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

Why I don’t want you to Innovate: the paradox of innovation

Guest Blog: Director, Innovation and Strategic Partnerships – Elliot Fung

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The word ‘innovation’ means different things to different people. Most organizations and leaders say that they want to be more innovative, or lead innovation, however to truly innovate means you have to be willing to think differently, produce and deliver in ways you aren’t likely equipped to do, take risks, bend the rules, and leap frog the status quo.

In truth, most organizations, governments, businesses and leaders are pretty much the opposite; they are successful in their industry because they set the rules, follow the rules, and deliver on incremental improvements that seem innovative, but are in reality only steps ahead of what they currently deliver on today. To be an innovator, especially in health care, ‘steps ahead’ isn’t good enough for patients – you must be willing to take risk, create a totally new paradigm, and most importantly leap frog the status quo. As a patient, I don’t want just better care for my grandmother, I want the best care possible.

So, I don’t want you to innovate. Yes, we need innovation to provide sustainable solutions to our vast health care challenges, like reducing emergency department wait times or providing effective mental health care; we need innovation to help find ways to spend our precious health care dollars in more efficient ways; we need innovation to continually drive improvements in health for all residents to ensure equity, regardless if you live in the suburbs or on the street. I don’t want you to innovate, I want you to disrupt.

The transportation industry, much like health care, is complicated, very old, impacts everyone, and most notably, entrenched. For almost 100 years the taxi industry has operated around the world in a conveniently standardized way, customers had a basic expectation of service, accepted marginal experiences but almost always paid the full fare. Uber absolutely disrupted the transportation industry by introducing ride sharing – and gave riders the ability to rate the drivers, but importantly, gave drivers the ability to rate the passengers. This not only encourages better customer service, but improves the customer experience for everyone, at an average cost of 30% cheaper than a traditional taxi.   Now, Uber is often referred to as a gold-standard of disruptive innovation and is worth an estimated 40 billion dollars. It’s time to Uberize health care.

In our work as brokers, connectors and catalysts; connecting health innovators to the health system to test, pilot and adopt innovative technology and processes, and catalyzing opportunities to provide better care for patients, better patient experiences, and support and grow our innovation ecosystem in Waterloo Wellington, the WWLHIN recognizes that it takes leaders coming together from all sectors to drive these changes. Real innovation, disruptive innovation, in solving our biggest health and social issues will be realized through the deepest collaboration across health, technology, community, social services and government, when those sectors come together to not only lead together, but truly put patients first.

So I don’t want you to simply innovate, I want you to disrupt.

Elliot Fung
@elliotgfung

#WeRally2021 for the Health and Wellbeing of Our Community

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When I introduce myself, I always start with three things. I am a dad. I coach soccer. And I’m the CEO of the Waterloo Wellington health system.

Sports has been an integral part of who I am my entire life. It teaches essential core values – dedication, perseverance, teamwork – and a whole lot about sweat equity.

It also has a value much greater in terms of health. When you hear about sports and health, an obvious connection is made between the benefits of physical activity and disease prevention. We all learned a long time ago from Hal Johnson and Joanne McLeod the importance of being active to keep fit and have fun!

A lesser known benefit is the connection between sports and one’s sense of community, also an important social determinant of health. Building a strong social network is key to one’s health – having people you can rely on to support you. Feeling connected and involved is also crucial for one’s mental health. There isn’t anything I wouldn’t do to support the kids I coach and mentor – something I learned from those who coached and mentored me through the years.

For me, sports has been a way to connect to my community and give back (outside of my day job) and I can’t think of a better way to build a sense of community though sports than by rallying together to host the 2021 Canada Summer Games.

This year, Kitchener, Waterloo, Cambridge, and the Region of Waterloo have come together to bid on the Games – competing against other communities like Niagara, Sudbury, and Ottawa.

The games bring with them investment in local sports infrastructure, more than $100 million in estimated economic activity for the host community, the opportunity to inspire and motivate our youth to get and stay active, and another way to bring Waterloo Region and the surrounding communities together.

A key criteria for winning the bid? Community Support. How do they measure community support? By the numbers. Let’s show the Bid Committee #whywaterlooregion. They arrive in town on February 28th to see what we’ve got to offer.

Join me in supporting the bid here. It takes only a minute to add your name. Then tell us why you rally and post your pic tagging @CanadaGames with #WeRally2021.

Bruce
@brucelauckner

Health Technology Innovation

Guest Blog: Director, Innovation and Strategic Partnerships – Elliot Fung

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Go North Canada, The Innovation City, The Start-Up City; these are all monikers that are being used more and more to define a thriving local innovation and technology culture right here in our own community.

We boast world-class universities and colleges that are all developing ground breaking research that is helping to re-shape health and bio-medical fields. We have first-rate front-line care providers who deliver exceptional care to patients every day, and entrepreneurs and innovators who have earned reputations for creating cutting edge technologies and ideas.

But, how do we capture the work from multiple industries to harness ideas, passion, valuable perspectives and solutions and get them working for our patients?

That question became a mission, and then a passion that saw the launch of the WWLHIN’s first ever Health Collision Day, in partnership with Communitech. More than 40 health care providers and researchers joined over 20 local health technology companies to “collide” with the intent to improve patient experiences and health outcomes through innovative solutions and new technologies.

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Elliot Fung with Ben Fluter and Andrew Ringer from Alaunus, a Waterloo based start-up

High tech start-ups pitched ideas and solutions to health care leaders from all sectors; hospitals, primary care providers, home care, long-term care and community health partners.

We heard from companies that have designed equipment that will improve patient care and outcomes. Others have developed tech solutions and algorithms that help with care provision, improve wait time management and provide remote care to patients who don’t live close to the care they need, or have trouble getting there. These were all companies started and growing right here in our LHIN, and we know there are many, many more.

The health system is eager to partner with our thriving local innovation and technology culture to broker relationships and partnerships, break down barriers to innovation, and together solve challenges that impact the experiences of our patients, our residents. To truly change our health care system, here and provincially, we have to find new ways of doing things, build non-traditional partnerships, and make our exceptional health and technology industries collide to help to build on improvements that have already been realized.

Health Innovation isn’t just cool and trendy, it is absolutely imperative.

We live in one of the most innovative communities, not only in Canada but the world. Together, we have an incredible opportunity to build the solutions that will address community problems, create a sustainable, patient-centred health system and empower patients and families like never before.

Elliot Fung
@elliotgfung

A Thank You to Family Doctors

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In my last blog, I shared my experience as a patient in our local health system. When I realized I needed medical care, the first place I turned to for help was my family doctor.

My family doctor was the one who connected me with the right care and walked alongside me during my journey. Having someone who knows me, who knows my family, and who always had my best interests first was critical to my health and recovery.

I can’t thank my doctor and his team enough and I know many, many, many others feel the same way. This week is Family Doctor Week – an annual opportunity to thank these heroes who work tirelessly to care for us from pre-birth to end-of-life.

Over the past few months, my colleagues and I have been fortunate to spend time shadowing a number of family doctors and their teams to see first-hand the work they do. Doctors like Anil Maheshwari at Grandview Medical Centre,the team at Langs Community Health Centre, and more. I am always looking for opportunities to shadow more primary care practitioners on the front-line so please invite us. You can reach us on twitter at @WW_LHIN and me personally on Twitter @brucelauckner or by email bruce.lauckner@lhins.on.ca

While this is a week to celebrate doctors, we know just as important are the nurses, nurse practitioners, and other members of the inter-professional health team who work alongside them. We also know that not everyone has access to this type of team-based primary care – we are working on ways to build equitable comprehensive primary care for all residents and we need the help of primary care and the rest of the health system to make this happen.

On behalf of the almost 800,000 residents in Waterloo Wellington – thank you to our local doctors. With you – our vision of better health for our residents is made possible.

Share your thanks on Twitter by using #lovemyfamilydoc.

Improving the Patient Experience: A Patient Perspective

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Working in health care there’s a funny phenomenon that occurs – we are so focused on helping others and improving care that we tend to compartmentalize people into targetable streams. We have one strategy for patients. One for caregivers. One for people working in health care. We often forget that they are all the same people. We are all patients.

This was never truer than earlier this year when I found myself in my doctor’s office after others found me slurring my words and not making sense. I have spent many years working to improve the patient experience without giving much thought to myself as a patient. Of course when I was caring for a loved one or listening to the stories of others, I was always struck by the need to do better to improve their experience. However, I think it speaks to the nature of those who work in health that we never say we are going to improve the experience for ourselves – even though we are also users of the health care system.

Sitting in my doctor’s office, I was vulnerable in a way I had never been before. I didn’t know what was wrong – only that I needed help. I felt fortunate to have great access to primary care – and I thought about how we need to continue to work hard to make sure everyone has this kind of access to their doctor or nurse practitioner.

On my way to the hospital, I was scared – much like I’m sure everyone is when they don’t know what’s wrong but the look on the doctor and nurse’s face the says it’s serious. Even though I took great comfort in knowing that the quality of care in our local hospitals is second to none – nothing eases the stress of the unknown. Nothing that is, except the incredible people working in our local health care system.

From triage to testing to admission I was overwhelmed with their confident compassion. “Don’t worry, we’re going to take care of you.” The simplest words meant so much to me and to my family at a very difficult time. The health care I received was of the highest quality but it was the way I was cared for that made the experience so much more. As I moved into rehab, all I could think was that the wonderful staff in hospital, primary care and rehab go above and beyond – Every. Single. Day. Regardless of what might be going on in their lives that day – stresses at home, a sick child or parent – patients were the highest priority in the moment.

My recovery was slow but steady and I am incredibly grateful for all the support I received across our health system. I am also grateful that I received care within an area of our health system where great focus has been placed on improving the patient experience through best practice and integration. I know that this is not the experience of everyone – but I also know we have what it takes to change that.

I am glad to be back and excited to share my experience as a patient as a means of continuing our work to improve the patient experience for all residents in Waterloo Wellington. Former hospital CEO Bonnie Adamson spoke recently at the National Forum on Patient Experience about how her perspective changed when she retired from her role to become a full-time caregiver. She said she wished she could go back and re-do her time as a CEO all over again. She said she thought she “got it” but she really didn’t until she had journeyed through the health system with a loved one.

I have the great fortune of utilizing this perspective now as we lead a high-quality, integrated health system for local residents – in partnership with all of the incredible heroes working in our health system. Collectively, we have one role – to improve the patient experience. From pre-birth to palliative care and everything in between. It’s an important one – for patients, for caregivers, for health professionals, for everyone. We are all patients, after all.

Bruce
@brucelauckner