Healthcare Change Makers

At the 2021 HIROC Conference, we had the honour of hearing from Marni Panas, Program Manager of Diversity and Inclusion with Alberta Health Services (AHS). This episode is a recording of that incredibly information session, edited for length.

While walking delegates through the work she and her team have done at AHS, Marni connected diversity and inclusion to patient safety and risk mitigation. Much of that work has meant collaborating with staff – involving them in policy, educational initiatives, and celebrations.

We encourage you to share this episode with healthcare Human Resources and leadership teams. Marni and her colleagues have found that leaders want to support these important conversations but either don't know how, or don't have the language to do so. But if we want to change culture, we need to start here.

Quotables:

"We also know that in a world of healthcare, having people bring their whole selves increases innovation, creativity (which is something healthcare depends on), and all of this has a direct impact on patient safety, patient experience, and patient outcomes." – MP

"An investment [in] diversity and inclusion is an investment in risk mitigation." – MP

"We know that one of the most effective ways of reducing discrimination is being able to see yourself in your healthcare system, being able to see yourself in your leadership." – MP

"We can do all the education that we want but if the systems themselves aren't supporting an inclusive environment or providing inclusive care, then we're not going to make a lot of impact." – MP

"It is the system that creates an environment and a culture where leaders feel supported, and workers feel empowered to be inclusive and anti-racist." – MP

"We want to celebrate diversity as a strength in our organization." – MP

"In this time of COVID we cannot be oblivious to all the other impacts on the health and wellbeing of our colleagues, our patients, our families." – Dr. Verna Yiu

"Leaders at all levels, especially our frontline leaders, play a vital role in changing culture." – MP

Mentioned in this Episode:

• Alberta Health Services
• AHS – Diversity and Inclusion
• AHS – Connect Care
• Marni Panas
• Canadian Institute for Health Information
• World Health Organization

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For this special edition of Healthcare Change Makers, HIROC is partnering with the Association of Family Health Teams of Ontario (AFHTO) to bring you the voices of health leaders on the cutting edge of advancing emergent technologies in clinical practices.

In today's episode, we speak with Dr. Mohamed Alarakhia about artificial intelligence (AI), automation in primary care, and what the future of healthcare could look like.

Dr. Alarakhia is a family physician at The Centre for Family Medicine Family Health Team in Waterloo Ontario, a Faculty Digital Health Lead at McMaster University's Michael G DeGroote School of Medicine, and the Managing Director of the eHealth Centre of Excellence.

When he's not teaching or caring for patients, Dr. Alarakhia is focused on seizing every opportunity to make clinicians' work easier by leveraging critical data and equipping clinicians with tools that automate day-to-day processes, such as his robot Bernie.

Although the COVID-19 pandemic inspired many to try innovative technology solutions to assist in rapidly-evolving care conditions, Dr. Alarakhia wants to ensure healthcare staff are better informed of the associated risks and opportunities with evidence-based studies.

At the 2021 AFHTO conference, Dr. Alarakhia presented a session on "Artificial Intelligence and Robots in Primary Care" alongside Dr. Ervin Sejdić. We encourage you to listen to Dr. Sejdić's episode of the podcast after this one to get a full understanding and appreciation of the critical work done by these experts.

Quotables:

"I think it's important for us to make sure that what we do is explainable. There's something called 'Explainable AI,' which really allows a clinician to understand what's behind the hood. Why is the AI or automation doing what it's doing? And I think that's really key for us to gain trust and confidence." – MA

"Clinicians value evidence. They want to know why they're doing something, what the benefits are or lack thereof. So, when we go to talk to clinicians about different technologies like automation, artificial intelligence, we go with evidence about what it has done, where the gaps are, and just be very open about that." – MA

"One can be more effective if they've got their personal life in order, know when to start and stop doing things, and done self-care. A lot of leaders have been going full tilt for so long during the pandemic and they're struggling. So, I think it's important to have that balance." – MA

"I feel that we have a great system, but we can do more. We have an opportunity to do more and make it easier, so people don't fall through the cracks." – MA

"We're at the cusp of doing something quite different right now. I've thought for a while that we have a capability to leverage tools that we're using every day a lot better." – MA

"Just like any intervention in medicine, we need to have a particular amount of evidence around it. We need to have rationale for using it, and we need to demonstrate that it works in a real-life context." – MA

"It's not about 'this is the greatest thing and why aren't you implementing it?' It's about here's another tool in your toolbox that you can use to help yourself and patients." – MA

Mentioned in this Episode:

Association of Family Health Teams of Ontario (AFHTO)

The Centre for Family Medicine Family Health Team

McMaster University's Michael G DeGroote School of Medicine

eHealth Centre of Excellence

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For this special edition of Healthcare Change Makers, HIROC has partnered with the Association of Family Health Teams of Ontario (AFHTO) to bring you the voices of health leaders advancing emergent technologies in clinical practices.

In today's episode, we speak with Dr. Ervin Sejdić, Research Chair in Artificial Intelligence for Health Outcomes at North York General, and Faculty Member at the University of Toronto. An engineer by training, early on in his career Dr. Sejdić identified a passion for data analysis and an interest in clinical medicine. His career today brings those two passions together.

We talk with Dr. Sejdić about his team's ongoing research in dysphagia, sensor-based prediction of falls, analysis of electrocardiograms, and the analysis of electronic health records.

Dr. Sejdić says the application of AI in medicine is still in its infancy. He sees the analysis of medical images coming as the next big splash for AI in clinical practice. We also talk with Dr. Sejdić about how we can make use of wearables, leveraging the sensors in our devices to learn about patient behaviour.

The next challenge for Dr. Sejdić is finding ways to translate his research from university and hospital labs into real-world solutions. He's optimistic about working with start-ups and industrial partners to develop his research into products that can change lives.

At the 2021 AFHTO conference, Dr. Sejdić presented a session on "Artificial Intelligence and Robots in Primary Care" alongside Dr. Mohamed Alarakhia. After this, check out Dr. Alarakhia's episode to learn more about how these experts are building a foundation for AI in medicine.

Quotables:

"I always knew that science plays a major role in every modern country, but it did not hit me until I was actually in the White House, meeting the American president, that it has that kind of a role, and that it is taken seriously." – ES

"I would encourage all young students to actually consider science and research as a potential way to contribute to society." – ES

"In theory, everything works. In practice, nothing works." – ES

"I think that's going to be the next big splash that AI will make in the medical world… we will be able to use AI algorithms to quickly analyze some of the medical images and come up with a summary for a clinician." – ES

"R&D is one aspect, but developing a product is a completely different beast. And typically, you cannot easily do it in a university lab."

"AI is about to change healthcare in ways we cannot predict. If our organizations don't act on it in a timely manner, they will be playing a catch-up game."

Mentioned in this Episode:

• North York General Hospital

• University of Toronto, Electrical and Computer Engineering

• Holland Bloorview Kids Rehabilitation Hospital

• Tom Chau

• Healthcare Change Makers, Episode 29 with Daniel Pepe

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Today we're talking with Bruce Squires, President of McMaster Children's Hospital and Vice President, Women's and Children's Health at Hamilton Health Sciences.

In this episode, we talk to Bruce about preventable harm and his approach to turning the corner on patient safety. Bruce says it's important to be explicit when talking about harm, sharing a realistic picture with clinical leads and teams.

Like many leaders, Bruce is focused on health human resources. He speaks to the need to build immersive learning environments, where staff have the tools and support from leaders to identify opportunities and act on them.

Bruce also speaks to the impact of COVID-19 on children and youth, describing it as disruptive and tragic. The measures imposed to keep our kids safe affected their physical, mental, and emotional health – effects that are most concerning for vulnerable children and youth.

But Bruce is ultimately optimistic. In looking to the next chapter of children's health, he believes the dialogue should be driven by the voices of children, youth and families – they are our future.

Quotables

"If you're going to focus on safety as a healthcare priority, you have to name it and you truly have to prioritize that. You need to make it the core mandate." – BS

"I think wherever I've seen kind of breakthrough performance, it's where the organization has made that explicit commitment to improving safety performance… to driving to zero harm." – BS

"There's lots of things that you can do outside… but if you don't have at its core a frontline situation, a day-to-day at the worksite sense of an element of control over your own work, and an opportunity to improve, then it's not going to be healthy and it's not going to support learning."

"These kids and their importance in recovery needs to be prioritized." – BS

Mentioned in this Episode:

McMaster Children's Hospital

Hamilton Health Sciences

Children's Healthcare Canada

Children's Hospital of Eastern Ontario (CHEO)

Canadian Medical Association

Newfoundland and Labrador Medical Association (NLMA)

Ontario College of Family Physicians

Mount Allison University

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Today we're talking with Liben Gebremikael, the first Executive Director of TAIBU Community Health Centre in Toronto. He's held the position since 2008. Liben is a social worker with over 25 years of experience in the primary healthcare sector, social services, and mental health field.

TAIBU was created to meet the specific healthcare needs of the Black Community – and as it's evolved, addresses all the social determinants of health including, education, income, lifestyle, and housing.

Their philosophy of care is built around a Zulu word 'Ubuntu', which means, we don't exist as individuals, we exist as a family and as a community. All issues at TAIBU are addressed from that lens and that philosophy.

For Liben, there's excitement and a sense of satisfaction at developing a culturally appropriate approach to specific illnesses that affect the Black community – illnesses like sickle cell disease and diabetes for example.

The larger issue that preoccupies Liben and his colleagues at TAIBU is the necessity of systems change. Eliminating barriers to care for racialized populations means big changes are needed at the systems level. As Liben explains, it begins with the four 'As'.

Quotables

"Sometimes the role of a leader is very strategic, but I believe you need to continue to put your feet on the ground and really listen to people and hear people. Once a social worker, always a social worker!" – LG

"People talk about a broken system. We say the system is not broken; it's working perfectly as it was designed. The challenge is, it was not designed for certain populations." – LG

"One of the African principles of self-determination is that our clients participate in design, in decision-making, in planning of services. Critical ingredients when you're talking about culturally appropriate approaches and services." – LG

"People are really engaging with the issue of equity, which is promising, but it requires a lot of work because it's very difficult to change the system quickly." – LG

"We are moving from just doing programs – we are incorporating the concept of systems change in all that we are designing moving forward." – LG

"If we continue in the long-term to address the systemic issue, then every CHC, every healthcare facility, every youth-serving agency will be meeting the needs of those racialized and marginalized communities and the system would be working for everybody." – LG

"I usually say COVID is like an x-ray. It showed us how broken the bones were." – LG

"We came through this huge impact of COVID-19 and we're still functioning as a community. As staff and as an organization, and many other CHCs would share this view, we need to hang on to this resiliency" – LG

"I would not use the word 'consultation', I use the word 'engagement' – engaging with communities and really being transparent and saying, 'We're here to listen and we're here to support'." – LG

Mentioned in this Episode:

Black Scientists' Task Force on Vaccine Equity

TAIBU Community Health Centre

Black Health Alliance

Dr. Christopher Morgan

The Ubuntu Village Project

Sickle Cell Association of Ontario

Black Creek Community Health Centre

Parkdale Queen West Community Health Centre

Rexdale Community Health Centre

Peloton Anti-Racism Initiative

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Today we're talking with Dr. Tim Rutledge, President and CEO of Unity Health Toronto. Tim was previously President and CEO of North York General Hospital.

Tim is a physician, trained in Emergency Medicine. He developed a strong interest in medical education early in his career and chaired the committee that developed the University of Toronto's first undergraduate course in Emergency Medicine.

From the earliest days of the pandemic, Unity Health put a strong emphasis on caring for and vaccinating people experiencing homelessness and Indigenous populations. Tim's own journey of leading the hospital during this turbulent time has led him to a new understanding of the lessons of anti-racism, equity and social accountability.

A big part of Tim's life – and one of the important ways he unwinds – is through music. He discovered his love of playing at the piano as a young man and he now plays and records on several instruments. Healthcare and leadership are of course his central preoccupations but coming back to his music always gives Tim a feeling of joy and fulfillment.

Quotables

"One of the most important attributes in my experience of an effective leader is the ability to listen. I mean capital 'L' listen. Listen to truly understand the issues." – TR

"COVID has really put into stark relief the fact that there was a disproportionate impact on vulnerable and racialized populations. It really has highlighted that equity is a key dimension of quality in healthcare. It's a major focus here at Unity and for me personally." – TR

"We need to recognize that we all have blindspots, as individuals and within our organizations. This is something we're going to have to put a lot of work into." – TR

"I think the most important thing we've been focussing on the last year or so is making sure that people have some time to unplug. We've been trying to be disciplined about that as well." – TR

"In Ontario we have fewer acute care beds per population than any other province, and fewer beds than any other country in the world. We're tied at the bottom with Mexico at 1.4 beds per thousand." – TR

"The power of the perspectives we get from our patients is not to be underestimated. Our patients are continually giving us great advice on how we can improve the care experience." – TR

"What we really need to focus on in the future healthcare provider is the human aspect. The clinician-patient relationship, connecting with patients in a way that optimizes their care and optimizes their experience. Plan for the many, deliver to the one." – TR

Mentioned in this Episode:

North York General Hospital

Unity Health Toronto

Clay Christensen

Donald Berwick

Eric Topol

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Today we're talking with Carmine Stumpo, President and CEO of Orillia Soldiers' Memorial Hospital. Carmine joined Orillia Soldiers' in 2018 after spending 21 years at Michael Garron Hospital in East Toronto.

Even if one of his first acts as CEO was participating in a polar swim fundraiser, Carmine has warmed up to every element of running a community hospital. This spring he was proud to unveil the hospital's five-year strategic plan under the banner "We Are One Community". The pandemic necessitated a radical reboot in how they structured the plan but Carmine is determined that all staff, volunteers and partners see themselves in that plan.

One of his proudest – and most difficult – moments during the pandemic was overseeing the hospital's support of a long-term care facility when it experienced a tragic COVID outbreak. Although he's been through crises before, Carmine said it was a humbling event that tested his personal resilience.

Quotables

"You need to be cognizant of the fact that there are really good practices and we need to celebrate that and appreciate that." – CS

"We were able to come up with a strategy that we believe reflects, in a very positive and forward-thinking way, the aspirations of this hospital and what aspire to be for our team." - CS

"The number one issue is, how do we continue to sustain the service and address some of our facility needs that we will have in the years to come which have been accelerated because of this tremendous growth. We see this as an opportunity." - CS

"As leaders, it was a humbling experience around an incredibly difficult situation and reminding ourselves why we're in the healthcare industry, how important it is to band together in these crises and do what we can to support because it is larger than any one organization." - CS

"The best advice I can give to an emerging healthcare leader is, leadership matters." - CS

"Volunteering to do that work, preparing vaccines was a ton of fun, great to work with our community, and was really re-energizing." – CS

With his avid interest in woodworking, near the beginning of the pandemic, Carmine challenged himself with building his office. It included a very attractive series of wine racks – and 'in true pharmacist fashion' he has positioned his licence as a certified mixologist.

Mentioned in this Episode:

Orillia Soldiers' Memorial Hospital

Roberta Place

Michael Garron Hospital

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For this special series, Voices Lifting the Community, HIROC is partnering with the Alliance for Healthier Communities to highlight the work of several of the presenters at their online primary healthcare conference in June.

Today we're talking with Kate Vsetula, Director of Community and Organizational Development at the Guelph CHC. One of the many programs Kate works on is ACEs which stands for adverse childhood experiences. Research has shown that those experiences are common and universal and can increase the potential for negative health outcomes later in life.

Together with her many community partners, Kate takes an upstream approach to ACEs that focusses on building resilience within individuals, the family and the community. It starts with how you pose the question – not by saying "What's wrong with you?" but "What happened to you?"

Kate has been recognized with a Woman of Distinction Award, the University of Guelph Emilie Hayes Community Partnership Award, and The Alliance for Healthier Communities Health Equity Award.

Quotables

"ACEs are experiences in childhood that can shape who we are and set the stage for who we will become." – KV

"ACEs do not predict your future, they just raise the risk of potential lower health outcomes. How we can adjust for that is by building community and family resiliency." – KV

"I have experience with ACEs in my life and I have lots of people around me who have had those experiences and I see that ensuring protective factors and building communities that can support people through this is a really great long game." - KV

"What we know is in our community, according to a local study we did as a coalition is that 81% of adults in the Guelph-Wellington area have experienced one ACE and that 31% of people have experienced four or more." - KV

"I believe in the quote that every system is perfectly designed to receive the results it gets – we need to backsolve on our systems that don't actually work to support those most marginalized." - KV

"The passion in your voice Kate truly epitomizes what this series is called, 'Voices Lifting the Community,' and not only your voice but the voices of your colleagues and the coalition." - PDS

"I feel so fortunate to work at the Guelph CHC because my work actually feeds my soul and keeps my passion going." - KV

Mentioned in this Episode:

Guelph CHC

Kingston CHC

Toward Common Ground

ACEs Coalition in Guelph and Wellington County

Adverse Childhood Experiences (ACEs)

Alliance for Healthier Communities

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For this special series, Voices Lifting the Community, HIROC is partnering with the Alliance for Healthier Communities to highlight the work of several of the presenters at their online primary healthcare conference in June.

Today we're talking with Cheryl Prescod, Executive Director at Black Creek Community Health Centre and member of the Alliance Black Health Committee, and Joelleann Forbes, Mental Health Therapist at Women's Health in Women's Hands Community Health Centre.

Early data of the COVID-19 crisis, broken down by race, revealed that COVID-19 disproportionately affected Black, racialized, and poor communities at much higher rates than the general population. This comes as no surprise to Cheryl and Joelleann who in their respective jobs and communities, see the consequences every day of racism and discrimination on Black women, and how it creates unequal access to treatment.

If there is an upside, the women are hopeful that the inequities and discrimination exposed by the pandemic lead to a permanent shift in attitudes – and activate the development of policies and programs tailored to Black communities.

Quotables

"For us, care is not only about having access to seeing a healthcare provider, but enabling folks to have the tools to access that care." – CP

"As a mental health therapist, witnessing how everyone has different boats and tools for how they're coping – some people don't have a boat at all, they might only have a piece of wood floating in the ocean." - JF

"For folks who were here alone in a new country and having to deal with settlement issues and perhaps not even knowing the language, it was really a double or triple pandemic because they were experiencing so much loss." - CP

"All this data that has been collected, and by that I mean the narratives and stories that our community members are sharing, cannot just disappear. It has to inform better policies in the future." – JF

"These stories tell us that people want to see themselves represented in the healthcare they're receiving. Even in the vaccination drive, this is an important piece and it will increase trust in our system." - CP

"It's always important to recognize that the Black identity is not a monolith. This means the experiences of the Black population should not be reduced to a single narrative." – JF

"It's not enough for us to say "I'm not a racist," – we have to be equally invested in being anti-racist and that is an actionable thing." – CP

"Our community is so much our strength and we have to work with them hand-in-hand." – CP

Mentioned in this Episode:

Women's Health in Women's Hands Community Health Centre

Black Creek Community Health Centre

Alliance Black Health CommitteeBlack Physicians' Association of Ontario (BPAO)

Alliance for Healthier Communities

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For this special series, Inspiring Impact, HIROC is partnering with AdvantAge Ontario to highlight the work of several of the presenters from their 2021 online education and networking event.

Today we're talking with one of the session presenters, Jennifer Cornell, Director of Long Term Care for the County of Grey. She moved into the position in 2019. During the tumultuous time that followed, she's been fortified by the support of the Long Term Care community where leaders are encouraged to express vulnerability and "Call a Friend" when they need help.

Jennifer has also derived strength from the County slogan, Colour It Your Way – words that express a promise and a philosophy of person-centred care. Making that philosophy central to every decision she says has meant talking about it a lot and getting curious about what it means to people.

Quotables

"In a new leadership role, in a pandemic, I have found and continue to find the Colour It model and that framework really helpful in taking a step back, taking a breath and thinking through how can I use Colour It to make a person-centred decision." – JC

"We use the Colour It language and the Colour It acronym to ask meaningful questions." – JC

"The Long Term Care sector is a really caring and compassionate and innovative and helpful group of leaders. When you reach out and say, 'Hey, I'm not sure how to handle this', someone responds." – JC

"Many times staff flexed their start time so they could support their kids at home and also still fulfill their commitment at work. We really took this very flexible approach." – JC

"Get clear on your purpose and vision. What is it you're trying to achieve as an organization or as a care home, then go out and start saying the words. Ask lots of questions. People will tell you when you ask them." – JC

"I do depend on my colleagues to give me a nudge and say, 'Hey, you've suggested I take a break, I think you need to take a break too.'" – JC

"It's so true when you talk about having that North Star of Colour It Your Way, making sure you remember and say it." – PDS

"We're in the early stages of two new builds, new redevelopments and so Colour It will be a very strong theme and guide – the North Star – to help us make sure we're on vision." – JC

Mentioned in this Episode:

AdvantAge Ontario

AdvantAge Ontario Annual Convention

Grey County Long Term Care

Grey Gables

Lee Manor

Rockwood Terrace

Colour It Your Way

Brené Brown

Happily Ever Older – Moira Welsh

Atul Gawande – Being Mortal

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