Empowering Clinical Leaders

Guest Blog by Gloria Cardoso, BScN, MHSc, CHE. Executive Lead, Primary Health Care

img_2017_clinical7Throughout my career, I have been fortunate to work with incredible clinicians. Whether it was as a critical care nurse, health leader within hospitals, home and community care, provincial physician membership organization and the Waterloo Wellington LHIN – I continue to be inspired by the commitment and passion of those who provide care for people in our community.

I love learning the story behind why people chose a clinical career and am amazed what I learn about people’s experience and how that shaped their path.

  • One Gerontologist told me about her grandfather who had Alzheimers. That experience shaped her desire to find ways to help seniors and their families live a quality of life with dementia.
  • One social worker told me about her experience with her younger sister who had leukemia. She wanted to work with children and families in the cancer unit as she understood firsthand how challenging the illness is on the person, family and friends.
  • One nurse practitioner explained her parents were clinicians and she wanted to carry the service vocation in the rural community in which she grew up. She came from a long history of clinicians in her family.

Most recently I met up with a past colleague who worked at a hospital as an infection control doctor. In the past few years he shifted his practice from hospital to treat people in the community who suffer from Hepatitis C. He saw a need, responded, and now has built a thriving clinic making it easier for these individuals to be healthy and get the care and support they need. Many of these people were overlooked by the health system but today they have a place to go for help. His story is one of Vision, Courage and Empowerment.

Amazing stories of people making a difference in our world. 

One of our local priorities is to empower clinician leaders to help drive meaningful system improvements. We commit as a LHIN to walk hand in hand with clinicians to make the necessary changes for our residents. We believe that patients and clinicians are our greatest advisors – helping us understand what is working, what needs fixing, and how best we might make needed change.

Listening to and supporting clinicians to make it easier for them to help their patients has resulted in significant improvements to care. One such example is our work to share information between mental health service providers and primary care practices. Our local clinicians told us this information was critical to help them help their patients – we listened, learned and now are making it happening.

We are currently recruiting for a Vice President, Clinical and Sub-region clinical leaders. These roles will be instrumental in helping reach as many clinicians as we can to seek their advice and input into changes needed to improve their patient and clinical experience. We’ve had a great track record working with clinical leaders and have outstanding clinical physician leads working with us. We look forward to adding additional clinical leadership to our LHIN team as we aspire to make it easy for people to stay healthy, and get the care and support they need.

Connecting Innovations in Agri-Food with the Health & Social Innovation Ecosystem

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Many innovations in health are focused on improving outcomes for patients. Recently, I had the opportunity to connect with dozens of thought leaders in the agri-food, environmental and life sciences industries through the Guelph Chamber of Commerce to hear about opportunities to do just that as well as support residents to live and stay healthy every day.

Bill Charnetski, Ontario’s Chief Health Innovation Strategist, spoke passionately about the innovation imperative and how we are leveraging innovation across government, private and not-for-profit sectors to drive better outcomes for residents while supporting local businesses, entrepreneurs and researchers.

Guelph is a city known for its innovative culture in agriculture and food science, life, biomedical and environmental research and manufacturing. The message Bill delivered is important as we look at ways to both support our local industries and create jobs while leveraging their expertise to improve the health of residents in our own communities.

argi_foodeventWe heard from thought leaders at University of Guelph who are conducting incredible research in molecular and cellular biology and how this research will positively impact patients.  I was equally inspired to learn about innovations in food science that will produce some of the healthiest whole grains, right in Guelph, offering an incredibly healthy food source for patients and residents. Integrating our innovations in the food supply sector with the health sector is important as we look forward.

Equitable access to local healthy food is also important. As a health system and a responsible partner in the broader community – if we are going to support residents to live healthy lives, we need to look at making access to healthy food much easier for all. We have local champions of food security taking on this challenge such as Community Support Connections, Meals on Wheels and More, an organization that continues to innovate to find healthier and more equitable solutions for residents.

We also have organizations creating momentum through social innovations such as the Working Centre in Kitchener, which innovates every day as they find solutions to support some of our most vulnerable residents, and St. Paul’s Greenhouse, a social impact incubator at the University of Waterloo whose students have developed many practical solutions to health problems and turned those solutions into local businesses.  And we have social impact programs at our local innovation hubs like Communitech and Innovation Guelph.

I look forward to connecting more and more innovators and growing our partnership with the Guelph Chamber of Commerce and our fellow Chamber members.

If you are interested in connecting with us or any of our innovation partners, please reach out to me at bruce.lauckner@lhins.on.ca or @brucelauckner.

 

A Huge Thank You to Nurses

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This week we have celebrated the incredible nurses working in our local health system. I was inspired by the diverse profiles of local RPNs, RNs, and NPs, working across the health system and how passionate they are about their patients. Most of them spoke about wanting to make a difference and the value they add supporting families through challenging times. I couldn’t agree more.

For me, I have been fortunate to have many great nurses care for me and my family over the years. I think of the care coordinator who helped make my mom’s final wishes a reality as well as those who cared for her in her home, the nurses at my family health team, and more. As a sports guy, I have had my fair share of injuries and as a dad, I’ve also spent a fair bit of time at the family doctor and in the ED worrying about my kids.

So on behalf of my family, and the thousands of families we serve across Waterloo Wellington – a heartfelt thank you for everything you do each and every day.

Bruce
@brucelauckner

Improving Hospice Palliative Care Across Waterloo Wellington


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Guest Blog – Emmi Perkins, Director, Regional Hospice Palliative Care Program

As demographics shift and our population ages, hospice palliative care is becoming more and more important to local residents. Observing this shift, the Waterloo Wellington LHIN continues to improve access, supports and resources to make sure the right care is available when residents need it.

The first question you might ask is – what exactly is hospice palliative care?

Hospice palliative care aims to relieve suffering and improve the quality of living and dying.

Hospice palliative care strives to help patients and families:

  • address physical, psychological, social, spiritual and practical issues, and their associated expectations, needs, hopes and fear.
  • prepare for and manage self-determined life closure and the dying process
  • Cope with loss and grief during the illness and bereavement.

Hospice palliative care is appropriate for any patient and/or family living with, or at risk of developing, a life-threatening illness due to any diagnosis, with any prognosis, regardless of age, and at any time they have unmet expectations and/or needs, and are prepared to accept care.

Over the last few years we have developed and implemented new strategies to improve the hospice palliative care patient experience. A great example of this is our successful Coordinated Bed Access Program.

The Coordinated Bed Access Program is a collaborative program, developed by hospice palliative care providers to communicate both demand for and availability of hospice palliative care beds throughout the region in a timely manner.  Depending on a patient’s needs, providers work together to match patients with available beds, which means patients are getting the care they need, faster.

Time is incredibly important in all aspects of a patient’s care, but especially in end-of-life care. It can mean the difference between honoring a patient’s preferred end-of-life care plan and having them pass away in a place that wouldn’t have been their first choice. Fortunately, 83% of local residents are able to pass away in their preferred place. But we still have more work to do to make this a reality for all residents.

Supporting residents to die in their preferred place is enabled through strong partnerships amongst hospice palliative care providers in each community.  These dedicated hospice palliative care teams are skilled and knowledgeable about palliative care and local resources and are therefore able to ensure the needs of patients with complex pain and symptom management issues are addressed in the setting of their choice.  Additionally,  these teams promote and support other providers in each community to identify patients who would benefit from a palliative approach to care and to deliver this comprehensive approach to addressing the needs of patients who are in their last year of life (and their caregivers).  A recent key enhancement to these teams is a standardized role for the hospice palliative care nurse practitioners to support primary care providers who are caring for patients with palliative care needs.

We are also undertaking planning activities to understand our current hospice palliative care resources and to plan for services that will be required in each sub-region to support equitable access to high quality hospice palliative care and in anticipation of greater future demand for hospice palliative care. Relative to other regions in Ontario, Waterloo Wellington is well resourced with respect to residential hospice and other end-of-life care beds.  In light of anticipated demographics shifts, we do need to better understand resources required to ensure high-quality care for patients whose preferred place of death is home.

But supporting care at end-of-life is only one component of hospice palliative care. As patients near end-of-life, we also need to develop supports to make the transition to hospice palliative care easier for patients and their families. One of the ways we will do this is to embed Advance Care Planning into all care settings.

It is difficult to know what to do when a loved one is diagnosed with a life-limiting illness. One of the best ways to prepare for this stage in life is to have a conversation about Advance Care Planning. Advance Care Planning is communicating your wishes, values and beliefs to your substitute decision maker (SDM) in the event you are incapable of making health care decisions for yourself. In order to assist and encourage patients to talk openly about their wishes we are supporting care providers and other community members to encourage individuals to identify their SDM and to have these conversations.

Overall, we have made many improvements to hospice palliative care in Waterloo Wellington. And as we continue to improve care, the patient experience will be our main focus. We want to create an equitable, accessible and experience focused health care system, and in order to achieve these goals we have to put the patient at the heart of everything we do, and this includes hospice palliative care.

From Innovation to Action, Collaboration is Key

Guest Blog: Elliot Fung

alaunusquoteA few months ago on this blog, I challenged our health care ecosystem to go beyond innovating and truly disrupt how we approach solutions in health care to improve patient experience and outcomes.  The response was outstanding!

In late March, the Office of the Chief Health Innovation Strategist of Ontario announced that Alaunus (www.alaunus.com), a Waterloo based software company, was awarded $100,000 through the Health Technology Fund to pilot an innovative solution in the home care delivery model; improving patient care, choice, and reducing administrative costs.  As part of a Health Innovation Team that includes a brain injury service provider, Health Quality Ontario, Wilfrid Laurier University and the WWLHIN, we hope to see some exciting and innovative improvements for patients and their caregivers through this pilot.  Later this month, I am excited to join Alaunus at the Ontario Centres of Excellence Discover 2017 conference where I will be celebrating their success and meeting with more innovative health technology companies from across the province.

Another technology company in Waterloo, CloudDX was also awarded over $400,000 to pilot a way to better manage chronic obstructive pulmonary disease for patients living at home, with their Connected Health Monitoring Kit.  At the same time that CloudDX is working on this pilot, the WWLHIN is excited to be piloting their Connected Health Monitoring Kit with 40 of our most complex home care patients, to help better manage their care and avoid having these patients have to visit the emergency department unnecessarily.

The WWLHIN is exploring the potential for these innovative technology solutions, as well as the dozens more that are developing within our robust innovation ecosystem through partners such as Communitech, Innovation Guelph, St. Paul’s Greenhouse and the Accelerator Centre.

However, we recognize that it’s not all about technology.  Being innovative and finding solutions for all residents must involve partnerships with the community, non-traditional health care providers, patients and caregivers, municipalities and many more organizations to find ‘whole of community solutions’ to complex social issues.

Working together, the WWLHIN has partnered with health and social service providers (justice, education etc.) to impact community wellbeing through the Wellbeing Waterloo Region initiative. As a proud sponsor of Wellbeing Waterloo Region, we recognize that no one organization alone can address complex community issues such as reducing poverty, improving high school graduation rates or addressing addictions.  This initiative provides a structured approach to working collaboratively on these issues using shared resources and common measurement.  Together we will lead using a collective impact approach by identifying shared priorities and actions that will positively impact wellbeing.

Innovation can mean different things to different people, but most importantly, innovating to take actions that will improve the patient experience and outcomes will help to truly transform our system.

If you have innovative or disruptive ideas or want to talk about this post, please reach out at elliot.fung@lhins.on.ca or tweet me @elliotgfung and @ww_wlhin.

Elliot Fung is the Director of Innovation and Strategic Partnerships at the WWLHIN, is a passionate supporter of the local innovation ecosystem and after many months of trying, still cannot successfully flip a water bottle.

 

Reflections as Emergency Department Physician Lead

Guest Blog: Dr. Ian Digby

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Headshot1It has been a pleasure to work as Emergency Department Lead for the Waterloo Wellington LHIN since 2013. Over this period, Ontario health care has undergone tremendous transformation and local hospitals have worked through innumerable changes to improve patient care. I am inspired by the work of so many people to maintain excellent emergency services.

Since 2013, the number of local Emergency Department (ED) patient visits has increased faster than population growth, while patient complexity (as measured by numbers of ambulance patients, admitted patients and triage acuity scales) has increased markedly. Despite these challenges local EDs have maintained top provincial rank for several wait time metrics. Simply put, hospitals have responded to “front door” pressures with improved performance and patient wait times.

Credit for these improvements goes to the individual staff at each hospital, but also to the shared work of the Waterloo Wellington Local Health Integration Network Emergency Department Integrated Clinical Council. The “WWLHIN ED Council” was created in 2013 with an agenda to promote quality improvement and improve patient experience and wait times. We adopted best practices for asthma, stroke, trauma care and ambulance offload and quality improvement for patient experience and flow. Council members openly shared data and learned from one another’s challenges and successes.

In the fall of 2015, the WWLHIN ED Council tackled the annual “seasonal surge” through a series of multi-stakeholder meetings with hospitals, public health, primary care, and long-term care (seasonal surge is an annual period in which health care providers see an increased volume of patients as a result of cold and influenza season). Members developed novel methods to communicate and reduce patient backlogs. In 2016, these methods saw some success with improved wait times, but this current winter seasonal surge has been a challenge across our health system as a result of unprecedented volumes. Nevertheless I believe we are in a better place due to our collective preparation and planning.

As ED Lead, I attended monthly meetings to shape Provincial policy around issues like physician recruitment, ED funding, Ebola response and the newest challenge of potent narcotic street drugs. In turn, I worked to translate these ideas into practice at ED Council and individual hospitals so we could stay ahead of the curve in championing best practices. Waterloo Wellington is viewed as a leader due to our ability to activate new care models.

We are in the midst of great change in Ontario health care with new Patients First legislation and transformation at the LHIN. For the next while I will be stepping back from a regional role and focusing my work on my home community. It has been a great pleasure to work with so many skilled and committed people across the LHIN and I look forward to continuing to work together.

*The Waterloo Wellington LHIN would like to thank Dr. Digby for his invaluable leadership over the past four years. Over that time, we have made significant progress in reducing wait times for local residents. We are fortunate to continue benefiting from his leadership at Guelph General Hospital and at our ED Council.

Waterloo Wellington LHIN Brings Clinicians Together for Critical Conversations

Guest Blog: Primary Care Physician Lead – Dr. Sabrina Lim Reinders

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Conversations are the cornerstone of practice. Only through conversation can we, as practitioners, discover the issues, pains, challenges and obstacles that patients face in order to assist them.

However, throughout our practice we may wonder what conversations should we be having with patients? How can we develop better relationships to support the patient experience?

To help answer some of these questions and more, the Waterloo Wellington LHIN recently hosted its annual Critical Conversations event. Critical Conversations is designed to encourage physicians, nurse practitioners, hospitalists and other health care providers to discuss the challenges they face and to learn new approaches to care from specialists and other practitioners.

By bringing health system leaders together, the Waterloo Wellington LHIN is supporting providers, enabling us to learn from each other to problem solve and better understand the challenges our colleagues face. This year’s Critical Conversations revealed important insights, with breakout sessions focusing on three main areas: newcomer health, advanced care planning and orthopedics and diagnostic imaging with a focus on shoulders.

I’d like to especially thank our facilitators Dr. Rachael Halligan, family physician, Regional Primary Care Lead for the Waterloo Wellington Regional Cancer Program, and Co-lead for Palliative Care, Dr. Michael Stephenson, family physician at Sanctuary Refugee Health Centre, Dr. Matthew Snider, orthopedic surgeon, and Dr. Chris Geddes, orthopedic surgeon, for sharing their expertise and answering complex questions about how clinicians can improve access and quality of care for their patients.

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Dr. Sabrina Lim Reinders welcomes attendees

Insights gained from the newcomer health breakout session included the need for a regional program to leverage the skills of experienced practitioners while building and increasing capacity. There is also a need to focus on relationship development with newcomers. Only by building trust with families and individuals are patients more willing to share their health histories, which will ultimately lead to more positive health outcomes.

Following newcomer health, the palliative care breakout session revealed the importance of initiating advanced care planning conversations with at risk or older patients, or at critical junctures, like surgeries. In addition, digital health solutions will likely be needed in order to share crucial end-of-life information with other health care professionals during care transitions.

The last breakout session focused on orthopedics and diagnostic imaging. Overall, there is a need for family practices to work with orthopedic surgeons to provide streamlined access to fracture clinics without having to go to emerge. Also, it is important to help manage patient expectations around what treatment will entail.

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Palliative Care breakout session

Through Critical Conversations 2017, many themes emerged as key areas for improvement. These insights will be used by the Waterloo Wellington LHIN to assist providers and increase efficiencies. By sharing insights and speaking with colleagues, we are working together to develop a more equitable and patient-focused health care system.

 

Sabrina Lim Reinders, Primary Care Physician Lead, WWLHIN