2020 EXTRA Improvement Projects

Health PEI

The Prevention and Reduction of Workplace Violence in Long-term Care

  • Mrs. Sarah MacDonald, Wellness and Safety Manager, Human Resources
  • Mr. Jason Rendell, Director of Human Resources
  • Ms. Shelley Connick, Administrator Long-Term Care Queens
  • Ms. Susan Clory, Director of Nursing Long-Term Care Queens
  • Mr. Philip Theberge, Quality & Risk Coordinator

The project will initially focus on developing a violence prevention and response model to be piloted in a long-term care (LTC) dementia unit with a goal of implementing the project developments to all Health PEI LTC sites. The model will be based on models seen in other jurisdictions and will outline processes, employee education/training, and using client-centered activities in care plans to reduce workplace violence. Engaging employees is vital to the project’s success. A survey and a focus group will be completed at the pilot site to identify workplace violence concerns and to determine which component(s) of the prevention and response model require developments.

The improvement project will help develop consistent processes to ensure timely incident investigation, debriefing and communication of corrective actions.

Health PEI will involve union representatives in the project design, implementation, and evaluation. The improvement project is expected to equip employees and managers with appropriate processes and education/training, which will decrease violence incidents in LTC. The project will contribute to improving staff safety and experience, as well as increase resident safety and quality of care.

St. Boniface Hospital

St. Boniface Hospital Harm Reduction Improvement Project

  • Mrs. Katarina Lee-Ameduri, Clinical Ethicist, Health Care Ethics Service
  • Mrs. Emily Hyde, Continuing Education Instructor, Cardiac Sciences Program
  • Mrs. Sarah Gilchrist, Director of Critical Care, Education Services and Respiratory Therapy
  • Dr. Thang Nguyen, Cardiologist

Healthcare facilities within the Winnipeg Regional Health Authority, including St Boniface Hospital (SBH), have been challenged with increasing emergency room visits and hospital admissions related to substance use. Manitoba does not have a safe consumption site nor provides harm reduction supplies in acute care settings or for outpatients.

SBH formally adopted a harm reduction philosophy policy in August of 2019.

The policy is the first step in formally developing harm reduction programs at SBH. This project aims to develop and implement harm reduction programming at SBH. The project has three stages so we can learn and develop as we move through providing harm reduction supplies from one unit to the entire hospital to SBH outpatients:

  • Harm reduction supply distribution to inpatients in the Cardiac Sciences Program (CSP) at SBH;
  • Harm reduction supply distribution to the broader inpatient population at SBH; and
  • The development of an outpatient harm reduction supply distribution center.

SBH would become the first hospital in Winnipeg to participate in inpatient harm reduction as well as outpatient harm reduction. We have partnered with Public Health Manitoba to provide free harm reduction supplies.

We are dedicated to moving forward and bringing harm reduction programs to SBH; however, the complexity of the project demonstrates the value of developing and fostering leadership skills.

Ministry of the Solicitor General and Ministry of Health, Ontario

Nurse Practitioner Led Integrated Primary Care Model for Corrections

  • Ms. Melanie Mayoh, Director, Corporate Health Care and Wellness Branch (CHCWB)
  • Dr. Michelle Acorn, Provincial Chief Nursing Officer
  • Ms. Linda Ogilvie, Manager, Corporate Health Care, Operational Support
  • Ms. Carrie Collier, Deputy Superintendent, Programs, Hamilton Wentworth Detention Centre

This project aims to improve primary care through the implementation of a nurse practitioner led (NP-led), integrated primary care model for correctional institutions in the province of Ontario, where the NP is the most responsible provider.

In Ontario’s provincial correctional system there are currently six staff NPs providing primary care collaboratively with physicians. This integration has reduced wait times for admission assessments in alignment with Ministry of the Solicitor General policy requirements. The NPs have pro-actively educated nurses on clinical subjects such as the management of withdrawal, hypertension and diabetes to improve patient outcomes. This has also received positive feedback from patients who are cared for by NPs.

Beginning with three early adopter sites, SolGen will recruit 14 additional full-time nurse practitioners to serve as the most responsible provider providing NP-led primary care with the intention of expansion of the model to 24 correctional institutions across the province. This model will dramatically increase access to, and consistency of, primary care provided in provincial correctional institutions. This initiative aligns with other MOH supported NP-led models of care such as the Attending NP in Long-Term Care Homes initiative and Nurse-Practitioner Led Clinics.

NP-led primary care will facilitate a holistic and comprehensive approach to corrections health care. This will be accomplished by merging an innovative medical and nursing lens and enabling leadership.

Department of Health and Social Services, Government of Yukon

Indicators Framework for Yukon's Health and Social System

  • Ms. Marguerite Fenske, A/Director, Insured Health & Hearing Services
  • Ms. Jennifer Potvin, Chief Information Officer / Director Information Services Branch
  • Mr. Justin Wallace, A/Director Program Support
  • Dr. Samantha Salter, Epidemiologist

This project will develop an indicators framework to support the implementation of the anticipated changes to the system arising from the Putting People First review. The department has primary responsibility for leading system transformation through partnership with stakeholders. A key component is the development of a framework for health status reporting, including publicly reporting key indicators from a broad range of health and social domains. As referenced in the Truth and Reconciliation Commission's Calls to Action, we will work with Indigenous governments and citizens in Yukon, using OCAP principles, to develop indicators that measure outcomes for Yukon's Indigenous population, with the goal of eliminating health inequities across the system.

While interventions focused on individuals and integrating care services for key population groups are important, these must be part of a broader focus on promoting health and reducing health inequalities across whole populations. Collaboration across a range of sectors and the wider community is required both within a population health system and an integrated care model (Alderwick, Ham and Buck 2015).

The department views an indicator framework as foundational to the Government of Yukon's 2020 strategic planning process. It will also facilitate Health and Social Services’ long-term objectives of becoming an evidence-driven organization. The department is committed to moving forward with full implementation of this initiative.

Centre intégré de santé et services sociaux de Chaudière-Appalaches

Improving Access to End-of-Life Care at Home – Beauce area

  • Mr. Marco Bélanger, Assistant Executive Director, General and Specialized Physical Health Programs
  • Ms. Marie-Ève Tanguay, Assistant to the Deputy Chief Executive Officer
  • Ms. Annick Bouchard, Clinical and Administrative Director, Optilab and Assistant Director, Multidisciplinary Services - Diagnostic and Telehealth Services Component
  • Ms. Stéphanie Simoneau, Assistant Director, Independent Living Support Program for Seniors

This project aims to improve access to palliative and end-of-life care at home in the Beauce area. To achieve this, management will establish a dedicated interdisciplinary team consisting of physicians, nurses, licensed practical nurses, a social worker, an occupational therapist, a nutritionist, a pharmacist and a health and social services assistant.

The EXTRA team will work closely with this interdisciplinary team to improve workflows and coordination within the care team.

The team will also look into the use of telehealth to support service delivery for patients and families. Given the geography and current labour shortages in Beauce, Telehealth would make more regular contact possible with both patients and families as well as with professionals and physicians in the interdisciplinary team.

Finally, by working with two patient partners, the EXTRA team can ensure that it is meeting the needs of the patients and families.

Centre intégré de santé et de services sociaux de la Montérégie-Centre

The SENSÉ Project, What Work is All About

  • Mr. Étienne Veilleux, Director, Disability Programming, ID-ASD-PD and VI
  • Ms. Alexandra Plourde, Assistant to the Director of Education and Academic Affairs, Education and Academic Affairs Branch
  • Dr. Sophie Gosselin, Deputy Head, Department of Emergency Medicine
  • Mr. Daniel Morris, Massage therapist, Dietitian, Patient Partner

The project’s goal is to improve the daily lives of visually impaired individuals by helping them join the job market through a position at the CISSS, the corollary being increased staff recruitment and retention. Our approach will focus on using the untapped potential of this group of individuals to offset local labour shortages. Our strategy is based on creating a talent development continuum, i.e. implementing a chain consisting of “schooling – internship at CISSSMC – employment at CISSSMC".

Among other things, creating this continuum requires developing partnerships with the education sector. These partner institutions will introduce mechanisms to adapt their teaching methods and tools in order to meet the specific needs of visually impaired students throughout their learning experience. The purpose of this approach is to ensure materials, tools and equipment used for education and training are both accessible and compatible.

Centre intégré de santé et de services sociaux de la Montérégie-Est

Developing and Implementing network case management for users who make repeat visits to the emergency department

  • Mr. Bruno Petrucci, Assistant Managing Director, Support, Administration and Performance
  • Ms. Maryse Hébert, Director of Multidisciplinary Services, Health and Social Services - Multidisciplinary Services
  • Ms. Nathalie Blanchard, Executive Advisor - Health and Social Services, Psychosocial Component - Multidisciplinary Services
  • Ms. Hassiba Hihat, Acting Assistant Director of Quality, Evaluation, Performance and Ethics

This project aims to make it possible for vulnerable populations to access quality, coordinated and continuous care that is in sync with other departments within the organization and the community. These personalized follow-ups will allow patients and families to actively participate in their care while being mindful of their personal experience, their level of literacy and their ability to self-manage. Case managers will also address determinants of health and other factors relating to vulnerability, whilst providing appropriate care and services. The support and assistance provided will enhance skill development in both patients and the various clinical teams that work with them. Personalized follow-up care will enable us to provide primary care that is adapted to the needs of each patient. The support will also extend to community care as we determine what local care and services patients require.

This project will allow the team to provide the appropriate care that are based on the needs of each patient, their experience, their knowledge and their involvement throughout their care journey. In addition, the strategic monitoring of this project will ensure innovative clinical practices are implemented while promoting the best use of human, clinical and organizational resources.

Centre intégré de santé et de services sociaux de la Montérégie-Ouest

Ensuring No One with Complex Mental Health Needs is Left Behind

  • Mr. Patrick Murphy-Lavallée, Deputy Chief Executive Officer
  • Mr. Patrick Dubois, Assistant Director, Quality, Evaluation, Performance and Ethics Branch
  • Ms. Lyne Daoust, Assistant Director of Professional Services - Operations, Professional Services and Medical Education Branch
  • Mr. Martin Turcotte, Chief, Secondary Addiction Services, Mental Health and Addictions Branch

This project aims to develop an approach that promotes individual recovery by allowing patients to remain in their own environment and encouraging greater involvement of their loved ones. All resources and the individual will be part of a single integrated network, where everyone will interact to make up a coherent trajectory from the perspective of the service user’s experience. Implementing an intervention plan that is adapted to the needs of patients will ensure continuous care in the community.

Despite the presence of non-intensive basic supports, supports of varying intensities and even intensive follow-up community-based teams, the EXTRA team believes that there are service gaps for clients with complex needs requiring personalised community-based care.

With this project, the EXTRA team hopes to improve community-based services to help provide effective and efficient care for these individuals who are often caught in the "revolving door" of hospital care. Our goal is to speed up the return of patients to their environment after repeated, lengthy stays in hospital.

We believe that this innovative project is fully aligned with the principles of effective, efficient, sound management in the context of patient-and-family centred mental health resources. Considering the regional responsibility of the CISSS de la Montérégie-Ouest as a care provider for clients with addiction issues and clients diagnosed with intellectual disabilities & pervasive developmental disorders (ID-PDD), we believe that there will be opportunities to quickly spread our model to our other partners in the Montérégie area.

Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec

Improving Information for Patients with Kidney Disease to Provide the Best Possible Care Pathway

  • Ms. Annie Walsh, Director of Administrative Affairs, Dialysis and Kidney Failure Program, Nephrology
  • Ms. Karine Lampron, Assistant Director of Ambulatory Primary Care and Chronic Disease Management
  • Dr. Jean-François Arcand, Nephrologist, Professional Services and Appropriateness of Care Branch
  • Ms. Marlène Champagne, Critical Care and Organ Donation Coordinator, Ambulatory Services and Critical Care Branch

This project aims to ensure a free and informed choice for patients who are about to start dialysis, whether the treatment is planned or provided in emergency situations. More specifically, we are looking to validate the patient’s understanding of the treatment, discuss their life plan (along with their family) and consider the psychosocial impact of renal replacement therapy. This confirmation will create a common vision among all stakeholders (including physicians) encompassing the needs, abilities, interests and aspirations of patients and families involved in the end-to-end clinical process.

By integrating information, we intend on fostering an approach that gives preference to home dialysis in order to comply with 2015 Ministerial guidance. CIUSSS MCQ nephrologists feel that home dialysis should be preferred given its substantial advantages: greater independence, no need to travel and a lower rate of complications. Finally, by providing more comprehensive information to patients in pre-dialysis, we hope to promote greater use of arteriovenous fistulae (AVF) in patients requiring treatment. AVF use should have a positive impact on patient survival rates according to a 2011 study by Perl et al. conducted in Canada on more than 40,500 patients with renal impairment.

Depending on the results of the improvement project, this new clinical process could spread throughout the Mauricie and Centre-du-Québec region.

Ministère de la Santé et des Services sociaux, Centre intégré universitaire de santé et de services sociaux du Centre-Ouest-de-l’Île-de-Montréal and Centre intégré de santé et de services sociaux de la Montérégie-Ouest

Access to Local Services for Patients Without a Family Physician, How to Achieve It?

  • Ms. Carine Sauvé, Ministère de la Santé et des Services sociaux, Director of Access to Local Care, Montérégie
  • Mr. Philippe Lachance, Ministère de la Santé et des Services sociaux, Director of Local Physical Care; Academic, Medical, Nursing and Pharmaceutical Branch
  • Ms. Prolet Tocheva, Centre intégré de santé et de services sociaux du Centre-Ouest-de-l’Île-de-Montréal, Business Processes Specialist, Bureau de l’accès aux services médicaux de proximité de Montréal
  • Ms. Mélanie Lapointe, Centre intégré de santé et de services sociaux du Centre-Ouest-de-l’Île-de-Montréal, Planning, Programming and Research Officer, Bureau de l’accès aux services médicaux de proximité de Montréal
  • Ms. Carmen Roy, Centre intégré de santé et de services sociaux de la Montérégie-Ouest, Executive Assistant, DSP, développement 1re ligne, Enseignement et affaires médicales

This project aims to improve access to local care and services, while taking into account the new challenges, constraints and levers in the wake of the pandemic. The newly established local teams are mandated to work with front-line medical teams, in collaboration with the Regional Director of General Medicine (DRMG), to facilitate the adoption and implementation of various measures to improve access to medical services. They must analyze bottlenecks in the care trajectory and propose solutions to improve access.

The objective of the project is to develop and implement solutions that are relevant, effective and adapted to clinical settings, following an in-depth analysis of the root causes of the problems.

The sub-objectives of the project are as follows:

  1. Develop a culture of access in local organizations and clinical settings to ensure that each patient is receiving the right care at the right time;
  2. Improve collaboration and communication between community organizations and the Ministry to take action which will improve access to care for local populations;
  3. Develop common knowledge and understanding of the problems regarding access to local healthcare throughout the patient care journey;
  4. Define support mechanisms to implement measures aimed at improving access in clinical settings and train local teams to support clinics in implementing these measures.

In the Montreal and Montérégie areas, the Ministry created “Access Offices”. These 2 offices are tasked with engaging regional stakeholders, as well as coordinating and supporting projects whose aim is to improve access to local healthcare services via Access Teams from their respective regions. Access Teams are defined in collaboration with patient partners, physicians and local medical clinics in order to maximize their positive impact on overall access to local healthcare services.

Local teams will be tasked with becoming experts in access to local care and services. They will support physicians and professionals who will be implementing new models to support access to primary care. They will be custodians of evidence, knowledgeable about innovative initiatives, equipped to support project and change management, and they will be conduits for communication between patients, professionals, the field and decision makers to improve and develop primary care and services.

Centre intégré universitaire de santé et de services sociaux de l’Ouest-de-l’île-de-Montréal and McGill University, Ingram School of Nursing

Developing an Interprofessional Education Program to Supervise Specialized Nurse Practitioner (SNP) Students

  • Ms. Mylène Lévesque, A/ Chief of University Education and Medical Internships, Academic Affairs, Teaching and Research Directorate
  • Ms. Beverley-Tracey John, Director of Nursing
  • Dr. Bruce Campbell, Managing Director, Medical Education, Academic Affairs, Education and Research Branch
  • Mr. Jérôme Ouellet, Assistant to the Director of Nursing, Nursing Branch
  • Mrs. Irene Sarasua, Nurse Practitioner Program Director and Assistant Professor, Ingram School of Nursing

The proposed Improvement Project would involve designing, experimenting and evaluating an interdisciplinary training program (physicians-nurses) by facilitating the acquisition of skills required to supervise of SNP students. The goal of this action plan is to address issues identified by stakeholders that currently undermine the integrity of our organization’s SNP clinical training program and the interest of physicians in becoming supervisors. Ultimately, the project aims to increase the number of physicians and SNP supervisors to bolster internship opportunities.

Developed as part of a healthcare organization-university partnership, the project will include citizen partners. As potential patients of SNPs, these citizens will be actively involved in the project, in particular through their contribution to SNP student training as co-educators or even facilitators in the case of simulations.

The action plan will be monitored with specific indicators and include documenting the SNP internship pathway in order to lay the foundations for what will become an SNP student induction program, including support for supervisors. Informed by our data collection findings, the action plan will focus on learning activities that target barriers and enablers to the interprofessional supervision of SNP trainees.

Our preferred methodological approach is to partner in collaborative research, which recognizes the specific skillset each stakeholder group contributes to the search for solutions and changes. Following the data collection phase, we intend on identifying interprofessional learning activities to help develop a model for the SNP internship pathway.

Ultimately, the foundations of the induction program identified by the EXTRA project will pool together the viewpoints of scientists, citizen partners, supervisors (physician-SNP students), SNPs, advanced practice advisers and managers. The project will produce a series of structuring activities that will lay the groundwork for an SNP student induction program. The project will take place in the CIUSSS’s U-FMG (University Family Medicine Group) as well as in a partner community FMG (Family Medicine Group) where CIUSSS SNPs practice and student SNPs also do placements. The combination of these two very different settings will provide an interesting sampling of cases that should help design and test a program that meets the needs of various settings and internship environments. This will also facilitate the project’s transferability, where applicable, to a wider range of clinical internship settings.