Change Day: A Simple But An Important Change In Communication Can Have A Lasting Impact

Guest Blog by the Chair of the Patient and Family Advisory Committee, Coreen Duke-Carroll


My desire to become an advocate for patients and caregivers began in 2004 when I landed in the ER and was hospitalized with an unusual condition that required months of rehabilitation. Then in 2012, my mother was diagnosed with cancer.

From 2012 until my mother’s death in 2016, I was her primary caregiver. I helped to care for my mother through her cancer treatments and through the tragic loss of my sister in 2014. My sister lost her life at the hands of her husband whom had been struggling with mental illness and addictions for many years.

Caring for my mother while journeying through the loss of my sister was one of the most heart wrenching and difficult times of my life. The loving support of my family and friends was immeasurable, and the amazing support I received from health care professionals was commendable. Although, there were trying and exasperating times that left me feeling as though I wasn’t being heard or that my input carried little to no value in the eyes of the health providers. Through these experiences I became passionate about patient and caregiver advocacy.

Now part of the Waterloo Wellington LHIN’s Patient and Family Advisory Committee (PFAC), I am inspired by the LHIN’s desire to incorporate the patient perspective into processes, programming and campaigns. By making the simple and important change of incorporating the patient and caregiver voice into the broader functioning of the organization, I can already see it having an impact.

For example, the amazing Change Day campaign was in-part created by PFAC – learn more about the Change Day campaign here. The PFAC was actively engaged in the creation of the Waterloo Wellington LHIN’s Change Day pledge: to communicate effectively with patients, families and caregivers at all points of the continuum of care so that they feel valued.

Communication is so critical to the patient and family member, it allows them to feel empowered, to make an informed decision about their care or the care of a loved one, and to know that their voice is valued and honored by the care provider.  Clear and respectful communication allows for productive and cohesive working relationships, which ultimately improves the patient experience. Not only do patients and caregivers need to be given the space to speak, but health providers need to have the presence of mind to listen respectfully to what is being said.

Reimaging how communication could function better in a patient/caregiver/health provider relationship may seem like a large or onerous task, it’s the simple changes that can have the largest impact.

Therefore, I challenge every health provider to take a moment to think about how a simple change in communication could empower patients and caregivers so that they feel valued. Something as simple as listening to a caregiver or to allowing patients time to ask additional questions or sharing their concerns can improve care, reduce tension, and positively impacts the patient experience.

Simple changes in communication can lead to trusting, lasting and healthy relationships, which ultimately serves to improve the patient experience. Please consider joining the Waterloo Wellington LHIN Change Day campaign, make a pledge to improve patient care through effective communication, learn more here.

State of the Health System


As the CEO for the local health system, I have the great privilege of working to improve the health of the 800,000 residents we serve across Waterloo Wellington.

Our health system is a community asset – one that has been built by the hard work of community leaders, health professionals, and through public funding over many years. The responsibility for overseeing and improving this vital community asset is not one I take lightly.

As investors and beneficiaries of the health system, our community deserves to know how it is advancing. This is why we are hosting our first State of the Health System Address. On September 29th, our community will come together to learn about the progress made in improving the local health system and the work still ahead to improve access, equity, and the patient experience.

I recently heard a story from one of our care coordinators, a social worker, who supports some of our most vulnerable residents with very complex health needs.

One of her patients was transitioning into palliative care and had an almost new hospital bed in their home they wanted to donate. Earlier that day, the care coordinator had heard from an occupational therapist about a patient who was sleeping on plywood without a mattress. This patient was blind and a recent double amputee who was suffering from not sleeping on a proper bed. It took some coordination – including a supportive landlord who offered to pick-up and move the bed – but that bed has changed the life of this patient.

Making the connection to provide a new bed for this patient isn’t a health procedure you’ll find in any textbook. However, it’s the one that will prevent a number of other health issues from occurring that would require additional services – not to mention the incredible impact on the patient’s quality of life.

These are the stories that inspire me as work to make it easier for residents to be healthy, and to get the care and support they need. I look forward to sharing more stories on September 29th.




Starting with the Patient Experience


True to our strategy, the past couple months have been focused on starting with the patient experience. To make meaningful improvements to the care experience for patients we need to listen directly to them. This is why our first initiative and announcement as a new organization was the launch of our Patient Experience Program.

As a foundational step, we are in the process of recruiting local residents to join our Patient and Family Advisory Committee. This committee of diverse patient and family members, representative of our community, will guide us in developing a Patient Experience Program that will embed the patient voice in everything we do within our organization, and across the local health system.

As we work to develop new ways to engage patients in their care and the design of their local health system, we also celebrated the implementation of a number of initiatives that have had an immediate positive impact on the patient experience.

For example, a new Rapid Recovery Therapy program helps patients go home from hospital sooner, allowing them to receive high-quality, intensive rehabilitative care in their home. The program increases capacity in the health system by freeing up rehabilitative care beds for patients with the most complex needs. Not only do patients achieve similar outcomes to their in-hospital peers, but they greatly appreciate being at home. A patient in the program shared “there was someone here every day, working with me and encouraging me. Being at home motivated me to do more. I was more active and felt more comfortable doing my exercises because I was in an environment that I knew”.

Not only has this delivered a better patient experience, but also improved the quality of care we provide. The Waterloo Wellington LHIN was recently recognized by the Ontario Stroke Network as a high performer and provincial leader in delivering high-quality stroke care. In particular, hospitals in Waterloo Wellington were the highest performers in all of Ontario for all but one of the metrics for stroke rehabilitation and reintegration. More residents in Waterloo Wellington receive care on a specialized stroke unit than anywhere else. Local residents go home faster, within target, and receive the highest number of minutes of in-home rehabilitation therapy.

As an organization, everything we do starts and ends with the patient experience. I continue to be impressed with the passion and dedication of our staff to their patients. As we increase opportunities to hear from patients directly and undertake more efforts to support clinicians and others on the front-line, patients will continue to benefit from tangible improvements in their care.



Improving Hospice Palliative Care Across Waterloo Wellington


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.