THE CONNECTION - hiroc.com...improvement, their system still wasn’t foolproof. So when HIROC began...

ANNE-MARIE MALEK What influences her patient safety agenda?

ISSUE 37 | SPRING 2016

CONNECTIONTHE

WORKING TO MAKE A DIFFERENCE Behind the scenes

at the Ontario Institute for Cancer Research

RESILIENCE HAS ITS REWARDS

The FM Global Leaders’ Forum: In property risk

management, being prepared is everything.

THE HIROC CONNECTION ISSUE 37 | SPRING 20162 3

Contents04 Top Healthcare Risks 2016 HIROC releases first Canadian report on a

Shared System for IRM

05 2016 Risk Management Conference: A day of learning and sharing stories

08 “Never, ever, ever give up!” Peterborough Regional Health Centre’s strong

IRM foundation

10 Working to Make a Difference: Behind the scenes at the Ontario Institute for Cancer Research

12 Checking in on RAC: New features, new risks, a new timeline!

13 Voices of our Subscribers: Anne-Marie Malek

14 Am I Safe? Supporting patient safety conversations in the home

18 You Have to ‘Give’ to ‘Get’: The Canadian Home Care Association celebrates 25 years

20 Asking Questions Safe Patients/Safe Staff receives safety award

Let’s Talk We want to hear from you!

What excites us most at HIROC is sharing

information and igniting conversations with the people who care about our industry and are committed to its transformation. That’s why we’ve launched the Let’s Talk blog – a space dedicated to the many voices in healthcare.

That means you!

We encourage you to pop by the site, letstalkwithhiroc.com, and learn how HIROC and its subscribers are #drivingchange.

If you have a story or conversation idea, send it to us today at [email protected].

Welcome to HIROC’s Newest Subscribers! Breastfeeding Committee for Canada

Cochrane Community Midwives Inc.

Community Care Northumberland

Guelph Family Health Team

Manitoba Institute for Patient Safety Inc.

Midwives Nottawasaga

Norfolk Roots Midwives

Red Community Midwives Inc.

Questions? Toronto4711 Yonge Street, Suite 1600

Toronto, Ontario M2N 6K8

Phone 416.733.2773

Toll-free Phone 1.800.465.7357

Fax 416.733.2438

Toll-free Fax 1.800.668.6277

Western Region1200 Rothesay Street

Winnipeg, Manitoba R2G 1T7

Phone 204.943.4125

Toll-free Phone 1.800.442.7751

Fax 204.949.0250

Submissions

Please contact Ellen Gardner at [email protected]

or Philip De Souza at [email protected]. We welcome

submissions to The HIROC Connection.

Please visit our website at HIROC.com to see

back issues of The HIROC Connection.

Cover photo: Anne-Marie Malek by Cliq Creative

22 Resilience has its Rewards: FM Global Leaders’ Forum shocks and educates delegates

25 Cleaning up at RVH

26 You Told Us

27 Ask a Lawyer: Updates to the law concerning physician-assisted death

Top Healthcare Risks 2016

Report on a Shared Canadian System for Integrated Risk Management

April 2016

ISSUE 37 | SPRING 2016 5

A Day of Learning and Sharing StoriesEach year the team at HIROC takes great pride in hosting our subscribers and partners at our AGM and Risk Management Conference. We all benefit from coming together to share knowledge and best practices, and one of the main highlights for us is hearing and sharing your stories.

Things happen to us or in our surroundings – a positive or maybe an adverse event – and when we share this story, our unique perspective helps shape the outcome and quite possibly has an impact on other people’s actions. Storytelling is essential because it keeps us connected.

At HIROC, we have the privilege of hearing your stories... hearing why you come to work every day and how you want to innovate. But most important, hearing who you want to improve safety for: the Canadian patient.

Like any story, it really is an epic journey, marked by moments of triumph, moments of defeat and the seemingly mundane encounters that are transforming the way healthcare is delivered in Canada every day. There are challenges but there are also pockets of extraordinary achievement in the quest to create a system that is safe for everyone. And we know, it’s that shared quest that keeps the momentum going.

This story is far from over.

We stopped a few delegates from the day and asked them about their:

Patient safety story…Risk management story…Personal motivator story…and here’s what they had to say…

In 2015, HIROC and a steering committee of healthcare stakeholders launched the HIROC Risk Register — an innovative and user-friendly Integrated

Risk Management program that facilitates the

identification, assessment, management and reporting

of key organizational risks.

In just one year, 84 healthcare organizations have signed

onto the Risk Register and almost 1,400 risks have been

entered into the system.

HIROC has summarized the key findings from the first

year of data collection in a special report, the first of its

kind in Canada. The report, called Top Healthcare Risks

2016: Report on a Shared Canadian System for Integrated

Risk Management, is now available to subscribers and

partners. HIROC is extremely grateful for the advice and

insights provided by the IRM Steering Committee and

is inspired by the enthusiastic interest in the program

taken by our subscribers.

If you would like a copy of the report, please write to

[email protected].

HIROC releases first Canadian Report on a Shared System for Integrated Risk Management

THE HIROC CONNECTION4

“In patient safety, it’s important to ‘Stop the line’ and ensure staff have safety on their radar each and every day.”

—Karen Morris, Manager, Patient Relations and Risk Management, Joseph Brant Hospital

“I love my job because where I work there is a strong culture, a culture which is supported by our hospital’s leadership.”

— Sharleen Ahmed, Chief Planning and Communications Officer, Runnymede Healthcare Centre

“I’m happy to be here, I received a lot of great information that I can take back and use in my projects.”

— Miae Kim, Patient Safety and Risk Coordinator, Orillia Soldiers’ Memorial Hospital

“When it comes to patient safety, if it doesn’t seem right, it probably isn’t. It’s important to trust your instincts.”

— D’Arcy Larson, Director, Clinical Informatics, Humber River Hospital

“Because the bar is always moving, patient safety can always be improved upon. And coming to conferences like this one allows me to stay on top of trends. It’s also a great networking opportunity!”

—Monica Jacobs, Director, Enterprise Risk and Emergency Preparedness, St. Michael’s Hospital

“This conference allows me to learn what others are doing and affirms that we are on the right track.”

—James Slater, Trustee, Regional Health Authorities of Manitoba

“Being a partner with HIROC has helped us to create our Integrated Risk Management process; it’s nice to be able to share it with people who are like-minded and want to learn about the journey.”

—Sarah Paquette, Junior Project Manager, Federation of Medical Regulatory Authorities of Canada

“I always say you have to treat a patient as you would anybody else, as if they were your loved one.”

—Jimmy Trieu, Director of Corporate Affairs, South Huron Hospital Association

“As a partner, we always try to look at other ways to help reduce risk. HIROC and FM Global share the same values; it’s a partnership that works.”

— Greg Bourne, Account Manager, FM Global


“Never, ever, ever give up!”

in a recent webinar. “I knew the matrix would help us to identify how to rank a risk and provide validation in decision-making.”

In 2009, PRHC’s Board saw an Integrated Risk Management (IRM) presentation at HIROC and began to ask questions about the possibility of adopting IRM at the hospital. However, having moved into a new building in 2008, there were competing priorities and it was decided more time was needed before beginning this implementation.

Colleen Petersen, Risk and Insurance Consultant at Peterborough Regional Health Centre (PRHC) will be the first person to tell you that PRHC’s risk management journey was not instantaneous.

That journey started in 2007 when PRHC took their first steps by introducing a risk matrix to rank priorities for capital purchases. That small but significant step, “was music to my ears,” said Petersen, who described her organization’s experience with HIROC’s IRM program

How Colleen Petersen helped Peterborough Regional Health Centre create a strong Integrated Risk Management foundation

By Michelle Holden

Four years later the IRM conversation took off at PRHC. The move from paper to electronic event recording was the first step. According to Petersen, “This was the foundation PRHC needed to be able to move forward.”

The Health Centre introduced an electronic event reporting system that used a 5 X 5 risk matrix to encourage staff and leadership to review events in terms of probability and impact. Although it was an improvement, their system still wasn’t foolproof. So when HIROC began developing the Risk Register application, Petersen recalls thinking, “What a miracle!”

To guide their transition to HIROC’s Risk Register, PRHC developed a policy to keep things consistent and identify roles and accountabilities for managing the risks identified. Although the team was fully on board, they started slowly by just looking at their top five risks and rolling out training sessions to introduce the program. Petersen communicated in her training sessions that risk management was not just her role; “Every one of us is a risk manager,” she told staff.

Making it Part of Your Everyday Work

Petersen truly believes that it takes two to three years for a new program such as IRM to really take hold:

• Year 1 – Time is needed to adjust to the new program and understand it.

• Year 2 – You start to operationalize the program and ask how you’re doing.

• Year 3 – The program becomes a part of your everyday work.

No matter which stage you’re at, “When a team invites you to refresh them on the program, you actually want to run out of the room, kick up your heels, and yell ‘yahoo!’” says Petersen.

Words of Advice

When Petersen reflects on their IRM implementation experience, she isn’t shy about sharing advice. “You need to have an abundance of patience,” she says. “You cannot be rigid with respect to timelines in going through this process; you need to dedicate time to answering questions and providing training to new staff as they come in.”

Petersen attributes a great deal of PRHC’s success to the Board and Senior Team’s support. “Having senior leadership involved is a big catalyst for success,” she said. From the beginning, the Health Centre’s leadership was interested in managing risks and finding the best possible program to help them do so.

While the role of Risk Manager and an IRM program may seem like a lot to take on, Petersen says it’s worth it. “Tell staff you’re available, be patient, and say you’ll help them look at their risks.” Petersen applies the philosophy of Charlie Brown when she offers these lasting words of advice, “Never, ever, ever give up!”

Michelle Holden is HIROC’s Communications and Marketing Coordinator

“Tell staff you’re available, be patient, and say you’ll help them look at their risks.”

—Colleen Petersen, Risk and Insurance Consultant at PRHC


Subscriber Profile

Working to Make a DifferenceBehind the scenes at the Ontario Institute for Cancer Research (OICR)

By Michelle Holden

The staff at the Ontario Institute for Cancer Research (OICR) has no hesitation answering the question, “Why do you like working here?” “Cancer touches almost everyone, so knowing you are coming to work to make a difference is a big driver,” says Jeanette Dias D’Souza, OICR’s Chief Financial Officer.

This is truly an organization where everyone from scientists, technicians, students and operations staff feel a part of the mission. “Everyone is excited to be a part of what we do here,” says Michelle Douglas-Prashad, Director of Finance at OICR.

OICR is a not-for-profit organization funded by the Government of Ontario since its launch in 2005. Headquartered in the MaRS Centre in Toronto’s Discovery District, OICR is a collaborative research network that focuses scientific excellence across the province on key areas of unmet need amongst cancer patients.

OICR’s research supports more than 1,700 investigators, clinician scientists, research staff and trainees, located at OICR’s headquarters and at hospital and university research organizations across the province. They are dedicated to research on the prevention, early detection, diagnosis and treatment of cancer.

“What’s often overlooked in labs is the importance of managing data,” says Dias D’Souza. “It’s a major problem if researchers cannot access the data in a logical or organized fashion.” For that reason, OICR considers Informatics and Bio-computing a major area of work.

The Institute was instrumental in the creation of the International Cancer Genome Consortium, which was established to sequence the genome of 50 different types of cancer. OICR houses the Secretariat for the ICGC and the Data Coordination Centre.

Moving Research Through the Pipeline

What sets OICR apart from other traditional research institutions is that it is a translational research institute — meaning it is grounded in a philosophy and way of working that is literally from ‘bench to bedside’. It’s an interdisciplinary approach that sees laboratory discoveries moving through clinical trials to point-of-care patient applications.

The Institute’s activities are focused on three translational research priorities:

1. Finding new ways to treat difficult cancers;

2. Optimizing cancer patient management, and treatment decisions; and

3. Driving improvements in cancer prevention and care delivery.

Innovations arising from OICR’s research are commer-cialized by the Fight Against Cancer Innovation Trust (FACIT), which was created to undertake OICR’s commercialization activities that are considered to be for-profit. “This partnership with FACIT allows OICR to accelerate the commercialization of its discoveries,” says Dias D’Souza.

The Next Generation

For OICR, cultivating and educating talent close to home is a priority as well. They run youth training programs, community engagement events, as well as supporting young scientists who are in the early phases of their careers. “Our eyes are always focused down the road because we know that we have a responsibility to ensure there are up-and-coming cancer researchers supported in Ontario,” says Dias D’Souza.

Dias D’Souza and the OICR team believe the best results are possible when they leverage their efforts and make as many connections as possible. “We are an Ontario institution, but we work very hard to collaborate with experts in Canada and across the world,” said Dias D’Souza. “We are on the cusp of a real breakthrough against cancer and are optimistic our approach will accelerate development of new treatments.”

Michelle Holden is HIROC’s Communications and Marketing Coordinator

“We are an Ontario institution but we work very hard to collaborate with experts in Canada and across the world.”

—Jeanette Dias D’Souza, OICR CFO

Subscriber Profile

OICR’s research supports more than 1,700 investigators, clinician scientists, research staff and trainees.


In 2012 and 2013, HIROC compiled a list of top risks for acute and non-acute care organizations. The list was based on claims reported by subscribers.

As part of our commitment to staying on top of emerging claims trends, HIROC recently refreshed the lists of top risks. Claims data was analyzed to provide a rank-ordered list of risks based on incurred claims costs.

Resources such as the Risk Reference Sheets have been developed to address these risks and have been incorporated into the Risk Assessment Checklists (RAC) program.

The time an organization has to submit their Year 1 of RAC has increased from six months to one year, from the time your account has been set up.

Coming SoonRisk Reference Sheets for non-acute care will be refreshed in 2016 to include updated information on claims themes and mitigation strategies. Watch for them on HIROC.com in 2017!

HIROC is developing a short introduction video and program overview of RAC to assist subscribers with orienting staff and leadership. An FAQ document will also be available.

HIROC will begin contacting acute care subscribers soon to enroll in Cycle 2 of RAC —please stay tuned!

Checking in on RAC

New features, new risks, a new timeline!

By Sara Chow

New Risks for Non-Acute Care: • Mismanagement of resident funds

• Improper performance of patient transfers and mobilization

• Mismanagement of ventilated patients

• Risks related to emergency medical transport (inappropriate decision-making, mismanagement of staff assignment and scheduling, aircraft and equipment issues)

• Mismanagement of the procurement process

• Failure to obtain consent/improper rights administration

New Risks for Acute Care: • Sewage backup

• Failure to perform therapeutic drug monitoring

• Mismanagement of operative vaginal deliveries

Acute Care Risks which have moved up: • Fire/lightning (from #28 to #16)

• Failure to appreciate status changes deteriorating patient (from #10 to #2)

• Retained foreign bodies (from #27 to #18)

• Healthcare acquired infections (from #11 to #5)

• Patient falls (from #13 to #8)

Acute Care Risks no longer in the Top 30: • Wrongful dismissal

• Healthcare acquired pressure ulcers

• Inadequate sterility

• Privacy breach

New RAC Features: • “Not applicable” response type

• “Not planning to implement at this time” action plan

• Privacy breach

How do you keep-up-to date with changes in the healthcare sector? That can be challenging. Information and education offered by HIROC, OHA, professional associations and other organizations is very valuable, as is staying on top of selected literature, reports and system-level strategy. One of the most effective and intellectually enjoyable ways of keeping current is through interactions with colleagues in which current issues are discussed, debated and translated through a strategic and operational lens.

How has HIROC influenced your patient safety agenda? HIROC’s commitment to and dissemination of leading practices and risk reduction strategies has been very beneficial. Their national scope and experience coupled with a focus on member support has proven to be a real

asset to our organization time and time again. Most recently, we adopted HIROC’s Risk Assessment tool and have incorporated it into our governance process in order to sharpen the focus on the highest areas of risk.

Who inspires you? I take inspiration from many sources, but my number one source is my family. Equally impactful is the inspiration provided by the patients, clients, residents and families we serve at West Park. Faced with life-changing health challenges, they reclaim their lives. Their journeys from crisis, to hope, to realizing potential create indelible impressions of personal triumph and the capacity of the human spirit.

Voices of our Subscribers

ANNE-MARIE MALEK President and CEO of West Park Healthcare Centre

“I take inspiration from patients, clients, residents and families. Faced with life-changing health challenges, they reclaim their lives.”

Sara Chow is HIROC’s Senior Healthcare Risk Management Specialist

—Anne Marie-Malek


Am I Safe?Supporting patient safety conversations in the home

By Jennifer Campagnolo and Wayne Miller

Providing safe care in an unpredictable home setting poses unique challenges. Supporting an individual’s choice to live at risk in their home environment is a complex issue. Understanding and accepting “what is safe?” requires a balance between a patient and family’s concept of risk and the healthcare provider’s knowledge and perception of acceptable risk.

Talking about safety and risk is not necessarily easy or automatic. To determine how to best support providers and patients in having conversations about safety, the Canadian Patient Safety Institute commissioned the Canadian Home Care Association to conduct an environmental scan of home care providers, primary health care teams and discharge planners. They wanted to know:

• are safety conversations a standard part of practice• who is involved in starting and continuing these safety discussions and,• what do providers and patients need to help them communicate better

Their goal with the scan was to lay the foundation for the development of specific tools to support and facilitate conversations about patient safety and risk management in the home setting.

Who Participated in the Scan?The team identified key points where risk assessments and safety conversations occur: acute care discharge planning/care coordination; primary care teams; and direct service providers. All three segments were engaged in the environmental scan, as well as professional associations and regulatory bodies.

What Did the Scan Reveal?

Although many participants regularly completed a risk assessment, only 32 per cent of survey responses indicated that they use a tool to support them in safety conversations with patients. When they did talk about tools, they were referring to policies that address patient safety issues and not tools to support conversations with patients and their carers. Among those surveyed, there was unanimous agreement that a suite of tools to support patient risk and safety conversations is needed.

Reframe the Conversation — Focus on SafetyConversations with patients and their carers about risk can be potentially difficult and uncomfortable. Patients often perceive these conversations as punitive and worry about loss of independence and the inability to remain in their home. They see risk management strategies as an attempt to restrict their life choices.

This can create reluctance on the part of care providers, patients and their carers to engage in these necessary conversations.

“Risk and risk-taking is often regarded in a negative light, but if you reposition the conversation to one about patient safety, it becomes much more positive and constructive,” says Wayne Miller, Patient Safety Improvement Lead with the Canadian Patient Safety Institute. “Patients have a desire to be safe and we believe would likely be willing to implement strategies that would maintain or add to their personal safety.”

Patients fail to recognize the elements of risk and safety present in their everyday lives. Together with their carers, patients go about their day-to-day activities, living as they have done for many years, continuing the same habits, in the same environment, often unaware of the physical or mental factors which may put them at risk.

It Starts With ConversationsHealthcare providers know that identifying and managing patient risks means engaging the care recipient and their family in open and candid conversations. “These discussions build trust and respect and help both parties understand what ‘being safe’ means to them,” says Jennifer Campagnolo, Safety Lead at the Canadian Home Care Association.

“Risk and risk-taking is often regarded in a negative light, but if you reposition the conversation to one about patient safety, it becomes much more positive and constructive.” — Wayne Miller, Canadian Patient Safety Institute

ISSUE 37 | SPRING 2016 17THE HIROC CONNECTION16

“Patients, carers, and providers need to recognize that safety conversations are another component of the risk assessment process. One should not occur without the other.”

Figure 1

Model of patient safety conversations where patients and carers drive iterative conversations about safety in the home. Key features of the model include:

Resources to Support Safety Conversations

The Canadian Home Care Association concluded after the scan that although there is a clear need for a suite of tools to support conversations with patients and caregivers, there cannot be a “one size fits all” approach.

“It is essential that the suite of tools be adapted to meet the unique needs of everyone involved, including the provider, patient and family,” says Campagnolo. “Conversations need to recognize mutual goals for care, and a patient’s right to make an informed decision regarding safety in the home.”

The key components of a suite of tools would address communication, decision-making and ethical or moral distress related to patient safety in the home. These tools should align with current risk management processes. “Patients, carers and providers need to recognize that safety conversations are another component of the risk assessment process and one should not occur without the other,” concluded Campagnolo.

For more information and the full Am I Safe? Report, please visit the Canadian Home Care Association at www.cdnhomecare.ca or the Canadian Patient Safety Institute at www.patientsafetyinstitute.ca

Jennifer Campagnolo, Safety Lead, Canadian Home Care Association

Wayne Miller, Patient Safety Improvement Lead, Canadian Patient Safety Institute

Safety Should Always be Part of the Conversation

“Safety conversations must take place often and involve the multiple care providers across many different settings of care,” says Campagnolo. The environmental scan identified a clear gap in this area. Conversations are being forgotten, dropped or ignored across care transitions. “Empowering patients and carers to engage healthcare providers in conversations and become vested parties in their own safety is critical,” she says, emphasizing that this approach ensures the conversations about patient safety take place no matter where or who is providing care.

Over time, patients experience changes in health status that may introduce new elements of risk or compound existing risk in their home setting. Managing those risks is only possible through the feedback and engagement provided by having continuous conversations.

A proposed communication model applied to the home and community setting builds on these two concepts: 1) patient and carers as empowered stewards of their own safety, and 2) safety is a continuous conversation.

Patient resources encourage them to engage healthcare professionals by asking “Am I Safe?” or “How Can I Be Safe?”. “Patient safety becomes a collaborative process whereby patients, carers and providers partner to plan, implement change and evaluate safety in the home,” says Campagnolo.

• Patient and carer are the focal point of the model, representing their lead role in conversations about patient safety.

• Home care services, primary healthcare and acute care discharge planning inform patient conversations and decision-making.

• Patient safety conversations occur in a continuous cycle of safety evaluation, education, implementation and monitoring.

• Patients and carers are empowered and capable of making informed choices about risk and safety with the assistance of the healthcare team.

— Jennifer Campagnolo, CHCA

Home Care Primary Health Care

HOW CAN I BE SAFE?

(Exploring management options)

AM I SAFE? (Assessment/reassessment

of patient safety)

AM I SAFER? (Implementation and monitoring of safety strategies)

Acute Care Discharge


Nadine Henningsen was standing in front of the dynamic ‘HIROC Reciprocal board’ at the 2015 CHCA Home Care Summit – a fun and unique invention by Nadine and her team, where delegates were urged to ‘give’ an idea on how to redesign home care and then ‘get’ a button. Delegates could select a button from four with the shout-outs, ‘Get Connected’, ‘Get Creative’, ‘Get Inspired’ and ‘Get Motivated’, all of it built around the word ‘Reciprocal’.

You know you’ve had an impact when the Executive Director of the Canadian Home Care Association (CHCA) says with a big grin, “The theme running through this conference is reciprocity! We’re all engaged in giving and getting ideas – from around Canada and around the globe.”

By Ellen Gardner

At CHCA Home Care Summit, you have to ‘give’ to ‘get’

Within hours of registration, the board was crowded with ‘give’ ideas. Everything from “Our home care is hospital-based, we want to convert to community,” to “Helping organizations across Canada provide safer care,” to “We need more dedicated palliative care services” and “Find innovative ways through research of better supporting older adults and family caregivers in home care services.”

Over 450 delegates and speakers paid tribute to the work done by CHCA during the past 25 years in advancing the important place occupied by home care on the healthcare spectrum and the essential work being done by home care providers.

Just how critical home care is in relation to our aging population was brought home by Jeff Huber, CEO of Home Instead Senior Care. “Forbes magazine recently talked about the Top 10 innovations in aging and home care was listed as being #1!” he said. Even though home care continues to be undervalued, he urged delegates to embrace their role as leaders and innovators. “We can improve the aging journey. It starts with us.”

Home Care is a High Risk ActivityOne constant that ran through the summit was agreement that providing personal care services is a high risk activity. Even if they know the risks, caregivers are often reluctant to have safety conversations with clients. “Because they’re in their homes, clients don’t see themselves at risk and worry that any kind of risk conversation will result in a loss of independence,” said Jennifer Campagnolo, Safety Lead, Canadian Home Care Association.

CHCA is currently working on a suite of tools to facilitate those safety conversations. “These tools need to be free, easily accessible and be built around a communications model that empowers caregivers to be the bridge across these transitions,” said Campagnolo. The need for addressing safety issues in home care is urgent – over a one year period CPSI found the rate of adverse events in home care clients was 10-13%. “We’ve created an action plan for patient safety in home care and our priority is education,” said CPSI CEO Chris Power. “Patients and families — not just caregivers — need to be part of everything we do.”

Medication Challenges Begin at the Door

When it comes to medication management, you can’t take away the risk, but you can mitigate the risk was the advice given by Ariella Lang, Nurse Scientist at VON Canada. The challenges in this area begin when you walk in the door since, “each home is a unique and complex environment for giving and receiving care,” she said.

Caregivers can be caught off guard because their goals of care (usually a need for compliance) do not always overlap with what’s happening in the household.

Ms. Lang’s findings confirm that safety in home care is inextricably linked to the capacities of caregivers and healthcare providers. She urges taking a big picture approach. “Effective approaches to safe medication management in home care must adapt to the complex reality that each home is a unique, unregulated private space,” she said.

Ellen Gardner is HIROC’s Manager of Communications and Marketing

“We’re all engaged in giving and getting ideas.”

— Nadine Henningsen, CHCA Executive Director in front of the popular HIROC

‘give’ to ‘get’ board.

Delegate Wendy Porch (left) displaying her Get Connected button with CHCA staffer Catherine Suridjan.


Asking Questions

Always on call, they respond quickly to the agitated, the confused, the defiant and (potentially) physically aggressive patients. They go in first and triage the situation: observe, coach and give other members of the medical team suggested changes to the critical care plan.

“We wanted our nurses to have a greater degree of comfort when they might have to defer from standardized procedures, i.e., calling for a psychiatric consult, to deliver a safe outcome,” says Wiesenfeld. “This is good for the patient and good for the staff.”

A key element of the program is the conversations initiated with patients’ families about the patient’s habits and preferences.

Dr. Lesley Wiesenfeld, head of the Geriatric Psychiatry Consultation Liaison Service at Mount Sinai Hospital, part of Sinai Health System, knew she and her nursing colleagues could improve how they responded to patients with severe mental health issues and older patients with dementia. “Nurses were telling us they needed more knowledge and more help,” she says.

Nursing and psychiatry teams got to together to create Safe Patients/Safe Staff, a program recently recognized with the 2015 National Healthcare Safety Award from the Canadian College of Healthcare Leaders. At the heart of the program are nurses trained in specialized psychiatric care who make up the Behavioural Optimization and Outcome Support Team (BOOST).

Safe Patients/Safe Staff Program receives safety award

By Christine Smith

The program includes a standardized form that lays out best practices in a pre-packed toolkit. “These are almost like ready-made care plans,” Wiesenfeld explains. “People with dementia often exhibit similar behaviours. There might be triggers, such as an extra sensitivity to lights, fear of needles, or a need to have a favourite stuffed toy with them.”

Staff elicits as much information as they can from patient families and caregivers. For example, what does the patient prefer to be called? How do they like to be soothed? What are they afraid of? What did they do during their working life? “We try to sensitize nurses to these individual patient needs and use the information to put together a more person-specific direction,” says Wiesenfeld.

Safety should not be an Afterthought

Two other components contributed to the program’s award-winning status: first, organization-wide collaboration and training that includes e-learning, workshops, debriefs and simulations (based on actual scenarios provided by nurses), and second, a focus on safety. As the program developed, the originators realized they couldn’t just focus on critical care with safety being an afterthought. “We learned that the more we took care of staff, the better the outcomes would be for the patients,” said Wiesenfeld.

They also discovered what Dr. Wiesenfeld described as “healthy tensions” between what was easiest and what was best for the patient. For example, nurses shared that if they couldn’t properly get an IV going due to a patient’s agitations, how would they explain to the doctor why his/her orders weren’t carried out? “Creating a culture where everyone is safe sometimes means we have to be realistic,” says Wiesenfeld.

A Program that is Data-Driven

“One of the most innovative and effective ways of assessing risk is through data-mining clinical records,” says Wiesenfeld. “When we do that, we can find patients who need help sooner. Our notes help us

identify high needs/high risk patients who might need our intervention.” They also rely on scans of electronic notes that produce an automatic report that might highlight, for example, which patients might have needed restraints, redirections or other interventions.

The team has been collecting metrics since the program began. Comparing the results on the Geriatric Institutional Assessment Profile (GIAP) (a self-report survey to assess a hospital’s readiness to implement a geriatric program), showed that nurses report feeling “less burdened” and “more supported.”

Other data being collected includes surveying patients, families and nurses and tracking the number of requests for BOOST team members.

A recent everyday interaction captures just how transformative the Safe Patients/Safe Staff program has become. After a morning review of charts, Dr. Wiesenfeld and her BOOST team nurse zeroed in on a night nurse’s notation that a patient in ICU appeared agitated and disoriented following heart surgery. They headed directly to the patient’s room and questioned family members about him, asking what he preferred to be called; what his fears were; what the patient liked to do. His preferences were noted for the critical care team.

“His family told us that in all of his previous hospital stays and surgeries, no one had ever taken the time to ask these questions and learn more about him,” says Wiesenfeld. “We gave them a different experience. An experience that reduces risk and improves safety for the patient and for the staff.”

Christine Smith is a freelance writer living in TorontoPhoto by Danny Santa Ana.

“We wanted our nurses to have a greater degree of comfort when they might have to defer from standardized procedures.”

—Dr. Lesley Wiesenfeld, head of the Geriatric Psychiatry Consultation Liaison Service at Mount Sinai Hospital (left), pictured with Mavis Afriyie-Boateng, BOOST team member.


Resilience has its RewardsFM Global Leaders’ Forum shocks and educates delegates

By Ellen Gardner

The feeling in the room at an FM Global Leaders’ Forum is one that could easily keep you on edge. They’re not just talking about the things that could seriously damage, much less flatten your facility, they also want to show you what it can look like when it happens.

At the annual FM Global Leaders’ Forum, HIROC employees enjoyed networking with subscribers and learning what’s happening in the world of property risk management.

“We can’t control mother nature – yet,” says one of the presenters, “but we can certainly do a lot to prevent the damage in the first place and mitigate the effects.”

The unavoidable message is that there are more risks out there than most of us imagine. Sure, we know about fire, floods and earthquakes. But wind? Thunderstorms? Yes, those can wreak havoc on a house or a building. When the wind is screaming, rain is driving down in five-gallon buckets, or hail is pinging off the ground, your roof is taking a beating, especially if the corner and edges are vulnerable. During a storm gravel can travel up six stories.

First-time attendee and HIROC Senior Account Executive Curtis Sadler was very impressed. He praised FM for its focus on education. “They don’t hang their hat on just being the big guy,” he said. “They collaborate with clients and they’re really listening. That’s what this conference is all about.”

FM ended the event the way they started it — reminding everyone that the ability to bounce back from a bad event comes down to one thing — resilience. “Resilience is fortitude, it’s guts, it’s perseverance,” said Amy Daley, AVP, healthcare and education practice leader at FM. Resilience for FM ultimately comes down to one thing — the ability to deliver on your mission no matter what happens.

Delegates share their takeaways:

“The whole event was very useful, especially the breakouts when we shared advice and stories from our own facilities. I will definitely be putting their checklist into action.” — Jeanette Dias D’Souza, Ontario Institute for Cancer Research (OICR).

“Our hospital has a good incident management system, but it’s good to see what other people are doing and take that information back, even something like having extra tarps on hand – that’s a strong takeaway!” — Sonja Albano, Trillium Health System.

Planning their attack

“This team works integrally together and I don’t think you can do it any other way,” said Krista Waaler, Manager of Facilities and Operations at the College of Physicians and Surgeons of Ontario (CPSO) as she and the Operations team accepted FM Global’s Highly Protected Risk (HPR) Award in March. When they’re handed FM’s recommendations or dealing with an operations problem, the team prioritizes on a daily basis, “We come in each morning and plan our attack,” says Building Operator Paul Kalika.

When asked about next steps for CPSO, Douglas Anderson, CPSO’s Associate Registrar and Corporate Services Officer responded with one word — proactive. “We want to be preventative. We know that in the long run this will save dollars and reduce risk.”

No Easy Fixes:HIROC subscribers win well-deserved FM Global HPR awards

From left to right: Rodel Figueroa (HIROC), Paul Sullivan (HIROC), Krista Waaler (CPSO), Bill Herridge (CPSO), Paul Kalika (CPSO), Mamoon Ali (FM Global), Douglas Anderson (CPSO). Centre: Basilio Pezzo (CPSO).

One of the most memorable parts of the Forum is a visit to the FM research lab in rural Rhode Island. This collection of small and large buildings nestled on 1,600 acres is the largest lab and testing space in the world. Wearing safety goggles and hard hats, participants watch as FM’s fire team creates a laboratory fire that quickly consumes a fully stocked cabinet and with flames licking the ceiling, could easily (if this was a real fire) destroy the whole lab.

The shocks continue with a simulated earthquake, a roof popping off in a windstorm, a piece of lumber slicing through a wall, and a fiery dust explosion.

Ever since its maverick founder Zachariah Allen raised eyebrows in 1835 when he focussed on loss prevention, FM has been preoccupied with three questions: what’s the hazard, what’s the potential impact, and what can we do to prepare?


Cleaning up at RVH

Royal Victoria Regional Health Centre’s (RVH) Pamela Oertel officially took on the new position in December 2015. She joined RVH as a housekeeping aide about a decade ago and was a coordinator before transitioning to the ESE position.

The role, which primarily encompasses education for staff, has led to leadership walkabouts, staff huddles and more extensive staff meetings. All of these measures are having a positive impact on patient safety at RVH.

“Housekeeping is a very large department with about 150 staff,” says Oertel. “We wanted to (have) consistency in cleaning practices to ensure patient safety and that the same message was being heard by all staff.”

For the Barrie, Ontario healthcare organization, hearing the message from one person is helping to build a culture of trust and contribute to awareness of best practices. As the person at the centre of the learning and communication, Oertel adjusts her schedule to accommodate different shifts so all employees receive the necessary education.

Conducting environmental audits of 90 per cent of the staff each quarter is very important to RVH. “Being flexible with my hours helps us meet that goal,” Oertel notes.

Having a designated role of an Environmental Services Educator (ESE) is having a sweeping impact on cleaning practices at a HIROC subscriber site

By Natalie Miller

RVH is already seeing encouraging results – with compliance related to Glo Germ audits of patient rooms on the rise. The audits include evaluating the cleanliness of the five key touch-points in a patient room: the bedside table, the handrails on the bed, the door knobs on either side of the door, the sink and the toilet seat rim.

Compliance was hovering around 70 per cent before the ESE role was created. It’s now 100 per cent.

From the start, Oertel knew her biggest challenge was going to be getting the message across. For that reason, she made it her personal mission to communicate about safe cleaning practices in ways that align with people’s different styles and learning abilities. While some prefer group settings, others excel through one-on-one hands-on demonstrations and reviews. Oertel incorporates both strategies into her teaching and training.

Auditing is a continual process at RVH and Oertel says education for new staff and refresher courses for current employees will be ongoing.

“Through education and using best practices, we are ensuring the environment is safe for patients. The best outcome is a safe environment, keeping hospital-acquired infections at a minimum and having a great team that feels confident.”

Natalie Miller works for Axiom News

“As part of my role in Engineering, I’m always looking for the best way to apply codes and standards to improve patient safety. Being here gives me a better understanding of the intricacies of building safety and I take that back to the hospital.” — Eric Card, Windsor Regional Hospital

“I’ve been at this event several times and I always pick up odds and ends by sharing stories. When I hear someone say the first person they call during a water discharge event (a flood) is the CEO, I have to jump in and challenge them – you need to first call the people on your emergency call list, they’ve got to be the first in line to take control and contact outside emergency services. Only then do you update your CEO and inform him/her of the updates and actions that have been taken. You’ve got to have a call list and a system in place for managing a crisis.” — Harry Hodder, Women’s College Health Research

“It’s always good to network with our subscribers and at the same time learn what’s happening in the world of property risk management. On top of that, we get to meet and learn from other healthcare organizations south of the border. Our insurance partner FM Global through their generosity has made all this possible. ” — Rodel Figueroa, Healthcare Insurance Reciprocal of Canada

Ellen Gardner is HIROC’s Manager, Communications and Marketing

“Shockingly Excellent Experiences”

CEO of the Southlake Regional Health Centre Dr. Dave Williams loves to share his hospital’s vision of creating shockingly excellent experiences and fostering a culture of listening and learning. “We want patients and families to be shocked by the (excellent) experiences they have at Southlake!” he said.

So, it’s no surprise that the hospital was chosen as the first recipient of the Highly Protected Risk (HPR) Award in 2016. Southlake is the seventh HIROC subscriber to receive the award since 2013.

Meeting HPR was a test of strength for the facilities team in terms of balancing public regulations, limited funds and the recommendations provided by FM Global. For Marcel Moniz, Director, Facility Operations and Patient Access, the award is the culmination of a two-year process in which everyone stepped up to the challenge. “We always talk about the outcome and the right thing to do, it really makes the job easier,” Moniz explained.

“Southlake has completed 17 of the 24 recommendations,” said Rodel Figueroa, HIROC’s Engineering Liaison Associate. “The recommendations were not easy fixes but with their team’s hard work and dedication, they were able to get there.”

From left to right: Mamoon Ali (FM Global), Sandra Smith (Southlake), Marcel Moniz (Southlake), Julie Pike (Southlake), Paul Sullivan (HIROC), Rodel Figueroa (HIROC), Dr. Dave Williams (Southlake).

Environmental services educator Pamela Oertel demonstrates cleaning techniques to a housekeeping aide at Royal Victoria Regional Health Centre.


Ask a Lawyer

Bill C-14: An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying). Under Bill C-14, a person who wants PAD must:

• Be eligible for publicly-funded health care services in Canada;

• Make the request voluntarily and give informed consent;

• Possess a serious and incurable disease, illness, or disability;

• Be in an advanced state of irreversible decline in capability;

• Be experiencing enduring and intolerable suffering as a result of their medical condition;

• Be facing the end of life — death must be reasonably foreseeable but no specific time period is required.

Pursuant to Bill C-14, physicians and nurse practitioners will be exempt from criminal liability for providing medical assistance in dying, and pharmacists and other persons are permitted to assist in the process. However, Bill C-14 does not set out whether, or how, a request for PAD can be refused and leaves protection of conscience for healthcare professionals up to the provinces and professional regulators.

I will report further once Bill C-14 has been passed into law. Gordon Slemko is General Counsel for HIROC.

A. Your confusion is understandable. Unfortunately, the law concerning physician-assisted death (PAD) is not settled. However, I can bring you up to date.

On February 6, 2015, in Carter v. Canada (Attorney General), the Supreme Court of Canada (SCC) unanimously struck down the Criminal Code prohibitions against assisted dying to the extent they prohibit PAD for a competent adult person who: (1) clearly consents to the termination of life; and, (2) has a grievous and irremediable medical condition (including an illness, disease, or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.

The SCC suspended its decision for one year (until February 6, 2016) to allow the federal and/or provincial governments time to draft legislation and medical regulatory authorities (Colleges) to develop policies and guidelines concerning the provision of PAD.

In December 2015, the newly-elected federal government applied to the SCC for an additional six-month extension of the one-year suspension period. On January 15, 2016, the SCC granted a four-month extension, with the result that PAD will now come into effect across Canada on June 6, 2016.On April 14, 2016, the federal government introduced

Q. There has been considerable media coverage recently concerning physician-assisted death. I thought physician- assisted death was legalized some time ago, but I have yet to see any evidence of that in my facility. Please tell me what I need to know.

Last June we asked subscribers for feedback on how we’re doing — what HIROC services you use and your level of satisfaction with those services. The survey was sent to key contacts (CEOs, CFOs and risk management staff) at all of our subscriber locations (close to 600 organizations).

What You Told Us You told us you are satisfied or very satisfied with HIROC (94%) and would recommend HIROC to a potential subscriber (98%). You specifically mentioned our focus on customer service, including friendly and knowledgeable responses. Risk Management services are used the most, with Insurance Services and Claims Management following closely behind.

When it comes to communications, you are most satisfied with The HIROC Connection, our publication covering subscriber stories, and Risk Watch, our monthly publication of ‘hot off the press’ peer-reviewed articles, best practices and related literature to promote evidence-informed risk management. You also indicated you are satisfied with the HIROC website (www.hiroc.com) and our webinars.

Ways We Can ImproveOur survey response rate was 12% and we feel we can do better. This year we are going to look at other ways we can reach out to you, including setting up one-on-one phone interviews.

Survey reveals high satisfaction with HIROC Services

We’re ListeningWe’ll be implementing a process where we acknowledge queries within 48 hours — we may not be able to fully answer your question, but we will get back to you to let you know we’re working on it.

You also told us we should be providing information that is specific to sectors other than acute care, such as long-term care, Aboriginal organizations, and primary care. This year we have added webinars with specific focus on some of these sectors to our webinar schedule. We’re also showing our speakers on camera during the webinar – something else you asked us to do.

Coming SoonThis year’s survey will be coming to your inbox in June 2016.We cannot tell you enough how much we appreciate your feedback – both positive and negative — and look forward

to receiving your responses!

By Annette Down

Annette Down is HIROC’s Senior Healthcare Risk Management Specialist

94%

98%

76%

78%

A Snapshot of Your Comments

are satisfied or very satisfied with HIROC

would recommend HIROC to a potential subscriber

have used Risk Management services in the last year

are satisfied with The HIROC Connection and Risk Watch

“The IRM/ERM dashboard enables our senior leaders to review organization risks at-a-glance. The Risk Register is a simple, customizable way to view organizational risks in a variety of ways, delivering the right information for the right leader.”

— Thea Bailey-Leung, Risk Management Specialist The Hospital for Sick Children

“Goodbye Excel spreadsheets! The online Risk Register is easy to use and offers a comprehensive risk record with descriptions, mitigation strategies, controls, and ratings. The Actions feature allows users to enter progress updates online and monitor each risk while the Audit Trail feature supports users in easily identifying updates or changes made to risks. Overall, the tool is user-friendly, sustainable and reduces duplication, particularly for management.”

— Lori Borovoy, Organizational Health and Performance Improvement, Central Community Care Access Centre

Includes comprehensive support All at no additional cost to youLearn more - [email protected]

THE HIROC RISK REGISTER

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