Hospital News January 2019

Special Focus: Professional Development + Education Inside: From the CEO’s Desk | Evidence Matters | Safe Medication | Ethics | Careers

January 2019 Edition

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Contents January 2019 Edition

IN THIS ISSUE:

Professional nal ent Development on and Education

21 ▲ Cover story: Addressing burnout

14

▲ Addressing burnout: Residents

16

COLUMNS Editor’s Note ....................4 In brief .............................7 Nursing pulse ................20

▲ Addressing burnout: Doctors

▲ Addressing burnout: Nurses

18

19

Doctors without Borders .. 50 Ethics .............................52 Evidence matters ...........53

▲ MSF

Long-term care news .....54

50

Safe medication ............61 From the CEO’s desk .....62 www.hospitalnews.com

Choosingg ly wisely

49

Big change takes big courage New way to pay hospitals offers lessons on change management

I

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Editor

Kristie Jones

editor@hospitalnews.com Advertising Representatives

Denise Hodgson

denise@hospitalnews.com Publisher

Stefan Dreesen

stefan@hospitalnews.com

By Karen Palmer and Noah Ivers f there’s one thing provincial governments across Canada can agree on, it’s that the status quo in healthcare is no longer good enough to deliver equitable access to high quality care in a cost-efficient manner. Ontario’s Ministry of Health under the previous government has led the way by altering how hospitals are paid, in an effort to encourage implementation of best practices in patient care.

Successfully executing big policy change in hospitals is hard work. So has it worked so far in Ontario? Yes and no. And are there lessons learned for other provinces?

Unequivocally, yes.

Some hospitals managed the change better than others. The “secret sauce” has been open communication and strong collaboration between experts who best understand patient care – like doctors, nurses and patients themselves, along with those who understand how hospitals work – like finance experts, hospital decision support teams and policy analysts.

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In 2012, Ontario hospitals started replacing some of their global budgets – the annual amount hospitals traditionally receive to fund all patient care – with something called Quality-based Procedures or QBPs. These “patient-based payments” give hospitals a pre-determined fee for each diagnosis (like pneumonia) or each procedure (like knee replacement) when patients are admitted.

The good thing about paying hospitals through global budgets is that they are predictable, stable and administratively very simple. The bad thing about global budgets, critics argue, is that they lack incentives to boost efficiency, are not always transparent or equitable and funding isn’t necessarily targeted at areas with the most impact on patients if government and hospital spending priorities don’t align.

The hope with QBPs was that they would improve access to care, reduce costs per admission, reduce variation in both costs and clinical practice and, most importantly, improve the quality of patient care.

Continued on page 7

Karen S. Palmer is a health care systems and policy research at Women’s College Research Institute in Toronto, an Adjunct Professor at Simon Fraser University and a Contributor to EvidenceNetwork.ca based at the University of Winnipeg. Noah Ivers is a family physician at Women’s College Hospital, Scientist at Women’s College Research Institute, and Assistant Professor at the University of Toronto.

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IN BRIEF

Pneumonia a leading Early follow-up by a cause of emergency physician after heart failure room visits last year lowers rates of death or the first time in at least five years, pneumonia was one of the top 10 reported reasons that Canadians went to the emergency department (ED) last year. According to the Canadian Institute for Health Information (CIHI), there were almost 135,000 pneumonia-related ED visits reported across the country in 2017–2018, marking a 13 per cent increase from the year before. More than one in four reported ED visits for pneumonia resulted in the patient being admitted to the hospital for at least one night.

Abdominal and pelvic pain, throat and chest pain, and acute upper respiratory infection were the top three main reasons for visits, together resulting in approximately one million reported ED visits last year.

Pneumonia is a concern both in the ED and throughout the entire hospital, as it is consistently among the top causes of in-hospital deaths in Canada.

Older adults made up approximately 65 per cent of pneumonia-related visits for admitted patients last year.

“Pneumonia is a serious illness and continues to be a concern in our emergency departments. As we approach the colder months, this new data is a

F

timely reminder to all Canadians to take action to prevent pneumonia.

Practising good hygiene, getting vaccinated and following advice from our public health units are good tips this time of year,” says Greg Webster, CIHI’s director of Acute and Ambulatory Care Information Services.

CIHI’s data also shows that visits to Canada’s EDs continue to climb. In 2017–2018, there were more than 11.4 million reported ED visits, compared with 11.2 million in 2016–2017. Despite the increased number of ED visits, year-over-year wait times remained relatively stable, with longer waits in the evenings and on weekends, as well as differences seen across hospitals.

More data on ED visits can also be found in CIHI’s Quick Stats and Your Health System web tools.

Recently, CIHI updated Your Health System with the latest year of data for 28 health indicators, including All Patients Readmitted to Hospital and Avoidable Deaths. Your Health System features facility-level data on long-term care, hospital deaths, hospital readmissions and more. A list of indicators and contextual measures that have been refreshed with new data is H also available. ■

or patients who receive emergency department care for heart failure, early follow-up by a physician within seven days after emergency department discharge is associated with lower rates of death or admissions to hospital, according to research published in CMAJ (Canadian Medical Association Journal).

However, the researchers found that less than half of the 34,519 patients in the study were seen by a physician within seven days of discharge from the emergency department.

“Unlike patients admitted to hospital, patients discharged from the emergency department do not receive daily assessment and investigations by physicians and nurses,” writes Dr. Clare Atzema, ICES, with coauthors. “These patients are left to arrange their own subsequent care.”

In Canada, the direct cost of heart failure is $2.8 billion a year.

There are more than a million visits to emergency departments for heart failure in North America annually.

As hospital admissions are the costliest aspect of care, systems are moving toward outpatient management when possible.

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Of the total 34 519 patients with heart failure discharged from the emergency department in the present study, 47 per cent (16,274) saw a physician within a week, and 83.6 per cent (28,846) received care within 30 days. Almost one-quarter (23.5%) of patients died within a year of their emergency department visit, with the lowest death rate (21.7%, 3533 patients) in those seen within seven days.

“Given our findings, we argue that scheduled follow-up appointments for patients with heart failure in the emergency department should be prioritized,” state the authors. “The most efficient way to do this is to provide an appointment before they leave the emergency department.”

The authors note that many patients are seen when doctors’ offices are closed but that linking hospital and outpatient records electronically could help schedule appointments.

“Effect of early physician follow-up on mortality and subsequent hospital admissions after emergency care for heart failure: a retrospective cohort study” was published in H December 2018. ■

Big change takes big courage Continued from page 4 As part of this funding shift, hospitals were also given clinical handbooks – outlining evidence-based care pathways for each QBP diagnosis and procedure – to give doctors, nurses and other care providers better guidance on how to provide “the right care, in the right place, at the right time” and at the right cost.

So how did this all pan out?

We recently published a study showing that, as with most complex system change, some hospitals managed better than others at rolling out QBPs. As one senior hospital executive put it, “I think the hospitals are pushing back and saying, slow down, because this is tougher to manage than we thought www.hospitalnews.com

and it’s got all kinds of complication in the implementation.”

Hospitals struggled to adapt if they were less ready for change, especially when it was more complex in nature, or they didn’t have the management capacity to support it.

Conversely, hospitals that were able to adapt showed a high degree of readiness for change and had good capacity to manage it, especially when new requirements were less complex.

Change never goes as planned, and large-scale change in complex health care systems is no exception.

Old patterns can be difficult to break. The first time you try, failure may seem inevitable, but as every en-

trepreneur knows, it should be viewed as an opportunity to learn and try again. Similarly, the ability to take stock along the way – through embedded evaluations – allows health system leaders to honestly look at what is working and what isn’t.

Whether as individuals or in complex systems, knowing when to admit that it’s time to change course is critical to any improvement.

We suggest that a structured process be put in place to help identify and choose the right tools for the job, so that adoption of new initiatives is enabled and desired outcomes are achieved. To that end, we propose that those seeking change – regardless of

the setting – ask three questions: Who needs to do what differently? Why isn’t that happening now? What can we do to enable change and overcome barriers?

Big change takes big courage, a shared vision and clear communication. Ontario’s efforts to explore how to implement change are valuable and instructive and Ontario’s Ministry of Health, hospitals, provincial health care agencies and care providers should be lauded for their efforts.

Scaling up Ontario’s successes to other provinces, and continuing to experiment, would help ensure that high quality affordable health care is availH able to all Canadians. ■ JANUARY 2019 HOSPITAL NEWS 7

NEWS

(left) The Peer Support Program has formed a collaboration with PetSmart Charities of Canada PAWS for Hope Pet Therapy Program at SickKids. During particularly traumatic circumstances, a therapy dog and their handler will attend a debriefing to provide additional support. Pictured: Dr. Gino Somers, Division Head, Pathology, and a designated physician peer; Lucy, Therapy Dog; and Joanne Somers Therapy Dog Handler, St. John Ambulance. (right) Members of the Peer Support Program at SickKids.

The power of peer support in healthcare

By Justin Faiola he Mental Health Commission of Canada states that healthcare workers are 1.5 times more likely to be off work due to illness or disability compared to workers from other sectors.

This figure illustrates the prevalence of mental health issues in society and that many people still suffer in silence, including those who work in healthcare.

As part of a robust employee mental health strategy, The Hospital for Sick Children (SickKids) recently launched a Peer Support Program for staff. The program is a confidential resource, offering individual mental health outreach and trauma support 24/7 to staff in need.

“For healthcare providers, the demanding nature of their work and the repeated exposure to trauma can challenge well-being and contribute to burnout, compassion fatigue or distress,” explains Kelly McNaughton, Manager of the Peer Support Program at SickKids.

“The goal of the Peer Support Program is to improve the psychological health and safety of staff and penetrate the cycle of silence around the topic of mental health.”

While traditional peer support programs have been patient-centred, peer support as a formal workplace-based program is a relatively new and unique approach.

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“Workplace peer support enables colleagues to help one another through some of the challenges we face both at work and in our personal lives,” says Kelly Anderson, Registered Nurse in the SickKids Emergency Department and a designated peer. “Peers act as a confidential ear to listen, and as a gateway to connect you with resources throughout the hospital that offer additional support when it is needed.”

The work to establish the Peer Support Program first began in 2016, when a SickKids steering committee was tasked with creating a mental health campaign to combat stigma.

In 2017, McNaughton’s position was created to lead the development of a peer support program at the hospital.

Over the next six months, McNaughton met with hospital leadership and staff to better understand the culture and mental health needs of employees at SickKids, and recruited staff to become peers in the program.

Forty two staff, including clinical, non-clinical and research, completed training in December 2017 to become designated peers. Certified in assessment, communication skills, trauma principles and trauma response, peers provide confidential support to their colleagues in need. They listen, inspire, gently challenge and encourage

while helping their colleagues deal with stress and personal concerns.

The Peer Support Program is also responsible for providing psychological support to staff after a traumatic event, such as a case where a child arrives at the Emergency Department badly injured or the death of a patient on an inpatient unit. Using the Critical Incident Stress Management model, peers and McNaughton, a clinical social worker, facilitate psychological defusings and debriefings. Defusings – which are more immediate interventions – can take place promptly or up to 12 hours after an event occurs, while debriefings will take place within 24-72 hours afterwards. These interventions help staff to process and reflect on the effect the event has had on their mental health.

As of December 2018, peers from the Peer Support Program have completed over 440 one-on-one sessions where they have provided direct support to staff and have facilitated 66 interventions involving traumatic events. The program has seen considerable uptake and success due to the unique approach; providing training to SickKids staff so that they can offer psychological and emotional support to their colleagues. These individuals have knowledge of the paediatric health-care and research environ-

ments, which allows them to better understand and empathize with the associated workplace stressors and psychological demands that their colleagues experience.

As the Peer Support Program celebrates its one-year anniversary this January, it will be focusing on several new initiatives this year. One of those initiatives will be involving the families and significant others of nursing staff in parts of nursing orientation to better prepare them for the challenges and mental health dynamics of the nursing role. The initiative will provide education to nurses and their families so that they have more awareness about the importance of mental well-being, and be able to better identify symptoms of burnout and compassion fatigue.

“The Peer Support Program aims to make a permanent, positive impact on the mental health journey of staff and contribute to the prevention of additional challenges and hardship in the workplace,” says McNaughton.

“Nurturing the well-being of our staff enables us to continue to fulfill our ultimate goal of providing the best care possible to patients and families at SickKids.”

Interested in learning more about the Peer Support Program at SickKids?

Contact Kelly McNaughton at kelly.

H mcnaughton@sickkids.ca. ■

Justin Faiola is a Communications Specialist at The Hospital for Sick Children.

8 HOSPITAL NEWS JANUARY 2019

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NEWS

Integrating new hospital technologies to address our largest healthcare hurdles

By Brett Belchetz echnology has changed almost every aspect of our lives in the past 30 years and while most individuals are able to easily upgrade their phone or computer, larger organizations like hospitals, with deeply embedded, complex infrastructure, can find it difficult to keep up. Advancements are being made, but with budget constraints and the need for continuous care, they’re often implemented in a disjointed manner that simply layers one system on top of another. With many recent

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10 HOSPITAL NEWS JANUARY 2019

studies, including a recent update from the Fraser Institute, showing that national wait times are continuing to lengthen, we can’t ignore the power that new innovations have to reduce the burden on our healthcare system.

While we’ve seen success in the nationwide implementation of electronic medical record systems, our adoption of technology has largely failed to address the hardest realities facing the Canadian healthcare landscape. Possibly the best example of this is provided by our staffing practices, which

have seen minimal innovation over the course of several decades. With ongoing physician shortages across the country, many hospitals, especially those in rural areas, have become reliant on locum staffing. This forces hospital administrators to focus on ongoing recruitment and adds significant travel and HR costs to already strained budgets. Beyond this, the temporary nature of locums makes knowledge transfer between physicians, nurses and other allied health practitioners difficult and in some cases, compromises continuity of care for patients.

Fortunately, developments in virtual care technology may offer a solution to the staffing challenges faced by our hospitals and communities. Now that telemedicine has reached a level of maturity where it can be relied on for accurate high definition video and audio, combined with peripherals such as digital stethoscopes and otoscopes, there is an opportunity to move quickly and strategically to implement it in the most effective ways possible. Encouragingly, steps are already being taken by both private companies and provincial governments. Telemedicine is gaining wide traction to improve access to primary care and many hospitals have begun using telemedicine to help patients remotely access specialist consultations without the need to be transferred to larger facilities. Just recently, Western Hospital in Alberton, PEI began piloting the nation’s first-ever tele-rounding system with Maple. This platform, which allows physicians located across the country to remotely conduct daily physician rounds through multi-person video, EMR integrated charting and new communications technolo-

gies, successfully treated 92 per cent of the hospital’s inpatients in the first two months of the pilot.

Administrators at Western Hospital are already seeing the impact that this approach can have. Paul Young, the Administrator for Community Hospitals West at Health PEI explains, “before the tele-rounding project, staff at Western Hospital were spending their time putting out fires, just to keep things going. With tele-rounding in place, we have been able to take a proactive approach. Resources are now being used to support levels of care and to deliver the highest level of service while we actively recruit to fill our physician vacancies.”

As Young alludes, the impact of this system goes beyond ensuring access to physicians, it also means that care providers in the community are under less strain. With research from the Canadian Medical Association earlier this year revealing that one in four physicians experience burnout, this is a key lever for improvement – the wellbeing of our health care providers is essential to the wellbeing of our country.

With technologies like this beginning to take off, implementations can be imagined for almost every part of a hospital. In my area, the ER, I treat www.hospitalnews.com

NEWS

Nurses Andrew Fudge and Cheryl Hackett at Alberton, PEI’s Western Hospital speak with Dr. William Dunlop from Ontario through Maple’s tele-rounding platform. countless patients who don’t actually require emergency care. In fact, according to Health Quality Ontario, 47 per cents of Canadians surveyed admitted going to the ER for a problem they knew wasn’t an emergency, because no primary care provider was available to them. It’s estimated that more than 40,000 Canadians per year visit ERs for prescription refills alone.

By integrating telemedicine with our existing ER triage system, nursing staff could evaluate a patient’s needs and connect them with province-wide networks of physicians, on the spot, for non-urgent care. This would eliminate the need for otherwise healthy people to consume expensive and limited ER resources, while reducing the morbidity and mortality of the hospital acquired infections these individuals are unnecessarily exposed to.

This kind of technology, if implemented properly, has the power to

transform our healthcare system and to solve many of our most pressing issues, Kaiser Permanente one of the largest hospital systems in the United States, recently announced that they will halt spending on new physical infrastructure, having been so successful with an integrated, system-wide approach to telemedicine, that they were able to divert 13 million visits into the virtual world last year. As we move to implement telemedicine in the Canadian healthcare system, it is most important that we do so in a similarly integrated way, that intertwines technology with our existing systems, rather than using it as an add-on. In this era of ever-expanding wait times, physician shortages and hospital closures, the alternative – layering technologies on top of one another, without thinking about how they will work together or how they will solve our biggest probH lems – just isn’t good enough. ■

Dr. Brett Belchetz is a practicing ER physician in Toronto. He is also the CEO and Co-founder at Maple (getmaple.ca), Canada’s only national telemedicine provider connecting Canadian patients and doctors for online medical visits. www.hospitalnews.com

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JANUARY 2019 HOSPITAL NEWS 11

NEWS

New tool strives to create healthier workplaces

by predicting and preventing employee depression

By MJ Deschamps t was in a paediatrician’s office following the birth of his daughter that Dr. JianLi Wang was first inspired to develop a tool that could predict people’s risk of developing depression.

It may seem like a peculiar jump to action, but for Dr. Wang, a mental health researcher, it dawned on him that while we engage in countless check-ups and tests related to our physical health over the course of our lives (starting from birth) to prevent us from getting sick, the same strategies are not in place when it comes to mental illness.

“When my daughter was born, follow-ups with our family doctor let us know whether things like her height and weight were on track, and whether she was growing in a normal way,” says Dr. Wang.

“It made me realize that while we engage in similar tests as adults to see if we are at risk for things like heart disease or diabetes, there isn’t a parallel way to evaluate our personal risk for depression.”

In 2008, through a Canadian Institutes of Health Research grant, Dr. Wang developed the first-ever risk calculator of its kind in Canada, which estimates personal probability of having a major depressive episode in the next four years, by asking questions related to age, family history, ongoing negative life events and childhood trauma.

The tool also informs people how their level of risk compares to the general Canadian population.

The risk calculator was launched online in 2013, and has since been used over 80,000 times.

Now, as director of the new Work and Mental Health Research Unit at The Royal’s Institute of Mental Health Research, affiliated with the University

I

Dr. JianLi Wang, director of the Work and Mental Health Research Unit at The Royal’s Institute of Mental Health Research.

IF YOU ARE 18 OR OVER, VISIT WWW.PREDICTINGDEPRESSION.COM TO ESTIMATE YOUR PERSONAL LIKELIHOOD OF DEVELOPING MAJOR DEPRESSION IN THE NEXT FOUR YEARS, AND BEGIN TAKING PREVENTATIVE ACTIONS (IF NECESSARY). of Ottawa, Dr. Wang has been working on adapting his risk calculator tool for organizational use.

This new tool tailored for employers includes predictors of depression as they relate to the workplace, such as job stress, work/family conflicts, and job performance. By enabling employers to evaluate how many of their employees will have depressive and anxiety disorders in the coming years, said

Dr. Wang, organizations could better ensure that the right policies and resources are in place to keep workers healthy.

As it stands, mental illness – and depression in particular – has a major impact on the Canadian workforce and economy.

Each week, 500,000 Canadians do not go to work due to mental health-related issues.

Dr. Wang said the huge financial and social burden and level of lost productivity that mental illness continues to impose for workplaces is finally causing employers to sit up and take notice.

“When I started doing research in this area 15 years ago, there were no employers talking about the mental health issues in their workplaces,” he says.

“Now, more and more organizations are witnessing and acknowledging significant depression and anxiety amongst their employees, and are beginning to take action to implement strategies to help keep their workforce well.”

Dr. Wang is currently in the preliminary stages of launching a demonstration study using his risk calculator at a large Ottawa-based organization.

In addition to the benefits it can offer both employers and individuals, Dr. Wang hopes that future iterations of his risk calculator could have wider policy implications, as well.

On a larger scale, he said, this sort of information could help with population health planning, by forecasting mental health trends across cities, provinces and/or nationally, and allocating sufficient resources accordingly.

Overall, says Dr. Wang, research and strategies related to the prevention of depression and other related mental illnesses must continue to move to the forefront of our mental healthcare landscape.

“When it comes to mental health, the problem is that we are almost always reactive – people wait until they become depressed to see a doctor and get treated,” he says.

“However, prevention can be H worth much more than treatment.” ■

MJ Deschamps works in communications at The Royal 12 HOSPITAL NEWS JANUARY 2019

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COVER: ADDRESSING BURNOUT

Embracing a new, holistic wellness concept

By Kim Slade e work, we care for and support our family, and we care for ourselves. We commit to juggling these roles in life, but doing so often puts us in overwhelming situations and constantly managing conflicting priorities.

This pattern of physical and mental strain can take a toll on our well-being, our ability to care for others, and sometimes, our health and safety at work. We have the power to control this. Public Services Health and Safety Association (PSHSA) recently launched www.healthy-worker.ca, a free website that provides curated resources and support on finding balance and what actions you can take to help you stay healthy and safe at work, in your family life and personal life.

The site utilizes relevant Canadian data such as the 2016 General Social Survey, which found that while 78 per cent of Canadians generally feel positive about their ability to balance work, life, family, and leisure activities, one in five experience difficulties doing so. In fact, although most participants in the PSHSA survey felt responsible for self-care, less than 50 per cent of participants were satisfied with the current state of their health and well-being, and identified stress and fatigue, retirement planning, weight loss, and overall health as top concerns. Additionally, 60 per cent of survey participants said they looked for information online in addition to speaking to a health professional to take action in addressing specific health and wellness concerns.

Healthcare workers in particular face a wide range of health and wellness stressors. They are at a high risk of developing burnout due to on the job demands, shift work and other

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risk factors. The healthcare sector is a constant changing work environment which requires continual improvement processes. Information found on www.healthy-worker.ca can assist healthcare workers learn more about caring for their well-being, balancing multiple demands of work and personal life while combatting the cumulative negative reactions to occupational stressors that cause burnout. Burn out is associated with a multitude of health problems, such as hypertension and sleeplessness. So the idea behind the healthy worker online platform is to assist workers with recognizing signs and symptoms to enable workers to make decisions and lifestyle changes that will help them find strategies for improved work, life and family balance.

BURNOUT IN HEALTH CARE The World Health Organization describes the characteristics of burnout as “feelings of intense fatigue, loss of control and an inability to produce concrete results at work.”

The negative effects of burnout can spill over into every area of life, including home, work, and personal life.

Because of its many consequences, it’s important to deal with burnout right away.

SIGNS OF BURNOUT The following list, which was put together by Forbes Coaches Council, identifies signs of burnout. If you are experiencing these, you should probably pay attention: • Avoiding tough conversations

• Lacking concentration • Asking yourself “am I burning out” • Avoiding human interaction • Being inauthentic – you put a “mask” on because you can’t get behind the team agenda • Calling in sick, a lot • Being irritable • Feeling unable to engage with people or projects • Becoming disillusioned and cynical • Feeling bored

THINGS YOU CAN DO TODAY TO HELP PREVENT BURNOUT According to Statistics Canada more than 3,400,000 Canadian workers feel burnt out. Burnout can’t happen seemingly overnight, so it is vital that we keep an eye on these signs.

Kim Slade is the Director of Emerging Markets and Commercialization at Public Services Health & Safety Association. She has a Bachelor of Arts in English and Communications and also has an Adult Education Certificate from OISE University of Toronto. Kim is also part of the Canadian Standards Association (CSA) Technical Committees on Occupational Health and Safety Training as well as the Paramedic Psychological Health and Safety in the Workplace Standard. She has been in the field of OHS training and education for the past 15 years.

14 HOSPITAL NEWS JANUARY 2019

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COVER: ADDRESSING BURNOUT This is particularly important if you have spent a long period working to either go beyond expectations, or just working hard to get stuff done without having your heart in the work that you are doing.

Here are three things you can do today to help prevent burnout: 1. Look at your to-do list and see if you can make it more realistic 2. Phone a friend – talk about how you are feeling and get their feedback on what to do, or just appreciate the opportunity to talk 3. Make a plan to reduce feelings of loss of control and intense task lists, break workload into manageable tasks and stick to your plan

PRACTICING MINDFULNESS HELPS COPE WITH FEELING BURNT OUT Mindfulness involves the self-regulation of attention to bring about a quality of non-elaborative awareness to current experience – an increased recognition of mental events in the present moment. From there, it in-

WWW.HEALTHY-WORKER.CA, A FREE WEBSITE THAT PROVIDES CURATED RESOURCES AND SUPPORT ON FINDING BALANCE AND WHAT ACTIONS YOU CAN TAKE TO HELP YOU STAY HEALTHY AND SAFE AT WORK, IN YOUR FAMILY LIFE AND PERSONAL LIFE. volves adopting a particular orientation toward one’s experiences in the present moment, an orientation that is characterized by curiosity, openness, and acceptance. This is often referred to in psychological terms as adopting a de-centred perspective on thoughts and feelings so that they can be experienced subjectively rather than reacted to negatively. The goal is to alter the impact of and response to thoughts, feelings, and sensations.

When one is mindful, the mind responds afresh to the unique pattern of experience in each moment instead of reacting mindlessly to fragments of total experience with old, relatively stereotyped, habitual patterns of mind.

ACHIEVE MINDFULNESS THROUGH MEDITATION Research has proven that practicing mindfulness through meditation improves both mental and physical health because it strengthens the part of the brain that helps you cope with stress and anxiety.

It can help improve your eating habits and prepare you to face the unexpected without fear and anxiety.

• Pay attention to details • Stay in the moment • Stay alert to stimuli without reacting emotionally • Be receptive to new information and ways of interpreting that information

• Try not to over-plan everything.

Most plans are too specific and prevent you from acting in the moment in response to new information • Pay particular attention to the body and your experience of it • Face your thoughts, sensations and external stimuli objectively and non-judgmentally • Be aware of unexpected or negative stimuli without practicing avoidance As we learn to practice mindfulness and cultivate change in our psyches, the effects transfer externally in terms of our cognitive skills, emotional skills, psychophysiology and brain function.

This means better stress management, behavior and social functioning.

Burnout can take a serious toll on your health, performance, career, mental well-being, and professional and personal relationships. Your health and happiness depend on you. Explore the categories on www. healthy-worker.ca to learn tips on finding balance and what actions you can take to help you stay healthy and safe at work, in your family life and H personal life. ■

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JANUARY 2019 HOSPITAL NEWS 15

COVER: ADDRESSING BURNOUT

Physician, heal thyself How one Ontario hospital is helping to prevent resident burnout

By Katherine Nazimek fter years of studying in medical school, young doctors are thrown into the rigorous, real-world practice of medical residency. They hold on their shoulders the new, nerve-wracking duty of saving people’s lives. They may experience long work hours, sleep deprivation, and overwhelming expectations. It is because of these pressures, that experts suspect many medical residents will also experience high levels of burnout.

In a survey conducted by the Canadian Medical Association in 2018, more than one in four physicians and residents reported high levels of burnout, and one in three screened positive for depression.

“Physician health, and especially the health of our medical residents,

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16 HOSPITAL NEWS JANUARY 2019

RESIDENTS WERE 48 PER CENT MORE LIKELY TO REPORT BURNOUT AND 95 PER CENT MORE LIKELY TO SCREEN POSITIVE FOR DEPRESSION THAN ALL OTHER PHYSICIAN GROUPS. is a growing concern in Canada, and arguably around the world,” says Dr. Ari Zaretsky, Vice-President of Education and Chief, Department of Psychiatry at Sunnybrook Health Sciences Centre in Toronto.

According to the survey, residents were 48 per cent more likely to report burnout and 95 per cent more likely to screen positive for depression than all other physician groups.

“In a hospital, human resources are our most precious resource,” Zaretsky adds. “If we can’t look after ourselves – after our own resident learners – then what does that say about our profession?”

THE RABBIT HOLE RUNS DEEP Dr. Shelly Dev, now a critical care physician at Sunnybrook says her second year of an internal medicine resi-

dency was the year she began to unravel.

“While determined to keep learning and growing, I started to become perpetually angry, frustrated, and anxious,” said Dev in an article she wrote for University of Toronto’s UofTMed magazine.

“I discharged patients too early, and had to readmit them days later. And I’d loathe them for coming back – as if they were doing it to spite me, to prove I wasn’t smart or capable enough.”

In a recent interview, Dev admitted that being a senior resident and no longer a junior, meant expectations of being competent, fast and unflappable.

“To think about how hardened I had become, was devastating,” she says.

“I was treating my patients as tasks. I wasn’t connecting with them as humans. As a result, I thought I wasn’t cut out for medicine.” www.hospitalnews.com

COVER: ADDRESSING BURNOUT Dr. Shelly Dev (left) says her second year of internal medicine residency was the year she began to unravel. Now a critical care physician at Sunnybrook, she works to ensure her residents feel supported.

Burnout is caused by more than the physical and mental exhaustion that comes with “the business of health care,” says Zaretsky. He says there is an emotional weight: life-altering and sometimes devastating medical illnesses, family challenges, and limitations on how much help one person and even an entire healthcare system can provide.

“Residents are often the first to see the systematic problems within the healthcare system,” he says. “They see people suffering and may feel powerless in making a difference.”

Ironically, left unaddressed, burnout can lead to further systematic issues, like medical errors, reduced patient satisfaction, and more physicians on disability leave, suggests Zaretsky.

Support services do exist through some universities and healthcare organizations, but many residents are not seeking help. According to the survey, 81 per cent of physicians and residents were aware of health services available to them, but only 15 per cent accessed those services in the past five years.

Among the most cited reasons for not seeking help were thinking their situation was not severe enough and feeling ashamed.

CHARITY BEGINS AT HOME To help mitigate resident burnout, Sunnybrook conducted a survey of its own; asking residents not only about their experience of burnout and depression, but also what they’d like to see as possible interventions. Despite its personal nature, and with assured anonymity, the survey had a response rate of 56 per cent.

“Our residents told us they did not want peer support groups composed of different resident groups together,”

How hospitals can support resident wellness

says Zaretsky. “This is probably because those peer support groups would lack anonymity and, as residents, they are in constant fear of being assessed.”

Instead, Sunnybrook’s Department of Psychiatry is conducting a pilot project that aims to ensure residents across the hospital can get the care they need, quickly. In addition to their regularly scheduled patient clinics, a group of psychiatrists are volunteering their time to offer psychiatric care to residents in distress.

While counselling services are available to residents through their university, the geographical distance of Sunnybrook was cited as a barrier to accessing those services.

“We can speak to them, meet with them, and provide the support they need locally for as long as they are struggling emotionally – whether it’s chronic or situational,” says Zaretsky.

“Our hope is that residents won’t delay getting help.”

Zaretsky adds that there is merit for peer support groups among individual departments, but residents need to feel safe.

Dev says this would require a system-wide cultural change. “There needs to be a lot more space for people as peers to talk to each other, or as seniors to talk to juniors, encouraging these conversations and telling each other our stories,” she says. “As physicians, we are going to see things that really find their way into our hearts – in positive and in sad ways. Sharing that bond and acknowledging that sometimes this job is really painful would create so much collegiality and support.”

All a mentor or leader needs to do to start the conversation, she says, is to ask: “How are you doing with everything?” ■ H

Katherine Nazimek is a Communications Advisor at Sunnybrook Health Sciences Centre www.hospitalnews.com

Dr. Heather Flett, psychiatrist at Sunnybrook Health Sciences Centre and associate director at University of Toronto’s Post-Graduate Wellness Office, offers suggestions on what hospitals can do to help support the health of their residents: BE AWARE Conduct a needs assessment to evaluate (and re-evaluate) the health of your residents. What is and is not working?

RECRUIT CHAMPIONS FOR WELLNESS Create formal roles within teams and programs to develop wellness initiatives for residency programs.

These initiatives may include educational sessions about depression, substance abuse, sleep hygiene, and nutrition, for example. Champions may also plan fun activities or ones that promote exercise.

REVISIT CAFETERIA HOURS Residents are often on shift until the late evening or early morning hours. Offering healthy food options during these hours can help ensure they eat regularly.

SCHEDULE MEETINGS WITHIN REGULAR WORK HOURS Make sure duty hour regulations are followed and supported.

Explore how the culture of medicine may impact a resident’s decision to stay beyond regular duty hours.

Although these are suggestions for how a hospital can help support its residents, it is equally important that each resident – and any individual – takes care of themselves and seeks help when they feel they may need it, says Flett.

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COVER: ADDRESSING BURNOUT

Physician health and wellness to take centre stage in 2019

Moving toward a vibrant and engaged profession

By Dr. Gigi Osler n October, over 500 delegates from more than a dozen countries gathered to make an important statement about physician health – it’s time for action. The International Conference on Physician Health in Toronto helped showcase a growing body of evidence that physicians are tired, burned out and looking for change. Setting the stage for this event was the release of the Canadian Medical Association’s (CMA’s) national snapshot report on results from its National Physician Health Survey (NPHS). With information gathered from nearly 3,000 physicians and residents, the results revealed that despite 82 per cent of physicians reporting high resilience, more than one in four also reported high levels of burnout.

This suggests the issue is more than an individual issue: other occupational and systemic factors are probably at play. Physicians who work in hospitals often work within a complex, ever-changing and at times chaotic environment, and they report low-

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er well-being (including emotional, social and psychological well-being) than their colleagues in other practice settings.

Research has shown that the health of our physicians is directly related to the quality of care that patients receive and even the overall performance of the healthcare system. With this knowledge, the CMA has begun taking steps toward improving physician health and wellness. Through our statement on physician health and wellness and recommendations set forth in our recent policy document on this subject, the CMA is committed to promoting a model of shared responsibility targeting individual and systemic factors that contribute to health and wellness through advocacy and collaboration.

Our first report from the NPHS helped us identify the prevalence of some health and wellness indicators within the profession in Canada.

What will follow is a second report that will explore the relationships between these issues and both be-

havioural and occupational factors, such as what leads to burnout or depression for physicians. This will help us better identify areas in which physician health and wellness can be supported, such as the role that factors such as career satisfaction, collegiality and work-life integration can play. By deepening our understanding of these predictors, these data become more actionable and will encourage the CMA and others to work with Canada’s physicians, policy-makers, governments and others to help improve the factors that can negatively affect the health of physicians as well as promote those that enhance wellness and fulfillment within the profession.

Seeing a colleague struggle is something we have all experienced. When physicians are suffering, we know that it can often be difficult for them to seek help. Through our physician health survey, we learned that the top reasons that physicians do not pursue support services is that either they do not think the issue is severe enough or they are ashamed to seek help. We

all need to play a role in reducing this stigma – if you or a colleague are looking for support, we encourage you to visit www.cma.ca/physicianhealth for a list of provincial and territorial physician health programs.

As of 2019, the CMA has created a new department dedicated to leading our work in physician health and wellness, led by Dr. Caroline Gérin-Lajoie, who recently joined the CMA as vice-president of physician health and wellness. She will use her extensive expertise and background at The Ottawa Hospital and the University of Ottawa to promote wellness to help the CMA innovate and continue to help drive meaningful and sustainable change in support of a vibrant and engaged profession.

We invite you to stay tuned to our website for the latest report on physician health and wellness, to be released in the coming months. The CMA is committed to continuing its efforts to ensuring improved health for physicians – after all, healthy docH tors lead to a healthy population. ■

Dr. Gigi Osler is the president of the Canadian Medical Association.

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COVER: ADDRESSING BURNOUT

How technology can help prevent nurse burnout

By Will Eadie here simply aren’t enough nurses to go around.

The nurse shortage stems from two facts. First, the country’s population is aging: more Canadians every year are in need of medical care. Second, rather than responding to the increased need, nurses are abandoning their careers. The Canadian Nurses Association expects that the country will be short 60,000 full-time positions for Registered Nurses (RNs) by 2022. While the supply of new nurses has been outpaced by the demand for over a decade, the issue has recently become a crisis With such a shortage looming, healthcare providers must make changes to retain their valuable nursing staff. But why are nurses leaving certain hospitals? And why are they leaving the entire profession? The answer is burnout.

Nurse burnout is more common than we realize. A state of exhaustion that impacts job performance, burnout can happen to anyone at any time. In an article for the Montreal Gazette, Ariane, an ICU nurse, described how her burnout crept up on her. For 20 years, she was asked to work “until she dropped,� and take on 12-hour shifts for over a week without a day off. Despite her pleas for help, her employer continued to demand more of her, until eventually, her physical and mental health deteriorated.

As time went on, Ariane became more cynical about her work. With management relentlessly adding more hours and tasks to her work day, Sharon began to lose her patience with colleagues and, more importantly, her patients. Even worse, the quality of her work began to suffer, putting her patients in harm’s way.

Ariane is one of thousands of nurses experiencing burnout. As the nursing shortage continues to intensify,

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it’s crucial that healthcare employers know how to recognize and prevent this from happening to members of their workforce. Here’s our best practices:

A THREE-STEP GUIDE TO REDUCING NURSE BURNOUT Nurse burnout has nothing to do with a worker’s skills or experience.

Like Ariane, many qualified caregivers are apt to experience burnout at some point in their career. Healthcare providers must understand that burnout is caused by flawed management practices that leave nurses, doctors, and other healthcare workers alike feeling overworked and underappreciated.

To prevent nurse burnout from escalating, healthcare providers must recognize that change begins with better processes focused on increasing engagement. Here are three key areas healthcare employers should be paying close attention: • Training: Nurses are at high risk of burnout when they are given new responsibilities or moving into new positions, especially if the new role comes without on-demand, self-service training. Onboarding without training can leave nurses feeling overwhelmed by new processes and procedures. This is why healthcare providers must implement digital tools that can train staff beyond patient care. This means including a curriculum for personal health and managing job-related stress. Such training will provide nurses with a sense of achievement and belonging. • Communication: Many organizations limit how much they communicate with their frontline workforce.

Health systems should not be one of them. When there’s a lack of transparency across an organization, nurses feel powerless within their roles.

By adopting a central, navigable platform for internal communication, healthcare providers can heighten nurses’ sense of connection to their colleagues, supervisors, and upper-management. And, it encourages teams to raise their hand when more help is needed. • Scheduling: Inflexible scheduling is one of the most frequent causes of burnout. Known for having very demanding work schedules, nurses need to be given more control over their hours. Healthcare employers can use

a digital workplace platform to give nurses the power to easily trade shifts and request time off.

Burnout can happen to any nurse at any point in their career, which is why it’s so important that healthcare employers know how to prevent it from happening to their workforce. If they don’t, overworked nurses like Ariane will move on to other opportunities. A digital workplace can help, especially when it comes to empowering nurses through better training, communicaH tion, and scheduling. â–

Will Eadie is Global Vice President of Sales and Strategy at WorkJam, the world’s leading provider of digital workplace technology.

Schulich School of Business injects healthy dose of real-world expertise into its MBA Healthcare Specialization Canada’s growing healthcare industry expected to account for $4.3-trillion by 2030 Three things in Canadian life are certain: Death, taxes and a future of rapid healthcare sector expansion due to one of the fastest-aging populations in the Western world.

The healthcare industry currently accounts for over $219-billion (or $6,000 for every Canadian), with private and public spending in this industry projected to reach $4.3-trillion by 2030. This is in contrast to other sectors that may experience slower growth or even decline.

Such accelerating growth will create unprecedented opportunities for advancement for those currently working in the healthcare industry or those just entering the industry, as long as they have the right managerial credentials, said Joseph Mapa, Executive Director of the MBA Health Industry Management Program at Schulich School of Business at Toronto’s York University. “This is an ideal time for health industry practitioners and professionals to invest further in their human capital as we prepare for tremendous future challenges and opportunities,� said Mapa, the former CEO of Sinai Health System, formed after the amalgamation of Mount Sinai Hospital, Bridgepoint Active Healthcare, Lunenfeld Tanenbaum Research Institute and Circle of Care, a home care organization. “The healthcare industry has never been so in need of highly specialized business leaders to drive innovation, creative thinking and change as the healthcare landscape evolves to meet the challenges of demographic and systemic changes,� said Mapa. That’s why so many part-time and full-time MBA students have enrolled in Schulich’s Health Industry Management Program (HIMP) since its launch in 2004, he said.

Mapa works closely with Program Director Amin Mawani, Associate Professor and Graduate Diploma Coordinator, in helping to shape the strategic direction of the HIMP program. Mapa has also served as an Executive-in-Residence, adjunct professor, mentor and executive advisor to the program and Schulich’s Career Development Centre.

The Health Industry Management Program (HIMP) builds on Schulich’s established strength in management fundamentals, delivering an industry-focused curriculum, intellectual content and career-based development.

The goal of HIMP is to enable students to leverage their learnings in pursuing exciting career opportunities and growth in this dynamic sector.

'UDZQ IURP PDQ\ GLVFLSOLQHV 6FKXOLFKÂśV +,03 IDFXOW\ DUH H[SHUWV LQ WKHLU ÂżHOGV DQG SOD\ OHDGLQJ UROHV in the private and hospital sectors as CEOs, entrepreneurs and consultants; in the public sector as SROLF\ DGYLVRUV DQG HFRQRPLVWV DQG LQ WKH QRW IRU SURÂżW VHFWRU DV FRQVXOWDQWV ERDUG PHPEHUV DQG administrators.

Graduates of Schulich’s MBA HIMP work in a variety of progressive roles such as program managers, directors, analysts, planners and consultants in the government, private and public healthcare sectors.

Core HIMP courses include: Business of Healthcare; Strategy in Healthcare; Economics of Healthcare; and Entrepreuneurship and Innovation in Healthcare.

JANUARY 2019 HOSPITAL NEWS 19

NURSING PULSE

Teach. Don’t preach.

Just one of the many lessons Mireille “Mimi” Mitchell has taken to heart as an RN in the community and elsewhere.

By Jonathan Sher our decades before RN Mireille Mitchell rose to oversee risk and quality for the Victorian Order of Nurses (VON), 12-year-old “Mimi” managed risk of another sort, displaying the sort of demeanour and acumen that would propel her journey as a nurse.

Asked to handle the register at the corner store owned by her parents in Verner, ON, Mitchell watched a woman slip products into her pocket and head to the counter with a few cheaper items in her hands. Mitchell punched in the prices and stated the real total.

When the woman cursed, Mitchell explained she had charged her for the items in her pockets. When the woman shouted and threw coins at her, Mitchell calmly lifted the hidden phone, the one that sounded in her family home next door, and her father arrived by her side in seconds.

The eighth of nine children, Mitchell was born and raised on the Quebec side of the Ottawa River in Témiscaming. It was there, at the age of three, that she declared she would be a nurse, a pursuit her parents encouraged even though no one in the immediate or extended family had ever gone beyond high school.

Married in 1985 and living in Hamilton, Mitchell applied and was accepted to the Mohawk College nursing diploma program. But the same week she received that news, she found out something else: She was pregnant.

About five years and two children later, Mitchell officially enrolled at Mohawk while also working as a registered practical nurse (RPN) at a long-term care home. In her third year, she did placements in three clinical

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Mireille “Mimi” Mitchell environments: the burn trauma unit at Hamilton General; a medical unit at McMaster University Hospital; and at a rehab facility called Chedoke Hospital.

While she loved front-line nursing, by 1996 she wanted more. That year, she started an online baccalaureate degree program at Charles Stewart University in Australia. She believed it would be her doorway to become an educator and manager.

That same year, Mitchell was hired

by VON, an organization that she says had become a magnet for top nursing talent. “There was no safety net,” she explains of nursing in the community vs. acute care. “You have to think on

your feet. You never know what you’ll see on the other side of the door.”

One encounter sticks out. Mitchell was visiting a dairy farmer northwest of Hamilton to inspect his catheter.

Rather than use sterile bags he said he couldn’t afford, the farmer rigged his own system, hooking a tube from his abdomen to scrap pieces of milking line, then to a household tap. Another length of milking line, which he placed inside a whiskey jug, completed the home-made system.

Rather than push him to immediately buy bags, Mitchell focused on building a rapport and gaining his trust. She explained that whatever he used, he needed to keep it clean. Only after his

infection eased did Mitchell explain he might qualify for funding to acquire bags, and later, he agreed.

Don’t preach. Teach. That was her approach.

After five years with VON, some of the organization’s work in the area was given to another provider contracted by the government, a turn of events that left Mitchell with part-time hours. She moved on, later working for Telehealth Ontario, where she’d put in eight years.

“You needed to be efficient and quick.

I learned a lot about different diseases,” she says of that experience.

Mitchell returned to VON in 2016 and became quality and risk manager. In this role, she evaluates critical incidents and seeks out patterns or problems that might require systemic reform, both in how care is delivered and money is managed.

One problem in home care remains beyond her grasp to correct: community nurses are paid far less than their hospital counterparts. That gap, as much as 20 per cent in some cases, causes good home care nurses to leave, and their exodus destroys the continuity of care that is so critical to patients.

“Nurses are not leaving by choice, but because of financial necessity,” she says.

This article was originally published in the September/October 2018 issue of Registered Nurse Journal, the bi-monthly publication of the Registered Nurses’ Association of Ontario (RNAO). You can read more about RNAO’s advocacy on the issue of pay equity in Enhancing Community Care for Ontarians (ECCO), a white paper released in 2014. Visit RNAO.ca/ ECCO to read the report and supportH ing resources. ■

Jonathan Sher is senior writer for RNAO, the professional association representing registered nurses, nurse practitioners, and nursing students in Ontario.

Since 1925, RNAO has advocated for healthy public policy, promoted excellence in nursing practice, increased nurses’ contribution to shaping the healthcare system, and influenced decisions that affect nurses and the public they serve. For more information about RNAO, visit RNAO.ca or follow us on Facebook and Twitter.

20 HOSPITAL NEWS JANUARY 2019

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JANUARY 2019 HOSPITAL NEWS 21

PROFESSIONAL DEVELOPMENT AND EDUCATION

New staff education program to erase stigma around mental illness

By Veronica Magee or people struggling with mental health, confiding in others can often be as difficult as battling their illness. This is partly because of the stigma attached to mental illness – the stereotypes that make people vulnerable to prejudice and discrimination.

Due to stigma, many people suffer in silence. Hamilton Health Sciences (HHS) is launching a new program to change that.

This fall, HHS will implement a staff education program called The Working Mind (TWM). It’s an evidence-based program developed by the Mental Health Commission of Canada (MHCC) to address and promote mental health and reduce the stigma of mental illness in the workplace.

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According to MHCC, mental illness affects one in five Canadians, and will indirectly affect everyone at some point in their life, either through a family member, friend, or colleague.

“We know that our people are at a higher risk of mental health problems than any other occupational group,” says Lisa Gilmour, manager of health, safety and wellness initiatives at HHS. She points to Mental Health Commission of Canada research that shows healthcare workers are 1.5 times more likely to be off work due to illness or disability than people in other sectors.

Chronic stress and burnout are common, and many health workers report a range of conditions related to workplace stress including depression, anxiety, and substance misuse.

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“We believe in talking openly about mental health among our employees, and working together to remove the stigma attached to mental illness,” says Michelle Cassidy, a healthy workplace coordinator.

“We want to reduce any negativity faced by our colleagues with mental health challenges by encouraging everyone to discuss these issues and help our colleagues seek the support they need.”

Part of Michelle’s job is to develop and implement an employee mental health strategy to build a mentally healthy working environment. “The goal is to create an environment where mental health is actively promoted, stigma is reduced, and people feel encouraged to seek support when they need it,” she says. “Overall, staff in a mentally healthy environment feel equipped with the appropriate knowledge and skills. There is a lot we can do to promote the mental health of our employees.”

The Working Mind is a natural tie to HHS’ strategic plan, which includes

a focus on engaging and empowering our people to do their best work. Supporting employee mental health is a key component.

Volunteer trainers from HHS will assist in delivering training and all employees are invited to take part. Those attending will learn how to recognize changes in their mental health and that of others, examine the impact of stigma and discrimination in the workplace, support colleagues with mental health problems, and use skills to improve their coping and resiliency.

Education sessions will be scheduled at H various sites. ■

Veronica Magee is a public relations Specialist at Hamilton Health Sciences. www.hospitalnews.com

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PROFESSIONAL DEVELOPMENT AND EDUCATION

Service with a smile:

Hospitals use service standards training to improve communication

By Nadia Daniell-Colarossi t North York General Hospital (NYGH) our goal is to ensure that when patients and families come through our doors they feel compassion, well cared for, and respected. We’ve heard clearly from our Patient and Family Advisors (PFAs) – volunteers who lend us their patient and family perspective to ensure everything we do at the hospital reflects their needs and

A

interests – that simple actions such as smiling, introducing yourself, listening, empathizing and responding appropriately when a concern is voiced is fundamental to the patient experience.

This is why the hospital has adopted Communicate with Heart™, an industry-leading practice on effective communication and relationship-building designed by the Cleveland Clinic. It consists of two programs that we pro-

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Learn more and register at cna-aiic.ca/leadership 24 HOSPITAL NEWS JANUARY 2019

Clara Ho, Consultant, Patient- and Family-Centred Care and Leela Prasaud, Patient and Family Advisor provide all new employees with training on our Patient- and Family-Centred Care approach and service standards. vide to our staff, physicians and volunteers: S.T.A.R.T with Heart and Respond with H.E.A.R.T.

S.T.A.R.T Smile and greet warmly, Tell your name, role and what to expect, Active listening and assist, Rapport and relationship building, Thank the person

H.E.A.R.T Hear, Empathize, Apologize when a concern is voiced, Respond, Thank Throughout the education session, participants in the Communicate with Heart program draw on their own experiences and learn from others in a group setting to reconnect with the patient, family, and caregiver perspective. The programs are interactive and involve breakout sessions to role-play different scenarios to identify opportunities to improve communication and build warm and supportive relationships. Whether someone has been working in healthcare for two years or 20, participants benefit from reflecting on their communication style and understanding how small changes can improve interactions with patients, families and colleagues.

MY NAME IS LEELA, HOW CAN I HELP? “When someone smiles at you and says ‘hello my name is,’ it opens the door that allows people to connect with each other – we can’t go on to build trusting relationships without

By the numbers: • In a 24-hour period, patients have approximately 2530 interactions with staff, physicians and volunteers.

• Over a three-day period, patients have approximately 100 interactions with staff, physicians and volunteers.

• Each interaction is 10 minutes or less • Since we launched the Communicate with Heart program in Sept 2017, over 1500 staff, physicians and volunteers have been trained. these vital first steps,” says Leela Prasaud, a NYGH Patient and Family Advisor. “These small actions enhance communication by setting a positive tone. This signals to patients and families that we are here to support them through every aspect of their care, even when they are not feeling their best.”

In addition to the feedback from our PFAs, there is ample evidence that using service excellence standards in healthcare settings is as beneficial to patients as the safe, high-quality treatment they receive. In a 2017, report from the Ontario Patient Ombudsman, Christine Elliot – now the Ontario Minister of Health and LongTerm Care, revealed the need to improve communication was a reoccurring theme in healthcare.

Continued on page 26

Nadia Daniell-Colarossi is a Senior Communications Specialist at North York General Hospital. www.hospitalnews.com

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PROFESSIONAL DEVELOPMENT AND EDUCATION

Enhancing

geriatric patient care with Medicine Refresher Day

By Kyla Young n October 18, 2018, a record number of 180 primary care providers, nurses and allied healthcare professionals who work as part of interdisciplinary geriatric teams across Northeastern Ontario, came together at the 5th annual North East Geriatric Medicine Refresher Day. This conference is aimed at building clinical capacity in specialized geriatrics across the region.

The event was hosted by the North East Specialized Geriatric Centre in Sudbury and brought together six experts from across the province to share

O

best practices in geriatric medicine with healthcare professionals serving older adults. Guest speakers included Dr. David Conn, Dr. Cindy Grief, Dr. Katriina Hopper, Dr. Joanne Ho and Dr. Lyne Giroux who covered a wide range of topics including, substance use disorders, grief, advanced care planning, geriatric clinical pharmacology, and dermatology.

A highlight from the day was a moving presentation delivered by Mr. Dale Hall who described his role as an active caregiver to his father-in-law who was diagnosed in 2016 with vascular

THE FOCUS OF THIS YEAR’S CONFERENCE ALLOWED THE SPEAKERS TO PRESENT EVIDENCE-BASED BEST PRACTICES ALONG WITH NEW LEADING INDUSTRY TOOLS AND SKILLS TO OPTIMIZE CARE FOR FRAIL, MEDICALLY COMPLEX, OLDER ADULTS. dementia. Mr. Hall reflected on their journey navigating the complexities of the healthcare system, which resonated professionally and personally with conference participants. Dr. Felicia Janulewicz, a Care of the Elderly Physician, says the information shared

at the conference will help patients across Northeastern Ontario. “I find it exciting that the education provided, especially the innovative approaches to substance abuse, polypharmacy, and grief, will help those health professionals who attended to better

Service with a smile Continued from page 24

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26 HOSPITAL NEWS JANUARY 2019

The challenge in hospitals is that speed and efficiency are necessary in order to care for the high volume of patients. The key is that kindness and empathy don’t carry any additional cost or take more time.

“People who work in healthcare are genuinely caring individuals who want the best for all patients, but there are times when administering a test or procedures can become quite routine,” says Jennifer Quaglietta, Director of Patient Experience, Quality, and Patient- and Family-Centred Care. “But we must never forget that for the patient and their family, it may be something completely unknown, confusing and sometimes scary, which is why we need to utilize strategies like service excellence standards to keep the patient experience at the forefront of everything we do.”

As the notion of patient- and family-centred care continues to evolve

and spread throughout the healthcare system it has given rise to the understanding that how care is delivered is just as important as providing the right, the quickest and most technically advanced care. When patients feel safe, calm and understood they are more likely to be an active participant in their care and be able to fully engage with their healthcare team.

“As a physician, we are often driven to ‘fix the problem’ as quickly and efficiently as we can. We focus on establishing a diagnosis and developing a treatment plan,” says Dr. Shaheen Doctor, Neonatogist and Medical Director of the Neonatal Intensive Care Unit. “Communicate with Heart helped me to understand the value of pausing in the ‘hearing’ and ‘empathizing’ phase of the patient interaction.

This small investment in time has a powerful effect on the interactions I H have with patients and families!” ■ www.hospitalnews.com

serve their elderly patients. The day concluded with a touching message on the caregiver experience which was a beautiful reminder of why we do this work, and why we continue to gather each year to share in our experience and knowledge.”

The North East Specialized Geriatric Centre is a leader in providing education in geriatric medicine and has hosted the North East Specialized Geriatric Medicine Refresher Day for five consecutive years. The focus of this year’s conference allowed the speakers to present evidence-based best practices along with new leading industry tools and skills to optimize care for frail, medically complex, older adults. Attendees were able to network and collaborate with regional partners regarding innovative healthcare delivery. “This event provides a wonderful opportunity to network with other geriatric medicine providers and experts in the field,” says Dr. Katriina Hopper, Geriatrician at the Sault Area Hospital. “As a geriatrician working in a northern, it is

Participants at the North East Geriatric Medicine Refresher Day in Sudbury. important to nurture and maintain these professional connections.”

Following the one-day conference, participants are asked to provide feedback in survey format on elements they enjoyed about the conference, areas of interest, and future opportunities for improvement. This year’s feedback highlighted an appreciation for the diversified topics and engaging speakers as well as the structure of the day which supported col-

laborative group discussion through question and answer periods and networking breaks. Future opportunities for improvement suggested tailored break-out sessions and varying clinical applications for all healthcare providers in order to emphasize the importance of teamwork and multidisciplinary expertise in geriatrics.

The planning committee reviews all feedback received through the online survey and uses this information to

Kyla Young is the North East Specialized Geriatric Centre’s Assistant.

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guide the development of future conference programs.

For more information on this year’s speakers and their presentations visit the North East Specialized Geriatric Centre’s website at www.nesgc.ca. The North East Specialized Geriatric Centre will be hosting next year’s conference on Thursday, October 17th in Sudbury, ON. Further information pertaining to this event will be updated throughout H the year on Twitter @NE_SGC. ■

PROFESSIONAL DEVELOPMENT AND EDUCATION

Training to improve HIV care

By Caroline Dobuzinskis ince its launch in 2011, the BC Centre for Excellence in HIV/AIDS (BC-CfE)’s highly regarded Education and Training program has engaged over 13,500 participants in educational programs and events by the end of June 2018. Of those, over 11,000 participated in lecture events, over 1,400 took online courses and over 580 attended clinical training programs.

“The BC-CfE clinical education program aims to diminish barriers to continuing education on HIV care and prevention for health care providers and the community at large, including those who may be in underserved or remote areas,” says Dr. Silvia Guillemi, Director of the BC-CfE Education and Training Program.

In October, Dr. Guillemi received the UBC Faculty of Medicine Award for Innovation in Continuing Professional Development/Continuing Medical Education. The honour recognized that Dr. Guillemi and her team had implemented “unique and innovative opportunities for training and education in the field of HIV/AIDS in BC”.

To offer learners the most up-todate content, the award-winning education programming often corresponds with the latest HIV care initiatives, highlighting new research from BC, Canada and abroad. The most recently launched training program will provide nurse practitioners in BC with the knowledge required to prescribe and monitor post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) for people at risk of acquiring HIV. This program was developed to facilitate access to HIV prevention medications (tenofovir/emtricitabine) that have been publicly available to eligible individuals in BC since January of last year.

The BC-CfE’s Education and Training programs reach individuals in multiple professional roles – from health care providers to researchers to community workers and people living with HIV. They are accessed from with-

S

Dr. Silvia Guillemi is the Director of the BC-CfE Education and Training program.

TO OFFER LEARNERS THE MOST UP-TO-DATE CONTENT, THE AWARD-WINNING EDUCATION PROGRAMMING OFTEN CORRESPONDS WITH THE LATEST HIV CARE INITIATIVES, HIGHLIGHTING NEW RESEARCH FROM BC, CANADA AND ABROAD. in all of BC’s Health Authorities, as well as nationally and internationally.

Reaching thousands with training programs for HIV prevention and care in British Columbia is key to improving access to the successful Treatment as Prevention® (TasP® ) strategy.

A large portion of the programming is globally accessible through online courses and online video access to lectures. Offline, the BC-CfE’s Intensive Preceptorship Program is a postgraduate program for family physicians and nurse practitioners that provides more hands-on, specialized clinical training. There is also a threemonth-long UBC Enhanced Skills in

HIV/AIDS residency program for family physicians.

The preceptorship consists of an online component followed by clinical placements at HIV clinics and other associated sites. Trainees participate in a series of tutorial lunch sessions focused on key issues related to the care of people living with HIV and their individualized learning objectives. Once the clinical placement is completed the trainees will access the ongoing mentorship. Feedback on the intensive preceptorship has been positive; trainees have expressed it has increased confidence when caring for people living with HIV and pro-

vides accessible, quality education.

Recently, the BC-CfE hosted a delegation of family physicians from Saskatchewan – Drs. Sarafa Tijani, Natasha McNamara, and Laura Marshall – for the week-long preceptorship. Their visit was arranged by the Saskatchewan Infectious Disease Care Network. In addition to increasing HIV prevention and care knowledge, the program highlighted how interprofessional teams could provide HIV care that addresses issues related to social determinants of health and harm reduction.

“It’s really nice to see how all the disciplines work together as a team. The medical side of HIV is just one small facet and it’s nice to see how the social determinants of health are addressed here,” says Dr. Marshall.

“It gave me lots of things to take back to my practice and my community,” says Dr. McNamara.

For more information visit bit.ly/ Ht BCCfE_education ■

Caroline Dobuzinskis is the Communications Coordinator at theBC Centre for Excellence in HIV/AIDS. 28 HOSPITAL NEWS JANUARY 2019

www.hospitalnews.com

PROFESSIONAL DEVELOPMENT AND EDUCATION Advertorial

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PROFESSIONAL DEVELOPMENT AND EDUCATION

Finding engaging ways to educate and prepare for accreditation

By Yeena Peng his year Markham Stouffville Hospital (MSH) participated in the Accreditation Canada survey process between September 24-27, 2018. Similar to other hospitals that are in their year of accreditation, staff, physicians and volunteers put in a monumental amount of work and countless hours planning and preparing for the actual survey. MSH is no exception. And for this reason, it was important for the MSH accreditation organizers to come up with exciting and engaging ways to educate and celebrate the accreditation process.

The term accreditation is not often associated with anything fun or exciting; rather it is often referred to as a process by which hospitals are

T

30 HOSPITAL NEWS JANUARY 2019

measured against a set of standards developed by Accreditation Canada and the Ontario Hospital Association to ensure continuous improvement of the quality of care delivered.

However, after months of hard work, in the final weeks leading up to the actual survey, it was time for MSH to have some fun. One week prior to the survey, MSH held an interactive accreditation fair, where ROP (required organization practice) leads developed games and activities at their booth for all staff, physicians and volunteers to participate in. Activities at the fair included an IPAC fashion show, where proper donning and doffing of PPE (personal protective equipment) was exhibited, as well as an area where staff were asked to aim for qual-

ity – literally aiming and shooting at a target with the correct answer.

The hospital also developed an escape room. The escape room concept was designed around a code orange that led to a patient being admitted to MSH. The scene unfolds with clues and questions to be solved within that patient room. All the clues revolve around/lead back to the ROPs. For example, patient Clark Kent, (which was purposefully selected) a person with two first names was intended, as a part of patient safety is ensuring that we are identifying people properly, but also MSH’s overall accreditation theme was focused on superheroes achieving a mission.

Teams then had to go into the room and evaluate the situation based on their accreditation knowledge they

gained over the past year – to solve the challenge and get out of the room as fast as they could. Participation in the escape room saw teams from a cross-section of departments and levels, from clinical areas at both the Markham and Uxbridge sites as well as leadership members through to corporate services staff. Everyone was engaged and excited. Even staff who couldn’t participate in the actual room, did not miss the enjoyment, footage from the escape room challenge was shared at the internal MSH celebration.

“The escape room was a successful activity that engaged staff at all levels, and was one of many methods of sharing information about accreditation,” says Barb Steed, Executive Vice President and Chief Practice Officer, MSH.

www.hospitalnews.com

PROFESSIONAL DEVELOPMENT AND EDUCATION

THE ESCAPE ROOM CONCEPT WAS DESIGNED AROUND A CODE ORANGE THAT LED TO A PATIENT BEING ADMITTED TO MSH. Throughout the accreditation process the committee ensured information was made available online, in hard copy and through hands-on learning (tracers), as well as creative experiences such as the escape room.

“This was important because we wanted to address the different types of learning styles every individual has.

The way each person receives and retains information is different from one another, even the way clinical and non-clinical staff learn and train can vary. We needed momentum to sustain the message for a year – and executing a mixture of activities allowed us to do so,” says Steed.

In early November, MSH announced that it was accredited with

Exemplary Standing – Accreditation Canada’s highest award.

“We are incredibly honoured to be placed among top-ranked hospitals in Canada achieving 100 per cent of the required organizational practices and 99 per cent compliance with over 2,300 internationally recognized standards,” says Jo-anne Marr, President & CEO, MSH. “This achievement is a testament to our staff, physicians and volunteers who are committed to providing exceptional care to our patients and families each and every day.”

Surveyors acknowledged despite its considerable growth in recent years that MSH has worked hard to maintain a warm and collaborative workplace. This is aligned with the unique

The escape room at MSH encouraged all level of staff and physicians to have fun while still learning and preparing for the accreditation survey.

And Steed agrees, “We don’t see accreditation as an event that takes place every four years, but rather as a constant process of quality Ht improvement.” ■

culture at Markham Stouffville Hospital – an honoured to care culture that focuses on continuous quality improvement and patient-centred care.

Yeena Peng is the Manager, Communications and Public Affairs at Markham Stouffville Hospital.

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JANUARY 2019 HOSPITAL NEWS 31

PROFESSIONAL DEVELOPMENT AND EDUCATION

How a leadership development program is helping to transform mental healthcare at owur hospital

By Carol Lambie t Waypoint, mental health care isn’t just what we provide for our patients, or part of our name. Like other successful organizations we are striving to create an atmosphere and culture where everyone feels their mental health is a priority. And while we all have a responsibility to treat each other with respect, it’s our leaders who set the stage to build a psychologically healthy workplace.

In today’s complex healthcare environment, hospitals require experienced, strong and collaborative leaders. Historically, advancement to leadership positions in healthcare was often based on the candidate’s academic or clinical accomplishments.

In recent years there has been an increased awareness of the importance of leadership and formal leadership training, bringing to light required competencies such as budgeting, team

A

Carol Lambie building, communication skills and emotional intelligence.

Leadership can come from anywhere in an organization. Investing in our people ensures leaders at all levels are equipped with the necessary skills

Addiction Awareness & Education: Breaking The Cycle Of Pain According to the Centre for Addiction and Mental Health (CAMH), 1 in 5 Canadians will experience a mental illness or an addiction problem. That’s why Crystal Smalldon, Executive Director at The Canadian Addiction Counsellors Certification Federation (CACCF), believes there’s an urgent need for service providers to have a thorough understanding of addictions care. “This will allow for more effective case management in referring substance abuse clients through the continuum of care,” she says.

But this can only be done if service providers are educated in the physiological and cognitive processes of individuals struggling with addiction issues, and if they know what resources they should utilize to best assist the person in need. It’s also critical to develop an appreciation of the many factors that contribute to the development of addiction issues and impact an individual’s recovery. Without comprehensive addiction education, a healthcare provider may not recognize the areas that require attention.

McMaster University Continuing Education recently launched its Professional Addiction Studies program, which has been accredited by the CACCF. The program meets all the core competencies related to addiction, and is designed to provide holistic information about various aspects of this complex human issue while recognizing the prominence of trauma in the addiction field.

Learn more at www.mcmastercce.ca/addiction-studies-program.

to not only care for our patients, but also for our staff. Our current Strategic Plan included objectives to implement psychological health and safety standards and enhance leadership capacity. Our goal is to create an environment that is caring, compassionate and empathetic for everyone, and where our staff feel supported through their day to day challenges, and are recognized for the work they do.

The National Standard of Canada for Psychological Health and Safety in the Workplace provided the tools and resources to guide our efforts in promoting mental health and prevent psychological harm. Targeted awareness campaigns for mental health week, promotion of civility and respect in the workplace, and education to gain a common understanding of what it means to be a psychologically healthy workplace were all part of the plan.

leading to increased stress levels and caregiver burnout. The LEADS in a Caring Environment framework outlines what caring looks like in action, detailing the capabilities they need to create such an environment.

The leadership team and I were the first cohort to complete the LEADS program, which began with 360 evaluations followed by education in each of the LEADS domains: Lead Self, Engage Others, Achieve Results, Develop Coalitions and Systems Transformation.

Our managers were next, followed by the latest cohort, a group of emerging leaders from across the hospital.

The process hasn’t stopped there.

We’re working on sustainability with continued education and the formation of triads and quads. These multi-disciplinary groups support the learnings, encourage developmental activities, and grow and develop all LEADS capabilities.

THE LEADS IN A CARING ENVIRONMENT FRAMEWORK OUTLINES WHAT CARING LOOKS LIKE IN ACTION, DETAILING THE CAPABILITIES THEY NEED TO CREATE SUCH AN ENVIRONMENT. We adopted the LEADS in a Caring Environment framework from the Canadian College of Health Leaders as the basis for our leadership development program. Dubbed Developing Our People, this dynamic initiative aims to foster a values-driven community of leaders built on sharing experiences, building relationships and a commitment to learning.

Why LEADS in a Caring Environment? Most people who work in the health system care about health and wellness. At least we assume this is the driving force compelling them to pursue this challenging, yet rewarding line of work. However no matter how eager they may have once been, the demands of the job, the routines, policies, procedures, protocols and practices, can overshadow the notion of caring for the welfare of another human being,

It was Peter Drucker who says “Culture eats strategy for breakfast.” We’re aiming to change the culture. It takes time but we’re making some positive strides. We’ve seen an improvement in our employee engagement survey scores related to how employees interact with their supervisor and how supported employees feel.

This isn’t the first time I’ve completed leadership training, but each time I learn something new. Collaborating with my colleagues, exploring new evidence and hearing new ideas always inspires me to become a better leader. Healthcare, and in particular mental healthcare is ever-evolving and there’s always more to learn.

If you’re thinking of implementing a leadership development program at your hospital, I would definitely H recommend doing so. ■

Carol Lambie is President and CEO, Waypoint Centre for Mental Health Care.

32 HOSPITAL NEWS JANUARY 2019

www.hospitalnews.com

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PROFESSIONAL DEVELOPMENT AND EDUCATION

Education night helps high school students prepare for a career in medicine

By Kaylee MacMillan s a healthcare professional, Shannon Puna thought she had all the resources she needed to answer any questions her Grade nine son asked about medical school.

“I work in healthcare. I’ve asked the doctors I work with what my son could start doing now to make a difference when he was ready to apply to med school,” says Puna. “I shared what I had learned with my son, but what really inspired him was hearing it firsthand from current family medicine residents at an Education Night.”

Education Nights are an initiative

by Barrie Area Physician Recruitment (BAPR), in partnership with Royal Victoria Regional Health Centre

A

(RVH), the Simcoe County District School Board and the Simcoe Muskoka Catholic District School Board.

The evening provides local high school students the opportunity to discuss prerequisite courses, how to apply to medical school and what to expect while at medical school – all directly with local physicians.

“We wanted a way to share with students what it takes to get into medical school,” says Brittany Thompson, physician recruitment coordinator with BAPR. “We thought, if we could get current residents from RVH’s Family Medicine Teaching Unit, a partnership with the University of Toronto, to host an education night, we could help alleviate some of the unknowns for high school students. The residents

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)EGL SJ (ƅ=SYZMPPIƅW LIEPXLGEVI majors are prepared for success through interprofessional IHYGEXMSR 7XYHIRXW JVSQ IEGL healthcare discipline, including XLSWI JVSQ XLI 7GLSSP SJ 2YVWMRK ERH 7GLSSP SJ 4LEVQEG] EVI involved in the whole care of

34 HOSPITAL NEWS JANUARY 2019

This hands-on education allows students to learn essential skills that top healthcare providers are looking for and help increase ]SYV IEVRMRK TSXIRXMEP

“WE WANTED A WAY TO SHARE WITH STUDENTS WHAT IT TAKES TO GET INTO MEDICAL SCHOOL,” could educate students, answer questions and even share personal stories from their journey to med school and becoming a physician.”

And the concept has taken off.

Since 2012, more than 300 high school students and their parents have participated in an Education Night.

“As a parent, I found the evening to be informative and well organized,” says Puna. “The speakers were engaged with the audience and the information was relevant. They even provided a basic timeline from high school straight through to residency. When I tried to share the information I had gathered from my colleagues with my son, it did not have the same impact as this Education Night. I do not believe that there is another source – and certainly not a single source – that would provide as much info as this event did.”

Parents and students aren’t the only ones benefitting from the Education Nights either.

“It was a privilege to speak to the high school students and parents from the community,” says Andrew Kim, medical student at Queen’s University and presenter at a recent Education Night. “It was a great opportunity to share our experiences so far in our own medical education and hopefully inspire curious students to explore a career in healthcare. The process of getting into medical school is, and should be, unique to each person so we were able to address the misconception that there is a ‘right way’ to get in. The journey is challenging but extremely rewarding and filled with opportunities for fun and personal growth.”

Dr. Anastasiya Nelyubina, chief resident in RVH’s FMTU, commented after the event that it gives her and other medical residents the opportunity to inspire future physicians to practice in the Simcoe Muskoka region.

In addition to Education Nights, another way physicians at RVH are sharing their medical expertise is through the health centre’s Observership program.

The program pairs students with a member of RVH’s professional staff for a 14-day placement in an area of the health centre. It provides an excellent opportunity for individuals who are passionate about healthcare to gain insight into how it’s delivered in hospitals as well as provide an understanding of various healthcare professions.

Medical education has always been a top priority at RVH. One of the health centre’s strategic directions is to Accelerate Teaching and Research and in May 2018, RVH opened its Centre for Education and Research (CER), creating a space within the health centre fully dedicated to learning and research. Beyond an official designated space for education and research, RVH is helping shape the next generation of healthcare providers by sharing its medical expertise.

For parents like Puna, it’s all about educating and inspiring the next generation of healthcare providers.

“I hope that events like the Education Night continue to happen. There is such a need for medical providers in our community – what better way to get them interested than when they H are young!” ■

Kaylee MacMillan works in communications at Royal Victoria Regional Health Centre. www.hospitalnews.com

PROFESSIONAL DEVELOPMENT AND EDUCATION

Dr. Giulio Didiodato, chief research scientist, Centre for Education and Research at RVH, guides high school students through a demonstration in RVH’s Simulation Lab. The students are participating in the health centre’s Observership program which provides students the opportunity to gain insight into how healthcare is provided as well as an understanding of various healthcare professions.

DEGREES THAT MEAN JOBS KNOWN FOR OUR HEALTHCARE DEGREES, OUR GRADUATES ENJOY SOME OF THE

HIGHEST JOB PLACEMENT RATES IN WESTERN NEW YORK AND NATIONALLY

DYC.EDU

PROFESSIONAL DEVELOPMENT AND EDUCATION

Burnout training

can help prevent physician burnout

By Dr. Rich Castellano

NEPHROLOGY AND MENTAL HEALTH NURSING PROGRAMS HELP NURSES SPECIALIZE IN THEIR PRACTICE Nurses in Ontario must stay current as they adapt their practice to meet the health care needs of diverse patients.

With chronic kidney disease on the rise and an increased focus on mental health promotion in the health care sector, there has never been more demand for nurses specializing in these two practice areas.

The Mental Health Nursing and Nephrology certificate programs at Durham College (DC) are designed to meet the professional development needs of nurses looking to enhance their knowledge and skills in these areas. With courses delivered online, busy professionals have the flexibility to study while also balancing work and other commitments. Courses can be taken individually or the full program can be pursued.

hysician health – particularly burnout and depression – is a mounting concern in Canada. A recent survey of 2,947 doctors across Canada by the Canadian Medical Association (CMA), the CMA National Physician Health Survey: A National Snapshot, revealed 26 percent of respondents admitting they have experienced burnout and 34 percent reporting symptoms of depression.

P

years. Among the most cited reasons for not using these services were: “believing the situation was not severe enough” and “being ashamed to seek help.”

There’s no question that emotional exhaustion is pervasive in the health profession. Many Canadian physicians commonly develop burnout incrementally as a result of escalated stress levels, unmanageable workloads, inefficiencies and feeling a loss

PROVIDER BURNOUT HAS NUMEROUS DOCUMENTED NEGATIVE IMPACTS ON PATIENT CARE, INCLUDING MEDICAL ERRORS, LONGER RECOVERY TIMES AND DECREASED SATISFACTION.

DC’s Nephrology certificate prepares nurses to work with affected patients across all stages of the kidney-care journey, from early detection through to dialysis, palliative care or transplant.

The Mental Health Nursing certificate explores issues and ethics and prepares nurses to assess patients, develop plans of care, and advocate for those with mental health issues across a variety of institutional and community settings.

To learn more or to register for these programs, visit www.durhamcollege.ca/ coned/ or call 905.721.3052. Courses start January 2019!

Although the majority of physicians and residents report being aware of the professional health services available to them, only 15 per cent says they utilized these resources in the last five

of control. Symptoms can gradually surface in the form of depersonalization, negative responses, feelings of inadequacy, incompetence or feeling unappreciated.

Continued on page 38

36 HOSPITAL NEWS JANUARY 2019

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Specialize in your nursing practice

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MENTAL HEALTH NURSING RN/RPN This online program is based on the Standards for Mental Health Nursing in Canada, and combines in-depth theoretical knowledge with hands on clinical practice. Upon completion, you will be prepared to assess, provide interventions, and advocate for mental health clients in a variety of institutional and community settings.

NEPHROLOGY NURSING RN/RPN The program prepares nurses to deliver kidney care to affected patients across all stages of the kidney care journey, from early detection through dialysis, palliative care and transplant. Current nurses will learn the knowledge required to promote and deliver competent, safe and ethical care to those at risk for developing or affected by renal disease and/or insufďŹ ciency.

The curriculum has been designed and developed in accordance with the Canadian Nurses Association (CNA) nephrology nursing competencies and standards of practice established by the Canadian Association of Nephrology Nurses and Technologists (CANNT).

Take a course or pursue the full program. Register today!

www.durhamcollege.ca/coned | 905.721.3052

PROFESSIONAL DEVELOPMENT AND EDUCATION

Burnout training Continued from page a Provider burnout has numerous documented negative impacts on patient care, including medical errors, longer recovery times and decreased satisfaction. Even worse, the effects of burnout can quickly progress into battles with depression, substance abuse, poor selfcare, suicidal thoughts and more.

WITH PHYSICIAN BURNOUT, PREVENTION STRATEGIES ARE KEY There is no doubt that healthy doctors deliver higher quality healthcare.

And, overwhelmed, stressed out, and burned-out doctors can be impaired in their ability to serve their patients.

These challenges are not new, and many providers have lived with this for so long they think it is normal.

Very few realize how small the changes need to be to make an enormous impact, especially if you know the warning signs and how to redirect your focus.

Now U.S. and Canadian physicians can obtain their required continuing medical education (CE/CME) hours through “Burnout Training.” Improved physician mental health and communication has been proven to enhance patient care. As part of this new holistic training, we focus on teaching providers how to better identify, measure and influence psychology, emotional literacy and nonverbal communication skills. Program participants learn how to: • Identify subtle cues and measure their emotions, including empathy, kindness and happiness • Create empathic communication in any situation with patients or team members • Diagnose and treat worrisome behaviors in patients and healthcare teams before they escalate

TAKE THIS QUICK TEST How can your organization get started in this process? I recommend

CMA National Physician Health Survey: A National Snapshot, revealed

26 percent

of respondents admitting

they have experienced burnout and

34 percent

reporting symptoms of depression. taking 60 seconds of your time to use this simple self-assessment and body language tool – you might dramatically change the course of your career: • What is the “Smile Score” of your team, 1-10 (with 10 being the highest)? Most teams have a combination of high, middle and low “smilers.” If you average out the team, what is their score? Be honest if you want the best solution for your challenges.

• What is the “Energy Score” of your team, 10 (with 10 being the highest)? Most teams have a mix of high, middle and low “energy” team members. If you average out the team, what is their score? Again, be honest if you want transparency and to achieve the best results.

• What is the “Story Score” of your team, 1-10 (with 10 being the highest)? We all have a story to tell. Some team members are very polished and well trained, and some are not. Some are so polished, they appear to others like rock stars, and others need more rehearsal. How do you rate the “story” score, or the experience your team creates for each patient 1-10 (with 10 being the highest)?

So why are these scores so impactful with regards to preventing burnout?

It is very clear that team members or providers that are burning out are not high in their body language scores. Surrounding ourselves with low or average smilers and low energy colleagues will bring us down. The real key is how do we get our team to increase their scores?

When we feel a sense of purpose, that we are making a difference, and that we are appreciated for our work and well rewarded, your body language will show this and your Smile Scores, Energy Scores, and Story Scores go up.

It may sound simple and easy, though how do we actually make this change?

That is what we teach! Either the administration or the team members themselves can take the lead and seek out or implement these CME trainings.

Confronting burnout and depression issues in the medical profession requires us to role model healthy behaviors and train our team to do the same. Together, through body-language awareness and training, we will continue to improve the healthcare experience and reduce burnout, assisting doctors to deliver the best possible H care to their patients. ■

Dr. Rich Castellano is a Wall Street Journal best-selling author. His Wall Street Journal Bestseller “The Smile Prescription,” explores the art of body language, facial expression and innovative communication strategies.

38 HOSPITAL NEWS JANUARY 2019

www.hospitalnews.com

We have a wide range of Medical Education programs to choose from!

The Centre for Distance Education offers a complete series of Professional Medical programs designed to give you the skills, experience and certification it takes to launch a successful career.

Unlike other schools that have lengthy wait lists, at CD-ED our classes start monthly, so you can start your career when you want!

In business since 1996, The Centre for Distance Education is a registered and licensed private career college, offering online education programs using the most current technology.

Benefits of Studying with CD-ED: • One on one support with industry experienced instructors • Programs geared to specific careers • You can study when and where you like

Choose from programs, such as: • Health Information Management Full Time • Health Information Management Part Time NEW! • Medical Office Administration • Medical Office Assistant

Go to cd-ed.com to learn more!

• CHIMA accredited HIM Programs • Our diverse Advisory Committee ensuring industry relevant course content • Medical Database Training • On site and virtual Practicums available

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PROFESSIONAL DEVELOPMENT AND EDUCATION

Enhancing the patient experience through

specialized Lean training

By Carla Wintersgill unnymede Healthcare Centre is committed to providing the tools and resources to empower its staff and promote engagement. By supporting ongoing professional development, the hospital is enhancing patient care.

Runnymede staff recently underwent Lean training with the goal of enhancing efficiency and patient care.

The goal of Lean is to provide the right services to the right patients in the right way by reducing waste in

R

processes, increasing value, and optimizing logistics. It’s an opportunity to review the hospital’s care and identify any non-efficient steps. “Lean perfectly matches hospitals,� says Morteza Zohrabi, a Lean Six Sigma master black belt and the trainer for Runnymede’s Lean sessions. “Everyone is coming here to help people.

By using Lean, they can find ideas for a wide range of improvement.�

Examples of waste include areas where staff duplicate actions, time spent waiting for information, or delayed decision-making. In some areas,

Runnymede Healthcare Centre staff spent a week undergoing specialized organizational efficiency training called Lean. the waste activities could be eliminated by redesigning or simplifying the current process. “Runnymede is committed to supporting our staff’s success,� says Sharleen Ahmed, VP, Strategy, People and Corporate Affairs. “Lean training provides an opportunity for professional development and ensures we are actively working toward providing

the most efficient, high-quality care possible.�

The staff spent up to six days in interactive training sessions that used a combination of tools, techniques and structures. “In healthcare we have the passion and desire to improve outcomes,â€? Morteza says. “We just need the tools and H structure to improve patient care.â€? â–

Carla Wintersgill is a Communications Specialist at Runnymede Healthcare Centre.

Organizational Programs to Improve Patient Safety Saegis QHHGTU CEETGFKVGF professional FGXGNQROGPV programs for hospital leaders and healthcare VGCOU that are FGNKXGTGF on-site at hospitals and healthcare institutions.

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Strategies for Managing Unprofessional Behaviour KU C workshop VJCV helps leaders recognize and address unprofessional behaviour within their healthcare teams. The workshop includes the development of personal and institutional improvement plans to ensure the program has a lasting impact. ,WUV %WNVWTG KU CP KPPQXCVKXG EQWTUG VJCV YKNN JGNR GPIGPFGT C EWNVWTG QH NGCTPKPI VJCV ECP KORTQXG RCVKGPV UCHGV[ .GCFGTU YKNN NGCTP JQY VQ TGKPHQTEG DGJCXKQWT VJCV UWRRQTVU VJG QTICPK\CVKQPÉœU U[UVGOU TGFWEGU PGICVKXG QWVEQOGU CPF KORTQXGU VGCO OQTCNG Communicating Unexpected Outcomes is a workshop HQT VGCOU that will improve transparency with patients and families after unexpected clinical outcomes.

Healthcare teams who participate in this program will learn to disclose clinical errors with empathy and respect, as well as to improve their support of other team members in these often-difficult circumstances.

Hospital and healthcare leaders interested in learning more can CALL 1-833-435-9979 or EMAIL info@saegis.solutions

40 HOSPITAL NEWS JANUARY 2019

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*QURKVCN CPF JGCNVJECTG VGCO NGCFGTU Organizational and cultural issues can impact team morale, put patients at risk and be costly.

To help you, Saegis offers theUG CEETGFKVGF RTQHGUUKQPCN FGXGNQROGPV RTQITCOU: Strategies for Managing Unprofessional Behaviour Just Culture Certification

Programs are delivered on-site at your hospital or institution

Find out more:

Communicating Unexpected Outcomes in Healthcare

1-833-435-9979 info@saegis.solutions www.saegis.solutions

As a member of the CMPA family, Saegis is uniquely positioned to help you address some of the most difficult challenges you, your team and your hospital will face.

Saegis is a wholly owned subsidiary of the CMPA that offers professional development, safety programs and practice management solutions to physicians, healthcare professionals and teams, clinics and hospitals.

Providing trauma simulation t

By Elise Copps

35-YEAR-OLD WOMAN, UNRESTRAINED DRIVER OF AN ALL-TERRAIN VEHICLE. ROLLED MULTIPLE TIMES INTO THE RAVINE, APPROXIMATELY EIGHT FEET DOWN AN EMBANKMENT. BLOOD PRESSURE IS 90/60, PULSE 110, RESPIRATORY RATE 40.

SHE HAS DECREASED BREATH SOUNDS ON THE LEFT SIDE AND AN UNSTABLE PELVIS. ETA IS 9 MINUTES. You receive this briefing from paramedics about a patient who’s en route to your hospital. What do you do?

This high-stakes situation was played out at a recent simulation training event at a community hospital in our region. A trauma scenario like this one is stressful for everyone.

It can be particularly tough for smaller hospitals. They don’t see trauma cases as often as the lead trauma hospital, which makes it difficult to practice the rhythm of these critical events.

That’s where realistic simulation training comes in. Last year, Dr. Paul

Engels, a trauma team lead with Hamilton Health Sciences’ Hamilton General Hospital (HGH), launched the Rural Trauma Team Development Course (RTTDC) in our region. The course was developed by the American College of Surgeons Committee on Trauma as a way to educate trauma care providers in smaller hospitals, so these providers can learn a standardized approach.

“Eventually, everyone in the region will be working from the same ‘song book’ so to speak,” says Dr. Engels.

“By providing the RTTDC, we have a certified and standardized approach to teaching within the Central South region.”

Hamilton General Hospital (HGH) is the lead trauma hospital for Central South Ontario. The hospital has a robust trauma program, and the majority of trauma patients in the region are sent directly to HGH for care. As the lead trauma hospital, HGH is responsible for providing education within the region, and working with regional partners to improve the trauma system. This training is part of that work.

So far, the team has hosted four training sessions at community hospitals across our region. During training, the course attendees learn the components of trauma care and what to do under different circumstances. Each

session typically includes a simulation of a pediatric, adult, and geriatric trauma case.

THE PATIENT ARRIVES IN THE EMERGENCY DEPARTMENT. BLOOD PRESSURE IS 88/64, PULSE 120, RESPIRATORY RATE 40 AND SHALLOW. CERVICAL COLLAR AND LONG BACKBOARD HAVE BEEN APPLIED. A SINGLE ATTEMPT AT IV ACCESS WAS MADE AND THIS WAS UNSUCCESSFUL. OXYGEN HAS BEEN APPLIED VIA NONREBREATHER MASK. NO MEDICATIONS BEEN GIVEN. THE PATIENT COMPLAINS OF SEVERE PAIN IN HER JAW AND IN HER LEFT CHEST, ABDOMEN/ PELVIS AND FLANK. Now the team has to assess and act. What are the patient’s exact injuries? What equipment is avail-

able, and where is it located? A scenario like this one prompts the providers to think about the resources they can make use of in dire circumstances.

“The goal is to get them thinking about how they work together,” says Dr. Engels. “What works well? What are their challenges and why? The focus is on them as a community hospital providing trauma care.”

Because the training takes place in the community hospital, the team gets authentic experience. They’re working with the space and tools they’ll have when a real trauma case comes through their doors. It allows them to test their action plan under the watch of seasoned trauma experts. Research shows this standardized trauma training speeds transfer time from a community hospital to a trauma centre.

“Effective treatment and speedy transfer to a regional trauma centre improves survival rates and recovery,” says Barb Klassen, Trauma Program Coordinator at HGH. “This program emphasizes early communication with the regional trauma team at HGH. That ensures patients get the best possible care at their community hospital, and can be transferred quickly to our hospital for specialized trauma care.”

Elise Copps is the Public Relations Specialist at Hamilton Health Sciences.

42 HOSPITAL NEWS JANUARY 2019

www.hospitalnews.com

n training THE TEAM LEADER CALLS THE REGIONAL TRAUMA HOSPITAL. A LIST OF ALL CURRENTLY RECOGNIZED INJURIES IS GIVEN. THE TRAUMA TEAM LEAD ADVISES ON THE BEST APPROACH TO STABILIZING THE PATIENT FOR TRANSFER. WITHIN AN HOUR, SHE IS LOADED INTO AN AIR AMBULANCE FOR TRANSFER TO HAMILTON GENERAL HOSPITAL. So far, the training sessions have been very well received by participants.

They get a chance to provide feedback to the trauma team about what works and doesn’t work with current processes. They are not only learning, but also improving the system as a whole.

Early data suggests the program is also moving the needle on patient transfer times. The trauma team plans to continue offering three to four sessions each year to community hospitals in H our region. ■

www.hospitalnews.com

Staff at Hamilton Health Sciences’ Hamilton General Hospital participate in the Rural Trauma Team Development Course.

HOSPITAL NEWS 43

PROFESSIONAL DEVELOPMENT AND EDUCATION Cedar-Sinai surgical resident viewing Essential GI Surgeries course on Oculus Rift in 360-degree virtual reality.

How virtual reality and streaming media are transforming medical education

By Brian Conyer ver the last decade, there have been two significant advancements in the way people experience video content. The first is that streaming media OTT platforms have made consuming content easily accessible across all connected devices. The second is the mass commercialization of virtual reality technologies that fully immerses consumers into virtual environments. Despite VRs slower than expected adoption in consumer-driven industries such as gaming and entertainment, analysts are extremely optimistic about the clear benefits the technology offers in healthcare and education. Grandview Research estimates the healthcare Virtual Reality (VR) and Augmented Reality (AR) markets will be a $5.1 billion industry

O

by 2025, and medical education will represent a sizeable portion of that.

With medical information and innovations growing at alarming rates, physicians must master more information in shorter time frames than their predecessors. The vast improvements of streaming media and fully immersive virtual reality technologies will fundamentally change the way medical professionals access and engage with educational materials. Virtual conferences and operating room experiences will provide unprecedented access to the most renowned physician leaders and will significantly reduce the cost of travel, conference fees, and missed work days that physicians currently incur to keep abreast the rapid influx of information in medicine.

STREAMING INFLUENCE IN MEDICAL EDUCATION Although the quality and volume of clinical evidence in modern medicine are abundant, the delivery mechanisms of this information remain outdated. This includes traditional print publications, antiquated websites with poorly designed user interfaces, and low-quality user-generated videos. Knowledge sharing at scale is undoubtedly a major challenge for the medical community, particularly for hospitals and geographies that lack resources, but the adoption of streaming video will ease this burden for the global community.

With thoughtfully produced educational videos leveraging the most cutting-edge video technologies currently available and featuring the foremost

subject matter experts, physicians will no longer need to attend to medical conferences or visit the operating rooms of expert surgeons to learn new information. On-demand streaming videos can provide physicians with the most relevant and pertinent information that is packaged to the preferences of the younger generation of doctors. Beyond the scalability and the economic benefits of educational video content for the medical community, this will be the preferred method of consumption because of its inherent accessibility and convenience.

In addition, streaming video also addresses many of the limitations that medical education currently faces.

The convenience of on-demand video is better suited for the chaotic and unpredictable schedules of the modContinued on page 46

Brian Conyer is CEO and Co-founder of GIBLIB. GIBLIB is the only streaming media platform to provide medical professionals anywhere in the world access to high-fidelity, immersive 360-degree virtual reality video content of the most current medical topics and sought-after surgical procedures performed by the world’s leading specialists.

44 HOSPITAL NEWS JANUARY 2019

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Financial support for your RPN continuing education may be available The Nursing Education Initiative, developed by the Ministry of Health and Long-Term Care (MOHLTC), gives Registered Practical Nurses registered with the College of Nurses of Ontario (CNO) an opportunity to apply for financial support for continuing education courses or programs that improve their knowledge and professional skills.

Nurses undertaking professional development courses or programs may be eligible for education grant funding of up to $1,500 this funding year (April 1, 2018 to March 31, 2019).

These education grants are intended to reimburse nurses who have paid base tuition fees as well as registration fees for conferences, seminars, and workshops. To be eligible for grant funding, the professional development courses or programs must enhance the quality of care and services provided in Ontario.

To learn more, visit rpnao.org, click on the Nursing Education Initiative box on the homepage for detailed information on the application process, program eligibility requirements, deadlines and more.

Please note that each year there is not enough funding to provide education grants to all of the nurses who submit eligible applications. Applicants are advised that funding is not guaranteed.

For more than 60 years, the Registered Practical Nurses Association of Ontario (RPNAO) has been the one true unified voice for Registered Practical Nurses (RPN) in Ontario. RPNAO advances the knowledge of RPNs so they can respond to the continually changing nursing environment, including eLearning programs on conflict de-escalation, leadership, patient-centered care, role clarity, and workplace violence prevention. To learn more about RPNAO, its mandate, and how RPNs contribute to Ontario’s health care system, visit rpnao.org.

Supporting Registered Practical Nurses working in Hospitals

Join the RPNAO Community.

And invest in your professional practice excellence.

For more than 60 years, the Registered Practical Nurses Association of Ontario (RPNAO) has been the one true unified voice for Registered Practical Nurses in Ontario.

Registered Practical Nurses comprise almost one-third of Ontario’s total nursing workforce. As the demands on Ontario’s hospital system grow and the need for innovative, practical, value- and outcome-driven health system solutions increases, it’s critical that knowledgeable and highly skilled RPNs continue to be essential to ensuring Ontarians receive safe and high quality care in our hospitals.

Members of RPNAO have exclusive access to the broadest, most comprehensive package of protection, professional development programs, career supports, and savings and discounts, available to RPNs in Ontario.

Visit rpnao.org to learn more.

A 4K head-mounted camera affixed to Dr. Yosef Nasseri, MD (left) to capture POV for the incision.

Transforming medical education STRESS, RESILIENCE, & HAPPINESS Special Seminar To Be Held What are the origins of happiness, stress, and fear? How can patients attain tranquility and bounce back from unpleasant or disastrous experiences? Áǝƺ ɀƬǣƺȇɎǣˡƬƏǼǼɵ‫ٮ‬ƫƏɀƺƳً ɀǣɴ‫ٮ‬ǝȒɖȸ ƬȒɖȸɀƺً ‫ٹ‬³Ɏȸƺɀɀً «ƺɀǣǼǣƺȇƬƺً ƏȇƳ RƏȵȵǣȇƺɀɀً‫ ٺ‬ is designed to provide health professionals with answers to these questions.

The course will cover remedies for overcoming stressful or damaging experiences.

The seminar will be presented four times in Alberta Province: Thursday, April 11, 2019 The Glenmore Inn, 2720 Glenmore ÁȸƏǣǼ ³0ً !ƏǼǕƏȸɵً ǼƫƺȸɎƏٕ Friday, April 12, 2019 Radisson Hotel and Convention Center, ‫הוٮ׎אדג‬Ɏǝ ɮƺȇɖƺ zȒȸɎǝɯƺɀɎً 0ƳȅȒȇɎȒȇً ǼƫƺȸɎƏٕ

Thursday, May 2, 2019 Radisson Hotel and Convention Center, ‫הוٮ׎אדג‬Ɏǝ ɮƺȇɖƺ zȒȸɎǝɯƺɀɎً 0ƳȅȒȇɎȒȇً ǼƫƺȸɎƏٕ Friday, May 3, 2019 Carriage House Inn, 9030 Macleod ÁȸƏǣǼ ³ȒɖɎǝً !ƏǼǕƏȸɵً ǼƫƺȸɎƏِ The seminar times will be 8:30 A.M. to 3:30 P.M.

The course will examine learned optimism, the savoring of pleasure, and proven ways to feel more joy in life. It will cover daily exercises that help to ǣȇƬȸƺƏɀƺ ɀƏɎǣɀǔƏƬɎǣȒȇ ƏȇƳ ɯƺǼǼ‫ٮ‬ƫƺǣȇǕ ǣȇ Ǽǣǔƺِ The course will review how genetics, personality, and the environment can create happiness.

The course will examine positive psychology’s role in tough times and in achieving better mental health.

To obtain more information, please contact: Biomed General, Box #622, Unit 235, 3545-32 Avenue NE, Calgary Alberta T1Y 6M6

BIOMED

Visit Biomed's Web site at www.biomedglobal.com Telephone: 1-877-246-6336 (toll-free) or (925) 602-6140 E-mail: info@biocorp.com

46 HOSPITAL NEWS JANUARY 2019

ern physician. The analytics will help content creators develop better and more engaging content. The ability to stream to any connected device can effortlessly reach a global audience.

Lastly, machine learning and predictive algorithms that analyze what viewers consume will further enhance individualized learning experiences.

VIRTUAL REALITY INFLUENCE IN MEDICAL EDUCATION While streaming fulfills the promise of accessibility and scalability, it is 360-degree virtual reality that provides the immersive medical education experience. With entertainment, people do not need to watch their favorite movie in VR, whereas in contrast, the immersion of VR delivers a critical element to education. For example, VR creates an authentic operating room environment for those learning new techniques and technologies such as advanced laparoscopy and robotics.

With a multitude of camera angles, including surgeon POV, 360-degree panoramic views of the OR, and digital overlays that highlight the surgical procedure, there has never been a better option to experience an authentic

Continued from page 44 OR environment other than physically being present.

Cedars-Sinai is a recent example of the integration of VR in medical education, becoming the first to offer a CME-accredited virtual reality course called the Essential GI Surgeries. The course offers 25 hours of high-definition, fully-narrated surgical procedures featuring the latest in laparoscopic and robotic techniques performed by Cedars-Sinai’s experts.

Cedars Sinai is ranked No. 3 in Gastroenterology and GI Surgery by the 2018 Best Hospitals edition of U.S. News & World Report, which means that anyone around the globe can now learn directly from some of the best physicians in the US and also earn continuing medical education credits.

As medical procedures continue to grow in complexity and become more technology-driven, the way medical education is shared and delivered must also keep pace. Streaming media and virtual reality are not a preference, but rather the clear evolution of medical education. Surgeons and physicians can learn from the convenience of their homes, digesting more information with improved context that will ultimately help them H provide better patient care. ■ www.hospitalnews.com

BIOMED PRESENTS...

STRESS, RESILIENCE, & HAPPINESS A Seminar for Health Professionals TUITION $109.00 (CANADIAN) Conference registration is from 7:45 AM to 8:15 AM. The conference will begin at 8:30 AM. A lunch break (on your own) will take place from approximately 11:30 AM to 12:20 PM. The course will adjourn at 30 DW ZKLFK WLPH FRXUVH FRPSOHWLRQ FHUWLÂżFDWHV DUH GLVWULEXWHG

Registration: 7:45 AM – 8:30 AM Morning Lecture: 8:30 AM – 10:00 AM • Perception, Thinking, Emotions, and Memory: Where Behavior Originates. • Life-Threatening Events: Why Do They Make Us Afraid, Angry, and Sad? • Happiness: An Emotion or a Mood? • Emotional Intelligence: A Key to Resilience? Social Intelligence? • How To “Sixâ€? Your Way To Happiness: Six Key Virtues and Their Major Strengths. • Acute Stress and Chronic Stress: Three Causes and Three Brain-Body Pathways of Fear. • Why Zebras Don’t Get Ulcers: Stress from Ourselves or the World. • Chronic Stress, Anxiety, and Depression: Negative Emotions and Moods. • Men, Women, and Stress: Sex and Gender Issues. Fight Or Flight Vs. Tend and Befriend. • Fear: Learning and Practicing Skills to Cope with Fear.

Mid-Morning Lecture: 10:00 AM – 11:30 AM • Achieving Tranquility: The Magic of Mindfulness Meditation. • Cognitive-Behavioral Therapy for Stress Management: Change Your Mind, Change Your Body. • Dental Management of Patient Stress: Distractions, Control, and Expectations. • Resilience: Developing the Capacity to Bounce Back from Stress and Trauma. • Practice Makes Perfect: How Resilience Can Get Better Over Time.

• Building Resilience: Learning to Use 10 Key Strategies When Challenged. • One Size Does Not Fit All: The Many Methods of Developing Resilience. • Positive Psychology: The Science of Well-Being, Life Satisfaction, and Happiness.

Lunch: 11:30 AM – 12:20 PM Afternoon Lecture: 12:20 PM – 2:00 PM • The “50-40-10â€? Rule: How Genetics, Personality, and the Environment Create Happiness. • Genes and Happiness: Are We Born Happy or Unhappy? Are There Happiness Genes? • Blissful Ignorance: Do People Really Know What Will Make Them Happy? • What Does Make Us Happy? What the Happiness Research Says. • Choices, Choices, Choices: Does Having More of Them Make Us Happier? • Happiness and Health: Does Greater Life Satisfaction Mean Less Disease and Longer Life?

Mid-Afternoon Lecture: 2:00 PM – 3:20 PM • Learned Optimism: Challenging Negative Thinking, Appreciating Strengths, and Looking Up. • Savoring Pleasure: How Mindful Enjoyment Helps Create Happiness. ‡ 1LQH 6FLHQWL¿FDOO\ 3URYHQ :D\V 7R )HHO 0RUH -R\ ,Q /LIH • Simple Daily Exercises That Help To Increase Life Satisfaction And Well-Being. • Positive Psychology’s Role in Tough Times and Mental Health. Psychotherapies.

Evaluation, Questions, and Answers: 3:20 PM – 3:30 PM

Biomed’s Website: www.biomedglobal.com

MEETING TIMES & LOCATIONS CALGARY, AB

EDMONTON, AB

EDMONTON, AB

CALGARY, AB

Thu., April 11, 2019 8:30 AM to 3:30 PM 7KH *OHQPRUH ,QQ 2720 Glenmore Trail SE Calgary, AB T2C 2E6

Fri., April 12, 2019 8:30 AM to 3:30 PM 5DGLVVRQ +RWHO &RQYHQWLRQ &HQWHU 4520 76th Avenue Northwest Edmonton, AB T6B 0A5

Thu., May 2, 2019 8:30 AM to 3:30 PM 5DGLVVRQ +RWHO &RQYHQWLRQ &HQWHU 4520 76th Avenue Northwest Edmonton, AB T6B 0A5

Fri., May 3, 2019 8:30 AM to 3:30 PM &DUULDJH +RXVH ,QQ 9030 Macleod Trail South Calgary, AB T2H 0M4

INSTRUCTOR

Dr. Michael E. Howard (Ph.D.) is a full-time psychologist-lecturer for INR. Dr. Howard is a boardFHUWLÂżHG FOLQLFDO QHXUR SV\FKRORJLVW DQG KHDOWK SV\FKRORJLVW ZKR LV DQ LQWHUQDWLRQDOO\ UHFRJQL]HG authority on brain-behavior relationships, traumatic brain injury, dementia, stroke, psychiatric disorders, aging, forensic neuro-psychology, and rehabilitation.

During his 30-year career, Dr. Howard has been on the faculty of three medical schools, headed three neuro-psychology departments, and directed treatment programs for individuals with brain injury, dementia, addiction, chronic pain, psychiatric disorders, and other disabilities.

Biomed reserves the right to change instructors without prior notice. Every instructor is either a compensated employee or independent contractor of Biomed.

FEE: CHEQUES: $109.00 (CANADIAN) per person with pre-registration or $134.00 (CANADIAN) at the door if space remains. CREDIT CARDS: Most credit-card charges will be processed in Canadian dollars. Some charges will be in U.S. dollars at the prevailing exchange rate. 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.

ACCREDITATION INFORMATION NURSES (RNs, RPNs, & LPNs)

7KLV SURJUDP LV GHVLJQHG WR SURYLGH QXUVHV ZLWK WKH ODWHVW VFLHQWLÂżF DQG FOLQLFDO LQIRUPDWLRQ DQG 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 accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

ACCREDITATION INFORMATION (cont'd) PHARMACISTS

$OEHUWD OLFHQVHG SKDUPDFLVWV VXFFHVVIXOO\ ÂżQLVKLQJ WKLV FRXUVH ZLOO UHFHLYH VWDWHPHQWV of credit. Biomed is an accredited provider through the American Council on Pharmaceutical Education. The ACPE universal activity number (UAN) is 0212-9999-19-001-L04-P. This is a knowledge-based CPE activity.

DIETITIANS

CPE Biomed, under Provider Number BI001, is a Continuing Professional Education (CPE) Accredited Accredited Provider with the Commission on Dietetic Registration (CDR). Registered Provider 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. This course has Activity Number 128674 and Suggested Learning Codes: 1120, 5460, and 6010. CPE Level: I.

SOCIAL WORKERS 6RFLDO :RUNHUV FRPSOHWLQJ WKLV SURJUDP ZLOO UHFHLYH FRXUVH FRPSOHWLRQ FHUWLÂżFDWHV 7KLV FRXUVH is cosponsored by the Institute for Natural Resources (INR). This program is approved by the National Association of Social Workers (Provider #886502971-1267) for 6 Social Work continuing education contact hours.

PSYCHOLOGISTS

Biomed General is approved by the Canadian Psychological Association to offer continuing education for psychologists. Biomed General maintains responsibility for the program.

REGISTRATION FORM

Please check course date:

Please return form to: Biomed General Box #622 Unit 235, 3545-32 Avenue NE Calgary, AB T1Y 6M6 TOLL-FREE: 1-877-246-6336 TEL: (925) 602-6140 Š FAX: (925) 687-0860

(This registration form may be copied.)

Thu., April 11, 2019 (Calgary, AB) Fri., April 12, 2019 (Edmonton, AB)

Thu., May 2, 2019 (Edmonton, AB) Fri., May 3, 2019 (Calgary, AB)

REGISTRATION INFORMATION

Please print: Name: Profession: Home Address: Professional License #: City: State: Zip: Lic. Exp. Date: Home Phone: ( ) Work Phone: ( ) Employer: E-Mail: QHHGHG IRU FRQÂżUPDWLRQ UHFHLSW

Please enclose full payment with registration form. Check method of payment.

Cheque for $109.00 (CANADIAN) (Make payable to Biomed General) Charge the equivalent of $109.00 (CANADIAN) to my Visa

MasterCard

American ExpressÂŽ

DiscoverÂŽ

Most credit-card charges will be processed in Canadian dollars. Some charges will be in U.S. dollars at the prevailing exchange rate.

Card Number: Signature:

(enter all raised numbers)

Exp. Date:

CVV:

(Card Security Code)

3OHDVH SURYLGH DQ H PDLO DGGUHVV DERYH WR UHFHLYH D FRQÂżUPDWLRQ DQG GLUHFWLRQV WR WKH PHHWLQJ VLWH

Š Biomed, 2019, CODE: SRH-C1000-HospitalNews

For all inquiries, please contact customer service at 1-877-246-6336 or (925) 602-6140.

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. A $15.00 fee ZLOO EH FKDUJHG IRU WKH LVVXDQFH RI D GXSOLFDWH FHUWLÂżFDWH )HHV DUH subject change without notice. The rate of exchange used will be the one prevailing at the time of the transaction.

PROFESSIONAL DEVELOPMENT AND EDUCATION

Professional development in food and nutrition in long-term care

By Dale Mayerson and Karen Thompson rofessional development is a process for increasing capabilities and improving confidence. This may focus on enhancing knowledge and competencies, or more generally on improving effectiveness.

Continuing competence is an expectation for registered health professionals (Regulated Health Professions Act, 1991 (RHPA)) such as Registered Dietitians, and should be encouraged and supported for other healthcare professionals working in Food and Nutrition services in LTC, such as Nutrition Managers. Both Cooks and Food Service Workers in LTC require mandatory education in order to be hired, and they also benefit from continuing to learn and keeping up with changes and trends in food services and in LTC. All levels of staff should promote an attitude of client-centred care, a commitment to continuing education and a desire to enhance personal knowledge, skills and judgement. This will benefit the individuals, the organization and the residents.

Professional development can be accomplished through access to education and training opportunities in and outside the workplace. The education may lead to enhanced credentials or certification, or may address specific areas of knowledge or skills. It may come from developing a relationship with a mentor or by simply watching or learning from others performing their work. Professional development is not limited to these more traditional choices and may include other options e.g. networking via social media or creating or contributing to a blog or website.

For dietitians, regardless of where they work, there is a philosophy of lifelong learning. Recent developments and research continue to amass new and changing information that dietitians are expected to understand.

These are only a few examples:

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• GMO foods – genetically modified organisms/foods • Gut microbiome • FODMAPs – fermentable oligo-, di-, mono-saccharides and polyols • Vegan, whole food and plant based eating • Nutrigenomics • Ketogenic diet • Alcohol • Vitamin D • Coconut oil Specifically in LTC, dietitians and others in food services are becoming proficient in the International Dysphagia Diet Standardisation Initiative; this includes the newly defined food textures and fluid consistencies that will be put into place across the globe in 2019/2020 (See www.IDDSI.org for more information.) Other research, taking place in Canada, is changing how LTC residents are provided with food and meal service, with special emphasis on residents with cognitive impairments that face challenges in eating an adequate healthy diet.

PROFESSIONAL SKILL DEVELOPMENT Professional organizations are a reliable resource for education, conferences and workshops on current, relevant topics and issues for professional development. For food service professionals in LTC in Ontario, these include: • College of Dietitians of Ontario (www.collegeofdietitians.org) • Dietitians of Canada (www.dietitians.ca) • Canadian Society of Nutrition Management (http://csnm.in1touch.org/) • Ontario Society of Nutrition Management (www.osnm.org) • AdvantAge Ontario (http://advantageontario.ca/) • Ontario Long Term Care Homes Association (www.oltca.com) • Local Public Health Departments (e.g. www.toronto.ca/food-safety)

• Restaurants Canada (formerly CRFA) (www.restaurantscanada.org) Keeping up with healthcare developments on a consistent basis can be challenging, but the internet is an excellent source of free information.

These are just a few examples that can be followed online or with apps.

There are free short courses, through organizations such as: • Advancing In (www.advancingin.com) • Prime (www.primeinc.org) Free articles and videos at: • Medscape (www.medscape.com) and • Medical News Today (www.medicalnewstoday.com) • New England Journal of Medicine (www.nejm.org) monthly table of contents with free articles For food service professionals, there are healthcare related videos and articles through food companies. These are just a few examples: • Nestle (https://www.nestlenutritioninstitute.org/) • Becel (https://secure.becel.ca/en/ healthcareprofessionals/).

• Abbott Nutrition Health Institute (https://abbottnutrition.com/continuing-education) There are many associations that have information relating to specific health conditions. The information is usually very reliable and credible and many sites have sections for healthcare professionals as well. Examples of these websites relevant to nutrition in LTC include: Diabetes Canada, Heart and Stroke Foundation of Canada, Osteoporosis Canada, Hypertension Canada, Alzheimer’s Society, Parkinson Canada and many more.

Relevant food service and nutrition information may also be found through various websites for food commodities.

Chicken Farmers of Canada, Pulse Canada, Egg Farmers of Canada, Dairy Farmers of Canada, Canadian Wheat Board and Beef Information Centre

are just some of the organizations that have available Canadian resources. A quick Google search will quickly identify many valuable sources.

PERSONAL AND INTERPERSONAL SKILLS Personal skills are an important part of success in the workplace and can be relevant in many roles. Personal development is part of professional development and is a lifelong process.

It is a way for people to assess their skills and qualities, consider their aims in life and set goals in order to realize and maximize their potential. Planning to make relevant, positive and effective life choices and decisions for the future requires considerable self-reflection and enables personal empowerment Communication and interpersonal skills can include listening, speaking and writing, as well as analytics and research. There are many examples of problems and situations that occur in LTC homes due to poor communication and lack of teamwork. They are highlighted in the Ministry of Health and LTC annual Resident Quality Inspection reports that are available at http://publicreporting.ltchomes.net/ for every LTC home in Ontario.

CONCLUSION From an organizational perspective, professional development helps to build and maintain the morale of staff members and is thought to attract and retain higher quality staff to an organization. Those who work in LTC should strive to make a difference each day by pursuing knowledge to continually improve in their work. In today’s world, information is available and readily accessible through the internet, making it easy for organizations and/or individuals to develop stronger, more knowledgeable Food and NutriH tion Departments. ■

Dale Mayerson, B Sc, RD, CDE, and Karen Thompson, B A Sc, RD are Registered Dietitians with extensive experience in Long-term care. They are co-authors of “Menu Planning in Long Term Care and Retirement Homes: A Comprehensive Guide” and have participated for many years on the Ontario Long Term Care Action Group, an advocacy group of Dietitians in Canada.

48 HOSPITAL NEWS JANUARY 2019

www.hospitalnews.com

NEWS

Choosing Wisely Canada: Diving into overuse in hospitals

By Tai Huynh his month, Choosing Wisely Canada, the national voice for reducing tests and treatments in healthcare, is launching a new campaign, Diving into Overuse in Hospitals. The goal of the campaign is to get hospitals across Canada to join the global Choosing Wisely movement by making changes, small or large, to reduce overuse. Participating hospitals get access to a wealth of resources, including a starter kit, webinars and other supports. Hospitals interested in being part of this, but are not sure if they have an overuse problem are encouraged to ask themselves the five basic questions below. A ‘yes’ answer to any of the questions means your hospital has an overuse problem. Even if the answers are ‘no’ across the board, the starter kit suggests ways hospitals can do a deeper dive to uncover other signs of overuse and what to do about it. The campaign hopes to mobilize and empower hospital staff to pause, question long-standing practices and take leadership on reducing overuse, avoiding potential harm to patients and freeing up precious hospital resources for more important uses.

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OVERUSE IN MY HOSPITAL: FIVE QUESTIONS TO ASK 1. Does my emergency department order both PT/INR and aPTT tests as a bundle?

2. Does my hospital still use CK testing to diagnose a heart attack?

3. Are inpatients at my hospital getting daily blood tests automatically?

4. Does my hospital still test serum & red blood cell folate levels?

5. Does my ICU still order routine x-rays for all patients?

Unnecessary testing and treatment is a pervasive problem in healthcare.

It is present virtually every hospital, department and clinic, irrespective of

EXAMPLES OF HOSPITAL SYSTEMS AND PROCESSES THAT CAN DRIVE OVERUSE INCLUDE: ORDER SETS, MEDICAL DIRECTIVES, LAB ORDER PANELS AND COMPUTERIZED ORDER ENTRY SYSTEMS, AMONG OTHERS. size or how diligent the clinicians are who work there. A 2017 report from the Canadian Institute for Health Information showed that in many clinical areas, up to 30 per cent of tests and treatments are potentially unnec-

essary. Take preoperative tests before low-risk surgery (such as endoscopy and cataract removal) as an example. Evidence shows that these types of tests do little to improve care, and the results can distress patients and waste

resources. Yet, the report showed that in Ontario, Saskatchewan and Alberta, 18 per cent to 35 per cent of patients who had a low-risk procedure had a preoperative test.

While clinicians ultimately make decisions about which tests and treatments to order based on the assessment of an individual patient, many of these decisions can often be influenced by hospital systems and processes that, if outdated or poorly designed, can nudge clinicians toward ordering tests and treatments that do not reflect evidence-based guidelines and practices. This can expose patients to avoidable harm, lengthen wait times, and consume precious hospital resources.

Examples of hospital systems and processes that can drive overuse include: order sets, medical directives, lab order panels and computerized order entry systems, among others.

Uncovering and refining systems and processes that are out of date or not evidence-based is one of the most effective ways to curb overuse within the hospital environment. There are many examples of this in lab testing, such as PT/INR and aPTT ordering.

This is one of the targets of the Diving into Overuse in Hospitals campaign. PT/INR (prothrombin time/ international normalized ratio) and aPTT (activated partial thromboplastin time) were tests developed in the early 20th century for specific and unique indications. Despite this, they are often ordered together routinely in emergency departments. PT/INR and aPTT are often unknowingly ordered together because most blood work in the emergency department is based on lab order panels that are outdated, often coupling PT/INR and aPTT tests as a bundle despite the fact that they are rarely required together. In some hospitals, laboratory software may also automatically run both tests even if only one was ordered.

Continued on page 60

www.hospitalnews.com

JANUARY 2019 HOSPITAL NEWS 49

DOCTORS WITHOUT BORDERS

A MSF doctor is taking her time to listen to a patient in the main ward of the MSF clinic in Mellut, South Sudan.

Copyright: Matthias Steinbach

Doctors Without Borders: Meaningful work that fosters leadership

By Claudia Blume ach year, Doctors Without Borders/Médecins Sans Frontières (MSF) sends more than 3,600 international staff to join more than 40,000 locally hired staff to provide medical aid in more than 70 countries in the world. From Canada, we sent 378 people to the field last year, more than half of them with a medical background.

MSF Canada recruiter Maher Najari explains what kind of professionals the organization is looking for, what

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professional development opportunities MSF offers and whether humanitarian work can be a long-term career option.

What kind of medical and non-medical professionals is MSF looking for?

We are always looking for physicians with specializations such as emergency doctors, pediatricians, psychiatrists, gynecologists, obstetricians, surgeons, infectious disease specialists, anesthe-

siologists and internal medicine doctors. Experience in areas such as HIV/ AIDS, TB, maternal health, nutrition and tropical medicine is an asset.

Nurses play a critical role in the delivery of medical aid in our programs.

Nurses with a broad range of experience are very sought-after, as well as nurses with specializations such as neonatal nurses, pediatric nurses, OR and ER nurses. We also need pharmacists, epidemiologists, midwives and mental health specialists.

People who work in the non medical fields within hospitals – such as administrators, human resources professionals and accountants – are also sought after by MSF. I worked as an analyst for an HR management consultant firm in Canada, for example, before becoming an HR coordinator for MSF projects in Iraq, Turkey and Niger.

Generally speaking, having work experience in remote, rural areas is a strong asset, as it’s similar to the con-

Claudia Blume is a Press officer, Doctors Without Borders/ Médecins Sans Frontières Canada.

50 HOSPITAL NEWS JANUARY 2019

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DOCTORS WITHOUT BORDERS

(MSF) SENDS MORE THAN 3,600 INTERNATIONAL STAFF TO JOIN MORE THAN 40,000 LOCALLY HIRED STAFF TO PROVIDE MEDICAL AID IN MORE THAN 70 COUNTRIES IN THE WORLD.

ditions our staff finds in many of the areas we work in. Speaking French, even at intermediate level, is a huge plus for anybody interested in working with us.

Fluency in other languages, such as Arabic, can also lead to a more successful application and more opportunities for placement.

departing and upon return to Canada, coverage of required vaccinations and related medical fees, accommodation and transportation, a comprehensive insurance package and medical and professional indemnity. We also believe strongly in investing into the professional development of field workers.

Does MSF accept international medical graduates?

International work experience, especially in low-resource settings, can be a real asset. We accept applications from Canadian permanent residents and citizens who are international medical graduates without Canadian credentials. In addition to the essential prerequisites that all physicians must meet, there are other requirements.

They include belonging to a medical association, having a valid medical licence and having practised medicine within the last two years. For more information people should consult our FAQ for international medical graduates on our website.

Can working for MSF be a longterm career option for Canadian health professionals?

We are actively looking for people who want to commit to a long-term career with MSF. Every fieldworker is assigned a career manager who briefs them before they go on an assignment, follows up with them while they are overseas and debriefs them after they come back. Career managers will discuss performance evaluations, a fieldworker’s interests and goals within MSF and offer training when possible.

Each of MSF’s operational centers in Europe has a learning unit that offers training programmes for field workers.

We also have a mentoring programme in which more experienced staff support their newer colleagues.

How long is a typical overseas assignment with MSF and what does MSF offer in terms of compensation?

The length of the first assignment is typically six to 12 months, depending on the needs in the field and the profile of the applicant. Certain medical profiles such as OBGYNs, anesthesiologists and surgeons are typically sent on assignments that last six to 12 weeks.

Working in the field with MSF is not a volunteer position, but it does require a spirit of volunteerism and our salary reflects this. During a first assignment, everyone receives the same salary for their first 12 months of fieldwork, regardless of their position.

The gross monthly salary is $2426 per month and we also offer pre-departure training, psychological support before www.hospitalnews.com

What professional development options do you offer to health professionals?

MSF offers a number of technical trainings for all of its staff, for example on HIV/AIDS, malaria or TB, that can be accessed online or face to face.

Most of the time, international health professionals will manage teams of national colleagues, so the main focus of our support and training opportunities is in the area of management and leadership.

There are many opportunities for professional growth and for taking on an increasing level of responsibility.

We need leaders within MSF! I met a nurse who was promoted to medical

team leader in a project and later became the medical coordinator, who is based in the capital. The medical coordinator is the highest level of responsibility for MSF’s medical activities in a whole country or region! She is now the medical referent at headquarters in Barcelona, overseeing the medical activities in many different projects around the world.

What kind of technical support do fieldworkers get when they work in the field?

We have medical protocols and guidelines, of course, and for specific questions they can talk to the medical team leader in the project, or the medical coordinator in the capital. We also have a telemedicine project that connects teams in the field with medical specialists around the globe. One of our biggest resources are our national colleagues, who can provide international staff with more background and context to cases they are seeing.

What kind of new skills can health professionals gain while working for MSF, and how beneficial is the overseas experience for their work back in Canada?

One of the main skills our staff gain overseas is leadership – how to manage a culturally diverse team, in challenging conditions with a high work load in – mostly – low-resource settings.

All these soft skills – managing stress, teamwork, flexibility, leadership – are not something you can learn about it in a book.

In my own experience and having spoken to many returned health professionals I hear a common refrain… working with MSF is among the most meaningful experiences on both a personal and professional level that they have ever done.

To find out more about working for Doctors Without Borders/Médecins Sans Frontières and how the recruitment process works, please go to our website. ■ H

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Manny Johar is Ontario’s mortgage SUPERSTAR! JANUARY 2019 HOSPITAL NEWS 51

ETHICS

Considering ethics in human resources

By Andria Bianchi

n most mid-to-large sized healthcare organizations and all Canadian academically-affiliated hospitals, anyone (i.e., patients, families, volunteers, clinicians, and staff) can contact an ethicist to obtain an additional, more impartial perspective on ethically complex matters that are relevant to their experiences. Human Resources (HR) is one area that may encounter ethically significant dilemmas that can have significant effects on individuals, teams, and entire organizations.

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ONE OF THE MOST COMPLEX AND ETHICALLY CONTENTIOUS TOPICS IN HR CONCERNS THAT OF HIRING PRACTICES AND STAFF SELECTION. In their 2001 review of ethical issues in HR systems, Buckley et al. say that “there are a number of issues in the design and implementation of human resources systems that have ethical implications, which may or may not be handled well.” Some of the topics and questions with ethical implications in which HR may be a key stakeholder are: compensation decisions (e.g. how can we ensure that the most deserving employees are granted adequate compensation increases if this is an HR goal?); performance appraisal processes (e.g. what should we do to mitigate the subjective and/or political nature of performance appraisals?); organizational reward systems (e.g. should we reward people based on the outcomes they achieve or based on the means that they use to achieve certain out-

comes?); managing and mitigating workplace bullying (e.g. how can we ensure that our policies apply equally to frontline staff and organizational leaders?); and staffing selection processes (e.g. is there a way to mitigate potential biases when hiring staff? Is it ever defensible to overlook applicants if their CV contains a gap?).

In Ontario (which is the context that I am familiar with), the Ontario Human Rights Commission (OHRC) offers guidance that may help to resolve some of the ethical dilemmas that organizations, and specifically HR systems, encounter. There are equivalent Human Rights Commissions across Canada. One area in which the OHRC provides guidance is around interviewing and making hiring decisions. They suggest that an employer should “aim for a fair process that focuses on each candidate’s ability to perform the essential job duties.”

As noted above, one of the most complex and ethically contentious topics in HR concerns that of hiring practices and staff selection. As stated by the OHRC, a fair process ought to be maintained when a person is being hired for a position. In order to ensure that a fair process is followed, they suggest that it should “be uniform, consistent, transparent, fair, unbiased, comprehensive and objective.” Certain steps can be taken in order to achieve these aims, such as: (1) ensuring that candidates are only asked specific job-related questions during an interview rather than questions about personal values or beliefs and/or (2) not prioritizing people to receive employment opportunities for reasons that are irrelevant and/or unduly detrimental to others (e.g. hiring a less-than-ideal employee for a new position because of an internal relationship).

From an ethics perspective, I often pause when I read words such as “unbiased” and “objective” since there is reason to believe that it may be impossible to make decisions (e.g. hiring decisions) in a completely unbiased and/or objective way. (A more challenging issue is that we don’t all agree about what objectivity consists of, but this is a point best set aside for a more philosophically-focused discussion.) Although members of a selection committee may not have any explicit biases that would obviously influence hiring decisions, it is almost certainly the case that everyone will have implicit or subconscious biases (i.e., biases that they are unaware of) and subjective values, preferences, and beliefs.

There is an existing body of literature on implicit biases. This literature often refers to the implicit bias test (IAT), which is a widespread test Continued on page 53

Andria Bianchi, PhD, is a Bioethicist at the University Health Network and a board member of the Canadian Bioethics Society.

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EVIDENCE MATTERS Continued from page 52 that is meant to determine a person’s implicit biases. As described by legal scholars Christine Jolls and Cass R. Sunstein, the tests have shown that traditionally disadvantaged groups are those with whom people tend to unknowingly hold certain biases against (even from members of the groups themselves!). Although some recent literature seems to suggest that implicit biases do not, in fact, influence human behaviour, the biases still exist; whether they do and/or how much they may influence human behaviour when it comes to making decisions (such as, say, hiring practices), is still up for debate.

In order to enable ethical decision-making for hiring processes, it is important to try to mitigate potential biases and remain as objective as possible. However, I think it is equally important to be transparent in noting that an unbiased and completely objective process is probably impossible.

In order to strive for less bias and more objectivity, it may be important to ensure that hiring committees are diverse and represent people who identify as members of different personal and professional groups. This will not eliminate bias and subjectivity, of course (specifically since each individual will bring their own subjective lens to the process), but it may at least encourage different perspectives and voices to be heard. Also, employing affirmative action/positive discrimination policies may help to mitigate waning conceptions of the kinds of people who should be employed for particular roles. Furthermore, it may be apt for all members of a hiring committee to reflect upon their own values, beliefs, preferences and potential biases in advance of a hiring process; this may inspire individuals to bring a more thoughtful approach to the staff selection process and encourage us to question what may be lost if we continue to hire similar people when roles open up.

Ultimately, the decisions that are made within an HR system will often, if not always, have an underlying ethical foundation, and they will not be entirely unbiased or objective.

Exploring the ethics of decision-making processes and consulting with an ethicist may prove to be illuminating when considering ethically defensible H organizational decisions. ■ www.hospitalnews.com

Hyperbaric oxygen therapy for chronic pain: A breath of new life for an old technology?

By Barbara Greenwood Dufour any people with chronic pain struggle to find treatment options that give sufficient relief. Over-thecounter pain relievers are often not effective enough, and opioids don’t tend to be very effective for the long term and carry significant safety risks.

Often, patients have to use a variety of different methods to cope with their pain, and there is a growing interest in incorporating non-drug therapies into this approach. Hyperbaric oxygen therapy (HBOT) is one non-drug treatment that has been proposed for helping manage chronic pain.

The descriptions of HBOT that are provided by some clinics make it sound like a modern spa treatment – you breathe fresh air while napping in a tube-shaped chamber and wake up feeling rejuvenated. But HBOT has been around since the 1600s and used for nearly a hundred years to treat decompression sickness caused by deep-sea diving accidents. Over the decades, it’s been shown to be effective for treating many other injuries and conditions, including diabetic ulcers, bone infections, acute thermal burns, carbon monoxide poisoning, flesh-eating disease, and severe anemia.

To receive HBOT, patients enter a sealed chamber. Once inside, the atmospheric pressure is increased to three times the normal air pressure, and the air is 100 per cent oxygen (air is typically about 21 per cent oxygen).

The chamber can be a single-person tube that a patient lies down in, or it can be a hospital room-sized chamber that can accommodate several patients, typically seated. In the case of a multi-patient chamber, the oxygen is delivered through a hood or mask.

The combination of pure oxygen and high atmospheric pressure allows patients’ lungs to take in more oxygen

M

than usual. The bloodstream then delivers the oxygen to tissues throughout the body, which fights infection and promotes healing.

In addition to the established indications for which HBOT has been shown to be effective, some clinics offer the therapy as an “investigational” treatment for other conditions, including those involving chronic pain – such as fibromyalgia, headaches, and complex regional pain syndrome.

HBOT would be a welcome addition to the chronic pain management toolkit if it is clinically effective. So what does the evidence say?

CADTH – an independent agency that finds, assesses, and summarizes the research on drugs and medical devices – was recently asked to look for the evidence on HBOT for the treatment of chronic pain in adults. To produce its Rapid Response Report on this topic (see Hyperbaric Oxygen Therapy for the Treatment of Chronic Pain: A Review of Clinical Effectiveness and Cost-Effectiveness), CADTH searched for the relevant research that’s currently available, finding one randomized controlled trial (RCT) and one prospective non-randomized study.

The RCT enrolled 60 female patients with fibromyalgia – a condition that causes chronic widespread pain throughout the body – who were provided HBOT each day for five days per week over two months. The study found that the treatment increased pain thresholds, physical function, and health-related quality of life, while decreasing tender points and psychological distress. Single photon emission computed tomography (SPECT) imaging of the participants’ brains after treatment showed that the areas where abnormal activity is typically seen in fibromyalgia patients had undergone beneficial changes.

The prospective non-randomized study enrolled 30 patients diagnosed with myofascial pain syndrome – a chronic pain disorder that affects the muscles or their connective tissues – who were administered HBOT for five days per week over two weeks. The treatment increased pain thresholds and health-related quality of life and decreased disability, effects that were found to be sustained at the threemonth point.

HBOT might not necessarily feel like a day at the spa, but it appears to be relatively safe. The RCT assessed adverse events associated with the treatment and, of the 60 patients in the study, 13 experienced mild and temporary barotrauma related to the change in air pressure. This was most likely pain or discomfort in the ears, and it didn’t prevent the patients from continuing with the treatments. Five dropped out of the study because of ear pressure issues, dizziness, or claustrophobia (it’s unclear what type of chamber was used in the study, but claustrophobia might be less of an issue in a room-sized chamber).

Although the research suggests that HBOT could benefit patients with fibromyalgia and myofascial pain syndrome, the evidence comes only from these two small studies. And since the studies were short in duration, we don’t know if HBOT would be effective over a longer time frame. The use of an old technology to treat a condition that seems recently to be on the increase is intriguing; and HBOT for these and, potentially, other types of chronic pain appears promising. More studies, however, are needed to confirm the results of the research conducted to date.

To learn more about CADTH, visit www.cadth.ca, follow us on Twitter: @ CADTH_ACMTS, or talk to our Liaison Officer in your region: www.cadth.

H ca/contact-us/liaison-officers. ■

Barbara Greenwood Dufour is a Knowledge Mobilization Officer at CADTH. JANUARY 2019 HOSPITAL NEWS 53

LONG-TERM CARE NEWS

CABHI-supported

app integrates serious gaming into geriatric education

By Rebecca Ihilchik cross Canada, nearly 33 per cent of frail elderly admitted to hospital from long-term care are admitted unnecessarily. Point-of-care staff including nurses and personal support workers must be more skilled than ever before in observing and responding to early, subtle signs of acute deterioration.

The SOS Educational App for Healthcare aims to strengthen geriatric specialty knowledge for these healthcare providers in order to prevent unnecessary emergency room visits.

A

The unique app, which can be accessed on one’s smartphone or computer, presents simulated case scenarios involving elderly clients to users in a multiple choice game format. Users – who range from working professionals to students – must assess these virtual clients based on the symptoms provided. The program enables users to monitor their learning outcomes and to tailor future learning to address identified performance gaps.

The technology is supported by the Baycrest-led Centre for Aging + Brain

Helping people live with independence, dignity and in comfort since 1925.

• Nursing • Physio and other therapies • Personal care and support • Homemaking

Also specializing in:

• Palliative support needs • Dementia care • Respite • Wound care

54 HOSPITAL NEWS JANUARY 2019

www.vha.ca 1.888.314.6622

THE SOS EDUCATIONAL APP FOR HEALTHCARE AIMS TO STRENGTHEN GERIATRIC SPECIALTY KNOWLEDGE FOR THESE HEALTHCARE PROVIDERS IN ORDER TO PREVENT UNNECESSARY EMERGENCY ROOM VISITS. Health Innovation (CABHI). The SOS app team is led by manager Dr. Raquel Meyer and interprofessional educator Jennifer Reguindin of Ontario’s Centres for Learning, Research & Innovation in Long-Term Care (CLRI) at Baycrest.

In 2018 the app won the prestigious Ted Freedman Award for Innovation in Education, a major international recognition.

“We took what students usually learn in a didactic manner and practice only in stressful situations, and turned it into an opportunity to compete and collaborate amongst themselves,” says Reguindin.

The app can be played at any time, meaning the educational component isn’t limited to time spent in the classroom or placement. It also provides instant feedback to the user.

“If you get a case wrong, the app gives you a reflective prompt. It teaches you clinical decision-making skills so that when you go back, you have a better understanding of the questions you should have asked,” says Dr. Meyer.

“During the testing period, the students and players were amazed that they were learning and improving,” says Reguindin. “Their level of awareness in how they engage and communicate in clinical settings increased and their instructors were noting the difference.”

Because the app is so accessible, it can help supplement specialized

knowledge for students or professionals who are not exposed to diverse groups of patients and cases – for example, those practicing outside of a central urban region.

“Clinical placements are getter scarcer, and alternative solutions like the SOS app are part of an upward trend toward integrating technology into clinical education,” says Dr. Meyer. “Given the extent to which this next generation of students is involved in gaming and is engaged in virtual spaces like social media, I think it’s wise for educators to think of how to tap into that and draw these students in.”

The app is supported by CABHI’s Spark program, which funds the development or refinement of early-stage innovations informed by the experience of point-of-care staff. Through Spark, CABHI is helping the SOS team refine the app from a beta version into a commercially viable product. They’re looking into packaging the SOS educational app into a suite of products to market to nursing and long-term care homes. They also plan to work with colleges and universities to explore how the app could function as a learning material in gerontology courses.

“I’m not sure that without CABHI’s support we would have gotten to the stage of having an actual business model and go-to-market strategy, so we’re incredibly grateful,” Dr. Meyer www.hospitalnews.com

LONG-TERM CARE NEWS RIGHT: Jennifer Reguindin and Dr. Raquel Meyer, SOS App innovators.

says. “CABHI brings a lot of expertise to the table in helping healthcare providers navigate this very different space and connecting us with the right resources.”

Integrating this crucial piece of education into an engaging, accessible platform across care homes and higher education means current and future point-of-care staff will be able to keep their knowledge up-to-date more easily than ever before. They’ll be better equipped to detect and respond to early signs of acute deterioration in the older adults they care for, and avoid preventable emergency room visits – resulting in a safer, healthier older adult population and a more efficient healthcare system.

“We know the app has potential not just for care of the elderly or in

long-term care, but for any clinical population: pediatrics, oncology, diabetes,” says Dr. Meyer. “We just think

there’s huge potential for one small innovation to have a large impact on the sector.”

Rebecca Ihilchik is the Marketing & Communications Specialist at the Centre for Aging + Brain Health Innovation.

Learn more at www.cabhi.com. The SOS App can be accessed and played H at http://sosapp.baycrest.org. ■

LONG-TERM CARE NEWS

The two-day Communications at the End of Life Train-theTrainer Workshop is available to long-term care (LTC) homes in Ontario.

Training workshop on communications

at the end of life available to long-term care homes

By Stephen Smith

M

aya Angelou the poet once says “I’ve learned that people will forget what you says, people will forget what you did, but people will never forget how you made them feel.”

Maggie’s grandmother was always the life of the party and this was evident in how she chose to die. She waited until all of her children and grandchildren were gathered around and in a moment of laughter that spread throughout the room, she drew her last breath. Tears were shed, but the laughter lent lightness to the situation and served as a reminder that Maggie’s 56 HOSPITAL NEWS JANUARY 2019

grandmother had died on her own terms, in a way that reflected her life.

How people perceive end-of-life care is greatly influenced by the language and attitudes that surround the subject.

Maggie is one of the instructors who teaches the two-day Communications at the End of Life Train-the-Trainer Workshop available to long-term care (LTC) homes in Ontario. The workshop – tailored to the needs of the LTC environment – prepares participants to strengthen personal support worker’s healthy attitudes towards end-of-life and communication skills in their own LTC homes.

UNDERSTANDING LIVING, DYING, AND DEATH WITHIN HOSPICE PALLIATIVE CARE Common perceptions of hospice palliative care often revolve around the person being close to death or actively dying. In reality, hospice palliative care extends beyond the scope of dying. It offers services to address physical, psychological, social, spiritual and practical needs, and provides support for loss and bereavement while also preparing for the dying process.

One workshop component tasks participants to reflect upon their feel-

ings and experiences on the difficult topics of death and loss. This exercise helps participants empathize with what a resident or their family or friends might be experiencing. “We often use words and phrases that seem softer and kinder,” a workshop instructor noted.

“But in doing so, are we not avoiding talking about the elephant in the room?” Participants are encouraged to use more direct language to help foster clarity and understanding for residents and their visitors. With this in mind, participants are shown exercises that they can teach to personal support workers to identify signs and maniwww.hospitalnews.com

LONG-TERM CARE NEWS

ARMED WITH AWARENESS OF SELF AND OTHERS, TRAINERS TACKLE THE QUESTION OF HOW TO HELP SOMEONE WHO IS DYING OR GRIEVING – THE ANSWER CAN BE SURPRISING. festations of grief. This is essential to understand the internal and external symptoms of grief and mourning.

FIXING ISSUES WITHOUT SOLUTIONS Armed with awareness of self and others, trainers tackle the question of how to help someone who is dying or grieving – the answer can be surprising. One participant says, “We often want to fix things – we want to give answers. But if we take a moment to sit and listen, understand where they are at, we can make the greatest difference.” While the initial response to someone in distress might be to react and help in whatever way possible, those who are grieving sometimes need an empathetic presence – someone who can be there, understand, and listen.

Long-term care professionals have the honour to engage in therapeutic relationships with individuals who are dying and their loved ones. This is often a time of reflection, where complex family dynamics can arise, increasing the need for a high level of clinical and bedside skills.

In order to be fully present for people who are grieving during the dying process and upon death, effective communication skills are critical. It is important to acknowledge that there is grief leading up to, and after death has occurred. Participants take home teaching techniques to strengthen four communication skills to foster therapeutic relationships: listening, paraphrasing, reflecting, and summarizing. One technique that partic-

Stephen Smith is a Communications Assistant at Bruyère Research Institute.

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Support is just a phone call away.

ipants found particularly useful was pairing personal support workers to practice these skills and provide constructive feedback to one another.

At first glance, communication skills might seem simple, but in a therapeutic relationship, everyone needs practice and support to develop these skills over time to use them effectively.

WHY HOSPICE PALLIATIVE CARE? Hospice palliative care is strongly informed by a philosophy, value, and care practice that believes all people matter. As a result, many Ontario long-term homes have embraced the hospice palliative care approach. Being comfortable talking about death and dying is critical for team members working in LTC. These communication skills support residents and their family members along the journey and as one participant stated, “We’re looking at comfort. It’s symptom management, it’s not just about physical pain. We talk about all aspects of pain – spiritual pain, H emotional pain.” ■

Communication at End-of-Life Train-the-Trainer Workshops gather long-term care (LTC) team members who train or coach personal support workers.

The Ontario Centre for Learning, Research and Innovation in Longterm Care (CLRI) at Bruyère and Algonquin College collaborated to develop the training material. The bilingual facilitators’ guide and four modules are available on the Ontario CLRI website.

By focusing on the psychosocial, spiritual, and communication aspects of end-of-life care, these tools complement the various training opportunities available to long-term care home teams, such as Pallium Canada’s LEAP program and courses offered by educational institutions.

In the fall of 2018, almost 100 Ontario long-term care homes participated in the training. This work is partially funded by the Ontario Ministry of Health and LongTerm Care, through the Ontario CLRI at Bruyère.

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1.877.289.3997 clientservice@bayshore.ca www.hospitalnews.com

JANUARY 2019 HOSPITAL NEWS 57

LONG-TERM CARE NEWS

Nutrition and dementia in long term care

By Dale Mayerson and Karen Thompson ccording to the Alzheimer’s Society of Canada, 564,000 Canadians are currently living with dementia and the number is expected to rise to 937,000 by 2030.

Dementia can affect the senses and disrupt all of a person’s usual thoughts and activities. Providing meals to residents with dementia presents a number of challenges that staff need to learn to recognize and to overcome.

Alzheimer’s Disease is the most prevalent type of dementia, but there are others as well. Vascular dementia can be caused by blockage or damage to the brain’s blood supply; this could be the result of stroke or diabetes.

Frontotemporal dementia can affect specific lobes of the brain that are associated with personality and behaviour.

Lewy-body dementia interrupts the brain’s message system and can affect thinking and movement. It is also possible to have several dementias presenting in an individual.

The disabilities of the individual vary with the degree of dementia, but the Alzheimers’ Society has summarized the disabilities as the seven As of Dementia: • Anosognosia – don’t recognize disability • Agnosia – no longer recognize senses • Aphasia – can’t speak or understand • Apraxia – no purposeful movement • Altered perception – no message from senses • Amnesia – loss of memory • Apathy – no drive or initiative

the colours and art used in the living environment can improve a resident’s ability to cope or it may make it worse.

The manner in which staff approaches residents with dementia can significantly affect residents’ behaviours and their day to day activities. New approaches from around the world are being considered and tried, such as the recent Butterfly Household Model of Care that originated in England.

A

DEMENTIA IN LONG-TERM CARE According to the Canadian Institute of Health Information (CIHI), in long-term care homes, 69 per cent of residents had dementia in 2015–2016.

92 per cent of residents with dementia required extensive assistance or are dependent for activities of daily living; 50 per cent of residents with dementia 58 HOSPITAL NEWS JANUARY 2019

CHALLENGES WITH FOOD INTAKE

had responsive behaviours due to the inability to communicate. 31 per cent had signs of depression and 40 per cent had severe cognitive impairment.

Activities of daily living include being able to groom, dress, bathe and feed oneself.

Staff provides a significant amount of assistance and supervision to support residents with dementia in their daily lives according to the needs of each individual. Residents with dementia may become easily frustrated by their inability to communicate, to find their way or to complete the ac-

tivities of daily living. Some homes have “locked” units that may have an increased staffing level and provide a more secure environment.

Long-term care homes generally have programing that helps staff to successfully interact with residents who have dementia, including those who may be aggressive with other residents and/or staff. These programs are developed in concert with residents, families and experts such as staff from Behaviour Supports Ontario and the Alzheimer’s Society. The physical layout of a long-term care home, and

Residents with dementia may have multiple challenges with eating. They may not recognize food when it is served or they may not remember how to feed themselves. Swallowing may be affected and residents may require careful staff assistance with eating.

Residents may be unable to sit for any period of time to eat their meals course by course, and may manage better by receiving all their courses together.

Homes may offer “finger foods” that allow residents to eat meals and snacks while wandering or pacing. Food intake is often less than ideal and fortified food items may be helpful to boost intake. As well, high protein snacks or liquid nutritional supplements may be offered to provide extra protein and other nutrients.

Home staff focuses on retained abilities, ensuring that residents eat as independently as they are able, perhaps with staff encouragement and cueing. Assistive eating utensils are available that support independence for those with specific eating issues.

Allowing residents with dementia to make food choices may encourage better food intake. Offering smaller, more frequent portions of food is another strategy that successfully increases the amount of food eaten for some individuals. Some research has shown that serving meals on brightly coloured plates also encourages residents to eat more. Further, ofwww.hospitalnews.com

LONG-TERM CARE NEWS

fering favourite foods at the time of day when a resident eats the best is another way to encourage optimum intake. This could be discussed with family who know the resident’s history and eating habits the best.

DIET AND DEMENTIA In most cases, the goal for residents with dementia is to liberalize the diet which means reducing unnecessary food restrictions in an effort to maximize quality of life. This has the benefit of increasing the variety of food available at meals and snacks, which may therefore result in an increased nutrient intake. Since most residents have more than one medical diagnosis, careful consideration is required in determining dietary needs. For example, a resident with dementia can also have diabetes, high blood pressure, osteoporosis, and constipation. The need for nutritional support, such as increasing

• Poor body positioning at meal leading to increased risk of coughing, choking

IN MOST CASES, THE GOAL FOR RESIDENTS WITH DEMENTIA IS TO LIBERALIZE THE DIET WHICH MEANS REDUCING UNNECESSARY FOOD RESTRICTIONS IN AN EFFORT TO MAXIMIZE QUALITY OF LIFE. calcium for bone health, monitoring carbohydrates for diabetes and maintaining sodium and boosting fibre intake, are all considered in light of the dementia. The dementia may alter the risk-benefit balance in this decision making.

Concerns with poor food and fluid intake can include: • Confusion due to dehydration, which can also lead to falls • Sarcopenia, or muscle loss, leading to overall body weakness • Inability to taste the food leading to greater risk of malnutrition

KEYS TO SUCCESS Collaboration among staff is important for successful interactions in the dining room with residents with dementia. Staff monitors residents at meals and snacks for food and fluid intake and shares this information with other care team members. An individualized diet plan is developed for each resident, and staff provides support in a manner that is individualized and as creative as possible to encourage optimal intake.

Family can offer insights into resident food likes and dislikes, and the best times to increase food intake.

Quality of life and resident satisfaction are the driving concerns for dining teams when planning care and service H in long-term care. ■

• Poor calorie intake leading to lack of energy • Poor fibre and fluid intake leading to constipation that the resident is unable to report • Difficulty chewing that may not be immediately recognized by staff, which may lead to choking incidents • Significant weight loss over longer periods of poor food intake • Weight loss can lead to bone loss in jaw and poorly fitting dentures • Greater caloric needs for residents who wander throughout the day • Anemia due to poor protein intake

Dale Mayerson, B Sc, RD, CDE, and Karen Thompson, B A Sc, RD are Registered Dietitians with extensive experience in Long-term care. They are coauthors of “Menu Planning in Long Term Care and Retirement Homes: A Comprehensive Guide” and have participated for many years on the Ontario Long Term Care Action Group, an advocacy group of Dietitians in Canada.

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NEWS

Choosing Wisely Canada: Continued from page 49

St. Joseph’s Health Centre’s head of hematology Dr. John Blondal (far left) was among those on hand for the grand opening of the health centre’s newly improved infusion clinic.

New infusion clinic improves patient experience and work environment for staff

By Emily Dawson t. Joseph’s Infusion (IV) Clinic is a lifeline in the community for people with infusion needs. A commitment to improve the patient experience, meet a growing demand, and reduce length-of-stay and emergency department (ED) visits led to its recent relocation within the Health Centre.

The new clinic, made possible through the St. Joseph’s Health Centre Foundation’s oncology fund, is dedicated to Dr. Moishe Davidson, in recognition of his exemplary work and invaluable commitment to our hematology and oncology patients.

A collaborative effort between the Oncology, Ambulatory Care Centre, and Redevelopment teams brought this project to fruition, and patients started using the new space on the first floor of the Morrow wing in August.

“The clinic is bigger and brighter for our patients, and has more space for the clinical team to deliver care,” says

S

Jennifer Spencer, patient care manager, Medicine.

The clinic, which conducts both infusion therapies and transfusions for patients referred primarily from the Oncology and Haematology programs, features an open concept layout and large windows to bring natural light into the treatment areas. The larger space accommodates more patients and promotes a safer work environment.

Before its relocation, the clinic had six treatment chairs, including two in the hallway, and was open three full days and two half days per week.

There are now eight chairs and the clinic will operate five full days every week.

Jean Barber says the new area has improved her experience. “I’ve been coming to this clinic every two weeks since 2013. The old space was over-crowded and noisy – it was right beside an elevator in a busy hallway,” says Barber.

“The new clinic is beautiful! It’s quieter and overlooks Lake Ontario.

The new furniture is more comfortable, and the chairs are more spread out.”

Barber’s bi-weekly appointments run between two and four hours each, which underscores the importance of a soothing environment. As a retired social worker, she also noticed how the new space enables safer care.

“The staff are always even-tempered and obliging but I know it was really difficult in the tight quarters with all the chairs, IV poles, and equipment they use. It feels much safer for everyone now.”

Spencer is proud of the new space.

“It’s been a real team effort. We’ve created capacity to offer more timely access to our patients. We can now minimize how often we redirect outpatients to the ED for urgent IV needs, explore ways to expand services, and H improve the patient experience.” ■

Emily Dawson works in communications at Providence, St. Joseph’s and St. Michaels.

60 HOSPITAL NEWS JANUARY 2019

One teaching hospital in Ontario decided to uncouple PT/INR and aPTT and revise their emergency department test panels, which resulted in a 50 per cent reduction in both tests.

Historical practices that have, over time, become routinized and ‘baked’ into the system set the course of overuse on auto-pilot, often taking decision-making out of the hands of busy clinicians, for better and for worse. On the one hand, there needs to be systems and processes to help stream workflow, improve consistency and standardization and take complexity out of everyday decisions. On the other hand, these systems and processes have their own inertia, and when they do not keep up with the evidence, they act as vectors for antiquated practices, allowing overuse to quickly multiply.

To date, Choosing Wisely Canada has partnered with over 70 professional societies from different clinical specialties and disciplines to develop lists of “Things Clinicians and Patients Should Question.”

These lists contain recommendations of tests, treatments and procedures that are not supported by evidence and could potentially expose patients to harm. Since the campaign launched in 2014, over 300 recommendations have been published, a significant number of which deal with unnecessary tests, treatments and procedures within the hospital setting. Diving into Overuse in Hospitals offers an opportunity to put these recommendations into practice to improve quality of care in hospitals, avoid harms from overuse to patients and improve stewardship of valuable reH sources. ■ Tai Huynh is Campaign Director, Choosing Wisely Canada. www.hospitalnews.com

SAFE MEDICATION

Missed dose medication incidents in the community

By Carolyn Kasprzak, Larry Sheng, Edmond Chiu, Puja Modi, and Certina Ho case scenario: Eliquis ® (Apixaban; an anticoagulant) prescription was discontinued in January. Bi-annual [prescriptions] printed in December were signed by [the doctor] in February. The bi-annual included an order to continue Eliquis®. Since this medication was recently discontinued [in January], the new order was not entered and was therefore not sent [and included] in the patient’s cycle fill.

Missed medication doses can be detrimental to a patient’s health, for example, causing relapse of symptom control (e.g. pain) or leading to the development of debilitating withdrawal symptoms for medications such as antidepressants and antipsychotics.

Furthermore, missed doses can potentially cause life-threatening harm if a high-alert medication, such as apixaban (an anticoagulant) is involved where the patient may be at risk of developing a stroke due to inadequate anticoagulation therapy. Incidents associated with missed doses often arise from system-based flaws and therefore are preventable when potential pitfalls in the healthcare workflow are identified and mended.

To examine medication incidents that resulted in missed doses, the Institute for Safe Medication Practices Canada (ISMP Canada) analyzed 156 medication incidents voluntarily reported to the Community Pharmacy Incident Reporting (CPhIR) program (https:// www.cphir.ca). These incidents were categorized into five main themes and further sub-themes (Table 1).

A

1. COMPLIANCE PACKAGING Compliance packaging (also known as multi-medication compliance aids, such as, blister packs, dosettes, and medication packets/rolls) is frequently

Table 1.

Summary of Themes & Sub-themes of Missed Dose Medication Incidents Main Themes:

Sub-themes:

Main Theme 1: Compliance Packaging

I. Over-the-Counter (OTC) Medications II. Medication Samples III.Medication Not in Stock IV. Complex Regimen V. Long Term Care (LTC) Home

Main Theme 2: Medication Regimen Adjustment

I. Over-the-Counter (OTC) Medications II. Medication Samples III.Medication Not in Stock IV. Complex Regimen V. Long Term Care (LTC) Home

Main Theme 3: Transitions of Care

I. Pharmacy (Prescription) Transfer II. Hospital Discharge III.Long Term Care (LTC) Admission or Discharge

Main Theme 4: Technological Complications

I. Systematic/Technological Flaw II. User Error

Main Theme 5: Medication Distribution

I. Pick Up II. Delivery

offered to patients in the community to improve medication adherence.

Medication incidents that resulted in missed doses often involved overthe-counter (OTC) medications and medication samples. Incidents also occurred when medications were not available at the time of compliance package preparation at the pharmacy due to drug shortages. It is important for pharmacies to have policies and procedures in place for compliance packaging preparation.

When medication dosing involves complex regimens (e.g. dosing only on certain days of the week or alternating dosages), missed doses may occur in

compliance packaging if documentation is inaccurate and if independent double checks are not in place. When possible, prescribers should simplify dosing regimens with consideration of available product formulations.

Pharmacy staff should be performing independent double checks, especially when patients have complex dosing regimens.

For ease of administration by the nursing staff, many long-term care (LTC) facilities have their residents’ medications prepared as unit-dosed medication packets/rolls by a community pharmacy. Missed dose medication incidents may occur due to

miscommunication between LTC and pharmacy staff (e.g. without adequate follow-up or verification on either side). An electronic information system for instant and reliable communication between LTC facilities and pharmacies may help prevent these incidents.

2. MEDICATION REGIMEN ADJUSTMENT Patients’ medication regimens are frequently adjusted to optimize their pharmacotherapy needs based on changing underlying disease states and goals of care. These changes may lead to insufficient doses if there is miscommunication between pharmacy staff and the patient, lack of medication reviews/reconciliation, and environmental distractions. When prescriptions are filled in compliance packaging, pharmacy staff should verify the most up-to-date prescription order and medication regimen changes should be clearly documented.

3. TRANSITIONS OF CARE Patients often move between different healthcare settings and providers. They may change community pharmacies when relocating to a new geographical region; they may be admitted to the hospital and get discharged with alterations to their medication therapy; and some may be admitted to LTC facilities, etc.

Unfortunately, during these transitions of care, patients are more vulnerable to medication discrepancies and incidents due to multiple factors, for example, inadequate handover between healthcare providers, and a lack of communication between healthcare providers and patients.

Continued on page 63

Carolyn Kasprzak is a Clinical Pharmacist at Runnymede Healthcare Centre and a Consultant Pharmacist at the Institute for Safe Medication Practices Canada (ISMP Canada); Larry Sheng is a PharmD Student at the School of Pharmacy, University of Waterloo; Edmond Chiu is a Medication Safety Analyst at ISMP Canada; Puja Modi completed a PharmD rotation at the Leslie Dan Faculty of Pharmacy, University of Toronto, and ISMP Canada in 2017; and Certina Ho is a Project Lead at ISMP Canada. www.hospitalnews.com

JANUARY 2019 HOSPITAL NEWS 61

FROMSAFE THE MEDICATION CEO’S DESK

Implementing Strategy: Charting the course for a new future

By Jo-anne Marr or most organizations, the strategic plan is the roadmap, the aspiration, the guiding light for the future. But what do you do when your five-year strategic plan requires a midterm course correction?

At Markham Stouffville Hospital (MSH), like many other hospitals, we had a five-year strategy that plotted the course for the hospital from 2014 – 2020. The strategy took into consideration a number of factors including clinical growth, funding, innovation and community need. It did a great job of looking at the current landscape and planning for the future.

But then the current landscape changed – dramatically. The introduction of the Patients First legislation brought forward major changes.

A significant focus on patient experience, the creation of a provincial patient ombudsman and new expectations were placed upon hospitals and health system providers. In addition, the digital health era was upon us, driving hospitals to harness new technology at a faster rate than ever before. And a provincial election and, potentially, a new government was on the horizon.

Regardless of any new government direction, it was clear that the environment had significantly changed.

Our organization needed to respond strategically in a very real and tangible way. Waiting until 2020 to launch our new strategy was no longer an option.

While some were excited about the new strategic planning mandate, others who had lived through our hospital’s massive expansion and renovation only a few years ago were anxious to have a ‘steady-state.’ A new strategic plan meant more change. If we were going to be successful in devel-

F

oping our new strategic plan, we needed to ensure that all of our partners in care, including our patients, had a meaningful voice about our future directions. It was essential that we committed to designing the future of MSH together.

We launched that renewed work 10 months ago and we now have a new vision, mission and strategic pillars that will drive our work for the next three years.

This plan leads us into the future by building on our past successes, acknowledging the challenges we face and by taking advantage of the opportunities that are ready to be seized.

Our vision is “care beyond our walls” and speaks to our commitment to serve the community beyond the boundaries of our physical facilities.

Of course, the MSH sites have walls, but we say that our vision is to deliver care beyond walls because we will proactively think, act and innovate every day to provide our patients with care that is connected to the community in which they live.

Our mission is to create an “honoured to care” culture; an expression of our humble and compassionate attitude, and recognition of the respect we have for the people who choose us for their care.

And underneath our vision and mission are our strategic pillars; delivering an extraordinary patient experience, embracing our community and empowering our people.

We insisted on a vision and mission that were short and memorable, and easy to recall strategic pillars.

We are very proud of the work that’s been done, and we’re excited about the implementation of our new plan. We also learned some lessons along the way.

Jo-anne Marr is President and CEO, Markham Stouffville Hospital.

1. ENGAGE WIDELY AND DEEPLY Taking the time to engage others in the planning and implementation process is time-consuming and arduous but well worth the effort. The final product is always better, clearer and more understandable. Taking the time to do this well reaps benefits as you move forward with implementation. That old adage that you have to slow down to speed up later is absolutely accurate.

Physician engagement is particularly important; time spent creating opportunities for meaningful dialogue, input and influence ensures less resistance and enables future success. The Board must also be engaged in the development process in a meaningful way – this is also a critical success factor. Consider the use of a steering committee populated with key leaders, Board and Foundation members, and community participants.

2. TAKE TIME TO UNDERSTAND THE ORGANIZATIONAL CONTEXT Take the time to understand the historical issues, sensitivities and biases. Just because you’ve implemented a strategic planning exercise several times before doesn’t mean that it will work the same way in another organization. Seasoned and experienced leaders understand this and adapt their approaches. At MSH, an assessment of why the previous strategic plan did not resonate or gain support was critical in order to ensure success going forward.

3. PAY CLOSE ATTENTION TO THE IMPLEMENTATION PLAN There are countless examples of beautifully crafted strategic plans that do not translate into successful Continued on page 63

62 HOSPITAL NEWS JANUARY 2019

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FROM THE CEO’S DESK

Continued from page 62 implementation. If carefully and thoughtfully managed, it can be a compelling and unifying experience that focuses the entire organization. At our hospital we have created steering committees for each of our three strategic pillars and our enabling processes and systems, each of which will be co-led by senior leaders. The committees and supporting working groups provide an exceptional opportunity to work collaboratively with individuals from across the organization in a meaningful and productive way.

We have a lot of work ahead of us as we move towards our vision of providing care beyond our walls. But we are confident that we have done our very best to respond to the changing landscape in healthcare and that it was the right decision to move forward early with a new strategic plan. We’ve consulted and engaged and have the right supports in place as we begin to implement our plan. It’s an exciting time for H Markham Stouffville Hospital. ■ Jo-anne Marr is President and CEO, Markham Stouffville Hospital.

Missed dose medication Continued from page 61 Upon discharge, medication reconciliation and patient education are crucial steps to ensure that medication changes after hospital admissions/discharge were followed up.

Hospital helplines for patients and other primary healthcare providers would ameliorate bi-directional communication post patient discharge.

When patients are transferring in and out of LTC facilities, there should be a standardized process to communicate admissions and discharges among different healthcare settings and providers. Essentially, communication is key to medication safety.

4. TECHNOLOGICAL COMPLICATIONS While health information technology, such as pharmacy software and electronic medical records, greatly improves efficiency, if there is a glitch in the software or when practitioners incorrectly use the technology, missed dose medication incidents may occur. Health information software de-

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ESSENTIALLY, COMMUNICATION IS KEY TO MEDICATION SAFETY. velopers should actively collaborate with their end-users (i.e. front-line healthcare practitioners) and consider human factors engineering principles when improving the UX (user experience) and UI (user interface) of the software. Adequate staff training of the software and technology is also fundamental.

5. MEDICATION DISTRIBUTION The final step of dispensing medication to patients at a community pharmacy is medication pick-up or delivery. Independent double checks

should be performed at medication pick-up to verify, for instance, the number of prescriptions being picked up, and for which medications, etc.

Multiple medications filled for the same patient should be placed together with system-based reminders for pharmacy staff. If prescription delivery is arranged, patients should always check the contents of the prescription bag before taking any medications and to call the pharmacy if they have any questions regarding their medications.

Despite healthcare professionals’ best efforts to constantly strive for safe medication use, incidents may still occur. Regardless of the practice settings, reporting medication incidents is highly encouraged, as it allows analysis to identify potential contributing factors, and consequently help resolve system-based flaws to prevent similar incidents from occurring in the H future. ■

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www.sehc.com JANUARY 2019 HOSPITAL NEWS 63

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