Healthcare Systems

VANCOUVER – Recipients of the 12th annual BC Health Care Awards were announced today at a gala luncheon in Vancouver. Twelve Gold Apple and six Award of Merit recipients were honoured.

Presented by the Health Employers Association of British Columbia (HEABC), the awards recognize British Columbians who are providing outstanding care and support. Awards are given in 11 categories to projects improving delivery through innovative and collaborative approaches and to people making a positive impact and inspiring those around them.

“BC’s medical professionals – including support staff – genuinely care about delivering quality care to British Columbians,” said Michael McMillan, HEABC’s President and CEO. “The BCHC Awards are an opportunity to recognize and celebrate the individual and team contributions made by these individuals.”

New this year – Dianna Mah-Jones Award of Excellence in Person-Centred Care

Named in honour of Dianna Mah-Jones, this award is for a team or project that makes use of leading practices to improve care for patients, residents or clients by focusing on the needs of the person rather than the needs of the system or service. Dianna Mah-Jones, an occupational therapist at GF Strong Rehabilitation Centre, was tragically killed, along with her husband Richard Jones, just three months after being named Provincial HC Hero at the 2017 awards. Our hope is that this ward will help to keep her memory and legacy alive by recognizing others who strive to deliver care that is respectful of the needs, values and preferences of individuals.

2018 Gold Apple winners

Provincial HC Hero & HC Hero – Provincial Health Services Authority

Glenn Braithwaite – District Supervisor, Emergency Coordinator, BCEHS

Glenn Jay Braithwaite is a Paramedic and District Supervisor at BC Ambulance Service, recognized for providing exceptional emergency response and for his clinical leadership abilities. He’s received several professional accolades for his heroic actions, and his outstanding commitment to patients, colleagues and the broader community.

Provincial HC Hero & HC Hero – Island Health

Dr. Ramm Hering – Physician Lead, Primary Care Substance Use, Island Health

By passionately and effectively advocating for improved services for patients dealing with substance use and addiction, Dr. Hering has inspired his colleagues to work together to develop new programs and create an efficient, client-centred system of addiction services.

HC Hero – Affiliate

Dr. David Agulnik- Emergency Physician, St. Paul’s Hospital

HC Hero – Fraser Health

Mits Miyata – Pharmacy Manager, Lower Mainland Pharmacy Services

HC Hero – Interior Health

Lynda Martyn – Registered Speech-Language Pathologist, Coordinator Kelowna Cleft Lip/Palate Clinic

HC Hero – Northern Health

Debbie Strang – Health Services Administrator, Quesnel

HC Hero – Provincial Health Services Authority

Dr. Faisal Khosa – Associate Professor, Radiology, Vancouver General Hospital

Dianna Mah-Jones Award of Excellence in Person-Centred Care

International Seating Symposium – Sunny Hill Health Centre for Children, Provincial Health Services Authority

The International Seating Symposium has created an international forum that fosters an exchange of ideas and a network of consumers, rehabilitation therapists, physicians, designers, and manufacturers of positioning and mobility equipment. This has inspired improvements in rehabilitation equipment and technology that have improved mobility, comfort and quality of life for people with disabilities.

Dianna Mah-Jones Award of Excellence in Person-Centred Care

Residential Care for Me: Megamorphosis – Seniors Care and Palliative Services, Providence

The goal of Residential Care for Me: Megamorphosis is to change the residential care culture from an institutional to a social model of care, and improve quality of life for residents by rapidly testing and implementing changes that focus on emotional connections, allow residents to direct each moment, and create the feeling of home.

Top Innovation

SNIFF: C. Difficile Canine Scent Detection Program – Vancouver Coastal Health

An innovative and dedicated team of people and a growing roster of pups known as the C. Difficile Scent Detection Program is pioneering a cost-effective method to improve and enhance C. Difficile surveillance and improve infection control and prevention practices.

Workplace Health Innovation

VGH Emergency Department Healthy Workplace Initiative – Vancouver Coastal Health

Vancouver General Hospital’s emergency department formed a multi-disciplinary team with the goal of working together to improve workplace health and safety, leading to an improved working climate where staff report feeling engaged and better able to provide the type of quality care that emergency patients deserve.

Collaborative Solutions

Improving Indigenous Cancer Journeys: A Road Map – BC Association of Aboriginal Friendship Centres, BC Cancer (Provincial Health Services Authority), First Nations Health Authority, Métis Nation BC

The Indigenous Cancer Strategy is a collaborative strategy that will improve indigenous cancer outcomes by addressing all steps of the cancer journey, from prevention and treatment, through to survivorship and end-of-life care.

This year’s Awards of Merit recipients are:

Dianna Mah-Jones Award of Excellence in Person-Centred Care

• Resources and Needs Review – Nanaimo Regional General Hospital, Island Health

Top Innovation

• Symphony QuickCall – Workforce Management Solutions, Provincial Health Services Authority

• Fall-unteers: A Volunteer-Based Falls Prevention Strategy in Residential Care – Holy Family Hospital Residential Care, Providence

Workplace Health Innovation

• Reducing Workplace Injuries through Leading Practices – Menno Place

Collaborative Solutions

• Regional Strategy for Reducing Ambulance Turnaround Times – BC Emergency Health Services, Provincial Health Services Authority, Fraser Health

• Vancouver Shared Care Team – Doctors of BC, Providence, Vancouver Coastal Health

Since the awards launched in 2007, more than 200 Gold Apples and Awards of Merit have been awarded to health employees who are improving BC’s healthcare system and patient care.

The 2018 BCHC Awards are generously supported by Great-West Life, Healthcare Benefit Trust, and Pacific Blue Cross.

Visit BCHealthCareAwards.ca,to learn more about the 2018 awards winners.

The Health Employers Association of British Columbia (HEABC) is the accredited bargaining agent for most publicly funded health employers in the province, representing denominational, proprietary and affiliate health employers, as well as the province’s six health authorities. HEABC coordinates the labour relations interests of 250 publicly funded healthcare employers and negotiates five major provincial agreements covering more than 120,000 unionized employees.

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With just eleven months to go before the Value-Based Purchasing component of the Affordable Care Act is scheduled to go into effect, it is an auspicious time to consider how health care providers, and hospitals specifically, plan to successfully navigate the adaptive change to come. The delivery of health care is unique, complex, and currently fragmented. Over the past thirty years, no other industry has experienced such a massive infusion of technological advances while at the same time functioning within a culture that has slowly and methodically evolved over the past century. The evolutionary pace of health care culture is about to be shocked into a mandated reality. One that will inevitably require health care leadership to adopt a new, innovative perspective into the delivery of their services in order to meet the emerging requirements.

First, a bit on the details of the coming changes. The concept of Value-Based Purchasing is that the buyers of health care services (i.e. Medicare, Medicaid, and inevitably following the government’s lead, private insurers) hold the providers of health care services accountable for both cost and quality of care. While this may sound practical, pragmatic, and sensible, it effectively shifts the entire reimbursement landscape from diagnosis/procedure driven compensation to one that includes quality measures in five key areas of patient care. To support and drive this unprecedented change, the Department of Health and Human Services (HHS), is also incentivizing the voluntary formation of Accountable Care Organizations to reward providers that, through coordination, collaboration, and communication, cost-effectively deliver optimum patient outcomes throughout the continuum of the health care delivery system.

The proposed reimbursement system would hold providers accountable for both cost and quality of care from three days prior to hospital admittance to ninety days post hospital discharge. To get an idea of the complexity of variables, in terms of patient handoffs to the next responsible party in the continuum of care, I process mapped a patient entering a hospital for a surgical procedure. It is not atypical for a patient to be tested, diagnosed, nursed, supported, and cared for by as many as thirty individual, functional units both within and outside of the hospital. Units that function and communicate both internally and externally with teams of professionals focused on optimizing care. With each handoff and with each individual in each team or unit, variables of care and communication are introduced to the system.

Historically, quality systems from other industries (i.e. Six Sigma, Total Quality Management) have focused on wringing out the potential for variability within their value creation process. The fewer variables that can affect consistency, the greater the quality of outcomes. While this approach has proven effective in manufacturing industries, health care presents a collection of challenges that go well beyond such controlled environments. Health care also introduces the single most unpredictable variable of them all; each individual patient.

Another critical factor that cannot be ignored is the highly charged emotional landscape in which health care is delivered. The implications of failure go well beyond missing a quarterly sales quota or a monthly shipping target, and clinicians carry this heavy, emotional burden of responsibility with them, day-in and day-out. Add to this the chronic nursing shortage (which has been exacerbated by layoffs during the recession), the anxiety that comes with the ambiguity of unprecedented change, the layering of one new technology over another (which creates more information and the need for more monitoring), and an industry culture that has deep roots in a bygone era and the challenge before us comes into greater focus.

Which brings us to the question; what approach should leadership adopt in order to successfully migrate the delivery system through the inflection point where quality of care and cost containment intersect? How will this collection of independent contractors and institutions coordinate care and meet the new quality metrics proposed by HHS? The fact of the matter is, health care is the most human of our national industries and reforming it to meet the shifting demographic needs and economic constraints of our society may prompt leadership to revisit how they choose to engage and integrate the human element within the system.

In contemplating this approach, a canvasing of the peer-reviewed research into both quality of care and cost containment issues points to a possible solution; the cultivation of emotional intelligence in health care workers. After reviewing more than three dozen published studies, all of which confirmed the positive impact cultivating emotional intelligence has in clinical settings, I believe contemplating this approach warrants further exploration.

Emotional intelligence is a skill as much as an attribute. It is comprised by a set of competencies in Self-Awareness, Self Management, Social Awareness, and Relationship Management, all leading to Self Mastery. Fortunately, these are skills that can be developed and enhanced over the course of one’s lifetime.

Keeping the number of handoffs and individuals involved in delivering the continuum of care, let’s examine how emotional intelligence factors into the proposed quality measures the Department of Health and Human Services will be using come October, 2012:

1.) Patient/Caregiver Experience of Care – This factor really comes down to a patient’s perception of care. Perceptions of care are heavily shaded by emotions. Patients consistently rate less skilled surgeons that have a greater bedside manner as better than maestro surgeons that lack, or choose not to display, these softer skills. Additional research into why people sue over malpractice also indicates how perceptions of care are formed. People don’t sue over a medical mistake in and of itself. People sue because of how they felt they were treated after the error occurred. From the patient’s perspective (and often their family’s) there’s a difference between being cured and being healed. The difference often can be found in the expression of authentic empathy through healthy, professional boundaries.

This is a key driver in patient decision-making as well. Patients tend to choose a hospital based upon one or two criteria; the recommendation of their primary care physician (with whom they have an established relationship) and/or upon the recommendations from family members or friends that have experienced care in a particular hospital or an individual surgeon. A quick look into the field of Applied Behavioral Economics supports this finding. Economic decision making is 70% emotionally driven with the remaining 30% based in rational thought. In many instances, it would appear that a lot of hospital marketing initiatives don’t seem to reflect an understanding of this phenomena. Waiting room times in Emergency Rooms have little to do with why patients choose a hospital, yet we see billboards everywhere that have the actual E.R. wait times electronically flashing along the roadside.

A patient’s experience (and perception) of care can be highly impacted at the handoff points within the continuum of care. Any new model of care will require exceptional cross-organizational communications to emerge. This requires a high level of engagement and commitment to the new vision at every patient touch-point.

This metric also addresses the caregivers’ experience of care. This speaks largely to the experience of nurses that are delivering that care. The research related to the impact of cultivating emotional intelligence in nurses clearly demonstrates a reduction in stress, improved communication skills, improved leadership and retention, the ability to quickly connect and engage patients, as well as a reduction in nurse burnout (which leads to turnover and additional stress amongst the remaining staff).

2.) Care Co-ordination – Again, this will require optimal engagement and pro-active communication intra-organizationally and cross-organizationally. Each handoff introduces opportunities for variable care to emerge that must be seamlessly co-ordinated. Poor co-ordination also introduces the risk of eroding the quality of the patient’s experience.

3.) Patient Safety – Research shows that the cultivation of emotional intelligence competencies in nursing contributes to positive patient outcomes, lowers the risk of adverse events, lowers costs at discharge, and reduces medication errors, all while lowering nurse stress, burnout, and turnover. Each time a nurse resigns it adds to the nursing shortage on the floor, requires additional hours from other nurses, and costs the hospital approximately $64,000, on average, to backfill the open position. Improving how an institution cares for its nurses improves the level of patient care and safety as well. In many institutions, this will require a shift in leadership’s perspective in order to support a culture that embraces and values the critical role nurses play in maintaining patient safety.

4.) Preventive Health – Elevating Self-Awareness and Social Awareness in clinicians helps them quickly connect and effectively communicate with patients. Subtle, non-verbal cues become more readily apparent, helping clinicians understand the fears and emotions of their patients. Self Management and Relationship Management helps clinicians communicate appropriately and supports the expression of authentic empathy through healthy, professional boundaries. All of these factors come into play when speaking with patients about lifestyle choices, course of treatment, and preventive health care.

From our own personal lives we’ve all learned we cannot “fix” other peoples’ behaviors. We can, however, be in relationship and help support healthy changes they’re ready to embrace. Pro-actively moving to improve preventive health will require deeper, more authentic relationships to emerge between front-line health care providers and patients.

5.) At-Risk Population/Frail Elderly Health – Like preventive health, being measured on the care of the community’s at-risk population and elderly will require an innovative approach to community outreach and pro-active communication. These are not populations that can be easily reached via Facebook or Twitter. Building effective relationships with these demographics will require trustful, human contact and deep engagement with each population, both of which are supported through the development of a mindful approach (i.e. emotionally intelligent) to the challenges at hand.

It will be interesting to see how reform unfolds and how leadership within the health care delivery system chooses to respond to the challenges that lie ahead. Systems and hospitals that choose to take an honest, evidence-based look at how they choose to lead, how they create and execute strategy, and the organizational culture they’re cultivating will be well served in preparing to successfully navigate this unprecedented change.

© 2011, Terry Murray.

Terry Murray is a professional coach and business executive with twenty-five years of progressive experience in strategic development, executive leadership, and the deployment of highly profitable business teams. His executive leadership with Fortune 1000 and start-up companies has directly contributed more than $1 billion in market capitalization growth throughout his career.

Terry is the founder and president of Performance Transformation, LLC a Professional Coaching and Strategic Development firm focused on igniting breakthrough performance through the authentic engagement and development of human talent. The company’s evidence-based programs and philosophical approach employs their proprietary Adaptive Coaching Process. The organization’s engagements align the clients’ human capital with their strategic imperatives driving tangible results, delivering a sustainable competitive advantage and an exceptional Return on Investment.