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Irene Jansen

CMAJ: Feds target redundancies and waste at Health Canada - 0 views

  • The budget, unveiled Mar. 29 by Finance Minister Jim Flaherty, will see cuts in health department spending to the tune of $309.9 million by fiscal 2014/15, some $200.6 million of which will be achieved through measures aimed at “enhancing coordination, consolidating operations and eliminating redundant activities” at Health Canada
  • “I'm hard pressed to see how that sort of money is going to come from consolidation of some services,” says Patty Ducharme, national executive vice-president for the Public Service Alliance of Canada. “With Health Canada, what can you consolidate that's not going to have a massive impact on the services that are delivered to Canadians?”
  • Health Canada and the Public Health Agency of Canada (PHAC) will adopt a shared services model
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  • The Canadian Food Inspection Agency (CFIA) will similarly merge its back-office functions with Agriculture and Agri-Food Canada
  • As part of its new action plan, CFIA will overhaul how it monitors and enforces food labelling regulations
  • the government will introduce legislation to wind down Assisted Human Reproduction Canada, the regulatory agency created in 2006 to promote the safety, health and rights of Canadians using reproductive technologies. The agency, which is slated for closure Mar. 31, 2013, is “no longer justified” in the wake of the 2010 Supreme Court of Canada ruling that substantially reduced federal authority over assisted human reproduction (http://scc.lexum.org/en/2010/2010scc61/2010scc61.html). Health Canada will take over responsibility for remaining federal functions, such as compliance and enforcement.
  • All told, the spending reduction measures will trim $111.7 million from the health portfolio in 2012/13. Those savings will grow to $218.5 million in 2013/14 and to $309.9 million by 2014/15.
Govind Rao

Traffic in ORs open door to infection: study; Complications alert - Infomart - 0 views

  • National Post Wed Sep 23 2015
  • New Canadian research is revealing an alarmingly high rate of human rush-hour-like traffic in operating rooms, possibly exposing patients to potentially "disastrous" bacterial infections with every swing of a door. Quebec researchers who secretly recorded how often staff entered or left an operating room during 100 hip or knee replacements - which require a "particularly aseptic environment" - found the doors were opened as many as 176 times during a single surgery.
  • Overall, there were about 71 door openings per surgery. With the average surgery lasting 112 minutes, this means a door opened every 1½ minutes. "I expected the number to be high, but not quite that high," said lead author Dr. Martin Bédard, an orthopedic surgeon at Hôpital de l'Enfant Jésus de Québec.
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  • Frequent door openings can disrupt the positive-pressure airflow system in the OR, "possibly introducing more bacteria into the OR and potentially contributing to contamination of the wound," Bédard and his co-authors write in the Canadian Journal of Surgery. The "bacterial count" in an OR is directly proportional to the number of people in the room, and the more people in the room, the more traffic flowing in and out. "As a surgeon, infection is your worst complication," Bédard said in an email interview. "It is clear that bacteria are brought into the operating room by the OR personnel and can potentially cause surgical wound infections. The best way to monitor traffic is to count door openings."
  • Some people had valid reasons for leaving the OR - to retrieve an instrument or joint component, for example. But others left to "chat with a friend" in the hallway, ask questions not related to the case or to get personal items, Bédard said. Entering an OR should be viewed as "a privilege and not a right," he said. "Before entering any OR, OR personnel should ask themselves this question: Is my presence really beneficial to the patient?" While the study focused on joint replacements, Bédard believes the findings likely apply to other surgeries as well.
  • A leading infectious-disease specialist said the volume of surgery traffic startled him. More than 200,000 Canadians get infected in a healthcare institution each year, and surgical site infections account for about a third of all hospitalacquired infections.
  • "The misery - because I see a lot of these patients - is significant," said Dr. Dick Zoutman, a professor at Queen's University in Kingston and chief of staff at Quinte Health Care in Belleville, Ont. Hip and knee replacements are among the most frequently performed operations in Canada, accounting for more than 104,800 surgeries combined in 2012-13, says the Canadian Institute for Health Information. According to the Quebec researchers, "Infection following total joint arthroplasty remains a disastrous complication for both the patient and surgeon." The cost to treat an infected prosthetic joint can reach $60,000.
  • "Once the bacteria are in contact with metal, it is very difficult, if not impossible to eradicate with antibiotics alone," Bédard said. Infections require repeat surgeries and, sometimes, temporary removal of the prosthesis in order to sterilize the knee. While the individual risk of infection is low - about one to two per cent - "one per cent times thousands of surgeries per year is not insignificant," Zoutman said.
  • Patients are frequently given antibiotics before surgeries and airflow systems push air away from the surgical wound to help prevent infections. But, like Pigpen in the Peanuts comic strip, humans "slough off " millions of cells from the skin's surface, Zoutman said. "The staff are gowned and gloved. But the patient is there, giving off their skin cells as we yank and pull and do the surgery ... we all know from the Pigpen theory of infectious diseases, the more people in the room, the greater the risk."
Govind Rao

Caring for the caregivers; Pilot program provides workplace support for employees deali... - 0 views

  • The Globe and Mail Wed Aug 19 2015
  • Brenda Hill has many identities. She works as a wealth adviser for BMO Nesbitt Burns in Caledon, Ont. She's the primary caregiver for her 78-yearold mother, diagnosed five years ago with Alzheimer's disease. And she's the mother of two twentysomething kids.
  • Yet, it's a new role that has helped her cope with the stress of juggling it all: She's a participant in a five-year pilot program launched by Mount Sinai Hospital's Reitman Centre for Alzheimer's Support and Therapy in co-operation with Bank of Montreal to help employees caring for family members with the disease.
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  • This program and others like it are signs that workplaces and policy makers are starting to take caregivers' needs more seriously. Last year, the federal government announced the Canadian Employers for Caregivers Plan, which called on a panel of employers for their suggestions about how to better support caregivers and keep them in the workplace. And in January, there was an extensive panel on the topic at this year's Human Resources Professionals Association (HRPA) conference. These conversations come just in time, too. A 2012 Conference Board of Canada study estimates the cost to employers in lost productivity because of caregiving responsibilities to be $1.28-billion a year.
  • Statistics Canada shows that 8.1 million Canadians are caregivers and, of those, 6.1 million are in the work force. Most of the caregivers are between the ages of 45 and 64, a group that also comprises the most experienced workers, says Allison Williams, a professor at McMaster University in Hamilton and research chair for the Canadian Institute of Health Research.
  • Since more than half of caregivers are helping their aging parents, Dr. Williams says the problem is set to worsen as the number of seniors requiring care is projected to double between 2012 and 2031.
  • For Ms. Hill, meeting regularly with her five fellow pilot-program members over the sixweek course provided an opportunity to share information about disease symptoms, develop a support network and gain expert advice on how to cope.
  • own compassionate care program back in 2002, predating the government legislation, offers eligible employees up to 13 weeks of leave over a two-year period. Eligible employees with at least three years of service receive 13 weeks pay at full salary. Since it was introduced, approximately 160 employees have taken advantage of the program. Human resources vice-president Tracy Lapointe says that while the program demonstrates respect for employees, there is also a strong business case that helps with more practical goals such as retention and staffing. "Their colleagues know they will be away for a certain period of time, so we can plan for it as [a] business, and have the right coverages in place."
  • In 2004, Canada implemented Compassionate Care Benefits as part of the Employment Insurance system, a program that allows caregivers - widely defined to include everyone from parents to children to friends to common-law partners - up to six months of benefits (expanded in the April, 2015, budget from a previous cap of six weeks). Yet, the 2012 Statistics Canada report also noted that only 12 per cent of caregivers had taken advantage of the program. Dr. Williams attributes this low uptake to lack of awareness.
  • While caregiving experts applaud the program as a positive step, they also say that caregiving can be much more protracted, and the kind of job that can require a morning off to drive a patient to a medical appointment, or an unplanned departure from work to head to an emergency room or senior's home.
  • That's when workplaces can help by instituting flexible work arrangements.
  • Sharon Baxter, executive director at the Canadian Hospice Palliative Care Association, says that companies need to make such policies official. "A lot [of] workplaces say that they accommodate caregiving, but they haven't written it into their policies and that can actually become a bit problematic because then you don't get the same consistency across employees. Somebody who works near the executive office has got a better chance of getting the time off than somebody that works in a plant," Ms. Baxter says.
  • For workplaces that have implemented policies and programs, the level of response is telling. Natalie Scott, managing director of global benefits and recognition at BMO, was surprised at the high turnout to an information session about the Alzheimer's pilot. "We had over 100 people attend. It was standing room only," she recalled. Pharmaceutical company GlaxoSmithKline, which introduced its
  • For instance, Ms. Hill learned that she should just listen to - rather than correct - the garbled stories her mother sometimes told, advice that reduced her mother's agitation, a symptom common to many people with dementia. Role-playing exercises helped participants to problem-solve complex situations, such as advocating for their loved ones more effectively with doctors. Ms. Hill has also been able to share her new knowledge with others; for instance, connecting her stepfather with an Alzheimer's Society support group and offering tips to her siblings. "People come to me now because they know I've gone this route and have information," she said.
  • For workplaces that ignore the needs of the growing contingent of caregivers, the risks are high. "The data we have now suggests that we are losing talented people, some of them senior people with considerable skills and experience. We're seeing absenteeism. We're seeing people reducing to part-time and 'presenteeism' and stress as well," says Donna Lero, a professor at the University of Guelph's Centre for Families, Work and Well-Being.
  • Another burden is the personal cost to individual employees who risk burnout, Dr. Williams says. "What usually happens first is fatigue, then mentalhealth issues like depression and anxiety, and then finally physical health issues."
  • While large employers with deeper pockets seem to be leading the charge on official policies, smaller organizations can also take steps. Revisiting start or end times, allowing employees to "bank" hours, and empowering managers to be flexible with their direct reports are common suggestions. "Some are as simple as making sure that the caregiver employee has the parking spot nearest to the exit door so that during their lunch they can take grandma to her specialist appointment," Dr. Williams says.
Govind Rao

First Nation takes water case to UN; NATIONAL DIGEST - Infomart - 0 views

  • The Globe and Mail Tue Oct 6 2015
  • A reserve cut off from the mainland and under a boil-water advisory for almost two decades is taking its case to the United Nations. Shoal Lake 40 First Nation, which straddles the ManitobaOntario boundary, became isolated a century ago during construction of an aqueduct that carries water to Winnipeg. The reserve has no all-weather road and has been without clean water for 17 years.
  • A delegation from the reserve is expected to travel to Geneva, Switzerland, in February to make its case to a United Nations committee on economic, social and cultural rights. Chief Erwin Redsky said his delegation will outline "all the human rights violations we suffer daily," including a lack of clean water, no freedom of movement and inadequate health care and education.
Govind Rao

Opinion: Canada needs a palliative-care strategy and focus on pain relief - 0 views

  • By Francis Scarpaleggia, Special to The Gazette May 27, 2014
  • MONTREAL — One measure of a society’s moral maturity and of the point it occupies on the scale of civilization is found in whether and how it provides physical and spiritual comfort to those in their final days of life. This notion very much guided the creation of the all-party Parliamentary Committee on Palliative and Compassionate Care, which in 2011 issued its report titled Not to Be Forgotten: Care of Vulnerable Canadians.
  • Governments are reticent, however, to offer routine treatment for pain as a core health-care service.
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  • But relief from pain is a human right. The Declaration of Montreal, adopted on Sept. 3, 2010 at the 13th World Congress on Pain, affirms, among other things, the “right of all people with pain to have access to appropriate assessment and treatment of the pain by adequately trained professionals.”
  • The result is that only 30 per cent of Canadians who will die this year will have access to palliative care, and only 16 per cent of Canadians will have access to such end-of-life care in a hospice. Further, the uneven distribution of palliative care across the country means that access to it is in reality a function of one’s postal code.
Govind Rao

Implications Of Mandatory Flu Vaccinations For Health-Care Workers - Health News - redO... - 0 views

  • May 27, 2014
  • Canadian Medical Association Journal Employers planning to implement mandatory influenza vaccination policies for health care workers need to understand the implications, according to an analysis published in CMAJ (Canadian Medical Association Journal). Vaccination rates among health care workers are less than 50%, well below the level necessary for herd immunity. Evidence indicates that vaccination of health care workers can benefit patient health, leading to a move by many to consider mandatory influenza vaccination as a condition of employment or to require employees to wear a mask during influenza season. Many health care workers favor condition-of-service influenza vaccination policies. However, in Canada, condition-of-service policies must comply with employment law, provincial human rights codes and the Canadian Charter of Rights and Freedoms. Condition-of-service policies that apply to unionized employees must be consistent with collective labor agreements, and vaccination policies should allow exemptions for religious beliefs and practices.
Govind Rao

Private MRIs wrong prescription - Infomart - 0 views

  • The Leader-Post (Regina) Mon Oct 26 2015
  • In the final sitting of the legislature before the spring election, Premier Brad Wall's government plans to pass Bill 179 to facilitate private user-pay MRIs in Saskatchewan. As a longtime family doctor, I see this as a cynical political move that caters to public fears about long wait lists for imaging, but which will actually work to make things worse for patients who truly need an MRI.
  • There is very clear evidence that, far from relieving pressures in the public system, offering a separate stream for the wealthy to jump the queue actually lengthens public wait lists. This has been shown over and over again, whether it be with cataract surgery, diagnostic imaging or surgical procedures. MRI is no different.
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  • In Alberta, where private MRI facilities advertise and operate, the median wait time for an MRI is much longer (80 days) than in Saskatchewan (28 days). Furthermore, the wait has lengthened in the public system in Alberta since privatized facilities came on the scene. The explanations are complex, but siphoning human capacity (doctors and technologists), as well as other resources, from the public system into the private and more lucrative stream plays a big role. So does the market generation of increased demand by deceptive advertising and promotion of privatized services.
  • Medical tests should be ordered in accordance with evidence-based guidelines about their usefulness and indications. Patient access to MRI is currently prioritized in Saskatchewan health-care facilities on the basis of medical need, from Level I (a life-threatening diagnosis or treatment requiring MRI within 24 hours) to a Level IV (stable patients needing long range diagnosis or management allowing for delay of 30-90 days).
  • This system works and prioritizes appropriately. While patients sometimes feel that an urgent MRI will make a difference to their outcome, this is rarely the case. When it is the case, patients are prioritized and get urgent access. Allowing private MRI's based on ability to pay and jump the queue will trample this well-developed, equitable system. It will allow the wealthy or anxious to bypass this system and result in two-tiered care.
  • We live in a society obsessed with health. Selling fear of sickness is profitable. But access to MRIs is not our most urgent health-care need. To suggest otherwise is to obscure the social and economic determinants that define who is healthy and who is not, and to further shift resources away from the sick towards the worried well.
  • The Wall government and the private MRI operators that will profit from this legislation have proposed a two-for-one deal, suggesting that one public MRI scan will be done for every private MRI performed. Don't be fooled. This will not get around the problem of prolonging public wait lists since it will siphon resources from the public system. If we really need more MRIs, why not increase capacity in the public system instead?
  • While MRI can be a useful tool, when inappropriately used it can lead to overdiagnosis or "false positives." This then triggers a costly cascade of subsequent investigations or interventions to reassure either physician or patient MRI technology has important limitations, and frequently finds unrelated non-significant abnormalities that frighten patients. For example, 90 per cent of healthy individuals over 60 years of age with no symptoms of back pain show degenerative abnormalities on MRI. Similarly, the vast majority of adults over 50 show knee damage on MRI and only clinical assessment by a doctor identifies whether or not these findings are significant. Early MRI has not been shown to improve outcomes in low back pain and may actually make for worse outcomes. A doctor examining for red flag symptoms can identify the very small number of patients for whom an MRI is useful.
  • Many MRI scans are therefore unnecessary. Allowing patients to purchase an investigation they don't need wastes resources, bypasses the role of an informed health-care provider, and may in the end actually harm patients with needless investigations and interventions. Physicians are engaged in initiatives to "choose wisely" in testing. Throwing the door open to investigations based on ability to pay, rather than medical need, flies in the face of sensible approaches to health resources.
  • And the queue-jumping is not just limited to getting an MRI. It will extend to preferential and quicker access to treatment options, such as specialist care and surgery based on the MRI results if positive.
  • Let's promote greater equity, not less, and preserve health care based on need, not two-tiered care based on ability to pay. Let's trust health-care providers to counsel patients about the right test at the right time and to prioritize patients appropriately. The marketplace has no role in these decisions.
  • Dr. Sally Mahood is a Regina family doctor and an associate professor, Family Medicine, University of Saskatchewan.
Heather Farrow

CUPE Equality History digital timeline | Canadian Union of Public Employees - 0 views

  • Oct 20, 2015
  • CUPE has a proud history of championing equality - within our union, our workplaces and our communities. Through the equality history project, we’ve now traced our role in key human rights struggles over the years, in Canada and internationally.
Heather Farrow

The Hill Times - 0 views

  • Aug. 17, 2016
  • Last month, 43 medical facilities were bombed, making it the worst month for this kind of attack since the beginning of the conflict.
  • Dr. Anas Al-Kassem in Aleppo, Syria in front of a clinic in 2014 that UOSSM Canada says has since been destroyed.
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  • The images shown in the media of parents crying over their lost children, of civilians being attacked in a war they didn’t sign up for, of bodies left in the streets are not an exaggeration. I cannot shake the image of water washing down the steps of a building, tainted red with the blood of innocent children and civilians. That is the reality in Syria, which is in the midst of the largest humanitarian crisis since the Second World War. It is imperative that the global community intervenes and puts an end to this heinous infringement of basic human rights.
Cheryl Stadnichuk

Ontario pledges $222-million to improve First Nations health care - The Globe and Mail - 0 views

  • Ontario has pledged to spend $222 million over three years to improve health care for First Nations, especially in the north where aboriginal leaders declared a state of emergency because of a growing number of suicides.The Liberal government also promised to contribute $104.5 million annually — after the initial three years — to the First Nations Health Action Plan, which will focus on primary care, public health, senior’s care, hospital services and crisis support.
  • in April because of an increasing number of suicides and suicide attempts, especially by young people.“We have learned from the recent health emergency declarations that communities need support in times of crisis and need to know that they can count on the provincial government,” Health Minister Eric Hoskins said Wednesday.“So we will establish dedicated funding, expanding supports including trauma response teams, suicide prevention training, positive community programming for youth, and we will fund more mental health workers in schools.”
  • The James Bay community of Attawapiskat declared a state of emergency
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  • Canada ranked No. 8 last year on the United Nations human development index, but the same indicators would place indigenous people in Canada at about 63, added Hoskins.“These inequities can no longer be ignored,” he said. “It’s not up to First Nations to right the wrongs of colonization. Government must invest in meaningful and lasting solutions so communities can heal and have hope.”
  • The Ontario plan will increase physician services for 28 communities across the Sioux Lookout region in the north by up to 28 per cent, and establish up to 10 new or expanded primary care teams that will include traditional healing.There will also be cultural competency training for front-line health-care providers and administrators who work with First Nations communities, more public health nurses and a dedicated medical officer of health.The government says it will also increase access to fresh fruits and vegetables for about 47,400 indigenous children, and expand diabetes prevention and management in northern and remote communities.
Heather Farrow

'Systemic racism' to blame for poor health care for First Nations: Ottawa doctor - 0 views

  • May 09, 2016
  • Canada’s First Nation’s health care — like the child welfare system — is built on a platform of racism, says an Ottawa-raised doctor who has become an outspoken advocate for better health services for First Nations.
  • Kirlew, 35, recently held MPs’ attention when he talked to the Commons Indigenous Affairs Committee about health care for First Nations living on reserves. “It is not just a little inferior, it is far inferior,” he said.
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  • Recently, the Canadian Human Rights Tribunal ruled that Canada discriminates against First Nations children on reserves by failing to provide the same level of child welfare services as exist elsewhere. The tribunal ordered the federal government to speed up changes in response to that ruling.
Heather Farrow

Join CUPE at the World Social Forum | Canadian Union of Public Employees - 0 views

  • Jul 5, 2016
  • The World Social Forum (WSF) is one of the largest global gatherings of civil society. It started in 2001 in Brazil, and brings together tens of thousands of activists with the intention of identifying solutions to the most important issues of our time affecting the economy, the environment, human and trade union rights, and democracy. 
Heather Farrow

Rise Up | - 0 views

  • We are making change and building a stronger labour movement that recognizes the struggles of all people facing inequality in the workplace and society. The Rise Up! conference is an opportunity for union activists to come together and explore equality and fairness for all. We can empower each other by acknowledging our struggles, celebrating our gains, and sharing our stories. As human rights activists, we celebrate diversity and use our collective power to create real change for all Canadians. Share your story. Be the change. Live the change.
Irene Jansen

Janet Bagnall: Short-term labour fix, or exploitation? - 0 views

  • In February, Quebec’s Human Rights Commission ruled that temporary foreign workers in the province are discriminated against: they are not covered by the labour-standards law or worker health and safety provisions, and consequently have little redress against abuse.
  • The more than 70 workers in British Columbia’s class-action suit allege that the owners of Denny’s restaurants failed to pay them full weekly wages and overtime pay as contracted and also did not reimburse them travel, recruitment and processing fees as promised.
  • Three years ago, the Alberta Federation of Labour warned that the temporary foreign worker program was becoming a permanent part of Canada’s labour market.
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  • Delphine Nakache and Paula Kinoshita. In their 2010 paper published by the Institute for Research in Public Policy, they warned of possible consequences that could undermine the country’s social fabric.
Irene Jansen

Victims of Violence - Elder Abuse - 0 views

  • elder abuse is abuse committed against a person in the advanced years of their life and can include physical, emotional or sexual abuse, financial abuse, medical deprivation or over-medication, neglect, or the basic violation of human rights.
  • In 2009, statistics Canada reported that 13% of the population was over the age of 65. In this year there were 7,900 reported incidences of elder abuse, a number that had increased by 14% since 2004. Statistics Canada reports that, of the incidences reported to police, approximately ⅓ were committed by family members of the elderly person (most commonly a grown child or spouse), ⅓ were committed by friends or acquaintances, and ⅓ were committed by a stranger.
  • Medical Abuse – This form of abuse usually occurs in an institutional setting. This involves "any medical procedure or treatment that is done without the permission of the older person or his/her legally recognized proxy". It also refers to actions that are not within accepted medical practice. Examples include medication, prescriptions, or treatments without the person’s consent, withholding medication, over-medicating (use of medical restraints), and forcing treatment
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  • Passive neglect is usually the failure to care for the older person which is not deliberate. In institutions this may occur because there are fewer staff members and there is difficulty in helping the elderly quickly and efficiently.
  • Abuse is also found in understaffed retirement homes and long term care institutions as employees are overworked and unable to give appropriate attention to the residents and patients there.
  • The Canadian Center for the Prevention of Elder Abuse cites the following reasons elder abuse may occur in an institution:
  • Systemic Problems: problems arise from the facility’s culture (whether or not they recognize the dignity and worthiness of their patients as expressed by upper management); inadequate staffing (insufficient number of people working at the facility or lack of appropriate training); staff minimization and rationalization of abuse; policy deficiencies; financial constraints (contributes to poor quality care); poor enforcement of standards of adequate care; work related stress and professional burnout; powerlessness and vulnerability of residents in general; staff retaliation (particularly in response to aggressive behaviours  in people with dementia).
Irene Jansen

The importance of government policies in reducing employment related health inequalitie... - 0 views

  • In this article we explore the relation between unemployment, poor working conditions, and health, and argue that governments and public health agencies should recognise that fair employment conditions should be regarded as a human right.
Irene Jansen

Ensuring dignity in the care of older people | BMJ - 0 views

  • 16 accounts of poor hospital care, of predominantly older people, heard by its helpline in the past year.1
  • patients were told to pass urine and faeces in their beds because it was easier for staff to change sheets than to take them to the toilet
  • inhumane care were also identified in the British Geriatrics Society led campaign, Do not Forget the Person, launched in 2010.2
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  • Recent reports from the Health Service Ombudsman,3 the Care Quality Commission,4 and the Equality and Human Rights Commission5 have also shed light on some appalling practices in care.
  • 47% of patients admitted were incontinent, 49% needed help with feeding, and 44% needed major help with transfers
  • a quarter of patients over 70 undergoing acute admission have dementia.7
  • A more recent prevalence study conducted in a general hospital found that 50% of people over 70 years admitted to hospital had cognitive impairment, 27% had delirium, 24% had possible major depression, and 8% had definite major depression, 8% had delusions, and 9% were agitated or aggressive.9
  • However, the 2011 national audit of dementia care in general hospitals showed that only 6% of 210 hospitals had a care pathway for people with dementia, only 6% of those with dementia were administered a test of cognition on admission and discharge, a quarter of hospital notes did not include an assessment of pain, and only 5% of hospitals required staff to be trained in the care of patients with dementia.8
  • The Preventing Abuse and Neglect in the Care of Older Adults (PANICOA) study
  • found that older patients often described acute hospital wards as “confusing and inaccessible”
  • A Royal College of Nursing project that undertook several surveys of more than 700 professionals and almost 1500 family carers, supporters, and people with dementia, found that older people with dementia have more complications and stay longer in hospital than those without dementia.11
Irene Jansen

Factory Efficiency Comes to the Hospital - NYTimes.com - 0 views

    • Irene Jansen
       
      sounds similar to what was done in a Vancouver hospital to improve efficiency of surgeries, cited in a CCPA report on public solutions to reduce waits
  • Using C.P.I., the hospital has reduced the waiting time for many surgeries from three months to less than one.
  • Lack of space in the recovery room was another logjam, and the hospital planned a $500,000 renovation to enlarge it. But a C.P.I. team saw that if a child’s parents went to a common waiting room during surgery, instead of an individual recovery room, more surgeries could be scheduled. Parents were given beepers to alert them when their child would arrive in the recovery room — and maps and colored lines on the walls helped point the way. Plans for the expensive renovation have been scrapped.
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  • Medical buildings often have standard benchmarks — basing the number of examination rooms, for example, on the expected volume of patients. Ms. Brandenberg and her team instead used C.P.I. to map out common paths that patients, staff members, supplies and information would flow through. They worked in an empty office building, using cardboard mock-ups of surgical sites, recovery rooms, anesthesia areas and waiting rooms. Fifty staff members then play-acted various scenarios to test the design’s effectiveness. The final design reduces walking distances and waiting times for patients by grouping related facilities together and creating rooms that can be used for more than one purpose. The hospital was able to shave 30,000 square feet and $20 million off of the new building
  • Last year, amid rising health care expenses nationally, C.P.I. helped cut Seattle Children’s costs per patient by 3.7 percent, for a total savings of $23 million, Mr. Hagan says. And as patient demand has grown in the last six years, he estimates that the hospital avoided spending $180 million on capital projects by using its facilities more efficiently. It served 38,000 patients last year, up from 27,000 in 2004, without expansion or adding beds.
  • checklists, standardization and nonstop brainstorming with front-line staff
  • The program, called “continuous performance improvement,” or C.P.I., examines every aspect of patients’ stays at the hospital
  • The system is just one example of how Seattle Children’s Hospital says it has improved patient care, and its bottom line, by using practices made famous by Toyota and others. The main goals of the approach, known as kaizen, are to reduce waste and to increase value for customers through continuous small improvements.
  • Similar methods are now in place at other hospitals and health systems, including Beth Israel Deaconess Medical Center in Boston, Park Nicollet Health Services in Minneapolis and Virginia Mason Medical Center, also in Seattle.
  • All medical centers, especially larger ones, would have significant return on investment by using operations management techniques like C.P.I., says Eugene Litvak, president and chief executive of the Institute for Healthcare Optimization and an adjunct professor of operations management at the Harvard School of Public Health.
  • “The health care industry could be on the verge of an efficiency revolution, because it is currently so far behind in applying operations management methodologies,” says Professor Litvak.
  • TO be sure, not everyone believes that factory-floor methods belong in a hospital ward. Nellie Munn, a registered nurse at the Minneapolis campus of Children’s Hospitals and Clinics of Minnesota, thinks that many of the changes instituted by her hospital are inappropriate. She says that in an effort to reduce waste, consultants observed her and her colleagues and tried to determine the amount of time each of their tasks should take. But procedure times can’t always be standardized, she says. For example, some children need to be calmed before IV’s are inserted into their arms, or parents may need more information. “The essence of nursing,” she says, “is much more than a sum of the parts you can observe and write down on a wall full of sticky notes.”
  • one-day strike by the Minnesota Nurses Association against six local health care corporations, including her employer, partly in protest of lower staffing levels her union thinks have resulted from hospitals’ “lean” methods
  • the Lean Enterprise Institute
  • George Labovitz, a management professor at Boston University, says there are limits to performance-improvement methods in hospitals. “Human health is much more variable and complex than making a car,” he said, “so even if you do everything ‘right,’ you can still have a bad outcome.”
  • Joan Wellman & Associates, a process improvement consulting firm in Seattle
  • examine the “flow” of medicines, patients and information in the same way that plant managers study the flow of parts through a factory
  • In a typical workshop at Seattle Children’s, a group of doctors, nurses, administrators and representatives of patients’ families set aside a 40-hour week to work through C.P.I. methods. They plot each “event” a patient might encounter — like filling out forms, interacting with certain staff members, having to walk various distances or having to wait for assistance — and brainstorm about how each could be improved, or even eliminated.
  • it never ends
  • Standardization is also a C.P.I. cornerstone. Last year, 10 surgeons at Seattle Children’s performed appendectomies, and each doctor wanted the instrument cart set up differently. The surgeons and other medical staff members used C.P.I. to come up with a cart they all could use, reducing instrument preparation errors as well as inventory costs.
Irene Jansen

CUPE. 2005. Inside the Chaoulli ruling (Section One): What the Court did (and did not) ... - 0 views

  • What did the court say? A slim majority of judges ruled that Quebec’s ban on private health insurance for publicly-insured services violated Quebec’s Charter of human rights and freedoms. The decision, based on selective and at times flimsy evidence, is not a blanket overturning of the ban.
Govind Rao

Hardline rules costing Ontario nurses | Windsor Star - 0 views

  • Aug 28, 2013 - 11:25 AM ESTLast Updated: Aug 28, 2013 - 9:39 PM EST
  • Re: Changes to nursing accreditation could keep cross-border nurses from coming back, by Beatrice Fantoni, Aug. 26.
  • The Star’s article on new rules from the College of Nurses of Ontario does an excellent job of highlighting how Ontario is at risk of forever losing registered nurses who work in the U.S.
  • ...2 more annotations...
  • For instance, the Ontario Nurses’ Association is supporting its members in challenging the CNO’s policies that discriminate against disabled nurses, including the branding of nurses as “incapacitated” on the CNO website, even though these nurses are able to work.
  • In fact, ONA has recently won an important commitment from the Ontario Human Rights Commission to discuss with the CNO the necessity of removing barriers that prevent nurses with mental health or addiction disabilities from accessing employment.
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