Medicine & Quality Matters

September 2019

News for the Interior Health Medical Community

VP Message from Dr. Mike Ertel, Vice President, Medicine & Quality

It’s hard to believe summer is winding down. As fall approaches, it’s important to reflect on our accomplishments and highlight areas of improvement so far this year. Our work to enhance physician engagement continues to progress. The results of the 2019 Doctors of BC Physician Engagement Survey show that Interior Health has led the province in increasing our physician engagement scores for the second year in a row. This is great news! It means physicians at IH are sharing their voice and being heard about what matters to them. The results of the survey’s highest ranked question, “satisfaction with the health authority as a place to practice medicine,” showed a 21 per cent improvement over 2018, and an 82 per cent since increase 2017. Strong, collaborative relationships between physicians and health authorities are critical to providing optimal patient care; and to fostering a work culture that values and supports physicians and their work in a way that improves job satisfaction. This is an area where we will continue to focus, but the survey results tell us we are on the right path. Part of the work we are doing to develop and improve health authority-physician relationships is through learning and growth opportunities. The NAVIG8 Emerging Physician Leaders Program, beginning in September, is an innovative approach to mentoring the next generation of physician leaders at Interior Health. Read more about this work on p. 3. Additionally, we continue to support quality improvement and engagement initiatives at sites across IH through Physician Quality Improvement and Facility Engagement projects. I am delighted to see colleagues put ideas into action and create meaningful relationships with physicians and staff alike. Engagement at the frontlines is truly impactful to the delivery of quality patient care. In a recent trip to Calgary, our Quality Team met with their counterparts at Alberta Health Services. They are very interested in our physician engagement and physician leadership

development programs. This fall, we’ll also be participating in a first-ever Physician Leadership Summit with our colleagues in Northern Health to discuss issues of mutual interest. As physician-engagement leaders in B.C., it’s notable that other provincial partners are looking to us for ideas and learnings to develop their own programs.

While on tour of East Kootenay and Kootenay Boundary, Dr. Mike Ertel

met with Dr. Nerine Kleinhans, Chief of Staff at Creston Valley Hospital

and Health Centre.

Page 2 | September 2019

“ Another key area of work has been the development of the 2019-22 Interior Health Quality and Patient Safety Strategic Plan. This plan outlines changes for and improvements to our delivery of quality care, through the engagement of patients, families, communities, and care providers. Led by our quality leaders, Dr. Devin Harris and Dr. Glenn McRae, this work will guide IH in the years to come. Read more on p. 5. We are also working on a new Chronic Pain Strategy. Chronic pain is, by definition, experiencing pain for more than 12 hours a day and it affects 23 per cent of the population. Michaela Swan, Director, Medicine & Quality Initiatives, and I are working closely with the Ministry to understand the needs of our communities and develop a Chronic Pain Strategy for Interior Health. In other Ministry work, I have started in a new position as Physician Advisor for the Ministry of Health. In this role, my responsibilities will include: Primary Care Transformation; Primary Care Networks; Specialized Care Service Programs; Urgent Primary Care Centres; and I’ll also be working with the College of Physicians and Surgeons of B.C. This work will take me to Victoria on a regular basis and I am looking forward to making meaningful connections. On a somber note, I would like acknowledge the passing and loss of two physician colleagues: Dr. Peter Nicholson and Dr. Jim Tisdale. As a pathologist at Vernon Jubilee Hospital, Dr. Nicholson made numerous contributions to the community and was highly respected by his peers in Vernon. Dr. Tisdale was a legend in primary care, basing his family practice in Kelowna. We’ll remember his kindness, intelligence, and sense of humour. To my team members, the entire Medicine and Quality team, and the medical staff who practice within our facilities, thank you for your ongoing hard work, input, dedication, and drive to improve quality of care within IH. You make coming to work extremely fulfilling, every day. Thank you and enjoy autumn.

VP message cont’d …

Page 3 | September 2019

NAVIG8 Emerging Physician Leaders Program

As part of the Physician Engagement Strategy, work is underway to equip physicians with the knowledge, skills, and behaviours to become the next generation of physician leaders in Interior Health (IH). The NAVIG8 Emerging Physician Leaders Program, beginning in September, will prepare a cohort of 26 IH physicians with vital leadership skills. The program format is 70 percent experiential, 20 percent mentorship, and 10 percent classroom learning. “These physicians will learn operational and administrative skills; receive mentorship from physician and administrative leaders; develop a deeper awareness of their own leadership strengths and opportunities; and gain deeper insights into how to engage, inspire, and motivate teams,” says Harsh Hundal, Executive Medical Director, Physician Engagement and Resource Planning. Harsh explains that current medical leaders had no formal administrative leadership training, as it’s not traditionally taught in medical school or typical residency programs. “Many physician leaders learned through a ‘sink or swim’ approach,” says Harsh. “We must do better to support the development of our future physician leaders. This new program will teach the conceptual, relational, and operational skills our physicians need to succeed.” The cohort selection for the inaugural NAVIG8 Emerging Physician Leaders Program began last August. Invitations were sent across IH to medical leadership, senior leadership, site managers, and physician partners to nominate candidates for the program. More than 155 nominations were received and, of these, 52 received multiple nominations. “You were not able to self-nominate, so this excellent response highlights that nominations came from non-physicians; the nominees are respected by staff and fellow colleagues; and the nominees are ‘stars’ in their particular facilities,” says Harsh. “This is a tremendous demonstration of the depth of physician leadership in IH.” The 52 physicians who received multiple nominations became the shortlisted candidates and were invited to apply for a position in the NAVIG8 Emerging Physician Leaders Program. Cont’d on p. 4.

Physicians leading physicians

FIRST COHORT* NAME FACILITY/COMMUNITY SPECIALTY

Dr. Juliann Aitchison SLGH, Salmon Arm General/Family Practitioner

Dr. Susan Benzer KBRH, Trail General/Family Practitioner

Dr. Jill Boulton KGH, Kelowna Pediatrics

Dr. Sarah Broder PRH, Penticton Internal Medicine

Dr. Paul Carey VJH, Vernon Psychology

Dr. Joslyn Conley RIH, Kamloops Nephrology

Dr. Jeffrey Douziech KGH, Kelowna Psychology

Dr. Dante D’Urbano KGH, Kelowna Pathology

Dr. Brian Forzley PRH, Penticton Nephrology

Dr. Kaveri Gupta RIH, Kamloops Internal Medicine

Dr. Meghan Guy GDH, Golden General/Family Practitioner

Dr. Jeff Hussey KBRH, Trail General/Family Practitioner

Dr. Jasmine Kerr KGH, Kelowna Internal Medicine

Dr. Nerine Kleinhans CVH, Creston General/Family Practitioner

Dr. Launny Lowden EKRH, Cranbrook Pathology

Dr. Paul Magnuson CMH, Williams Lake General/Family Practitioner

Dr. Elizabeth Parfitt RIH, Kamloops Infectious Diseases

Dr. Annemie Raath RIH, Kamloops GP (Hospitalist)

Dr. Michael Robinson KBRH, Trail Urology

Dr. Andrew Sellars SLGH, Salmon Arm General/Family Practitioner

Dr. Julian Sernik EKRH, Cranbrook Orthopedic Surgery

Dr. Michael Slatnik Grand Forks General/Family Practitioner

Dr. Jacobus Steyn RIH, Kamloops Cardiology

Dr. Aleksander Tkach KGH, Kelowna Neurology

Dr. Shauna Tsuchiya RIH, Kamloops General/Family Practitioner

Dr. James Wiedrick KLH, Nelson General/Family Practitioner

* Cohort as of Sep. 9, 2019; subject to change.

Page 4 | September 2019

NAVIG8 cont’d …

The application asked physicians about: future leadership aspirations; key issues facing IH and the B.C. health system; involvement in change initiatives; and other leadership positions held in IH or other organizations. After a thorough review of all applications, 26 physicians were selected to participate in the program. “The program will bring together physicians from different geographies and diverse specialties, like surgery and psychiatry with primary care providers,” says Jarnail Dail, Director of Physician Engagement and Leadership Development, and Harsh’s dyad partner. The 26 physicians currently registered for the program are divided equally between IH East (8), IH Central (9), and IH West (9). There are 13 women and 13 men, of which 15 are specialists and 11 are general practitioners. Jarnail says “this equal distribution was not planned, but is reflective of the diversity of physicians in IH.” To help shape and guide this program, the NAVIG8 Emerging Physician Leaders Advisory Council was formed. “This nine-member council is all IH physicians, cementing that the program is physician-led, physician-built, and self-driven,” says Harsh. Two council members are also participants of the cohort because, as Harsh says, “their voice is integral to the co-development and relevancy of the program.”

The council has matched physicians with administrators for their dyad partnerships; found senior medical leaders for mentorship and coaching; developed the program curriculum; and built an extranet site to house tools, resources, and information. Alberta Health Services (AHS) is embarking on a similar journey and Harsh and Jarnail acknowledge how partnering with AHS has helped to help build the program. They also extend thanks to consultant Rose Harrison, who has provided support to both organizations. The NAVIG8 Emerging Physician Leaders Program is a two-year program; the next cohort will be in 2021.

The Physician Engagement team (L-R) Jarnail Dail, Diana Stanley,

Marlis Gauvin, and Dr. Harsh Hundal worked together to develop

the principles for the NAVIG8 Emerging Physician Leaders Program.

Page 5 | September 2019

Dyad leads quality improvement changes across IH

Quality improvement begins with our people. It’s a simple, but big, statement. “Quality touches almost every aspect of what we do at Interior Health, every day,” says Dr. Devin Harris, Executive Medical Director, Quality and Patient Safety. “From the nurse who works night shifts, to patient transportation, to a physician in the emergency department – everything revolves around quality.” To help understand the full scope of quality services and practices within Interior Health, internal and external reviews were conducted in 2017 and 2018. “We found we have great structures, processes, and people supporting quality, but in separate pockets throughout the organization,” says Devin. “There was an opportunity to align these pieces in a well-articulated plan to understand how they fit together.” In January, Devin and his dyad partner, Dr. Glenn McRae, Executive Director, Quality and Patient Safety, began to develop a Quality and Patient Safety Strategic Plan. “The plan encompasses all of the things IH is doing well; and how we can support and enhance our great work over the next three years, so we are one of the highest performing health organizations,” says Devin. The Quality and Patient Safety Strategic Plan is organized into four areas of focus: Culture and People; Quality Learning System; Quality and Patient Safety Management; and Patient, Family and Community Engagement. “Previous quality plans outlined the work the Quality Department would do,” explains Glenn. “This plan outlines the work that IH is going to do to support quality care for our patients, populations, and communities.” With people at its core, the plan incorporates 23 recommendations from the external review, into 33 broad tactics, that outline and encourage engagement of medical staff, employees, and patients to support a culture where quality processes and conversations happen all the time. “If we have an engaged workforce who want to be where they are, who take ownership for what they do, and who are excited to come to work, then everything else flows from that,” says Devin. As dyad leaders of this program, Devin and Glenn say they don’t “own” quality. They do say they “own the responsibility to build

and describe how the organization (IH) approaches quality.” At present, Devin and Glenn are meeting with managers and leaders across IH, in a deliberate way, to share the plan, ask questions, and talk about how to encompass their work and people in the plan. “The ‘aha’ moment for many is that the plan encompasses work we have been doing all along; it just didn’t have the term ‘quality’ associated with it,” says Glenn. Devin and Glenn’s shared vision to improve quality and patient safety for the organization, lends well to the success of their dyad relationship; however, their differences are also complementary. As a physician leader, Devin brings quality perspectives from his clinical and medical leadership experiences. Glenn is a registered nurse with a doctorate, former Chief Nursing Officer for IH, and has previously led Quality and Patient Safety portfolios in the Middle East and in Alberta. In the last year of working together, they have developed mutual trust and respect. “When you work in a dyad leadership role, you have to be comfortable not talking and not feeling like you need to know everything,” says Devin.

Cont’d on p. 6.

Devin and Glenn say the Quality and Patient Safety Strategic Plan would

not have been possible without the expertise of the Health System Planning

team: Corporate Director Jen Miller and Coordinator Ruth Koenig.

(L-R: Ruth, Glenn, Jen, and Devin).

Page 6 | September 2019

Quality improvement cont’d …

“Let your partner be the expert in the areas where you are not. If something for me gets tricky or difficult to navigate, I know that Glenn has my back, and conversely, I have his.” One of the ways Glenn knows this dyad is functioning is by the arm’s length distance they have. “We don’t always go two-by-two,” says Glenn. “I trust Devin to go to meetings and accurately represent our files. For this to be successful, we need to have a strong foundation of trust.” Though trust may take time to establish, Devin and Glenn have brought forward past dyad experiences to this current one. “We are both firm believers in quality improvement in health care, through the methodology of engaged employees and physicians, a culture of quality, and solid infrastructures – this is what the Quality and Patient Safety Strategic Plan is about,” says Glenn. The other aspect of people that Devin brings to the table is the engagement of patients and their families. “We should not be delivering health care upon people, but with people,” explains Devin. “They need to be our partners and part of the decision making, which includes planning, implementing, designing, and monitoring their care.” This dyad continues to present the plan, its tactics, and three-year focus to leaders across IH. More information about next steps will be shared with the organization in the fall.

This fall, get your flu shot. The seasonal influenza vaccine

is safe and the most effective way of preventing the spread

of influenza.

Page 7 | September 2019

A true quality mindset: Eliminating surgical site infections at KBRH

Orthopedic surgeon Dr. Mike Hjelkrem noticed a slight uptick in surgical site infections for hip and knee replacement patients at Kootenay Boundary Regional Hospital (KBRH) in late 2017. He then made the decision to temporarily halt hip and knee replacement surgery. His four fellow orthopedic surgeons at the hospital quickly followed suit. “We looked at our numbers and said ‘we need to regroup,’ ” explains Dr. Hjelkrem. To help explain the cause of the infections, a working group was struck. Led by Dr. Hjelkrem, Health Service Administrator Jane Cusden, and OR Manager Cindy Ferguson, the team developed a set of quality improvement criteria and consulted broadly with specialists both within and outside of Interior Health. “We contacted UBC, which is a world leader in infection prevention,” says Dr. Hjelkrem. “We also talked to the cleaners, the engineers, the nurses, the student nurses and the med students, and the people in the OR. They all brought ideas.” In addition to taking a hard look at the structures and processes within KBRH; like ventilation, OR temperature, pressure, and humidity, and Medical Device Reprocessing (MDR); they also looked at patients themselves. “There are several factors we consider that can increase risk of infection, such as a higher body mass index, diabetes, anemia, and smoking,” says Dr. Hjelkrem. Moreover, the majority of surgical site infections result from bacteria that patients carry themselves. Many of these bacteria live in the warm, moist environment of our nasal passages. Patients are normally given a topical antibiotic ointment to apply

for five days before their surgery, though compliance can be low. The team landed on an innovative alternative: nasal photodisinfection therapy. KBRH has begun a two-year quality initiative pilot to assess this technology. Prior to surgery, the nurse swirls an applicator with a photosensitizing solution in the patient’s nostrils. The nurse then inserts illuminators and activates a laser that zaps dead the microbes. The laser doesn’t harm the patient’s tissues or result in increased bacterial resistance. KBRH is the second hospital in Canada, after Vancouver General Hospital, to introduce this technology. It was first used at KBRH in January 2019 on Lennox Embree, a long-time resident of Trail. “The procedure was simple and obviously effective,” says Lennox, who experienced no complications. “Since my surgery, I’ve been able to travel to Haida Gwaii and I picked huckleberries for four days straight. I would like to compliment all the KBRH staff – they are top notch.” All the structural improvements to KBRH and patient-optimization steps have impacted the hospital infection rate as a whole. According to Dr. Hjelkrem, the infection rate is down an astounding 50 per cent. But KBRH is not done. Staff and physicians, energized by the culture of openness, are committed to continuous improvement. “This has been a great evolution for staff to feel comfortable and be heard if they have a concern,” says Jane. “A true quality mindset is now built into day-to-day work in the OR.” “Everybody’s voice matters,” says Dr. Hjelkrem. “We are excited and engaged.”

OR Manager Cindy Ferguson demonstrates the nasal

photodisinfection therapy with KBRH staff.

Orthopedic surgeon Dr. Mike Hjelkrem.

Page 8 | September 2019

The Llama of Medical Affairs

Norm the llama continues to be passed between Medical Affairs team members who demonstrate the qualities of resiliency: adaptability, persistence, patience, balance, and curiosity. Medical Affairs llama people are:

Sociable and communicative

Adventurous and have a lot of experience to share

Kind and loving to friends and family

Simply a call away when a friend is in need

Practical and self-aware

Constantly driven to improve themselves

Thank you Cheryl, Sharon, and JP for being resiliency champions!

AUGUST Sharon Hunt

Credentialing & Privileging Assistant,

Grand Forks

SEPTEMBER JP Babcock

Credentialing & Privileging Assistant,

Kelowna

JULY Cheryl Askew

Medical Administrative Assistant, Trail

Why PQI? Watch this video to learn more about the PQI initiative

Page 9 | September 2019

IH Executive & Senior Medical Leadership

Dr. Mike Ertel, Vice President, Medicine and Quality 250-469-7070 ext.12216

Dr. Zoe Ayling, Senior Medical Director, Credentialing & Privileging 250-488-8720

Dr. Nick Balfour, Executive Medical Director, IH Central & Transport 250-469-7070 ext. 12597

Dr. Curtis Bell, Executive Medical Director, Primary & Community Care 250-469-7070 ext.12215

Dr. Glenn Fedor, Senior Medical Director, Thomson Cariboo 250-398-0777

Dr. Andy Hamilton, Executive Medical Director, Surgical Services 250-770-0877

Dr. Devin Harris, Executive Medical Director, Quality & Patient Safety 778-214-4833

Dr. Nancy Humber, Senior Medical Director, IH West 778-209-0345

Dr. Harsh Hundal, Executive Medical Director, Physician Engagement & Resource Planning 250-469-7070 ext. 12245

Dr. Lawrence Jewett, Senior Medical Director, East Kootenay 250-489-6472

Dr. Norm Kienitz, Executive Medical Director, IH West Tertiary, IH Trauma 250-469-7070 ext. 12597

Dr. Douglas Kingsford, Chief Medical Information Officer 250-469-7070 ext. 12208

Dr. Darren Lorenz, Senior Medical Director, Shuswap 250-253-1461

Dr. Sue MacDonald, Executive Medical Director, Aboriginal Health, Physician Leadership, & KB 250-469-7070 ext.12208

Dr. Doug Smith, Executive Medical Director, Residential Care, Palliative Care, & MAiD 778-214-4657

New Faces in Medicine & Quality

Manager, Patient Care Quality Office / Patient Safety Investigations

Effective Sept. 24, 2019

Project Lead, Medical Program Transformation

Effective July 10, 2019

Department Head, KGH Laboratory / Area

Medical Laboratory Director, IH Central

Effective Aug. 13, 2019

Consultant, Pain and Symptom Management

and Palliative Care Effective July 2, 2019

Edgar Chavez Dr. Kevin Wade Fiona Macleod Dr. Dante D’Urbano

Welcome to the M&Q team!