Our Shared Purpose newsletter - March 2019

OUR SHARED PURPOSE March 2019

Bridging cultures and languages Interpreters provide support for patients and care providers (pg. 7)

Iron Mom How an app is helping women have the healthiest pregnancy possible (pg. 2)

THE

ROOT RESEARCH 101

OF WHY What it takes to innovate (pg. 4)help doctors Better techniques and staff manage responsive behaviours (pg. 4)

Meeting new friends, enjoying rehab experiences Unique partnership with Variety Village helps patients transition and return home (pg. 8)

Care without judgment Providing care for pregnant women with addictions (pg. 3)

Dr. Michelle Sholzberg is the co-creator of Iron Mom at St. Michael’s

Dr. Alice Ordean is the medical director of St. Joseph’s T-CUP clinic.

Care without judgment

Iron Mom How an app is helping women have the healthiest pregnancy possible

Dr. Suzanne Turner, medical director of St. Michael’s Substance Use in Pregnancy clinic, holds a 2018 Values in Action award that she accepted with the clinic’s Dr. Erin Lurie (far left) from Mission and Values Manager Donna Romano and Unity Health Toronto CEO and President Dr. Tim Rutledge

by Amber Daugherty

Providing care without judgment for pregnant women with addictions

by Mary Dickie

It’s a generally accepted fact that many women develop anemia

diminished concentration affecting IQ, reduced work productivity –

Pregnant women with addiction issues can face barriers like

in pregnancy, a condition in which the body doesn’t have enough

and the potential for a blood transfusion, which comes with its own

poverty, insecure housing and violence on top of the health risks

Ordean, medical director of T-CUP. “There’s no sign saying pregnant

healthy red blood cells to carry oxygen to tissues, often leaving

heightened risks. Risks to the baby include reduced birth weight,

of substance use. To make matters worse, they are often reluctant

addicts come here. So they can sit in the waiting room with other

preterm delivery, poor academic performance

to seek out the medical care they need, says Dr. Suzanne Turner,

mothers and feel like a normal person. And our appointments are

into early childhood years and more.

medical director of St. Michael’s Substance Use in Pregnancy clinic.

longer, so we can problem solve for various issues in one visit.”

women feeling tired and weak.

“

solution because it doesn’t contain enough iron

Treating iron deficiency isn’t as simple as handing out iron pills – it requires a culture change and IRON MOM addresses that need.

and because it contains calcium, which blocks

DR. MICHELLE SHOLZBERG

But a team at St. Michael’s believes the

condition can be a thing of the past – if women get more iron. That’s why they’ve created IRON MOM, a tool to help expectant mothers get the right amount of iron for the healthiest pregnancy – and baby – possible.

“It takes about the equivalent of 177 steaks

to make a baby and to make the extra blood that a woman needs to sustain her pregnancy,” said Dr. Michelle Sholzberg, one of the creators of IRON MOM. “You cannot eat your way out of an iron deficiency. And the prenatal vitamin is not a

the absorption of iron. Treating iron deficiency isn’t as

“

CO-CREATOR OF IRON MOM ST. MICHAEL’S

simple as handing out iron pills – it requires a culture

IRON MOM presents all of this

they don’t even need an appointment.

now for expecting moms at

protection services,” says Dr. Turner, whose team won the St. Michael’s

St. Michael’s. It has guidance on how to properly

2018 Values in Action award for social responsibility.

referral, they can just come by,” says Dr. Turner.

take iron supplements and manage side effects

and provides supports for women to feel more

we tell them their health is first and foremost, and we have social

obstetrician’s office for a 9 a.m. appointment just by being flexible.”

empowered to speak to their care providers

workers working with child protection to provide the best outcomes

to ensure they’re receiving enough iron. The

for everyone.”

not,” says Dr. Ordean.

ultimate goal is to spread this across the country

so all women become more aware of the

for Substance Use in Pregnancy ( T-CUP) at St. Joseph’s each provide

come during the first trimester have better outcomes in terms of

importance of iron in pregnancy.

comprehensive, compassionate pre- and post-natal care without

reduced substance use than women who show up later. But even

“This is important to me because I

judgment. They are family medicine-based clinics, with physicians

just by getting prenatal care and not stopping their addiction, they

feel strongly that this is a neglected women’s-

and nurses trained in obstetrics and addiction care supported

will still have improved outcomes.”

health issue and it interferes with the basic needs

by social workers, addiction counselors and related community

of pregnancy,” said Dr. Sholzberg. “If there’s a way to

organizations to provide integrated care for patients and their babies.

medical risks, why wouldn’t we take it?”

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OUR SHARED PURPOSE

At the St. Michael’s clinic, in the St. James Town Health Centre,

present for prenatal care because they’re concerned about child

help improve the quality of life for new moms and babies and reduce

including fatigue, shortness of breath, postpartum depression,

information in a helpful app that’s available right

change and IRON MOM addresses that need.”

Iron deficiency in pregnancy can cause a multitude of problems

“The majority of women with a history of substance use don’t

“The mums love coming to a family medicine clinic,” says Dr. Alice

“That’s a huge barrier, but if we can get them into the clinic,

The Substance Use in Pregnancy clinic and the Toronto Centre

“If a patient is staying at a shelter, they don’t have to call or get a “We’ve reached a lot of women who’d never make it to an “They know they can come for care, whether they’re using or “And the earlier we can get them in, the better. Women who

Our Shared Purpose is a monthly newsletter highlighting our people and the ways they are improving care, patient experience and the health of our communities.

Learn more: www.unityhealth.to

OUR SHARED PURPOSE

3

Getting to the root of why Effective de-escalation techniques for responsive behaviours help staff and physicians see the person and address their needs

by Emily Dawson

(L-R) Cecilia Santiago, nursing practice manager, and Lori Whelan, Leadership & Organizational Development consultant, recently shared Managing Responsive Behaviours findings at the IPBR showcase.

Teams across Unity Health Toronto say training programs on

to calm or divert attention in a patient showing responsive behaviours,

managing responsive behaviours, which can include cursing and

which only provides transient solutions,” said Huy Ngo, the corporate

resistance to essential care, are having immediate and positive

advanced practice clinical educator who led the GPA initiative from

benefits. People with complex mental health, dementia and other

conception to implementation at St. Joseph’s.

neurological conditions may exhibit responsive behaviours, which are

“What GPA teaches is a deeper understanding of why this happens,

verbal and non-verbal actions that try to communicate what someone

effective verbal de-escalation techniques and practical tactics to work

wants or feels.

with the person to address their needs.”

Gentle Persuasion seminars at Providence (top left and bottom right) and St. Joseph’s bring clinicians together to learn techniques to prevent and de-escalate responsive behaviours

Jube Walker, director of care at the Cardinal Ambrozic Houses

keeping observers with patients at all times. However, there’s very little

equipped to compassionately care for patients and residents after

of Providence and a certified GPA instructor, said she appreciates the

data to demonstrate that observation actually prevents harm, and it’s

alterations to the MRB curriculum with course materials for specific

participating in this training – which also helps support our workplace

program’s discussion about “personhood” and the explanation of a

expensive,” said Santiago. “The benefits of MRB are felt by the patient,

patient populations in different programs, and 479 practitioners have

violence prevention strategies,” said Mitch Birken, senior director of

person’s journey with dementia.

staff and our health-care system. Most importantly, it’s more person-

participated.

Human Resources Consulting.

centred.”

training,” said Walker.

revealing how much they value the sessions.

St. Joseph’s and the Managing Responsive Behaviours (MRB) training

A working group co-led by Cecilia Santiago, a nursing practice

Providence, 67 staff have completed the full-day training and the

is in place at St. Michael’s.

manager at St. Michael’s, designed the MRB training specifically for their

Houses leadership even hosted a session for families and caregivers.

came in thinking I would learn nothing and I left with information that I

The two training programs share the same goal: to provide a variety

acute-care context. St. Michael’s prioritized the work in support of the

Twelve people attended that session.

am eager to practice!’” said Ngo. “That’s the kind of response that makes

of activities that can help staff successfully prevent and de-escalate

Senior Friendly Community of Practice initiatives through the Toronto

me realize GPA is changing lives.”

responsive behaviours.

Academic Health Science Network.

people as of January 2019, which is almost 93 per cent of its compliance

rate to reach 377 staff.

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“We’ve heard that staff feel safer, more confident and better

The Gentle Persuasion Approach (GPA) is used at Providence and

In the past, clinicians would use distraction methods alone to try

OUR SHARED PURPOSE

“It really helps frame understanding and engagement in the

“Prior to MRB, we were using a lot of constant monitoring –

The impact of GPA and MRB is growing across our network. At

Eight GPA-certified coaches at St. Joseph’s have trained 350

Since the start of the pilot, Santiago and the team have made

Training participants are reaping the benefits and their feedback is “The best feedback I received came from a nurse who told me, ‘I

OUR SHARED PURPOSE

5

A MORE THOUGHTFUL APPROACH TO GENDER EQUITY The current focus on implicit bias risks masking broader structural barriers to women’s advancement in STEMM fields, Dr. Cheryl Pritlove and her colleagues at St. Michael’s Applied Health Research Centre wrote in a commentary recently published in The Lancet.

The researchers hope their piece encourages people to think critically about individual-level interventions. They say implicit bias training is one important change, but that policies must also consider the vast and systemic nature of gender inequity.

“In order for institutional policies to be meaningful and encourage positive change, they need to take into consideration the broader systems that intersect,” Dr. Pritlove said.

Researchers Kari Ala-leppilampi, Dr. Cheryl Pritlove, Dr. Clara Juando-Prats and Dr. Janet Parsons co-authored a piece on unconscious bias training in The Lancet. (Photo: Katie Cooper)

Bridging cultures and languages Interpreters provide support for patients and health-care providers

by Amber Daugherty

FROM BEDSIDE, TO BENCH, AND BACK TO BEDSIDE With support from MaRS Innovation and the Banting and Best Diabetes Centre, Drs. Richard Gilbert and Darren Yuen, scientists at the Keenan Research Centre for Biomedical Science (KRCBS), found a new way to tackle the problem of fibrosis – or the excessive tissue scarring that leads to kidney, liver, lung and heart failure. They then turned their discoveries into a biotechnology company, Fibrocor Therapeutics.

Their own research at the KRCBS and collaboration with the Pathology Department at St. Michael’s is the foundation of this discovery.

“We have a breakthrough strategy in the ability to develop new therapies for fibrosis-related disease,” Dr. Gilbert said.

This is what kidney fibrosis looks like under the microscope – a disease Fibrocor is fighting. (Photo provided by: Dr. Adriana Krizova, pathologist at St. Michael’s)

Silvia Croci is an Accredited Community Interpreter who provides Italian interpreter support at St. Joseph’s

High quality health care involves providing information to patients so

conversation – that’s what you always have to remember. I am also

they can make informed decisions about their own health – which

usually briefed beforehand which helps me prepare in advance for

can become a challenge when patients and providers don’t speak the

interpreting situations that are more emotionally challenging.

same language. This is when interpreter services becomes vital. At each of our sites, we have partnerships with agencies or interpreters who become part of our care team, providing interpretation support for both health-care providers sharing diagnoses and advice and for patients communicating their questions and wishes. Silvia Croci is an Accredited Community Interpreter who provides Italian interpreter support at St. Joseph’s – we caught up with her to learn more about

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INTRODUCING THE GLA:D CLINIC AT PROVIDENCE SHARING MEDICAL IMAGING DATA TO CUT RADIATION DOSES Providence has opened a GLA:D program for conservative

what she does.

management of osteoarthritis in hips and knees. designed Patients might expect radiation doses forOriginally CT scans to be in Denmark, GLA:D Canada is making this program available comparable from one hospital to the next, but a team at across the country. GLA:D offers 12 exercise and two St. Michael’s Hospital saysclients the dose variance classes can be startling. education sessions over seven weeks.

The team is collecting and analyzing data from eight hospitals for the “The ultimate goalsMetadata are to help people avoid surgery, assist Medical Imaging Repository of Ontario (MIMRO) in pain management, improve strength, provide education on the to help reduce the province’s average radiation dose per scan. challenges of living with arthritis, and instill a sense of accountability Using artificial intelligence to sort the hospitals’ data, the team with patients for their owndata care,”by said Annascanner Marie Sneath, professional generated comparative facility, and exam to help practice leader for Physiotherapy at Providence. determine best practices. MIMRO is funded primarily by St. Michael’s The Toronto LHIN has Regional Assessment andCentral was created by linked two ofwith its radiologists, Centres to provide assessment and registration.

Both St. Michael’s Drs. Timothy Dowdell and Bruce Gray. and St. Joseph’s operate GLA:D programs, demonstrating that Unity Radiologist Dr.isBruce Gray and analystsupport Lianne Concepcion reviewwith data Health Toronto helping thedata system more clients submitted to MIMRO. (Photo: Katie Cooper) osteoarthritis.

becomes especially important when they’re making difficult decisions

OUR SHARED PURPOSE Dellene Sakaguchi is one of seven GLA:D trained physiotherapists in Providence’s program.

How do you describe the job of an interpreter?

We get to be the voice of patients to support them in their care. That because not everyone always agrees – my role is to make sure that everything said is interpreted accurately and clearly.

What kind of an impact does that have on you?

Interpreters can experience vicarious trauma because of exposure to stressful and emotionally charged situations. The interpreter community in recent years has developed a debriefing program to provide support – I’m a facilitator and in those sessions, we provide a confidential space for interpreters to speak about their experiences without judgment.

Why is it important to have interpreters as part of health-care teams?

When receiving care, it’s critical that patients understand the medical information being given to them in order to make informed decisions and for providers to understand patients’ needs. Relying on family members for interpretation can pose issues because there’s emotion

You might have to interpret a negative diagnosis for a patient –

involved and they’re not trained so they may not know the medical

like that their treatment isn’t working or palliative care is their

terminology. Interpreters help make the experience better for both

only option. Is it difficult to not show emotion during those

patients and providers by reducing the risk of misunderstandings and

conversations?

communication errors and providing patients the opportunity to be

Yes, but interpreters are trained to be neutral. Interpreters may be

more involved in their care. Our job is helping empower them to have

physically present during the conversation but they are not part of the

the best care experience possible.

OUR SHARED PURPOSE

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Enjoying new rehab experiences New program is an effective transitional resource for returning home

by Emily Dawson

Gregory Clark visits Variety Village up to three times a week, where he continues working toward his rehab goals.

When Gregory Clark was discharged from Providence, he felt a little discouraged. “Although I was physically stronger after my rehab, and I could do more than I thought I’d be able to, I wasn’t working and I was worried I’d be bored at home. I knew that could set back all the progress I’d made,” said Clark.

Clark was both an inpatient and an outpatient at Providence. As a

recent amputee, he had to learn to stand, balance, walk and manage a prosthetic leg. The challenge was daunting, but he was dedicated to his rehab.

“I set realistic goals and didn’t expect to run and jump right away.

I had to give it time to see progress, and I had to follow everything my

Gregory Clark with members of his Variety Village care team including Providence physiotherapists Rony Toma and Christian Leyco.

therapists told me.”

“I do many of the same physio exercises I did at Providence, and even

work with one of the same therapists.

There was no “easy way” for Clark – it was sheer hard work and

will. “I came to Providence in a wheelchair and I left with a walker,” he

said.

reason, they’ll call me and ask why I wasn’t there. They notice. It’s an

Outside Providence, he needed a source of social and physical

“I’ve made a lot of great friends. If I have to miss a session for any

amazing place - I’d recommend it to anyone.”

stimulation. Clark had heard about the Rehab to Community

Transition program through a unique partnership with Variety Village.

transitional resource for people returning home. It’s all part of

He embraced the idea and started going to Variety Village three days

Providence’s commitment to helping people flourish beyond our

a week.

walls.

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Clark’s voice is animated when talking about Variety Village.

OUR SHARED PURPOSE

Providence’s partnership with Variety Village is an effective