Qualitycast North

The Northern Medical Program (NMP) is an inspiring Northern success story based on community action.  The NMP is a unique medical undergraduate program that educates future doctors with a focus on rural health. Dr. Paul Winwood is the current Regional Associate Dean of the program, a position he has had for over 10 years. Originally from the United Kingdom, Dr. Winwood settled in Prince George to practice gastroenterology, academic medicine, and provide leadership to the NMP. He loves the community here and especially enjoys spending time outdoors with his family, skiing in the winter and boating in the summer. In this episode Dr. Winwood shares the history of the NMP and describes the various ways the program ensures the quality of education,  performance, and learning experiences of the students. We discuss how the profile of medical learners has changed to improve the diversity of physicians entering medical practice, and how the program has influenced physician retention in the North, especially in Indigenous communities.

In this episode, Qualitycast North is leaving the snowy North (yes we still have snow in March) and heading South to showcase some of the excellent Quality Improvement work being done by  2 physicians in the Fraser Valley area; Dr. Diala El-Zammar and Dr. Raj Johal.  Dr. El-Zammar and her family came to Surrey, BC, Canada from Lebanon when she was 9. A self-described ‘nerd’, her love of sciences led her to medicine, and she now practices in the Emergency Department at Chilliwack General Hospital. Dr. Johal also grew up in Surrey and was influenced to pursue medicine by his parents who worked in healthcare and the sciences. He is currently a family physician in his hometown of Surrey and is the provincial PQI champion for publishing.

Dr. El-Zammar shares her very successful  and innovative quality improvement work in implementing a virtual follow up process for emergency department patients. Integral to quality improvement is sharing the work and results through a variety of media including publishing.  Also in today’s episode, Dr. Johal discussing the topic of QI publishing, including the why and how of publishing QI work, and what supports are available to PQI teams, and we’ll hear about Dr. El-Zammar’s experience publishing her QI work in the ‘BMJ Open Quality’ journal. They also share what they enjoy most about living and working in BC.

You can read Dr. El-Zammar and Dr. Johal published article here:

El-Zammar D, Johal R, Eng J, Schultz, T. Implementation of an emergency department virtual follow-up care process in a community-based hospital: a quality improvement initiative. BMJ Open Quality 2022;11:e001782. doi: 10.1136/bmjoq-2021-001782

Dr. Magda Du Plessis is passionate about maternal care, providing the best patient care possible, and quality improvement. She is part of the multidisciplinary team at the Chickadee Maternity Collaborative in Dawson Creek, BC, that includes other physicians, nurses, midwives, pharmacists, and administrative staff. Dr. Du Plessis led the team through a quality improvement project that aimed to have 100% of eligible pregnant patients in the South Peace registered with the Chickadee Maternity Collaborative, to ensure comprehensive, wrap-around care, while also seeking to decrease the rate of caesarean sections and patient safety events. With support from a physician quality improvement coach and a practice support coach, and the use quality improvement tools, the team met their goals; within the first year of operation 100% of eligible patients were registered within the collaborative, the caesarean section rate dropped from 33% to 25%, and there were zero patient safety reports. Dr. Du Plessis credits this success to teamwork, coaching, and the passion of the team. While there were challenges, patients ultimately appreciated the new, team-based, collaborative model of care that includes longer appointment times, and supportive discussions throughout the reproductive health experience. She also shares how her and her family enjoy all of the recreational activities the South Peace has to offer, from fishing, to skiing, to snowmobiling. 

Growing up, Dr. Danette Dawkin didn’t initially see herself pursuing medicine, but after receiving a pamphlet for UBCs rural medicine program, she was inspired to apply, and is now a family physician that has provided services in many rural and Indigenous communities across the North. Implicit biases are unconscious assumptions that can affect how patients are treated based on characteristics such as race, gender, weight, drug-use, and marital status. Dr. Dawkin recently developed a reflective-practice based course to improve cultural safety in healthcare services in the Northeast community of Chetwynd, BC. She brought together an interdisciplinary, dynamic team to learn, discuss and reflect on the internal, implicit biases that we all carry, with the goal of providing care that is rooted in humility and curiosity. Dr. Dawkin shares her experiences with the uncomfortable and difficult work of confronting our own implicit biases, why this approach is so challenging, and how it can ultimately make care safer for everyone. 

Have you ever wondered what the CEO of a large, complex, healthcare organization does, or how leadership and governance supports quality care? In this episode of Qualitycast North we further explore the relationship between quality and healthcare leadership through a conversation with the longest serving Health Authority CEO in recent provincial (BC) history, the current CEO of Northern Health, Cathy Ulrich. Cathy shares her journey through her early career in rural nursing, to rural operational leadership, to strategic leadership. Cathy also discusses her love of gardening, her appreciation for the people within our organization and the people we serve and outlines her top 4 lessons for successful leadership.

Dr. Helene Smith is a Family Practitioner based in Quesnel BC, and also the Chair of the Northern Health Medical Advisory Committee, also referred to as NH-MAC. Originally from South Africa, she found her niche in rural family practice, and eventually became more involved in leadership roles.

Since late 2020, provincial healthcare has been making efforts to improve cultural safety for Indigenous patients and healthcare workers. In this episode, we explore the relationship between medical leadership, cultural safety and humility, and quality. Dr. Smith shares her vision for cultural safety and the commitment that medical leaders have made to a cultural safety action plan. She also provides an informative overview of the purpose and structure of the Northern Health Medical Advisory Committee, and how it influences physician quality in Northern Health. 

Dr. Breanne Abbott is a primary care physician at the Stikine Health Centre, which is located on the traditional territory of the Tahltan Nation, in the community of Dease Lake. The Stikine Health Center is one of Northern Health’s most remote clinics and services an area the size of France, with the closest critical care facility nearly 600 kilometers away. Dr. Abbott first visited the area as a medical student and was amazed by the opportunities for recreation, the natural beauty, and the friendly community. After completing medical school and returning to Dease Lake to practice, she now shares the experiences of the area with her husband and son, who all love their time there. 

Maintaining clinical skills and competencies is key for providing quality health care, especially in urgent, life-threatening situations in remote locations. When Dr. Abbott became interested in doing a Physician Quality Improvement (PQI) project, she saw an opportunity to focus on supporting the Stikine Health Centers small but mighty team to maintain their life support skills. The aim of her project was to improve the comfort and competence of health care professionals providing cardiac emergency care in the Stikine area by 50%. To meet this goal, she acquired a cardiopulmonary resuscitation (CPR) meter and facilitated the funding and logistics to have trainers travel to Dease Lake to provide on site basic life support (BLS),  advanced cardiac life support (ACLS) and pediatric life support (PALS) training tailored for the local, remote context. Overall, her project was a resounding success! Not only was the project a great opportunity for team building, but the team was also able to see improvements in all measured areas of the project. Dr. Abbott has since put her PQI training to use on further projects, such as remote airway training, and improving availability of blood products.  You can learn more about Dr. Abbotts project and view her storyboard here.

Dr. Breanne Abbott is a primary care physician at the Stikine Health Centre, which is located on the traditional territory of the Tahltan Nation, in the community of Dease Lake. The Stikine Health Center is one of Northern Health’s most remote clinics and services an area the size of France, with the closest critical care facility nearly 600 kilometers away. Dr. Abbott first visited the area as a medical student and was amazed by the opportunities for recreation, the natural beauty, and the friendly community. After completing medical school and returning to Dease Lake to practice, she now shares the experiences of the area with her husband and son, who all love their time there. 

Maintaining clinical skills and competencies is key for providing quality health care, especially in urgent, life-threatening situations in remote locations. When Dr. Abbott became interested in doing a Physician Quality Improvement (PQI) project, she saw an opportunity to focus on supporting the Stikine Health Centers small but mighty team to maintain their life support skills. The aim of her project was to improve the comfort and competence of health care professionals providing cardiac emergency care in the Stikine area by 50%. To meet this goal, she acquired a cardiopulmonary resuscitation (CPR) meter and facilitated the funding and logistics to have trainers travel to Dease Lake to provide on-site basic life support (BLS), advanced cardiac life support (ACLS) and pediatric life support (PALS) training tailored for the local, remote context. Overall, her project was a resounding success! Not only was the project a great opportunity for team building, but the team was also able to see improvements in all measured areas of the project. Dr. Abbott has since put her PQI training to use on further projects, such as remote airway training, and improving availability of blood products.  You can learn more about Dr. Abbott's project and view her storyboard here.

Qualitycast North is thrilled to kick off its second season by featuring Dr. Herman Johal, and his quality improvement work on creating an intubation checklist for the emergency department physicians at the University Hospital of Northern BC (UHNBC), located in Prince George, BC, Canada.

Dr. Johal is an emergency medicine physician practicing at the emergency department at UHNBC. He spent his childhood in Prince George, and after attending medical school, returned full circle to serve the community he grew up in. He credits the amazing healthcare team and collaborative environment of the UHNBC emergency department for creating an enjoyable work environment.

Medical intubation is the process of inserting a breathing tube into a patient's airway to assist breathing in cases of severe illness or trauma. Drawing from the INTUB study (Russotto et al. 2021) and concepts of the surgical safety checklist (Haynes et al. 2009), Dr. Johal saw an opportunity to improve team dynamics, communication, and patient safety during intubations. He developed and implemented a local, standardized intubation checklist and a point-of-care reference card for emergency physicians, which was very well received by the team; 100% of Nurses & MDs surveyed say they would promote the ongoing use of the checklist.

Additional information and storyboard: Development of an Airway Checklist for UHNBC Emergency Physicians | Northern Health PQI Projects (nhpqi.ca)

References:
Russotto V, Myatra SN, Laffey JG, et al. Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients From 29 Countries. JAMA. 2021;325(12):1164–1172. doi:10.1001/jama.2021.1727

Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC, Merry AF, Moorthy K, Reznick RK, Taylor B, Gawande AA; Safe Surgery Saves Lives Study Group. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009 Jan 29;360(5):491-9. doi: 10.1056/NEJMsa0810119. Epub 2009 Jan 14. PMID: 19144931.

Dr. Chui and Deanna reflect on the first season of Qualitycast North, discussing their favorite moments and most popular episodes, and providing some insights into some of the exciting quality improvement work that will be featured in season 2.