• Working Shoulder-to-Shoulder in an Age of Physical Distancing

    by Nadine Morris | Apr 21, 2020

    As I write this blog, the world is grappling with the COVID-19 pandemic. These are tough, challenging times. Glimmers of hope and inspiration come from health systems in Canada and around the world responding to the challenge in creative and innovative ways that serve their communities’ needs.

    We are deeply grateful to all those working to ensure the health of everyone in Canada and globally, including CFHI staff with skills needed for immediate pandemic response who have volunteered to support the effort. Like many others, we too know and care for people who have been directly affected by COVID-19. Our thoughts are with them and others affected, as well as those who have tragically lost loved ones during the pandemic.

    At CFHI, we have been engaging with our partners to prepare and respond to the COVID-19 pandemic for some time. In this very busy time, adding value not noise is our mantra! Consistent with our strategy, we remain committed to supporting our partners to deliver more improvement with, and for, more people that lasts. But what it means to work “shoulder-to-shoulder” with the health sector has evolved. Most obviously, this means enabling virtual ways of connecting and pivoting our programs to focus on immediate priorities during this unprecedented time.

    Doubling down on enabling better care closer to home and community is a continued focus. Examples include use of e-consults, supporting management of chronic conditions at home so that people need to visit hospitals less often, person-centred care in long-term care, new models of home palliative care, and embedding palliative approaches in long-term care. And we’re hearing from teams we work with about why this work particularly matters now:

    “I want to thank you for your incredible Priority Health Innovation Challenge (PHIC). At a time where extreme measures have been put in place due to Coronavirus (i.e. hospital services being closed, postponed clinic visits/diagnostic testing and respiratory resources falling short) the challenge funds have enabled some continued respiratory care for our most complex vulnerable patients in the community. . . Over the next few weeks these home visits will stop the spread, keep children safe and optimally managed on their respiratory supports and keep them out of the Intensive Care Units, which are already past capacity. A simple thank you is not enough; CFHI’s health innovation challenge has the potential for an even greater impact then we had ever imagined.”

    PHIC team from The Children’s Hospital of Eastern Ontario

    At the same time, we recognize that while health systems across the country are urgently responding to today’s needs, we can be a strategic reserve – looking a bit ahead to begin to address problems that our partners active in immediate response may not able to focus on right now.

    With the Canadian Patient Safety Institute and other partners, for example, we are seeking meaningful and effective ways of partnering with patients, family members and their other care partners, with the goal of tapping into their insights to improve care and policies in a pandemic context. For instance, COVID-19 has led to rapid changes to policies and practices as organizations manage the tension between patient- and family-centred and partnered care, and infection control and safety. Yet there are also a number of creative solutions springing up across the country. Our first webinar in a new series shines a light on this issue. Our next webinar in a series dedicated to facilitating discussions about emerging issues, policies and practices impacting patient engagement and partnership during COVID-19 focuses on supporting the emotional well-being and mental health of patients and families.

    In addition, we are focusing on enabling essential non-COVID-19 care. In doing so, we’re bringing forward creative solutions and hard-won lessons learned from countries ahead of us on the pandemic curve, as well as building on Canadian experiences and models of care that address this challenge in rural and remote communities, as well as urban centres.

    Throughout, as we announced in February, the Canadian Patient Safety Institute and CFHI continue to pursue an amalgamation to form a single quality and safety organization with expanded capacity to improve healthcare for everyone in Canada. I realize that with many competing priorities you may not be thinking about the amalgamation of our two organizations, but I wanted to assure you that this work continues and seems even more necessary now than when we embarked on this journey. Likewise, we have joined with other partners in a network of health organizations with pan-Canadian mandates in order to help coordinate our work in pandemic response.

    I want to close by emphasizing our commitment to working shoulder-to-shoulder (virtually) with you while our premises are closed to meet the COVID-19 challenge. If there is a specific way we can support you, please reach out. We are all in this together.

  • Family Caregivers as Essential Partners in Care: More Than Just A Visitor

    by Nadine Morris | Apr 17, 2020

    Over the past weeks, the COVID-19 pandemic has put our healthcare system under pressure never before experienced. Hospital, community and clinical leaders are changing policy and practice almost daily in order to stay in front of the curve of patients becoming ill with COVID-19. In parallel, they are doing their best to protect their environments, patients and healthcare workers from being exposed to and contracting the virus.

    In an era where patient centered care is valued and collaboration with people with lived experience is expected, the COVID-19 crisis presents significant tensions between patient and family centred care, patient safety, provider safety and infection control. We are hearing from patient partners that there has been a marked decrease in authentic patient engagement and partnership across the system as the pandemic evolved and healthcare organizations responded. At the same time, many organizations have stepped up their engagement and partnership with patients, families and caregivers and have included in them in virtual calls/webinars, and as active members of COVID-19 pandemic response teams. As we look ahead, now is the time to ensure the continuation of meaningful engagement and partnership with people with lived experience to strengthen policy and practice.

    The evidence is clear that the presence and engagement of patients in their care, and partnership with family members and caregivers (‘family’ as designated by patients) improves patient experience, safety and outcomes.1 While healthcare organizations restrict ‘visitors’ in order to protect patients and healthcare workers, one to two family caregivers who are identified as ‘essential partners in care’ is a very different role and responsibility.

    In late 2015, the Canadian Foundation for Healthcare Improvement launched a national campaign to encourage healthcare institutions to welcome family caregivers as partners in care and adopt open visitation as part of family presence policies. CFHI augmented the campaign with a change package, tools, resources and an e-collaborative. CFHI also hosted a pan-Canadian policy roundtable to support the Better Together campaign to shift the notion of families and caregivers from visitors, to partners in care. Since the campaign started, we have seen a notable increase in family presence policies in healthcare institutions across Canada.2

    Over the past month, in an effort to minimize and control the risk of COVID-19 cases, many hospitals have made significant changes to their ‘open family presence’ and ‘visitor policies,’ and the vast majority of organizations, have instituted very restrictive or ‘zero visiting’ policies. Exceptions exist in some organizations for patients who are near end of life and women giving birth – both of whom are permitted one visitor. In pediatric centres, there are promising examples of strong policies where one to two family members are identified as ‘essential partners in care’ and are permitted at their child’s bedside.

    The rapid shift to highly restrictive policies is understandable given the nature of the COVID-19 crisis. But such policies are very difficult for patients, families and caregivers, causing significant emotional distress, concerns for patient safety and the lack of ability to support loved ones while in hospital. Families and caregivers must remain partners in care, but that partnership may look different during these challenging circumstances.

    How healthcare organizations have developed and implemented restrictions has varied, with some taking creative and innovative approaches that enable families and caregivers to remain partners in care. Some prioritized engaging with their Patient and Family Advisory Councils to discuss what restrictions might be required and why, as well as their implementation - including how to best communicate the changes. Some organizations have also put in place options that support ongoing contact between patients and their family/caregivers through virtual means including phone, text and email – even offering the appropriate tools (e.g. iPads).

    However, with the crisis rapidly evolving, moving quickly was understandably important. Many directives and shifts in policy were implemented without engaging patients, families and caregivers or a broader staff discussion, including a shift in language that reverts to families and caregivers as visitors rather than as partners in care. Effective and appropriate communication about policy change and how families and caregivers can continue to partner in care is essential.

    Family caregivers often support minor medical procedures, feeding, ambulation, cognitive stimulation, patient hygiene, medication adherence and are often essential in ensuring coordination and continuity of care. We know their presence reduces patient anxiety, supports patient safety and improves the accuracy and quality of shared information. Their role in non-critical care is essential to supporting overstretched clinical team resources. Many family caregivers are familiar with infection control protocols and can physically isolate and participate in COVID-19 screening.

    Together, we have the opportunity to learn how healthcare organizations can develop an ‘essential partners in care’ approach as the COVID-19 pandemic evolves. Family caregivers are more than ‘visitors’. Family and caregivers are important to the healthcare system, and we have an opportunity to develop policy that ensures ongoing engagement and partnership – in ways that take into account everyone’s safety – to support them as essential partners in care in times of crisis, and beyond.

    1 Institute for Patient- and Family-Centered Care. (2015). Canadian Foundation for Healthcare Improvement On Call Webinars: Better Together Campaign: Spreading Family Presence Policies to Accelerate Healthcare Improvement. Retrieved from: http://www.cfhi-fcass.ca/WhatWeDo/on-call/better-together-part1

    Levine, C., Halper, D. E., Rutberg, J., L., & Gould, D. A. (2013). Engaging family caregivers as partners in transitions: TC–QuIC: A quality improvement collaborative. New York: United Hospital Fund.

    Smith, L., Medves, J.M., Harrison, M.B., Trammer, J.E., & Waytuck, B. (2009). The impact of hospital visiting hour policies on pediatric and adult patients and their visitors. Joanna Briggs Institute Library of Systematic Reviews, 7(2), 38-79.

    American Association of Critical-Care Nurses. (2011). AACN practice alert: Family presence: Visitation in the adult ICU. Retrieved from http://www.aacn.org/WD/ practice/docs/practicealerts/family-visitation-adult-icu-practicealert.pdf

    Cappellini, E., Bambi, S., Lucchinim A., & Milanesio, E. (2014). Open Intensive Care Units. Dimensions of Critical Care Nursing, 33(4), 183-193.

    Ciufo, D., Hader., R., & Holly, C. (2011). A comprehensive systematic review of visitation models in adult critical care units within the context of patient- and family-centered care. International Journal of Evidence-Based Healthcare, 9(4), 362-387.

    Whitton, S., & Pittiglio, L.I. (2011). Critical care open visiting hours. Critical Care Nursing Quarterly, 34(4), 361-366.

    From 2015 to 2020, the percentage of hospitals with accommodating visiting policies (defined as having over 12 hours a day with times in the morning and evening) increased from 32% to 73% From 2015 to 2020, the percentage of hospitals that specifically describe their policies as open/flexible/anytime to accommodate families (a proxy for fully open family presence policies) increased from 23% to 67%. (Source: CFHI Better Together Report 2020)

  • Primary Care: A foundation for a high performing health system

    by Nadine Morris | Jul 23, 2019

    Primary healthcare is at the heart of well-functioning health systems. According to the World Health Organization (WHO), the central focus of primary healthcare is individuals, families and communities. In this model, people’s individual care needs are supported by multi-disciplinary primary care teams who are a first point of contact for integrated health services that will meet most of their health needs over their lifetime.

    Evidence shows that health systems with strong primary healthcare at their core deliver better health outcomes, efficiency, and equity.

    In thriving primary care systems, health needs are addressed by a team you trust. In both global and Canadian visions of primary care, person-centredness, comprehensive care (including health promotion, disease prevention, treatment, rehabilitation, palliative care, and more), and continuity of care are key. For instance, the College of Family Physicians of Canada recently described the Patient’s Medical Home as a family practice defined by its patients as the place they feel most comfortable presenting and discussing their personal and family health and medical concerns. In this 2019 update, they acknowledge a shift toward interprofessional practice structures that strive to ensure the right provider, at the right time, in the right place, for the right care. Using this model, nobody ‘falls through the cracks’ when moving between different parts of the health system.

    In the 21st Century, being able to offer seamless care closer to home and community means we need to take advantage of appropriate digital solutions, such as eConsults. Traditionally, patients have had to attend a face-to-face appointment to get specialist advice. In Canada, this process tends to involve longer waits for care than in a number of other countries, according to surveys conducted by the Commonwealth Fund. With eConsults, information moves, but the patient doesn’t have to. Primary care teams can get advice from specialists via phone, secure messaging, or other technologies. The World Health Organization has said that the “use of remote consultation services or telemedicine can be used to improve information flows between patients and health workers as well as better integrate primary care with referral care.“

    We’ve seen the value of eConsults first hand via the Connected Medicine Collaborative. Eleven teams in seven jurisdictions spread leading eConsult services, inspired by the Champlain BASETM eConsult service first launched in Ontario and the Rapid Access to Consultative Expertise (RACETM) model from British Columbia. These services enable primary care providers to connect with specialists via phone, app, and/or secure messaging.

    The numbers are impressive. More than 12,000 consults took place during the 18-month collaborative alone, and usage continues to grow. Most were completed in 7 days or less. In many cases, patients no longer needed referrals for face-to-face specialist appointments or visits to an emergency department that would otherwise have taken place.

    But it’s the stories that really bring the value of eConsults to life. For instance, Edwina Nearhood has lived with congenital heart disease for 30 years. She has faced major barriers to accessing specialist care from her home in Fort St. John, B.C. As a result of this collaborative, she has benefitted from easier access to care for her urgent needs.

    Stories like Edwina’s show that innovations like eConsult can be win-win solutions. Patients receive care closer to home with a healthcare provider they know and trust and who has access to timely advice from specialist colleagues. Primary care providers can offer their patients more comprehensive, seamless care. And specialists can give just-in-time advice to primary care colleagues that supports high quality patient care.

    While there is still much to do to enable all people in Canada to benefit from these solutions, the teams who took part in the Collaborative are shining a light on the path to make more improvement available to more people. At CFHI, we look forward to continuing to work shoulder-to-shoulder with these teams and other committed to shaping better healthcare for everyone in Canada. Want to join us? Please explore our opportunities to work together, in primary care and other aspects of the health system, toward the improvement goals we share.

  • Pulling Back the Curtain: My First Year as CFHI’s Patient Partner

    by Nadine Morris | Apr 25, 2019

    “Isn’t it funny how day by day nothing changes, but when you look back everything is different?”

    Daryl Bell, a respected leader in patient and family centred care at Kingston Health Sciences Centre, often referred to this quote by C.S. Lewis in his presentations.

    I’ve thought of this quote often during my first year as CFHI’s Patient Partner. I thought of it when CFHI’s Bridge-to-Home Spread Collaborative — which has a focus area influenced by patients and families — included patient partners on the steering and evaluation committees and on all of the improvement teams who are working toward improving the patient experience of transitions from hospital to home. I thought of it when I co-chaired a learning exchange supported by many organizational partners from across Canada which included 25 individuals with lived experience from underserved communities as steering committee members, presenters and participants. And I thought about it when the Vice President of Corporate Services started looking for plain language lawyers in response to feedback from a patient partner who found the language in contracts didn’t reflect the relationship she thought she had with the organization; and I thought of that quote on April 5th when CFHI launched Innovation Challenges that require a patient and/or family caregiver as a team member.

    By welcoming the perspectives of patients and families and actively engaging them, we better understand their experience and learn where there are opportunities to improve. As a member of the Patient and Citizen Engagement team, my role as the Patient Partner is to bring a patient perspective to the work of CFHI. The role was created to support partnering with more patients in a meaningful way, to find opportunities to model it, and to help the organization build capacity around this way of working. But I am not the only patient perspective at CFHI, there are many others who participate in our programming, providing their insight and sharing their experiences.

    To be honest, it was an experiment, a quality improvement project of our own. I, a patient and family experience advisor, was invited to see behind the curtain.

    It has given me a new understanding of the challenges and constraints that individuals who truly want to engage with patients are working within. There are things like budgets, strategic plans, mandates and accountability agreements. There are policies, processes and reporting lines and A LOT of meetings! Sometimes things seem to take forever and other times you feel like you are drinking out of a fire hose.

    There are champions, resistors and those who are “already doing it”.

    Many organizations hide these challenges behind the curtain. They wait to engage patients when they have the ducks in a row, the cake is partially baked, when they won’t have to say, “I don’t know”. It strikes me that the apprehension some staff and leaders may feel that patient partners will ask for things that the organization can’t do, comes from not being transparent about these challenges. That the frustration and disillusionment that patient partners sometimes feel comes from putting their heart and soul into a project only to find out there are barriers that were not shared with them that will impact success.

    However, just because I am now aware of those constraints does not mean that I accept them. It does not mean that I stop challenging the status quo. More than ever I question “why?” In fact, it seems to me that more than ever staff are now asking the same question. Together we are stumbling across the challenges and instead of saying “we can’t” we ask, “how can we?”. We are having honest conversations, sharing ideas, celebrating successes, problem solving and building relationships with more patient partners. We are learning, making mistakes, taking risks and evolving.

    The creation of this role was an important experiment. As we look to the future, we are examining how we have evolved, and thinking about what comes next. I believe there are a mosaic of ways to engage and that the patient perspective must be embedded at all levels of an organization to accelerate change. I believe that where and when the patient voice is invited to participate in conversations does make a difference.

    Patient engagement is a key lever for healthcare improvement. It means meeting people where they are on the spectrum of engagement, recognizing the need to continuously strengthen the foundation and evolving to improve it.

    It also means welcoming, supporting and building capacity for more patients, families and caregivers to be engaged in healthcare improvement in different ways at different times. Those of us doing this work, regardless of our role in it, will continue to teach, learn and make some mistakes. We will hopefully keep pulling back curtain and improving the patient experience and outcomes, together.

    Photo of Angela Morin and Carol Fancott

  • Are you ready to deliver more improvement for more people, and make it last?

    by Nadine Morris | Apr 02, 2019

    I am excited to share with you our plans to launch two new outcomes-based innovation challenges focused on delivering more improvement for more people – and making it last. Supported by a coalition of leading Canadian healthcare organizations, we’re aiming to build a community of innovators, connect them with experts and other resources to accelerate change, and reward creative solutions that deliver lasting results.

    These Challenges are for teams that want to move the dial on health outcomes, working together to reach more people. Participating teams benefit from program support and other resources, connections with other innovators, and the potential to receive awards. Teams can gain profile as they improve access and outcomes.

    The Priority Health Innovation Challenge focuses on identifying and growing promising innovations in two shared health priorities – improving access to mental health and addictions services, and home and community care. Over 18 months, the Challenge will support teams to move the dial on one or more of 12 common indicators, from wait times for community mental health services and rates of self-injury to access to homecare services that help recipients stay at home and caregiver distress.

    Did you know that “open innovation” challenges have been used as far back as Napoleon’s time and have been rediscovered in recent years? They can be an effective way to:

    • Identify promising innovations
    • Support the spread and scale of proven innovations
    • Celebrate success and foster widespread participation
    • Building communities that support people and organizations with a common goal

    The Momentum Challenge is for teams that have recently completed CFHI programs and want to ensure long-term success by working over 12 months to embed and expand their proven innovations to reach more people who could benefit. This “invitation only” Challenge is open to teams that have participated in the INSPIRED COPD Scale Collaborative, Connected Medicine Collaborative and New Brunswick Appropriate Use of Antipsychotics Collaborative.

    These two Challenges line up with CFHI’s mission to work shoulder-to-shoulder with partners to accelerate the identification, spread, and scale of proven healthcare innovations. Together, we will identify and grow promising innovations in shared health priorities, while expanding proven innovations to reach more people.

    Visit the CFHI website at cfhi-fcass.ca/Challenges for more information.

    Are you ready?

  • Partnering with patients to improve transitions in care

    by Nadine Morris | Mar 25, 2019

    Every day, people from across Canada are discharged from institutional care settings. This can be a vulnerable time for patients, especially if they don’t feel they have the information they need to confidently care for themselves after they leave. In particular, transitions from hospital to home can be challenging and pose potential risk for patients at a time of significant stress.

    This week, CFHI announced the 16 organizations who will participate in our Bridge-to-Home Spread Collaborative. Through this 17-month quality improvement initiative, CFHI is tackling a long-standing issue in healthcare, one that has been identified by patients and families time and time again. That is that patients and their families or caregivers, often feel ill-prepared when they leave institutionalized care – whether it be from hospital, rehabilitation or from an out-patient setting. And there is evidence to show that poor transitions in care can result in adverse events and poor patient outcomes, emergency room visits, and even hospital readmissions. 123

    A transition in care involves any action that ensures the coordination and continuation of healthcare for a patient who is moving between different locations or levels of care. This can happen at many different points in the health system, including the transition to home. Through the Bridge-to-Home Spread Collaborative we are asking the question: How do you make the transition home better for patients and their families or caregivers?

    Part of the answer is through the meaningful involvement of patients and families.

    From the conception of this program to its design—the innovation we’re spreading was co-designed together with patient partners—to selection of teams, curriculum development; as team coaches and faculty, right through to evaluation—patients and caregivers are involved throughout the multiple layers of this initiative. They are also playing an important role as members on all participating teams.

    Teams participating in this Collaborative will work together with patient and family advisors to adapt, design, implement and evaluate a patient-oriented care transitions bundle that will improve their experience of transitions from institutionalized care to home or community care.

    The bundle includes:

    1. A patient-oriented discharge summary (known as PODS): PODS is an innovation from OpenLab, a design and innovation lab with University Health Network (UHN). A simple tool that was codesigned by patients and providers in 2014, it is used to engage patients and caregivers in collaborative discharge planning to ensure they consistently get the information they need to transition home. It has been adapted for several different care settings across the spectrum, such as paediatric, rehabilitation, acute, adult care, mental health, and surgery.
    2. Patient and caregiver education: Providing patients and caregivers with the information they need to transition and ensuring they understand the information is critical for success. Teach-back is one educational method that involves patients in their care by asking them to explain, in their own words, what they have learned to manage their care at home.
    3. Welcoming caregivers as partners in care: Family members and caregivers are important allies for quality and safety. Involving them in transition planning, education and support once the transition is underway strengthens their role in helping to support the patient following discharge.
    4. Post-discharge follow-up:  Teams will look at strategies to best support patients and caregivers following discharge that fits within the context of their work.

    This initiative has been built around the fundamental principle that when patients can understand and be part of their healthcare, can take control of the information they need, feel confident, and are part of the decision-making process, then they can leave an institutionalized care setting ready to manage their care as they transition to home. That’s a win for everyone!

    Learn more about the Bridge-to-Home Spread Collaborative.

    1 Forster, A. J., Murff, H. J., Peterson, J. F., Gandhi, T. K., & Bates, D. W. (2003). The incidence and severity of adverse events affecting patients after discharge from the hospital. Annals of Internal Medicine, 138(3), 161-167. doi:200302040-00007 [pii]

    2 Burke, R. E., Kripalani, S., Vasilevskis, E. E., & Schnipper, J. L. (2013). Moving beyond readmission penalties: Creating an ideal process to improve transitional care. Journal of Hospital Medicine, 8(2), 102-109. doi:10.1002/jhm.1990 [doi]

    3 Coleman, E. A., Parry, C., Chalmers, S., & Min, S. J. (2006). The care transitions intervention: Results of a randomized controlled trial. Archives of Internal Medicine, 166(17), 1822-1828. doi:166/17/1822 [pii]

  • EXTRA: Executive Training Program exceeding my expectations

    by Nadine Morris | Dec 10, 2018

    Last year, when my Assistant Deputy Minister (ADM) suggested that our health and social service department was looking to support a team to be part of the Canadian Foundation for Healthcare Improvement’s (CFHI) EXTRA: Executive Training Program, my immediate thought was (insert self pity voice here), ”I can’t possibly add something else to my workload...I already did my masters…surely this could wait until next year, when there is less change.” Of course, my outward response was, “Wow, what an amazing opportunity – thank you!”

    Joking aside, and despite initial reservations based on workload, the EXTRA program has exceeded all my expectations. The program has provided tremendous learning opportunities that have been, and will continue to be, of great benefit to me personally, to the team I am working with, and for the rest of the healthcare system we work in. I have also had the fantastic opportunity to connect with amazing people, both within my ‘home’ team and from across the country. Despite our regional differences and the so-called ‘local flavour’ of each health system, I’m impressed by the dedication of the other EXTRA teams to tackle the common challenges we all seem to be facing. I have even had the side benefit of being invited for a site visit to another area to see first-hand how they are applying their improvement project to a challenge that we are also facing (next project already!).

    Before I carry-on extolling the excellent attributes of the EXTRA program, I do have to disclose my bias for experiential learning, which EXTRA strongly emphasizes. Over twenty years ago, I was trained in problem-based learning (physiotherapy) at McMaster University, so experiential learning is not new to me and it is most certainly my preferred kind of learning. That said, I was still somewhat skeptical about what exactly executive level experiential learning would look and feel like. In our fast-paced, pressured daily work lives, how would the structure of this program support the learning I needed, in addition to the execution of a relevant quality improvement program? The EXTRA program structure does achieve this through a variety of methodologies. In addition to the experiential aspects, there is a blend of self study, didactic and interactive residencies and a team coach. All these elements combine to support teams and strike the fine balance of creating excitement for project’s progress, as well as relevant learning that is immediately applicable to a variety of aspects of healthcare executive work.

    So despite my initial misgivings, I am incredibly grateful to have this opportunity and so glad I didn’t miss out on it. To be perfectly frank, it is a lot of work, but not for a moment has the effort felt futile or wasted. Thank you!

    Learn more about Yukon Health and Social Services and Yukon Hospital Corporation’s improvement project.

    Health and Social Services (YK)/ Yukon Hospital Corporation (YK)

    Dallas Smith, Amy Riske, Laura Salmon and Stefanie Ralph from the Health and Social Services (YK)/Yukon Hospital Corporation (YK) Cohort 14 EXTRA team.

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  • Saying Thanks as my Journey Begins

    by Nadine Morris | Oct 05, 2018
    Thanksgiving Day is just around the corner and this year, in particular, I have much to be thankful for.

    CFHI’s team and Board have been wonderfully welcoming since I joined the organization in September. Their knowledge and talents are deep and varied, essential elements to delivering on our commitment to better health and care.

    This is a goal that we also share with our many partners across Canada. 

    We owe a particular debt to the patients and caregivers who share their experiences to help co-design improvements that will benefit people who share similar paths to theirs. For instance, a few days ago, Kathy Smart shared her insights with people from across Alberta who are striving to improve care for those with chronic obstructive pulmonary disease (COPD) as part of the INSPIRED COPD Collaborative Regional Roundtable. 

    Likewise, I am grateful for the many dedicated individuals and teams from across the country with whom we work shoulder-to-shoulder to make care better. Teams like those working on shifting care from hospital to home; the appropriate use of medications; a palliative approach to care that provides the right care, in the right place, at the right time; improving the quality and experience of patients through care transitions; and those supporting partners to contribute to closing the gap in Indigenous Health. 

    While this represents just a small sample of our work, the heavy-lifting of these individuals and teams is a perfect example of all the ways change is happening. 

    Supporting their efforts are faculty, advisors, and volunteer reviewers who help guide the way. They are essential to the success of all CFHI’s programs. So too are our partner organizations – the local, provincial/territorial, national, and international groups that we work with to design and accelerate innovations that deliver more improvement to more patients and families, care providers, and the health system as a whole.

    It will take all of us and more to deliver the on-going improvements in patient experience, access, quality, and value that Canadians expect and deserve. 

    As I begin my role as President and CEO, my mantra is ‘listen, learn, and connect.’ That’s why I am also very thankful to all those who have generously given me their time and thoughtful advice on CFHI’s direction. As we share our refreshed corporate strategy over the coming weeks, I will look forward to hearing your thoughts on how we can chart our way forward together. 

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  • How to Create Buy in for Change? Think Like an Alien.

    by Nadine Morris | Sep 20, 2018

    Effective communication is key to healthcare improvement. If we want our ideas to make a difference and create change, we need to co-create ownership with stakeholders. Clear, consistent communication that considers the context of our audience can help ensure our ideas resonate. For many healthcare leaders, this means changing the way we communicate.

    Many communication breakdowns result from people starting at different points of understanding. Healthcare professionals, like many highly-specialized fields, are notorious for using jargon and acronyms that can create barriers to engaging others.

    CFHI recently held a webinar on effective change management with teams participating in the INSPIRED COPD Scale Collaborative. Part of the session was devoted to helping teams leverage communication to influence stakeholders and build awareness for their programs. We encouraged teams to think outside the box about how they communicate their improvement projects to others. They were forced to think differently. How different? We asked teams to imagine themselves as aliens!

    The Activity:

    This activity was adapted from the ‘alien at dinner’ change management exercise. Teams were provided with the following instructions:

    You are an alien who is observing the INSPIRED program in your jurisdiction for the first time. You are to report back to people on your home planet about what you witnessed, telling the story from your perspective as an alien (outside observer) who knows nothing about the program or its context. Avoid using any acronyms or slang as it needs to resonate and be understood by those who have no experience in our healthcare system.

    Think about how you would describe the different activities, as well as the goals of care and outcomes. You have no more than 1-2 minutes to tell your story.

    The Result:

    By requiring teams to understand their programs as outsiders, this activity forced them to remove their own perceptions and consider an audience who knows nothing about their project or its context - an exercise that teams found had real value. Even as members of the INSPIRED project team, we gained greater clarity about the improvement projects based on their use of ‘alien-friendly’ language and descriptions. It allowed teams to identify items that might not make sense to those with an outside perspective and helped them determine areas for change. But, the most impressive result of all were the compelling and impactful stories teams created about their projects, like the one the team from Health PEI told to explain how they spread the INSPIRED program across the province.

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  • Le choix de la langue : le savoir-faire de la santé à la FCASS

    by Nadine Morris | Jun 05, 2018

    Available in French only.

    Depuis septembre 2016, j’apporte une perspective francophone à la FCASS. Étant originaire de Lévis, la Rive-Sud de Québec, la langue française occupe une place primordiale dans ma vie de tous les jours. Lorsque j’ai débuté avec la FCASS, j’ai remarqué que l’organisme avait déjà de bonnes relations de travail avec des partenaires francophones. Il fut donc important pour moi de connaître les projets collaboratifs présents au Québec et de rendre ceux-ci accessibles aux francophones. 

    L’atmosphère francophone à la FCASS 

    Tous les jours j’utilise la langue française au travail. J’ai toujours senti le soutien et la liberté de m’exprimer dans la langue de mon choix. D’ailleurs, saviez-vous que plus de 40% des employés de la FCASS sont bilingue? Les employés francophiles démontrent aussi un grand intérêt à participer à des activités favorisant l’utilisation des deux langues. Ainsi, j’invite mes collègues à bavarder lors des dîners-causeries et participer à des jeux permettant de développer leurs vocabulaires. De plus, nous avons récemment lancé une nouvelle activité appelée « pause-causerie » qui consiste à agencer un francophone mentor avec un francophile lors d’une marche de 15 minutes en français. Xenia Nei, agente des finances nous a confié « cette activité est une bonne opportunité pas seulement pour pratiquer le français, mais aussi pour apprendre à connaître une collègue. Bien qu’aussi les diners-causeries soient amusants, je trouve qu’en groupe j’ai peu d’occasions de contribuer. Donc la pause-causerie est meilleure à cet égard. » De plus, cette activité permet de s’ajuster à plusieurs niveaux de français. 

    J’accorde aussi beaucoup d’importance aux échanges de l’organisme sur les médias sociaux. Bien que nous partageons notre contenu en français, nous restons à l’affût du partage de connaissances, d’évènements et de l’actualité dans le domaine de la santé au Canada. C’est une belle opportunité d’agrandir notre réseau et d’échanger davantage avec des innovateurs en matière de services de santé. 

    Travailler main dans la main…nous amène loin 

    En travaillant aux communications, j’ai vite compris que l’implication de cette deuxième langue officielle du Canada ne se limite pas seulement à la culture de l’organisme, mais elle permet aussi de diffuser l’amélioration des services de santé en français. En 2016-2017, 24% des équipes participantes aux projets collaboratifs de la FCASS étaient francophones. Je me rappelle qu’en 2017, j’étais très contente d’apprendre que le CISSS de Chaudière-Appalaches allait participer à la cohorte 13 d’EXTRA afin de maximiser les tâches des préposés aux bénéficiaires, puisque des membres de ma famille sont dans des CHSLD dans cette région et je savais que ce projet allait avoir un impact direct sur mes proches.  

    Depuis 2004, la FCASS est surtout reconnue au Québec par le programme de formation pour cadres FORCES dont plus de 74 équipes québécoises y ont participé. Ainsi, ce programme a permis d’ouvrir des portes à plusieurs autres projets collaboratifs au Québec. En 2016-2017, plus de 6 projets collaboratifs y étaient présents et maintenant, cette présence ne fait que prendre de l’expansion. Afin de soutenir l’innovation, la FCASS offre l’accès à plus de 17 enseignants bilingues de la faculté; il est donc possible aux participants de communiquer directement dans la langue de leur choix.  

    En outre, le projet collaboratif sur l’utilisation appropriée d’antipsychotiques au Nouveau-Brunswick (UAA-NB) est présent à travers la province depuis 2016 et offre un support bilingue lors de réunions, webinaires, formations avec un mélange de conférenciers francophones et anglophones. Marie Agapitos, agente de programme francophone de l’UAA-NB, nous faire part de son expérience; « étant le point de contact francophone de l’équipe, nous avons offert aux équipes dans la langue de leur choix, ce qui a facilité la communication et le développement des relations de travail. Il s’agit d’une expérience positive et j’ai aussi appris à les connaître davantage. » 

     Depuis novembre dernier, le projet d’utilisation appropriée d’antipsychotiques est maintenant diffusé au Québec sous le nom Optimisation des pratiques, des usages, des soins et des services – Antipsychotiques (OPUS-AP). Ainsi, le CIUSSS de l’Estrie – CHUS a été mandaté par le Ministère de la Santé et des Services sociaux du Québec pour diriger le projet OPUS-AP au nom de l’ensemble des CISSS et des CIUSSS de la province. De plus, l’implication du Ministère de la Santé et des Services sociaux, la FCASS, l’Institut national d’excellence en santé et services sociaux (INESSS), le Regroupement provincial des comités des usagers et la Fédération québécoise des Sociétés Alzheimer ont rendu possible cette démarche. Lors du lancement d’OPUS-AP en novembre dernier, les professionnels de la santé étaient si enthousiastes à l’ idée de travailler en partenariat avec la FCASS dans l’implantation d’une pratique novatrice qui a pour objectif l’amélioration des services de santé. Il s’agit donc du premier projet collaboratif provincial de la FCASS se déroulant uniquement et entièrement en français. D’ailleurs, le début de cette démarche au Québec suscite beaucoup d’engouement et un bon potentiel de développement en matière d’optimisation des pratiques, des usages et des soins et services au Québec. 

    Travailler directement en français avec les parties prenantes francophones m’a permis d’avoir une meilleure compréhension des réalités des systèmes de santé. C’est toujours intéressant de découvrir les défis rencontrés; les barrières existent, mais les équipes trouvent des solutions créatives pour les contourner. De plus, je réalise que ces relations de travail comptent vraiment beaucoup pour moi puisque les réalisations de la FCASS ont un impact direct sur la santé de mes proches. Je suis fier de contribuer à l’amélioration des services de santé dans les régions francophones du pays.  

    Audrey Lemieux

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  • In the Dark: What I Learned About Our Healthcare System on My Way to the Operating Room

    by Nadine Morris | May 03, 2018

    My recent journey into the Canadian healthcare system started with a “pop.” I was walking down the street when I felt a snapping in the back of my ankle and a searing pain. It wasn’t long before I learned that I had ruptured my Achilles tendon. Surgical repair was in my future.

    As someone working in a healthcare improvement organization, it’s always fascinating to see healthcare up close. What I saw confirmed my belief that, while the foundation of our system is solid, there’s plenty of room for improvement. And this improvement is particularly important for others in our country who just don’t have the advantages that helped me navigate my way back to health.

    First, the positive:

    Great providers and care: Every healthcare provider I met was kind, caring and professional. The volunteers who roamed the wards telling corny jokes and playing beautiful music truly lifted my spirits. And I have no doubt that I received world class clinical care.

    No money, no problem. . . for me at least: Thanks to our taxpayer funded hospital and physician system, money never crossed my mind. Not when I went to the emergency department (ED). Not when I was in hospital for my procedure or during follow-up care. It helped that my employer-sponsored insurance covered the cost of a semi-private room, medications and some physiotherapy – important health services that many Canadians may have difficulty accessing.

    But there were definitely aspects of my experience that could be improved:

    Waiting and the unknown: I was initially told to arrive at 9:30 a.m. on a Thursday for day surgery. As the day wore on I started to have my doubts. There was a glimmer of hope at 3 p.m. when an anesthesiologist began to discuss my options, but soon I was told they couldn’t fit me in. My surgeon said they would re-schedule over the weekend. No problem. I was nervous and this felt like a stay of execution.

    My surgeon’s office told me to show up at the ED Saturday at 7 a.m. They inserted an IV, took some blood, my history (again), and my insurance information. That afternoon I was transferred to the orthopaedics floor - my new home away from home.

    Each day in hospital was similar. I would fast all day until I knew that the window for surgery was closed. Then I’d feast on hospital food or takeout before starting my fast again at midnight. My days were mostly spent probing for more information from nursing staff, other patients and their families, and the surgeons.

    I learned I was low priority and they couldn’t say when my surgery would take place. I couldn’t go home, sleep in my own bed, and come back the next day or I’d lose my place in line. An appointment, instead of standby, wasn’t an option as every surgery was based on triage. How long might I wait? No one knew. Maybe a delusion from lack of food, but I pictured myself marooned and growing old in the hospital.

    My number was finally called Tuesday morning. It felt like I had won the lottery and I’ll admit to high-fiving a few staff. I’m pretty sure I gave a few more as I regained consciousness.

    I have no doubt others before me needed surgery more than me or had waited longer — but clear communication from hospital staff would have really improved my experience. I understand they didn’t know when I would have surgery, but they knew the system by which those decisions were made. They knew I was on a standby list. They knew their policy on surgical wait times for admitted patients. They knew how many were on their list each day. I would have loved to know those things. And someone who needed to make childcare arrangements or deal with a demanding employer would have needed that information even more.

    Discharge: The morning of my discharge from hospital, the surgeon and team stopped by my bed. I know discharge and other transitions in care are really important. Could I move my leg I asked? Yes, but not too much was the reply. I was told that other instructions would be found in my discharge summary.

    The summary was clear on which surgery I had, who had performed it, and who the most responsible physician was. Otherwise, my instructions were to call my family physician if I had an issue and to schedule a follow-up appointment in two weeks.

    This wasn’t at all helpful in preparing me for my recovery. To supplement this lack of information I went online and found amazing resources like this myhealth.alberta.ca guide with instructions for wound care, non-medication pain management and more. Innovations like patient oriented discharge summaries can’t come soon enough!

    I don’t mean to complain. . .

    This isn’t about complaining, but about sharing my experience and asking how we can do better. How can patients have better experiences of care? How can we ensure they feel confident and safe transitioning home? I have to admit that I feel a twinge of guilt: will my kind and competent surgeon find out and hold it against me? Will people just see this as whining about my healthcare when so many people have more serious medical issues?

    Maybe my reticence reflects a stereotypical Canadian politeness. Or perhaps it stems from our collective exaltation of our publicly funded healthcare system — an affection that I share and that drove me to work in this sector. As Canadians we accept healthcare that is middle of the pack – at best. As CFHI President Maureen O’Neil has asked, “Do we love our healthcare system too much?

    Improvement starts by recognizing that we can and need to do better. While my wait for care was merely an inconvenience, I can’t picture what someone with less advantages than me would have done: a single parent; someone who didn’t have an understanding employer; or someone who didn’t speak the language. And imagine if I hadn’t found those online resources and suffered a blood clot – how would I have even known the symptoms? Or where to go?

    What do you think? Have an experience you’d like to share? Or a suggestion for ways to improve our system? Let us know…

    Graeme Wilkes

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  • Transforming the Cancer Experience

    by Nadine Morris | Mar 23, 2018

    Our healthcare system is arguably facing some of the greatest challenges in its history.  An aging population, breakthroughs in treatments, and changing patient needs have led to a system that is increasingly under pressure.  In this context, and at a time when resources are stretched, the role that patients play has become ever more important. There is an international body of evidence that shows that patient activation can significantly improve quality in healthcare.  In many jurisdictions patient activation is now a valuable way to empower patients, to improve their experience and health outcomes and to control costs, especially for populations characterized by high levels of healthcare utilization such as cancer patients.

    Moreover, for many the passive term “patient” seems outdated. Increasingly patients are becoming healthcare consumers and want to be more self-reliant and better able to manage their condition with greater independence. A recent survey by the Commonwealth Fund found that 71% of patients seek greater responsibility for their own healthi. Unfortunately, existing care delivery rarely supports this emerging demand.

    In 2011, the Ottawa Regional Cancer Foundation launched a new community-based health and social care service for cancer patients, their families and caregivers: Cancer Coaching has been effective in helping cancer patients become active participants in their care leading to improved health outcomes and contributing to a more positive healthcare experience.

    In 2017, when the Canadian Foundation for Healthcare Improvement (CFHI) selected the Cancer Foundation for its EXTRA: Executive Training Program, a significant milestone was achieved.  This unique opportunity not only sparks the broader implementation of Cancer Coaching, it has provided our Leadership Team with the opportunity to learn from Canadian healthcare champions. Supported by EXTRA coaches and faculty, we are acquiring the knowledge and skills we need to develop effective scale-up and spread strategies. And coming together with leading healthcare innovators at the residencies has enabled us to build a powerful network, one we will rely on for years to come.

    CFHI has shown exceptional foresight in welcoming us, a community group, a non-traditional contributor to healthcare improvement, into a program that aims to develop future leaders and to support them in their quality improvement project implementation. My colleagues John Ouellette, Vice President, Philanthropy and Johanne Levesque, Senior Vice-President, Survivorship Care, Professional, Practice, People and Culture, share my appreciation for this opportunity. It is our hope that armed with EXTRA learning, we will be able to enlist healthcare professionals from across the province and the country to the practice of Cancer Coaching.  Our vision is to transform the cancer experience for the thousands who will be touched by cancer in the years ahead.

    It would be a pleasure to speak with you about Cancer Coaching and to help you explore ways of making this innovative service available to people in your community.  You can contact me at leagen@ottawacancer.ca

    Linda Eagen
    Founder of Cancer Coaching
    President and CEO, the Ottawa Regional Cancer Foundation

    Linda EagenLinda Eagen at the EXTRA: Executive Training Program residency.

    ORCF teamLeft to right : Johanne Levesque, John Ouellette, Linda Eagen.


    i The Commonwealth Fund (2012), International perspectives on Patient Engagement: Results from the 2011 Commonwealth Fund Survey.

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  • Reflecting on the Journey of Patient Engagement

    by Nadine Morris | Feb 28, 2018

    Since 2010, CFHI has been supporting teams to build their capacity to meaningfully engage with patients and families.  Although the concept of patient-centred care’ has been around for decades, and there have been movements demanding more rights for patients to be involved (e.g. from persons with disabilities, HIV, paediatrics, mental health), in 2010, we were still in the early days of ‘patient engagement’ as we know it now, however, the notion of recognizing the value of (and hence actively seeking out) the lived experiences of patients and families to improve care and drive system change is a more recent phenomenon in Canada.  Not only seen as the ‘right thing to do’, there are increasing legislative and policy demands on organizations to ensure that they are engaging with patients across the health system. As CFHI has supported the work of engagement as a catalyst for improvement, we recognize that organizations are at different points along the journey to fully embed the perspectives of patients and families in these efforts. 

    While patient engagement may seem like a buzzword to some, the next ‘shiny thing,’ we see the reality of patient engagement and its important role to design, deliver and evaluate health services. Patients are an untapped resource and are perfectly positioned to take a more active role – not only in partnering with their healthcare providers to determine their care – but also together with teams of providers and leaders to shape how healthcare is organized, how it is delivered, and yes, how it can be improved.

    When we involve patients and caregivers, everyone benefits.  

    It’s about bringing the unique and diverse perspectives that only patients can bring, of recognizing their ‘expertise by experience’ to help shape organizational design and governance and policy. When done well, meaningful and purposeful participation provides an opportunity for patients, caregivers, healthcare providers and administrators to collaborate to create better healthcare experiences, improve patient safety and quality, and improve health outcomes.

    However, meaningful engagement is not just about what patients and caregivers do, it’s also about what organizations do. Organizations need to support and role model engagement by creating opportunities for input and shared decision-making at all levels. A collaborative approach encourages everyone to share their experiences, ask questions, and challenges the status quo. By ensuring patients and caregivers are active participants and embedded in decision-making structures, organizations can begin to build patient experience into how we deliver healthcare.

    In many ways, I feel like I have come full circle with CFHI.  I was one of the ‘early adopters’ in CFHI’s first ‘Patient Engagement Projects’ initiative in 2010, and I think back to many other leaders from organizations across Canada with whom I still stay connected and continue to learn together with and from. We remain passionately embedded within this field as we all strive to keep the patient voice at the forefront of the work we do. I think back to some of this early work, when we are all asking ourselves: how can we meaningfully partner with patients and families in our work?  What does patient engagement mean? What can we do to support patients and families to work with us?  How can we prepare staff to welcome the perspectives of patients?  What impact are we having when we engage with patients in our work?

    Since arriving at CFHI last year, I have had the opportunity to reflect on how rapidly the field has evolved over the past decade – from the early projects that focused on developing infrastructure to support engagement activities – to the more recent that have worked specifically on policy and quality improvement initiatives, co-designing processes and systems of care with patients and families to implement new patient-centred practices.

    Through the collaboratives that CFHI has supported  we’ve heard many voices and learned many lessons. To share these insights, we developed two “tips sheets,” one based on what has worked for healthcare providers and leaders when partnering with patients and caregivers in their quality improvement initiatives, and the other based what works best for patient and family advisors to partner and contribute in meaningful ways.

    Each provides a series of ‘lessons learned’ on how to facilitate the engagement process, and how patients and providers may work together on improvement efforts. We hope these tips sheets will help you on your own patient engagement journey and support a more patient-centred approach to improvement initiatives.

    The engagement practices shared in these tips sheets may provide an opportunity for you to reflect on experiences you have had, or validate what you may be doing already.  

    I also encourage you to check out the hashtag "#HowNotToDoPtEngagement", started by @couragesings, inspired by a blog written by Isabel Jordan - providing patient perspectives that I think are congruent with some of our CFHI lessons learned on ‘how to engage’ from patient and provider perspectives.

    By working together to design, implement and evaluate improvements, we help organizations understand and create the winning conditions to accelerate healthcare improvement. It’s happening now. We hope these tools will help you on your journey.

    Angela Morin and Carol Fancott

    Carol Fancott, Director and Angela Morin, Patient-Partner

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  • 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?

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  • 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!

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  • Five Things I Learned About Moving a Big Office

    by Nadine Morris | Oct 24, 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. 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. 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. 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. 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. 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.

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  • 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. 

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  • 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.

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