Baycrest Geriatric Health Care System - HIROC

…keeping subscribers connectedIssue # 25June 2010

IN THIS ISSUE:Channelling the Chain of Command. . . . . . . . . . . . . . . . .1

Winner of the 2010 Healthcare Insurance Reciprocal of Canada Award . . . . . . . . . . . . . . . . . . . . . 2 Baycrest Geriatric Healthcare System. . . . . . . . . . . . . . . . . . . . . .3

Canadian Healthcare Risk Management Network Focuses on Risk, Patient Safety and Quality . .4

HIROC’s Annual General Meeting Highlights Growth During Challenging Times. . . . . . . . . . . . .5

Annual Risk Management Conference. . . . . . . . . . . . . . . . . . .6

Mount Sinai Hospital Connects Staff Wellness and Paitent Safety. .7

New Subscribers of HIROC . . . . . .8

Ask a Lawyer. . . . . . . . . . . . . . .. . 10

Save the Dates for HIROC Conferences. . . . . . . . . . . . . . . . . 11

HIROC Welcomes New Vice President, Healthcare Risk Management. . . . . . . . . . . . . 12

A New Role for Eleanor Morton. . .12

continued on page 2

“Silence in the face of potentially crucial conversations—conversations in which the stakes are high, emotions run strong,

and there are sharply opposing viewpoints is typically the path of least resistance in any organization. Unless leaders go to extraordinary lengths to counter the tremendous natural pressure that people feel to remain silent, disaster is inevitable.” 1

A chain of command defines hierarchical lines of authority and provides a mechanism for individuals

to resolve issues and concerns. In the hospital setting, a chain of command policy supports patient safety and

enhances patient care. It creates a framework for the timely and acceptable resolution of conflict and, more importantly, defines that

communication must occur without fear of reprisal.

A post-surgical patient’s respiratory status is worsening. The primary care nurse contacts the surgeon to advise of her concerns and questions whether the patient needs to be intubated. The surgeon chastises the nurse for what he perceives to be an order and declines to attend to the patient at that time. What to do?

In circumstances where there are conflicting interpretations of a patient’s clinical status, nurses cannot neglect their duty to ensure the patient receives an acceptable standard of care. As suggested by one nurse, the first step in this circumstance involves clarifying the intent of the communication and providing clinical information to support their concerns. In the event the matter remains unresolved, the nurse, in accordance with regulatory, ethical and legal obligations, must act to prevent injury to a patient. Invoking a chain of command enables the nurse to utilize administrative channels to do so.

Developing and implementing a chain of command policy is a critical first step to improving patient safety. An effective chain of command policy includes determining and implementing a line of authority and responsibility through which concerns can be escalated. A specified sequence or order of contact i.e. charge nurse, nursing director, chief of staff, administrator on call and/or risk manager, must be identified. Chain of command policies should incorporate aspects of organizational policies or procedures related to documentation, incident reporting, whistle blowing and code of conduct. The individuals in a chain of command must be able to use their position and power to ensure the patient receives the appropriate care.

1 Silence Kills, Exploding Shuttles, Media Meltdowns, and Health Care Disasters. What’s the Underlying Cause? Joseph Grenny.

Channeling the Chain of Command

2 The HIROC Connection • June 2010

continued from page 1

Preventing patient harm is an inherent duty guiding both healthcare professionals and organizations alike. Implementation of a chain of command policy promotes communication and collaboration among care providers. In addition, it provides a process whereby concerns are conveyed in a consistent and structured manner.

The Maryland Patient Safety Communication Centre reported that communication issues were “the root cause for 65% of sentinel events reported to The Joint Commission”.2 It is the responsibility of all care providers to communicate effectively. The failure of an organization’s leadership to foster a culture of open and transparent communication contributes to gaps in patient care and decreased staff morale. A well established and effective chain of command policy improves the quality of care provided to patients by creating a system of checks and balances.

Recognizing that implementation of a chain of command can be difficult due to inherent barriers in the healthcare setting; effective communication is paramount, particularly when lives depend on it.

“Effective communication and teamwork is essential for the delivery of high quality, safe patient care. Communication failures are an extremely common cause of inadvertent patient harm. The complexity of medical care, coupled with the inherent limitations of human performance, make it critically important that clinicians have standardized communication tools, create an environment in which individuals can speak up and express concerns, and share common “critical

2 The Maryland Patient Safety Centre, Embedding Teamwork and Communication Improvement Strategies in the Work Environment: The JHM Teamwork and Communication Program.

language” to alert team members to unsafe situations. All too frequently, effective communication is situation or personality dependent”. 3

Healthcare providers are frequently reluctant to ‘speak up’ about safety concerns; this can be as a result of intimidation or fear of reprisal. The inability of a healthcare provider to escalate a safety issue has been widely viewed as a root cause of many adverse events. Many organizations are now looking at communication programs focused on providing staff with the necessary skills and tools to address this issue. Programs such as SBAR, Crew Resource Management, and other similar programs all teach strategies to ‘speak up’ and provide the knowledge base to enable individuals to understand the importance of how and when to escalate an issue, regardless of their position. Developing this skill set empowers healthcare workers and enables organizations to enhance their patient safety culture.

Failure on the part of organizations to invoke a chain of command process may increase liability exposure in circumstances where patient harm could have been avoided. As such, it is incumbent upon organizations to provide healthcare workers with all available means to ensure the best interests of patients are being served and the standard of care has been met.

3 Human Factor: The critical importance of effective teamwork and communication in providing safe care, M Leonard, S Graham, D Bonacum.

Kathryn CallfasHealthcare Risk Management Services Consultant

HIROC

Joanna KeownHealthcare Risk Management Specialist

HIROC

4ANNOUNCEMENTWinner of the 2010 Healthcare Insurance Reciprocal of Canada AwardThis year’s Healthcare Insurance Reciprocal of Canada Award for highest mark in the “Best Practice” paper

submitted to the Canadian Healthcare Association’s Risk Management and Safety in Health Services Program was presented, in Ottawa, to Wendy Harrison, Manager, Education & Practice Development, Capital Health Edmonton

Area, St. Albert, Alberta.

Ms. Harrison’s winning paper was titled, “Implementation of Medication Reconciliation in Home Care”.

Students from all over Canada participated in the program. Congratulations to Wendy and all of the other graduating students.

3The HIROC Connection • June 2010

continued on page 4

4Exit - Seeking Client AssessmentBaycrest Geriatric Health Care System

Located in Toronto, Baycrest is one of the world’s premier academic health sciences centres focused on aging. Baycrest provides care and

service to approximately 2,500 people a day through the Baycrest Geriatric Health Care System, which includes a unique continuum of care from wellness programs, residential housing and outpatient clinics, to a 472-bed nursing home, and a 300 bed complex continuing care hospital facility with an acute care unit.

Exit seeking has been identified as a significant client safety risk issue at Baycrest. The consequences of exit seeking can lead to serious consequences for clients/patients which include injuries and/or death. The exit seeker will intentionally or unintentionally leave the premises to which the person is assigned without giving explicit advance notice. The client may or may not have made a conscious choice and his/her cognitive state may vary (Nelson & Algase 2007 Evidence-based protocols for managing wandering behaviours). Similarly the ‘wandering’ client will exhibit “meandering, aimless, or repetitive locomotion that exposes the individual to harm, frequently incongruent with boundaries, limits or obstacles” (Boltz, M. 2006 Wandering and Elopement: Litigation Issues.

With the type of vulnerable clientele and a large facility covering approximately 1.2 million square feet, Baycrest launched a Failure Mode and Effect Analysis (FMEA) project to conduct a full system review of the organization’s practices with respect to exit-seeking client protocols. FMEA uses a systematic method for identifying and addressing product and process problems before they occur. This patient safety-related prospective analysis would identify the gaps in the process and recommend appropriate changes for improving the existing system in order to prevent/minimize exit-seeking events.

The project also addressed one of the required organizational practices (ROP) of Accreditation Canada which is to “carry out one patient-related prospective, analytical process per year (e.g. FMEA) and implement appropriate improvements/changes.”

The stakeholders impacted by the project include the clients and their families and caregivers, department or unit staffing, program/department leaders, the multi-

disciplinary teams, support staff such as those in security, physical plant and communications,

as well as public affairs and stakeholder relations.

After the process mapping was completed, nine key areas for further exploration were identified: admission and assessment, client registration, exit-seeking detection equipment, environment and human factors, exit-seeking emergency response plan and

leadership of the client exit-seeking program.

There was lack of consistency in early identification and documentation

of exit seekers, either through the referral or assessment process. Similarly there were no

guidelines to support the clinicians on what information was relevant. The task group assigned to this activity, focused on pre-admission information and post-admission assessment. (The actual registration process of exit seekers and the related intervention plans would be addressed separately.

An exit-seeking assessment tool along with the appropriate guidelines were developed and piloted in both the Hospital and Long Term Care areas of Baycrest.

The referral and pre-admission workgroup has developed recommendations and will forward them to external providers, to ensure referrals to Baycrest contain all the currently required information, as well as relevant information identifying exit-seeking behaviour.



The registration workgroup is currently reviewing and revising the registration process for clients to Baycrest’s exit seeking monitoring system, incorporating relevant and current information for sharing and notification of exit seeking clients amongst client care providers. The need to minimize paperwork and enhance electronic notification will be essential.

There is also an urgent need to establish the appropriate physical or environmental control measures for both clients who have and have not been identified as having exit- seeking or wandering tendencies.

In order to balance the organization’s patient safety standards with the quality of life needs of the client, Baycrest is currently searching the market for leading edge technology, which will provide real-time client tracking. In the meantime, a comprehensive preventative maintenance program for the existing equipment is being implemented to ensure ongoing equipment performance including routine testing of all pagers. In addition to enhanced staff training, appropriate downtime procedures are being identified. Various levels of security systems, from adaptable push button (single or double) to keypad

systems have been introduced in order to match client risk and capacity.

When a client is declared missing and a code yellow is announced, the need to have a comprehensive communication strategy is vital. The methodology and content/language of pertinent client information are being reviewed. Similarly, Baycrest is currently examining the most effective and quickest method of communicating with the client’s unit staff via dedicated phones and pagers.

Exit doors on the behavioural units in the hospital and nursing home have been camouflaged in order to distract the clients and reduce the desire to leave the unit.

Immediate response and enhanced attention to the numerous exits during a power interruption or fire code is provided by security personnel and physical plant personnel to prevent an exit-seeking event.

Overall, awareness raising and training is on going for all staff, clients families and caregivers, and volunteers with respect to client exit-seeking behaviours. Specific staffing roles and responsibilities need to be constantly delineated and updated.

Eileen ChangPatient Safety & Risk Management Specialist

Baycrest Geriatric Health Care System

4PATIENT SAFETYCanadian Healthcare Risk Management Network Focuses on Risk, Patient Safety and Quality

The Canadian Healthcare Risk Management Network Executive would like to thank everyone who completed our survey in January. Our goals for 2010 will be based on your feedback, which indicated that the most important benefit to being a member of the CHRMN was, in your opinion:

1. Knowledge sharing on issues related to risk, patient safety and quality

2. Networking

3. Educational opportunities

4. Listserv

We will be sending information out shortly about the new Journal Club and Mentorship Program. We are also planning an Enterprise Risk Management workshop in the Fall. If you are not yet a member and would like to participate in these activities, please contact Joanna Keown, Chair, Membership Committee at [email protected].

Shirley AtkinsonChair, CHRMN

Toronto Grace Health Care


HIROC’s Annual General Meeting Highlights Growth During Challenging

continued on page 6

While the past year has been challenging

for many organizations, HIROC fared quite well. This was the key message during HIROC’s 23rd Annual General Meeting, held in mid-April. The event was attended by over 170 representatives from subscriber organizations.

HIROC continues to be financially strong and well positioned to support subscriber insurance, claims and risk management needs. During the meeting, Giles Meikle, chair of the Board of Directors, reported a net income for 2009 of $60 million, comprising comprehensive income of $61.6 million and a small underwriting loss of $1.3 million. This loss was due to the fact that HIROC had to increase claims reserves to reflect the impact of the new Harmonized Sales Tax as it applies to future legal costs on outstanding claims in Ontario.

Peter Flattery, CEO, also reported that the results for the first quarter of 2010 were very positive, comprising an underwriting profit of $621,000 and comprehensive income of $12.9 million for a total of $13.5 million.

HIROC continues to be the leading provider of healthcare liability insurance in Canada and in 2009, welcomed 29 new subscribers, bringing the total number of subscribers to approximately 500, representing more than 600 organizations across the country. The new subscribers include a diversity of healthcare-related organizations, including regulatory colleges, family health teams, community health centres, midwifery practice groups and hospitals. No subscribers left HIROC in 2009.

Highlighting board activities of the past year, Board Chair Giles Meikle noted that assessments of each Director were conducted as part of the Board’s commitment to continuous improvement. The results indicate that individual Board members function at a high level, ensuring they are effective in their governance role to HIROC and its management team.

During the meeting, HIROC bid farewell to three board Directors who have completed their terms. Giles Meikle thanked Catharine Tolton, Randy Lock and Ron Haines for their contributions to HIROC, which included participating on and chairing several committees of the Board. Ron Haines also served as Chair of the Board from 2006 to 2008.

HIROC welcomed three new Directors, Elizabeth Martin, Trustee at Sunnybrook Health Sciences Centre in Toronto, Ontario; Dwight Nelson, President and CEO of Regina Qu’Appelle Health Region in Regina, Saskatchewan; and Charles Penner, Vice President, Medical and Diagnostic Services at Brandon Regional Health Authority in Brandon, Manitoba.

Giles Meikle also completed his term as Board Chair and will continue to serve on the Board as Past Chair. Bryan Leier, trustee on the board of the Canadian Mental Health Association’s Saskatchewan division, was elected chair and Elizabeth Bardon, chief of public relations and community engagement at Hotel Dieu Hospital in Kingston, Ont. was elected as Vice-Chair.

Advancing Our VisionReporting on the achievements of the past year, Peter

highlighted how HIROC continued to pursue opportunities to advance its vision of partnering to create the safest healthcare system.

The Risk Management department developed 12 new Modules of the Risk Management Self-Appraisal Modules (RMSAM™). Subscriber feedback about RMSAM™ is positive, yet we continue to work with subscribers to make the tool less resource intensive. We are currently partnering with Accreditation Canada to compare RMSAM™ questions against those in Accreditation Canada’s required organizational practices to remove duplication and create a more streamlined and efficient process.

HIROC also made significant investment in information technology to improve our efficiency and provide more



meaningful reports to subscribers and other stakeholders.

As part of the ongoing government relations strategy, HIROC staff continued to meet with government officials across the country in order to raise awareness about issues that are important to subscribers and to establish relationships that will advance HIROC’s healthcare patient safety vision and reduce costs. As part of this strategy, HIROC published position papers on Apology Legislation, High-risk Communications, Adverse Medical Incidents, Tort Reform and Healthcare, Class Action law suits and Physician Credentialing. We also published white papers on Subrogation and Cost Efficiencies in

Healthcare, Class action Proceedings, and Disclosure. All papers are available on our website.

Mr. Flattery expressed HIROC’s ongoing concern related to class actions as their frequency and severity continue to increase each year. They currently represent more than 10 per cent of HIROC’s claim costs. HIROC is committed to raising government awareness and appreciation of the significant costs these actions represent in the healthcare sector. We want to ensure adequate monetary awards are made in those cases where there has been actual injury suffered, but we also need to ensure unnecessary costs and awards are avoided.

You can read more about HIROC accomplishments in our 2009 Annual Review, available in the Subscriber Only section of our website, www.hiroc.com.

Annual Risk Management Conference

The eighth annual Risk Management Conference was,

another great source of education as and an inviting venue for networking our 170 registrants. Dr. Brian Goldman, host of CBC’s White Coat/Black Art, began the Conference with an entertaining yet informative presentation on an Emergency Physician’s Perspective of Patient Safety. A panel presentation followed with Ira Parghi, Partner, Health Law Group at Borden Ladner Gervais LLP and two representatives from Villa Colombo Services for Seniors, Wieslawa Stepkowska, Director of Resident Services

and Chief Safety Officer and Nikki Mann, RN. The trio of presenters spoke on the subject of Dementia—Client Risks and Legal Consideration. Rhoda Lordly, Risk Manager at Toronto Rehabilitation Institute shared her organization’s experiences on Unregulated Health Professionals—What are the risks?

The afternoon session began with a presentation on the ISMP—Canadian Pharmaceutical Bar-coding Project, delivered by Sylvia Hyland, Vice President and Chief Operating Officer, ISMP Canada. Following was our second panel presentation on Patient Relations & Cultural Diversity delivered by KD Braden, Director of Risk & Quality, Whitehorse General Hospital,

Sandy Dayes, Patient Relations Advisor, Credit Valley Hospital and Remi Ejiwunmi, Midwife, Trillium Health


Centre. The day concluded with the duo presentation of Dr. Howard Ovens, Director of Schwartz/Reisman Emergency Centre, Mount Sinai Hospital and Anna Marrison, Partner, Health Law Group, Borden Ladner Gervais LLP speaking on Police Issues—Know your Rights: an organizational and legal perspective.

Following are some of the comments received on this Conference’s evaluation forms.

“The topics spanned a good cross-section of topics that do not only pertain to acute care settings.”

“I was struck by a comment in the first presentation about changing ANGER into UNDERSTANDING. That alone made the day worth while.”

“Great day all round. Learned a number of things that will help me in my day to day work.”

“Great idea to have different RM staff introduce themselves and then the speakers.”

“I really appreciated the use of USB keys for handouts!!!”

“Congratulations to HIROC and the organizing committee for another great conference!”

Once again, we would like to articulate our thanks to the speakers, Planning Committee members and all others involved in making this Conference a success. We look forward to having you attend the 2011 Risk Management Conference.

Arlene KraftManager, Healthcare Risk Management

HIROC

4Patient SafetyMount Sinai Hospital Connects Staff Wellness and Patient Safety

In celebration of Canadian Patient Safety Week and Healthy Workplace Month 2009, the Office of Patient Safety and the Department of

Organizational Development at Mount Sinai Hospital partnered to host the ‘Colours of Care Mural’ contest. This contest challenged staff, physicians, students and volunteers to team up and design a mural that would visually represent the link between staff health and wellness and the organization’s commitment to patient safety and quality of care. Examples of initiatives that could be highlighted included:

• Teaching and mentoring new staff about health and safety

• Offering to help a staff member who needs a hand

• Providing moral support and encouragement to the team

• Taking care of yourself! (Good nutrition, exercise, stress management and sleep)

• Washing your hands and encouraging others to do so

• Taking your breaks and encouraging others to do so

• Double checking a medication

• Communicating effectively

• Taking your vacation

• Seeking clarification if you are not sure of something

• Suggesting ideas to make a process work better

Mount Sinai staff and physicians chose the winning mural by casting their votes on-line during Patient Safety Week in November of 2009. The winning design was created by members of the Obstetrics and Gynaecology Department. This mural depicts a tree showing the four seasons of the year that are analogous to the span of life and incorporates photographs of the Mount Sinai Community. “This design was chosen because it depicts how everything we do plays a role in a patient’s journey through the seasons of life”, said Dr. Maureen Shandling, Senior Vice President, Medical. The concept artist and a volunteer artist from the community dedicated 16 hours to the painting of the mural on a wall in the hospital cafeteria. The finished product was revealed at an unveiling ceremony in March in the presence of Mount Sinai staff, physicians and the senior leadership team.

New Subscribers of HIROCWe are pleased to welcome the following new subscribers that have joined HIROC since the March 2010 issue of The HIROC Connection.

ONTARIOAlexandra Marine and General Hospital (AMGH) provides primary healthcare to approximately 25,000 people in Huron County and the community of Goderich, Ontario. AMGH is a full service community hospital providing on-call coverage for internal medicine, general surgery, diagnostic imaging, anaesthesia, and obstetrics. Mr. William R. Thibert is the President and Chief Executive Officer, and Mr. Jim Grafton is the Chief Financial Officer for the hospital. . The Cardiac Care Network of Ontario (CCN) is comprised of member hospitals that provide a wide range of cardiac services in Toronto, Ontario. CCN assists in the planning, coordinating, and evaluation of cardiovascular care and developing the necessary strategies to manage and improve cardiovascular disease. Mr. Lee Norbeck is the Manager, Finance for the Network.

Hanover & District Hospital has been providing primary healthcare services to the residents of Hanover, Ontario and its surrounding rural township since 1923. A new hospital was built in 1973, complete with a 24-hour emergency department. Services include a multi-purpose intensive care unit, medical/surgical acute care, and a medical day hospital program. Ms. Katrina Wilson is the President and CEO, and Ms. Marnie Ferguson is the VP Finance & Corporate Services.

Lady Minto Hospital was founded in 1911, and named for Mary Caroline Grey, wife of Lord Minto, a former Governor General of Canada. Celebrating 90 years of primary healthcare to the community of Cochrane, Ontario, their motto “Caring Together” reflects a wide range of services that include palliative care, paediatrics, and long-term chronic care. Tim Horton was born at Lady Minto Hospital in 1930. Mr. Dan O’Mara is the Chief Executive Officer.

Nazareth House has been a safe haven to women at risk and their children for 25 years. Founded by the Sisters of St. Joseph of Toronto, those who live at Nazareth House feel valued and supported in a safe, non-denominational environment. The provision of one-on-one counselling and the opportunity to enhance life skills assists women in attaining inner strength, hope and independence. Sister June Dwyer is the Executive Director.

The Northwest Health Alliance is a shared services corporation responsible for the operation and provision of patient information support and PACS (Picture Archiving and Communication System) that various healthcare organizations can opt to purchase. Located in Thunder Bay,Ontario the Alliance was established by 12 hospitals in Northwestern Ontario as an electronic network connecting medical record information images to computers. Mr. Bruce Sutton is the Executive Director for the Alliance.

The Port Community Health Centre provides primary healthcare to residents with no family physician, and who live within a 50k radius of the Centre. Located in Port Hope, Ontario, the Centre gives special consideration to the elderly with chronic illness, youth at risk, those struggling with mental health issues and people living on fixed or limited incomes. Community outreach programs and workshops are open to the public and include nutrition education and counselling. Ms. Joanne Watson is the Manager of Administrative Services.

The St. Michael’s Hospital Academic Family Health Team is a collaborative, patient-centred program that provides healthcare services through an inter-disciplinary team of medical professionals. In addition to increased access to care and reduced wait times, research and education is conducted and related to primary healthcare. Dr. Brian Cornelson is the Secretary-Treasurer for this FHT located in Toronto, Ontario.


The West Parry Sound Health Centre offers a wide range of programs and services including chronic care, health education, community outreach, and an anti-venom depot. The Centre’s logo is a blue square with four wave patterns that represents the Centre’s locale of Georgian Bay, Ontario, the four seasons and the four stages of life. The bottom wave is Birth and Spring, followed by Adolescence and Summer, Adulthood and Fall, and the Elderly and Winter. Mr. Donald Sanderson is the Chief Executive Officer, and Mr. Dave Gohier is the Director, Environmental and Support Service.

Wingham & District Hospital is a contemporary acute care facility providing an extensive range of quality patient care services and programs to rural Southwest Ontario. These include medical, surgical, paediatric and 24-hour emergency department service. Various community health related education programs are offered, as well as multiple out-patient specialist clinics providing local service. Ms. Margret Comack is the Chief Executive Officer, and Ms. Linda Deans is Vice President, Operations.

ALBERTA. The Medical Student’s Asscoiation (MSA) the aims and objectives of this Association shall be to deal with all matters pertaining to the philosphical educational and social acitives of the medical student body. In particular the association will as as the representative voice of medical students on any topic and to expose members of the MSA to their social and academic responsibilites as medical students and future doctors, through whatsoever means possible. Mr. Hebert Liu is Vice-President, Internal Academic.

NEW BRUNSWICKThe New Brunswick Chiropractors’ Association is a regulated member of primary healthcare providers with 60 graduates of accredited colleges in Canada and the United States. Trained in the neuromusculoskeletal system, chiropractors diagnose and treat disorders of the spine and body joints. The Association is committed to providing outstanding and affordable care to all residents in the province of New Brunswick. Mr. Mohamed El-Bayoumi, PhD is the Executive Director.

NOVA SCOTIAThe College of Registered Nurses of Nova Scotia (the College) is the regulatory body for registered nurses and nurse practitioners licensed to practice in various healthcare environments in Nova Scotia. Operations include financial administration, accreditation, professional development and member services. The mission of the College: Registered nurses regulating their profession to promote excellence in nursing practice. Ms. Donna Denney is the Executive Director, and Ms. Colleen Arnold is the Director of Corporate Services.

YUKON TERRITORY

Watson Lake Hospital provides comprehensive healthcare programs to a population of 2,200 people residing in the rural community and surrounding area of Watson Lake, Yukon Territory. On April 1, 2010, the Yukon Hospital Corporation assumed full management responsibility of Watson Lake Hospital. A new hospital facility is currently under construction and will offer enhanced community health services, including First Nations Health Programs, nursing and emergency medical services and physician clinics. Mr. Joe MacGillivray is the Chief Executive Officer, and Mr. Nick Leenders is the Director of Finance.



4FEATUREAsk a Lawyer

Q:My hospital is considering scanning patient charts and then destroying the originals. I understand that many hospitals do this,

however, is such a practice problematic from a legal perspective? Would the hospital’s defence be undermined if it were sued and was unable to produce the original paper chart?

A: The practice of scanning paper records and subsequently destroying the original records is widerspread

amongst hospitals given the costs associated with storing paper records.

The conversion of medical records from paper to an electronic format is expressly authorized by a regulation to the Public Hospitals Act, so there is no difficulty with scanning (also known as electronic imaging) from a legislative perspective. The same regulation also sets out minimum retention periods for the records.

However, there are a number of practical issues to be aware of when considering scanning. These issues include the following:

• An experienced and reputable organization should be retained to perform the scanning. There are a number of companies which specialize in the scanning of documents for large organizations. It is recommended that hospitals retain a company with a proven track record in the field.

• Safeguards should exist to ensure the electronic copies are sufficiently reliable. Scanned images must be readily accessible; the scanning process should involve some form of quality assurance to ensure that the original record has been accurately and completely scanned. Scanned images should be of good quality and not cut off in any way. Also, care should be taken to ensure that the back of double-sided documents are copied.

• The scanned records should be maintained in a “read only” format so they cannot be altered after scanning.

• A written policy should be prepared which explicitly sets out when and what documents are to be scanned and when the originals are to be destroyed. Original

records should not be destroyed on an ad hoc basis or worse, selectively targeted for destruction. In the event of litigation, such conduct could result in the assertion that the records that were destroyed were unfavourable to the hospital’s case. Such a presumption could significantly undermine a hospital’s defence.

• To be safe, in the event of litigation, original records which have not been scanned should be preserved

until the matter has been resolved. This practice will eliminate any issue regarding

the authenticity of the record.

• Original records should also be preserved where litigation seems likely. In situations of anticipated litigation, it is more difficult to provide a fixed rule as to how long original records should be kept. Although the limitation period for

commencing civil actions is typically two years, there are many factors

which may delay when the limitation period commences (for example, limitation

periods do not begin to run for a minor until the minor reaches the age of 18). Accordingly, it

is recommended in cases where litigation seems likely, that the original records be preserved for as long a time as is reasonably practical.

Gordon SlemkoGeneral Counsel

HIROC

This column is intended to convey brief and general information and does not constitute legal advice. Readers are encouraged to speak to legal counsel to understand how the general issues discussed in this column may apply to their particular circumstances.

Subscribers are invited to submit questions of a general legal nature to our resident general counsel Gordon Slemko at [email protected]. Gord will select from the queries submitted and will provide his corresponding response.


Mark your calendars for these upcoming HIROC videoconferences:The Challenge of Dealing with Difficult Patients in the Face of Bill 168Thursday, September 16, 2010 10:00 - 11:00 a.m. (EST)Presenter: Kristin Taylor, General Counsel, CAMH

Designing Safer Healthcare Systems: A Human-Centred Approach Thursday, October 14, 2010 10:00 - 11:00 a.m. (EST)Presenter: Anjum Chagpar, Manager, Healthcare Human Factors, University Health Network

Engaging Boards in Quality and Patient Safety: Sunnybrook’s ExperienceThursday, November 18, 2010 10:00 - 11:00 a.m. (EST)Presenters: Ru Taggar, Director, Quality and Patient Safety, Sunnybrook Health Sciences Centre; Marcia Visser, Board Member, Sunnybrook Health Sciences CentreThese educational sessions are hosted on the Ontario Telemedicine Network (OTN) and are also available via webcast.

Please stay tuned for emails with additional registration information. If you do not currently receive these emails, please contact Mallory Motley at [email protected] to subscribe to the mailing list.

Save the Dates for HIROC Conferences

4Staff Transitions at HIROCA New Role for Eleanor Morton

Eleanor Morton, previously Vice President Risk Management, will continue at HIROC as Healthcare Risk Management Associate, working three days per week.

In addition to taking on special projects, Eleanor will serve as a mentor, advisor and resource to the healthcare risk management department and other departments within HIROC.

HIROC is pleased Eleanor will continue to share her knowledge and expertise with HIROC staff, subscribers and partners.


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HIROC Welcomes New Vice President,Healthcare Risk Management

HIROC recently welcomed a new Vice President, Healthcare Risk Management to the leadership team. Polly Stevens brings a wealth of experience in the areas of healthcare risk management and quality improvement.

For the last 10 years Polly served as Director, Quality and Risk Management at the Hospital for Sick Children in Toronto, where she led the

development and implementation of a number of programs, including the nationally and internationally recognized SickKids Blueprint for Patient Safety. Prior to joining Sick Kids, Polly was the Director, Quality and Risk Management at North York General Hospital. She also currently serves as Adjunct Professor in the Department of Health Policy, Management and Evaluation at the University of Toronto.

Polly earned a Masters of Health Science (Health Administration) from the University of Toronto and a Bachelor of Administrative Studies

(Honours) from York University. She has completed the Patient Safety Leadership Fellowship of the American Hospital Association and the

Advanced Health Leadership Program of the Rotman School of Management. In 2007, the University of Toronto Society of Graduates in Health Policy Management and Evaluation presented Polly with the Leadership Innovation Award for her work in patient safety.

“I’ve always greatly admired HIROC,” says Polly, who drew upon the support provided by HIROC while in her previous positions at Sick Kids and North York General Hospital. “I was really drawn to the vision of partnering to create the safest healthcare system as it is aligned to my professional and personal goals and values.”

“I’m looking forward to partnering with HIROC’s subscribers to continue developing and promoting best practices in risk management and patient safety,” says Polly.

We are delighted to welcome Polly aboard!

Baycrest Geriatric Health Care System - HIROC

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