OUR SHAREDPURPOSE

JUNE 2018

A high school’s mission to support

the homeless Teaming up with

St. Michael’s to give back (pg. 2)

Collaboration across the network

Students learn about supporting

patients in different settings (pg 3)

How an innovative technique is speeding up recovery

Supporting seniors in the city Education, specialized services help keep patients healthy at home, in hospital and in the Houses (pg. 4).

How proper nutrition in hospital can get you home faster A new tool being used by dietitians is helping reduce length of stay (pg. 8).

Home witha new hip in 12 hours

OUR SHARED PURPOSE2

Our Shared Purpose is a monthly newsletter highlighting our people and the ways they are improving care, patient experience and the health of our communities.

Learn more:www.oursharedpurpose.com

What does it take for an idea to become a city-wide initiative? In this case, it took a high school, a local community hospital, a shared interest in advocacy, and a continuing friendship between a high school teacher and her former student. Last December, Emily Carreiro, a St.Michael’s Hospital administrative assistant, contacted her former high school teacher Linda Izzo with an idea to create care packages for the homeless or displaced patients upon discharge from the hospital. Izzo, who co-ordinates Marshall McLuhan Catholic Secondary School’s Peer Ministry program, jumped at the chance to strengthen this mission and outreach. Within three months, the high school donated 8,704 items - various essentials such as toothbrushes, toothpaste, soap, lotion, socks, a hat, feminine hygiene

products, lip balm and tissue - that quickly filled 814 care packages. The campaign was named Be An Angel after the St. Michael’s archangel, and the care packages created through it were given to patients discharged from St. Michael’s emergency department, trauma clinic and neurosurgery clinic. “This project really opened our eyes.

When we think of helping homeless and disadvantaged people, we don’t often think of a hospital,” explained Izzo. The campaign’s success enabled the distribution to expand and support 200 clients

currently helped by The FOCUS Team, a partnership between St. Michael’s and Cota that supports individuals living with serious mental health illnesses that significantly impair their ability to live independently.

BY SELMA AL-SAMARRAI

When a hospital and high school come togetherA city-wide campaign for the underhoused

This project really opened

our eyesLINDA IZZO

HIGH SCHOOL TEACHER“

OUR SHARED PURPOSE 3

Helping patients understand ‘transitions in care’ from acute to rehab to community settings is a person-centred approach that keeps people informed, engaged, and confident throughout their health-care journey. How to have these conversations is a fundamental skill for students to learn and practice. In our first two network-wide collaborative learning placements, 25 students explored this theme, and discovered how collaborative practice better supports patients along the continuum of health-care services. The cross-network placement opportunity marked a milestone in the education portfolio and was a team effort between colleagues Lindsay Beavers from St. Michael’s Hospital; Melissa Goddard from Providence Healthcare; and Kaitlyn Vingoe and Tina Stewart from St. Joseph’s Health Centre. Collaborative learning helps students from diverse disciplines learn with, from and about each other. “It’s inclusive, and brings in patients, families and our administrative and support colleagues, too,” said Beavers “The transitions in care theme offered a learning experience spanning our network’s clinical settings: acute care at St. Michael’s; community care at St. Joe’s; and rehab at Providence.”

The team used an arts-based program, which research shows is an effective way for students to learn. As part of their placement, students were asked to design an art installation to represent and reflect their key learnings. “Through art, we were able to creatively translate what

we do professionally into themes, and open up alternative avenues of communication about our roles and skills. It also sparked conversations that will help us communicate with patients using other forms of expression, rather than relying on medical jargon,” said Angie Bradley, a Social Work student who participated in the learning placement. In total, the students represented 12 professions; this diversity deepened their insight

on the theme. Video conferencing technology enabled students to virtually collaborate across sites, and they were taught synchronous content before independently creating their artwork. “I think in many cases, and this is also true outside of health care, different disciplines operate in silos. Opening up communication and approaching our jobs in partnership with other practitioners builds more person-centred care,” said Bradley.

High-touch learning with a high-tech twist

BY EMILY DAWSON

A cross-network learning placement for students

It also sparked conversations that will help

us communicate

with patients ANGIE BRADLEY

SOCIAL WORK STUDENT

“

OUR SHARED PURPOSE4

Celebrating Senior’s Month across the network

Debra McGraw, activation assistant, and Janny, resident, play cards

BY SELMA AL-SAMARRAI

Joan Powers looks forward to every Tuesday when she gets to revisit her childhood with a game of cribbage. “It gets very competitive – it keeps me sharp,” says 84-year-old Powers, a resident at the Cardinal Ambrozic Houses of Providence since last year. “I would not have met Janny otherwise,” she adds, referring to her new friend. Helping residents successfully transition to long-term care requires a holistic approach and activation assistants

like Debra McGraw have an important role in the Cardinal Ambrozic Houses of Providence. They pay special attention to the unique needs of the nearly 288 residents and help them to flourish in a new environment through the design and development of meaningful activities. Programs span from

intellectually-geared interactive word puzzles and card games to mindful exercises such as chair yoga – each one adapted to a resident’s level of ability while placing great emphasis on social inclusion and cognitive health.

Ninety-four-year-old Anne Nicholson has been coming to the Elderly Community Health Services (ECHS) clinic at St. Joseph’s Health Centre for 15 years, and has received care from a rheumatologist, a respirologist, a chiropodist, a dermatologist and a physiotherapist. But there’s always been one constant. “The physician I was referred to from the very beginning, Dr. Marcia Varga, is the one I continue to see today. She is so caring, doesn’t rush you out of the office, really takes an interest in your condition, and tries to be as helpful as possible,” says Nicholson. The outpatient ECHS’s multidisciplinary team, which cared for 3,250 elderly patients in the 2017-18 fiscal year, includes geriatricians, physiotherapists, occupational therapists, speech/language pathologists, social workers and nursing staff. The clinic’s newest service, the Caregiver Support Program, was developed in response to a gap identified by team members, who were hearing increased concerns from caregivers about supporting a newly diagnosed family member. The six-week program focuses on how to help care for loved ones with dementia and includes strategies to manage changes in behaviour, communication tips, and interactive sessions. “Our new Caregiver Support Program is a strong example of how aware the clinic staff is to the needs of patients and how they appreciate the challenges our patients and their families live with,” says the Head of Geriatrics, Dr. Fiona Menzies.

Anne Nicholson has been a patient of the ECHS clinic for 15 years and counting.

It gets verycompetitive — it keeps me sharpJOAN POWERSRESIDENT

“

OUR SHARED PURPOSE 5

Frances Carbonel began her nursing career in General Internal Medicine at St. Michael’s Hospital just over 11 years ago and often worked with elderly patients who had multiple health conditions, occasionally including frailties and cognitive impairments. “I found myself wanting to help improve their health outcomes so that they can function well and subsequently as independently as possible in their own homes,” explains Carbonel. It was through this interest that she decided to pursue one of the four evidence-based geriatric education courses at St. Michael’s, which launched in 2017. After taking the course, Carbonel transitioned her career towards geriatric care by joining the Elders Clinic at St. Michael’s. “The need for standardized, accessible geriatric focused education was identified through staff feedback in previous needs assessments,” explains Lori Whelan, quality

improvement specialist for St. Micheal’s Senior Friendly Hospital Strategy. To date, 106 staff members have completed at least one of

the courses. Carbonel took the Geriatric Resource Nurse course, which is designed to educate nurses on providing acute care for hospitalized older adults, and includes an Interprofessional Geriatric Education day along with other health disciplines to enhance collaborative learning. “I especially appreciated being able to dialogue with a multidisciplinary team during the Education Day because it

really does require a group effort, at all levels, to improve outcomes for older adults,” said Carbonel.

BY THE NUMBERS

34,460

18,604

4,724

3,250

353

visits TO OUR EMERGENCY DEPARTMENTSBY PATIENTS OVER THE AGE OF 65

VISITS TO ST. MICHAEL’S HOSPITAL’SEYE CLINIC

VISITS TO PROVIDENCE HEALTHCARE’SSTROKE/NEURO OUTPATIENT CLINIC

VISITS BY ELDERLY PATIENTS TO OURELDERLY COMMUNITY HEALTH CLINIC

TOTAL RESIDENTS IN THEHOUSE OF PROVIDENCE

ALL NUMBERS FROM THE 2017-18 FISCAL YEARLaura Shapiro, occupational therapist, tries on an age simulation suit with the help of Lindsay Beavers, collaborative learning specialist.

I found myselfwanting to

improve their health outcomes

FRANCES CARBONELNURSE“

OUR SHARED PURPOSE6

Leonard Benoit is a nurse and understands how to

navigate the health-care system. But for other First

Nations, Inuit and Métis peoples, concern about

stigma, discrimination and other factors can prevent

them from coming into the hospital – even at the

expense of their own health. Indigenous People

disproportionately show rising rates of cancer and

are diagnosed at a stage when it’s too late to talk

about a cure.

To support these patients, Leonard became an aboriginal navigator with with the Toronto Central Regional Cancer Program, a position that supports patients at hospitals across Toronto – including St. Joseph’s and St. Michael’s – as they navigate the health-care system. We caught up with him to learn more about his role and how he’s helping enhance patient experience.

Why is a role like this necessary?

A lot of people don’t know Indigenous culture or language, which can create barriers in providing appropriate care. First Nations, Inuit and Métis peoples have different spiritual needs, including smudging, which some hospitals have policies for and others are still working on. It’s important that we educate health-care professionals about different cultural needs so that when anyone walks into a space they feel welcome and safe. Indigenous Peoples also have a complicated relationship

with institutions because of perceived stigma and discrimination, so I work with them to learn what their needs are and what I can help them with. If we can help Indigenous patients feel more comfortable navigating the health system, I think we would see them access care faster and serious issues caught earlier through screening.

How do you provide support in this role?

A cancer diagnosis can prompt a lot of fear – I can help by going to appointments, asking questions and explaining anything the patient doesn’t understand. I’m also a resource for staff – I bring the perspective of the patient to the care team to help them understand issues that may be at play

including historical trauma, PTSD, perception of stigma and so on. Having these conversations makes it easier for patients to access care and hopefully have a better outcome. Reaching out to me is another layer of wraparound support.

Why is it important to you to support the Indigenous community in this way?

This role was created to get people screened and into treatment sooner so that they have better outcomes and I’m happy to contribute to that goal. I am First Nations and this allows me to do amazing things with my brothers and sisters, to dabble in a little bit of nursing and to help connect people to the care they need – both in hospital and in the community. Leonard is one of ten Aboriginal navigators across the province with CCO. He has an office at St. Michael’s Hospital and can be reached anytime via email: benoitl@smh.ca.

Questions & Answerswith Leonard Benoit,Aboriginal Navigator

BY AMBER DAUGHERTY

Reaching out to me is

another layer of wraparound

support“

OUR SHARED PURPOSE 7

Sportscaster Vic Rauter is famous for announcing

major sports wins, but earlier this year he participated

in a novel hip replacement surgery that has become

a win for patients and staff alike at St. Michael’s

Hospital. With a deteriorating hip, Rauter was introduced to Dr. Amir Khoshbin, an orthopaedic surgeon at St. Michael’s who was touting a new, same-day discharge option for hip replacements. St. Michael’s had become the first hospital in Toronto to offer same-day discharge for hip replacement surgery in January 2018. Rauter was intrigued. “I had heard about this rapid discharge option in the United States,” he said. “But now that it was an option at my hospital, where I was born and had my first joint replacement, I knew I had to sign up.” Since November 2017, Dr. Khoshbin had been laying the groundwork to give suitable patients the option of a same-day discharge for hip replacements.

“It’s a culture change.” Dr. Khoshbin said. “It takes the right team, the right hospital and the right patient to make this surgery successful.” Every department that would care for the same-day patients worked closely with orthopedics to plan the safest possible experience. The team determined how to screen for patients eligible

for same-day hip surgery. St. Michael’s has completed about 15 same-day discharge hip replacement procedures. Each procedure saves the hospital about 20 per cent of the costs associated with a longer recovery in-hospital. More importantly, it offers patients rapid and safe healing. “To say it was miracle-like is not an overstatement,” Rauter said. Within three weeks, he was gardening without any arthritic pain. “I’m very grateful to the entire team.”

BY ANA GAJIC

HOME WITH A NEWHIP IN HOURS

Dr. Khoshbin and his team perform a same-day hip replacement surgery on a patient in late May.

12

VIC RAUTERSPORTSCASTER, PATIENT

To see extended coverage of our

same day hip surgery visit us online at

www.stmichaelshospital.com

OUR SHARED PURPOSE8

Reducing pressure injuries

and length of stay — with food

BY AMBER DAUGHERTYSharon Chandra, dietitian, performs an SGA on a patient

Providence opens new Knowledge CentreProvidence Healthcare opened its new Knowledge Centre, a dedicated

environment that is supporting education, professional development and

innovation.

Accessible for both staff and students, the Knowledge Centre houses

the BMO Resource Centre, simulation labs, classrooms and coaching

rooms. It also provides flexible space that can be configured as full rooms,

hubs, or pods.

To promote teamwork, inclusion and sharing best practices,

Providence’s nursing and professional practice leads are co-located to

enable better connectivity among our leaders.

One of the most important medications you may take in hospital is food. Eating properly helps you recover faster, reduces your chances of developing additional complications and helps ensure you don’t have to come back again after you’ve gone home. A new process at St. Joseph’s is making it easier for staff to have important conversations about nutrition with patients and help them get the nutrients they need. When a patient is admitted to the hospital, they’re asked questions about their diet – have they recently lost weight without trying and are they eating less than usual? If the patient answers yes to both, a dietitian follows up with them to conduct a subjective global assessment (SGA). “It’s a mix of questions and a physical exam,” said Antonia Morganti, registered dietitian. “We’ll look at factors that may be impacting their ability to eat and also show them if they have signs of muscle wasting or fat loss so they can understand that their ability to recover is reduced when they’re not eating properly.” The Canadian Malnutrition Task Force highlights that almost half of patients admitted to hospital are malnourished, which can contribute to a range of issues including increased

risk for pressure injuries, an increased length of stay and general decrease in stamina and health. The SGA is a tool that can be used to identify potential malnutrition so the care team can help intervene. Strategies for supporting malnourished patients can include changing their diet, referring them to a speech-language pathologist if there are functional issues with eating, or adding additional protein to the food they are consuming. “We work with patients to get consent before beginning any of these measures because it’s critical they appreciate how significant food is to their health,” Morganti said. “I always want people to understand that it’s not OK that they’re not eating well and that we’ll do everything we can to work with them to change that. “Our goal is to get people home healthy as quickly as possible,” she said. “We’re really focused on working with our patients and families to help make nutrition a key part of their stay so that they’re strong enough to recover and then know how to maintain a healthy diet when they’re back in their own homes.”