads.

Learn when you want

eLearning is available 24 hours a day, 7 days a week from any computer with an Internet connection. Just-in-time learning is the delivery of learning when it is needed, and can come in very handy in a health care setting. No one retains 100 per cent of the knowledge they gain from an educational session, and that retention level only decreases with time. When an offering is online a learner can theoretically access course content at 2 a.m. should he or she feel the need. Calling up a facilitator for a refresher on their class material however, may not go over so well.

Learn where you want

Many health care facilities have more than one location, and it is becoming increasingly difficult to send staff offsite to training sessions. On one hand, the time that it takes to travel from one facility to another is time that could be better spent. On the other, the travel itself usually has a cost associated with it. eLearning however, is not location dependent which makes it extremely accessible and convenient. Organizations can train a much larger population with no extra effort or cost.

Learn consistently

Whether viewed from an emergency room in Victoria or a retirement community in Halifax, eLearning course content will always be consistent. Curriculum developers can finally rest easy knowing their message will remain intact as it is distributed to the masses. eLearning courses are also extremely easy to maintain. If a course is housed online in one central location, then one update is all it takes for every learner to get the most up to date material.

Improve ROI

Though an eLearning module takes longer to develop than a traditional classroom equivalent, it is in the recurring costs

that return on investment can be realized. Design, development and implementation costs are common to both eLearning and classroom training. Where costing diverges between the two is after the course has been launched. An eLearning course has minimal costs associated to it after a launch. Classroom courses however must take in to account venue rental, facilitator costs and facilitator time. These are costs that recur for the duration that the course is offered. Depending on how long a course is run, an eLearning offering may be the more cost effective solution. These are just a few of the many benefits that eLearning brings to the educational landscape. It allows participants to learn at their own pace, provides access to valuable learning experiences where and when they need it, and makes a positive impact on the bottom line. So, when it comes to selecting a method of training for your health care organization, make sure you explore all your options. Ask yourself what’s important to you, and make a decision based on the option which best aligns H with these values. ■ Mathew Kennedy is the Manager, Learning Design and Development at The Public Services Health & Safety Association.

Online learning that’s bottom line friendly. Train your staff with ease – and within budget – by taking advantage of the wide variety of health-based online learning options offered by the Ontario Hospital Association. Training Modules.

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Professional Development and Education


• • • • • • •



Professional Development and Education


Cost effective training for geographically diverse staff By Tracy Scott


raining thousands of health professionals across a diverse geography like Newfoundland and Labrador is no small challenge. Health care providers such as nursing and allied health staff, and personal care attendants require ongoing education and training to ensure they are providing care based on the latest best practices. The complexities of providing affordable and accessible education and training are increased as health care providers work in many different environments, including hospitals, long term care, and home and community settings. Eastern Health, the largest integrated health authority in the province, has had to address these issues on a regular basis. Saint Elizabeth and Eastern Health partnered to assess the value of eLearning to support the education and training needs of the Eastern Health staff. Founded in 1908, Saint Elizabeth is a leader in responding to client, family and system needs. As an award-winning not-for-profit and charitable organization, Saint Elizabeth is known for its track record of social innovation, applied research and breakthrough clinical practices in home and community care. With a team of 7,000 nurses, rehab therapists and personal sup-

port workers, Saint Elizabeth delivers more than six million health care visits annually across Canada. Since 1999, Saint Elizabeth has adopted eLearning as a primary method to educate and motivate staff and health care providers across the country. Saint Elizabethâ&#x20AC;&#x2122;s web-based eLearning solution, @YourSide ColleagueŠ, includes competency-based programs and courses to support ongoing professional development, all of which can be completed at the learnerâ&#x20AC;&#x2122;s own pace and convenience. â&#x20AC;&#x153;Fifteen years ago, we needed a flexible, virtual learning strategy to reach our staff in the far corners of Ontarioâ&#x20AC;?, says Nancy Lefebre, Senior Vice President, Knowledge and Practice at Saint Elizabeth. â&#x20AC;&#x153;We were the first home care provider in Canada to develop our own eLearning products and have since perfected our delivery process,â&#x20AC;? she adds. Eastern Health selected diabetes for its chronic disease management focus, as Newfoundland and Labrador has the highest prevalence of diabetes in Canada and future projections for the province are concerning. Michael Cloutier, President and CEO of the Canadian Diabetes Association, says â&#x20AC;&#x153;By 2020, 32 per cent of Newfoundlanders and Labradorians will be living either with diabetes or pre-diabetes.â&#x20AC;?

The Saint Elizabeth web-based diabetes education program provides interactive learning and all content is based on current Clinical Practice Guidelines from the Canadian Diabetes Association. Eastern Health is demonstrating proactive leadership by taking action now to provide staff with a resource that can assist them in the care and support they provide to clients and families who are living with diabetes. The Saint Elizabeth web-based diabetes education program provides interactive learning about pathophysiology, prevention, nutrition, exercise, medication management, monitoring and long term complications. All content is based on current Clinical Practice Guidelines from the Canadian Diabetes Association. The education is designed to increase knowledge, skill and confidence for the provision of holistic, evidence-informed and quality care. The virtual delivery method provides an enhanced interactive

learning experience while also reducing costs to the health care system by cutting down on travel and in-class time. Saint Elizabeth has been providing education and training to their own staff and to thousands of others including health care professionals in First Nations, Inuit and Metis communities, correctional facilities, long term care homes, hospitals and other health care institutions â&#x20AC;&#x201C; always with a dedication to increase the quality of care provided to the client. For more information about education and training solutions, please contact Kim Miller at Saint Elizabeth Education Services at or by calling H 1-855-400-7337. â&#x2013; Tracy Scott is Program Lead, Education Services at Saint Elizabeth.

Making Time for Professional Development We all know that professional development (PD) is important and necessary. For most, it is either required by employers or to maintain DOLFHQVH/LIHJHWVEXV\WKRXJKDQGĂ&#x20AC;QGLQJWLPHIRU3'FDQEHFRPH challenging. With this in mind, CSMLS is pleased to offer various types RISURIHVVLRQDOGHYHORSPHQWWKDWDUHVSHFLĂ&#x20AC;FDOO\GHVLJQHGIRU\RXU convenience and learning needs.

Decrease Cost. Increase Efficiency. The Ontario Hospital Association in partnership with the Leading Edge Group now offer a suite of online and in-class lean education and training programs to help you and your organization decrease cost while increasing efficiency, quality and safety. Programs include: Lean Yellow, Green and Black Belt, Six Sigma, Value Stream Mapping and 5S for Health Care Get started today at

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Express courses are a concise way to maintain competence in a VSHFLĂ&#x20AC;FVXEMHFWDUHDDQGFDQEHFRPSOHWHGLQDVOLWWOHDVDZHHNHQG

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Traditional courses not for you?

Professional development opportunities exist outside of structured courses. Take LABCON for example, this annual national conference hosted by CSMLS attracts medical laboratory professionals from across Canada for three days of learning, collaborating and networking. There is also Communities, an online forum to help CSMLS members connect and tap into the collective wisdom of the laboratory community. At CSMLS, we are proud to offer medical laboratory professionals FRQWLQXLQJHGXFDWLRQGHVLJQHGVSHFLĂ&#x20AC;FDOO\WRĂ&#x20AC;WWKHLUOHDUQLQJQHHGV

Visit for more information HOSPITAL NEWS JANUARY 2014

Professional Development and Education


Advance Your Health Career Health Informatics is an umbrella term for an area of expertise that spans information technology, health care, and management to deliver less expensive and higher quality health care systems. Located in downtown Toronto, close to several major hospitals and health care facilities, Ryerson University is in a unique position to offer a current and relevant Health Informatics program. Ryerson University’s G. Raymond Chang School of Continuing Education offers a Certificate in Health Informatics that is designed to give students the skills required to move into the profession, as well as information about the ethical, legal, privacy, and social issues that shape the field. The program closely reflects the recommendations of COACH: Canada’s Health Informatics Association.

Ryerson University’s G. Raymond Chang School of Continuing Education offers several health-related courses and programs for professionals seeking to advance their health careers. These dynamic and innovative learning opportunities can help you launch your career in some of Canada’s most in-demand health care jobs. Courses are offered in formats that meet the needs of your busy lifestyle.

Health Informatics

Health Studies

Health Services Management

We serve adult learners who are often adding education to many other life commitments. Courses are offered part-time and in convenient online formats. Ryerson remains committed to providing and applying theoretical knowledge, and our courses are taught by professionals who have both theoretical and applied expertise. Visit to learn more about this dynamic program.

Daniel Smith Learner, Health Informatics Data and Utilization Specialist, The Scarborough Hospital

“I work in the technical side of health care, and I registered in The Chang School’s Health Informatics program to help keep my skills relevant and open doors for future opportunities. I am just completing my first course and to my surprise, I still have great work-life balance and actually enjoy my weekly assignments. I had some fears about the differences between online courses and the traditional in-class model, but the instructors have been superb and very supportive. I also enjoy collaborating and interacting with fellow health care professionals. It provides opportunities to see what others in the field are doing, and has even given me ideas on how I can effect change in my own workplace.”

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Free online learning course nfection prevention and control (IPAC) core competencies are basic knowledge and skills all health care workers in Ontario need to possess about infection prevention and control, regardless of their role or position, education or experience. Public Health Ontario has released a free IPAC Core Competencies Online Learning Course based on the Provincial Infectious Diseases Advisory Committees (PIDAC) best practices. This innovative, interactive program provides health care providers with essential information on Routine Practices to protect themselves, their patients, and co-workers from infections. The program can be accessed by individual health care workers via the Public Health Ontario website or it can be downloaded to an organization’s Learning Management System. All health care providers in Ontario, regardless of their role or the health care setting in which they work, are expected to understand and follow Routine Prac-


tices. This includes and is not limited to physicians, nurses, personal support workers, dentists, pharmacists, emergency service workers, rehabilitation therapists, respiratory therapists, laboratory staff, administrators and other allied health professionals, housekeepers, maintenance staff, students, volunteers and anyone conducting activities where health care is provided. Three Routine Practices components are currently available: • Occupational Health and Safety • Chain of Transmission and Risk Assessment • Health Care Provider Controls Each component takes approximately 30-45 minutes to complete and can be stopped and then resumed at the same spot. Tests are included at the end of each component to reinforce learning, and a certificate is generated upon successful completion. To find out more visit or email ipac@ H ■

Get back in the game

and refresh your nursing skills at Durham College According to a study conducted by Adzuna in 2013, nursing is one of the top 10 most stressful jobs in Canada. It’s understandable that you may need to take a break and step away for a period of time. When you’re ready to return, it’s important you’re fully prepared for the responsibilities required of you. In order for you to get back on track before returning to your workplace, Durham College’s School of Continuing Education is now providing a comprehensive Returning to Practice program.

KHDOWKVFDSHȂb$%HWWHU9LHZ Check out, the Ontario Hospital Association’s exciting new website offering a broad range of health care news and information, helping you navigate the fascinating and complex ODQGVFDSHRI2QWDULRèVHYHUFKDQJLQJKHDOWKFDUHV\VWHPb Sign up today at to receive the healthscape email update.

Consisting of four modules, the program is designed for registered nurses (RNs) who have successfully completed the Canadian Registered Nurse Examination (CRNE) but have been out of practice for more than three years or for those who are internationally educated. Through the Returning to Practice program, the College of Nurses of Ontario (CNO) will review each RNs learning needs individually and assist by enhancing your previously learned skills while allowing you to obtain current information through practical experiences in a community- or hospital-based setting. With monthly intakes beginning in January 2014, each 12-week course will provide you with the opportunity to refresh your clinical skills for clients in a variety of health sectors including pharmacology, informatics, cultural concepts, health assessment, leadership, documentation, community and mental health. If you’re interested in getting back into the nursing profession and restoring your skills, then check out the Returning to Practice program at Durham College. FOR ADMISSION REQUIREMENTS AND MORE INFORMATION, CALL 905.721.2000 ext. 2667 OR VISIT


Professional Development and Education P11








P12 Professional Development and Education

Do you know how to call a Code Blue? By Geoff Koehler

veryone across St. Michaelâ&#x20AC;&#x2122;s Hospital â&#x20AC;&#x201C; from emergency room nurses to finance staff â&#x20AC;&#x201C; has access to some of Canadaâ&#x20AC;&#x2122;s most innovative CPR training. Unlike other CPR courses, St. Michaelâ&#x20AC;&#x2122;s Basic Life Support program teaches CPR that is specific to the hospital, training staff to deal with cardiac arrests in their realworld environment. â&#x20AC;&#x153;Working in a hospital, we have a high chance of being involved in a Code Blue,â&#x20AC;? says Dr. Natalie Wong, the programâ&#x20AC;&#x2122;s medical director. â&#x20AC;&#x153;A cardiac arrest is the wrong time to ask, â&#x20AC;&#x2DC;What should I do?â&#x20AC;&#x2122;â&#x20AC;? The program tailors lessons to each area or group. The MRI department requested specific practice scenarios because its emergency situations often differ from the rest of the hospital. The St. Michaelâ&#x20AC;&#x2122;s CPR course is two hours shorter than that offered by the Heart and Stroke Foundation. Dr. Wong said she hopes to further cut down on in-class time by creating an e-learning module that will roll out soon. Developed by the same group that produced Dr. Mike Evansâ&#x20AC;&#x2122; â&#x20AC;&#x153;23½ hoursâ&#x20AC;? video, the module will provide necessary background information for the course. â&#x20AC;&#x153;Students can do the module at their leisure before the course,â&#x20AC;? says Dr. Wong. â&#x20AC;&#x153;This means they come with a wealth of


knowledge and we can get right to handson practice.â&#x20AC;? Research recently published in Resuscitation showed that the St. Michaelâ&#x20AC;&#x2122;s course ensures CPR quality and skill retention because it uses audiovisual feedback defibrillators and performance reviews. In class is only the first chance to assess studentsâ&#x20AC;&#x2122; CPR skills. The Basic Life Support program is establishing mock Code Blues for care areas across St. Michaelâ&#x20AC;&#x2122;s. â&#x20AC;&#x153;Mock codes are a better, safer way to practice and assess how staff perform CPR in real-time,â&#x20AC;? explains Dr. Wong. â&#x20AC;&#x153;Weâ&#x20AC;&#x2122;re replicating the stress of the moment in the same environment that they provide care.â&#x20AC;? â&#x20AC;&#x153;Our programâ&#x20AC;&#x2122;s focus on research and

quality means that results feed back directly into the program,â&#x20AC;? says Dr. Wong. â&#x20AC;&#x153;Other hospitals have come to us to model their teaching program after St. Michaelâ&#x20AC;&#x2122;s.â&#x20AC;?

Photo: Katie Cooper, Medical Media

For more information on the program, H please contact â&#x2013; Geoff Koehler is a media relations advisor at St. Michaelâ&#x20AC;&#x2122;s Hospital.

Free webinars provided by Canadian Institute for the Relief of Pain Disability

ara Himelstein is a hospital social worker, and a participant in the regular online education webinars presented for free by the Canadian Institute for the Relief of Pain and Disability. As with many other health providers who participate in these online events, she finds the webinars have dual value in her job. â&#x20AC;&#x153;I have found the webinars on pain helpful in discussing and understanding the concerns of patients about their pain,â&#x20AC;? Himelstein says. â&#x20AC;&#x153;I have


Partner with PSHSA for Mandatory Supervisor Awareness Training


s of July 1, 2014, all supervisors in Ontario must complete occupational health and VDIHW\DZDUHQHVVWUDLQLQJ5HJXODWLRQLVWKHĂ&#x20AC;UVWRILWVNLQGLQ&DQDGDDQG UHSUHVHQWVDPDMRUVXFFHVVLQWKHDGYDQFHPHQWRIZRUNSODFHKHDOWKDQGVDIHW\LQ our province. However, since the Ministry of Labourâ&#x20AC;&#x2122;s announcement of the new regulation, we have VHHQDQXPEHURIRUJDQL]DWLRQVWDNLQJDGYDQWDJHRI2QWDULREXVLQHVVHVE\FRQIXVLQJWKH requirements and providing misleading information. If youâ&#x20AC;&#x2122;re unsure about the role of mandatory training in your organization, please contact the Ministry of Labour or your Safe :RUN$VVRFLDWLRQGLUHFWO\ In preparation for July, Public Services Health & Safety Association encourages Ontarioâ&#x20AC;&#x2122;s healthcare organizations to complete the mandatory health and safety awareness courses before the compliance date.

The Ministry of Labour has developed an excellent occupational health and safety awareness program which provides fundamental information on rights and duties under the Occupational Health and Safety Act (OHSA), roles of health and safety representatives and Joint +HDOWKDQG6DIHW\&RPPLWWHHPHPEHUVDQGFRPPRQZRUNSODFHKD]DUGV+RZHYHUZKHQ it comes to supervisors, itâ&#x20AC;&#x2122;s important to understand the difference between compliance and competence.

When describing the role of the supervisor in the OHSA, the word competent is used many WLPHV$FRPSHWHQWVXSHUYLVRULVVRPHRQHZKRLVTXDOLĂ&#x20AC;HGGXHWRNQRZOHGJHWUDLQLQJDQG experience. They are familiar with the OHSA as well as the regulations which apply to their ZRUN7KH\DOVRKDYHNQRZOHGJHRIDQ\SRWHQWLDORUDFWXDOKHDOWKDQGVDIHW\KD]DUGVLQWKH ZRUNSODFH 1RRQHLVPRUHLQĂ XHQWLDOLQWKHZRUNSODFHWKDQWKHVXSHUYLVRUDQGLWLVLPSRUWDQWWKDW WKRVHZLWKDXWKRULW\RYHUZRUNHUVKDYHDJUHDWHUXQGHUVWDQGLQJRIWKHLUOHJDOUHVSRQVLELOities and obligations when it comes to protecting the health and safety of everyone in the ZRUNSODFH7KH0LQLVWU\RI/DERXU¡VWUDLQLQJSURJUDPLVDJUHDWSODFHWRVWDUWDQGWKLV guarantees compliance. However, in order to be a competent supervisor, it is also important WROHDUQKRZWRQDYLJDWHOHJLVODWLRQDQGH[SODLQZRUNVLWHSURFHGXUHV 36+6$ KDV GHYHORSHG D VHOHFWLRQ RI RIIHULQJV WR DVVLVW 2QWDULR ZRUNSODFHV DQG VXSHUvisors meet both compliance and competence. PSHSAâ&#x20AC;&#x2122;s Mandatory Supervisor Awareness Training course will be available both online and in the classroom late January 2014. For more information about this training, please visit


Basic Life Support director, Dr. Natalie Wong, instructs M.Sc student, Matthew Common, in CPR. )

also referred patients to the webinars.â&#x20AC;? The Canadian Institute for the Relief of Pain and Disability (CIRPD) has been running a free webinar series since 2011, thanks to funding support by the Government of BCâ&#x20AC;&#x2122;s community grant program. CIRPD offers bi-weekly education sessions on chronic pain-related issues as well as workplace health, disability prevention and return-to-work/stay-at-work issues. The popularity of the public webinar series has been growing, with as many as 600 registrants signing up for a live event. These sessions are recorded and available for download. To-date the webinars have been downloaded or viewed by over 30,000 people. The live, interactive events provide a unique opportunity for health professionals and the public to interact with health researchers and clinicians with the goal of reducing the gap between what is known from high quality research and what is

The live, interactive events provide a unique opportunity for health professionals and the public to interact with health researchers and clinicians done in public education, policy, training and practice. Why webinars? In the past, CIRPD delivered most of its educational programs via conferences and workshops. Conferences and workshops are costly to run and difficult for many health providers to take time off work and attend. â&#x20AC;&#x153;The transition to internet-based educational programming has led to the ability to reach out to over 91 BC communities,â&#x20AC;? says Marc White Ph.D., CIRPDâ&#x20AC;&#x2122;s executive director. It also provides an opportunity for health professionals and the public to view the webinars at a time that fits their schedule. The 38 webinars available on the website are created by health researchers, health and medical experts throughout North America and beyond. They represent different perspectives on chronic pain and return-to-work research from psy-

chologists, physiotherapists, occupational therapists, nurses, physicians, pharmacists, and researchers. A sampling of the topics available include: opioids for chronic pain, the current state of the science of pain, neck pain, back pain, CBT approaches for managing pain, the biopsychosocial model and pain, mindfulness for chronic pain, and chronic pain and sleep. Neil Pearson is a physiotherapist who has both participated in and presented CIRPD webinars, including a 5-part series on yoga for chronic pain. â&#x20AC;&#x153;Many times clinicians struggle with how to educate their patients, and with the CIRPD sessions, we are offered a chance to learn from how the experts talk about pain and recovery,â&#x20AC;? says, Pearson. Brenda Bouttell (RN, BScN)- is Chronic Pain Clinical Lead- at Comox Valley Nursing Center in Courtenay BC. She describes the series as â&#x20AC;&#x153;an excellent platform for professional and client education,â&#x20AC;? adding that she frequently uses the webinars in her appointments and encourages clients to review them at home. â&#x20AC;&#x153;The quality and credibility â&#x20AC;&#x201C; evidenced based information â&#x20AC;&#x201C; is valued. The format allows for people to participate in their own homes or in a group situation.â&#x20AC;? Dr. Andrea Furlan is a staff physician and scientist at the Toronto Rehabilitation Institute, an Assistant Professor in the Department of Medicine at the University of Toronto, and Associate Scientist at the Institute for Work & Health. As well as being a past presenter, she is a vocal supporter of the chronic pain webinars because of how they enhance the patient experience: â&#x20AC;&#x153;I print the page showing all the webinars, and my clinic nurse gives that page to my patients with chronic pain,â&#x20AC;? Furlan says. â&#x20AC;&#x153;We tell the patients there is lots of information on the web, but that the CIRPD webinars are trustful and not conflicted by industry.â&#x20AC;? All webinars are free, and they are available live (with Q&A interaction with presenters), or for viewing online later. Webinars remain on the CIRPD website and are updated as new research knowledge is available. Past presenters include some of the leading researchers in the chronic pain field and beyond. To view online pre-recorded events or to register for free upcoming webinars, go H to â&#x2013;

Professional Development and Education P13


P14 Professional Development and Education

Join us for the York University

Certificate in Clinical Leadership! This program centers on leadership that improves clinical outcomes with a focus on patient centered care, and leading successful interdisciplinary teams. Our program features a world-class team of inter-prrofessional instructors. This 4-day certificate develops your skill-set in over 10 primary competency areas needed to succeed in Clinical Leadership. Let the Certificate in Clinical Leadership help you take the next step in your career plan. A highly collaborative evidence-based program • Broaden and accelerate multidisciplinary management skills • Achieve your strategic goals • Address and capitalize on the behavioural underpinnings of management that can ensure a successful team • Enhance communication with your team, and with patients and families • Sharpen and practice your critical and complexity based thinking, decision making, dealing with conflict and change, and teamwork skills What our program participants are saying: “My last five days have been a transformational learning experience. The course met my needs as a busy, frontline clinical manager. I needed this information to be effective and successful in my career.” Uchenwa Genus, Manager, Pharmacy Services, York Central Hospital, June 2012 session Contact us for more information: Tania Xerri or Deborah Tregunno, Program Director – 416 736-2100 ext 22170;;

define your course W W W. M I C H E N E R . C A / C E

Continue to grow with our evolving health care system. Whether you want to enhance your skills or build new ones, The Michener Institute has hundreds of continuing education opportunities to choose from. Achieve your professional development goals Gain skills that are in high demand and maintain the competencies and credentials essential to your field. Through graduate certificate programs, simulation-enhanced workshops and online learning, The Michener Institute offers course options in specialties such as: t Health Care Leadership tDiabetes Education tClinical Research tQuality Management

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Flexible learning options In class or online, The Michener Institute brings you a variety of learning options to suit your needs and your schedule. Enroll in any of our refresher courses at any time of the year. Most of our courses are available online or through the new hybrid option, combining online learning with on-site, simulation-enhanced workshops. Better yet, many of our Primary and Critical Care courses can even be delivered through your workplace. Visit for more information about our graduate certificate and specialty programs and customizable and flexible learning options.

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Improve clinical outcomes and patient centred care with two outstanding professional executive education programs.

Emergency Management for Health Care Certificate

Certificate in Clinical Leadership – NEW Format and NEW Pricing! Next Session March 24 – 27, 2014 For more information please visit: The Project Management Course for Health & Social Services Next session April 7 – 9, 2014 For more information please visit: This course is offered in partnership with Schulich Executive Education Centre, Schulich School of Business, York University Contact Us: Phone: 416-736-2100 ext: 22170 | Email:

Focused specifically on emergency planning and preparedness for hospitals and health care institutions, the Ontario Hospital Association’s new Emergency Management for Health Care Certificate is an emergency management credential recognized in health care settings in both Ontario and beyond.

Presented in partnership with:


Professional Development and Education P15


















deďŹ ne your course W W W. M I C H E N E R . C A / C E

Continue to grow with our evolving health care system. Located in the heart of Torontoâ&#x20AC;&#x2122;s hospital district. DF!NJDIFOFSDB


222 St. Patrick Street|5PSPOUP 0OUBSJP|.57


P16 Professional Development and Education

Legal Risk Management in

Documentation and Charting for Nurses Monday, March 3, 2014 Osgoode Professional Development Downtown Toronto Conference Centre

Get practical advice on managing the key legal risks and dilemmas facing nurses around documentation and charting in 2014, including: v v v v v v v


Plus! Reinforce your learning in the intensive workshop included in the course: Exploring Strengths and Weaknesses in Documentation and the Legal Implications


CFHI recognizes Margot Wilson and Sandra Barr, 2010 EXTRA Fellows, of Providence Health Care in Vancouver, who introduced a comprehensive telephone advice line to facilitate family doctorsâ&#x20AC;&#x2122; access to a variety ŽĨĆ?Ć&#x2030;Ä&#x17E;Ä?Ĺ?Ä&#x201A;ĹŻĹ?Ć?Ć&#x161;Ć?Í&#x2DC;KĆ&#x2030;Ä&#x17E;Ć&#x152;Ä&#x201A;Ć&#x;ĹśĹ?Ä&#x161;ĆľĆ&#x152;Ĺ?ĹśĹ?Ć&#x152;Ä&#x17E;Ĺ?ƾůÄ&#x201A;Ć&#x152;Žĸ Ä?Ä&#x17E; hours, the advice line known as RACE (Rapid Ä?Ä?Ä&#x17E;Ć?Ć? Ć&#x161;Ĺ˝ ŽŜĆ?ƾůĆ&#x161;Ä&#x201A;Ć&#x;Ç&#x20AC;Ä&#x17E; Ç&#x2020;Ć&#x2030;Ä&#x17E;Ć&#x152;Ć&#x;Ć?Ä&#x17E;Íż ĹľÄ&#x201A;ĹŹÄ&#x17E;Ć? Ĺ?Ć&#x161; possible for family doctors to call one number, Ä?Ĺ&#x161;ŽŽĆ?Ä&#x17E;ĨĆ&#x152;ŽžÄ&#x201A;Ć?Ä&#x17E;ĹŻÄ&#x17E;Ä?Ć&#x;ŽŜŽĨĎ­ĎŹĆ?Ć&#x2030;Ä&#x17E;Ä?Ĺ?Ä&#x201A;ĹŻĹ?Ç&#x152;Ä&#x201A;Ć&#x;ŽŜĆ? and speak to the kind of specialist they needâ&#x20AC;&#x201D;usually within a few minutes. Ä&#x201A;Ć&#x152;ĹŻÇ&#x2021;Ĺ?ĹśÄ&#x161;Ĺ?Ä?Ä&#x201A;Ć&#x;ŽŜĆ?Ć?Ĺ&#x161;Ĺ˝Ç Ć&#x161;Ĺ&#x161;Ä&#x201A;Ć&#x161;ĨÄ&#x201A;ĹľĹ?ĹŻÇ&#x2021;Ć&#x2030;Ĺ&#x161;Ç&#x2021;Ć?Ĺ?Ä?Ĺ?Ä&#x201A;ĹśĆ? and specialists embrace RACE. 78 percent of calls are returned within 10 minutes, and 80 percent of calls between doctors last less Ć&#x161;Ĺ&#x161;Ä&#x201A;Ĺś Ď­Ďą ĹľĹ?ŜƾĆ&#x161;Ä&#x17E;Ć?Í&#x2DC; /Ĺś ĨÄ&#x201A;Ä?Ć&#x161;Í&#x2022; Ä&#x161;Ĺ˝Ä?Ć&#x161;Ĺ˝Ć&#x152;Ć? Ä&#x201A;Ć&#x152;Ä&#x17E; Ĺ˝Ĺ&#x152;Ä&#x17E;Ĺś Ä&#x201A;Ä?ĹŻÄ&#x17E;Ć&#x161;Ĺ˝Ä&#x201A;Ä?Ä?Ä&#x17E;Ć?Ć?Ć&#x161;Ĺ&#x161;Ä&#x17E;Ć?Ä&#x17E;Ć&#x152;Ç&#x20AC;Ĺ?Ä?Ä&#x17E;Ç Ĺ&#x161;Ĺ?ĹŻÄ&#x17E;Ć&#x161;Ĺ&#x161;Ä&#x17E;Ĺ?Ć&#x152;Ć&#x2030;Ä&#x201A;Ć&#x;Ä&#x17E;ĹśĆ&#x161;Ć? Ä&#x201A;Ć&#x152;Ä&#x17E;Ĺ?ĹśĆ&#x161;Ĺ&#x161;Ä&#x17E;Ä&#x17E;Ç&#x2020;Ä&#x201A;ĹľĹ?ĹśÄ&#x201A;Ć&#x;ŽŜĆ&#x152;ŽŽžÍ&#x2DC;ZÄ&#x17E;Ć?ƾůĆ&#x161;Ć?Ć&#x152;Ä&#x17E;Ç&#x20AC;Ä&#x17E;Ä&#x201A;ĹŻ that RACE has generated a 62 percent drop Ĺ?ĹśÄ?ŽŜĆ?ƾůĆ&#x161;Ä&#x201A;Ć&#x;ŽŜĆ?Ä&#x201A;ĹśÄ&#x161;Ä&#x201A;ĎŻĎŽĆ&#x2030;Ä&#x17E;Ć&#x152;Ä?Ä&#x17E;ĹśĆ&#x161;Ć&#x152;Ä&#x17E;Ä&#x161;ĆľÄ?Ć&#x;ŽŜ in ER visits. &,/Ĺ?Ć?Ä?ŽžžĹ?ĆŠÄ&#x17E;Ä&#x161;Ć&#x161;Ĺ˝Ç Ĺ˝Ć&#x152;ĹŹĹ?ĹśĹ?Ç Ĺ?Ć&#x161;Ĺ&#x161;ĹŻÄ&#x17E;Ä&#x201A;Ä&#x161;Ä&#x17E;Ć&#x152;Ć?ĹŻĹ?ĹŹÄ&#x17E;DÄ&#x201A;Ć&#x152;Ĺ?Ĺ˝Ć&#x161;Ä&#x201A;ĹśÄ&#x161;^Ä&#x201A;ĹśÄ&#x161;Ć&#x152;Ä&#x201A;Ç Ĺ&#x161;Ĺ˝Ä&#x201A;Ć&#x152;Ä&#x17E; ĹľÄ&#x201A;ĹŹĹ?ĹśĹ?Ć&#x152;Ä&#x17E;Ä&#x201A;ĹŻÄ?Ĺ&#x161;Ä&#x201A;ĹśĹ?Ä&#x17E;Ć&#x2030;Ĺ˝Ć?Ć?Ĺ?Ä?ĹŻÄ&#x17E;Í&#x2DC;tÄ&#x17E;ůŽŽŏĨŽĆ&#x152;Ç Ä&#x201A;Ć&#x152;Ä&#x161;Ć&#x161;Ĺ˝Ć?Ĺ&#x161;Ä&#x201A;Ć&#x152;Ĺ?ĹśĹ?Ć&#x161;Ĺ&#x161;Ä&#x17E;Ç Ä&#x201A;Ç&#x2021;Ć?Ç Ä&#x17E;Ä?Ä&#x201A;ĹśĹ&#x161;Ä&#x17E;ĹŻĆ&#x2030; Ç&#x2021;ŽƾĆ&#x152;Ĺ˝Ć&#x152;Ĺ?Ä&#x201A;ĹśĹ?Ç&#x152;Ä&#x201A;Ć&#x;ŽŜÄ&#x161;Ĺ˝Ć&#x161;Ĺ&#x161;Ä&#x17E;Ć?Ä&#x201A;ĹľÄ&#x17E;Í&#x2DC;


Apply online for the EXTRA program for healthcare improvement before February 5th:

Osgoode Professional Development, 1 Dundas Street West, Suite 2600, Toronto



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

Osgoode Professional Development (OPD), a division of Osgoode Hall Law School at York University, provides lifelong learning programs for lawyers and other professionals, including those working in the health care sector. Whether youâ&#x20AC;&#x2122;re looking to learn or refresh skills or simply get an update on recent developments, consider OPDâ&#x20AC;&#x2122;s rich and diverse programs. We provide a number of non-degree seminars, certificate programs and workshops for health care professionals, including the areas of law relevant for nurses, hospital liability, long-term care and mental health law.

Relevant. Respected. The Diploma in Health Care Management.

Choose from these cutting-edge and comprehensive upcoming programs: Mental Health Law for Children and Youth (January 15, 2014)



/HJDO5LVN0DQDJHPHQWLQ'RFXPHQWDWLRQ and Charting for Nurses (March 3, 2014)

Advising the Elderly Client (February 19 - 20, 2014) 7KH1DWLRQDO6\PSRVLXPRQ0HQWDO'LVRUGHU DQG&ULPLQDO-XVWLFH(February 21, 2014)


For a complete list of upcoming events or to register for any of our programs: visit: call: 416.597.9724 or 1.888.923.3394 e-mail:

Bridging the gap between clinical training and executive development (MHA and MBA programs), the Ontario Hospital Associationâ&#x20AC;&#x2122;s Diploma in Health Care Management recognizes the completion of a broad spectrum of practical and relevant programs of study in leadership and management. Prepare yourself with the skills necessary to thrive in todayâ&#x20AC;&#x2122;s rapidly changing health care climate. Learn more at

Osgoode Professional Development, 1 Dundas Street West, Suite 2600, Toronto CLE



Professional Development and Education P17

Have a great idea for improving healthcare? Apply for EXTRA! Our EXTRA program for healthcare improvement is celebrating a decade of helping healthcare leaders make a difference. EXTRA teams have had a major impact on healthcare across Canada. Dramatic drops in:

Surges in:



BE PART OF THIS IMPRESSIVE LEGACY Application deadline February 5, 2014 The Canadian Foundation for Healthcare Improvement is a not-for-proďŹ t organization funded through an agreement with the Government of Canada.


P18 Professional Development and Education


FOOD, MOOD, AND COGNITION Special Seminar To Be Held

Can food intake affect the brain? Can giving the brain a certain type of food improve intelligence and memory? The scientifically-based course, â&#x20AC;&#x153;Food, Mood, and Cognition,â&#x20AC;? examines the relationship between diet and mental performance. The course reviews obesityâ&#x20AC;&#x2122;s possible effects on mental health and mental function. It looks at new research showing how the gut may function as a sort of second brain. The course examines the relationship between junk food and depression and junk food and anxiety. It reviews the health impact, if any, of food additives, preservatives, pesticides, and genetically modified foods. The course discusses how diet can affect oral health. It answers the question: Can we eat our way to happiness? The seminar will be presented by one of North Americaâ&#x20AC;&#x2122;s leading biochemists and clinical dietitians, Dr. Laura Pawlak (Ph.D., R.D.). The seminar will be presented three times in Ontario Province: Wednesday, May 7, 2014, at the Best Western Lamplighter Inn, 591Wellington Road South, London, Ontario; Thursday, May 8, 2014, at The Old Mill, 21 Old Mill Road, Toronto, Ontario; and Friday, May 9, 2014, at the Delta Markham, 50 East Valhalla Drive, Markham, Ontario. On each date, the seminar times will 8:30 A.M. to 3:30 P.M. The seminar is sponsored by the Biomed Corporation, North Americaâ&#x20AC;&#x2122;s largest provider of live seminars for health professionals. Biomed neither solicits nor receives any gifts or grants from any entity. Specifically, Biomed takes no funds from pharmaceutical, food, or insurance companies. To obtain more information about the seminar, please contact Biomed, Suite 228, 3219 Yonge Street, Toronto, Ontario M4N 2L3

Visit Biomedâ&#x20AC;&#x2122;s web site at Tel.1-877-246-6336 (toll-free) or (925) 602-6140 Fax: (925) 687-0860 E-mail:

Graduate School

take your career to the next level UNDERGRADUATE PROGRAMS Dietetics (5-yr. BS/MS) Exercise and Sports Studies (BS) Health Analytics (BS) Health Services Management (BS) Nursing (2-yr. RN to BSN) Nursing (4-yr. BSN) Pharmacy Physical Therapy program Pre-Dental / Medical / Veterinary MASTERâ&#x20AC;&#x2122;S PROGRAMS Community Health Nursing Ä&#x2018;ĆŤ 2*! ĆŤ(%*%(ĆŤ1./%*# Ä&#x2018;ĆŤ 10%+* Ä&#x2018;ĆŤ *#!)!*0 Family Nurse Practitioner Occupational Therapy Physician Assistant


High School Students  Transfer Students University Students  Graduate Students Working Professionals HOSPITAL NEWS JANUARY 2014

DOCTORAL PROGRAMS Chiropractic (7-yr. BS + DC) Health Administration (Ed.D.) Nursing Practice (DNP) Pharmacy (PharmD) Physical Therapy (DPT) ADVANCED CERTIFICATES Clinical Research Associate Family Nurse Practitioner (post-master's certiďŹ cate) Health Services Administration Long-Term Care Administration Nursing and Health-Related Professions Education


Professional Development and Education P19

Upcoming Conferences:

Activity Based Funding Conference 29â&#x20AC;&#x201C;30 January 2014 | Metro Toronto Convention Centre

National Patient Relations Conference 1 - 2 April 2014 | Hyatt Regency Vancouver

National Telemedicine Conference 10 - 11 April 2014 | Metro Toronto Convention Centre

Pressure Ulcer Prevention Conference Metro Toronto Convention Centre 29 - 30 May 2014

e-Medication Management Conference

Emergency Department Management Conference

12 - 13 June 2014 Metro Toronto Convention Centre

29-30 September 2014 Metro Toronto Convention Centre


P20 Professional Development and Education BIOMED PRESENTS...

FOOD, MOOD, & COGNITION A Seminar for Health Professionals TUITION $109.00 (CANADIAN)


Laura Pawlak, Ph.D., M.S.

The seminar registration period is from 7:45 AM to 8:15 AM. The seminar will begin at 8:30 AM. A lunch (on own) break will take place from 11:30 AM to 12:20 PM. The course will adjourn at 3:30 PM, when course compleWLRQFHUWLÂżFDWHVZLOOEHGLVWULEXWHG

Registration: 7:45 AM â&#x20AC;&#x201C; 8:30 AM Morning Lecture: 8:30 AM â&#x20AC;&#x201C; 10:00 AM z Brain Food. How Food and Nutrients Affect Brain Cells. z Dietary Supplements and Cognition (Omega 3, Gingko, Coconut oil, etc.): What Really Works? z Shaping a Better Brain. Food for Thought. Feeding the Brain to Optimize Academic Success. z Western Diet and Cognitive Impairment â&#x20AC;&#x201C; Causing Hippocampal Dysfunction. The Insidious Effect of Saturated Fats. Does Sugar Make Us Dumb? z The Hungry Brain. Overeating and Brain Deterioration. Energy Balance, Brain Health and Cognition. z Obesity and Poor Mental Health. Is it What We Eat, or Whatâ&#x20AC;&#x2122;s Eating Us?,QWHUDFWLRQV%HWZHHQ6WUHVV6DGQHVVDQG)RRG,QWDNH2EHVLW\$VVRFLDWHG%UDLQ,QĂ&#x20AC;DPPDWLRQÂą3URPRWLQJ$GGLFWLYH%HKDYLRUV" Mid-Morning Lecture: 10:00 AM â&#x20AC;&#x201C; 11:30 AM z Food and Mood. The Link Between Junk Food and Depression/Anxiety. 7KH5LVHRI0HQWDO+HDOWK'LVRUGHUVLQ2XU<RXWK,QĂ&#x20AC;DPPDWLRQDVWKH&RPPRQ'HQRPLQDWRU" z The Gut as Our 2nd Brain: Your Gut Has a Mind of its Own. Could the Gut be the Center of Many of Our Physical and Psychiatric Ailments? Gut Signals That Impact Overeating, Mood and Cognition. Gut '\VIXQFWLRQ,QĂ&#x20AC;DPPDWLRQDQG%UDLQ+HDOWK z Our Inner Ecosystem. How Gut Bacteria Shape Our Minds and Bodies. To What Extent Can We Blame Our â&#x20AC;&#x153;Bugsâ&#x20AC;? for Obesity and Depression? z The Gastrointestinal (GI) Barrier: Our Defense Against the External Environment. Leaky Gut Syndrome. Lunch: 11:30 AM â&#x20AC;&#x201C; 12:20 PM Afternoon Lecture: 12:20 PM â&#x20AC;&#x201C; 2:00 PM z Chronic Stress: +RZLW,PSDLUV2XU,QWHVWLQDO%DUULHUDQG$OWHUV*XW%DFWHULD(YLGHQFH7KDW*XW%DFWHULD$FWXDOO\,QĂ&#x20AC;XHQFH+RZ:HOO:H5HVSRQGWR6WUHVV z Do All Diseases Begin in the Gut? 7KH/LQN%HWZHHQ$OWHUHG*,)XQFWLRQDQG$OOHUJ\,QĂ&#x20AC;DPPDWRU\'LVHDVHV$XWRLPPXQH'LVHDVHV'LDEHWHV$UWKULWLV$XWLVP$''$'+'2EHVLW\(DWLQJ'LVRUGHUV Depression, and Other Chronic Disease States. z 7KH&XUVHRIWKH,QĂ&#x20AC;DPPDWRU\:HVWHUQ'LHWPromoting Gut Dysfunction and Toxic Intestinal Bacteria Thatâ&#x20AC;&#x2122;s Taking a Toll on Our Health. z Americaâ&#x20AC;&#x2122;s Chemical Cuisine: )RRG$GGLWLYHV3UHVHUYDWLYHV3HVWLFLGHV*HQHWLFDOO\0RGLÂżHG)RRGV:KDW,PSDFWLVLW+DYLQJ2XU*XWDQG%UDLQ+HDOWK"'DQJHURXV*UDLQV:KR&RXOG%HQHÂżW)URPD Gluten Free Diet? z Medications That Cause Digestive Problems (eg., Antibiotics, NSAIDs, etc.). Mid-Afternoon Lecture: 2:00 PM â&#x20AC;&#x201C; 3:20 PM z Dental Health Implications. Impact of Diet, Obesity and Depression on Oral Health. z The WAY to Eat to Improve Gut health, Brain Health, Appetite and Weight Control, Dental Health, Energy, Mood and Cognition. Whatâ&#x20AC;&#x2122;s the Secret? z Can We Eat our Way to Happiness? Diet as a Depression Cure. Nutrition for Addiction Recovery. z Food Allergies: How Common Are They Really? z New-Fangled Fibers: Will the Real Fiber Please Stand Up? z Prebiotics and Probiotics: Superfoods or Super Swindle? Probiotics to Treat Depression? The GAPS (Gut and Psychology Syndrome) Diet. What to Recommend to Our Patients? Evaluation, Questions, and Answers: 3:20 PM â&#x20AC;&#x201C; 3:30 PM




Fri., May 9, 2014 8:30 AM to 3:30 PM Delta Markham 50 East Valhalla Drive Markham, ON

Thu., May 8, 2014 8:30 AM to 3:30 PM The Old Mill 21 Old Mill Road Toronto, ON

CHEQUES: $109.00 (CANADIAN) with pre-registration. $134.00 (CANADIAN) at the door if space remains. CREDIT CARDS: Charges by credit card will be processed in U.S. DOLLARS at the prevailing exchange rate. Note: some Canadian banks may add a small service charge for using a credit card. The tuition includes all applicable Canadian taxes. At the seminar, participants will receive a complete course syllabus. Tuition payment receipt will also be available at the seminar.


7KLVSURJUDPLVGHVLJQHGWRSURYLGHQXUVHVZLWKWKHODWHVWVFLHQWLÂżFDQG clinical information and to upgrade their professional skills. Numerous registered nurses in Canada and the United States have completed these courses. This activity is co-provided with INR. Biomed is an approved provider of continuing nursing education by the Arizona Nurses Association, an accredited approver by the American Nurses Credentialing Centerâ&#x20AC;&#x2122;s Commission on Accreditation.

Dr. Laura Pawlak (Ph.D., M.S.) is a full-time biochemist-lecturer for INR. Dr. Pawlak undertook her graduate studies in biochemistry at the University of Illinois, ZKHUHVKHUHFHLYHGKHUPDVWHUVDQGGRFWRUDOGHJUHHV$XWKRURIVFLHQWLÂżFSXElications and many academic books, she conducted her postdoctoral research in biochemistry at the University of California San Francisco Medical Center. On such subjects as brain biochemistry, geriatric care, pharmacology, womenâ&#x20AC;&#x2122;s health issues, and nutrition, Dr. Pawlak frequently speaks to audiences of health professionals. Biomed reserves the right to change instructors without prior notice. Every instructor is either a compensated employee or independent contractor of Biomed.



Pharmacists successfully completing this course will receive course FRPSOHWLRQFHUWLÂżFDWHV%LRPHGLVDFFUHGLWHGE\WKH$FFUHGLWDWLRQ&RXQFLO for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. The ACPE universal activity number (UAN) for this course is 02129999-14-001-L01-P. This is a knowledge-based CPE activity.



Biomed, under Provider Number BI001, is a Continuing Profes- Accredited Provider sional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RDâ&#x20AC;&#x2122;s) and dietetic technicians, registered (DTRâ&#x20AC;&#x2122;s) will receive 6 hours worth of continuing professional education units (CPEUâ&#x20AC;&#x2122;s) for completion of this program/materials. Continuing Professional Education Provider Accreditation does not constitute endorsement by CDR of a provider, program, or materials. CDR is the credentialing agency for the Academy of Nutrition and Dietetics (AND).

PSYCHOLOGISTS &RXUVHFRPSOHWLRQFHUWLÂżFDWHVZLOOEHGLVWULEXWHGWRSV\FKRORJLVWVFRPSOHWing this program. This activity is co-provided with INR. INR is approved by the American Psychological Association to sponsor continuing education for psychologists. INR maintains responsibility for this program and its content.


Social Workers completing this program will receive course completion FHUWLÂżFDWHV

1) 2) 3) 

5) 6) 7)

Participants completing this course will be able to: describe how nutrition can be used to enhance cognitive function. characterize the relationship between diet, obesity and poor mental health. describe how gut health can affect brain health, and vice versa. H[SODLQKRZVWUHVVDQGLQĂ&#x20AC;DPPDWLRQLPSDFWWKHJXWDQGWKHEUDLQDQGWKHUHIRUHLQĂ&#x20AC;XHQFHRXUSK\VLFDODQGPHQWDOKHDOWK list interventions to improve appetite control and mood. outline the relationship between food, mood and dental health. describe, for this course, the implications for dentistry, mental health, and other health professions.

SPONSOR %LRPHGLVDVFLHQWLÂżFRUJDQL]DWLRQGHGLFDWHGWRUHVHDUFKDQGHGXFDWLRQLQVFLHQFH and medicine. Since 1994, Biomed has been giving educational seminars to Canadian health-care professionals. Biomed neither solicits nor receives gifts or grants from any HQWLW\6SHFLÂżFDOO\%LRPHGWDNHVQRIXQGVIURPSKDUPDFHXWLFDOIRRGRULQVXUDQFH companies. Biomed has no ties to any commercial organizations and sells no products of any kind, except educational materials. Neither Biomed nor any Biomed instructor has a PDWHULDORURWKHUÂżQDQFLDOUHODWLRQVKLSZLWKDQ\KHDOWKFDUHUHODWHGEXVLQHVVRUDQ\ other entity which has products or services that may be discussed in the program. Biomed does not solicit or receive any gifts from any source and has no connection with any religious or political entities. Biomedâ&#x20AC;&#x2122;s telephone number is: (925) 602-6140. Biomedâ&#x20AC;&#x2122;s fax number is: (925) 363-7798. Biomedâ&#x20AC;&#x2122;s website is, Biomedâ&#x20AC;&#x2122;s corporate headquartersâ&#x20AC;&#x2122; address is: Biomed, P.O. Box 5727, Concord, CA 94524-0727, USA. Biomedâ&#x20AC;&#x2122;s GST Number is: 89506 2842.

Charges by credit card will be processed in U.S. dollars. The prevailing rate of exchange will be used.


ExpressÂŽ, or DiscoverÂŽ by calling


(This number is for registrations only.) Fax a copy of your completed registration formâ&#x20AC;&#x201D; including Visa, MasterCard, American ExpressÂŽ, or DiscoverÂŽ Numberâ&#x20AC;&#x201D;to (925) 687-0860.

By fax:

For information about seminars in other provinces, please call 1-877-246-6336 or (925) 602-6140.

REGISTRATION INFORMATION Individuals registering by Visa, MasterCard, American ExpressÂŽ, or DiscoverÂŽ will be charged at the prevailing exchange rate. If the credit card account is with a Canadian bank, the USA tuition will be converted into the equivalent amount in Canadian dollars (approximately $109.00) and will appear on the customerâ&#x20AC;&#x2122;s bill as such. The rate of exchange used will be the one prevailing at the time of the transaction. Please register early and arrive before the scheduled start time. Space is limited. Attendees requiring special accommodation must advise Biomed in writing at least 50 days in advance and provide proof of disability. Registrations are subject to cancellation after the scheduled start time. A transfer at no cost can be made from one seminar location to another if space is available. Registrants cancelling up to 72 hours before a seminar will receive a tuition refund less a $35.00 (CANADIAN) administrative fee or, if requested, a full-value voucher, good for one year, for a future seminar. Other cancellation requests will only be honored with a voucher. Cancellation or voucher requests must be made in writing. If a seminar cannot be held for reasons beyond the control of the sponsor (e.g., acts of God), the registrant will receive free admission to a rescheduled seminar or a full-value voucher, good for one year, for a future seminar. A $35.00 (CANADIAN) service charge applies to each returned cheque. Nonpayment of full tuition may, at the sponsorâ&#x20AC;&#x2122;s option, result in cancellation of CE credits issued. The tuition includes all applicable Canadian taxes. At the seminar, course participants will receive a complete syllabus. Tuition payment receipt will also be available at the seminar. A $15.00 fee will be charged for the issuance of a GXSOLFDWHFHUWLÂżFDWH)HHVVXEMHFWWRFKDQJHZLWKRXWQRWLFH

REGISTRATION FORM Wed., May 7, 2014 (London, ON) Thu., May 8, 2014 (Toronto, ON)

Please print: Name: Home Address: City: Province: Postal Code: Home Phone: ( ) Work Phone: ( ) Please enclose full payment with registration form. Check method of payment. Check for $109.00 (CANADIAN) (Make payable to BIOMED) Charge the equivalent of $109.00 (CANADIAN) to my Visa Card Number:

There are four ways to register: Online: By mail: Complete and return the Registration Form below. By phone: Register toll-free with Visa, MasterCard, American

(enter all raised numbers)

Fri., May 9, 2014 (Markham, ON)


For information about seminars in other provinces, please call 1-877-246-6336 or (925) 602-6140

Please check course date:




Profession: Professional License #: Lic. Exp. Date: Employer: QHHGHGIRUFRQÂżUPDWLRQ UHFHLSW

MasterCard Exp. Date:

American ExpressÂŽ

DiscoverÂŽ CVV:

(Card Security Code)




Wed., May 7, 2014 8:30 AM to 3:30 PM Best Western Lamplighter Inn 591 Wellington Road South London, ON

Please return form to:


Suite 228 3219 Yonge Street Toronto, Ontario M4N 2L3 TOLL-FREE: 1-877-246-6336 TEL: (925) 602-6140 FAX: (925) 687-0860




Focus 11

Improving staff engagement and work life By Catalina Guran mproving Staff and Physician Engagement and Worklife is a priority focus at Mackenzie Health. An integral part of the organization’s vision to ‘create a worldclass health experience’ and its Human Resources strategy, it is also one of Mackenzie Health’s three Wildly Important Goals (WIGs)-the areas of major focus for the year which help to drive key corporate initiatives. Following 12 months of sustained efforts, Mackenzie Health increased the overall engagement of its over 2,300 employees by 14 per cent. This notable


The most recent program implemented within the organization is the Kudos Awards Program, an initiative that aims to recognize and celebrate individuals and teams that go above and beyond to create the best possible experience for patients and families

improvement was achieved through focused communication, recognition and development initiatives. Daily huddles, monthly department meetings and management roundings are an integral part of the organizational culture at Mackenzie Health. From quick check-ins to ensure everyone is ready to complete their work for the day, to biweekly department meetings meant to ensure that everyone is aware of the team’s current projects and priorities, to brief check-ins with managers to ensure staff have the resources they need to complete their work effectively, Mackenzie Health has created numerous communications channels to ensure that they are able to do their job at the highest level of quality. Mackenzie Health staff are also involved in the development of the organization’s roadmap, directions and corporate initiatives. In 2012, Mackenzie Health launched its new brand, as well as its new Mission, Vision, Values statements, Commitment to Caring and Patient Declaration of Values. It also developed its Strategic Plan for 2013-2016, a roadmap to guide the organization for the next three years. These were all drafted in consultation with staff and are regularly reinforced at daily huddles and departmental meetings.

Capacity building for transformation:

A strategic and adaptive challenge for health care leaders By Ted Ball

here is lots of rhetoric around about some big event being planned for our health care system called "transformation". At Queen's Park, they even set up a "Transformation Secretariat" which, over the past 10 months, has set up 37 local integrated health service partnerships called "Health Links" - each with an approved Business Plan that sets out the agreed-upon outcomes (bottom-line results) for which the "lead partner" will be held accountable for achieving by their LHIN. The truth about "complex, adaptive, human systems", like the health care sector, is that until and unless we build the internal capacity for transformation in our senior and middle managers-and in physicians and front-line staff-there will be no actual transformation. Just a lot of rhetoric. The people in our organizations who worry about things like skills for transformation are called Organizational


Development Departments-often found somewhere in the basement of the HR Department. There are wonderful examples of highly strategic capacity-building programs in many leading hospitals and several CCACs in Ontario. The Association of Ontario Health Centres even has an office for "Capacity-Building" for their members. Having worked in the transformation capacity-building field in the health care sector for over 20 years, I have had the opportunity to witness/participate in breakthrough performance improvements that were the product of strategic investments in building the internal capacity of the organization to transform itself. Yes. You can use many of the same tools and processes in each Health Linkbut the sequence, the approach, and the results, will always be unique and different. One-size does not fit-all. Continued on page 13

At Mackenzie Health, huddles are an integral part of the organizational culture. Conducted on a daily basis, they are aimed to identify any issues or process challenges, and ensure everyone is ready to complete their work for the day. Every individual on the Mackenzie Health team plays a part in delivering on its mission to relentlessly improve care to create healthier communities. They do so by demonstrating commitment and values in their daily work, and through their interactions with colleagues, patients and family members. Mackenzie Health acknowledges and celebrates their contributions to the organization through sustained formal and informal recognition programs. The most recent program implemented within the organization is the Kudos Awards Program, an initiative that aims to recognize and celebrate individuals and teams that go above and beyond to create the best possible experience for patients and families. It gives staff, physicians and volunteers the opportunity to be acknowledged and to thank others for great work. Awards can be received by any member of the health care team and can be given by coworkers, patients or families in recognition of a job well done. Mackenzie Health is committed to the ongoing learning and development of its staff, its most valuable asset. A key component of this commitment is ongoing learning and development for all employees, including the leadership team. Along with its colleague hospitals primarily in the Central Local Health Integration Network (LHIN), Mackenzie Health has been actively engaged in the delivery of a regional Leadership Development Program that is leading edge and supports best practice. The program curriculum was developed collectively by participating hospitals, resulting in a program by and for health care leaders.

The program is the first of its kind in Ontario and is facilitated by recognized experts from the Hay Consultant Group in the area of progressive leadership development. A number of Executives, Directors, Managers and Supervisors have been engaged in active cohorts consisting of individuals from all of the participating hospitals. At Mackenzie Health, employee satisfaction and engagement is gaged periodically through internal and third-party surveys. Recent results demonstrate an approximate 80 per cent satisfaction in current role, confirming both strong staff engagement and organizational commitment to soliciting feedback and supporting continuous quality worklife improvements at the individual, team and organizational level. In November 2013, Mackenzie Health was recognized for its staff engagement efforts with the 2013 Quality Healthcare Workplace Award-Gold. The Quality Healthcare Workplace Awards is a partnership of the Ontario Hospital Association and the Ministry of Health and LongTerm Care’s HealthForceOntario. Over the past three years, Mackenzie Health’s track record of achievements has been nothing short of inspiring. This and other recent awards are further evidence of the amazing transformation taking place at Mackenzie Health, in support of its vision to create a world-class health H experience. ■ Catalina Guran is a Communications and Public Affairs Consultant at Mackenzie Health.

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12 Focus


Seven evidence-based messages to help protect hospital workers By Cindy Moser he health care sector has more workplace injuries than any other in Canada. According to the most recent numbers from the Association of Workers’ Compensation Boards of Canada (AWCBC), health care workplaces had over 40,000 accepted lost-time claims in each year from 2009 to 2011. These numbers have faces: Wendy, the registered nurse who suffered acute lowback pain after transferring a patient; Ron, the night cleaner whose lack of sleep was blamed in part for his spill of hazardous chemicals; Clara, the ICU nurse who poked herself with a needle when she stumbled on a chair beside a patient’s bed. Incorporating evidence-based practices and policies is one way to help prevent injuries affecting hospital workers like Wendy, Ron, Clara and the thousands more like them—and help is available from the Institute for Work & Health (IWH). As an independent, not-for-profit Canadian research organization based in Toronto, IWH promotes the use of evidence among work-health professionals. It develops research-backed resources in two main areas: (1) workplace injury prevention and (2) recovery and return to work. Here is a quick look at some of the research from the Institute—and the practical tools and advice it gives rise to.


1. Implement a participatory ergonomics program to reduce musculoskeletal disorders. Participatory ergonomics (PE) is one approach to preventing workrelated musculoskeletal disorders (MSDs). PE involves including workers, supervisors and others in the workplace to identify and come up with solutions to improve their work environments and reduce MSD risks.

Based on its findings that PE programs can reduce MSD symptoms, workers’ compensation claims and days lost from work, and further findings about what makes PE programs work, the IWH created a concise guide called Reducing MSD Hazards in the Workplace: A Guide to Successful Participatory Ergonomics Programs. It provides advice on what needs to be done up-front to give your PE program the best chance at success and to prevent problems down the road.

Shift work is a fact of life in hospitals, so knowing its potential health effects and what can be done to decrease these effects is important 2. Implement programs to overcome MSD risks. Some years ago, IWH reviewed the research to determine what programs might help reduce the risk of MSDs among health care workers. It found two programs in particular are most likely to be effective. The first is a patient-lifting program with three components: (1) a worksite policy change, such as zero-lift policies; (2) new patient handling equipment, such as overhead or floor lifts; and (3) training on the equipment and on patient handling. The other program is exercise training, consisting of aerobic or strength-training exercises, or both. In more recent research, IWH teamed up with the Centre for Addiction and Mental Health (CAMH) in Toronto, to create and pilot an evidence-based online

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ergonomics program. The nine-module program is based on the latest evidence from ergonomics research, and complies with established office ergonomics standards from the Canadian Standards Association (CSA) and American National Standards Institute (ANSI). The pilot at CAMH showed workers who took the online training increased their knowledge about the risks of computer work, made appropriate changes to the set-up of their workstations, improved their working postures, and experienced less pain and/or discomfort at the end of their workday. The training program is expected to be online in 2014. 3. Understand the barriers to implementing needlestick injury prevention programs. In 2007, Ontario introduced a regulation to promote the adoption of safety-engineered needles for the prevention of needlestick injuries. Yet needlestick injury declines in the province have not been substantial. To explore why, IWH looked at the implementation of these needles at three acute-care hospitals. Although all three hospitals responded with integrity, the research showed evidence of inconsistent implementation and outcomes. Some front-line workers developed strategies to avoid using the safetyengineered needles, and a conflict sometimes existed between the values health care workers placed on performance and patient care and the learning curve associated with the initial use of the needles. 4. Understand and address the effects of shift work. Shift work is a fact of life in hospitals, so knowing its potential health effects and what can be done to decrease these effects is important. IWH and the

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Occupational Cancer Research Centre have held two symposiums to outline what we know so far, and the outcomes of these collaborations are available online. The most recent research from IWH in this area confirmed that workers are more likely to be injured on the job during the evening, night or early morning hours than during a regular daytime shift. The study found that about 12 per cent of work injuries experienced by women and six per cent of work injuries experienced by men were attributed to the higher risk of work injury during evening, night and early morning hours. Two possible reasons for this are worker fatigue due to sleep disturbance and/or long work hours, and lower levels of supervision and co-worker support during non-daytime hours. 5. Help newcomers understand their health and safety rights and responsibilities. If you have recent immigrants working in your hospital, an 11-item toolkit from IWH may be a welcome addition to your prevention resources. It provides the modules needed to teach recent immigrants to Ontario about occupational health and safety and workers’ compensation. (A version is also available for Manitoba workplaces.) The toolkit, called Prevention is the Best Medicine, was born out of IWH research that shows newcomers are more likely than Canadian-born workers to be in jobs with a higher number of health and safety hazards. The toolkit includes a fact sheet and vocabulary list for newcomers, lesson plans and presentation slides for instructors. 6. Provide helpful advice to workers with back pain. Based on a review of evidence about managing acute back pain, IWH produced a booklet called So Your Back Hurts..., which was reviewed by the Cochrane Back Review Group (housed at the Institute). The booklet provides advice about staying active, the use of overthe-counter pain-relieving drugs, and the potential short-term benefits of spinal manipulation, heat and massage. 7. Develop respectful workplaces to help decrease absences among nurses. According to an IWH study of Canadian nurses, emotional and physical abuse at work, as well as disrespectful and unsupportive work environments, are associated with prolonged work absences among nurses. This suggests hospitals with an absenteesim issue may want to consider implementing violence prevention programs, giving nurses a sense of control over their work, and offering self-management programs that focus on pain. All reports, booklets and guides are availH able for download at ■ Cindy Moser is the communications manager at the Institute for Work & Health. She can be reached at cmoser@




Building for transformation: Continued from page 11

The gratitude wall at one of St. Josephâ&#x20AC;&#x2122;s Health Care Londonâ&#x20AC;&#x2122;s sites, filled with heartfelt appreciation and gratitude. The gratitude walls were open to all staff, volunteers, patients and visitors during October leading up to Thanksgiving.

The attitude of gratitude By Amanda Jackman uring the holiday season many people took a few extra moments to focus on the things in life they are most grateful for. At St. Josephâ&#x20AC;&#x2122;s Health Care London (St. Josephâ&#x20AC;&#x2122;s) discovering ways to show gratitude to one another is a year-round endeavor. â&#x20AC;&#x153;We hear very positive feedback from the staff at St. Josephâ&#x20AC;&#x2122;s when we run a gratitude initiative. In a busy health care setting it is a great reminder to express our appreciation to colleagues,â&#x20AC;? says Cathy Parsons, nursing practice consultant at St. Josephâ&#x20AC;&#x2122;s. â&#x20AC;&#x153;When we plan something creative it gives people a chance to recognize p others in a special way. The fun helps relieve stress while also boosting osting staff morale.â&#x20AC;? St. Josephâ&#x20AC;&#x2122;s Quality Workplace Committee (QWC) contributes to the organizationâ&#x20AC;&#x2122;s overall capacity to create a healthyy ntable workplace and is accountable for establishing effective organization wide strategies. It is also responsible for looking at the results of staff surveys and responding to survey feedback. â&#x20AC;&#x153;The committee meets its mandate by identifying, recommending and adopting healthy workplace practices that are guided by employee ideas and responses,â&#x20AC;? says Wendy Reed, director, Occupational Health and Infection Control. â&#x20AC;&#x153;Many of the ideas that spring from this group are intended to help support staff response to change and initiatives are created to help address issues and bridge gaps.â&#x20AC;? The groupâ&#x20AC;&#x2122;s aim is to create and sustain a working environment that inspires employees' growth, builds on their strengths, and fosters collaborative relationships which can promote a resilient and engaged workforce committed to care and service, making a difference in the lives of others. â&#x20AC;&#x153;One of the many benefits to expressing gratitude consistently and freely is that it


fosters an environment where people experience a greater sense of purpose,â&#x20AC;? says Susan Greig, professional practice leader at St. Josephâ&#x20AC;&#x2122;s. â&#x20AC;&#x153;It is a visible demonstration of how we can all make a difference and the benefits are far-reaching. Research in the field shows practicing gratitude can increase work satisfaction and happiness in general, strengthen the immune system, lower blood pressure, aid with sleep, build relationships and more.â&#x20AC;? Some of the novel ways to express gratitude offered to staff and physicians at St. Josephâ&#x20AC;&#x2122;s have included flowers of gratitude where flowers were pre-purchased by individuals and delivered by volunteers to p recipients. More than 640 flowe owers were handed out acr across the organizatio tion. In the spring, ov over 350 packets of see seeds for the sowing seeds of gratitude initiative wer were hand delivered with cards to ha happy recipients. This fall staff, volunteers, patients and visitors filled gratitude walls with heart-felt thoughts of appreciation and thanks. The messages on the walls were profound and reflective of the very different areas of care in the St. Josephâ&#x20AC;&#x2122;s family of sites. Some of the captions included, I am grateful forâ&#x20AC;Ś my four replanted fingers; my father's service for our country; a job I love; my vision; hope; being able to walk. Throughout the year a gratitude blog and e-cards of thanks are also available to staff. As it is with expressing gratitude, kind words and inspiration are contagious; the QWC has been enthused by the grateful words of others and are encouraged to design future activities that realize the vision H for gratitude across the organization. â&#x2013; Amanda Jackman is a Communication Consultant at St. Josephâ&#x20AC;&#x2122;s Health Care London.

Best practices for successful transformation suggest that organizations, or systems of organizations, ought to invest one to five per cent of their payroll budget on internal/intact team learning-by-doing, just-in-time capacity-building programs. The most effective capacity-building programs are those in which the CEO plays a lead role in the capacity-building process. Bonnie Adamson, CEO of London Health Sciences Centre, for example, took her entire 300-person senior/ middle managers through an 18-month, 12-day Leadership Development Dialogue focused on leading transformation. At North Bay General Hospital, over the past year or so, their CEO, Paul Heinrich took his organization on a Lean Thinking/Quality Learning journey. Within the Health Link partners, there will be several Organizational Development Specialists. Chances are that each health service provider (HSP) uses different "frameworks" and "different" language for talking about, planning for, and implementing change. Language for the same Balanced Scorecard tool can mean completely different things in different HSPs. Much to the apparent bewilderment of the "one-size-fits-all" approach to capacity-building, each and every Health Link will be absolutely different from each other. There will also be deep corporate memories about what worked, and what didn't work in previous big change initiatives. As any transformation practitioner will tell you, those historical memories must be accounted for in any bottom-up transformation capacity-building efforts that are undertaken. The CEO of the "lead partner" for each Health Link ought to get agreement from the CEO group to call a meeting of all the organization development (OD) departments to explore and compare lessons learned, and to determine the most appropriate common language and frameworks for the Health Link Partners. People also need to stop being so toolfocused on this journey. If all you know is, how to use a hammer, pretty soon most things will begin to look like a nail. While the IDEAS program from Intermountain Health Care in Utah has some useful quality tools that can be helpful to your organization, and to your Health Link, a capacity-building program from a "bottom-up perspective", starts with finding out where each of the partners are on their individual learning journey-

Focus 13

and then determining how best to move forward. In the adult learning business, that's called meeting the learners where they are. You don't give grade eight math tests to grade three students, or grade three tests to grade 12 students. The thing to remember is that each Health Link will be at a different stage of health system transformation. As they say, â&#x20AC;&#x2DC;when you've seen one Health Link, you've seen one Health Linkâ&#x20AC;&#x2122;. So, a centralized, one-size-fits-all skills development program, can't possibly respond in a way that meets their actual learning needs. This is the same principle as being patient-centred and people-centred. Learning programs need to wrap themselves around the idiosyncratic realities of each unique combination of organizational memory/wisdom/experience. Top-down, "one-size-fits-all", centralized training is certainly not sufficient, if you want to succeed. We also need "bottom-up" and customized learning experiences-using the same tools and frameworks, where appropriate.

The most effective capacity-building programs are those in which the CEO plays a lead role in the capacitybuilding process However, while each of the Health Links in a LHIN could use common tools-like a Health Link-Level Balanced Scorecard, or Patient Experience Design Storyboarding-they would look very different in each one. If a CEO has decided to lead a transformation of their organization, and to participate as a highly collaborative partner in their Health Link, they should think about having the OD Team report directly to the CEO-and shift the CEO's role into developmental facilitation-providing highly visible leadership-for a full-day Management Dialogue Workshops each month. This morphs the role of the CEO/ Adaptive leader into a developmental facilitator/teacher role. That's the challenge for health care leaders over the next few years. Some key solutions are in the field of organizational development-a key strategic driver for H transformation. â&#x2013; Ted Ball is a Transformation Capacity-Building Coach at Quantum Transformation Technologies. He blogs @

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14 Focus


Bluewater Health launches strategic plan: for Emily

Sue Denomy, President and CEO said, “Each of us, no matter our individual role, has an influence on Emily’s experience of care. As we go about our day-to-day work, we are invited to consider, ‘How does what I am doing help Emily?’ and ‘Will what I’m doing make it better for Emily and her family?’” Emily’s image is displayed in hospitals in Sarnia and Petrolia and within all Strategic Plan communications.

By Kim Bossy trategic Planning. Though it’s a key activity that successful corporations undertake every three to five years, there is no single best way, nor one size fits all model. Like all Ontario hospitals, Bluewater Health has seen continued pressure on the healthcare system, marked by increased demand for services from an aging population, new methods of care and treatment, and new models of care within ambulatory and community care settings. Leaders are taking action to transform the system, with expectations for improved access to care, expanded community partnerships, greater service integration, new performance and productivity level expectations and evolving financial incentives to support this direction. With this environmental scan front of mind, Bluewater Health’s Board of Directors determined that the current Mission, Vision, Values and five strategic themes established in 2009 (shown below), continued to position our hospitals favorably in the context of a rapidly changing health care environment and in service to our communities. According to Mike Lapaine, Vice-President, and co-lead for the organization’s strategic plan, “To start from a point of strength rather than start anew, we developed a modified planning process for the 2013-15 cycle, building upon the existing Strategic Plan. We created an internal planning process led by a Steering Committee to develop and facilitate the 8-month planning milestones. The Steering Committee was tasked with developing a process to identify the Strategic Priorities for each theme and to identify the goals and initiatives to support the Mission and reflecting


Launching the Plan

At the strategic plan launch, Barb O’Neil, Chief Nursing Executive, introduces Emilya composite image of staff, physicians and volunteers-to exemplify that each of us contributes to patients’ and families’ experiences of care at Bluewater Health. both the Ministry and LHIN directions and the emerging needs of Sarnia-Lambton county residents.”

Planning Summit I

A common approach to Strategic Planning is to bring the Board, Medical and Administrative leaders together for a concentrated two or three day, off-site, strategic planning retreat. Instead, Bluewater Health created two inclusive Planning Summits, separated by several months. The first Summit was an opportunity to share information and data with the Board and senior medical and administrative leaders describing the current state. A significant amount of pre-reading material was made available to participants including an environmental scan, market share report, community demographic profile, achievements since the last strategic plan, strengths and opportunities, and LHIN and Ministry priorities.

An important part of the planning process was gaining fulsome internal and external input on the organization’s ‘Must do! Can’t fail!’ priorities from the perspective of stakeholders. A quick and easy survey was both e-mailed and website posted, and discussed through facilitated sessions and focus groups. The feedback demonstrated a significant continuity of direction including the need to focus on the patient and family, to aggressively pursue quality and safety initiatives, to recognize the strengths and resourcefulness of our people, create innovation, build strategic relationships, optimize the new facilities and manage financial resources wisely. Almost 450 suggestions were themed, collated and summarized, helping to guide the creation of the draft strategic priority and intention statements. The outcome of the first Planning Summit was a precise summary of the direction the organization should take as it developed strategic priorities to support our Mission.

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Next, we brought the organization’s tactical team together to share the work completed to date and provide an opportunity for these leaders to offer further suggestions and tweaking before the second Planning Summit. Their input was particularly valuable when assessing the organization’s capability and resourcefulness to carry the strategic priorities and goals forward. The second Planning Summit brought the entire leadership team together, and with clear direction from the strategic priorities, we developed eight corporate goals beginning with “We Will” statements to guide the implementation phase. To strengthen our resolve, we described what the success of each goal would mean for patients and their families and for those associated with Bluewater Health. We felt that by embedding the importance of achieving each goal for stakeholders, meaningful and realist implementation strategies would develop. Perhaps most importantly, we embedded ‘Emily’ into all we do. Emily is a visual composite of individual photographs of staff, physicians and volunteers of Bluewater Health. She is the image of every patient and patient family we have cared for in the past, are currently caring for and will care for in the future.

Bluewater Health’s Strategic Plan renews the hospitals’ focus on creating exemplary healthcare experiences. The plan identifies eight corporate goals: • Embed Patient & Family-Centred Care • Improve Access to Care • Ingrain Patient Safety • Advance Technology • Achieve Financial Health • Optimize Partnerships • Develop Our People • Create a Lean Culture Stéphane Thiffeault, Chair, Bluewater Health Board of Directors said, “This Plan will contribute to improved patient experiences, improved outcomes for our patients and ultimately, the health of our community.” The modified planning process proved to be very successful. When asked for process feedback, the Board and its Standing Committees: • Were grateful for the longer timeframes to receive, review and debate the input documents • Believed that the information available to them gave them greater confidence that the final strategic priorities chosen were the most appropriate to guide Bluewater Health for the coming three years • Were supportive of the two-step approach, which minimized stress and logistics compared to the typical 2 to 3 day weekend retreat • Expressed confidence that the in-house approach and stakeholder inclusiveness was a strength of the process • Were pleased to see the congruence brought forward from the simple “Must do! Can’t fail” feedback. After final approval by the Board, we prepared to launch our Strategic Plan across the entire organization and beyond to the Sarnia-Lambton community. At celebratory events, led by the Board Chair and CEO, internal and external stakeholders had the opportunity to connect with Steering Committee members who accompanied storyboard exhibits, discussing the theme, priorities, goals, and expected outcomes of each strategic direction. Concludes Denomy, “We are excited about this Plan which reflects the vision of the way we want and need to be and where our strategic themes, priorities and goals will take us... To provide exemplary healthcare experiences for patients and families every time.” For more information, please contact Mike Lapaine, VP Operations, Chief Operating Officer, mlapaine@bluewaterhealth. H ca, 519-464-4452, Ext. 4722. ■ Kim Bossy is Chief, Communications & Public Affairs at Bluewater Health.

Focus 15


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16 From the CEO's Desk

Opportunity in the face of overcapacity By Andrée Robichaud his year Thunder Bay Regional Health Sciences Centre (TBRHSC) celebrates 10 years of advancing world-class patient and family-centred care in an academic, research-based, acute care environment. When TBRHSC first opened its doors 10 years ago, it was hailed as the “Jewel of the North,” a stunning, state-of-the-art acute care facility serving the health care needs of people living in Northwestern Ontario. Those were exciting and challenging times. Setting a goal to provide excellent healthcare to about 250,000 residents spread out over a region the size of France was ambitious, to say the least. But through innovative strategies, such as telemedicine, we are reaching out to provide care to the region. In 2011, our program met or exceeded all Accreditation Canada’s 2010 standards for best practices specific to a Telemedicine program. Additionally, Tele-visitation was designated a “leading practice” by that same survey team. Today, TBRHSC, like many other hospitals in Canada, is facing another challenge, that of overcapacity. We are often faced with gridlock, a situation where there are more patients than beds available. As a result, new patients often have to wait in the Emergency Department (ED) for a bed to open up. Our ED is the second busiest in Canada.



In 2012-2013, there were 111,657 visits to the ED. Yet, it remains a provincial leader in wait times for non-admitted ED visits. And, despite the high rate of activity, admissions from the ED are not significantly contributing to overcapacity at TBRHSC. TBRHSC has the lowest admission rate versus the other Ontario teaching hospitals.

Since the Home First Philosophy was implemented in fall 2010, more patients are discharged home and fewer patients to Long-Term Care. The increasing service volumes are attributable to systemic factors outside of TBRHSC’s control. An ever-increasing number of beds at TBRHSC are occupied by Alternate Level of Care (ALC) patients who no longer need acute care, but cannot be discharged because there is no appropriate location available to them, such as a long-term care facility, the patient’s own home with support from community care providers, or rehabilitation. As a result, our Health Sciences Centre is often in an overcapacity situation. A number of strategies were implemented to reduce the strain. This includes the addition of 10 beds to create an ALC

Overflow Unit; the addition of a Utilization Coordinator, Social Worker, and Physiotherapist on weekends to facilitate the discharge of patients; twice-daily bed meetings with senior leadership to identify opportunities to reduce overcapacity pressures; and a staff member assigned to patrol the halls every 20 minutes to ensure fire routes remained clear. Also, to enhance the level of privacy and safety for patients waiting for beds, TBRHSC completed minor renovations to a number of patient lounges to be made available as patient rooms when the number of patients admitted exceeds our regular capacity. From 2010 to 2013, we further improved patient flow by implementing a Medical Short Stay Unit; Nurse-Led Outreach Team; enhanced Telehomecare (CHF, COPD) and a Telehomecare Steering Committee; Patient Flow Strategy Project Team; and participation in the Mobilization of Vulnerable Elders (MOVE-ON) Research Project. System Partnerships including Home First (Transition Management); Resource Matching and Referral; TB Interim LTC Closure/Category 1-Crisis Planning Group; Self-Management Programs; and Integrated Non-Urgent Patient Transportation Planning Group. TBRHSC has been identified as a high performer with respect to efficiency benchmarking measures. However, the ongoing situation presented opportunities to take a closer a look. While we were already operating efficiently, we were able to identify and pursue ways to further improve. In 2013-2014, additional patient flow improvements included implementing Performance Measurement and Reporting; Standardized Admission and Discharge; ED P4R Investment; additional integrated patient flow software modules; Support positions (Data Analyst, IS); Temporary Additional Inpatient Bed Capacity (ALC Overflow Unit)-Business Case; and participating in the Senior Friendly Hospital Strategy. Also, TBRHSC continues to participate in the System-Wide Surge Planning Team. The Home First Philosophy has also contributed significantly to addressing ALC pressures in the region. Since the Home First Philosophy was implemented in fall 2010, more patients are discharged home and fewer patients to Long-Term Care. These initiatives are making a difference. In spite of ALC and overcapacity challenges, we continue to provide quality acute care, and to progress as an academic health sciences centre. Our commitment to Patient and Family Centred Care fuels our activity. We remain the only hospital to receive designation as a Leading Practice for Patient and Family Centred Care by Accreditation Canada, and recently welcomed our 100th Patient Family Advi-

Andrée Robichaud sor (PFA) to our team. Involving PFAs in our decisions ensures patients and families remain at the centre of everything we do, and that all of our strategies consider their needs first. It is during times like this when I realize the value of a team of health care providers, staff and volunteers that is committed to Patient and Family Centred Care. Their ongoing dedication to ensure the best possible patient care during these times of overcapacity pressures is extraordinary. While it is, of course, the people who make the principal difference in healthcare, a state-of-the-art facility contributes to outcomes. Environment has a significant impact on peoples’ ability to heal as well as on the health care team’s effectiveness. Nearly 10 years after its construction, TBRHSC is still attracting international attention for its innovative design. TBRHSC made sixth place on a list of the world’s 30 most architecturally impressive hospitals and is the only Canadian hospital on the list. The website is a resource for those looking for information about careers and education in Public Health. It notes that “a new generation of medical facilities is changing the face of the hospital, literally. These places take a more holistic approach to healthcare-one that takes the healing environment into consideration. As a result, the hospitals on this list may be more welcoming. While patient care remains their primary objective, many have put almost equal care into their clients’ surroundings.” I am tremendously proud of the people and place that is Thunder Bay Regional H Health Sciences Centre. ■ Andrée Robichaud is President and CEO at Thunder Bay Regional Health Sciences Centre.


Focus 17

Southlake first hospital in North America to incorporate newly released advanced training program By Judy Murdoch udith Schubert, President of the Crisis Prevention Institute (CPI), was in attendance at the ground-breaking CPI Nonviolent Crisis Intervention training session at Southlake Regional Health Centre recently. She joined 30 staff members from a number of Southlake’s clinical areas who were there to learn advanced techniques for protecting themselves and their patients when faced with the potential for aggression. As the first hospital to roll out this newly released training, Schubert was keen to observe its impact. Southlake has utilized CPI’s Nonviolent Crisis Intervention® program, known worldwide for crisis prevention and intervention training, for many years. Now, in an effort to proactively seek out advanced safety initiatives, Southlake has become the first hospital in North America to offer a new, targeted program to all staff members who are identified to benefit from safety training. “We are in this profession because we care about people and the protection of Southlake’s patients and staff is something that is taken very seriously,” says Dr. Dave Williams, Southlake President & CEO. “Utilizing advanced training helps us ensure we have the right tools to be safe, stay safe, and when necessary, understand how best to neutralize a situation.” Nonviolent Crisis Intervention-MAPA Edition (Management of Actual or Potential Aggression), was initially offered as an advanced training program on a very limited basis. Determined to add this expertise, which provides an advanced Decision Making Matrix to enable people to react accordingly in situations that present risks to themselves or others, Southlake sent two CPI Certified Instructors for training.


Strategies from this training give people working in areas that see highly stressed patients and family members the skills to safely and effectively respond to anxious, hostile, or violent behavior while balancing the responsibilities of care. “With an emergency department that sees over 90,000 visits a year, a mental health department serving over 18,000 patient visits, and with many regional programs, Southlake treats patients with complex health needs, and in many cases, they, and their family members, are under considerable stress,” says Stephen Cruickshank, Southlake Child and Youth Counselor. “People who come to hospitals are experiencing a wide range of circumstances. Sometimes they are simply at their boiling point,” adds Gordon Semple, Southlake Staff Education and Safety Officer. “Just because someone looks angry does not

Crisis Prevention Facilitators Stephen Cruickshank, Kim Nelson, Janet Giannini, and Gord Semple have delivered over 1800 hours of training to their colleagues at Southlake. mean they do not need our assistance. We can’t just say zero tolerance. As caregivers, we have a duty of care.” Strategies from this training give people working in areas that see highly stressed patients and family members the skills to safely and effectively respond to anxious, hostile, or violent behavior while balancing the responsibilities of care. “When people are in a situation of unexpected chaos, confusion, pain or significant loss, their behaviour can change dramatically. In situations like these, many people emerge presenting versions of themselves that are far outside their normal behaviour,” says Judith Schubert. “Just about every day we hear of critical situations involving violence where someone close to the aggressor says the person is ‘not usually like that’.” Every situation is unique. Sometimes acting-out is alleviated once the person has had their concerns addressed and has time to deescalate. At other times, the situation does not readily deescalate. It is important for caregivers and staff members to be aware of these situations and to put safeguard precautions in place with the notion of prevention. The Advanced CPI course examines the likelihood and severity of risk behaviours and considers external factors that must be managed in conjunction with the primary intervention-environmental factors, other people at risk, objects that could be used as weapons, time, and availability of resources and assistance. The emotional components cannot be overlooked. Grief, anger, worry, and hopelessness can overtake the brain’s rational response mechanisms. “Rather than seek a ‘one-size-fits-all’ solution, those providing care need to have capabilities and confidence so they can be attentive to the evolving moments before them, pay attention to fluctuations and evaluate all variables,” adds Schubert. Bypassing careful risk assessment can easily result in a well-meaning staff member inadvertently escalating the situation. CPI uses a “train the trainer” model which allows staff to become facilitators who can train staff in their own organization. “Training must apply to the people

in the room; otherwise, these people may as well just read a manual,” says Judith Schubert. “That’s why we certify instructors to provide training to their fellow staff members. These trainers know the audience, know what they are experiencing and what they are working to address.” The hospital currently has four facilitators who have received extensive training and have used their learned expertise to deliver over 1800 hours of targeted training to Southlake staff throughout the organization. These facilitators understand the unique situations that can face Southlake personnel. As a high reliability organization, dedicated to putting safety and quality at the forefront, Southlake has been proactive in developing initiatives targeted to keeping patients, staff, volunteers and visitors safe.

The Hospital recently created a Workplace Violence Prevention Committee, made up of members of the leadership team, frontline staff, Service Employees International Union and Ontario Nurses’ Association representatives, medical staff, the Joint Occupational Health and Safety Committee, the Public Services Health & Safety Association and York Regional Police. “Whether it is in strategies learned from specialized training, or working to reduce the risk of workplace violence, knowledge and training is key to addressing potentially unsafe situations and creating a safe environment for everyone who walks through H our doors,” adds Dr. Williams. ■ Judy Murdoch is a Media and Government Relations Specialist at Southlake Regional Health Centre.

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18 Focus


Engaging employees through in-house programs By Sara Macdonald


eing recognized as one of Canada’s Top 100 Employers doesn’t happen overnight. At Provincial Health Services Authority (PHSA) it’s been a process of continuous improvement-of reassessing and refining the employee experience that we provide for the 19,000 staff working at over 270 locations across British Columbia. PHSA, the first organization of its kind in Canada, is responsible for specialized, province-wide health care services in BC. Its agencies-including BC Cancer Agency, BC Children’s Hospital, BC Mental Health & Substance Use Services, and BC Women’s Hospital and Health Centre-

It is often about low-cost innovative, creative ways to engage employees, to give them a voice, and to ensure they have the tools to excel both personally and professionally

each bring a unique group of employees to PHSA’s mosaic of cultures that span generations and demographics. As PHSA develops programs to meet the needs of its people, the organization has learned that it’s not only costly programs that have a deep impact. Indeed, it is often about low-cost innovative, creative ways to engage employees, to give them a voice, and to ensure they have the tools to excel both personally and professionally. Whether an employee is at the start of their career, or in a leadership role, the goal at PHSA is to create programs to help people succeed professionally. There is a robust catalogue of in-house programs and courses to ensure its teams are equipped for growth. LearningHub is a cost-effective learning system housing over 840 training courses, most available at no cost. Over 12,000 learners are registered for courses such as project management, depression in the workplace, and chemotherapy certification for pharmacists. LearningHub allows PHSA to adapt to changing educational

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Oncology nurses at PHSA’s BC Cancer Agency care for a vulnerable patient population and forge long-lasting friendships in the workplace. needs, and the eLearning specialist trains departments to create their own courses. The online platform is available 24/7 and ensures teams across the entire provinceincluding rural and remote areas-can participate and have the same experience as their colleagues in urban areas. For young employees (over 13 per cent of PHSA’s workforce), there are employeeled training programs designed to give the opportunity to consolidate skills and practice working as a member of an interdisciplinary team. For example, the Nursing Resource Team (NRT) at BC Children’s Hospital, is an innovative approach that provides foundational education in the different pediatric subspecialties. This ensures not only that patient care and safety remain at the forefront; it also helps to develop a young nurse and identify career passions and pathways for the future. For seasoned employees, including frontline staff and leaders of all levels, PHSA has a number of in-house programs promoting a culture of continuous learning. • Employee-led coaching programs are offered in three tiers, each designed to meet the needs of the individual staff member and prepare them for the next tier. Working with peers, participants put theory into practice and develop connections with colleagues across other departments. • Leadership LINX is a province-wide collaboration is designed to specifically target the challenges health care leaders face in BC. The program, which launched in January 2013, is for all levels of leadership, from emerging leaders to senior leaders. In an effort to engage and equip our workforce as change-makers, PHSA developed a program, “imPROVE,” based on Lean principles. The program empowers employees to redesign their own work processes to identify and reduce waste, and improve patient safety, quality, and outcomes. imPROVE is not about quick-fixes; it is about long-term change. Over 2,100 employees have gone through training or participated in a “Lean” event, and have contributed invaluable expertise, knowledge, and innovative suggestions on how to improve the organization. PHSA wants its employees to succeed at work, but also wants to ensure employees live fulfilling, healthy lives outside of work. As such, in addition to our extended benefit plans, PHSA offers many programs to help employees attain, maintain and enjoy a healthy physical, mental, and financial life.

On-site, subsidized fitness programs at many locations include yoga, Pilates, and Nordic Pole Walking, and the organization has negotiated deep discounts at local fitness centres across BC. PHSA organizes pocket markets, health fairs, and stretch aid attendant training. Courses such as Financial Literacy for Health Care Workers provide a safe, non-sales environment led by financial experts to help attendees understand their finances. These events take place during lunch and are brought right to the employees. A robust website is accessible to staff from any computer at Addressing the needs of PHSA employees outside of work is important, as is allowing them to bring their personal values into the workplace. One example is PHSA’s award-winning Green+Leaders program, our employee-led “green team”. Launched in 2009, it is now active in over 110 PHSA departments and has been implemented across the other Lower Mainland health authorities. The program is based on behavior-change campaigns that occur through one-to-one peer conversation. More information can be found at http:// In order to develop, launch, and further all of these programs, effective and meaningful communication strategies are critical. PHSA uses digital tools for province-wide reach, and facilitate town hall meetings and departmental staff meeting at a local level. This helps ensure alignment amongst our 19,000+ employees, and provides the platform for robust, two-way communication. The organization’s intranet, POD (PHSA On Demand), is an all-encompassing platform for relevant communication, tools, and feedback. The e-newsletter, PHSANews, is a collection of stories from across PHSA that communicates important information, events, and achievements. It is created entirely of stories submitted by employees at all levels of the organization. Relevant development opportunities, employee well-being, and timely, twoway communications is how we empower our people to succeed, and to play a meaningful part in steering PHSA into the H future. ■ Sara Macdonald is a Specialist with PHSA’s Talent Acquisition & Employee Recognition team.

Ethics 19

Assisted suicide: Whose voices, whose choices? By Kevin Reel


hinking back on 2013, there was one ethical issue that prevailed in the public eye above all others-assisted suicide. This has been driven in part by the continuing attention to stories from 2012. People like Gloria Taylor in British Columbia and Nagui Morcos in Ontario catapulted the debate to the headlines and the courts. The debate has continued in the media, in government and in healthcare at large. Public awareness has mushroomed this year, 20 years since Sue Rodriguezâ&#x20AC;&#x2122; unsuccessful bid for legal assistance to end her own life. A growing number of stories like those of Amy Doolittle, Susan Griffiths and more have brought the experience of those wishing for help in dying to our attention over and over again. More recently, Donald Low shared his story before dying. The theologian Hans Kung has expressed his own wish for such assistance. A poignant differing choice was voiced by Larry Librach, a palliative care physician in Ontario who died of cancer. He described being both fearful of death and able to confidently choose palliative care as his plan. In politics, the Quebec government is set to pass its medical aid in dying bill. The federal Conservatives passed a motion at their party conference expressing their



opposition to the idea of assisted suicide. Gloria Taylor's case might end up in the Supreme Court of Canada in 2014. There are some very understandable fears expressed by opponents-the sorts of 'yuck' factors that indicate deeply held values coming into the equation. Yuck factors are a great flag telling us to 'stop and think'they highlight that there's something important here to ponder. Yuck alarms are not always straightforward, the 'think' part of the yuck response is always crucial to sift emotions and ethics. Among those fears is the â&#x20AC;&#x2DC;slippery slopeâ&#x20AC;&#x2122; argument-which anticipates misuse of the power to intentionally end someone's life. Another fear comes before the slope... the pressure for people to feel they ought to end their life as they are becoming a burden to others... more like a nasty push. Alternatives to assisting suicide are also emphasized as the better way. High quality palliative care can manage the discomfort of the dying process and make any notion of ending life prematurely unnecessary. All these ideas warrant great consideration. The further development of palliative care services is something few could object to. Presently it is available only to a minority of people in Canada. When it is available to all, what do we say to a person who tells us that they would still wish to avoid the increasingly burdensome experi-

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How would you respond to your patient who tells you that they find daily existence a burden no longer worthwhile, offering little meaning and purpose? If we don't consider legalizing assisted suicide, some big questions remain: How would you respond to your patient who tells you that they find daily existence a burden no longer worthwhile, offering little meaning and purpose? What if they say they've had enough of their struggle in breathing, their need for three people to assist them to use the toilet, their inability to shift in bed or chair when a cramp or twitch or itch nags at them? Increasingly unable to engage with the world around them, they are left to endlessly ponder their own end. In the face of these reasons

for asking that they be assisted to end their life sooner than it will otherwise, what would you say? How can you respond with consideration of their capable request, their best interests? If we do consider trying to honour the differing needs and wishes of patients like Larry, Donald, Gloria and others yet to come, how do we sift through our own 'yuck' reactions to discover what could and what should be possible? What safeguards do we need to put in place to allay the fears of so many people, including other patients? Do you fear health care professionals will overstep the intent of such a law and abuse it? If we move to legalize, what do you think are the most important of those safeguards? In either case, there will be vulnerable and frightened people to support, as there are always in health care practice. Whose voices give you those 'yuck' feelings? Should any voices carry more weight than others? Can we hear them all, and offer the H choices they want? â&#x2013; Kevin Reel is a Clinical and Organizational Ethicist at Southlake Regional Health Centre and Mackenzie Health and an Assistant Professor, Department of Occupational Science and Occupational Therapy, University of Toronto.

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Better care for a better life JANUARY 2014 HOSPITAL NEWS

20 Focus



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January 2014 Edition  

Focus on Professional Development/Recruitment and Retention, Health and Safety for health care professionals. PLUS: Special Professional De...

January 2014 Edition  

Focus on Professional Development/Recruitment and Retention, Health and Safety for health care professionals. PLUS: Special Professional De...