Model of Care Project - press release

I received this press release in my email inbox this afternoon and thought I should share it here. The Model of Care Project referenced in the release represents an effort to promote collaborative practice and interprofessional care in the PEI health system.

For Immediate Release
June 17, 2009

The Department of Health Begins Work on a Province-wide Model of Care

CHARLOTTETOWN, PEI -- Over eighty people from across the provincial health system came together recently to form the Model of Care Design Team and to begin work on improving the ways in which health care is organized and delivered on Prince Edward Island.

“The results of the 2008 review of our health system indicate that we need to work together as an integrated health system to continue to provide quality health care for all Islanders,” said Premier Robert Ghiz. “The Model of Care Design Team is making an important contribution in achieving the Government’s vision of One Island Community, One Island Future, One Island Health System.”

Similar to other jurisdictions, Prince Edward Island’s health system faces human resource shortages, increasing demands for services and rising health care costs. The work of the Model of Care Design Team involves the creation of a “made in Prince Edward Island” solution that address these challenges.

Specifically, the Model of Care Design Team will look at clarifying the roles of Island health care providers and support staff, and improving the interactions between these roles so that all members of the health care team are empowered to work to their full potential.

“We know that our most valuable health resources are the people working within the health care system. The Model of Care Project will ensure that the effort they put forth produces optimal results across the system,” said Minister of Health, Doug Currie. “We need to find ways to operate as a team and to create opportunities to leverage the collective skills and talent of our team.”

In a display of the Government’s support for the project, Premier Ghiz, Minister Currie and Provincial Treasurer Wes Sheridan visited the team on the second day of their three-day planning session. “As a government, we recognize the importance of listening to those who work within our health care system,” said Minister Sheridan. “I was certainly impressed with the energy and enthusiasm of those involved in the Model of Care project, and have every confidence that their recommendations will enhance the way health care is delivered to all Islanders.”

Model of Care Design Team members come from across the province and represent a wide range of health care skills and perspectives, including physicians, nurses, support staff and associations.

In addition to ensuring that our health system can continue to deliver high quality care sustainably, a redesigned model of care will empower health care providers to work collaboratively to the full potential of their abilities and training. Research supports that an effective model of care can improve both the quality of care and the quality of work life for health care providers.

The Design Team will reconvene this month to continue this important work, and detailed planning will take place over the summer for the implementation of the redesigned model.

BACKGROUNDER

In November 2008, the results of the Corpus Sanchez (CSI) Health System Review were released. Hundreds of Island health care providers, public citizens and stakeholders participated in this review, contributing to the sustainability of the health system and the improved health services for all Islanders.

The Government of Prince Edward Island has endorsed the report’s general direction of One Island Health System. Extensive investigation, review and planning are now underway across the health system to determine which solutions will work best for Prince Edward Island. This is the work of the Department of Health’s Integrated Health System Project.

The Integrated Health System project will concentrate on operational improvements and service realignment. The goals are to improve health outcomes, enhance access and refocus the emphasis of the care delivery system on primary health care and services that can appropriately and safely be provided locally.

The Model of Care Project, referred to officially as the Collaborative Care Team Project, is looking into the ways in which health care providers and support staff can operate as a team. The redesigned model of care within One Island Health System will be centered on patient needs and will strive to make the best use of the system’s skills and expertise. The model will ensure that the most appropriate member of the health care team can provide the most appropriate service at the most appropriate time and place.

The Prince Edward Island Department of Health employs over 2000 health care providers, including physicians, registered nurses, licensed practical nurses, resident care workers and allied health professionals. The 2008 review of the health system reveals that the existing care delivery system is limiting the capacity of these care providers to work to the fullest extent of their abilities.

Opportunities for improvement exist in staffing models, work processes, and the use of information and supporting technology. National research and best practices show that Model of Care strategies are being used to reduce health system barriers by creating and supporting interdisciplinary, collaborative care delivery environments.

The Model of Care Project is just one of the initiatives underway in the effort to achieve One Island Health System. More information on this and the Integrated Health System Project can be obtained through the Project Management Office at healthinput@gov.pe.ca or

(902) 368-5810.

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Job Satisfaction and Retention Survey

Last week the PEI Health Sector Council announced the release of the Job Satisfaction and Retention Survey report. This report provides an analysis of job satisfaction and retention issues among the Registered Nurse (RN), Licensed Practical Nurse (LPN) and Resident Care Worker (RCW) occupational groups on Prince Edward Island. The Job Satisfaction and Retention Survey asked questions regarding place of work, years in practice, work schedule, work environment, wages, respect, scope of practice, performance review and retirement.

Exemplary Care: Registered Nurses and Licensed Practical Nurses Working Together

The Association of Registered Nurses of PEI, the Licensed Practical Nurses Association of PEI, and the PEI Health Sector Council today announced the release of Exemplary Care: Registered Nurses and Licensed Practical Nurses Working Together. This publication highlights the guiding principles shared among RNs and LPNs and clarifies some of the key differences between RNs and LPNs in clinical practice. The discussion and examples presented in the report reflect the practice of typical nurses and is intended to promote an understanding of:

• the scope of practice of each group,
• the practice expectations when both groups work together, and
• the contributions that both groups bring to the care setting.

Having a full understanding of the different health care contributions of RNs and LPNs will enhance and improve the process of collaboration and effective decision-making in the clinical setting.

RNs and LPNs are two health professions that work very closely together. This document represents an important milestone in fostering mutual knowledge-sharing and increased collaboration between the two professions to relieve some of the tremendous human resource pressures on the health system and create an exemplary health care workplace. A more efficient, collaborative nursing practice benefits all of us – nurses, other allied health professionals, and clients of the health system. An efficient, collaborative nursing practice enhances our ability to recruit and retain nurses and leads to better utilization of human resources and, consequently, savings in financial resources.

I hope you get a chance to read and comment on this document.

Cheers,
Mark

Teams in Action: Primary Health Care Teams for Canadians

Last week the Health Council of Canada released a report on health teams in Canada called Teams in Action: Primary Health Care Teams for Canadians. The report was released exclusively as an e-document to limit paper use and save some trees in the process. The HCC asked if I would post a link to the report here and I am happy to oblige, especially considering its focus on Collaborative Practice, one of our favourite topics at the Health Sector Council.

The Teams in Action report profiles many of the public health benefits of collaborative practice in health care, what makes a collaborative health team and efforts to encourage the formation of health teams, and the extent of access to health teams across Canada. Although the report is not health human resource specific, it does make note of the human resource benefits of collaborative practice, including increased job satisfaction and greater knowledge and skill-sharing among health professionals in a collaborative practice setting. In addition to the main report, the HCC has also released backgrounders and supplementary reports specific to each Canadian jurisdiction, including Prince Edward Island. Check out the other site-specific documents here.

Have a look at the report, spread it around, and post your thoughts here. And I promise, the PEI Health Sector Council is not a branch of the Health Council of Canada, despite appearances from the last number of posts!

Cheers,

Mark

Prince Edward Island's Intergrated Palliative Care Program

This post originally featured a video profile of PEI's Integrated Palliative Care Program that was produced by the Health Council of Canada. I've since removed that video as it is somewhat out-of-date and doesn't reflect the current reality of palliative care in PEI. The video can still be viewed on the Health Council of Canada's website if you're curious, but I feel it is important to stay current with these posts. I will have more to say about palliative care and collaborative practice on PEI in the future.

Cheers,
Mark

Canada's Health Care System: Dissed in America

I touched on some of the differences between Canadian and American health care in my last post. Here is a recent press release from the Health Council of Canada also addressing the issue. It highlights some interesting facts on per capita spending on health care in the two countries. There are also some links in the release to the Health Council of Canada's discussion boards that are worth checking out.

FOR IMMEDIATE RELEASE

Canada’s Health Care System:
Dissed in America

TORONTO (April 6, 2009) – When U.S. President Barack Obama recently announced his intention to create a public health care system that would be accessible and affordable for all Americans, he touched off a firestorm of criticism with some south of the border saying Canadian-style health care is not the way to go.

The critics say that Canada has long wait times, inadequate access to diagnostic equipment, and a shortage of specialists, making our health care system a poor example to emulate.

Some of the criticisms about the Canadian system heard in the U.S. include:

Canadians [have] to wait more than a year to get hip replacements, with some patients ending up addicted to pain killers due to the long wait. We Americans will never put up with a system like that.
Health Care Reform Analysed at United Way Meeting. Bill Corley, Indianapolis Star

Routine care in Canada is pretty good — just hope you aren't really sick or have a chronic condition.
Canada isn’t Utopia. Howard Wilkin, Desert News

Are these criticisms accurate?

Canada’s publicly-funded system is founded on the principle of universality, meaning that everyone is entitled to the same services regardless of their ability to pay. Last year, we spent $172 billion on our system. On a per capita basis, we spend 48% less than in the United States, where health care is not universal and some 47 million people do not have health care coverage.

Canadians live longer than Americans and appear to have similar or better health outcomes in most aspects of healthcare. Despite the significant amount of money Americans are spending, are they getting value for their money?

Are Canadians and Americans getting value for the money we spend on our health care systems? What do you think?

“We want to hear what Canadians are saying about these issues,” notes John Abbott, Chief Executive Officer of the Health Council of Canada. The Council recently launched www.CanadaValuesHealth.ca for exactly this kind of discussion.

It’s time for Canadians to speak up on such questions as:

• What do we value about our publicly-funded system? Are there ways to improve and build upon what we have? What constructive new ideas and suggestions can we come up with?
• Can we make our dollars go further? Can we get a bigger bang for our buck? Where can we improve our system to get better value?
• Can we sustain the system without having to spend billions more?
• What can the United States learn from our experiences with universal coverage?

Visitors to www.CanadaValuesHealth.ca can join in this important discussion, watch videos, listen to podcasts, read what other people are saying, and more.

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Pierre Lachaine
Health Council of Canada
Phone : 416-480-7085
plachaine@healthcouncilcanada.ca

Jaclyn Clare or Rachel Sa
PR POST
Phone: 416-777-0368
jaclyn@prpost.ca

About the Health Council of Canada

Created by the 2003 First Ministers’ Accord on Health Care Renewal, The Health Council of Canada is mandated to monitor and report on the progress of health care renewal in Canada. Councillors were appointed by the participating provinces, territories and the Government of Canada.

And now for something completely different...

This post isn’t specifically related to health human resources but I just had to bring it to attention, mostly for its comedic value. I was surfing some of the health blogs this morning and came across this post on Dr. Wes’ blog. Hilarious. A colonoscopy contest? Is this for real? Apparently so. Here is a link to the contest, sponsored by CBS and supported by the National Cancer Institute.

A lot of ink has been spilled about the differences between Canadian and American health care. Debating the merits and faults of either isn’t something I’m going to get into here. But nothing strikes me as more indicative of that difference than a sweepstakes contest offering free health care. Then again, a certain Halifax radio station had a contest a few years ago offering free plastic surgery (let’s just say, to ‘enhance’ certain assets) to the lucky winner. So, I guess crass reality show-style promotional events aren’t restricted to American-style health care. It’s funny, it’s weird. What do you think?

To give this post a bit of context and draw attention to the real issue here, I’d like to highlight a few facts (from the PEI Ministry of Health Annual Report 2006-2007 and the Health Canada website):

• Colorectal cancer (which the colonoscopy screens for) is one of the most common forms of cancer (including lung, prostate and breast cancers) affecting Canadians, with an incidence rate of 62 men and 41.1 women per 100,000 population in 2006.
• Incidence rates for colorectal cancer were higher for PEI than the rest of Canada (64.9 men and 52 women per 100,000 population). They were also higher for lung, prostate and breast cancer.
• Mortality rates for colorectal cancer were higher in PEI (31 men and 22 women per 100,000 population in PEI versus 27 men and 17 women in Canada). They were also higher for lung, prostate and breast cancer.
• Risk factors for colorectal cancer include age (over 70 most at risk), heredity, diet (high in red meat and low in vegetables may increase risk), weight, alcohol consumption and smoking.
• Colonoscopy is one of a number of screening techniques and is considered to be the most thorough screening technique.

It is somewhat disconcerting that the PEI incidence rates for colorectal and other cancers are higher than the Canadian average. There are likely many reasons for this – could human resources be one of them? Availability of human resources must certainly have an effect on mortality rates from these cancers. A 2006 article in the Montreal Gazette suggests that a lack of specialists and equipment in Québec is to blame for year-long wait lists for colonoscopies in that province, prompting many to pay for the procedure in one of Montreal’s many private clinics. Still, I don’t think we’ll see anything as bizarre and ‘un-Canadian’ as the CBS/National Cancer Institute colonoscopy contest on this side of the border anytime soon.

I believe it is also important for all of us to stay on top of managing our own health by living a healthy lifestyle and communicating with our physicians, pharmacists and other health care providers. It is always best to identify issues early.

Cheers,
Mark

Best Practices in Interprofessional Care Case Study

This Health Council of Canada video presents a brief case study of a successful collaborative practice facility in Twillingate, a small community of about 2,500 people on the northeast shore of Newfoundland. The chronic disease care team described in the video exhibits qualities that I think we can consider best practices in collaborative care – namely, that collaborative care is a team-based approach where practitioners from different occupations and levels of the health system come together to discuss an individual client’s case. The approach is client-centred, includes the patient as a team-member, and promotes the sharing of knowledge between disciplines. Seems like a no-brainer, I know. That collaborative care is a somewhat revolutionary health care delivery model may be a revelation to some, but the degree of collaboration exhibited by the chronic disease team in Twillingate is not the norm. However, collaborative practice facilities and teams are becoming more prevalent. We have good examples on PEI which I will be profiling in future blog posts. Stay tuned!

Embedding of this video is disabled, so you'll have to link directly to Youtube to view it. Sorry about the extra step!

http://www.youtube.com/watch?v=PADGp1I34is&feature=channel

PEI Family Medicine Residency Program

The Department of Health released a press release last week announcing that five family medicine residents will be starting their two-year residency at the QEH and Prince County Hospital. The idea behind the residency program is to encourage family doctors to establish practices on the Island following their training. Recruiting family doctors is becoming a challenge everywhere, let alone in a rural setting like PEI, so with any luck the program will be successful and we will see more family doctors setting up practice here. Incidentally, there is some evidence (like this study from Canadian Family Physician) to suggest that providing training in rural medicine to medical students increases the chances that they will go on to set up practices in rural areas.

For Immediate Release March 12, 2009
Five Residents Identified for PEI Family Medicine Residency Program

CHARLOTTETOWN, PEI -- The province announced today that five family medicine residents have been identified to begin their two-year training program on the Island this July.

“This is tremendous news for Islanders and I’m extremely pleased that we now have five talented medical school graduates identified and ready to start their training on Prince Edward Island this summer,” says Premier Robert Ghiz. “Establishing the PEI Family Medicine Residency Program has been a top priority for my government, and it will help significantly in the recruitment of additional family physicians for the province.”

The five medical school graduates were identified by Dalhousie University. Four of the students are graduates of Canadian medical schools and one is a graduate of an international medical school.

To train as a family physician, a medical school graduate must complete two years of residency training under the guidance of a practising, credentialed physician – also known as a preceptor.
“I’m very excited about five exceptional medical school graduates who will receive their two-year training across the Island,” says Health Minister, Doug Currie. “Medical residents who train here have the highest potential to stay, plus second-year residents can work as qualified physicians under the supervision of a licensed physician, which will help with patient workload. This will enhance our current recruitment initiatives and assist in ensuring we have an adequate number of family doctors into the future.”

During the past two years, Island physicians have been part of curriculum and faculty development, and have been receiving training in integrating medical students into their clinical practice.

“This is the result of several years of planning for the implementation of the program, says Dr. George Carruthers, site director. “Currently there are about 30 preceptors on the Island who provide training at the post-graduate level. Island preceptors are looking forward to having the residents train here, which will result in enhancements to the Island medical community overall, and to patient care.”

The PEI Medical Residency Program will be based and operated from a site at the Queen Elizabeth Hospital with rotations at Prince County Hospital and throughout communities across the Island.

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PEI Health Careers Directory

Last spring the Health Sector Council released the PEI Health Careers Directory, outlining 62 health occupations practiced on the Island. The booklet scratches the surface really; there are so many options for people interested in pursuing a career in health.

Each career gets a brief write-up including a job description, salary range, high school preparation and post-secondary requirements, and a list of schools offering programs leading to a job in the career profiled. So, for example, the entry for Medical Laboratory Technologist looks like this:

Health Profession: Medical Laboratory Technologist

Job Description: Medical Laboratory Technologists perform sophisticated laboratory tests that help diagnose and treat disease

Approximate Salary: $40,000 - $57,500

High School Preparation: Academic high school diploma with an emphasis on biology, chemistry, computer science and math

Academic Requirements: Post-secondary studies in medical laboratory science – usually a 2- or 3-year program at the community college level

Schools in Atlantic Canada: College of the North Atlantic, NL (3-year program); New Brunswick Community College Saint John Campus, NB (2.5-year program)

Each of the careers fits into a loosely defined category – Cancer Care, Clinical Laboratory Science, Dentistry, Diagnostic Imaging, Health Information and Communication, the Medical Profession, Mental Health, Nursing, Pharmacy, Public Health, Special Technologies and Services, Therapy and Vision Care. The categories make it easy to look up careers that you might be interested in. If you’re curious about nursing, for example, open up the section on Nursing and you’ll see that there are seven nursing-oriented jobs listed. If you enjoy science and lab work, check out Diagnostic Imaging or Clinical Laboratory Science for jobs that lean in that direction, like medical laboratory technologist.

Check out the booklet; let me know what you think. We have hardcopies at the office for anyone interested (our contact info is on the PEIHSC website). Also, we’ll probably revise the booklet in the future, so if you work in any of the occupations listed and notice something that should be changed or updated (like the salary ranges) please get in touch with me.

Cheers,

Mark

Recruiting the ‘Facebook Generation’

Julie Murphy, Administrative Assistant with the Health Sector Council, sent me the following article on recruitment strategies for Gen Xers and Yers. The article points out that recruitment strategies highlighting job benefits and salary through the use of traditional media (newspaper ads, for example) do not resonate with the 18-32 age bracket, and how the most successful recruitment campaigns are turning to new venues (social media like Facebook, blogs, and Youtube) to send a different message (social responsibility and personal values versus job security and salary) about what it means to work with a particular organization. I think a good example of this recruitment style is the recent Canadian Forces campaign – you’ve probably seen some of the grainy, edgy, documentary-style recruitment ads on TV. You can also check out individual videos on the Canadian Forces website and on Youtube (like the Fight Chaos and Fight Distress/Chaos/Fear videos). I probably wouldn’t last a day in the forces, but these videos make me want to join and make a difference in the world...for a few seconds at least.

So what does this mean for the health sector on PEI? Can it learn something from recruitment strategies that emphasise changing the world, making a difference, and personal growth over salary range and mission statements? Certainly people working in the health sector are often drawn to the field out of a desire to ‘do good’ and change lives. But this aspect of health sector careers is rarely (if ever) stated in the job postings I see on the job board.

What do you think? Would a shift in focus in health sector recruitment to a more youthful, tech-savvy demographic with an emphasis on values and ethics serve to entice more health workers to the Island? In my opinion, yes, a different recruitment approach probably would serve to generate more interest in the PEI health sector. I’m not sure what that approach would necessarily look like; imagine the Canadian Forces videos but instead focusing on medical careers, nursing and so on. But there’s another piece to that puzzle, which is ensuring that once we attract the so-called ‘Facebook generation’ to the PEI health system we keep them there. That’s the key component really. If the workplace doesn’t live up to the expectations of a new recruit, they probably won’t stick around, and ensuring that we have an exemplary workplace here on the Island goes hand-in-hand with recruitment, whatever the approach.

Wooing Facebook Generation with Meaning, Spirit

By Carly Foster
June 1, 2008

In the 70s, it was stability. The 80s: Money. The 90s: Balance. Now, some analysts say employee recruiting and retention is about communicating the meaning and purpose of work, even more so than the value of benefits and total rewards.

The path to recruiting and retaining the so-called Facebook Generation is not through fancy gimmicks and traditional advertising - it's through meaning, spirit and tech-savvy company promotion, says Tod Maffin.The broadcaster, blogger and social media strategist was the keynote speaker at EBNC's recent sold-out Canadian Benefits Summit, discussing "Recruiting the Facebook Generation: How to Win the War on Talent."

read more of the article here...

More survey results...oh, and Happy Friday!

A couple of weeks ago I posted results from the Health Sector Council’s grade 12 exit strategy survey showing that parents are the strongest influence on students’ education and career plans. I’d like to point out a few other results from the survey in this post.

One of the things we found was that many students were interested in the health sector as a career option (33% of students indicated interest). When asked about specific occupational groups within the health sector that they were interested in pursuing, the majority indicated nurse (22.3%), doctor (18.2%) and pharmacist (9.5%). Either students are not interested in other health careers, or (more likely) are not aware of the variety of health careers available.

Later in the survey students were provided a list of 62 health occupations that are practiced on PEI – jobs like medical lab technologist, addictions counsellor, emergency medical technician, resident care worker, nuclear medicine technologist, and so on – and were asked to indicate which careers looked interesting. Each entry included a small amount of information on the occupation, including salary range and education requirements, so that students could make an informed decision. Not surprisingly, many students were interested in other health careers, in addition to nurse, physician and pharmacist. Interest was strong in higher salaried positions like medical physicist, dentist, family doctor, specialist physician and psychiatrist, but was also strong in occupations with much lower remuneration – jobs like addictions counsellor and child development worker – suggesting salary wasn’t the sole factor influencing students’ expression of interest. In fact, the most popular jobs were those that included a high degree of social interaction and whose practitioners might be viewed as helping clients ‘better’ themselves (addictions counsellor, child development worker, psychiatrist, psychologist, social worker, dietitian and physiotherapist, for example).

Overall interest in health careers increased dramatically (from 33% to 53.6%) after the students reviewed the 62 occupations, suggesting that the more health career information students have at their disposal, the more likely they are to find a job that matches their interest. Not rocket science, obviously, but the simple fact is that many students don’t have access to this information. As I mentioned in an earlier post, we have a directory of PEI health careers available for download. Let me know if you want a hard copy.

Cheers,
Mark

A Family Health Team model

The article below describes a community’s response to pressures affecting its health human resources and its ability to deliver effective, quality health care. Many of the issues raised in the article are ones that we share in PEI – physician recruitment challenges, shifting demographics among the medical profession whereby more medical school graduates are choosing to specialize rather than enter family medicine, physician retirement, and so on.... Granted, there have been some good news stories, including some recent success recruiting physicians, but the times are changing and recruitment is just one piece of the puzzle.

The article outlines the development of an interprofessional, team-based health delivery system for the Peterborough region of Ontario, adhering to the ideals of collaborative, patient-centred care outlined in one of my previous blog posts. The Peterborough region currently has five interprofessional family health teams (two in the city of Peterborough), consisting of family doctors, nurse practitioners, receptionists (yes...they are an integral part of the health team concept), registered nurses, dietitians, social workers and so on. In 2008 the Peterborough Regional Health Centre was opened with the intention of expanding the interprofessional care concept to include outpatient services and bring specialist physicians into the mix.

It’s an interesting concept and one that appears to be working. Fourteen thousand people have been taken off the waiting list for a family doctor in the Peterborough region in the last two years and wait times have decreased. We have family health teams on PEI and I’m not sure how they compare to those in Peterborough, but the two jurisdictions are strikingly similar. Peterborough and Prince Edward Island are almost exactly equivalent in population (139,818 in PEI as of 2008 vs. 133,080 in Peterborough as of 2006). Both jurisdictions are also largely rural and comparable in overall area and population density (23.9 people per square kilometre in PEI vs. 35 per square kilometre in Peterborough).

I think it’s something that bears watching. If successful, some of the concepts that drive the Peterborough model might be worth adopting on PEI. For one thing, I’m curious to know how many people the Peterborough health teams count as patients compared to PEI teams. I’ll keep you posted if I find out. What are your thoughts?

The Perfect Storm

How a community calmed the rough waters of health care
By Gordon Gibb

You’ll have to forgive Dr. Don Harterre for choosing a winged warthog as his office mascot. The diminutive porker suspended above his desk serves as a delicious metaphor in view of recent success implementing family health teams in Peterborough, Ont., — something one local physician predicted would only happen "when pigs fly."

In Peterborough, an idyllic city of 75,000 located 90 minutes northeast of Toronto, health care is something people love to talk about these days.

Little wonder. The sprawling, state-of-the-art Peterborough Regional Health Centre (PRHC) is slated to open in June, consolidating two outdated hospitals into one meticulously planned facility. The Peterborough Clinic has just moved into a new building adjacent to the PRHC, with its orphaned facility downtown tagged to house expanded vascular health services. Five family health teams are flourishing. And upwards of 14,000 people have come off the waiting list for a family doctor in the past two years.

read the rest of the article here...

Happy humpday!

Some comic relief is in order after the last number of serious and reflective posts. Here's a bit of satire to lighten the mood.

A debate from the Canadian Medical Association Journal

The following two articles: Physicians, it‘s in your court now, by Stephen Lewis, and Doctors put patients first in health care debate, by Albert Schumacher, present two sides of a heated debate on the responsibilities that governments and physicians have played in the health care crises facing Canada, and the roles that each should assume in solving them. The articles were originally published in the Canadian Medical Association Journal and I’m linking to them here to spark some debate; they do not necessarily represent my views or the opinion of the Health Sector Council.

The two articles present very polarized points of view and both authors are painting with broad strokes. Have a read and let us know what you think. And don’t forget to check out the e-letter responses at the bottom of each article; there are some great responses to Lewis and Schumacher from other physicians and medical students (see this one in particular).

All of this being said, it would seem to me that moving away from polarized points of view and finding the “best” and “doable” solutions to all of our healthcare problems would be more appropriate than trying to figure out who is to blame. But that is just me….what do you think?

Cheers,
Mark

This just in - students actually listen to their parents (sometimes)!

The PEIHSC released a report on grade 12 students’ education and career plans in January. The report was based on a survey we conducted with grade 12 students during the 2007/2008 school year, and we were really impressed with the number of students (almost half of the grade 12 population) who took the time to fill out the survey. I thought this would be a good venue to point out some of the findings of the survey, especially for members of the public who might not be aware of it.

For this post I’d like to focus on the part of the survey where we asked students about what influences their education and career plans. We found that parents have the most influence on high school students’ plans (does this surprise you?). We asked students the degree to which their career plans were influenced by three different factors – parents/guardians, friends and career promotions campaigns. 36.6% were influenced “some” or “a lot” by career promotions campaigns, 39.6% were influenced “some” or “a lot” by friends, and 66.8% were influence “some” or “a lot” by parents. That’s a significant percentage of high school students who rely on parents for information and insight on future education and careers, and I think it drives home the fact that parents need to have access to the right information.

In an effort to get information out there about opportunities in the health sector and the variety of occupations available, we published Health Careers on PEI, a directory of 62 health occupations practiced on the Island. Most of us are aware of the staffing issues with physicians, nurses and pharmacists and that demand for those careers are high, but there are other health careers that are also in high demand. Additionally, many health careers are accessible to people who may not be interested in pursuing the education required for a career as a family doctor or specialist surgeon. Occupations like medical laboratory technologists, licensed practical nurses, dental hygienists, resident care workers and emergency medical technicians require between 6 months and 2 years of college education.

If you would like a hardcopy of the Grade 12 Exit Strategy report or the health careers directory drop me a line or give me a call and I’ll see what I can do for you. My contact info can be found on my profile or the Health Sector Council website.

Cheers,
Mark

HR strategies to address shift work

My phone rang at 5:30 this morning, waking me from a deep sleep and giving me an instant feeling of dread. My heart pounding, I thought: “this can’t be good.” Luckily it was the wrong number; the call was for someone else, letting them know there was a day-shift available (at the hospital, possibly?) if they were interested. I fell back asleep and then had trouble getting up at my usual time of 7:00 (or so), which I would like to blame on the 5:30 call but is more likely due to my habit of staying up too late.

Health workers must be pretty used to those kinds of disturbances, considering the prevalence of shift-work and casual employment in the health sector. So after getting to work I did a little searching and came across a fact sheet on the health effects of shift-work and some of the things that can be done (by employees and employers) to address them. Most of these suggestions are quite simple, but even simple strategies can be difficult to follow.

For those of you who work shifts, do you enjoy it? How do you adjust to irregular shifts or those early morning calls? For the health sector employers reading this, do you have strategies in place to address the human resource issues that arise due to shift-work?

What are the health effects of shiftwork?
from the Workers Health Centre website

Partial sleep deprivation is the main problem that affects the health of shift workers.

Night work disturbs the circadian rhythm in the human body. This is an internal body clock that is synchronised to a 24 hour period. It regulates a number of physiological functions such as body temperature, hormone secretion, heart rate, blood pressure, respiration, digestion and mental alertness. It lets us know, among other things, when to sleep and when to eat. Shiftworkers can have health problems because this internal clock is disturbed.

Shift workers and extended hour workers suffer from sleep disturbances and the physiological consequences that result from it. The social effects extend to their family and friends.

Researchers have found several negative health effects in shiftworkers and workers on extended hours. Some of these are:

• increased heart disease
• gastric ulcers and gastro intestinal problems
• social problems and minor psychiatric disorders
• sleep disorders and increased fatigue
• increased error rates and accident rates.

Some personal factors can make workers more susceptible to problems when doing shiftwork or extended hours. These include:

• a heavy domestic work load
• psychiatric illness
• a history of alcohol or drug abuse
• epilepsy
• diabetes
• heart disease

How can employers address shiftwork problems?

There are a number of steps that employers can take to address the problems faced by shift workers. Some of the solutions suggested for employers are:

• Improve workplace lighting and canteen and recreation facilities.
• Ensure workers undertake no more than two consecutive night shifts.
• Ensure workers undertake no more than two or three consecutive 12 hour shifts.
• Ensure an even distribution of days off with shift blocks.
• Avoid compacting shifts to produce longer breaks.
• Allow workers time for breaks, time to move around and time to interact with other workers.
• Ensure job rotation by moving employees to different tasks or responsibilities.
• Educate workers on lifestyle advice such as eating and sleeping patterns.

In addition, shift workers should have the same access as day workers to services such as counselling and the same opportunities for participation in training and meetings. Workplace safety committee meetings should also be scheduled for those on evening and night shifts.

Solutions for workers

The shift worker can also take a number of steps to make living with shift work more bearable.

Setting up the conditions for sleep is very important

Family, neighbours and friends need to know and understand the shift schedule.

Let relatives and neighbours know about the work schedule. The bedroom must be dark and cool. Noise levels can be reduced by heavy curtains and sound insulation on the doors and windows. An air conditioner can mask minor noises from outside. An answering machine for the phone and lowering the ring tone may also be helpful.

There should be a routine for waking up as well, just as there is for the average day-worker.

Night-shift workers should exercise

Exercising is not an easy task because shift workers usually start the day exhausted and pressed for time. However, exercise can simply mean being active in general; for example, a walk around the neighbourhood for half an hour or a game of backyard soccer with the children. Exercise should be a part of every day, but vigorous exercise should be avoided within the last two hours before bed time.

Shift workers’ diet is very important

Shift workers should have three meals a day, at roughly the same time every day. The timing of meals can keep energy levels up, improve sleep and help the body adjust to the shiftwork schedule.

Restrict the intake of caffeine, not only in coffee and tea, but in soft drinks too.

Healthy snacks like fruit and fruit juice, raw vegetables and cheese are very good at home or at work.

Family understanding and co-operation is crucial

Stress seems a common problem in shiftworkers’ lifestyle and a good home environment can help reduce stress.

Useful hints to apply during shiftwork

• When the work is sedentary, contact others on the same shift regularly; it may help to keep alert.
• Stand up and walk occasionally.
• Go to the toilet and wash your hands and wet your face.
• Be aware of fatigue after the shift is over, especially while driving home.
• Keep your mind active by listening to the radio.
• Avoid overall heating - in winter, it is better to direct warmth to the feet and open the window a little to let the fresh air in on your face.
  

The Expanding Health Team - Nurse Practitioners

The health sector is changing, not only in PEI and Canada but worldwide, and with good reason. Why?

There is no other option.

One of the most startling statistics I read in the Corpus Sanchez report was the rate at which the cost of the health system is growing relative to the provincial treasury. Based on that report, by 2013 our health system will consume all new incremental revenue, meaning the spending of every other department will have to be frozen in order to pay for increases in the health budget. By 2014, only five years from now, other departments will have to reduce spending to pay for health care cost increases. It’s a sobering statistic....

As we move toward a primary care model – community-based, preventive, continuous and integrated care with a focus on interprofessional collaboration – we have to find new, more efficient ways of accessing the health system to avoid the grim situation described above. One way of doing that is to make better use of the health team.

Nurse practitioners are a central part of the health team. According to a recent CBC report, nurse practitioners can see from 60 to 70 percent of patients that would normally see a family doctor. That is a significant burden removed from the family doctor and also a much more cost-effective way of accessing the health system. After all, a nurse practitioner exerts a much lighter burden on the province’s pocketbook than a doctor.

The article at this link is from a Newfoundland perspective, but is also relevant to PEI and presents a good example of how nurse practitioners can help ease demands and pressures on the health system.

Mark

Recruiting men to nursing

I was checking out a few university websites yesterday looking for information on programs in dentistry, wondering what kind of entry requirements there were and whether my BA would give me the necessary background to get into one of them. Simply out of curiosity, of course; I’m not thinking of leaving the Health Sector Council.

Not surprisingly, the courses I took on Maritime Archaic Prehistory, Old English and Medieval Art and Architecture may not have prepared me for a doctorate in dental surgery. Apparently dentists need some sort of science background...go figure. So I was chatting to James about this (again, this is all hypothetical) and he said, “What about becoming a dental hygienist?”

I hadn’t considered a dental hygienist program, and that made me wonder why? Did it have something to do with dental hygienist being a primarily female profession? Was I conditioned to omit dental hygiene as a consideration for this reason? Dental hygienists are in-demand after all, work regular hours as far as I know, and get paid well. It sounds like a great profession with great opportunity.

James sent me a CBC article on the challenges of recruiting men into nursing professions, another field represented primarily by women. Here is a link to that article. The article points out that although men make up about 10-13% of students in nursing programs, only 5% of practicing nurses are men. Additionally, male students are more likely to drop out of nursing programs than female students. Why is that?

The article also points out that there is no shortage of people applying to nursing programs. In that light, should we be concerned with recruiting men into nursing programs (or other traditionally female occupations)? While I’m not sure that recruiting men into occupations traditionally practiced by women is important just for the sake of creating gender balance, I do think it is important to encourage people to pursue the career path of their choice.

It’s a tricky subject, and one that is difficult to discuss wearing my PEIHSC cap and trying to stay on the path of political correctness. So, as usual, I will turn the question back on you and get your take. Why aren’t more men becoming dental hygienists, RNs, LPNs, etc.? Is it important to recruit more men into traditionally female occupations? Click on the comments link below this entry to let us know.

Cheers,
Mark

CUPE Article on RPNs' Scope of Practice in Ontario

The article reproduced below (find the original here) gives another perspective on an issue that’s very similar to the one affecting health facilities in rural communities on PEI. What’s your take? Do you think that some of the pressures facing rural hospitals and their emergency rooms in particular could be eased by expanding LPNs’ scope of practice as this article suggests? Are we even at a stage where we can consider expanding LPNs’ scope of practice when they are limited by their scope of employment?

RPNs can ease ER crisis at Huron Perth’s Seaforth – Another rural hospital cuts services as McGuinty government turns its back

January 28, 2009 11:09 AM

LONDON, Ont. – Expanding the scope of practice for Registered Practical Nurses (RPNs) can ease the Emergency Room (ER) crisis at Seaforth Community Hospital, says Michael Hurley, President of the Ontario Council of Hospital Unions OCHU/CUPE, which represents 40 workers at Seaforth. “We have to respond to the shortage of nurses,” Hurley says. “But cutting emergency room (ER) services is not an acceptable way to respond to inadequate resources or staffing.”

Hurley encouraged hospitals to expand the scope of practice of RPNs, graduates of a two-year program, to better serve the public.

“By realigning nursing duties across the Huron Perth Healthcare Alliance and using RPNs appropriately, we can address the nursing shortage at Seaforth,” Hurley says.
As of February 7, Seaforth Community Hospital will cut its 24-hour ER down to 12 hours, and remain open only from 8:00 AM to 8:00 PM. Hospital officials say that ambulances will be diverted to other hospitals during the shut-down times.

But Hurley warned that it is the chronic underfunding of the health system underlies ER closures at Seaforth, and elsewhere, and not just the nursing shortage.

“Cutting ER services is a direct response to the financial pressures on the health care system,” Hurley says. “This is yet another example of a rural hospital losing services in a wave of underfunding and restructuring that the McGuinty government is forcing onto hospitals.”

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Contact:
Michael Hurley, President, OCHU/CUPE, cell: 416.884.0770

David Robbins, CUPE Communications, cell: 613.878.1431

Scope of Practice vs. Scope of Employment

Scope of practice, like collaborative practice, is a phrase that we often hear in the health sector. Before I started working at the PEIHSC I had never heard the phrase ‘scope of practice’, but since then it has become part of my daily vocabulary. Scope of practice is something that we will probably visit often here, so I thought I should give you a definition. It is also important to distinguish scope of practice from scope of employment. Here you go:

Scope of Practice: The procedures, actions and processes for which an individual or occupational group has received training/education.

Scope of Employment: The procedures, actions and processes which an individual is authorized to perform in their workplace.

Ideally your scope of practice and scope of employment match, and the tasks that your employer or manager authorizes you to perform are equivalent to your training.

Sounds simple, right? Not so much.

Scope of employment might be different from scope of practice for any number of reasons – regulated health occupations’ scopes of employment are dictated by legislation and job descriptions, while unregulated health occupations’ scopes of employment can be more arbitrary and dependant on the will of the employer. Ensuring that scope of employment and scope of practice match is an important human resources issue; it has a major effect on job satisfaction and certainly influences our ability to recruit and retain health personnel.

That’s it in a nutshell. Feel free to expand on these definitions. We’d also like to hear about your own experiences in the comments section.

What is ‘Collaborative Practice’ anyway?

Collaborative practice, interprofessional care, interdisciplinary care...these are phrases that get kicked around a lot in health literature, conferences and board meetings. The PEIHSC held a forum in May 2008 called the ‘Collaborative Practice forum’, so you would think that when the new Executive Director at the PEIHSC called me into his office to talk about our next year of activities and asked if I could define collaborative practice that I could give a pretty good answer, right? Well, I found myself stumbling to come up with a clear definition of how collaborative practice and interprofessional care differs from how the majority of health facilities currently operate.

I went back to an article I wrote on this subject in one of our newsletters where I quoted a definition of collaborative practice by Carol P. Herbert. She defines collaborative practice in her article “Changing the culture: interprofessional education for collaborative patient-centred practice in Canada” as “the continuous interaction of two or more professionals or disciplines, organized into a common effort, to solve or explore common issues with the best possible participation of the patient.” But what makes a practice truly collaborative, and how does that definition distinguish a collaborative practice from any other practice?

At its core, interprofessional care has to do with breaking down walls and making a shift from autonomy to interdependency. Individuals engaged in collaborative practice are mutually dependant on each other and are aware of each others’ expertise. Power is shared among team members, including the patient. Making this shift might mean the actual removal of physical walls and changing a practice into an open concept space with minimal or zero private office space. It will certainly mean instituting practices that promote collaboration and the sharing of information – multidisciplinary rounds for example, where the practitioners in a collaborative practice facility meet to discuss and recommend steps for a particular client’s care, often with the participation of that client.

James and I recently met with two individuals who were instrumental in setting up a collaborative practice facility here in Charlottetown. Something about the facility that struck both of us as a defining characteristic of interprofessional care was the adoption of a horizontal communication structure. Adopting a philosophy of horizontal communication blurs the lines between roles, removes traditional boundaries and promotes the deliberate exchange of knowledge, skills and expertise.

Getting back to Carol Herbert’s definition of collaborative practice, I think that three of the key concepts in that definition are “continuous interaction”, “organization” and “patient participation.” I’m sure that almost any health worker would agree that they interact with other health professionals to solve and explore common issues for their patients. Continuous interprofessional interaction that is organized by means of institutional policies and models of care, which includes the client as a contributing member of the team is what really distinguishes interprofessional care.Of course, that’s just my opinion. We’d like to hear yours.

Cheers,
Mark

It's a blog!

Welcome to Health Views, a blog created by the PEI Health Sector Council to discuss health human resource issues relevant to the PEI health system. This blog is designed to facilitate the sharing of information and stimulate discussion around current and emerging HHR issues in three categories:

· Recruitment and retention
· Collaborative practice
· Optimization of health human resources

These categories are intentionally broad so that we can explore a variety of topics – issues like scope of practice, interprofessional care, health worker shortages, workplace bullying, education and public awareness of health human resource issues and the changing paradigm of health care on a regional and global scale. The PEIHSC has explored many of these issues since its inception in 2006. Scope of practice and interprofessional care were discussed in two forums (the Scope of Practice Forum 2007 and Collaborative Practice Forum 2008) and a series of focus groups. Recruitment and retention of health workers was addressed by a Job Satisfaction and Retention Survey in 2008, and health career promotion was the focus of two exit strategy surveys conducted with grade 12 students in 2007 and 2008 and the directory of Health Careers on Prince Edward Island. Check out our quarterly newsletter, Health Benefits, for further discussion of these and other issues.

Stay tuned to the site for upcoming articles and commentary. We welcome your comments and also invite you to submit articles and commentary to be considered for future postings.

Cheers,
PEI Health Sector Council Staff