The Interview: January - March 2018

MAR 2018

THE

INTER-VIEW

TCI HOSPITAL LEADERSHIP FORUM - 'A SUCCESS' Welcome to the January - March 2018 edition of Turks and Caicos Islands Hospital Newsletter, which features stories from across the health care organisation. A new edition is published at the end of every quarter.

INSIDE THE ISSUE

In an emergency, what treatment is given by ear?

Words of Comfort. - Abraham Verghese, MD

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Turks and Caicos Islands Hospital welcomes new Chief Executive Officer.

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Revised Strategic Plan 2017-2020 launched across the hospital in a series of meetings.

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Over 50 hospital managerial staff convene for leadership forum at The Palms Resort.

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Employees compete for $3,000 prize pool in a Diamond Challenge.

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Family of accident victim shares emotional testimonial of son's life-saving surgery.

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Other speakers included members of the company’s senior management team along with present and former Minister of Health and Human Services, Honorable Edwin Astwood and Honorable Doctor Rufus Ewing, respectively.

InterHealth Canada - Turks and Caicos Islands Hospital hosted a leadership forum for over 50 internal staff at the Messel Ballroom of the Palms Resort on March 9th, 2018 under the theme “Beyond the Boundaries - Elevating Leadership through Excellence & Innovation”.

The format included a plenary session and half-day workshop to afford organizational leaders and middle management staff the opportunity for exposure to different models, best practices and application of leadership principals in an effort to stimulate self reflection and skill enhancement.

The forum featured a line-up of organizational and external speakers, which included Ambassador Joan Underwood of Antigua who is a veteran senior management consultant, policy advisor and expert in training programmes for public and private sector executives.

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Participants were also exposed to the principles of Emotional Intelligence (EI). The EI workshop facilitated by Ambassador Underwood was designed to bridge the connection between leadership styles and the manner in which individuals recognize, connect with, and learn from their own mental and emotional state, and those of others.

During the presentations, references were made to situational leadership and the importance of morality, citing examples of prominent persons in history who used their position of authority for both positive and negative objectives. It was stressed that leadership should not be perceived as a position of authority, but rather a personal attribute which transcends hierarchy.

Leaders can be found at all levels within an organization and there is a difference between ‘managers’ and ‘leaders’ Manager of Education at InterHealth Canada – TCI Hospital, Jacqueline Moe-Cox said: “The sessions were interactive and informative; participants took the opportunity to engage in stimulating intellectual discussion with the facilitators on various aspects of leadership."

John C. Maxwell

"The facilitator of the EI workshop used practical examples, exercises such as the Johari window and team activities to deliver an invigorating session on how Emotional Intelligence principles can be used to positively impact leadership.”

She continued: “Comments made during the session and written evaluations indicate that both sessions were well-received by participants and they left invigorated and inspired to implement some of the techniques to enhance their personal leadership skill sets to the organization’s advantage.”

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BON

VOYAGE Employees from across the Turks and Caicos Islands Hospital bid farewell to then Chief Executive Officer of InterHealth Canada TCI Ltd, Daniel Carriere who resigned for family reasons, effective January 31, 2018. During the sendoff event, managers and frontline staff reflected on their best moments in the work environment, and extended good wishes to the hard-working health care boss.

Gaston Levac, a former Chief Executive Officer of hospital operations within Ontario Canada was appointed as interim CEO and immediately assumed the post following Carriere’s departure earlier this year.

John Hyland, InterHealth Canada Legal Director

Speaking on behalf of the InterHealth Canada Board, John Hyland said: “Daniel’s contribution to the success of the TCI Hospital and its increasing international recognition as an example of how even small hospitals in the region can and should perform, cannot be overstated. Since joining us in September 2015, he has strengthened the administration, overseen the company’s policy of continuing improvement in performance in all departments, continued the programme of promoting Belongers to positions of greater responsibility within the Hospital, encouraged the attendance of staff at Seminars and other Continuing Education courses, played a leading role in the preparation of plans for the strategic development of the Hospital over the coming years.

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"Importantly and perhaps for him most memorably, through his leadership by example and with the support of his Senior Management Team, he was able to ensure the continued operation of the Hospital through Hurricanes Irma and Maria and the implementation of the necessary recovery programme. He leaves with our hopes and very best wishes for the future.”

Daniel Carriere said: “It has been an enormous privilege to have led the organization over the past two plus years. I have immensely enjoyed my experience in this beautiful country with such talented hospital personnel. I have met such great people both inside and outside the hospital and have experienced so many new and exciting challenges that have enriched my personal and professional life. I have benefitted from the wisdom obtained from professional colleagues and historical guidance from IHC Board members, many of whom are legacy participants in the original development of the two hospitals in Providenciales and Grand Turk; they remain committed to the hospital and the country of TCI.” Mr. Carriere is a veteran in the health care industry having joined InterHealth Canada as Chief Executive Officer in September 2015.

Carriere had previously held several senior administrative positions in Ontario’s health care sector and is recognized for his accomplishments in advancing services and quality of care.

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NEW CEO APPOINTED TO TCI HOSPITAL Professional Background Gaston Levac formerly served as President and Chief Executive Officer of various health care entities such as the Canadian College of Health Service Executives, Thunder Bay Regional Hospital, Laurentian Hospital and West Nipissing General Hospital in Canada.

As a former Surveyor of the Canadian Council on Health Services Accreditation, Levac boasts over 20 years of experience in numerous surveys in Canadian and international health care organizations, including health services offered in various military bases in Canada and several hospitals in the Caribbean. Levac has been involved in numerous professional activities. These include: Member - Board of Directors of Ontario Hospital Association, Member and Chairman - Canadian Hospital (now Healthcare) Association (OHA), Founding Member - Joint Priorities & Planning Committee with Ontario Ministry of Health and OHA, Member and Chairman of Board of Directors – Cambrian Community College and Chairman of the “Access to Care in the North” provincial Task Force.

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BY NIKIRA JOHN

"The consumer demand for accredited facilities and quality health care services continues to increase globally due to various industry factors including medical tourism. Therefore, accreditation acts as a quality assurance mechanism for patients, an emblem of distinction for the health care organization, and also ensures that we play our expected role in the national health care system.” - Gaston Levac, Interim CEO, InterHealth Canada (TCI) Ltd Turks and Caicos Islands Hospital has been accredited at the Diamond level since March 2012 and is currently one of the few Diamond accredited hospitals in the Caribbean. This is the highest level achievable under the international accreditation program.

Turks and Caicos Islands Hospital is scheduled to undergo a robust independent reassessment of its performance against recognized standards of best practice outlined under the Accreditation Canada International (ACI) Qmentum Program on June 11th -15th 2018.

During an ACI assessment, an external survey team dedicates five days to survey the Cheshire Hall and Cockburn Town Medical Centres. The three surveyors were recently declared to the organization. These trained peer reviewers will examine the hospital’s internal systems and processes, observe activities and gather data through interviews with patients and staff.

A full-site survey is carried out every three years to retain accreditation status.

ACI is one of only three accreditation bodies in the world, which focuses exclusively on health care services, and is acknowledged as the most-sought after accreditation organization for demonstrating a high level of compliance with rigorous standards.

Successful facilities are awarded Gold, Platinum or Diamond status in accordance with the quality of service and care delivered to patients.

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The performance of the health care facility is measured against 15 service standards and 32 required organizational practices (ROP's) with an exhaustive criteria. These performance benchmarks focus on quality and safety throughout all aspects of the organization’s services including clinical care, governance, leadership and infrastructure. Several readiness assessments were conducted within the past 12 months by an overseas independent consultant specializing in health care accreditation.

These are periodically initiated by the local health care organization as an invaluable tool to provide an official measurement of its preparedness and progress related to standards, audits and action plans.Â

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UNDERSTANDING OUR ACUTE SECONDARY HEALTH CARE SYSTEM

DID YOU KNOW?

For more answers to frequently asked questions, visit our website FAQ section: www.tcihospital.tc

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CHAD ROSOW'S STORY

When I got up around 3 am, I realised my son Chad and nephew Collin weren't home. The next day they were scheduled to return to New York. I went back to sleep until 6 am when my wife woke me saying Chad and Collin were in a car accident. I got up, called the Emergency Room and headed over to Cheshire Hall Medical Centre, not sure where it was located or what I would find.

Both were in the Emergency Room. Our son Chad was complaining of extreme stomach pain. He’d already had one dose of morphine and asked for more. This was around 6:30 am.

The emergency room doctor, Dr Doshia Auguste called the Head of Surgery Dr. Bonnie Mauchaza (left), who was on his way. After reviewing the CT scan Dr. Mauchaza recommended emergency abdominal surgery to determine the cause of Chad’s severe pain.

The father of an accident victim shared a testimonial on the care received at Cheshire Hall Medical Centre on Providenciales.

Dr. Mauchaza then cleared the surgical schedule and immediately set the wheels turning to help Chad.

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"THERE WERE MANY LONG MOMENTS WHEN I PREPARED MYSELF FOR THE WORST." Chad's father, Joel Rosow returned to Turks and Caicos Islands Hospital during the month of March, several weeks after his son's accident to conduct a two hour workshop on Stress Reduction. Rosow reflected on how he personally managed his son's encounter with a life and death scenario. A number of health care staff who were a part of his son's care team were present during the emotional session.

Chad and his cousin Collin were drunk from a long night of drinking. They hitched a ride from the bar in Salt Mills to their intended destination, The Somerset on Grace Bay. The driver, another guest at the resort, was also inebriated and wrecked the car at the IGA roundabout on Leeward Highway. The car was totalled.

Waiting almost four hours while Chad was being reconstructed afforded time for continual prayer.

There were many long moments when I prepared myself for the worst. Mercifully, Dr. Mauchaza and Dr. Burgess saved my son Chad s life. Had this unfortunate accident occurred before Cheshire Hall Medical Centre was built Chad would have had to have been airlifted to Miami and who knows what the outcome might have been. Dr Mauchaza exudes professionalism and experience. We, Chad and I were confident Dr. Mauchaza would put him back together.

The driver failed to circle the roundabout. Instead he went through the centre landing into the white concrete wall on the other side. Driver and cousin Collin were protected by their seat belts and air bags.

Chad in the back had a seat belt fastened but no air bag.

Dr. Mauchaza, Dr. Burgess and the entire High Dependency Unit nursing staff delivered the highest level of professional care around the clock for over two weeks healing Chad back to health. The physicians, nurses, and support staff including the custodial staff and cafeteria personnel all contributed to Chad’s recovery.

Sadly, Chad was nearly cut in two by the crash impact.

Dr. Mauchaza and Dr. Phillip Burgess (right) worked for about four hours putting Chad back together. His abdominal muscles were cut right through, there was small and large intestine damage and muscles needing repair. Because of the involvement of the intestines, risk of infection was a serious concern. The CT scan showed only the possibility of a small tear in the small intestine. Dr. Mauchaza wisely recommended emergency surgery.

We remain eternally grateful to the Cheshire Hall Medical Centre and especially Dr. Mauchaza and Dr. Burgess for saving Chad’s life and returning him to health.

Sincerely Joel Rosow

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WORLD KIDNEY DAY WALK Health care professionals from TCI Hospital provided complimentary health checks to attendees during the World Kidney Day walk held on Saturday, March 10th at Butterfield Square in Downtown Providenciales. In support of the National Kidney Foundation, the event was hosted by the Ministry of Health, Agriculture, Sports and Human Services in collaboration with and under the sponsorship of Graceway IGA.

CHRONIC KIDNEY DISEASE (CKD) AFFECTS APPROXIMATELY 195 MILLION WOMEN WORLDWIDE AND IT IS CURRENTLY THE 8TH LEADING CAUSE OF DEATH IN WOMEN, WITH CLOSE TO 600,000 DEATHS EACH YEAR. This year, the main focus is on women and chronic kidney disease.

The International Federation of Kidney Foundations (IFKF) states the risk of developing chronic kidney disease is just as high in women as in men, and maybe even higher. Studies have shown that CKD is more likely to develop in women when compared with men, with an average prevalence in women of 14% when compared to 12% in men.

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know your numbers BUILDING A MORE HEALTH CONSCIOUS SOCIETY

OVER 160 SCREENINGS recorded AT FORTIS FUN RUN Doctors and Nurses from TCI Hospital provided complimentary health checks to attendees during the Fortis TCI 10th Annual Fun Run held on Saturday, March 17th in Providenciales. Be encouraged to 'Know Your Numbers' and be aware of key numbers such as Cholesterol, Blood Pressure, Blood Sugar/Glucose and Body Mass Index (BMI). By keeping those numbers within a healthy range, you can greatly improve your health and reduce your risk for various health ailments.

Move-A-Thon 2018 Health Fair

TCHTA Wellness Exposition

Global Youth Day Outreach Initiative

Move-a-thon is an annual event and a major fundraiser for Nutrition in Demand. Nutrition in Demand is a non profit organization aimed at raising awareness of healthy eating through a variety of projects. TCI Hospital is among other medical companies who support the event on an annual basis.

WWW.TCIHOSPITAL.TC • 14INFO@TCIHOSPITAL.TC

REVISED STRATEGIC PLAN LAUNCHED The Senior Management Team under the direction of the Chief Executive Officer introduced InterHealth Canada - TCI Hospital's new Strategic Plan 2017-2020.

A total of 10 sensitisation sessions were held in late February across Cheshire Hall and Cockburn Town Medical Centres to launch the organisation's Strategic Plan 2017-2020. Gaston Levac, Interim Chief Executive Officer at TCI Hospital reinforced the hospital's revised mission, vision, values, pillars and priorities to reflect the direction of the organisation. The Operating Plan 2017-2020 is a much more comprehensive

structured framework, which supports the Strategic Plan, and is scheduled to be internally launched in another series of upcoming company wide meetings to ensure and encourage staff engagement and feedback at all levels.

A strategic plan typically covers a three to five year period. The document is updated to reflect changes in the population, acuity of patients, staffing and programmes.

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"The feedback received was positive and staff were appreciative of the opportunity for engagement."

The Turks and Caicos

OUR MISSION

Hospital, by nature, will exceed expectations through its commitment to professional excellence, safety to all and continuous quality improvement.

Our innovative and learning environment shall deliver efficient and effective services providing value for money.

InterHealth Canada TCI Ltd Strategic Plan 2017-2020

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Persons may experience situations every now and again that can impact their general wellbeing. InterHealth Canada - Turks and Caicos Islands Hospital has recognised these challenges and has introduced an Employee Assistance Programme to offer practical, real-world solutions to employee life issues that may derail productivity and satisfaction in the home and work environment.

The support program is operated by Inova, a comprehensive, top-ranked international provider of employee assistance services with a team of Master’s level counsellors. Inova offers the services of 60,000+ counselling providers in the U.S. and more than 10,000 providers in over 200 countries around the world.

The Employee Assistance Programme was formally launched on March 1st 2018 and provides an independent, impartial source of information and support. The service will also be accessible to household members close to employees, such as a partner or family member.

Information can be provided over the phone, via email, or by post; and counselling is offered at a time and location convenient to the employee.

The complimentary service is available 24 hours a day, 7 days a week, 365 days a year and there is no cost to the employee. Each employee has access to 5 counselling sessions per issue, per year and confidentiality and privacy is guaranteed. Personal information will not be disclosed and InterHealth Canada will only receive utilisation statistics and general information about work related issues to guide quality improvement initiatives. The Employee Assistance Programme will provide counselling and advice on a wide range of work and personal issues. Some of these issues may include, but are not limited to: - Improving relationships - Parenting - Couples’ support - Managing stress - Managing life changes

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- Career success - Surviving the loss of a loved one - Managing workplace pressure - Improving esteem and confidence - Referrals to local financial or legal resources - Pursuing personal interests ·- Maintaining physical health Counsellors will provide an assessment of the issue, recommend a short or long term solution, offer a referral (if necessary) to local or national based resources and follow-up with the employee and/or user. In addition to contacting the service via telephone, employees can also access online information and support. InterHealth Canada Turks and Caicos Islands Hospital employs nearly 300 persons.

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NATURALLY EXCELLENT, WHERE EVERYONE IS ENVIOUS OF OUR CULTURE AND CUSTOMERS RECEIVE THE FULL BENEFIT OF OUR OBSESSION WITHÂ QUALITY. OUR VISION

InterHealth Canada TCI LTD Strategic Plan 2017-2020

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Parliament Speakers tour TCI Hospital

(L-R): Gaston Levac - IHC CEO, Hon. Dwayne Taylor and Hon. Buck Watts Speaker of the Turks and Caicos Islands House of

Hon. Francis (Buck) Watts was elected to the

Assembly, Honourable Dwayne Taylor along with

Legislature of Prince Edward Island in the

Speaker of the P.E.I. (Prince Edward Islands)

provincial election held on May 28, 2007, and was

Legislature, Buck Watts and Clerk of P.E.I,

re-elected on October 3, 2011, and May 4, 2015.

Legislative Assembly, Charles MacKay conducted a tour of Cockburn Town Medical Centre in

A Liberal Member of the Legislative Assembly, he

Grand Turk on Tuesday, 06th February 2018 and

represents the constituency of Tracadie-

Cheshire Hall Medical Centre in Providenciales

Hillsborough Park, a unique riding comprised of

on Thursday, 08th February 2018.

both urban and rural elements.

Honourable Taylor was elected to the Legislature in 2003 representing the constituency of West Road, Grand Turk. He was then elected Deputy Speaker of the Council. Taylor was recently elected Speaker of the Turks and Caicos Islands House of Assembly in 2016 under the current PDM Administration.

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SURPRISE BIRTHDAY PARTY FOR YOUNG PATIENT FEB February 13th 2018 marked a special day for one of our younger patient's who celebrated her 5th birthday.

TICKLED PINK 08

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Zharyia Stubbs was tickled pink after a surprise gathering from our health care team.

Despite her lung condition, the little princess was enveloped with hugs, warmth, her flashy tiara and a barbie castle to brighten her day.Â

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THE INTERVIEW www.tcihospital.tc | info@tcihospital.tc

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ONCO LOGY

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the diamond challenge Employees at Turks and Caicos Islands Hospital are being pitted against each other in an incentivebased competition for a prize pool of US$3,000 to spotlight the most exemplary quality improvement initiative introduced over recent years.

‘The Diamond Challenge’ was announced as the health care organisation prepares for another accreditation assessment in June 2018.

Accreditation is an independent assessment of a health care organisation’s performance against internationally recognised standards of best practice.

The Turks and Caicos Islands Hospital has been accredited at the Diamond level since March 2012, which is the highest level achievable under the ACI Qmentum International Accreditation Program. A full-site survey is carried out every three years by independent overseas assessors to retain accreditation status.

Hospital employees may enter individually or as a team of no more than five persons. However, initiatives must show elements of the team dynamics. The quality improvement initiatives submitted must have been implemented between the years 2015 – 2018 and must show measurable impact or evidence of improvement in the practice environment.

The primary objective of the competition is to recognize health care professionals and encourage teams to evaluate and audit the output of their respective quality improvement initiatives in conjunction with the company’s strategic plan to continuously improve the delivery of health care services. The winners will be revealed on June 8th, 2018.

Submissions will be in poster format with strict guidelines, success factors, supporting literature/research and evidence coupled with a fast paced 3-5 minute in-person presentation before a diverse panel of judges.

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InterHealth Canada - Turks and Caicos Islands Hospital is seeking to form a standing committee to improve stakeholder engagement and ensure the inclusion of public opinion in future service improvement initiatives.

The private health care management company released a public request for applications to become a member of the Community Advisory Committee (CAC) as an act of community service and devotion to volunteerism. Interested persons should provide information demonstrating that he/she has the experience, attributes and insight to deliver relevant and rational suggestions and perspectives on health care matters of general interest to the community. The CAC shall bring together individuals with a variety of experiences with IHC - TCI: • To provide feedback on, and ideas for, initiatives and programs that enhance, ensure and embrace the model of patient-centered care; •To be a collaborative, positive and rational champion for the enhancement of high-quality patient-centered care at IHC - TCI; • To advance patient engagement and patient-centered care principles and practices at both medical centres;

Other duties may be assigned from time to time by the committee. Stakeholders are defined as the patients, staff, volunteers, healthcare providers and residents served by Turks and Caicos Islands Hospital. The attention of interested applicants is drawn to a section of the Terms of Reference setting forth the guidelines of the Community Advisory Committee. The committee shall comprise of the following: • A Co-Chair model by the end of the first year; • A minimum of ten general (non- IHC - TCI) members; • Two ex-officio members, which will be the CEO and Manager of Public Relations and Marketing whose roles help to enhance CAC activities; • Any other attendees will be by invitation only based on the agenda; In order to ensure a balanced representation, at least 50% of the members of the CAC shall be family/patient/community representatives who are not directly affiliated with InterHealth Canada – Turks and Caicos Islands Hospital. The term for general members is two years, renewable for a maximum of 2 terms (4 years). The CAC shall meet every second month or at the call of the Co-Chair(s).

Persons of varying professions and skill sets were encouraged to apply for membership. However, potential applicants should possess the following core qualities:

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• Pre-existing passion for causes including health care matters • Eagerness to participate at every meeting • Dependable and consistent • Strong desire for stewardship to others • Supportive, but willing to express their own opinion • Willing to learn as much as possible about health care operations • Community-connections; knowledgeable of community concerns • Uphold a positive reputation in the community and good character Applications were accepted in the format of a letter containing the following information: Description/personal background of the applicant; Details of previous or current civic-involvement or affiliations; Professional/educational credentials.

Members will be selected in accordance with a process set out in the CAC terms of reference. The deadline for expressions of interest was announced as April 6th, 2018.

Turks and Caicos Islands Hospital Public Relations & Marketing Department; PO Box 1044, Providenciales, Turks and Caicos Islands, BWI; Office Phone: +1 649941-2800 Ext: 71223; E-mail: info@tcihospital.tc

THEINTERVIEW

HAPPENINGS FROM ACROSS OUR HEALTH CARE FACILITIES Career's Day at Enid Capron Primary "What do you want to be when you grow up?" It's a fun and common question posed to kids to gauge and tickle their interests.

Job Readiness Mock Exercise Representatives from the Human Resources Department traveled to HJ Robinson High School on Grand Turk to participate in the Exit Readiness Mock Interview Exercise.

The exercise was held on February 21st to sensitize upper level students on the expectations of applying for a job. Students were interviewed by members of the HR team to create a real-life scenario and given recommendations on how they can improve.

Grand Turk VTE Survey Winner The Venous Thromboembolism (VTE) Quiz was one of the initiatives launched during the hospital's VTE awareness month in October 2017.

World Thrombosis Day was also observed during this period. The first two staff members across both hospital sites to achieve a score of 100 % received a $100.00 USD gift certificate. Physiotherapist based at Cockburn Town Medical Centre, Marsha-lee Whitlock, won the competition on Grand Turk. Winners of the Cheshire Hall Medical Centre Quiz were announced in the most recent newsletter edition.

THREE NEW YEARS DAY BABIES The first baby of 2018 born at Cheshire Hall Medical Centre on Providenciales was delivered in the early afternoon hours of the New Year.

The 2lbs, 2oz girl entered the world at 1:17 p.m., born to mother Esther Duveau and father Nicolas Dieuffrant.

Just over six hours later, another baby girl weighing 6lbs, 6oz was delivered at 7:35 p.m., to mother Jean Louis Meritable and father Norcillien Doreus.

The third baby delivered on New Year’s Day at 11:37 p.m. altered the pattern of baby girls being recorded as the special day nearly came to a close.

A bouncing baby boy named Bradley Arthur was born to mother Nanoune Celestine and father James Arthur. Little Arthur weighed 6lbs, 4oz at birth.

The parents received a gift bath tub stuffed with infant-care items such as diapers, clothes, bibs, baby wipes, and more, courtesy of Turks and Caicos Islands Hospital.

Commenting on the birth, Deputy Chief of Clinical Services at TCI Hospital, Mikette Been said: “Congratulations to each parent on their new born. Our doctors and nurses are always happy to share in this very special moment.

In 2017, there were no babies born on the actual first day of the year at our health care centres, hence, we were hoping for a new year’s baby, and surprisingly there was a trio.

This is the first year since opening in 2010 that as many as three babies were delivered on January 1st at our health care facilities."

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JAN - MAR 2018 | ISSUE

During the Enid Capron Primary School Career Exposition on Thursday, February 1, medical and clinical staff at TCI Hospital were happy to provide students with insight into the various careers in health care and the qualities required for students who may desire to join the field in the distant future.

THE INTERVIEW

CODE BLUE DRILLS Teams participate in a refresher session on responding to a code blue scenario.

EDUCATION DEPARTMENT:

Every second counts.

Over a dozen random code blue drills are scheduled for 2018 across various departments at TCI Hospital as part of the health care facilities robust continuous professional education program to ensure staff are always refreshed on the response and procedures expected in a code blue scenario. Code Blue is an emergency hospital code used to indicate a patient requiring immediate resuscitation.

The Office of Education, which is a division of the Human Resources Department, is mandated with co-ordinating and administering a suite of mandatory and optional programs, which include soft skills workshops, in-service training, continuing professional education, web-casts, online learning and professional recertification for staff.

The department invests much time in ensuring that the clinical and non-clinical human resources of the Hospital are afforded the opportunity to develop and enhance their technical skills and abilities.

Drills are also conducted for other codes throughout the year.

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DOCUMENTATION & ROOT CAUSE ANALYSIS Special CME Presentation CNA Hardy, a leading specialist commercial insurance provider, conducted a two-day workshop at Turks and Caicos Islands Hospital on March 13th-14th, 2018. The company is also the health care organisation’s insurer and due to this connection has provided various educational sessions.

Root cause analysis (RCA) is a structured method used to analyse events. Initially developed to analyse industrial incidents RCA is now widely deployed as an error analysis tool in health care.

Quality and patient safety are central to the values of the Turks and Caicos Islands Hospital. As a result, the organisation continues to focus initiatives on further strengthening these areas.

Isha Honore, IHC Quality Risk and Patient Safety Manager said: "We are grateful for the opportunity to learn from, and exchange knowledge with experts in the field. We wish to extend a big thank you to CNA Hardy for another excellent workshop."

CNA Hardy International Risk Director, Caroline White who is also a registered nurse, presented on the topics of Incident Management, Root Cause Analysis and Documentation. Health care organisations must dig deep to unearth the root cause(s) and develop solutions that address the problems from a systems perspective.

Caroline White and her two colleagues visited the Turks and Caicos Islands Hospital in 2017 to provide a special presentation on risk analysis and risk registers.

White also met with various clinical teams last year.

STABILISATION OF COMMON NEUROLOGICAL CONDITIONS Dr. Nicholas Qandah DO, FACOS, Director of Neurological & Spine Surgery at Mohawk Valley Health System, St. Luke & St. Elizabeth Hospitals conducted a special presentation at TCI Hospital on March 8, 2018.

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The CME was titled Emergency Stabilisation of Common Neurosurgical Conditions. Many neurosurgical conditions present and inorder to provide an optimal outcome, prompt recognition and response is required.

HEALTH PROMOTION

CANCER: COMMON QUESTIONS Interview with Gemma Watson Oncology Specialist Nurse

In observance of World Cancer Day marked on February 4, 2018, Oncology Specialist Nurse at Turks and Caicos Islands Hospital, Gemma Williams-Watson answered some common cancer questions. For educational purposes, these questions and answers are simplified below.

1. What is cancer?

Cancer is when cells in the body divide and grow in an uncontrolled manner. These cells then form lumps or tumors.

Cancer can spread to other areas of the body and therefore early detection and treatment is essential to cure.

2. What causes cancer?

We can’t say what causes cancer but we do know many risk factors or lifestyle choices that can increase your risk of getting cancer. By minimizing or eliminating these factors you can then decrease your risk.

For instance, we know smoking, lack of exercise and obesity, and a poor diet are all risk factors for cancer. We also know that if you have a strong family history of cancer it can increase your own risk. This is a risk that is uncontrollable so it is even more important to make a conscious effort to decrease your risks and attend regular screening.

3. How is cancer diagnosed?

Different cancers are diagnosed in different ways, and therefore a range of screening techniques are recommended.

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TREATMENT OPTIONS AND RISK FACTORS Screening is designed to detect cancer at its earliest stage, and then further testing is done to understand the individual’s cancer in more detail. Screening methods include mammograms, colonoscopies, pap smears and certain blood tests. If a tumor is identified following a screening then further tests must be performed such as a tissue biopsy and scan to give the doctor additional information.

6. Which type of cancer is most severe?

The majority of cancers, if detected in the early stages, can be treated effectively and are potentially curative. Cancer that is diagnosed in an advanced stage, meaning when it has spread to other organs or parts of the body, makes cure less likely and sometimes not possible at all. In these cases the focus of treatment then shifts from cure to controlling the spread of cancer and increasing a patient’s quality of life. To say one cancer is worse than another is not really possible. All cancers are serious conditions and must be treated quickly to get the best results.

4. How is cancer treated?

Treatment is specific to the type of cancer and the individual patient. Modes of treatment include surgery, chemotherapy, hormone therapy and radiotherapy, but not all patients will require all of these treatments. The treatment plan is based on the individual patient and their clinical picture.

7. Can injuries cause cancer?

No, there is no evidence to show that previous injuries can be a direct cause of cancer.

For example, how well the patient is and if he/she has any other health problems. This information is reviewed along with lab reports and scans etc. Treatment is tailored to an individual. This is why not all breast cancer patients will receive exactly the same treatment. There are many different types of breast cancer and each requires a specific treatment plan.

8. Can stress cause cancer?

What we do know is that chronic stress or high levels of stress maintained for long periods of time can have an impact on your immune system. For example, you may feel more exhausted and be more susceptible to coughs and colds. We also know that high levels of stress can cause an imbalance in the body’s naturally produced hormones and that some cancers are hormone driven, so this means there is a possible link between the two, but we can’t state that stress directly causes cancer.

Doctors around the world in the field of Oncology follow international treatment guidelines. These guidelines direct the treatment plan; identify a particular type of surgery or specific drug regimen. The treatment is not solely chosen by the doctor, the decision is directed by these international treatment guidelines.

9. What are the risk factors for cancer?

Some risk factors include smoking, high alcohol intake, lack of exercise and obesity, and poor diet. These risks can be managed and decreased by sensible life choices. Making the right choice and making a concerted effort to ‘live well’ is incredibly important for your own wellbeing. Also, if you have a strong family history of cancer this can increase your own risk so regular screening and self checks are extremely important.

Cancer treatment is now becoming more personalised due to gene and hormone profile testing, whereas before it was almost ‘one size fits all’. In some cancers these tests can help to identify exactly which drugs will help a particular patient’s type of cancer.

When a treatment decision is being made, many pieces of information must be assessed to build a clinical picture of the patient. For instance, the scan report, lab report, blood tests and hormone receptors plus the patient’s medical history, current health status and personal preferences are all taken into account.

This clinical picture is then compared to the guidelines and a particular treatment plan is decided specific to the patient.

10. Is cancer contagious?

No, cancer is not contagious. Cancer is formed due to a malfunction in cell growth; it is not passed on via bodily fluids or touch.

11. Can cancer be prevented?

We’ve spoken about the risks and how to minimize your own cancer risk but unfortunately we are unable to completely prevent it which is why screening and early detection is so important.

Some of these examples include: every breast cancer patient do not require a mastectomy; every breast cancer patient do not require radiotherapy; Some breast cancer patients will require hormone therapy after they have completed chemotherapy, and some patients will not require any hormone therapy. It is very specific to the individual, which is why patients should not compare themselves to other patients, even if they appear to have the same diagnosis.

12. What are the side effects of cancer treatment?

There are different modes of treatment and each of these have their own possible side effects. Chemotherapy alone has many different potential side effects but not all chemotherapies have the same ones.

5. What are the different types of Cancer?

There are more than 100 types of cancer, but some are more common than others. The most common cancers seen in the Turks and Caicos are breast, prostate and colorectal.

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For instance, not all chemo drugs result in hair loss. Radiotherapy, depending on where the patient’s cancer is located, will result in different side effects because the rays are being aimed at different parts of the body. Before a patient begins any form of treatment, the side effects are discussed so they are able to make an informed decision about commencing treatment.

17. Has there been a large number of deaths in the TCI due to cancer?

As we know, a number of patients passed away in 2017 that had been diagnosed with cancer and as a result of this, it was important to review the data about these patients. Upon reviewing the data, some really important related factors were highlighted.

Some of the patients that passed away succumbed to other health issues rather than the cancer. So although the patients did have cancer, that is not why they passed away.

13. Are the symptoms of cancer treatment severe?

All types of treatment have side effects so it is important that the advantages are weighed against the disadvantages before commencing any sort of treatment. It is also important to say that not all patients respond in the same way. For instance, 100 patients with breast cancer could be given the same drug, but each patient will report a different side effect profile. This is because we are all individuals and therefore, patients are all different in how they cope with different situations. Some patients do find the side effects difficult to deal with and when that happens we discuss all possible options available.

Some patients even at diagnosis have advanced cancer so cure becomes almost impossible. In this group of patients, our aim is to ensure they feel as well possible for as long as possible. We aim to minimise symptoms such as pain or nausea and continue to care for them based on their personal preferences and individual needs.

Another key point to make is that cancer cells are very clever and often stop responding to cancer treatment especially if the patient has an aggressive cancer or they have had a lot of previous cancer treatment.

Medical science is providing us with new treatment possibilities every day through research and drug trials, but unfortunately even medical science cannot always offer the cure or answer we would hope for.

14. What happens when cancer goes into remission?

Complete remission means there is no sign of the cancer on physical examination, on a scan or in any other test. Some doctors may use the phrase ‘no evidence of disease’. It is also important to say that remission and cure is not the same thing.

We are very lucky in the Turks and Caicos because we have virtually unlimited access to medications whether it’s chemotherapy or supportive treatments. This allows us to offer multiple treatments if these are what the patient require. Some patients do decline treatment due to personal beliefs or concerns; some make a decision between the family that acute medical treatment is not what suits them or their wishes. In these cases, we continue support the patient and offer other forms of assistance and care wherever we can.

If the cancer is in remission it does not mean the cancer is cured. If the cancer does come back it is usually within 5 years of the original diagnosis. After that 5 year period, if there is still no sign that the cancer has returned, some doctors may say that the patient is then cured.

15. Can cancer be cured?

Yes, many cancers can be cured if they are diagnosed early. This is why regular screening is so important. When cancer spreads to other areas of the body it makes it very difficult and often impossible to cure. If people attend screening regularly, tumors can be identified early – this gives the patient the best chance for a positive outcome.

16. Is there a concern for cancer diagnosis in the TCI? The hospital cancer registry collates data on all patients diagnosed by or referred to the hospital. The trends formed by the data can then help plan care for the future. From this data we found that in 2015 there was a large increase in the number of cancer diagnoses, but since then the annual number of cases diagnosed at the hospital have decreased. In 2016, there was a drop in annual numbers compared to 2015, and again in 2017, there was a decline in the annual number of cases diagnosed compared to 2016.

The number of patients diagnosed with cancer feels high because it is such a small community and for many people these patients may be friends or even relatives so it is understandable that it feels very personal and close to home.

Cancer is certainly in the forefront of everyone’s mind which is good.

Cancer is an extremely important disease to be actively aware of as it is increasing globally and we should be making a conscious effort to live healthy and get screening when recommended.

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OPERATING ROOM NURSES BECOME CERTIFIED TRAINERS

Two Operating Room Nurses at Turks and Caicos Islands Hospital are now certified trainers for Endoscope Reprocessing following the completion of a course offered by the Society of Gastroenterology Nurses and Associates (SGNA). Senior Registered Nurses, Haydee Dayupay and Jenifer Masiclat, recently travelled to Plymouth, Minnesota to complete the training requirements.

While the transmission of infectious organisms during gastrointestinal endoscopy is considered low, the prevention of infection through increased vigilance and continuous training is imperative. Therefore, TCI Hospital has sought to ensure an astute investment in maintaining the competencies for the Surgical Services team on an annual basis.

Chief of Clinical Services, Douglas Moore said: “The inclusion of international best practices in the area of Infection Prevention is a key principle in reprocessing surgical endoscopy devices. Jenifer and Haydee have gained the knowledge and skills necessary to develop and implement a continuing education and quality assurance program for our facility as trainers.

These leadership qualities demonstrate our true commitment towards setting the bar higher for quality improvement at Turks and Caicos Islands Hospital.”

The Society of Gastroenterology Nurses and Associates (SGNA) is a professional organisation of nurses and associates dedicated to the safe and effective practice of gastroenterology and endoscopy. SGNA is accredited as a provider of Continuing Nursing Education by the American Nurses Credentialing Centre’s Commission on Accreditation.

The certification allows the Surgical Services Department at Turks and Caicos Islands Hospital to incorporate the latest international standards, guidelines and techniques to ensure endoscopes are cleaned safely and effectively.

Endoscopic diagnostics and therapeutics continue to expand as new technology enable minimally invasive techniques and endoscopic equipment to improve clinical outcomes and also reduce risk. The organization’s commitment to keep pace with these improvements provides the opportunity to offer a wider range of endoscopic services.

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H E A L T H

HEALTH

PROMOTION |

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INTERVIEW

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in the media WORLD CANCER DAY In anticipation of World Cancer Day, Doctor Phillip Burgess - General Surgeon at Turks and Caicos Islands Hospital and Gemma Watson - Oncology Specialist Nurse appeared on 'Health Matters' to discuss the topic of cancer. Radio Turks and Caicos 107.7fm aired the show on Monday, Jan 29th.

World Cancer Day is an international day marked on February 4th to raise awareness of cancer and to encourage its prevention, detection, and treatment.

THE DIAMOND CHALLENGE TCI Hospital Quality Risk and Patient Safety Manager, Isha Honore sat down with PTV to discuss “The Diamond Challenge”. Hospital employees are being invited to showcase a quality improvement initiative in a competition to win a prize pool of US$3,000. Staff members are excited and gearing up for the competition.

FLU SEASON - HEALTH EDUCATION General Practitioner, Doctor Henry Blythe sat down with PTV News to discuss the flu virus -- signs, symptoms, prevention and flu treatments. Influenza (Flu) season reoccurs annually during the cooler months and is characterized by a prevalence of outbreaks of Influenza.

Seasonal flu outbreaks can happen as early as October, however, most of often flu activity peaks between December and February.

H E A L T H

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T H E

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QUALITY RISK AND PATIENT SAFETY ROUNDS

Quality Risk Patient Safety Walk Rounds were launched at Cheshire Hall Medical Centre during the latter weeks of March and will be conducted by an assigned Senior Manager supported by a team on a quarterly basis.

The initiative seeks to demonstrate senior managers’ commitment to quality and safety for patients, staff and the public; Increase staff engagement and develop a culture of open communication; Identify, acknowledge and share good practice; Support a proactive approach to minimising risk, timely reporting and feedback; Strengthen commitment and accountability for quality and safety.

'GUESS WHO IS THE BABY' CONTEST? The Public Relations and Marketing Department at TCI Hospital is currently devising a fun 'Guess who is the baby contest?'

Participants will be invited to submit a baby picture of themselves to one person who will keep track of their identities.

The pictures will be shared with staff via notice boards and other mediums inviting persons to make their official guesses via ballots. The ballots will be tallied on a designated day and the person with the most correctly guessed pictures will win a prize.

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ABOUT THE EDITOR

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