Seniors volunteer more than any other age group. Photo courtesy of Corporation for National and Community Service.

You’ll likely find them around every corner: senior volunteers who make a difference each day in hospitals, community organizations, neighbourhoods and senior centres. In total, these unsung heroes are making a bigger impact than ever as budgets remain flat and community needs escalate. Now, here’s your chance to honour their efforts.

The Home Instead Senior Care® network has launched the Salute to Senior Service public education program to honour the many volunteer contributions that older adults make in the community. The award program includes a search for the most outstanding senior volunteer in each province and culminates with the selection of a national winner during Seniors Month in June. In addition to showcasing senior volunteers, the program features important information about the benefits of volunteerism from the Home Instead Senior Care network.

Salute to Senior Service nominees must be 65 or older, and volunteer at least 15 hours a month, making a positive impact on their communities through volunteerism. Nominations are now being accepted and can be submitted at www.SalutetoSeniorService.com until March 15, 2012. Nomination forms are available online or by going into a local Home Instead Senior Care office.

Provincial Senior HeroSM winners will receive plaques and their stories on the www.SalutetoSeniorService.com website. What’s more, $5,000 will be donated to the national winner’s non-profit charity of choice.

“Helping others defines life for many retired seniors,” said Jack Voykin, of Home Instead Senior Care in Vancouver. “And what a difference we have observed in seniors’ health, attitude and outlook among those who choose to stay active as they age.”

The Salute to Senior Service award program came about as a result of a national research study conducted by the Home Instead Senior Care network in Canada. Four hundred senior volunteers were interviewed to measure their impact on the local community, and to better understand what motivated them to volunteer. The telephone interviews were conducted with seniors age 65 and older who volunteer their time through unpaid community service. The sampling error is +/- 4.9 per cent at a 95 per cent  confidence level.

According to the study, 47 per cent of seniors volunteer their time through unpaid community service, and 21 per cent of the senior volunteers volunteer in hospitals and health care organizations. Furthermore, they donate an average of 16.5 hours per month. Ninety-eight per cent of seniors who volunteer say that their volunteer work is important in comparison to other things they do in their lives.

“Another interesting finding from the research is that nearly three out of five senior volunteers say they volunteer more now because the need is greater as a result of the economy,” says Voykin. “Seniors are obviously a very giving group. They also do so for their own health.”

The study found that 86 percent of senior volunteers who suffer from chronic health conditions say that staying active through volunteering helps them manage their health problems. Indeed, 93 per cent of those who responded to the survey said that seniors who volunteer are healthier and happier than seniors who don’t volunteer.

“There is an important link between healthy aging and volunteering,” says Jean-Guy Soulière, Chair of the National Seniors Council. “Seniors volunteer more than any other age group. You just can’t put a dollar figure on how much seniors who volunteer contribute to the country. But I can tell you that a lot of organizations would die if not for those volunteers. And let’s not forget that a lot of people who do things like caring for other family members don’t consider that to be volunteering, but it is.”

According to the 2007 Canada Survey of Giving, Volunteering and Participating, although the likelihood of volunteering tended to decrease with age, the actual number of hours devoted to volunteer work increased with age. Seniors 65 and older gave more hours to volunteering than any other age group, with an average of 218 hours a year, compared with 138 hours a year for people aged 15 to 24.

“The Salute to Seniors Service award program helps communities redefine aging,” said Voykin, of Home Instead Senior Care. “Every day we see seniors who still have so much to give, not only to their communities but to their families and loved ones.”

To nominate a senior volunteer or for more information about the Salute to Senior Service public education program, go to www.SalutetoSeniorService.com or call Home Instead Senior Care at 1-866-996-1087.

One of the posters used to educate staff on how and what to recycle.

Understanding behaviour and best practice

In order to design the most effective system possible, we attempted to understand recycling behaviour and what drives it. Of interest, results from a literature review by Meredith Hunt, Lower Mainland Health Authorities Green+Leaders Coordinator, found there is no conclusive evidence on what drives recycling behaviour. Rather drivers seem to differ between individual settings. For example, people may actively recycle at home, yet they may recycle less in a public space or at work. Although we may not yet be able to pin-point the rationale behind recycling behaviour in hospitals, from research review and experience, we do know:
•    Convenience and knowledge are influencing factors
•    Past behaviour is a predictor of future behaviour
•    The societal norm is an influencing factor
•    Others’ behaviour is a stronger influence than
•    Reporting back encourages and improves recycling
•    Signs with persuasive messages are more effective than single prompts

We have identified the barriers and benefits to recycling allowing behaviour change tools to be designed with these in mind; employ as much face to face communication as possible; used incentives to reward recycling behaviour; focused on social norms and inclusive language in our marketing materials; reported back on progress of the program.

Program overview

The Recycling Renewal Program provides health authority-wide recycling of refundable beverage containers; rigid plastic and tin; soft plastic; mixed paper and batteries.

To engage staff at the site level, administration is required to approve suggested implementation tasks and timelines. From here, each department/unit is consulted for feedback on recycling bin type, location and quantity. At the lab in Royal Columbian Hospital, department champions have gone above and beyond to make sure their department is recycling as much material as possible –they have even set up a styrofoam re-use program!

Getting the recycling bins out on the floor (bin roll-out) is accompanied by distribution of awareness and instructional posters, email and newsletter announcements, training for recruited ‘Recycling Champions’, recycling display days, department in-service training and on-line resources.

Indicators tracked by the recycling team measure program success and effectiveness. Data for these indicators are obtained through the following:
•    Pre and post waste audits to determine the composition of the waste and recycling streams
•    Pre and post surveys to measure staff awareness and satisfaction
•    Post implementation visual audits to measure contamination, identify possible bin re-allocation and flag areas that may need further education
•    Diversion rates calculated from vendor invoices using waste and recycling volumes to identify change in volumes and rates

The Lower Mainland Health Authorities commit to achieving diversion rate targets of 35 per cent in 2011/12, 50 per cent in 2013/14 and 70 per cent in 2014/15.  These progressive targets align with the Metro Vancouver goal of 70 per cent diversion in 2015.

Challenges and solutions

In addition to the common recycling challenges of placement, contamination, a constantly changing recycling market, communication and education, healthcare faces a unique set of recycling challenges.  The table below outlines both common and healthcare specific challenges and details the recycling team’s solutions.

As the Recycling Renewal program is implemented at each site the team works to address challenges that arise with creative and effective solutions. At UBC and Richmond Hospitals, staff have set up their own collection boxes in each clinical room and then sort out recycling at centralized stations ensuring as much material as possible is recycled.

Results

The Lower Mainland Health Authority Recycling Renewal Project began in the summer of 2010.  Since then, the recycling team has added over 1,100 bins to seven acute care sites (St. Paul’s-SPH, Mount St. Joseph’s-MSJ, G.F. Strong-GFS, UBC Hospital-UBC, Royal Columbian-RCH, Lions Gate – LGH and Richmond – RH).  Planning is currently underway at Children’s & Women’s Hospital (C&W) and Burnaby Hospital (BH) with implementation scheduled this winter.

The proportion of recyclables in general waste has decreased at GF Strong Rehabilitation Centre, UBC Hospital and Royal Columbian Hospital as measured by the pre-program and post program waste audits. This decrease has varied between 3-13 per cent by site.

The proportion of staff reporting very low satisfaction levels dropped dramatically at GF Strong Rehabilitation Centre and Royal Columbian Hospital after the program was implemented, 80 per cent and 50 per cent respectively. Surveys for UBC Hospital are still to be conducted.

Post implementation awareness results at GF Strong Rehabilitation Centre and Royal Columbian Hospital show an increase in the percentage of people that know who to contact if they have questions regarding recycling, 15 per cent and 20 per cent respectively. Given that both sites still report less than 30 per cent of respondents know who to contact about recycling, we would like these numbers to be higher.

Post implementation visual audits are conducted immediately after the program is implemented.  Overall, these results indicate staff at each of these sites are generally informed on how to recycle correctly and are following through.

In general Health Authority staff from CFOs and executives to front-line doctors and nurses, are excited about the Recycling Renewal Program.

Although we encounter challenges with each site, we also find enthusiastic staff that continue to put great effort into recycling as much material as possible within their departments and hospitals. UBC Hospitals’ Transitional Care Unit immediately and significantly decreased glove contamination (they can’t be recycled) with strong internal communications, by doing their own visual audits, and truly taking the program under their wing. With site implementation on schedule and positive post-implementation results from our first three sites we anticipate this program to be a great success.

The NICU at Sunnybrook Health Sciences Centre.

As the single room care model becomes the norm in Neonatal Intensive Care Unit planning and design, the single rooms can be arranged in a variety of configurations which have direct impacts on patient care delivery, operational efficiency and cost.

Parkin analyzed six of our single room care redevelopment projects from across North America.  Each of the six projects employed a unique approach to the overall departmental floor plan and circulation patterns can be categorized as NICU ‘plan typologies’.  Using urban and hospital planning terminology and conceptual diagrams, the various ‘plan typologies’ include ‘Centre Core’, ‘Spine & Cluster’, ‘Race Track’, ‘Cul-de-sac’, ‘Street and Block’ and ‘Double-Loaded Street and Block’. Common statistics and characteristics were gathered for each of the six ‘plan typologies’ to establish a base line for evaluation and an understanding of the site, program and project specific parameters which would affect planning decisions.

The arrangement of circulation corridors, entrances and exits, adjacencies to other hospital departments, care stations, support services, distribution of supplies, staff amenities and access to natural light and views varied considerably among the projects.  The impact of less tangible design objectives – including culture, values, community, site and program – also played a significant role in the design and planning process.

Each ‘plan typology’ was assessed based on a common set of performance criteria including space allocations, circulation efficiencies (care-giver footsteps and separation of public and service circulation), infant and family comfort, privacy, safety and security, potential for future expansion, access to support services and availability of natural light and views for the infants (if desired), family and staff.  A ‘scorecard’ type evaluation and qualitative analysis of each project resulted in comparative observations and qualitative assessments of each ‘plan typology’.

The example provided illustrates one of the ‘plan typologies’.  Each example had project-specific variables such as program, acuity levels, regulations, site/building context and budget, making accurate and direct comparisons difficult.  All six projects had single care rooms with a family sleep zone, provision for bedside charting, provision for charting near the room, supply cart in room (including medications), some form of patient monitoring and a high degree of control of sound, light and temperature in each room.

The double-loaded street and block typology used in Sunnybrook Health Sciences Centre’s NICU.

The following example from the Sunnybrook Health Sciences Centre in Toronto, Ontario is an example of a ‘double loaded street & block’ plan typology.  Sunnybrook is a large urban campus teaching hospital and is a regional centre for neonatal care with a commitment to family centered care.  The Sunnybrook model is unique from the other projects in that there is a separate corridor system for parents to access their baby’s room and meet the hospital caregivers ‘face to face’ at the bedside.

The project was a vertical addition to the M-Wing which was occupied in September 2010.  It is a Level II/III NICU with nurse/infant ratios of 1:1 or 1:2.  The NICU is one floor below the new Labour and Delivery unit with a dedicated elevator for patients and staff.  Each room benefits from a direct observation chart desk with a decentralized work station in each cluster of rooms.

Conceptual Floor Plan

Upon review and analysis of the six plan typologies, it is apparent that there is no ideal plan configuration because each project is unique to its program, location and specific user care philosophy.  It becomes a matter of establishing clear planning and design priorities and operational objectives.

In the Sunnybrook example, priority was given to a family-centered care model with secure family and visitor access segregated from staff and service circulation routes.  Each patient area has a separate family entrance/zone and a medical/clinical entrance/zone.   The segregation of the public circulation (family & visitors) from the service circulation (medical/clinical/support staff) circulation system enhances family comfort, safety and privacy, infection control and operational efficiency.  As the unit is located on a large floor plate (originally designed to be fitted out with surgical suites), the patient rooms were moved ‘inboard’ within the floor plate which eliminates the option to bring natural light to the space (like the womb).  The family and staff support spaces (lounges, offices, etc.) are located on the perimeter of the unit to provide and abundance natural light and views.  The trade-offs in the ‘double loaded street and block’ configuration are a larger allocation of departmental gross floor area to circulation space, minimal natural light in the patient care areas and longer travel distances for staff.

Innovative planning and design which utilizes ‘borrowed’ natural light or decentralized support spaces to reduce travel distances can overcome the trade-off associated with a particular plan typology, resulting in an NICU layout customized to a hospital’s ambitions and objectives.

Dr. Carolyn McGregor (UOIT) and Dan Coghlan, VP Finance, Information Management and CEO at Providence Care, shake hands in front of a PaJMa model, that provides a visual display of patient interactions and information flow on a care unit.

As the implementation of electronic patient record (ePR) begins at Providence Care in Kingston, examination of current processes and planning for future processes have led to a number of quality improvement initiatives involving documentation, oversight and equipment.

“The electronic patient record isn’t just about saving paper,” says Robin Saunders, Providence Care’s Director of Decision Support. “It’s also about learning what we’re doing and how we’re doing it, and making changes that benefit the patients, clients and residents we serve.”

Providence Care’s ePR team has been working with undergraduate and graduate students from the University of Ontario Institute of Technology (UOIT) in the Faculty of Health Sciences and the Faculty of Business and Information Technology.

Together, Providence Care and UOIT are examining clinical workflow processes using Patient Journey Modeling Architecture (PaJMa), the process modeling methodology developed by Dr. Carolyn McGregor (Ph.D., Associate Professor in the Faculty of Business and Information Technology, Associate Dean of Research, and the Canada Research Chair in Health Informatics at UOIT ) and Dr. Jennifer Percival, (Ph.D., Assistant Professor in the Faculty of Business and Information Technology).

PaJMa models are detailed diagrams that map out client/resident/patient interactions from admission to discharge across the organization, and how information flows between clinicians within the circle of care. Currently, PaJMa models have been created for each of the inpatient units at Providence Care. A careful examination of these processes will allow the organization to look for efficiencies and opportunities to standardize processes as we move towards the implementation of the ePR.

Saunders says planning for the ePR has also improved the quality of documentation. Nursing Care and Observation Flow sheets have been developed and are in place in two inpatient mental health units so far.  These sheets ensure regular and consistent documentation for each patient on each shift.  Staff input has been integral to the implementation and revision of this documentation tool. Plans are in place to roll the flow sheets out to all mental health units over the next six months, with the eventual goal of building them into the electronic record.

Additionally, an Inter-Professional Care Planning Working Group has been established and is moving ahead with plans to implement the utilization of an electronic care plan, B Care’s “Care Plan Wizard”, during inter-professional team meetings. The Care Plan Wizard utilizes the Resident Assessment Instrument – Mental Health (RAI-MH) data to highlight areas requiring further assessment and individualized care planning. The goal is to roll out use of the Care Plan Wizard at inter-professional team meetings over the next year.

Finally, equipment pilots are currently underway as well, incorporating use of best practices with use of technology.  Different groups of staff have had the opportunity to complete a Falls Risk Assessment Tool (FRAT) and the Braden Skin Assessment Scale electronically, at the point of care, using different computer work stations on wheels.  The work stations are also equipped with links to the online Compendium of Pharmaceuticals and Specialties, Registered Nurses Association of Ontario website for quick access best practice guidelines, and to the College of Nurses of Ontario website.  These pilot initiatives will allow staff to have input into future product selection for the organization.

“Providence Care is learning that implementation of an electronic health record changes not only how and where one creates and stores documentation,” says Saunders.  “It also greatly enhances quality of care, oversight and clinical efficiency.”

Right now our focus is all about the build. Across the Health Centre we continue to make progress with the development of order sets and the streamlined process to get those order sets vetted and ready to go when the system is ready to run. We’re coming toward completion of that piece of work and it will then be taken to our analysts and other members of the Information Services team to be built into the system.

The next big thing on the horizon is the go live of clinician order management, which is set to begin towards the end of 2012. This stage of work will follow a “pop-bang” approach, with the first go live taking place in an isolated inpatient unit, followed closely by the second go live which stretches the project to all inpatient areas of the Health Centre. And finally bringing the third go live to the emergency department. In preparation for the first go live of Phase II, Stage 2, the order sets will be completed, followed by the use of the system in a testing environment to validate that everything is working.

Dovetailing with that work is the development of a training and education strategy for eCare. Tajbanu Thobani-Lakhani, eCare Education Coordinator, is charged with coming up with a strategy to prepare not only the physicians and clinicians, but also the entire hospital.

Mark Vimr, Executive Vice President, Clinical Programs, sees eCare as part of our overall strategy to Put Patients First in all aspects of care. “Once fully implemented, our eCare project has the potential to enhance several of the Health Centre’s priorities such as increasing safety, improving quality of care, and leading to better overall patient experience,” says Vimr, who is also Chief Nursing Executive. “All Health Centre clinicians and physicians will have access to the same electronic patient records and this will help ensure a smoother transition for patients as they navigate throughout our organization.”

Integral to the go live strategy and education strategy is ensuring that we have good champions and super users out while we go live, who are available to answer questions and support all members of our health care team. To increase our success and reduce bumps in the road as we implement eCare, we are involving staff in the design and usage of how we put electronic records into daily practice. One group providing the Health Centre with this input is our Physician Advisory Group.

“Our hospital is seeing an increase in the level of physician engagement, particularly in our emergency epartment (ED) when it comes to eCare,” says Dr. Paul Sullivan, Physician Lead, eCare at the Health Centre. “A lot of thanks for that can go to Drs Andrew Sue-A-Quan, Albert Lau and Steven Rhee because they truly understand the affect that eCare will have on the flow of their day. They have come on board and stepped into champion roles for the ED in preparation for this and are actively involving themselves in the development and communication of this project,” he adds.

To continue with the engagement of the physicians at the Health Centre, we are in the process of planning a “Day in the Life” walking road show that would visit various departmental meetings. This will allow for the division heads and members of each department to get the first glimpse of how the Health Centre integrates the computer into what we are doing now.

Ideally, eCare will lead to more coordinated care as a patient’s electronic record follows them throughout their health care journey within our hospital. This will reduce the number of times patients are asked the same questions and can reduce adverse events caused by human error and help increase patient safety. We anticipate electronic records will improve patient care and health outcomes throughout the hospital.

Andrew Brearton, Chief of eCare, said the goal of eCare is one patient, one chart. He says “In spite of the anticipated challenges we have encountered we are fully committed to the original goals which Put the Patient First. (And doing this) while ensuring that the engagement and adoption activities are fully aligned with the workflow transformation activities to optimally support staff and physicians in this very complex change management process.”

This is the second installment of a three-part series examining various aspects of OR supply chain improvement projects, based on the Ontario Hospital Association’s guidebook, Optimizing Your Perioperative Supply Chain: A Guide to Improvement Projects.

St. Joseph’s Health Centre in Toronto participated in an Ontario Hospital Association pilot program to develop OR supply chain efficiencies. Here, St. Joe's storekeeper scans inventory as he replenishes stock in the OR storage area.

When the newly appointed inventory coordinator at St. Joseph’s Health Centre Toronto started taking stock of the hospital’s OR sterile core, his biggest surprise was the excess.

“There were a lot of items that were physically there that hadn’t been accounted for,” says Jonathan Laceda, explaining that they mostly came in through custom packs. But these sometimes-expired and often-unwanted items took up valuable real estate.

An imbalance like this is all it takes to throw off a delicately calibrated OR supply chain, and since medical-surgical supply expenditures can be as much as half of an acute care hospital’s operating room budget, it pays to have your system performing optimally. But cost savings are just one advantage.

What if clinicians could find what they needed when they needed it – every time?  How would that change things? These were questions the St. Joseph Health Centre’s team asked itself as one of the 14 sites participating in an Ontario Hospital Association pilot program to develop OR supply chain efficiencies.

Is undertaking an OR inventory project worth it?

In the guidebook developed as a result of the program, pilot sites reported that the typical benefits of an optimized OR inventory process tended to come in three forms:

The first was improved OR supply chain ‘customer service’ levels, which was simply a result of things like faster order cycle times, having supplies when and where they were needed, having less inventory on hand, and having less OR suite delays – all of which improved staff satisfaction.

The second was that clinical staff spent less time placing orders and replenishing supplies, which meant they could direct more attention to patient care, which again improved job satisfaction.

And the third was more administrative. Having improved medical-surgical supplies usage information helped to standardize supplies and equipment, lower supply costs and create more accurate procedure and surgical case costing.

What exactly is OR inventory optimization?

Optimizing your operating room inventory is essential to streamlining the movement of materials from the supply chain to their point of use.
A fully optimized operating room is one where an appropriate level of inventory is available when and where it is required to support ongoing clinical procedures and patient care. At the same time, it must ensure that the replenishment process is efficient and effective, which will in turn optimize your investment in inventory.

Where do you start?

Investigating your OR inventory involves reviewing both the physical locations used to store supplies (these include areas of the surgical suite, the OR sterile core and the medical device reprocessing (MDR) areas), and the location of the system(s) used to store the data, namely, the item master files.

As one of the pilot hospitals participating in the operating room supply chain project, St. Joseph’s Health Centre completed a number of improvements, but one of its strongest areas of success was in optimizing its inventory. Here’s an overview of what the team there did.

Learn what is actually there

Starting with a five-year usage report listing every item the OR had ordered in that time, the project team compared it to what was actually stored in the department.

They found almost 400 items that were not on the usage report. Many came from trials, and some were just leftover items from custom packs. There were also some instances of hoarding, recalls inventory coordinator Laceda, referring to caches of items stowed away in anticipation of future shortages.

With storage cleared of expired, redundant and cached supplies, the team set about finding the best place to locate items.  It used a blueprint of the space and mapped the path a clinician typically follows while supporting a procedure. This illustrated the problems of multiple stock locations for single items and the general confusion over where some things were stored.

Develop patient-centric storage

The system they devised also aimed to keep the clinician, as much as possible, in the OR with the patient rather than having to go in and out in search of supplies.

Interestingly, this was not much different from the model that existed for the department before the project, which called for closed, mobile cabinetry that would keep all emergency supplies in the OR.

“It just wasn’t supported,” says Laceda, who has since implemented a storekeeper position dedicated to replenishing items stored in the ORs.
Individual storage carts in the central core are now organized by either the storage of item types (dressings, anesthesia, IV’s) or by service (ENT, Gynaecology). These are used to supplement case carts and the dedicated OR theatre carts, such as the ones for anesthesia.

Improving OR inventory systems is one of the four foundational projects discussed in the OHA guidebook Optimizing your Perioperative Supply Chain.

Does your OR inventory need improvement?

The following service failures are often signs that an OR inventory optimization project may be warranted:

Customer service failures such as:
• Constant ‘stock outs’ of needed medical-surgical supplies;
• Surgical procedure delays due to medical-surgical supply issues; and
• Staff unable to locate medical-surgical supplies when required.

Process fragmentation such as:
• Variances in practices, responsibilities and accountabilities across the OR for supply replenishment;
• Lack of historical usage information to understand replenishment needs;
• Excessive clinical time spent on inventory replenishment;
• Multiple and redundant locations of OR inventory;
• Limited/no documentation for procedures and policies;
• Long training periods and high staff turnover;
• Visually disorganized and cluttered OR inventory storage; and
• No ability to manage non-stock or consignment inventories (i.e., not managed through PAR1 levels).

To learn more and to download a free copy of the guidebook, visit www.oha.com and select ‘Supply Chain Strategies and Initiatives’ from the ‘Services’ tab.

Medical Director and Chief of Emergency and Urgent Care Dr. Tom Chan samples some of the new congee The Scarborough Hospital will be adding to its General campus patient menu as part of the hospital’s ReFRESHing our Menu project.

Often the struggle for health care food service is balancing a variety of dietary needs with tight budgets. This delicate balance can make it difficult to provide meals that also taste great. However, now some Ontario hospitals are making progress and increasing the amount of fresh, local food in their kitchens and even providing in-house, home cooked meals.

This has been achieved in part with help from the Greenbelt Fund, a grant program supported by the Ontario Ministry of Agriculture, Food and Rural Affairs, and the dedication of staff and suppliers.

The following Greenbelt Fund grantees have shared their top three tips for including more local food.

St. Joseph’s Health Centre, Guelph

Providing care to a range of aging patients, residents and clients, St. Joseph’s Health Centre has been working to incorporate more local, home-cooked meals onto their menu. Leslie Carson, Manager of Food & Nutrition Services, has been a key part of those changes. Here are her tips:

•    Focus on quality vs. quantity. Offer portions that reflect the nutritional and energy needs of an aging population. This provides an opportunity to offer higher quality local foods that can be more expensive.
•    Eat food close to nature and create a flexible menu to take advantage of in season fruits and vegetables. A beautiful red-skinned potato from Ontario soil is not only cheaper, but much better tasting and nutritious compared to a processed alternative. From a therapeutic perspective, think of all the diets that are compatible with the plain potato vs. processed potato: gluten free, salt reduced, diabetic, low fat, multiple allergens, etc –you name it; the plain potato wins hands down.
•    Create a connection between the food you serve and your clients. Let your clients know they are eating local beef or potatoes (put it right on your menu) – they will have much more “buy in” to pay for or consume a meal they know they can feel good about supporting.

The Scarborough Hospital

The Scarborough Hospital recently launched ReFRESHing our Menu, an exciting new project to improve inpatient food at their General campus. This new menu will ultimately introduce over 20 new items to patients that are cooked from scratch using local ingredients. Anne Marie Males, Vice President of Patient Experience, offers the following tips for those health care facilities looking to incorporate more local food in their institution.

•    Identify champions at all levels of the organization. Without senior management buy-in and grassroots support from the front line, a local food project will stay in the “wouldn’t it be nice” category.
•    Find some quick wins. A few highly visible, positive projects (ideally some with press coverage) will help build support within the organization
•    Don’t be afraid to move slowly. Consolidate your wins and keep moving. Making changes to processes and systems in a bureaucratic environment can be frustratingly slow, but don’t lose hope.

St. Joesph’s Health System, Group Purchasing Organization (SJHS-GPO)

The SJHS-GPO works on behalf of 16 members, representing 28 health care facilities. SJHS-GPO recently worked with My Sustainable Canada to conduct an audit to determine the origin of food products purchased by health care facilities. The data collected was used to transform SJHS-GPO’s RFPs to include a request for food origin information. Candice Bester, Manager, Nutrition Group of the SJHS-GPO, has identified the following tips to bring more local food into your facility:

•    Work with your GPO. Insist on attaining the origin of your contracted food products.
•    Increase your awareness of suppliers. Get to know the local food suppliers in your region and invite them to be part of the process of change at your facility.
•    Share successful product information. The only way to change the amount of local food served at institutions is to share the successes and progress made within your organization with other colleagues in the health care sector.

Marek Hospitality Inc., is working with their clients to meet the growing demand for local food in hospitals and health care facilities. Sandra Matheson, President of Marek Hospitality, offers these suggestions to organizations looking to work with suppliers to increase access to local food.

•    Get to know your local producers. Invite a local produce supplier to set up display with local food samples at your facility. Get to know what is available seasonally and encourage staff to come up with new menu options incorporating local food.
•    Commit to buying local. Inform your supplier that you want to commit to buying local and ask them to indicate on order forms which products are local. A good produce supplier will support you to make these changes happen.
•    Promote. Once you have more local food on your menu, promote it by creating point of sale items, identify who the local farmers are, develop new recipes highlighting the flavour of fresh fruits and vegetables and create internal newsletters touting the efforts of staff and suppliers.

Dr. Mary Pothos, a Pediatrician at Children’s Hospital of Eastern Ontario (CHEO) examines a young patient. Photo credit: Graham Mastersmith.

On the campus of the Children’s Hospital of Eastern Ontario (CHEO), recent privacy software innovations have been united with a clinical database to create one of the most comprehensive, secure, and coveted mother-child registries in Canada. BORN (Better Outcomes Registry and Network) Ontario has joined forces with the Electronic Health Information Laboratory to protect personal privacy while guaranteeing the optimal data release. Now health care providers, public health professionals, governments and researchers are all eager to access the registry to inform their work in facilitating care, policy development, quality assurance initiatives and health services utilization research.

Headquartered within secure offices inside the Centre for Practice Changing Research with satellite offices in other Ontario locations, BORN integrates maternal-child data for all hospital and home births in the province (approximately 140,000 babies each year) as well as prenatal and newborn screening. Health research can provide vital information on disease trends, risk factors, outcomes of treatment, and patterns of care but the access relies on the handling and sharing of the sensitive personal information.

The risk of a breach of personal information is very real: recall a new mom and baby met at a park, forget names, discard unique health card numbers and erase knowledge of a home address. If, like a nosey neighbour, the baby’s date of birth can be obtained along with the mother’s age and her postal code, then 95 per cent of mothers and babies can potentially be identified in Canada’s most populous province, giving rise to the need for privacy software if the benefits of the data are to be realized.

“From the perspective of a researcher, I think it is BORN’s responsibility to educate people about our data – how it has to be kept secure, used and people’s privacy respected, and how we need to be careful about destruction. It’s part of our responsibility to educate the people using BORN data or requesting BORN data,” says Dr. Ann Sprague, BORN’s Scientific Manager.

The privacy software tool that protects and permits access to the most personal of data emerged from the work of  Dr. Khaled El Emam and the team at  the Electronic Health Information Laboratory (EHIL) at the Research Institute of the Children’s Hospital of Eastern Ontario. The EHIL team is composed of computer scientists, software engineers, mathematicians, statisticians and privacy experts and the lab’s work is internationally recognized for conducting research on risk assessment methods for handling health data.

BORN’s “prescribed registry” status was granted under Ontario’s privacy legislation and allows BORN to use and disclose personal health information for the purpose of facilitating or improving the provision of health care, and the information can also be used for secondary purposes, such as research. BORN’s leadership team is committed to meeting all industry best practices to protect against unauthorized accidental or intentional release of information.

“I like this tool because it’s an objective measure. It tells me what the risk is and I know that there’s a methodology and sound rationale to back it up,” says Dr. Sprague, acknowledging that word has spread through the various communities that this rich data set is accessible.

The risk assessments consider the security measures of data handlers and data recipients to set the appropriate release thresholds, dramatically changing the interactions between BORN and researchers. Dr. Sprague describes the process as far more collaborative while streamlining decision making.

Dr. Sprague and the other leaders of BORN Ontario are determined to take every possible step to maintain a registry that meets and exceeds all current and future security and privacy requirements, making it worthy as “one of the world’s safest and largest” maternal-child registries.

In 2011, a version of this privacy software was shared with the medical research communities in Canada and the U.S when Dr. El Emam released the free, online Wizards for Research Ethics Boards and Institutional Review Boards.

Located in many of the research hospitals and medical universities throughout North America, the boards are the oversight bodies entrusted with reviewing investigative medical research proposals and assessing and managing the risks associated with those proposals.

“Reducing the decision-making time for research ethics boards is critical,” adds Dr. El Emam, emphasizing that the time to approve research proposals can be reduced from months down to days — or even a few hours — when the software is implemented to ensure compliance with government standards.

A screenshot of one of the avatars in the Smart Condo virtual living suite.

Homes and condos wired with sensors and remotely monitored by clinicians could signal a whole new approach to healthcare that gives Canadian seniors the support they need to age safely at home.

Health care organizations across Canada are urgently seeking creative new ways to deliver affordable, high-quality healthcare to the elderly that will enable them to live independently longer. According to Statistics Canada, the number of Canadian seniors will increase from 4.2 million from 2005 to 9.8 million by 2036.

Technology can play a key role in addressing how the health care system can deliver better care, more efficiently, to this expanding – and expensive – demographic.

A new pilot project called the “Smart Condo” is one of the world’s most advanced examples of remote monitoring capability to assist seniors in aging in the right place. Since June 2011, University of Alberta researchers have been using IBM software to study elderly clients who volunteered to stay in a model, self-contained “independent living suite” at the Glenrose Rehabilitation Hospital in Edmonton. The team outfitted the suite with sensors and smart devices that collect and track information about the daily activities of the seniors. Tiny sensors were embedded on cupboard, bathroom and bedroom doors, kitchen appliances and light fixtures throughout the suite.

Supported by IBM Centre for Advanced Studies Alberta, this unique pilot is aimed at providing Health-Science Education Research Consortium researchers at the University of Alberta with insights on how to enable Canada’s aging population to remain at home. Clinically relevant information is recorded to improve their health and wellbeing.

A permanent Smart Condo installation is currently being completed inside the University of Alberta’s new Edmonton Clinic Health Academy (ECHA). The installation will be housed in the Smart Condo simulation space of ECHA and will provide the team with a long-term space in which to conduct a systematic suite of experiments on the use of novel technologies to support people with chronic conditions at home.

IBM WebSphere Sensor Events software collects and fuses sensor data from a range of medical and physical inputs – from heart-rate and body weight to electricity consumption and the use of doors, furniture, light switches and appliances. The analysis results are also used to animate an avatar of the occupant that mirrors their activities in a virtual version of the apartment. Advanced inferencing algorithms accurately recognize the activities of the condo occupants and can potentially identify adverse events.

The use of avatars and 3D imaging counters the potential ‘Big Brother’ effect that could arise from intrusive video system recording of the occupants’ activities, while at the same time providing an intuitive view of their activities.

Designed to help patients rehabilitate after conditions such as stroke or fractures, the Smart Condo data stream is analyzed to determine if medications are being taken as prescribed or if there are indications a patient is in need of a revised therapy regimen. For instance, a senior who goes to the kitchen and opens, shuts, then reopens cupboard doors but doesn’t turn on the water faucet or touch the stove settings may have a cognitive impairment.

“It is clinically relevant to know the regular activity level of a patient,” says Eleni Stroulia, researcher and chair of Service Systems Management at the University of Alberta. “Exceptions from regular patterns usually signal some need to investigate.”

All data from the pilot is recorded to provide ongoing resident assessment and observation to ensure the safety of individual. Health care professionals who receive a live stream of a patient’s activity could be alerted to intervene in case a harmful event happened. In response, they could conduct an in-house visit, or they could even go in the virtual world to communicate with the patient there.

The Smart Condo data will be used to understand how to make better use of health care resources, enable better communication and collaboration among clients, family members and providers, and contribute to early intervention and long-term management of chronic diseases. Researchers and clinicians will also learn how to support older people for independent living, and extend the length of time seniors are able to live in their homes.

“We know data is being generated all the time, but harnessing, aggregating, analyzing and gaining insights from it have been challenging,” Dr. Stroulia notes. “Viewing data as diverse as heart rate monitor and electrical consumption independently, out of context, means very little. The IBM software enables us to visualize data and actually see a patient’s ability to function independently, so clinicians can better observe the patients and, if necessary intervene. It has provided visibility to the physical world in a completely novel way.”

In the future, Dr. Stroulia imagines patients could agree to wear heart-rate or blood-glucose monitors in their homes. If they took their insulin or heart medications at the right time, their heart beat or blood sugar levels could be further evidence of compliance with the medical regime.

Companies building new facilities for seniors could use sensors to monitor patients with more complex health problems. The sensors could help staff determine the needs of the residents while still giving them some independence.

Keeping seniors at home longer has enormous implications for the future of healthcare in Canada as our population ages. Instrumented, intelligent and integrated, the Smart Condo is an important step in making that goal a reality.

A groundbreaking program, the Virtual Emergency Room, was established as a solution to this problem. It involves a partnership between four hospitals in central east Ontario: Lakeridge Health Corporation (Oshawa), Peterborough  Regional Health Centre, Ross Memorial Hospital (Lindsay), and Ontario Shores Centre for Mental Health Sciences (Whitby), with the technical support of Ontario Telemedicine Network (OTN).

The Virtual ER uses video-conferencing technology to connect children with mental health needs and psychiatrists in other communities.

The Virtual Emergency Room serves youth 17 years of age and younger with complex mental health issues resulting in serious psychiatric, emotional and/or behavioural disturbances. Using live two-way videoconferencing technology, these children now receive an in-depth consultation provided by a child psychiatrist at a remote site within 72 hours of referral.

“One in five children in Ontario struggle with a diagnosable emotional, mental or behavioral disorder, but accessing help can be a serious challenge for families,” says Wendy Decaire, Mental Health Program Director at the Ross Memorial Hospital. “There are very few child/adolescent psychiatrists, and they practise in large urban centres. In the past, that has left families in crisis with long waits and exhausting commutes. Now, children can be assessed in their home hospital by a psychiatrist at a partnering hospital.”

Since its implementation in February 2009, more than 300 children have been served through the Virtual ER program at Ross Memorial Hospital. A significant highlight of the program is that only one child has required an inpatient admission. The success of the Virtual ER is attributable to the commitment of Project Coordinator, Jane Thompson, who is a dedicated resource to the program and helps families and staff throughout the region access the service.

Prior to the program going live, a standardized triage process was developed, as well as an assessment tool. Additionally, an education protocol was developed with a needs assessment and training packages for staff at all participating facilities. All crisis staff and psychiatrists were trained, and crisis staff were tested and certified.

The Virtual ER facilitates timely and equitable access to care, particularly in remote regions, capitalizes on scarce psychiatric resources, eliminates barriers created by time and distance and keeps families in their home communities.

The Ross Memorial team knew, even before the evidence started coming in, that the Virtual ER would help meet an enormous local need. And now the team also has the endorsement of Accreditation Canada. The Ross Memorial learned in December that its Virtual ER submission met all the required criteria and was approved as a Leading Practice.