The Northern Way May 2016 by Northern Health

A magazine for NH staff and physicians Volume 3 路 Issue 1 路 May 2016

Read about Northern Health's marathon man - P. 6

Cathy Ulrich introduces the 2016-2021 Strategic Plan - P. 2

IN THIS ISSUE Viva Swanson shares her breast cancer journey.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Mobile support teams provide services to First Nations communities. . . . . . . . . . . . . 20 Tammy Rizmayer and Renee Logan win BC Patient Safety and Quality Council awards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Kidney Care Team provides help via telehealth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 the northern way of caring

editorial A message from Cathy Ulrich, President and CEO

elcome to the May 2016 edition of The Northern Way, the magazine for Northern Health's staff and physicians.

Through the stories and images in this issue, we’ll once again feature the amazing work being done throughout Northern Health. In addition, I’d like to take this opportunity to introduce you to the 2016-2021 Strategic Plan: Looking to 2021. In 2009, a Strategic Plan was developed that outlined an ambitious vision for health services in the north. Over the last six years, significant progress has been made and much has been learned about what changes are needed to achieve this vision. These learnings, together with the feedback gained through a region-wide consultation process with staff, physicians and external partners, informed the development of the 2016-2021 Strategic Plan. The 2016-2021 Strategic Plan describes the path we will take over the next five years to continue the transformation of health services in northern BC in order to improve the health of the people we serve. The plan recommits us to this vision for health services in the north and outlines the work necessary to achieve it. On behalf of Northern Health, I would like to thank you for the time you took over this last year to provide your feedback, thoughts and stories through focus groups and the online ThoughtExchange process. I look forward to the conversations we will have in the coming months about this plan, what it means, and the role you can play in implementing the plan. As we look forward to 2021, we believe that the implementation of the 2016-2021 Strategic Plan will further Northern Health’s vision to lead the way in promoting health and providing health services for northern and rural populations.

Strategic Plan Vision Northern Health leads the way in promoting health and providing health services for Northern and rural populations.

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

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Values Value statements guide decisions and actions. We will succeed in our work through: • • • •

Empathy: Seeking to understand each individual’s experience. Respect: Accepting each person as a unique individual. Collaboration: Working together to build partnerships. Innovation: Seeking creative and practical solutions.

Strategic Priorities Healthy People in Healthy Communities Northern Health will partner with communities to support people to live well and to prevent disease and injury.

Coordinated and Accessible Services Northern Health will provide health services based in a primary care home and linked to a range of specialized services which support each person and their family over the course of their lives, from staying healthy, to addressing disease and injury, to end-of-life care.

Quality Northern Health will ensure a culture of continuous quality improvement in all areas.

Enabling Priorities These two priorities cut across all parts of the health care system and are critical for enabling Northern Health to achieve its Strategic Priorities.

Our People Northern Health provides services through its people and will work to have those people in place and to help them flourish in their work.

Communications, Technology, & Infrastructure Northern Health will implement effective communications systems, and sustain a network of facilities and infrastructure that enables service delivery. For more information about Northern Health’s 2016-2021 Strategic Plan, visit the page on OurNH (http://bit.ly/NHStrategicPlan).

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contents Healthy People in Healthy Communities.......................................................................................................................................... 6 Why Do I Run?...................................................................................................................................................................... 6 Health equity – better health care for all populations................................................................................................... 8 Canada Winter Games legacy – one year later........................................................................................................... 10 Do you want to quit smoking in 2016?............................................................................................................................ 12 Coordinated and Accessible Services........................................................................................................................................... 14 Viva Swanson – my journey through the system as a cancer patient..................................................................... 14 Car 60 – innovative partnership offers help to people in crisis................................................................................. 18 Mental health and addictions teams to support First Nations communities........................................................... 20 Nazko First Nation welcomes mobile support teams.................................................................................................. 22 Lifeline program – emergency support at the touch of a button............................................................................... 23 Quality.................................................................................................................................................................................................. 24 Health Emergency Management BC develops culture of preparedness................................................................ 24 Tammy Rizmayer named 2016 Everyday Champion at BC Quality Awards ............................................................. 26 Renee Logan wins 2016 Leadership in Quality Award at BC Quality Awards......................................................... 28 Our People.......................................................................................................................................................................................... 30 New Northern Health policy takes aims at targeted violence in the workplace.................................................... 30 The Learning Hub – Northern Health’s new learning management system ........................................................... 31 Communications, Technology & Infrastructure............................................................................................................................ 32 Northern Kidney Care Team expands access to specialists in northern BC........................................................... 32

THE NORTHERN WAY Volume 3 · Issue 1 · May 2016

To read our magazine online, visit http://bit.ly/TNWMay2016

Publisher · Steve Raper Associate Publisher · Michael Erickson Editor/Contributor · Joanne MacDonald Additional Contributors: Marlene Apolczer ∙ Eryn Collins ∙ Justine Derksen ∙ Gail Haeussler ∙ Theresa Healy ∙ Cormac Hikisch ∙ Sonya Hirschberg ∙ Samantha Jones ∙ Michelle Lawrence ∙ Jane MacPherson ∙ Viva Swanson ∙ Vince Terstappen ∙ Nancy Viney On the cover: Cormac Hikisch competes in the 2015 Mount Robson Marathon on Sept. 9, 2015 Photo: Beth Russell, Valemount, BC

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 — 2016-2021 Northern Health leads the way in promoting health and providing health services for Northern and rural populations.

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 where you can find personal stories about programs, events and activities from across our region. And we hope we can share a few tips and ideas with you 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 magazine or comment on a story in this issue, please contact us at: hello@northernhealth.ca.

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Why do I run? By Cormac Hikisch, Health Services Administrator, Northwest HSDA – East Cluster, Cormac.Hikisch@northernhealth.ca Marathon (http://www.mountrobsonmarathon.ca/), now redefined as an “Ultra” — a 50-kilometre mountain run up the most popular hiking route in the Rockies; a three- or four-day gruelling hike that we’re now undertaking in a little over four hours. One hundred and twenty brave warriors of all ages and abilities are giving this epic run a try. My return to the marathon was a personal challenge, having placed second in 2014. Enamoured by the unbelievable volunteer support and the stunning trail and views — perhaps this year I can move up one final notch? Seriously, why do I run? I ask myself again as the effort increases, past the “edge” of comfort … the constant banter in one’s head thinking of pace, effort, heart rate, footing, water and calorie intake, left foot, right foot, up hill, down hill, repeat … Another gazelle catches me, and I increase the pace to maintain stride; we strike up a broken conversation, he, an engineer from Montreal, me, a lowly northern boy from Smithers. We strain up the Valley of a Thousand Falls (aptly named) keeping tabs on each other, the first runner long gone.

Cormac Hikisch competes in the Mount Robson 50-kilometre ultra marathon on September 9, 2015. Photo: Beth Russell, Valemount, BC

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hy do I run? I ask myself this question with some exasperation as I’m pounding up the Berg Lake Trail at Mount Robson Provincial Park (http://bit.ly/21FJrGG) near Valemount, chasing a gazelle of a runner well out in front of me, and being pursued by a small army behind. It is the 2015 Mount Robson

Now this is why I run! I stand elated as it flattens out along Berg Lake (http://bit.ly/1pht1s5), hanging glacier calving off into sky blue water, mountains surrounding us. The pace picks back up, we careen up the trail, hopscotching over rocks like in a child’s game. The race is on, front runner only 45 seconds ahead, and a couple dozen bobbing runners strung out tightly behind working their way through the landscape. Half way already?! More than two hours done at the turnaround — stop thinking and get going! We all pick up the pace on the return trip, legs hammering over the rough terrain, trying to soak in the preposterous scenery with short glances without stumbling. Down the Valley of a Thousand Falls I descend like a man possessed, past the

NH | healthy people in healthy communities edge of control, but finally ahead of “Montreal”, footsteps still rattling just behind. Karma appears as I spot a smiling Wet’suwet’en friend, Barby Skaling, far from the Bulkley Valley, lumbering under an enormous backpack — worth stopping for a quick good-luck hug, surprised looks and cheers — and then, frantically, I am away again, all the more determined. “Only” 10 kilometres to go and suddenly there is the frontrunner, his pace flagging like a wounded animal, and I know he is mine. Nine kilometres, eight … I take the lead with empathy, knowing this poor guy is “cooked” and it is going to be a long and painful eight kilometres home. Okay, this is perfect, just cruise home at this pace, mission accomplished, really starting to hurt now, but I just have to maintain, I can do this, finish line is only … “Hey, Smithers!” I hear just behind me. Uhoh. “Hey, Montreal!” I echo back through clenched teeth. Montreal bounces up alongside me like he’s on a Sunday stroll ... lovely, caught with seven kilometres to go. I know how this works. Never ends well for the guy in front. Well, I guess second place is good enough. The mind starts to accept. … Why do I run again? But wait — I’ve been there, done that already. I’ve run hard all summer, up and down mountains. I’ve just driven all this way, trained right, tapered right, might not get a chance again like this, not getting any younger. So I start picking up the pace, ever so slightly like it’s not happening … six kilometres … perceptibly faster now … five kilometres … even faster … we are still running side-by-side down the winding trail, in silence.

In addition to winning the overall marathon, Hikisch also took home the Masters' category honours. He's pictured here with his fellow Masters' winners. (l-r) Chris Coolican (second place) Cormac Hikisch (first place), Rick Brewster (third place). Photo: Alex Buri, Smithers, BC

Now the race is on. No more banter, just ever faster. Four kilometres … now we’re flying down the route, yelling at hikers to please give us space, careening around corners, over bridges, dodging obstacles … three kilometres … Finally, a small gap from Montreal appears, but my body is screaming to stop, or at least slow down. But I know I can’t stop now. The final two-kilometre flat road to the Mount Robson Park Visitor Information Centre isn’t the reprieve I’d longed for, but the final 7½ minutes of nearsprinting agony. Montreal still just behind. Not until rounding the final corner, four hours after starting, do I see the finish line and know my goal has been achieved! We high five after the finish, swapping stories and laughs, happy to be finished, but even happier that we’d started.

The marathon’s challenging course takes runners more than four hours to complete. Photo: Beth Russell, Valemount, BC Why do I run? For the challenge, for the camaraderie, for the beauty, for the ability to adventure beyond what was once incomprehensible, for the memories. And, most of all, because I still can. And for that, I am most grateful. Editor’s note: The 42-year-old Cormac Hikisch won the 2015 Mount Robson 50K Ultra Marathon in a time of 4:03:19.

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Health equity: Eliminating societal disparities to provide the best health care for all By Theresa Healy, Lead, Healthy Community Development – Community Engagement, Theresa.Healy@northernhealth.ca at once simple and complex; easy to apply and difficult to monitor; a matter of justice and a matter of pragmatic financial savings. Recently, Northern Health was fortunate to host a national health equity forum. Sponsored by the National Collaborating Centre for Determinants of Health (nccdh.ca) and hosted out of the University of Northern BC (http://www.unbc.ca/), the North West Health Equity Forum linked practitioners in Whitehorse (Yukon), Grande Prairie (northern Alberta), and Prince Albert (northern Saskatchewan) with those of us from across northern BC. Work at the forum brought the concepts of health equity to life and framed them with a northern Canada lens. At the forum, we learned how specific factors can impact certain groups and limit their opportunities for health. In short, if we do not understand the context of our patients’ and clients’ lives, we run the risk of reverting to individual responsibility as the cause of their poorer health outcomes. Instead, we must work to recognize and address the barriers or health inequities that are the root causes preventing people from finding and enjoying good health. Image created by Carla Joseph, artist. Painted live during the public session of the national North West Health Equity Forum co-hosted by Northern Health.

hen I look at Northern Health’s mission and vision, I often think of it as “to build healthier northern residents in healthier northern communities.” This has inspired many thoughtful and effective approaches to the complex challenges of living healthier lives in northern BC. One important strategy in this ongoing work is addressing issues of health inequity. Health inequities exist when there are avoidable and unfair differences in health outcomes between specific population groups. Addressing inequities means understanding and identifying health equity in a northern BC context.

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Health equity is a new field that is rapidly expanding as people grasp the potential for real change that health equity promises. It is

What does this look like? Consider this scenario: A young woman is encouraged to support her children to be more physically active. Yet, without the resources to buy shoes, her children cannot participate in organized sports. A health practitioner, knowing this, suggests, “Let the children play outdoors. They will create their own physical activity.” However, at the next visit to the health care practitioner, the mother admits the children have not played outside and are still spending too many hours on video games. What the mother doesn’t mention is that the neighbourhood she lives in with her children is unsafe and the children’s playground is a haven for drug dealers. What we learned and uncovered at the forum was hope. We found that many practitioners in the north already work with an innovative health equity lens. They are also willing to support others in adopting it.

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Health equity is a new field that is rapidly expanding as people grasp the potential for real change that health equity promises. It is at once simple and complex; easy to apply and difficult to monitor; a matter of justice and a matter of pragmatic financial savings.

Equality vs. Equity. Northern Health graphic

Further, Northern Health has already implemented many innovations that introduce health equity. The IMAGINE Grants, for example, fund projects designed by community members to address the health inequity issues they identify as priorities. These projects show how communities can build sustainable solutions to local health inequities that impact health and well-being. Past projects include funding for: • Community gardens where people can grow and access vegetables; • The restoration of baseball fields to create a safe and inclusive environment for all community members; • Accessible playground equipment to support opportunities for all children to play.

Health equity at work Health equity is a tool that any member of the organization — from janitor to surgeon — can apply within their practice to support Northern Health’s mission. We bring health equity closer every time we speak to or support our clients in a way that opens the door to conversations about the context of their lives. When people can tell us the full story of their lives, we can start to address the real barriers to health improvements. This approach also allows us to support patients and clients as partners in the work of building healthier northern communities. Understanding health equity can impact thinking and action at every level: • A senior executive in the health authority might recognize that more educated and

Theresa Healy, Lead, Healthy Community Development - Community Engagement

affluent families are better able to access our healthy living programs, compared to those at the bottom. They may dedicate specific resources to closing this gap. • A family doctor may say we need to help everyone access the resources they are entitled to so that we can improve the health of the entire population. Some family doctors do this by working with marginalized populations. They help patients with their taxes so that patients and families get all of the social service funding they are entitled to. • In conversation with a city planner, an environmental health officer realizes that fewer children are experiencing the natural world. This deficit may partially explain increasing rates of obesity and depression among children. Their conversation and work begins to focus on how to increase access to nature in the city. • A janitor is well connected in the local community. He sees a patient’s room crowded with worried friends and relatives. He finds an empty room and a coffee pot and invites the relatives to have a private space together, away from the bedside, where they can plan. What will health equity look like in your work? Note: All of the examples above, except the janitor, are adapted from the Glossary of Essential Health Equity Terms (http://nccdh.ca/resources/glossary/) developed by the National Collaborating Centre on the Determinants of Health. The janitor story is an actual example from a Northern Health facility.

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2015 Canada Winter Games project team creates lasting health legacy for northern communities By Vince Terstappen, Communications Advisor – Population and Public Health, Vincent.Terstappen@northernhealth.ca The planning and innovations were about much more than the two-week Games event. That’s how Kelsey Yarmish, Regional Director, Population Health, describes the lead-up to the 2015 Canada Winter Games (http://bit.ly/21FKQNg). The Games took place in Prince George – with long track speed skating events in Fort St. John – from February 13 to March 1, 2015. The two-week period was undoubtedly a success! Community members and visitors enjoyed inspiring athletic performances, a festive sense of community was palpable, and Northern Health staff members and physicians were out in full force as volunteers, health promoters, medical attendants, and public health professionals, to name just a few hats that were worn. But, remember, this was “about much more than the two-week Games event.” When Northern Health first signed a memorandum of understanding with the 2015 Canada Winter Games Host Society, there were (l-r) Sheila Gordon-Payne, then Health Services Administrator, and Prince Rupert Mayor Lee Brain. Photo: Northern Health file photo

two clear legacy goals: 1. To develop Games legacy documents/plans that benefit other communities and can be built from for future events; 2. To ensure upstream health benefits that last up to and beyond the Games, through healthy communities and a variety of communityowned initiatives and programs. “In 2014, one year before the Games were set to start, Cathy Ulrich sat with our team and encouraged us to think about legacy,” says Yarmish. “We were asked to look beyond the event and to think about health legacy and the contributions to healthier northern communities far into the future.” Now one year post-Games, what does this legacyplanning look like? “The 2015 Canada Winter Games legacy document is nearing completion,” says Dr. Anne Pousette, Host Committee Medical Representative and Executive Director of Wellness in Northern B.C. “We’ve gathered data on the planning, implementation, and evaluation of all sorts of processes – from human resource planning to communicable disease surveillance and concussion training – that were essential to being prepared for the influx of 10,000-15,000 visitors to Prince George, while ensuring ongoing high quality services for Northern Health’s population. This information is now being summarized in a single legacy document.” With this new resource, future host communities for large events will be able to see how Prince George’s health care services were affected by the Canada Winter Games, how the project team prepared for various aspects of the Games, and how the team used the Games to promote upstream health benefits and a lasting health legacy. Those upstream health benefits were the second legacy goal that Northern Health articulated from the outset.

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“There’s a legacy of collaboration, of health promotions,” says Mandy Levesque, Lead, Healthy

NH | healthy people in healthy communities Community Development, Integrated Community Granting, who coordinated health promotion efforts during the Games. “In the year since the Canada Winter Games, for example, we’ve partnered on National Health & Fitness Day and the inaugural Physical Activity and Health Summit for the north. These connections flowed from the Games.” The 2015 Canada Winter Games provided an opportunity to inspire healthier communities and populations across the north. The IMAGINE: Legacy Grants were a key tool in building a health legacy in communities. “We awarded 89 grants in 34 northern communities totalling nearly $280,000,” says Levesque. “These grants support grassroots work in the community to promote health and prevent chronic disease and injury.”

Welcome to this

Smoke Free Outdoor Space.

A peek at just a few of the projects provides a great sense of the legacy that the Games helped to create. IMAGINE: Legacy Grants supported: • A Community Fitness Challenge in Chetwynd that saw participants walk over 64,000 km;

Clear the air for everyone to enjoy!

• Snowshoes for children at the Kids Kare Center in Quesnel; • A helmet safety event organized by the Prince Rupert RCMP; • Composting and preserving workshops for kids at Sk’aadgaa Naay Elementary School in Skidegate. The positive response and compliance with the Canada Winter Games Smoke-Free and TobaccoFree Policy has led to further development of smoke-free bylaws across the region. “In 2015 and 2016 to date, we’ve seen the City of Quesnel adopt a smoke-free outdoor places bylaw and the City of Prince George completing public consultation for a proposed bylaw to prohibit smoking and vaping,” says Nancy Viney, Northern Health Tobacco Reduction Lead. There are some early conversations happening on this topic in Prince Rupert and Terrace, as well. The 2015 Canada Winter Games also saw several health promotion tools being launched, including: • The Growing for Gold (http://bit.ly/GrowingforGold) campaign, which continues to provide decals to businesses and community spaces that are breastfeedingfriendly. • Spirit the caribou – Northern Health’s mascot – who has made appearances at Canada

the northern way of caring

Clockwise from top: Spirit the caribou. Graphic promoting breastfeeding in public places Graphic promoting smoke free outdoor space

Day in Houston, the Pride Parade in Prince George, and Seniors’ Day at the B.C. Northern Exhibition, among other events. All staff can book Spirit for health promotion in their community. Look for the Book the Mascot page on OurNH (http://bit.ly/BooktheMascot). • New, co-branded communication tools to promote concussion recognition, treatment, and management training through http://cattonline.com have been distributed throughout the region and are available for all programs to order. These tools, and others, continue to create healthy changes across our communities. “Looking at past Canada Games, we were truly on a new path in setting health legacy goals,” says Yarmish. “The health legacy resulting from the 2015 Canada Winter Games has been the result of the vision that Northern Health and other key partners set at the beginning.”

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Do you want to quit smoking in 2016? By Nancy Viney, Regional Nursing Lead: Tobacco Reduction, Nancy.Viney@northernhealth.ca Nicotine Replacement Therapy through the BC Smoking Cessation Program (http://bit.ly/1RealnA) every calendar year. You have access to a choice of patches, gum, lozenges or inhalers. Visit any local pharmacy to pick up your therapy of choice. If you’re interested in quitting smoking or cutting down on the amount that you smoke, using nicotine replacement therapy can decrease withdrawal symptoms and help you succeed. You may decide to try using nicotine replacement while you are working to reduce cravings and withdrawal, even if you don’t want to quit yet.

All Northern Health employees can access up to $300 to cover the cost of smoking cessation medications such as Varenicline/Champix or Bupropion/Zyban. Contact Northern Health's Benefits department at hrbenefitsservices@northernhealth.ca to obtain the required Blue Cross form to access this benefit.

The nicotine contained in tobacco products is a very addictive substance that has an almost immediate rewarding effect when inhaled and absorbed through the lungs. This quick response of nicotine in the pleasure centres of the brain turns an occasional cigarette into a daily addiction and may be making it difficult to quit.

Information, support and free counselling can be accessed at quitnow.ca with free counselling available by email, phone or text. You can also join other tobacco users who are trying to quit for group counselling or forums. There are learned behaviours and social behaviours associated with smoking that are challenging and take time to change. Support from others can help you succeed with this.

Stock photo

f you are a tobacco user, you have likely considered quitting smoking. Most smokers want to quit and perhaps the reasons to stop smoking are starting to out-weigh the reasons to smoke. Many tobacco users have been successful quitting and you can, too!

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Nicotine replacement therapy such as nicotine patches, gum, lozenges and inhalers deliver nicotine more slowly and work to relieve the discomfort of withdrawal and are less addictive. Most people who use these products to reduce their smoking or quit find that they can lower the dosage of nicotine they are using and eventually not need it at all. If you have tried these products before and still had cravings, it’s possible that you were not getting enough nicotine and may need a higher dose. All British Columbians can access 12 weeks free

Working in a smoke-free environment can help you avoid some of the triggers that may make you think about smoking. It’s important for all of us to comply with the Northern Health Smoke Free Grounds Policy to create an environment that enables our patients, their family and friends, and our co-workers to avoid the harmful effects of tobacco smoke and supports those who have made the choice to quit. Let us know how we can help you or the people you care for escape the addictive grip of tobacco to lead a healthy life!

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Protect yourself with healthy habits like these: →

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

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

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

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

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

Make the healthy choice today.

northernhealth.ca #healthynorth

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The northern way of caring — my journey through the health care system as a cancer patient By Viva Swanson, Executive Lead, Perinatal Program, Viva.Swanson@northernhealth.ca

Viva Swanson, Executive Lead, Perinatal Program. Photo: Jamie Ross

hat is the “northern way of caring”? As a registered nurse, it means a gold standard of practice to me. It also means a culture of commitment, compassion and caring beyond what is expected. When I became a patient in my home community of Fort St. John, I experienced an outpouring of love, expressions of concern, hugs, texts, emails, cards, flowers, and a health care system centred on this patient and her family. I am a breast cancer survivor and this is my story.

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At the end of February 2015, I discovered a very

small pea-sized lump just under the surface of my left breast. I wasn’t concerned so I deferred going to see my family doctor until the end of March when he returned from a family vacation. I’m a nurse and, quite honestly, I arrogantly believed that if cancer lingered within my system, I would know. On March 25, 2015, I went to see my family physician and shared my discovery. He completed a physical exam and ordered a diagnostic mammogram and ultrasound. What followed was a seamless series of transitions in care and

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Viva’s health care team: Back row (l-r) Bobbi Sue Clendenning, Chief Radiation Therapist, Steven Brown, Radiation Therapist. Front row (l-r) Chris Tan, Radiation Therapist, Viva, Eda Camandang, Radiation Therapist, James McLellan, Radiation Therapist-Dosimetrist, Alison Bowery, Radiation Therapist, David Morris, Radiation Therapist. Photo: Kim Lawyer, Physics Assistant, BC Cancer Agency an unbelievable sequence of events that reflect Northern Health’s commitment to providing high quality health care.

the biopsy. I then returned to my family physician’s office and he referred me to the general surgeon for a surgical consult.

Shortly after leaving my 9 a.m. appointment with my family doctor, I went to the Fort St. John Hospital to submit my diagnostic imaging requisitions. I assumed that I’d have to wait a few days for the requested tests, but was surprised to hear that same day bookings were available for potentially urgent cases such as a lump found in the breast. I was asked to return to the department for a 2 p.m. mammogram appointment that would be followed by an ultrasound at 3 p.m.

I was stunned.

By 4:30 p.m. on March 25, I’d seen my family physician and had my mammogram and an ultrasound. The ultrasound technician noted a deformity in the lymph node in my left armpit and kept investigating. She left the room, conferred with the radiologist, and returned to ask me if I would stay for a biopsy. To my shock and surprise, she told me that I had a suspicious mass. I had

Diagnosis confirmed Sixteen days later, I was seated in our general surgeon’s office. The diagnosis was confirmed. I laughed, then I paused and asked him, “Are you kidding?” He shook his head, looked me in the eye and said, “No. I’m sorry. You have breast cancer.” The cyst that I’d discovered was benign, but underneath, deep within the left breast was a malignant tumor: infiltrated ductal carcinoma which had spread to my lymph nodes. We discussed surgical options and I was to return to his office on the following Tuesday with a decision. The following Wednesday, I attended the preanesthetic clinic and was scheduled for surgery on the Thursday, April 16 slate. I had surgery six days following my diagnosis.

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NH | coordinated and accessible services needed to be extracted. Not only would this procedure minimize additional trauma to me; the new technique would also improve my surgical outcome. The surgery was a success.

Family support key to recovery As I entered treatment, I experienced the value of technologies such as telehealth videoconferencing which allowed me to stay home in Fort St. John for the majority of my plan of care. This included the surgical insertion of a venous access device, 24 weeks of chemotherapy, followed by four weeks of radiation therapy at the BC Cancer Agency Centre for the North in Prince George.

Top (front to back): Jordan (age 13), Viva, Josh (age 17), Tristan (age 20) and Randy. Photo: Amanda Marquardt

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To prepare for surgery, I had to go to the nuclear medicine department for a scan to identify the lymph nodes to which my cancer had most likely spread. I was to be the first patient in our facility to trial what is referred to as the “Prince George Protocol”, a 3-D scan that would enable my surgeon to identify the lymph nodes that

My care was certainly “closer to home”, and I can’t imagine how hard it would have been to be away from home for treatment. I truly believe that being home with my husband and our boys, and being able to sleep in my own bed every night, really helped me to stay positive and feel better able to cope with my cancer diagnosis and treatment. Besides, I believe my greatest healing was found in bedtime cuddles and seeing my boys every day and how well they were handling our situation. They are my biggest cheerleaders. My cancer care team included my family physician, two general practitioner oncologists, three registered nurses and the Cancer Care Centre unit clerk. I was so grateful to be surrounded by health care providers with whom I had worked many years and, more importantly, trusted as professionals and cherished as friends. To be cared for in my second home, the Fort St. John Hospital, meant I was comfortable in my surroundings and confident that I was getting the best care possible. The team welcomed the inclusion of my husband and three sons, my mom, and many friends in my course of care, and ensured our questions and concerns were addressed at all times. More importantly, “frugs” (friendly hugs) were offered on my bad days, to celebrate my treatment milestones, or simply cheering when I got my neutrophil count (one component of my white blood cell count) above 1.5. There were also many examples of simple process improvements for all patients in our health care system that were extremely meaningful to me throughout my cancer journey. These included: • Reserved, same day appointments for diagnostic imaging;

NH | coordinated and accessible services growing in my body and I didn’t even know it. I believe this experience has been a gift and one that I will be able to grow from in both my personal life and professional practice. Patient-centred care has a brand new meaning to me, and one that will certainly shape how I contribute to Northern Health in the future.

(l-r) Alison Foster, Cancer Care Unit Clerk, Colleen Skinner, RN Cancer Care Nurse, Viva, and Shelly March, RN Cancer Care Nurse. Missing from photo: Dr. Richard Moody, Viva’s family doctor, and Drs. Michael Wright and Becky Temple, Viva’s GP Oncologists. Photo: Northern Health file photo • Fast track queuing at the hospital lab accessioning; • Two-client identifiers; • Regularly reviewed appointment pre-booking for chemotherapy and radiation therapy; and

I am so grateful for a system that enveloped me in the care that I required to overcome my diagnosis. In all honesty, I have struggled to find the words to accurately express my sincere appreciation for my Northern Health family and how they rallied around me to provide the most incredible care to me and my family: to my body, my heart and my soul. And that is, to me, “the northern way of caring.” Thank you! Editor’s note: On Tuesday, March 8, 2016, Viva was advised by her oncologist that she was cured of her breast cancer. Says Viva: “Cured is the word!! His word, not mine! I am so happy!!”

• The use of the clinical information system software to communicate between disciplines, as well as the use of available technologies, such as telehealth. Consistent reference to established evidencebased practice in both the community oncology centre and radiation therapy centre instilled in me a strong faith in the care provided.

Life after treatment The “northern way of caring” has been a standard of care that I’ve been driven to achieve in my own practice. I am beyond overwhelmed by the degree of professionalism, care and compassion bestowed upon me and my family throughout this health care adventure. It’s now been over a year since I first found the small lump in my breast. Some days it’s hard to remember my life before my cancer diagnosis; the days when I saw myself as a nurse first, rather than a patient. I still can’t believe that cancer was

Viva, on the day she was declared “cancer-free.” Photo: Emily Marie Sonnenberg

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NH | coordinated and accessible services

Car 60: An innovative community partnership offering proactive help to people in crisis By Michelle Lawrence, Manager, Community Services, Michelle.Lawrence@northernhealth.ca

community mobile response program that was created to assist adults in crisis due to mental health or substance-use issues, is drawing positive reviews across Prince George. The Urgent Community Response Team (Car 60), a joint partnership between Northern Health and the Prince George RCMP, was officially launched in April 2015. Based on a similar program in Surrey, B.C., Car 60 teams Northern Health nurses — who specialize in mental health and addictions — with plain-clothes RCMP officers. The team members respond in an unmarked police car to complaints involving people with apparent mental health or substance-use issues who are in crisis. In the past, general duty police officers responding to such calls would have to spend several hours at the hospital while the individual brought in was

The Car 60 program receives a Healthier You Award - Mental Health in the Workplace Award Car 60, a partnership between Northern Health and the Prince George RCMP, received a Healthier You Award in fall 2015 for their community program that provides better support for the mentally ill on the street. At the time of this award nomination in fall 2015, Car 60 had responded to over 200 calls. The Healthier You Awards are presented annually by the Prince George Citizen to people, organizations and businesses for their contributions to northern BC’s health and wellness. To read more visit:

http://bit.ly/1UCFx29

treated by health care professionals. General duty officers now respond to a call, assess the situation and, if it involves people with mental health or substance-use issues, will call in Car 60. The nurse and police officer together decide if the person in crisis needs to access community resources or be taken to hospital for medical attention. “This program was partially implemented because it was identified that the RCMP needed support when they attended mental health and substancerelated calls. We are working with them in partnership to ensure members of our community get the supports they need,” says Aaron Bond, Northern Health's Director, Specialized Services, Northern Interior. “The new Car 60 program is part of the strategy to improve access to care for residents in Prince George. This program will see folks reconnecting with those they know and trust in the health care system for supportive follow-up care.”

Mental health complaints increase PP || 18 18 P | 18

Supt. Warren Brown, Officer in Charge of the Prince George RCMP. Photo: Craig Douglass

In 2015, Prince George RCMP responded to 1,037 mental health complaints, a three per cent increase in such calls over the previous year. The

NH | coordinated and accessible services Car 60 team responded to approximately 600 of those mental health complaints from April 2015 to December 2015, or 66 calls per month. “Of the 66 calls per month, an average of 16 individuals required more intensive mental health and substance use support and were apprehended under the Mental Health Act,” says Shawn Arnott, Northern Health Team Lead, Mental Health, Prince George. “An average of 11.4 clients of those apprehended ended up being admitted to hospital.”

Car 60 team offers wrap-around care to clients Supt. Warren Brown, Officer in Charge of the Prince George RCMP, says the Car 60 Program is likely one of the most, if not the most beneficial policing partnerships the Prince George city detachment has seen in recent years. He says when police are able to provide proactive policing programs, they have most often focussed their efforts on the top one per cent of those people who cause the most harm: prolific offenders who steal vehicles, break into houses and businesses, and rob people and businesses. While this is a necessary response by police in efforts to keep neighbourhoods safe, Brown says police simply don't have the time or expertise to provide adequate service to a segment of the community that takes up much more police time; namely, those people suffering from mental health and substance abuse issues. “Up until the Car 60 Program, when a crisis occurred in these peoples' lives, our response was simple yet inadequate; stop the crisis and transport them either to jail or the hospital. Our members, albeit well intended, simply did not have the time to provide the necessary care and after care, and the client or offender was often dealt with on a daily basis. Much of their activity included petty crimes including disturbances, minor assaults, and mischiefs,” says Brown. “The Car 60 Program has provided a more thorough first response and after care for these clients. From a strategic and innovative perspective, it has provided wrap-around care

(l-r) Const. Sonya Blom, Alexandra Orser, RN, Michelle Quinn, RPN, and Const. Nancy Roe. Photo: Darren Smit that goes beyond putting a Band-Aid on the momentary crisis. From a community perspective, I believe this is a better use of our resources as it identifies root causes.”

Program receives widespread community support A plain-clothes officer attached to Car 60 says people in crisis appear less apprehensive talking to police with a nurse present. “And we have more time to take in the scenario and gather collateral information to support what the individual needs. For example, do they need a mental health team or hospitalization?” says Const. Sonja Blom. “We’ve received overwhelmingly positive support from the community, general duty RCMP, and Northern Health staff.” Arnott adds that RCMP and health care providers working in Car 60 receive ongoing education on their roles within a mental health and substance use crisis. “And we are noticing fewer general duty apprehensions under the Mental Health Act and more individuals connected directly to community services,” he says.

Car 60 operates seven days a week from 12 noon to 9 p.m., the hours which statistics have shown produce the highest volume of calls for service. The program is funded annually by the BC Ministry of Health, as part of a $20.25 million investment to BC’s health authorities to support programs and services for those with severe mental illness or substance use issues. An assessment of the program will be ongoing both from the health care side, and from the RCMP.

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NH | coordinated and accessible services

Mobile support teams take shape to provide mental health and addictions services to First Nations communities By Joanne MacDonald, Communications Consultant, Joanne.MacDonald@northernhealth.ca

(http://bit.ly/1NL3jDt) and the FNHA, and will offer culturally appropriate services to meet communityspecific needs with a focus on holistic health and wellness. Communities are guiding the path forward on service scope, scheduling, staffing, and cultural orientation to providers to support culturally appropriate care. Jim Campbell, Northern Health’s Executive Lead, Mental Health and Addictions (http://bit.ly/1S3NIOT), says the mobile support teams will initially travel to 11 First Nations communities, and be comprised of two to four health care providers. The teams will consist of registered nurses or registered psychiatric nurses, social workers, and/or clinical counsellors. Phase one will see the mobile support teams begin operating in three communities; phase two will consist of the same process being repeated in the remaining communities.

Karla Tait, Mental Wellness Advisor, Northern Region, for the First Nations Health Authority. Photo: Selfie

irst Nations communities in northern BC are leading the discussion in determining how they would like their community members to be supported in the area of mental health and substance use. It’s part of a new relationship in health between First Nations communities, Northern Health and the First Nations Health Authority (FNHA) (http://www.fnha.ca/), a tripartite partnership that provides flexibility and innovation in developing pathways for better health services with First Nations communities.

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As part of this work, a new $3.2-million mobile support team initiative will travel to northern First Nations communities to provide mental health and substance use support services. The team is jointly funded by BC’s Ministry of Health

“Each of the communities has formed Project Advisory Committees (PACs) with the three partners: FNHA representatives, Health Directors from the First Nations communities, and Northern Health representatives,” says Campbell. ”There’s a great deal of involvement by all the partners in developing these services.” The PACs have been creating a vision for the new services, finding office space, developing job descriptions, and setting up interview panels. When the recruiting process is complete, Campbell says staff will be provided cultural orientation with the First Nations communities before beginning work.

Key objective - building relationships Karla Tait, Mental Wellness Advisor, Northern Region, for the FNHA, says continued community input will be key to the success of the initiative. “First Nations communities may have mental wellness or substance use challenges. But a lot of our communities don’t have the capacity to

NH | coordinated and accessible services provide adequate supervision, resources and supports to help community providers work with clients to address these problems effectively,” says Tait. “So this is a wonderful partnership agreement because it addresses the lack of infrastructure support and will bring health care providers into our communities to deliver culturally safe and respectful services. That’s the beauty of this partnership, that the communities will be able to benefit from Northern Health resources and receive much better access to a continuum of other services.” She notes there is also potential for these providers to be advocates for culturally safe care within the Northern Health structure, as well as ensure better follow-through and linkage back to community services when clients are discharged from specialty or out-of-community services. Frequent turnover of mental health service providers is challenging for those seeking support. “When you have isolated practitioners, it’s just a recipe for compassion fatigue. I think this is an excellent opportunity to increase the supports and the network of providers who are facing the same challenging issues,” she says. A key objective for the teams will be to develop relationships in the communities and become trusted providers who can demonstrate culturally appropriate care. “So they’ll be able to see the challenges and triumphs, and will have a better contextual knowledge of the community they’re in, which they can then use to create more relevant treatment plans, more comprehensive assessments of their clients, and more effective community-level intervention,” says Tait.

Staff recruitment ongoing David Loewen, Northern Health’s Lead, Community Engagement, Education, and Evaluation, Aboriginal Health, says one of the big challenges that Northern Health now faces is staff recruitment for the teams. He says the teams will report to Northern Health but will also be involved working with the PACs. “We will absolutely have to go outside of Northern Health for staff to ensure we meet our objectives,” he says. “The thought of having nine or 10 of these teams out and about in our communities, especially some of the isolated ones, is exciting and challenging and scary at the same time. But

The thought of having nine or 10 of these teams out and about in our communities, especially some of the isolated ones, is exciting and challenging and scary at the same time. But it’s good to know these teams will be constantly on the road providing support. David Loewen, Northern Health's Lead, Community Engagement, Education, and Evaluation, Aboriginal Health

it’s good to know these teams will be constantly on the road providing support.”

Partnership approach = effective, sustainable services Karla Tait says that she’s pleased with how the partnership process has worked so far, but adds there is still work to do and history to overcome. “First Nations communities are on an unequal playing field due to the impacts of colonization, evident in the current disparities in all of the social determinants of health within our communities. Without acknowledging this history, external mental health providers are prone to pathologizing our members, providing treatment that is limited to symptoms of these deeper and more widespread challenges,” says Tait. “The providers coming to these teams will have that lens and will benefit from collaboration with their First Nation’s community health teams as they develop wellness and treatment plans which address root causes and build up resiliency factors. This partnership approach has much more potential to result in culturally relevant, effective and sustainable mental health and overall wellness services.” Adds Tait: “We want to make this a patient and community-centred care approach that honours and utilizes the cultural resources which have made our First Nations communities resilient.”

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NH | coordinated and accessible services

Nazko First Nation welcomes mobile support teams By Joanne MacDonald, Communications Consultant, Joanne.MacDonald@northernhealth.ca

We could definitely hire the people with the best education and experience to work on the team, but it's identifying that champion that the people can connect with that's most important. Lana Koldeweihe, Band Manager, Nazko First Nation

hen Lana Koldeweihe describes why community mobile support teams are so important to First Nations communities, her passion is palpable. Koldeweihe is the Band Manager for the Nazko First Nation (http://nazkoband.ca/) located near Quesnel, who has played a key role in the creation of the mobile support teams providing mental health and substance use support services to northern BC First Nations communities. The team in Quesnel is scheduled to begin operating in April 2016. Koldeweihe began lobbying for local support services three years ago when she was working for the Lhoosk'uz Dene Nation. After a series of health crises occurred in the community, she and her team attempted to access local health care services in Quesnel, but the service providers were all booked months in advance. “We needed to be able to access counsellors and psychologists to get assessments done quickly, but none of that was available in Quesnel,” says Koldeweihe. “We also had youth to be assessed for mental health concerns and we weren’t able to access that here. Due to the situation, we would have had to send our youth out of the community to get assessed and they may have ended up as far away as Kelowna or Vancouver. That meant they would have been taken far away from families. It wasn’t appropriate.” Not only did community members need support – so did Koldeweihe’s staff members.

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“Based on the severity of the crises, I identified that our team had started to burn out. They

needed support, as well,” she says. “Quite often when we hire our staff, they’re related to our community members. We’re all connected. So when our people experience a crisis, it can really take a toll on our staff.” She reached out to the First Nations Health Authority (FNHA) for an emergency crisis team, and the FNHA was able to respond to the immediate need of the communities. To meet the long-term needs of each community, a permanent team would provide continued support when called upon for the four First Nations communities located in the Quesnel area: Nazko First Nation, Esdilagh First Nation, Lhoosk’uz Dene Nation and Lhtako Dene Nation. Flash forward to 2016 and Koldeweihe, who has been the Nazko Band Manager since May 2015, is pleased with the progress of the mobile support team initiative. She and her team have had several meetings with the other Band representatives, FNHA and the Northern Health team to identify needs, discuss the terms and conditions of hiring, and how they can work collaboratively to provide all the services. “It’s been a real team effort to build bridges and fill in the gaps to support all the service providers here in Quesnel,” she says. “There are a lot of great champions in our community. We could definitely hire the people with the best education and experience to work on the team, but it’s identifying that champion that the people can connect with that’s most important.” Her main objective is to see the mobile support team establish support services that will minimize the time it takes for a child, adult or elder to get assessed so that the proper health care services can be delivered to meet their needs. “Our whole system has been failing everyone for years, right from our little people to our elders. Some of our people go their whole lives without being assessed or diagnosed,” says Koldeweihe. “This has been a long time coming and it’s great getting everything finalized and seeing the movement forward. I’m sure there will be kinks in the road. It is a work in progress.”

NH | coordinated and accessible services

Northern Health Lifeline program – emergency assistance at the touch of a button By Samantha Jones, Samantha.Jones@northernhealth.ca and Jane MacPherson, Communications Specialist, Philips Lifeline, jane.macpherson@philips.com

or more than 26 years, the Northern Health Lifeline program has been delivering peace of mind to seniors and patients knowing help is available at the push of a button in the event of medical emergencies or falls. Lifeline’s early intervention means improved outcomes for medical emergencies but, as the statistics below demonstrate, the service provides every day support and reassurance so subscribers can continue to live independently. In most cases, neighbours, caregivers, or staff can provide assistance. For the Northern Health region, we received a total of 988 subscriber alarms in 2015, of which: • 79 alarms required some level of assistance; • 10 falls were detected by our AutoAlert fall detection technology; • 34.2 per cent of help calls were resolved without Emergency Services (EMS); • 43 per cent of help calls resulted in a transfer to hospital. With Lifeline, seniors are less likely to rely on EMS for protection and care. But for those who need it, Lifeline provides the emergency help they need, right away. Local Lifeline subscriber John Knutsson, of Prince George, knows firsthand about Lifeline’s quick response. “The first time I used it, it was at night on the weekend. My catheter was blocked and I couldn’t get hold of a nurse. I was in pain so, in desperation, I pushed my button,” he explains. “Lifeline answered promptly and I explained what kind of help I needed over the phone. They arranged for two paramedics to come to my home. The paramedics were then able to get me

An elderly Lifeline subscriber wears a portable alarm device around his neck that enables him to push a button for assistance in the event of a fall or other emergency. Photo: Philips Lifeline the help I needed and I didn’t have to go to the hospital.” What sets us apart? Our local Lifeline program is the only one partnered with Philips Lifeline (www.lifeline.ca), a leader in health care innovation and committed to connecting care from hospital to home with services that are designed to help seniors and patients to live at home for longer. Northern Health Lifeline is the medical alert provider that offers AutoAlert (http://bit.ly/1PpoFnC) – an added layer of protection. Lifeline with AutoAlert detects over 95 per cent1 of falls which is a very high industry standard. Our only focus is medical alarms and our highly trained Lifeline Personal Response Associates are trained to the sensitivities of working with seniors and can provide reassurance if needed. For more information or to refer a patient, please contact the Northern Health Lifeline Program (http://bit.ly/1Rx8Lsy) by calling 250-565-7498 or 1-800-851-0184.

Total button pressed

Help-needed calls

Alarms assisted with no EMS

Falls detected automatically

Alarm assisted Alarm assisted with transport - No transport to hospital to hospital

988

34.2%

12.7%

43.0%

1 Figure is based on the number of undetected falls that have been reported to Philips Lifeline by U.S. AutoAlert subscribers for the period from January 2012 through July 2012. Undetectable falls can include a gradual slide from a seated position, such as from a wheelchair, which may not register as a fall.

22.8%

Reported statistics for Northern Health region, and Smithers and Prince Rupert Lifeline Programs from January 1, 2015 to December 31, 2015.

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NH | quality

Health Emergency Management BC: Developing a culture of emergency preparedness By Eryn Collins, HEMBC Coordinator, Eryn.Collins@northernhealth.ca

The Little Bobtail Lake Wildfire between Prince George and Vanderhoof started on May 10, 2015. It grew to more than 200 square kilometres in size, prompted evacuation alerts and orders in the area, and had officials concerned it could damage telecommunications infrastructure along the Highway 16 corridor. Photo: Jim Fitzpatrick

Greyhound bus rolls over on a snowy highway south of Prince George in January 2016; it takes just minutes to establish the Site Emergency Operations Centre at the University Hospital of Northern BC.

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A massive early-summer wildfire threatens to damage communications infrastructure serving much of the Northwest Health Service Delivery Area in 2015; Northern Health’s Emergency Operations Centre activates within a matter of hours. Northern Health’s emergency management system similarly kicks into gear when a 2014

wildfire in northeast BC forces the evacuation of Hudson’s Hope, including the local health centre. In reality, the health care system in northern BC is almost always responding to some type of unexpected event, emergency or disaster. The practice of emergency management, though — in general and in the health sector — is about much more than responding; and this is the foundation of Health Emergency Management BC's (HEMBC) (http://bit.ly/1pHc6iX) goal to develop a “culture of emergency preparedness” across Northern Health.

NH | quality HEMBC is a program of the Provincial Health Services Authority (http://www.phsa.ca/), with staff in each of BC’s five health regions. Established in 2013 through the consolidation of existing health authority emergency management teams, HEMBC provides expertise, education, tools, and support for the health system to also tackle the other pillars of emergency management: mitigation, preparedness, and recovery. “Of course, we know that health care is, already and always, extremely busy on all fronts,” says Jim Fitzpatrick, HEMBC Director for the Northern Health region. “So preparedness training, and planning, have to be really efficient and developed through close collaboration with Northern Health staff, to get the best bang for the buck in such a busy environment.” Steve Raper, Northern Health Regional Director of External Relations. Photo: Northern Health file photo Code Grey (System Failure). HEMBC supports the development of these plans with templates that facilities can customize with the specific steps staff would take in the event of a code situation. Another key aspect of health emergency management is making sure the lessons learned from emergency response experiences are incorporated into future plans and training. This “culture of continuous improvement” is a goal that HEMBC supports by encouraging and facilitating Lessons Learned – After Action Reviews following both real, and exercise or mock emergency events. Follow-up from these reviews includes not only updating existing plans, but also sharing ideas for improvement with other Northern Health facilities, so the whole region’s preparedness efforts benefit from the experience.

Jim Fitzpatrick, HEMBC Director for the Northern Health region. Photo: Northern Health file photo Training and exercises take many forms: from fire and evacuation drills; to “tabletop” discussions around the response to a mass-casualty incident; to teaching staff how to use specially-designed devices for moving patients or residents during an evacuation. Preparation also includes developing and maintaining plans for BC’s 11 Standardized Hospital Colour Codes, including Code Green (Evacuation); Code Yellow (Missing Patient); and

“We have a fantastic working relationship with HEMBC,” says Steve Raper, Northern Health Regional Director of External Relations. “We are working together to raise the bar on health emergency management planning and preparation, across the organization and with our community partners.” For more information on HEMBC resources and support for health emergency management in Northern Health, contact Jim Fitzpatrick at 250565-5584, Jim.Fitzpatrick@northernhealth.ca or HEMBC Coordinator Eryn Collins at 250-649-7542, Eryn.Collins@northernhealth.ca

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NH | quality

Tammy Rizmayer: Everyday Champion goes above and beyond for patients suffering from kidney disease By Marlene Apolczer, Northern Interior Quality Improvement Lead, Quality and Innovation, Marlene.Apolczer@northernhealth.ca

eet Tammy Rizmayer, the winner of the 2016 BC Patient Safety and Quality Council's Everyday Champion award (http://bit.ly/1Zp4dL8). The provincial award celebrates an individual who shows a passion and commitment for improving quality of care. Based at the University Hospital of Northern BC in Prince George, Tammy has been the Renal Social Worker for Northern Healthâ&#x20AC;&#x2122;s regional renal program since 2009. In her role, Tammy works with patients suffering from kidney disease and their families, many of whom live outside of Prince George and on low incomes. To reduce the financial burden of travel to Prince George and Vancouver, Tammy

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has partnered with accommodation and travel providers to help patients and their families travel to and from medical appointments at a reduced cost. She was also instrumental in establishing a $25,000 bursary fund that helps patients overcome travel cost barriers. Born in Quesnel, Tammy has been in the social work field for almost 30 years. She began her career as a home support worker and taught parenting skills to at-risk families. She joined Northern Health in 2007 and started working in the renal department six years ago. Her goal is to ensure that the patients she serves have the services and supports in place to keep them out of

A BC provincial voting campaign throughout the month of November determined whether Tammy or three other finalists would be chosen as the 2016 Everyday Champion. (l-r) Sheri Yeast, Regional Manager, Kidney Care Program (Tammyâ&#x20AC;&#x2122;s nominator) and Tammy Rizmayer. Photo: BC Patient Safety & Quality Council

NH | quality the hospital and off dialysis for as long as possible. She follows patients through the journey of their illness – from chronic kidney disease, through dialysis, and then through to post-transplant when they return from Vancouver. I had the pleasure of talking to Tammy about her Everyday Champion nomination and award. Tammy was nominated by Sheri Yeast, Regional Manager, Northern Kidney Care Program, Renal Care, and Dr. Anurag Singh, Medical Director, Northern Health Kidney Care Program.

What inspired you to get involved in the work that you are doing? My mom was a big influence for me getting involved in the social work field. She was a single mom raising four children and pursued her degree in social work. She was an instructor in the Social Service Worker program at the College of New Caledonia (http://bit.ly/1pHcqOW) and taught and mentored me and many of my colleagues. I was also impacted by the people that I worked with in my home support role and wanted to make a difference in their lives. I wanted to advocate for and support people that I was working with and saw getting my social work degree as a way to show them that someone was on their side and wanted them to be successful and healthy. I’m continually inspired by the patients that I work with and I learn as much from them as they do from me. They are the experts in their own health and their medical condition. They are living their journey and need to tell us what is going on, and we use our expertise to support them. It’s amazing to see the difference in the quality of people’s lives post-transplant.

What are some of the challenges that you have faced in your career and how have you dealt with them? I deal with patients who are dying and I need to support patients in the clinic who have experienced that loss. Our patients develop close relationships, seeing each other multiple times a week over a number of years, and when a patient dies it has a significant impact on the other patients in the clinic, and the staff. It is also difficult to manage the information sharing when someone dies, as confidentiality does not allow us to share that information in the clinic. We have an excellent team of caregivers within the renal team and social work team, and we all look out for and take care of each other.

What does being nominated as an Everyday Champion mean to you? It means that people are recognizing that I love my job and the patients that I work with. It is quite humbling that I am being recognized this way. To have a formal recognition of my work warms my heart. Every one of my colleagues does an extraordinary job and it feels odd to be singled out when you are a member of such a great group of professionals. Tammy Rizmayer

If you had to choose one reason for going above and beyond, what would it be? For me, it’s asking, “How can I give back to the patients that I work with and how can I make a difference and be a positive presence in someone’s life?”

What advice do you have for someone who wants to go above and beyond to provide quality care for our patients? Be genuine and do it for the right reasons. If you want to go above and beyond, you should not care if anyone notices what you are doing. If you are doing it because it is the right thing to do, recognition should not play a part in why you are doing it.

What does it mean to you to be chosen as the 2016 Quality Awards Everyday Champion? I am thrilled and it is quite an honour to be acknowledged for the work that I do and recognition that our whole renal team and social work team do really good work. It is really nice that staff at Northern Health are acknowledged for their great programs and the people who are working in them. This is affirmation for me that I made the right career choice in being able to directly impact people’s lives.

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NH | quality

Renee Logan wins 2016 Leadership in Quality Award: Ensuring patient safety and effective care delivery through intravenous therapy By Sonya Hirschberg, Communications Consultant, slhirschberg@gmail.com and Joanne MacDonald, Communications Consultant, Joanne.MacDonald@northernhealth.ca

out-patient medication delivery such as continuous infusion medication therapy.

(l-r) Renee Logan and Michael McMillan, Chief Operating Officer, Northern Interior (Renee’s nominator). Photo: BC Patient Safety & Quality Council

o any patient who’s had to endure numerous needle sticks by a nurse in search of a vein, the name Renee Logan might not mean much. But chances are good that they’re reaping the benefits of her work. Logan is the parenteral nurse who’s worked for the last 11 years to develop Northern Health’s Parenteral Services department, creating the resources, policies and training program that’s used throughout Northern Health for staff delivering treatment via patients’ veins.

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These services at the University Hospital of Northern BC (UHNBC) and facilities across Northern Health include treatments that require vascular access, blood product transfusion and

The BC Patient Safety and Quality Council (BCPSQC) (https://bcpsqc.ca/) recognized Logan’s work in February 2016, presenting her with the 2016 Leadership in Quality Award (http://bit.ly/1Nlu70z) for developing and leading a team of trained, skilled nurses specializing in parenteral therapy. She was also recognized for her work as an educator for medical services and as a frontline clinician. Logan, who’s worked for Northern Health for 27 years, was among the first UHNBC nurses (in 2005) to be trained on peripherally inserted central catheters (PICC lines), which are used to deliver medication into veins such as antibiotics or chemotherapy; and was the first to implement the use of ultrasound and a new insertion technique known as Modified Seldinger Technique for PICCs. Her techniques are effectively reversing the number of patients who refuse or miss treatments due to difficulties with obtaining and maintaining vascular access through intravenous apparatus. Logan says she was thrilled to receive the BCPSQC award. “This has been an amazing experience for me from the beginning, starting 11 years ago, to see the difference it has made for patients and for staff, simply by treating IV therapy as a specialty,” says Logan. “When I learned that our chief operating officer (Michael McMillan) had nominated me for an award such as this, I was

NH | quality speechless...and that is a first for me! I am very proud. Then to actually win put me over the top! It's truly an honour.” In 2009, Logan became the first nurse in BC to begin delivering the antibiotic Vancomycin via continuous infusion for patients. In collaboration with Dr. Abu Hamour, Infectious Diseases Specialist, and the UHNBC pharmacy, the technique allows blood work for serum levels to be drawn at the patient’s convenience instead of only at 8 a.m. each morning, as was previously required. Another efficient and effective method that Logan has introduced to Northern Health consists of nurses using a special ultrasound, called a vein finder, so they can more easily locate veins on patients and make their hospital experience less intrusive. Simply put, Logan’s efforts have reduced the number of needle pokes that patients may experience while in hospital, allowing for more efficient medication, blood and nutrient delivery, while better meeting patient needs, enhancing patient comfort and reducing the risk of infection. In his letter supporting Logan’s award nomination, Michael McMillan said Logan exemplifies the concept and qualities of a frontline leader. “She is an inspiration for all staff with her passion, her knowledge and her willingness and ability to share the expertise she has developed with staff, physicians and patients,” said McMillan, Northern Health’s Chief Operating Officer, Northern Interior. “Renee is known across the organization as someone who not only has deep knowledge and expertise but who also brings a smile and her enthusiasm to every situation … Her development of the Parenteral program in Prince George is a system level support to staff, physicians and patients across the north.” Logan has achieved numerous safety and care quality enhancements through her work, including: • The development of a protocol for blood draws (lab samples) from central lines that corrected a problem of abnormal hemoglobin results; • A zero infection rate at Northern Health for the past 10 years related to the usage of PICC lines; • A reduction in occlusion rates (blood vessel blockages) at Northern Health;

• The creation of a custom-made “Line Insertion Pack” for Northern Health to provide the necessary supplies and to achieve maximum barrier precautions for PICC insertions (can be used for all central venous access devices), which improved both patient safety and cost savings; • An increase in the number of patients (referrals) seen every year (since 2008) in Northern Health’s IV therapy program: »» 2008: 5,375 patients; »» 2009: 6,749 patients; »» 2010: 6,568 patients; »» 2011: 7,540 patients; »» 2012: 7,955 patients; »» 2013: 9,152 patients; »» 2014: 9,311 patients. Logan also sits on numerous committees, both for professional development and as a Northern Health representative. They include: • Canadian Vascular Access Association (http://cvaa.info/) (Certified CVAA member); • Canadian Vascular Access Association Community Infusion Alliance; • Canadian Vascular Access Association Awards Committee; • Infusion Nurses Society (INS) member (Certified CRNI member); • Provincial Blood Coordinating Office Nursing Resource Group (http://bit.ly/1RiB1A3) (Northern Health Representative); • University Hospital of Northern BC Nutrition Support Committee; • Health Shared Services BC IV Sets, Solutions, Pharmaceuticals and Hemostatic Agents Project For BC Health Authorities (Northern Health Representative); • HealthPRO Advisory Subcommittee for PICCs and PORTS. Logan says she plans to continue promoting the benefits of IV therapy as well as encouraging the ongoing education of her nursing colleagues. “I see winning this award as an opportunity to heighten the awareness of how valuable it is when facilities support education for nurses, at all levels, in building knowledge and skills for vascular access and infusion therapy,” she says.

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NH | our people

New Northern Health policy aims to protect health care workers from targeted violence By Joanne MacDonald, Communications Consultant, Joanne.MacDonald@northernhealth.ca

Prevention Team. “Identifying, assessing and managing targeted violence requires distinct protocols beyond what is already in place for managing workplace violence.”

Daniel Bomford is the Area Safety Advisor, Workplace Health & Safety, Northern Interior. Photo: Michael Erickson

Workplace violence is any type of violence that a health care worker can be exposed to in the work environment. It can include violence from clients, patients or residents in the form of verbal, physical or sexual abuse. It can also include worker-toworker violence, or violence from outside sources like visitors. Campbell explains that targeted violence goes to the next step.

aniel Bomford has a new mantra that he’s using to spread an important message to Northern Health managers: when, how, and why. Those three words are shorthand for the information that Bomford, Area Safety Advisor, Workplace Health & Safety for the Northern Interior, is providing to Northern Health managers about how to deal with targeted violence aimed at Northern Health employees on the job. “We’re trying to make sure that people know when to report threats of violence, how to report, and why to report,” says Bomford. Shannon Campbell is a Lead for Workplace Health & Safety, for Interior Health and Northern Health. On December 2, 2015, Workplace Health & Safety announced that they’ve expanded the resources and supports available to Northern Health employees with the new Targeted Violence: Management and Response Decision Support Tool (DST) (http://bit.ly/1LEy1kF).

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“We had policies for situations that happened in the moment but not on targeted violence,” says Campbell, who leads Northern Health’s Violence

“That could include situations where there are threats made to a worker that someone is going to come to the workplace to harm an individual,” she says. “The threat could come from a patient, another worker, outside people or people within their private lives.” The new DST was created in response to the increase in these types of incidences being reported in all workplaces, not just in health care. The new DST is “a one-stop shop tool for managers on how to handle targeted violence,” says Bomford. It supports the idea that any threat or risk of targeted violence will be treated seriously and will be quickly assessed and managed. The safety of the potential targets will be of paramount concern. “Our goal is to raise awareness to report targeted violence early, and teach them the best ways to mitigate these incidents,” he says. Adds Campbell: “The more we can get the information out to our staff, the better.” For more information visit the Workplace Health and Safety page (http://bit.ly/27eiL5v) on OurNH. To contact your Area Safety Advisor, email WorkplaceInjury@northernhealth.ca

NH | our people

The Learning Hub: Northern Health’s new learning management system By Gail Haeussler, eLearning Advisor, Gail.Haeussler@northernhealth.ca

orthern Health is striving to create a culture where education flourishes. The Learning Hub will be Northern Health’s one-stop place to access, register, and track all education within the organization.

activities for all of their direct and indirect reports.

eLearning can be accessed on the Learning Hub and we are beginning to develop eLearning modules for many different disciplines. We have developed Northern Health Standards for Online Education so that all of our educational materials Northern Health has entered a partnership with are a quality product. In preparation for the volume the Provincial Health Services Authority (PHSA) of eLearning requests, we are establishing a to join the Learning Hub. In late 2016, the other prioritization process that will address the size/ health authorities will also be joining the Learning scope/support needed for each project while Hub, but we are the first! We completed a full taking into roll-out to all of consideration Northern Health in the strategic early April. Course directions of The Learning Hub Registration Northern Health. can be accessed by employees, physicians, midwives, students, patients, and families. Northern Health staff will be able to log into the Learning Hub using their Northern Health Active Directory account – the same username and password that they use to log into any Northern Health computer, iSite, and other Northern Health applications.

Blended Learning

Progress Tracking

Learning Hub Employees, Physicians, Students

eLearning

The Learning Hub will also enable educators to utilize blended learning. Blended learning gives educators the opportunity to combine an eLearning module or pre/post reading material with a face-toface education session.

All of our Learning Pathways will be housed on the Learning Hub. Learning Pathways are currently being developed for all positions in Northern Health and will enable an employee to see what competencies they need from their first orientation through their journey in a position.

Learning Pathways

Learners will go to one place, The Learning Hub, to register for any kind of Northern Health learning opportunity – both classroom and eLearning. All education opportunities will be tracked in a central system. Learners will be able to see what education they have completed. We have also transferred previous learning histories to the Learning Hub so employees will be able to see past course completions. Later in 2016, managers will be able to download reports of the learning

Information on the Learning Hub (http://bit.ly/27eiL5v) and resources for Course Managers and Course Developers can be found on OurNH under Training & Education or by emailing educationservices@northernhealth.ca

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NH | communications, technology & infrastructure

Northern Kidney Care Team helps expand access to specialist care in northern BC By Justine Derksen, Medical Affairs, Coordinator, Physician Engagement Initiatives, Justine.Derksen@northernhealth.ca

(l-r) Dr. Anurag Singh, Nephrologist and Medical Director, Northern Health Kidney Care Program, Carly Phinney, Clinical Dietitian, Maureen Paciejewski, Registered Nurse, and Lyn Johnson, Renal Pharmacist. Photo: Justine Derksen

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orthern Healthâ&#x20AC;&#x2122;s Kidney Care Team is pioneering a patient-centered model of care by providing medical opportunities to patients closer to home in northern communities. The team was awarded a grant by the Specialist Services Committee (SSC) (http://www.sscbc.ca/) to build telehealth services across the kidney program in the north. The SSC is a joint committee between the Doctors of BC and the BC government, with input from health authorities. This quality improvement project is unique in the

fact that it is modelled after face-to-face care, provides patient education and involves virtual access to the whole multidisciplinary team during consultation. Within Northern Healthâ&#x20AC;&#x2122;s vast geographical area, residents in rural and remote communities have limited access to specialist care. The vision of the Kidney Care Team is to address this challenge by regionalizing a team-based telehealth kidney service, investing in technology and providing services closer to home (similar to the face-to-

NH | communications, technology & infrastructure face model of care) where patients no longer need to travel long distances to larger centres. The team recognizes that telehealth care will not completely replace face-to-face consultations, but that there is potential to reach more patients in remote communities, including First Nations, and to increase patient engagement with specialist health care services. The Kidney Care Team – comprised of a physician, nurse, dietician, pharmacist, social worker and unit clerk – are working to keep care delivery relevant and coordinated by partnering with the BC Renal Agency (http://www.bcrenalagency.ca/) on the development of a provincial template for kidney care via telehealth. The team is collaborating with Northern Health’s chronic disease department to ensure coordination of team-based care, and involving family physicians in primary care homes in the project activities. Also, clinical practice consultant nurses within these communities will act as a liaison between the Kidney Care Team and the patient, and will support connecting patients to specialist services closer to home. Additionally, there are goals to partner with the First Nations Health Authority (http://www.fnha.ca/) to support their telehealth vision. Evaluation of this project will analyze patient and provider experiences which will inform the success of telehealth care and will help shape the model to ensure the best patient care is provided. Overall, the expectation is that more patients will be seen and this project will grow and influence a variety of team-based care projects. In the end, the model could be utilized as part of everyday clinical practice in many communities, where increased communication and patient engagement will support patient-centered care. Dr. Singh, a nephrologist on the Kidney Care Team, recalls one patient’s experience. “A new immigrant worker was urgently referred from a remote rural community with very advanced kidney disease. The referral letter stated that he was adamant he was not leaving his community to go and see a specialist. I was able to see him the next day via telehealth and after meeting the renal team and receiving education about his condition, he was convinced to come to Prince George on the Northern Health Connections bus for surgery to prepare for dialysis,” says Dr. Singh. “This gentleman is now doing home dialysis at night and is able to work and earn a living during

the day without moving from his community. This is a great example where, connecting via telehealth, the kidney team was able to alleviate his fears, avoid unnecessary travel and stress but, above all, deliver the education about his kidney disease and motivate him for homebased dialysis. As a provider, this is immensely satisfying, as timely intervention to address an urgent clinical and educational need was met to provide the best care for this patient.” This article was originally published on the Northern Health Physicians Website on November 20, 2015.

The Northern Health Kidney Care Team was one of 12 winners in the 2015 Healthier You Awards sponsored by the Prince George Citizen newspaper. The team received the Technology in Health Care Award for its patient-centered model of care that provides telehealth services for kidney patients closer to home across the north.

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NH | communications, technology & infrastructure

Tele-Kidney-Care at Northern Health

1 10 in

Canadians have Kidney Disease

5% of People in Northern BC with significant kidney disease are under the care of specialist kidney team.

Early Intervention and longitudinal care by an interdisciplinary team is the best way to lower the risk of needing dialysis, improving overall health and mortality. Geographic expanse and socio-economic factors prevent patients needing this service from travelling to Prince George.

Utilizing Tele-Communications Technologies ✔ Incorporate video conferencing in delivery of every aspect of kidney outpatient care including Transplant and Home Dialysis

✔ Using advancements in digital and communication technologies to complement, but not replace, face-to-face care

✔ Evaluate experience and share models with other regional specialist programs and other provincial renal programs

✔ Piloted initially in North-West (Terrace), the aim will be to connect with every small community in Northern BC

Program Services ✔ Northern Health Kidney Care Program has made a commitment to provide access to its patients closer to home ✔ The program team was successful in obtaining funding to undertake a pilot project to standardize delivery of team based kidney care via Telehealth

Kidney Care Team: ✓ Physician ✓ Nurse ✓ Pharmacist ✓ Dietician ✓ Social Worker ✓ Unit Clerk

✔ During 3 years of this initiative, virtual care via Videoconferencing will be incorporated in every aspect of ambulatory kidney care

Source: Developed by Muhammad Rahman, Project Manager, Telekidney Care Project, with the Northern Health Kidney Care Team.

Prince George

Project Timeline: March 2016: Terrace Project Startup

✓ Hiring of necessary staff ✓ Office supplies and space, printing ✓ Team kickoff ✓ Advisory group terms of reference ✓ Clinic oversight, and evaluation plan

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✓ Post implementation result ✓ Type of visits completed in Terrace ✓ Process mapping ✓ Education and Training ✓ Visit sites ✓ Documentation of best practices

August 2016: 6 month report

December 2016: Delivery of seminars ✓ 24 month results from Terrace ✓ 12 month results from Ft. St. John ✓ Sustainability plan

✓ Hiring of necessary staff ✓ 12 months post-implementation results from Terrace ✓ Connect with all small communities within Northern BC

March 2018: Post-implementation plans

NH | communications, technology & infrastructure

take nature photos of northern BC?

share them to win! Photo by Elle Ambrosi

Email your northern BC photos along with your name and the location where the picture was taken to HealthPromotions@northernhealth.ca and you'll be entered to win a $10 Tim Hortons gift card. We'll use your photos to spread our love of northern BC through our popular weekly We Northern BC posts on Facebook (http://bit.ly/1SIjwMp).

Photo by laurel traue Every month, we'll select a winner through a random draw. The contest is only open to Northern Health staďŹ&#x20AC; members. Photos shouldn't include any faces, must be taken by Northern Health staďŹ&#x20AC; members, and must be taken within the Northern Health region.

Photo by carol ann lees

P | 35 the northern way of caring

northernhealth.ca #healthynorth

“I get to witness community-born projects that are driven to enhancing cultural safety and respect.” -Jessie King Lead, Reseach & Community Engagement, Aboriginal Health

How are YOU Living the NEW

NH Values?

After receiving feedback from staff, physicians, partner organizations, and stakeholders, Northern Health's Strategic Plan 2016 to 2021 was created. Along with updated priorities that can be found in this issue’s editorial, the new plan includes updated values.

Value statements guide decisions and actions. We will succeed in our work through:

Empathy

Seeking to understand each individual’s experience.

Respect

Accepting each person as a unique individual

Collaboration

Working together to build partnerships.

Innovation

Seeking creative and practical solutions. For more information about Northern Health’s Strategic Plan 2016 to 2021, please speak with your manager or visit the Strategic Plan page on OurNH. P | 36