Our Shared Purpose - February 2020

OUR SHARED

PURPOSE February 2020

NEW PARTNERSHIP IMPROVES ACCESS TO BARIATRIC CARE

ST. JOSEPH’S NEW REDEVELOPMENT INVESTMENT

HOW DESIGN AND SIMULATIONS IMPACT PATIENT CARE

PATIENTS

PATIENT STORYTELLING PROVIDES NEW PERSPECTIVES ON CARE

as

TEACHERS Program opens dialogue between patients and medical students through the power of storytelling (pg.4)

ACHIEVING QUALITY TOGETHER

WHAT DOES PATIENT STORYTELLING MEAN?

BY DR. JANE BURNS WITH THANKS TO ROBYN DAVIES, DR. PAULINE GREENHILL AND DR. DIANE TYE PHOTO BY KATIE COOPER

I N T E G R AT I N G C A R E

Partnership to improve local access to bariatric surgical care New Bariatric Centre of Excellence brings

Recently, Providence led an exercise with interprofessional

as one practitioner said when my anti-depressant medication was

care closer to home for many patients.

students to explore transitions in care and the group invited Dr.

increased. I doubt this would be said to someone with diabetes or

Jane Burns, a patient at Providence, to share her experiences. The

Parkinson’s! I did not feel comfortable responding to this comment.

BY EMILY DAWSON ANDREA NAMETH, MICHAEL GARRON HOSPITAL PHOTO BY KATIE COOPER

Providence’s team meets to discuss the day’s client visits. Left to Right: Nahid Alam, Administrative Coordinator; Sean Chai-Chong, Pharmacist; Shilin He, Registered Dietitian; Hazel Ramos, Administrative Coordinator; and Baan AlShalchi, Registered Nurse.

What should educators keep in mind when they ask patients to

Michael Garron Hospital (MGH) and Unity Health Toronto have

this is the right time to undergo bariatric surgery and discuss different

share their story?

partnered to open a Bariatric Centre of Excellence (BCoE) to

factors to consider as they make this decision.

How did it feel to be asked to share your story?

Patients can feel vulnerable and/or nervous about speaking in case

provide our communities with access to bariatric surgical care

I appreciated the opportunity to share observations on my hospital

it’s seen as ungrateful. We need to feel that our care will not be

close to home.

surgical sites, the BAC team will follow patients for up to one year and

stays, starting with St. Michael’s in October 2018 and Providence since

compromised by sharing our stories. Patients may keep quiet for fear

help them transition to their family physician for ongoing care.

November 2018.

of offending the staff we rely on - not because we don’t care about

manage chronic conditions related to obesity, such as diabetes and

how we’re treated!

hypertension, yet access to surgery remains a challenge. By enabling

people every year and provide easier access to integrated bariatric

students then collaborated on an art project that reflected their shared learnings from Dr. Burns.

I have experienced how different professions approach patients.

Some emphasize building trust and call me by my preferred name.

“Bariatric surgery is one of the most effective ways for people to

Following surgery, which can take place at any of the three

“This is a patient-focused solution that will benefit hundreds of

people to receive surgery and care closer to home, we can support

care,” said Sonya Canzian, Chief Nursing and Health Professions Officer

With staff in other professions, interactions felt less adult-to-adult and

What was it like sharing your story?

more people on their journey to better health and a better quality of

at Unity Health.

they often use a generic “Momma” or “Poppa” for older patients (thus

It feels like an acknowledgement of my point of view. Based on the

life,” said Dr. Ori Rotstein, a bariatric surgeon and Vice-President of

modelling this behaviour to students). I don’t think they realize how

artwork, I believe the students heard me, especially about the impact

Research at Unity Health.

Network (OBN), a collaborative network funded by the Ministry of

condescending it feels. When I am called by my name, I feel recognized

of negative language and interactions. When I am told “you’re so much

Health.

as a human being.

stronger than when you first came when we had to use the lift to get

manage obesity. The Unity Health – MGH BCoE started with the

It also allowed me to remind practitioners to take mental health

you out of bed,” this sends an encouraging message that helps me

opening of a Bariatric Assessment Centre (BAC) at Providence in

living in these catchment areas often received bariatric surgery

into account. Just as patients arrive in hospitals with comorbidities like

stay powerfully on track. Conversely, when I am told “your body is half

October and a partnership of three existing bariatric surgery sites:

elsewhere, based on where the OBN’s assessment centres were

diabetes and Parkinson’s disease, they can also arrive with depression

dead. Your left arm doesn’t move and your left leg is stiff as a board,”

St. Michael’s, St. Joseph’s and MGH. Together, the centre provides

located in the Greater Toronto Area.

and anxiety. Mental and psychological conditions are not a choice; they

I feel hopeless.

comprehensive pre-operative, peri-operative and post-operative

bariatric surgical care.

impacts access to, uptake and retention in bariatric surgery,” said Kelly

Tough, manager of the Unity Health – MGH BCoE.

stalk you. It is not helpful to be told “stop feeling sorry for yourself,”

A BCoE provides services with a team of experts to help people

Patients seen at the BCoE will first visit Providence to meet with

Bariatric Centres of Excellence are a part of the Ontario Bariatric

Prior to the opening of the Unity Health – MGH BCoE, patients

“Geographic location is one of the most important factors that

an inter-disciplinary team of dietitians, social workers and nurses

Our Shared Purpose is a monthly newsletter highlighting our people and the ways they are improving care, patient experience and the health of our communities.

along with psychiatry, medicine and surgery specialists. Through a

surgery services in our local areas.”

Learn more: www.unityhealth.to

comprehensive orientation program, the team helps patients assess if

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OUR SHARED PURPOSE

“Our shared goal is to improve equity and access to bariatric

OUR SHARED PURPOSE

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I N T E G R AT I N G C A R E

opens their “iteyes to the

people, telling their story can be quite emotional. She’s extremely

OUR PATIENTS,

knowledgeable and committed to making this the best it can be for

OURTEACHERS

lives, not the diseases, lived during cancer

BY AMBER DAUGHERTY

PHOTOS BY KATIE COOPER

IT’S BEEN TWO YEARS

since

Jennifer Schultz first stood in front of a group of medical students and shared her story – about

triggering so I wanted to make sure they were fully supported,” she

outline what parts they wanted to share. I enjoy connecting with people so I thought that was important to do.”

With Mooney’s introduction came a new level of dialogue between

and is met with silence, Mooney gently nudges, asking students

recovery. Since then, she’s refined

to respond directly to one aspect of the story. Patient teachers also

the story and told it to hundreds

comment on one another’s stories, sharing similarities and differences.

“I think that helps the students take even more away from it

helping them connect

because they can see a different cycle of care,” said Schultz. “We as

the patient they may

patient teachers will talk back and forth and say, ‘Oh you had that experience? That’s funny because this is what mine looked like.’”

One of the other new pieces is that more time is spent at the

beginning of each session with students giving an introduction about

“The Patient as Teacher

who they are and what specialties they might be interested in pursuing.

program helps students see beyond the

Part of the patient teacher sessions have been about being a bit more

medical – it opens their eyes to the lives, not the

flexible with the storytelling so if they have a story about part of

diseases, lived during cancer,” Schultz said. “I tell the

their journey that relates to what many of the students are currently

“

students every time that the day you diagnose someone

PAT I E N T T E AC H E R

with cancer, you’re dropping a bomb on them – you don’t know what’s going on in their lives but now every aspect of that life is

OUR SHARED PURPOSE

“Patient teachers are generously sharing their story which can be

months of treatment, surgery and

of other future surgeons,

JENNIFER SCHULTZ

4

patient teachers and students. When someone has shared their story

DR. JORY SIMPSON

Unity Health’s patient and family partner program.

going through a breast cancer diagnosis,

in such an enormous way.

FO U N D E R O F PAT I E N T A S T E AC H E R P R O G R A M

For Mooney, it’s just part of her job as the specialist who oversees

teachers one-on-one so I could understand their story and help them

human who’s being impacted

EXPERIENCE AND E N G AG E M E N T S P EC I A L I S T

said. “So when I took on the facilitator role, I met with all of the patient

be operating on with the

STEPHANIE MOONEY

everyone involved.”

experiencing, they might bring that up first.

“It’s all about listening to see how they can relate with real life

experiences,” said Mooney. “And we make sure to ask the students about

impacted. This program helps bring that into focus.”

any positive or negative patient experiences they’ve run into during their

In the two years since launching, the Patient as Teacher program

rotation – often, everything comes back to communication, so these

has shifted significantly, starting out as an opportunity for real patients

sessions are an opportunity for them to learn from real patients about

to tell their story front to back to medical students. Since then, it’s

how they could connect better with the people they’re caring for.”

become much more of an engagement opportunity with students and

patients connecting on a human level and talking about the impact they

when, after students have met multiple patient teachers and completed

can have on one another. Dr. Jory Simpson, the St. Michael’s surgeon

their rotation, they’re asked to create a piece of art that reflects what

who founded the program in 2017, said that’s largely to do with the

they learned. Students have created paintings, poetry, photography,

introduction of facilitator Stephanie Mooney.

songs and more. Starting next year, patient teachers will be invited to

their presentations so they can see what kind of an impact their story

“Not everyone is natural storyteller and not everyone’s story is

One of the most talked about parts of the program is at the end

relevant to all of our students,” said Dr. Simpson. “Stephanie worked with

had.

our patient teachers to design a storytelling workshop and then a formal

orientation session that happened this summer to help make patient

from my story,” said Schultz. “I can’t wait to see more of the artwork

teachers more comfortable. She also connects with them before they

because it really shows what they learned and what part of our stories

go into each session and debriefs with them after because for some

they connected with and will take with them.”

“For me it will give me a sense of what these students took away

OUR SHARED PURPOSE

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BREAKING DOWN BARRIERS TO BIOMEDICAL RESEARCH As a basic research scientist, Dr. Valeria Di Giovanni understands how difficult it can be to collect, store and access patient samples for research. Now, at St. Michael’s, she’s hoping to improve the process.

Dr. Di Giovanni is helping to create a centralized biobank of patient samples for biological research. Currently, scientists at St. Michael’s operate various biobanks. They are costly and time consuming to manage, she said.

With one biobank, scientists can share the costs and offload collection and maintenance.

“Our biobank could be a place that scientists from all over retrieve samples that’ll have impact on patient outcomes,” said Dr. Di Giovanni.

WHICH MILK IS BEST FOR CHILDREN? A study led by St. Michael’s found children who drank whole milk had 40 per cent lower odds of being overweight or obese compared with children who consumed reduced-fat milk.

The research analyzed 28 studies that explored the relationship between children drinking cow’s milk and the risk of being overweight or obese. None of the studies showed that kids who drank reducedfat milk had a lower risk of being overweight or obese. Eighteen studies suggested children who drank whole milk were less likely to be overweight or obese.

Dr. Jonathon Maguire, scientist at MAP Centre for Urban Health Solutions, next hopes to establish the cause and effect of whole milk and lower risk of obesity in a randomized controlled trial.

‘DISABILITIES ARE NOT ALWAYS SHARING IMAGING DATA APPARENTMEDICAL OR VISIBLE’ TO CUT RADIATION DOSES

6

Over one billion globally experience form of disability, Patients mightpeople expect radiation dosessome for CT scans to be yet despite having greater health needs, people with disabilities comparable from one hospital to the next, but a team at often encounter barriers to accessing care andvariance have worse outcomes.

St. Michael’s Hospital says the dose can be startling.

The team A study led by Dr. Andrew Pinto and Dr. Tara Kiran, family is collecting and analyzing data from eight hospitals physicians with St. Michael’s Academic Family Health Team and for the Medical Imaging Metadata Repository of Ontario (MIMRO) researchers at the Li Ka Shing Knowledge Institute, examined how to help reduce the province’s average radiation dose per scan. patients responded to being asked about part of a survey Using artificial intelligence to sort thedisabilities hospitals’asdata, the team and compared responses to data available in charts. generated comparative data by facility, scanner and exam to help determine While most patients were willing to answer a question best practices.

MIMRO is funded primarily by about disability, the research showed they may have chosen not St. Michael’s and was created by two of its radiologists,to disclose certain disabilities.

Drs. Timothy Dowdell and Bruce Gray.

“Disabilities are not always apparent or visible, even to health Radiologist Brucesaid.

Gray and data analyst Lianneinterest Concepcion data providers,” Dr.Dr.Pinto “There has been in review routinely submitted to MIMRO. (Photo: Katie Cooper) identifying which patients have specific disabilities in order to identify OUR SHARED PURPOSE disparities and take action to reduce them.”

INVESTING IN OUR FUTURE

Design and simulations for better care spaces New trauma bay at St. Michael’s shows the impact of simulations on hospital design

BY SELMA AL-SAMARRAI

PHOTOS PHOTOS BY

BY KATIE KATIE COOPER COOPER

Extensive simulation exercises were performed in order to help inform and perfect the design of the trauma bay before it opened to patients.

A brand new trauma bay is set to open inside St. Michael’s Slaight

Family Emergency Department (ED) this month after a lengthy

table-top simulations, where a massive blueprint was used to visualize

and carefully planned testing and design process that ensured

and test the use of the room.

trauma patients will get the best possible care when they need

it most.

team built a replica trauma bay where the trauma team ran a full-scale

simulation.

“No patient should ever be the first test of a new trauma care

The teams used various simulation techniques. It started with

Next came the mock-up simulation: the Operational Readiness

space; that’s a key principle behind the design of our new trauma bay,”

explains Dr. Andrew Petrosoniak, Emergency Physician and Trauma

completed trauma bay to finalize key details.

Team Leader at St. Michael’s and Unity Health Toronto’s Clinical

A key resource used in the design of the trauma bay was the findings

Integration and Translational Simulation Lead.

of the 2016 TRUST study, conducted by Dr. Petrosoniak and Dr.

Chris Hicks, fellow St. Michael’s Emergency Physician and Trauma

As a Level 1 adult trauma centre, St. Michael’s cares for an average

Finally, they conducted six in-situ simulations inside the almost

of 1,100 patients in its trauma bay per year.

Team leader. The year-long study, supported by the Allan Waters

The Operational Readiness team, led by Dominic Gascon,

Family Simulation Centre, observed and inquired about how trauma

Operational Readiness Specialist, and Margaret Moy Lum-Kwong,

team members interact with one another and with the space to see

Senior Director of Operational Readiness, and the ED and trauma teams

what changes they could implement to make the trauma bay more

began partnering on the design of the new trauma bay back in 2017.

conducive to efficient and collaborative patient care.

OUR SHARED PURPOSE

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INVESTING IN OUR FUTURE

Major new investment for St. Joe’s redevelopment Provincial funding will support work to reimagine St. Joseph’s and care for west-end neighbourhoods

BY MICHAEL OLIVEIRA

Deputy Premier and Minister of Health Christine Elliott poses with Unity Health Toronto President and CEO Dr. Tim Rutledge during the funding announcement event. (PHOTO CREDIT: Government of Ontario)

Unity Health Toronto was thrilled to recently welcome Deputy

Premier and Minister of Health Christine Elliott to St. Joseph’s

Etobicoke rely on this very hospital for care and so I’m very excited

for an announcement that the province is supporting a major

and pleased about this announcement because additional funding for

redevelopment plan.

redevelopment of this hospital is going to improve access to care and

The $5 million investment will help us start

the process of planning and reimagining the St. Joseph’s site with a new patient tower and renovations to existing facilities.

“We would like to thank the leadership and the

staff here at St. Joseph’s Health Centre,” Elliott said at the event.

“This hospital has been vital to the health needs

of the people living in the west end of the city of Toronto for many, many years – almost a century.

And it’s played an important role in teaching the

increase capacity.”

“This hospital

has been vital to the health needs of the people living in the west end

future leaders of our health care system.”

Elliott was also joined by Kinga Surma, the member of provincial

Parliament for Etobicoke Centre, who thanked all St. Joseph’s staff, physicians and volunteers for everything they do for patients.

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OUR SHARED PURPOSE

“

“Many of my constituents in Etobicoke Centre and across

Unity Health President and CEO Dr. Tim Rutledge

thanked the government for the investment and said he “looks forward to reimagining the future of St. Joseph’s Health Centre, building on almost a century of care.”

“And we will be reimagining this future in

partnership with other health care providers in west Toronto, as well as members of our communities, to provide the best possible, connected care experiences for those that we serve.”

This funding is great news for Unity Health Toronto

and the half a million people we care for in Toronto’s west-end neighbourhoods. We’ll share more about the planning process is the months to come.