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Christine Power, Chair, Board of Directors, Association of Canadian Academic Healthcare Organizations

eight policy challenges that can be grouped across the headers of community-based and primary health care, health system capacity building and research and applied health system innovation

Given that we are seven plus years into the 2004 health accord, we believe it is time to open a dialogue on what a 2014 health accord might look like. Noting the recent comments by the Prime Minister and Minister of Health, how can we improve accountability in overall system performance in terms of value for money?

February 7, 2014

Dismissing a union policy grievance, a British Columbia arbitrator held that a provincial government policy requiring health care workers to get a flu shot or wear a mask while caring for patients during flu season was a reasonable and valid exercise of the employer's management rights.

Arbitrator upholds mandatory flu shot policy for health care workers

Pamela Fralick, President and Chief Executive Officer, Canadian Healthcare Association

I will therefore be speaking of home care as just one pillar of continuing care, which is interconnected with long-term care, palliative care and respite care.

The short-term acute community mental health home care services for individuals with mental health diagnoses are not currently included in the mandate of most home care programs. What ended up happening is that most jurisdictions flowed the funding to ministries or other government departments that provided services through established mental health organizations. There were few provinces — as a matter of fact, Saskatchewan being one of the unique ones — that actually flowed the services through home care.

In Ontario, the hazards of health care work were dramatically highlighted during the SARS crisis. Overall, 375 people contracted SARS in the spring of 2003. Over  three quarters were  infected in a health care setting, of whom 45% were health care workers.

Justice Archie Campbell led a commission to learn from SARS, and highlighted the danger for staff working in health care settings – and in this case, hospitals. The report opens by stating “hospitals are dangerous workplaces, like mines and factories, yet they lack the basic safety culture and workplace safety systems that have become expected and accepted for many years in Ontario mines and factories.”

Workplace injuries have been steadily declining over the past two decades.  In 1987, 48.9 of 1,000 working Canadians received some form of workers’ compensation for injury on the job, and this has declined continuously to 14.7 per 1,000 in 2010. While injury rates for health care workers have declined slightly over that same time period, they remain stubbornly difficult to change.

Abstract The World Health Report launched the Health Workforce Decade (2006-2015), with high priority given for countries to develop effective workforce strategies including healthy workplaces for health workers. Evidence shows that healthy workplaces improve recruitment and retention, workers' health and well-being, quality of care and patient safety, organizational performance and societal outcomes. Over the past few years, healthy workplace issues in Canada have been on the agenda of many governments and employers. The purpose of this paper is to provide a progress update, using different data-collection approaches, on knowledge transfer and uptake of research evidence in policy and practice, including the next steps for the healthy workplace agenda in Canada. The objectives of this paper are (1) to summarize the current healthy workplace initiatives that are currently under way in Canada; (2) to synthesize what has been done in reality to determine how far the healthy workplace agenda has progressed from the perspectives of research, policy and practice; and (3) to outline the next steps for moving forward with the healthy workplace agenda to achieve its ultimate objectives. Some of the key questions discussed in this paper are as follows: Has the existing evidence on the benefits of healthy workplaces resulted in policy change? If so, how and to what extent? Have the existing policy initiatives resulted in healthier workplaces for healthcare workers? Are there indications that healthcare workers, particularly at the front line, are experiencing better working conditions? While there has been significant progress in bringing policy changes as a result of research evidence, our synthesis suggests that more work is needed to ensure that existing policy initiatives bring effective changes to the workplace. In this paper, we outline the next steps for research, policy and practice that are required to help the healthy workplace agenda achieve its ultimate objectives. The early decades of the 21st century belong to health human resources (HHR). The World Health Report (World Health Organization [WHO] 2006) launched the Health Workforce Decade (2006-2015), with high priority given for countries to develop effective workforce strategies that include three core elements: improving recruitment, helping the existing workforce to perform better and slowing the rate at which workers leave the health workforce. In this recent report, retaining high-quality healthcare workers is discussed as a major strategic issue for healthcare systems and employers, and improving workplaces as a key strategy for achieving this goal. The workplace can act as either a push or pull factor for HHR. Heavy workloads, excessive overtime, inflexible scheduling, safety hazards, poor management and few opportunities for leadership and professional development are among the push factors that result in poor recruitment and retention of HHR. Evidence shows that healthy workplaces improve recruitment and retention, workers' health and well-being, quality of care and patient safety, organizational performance and societal outcomes. What are healthy workplaces? Based on existing definitions, there is not yet a standardized and comprehensive definition of healthy workplaces. In this paper, we define healthy workplaces as mechanisms, programs, policies, initiatives, actions and practices that are in place to provide the health workforce with physical, mental, psychosocial and organizational conditions that, in return, contribute to improved workers' health and well-being, quality of care and patient safety, organizational performance and societal outcomes (Griffin et al. 2006). Over the past few years, healthy workplace issues in Canada have been on the agenda of many governments and stakeholder organizations. Nationally and internationally, robust evidence has been accumulated on the impact of healthy workplaces on workers' health and well-being, quality of care, patient safety, organizational performance and societal outcomes. This evidence has provided guidance for governments and employers in terms of what should be done to make the workplace healthier for healthcare workers. Across Canada, many initiatives to improve the working conditions for HHR are currently under way, but the continuing concerns suggest that barriers remain. An assessment of the progress to date is necessary in order to inform the next steps for research, policy and practice.

Toronto Star Thu Apr 16 2015 Page: A21

With a federal election on the horizon, we're starting to see policy topics creeping, as they so rarely do, into the headlines: the economy, energy prices, jobs, even climate change. But what seems surprisingly absent from the political conversation so far is any discussion of an issue that is traditionally top-of-mind for Canadians: our health, and how we can improve it. Health for many pundits is all about health care. And while health care deserves its place in the political spotlight, it's also essential that voters understand a too-often ignored, inextricably linked issue: the human and economic costs of poverty on health.

These costs aren't just personal - affecting those unfortunate many beneath the poverty line - but affect our economy and our communities as a whole. Fail to address poverty, and you fail to address health. Fail to address both and your discussions about the economy or jobs or markets (which rely on healthy Canadians and healthy communities) are incomplete. More than three million Canadians struggle to make ends meet and what may surprise many is the devastating influence poor income, education and occupation can have on our health. Research shows the adage, the "wealthier are healthier," holds true, as the World Health Organization has declared poverty the single largest determinant of health.

Toronto Star Thu Jul 2 2015

A nurse is punched in the face by a patient. Another is kicked in the breast. One patient calls a nurse a "Nazi b---h." Another throws urine.

One man fondles his genitals in front of a hospital staffer. Another spits in a nurse's face. These are all incidents of assault that hospital staff reported in 2014 at University Health Network (UHN), according to information obtained by the Star through an Access to Information request. Over the past three years, reports of violence on hospital staff by patients and families of patients have been on the rise - in some cases doubling, according to information provided to the Star. In an email to the Star, a UHN spokesperson said the increases are probably the result of changing violent-incident reporting requirements. There are similar increases in violent incidents reported at other Toronto-area hospitals, statistics show.

The Lucian Leape Institute at the National Patient Safety Foundation today released a report focusing on the health and safety of the health care workforce

Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Health Care contends that patient safety is inextricably linked to health care workers’ safety and well-being because caregivers who suffer disrespect, humiliation, or physical harm are more likely to make errors or fail to follow safety practices.

“Most health care organizations have done little to support the common contention that ‘people are our most important asset.’”

Toronto Star Thu Sep 3 2015

The federal party leaders may be paying little attention to the many troubles that vex Canada's health-care system, but Dr. Samir Sinha doesn't have that choice. The director of geriatrics at Mount Sinai and the University Health Network hospitals faces a constant struggle to meet elderly patients' needs. It is a demographic the system wasn't designed to serve. When it comes to home and community care services, the system is seriously faltering, warns Sinha, who is concerned that if the problems are not addressed soon they will get much worse as the seniors population grows.

The health-care system isn't ready to meet the current needs and the future needs of our aging population. There is almost a situation where everyone is putting their heads in the sand," said Sinha, who also serves as the provincial lead for the Ontario Seniors Strategy. With just over six weeks left in the federal election campaign, Sinha hopes the leaders will turn their attention to seniors' pressing health needs. It would make good political sense, given that more than 80 per cent of seniors vote, he noted.

The Telegram (St. John's) Tue Oct 18 2016

John Haggie and other health ministers will push for the restoration of the previous six per cent annual increase in federal health transfers in a renewed Health Accord. When they meet with federal Health Minister Dr. Jane Philpott in Toronto today, one item should be added to the agenda. Isn't it time to revisit the Canada Health Act and fine-tune it? Over the past decades, many violations have occurred. Up until last year, Ottawa clawed back nearly $10 billion from Alberta, Manitoba and especially British Columbia for extra billing. Private MRI clinics are operating in British Columbia, Alberta, Quebec, New Brunswick, Nova Scotia and Saskatchewan.

Dr. Brian Day's court challenge is underway in Vancouver. The main issue is whether Canadians should be permitted to pay privately for "medically necessary services" already covered by their provincial health plan. Is there a need for increased private health care in Canada? If so, can it be implemented without jeopardizing the public system?

Toronto Star Fri Oct 16 2015

Health Minister Rona Ambrose acted for an "improper purpose" when, during a political and media firestorm, she banned drug products from Canadian pharmaceutical giant Apotex's two Indian facilities, a federal court judge has ruled. The decision, handed down by Justice Michael Manson this week, said Ambrose ignored the company's right to respond to the government's concerns before the sweeping regulatory action was taken a year ago. The judge also quashed the ban and told the minister to take back her public statements related to the ban. "The import ban was motivated by the minister's desire to ease pressure triggered from the media and in the House of Commons," the ruling said, adding that it was "an action taken without legal authority."

"As Minister of Health, I remain committed to protecting the health and safety of Canadians." A Health Canada spokesman said the department is reviewing the decision. After the Apotex suit was filed in court last year, Ambrose told the Star that she stood by her decision to ban Apotex products. "Canadians expect Health Canada to take the action needed to help protect them from drug safety risks," she said at the time. "We stand by our decision to take precautionary action to protect the health and safety of Canadians." During cross-examination of Health Canada witnesses during the case, officials stated there was no evidence that products "produced a risk or threat to the health of consumers," the judge noted in his ruling.

CMAJ March 17, 2015 vol. 187 no. 5 First published February 9, 2015, doi: 10.1503/cmaj.109-4992

Lauren Vogel

The Supreme Court of Canada unanimously struck down the ban on physician-assisted death to mentally competent patients who are suffering and deemed impossible to remedy or cure. The court ruled that the ban infringes on provisions for life, liberty and security of person in Section 7 of the Charter of Rights and Freedoms. Parliament has 12 months to draft new legislation. Physicians will not be compelled to assist

Calgary Herald Mon Jan 19 2015

Rats scurrying down hospital hallways, chewing through wires and nibbling on food scraps near the cafeteria. These are a few of the recent rodent sightings reported by public health inspectors, nurses and staff members at B.C. Women's and Children's Hospital in Vancouver.

Inspectors issued verbal and written directives after the Dec. 22 visit, according to the environmental health inspection report, which notes: "Minimal pest proofing has been completed to date which is contributing to the difficulty in controlling and abating the rodent activity with the food services." The report also mentions: "A number of food products have been chewed through resulting in products being discarded," and "wiring of equipment chewed on in the retail side which also raises a safety concern." The most recent inspection report lists a "Target Completion Date" for rodent control recommendations as Jan. 27. Taki said the hospital has an action plan in place with the help of the pest control company. "We've asked them to almost quadruple-up on the service until everything gets under control," said Taki.

In the article Patient Safety –Worker Safety: Building a Culture of Safety to Improve Healthcare Worker and Patient Well-Being, Annalee Yassi and Tina Hancock note that: “Patient safety and access to high quality patient care are the top priorities for the healthcare system. However, according to the Canadian Adverse Events Study approximately 7.5 percent of Canada’s 2.5 million hospital patients experienced at least one adverse event in 2000 and up to 23,750 patients died as a result…Many of these events were potentially preventable.” (Healthcare Quarterly, October 2005). Yassi and Hancock’s research connects the dots between safety in the workplace, the safety of workers and patients, and workplace conditions:

by Joseline Sikorski

“Workers in high -injury rate facilities had more negative perceptions of their job demands and workload pressures than workers in low injury facilities. They were more likely to report that they did not have time to get their work done, to work safely, to find a partner, or to use a mechanical lift. Workers in high-injury rate facilities also reported more pain, more burnout, poorer personal health and less job satisfaction. Conversely, workers at facilities with low injury rates were more likely to agree that their facility had enough staff to provide good quality care and did indeed provide good to excellent care.” (Healthcare Quarterly, October 2005).

Healthcare Quarterly, 16(4) October 2013: 6-9.doi:10.12927/hcq.2014.23643

Psychological health and safety are growing priorities in Canadian workplaces, including Canadian healthcare settings. The workplace has a key role to play in promoting mental health. The Canadian Healthcare Association recently adopted a position statement strongly encouraging members and all health stakeholders to adopt and take action to implement the new voluntary standard, outlined in Psychological Health and Safety in the Workplace. The Canadian Healthcare Association (CHA) recently adopted a position statement (2013) strongly encouraging members and all health stakeholders to adopt and take action to implement the new voluntary standard outlined in Psychological Health and Safety in the Workplace (CSA Group 2013). (On January 1, 2014, CHA is merging with the Association of Canadian Academic Healthcare Organizations [ACAHO] to create a new national health organization). Championed by the Mental Health Commission of Canada (which has applauded "CHA for its leadership on developing this position paper and highlighting the importance of psychological health and safety in the workplace" [CHA 2013, November 26]), the standard was developed collaboratively by the Bureau de normalisation du Québec and CSA Group.

Toronto Star Mon Feb 9 2015

Canada's biggest pharmacies are selling allergy pills made with ingredients from a drug facility in India that hid unfavourable test results showing excessive levels of impurities in their products, a Star investigation has found. Recently, the Star purchased packs of over-the-counter desloratadine tablets from Toronto-based Shoppers Drug Mart, Rexall, Walmart and Costco stores.

One month before, on Dec. 23, Health Canada had announced these antihistamines - made by Pharmascience - were under quarantine after serious problems were unearthed during an inspection of the company's drug facility in India. Inspectors found unsanitary conditions at the facility, including high growth of bacteria and mould. Even though government inspectors discovered significant misconduct dating back to 2012, the December quarantine technically affects only new products made in the past month and a half - not ones already sitting on store shelves.

by Wendy Glauser, Mike Tierney & Michael Nolan (Show all posts by Wendy Glauser, Mike Tierney & Michael Nolan) March 31, 2016

In recent years, various health care professions have called for better regulation – including paramedics, personal support workers, physician assistants and others. Inadequate regulation has led to confusion that can put the public at risk, representatives of the professions say.

For many paramedics in Ontario, the Emergency Health Services Branch of the Ministry of Health sets the rules around how paramedics transport people and provide basic care like managing wounds, while base hospitals delegate more advanced care activities like administering medications and inserting breathing tubes.

The Sudbury Star Wed Sep 16 2015

A former health minister from the United Kingdom says he believes "private clinics are a bad option for the people of Canada." Frank Dobson, who was health minister from 1997 to 2000 in Tony Blair's Labour Party government, made a stop in Sudbury on Tuesday. Dobson was invited by the Ontario Council of Hospital Unions (OCHU) to speak about the pitfalls of privatization of health-care services in the United Kingdom. He is visiting eight other communities in the province to give his take on health-care privatization and how it may affect the health-care system in Ontario. "I wouldn't recommend the British model to anyone because it has basically been a rip off," Dobson said.

"The money going into running the system (in Britain) has gone up from between four and six per cent of the total National Health Service spending to somewhere between 12 and 15 per cent of NHS spending going on this semi-commercial system and that is somewhere around 8 billion pounds a year extra going on the cost of running the services (that are) not going on patient care, Dobson said. Dobson also provided other examples of why the system is flawed in the Britain.

As of June 30th refugees in Canada will be cut off access to treatment for chronic diseases including hypertension, angina, diabetes, high cholesterol, and lung disease.

“The changes are being justified using three flawed arguments. First, we are told that refugees are abusing our health care system. The reality is the exact opposite. Our challenge as physicians is to engage vulnerable people with the health care system, especially prevention and primary care, not turn them away. I have never met a refugee who came to Canada because they wanted better health care. In comparison to starvation, torture, and rape, getting vision care is never the motivation. Second, they say they are doing this for public safety. Actually, they are endangering public safety by denying basic health care services. People only pose a risk to the public if they are not properly engaged in health care. For example, if a person with tuberculosis is only offered care after they are spitting blood, they will have already infected others. Third, the Minister claims this is about saving taxpayers money. When you stop providing preventive care you wind up with repeated emergency room visits and preventable hospitalizations that cost a lot more money,” said Dr. Mark Tyndall, Head of Infectious Diseases at the Ottawa Hospital and Professor of Medicine at the University of Ottawa.

The Canadian Heath Coalition sees the cuts to refugee health care services as part of a broader pattern emerging from the recent federal budget. Other cuts that affect the health of vulnerable Canadians include: mental health services for soldiers at Petawawa; systematic spending cuts to aboriginal health programs; the elimination of Health Canada’s Bureau of Food Safety Assessment and food safety inspection at the CFIA.