hospital news 2016 january edition

INSIDEEthics ..................................................10

Evidence Matters ...............................13

From the CEO's desk .......................... 17

Legal Update ......................................20

Nursing Pulse .....................................21

Doctors without borders: Refl ections from troubled waters

The discovery of the CEA antigen

6 16

FOCUS IN THIS ISSUEPROFESSIONAL DEVELOPMENT/CONTINUING MEDICAL EDUCATION/HUMAN RESOURCES:Continuing Medical Education for health care professionals. Human resource programs implemented to manage stress in the workplace and attract and retain health care staff. Health and safety issues for health care professionals. Quality work environment initiatives and outcomes.JAN. 2016 | VOLUME 29 ISSUE 1 | www.hospitalnews.com

Canada's Health Care Newspaper

1-866-768-1477

incivilityStory on page 14

Taming workplace

HOSPITAL NEWS JANUARY 2016 www.hospitalnews.com

2

y name is Chris Cull and I am in long-term recovery after a seven-year opioid addiction and dependency.

Unlike and not unlike a lot of Canadi-ans, I didn’t start down the path of opioid abuse through a prescription. When I was 22 years old, my father, after a roughly six-year battle with Huntington’s Disease, suc-ceeded in taking his own life. The result of that incident was pure devastation. In ret-rospect, I was not maturely nor emotionally developed enough at the time to manage the loss productively, so I turned to Perco-cets which I got off the streets to try and numb out my pain.

That then escalated into using fi ve 80mg Oxycontins a day, over a two year span that eventually saw me lose my house, my girl-friend and over six fi gures in cash. I decided to enter a harm reduction program, which took fi ve years from beginning to end, to beat my opioid dependency. Finally free from addiction, I set the biggest challenge for myself I could think of: To ride my bicy-cle across Canada and fi lm a documentary with the goal of bringing awareness around this growing health concern and show how prevalent the prescription drug crisis has become. What I found was troubling to say the least.

I stopped and walked around in every town I passed through to talk to the local community about prescription drug abuse. The phrase I heard most often was, ‘You’ll fi nd a lot of that around here.’ And when you start to hear that in every city, in ev-ery province, across the entire country, it begins to raise questions as to why this is occurring and what we can do about it.

I was given the opportunity to inter-view many people across the country who have been affected by the prescription drug abuse epidemic; abuse commonly began through legitimate dosage of pre-scribed opioids for pain and, of course, recreational use.

Some of the stories I encountered include an 18-year-old girl from Regina, Saskatche-wan, who developed a physical dependency in high school at the age of 16 after being prescribed Oxycontin due to a hairline frac-ture in her pinky fi nger. Another unforget-table story I encountered was that of an el-derly woman in Northern Ontario who was

prescribed opioids for chronic pain, who eventually became physically dependent, then began doctor shopping so she could sell her prescriptions to supplement her in-come as well as feed her addiction.

Stories like these exist everywhere across the country and with an estimated 432,000 Canadians currently dependent on either heroin and/or opioid painkillers, the time has come where we need to at minimum mitigate this problem.

How to do that with such a complex problem to solve is diffi cult; there are so many different variables and dynamics that play into it. I am not a doctor nor a medical professional of any kind, but after studying the broad scale of the problem and looking at it objectively, I have a few thoughts, us-ing sensible logic, as what to work on.

I believe that awareness, education, pre-vention and treatment working collectively with medical professionals, academics, gov-ernment, and the general public is where we can improve.

The fi rst step to solving any problem is recognizing there is one, which is where awareness comes into play. As a person who has felt the stigma associated with be-ing addicted to and dependent on prescrip-tion painkillers, I understand how diffi cult it can be to seek help. But I encourage ev-eryone who has been touched by this crisis to speak out and share their story so we can make it easier for those in the future to seek help without the overwhelming feeling of shame.

By doing so, we shine a spotlight on the crisis and show how prevalent it is.

Education on opioids is the most im-portant factor in this entire equation as it plays a vital role in both prevention and treatment. Both the physician and pa-tient need to have a clear understanding of the potential for harm that comes with prescribing opioids. This is particularly im-portant with chronic pain where sustained opioid use develops into a quick tolerance to the drug, leading to higher dosages and/or physical dependency.

If all parties involved are educated on the potential for harm with opioids and even being educated on non-drug thera-pies for certain pain states, then the po-tential for prevention is much higher.

The one thing I found in my travels that is severely lacking is adequate resources for treatment, especially in rural areas. Whether it be harm reduction, counsel-ling or meetings, the lack of resources pertaining to opioids in specifi c areas is

appalling. One way to help improve access to treatment would be to encourage and support rural GPs to play a role in their communities by offering treatment for opi-oid dependence. If we can give everyone the tools they require to fi x the problem, we can signifi cantly lower the alarming statistics.

With the right support and resources, people suffering from opioid dependence can move on from addiction and live in re-covery. One amazing resource I am proud to align myself with in my personal mission to help provide Canadians with access to the opioid addiction services they need is ORbeOK.ca. The site is one of the fi rst and most comprehensive websites for Ca-nadians suffering from opioid dependency. ORbeOK.ca offers educational resources on what opioid dependence is, how to recognize if you or someone you love is becoming dependent, community news as well as where to go to get the medical and emotional help you need.

That being said, I understand every-thing involving the opioid epidemic is much easier said than done and it will take time. But I am confi dent it can be done.

This is by no means a “how to” note as there are many more pieces to the puzzle than I have highlighted – it is simply a call to action. As mentioned, there are so many different variables to the equation and it is not a black and white issue.

Understanding that, we need to fi nd a balance within the spectrum of every-thing the opioid epidemic entails and take a new approach to it. If we all do our part – whether it is physicians, pharma-cists, academics, government, industry or the general public – we all have our own part to play in this and if we can change it now, we can look forward to a brighter future tomorrow.

Sincerely, Chris Cull

M

An estimated 432,000 Canadians currently dependent on either heroin and/or opioid painkillers.

Re: Rethinking opioid use

After battling his own opioid addiction, Chris Cullen bicycled across Canada while fi lming a documentary to raise awareness of what he believes is a prescription drug crisis.

Letter to the Editor

INSIDEFrom the CEO’s Desk ........................... 8Safe Medication ................................. 17Nursing Pulse .....................................26Evidence Matters ...............................27Legal Update ......................................28

Word rst:Sunnybrook unlocks blood-brain barrierA good year for health care infastructure

222

FOCUS IN THIS ISSUEYEAR IN REVIEW/FUTURE OF HEALTHCARE/ACCREDITATION/PHARMACOLOGY:Overview of advancements and trends in healthcare in

2015 and a look ahead at trends and advancements in

health care for 2016. An examination of how hospitals are

improving the quality of services through accreditation.

An examination of safe and effective use of medications

in hospitals and clinical pharmacology.

DEC. 2015 | VOLUME 28 ISSUE 12 | www.hospitalnews.com


1-866-768-1477

Story on page 12

RethinkingopioiduseBy Dr. David Juurlink

(December issue)

Psychoeducational and Training Programs for Depression, Anxiety, Guilt, Anger, and more.

Hypnotherapy for Depression, Anxiety,and Phobias.

Counselling for solving life’s problemsand spiritual crisis.

Online sessions are available.

647.875.2181

NoStressClinic.com

JANUARY 2016 HOSPITAL NEWSwww.hospitalnews.com

3 In Brief

Be part of a great team. Enjoy a balanced lifestyle. Impact lives.

We offer nursing professionals a career like no other. A variety of work environments

meaningful care to patients and their families.

non-clinical roles for Registered Nurses and Nurse Practitioners in different settings

dedicated team, visit ccacjobs.ca/nursing-jobs

ccacjobs.ca

CCAC has the nursing career you want

The median wait time for Canadians seeking medically necessary surgery or other therapeutic treatment remains stag-nant for the third consecutive year, fi nds a new study by the Fraser Institute. The study, an annual survey of physicians from across the country, reports a median wait time of 18.3 weeks, up slightly from 18.2 weeks in 2014. In 1993, the wait time was just 9.3 weeks.

The study examines the total wait time faced by patients across 12 medical speci-alities from referral by a general practitio-ner (ie: a family doctor) to consultation with a specialist, and subsequent receipt of treatment.

“These protracted wait times are not the result of insuffi cient spending but be-cause of poor policy. In fact, it’s possible to reduce wait times without higher spend-ing or abandoning universality. The key is to better understand the health policy experiences of other more successful uni-versal health care systems around the developed world,” says Bacchus Barua, senior economist at the Fraser Institute’s

Centre for Health Policy Studies and au-thor of Waiting Your Turn: Wait Times for Health Care in Canada, 2015 Report.

On a provincial basis, Saskatchewan now has the shortest waits in the coun-try at 13.6 weeks, a dramatic turnaround from 2011 when it was among the coun-try’s longest wait times (29.0 weeks). It’s followed by Ontario (14.2 weeks), Que-bec (16.4 weeks), and Manitoba (19.4 weeks), which has also decreased wait times since its 2013 high of 25.9 weeks.

For the third consecutive year, British Columbia recorded an increase in wait times with its median wait now sitting at 22.4 weeks.

Meanwhile, the Atlantic provinces face the longest median wait times: Prince Edward Island (43.1 weeks) followed closely by New Brunswick (42.8 weeks) and Newfoundland and Labrador (42.7 weeks). However, the number of survey responses in Atlantic Canada were lower than other provinces which may result in reported median wait times being higher or lower than those actually experienced.

Among the various specialities, the longest referral-to-treatment wait times exist for patients requiring orthopaedic surgery – the treatment of ailments relat-ed to bones, joints, and muscles – at 35.7 weeks and neurosurgery (27.6 weeks), surgery performed on the nervous system.

In fact, patients requiring such treat-ments can expect to wait over 15 weeks to just get a consultation with a specialist after getting a referral from their family doctor.

“These wait times for medically neces-sary treatment in Canada are not simply minor inconveniences. They can result in pain and suffering for patients, con-tribute to lost productivity at work, de-creased quality of life, and in the worst cases, disability and death,” Barua says.

On a somewhat better note, patients face much shorter referral-to-treatment wait times, relative to other treatments, for radiation oncology (4.1 weeks) and medical oncology (4.5 weeks) – specialties involved in the treatment of cancer. ■H

Canadians still wait more than 18 weeks for surgery

Even with cardiac rehab (CR) programs tailored to their needs, women heart pa-tients miss more than half of the sessions prescribed to them, according to a joint study by York University and the University Health Network (UHN).

“However, they may adhere more to a CR program and benefi t from it, if they are able to make their own choice on which model of program they attend,” says Professor Sherry L Grace in the Faculty of Health at York U.

“Participating in a cardiac rehab program greatly reduces death and hospitalization, as well as helps in improving the quality of life for heart patients,” says Grace, who is also a senior scientist at the UHN. “Un-fortunately, many patients do not use these proven services, and women are much less likely than men to access them, and to fully participate once they do.”

To test what might improve female heart patients’ adherence to cardiac re-hab, Grace and her colleagues compared women’s participation in one of the three program models offered. Study participants were randomly assigned to in a mixed-sex (co-ed) program, women’s only program or home-based program model. The research-ers recruited women from six cardiac care facilities in Ontario and referred them to one of these three most-commonly avail-able CR models.

The study, CR4HER, published in Mayo Clinic Proceedings, assessed adherence to the program as well as improvements in exercise capacity, which is strongly linked to better survival.

The researchers found that women only attended just over half of the 24 ses-sions offered, regardless of the model they were assigned to. However, the participants achieved signifi cant improvements in their exercise capacity.

“The results suggest that women should be encouraged to participate in cardiac re-hab, offering them the program model of their choice,” says Liz Midence, lead author and PhD candidate at York U. “We should inform women of the benefi ts of cardiac re-hab and use all the tools at our disposal to promote their full participation.”

Midence notes that women might have limitations such as taking time off from caregiving responsibilities and access to transportation. “They may be more likely to fully participate in a home-based program, where they can be supported by the cardiac rehab staff by phone at a convenient time for them, to make the changes they need to manage their heart condition.” ■H

Women attend less than half of cardiac rehab sessions

Wait time alliance report card revealsImportant lessons for next Health Accord

The Wait Time Alliance’s (WTA) tenth national report card shows that, despite encouraging signs that wait times for the initial fi ve areas identifi ed in the 2004 Health Accord are being reduced, progress to reduce waits for other medical procedures and treatments is spotty across the country.

“The upcoming work between the fed-eral and provincial and territorial govern-ments on a new Health Accord for Canada is a great opportunity for our elected lead-ers to create a new national vision for our health care system,” says Dr. Chris Simp-son, chair of the WTA. “The WTA report card shows that Canadians need action to reduce waits beyond the initial fi ve areas identifi ed in the 2004 Health Accord.”

As in previous years, the 2015 WTA report card found that Canadians are still waiting too long for care and that signifi -cant variation exists among some prov-inces; timely access is often still affected

by where you live, and often, how old you are. Key fi ndings in the 2015 report card include:•Nationally, the picture of timely access has not changed signifi cantly over the past year. Those provinces who did well in 2014 continue to be the best in 2015 – Saskatchewan, Ontario and Newfound-land and Labrador; •The number of provinces reporting Emergency Department wait times con-tinues to grow. PEI and BC are the latest to do so in approximate real time – updat-ed every fi ve minutes; •On the primary care front – PEI now re-ports on wait time to access a family physi-cian – the fi rst province to do so; •New in 2015, the report card draws spe-cial attention to the issue of timely access to care for elderly Canadians and also looks at wait times for those populations falling under federal jurisdiction (First Na-tions, refugees, veterans, Canadian Forces

and inmates in federal prisons).“If we are going to reduce wait times

across the system on a sustained basis, we must better integrate areas such as primary care, mental health services, home care, long-term care and palliative care,” adds Dr. Simpson. “Shortages in these areas all too often lead to more people, particularly seniors, spending more time in hospital when they could and should be getting care elsewhere.”

The WTA report cited the current lack of suitable living arrangements for seniors, such as supportive residential care models and long-term care beds, as having a huge impact on our health care system. Many senior patients are left waiting in acute care hospital beds until more appropriate care can be arranged. As a result, hospitals simply run out of beds and become over-crowded, leading to longer wait times in the emergency room and for tests and surgeries. ■H


4

THANKS TO OUR ADVERTISERSHospital News is provided at no cost in hospitals. When you visit our advertisers, please mention you saw their ads in Hospital News.

FEBRUARY 2016 ISSUEEDITORIAL JAN 8ADVERTISING: DISPLAY JAN 22 CAREER JAN 26MONTHLY FOCUS: Facilities Management and Design/Health Technology/Greening Healthcare/Infection Control:Innovative and efficient health care design, the greening of healthcare and facilities management. An update on the impact of information technology on health care delivery. Advancements ininfection control.+ INFECTION CONTROL SUPPLEMENT

MARCH 2016 ISSUEEDITORIAL FEB 5ADVERTISING: DISPLAY FEB 19 CAREER FEB 23MONTHLY FOCUS: Gerontology/Alternate Level of Care/Home Care/Rehab: Geriatric medicine, aging-related health issues and senior friendly strategies. Best practices in care transitions that improve patient flow through the continuum of care. Programs and advancements designed to keep patients at home. Care in rural and remote settings: enablers, barriers and approaches. Rehabilitation techniques for a variety of injuries and diseases.+ LONG TERM CARE SUPPLEMENT

UPCOMING DEADLINES

Guest Editorial

Hospital News is published for hospital health-care professionals, patients, visitors and students. It is available free of charge from distribution racks in hospitals in Ontario. Bulk subscriptions are available for hospitals outside Ontario.

The statements, opinions and viewpoints made or expressed by the writers do not necessarily represent the opinions and views of Hospital News, or the publishers.Hospital News and Members of the Advisory Board assume no responsibility or liability for claims, statements, opinions or views, written or reported by its contributing writers, including product or service information that is adver-tised.Changes of address, notices, subscriptions orders and undeliverable address notifications. Subscription rate in Canada for single copies is $29.40 per year. Send enquiries to: [email protected] Publications mail sales product agreement number 40065412.

Cindy Woods, Senior Communications OfficerThe Scarborough Hospital, Barb Mildon, RN, PHD, CHE , CCHN(C)VP Professional Practice & Research & CNE, Ontario Shores Centre for Mental Health Sciences

Helen Reilly,PublicistHealth-Care CommunicationsJane Adams, PresidentBrainstorm Communications & Creations David Brazeau Director, Public Affairs, Community Relations and TelecommunicationsRouge Valley Health System

Bobbi Greenberg, Health care communicationsSarah Quadri Magnotta, Health care communications

Dr. Cory Ross, B.A., MS.C., DC, CSM (OXON), MBA, CHEDean, Health Sciences and Community Services, George Brown College, Toronto, ONAkilah Dressekie,Ontario Hospital Association

ADVISORY BOARD

610 Applewood Crescent, Suite 401 Vaughan Ontario L4K 0E3TEL. 905.532.2600|FAX 1.888.546.6189

www.hospitalnews.com

EDITORKRISTIE [email protected]

ADVERTISING REPRESENTATIVEDENISE [email protected]

PUBLISHERSTEFAN DREESEN CREATIVE DIRECTORLAUREN REID-SACHSSENIOR GRAPHIC DESIGNERJOHANNAH LORENZO

GRAPHIC DESIGNERSANGEL EVANGELISTACAROLINE PAPINEAUNICK MCGRAWRENATA VALZJEFF CHARDARUN PRASHADALICESA LAROCQUEKATHLEEN WALKERSTEPHANIE GIAMMARCOBILLING AND RECEIVABLESMATTHEW PICCOTTI PHIL GIAMMARCO

facebook.com/HospitalNews

ASSOCIATE PARTNERS:

A LEGACY THAT WILL KNOW NO BORDERSLEAVE A GIFT IN YOUR WILL TO MSFHelp us provide medical assistance wherever the need is greatest by remembering Médecins Sans Frontières/ Doctors Without Borders with a gift in your will.

For information, contact Emily Harris: 1-800-982-7903 or [email protected]

msf.ca/mylegacy

hose nine words describe what every patient who en-ters a hospital expects from their care teams. And we all

know that, try as we might, people do come to harm in ways that can be pre-vented. Hospital acquired infections, in-juries from falls, bed sores, and medica-tion errors are examples of preventable harm that occur every day in healthcare organizations.

In a video we produced for our An-nual General Meeting last June we de-scribed how dangerous all hospitals are and underlined the need to have frank discussions about our need to improve. We cannot change what we don’t mea-sure and acknowledge. A signifi cant component of this change is that we need to approach preventable harm as an opportunity to learn and fi ne tune the system. Frank and supportive discus-sions need to take place on how we must change so that no patient is hurt as a result of a hospitalization.

I lead University Health Network – a health care system that includes acute care hospitals, rehabilitation facilities, and long-term care. In our health sys-tem, a community of nearly 20,000 care providers and volunteers work together to provide world class clinical care, in-novative research and technology solu-tions to health problems, and education for 7,000 students a year in a variety of health disciplines. Our community is now committed to use our talent, exper-tise and resources to reduce and eventu-ally eliminate preventable harm for the patients we serve.

As a part of a structured transforma-tion process, we have conducted a Speak Up for Safety survey that was carried out across the entire system. This safety survey tool has been used in healthcare organizations across North America and allows us to benchmark our safety cul-

ture against hundreds of other hospitals and health systems and to monitor safe-ty culture over time as we undergo our safety transformation. The response rate to our survey was extraordinary. Two of our hospitals achieved a 100 per cent re-sponse rate, with an overall response of 74 per cent at UHN. This is unequivocal evidence of the engagement of our or-ganization around the commitment that we have made to our patients and the community that we serve.

For critical insights on improving safety, we are looking to other industries that have made extraordinary safety improvements over the past 30 years. These industries include aviation, nu-clear power, and chemical manufactur-ing – industries that have a relative com-plexity of the work environment similar to healthcare and where reliability and resilience have been hard wired into the workforce. Collectively, these industries have adopted practices known as high reliability. In high reliability industries safety is a core value and employees are supported and trained to spot problems before they happen and take immedi-ate action. The lessons learned from success in other industries are applicable to healthcare.

Two of the most important critical success factors in safety transformation are the presence of a CEO, who sees themselves as the Chief Safety Offi cer,

and constant engagement of the Board. Indeed, we have commitment from my-self and the UHN Board to aggressively pursue this safety transformation.

Our journey to improve safety will not be easy, nor will it be quick. And so, we have collaborated on this with peer hospitals including the Hospital for Sick Children, Sinai Health System, and Women’s College Hospital. This collabo-ration will help accelerate progress by al-lowing us to share approaches, resources and tools designed to make our hospi-tals safer for our patients and staff. Pa-tients and staff will be part of a common safety culture that extends across our organizations.

Safety is an implicit expectation that Ontarians have of our hospitals. For those who would like to read more about High Reliability Organizations I recommend two books – Why Hospitals Should Fly by J.D. Nance and Manag-ing the Unexpected by Karl Weick and Karen Sutcliffe of the University of Michigan. The fi rst is written in novel form and imagines what it would be like to work in a hospital that has ad-opted the principles of high reliability organizations. The second book is a seminal work that outlines the principles in more detail.

We work with caring, concerned and dedicated people who want the best outcomes for their patients. By work-ing together, speaking up for safety, and supporting our workforce to change practice and behavior, we can transform our organizations become stronger and more resilient over time. We hope that our efforts may precipitate a safety trans-formation that extends across the entire health care sector in Canada. ■H

Dr. Peter Pisters is President & CEO, University Health Network. Follow him on twitter @ppisters

By Dr. Peter Pisters

T

In high reliability industries safety is a core value and employees are supported and trained to spot problems before they happen and take immediate action

Don’t hurt me. Heal me. Be nice to me


5 PROFESSIONAL DEVELOPMENT/CONTINUING MEDICAL EDUCATION/HUMAN RESOURCES Focus

ncil London spends his days at Sunnybrook assisting with au-dio-visual requests for the hos-pital’s 10,000 staff, volunteers

and physicians. Every Wednesday evening, he hits the basketball court and blows off some steam for a couple of hours. What’s different about his basketball team? Ancil is sinking hoops with other Sunnybrook employees from across the hospital.

“We’re literally an interdisciplinary team,” says Ancil, audio-visual technician at Sunnybrook, with a laugh. “The team is a mix of staff providing frontline care, support staff and everything in between. Thanks to the basketball team, I’ve built amazing friendships with people across the hospital that I would have likely never met under normal circumstances.”

The basketball team is just one of sev-eral sports teams formed as a result of Sun-

nybrook’s Quality of Work and Life Pro-gram. The program’s overarching goal is to ensure staff are coming to work in the best possible mental and physical condition.

“Over the last few years, we’ve focused on building teams at work to develop, more and more, our sense of community,” explains Marilyn Reddick, Vice President of Human Resources, Organizational De-

velopment and Leadership at Sunnybrook. “Forming basketball, soccer, volleyball and hockey teams at the hospital has created a sense of fun, allowing staff to play together and keep stress in check.”

Sports teams are not the only focus of the Quality of Work and Life Program. There are other wellness programs, includ-ing yoga, pilates and Zumba classes, as well

as onsite fi tness centres at two of the hospi-tal’s campuses. Another element includes fostering a family-friendly environment, with an on-site daycare at Sunnybrook’s largest campus and opportunities for fl ex-ible work schedules. The hospital strives to attract and retain staff with families, and was named as one of Canada’s Top Family-Friendly Employers for several years in a row. And of course recognition and cel-ebration are an important part of the pro-gram, with opportunities for development for all roles across the hospital.

“By supporting life-long learning and ca-reer development through courses, fi nan-cial assistance for education, and a culture where we are all teachers and learners, we are ensuring that you can live and grow your career at Sunnybrook,” says Reddick. “We want to ensure our staff are happy, challenged and rewarded for the hard work that they put in everyday.”

For Ancil, the experience of bonding with fellow staff has helped contribute to his satisfaction at work. “I look forward to coming to work every day,” says Ancil. “It often feels like the people I work with are more than just colleagues, they’re teammates.” ■H

Marie Sanderson works in Communications and Stakeholder Relations at Sunnybrook Health Sciences Centre.

Fostering a sense of community By Marie Sanderson

A

The program’s overarching goal is to ensure staff are coming to work in the best possible mental and physical condition.

Sunnybrook’s basketball team takes a short break from the court for a photo.Ancil London is pictured standing in the second row, far right.

Photo credit: Doug Nichoslon

The BoardwalkDesigned & built with the professional & the executive in mind

Luxury CondosDOWNTOWN CHATHAM

121 King Street West

• One, Two & Three bedroom suites• Located on the Thames• Spacious suites, coffered ceilings, stainless steel appliances including washer & dryer• Indoor parking & storage locker available• Professionally managed• Lease from the $1100s

Now Leasing for SUMMER 2016 ... www.BoardwalkChatham.com


6 Focus PROFESSIONAL DEVELOPMENT/CONTINUING MEDICAL EDUCATION/HUMAN RESOURCES

hen Italy’s “Mare Nostrum” maritime SAR (search-and-rescue) operation was ter-minated in November 2014,

only a few Italian Coast Guard and pass-ing merchant vessels remained as rescue resources for the deadliest refugee route in the world, the central Mediterranean from Libya to Italy. The resulting carnage was as terrible as it was preventable, with almost 1800 people perishing by the end of April 2015, while attempting to reach Europe in overcrowded, unseaworthy craft.

Of course maritime SAR is only a band-aid solution to a tiny part of the overall situation. There are currently 60 million people worldwide, or 1 in 120, displaced from their homes by state-sponsored violence, climate change ef-fects such as drought and fl oods, repres-sion, coldly-calculated terrorism, and crimes against humanity. The fl ow of

“irregular migrants” in 2015 is a global issue that is straining the European ca-pacity to accept them. But in 2014 over 150,000 had attempted the central Med-iterranean crossing, and in early 2015 there was no signifi cant rescue capacity on hand.

True to form, MSF (Médecins Sans Frontières/Doctors Without Borders) had already decided to intervene, having had projects in many of these refugees’ countries of origin since years prior. The two per cent mortality rate on the central Mediterranean migrant route was also impossible to ignore. MSF’s Amsterdam offi ce therefore negotiated a partnership with MOAS (Migrant Offshore Aid Sta-tion), to rescue and provide medical and humanitarian care for these “boat peo-ple”. MSF also intended to gather testi-monies when possible and advocate for adequate SAR resources.

Refl ections from troubled watersWBy Dr. Simon Bryant

Doctors without Borders:

Continued on page 7

Dr. Simon Bryant assists refugees

rescued from the Mediterranean.

OPSEU Health WorkersWorking for your community

joinopseu.org [email protected] facebook /joinopseu



Continued from page 6

This would be the fi rst-ever ship-based MSF project, on a 40-meter fi shing boat adapted for SAR work, the Phoenix.

This was also my fi rst-ever MSF project, full of surprises despite an excellent prepa-ration. Within 24 hours of setting sail on May 2nd we’d rescued 369 children, wom-en, and men from one sinking wooden boat. After a long midnight pause to assist another 109 from an infl atable raft onto a nearby oil tanker, we headed north to Italy. In 28 repetitions of the same basic proce-dure over the summer of 2015, always ac-cording to the instructions of the Maritime Rescue Coordination Centre in Rome, we plucked 6,985 people from grossly overcrowded and unseaworthy wooden boats and infl atable rafts. I learned much about the “migration crisis”, MSF, SAR techniques, and humanity.

The benefi ciaries weren’t so much seek-ing a dream-future in Europe as fl eeing an ongoing nightmare featuring war-related violence (e.g. in Syria and South Sudan), summary imprisonment and extortion (e.g. in Libya), systematic repression, military conscription and forced labour (e.g. in Er-itrea), rape, widespread chronic poverty and unemployment, and terrorist atroci-ties. They came from a surprising number of countries. Many from Pakistan, Bangla-desh, and the Philippines had worked in Libya for years before the utter collapse of civil order there forced them into the dangerous sea-crossing attempt. All those I encountered had no safe, legal way to ap-ply for asylum, or even to return to their distant homes.

We diagnosed and treated conditions ranging from minor injuries to fatal car-bon monoxide poisoning. Skin abscesses and scabies were commonplace, due to unhygienic conditions in transit and in detention in Libya. People were univer-sally exhausted and for the fi rst several hours aboard would often sleep soundly on the metal deck, often only to later re-port that it was the best rest they’d had in months, or even years. Seasickness was the rule rather than the exception, and late effects of torture and trauma were not uncommon. After encountering cases of hypertensive emergency and testicular torsion I thought no presentation would surprise me.

I was truly astonished, therefore, to en-counter a sick hemodialysis patient among those rescued. She’d had no treatments for three weeks since deciding to gamble her very last funds on the risky sea-pas-sage, and was in trouble with shortness of breath, peripheral edema, and ominously tall peaked T-waves and dysrhythmia showing on our cardiac monitor. Intrave-nous calcium gluconate soothed her heart rhythm, followed by her helicopter evacu-ation to defi nitive care in Italy, which did much the same for mine.

Certain persistent memories remind me of priorities:

On the sobering, darker side: fifty-two corpses tangled below deck in one wood-en boat, victims of carbon monoxide and global indifference; one survivor of that incident, whom we intubated and trans-ported to an eventual demise despite intensive care in Italy; and a helicopter crew searching the sea on August 5th, after 200 drowned when a wooden boat capsized. These dead people felt they had no other viable option. You and I, in their shoes, would have reached the same very unfortunate conclusion.

On the inspiring, brighter side: in May 2015 the European Union effec-tively reinstated the rescue resources of the summer of 2014, and many lives were consequently saved; a man with a broken knee healed at ninety degrees of flexion, after a truck accident in the Sa-hara that killed 23 others, was assisted by his companions for months. When-ever I’d catch his eye he’d flash a wide smile accompanied by an enthusiastic “thumbs-up” gesture. Another rescuee had spent months in summary deten-tion in Libya, having no money to bribe himself out, and no relatives to forward any. He was slow to respond, had the bi-lateral lower-limb edema of the severely protein-malnourished, a hemoglobin level about one-third of normal, and a look of death about him. His compatri-ots passing through that place raised the cash to bail him out, onto the tragic boat from which we rescued them all.

Since my return home from the Medi-terranean a few weeks ago there have been terrible killings in Beirut, Paris, and elsewhere, underscoring the urgent need for humanity, and not violence, to prevail. In the summer of 2015 our team on the Phoenix disembarked in Europe 6,877 women and men, and 108 clearly blameless persons below the age of five. I sincerely hope those children mature to enable a more humane world than exists today. ■H

Simon Bryant is a physician from Canmore, Alberta.

S P A C E F O R

THE PARKDALE MEDICAL TOWER1081 CARLING AVENUE

LEASE

FOR MORE INFORMATION PLEASE CONTACT:

Julie Taggart, Leasing (613)234-7000 ext. 222

[email protected]

The Parkdale Medical Tower is conveniently located on Carling Avenue between Parkdale Ave. and Hamilton Ave. Situated between the Royal Ottawa and the Ottawa Civic Hospital. Current tenants are pre-dominantly in the Medical field with Pharmacy, Bio-Lab and Helix Hearing.

Excellent Access to and from Queensway (HWY 417)

Easy access from OC Transpo routes

Parking is available for both tenants and clientele.

Manager on site

W W W . T A G G A R T . C A

Troubled waters

Over the summer of 2015 we plucked 6,985 people from grossly overcrowded and unseaworthy wooden boats and infl atable rafts.

Migrant deaths in the Mediterranean by month2014 2015

Source: IOM

1400

1200

1000

800

600

400

200

0Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

800 from Sunday 19 April

Aging is not a challenge - it is a journey and we embrace it, learn from it and innovate to enhance how it is and will be experienced.



atigue in the workplace is an emerging health and safety is-sue that requires increased un-derstanding of its impact and

prevention. With its mandate to improve safety in the Ontario workplace, the Pub-lic Services Health and Safety Association (PSHSA) is taking major steps to improve how fatigue will be prevented and handled in the workplace.

A link between fatigue and impacts on work performance has been shown and increasingly health care professionals are also taking steps to prevent and address fatigue as part of creating healthy work environments. Research has shown that more than 20 per cent of all serious inci-dents and negative patient outcomes are fatigue-related.

Numerous factors may cause fatigue to develop including heavy patient load, shift work and a fi eld that is always chang-ing and evolving for nursing professionals. In addition stress from reduced budgets, staff scheduling and a slowing economy all go towards adding to an already stress-ful workplace. The organization itself suf-fers when its staff are subjected to fatigue which may result in increased absenteeism, turnover, and increasing Workers’ Com-pensation costs. This could also result in confl ict between management and workers which only adds to the overall dysfunction and challenges. The recent classifi cation of shift work as ‘probably carcinogenic to humans’ by the International Agency for Research on Cancer (IARC) and the 2013 research in Occupational & Environmen-tal Medicine indicating that breast can-cer risks are doubled for female long term night shift workers makes this a critical health issue to address.

In nursing, when workers experience fatigue, it can cause lack of concentra-

tion which can lead to reduced situational awareness (SA) – the constant state of knowing what’s going on in your immedi-ate environment, why it is happening and what is likely to happen next. Fatigue can also contribute to stress which may lead to poor decision-making and unintentional medical errors. In some situations fatigue can be addressed by getting suffi cient sleep or leaving a stressful work environment; however, continuing a poor sleeping rou-tine or not coping with the workplace en-vironment will continue to contribute to ongoing chronic fatigue.

The results of a joint CNA/RNAO national research study (2010) of more than 7000 RNs representing all sectors of health care indicated that:• Nurses working 12.5 hours or longer are

found to be three times more likely to make an error.

• Of the 7,000 nurses polled, 80 per cent feel tired after work.

• Of the 7,000 polled, 55 per cent feel they are “almost always” tired at work.

• On average, nurses work more than 40 hours a week.

• During a 28-day study, every nurse in-volved worked at least one overtime shift.

• Two out of three nurses work 10 or more overtime shifts in 28 days. Implementing fatigue management

strategies has had a positive impact in other sectors. Developing effective inter-ventions relevant for the health care and community service sector is crucial. The Public Services Health and Safety As-sociation is delving into the causes and consequences of fatigue across various sec-tors. We are looking to develop strategies to build awareness, address and mitigate fatigue which is emerging more as a work-place issue.

As pointed out in the RNAO Best Prac-tice Guideline “Preventing and Mitigating Nurse Fatigue in Health Care” a multi-pronged approach is needed with strate-gies from External/ System partners (like PSHSA), workplaces and individuals.

Last month PSHSA announced it is providing leading work-related injuries re-searcher, Lora Cavuoto with Fatigue Sci-ence Readibands, a wearable wrist-worn technology that monitors sleep, activity and fatigue. The goal is to gather data-driven research to understand the impact of fatigue and implement innovative solu-tions to prevent it as a workplace hazard.

Studies have shown that fatigue is about four times more likely to contribute to workplace impairment than drugs or al-cohol, and a fatigued worker is at 70 per cent greater risk of accident than a non-fatigued worker.

“We know that fatigue in the workplace is a major health and safety issue,” says Glenn Cullen, VP Corporate Programs and Product Development, PSHSA. “We need to learn how to prevent fatigue in the workplace and new technology like Fatigue Science Readibands will help us develop effective Fatigue Risk Management Pro-grams. We are aiming to develop ways to intervene before fatigue becomes a risk to the health and safety of workers and con-trol the hazard once it has been identifi ed.”

PSHSA is supplying researcher Cavuoto with Fatigue Science Readibands that pro-vide 24/7 measurement of sleep patterns and mental fatigue. Wearing the Read-

ibands, study participants will be asked to perform a set of tasks, with participants’ natural variation in sleep-related fatigue and work-load factored in to the experi-ment. With this data, Cavuoto will be able to estimate fatigue based on work sched-ule, sleep and work conditions, and test these fi ndings in a real-life scenario.

The research will evaluate the inter-action of sleep-based fatigue and work-load in targeted industries that utilize shifts such as health care and emergency services. It will also evaluate fatigue mitigating interventions for the purpose of improving program effectiveness in the workplace.

“Today, we have little understanding of when and how fatigue intervention should be implemented,” says lead researcher Lora Cavuoto. “This research partnership with PSHSA will allow us to build fi rst-of-its-kind fatigue interventions and customize them for particular industries, like health-care, fi re departments, police and mining to name a few.”

Managing fatigue is key for maintaining a culture of quality and patient safety with-in our healthcare system. To reduce the damaging effects of that fatigue presents, workers must address the core issues and develop coping mechanisms. One should be aware of the root causes, symptoms and effects on body, mind and performance.

The PSHSA fatigue study is scheduled to begin in early 2016. As a result of the study and learnings, PSHSA is looking forward to providing products and services to assist the workforce in Ontario with ad-dressing this pervasive issue.

Public Services Health & Safety Associ-ation (PSHSA) works with Ontario’s pub-lic sector workers and employers, providing occupational health and safety training, resources and consulting to reduce work-place risks and prevent workplace injuries and illnesses. ■H

Henrietta Van hulle is Executive Director, Health & Community Services, Public Services Health & Safety Association.

Acceptance and Commitment Therapy Experiential Workshop

January 30, 2016 (Saturday-full day)Conducted by Dr. Kenneth Fung, MD, FRCPC, MScClinical Director, Asian Initiative in Mental Health, Toronto Western Hospital, UHN Associate Professor, Department of Psychiatry, University of Toronto

Acceptance and Commitment to Living and Dying Workshop

January 31, 2016 (Sunday-full day)Conducted by Dr. Jane Smith-Eivemark, DMinManager of Spiritual Care, Trillium Health Partners (Mississauga) Assistant Clinical Professor, Department of Family Medicine, McMaster University

Sustainable Compassion Training Workshop

October 16, 2016 (Sunday-full day)Conducted by Dr. John Makransky PhD, Associate Professor, Boston College

$150/workshop (register by Jan. 8/16) $175/workshop (after Jan.8/16 or $450 for all 3)

On-line Registration: https://bit.ly/ECABSI [email protected] 416-910-4858

MINDFULNESS & BUDDHISM IN PROVIDING CARE

WORKSHOPS TAKE PLACE AT EMMANUEL COLLEGE, ROOM 119, 75 QUEEN’S PARK CRESCENT

A U of T Faculty of Medicine Accredited continuing professional development event.

Dealing with By Henrietta Van hulle

F

Research has shown that more than 20 per cent of all serious incidents and negative patient outcomes are fatigue-related.

ONTINUING MEDICAL EDUCATION/HUMAN RESOURCES

workplace fatigue



ecognition can make all the dif-ference in promoting a quality work environment. With both the Long Service and Values in

Action Awards, Runnymede Healthcare Centre recognizes the remarkable contri-butions of staff that ensure a positive expe-rience for the hospital’s patients and fellow team members.

The Long Service Awards recognize those staff members that have raised the bar with their commitment to Runnymede. Recognizing commitments of fi ve, 10, 15, 20 and more years of commitment, these outstanding staff members contribute their years of knowledge and share this experi-ence with everyone they work with.

Margaret Tobin, whose 29 year com-mitment was recognized in 2015, says that “working at Runnymede is like being part of a community. All the years that I’ve spent here have allowed me to under-stand the hospital, and the unique needs of Runnymede’s patients. Being recognized for this experience makes me feel really appreciated.”

The Long Service Awards also share the tight-knit community that has sprung up amongst staff at Runnymede Healthcare Centre. “Seeing their colleagues recog-nized for their long-standing contributions to Runnymede is inspiring to those work-ing towards longer service milestones as well as new hires,” says Director of Human Resources Richard Mendonca.

The Values in Action Awards continue to be an important part of recognizing staff members’ exceptional contributions towards making Runnymede Healthcare Centre a great place to work. These awards were established in 2012 and have since ac-knowledged the ways that recipients have exemplifi ed Runnymede’s ICARE Val-ues in the areas of Integrity, Compassion, Accountability, Respect and Excellence.

The Values in Action Awards serve to recognize those staff members who have gone above and beyond the call of duty in their job performance, but there have been additional outcomes in the workplace cul-ture since Runnymede began handing out

these awards. Chief Planning & Com-munications Offi cer Sharleen Ahmed ex-plains that “since implementing the Values in Action Awards, there has been an in-crease in awareness of Runnymede’s values as we all work to incorporate those into our daily work. These values can be seen in action when someone offers a supportive ear to a patient; they take on extra work to make sure an event goes off without a hitch, or any of the many ways that people here contribute to making Runnymede an outstanding hospital and a special place to work.”

For Administrative Assistant Justyna Slazyk, receiving a Values in Action award in 2015 meant a lot more than just hav-ing a certifi cate to put on the wall. “Being nominated by my peers and recognized by the Awards committee felt like a big deal to me. Feeling recognized not just by my manager but other people that I work with made me feel motivated to work even harder.”

“We know from experience that shar-ing our appreciation for our team mem-bers brings everyone closer together and improves the overall workplace environ-ment,” says Ahmed. “These awards give everyone a chance to recognize some of our most dedicated staff and in turn, to strive further to bring Runnymede’s values to everything we do.”

It’s not just staff that are being awarded. Runnymede’s positive workplace has been recognized by several industry awards, in-cluding receiving the Quality Healthcare Workplace Award (QHWA) three years running, as well as Exemplary Standing

from Accreditation Canada. The hospi-tal has received a Leading Practice award from Accreditation Canada, which recog-nizes their commitment to promoting a culture of wellness and work-life balance.

In October 2014 Runnymede embarked on a new strategic planning process and their dedication to staff is an integral part of the ambitious, fi ve-year strategic plan, Vision 2020: Redefi ning Possible. The plan outlines Runnymede’s bold new vi-sion, transforming healthcare together, and acts as a roadmap to achieving the hospital’s new strategic directions: You fi rst; Lead innovation; Access and sup-port; and Supporting transformation.

You fi rst is an important commitment. It refl ects the hospital’s goal of putting

patients at the centre of decision-making processes in addition to ensuring that staff have the support the need to deliver an outstanding patient experience and en-hance their own practice as a member of the Runnymede team.

Runnymede recognizes that an invest-ment in staff will foster a culture of clini-cal excellence, curiosity and innovation which are essential components of the hospital’s strategic directions and will pay dividends for patients now and in the future and ensure ongoing quality improvement. ■H

Alison Terpenning is a Communications Specialist at Runnymede Healthcare Centre.

Research, Recovery and Quality in Mental Health

Ontario Shores’ 5th Annual Mental Health Conference

Tuesday, March 1 andWednesday, March 2, 2016

This two-day conference will focus on new research in mental health and exploring issues in mental health care quality and promising quality improvement initiatives.

Keynote speakers: Dr. Sandy Simpson, Dr. Ian Dawe, Nicholas Watters and Lee Fairclough.

For more information and registration details,visit: ontarioshores.ca/research.

Featured Speaker:Mark Henick

Mental Health Advocate

Promoting a positive workplaceBy Alison Terpenning

R

“We know from experience that sharing our appreciation for our team members brings everyone closer together and improves the overall workplace environment.”

Runnymede’s Values In Action Award display brings recognition to the forefront


10 Ethics

still recall the fi rst time I re-ceived an email announcing a colleague was ‘no longer with the organization effective im-

mediately’. I assumed there had been some egregious conduct leading to an immediate dismissal. I had never before encountered this ‘industry standard’ when fi ring a mem-ber of staff.

When I spoke with other colleagues about it, I then found out there was no misconduct at all – there was a service redesign and someone’s post was deleted.

The odd relief I felt about the nature of the incident soon gave way to a creeping sense of dismay – why did this happen this way? Apparently it is the industry standard in much of Canada. It was not something I had known in the UK, at least not in the public sector.

It has continued to happen with some regularity. Sometimes I lose colleagues with whom I have worked closely; on occa-sion I have even seen the signs of it coming where service changes or performance is-sues might be behind it. I have had friends

and family members experience it as well. It has sometimes seemed an appropri-ate change, but it has never felt right, for various reasons.

First of all, there is the impact this prac-tice can have on the person at its centre. Some people might see it coming; a few might even feel it is a welcome relief (as is suggested by some of the advice on the internet from HR consulting agencies). I have seen some friends struggle with profound depression and anxiety, loss of self-esteem and increasing hopelessness

after being ‘walked out’. In discussions with them, it is typically the process more than the result that is the source of their distress.

Those infamous taxi chits often become the central joking point – the recognition that the process might cause such deep upset that it is considered ‘caring’ (or less than negligent?) to offer a taxi ride home and then another when you come to fetch your belongings on another day. Such car-ing might be an effort in certain industries. In an industry like healthcare it amounts to little. Surely we can do better given what we know of the way human interac-tions happen?

The other reasons I feel this practice is often morally wrong are to do with the enduring damage to the organization it-self, and the effects it has on the remaining staff. While much of the commentary one can fi nd on various websites about this rec-ommended practice centers on avoiding harm to the organization, it seems (from my limited experience) that many of the concerns identifi ed are rarely addressed. Yes, the legal ramifi cations are typically front and centre. The lingering sense of dismay and distrust across the organization are left to fester. The stories of dismissal become part of a folklore that is shared for years – among old and new staff.

Ultimately, it would seem to me that the primary ethical problem is the absurd shift in status it confers upon a person. One moment you may be entrusted with the health, well-being and confi dential personal health information of thousands of people. Ten seconds from now, after the uttering of a few key words, you are per-sona non grata. You may even be a licensed healthcare professional, but you are so un-worthy of trust you must be removed im-mediately. (I do not include here any situ-ations of egregious conduct – only those where someone is no longer required or wanted for lesser reasons).

The convenience of this practice speaks to its popularity. The lack of imagination associated with it is glaring – especially in healthcare, where values are purported to play an important role in the way hospi-tals work. These values typically include such laudable aims as respect, compassion, caring, teamwork, trust, communication, excellence and innovation. It escapes me how these are applied in those situations where an employee is subjected to taxi chit termination.

Perhaps there is evidence that this is clearly the best practice – in all the situ-ations where it is applied. Or perhaps we are applying the tactic in a manner akin to off-label prescribing – convinced by some-one selling the idea that it is a wise practice here, too.

I for one would hope that the values we espouse in our work with our patients and our colleagues might suggest some alterna-tive ways of caring about people when hard decisions are taken.

That humane and innovative institu-tional character we show the world in our mission statements and the like ought to govern our sense of an appropriate inward-looking countenance as well. ■HKevin Reel is an Assistant Professor in the Department of Occupational Science and Occupational Therapy at the University of Toronto.

VS.

Your Advantage, in and out of the courtroom.

www.thomsonrogers.com

Ethics and HR practice:

By Kevin Reel

I

Are two taxi chits good enough?



he Ontario health care system is in a period of signifi cant transformational change. In order to continue driving the

shared objective of a high-performing, in-tegrated and sustainable health care sys-tem, a positive relationship between hos-pitals and physicians at all levels is critical. The enhancement of the partnership be-tween hospitals and physicians will result in greater levels of satisfaction and engage-ment on the part of physicians working within robust and high-performing hospi-tals, which will improve both patient care and patient safety.

The importance of these relationships and their impact on the sector prompted the Ontario Hospital Association (OHA) to identify hospital-physician relations as one of its three areas of thought leadership. Working collaboratively with other health system stakeholders such as the Ontario Medical Association (OMA), the OHA has set objectives that will:• Identify cultural and structural barriers

to the improvement of relationships;• Develop strategies to champion innova-

tive models to engage physicians in hos-pital leadership; and

• Improve hospital-physician alignment to enhance patient care and patient safety.

Currently, there is limited data regarding the current status of hospital-physician relationships in Canada. To better un-derstand the issue, the OHA conducted a comprehensive review of the literature which explored: • Attitudes of physicians and hospital

management towards a better alignment of purposes;

• Factors affecting hospital-physician relationships; and

• Strategies to enhance the alignment between physicians and hospital management.The literature review canvassed Canadi-

an, American and international research. While the nature of the legal relationship between physicians and hospitals varies across jurisdictions (i.e., employer-em-ployee, independent contractor, or other models), the research highlights consistent themes that infl uence the working rela-tionship between physicians and hospital management. The research also provides some insight into successful strategies for enhancing physician engagement; howev-er, local solutions may need to be tailored to individual circumstances and working environments.

Additional research focused within On-tario will be helpful to better understand the strategies that hospital management and physicians are currently using to fos-ter effective relationships. To this end, the OHA has been conducting member surveys and informational interviews with selected physician leaders and hospital management to determine the current state of hospital-physician relationships in Ontario, and to ascertain barriers and relevant best practices from a provincial perspective.

Following the review, seven consider-ations for leaders to refl ect upon to suc-cessfully foster and maintain positive rela-tionships emerged:

1. Supporting a culture of trust, respect and collaboration.

The foundation for building construc-tive and collaborative relationships is to create a culture of trust and respect among hospital boards, administrative leaders and physicians. To do that, it is important to understand and address the underlying characteristics and values important to physicians, (autonomy, time restrictions, and different styles of decision-making). Ultimately, there must be a shared commit-ment that promotes management’s under-standing of what physicians require to pro-

vide quality patient care, and physicians’ understanding of hospital governance, management and government/legislative requirements

2. Creating shared purpose and values among hospital boards, administration and physicians.

Creating a shared purpose (mission, vi-sion and values) with active participation by all stakeholders promotes ownership of a common agenda for all stakeholders and helps to ensure that work is driven by a shared platform of consensus and com-mitment to common objectives. Roles, responsibilities and accountabilities should be clearly articulated and mutually respected.

3. Communicating effectively.Effective communication among hospi-

tal boards, management and physicians is critical in creating a culture of trust. Given that physicians value evidence-based data, investing in information technology can provide physicians with meaningful data to facilitate their understanding of and involvement in hospital issues. Equally im-portant is the need to provide timely oppor-tunities to openly discuss sensitive issues.

4. Providing support and educa-tion to develop management skills for physicians.

An environment that identifi es and supports physician leaders, and provides opportunities for individual and collec-tive leadership growth, should be devel-oped. Physicians taking on leadership roles benefi t from training in key areas such as change management, fi nance and leader-ship development.

5. Enhancing organizational structures and processes to support and encourage clinical leadership.

It is essential to create administrative structures and collaborative approaches to problem-solving that facilitate more effec-tive engagement of physicians in all aspects of hospital operations. Administrative de-cision-making should be evidence-based, impact-sensitive, outcome-oriented, fair, transparent, and timely.

6. Encouraging and empowering phy-sicians to take leadership roles in the design, implementation and evaluation of a broad range of hospital and system initiatives.

Relationships are enhanced where phy-sicians participate in decision-making at all levels of the organization, and are pro-vided with meaningful opportunities to participate in the design, implementation and evaluation of hospital initiatives.

Perspectives on Communication Competency

Explore the relationships, challenges and opportunities in communication competency and practical language skills for professional practice, with international experts from:

• Medical education • Applied linguistics • Health care practice • Professional regulation

ANNUALSYMPOSIUM

February 23, 2016 MaRS Collaboration Centre Toronto, Canada

www.perspectives2016.com

Themes from the literatureT

It is essential to create administrative structures and collaborative approaches to problem-solving that facilitate more effective engagement of physicians in all aspects of hospital operations.

Continued on page 19

Effective working relationships between hospitals and physicians:

This is Part 1of our 3 Part Series onEffective working relationships between hospitals and physicians

SPECIAL PROFESSIONAL DEVELOPMENT SUPPLEMENT See page P1INSIDE



ill is exhausted. She and her partner, Paul, are struggling with childcare because of her shiftwork. Paul is unexpectedly

– and hopefully only temporarily – unem-ployed. Jill’s arm is still sore and stiff, days after a patient struck her, and now there is that little bit of anxiety every time she ap-proaches a patient to deliver care. Between the pressures at home and work, some-times she feels like she’s on auto-pilot. Jill is really distracted and hoping that Paul fi nds employment soon.

Andrew is a new manager at his facil-ity and is just back to work after taking a week off to get his parents moved from another province into an assisted living ar-rangement in the town where he lives. His teen-aged son is starting to get into trouble at school; he’s had two calls from the Prin-cipal just this week. Today, two of his staff called in sick; one just went off on short term disability. He’s not sure how he’s going to balance home, his parents and his new position. He’s not feeling himself at all.

Do either of these scenarios seem famil-iar to you? Maybe you know a “Jill” or an

“Andrew”? A person’s mental health can be affected by everyday life and stressors, including those experienced in the work-place. Chances are that you, or someone you work with, is struggling and may have

a mental health problem or illness; 1 in 5 Canadians do.

Workplaces are central to our lives; many of us spend more time with our col-leagues than we do our families. Many Ca-nadian workers report rising stress levels, increasing work pressures, and challenges balancing competing work and family de-mands. In fact, in any given week, 500,000 Canadians won’t go to work due to men-tal illness. Today, 30 per cent of disability claims and 70 per cent of disability costs are attributed to mental health related situations. Between $2.97 and $11 Billion per year could be saved by creating psycho-logically safer and healthier workplaces. The picture isn’t pretty and we know that things can be even more challenging in the health sector: • Health sector workers are 1.5 times more

likely to be off work due to illness or dis-ability than people in all other sectors.

• Over 40 per cent of Canadian physicians report that they are in the advanced stages of burnout – a critical condition for Canadian nurses and other health care workers.

• Stress, anxiety, depression, burnout and substance misuse are work-related conditions reported by Canadian health-care workers.

• Many health care workers report that tiredness, exhaustion, or sleep depriva-tion negatively affects the care they de-liver.An organizational culture that puts em-

ployees’ psychological health and safety on a level playing fi eld with physical health

and safety will cultivate engaged, sup-ported and more satisfi ed employees along with safer and more effective patient care. Research suggests that integrating patient and employee safety can lead to better safety practice and outcomes.

While the issue of workplace mental health isn’t unique to Canada, one solu-tion is – the National Standard of Canada for Psychological Health and Safety in the Workplace (Standard). The fi rst of its kind in the world, the Standard is a set of guidelines, tools and resources for an orga-nization to focus on promoting employees’ psychological health and preventing psy-chological harm due to workplace factors.

Following the launch of the Standard in 2013, many Canadian organizations of all sizes and sectors have answered the call to commit to building a mentally healthy workplace by implementing the Stan-dard, in whole or in part. For example, HealthCareCAN, a national organization representing hospitals and health care organizations, released a position state-ment strongly encouraging its Members and all health system stakeholders to adopt the Standard.

A catalyst for our continued work and building on the momentum of the policy, the Mental Health Commission of Canada (MHCC) and HealthCareCAN have been working in partnership to advance work-place mental health in the health sector and to increase uptake of the Standard in hospitals and healthcare organizations across the country, including a series of co-hosted roundtables across Canada.

The Mental Health Commission of Canada (MHCC) is also carrying out a case study project, which is tracking over 40 organizations in the private and public sectors as they implement the Standard. Of the participating organizations, 18 are in the health care sector, comprising the largest sector represented in the study. HealthCareCAN and MHCC have com-missioned research involving an in-depth analysis of the 18 health sector organiza-tions to identify promising or unique fac-tors (barriers or enablers) related to imple-menting the Standard. Findings from this research will be shared and will provide insight into and motivation for other hos-pitals and healthcare organizations to start their journey implementing the Standard. Watch for more details in future issues of Hospital News as our work unfolds in 2016.

To learn more about MHCC’s and HealthCareCAN’s efforts and next steps, visit http://www.healthcarecan.ca

For more information on the Standard and its implementation guide, and to download both for free, visit www.mental-healthcommission.ca ■H

Susan Anderson is Senior Policy Analyst and Jennifer Kitts, Director, Policy and Strategy, at HealthCareCAN. Sandra Koppert is Program Manager, Prevention and Promotion Initiatives and Ed Mantler is Vice President, Programs and Priorities at Mental Health Commission of Canada.

J

EMERGENCY LOANSFOR HOMEOWNERS!

Manny Johar is Ontario’s mortgage SUPERSTAR!

WE REPRESENT OVER 400 LENDERSManny provides 1st, 2nd and 3rd mortgages even with:• Horrible Credit

• Bankruptcy

• Unemployed

• Power of Sale

• Mortgage Arrears

• Property Tax Arrears

• Self-Employed

• Pension & Disability

“My husband lost his job. We fell behind on our mortgage. The bank was seizing our home. I still can’t believe that you gave us an emergency mortgage with no proof of income. You saved our home & gave us extra cash to get by until he finds another job. Thanks Expert Mortgage!” C.S.

Ask him about COMMERCIAL – FARM – CONSTRUCTION loans!

Call Manny 7 DAYS A WEEK 1.888.646.7596 or www.MannyJohar.ca

Licence # 12079

Does your bank offer payments THIS LOW?

Rates from

2.05%!

As of February 1, 2015, OAC

Mortgage Amount$200,000

$220,000

$240,000

$260,000

$280,000

$300,000

$320,000

$340,000

$360,000

$380,000

$400,000

MonthlyPayment$671.89

$739.08

$806.27

$873.46

$940.65

$1,007.84

$1,075.84

$1,142.21

$1,209.40

$1,276.59

$1343.78

Bi-WeeklyPayment$309.96

$340.95

$371.95

$402.95

$433.94

$464.94

$495.93

$526.93

$557.92

$588.92

$619.92

Amortization up to

35 Years!

Mortgage Agent

Improving psychological health and safety in the health sectorBy Susan Anderson, Jennifer Kitts, Sandra Koppert and Ed Mantler

Health sector workers are 1.5 times more likely to be off work due to illness or disability than people in all other sectors.

Many health care workers report that tiredness, exhaustion, or sleep deprivation negatively affects the care they deliver.

SPECIAL PROFESSIONAL DEVELOPMENT SUPPLEMENT See page P1INSIDE


THE 14TH ANNUAL

S U P P L E M E N T

Development & Education


P2 Professional Development and Education

On November 30, 2015, the Centre for Addiction and Mental Health (CAMH) and the recently established Medi-

cal Psychiatry Alliance (MPA) celebrated the launch of a unique mental health training centre to help health profession-als care for patients with complex mental health needs more effectively.

Called the Simulation Centre, the new education hub is located at CAMH and will provide a safe learning environment for students, trainees, and health profes-sionals to explore their clinical practice and test new approaches to treating com-bined physical and mental illness. While simulation training has been well-estab-lished in physical health specialties such as surgery and anesthesiology, the new Simulation Centre at CAMH is the fi rst of its kind in Canada to focus primarily on mental healthcare.

“There’s not enough opportunity to re-hearse aspects of learning before you actu-ally confront it with your patients and cli-ents,” says Dr. Ivan Silver, Vice President, CAMH Education. “It’s a missing ingredi-ent in mental health – we do a lot of learn-ing on the job, but we need better ways to prepare clinicians before they actually need to use a skill in practice.”

The Simulation Centre is supported by the Medical Psychiatry Alliance, a collab-orative partnership between CAMH, the

University of Toronto (U of T), the Hos-pital for Sick Children and Trillium Health Partners, with the goal of transforming mental healthcare in Ontario. The new training centre supports the MPA’s man-

date to transform the delivery of mental health services for patients suffering from both physical and mental illnesses.

In Ontario, 1.3 million people suffer from combined physical and mental health ill-nesses. In many cases, treatment of these patients fails because health care profession-als are trained to focus on either physical or mental illness but not both at the same time. As a result, physical symptoms with a men-tal health origin can often go unaddressed.

To meet the challenge of treating people with complex mental and physical health care needs, the MPA is creating a new model of integrated care that includes a new approach to the education of health care professionals. The Simulation Centre at CAMH will train health care staff using the new model of care.

Dr. Benoit Mulsant, MPA Executive Di-rector and Chair of the Department of Psy-chiatry at the U of T, says it’s his hope “that in the years to come, we will have trained our health professionals to integrate men-tal and physical care so that it becomes the norm to do in our health care system.”

In addition to hands-on mental health training available within the Simulation Centre, the MPA is rolling out other con-tinuing education initiatives in the coming year to help health professionals care for this population of patients. In collaboration

with Trillium Health Partners and U of T, the MPA plans to offer a medical psychiatry certifi cate program to equip current health professionals already working in their re-spective fi elds with the skills and resources needed to better treat patients suffering with both mental and physical illnesses.

The MPA is already transforming curricu-lum in U of T’s Undergraduate Medical Edu-cation program so that future health leaders will be better equipped to care for patients in a more integrated health care model.

“If we want to teach innovative models of care, we need new tools andapproach-es,” says Dr. Mulsant.

Established in January 2014 through a $60 million grant, the MPA has a six-year man-date. During this time, the MPA aims to:• Improve quality of life and increase life

expectancy for those with serious, simul-taneous mental and physical illnesses, while reducing the burden of illness on families, the healthcare system and so-ciety

• Create a new model of clinical care to support patients with both mental and physical issues

• Teach current and future health profes-sionals how to prevent, diagnose and treat mental and physical illness within a novel integrated care model

• Deepen our understanding of the inter-action between body and brain regarding co-morbid mental and physical illnesses.For more information, please visit www.

medpsychalliance.ca. ■HSandeep Dhaliwal is a Senior Communica-

tions Advisor with the Medical Psychiatry Al-liance (MPA). Supported by The Centre for Addiction and Mental Health (CAMH), The Hospital for Sick Children, Trillium Health Partners and the University of Toronto (U of T) in conjunction with the Ministry of Health and Long-Term Care and an extraordinarily generous donor, the MPA is dedicated to transforming the delivery of mental health ser-vices for patients who suffer from physical and psychiatric illness or medically unexplained symptoms.

First Simulation Centre devoted to training mental health care professionals opens By Sandeep Dhaliwal

At the offi cial opening of the Simulation Centre at CAMH. From left to right: Dr. Ivan Silver, Vice President, CAMH Education; Dr. Catherine Zahn, President and CEO,CAMH; Dr. Benoit Mulsant, Executive Director, Medical Psychiatry Alliance; and Dr. Trevor Young, Dean, Faculty of Medicine, University of Toronto.

O

Called the Simulation Centre, the new education hub is located at CAMH and will provide a safe learning environment for students, trainees, and health professionals to explore their clinical practice and test new approaches to treating combined physical and mental illness.


Professional Development and Education P3

Visit michener.ca/ce-brochure to view the full course brochure

Diabetes specialty programs

Management & Leadership Certif icates

facebook.com/ TheMichenerInstitute

youtube.com/ TheMichenerInstitute

twitter.com/ MichenerInst

Seniors curriculum

M I C H E N E R . C A / C E

Health care is changing• Enhance your scope of practice

• Update your credentials

• Plan your future

R e g i s te r f o r o n l i n e co u r s e s & wo r k s h o p s to d ay ! Join our mailing l ist and be the first to hear about new courses and certificate programs

CE

Chronic illness

Quality improvement

Supporting your role in the health system

Aging population

C O N T I N U I N G E D U C A T I O N A T T H E M I C H E N E R I N S T I T U T E



“ When employers see McMaster University on

my resume, they know I have the knowledge

and skills. McMaster is the only program that

offers the Health Information Management

diploma at the university level.”

– NUSRAT FARHANA

GRADUATE, HEALTH INFORMATION

MANAGEMENT DIPLOMA PROGRAM

McMaster Centre for Continuing Education

Discover. Possible.www.mcmaster-health.ca

EXPERIENCE INNOVATION IN HEALTH CARE EDUCATION

LEARN MORE

www.mcmaster-health.caCentre for Continuing Education | McMaster University | 905-525-9140 ext. 24321 | mcmastercce.ca

WATCH NUSRAT’S STORY: www.mcmastercce.ca/nusrat

Hospital News APPNow Available

Reporting on best practices in Canada, including new equipment and technology and the people that make a difference.

Celebrating Over 25 Years!

INSIDESafe Medication .................................12

From the CEO’s desk .........................13

Evidence Matters ...............................14

Legal Update ...................................... 17

Nursing Pulse .....................................23

FOCUS IN THIS ISSUEPAEDIATRICS/AMBULATORY CARE/NEUROLOGY/HOSPITAL-BASED SOCIAL WORK:

AUGUST 2015 | VOLUME 28 ISSUE 9 | www.hospitalnews.com


Why Canada needs to do more

Lymedisease

Paediatric programs and developments in the treatment of paediatric disorders. Specialized programs offered on an outpatient basis. Developments in the treatment of neurodegenerative disorders, traumatic brain injury. Social work programs helping patients and families address the impact of illness.

INSI

DE CAPHCSUPPLEMENTSee page C1

By Sarah Quadri Magnotta

Unravellingthe mystery of

See page 7

NEW!



cceMcMaster Centre for Continuing Education

Discover. Possible.www.mcmastercce.ca

www.mcmastercce.ca/health

@McMasterContEd facebook.com/McMaster.Continuing.Education youtube.com/McMasterContEd

Centre for Continuing Education | McMaster University | 1 James Street North, Hamilton, Ontario | 905-525-9140 ext. 24321

Discover. Possible.

The McMaster CCE courses transcended my expectations.

Almost immediately after taking the program, I was

granted my professional certification as an addiction

counsellor. On top of that, I was offered a supervisory

position with my current employer.

Mike Hughes, McMaster CCE Addiction Caseworker

Diploma graduate, CACCF, Team Lead,

Reconnect Mental Health Services

Study online with McMaster University. Apply today!

Case Management Certificate Deadline April 18 for May start

Health Information Management & Health Informatics Diploma programs Deadline July 15 for September start

Addiction Education Diploma or Certificate Ongoing application & enrolment

McMaster is a leader in healthcare education. Invest in yourself to see results for your organization and your clients.



hen it comes to making im-provements in the health care arena, Dr. Roger Wong, As-sociate Dean of Postgraduate

Medical Education at the University of British Columbia, knows medical residents have a key role to play.

But what’s the best way to equip the next generation of medical practitioners with the skills and knowledge needed to improve clinical processes and patient care over the course of their training and medical career?

A recently released e-book, Teaching Quality Improvement in Residency Education, sheds light on teaching quality improve-ment (or QI) in the health care setting, a topic that has garnered increased attention from postgraduate medical education pro-grams across the country in recent years.

The user-friendly publication, which offers practical tips and tools for teaching (and assessing) QI competencies, repre-sents a culmination of years of medical ed-ucation research by Dr. Wong. Developed in partnership with the Royal College, the new resource was offi cially unveiled dur-ing the 2015 International Conference on Residency Education, which was held in Vancouver last fall.

We recently sat down with Dr. Wong to fi nd out where his passion for teaching QI began, and what his e-publication means for medical educators and residents across Canada.

When did the idea forthis e-publication emerge?

Years ago, before my time as the Asso-ciate Dean of Postgraduate Medical Edu-cation at UBC, I served as the associate

program director of the Internal Medicine Residency program. At that point in time, the topic of quality improvement was be-ginning to gain a lot of attention in the medical community, and there was cer-tainly a strong appetite at UBC to develop a QI curriculum to teach residents.

So I decided to take on the task. Back then, very little had been written about the subject of teaching and assessing QI com-petencies, so I knew taking on the project would be challenging, and offer an oppor-tunity to be quite innovative.

After implementing the new QI cur-riculum within the UBC environment, my colleagues and I began to share our thoughts and experience with medical ed-ucators from across the country. By 2007, I had received national recognition for my work, earning the Royal College’s Donald Richards Wilson Award, which recognizes those who have demonstrated excellence in integrating the CanMEDS roles into a Royal College training program.

Our QI curriculum continued to catch the attention of a lot of people – includ-ing the Royal College’s Dr. Jason Frank, Director of Specialty Education, Strategy and Standards, who recommended that I partner with the Royal College to write a book about teaching QI to residents. Not one to turn down an opportunity, I agreed and worked with the Royal College to de-velop the e-book. Looking back, although it was a lot of work, I’m so glad I took on the project – I had the opportunity to meet and work with a very talented pool of peo-ple from both within the Royal College, as well as the UBC environment.

What can readers expect to take away from your book?

While many people recognize the im-portance of continuous improvement in the quality of care delivered in healthcare and in medicine, a lot of times, what they may not realize is how essential it is to teach our up-and-coming physicians and surgeons about QI – it’s a skillset and com-petency that must be taught like any other.

The intention of this book is to provide a user-friendly guide for medical educators

looking to develop and implement a QI curriculum. The publication covers every-thing from setting learning objectives to as-sessing competencies and curriculum eval-uations (at the foundational and advanced level). Readers will walk away with a host of tips, lessons learned, and assessment tools that they can download and modify to meet their specifi c program needs. An-other big feature of this book is that it is very resident focused and looks at how trainees can be engaged and inspired to get involved in the important work of quality improvement in the health care setting.

At the 2015 International Conference on Residency Education (ICRE), where the new CanMEDS framework was launched, the book was positioned as one of the tools that can help residency programs imple-ment competency-based curriculum.

Why are you passionate about this topic?

As a medical educator, I have the plea-sure of meeting and working closely with residents. And over the years, many have come to me with stories and examples of processes in clinical settings that they feel are not working as effectively or effi ciently as they could be. At fi rst, they feel quite discouraged about what impact they can make ‘as just residents’ – but after being exposed to the QI curriculum, and learn-ing about some of the methodology and tools at their disposal, I see a huge change in their outlook – they feel empowered. By teaching future doctors how to do quality improvement work, we are empowering them with tools to make a change for the better of healthcare, and their patients. So, for me, QI is really a fundamental skillset that makes a huge impact, and being able to publish and share what I’ve learned about QI with other medical educators and residents is very exciting.

Copies of Dr. Wong’s e-book, Teaching Quality Improvement in Residency Educa-tion, are available on the Royal College’s website. ■H

Kerry Blackadar is a Communications Co-ordinator, Faculty of Medicine, The Univer-sity of British Columbia.

Teaching quality improvementin residency education Dr. Roger Wong reveals what the launch of his new e-book means for medical educators and residents across CanadaBy Kerry Blackadar

W

Dr. Roger Wong.

The Health Information Management profession is one of constant change. The Centre for Distance Education offers a dynamic HIM program that recognizes the needs of both industry and the students. Last year was the introduction of the Mock National Certification Exam to assist CD-ED students in their prepara-tion for this intense exam credentialing HIM professionals. This was exception-ally well received, and students were thankful for this opportunity to practice for the exam. The Mock NCE was then expanded to be offered at a minimal cost to HIM students from any HIM program. The uptake and positive response indicates that this is a valued resource for all HIM students in Canada.

With the success of this first “learn it online now” project, CD-ED has expanded their LION professional and personal development offerings to now include a Classifications module. In this self-directed module, enrollees progress from an introduction to the 2 primary classification systems used in Canada (ICD10CA and CCI) to applying the codes to real records while adhering to national stan-dards at www.learnitonlinenow.com

In recognition of the diversity of students, and their life experiences, CD-ED is planning for the 2016 implementation of a part-time option that will allow the students to take 3 years to complete the HIM program. This will allow those students who are balancing work life and their personal life to now also take on a challenging academic program and be successful.

We are so pleased for and proud of Dr. Shapoor Shayegani. Dr. Shayegani is the first and only Canadian who holds the prestigious title of IHTSDO Consul-tant Terminologist (http://www.ihtsdo.org/participate/consultant-terminolo-gist-program). This is a fabulous recognition of Shapoor’s expertise, and we are privileged to have him as an instructor with the CD-ED Health Information Management Program.

As the HIM profession evolves, so does the program

www.cd-ed.com



If you love helping people but haven’t found the right niche for yourself in the industry, you should consider a career in Health Information Managment (HIM). CD–ED makes it easy to train on your time from your own home and transition with confidence to the new career path you’ve been looking for.

Love healthcare but feel like you’re wearing the

wrong uniform?

Complete flexibility–manage school around family, work & opther responsibilities

24/7 support: via email, chat, online classroom webinars & toll–free phone calls

Graduates have achieved an industry leading success rate on their national certification exams

Professional career training from industry experienced instructors

Start dates available every month

Professional career placement support

Financial aid for those who qualify

ISO 9001 Registered College

We can help...

We offer

Call or email to speak with our Admissions Representative

[email protected] www.cd-ed.com

1 866 446 5898



It’s Your Education Grab a Front Row SeatEver dozed through a monotone lecture in a dusty lecture hall? No more. Education should be engaging, interactive, and facilitated by industry thought leaders. You’ll want to get a front row seat for these programs.

The Ontario Hospital Association (OHA) offers 50+ certificate courses to help health care professionals acquire the knowledge and skills necessary to face the challenges of today’s health care climate. These programs help more than 1,400 professionals from the industry, including front-line staff, human resources, emerging leaders and more.

LEARN MORE oha.com/courses

Think of the last time you felt truly inspired. Imagine if you could multiply that productive energy by 100. Or even 1000.

There’s nothing more invigorating than a room bursting with great ideas and energy for change. The Ontario Hospital Association’s (OHA) conferences are designed with this in mind. Built by members and for members, our conferences offer participants an opportunity to share leading practices and information about industry-wide issues and trends.

Great Minds Meet Here Welcome to Your Next OHA Conference

LEARN MORE oha.com/conferences

Advance Elder-Care in your organization, Join the ACE Collaborative.

The Canadian Foundation for Healthcare Improvement (CFHI), in partnership with the Technology Evaluation in the Elderly Network (TVN), is inviting applications from healthcare delivery organizations to participate in a quality improvement collaborative focused on spreading innovative elder-friendly care practices. Too often in Canadian healthcare, promising innovations remain isolated pockets of excellence. Any organization working to improve patient care, health outcomes and value-for-money should ask: “What’s out there that works?” The Acute Care for Elders (or ACE) collaborative will support participating healthcare delivery organizations across Canada and internationally with the implementation, evaluation and spread of proven evidence-informed elder-friendly care practices. The ACE collaborative responds to what those working in healthcare across Canada and internationally are telling us they need in order to kick-start sustainable improvement at the service delivery level: seed funding, an evidence-based program and coaching to support the implementation of specifi c elder-friendly practices. Benefi ts of Joining the Collaborative• Up to $40,000 in seed funding to implement the initiative• CFHI collaborative support with the implementation, evaluation and spread of proven

evidence-informed elder-friendly care practices• Peer-to-peer networking and exchange among the entire cohort• Monthly team educational webinars• Support for performance measurement and evaluation• An in-person workshop to foster cross-team learning and sharing• Access to a network of expert faculty coaches, including Dr. Samir Sinha and his team who have

led the ACE Strategy at Mount Sinai• Individual coaching to ensure a rapid pace for testing change and troubleshoot, as needed• Access to online learning tools and activities• Award winning strategy recognized by Accreditation Canada as leading practices.

For more information on joining the ACE collaborative, visit cfhi-fcass.ca/ACE. Deadline for application is February 1st, 2016.



A 14-month bilingual improvement

program that supports breakthrough

innovations to achieve better care,

better health and better value.

DOWNLOAD YOUR APPLICATION TODAY

The Canadian Foundation for Healthcare Improvement is a not-for-profi t organization funded through an agreement with the Government of Canada.

Application deadline: FEBRUARY 15, 2016

cfhi-fcass.ca/EXTRA

EXTRA: Executive Training ProgramBuilding Capacity. Enhancing Leadership. Delivering Improvement.



n September, three anaesthesi-ologists from the University of Ottawa were awarded a World Federation Of Societies of

Anaesthesiologists (WFSA) Innovation Award for the creation of online tools to support a competency-based anaesthesi-ologist residency programme.

Dr. Christopher Hudson, Dr. Viren Naik and Dr. Emma J. Stodel designed the learn-er driven programme in response to the evolving needs of graduate medical educa-tion and 21st century healthcare.

“Calls for reform in how physicians are trained have been longstanding,” explains Dr. Emma Stodel, “In many of the current systems, programs defi ne the successful completion of training based on the length of time a trainee is in a program, assum-ing that trainees will develop the required competencies to practice after a predeter-mined amount of time.”

“However, the restrictions around resi-dent duty hours, pressure to reduce costs associated with resident training, and the need for improved accountability for pa-tient safety, have led many countries to consider a competency-based approach to medical education.”

Rather than focusing on the length

of time a resident is in training, as is the case with existing programs, the new tools focus on attaining specifi c competencies required of an anaesthesiologist to ensure positive patient outcomes.

“The online tools identify the abilities

required of the physician and then design the curriculum to support the achieve-ment of them. This paradigm defi es the as-sumption that competence to practice as a fully rounded physician is achieved based on time spent on rotations and instead re-quires residents to demonstrate the com-petencies deemed necessary for patient care,” Dr. Stodel explains.

For some trainees, this may require more time than the typical programs, while oth-ers may be able to accelerate their training and enter the workforce earlier or engage in further specialized training.

One key component of the program is the Clinical Case Assessment Tool (CCAT), an online resident-driven assess-ment used throughout the program.

“The resident’s self-assessment is shared with the staff who assess performance on a behaviourally anchored scale ranging from “Staff had to do” to “Staff did not need to be there” and documents their assessment based on what was done well, what needs to be improved, and next steps for learn-ing,” Stodel explains.

The tool increases face-to-face feedback to residents and allows data to be easily analyzed and interpreted for learning, re-search, and quality improvement purposes.

Another element of the program is a series of learning cases, completed by resi-dents during the ‘Core of Discipline’ stage of their program starting seven months into their training. The learning cases are designed to replace traditional academic half-days. Unlike academic half-days, Drs. Hudson, Naik and Stodel’s learning cases are linked to the module the resident is in so residents learn topics most relevant to them at the time.

The learning cases are based on the format of the Royal College of Physicians Surgeons Canada (RCPSC) oral examina-tions. Residents are provided with a case scenario followed by questions to direct their learning and selected resources. They are then expected to spend time engaged in self-directed learning for each case, fol-lowed by a meeting with a staff anaesthesi-

ologist to discuss the case and are assessed against an expected level of competence.

“By reviewing the topic before interact-ing with staff, the staff-resident discussions can be at a more advanced level, mirroring a ’fl ipped classroom’,” according to Stodel.

Learning cases are delivered through a custom-built electronic system that stores and manages access to cases, tracks com-pletion, and documents assessment. Data from this system will be automatically fed into in-training evaluation reports (ITERs) so evaluators know whether module re-quirements have been satisfi ed, as well as to a central dashboard that will provide a summary of resident progress.

Five months into the new program an-ecdotal comments from staff indicate that the program residents are more skilled and more confi dent than residents from the traditional program at this stage of train-ing.

“The biggest impact we have seen since the introduction of the above tools is the engagement from the faculty. Utilizing the electronic CCAT, the faculty are feeling empowered to provide more specifi c and detailed learning assessments. Anonymous survey results suggest that the culture change related to CBD methodology has improved the quality of their assessments,” says Dr. Stodel.

As the WFSA Innovation Awards en-courage and support innovation in anaes-thesiology that has had, or is likely to have, a positive impact on surgical patient out-comes, the creators’ intention is to share the electronic tools they developed with other departments and institutions across Canada was looked upon very favourably.

“Innovation in the fi eld is a large part of improving standards in anaesthesia care globally. Recognizing and rewarding innovation is good for medical staff and patients and will have a positive impact on future generations,” adds Julian Gore-Booth, Chief Executive of the WFSA. ■H

Niki O’Brien is a Communications Offi cer at The World Federation Of Societies of An-aesthesiologists.

Anaesthesiologists advance medical education in CanadaBy Niki O’Brien

Dr. Naik teaching in simulation.

I

EDUCATION AT THE INTERSECTIONOF HEALTH, BUSINESS, AND TECHNOLOGY

People become healthcare professionals to help make people better. The DeGroote School of

Business at McMaster University is working hard to make healthcare better by helping health

professionals and administrators attain the leadership and management skills they need to

deliver care more effectively.

The healthcare sector is burdened by business processes designed by clinicians and technology

designed for business processes – not patients. Healthcare management sits at the intersec-

tion of health, business, and technology and the DeGroote School is able to draw on McMas-

ter’s faculties of Engineering and Health Sciences to provide a truly interdisciplinary approach to

health management.

The variety of health management programs available at the DeGroote School means that there

is something for everyone in the health sector. In addition to the well-known MBA specializa-

tion in Health Services Management, the School offers an MSc in eHealth, and Masters in

Health Management, a PhD in health policy and a suite of health-specific leadership and

development programs for healthcare executives.

Coming soon: The DeGroote School of Business will be adding a Health Management area of study to its

existing Business PhD program. This new area of study will also be offered on a part-time basis

allowing health management professionals earn a doctorate without interrupting their careers.

For more information about all of DeGroote’s programs, visit www.DeGrooteSchool.ca/ programs



ANY WAY YOU SLICE IT...HEALTH CARE IS A TRICKY BUSINESS TO MANAGE

DeGroote offers a variety of programs to suit your interests, expertise, and career goals:

• MBA Health Services Management

• Master of Health Management

• MSc in Global Health

• PhD in Health Policy

• MSc in eHealth

• Healthcare Leadership Development Program

DeGrooteSchool.ca/programs

SPECIAL PROFESSIONAL DEVELOPMENT SUPPLEMENT



ARE YOU A HEALTH TRADE PROFESSIONAL TRAINED ABROAD?PASSI aims to provide specialized training for professio-

health as well as assistance to facilitate their integration

You’ll get:Training and workshops » Key skills » » CPR, AED level C and First aid » WHMIS and more

Development techniques

Networking opportunities » Workplace visits » Conferences » Meetings

Possibility of pairing with

[email protected] 742-2475 | 1 800 267-2483, poste 2475

Funded by:

ACCESS TO HEALTH TRADES FOR IMMI-GRANTS PROGRAM

PASSITo better perform on the labour market

subsidized

Program

SESSION

FEBRUARY 2 TO MARCH 31

Get JHSC Certified before the

new Standard Takes Effect and

Be Certified For Life

The Public Services Health and Safety Association is an approved training provider and all trainers are specialized in the hazards of the health and community services sector. There are a variety of delivery options for Part 1 and Part 2 Certification Training and both courses can be bundled for extra savings. Training is available across Ontario. If you complete training before the new standard takes effect on March 1, 2016, you will be certified for life and can take your refresher training on your own terms.

Effective committees can assist employers in reducing the risk of occupational illness and injury

Learn more at pshsa.ca/jhsc

416-250-2131 1-877-250-7444 pshsa.ca

Call 1-877-250-7444 or book at

pshsa.ca/jhsc. Talk to one of our

consultants in your area today

and get more for your health and

safety budget.

Hospital News Delivered To Your Inbox!

YOU don’t have to wait!

Get your digital copy of Hospital News emailed to you,

the minute it comes out.

Sign me up!Sign me up! Just send email to

[email protected]

Cutting-Edge Learning It’s Just a Click AwayIf you’re a health care professional, you’ll agree: there just aren’t enough hours in the day. Today’s fast-paced world leaves little time for traditional classroom learning. Yet, modern technology affords health care professionals the convenience of staying current with the latest issues and trends, from the comfort of home or workplace.

The Ontario Hospital Association (OHA), a leading industry authority, offers more than 60 broadcasts per year on a variety of health-related topics. With live broadcast programming, it’s more convenient than ever to excel in your career.

LEARN MORE oha.com/broadcasts




Bundle Cert 1 & 2 and save. Call 1-877-250-7444 to register and talk to a Regional Consultant.

The JHSC Standard is Changing. Learn More: pshsa.ca/jhsc

Q: How long have you worked with the Public Services Health and Safety Association as your Health and Safety training partner? How is it a good fi t?

A: Hamilton Health Sciences (HHS) originally worked with OSACH in the early 2000s and have enlisted JHSC Certifi cation training services of PSHSA since 2012. The service that PSHSA provides is excellent. A highly valued characteristic of the training is that it is delivered from PSHSA staff who have relevant health care experience and are able to connect with our members. We continue to hear from our members how in tune their staff are to our environment and are able to share relevant examples. It creates a great learning atmosphere.

Q: What is important for a good JHSC training program? How does PSHSA deliver?

A: PSHSA’s certifi cation program provides all JHSC members with a clear understanding of the OHSA, including how they fi t in supporting the organization’s health and safety program and ways they can make an impact in supporting workers’ concerns. The diff erent methods used to deliver the training keeps the members interested and engaged.

Q: What are emerging health and safety issues that the JHSC are faced with and how does PSHSA assist?

A: As PSHSA is funded by the Ministry of Labour, they are consistently involved in discussions related to emerging health & safety issues and implementation plans of new legislation. Within the training sessions off ered to us, PSHSA staff provide opportunities for us to discuss and better understand new issues that workers are raising to our Committee members. Through these discussions, our members gain tools to better assist them in identifying health and safety issues and methods to support our workers.

Q: What sets PSHSA apart from other training vendors? How can we do better?

A: PSHSA’s knowledge of health care settings and focused training geared to our challenges is the diff erence for us. They tailor the training to include our practices and processes which greatly helps everyone understand their role. Our members immediately are engaged in the training off ered as PSHSA staff have practical experience within our settings which provides insight to the challenges our hospitals see.

Steve Jamieson

Safety Manager, Health, Safety and WellnessHamilton Health Sciences“

PSHSA sat down with Steve to discuss what makes a good JHSC and how PSHSA has built a successful partnership with Hamilton Health Sciences:

“Our partnership with the Public Services Health

& Safety Association allows for JHSC training that

is focused on the health & safety issues that our

hospitals see. It is relevant training and PSHSA

knows how to connect with our JHSC members to

keep them engaged.”




earning and development is important in any industry, but it’s particularly crucial for health care professionals to

continuously enhance their knowledge on key topics.

That’s why Cancer Care Ontario has launched an e-learning platform for the health care community. Available at el-earning.cancercare.on.ca, the accredited online courses are free of charge and can be accessed by clinical and administrative staff across the province anytime, from anywhere.

The courses are accredited for Mainpro-M1 credits by the College of Family Physi-cians of Canada (CFPC) and the Ontario Chapter and focus on Cancer Screening and Aboriginal Relationship and Cultural Competency courses. They were devel-oped based on discussions with experts and an expressed interest in building knowl-edge in these specifi c areas.

“Offering online courses ensures that we’re able to reach all health care provid-ers across Ontario, regardless of their geo-

graphic location,” says Dr. Suzanne Stras-berg, Provincial Primary Care Lead, Cancer Care Ontario. “The courses give doctors, nurses and health care administrators the chance to increase their understanding of Ontario’s organized cancer screening pro-grams and guidelines as well as key issues faced by Aboriginal Ontarians. Ultimately, this contributes to an improved patient ex-perience and better quality of care.”

Cancer Care Ontario is offering four cancer screening courses to help primary care providers better understand Ontario’s guidelines for breast, cervical and colorec-tal screening, including limitations and benefi ts. Each course takes about 30 min-utes and is accredited for 0.5 Mainpro-M1 credits.

Nine Aboriginal Relationship and Cul-tural Competency courses are designed to enhance knowledge of First Nations, Inuit and Métis history, culture and the health landscape to improve patient experience and person-centred care. The courses are geared to health care providers, profes-sionals, administrators and others working with First Nations, Inuit and Métis com-

munities. Eight of the courses take about 60 minutes and each is accredited for 1.0 Mainpro-M1 credits, and one course takes about 30 minutes to complete and is ac-credited for 0.5 Mainpro-M1 credits.

“What we often hear in the communi-

ties we work with is that there’s a desire to create a greater understanding of the unique needs of First Nations, Inuit and Métis people,” says Alethea Kewayosh, Di-rector, Aboriginal Cancer Control, Cancer Care Ontario. “One of the priorities in our Aboriginal Cancer Strategy is to continue

building productive relationships and edu-cate healthcare professionals about the distinct needs of these communities. Our hope is that these Aboriginal Relation-ship and Cultural Competency courses will help enhance the healthcare experience for many First Nations, Inuit and Métis cancer patients and caregivers across the province.”

In September, Cancer Care Ontario launched the third Aboriginal Cancer Strategy (ACS); a four year plan that guides how the organization works to-gether with partners to improve the per-formance of the cancer system for First Na-tions, Inuit and Métis people. ACS III is a direct deliverable of the Ontario Cancer Plan IV and refl ects the shared priorities of Cancer Care Ontario, the Regional Can-cer Programs and First Nations, Inuit and Métis communities.

Healthcare professionals can visit elearning.cancercare.on.ca to learn more about Cancer Care Ontario’s online e-learning courses and register today. ■H

Erin MacFarlane is a Communications Advisor, Cancer Care Ontario.

Online e-learning

Courses for cancer screening and Aboriginal cancer careBy Erin MacFarlane

Cancer Care Ontario is offering four cancer screening courses to help primary care providers better understand Ontario’s guidelines for breast, cervical and colorectal screening, including limitations and benefi ts.

L

WE MADE ROOM FOR EDUCATION. WILL YOU?Tight budgets. Hectic schedules. High travel costs. When it comesto continuing education for busy professionals, there are plenty of challenges and not enough solutions. Until now.

To make education more accessible, the Ontario Hospital Association (OHA) has recently launched a state-of-the-art Education Centre, a 12,000 square foot facility located in downtown Toronto. Employing a sophisticated suite of broadcast technology, the Education Centre allows the 55,000+ health care professionals who attend our programs annually to participate virtually from any location.

oha.com/educationcentreTAKE A VIRTUAL TOUR




ÊTES-VOUS UN PROFESSIONNEL

PASSI vise à vous offrir une formation spécialisée ainsi qu’une assistance pour faciliter votre intégration sur le marché du travail ontarien dans votre domaine d’expertise.

de formations et d’ateliers » Aptitudes clés recherchées par les employeurs

» Techniques de perfectionnement

» RCR et premiers soins/DEA niveau C » SIMDUT et plus

d’occasions de réseautage » Visites en entreprise » Conférences » Rencontres

de possibilité de stage avec des travailleurs.

[email protected] 742-2475 | 1 800 267-2483, poste 2475

PROGRAMME D’ACCÈS AUX SERVICES DE SANTÉ POUR LES IMMIGRANTS

PASSIPour mieux performer sur le marché du travail

Programme

subventionné

2 FÉVRIER AU 31 MARS

Inspire and change lives.Apply now for one of our Health and Wellness Studies programs. Several of our programs are offered in both the fall and winter or in a compressed format, and all of our full-time programs feature field placement components and practical labs for hands-on learning.

Esthetician Food and Nutrition Management (fall/winter) Healthcare Environmental Services Management Pharmacy Technician (fall/winter) Massage Therapy (fall/winter – compressed) Fitness and Health Promotion (fall/winter – compressed) Workplace Wellness and Health Promotion

(fall – two sites)

Continuing Education programs: Reflexology Athletic Taping (for Registered Massage Therapists) Medical Esthetics for Nurses

For more information on any of our offerings, please visit centennialcollege.ca/community-health or call 416 289-5000 x 8068. See where

experience takes you.

For the past 10 years, the Governance Centre of Excellence (GCE) has supported health care and not-for-profit boards with education programs and thought leadership tools and resources.

To sign up, visit thegce.ca/subscribe

During this milestone year, we’d like to thank our supporters and invite you to celebrate this occasion with us! Sign up for a chance to win one of many great prizes, including:

• $100 Starbucks Gift Cards

• $100 Oliver & Bonacini Gift Cards

• Keurig 2.0 K400 Brewing System

Celebrating 10 Years of Governance Excellence

JOIN IN CELEBRATING OUR 10 YEAR ANNIVERSARY FOR A CHANCE TO WIN



Osgoode Professional Development (a division of Osgoode Hall Law School at York University), provides lifelong learning programs for lawyers and other professionals, including those working in the health care sector.

We have a diverse range of programs ‒ from one hour to 5 days ‒ developed by and for health professionals. Whether you’re looking to get an update on recent developments or develop a solid foundation with one of our intensive

OsgoodePD’s experienced faculty of leading health and legal experts will equip you with the knowledge, strategies and practical skills you need to advance your career.

OSGOODEPROFESSIONAL DEVELOPMENT CONTINUING LEGAL EDUCATION

What past attendees have said:

“The information in this course should be mandatory in all health care training programs”Janice Janz, RN, University Health Network – Toronto Western Hospital

“Well organized. Dynamic and knowledgeable presenters. I would recommend this to all health professionals and legal counsel who work in liability, risk management and patient safety.”Deborah Perry, Risk Management Consultant, Eastern Health

“This was a very informative education session. My charting

Dawn Bunnett, Belleville Nurse Practitioner

Learn more: osgoodepd.ca/HNhealthlaw

Spiritual Care CPE/PCE Training

Chaplaincy & Ethics Social Justice Focus

Inter–Religious Dialogue

Master of Pastoral Studies2 yr Program – 20 courses

Streams in Spiritual Care and Social Ministries for Christians, Muslims, Buddhists and others

(CRPO Stream forthcoming)

Diploma in Buddhist Mindfulness & Mental HealthPart–time Program – 6 courses www.emmanuel.utoronto.ca

Engaging Belief and PracticeMulti-Religious Approaches to Spiritual Care at Emmanuel College

Do you have a passion for social justice? Are you interested in exploring matters of religious practice and belief, and gaining expertise in spiritual care and counselling? Do you have a vision for holistic care?

The Master of Pastoral Studies (MPS) program at Emmanuel College offers students the opportunity to gain skills in spiritual care, theological analysis and approaches to mental health and well-being. The MPS has a number of streams in spiritual care and social ministries for Christians, Muslims, Buddhists and others. With an emphasis on inter-religious dialogue, this professional master’s degree prepares students for careers in the non-profit sector and in a variety of settings such as hospitals, prisons and educational institutions. Graduates can also be certified with the Canadian Association for Spiritual Care (CASC).

The MPS provides a wealth of opportunities for those from different religious backgrounds who wish to integrate belief and practice. Emmanuel College also offers a Diploma in Buddhist Mindfulness & Mental Health, and an Applied Buddhist Studies Initiative (ABSI) starts January 2016 in collaboration with the Buddhist Education Foundation of Canada. The MPS: Muslim Studies program is an initiative that stems from Emmanuel College’s goal to foster dialogue between Muslims and Christians, and others within the larger community. Emmanuel College continues to work on developing a stream to coordinate with the new College of Registered Psychotherapists of Ontario. Emmanuel College Principal Mark Toulouse writes, “These programs naturally emerge out of the College’s vision which recognizes that concepts of justice, goodness and love are larger than any one particular religion or tradition can fully define by itself.” These programs emphasizing spiritual care in a variety of religious traditions are the first of their kind in Canada.

Emmanuel College is a theological college of Victoria University in the University of Toronto. Emmanuel provides an education characterized by rigorous theological inquiry, contextual analysis, commitment to justice, and inclusive practice.

www.emmanuel.utoronto.ca



The health care industry is complex and ever-changing, and the beginning of each year provides a perfect opportunity to evaluate your career.

The Ontario Hospital Association (OHA) is committed to providing premium tools and training for busy health care professionals, offering flexible education opportunities, such as:

Make Plans, Not Resolutions

Take Charge of Your Education This Year

• Virtual and blended learning sessions let you attend in-person or from the comfort of workplace or home

• Over 50 certificate programs provide practical workplace applications

• Online certificate courses provide a cost-effective and easily accessible training option

• Online training modules offer a convenient and affordable way to train staff

• New Education Catalogue allows you to view all programs at-a-glance

LEARN MORE oha.com/catalogue

PART-TIME CERTIFICATES

communityservices.humber.ca/ce

REGISTER BEFOREJANUARY 15, 2016

Humber’s School of Social and Community Services is dedicated to delivering more than education. Pathways are available that allow full- and part-time students to reach their academic and career goals. Do you want to help change lives? Programs and courses offered in Human Services give you a chance to make a difference in your community.Certificates in Crisis Intervention and Counselling, Case Management, Psychosocial Rehabilitation and Children’s Mental Health are featured on the continuing education platform. Whether it is to upgrade skills or add to existing ones, individuals can take courses towards these certificates on a part-time basis. Part-time studies offers a great way to try out a new career path while working. Understanding the importance of flexibility in helping students pursue their academic goals, the school provides classes during times that are convenient for people juggling work and life responsibilities. With ever-increasing online learning options, students can study from virtually anywhere. Part-time courses could help you advance your career through the acquisition of new skills. Your employer may even offer tuition reimbursement for your continuing education.With over 200 part-time courses, Humber’s School of Social and Community Services offers the critical courses to learn what is needed in today’s world. Program topics range from Settlement Counsellor to Managing in the VAW (Violence Against Women) Sector to Child Welfare and Forensic Practice. Course offerings include Responding to Abuse, Suicide Prevention, Urban Sociology, Physical Aging, Wellness and Promotion of Abilities among many others. Promises Derek Stockley, Dean of the School of Social and Community Services, “We are dedicated to delivering more than an education - we are changing lives.” Visit us at communityservices.humber.ca/ce to find out more.

Part-Time Studies in Human Services Opens Doors



When Faye Fu decided to go to George Brown College to upgrade her dental assistant skills, it wasn’t about increasing her salary or competing with her colleagues – it was about self-betterment.

“I took the courses for my personal interest. It was for me – I felt no pressure to do it,” says Faye.

With medical practices, technology and dental office needs constantly evolving, Faye wanted to improve her skillset. George Brown’s Dental Assistant Level II Upgrade Certificate proved to be the right program for Faye.

“I trust George Brown. It is a high-standard community college,” says Faye. “The times work so well because it is every other Saturday and Sunday. I don’t have to skip my work, it doesn’t bother my job and I still can have weekends to do my stuff.”

Faye found the courses to be a perfect combination of hands-on patient work and dental office reality – with the teacher walking students through clinical sessions and building up their dental theory, skills and confidence.

Taking the upgrade certificate not only helped Faye pass the National Dental Assisting Examining Board (NDAEB) exam – it has allowed her to smoothly adapt to more challenging tasks at the dental office where she works. Above all, the courses helped Faye reach her personal goal of self-development.

“The certificate has opened me up to many more opportunities … What I do now is more advanced and I can do more intra-orally,” she explains. “It’s a good challenge, to learn something new and go ahead. Honestly, it was wonderful.”

George Brown College helps dental assistant progress to a new level

To learn more about the Dental Assistant Level II Upgrade Certificate, visit coned.georgebrown.ca/health.

Faye Fu

Happy New Year!From all of us at Hospital News!

It has been a pleasure to serve you in 2015,and we look forward to serving you in the future.

Professional development opportunities for health professionalsContinuing Education at George Brown CollegeGeorge Brown College has a range of certificates that are geared to health professionals and offered on a part-time basis through Continuing Education.

Courses for these certificates start this January:

coned.georgebrown.ca/healthFor more information, contact us at 416-415-5000, ext. 2126, or [email protected].



technical exam for colorectal surgery fellows piloted by a St. Michael’s physician could lead to a paradigm shift in certifi ca-

tion for all surgical fellows.Surgical residents are currently assessed

on their knowledge through written exams and for their judgment through oral exams. However, there is no formal assessment of technical skill at the time of certifi cation.

Dr. Sandra de Montbrun, a colorec-tal surgeon, has been working with the American Society of Colon and Rectal Surgeons to develop a technical skills exam for the purpose of certifi cation in the United States.

“This is the fi rst time that any North American surgical society has moved for-ward with developing a technical skills exam with the purpose of certifi cation for high stakes assessment,” says Dr. de Montbrun.

Implementing this sort of test could lead to improved patient outcomes.

“If we can identify the residents who show defi ciencies in technical skill and re-mediate them during their training, there is a potential impact on patient care,” she adds.

The technical exam takes place in a surgical skills lab setting and is made up

of eight different technical skill tasks. The students are observed by an examiner who evaluates their performance.

She has led three pilot studies to prove the validity of the technical exam. The fi rst study, held at the University of Toronto in 2011, compared general surgery residents to colorectal residents.

“We found there was a difference in their performance, giving some initial evi-dence of validity to the test,” says Dr. de Montbrun. The results from the second pilot study suggested that this exam iden-tifi es technical defi ciencies in people who would otherwise go on to be certifi ed with the current board certifi cation process.

For 2014, the Colorectal Objective Structured Assessment of Technical Skill, or COSATS, exam became a mandatory component for certifi cation for the Ameri-can Board of Colon and Rectal Surgery. It was the fi rst time in North America that a technical skills exam was a required com-ponent for certifi cation.

“The purpose of the exam was to col-lect data on the exam itself,” says Dr. de Montbrun. “Candidates were not assigned a pass/fail status, but we had to adminis-ter it to the entire cohort of people to get an idea of what the data would look like with the entire group of examinees taking their board exam.” The results of this most

recent pilot have been submitted for pub-lication.

There is no timetable for the COSATS exam to become a permanent component of The American Board of Colon and Rec-tal Surgery exam. At the same time, the American College of Surgeons is inter-

ested in moving forward with a technical exam for general surgery training in the United States.

The Royal College of Physicians and Surgeons of Canada does not yet have plans to incorporate the COSATS into Canadian certifi cation. ■H

By Greg Winson

St. Michael’s doctor develops skills test for surgical residents

Dr. Sandra de Montbrun evaluates a surgical fellow in the Allan Waters Family Simulation Centre skills laboratory.

Photo by Katie Cooper

A



here’s an extra set of eyes and ears providing a unique per-spective to students in the Sunnybrook Canadian Simula-

tion Centre: a patient.The new initiative has a patient vol-

unteer participating in a simulation sce-nario for third-year medical students on anesthesia rotation. The patient volunteer interjects during the simulation in order to help students articulate why an x-ray wouldn’t be required in this situation. She then shares her own story about a surgical experience and also provides feedback to the students.

The fi rst volunteer, Ruth Milikin, says she’s delighted to be taking part.

“There’s so much anxiety that comes with being a patient,” she says. “I’m re-minding the students to take a moment to reassure the patient, answer questions, and be open with the time line – even just that can help. Giving a sense to the patient that you know their history, having a kindly dis-position and listening. Really, that’s num-ber one: listening.”

Medical student Ali Damji said he hopes having patients involved in training becomes a standard.

“This is real-time feedback. We don’t often – or ever – sit with a patient and get feedback on how we are doing,” Ali says. “By involving a patient in our simulation session, we are reminded this is a person.

This is their life. This is their family mem-ber and they might be scared or upset.”

Ruth helped remind him that even ex-plaining why he may only have two min-utes to talk can help allay a patient’s fears. It’s something he will try to communicate better with patients in the future, he says.

“Some of the most fantastic teachers are our patients,” Ali adds.

“Patients need a voice and this is an ef-fective way to do it. I’m honoured to have the opportunity to be involved in this, and have a positive impact on the future of medicine.”

Involving patients in education activities is one of several ways Sunnybrook is creating meaningful opportunities for engaging patients and families in the unique activities of an

Academic Health Sciences Centre – research, education, patient care, and administration.

“By engaging patients and families in all aspects of Sunnybrook, we can gain pow-erful insight and use that to improve the experiences for all of our patients,” says VP, Communications Craig DuHamel. ■H

Alexis Dobranowski works in communica-tions at Sunnybrook Health Sciences Centre.

Sunnybrook Simulation Centre welcomes patients to help train medical studentsBy Alexis Dobranowski

Third-year medical student Ali Damji receives feedback from patient Ruth Milikin after a simulation session.

Photo credit: Doug Nicholson

T

Empower Yourself and Your Staff with Online Training ModulesFrom Accessible Customer Service Standards to Wound Care and more, the Ontario Hospital Association’s (OHA) range of online modules will enable you to train yourself and your staff efficiently and within budget.

These online training modules empower participants through self-paced independent learning. The interactive modules enrich the learning experience, while program quizzes assess and enhance students’ knowledge. A variety of learning styles are addressed through text, audio, video and instructive activities.

LEARN MORE oha.com/onlinemodules

CFHI Inviting Applications from Organizations to Build Capacity, Enhance

Leadership, Deliver Improvement

The Canadian Foundation for Healthcare Improvement is calling for motivated organizations to apply to EXTRA: Executive Training Program, the only bilingual, pan-Canadian improvement fellowship in Canada.

The 14-month program builds leadership and organizational capacity to achieve breakthrough, sustainable innovations that achieve better care, better health and better value. Teams of three to four leaders, from one or more organizations, work collaboratively to design, implement and evaluate an evidence-informed improvement project addressing a pressing clinical, organizational, regional or provincial/territorial challenge.

EXTRA is grounded in the complex reality of leading and managing in today’s health and healthcare environments. Teams work with CFHI faculty and coaches to tackle healthcare challenges such as addressing the needs of a target population; designing a new product, process or service; improving an existing process or service; spreading a promising practice; and -developing a framework or infrastructure for improved governance, management or quality.

Since its launch in 2004, the EXTRA Program has supported more than 300 healthcare professionals from 120 organizations across Canada.

EXTRA’s 2016 cohort will comprise up to ten organizations to take part in the program, beginning in April 2016. This year, CFHI is encouraging applications from, and will create space for, up to three organizations focusing on palliative care.

Learn more about the program and how to apply by February 15, 2016 at cfhi-fcass/EXTRA.



The best way to care for her may be to participatein this collaborative.Apply now to the ACE collaborative.

The Acute Care for Elders (ACE) Collaborative is funding innovative, new ways to provide care for older Canadians.

Join and benefi t from support.

Deadline February 1st, 2016

cfhi-fcass.ca/ACE

CFHI is a not-for-profi t organization funded by the Government of Canada.



earning has always been central to work and life at Hamilton Health Sciences. Supporting and developing

our people is a key part of our strategic plan – to engage, enable and empower our people to deliver on our mission of providing excellent healthcare for the people and communities we serve and to advance healthcare through educa-tion and research.

The Hamilton Health Sciences Cen-tre for People Development is making a signifi cant contribution to achieving this objective by providing staff and physicians at Hamilton Health Sciences with formal learning opportunities to help them grow and enhance their leadership ability. At Hamilton Health Sciences we believe in the notion of a leader in every chair. Lead-ership is not a title, it is a being: regardless of the role we all lead.

“Our staff and physician engagement surveys have underscored how much our staff and physicians value development op-portunities. The Centre for People Devel-opment, which opened in May, 2015, was built with extensive stakeholder consulta-tion. It was designed to provide learning opportunities that strengthen our people’s ability, individually and collectively, to per-form with great ability and care with great

compassion. We live in an ambiguous and changing world, we must continue to grow, develop, think differently and be agile and adaptable”, says Andrew Doppler, Vice President, Human Resources.

Offering learning and development opportunities to staff, formal leaders and physicians, the centre offers a wide range of programming in leadership, quality and performance, compassion and resilience and team performance. Some programs include Mindfulness Based Stress Re-duction, Personal Power and Resilience, Leading Organizational Change and Team Simulation Based Learning focused on important clinical priorities such as early detection of sepsis.The Centre is unique from other providers of formal development, as it incorporates the following:• facilitators who are recognized experts in

their fi eld and also appreciate the chal-lenges of the health care environment

• learning that is practical, blended and focused on adult learning principles

• treats the learner as a “whole being”• a learning environment where new

learning can be practiced/applied im-mediately in people’s operating context

• the opportunity to network with other health care professionals across disci-plines and roles

• a curriculum that refl ects strategic and operational goals of the organization

• a curriculum that refl ects what our peo-ple say they need and want The Centre refl ects the very latest think-

ing on what separates high performing lead-ers (formal and informal) from average lead-ers. “Leaders want to get better in the here and now, not to be judged against a com-petency map or be sold an abstract theory about what leadership should look like… Leadership development is more about ap-plication than theory” (Warner, 2015).

Evaluations strongly indicate that the

Hamilton Health Sciences Centre for People Development is delivering this type of learning, offering relevant, engaging programming that directly translates into enhanced performance.

For more information please contact Kathryn Adams, Organizational Devel-opment Specialist, Hamilton Health Sci-ences. ■H

Calyn Pettit works in Public Relations & Communications at Hamilton Health Sciences.

Centre for People Development supports hospital staffBy Calyn Pettit

LDanielle Fry, occupational therapist at McMaster Children’s Hospital, is one of more than 11,000 Hamilton Health Sciences staff who now have access to specialized, unique professional development programming through the hospital’s Centre for People Development. Courses are also open to non-HHS employees.

Welcome to the online health care career destination for employers and job seekers.

Employers

Post jobs and connect with the industry’s best and brightest.

Job Seekers

Create an account, sign up for job

care today!

healthscapejobs.ca: A Destination for Health Care Careers

REGISTER TODAYhealthscapejobs.ca



Broaden Your Nursing Horizons with Durham College’s Mental

Health Nursing Program

call 905.721.2000 ext. 2496 or visit www.durhamcollege.ca/coned.

Careers in health-careGet the qualifications you need to further your career in these areas:

CONTINUING EDUCATIONWWW.DURHAMCOLLEGE.CA/CONED

For full details on these programs visit our website today.

• Advanced Wound Care• Child Development Practioner• Children’s Mental Health• Dementia Studies – Multidiscipline• Diabetes Worker/ Educator• Food Service Worker• Foot Care Advanced and Diabetes• Gerontology• Hospital Nursing Unit Clerk

• Mental Health Nursing RN/RPN• Mental Health Rehabilitation• Occupational Health Nursing RN• Oncology Nursing RN/RPN• Palliative Care• Perinatal/Obstetrics RN/RPN• Perioperative Nursing RN/RPN• Sterile Processing

Special Seminar To Be Held

Insomnia, obesity, and diabetes are the consequences of excessive stress.

examines how stress affects the brain and predisposes patients toward cardiovascular disease, dementia, and hormonal disorders.

It shows how stress can affect memory and learning.

The seminar presents ideas for the management of stress and examines how stress

marriage, sex, and suicide. It covers medications used to treat stress.

The seminar will be presented three times in the Ontario Province: Wed., May 11, 2016, Best Western Lamplighter Inn, 591 Wellington Road South, London, Ontario; Thu., May 12, 2016, Radisson Hotel, 55 Halcrown Place, Toronto, Ontario; and Fri.,

provider of live seminars for health professionals. Biomed neither solicits nor receives any gifts or grants from any entity.

Stress, Anxiety, and Depression

To obtain more information about the seminar, please contact Biomed, 3219 Yonge Street, Suite 228, Toronto, Ontario M4N 2L3.



Please print:Name: Profession:Home Address: Professional License #:City: Province: Postal Code: Lic. Exp. Date:Home Phone: ( ) Work Phone: ( ) Employer:Please enclose full payment with registration form. Check method of payment. E-Mail:

Check for $109.00 (CANADIAN) (Make payable to BIOMED GENERAL)Charge the equivalent of $109.00 (CANADIAN) to my Visa MasterCard American Express® Discover®

Card Number: Exp. Date:(enter all raised numbers)

Signature:

Most credit-card charges will be processed in Canadian dollars. Some charges will be in U.S. dollars at the prevailing exchange rate.

Dr. Michael E. Howard (Ph.D.) is a full-time psychologist-lecturer for INR.

who is an internationally-recognized authority on brain-behavior relationships, traumatic brain injury, dementia, stroke, psychiatric disorders, aging, forensic neuro-psychology, and rehabilitation.

During his 30-year career, Dr. Howard has been on the faculty of three medical schools, headed three neuro-psychology departments, and directed treatment pro-grams for individuals with brain injury, dementia, addiction, chronic pain, psychiatric disorders, and other disabilities.

Biomed reserves the right to change instructors without prior notice. Every instructor is either a compensated employee or independent contractor of Biomed.

LEARNING OBJECTIVES Participants completing this course will be able to:1) describe the structure and function of neurons, glia, neurotransmitters, and

brain regions.2) explain how the brain produces and is affected by stress, anxiety, and depres-

sion.3) determine the major differences between acute stress and chronic stress.4) explain the proposed new criteria for diagnosing anxiety disorders and major

depressive disorder.5) outline the symptoms and treatments for the major anxiety disorders, includ-

ing dental anxiety.6) list the differences and similarities between major depressive disorder and

bipolar disorder.7) describe how the information in this course can be utilized to improve patient

care and patient outcomes.8) describe, for this course, the implications for dentistry, mental health, nursing,

and other healthcare professions.

SPONSOR

and medicine. Since 1994, Biomed has been giving educational seminars to Canadian health-care professionals. Biomed neither solicits nor receives gifts or grants from any entity.

Biomed has no ties to any commercial organizations and sells no products of any kind, except educational materials. Neither Biomed nor any Biomed instructor has a

other entity which has products or services that may be discussed in the program. Biomed does not solicit or receive any gifts from any source and has no connection with any religious or political entities. Biomed’s telephone number is: (925) 602-6140. Biomed’s fax number is: (925) 363-7798. Biomed’s website is, www.biomedglobal.com. Biomed’s corporate headquarters’ address is: Biomed, P.O. Box 5727, Concord, CA 94524-0727, USA. Biomed’s GST Number is: 89506 2842.

ACCREDITATION

MEETING TIMES & LOCATIONS

TUITION: CHEQUES: $109.00 (CANADIAN) with pre-registration. $134.00 (CANADIAN) at the door if space remains. CREDIT CARDS: Most credit-card charges will be processed in Canadian dollars. Some charges will be in U.S. dollars at the prevailing exchange rate. Note: some Canadian banks may add a small service charge for using a credit card. The tuition includes all applicable Canadian taxes. At the seminar, participants will receive a complete course syllabus. Tuition payment receipt will also be available at the seminar.

There are four ways to register: Online: www.biomedglobal.comBy mail: Complete and return the Registration Form below.By phone: Register toll-free with Visa, MasterCard, American Express®, or Discover® by calling 1-888-724-6633. (This number is for registrations only.) By fax: Fax a copy of your completed registration form— including Visa, MasterCard, American Express®, or Discover® Number—to (925) 687-0860.For information about seminars in other provinces, please call

1-877-246-6336 or (925) 602-6140.

HOW TO REGISTER

6 CONTACT HOURS / www.biomedglobal.com

Please return form to:BIOMEDSuite 228

3219 Yonge StreetToronto, Ontario

M4N 2L3TOLL-FREE:

1-877-246-6336TEL: (925) 602-6140FAX: (925) 687-0860

Please check course date: For information about seminars in other provinces, please call 1-877-246-6336 or (925) 602-6140

The seminar registration period is from 7:45 AM to 8:15 AM. The seminar will begin at 8:30 AM. A lunch (on own) break will take place from 11:30 AM to 12:20 PM. The course will adjourn at 3:30 PM, when course comple-

A Seminar for Health ProfessionalsTUITION $109.00 (CANADIAN)

INSTRUCTORNURSES (RNs, RPNs, & LPNs)

clinical information and to upgrade their professional skills. Numerous registered nurses in Canada and the United States have completed these courses. This activity is co-provided with INR.

Institute for Natural Resources (INR) is an approved provider of continuing nursing education by the Virginia Nurses Association, an accredited approver by the American Nurses’ Credentialing Center’s Commission on Accreditation.

PHARMACISTSPharmacists successfully completing this course will receive

-tion Council for Pharmacy Education (ACPE) as a provider of continuing phar-macy education. The ACPE universal activity number (UAN) for this course is 0212-9999-16-002-L01-P. This is a knowledge-based CPE activity.

DIETITIANSBiomed, under Provider Number BI001, is a Continuing Profes-

sional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians (RD’s) and dietetic technicians, registered (DTR’s) will receive 6 hours worth of continuing pro-fessional education units (CPEU’s) for completion of this program/materials. Continuing Professional Education Provider Accreditation does not constitute endorsement by CDR of a provider, program, or materials. CDR is the creden-tialing agency for the Academy of Nutrition and Dietetics (AND).

PSYCHOLOGISTS

completing this program.This activity is co-provided with INR. INR is approved by the American

Psychological Association to sponsor continuing education for psychologists. INR maintains responsibility for this program and its content.

SOCIAL WORKERSThis activity is co-provided with INR. Social Workers completing this

by the National Association of Social Workers (Provider #886502971-1419) for 6 social work continuing education contact hours.

Wed., May 11, 2016 (London, ON) Fri., May 13, 2016 (Markham, ON)Thu., May 12, 2016 (Toronto, ON)

BIOMED PRESENTS...

REGISTRATION FORM

REGISTRATION INFORMATION

Individuals registering by Visa, MasterCard, American Express®, or Discover® will be charged at the prevailing exchange rate. If the credit card account is with a Canadian bank, the USA tuition will be converted into the equivalent amount in Canadian dollars (approximately $109.00) and will appear on the customer’s bill as such. The rate of exchange used will be the one prevailing at the time of the transaction.

Please register early and arrive before the scheduled start time. Space is limited. Attendees requiring special accommodation must advise Biomed in writ-ing at least 50 days in advance and provide proof of disability. Registrations are subject to cancellation after the scheduled start time. A transfer at no cost can be made from one seminar location to another if space is available. Registrants cancelling up to 72 hours before a seminar will receive a tuition refund less a $35.00 (CANADIAN) administrative fee or, if requested, a full-value voucher, good for one year, for a future seminar. Other cancellation requests will only be honored with a voucher. Cancellation or voucher requests must be made in writing. If a seminar cannot be held for reasons beyond the control of the sponsor (e.g., acts of God), the registrant will receive free admission to a rescheduled seminar or a full-value voucher, good for one year, for a future seminar. A $35.00 (CANADIAN) service charge applies to each returned cheque. Nonpayment of full tuition may, at the sponsor’s option, result in cancellation of CE credits issued.

subject to change without notice.

CPEAccredited

Provider

CVV:(Card Security Code)

Instructor: Michael E. Howard, Ph.D.

STRESS, ANXIETY, & DEPRESSION

Registration: 7:45 AM – 8:30 AMMorning Lecture: 8:30 AM – 10:00 AM

The Three Brains. Pathways for Stress, Anxiety, and Depression. Brain Adaptation and Genetics. How Early Adverse Experiences and Genes Affect the Risk for Stress. Sympathetic and Parasympathetic: The Automatic Yin and Yang of Stress. Stress and Stressors: Does the World Stress Us or Do We Stress Ourselves? Stress and Life: Has Chronic Stress Become the Biggest Killer of North Americans? Why Zebras Don’t Get Ulcers: The Upside and Downside of the Thinking Brain.

Mid-Morning Lecture: 10:00 AM – 11:30 AM The Brain Structures of Stress: Hypothalamus; Pituitary Gland; Sensory and Frontal Cortex; Amygdala; and the Hippocampus. Men, Women, and Stress. Important Gender Differences in the Stress Response. How Chronic Stress Creates Two Opposing and Dangerous Conditions: Chronic Stress and Life-Threatening Diseases: Cardiovascular Disease, Diabetes, Autoimmune Disorders, and Alzheimer’s Disease. The Obesity Epidemic: Does Chronic Stress Create Big Waistlines? Stress, Marriage, and Immunity: Is Marriage Healthier for Men or Women? Sleep Disturbance:

Lunch: 11:30 AM – 12:20 PMAfternoon Lecture: 12:20 PM – 2:00 PM

Brain and Body Aging. Does Chronic Stress Accelerate Aging and Shorten Lives? Memory, Learning, and Stress. How Stress Causes Forgetfulness. Chronic Stress and Brain Damage. Hypochondria: When Fear of Being Sick Becomes an Illness. The Basics of Stress Management. Achieving Tranquility. The Magic of Mindfulness Meditation. Dental Management of Patient Stress. Distractions, Control, and Expectations. Getting a Root Canal and Catching a Cold. Are They Related? Major Anxiety Disorders: Causes; Symptoms; and Treatments. Anxiety Medications: SSRI’s; SNRI’s; Benzodiazepines; Buspirone; Tetracyclics; Tricyclics; Propranolol and Prazosin; The Role of Morphine.

Mid-Afternoon Lecture: 2:00 PM – 3:20 PM Dental Anxiety: How Prevalent? Dental Use of Eugenol and Olfactory-Induced Anxiety. Stress and the Biology of Depression. Stress Hormones and Neurotransmitters. Depression, Sex, and Suicide. Do Antidepressants Raise the Risk? Seasonal Affective Disorder (SAD). Does Light Therapy Really Work? Bipolar Disorder: When Depression Is Not Really Depression. Mania Vs. Hypomania. Treatment of Bipolar Disorder: Can This Be Cured?

Evaluation, Questions, and Answers: 3:20 PM – 3:30 PM

LONDON, ONWed., May 11, 20168:30 AM to 3:30 PMBest Western Lamplighter Inn591 Wellington Road SouthLondon, ON

MARKHAM, ON Fri., May 13, 20168:30 AM to 3:30 PMCourtyard Toronto NE Markham7095 Woodbine AvenueMarkham, ON

TORONTO, ONThu., May 12, 20168:30 AM to 3:30 PMRadisson Hotel55 Hallcrown PlaceToronto, ON


13 Evidence Matters

he number of new health tech-nologies – medications, medi-cal devices, procedures, and diagnostic tests – that become

available each year in Canada is staggering. At the same time, new evidence on exist-ing health technologies is constantly emerg-ing. It is next to impossible for busy health care providers to stay abreast of all the new evidence and developments in diagnosing, treating, and managing their patients’ care.

That’s why having quick access to reli-able evidence and information to use in practice is so important and why organi-zations such as CADTH – the Canadian Agency for Drugs and Technologies in Health – are here to help. CADTH is an independent health technology assess-ment (HTA) agency offering synthesized and critically appraised evidence on drugs, medical devices, diagnostics, and proce-dures that is both reliable and timely. Our HTA work provides the evidence piece to the many decision-making puzzles faced by health care providers in their daily practice. Our evidence, together with a health care providers’ clinical experience, clinical judg-ment, and knowledge of their patients and the local context they live in can result in better outcomes for patients and the Cana-dian health care system.

And there are many ways that health care providers can access our evidence to use in clinical practice. Our website provides free access to all our reports, recommendations, and practice tools. And each month in Hos-pital News we feature evidence from one or a few of our recent reports in our Evidence Matters column.

But often busy clinicians have only a minute or two to spare. Is that enough time for you to fi nd new evidence to use in clini-cal practice? CADTH and CMAJ think it is – and it’s as simple as a true-or-false quiz.

On the homepage of CMAJ, a new, peer-reviewed true-or-false quiz based on a recent CADTH report is regularly fea-

tured. These quizzes bust clinical myths and provide evidence-based information on new or controversial topics. And they are very simple to use. After reading the short statement about a practice-relevant topic, you can vote on whether you believe the statement to be true or false. You can see how your answer compares with others who have voted – with the percentages of true and false votes. You can then “check your answer” and learn why the statement was true or false with a brief explanation. The original CADTH report on which the quiz is based is can always be accessed by the provided link.

Some popular topics for the quizzes have included: sexually transmitted infection testing in young women, self-monitoring of blood glucose in patients with type 2 diabe-tes, probiotics for the prevention and treat-ment of gastrointestinal disorders, ASA and oral anticoagulants for stroke prevention, treatments for obstructive sleep apnea; and treatments for constipation.

Since CMAJ launched the true-or-false quizzes in March 2013, they have been ac-cessed by thousands of health care provid-ers. And depending on the topic, the per-centage of correct answers can vary widely – from 85 per cent who correctly identi-fi ed that all sexually active women under

the age of 25 should be screened for chla-mydia, to less than 30 per cent who cor-rectly answered quiz questions on monitor-ing of blood glucose in patients with type 2 diabetes.

True or false? Is there fast, fun, and free CME available to health care providers in Canada? The answer is true. Knowing the latest evidence can help with making im-portant decisions in Canadian health care. Why not grab your smartphone, tablet, or laptop and take a few moments to test your knowledge with the CMAJ true-or-false quizzes from CADTH at www.cmaj.ca. And if you have more than a minute or two, the archives of the CMAJ true-or-false quizzes are available at www.cmaj.ca/site/misc/poll_archives.xhtml, and offer over 30 quizzes from CADTH, as well as quiz-zes from Choosing Wisely Canada and the Canadian Task Force on Preventive Health Care (CTFPHC).

If you would like to learn more about CADTH and the evidence it has to of-fer to help guide health care decisions in Canada, please visit www.cadth.ca, follow us on Twitter: @CADTH_ACMTS, or talk to our Liaison Offi cer in your region: www.cadth.ca/contact-us/liaison-offi cers. ■HDr. Janice Mann, Bsc, MD is a Knowledge Mobilization Offi cer at CADTH.

True or False?

By Dr. Janice Mann

T

There is fast, fun, and free CME from CADTH and CMAJ

Why not grab your smartphone, tablet, or laptop and take a few moments to test your knowledge with the CMAJ true-or-false quizzes from CADTH at www.cmaj.ca

SPECIAL SUPPLEMENT ON INFECTION CONTROLFor advertising info, email [email protected]

COMINGIN FEBRUARY 2016



aria’s husband, Tony, is about to go through a serious medi-cal procedure. While Tony is being prepped, the couple

overhears a nurse make a belittling com-ment to the co-worker who is tending to him. The affected co-worker is clearly up-set and distracted. Her attempt to draw a blood sample misses. She apologizes and tries again unsuccessfully. This situation adds to the stress that Tony and Maria al-ready feel. They become wary of the hos-pital staff. Recounting their experience to family and friends, they spread word of the upsetting event.

Hospital administration, managers, team leads and Human Resources pro-fessionals tend to underestimate the far-reaching impact of situations like this that take place between hospital personnel. Known as workplace incivility, these low-intensity, seemingly insignifi cant words or actions that show lack of regard for others’ feelings manifest in many forms: belittling comments such as what Maria and Tony witnessed, gossip, exclusion, dismissive gestures (eye rolling, lip sounds), skipping greetings, silent treatment, and rude use of mobile devices. In hospitals, many peo-ple complain about colleagues who com-municate with one another in a foreign language that is not understood by their co-workers, who in turn are left feeling ex-cluded and upset.

Hospital susceptibility It is no secret that many hospitals strug-

gle with persistent incivility issues. “Inci-vility is an ongoing challenge in the health care sector. Some hospitals are beginning to recognize that civility is critical to pa-tient care and to maintaining excellence,” says Emma Pavlov, Executive Vice Presi-dent, HR and OD at University Health Network and Program Director of the Masters Certifi cate in Healthcare Man-agement at the Schulich Executive Edu-cation Centre.

When daily work involves life and death, attention to relationships is often trumped by attention to the task at hand. Ever-present stress triggers discourteous behaviour. A hierarchical structure com-pounded by the fact that physicians are not employees of the institution can re-sult in a lack of consistent consequences. As jobs are performed with tight physical proximity and high role-interdependence, there is little time or space to check one-self before resorting to poor behaviour. Managers who manage large groups can’t stay on top of incivility. Rotating charge nurses who, after their turn in a leader-ship position return to work with peers, fi nd it challenging to deal effectively with incivility, especially of the chronic kind. A multitude of stakeholders contributes to the pressure, which leads to rudeness. And fi nally, multicultural health care environments where the stronger bonds that naturally connect people of the same background can result in cliques and frac-tures along cultural lines.

The real-life effects of incivility

Incivility is not as trivial as seems at fi rst glance. In fact, it sends malignant tentacles into vital organizational organs and ends up bleeding into the quality of care itself. As humans, we all engage in some forms of incivility, but realizing its effects should give anyone who cares about healthcare reason to pause.

Exposure to incivility affects motiva-tion. Research from across 17 industries shows that 48 per cent of respondents who were asked about their reaction to a workplace incident where they were treated in an uncivil manner reported that they purposely lowered their work ef-fort. It also affects people’s ability to do their jobs: 80 per cent of respondents said that they lost time worrying, and 66 per cent reported that their performance de-clined following an incivility incident.

Collaboration and teamwork are also compromised. A training simulation of NICU teams found the experience of in-civility reduced the amount of informa-tion sharing and help seeking between team members, which led to poor team diagnostic and procedural performance. Research based on more than 400 health professionals has found that having an uncivil colleague or supervisor exacer-bates mental and physical health prob-lems associated with overwork and not having enough control over one’s work. Using a sample of employees from fi ve Canadian hospitals, research found the more incivility employees experience, the less satisfi ed and less committed they are to their job.

And then there’s the direct effect on patients and their families. Twenty-fi ve

per cent of people who participat-ed in the 17-industry study above admitted to researchers that they took out their frustration on a customer or client after an inci-vility event. That’s one out of four people—nothing to sneeze at.

Uncivil behaviour among hospital personnel will inevi-tably spill over into the inter-face with patients. Hospital employees who are distract-ed by colleagues’ incivility make mistakes, take longer breaks, forget information, and offer no creative solutions when that’s what is needed. Or, as happened to Maria and Tony, when team members are uncivil with each other, patients who witness the behaviour will feel worry, anxiety, and mistrust. Other times, staff mem-bers who are used to treating each other discourteously will inadvertently deal with a patient in the same manner or will refer to patients behind their backs in derogatory ways.

Paths to solutionsTaming workplace incivility requires a

thoughtful, multipronged approach. In-deed, many hospitals are already putting this matter on their agenda in commend-able ways, thereby ensuring patients’ paths are not impacted negatively by the undesirable and unnecessary damage that incivility leaves in its wake. Adds Pav-lov, “UHN has invested signifi cant ef-fort putting in place a host of measures to increase leaders’ and staff capacity and confi dence to deal with situations early on. This is an ongoing effort for us

and other hospitals, and one that is well worth the investment.”

Consistent good modeling by those in leadership is an imperative – leaders need to examine their own behaviour and tame their bad habits. A manager might con-vince herself that he absolutely must be reachable at all times but fails to see that staff experience his BlackBerry addiction as disrespectful. Modeling is not about being utterly fl awless but rather about au-thentically striving to do better, owning up to slips, being open to feedback, and doing things differently next time.

Having a shared understanding across the board as to what comprises incivility is crucial too. In many hospitals, all too often people say “she bullied me” or “he’s a bully” to describe a situation in which they experience even a minor instance of being treated with disrespect. However, the term “bullying” should be reserved to rare and serious situations; it refers to the repetitive mistreatment over time of a person by one or more others.

Taming workplace incivilityBy Sharone Bar-David

M

Continued on page 15

Cover story

Sharone Bar-David speaks at a conference.

offer nowhat is d h h i l d h i ll

t-e y a

SPECIAL SUPPLEMENT ON INFECTION CONTROLFor advertising info, email [email protected]

COMINGIN FEBRUARY 2016



Continued from page 14

However, in most cases the problem be-haviour qualifi es as incivility rather than bullying. Clearing the rampant confusion around the distinctions between incivil-ity and other forms of bad behaviour can go a long way toward desirable change. This can be accomplished with clear poli-cies, effective training, ongoing dialogue, and the provision of learning tools and strategies. At UHN, says Pavlov, “we have made signifi cant efforts to change the conversation from one that is about bullying to one that is more accurately focused on incivility and disrespect.”

The next order of business is to em-power staff and leaders at all levels to shift from being bystanders to becoming “upstanders.” Bystanders’ silence con-dones bad behaviour and contributes to the distress of the person who is subject to it. When Tammy witnesses Charisa speaking rudely to Rodney of the envi-ronmental staff and says nothing, an op-portunity for correction and learning is missed. Charisa assumes her behaviour is acceptable and will repeat it in the fu-ture, Rodney’s work will be compromised by his upset and worry (possibly leading to missing contaminated surfaces), and Tammy will for hours feel bad for having betrayed her personal integrity.

Meanwhile, patients who interact with the three professionals are sure to note the lack of focus and poor demeanour. Everyone in this scenario would have benefi ted if Tammy had been an upstand-er – someone who takes positive action even if he or she is alone in doing so.

Tackling the underlying beliefs that shape the work environment is another

key path. Much of the incivility in hos-pitals is nurtured and even fueled by po-tent core notions that go unnoticed and unquestioned. These notions are some-times shared overtly; however, they often percolate under the surface, accepted as truth without anyone ever stopping to question them or examine their negative effects more closely.

Common examples of such beliefs that are prevalent in healthcare include: in our high-pressure environment, it’s okay to skip the niceties; people shouldn’t be so sensitive – if you want to enter the kitchen you have to tolerate the heat; no one can hold doctors accountable for abrasive conduct; we’re like a family here – we don’t have to watch every word we

say to each other; it’s okay to let loose by speaking one’s mother tongue with a col-league even if others don’t understand it; the best way to release steam when you’re frustrated with someone is to vent about them to another colleague.

When the group you belong to (a team, a division or even the entire hospital) buys into such beliefs, its members accept conduct that they otherwise would not. It is as if everyone has blinders on, prevent-ing them from seeing uncivil behavior for what it is.

Finally, addressing instances where incivility has become chronic is a must-do. On many teams, poor interpersonal conduct has become a built-in feature. Other times, the chronic bad behaviour of one or two people has a negative ef-fect on an entire group. When leaders fail to address these situations effectively, it sends a strong condoning message. This in turn has a ripple effect, discouraging those who want to do better and inadver-tently giving rise to similar bad behaviour by others who perceive that there are no meaningful consequences.

As complex and challenging as it may be, hospitals need to take charge of inci-vility in a visible and decisive way to en-sure that their commitment to excellence in patient care is upheld. ■H

Sharone Bar-David is author of Trust Your Canary: Every Leader’s Guide to Taming Workplace Incivility and president atBar-David Consulting, a fi rm specializing in creating civil work environments.

Workplace incivility

Research from across 17 industries shows that 48 per cent of respondents who were asked about their reaction to a workplace incident where they were treated in an uncivil manner reported that they purposely lowered their work effort.

Clearing the rampant confusion around the distinctions between incivility and other forms of bad behaviour can go a long way toward desirable change.

Incivility

Harassment

Bullying

Physicalviolence

1

2

3

4

A Severity Continuum

BAR-DAVIDCONSULTING

www.sharonbardavid.com©SharoneBar-David 2009



major preoccupation for cancer researchers in the early 1960’s was the search for a specifi c bio-marker, material or molecule,

that would distinguish tumour cells from regular cells – in essence, a way to identify cancer through a simple blood test.

“Numerous attempts had been made, but none had been successful. The common wisdom at the time was that such a marker would not be found,” says Dr. Phil Gold, the Douglas G. Cameron professor of Medicine at McGill University, the fi rst director of the Goodman Cancer Centre, current Ex-ecutive Director for the Research Institute of the McGill University Health Centre and former chair of the McGill Department of Medicine. “For myself and my then PhD su-pervisor Dr. Samuel Freedman, it sounded like a challenge we were happy to accept.”

After completing his fi rst year of resi-dency at the Montreal General Hospital (MGH) Dr. Gold worked on his PhD in the laboratory of Dr. Freedman, who was the director of the Division of Allergy at the MGH and subsequently dean of medicine at McGill University. In 1965 they published their discovery of the carcinoembryonic an-tigen (CEA), which is produced during the growth of the bowel. Subsequent studies led to the development of the CEA blood test –the fi rst blood test approved, international-ly, for the detection and management of hu-man cancer. A lot has changed in the past fi ve decades, but the CEA test remains the most frequently used blood test in oncology around the world today. This breakthrough discovery by the two researchers, made over 50 years ago, is a true gift from Canada to the world.

Dr. Gold shares some of his memories of the ground breaking discovery. The re-search utilized a few new and unique ideas: “We employed immunologic technologies, which had not been used in cancer research at that time,” he recalls. “We focused on rabbits because they are good producers of antibodies, and we used colon tumours because they grow differently from other tumours making it easier to compare the tu-mour tissue with normal tissue, which was taken from the same individual.”

Drs. Gold and Freedman exposed new-born rabbits to samples of normal tissue of the human colon, to make them immu-nologically tolerant to these tissues. Later, they injected the rabbits with cancer cells from the same donor. The rabbits responded to the molecule in the cancer tissue. This identifi ed the cancer molecule, which was subsequently found in human embryonic digestive organs, as well as in cancer, lead-ing to the designation of CEA.

“The discovery of CEA was signifi cant because it was the fi rst time that a tumour biomarker had been clearly demonstrated to exist, even though very small amounts of CEA were also present in normal tis-sue,” explains Dr. Gold. “Therefore, we were able to establish a blood test that allowed us to examine the blood samples of individuals with a variety of different conditions to see if this would be helpful in the diagnosis, management, and treat-ment of cancer patients.”

The CEA test is the standard against which other human tumour markers are measured. It is presently the most com-mon blood test for cancer, with an ap-parent market value of well over a billion dollars annually to the pharmaceutical industry. Various cancer organizations across the world have established that the blood test for CEA is instrumental in pre-dicting the future outcome and in moni-toring the management of the disease in patients with colon cancer. This discov-ery has helped shape the modern era of cancer immunology and tumour markers.

Making such an impactful discov-ery informed the trajectory of Dr. Gold’s career, “The immediate result of having discovered CEA was the excitement of suddenly having a large group of interna-tional collaborators with whom to work which led to a rapid expansion of data on CEA.” He continues, “I’m certain that the CEA phenomenon was a signifi cant factor in allowing me to initiate the Mc-Gill (now Goodman) Cancer Centre, and to the take on the post of Physician-in-

Chief at the MGH, and Chair of the De-partment of Medicine at McGill. These opportunities allowed me to pay back all that the university and hospital had done for me.”

Dr. Gold’s distinguished career has earned him an induction into the Cana-dian Medical Hall of Fame, an appoint-ment as an Offi cer of l’Ordre National du Québec, as well as a Companion of the Order of Canada, amongst other coveted awards. When asked about the future of cancer, Dr. Gold is optimistic. “I have no

doubt that a variety of cures for cancer will be forthcoming. Indeed, many are already in place and such conditions as Hodgkin’s disease and Chronic Myelogenous Leuke-mia are now virtually curable,” he says. “In addition, many other common can-cers such as those of the bowel, breast, and even lung, are now being treated with ever increasing success.” ■H

Sandra Sciangula works in Public Affairs & Strategic Planning at McGill University Health Centre.

Canada’s gift to the world: The discovery of the Carcinoembryonic Antigen (CEA)By Sandra Sciangula

A

The discovery of CEA was signifi cant because it was the fi rst time that a tumour biomarker had been clearly demonstrated to exist, even though very small amounts of CEA were also present in normal tissue.

(above) Dr. Phil Gold and Dr. David Thomson pictured here in 1971, published the CEA blood test together.(right) Dr. Phil Gold in 1970 at the University Medical Clinic Labs at the Montreal General Hospital.


17 From the CEO's Desk

appy new year Hospital News readers! 2016 will bring about much change for Bruyère Continuing Care as January

signals the start of both a New Year and new leadership for Bruyère. For readers not familiar with Bruyère, we are located in Ottawa, ON, and pride ourselves in pro-viding evidence-based care to the vulner-able and medically complex, with a focus on people who require integrated seniors health, sub-acute care and palliative care.

As I begin my new role as President and CEO on January 9, 2016, I want to thank Bernie Blais for his leadership at Bruyère over the last 3 1/2 years as he retires from a 45-year career in healthcare. He has been a great mentor and collaborator.

After eight years as Bruyère’s Chief Financial Offi cer and one year as Chief Operating Offi cer, I have a great depth of understanding of the challenges and op-

portunities presented to Bruyère. We have established strong partnerships with other providers within our region to ensure ef-fective transitions for people which is a key element to ensure the future success of the health system.

The mission and values set out 170 years ago as led by 27-year-old Sister Élisabeth Bruyère is part of our DNA. This commit-ment to respecting the rich traditions the organization was built on while investing in research and academics is why I am so proud and excited to be the new president of Bruyère.

Working with our colleagues in the re-gion and provincially – we will support each other and enhance health care in our community. We recognize the urgency is great – with a rapidly aging population and with the prevalence of chronic conditions on the rise, we will need to be prepared to support those who may need our care and services in one way or another.

Bruyère is not satisfi ed by status quo. Instead we are passionate about improve-ment and ensuring that the next genera-tion has a better health system and better health outcomes than currently being ex-perienced. We are also interested in train-ing the future leaders of tomorrow and providing exposure to all of the other areas in our health system. Our number one goal is to help people home.

Bruyère is rising to a higher standard of customer service, delivering a ‘human ser-

vice.’ The patient experience begins and ends with people. Our strong reputation in the community has allowed Bruyère to not only impact change within its facilities but has allowed it to help other organizations fi ll important health needs in our commu-nity – such as hospice care.

In this spirit, our leadership team is re-lentless in their pursuit of quality improve-ment initiatives and streamlining regional processes between our health care partners in the region and to build effi ciencies for

our community. Bruyère is committed to enhancing lives and transforming care. Our vision complements that of our part-ners and policy makers at all levels – fed-eral, provincial and municipal – which ensures that we are always maximizing op-portunities.

Together, we envision and are plan-ning to bring the best minds, evidence and practice to our community ensuring that seniors and those with complex conditions remain healthy and independent. Our vi-sion also sees a program of distinction in brain health. Care will be provided to patients and will be in an ideal situation to carry out the clinical research that will lead to better diagnosis, better care and ul-timately prevention.

At Bruyère, planning for and respond-ing to the needs of our aging and medi-cally complex populations is central to our mission. Aging is not a challenge - it is a journey and we embrace it, learn from it and innovate to enhance how it is and will be experienced. Building on the legacy by Bernie Blais, we will continue to be bold, courageous and revolutionary.

We are grateful for the ongoing support of this generous community, our partners and our dedicated team. Together we will continue to be a cornerstone in the region-al health care community. ■H

Daniel Levac is President and CEO, Bruyère Continuing Care.

Enhancing lives: Transforming care By Daniel Levac

H

Aging is not a challenge – it is a journey and we embrace it, learn from it and innovate to enhance how it is and will be experienced. Daniel Levac



athleen Farr has a dilemma. The registered nurse at Bar-

rie’s Royal Victoria Regional Health Centre (RVH) has just

been assigned to an extremely anxious el-derly patient who does not speak English.

Needing a little assistance with the situation, she immediately turns to the co-worker to her right, shares what she thinks she should do to help the patient and then asks for her colleague’s opinion.

Except Farr is not actually caring for the patient. She is participating in a staff-en-gagement activity known at RVH as Mis-sion Possible.

For over a year the health centre has used gamifi cation to embed its mission, vision and values and advance its patient-focused strategy, enabling staff to discuss how they can live the corporation’s values despite challenging work and personal situations.

Mission Possible was developed in-house by RVH’s Corporate Communica-tions team and designed as a colourful and interactive board game to sustain the health centre’s MY CARE philosophy, particularly the values of Work Together, Respect All, Think Big, Own It and Care.

“This unique activity engages staff in an innovative and fun way, prompting thoughtful, frank conversations and brain-storming solutions,” says Suzanne Legue,

vice-president, Strategy, Communications and Stakeholder Relations. “The tool en-ables participants to connect the dots be-tween our values, employees’ behaviour and RVH’s strategy in a way that sitting in a meeting never could. Signifi cant re-search shows that when your employees and physicians are engaged, the patient experience and outcomes improve. Sim-

ply put – higher engagement means better patient care.”

Mission Possible, which resembles a typical board game, guides participants through a series of real-life professional and personal challenges. Clear instruc-tions and an intuitive design means the 20-minute activity can be completed without a facilitator, although ideally, a

department leader is on-hand to promote team-building. The goal is a lively and robust discussion about how values can be applied to real-life situations and challenges.

“It is a great game. There are good sce-narios which inspired great discussions. All the scenarios we selected during play have all happened to me in a workplace,” Kathleen Farr, RN, Dialysis.

A 2014 report by Technology Advice found that 54 per cent of employees would be much more likely to perform a task if it had game elements. In fact, gamifi ca-tion is quickly becoming a highly effective training tool; applying gaming designs and concepts to learning scenarios in order to make them more engaging and entertain-ing for the learner.

All new RVH hires participate in the activity during orientation while existing staff participate in a team Mission Possible session annually. The results have been re-markable. In a 2014 employee survey, 68 per cent of staff said they remember the health centre’s vision and apply it to their work day. Within six months of launching Mission Possible, another survey revealed that number had jumped to 83 per cent.

“Mission Possible is extremely fun and a great team building exercise,” says Kim Roberts, administrative assistant, RVH cancer centre. “The game is excellent and it covers all the RVH values.”

RVH president and CEO Janice Skot notes, RVH’s values were developed through signifi cant staff consultation and refl ect the personal values the health cen-tre’s employees hold most dear.

“We know that in the busy, challenging world of healthcare, if employee’s day-to-day behaviours default to their values – their True North – we can consistently put patients fi rst and successfully execute our strategy. That is why using innova-tive strategies, such as Mission Possible, to hardwire these values into the day-to-day work habits of staff is so very important. It’s important for them and ultimately to the patients who will benefi t.” ■H

Donna Danyluk is with the Corporate Communications department at Royal Victoria Regional Health Centre in Barrie

Creating a staff engagement ‘game’By Donna Danyluk

K

Royal Victoria Regional Health Centre’s (RVH) Respiratory unit staff participate in an innovative staff-engagement activity called Mission Possible. It was developed in-house by RVH’s Corporate Communications team and designed as a colourful and interactive board game.

he Hospital for Sick Children (SickKids) is proud to have been named one of Canada’s Top 100 Employers for 2016

by Mediacorp Canada Inc. This is the fourth time in the last fi ve years SickKids has received this award.

SickKids was chosen from applicants from across Canada. Employers of any size may apply for the award, whether private or public sector. Applications are assessed against those of peer orga-nizations based on the following eight criteria: physical workplace; work at-mosphere & social; health, fi nancial & family benefi ts; vacation & time off; employee communications; performance management; training & skills develop-ment; and community involvement.

“The reason SickKids is such an in-credible place to work is because of our staff and volunteers,” says Dr. Michael Apkon, SickKids President and CEO. “SickKids is a collaborative team envi-ronment that truly relies on the compas-sion, dedication and innovation of our employees.”

SickKids’ investment in ongoing staff training and development was cited as a winning combination. Staff are provided with a wide range of online and in-class learning opportunities to augment their on-the-job learning and development experiences. This includes tuition sub-sidies through the hospital’s staff con-tinuing professional development fund for courses, workshops or conferences related to an employee’s role. SickKids also hosts over 100 conferences each

year and offers a variety of in-house edu-cational programs such as KidTALKs, live discussions led by SickKids experts.

“We’ve worked hard to make sure we are supporting employees in a number of ways,” says Susan O’Dowd, Vice-Pres-ident of Human Resources at SickKids. “We’re delighted to be recognized for this as a top employer in Canada.”

SickKids’ commitment to creating a healthy work environment through its wellness program was also noted as one of the reasons the hospital was honoured. SickKids offers employee subsidized memberships to its onsite fi t-ness facilities, including instructor-led classes in boot camp, Pilates and yoga. The nomination also highlighted other aspects of SickKids’ wellness program including its Employee Assistance Pro-gram, weekly seated massage therapy, walking and running clubs, meditation/refl ection rooms and onsite facilities, in-cluding employee shower facilities and bike lockers.

The hospital’s physical environment also impressed the Mediacorp judges and was given a grade of A. SickKids’ new-est building, the Peter Gilgan Centre for Research and Learning, opened in 2013 and offers 21 storeys of state-of-the-art laboratories and learning facilities. The campus’ year-round farmers’ market, open concept hospital atrium and out-door patios were also highlighted in the nomination as notable features.

“From wellness initiatives to employee assistance programs to education and training opportunities, we want to make sure staff fi nd meaning and value in their work and continue to provide the best for our patients and families,” says O’Dowd.

The Top 100 Employers were an-nounced on Nov. 9 in a special editorial feature in The Globe and Mail, and are listed on Canada’s Top 100 Employers’ website. ■HRebecca Skinner is a Communications & Marketing Offi cer, The Hospital for Sick Children (SickKids).

SickKids is one of Canada’s Top 100 Employers!By Rebecca Skinner

T



s a recruiter for Doctors With-out Borders Canada/Méde-cins Sans Frontières (MSF), I am often asked by fi rst-time

medical fi eldworkers what professional challenges they will face during their as-signments overseas, and what impact their experience with MSF will have on their career development.

I truly believe that the most challenging aspects of doing humanitarian work also provide the most rewarding and enriching experiences to our fi eldworkers, both on a professional and a personal level.

I have spoken to hundreds of health care workers who have gone on fi eld as-signments with MSF, and here is what they found most rewarding in terms of their ca-reer development:

Returning to Canada invigorated, and as better health care professionals

Spending nine to 12 months providing vital lifesaving care to some of the world’s most vulnerable people is a humbling expe-rience, since the needs often outstrip what is possible for health care professionals to provide. Many fi eldworkers come back with a renewed sense of empathy, which is essential to being a great health care provider – something that is true whether someone is a nurse, doctor, pharmacist or any other kind of health worker.

Acquiring new skills, knowledge and experience

Our fi eldworkers are often put into situations where they have to go outside of their comfort zones as professionals –whether they are being exposed to new diseases or pathologies, having to adapt to new cultures or living 24-hours-a-day with the same people they work with.

Gaining leadership skillsInternational fi eldworkers often have

managerial responsibilities, and are called upon to supervise dynamic, multidisci-plinary teams in very trying circumstances. Many of our recruits point to these expe-riences as contributing greatly to making them better and stronger leaders.

Possibilities of career growth within MSF

Many people are not aware that MSF wants people to stay and grow within the organization, and to take on more responsi-bility. To help us do that, MSF offers train-ing and career planning to our fi eldworkers from their very fi rst assignments onwards. We need people at all levels of our opera-tions, from coordination positions – such

as medical coordinators and country direc-tors – to technical advisers in our various headquarters around the world. We have Canadians involved in every part of the or-ganization, from medics on their fi rst over-seas assignments to the offi ce of the MSF International President – a role currently fi lled by our very own Dr. Joanne Liu, from Montreal!

Who does MSF need?I know that the readership for Hospital

News is quite varied, so let me share with you what types of health care professionals we are currently looking for: We need phy-sicians, nurses, pharmacists, midwives and

administrators – and accountants too! For the complete list, check out our website at www.msf.ca and click on “Work with Us.” Professionals who also speak French or Ar-abic, have some global health experience or backgrounds working in rural and re-mote northern communities are especially sought after.

To get more information, see videos, read testimonials and apply, go to MSF.ca. If you have specifi c questions you can write to me at [email protected] ■H

Owen Campbell, a former MSF fi eldworker, is the manager of recruitment for MSF Canada.

Hospital News Delivered To Your Inbox!

YOU don’t have to wait!

Get your digital copy of Hospital News emailed to you, the minute it comes out.

Sign me up!Sign me up! Just send email to

[email protected]

Professional developmentthrough humanitarian workBy Owen Campbell

A

7. Setting clear and measurable objectives, as well as performance expectations.

Goal-setting with annual objectives and performance reviews should be developed for physicians participating in manage-ment, in a process similar to the evaluation of hospital leaders.

In setting such goals, it is imperative to outline role descriptions, responsibilities, expectations, and lines of accountability.

ConclusionWhile there are opportunities for fur-

ther research with respect to organiza-tional strategies used to achieve alignment between hospitals and physicians, a num-ber of conclusions can be drawn from this literature review. Though many structural and cultural aspects of an organization contribute to creating an effective work-ing relationship between hospitals and physicians, this article highlights the key themes prevalent in the research, regard-

less of hospital size, type and geographic location. The information gleaned from the OHA’s member surveys and infor-mational interviews should provide addi-tional insight to how organizations can be more successful in achieving alignment.

The hospital-physician relationship will benefi t from further exploration, and les-sons may be learned from other sectors that have successfully transformed orga-nizational cultures in an effort to improve quality, patient experience, performance, and staff engagement. The OHA will con-tinue to work with key stakeholders to gather leading practices in this area and share them with physicians and hospital management across the province.

Stay tuned for the next article in this series, coming in the February issue: Part 2: A Practical Approach to Enhancing the Relationship. ■H

This article was submitted by The Ontario Hospital Association.

Continued from page 11Effective working relationships


20 Legal Update

n December 10, 2015, Ontario announced Christine Elliott as the province’s fi rst Patient Ombudsman. It is anticipated

her appointment will come into effect on July 1, 2016, concurrently with amend-ments to the Excellent Care for All Act setting out the role’s functions and powers.

Many stakeholders are concerned, how-ever, that the amendments to the Act fall short, because the Patient Ombudsman will not be as independent or empow-ered as the Ontario Ombudsman. While Health Minister Eric Hoskins has stated that the Patient Ombudsman will be free to criticize the government “as she sees fi t,” she will be an employee of the Ontario Health Quality Council (OHQC) who can be terminated for cause, and will report to

Minister Hoskins (whereas the Ontario Ombudsman is an offi cer of, and reports to, the Legislative Assembly).

Stakeholders are also concerned that the Act does not empower the Patient Ombudsman to investigate for-profi t health sector organizations, such as retire-ment homes or private clinics that receive public funds, nor does it allow expressly her to investigate systemic issues affecting the industry.

Regardless of these concerns, health sector organizations need to amend their existing complaint policies before July 1, 2016 to address possible Patient Ombuds-man investigations, and to ensure that those policies are robust and effective to help avoid investigations in the fi rst place and demonstrate that adequate investiga-

tions occurred where complaints to the Pa-tient Ombudsman are (inevitably) made.

The Patient Ombudsman will be re-sponsible for responding to complaints from patients, substitute decision-makers, and caregivers regarding care provided by public hospitals, community care access centres (CCACs), and long-term care fa-cilities. Other organizations that receive public funds will not fall within the Patient Ombudsman’s jurisdiction (unless and un-til prescribed by the Minister).

The Patient Ombudsman will work with all parties to resolve the complaint, unless (a) the complaint relates to a matter that is within the jurisdiction of another person or body or is the subject of a proceeding, (b) the subject matter of the complaint is trivial, (c) the complaint is frivolous or

vexatious, (d) the complaint is not made in good faith, (e) the patient, former pa-tient, caregiver or other prescribed person has not sought to resolve the complaint di-rectly with the health sector organization; or (f) the patient, former patient, caregiver or other prescribed person does not have a suffi cient personal interest in the subject matter of the complaint.

These exemptions will shield a wide swath of matters from investigation, and underscores why hospitals must have ro-bust and effective complaint resolution mechanisms in place. Under the Act, “pro-ceeding” includes a proceeding held in, be-fore or under the rules of a court, a tribunal (including a hospital’s board of directors, when sitting as a tribunal under the Statu-tory Powers Procedure Act), a commission, a justice of the peace, a coroner, a specifi ed regulatory committee, or an arbitrator or a mediator. This exemption also bars any in-vestigation of matters falling within the ju-risdiction of the Health Professions Appeal and Review Board or the Health Services Appeal and Review Board, or existing la-bour and employment dispute resolution mechanisms.

In resolving complaints, the Patient Ombudsman will have the power to inves-tigate, including investigations undertaken on her own initiative. Any caregiver, pa-tient or former patient, or offi cer, employee, director, shareholder or members of health care organization may be summoned by the Patient Ombudsman to provide infor-mation under oath or produce documents relating to the investigation. The Patient Ombudsman will also have the power to enter any health sector organization, but only with the organization’s consent or a search warrant.

Following an investigation, the Patient Ombudsman will be able to make recom-mendations to the health sector organiza-tion. The Patient Ombudsman will also report to the Minister on her activities and recommendations at least annually, will provide periodic reports to local health in-tegration networks (LHINs) on her activi-ties and recommendations, and will make all reports publicly available.

While there is little doubt that the cre-ation of the Patient Ombudsman is an im-provement from Ontario being the only province in Canada not to have a patient ombudsman, it remains to be seen whether she will have the ability to effect meaning-ful change to Ontario’s healthcare indus-try, or whether she will meet Ontarians’ expectations. ■H

Michael Watts is a Partner, Jeffrey Murray and David Solomon are Associates in the Toronto offi ce of Osler, Hoskin & Harcourt LLP.

Ontario’s new patient ombudsmanBy Michael Watts, Jeff Murray and David Solomon

O

ealth care workers are de-voted to providing safe, high-quality care to their patients, and oftentimes, this

can come at the expense of their own well-being. Hospital staff face a range of unique risks to their health and well-be-ing on the job: they may be at increased risk of suffering from burnout or exhaus-tion, stress and fatigue, as well as higher rates of violence and client aggression. A healthy and supportive workplace can make all the difference.

Trillium Health Partners is making a variety of health and wellness activities easily accessible to its staff to support a healthy workplace. In 2012, Trillium Health Partners launched the LiveWell program, a multi-faceted platform offer-ing a variety of exercise classes such as Zoomba, Pilates and Yoga, walking and running groups and access to a gym. The LiveWell program offers wellness events throughout the year, including movie nights featuring movies such as Roko Belic’s Happy, and monthly webi-nars focused on monthly wellness and stress management topics like Goal Set-ting for Personal and Professional Suc-cess , Impact of Shift Work on Mind and Body, or Coping with ‘Compassion Stress’. LiveWell also offers special initia-tives throughout the year, like October’s Healthy Workplace Month, which boasts a 98 per cent satisfaction rate from par-ticipating staff.

“Putting patients fi rst is what our nurs-es, physicians, and other health care pro-fessionals at Trillium Health Partners do. But it’s just as important to be aware and attentive to your own needs so that you can continue to be able to help, and heal others,” says Nicole Stibbe, Manager, Employee Health, Safety and Wellness at Trillium Health Partners.

The Connection Cart is a popular part of the hospital’s LiveWell program. It’s a large push cart stocked with an ar-ray of hot beverages and snacks, along with wellness resources. It travels be-

tween Trillium Health Partners’ three sites offering a healthy break, snacks, information about wellness resources and printed schedules for a varied menu of wellness activities. Employee Health, Safety and Wellness staff take the Con-nection Cart to Trillium Health Partners’ clinical and corporate departments sev-eral times throughout each month, pay-ing special attention to programs in the hospital where stress or workload levels might be especially high, and organizing targeted resources as appropriate to their specifi c situations.

“The idea behind Connection Cart is to have your ear to the ground, being responsive to what staff in the organiza-tion might be going through at any given time, whether it’s supporting staff deal-ing with the loss of a patient following a Code Pink, or helping staff to manage stress through an intense project. It’s de-signed to connect with our staff’s well-ness needs in real time,” says Ivian Tcha-karova, Wellness Specialist at Trillium Health Partners. “It’s also an opportunity

for our staff to pause, refl ect and have an unexpected moment of self-care.”

The LiveWell program also includes a mobile mini-massage program, laughter yoga, and lessons in stress management techniques such as Emotional Freedom Technique (EFT) tapping.

“LiveWell exercise classes helped me get stronger, fi tter and calmer,” says Maxine Benjamin, Physiotherapy Assis-tant, Surgery at Trillium Health Partners. “The boost in energy levels is amazing. Having the classes at the hospital is very convenient and makes it easier to get to the classes after work. The classes are also provided to us free of charge, and that is a wonderful incentive to attend.”

Over the past year, there were 714 wellness events offered through the Tril-lium Health Partners’ LiveWell Program, with a strong attendance of more than 10,653 participants. ■H

Ania Basiukiewicz is a Communications Advisor at Trillium Health Partners.

hospital staff to wellness resources in “real time” By Ania Basiukiewicz

HMany stakeholders are concerned, however, that the amendments to the Act fall short, because the Patient Ombudsman will not be as independent or empowered as the Ontario Ombudsman.

Trillium Health Partners staff taking a moment of self-care with LiveWell travelling Connection Cart

LiveWell program connects


21 Nursing Pulse

n a typical day at the campus recreation and wellness centre at Durham College, RN Teresa Engelage and her four nurs-

ing colleagues and two physicians will as-sess 100 to 120 students for health issues ranging from allergies to mental health challenges. “We’re like their family doctor when they’re going to school… (we) offer them long-term solutions and continuous care,” the seasoned campus health nurse says, adding that she always fi nds time to sit down with students to explain some of the school resources available to them.

“Nurses are an integral part of the over-all health and culture of an academic in-stitution,” says Lindsey Thomas, a former campus health nurse and current professor for the school of health and community ser-vices at Durham. “We are there to provide care… when they are in need of medical or psychological interventions,” Thomas says, adding that campus RNs are also “…a comforting person to talk to when in need of any health advice and support.”

Looking to give the role more recogni-tion, Engelage and Thomas launched the Ontario Campus Health Nursing Associa-tion (OCHNA), an interest group of the Registered Nurses’ Association of Ontario (RNAO), in February 2015. With 22 mem-bers to date, OCHNA has a mandate to promote campus health nurses and the work they do for students. “This group was formed to not only advocate for the impor-tance of our role within academic institu-tions and as advocates for our student pop-

ulation, but to also act as a support system for the RNs who practise in this environ-ment,” says Thomas, who, in partnership with Engelage, co-chairs the group.

Engelage and Thomas believe that through this new interest group, and with the support of RNAO, they will also be able to tackle one of the biggest issues affecting students: mental health. According to a U.S-Canada study, one-in-four students who visit an on-campus health centre for a routine medical problem shows signs of de-pression, and many of those students report they have considered suicide.

In 2012, Ryerson University’s centre for student development and counseling re-ported a 200 per cent increase in demand from students in crisis situations such as suicide. University of Toronto campus RN Rovina Girn points out that campus health nurses are the frontline when it comes to

this issue. During a time in their lives when they are moving away from home and fi nd-ing their independence, it is important they have someone to confi de in and guide them, she says.

“During the busy times (like exam sea-son), at least a couple times a day, a student may be feeling suicidal or stressed out and they have no support,” says Girn. They may be “…able to fi nd a connection with the nurse,” whose scope of practice includes scanning for suicidal thoughts and deter-mining whether follow-up is needed with a counsellor or if the student needs to go to the hospital.

Christine Philbrick, director of research for OCHNA, says mental healthcare a top priority for the interest group, and so is advocating for changes to certain cam-pus policies. “We’d like to continue to im-prove on policies related to mental health, discrimination and harassment,” she says, “Our goal is to make our campuses a bet-ter learning environment for students and to enhance their personal health,” she explains, suggesting they would also like to explore policies that prohibit the use of tobacco on campus. The group is also look-ing to share best practices between campus health nurses so they can enhance the care they provide to students.

To make these aspirations a reality, the group hosted its fi rst member meeting in November. They focused on goals for the coming year, and the resolution(s) they hope to bring forward at RNAO’s annual general meeting next spring. The team is

already thinking about putting forward a resolution that will encourage universities and colleges to continue funding roles for RNs and RPNs on campus.

Although their work is sometimes over-looked, Engelage says she is proud and happy to be a campus RN at Durham Col-lege. “I recently got a letter from a student who wrote… ‘I was seen by the nurse today and she spoke to me like I mattered, and that I was normal. She didn’t speak down to me or make me feel like I was inferior.’” Engelage remembers the student well, and explains that she was having suicidal thoughts during her visit. The young wom-an was eventually sent to the hospital, and Engelage was truly touched to receive the note of gratitude.

This story “… really speaks to our nurses and how they understand what these young people need,” Engelage says. “We need to realize how important nurses are in the health centres, and talk (to our politicians) about how important it is to have these health centres – and RNs – on campus.”

With OCHNA still in its infancy, Engelage, Thomas, Philbrick and Girn, along with other members of the group, are working hard to reach out to more RNs, NPs, and nursing students working in aca-demic settings. Their goal: to become the leading voice for campus health nurses in Ontario. ■H

Victoria Alarcon is editorial assistant for the Registered Nurses’ Association of Ontario.

RNs on campus help studentsBy Victoria Alarcon

O

According to a U.S-Canada study, one-in-four students who visit an on-campus health centre for a routine medical problem shows signs of depression, and many of those students report they have considered suicide.

Denise Hodgsonat 905-532-2600 x2237 [email protected]

Stefan Dreesenat 905-532-2600 x2235 [email protected]

Booking Deadline:

22JAN

Material Deadline:

26JAN

FEBRUARY 2016 EDITION

Next ISSUE!

Annual Healthcare Infection Control Supplement

For more information and to secure a position, please call

Hospital News pleased to announce our annual Infection Control Supplement that will run in the February issue.

The special insert will provide an opportunity for IPAC Canada members to showcase their products and services to Hospital

News’ highly targeted audience of healthcare professionals and decision-makers. It will also provide readers with an

overview of how Canada’s healthcare infection prevention and control companies are contributing to better health and

safer care for Canadians.

Don’t miss out on this unique opportunity to share your innovations with the people who have the authority to purchase your products—healthcare decision-makers

in partership with IPAC Canada

CALLTODAY!


22 Careers

Are you ready to fi nally QUIT THINKING about nursing in the US and get serious about advancing your career?

Looking for an employer that will sponsor you for a Green Card?WE CAN HELP!For the past 14 years, we have helped over 2,000 nurses, just like you, fi nd a rewarding nursing career in the United States. Leaving Canada for a job in the US can be confusing and scary.

Let us hold your hand and walk you through our proven process that has helped thousands of nurses realize their dreams.

We’re so sure about it, we will pay your airfare and hotel costs to come and join us at one of our RN Hiring Events in the US! No commitment required – you just have to be serious about your desire to work in the US and meet our qualifi cations.

APPLY TODAY TO ATTEND THE #1 RN HIRING EVENT FOR RNS, LIMITED TO 100 APPLICANTSWe’re so sure about it, we will pay your airfare and hotel costs to come and join us at one of our RN Hiring Events in the US! No commitment required – you just have to be serious about your desire to work in the US and meet our qualifi cations.

QUALIFICATIONS:

April 4-6, 2016

The #1Hiring EventFor RNs

USAGreen Cards

for RNs!

www.cehealthcareers.com

WHAT ARE NURSES SAYING…“Being considered as one of the applicants for the Crytzer England Group was one of the highlights of my career thus far. I was impressed by how organized the job fair was. I was also enthused by the acknowledgements that Crytzer England Group received from employers and top US healthcare institutions with prestigious backgrounds. I was honored to receive off ers from these employers. Crytzer England Group takes pride in seeking the best nurses. If you have that passion and drive to pursue a better future, then Crytzer England Group will take you to where you deserve.”

Marvin P., BSN, RN – Newmarket, ON

“I decided to fi nally pursue the big change I was looking for in my life and my career and thanks to you all it actually happened. I traveled to your interview expo in Washington DC and was beyond impressed by what happened during those three days. Working with Crytzer England just made everything so easy! The community tour and hospital tour were so helpful and having it all arranged by your group was the icing on the cake. Once I accepted the position, I was once again so grateful to have you and Kim, help me navigate the licensing and TN visa process in order to move from Canada to DC. Sincere Thanks.”

Leyna S., BSN, RN – Victoria, BC

CALL TOLL-FREE 877-722-7469 TO SPEAK WITH A RECRUITER OR EMAIL: [email protected] TO REQUEST AN APPLICATION


23 Health Care Technology

Working Environment

CAMP DOCTOR

Parry Sound

905-569-7595/877-569-7595www.campkodiak.com

info@campkodiak

CareersDEADLINE FOR FEBRUARY ISSUE:

JANUARY 26, 2016

VIEW CAREER ADS AT: www.hospitalnews.com

cientists at Lawson Health Re-search Institute, in collabora-tion with Ceresensa Inc., have produced the fi rst commercial

imaging product available in the world for PET/MRI scanners. The novel PET-trans-parent MRI head coil provides unparalleled images to advance the study, diagnosis and treatment of a wide range of diseases.

Lawson installed Canada’s fi rst whole body PET/MRI scanner at St.Joseph’s Hos-pital, part of St. Joseph’s Health Care Lon-don, in 2012.

This hybrid imaging scanner combines magnetic resonance imaging (MRI) and positron emission tomography (PET) into one powerful and simultaneous whole-body system, with substantial and innovative results.

Patient diagnosis is faster and overall in-formation available from the scan is better and more detailed.

“With only 50-60 PET/MRI scanners installed worldwide, Lawson’s Imaging pro-gram has made signifi cant early contribu-tions to this young technology and pioneer-ing system,” says Dr. Jean Théberge, Lawson Imaging Scientist and Physicist in Diagnos-tic Imaging at St. Joseph’s.

During scans, a coil is positioned around the head. The coil contains several ele-ments, called channels, which detect the MRI signals being emitted. No gamma rays are used in standard MRI and so the components are not designed to avoid ab-sorbing this radiation. For PET images,

participants are injected with a radioac-tive material which emits gamma rays. The problem is that in a hybrid PET/MRI scanner, the PET gamma rays are absorbed by the MRI head coil, resulting in a loss in the quality of data at the level used for research.

“Our challenge was to create a MRI head coil with 32 channels for research-grade scans that would be transparent to gamma rays,” explains Adam Farag, Scientifi c Di-rector and co-founder of Ceresensa.

Together, Dr. Théberge and Farag arrived at a design that solved the problem, mak-ing possible advanced and highly effective neuroimaging with both MRI and PET. This was done through signifi cant changes to the geometry of the existing coil and, thanks to the wide array of imaging equipment at Lawson, careful testing and selection of materials. With PET-friendly geometry and PET-friendly materials, the result is simul-taneous acquisition of images and informa-tion from both the PET and MRI scans –

giving a more complete picture of the area being studied.

The coil is so transparent to the PET pro-cess that it can be used without correction for attenuation. Attenuation is any reduc-tion in the strength of a signal leading to image noise, artifacts or distortion that may decreases the scan’s accuracy. “The number of gamma rays lost due to attenuation with-in the coil is less than two per cent, a fi gure that is not matched by any other published designs,” notes Farag.

For research in the areas of neuropsy-chiatry and neurodegenerative diseases, the scan provides a more complete set of brain markers that can be studied – all from a sin-gle exam. In clinical settings, the high de-gree of transparency of the coil paired with a PET/MRI scan greatly increases the ef-fectiveness and accuracy of the information provided to physicians as part of a patient’s diagnosis and treatment.

Work is underway for the develop-ment of coils for other parts of the

body, including the heart and prostate. “Simultaneous PET/MRI has changed

what we can dream of for brain imaging research and clinical applications,” says Dr. Théberge.

“PET/MRI has proven to deliver uncom-promised quality compared to standalone PET or MRI scanners. Our brain imaging coil extends this quality to advanced neu-roimaging applications, attracting neurosci-entists previously specialized in only PET or MRI. This opens up considerable possibili-ties for coll aboration and synergy.”

At Lawson, the coil will be used for re-search in schizophrenia and depressive disorders, Alzheimer’s Disease and Fronto-Temporal Dementia, and the study of brain damage resulting from chronic dialysis.

The PET-transparent MRI head coil, and its design and implementation, are the sub-ject of a provisional patent (USA). ■HLaura Goncalves works in Communications & External Relations at Lawson Health Research Institute.

Imaging technology developed at Lawson By Laura Goncalves

S

The novel PET-transparent MRI head coil provides unparalleled images to advance the study, diagnosis and treatment of a wide range of diseases.

Adam Farag, Scientifi c Director and co-founder of Ceresensa (left) and Dr. Jean Théberge, Lawson Imaging Scientist collaborated in creating the fi rst commercial imaging product in the world for PET/MRI scanners.

A close up of the PET-transparent MRI head coil.

www.manitoucamp.com contact David at 416-322-5888; or [email protected]

Nurses/Practitioners forchildren's summer camp

near Parry Sound-Room andBoard, great salaryJune 23 - Aug 18

first time grads andexperienced nurses - If youlove the outdoors and love

children this will be thesummer of a lifetime!

CAMP MANITOU

To advertise please contact

DeniseHodgson

[email protected] ext. 2232

Join thousands of Médecins Sans Frontières (MSF) doctors helping people in crisis around the globe. We need medical expertise in a wide range of specialties, including yours.

Interested?

Call 1-800-982-7903 or visit www.msf.ca/recruitment

work with us

© F

iona

Mor

ris/M

SF



When the problems are facility-wide,the solutions have to be .

Learn more at www.cloroxhealthcare.ca © 2015 Clorox Professional Products Company1. S.S. Huang, R. Datta, R. Platt, Archives of Internal Medicine, 2006. 2. B. Koll, American Journal of Infection Control, June 2009.

*Use as directed on hard, nonporous surfaces

Clorox Healthcare® Professional Disinfecting Bleach Products kill C. difficile spores quickly :wipes 3 minutes, liquids 5 minutes and 46 other pathogens like MRSA & VRE in 1 minute*

• 33% of non-CDI rooms have tested positive for C. difficile.2

• 55% of high-touch areas in patient rooms have tested positive for C. difficile.2

1

1

®

hospital news 2016 january edition

Documents