Hospital News 2015 November Edition

INSIDEEvidence Matters ...............................10

Ethics .................................................. 17

Data Pulse ..........................................18

From the CEO’s desk .........................24

Legal Update ......................................28

Nursing Pulse .....................................35

First TAVI procedure on pregnant patient

Sunnybrook reaches out to its virtual community

2 31

FOCUS IN THIS ISSUETECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE/HOSPITAL PERFORMANCE INDICATORSDigital health advancements and new technology in healthcare. Programs and initiatives focused on enhancing the patient experience and family centred care. An examination of health system performance based on hospital performance indicators.NOV. 2015 | VOLUME 28 ISSUE 11 | www.hospitalnews.com

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2 Focus TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE/HOSPITAL PERFORMANCE INDICATORS

or just a moment, put yourself in Sarah Sayle’s shoes.

You’re a busy mom of two even busier girls, both under

the age of two. Juggling the daily demands of an infant and a toddler, you learn there’s one more on the way. This time, a baby boy. Life’s about to get a whole lot busier.

Is your head already spinning? Few can relate, let alone imagine life with three little ones under three. Still, Sarah and her husband are prepared to take it all in stride.

Suddenly, a second wave of news strikes: Sarah, 29, who was born with a congenital heart defect, needs to have heart surgery. Her aortic valve has given out under the physical stress of pregnancy.

“I didn’t know what was going to hap-pen,” says her husband. “She went for a doctor’s appointment in the morning, was supposed to be back by noon and instead was admitted to hospital.”

Sarah needed to make a decision right away. She had three options: wait until her baby was born to have open-heart surgery, risking death for both her and/or her un-born child in the meantime; terminate the pregnancy and proceed with open-heart surgery; or undergo a specialized valve replacement while pregnant – something that had never been done before.

Sarah’s decision was clear. At sixteen weeks pregnant, she underwent a trans-catheter aortic valve implantation (TAVI) procedure, where a new valve is inserted into the heart via an incision made in the groin. For TAVI patients, the physical stress and recovery of the surgery is mini-mized – the best option for those who are too frail or in unique situations such as Sarah’s.

“Our main goal was to save Sarah’s life,” says Dr. Rich Whitlock, cardiac surgeon at Hamilton General Hospital.

Although Dr. Whitlock and his team were confi dent that TAVI was the best op-tion for Sarah, it took careful planning and collaboration between both the cardiac

and obstetrics teams to ensure a smooth journey for both mom and baby.

“Everyone was constantly checking in on me,” says Sarah. “My obstetrician even visited me in recovery at the General to make sure everything was okay.”

Sarah recovered well from her surgery. On Sept. 22, Sarah and her family wel-comed a healthy baby boy, Peter, weighing 7lbs 12oz. He spent his fi rst few days being closely monitored by staff and physicians in the neonatal intensive care unit at Mc-Master Children’s Hospital before heading home to meet his two big sisters.

“Sarah’s case is something you read about in a textbook,” says Dr. Michelle Morais, obstetrician at McMaster Univer-sity Medical Centre who helped to deliver baby Peter. “You maybe see it once or twice in a career.”

Dr. Morais says other health care teams will read about and learn from Sarah’s case, a world fi rst not only due to her pregnancy, but also her age – she’s the youngest TAVI patient to date. The learnings shared be-tween the two teams are invaluable for future TAVI and other cases. Together, they’ve exemplifi ed the epitome of collabo-

ration and interdisciplinary care, and the positive outcomes for both Sarah and baby Peter are proof.

“It was perfect,” says Dr. Whitlock. “It was a textbook case.” ■H

Calyn Pettit is a Public Relations Specialist at Hamilton Health Sciences.

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World’s fi rst TAVI procedure on pregnant patientBy Calyn Pettit

F

A transcatheter aortic valve implantation (TAVI) procedure is where a new valve is inserted into the heart via an incision made in the groin.

On Sept. 22, 2015 Sarah Sayles and her husband welcomed baby Peter, who was just sixteen weeks gestation when his mother underwent a specialized aortic valve replacement – the fi rst case of its kind in the world.

Moving to the forefront of health care technology

t Mackenzie Health, patients are at the heart of every-thing we do. As a regional health care provider serving

a population of more than half a million people across York Region and beyond, Mackenzie Health is evolving its IT infrastructure to benefi t both the existing Mackenzie Richmond Hill Hospital as well as the new Macken-zie Vaughan Hospital expected to be completed in 2019.

Recently, the organization introduced ICAT Healthcare, a strategy that will see Mackenzie Health propel its infor-mation, communications, and automa-tion technology (ICAT) systems to a leadership position within the health care industry over the next four years.

Nationally recognized for its commit-ment to safety, quality patient care and innovation, Mackenzie Health works with health care, technology and aca-demic partners to constantly evolve and

adapt to keep current with best practice and technology changes.

“ICAT Healthcare serves as a key pil-lar in helping Mackenzie Health achieve its vision to create a world-class health experience for its patients by providing our staff and physicians with world-class technologies to enable that care,” says Richard Tam, Executive Vice President and Chief Administrative Offi cer at Mackenzie Health.

New fi rst-in-Canada hospital portable data centre

The recent addition of Mackenzie Health’s state-of-the-art, portable data centre, puts Mackenzie Health at the forefront of health care IT infrastructure as the fi rst health care organization in Canada to acquire this kind of technol-ogy. Mackenzie Health is among the fi rst of only a handful of health care organiza-tions across North America to do so.

By Stefanie Kreibe

A

Continued on page 6

NOVEMBER 2015 HOSPITAL NEWSwww.hospitalnews.com

3 In Brief

Half of people internationally say they have had a cough or cold in the last 12 months and over a quarter report suffer-ing from insomnia or problems sleeping. These are fi ndings from a recent GfK on-line survey that asked over 27,000 people in 22 countries which health conditions from a given list they had experienced in the past 12 months.

The possible conditions asked about included items such as skin conditions, allergies, vomiting or diarrhea, diabetes or pre-diabetes and high cholesterol or blood pressure. But, internationally, the top fi ve most common conditions that people say they have experienced in the past 12 months are a cold (which was bundled with a cough, sore throat, up-

per respiratory infection, fl u or infl uenza and was reported by 51 per cent), prob-lems sleeping (27 per cent), muscle or joint pain due to injury or over exertion (25 per cent), weight problems (21 per cent) and migraines or severe headaches (21 per cent).

Looking at the breakdown between men and women, there are some clear gender differences. For almost all the conditions listed, women have higher percentages saying they have expe-rienced these in the last 12 months than men.

Both genders report a cold or cough as being the most common complaint (53 per cent of women and 49 per cent of men), but, for women, the next most

common complaint is insomnia (32 per cent), while, for men, it is a tie-breaker between muscle or joint pain due to over-exertion or injury, and insomnia (both standing at 24 per cent). There is also a difference in what items make it into the top fi ve for each gender. For women, mi-graine or severe headache is their third most common complaint, but does not feature in men’s top fi ve list (reported by 27 per cent of women and 15 per cent of men). And for men, heartburn or acid refl ux is their fourth most common complaint, but does not feature in the women’s top fi ve list – even though more women than men report having experi-enced it over the last year (19 per cent of men and 21 per cent of women). ■H

ranks 2nd after cold as most common health complaint

The Expert Panel on Options for a Leg-islative Response to Carter v. Canada has returned from its fact-fi nding trip to Port-land, Oregon, where it learned how as-sisted dying, which has been legal there for nearly 20 years, is practiced.

During their three-day visit, Dr. Har-vey Max Chochinov, Chair of the Panel, Benoît Pelletier and Catherine Frazee met with nine individuals and organizations to discuss the implementation and op-eration of assisted dying in Oregon. Panel members engaged in discussions with the co-author of Oregon’s Death with Dig-nity Act, as well as with experts from the medical profession and disability rights organizations. The Panel’s fact-fi nding mission concluded with an exchange of ideas with Dr. Linda Ganzini, a prominent researcher in geriatric mental health, end-of-life care, and palliative care for the terminally ill.

“We were impressed by the discussions we had with experts from a range of disci-plines,” says Dr. Harvey Max Chochinov, Chair of the External Panel on Options for a Legislative Response to Carter v Canada. “The insight they provided has given us a more thorough understanding of Oregon’s Act. These consultations are of great im-portance to the Panel’s work in develop-ing effective options for the government to consider when developing well-crafted laws for Canadians.”

The Oregon mission was a follow up to the Panel’s previous study of physician-assisted dying in three European countries – Belgium, The Netherlands, and Switzer-land. Both are part of a larger program of consultation that includes a national on-line consultation with Canadians (www.externalpanel.ca), meetings with expert groups and individuals, and in-person con-sultations set to resume immediately fol-lowing the federal election.

Canadians are encouraged to provide their insights to the Panel on how physician-assisted dying can be implemented in Can-ada at: www.externalpanel.ca/issuebook/. ■H

Federal panel studies U.S. approach to physician -assisted dying

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Use of restraints in Ontario’s long-term care homes has been cut in half

Insomnia

The Ontario Long Term Care Associa-tion welcomed the release of Health Qual-ity Ontario’s (HQO) annual report on the health system, Measuring Up, calling it an opportunity to celebrate quality im-provement efforts in Ontario’s long-term care homes and highlighting the need to provide additional support to homes to ex-pand their efforts.

Long-term care homes showed either improvement or relative stability on three key measures of care, including restraint usage, falls, and new or worsening pressure ulcers. “Homes have either held steady or improved during a time of intense change, when new residents have become increas-ingly medically complex and with a higher rate of dementia,” says Candace Chartier, RN, CEO of the Ontario Long Term Care Association. “These results demonstrate that long-term care homes are successfully creating a culture of person-centred care and quality improvement.”

Chartier noted that restraint use in particular has dropped from 16.1 to 7.4 per cent in just four years (2010/11 to 2014/15). “The decrease in restraint use benefits our residents tremendously, both in their health and quality of life.”

The Association pointed to data which demonstrates the increasing needs of seniors in long-term care homes. Seniors who come to long-term care are at a much more advanced stage of physical and cognitive decline than they were in the past. The vast majority (93 per cent) of residents have two or more chronic health conditions; 62 per cent of residents live with Alzheimer’s or another form of dementia; and 46 per cent display some level of aggressive behavior related to their dementia or mental health.

To help support the increasing needs of residents, the Association has re-newed calls to government to imple-

ment recommendations to strengthen the quality of care homes are providing to approximately 100,000 seniors every year. The Association is calling for im-mediate action to continue to improve seniors’ care in Ontario, including: • Implementing a plan to modernize ev-

ery long-term care home in Ontario that has been classified as outdated by the province – increasing the quality of care to the 35,000 seniors who live in these homes.

• Providing the necessary funding to ensure that long-term care home op-erators can hire the staff required to care for the growing needs of our ag-ing population.

• Establishing dedicated dementia and mental health support teams in every home, ensuring the safety and com-fort of the more than 65,000 seniors living in long-term care homes with Alzheimer’s and other dementias. ■H

www.hospitalnews.comHOSPITAL NEWS NOVEMBER 2015

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DECEMBER 2015 ISSUEEDITORIAL NOV 9ADVERTISING: DISPLAY NOV 20 CAREER NOV 24MONTHLY FOCUS: Year in Review/Future of Healthcare/Accreditation/Pharmacology: Overview of advancements and trends in healthcare in 2016 and a look ahead at trends and advancements in health care for 2016. An examination of how hospitals are improving the qualityof services through accreditation.

JANUARY 2016 ISSUEEDITORIAL NOV 30ADVERTISING: DISPLAY DEC 11 CAREER DEC 15MONTHLY FOCUS: Professional Development/Continuing Medical Education (CME)/ Human Resources:Continuing Medical Education (CME) 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.+ PROFESSIONAL DEVELOPMENT SUPPLEMENT

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began medical school opti-mistic about what becoming a physician meant I could do for my future patients.

Naively, I presumed my career would in-volve treating patients’ illnesses so they could return to lead full and fulfi lling lives. Yet for the one in seven Canadians living in poverty, it is often diffi cult for doctors to achieve this goal.

Take Christina, a 64-year old woman with diabetes, who came to me with new-onset numbness in her fi ngers and toes (a serious and progressive conse-quence of poorly controlled diabetes). As she struggled to leave on her walker, her prescription fell out of her purse. When I retrieved it for her, she mentioned that it hardly mattered because she would not have enough money to purchase the medication anyway.

Then there was Andrew, a 36-year old man who had been physically assaulted while panhandling. He had a prosthetic hip from a work accident that had left him with a pronounced limp, a chronic disability and no job. While I could screen Andrew for fractures and neuro-logic defi cits, I could do nothing for his unemployment or his inability to fi nd safe shelter at night.

These are but two of many encounters I have had that starkly contrast the val-ues of social medicine I have learned in medical school. What good is it to treat illness if we can only send our patients back to the conditions that helped make them sick to begin with?

Healthcare is just a small part of what determines our well-being. In fact, our health is strongly infl uenced by factors such as income, our working environ-ment and affordable housing, over which neither patients nor medical doctors have much control. This is why Canada needs better public policy that safeguards the global health of all Canadians.

As the ninth richest country in the world, we have managed to ignore the erosion of social assistance and the rise in income inequality that has taken place over the last decades. While we are one of the countries consistently spend-ing the most on healthcare, we don’t do a very good job of providing a social safety net for the growing numbers of Canadi-ans who are living paycheck to paycheck or are under or unemployed. We are also one of the few OECD countries without a national housing and homelessness strategy, which the United Nations Com-mittee on Economic, Social and Cultural Rights considers a “national emergency.”

For a nation that once prided itself on being ranked “the best country in which to live,” we have a lot to do before war-ranting the title once again.

It does not have to be this way. Pub-lic policy decisions, including those that determine the allocation of tax revenue, strongly infl uence health outcomes. These decisions need to be critically re-examined, particularly when most Cana-dians have demonstrated their support for policies that improve conditions for the most vulnerable.

In 2009, a Nanos research poll re-ported that most Canadians strongly supported the public health system and strengthening publicly funded health-care. In 2014, a poll by the Broadbent Institute found that 77 per cent of Ca-nadians recognize the widening income gap as a serious issue for the country, while 71 per cent believe this gap un-dermines Canadian values. The same poll found that most Canadians are in favor of increasing taxes to fund public programs that will reduce the impacts of income inequality.

This means that Canadians are far ahead of their governments in support-ing solutions to close the gap between the rich and poor, and, often at the same time, the healthy and unhealthy.

Canada’s current public policies could better meet both the health needs and social values of its citizens. As a soon-to-be physician I hope to practice medicine in a nation where in-come is not an obstacle to good health, and where polices and legislation are accountable to Canadians’ priority of health for all. ■H

Vivian Tam is a second year medical student at the Michael G. Degroote School of Medicine at McMaster University and Elizabeth Lee-Ford Jones is an expert advisor with EvidenceNetwork.ca, andProfessor of Paediatrics at The Hospital for Sick Children and the University of Toronto.

By Vivian Tam with Elizabeth Lee-Ford Jones

I

Sometimes doctors can’t fi x what makes their patients sick in the fi rst place

What I didn’t learn in medical school

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5 TECHNOLOGY IN HEALTHCARE/PATIENT EXPERIENCE/HOSPITAL PERFORMANCE INDICATORS Focus

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Currently used by technology giants such as Microsoft, Google and high secu-rity military installations, the data centre ‘future proofs’ Mackenzie Health to be able to adopt a wide range of new and emerging technologies. It will also support the work of Mackenzie Health’s Innova-tion Unit and as well as enable the orga-nization’s medical electronic record adop-tion to go from EMRAM 3 to EMRAM 7 in just two years.

The new data centre also helps Mack-enzie Health to set the stage for future innovation that will see the Mackenzie Richmond Hill and Mackenzie Vaughan Hospitals become a truly ‘smart hospi-tal’. This means having digital technolo-gies that have interconnectivity between systems so that they share information to better support clinicians to care for their patients.

“A key aspect of our ICAT Healthcare strategy is to introduce the majority of new technologies at Mackenzie Richmond Hill Hospital well in advance of the opening of the new Mackenzie Vaughan Hospi-tal,” says Mackenzie Health President and CEO Altaf Stationwala.

“By incorporating these technologies into their practices today, they will be well versed in the latest technologies when the future Mackenzie Vaughan Hospi-tal opens. This approach will also enable both hospitals to share some of the most advanced technologies to enhance patient care delivery and safety creating a truly ‘smart hospital’,” adds Stationwala.

Preparing for tomorrow, today

In 2019, Mackenzie Health will com-plete construction of the new Mackenzie Vaughan Hospital and will continue to operate Mackenzie Richmond Hill Hos-pital. In preparation for this signifi cant addition, in 2014, Mackenzie Health launched its Innovation Unit project and has been working with a variety of part-ners to refi ne and advance the project, which is a living laboratory for health care technologies. A fi rst in Canada, Macken-zie Health’s is Innovation Unit is an acute care medical unit where health care in-novations are developed, evaluated and adopted, with the goal to have other patient care units at Mackenzie Rich-mond Hill Hospital, as well as the new Mackenzie Vaughan Hospital adopt those most successful.

The introduction of Mackenzie Health’s ICAT Healthcare strategy, supported by its fi rst-in-Canada, state-of-the-art data cen-tre, will provide technology solutions that enhance patient care through world-class technological solutions. Supported with accurate and consistent patient informa-tion across a multitude of devices, ICAT Healthcare will help Mackenzie Health incorporate easy to use systems ultimately enhancing patient care delivery and safety.

Mobile Way fi nding App and much more

ICAT Healthcare also enables Mack-enzie Health to support a variety of ex-citing new technologies such as a new fi rst-in-Canada GPS Mobile Way fi nd-ing App and electronic kiosk system and a Bring Your Own Device program to enable staff and physicians to receive

secure Mackenzie Health email on their personal smart phones, tablets and com-puters. These new technologies are being developed now, to prepare for the future of healthcare at Mackenzie Health.

Going forward, the ICAT Healthcare strategy will enable our staff and physi-cians to enjoy:• more time at the bedside to care for their

patients;• better communication and tools at their

fi ngertips;• faster response times; and• reduced human error incidence, through

the use of technology. ICAT Healthcare will also help to cre-

ate an exceptional care experience for pa-tients by:• integrating care delivery customized to

individual patient needs;• enhancing bed-side care as clinicians

can better interact with patients with the technology; and

• enhancing communications for patients with special needs such as built-in lan-guage translation services and touch screen technology for patients with lim-ited mobility.The impact on the delivery of care at

Mackenzie Health will be pervasive. It may also help to establish new standards across the health care industry including:• immediate access to clinical data any-

time, anyplace across the organization; and

• the development of clinical decision support tools to further improve safety and quality of care, shorten length of stay, and reduce readmission to hospital. ■H

Stefanie Kreibe is a Communications and Public Affairs Consultant at Mackenzie Health.

Celebrating the launch of Mackenzie Health’s ICAT Healthcare.

Continued from page 2

Health care technology

Hospital professionals give their best every day. They deserve the best representation. OPSEU.

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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

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he benefi ts associated with the use of digital health, such as improved patient outcomes, effi ciencies and improved ac-

cess to care, are becoming a core part of day-to-day hospital care. Now is the time to focus on extending these effi ciencies and benefi ts to patients, which is one of the biggest developments in the digital health revolution. According to Michael Green, President and CEO of Canada Health Infoway, providing Canadians with their health information and digital tools to help them be informed, engaged mem-bers of their own care team is transforming healthcare.

“Information is critical to quality care, whether patients are in hospital or manag-ing their conditions themselves at home,” says Green. “The vast majority of Cana-dians want secure access to online patient services, and never before has Canada been better positioned to do that.”

Access to an online patient portal helped cancer survivor Judith Morley and her family manage her care and treatment, and she thinks every Canadian should have access to digital health.

“Digital health greatly improves the pa-tient experience,” says Morley. “Whether you’re waiting to learn how your cancer treatment is progressing or you’re book-

ing your child’s medical appointment, who wouldn’t rather have the ability to do those things online, quickly and securely?”

Judith is in good company. Patient por-tals are already providing Canadians with access to their health information such as initiatives at Toronto’s Holland Bloorview and Sunnybrook Health Sciences Centre, the Children’s Hospital of Eastern On-tario in Ottawa, and Nova Scotia’s patient portal project.

Green points to e-booking and view-ing lab test results as examples of areas in which there should be immediate expand-ed access. The vast majority of Canadians want to be able to do these things. Be-tween six and 10 per cent of Canadians are able to.

“Leveraging these untapped opportu-nities to support patient-centered care through consumer access to digital health tools and capabilities is the current fo-cus in Canada’s digital health journey,” adds Green.

He also points out that Canada, in par-ticular, is a country where the expansion of consumer-oriented digital health makes a great deal of sense.

“We are among the highest users of the internet in the world,” says Green. “Cana-dians go online to shop, to read or watch the news, to bank, and to communicate with friends. And research is showing that they know digital health makes health care easier and more convenient, and they want access for themselves.”

The economic case for digital health is also clear, particularly when one considers the value that electronic healthcare has already brought about. Since 2007, digi-tal solutions such as telehealth, drug and diagnostic imaging systems and physician electronic medical records have resulted in an estimated $13 billion in access, quality and productivity benefi ts for Canadians.

The Medical Post recently convened an expert panel to discuss the state of elec-tronic technology in healthcare. The com-parison was made between health care to-day and the banking industry 15 years ago. Back then, many banking executives were concentrating their efforts on providing services through ATMs, assuming that this was what customers really wanted. It turned out, of course, that what customers also wanted was the freedom and fl exibil-ity to take control of all their own bank-ing themselves, online. That consumer desire for control and involvement is ex-

actly what Michael Green says health care planners should be thinking about.

“Together with our partners, Infoway has spent the last 14 years working to im-prove the health of Canadians by accel-erating the development, adoption and effective use of digital health solutions,” he says. “As a country, we have made ex-traordinary progress and we fi nd ourselves in the enviable position of being able to enhance the patient experience by improv-ing outcomes and reducing the amount of time required to renew prescriptions, book appointments or manage illnesses.”

Access to the portal provided Judith and her family with online access to her medical information. Despite the stress and confusion of the multiple tests, ap-pointments and treatments that her can-cer required, they were able to use the portal to review her information and prog-ress securely from home. It also helped keep them in contact with members of her care team who provided clarifi cation or answered questions as needed.

“In hindsight, digital health gave my family hope at a time when I was overcome with anger and grief, and was unable to grasp what was happening to me, let alone focus on the value of digital health,” says Morley. “Today, I am cancer-free. While I haven’t looked back since conquering my battle with cancer, I am grateful that the experience led me to digital health.” ■H

Dan Strasbourg is Director, Media Relations Canada Health Infoway.

RelayHealth will accelerate Ontario’s Health Links strategyIdeally suited for the successful operation of Health Links, RelayHealth offers secure collaboration among patients and all their healthcare providers, including physicians, laboratories and hospitals, wherever they are located.

Enabling Patient AccessThe implementation of RelayHealth in your institution may lead to reductions in:

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Empower Patients. Empower Health Care Teams. Patients are demanding more involvement in their own health care. Doctors, pharmacists and other health care providers are challenged to work collaboratively to deliver quality services to their patients.

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10

elicobacter pylori is a trouble-making bacterium that infects the stomach and can cause indigestion, stomach ulcers

and, in rare cases, stomach cancer. H. py-lori can be treated with antibiotics, but an accurate diagnosis of infection is impor-tant before starting treatment. Once the course of antibiotics is complete, a follow-up test is needed to make sure the H. py-lori are history.

There are several different tests for H. pylori, and choosing the most appropri-ate test depends on the patient’s age and symptoms. For example, patients with symptoms of cancer will need an endos-copy – a camera in a tube inserted through their throat into the stomach – but other patients could be tested with less invasive methods. These methods include blood tests, urea breath tests, or stool tests. The stool tests are called stool antigen tests be-cause they look for H. pylori antigens (bits of the H. pylori bacteria that stimulate our immune system).

Many experts consider urea breath test-ing to be the best non-invasive test for H. pylori, but it requires special equipment and is not readily accessible in rural and remote locations. In some areas of Canada, doctors and other health care providers use stool testing as the fi rst option, saving patients the time and money it takes to travel outside their communities. Howev-er, this practice is not consistent across the country – many patients are still referred to larger city clinics or hospitals for urea breath testing.

To clear up some of the uncertainty about which test to choose, CADTH re-viewed the evidence on H. pylori stool an-tigen tests to fi nd out how accurate they are compared to other tests. CADTH is an

independent agency that fi nds and sum-marizes the research on drugs, medical de-vices, and procedures.

CADTH reviewFor this project, CADTH found more

than 200 publications in a literature search for publications between January 2009 and December 2014. Researchers narrowed down the list to 24 reports that were the most relevant. Of these, one report was a clinical practice guideline document, two were economic reports, and 21 were diag-nostic studies – 15 of which were for initial testing for suspected H. pylori infection and six of which were for follow-up testing after treatment.

Taking a look at all this research, CADTH found that many (but not all) of the stool antigen tests had good diagnostic sensitivity and specifi city. In other words, many of the stool tests were good at cor-rectly identifying people who had H. pylori (good sensitivity) and good at identifying those people who did not have H. pylori (good specifi city).

Which type of stool antigen test is best?

There are several commercially avail-able stool antigen tests for H. pylori that use either monoclonal or polyclonal anti-bodies. Monoclonal antibodies are more specifi c to H. pylori but more expensive to produce, while polyclonal antibodies are less specifi c but less expensive. With both types of tests, the antibody recognizes the H. pylori antigen, and this reaction causes the positive sample to turn a different co-lour. Some of the tests can be performed in the doctor’s offi ce, with results available in a few minutes, but others need to be sent out to a lab.

The CADTH review showed that, generally, the monoclonal antibody tests performed better – the results from these tests were close to or just as accurate as the results from urea breath testing or en-doscopy. Some of the polyclonal tests also performed well, but some showed lower sensitivity.

In particular, the stool tests that worked the best for initial diagnosis were:

• Testmate pylori antigen [TPAg EIA] (a lab-based test using monoclonal anti-bodies)

• Premier Platinum HpSA Plus (a lab-based test using monoclonal antibodies)

• Amplifi ed IDEIA Hp StAR (a lab-based test using monoclonal antibodies)

• EZ-STEP H. pylori (a lab-based test us-ing polyclonal antibodies)

• Atlas H. pylori antigen (an in-offi ce test using monoclonal antibodies)

The stool tests that performed the best for follow-up were: • Testmate rapid pylori antigen [Rapid

TPAg] (an offi ce-based test using mono-clonal antibodies)

• Testmate pylori antigen EIA [TPAg EIA](a lab-based test using monoclonal antibodies)

• Amplifi ed IDEIA Hp StAR (a lab-based test using monoclonal antibodies)

• HpSA ELISA II (a lab-based test using monoclonal antibodies)

• RAPID Hp StAR (an in-offi ce test using monoclonal antibodies)

• ImmunoCard STAT! HpSA (an in-offi ce test using monoclonal antibodies)The clinical guideline document in-

cluded in the CADTH review aligned well with these fi ndings because it recom-mends choosing a stool antigen test that is laboratory-based, validated, and with monoclonal antibodies. This test could be used reliably for the initial diagnosis and for the follow-up testing after antibiotic treatment.

The two economic reports included in the review examined only specifi c situa-tions, but they did fi nd the stool antigen tests to be cost-effective in these situa-tions, meaning they provided good value for money.

Who can benefi tThese results are encouraging for rural

and remote patients and their health care providers. There are also implications for developing countries and health care cen-tres – in Canada or abroad – that want to provide less invasive testing options that could potentially offer cost-savings.

To learn more about CADTH, visit www.cadth.ca, follow us on Twitter: @CADTH_ACMTS, or talk to our Liaison Offi cer in your region: www.cadth.ca/con-tact-us/liaison-offi cers. ■H

Kasia Kaluzny, MSc, is a Knowledge Mobilization Offi cer, CADTH.

Evidence Matters

Testing for Helicobacter pylori: Can stool provide the answer?By Kasia Kaluzny

HThere are several different tests for H. pylori, and choosing the most appropriate test depends on the patient’s age and symptoms.



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MEDEC – Focus on MEDEC members making a difference in Canadian Healthcare



ncorporating the insights, ideas and feedback of patients and their family members in the design and delivery of

health services has been crucial to provid-ing patient-centred care in many hospitals for the last several years.

In home care, the notion of clients (pa-tients) and their families as “co-designers” of quality improvement initiatives and di-rect care services is relatively new, and one that VHA Home HealthCare (VHA)–an Ontario-based, not-for-profi t, charitable organization in its 90th year – is deter-mined to apply.

In 2013, VHA began paving the way to incorporate the Client and Family Voice into everything it does. The community model VHA developed is largely based on Britain’s National Health Service’s (NHS) transformative “nothing about me without me” philosophy and research, which em-power patients and their families to help direct their own care needs. “This model is so exciting,” notes VHA Vice President of Client Services and Chair of the Client and Family Voice Steering Committee, Barbara Cawley, “because it takes client-centred care a step further so clients and their family members are true partners in designing and developing VHA services and how we deliver them.”

Before creating its own community care-based model, VHA met with hospi-tals identifi ed as being ahead of the curve in this area, including Holland Bloorview Kids Rehabilitation Hospital and North York General Hospital. “They really helped to steer us in the right direction,” Cawley says. “Based on their advice we determined how to approach the implementation of the Client and Family Voice strategically. They also provided ideas about the nuts and bolts of recruitment – for identifying both Client and Family Voice partners and projects that would greatly benefi t from client and/or family input.”

She adds that while insights were ex-tremely helpful, there were some unique challenges VHA had to work out for itself. “We don’t have a ‘building’ in the same way

that a hospital does. Our workers and our clients and families are in their home so we knew we’d have a greater challenge with recruiting them for projects. We can’t just walk down to their room to see if they’d be interested in joining,” Cawley says. “Get-ting the word out amongst our more than 2,000 staff and service providers – so that they understand what we’re doing and how they can support us – was also something we had to consider carefully.”

Though it is still relatively early days for the initiative, there have already been sev-eral successes that signal VHA is headed in a positive, more inclusive direction. One of the most exciting is the creation of a Client and Carer Advisory Council. Two-thirds of the members are VHA clients or caregivers who are receiving or have received ser-

vices from VHA. The council’s vision is to “act as the voice of the client in planning, developing or evaluating services.” Since its inception in 2014, the team has been involved in: reviewing and making recom-mendations on VHA’s quality improve-ment initiatives; advising staff on educa-tion to improve the client experience; and sharing personal stories and home care experiences with our board and leader-ship team, amongst many other activities. Outside of the council, client and family partners at VHA have also been involved in various capacities, including:• Discussing their experiences as a cli-

ent or caregiver during staff education sessions;

• Providing feedback to Human Resources on hiring;

• Offering insights and ideas on the de-sign and content of a client and family newsletter;

• Sharing their experiences with the rehab equipment/Assistive Devices Program (ADP) processes;

• Nominating staff and service providers for VHA’s newly minted Client Choice Awards.The application of client and family

partnering to home care is starting to see a lot of interest from other community care agencies, especially after VHA’s presenta-tions on the topic at the Canadian Home Care Conference in Banff and Accredita-tion Canada’s conference in Vancouver, both held last year. “People were defi nitely keen to learn more about our experience,” notes Cawley, “especially since client and family involvement will be part of the next wave of accreditation criteria for home care organizations.”

VHA has also begun to pay the knowl-edge forward by advising other home care organizations on starting their own Client and Family Voice initiatives. Recruitment of clients and family members is also climb-ing as VHA’s “roadshow” rolls out and an organizational culture shift takes hold. “Our progress wouldn’t have been possible without all the support we received from North York General Hospital and Holland Bloorview Kids Rehabilitation Hospital,” says Cawley. “Though it’s nice to be per-ceived as innovators, it’s an innovation we need to actively share and support. The more we promote this, the more positive impact it will have on all home care clients – and that’s what’s most important.” ■H

Pamela Stoikopoulos is Communications Manager at VHA Home HealthCare.

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Co-designing home careBy Pamela Stoikopoulos

I

The community model VHA developed is largely based on Britain’s National Health Service’s (NHS) transformative “nothing about me without me” philosophy and research, which empower patients and their families to help direct their own care needs.

Client and Family Voice helps VHA better refl ect the needs of its home care clients and the loved ones who support them.

with clients and their families

See our Special Supplement on page M1

MEDEC – Focus on MEDEC members making a difference in Canadian Healthcare



Our healthcare system is under pressure.

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program at Rouge Valley Health System (RVHS) is helping to keep patients with chronic obstructive pulmonary

disease (COPD) out of hospital.RVHS offers an education and self-

management clinic on COPD for outpa-tients as part of its Living Well chronic dis-ease education program that also includes clinics for asthma, osteoporosis, arthritis, chronic pain, hypertension, and smoking cessation. The COPD clinic was started in March 2013, based on a module from the Ontario Lung Association and input from the RVHS respirology team.

COPD is a chronic disease that lim-its airfl ow to and from the lungs, causing shortness of breath and other breath-ing problems. The Canadian Institute of Health Information (CIHI) states that COPD now accounts for the highest rate of hospital admission among major chronic illnesses in Canada. Further, hospital read-missions are higher among COPD patients than any other chronic illness. Rouge Val-ley’s COPD clinic, which teaches patients self-management of their condition, is helping to bring these rates down.

“The goal of this clinic is for patients to

move towards a comprehensive and proac-tive approach to chronic disease preven-tion and management. Patients can learn techniques that allow them a much bet-ter quality of life while living with their condition. With triggers under control, emergency visits and the subsequent read-missions can decrease,” says Amber Curry, manager, inpatient surgery, ambulatory care unit, pre-admit and fracture clinic, RVHS.

Most of the participants who come to the education clinic are on a cycle of emer-gency department visits and/or being re-admitted to hospital. Staff and physicians refer these patients to Susan Bradbury, a registered practical nurse who runs the Living Well program. She visits patients while in hospital to inform them about the COPD clinic and the benefi ts of learning to manage the condition successfully. The majority of these patients attend, some-times with family members who wish to learn how to help their loved ones.

The clinic has proven to be life-chang-ing, helping patients to break the cycle of continual hospital visits. Since September 2014, only one out of 82 patients was re-admitted to hospital for a COPD exacer-

bation within 30 days after completing the COPD program, and only six were read-mitted within 90 days.

Janet Gayle is one of those COPD clin-ic graduates who has learned how to get her breathing under control and has not needed to go back to the hospital. “Before I went to the clinic, I was having trouble breathing when I was doing anything. Ev-ery time I got a cold, it would go straight to my lungs, and I’d be hospitalized,” says Gayle.

An asthma sufferer for over 30 years, she was diagnosed with COPD in Novem-ber of 2012. She lived a restricted life, not able to do housework or climb the stairs without gasping for breath. Sometimes fra-grances and perfumes that her co-workers wore would prompt an attack, or she could not go to her son’s hockey games because the cold air in the arena would make it dif-fi cult to breathe. Even enjoying herself out with friends was hard, as laughing would bring on a coughing fi t.

By participating in the clinic, Gayle learned the best way to get oxygen into her compromised lungs. She also learned how to manage environmental triggers and her medications. And, in the two years since she fi nished clinic, she has not needed to go to the emergency department.

Rouge Valley respirologist Dr. George Philteos, who is involved in the COPD program, says: “I have been very pleased with the feedback I have received from pa-tients. They have a better understanding of their disease and have learned valuable coping strategies that impact their quality of life.”

Gayle agrees. “You can live with your COPD, and you can have a fulfi lling life, but have to know how. Now I know how. I credit the COPD clinic,” says Gayle.

For more information, call Rouge Val-ley’s Living Well program at 905-683-2320 ext. 1182 or go to www.rougevalley.ca/liv-ingwell. ■H

Jane Kitchen is Communications Specialist at Rouge Valley Health System.

heila Lucas had her fi rst open heart surgery to repair a faulty mitral valve at age 21. Twenty years later, she underwent a

second surgery, and now, at 64, is likely facing another heart operation.

To ensure she’s in the best shape pos-sible, Sheila was referred to the Cardiac Rehabilitation and Secondary Prevention (CRSP) Program at St. Joseph’s Hospital in London. There, she would fi nd care and support that extended beyond the program and address health care needs she didn’t know she had.

Designed for individuals with known heart disease, the six-month CRSP pro-gram is a safe and effective way to over-come some of the physical and psychologi-cal complications of heart disease, limit the risk of developing more heart trouble, and assist in the return to an active social or work life after a heart event.

For Sheila the program was an opportu-nity to improve her fi tness level and reduce the strain on her heart. Tragically, her hus-band recently died suddenly, three months after being diagnosed with cancer. She was beginning the program in a vulnerable state, physically and emotionally.

“I was way overweight and my heart was bad. I couldn’t breathe. I couldn’t walk. My ankles were swollen. I couldn’t bend over to do my shoes up. I couldn’t go from the parking lot into the grocery store without feeling like I was dying. I couldn’t do any-thing,” says Shiela.

During the initial comprehensive assess-ment at the CRSP program, the news got worse. Sheila also had type 2 diabetes.

“It was a shock. I was overwhelmed as it was – this was another blow.”

But working with the interdisciplinary cardiac rehab team, which includes phy-sicians, kinesiolgists, psychologists, dieti-tians, nurses, and others, Sheila slowly be-gan making progress. For the diabetes, she was enrolled in a class at the Diabetes Edu-cation Centre, also at St. Joseph’s Hospital.

Sheila’s care experience is part of a focus on integrated chronic disease management at St. Joseph’s Hospital, which is chang-ing the ways programs think and patients are seen.

For the most part, hospital programs have care delivery models divided by dis-ease-specifi c silos, explains Mary Mueller, Director, Medicine Services at St. Joseph’s.

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Breaking down the silos

By Dahlia Reich

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Changing the way programs think and patients are seen is improving the patient experience at St. Joseph’s Hospital in London.

Continued on page 15

Living Well education program helps keep COPD patients out of hospital By Jane Kitchen

A

Susan Bradbury, RPN, (left) measures patient Janet Gayle’s lung function using a spirometer. Gayle was a participant in the COPD clinic, part of the Living Well program offered at Rouge Valley Health System.



For example, at St. Joseph’s Hospital there is the Centre for Diabetes, Endocrinology and Metabolism and CRSP. Traditionally, there has been little or no integration or coordination of care between these two programs even though their patients share common risk factors.

To break down the silos, a plan has been developed at St. Joseph’s to bring programs together in the care of patients with chronic diseases. First up was creat-ing new care pathways for diabetes care and cardiac rehabilitation. Looking at identifi ed risk factors seen in patients in both programs, a coordinated, collabora-tive care model was developed to optimize the care and service for these patients.

It begins with a comprehensive medi-cal assessment for all patients entering CRSP. This starts the ball rolling to sys-tematically detect and address all vas-cular health risk factors and behaviours. For patients presenting in CRSP with diabetes or pre-diabetes it means they are now referred to the appropriate diabetes services specifi c to their needs – Diabetes Education Centre, Diabetes, Endocrinol-ogy and Metabolism Clinics, or Primary

Care Diabetes Support Program – all part of St. Joseph’s. Since March 30, 2015, 53 cardiac rehab patients have been referred to diabetes services. More importantly, 74 per cent did not know they had diabetes and are now being offered care for that condition.

As well, new diabetes patients at St. Joseph’s now receive exercise education within the Diabetes Education Cen-tre and routine screening for referral to cardiac rehab’s exercise programming. If eligible, they are offered enrollment into a six-month program. Exercise is a key component in care for type 2 diabetes patients yet many don’t get enough physi-cal activity. Since July 2015, 23 out of 33 diabetes patients were found to be eligible for the exercise program and 70 per cent accepted enrollment.

“Bringing programs together in this way is very exciting work that we are slowly expanding across St. Joseph’s Hos-pital,” says Karen Perkin, Vice President, Patient Care, and Chief Nurse Executive. “Essentially, we are combining our ser-vices in the best way possible around the needs of the patient.”

For Sheila, the focus on integrated care has been life changing. Her weight is on the downswing, her stamina, heart health and emotional wellbeing are on the up-swing, and her understanding of what she needs to do to regain her health is empow-ering.

“I don’t know what I would have done

without St. Joseph’s, ” says Sheila. “I was such a mess physically and emotionally. St. Joseph’s has been a true blessing. Everyone has been so encouraging. They keep me motivated.” ■HDahlia Reich works in Communications & Public Affairs at St. Joseph’s Health Care, London.

Designed for individuals with known heart disease, the six-month CRSP program is a safe and effective way to overcome some of the physical and psychological complications of heart disease, limit the risk of developing more heart trouble, and assist in the return to an active social or work life after a heart event.

Sheila Lucas works on improving her heart health with registered kinesiologist Shannon DeLuca at the Cardiac Rehabilitation and Secondary Prevention Program at St. Joseph’s Hospital in London.

Continued from page 14Breaking down the silos

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new approach to providing critical care in Canada, pio-neered in Northeastern Ontar-io has won a provincial award

for health care innovation.The Virtual Critical Care (VCC) Unit is

this year’s recipient of the Minister’s Med-al Honouring Excellence in Health Qual-ity and Safety, presented by Health Quality Ontario.

Launched in May of 2014, VCC is the fi rst critical care model of its kind in Can-ada.

Based at Health Sciences North/Hori-zon Santé-Nord (HSN) in Greater Sud-bury, Virtual Critical Care received start-up funding through the North East Local Health Integration Network (NE LHIN) and uses a special software program creat-ed by the Ontario Telemedicine Network (OTN).

Virtual Critical Care uses the latest in videoconferencing technology and electronic medical records sharing to connect HSN with smaller Critical Care units and Emergency Departments at 22 other hospitals across Northeastern On-tario.

Under the VCC model, a team of Intensive Care Unit (ICU) physicians, specially trained nurses and ICU respira-tory therapists based at HSN are avail-able for around-the-clock consultations for critically ill patients at participating hospitals. Other allied health profession-als such as dietitians and pharmacists are also available for consultation during scheduled hours.

The goal of VCC is to enhance the di-agnosis and treatment of critically ill pa-tients across Northeastern Ontario, and potentially avoid the transfer of patients

out of their local hospitals, away from their families and support systems.

Since being launched in May of 2014, VCC has been used for 227 patients, with an additional 355 follow-up visits, for a total of more than 19,362 VCC care min-utes. Thanks to VCC, 80 patients avoided a medical transfer by air ambulance, at approximate savings of $1,360,000 to the health care system.

“The Virtual Critical Care Unit has been a major advance in the care of critically ill patients in our region and represents the future of acute care medicine. The ability to instantly bring the HSN Critical Care team to the bedside of patients across the region has been remarkable,” says Dr. Der-ek Manchuk, Medical Lead for the VCC and Critical Care Lead for the NE LHIN. “Our partner hospitals, the NE LHIN, On-tario Telemedicine Network, Criticall, and the Ministry of Health have all come to-gether with us to make this new program a reality. I’m very proud of this ‘made in Northern Ontario’ program that was the fi rst of its kind in Canada.”

“Patients are entitled to receive care based on the best scientifi c evidence and should receive the same quality of care re-gardless of geographic location.Telemedi-cine can remove the barrier of distance and ensure critically ill patients receive the right care, at the right time, in the right place, by the right provider. It is very hum-bling to work with such a large group of special people so fully invested in the suc-cess of the NELHIN Virtual Critical Care program. Kudos for a job very well done,” adds Renee Fillier, Virtual Critical Care Nurse Clinician at HSN. ■H

Dan Lessard is a Media and Public Relations Offi cer, Health Sciences North.

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Virtual critical care modelwins provincial health awardBy Dan Lessard

A

Dr. Derek Manchuk, Medical Lead for VCC Unit at Health Sciences North (HSN) in Sudbury and Medical Lead for Critical Care, North East Local Health Integration Network (NE LHIN) confers on Virtual Critical Care consult with Diane Whalen, Registered Nurse, Virtual Critical Care team at HSN.

• Blind River (Blind River District Health Centre)

• Chapleau (Services de Santé de Chapleau Health Services-Chapleau General Hospital)

• Cochrane (MICS Group of Health Services - Lady Minto Hospital)

• Elliot Lake (St. Joseph’s General Hospital)

• Englehart (Englehart and District Hospital Inc.)

• Espanola (Espanola Regional Hospital and Health Centre)

• Hearst (Hôpital Notre-Dame Hospital)

• Hornepayne (Hornepayne Community Hospital)

• Iroquois Falls (MICS Group of Health Services - Anson General Hospital)

• Kapuskasing (Sensenbrenner Hospital)

• Kirkland Lake (Kirkland and District Hospital)

• Little Current (Manitoulin Health Centre)

• Matheson (MICS Group of Health Services - Bingham Memorial Hospital)

• Mattawa (Hôpital de Mattawa General Hospital)

• Mindemoya (Manitoulin Health Centre)

• New Liskeard (Temiskaming Hospital)

• North Bay (North Bay Regional Health Centre)

• Parry Sound (West Parry Sound Health Centre)

• Smooth Rock Falls (Hôpital de Smooth Rock Falls Hospital)

• Sturgeon Falls (West Nipissing General Hospital)

• Sudbury (Health Sciences North)• Timmins (Timmins and District

Hospital)• Wawa (Lady Dunn Health Centre

Hospitals in Northeastern Ontario that are part of the Virtual Critical Care Unit:

“Patients are entitled to receive care based on the best scientifi c evidence and should receive the same quality of care regardless of geographic location. Telemedicine can remove the barrier of distance and ensure critically ill patients receive the right care, at the right time, in the right place.”


17 Ethics

embers of the public would be pleased to know that our hos-pitals expend signifi cant re-sources (fi nancial and human)

on quality improvement. Reports like the Institute of Medicine’s ground-breaking 1999 report, To Err is Human, have made those who work in healthcare painfully aware of just how much work is needed to improve the quality of the care provided. Many hospitals have quality improvement departments, or at least people on staff who are trained in quality improvement methodologies.

More recently there has been a move-ment towards creating cultures of quality improvement in organizations, to encour-age and empower employees and physicians to lead quality improvement efforts right at the point of clinical care. This is obviously a good thing.

A natural question that follows is, “How do we know if we are successful at actually improving quality?” The obvious answer is to fi nd ways of measuring it. Thus we have quality and performance indicators: wait times data, infection rates, falls rates, criti-cal incident data, and an endless list of acro-nyms like ALC, HSMR, EDLOS, and so on.

Senior leaders and Board governors de-vote countless hours to monitoring and discussing their hospital’s performance on each of the indicators, typically via a bal-anced scorecard: a document that contains a dizzying array of numbers and trend in-dicators, such as arrows pointing in differ-ent directions and colour codes (green is good, red is not good). Hospitals are now held both publicly and fi scally accountable for their performance – certain indicators are publicly reportable, and hospitals (as well as individual senior executives) can be penalized fi nancially for not meeting certain targets.

In theory, all of this is a good thing. But there is a drawback to the emphasis on data and indicators in the health care world: it de-humanizes what is at its heart a very human endeavour – the provision of care to people in need. Even the part of qual-ity that is more inherently human – the patient experience – gets reduced to indi-cators on a balanced scorecard, by track-ing data related to complaints or concerns, for example.

The problem is the more time we spend focused on data and indicators the more disconnected we become from the people represented by those indicators. Patients lose their individuality, their human-ness, and instead become faceless numbers in a spreadsheet and balanced scorecard. The tangible risk here is that we are psychologi-cally less motivated by data than we are by individual stories. As Mother Theresa once said, “If I look at the mass I will never act. If I look at the one, I will.”

Many leaders in healthcare have begun to recognize this and have introduced various strategies to re-humanize health care qual-ity. For example, I have heard of hospitals that begin Board meetings with the sharing of a patient story to set the tone from the beginning that the hospital’s work is about the people it serves. There is also a new movement in hospitals to create Patient and Family Advisory Councils (PFACs) to

integrate the patient perspective into hos-pital planning and decision making, and there is great potential for these councils to further re-humanize healthcare. If uti-lized properly these PFACs can help us see everything we do through the eyes of our patients, from building and renovating our facilities to developing policies. I recently read that Thunder Bay Regional Health Sciences Centre has even taken the step

of inviting one of their PFAC members to join their Quality of Care Committee. What better way to re-humanize the hos-pital quality agenda than to have an actual patient or patient’s family member sitting at the Quality table? ■H

Jonathan Breslin, PhD is an Ethicist at Southlake Regional Health Centre and Mackenzie Health.

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(Re-)humanizing the data-driven world of healthcareBy Jonathan Breslin

M

The more time we spend focused on data and indicators the more disconnected we become from the people represented by those indicators.


18 Data Pulse

ow many Canadians had a good experience from the care they were provided? How of-ten did doctors and nurses lis-

ten carefully to the patient? Are patients providing input into their care pathway? Did the treatment improve the patient’s health and achieve its desired outcome?

These are important questions to ask because understanding the patient’s view on health service delivery and their per-spective on their health status is an es-sential component of patient-centred care and quality improvement. While patient reported experience measures (PREMs) capture the patient’s view on health ser-vice delivery (e.g., communication with nurses and doctors, staff responsiveness, discharge and care coordination), patient reported outcome measures (PROMs) provide the patient’s perspective on their health status (e.g., symptoms, functioning, mental health). PREMs and PROMs are complementary and are meant to be used together to capture a more complete pic-ture of the patient journey.

There has been an increased recogni-tion of the importance of the patient’s per-spective in supporting a patient-centered approach to providing quality healthcare. In Canada, the availability of standardized patient-reported information has been lim-

ited. Health service providers, administra-tors and policy-makers have indicated a desire and need for comparable patient-re-ported measures to better understand and improve quality of care as well as service delivery and outcomes.

In response to this need, the Canadian Institute for Health Information (CIHI) has led the development of a pan-Canadi-an approach for the collection of PREMs for inpatient care and is working closely with jurisdictions across Canada to un-derstand the need to measure patient experience across other sectors. CIHI is also working with several collaborators to lead and facilitate a common approach for PROMs collection and reporting across Canada.

Developing the Canadian Patient Experiences Survey Inpatient Care (CPES-IC) and Canadian Patient Experiences Reporting System (CPERS)

In 2011, CIHI was approached by sever-al jurisdictions to lead the development of a standardized PREMs survey for inpatient care as there was no other pan-Canadian survey tool to capture patient experience information.

CIHI, in conjunction with the Inter-Ju-risdictional Patient Satisfaction Group and survey research experts, applied rigorous survey and testing methodology to develop the CPES-IC. National organizations such as Accreditation Canada, the Canadian Patient Safety Institute and the Change Foundation also provided input into the development process.

The Canadian Patient Experiences Sur-vey – Inpatient Care (CPES-IC) includes questions from the American Hospital Consumer Assessment of Healthcare Pro-viders and Systems (HCAHPS) survey. HCAHPS was chosen as the base survey as it is a rigorous tool widely used in the United States for over 10 years, already ad-opted in a few Canadian jurisdictions and will allow for international comparisons.

The CPES-IC is administered post-dis-charge and touches on a number of patient experience themes, some of which include:• admission and discharge processes;• communication with nurses and doctors;• responsiveness of staff; and• coordination of care.

CIHI built a survey collection database in spring 2014 to house patient experience survey data and as of spring 2015, the sys-tem is available to receive CPES-IC data

from participating jurisdictions. Together the CPES-IC and CPERS standardizes the collection of patient experience in-formation, ensures the comparability of data from participating organizations and ensures the minimum necessary data ele-ments required for comparative reporting and analysis.

Next Steps for PREMs at CIHI

Implementation of the CPES-IC has al-ready begun in Alberta and Manitoba and CIHI is providing support to additional jurisdictions interested in adopting the CPES-IC. In the near future, CIHI will be providing measures/results back to partici-pating jurisdictions. These reports along with nationally comparative PREMs infor-mation will further enrich existing health data to support improvements at the facil-ity and system level.

CIHI is working closely with jurisdic-tions across Canada to understand the need to measure patient experience across other sectors.

For a copy of the public domain sur-vey and for more information on the CPES-IC and CPERS, please visit www.cihi.ca/prems.

PROMsIn the past year, CIHI has also devel-

oped a new program of work focused on PROMs. Similar to PREMs, stakeholders have indicated a desire for CIHI to provide leadership and guide the development of a common approach to PROMs across Canada.

Following an environmental scan of the Canadian and international PROMs landscape in 2014 which revealed varia-tions in existing local and regional PROMs programs, CIHI hosted a pan-Canadian PROMs forum in February 2015 to discuss opportunities to develop a common ap-proach to PROMs in Canada, including common tools and coordinated adminis-tration and reporting.

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Putting the focus on patientsBy Kira Leeb and Greg Webster

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CIHI’s pan-Canadian approach to capturing the patient perspective: PREMs and PROMs


About CIHICIHI is an independent, not-for-profi t organization that provides essential information on Canada’s health system and the health of Canadians. CIHI is viewed as a leader in developing standards for data collection and reporting, and provides comparative reports and information to jurisdictions and federal organizations, such as Health Canada, to support policy and health system decision-making. With 30 data holdings, CIHI collects a wealth of clinical and administrative data from various clinical areas and sectors of care.

MEDTECH Focus on MEDEC members making a difference in Canadian Healthcare

HOSPITAL NEWS SPECIAL SUPPLEMENT

Canada’s Medical Technology Companies

HOSPITAL NEWS FEBRUARY 2015 www.hospitalnews.com

M2 MEDEC 2015 — Focus on MEDEC Members Making a Difference in Canadian Healthcare

n behalf of our association, welcome to the second Hos-pital News MEDEC MedTech Insert. We’re pleased to once

again have this opportunity to share news about exciting initiatives involving the medical technology industry that are im-proving patient care, increasing health system sustainability while highlighting ex-amples of our valued partnerships with the health care community.

While the health care system contin-ues to face immense challenges such as a rapidly aging population and constrained resources, this has also led to an increased recognition that collectively we need to do things differently in order to meet these challenges and ensure the sustainability of our health care system. Within this con-text, we often hear the term health care innovation being referenced. While it can often mean different things to different people, I think it ultimately means some-thing that’s better for patients and better for the health care system.

Our industry strives to be a partner in the drive to bring about health care inno-vation within Canada’s health care system. Medical technology is not just innovative because new and exciting technologies are being developed every day, but because of the unique value offered by many of these technologies – enabling better care for patients, while improving sustainability of the system.

While achieving adoption of new medi-cal technologies into Canada’s health care system continues to be very challenging compared to other countries, we believe that medical technology’s value in Canada is increasingly being recognized and gov-ernments/health care providers are inter-ested in seeking solutions.

Within this context on innovation, a number of important advancements have taken place as of late. Examples include:

• Ontario Government implementing all Ontario Health Innovation Coun-cil (OHIC) Recommendations – In the province’s spring budget it was announced that the Wynne government would be adopting the transformative recommen-dations put forth by the Ontario Health Innovation Council (OHIC). While some progress has so far been made towards implementation, the recent appointment of William Charnetski as the province’s fi rst-ever Chief Health Innovation Strate-gist is a catalyst to make the Council’s full recommendations a reality. The recom-mendations seek to make Ontario a lead-ing centre not only for new and innovative health technology, but also for bringing that technology to market both in Ontario and around the world.

• Advisory Panel on Healthcare In-novation released its report to the gov-ernment – This federally appointed panel chaired by Dr. David Naylor presented wide ranging recommendations to the pre-vious government this past July in their 164-page report. While the report tackled a variety of aspects of healthcare in Cana-da, there were many recommendations put forth by the panel that, if implemented, would improve the environment for the adoption of medical technologies in Can-ada. Examples include making changes to Canada’s regulatory requirements and implementing measures to integrate ser-

vices and create shared budgets in health-care, which the panel suggests may address some of the frustrations of innovators and industry stakeholders seeking greater clar-ity about purchasing decisions.

• Alberta Strategic Clinical Networks (SCNs) as Pathway for Innovations – The SCNs were established to be the en-gines of innovation in Alberta’s health care system and they offer a unique en-vironment where networks of health care professionals and researchers that are pas-sionate about specifi c areas of health are driving innovations within their specialty areas. MEDEC has been collaborating closely with the SCNs to establish them as potential pathways for innovative technol-ogies to make their way to patients. Please see page M7 in this insert for more details about this collaboration.

These are just a few examples of the in-creasing recognition of the opportunities presented by medical technology and the willingness from a diverse array of health care partners that are seeking to collabo-rate for the benefi t of patients and the sys-tem. As the health system adapts to better serve patient needs, MEDEC is constantly seeking to ensure that our association and industry is being responsive to the needs of the system as well.

One example of adapting to meet health system needs is through MEDEC’s recent establishment of a Hospital to Home com-mittee in order for us to constructively build relationships and collaborate within this increasingly important segment of healthcare.

Opportunities for transformation with-in this area of healthcare are abundant, given the almost universal move towards this type of care, in conjunction with the fact that advanced new technologies are being introduced every day that contribute to patients being able receive care in their own their own homes or in a community setting.

We greatly value our many partner-ships with our health system partners and we look forward to continue and build upon these relationships in order to im-prove patient care, as well as the health care system. ■H

Brian Lewis is President and CEO of MEDEC.

A letter from MEDEC PresidentO

Medical technology is not just innovative because new and exciting technologies are being developed every day, but because of the unique value offered by many of these technologies – enabling better care for patients, while improving sustainability of the system.

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M3 Focus on MEDEC Members Making a Difference in Canadian Healthcare — MEDEC 2015

INNOVATING PATIENTS ANDPROVIDERS



n 2012, Alberta Health Servic-es launched Strategic Clinical Networks (SCNs) to be “the engines of innovation in the

province’s health care system”. The SCNs consist of networks of health care profes-sionals and researchers that are passionate about specifi c areas of health and are driv-ing innovations within their specialty area – aiming to deliver better care and better value for every Albertan.

Last June, the SCNs and MEDEC hosted an introduction day. The plan was to establish an actionable framework for a needs based approach to the adoption of innovative medical technologies. It brought together a diverse group of stake-holders, including Alberta Health Services (AHS), Alberta Innovation and Advanced Education, the Institute of Health Eco-nomics, TEC Edmonton Health Accelera-tor, and BioAlberta.

“We wanted broad representation at the table, because Alberta is on the cusp of developing a new market dynamic,” says Robert Rauscher, VP Western Canada for MEDEC. “We got an agreement among key players for a framework on how to move this forward.”

The stakeholders’ integral role resulted in 13 key recommendations structured around fi ve themes. Six months later, the fi ndings are beginning to bear fruit, with the SCNs focusing on what’s actionable, and leading from there.

“We are targeting three main areas, ini-tially, for proof of concept,” says Dr. Blair O’Neill, medical lead for the SCNs. “In order to focus our efforts and in response

to where industry feels there may be early synergies, a few SCNs were suggested to lead. First, the Cardiovascular Health and Stroke Network will bring a focus on ar-rhythmia management devices. On the stroke side, it will explore unmet needs around improving therapies for endovas-cular intervention. For instance, we need improved embolic protection devices for carotid stents, and better technologies for

acute stroke intervention, including bet-ter imaging, brain protection-cooling de-vices, and pharmacology. This way we can increase the window where patients can benefi t from interventions that will reduce the damage caused by stroke.”

Dr. O’Neill says that the second and third pilot SCNs, Surgery and Critical Care, will be asked to develop a list of gaps or unmet needs in patient care that could be addressed by innovation.

“Within Critical Care, we know remote monitoring technologies can help expand expertise in rural Alberta,” he says. “It can predict patients who are deteriorating ear-lier to help achieve better outcomes.”

This is how innovation occurs – by lis-tening to the real requirements of the ex-perts in the fi eld. In Albert’s case, momen-tum is being built from the June fi ndings, leveraging the province’s unique levers.

“MEDEC asked us to come up with the ideas,” says Dr. O’Neill. “By presenting them to industry, we can fi nd something that’s already been worked on, or that industry can examine because there’s a business case.”

And in Alberta, by having everyone on the same page, and working on a con-sensus basis, device manufacturers assure their market relevance. That means listen-ing to who’s buying.

“An example is Glenrose Rehabilitation Hospital in Edmonton, which has a fairly sophisticated reverse trade show,” says Dr. O’Neill. “They present to the medical de-vice industry, along with venture capital-ists and other partners listening. The best ideas are developed.”

The ongoing process is iterative. The SCNs will learn from round one, and ap-ply that knowledge to round two. With proven solutions brought to the table, and the right buy-in, innovation becomes more than an abstract idea.

“We are rolling out something that’s practical,” says Rauscher from MEDEC. “It’s a good approach for developing a mechanism that allows adoption of new innovation, placing it within an applied research context.”

One of the mandates of Alberta’s SCNs is that they must introduce innovative new technologies to improve healthcare. They are also acutely aware of funding

constraints, and the challenges related to mothballing older technologies. This is critical given the gaps in the system. In a zero sum game, older low value tech-nologies must be retired to make room for newer, higher value technologies. It is why the approach taken by MEDEC and the other stakeholders in Alberta is so neces-sary. Decisions are made with input from those who know the medicine, the patient requirements and, yes, the costs – particu-larly when addressing ineffi ciencies.

Alberta’s SCNs also have access to ex-perts at the University of Calgary and the University of Alberta. It can often take more evidence to decommission some-thing than to bring in a new technology, and the link to academia builds a long-term knowledge base.

“After the fi rst three networks, we’ll have learned something,” says Dr. O’Neill. “Then we’ll go to round two and pick sev-eral more SCNs.”

As it stands, of the thousands of medical devices brought into play each year, a rela-tively small percentage are truly disruptive. Those that are can improve outcomes, but can also create discord. All of this is hap-pening within the context of a cost-con-strained system.

“We are doing this in a zero sum game,” says Dr. O’Neill. “We have to look at we have been doing, and eliminate those things that haven’t been delivering a lot of value to patients.”

The good news, of course, is that Al-berta’s SCNs have stakeholders across the board. That puts them in an excellent position to make the right decisions, to be a leader in healthcare transformation for years to come, and in the continued pur-suit of quality patient care better achieved through the adoption of relevant medical technologies. ■H

Alberta sets the stage for innovationI

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Ambulatory Gynaecological ClinicsIt is clear that many gynaecological procedures that are currently performed in the operating room are well-suited to be performed in an ambulatory clinic setting. Indeed, among the many advantages of an ambulatory setting are decreased anaesthetic risks, speedier patient recovery, improved postoperative pain control and reduced costs. The tremendous in-terest – both globally and in Canada – to develop and establish ambulatory gynaecologic clinics bodes well for women’s health.

Abnormal Uterine Bleedingand Endometrial AblationAbnormal uterine bleeding is a common problem in women: 41,000 hysterectomies are performed in Canada each year, 25% of which are for the diagno-sis of abnormal uterine bleeding. However, there are a number of less invasive interventions for abnormal uterine bleeding, including ablation. When these in-terventions are utilized, recovery time is briefer and women return to their activities of daily living more

tomy rates (up to 40%) may result.1

Global endometrial ablation is a surgical proce-dure that was developed to lighten or discontin-ue menstrual periods; it offers a speedier, safer and simpler alternative to hysterectomy. Endo-metrial ablation is performed vaginally, frequently with only local anaesthesia and with no externalexcisions.

Key Data: Endometrial AblationThe NovaSure® endometrial ablation procedure is safe and comfortable in either the operating room or clinic setting. Indeed, NovaSure® is a proven technol-ogy, with >2.5 million procedures performed to date. The NovaSure® system uses radiofrequency energy to destroy or ablate the endometrium of the uterus; ablation takes only 90–120 seconds to complete, and is well-tolerated in the ambulatory setting.2 At the Regina General Hospital Women’s Health Centre, at 6- and 9-month follow-up, >90% of women reported that they are pleased with the outcome, and fully two-thirds report that they are no longer menstruating.

durability of the NovaSure® endometrial ablation system 5 years after the procedure had been per-formed in women with severe menorrhagia second-ary to dysfunctional uterine bleeding.3 In this study of 107 patients, no intra- or postoperative complications were observed. At 5-year follow-up, amenorrhea was reported and successful reduction of bleeding was achieved in 75% and 98% of patients, respectively. The author concluded that the NovaSure® system is safe and effective in women with severe menor-rhagia and dysfunctional uterine bleeding.

Key Recommendations:Endometrial Ablation andAmbulatory Gynaecology ClinicsThe provision of outpatient gynaecological proce-dures has been proposed for many years. In 2002, the Ontario Women’s Health Council recommend-ed the development of ambulatory sites around the province for investigation and management of abnor-mal uterine bleeding.4 The Council’s task force rec-ommended that minimally invasive surgical options (e.g. endometrial ablation) were an important, but underutilized, therapy for abnormal uterine bleeding in Ontario.In 2006, the Ontario Endometrial Ablation Guideline

sites for the investigation and treatment of dysfunc-tional uterine bleeding be developed, utilizing the protocol of endometrial ablation.5

In 2013, the Society of Obstetricians and Gynaecol-ogists of Canada published guidelines entitledAbnormal Bleeding in Pre-Menopausal Women.6 A key recommendation is as follows: “Non-hystero-scopic ablation techniques offer similar patient satis-faction results, with fewer risks of complications and less anaesthetic requirement than traditional hys-teroscopic ablation.”

In 2015, the Society of Obstetricians and Gynae-cologists of Canada published guidelines entitled Endometrial Ablation in the Management of Abnor-mal Uterine Bleeding.7 The guidelines included the following statement: “The use of local anaesthetic

and blocks, oral analgesia, and conscious sedation allows for the provision of non-resectoscopic endo-metrial ablation in lower resource-intense environ-ments, including regulated non-hospital settings.”The 2015 guidelines further noted, “Endometrialablation performed in a hospital-based procedure room or a free-standing surgical centre, rather than an operating room, offers the advantages of apatient-centred environment, easier scheduling and reduced costs per case.”7

Ambulatory Gynaecology ClinicsTable 1logical clinics for patients and the healthcare system.Figure 1 depicts the “iron triangle” of healthcare.8

The principle behind the concept of the iron trian-gle is that there are 3 complementary healthcare issues: access, quality and cost containment. In a perfect world, all 3 can be achieved in balance without compromising any individual component. Ambulatory gynaecological clinics achieve this by delivering high-quality care and providing ex-cellent access to much-needed services, at a re-duced cost.SummaryMoving gynaecological procedures to an accredited ambulatory clinic is safe and cost-effective, and pro-vides optimal clinical outcomes. Furthermore, ambu-latory clinics provide a quality work environment forall employees (i.e. doctors, nurses and allied staff). This type of clinic also augments work volume with-out affecting patient safety, while reducing the role of hysterectomy in the management of abnormal uter-ine bleeding.Ambulatory care clinicians have been compelled to develop opportunities to improve operational per-formances and cost, while enhancing the quality of care delivered to patients. Much is expected of these healthcare professionals, and they deliver!For further information, please email [email protected].©Hologic Canada Ltd., 2015

Alternatives to the Acute Care Hospital Sectorfor Women’s Health Interventions

The Importance of Ambulatory Gynaecological Clinics

References: 1. Fergusson RJ, et al. Cochrane Database Syst Rev. 2013;11:CD000329. 2. Hologic website. NovaSure® Endometrial Ablation. Available at: http://www.hologic.com. 3. Gallinat A. J Reprod Med. 2007;52:467–472. 4. Stewart D, et al. Toronto, ON: OntarioWomen’s Health Council; 2002. 5. Health Quality Ontario. Ont Health Technol Assess Ser. 2004;4:1–89. 6. Singh S, et al. J Obstet Gynaecol Can. 2013;35:473–479. 7. Laberge P, et al. J Obstet Gynaecol Can. 2015;37:362–376. 8. Kissick W. Medicine’s Dilemmas. New Haven, CT: Yale University Press; 1994.

Efficiency/Cost containment

High-quality care Patient access

Figure 1. The iron triangle of healthcare

Improved access to careRelaxed and patient-centred approach to surgical and postoperative careLess invasive proceduresFaster recovery and return to normal functionDelivery of excellent serviceReduction in procedure wait time

High-quality specialized care

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epresentatives of medical de-vice companies are often re-quired to enter hospitals and other health care facilities

for many different reasons, including: training health care professionals on the safe and effective use of devices, demon-strating new and advanced technologies that can improve patient outcomes and increase system sustainability, or servic-ing vitally important medical equipment like an MRI. The members of MEDEC operate in the Canadian health care system in partnership with the medical community based on the strong founda-tion of the industry’s (MEDEC’s) Code of Conduct and are deeply committed to patient safety.

MEDEC understands the desire by some health care institutions to imple-ment credentialing requirements in or-der to coordinate admission to certain areas of their facilities by suppliers and external contractors.

In Canada, the process of collecting and storing data for any credentialing system is infl uenced by a number of laws in the areas of privacy and human rights. These legal considerations, as well as the awareness of issues involving the vendor credentialing experience in the U.S., led to the effort to establish a vendor cre-dentialing standard in Canada.

The situation in the USThe vendor credentialing cost impli-

cations on the U.S. health care system have been staggering – primarily due to the inconsistency in credentialing re-quirements across health care facilities. Vendor credentialing has added nearly $1 billion in costs to the health care system in the U.S. and many companies have had to hire internal staff in order to track and manage all of the differing training, background checks and health and safety requirements in order to be-come credentialed.

Additional challenges are created by the various differences in timelines required for each of the credentialing requirements (some ask for annual up-dates, others biannual etc.). This lack of consistency has burdened the U.S. healthcare system with considerable and avoidable costs and caused signifi cant confusion that has led to a loss of focus towards everyone’s shared objective of ensuring that patients receive the best possible care.

The HSCN national standard for vendor credentialing

With a keen understanding of the challenges faced in the US and with Canadian privacy and human rights laws in mind, in 2012 the Healthcare Supply Chain Network (HSCN), a Ca-nadian association comprised of health care provider and supplier professionals (hospital representatives, shared services and group purchasing organizations and industry representatives), developed a Canadian National Standard for Vendor Credentialing.

MEDEC has fully endorsed the HSCN National Standard for Vendor Credentialing in Canada. It’s an effi -cient, effective, and reasonable solution that allows for health care providers who have adopted the standard to log onto a

password protected website in order to view attestations by vendor companies who have completed the requirements of the Standard, which include elements that deal with a variety of things such as immunizations and training.

The HSCN national standard:• Creates consistency• Avoids the excessive and unnecessary

duplication and resulting costs experi-enced in the U.S.

• Addresses Canadian legal issues that form barriers for vendors to meet their credentialing requirements

• Is adaptable – by virtue of HSCN’s position and its membership from the provincial and territorial health care provider community and vendors, it is a perfect forum for the evolution of the standard if laws and practices changeover timeThe HSCN Standard has also been

implemented by Health Shared Ser-vice British Columbia (HSSBC), which covers all health care providers in the province and it’s been recently been rec-ognized by Québec’s Ministry of Health and Social Services as the acceptable standard for Québec health care facilities to rely upon if credentialing is deemed necessary (as of January 1st, 2016).

The Standard provides consistency and ensures that the privacy and human rights of supplier representatives are re-spected, while allowing Canadian health care organizations to achieve their cre-dentialing objectives without overbur-dening the system with unnecessary costs. It is for these reasons that MEDEC fully endorses the HSCN National Stan-dard for Vendor Credentialing.

For more information about the HSCN National Standard for Vendor Credentialing, please visit: http://www.hscn.org/national-standard.aspx ■H

Best practices in interactionswith health care providers

MEDEC Code of Conduct: Demonstrating Commitment to Ethical Business Practices The MEDEC Code of Conduct, which has recently been updated for 2015, is a valuable tool for supporting ethical business practices and socially responsible industry conduct, in light of the important relationship between member companies and health care professionals in meeting the healthcare needs of patients. “We know that our members are committed to conducting their businesses in alignment with accepted ethical practices, and the Code formalizes these practices by providing MEDEC Code of Conduct Certifi cation” says Brian Lewis, MEDEC President and CEO. “Additionally, Code certifi cation recognizes the increased expectation we are seeing for life science vendors, such as our members, to be aligned with a code of ethical practices.”

Changes in 2015 CodeMEDEC’s restated code expands into important new areas, including the following.• On-site Product Demonstrations and

the need for documentation between the health care organization and company to outline the purpose, duration, equipment and scope of the demonstration.

• Site Visits which are necessary to evaluate products. Whenever possible, site visits should occur in Canada. Companies should fund expenses only for attendees with a bona fi de professional interest in the equipment.

• Third Party Intermediaries (TPIs).Reminder that each company is responsible to train TPIs on various foreign and local anti-bribery and health care compliance policies, including training on the company’s own internal compliance program.

• Greater Clarity and Addition of Glossary – The MEDEC Code of Conduct Committee amended sections of the document to provide greater clarity and added a glossary so that there is common understanding of the terms being referenced.

These code updates were made to refl ect the changing expectations within business and health care environments.The principles of the code, which is a “living” document, are regularly updated. Originally developed by MEDEC member companies in 2005, it was updated in December 2009, September 2012 and April 2015 by the MEDEC Code of Conduct Committee. “There is growing recognition about the need for codes of ethics around the world,” says Stephan Ekmekjian, Chair, MEDEC Code of Conduct Committee, who recently represented the association at the Asia-Pacifi c Economic Cooperation (APEC) Business Ethics for SMEs Forum. “In the APEC region, for example, the number of such codes has soared from 33 in 2012 to 65, representing 19,000 fi rms, including 13,000 small and medium-sized enterprises, in the medical device and biopharmaceutical sectors. I take pride in MEDEC leading the way in Canada with our code to safeguard our members’ business relationships with health care professionals, affi rm legitimate business practices and, ultimately, enhance patient care.”

Stephan Ekmekjian, Chair of MEDEC’s Code of Conduct Committee and Health Care Compliance Offi cer with Johnson & Johnson Canada, recently attended the APEC Business Ethics for SMEs Forum in Manilla. Mr. Ekmekjian was a facilitator and moderator at the event and he has been invited to join the long-standing APEC mentor group as MEDEC representative.

R MEDEC understands the desire by some health care institutions to implement credentialing requirements in order to coordinate admission to certain areas of their facilities by suppliers and external contractors



arlier this year, Clinical Trials Ontario (CTO) rolled out the CTO Streamlined Research Ethics Review System, a highly-

effi cient approach to research ethics review that reduces the time and effort involved in launching multi-centre clinical trials.

The new CTO Streamlined System al-lows any single CTO Qualifi ed research ethics board (REB) in Ontario to provide ethics review and oversight for multiple re-search sites participating in the same clini-cal trial.

This means, for example, that a trial with 10 participating sites no longer has to go through 10 separate REB reviews for the same study protocol.

The fi rst industry-sponsored global multi-centre clinical trial to use the CTO Streamlined System received province-wide ethics approval of the study protocol in Ontario in just two months from the time of submission.

The CTO Streamlined System by the Numbers

Since its launch, there has been signifi -cant uptake by the clinical research com-munity as sites and sponsors come on board to use the CTO Streamlined System.

• 18 studies – eight of which are in-dustry-funded – are already using CTO Stream, the web-based platform for coordinating research ethics reviews

that features document management and communication between multiple institutions and REBs.

• 11 REBs are CTO Qualifi ed. These REBs have undergone an external review

of policies and procedures and meet a high quality and transparent standard for gover-nance, membership, operations and proce-dures. They can provide ethical review and oversight of multi-centre clinical research on behalf of participating research sites across Ontario.

• 44 research sites have already signed on to participate in the CTO Streamlined System. What used to take months can now take days. Instead of each research site sub-mitting a full research ethics review applica-tion to their local REB a process that can take up to six months, a participating site can join an approved protocol in just days.

With a user-friendly interface and com-mon REB application forms, the CTO Streamlined System harmonizes processes and reduces the time and administrative burden involved in multi-centre clinical trials in Ontario.

“The new CTO Streamlined System signifi cantly enhances the clinical trials environment in Ontario, while supporting the highest ethical and quality standards,” says Susan Marlin, President and CEO of CTO. “Stakeholders are recognizing the importance of this new approach, which was conceived, designed and built by the clinical trials and research ethics commu-nities in Ontario.”

In June 2015, the CTO Streamlined System was highlighted in Ontario’s 2015 Burden Reduction Report as one of 28 ini-tiatives across government that are “mod-ernizing services and making it easier for businesses to succeed.”

Building on the success of the CTO Streamlined System, CTO is working on other streamlining measures, such as pro-cesses to support effi cient contract review for multi-centre clinical research. CTO is also committed to increasing public and participant engagement in clinical trials and promoting Ontario’s clinical trials strengths.

A stakeholder-led organization estab-lished with support from the Government of Ontario, CTO’s vision is to make On-

tario a preferred location for global clinical trials, while maintaining the highest ethi-cal standards for participant protection. To learn more, visit www.ctontario.ca

Attend a Free CTO Informational Webinar

Researchers, REB staff, REB operations personnel, industry sponsors and institu-tion representatives are invited to join the more than 400 people who have attended CTO’s informational webinars to learn how they can take advantage of the CTO Streamlined System.

Webinars are free to attend and are cur-rently ongoing. Register for free at www.ctontario.ca/webinars.

Please contact CTO at [email protected] for more information about the CTO Streamlined Research Ethics Re-view System or to request a live demo of CTO Stream. ■H

Benefi ts of the CTO Streamlined Research Ethics Review System• Reduces the costs and improves the speed of conducting multi-centre clinical trials in Ontario.• Enhances effi ciency while supporting high-quality ethical reviews.• Leverages the excellent research ethics review and administration capacity across Ontario’s institutions.• Eases the overall burden on investigators and saves time by moving to a single ethics review, instead of multiple ethics reviews for the same clinical research.• Provides a supportive and complementary approach to conducting multi-site studies, both investigator-initiated and industry-sponsored.• Enables special expertise built up by individual REBs to be accessed more readily.

Streamlining research ethicsreview for clinical trials in Ontario

More than 3,200 clinical trials are underway in Ontario at any given time.

E

Photo by Mark Ridout, courtesy of Clinical Trials Ontario.



TOSHIBA celebrates its 100th anniversary in the healthcare business. Throughout our 100-year history in the medical device business, Toshiba has responded to our customers’ needs by providing a wide range of high-value solutions. These efforts have made us the top company in our business segment in Japan and have given us an expanding global presence in over 135 countries around the globe.

patient outcomes and patients’ quality of life. From corporate programs to the wide range of product features that protect patients and healthcare providers, we have made safety a top priority in everything we do.

While always strictly adhering to our company’s well-known tradition of excellence and quality, we will continue to respond to changes in the industry and the needs of our customers, and pursue our mutual goal of improving healthcare delivery. Our products and our company will remain dedicated to our “Made for Life™” philosophy.

toshiba-medical.ca



n Sept. 10, Ontario’s Ministry of Health and Long-Term Care announced that the Wynne government had appointed

William Charnetski as the province’s fi rst-ever Chief Health Innovation Strategist. While Mr. Charnetski’s responsibilities in this role will be wide-ranging, he will ul-timately ‘champion Ontario’s health tech-nology innovation sector’.

The creation of an Offi ce of the Chief Health Innovation Strategist was a recom-mendation of the Ontario Health Innova-tion Council (OHIC), whose report was presented to the Ontario government in December 2014 and received full validation through the government’s commitment in their 2015 Budget to implement all of six of the report’s recommendations. MEDEC strongly believes that the recommendations provided in the OHIC report have the po-tential to positively transform the way in which the medtech industry operates in Ontario and Mr. Charnetski’s appointment paves the way for the remaining OHIC rec-ommendations to be implemented.

The remaining six recommendations in the report are:• Establishing a new $20-million Health

Technology Innovation Evaluation Fund to support made-in-Ontario technologies

• Using newly created Innovation Bro-ker positions to connect innovators and researchers with opportunities in the health care system

• Streamlining the adoption of health care innovations across the health system

• Shifting to procurement practices that focus on outcomes, such as fewer hospi-tal readmissions and the long-term value of medical devices

• Investing in the assessment of emerging innovative health technologies to get those products to market faster

Mr. Charnetski takes on this role having worked as a senior executive in the private sec-tor for a number of years. Prior to that, he prac-ticed law and held roles working in government.

MEDEC congratulates Mr. Charnetski for being chosen in this distinguished role and we look forward to fostering a highly collaborative relationship with him and his offi ce going forward. ■H

Paving the way for improvementsto Ontario’s MedTech environmentO

Mr. Charnetski’s appointment paves the way for the remaining OHIC recommendations to be implemented

We aim to maximize the quality, safety, and efficiency of medical care, supporting

clinical practice with reliable quality products and innovative, cutting-edge technologies.

Toshiba: A Focused Perspective in Diagnostic Imaging

www.toshiba-medical.ca

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round the world, the medi-cal device industry and many leading health care provid-ers have chosen the Global

Data Synchronization Network (GDSN) and its GDSN-certifi ed data pools as the systems of choice for the secure, accurate global electronic communication of supply chain data. These suppliers and providers recognize the benefi ts of the effi ciencies and enhanced patient safety offered by the GDSN-certifi ed system, and are commit-ted to its implementation.

The GDSN is built around the GS1 System of Standards including the GS1 Global Registry, GDSN certifi ed Data Pools, the GS1 Data Quality Framework and GS1 Global Product Classifi cation, which, when combined, provide a power-ful environment for secure and continu-ous synchronization of accurate data . The objective of the GDSN is to provide an assured, secure, seamless, point-to-point information exchange between manufac-turer, distributor and health care provider. The GS1 Global System of Standards en-sures a single solution that provides the highest level of accuracy and data integrity for the global health care world.

Ongoing collaboration between provid-ers and suppliers has resulted in signifi cant development of the GDSN system to op-timally meet health care provider require-ments. As an example, a collaborative of fi ve of the largest health care providers in the U.S. called the Healthcare Trans-formation Group have made tremendous progress by working hand-in-hand with the medical device industry to implement GS1 standards through GDSN-certifi ed data pools.

In addition, on the global stage this col-laboration toward the ongoing develop-ment and uptake of the GDSN is exempli-fi ed through the GS1 Healthcare Global GDSN Implementation Work Group. This group, which consists of GDSN-

certifi ed data pool operators, medical de-vice company logistics professionals and others, was assembled in order to discuss and determine such things as the required product attributes for medical devices in order to meet global and country-specifi c requirements.

While there is industry-wide recogni-tion for the benefi ts that health care data standards can provide both clinically and operationally, data standards utilization is still very low in Canadian healthcare at this point in time. However, implementa-tion plans are now beginning to take shape in some provinces. For example, the prov-ince of Quebec has indicated that they are moving towards the adoption of the GDSN for medical device product data. Another example is an exciting new ini-tiative taking place in Alberta known as the Canadian Healthcare Medical Device Standards Project.

The goal of the Canadian Healthcare Medical Device Standards Project is to showcase the value of GS1 standards implementation in terms of the patient quality and safety improvements and that can be gained by implementing product data standards through the GDSN and enhanced health system effi ciencies de-rived from data synchronization and e-commerce transactions. At the conclusion of the project, the participants will deliver a simplifi ed, sustainable and global model for standards implementation that others in the industry can utilize.

This project’s participants are Alberta Health Services, Baxter Corporation, Car-dinal Health Canada, Canadian Hospital Specialties Ltd., Cook Medical Canada, Medtronic , Johnson & Johnson Medical Products Inc. and MEDEC. The project will be executed in two phases:

• Data synchronization: Create a sus-tainable, effi cient model for sharing prod-uct data via GDSN-certifi ed data pools between participating supplier/distributor stakeholders and Alberta Health Services.

• e-Commerce: Subsequently utilize GS1 data attributes in electronic data interchange (EDI) order transactions be-tween participating supplier/distributor stakeholders and Alberta Health Services.

“The ability for all stakeholders in the health care supply chain to utilize global data standards holds tremendous potential for improving the safety of our patients and the operational effectiveness of our indus-try,” says Jitendra Prasad, chief program of-fi cer, Contracting, Procurement and Sup-ply Management, Alberta Health Services (AHS). “The only way we can develop a model for sharing and transacting data that benefi ts everyone is to work collab-oratively together. At AHS, we are proud of the role we are playing to create such a model that others in the industry can learn and benefi t from.”

GHX, a software and services company and GDSN-certifi ed data pool provider will manage the project amongst all the stakeholders, and document and publish the fi ndings of the group’s success in a white paper that details the value derived from implementing GS1 standards from the perspective of provider, supplier and distributor organizations. The paper will be

made available to the health care industry so that other providers and suppliers can replicate this model within their own trad-ing partner relationships.

“We have assembled a group of stake-holders in Canada who are serious about demonstrating the value of fully imple-menting GS1 standards and are willing to showcase this proof of concept in their own organizations to accelerate industry-wide adoption,” says Nils Clausen, AVP Supplier Sales, GHX North America. “All parties are committed to working collab-oratively together to achieve successful outcomes that will benefi t not only their organizations but healthcare as a whole, including the patients they serve.”

As supporters of GS1 Standards in healthcare implemented through the GDSN, MEDEC is pleased to be a sup-porting partner of this project and we are excited about the prospects of increas-ing adoption of the GDSN in healthcare across Canada. ■H

A

Product data synchronization

GDSN usageby the numbers

965,351Registered Medical Device GTINs

(Global Trade Identifi cation Numbers – unique products or services)

36,126Registered data sources

(suppliers)

GDSN-certifi ed Data Pools– There are three Canadian-based

GDSN-certifi ed data pool providers: Commport Communications, GHX Canada and GS1 Canada. Data recipients looking to utilize the GDSN can choose any data pool, with many based in countries all over the world. One of the benefi ts of the GDSN is that companies that operate globally only have to be a part one data pool in order to utilize the GDSN around the world. For a list data pools, visit: http://www.gs1.org/docs/gdsn/gdsn_certifi ed_data_pools.pdf

Dec. 1 - 2, 2015 | International Plaza Toronto

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©2015 Hologic, Inc. Printed in USA. Hologic, NovaSure and The Science of Sure are trademarks or registered trademarks of Hologic, Inc. and/or its subsidiaries in the United States and/or other countries. This information is intended for medical professionals in the U.S. and other markets and is not intended as a product solicitation or promotion where such activities are prohibited. Because Hologic materials are distributed through websites, eBroadcasts and tradeshows, it is not always possible to control where such materials appear. For specifi c information on what products are available for sale in a particular country, please contact your local Hologic representative or write to [email protected].

REFERENCES: 1. Cooper J, Gimpelson R, Laberge P et al. A randomized, multicenter trial of safety and effi cacy of the Novasure System in the treatment of menorrhagia. J Am Assoc Gynecol Laparosc. 2002;9:418-428 2. NovaSure Instructions for Use 3. Gallinat A. An impedance-controlled system for endometrial ablation: Five-year follow up on 107 patients. J Reprod Med. 2007; 52:467-472

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Registration information coming soon

Sign up for conference updates via email at [email protected] with the subject line Medtech Conference.

MEDEC’s MedTech Conference is Canada’s preeminent information exchange and

educational forum for the medical technology industry – tackling issues such as

innovation and change within the healthcare system. Attendees will hear from

and engage with high-profile health system leaders and network with colleagues.

Previous year’s conferences have hosted dignitaries such as Ministers of Health,

Hospital CEOs and other influential thought leaders and this year is shaping up to

be no different!

MARK YOUR CALENDARand plan to join us for MEDEC’s not-to-be-missed annual conference!

SAVE THE DATE: MEDEC’s 2016 MedTech ConferenceApril 26 and 27!The annual signature conference of MEDEC and the Canadian medtech industry will take place on April 26th and 27, 2016 at the Sheraton Toronto Airport Hotel & Conference Centre, 801 Dixon Road, Toronto.



n the clinical care setting, a patient’s personal health in-formation (PHI) is a powerful catalyst for optimizing health-

care outcomes. When utilized appropri-ately, it can have a critical role to play in enhancing the quality of care that a pa-tient receives. Recent regulatory and leg-islative developments have aimed to en-hance protections around the collection, use and disclosure of PHI in the clinical context; however, these advancements have been centered on the concept of en-hancing legislative compliance through disciplinary measures.

Much of the focus of these develop-ments has been on the punitive aims of the Personal Health Information Protec-tion Act (PHIPA) – the primary piece of legislation governing PHI – and in par-ticular, has sought to advance legislative compliance by emphasizing the legal con-sequences for breaching patient privacy. Undoubtedly, PHI is among the most sensitive types of information. Patients are entitled to expect that their confi -dential details will not be inadvertently or purposefully disclosed without proper authorization – and that those who do

so will be disciplined and/or sanctioned appropriately.

Yet, PHIPA, like many other pieces of legislation, has multiple purposes. Apart from its punitive rationale, focused on de-terring unwanted conduct, the legislation

also seeks to create a framework to facili-tate the effective provision of healthcare. In this regard, it recognizes the impor-tance of disclosure of PHI to clinical care, and aims to provide secure parameters within which PHI can be freely exchanged between patients and clinicians, and also within a patient’s circle of care.

This more positive aim of the legisla-tion corresponds to how PHI is used to ad-vance clinical care. A patient who knows that his or her PHI will remain confi den-tial is more likely to be forthcoming about sensitive medical details. In turn, this may give clinicians a more complete medical history, allowing them to implement the most appropriate care plan. As part of the privacy compliance framework, PHIPA envisions clinicians (or health informa-tion custodians generally) to be key play-ers in safeguarding PHI – knowing that they may rely on patient’s full and frank disclosure of PHI as an important tool in diagnosis and treatment advice.

When considering the collection, use and disclosure of PHI in clinical care, a proper balance must be struck between the various purposes of PHIPA. Over-emphasizing the punitive aims of the legislation risks creating a climate of fear around how to appropriately use and dis-close PHI – particularly for clinicians. On the other hand, in focusing only on the importance of facilitating the fl ow of PHI, one may overlook the clinical and prac-tical signifi cance of the deterrent aims of the legislation. An ideal approach to the

conversation around privacy compliance is one where the negative consequences for breaching privacy are equally voiced and heard alongside more encouraging, positive-based rationales.

In striking the right balance, it is also important to consider the broader insti-tutional context. The use, disclosure and collection of PHI does not occur within an operational vacuum – paper charts, electronic information systems and in-stitutional policies (as they relate to IT) are all vehicles that are used to enable (or sometimes prevent) access and disclosure of PHI. These operational aspects may come with their own limitations and re-source challenges. Accounting for these operational factors is also a signifi cant part of the privacy compliance picture, given the practical daily workfl ow implications.

Additionally, in the compliance envi-ronment, the role of relevant stakehold-ers has to be considered. For example, the Ontario Information and Privacy Commis-sioner plays an important role in ensuring that individual health care providers and health care institutions are accountable for meeting legislative requirements.

The use of personal health information in clinical care:

By Alice Melcov

I

Patients are entitled to expect that their confi dential details will not be inadvertently or purposefully disclosed without proper authorization – and that those who do so will be disciplined and/or sanctioned appropriately.


Finding the right balance



ealth care organizations across Canada are putting an increas-ing emphasis on involving clients and families in health

care. They’re doing this with individuals (i.e., involving clients and families more in care plans) and by consulting more broadly with clients and families when implement-ing new programs or policies. This in-creased participation has improved health care outcomes and client satisfaction, and has encouraged more organizations to fo-cus on client- and family-centred care (CFCC) in Canada and internationally.

At Accreditation Canada we are helping to lead this shift through our Qmentum accreditation program. We made signifi -cant revisions to Qmentum to strengthen its CFCC focus across the care continuum. The new requirements are expected to per-meate an organization’s culture, promoting collaboration among clients, families, and providers in all aspects of all service design, delivery, and evaluation.

Through collaboration with our CFCC pan-Canadian Advisory Committee (which had equal representation from pa-tients, families, and service providers), the wording and requirements in the standards were modifi ed to refl ect a focus on CFCC, and will start being evaluated by Accredi-tation Canada surveyors during on-site surveys in January 2016.

Where to begin? We created a webcast for our clients

who need an introduction or a refresher around implementing CFCC throughout their organization. For many organiza-tions, focusing on CFCC is par for the course, while for others, it is entirely new. No matter where they are in the process of implementing CFCC, the changes in our standards support health care and social services organizations in embedding this approach throughout their organization, from direct care providers through to gov-ernance and leadership. While these re-quirements represent a signifi cant shift in philosophy and culture for some organiza-tions, the need for this change was clear.

CFCC and Leading PracticesAlso beginning in January 2016, CFCC

will be strengthened in the Leading Prac-tice submission process. There will be a stronger focus on how the patient is in-volved in Leading Practices and organiza-tions will need to describe this aspect more fully.

Examples of client and family involve-ment:• Clients and families participate as stake-

holders from the onset of a Leading Practice to inform both the project and implementation process.

For example, organizations could seek CFCC input from advisory groups, focus groups, formal surveys, or informal day-to-day feedback. • Clients and families participate in evalu-

ating the Leading Practice to inform fu-ture changes and improvements.

• Through CFCC feedback, organiza-tions use the experiences of clients and families as a basis to develop the Leading Practice.

• Organizations use ideas brought forward by clients and families to improve care processes.To help you understand what a CFCC-

focused Leading Practice looks like, we have included two excellent examples below:

Clients and families at the centre of care By Jil Beardmore

H

It also has an educational mandate in creating awareness about rights and obli-gations under PHIPA. Provincial regula-tory colleges that govern regulated health professionals also inform the compliance environment – through both disciplinary and educative authority. The functions performed by these external bodies also shape the overall context for privacy com-pliance.

A robust dialogue about privacy compli-ance acknowledges that there are no easy solutions. The dynamics around the use of PHI in clinical care are complex – and fi nding the right balance between often competing considerations presents both clinical and operational challenges. More-over, the privacy compliance framework is one that requires a nuanced approach – accounting for the interplay between en-forcement and clinical care rationales. A thorough awareness of the various factors at work (and understanding that there is no one-size-fi ts-all approach for any par-ticular setting) is arguably the best start-ing point to striking that balance. ■HAlice Melcov is a Legal and Policy Advisor with the Ontario Hospital Association. The views expressed in this article are solely those of the author, and do not represent the position or policies of the Ontario Hospital Association.

The CIHI PROMs Forum was attend-ed by senior policy-makers from federal/provincial/territorial governments, senior health system decision-makers, interna-tional guests as well as selected clinicians and senior researchers actively involved in using PROMs. A PROMs background document and the PROMs Forum sum-mary are available at: www.cihi.ca/proms.

Building on the input obtained at the PROMs Forum, CIHI launched a pan-Canadian PROMs advisory committee to support collaboration and inform deci-sions on PROMs surveys and approaches for data collection and reporting. PROMs demonstration projects and working groups for two priority clinical areas (hip and knee arthroplasty and renal care) are now underway. CIHI will continue to en-gage in activities to support the availability of comparable PROMs data to Canadians.

For more information on CIHI’s PROMs program of work, visit www.cihi.ca/proms. ■HKira Leeb is Director, Health System Performmance at The Canadian Institute for Health Information and Greg Webster is Director, Acute and Ambulatory Care Information, Canadian Institute for Health Information.

Finding the right balanceContinued from page 19

Data pulseContinued from page 18

Leading Practice: photoVOICE at the North Bay Regional Health Centre (NBRHC)

The NBRHC uses a highly interactive program called photoVOICE to help its inpatients express themselves through photography. They participate in a program that concludes with a public exhibit that gives voice to their experiences. It’s a way to encourage inpatients to share their stories, and for the staff who work with them on a daily basis to get to know them better. Many of the inpatients struggle with illnesses like bipolar disorder, schizophrenia, depression, and Alzheimer’s disease and often have diffi culty communicating. This program helps them fi nd a way to share their stories, in part, so staff can better understand how to participate in their recovery. The program has been incredibly effective on both fronts, empowering inpatients and helping staff get to know them.

Leading Practice: Social media and the patient experience at Sunnybrook

Sunnybrook Health Sciences Centre was an early adopter of social media, which it uses to engage patients and their families. It uses outlets like Facebook and Twitter to stay connected to patients, gather feedback, and respond to patients’ needs and inquiries. Social media channels help staff listen to and communicate with patients, and provide health tips and facts, including prevention information, surgery explanations, and after-illness care tips. With over 27,000 followers on Twitter and over 11,000 Facebook friends, Sunnybrook is now a public platform for questions and feedback throughout the continuum of care. Patients and families can easily engage with the hospital at any hour of any day and receive a swift response.

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There has been an increased recognition of the importance of the patient’s perspective in supporting a patient-centered approach to providing quality healthcare.

Jil Beardmore is a writer/editor at Accreditation Canada.



Patients. Families. Healthcare Providers.Family presence improves patient experience and outcomes.

> FAMILY PRESENCE

REDUCES READMISSIONSAND GETS

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ospital boards appoint leaders but it is the health care sys-tem that builds them. Some may bring experience from the

broader public sector or academia, but an Ontario Hospital Association (OHA) sur-vey conducted this spring found the aver-age CEO had 28 years of health care expe-rience – most of which came from working in Ontario. And given their ages, should these leaders choose to retire at 60, the system could lose almost half in the next three years.

Succession planning and developing leaders has been on many hospital board agendas for some time and was identifi ed as a key issue by the OHA fi ve years ago. Since then, much work has been done to address the issue.

But for a health system facing frozen budgets, resource shortages, and the fi rst drop in this country’s registered nurses in almost 20 years, what is the current state of the talent development pipeline? The next system leaders may be poised to take on the rigours of transformation, but where will the following generation come from?

“Three or four times a year I’ve had medical students approach me wanting to know how best to position themselves for leadership. And they hadn’t even gradu-ated yet,” says Dr. Barry McLellan, CEO of Sunnybrook Health Sciences Centre. “I think it’s a very good sign.”

McLellan, like many of his colleagues, is heartened by the optimism and ambition he is seeing in this young cohort of medi-cal and other health care professionals. But system transformation will require more than optimism and ambition.

To cultivate system leaders, some hospi-tals are engaging in important talent devel-opment work to identify and build leader-ship capacity within the system. In some ways, there is a sense of urgency behind this work because the system will see a de-mographic shift that threatens to deliver a double impact.

Not only will healthcare see the same wave of retiring boomers that is threaten-ing to disrupt other sectors, but the de-mand for health services is also set to rise as the population ages. Essentially, a large contingent of health care workers will leave their offi ces, operating rooms and patient bedsides, and become the clients.

“I don’t have a sense that we’re ready for that demographic bulge or what’s go-ing to happen on the consumer side with this aging cohort,” says Ray Racette, presi-dent and CEO of the Canadian College of Health Leaders, an organization focused nationally on identifying, developing and supporting leadership in healthcare.

Despite the work he is seeing in health care leadership development and the relative stability he is seeing in On-tario hospital leadership, Racette says it’s important to pay attention to this shift. “It’s a time to be a little nervous,” he says.

The growing complexity of the leader-ship role and an aging cohort has some ob-

servers also worrying about the short-term future of the system’s current leaders. As the retirement wave washes through indus-tries and sectors, a signifi cant exit of these leaders, specifi cally hospital CEOs, could cause further disruption for a system in the midst of transformation.

The OHA’s current demographic fi g-ures on this province’s hospital CEOs say that half fall into the 52-to-59-year-old age bracket. And the rate of retirement is accelerating – from four per cent in 2012 to 11 per cent in 2014. Seeing more senior leaders considering retirement begs the question: Are there enough in-line who are ready to replace them?

The most likely source of CEOs, it seems, is another hospital’s senior team. The OHA survey found that 60 per cent of the responding CEOs had been senior ex-

ecutives before taking on their role. But a look at the OHA’s 2014 HR Benchmarking survey found that the external job fi ll rate was signifi cantly higher than the internal job fi ll rate when it came to CEO and se-nior hospital executive positions. In short, most CEOs appear to come from senior lev-els and from other hospitals.

External candidates are more common for hospitals in large urban markets like To-ronto, as was the case for Sarah Downey, President and CEO at Toronto East Gen-eral Hospital. Downey took the reins of this community hospital in April of this year, having been an executive vice president at The Centre for Addiction and Mental Health (CAMH) and a vice president at the University Health Network before that.

“I think there are a lot of highly qualifi ed candidates out there who are ready to make that shift,” she says of the CEO candidate pool. When she was contacted in 2014 to gauge her interest in leading a hospital, there were eight CEO searches across Can-ada underway at the time.

Barbara Nixon is not surprised by these numbers. A partner in the executive search fi rm Promeus, she says her team has worked on three CEO searches in the last 18 months, is currently working with Thunder Bay Regional Health Sciences Centre and Thunder Bay Regional Research Institute to fi nd its new top executive, and is poten-tially involved in two other CEO searches.

Nixon thinks health care organizations have more work to do to improve succes-sion. “They are getting better at it, and

people are recognizing it’s important, but I would say that over the last decade it’s not something the health system has focused on,” she says, explaining that most recruit-ing fi rms encourage a search that includes internal candidates but that hospital boards tend to want an external search to ensure that there has been a competitive process.

“We’re at an interesting juncture in terms of not only getting the right talent and the right skills but also making sure [se-nior managers] want the job,” says Nixon.

While many senior leaders tend to come from other hospitals to take on a CEO role, boards are also careful to assess and develop internal talent. And if they want to maintain a current strategic direction, it can be even preferable.

When Bluewater Health’s president and CEO Sue Denomy announced her plans to leave in 2015, an internal candidate was deemed important for continuity. Vice president of operations and chief operating offi cer Mike Lapaine was interviewed and selected by the board and will take on the CEO role in January of next year.

“The decision to hire an internal candi-date over an external one really depends on the situation of the organization at the time,” says Lapaine, citing the importance of a senior executive’s pre-existing rela-tionships with external health care partners in the community as an important factor. Sue Denomy says this is one of the key traits for successful CEOs in the current health climate.

Where will the next generation of hospital CEOs come from?By Yvan Marston

H

Dr. McLellan, CEO, Sunnybrook Health Sciences Centre at one of the hospital’s leadership development sessions.

Cover story

Photo courtesy of MediaSource-Doug Nicholson.


Large- and medium-sized hospitals are more likely to have a robust leadership development system at work, but all hospitals have the opportunity for staff to understand and even participate in the development of care in the community.



“It’s not enough to go the traditional route of being an accountant to manager of a department, to director and VP. The skill set needed now is one that under-stands broad performance such as utiliza-tion rates and understanding the impact of the hospital within the community,” she says, adding that with system change, it’s important for CEOs to be able to under-stand what is best for the community rath-er than what is simply best for the hospital.

This type of broader approach to leader-ship thinking is at the heart of most lead-ership training. Bluewater’s own formal-ized leadership training is in its third year and it partnered with Lambton College to launch a Board of Governor’s certifi cate program for leaders. But future leadership, Denomy offers, should also be understood in the hiring processes at levels below se-nior executives.

“You should be recruiting with the no-tion that you want to keep them and advance them. Rather than hiring for a single position, consider what’s ahead and what opportunities they could grow into,” she says.

Large-and-medium-sized hospitals are more likely to have a robust leader-ship development system at work, but all hospitals have the opportunity for staff to understand and even participate in the de-velopment of care in the community.

Sunnybrook’s senior team is part of a number of processes outside the hospital, from Health Links to LHINs to ministry of health projects; it works to fi nd new ways to provide care outside the hospital, explains CEO, Dr. Barry McLellan.

He sees the next generation of senior leaders not only as assets to the hospital, but as stewards of the health system itself.

“They need to be system leaders and spend more time on issues like how best to provide primary care, and how commu-nity care can, frankly, prevent people from coming to hospitals and help them to get out of hospitals sooner,” he says.

It’s a team-based approach but where the team is beyond the hospital walls so that the skill is not only in partnering, but also in having a lens on the needs of the patients and how a system can deliver that, he explains.

While healthcare has some learning to do in the area of leadership develop-ment, Sunnybrook stands among those taking matters into its own hands. The hospital’s Leadership Development Insti-tute works with U of T’s Rotman School

of Management and York University’s Schulich School to deliver leadership pro-gramming for middle and senior managers, and initiatives such as its strategic work-force planning retreat, tackles succession planning and allows managers to discuss emerging leaders and their development. It’s an environment where leadership is seen as a shared resource.

“We’re growing talent and we have leaders growing within the organization, but if individuals benefi t from our lead-ership training and go off to work for an-other hospital in a more senior leadership position, that’s great for the system,” says McLellan.

Southlake Regional Health Centre’s president and CEO Dr. Dave Williams holds a similar perspective on the impor-tance of taking a broader view on building leadership capacity because, as he puts it, the big changes in healthcare are going to occur at a system level.

“We can support emerging leaders by decreasing the competitive aspect and placing a greater importance on collabora-tion,” he says. Southlake is one of the six GTA and York Region hospitals that make up The Joint Centres for Transformative Healthcare Innovation, which served to formalize the knowledge sharing in which these hospitals were already engaged.

Designed to share innovative ways to improve patient care and increase effi -ciency, it’s a collaborative unlike any in the province. And it serves as a means for partners to identify talent in various orga-nizations.

“If you are developing a leader and they’re good but they don’t have the op-portunity to move up, you run the risk that they will fi nd a job elsewhere. In that case, what they’re doing is bringing your organi-zation’s best practices to a new organiza-tion. And that’s immensely powerful,” he explains.

Williams sees consumer expectation as the next big force of change in healthcare. If the goal of the system is to maintain wellness and meet needs, then leaders have to understand not only how to work with families and patients, but how to work with other providers and institutions to deliver better care.

That’s why the notion of building lead-ers for the system is so important, says Wil-

liams, because it cuts to the heart of the matter. “Not everyone who needs health-care goes to a hospital.”

As a broad approach to system leader-ship takes root, the OHA’s president and CEO, Anthony Dale, points out that the current hospital leadership has been driv-ing change in a number of ways.

“Ontario’s fi scal challenges have gen-erated new ways about thinking about health system transformation, and hospi-tal leaders have been at the centre of this

innovation, driving forward with quality improvements, such as integrated funding models for post-acute care, funding reform and health hubs,” explains Dale. “Thanks to this leadership, hospitals are becoming more effi cient and providing better quality of care for patients.” ■H

Yvan Marston is a Toronto-based communications writer who has helped to develop several reports on health human resources.

To cultivate system leaders, some hospitals are engaging in important talent development work to identify and build leadership capacity within the system.

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Hospital CEOs


24 From the CEO's Desk

oday’s health care system can be characterized as one that is under enormous strain given our demographic and eco-

nomic realities. The changes underway in Ontario are nothing short of daunting and the stakes couldn’t be higher. At the heart of this transformation is a desire to sustain our cherished system that is anchored on the principle of universality, while we also pursue improved service access for our communities and better quality of care for our patients.

There is no doubt that to achieve these lofty goals, our system will need to adapt in so many ways – deploying new medical technologies, leveraging electronic health records, integrating our providers to re-move the silos within the system, and em-bracing a more holistic approach to health and wellness, to name a few. I believe that one particular strategy holds the most promise in leading this health system trans-formation – the relationship and approach we take as providers with our patients, their families, and caregivers.

There is a growing body of research and evidence on the links between the patient experience and clinical safety and health outcomes, as well as improvements in satisfaction and system cost effectiveness. Other jurisdictions have long recognized the importance of engaging patients when redesigning their health care system. For example, in 2004, the British Design Coun-cil noted: “The biggest untapped resources in the health system are not doctors but users (of the service). We need systems that allow people and patients to be rec-ognised as producers and participants, not just receivers of systems… At the heart of the approach users will pay a far larger role in helping to identify needs, propose solu-tions, test them out and implement them, together.”

The British National Health Service’s Institute for Innovation and Improvement embraced this approach and defi ned fi ve

‘core principles’ of experience-based co-design in a health care context:• A partnership between patients, staff,

and carers; • An emphasis on experience rather than

attitude or opinion; • Narrative and storytelling approach to

identify ‘touch points’; • An emphasis on the co-design of

services;• Systematic evaluation of improvements

and benefi ts.In short, redesigning services is seen as

a shared activity between providers and their patients, families, and caregivers. It’s a partnership approach that requires direct user and provider participation in a face-to-face collaborative venture to co-design services. The focus is shifted to one of de-signing experiences as opposed to systems or processes, thereby requiring new meth-ods, such as narrative-based approaches and in-depth observation.

A patient-centred philosophy to care represents a paradigm shift for our health care system, and it also means a cultural shift at the institutional level. At the sys-

tem level in Ontario, this transformation is not only recognized as essential, but it’s well underway. The Ministry of Health and Long-Term Care has set the stage and ex-pectations through their action plan, “Pa-tients First: Action Plan for Health Care,” which is “designed to deliver on one clear promise – to put people and patients fi rst by improving their health care experience and health outcomes.” In addition, Health Quality Ontario has identifi ed the patient experience as a top priority with dedicated resources to support providers and patients to implement leading practices. New regu-lations further enhance the involvement of patients and provider responsiveness to their needs, such as patient participation in preparing the hospital’s annual Quality Improvement Plans.

At the institutional level, there are nu-merous organizations in the province that have led the way – shout outs go to Kings-ton General Hospital for their comprehen-sive patient engagement strategy, including their Patient and Family Advisory Coun-cils, and the groundbreaking Northumber-land PATH (Partners Advancing Transi-tions in Healthcare) project sponsored by The Change Foundation, among others.

At The Scarborough Hospital, we have a longstanding history of understanding and adapting to the needs of one of Canada’s most diverse populations. We were one of the fi rst hospitals in Ontario – over 20 years ago – to dedicate a department and a director focused on diversity, to meet the needs of our changing community and pa-tient profi le. In 2009, we took our actions a step further, embedding the patient ex-perience in the core of our new mission statement, “To provide an outstanding care experience that meets the unique needs of each and every patient.”

Over the years, this mission has become a passion and an intrinsic way in which we operate. It’s clear our team has a strong foundation to guide this journey of trans-formation and further evolve our culture of

patient engagement. Our approach at The Scarborough Hospital is multi-faceted and touches the organization at all levels – at the top through our Board governance, at the program/service level in planning and design activities, and at the front-line where the interface between staff and pa-tients matters most.

At the governance level, earlier this year our Board of Directors approved a new strategic plan, and “Patients as Partners” was identifi ed as one of four new strategic directions for the organization. We wish to engage patients and families in a mean-ingful way to enhance their experience, promote shared care, and improve quality of care.

As well, our hospital recently transi-tioned its community council to one with an expanded mandate that now includes the ‘patient voice.’ The Community and Patient Advisory Council will provide guid-ance on overarching patient engagement activities and reports directly to the Board of Directors. In addition, the Quality and Safety Committee of the Board is focused on how to best monitor and measure our success in achieving better outcomes from these patient engagement activities.

At the patient program/service level, The Scarborough Hospital adopted Lean quality improvement methods a number of years ago, which have demonstrated suc-cess in improving care outcomes and oper-ating effi ciencies. A core principle of Lean is to engage those who perform the work – namely, the front-line staff – in designing better solutions to remove waste in their processes and focus on adding value to our patients. We have extended these Lean ac-tivities to include patients and caregivers to co-design our processes and take into account their experiences.

At the front-line level, an enhanced model of interprofessional care, based on key patient-centred principles, is being developed with a goal of learning with, from and about each other (providers and patients) to develop better perspectives. Other deliverables being pursued that en-gage patients and caregivers span the or-ganization: the development of shared care plans; change of shift reports at the patient bedside; a review of the hospital’s visitor policy; patient involvement in new staff orientation; and, improvement in hospital way fi nding; to name a few.

From international best practice re-search, to what we’ve learned right here in our own hospital, it’s clear that collabora-tion with our patients and families will lead to better care experiences, improved qual-ity outcomes, and a more effi cient health care system overall. While this journey may not always be smooth, it’s worthy of our collective energy and commitment. ■H

Robert Biron is President and CEO, The Scarborough Hospital.

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Making our patients our partnersBy Robert Biron

T

There is a growing body of research and evidence on the links between the patient experience and clinical safety and health outcomes, as well as improvements in satisfaction and system cost effectiveness.

Robert Biron



esearch shows that many se-niors admitted to hospital emergency departments expe-rience a signifi cant decline in

functional ability, which can extend their hospital stay and create additional com-plications. As a result, they often need ad-ditional help to regain their independence before they can return home safely.

At Trillium Health Partners, over half of all patients admitted via the emergency department (ED) are 65 years of age or older. Christine Dias, Trillium Health Part-ners’ Clinical Nurse Specialist in Geriatric Emergency Management, knew there had to be a simple solution that could help el-derly patients remain more mobile during their hospital stay, helping them go home faster.

“When thinking of this problem, I knew the solution had to fi t a busy emergency department – it needed to be a simple, fast, and an easy fi t for ED nurses to work with,” says Christine Dias. “So, I came up with Eat in a Seat – a simple way for elderly pa-tients who are medically able to do so, to get up and eat at least one meal per day while seated in a chair.”

Eat in a Seat empowers elderly adult patients to retain more of their functional abilities by eating at least one meal a day in a seated position, helping them retain key functional abilities such as balance, mobil-ity, or independence with self-care activi-ties, and improving the overall patient ex-perience. In the fi rst three months of the program operating at Trillium Health Part-ners’ Mississauga Hospital, the number of seniors admitted to the ED who were up in a chair for breakfast went from two per cent since its inception in March 2015, to a remarkable 63.8 per cent this past June. This was due in part to the overwhelming-ly positive response Eat in a Seat received from the ED nurses, most of whom Chris-tine was able to personally train as part of Trillium Health Partners’ annual skills day this year.

“Eat in a Seat is easy to implement be-cause it is the same treatment for every pa-tient, allowing us to assess them and their mobility needs,” says Nancy Gilchrist, Emergency Department Nurse, Trillium Health Partners. “It promotes healthy eating and cognitive stimulation for our patients, and patients really enjoy getting

out of bed and sitting in a chair to eat – it makes them feel better. They smile when their food arrives and their families com-ment on how wonderful it is to see them out of bed. I fi nd it encourages them to be more independent.”

Patient Florence Muirhead agrees. “It’s so much more comfortable and enjoyable not to have to eat in your hospital bed,” she says. “It just feels so much better.”

Eat in a Seat is currently running as a pilot program at the Emergency Depart-ment of Trillium Health Partners’ Missis-sauga Hospital site, and is being consid-ered for broader adoption across its other sites and program areas. ■H

Ania Basiukiewicz is a Communications Advisor at Trillium Health Partners.

Innovative program helps seniors in ED get home fasterBy Ania Basiukiewicz

R

Christine Dias, Clinical Nurse Specialist developed the Eat in a Seat Program for patients like Florence Muirhead who are medically able to get up and eat at least one meal per day seated in a chair.

‘Eat in a Seat’

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COMING IN JANUARY 2016



t’s been a remarkable 12 months at Ontario Shores Centre for Mental Health Sci-ences (Ontario Shores).

Since being recognized by Healthcare Information and Management Systems Society (HIMSS) for achieving Stage 7 in the Electronic Medical Record Adoption Model (EMRAM) in October, 2014, there has been a steady stream of celebrations.

Becoming the fi rst hospital in Canada and the fi rst mental health hospital in the world to achieve the HIMSS Analytics EMRAM Stage 7 Award has proven to be a hallmark achievement for our organiza-tion. More recently, Ontario Shores was named a 2015 recipient of the HIMSS Nicholas E. Davies Enterprise Award for Excellence, which recognizes the outstand-ing achievement of using health informa-tion technology to substantially improve patient outcomes while achieving return on investment. We are the fi rst hospital in Canada and one of 77 organizations in the world to receive this prestigious recogni-tion.

Awards and recognition is wonderful. The attention we have received as a result of these accomplishments not only en-hances the reputation of our organization, but also instills a greater sense of pride in our patients, staff, family members and the community.

As proud as we are of our accom-plishments, we’ve enjoyed the journey much more.

Ultimately within our organization, achieving Stage 7 or any other achieve-ment must result in providing an answer to one simple question.

What does this mean for the care being provided at Ontario Shores?

As the Director of Professional Practice and Clinical Information, it is important for me to highlight that achieving Stage 7 and earning the Davies Award was not about the awards themselves but rather about the principles this designation pro-motes: patient safety and quality of care. Our transformation advanced a culture of adoption with our electronic medi-cal record (EMR), where we are not just ‘dumping’ data into the EMR but in fact using the information towards enhancing patient safety and the quality of mental health care we provide at Ontario Shores.

An example of such quality is the wide-spread use of our computerized physician order entry (CPOE), where prescriptions are no longer handwritten or transcribed.

Our excellent and engaged team of physi-cians truly appreciates the safety concerns related to non-CPOE order entry. Our CPOE rates have been greater than 90 per cent (currently 94 per cent) for over a year, demonstrating the positive impact the EMR has on practice. Before having an electronic medical record, we would not have been able to effectively deter-mine any of this information and promote patient safety in this domain. Similarly, our nurses who are dedicated to patient safety, have been adhering to best prac-tices related to medication administration by ensuring that at minimum, 95 per cent of the time or greater, medications are being scanned into the electronic Medi-

cation Administration Record prior to administration.

In addition, from a quality of care lens, we have leveraged data analytics to sup-port the implementation and adherence to our Clinical Practice Guidelines in the assessment and treatment of schizophre-nia and metabolic monitoring. For exam-ple, we have seen a 27 per cent increase in adherence to metabolic monitoring for people on antipsychotics and almost a 20 cent decrease in the percentage of pa-tients on multiple antipsychotics, which all align with evidence-based practices recommended in the Clinical Practice Guidelines. The use of the EMR has been integral to this process, as it has provided

us with the ability to transform the clini-cal team’s day-to-day documentation into clinical dashboards available to our provid-ers and clinical leadership teams, inform-ing them of key information about adher-ence and outcomes related to our Clinical Practice Guidelines.

These are just a few examples of how we, at Ontario Shores, are advancing ex-emplary mental health care while leverag-ing the EMR as an enabler. Today, in our paperless clinical environment, our EMR system supports enhanced patient safety, improves the delivery and quality of mental health care, and uses standardized clinical documentation in an environment which is effi cient, secure and collaborative. We look forward to continuing to build on our work thus far and advance the care being provided at Ontario Shores to our patients and families. ■H

Sanaz Riahi is Director of Professional Practice and Clinical Information at Ontario Shores Centre for Mental Health Sciences.

First Canadian hospital to win prestigious awardBy Sanaz Riahi

I Our transformation advanced a culture of adoption with our electronic medical record (EMR), where we are not just ‘dumping’ data into the EMR but in fact using the information towards enhancing patient safety and the quality of mental health care we provide at Ontario Shores.

From labs to lives:Innovation improves quality of life of Canadians

round-breaking technological advancements and innova-tive treatments and therapies enhance a patient’s experience

in a hospital setting, prevent exposure to illness, and improve health outcomes and quality of life. From coast to coast, Canada’s health research community is dedicated to promoting innovation, facilitating inquiry, and integrating re-search into practice.

A pivotal study led by researchers at Fraser Health and Vancouver Coastal Health aims to improve the reproductive health of immigrant women who may have been exposed to dangerous contaminants including heavy metals and environmen-tal toxins. Researchers believe that wom-en could potentially be exposed to such contaminants through imported powders, candies, cosmetics, occupations such as metal work, welding or furniture refi n-ishing, glazed cookware or those made of copper or bronze, or diet.

The study will test these women’s con-taminant level and teach them how to re-

duce their exposures and concentrations if they are too high. This is especially useful information for women who intend to be-come pregnant, as materials such as lead and mercury are known to be transmitted from pregnant mothers to their fetuses, af-fecting fetal development and growth.

In Ottawa, Hôpital Montfort has devel-oped a sleep clinic that includes a sleep laboratory at the cutting edge of technol-ogy dedicated to the diagnosis, evaluation and treatment of sleep disorders, includ-ing sleep apnea, a serious disorder that causes your breathing to stop repeatedly while you sleep. These breathing pauses or “apneas” usually last 10 to 30 seconds and can occur many times throughout the night. For sufferers, sleep apnea is like be-ing shoved in the shoulder all night long. Every time you stop breathing, it gives you a little shove just to get you going again. Other symptoms include headache, acid refl ux, snoring and sweating throughout the night.

Sleep apnea is also associated with a two-fold increase in risk of developing

cardiovascular diseases. To better under-stand this association, researchers from the Institut de recherche de l’Hôpital Montfort (IRHM) explore how obstruc-tive sleep apnea may disrupt blood lipids clearance, a potential culprit favoring cardiovascular disease development in these patients.

The researchers are also investigat-ing a cutting edge non-pharmacological intervention involving a combination of educational, cognitive, and behavioural interventions in chronic insomnia pa-tients in a study supported by the Cana-dian Institutes of Health Research. This study is also looking to improve access to health services for Francophones liv-ing in minority communities by offering these interventions through videoconfer-ence or telemedicine. Hôpital Montfort’s ground-breaking sleep laboratory and the IRHM researchers are working together to offer Canadians the treatment they need for a much needed good night’s sleep and improve their quality of life.

By Claire Samuleson

G


At Ontario Shores our fully integrated EMR is allowing us to use information to enhance patient safety and the quality of mental health care.

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ospitals are constantly tasked with the challenge of increas-ing internal capacity without compromising existing bud-

gets or the patient experience. To that end, many have turned to Lean and Six Sigma training as a collaborative means to seek out bottlenecks and streamline pro-cesses for the greater good.

In June 2014, Integrated Health Solu-tions, a division of Medtronic, embarked on a project with William Osler Health System’s (Osler) Diabetes Education Cen-tre at Brampton Civic Hospital, focused on freeing up capacity to meet growing patient demand. Osler’s Diabetes Educa-tion Centre provides essential educational and nursing services to help individuals and their families understand, control and manage diabetes. It offers various catego-ries of services: nursing and dietitian sup-port for Type 2 diabetes patients; coun-selling and insulin management for Type 1 diabetes patients; gestational diabetes management for pregnant women; and paediatric diabetes support.

One interesting anomaly of note is that Peel Region has one of the highest preva-lence rates of diabetes in Canada, 10 per cent versus the national average of just over fi ve per cent, placing signifi cant de-mand on the Diabetes Education Centre. Among other issues, the Diabetes Edu-cation Centre was experiencing a 45 per cent no-show and cancellation rate, tak-ing time away from other patient visits and leading to longer wait times.

Integrated Health Solutions worked with the Osler Diabetes Education Centre to tailor a solution that would increase the number of new patient visits and capacity for classes, as well as decrease the number of no-shows. The fi rst step was to con-duct a fi ve-day formal Six Sigma training workshop for project teams comprised of dietitians, nurses and administrative staff.

Over that time, the teams worked togeth-er to review processes, fi nd bottlenecks within the system, and develop solutions.

A key element involved mapping the value stream of the process from the pa-tient’s perspective, assessing what worked/what did not, how long each step took, and its inherent value. This mapping ex-ercise is considered to be one of the stron-gest tools in Lean training.

Following the fi ve-day engagement, Integrated Health Solutions then worked with the team to develop an action plan outlining tasks and requirements. The pro-gram’s clinical services manager followed up on every action item to ensure the deadlines were met. This was facilitated through daily performance huddles for di-etitians, nurses and administrative staff.

Key action items included streamlining the medical reporting systems by merging three databases into one. This initiative alone saved over 2,300 working hours and allowed staff members to focus less on ad-ministration and more on interacting with patients. Another signifi cant outcome was reducing redundancy by eliminating a 25 per cent overlap in what dietitians and

nurses were covering during patient ses-sions. This move reduced session times by 25 per cent with no negative impact on training or the perceived patient experi-ence.

Overall, the outcomes have been ex-ceptional. New patient visits per full-time employee have increased by 33 per cent; gestational diabetes management capacity has increased by 20 per cent; and impaired glucose tolerance class capacity has seen a 45 per cent improvement.

In addition, the no-show rate has been reduced from 45 to less than fi ve per cent, allowing for more patient interactions with no additional time investment. Lastly, streamlining paperwork has saved 2,600 hours of team time annually; while data re-dundancy has been reduced by 60 per cent.

To ensure a sustainable process, the entire project team earned their Lean Six Sigma Yellow Belts. This has provided the Diabetes Education Centre with the inter-nal capacity to continue managing similar projects and enabled it to be much more effective in improving internal capacity on an ongoing basis.

Perhaps the most important takeaway from this is that all of these outcomes were achieved while maintaining patient satisfaction rates and service delivery. Medtronic Integrated Health Systems was pleased to be a key community partner to Osler and looks forward to partnering with other health care providers to help address the needs of their communities. ■H

Morteza Zohrabi, MD is a Lean Sigma Black Master Belt and Integrated Health Solutions Lead Consultant at Medtronic Canada.

Expanding capacity without adding resources By Morteza Zohrabi

H

A key element involved mapping the value stream of the process from the patient’s perspective, assessing what worked/what did not, how long each step took, and its inherent value.

The fi rst step in the Integrated Health Solutions process was to conduct a fi ve-day formal Six Sigma training workshop for project teams comprised of dietitians, nurses and administrative staff.


Researchers and physicians at Vitalité Health Network and Horizon Health Net-work in New Brunswick have partnered on a project aimed at ending the use of slid-ing scales to determine insulin therapy for diabetes. Evidence shows that the sliding scale approach in which regular insulin is given only in response to particularly high blood glucose levels can lead to erratic glu-cose control, resulting in patient risk and longer hospital stays. Researchers wish to enable the adoption of novel treatments including a nutritional insulin regimen based on individualized treatments and a collaborative model of care.

About one in 10 residents of New Bruns-wick live with diabetes. About 20 per cent of all hospitalized patients have diabetes, but use almost 30 per cent of beds in the province. Developing better protocols for glycemic management will result in better

health outcomes for patients living with diabetes and ultimately health care sus-tainability in New Brunswick and across the country.

In Prince Edward Island, clinician sci-entists are leading a study aimed at eradi-cating hepatitis C. Newly approved oral medications have proven cure rates of 90 to 97 per cent and minimal side effects. Previous generations of hepatitis C medi-cations were given intravenously over long periods of time, with side effects including pain, fatigue and low blood counts. The next challenge is dissemination – getting these medications to everyone who’s in-fected in order to wipe out the virus in the population as a whole. ■H

Claire Samuelson, MA is a Policy Analyst, Research and Innovation at HealthCareCAN.

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From labs to lives


28 Legal Update

n today’s complex technology environment there are doubts across many sectors as to whether there is enough focus

on supplier relationships and in the context of cybersecurity. Healthcare is no excep-tion. Hospitals and other health care fa-cilities hold vital data about their patients, staff, and medical practices. These institu-tions are high value targets for unscrupu-lous theft of data. Add to this the increas-ing number of connected or electronically tagged medical devices entering the health system, and the result is a rich fi eld for criminal organizations, disgruntled insiders and others bent on mischief to penetrate and disrupt health-related systems.

An institution’s focus on cybersecurity must extend beyond locking down and monitoring its internal systems and in-formation practices. Some of the largest data breaches, including in health care, have occurred in connection with suppli-ers providing services to the enterprise, not a failure of internal practices and policies. Some of these suppliers were not technol-ogy suppliers at all, but rather suppliers of non-technology related products and ser-vices who had incidental access to systems. Extending safe data practices from internal practice to suppliers involves focusing on pre-contract diligence, contract terms and attentive contract compliance manage-ment throughout the supplier relationship.

In health care systems, data security is also governed by legislation protecting personal health information. Such legisla-tion recognizes the importance of suppliers in the protection of personal information. For example the Personal Health Informa-tion Protection Act (Ontario) deals specifi -cally with the responsibility of agents and service providers with respect to personal health information, and regulations to the Health Information Act (Alberta) set out general provisions that must be included in an agreement with an “information manag-er”. While bearing these legislative require-ments in mind, agreements with suppliers should be generally based on best practices and direct the supplier to take practical steps that will help prevent breaches and, if a breach occurs, bring the supplier into the process to solve or reduce the impact of the breach.

The following are proactive steps that health care institutions should take to manage these risks.

Knowing the environment. First it is important to have a full appreciation of what data and systems are vital to the operation of the institution or represent a privacy or patient safety risk. The mapping of these data categories allows for risk man-agement with respect to how such data is used internally and if, when, and how it is accessed by a third party supplier. The in-stitution should have an inventory of sup-pliers and associated supplier contracts, as well as a corresponding ranking or rating of the cybersecurity risk associated with the services provided under each supplier con-tract. Knowing where high risk data, sys-tems, and suppliers reside helps direct focus to the areas requiring most attention in an environment where resources for these ac-tivities are inevitably limited.

Knowing the supplier. When the deci-sion is made that a signifi cant data set or system is to be made accessible to a sup-plier, the institution should, either through a request for proposal process or other fact fi nding process, diligently investigate the promises and actual practices of the sup-plier with respect to cybersecurity.

Such investigation can include secu-rity questionnaires, site visits, review of supplier policies, review of security con-trols, and available third party audits of security practices.

Contracting for compliance. Informed by the knowledge gained through the “due diligence process”, the contract with the supplier should include certain key provi-sions such as the following:

• an obligation to comply with relevant in-stitution policies (e.g. physical security, requirements for connecting to systems, terms restricting access to and removal of data, and encryption requirements);

• an obligation for the supplier to com-ply with its own policies (which have been disclosed during the due dili-gence process);

• an obligation to comply with laws, specif-ically those laws in the institution’s juris-diction applicable to privacy of personal health information;

• reference to relevant external standards, such as the ISO/IEC 27000 series of standards;

• personnel related terms, such as back-ground checks and training;

• restrictions on subcontracting to ensure data and responsibility remains with the party the institution has vetted, unless agreed to otherwise;

• threat monitoring and penetration test-ing practices;

• provisions allowing audits by the insti-tution and obligating the supplier to maintain its ongoing program of audits by third parties (e.g. annual audits of controls);

• restrictions on use of data (even if anon-ymized) and obligations to return or de-stroy data at conclusion of contract; and

• obligations to promptly notify the insti-tution of data breaches or unauthorized access of data.Monitoring compliance. Ensuring that

promises made by suppliers with respect to cybersecurity are actually carried out is vital. The institution should ensure that as part of the inventory of supplier contracts discussed above and following the enter-ing into of new agreements with suppliers, there is a clear understanding of the tools available to promote compliance with the cybersecurity requirements. Appropriate personnel should be required to ensure that reporting, monitoring, and audit tools in the contracts are actually exercised with rea-sonable frequency, especially with respect to supplier contracts that touch high risk or high value systems or data.

Cybersecurity-related risk is not a tempo-rary risk faced by health care institutions or other sectors of society, but instead, a per-manent feature of risk management. Strong internal polices and controls are essential and extending the same signifi cant level of scrutiny and rigor applied internally to sup-plier relationships is another important ele-ment in any risk reduction strategy. ■HSimon Hodgett is a Partner in the Technology Group at Osler and a member of the fi rm’s Health Industry Group.

Supplier relationships can be a weak link in privacy and data security chainBy Simon Hodgett

I

Some of the largest data breaches, including in health care, have occurred in connection with suppliers providing services to the enterprise, not a failure of internal practices and policies.

nformation technology (IT) advancements in healthcare have presented many op-portunities and challenges

as clinical leaders seek the best road to wise and impactful investments that will have the greatest benefi t to patient care. Whether it’s a large-scale electronic health record, or a specialty clinical in-formation system, the ability to align op-erational and clinical objectives is no easy feat.

These complexities were top of mind when The Scarborough Hospital (TSH) implemented a new perioperative IT so-lution for the hospital’s operating rooms (ORs) in 2013. This project was part of the organization’s ongoing commit-ment to support quality improvement initiatives and increase the use of LEAN health care processes.

Our goal was to choose the best peri-operative IT solution that would help us improve performance and reduce our supply and equipment costs. With 12 OR suites, eight procedure rooms, plus an eye centre with two ORs, all spanning the hospital’s two campuses, implementation of this new solution did not come without its share of challenges.

Critical to the selection process was the ability of any new perioperative IT solu-tion to interface with both TSH’s MEDI-TECH electronic health record and No-vari patient access systems. Following

a comprehensive Request for Proposal process, TSH chose Surgical Information Systems (SIS) as their perioperative IT solution. SIS was chosen for its ability to satisfy both the hospital’s clinical objec-tives, as well as how easily it could inter-face with our existing IT systems.

Features such as intelligent surgical scheduling, nursing documentation au-tomation, perioperative-focused analyt-ics, training programs, and in-room and

mobile communications, allowed us to enhance the overall quality of our OR operations.

The Surgery program devised an ac-celerated plan to implement the SIS sys-tem within six months. This included a core team of three staff members working alongside educators. Computer training rooms were set aside to educate nurses on the new standardized workfl ows. This strategy eased the transition process and hastened adoption of the new system.

Capturing data and viewing dynamic, near real-time dashboards enabled TSH to improve purchasing decisions, better manage room blocking and utilization, and increase productivity. Within the fi rst year of implementation, TSH increased the number of early or on-time surgery completions by 35 per cent and increased room turnovers completed in less than fi ve minutes by almost 150 per cent.

Staff are now able to identify key areas of process improvement on an ongoing basis by having data at their fi ngertips. The thoughtful, strategic deployment of the SIS perioperative IT solution allowed TSH to be more effi cient, as well as im-prove the care experience for patients and families. ■H

Nurallah Rahim, RN, BScN, MHA, is Director of Surgical Services at the Scarborough Hospital in Scarborough, Ontario.

By Nurallah Rahim

I

An Operative Approach toHealth IT Implementation



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Developments in patient-safety practices.

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t’s 8 am and a team of 11 cli-nicians is gathering to discuss the needs of the nearly 100 individuals they serve in the

community, just as they do each week day morning. These health care professionals are part of ACT 3, one of seven community mental health teams across Southwestern Ontario managed by St. Joseph’s Health Care London. But the offi ce is rarely where you will fi nd these dedicated teams.

ACT stands for “Assertive Commu-nity Treatment” – a team approach that has been well documented as an effective model of community care for those living with severe and persistent mental illness. The teams are mobile, inter-professional and provide treatment, rehabilitation and support services to clients within commu-nity settings.

“We like to think of ourselves as a hos-pital on wheels,” says ACT 3 coordinator Joseph Morgan. “We go to the client wher-ever they are, whether it’s their home, a shelter or drop-in centre…even if they are currently without a place to live. We pro-vide care anywhere.”

ACT teams work together with the cli-ent and other community providers to be-

come collaborative partners in the client’s recovery, explains Morgan.

“The reality is, some individuals may have to cope with a mental illness for the long-term, often for a lifetime. We treat our clients with dignity and help them gain the skills they need to better manage their illnesses and their lives. We aim to inspire hope and encourage our clients to stay connected with us and their families to continue treatment that will allow them to live independently in the community. We constantly advocate for their needs and are non-judgmental with the choices they make.”

ACT team members are social workers, occupational therapists, nurses and psy-chiatrists. Depending on individual need, they provide medication support; addic-tion intervention, monitor physical health and mental functioning, assist with daily living skills, encourage positive lifestyle changes and seek appropriate community resources for their clients.

“First and foremost we work to im-prove the quality of our client’s everyday lives, which is especially important for those who have limited fi nancial means, family support or housing options,” says Morgan.

By building relationships with cli-ents, the ACT model also helps reduce hospital admissions, visits to emergency rooms and crisis scenarios for those with mental illness.

For those who do require hospital re-admittance, the aim is a reduced average length of stay.

“This kind of support,” says Morgan, “makes a huge difference to a great many people in our community.” ■H

Renee Sweeney is a Communications Consultant at St. Joseph’s Health Care London.

hunder Bay Regional Health Sciences Centre (TBRHSC) has launched Alert 99, a new policy that addresses the im-

mediate care of any person who requires medical attention or has experienced a collapse and/or trauma within the Health Sciences Centre building.

If a person has collapsed in a non-clini-cal area of the Health Sciences Centre but is responsive, able to communicate and answer questions, an Alert 99 is called. If that same person has experienced an in-jury, Alert 99 Trauma is called. Both alerts have specifi ed response teams that are trained to address the incident safely and effi ciently.

“Safety is always our priority here at the Health Sciences Centre and this policy helps to ensure the wellbeing of every per-son who comes through our doors,” says Jennifer Masiak, Lead for Emergency Plan-ning and Enterprise Risk Management, TBRHSC.

Alert 99 encompasses the whole spec-trum of incidents from minor slips and falls, to more serious collapses resulting in trauma. It is different from a Code Blue, which is used in cases of cardiac arrest.

“We developed Alert 99 to address col-lapses or incidences requiring care within non-clinical areas of the hospital,” ex-plains Kerry Posselwhite, Clinical Nurse Specialist for Emergency and Trauma Ser-

vices, TBRHSC. “Rather than calling an unnecessary Code Blue, we wanted to en-sure that we were responding in the best way possible, with the most appropriate resources.”

After creating a new hospital wide pol-icy, the next challenge becomes making everyone aware of it – which is not an easy task considering the Health Sciences Cen-tre has nearly 3,000 employees and hun-dreds of volunteers.

“This project was unprecedented for us given the level of awareness that was required by everyone in the hospital,” explains Kendra Walt, Interprofessional Educator, RN, TBRHSC. “Responding personnel such as nurses, security guards, and respiratory therapists were given for-mal training. The rest of the staff and vol-unteers were given information packages.”

Since the policy was launched on June 29th, four or fi ve calls have been made and all of them have gone very smoothly.

“Feedback has been nothing but posi-tive,” says Walt. “Alert 99 has been espe-cially helpful for staff and volunteers who would not normally have received front-line response training. Everyone is happy to now have clear directions on what to do should someone collapse and they can confi dently be a part of ensuring safety within the Health Sciences Centre.” ■H

Maryanne Matthews is a Communications Offi cer at Thunder Bay Regional Health Sciences Centre.

By Maryanne Matthews

T

New policy streamlines patient safety

Jennifer Masiak, Lead for Emergency Planning and Enterprise Risk Management, Kerry Posselwhite, Clinical Nurse Specialist for Emergency and Trauma Services, and Kendra Walt, Interprofessional Educator, RN, are just a few of the dedicated health professionals from TBRHSC who helped develop and implement Alert 99.

Community care in ACTion

By Renee Sweeney

I

St. Joseph’s Assertive Community Treatment teams are on the go, providing care and support to individuals living with persistent mental illness wherever they may be.

Social worker Susanne Goudswaard, left, visits with ACT 3 client Tobi over coffee each week to discuss and monitor how she’s doing with daily tasks, overall functioning and to intervene should she be experiencing diffi culties. Providing side-by-side assistance with daily tasks is also a part of a comprehensive rehabilitation plan for all ACT clients.



ow does a hospital, with pa-tients from across Ontario, initiate a dialogue with pa-tients and families, both dur-

ing their hospital stay and beyond? For Sunnybrook, the answer was as simple as looking online.

With a strong social media presence, Sunnybrook began to reach out to patients and their families online. The hospital’s 26,000 Twitter followers and others were invited to offer their opinion on a variety of issues impacting the patient experience at Sunnybrook. A special section of the website, www.sunnybrook.ca/engagement,

has been dedicated as the hospital’s vir-tual town hall.

The issue of caller ID, and whether or not the hospital should have ‘Sunnybrook’ identifi ed as an incoming caller, was an ideal engagement issue. Due to a sense of privacy, calls from the hospital ap-peared as ‘Unknown Name’, which made sense when caller ID was fi rst introduced on home phones. The logic was to main-tain a patient’s privacy in a home where other members of the household may be unaware the person was a patient at the hospital.

With the mass proliferation of cell-phones in the past few years, people began ignoring calls from an ‘Unknown Name’ and as a result were missing information such as clinic appointment times. To settle the issue, Sunnybrook took to its online community and asked a simple question: “Are you happy with the call appearing as ‘unknown’ or would you prefer to know the call is coming from Sunnybrook Hos-pital?” Over 85 per cent of respondents said they would prefer to know the call is appearing from Sunnybrook. Based on this feedback, calls are now identifi ed as “Sunnybrook Hospital”.

“Reaching out online seemed to make the most sense for our organization,” says

Craig DuHamel, Vice President Commu-nications and Stakeholder Relations at Sunnybrook. “About 65 per cent of our patients live outside of Toronto and it seemed unreasonable to ask them to come in for a meeting. This way, they can en-gage on a topic on their own time, from the comfort of their own home.”

Sunnybrook has asked its virtual com-munity to weigh in on issues such as whether or not the hospital should build shelters for smokers, to asking people their opinion on redesigning the main en-tranceway to its busiest campus.

Feedback from the online engagement is provided to those areas internally who

will benefi t most from the information. The results are also shared with the Se-nior Leadership Team, who use the infor-mation collected to help inform decisions.

“Patients appreciate us asking their opinions, and it’s quick and easy to en-ter the debate,” says Sivan Keren Young, Manager of Sunnybrook’s web communi-cations team. “This is our modern-day virtual town hall and we’re getting tan-gible results from putting patients fi rst.” ■H

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

Sunnybrook reaches out to its virtual communityBy Marie Sanderson

H

Sunnybrook has asked its virtual community to weigh in on issues such as whether or not the hospital should build shelters for smokers, to asking people their opinion on redesigning the main entranceway to its busiest campus.

Patient Sally Nicholson visits a recent engagement topic at www.sunnybrook.ca/engagement from the comfort of her front porch. Photo credit: Media Source).



ne year since its launch, Hospital Elder Life Program (HELP) of the Thunder Bay Regional Health Sciences

Centre (TBRHSC) has a lot to celebrate. “The HELP program is primarily

known as a delirium prevention program, but is also known for maintaining cogni-tive and physical functioning, maximiz-ing independence at discharge, reducing hospital stays, and reducing readmis-sion rates,” explains Kelsey Lecappelain, HELP Coordinator, TBRHSC. Delirium is a sudden onset of confusion and can be brought on by a number of factors that are assigned with lengthy hospital stays.

“In our fi rst year on our pilot unit, The HELP Program has shown success in reducing average elderly hospital stays from 12 to 7 days, reducing delirium rates from 10 per cent down to one per cent, reducing the number of senior patients discharged to long-term care from 10 to one per cent, and preventing mental and functional decline in older patients while maintaining their dignity and respect,” says Lecappelain.

A registered, comprehensive program of care for hospitalized older patients, HELP was designed to prevent delirium and functional decline during hospitaliza-tion. Using a team of well-trained volun-teers, it helps elderly patients to be more functional and independent when dis-charged from hospital.

Over 400 senior patients have been enrolled in the program to date. Patients receive daily visits from volunteers who provide therapeutic activities and games, walking or exercise, and help with feed-ing. In the past year, HELP volunteers have collectively provided over 1,600 hours of quality time with patients.

“HELP is an important program, pro-viding meaningful and cost-effective care that speaks loudly to TBRHSC’s Seniors Health initiative, which is a Strategic Di-

rection identifi ed in TBRHSC’s Strategic Plan 2020. It also provides a constructive, concrete experience to prepare families, communities, and our health care system for our aging society,” says Lecappelain. The need for senior care in the com-munity is growing rapidly and the HELP program has been crucial in maintaining the highest level of personal attention and support that is valued by TBRHSC patients and their families.

“The volunteers were there when I

needed to talk. HELP is an excellent program and I am very happy it’s being implemented,” stated a previous HELP patient. “This is a great program for my mother,” said another patient’s family member. “The volunteers are friendly and great for my mother’s morale. Our family is extremely satisfi ed.”

Lecappelain also notes that patients and families aren’t the only ones benefi ting from HELP. TBRHSC staff is also happy to have the program on their units. “We have received really positive feedback from staff, stating that their patients have been hap-pier, they enjoy the interaction, and their cognitions have improved thanks to the HELP program,” she says.

TBRHSC is always looking for more vol-unteers to provide support and compan-ionship for patients enrolled in the HELP program – particularly those who are avail-able for daytime shifts. If you are over 18 and interested in becoming a HELP volun-teer, please contact Volunteer Services at 684-6267 to learn more.

The HELP program will be featured in the CBC series “Keeping Canada Alive”, which will give viewers an unprecedented look at the health care system and the powerful emotional stories that take place within it. “Keeping Canada Alive” airs Sundays at 9 p.m./9:30 NT starting Oct. 4 on CBC. It can also be viewed online at www.cbc.ca/keepingcanadaalive ■H

MaryAnne Matthews is a Communications Offi cer at Thunder Bay Regional Health Sciences Centre.

Improving care for elderly patientsBy Maryanne Matthews

O

Patients enrolled in HELP receive daily visits from dedicated, well-trained volunteers who help reduce delirium and improve the overall experience of TBRHSC’s senior patients.

Please contact Denise Hodgson

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t delivers a life-saving shock to the heart without ever actu-ally touching it. Doctors at St. Paul’s Hospital, in collabora-

tion with Cardiac Services BC and a group of physicians from around the province, have taken a step towards revolutionizing the care of people with cardiac arrhyth-mias in British Columbia by implanting the fi rst ever subcutaneous implantable cardioverter defi brillator (S-ICD) in BC.

“One of the biggest challenges we face with implantable defi brillators is the inva-siveness of the procedure, ” says Dr. Jamil Bashir, cardiac surgeon and director of the laser lead extraction program at St. Paul’s. “This new device is a paradigm shift that allows us to shock the heart without hav-ing to place a wire in the blood vessels. Because the heart and blood vessels are untouched, the potential for blood vessel injury is eliminated, the potential for sys-tem infection is reduced and the patient’s vein access is preserved for the future.”

The primary purpose of the device is to monitor the patient’s heartbeat and deliver a potentially life-saving shock that disrupts a fast heart rhythm and resets the heart. Conventional ICDs, which involve a lead being placed in the veins of the upper chest, are connected directly to the heart. This feature is required for many patients who receive an ICD, and remains the stan-dard of care in BC. The S-ICD, on the

other hand, uses electrodes placed just un-der the skin (in the extrathoracic space) and not in the heart, leaving the heart and veins untouched. The device delivers a shock across the chest wall with the heart positioned in between.

Mike McLellan, a sporting goods whole-saler from Squamish, was the fi rst patient in BC to receive a S-ICD. The 44-year old father of three has not only fully recovered from surgery, but completed a grueling, four-day, 650 kilometer bike ride just a few months after having the device implanted.

“The S-ICD will only fi re if it detects that I need it, ” says McLellan. “I kind of look at it like a lifejacket. It’s always lis-tening to my heart and it can differentiate between exercise and a medical issue.”

The S-ICD provides defi brillation therapy for the treatment of life-threat-ening ventricular tachyarrhythmias. It is a promising new device because the ab-sence of an intracardiac lead means the need for complicated surgeries to extract failed leads is avoided. This complica-tion occurs in about one in 200 patients every year.

“To be the age that I am, relatively young for heart issues, it allows you to not be at risk for that invasive lead removal or lead extraction with traditional ICDs,” says McLellan.

Nearly 1,000 conventional defi brillators are implanted in patients around the prov-

ince per year for protection against poten-tially fatal arrhythmias. In addition to the defi brillation feature of an ICD, many pa-tients also require longer term pacing. At this time, the S-ICD is currently unable to provide this therapy but may eventually be suitable for patients with other types of heart disease.

Since the fi rst procedure, St. Paul’s Hos-pital, in collaboration with Cardiac Ser-

vices BC and a provincial physician review panel, has implanted 18 more S-ICDs into patients. The implant team has been led by Dr. Bashir, cardiac surgeon and direc-tor of laser lead extraction program at St. Paul’s. ■H

Justin Karasick is Director, Communications & Public Affairs at Providence Health Care.

By Justin Karasick

I

St. Paul’s Hospital implants next generation defi brillator

Mike McLellan of Squamish was the fi rst person to have an S-ICD, or sub-cutaneous implanted cardio defi brillator, installed at St. Paul’s Hospital in Vancouver. He recently completed a four-day, 650 Km bike ride, only months after the operation.

One of the biggest challenges we face with implantable defi brillators is the invasiveness of the procedure. This new device is a paradigm shift that allows us to shock the heart without having to place a wire in the blood vessels.



nce upon a time, there was a simple way to gather health-related information: Visit your family doctor or local medical

facility, go to your local public library, con-tact a community agency or medical estab-lishment or ask friends and family for help.

In more recent times, it became the norm to search “Professor Google” for de-tails about any and every topic under the sun. The problem was, however, that this method of gathering information would pull up just that – “everything under the sun” – and it was often diffi cult to fi nd details that were locally-based, and rel-evant to the person who was searching. Whether one was looking for the avail-ability of a family doctor or medical clinic close-by, or trying to fi nd out information about community supports or agencies, the vast scope of data available via Google and similar search engines was daunting, to say the least. While Google was indeed a considerably easier way to search infor-mation, the challenge was that the search engine provided an almost infi nite number of possibilities – making it diffi cult and of-ten time-consuming for those who needed information quickly and effi ciently.

In the area of healthcare in particu-lar, time and specifi city was often of the essence, as information that was being searched was often done so with an im-mediate or pressing need as the catalyst. A sudden illness, a diagnosis required for those strange set of symptoms, or an ur-gent need for a community agency or sup-port system that would provide respite or homecare for an elderly senior – these were all events that would require detailed in-formation that was both correct, and often specifi c regarding location. For example, those searching for details on how to fi nd a Personal Support Worker (PSW) to care for their aging parent, or a new Canadian looking for resources close to home would need to be able to determine online sourc-es that would directly meet their needs - a task that wasn’t easy in the almost infi nite rage of information on the web.

Technology had provided the tools to search for this information online, but there were still challenges to be overcome:• Senior citizens and the elderly were

often not able to access online informa-tion, due to lack of resources, an un-derstanding of the Internet or lack of awareness that details could be found online

• New Canadians faced limitations in fi nding required information due to lan-guage barriers, lack of access to resourc-es or being unaware of where to start in their search for support

• New parents who are limited in their ability to get out of the house, or who do not have an existing support system in place to provide help during the early days of parenthood

• All of the above who may require the services of a medical professional, a fam-ily doctor, a community support agency and moreWith these facts in mind, two particu-

lar health care-related organizations that catered to these specifi c groups recog-

nized the challenges faced by so many in the community. With the goal of provid-ing simple solutions to the problems that existed, the Toronto Central Community Care Access Centre (CCAC) created a dedicated site that acted as a “one-stop shop” of resources for the community.

The site – TorontoCentralHealthline.ca – takes away the challenges that face those who are looking for information on larger search engines by providing all relevant resources, information and content on one dedicated site. The website allows visitors to search information by specifi c postal code, allowing them to hone in on resources, services and information that is close to home. The site also provides a portal that offers detailed information that is categorized by topic, including Mental Health, End of Life Care, People With Dis-abilities and more. In addition, it has dedi-cated sub-pages that are catered to New Canadians, Caregivers and Mental Health and Addiction.

OBy May-Lin Poon

How technology in healthcare can support the community

indsor Regional Hospital (WRH) is always seeking out new opportunities and possi-bilities to improve the patient

experience. This fall, the hospital was giv-en the opportunity to lead by example and educate other hospitals throughout North America on some of the successful strate-gies it has put in place to help ensure an outstanding experience for patients.

Five hospital programs were presented and on display at the Mayo Clinic Delivery Science Summit, which was held Septem-ber 16-18, 2015, in Rochester, Minnesota.

Selected among hundreds of appli-cants, the poster presentations by WRH involved:

‘From Boardroom to Bedside: Engag-ing the Entire Organization in Patient Safety & Quality’’ which is about efforts to ensure knowledge about WRH’s 14 cor-porate quality indicators was effectively communicated to those who provide care at the bedside.

‘Lean On Me: Practical Strategies for Improving Patient Satisfaction Through Improved Emotional Support’ which fo-cuses on WRH’s efforts to provide emo-tional support to patients, including a number of programs for patients designed and developed by the Patient Experience Task Force.

‘Right Place, Right Time, Right Care: Short Stay Medical Unit Improves Pa-tient Flow’ which is about efforts to im-prove the transition of patients from the Emergency Department to in-patient beds so that patients requiring a bed aren’t left waiting in the ED.

‘Concierge Program: Improving Pa-tient Satisfaction Through Enhanced In-teraction’ which is about offering a variety of services to patients and family members while waiting for treatment or during their hospital stay.

‘WellCome Mat: Strategies for Help-ing Patients Feel WellCome’ which is about improving the emotional support we provide to our patients through a unique hospital orientation program that is pro-vided to newly admitted patients on medi-cal units.

“We are proud that our programs to improve the quality of care we provide and the patient experience they need are being recognized and shared with leaders throughout the continent,” says David Musyj, WRH President and CEO. “The programs are a true refl ection of our con-tinuing vision to provide Outstanding Care – No Exceptions!”

In 2012, WRH was informed it was the fi rst Canadian hospital to make clini-cal quality-of-care presentations at an in-ternational conference held at the Mayo Clinic, a non-profi t world leader in medi-cal care, research and education.

The conference was attended by hun-dreds of health care and related profes-sionals, including clinicians, scientists, ad-ministrative leaders, policymakers and IT professionals. The conference focused on ways to enhance the patient experience, improve health outcomes and manage the cost of care. Current research and con-crete examples were presented, providing

tools for practice implementation, policy change and further research.

Presentations emerged from a variety of institutions and across many disciplines, including health economics, qualitative research, systems engineering, clinical sta-tistics, implementation science, sociology and clinical informatics.

In addition to being able to promote its own patient experience concepts, WRH representatives who attended the confer-ence were also given the opportunity to hear from leaders throughout the conti-nent on many aspects of enhancing the patient experience, improving population health and managing the total cost of care.

“It was an opportunity to learn about methods used to understand how patients experience their care by capturing events in ways that are respectful of patients and clinically useful,” says Lisa Landry, a member of WRH’s board of directors who joined frontline staff at the conference.

One session Landry found engaging centered on a discussion of the important role of clinical preventive services in im-proving population health, highlighting its cost effectiveness. A variety of approaches to developing sustainable health care sys-tems were described, all of which connect to local community resources in order to address underlying determinants of health.

The WRH programs displayed in a post-er exhibit depicted a variety of initiatives whose goals were centered on improve-ment of patient throughput, satisfaction, safety and post-operative care.

The WellCome Mat program received great accolades from the many patient care providers that walked the poster dis-plays throughout the conference. Once again, WRH has something to be proud of,” Landry adds. ■H

Steve Erwin is Manager, Corporate Communications at Windsor Regional Hospital.

Ensuring outstanding patient experience

Rheem McLennan, WRH volunteer, standing beside a poster for the WRH “WellCome Mat” program at a Mayo Clinic conference.

By Steve Erwin

W



35 Nursing Pulse

s a police offi cer in Hamilton, Ingrid Boiago saw hundreds of cases of elder abuse. She found one woman covered with lice

head-to-toe, dehydrated, and emaciated. Her toenails had grown under her feet, and she was confused because her daughter had given her too much medication. Today, that woman is a resident at Dundurn Place Care Centre, the Hamilton long-term care facil-ity where Boiago is now clinical director of nursing. It’s a job that allows her to weave her nursing and policing skills together.

She investigates complaints at the home, and says her background in law enforce-ment in Hamilton – where many Dundurn residents have spent most of their lives – has given her unique insight into the pov-erty and poor health many of them faced.

Boiago graduated from Hamilton’s Mo-hawk College as an RN in 1980, but spent the last 20 years on the Hamilton Police Service, including four years investigating crimes against seniors. Her career has been full of serendipitous twists. After university, she wanted to be a doctor. But when she didn’t get into medical school, her father suggested she try nursing. By the time she graduated, she’d found her passion in psy-chiatric nursing. “I love fi guring out why people do and say the things they do,” she says.

After nursing school, Boiago worked on an acute psychiatric ward. She met doctors interested in forensics, and began working with them in local jails to determine if in-mates were mentally fi t to stand trial. She faced violent murderers and pedophiles, but was never fearful; she was fascinated. She began assisting her psychiatrist colleagues with their research and was working on a tool to predict if a criminal would reoffend when her career took an unexpected turn.

She called the Hamilton police looking for statistics, and they offered her a job.

At the time, the force was looking to get into behavioural sciences, including

forensic psychiatry, and they thought her background was a perfect fi t. She decided to apply, and was hired. Then in her late-30s, she spent 16 weeks at police college alongside men in their 20s running, march-ing, and having her bed inspected every morning. “We had to do nursing corners, so I made everyone’s bed,” she recalls.

Boiago joined the force in 1994 and spent time on patrol, worked on domestic and sexual assault cases, and in the fraud offi ce. She always maintained her nursing license, and when she joined the Crimes Against Seniors/Senior Support Unit in 2010, she approached her work with a nursing lens.

She would help people fi nd housing if needed, or connect them with community agencies. Other offi cers didn’t understand why she bothered, but she couldn’t ignore her desire to improve health. Having a nurse on the force proved helpful when her colleagues noticed some seniors had trou-ble living independently.

In 2011, she became certifi ed to assess adults to determine their ability to make their own decisions about their property and personal care, a position only open to regulated health providers. “Any doors that have been opened have been because of my nursing,” she says. “It’s part of who I am, and what’s shaped me. In hindsight, it made me a much better police offi cer.”

Last year, Boiago decided to go back to healthcare. She was about to be moved off the seniors’ unit and back to patrolling the streets. “I’m almost 60 and I didn’t think I could go back to chasing kids and stolen cars,” she says.

She decided to apply for a nurse educa-tor position at Dundurn. She got the job and then, a few months later, the clinical director position opened up, so she applied for that too. “I feel like I’ve fi nally found my place,” she says, suggesting it’s because of the different jobs she’s done. “I feel more rounded in terms of having all those experi-ences. Who knows what I’ll do next.” ■HJill Scarrow is a freelance writer in Burlington, Ontario. This article was Originally published in the May/June 2015 issue of Registered Nurse Journal, the fl agship publication of the Registered Nurses’ Association of Ontario (RNAO).

By Jill Scarrow

From nursing to policing, and back againA

After two decades in law enforcement, Hamilton RN returns to the career she’s always loved.

For health care professionals and com-munity agencies, the site provides a portal that can be pulled up on the spot, while patients or clients are present, allowing for immediate information sharing.

Realizing the need for easy online ac-cess to information about healthcare, the Province of Ontario also implemented a resource to assist Ontarians who were looking for a family doctor. Health Care Connect puts those in need of physician in touch with a doctor or nurse practi-tioner within their area. Similar to The Healthline, the site uses postal code

and location-based information to fi nd a practitioner who is close to the re-quester’s home. To date, 80 per cent of those who use the program have been successful in fi nding a doctor or nurse practitioner through the site. For more information, visit the Ministry of Health and Longterm Care at http://www.ontar-io.ca/page/find-family-doctor-or-nurse-practitioner ■HMay-Lin Poon is the Manager of Client Services, Information & Referral, at the Toronto Central Community Care Access Centre.

Continued from page 34Technology in healthcare

Educational & Industry Events

To list your event, send information to “[email protected]”.

We try to list all events and information but due to space constraints and demand, we cannot guarantee it. To promote your event in a larger, customized format please send enquiries to “[email protected]”

To see even more healthcare industry events, please visit our website

www.hospitalnews.com/events

November 2-4, 2015 Health Achieve 2015 Metro Toronto Convention Centre, Ontario Website: www.healthachieve.com

November 5-7, 2015 12th National Respiratory Care & Education Conference Niagara Falls, Ontario Website: www.cfhi-fcass.ca.

November 16-19, 2015 World Forum for Medicine Duesseldorf, Germany Website: www.medica-tradefair.com

November 17-18, 2015 Rx&D Annual General Meeting Hyatt Regency, Montreal Website: www.canadapharma.org

November 23-25, 2015 This is Long Term Care 2015 Toronto, Ontario Website: www.oltca.com

November 29- December 4, 2015 RSNA Annual Meeting 2015 McCormick Place, Chicago, United States Website: www.rsna.org

December 1–2, 2015 Data Analytics for Healthcare International Plaza Hotel Toronto, Ontario Website: www.healthdatasummit.com

December 1, 2015 Health Canada: Financial Models and Fiscal Incentives in Health and Health Care InterContintental Toronto Centre Hotel, Ontario Website: www.conferenceboard.ca

January 26-27, 2016 12th Annual Mobile Healthcare Toronto, Ontario Website: www.mobilehealthsummitdata.com

March 1-5, 2016 13th Annual Critical Care Conference Whistler, British Columbia Website: www.canadiancriticalcare.ca

April 16-19, 2016 The Canadian Conference on Medical Education Fairmont The Queen Elizabeth, Montreal Website: www.mededconference.ca

April 17-19, 2016 Putting the Pieces Together – Collaborating for Quality Hospice Palliative Care in Ontario The Sheraton Parkway and Convention Centre, Richmond Hill Website: www.hpco.ca

June 5-7, 2016 Annual OACCAC Conference Westin Harbour Castle Hotel, Toronto Website: www.oaccac.com



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Hospital News 2015 November Edition