INTOUCH MARCH 2018
(Photo by Katie Cooper, Medical Media Centre)
Teas for two: goodbye to Doug and Bob “When Doug and I first began talking about retiring a couple of years ago, he told me he would leave when I left,” said Dr. Bob Howard, president and CEO. “I told him we couldn’t both go at the same time; he’d either have to leave before or after me. Turns out he’s getting his way!” On March 5 and 6, St. Michael’s Hospital celebrated two long-time and beloved leaders at their respective Printed on 100 per cent recycled paper
farewell teas: Dr. Douglas Sinclair, chief medical officer, and Dr. Howard. Their last day is March 16.
lead for Quality. To relax, he works one day a week in the Emergency Department, and will continue to do so.
Dr. Sinclair was enticed away from Nova Scotia in 2010 to join St. Michael’s as our executive vice-president and chief medical officer. In this role, he had oversight of the Inner City Health, Diabetes and Perioperative programs, Medical Imaging, Laboratory Medicine and Pharmacy, and was the corporate
The hospital also thanks Dr. Howard for his service. He is stepping down after almost 36 years here, the last year of which he has been the president and CEO of the Providence, St. Joseph’s and St. Michael’s health network.
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Farewell
OPEN MIKE with
Dr. Bob Howard
President and CEO (interim)
After more than 35 years of exemplary service to patients and families, and as a mentor and leader to staff and clinicians across St. Michael’s Hospital and health care in Ontario, Bob Howard is retiring this month. At a recent celebration, he spoke passionately about his career and sent his praise and thanks to many – including former classmates in medicine and engineering, residents and colleagues, friends and family, and his wife Dr. Brenda McDowell, a recent retiree herself from St. Michael’s Department of Family and Community Medicine. And in classic Bob-style, he reflected on the values and culture of this hospital and the roots that brought us here. Below are some excerpts: We are all blessed to work in health care. There is no higher calling than to be given the privilege to care for those who are vulnerable and in need. St. Michael’s is a particularly special place to carry out this work. Our culture, rooted in the legacy of the Sisters of
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St. Joseph, is unique and special. Perhaps the most important corporate value the sisters gave us is the one called human dignity. It means that we are meant to recognize the importance and dignity in every person. We do not give it to them. They inherently have it as children of God. It is our job to recognize it by being open, accepting and nonjudgmental. All are welcome, especially those living with disadvantage or marginalization. We have now joined with two other hospitals that share the same commitment. We have pooled our resources. We have markedly enlarged our health-care footprint and therefore we have created new and exciting opportunities to make a positive impact on the health-care system. We have selected a person of honour, integrity and vision, committed to the mission of the sisters, to lead us forward, Dr. Tim Rutledge. Welcome, Tim. The future has never looked brighter for St Michael’s and the new network. I congratulate you all. You can count on me to be watching and cheering from the sidelines. Best of luck. God bless everyone. Thank you.
Follow St. Michael’s on Twitter: @StMikesHospital
Bob’s list of big events that happened during his time at St. Michael’s
Construction of the Cardinal Carter Wing starting in the late 1980s.
The infamous debt of 1991: $60 million on an annual operating budget of $150 million, paid off in six years through restructuring and efficiencies. Balancing the budget became a high priority from that point on.
The Wellesley merger of 1998. We doubled in size. Set us up to be a full-service tertiary care hospital.
The 1999 Strategic Plan. The board confirmed research and education as core businesses of the hospital. We could now aspire to be a world-class academic hospital.
SARS in 2003. The whole hospital came together to do whatever had to be done for our patients.
The planning and construction of the Li Ka Shing Knowledge Institute and the Keenan Research Centre, which formally opened in 2010.
The success we have had on the Quality Improvement agenda, and the almost complete Peter Gilgan Patient Care Tower and campus-wide renovations. This will give us the proper operating model and facility to realize our goal of becoming the Canada’s premiere critical care hospital located in the heart of the city.
Our recent integration with St Joseph’s Health Center and Providence Healthcare, making us the only full spectrum health care system in urban Toronto.
Fundraising. Without it, not much of what we have accomplished would have been possible.
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Construction milestone: Crane removed from inside patient care tower By Leslie Shepherd
How do you remove the tallest freestanding construction crane in Ontario, the one standing in the middle of the almost completed Peter Gilgan Patient Care Tower? By bringing in the second-tallest mobile construction crane in Canada. That’s what the Planning team did on March 3 and 4 to dismantle and remove the crane that arrived in early 2017 to help tear down the 17-story Cardinal Carter South stairwell. Demolition of the staircase was necessary to link the new patient care tower to the existing hospital. “Removing the crane is a big milestone in the St. Michael’s 3.0 construction and redevelopment project,” said Mike Keen, chief planning and redevelopment officer. “It was standing in the middle of the new atrium, so now that it’s gone, the atrium roof can be completed and workers can fill in the floor at level 1, the large seating area adjacent to the new retail area.” The mobile construction crane, rented from Forma-Con Construction, was parked on Bond Street, which was closed from the parking lot driveway of the Metropolitan United Church to Queen Street. Over the course of the weekend, the crane swung over the Donnelly and Bond wings to remove the freestanding crane chunk by chunk. A smaller crane was used to deposit the pieces in a truck for removal.
The second-tallest mobile construction crane in Canada was brought in to remove the construction crane that helped tear down the 17-story Cardinal Carter South stairwell. (Photo by Tom Parker, Planning)
Rendering: An architectural rendering of the atrium in the Peter Gilgan Patient Care Tower. (Courtesy of NORR Consultants Ltd.) 4 | IN TOUCH | MARCH 2018
Hilary Every, a clinical specialist in Respiratory Therapy, performs a diaphragm thickening fraction ultrasound at the bedside. (Photo by Yuri Markarov, Medical Media Centre)
New initiative equipping respiratory therapists in critical care with valuable skillset By Ana Gajic
Respiratory therapists at St. Michael’s Hospital will be the first in Toronto to learn to perform state-of-the-art diaphragm ultrasounds that will help clinicians decide when to wean patients off ventilators and gain greater insight into ventilator-dependent patients. The Centre of Excellence for Mechanical Ventilation, an interprofessional team of clinicians who care for ventilated patients, is rolling out a training program that will teach respiratory therapists how to use ultrasound at the bedside to measure diaphragm thickening fraction and diaphragm displacement. A diaphragm thickening fraction ultrasound shows whether a ventilated patient’s diaphragm is stressed during breathing. “Having this skillset added to respiratory therapists’ toolkits will help provide better measurements to
understand our complex patients,” said Thomas Piraino, a clinical specialist in the centre. “It will show us why certain patients are complicated and guide our care.” If a patient requires a diaphragm ultrasound, the team currently orders a diaphragm excursion ultrasound through Medical Imaging. This type of scan shows whether the diaphragm is moving, but for ventilated patients it is not an accurate measure of how hard the muscle is working to keep the patient breathing. The diaphragm thickening fraction respiratory therapists are learning to perform measures the level of stress on the diaphragm during breathing. There has been limited access to this measurement, which is gaining popularity in research studies. “This project represents translational innovation from research to clinical use,” said Dr. Laurent Brochard, a physician in critical care and the lead of the
centre. “It concerns the function of patients’ respiratory muscles, which is an important issue for our patients and is heavily studied and discussed in Toronto. It is also a great development opportunity for our staff.” Understanding a patient’s diaphragm muscle function allows the care team to identify why a patient may be having difficulty weaning off a ventilator and what the next steps should be. The overall goal is to train approximately 70 per cent of the full-time respiratory therapists in this skill. “It demonstrates the overall vision for the centre, which weaves technology and innovation into daily practice,” said Kari White, clinical leader manager for the Respiratory Therapy Department. “We have embraced the concept of individualized care plans. This is one more step to help us provide the best possible care.” MARCH 2018 | IN TOUCH | 5
Terri Tessama, a cashier in the Marketeria, and Jim McDougall, the Operations Leader in the Clinical Engineering Department. Tessama and McDougall were part of a team that organized a donation of 30 home hemodialysis machines to the Kidney Failure Dialysis Charity Organization in Ethiopia. (Photo by Yuri Markarov, Medical Media Centre).
Access to hemodialysis technology: From Toronto to Addis Ababa By Kelly O’Brien
As a cashier in the Marketeria, Tiruwork Tessama, better known as Terri, meets people from all over St. Michael’s Hospital at her till. It was there that she met Elizabeth Anderson, the Clinical Leader Manager of the Kidney Care Centre and Home Dialysis Clinic, and heard that the hospital was replacing its 30 home hemodialysis machines. Tessama asked Anderson if she had thought of donating the old machines, and told her she knew of an organization based in Ethiopia that would take them. “Many people in Ethiopia who need dialysis aren’t able to access it, either because of where they live or because it’s too expensive,” Tessama said. “I had heard about the problem through my church community, and when I heard Liz talking about the old machines I thought it would be a great way to help.” 6 | IN TOUCH | MARCH 2018
Anderson reviewed the hospital’s policy and agreed to donate the 30 home hemodialysis machines to the Kidney Failure Dialysis Charity Organization in Addis Ababa, the capital of Ethiopia. A team from the Kidney Care Clinic and the hospital’s Clinical Engineering Department worked with Tessama to prepare the machines for use by patients and clinicians there.
In addition to the hemodialysis machines, the team is also donating 30 reverse osmosis machines, and other equipment needed for dialysis. If purchased new, the cost of each package would be roughly $30,000.
“Terri presented us with a great opportunity to give back, and our team was more than happy to help,” said Anderson. Home hemodialysis machines are similar to those used in hospital, but are used less frequently and therefore have a longer life. Home machines are used an average of 12 hours a week, and inhospital machines are used an average of 20 hours a day, said Anderson. Once they arrive in Ethiopia, the machines will be used in clinics and hospitals in and around Addis Ababa. In addition to the hemodialysis machines, the team is also donating 30 reverse osmosis machines and other equipment needed for dialysis. If purchased new, the cost of each package would be roughly $30,000. “This is a very generous gift, and I can’t thank Liz and her team enough for making it happen,” said Tessama.
Shivalee Paliwal, a performance and wellness consultant, demonstrates “chair yoga.” (Photo by Yuri Markarov, Medical Media Centre)
Wellness certificate program helps hospital staff commit to self care By Emily Holton
A new, one-year certificate program at St. Michael’s Hospital offers clinical and administrative staff a different kind of professional development: how to support one’s own wellness. “To me, wellness is not just about the absence of disease,” said Shivalee Paliwal, the performance and wellness consultant leading the program. “I’m talking about helping people reach their full potential for physical, mental and social well-being.” Paliwal said she believes that when staff’s wellness improves, so do organizational outcomes – it’s in everyone’s best interest to nurture wellness at work. Her goal is to equip staff with the tools to better navigate
stress, improve their physical and mental health and have stronger social interactions.
building resilience and cultivating gratitude.
She began with weekly “chair yoga” and lunch-hour guided-meditation sessions in spare meeting rooms.
Participants can join as few or as many sessions as they wish, but those who participate in all 10 receive a certificate of completion.
“I put the call out in the Daily Dose, hoping at least one or two people might show up,” said Paliwal. “It’s been so exciting to see such a great turnout every week, and a clear desire among staff to explore these topics more deeply.”
A homework component is central to each workshop. It asks participants to pick a daily, personal practice and stick to it for 30 days. Examples include five minutes of deep breathing or a few pages of journal writing.
In response, Paliwal has developed the I Am Wellness certificate program, 10 workshops offered to staff free of charge through Corporate Health and Safety Services. Topics include breathing and posture, meditation and mindfulness,
“It’s about forming habits,” said Paliwal. “People vary largely in how long it takes them to stick to something, but 30 days is long enough to see impact and help them decide how they want to proceed afterwards.” MARCH 2018 | IN TOUCH | 7
Q&A By Leslie Shepherd
DR. DOUG SINCLAIR
Dr. Doug Sinclair is retiring this month as chief medical officer. He reflects on his career and his time at St. Michael’s.
Q. Tell us about your first impression when you started at St. Michael’s. I started on Jan. 2, 2010, and I remember thinking when I got here and sat at my desk, “I made the right decision. I’m in the right place.”
Q. What are your future plans? For the first time in my life, I don’t have a clear plan, which is exciting and scary. I’m going to take a break and think what I might do to make a contribution to the health-care system, either here or in Halifax. In the meantime, I’m going to continue to work in the Emergency Department at St. Michael’s. We’re going to Florida for four weeks. In November I’m going to Ethiopia to work with Dr. James Maskalyk, another emergency physician at St. Michael’s who is training emergency doctors there.
Q. What has been the biggest change in medicine or health care you have witnessed over your career? I remember the early days of AIDS when I was an emerg doc in Halifax. We all felt so helpless. All of these mostly gay men were
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returning from Montreal and Toronto, really sick. There was no treatment for them and many of them were disowned by their families. Now, for many people AIDS is a chronic disease they are living with. The other big change, from an emergency medicine perspective, is that when I first started, when patients needed a painful procedure or were in great pain, we were limited in what we could do for pain relief or sedation. Now we can drain an abcess and people don’t even feel it.
Q. What was the proudest moment of your career? I am most proud of the people I have recruited or mentored leaders who are doing great work.
Q. Many people know that you play the trombone. Is there any new past-time you hope to take up now? I have been taking music theory lessons for a couple of years. My goal is to produce some simple horn arrangements.
Q. What will you miss most about St. Michael’s? All of the people I work with. It’s a great group of leaders, managers and front-line staff.