OUR SHARED PURPOSE JUNE 2018
A high school’s mission to support the homeless Teaming up with St. Michael’s to give back (pg. 2)
Collaboration across the network Students learn about supporting patients in different settings (pg 3)
Home with a new hip in 12 hours How an innovative technique is speeding up recovery
Supporting seniors in the city Education, specialized services help keep patients healthy at home, in hospital and in the Houses (pg. 4).
How proper nutrition in hospital can get you home faster A new tool being used by dietitians is helping reduce length of stay (pg. 8).
When a hospital and high school come together A city-wide campaign for the underhoused
Our Shared Purpose is a monthly newsletter highlighting
BY SELMA AL-SAMARRAI
our people and the ways they
What does it take for an idea to become a
products, lip balm and tissue - that quickly
are improving care, patient
city-wide initiative? In this case, it took a
filled 814 care packages. The campaign was
experience and the health of
high school, a local community hospital,
named Be An Angel after the St. Michael’s
a shared interest in advocacy, and a
archangel, and the care packages created
continuing friendship between a high
through it were given to patients discharged
school teacher and her former student.
from St. Michael’s emergency department,
trauma clinic and neurosurgery clinic.
“
Last December, Emily Carreiro, a
St.Michael’s Hospital administrative assistant, contacted her former high school teacher Linda Izzo with an idea to create care packages for the homeless or displaced patients upon discharge from the hospital.
Izzo, who co-ordinates
“This project really opened our eyes. When we think of helping
This project really opened our eyes LINDA IZZO HIGH SCHOOL TEACHER
homeless and disadvantaged people, we don’t often think of a hospital,” explained Izzo. The campaign’s success enabled the distribution to expand and support 200 clients
Marshall McLuhan Catholic Secondary
currently helped by The FOCUS Team, a
School’s Peer Ministry program, jumped
partnership between St. Michael’s and Cota
at the chance to strengthen this mission
that supports individuals living with serious
and outreach. Within three months, the
mental health illnesses that significantly
high school donated 8,704 items - various
impair their ability to live independently.
essentials such as toothbrushes, toothpaste, soap, lotion, socks, a hat, feminine hygiene 2
OUR SHARED PURPOSE
our communities. Learn more: www.oursharedpurpose.com
High-touch learning with a high-tech twist A cross-network learning placement for students BY EMILY DAWSON
Helping patients understand ‘transitions in care’ from
acute to rehab to community settings is a person-centred
shows is an effective way for students to learn. As part of their
approach that keeps people informed, engaged, and confident
placement, students were asked to design an art installation
throughout their health-care journey. How to have these
to represent and reflect their key learnings.
conversations is a fundamental skill for students to learn and
practice.
“
In our first two network-wide collaborative
learning placements, 25 students explored this
theme, and discovered how collaborative practice better supports patients along the continuum of health-care services.
The cross-network placement opportunity
marked a milestone in the education portfolio and
The team used an arts-based program, which research
“Through art, we were able to creatively translate what we do professionally into themes, and open up
It also sparked conversations that will help us communicate
alternative avenues of communication about our
with patients
on medical jargon,” said Angie Bradley, a Social
ANGIE BRADLEY SOCIAL WORK STUDENT
was a team effort between colleagues Lindsay
roles and skills. It also sparked conversations that will help us communicate with patients using other forms of expression, rather than relying Work student who participated in the learning placement. In total, the students represented 12 professions; this diversity deepened their insight
Beavers from St. Michael’s Hospital; Melissa Goddard from
on the theme.
Providence Healthcare; and Kaitlyn Vingoe and Tina Stewart
from St. Joseph’s Health Centre.
virtually collaborate across sites, and they were taught
synchronous content before independently creating their
Collaborative learning helps students from diverse
Video conferencing technology enabled students to
disciplines learn with, from and about each other. “It’s inclusive,
artwork.
and brings in patients, families and our administrative and
support colleagues, too,” said Beavers “The transitions in care
health care, different disciplines operate in silos. Opening
theme offered a learning experience spanning our network’s
up communication and approaching our jobs in partnership
clinical settings: acute care at St. Michael’s; community care
with other practitioners builds more person-centred care,”
at St. Joe’s; and rehab at Providence.”
said Bradley.
“I think in many cases, and this is also true outside of
OUR SHARED PURPOSE
3
Celebrating Senior’s Month across the network BY SELMA AL-SAMARRAI
Debra McGraw, activation assistant, and Janny, resident, play cards
Anne Nicholson has been a patient of the ECHS clinic for 15 years and counting.
Joan Powers looks forward to every Tuesday when she
Ninety-four-year-old Anne Nicholson has been coming
gets to revisit her childhood with a game of cribbage.
to the Elderly Community Health Services (ECHS) clinic at
“It gets very competitive – it keeps me sharp,” says
St. Joseph’s Health Centre for 15 years, and has received
84-year-old Powers, a resident at the Cardinal Ambrozic
care from a rheumatologist, a respirologist, a chiropodist, a
Houses of Providence since last year. “I would not have met
dermatologist and a physiotherapist. But there’s always been
Janny otherwise,” she adds, referring to her new friend.
one constant.
“
Helping residents successfully transition to long-term
“The physician I was referred to from the very beginning,
care requires a holistic approach and activation assistants
Dr. Marcia Varga, is the one I continue to see today. She is so
like Debra McGraw have
caring, doesn’t rush you out of the office, really takes an interest
an important role in the
in your condition, and tries to be as helpful as possible,” says
Cardinal Ambrozic Houses of
Nicholson.
Providence.
It gets very competitive — it keeps me sharp JOAN POWERS RESIDENT
The outpatient ECHS’s multidisciplinary team, which cared
They pay special attention
for 3,250 elderly patients in the 2017-18 fiscal year, includes
to the unique needs of the
geriatricians, physiotherapists, occupational therapists,
nearly 288 residents and help
speech/language pathologists, social workers and nursing
them to flourish in a new
staff.
environment through the
design and development of
Program, was developed in response to a gap identified by
meaningful activities.
team members, who were hearing increased concerns from
Programs span from
caregivers about supporting a newly diagnosed family member.
The clinic’s newest service, the Caregiver Support
intellectually-geared interactive word puzzles and card games
to mindful exercises such as chair yoga – each one adapted
loved ones with dementia and includes strategies to manage
to a resident’s level of ability while placing great emphasis on
changes in behaviour, communication tips, and interactive
social inclusion and cognitive health.
sessions.
The six-week program focuses on how to help care for
“Our new Caregiver Support Program is a strong example
of how aware the clinic staff is to the needs of patients and how they appreciate the challenges our patients and their families live with,” says the Head of Geriatrics, Dr. Fiona Menzies. 4
OUR SHARED PURPOSE
BY THE NUMBERS 34,460
visits TO OUR EMERGENCY DEPARTMENTS BY PATIENTS OVER THE AGE OF 65
18,604
VISITS TO ST. MICHAEL’S HOSPITAL’S EYE CLINIC
4,724
VISITS TO PROVIDENCE HEALTHCARE’S STROKE/NEURO OUTPATIENT CLINIC
3,250
VISITS BY ELDERLY PATIENTS TO OUR ELDERLY COMMUNITY HEALTH CLINIC
353
TOTAL RESIDENTS IN THE HOUSE OF PROVIDENCE ALL NUMBERS FROM THE 2017-18 FISCAL YEAR
Laura Shapiro, occupational therapist, tries on an age simulation suit with the help of Lindsay Beavers, collaborative learning specialist.
Frances Carbonel began her nursing career in General
improvement specialist for St. Micheal’s Senior Friendly
Internal Medicine at St. Michael’s Hospital just over 11 years
Hospital Strategy.
ago and often worked with elderly patients who had multiple
health conditions, occasionally including frailties and cognitive impairments.
“I found myself wanting to help
improve their health outcomes so that they can function well and subsequently as independently as possible in their own homes,” explains Carbonel.
It was through this interest that
she decided to pursue one of the four evidence-based geriatric education courses at St. Michael’s, which launched
To date, 106 staff members have completed at least one of
I found myself wanting to improve their health outcomes
“
FRANCES CARBONEL NURSE
the courses. Carbonel took the Geriatric Resource Nurse course, which is designed to educate nurses on providing acute care for hospitalized older adults, and includes an Interprofessional Geriatric Education day along with other health disciplines to enhance collaborative learning. “I especially appreciated being able to dialogue with a multidisciplinary team during the Education Day because it
in 2017. After taking the course, Carbonel transitioned her
really does require a group effort, at all levels, to improve
career towards geriatric care by joining the Elders Clinic at
outcomes for older adults,” said Carbonel.
St. Michael’s.
“The need for standardized, accessible geriatric
focused education was identified through staff feedback in previous needs assessments,” explains Lori Whelan, quality OUR SHARED PURPOSE
5
Questions & Answers with Leonard Benoit, Aboriginal Navigator BY AMBER DAUGHERTY
Leonard Benoit is a nurse and understands how to navigate the health-care system. But for other First Nations, Inuit and Métis peoples, concern about stigma, discrimination and other factors can prevent them from coming into the hospital – even at the expense of their own health. Indigenous People disproportionately show rising rates of cancer and are diagnosed at a stage when it’s too late to talk about a cure.
with institutions because of perceived stigma and
To support these patients, Leonard became an aboriginal
for staff – I bring the perspective of the patient to the care
navigator with with the Toronto Central Regional Cancer
team to help them understand issues that may be at play
Program, a position that supports patients at hospitals across Toronto – including St. Joseph’s and St. Michael’s – as they navigate the healthcare system. We caught up with him to learn more about his role and how he’s helping enhance patient experience. Why is a role like this necessary?
A lot of people don’t know Indigenous culture or language,
including smudging, which some hospitals have policies for and others are still working on. It’s important that we educate health-care professionals about different cultural needs so that when anyone walks into a space they feel welcome and safe. Indigenous Peoples also have a complicated relationship
OUR SHARED PURPOSE
patients feel more comfortable navigating the health system, I think we would see them access care faster and serious issues caught earlier through screening. How do you provide support in this role?
A cancer diagnosis can prompt a lot of fear – I can help
by going to appointments, asking questions and explaining anything the patient doesn’t understand. I’m also a resource
“
Nations, Inuit and Métis peoples have different spiritual needs,
6
are and what I can help them with. If we can help Indigenous
including historical trauma, PTSD, perception
Reaching out to me is another layer of wraparound support
which can create barriers in providing appropriate care. First
discrimination, so I work with them to learn what their needs
of stigma and so on. Having these conversations makes it easier for patients to access care and hopefully have a better outcome. Reaching out to me is another layer of wraparound support. Why is it important to you to support the Indigenous community in this way?
This role was created to get people screened
and into treatment sooner so that they have better outcomes and I’m happy to contribute to that goal. I am First Nations and this allows me to do amazing things with my brothers and sisters, to dabble in a little bit of nursing and to help connect people to the care they need – both in hospital and in the community.
Leonard is one of ten Aboriginal navigators across the
province with CCO. He has an office at St. Michael’s Hospital and can be reached anytime via email: benoitl@smh.ca.
HOME WITH A NEW HIP IN 12 HOURS BY ANA GAJIC
Dr. Khoshbin and his team perform a same-day hip replacement surgery on a patient in late May.
Sportscaster Vic Rauter is famous for announcing major sports wins, but earlier this year he participated in a novel hip replacement surgery that has become a win for patients and staff alike at St. Michael’s
“It’s a culture change.” Dr. Khoshbin said. “It takes the
right team, the right hospital and the right patient to make this surgery successful.”
Every department that would care for the same-day
patients worked closely with orthopedics to plan the safest
Hospital.
possible experience.
With a deteriorating hip, Rauter was introduced to
The team determined how to screen for patients eligible
Dr. Amir Khoshbin, an orthopaedic surgeon
for same-day hip surgery.
at St. Michael’s who was touting a new, same-
day discharge option for hip replacements.
day discharge hip replacement procedures.
St. Michael’s had become the first hospital in
Each procedure saves the hospital about 20
Toronto to offer same-day discharge for hip
per cent of the costs associated with a longer
replacement surgery in January 2018. Rauter
recovery in-hospital. More importantly, it
was intrigued.
offers patients rapid and safe healing.
St. Michael’s has completed about 15 same-
“I had heard about this rapid discharge
“To say it was miracle-like is not an
option in the United States,” he said. “But now
overstatement,” Rauter said. Within three
that it was an option at my hospital, where I
weeks, he was gardening without any arthritic
was born and had my first joint replacement, I knew I had to sign up.”
VIC RAUTER SPORTSCASTER, PATIENT
Since November 2017, Dr. Khoshbin had been laying the
groundwork to give suitable patients the option of a same-day discharge for hip replacements.
pain. “I’m very grateful to the entire team.” To see extended coverage of our same day hip surgery visit us online at www.stmichaelshospital.com
OUR SHARED PURPOSE
7
Reducing pressure injuries and length of stay — with food BY AMBER DAUGHERTY
Sharon Chandra, dietitian, performs an SGA on a patient
One of the most important medications you may take in
risk for pressure injuries, an increased length of stay and
hospital is food. Eating properly helps you recover faster,
general decrease in stamina and health. The SGA is a tool that
reduces your chances of developing additional complications
can be used to identify potential malnutrition so the care team
and helps ensure you don’t have to come back again after
can help intervene. Strategies for supporting malnourished
you’ve gone home. A new process at St. Joseph’s is making it
patients can include changing their diet, referring them to
easier for staff to have important conversations about nutrition
a speech-language pathologist if there are functional issues
with patients and help them get the nutrients they need.
with eating, or adding additional protein to the food they are
consuming.
When a patient is admitted to the hospital, they’re asked
questions about their diet – have they recently lost weight
without trying and are they eating less than usual? If the
any of these measures because it’s critical they appreciate
patient answers yes to both, a dietitian follows up with them
how significant food is to their health,” Morganti said. “I always
to conduct a subjective global assessment (SGA).
want people to understand that it’s not OK that they’re not
eating well and that we’ll do everything we can to work with
“It’s a mix of questions and a physical exam,” said Antonia
“We work with patients to get consent before beginning
Morganti, registered dietitian. “We’ll look at factors that may
them to change that.
be impacting their ability to eat and also show them if they
have signs of muscle wasting or fat loss so they can understand
possible,” she said. “We’re really focused on working with our
that their ability to recover is reduced when they’re not eating
patients and families to help make nutrition a key part of their
properly.”
stay so that they’re strong enough to recover and then know
how to maintain a healthy diet when they’re back in their own
The Canadian Malnutrition Task Force highlights that
almost half of patients admitted to hospital are malnourished,
“Our goal is to get people home healthy as quickly as
homes.”
which can contribute to a range of issues including increased
Providence opens new Knowledge Centre Providence Healthcare opened its new Knowledge Centre, a dedicated environment that is supporting education, professional development and innovation. Accessible for both staff and students, the Knowledge Centre houses the BMO Resource Centre, simulation labs, classrooms and coaching rooms. It also provides flexible space that can be configured as full rooms, hubs, or pods. To promote teamwork, inclusion and sharing best practices, Providence’s nursing and professional practice leads are co-located to enable better connectivity among our leaders. 8
OUR SHARED PURPOSE