quips conference programme

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CONTENTS

Welcome 2

Conference at a glance 3

Speaker biographies 4

Oral QI Presentations 8

Breakout Sessions 11

Poster Competition 15

Organizing Committee 17

Sponsors & Exhibitors 18

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Welcome to the third annual Quality Improvement and

Patient Safety Conference!

We are excited to have you here today since the goal of this

conference is to bring together people who believe that

healthcare can improve and wish to lead the discussion on

how change can happen. For the past three years, this

conference has been organized by an interdisciplinary

group of students at the U of T IHI Open School Chapter

and likewise the conference attendees have been from

various backgrounds from the clinical professions to

engineering to policy.

This year's conference will look at Innovations in Healthcare

Delivery with a focus on processes and their

implementation. As many of you know, processes are

integral to the functioning of our healthcare system and

allow us to improve quality of patient care with respect to

the nine dimensions of quality: safety, accessibility,

effectiveness, efficiency, patient-centeredness, equity,

appropriate resources, integration, and population health.

Gathered here today are informed leaders with a depth of

experience. They will discuss potential solutions, the role of

leadership, and interdisciplinarity in fostering innovation.

Over the past year, we have designed a spectacular

program for you with the immense support of our faculty

advisors and mentors. This conference was intended to

spark discussions with students and professionals of

different disciplines. Please join the debate as we explore

the challenges and opportunities in healthcare delivery

innovations.

Sabrina Tang

Conference Lead, 2012-2013

MHSc Clinical Engineering Candidate (2014)

Founded in 2009, the University of Toronto Chapter of

the Institute for Healthcare Improvement Open School

(UT IHI) aims to develop students’ foundational skills in

Quality Improvement (QI) and Patient Safety (PS) through

education and practical experience opportunities. Our

Chapter is currently followed by 800 students and

professionals in multiple healthcare and related

disciplines, including nursing, pharmacy, medicine, allied

health, social work, occupational therapy, physiotherapy,

engineering, public health and policy, and health

administration.

Each year, our interdisciplinary leadership team

organizes Quality Improvement Projects in local

communities, observerships at QI and PS agencies,

monthly seminars, and finally, an annual conference on

the most engaging topics in healthcare. We hope that

through these initiatives, students will become aware of

the need for change in healthcare and learn ways to

achieve that change.

Over the past three years, I have had the pleasure of

working with students, faculty advisors, and other

collaborators who were passionate about healthcare

improvement. I hope the third annual Quality

Improvement and Patient Safety Conference introduces

you to the breadth of opportunities available for effecting

positive change in healthcare, and inspires you to join our

quest to make our system more patient-centered,

effective, efficient, timely, equitable, and safe.

Cindy Shen President, 2012-2013 MD Candidate (2015), MPH, BSc

WELCOME 2

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FRIDAY 3 MAY

4:45PM

Registration and Refreshments

Li Ka Shing Lobby

5:30PM

Opening Remarks

Dr.Sioban Nelson

Dean of Nursing, University of Toronto

Dr.Robert Howard,

President & CEO, St. Michael’s Hospital

5:35PM

Keynote Speech

Marian Walsh

CEO, Bridgepoint Health

6:30PM - 7:30PM

Networking and Refreshments

SATURDAY 4 MAY

8:00AM

Registration and Breakfast

Lesley Dan Lobby

8:45AM

Opening Remarks

Dr.Maureen O’Neil, President

Canadian Foundation for Healthcare Improvement

Ms.Lynn Dionne, Manager of Capacity Building

Health Quality Ontario

9:00AM

Opening Plenary, Eliminating barriers to specialty care

Dr.Nick Kates, Director of Programs

Hamilton Family Health Teams

9:45AM - 10:15AM

Networking and Poster Competition

10:15AM Panel Discussion ‘Interdisciplinarity & Innovation’ See & 6 for panelists

11:45AM - 12:45PM Lunch and Poster Competition

12:45PM Breakout Sessions See Page 11-14 for detailed list

2:15PM - 2:30PM Networking Break

2:30PM Oral QI Presentations See Page 8 for more information

3:30PM Closing Plenary, Innovation and finding the leader within Patti Cochrane, VP Patient Services Trillium Hospital

4:15PM - 4:30PM Closing Remarks

CONFERENCE AT A GLANCE 3

Breakout Session Locations

1. The Quality Improvement (QI) Toolbox

Meet in Leslie Dan lobby to be guided to HSB

2. Using Simulation to Improve Patient Safety Health Sciences Building, Simulation Lab 3. Design of performance feedback in healthcare Leslie Dan Building, Room 310 4. Plan-Do-Study-Act (PDSA) Cycles Leslie Dan Building, Room 850 5. Healthcare Funding Basics and Reform Leslie Dan Building, Room B250 6. User Centred Design Health Sciences Building, Room 100 7. Lean and Value Stream Mapping

Health Sciences Building, Room 108

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Emcee & Moderator

Keynote Speaker

Dr. Michael Rachlis, MD, MSc, FRCPC, LLD (Honoris Causa) Adjunct Professor, Dalla Lana School of Public Health, University of Toronto Dr. Michael Rachlis was born in Winnipeg, Manitoba in 1951 and graduated from the University of Manitoba medical school in 1975. He interned at McMaster University and then practiced family medicine at the South Riverdale Community Health Centre in Toronto for eight years. He completed specialty training in Community Medicine at McMaster and was made a fellow of the Canadian Royal College of Physicians in 1988. Dr. Rachlis practices as a private consultant in health policy analysis. He has consulted to the federal government, all ten provincial governments, and two royal commissions. He is also an

associate professor (status only) with the University of Toronto, Dalla Lana School of Public Health. Dr. Rachlis has lectured widely on health care issues. He has been invited to make presentations to committees of the Canadian House of Commons and the Canadian Senate as well as the United States House of Representatives and Senate. He is a frequent media commentator on health policy issues and the author of three national bestsellers about Canada's health care system. In his spare time, Dr. Rachlis enjoys cycling and duplicate bridge.

Marian Walsh

President and CEO, Bridgepoint Health

Marian Walsh is President and CEO of Bridgepoint Health. Identified as “a futurist” by Healthcare

Manager Magazine., she is a visionary and has been an effective advocate for transforming the

health care system to meet the evolving needs of patient for over 30 years. At Bridgepoint,

Marian has built Canada’s leading healthcare organization for research, education and care

focused on complex chronic disease and disability. Currently, she is overseeing redevelopment of

the new Bridgepoint Hospital, a state of the art, purpose built, 680,000 sq. ft. facility scheduled to open in 2013.

Prior to Bridgepoint, Marian held leadership and advisory roles that have greatly influenced understanding and the

direction of complex chronic care in the Province and across Canada. In addition to her responsibilities at Bridgepoint,

she was interim President and CEO at Women’s College Hospital. Previously she was President and CEO of Toronto’s

Home Care Program, a Special Advisor to Newfoundland’s Ministers of Health and Social Services, and CEO of St. John’s

Regional Home Care Program (NFLD.). Her national leadership roles include Founding President, Canadian Home Care

Association, President, Canadian Association of Social Workers, and Canadian Representative, International Federation

of Social Welfare. She plays an active role in the Ontario Hospital Association, the Rehab Network of Toronto, and the

Complex Care and Rehabilitation Leadership Council of Ontario. She is also a member of the Advisory Committee,

Department of Health Policy, Management and Evaluation, University of Toronto, and a member of the Board of

Medavie Blue Cross.

SPEAKER BIOGRAPHIES 4

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Panelist

Plenary Speaker

Dr. Nick Kates, MD, MBBS, FRCPC

Professor, Psychiatry and Behavioural Neurosciences, McMaster University

Associate Member, Department of Family Medicine, McMaster University

Director of Programs, Hamilton Family Health Teams

Nick Kates is a Professor in the Department of Psychiatry and Behavioural Neurosciences, with a

cross appointment in the Department of Family Medicine. He is also director of quality improvement

for the Hamilton Family Health Team and a Senior Advisor to Health Quality Ontario. His major

academic activities are in the area of community and social psychiatry, particularly the relationship between mental

health and primary care, quality improvement and redesigning systems of care, chronic disease management and in

innovative approaches to education.

He was previously the Ontario lead for the Quality Improvement and Innovation Partnership (QIIP), which assisted

Primary Care Practices to build capacity and capability for quality improvement, and has a Green Belt in Lean/Six Sigma.

For 12 years he was director of the Hamilton HSO (now FHT) Mental Health and Nutrition Program, which now integrates

mental health counsellors, dietitians and psychiatrists into the offices of 148 family physicians across Hamilton. This

program, which won a significant achievement award from the American Psychiatric Association in 1998, has become a

model for the innovative integration of specialized services into primary care that has informed policy and decision-

making at both the provincial and federal level. He has participated in many provincial and national planning committees

and initiatives for mental health and primary care and has consulted to over 100 Canadian and International

governments, organizations and programs, including programs in Holland, Denmark, the U.S., the U.K., Israel, Ethiopia,

New Zealand and Australia. He has published over 60 articles and authored 2 books.

Since 1997 he has been the co-chair of the CPA/CFPC Collaborative working group on shared mental health care in

Canada, and was the chair of the Canadian Collaborative Mental Health Initiative funded through the National PHCTF to

develop a strategy for collaboration between mental health and primary care services across Canada. He was director of

a community mental health clinic in Hamilton for 10 years, spent 7 years as director of the McMaster Psychiatry

Residency Program, and was director of the Hamilton Region Psychiatry Program for 10 years.

Dr. Karen Hall Barber, BSc (Hons), MD, CCFP Assistant Professor and Clinical Program Coordinator, Department of Family Medicine and Family Health Team, Queen’s University

Karen Hall Barber is a passionate advocate for the importance of quality and safety in primary care.

She completed a Biology degree at Bishop’s University before heading to Ottawa for her medical

training, and then Dalhousie for her residency. After completing her training, she spent nine years

practicing rural family medicine in Indiana. She joined the Department of Family Medicine at Queen’s

University in 2007 as an Assistant Professor. She is also the Physician Lead (and QI champion!) for the

Queen’s Family Health Team.


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Panelist

Panelist

Danyal Martin, BAH, BEd, MA, MSC (HQ) Candidate Clinical Program Coordinator, Department of Family Medicine and Family Health Team, Queen’s University Danyal Martin is a strong promoter of quality and safety in primary care and has special interest

in electronic medical records and process improvement. She completed two bachelor’s degrees

(Drama/History and Education) and a master’s degree (History) at Queen’s, and is currently

completing an MSc in Healthcare Quality. Danyal joined the Queen’s Department of Family

Medicine and the Queen’s Family Health Team in 2009 as the Clinical Program Coordinator.

Kathy Trip, RN, MN Nurse Practitioner, GIM, UHN Assistant Professor and Graduate Placement Coordinator, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto Kathy started her career at the University Health Network (UHN) as a research registered nurse with the Bone Marrow Transplant program, which lead led her to develop UHN’s Stem Cell Collection program. During that time, Kathy pursued her undergraduate and graduate studies,

leading her to become a nurse practitioner (NP). She has acted as NP in the Transfusion unit and has passionately worked with oncology patients admitted to TGH.

Most recently, Kathy has been instrumental in the development of REACH (Reducing Emergency and Acute Care Hospitalization), an urgent oncology care clinic at Princess Margaret Hospital. Kathy has been invaluable at REACH, as she acts as an NP, as well as provides clinical leadership and oversees program planning and development of this significant initiative. Kathy has utilized the innovations of several CICC projects at REACH, including Procedure Carts and the use of Rypple (www.rypple.com, a web-based application which allows users to get quick and anonymous feedback), to obtain feedback from clinicians sending patients to the REACH clinic.

Along with Anne Van Deursen, Kathy was co-developer of the General Internal Medicine (GIM) amazing initiative, an exciting annual interprofessional symposium that is aimed at highlighting the important work of GIM and providing a forum for continuing education for GIM specialists.

Recently seconded to the University of Toronto Faculty of Nursing Graduate program, Kathy hopes to introduce the innovative work of the CICC to her colleagues. She will also continue her work at REACH and as a reviewer with the Ontario Cancer Research Ethics Board.

Thodoros Topaloglou Chief Information Officer (CIO), Rouge Valley Health System Adjunct Professor, Department of Mechanical and Industrial Engineering, University of Toronto

Panelist


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Plenary Speaker

Patti Cochrane

Vice President, Patient Care Services, Trillium Health Partners – Mississauga Hospital

Patti Cochrane is accountable for clinical operations and programs at the Trillium Health Partners – Mississauga Hospital.

During the merger of the Credit Valley Hospital and Trillium Health Centre, Patti was

Vice President, Patient Services, Quality and Practice and Chief Nursing Officer at

the organization’s Trillium sites. Previous to that, Patti was Vice President, Patient Services and

Quality and Chief Nursing Officer at Trillium Health Centre. She has also held a wide range of

clinical roles including Associate Vice President, Performance Excellence and Director of a number of health systems

since the creation of Trillium Health Centre in 1998, and other roles with the Mississauga Hospital starting in 1991.

Patti is a registered nurse with a Bachelor’s Degree and a Masters in Health Science in Health Administration and has

recently completed her Canadian Health Executive program designation.

Her accomplishments over the years have been numerous and have included leading patient-centeredness initiatives,

the design of the decentralized inpatient tower, advancing innovative models of care and quality improvement

engagement and adoption. In 2006, she was the recipient of the Innovation Award from the Society of Graduates at

the University of Toronto for her inpatient design work. Patti is currently a board member for the Cardiac Care Network,

Quality Health Network and is a healthcare speaker on various topics such as quality.

SPEAKERS: SPONSOR REPRESENTATIVE ____________________________________________

Dr.Robert Howard

President & CEO, St.Michael’s Hospital

Dr.Sioban Nelson

Dean of Nursing, University of Toronto

Dr.Maureen O’Neil President, Canadian Foundation for Healthcare Improvement

Ms. Lynn Dionne Manager of Capacity Building and Quality Improvement Planning, Health Quality Ontario


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1. Initiative to Decrease Diagnostic Hysteroscopies Performed in the Operating Room Authors: Ally Murji MD, Stephanie Leung MD, Nicholas Leyland MD

INTRODUCTION: At our institution the practice of diagnostic hysteroscopy (DH), often combined with uterine curettage, was commonly performed in the main operating room (OR) under general anesthesia. These surgical procedures are purely diagnostic but yet require a general anesthetic, are associated with complications and utilize hospital resources. Sonohysterography, a minimally invasive technique, can be performed in the office and is equally effective in diagnosing uterine pathology. OBJECTIVES: To evaluate the effectiveness of multiple Plan-Do-Study-Act (PDSA) cycles to reduce DH performed in the OR. METHODS: To obtain baseline data, we conducted a retrospective chart audit at a University teaching hospital for the year 2011. Procedures were followed prospectively in 2012 to evaluate the effectiveness of three groups of interventions: 1) Provision of readily accessible sonohysterography 2) Case review and staff education 3) Mentorship of staff gynecologists in operative hysteroscopy in the OR. RESULTS: 111 DH were performed in 2011 for post-menopausal bleeding (54), abnormal uterine bleeding (35), polyps (15) and other (7). 15 (14%) patients had pre-/malignant pathology. The complication rate was 8% (8 minor, 1 major). The annual institutional cost of these procedures was $180,000 and 18.5 OR days. During the intervention period (2012), 33 DH were performed, a 70% reduction from 2011 resulting in savings of $122,400 and 12.5 OR days. In the final quarter of 2012, there was an 81% reduction in procedures. DH performed in the final quarter was for misleading pre-operative imaging (3) and failed office biopsies/ sonohysterography (2). CONCLUSIONS: DHs require a general anesthetic, have significant complication rates, and utilize coveted OR time and resources. Interventions to change the culture at our institution have decreased the number of DH resulting in improved patient care, cost savings and OR utilization. While some DH are unavoidable, future PDSA cycles should evaluate the quality of preoperative imaging to further reduce DH. ________________________________________________________________________________________________________________________

2. UHN Telehealth: Using a Workflow Analysis Tool to Improve Delivery of Care Authors: Bhupinder Sahota, Sofiya Hudani, Maryam Monadi, Swati Trivedi, Selina Yim

INTRODUCTION: UHN Telehealth provides video-teleconferencing services when the clinician and patient are not in the same location. To ensure improved delivery of their services, the need to gauge physician satisfaction in this process has become apparent. Hitherto, this has not been systematically investigated. OBJECTIVES: To design and implement a workflow analysis tool that captures current physician workflow and identifies how to best incorporate Telehealth services into regular routine. In doing so, we anticipate to see at least a 20% increase in the physician rating scale regarding the compatibility of Telehealth services with current workflow by October 2013. METHODOLOGY: Eight regular users were carefully-selected to undergo in-depth interviews lasting 10-30 minutes each over a two month period. The results were recorded and transcribed by different team members to avoid bias. Common themes were identified and this guided the creation of the tool. Key areas include current process, the need for pre-visit forms, assessment needs, and an approach to patient investigations. This tool will be used next on four physicians who come from different UHN sites and specialties. Each will be asked to rate how well Telehealth fits into

ORAL QI PRESENTATIONS 8

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their current workflow and this number will be reassessed in 6 months after acting on the identified areas of concern with these and other physicians. RESULTS: The majority of physicians consider that Telehealth creates more work in their schedule. Miscommunication about expectations and needs between Telehealth staff and physicians was identified as the root of the problem. We project that the trial of the workflow analysis tool will guide Telehealth towards actionable items which will improve their services. This is based on prior investigations which have been captured in our tool. CONCLUSIONS: The physician experience with Telehealth is paramount to future usage and adoption with new users. By incorporating Telehealth appointments into regular workflow we hope that they are seen less as a burden and more as an opportunity to attract a greater number of patients. In turn, we hope to optimize the usage of Telehealth to reach its intended purpose and provide an enhanced model of patient care designed to improve outcomes and delivery of care.

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3. Implementation of the Business Performance System (BPS) with LEAN Engineering Principles at The

Scarborough Hospital: Improving Employee Engagement Authors: Thomas Bodley, Belinda Ly, Prateek Seghal, Tirath Thakkar Supervisors: Alfred Ng, Meredith Burrel, Kim Brophy, Laura Kane

INTRODUCTION: LEAN management empowers frontline staff to identify improvement opportunities (IOs) in daily work routines. The Scarborough Hospital (TSH) has implemented the Business Performance System (BPS), using LEAN principles on three inpatient units. Daily staff huddles generate and address IOs to enhanced patient care. OBJECTIVES: The project goal was to increase the number of IOs initiated at TSH by 25% from 2012 baseline levels by April 2013 through the Plan, Do, Study, Act framework. METHODS: Focus groups were held with inpatient unit leaders and QI directors to identify barriers to BPS utilization. Based on feedback, unit leads were coached to modify their huddle approach and re-focus on generating new IOs. The number of weekly IOs is being tracked and performance feedback to the units will be a second intervention to increase staff motivation. RESULTS: The hospital wide IO rate after BPS implementation in May 2012 was 9.3 per month. There was a decline throughout 2012 with year-end IOs of zero per month. Decreased staff engagement, competing time stressors, and changes in approach to the daily huddle were driving low IO rates. The huddles were not focusing on IO generation but discussing performance metrics on the wards instead. In addition, weekly huddle rates decreased to less than 5 huddles per week. A behavioural intervention is ongoing to re-align manager and staff approach to the huddle board. Data from 2013 is pending and collection will be complete April 2013. CONCLUSIONS: Sustained health care employee engagement through LEAN engineering is challenging: time constraints, focusing staff culture on QI, and understanding the importance of measuring performance are substantial hurdles. However, LEAN management represents an initiative to integrate QI and empower staff. Ongoing support, feedback and a willingness to respond to staff needs are methods being tested to help implement the BPS and increase quality and safety of patient care.

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4. Falls Prevention Program: The Role of Champions in the Sustainable Implementation of Patient Safety

Programs Authors: Christine Wong, Terri Irwin

INTRODUCTION: Although many patient safety programs focus on improving care, it is difficult to implement a program that is functional and sustainable at an organizational level. The success of a program depends on the commitment of the practitioners involved, and their openness to change. Clinical Champions facilitate successful program implementation as their roles include igniting initiatives, peer education, patient advocacy, cultivating relationships, and navigating boundaries. At St. Michael's Hospital (SMH), Falls Champions have been executed across 12 units, which have contributed to the successful implementation of the Falls Prevention Program. OBJECTIVES: To assess the effectiveness of unit champions in successfully implementing the Fall Prevention Program at SMH. METHODS: Falls Champions were selected on a voluntary basis on 12 inpatient units, and received training regarding the role of a "champion", the Falls Prevention Program, and effective teaching strategies. The success of Falls Champions in program implementation was measured by the completion compliance of the Fall Risk Assessment (FRA) that identified patients at risk, and the completion of the SIMPLE Falls Prevention Intervention Tool. The results were attained through biweekly audits, and were discussed in Community of Practice meetings over a 6-month period. RESULTS: During the 6-month period, the completion compliance of the FRA and SIMPLE Intervention Tool increased across all 12 units. On the Neurosurgery, Trauma, and Acute Care Services Unit, where the program was initially piloted, the completion compliance rate during the first audit for the FRA was 30% and 8% for the SIMPLE Intervention Tool. Since then, the completion compliance for both assessments has increased to an average of 89% over a 6-month period. CONCLUSIONS: Unit Champions facilitate successful program implementation by exhibiting extensive knowledge of the program, effective ability to communicate among peers, provides unit-specific education, displays availability and openness, and verbalizes feedback to accurately represent the unit. ________________________________________________________________________________________________________________________


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THE QUALITY IMPROVEMENT (QI) TOOLBOX

FACILITATORS: Karen Hall Barber is a passionate advocate for the importance of quality and safety in primary care. She completed a Biology degree at Bishop’s University before heading to Ottawa for her medical training, and then Dalhousie for her residency. After completing her training, she spent nine years practicing rural family medicine in Indiana. She joined the Department of Family Medicine at Queen’s University in 2007 as an Assistant Professor. She is also the Physician Lead (and QI champion!) for the Queen’s Family Health Team. Danyal Martin is a strong promoter of quality and safety in primary care and has special interest in electronic medical records and process improvement. She completed two bachelor’s degrees (Drama/History and Education) and a master’s degree (History) at Queen’s, and is currently completing an MSc in Healthcare Quality. Danyal joined the Queen’s Department of Family Medicine and the Queen’s Family Health Team in 2009 as the Clinical Program Coordinator.

ABOUT: Even the very best clinicians and clinics will at some point experience an instant where they think that the care they deliver could be better – perhaps it could be safer, or more patient-centred, or even just more efficient, but in some way, it could be improved. But what do you do when you encounter something that could be better? How do you get started? The purpose of this workshop will be to provide participants with a framework for tackling issues of quality within a healthcare setting, specifically with reference to an interdisciplinary primary care environment. Using interactive activities and case studies, this workshop will explore how to identify and focus your QI project and how to engage others in your initiative. Lastly, participants will also learn about some of the tools of QI and how to incorporate them into projects.

OBJECTIVES:

1. Highlight the importance of an interdisciplinary, collaborative, and systems-based approach to QI 2. Provide a framework for understanding and addressing QI issues 3. Explore some of the tools of QI and how to use them

OUTCOMES: At the end of this presentation, the conference attendees will be able to,

1. Explain how to pick an appropriate QI project and how to focus the project aim 2. Describe and apply some of the tools of QI (e.g. Ishikawa diagrams and process mapping) 3. Explain the importance of data, how to get it, and how to use it 4. Describe the importance of “blame free” cultures and how to engage stakeholders

BREAKOUT SESSIONS 11

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USING SIMULATION TO IMPROVE PATIENT SAFETY

FACILITATORS:

Maureen A. Barry is a Senior Lecturer and Year 2 Coordinator for the undergraduate program at the Lawrence S.

Bloomberg Faculty of Nursing at the University of Toronto. She received her Master of Science in nursing from the

University of Toronto. She has been involved in nursing education for over twenty years and has taught in Nova Scotia,

Quebec, and Ontario. Her clinical background is adult medicine and surgery and critical care. She has extensive

experience in global health, having worked for 5 years in clinics in rural Kenya and Ethiopia and taught medical English

in China. More recently, she has done volunteer work during sabbatical time in Zimbabwe and South Africa. She

currently teaches medical–surgical nursing and persistent illness and is simulation lead for the Faculty of Nursing

undergraduate program. She has won the Council of Ontario University Programs in Nursing (COUPN) Teaching

Innovation Award as well as multiple U of T Nursing teaching awards. Her primary areas of interest and expertise are

clinical teaching, simulation, web-based learning and technology in nursing education, test theory and development,

and global health issues.

Sarah Johnston completed her Bachelor of Science in Nursing at McMaster University and her Masters of Nursing at

the University of Toronto in 2006. Sarah has practiced nursing for many years primarily in the acute surgical adult

population and is experienced in clinical teaching. Presently, Sarah holds a lecturer position at the Lawrence S.

Bloomberg Faculty of Nursing at the University of Toronto where she is involved in undergraduate nursing education

and simulation facilitation.

TAMING THE BEAST: REFINING AND REFRESHING THE DESIGN OF PERFORMANCE FEEDBACK IN HEALTHCARE

FACILITATOR: Valerie Mais graduated from Industrial Engineering at the University of Toronto in 2010, and since then has been a project lead at the Centre for Innovation in Complex Care (CICC). The CICC is a highly collaborative, interprofessional healthcare innovation hub within a network of four large teaching hospitals right in the core of downtown Toronto. At the Centre, Valerie experiments with implementing new ways to capture and display patient experience, care quality, efficiency and interprofessional team “health” data in meaningful ways for frontline healthcare providers. She is a firm believer that the miracles of data visualization and infographic design can help remedy some of the strain that our current healthcare system is experiencing. Back in 2011, Valerie also held the position of QI Project Lead with the UofT IHI Open School. In her spare time, she kayak fishes – but doesn’t really catch anything.

OBJECTIVES:

1. Take a look at the status quo of how feedback is collected and displayed to providers 2. Discover new approaches to the design of data and feedback (i.e. infographics!), including our work at the

Centre for Innovation in Complex Care (CICC) 3. Experiment with designing feedback in a fun and friendly competition (with prizes of course!)


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PLAN-DO-STUDY-ACT (PDSA) CYCLES

FACILITATORS:

Margaret Millward holds a Bachelor of Science in Nursing from the University of Western Ontario, a Master of Nursing (Administration) from the University of Toronto, the Improvement Advisor designation from the Institute for Healthcare Improvement and a Lean Six Sigma Black Belt Certification. Before to joining the Health Quality Ontario, Marg worked at various progressive positions within Public Health and Community Care Access Centres across both urban and rural sites. She has expertise working with diverse clientele from prenatal education to the Management of a palliative care team. As a Regional Manager of Business Process and Evaluation her interest in quality improvement flourished in the Flo Collaboratives.

Marg worked as the Team Lead on the Integrated Client Care Project- at Health Quality Ontario that focused on attaining better quality care for palliative community care clients. Currently she is working on the Primary Care Quality Improvement Plans and the curriculum for the BestPATH program at HQO.

Susan Taylor joined Health Quality Ontario (HQO) following the transition from the Centre of Healthcare Quality Improvement in April 2011. She is currently the Program Manager with Access and Chronic Disease, focused on the primary care sector and its role within the system of care.

With over twenty years of progressive leadership positions, she has led improvement work in both acute and community care sectors. She is passionate about the application of improvement methodology to drive implementation of inter-professional, evidence based practice, and looks to Experience Based Design to ensure inclusion of the voice of the client in defining value and redesigning processes. She is committed to working collaboratively with a variety of stakeholders to improve service delivery, and is excited by the movement toward establishing truly integrated care.

Susan has an undergraduate degree in Nursing and a Master’s in Business Administration from McMaster University. As well, she holds the Improvement Advisor designation from the Institute for Healthcare Improvement, Lean Certification from Society of Manufacturing Engineers and is a certified Lean Six Sigma Black Belt.

HEALTHCARE FUNDING BASICS AND REFORM

FACILITATOR: Gavin Wardle is the Director of Clinical Projects at the Preyra Solutions Group, where he manages all aspects of the firms clinically focused projects and is the firm’s senior methodologist for the analysis of clinical and health care cost data. Gavin combines expertise in policy analysis, analytics, and research to address problems in health service planning, funding, and evaluation. His professional services work includes the development of population and case mix methods for health care funding, case mix methodology, clinical quality measurement, and health care cost analysis. Gavin has a PhD in health services research from the University of Toronto. He is a reviewer for Medical Care, Health Policy, and BMJ Quality and Safety.

ABOUT: Faced with ageing populations, weak fiscal outlooks, and ever increasing demands for care, jurisdictions around the world are looking to reduce the rate of increase in health care expenditures. Most jurisdictions have hospital payment reform at the center of their strategies to contain the growth in health care costs. In this session, Gavin will describe the design and objectives of common approaches to funding, with an emphasis on hospital funding. Gavin will discuss current funding reform in Ontario, including the Health Based Allocation Model and Quality Based Procedures. Gavin will describe in detail HBAM’s design and applications as a tool for health care management.


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OBJECTIVES:

1. Introduce common mechanisms for health care funding 2. Describe current health care funding reform in Ontario, including the Health Based Allocation Model (HBAM) and

Quality Based Procedures (QBP) 3. Describe HBAM methods and applications

OUTCOMES: At the end of this presentation, the workshop attendees will be able to

1. Understand and discuss common funding mechanisms 2. Describe design and objectives of health care funding reform in Ontario 3. Understand management and funding applications of the Health Based Allocation Model

USER CENTRED DESIGN

FACILITATOR: Peter Weinstein is a human factors analyst. His interests include patient safety, interface design, resilient systems, and integrating user centered and participatory design techniques into healthcare. Peter has a BEng in Aerospace Engineering specializing in space systems design and operated an IT consultancy before earning a MHSc in Clinical Biomedical Engineering from the University of Toronto. In his Master’s Thesis, Peter developed methods to train clinicians in Heuristic Evaluation, and specifically explored the impact of professional backgrounds on the outcome of the evaluations.

His recent projects include: the design of a mobile clinical collaboration system for use across disciplinary and institutional boundaries and a new portal for UHN patients. His expertise includes the use of rapid prototyping techniques to explore, develop, and refine designs across different platforms and contexts. He is extremely passionate about clinical engineering and the potential it has to bring important change to healthcare systems both in Canada and around the world.

ABOUT: User Centered Design (UCD) is an iterative process that ensures the end users’ needs, wants, and limitations are central to each stage of design. It can be applied to a wide variety of systems and processes to make them intuitive, simple, safe, efficient, and even pleasurable to use. In this session, you will learn about core usability principles known as “heuristics” and how these can be applied to innovations in healthcare. We will break into small groups and apply these principles to a simple system using a technique known as heuristic evaluation.

OBJECTIVES:

1. Define User Centered Design (UCD) 2. Relate UCD concepts to healthcare innovation and improvement 3. List core usability design principles 4. Demonstrate the method of heuristic evaluation


1. Understand and discuss the User Centred Design (UCD) process 2. Perform a basic heuristic evaluation with usability design principles 3. Apply a new framework to the systems, technologies, and processes in your own work and life


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INTRODUCTION TO LEAN AND VALUE STREAM MAPPING

FACILITATOR: Scott Ovenden has a wide variety of clinical, managerial and performance improvement experience within the healthcare sector. Over the past 7 years, he has supported several province-wide quality improvement projects and provided coaching support for Lean improvement efforts. These experiences have provided him the opportunity to work with a wide range of healthcare personnel, from clinicians to senior executives, from a number of hospitals and community care providers. Most recently, Scott’s work has focused on sustaining process and performance improvements through the development of a Lean management system in healthcare organizations. Scott has a Bachelor of Physical Education from McMaster University, Bachelor of Science in Physiotherapy from Leeds Metropolitan University and Masters of Health Science from the University of Toronto.

Kevin Bahadur is a Change Management Specialist with the Transformation Management Office. Kevin has worked in the Lean/Continuous improvement field for over 10 years. At Rouge Valley Health Systems Kevin focuses on the planning and leading of improvement initiatives and will also coach and supports staff in LEAN principles and practice. Prior to joining Rouge Valley Health Systems Kevin worked in the retail sector utilizing lean and six sigma methodologies. Kevin was trained in lean by Toyota / Nummi and has also completed his six sigma black belt. Kevin started his journey working in the automotive sector where he was exposed to quality systems, work methods, continuous improvement, and formal problem solving techniques.

ABOUT: Over the past decade, the application of Lean thinking, tools and techniques has been widely applied across the healthcare sector. While the tools and techniques receive the most attention, at its’ core, Lean is a philosophy which promotes a customer (patient) focused approach by reducing waste through the elimination of activities that do not add value. Lean empowers staff and physicians to generate and implement value-added innovative solutions to problems.

This session is an introduction to basic Lean concepts and will feature and interactive Value Stream Mapping session.

OBJECTIVES:

1. To review Lean principles and discuss how they apply to healthcare 2. To define ‘value’ and ‘waste’ as they relate to delivery of services 3. To introduce the concept of value stream mapping and practice facilitating the use of this Lean tool


1. Understand of the origins of Lean and its’ applicability within healthcare 2. Define core Lean principles and terminology 3. Gain some experience in participating / facilitating a Value Stream Analysis


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Alzheimer’s disease, Technology and Home: A systems-based approach to design Tizneem Jiancaro

Can Overhead Lifts Prevent Staff Injuries in a Hamilton Nursing Home? Charlie Goldsmith, Karen Pow

Development of QI Education Modules at Providence Healthcare Mathura Anandarajah, Agnes Chow, Ruth Hu, Connie (Boya) Xiong, Khuzaima Zafar

Evaluating the Effectiveness of Multimedia Communication on Resident Compliance and Perception towards Hand Hygiene Padina Pezeshki, Greg Dungca, Mike Oh, Fanyu Yang

Impact of Computerized insulin order sets on glycaemic control & processes of care in hospitalized patients: an interrupted time-series study Bertha Wong,Muhammad M. Mamdani PharmD MPH, Catherine H.Y. Yu MD MHSc

Improve efficiency with patient assessments in room 38 Gladys Chan, Jawaria Zafar, Jennifer Hunter, Mehran Hydary

Improvement of prescription processing efficiency at the hospital for sick children outpatient pharmacy through prescription stratification and workspace redesign Rubeeta Gill, Kristoffer Flores, Kevin Yau, Neal Kaw, Albert Gheorghita, Ting Ting Liu

Improving blood glucose control in post-surgical cardiac patients Samra Mian, Ashley Corallo, Linda Hewei Tang, Sean Choi, Esmeralda van Riemsdijk, Lisa Bunn, Chris Hayes, Eman Leung

Improving hospital medication labeling by involving designers and human factors professionals Jennifer Jeon, Laura Parente, Monique Pitre, Kevin Armour

Initiative to Decrease Diagnostic Hysteroscopies Performed in the Operating Room Ally Murji MD, Stephanie Leung MD, Nicholas Leyland MD

Metric Definition and Data Dashboard Design for Bone Marrow Transplant Process at Sick Kids Aditya Martowirogo, Taissia Sidorok, Kota Talla, Akib Uddin, Shulin Zhang

POSTER COMPETITION 15

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Put a Face to a Name: Providing Hospital Patients with Photographs of their Clinicians to Improve Communication Lora Appel Reducing the Incidence of Central Line Infection in the Medical Surgical Intensive Care Unit C. Santiago, N. Siddiqui, G. Balagasay, E. Butorac, K. Wannamaker, M.T. Diston, J. Soliven, G. Coulas,C. Hayes, MD, FRCPC

Reduction In Readmission Rates At Trillium Health Centre & Credit Valley Hospital Adeel Alam, Zareen Babar, Franky (Fuh-Ching) Liu, Taraz Kozak

Tailoring and Implementing Checklists for Intensive Care Shadi Ghajar-Khosravi, Aynsley Young, Antoine Pronovost, and Mark Chignell

The innovation of m-health technology to support home care safety Winnie Sun, Dr. Diane Doran, Dr. Sean Doherty and Dr. Rafik Goubran

Transfer of Accountability: Standardizing RN to RN Shift Handover in a Large Academic Hospital Terri Irwin, Cecilia Santiago & Heather Campbell

Undergraduate students driving change: promoting germ awareness through quality improvement Meagan Sandhawalia, Rana Allawnha, Jamie Crawley PhD RN, Michelle Freeman PhD RN, Gwen Ebbett, Joan Dalton, Dino Spagnuolo

Validation of a Comprehensive Medicine Discharge Summary Assessment Tool Brian Eiss, MD, Cathy Jalali, MD, Jeanne Teresi, Ed. D, Ph. D., Eugenia Siegler, MD and Lia Logio, MD

Walking the Talk: How Nurses Embed Quality With Bedside Reporting Stephanie MacDonald, RN, BScN, BA; Cindy Eikens-Stafford, RN BScN CGN (C), Joanne Bennett, BScN MHS

POSTER COMPETITION 16

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THANK YOU! The organizing committee would like to thank Dr. Michael Rachlis for his invaluable guidance and help with the conference.

We would also like to thank our faculty advisors for their continual support of our conference and chapter.

Paula Blackstien-Hirsch, MHSc, MSc, BSc (PT)

Dr. Anne Matlow, MD, MSc FRCPC

Dr.Olavo Fernandes, RPH, BscPharm, CPR, PharmD,

FCSHP Dr. Michael W. Carter, PhD, MMath, BMath

Dr. Katherine Berg, PhD, PT

Marie Rocchi, MDE, BScPhm

Dr. Kaveh Shojania, MD Kathy Trip, RN, MN

Dr. Chris Hayes, MD MSc MEd FRCPC

Dr. Ross Baker, PhD

Dr. Daniyal Zuberi, PhD Dr. Emily Seto, PhD, PEng

ORGANIZING COMMITTEE

Sabrina Tang, Conference Lead Clinical Engineering Cindy Shen, President Medicine Margaret Saari, VP Education Nursing Akib Uddin, VP Operations Clinical Engineering

Manas Bhatnagar, VP Collaboration Clinical Engineering Heather Thomson, VP Recruitment Nursing Laetitia Tam, VP Practical Experience Medicine Tanvi Agarwal, VP Communication Medicine

Andrea Jovanovic, Website Lead Industrial Engineering Jacqueline Chan, QI Projects Lead Industrial Engineering

ORGANIZING COMMITTEE 17

We would also like to thank members of the Marketing team (Aileen Mens, Gillian McRae, IIyse Lax) and other volunteers

for their valuable support.

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PLATINUM SPONSORS

SILVER SPONSORS

BRONZE SPONSORS

SPONSORS & EXHIBITORS 18

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OTHER SPONSORS

SPECIAL THANKS

EXHIBITORS

SPONSORS & EXHIBITORS 19

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NOTES 20

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NOTES 21

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quips conference programme

Health & Medicine

patient safety conference

pm registration

healthcare system

healthcare improvement

healthcare leslie dan

pm closing remarks conference

pm lunch

multiple healthcare