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
2
OUR SHARED PURPOSE
“Our shared goal is to improve equity and access to bariatric
OUR SHARED PURPOSE
3
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
5
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. 8
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.