Arts-based learning project teaches clinical skills focus in this issue
Professional Development/ Recruitment and Retention/ Health and Safety
Canada’s Health Care Newspaper january 2013
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.
Volume 26 Issue 1
Thunder Bay Regional Health Sciences Centre Brings Wellness... Inside Caregiver.........................................................2 Ethics...............................................................2 Nuring Pulse.................................................13 From the CEO's desk����������������������������������� 16 Green Column...............................................17 Careers��������������������������������������������������������� 26
The Inside Out Project benefits staff at Misericordia Health Centre By Judy Owen
olly Normand could have been in a warm cafeteria eating her lunch. Instead, the benefits coordinator at Misericordia Health Centre in Winnipeg bundled up and headed outside for a brisk walk on a chilly, rainy fall day. And she wasn’t the only staff member participating in the lunch-time walking club that’s part of a new initiative at the health centre called the Inside Out Project. “We all had our hoods up and we were just stomping out in the rain,” Normand said with a laugh. “That first day was freezing.” Launched in October, Inside Out is a unique project offering programming and health information to improve staff wellness on physical, mental and social levels. The project is modelled after the Public Health Agency of Canada’s 12 Determinants of Health, which include education and literacy, gender, income and personal health practices. Misericordia Health Centre’s education committee wanted to showcase the determinants and came up with the project. “We took all social, fitness and spiritual sessions within the facility and we put them under the umbrella of Inside
Misericordia’s walking group led by Holly Normand (in black, red mitts) and Sharon Stanley (in black, patterned scarf) on a cool fall day. Out,” human resources director Sharon Stanley said. “We’re already doing a lot and now we’re adding extra ones. For each determinant of health, we’ve assigned a committee member a determinant and a month of the year. They’re looking for speakers, material, lunch-and-learns.” October focused on the determinant of personal health
practices and coping skills. “We handed out a day’s worth of nutritious meal plans at the walking group, for example,” said Stanley, who’s part of the club that averaged 25 members in October. A workshop featured a speaker from Blue Cross’s employee-assistant program, who gave information on how to read food labels.
Spirituality sessions with speakers were also held at the faith-based centre. “That is an essential component to the full being,” Stanley said. “We can’t look after our body or just our mind or just our spirit. They’re all interwoven together to make the complete person, to make everybody who they are.”
November is national prostate month, a theme that corresponded to the gender determinant of health. “We’ll be doing men’s health issues, we’ll be doing communicating techniques across genders,” Stanley said. There may also be information sessions related to LGBT (lesbian, gay, bisexual and Continues on page 5
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Be the health professional clients know they can rely on to see things from their perspective and guide them as they navigate the complexities of the health care system, planning their care and supporting them so they can access the community services they need to maintain their independence and quality of life. RNs, MSWs, OTs, PTs, RDs and SLPs are invited to apply. For details, locations and employee videos, or to apply, visit ccacjobs.ca. 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 French-speaking candidates.
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Hospital News, JANUARY 2013
Self-care for the elder caregiver By Bart Mindszenthy
he vast majority of health care professionals are amazingly dedicated to helping others maintain or regain a healthy lifestyle. Regardless of whether it's a nurse or a physician or a personal support worker or any other front line care professional, there is a consistent commitment to provide care to those they treat or help in some way. And a great many of them also shoulder caregiving responsibilities for aging parents. That double-barreled challenge of professional caregiving by day and eldercare giving by night to loved ones inevitably extracts a physical and emotional toll. It is a toll that, if unrecognized and unaddressed for a period of time, can lead to many different kinds of stress-related illnesses, and so the caregiver needs the care. Watch for the signs And the signs of resulting personal issues more often than not are even more submerged, avoided and denied
for a host of well-intentioned reasons. That's why it's important to look for those signs. Here are just four of the many questions to ask yourself as a starting point to an informal and totally qualitative selfassessment of your state of being: 1. Are you thinking about and/or worrying more about any aspect of a parent's state of health? 2. Are you feeling more frustrated by what you perceive to be your parent's sense of disregard for his/her wellbeing and your efforts to help? 3. Are you more short-tempered overall, but especially with that parent and family members? 4. Are you finding yourself less rested in general? If you honestly answered 'yes' to at least two of these questions, you may want to take a closer look at how your parent really is and how you're dealing with his or her needs... and your own. And you may want to do that sooner or later. If you honestly answered
'yes' to at least three of these questions, you should take a closer look at how your parent really is and how you are dealing with it for her/ him and, as importantly, for yourself. Helping yourself The fact is that if you're getting worn down by family eldercare responsibilities, at some point you'll become worn out. It's at that point the quality of your work will suffer, your ability to help those loved ones will be compromised, and you'll be endangering you own wellbeing. I know this because I've lived it: been there, done it, got the tee shirt, and paid the personal price physically and emotionally. So let me share four strategies I learned the hard way; strategies for coping and selfpreservation through the trials and tribulations of the rocky road of caring for aging and ever more needy parents. 1. Don't try to do it all. You can be a loving, caring daughter or son, but you can never be all they expect, think they need, or you feel you
should give. Define what you can do well consistently and what you can't, and then get the right kinds of support for those you can't. 2. Don't second guess yourself. If you've considered the positives and negatives of any required action or decision and determined what you believe is the best right action, take it and live with it. Otherwise, you'll be second guessing yourself to the point of distraction... and fall victim to the stifling impact of paralysis by analysis. 3. Do get regular 'me' time. Having some personal time just for yourself is vital. Take a walk, read a book, listen to music, ride a bike, do a jigsaw puzzle, whatever: just take some quiet time, turn your mind off. It's therapeutic. 4. Do build a game plan. As events unfold, you'll have a good idea of what's to come and when. In other words, if you take a hard look at the horizon of your personal elder-caring frontier, you can and should create a plan-- a course of action-- for how you'll deal with the inevitable
issues and challenges that will come to pass. A plan helps guide you; it often will make you discover hurdles and options you otherwise might miss. Moving ahead One of the very significant challenges of caring for aging parents or other loved ones is that we too often forget about or ignore ourselves: what we need, how to be prepared, fortified, recharged, and personally sustainable. We can do that only at our peril. The implications and consequences are real and harmful. The Scout's Motto says it all: Be Prepared. Bart Mindszenthy, APR, FCPRS is the Host of <a href="http://www.mycarejourney.com">mycarejourney. com</a> and best selling author on the issues and challenges of caregiving for elderly family members. His column on caregiving appears quarterly in Hospital News.
What does ethics have to do with recruitment and retention? Jonathan Breslin, PhD Recruitment and retention of high quality health care staff is an ongoing challenge for hospitals in Canada, especially when it comes to nurses. A 2008 study by the Canadian Nurses Association predicated that Canada would face a shortfall of 113,000 nurses by the year 2016. A more recent study cited a mean nursing turnover rate in Canadian hospitals of just under 20%. As a result hospitals have turned their attention to various strategies to help recruit and retain quality nurses (among other positions). These strategies include attention to issues like workplace safety and the introduction of staff wellness programs. But would you believe if I told you that devoting attention to ethics in a health care organization can help with recruitment and retention, particularly when it comes to nurses? Allow me to explain by posing another question. Have you ever encountered a situation as a front line worker or
administrator in which you felt like you had no choice but to go along with something you believed was morally wrong? Perhaps it was a situation in which you felt forced to do something that conflicted with your professional values or code of ethics? Usually when I ask that question in a room full of health care workers I’m met with a sea of raised hands. That kind of experience is so common in health care that I would be concerned if someone didn’t raise a hand. What impact did that situation have on you? Stress? Lost sleep? Frustration? Did you feel reluctant to return to work? That is called moral distress, and it is a well-documented phenomenon in health care. It is a specific type of work related stress associated with encountering the kinds of situations described above. There is a lot of research on the topic of moral distress but unfortunately it has remained largely hidden in nursing ethics journals that few health care professionals read. A few years ago
a colleague and I published a paper on the topic in the nursing administration journal, JONA’s Healthcare Law, Ethics, and Regulation (Bell J and Breslin JM. “Healthcare provider moral distress as a leadership challenge,” 10 (4); 2008: 94-97). What the research shows is that moral distress is quite prevalent amongst health care providers, especially nurses. This is most likely due to the fact that nurses spend the most time with patients and their families but also have limited authority to impact the care plans of their patients. Research also shows that there is a direct link between moral distress and emotional exhaustion, burnout, and turnover. So to put this all together: (1) many health care providers experience moral distress in their work; (2) some of those health care providers do leave their positions, and in some cases their professions altogether, in response to unresolved moral distress; and (3) many of those who stay in their jobs report high levels of stress,
disengagement, and emotional withdrawal. Although much of the literature focuses on nurses, similar experiences have been reported in studies of physicians, social workers, pharmacists, and respiratory therapists. It doesn’t require too much of a stretch to hypothesize that moral distress is a potentially significant contributing factor to sick time and turnover rates amongst health care providers in Canadian hospitals. Since moral distress is a particular type of stress associated with encountering morally difficult situations, existing efforts to improve retention and manage turnover will have limited impact on the prevalence and effect of moral distress. What is required is a willingness on the part of hospital administrators to implement interventions specifically tailored to the moral component of moral distress. Such interventions include the development and revision of policies addressing recurring ethical issues, the existence of a functioning ethics
committee and a process for resolving ethical issues, ethics education, and ethical decision making tools. A more specific type of intervention that I have used with success in organizations is what I call an “ethics debriefing”, which combines the beneficial aspects of a stress debriefing with ethics case analysis. These interventions are all components of what Accreditation Canada calls an ethics framework, and they require someone with the appropriate expertise (like an ethicist or ethics consultant). They also require hospital leaders who recognize the link between ethics and staff satisfaction, recruitment, and retention. Jonathan Breslin is an independent ethics consultant and educator and an Assistant Professor in the Institute of Health Policy, Management and Evaluation at The University of Toronto.
HOspital News, JAnUARY 2013
Focus: prOFessiONal DevelOpMeNt/reCruitMeNt aND reteNtiON/HealtH aND saFety
Lakeridge Health eliminates injuries with innovation and collaboration By Jessica verge
common hospital task once plagued by injuries is now incident-free at Lakeridge Health thanks to innovative thinking and collaborative effort. For the Service Associates (SAs) who work hard to keep our hospital clean, wet mopping is an essential part of day-to-day duties. It’s also a task that leaves them vulnerable to overexertion, strains, chemical exposure, and slips, trips and falls. In the 20102011 fiscal year, our SAs sustained more than 40 injuries related to wet mopping. However, this year-to-date, the number of injuries reported is 0. This dramatic reduction is the result of an innovative approach taken by our Occupational Health, Safety & Wellness team. Using Job Hazard Analysis (JHA), a popular tool in the private sector but virtually unheard of in Ontario’s Acute Care facilities, Lakeridge Health has made the job of an SA safer than ever. “Fewer injuries sustained by colleagues’ means a better work experience, which ultimately leads to a better patient experience and that’s
what we are all here for,” says Peter Clancy, Director of Occupational Health, Safety & Wellness at Lakeridge Health. Clancy led the charge to introduce the JHA, a process that breaks down a particular job into various tasks and evaluates the risk associated with each part of that task, which leads to the development of preventative strategies to reduce the risk of injury. An integral part of making the JHA work for Lakeridge Health was the involvement of frontline colleagues. Occupational Health, Safety & Wellness teamed up with Environmental Services, who turned to their Staff Council to help develop a JHA specific to wet mopping, soiled linen handling and portering. When they looked at wet mopping, the team identified each individual task that is involved, such as clearing the area of obstructions, putting up wet floor signs, preparing the cleaning agents, filling and mopping bucket, and submerging and lifting the mop. For wet mopping alone, they identified 17 individual tasks, each with their own risk factors. Hazards presented by these actions ranged from awkward postures and ergo-
nomic concerns, slipping risks for the SA and others, chemical exposure, incidental contact with equipment or furniture, and strains from moving obstacles. In an effort to eliminate injury, the team then suggested preventative actions. For instance, the SA must ensure the bucket is clean and empty before filling. Identified as high risk for the possibility of getting sprayed or spilling, the team has directed SAs to never fill the bucket more than half full and only with the appropriate chemical. Such recommendations were made for every task involved in the wet mopping process. The introduction of the JHA is just one of the ways Lakeridge Health intends to meet a key goal of its Strategic Plan, to completely eradicate the top three categories of lost time injuries— patient handling, manual material handling and slips, trips and falls—over the next five years. “The reduced number of injuries we’re currently seeing demonstrates that the systems we have in place will achieve our desired outcomes, making the role of our SAs injuryfree,” says Clancy. Environmental Services,
Jeff Horne, a Lakeridge Health service Associate, is reducing his risk of injury by adopting the recommendations from the Job Hazard Analysis for making wet mopping safer. Photo credit: Lesley Bovie which includes SAs, continues to use preventative measures as outlined in the JHA as the best approach to avoiding injury and is currently working to identify other physically demanding tasks performed by our SAs in an effort to develop JHA’s for those tasks as well. For the 2012-2013 fiscal year, Lakeridge Health will be developing a JHA specific to patient handling,
north York General opens dialogue between Mental Health and spiritual Care Professionals By amanda Monaghan
n October 30, North York General Hospital (NYGH) hosted the Inaugural Mental Health and Spiritual Care Symposium. The Symposium was organized jointly by Dr. W.L. Alan Fung, Medical Director of Research, Psychiatry, and Reverend Joan SilcoxSmith, Director, Spiritual and Religious Care, and promoted understanding of the work between mental health and spiritual care professionals, and provided a forum for dialogue between the two
professions. Fern Quint, RN of the NYGH Mental Health Program, also contributed significantly towards the planning and organization of the Symposium. NYGH is a leader in interprofessional collaboration and education between mental health and spiritual care professionals. The link between mental health and spiritual care runs deep and covers topics as broad as the care of patients with psychotic, mood, anxiety and/or substance use disorders, end-of-life care, and mindfulness interventions, to name a few.
(from left to right) dr. Mary Marrocco, Professor Trevor Young, Reverend Joan silcox-smith, dr. Tom Ungar, dr. Jen Fink, dr. donna McRitchie, dr. donna edwards, dr. Alan Fung, dr. Jerome Perera. Absent from the photo: Rabbi norman Berlat, and Fern Quint, Rn
including lifting, transferring and repositioning. By utilizing the concept of the Job Hazard Analysis, Lakeridge Health is well on its way to achieving its ultimate goal—to become the healthiest hospital workplace in Ontario. Jessica Verge is a Communications Officer at Lakeridge Health.
There is a great deal of enthusiasm from both mental health and spiritual care professionals in increasing collaboration in order to enhance the service provided to individuals with mental health issues. Some potential benefits in such collaborations include: better adherence to treatments, reduced stigma, enhancement of service provision, and reaching more people in need earlier. The symposium was the first of its kind in the GTA, and drew over 125 participants from across Southern Ontario and from various professional backgrounds, including mental health, primary care, spiritual care and academia. Continues on page 22
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Stress does not lead to success If you are reading this editorial you may be breathing a sigh of relief that we have survived another apocalyptic prediction (the end of the world according to the Mayan calendar). And even if you don’t believe in such soothsayers and prophets you can get stressed out thinking about the financial cliff, global warming, environmental disasters and tragic shooting sprees. More personally we are constantly in the midst of stress in our personal and professional lives. In fact, we have come to regard stress as pretty much normal to our day to day existence. “The fight-or-flight alarm reaction exits today for the same purpose evolution originally assigned to it: to enable us to survive,” says Gabor Mate in his book When the Body Says No. “What has happened is that we have lost touch with the gut feelings designed to be our warning system. The body mounts a stress response, but the mind is unaware of the threat.” Since most of the time the threat is less tangible than running away from tyrannosaurus rex, in modern life, the "fight or flight" response doesn’t really help. Yet those same stress hormones still flood our system, preparing us for physical action. And if we are under stress frequently, it can definitely erode our health. There are a myriad of physical ailments and diseases that can result from continued exposure to stress such as chronic fatigue, lower immune response, high blood pressure,
pain, heart disease, asthma, insomnia and many others. Stress can lead to high rates of absenteeism as well as lower productivity and inability to work at an optimum level. Stress can affect memory, the ability to make decisions and react to new information. In a health care environment it’s critical that staff function at optimal levels at all times. And yet too often health care workers are the people who are the least equipped to deal with ongoing stress. A recent report highlighting the extent to which nurses across the country are experiencing fatigue on the job points to the need for changes in the workplace to ensure patient safety isn’t compromised. The research report, Nurse Fatigue and Patient Safety, was prepared by the Canadian Nurses Association (CNA) and the Registered Nurses’ Association of Ontario (RNAO). The report states: In a survey of more than 7,000 registered nurses across all sectors of health care, more than 55 per cent reported feeling almost always fatigued during work, while 80 per cent indicated they always felt fatigued after finishing work. In addition to depleting their physical energy levels, nurses said fatigue interfered with their ability to make good judgments and sound decisions. Nurses point to relentless and excessive workloads, ongoing staffing issues and sicker patients as the key reasons for their fatigue. But it’s not just nurses who
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are in danger of “running on empty.” Health care workers are subject to stress that most people never encounter in the workplace. Although they are highly trained professionals, the death of a patient, being responsible for the care of several patients in critical condition and being assaulted by a patient are all stressful situations that are encountered daily in health care environments. So how can we ensure that health care environments are healthier places to work? I guess the first step is recognizing the problem. More and more facilities are and are also responding in creative ways. Projects such as The Inside Out Project benefits staff at Misericordia Health Centre offer programming and health information to improve staff wellness on physical, mental and social levels modeling after the Public Health Agency of Canada’s 12 Determinants of Health, which include education and literacy, gender, income and personal health practices. Bullying, so painfully highlighted in the media after the death of Amanda Todd, is emerging as another stressor in the workplace alongside workplace violence. Hospitals such as Rough Valley Health System are addressing this problem through their Respect in the Workplace/Bullying Awareness training program. And when the stress results in illness it’s important for hospitals to respond to the needs of their staff. This is well illustrated through Thunder Bay Regional Health Sciences Centre’s Return to Work Program which helps employees ease back into work for an earlier and safer return. There is probably no more stressful job than that of paramedics who deal with high pressure, high stress situations routinely. But even though they are well equipped for their jobs, their training focuses on saving lives, not for dealing with death. Showing up for work and having to deal with a trauma scene, a cardiac arrest or miscarriage can be extremely stressful. BC Ambulance Service is recognizing this and is offering paramedics a course Dealing with Death and Dying to ensure that they have the skills to deal with their own feelings and values in these situations. We hope you enjoy this issue which is chock full of positive stories. What a great way to start the year! Julie Abelsohn, Acting Editor
Hospital News, JANUARY 2013
Focus: Professional Development/Recruitment and Retention/Health and Safety
The Inside Out Project benefits staff at Misericordia Health Centre Continued from cover transgender) issues, she added. December’s determinant is income and social status, which fits with the month’s holiday spending.“We’re looking at how you budget, how do you maximize your income tax
Misericordia leads the other two days so there’s always someone to walk with. Normand has been at Misericordia for eight years and has taken the Zumba classes. She likes the camaraderie of walking with other staff.
“It’s nice to actually talk to them on a personal level,” Normand, 40, said. “I walk with a couple of other girls that I don’t get to see very often. We talk about personal issues outside of work – about their families, what they’re doing.”
She also appreciates the
Public Health Agency of Canada’s 12 Determinants of Health 1. Income 2. Social support 3. Education and literacy 4. Employment and working conditions 5. Personal health practices and coping skills 6. Physical environments 7. Biology and genetic endowment 8. Healthy child development 9. Health services 10. Gender 11. Social environments 12. Culture
return, what supports are available for care-givers, how do we keep our parents well, what do we watch for, how do we live simply with sustainability in mind.” One idea being considered is promoting a “buy nothing day” to staff. “Buy nothing anywhere in that 24-hour period,” Stanley explained. “You bring your lunch, you bring your coffee, you have the water that’s at the fountains. “Just what would that look like for a full day for you? Where is that impact? It was kind of an interesting thought.” There may also be a money-management session and a swap meet for books and CDs. She predicted the project will have wide-ranging benefits. “The awareness will be on how helpful and useful we are to one another – our community, ourselves, our families,” Stanley said. “It extends beyond the job we do. It extends right throughout the organization.” The project enhances staffwellness programs already at Misericordia. The facility has a fitness centre available 24/7, including classes such as Zumba, yoga, tai chi, pilates and circuit training. Staff can also take aquasize classes in the centre’s indoor pool and play on the facility’s soccer team. Stanley likes the idea of the walking group because anybody can do it without equipment. Walks are three times a week for a half hour. One day is led by the manager of the local Running Room, while a point person from
health benefits. “I’m more productive. I feel a lot better,” Normand said. “I don’t feel as tired in the afternoon.“It’s a great place to work and (the Inside Out Project is) just another added bonus to the facility.” That’s the kind of feedback Stanley is receiving from staff, as well as community members who were welcomed to join. “I think Inside Out is really an opportunity for us to showcase all the fabulous things we do and continue to do,” Stanley said.“It’s not static. Every year, we will continue with the determinants. We may continue to keep some of the initiatives, but we’re perpetually going to grow it with new ideas, new energies and input welcome from the community, staff and volunteers.” Judy Owen is a Winnipegbased freelance writer.
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Hospital News, JANUARY 2013
Focus: Professional Development/Recruitment and Retention/Health and Safety
Thunder Bay Regional Health Sciences Centre helping sick leave employees ease back into work By Graham Strong
e tend to take a black-or-white approach to sick leave. Traditionally, if an employee became sick or injured, the organization would get a doctor’s note giving a return date. In other words, one day they are off work and the next they’re back to full hours. But is that a realistic expectation? Is it really the best thing for the employee? The Thunder Bay Regional Health Sciences Centre’s (TBRHSC) Return to Work Program is helping employees ease back into work for an earlier – and safer – return. This graduated system of modified hours and duties customized to personal and organizational needs “work-hardens” employees to help them gradually get them back to work. “We help employees transition over time from being totally unable to work to getting back to their full hours and duties,” said Lorraine Campbell, Manager of Occupational Health and Safety at the TBRHSC in Thunder Bay, Ontario. Research shows that getting back to work faster can actually be a huge benefit for the employee. The Institute for Work and Health, a not-for-profit research organization in Ontario, did a systematic review and found that most research studies concluded that returning to work was beneficial to the employee both physically
Cutline: Lorraine Campbell (left) and Rod Morrison of the Thunder Bay Regional Health Sciences Centre. The TBRHSC’s Return to Work Program allows employees to ease back into a regular work schedule earlier and safer through a graduated schedule of modified hours and duties. and mentally. It also clearly helps the institution from an HR and a financial perspective since any illness or injury can negatively affect an organization. Either a replacement needs to
on modified duties, reduces overtime hours and eases the burden on other employees. If the injury is work related, WSIB claims can increase the financial burden for the organization. Each hour back
Occupational Health department: Louise Harrison, who coordinates those with workrelated injuries, and Roberta Wood, who coordinates non-work-related injuries. Together, the team creates a
We help employees transition over time from being totally unable to work to getting back to their full hours and duties be found or other employees will be required to take on extra duties and/or work longer shifts. Getting employees back to work sooner, even
to work can be worth up to ten hours of recovered salary to the system. But ultimately, it comes down to how this approach benefits the employee. “For many reasons, it’s better for the employee to return to work earlier within their restrictions. They are at lower risk for depression, it improves their physical health because it keeps them moving and active, and it helps them ease back into work instead of going to full hours all at once,” Campbell said. The success of the program relies upon getting that list of restrictions from the employee’s physician. For example, if the employee is having knee surgery, they usually require eight weeks to fully recover. However, that employee may be able to return for restricted duties and modified hours after four to six weeks. Under the Return to Work program, a meeting is set up at that time between the employee, Human Resources, a union representative (if applicable), and one of two Disability Consultants from
schedule based on the restrictions supplied by the employee’s physician. The first priority is to find work for the employee similar to their current position and in their current department. If that is not possible, alternate positions may be found including on projects that are physically less demanding like hand-washing compliance audits or other important projects. These types of short-term positions have traditionally been difficult to staff for various reasons, yet have a significant impact on the TBRHSC. Safety for the employee is always the guiding priority. The employee’s work status is reviewed with adjustments made to the employee’s work schedule as necessary to ensure a healthy return to their previous work status before the injury. “Each staff member remains on a modified work schedule, building them up over time to full hours and full duties,” Campbell said. “In an organization as big as the TBRHSC, it’s unavoidable that some will be on
injury or sick leave,” said Rod Morrison, VP, Human Resources and Organizational Development. He added that on any given day, the TBRHSC, which employs approximately 2,700 people, could have 60-90 employees on sick leave. “The Return to Work Program is one way we are managing the situation – rather than being managed by it – and helping employees get back to work earlier.” By all accounts the program is working, though there have been some challenges. One was getting the required information from physicians. Initially, some had concerns about how this approach affected their own patient confidentiality obligations. As well, doctors were simply not used to a graduated approach, i.e. providing a list of restrictions instead of a return-to-work date. Over time though, these have become less of a problem, Campbell said. Compliance is sometimes an issue as well. If an employee is asked to do something their doctor has restricted them from doing – move a patient, for example – he or she is supposed to decline. That hasn’t always happened though. The TBRHSC meets that challenge through employee education (e.g. injury prevention) and by managers reinforcing with staff that they must adhere to their work restrictions. Overall though, this program combined with related programs (including prevention and other Occupational Health and Human Resources programs) has had a significant impact on hours lost to injury and illness, and has proven to be an effective way of easing employees back into the workplace after injury or illness. “Not only has the Return to Work Program helped the organization to function more efficiently, but it’s had a big effect on employees themselves. They feel like they are making a valuable contribution, and they appreciate the fact that they can work shorter shifts and modified duties to build up to their regular hours instead of being expected to do it all at once,” Campbell said. Graham Strong is a freelance writer specializing in healthcare and medical research. He is based in Thunder Bay.
Hospital News, JANUARY 2013
Focus: Professional Development/Recruitment and Retention/Health and Safety
Arts-based learning project teaches clinical skills By Steph Parrott
en university students pursuing careers in health care wrapped up a summer internship at Baycrest Health Sciences with the unveiling of a collaborative work of art. They created the abstract large-scale masterpiece with elderly residents of Baycrest’s Apotex Centre, Jewish Home for the Aged. The work was the result of a unique arts-based learning project designed to help the students develop clinical skills they’ll use in their future careers. The summer internship is an initiative of Baycrest’s recently-opened Centre for Learning Research and Innovation (LRI) in LongTerm Care which is housed within the Baycrest Centre for Education and Knowledge Exchange in Aging. Baycrest is one of three health care organizations in Ontario with the LRI designation from the Ministry of Health and LongTerm Care. “We created the internship as part of our Centre for LRI mandate to develop future leaders in geriatric care. The program is designed to introduce students to basic core geriatric competencies,” said Raquel Meyer, manager of the Centre for LRI at Baycrest. The interns, who are studying different health-care disciplines, including pharmacy, nursing, kinesiology and nutrition, all have a keen interest in the field of geriatrics. During their 10 weeks at Baycrest, they participated in small group learning, job shadowing, clinical rounds and program evaluation. The arts project provided an opportunity for the interns to engage with residents, some of whom were cognitively frail. “It allowed these novice healthcare students to build connections and create relationships with residents,” said Jennifer Reguindin, interprofessional educator of the Centre for LRI. Melissa Tafler, a social worker and clinical research coordinator at Baycrest, facilitated the arts-based learning project along with visual artist Jeff Nachtigall. She noted that the time students spent working with elderly clients on the project taught them valuable skills such as establishing an authentic relationship with clients, uncovering the story of the person behind the diagnosis and personal and professional growth through reflection. “These skills are not easy to teach in a more traditional didactic learning environ-
Helen Kravetz admires the wall of art she helped create over the summer with the help of university students who are pursuing careers in healthcare. Students are from left to right: Stephanie Consky, Jennifer Chen and Amanda Tavares (in back). Artist-inresidence Jeff Natchigall who guided the project is at far right. ment,” said Tafler. Prior to the start of the project, the interns participated in a two-part workshop where they were introduced to the idea of using art in a health-care setting and as a means of developing clinical skills in geriatrics. After completing the workshop, the students met with Baycrest’s nursing home residents, individually and
in small groups, painting together to create a stunning abstract work of art that is now permanently displayed on the 7th floor of Baycrest’s Apotex Centre. “As they worked on the art piece, the students put into practice the ideas introduced in the workshop,” said Tafler. “The art facilitated relationship building, finding ways of communicating when lan-
guage fails, and seeing clients through a holistic lens instead of a discipline-specific perspective. These are insights that will serve them well in their careers.” Interacting with clients was not new for some of the interns. Amanda Tavares, a second year nursing student came to the internship having already completed five clinical rotations as part of her nurs-
ing program. But she says she learned a lot from working with residents in a different way. “This experience was different in that I did not feel like I needed to assess the resident,” she said. “Reflecting on each session I realized that I was developing my clinical skills. I was developing my observation skills while watching the residents paint and my problem-solving skills as I tried to help them.” Tavares added the project demonstrated the importance of a patient-centred approach to health care. “It’s important to discover the history and interests of the person you are working with as it helps to develop a stronger relationship,” she said. “This is something that I can take with me as I move forward with my career.” Baycrest has a strong foundation of arts-based programming for clients across the campus, including three creative arts studios, artsbased scientific research, and a collection of donated art displayed through¬out its buildings. Tafler added the arts-based learning project “demonstrates that there’s a place for arts to be more fully integrated into the fabric of our health-care environment, including education.” Steph Parrott is a writer at Baycrest Health Sciences.
Hospital News, JANUARY 2013
Focus: Professional Development/Recruitment and Retention/Health and Safety
Thunder Bay Regional Health Sciences Centre Brings Wellness Opportunities to the Workplace By Janine Chiasson and Donna Faye
hunder Bay Regional Health Sciences Centre (TBRHSC) is taking wellness seriously. As part of a strategic visioning and renewal process, Prevention and Screening Services emerged late last year as a new service to help promote and support wellness across the entire Health Sciences Centre. Some of the work of Prevention and Screening takes place off campus, but there’s plenty to do on campus too with a staff of 2700 people – not including hundreds of students, physicians, and others. Staff Get Moving From early spring to late fall, Prevention and Screening runs a weekly walk/run group open to staff of all ability levels. The group is a fun way to develop new relationships with colleagues and inspires people to stay after work for a bit of exercise and a visit. Group participants have been known to use the walk/run group as a springboard for more regular or prolonged activity in their lives including daily walking, progressing to regular running, and even entering competitive events. Fresh Market On-Campus In time to capture the harvest season, this September Thunder Bay Regional Health Sciences Centre’s (TBRHSC) Eat Smart! Team partnered with local farmers to launch an on-site fresh market. The Fresh Market strengthens TBRHSC’s vision of Healthy Together by giving staff, patients, families and visitors the opportunity to purchase locally grown food. It was a great opportunity to promote healthier eating habits by educating people about what they can do with beets, turnips, chard, beans, and a cornucopia of other farm fresh items. Recipes and nutrition information give people the knowledge they need to make food choices that are a good fit for their lifestyle and
Screening sees what you can’t. Women from all areas of Thunder Bay Regional Health Sciences were game to help promote screening by modeling in a photo shoot to encourage their colleagues to get screened. From L-R: Sandra Stoger, Director of Clinical Trials; Cathy Desando, Secretary, Occupational Health + Safety; Zorka Pavletic, Housekeeping Attendant; Jo-Anne Malcolm, Mail Lady. tastes. “By reminding people of local food options available to them, we stimulate interest in trying new recipes that are creative, tasty, and healthful,” says TBRHSC Director of Prevention and Screening,
interest in healthy lifestyle change. Scores of people came. Visitors to the event could have their blood pressure tested; screen for diabetes risk and check their blood glucose
rific. One participant wrote, “I think this is wonderful. Everyone is so busy and we tend to neglect ourselves.” Your health. Your workplace. Your voice. Before the year is out,
Women were very positive about on-site screening, and felt that the opportunity to conveniently screen during their work day was terrific. Alison McMullen. “With just a few ingredients and a little time in the kitchen, you can have a made-from-scratch meal on the table that is delicious and nutritious.” TBRHSCH Health and Wellness Event Wellness is not just about food. In October, all TBRHSC staff were invited to Take Care of Business at an inaugural Health and Wellness Event. This drop-in event offered tangible screening and prevention opportunities as well as information and resources to spur and ignite
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TEMPORARY NURSING AGENCY or NURSING RESOURCE TEAM? If yes, please help us better understand this type of work by taking part in a short web survey led by the University of Toronto. This is a limited opportunity, so please take action before February 12, 2013. For more information and to sign up for this research study please go to:
level; get a flu shot; receive a Heart Health Assessment; find resources for tobacco cessation; get tips for staying active; take the Work/ Life Balance Quiz; pick up Canada's Food Guide; learn more about TBRHSC employee health benefits; and much more. On-Site Breast and Cervical Screening In addition, female staff could squeeze screening into their work day with both Pap tests and mammograms available on-site. Interested women called a Confidential Cervical Hotline to book both their breast and cervical appointments and took a short walk down to Occupational Health and Safety, stepped outside to the Ontario Breast Screening Program mobile coach, or headed to diagnostic imaging to visit the Linda Buchan Centre for Breast Screening and Assessment. Women were very positive about on-site screening, and felt that the opportunity to conveniently screen during their work day was ter-
TBRHSC Prevention and Screening staff will complete an all-staff survey that asks staff, “What do you need to be healthy?” Responses to the survey will give valuable insight into how staff perceive their level of wellness, and guide future health and wellness initiatives in the workplace. The Staff Health & Wellness Survey takes just 5 to 10 minutes to complete (online or through hard copies) and participants have a chance to win an iPod shuffle or gift cards for our on-campus coffee shop. Tackling Flu Season Research shows that when flu shots are provided to healthcare staff, frequency and severity of influenza outbreaks are reduced, along with influenza-associated illness in patients. Healthcare staff immunization also minimizes absenteeism and reduces the financial burden on healthcare organizations. But in spite of the evidence, immunization rates among staff in hospital settings remain well below the public
health target of 100 per cent. Three years ago, in an effort to improve influenza immunization rates at TBRHSC, Occupational Health and Safety came up with an innovative approach. In addition to the Department’s regular program of providing immunization to staff through departmental pre-bookings and individual appointments, it inaugurated a “roving” immunization cart under the leadership of Occupational Health and Safety Manager, Lorraine Campbell. The roving carts have been a great success. An advance e-mail is sent to department managers allowing them to pre-book the roving cart. Managers then advise staff when immunization has been booked for their department or meeting before the team of two to three nurses arrives with the cart. Remarkably, the fast paced and high pressure Emergency Department proved most receptive and appreciative of the immunization visits, and the Housekeeping Department was another exceptional supporter, says Debbie Babiak, Occupational Health Nurse. “It’s the convenience of having it done at work, whether it’s influenza immunizations or screenings,” she says. In addition to planned visits, the roving cart makes unscheduled stops, especially to nursing units, to ensure that staff on all shifts can get immunized.“It’s important to have someone on the team, such as a senior nurse, who knows people on the unit, or who isn’t afraid to say, "Hi, have you had your flu shot yet?’” says Babiak. But there’s no pressure; the roving cart nursing team uses a friendly approach and never pursues those who refuse immunization. As additional incentive, participating staff are entered into a draw for gift cards at the end of the flu shot campaign. Not including countless physicians, volunteers, students and security staff who use the mobile immunization clinics, last year, 1,173 staff members were immunized by March 2012 – this year, TBRHSC hopes to see that number increase. Janine Chiasson is Health Promotion + Communications Planner with Prevention + Screening Services and Donna Faye is Communications Officer, both at Thunder Bay Regional Health Sciences Centre.
HOspital News, JAnUARY 2013
Focus: prOFessiONal DevelOpMeNt/reCruitMeNt aND reteNtiON/HealtH aND saFety
experiential course helps paramedics deal with death and dying By Catherine Bianco
hile paramedics across Canada are dedicated to saving patients, death is a reality in the profession. Paramedics can deliver death notifications in the field, at trauma scenes and in homes for reasons as diverse as cardiac arrest, miscarriage, stillbirth or sudden, unexpected death. Now, an innovative, experiential course ‘Dealing with Death and Dying’ created by BC Ambulance Service will ensure that paramedics have the skills to help them speak about a subject that is not easily broached. Unique in Canada and most of North America, the course focuses on sensitive subject matter that touches on the heart and emotions of its participants, rather than the traditional paramedic educational emphasis on cognitive and psychomotor skills or ‘head and hands’. The intent of the course is not only to address the skills needed to deliver the message but also to engage paramedics in the reality of dealing with their own feelings and values while looking at the situation from the survivor’s point of view.
field for over 33 years as an EMT/D, having to deal with death never gets any easier. A lot has changed over the years for the better with the education and training that is offered . . . . The curriculum states both "birth and death" are very private experiences. The first one most people prepare for, the second is very rarely prepared for. That’s why this training is essential . . . .” Catherine Bianco works in Communications for the Emergency and Health Services Commission and BC Ambulance Service.
BC Ambulance service paramedics during ‘dealing with death and dying’ course. • Providing comfort to next of kin Hong captures the spirit of the course when he remarks that survivors and next of kin “will remember this moment for the rest of their lives: the words, the music or sounds in the background, the smells in the air.” He says this begins the healing process “when paramedics need to be as supportive as we can possibly be.” A key component of the course teaches paramedics how to deliver a death notifi-
Working in the field for over 33 years as an EMT/D, having to deal with death never gets any easier. “The course gives paramedics practical tools to support survivors and next of kin at vulnerable times in their lives,” says Elizabeth WilsonTagoe, learning design specialist with BCAS. She and education officers Don Hong and Colin Fitzpatrick, who are also paramedics, created the course from the results of focus groups, interviews and scenario development sessions. About half of the 2,600 BCAS Primary Care Paramedics have taken the course since its September 2012 introduction. They call it ‘emotionally draining’, ‘very realistic’ and a ‘very emotional course’. Highlights include: • ‘Painting a picture’ for physicians at the 15-minute mark of resuscitation to ensure there is no underlying cause that would warrant patient transport to a hospital • Managing the scene at a resuscitation attempt • Delivering death notification under a variety of circumstances
cation to next of kin and how to fill the empty space when no one is talking. This is accomplished through three short video scenarios – created by BCAS training officers, representatives of Mothers Against Drunk Driving and the Alberta Health Services Emergency Medical Services – that show a paramedic delivering a death notification with increasingly emotional responses by the survivor. For example: ‘You’ve just discontinued resuscitation on a 70-year-old male, have informed the wife her husband has died and she says, “Oh, I feel so terrible. The last conversation we had was an argument.” What are you as a paramedic thinking, feeling and doing when confronted with this information? Put yourself in the wife’s shoes and consider what she is thinking, feeling and doing?’ The course is delivered by two facilitators over four hours. “It’s a different kind of course to deliver,” said Colin Fitzpatrick, education officer for BCAS and one of the cocreators. “Because the course
leans to the emotional side, it’s heavily facilitated. We allow only 12 participants, and the facilitators must be nimble enough to deal with emotions that arise during instruction.” BCAS is currently fielding inquires from across Canada and the U.S. about the course. Hong, Wilson-Tagoe and Fitzpatrick are running Skype sessions with interested agencies to explain how the curriculum was designed and used during class. Responses
have been positive, and they are now looking at ways to distribute the curriculum, while keeping the integrity of the course intact. The course is also a hot topic on the LinkedIn group EMS World, as BCAS posts the media coverage – both print and broadcast – that followed the course introduction. One group member said, “Thank you for sharing this touching information with everyone. Working in the
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News, JAnUARY 2013 www.hospitalnews.com 10 HOspital Focus: prOFessiONal DevelOpMeNt/reCruitMeNt aND reteNtiON/HealtH aND saFety
Laying the foundation for a healthy staff culture By Dianne Martin
ow staff morale. It's the carbon monoxide of health care cultures. Indeed, problems with employee morale can lead to a host of unpleasant side effects, including, but not limited to, burnout, increased employee absences, lower staff retention rates and, of course, deteriorating quality of patient care. Healthy staff culture can help contribute to excellence in patient outcomes. Developing and maintaining a strong, healthy organizational culture is achievable. However, it requires a genuine, ongoing commitment from hospital leadership and vigilance to ensure the mechanisms are in place to help foster high staff morale, to monitor for potential warning signs and to address them in a timely manner. root causes In my travels working with numerous health care organizations that have implemented changes to their nursing teams over the years, I’ve observed four common culprits responsible for eroding staff morale and, in turn, contributing to unhealthy cultures: Perceived lack of empowerment: A nurse may be the most relevant care provider because of their close contact
with a specific patient, but they’re often excluded from the decision-making process. They’re concerned the change may lead to poor patient outcomes but their knowledge isn’t considered. The result? Feelings of helplessness that lead to poor morale. Feelings of insecurity regarding stability of employment: Leaders within many hospitals that are actually scrambling to fill nursing vacancies would be shocked to learn how many of their nurses struggle with chronic feelings of insecurity about the stability of their jobs. Workload challenges: Dealing with unmanageable workloads for an extended period can also impact staff morale. There’s nothing as heartbreaking as a health care provider who wants to provide the best quality of care possible, but simply isn’t able to because of the growing pressures of today’s workloads. Lack of trust in their employers and each other: Once an employee feels their trust has been violated, it’s extremely difficult to restore and morale problems can follow. Imagine a hospital that reduces staff numbers with a promise that they’ll add staff when the acuity level increases. For whatever reason, they’re unable to deliver
on their promise. Despite good intentions, a promise is broken and morale suffers. 10 tips for fostering optimal employee morale As with your health, poor morale and toxic cultures are much easier to prevent than they are to fix once the damage has been done. With that in mind, here are 10 tangible ways to lay the foundation for a healthy culture. • Remember the ‘why’: Ensure everyone understands the motivation behind the change. It’s easier to embrace change when we understand it’s based on sound reason and need. • Focus on the patient: Nurses and other members of the health care team are motivated by their ability to provide excellence in health care. Leading change through the lens of quality of care can keep care providers engaged and energized. • Monitor for misunderstandings: Sometimes, what leaders believe they said isn’t what employees believe they heard. Checking for mutual understanding can prevent issues down the road. • Ensure role clarity: Role clarity translates into a sense of purpose. Use strong role descriptions to avoid confusion and misunderstandings. • Empower staff: Involve
Ten ways to take control of your life and enjoy a balanced lifestyle By lisa Carter
he holidays may be over but January is when many people still
feel overwhelmed and out of control. Between trying to balance work, finalize reports, restructure budgets and priorities for the year ahead – in
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addition to following through on New Year’s resolutions like going to the gym, visiting friends and family and so on – it might seem that there are not enough hours in the day. A balanced lifestyle is when you feel that even though chaos seems to surround you, you are confident that you can manage most aspects of your life calmly, feeling grounded, clear-headed and motivated. Research proves that living a balanced lifestyle will result in improved health, stronger relationships and feelings of gratefulness for what you have accomplished – which is why we encourage this with our staff, students and volunteers at the Canadian Hospital of Eastern Ontario (CHEO) Research Institute. The following ten tips will help you to assess where you are today and help you to determine where to go from here: 1. reCogniZe: Set aside some time to really look at your life, both personal and professional. Be honest with yourself and notice the areas of your life that you may be overlooking.
staff in decision-making. Really involve them. Not just as a formality, but base decisions on staff input. Transparency and input greatly improves the chance of buy-in. • Be visible, be a resource: Nurses within strong teams have identified access to their manager as being significantly linked to job satisfaction. Carve out time to be accessible to staff. And senior management need to facilitate this by ensuring a manageable span of control. • Build trust: Keep your promises to staff. They’ll understand changes are needed if they know you’ll provide them with what they need to keep patients safe. Ensure consistency between your words and actions. • Watch for moral distress: Workplace stress is a reality. But when uncontrolled, care providers can feel ‘moral distress’ related to their inability to provide the quality of care that they want to, which can lead to burnout and disengagement. Regularly review nurses’ perceptions of the quality of care they’re able to provide. • Model humility, flexibility, respect and caring for others: Assuming employees know how you feel about them is a recipe for disaster. When you’re proud of what you see, tell them. It will be a welcome
surprise. Recognize their expertise and follow their lead when possible. Seek feedback on what your staff most need from you each day. Be okay with being wrong. And hold people accountable for the way they treat one another. • Socialize and encourage fun: Nurses and other care providers thrive in busy organizations in part because of the strong bonds they have with each other. Strengthening and celebrating that bond will go a long way to ensuring a strong team that can weather adversity. Low staff morale comes at an incredibly high cost. And just as we tell patients that prevention is the best medicine, the same principle applies with fostering a healthy workplace culture. By implementing the proactive, strategic measures outlined above, health care leaders can help to prevent these problems and issues from taking hold in the first place.
2. CoMMiT: Make your new mantra “BALANCE”. Reinforce your commitment every day. Write it down! Shout it out! Post it online! Tell your friends that developing a balanced lifestyle is now your priority.
when you are well rested. 7. Move: Make the most of your wakeful hours and do something to elevate your resting heart rate every day. 8. CalM: Incorporate 5-minute stress busters into your schedule. Deep breaths,
Dianne Martin (RPN RN BScN MA) is the Executive Director of the Registered Practical Nurses Association of Ontario (RPNAO)and a graduate of the Master of Arts in Leadership program at Royal Roads University.
Research proves that living a balanced lifestyle will result in improved health, stronger relationships and feelings of gratefulness 3. adapT: Find what tools and techniques work for you. Customize your choices. Remember, in this case, one size does not fit all. 4. design: Develop and plan your professional and personal responsibilities. Set attainable goals, identify priorities and establish deadlines. This will enable you to focus and complete tasks. 5. Fuel: Food is your body’s source of fuel; include healthy options in every meal. 6. resT: A good night’s sleep is so important. Studies have shown that you are far more productive and focused
walk, stretch, and find reasons to laugh every day. 9. real: Remember that no one is perfect. Just commit to doing your personal best every day and you’ll be able to celebrate your successes. 10. reFleCT: Consider and relish your accomplishments. Remember: Life is to be enjoyed! Improve the quality of your life by living a balanced lifestyle! Lisa Carter is Health & Safety Manager at CHEO Research Institute.
Hospital News, JANUARY 2013
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News, JANUARY 2013 www.hospitalnews.com 12 Hospital Focus: Professional Development/Recruitment and Retention/Health and Safety
St. Michael’s endoscopy conference an international draw By: Navindra Budhram
ore than 300 health professionals and medical students descended at a Toronto hotel recently for a St. Michael’s Hospital-led international course on endoscopy techniques —considered the gold standard in endoscopy courses. “This course is unique in Canada,” said Dr. Gary May, division head at St. Michael’s. “It’s the only GI course in Canada which demonstrates live procedures and is the first in North America and the second in the world to use this format of teaching.” The 25th International Course on Therapeutic Endoscopy was hosted by Drs. Gary May, Paul Kortan, Norman Marcon and Gabor Kandel from St. Michael’s Hospital’s therapeutic endoscopy program at the Fairmont Royal York Hotel in Toronto. The three-day symposium, which examines the latest procedures and developments in endoscopy, has become a staple of the hospital’s therapeutic endoscopy program. It featured live endoscopic procedures beamed in real time to the hotel and a satellite meeting in Vancouver. It was lead by a multinational team of experts, including those from Canada, the United States, the Netherlands, Belgium, France, Japan, Egypt and India. Experts demonstrated and taught the latest therapeutic endoscopy techniques, treatments and assessments as
Drs. Robert Hawes of the Florida Hospital Thoracic Cancer Prohram, (left), and Jerry Way, of Mount Sinai Hospital in New York, (right), performing a procedure during a live transmission from St. Michael's Hospital. Photo Courtesy of Katherine Cooper, Medical Media, St. Michael's course attendees observed from two large screens in the Canadian Room at the hotel. One displayed the team conducting the procedure while the other displayed the procedure. Many procedures
mucosal resection, which removes early superficial cancers. “The live procedures provide learning in a way that you can’t get through lectures or videos,” said Dr.
The course represents one of the major components of the therapeutic endoscopy program at St. Michael’s which is the only program in the GTA that offers a full range of advanced endoscopic
The Advanced Therapeutic Endoscopy Centre at St. Michael’s is one of the largest and most advanced in Canada, treating more than 14,000 patients a year. and techniques have been shown live for the first time, anywhere in the world, at the course, including endoscopic
Serving the Greater Toronto Area for over 18 Years
Kortan, a staff physician at St. Michael’s. “Videos tend to be edited and you only see the best cases.” Live procedures were embedded around a series of in-house speakers, including Dr. Ibrahim Mostafa, from the Cairo Training Centre in Egypt, discussing endoscopic management and Dr. Florence Wong of the University Hospital Network in Toronto, discussing medical management. “Organizing this course is a monumental task and takes about one year to organize,” said Dr. May. “We take one month off after the conference and then begin planning for the next one. Because our guests are prestigious and in high demand, they require one year’s advanced notice to book. It’s considered to be the gold-standard of endoscopy courses.” The course, which first occurred in 1983, is the longest running of its kind. It officially became an annual event in 1987. The 26th course will occur at the Fairmont Royal York Hotel, in Toronto, from Oct. 9-11, 2013.
services. Other hospitals in Toronto, Ontario and across Canada send their most challenging gastrointestinal cases to St. Michael’s for therapeutic endoscopy. “Within the realm of therapeutic endoscopy, St. Michael’s is world-renown, because of our staff, the course and our fellowship program,” said Dr. May. “Our graduates of the fellowship program are highly successful — we’ve trained roughly 110 individuals since the program began in 1983. The greatest joy a teacher can have is to see their students succeed.” The fellowship program initially had one fellow at a time, but grew to two in 1988, three in 1989 and four in 1995 to the present. The growth of the program was due chiefly to the high demand that came from the reputation and success that the program earned over the years. “Our fellows come from all over the world,” said Dr. Kortan. “Because of our program’s reputation, we receive a considerable amount of applications, which allows us to choose from the very
best available. Many of those who train here now work in other hospitals in the GTA, Ontario, Canada and around the world.” The Advanced Therapeutic Endoscopy Centre at St. Michael’s is one of the largest and most advanced in Canada, treating more than 14,000 patients a year. It is also recognized as one of the premier endoscopic centers in the world for training in advanced therapeutic endoscopy. “The Advanced Therapeutic Endoscopy Centre was named as one of the world centre’s of excellence in endoscopy by the World Endoscopy Organization,” said Dr. Marcon, staff physician at St. Michael’s. “Our centre was the only one in North America to be recognized when the WEO issued its first round of honours.” In early in 2011, the therapeutic endoscopy program received a $5 million donation from Wallace and Margaret McCain, of McCain’s Food Ltd, in honour of Dr. Kortan and his colleagues. Of that, $3 million will go toward recruiting a world-class physicianresearcher who will hold the newly created Wallace and Margaret McCain Chair in Therapeutic Endoscopy. The remaining $2 million will support other initiatives within the department. Endoscopy is the examination of the gastrointestinal tract — the esophagus, stomach, bile duct, pancreas, small bowel and large bowel — with a flexible videoscope. Therapeutic means the procedure can provide treatment (therapy), in addition to a diagnosis. Navindra Budhrama is a PR intern from Humber College.
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Hospital News, JANUARY 2013
Bullying is alive and well in nursing By Rhonda Seidman-Carlson
his past fall, the terrible issue of bullying was front and centre once again. The story of Amanda Todd and her cry for help, and subsequent death, were difficult for me to bear. There is no doubt this girl suffered from depression, but the taunting, ridicule and isolation she experienced is something no one should have to endure. In response to this tragic event, schools throughout the province held vigils and assemblies to talk about bullying, its impact, its causes and how to stop it. It is important to hear the messages being shared with our youth: do not be silent when you know someone is being bullied, and; just because someone is ‘different’ does not give another person the right to bully them. These same messages have been echoed across Canada. As president of Ontario’s professional association for registered nurses, I believe RNs – if placed in the school system and supported to use their full knowledge and ability – can make a tremendous
contribution to everyday student life by helping and supporting children and adolescents at a tender time in their lives. But that is not why I’ve chosen to speak out on this issue. The truth is bullying is alive and well within the nursing profession, and we know it. That makes me very angry and very sad. The Registered Nurses’ Association of Ontario’s (RNAO) board of directors, which I am privileged to lead, has heard about instances of bullying between registered nursing students and registered practical nursing students at educational facilities. We have also heard about nursing students being bullied during clinical placements. I have personally heard people discuss the bullying that goes on between members of staff in various health-care organizations. There are lots of theories about what causes bullying in these three scenarios. They include: fear (that perhaps one professional group will take over the jobs of another); frustration (for example: staff nurses feeling overwhelmed with everyday demands and feeling they are not able to respond to the many needs
of a student nurse); or poor self esteem (perhaps asserting ‘control’ over other nurses so that one’s gaps or deficits will not be highlighted). Regardless of the underlying issue, bullying is never the correct way to address these fears, frustrations and esteem concerns. Why does bullying continue? I think it is because we stay silent. The message provided to students in the wake of Amanda Todd’s death is the same message we as nurses should heed. Staying silent amounts to condoning the very act we find abhorrent. Staying silent includes us in the group of bullies. Most organizations have a code of conduct and a whistleblower process so that one can identify bullying to an external source. RNAO’s best practice guideline, Preventing and Managing Violence in the Workplace, includes recommendations on how to identify and address violence, including bullying. However, there is one simple intervention. Identify what you see and hear as bullying and insist that it stop. Speak with your teacher, manager or VP until someone listens. Do
not engage in the gossiping about a colleague (a subtle form of bullying) and clearly state that you will not allow bullying to go on. This is a shared responsibility. Many of Amanda’s classmates have said they regret staying silent. They will have to live with that regret for the rest of their lives. While I have not heard of a nurse who was bullied and resorted to suicide, I have heard of nurses who were bullied and left their workplace or the profession altogether as a result. We cannot afford to let this happen. The decision to confront – and the responsibility to report – lies with each of us. I recently heard Dr. Izzeldin Abuelaish speak at a community event. He grew up in the Javalia refugee camp in Gaza and eventually obtained his medical degree. He is a religious and committed family man. In 2006, he lost his three daughters and a niece in a shelling incident. Rather than hate or accuse, he has used this tragic event as a driver for peace. He tells everyone he meets: “Hate is not a response to war.” Each person can and needs to make a difference towards peace, he says.
The peace he talks about is not only limited to the Middle East but, in each family, each workplace and each community. As president of RNAO, I urge all nurses to bring this message back to their workplaces, educational institutions and health-care facilities. This is an issue we must deal with head on. Bullying is a type of war on the soul. Please do not respond to bullying with more bullying, and please do not respond to inappropriate behaviour – whether linked to fear, frustration or self esteem – with silence. Rhonda Seidman-Carlson is president of the Registered Nurses’ Association of Ontario (RNAO). Since 1925, RNAO 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. Not a member? Visit www.RNAO.ca to join, and take full advantage of our member benefits.
News, JANUARY 2013 www.hospitalnews.com 14 Hospital Focus: Professional Development/Recruitment and Retention/Health and Safety
PROJECT UPLIFT: A staff education program for patient handling By Arlene Whitehead and Judy Swain, RN
n 2003, Woodstock General Hospital (WGH) was faced with ever increasing staff injuries due to patient handling. Change management was required in order to decrease the human and financial costs associated with workplace injuries. WGH’s Occupational Health and Safety Department (OH&S) with the assistance of the Director of Ambulatory Rehabilitation evaluated and classified the musculoskeletal injuries of patient handlers. Subsequently, a staff education program for patient handling was jointly developed and initiated by WGH and Arjo Canada, now ArjoHuntleigh, to assist in addressing current healthcare challenges: high injury rates, budgetary constraints, nursing shortages, and safety requirements. This education program focused on three key outcomes 1. reductions in staff injuries and WSIB costs 2. comfortable, safe hospital stays for patients requiring lifting/transferring assistance and 3. staff and patient satisfaction. PROGRAM EVIDENCE Literature suggested traditional education in body mechanics and manual lifting was not evidence based in reducing injuries. Additionally, comments on
Arlene Whitehead DipPT BHScPT and Director of Ambulatory Rehabilitation and Danielle Wynee, Clinical Consultant ArjoHuntleigh. They are holding the photo board that was on display at OHA. patient comfort during manual transfers were not positive. Various educational models were examined and several critical components for a patient handling program were identified: • Minimal Lift Policy Development
patient handling safety • Quality monitoring of injury rates/costs, satisfaction, safety indicators In 2005, WGH contracted ArjoHuntleigh, an international manufacturer and supplier of patient lifting/ transferring devices, and its
ing devices. Project Uplift ensured staff training and support by Transfer Mobility Coaches. PROGRAM DEVELOPMENT ArjoHuntleigh’s training processes and tools, including mini-mobility assess-
Most importantly, the success of this program is reflective of the exemplary commitment from all levels of staff. • Peer coaches in patient areas to support and train staff in achieving proficiency with lifting equipment • Sustainable cultural change, focusing on enhanced
Diligent Program to assist in implementing a program to reduce injuries. Although new in Canada, ArjoHuntleigh’s Diligent program had been implemented in 565 healthcare facilities in the United States, with substantiated outcomes since 2001. Woodstock Hospital was the first, and continues to be the only Canadian hospital to contract Diligent. At Woodstock Hospital, the ArjoHuntleigh Diligent Program was given a customized name “Project Uplift”. Project Uplift addressed the following: • Minimal lift policy development • ‘Train the Trainer’ program for Transfer Mobility Coaches (TMCs) • Monthly on-site consultation days • Financial guarantee of a 60 per cent reduction in WSIB costs • Support for cultural change Coincidentally, the development of Project Uplift coincided well with the MoHLTC funding announcement for lifting devices as part of the Ontario Nursing Strategy. By 2006, WGH had acquired 42 additional lift-
ments, algorithms and training quizzes were adopted by Woodstock Hospital. ArjoHuntleigh also provided team shirts for the TMCs, highlighting Project Uplift’s profile. WH developed and implemented additional initiatives to enhance the program: • Staff training and new staff orientation monitoring systems • Lifting device supply systems (sling and maxislide availability, bariatric patient management, etc.) • Monthly TMC “free lunch and learn” sessions hosted by OH&S staff and the ArjoHuntleigh consultant • TMC newsletters, group email to facilitate information dissemination • Project Uplift logo development • Hospital and communitywide celebrations and publications of Project Uplift successes OUTCOMES After three years, Project Uplift achieved a 69 per cent reduction in staff injuries and a 99.7per cent reduction in WSIB costs related to lifting, transfers and repositioning. In addition, staff satisfaction
was increased and patients receive care that addresses comfort, safety and quality of life. Staff innovation also came to the forefront with one of the transfer devices now being routinely used in mammography, an equipment role not previously identified by ArjoHuntleigh. In 2012, Project Uplift continues to reap benefits in staff safety by reducing staff injuries and WSIB expenses as demonstrated by the chart below. Patient safety and comfort continues. As well, the call for increased safety continues to be further solidified with Accreditation Canada, identifying safety in many required organizational practices. Project Uplift keeps safety in the forefront at Woodstock Hospital. Although Project Uplift is a contracted program, educational principles can be replicated by any hospital. Success is dependent on: 1. strong commitment from administration and management 2. training courses for Transfer Mobility Coaches addressing leadership skills 3. and lifting device clinical application 4. smonthly/ongoing TMC support systems 5. staff training and monitoring systems. Most importantly, the success of this program is reflective of the exemplary commitment from all levels of staff. Woodstock Hospital’s CEO and Board of Trust support a safe hospital environment, and are willing to put forth the time, energy and resources into safety programs such as Project Uplift. Judy Swain, RN is Occupational Health and Safety Leader for Woodstock Hospital and her range of experiences provide her with strong knowledge base to assist in achieving success in prevention and promotion of staff health and safety as it relates to safe patient handling. Arlene Whitehead, DipPT,BHScPT has been the Director of Ambulatory Rehabilitation at Woodstock Hospital since 1991. Currently, she is the Director of Physiotherapy, Occupational Therapy, Recreational Therapy and the Woodstock Rehabilitation Clinic.
Helping you make an informed Decision THE 11TH ANNUAL Professional Development & Education Supplement
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Health care workers need to train for the inevitable: Sooner or later, disaster will strike By Norm Ferrier
ust weeks after Superstorm Sandy and an estimated $63-billion in damage in the United States alone, the timing could not be better to underscore that contrary to popular belief, disasters are not abnormal events. Defined by the government of Canada as any situation that generates just one more issue than a local community has the resources to deal with, federal records demonstrate that over the past 100 years, a disaster of some sort has occurred in Canada every two months on average. But for hospital staff including doctors and other front line clinicians, crisis management is all in a day’s work, which goes a long way to explaining their sometimes cavalier attitude toward disaster planning. At least that is what more than 30 years of experience tells me, as a recently retired senior planning officer of the largest EMS (Emergency Medical Service) in Canada and instructor of the Emergency Management for Health Care Certificate program offered by the Ontario Hospital Association. The passive posture of clinicians is mirrored by hospital business managers, who, faced with a host of conflicting priorities, ask why they should spend money on planning for some-
thing that never happens. Except that sooner or later, it always does. Which is the moment that a hospital’s higher risk exposure – because hospitals are in custody of people at their most vulnerable – becomes glaringly apparent. In the case of Sandy, several hospitals in New York and New Jersey were evacuated, immediately creating an emergency for every other hospital in the vicinity. And as of mid-December, five hospitals in the area are still struggling to reopen. So allow me to state the obvious: hospitals and other health care institutions must plan for disaster. And then something that may not be quite so obvious, but is every bit as crucial, various levels of government offer disaster planning training, but it is purely generic. It has no focus whatsoever on the distinct, highly specialized hospital and health care environments. What’s required is a program that focuses specifically on emergency planning and preparedness for hospitals and other health care institutions, and on helping them develop in-house expertise - one of the key objectives of the OHA’s certificate program. I am exaggerating only slightly when I say that in the past, most people who ended up in emergency management
Emergency Management for Health Care Certificate
did so almost by accident, often by walking past the wrong door. I’ve seen everyone from the hospital pharmacist to the parking supervisor be volunteered for the role, which never became more serious than a sideline. Actual emergency planning was often just as haphazard. Accreditation would be approaching, so the hospital would strike a committee, figure out how to hold an exercise, do it and document it – and as soon as it was over, the committee would be disbanded and its accumulated experience would be lost. That kind of approach must be a thing of the past. Emergency planning is a process, and emergency plans must be evergreen documents. And you need people who are actually trained properly to perform a leadership role. It could be a person at the hospital who has another job, but increasingly it is a full-time individual. In fact, in an age of hospital amalgamation, there is a new staffing risk – and an opportunity. As hospitals are slowing but surely merging into corporations that have multiple sites, each site may have .25 of a full-time employee, but no one with overall corporate responsibility for emergency planning and procedures. The opportunity is for hospitals to consolidate those part-time roles into an individual
or group with full-time responsibility . Not only is emergency preparedness a “motherhood” issue for hospitals and health care providers (the communities we serve absolutely believe we are capable of effectively dealing with the results of any disaster – and react badly when we fail to do so), but disasters are events which absolutely can, and will, happen. From a risk management perspective, it only makes sense to ensure we have staff with the knowledge and training to deal with them. For more information about the Emergency Management for Health Care Certificate program visit www. oha.com/EmergencyManagement Norm Ferrier spent 30 years of his career focused on emergency planning. Now retired as planning officer of Canada’s largest Emergency Medical Service, he holds a Master of Science in Emergency Planning and Disaster Management from the University of Hertfordshire in the United Kingdom. Mr. Ferrier holds additional emergency planning credentials in Canada, the United States and Australia, and is author of the university-level textbook, Fundamentals of Emergency Management.
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We realize that you have busy schedules and busy lives. Our key priority for the coming year is to expand your options so that you can learn on your own time…at your own pace… and in the comfort of a setting convenient for you. With recent changes, you can now enroll in our refresher courses anytime in the year and have a full year to complete them. You can also take most of our courses online. We have introduced new hybrid courses combining online and hands-on workshops. And the majority of our Primary & Critical Care courses are offered in your workplace. If you want to simply take a course to enhance your skills or build important new competencies in your profession – we have hundreds to choose from. Or you may consider taking a full certificate program for new possible directions to enhance your career opportunities. Most of our certificates can be completed in as a little as sixteen months and offer specialties in Health Care Leadership, Clinical Research, Quality Management, Diabetes Education, Imaging Informatics and more. Whatever your need or interest, we are here for you. Let us help you define your course. B E S T
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Energy - The Sex of 2013 By Brady Wilson
ex is so over-rated. What today’s healthcare worker really wants is to wake up without that pit of exhaustion in the stomach – that feeling of deep depletion where all you can think about is going back to bed. Delivering competent and compassionate care in this fatigued state means you have to dig into your reserves so far that there’s practically nothing left to give to your partner, your kids or your community. Clearly there’s a better way to operate. But what is it? Imagine yourself at the end of a really productive day – a day where you had a lot of important things to get through. There’s a glow around you as you reflect on the achievements of your day. You accomplished every task excellently and even knocked off a few extras. Let me ask you, to what do you attribute your performance on that kind of a day? One could argue that the day before might have been just the opposite; you got to the end of it and felt your productivity was lacking. So how do you explain the spike in your performance from one day to the next? Your talents don’t change from one day to another – you’re pretty much hard-wired with those. Your education and skill level don’t change that much either. So what can create a spike in your performance from one day to the next? Consider this as an answer: your personal energy level. Energy, from a physics point of view is simply the ability to get work done. Think of the value-adding tasks of your day. Energy is required for every one. For example, it takes energy to plan and prioritize. In fact, even though your brain represents only a tiny percentage of your body weight – it burns about 25 per cent of your body’s energy. It takes energy to undertake a task. Remember
writing essays? Once you got started, you got into an easy flow, but it was starting them that took so much energy. It takes energy to step into uncomfortable conversations. It takes energy to innovate. It takes energy to follow through on the last few, but important details of a project. Every important thing you do requires energy. Managing time is important, but managing energy is vital. If your energy stores are low, you can have all the time in the world and you will dither it away, but if your energy level is high, you can face tight timeframes, yet crank out amazing results. Your Personal Energy Level – What is it? It’s not just raw physical drive, although it has a physical element to it. And it definitely isn’t mimicking that perky person with the sunny disposition that never entertains a negative thought. It’s actually a blend of several elements that, working together, allow you to be a remarkable person. In fact, it is energy that deploys all of your strengths. Last summer I tried to juggle two big projects; building a cottage and training for an Ironman. I did my very best to manage both, but the building project was intensely physical and I ended up going into the Ironman with some energy depletion. What happened next was tough. I did the swim and the bike portions, but 31 kilometers into the 42 km run my body went into shock. Unfortunate - I failed not because I didn’t have the strengths but because I lacked the energy to deploy those strengths. The proof: I did another Ironman a month later after carefully managing my energy and had a great experience. Remember, you have talents, skills and strengths but none of them get deployed without energy. So here are five practical things you can do to manage
You should know. At the OHA, we offer more than 60 conferences and seminars each year – and every one of them covers the content you want and need. You should know: the subject matter is developed by OHA members like you, who take part in our needs assessment survey and participate on our conference planning committees. The result is highly relevant content, delivered by subject-matter experts – keeping you on the leading edge of health care issues, trends and thinking.
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your personal energy level: 1. Navigate your hot buttons: Name the Tension 2. Harmonize your needs: Draw out what matters most 3. Align your beliefs: Shrink your circle of concern 4. Focus your mind: Stop multi-tasking 5. Recover your body: Install power plants Navigate Your Hot Buttons: Name the Tension There are two systems in your brain that have completely different functions - your rational system and your emotional system. When they work together in harmony you can be a truly remarkable human being. But when they don’t, you squander vast amounts of energy. Your pre-frontal cortex is the part of the rational system that is responsible for logical, future-based, generative thought. Your amygdala is the part of the emotional system that is responsible for managing the stimulus-response mechanism - keeping you safe so you can pass your genes on to the next generation. The amygdala receives sensory input from your surroundings and if that input matches painful experiences from your past it pumps hormones into your body that, if uncensored, send you into a powerful fight or flight response that burns up large stores of energy. This is great if you truly are in danger but a tragic waste of fuel if you aren’t. And here’s the beauty of your wiring – the two systems function like a see-saw; arousing one suppresses the other. For example, if you are hiking with your daughter in Algonquin Park and a bear moves toward you in a menacing way, your amygdala will instantly be on full arousal - you will be endowed with rigid certainty and super-human strength. This Continues on page V
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PROFESSIONAL DEVELOPMENT AND EDUCATION 2013 Continued from page IV will instantly suppress the complex thought systems of the cortex. And that’s a good thing. What you need in this moment is the extreme, black and white, binary thinking that will prompt lightning-fast decisions. This principle of arousal and suppression really gets useful when something or someone hits one of your hot buttons. The emotional end of the see-saw is getting aroused and you sense it happening. If you can do something to arouse the rational system, you can suppress your emotional reaction and bring your best self back to the table. There are many tools I could offer you, but here’s a simple one you can use to arouse your rational system any time you are beginning to feel an emotional reaction coming on. We call it name the tension. If you are experiencing inner tension or stress and you focus your cortex on giving that tension a name, you reduce your allostatic load (your stress load) by up to fifty percent. I’ll give you an example. A friend of mine was asking me for help - she had to have a difficult conversation with a doctor but was fearful she would start to cry if she did so. She was concerned that if she began to cry she would lose credibility and appear unprofessional. I asked her, “What would happen if you say, ‘I need to have an important conversation with you and because it’s so important, I’ll probably start to cry. That doesn’t mean I need a Kleenex box or that the conversation has to end.’” My friend looked at me and replied, “I think I could say that.” The next day she had a conversation with the physician and it went brilliantly, deepening the relationship between the two of them. Here’s my question: after naming the tension, did my friend start to cry? No she didn’t. Naming the tension had reduced her stress load by fifty percent and she was able to deploy all her conversation strengths because
she wasn’t wasting any energy trying to push down her fear. Our typical strategy in this situation – trying to suppress the negative emotion really is a waste of energy. You invest the psychological effort of ‘stuffing’ yet your limbic system remains fully aroused. You may be glad to know that you don’t even have to name the tension out loud. (and in some situations it may not be appropriate to do so) The benefit comes from focusing your cortex on giving a name to the tension you are feeling. You arouse the rational end of the see-saw and the emotional end gets suppressed. Try this next time you feel your hot button get pushed. For more on this see David Rock’s great book “Your Brain at Work” Harmonize Your Needs: Draw out what matters most Every one of us has five driving needs that are as vital to us as oxygen. If these needs are met, energy is released inside of us. If they are not met, energy depletion occurs. Here are the five driving needs that matter most to us: security, belonging, freedom, significance and meaning. But not every one of these needs is of equal importance to every person. Belonging and significance matter most to you while freedom and meaning matter most to me. Imagine you and your partner are traveling across Europe with a Eurail pass. He wants to be able to pick up and explore in a moments notice so he’s only brought one backpack. But security matters most to you so you don’t want to be caught without something you need. You end up packing two huge suitcases full of stuff – ‘just in case’. When his footloose need to explore is constantly blocked by your two huge suitcases, some dicey conflict might ensue. These kinds of competing needs produce powerful tensions in a hospital. For example, a surgeon’s need for significance (he wants a high-performing
OR team able to crank out LOTS of surgeries and he comes across as impatient and dismissive) is in tension with a nurse’s need for belonging. (she wants to work on a team where she feels accepted – that her input and ideas are listened to and valued) You can see where this will go. There’s something right inside tension that we absolutely need to perform at our best: energy. Wherever there is tension there is energy. You don’t get to decide whether energy will be released from the tension you have with another person – you do get to decide whether it will be productive or destructive energy. Is it possible for both the surgeon and the nurse to get their needs met? It really is. He can have a highperforming team and she can experience a strong sense of belonging. How frequently do we pull the productive energy out of these types of tensions? Not frequently enough. Here’s what you can do to increase the odds of that happening. Go into conversations with one goal in mind: to draw out what matters most. ‘Draw out’ is a two-way action. You draw out of the other person what matters most to them and you draw out what matters most to you and help them see it. Once you’re clear on what matters most to each of you, you can identify the common ground that exists between your two (often competing) sets of needs. Getting to common ground takes some of the threat out and allows you to explore each other’s worlds more fully. Often, in this process, a solution presents itself that harmonizes your competing needs. I have many, many stories and cases of how we have witnessed this happening in hospitals. Align Your Beliefs: Shrink Your Circle of Concern Hospitals are caught in the perfect storm. Patients are heavier, sicker, older and more ‘entitled’ today than at any time in history. And we’re trying to delivContinues on page VI
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PROFESSIONAL DEVELOPMENT AND EDUCATION 2013
Continued from page V er care to these patients with an aging workforce that is increasingly hamstrung by fiscal constraints. Sometimes it can make the task feel almost impossible. In this environment it is difficult for healthcare workers to ward off the victimitis virus – the belief that “there’s nothing we can do”. When a process doesn’t work, we wash our hands of it and say to ourselves, “Administration doesn’t have a clue about our reality.” When we witness a co-worker being bullied, we say to ourselves, “That person is never going to change”. But this belief that “I am powerless” has a deadly side-effect – it’s a low-grade feeling of apathy, frustration and cynicism that feeds like a cancer on our healthy energy. So what can you do about this? Align your beliefs with reality. In every situation you have a circle of concern and a circle of influence. Your circle of concern includes anything you could be concerned about: ministry cutbacks, a patient who yells at you with vulgar language, an upcoming merger with another hospital and team meetings that waste your time. Within that circle of concern is your circle of influence. That circle is comprised of the things that you are concerned about and also have some influence over. For example, you can have a very direct conversation with the abusive patient and you can ask your manager if it would be possible to circulate an agenda prior to team meetings, have rotating facilitators and ensure that roles and actions are clarified before the meeting ends. The ministry cutbacks and the upcoming merger still remain in your circle of concern – they concern you but there’s not much you can do to influence them. The goal is simple - grow your circle of influence as big as possible so you can shrink your circle
of concern. Why? The more concerns you have the more energy gets depleted. I’ve discovered that many of our beliefs are not aligned with reality. It’s enticing to believe, “I have no power – there’s nothing I can do about this.” After all, that absolves you of your responsibility. But you’re left with a set of ongoing, annoying concerns that will ultimately consume far more of your energy than addressing the situation would have. Focus Your Mind: Stop multi-tasking Seriously, stop multi-tasking. Your brain is only wired to focus on one thing at a time. This doesn’t mean that you can’t drive your car and talk to your mother at the same time. It does mean that anytime you try to focus simultaneously on two conscious brain tasks (like deciphering data on a monitor and listening to a colleague’s directions) your performance and accuracy will suffer on one of those tasks, or sometimes both. A few years ago I heard a simple sentence that has changed how I operate. It’s attributed to a Buddhist monk and it goes like this; “When I chop wood, I chop wood. When I carry water, I carry water.” So for the last couple of years, when I do any task, I give it my full, undivided attention, focusing all my mental energy on it. This has not only saved me from dissipating my precious energy stores, it has enabled me to savour some important moments. I am asking you to try this. Is it possible you could experience more moments of ‘savour’ in your delivery of both compassionate and competent care by listening with intense interest when it’s time to listen and acting with efficient precision when it’s time to act? Let’s be clear on what I’m not saying here. I’m not saying you should never do two things at once, since many routine tasks can be done almost unconsciously. I am saying that if you attempt to do two tasks that require mental focus, you’ll dissipate your
mental energy and complete one or both tasks less expertly than you would have if you had focused on one at a time. Recover Your Body Install power plants This recommendation is very physical. Your body is made up of little power plants called mitochondria. Like your car, they combine oxygen and fuel and produce energy. Every time you’re able to get up from the cafeteria table and go back to work, you can thank your mitochondria. The more power plants your body has, the more energy you have at your disposal every day. And here’s the best part. You get to decide how many power plants are installed in your body. Here’s what I mean by that. Your lean muscle mass has five times more mitochondria than the ‘not so lean’ parts of your body. So every single time you do something that turns your soft muscle into lean muscle you install more power plants in your body and you up your energy level. My wife Theresa joined a running clinic a few years ago that advertised “Learn How to Run 5km”. She had been completely sedentary for over thirty years. In twelve weeks she ran her first 5km race. Then she started leading clinics. Then she did a 10km race. Now she’s doing half marathons. And she’s leaner than ever. And she has more energy than ever. So walk. Do yoga or Pilates – for even 10 minutes a day. Cycle to work. Take the stairs. Join a running group. Work out at the gym. Do one simple thing that will turn soft muscle into lean muscle and you’ll find yourself some more energy. Brady Wilson is an author and expert on how conversation affects organizational energy to create dynamic results.
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Who should apply? • Health Practitioners • Health Administrators or Research Ethics Administrators • Ethics Committee Members or Research Ethics Board Members • Lawyers, Journalists, Policy Analysts, Privacy Oﬃcers, Regulators,
Educators, and Researchers focusing on health
Graduate Studies in Bioethics www.utoronto.ca/jcb Master of Health Science (MHSc) in Bioethics This professional degree program is designed to help clinical practitioners, health and research administrators, and other health leaders increase their knowledge and skills in bioethics. While many of our graduates use their training to enhance their current professional roles, others are leading ethics programs in health organizations across Canada and internationally. This two-year course-based professional program is oﬀered in modular format with a strong emphasis on interprofessional exchange and practical experience informed by theory. The program does not require a thesis, but does include learning in an applied setting and a capstone project. Recruiting now for September 2013. Application deadline February 18, 2013.
Collaborative Program in Bioethics
Transforming the Patient Experience 2013 Knowledge Exchange May 9 & 10, 2013 Poster Presentation Opportunity Attendees of Transforming the Patient Experience 2013 Knowledge Exchange are invited to provide a scholarly poster based on any one or more of the themes that shape the patient and family experience – interprofessional education, collaborative practice, patient- and family-centered care and patient safety. This will provide attendees with an additional way of sharing their experiences and lessons learned through efforts to improve the patient and family health-care experience. Tell us about your quality improvement initiatives, special practicebased projects, innovations or research studies. What issues have you and your team explored? What did you do to address these issues? What did you learn from your experience? Have your findings led to changes in practice? KGH will accept submissions whose content is aligned with the theme of transforming the patient experience. Space is limited.
This master’s and doctoral research-stream program is oﬀered in collaboration with ten graduate units at the University of Toronto: Health Policy, Management & Evaluation; Law; Medical Science; Nursing Science; Pharmaceutical Sciences; Philosophy; Public Health; Rehabilitation Science; Religion; and Social Work. Recruiting now for September 2013. Application due dates vary by graduate unit.
For more information visit www.kghconnect.ca/conference To book space for your poster presentation, contact Lenora Duhn, email@example.com
Hospital News, JANUARY 2013
PROFESSIONAL DEVELOPMENT AND EDUCATION 2013
Hospital News, JANUARY 2013
PROFESSIONAL DEVELOPMENT AND EDUCATION 2013
soaR iN youR health CaRe CaReeR
yerson University’s G. Raymond Chang School of Continuing Education has a long history of, and a strong reputation for, providing practical and applied programs. A variety of our certificate programs can be completed
in a short time. Learners from the health care sector can choose from several Chang School programs to add a career-focused specialization to their resumés.
NuRsiNg CouRses aNd CeRtifiCates • Post-Diploma BScN Degree for Registered Nurses – Offered through a flexible, part-time, online format. • NEW – The Certificate in Advanced Nursing Leadership and Management is a certificate for post-baccalaureate nurses and is available through a combination of on-line and in-class courses. • NEW – Paediatric Health Assessment course is available online.
foR moRe iNfoRmatioN about nursing courses and programs, visit www.ryerson.ca/ce/nursing. Email: firstname.lastname@example.org Phone: 416.979.5000, ext. 4775
Nuring flyer_med ad.indd 1
Broaden your nursing horizons with Durham College’s Mental Health Nursing program As a nurse, it’s important to be qualified in a wide range of health matters, including the mental health sector. People who suffer from mental health issues need a specialized sense of compassion and care from competent and trained professionals. Durham College can provide that high quality training through the Mental Health Nursing certificate program. The program, based on the Standards for Psychiatric/Mental Health Nursing in Canada, prepares licensed registered nurses and registered practical nurses (RN/RPN) with theoretical knowledge and hands-on clinical practice. Nurses study core mental health components including crisis intervention, issues and ethics, therapeutic techniques and group therapies. Upon completion, nurses will be prepared to assess, provide interventions and advocate for mental health clients in a variety of institutional and community settings. The Ontario Shores Centre for Mental Health Services in Whitby, Ont., is pleased to be a training partner and curriculum collaborator for the program. RPN Jaime den Hartog, currently employed at Ontario Shores, credits the Mental Health Nursing program with enhancing her nursing skills. “I feel that the program has greatly improved my professional knowledge,” said den Hartog. “I now have a better understanding of mental health issues and have strengthened my ability to have therapeutic interactions and provide successful crisis intervention. I highly recommend this program.” If you’re interested in specializing in mental health or expanding your qualifications, why not check out the Mental Health Nursing program at Durham College. For more information, call 905.721.2000 ext. 3776 or visit www.durhamcollege.ca/coned.
12/19/12 1:27 PM
Excellence in Education
The health care environment is more challenging than ever. And with our new brand vision – to be the recommended resource for board members striving for organizational excellence – we’re focused on improving governance by providing boards with the practical, evidence-informed education, tools and resources they need at every stage of the trustee lifecycle. Learn more at www.thegce.ca
Hospital News, JANUARY 2013
PROFESSIONAL DEVELOPMENT AND EDUCATION 2013
Every stage of life brings new health challenges. Whether you’re on the front-line or one of the behind the scenes people your dedication to helping others is what matters. if you’re looking to advance your career or start a new one, we want to help by offering you the opportunity to continue working while pursuing your goals. Certificates • children’s Mental Health • dementia Studies • gerontology • Hospital/Nursing unit clerk • Medical Office Administration • Medical transcriptionist • Mental Health Rehabilitation • Occupational Health Nursing RN • Oncology Nursing RN/RPN • Palliative care • Sterile Processing
Graduate Certificate • Mental Health Nursing RN/RPN Diploma • Social Services Worker Recognition of Achievement • diabetes Worker/Educator • Food Service Worker • Perinatal/Obstetrics RN/RPN
courses are available in-class, online and on an online monthly in-take basis which means you can start on your new path sooner. call us today or check our website for all you options.
www.durhamcollege.ca/coned I 905.721.3052 hospital_news_full_page.indd 1
12/7/12 8:48 AM
HospItal News, JANUARY 2013
PROFESSIONAL DEVELOPMENT AND EDUCATION 2013
Your Career in Health Information Management Starts Here!
The Diploma in Health Care Management.
Bridging the gap between clinical training and executive development (MHA and MBA programs), the Ontario Hospital Association’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 today’s rapidly changing health care climate. Learn more at www.oha.com/diploma
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. Our online modules cover a multitude of topics, including Accessible Customer Service Standards, Freedom of Information, Hand Hygiene and Personal Protective Equipment – to name but a few. Flexible pricing options are available. To learn more about this state-of-the-art learning experience, contact Katie Byrne at email@example.com.
Harvard ManageMentor From the legendary Harvard Business School comes Harvard ManageMentor (HMM): an online resource, with over 42 modules, that gives your employees the tools and resources they need to address everyday management challenges — with a click of a mouse.
Purchase your HMM license through the OHA and get 65% off the regular rate. You can get 50 subscriptions for 50 employees for only $5,000 – an extraordinary savings of $10,000.
To learn more, go (where else?) online: to www.oha.com/trainyourstaff
n 2009, the Health Informatics - HIM Human Resources Report stated that labour and skills shortages will constrain the successful implementation of Electronic Health Information System technologies in Canada. With an anticipated 12,000 jobs required in HIM by 2017, it recommended that system-based, human resources planning measures be a priority. Subsequently the Centre for Distance Education (CD-ED) developed an online Health Information Management Program whereby students will learn skills in the collection and analysis of health data to provide information used by clinicians, the health system, government agencies and researchers. In early 2012, the Centre launched a 102-week HIM Diploma Program where students will learn to confidently collect, maintain, manage and secure health information. Sandra Cotton, HIM Program Coordinator, stated “Key e-health occupations require a solid educational background such as the HIM program offered at CD-ED where students receive an unparalleled education that prepares them for the new challenges of the health care system.” This completely on-line program combines instructor-led web courses with hands-on experience in different settings. CD-ED provides ongoing support. This is the first completely online HIM program recognized by the Canadian Health Information Management Association (CHIMA), and is based on the highest education standards established in the Learning Outcomes for HIM. "We are excited about this two-year distance education program. It will meet a real need in Canada for students and professionals to take this program in a distance education format," said Gail Crook, CEO of CHIMA. "CHIMA and the Canadian College for HIM wishes the Centre for Distance Education great success with its program." Graduates may also use HIM-acquired skills in the educational and legal sectors. “As a completely on-line, real-time program, learning materials are updated as new information is learned from the constantly changing health care environment,” said Cotton. Canada's Centre for Distance Education has been providing online college courses with career-focused training since 1996. Its head office is located in Sydney, Nova Scotia with offices in Newcastle and London Ontario and Tampa, Florida.
Sought after Health Careers include Chiropractic. Always at the forefront of health care education is D’Youville College in Buffalo where they have been providing education in this vital field since the 1940s. Their excellent reputation locally and nationally attracts students from all over the world. Today, D’Youville offers a Doctor of Chiropractic program with both undergraduate and graduate entry options. Established in 2004 as the only chiropractic degree program within a larger liberal arts university setting offering health-related professional programs, this unique program offers entry to high school graduates, transfer students and at the professional level. “Our chiropractic program is enriched by collaboration with D’Youville’s programs in nursing, pharmacy, physical therapy, occupational therapy, physician assistant and dietetics. Students receive the opportunity to be part of an integrated curriculum that prepares them for a world of coordinated health care.” said, Linda E. Fisher, Director of Graduate Admissions. D’Youville offers exceptional facilities and state-of-the-art technology to students in the program. Hands on clinical internships with rotation through five sites offers a variety of clinical setting experiences not found in other programs . With scholarships available at both the undergraduate and graduate level, D’Youville offers an excellent educational opportunity at an affordable cost. Founded in 1908, D’Youville is a private co-educational college offering bachelor’s, master’s and doctoral programs in a wide variety of fields. “We’ve built an international reputation for preparing our students for the challenges of the working world, particularly in the health care field” said Fisher. The college admits students each year to begin in either January or late August. They are currently still accepting applications for the Fall 2013 academic term. For more information on both undergraduate and graduate programs visit D’Youville on the web at www.dyc.edu.
HospItal News, JANUARY 2013
PROFESSIONAL DEVELOPMENT AND EDUCATION 2013
Health Information Management Program Oﬀers monthly program starts 20 – 25 hours per week course requirements Combines virtual and in-house practicums E-book learning, connect 24/7 Eligible for National Certiﬁcation after program completion
Enroll today and enjoy the convenience, ﬂexibility and savings of distance learning.
1 866 446 5898 firstname.lastname@example.org
C E N T R E FOR Your future-at your ﬁnger tips
HospItal News, JANUARY 2013
PROFESSIONAL DEVELOPMENT AND EDUCATION 2013
New Year. New Career. Start Training Now!
• • • •
DISCOVER IMPROVE ACHIEVE
Physiotherapy Assistant • Occupational Therapy Assistant Pharmacy Assistant • Addiction Worker Medical Office Assistant • Personal Support Worker Community Services Worker
CONTACT US TODAY! WINDSOR
Top 4 Reasons to Work in the Healthcare Industry
hen deciding what career path to take, it is important to explore the industry and ensure that career goals will be met and job opportunities exist. Educational institutions like triOS College, work closely with healthcare professionals to understand industry trends. triOS asked industry professionals to list the top 4 reasons to consider this sector. Here is what they said: 1. Significant Job Growth Due to the aging population, the healthcare industry is blossoming into one of the biggest in Canada. The industry is experiencing a shortage of skilled professionals in several sectors of the field including medical transcription, personal support work and many more. The Human Resources and Skills Development Canada “Ten-Year Outlook for the Canadian Labour Market*” report indicates that healthcare will be one of the strongest sectors for employment opportunities within the next few years. 2. Variety of jobs and placement settings There are so many opportunities that exist within the healthcare field including Pharmacy Assistant, Community Services Worker, Physiotherapy Assistant, Addiction Worker and many more. Those who graduate from these fields have the opportunity to work
in settings such as hospitals, doctors’ offices, medical clinics, pharmaceutical companies, government health agencies and a variety of other medical settings. 3. A Rewarding Career For a satisfying career that makes a difference in people’s lives, the field of healthcare is a great choice. Careers that exist within the field are challenging and incredibly rewarding. Those working within the healthcare industry can say they touch lives every single day and make a difference in the world. 4. A Dynamic Environment Consider the fascinating environment healthcare professionals are immersed in. There is rarely a dull moment on the job and they get to work first hand with individuals. Rarely do those in the healthcare industry experience the same day twice. There are so many opportunities within the healthcare sector. For those serious about pursuing their dreams and entering this satisfying industry, healthcare programs offered at triOS College can be the first step in the right direction. What are the benefits of enrolling in a program at triOS College? • Proven history with over 20,000 successful graduates • Shorter programs so students can become job-ready sooner • Small classes where students
receive significant attention from instructors • Personalized approach to learning • Innovative programs led by highlyexperienced instructors • Leading-edge curriculum • Canadian-owned and operated • Frequent start dates • Morning, afternoon, evening and weekend schedules • Work-term internships included in most programs • Program courseware (uniforms/text books) included • Dedicated Career Services team • Positive presence in the community • Widely recognized by employers and industry associations • Modern and updated campus facilities • Nine convenient and easy-to-access locations • Registered by the Ministry of Training, Colleges and Universities • Largest independent career college in Ontario Student Testimonial “I enrolled in the Personal Support Worker program at triOS College after being laid off from a factory job. The teachers and staff were excellent and assisted me in every way possible, which was wonderful as my English was not great. With their assistance, I got an amazing internship. After my placement ended, my internship host hired me on full-time. I love my job now, and owe all my success to triOS.”
– Marthe McDonald, Personal Support Worker Graduate. Beginning school is a big step to take and triOS College is committed to making the process as seamless as possible. Interested students can attend an information session with an education consultant to learn more about the industry they are considering. triOS College has many different programs that will fit many different needs and lifestyles. Students receive theoretical and practical experience that ensures success after they graduate. About triOS Since its inception in 1992, triOS College has prepared over 20,000 jobready graduates for rewarding careers. triOS originated as a technology education provider and has now grown to offer programs in business, law, technology and healthcare. Students receive a career-focused approach to education and have internships included in most programs. triOS is the proud recipient of numerous distinctions including being named one of Canada’s 50 Best Managed Companies two years in a row. triOS has nine campus locations across Southern Ontario and is registered as a Private Career College under the Private Career Colleges Act of Ontario. More information about triOS College may be found at www.trios. com, Facebook: www.facebook.com/ groups/trioscollege/ Or Twitter: www. twitter.com/trioscollegeBTH.
Hospital News, JANUARY 2013
PROFESSIONAL DEVELOPMENT AND EDUCATION 2013
The Osgoode Certificate in
March 6 - April 29, 2013 5 Modules over 9 Weeks Priority Service Code: 12-58HN
This unique certificate program is designed for health care professionals. You will learn about: Module 1 — Accountability in Health Care: The Legal Framework Module 2 — Consent and Capacity Module 3 — Medical Malpractice: Key Principles Module 4 — Health Information, Privacy and Security/Risk Management in Health Care Module 5 — Regulation of Health Care Professionals and Other Legal Issues Affecting Health Care Providers
Program Directors: Cindy D. Clarke, Borden Ladner Gervais LLP Wendy Whelan, Borden Ladner Gervais LLP Registration Fee: $3295 plus HST
The Osgoode Certificate in
Mental Health Law April 8 - May 14, 2013 5 Modules over 5 weeks Priority Service Code: 12-62HN
This practice-based program was developed to give you the knowledge and practical skills you need to competently and confidently handle mental health law issues. Topics include: Module 1 — Overview of Mental Health Law in Ontario Module 2 — Consent, Capacity and Substitute Decision Making Module 3 — Special Issues in the Geriatric/Pediatric Context and Cultural Issues in Mental Health Module 4 — Privacy, Confidentiality and Risk Assessments Module 5 — Mental Health – The Forensic System
Program Directors: Mary Jane Dykeman, Dykeman Dewhirst O’Brien LLP Kate Dewhirst, Dykeman Dewhirst O’Brien LLP Registration Fee: $3195 plus HST
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 you’re looking to learn or refresh skills or simply get an update on recent developments, consider OPD’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.
Choose from these cutting-edge and comprehensive upcoming programs: The Osgoode Certificate in Clinical Risk, Negligence and Claims Management in Health Care (Starts January 21, 2013) The Osgoode Certificate in Health Law (Starts March 6, 2013) The Osgoode Certificate in Mental Health Law (Starts April 8, 2013)
For a complete list of upcoming events or to register for any of our programs: visit: www.osgoodepd.ca call: 416.597.9724 or 1.888.923.3394 e-mail: email@example.com Osgoode Professional Development, 1 Dundas Street West, Suite 2600, Toronto
Register now by visiting www.osgoodepd.ca, calling 416.597.9724 or 1.888.923.3394 or emailing firstname.lastname@example.org. Inquire about group discounts and financial aid.
Osgoode Professional Development, 1 Dundas Street West, Suite 2600, Toronto
Get Lean Online
ARTHRITIS, BACK ACHE, & BONE DISEASE Special Seminar To Be Held
Decrease Costs. Increase Efficiency. The Ontario Hospital Association now offers three online Lean Health Care programs – Yellow, Green and Black Belt to help you and your organization decrease cost while increasing efficiency. To help get you started on your Lean education we’re offering $50 off the Online Lean Yellow Belt registration. Get started today at www.oha.com/GetLeanOnline Offer expires January 21, 2013.
onquering and avoiding arthritis, back pain, and bone disease are goals for many people. Improper sleeping positions, the wrong kind of exercise, and bad nutrition can result in penetrating, unfathomable pain. Bad dietary habits can also cause bone disease. From a strictly scientific standpoint, the six-hour seminar, “Arthritis, Back Ache, and Bone Disease,” will examine the causes and treatments for arthritis, back ache, and bone disease. The seminar will be presented by two of North America’s leading physician experts on arthritis, back ache, and bone disease: R.S. Hullon, M.D., J.D. and N.B. Katz, M.D., Ph.D. The seminar will be presented four times in Ontario Province: Thursday, May 2, 2013 in Ottawa; Friday, May 3, 2013, in Toronto; Thursday, May 9, 2013, in London; and Friday May 10, 2013, in Richmond Hill.
Dr. Hullon will be the presenter on Thursday, May 2 (Ottawa) and Friday, May 3 (Toronto). Dr. Katz will be the presenter on Thursday, May 9 (London) and Friday, May 10 (Richmond Hill). The seminar is designed to provide healthcare professionals with the latest research and information on arthritis, back disorders, and bone disease. Specifically, the seminar materials will cover the latest medical and surgical therapies for these ailments. Seminar materials will include information on the prevention of back disorders and cover how diet and nutrition can play a role in preventing bone disease. The seminar is sponsored by the Biomed Corporation, North America’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, 3219 Yonge Street, Suite 228, Toronto, Ontario M4N 2L3. Visit Biomed’s web site at www.biomedglobal.com. Telephone: 1-877-246-6336 (toll-free) or (925) 602-6140. Fax: (925) 363-7798. E-mail: email@example.com
Hospital News, JANUARY 2013
PROFESSIONAL DEVELOPMENT AND EDUCATION 2013
ARTHRITIS , BACK ACHE, & BONE DISEASE A Seminar for Health Professionals TUITION $109.00 (CANADIAN) Instructors: R.S. Hullon, M.D., J.D. (May 2 & 3) Nikita B. Katz, M.D., Ph.D. (May 9 & 10) 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 completion certificates will be distributed.
My Aching Back: Why Is Back Pain So Troublesome? Why So Common? Preventing Back Pain: Tips for Proper Posture and Lifting at Work and at Home. Sleep and Back Pain. What Is the Best Mattress for Back-Pain Sufferers? Omega-3 Fatty Acids for Neck and Back Pain: An Alternative to NSAIDS? Omega-3 Fatty Acids and Joint Health. The Needle: Acupuncture for Low Back Pain. Does the Needle Bring Relief? Latest Studies: Use of Acupuncture for Joint Pain. Degenerative Disc Disease. Gene Therapy: The Treatment of the Future. Artificial Disc Replacement for Degenerative Disc Disease. Fusion Surgery. Herniated Discs vs. Degenerative Discs: Comparison of Symptoms and Approaches to Treatment. Arthritis: What Are the Causes? Why Is Arthritis So Painful? Arthritis and Heart Disease: Heart Disease Risk and Rheumatoid Arthritis (RA) Patients. The Significance of Early Adequate Treatment of Arthritis. Runners and The Risk of Osteoarthritis: Can Running Wear Out the Joints Faster? When Should Patients Stop Running? Holy Guacamole! Avocados and the Role of Avocado Soybean Unsaponifiables in Osteoarthritis. Salsa and Guacamole: The Ultimate Power Food? Relaxation Therapy for Arthritis: The Benefits of Tai Chi, Yoga, Massage, and Meditation. Sports Injuries and the Risk of Arthritis: Avoiding Knee Replacement Surgery. Role of Stem Cells in Knee Repair. Can Chocolate Prevent Calcium Absorption? Best Dietary Sources of Calcium. Flossing for Healthier Joints? Periodontal Treatment and the Effect on Joint Pain. The Effect of Rheumatoid Arthritis on Oral Health. TM (Temporomandibular) Joint Arthritis: Prevention and Treatment Options for TM Joint Arthritis. Rheumatoid Arthritis and Oral Health: The Importance of Saliva. Obesity and Arthritis: Why Weight Alone Is Not the Main Factor. Diet, Food Allergies, and Rheumatoid Arthritis: How a Good Diet Plan May Help Prevent Arthritis. Is Inflammation the Common Link? The Abnormal Immune Response in Rheumatoid Arthritis: Genes and T-Cells. Joint Replacement Surgery: When Does Surgery Become an Option? Recent Developments in Joint-Replacement Surgery. Joint Resurfacing vs. Joint Replacement: When Is Joint Resurfacing an Option? Partial Knee vs. Total Knee Replacement. Vitamin D, Calcium, and Bone Health: Effect of Sunlight on the Metabolism of Vitamin D. Regulation of Calcium by Vitamin D. Osteoporosis: Four Important Steps in Preventing Osteoporosis. Foods That Worsen Osteoporosis. Sodium Intake and Bone Health. Recognizing Red Flags. When Back Pain Signals Serious Illnesses (osteomyelitis, cancer, abscess, compression fracture, and MS).
6 CONTACT HOURS / www.biomedglobal.com
MEETING TIMES & LOCATIONS OTTAWA, ON
Thu., May 2, 2013 8:30 AM to 3:30 PM Hilton Garden Inn Ottawa Airport 2400 Alert Rd. Ottawa, ON
Thu., May 9, 2013 8:30 AM to 3:30 PM Best Western Lamplighter Inn 591 Wellington Rd. South London, ON
Fri., May 10, 2013 8:30 AM to 3:30 PM Sheraton Parkway Toronto 600 Highway 7 East Richmond Hill, 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.
This program is designed to provide nurses with the latest scientific and 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. Institute for Natural Resources (INR) is an approved provider of continuing nursing education by the Virginia Nurses Association, an accredited approver by the American Nurses’ Credentialing Center’s Commission on Accreditation.
Pharmacists successfully completing this course will receive course completion certificates. Biomed is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. The ACPE universal activity number (UAN) for this course is 0212-9999-13-001-L01-P. This is a knowledgebased CPE activity.
Biomed, under Provider Number BI001, is a Continuing Accredited Provider Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RD’s) and dietetic technicians, registered (DTR’s) will receive 6 hours worth of continuing professional education units (CPEU’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.
Course completion certificates will be distributed to psychologists completing 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 certificates.
LEARNING OBJECTIVES 1) 2) 3) 4) 5) 6) 7) 8) 9)
Participants completing this course will be able to: describe the causes of arthritis, back ache, and bone disease. outline the differences among rheumatoid arthritis, osteoarthritis, and back disorders. describe the relationship among vascular health, inflammation, and arthritis. list evidence-based strategies that might reduce patient risk for back disorders, arthritis, and bone disease. discuss exercise, diet, and alternative treatment options for arthritis, back aches, and bone disease. discuss existing and proposed treatment options for arthritis and back pain. outline the connection between oral health and arthritis. outline approaches that dental professionals need to use for patients with arthritis and bone disease. describe, for this course, the implications for dentistry, mental health, and other health professions.
SPONSOR Biomed is a scientific organization dedicated to research and education in science 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 entity. Specifically, Biomed takes no funds from pharmaceutical, food, or insurance 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 material or other financial relationship with any health carerelated business or any 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. Biomed’s telephone number is: (925) 602-6140. Biomed’s fax number is: (925) 363-7798. Biomed’s corporate headquarters’ address is: Biomed, P.O. Box 5727, Concord, CA 94524-0727, USA. Biomed’s GST Number is: 89506 2842.
Please check course date: Thu., May 2, 2013 (Ottawa, ON) Fri., May 3, 2013 (Toronto, ON)
Thu., May 9, 2013 (London, ON) Fri., May 10, 2013 (Richmond Hill, 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 Charges by credit card will be processed in U.S. dollars. The prevailing rate of exchange will be used.
Card Number: Signature:
HOW TO REGISTER
INSTRUCTORS Dr. R.S. Hullon (M.D., J.D.) is a physician and surgeon specializing in trauma and orthopedics. His medical experience includes diagnosis and treatment of infectious diseases, neurological disorders, neurodegenerative diseases (multiple sclerosis, Parkinson’s, and Alzheimer’s diseases) and psychiatric disorders (personality and mood disorders). Dr. Nikita B. Katz (M.D., Ph.D.) has practiced as a board certified physician and has served as lecturer and full-time researcher at the University of Utah Medical School. Dr. Katz is the author of numerous scientific publications and monographs in the fields of neuroscience, molecular biology, protein biochemistry, and artificial intelligence. Biomed reserves the right to change instructors without prior notice. Every instructor is either a compensated employee or independent contractor of Biomed.
(enter all raised numbers)
There are four ways to register: Online: www.biomedglobal.com By mail: Complete and return the Registration Form below. By phone: Register toll-free with Visa, MasterCard, American Express®, or Discover® by calling
(This number is for registrations only.) Fax a copy of your completed registration form— including Visa, MasterCard, American Express®, or Discover® Number—to (925) 687-0860.
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 Express®, or Discover® 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 customer’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 sponsor’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. Fees subject to change without notice.
For information about seminars in other provinces, please call 1-877-246-6336 or (925) 602-6140
REGISTERED NURSES (RNs) & LICENSED PRACTICAL NURSES (LPNs)
Please return form to:
Profession: Professional License #: Lic. Exp. Date: Employer: (needed for confirmation & receipt)
Please provide an e-mail address above to receive a confirmation and directions to the meeting site.
Suite 228 3219 Yonge Street Toronto, Ontario M4N 2L3 TOLL-FREE: 1-877-246-6336 TEL: (925) 602-6140 FAX: (925) 687-0860
RICHMOND HILL, ON
Fri., May 3, 2013 8:30 AM to 3:30 PM The Old Mill 21 Old Mill Rd. Toronto, ON
Focus: Professional Development/Recruitment and Retention/Health and Safety 15 Hospital News, JANUARY 2013
Developing leaders for changing times: Investing in leadership development to improve care By Jessica Herbison
ike many healthcare providers, Providence Care knows about change. The need to embrace change – as individuals, as an organization and as an industry – is our new reality. With new standards of care, a growing population and shifting demographics, strong leadership skills are essential in today’s complex healthcare environment. Faced with significant pressures on time and resources, Providence Care intentionally started to develop participatory leadership competencies within the organization. Participatory leadership fosters an environment of strong collaboration and shared responsibility to enable rapid change. Providence Care began to look at engaging in this non-traditional approach to developing leadership, Lauri Prest, Director of learning and leadership services explains, “It is clear that traditional and conventional methods of leadership are not sustainable for the type of leadership that is needed today.” She began calling on global stewards like Margaret Wheatley, Juanita Brown, Toke Moller and Tim Merry to share their stories and world experience in methods of conversational participatory leadership. This “meeting of the minds” led to the creation of a leadership program that uses participatory methods to harness innovation and lead change. The leadership development strategy was designed to build internal leadership capacity based on the organizational values of respect, dignity, compassion and stewardship. “Change is fast, transition is what’s slow. To lead change through the values of our organization, the focus should be on strengthening our community through leadership practices that host valuesbased conversations enabling collaborative and wise action,” says Prest. A six-week experiential leadership development program was started that incorporated an additional six month, mentor-guided practicum. Integrating a practicum in to the program means that emerging leaders are putting their newly acquired knowledge directly to work. Participants of the program identify opportunities within the organization – seeking innovative ways to lead change. Attendees practice participatory methods
Participants of the “Partnerships that Work” workshop engage together in meaningful conversations during one of the days exercises. of engagement to improve processes that have a direct impact on the patient, client and resident experience. “The effort we put into leading intentionally and working collaboratively has resulted in the delivery of sustainable, responsive and quality person-centred care. We can truly see a change in how we relate to each other and the type of care we provide through work that was initiated in the leadership development program and practicums,” explains Prest. The Partnerships That Work conference held in Kingston
this past spring is an example of the work emerging from the leadership development program. Fifty-five front-line clinicians, administrators and policymakers from across the South East region participated in this one day knowledge exchange. The conference encouraged participants to move forward with current collaborations, establish new partnerships, and generate innovative ideas for the future of mental health care in the region. Partnerships That Work was organized in part by Karin Carmichael, a graduate of the
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leadership development program. Many of Carmichael’s team also participated in the leadership development program and together they formed the Client Transition Working Group. In collaboration with staff from the Frontenac Community Mental Health & Addiction Services they are successfully working to create a better plan and supports to transition clients to the community. Based on the participatory methods that they learned at Providence Care’s leadership program, the working group used World Café and
Appreciative Inquiry techniques to solicit involvement in the planning process. “The results have been significant with respect to getting commitment from all those involved in this process,” explains Carmichael. “We are cultivating leadership right from the front line and engaging clients in their care.” “Collaboration is increasingly seen as a key factor in the efficient delivery of care and in the improvement of the health system as a whole,” says Prest. The leadership development program is setting the stage and continues to grow – over 250 staff and community partners have participated, with hundreds more affected by the leadership initiatives that have sprouted from the program. Providence Care has been intentional about developing sustainable internal leadership capacity “We are taking the time to understand how to design and lead change within multidisciplinary teams and the complex systems within health care. [We are] building a common language, framework and set of principles to lead as a community of practice through the values of the organization.” Jessica Herbison is Communications Officer – Redevelopment Specialist at Providence Care in Kingston.
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News, JANUARY 2013 16 Hospital From the CEO’s Desk
Why big changes are needed in our health care “system”
By Rik Ganderton
his blog may be considered controversial by some and beyond the purview of a hospital CEO. I am writing it because, as a leader in the system I need to communicate the valid need for change and what is driving that. The need has been there for years. The difference now is the globally-precipitated financial crisis. I am not taking political sides, but I am saying the system needs to change. It has been widely reported in the media that the province has a $14 billion annual operating deficit and accumulated debt of $237 billion. The accumulated debt represents approximately $17,770 for every man, woman and child in Ontario. The province’s annual revenues were $106 billion in 2010/11. (This is all the money the province collects from taxation and user fees, which are the government’s only source of income.) So the accumulated debt is 2.25 times the province’s annual revenue. While there are diverse, if not diametric opinions, on the reason for the deficit and the debt, there is considerable consensus that a major causal factor is the global financial crisis of 2008 and the subsequent anemic economic growth globally. By March 31, 2018, the projected date by which the province has publically said it will balance the annual books, the accumulated debt is expected to be some $275 billion. The Wall Street rating agencies have been to town and have said that if Ontario wants to retain its credit rating it has to get its fiscal house in order. This mandate will apply to any future government, regardless of political stripe. One of the ways the province is balancing the annual books is by reducing the rate at which health care expenditures are growing. The government is trying to cap that rate to 2.5 per cent a year. That’s no small order. In the last 10 years, health care spending increases have amounted to more than six and a half per cent a year. Currently, the province spends $47 billion per year or 42 per cent of its annual revenue on healthcare (hospitals, doctors, homecare, long-term care, community care and drugs). So there really is no need to change very much in
Rik Ganderton is President and CEO, Rouge Valley Health System the health care system as long as we keep spending more, right? In my opinion – wrong! What are hidden in the numbers are three important facts that have profound implications for how health care is delivered.
restructure how we deliver services. From a hospital perspective the impact is likely to be greater. In Ontario’s Action Plan for Health Care, the government has also said that it intends to shift certain procedures and care from
health care is diminished even more by every dollar spent on interest payments. Any future government will have the same problem. Furthermore, there is ample evidence demonstrating that the current health care system is not really a system. (Ask most patients trying to navigate through it!) It is inefficient, quality is not consistently high, access is confused with geographic proximity and a high quality patient experience is often lacking. In my view there is currently enough funding in the health care system (with the proposed 2.5 per cent annual budget growth) to meet patient need during the provincial budget balancing cycle. However, the status quo is not an option if we are to achieve this. We have to fundamentally change the delivery model and create a real “system” not a bunch of fragmented silos. Here are a few examples of such fundamental changes needed: • We need to eliminate the fragmented governance and create real integrated delivery organizations that are accountable for quality, access and cost across the continuum of care - this
Health care has to change. The way we are presently organized is a barrier to delivering better quality and better value for our limited tax dollars. 1. The population of the province will grow by a little more than one per cent a year over the next few years. Every one of these additional people will be entitled to health care. 2. We are all aging and the impact of this, on health care demand, will result in yet another increase of a little more than one per cent. 3. We have to deal with inflation factors, such as increasing costs of supplies, drugs and salaries of unionized and non-unionized employees, and billing rates of doctors. In real terms that 2.5 per cent will be eaten up by growth in demand through aging and population increases. That means every nickel for increased salaries or supply and drug costs, not offset by improved efficiency, will result in real service reductions unless we quickly
hospitals to community based care – increasing investment and shifting resources to the community by four per cent a year. Since hospitals are the largest component of healthcare expenditures it is pretty clear that they will be one of the main places from which to take those health care tax dollars. (Physician services are likely to be the other one). This may not necessarily be a bad thing; hospitals are often not the most cost efficient delivery model for many services. In my opinion there is very little financial wiggle room left to avoid the necessary and needed restructuring of the health care system. The suits from Wall Street are watching and the debt rating is crucial. If the province’s debt rating decreases, then the province’s cost of borrowing increases. The government’s ability to fund
means reducing the number and levels of governance/ boards; • Good quality is more important than proximity to mediocre or poor quality service that is available just around the corner – we must consolidate services to drive quality and cost effectiveness; • We have too many physical hospitals (particularly in the GTA) – many are aging and are too expensive to maintain – we need to merge and rationalize our physical plant so that we can deliver more and better care more efficiently. (We can pay for much of the upgrades and new facilities from the savings gained by eliminating old plants.) • We need to understand and accept the research evidence that shows that aggregating services increases quality and efficiency – this means physicians and other
clinicians with specialized expertise need to move and work together in hospitals which will focus on services and patients they are trained to serve; • Hospitals cannot be all things to all people - many procedures can be done outside a hospital more cheaply, safely and with better quality outcomes; • We have to deliver care using best practices – Medicine is more science than art these days and using best practices and measuring compliance by all care providers is critical. In the coming electoral campaigns we will hear much in the way of promises from every political party. The provincial financial numbers paint a serious picture, irrespective of which political party occupies Queen’s Park! There is a danger that we will tax our way out of this need to change. Raising taxes to provide more health care funding would be wrong as we would be wasting more money on an inefficient system and delaying the inevitable – fundamental change that is required. Health care has to change. The way we are presently organized is a barrier to delivering better quality and better value for our limited tax dollars. We need the political will from every party to support change that is necessary and inevitable. Moreover, we need our citizens, and voters, to fully understand the problem, to contribute to the debate on solutions, and to accept and support the solutions required to create a sustainable health care system. This blog is part of a series we’ve been talking about this year on transforming health care. We will have more to come. In future blogs I will talk about some of the alternatives for the needed restructuring. I welcome your views on this topic. What options seem realistic to you, or what would you propose? * Please post a comment on our blog at rvhsblog.blogspot.ca or email us at communityrelations@rougevalley. ca. Rik Ganderton is President and CEO, Rouge Valley Health System.
Hospital News, JANUARY 2013
Greening our way into 2013
By Dylan Dingwell
n 2012, the Canadian Coalition for Green Health Care (www.greenhealthcare.ca) reached more people and organisations than ever before. We dramatically expanded our membership among health care facilities and health systems, as well as environmentally-conscious businesses, non-profit groups and individual environmental champions. Today, the Coalition's health care members represent over a quarter of all hospital beds in Canada, and our business associates include some of the largest and most innovative health service companies in the world. Thanks to sponsorship from Philips Lighting, we delivered the free online Canadian Green Health Care Digest each week in 2012, providing the latest green health care news and event information to thousands across Canada and beyond. In July, at Norfolk General Hospital (NGH), we held the first official session of 'Getting to Green', the environmentallysustainable health care workshop, which was developed with support from Johnson & Johnson. Highlighted by a tour of NGH's facility and a fabulous local food lasagna for lunch, the workshop was a huge success, with attendees from a wide variety of health care organisations coming together to learn and share their expertise on greening health care. We also kicked off our 'GreenWeb' educational series over the summer with a webinar on local food for health care. Green Web webinars will continue throughout the year. Watch the Digest for announcements. Our initiatives in 2012 targeted some of the most exciting and impactful areas where health care is going green. Notably, we studied hospital food provision and identified opportunities for local and sustainable food options
in health care with funding from the Ontario Ministry of Agriculture, Food, and Rural Affairs, and we launched the ENERGY STAR Health Care Energy Leadership Program (HELP) with support from Natural Resources Canada, aiming to bring meaningful energy efficiency resources and strategies into focus for health care facilities nationwide. Given our 2012 base of solid successes, 2013 looks extremely promising with even more opportunities for the Coalition to work with the health care community to enhance environmental sustainability and practices that protect human health and decrease health care’s impact upon our fragile environment. With funding from Ontario Centres of Excellence and a consortium of business partners led by Trane, we're going to be piloting Green Revolving Fund and model for health care energy projects, a national first. We are also working with health care leaders in Nova Scotia to study the resiliency of health care facilities to climate change and extreme weather events, supported by the Nova Scotia Climate Change Adaptation Fund, and our partners, Health Canada, the Canadian Healthcare Engineering Society, and Guysborough Antigonish Strait Health Authority. And we're going to continue to building and enhancing the national network of green health care supporters. If you want to become a part of Canada’s premier integrated green health care resource network; a national voice and catalyst for environmental change, check us out at www. greenhealthcare.ca or email email@example.com Dylan Dingwell is Project Coordinator & Webmaster for the Canadian Coalition for Green Health Care. He can be reached at: firstname.lastname@example.org
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News, JANUARY 2013 www.hospitalnews.com 18 Hospital Focus: Professional Development/Recruitment and Retention/Health and Safety
Yoga in the workplace helps relieve stress and improves concentration By Helen Goldstein
here's a growing body of research to substantiate how important it is for people working in high stress jobs to take a few moments each day to do some relaxation exercises which include meditation, yoga and deep breathing or breath awareness. Health care workers in particular spend most of their day on their feet dealing with high stress, busy, fast paced and generally unpredictable days. You tend to be affected physically, mentally and emotionally by the demands of your patients and must remember it’s important to take care of your own well being. Standing on your feet as well as working in an office or at a computer for prolonged periods of time can put strain on the neck, shoulder, leg and back muscles which in turn can lead to tension and stiffness. This tension can cause headaches, as well as back, hip, neck and shoulder pain. If left unattended, it could also impact your ability to function effectively at work and your overall quality of life. Not to mention the anxiety and stress you might feel dealing with patients, the system and co-workers. It is possible to relieve so many of the physical as well as emotional issues we may experience with simple exercises that can be done while standing or sitting at one's desk. I have found that in over 20yearsof teaching Yoga based wellness in large and small corporations, the participants typically experience: released tension, increased flexibility, stronger muscles, decreased stress and anxiety, a comfortable resting heart rate, decreased pain, improved immunity, better concentration and focus. I have seen profound changes in the workplace as a result of wellness programs like seated yoga. Due to the need for trainers, I offer online certificate trainings for wellness professionals on how to deliver wellness in the workplace. Employers and employees love these exercises for many reasons: it's time and cost efficient, you do these exercises in your work clothes, it builds a cohesive community in your organization, it takes up very little space, as you are standing, and a chair and or desk is all you need if you are desk prone. These exer-
Helen Goldstein in seated yoga warrior posture. cises are non-competitive and process oriented. They can be done in a group or by yourself in less than three to five minutes each so you can take a break now and then as you need to take care of yourself. So take a few minutes to experience this simple, easy to learn and very efficient sequence of breath and movement exercises which can help you deal with whatever life throws at you. Before you begin: • Breathing is very important in the practice of Yoga. When doing the exercises you want to take deep, slow breaths in and out. • Exercises should be done slowly and with awareness of sensation and thoughts...this will give you the full benefit. Take a few moments to close your eyes just be quiet before you start to gain concentration and focus. • Be aware of your posture, your upper body should be straight and tall, yet relaxed, your feet firmly grounded on the floor PLEASE NOTE: if you have any pre-existing health concerns relating to the neck, back, legs or shoulders it is recommended that you check with your doctor prior to initiating this type of activity. As with any physical activity, if you experience pain or discomfort from these exercises you should discontinue the activity. GETTING STARTED You do not need to do the whole yoga routine given her; pace yourself and add pieces as you feel more comfortable. Become accustomed to the movements and breathing, they are different from what you may have experienced before.
Let's start with breathing: centers mind and body This breathing helps you get present and ready for your yoga practice. Sit or stand with your spine straight, feet on the floor (if sitting put your feet on a cushion or a book if they don’t reach the floor). The trick to encourage deep breathing is to exhale more fully. While holding the hands over your ribs, take a deep breath in through the nose, then exhale slowly, focusing on drawing the navel to the spine as you expel the air completely. Then allow your lungs to fill completely from the bottom to the top. Repeat for five breaths or for as long as is comfortable. Sun Breath: grounding and focusing Sun breath is a variation of deep breathing. Again, with your spine straight, inhale and raise the arms horizontally to each side; then raise them straight up in the air until the palms touch. Exhale, and lower the arms to the side. Repeat for five to eight breaths. Neck Stretch: releases tension in neck and shoulders During an exhalation, slowly tilt the head towards your right shoulder. Rest for two to three breaths, allowing the neck muscles to slowly relax. Repeat to the other side. To move a bit deeper into the neck stretch, place your opposite hand on your ear. For instance if your ear is resting towards your left shoulder, place your left hand on your right ear. Do not push or force, simply allow the weight of your hand and arm deepen the sensation of your stretch. Hold for about two to three deep breaths and bring
the head back and repeat on the other side. Notice how one side may be different from the other. Just be aware and breathe… Come back to center, turn your head to look out over your right shoulder. Hold for two to three breaths, allowing the head to slowly deepen into the stretch. Repeat other side. Then bring your chin down to your chest and just watch the sensation. To enhance this sensation you may interlace your fingers and place your hands on the ridge of your head above your neck, please do not put them on your neck, bring your elbows together and without pushing or forcing allowing the weight of the arms to stretch your neck in a gentle way.Roll up slowly and gently back to centre. Repeat these exercises two to three times. Neck stretches should not cause pain. Cat and Dog Stretches: creates flexibility in the spine and releases tension With both feet flat on the floor and the knees slightly bent, round the back during an inhalation, dropping the shoulders and the head towards the chest. Try to imagine that you are pressing deeply into something right behind you. Keep both hands resting on the thighs elbows bent slightly to the side. This is the dog stretch. On the exhalation, arch the back, pulling the shoulders as far back as possible. Lift your chin and bring your teeth together. Eyes can gaze up or be closed. This is the cat stretch. Do this four more times. Forward Bend: good for digestion and lowers anxiety As you exhale, move your
chest towards the thighs, bending down as far as possible with your spine straight. Keeping the spine straight is more important than how far down you bend. Then totally release the spine and just hang out. As you inhale, slowly stretch back up while reaching the hands as high as possible over the head. You can also just bend over and dangle and keep your head really relaxed. To intensify this posture place your hands on the opposite elbows and press down to the ground –keep your knees soft. You will feel this in your lower back, and legs. Repeat this pose four more times. Warrior I: an advanced posture great for stretching inner thighs and building confidence This can be done standing by opening the legs wide and pointing the right foot to the right and twisting the left foot around so it points to the right as well. In a chair you would sit sideways. The left legshould be stretched behind the chair while the right leg should be flat on the floor with the knee at a ninety degree angle over the ankle. With the torso straight, during an inhalation, raise the arms straight up above your head so the palms face each other. Hold this pose for three breaths. For extra challenge if sitting, engage the legs to lift up from the chair. Repeat two more times; then, repeat on the other side. Warrior II: This pose is similar to warrior 1. Bring yourself into the Warrior 1 position and instead of the arms coming above your head, bring them out to the side with the arms parallel to the floor while the torso faces forward. Look out over the front arm, and hold for three breaths. You can also look over the back shoulder. For extra challenge, engage the legs to lift up from the chair. Repeat two more times; then, repeat on the other side. Spinal Twist: this is great for the digestive system, the spine, the central nervous system and for toning the waist and hips... The spinal twist is also done while standing or sitting. While standing place your hands on the opposite elbows, ground your feet firmly and slowly twist your torso so you can see over one shoulder while keeping your hips and lower body facing forward.... Continues on page 19
Focus: Professional Development/Recruitment and Retention/Health and Safety 19 Hospital News, JANUARY 2013
Four Priorities to get the health Care System out of the emergency room By Gabriela Prada and Louis Thériault
anadians associate their health care system with national pride. However, this pride does not match the results delivered by the system. Canada does not have, as many Canadians still incorrectly believe, “the best health care system in the world”. Despite increased investments in health care over the past decade, Canada has not been able to improve its performance compared to other countries. And more worrisome, performance in key indicators, like infant mortality and mortality due to diabetes has deteriorated. Jeff Turnbull, former president of the Canadian Medical Association, noted last year in a public discussion that health care is a foundational pillar of Canada but “the foundation is eroding below us’’. There is overall agreement that a transformation is needed. However, the pace of change is painfully slow. The Conference Board of Canada’s first-ever Summit on Sustainable Health and Health Care made evident that we need to face some inconvenient truths if we are to make progress transforming health care in Canada. The current system, designed in the 1960s, is ill-equipped to efficiently support delivery of modern health care services. We are attempting to deliver current services within the constraint of outdated physical infrastructures, models of care and labour contracts and inadequate technologies. As a result of all these shortcomings, our hospitals have been left with the task of not only providing the acute care services they are intended to provide, but also primary care, rehabilitation, and to a certain extent, even long-term care. It is well known that seniors often occupy alternative level of care beds (hospital beds allocated to patients who are ready for discharge but are waiting for placement in home or residential care). A new report from the Canadian Institute for Health Information found that 54 per cent of seniors occupying these beds are waiting for residential care. This situation has overloaded our hospital capacity to provide services, keeping our emergency rooms crowded and adding to high health care costs. The recent Conference Board briefing The Inconvenient Truths about Canadian Health Care identi-
fied four priorities that will help to get the health care system out of the emergency room. These include: Build a more transparent and accountable health care system with respect to goals, management, and performance. Health care should put less emphasis on counting transactions and interventions, and more on knowing whether these interventions make a difference in patients’ lives. Improving the quality of health care services and increasing value for money requires a fundamental transformation in the culture,
care, not the emergency room, should be the first contact point within the health care system. Aging and growing chronic disease prevalence have changed the demand for health care services. This new demand can be addressed more appropriately and cost effectively in primary care. There is a strong consensus that inter-disciplinary family care teams should be the standard model for primary care and these teams should be expanded and strengthened in all provinces and territories. Primary health care providers should be equipped, tasked,
There is overall agreement that a transformation is needed. However, the pace of change is painfully slow. compensation models, incentives, and working practices of health care providers and administrators. This shift in culture and practice should be supported by measuring outcomes and establishing accountability frameworks tying these outcomes to performance targets. Creating greater transparency and accountability in a properly configured system will go a long way in mobilizing support for changes among all stakeholders—patients, taxpayers, and care providers. Fix the gateway to the health care system. Primary
and accountable for delivering effective chronic disease management, as well as encouraging and supporting health and wellness among their populations. Invest in technology. More intensive and standardized use of information technology would allow providers to collect, record, and share clinical information, which would lead to more efficient treatments and increases in health care system productivity. Progress on applying information technology more widely within the health care system has been stifled by sup-optimal strate-
gies to engage health providers in the uptake of these technologies. Providers need be more involved to speed up change and adoption. Greater use of tele-health technologies would allow patient monitoring from home or community-based practices and would decrease the need for hospital services. Align the health care system with the needs of an aging population. Hospitals are risky places, particular for seniors who are more vulnerable to infections, and who don’t cope well with limited mobility and disruptions in their routines. Health care transformation in Canada needs to include effective models to provide access to appropriate geriatric, psychological, and physical care, as well as the behavioral, social, and healthy living support required to maintain seniors’ independence and safe living at home. The required transformation will not be possible without a true interprofessional dialogue and participation of patients and families. Everyone needs to engage in an open-minded dialogue and come to the discussion table—not to defend their own interests, but to advance the interests of patients and their families. Time is of the essence. Let’s move from rhetoric to action. Gabriela Prada is Director, Health Innovation, Policy and Evaluation, and Louis Thériault is Director, Health Economics, both at The Conference Board of Canada.
Yoga in the workplace helps relieve stress and improves concentration Continued from page 18 Sitting with a straight spine, slowly turn your whole torso left, as if looking over the back of the chair. Put your hands in a comfortable position on the back of the chair and use this as a gentle lever. During the inhalation, lengthen the spine as much as possible. During the exhalation, twist the spine as far as possible without causing pain. Do this for five breaths; repeat the pose on the other side. Doing two or three of these poses a couple times each day as you sit at your desk or stand just about anywhere.is a great way to re-energize your body and mind. . You will feel the difference in your well-being and you will be more efficient, focused and relaxed.. Once you establish a routine of doing standing or chair yoga, and you begin to feel the benefits you will want to incorporate this into your daily life. And remember the most important part...Breathe! Helen Goldstein, certified by Dr.Deepak Chopra, owned The Yoga Studio Toronto. She hosts on line trainings, teaching wellness professionals how to deliver wellness in the workplace. www.theworkplacewellnessinstitute.com
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News, JANUARY 2013 www.hospitalnews.com 20 Hospital Focus: Professional Development/Recruitment and Retention/Health and Safety
Hospitals and EFAPs create a healthier workplace
By Tim Davison
he Employee and Family Assistance Program (EFAP) exists within a hospital’s benefits program to support hospital employees and their dependents, helping them cope with personal and workplace issues. The intent is to provide a healthier workplace, and help maintain employee engagement. Some hospitals make better use of their EFAP than others, but there are creative ways to leverage your EFAP and increase the return on investment for this valuable employee and organizational resource. It starts with a strategic shift in thinking: stop thinking about EFAP as a reactionary service and look at it as a strategic wellness partner, complementing your internal programming. Here are five ways to do that. 1. Integrate EFAP with your wellness committee. A robust wellness committee comprises front-line staff and those who monitor benefits information (i.e., Director of Benefits). It should also include HR, occupational health professionals, practice leaders, and senior management. The committee’s mandate is driven by information – organizational metrics on
short-term and long-term disability trends, absenteeism, health plan utilization, and engagement surveys – all the data points that measure the wellness of your workforce. Such information is vital because these cost drivers impact hospital efficiency. Consider having your EFAP representative participate in committee meetings to help ensure communication, and that use of the EFAP is aligned with your data and wellness objectives. 2. Develop a targeted, internal communications plan. Creatively promote your EFAP to employees, and technology can help. If someone has a problem at home that impacts their job – perhaps involving a spouse, children or elderly parents – they must know where to turn for help. It’s great if they can speak to their manager, but many people don’t, or won’t. Think of every person and resource this employee might turn to in their time of need, and make sure every resource person has education on the EFAP services, effectively making them a supportive referral agent. If you think your employee would use the hospital’s intranet (internal web for employees) or
internet to get help, access to your EFAP provider’s site or to your insurance partner’s portal should be made as easy as possible. If your EFAP offers a smartphone application, consider deploying it on company-issued devices so people leaders and others have ready access both to contact information and resources when they identify a potential issue or employee in need of support. 3. Build stakeholder relationships. Identify those parties who will leverage the EFAP as a resource – executives, people leaders, union leadership, occupational health workers – and see that each of them gets face time with whoever is running the EFAP. Why? Every one of these people should be ambassadors for the EFAP. This is about buy-in from the people who matter and who can make a difference. In this way, they and your EFAP can better respond to any employee situation. 4. Leverage workplace training through your EFAP provider. Hospitals have seen every type of situation – the authoritarian doctor who unloads on nurses, the nurse who unloads on technical staff, incidents of violence and harassment
involving not only staff, but patients and family members of patients. These interpersonal challenges detract from the personal health, wellness, and effectiveness of staff. EFAP training services for people leaders – both in-class and online – can help leaders recognize the symptoms of employees in trouble, and coach them on how to help defuse such situations. For example, personnel who are experiencing compassion fatigue – burnout from caring for others while not necessarily taking care of themself – will benefit from one-on-one resiliency coaching on selfcare, courtesy of your EFAP provider. EFAP providers offer seminars and workshops on specific issues, such as workplace violence prevention, or averting ‘peer-topeer’ bullying. These issues are not isolated, but long-term issues which, when untreated, lead to organizational crisis. As such, it is best practice to incorporate targeted strategies with support and education offered over 18 months or more. 5. Make the most of online services. Hospitals often attempt to offer wellness events for staff, which produce low attendance. The reality of the
St. Joseph’s Health Care London’s commitment to quality worklife and care pays off By Amanda Jackman
or several years St. Joseph’s Health Care London (St. Joseph’s) has been implementing strategies to help improve the quality of worklife for staff and the quality of care for patients and residents at all of its sites. “St. Joseph’s is committed to improving the quality of worklife for our staff through many different mechanisms,” says Deb Miller, director, organizational development and learning services. “That includes a deliberate obligation to staff health, the implementation of our learning management system, and regular surveys of staff to find out where we can improve.” The organization’s Quality Workplace Committee and the Human Resources Planning Council are both integral in identifying the needs and gaps in the organization and creating an innovative plan to ensure quality in both workplace and care. One of the key initiatives that helped to improve workplace quality at St. Joseph’s was the commit-
Some members of St. Joseph’s Health Care London’s food and nutrition services team with their gratitude chain. A tangible example of recognition and a spin-off of a quality worklife initiative. Clockwise, from top, Cathy Campbell, Carl Campbell, Kelly Goss, and Jennifer Garlicki. ment to have all leaders and board members participate in Mission Leadership training. “We require all leaders to take this course”, says Karen Stone, vice president, human resources. “It helps our leaders understand the heritage
and legacies of mission leadership at St. Joseph’s while understanding Catholic principles of health care which guide our decisions, behaviours and ethical framework.” The leader feedback received after the course
indicated a strong commitment and understanding of the approach for clinical and organizational ethics as well as a better understanding of how to collaborate and foster partnerships while deepening personal commitment to the values of the organization. The mission leadership course is only one example of the initiatives St. Joseph’s has established. Another key initiative is staff and patient satisfaction surveys; where data is collected and used to make choices for action and improvement. The Quality Workplace Committee has helped to plan and implement other strategies including health programs such as walking challenges, and ‘self-care samplers’ as well as many recognition ideas including flowers of gratitude and ‘gratitude chains’ where staff can personally acknowledge each other. The work of all involved is paying off. St. Joseph’s is seeing tangible results from their efforts. Not only healthier, happier and more satisfied staff and patients but this year St. Joseph’s won the Gold Quality Healthcare Workplace
high-pace, healthcare environment with changing priorities is a big hurdle. Leveraging your EFAP’s online, 24/7 wellness programs with JustIn-Time access can help. These services allow employees to log into secure websites, receive support through coaching on the telephone, view wellness videos, and “chat” live with counsellors on the Internet. Such services are offered at the most convenient time for the employee, and are conducted in absolute privacy. Indeed, an online JIT service is a cost-effective resource that is convenient for shift-work employees, resulting in long-term organizational savings. The key is that employees can address the very issues that will prevent them from attending work before absence becomes a reality. Remember, it all comes back to taking maximum advantage of your EFAP provider’s capabilities, and working with them in partnership to protect your most valuable asset – your employees. Tim Davison is the Regional Director for Ontario, Sales & Account Management, Health and Wellness, for the Shepell.fgi brand of Morneau Shepell. Award (QHWA). The award was created through a partnership between the Ontario Hospital Association and HealthForceOntario to recognize efforts to improve workplaces in ways that contribute to staff and care providers’ quality of worklife and the quality of the care and services they deliver. In the last six years St. Joseph’s Health Care London has been honoured three times with an award recognizing the incredible work and dedication of the organization. “Leadership at St. Joseph’s takes quality of care and quality of worklife very seriously,” says Stone. “And we know our staff, patients and residents benefit greatly from it.” “We continually hear feedback from the community about St. Joseph’s being different,” says Miller. “We often hear compliments about our comforting and warm staff. We believe if staff are feeling supported, it’s going to show in the care and service they provide which greatly contributes to a culture of respect and pride at St. Joseph’s.” Amanda Jackman is a communications consultant at St. Joseph's Health Care London.
Hospital News, JANUARY 2013
News, JANUARY 2013 www.hospitalnews.com 22 Hospital Focus: Professional Development/Recruitment and Retention/Health and Safety
‘Respect’ training helps to raise awareness on code of conduct, bullying, and workplace violence By Akilah Dressekie
new hospital-wide training program is helping to educate staff, physicians and volunteers at Rouge Valley Health System (RVHS) on how to recognize the signs of bullying and workplace violence. The Respect in the Workplace/Bullying Awareness training, led by Rouge Valley’s organizational learning and occupational health and safety teams, was first introduced as a pilot project at RVHS in July and August 2012. At that time, organizational learning focused their first sessions on the diagnostic imaging and lab departments at both hospital campuses.
Since then, the program has gone hospital-wide, with more than 1,500 staff, physicians and volunteers at Rouge Valley’s two hospital campuses in east Toronto and west Durham Region taking the one-hour mandatory training sessions. The second round of training sessions began in November, continuing into December. An online training module is also being developed for staff members who were unable to attend the inclass sessions. The goal is to have all staff, physicians and volunteers at Rouge Valley trained by early 2013. “This education program is a graduation from our original ARC (Accountability, Respect and Care) program, with a focus on our code of
conduct, violence in the workplace, and bullying,” explains Bill Hamilton, manager, organizational learning and development. “It provides our staff with more awareness on how to recognize when they see this happening, what to do, and who are their support resources to turn to. For example, your manager, human resources, or your union representative, are just a few of the places to turn.” As Rouge Valley’s human resources department has updated the hospital’s current policies on respect in the workplace and code of conduct into one policy, educating staff on these policies is how the training was initially developed. “Under the Occupational
A step forward for mental health? The new Standard for Psychological Health of a Workplace By Patti Boucher
orkers’ mental health and wellbeing will be the new thrust for employers thanks to a new CSA standard on protecting the psychological health of employees. Due out this fall, the National Standard for Psychological Health and Safety sets out goals and processes to help employers establish a strong and comprehensive program, and addresses the needs of millions of Canadians touched by mental illness. An estimated 1 in 5 Canadians experience a mental health problem at some point in their lives, while a survey of 1056 Canadian employees (2000), revealed 62 per cent were “very stressed” at work. The cost to employers is huge, with the economy losing $51 billion in terms of health care and lost productivity (Dewa, CS et al). On any given week, at least 500,000 employed Canadians are unable to work due to mental illness (Statistics Canada), and according to the Canadian Mental Health Association (2007) 74 per cent of employees off work due to mental health issues do not return. With one third of our lives spent at work, it’s important for employees to feel safe, encouraged and supported. That’s where the new, voluntary standard fits in. The standard not only mitigates
employers’ costs, but contributes to the overall health of an organization. For example, as depression and anxiety become the main cause of disability in developed countries, the cost to the employer includes increased disability insurance premiums, rising health and benefits costs, and the expenses associated with replacing absent employees. In contrast, looking after workers’ mental health benefits productivity, focus and morale and leads to engaged, enthusiastic employees. The standard will also help employers recruit and retain employees by making them feel valued and respected. Championed by The Mental Health Commission of Canada and developed by the Canadian Standards Agency (CSA) and Bureau de normalization du Quebec (BNQ), the standard offers specific steps to help employers create a psychologically safe and healthy workplace, educating staff about stigma, and ensuring regular audits on policies and procedures. The standard urges organizations to: • Develop a policy committed to the development, implementation, funding, continuous improvement and review of psychological safety • Promote workers’ wellbeing and engage workers in the process • Review psychological health and safety system objectives every three years
• Provide risk assessment with investigation of all incidents • Monitor, audit and improve psychological health and safety systems Offering far more scope than the obligations currently imposed on employers by health and safety and human rights legislation, the CSA standard is seen as a positive step forward in that it will assist employers to develop a strong and robust program. Mental Health at Work – The Facts: • 1 in 5 Canadians will have a mental illness in their lifetime – 1 in 4 will have a friend, family member or colleague with one • Canadians in the lowest income group are 3-4 times more likely to report fair to poor mental health than those in the highest income group • 43% of Canadians have a colleague with a mental health issue • 74% of employees off work with a mental health issue do not return • Work-related mental health problems can stem from an employee’s private life, workplace or society • Health care employees take the most time off work for illness or disability Patti Boucher, RN, BHSC(N), MHSM, COHN(C), CRSP, CDMP is Vice President Prevention Services at the Public Services Health & Safety Association.
Health and Safety Act, Bill 168 relates specifically to workplace violence. There is a requirement for organizations to give training and help raise awareness on this issue among their employees. It requires organizations to have policies that address it,” explains Mark Richard, manager, occupational health, safety and wellness. Under the workplace violence and harassment policy, RVHS provides support to staff who either have questions about what to do if they witness workplace violence or bullying, or if they are experiencing it themselves. Attendance has been high in most sessions. Part of the program’s success is because of support from the senior management and all management
levels. Rouge Valley’s organizational learning department has also been able to target specific departments by scheduling sessions for certain floors, allowing managers to support and schedule their staff in these areas, giving them time to leave their units and attend. Each training date offers up to four sessions each day. So far, the response to the training, and the content itself, has been strong, with staff giving positive feedback. “They’re happy to see a corporate initiative designed at addressing harassment and bullying,” explains Bill. Akilah Dressekie is the Senior Communications Specialist at Rouge Valley Health System.
Corporate culture and workplace wellness are leys to success at NYGH By Noemie Terrio
here is something special people notice when they come to North York General Hospital (NYGH). When staff, physicians and volunteers come through the front doors at the beginning of their work days, they smile. It’s not just a job, it’s a passion. They’re not just colleagues, they’re friends. Everyone understands they are working together to put patients first. Values of respect, integrity, excellence and compassion are woven through daily work – from front-line clinical staff to administrative roles – in an environment of patient- and family-centered care. To support and reinforce this corporate culture, NYGH places great importance on recognition, compensation, balance and wellness. Open communication is encouraged, and regular employee surveys are used to continually examine how the workplace can be improved. With this philosophy in mind, NYGH was thrilled to accept two industry awards, further encouraging and reinforcing the Hospital’s vision to lead the pursuit of excellence in this area. North York General had the honour of being awarded Canada's 10 Most Admired Corporate Cultures of 2012: Broader Public Sector. The
award is founded and presented by Waterstone Human Capital, a leading retained executive search firm specializing in recruiting for fit. Awards are presented to organizations with cultures that have helped them enhance performance and sustain a competitive advantage. And, for the third consecutive year, NYGH proudly accepted a Gold Quality Healthcare Workplace Award at the Ontario Hospital Association's (OHA) 2012 HealthAchieve conference. The awards program recognizes organizational efforts to improve health care workplaces in ways that contribute to providers' quality of work life and the quality of care and services they deliver. The Occupational Health, Safety and Wellness department plays a key role in ensuring staff, physicians and volunteers have a healthy and safe work environment. The department provides services like immunizations for communicable diseases, performs regular blood pressure checks and assesses workplace settings to ensure staff is healthy and safe at work. Noemie Terrio Noemie Terrio is in Corporate Communications & Public Affairs at North York General Hospital.
Focus: prOFessiONal DevelOpMeNt/reCruitMeNt aND reteNtiON/HealtH aND saFety 23 HOspital News, JAnUARY 2013
Markdale Hospital reduces 0utbreaks, increases hand hygiene compliance as part of ‘stop Infections now Collaborative’ By Jo-anne McConnell
year and a half ago, Grey Bruce Health Service’s Markdale hospital experienced their third outbreak of the hospitalassociated superbug known as methicillin-resistant staphylococcus aureus (MRSA). Staff at the small 14 bed site were frustrated and recognized that the traditional control strategies were simply not working. More education, more policies and more checklists were not the answer. A small group of nurses and environmental services staff, supported by Infection Prevention and Control, volunteered to put together a team to explore the problem. This group is known at Markdale hospital as the SINC (Stop Infections Now Collaborative) and swim team. SINC is an 18-month collaborative sponsored by the Canadian Patient Safety Institute’s Safer Healthcare Now Program, which provides virtual learning sessions and support for patient safety teams across Canada and the US. Teams learn about behavioral change techniques such as Liberating Structures, including Positive Deviance, and how to apply those techniques to the Team’s chosen model for improvement. The program was designed to help healthcare organizations improve compliance with evidence-based strategies to reduce healthcare associated infections and includes hand hygiene, environmental cleaning and surveillance. The Markdale team is considered to be one of the top five teams participating in this collaborative and have shared their learning’s and experiences with other teams. Markdale’s goal is to achieve a 30 per cent decrease in the spread of MRSA and increase compliance with hand hygiene to a consistent 85 per cent. To do this, staff realized they had to come up with some innovative quality control initiatives to increase staff, patient and public infection control knowledge. The team is now a year into the collaborative and they have surpassed their goals – the hospital is outbreak free and the most recent audit demonstrates that staff have increased hand hygiene compliance to 100 per cent. Liberating structures are easy to learn microstructures that help to organize how staff interacts with individuals and groups by building shared goals and sharing knowledge. Having learned and practiced Liberating Structures, the team
has discovered they are working with one another differently. While exploring the many challenges that prevent staff from complying with infection prevention and control measures, one of the most valuable lessons has been to ensure that everyone at the Markdale Hospital is involved in problem solving. This approach has created a noticeable, positive culture shift within the hospital. All team members, regardless of profession or position, are focused on their common goal and communi-
cate with each other to reach their goal. Team members recognized that patients also had a role to play in increasing hand hygiene compliance and reducing MRSA. Staff decided to ask a willing patient to help. Each time staff entered or exited the patient’s room, she would remind them to clean their hands. Staff in turn would paste a paper hand on the patient’s wall. By the time the patient was discharged, she had many hands covering the wall. When interviewed the
patient told the team she felt good about being part of the team and taking an active role in her own safety. She believes that this shared partnership would be beneficial for many other patients. Staff and the patient enjoyed this innovative method of increasing hand hygiene compliance and are working towards adopting this practice routinely. The SINC team members are proud of their accomplishments and new ways of working together. They have engaged everyone in new
conversations at all levels and have been successful in finding local solutions to problems. When asked how they would feel if they had to go through another outbreak, they said they wouldn’t see it as a failure, but as a situation they are now better prepared to respond to. Chief Quality Officer at Grey Bruce Health Services says that any leaders who have chosen this pathway need to allow their team to “find their Continues to page 24
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News, JAnUARY 2013 www.hospitalnews.com 24 HOspital Focus: prOFessiONal DevelOpMeNt/reCruitMeNt aND reteNtiON/HealtH aND saFety
Risk Assessment checklists aim to increase the impact on patient safety By sara Chow
n 2011, the Healthcare Insurance Reciprocal of Canada (HIROC) began to re-focus and streamline RMSAM™, our self-appraisal program. This initiative, called the Risk Assessment Checklists, aims to increase the impact on patient safety and decrease claims by focusing on the highest ranked risks in the HIROC database. HIROC rolled the Risk Assessment Checklists, a more streamlined and userfriendly risk assessment program, to its subscribers in the acute care sector in October, 2012. HIROC identified and ranked the top 30 high-cost, high-frequency risks for the acute care sector, as seen in HIROC’s claims database, the largest in Canada for healthcare liability. These 30 risks, listed below, comprise approximately eighty five percent of claims costs in acute care and inclue risks related to clinical practice, employment practices, property damage and premises liability. The Risk Assessment Checklists program takes the top 30 risks and then creates a Checklist of the ten most
impactful mitigation strategies to address the risks. We have ensured the mitigation strategies are action-oriented and practicable. Organizations assess themselves against these mitigation strategies and determine if it has been implemented within their facility. For the mitigation strategies that have been partially or have not been implemented, the organization is required to develop actions plans. A score is tied to each response: Yes – 100; Partial – 50; No – 0. This allows the program to calculate an average implementation score, a reflection of the degree to which the mitigation strategies have been implemented, for each Checklist. These standardized responses facilitate the compilation of a number of comparison reports, which will be available to users using the program. The Risk Assessment Checklists is web-based – no software installation is required. It has pre-defined dropdown menus which enable users to select a response and action plan, where required. Dropdown menus are user-friendly and reduce the workload for the
individuals involved in the risk assessment. The Checklists can be completed by the Risk Assessment Checklists coordinator (the person within the organization who has oversight of the risk assessment) or subject matter experts, e.g., clinical and operational leaders within your organization. Multi-site organizations are able to roll out the Checklists to each site, which allows for better analysis of data and identification of areas for improvement. Coordinators will have the ability to develop reports which aggregate data from two or more sites if they desire. Although you don’t need formal teams to complete the Checklists, having the input of frontline staff will provide additional insights. HIROC recognizes that organizations cannot begin to address all risks at the same time. Organizations will be able to include their own ranking of the 30 risks within the program (optional) and to select their top three areas of focus (i.e. Checklists) for the upcoming year. a three-year cycle: The Risk Assessment Checklists follow a three-year cycle.
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Year 1: Complete risk assessment. Year 2: Update responses to Year 1. Year 3: Update responses to Year 2. Year 4: Start at Year 1. Once an organization has online access to the program in Year 1, it has six months to complete the risk assessment. Years 2 and 3 submissions are due one and two years, respectively, from the Year 1 due date. Tracking changes over time: At the end of each year, the program will provide a Summary Report or Risk Register for the organization. This Register will display the names of the 30 risks and their average implementation scores. The annual updates, and changes to average implementation scores, will allow mitigation strategy implementation efforts to be tracked over time within an organization and across the 30 risks. The launch of Risk Assessment Checklists is an exciting development and we will be taking every step to ensure the program does what it is intended to do: enhance patient safety through effective risk management and evidence-based mitigation
strategies. The Risk Assessment Checklists will be updated regularly as claims trends or additional mitigation strategies emerge. Identification of top risks and mitigation strategies for the non-acute care sectors is presently underway. HIROC works in partnership with healthcare organizations across Canada to create meaningful and productive change resulting in greater safety, a reduction in claims and incidents, and improved system efficiency. Founded in 1987 with 52 healthcare organizations in Ontario, HIROC has expanded to over 500 subscriber organizations across Canada. Subscribers include regional health authorities, hospitals, long-term care facilities, community health centres, midwives, homecare organizations, associations and regulatory colleges. Please contact us with any questions about the Risk Assessment Checklists, email@example.com Sara Chow is a Healthcare Risk Management Specialist at Healthcare Insurance Reciprocal of Canada.
Markdale Hospital reduces 0utbreaks, increases hand hygiene compliance as part of ‘stop Infections now Collaborative’ Continued from page 23 way.” Leaders need to put the structures in place to support their staff to move ahead with new initiatives. With this initiative, the team was not only successful in reducing outbreaks, but they also learned to work better together as a team, an outcome which will have benefits well beyond this project. Jo-Anne McConnell is the Corporate Infection Prevention and Control Coordinator with Grey Bruce Health Services. GBHS has six hospitals in Northern Grey and Bruce counties.
Focus: Professional Development/Recruitment and Retention/Health and Safety 25 Hospital News, JANUARY 2013
St. Joseph’s Health Centre’s Leadership Development Program gives leaders the tools they need for success By Michelle Tadique
he Leadership Development Program at St. Joseph’s Health Centre, Toronto, enables our management team to enhance their leadership capabilities and competencies and gives them the tools they need to be successful in their roles. Providing this important program to our leaders and dedicated time to pursue professional development activities is an investment that supports our Vision to be Canada’s Best Community Teaching Hospital. To date, 42 management members have graduated from the program and the next cohort is set to graduate this spring. Elizabeth McLaney, Director of Interprofessional Education and Collaboration, explains that it was important for the organization to have a specialized program that was unique to St. Joe’s. Launched in 2009, a key aim of the program was to create a common language for talking about leadership. “Historically, staff would go to external leadership development courses or workshops because we didn’t have a comprehensive and sustained approach to leadership development on site,” she said. “So part of the strategy (in developing our program) was adopting a framework and model that we could use at St. Joe’s. In our case, the program is based on Kouzes & Pozner’s, The Leadership Challenge.” “Our program is a way to bring our leaders together – both in learning the content of the curriculum and in growing and developing their relationships as members of the leadership team,” explains McLaney. “Attendees often comment on the fact that the program allows them to get
Elizabeth McLaney, Director of Interprofessional Education and Collaboration, graduated from St. Joseph's Leadership Development Program in 2009. She also supports the program by teaching several components and works to recruit internal content experts. know people that they would not often work with, which makes it easier to connect when they do have shared tasks.” The program provides education on five key leadership practices that successful leaders use everyday: • Model the Way – ensuring that leaders “walk the talk” and model the behaviours and attitudes they would like to see in their own staff • Inspire a Shared Vision – challenging individuals to think about their higher level vision by imagining possibilities and finding common purpose • Challenge the Process – seeking opportunities, experimenting, taking risks, and learning from experience • Enable Others to Act – fostering collaboration and strengthening others
North York General opens dialogue between Mental Health and Spiritual Care Professionals Continued from page 3 NYGH's Dr. Donna McRitchie, VP Medical & Academic Affairs, and Dr. Tom Ungar, Chief of Psychiatry & Chair of Medical Advisory Committee, gave the opening remarks. Speakers included Professor Trevor Young, Chair, University of Toronto Department of Psychiatry, Rabbi Norman Berlat, Director of Spiritual Care at Baycrest, Dr. Donna Edwards, Family Physician, Missionary Health Institute', Dr. Jen Fink and Dr. Jerome
Perera, PGY4 Resident Physicians, Department of Psychiatry, University of Toronto, and Dr. Mary Marrocco, Founder, St Macrina Counselling Services. Attendees expressed their appreciation for recognizing the strong links between mental health and spiritual care. The Symposium's success will support the case for an annual conference on this topic involving other academic and health care institutions from Ontario and beyond. Speaker Comments: “…The symposium just
• Encourage the Heart – recognizing people on a day to day basis and celebrating accomplishments (Kouzes & Posner, 2012) Through the program’s four main components – a 360 leadership appraisal, personalized coaching sessions with an individual learning plan, interactive classroom learning/ workshops and an experiential learning leadership project participants are able to examine the behaviours that leaders utilize as the foundation to leadership and explore the current context and opportunities for leadership in health care today. The program is also complimentary to the Health Centre’s leadership performance appraisal process, with the leadership competencies that management is evaluated on being aligned with the program’s five practices. confirmed how important it is to care for the soul and mind of people.” “I enjoyed myself greatly and learned a lot from the expert speakers. I truly believe this to be a very important topic and I am genuinely looking forward to attending the next symposium.” “I was amazed by the rich variety of speakers. So stimulating!!! I am looking forward to the next symposium hoping that this will be a regular event. The symposium attracted many people who were eager to learn.” Amanda Monaghan is a Communications Coordinator at North York General Hospital.
Another distinctive aspect to the program is that it provides the opportunity to leverage and meld both internal and external expertise. “Some portions of the program are presented by external facilitators while others are led by leaders from within the organization. The Quality & Performance Excellence portfolio, for example, teaches about project management from a quality improvement perspective; and our Executive Vice President of Clinical Programs and Chief Nursing Executive teaches about Accountability and Execution,” said McLaney, who supports the recruitment and development of the internal content experts and also presents some of the teaching components. “There is also a component of the program which talks about leadership in a Missionbased organization, and that is presented by our CEO,” said McLaney. “Our management team wouldn’t be able to get that through a program offered elsewhere. Participants have said over and over again that this is an aspect of the program that is much appreciated, because it gives them a different connection – especially with senior leaders - and it helps to humanize the experience of leadership. It is also a unique opportunity for senior leaders to model the lesson that leadership is a process of growth, and that leadership learning happens on an ongoing basis.” “Part of my role is to build a culture of collaboration,
so I teach about stakeholder engagement and influencing with integrity. Throughout the seven months of the program I work to keep the spirit of leadership top of mind by doing things like holding check in meetings with the participants and circulating relevant literature that builds on the themes addressed in the program,” she said. Ann-Marie Marcolin, Manager of Patient, Family and Community Engagement, graduated from the program in 2011. “Participating in St. Joseph’s Leadership Program afforded me a wealth of both professional and personal learning opportunities,” she said. “Being given organizational support to carve out dedicated time to reflect, discuss and learn about the art of leadership is an invaluable gift that I am most grateful to have been given.” The Leadership Development Program at St. Joe’s builds on our commitment to Inspire our People. “We know that leadership development is an important part of being a learning organization,” says McLaney. “By creating a venue for people to expand their capacity and learn together we know that we will be best equipped to adapt to the changing landscape of health care and to support learning by staff at all levels.” Michelle Tadique is a Communications Associate at St. Joseph’s Healthcare.
Hospital News, JANUARY 2013
ICU/ER, Nurses, RN, RPN, PSW
Deadline for January 2013 Issue: January 27, 2013
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Deadline for January 2013 Issue: January 27, 2013
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Hospital News, JANUARY 2013
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At Toronto Central Community Care Access Centre (CCAC), we continually focus on new ways to deliver excellence and help clients and their families get the health care services and support they need. As we implement several innovative new programs, we are looking for Registered Nurses and Care Coordinators to play a key role in meeting the needs of Torontonians. Whether you’re an RN wishing to explore case management while using your hands-on clinical skills in a different kind of health care environment, or you’re a nurse or other health professional looking to bring your expertise and interdisciplinary focus to a case management function, this is an exceptional opportunity to join our team. Registration or certiﬁcation in good standing with the appropriate professional college or association is essential for all roles, as is the ability to work with culturally diverse groups.
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Better care for a better life
strong clinical experience and knowledge of the school mental health and addictions service system for children and youth, you’re ready to be part of the exciting, recently launched School Mental Health & Addictions Nursing Team. Along with providing health-related advice and strategies for parents, teachers and schools to build capacity in recognizing and addressing students’ issues and needs in this critical area, you will help students and parents access services such as family health care, community mental health and/or addictions agencies. English/French bilingualism is required.
Bilingual Client Services Managers – Your passion for community health care, 3 to 5 years of experience managing in a multidisciplinary, culturally diverse health care environment, and strong operational management skills will drive your success in leading and managing change by contributing new ideas and new ways of delivering excellence. A bilingual relationship builder and people manager, you will oversee the ongoing management, planning and evaluation of case management and community health care coordination within your assigned area. A graduate degree (or equivalent) in Social Sciences, Nursing, Health Administration or a related ﬁeld is expected. Nurse Practitioners, Palliative – You are a recognized relationship builder, fully equipped to work as part of an inter-professional model of palliative care in building capacity and competence in families, our diverse service partners, and physicians. With your deep understanding of the psychosocial needs of oncology and palliative care clients, and of Ontario’s health care environment, you will provide diagnosis, treatment, pain and symptom management, counseling and coaching to clients – allowing for compassionate end-of-life care and the choice of death at home. Current registration as an RN Extended-Class (Primary Care or Adult) with the CNO is required. Bilingual Care Coordinators/Case Managers – Every day in Ontario, people of all ages and backgrounds rely on our team of health professionals to ease their fears and act as their guide through a complex health care system. Using your clinical experience, case management skills and knowledge of health services in Ontario, you will conduct face-to-face or telephone assessments, explain relevant services, and coordinate and monitor their implementation to meet your clients’ unique needs. You may work in a variety of settings to plan and coordinate care – the community, a local hospital or one of our ofﬁces – so be sure to indicate whether you have a preference. Applications welcome from experienced RNs, MSWs, OTs, PTs, RDs and SLPs. Full position details are available online at www.ccacjobs.ca. If you are seeking a chance to truly make a difference in the lives of others as well as your own, please apply online at www.ccacjobs.ca or send your resume directly to: email@example.com, or Human Resources, Toronto Central Community Care Access Centre, 250 Dundas Street West, Suite 305, Toronto, ON M5T 2Z5. Fax: 416-506-1629. 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 French-speaking candidates.
Toronto Central CCAC services are made possible through the funding support of the Toronto Central LHIN
ccacjobs.ca CZ2-TOR-033_FIN.indd 1
12/19/12 9:37 AM
HOspital News, JAnUARY 2013
Support staff make your hospital run.