A publication for Staff and Physicians of IH
5KEY STRATEGIES Shifting Our Focus for 2016-2018
ENHANCE ACCESS TO APPROPRIATE PRIMARY HEALTH CARE
IMPROVE PRIMARY AND COMMUNITY CARE DELIVERY AND OUTCOMES FOR FRAIL SENIORS LIVING WITH COMPLEX CHRONIC CONDITIONS
PRIMARY HEALTH CARE SENIORS CARE
RURAL CARE MENTAL HEALTH AND SUBSTANCE USE
SURGICAL ACCESS
IMPLEMENT A RENEWED SYSTEM OF CARE FOR RURAL B.C.
IMPROVE PRIMARY AND COMMUNITY CARE DELIVERY AND OUTCOMES FOR MENTAL HEALTH AND SUBSTANCE USE CLIENTS
IMPROVE TIMELY ACCESS TO ELECTIVE SURGERY
A message from Chris Mazurkewich, Interior Health’s CEO.
Ways you can stay engaged in your day-to-day.
Terry Lake speaks about his vision for our province’s health-care system.
Patient voices guide IH website changes.
Inclusivity is key in designing places of solace in IH facilities.
Taking the guess work out of healthy eating.
Featuring Rose Soneff, Public Health Dietitian.
Staff-submitted photos of places in our region.
Snapshots of our staff in action and trending health-care videos.
B.C. Health Minister Terry Lake with his father, Morrie. Story p. 6.
The @InteriorHealth magazine is a monthly publication created by the Communications Department of Interior Health. Past issues of @InteriorHealth can be found on our website under About Us/Media Centre/Publications & Newsletters. If you have story ideas for future issues, please e-mail: IHAcommunications@interiorhealth.ca Deadline for submissions to the April 2016 @InteriorHealth magazine is March 11. Editors: Amanda Fisher, Breanna Pickett Designers: Breanna Pickett, Kara Visinski, Tracy Watson IH Communications Contributors: Lesley Coates, Susan Duncan, Patrick Gall, Karl Hardt, Megan Kavanagh, Breanna Pickett, Erin Toews, Tracy Watson
Every person matters
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lmost everywhere I go, I hear about the shortage of family physicians. I personally know at least a dozen people between the ages of 30 and 70 who don’t have access to a primary-care practitioner.
IH President and CEO Chris Mazurkewich
At Interior Health, we want to set new standards of excellence in the delivery of health services in B.C. and to also promote healthy lifestyles and provide needed health services in a timely, caring, and efficient manner. To achieve this, we are guided by the following strategic goals: Goal 1 Goal 2 Goal 3
Goal 4
The articles featured in the @IH newsletter are great examples of how we’re achieving our goals … and realizing our vision and mission.
So, I get how concerned people feel when they don’t have a family doctor. They don’t want to sit for hours in an Emergency Department or a walk-in clinic – they want to be connected to a health-care provider who knows their story. That’s why Interior Health and the Ministry of Health are committed to changing how care is offered. We are listening to what people are telling us and we are responding. Shifting where and how care is provided and who provides it is not without complications, but nothing great was ever built without hard work and co-operation. We are asking our physicians and nurse practitioners to help us develop a health-care system in which people have a comfortable place to go in their community when they are sick or injured, or even when they are healthy and want to prevent illness. It’s great to see that Health Minister Terry Lake offered some of his own thoughts about the direction of health care in B.C. in this month’s @IH. Please take a moment to read his story, which tells of his own father’s experience with the health system. As Minister Lake indicates, our priority focus is on the people who need us the most – frail seniors, people with serious mental health and substance use illnesses, and those with complex chronic health conditions. However, our vision makes room in the system for others as well, such as the mom with a sick child or the person waiting
for elective surgery. As we move forward, you will hear us talking about the Primary Care Home. It’s a team-based way to attach patients to primary-care providers and it’s a model that is being effectively used in other countries. Although the makeup of these homes varies, all have one common factor – they are person-centred and access to care is smooth and easy to navigate. One thing is for sure – patients won’t be left to find their own way through a confusing system of services located all over a community. We also want to strengthen our community services so patients are not spending unnecessary time in hospital beds. During my visit to Cranbrook in December, I was told there were about 30 patients in East Kootenay Regional Hospital due to diabetes complications; however, half of those might never have been admitted to hospital if appropriate services were available in the community. It’s important for everyone to understand that the way we provide health care has to change if we want to keep the system sustainable, responsive to what people want for their care, and taking into account the different medical conditions we deal with today. That’s my ask of you – regardless of what you do or where you work in the system, be aware of why we need to change and think about how we can do that. This work is exciting and it must be inclusive. I’m interested to hear your thoughts as health-care employees – and as patients. It’s a time for innovative thinking and a free exchange of ideas. The next best solution could just be waiting for an invitation to share – so please share!
On a recent visit to the B.C. Interior, Health Minister Terry Lake spoke to @IH Magazine about how his vision for our province’s health-care system intersects with planning underway in Interior Health.
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ven before he was named B.C.’s Minister of Health, Terry Lake was watching health-care systems worldwide shift their resources toward patient-centred care in community settings.
After his appointment in June 2013, he was eager to lead B.C. in the same direction – one that all Canadian provinces are currently moving toward. He believes British Columbia is a bit ahead of the curve and credits Deputy Health Minister Stephen Brown for much of the innovative planning that has occurred in two years. “We spent the better part of a year looking at the system, reading a lot of material, looking at other systems, best practices in other jurisdictions, and I think that investment in time and energy to look at the system in a complete way has formed the foundation of where we will be moving health care – over the next 20 years really.” Midway through this foundational work, Terry’s own dad
got sick and he saw firsthand the challenges of the traditional hospital-based system. “I think it was a very good illustration of something we knew had to occur. We had developed our plan before my dad had his episode, but it really drove the point home for me in reality the things we were talking about in this province.” Morrie Lake was transported by ambulance to Kelowna General Hospital in the middle of the night where he was diagnosed with deep vein thrombosis. “A vascular surgeon removes the blood clot, saves his leg, and probably saved his life because he had heart bypass surgery before and he has other chronic conditions,” says Terry. But then, Morrie goes into a hospital bed and is there for three weeks with not a lot of moving around or activity. After he finally goes home, regular physiotherapy occurs, he is up moving around, his spirits lift, and he starts to do better.
“I am confident if he had been out of hospital a week earlier with more intensive home supports, he would have improved faster,” says his son, adding that’s the reality he wants for all of the frail elders in B.C. when they need care. The redesigned health system proposed for B.C. will reserve hospital beds for acute medical patients and move people home to recover with proper supports, whether that is for a physical or a mental health issue and wherever home is. “In fact, we want to head off the hospital in many cases by responding to people’s needs in place – and that may be in an apartment like my dad or it may be residential care – but there will be active surveillance through the primary care home for people at risk of a hospital admission.” The minister’s vision for the health system is being put into practice in Interior Health through its decision to focus resources on strategies that will shift care from hospital to proper community services. Minister Lake says he is invigorated by the uptake he is seeing among physicians, front-line health staff, and health-system leadership for a system centred on people. “One thing that everyone agrees on is that care should be about the patient. Whatever decision we make should be person-centred. It shouldn’t be about institutions, it shouldn’t be about physicians, it shouldn’t be about the health industry – it should be about the people we serve.” The challenge is convincing those same people that kind of care doesn’t require bigger hospitals. “It’s difficult for communities to understand why we are not funding new hospital beds because every community loves their hospital, and local government officials love their hospitals. “When we open residential and hospice beds and expand home and community services, which means some hospital beds can close as we move out patients who should no longer be in those beds, people view that as their hospital potentially shrinking. Yet it’s the right thing to do.
Kamloops North Thompson MLA Terry Lake is joined by his dad, Morrie, on election night in May 2013.
medical services, as other health-care providers, such as nurse practitioners, primary care nurses, and therapists, are able to support general practitioners in meeting patient needs, especially those with a chronic illness. As well, the Health Minister is hopeful that healthy people will take advantage of their good fortune by working to stay healthy. Despite a fast-paced political world, he tries to follow that health promotion rule himself by running regularly and eating as nutritiously as possible, given his lifestyle where meals can be on the fly. “I’m always sort of 10 pounds over what I want to be, maybe that’s normal, but my biggest weakness is I’m not a good sleeper. So, that’s something I have to work on. We all have some challenge, I think, but we do need to do our best to stay well.” In the meantime, B.C. residents can be assured that when their Health Minister lies awake at night his brain is churning over ways to create the most efficient and effective health-care system.
For example, a pilot program in Nova Scotia for an electronic health record particularly interests him because “We have to help the public understand that’s where health it has the potential to bring all aspects of a seamless care must be today, given the demographics of our health-care system together as it empowers the patient populations and in response to everything people are to invest in his or her own care. telling us about where they want their care. None of it will happen quickly or without growing pains, “Strengthened community supports for seniors is also the but the Health Minister is confident there is no turning back better approach for people with mental health issues, as from the shift that will ensure everyone, including the well as people who live in rural and remote areas of the generations ahead, will get the right treatment from province,” says the Health Minister. a strong and responsive health-care system. He is also enthusiastic about the development of the primary care home model that will help expand access to
Read more about the Ministry policy papers on the Ministry of Health website.
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avigating the health system at end of life can be overwhelming.
Choices regarding cardiopulmonary resuscitation (CPR), life support, artificial hydration and nutrition, and organ donation must be discussed and communicated to care providers. And there are other decisions to be made: Will you receive care at home? In hospital? At a hospice? What are your personal preferences? Financial needs? The needs of family and other loved ones? Now, the website for palliative care in Interior Health has been revamped with important input and guidance from the BC Patient Safety & Quality Council Patient Voices Network volunteers. The new site is more user-friendly and easier to navigate, while offering vital resources for patients, loved ones, and care providers. “The information is very important at a sensitive time in people’s lives, when they are experiencing a lot of emotional stress,” says Elisabeth Antifeau, Home Health Practice Lead, Complex Populations/Palliative, End of Life. “The information has to meet practical needs, but it also needs to be sensitive.” The newly designed web pages are broken down into six, easy-to-understand sections: What is palliative care?; Making the tough decisions; Choosing care options; Caregiving and supports; What to expect in the final days; and After death.
Elisabeth Antifeau will direct patients to the new Palliative Care web page on the IH website. Patient Voices Network volunteer Diane Edlund (pictured in the table of contents on p. 3) was able to share her personal experience in planning the new web site after losing both parents to cancer.
they are looking for quickly and easily.” Elizabeth adds: “The volunteers also gave us important insight into the language used. For example, they agreed that it should be written from the first person versus third-person perspective. The first-person voice reflects the importance of intimacy for this topic. We heard loud and clear that this website should be speaking directly to the user, with clear, sincere language.” Okanagan resident Diane Edlund was one of several volunteers from the Patient Voices Network who helped with the site. Diane, who lost both parents to cancer, says she finds volunteering in this capacity personally rewarding. “It’s a great way to give back and I’m a real advocate of the Patient Voices Network, because their mandate is to include the patient voice not only in things like website and brochure development, but throughout the system, at a strategic level. I believe the patient voice needs to be heard, especially when we are talking about things that directly impact care.” The end result is truly a team effort, according to everyone involved.
“The success of this group was due to our team effort,” “Our Patient Voices volunteers generously contributed says Cranbrook resident Kevin Dunk, who is also a more than 12 hours of their time to guide the development volunteer with the Patient Voices Network. “Each of us of the web pages,” says Elisabeth. brought something different to the table and Elisabeth was great at facilitating discussion and setting the tone.” “All of them spoke about their experience losing loved ones and these patient journeys helped us decide how to Visit the new Palliative Care structure information on the website. People can go to the website to learn more about section they feel is best for them, to find the information our palliative care resources.
Inclusivity is key in designing places of solace in IH facilities
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nside Salmon Arms’s Shuswap Lake General Hospital (SLGH) is a small room where the door is adorned by a lovely stained glass window. This will be the setting for a Sacred Space.
In the planning, its placement near the 10th Street NE entrance was mere convenience – that’s where space was available for transformation into this special room. Soon, however, it became apparent how fitting this entry-way location truly was. Once fully developed, the Sacred Space will welcome one and all to SLGH, regardless of culture, faith or individual circumstance. Those who enter in search of solace will be accepted for who they are and where they are in their health-care journey. That’s the purpose and meaning behind all of Interior Health’s Sacred Spaces, says Viktor Gundel, Interior Health’s Spiritual Health lead. Viktor was involved in the opening of IH’s first Sacred Space at Royal Inland Hospital (RIH) in Kamloops six years ago and is now guiding the
framework to open SLGH’s Sacred Space. “The human experience of pain is universal. It’s often life changing, both spiritually and culturally. An inclusive, patient-centred and holistic approach to health care is the unifying and often transformative element,” says Viktor. “Being healthy goes beyond simply addressing physical pain. We know that patient outcomes are improved when we also address emotional and spiritual distress triggered by pain. And that’s why Interior Health puts value in a holistic-care model that encapsulates all three.” Historically, most IH facilities have included chapels for Christian-based faiths and, more recently, accommodations for cultural ceremonies, like smudging, for First Nations patients. There is increasing evidence-based recognition, however, that a person’s health-care decisions are shaped by their history and experiences, says Viktor, adding that our Interior communities are becoming increasingly diverse in
culture and ethnicity. Thus, it’s important to be inclusive of all spiritual and cultural values when designing places of comfort and faith-based ceremony in our hospitals. Royal Inland’s Sacred Space was the first within IH to be fully operational, and spaces are also in various stages of planning and development at Shuswap Lake, Kelowna General, Vernon Jubilee, and Penticton Regional hospitals. Interior Health is not alone in this view. The Ministry of Health is in the process of developing guidelines for the inclusion of Sacred Spaces across the province – work in which Viktor and his Spiritual Health colleagues across the province have been participating. “The vision of this framework,” says Viktor, “is to integrate various spiritual, religious, and Aboriginal community perspectives in the form of a clinically cohesive space that will draw upon the diverse population’s holistic needs, in order to help our patients and our staff through grief, closure, and healing during critical events in their lives.” In Salmon Arm, an advisory group is being struck to plan for the use of SLGH’s Sacred Space. It’s still at beginning stages of creation, but it is hoped that representatives for this group will include hospital leadership, employees and physicians, and Volunteer Services, as well as IH’s Aboriginal Health and Spiritual Health teams, but also the various local First Nations Secwepemc bands, and a diverse spectrum of community-based faiths and stakeholders, including the Catholic, Anglican, and evangelical churches, along with Muslim, Buddhist and Sikh faiths. “This was the process followed when Royal Inland created its Sacred Space, and it was most successful,” says Peter du Toit, Acute Health Service Administrator in Salmon Arm. “It’s really important that we create a space inclusive of all cultures and faiths, and that people know it is accessible at any time of day, for any patients and their families, our employees, or social workers and their clients.” “It’s about more than simple design of the Sacred Space itself,” adds Brad Anderson, IH’s Aboriginal Health Program Director. “It’s about endorsing a framework for use of the space that has been built by all partners collaboratively. Having sacred spaces within our facilities shows IH’s commitment to advancing cultural competency and increasing access to Aboriginal populations. It also helps in signalling to our communities that everyone is welcome at our hospitals – and that, in fact, can help when it comes to recruitment of health-care professionals.” The proof is in the relationships that have been built through the creation of RIH’s Sacred Space. Consider the comments made at opening by Dr. Sheik Hosenbocus, Kamloops child psychiatrist who was, at the time, president of the growing Muslim Community of Kamloops: “For years we have prayed in the hallways, cubbyholes, and corners in our hospital. We feel gracious for being equally included in co-creating this Sacred Space.”
Above: These takeaway stones, which represent the spiritual journey, are offered to patients and their families at the RIH Sacred Space. Left: Viktor Gundel, Spiritual Health Lead (R), and Brad Anderson, IH Aboriginal Health Program Director, at the entrance to Royal Inland Hospital’s Sacred Space, a place that welcomes all regardless of culture, faith or individual circumstance. Below: Mark Pugh, SLGH Health Service Manager (L), and Peter du Toit, Acute Health Service Administrator, at the entrance to the room that will become the new Sacred Space at Shuswap Lake General Hospital.
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No more guess work ver wonder how many calories are in the beef sandwich you bought from the cafeteria? Or how much sodium is in that chicken corn chowder?
Now, it is easier than ever to make informed choices about menu items at cafeterias and other food outlets located within IH facilities. Many of us lead busy lives – the majority of British Columbians now dine out three or more times per week. Almost one quarter of all Canadian household food dollars are spent in restaurants. Recognizing that the menu choices we make have a significant impact on our health, B.C.’s Informed Dining program provides customers with important nutrition information, particularly about calories and sodium. Informed Dining is focused on providing information to consumers in participating restaurants and, in collaboration with the health authorities, the program includes hospital cafeterias and other food outlets, such as coffee kiosks.
Interior Health Staffing Clerk Christina Wuthe, with Cook Clay Teneycke, is a regular customer at the PRH cafeteria and appreciates the nutrition information now available to help guide menu choices.
“Our cafeterias serve hundreds of staff, patients, families, and friends, including many customers with chronic health conditions. As health-care providers, we need to lead by example and also have a responsibility to provide patrons with the information they require for decision making,” says Marilyn Smith, Food Services Manager, Kamloops Region. “It’s not about labelling food items as ‘good’ or ‘bad.’ It’s about providing essential nutrition information to help our customers make informed choices.” Participating Interior Health sites include: Royal Inland, Penticton Regional, Kelowna General, Vernon Jubilee, Kootenay Boundary Regional, East Kootenay Regional, and South Okanagan General hospitals. They are identified by a sign on their front door, featuring an “i” logo on a yellow background and the phrase “Informed Dining.” Interior Health cafeteria nutrition menus are available on the Healthy Families BC Informed Dining in Health Care website. Nutrition information is also posted in menus displayed in participating cafeteria and food outlets. At the same time, Interior Health cafeterias have introduced new healthier, heart-friendly recipes and menu choices. There are good reasons to stay informed: Canadians consume more than double the amount of sodium we need; eating too much sodium can cause high blood pressure, stroke, heart disease, and kidney disease; and carrying excess weight can increase the risk for Type 2 diabetes, heart disease, and various cancers. To learn more, visit www.healthyfamiliesbc.ca.
Rose Soneff, Public Health Dietitian @IH: Tell us about your role at IH. I work at the Kamloops Public Health Unit as a Public Health dietitian. Formerly called community nutritionists, Public Health dietitians are registered dietitians who work with community groups, early childhood programs, school districts, organizations, health professionals, educators, and local government to support and promote healthy eating. Our work aims to improve access to healthy food, improve people’s food shopping and preparation skills, and promote the social and cultural aspects of eating. We accomplish this through providing consultation on food policy development, supporting the development of new programs and services, and promoting healthy eating initiatives. We also provide training and resources to support health professionals, Interior Health employees, and physicians in providing the public with up-to-date healthy eating information.
@IH: What is fun or exciting about the work you do? Who doesn’t eat? The work we do touches someone, at some point, throughout the day when they eat, prepare food, or purchase food. We influence an individual’s choice, but we also influence the environment around them when they make that choice. Some examples include: vending machines with healthy options; concessions that provide healthy offerings; cities where they plant vegetables or fruits that people can eat, instead of ornamental plants; and encouraging child-care providers to offer new foods at their daycare.
@IH: Is there a particular project you have been
involved with that stands out for you? When we first started working with schools on Food Policy (determining how food is purchased, sold, and priced) there was a school fair to be held at Lac La Hache Elementary. Instead of a ‘Cake Walk,’ we had a ‘Fruit and Vegetable Walk.’ If a student stopped on the number called during the walk, they could choose from a bowlful of fruit with dip, or vegetables with dip. The game was a hit! Not only did the children love the new format, but the little bowls of vegetables were depleted first, to the shock and amazement of parents.
I watched a student sit down with his little bowl of vegetables and happily munch away.
@IH: What makes for a really great day at work?
I am a resource for people. I may not know the answer, but I can usually find someone to provide the answer or get them to the next step. If I can help a nurse to provide practical information for one of her clients, or direct someone to some potential funding sources for a food security project, or help someone feel comfortable breastfeeding anywhere, or someone thanks me for ways to save money, eat well, and prevent food spoilage – then I have had a great day.
Public Health Facts & Figures
2005
Year the term “locavore” was defined – meaning one who eats locally grown food, when possible
47% Kamloops Public Produce Project, offering herbs and vegetables, free to the public.
$914
Average monthly cost to purchase a nutritious food basket for a family of four in B.C.
15
18 tsp
Average intake of added sugars per day for an adult*
Minutes on average spent preparing dinner
*Heart & Stroke Foundation recommends a decrease to 12 tsp per day. Stats gathered from 2015-2016 data. Nominate a colleague, manager, or site for a future spotlight.
Reported IH residents who have fruit and vegetables five times or more per day
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Public Health dietitians in IH
Vernon Submitted by: Shawn Berglund
Fintry Submitted by: Glenn Coello
Kamloops Submitted by: Wanda Turner
Where We Live & Work ... A Spotlight on Our Communities Covering more than 215,000 square kilometres, Interior Health is diverse in nature and composed of vibrant urban centres and unique rural communities. Photos are submitted by employees and posted to the InsideNet. Select photos are featured in @IH.
Submit your photos of the beautiful places that make up IH on the InsideNet.
Dr. Jill Boulton poses for a photo in the stabilization nursery during a photo-shoot of the new perinatal (maternity) unit located in the Interior Heart and Surgical Centre at Kelowna General Hospital. The new unit provides a welcoming and calming atmosphere in which our tiniest patients can get the best start in life. It features expanded clinical space, private labour and delivery rooms, private and semi-private postpartum rooms, and a modern neonatal intensive care unit with central monitoring.
On Feb. 29, it was Mad Hat day at the Kelowna Health Centre and several good sports put their heads on the line for judging by their colleagues. Carmen Wentland, Prenatal Registry Nurse, won first prize for her millinery talents. Check out some of the other creations on our Facebook page.
Dr. Paul Dagg, Program Medical Director for Mental Health and Substance Use, and Joanna Macaulay, Leader Tertiary Mental Health Services, along with support from teams across IH, were awarded the annual IH Quality ‘Team’ Award for their work to improve the care and management of mental health clients referred to Hillside Centre by air transport. L-R: Linda Comazetto, Director, Quality, Risk and Accreditation; Dr. Paul Dagg; Joanna Macaulay; and Naomi Erickson, Manager, IH West Quality and Patient Safety. Do you know someone who has done work to improve patient safety, appropriateness of care, efficiency, or accessibility to care? Send a nomination form to IHQualityAwards@interiorhealth.ca.
For Tom, aging well includes walking every day with his wife, playing hockey and socializing with his hockey team, and thinking about his housing needs so he and his wife can age in place as long as possible. Find out more about how Tom and other British Columbians are planning to age well. Watch more stories about aging well at www.healthyfamiliesbc.ca.
International Women's Day (March 8) is a global day celebrating the social, economic, cultural, and political achievements of women. The day also marks a call to action for accelerating gender parity. Events are happening around the globe to celebrate, reflect, advocate, and take action. Learn more at www.internationalwomensday.com. #PledgeForParity
Did you know that one in 10 Canadians has kidney disease? Because there are often no symptoms until kidney disease is quite advanced, many people aren’t aware that they have the disease until they’ve already lost most of their kidney function. That is why screening and early detection are so important. Take an online kidney function quiz or visit www.kidney.ca to learn more.