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Health care enters a new era in Saskatchewan by Jonathan hamelin
Saskatchewan’s health care system is undergoing a dramatic transformation. “Health care, perhaps more than any other area, is always changing,” said Minister of Health Jim Reiter. “In Saskatchewan, we’re constantly adjusting to new technological and medical advancements. We’re also making changes on the administrative side. Certainly it’s an interesting and exciting time for health care in Saskatchewan.” One of the major changes involves amalgamating the province’s 12 health regions into the Saskatche wan Health Authority (SHA). The government is tentatively targeting December 4, 2017 for the launch of the SHA. The SHA’s head office will be located in Saskatoon and will employ 300 to 400 people. As Reiter explained, the move to a single heath care authority is meant to eliminate some of the inconsistencies that exist under the current system, with each region approaching things in different ways. “People often focus on the dollars involved, and while there will be cost savings, that’s not the primary driver. The primary driver is continuity and consistency of care across the province,” Reiter said. “Long gone are the days where the citizens of Saskatchewan feel that it’s okay to have different
Saskatchewan Minister of Health Jim Reiter. s u PP li e d Ph oto
levels of care in different areas. “Our goal is to think as one unit. There have been cases in the past where the closest ambulance didn’t go to pick someone up because it was in a different region. We want to get rid of that border mentality in the province.” It has been a lengthy process to launch the SHA. A three-person panel consisting of Dr. Dennis Kendel (former CEO of the Physician Recruitment Agency of Saskatchewan), Brenda Abrametz (Chair of the Prince Albert Parkland RHA) and
Tyler Bragg (President and CEO of Pinnacle Financial Services and former chair of the Cypress RHA) conducted a several-month review that included input from the public in the form of written submissions and consultations with key health system stakeholders. “We said from the onset that we wanted to learn from things that happened in other places,” Reiter said. “The panel looked at other jurisdictions, primarily Alberta. It’s fair to say Alberta had some significant bumps along the way and I think the single biggest
Scott Livingstone has been appointed CEO of the new Saskatchewan Health Authority. P ost media file P hot o
issue pointed to was they probably fast-tracked it too much. They essentially did it overnight and there were a lot of issues that came out of that.” The 10-person board of directors to govern the SHA was announced in June and finalized in August. R.W. (Dick) Carter of Regina was named the Chairperson. On August 23, it was announced that Scott Livingstone would serve as the first CEO of the SHA. Livingstone was most recently the CEO of the Saskatchewan Cancer Agency. “We have a very talented
leadership group in place,” Reiter said. Recently, the government announced changes to the human papilloma virus (HPV) vaccine program. The vaccine, which had been available to Grade 6 female students in the province, is now available to Grade 6 male students as well. HPV is the most common sexually-transmitted virus in Canada and is linked to a number of cancers, including mouth, throat and cervical cancers. Reiter noted that many provinces are moving in a similar direction and the decision was
based on input from the government’s medical experts. Saskatchewan also continues to utilize Remote Presence (RP) technology, which aims to make remote care more accessible through the use of robotics and portable devices that are equipped with high resolution cameras. Dr. Ivar Mendez, the Unified Head of Surgery at Royal University Hospital and an RP expert, continues to head up the initiative. “Dr. Mendez has done outstanding work in that field to bring specialized medical treatment to people in remote areas,” Reiter said. Reiter said people can anticipate more technological advancements moving forward that will strengthen the province’s health care system. On the infrastructure front, one of the developments many people are looking forward to is the Jim Pattison Children’s Hospital of Saskatchewan, which is expected to open in 2019. There are certainly changes on the horizon and Reiter noted that managing these changes will continue to be paramount. “Innovation is going to be front and centre in health care in the future,” Reiter said. “We want to position ourselves to take advantage of changing technologies and medical advancements so we offer the best possible health care to the citizens of this province.”
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HealtH care providers week Accountable Care Unit:
Better care, better patient outcomes by hilary Klas sen
A new model of care being trialed in a Saskatoon hospital is injecting some adrenalin into an overtaxed health system. The Accountable Care Unit at St. Paul’s Hospital was launched in April. It’s only been a few months, but care providers there are already sensing positive changes. “It’s a very different system than what we used to have,” says Dr. Anne Pausjenssen, who is the physician lead for the trial. “It’s far more efficient. I love this new model of care.” Early indicators suggest there is a lot to love about the new system. Its main strength is the team approach. Accountable Care requires all care providers to participate in Structured Interdisciplinary Bedside Rounds (SIBR) at the pa-
tient’s bed. Physicians, nurses, pharmacists, dietitians, social workers, physical and occupational therapists and Client Patient Access Services (CPAS) all work together on the same unit to provide care centred around the patient. The team meets with the patient and their family daily. “We are talking and listening to the patient every day about what their concerns are and what their goals are for their health care. As a team we hear what they feel they need that day and we can then make sure we are working towards getting there,” says Pausjenssen. There is evidence that a trust relationship is being built between patients and care providers. Melissa Babcock is the nurse manager for the internal medicine unit on the seventh floor at St. Paul’s. Pausjenssen says
one of the reasons their unit in the Saskatoon Health Region was chosen to try out the new care model is because of Babcock’s consistent record of careful attention to improving care. Babcock has heard from some patients that they like the new care model. “One patient told me, ‘It actually makes me a better patient because I’m not worried about what’s happening next or what the plan is’.” Another patient who has been in and out of the hospital with a chronic illness said, “For the first time in 10 years I’m not having anxiety during this admission.” Understanding what the plan was impacted both her physical and mental health. Babcock has also seen members of the care team coming out of bedside rounds with big smiles on their faces. “They’re saying,
‘I love this! I know what’s going on and I feel like I’m part of the team’.” Staff satisfaction surveys have seen an increase in satisfaction with the new model. T he model was fi r s t trialed by the Regina Qu’Appelle Health Region at the Pasqua Hospital. Pausjenssen says a recent meeting with members of that region suggests there may be potential personnel savings with higher nurse satisfaction, less turnover of nurses, less sick time and less overtime. A news release from the province reported reduced lengths of hospital stays and reduced rates of readmission. A big difference is, physicians no longer dash from floor to floor looking for their patients, they stay in their designated unit all S e e a c c o u n ta b l e o n b5
The Accountable Care model brings together an interdisciplinary team to provide care to hospital patients. The model features Structured Interdisciplinary Bedside Rounds (SIBR). All team members are required to be SIBR certified, in order to bring the best possible care to patients. su P P lied P hot o
Arm yourself Don’t wait. Protect yourself and those close to you. Get your flu shot now. Seniors, people with underlying chronic health conditions, children under 5, and pregnant women are at higher risk of serious illness from influenza. To find out where and when to get a flu shot, call your public health office or HealthLine 811 or check saskatchewan.ca/flu.
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Celebrating
Healthcare Providers’ Week Every day, Saskatchewan’s dedicated healthcare providers care for our province’s patients and families. Join registered nurses in saying “thank you” for all that they do.
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The RQHR’s Seniors House Call Program takes a collaborative approach. The team includes nurse practitioners, community paramedics, pharmacists, dieticians, social workers, occupational therapists, registered nurses and community support workers. RQhR
Seniors House Call Program is just what the doctor ordered by Pat rediger
While the goal for most people is to keep the doctor away, one Regina Qu’Appelle Health Region (RQHR) program is bringing care directly to seniors. Through the Regina Qu’Appelle Health Region’s Seniors House Call Program, seniors who are experiencing urgent care issues that are non-acute receive in-home visits from a team of health care professionals. In consultation with the patients’ family doctor or primary care provider, the Seniors House Calls team assesses the patient, provides treatment if needed and develops a care plan. “So many seniors we see aren’t able to leave their homes for health care appointments for one reason or another,” said Lisa Bratkoski, Seniors House Call Program manager. “This service ensures that these factors do not prevent them from receiving the necessary and appropriate health care services to support them in the management of their personal health while remaining in community. We work hard to satisfy the needs of all of our clients and we have received overwhelming support from their family and caregivers who say this program has such a positive impact on their lives.” The program was launched in April 2016. Aca c c o u n ta b l e F r o m b4
day. In the past, Pausjenssen could have had patients on up to eight different units. “I would start my day not really knowing where my sickest patient was within the hospital and being anxious about whether I was getting to the sickest patient soon enough. But now all my patients are on one floor.” The model also provides a built-in mechanism to address patient safety. “Every day we are reviewing a safety checklist,” says Pausjenssen. Risks associated with blood clots, blood sugar, potential for infection and ulcers are being tracked and Pausjenssen says there is potential to make huge gains in improv-
cording to Sheila Anderson, executive director, Urban Primary Health Care for RQHR, the program fills a gap between acute care services and community services. She noted that seniors often see the emergency room as the only option available to them for urgent non-acute care concerns. This is especially true for those who are not connected to a primary care provider or are house-bound. It was also identified that there is an opportunity to better support seniors in the community after they are discharged from the hospital to prevent a re-admission. That’s where the Seniors House Call Program comes into play. Open seven days per week from 8 a.m. to 7 p.m., the program receives calls from patients and their family members, as well as referrals from health care professionals such as family doctors, acute care staff and/ or homecare staff. After talking to a community paramedic and answering some questions, it’s determined whether a house call should take place and how urgent the need for care is. “We go into the home and make an assessment to see if we can provide additional services that will prevent an unnecessary visit to the emergency room or admission into the hospital,” Anderson said. “Our goal is to support their immediate
ing patient care. Having a pharmacist on the team is also new. Being assigned to a single unit means there is more time for pharmacists to review patients’ medications during their stay and during discharge to ensure they are on track. That care will soon extend to weekends. Physical therapy will also soon be available seven days a week, both of which are big changes, Pausjenssen says. Measuring patient outcomes at a unit level rather than a hospital or system level is motivating to care providers. “It’s like getting your own report card, and I want to get an A+,” says Pausjenssen. In fact, the new model
health need and connect them to community services for ongoing support.” When the program first launched, it consisted of nurse practitioners and community paramedics. Over the past six months, the team has expanded to include pharmacists, dieticians, social workers, occupational therapists, registered nurses and community support workers. Together, the team can address numerous health and social issues. According to Bratkoski, one example of a patient the Seniors House Call Program team could work with would be a senior living at home with lung disease. This senior may or may not utilize homecare services. If one day their lung disease suddenly worsens, the senior may not have the ability to visit their family doctor. In this case, the team would visit the senior in the comfort of their home. After collaborating with this patient’s family physician, completing an in-home assessment, developing a treatment plan and stabilizing the patient, the team would then connect the patient to appropriate resources in the community such as the Chronic Disease Management Team. Bratkoski said another example would be a senior living with diabetes. If the patient is unable to get to the grocery store due to mo-
has made her want to work in a hospital again. “It allows for a really standard day and it makes the unit feel more calm because there’s structure.” Saskatchewan is the first province to test the Accountable Care model, but Pausjenssen says other provinces are considering it as well. She believes the move to a single health authority in Saskatchewan is finally breaking down barriers between different health units. “We’re actually able to celebrate and replicate what another district is doing well. In the past there used to be a sense of competition and now we’re sharing strategies for how to improve patient care within the province. I don’t think that would have happened without this move to a single health authority.” Working together as a team has increased the level of trust and respect team members have for one another. “It works out better for the patient and for everyone. It’s better care,” says Pausjenssen. “We’re really excited about it,” says Babcock. “There’s so many positive things with this model of care!”
bility, finances, transportation or any other reason, they may rely on convenient foods from the corner store for meals, which isn’t great for anyone, especially someone with diabetes. The team would help connect this individual to community food support programs like REACH Regina or the local food bank, while also arranging for a visit from the team’s dietician. The dietician provides some diabetic education and ensures the senior is aware of all of their dietary options and how to best manage their diabetes independently. Whatever the situation,
Bratkoski said the key to the team’s effectiveness is collaborating with family doctors, other healthcare colleagues, EMS colleagues and community-based resources. “We get lots of referrals directly from physicians, which we love,” she said. “We contact them and collaborate with them after getting a referral to find out more about the patient. It’s great to be able to work with physicians and enhance or support their treatment plan in the community.” Since inception, the Seniors House Call Program has made 3,000 house calls. The team made 330 visits
in September alone which suggests momentum for the program is building. “ We’re pretty excited about that,” Bratkoski said. “As our team is growing and developing, the amount of people we’re able to reach and support is also growing exponentially.” In Regina, the Seniors House Call Program team can be reached at (306) 7666280. Upon calling, you will be asked information about the patient’s medical history and their health care providers. All of the services are free of charge. For more information, visit http://www. rqhealth.ca/SHC.
MRI – No more waiting! You can now pay for your MRI exam and have it done in Saskatchewan. Since February 2016, when the provincial government enacted The Patient Choice Medical Imaging Act, patients have been able to purchase their MRI exams. For every paid MRI performed, Open Skies must complete an MRI exam for a patient on the public waitlist at no charge to the patient or the public system, resulting in overall shorter wait times and reduction in costs to the public healthcare system. Open Skies is owned and operated by a group of local Radiologists. Located in Regina’s south end, it is within walking distance to hotels, restaurants and shopping. We are fully accredited by the Saskatchewan College of Physicians and Surgeons. Another feature of Open Skies is our unique MRI scanner, a Philips Panorama High Field Open (HFO). We are very proud to have the only truly open high field MRI scanner in Canada. Our HFO, unlike conventional closed bore systems, has a 360 degree viewing angle which means the patient can see out of the machine at all times. Patients, especially those who suffer from claustrophobia or who are heavier set, have shown a strong preference for our open magnet. Since inception, we have successfully examined countless patients whose claustrophobia prevented them from completing their exam with conventional MRI and whose only alternative was to have their MRI under general anaesthetic. On a number of occasions, Open Skies has received referrals from out-of-province providers because of our unique technology. We invite you to spend a few moments on our website www.openskies.ca to learn more about our magnet and our services. Our facility can perform all types of MRI exams with the exception of Breast MRI. We also have our own PACS system (secure storage and communication system for medical imaging exams), which communicates our patient exams through to the Provincial PACS where patients’ physicians can view the exams, once they have been interpreted by the Open Skies’ Radiologist.
For more information, refer to our website openskies.ca You do have an option!
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HealtH care providers week Maintaining health is a two-way street by VicKie cammacK Columnist, Troy Media
Achieving health and well-being is never a solo act. Throughout our lifetime, the people who are closest to us – our family and friends – are the greatest influence on our health. As we are on theirs. This is interdependence. Far too often when the professional care system is involved, recognition of interdependence falls by the wayside. That’s too bad because neither family caregivers nor professional care providers can achieve well-being for people with chronic and complex diseases (the vast majority of heath-care interventions today) on their own. This is especially critical when it comes to living well with disability and/or long-term health challenges such as dementia, chronic obstructive pulmonary disease (COPD) and congestive heart disease. Natural caregivers provide 80 per cent of care and need to be to seen as essential to the whole care process – assessing, planning, delivering and evaluating it. When care is required over time, a new kind of relationship between professional care providers, caregivers and the person receiving care is needed. This relationship acknowledges the interdependence of everyone in the care circle. It requires professional providers to move from a relationship that is one-way – prescriptive, as in expert to patient – to one that is two-way – welcoming, inclusive and consultative. I was given an example of what a truly consultative relationship looks like recently when an interior design consultant came to my home. She was curious. She wanted to know what my goals were. She listened
carefully, asked lots of questions and made notes. Then she walked around, noting things like our style of furnishings and our colour preferences. Her expert eye had her asking questions about the amount of natural light, our capacity to do small renovations ourselves and future plans for the house. She took measurements. Then out of thousands of possibilities, she proposed some viable alternatives. We discussed pros and cons, prices and installation times. Together, we designed a customized plan and got started. This designer did pretty much what I want my family’s health-care providers to do. Ask smart questions, learn about us and discuss possible solutions based on what they hear, see and assess is possible. But unlike a design consultation, a consultative approach related to our health is no luxury. The implementation and sustenance of sustainable, nourishing, life-giving care depends on it. As caregivers, we have a central role. Professional providers need the expertise of those who know the person being cared for best. Regardless of their stature or busyness, we should expect all our providers (including specialists, physicians, home care aides, physical therapists, nurses, social workers, etc.,) to seek and respect our deep knowledge of the person being cared for. Respectful consultation is a start. Then let’s create new caring partnerships, practices and policies that support the hands-on caring and emotional sustenance provided by natural caregivers throughout the healing journey. When our interdependence is recognized, the maximum value of our freely-given natural care will be contributed and, most importantly, the
health, well-being and peace of mind of those we love will be enhanced. Vickie Cammack is a social innovator who has established groundbreaking organizations dedicated to strengthening community and addressing isolation, including Tyze Personal Networks, Planned Lifetime Advocacy Network (PLAN) and the Family Support Institute of British Columbia. Her unique response to the isolation and loneliness that underpins some of our most intractable social problems – a network model of care – has been adopted internationally. She is a member of the Order of Canada. She writes Caring Connections with Donna Thomson.
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CONTINUING OUR TRADITION OF EXCELLENCE IN PATIENT CARE
Radiology Associates of Regina, a locally owned and operated Medical Imaging facility, takes pride in having served our community for over 70 years.
We provide a safe, caring and comfortable environment at 3 convenient locations throughout Regina:
• 2727 Parliament Ave in the South • 6350 Rochdale Blvd in the North • 214 University Park Drive in the East Our clinics have up to date, state of the art Medical Imaging equipment, operated by well trained, registered technologists who are required to keep current with new clinical standards. All images and reports are available province-wide on our new RIS/PAC (storage and communication system for medical images). This enables physicians, specialists and all health care teams to access patient images and reports almost immediately after exams has been completed. At Radiology Associates of Regina we offer a wide variety of service to help improve the health of our community: Ultrasound, Mammography, X-Ray and CT (contracted by RQHR). We offer ultrasound appointments at our Rochdale and Parliament Ave locations on referral basis from your physician. We
have an accredited team of sonographers that specialize in Obstetrics, including high risk Obstetrics and Musculoskeletal (MSK) Imaging, as well as routine ultrasound scans. Having a large number of sonographers, helps us to fulfill the urgent requests and provide shorter wait times. All ultrasounds must be referred by your physician. Our Mammography Department at our Parliament location offers digital imaging for routine breast screening and diagnostic imaging exams for both women and men. Our Mammography Department is fully accredited by the Canadian Association of Radiologists. Again, all mammography appointments must be referred by your physician.
to the national reference levels, the RAR CT scanner decreases the dose to the patient very significantly (by 20% to 80%) depending on the type of examination. RAR is proud of its efficient operation; the average timespan from the point of patient registration to completion of the CT scan is 32 minutes. The average time for a preliminary CT report (which can be viewed online by referring physicians) is within 4.5 hours of completion of the CT exam. Our professional team consists of specialized radiologists, experienced technologists, knowledgeable support staff, administration and IT/IS staff.
All three locations provide X-Ray services using digital equipment, which helps to reduce the radiation dose patients receive. No appointment is necessary for X-Ray examinations, as we accept walkin patients. We accept referrals from any health care practitioner.
All RAR employees and radiologists continuously strive for excellence, therefore providing high quality health care to all.
RAR is proud to operate Saskatchewan’s only privately owned CT scanner. Since 2011, RAR has been contracted by the RQHR to assist it in providing timely CT studies to patients from south-eastern Saskatchewan. CT is a fully accredited Department.
From our patients.
Our technology is a GE Lightspeed VCT 64 slice CT scanner and special software (ASIR), which allows high quality exams to be performed while markedly reducing radiation. In order to measure how well we are doing, RAR performs an annual dose survey and have shown that, compared
Please visit our website www.rarsk.com for more information. I found the CT staff/Technologists to be very respectful and knowledgeable. They were personable, helping my visit to be less tense/more relaxed. It was a good visit! I wanted to convey what a great experience I had today. From the moment the receptionist welcomed me with her friendly attitude to the X-Ray tech. They were kind and compassionate. Well done to a seamless team! The office is benchmark! REG00261135_1_1
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HealtH care providers week Registered Nurses have vital role to play in changing Saskatchewan’s health care environment
by Jonathan hamelin
In Saskatchewan’s complex and ever-changing health care system, Registered Nurses (RNs), Registered Psychiatric Nurses (RPNs) and Registered Nurse Practitioners (RN[NPs]) are continuing to Make the Difference. “Registered nurses are the leaders of the team,” said Tracy Zambory, RN, president of the Saskatchewan Union of Nurses (SUN). “We’re the ones charged with doing the initial assessment when a patient enters the system and we keep track of them as they progress through the system. We have the education and experience to be able to understand the subtle changes in a patient’s condition. We can sit and talk with their family so they understand what’s going on with their loved one.” The public has always looked to RNs for support, guidance and leadership, especially in times of great uncertainty like the province is currently facing. The needs of the patient population are changing; patients now require a different level of care, attention and expertise. The province is also exploring a significant health system redesign, which will involve a merging of health regions, among other potentially major changes. As key influencers, RNs are ready to help navigate the changes in the health care system. “We truly need to be part of the transition team and work with the government on innovative strategies,” Zambory said. “We really think that there are places in the system where we could better use the skills of registered nurses.”
Saskatchewan residents are looking to Registered Nurses for support, guidance and leadership as changes take place in the province’s health care system. s u N
One innovative solution is to strategically place registered nurses in areas where their skills can be better utilized, such as RN(NP) s in emergency rooms and better using RNs and RN(NP)s in primary healthcare and community settings. This would help keep patients out of the acute health care system, which is a significant cost driver. “Nurse practitioners in emergency rooms could examine patients who have less complex and more common ailments,” Zambory said. “The nurse practitioner would be taking the pressure off the doctors in the emergency room and allowing them to focus on the large incidents. Placing RNs in a community setting would enable them to teach people how to better manage their chronic illnesses.” Another key to the success of the new health care strategy will be to
ensure that patient care isn’t being negatively impacted by a shortage of RNs. As research has indicated, any decision that reduces the number of direct care providers to curb spending is a decision that will put patients at an increased risk. This past spring, in a survey of 1,500 SUN members, 85 per cent said they are aware of times patients have been put at risk due to short-staffing, with 45 per cent of those reporting this occurs “frequently”. Almost 50 per cent of SUN members said there were vacancies in their workplace that are not being filled. Staff shortages have causes RNs to work large amounts of overtime and this has led to high levels of stress and burnout. In the summer, the Saskatchewan Ministry of Health reported a very worrying 28 per cent increase in critical incidents compared to
When a patient enters the health care system, Registered Nurses are responsible for the patient’s initial assessment. Their education and experience enables them to understand subtle changes in a patient’s condition.suN
last year, with most of those being related to the provision of direct care. “In many of the larger or long term care facilities in the province, there may be one registered nurse to 100 to 120 patients. One of the biggest worries our members express is that changes in condition or worsening conditions have the potential to be missed,” Zambory said. “We are put in charge of people when they’re at their most vulnerable. We need to be able to be with them.” She added that “as registered nurses, we recognize the importance of looking at health care holistically, whether it is for individual patients or the entire system. We understand that investing in models of care that prioritize safe staffing based on patient needs is the only path forward. Research has shown that safe staffing leads to de-
creased hospital infections, fewer complications and better outcomes overall.” There has been a large outpouring of support for RNs from the public and other health care professionals during these challenging times. As part of SUN’s campaign, Making the Difference, (makingthedifference.ca/) members of the public have been sharing their inspiring stories about how RNs have made a difference in their lives. “Registered nurses are dealing with patients on an hourly basis, whether this is managing their vital signs, monitoring treatment plans that we initiate, detecting changes in patient status,” said Dr. Chance Dumaine, a physician at St. Paul’s Hospital in Saskatoon. “They really help me do my job both efficiently and safely.”
Health Care Provider Week
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A full complement of health care providers doing their part in our public system ensures that patients, clients and residents receive the best possible care. Unfortunately, SEIU-West health care providers are working short every day. Join the campaign to stop government cuts to public health care funding. REGXS381996_1_1