• Do we love our healthcare system too much?

    by Nadine Morris | Jan 03, 2018

    (This post is a modified version of a speech delivered at The Walrus Talks Health on November 28, 2017.)

    Canadians love medicare too much… twice as much as hockey. Three times as much as the Queen. Tommy Douglas tops the charts as the greatest Canadian because of his conviction and political courage in removing income as a barrier to healthcare.

    Canadians look south and heave a sigh of relief that we don’t have millions of our citizens with no healthcare coverage at all. Our love of medicare and its status as an icon in our national mythology is a barrier to making necessary improvements. This exalted status has frozen in time how we organize services, who actually provides care and which services are covered. Compared to other developed countries our healthcare system is ranked close to the bottom – and right at the bottom in the time it takes to get an appointment with a specialist.

    Why is it so hard to change?

    Let us step back to the late 1950s when the Co-operative Commonwealth Federation (CCF) government lead by Tommy Douglas was designing a new health system. Saskatchewan wanted good connections between general practitioners (GPs) and specialists, with public health and social services. There was even talk of community boards to ensure patient and community feedback. Unfortunately, an election was coming. Tommy Douglas’s Cabinet was worried that this fundamental reform would be lost if they tried to sell a whole new approach. Instead, Cabinet agreed government would insure everyone so that people didn’t have to pay for doctors’ visits. (Tommy Douglas’ government had already insured hospital care in 1947.) Left aside was the dream of creating an unbroken continuum of care. They settled for a payment system, not the well-connected health system they wanted. Although peoples’ incomes were no longer a barrier to doctors’ care, there was no coverage of dentists, physiotherapists, psychologists, or drugs.

    When the federal government brought in medicare in 1966, all provinces eventually adopted the Saskatchewan compromise. Private insurance through employers, particularly large employers, looked after care not covered by medicare. Unfortunately, at least 30% of Canadians didn’t and don’t have those benefits. They must pay for these health services and drugs – not much different from America. However, it is much different from European countries. This is one of the main reasons we fare badly in international comparisons.

    It isn’t efficient or even the most appropriate care to have only hospitals and doctors’ visits fully funded. It is inefficient not to cover drugs; to have patchy access to affordable home care and nursing homes; to make it hard for people to see a psychologist or a physiotherapist. It is definitely not good care when people with mental health or addiction problems have to wait months for treatment unless there is a dramatic crisis.

    It is possible, indeed probable, that because medicare is our number one love, tampering with it exacts a huge price. Most governments are reticent about saying to their citizens that we have problems, that we could do much better, that there is lots of room for innovation and improvement. Staying the same, with nearly 40% of every province’s program budget spent on healthcare means we will be starving income support, education, housing, social services – the very kinds of supports that are important for good health. Curiously, there is little discussion of why our healthcare is less safe, say, than the Dutch.

    Provinces have tried to improve healthcare by creating regional management structures (like the Local Health Integration Networks in Ontario), through various financial incentive payments to doctors, joining with the Canadian Institutes for Health Research in supporting patient oriented research.

    We have had limited success in improving performance. We are still near the bottom of the charts.

    The technology revolution has huge potential to give more control to us – as citizens and patients –  to manage our own health. Is anybody here becoming an obsessive step counter? The sky is almost the limit. We see it in action in post operative follow up as the Ottawa Heart Institute has been doing; but email appointments with your family physician? Not usually. Any innovation you can think of is happening somewhere in the world. We need to bring them home to Canada, try them out here, create our own, and change regulations to accommodate them if we have to. Both the Champlain BASE™ eConsult Service (BASE™) and the Rapid Access to Consultative Expertise (RACE™)—two leading Canadian innovations--dramatically speed family doctors’ access to specialists’ advice. Patients don’t have to wait months to see a specialist because in all but about 30-40% of cases the GP can handle it. This will be especially helpful to people in rural and remote parts of the country. CFHI helps hospitals and healthcare organizations incubate, spread and scale better ways of providing care. We work with the innovative doctors, nurses and administrators, for example, to reduce inappropriately prescribed antipsychotics to people with dementia in nursing homes, to provide care at home for people with advanced chronic obstructive pulmonary disease, to share innovations like Dr. Liddy and Dr. Keely’s. The results? Better care which costs less than the status quo.

    What do I recommend for our much-loved but underperforming medicare?

    Make it easy for one province to learn from another. Support through regular health budgets the best local ideas of doctors, nurses and other care providers to encourage positive change.

    Put expanding coverage of health services on the agenda.

    Dare to experiment with both private and public, for-profit and not-for-profit providers as long as patients’ income doesn’t determine access.

    Put patients and their families at the centre.

    Which brings it back to us. No more unconditional love. We should have the quality of care that Tommy Douglas fought for. After almost 60 years, isn’t it time?

  • Our journey of walking the talk of patient engagement

    by Nadine Morris | Nov 13, 2017

    This week, CFHI welcomed Angela Morin to our Patient and Citizen Engagement team in the role of Patient Partner. The process to hire for this role was heartening—the number of highly qualified patient partners that came forward to be considered demonstrated to all of us the pool of talent, dedication and contributions that patients can make to healthcare system improvement and re-design. I am thrilled that Angela has joined our team. She is a highly respected patient partner with a depth of experience across the health system at local, regional, provincial and national levels, and is a partner who can provide insights into engagement practices and perspectives to respectfully challenge the status quo. I am equally thrilled for what I think this position represents for CFHI. 

    When I started at the Foundation as the Director, Patient and Citizen Engagement earlier this year, I entered the organization with a sense of humility and privilege to serve in this capacity. I knew CFHI had contributed greatly to the field of patient and family engagement (PFE), as an early and strong proponent for engagement across the health system, building capacity of healthcare organizations across Canada. As I looked across the four collaboratives that we have conducted thus far in PFE, I could see how the portfolio has evolved—moving us from patient and family engagement that we support others to do, to embedding these same practices in our work within CFHI as we develop, deliver, implement and evaluate activities and collaboratives. We recognize that patient engagement is a journey and I see the promise of what this role of Patient Partner will bring to CFHI as we continue on our journey. The Patient Partner is not THE patient for all of our teams, but rather, will bring a voice to the ‘how’ and the ‘why’ we might want to partner with patients in our work. The presence of a Patient Partner at CFHI will help us to ‘walk the talk’ of engagement in consistent ways across the organization. It will also help us to engage meaningfully and in fulsome ways that shape all of the work that we do, across all teams, and the ongoing influence we can have to transform care across the Canadian healthcare system.

    I have given a lot of thought to what it means to now bring a patient partner inside—as part of our staff at CFHI. Does it start to change their ‘patient’ identity? Will she start to speak ‘CFHI-speak’? Who does she represent? We know that engaging with patients is no simple task—and to recognize and continue to ask these questions, we can remain reflective in our work. What Angela brings to us, and what her role is positioned to do, is to capitalize on her expertise as a patient partner, to help us continue to learn and to consistently embed meaningful partnerships with patients and families in all that we do. Engaging and partnering with patients and families is a culture change, it’s a way of being—to consider, to respect, to listen intently to others’ perspectives and to welcome a diversity of voices to create something new. We are well on our journey!

  • Five Things I Learned About Moving a Big Office

    by Nadine Morris | Nov 01, 2017

    In late June, CFHI moved to a new office space. After 14 years in Ottawa’s west end, we have now set up shop downtown, at 150 Kent Street.

    In addition to moving, we completely redesigned 17,469 square feet of office space to meet the current and future needs of our organization. So not only did we have to manage moving vans and storage boxes: we also needed to act as building contractors for electrical, millwork, plumbing, drywalling, flooring, lighting – the list goes on!

    But it was all worth it. It’s a great space: a modern open concept with lots of natural light, ergonomically-friendly office furniture with height-adjustable desks, cozy collaboration areas for brainstorming, fully-wired meeting areas, and a Starbucks-café style kitchen that includes an espresso/cappuccino/latté machine.

    As the project manager for the move, I’m happy to report that our 59 staff members are settling in well to the new environment. The move itself went remarkably well – but not without its challenges. While everything appeared tranquil on the surface, there was lots of furious paddling going on underneath. It was a huge project and I’d be lying if I said it wasn’t stressful. However, when they say, “It takes a village,” it really does. This office move was no different and was an excellent example of bringing many individuals together to achieve success.

    I’m happy to share with you what I’ve learned.

    1. 1. Plan. Plan. And plan again. Even the best-laid plans can come completely undone in the blink of an eye. Just when you think that every Excel spread sheet is finalized, there are always – repeat, ALWAYS! – curve balls that get thrown at you. Having one tradesperson unavailable, for example, creates a domino effect that can cause weeks of delay. Prepare to be flexible.
    2. 2. Surround yourself with good people. They say that people’s true colours show most during times of stress. That was certainly my experience. Sometimes you just need a shoulder to lean – and, yes, cry – on. I found strength in friends and co-workers, who went from being “dearest confidante” to “bona fide therapist.” And I also discovered new sources of strength in the team of people assembled to support the move. Reach out. Involve others. You’ll be surprised at what people can do when they’re asked.
    3. 3. Involve staff from the beginning and keep them in the loop. Change is hard, and people react differently to it. Some of our staff were excited about moving to the new space, while others were not thrilled with the idea. Keep in mind that change – even one that may be welcome and needed – is an emotional process, and respect people’s need for timely information. I can’t emphasize enough how important it is to keep the lines of communication open, at all stages of the process. What worked for us?
      • We invited staff to join the Office Space Team to help select and evaluate the various properties, and to discuss transportation and other issues.
      • We conducted an all-staff survey asking people what they would like to see in the new office space, and we incorporated these suggestions wherever we could.
      • Each week, at Monday’s huddle, I provided an update to staff on where we were in the selection process and which properties were making it to the short list. We sent weekly email updates, too. We even reported when there was nothing to report!
      • Once a decision was recommended and approved by our Board of Directors, we held a kick-off meeting where I made a full presentation to all staff and invited people to ask questions.
      • My office door was always open to anyone who wanted to talk.
    4. 4. Do all you can to maintain (a) perspective; and (b) your sense of humour. This is sometimes hard to do when there are so many balls up in the air. Remember all those clichés and hold them close: the world won’t end if you miss a deadline; Rome wasn’t built in a day; and there is a silver lining in every cloud. Take the time to laugh!
    5. 5. Celebrate your success. On the first day in our new office, we held a mimosa-themed celebratory breakfast for all staff, to welcome everyone to their new ‘home’ and to recognize the hard work and dedication of the people on the team. I bought gifts for my nearest-and-dearest and made sure that everyone was acknowledged publicly. It’s important for staff to see that the successful outcome was a product of everyone’s energy and input.

    The bottom line? We survived! And we’re proud of our new office space: it’s bright, comfortable, modern, and reflects CFHI’s personality. We made change happen … together … in our new office space.

    I welcome you to come by and visit our offices if you are ever in the area. I would love to meet with you to discuss our office move and give you a tour.

    How about you? Have you experienced something similar, and do you have any suggestions to add?

    Nancy M. Quattrocchi

    Vice-President, Corporate Services, CFHI

    Starbucks-café style kitchen

    Starbucks-café style kitchen includes an espresso/cappuccino/latté machine.

    One of our cozy collaboration areas.

    One of our cozy collaboration areas.

    CFHI reception area.

    CFHI reception area.

    Innovation Room

    Our Innovation Room features comfortable seating, natural light and a large screen monitor.

  • Bringing a Voice to Residential School Survivors with Dementia

    by Nadine Morris | Oct 11, 2017

    Note: The information and material here may trigger unpleasant feelings or thoughts of past abuse.

    If you're experiencing emotional distress and want to talk, call the 24 Hour Residential School Crisis Line at 1-866-925-4419 or the First Nations and Inuit Hope for Wellness Help Line 1-855-242-3310.

    My dad, Duncan Harry, was from Ts'kw'ay'laxw First Nation in Pavilion BC.

    He was a skilled and proud ironworker—a foreman—who was well-liked and respected by his coworkers and bosses. In 1976, he suffered a workplace injury, falling 20 feet and landing on a concrete slab. Despite his accident, he continued to work until the injuries forced him to stop fourteen years later.

    In 2011, Dad was officially diagnosed with dementia.

    Ironworker Duncan Harry

    Ironworker Duncan Harry just below the original fabric dome of BC Place in Vancouver.

    He was first hospitalized in April 2015 because of a badly ulcerated, severely infected leg. His leg was amputated above the knee, one month later. He remained in hospital until mid-November of that same year. On December 2, 2015, he passed away in hospice.

    Throughout Dad’s hospital stay, I would stop after work and stay with him until he fell asleep. I quickly found that the dementia caused him to believe that he was back in residential school. My dad had attended both St. Joseph's Residential School in Williams Lake, BC and Kamloops Indian Residential School in Kamloops, BC.

    When I'd arrive at the hospital, I often found him shaking, teary and sometimes crying. He would ask me how they let me in. He would tell me that he didn't talk all day because he didn't want to get into trouble. My mom and I did our best to reorient him each day, and to let the care aides, nurses and doctors know that this was what he was experiencing. We had to repeat this “orientation” each time he was moved to a different ward (which was frequently).

    Each time Dad was moved, we found it was extremely difficult to convince staff that what they thought was agitation and aggressive behaviour was actually night terrors and a response to his perceived environment – to Dad thinking he was back in residential school. Mom and I asked repeatedly that staff call us to be with Dad anytime (day or night). We both live and work within five minutes of the hospital. This never happened. Instead, staff continued to call security, use restraints and inject him with antipsychotic medications when he became agitated or aggressive. This was not making things better for him. It made it much worse.

    I was extremely protective of my dad during his time in hospital, the Tertiary Palliative Care Unit (TPCU) and hospice. Mom and I made sure to assist every time the nurses washed and re-positioned Dad, as it was very frightening for him. The last word he ever said was "No!" when the nurses were washing him.

    Sheryl and her Mom comforting Sheryl’s dad

    Sheryl and her Mom would comfort her Dad from the time he woke up until the time he went to sleep as they waited in hospital for his surgery.

    When my mom and grandma wanted Dad to have the last rites, I was very concerned that having a priest standing by his bed would really scare him. I talked to one of the nurses about the possibility of finding a priest who would come in regular clothing and whisper the last rites while Dad was sleeping. The nurse was very understanding – but unfortunately, he advised that the one priest he was able to reach was unwilling to accommodate our request. Thankfully for Dad and our family, he recommended the Hospice Spiritual Coordinator, who was lovely.

    After Dad passed away, I started seeing a grief counsellor. Eventually, I started volunteering and took a hospice volunteer education program. They have put me in touch with one of the nurses from TPCU, who advised that they had begun doing things differently since my dad's time with them. At the time Dad was there, staff were not aware of the effects of residential schools on survivors. I was told that this has since started to change.

    I feel great concern about Dad's fellow residential school survivors. Some may have dementia. Some likely experience post-traumatic stress. Some will end up in hospital. I worry that these survivors will experience – or are experiencing – the same things that Dad did. Many survivors would now be around Dad's age when he was diagnosed.

    I believe there is an urgent need to educate healthcare workers (as well as survivors and families) about what happens when residential school survivors, post-traumatic stress, dementia and hospitals collide and the most effective ways of helping, communicating with and supporting survivors and families.

    I don't believe survivors should be re-traumatized in hospital. Families shouldn't feel they need to be with their loved ones in hospital 24 hours a day to protect them from further trauma. They should be there because they choose to be. Because they are partners in care. Because they are helping to provide patient-centred care.

    The elder years are a time that should be respected and honoured. I really did my best to honour Dad’s journey throughout his time in hospital, TPCU and hospice. He loved to help people and I am positive he would really want to help his fellow Residential School Survivors and anyone with post-traumatic stress.

    I feel like my Dad and I share the same soul, or the same kind of soul. In my first year of grieving, I was tortured, wondering why he had to suffer so much during his life. I am still trying to understand this, but I think I'm here to do something about his suffering, even though he's across with our ancestors now.

    I have signed up to volunteer with the Patient Voices Network. In September of this year, I attended the Better Together Policy Roundtable as one of CFHI’s Patient Advisors. I want to bring a voice to this issue. I hope you will as well. 

  • It’s happening now!

    by Ken Reece | Sep 23, 2017

    You have probably heard this slogan more than a few times from CFHI… and may quite literally have the t-shirt. We launched the “It’s happening now!” campaign just over a year ago as a way to share stories that show change and innovation in healthcare are not only possible, they are happening now.

    As we launch our new blog platform today, I want to take the opportunity to share with you not only what is happening now, but what lies ahead as we enter another busy and exciting fall.

    Across New Brunswick, nursing homes are adopting resident-centred approaches to dementia care that are reducing the inappropriate use of antipsychotic medication. This is CFHI’s first scale collaborative and it builds on the stellar work spreading these approaches in 2014-15. The province-wide collaborative – which is a partnership with the New Brunswick Association of Nursing Homes – is in its second phase, with 43 organizations implementing non-medication approaches to manage challenging behaviours associated with dementia. It is gratifying to see rates of antipsychotic use tapering across Canada, but there is still more work to do.

    If, like me, you lamented the recent Commonwealth Fund report once again showing Canadians are the most likely to wait two months or longer to access specialist care, you may be interested to know that our Connected Medicine partnership is ramping up. Together with the College of Family Physicians of Canada, Canada Health Infoway, and the Royal College of Physicians and Surgeons of Canada, we are supporting organizations to implement proven remote consult services like RACE™ telephone consult and BASE ™ e-consult. We look forward to announcing participating teams soon.

    On the national priority of reducing the number of patients in hospital who could be better cared for at home or in the community, we are scaling-up INSPIRED approaches to COPD. A hospital-to-home model of care that supports patients living with moderate to severe COPD and their families, the INSPIRED COPD Outreach Program™ is a proven innovation that we spread across Canada in 2014-15. Now we have reached out to those teams to help expand their COPD programs to all those in their populations who stand to benefit. We recently held a merit review of the applications and I look forward to announcing the selected teams in the coming weeks.

    We are developing tremendous practical knowledge about spread and scale through this programming and I look forward delving deeper into this fascinating topic in a future blog post. 

    And while we have always issued open calls to participate in our collaboratives and EXTRA: Executive Training Program, this year we issued our first ever Open Call for Innovations – in palliative and end-of-life care. We had an outstanding response, with 69 applications from which we gave 9 CFHI Palliative and End-of-Life Care Innovation Awards at our CEO Forum. As a recent Canadian Partnership Against Cancer report demonstrates, Canada needs earlier integration of palliative care into patients’ treatment plans, more community-based multidisciplinary palliative care services and better data to assess the quality and timeliness of palliative care.

    CFHI is constantly cultivating and scanning for innovations to spread across Canada and we will be drawing on the results of CEO Forum to inform future programming in palliative and end-of-life care, including our spread collaboratives, with work in this area expanding this fall. Together with CPAC, we recently held a meeting with stakeholders from across the country to explore the potential to spread programs where paramedics provide palliative care in the home. Successful programs in Nova Scotia, PEI and Alberta were highly rated by CEO Forum participants, and stakeholders at our recent meeting expressed interest in adapting and adopting these programs.

    So, as you can see, we are once again anticipating a busy few months, but we remain truly energized by the knowledge that this work is making a difference. Better health, better care and better value are possible when we work shoulder-to-shoulder!

    I hope our new blog platform provides you with another avenue to engage with us, to join the conversation and to share your insights, advice and inspiration. Let us know your improvement priorities and how we can help in the comments below or by participating in our survey.

    Together, we can spread the word and make change happen.