The Northern Way June 2015 by Northern Health

A magazine for NH staff and physicians Volume 2 · Issue 1 · June 2015

IN THIS ISSUE Integrated health services delivering patient-centred care. . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Concussions matter!. . . . . . . . . . . . . . . . . . . . . . . . . 22 Introducing Spirit the caribou. . . . . . . . . . . . . . 24 Jim Terrion - BC’s top fundraiser for Terry Fox Foundation. . . . . . . . . . . . . . . . . . . . 28 Northern Health at 2015 Winter Games.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 the northern way of caring

contents Integrated Accessible Health Services................................................................................................................................ 4

Integrated health services: Delivering patient-centred health care from cradle to grave................................................... 4

Prince George Division of Family Practice supports Northern Health’s move to integrated health services........................................................................................................................................................... 8

Nurse practitioners: bolstering the ranks of northern health care professionals............................................................. 10

Vanderhoof health care providers take aim at chronic pain.......................................................................................... 11

High Quality Services....................................................................................................................................................... 14

At Northern Health, the Patient Care Quality Office is about quality improvement — not blame..................................... 14

Clean your room . . . why your mother was right!....................................................................................................... 15

Northern Health implements final phase of CBORD food and nutrition meal service system......................................... 16

What is accreditation and why does it matter to me?.................................................................................................. 18

Using documented evidence in your health care practice can reap rewards................................................................ 19

2015 Northern Health Quality Conference: Focused Improvement.............................................................................. 20

A Population Health Approach.......................................................................................................................................... 22

Concussions matter! Have you completed the CATT?................................................................................................ 22

Citizen Series Webinars: Helping northerners build healthier, sustainable communities ................................................ 23

Introducing Spirit the caribou, Northern Health’s new mascot...................................................................................... 24

A Focus on Our People................................................................................................................................................... 26

A conversation with Dr. Ramesh Kamath: Lead physician at Fort St. John Unattached Patient Clinic supports team-based care................................................................................................. 26

Jim Terrion: Northern Health employee is BC’s top fundraiser for the Terry Fox Foundation .......................................... 28

New Lakes District Hospital and Health Centre opens ahead of schedule................................................................... 30

Northern Health goes for gold at the 2015 Canada Winter Games.............................................................................. 31

Privacy tips for health care workers: The dos and don’ts of collecting personal information from patients............................................................................................................................................................ 32

New Queen Charlotte/Haida Gwaii Hospital taking shape........................................................................................... 34

The Northern Way Volume 2 · Issue 1 · June 2015 Publisher · Steve Raper

To read our magazine online, visit www.issuu.com/northern-health/docs/the-northern-way-2015-june

Editor/Contributor · Joanne MacDonald Additional Contributors: Marcia Bertschi · Helen Bourque · Tamara Checkley · Sabrina Dosanjh-Gantner Jonathon Dyck · Mike Erickson · Denise Foucher · Lexie Gordon · Tanis Hampe Joni Kenner · Candice Manahan · Shellie O’Brien · Raquel Miles · Yvette Rutherford Vince Terstappen · Neil Wilson On the Cover: Northern Health staff at the newly-constructed Lakes District Hospital and Health Centre celebrate their new facility in front of the hospital’s Emergency department. The new hospital opened on February 4, 2015. Photo: Joanne MacDonald

Mission Statement — Our Purpose Through the efforts of our dedicated staff and physicians, in partnership with communities and organizations, we provide exceptional health services for Northerners.

Vision — A Picture of 2015 Northern Health leads the way in promoting health and providing health services for Northern and rural populations.

editorial A message from Cathy Ulrich, President and ceo

elcome to the June 2015 edition of Northern Health’s magazine for staff and physicians. Our stories in this issue are written by and about Northern Health staff and physicians, and not only include information about how we deliver our health care services, but also profile some of our colleagues across the region. You’ll notice that our magazine now has an official name. I’d like to congratulate Joni Kenner, Information Privacy Audit Analyst, and Kate Ames, Staffing Services clerk, the winners of our “Name the Northern Health magazine” contest. They were co-winners of the contest for separately suggesting the name, The Northern Way, which now graces the front cover of this issue. Thank you, Joni and Kate! As many of you may know, we’re going through a major transformation in how we deliver health care services in the north using the integrated health services approach. Our cover story explains how integrated health services works — namely, that physicians, Northern Health staff and our community partners are creating interprofessional teams of health care providers who will regularly collaborate and communicate with each other about their patients’ care and treatment. Most importantly, this new approach is designed to ensure that patients and their families are included in their own care management. I encourage you to read our cover story on page 4 to learn more about integrated health services. A particular highlight of this past winter for Northern Health was our involvement in the 2015 Canada Winter Games. Our Games medical team included physicians, nurses, physiotherapists and athletic therapists all providing first-rate volunteer medical services to the Games athletes, coaches and visitors. Our Public Health Promotions team conducted daytime venue blitzes and staffed an engagement booth inside the Athletes’ Village, handing out thousands of informational and promotional items. Meanwhile, our public health protection team also conducted regular environmental health assessments to ensure everyone stayed healthy. We had to undertake extensive preparedness efforts to meet the challenges of the Games, all the while maintaining current health care services for northern

residents. Our efforts paid off - our team was able to collect extensive data about the Games. This data will help our team create a legacy document detailing all of the challenges, strategies, and activities undertaken during this large event. In addition, I’m very proud to report that our preparedness efforts have also garnered us a national communications award from the Canadian Public Relations Society (CPRS). The Gold Award for Excellence in the Best Special Events Projects category will be presented to Northern Health at the CPRS annual conference in Montréal on June 2, 2015. Read more about our Canada Winter Games preparedness project on page 31. Among the other stories you’ll read in this issue: •

Northern Health staffer Jim Terrion is the top BC fundraiser for the Terry Fox Foundation;

•

Dr. Ramesh Kamath leads the medical team at Fort St. John’s Unattached Medical Clinic; and

•

Northern Health introduces a new mascot, Spirit the caribou.

Last, but not least, don’t forget that we want to hear your stories! If you’d like to contribute a story to The Northern Way or comment on a story in this issue, please contact us at hello@northernhealth.ca Cathy Ulrich (centre) is flanked by Northern Health’s 2015 Canada Winter Games medical team as she receives a Community Partnership award from Games’ CEO Stuart Ballantyne. Photo: Joanne MacDonald

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NH | high quality services

NH | integrated accessible health services

Integrated health services: Delivering patient-centred health care from cradle to grave By Joanne MacDonald, Communications Officer, Joanne.MacDonald@northernhealth.ca

t’s safe to say that Mike Simpson is leading the hands-on work for one of the biggest transformations in health care delivery that northern BC has ever experienced. Simply put, Simpson is collaborating with Northern Health staff, physicians, community agencies, the First Nations Health Authority and Divisions of Family Practice to implement a system (http://bit.ly/1pi6EOV) that delivers coordinated, integrated health services to people and their families throughout the north.

According to Kelly Gunn, Northern Health’s Vice President, Primary and Community Care and Clinical Programs, the new system of integrated health services is coming soon. “We’re working toward substantial completion of the implementation planning work by October 2015 region-wide,” says Gunn.

What is coordinated, integrated health care? Simpson, Northern Health’s Executive Lead for Community Services Integration and Implementation, explains the new system this way. “The core of integrated health services is the primary care home [http://bit.ly/1FIweaI] — the family physician’s office. Within that primary care home, the key thing is helping individuals create a long-term relationship with a physician or a nurse practitioner. Then if other specific services are needed, the physician or nurse practitioner will bring in other members of the interprofessional team to address those needs,” says Simpson. “The reason for that is our initial feedback from patients shows that they benefit from that relationship with their physician or nurse practitioner both in terms of improving their health and their satisfaction with the treatment they receive.”

Mike Simpson is Northern Health’s Executive Lead for Community Services Integration and Implementation. Photo: Joanne MacDonald

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This new way of delivering health care will see family physicians and nurse practitioners communicating and collaborating regularly with individuals and their families about their treatment needs, supported by an interprofessional team composed of specialists and Northern Health staff. The latter include: primary care nurses; mental health clinicians; social workers; occupational therapists; physiotherapists; life skills workers; dietitians; and others.

The new team-based care model means that physicians and/or nurse practitioners will work with the rest of the interprofessional team members from Northern Health as well as specialists, sharing information via electronic medical records (EMR), as well as in face-to-face meetings. But they’ll also include individuals and their families in their own care management. “That’s an important shift we’re making,” says Simpson. “We’re bringing the person and family into their care planning so we’re working ‘with’ them, not ‘for’ or ‘to’ them. We don’t want anyone to fall through the cracks.”

NH | integrated accessible health services Primary Care Nurse Ricki Smith is based at Highland Health and Family Development Centre in Prince George. As part of an interprofessional team attached to nine physician practices, she says the new system gives people easy access to health care providers. “In our practice, people don’t have to repeat their stories all the time. They feel supported and heard and the team really tries to anticipate their needs,” says Smith. “And the team asks questions on behalf of the person being served in an effort to highlight all aspects of their current health status. Also, for those without family support or who have cognitive issues or just can’t hear, we’ll join them at their doctor’s appointments.” She adds that relationships between physicians, their medical office assistants (MOAs), and community agencies, “are great.” Adds Smith: “I believe the team members trust me and trust my decision-making, so there’s a lot of respect between individuals on the team. We each recognize we have our own specialized body of knowledge. We share that pool of knowledge and it provides better care for the patient and their family. I also have that knowledge to carry on to the next client.”

Laura Johnston is Northern Health’s Regional Project Manager for Integrated Health Services. Photo: Joanne MacDonald

Prototype communities share experiences

11 Prince George-based physician practices; and at the Fraser Lake Community Health Centre.

Extensive groundwork has been done in the three Northern Health communities set up in September 2012 as the prototypes for integrated health services: Fraser Lake (small community); Fort St. John (medium); and Prince George (large).

Laura Johnston, Northern Health’s Regional Project Manager for Integrated Health Services, says it’s important to acknowledge the prototype work that’s been done to date.

The best practices gathered from their team-based care work are already being implemented at such integrated sites as the Fort St. John Prenatal Clinic; at

“Due to the accumulation of knowledge from their work over the past two years, we’ve been able to take these next steps where we can confidently move from testing to implementation,” says Johnston.

“This change to integration is very transformational in that it is really shifting how we’re delivering services everywhere. We need to figure out how to get out of the acute care business. We need to invest in more services in the community to support people in the community, as compared to thinking that the hospital is the best place for them. I would love to start closing beds in the hospital and using those resources to keep people where they want to be. They don’t want to be in the hospital, they want to be in their homes. Same as in residential care — we’ve got great facilities but at the same time, they’d rather be in their own home.” Angela De Smit, Chief Operating Officer, Northeast, on how integrated health services are changing health care delivery Photo: Joanne MacDonald

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NH | integrated accessible health services Integration teams coming to each HSDA All of Northern Health’s Chief Operating Officers (COOs) are developing an integration implementation plan for their specific Health Service Delivery Area (HSDA). Interprofessional teams are now being developed region-wide and a preliminary schedule shows: •

The Northwest is proceeding with wide-scale implementation;

•

The Northeast is concentrating on Fort St. John expansion and implementation in Chetwynd;

•

The Northern Interior is concentrating on scaling up Prince George and the Lakes District.

Simpson says each of the COOs is taking into consideration the readiness of their physician partners and the staffing resources available in Northern Health, such as services that are provided in the primary care home versus specialized services within Northern Health. “I’m referring to those services that need a level of intensity or access to a specialist that usually cannot be provided within a primary care practice or primary care home; for example, chronic disease management, renal services, heart services, COPD, or psychiatry,” he says. The next step for the COOs and their leadership teams will be to start discussions with unions, their managers and staff about how to prepare for the transition and the process for moving positions. Implementing integrated health services will result in some Northern Health jobs changing, with workforce transition plans being drawn up for each HSDA.

“These plans will determine which positions will move to the interprofessional teams and which positions will be retained to provide both regional and specialized services,” says Simpson. He added that work is being done on a management structure to oversee the work of primary care, the interprofessional teams and other services at the HSDA level.

Regional alignment of services Work has also begun on realigning different levels of service such as improving a person’s journey to and from a specialist, especially if it means that travel outside of their community is necessary for an appointment. Simpson says it will be important to ensure that the patient’s information is shared electronically between a primary care home and specialist. Indeed, the Information Technology Services department’s goal is to specifically move all health care providers onto the same electronic medical records system, namely, Integration Community Clinical Information Systems (ICCIS). Simpson adds that service realignment must also take into account that certain Public Health services (http://bit.ly/1F6obPq) must remain within Public Health. They include: •

facility and residential care licensing;

•

child care licensing;

•

environmental protection, including water, sewer, food inspection; and

•

population health strategies, such as the recent Quit Now stop smoking strategy.

“We need Public Health to be able to continue to

“Our interprofessional teams will be comprised of various health care professions working in a specialized capacity to support the needs of the primary care homes. Some needs will be communityspecific; however, general needs to support complex and chronic care, and enhanced services to maternal health are currently included in the implementation planning and design. Communities will work within existing resources to support the integrated care delivery to their patients. By collaborating across community care (i.e., current primary care, public health, home and community care, and mental health and substance use), the goal to reduce current service delivery inefficiencies is optimized and we can provide better and coordinated care.”

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Penny Anguish, Chief Operating Officer, Northwest, on how the northwest is gearing up to deliver integrated health care Photo: Submitted

NH | integrated accessible health services provide those kind of population-based changes and strategies and to stimulate the whole organization to think ‘upstream’,” he says.” Dr. Ronald Chapman, Northern Health’s Vice President, Medicine and Clinical Programs, notes that changes may also have to be considered for the payment models for physicians and nurse practitioners. “Physician compensation is not always congruent with this integrated health services approach so we will need to work with physicians, the Ministry of Health, and the Doctors of BC to identify and address some of the potential issues,” he says.

Simpson echoes Loiselle’s comments. “By using a team-based primary care model, we’re building partnerships with individuals, their families, physicians and our staff to deliver sustainable, quality care and improved experiences of the health services provided,” says Simpson. “Our future at Northern Health is all about involving people and their families in their own health care, with the ultimate result being better health outcomes.”

IHS = one-stop shopping Despite the transformative changes that Northern Health is facing, Social Worker Brigitte Loiselle supports integrated health services as the way of the future in health care. She’s another member of the interprofessional team based at Highland Health and Family Development Centre in Prince George. As a front-line worker, she describes the benefits of integrated health services for the people we serve and health care providers as akin to “one-stop shopping.” “What I’m finding is we’re really meeting the needs of the people who would fall through the gaps normally. People in this system have access to services that they wouldn’t before — not just one service, it could be a multitude,” says Loiselle. “People that might have ended up in long-term placement are now functioning at home. They’re getting referred to different agencies to help them and they’re not falling through the cracks and getting sicker as they may have before. The team-based care approach takes the burden off me and other health care providers and, in time, this approach will ease the burden on acute care services.”

Brigitte Loiselle is a Northern Health social worker and a member of an interprofessional team of health care providers based at Highland Health and Family Development Centre in Prince George. Photo: Joanne MacDonald

“Make no mistake, these early days of team-based care are really tough on our amazing staff — they are having to figure out new ways of delivering care, how to chart in an electronic medical record and to work in new partnerships all the time — all while receiving plenty of new requests to serve clients. Despite all of these challenges, we continually hear from the staff delivering team-based care that this is the way to go for patients and for staff. When we have our staffing ratios right, they are able to be more consultative with one another, they are able to be nimble as a team and respond effectively to situations that come up, and they are able to partner with physicians in ways that our old system structures couldn’t support.” Suzanne Campbell, Director, Community Services, Prince George, on how two Prince George interprofessional teams are collaborating with 11 physician practices Photo: Joanne MacDonald

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NH | integrated accessible health services

Prince George Division of Family Practice supports Northern Health’s move to integrated health services By Joanne MacDonald, Communications Officer, Joanne.MacDonald@northernhealth.ca

or Dr. Garry Knoll, it doesn’t get much better than to receive a pat on the back from one of his patients.

“A patient of mine came in a few weeks ago, and this is an 89-year-old guy who’s living independently. He told me that the best thing I ever did was introduce him to the primary care team. It’s made a big difference for him and his health,” says Knoll, Chair of the Prince George Division of Family Practice (http://bit.ly/1Eo60mx). Knoll’s primary care team — or interprofessional team — consists of physicians working with registered nurses, social workers, occupational therapists, physiotherapists and, more recently, a mental health worker and life skills worker. Many of these interprofessional team members are Northern Health staff based at various work sites who collaborate with physicians or nurse practitioners and patients at the

primary care home, the main point of entry into the health care system for individuals. Working together, they assess the patient’s care needs, identify the patient’s health goals, provide followup and coordinate the patient’s treatment. “There are so many different services and options for health care that it’s difficult to have all these things brought together in the context of a specific patient. The challenge is to find what the best options are for patients when they’re facing health care choices,” says Knoll. “With multiple comorbidities and multiple health conditions, there are often many services that overlap and many health needs that come up that need a team approach. We have patients who would be in hospital or in care if it were not for the integrated team that’s helping us at our practice.”

Dr. Garry Knoll, Chair of the Prince George Division of Family Practice, discusses how integrated health services will work at an open house in Prince George.

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Photos: Joanne MacDonald

NH | integrated accessible health services There are currently 11 physician practices in Prince George delivering health care services using a teambased care approach. Olive Godwin, the Prince George Division’s executive director, says the practices were chosen to participate based on perceived readiness, optimized electronic medical records (EMR), and their engagement in quality improvement activities. “Team-based care is the way that patients think we always have worked, but we’re late to the party in actually reorganizing our services in the way that patients should be served or want to be served,” says Godwin. “From a medical model perspective, patients were often thought of in the disease categories and not as a whole person. That’s changing, and all of that together will provide a better level of care for patients, particularly as we age and the level of complexity increases.” At Dr. Barend Grobbelaar’s Prince George practice, nurse practitioner Helen Bourque is part of the primary care team. Northern Health pays her salary, with Grobbelaar and his colleagues subsidizing Bourque’s space and supplies, and receiving a small stipend from Northern Health to help cover her overhead. Grobbelaar supports integration; however, he says that it signals a major change in the way that physicians will conduct business. “Right now, we’re embarking on a big project called integration. And what we are doing is attempting to integrate a private, fee-for-service system with a public, salaried system,” says Grobbelaar, Vice Chair of the Prince George Division of Family Practice.

“We are going to have to be very innovative and we have to figure out the best way to support doctors for how they work — and less so for how much they work.” Dr. Barend Grobbelaar, Vice Chair, Prince George Division of Family Practice

“As people can imagine, there will be challenges with that, because the two systems have different drivers. So for our effort to be sustainable, we are going to have to be very innovative and we have to figure out the best way to support doctors for how they work — and less so for how much they work.”

Dr. Barend Grobbelaar is the Vice Chair of the Prince George Division of Family Practice and runs his own private practice. He notes that the success of integration depends, in large part, on physicians and their integration partners developing comprehensive care plans for patients. However, creating care plans can be time-consuming; as well, they must be maintained in order for patients to receive responsive, comprehensive and coordinated health care from their family practitioners, community health care professionals or specialists. As a result, Grobbelaar says the value of a care plan must be weighed against the number of patients that doctors could normally see and treat in the time that it takes to develop the care plan or interface with an interprofessional team. After all, says Grobbelaar, the fee structure currently in place does not compensate doctors to develop care plans. “So we’re going to have to demonstrate the functionality of integration. I think there’s a general buy-in with the concept that integrated care is better than siloed care. I don’t think anybody would contest that,” he says. “However, the learning curve for actually developing a comprehensive care plan is a part of what I was alluding to in saying that we have to support doctors in how they practice — as opposed to how much they practice.”

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NH | integrated accessible health services

Nurse practitioners: bolstering the ranks of northern health care professionals By Helen Bourque, Nurse Practitioner Lead, Helen.Bourque@northernhealth.ca

t was in 2005 that the BC government introduced a new class of health care professionals — nurse practitioners — to alleviate the shortage of primary care providers in the province. And, in short order, it’s paying off. Qualified to assess, diagnose, and treat patients for many different problems, nurse practitioners can order tests, interpret the test results, refer patients, and prescribe medications. They manage a variety of patient conditions and concerns in the course of a workday, from newborn checkups to women’s health; diagnose new acute problems; and refill medications for ongoing diseases. They may see patients who struggle with mental health, addictions, and/or chronic pain. Nurse practitioners have a graduate level of education, and must meet rigorous requirements through the College of Registered Nurses of British Columbia (CRNBC) (http://bit.ly/1HzKFhy) in order to be licensed. There are three streams of licensure for nurse practitioners: family (care for patients from cradle to grave); adult; and pediatric. The position offers a new and exciting option for people interested in becoming health care professionals. As Paula Gansner describes it, being a nurse practitioner provides a “better fit” for her than did her previous job as a registered nurse.

Northern Health’s nurse practitioners gathered for a regional meeting in Prince George on March 12, 2015. Photo: Joanne MacDonald

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“I wanted to practice in Fort St. John because of the opportunities to consolidate my practice as an NP and because of the amenities the community has to offer,” says Gansner, who works in the community’s Unattached Patient Clinic. “The NP scope of practice is vast in Fort St. John and I do things I might never have an opportunity to do in the city, medically speaking. It’s very stimulating and offers amazing learning experiences.”

Finding a niche in northern BC Northern Health (www.northernhealth.ca) hired its first nurse practitioner in 2005 in the Fraser Lake Community Health Centre. By 2010, Northern Health had approximately 10 nurse practitioners working in northern BC. Today, there are 24 nurse practitioners employed across Northern Health, and four working in private industry or in partnership with Northern Health to provide primary care services to patients. Offering a competitive wage and educational incentives, Northern Health also provides a strong community of practice for nurse practitioners. Lauren Irving works as a nurse practitioner with a diverse health care team at Central Interior Native Health Society (www.cinhs.org) in Prince George. She says providing team-based primary health care to a largely marginalized population gives her the opportunity to consolidate her skills and treat a wide variety of health concerns.

NH | integrated accessible health services “I work with physios, counsellors, social workers, registered nurses, doctors and a fellow NP, to name a few,” says Irving. “It’s fantastic to have everyone under the same roof and working closely with one another to provide patient care. I believe it really enhances health care for patients when they receive care from a multidisciplinary team.” Northern Health’s strong vision of primary care also gives family nurse practitioners the opportunity to work to their full scope of practice in many rural and remote settings. Theresa Smith, a nurse practitioner based in Fraser Lake, says the opportunity to keep her hand in acute care at the Fraser Lake Community Health Centre is an added bonus in her job. She values the opportunity to work with an occupational therapist, mental health and public health clinicians, dietitians, visiting specialists, as well as skilled physician and nursing colleagues. “My team is awesome. I feel like we collaborate very well and this is fostered by being a pilot site for integration in Northern Health,” says Smith. “I work with a wide variety of professionals and I feel that we use each other and our skills to their full realizations. I feel valued and that goes a long way in making a work day something I look forward to.”

Varied employment opportunities Nurse practitioners work in fee-for-service practices; clinics that are non-profit and in partnership with Northern Health; and clinics that are considered alternative payment plan sites, where everyone

“I work with a wide variety of professionals and I feel that we use each other and our skills to their full realizations. I feel valued and that goes a long way in making a work day something I look forward to.” Theresa Smith, Nurse Practitioner based in Fraser Lake

is on salary, physicians included. Many nurse practitioners are also involved in teaching through the University of Northern BC in the nursing program (http://bit.ly/1Bh17M3) and/or assisting with clinical skills teaching for the Northern Medical Program (http://bit.ly/1oy8ltO). They take on students (nurse practitioners or medical students) and also work with residents. “I still have to explain my role to patients sometimes, so there is some education about nurse practitioners that needs to happen,” says Gansner. “But the patient feedback I’ve had is that, in general, they’re all grateful to have access to more health care professionals. It’s been a great experience so far. I’d been thinking of staying here for two years, but now I’m thinking of staying indefinitely.” Helen Bourque was appointed Northern Health’s Nurse Practitioner Lead in summer 2014. She has worked for Northern Health for the past 12 years, transitioning from her role as Clinical Educator in Home and Community Care, to nurse practitioner. She is an Adjunct Professor in nursing at UNBC, teaching in the Rural Nursing Certificate Program. She works part-time in a fee-for-service setting in Prince George.

Vanderhoof health care providers take aim at chronic pain By Raquel Miles, Lead, Practice Support Coach, Vanderhoof and Lead, Primary Health Care Community Programs Integration, Fraser Lake, Raquel.Miles@northernhealth.ca

n interprofessional team of health care providers in the rural community of Vanderhoof is making a difference in the lives of people living with chronic pain. It all began in the fall of 2013, when Vanderhoof physician Dr. Suzanne Campbell expressed keen interest in the Practice Support Program (PSP) chronic pain module (http://bit.ly/1Eo6qt9). Dr. Campbell — along with team members Occupational Therapist Valerie Pagdin, Mental Health Clinician Brad Van Dolah, Omineca Medical Clinic Chronic Disease Manager Heather Goretzky and Practice Support Coach Raquel

Miles — attended two Train the Trainer sessions for the pain module in Vancouver. The team returned to the community inspired to begin building a multi-faceted, long-term, sustainable chronic pain strategy that positively impacted the experience and lives of people living with chronic pain by offering local resources. Significant pieces of work included: • •

using tools in the electronic medical record to track patients’ pain experience and symptoms; building, testing and embedding a standard service request process for all physicians and community programs;

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NH | integrated accessible health services

(l-r) Heather Goretzky, Dr. Suzanne Campbell, Raquel Miles and Valerie Pagdin. Photo: Gurwinder Lilly •

•

“wrapping” all individuals living with chronic pain with a local team that included the physician, occupational therapist and mental health clinician; Partnering with Northern Partners in Care (http://bit.ly/1Raqzw2) to pilot a remote support model with a chronic pain specialist, psychologist and physiotherapist for family physicians and allied health professionals in the community.

The training sessions in Vancouver also prompted the team to focus on provincial resources and support with a focus on self-management. “After the PSP session in April, our interprofessional team was inspired and very interested in connecting with the University of Victoria Chronic Pain Self-Management program [http://bit.ly/1dpmEwZ] to explore bringing their workshop to Vanderhoof,” says Dr. Campbell. After months of planning and working collaboratively with the self-management program coordinator for northern regions, the six-week workshop was offered for the first time October 8 until November 12, 2014.

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Dr. Campbell and her colleagues identified individuals living with chronic pain who were personally invited to participate in the workshop. Two volunteers from Prince George facilitated the weekly three-hour sessions. Eleven local people completed three or more of the weekly sessions with another five people able to attend one or two sessions for a total of 16 participants. Followup telephone evaluations completed by Goretzky captured overwhelming support for the program.

A couple of important themes emerged from the evaluations. First, 50 per cent of respondents indicated that “connections” – connecting and building relationships with other people in the community living with chronic pain – were incredibly important and rewarding and made them feel “less alone”. The second theme identified was “goal setting” and the usefulness of a tool called Brief Action Planning to help set small achievable goals. The incredible success of this workshop in our community can be summed up by the overwhelming number of participants who would recommend this workshop – 87.5 per cent, or 14 out of 16 participants, said they would recommend this workshop to others. The patient experience and satisfaction surveys unequivocally show the University of Victoria’s SelfManagement Chronic Pain workshops were a success in Vanderhoof. “Our team is thrilled with the patient evaluation results and this kind of data solidifies our commitment to offer the workshop again in our community in the near future,” says Dr. Campbell. “This is a great example of physician engagement and practice improvement, team-based care, system transformation, patient engagement and selfmanagement at work. I applaud the work of this team in making a difference in the lives of individuals living with chronic pain.”

Protect yourself with healthy habits like these: →

Make food personal: grow, gather, catch, preserve, cook, and eat food together.

→

Increase your physical activity to improve your health and wellness. Limit your sitting and screen time!

→

Playing safe is more fun! A concussion could put you out for the season.

→

Vaccines save lives! Vaccines can help you to live free of illness and disability associated with preventable diseases.

→

Talk to a public health nurse for confidential, non-judgmental, and positive sexual health information.

Make the healthy choice today.

northernhealth.ca #healthynorth

the northern way of caring

NH | high quality services

At Northern Health, the Patient Care Quality Office is about quality improvement — not blame By Yvette Rutherford, Regional Manager, Patient Care Quality Office, Yvette.Rutherford@northernhealth.ca

id you know that Northern Health has a Patient Care Quality Office (http://bit.ly/1cSjKA5)? And do you know what it does? The office, often referred to as the PCQO, is physically located in Prince George but is a regional office covering every community and service offered through Northern Health.

As Northern Health’s only full-time PCQO employee, I can be contacted by patients at the PCQO Monday to Friday, from from 8 a.m. to 4 p.m. via a toll-free number:1-877-677-7715. Patients can also send me a letter or email at patientcarequalityoffice@northernhealth.ca. The office has a mandate in legislation, the Patient Care Quality Review Board Act (http://bit.ly/1FIyFtO), which requires every health authority to have a PCQO. And it’s important to remember that the office has a quality improvement focus — and is not about blame. My responses to the complaints I receive are as varied as the complaints themselves, and can involve answering direct questions about a patient’s care, or perhaps offering an apology for our Northern Health staff who are not meeting our patients’ expectations. With each complaint, I work with the managers of the department or program in question to try to find a satisfactory resolution. If the issue cannot be resolved at the PCQO level, then there is an escalation process that involves the Patient Care Quality Review Board (http://bit.ly/1LtOPWG) in Victoria. The Review Board reviews the complaint and the health authority response, and then makes recommendations on how we could improve health care or how the PCQO process could improve.

Yvette Rutherford is Northern Health’s Regional Manager, Patient Care Quality Office. Photo: Joanne MacDonald The purpose of the office is to give patients and clients an opportunity to raise concerns about the care or services they have received that have gone unresolved at the local level. This might involve: • •

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•

a complaint about the care a patient has received while in hospital; dissatisfaction with the number of home support hours allocated; or unhappiness at how a matter was communicated to a client.

Health care professionals are excellent at identifying the big issues — the sentinel events that everyone agrees that something went wrong. However, in the day-today hustle and bustle of our jobs, it can sometimes be easy to miss the small things. The way a person receives the news that their loved one is dying, or the way in which a remark from a nurse is interpreted, can be devastating for that person. If you, as a Northern Health staff member, gets a call from me at the PCQO, do not panic: just remember that complaints should not be considered as something negative to avoid, but instead are opportunities for us to reflect and improve upon our work.

NH | high quality services

Clean your room . . . why your mother was right! By Marcia Bertschi, Quality Improvement Advisor, Marcia.Bertschi@northernhealth.ca and Tamara Checkley, Research and Evaluation Coordinator, NW, Tamara.Checkley@northernhealth.ca

uite often we don’t recognize that our physical environment or our equipment and supplies do not support our everyday processes. We are too immersed in our day-to-day responsibilities to stand back and reflect on our physical environment, and we miss opportunities to make our workplace support, rather than frustrate, health care or service delivery. 5S (http://bit.ly/1cSkHIB) is a simple tool to help you organize your work space, including equipment, supplies, forms, etc., to minimize frustration and maximize efficiency. 5S — which stands for Sort, Set In Order, Shine, Standardize and Sustain — is a foundational tool for Lean and builds the groundwork for engagement. As you may know, Lean initiatives aim to create more value for customers while minimizing waste. S o, as N o r t h e r n H e a l t h wo r ks towa rds supporting a culture of continuous improvement, there is an opportunity for every work environment to be reviewed through a 5S lens. To support you and your team in doing a 5S project in your department, our Quality Improvement team has created a 5S site that provides all the information you need to get started: The page includes: •

A how-to guide providing the steps in each stage of the 5S program;

•

A checklist so you can compare the space to be organized before and after; and,

•

Storyboards so you can review ideas from others that have already been completed.

Ready for spring cleaning? Here’s how do a 5S: •

Identify the area you want to start with;

•

Get the people who work there together to make decisions;

•

Book time off of regular work or allocate time out of the regular work (see backfill funding (http://bit.ly/1LtQawV) you can apply for);

•

Organize the space within the allotted time frame;

•

Make a to-do list for the remaining space;

•

Incorporate maintenance into daily and other regular routines;

•

Review to see if changes are maintained and make adjustments accordingly; and

•

Celebrate your hard work.

5S empowers the whole team to work together and design your workspace to best meet your needs. It allows you to accomplish visible change in a short period of time, resulting in safer workspaces and reduced time searching for supplies. We want to hear about your work, and have created a simple 5S storyboard. If you submit your storyboard then we will have a monthly draw for a $25 dollar gift card and a quarterly draw for a supported 5S activity from our team. So we challenge you — try out the 5S tool!

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NH | high quality services

Northern Health implements final phase of CBORD food and nutrition meal service system By Neil Wilson, Project Leadâ&#x20AC;&#x201D;Nutrition and Food Information Systems, Neil.Wilson@northernhealth.ca

BORD is a food and nutrition information system used and respected worldwide. It is the meal service system of choice in all health authorities in British Columbia (except for Vancouver Coastal) and has been in use province-wide for several years in Alberta. The CBORD system (http://bit.ly/1Eo8521) is a tool that helps Northern Health with the detailed annual management of $7.5 million of food and related

In the Food Services Department, University Hospital of Northern BC: Top left: (l-r) Jean Schening, Food Service Manager, Holly Branisel, Food Service Supervisor; Top middle: Kathy Nevison, Cook; Bottom left: Helen Lai, Food Service Worker; Bottom middle: Kathy Nevison and Dawn Taylor, Cooks; Bottom right: (l-r) Aurora Mernickle, Food Services Supervisor, and Linda Irzinger, Food Service Clerk. All photos: Joanne MacDonald

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supplies through its journey from ordering to serving 560 acute care patients, 1,100 complex care residents, Meals on Wheels clients, adult day care clients, as well as cafeteria and catering customers. Northern Health is in the final phase of implementation of the CBORD system in its 18 acute care and 13 complex care facilities, which are served by 26 kitchens operated by Northern Health employees. The CBORD project started in June 2011 and is scheduled to wrap up at the end of June 2015. Gateway Lodge was the first Northern Health facility to use the CBORD system, going live on October 29, 2013. The final go-live is planned for Bulkley Valley District Hospital on June 17, 2015. Hereâ&#x20AC;&#x2122;s how it works. The CBORD database includes standardized ingredients, recipes, diet restrictions,

NH | high quality services allergens, traits and menus. Linked to the Canadian Nutrient File (http://bit.ly/1Llu7rr)— a comprehensive, computerized database that lists the nutrients in foods commonly consumed in Canada — the CBORD system analyzes recipes and menus for nutrient composition. Meshing this information with patient and resident data, which is also stored in the database, the CBORD logic decides which foods meet the patient’s or resident’s needs. It then creates various production reports for the kitchens, which reflect the food choices made, and also prints patient-specific tray tickets and nourishment labels for each meal. Based on menu forecasts, CBORD helps to estimate vendor food orders, creates electronic orders for transmission to some vendors, and enables good practice for receiving, issuing and tracking inventory. Besides meeting the primary goal of improving patient safety, CBORD will track all products through the system and will generate reports to enable improved cost control when the system is fully functional. Key to the operation of CBORD is the Regional Diet Office and its staff, who form a hub for the flow of information from numerous sources such as the

Admission/Discharge/Transfer (ADT) interface, nursing, and food service operators. The Regional Diet Office for Northern Health is the first of its kind in BC, and has been established to handle all patient diet changes, patient preferences and menu information for all of Northern Health’s acute and complex care facilities in northern BC. It will help ensure that all diet orders, allergies and preferences are handled identically across the region.

Top centre: Gordon Callander, Cook; Top centre left: Gurjit Seehra, Food Service Worker; Top centre right: Patient tray ticket; Top right: (l-r) Kari Daly and Chantal Van Egdom, Food Service Workers; Bottom left: Shirley Thomson (front) Debbie Garraway (rear), Food Service Workers; Bottom middle: Jessica Harvey, Food Service Worker; Bottom right: John Paul Maranan, Food Service Worker.

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NH | high quality services

What is accreditation and why does it matter to me? By Lexie Gordon, Quality Improvement Lead, Northeast, Lexie.Gordon@northernhealth.ca

want only the best care for my family and friends. In the past 10 years, my family has needed health services to support aging parents and grandparents. Maternity services were needed to bring a grandchild into the world; a few years later, emergency services were needed to save the life of that grandchild from a near drowning. We got all of these services from Northern Health.

“The names of the patients whose lives we save can never be known. Our contribution will be what did not happen to them. And, though they are unknown, we will know that mothers and fathers are at graduations and weddings they would have missed, and that grandchildren will know grandparents they might never have known, and holidays will be taken, and work completed, and books read, and symphonies heard, and gardens tended that, without our work, would never have been.” Donald M. Berwick, MD, MPP - President and CEO, Institute for Healthcare Improvement

Lexie Gordon is Northern Health’s Quality Improvement Lead, NE, and spearheads the organization’s accreditation preparation and compliance work. Photo: Joanne MacDonald Participating in Accreditation (www.accreditation.ca) helps Northern Health keep up-to date with the best practices and safety requirements in health care. Accreditation helps us identify what we are doing well and what we could do better. We are held accountable for making improvements and for making them “stick”. The multi-year improvement cycle of self-assessments, survey tools and site visits is good for us and everyone in our care. Sometimes if we are stressed with preparation details and logistics, we forget the real reason for the site visit by Accreditation Canada surveyors to our health care facilities — improving quality and safety.

History of Accreditation P | 18

Since 1958, Canada has had an accreditation program to improve the quality of health care. The

origins date back to 1917 when surgeons in both Canada and the U.S. developed a one-page minimum standard for hospitals. Now, Accreditation Canada conducts widespread consultation, research and evaluation to develop national standards for many services. Standards focus on things vital to quality: leadership, people, processes, information and quality performance. Ten to 60 pages can be required to cover the detail and complexity of standards in a single service. Required Organizational Practices (ROPs) (http://bit.ly/1Ak2VsP) are also an important part of accreditation. An ROP is based on proven practices that, if implemented, will improve quality and safety. ROPs cover six safety goal areas: safety culture, medication use, communication, worklife/workforce, infection control, and risk assessment. Northern Health has undergone three accreditation cycles: 2008, 2011 and 2014. As a result of the 2014 survey, we are required to submit more evidence that we are meeting the standards for required organizational practices: e.g. preventing falls and pressure ulcers, improving client identification.

Quality improvement a priority for Northern Health As a Quality Improvement Lead in the Northeast for Northern Health, I also only want to work in an organization that I can take pride in. While some care

NH | high quality services received by my family has been stellar (my granddaughter is now a vibrant and healthy three-year-old), some care needs to be improved. My family knows that care teams don’t always communicate with one another. We know that medications don’t always get reviewed when they should. We know that preventable deaths still happen despite the best efforts of staff.

The work we are doing now to achieve standards and required organizational practices on an ongoing basis will also relieve the anxiety that seems to come with welcoming surveyors to observe our innermost workings again in 2018 — our next site survey. After all the preparatory work we did in recent years, there was a lot of relief when the June 2014 site survey was over!

We can be proud of the work done to make patients safer in our care through required organizational practices and other work done to meet all accreditation standards. There is no doubt that we have more work to do to keep all patients safe and deliver high-quality care every time.

I believe that accreditation helps Northern Health do the right thing for every patient, every day, at every site for my family and yours. Accreditation provides me and you with a measure of assurance that Northern Health provides quality care and safe care.

Using documented evidence in your health care practice can reap rewards By Candice Manahan, Executive Lead, Physician Quality, Candice.Manahan@northernhealth.ca

t Northern Health, we have made a commitment to establish the organizational structures and processes required for effective decisionmaking and managing the changes that are needed to improve quality. This commitment drove our Policies, Procedures and Clinical Practice Standards team to improve staff access to current, meaningful clinical practice standards — best practices — to fit our northern context. Now we want all staff to benefit from our efforts.

The benefits of using documented evidence in health care practice are illustrated in an article written by Joanne Gard Marshall et al (http://1.usa.gov/1HzmsVO), published in the January 2013 issue of the Chicagobased Journal of the Medical Library Association (http://bit.ly/1IPSFLE). Marshall and her colleagues conducted a survey among 16,122 physicians, residents and nurses across 118 hospitals who had recently accessed the best information and research available to inform their practice. Marshall’s team found that: •

Three-quarters of the staff said that they handled patient care differently after reading evidence;

•

95 per cent said the information resulted in higher quality care and better informed decisions;

•

85 per cent said having the information saved them time; and

•

Staff avoided adverse events: misunderstanding of disease (23 per cent) misdiagnosis and adverse drug reactions (13 per cent); medication errors (12 per cent); and patient mortality (6 per cent).

Thanks to the input from Northern Health staff from across the region, the Policies, Procedures and Clinical Practice Standards (http://bit.ly/1K9Q0tv) page on OurNH has been revised to support staff in accessing evidence to inform their practice. The website has been revamped to include a Google search that searches our current Northern Health standards, as well as Mosby’s Nursing Skills (http://bit.ly/1Ak3rY1), and other provincial or national resources, to ensure staff have relevant information in a timely manner. Staff can search the website alphabetically and by category. We also host a series of clinical teaching videos, presentation and learning materials to support best practice. Staff indicated they wanted to be alerted when policies were revised or added. Staff can now set up email alerts to find out when new information is available, and the policy office will send out quarterly newsletters to alert staff about what’s new in policies or standards. Another function of the site is that it is always open to feedback. If you read a policy or standard that needs edits or revisions, you can send a note to the “Provide feedback” function on the Policies, Procedures and Clinical Practice Standards home page. This feedback function can facilitate peer review and continuous quality improvement. To take an eight-minute virtual tour of the website and learn how to set up alerts, go to: Alerts for Policies, Procedures and Clinical Practice Standards (http://bit.ly/1LluKBc). To have someone from the Policy and Clinical Practice Standards office come talk with your team, contact Denise.Murray@northernhealth.ca.

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NH | high quality services

2015 Northern Health Quality Conference: Focused Improvement By Tanis Hampe, Regional Director, Quality and Innovation, Tanis.Hampe@northernhealth.ca

vice-president recognizing his “Improvement Heroes”, a provincial quality leader highlighting energy for change, interactive sessions with teams of architects and builders, and a journey through the jungle providing lessons about communication and planning were all part of the 2015 Northern Health Quality Conference experience. The conference was held March 16 and 17, 2015, in Prince George with the theme of “Focused

Top left: Martha Burd; Top middle: (l-r) Fraser Bell, Angela Pace, Sherri Lutz and Jane Wilde; Top centre spread: (l-r) Susan Kragt, Jason Jaswal, Karen Gill, Joanne Cozac, Lila Anderson; Bottom left: (standing l-r) Julie Creaser, Marcia Bertschi, Beth Ann Derksen, (sitting l-r) Mary Henderson-Betkus and Aileen Serle; Bottom right: (l-r) Lila Anderson, Krista Braddick, Sherri Lutz; Bottom centre spread: (l-r) April Price, Shelley Hatcher, Nicholas Aldred, Colleen Bowers, Ann Syme.

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Improvement.” Cathy Ulrich, Northern Health’s President and CEO, opened the conference by acknowledging the accomplishments in Northern Health that have moved our organization’s strategic plan ahead. She introduced the Ministry of Health Strategy and inspired conference attendees to think about what health in Northern BC will look like in 2035 and what we need to do to get there. Cathy also challenged the participants to think about the values of Northern Health and what the “northern way of caring” means to us, encouraging us to celebrate the improvement and innovation that staff do every day in our organization. Fraser Bell, Vice President, Planning, Quality and Information Management, acknowledged a shift in our organization over the past five years: “I can see Northern Health growing in our quality improvement capabilities.”

NH | high quality services Forty-six presenters highlighted Northern Health’s quality improvements participating in workshop, panel, fishbowl and traditional conference presentation formats. A staff panel shared how improvements focused on capacity and flow are underway in each Health Service Delivery Area. A record number of storyboards were showcased at this year’s conference. Judges evaluated the 47 storyboards to select the Top 5 and conference attendees voted “Rotary Manor Adult Day Away Program and Dawson Creek & District Hospital Alternate Level of Care Initiative” as the Best Storyboard. Quality improvement is a team effort. The Top 5 storyboards alone included a total of 42 team members in their projects. Think about how many Northern Health staff contributed to the amazing improvements highlighted on all 47 storyboards. Presentations, storyboards and other conference materials can be found on the Innovation and Development Commons website (http://bit.ly/1Llv9Uj). The theme for next year’s conference is Patient and Family-Centred Care, which is at the heart of quality care. What does this mean in our day-to-day activities in

Northern Health? How do we collaborate with patients and families in their care? And what improvements are we making in our system to improve the patient experience?

Top 5 Storyboards at the 2015 Quality Conference An Outpatient Physiotherapy Waitlist Management Strategy in a Northern Rural BC Public Practice Contact: Angela Pace, Rehab Manager, Kitimat

Implementation of the Dysphagia Screening Checklist Contact: Julie Lidstone, Tysen LeBlond & Amy Horrock, Regional Dysphagia Management Team

Improving Emergency Preparedness at DCDH Contact: Kelsey Breault, Infection Prevention and Control, Dawson Creek

Nurse Manager Impact on Improving Patient Care Contact: Jane Wilde, Director of Care, Prince Rupert & Haida Gwaii

Rotary Manor Adult Day Away Program and Dawson Creek & District Hospital Alternate Level of Care Initiative** Contact: Barb Tivadar, Activities Director, Long Term Care, Dawson Creek **Voted best storyboard of the conference

Top middle: (foreground l-r ) Roma Toor and Heather Chafe; Top right: (l-r) April Price and Jaclyn Sawtell; Bottom right: (l-r) Laura Johnston, Jesse Priseman and Sheena Smith. All photos: Joanne MacDonald

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NH | a population health approach

Concussions matter! Have you completed the CATT? By Shellie O’Brien, Injury Prevention Coordinator, Shellie.OBrien@northernhealth.ca and Denise Foucher, Injury Prevention Coordinator, Denise.Foucher@northernhealth.ca

The CATT is the first free online tool of its kind in Canada, providing up-to-date evidence-based education, tools and resources to help prevent, recognize, and properly manage a concussion. It provides specialized toolkits for: • • •

nce seen as just a knock to the head or “getting your bell rung”, concussion is now recognized as a traumatic brain injury requiring immediate recognition and management for full recovery. Every day this preventable injury takes people out of school, work and play, costing BC $2.4 million in 2010 for hospitalizations alone. The following statistics tell the story: •

•

• •

Northern Health has the highest rate of hospitalization for concussions of all the health regions in BC; 1 in 5 youth in northern BC reported experiencing a concussion in the past year, with many not seeking medical help to diagnose and manage to a full recovery; Children and youth up to age 19 represented almost 40% of concussion cases seen in emergency departments. The highest rate is for males ages 10-14; This age group takes longer to recover from concussion than adults; Most of these cases came from a sport-related injury.

In response to this burden, and with the opportunity to create a health legacy from the Canada Winter Games, as well as with the generous support of the Concussion Awareness Training Tool (CATT) (www.cattonline.com) and (www.preventable.ca), the Concussions matter! campaign was created.

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The campaign was designed to increase knowledge and awareness around concussion across the north.

Medical professionals; Parents, players, and coaches; and Educators.

Based on established international principles (Zurich Concussion Guidelines), the CATT has been reviewed provincially and nationally. These toolkits provide quick and easy access to numerous resources including journal articles, handouts, videos, recommended websites, SCAT 3 concussion assessment tools used by medical professionals, learning modules (for which physicians can claim CME Mainpro-M2 credit) and more. Reaction from Northern Health staff that have completed the CATT has been overwhelmingly positive. “Thanks for providing the link to this awesome resource. I found the short education presentation very informative and helpful,” says Taryn Opel, RN, Public Health Nurse, in Smithers. Daniel Bomford, Area Safety Advisor, Prince George, says, “Very interesting and informative. I know from experience that none of the recommendations were followed in my early years of university rugby.” Good concussion management reduces the risk of further brain damage and decreases health care costs related to long-term associated health issues. How a concussion is handled in the minutes, hours and days following an injury can significantly influence the extent of damage and recovery from that injury. Learn more about concussion to help our community members stay in the game, keep active, and have fun injury-free. Help standardize concussion knowledge and care throughout the north: Have you completed the CATT?

NH | a population health approach

Citizen Series Webinars: Helping northerners build healthier, sustainable communities By Sabrina Dosanjh-Gantner, Lead, Healthy Community Development-Local Government, Sabrina.Dosanjh-Gantner@northernhealth.ca

orthern residents often face challenges in participating in education, training and professional development because opportunities can be extremely costly, geographically inaccessible or limited by a lack of human resources in northern organizations. In response to these needs, Northern Health’s Healthy Community Development team (http://bit.ly/1Lm5NWh) has partnered with BC Healthy Communities (BCHC) (www.bchealthycommunities.ca) to design and deliver an innovative educational opportunity that is accessible to any northerner with access to a phone line, a computer and Internet connection. This partnership resulted in the development of the Citizen Series (CS) Webinars (http://bit.ly/1JHZCh5). Northern Health and BCHC are currently hosting the fifth year of the CS Webinars, which focus on topics with a northern lens and on the learning needs of northern, rural and remote communities. The webinars take place four times a year and have focused on important topics such as: health impacts of resource development; aging in place; and digital storytelling. Each webinar has a unique panel of speakers, who bring perspectives and experience from multiple levels, such as national/international, provincial and northern. This framework ensures that while the webinars include presenters with international, national or provincial reputations, the northern presenters are equally valued for their perspective and experiences. The value and impact of the CS Webinars is evident by the high participation and the feedback received from participants. As one webinar participant noted, “The extent of the participation was the main success of this webinar. The huge ‘buy-in’ bodes well for the future webinars in that they can access a large pool of activist leaders across the north/province as a whole. Having designated guest speakers/presenters was excellent and focused the discussion around a few major concerns.” Webinar participants also often provide insightful feedback as to how their practice has been impacted. In the words of another webinar participant, “It will direct me to consider the importance of community development in the work I engage in with families. Poverty, poor housing, etc., need to be considered

and addressed to better support families in moving from poor family health outcomes to healthier ones.” The CS Webinars continue to grow in popularity and depth of topics. It is often difficult to find effective ways of engaging diverse stakeholders in dialogues regarding topics that are affecting northern communities, especially when varying perspectives abound. However, the CS Webinars have been able to bridge these difficulties, and have played a significant role in supporting participants to learn, engage, expand assets, and collaborate around local actions that contribute to building healthier, sustainable and resilient communities in the north.

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NH | a population health approach

Introducing Spirit the caribou, Northern Health’s new mascot By Mike Erickson, Project Assistant, Health Promotions, Michael.Erickson@northernhealth.ca

here’s a new face of healthy living in northern BC. He eats a lot of fruits and vegetables, gets plenty of physical activity outdoors, and has some pretty solid gear to protect his head and prevent injuries! Spirit, a caribou designed by 13-year-old Prince George resident Isabel Stratton, is Northern Health’s new mascot and will be promoting healthy living across the province!

In case you were wondering where Spirit came from, as Isabel tells the story, he has had quite the journey to a healthy life himself! “When Spirit was young, he was adventurous and loved to explore. Throughout the years, he became big and strong. One day, when Spirit was out discovering the world, he got a really bad cold and had to go visit the doctor. The doctor said that even though it was a minor cold, it is important to be healthy so that Spirit can prevent other diseases. To help prevent other sicknesses, he learned that it is important to wash his hands and get lots of exercise. Spirit the caribou lives all around northern B.C. It’s important for him to stay healthy so he and his family can stay strong. Spirit really enjoys exercising, eating well, and making the right choices for himself and his body.” We can’t wait for you to meet Spirit at a healthy event near you! This article was first published in the Northern Health Matters blog on January 13, 2015.

Spirit the caribou goes for a winter stroll. Photo: Paul Alberts Spirit the caribou visited with hundreds of children and their parents during the 2015 Canada Winter Games, while attending many of the athletic events around Prince George. In this photo, he is at the CN Centre. Photo: Joanne MacDonald Proudly sponsored by the Spirit of the North Healthcare Foundation (www.spiritofthenorth.ca), Spirit arrived just in time for the 2015 Canada Winter Games. At his stops throughout the region, Spirit will be encouraging children to develop healthy habits like living an active lifestyle, eating healthy foods, wearing protective equipment, and more. Getting children excited about their health is key to building a healthier north!

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Spirit will be travelling across northern B.C. to take part in community events and to engage the youngest members of our communities on healthy living issues. Spirit will make health more fun and accessible to a young audience, leading to healthy habits for life!

Let’s blog about health! At Northern Health, our staff and our partner organizations do a lot of great and interesting work with individuals and communities to promote health. We hope the Northern Health Matters blog will be a place And we hope we can share a few tips and ideas that will start you on the right track to living a healthy life — for you, your family, and your community! Have a story idea or want to share a healthy success from your community? Let us know how you show that northern health matters! Contact us at healthpromotions@northernhealth.ca

We want to hear your stories! In each issue of The Northern Way magazine, we’ll be featuring stories about health care across the region — and we need your help! We’re looking for engaging, personable stories written by — and about — Northern Health staff and physicians. We want to hear about the things that you and your colleagues do — and do well. Your stories will illustrate how we, along with our community partners, can improve the work that we do. And we’ll raise awareness and support for all of the work across Northern Health that occurs on a daily basis. If you’d like to contribute a story to your new magazine or comment on a story in this issue, please contact us at hello@northernhealth.ca

northernhealth.ca

#healthynorth

the northern way of caring

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NH | a focus on our people

A conversation with Dr. Ramesh Kamath: Lead physician at Fort St. John Unattached Patient Clinic supports team-based care By Joanne MacDonald, Communications Officer, Joanne.MacDonald@northernhealth.ca

r. Ramesh Kamath arrived in Fort St. John in August 2014 from Vancouver, after completing the highly competitive International Medical Graduate Program (http://imgbc.med.ubc.ca) at the University of BC.

Was it a joint decision for you and your wife to move here? I guess it’s kind of both. We did know that there were oil and gas opportunities here. I’d come up here last year and had a look around. I decided I’d do ER at the Fort St. John Hospital for a month while I was still a resident, see how I liked it. And it was nice. There is a lot of work that a family doctor can do up here, unlike in the big cities. You don’t have a whole lot of specialists up here so you get to do a lot more. So that was appealing to me.

Were you a family doctor in India? No, I did internal medicine followed by diagnostic cardiology. I did echocardiograms, Holter monitors and treadmills, and practiced as an internist.

What have been some of the challenges you’ve faced working in a smaller community than Vancouver?

(l-r) Dr. Ramesh Kamath and Nurse Practitioner Paula Gansner work on the health care team at Fort St. John’s Unattached Patient Clinic. Photo: Joanne MacDonald

I was completely overwhelmed when I started in August last year. Being the only physician here, and with the type of work and the loads we had, it was truly overwhelming; but then I wasn’t looking at the day-today stuff like fevers, flus, or coughs and colds. It was mostly complex conditions so it took a lot of time.

Originally from India, Dr. Kamath and his wife, Madhu Toshniwal, are the parents of two grown sons, who both studied as international students at McGill University in Montreal, but now live in London, England, and San Francisco, respectively. After completing his program at UBC, Dr. Kamath and his wife chose to move to Fort St. John to work, rather than going to Vancouver Island or B.C.’s interior. While he leads Fort St. John Unattached Patient Clinic (UPC), Madhu is employed by the BC Oil and Gas Commission as Director, Compliance Management and Audit Services.

One of the biggest challenges we had when we started is that we had no previous data. So that was a major problem to find out what medications the patients were on, what tests had been done so far, what specialists had been seen, because we had nothing on file. At times it would take 40 to 45 minutes to see a patient, and even then it was probably incomplete information. We’d be calling up pharmacies to see what medications they were on because patients would come in and say they need a refill. Then you’d find out they were on least six medications and one had to know why.

Dr. Kamath, an independent contractor who receives fee-for-service compensation at the Northern Healthoperated UPC, recently sat down to talk to The Northern Way about his decision to work in BC’s north.

So that was a big challenge, in addition to the numbers of patients that we had coming in and the wait lists they were facing. I think a month and a half or two months to be on a wait list, that’s a bit difficult to swallow.

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NH | a focus on our people Are you talking as a doctor or a patient? Both. Oftentimes a patient will say, ‘I haven’t seen a doctor for the past six or eight months and now I have problem 1, 2, 3, 4, 5, 6, 7,’ and he’ll go down the list. There’s no way I can do justice to that appointment in my regularly scheduled 10 to 15 minutes because he’s been waiting. So you do the best you can and handle the most important and the most critical at one time.

to eat. So I was kind of attuned to this monthly multidisciplinary approach and it was very useful. It would be great in Fort St. John, as well, as we have a sizeable diabetes population, for example. People can see they’re not the only ones in the same boat and it makes a difference to their attitude towards their illness.

I think things are getting better. We now have better previous records, things are being transferred. Even a simple record transfer from a former doctor to us took up to two months. So of course I’m looking forward to having more physicians here so we can split up workloads, have less wait times and do good continuity of care.

You’re expecting four new physicians this fall to Fort St. John. Will they all work at the UPC? They’ll all be here. The plan is that some of us will take on regular patients and the patients will have a regular family doctor.

The Unattached Patient Clinic relies on several health professionals to support you, including nurse practitioner Paula Gansner. How is that working out? That’s been helpful having all the different health care providers, such as a nurse practitioner, dietitian, social worker, etc. Having the mental health professional who comes in almost every day has been good because we do have a sizeable number of people who need counselling advice. It’s not always just medicines that they need. The patients’ wait times are less because the specialist is right here, and it frees me up to do other things.

Northern Health is implementing a new health care model in which primary care homes collaborate with interprofessional teams consisting of different health care providers to provide seamless care for patients. Is that something you’d like to see more of here? Team-based care is a good approach. At the clinic where I used to work in Vancouver as a resident, we used to have pharmacists and dietitians coming in and helping. We would also sometimes have respirologists come and spend a day and see people with COPD, and help out and tell them how to use their puffers and so on. That way, the patient would hear it from an expert rather than a doctor taking on six different things. We also used to have a specialist in diabetes come and tell patients, in a group, how to eat and what not

Dr. Kamath at his computer. Photo: Joanne MacDonald

Have you had any feedback from patients about the benefits of team-based care? I think they do appreciate when they get follow-up calls from the clinic, from a nurse or someone explaining things to them. But where I’ve seen a fair amount of appreciation is in the mental health area: a) because it’s quicker, b) because they can come to a clinic and they don’t have to go to a mental health place. Some of them have said there is some degree of stigma going to a mental health place whereas here they’re just coming to a medical clinic. They feel it’s easier and more comfortable to come here and discuss things.

What are the benefits of working in a boom community like Fort St. John? You get to do a lot more and you have a lot more independence. I guess one realizes where your strengths and limitations are, whether it’s ER rotations or OR assist, which I do in addition to the clinic. So it definitely broadens one’s horizons. I think, too, that every single day in the clinic with diverse patient loads is good for the mind (the grey cells) as well!

Do you think you’ll be here for some time? That’s the plan, and the winter hasn’t been bad this year!

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NH | a focus on our people

Jim Terrion: Northern Health employee is BC’s top fundraiser for the Terry Fox Foundation By Joanne MacDonald, Communications Officer, Joanne.MacDonald@northernhealth.ca

t the age of 55, Jim Terrion is a legend. And he’s become legendary by doing what’s come naturally to him for the last quarter century: namely, fundraising for the Terry Fox Foundation (www.terryfox.org). His total as of 2014 — an impressive $614,416 — has made him the Foundation’s top fundraiser in BC.

“The more than half a million dollars that Jim has singlehandedly raised over the past 25 years shows his remarkable dedication to Terry’s dream and shows that nothing is impossible if you try. I have spoken to many of Jim’s supporters over the years and they are more than happy to continue to share in Terry’s dream through their support of Jim and his fundraising efforts. It is the dedication, passion and effort of people, just like Jim, that bring that cure closer every single day.”

Inspired by Terry Fox to make crosscountry trek Jim, who works for Northern Health’s housekeeping department in the lab at the University Hospital of Northern BC, made his first foray into fundraising in 1990. As a long-time admirer of Terry Fox, Jim, who was born almost completely deaf, walked from Edmonton to the Atlantic provinces. He then walked back to his hometown of Prince Rupert, travelling more than 9,900 km during the entire trek. “I watched Terry Fox on TV from the day he started his walk,” says Jim, communicating in sign language through his mother Faye. “And I thought, Terry had a Jim Terrion holds his BC Community Achievement Award, presented in 2006. (l-r) Jim Terrion receives the torch from Scott McWalter on the final leg of the 2015 Canada Winter Games Torch Relay in Prince George on February 13, 2015. Photo: Sarah Bonnar Now, 25 years after he began his initial fundraising efforts, Jim will celebrate his milestone anniversary by walking this September in the 2015 Terry Fox Run in Port Coquitlam, home of the Fox family. Donna White, BC and Yukon Provincial Director for the Terry Fox Foundation, says Jim’s efforts have been nothing short of remarkable.

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“To date, the Terry Fox Foundation has raised close to $700 million dollars over the past 35 years, all in the name of Terry Fox. Jim has played an incredible part in bringing Terry’s dream, of a world free from cancer, one step closer to becoming a reality with every dollar he has raised,” says White.

Photo: Joanne MacDonald

NH | a focus on our people disability, same as me. So I thought I would like to do the walk that he did, too.”

Lauded for his efforts

Faye says Jim’s 1990 walk — entitled, “The Silent Walk”, in support of people with hearing issues — gave him legitimacy and, after returning, she says he then knew how to approach people for donations to the Terry Fox Foundation.

•

1992 Terry Fox Run Certificate of Appreciation, presented by Terry’s mother, Betty Fox;

•

2006 BC Community Achievement Award, presented by then-BC Premier Gordon Campbell and then-Lt.-Gov. Iona Campagnolo.

“Since he couldn’t speak, he would write notes explaining that he was fundraising. I was there, too, and people were generous,” she says. “That’s been his holiday from work for 25 years. He always takes it in September so he can fundraise and then do the Terry Fox Run.” Jim relocated to Prince George in 2006.

Taking his fundraising on the road This year, Jim’s fall fundraising schedule seems nothing short of a whirlwind: •

September: Fundraising and participating in the Prince Rupert Terry Fox Run;

•

September: Celebrating his 25th anniversary as a Foundation fundraiser by walking in the Port Coquitlam Terry Fox Run, dates permitting;

•

November: Flying to Kuala Lumpur, Malaysia, with a friend to participate in the local Terry Fox Run.

Along the way, Jim has picked up a number of awards, including:

He’s also had the honour of dropping a puck at centre ice at the start of a Vancouver Canucks home game. More recently, Jim was also named as one of the torchbearers for the 2015 Canada Winter Games, held in Prince George in February. “I was very, very happy and excited to be a torchbearer,” says Jim. Faye says what makes Jim’s efforts all the more notable is that a Vancouver doctor told the Terrion family when Jim was 12 years old that he would never amount to much in his lifetime because of his hearing disability. The comment came after the family spent years trying to get Jim admitted to a school for the deaf. “I remember that and I will never forget that. I wish I could have shown her what he’s done,” says Faye. “So there I fought all these years to get him into school, and now we’re fighting off all these awards!”

Faye supports Jim in his fundraising efforts by interpreting for him and going door-to-door in their Prince George neighbourhood; Jim, meanwhile, canvasses local businesses. Faye also travels with Jim to Prince Rupert each year to do the walk.

To contribute to the cost of Terrion’s trip to Malaysia, visit the Scotiabank Hart Highway branch at 6541 Hart Highway, Prince George.

“It’s just amazing because there’s not a door that they don’t invite you in,” says Faye. “They’re always happy to see him and it’s just wonderful.”

(l-r) Faye and Jim Terrion are celebrating Jim’s 25th year of fundraising for the Terry Fox Foundation. Photo: Joanne MacDonald

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NH | a focus on our people

New Lakes District Hospital and Health Centre opens ahead of schedule By Jonathon Dyck, Lead of Public Affairs and Media Relations, Jonathon.Dyck@northernhealth.ca

he new Lakes District Hospital and Health Centre is now open for business in Burns Lake, BC. The $55-million facility was completed months ahead of schedule, and officially opened to the public on February 3, 2015.

quality, sustainable health-care services,” said Dr. Charles Jago, Northern Health board chair. “This project will enable Northern Health physicians and clinicians to deliver client-focused health care services in a modernized environment, ultimately improving outcomes for patients.” The project was officially announced in April 2012, and the first big milestone was the move of the old nurses’ residence in December 2012. The groundbreaking ceremony for the project was held on April 12, 2013, with excavation of the site. Construction began in January 2014 with substantial completion of the hospital in December 2014. The new hospital was opened to patients in early February 2015.

Lakes District Opening - (l-r) Dr. Charles Jago, Northern Health Board Chair; Anne Desrosiers, Burns Lake Nurse Practitioner; Jerry Peterson, Acting Chair of the Stuart Nechako Regional Hospital District; Health Minister Terry Lake; Dan George, Burns Lake Band Chief; and John Rustad, MLA Nechako Lakes and Minister of Aboriginal Relations and Reconciliation, put their messages in the time capsule that will be opened in 25 years to remember the grand opening celebration for the new Lakes District Hospital and Health Centre.

Work is now under way to demolish the old facility, which will be followed by landscaping and paving of the new parking lots. This work is expected to be completed this summer. PCL Constructors Westcoast Inc. built the new Lakes District Hospital and Health Centre. The total project cost of $55 million was shared between the Government of British Columbia and Stuart Nechako Regional Hospital District.

Photo: 6ix Sigma Productions Ltd. The new hospital has 16 beds and will provide acute care and emergency services, diagnostic imaging, lab services and pharmacy. A medical clinic offers primary, outpatient and acute care, along with the delivery of mental health and addictions and public health services, as well as home- and community-care services. The facility is a two-storey building totalling approximately 6,100 square metres (65,000 square feet). The movein occurred in stages, with the services from the old hospital moving in first, and physicians moving in at a later date.

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“This project is an important investment for families and future generations in the Village of Burns Lake and the surrounding communities in the delivery of

(l-r) Tanya Daniluk, LPN, and Crystal Havens, Unit Clerk. Photo: Joanne MacDonald

Marie Hunter, Lakes District HSA, in hospital ambulance bay. Photo: Joanne MacDonald

NH | a focus on our people

Northern Health goes for gold at the 2015 Canada Winter Games By Vince Terstappen, Project Assistant, Health Promotions, Vince.Terstappen@northernhealth.ca

hen Prince George’s successful bid for the Canada Winter Games was announced in 2010, one thing was abundantly clear: this was going to be big! With 15,000 visitors including elite young athletes coming to the region over a two-week period, Northern Health would be seeing essentially a 10 per cent bump in population in its biggest centre. “We didn’t know what the impact of the Games would be on a community,” says Dr. Anne Pousette, a member of the steering committee created to prepare Northern Health for the Games, “though we knew that it would be a big impact because we are in a relatively small centre.” It would be a big impact that, with effective planning, could be a very healthy one, too. “For past Games, health promotion has been limited to including a brochure or two in the athletes’ welcome packages,” says Mandy Levesque, Regional Lead for Physical Activity and Chair of the Health Promotions Committee. “We wanted to do more.”

(l-r) Tanya Schilling, Mark De Croos and his daughter Emira volunteer at Northern Health’s information booth during the 2015 Canada Winter Games in Prince George. Photos: Joanne MacDonald

To get the planning process started, the committee looked to other health authorities and Games host communities for information and guidance. They soon realized, though, that this information didn’t exist. “In the past, for other Games, it seems like the learning just stopped,” says Jim Fitzpatrick, Northern Health’s Canada Winter Games Health Care Operational Lead. “Our collaboration was truly built from the ground up.” Northern Health’s preparations were wide-reaching and thoughtful, with the potential for a positive legacy kept at the forefront. Where past Games saw external professionals flown in and out of communities, for example, Northern Health’s planning team arranged for training and education of local professionals on concussions, sports first response, and more, leaving behind new skills and knowledge for the region. “The feat in all of this is the planning itself,” says Dr. Pousette. “We started with nothing.” The team is committed to ensuring that other health authorities don’t feel the same way. Work is already under way on a knowledge-sharing document that details all of the planning that was undertaken and the lessons that were learned, from sharing medical supplies to developing a tobacco-free Games policy

(l-r) Dr. Anne Pousette and Dr. Janet Ames examine Spirit the caribou at the Games’ polyclinic. and piloting new syndromic and disease surveillance strategies. The Games are over but the “big impact” may still be coming. “We’ve planted lots of seeds,” says Fitzpatrick. Editor’s note: Northern Health won a national 2015 Gold Award of Excellence from the Canadian Public Relations Society in the Best Special Events Category for its submission, “Northern Health Preparedness for the 2015 Canada Winter Games Project”.

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NH | a focus on our people

Privacy tips for health care workers: the dos and don’ts of collecting personal information from patients By Joni Kenner, Information Privacy Audit Analyst, Joni.Kenner@northernhealth.ca

ave you thought about what it’s like to share your most personal information with a complete stranger? In the following article are a few helpful reminders for health care workers on how to use best practices when providing health care services to patients. Read about the importance of respecting the privacy of the patients and your co-workers and how you can take that extra step to secure personal information.

Joni Kenner, Northern Health’s Information Privacy Audit Analyst. Photo: Joanne MacDonald

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•

Limit the information you collect. Only collect what is necessary to perform your job duties.

•

Always log off your computer when you leave the room or finish your shift. You are responsible for your password so it is recommended you do not share it with anyone. If you suspect someone has your password, change it immediately.

•

Only access a record if it relates directly to your job function. This information should be used strictly for its intended purposes.

•

Never access your own record. If you access a family member, co-worker or friends’ record ensure it is strictly for the purpose of performing your job.

•

Only share personal information with the individuals who are providing the health care services directly to the patient/client/resident. Personal information about clients/patients/ residents should not be discussed outside of work.

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Never discuss patients/clients/residents’ personal information in a public area. This includes but is not limited to elevators, restaurants, hallways, cafeterias, airports, etc. Even though you may not identify the patient by name there are other ways to identify a person: for example, by illnesses, deformities or ethnicity, etc., especially in rural communities.

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When traveling with a Northern Health laptop, ensure your device is locked at all times. Take only the personal information you require to perform your job. Only use encrypted devices approved by Northern Health. If your laptop or electronic device is stolen report it immediately to your department head or manager and the Privacy Office for Northern Health.

•

Remember, access to your own Northern Health record is available through the Health Records department. Although you may have the capability to access your own record or the record of someone you know, you should not access a record unless it is to do your job.

Personal information is shared for specific reasons whether it’s for personal care, research or required by law. Personal information collected by Northern Health employees should always be treated with the utmost respect and protected with the highest of standards in daily practice. If you would like to learn more about privacy, you can visit the Privacy Office page on OurNH (http://bit.ly/1EovZdz). There are also several informative websites available, including that of the Office of the Privacy Commissioner of BC (www.oipc.bc.ca). If you have any other questions, please call the Privacy Office at 250-565-5822 or email us at privacy@northernhealth.ca. Also see the case study at top of page 33.

NH | a focus on our people “Need to Know” – from A practical guide to the Health Information Act – Office of the Information and Privacy Commissioner A patient with a history of drug abuse is admitted for an emergency appendectomy. A file is obtained from her doctor that contains a detailed history of her treatments over the past few years. During night shift, a nurse not involved in her care browses through the file. Is this wrong?

• Access to such files should be restricted to persons treating the patient. Custodians should have a clear policy about this and staff should be trained accordingly. • Custodians must create sanctions to encourage affiliates to follow the rules.

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NH | a focus on our people

New Queen Charlotte/Haida Gwaii Hospital taking shape By Jonathon Dyck, Lead of Public Affairs and Media Relations, Jonathon.Dyck@northernhealth.ca

he structural steel for the new Queen Charlotte/ Haida Gwaii Hospital is in place, and construction crews are beginning to work on enclosing the facility. After the building is fully enclosed, work will begin on developing the interior features. It is expected the facility will be completed in late 2015, followed by commissioning and training preceding the move in February 2016.

the project site is tight, the design builder Bouygues Building Canada brought in a crane to help with the construction of the building structure. Following enclosure of the facility, the crane will no longer be used on-site. The materials for the project have been delivered to Haida Gwaii in six shipments on barges. Another barge of materials was scheduled to arrive on Haida Gwaii in the spring.

The new hospital will feature bright, modern facilities with local cultural influences; expanded single-bed rooms with private washrooms; and secure patio space with views of the ocean for patients and their families. There will be eight acute-care beds; a labour, delivery and recovery suite; a home and community care wing with eight residential-care beds; a primary care centre; and space for diagnostic imaging, laboratory and pharmacy services.

The total value of the replacement hospital is up to $50 million, and the funding will be cost-shared by the province and the North West Regional Hospital District. Bouygues Building Canada and architecture and design firm Perkins + Will are working collaboratively to build the new Queen Charlotte/Haida Gwaii Hospital.

The facility will be a two-storey building, approximately 5,000 square metres (54,000 square feet) in size and will improve patient comfort and working conditions for staff and physicians. The existing hospital, built in 1953 and opened in 1955, is approximately 1,670 square metres (18,000 square feet). The project began with clearing of rock and soil on the site. There were over 2,200 cubic meters of topsoil and rock taken from the site. The new hospital is being built around the current facility that is still in operation. As

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Two views of the new Queen Charlotteâ&#x20AC;&#x2030;/â&#x20AC;&#x2030;Haida Gwaii Hospital. Photos: Jack Litrell

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