nh magazine 2014 september
DESCRIPTION
ÂTRANSCRIPT
Volume 1 · Issue 1 · September 2014
the northern way of caring
IN THIS ISSUE
Wash your hands! . . . . . . . . . . . . . . . . 4
Northern Health offers routine
HIV testing to everyone. . . . . . . . . . . 10
Patient simulation centres . . . . . . . . 12
Quality Conference 2014 . . . . . . . . . 14
A woman’s harrowing journey
with sepsis . . . . . . . . . . . . . . . . . . . . . 29
[Insert Northern Health magazine title here]
magazine
naming contest
details on page 3!
contentsHigh Quality Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Wash your hands! Proper hand hygiene measures cut infection rates across northern BC . . . . . . . . . . . . . . . . . . . . . . . . . 4
Survey reveals support for improved hand hygiene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Dawson Creek declares war on incorrect hand hygiene practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
5S project helps streamline Bulkley Lodge maintenance department . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Taking aim at stigma: Northern Health offers routine HIV testing to everyone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Quality Improvement Training in Northern Health: What’s a belt? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Patient simulation centres offer quality medical training to clinicians and students in safe environments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Northern Health achieves accreditation after surveyor visit in June 2014 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Quality Conference 2014: Collaborating for Improvement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Integrated Accessible Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Fort St. John Prenatal Clinic: Providing benefits for expectant mothers and health care professionals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Northern Health to expand patient-centred care throughout northern BC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Fort St. James: Partnering in Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
A Population Health Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Men’s Health – Let’s blog about it! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
2014 All Native Basketball Tournament: More than a sporting event . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Health Promotions team makes healthy living fun and accessible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
A Focus on Our People. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
In her own words . . . A woman’s harrowing journey with sepsis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Turn off the lights! Northern Health takes team approach to energy conservation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Hospital replacement projects to offer health care services in modern environments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
NORTHERN HEALTH MAgAzINE
Volume 1 · Issue 1 · September 2014
Publisher · Steve Raper
Editor/Contributor · Joanne MacDonald
Additional Contributors Debra Woods · Sam Milligan · Tanis Hampe Tammy Hoefer · Lexie Gordon · Doreen Bond Jeanette Foreman · Theresa Healy · Pam Mulroy Jessica Quinn · Kendra Kiss · Jonathon Dyck Sherri Tillotson · Jim Coyle
On the Cover: Northern Health’s flash mob took place September 2012 in the lobby of the University Hospital of Northern BC. It was organized by the Healthier You Promotions and Engagement (HYPE) team for the September Healthy Living Challenge.
Photo: YellowRibbonPhotography.ca
To read our magazine online visit http://issuu.com/northern-health/docs/nh-magazine-2014-september
Mission Statement — Our PurposeThrough the efforts of our dedicated staff and physicians, in partnership with communities and organizations, we provide exceptional health services for northerners.
Vision — A Picture of 2015Northern Health leads the way in promoting health and providing health services for northern and rural populations.
P | 2
We want your feedback! Take our reader survey at northernhealth.ca/survey
Help us name our new Northern Health magazine — you could win a prize!You can enter as many times as you like and everyone who sends in a suggestion will be entered into a prize draw. Send in multiple entries for multiple chances to win!
To enter, please answer these questions:1) What do you think we should call this new magazine?2) How can we contact you? • Yourname • Email • TelephoneSend your title suggestion(s) and contact information to [email protected] for entries is October 1, 2014.
editorialA message from Cathy Ulrich, President and ceo, and Fraser Bell, Vice President, Planning, Quality and Information Management
Our magazine will be published twice a year, in both print and online versions. So in addition to putting this magazine right into your hands, you’ll also have the option to read a digital version.
One more thing: we want to hear your stories! If you’d like to contribute a story to your magazine or comment on a story in this issue, please contact us at: [email protected]
Welcome to Northern Health’s new magazine for staff and physicians that features inspiring stories about how we deliver quality health
care services across our region.
All of our stories are written by — and about — Northern Health staff and physicians. In each issue, we’ll feature articles about the things that we do and do well. We’re talking about the high quality health services, programs and initiatives that we provide every day and how they are actually performed. These stories will illustrate that many of the day-to-day things that people do in their jobs prove that we are living our Northern Health vision and mission through our strategic plan. In other words, we’ll highlight how our staff, physicians, and community partners routinely provide exceptional health services for northerners and live “the northern way of caring”.
You may be wondering why we currently don’t have a title for our new Northern Health magazine. That’s because we want you, our staff and physicians, to help us choose a name that’s reflective of our organization and the people that work here. So we’re encouraging you to enter our contest to find a catchy name for our new magazine! Be creative, have some fun with it and enter our contest — see details in the box below. You could win a great prize!
The stories in each issue of our Northern Health magazine will give you a snapshot of many of the departments or services operating within Northern Health. And we believe they’ll inspire you. You’ll see that the stories not only highlight the benefits of our focus on quality in the work that we do to improve service delivery, but they also raise awareness and support for all of the work across the region that occurs on a daily basis.
Among the stories you’ll read in this issue:
• ThecommunityofFortSt.JamesandNorthernHealth partner to recruit physicians;
• ADawsonCreeknursenarrowlysurvivessepsis;
• NorthernHealthstaffuseinnovativetacticstoimprove hand hygiene compliance rates; and
• NorthernHealthandtheNorthPeaceDivisionofFamily Practice respond to a medical manpower crisis and create the new Fort St. John Prenatal Clinic.
P | 3
NH | high quality services
P | 4
John Short was working as a nurse in the emergency department of Mount Sinai Hospital in Toronto when the SARS epidemic hit in 2003.
He was one of several health care professionals who were sent home on what he dubbed “house quarantine’” after hospital officials determined that staff members who had come into contact with SARS-infected patients needed to be quarantined for 10 days.
“I had to stay home and have friends deliver groceries to my door. We had to rule out any possibilities of infection and make sure we didn’t have any symptoms
Wash your hands! Proper hand hygiene measures cut infection rates across northern BCBy Joanne MacDonald, Communications Officer, [email protected]
before returning to work,” says Short, who now works as Northern Health’s Site Administrator at the Northern Haida Gwaii Hospital and Health Clinic in Masset, BC. Short is also one of the site’s hand hygiene auditors.
“Those were the days when we used to double-glove and double-gown. So because of SARS, I feel I now have a deeper appreciation of what breaking the chain of infection means. When you see people dying, you understand how important infection prevention and proper hand hygiene measures are to prevent infections from spreading.”
According to Deanna Hembroff, Northern Health has reached a turning point in the fight against the spread of infection. As Northern Health’s Regional Manager, Infection Prevention and Control, Hembroff leads Northern Health’s Hand Hygiene Program and is also co-chair of the Provincial Hand Hygiene Working Group of British Columbia.
Hand cleaning compliance rates are significantly improving across Northern Health, and Hembroff credits the improvement to Northern Health’s 7,000 staff and the leadership making hand hygiene compliance a priority throughout the organization’s facilities. Northern Health’s current hand hygiene compliance target is 85 per cent — the measurement of how often staff members would ideally clean their hands when they have an opportunity.
“Cleaning hands is one of the most simple and cost-effective ways to prevent patients from getting infections while they’re in hospital. And our Northern Health hand hygiene audits show that we continue to see improvement when it comes to our compliance rates,” says Hembroff.
“In Quarter 3 of 2013–2014, we increased to 76 per cent, up from 71 per cent in Quarter 2. We are seeing that our sites are reporting their audited compliance rates more consistently. And, overall, our Northern Health rates for infection remain low.”
NH | high quality services
(l-r) Deanna Hembroff, Regional Manager, Infection Prevention and Control, and Penny Brawn, Coordinator, Sterile Processing, use a hand sanitizer near an elevator at the University Hospital of Northern BC. Photo: Joanne MacDonald
NH | high quality services
P | 5
In 2012–2013, Northern Health facilities reported the following patient infection statistics:
• Methicillin-resistantStaphylococcus aureus (MRSA): 1.03 infection /1000 patient days;
• Clostridium difficile (C-difficile): 0.34 infection /1000 patient days;
• Surgicalsiteinfections:5infections/100patients.
Hembroff notes that in Canada more than 200,000 patients contract infections every year while receiving health care, with more than 8,000 of these Canadians dying each year from health care acquired infections. Meanwhile, the Centers for Disease Control in the United States estimates that on any given day, one in 25 hospitalized patients will get a health care acquired infection.
“Northern Health has a population of approximately 300,000, so if each person was admitted to hospital, that’s a potential of 12,000 infections,” Hembroff says. “To put that in perspective, that’s close to the populations of either Prince Rupert, Terrace or Dawson Creek.”
Hand hygiene audits educate staffEvery quarter, in acute and long-term care sites across Northern Health, trained auditors observe how often hospital health care workers clean their hands before and after they come into contact with patients and their environment. Their purpose? To encourage staff
to regularly clean their hands to help prevent patients from getting infections while in hospital, and help staff protect themselves from communicable diseases.
Staff members, including nurses, physicians, clinical support services and others, such as housekeeping staff, are included in the audit process.
Short says auditors, standing a slight distance away from the staff member, record whether staff wear gloves or use a hand sanitizer when they enter a patient’s room. They also note if a staff member removes their gloves or washes their hands after leaving a room.
Glove use is not considered a substitute for hand cleaning.
“When we first started auditing, it was just up to staff to be wearing gloves. But as we progressed, we realized the main problem was staff removing items from a room. Were they leaving the item somewhere or letting go of the item? When they come out, do they remove their gloves? Do they immediately wash their hands?” says Short.
Statistics from the annual Provincial Hand Hygiene Perception Survey conducted by all seven of BC’s health authorities, showed that Northern Health staff and physicians are growing more aware of correct hand hygiene procedures. A total of 1,378 of Northern Health’s more than 7,000 employees participated in the 2013 survey, an increase from 16 per cent in 2012 to more than 18 per cent in 2013.
Key facts from the survey showed:
• NorthernHealthhadthesecondhighest response rate among all BC health authorities;
• 98percentofnorthernhealthcareworkersagreed that hand hygiene is important to them;
• 40percentnotedthey’recomfortablereminding a physician to wash their hands; and
• 84percentarecomfortablebeingremindedby a patient to clean their hands.
The survey’s environmental data also revealed that staff noticed improvements in the availability of hand hygiene products, such as filled soap, alcohol-based hand rub and paper towel dispensers.
— Joanne MacDonald
Survey reveals support for improved hand hygiene
“When you see people dying, you understand how important infection prevention and proper hand hygiene measures are to prevent infections from spreading.”
John Short, RN, Site Administrator, Northern Haida Gwaii Hospital and Health Clinic
NH | high quality services
P | 6
“If contamination occurs, the auditor will wait until the clinician has finished their task and talk with them supportively to see if they realized they broke the sanitation chain — and when. Then we share our observations with them. Clinicians do see this as being helpful.”
Short says increased auditing is leading to a better understanding among staff about why hand hygiene compliance is being monitored.
“Auditing is a tool that’s in place to remind everyone that, ‘Aha! Right! Pay attention to your hand hygiene today,’” he says. “We tell staff that this is a supportive necessary tool, that there are no consequences for errors, and that the work is to reduce infection rates for ourselves and our community. Hopefully this will make our team see that good auditing results are more of a measure of success than merely ‘compliance.’”
On track to reach compliance goalNorthern Health releases regular quarterly hand hygiene reports and monthly reports that contain hand hygiene data collected at Northern Health facilities. Fraser Bell,
Northern Health’s Vice President, Planning, Quality and Information Management, says these are important tools that keep staff abreast of their hand cleaning progress.
“We’re continually working with our sites to improve hand hygiene measures and our goal is to eventually have a 100 per cent hand hygiene compliance rate,” says Bell. “In the meantime, our current goal of 85 per cent compliance is something I believe is more immediately obtainable and measurable.”
Dr. Ronald Chapman, Northern Health’s Vice President of Medicine and Clinical Programs, adds that the heightened attention to regular hand cleaning is occurring across all departments.
“Increasing the use of correct hand hygiene procedures will go a long way toward preventing the spread of infections and protect patients, staff, and physicians,” says Dr. Chapman. “We seem to be on track to reach 85 per cent compliance in three years.”
Meanwhile, Hembroff says that while environmental cleaning methods, screening to monitor high risk people, and transmission precautions are also important infection-prevention tools, she’s hopeful that regular hand washing will continue to resonate with staff.
“Let’s face it — proper hand cleaning remains one of our cornerstones because anyone can access alcohol hand rubs in hospital or clinic lobbies, near elevators, on wards and in patient rooms,” she says.
“Yes, we still have a lot of work to do. But more and more staff are realizing that regular hand cleaning is the key to infection prevention for the average person. And we owe it to our patients, our colleagues and ourselves to make it part of our daily routine.”
“We’re continually working with our sites to improve hand hygiene measures and our goal is to eventually have a 100 per cent hand hygiene compliance rate.”
Fraser Bell, Vice President, Planning, Quality and Information Management
Did you know??• Alcohol-basedhandrubisthepreferred
method for performing hand hygiene in health care settings;
• Soapandwateraretobeusedwhenhands are visibly dirty, and in exceptional situations.
John Short, Site Administrator, Northern Haida Gwaii Hospital and Health Clinic, conducts a hand hygiene audit on housekeeper Pat Crouse. Photo: Lisa Froese
John Short audits nurse Jennifer Chow.
Photo: Lisa Froese
NH | high quality services
P | 7
It all started on August 18, 2013, when a northern BC newspaper reported that staff at the Dawson Creek and District Hospital had one of the lowest
handwashing rates across Northern Health.
Using provincial health data, the newspaper wrote that the hospital’s staff and physicians had only washed their hands an average of 54 per cent when they had an opportunity through 2012–2013.
Joelle Adams, the hospital’s Unit Manager, MSP and Oncology, says the statistic shocked everyone because they’d thought they were diligent about washing their hands.
“What we didn’t know was that the auditors were observing when we first went into the room,” Adams says. “And you have to wash your hands before you go in the room, even if you’re not touching anyone. So we declared war on improper hand hygiene methods.”
Staff, including nurses, surgeons, doctors, lab technicians, and housekeeping held discussions and quickly began using improved hand hygiene procedures.
“We’d applaud people every time we saw them clean their hands. I tried to make it a joke by putting hand pumps out to the extreme, with about three or four along a nurses’ station,” says Adams, who is a hand hygiene auditor in her department. “I was almost like a Walmart greeter, reminding people to wash their hands before entering a room. Even the doctors thought it was a good joke!”
The blitz paid off. By mid-September 2013, Northern Health’s quarterly compliance rates showed hospital
Dawson Creek declares war on incorrect hand hygiene practices
staff improving to a rate of 82 per cent. Kelsey Breault, the hospital’s infection prevention and control practitioner, attributes much of the improvement to Jaret Clay, South Peace — Health Services Administrator.
“He’s been instrumental in the rapid improvement in the hospital’s compliance rates,” she says, noting that department managers are now required to submit a minimum number of hand hygiene audits each month, documenting how often staff properly clean their hands.
“The negative media coverage also had a somewhat positive result in that staff and physicians were more engaged with achieving better results,” says Breault.
Adams adds that posters are regularly displayed in units, reminding staff about the hospital’s monthly hand hygiene compliance rates.
“People now point out, ‘See, I’m washing my hands,’” says Adams. “You could say that with the way we now approach proper hand hygiene methods that we’re almost over the top!”
— Joanne MacDonald
“You have to wash your hands before you go in the room, even if you’re not touching anyone.”
Joelle Adams, Unit Manager, MSP and Oncology, Dawson Creek and District Hospital
Joelle Adams, Unit Manager, MSP and Oncology, Dawson Creek and District Hospital, demonstrates how to use a hand sanitizer.
Photo: Joanne MacDonald
NH | high quality services
P | 8
5S project helps streamline Bulkley Lodge maintenance departmentBy Debra Woods, Regional Manager, Strategic Initiatives and Project Support [email protected]
When Mark Schelter decided to re-organize the maintenance department at Bulkley Lodge in Smithers using a quality improvement
approach, he had a few simple goals.
As a member of the residential facility’s maintenance team, he wanted to reduce the time he spent searching for tools or parts in the cluttered workplace. He also wanted to make it easier to train casual employees and enable them to find parts without having to ask for assistance from others.
“Ultimately, I wanted my improvement project to save people time on day-to-day repairs and maintenance so they could focus their time on larger improvement initiatives around the building,” says Schelter.
So he set out to locate, sort and organize his inventory and tools. Using a 5S quality improvement approach — a systematic method that enables teams to organize their workplaces in a safe and efficient manner — Schelter noted that his inventory was mostly contained in cardboard boxes on shelves, in no particular order.
The scope of the Bulkley Lodge maintenance department is broad and includes, but is not limited to: boiler repairs; kitchen equipment repairs; the replacing of light ballasts; the maintenance of nursing equipment and laundry machines; installing bed alarms; painting; and cutting grass.
“Every department relies on one maintenance person to keep them operational,” says Schelter. “If any department is down, it ultimately affects patient satisfaction.”
He began his project by storing parts and their related equipment together in the same location, rather than having one centralized parts location.
“An example of this was rather than store boiler pump parts and HVAC belts in the shop, they were relocated to the appropriate mechanical room, with added shelving, hooks and clear labels, so that the parts inventory can be seen visually at a glance,” he says. “This is an example of one simple improvement, when you consider that all building belts were previously hanging tangled in one place far from the HVAC units.”
Vise table before cleanup
Vise table after cleanup
Colour-coded shelves
All workplace photos: Mark Schelter
NH | high quality services
P | 9
Secondly, he eliminated obsolete parts, freeing up storage space for priority inventory. His third step consisted of sorting supplies into four distinct categories: nursing equipment; kitchen–housekeeping laundry; electrical and lighting; and building equipment. All parts and supplies were then tagged, labelled, colour-coded and organized in alphabetical order on shelves.
Schelter also reorganized his tools, labelling their storage locations; and reorganized his filing cabinet, manuals and parts lists.
Lastly, with the department’s paper-based system transitioning to an electronic system using computer management software, the workflow for work order requests and inventory management has begun to improve. Schelter says the upgrade will enable the department to maintain a preventative maintenance schedule as the electronic system will enable better management of day-to-day repairs.
The feedback Schelter has received shows that his 5S project has led to a clean, organized workspace that is enjoyable to work in, has improved employees’ attitudes, and has reduced the number of calls to the head of the maintenance department when he is away from the building.
An additional benefit? Safety measures have dramatically improved, with personal safety gear clearly labelled and more accessible in prominent locations. Eye, ear and face protection are now being used more often than in the past.
“At the end of the day, each department at this facility is a piece of a puzzle that fits together to create an effective and caring environment,” Schelter says. “Did my 5S project directly make any resident’s life better? Probably not. But does a more efficient and operational department help this facility run smoother? Absolutely.”
Saw table before cleanup
Saw table after cleanup
“Every department relies on one maintenance person to keep them operational. If any department is down, it ultimately affects patient satisfaction.”
Mark Schelter, Maintenance Team, Bulkley Valley District Hospital
Mark Schelter says his quality improvement project saves people time doing daily repairs so they can focus on larger improvement initiatives.
Photo: Jeneen Rathwell
NH | high quality services
P | 10
Taking aim at stigma: Northern Health offers routine HIV testing to everyoneBy Sam Milligan, Regional Blood Borne Pathogens Health Systems Navigator [email protected]
Northern Health is taking steps to reduce the stigma around HIV by introducing routine HIV testing for everyone, not just people at risk.
In addition to current risk-based testing guidelines, Northern Health has adapted the 2014 HIV testing guidelines developed by the British Columbia Office of the Provincial Health Officer. These guidelines recommend that everyone between 18 to 70 years of age, in both acute care settings and the community, be offered an HIV test every five years as part of routine health screening.
Preceding the release of the 2014 HIV testing guidelines, the University Hospital of Northern BC initiated the routine offer of HIV screening in December 2013 to all admitted patients who are having blood work taken for another reason while admitted.
“The Public Health Agency of Canada estimated in 2011 that approximately 25 per cent of people living with HIV in Canada are unaware of their HIV-positive status. Evidence also suggests that this 25 per cent account for up to 70 per cent of all new HIV infections,” says Bareilly Sweet, Northern Health’s Regional Coordinator, Blood Borne Pathogens Services.
“We also know that nearly 55 per cent of new HIV diagnoses in Northern Health are diagnosed late, with close to 20 per cent of new diagnoses fitting the criteria for advanced HIV. This means that over half of the people living within Northern Health’s region should already be on HIV treatment at the time of their HIV diagnosis.”
Historically, the reason for an HIV test has fallen into two categories: routine testing for women during pregnancy, and voluntary testing for everyone else. The problem lays in the second option — voluntary testing. For voluntary testing to occur, two conditions have to be met:
• Healthcareprovidersneedtoasktheirclientsabout risk and risk-related behaviour; however, current research evidence suggests such conversations are very difficult for health care providers to initiate with patients; and
• Patientsneedtoknowtheyareatrisk,recognizethat risk, and be willing to disclose risk to their health care provider.
“Unfortunately, the current testing criterion stigmatizes testing. This discourages clinicians from offering an HIV test and discourages patients from seeking and/or accepting an HIV test,” says Sweet. “But that won’t stop us from continuing our work to normalize HIV testing, because routine testing will catch HIV infections in the early stages. And that’s what we need to do, because then we can improve the patient experience on every step of the HIV journey.”
St. John Hospital in Vanderhoof, Stuart Lake Hospital in Fort St. James and the Fraser Lake Health Centre began implementing the routine offer of HIV testing in the spring of 2014. Lakes District Hospital and Health Centre in Burns Lake and GR Baker Hospital in Quesnel are in the preparatory stages to begin offering HIV testing in the fall of 2014.
As a member of the Blood Borne Pathogens team, Sam Milligan provides HIV/HCV education and consultation services to regional Northern Health programs and communities.
Photo: Joanne MacDonald
NH | high quality services
P | 11
Quality Improvement Training in Northern Health: What’s a belt? By Tanis Hampe, Regional Director, Quality and Innovation, [email protected]
Northern Health is committed to a culture of continuous quality improvement and patient safety and has invested in an in-house Quality
Training Program for all staff, volunteers, physicians and partners to support this goal.
Lean is a quality improvement methodology that includes a set of principles and tools to improve service delivery processes.
Teams at Northern Health have completed more than 100 improvement projects applying Lean tools, including: decreasing the number of medications and dosages for residents of Rotary Manor in Dawson Creek; improving wait time for referral for cardiac services regionally; and workplace organization using the 5S methodology in operating room units in Dawson Creek and Prince Rupert.
Lean training is categorized into levels of “belts” by organizations around the world. Here’s how the belts look in Northern Health:
• White Belt — Introduction to Lean (60–90 min). Complete your White Belt online now.
• Yellow Belt — Lean-in-Practice (1 day). Lean concepts are reviewed and practiced through a simulation in this interactive workshop.
• Green Belt — Intermediate Quality Improvement training (6 months). Green Belts lead continuous improvement and projects with support.
• Black Belt — Advanced training (1+ year). Black Belts apply sophisticated expertise to manage complex quality improvement and portfolios of projects.
“It was a great experience. I really liked being in a room with people from all different sectors in Northern Health,” says Flo Sheppard, dietitian, who took the Yellow Belt workshop in Terrace. “It provided an opportunity to take an integrated approach to a common goal. The simulation really highlights how all Northern Health employees have insight into how to improve our work.”
Come on out and join a workshop! Upcoming workshops are available on the event registration calendar on the Innovation and Development Commons (IDC) website on OurNH, Northern Health’s intranet.
For more information about quality improvement training, visit the Quality and Process Improvement site at the IDC.
Green Beltcertification
Introduction toLean
(White Belt)
Lean in Practice(Yellow Belt)
Introduction toQuality Improvement
IntermediateQuality Improvement
(+ Lean Green Belt)
Black Belt
Quality Training Program(https://idc.northernhealth.ca/qt/default.aspx)
Northern Health staff members participate in quality improvement training in Dawson Creek.
Photo: Tanis Hampe
NH | high quality services
P | 12
Patient simulation centres offer quality medical training to clinicians and students in safe environmentsBy Tammy Hoefer, Regional Manager, Innovation and Development Commons [email protected]
Patient simulation centres are flourishing in northern BC, thanks to a partnership between Northern Health, the University of British Columbia’s
Northern Medical Program, and the University of Northern British Columbia’s (UNBC) School of Nursing.
Fort St. John, Quesnel, Prince George, and Terrace are the four host communities for the Northern Clinical Simulation Program, which offers quality, innovative training and updating opportunities for clinicians, medical and nursing students. The program features mobile equipment that can also be used at other sites across the region.
• MillsMemorialHospitalinTerrace;
• FortSt.JohnHospital.
Clinical simulation centres had previously been built at UNBC’s Prince George and Quesnel campuses.
At the centres, doctors, nurses, and medical and nursing students practice together in a safe environment that mimics an actual hospital ward, clinic, or emergency department. The facilities housing the centres have been renovated to recreate critical care and ward rooms, and are fitted with a range of technologies for diagnoses and treatments.
The patient simulator mannequins can recreate preprogrammed scenarios for routine procedures, emergency care, and defibrillation and resuscitation, and can also respond to clinical interventions or instructor control. The mannequins are equipped with spontaneous breathing, airway control, voice and other sounds, which make them ideal for realistically simulating basic patient care and advanced life-saving procedures during medical emergencies. Recordings allow users to review their work and, at some of the centres, one-way mirrors block other students or instructors from view.
Tanya Barrett, a clinical nurse educator at UHNBC and a UNBC nursing program instructor, says the simulation centres teach clinicians and students how to work in teams of multidisciplinary health care professionals.
“The labs actually train nurses, doctors, and other allied health care providers not only how to deal with certain procedures, but also how to work together, unified as a team, with each person bringing expertise from his or her own discipline,” says Barrett. “Simulating the team provides a visual, practical, and virtual experience of working with professionals from many disciplines.”
“The patient simulation program, in partnership with UNBC and the UBC Faculty of Medicine, has been extremely successful in providing exceptional training opportunities in the north,” says Dr. Charles Jago, Northern Health Board Chair. “This is highlighted by a 10 per cent increase in use from 2012 to 2013.”
The simulation centres were built out of a $2.4 million investment by the partners and are housed at:
• UniversityHospitalofNorthernBritishColumbia(UHNBC) in Prince George;
• G.R.BakerHospitalinQuesnel;
“The labs actually train nurses, doctors, and other allied health care providers not only how to deal with certain procedures, but also how to work together, unified as a team.”
Tanya Barrett, Clinical Nurse Educator, UHNBC, and UNBC nursing program instructor
Photo: Tim Swanky
NH | high quality services
P | 13
Northern Health achieves accreditation after surveyor visit in June 2014By Lexie Gordon, Quality Improvement Lead, Northeast HSDA, [email protected] and Jeanette Foreman, Quality Improvement Lead, Northwest HSDA, [email protected]
Providing high quality services is a priority at Northern Health, and staff and physicians demonstrated how they deliver exceptional
health services when Accreditation Canada surveyors visited Northern Health sites across the north from June 1 to 6, 2014.
Accreditation is an external peer review process that Northern Health uses to assess and improve the services that are provided based on standards of excellence. Accreditation is an opportunity to share the great work that staff and physicians do every day throughout Northern Health.
The accreditation program is voluntary and is recognized by the provincial and federal funders of health services. All health authorities in BC undergo this process.
Participation and achievement of national standards of care gives reassurance to the public, patients and families, caregivers and the entire organization that Northern Health is providing high quality services.
To find out how the Accreditation process works, as well as details about the various standards, visit Quality of Care – Patient Safety on Northern Health’s intranet, OurNH.
To prepare for Northern Health’s June 2014 accreditation process, staff completed self-assessment surveys. More than 1,500 Northern Health staff and physicians completed the surveys. This is a 50 per cent increase in participation compared to the previous accreditation
cycle in 2011. Thanks go out to all who participated!The results from the self-assessment surveys were then used to prioritize practices that may need improvement to meet required standards of excellence. Staff are invited to continue their commitment to excellence and “the northern way of caring” throughout this survey cycle and beyond. By working together, patient care and safety can be improved.
Leading up to the site survey, a selection of Required Organizational Practices (ROPs), were featured and explained on OurNH. Accreditation Canada defines an ROP as an essential practice that organizations must have in place to enhance safety and minimize risk.
In its final report, the Accreditation Canada surveyor team gave Northern Health this assessment:
“The dedication and commitment of the entire NH health care team is impressive. There is terrific community engagement and support right across the authority, which is a testament to this dedication and commitment. There is a corporate commitment to continually improving work life through a strong commitment to staff safety. Process improvement is also a key focus, with staff enthusiastically engaged in projects.”
Nursing student Laine Becker says a major benefit of the simulation labs is that he can be exposed to critical emergency situations that are clinically very realistic, without actually putting any patients at risk.
“We left feeling like we wanted more,” says Becker.
Additionally, the centres offer updating and training for health care workers located in rural and remote northern regions, who might normally not be faced with full-spectrum experiences in the clinical setting.
“One of the biggest issues our rural staff face is that certain health situations or crises do not occur often, so it’s important for them to be able to maintain their clinical skills with things such as simulation. Then they can actually provide safe, quality care when it happens
for real,” says Cathy Ulrich, Northern Health’s President and CEO.
“As a province, our goal is integrated health care. Health authorities are striving to move to a state where all of care is team-based care. So, Northern Health has facilitated inter-professional training and team-based care using the simulation labs. And that, ultimately, will improve the quality of our health care.”
Photo: Tim Swanky
NH | high quality services
P | 14
Quality Conference 2014: Collaborating for ImprovementBy Tanis Hampe, Regional Director, Quality and Innovation, [email protected]
How does an organization create a culture where quality happens? That was the question posed by Cathy Ulrich, Northern Health’s President and
CEO, when she opened the 2014 Quality Conference in Prince George on March 13, 2014.
The conference theme, “Collaborating for Improvement”, attracted approximately 130 Northern Health staff and physicians who showcased a variety of quality improvement initiatives. Throughout the day, they interacted with colleagues in breakout sessions and small table discussions about quality challenges in health care. Participants were also treated to a comedic dramatization of a patient’s frustrating journey through the health care system.
In her keynote speech, Ulrich said structure, process and people are three “buckets” that help to create, build and support quality improvement throughout Northern Health.
“We have our strategic plan that gives Northern Health focus. And we use many important processes, including Lean training and PDSA cycles, that help us bring quality into the work that we do,” said Ulrich. “And we have people with expertise, passion and commitment working hard to provide quality services and care designed by, and for, people in the north.”
Fraser Bell, Northern Health’s Vice President, Planning, Quality and Information Management, discussed Northern Health’s new quality framework, a living document that will serve as a guide for the organization’s quality improvement initiatives and will be regularly updated.
Bell said the framework will:
• InformandinvitedialogueaboutqualityacrossNorthern Health;
Top left: Marcia Bertschi (right) leads a World Café discussion. Top right and facing page: (l–r) Shelley Hatcher, Tom MacLeod and Jim Campbell (facing page) discuss quality challenges in health care. Bottom left: Debra Woods plays a surgeon in a comedy sketch about health care. Bottom centre: Cathy Ulrich delivers the keynote speech. Bottom right and facing page: Storyboards on display describe new quality improvement initiatives.
P | 14
NH | high quality services
P | 15
• Focuseveryoneonthequalityissuesthatareidentified as priorities; and
• Serveasabaselineforqualityimprovementuponwhich Northern Health can improve.
“Quality improvement is everyone’s accountability and responsibility,” said Bell.
The World Café session stimulated wide-ranging staff comments about quality in Northern Health. Participants engaged in discussions about where Northern Health has been strong in enabling quality in the organization; where Northern Health has been challenged as an organization in our ability to support staff in improving quality; and how Northern Health should celebrate and share quality stories across the region.
Themes from these discussions are posted with other documents from the conference on the Innovation and Development Commons (IDC) website on OurNH, Northern Health’s intranet.
More than 40 storyboards featuring new quality improvement initiatives were also on display, with
four teams awarded prizes for best storyboard in the following categories:
• A Focus on Our People: Lean Cultural Transformation in South Peace HSDA — Contact: Jaret Clay, Health Services Administrator, South Peace.
• A Population Health Approach: Hope to Health: The introduction of routine offering of HIV/HCV testing in acute care — Contact: Sam Milligan, Regional Blood Borne Pathogens Health Systems Navigator.
• Integrated Accessible Health Services: Improving Flow in the Northwest Health Service Delivery Area to provide “Care in the Right Place” — Contact: Penny Anguish, Chief Operating Officer, Northwest.
• High Quality Services: Patient Preparation for Cardiac Transfers, UHNBC — Contact: Reina Pharness, Regional Manager, External Business Contracts, and Melanie Mogus, Outcomes Analyst, Planning and Performance Improvement.
Top centre: Fraser Bell discusses Northern Health’s new quality framework. Top right: Jeanette Foreman leads World Café conversation. Bottom right: Jaret Clay (right) joins a discussion at a breakout session.
All photos: Joanne MacDonald
P | 15
the northern way of caringnorthernhealth.ca #healthynorth
Let’s blog about health!At Northern Health, our staff and our partner organizations do a lot of great and interesting work with individuals and communities to promote health. We hope the Northern Health Matters blog will be a place
ctivities from across our region. And we hope we can share a few tips and ideas with you that will start you on the right track to living a healthy life — for you, your family, and your community!
Have a story idea or want to share a healthy success from your community? Let us know how you show that northern health matters! Contact us at [email protected]
We want to hear your stories! In each issue of our new Northern Health magazine, we’ll be featuring stories about health care across the region — and we need your help!
We’re looking for engaging, personable stories written by — and about — Northern Health staff and physicians.
We want to hear about the things that you and your colleagues do — and do well. Your stories will illustrate how we, along with our community partners, can improve the work that we do. And we’ll raise awareness and support for all of the work across Northern Health that occurs on a daily basis.
If you’d like to contribute a story to your new magazine or comment on a story in this issue, please contact us at: [email protected]
We also want your feedback! Take our reader survey at northernhealth.ca/survey
Knowing is betterSay ‘yes’ to routine HIV testing
Northern Health is phasing in the routine offering of HIV testing across northern BC
The new practice follows the 2014 HIV testing
that everyone between 18 to 70 years of age, in both acute care settings and the community, be
of routine health screening.
The only way to know if you have HIV is to
get tested.
For more information on this project,
please visit hiv101.ca
the northern way of caring
Dr. Abu Hamour, Northern Health Medical Lead,
Blood Borne Pathogens Services
the northern way of caringnorthernhealth.ca #healthynorth
Let’s blog about health!At Northern Health, our staff and our partner organizations do a lot of great and interesting work with individuals and communities to promote health. We hope the Northern Health Matters blog will be a place
ctivities from across our region. And we hope we can share a few tips and ideas with you that will start you on the right track to living a healthy life — for you, your family, and your community!
Have a story idea or want to share a healthy success from your community? Let us know how you show that northern health matters! Contact us at [email protected]
We want to hear your stories! In each issue of our new Northern Health magazine, we’ll be featuring stories about health care across the region — and we need your help!
We’re looking for engaging, personable stories written by — and about — Northern Health staff and physicians.
We want to hear about the things that you and your colleagues do — and do well. Your stories will illustrate how we, along with our community partners, can improve the work that we do. And we’ll raise awareness and support for all of the work across Northern Health that occurs on a daily basis.
If you’d like to contribute a story to your new magazine or comment on a story in this issue, please contact us at: [email protected]
We also want your feedback! Take our reader survey at northernhealth.ca/survey
NH | high quality services
P | 18
Fort St. John Prenatal Clinic: Providing benefits for expectant mothers and health care professionalsBy Joanne MacDonald, Communications Officer, [email protected]
Nicole Stark admits she was nervous when she was advised by her family doctor to go to the new Fort St. John Prenatal Clinic early in her
pregnancy. But as the clinic’s first official patient when it opened on January 6, 2014, Stark says it didn’t take her long to adjust to the community’s new model of prenatal care for expectant mothers.
The new clinic is located in the Birthing Centre of the Fort St. John Hospital. Local physicians work rotations at the clinic, providing prenatal care and performing deliveries. They are supported by a team of health care providers including public health nurses; mental health and addictions clinicians; dietitians; a diabetes educator; an obstetrician; and social workers.
“At first I was apprehensive. But each doctor brings their own knowledge on pregnancies to the clinic,” says Stark, who was approximately 18 weeks pregnant when the clinic opened. “I think I’ve had better care at the new clinic. The doctors seem to be on the ball more, being in a full-day pregnancy mindset.”
The new prenatal clinic is open to all pregnant women and is a partnership between Northern Health and the North Peace Division of Family Practice. After a woman’s pregnancy is confirmed at her initial visit with her family doctor, she is then directed to the new prenatal clinic for the rest of her prenatal appointments.
“Expectant mothers may not always see their personal family doctor when they go in for their regular prenatal appointments, or when they’re ready to deliver their baby,” says Dr. Richard Moody, chair of the North Peace Division of Family Practice. “But they can be assured that they and their baby will receive high quality maternity care throughout their pregnancy.”
The clinic addresses the community’s ongoing physician shortage that sees local doctors maintaining their regular practices while also providing safe, high quality care to emergency department, operating room, anesthetic and obstetric patients.
Up to 670 babies were born in Fort St. John in 2013, while similarly-sized communities average between 75 and 350 births per year. From January 6 to March 3, 2014, the clinic’s staff processed 378 patients, accounting for a total of 1,010 patient visits. These visits included phone consultations and other visits
Nicole Stark was the first official patient at the Fort St. John prenatal clinic when it opened on Jan. 6, 2014. Photo: Rose Perrin
NH | integrated accessible health services
P | 18P | 18
“I think I’ve had better care at the new clinic. The doctors seem to be on the ball more, being in a full-day pregnancy mindset.”
Nicole Stark, expectant mother and first patient at Fort St. John Prenatal Clinic
P | 19P | 19
NH | integrated accessible health services
that were not specifically coded clinic visits. The clinic is currently booking a maximum of 29 appointments per day.
During the first three months of operation, the clinic’s public health staff referred 39 expectant mothers to 23 different community services for assistance, dealing with such concerns as smoking cessation, substance use, lack of personal support, and anxiety and depression.
Angela De Smit, Chief Operating Officer, northeast, says these statistics indicate that the clinic’s team-based care approach has positively impacted patients. She notes that under the old model of maternity care, the referrals of expectant mothers to community agencies may never have happened or may have occurred later in their pregnancies or post-delivery.
Joanne Cozac, Manager of Patient Care at the Fort St. John Hospital, says the biggest challenge for Northern Health staff and local physicians was to get the clinic ready for operation in a short period of time. It took the partners less than four months to identify the need for additional maternity services in Fort St. John and to actually open the clinic’s doors for business.
“We were in a hurry to implement this new model of care as the existing model of prenatal care was no longer sustainable given the physician shortage,” Cozac says. “So far, the people working at the clinic are pleased with the support they’re getting to deliver care, and our patients seem to be happy with the care they’re getting. It’s still a learning process but we’re happy with the results.”
Dr. Glen Hamill, the clinic’s lead physician and a member of the North Peace Division of Family Practice, says that the new clinic is already successfully meeting one of its main goals: namely, to enhance and standardize prenatal care for the growing community.
“Some days it’s a challenge to have a physician on-site for clinic appointments due to our physician shortage. We have only needed to cancel clinics on two half days,” says Dr. Hamill. “But there is always a doctor on call for deliveries and there are always plans in place to ensure that patient care is provided.”
The new clinic has also resulted in a crossover benefit for staff at the clinic and the hospital’s Birthing Centre.
“The positive impact of having a physician onsite means they are supporting the primary care nurse and acute care nurses in the clinic and also in the Birthing Centre. Having the extra staff around as sounding boards and having a physician immediately available if something’s going on creates confidence for everyone,” says Viva
Swanson, RN Clinical Advisor for the prenatal clinic.
“This crossover was a benefit we were shooting for, and it’s created a collegiality between the clinic and Birthing Centre staff. They get to debrief on cases together and there’s much more integration among the staff.”
Swanson adds that, perhaps most importantly, expectant mothers are happy with the clinic’s environment.
“The exposure that the patient has to care providers has tripled. Before they had access to one physician, now they have access to physicians, nurses and other team members,” says Swanson. “The feedback I’ve had from mums is that they really appreciate the value-add of the education they get with our team-based approach.”
Northern Health hospital and community staff in Fort St. John implemented the new prenatal clinic in a short period of time in efforts to address the community’s physician shortage.
“The exposure that the patient has to care providers has tripled. Before they had access to one physician, now they have access to physicians, nurses and other team members.”
Viva Swanson, RN Clinical Advisor for prenatal clinic
Photo submitted
P | 20
NH | integrated accessible health services
It’s Monday, February 3, 2014, and there’s a buzz in meeting room 208 of the Prince George Civic Centre as a group of Northern Health leaders — executives,
chief operating officers, health service administrators, directors and physicians — gather for a day-long workshop.
Northern Health to expand patient-centred care throughout northern BCBy Sherri Tillotson, Regional Evaluation Lead, Integrated Primary and Community Care [email protected]
They’ve come together to plan for the region-wide implementation of integrated health services in Northern Health. It’s a new model of health care with the patient at the centre, designed to increase the quality of care and, ultimately, result in better health outcomes.
Integrated health services — or team-based care — has been underway in the prototyping communities of Fraser Lake, Fort St. John and Prince George since fall 2012.
Northern Health’s integrated care teams, along with Divisions of Family Practice, physicians and health care professionals, are working to provide comprehensive primary care to those we serve. This will be done using best practices and evidence to improve outcomes, increase patient satisfaction, and to sustain our health system from a financial perspective.
Top left: (l-r) Dr. Dick Raymond and Dr. Bill Clifford; Top centre: Martha MacLeod; Top right: (l-r) Cathy Ulrich and Suzanne Johnson; Bottom left: (l-r) David Ross and Donna Flood; Bottom right: (l-r) Bonnie Urquhart, Michael McMillan, Ibolya Agoston, Ana Paterson and Marcia Leiva.
“Providing patient-centred care is in our strategic plan. We need to design our services with the people we serve at the centre of our minds.”
Cathy Ulrich, Northern Health President and CEO
P | 20
P | 21P | 21
NH | integrated accessible health services
A new health care system will see family practitioners delivering coordinated and accessible health care to their patients in collaboration with multidisciplinary teams of specialists and community health care professionals. They won’t be so alone! The teams will include a variety of clinicians and health care workers who will carry out a number of important care functions such as home nursing and rehabilitative care.
This wraparound approach to health care aims to keep patients from falling through the cracks and ensure they get the care they need. It also aims to create better experiences for patients, physicians and health care professionals.
To see how confusing the health care system can be for some patients view our video about Primary and Community Care Integration on the Northern Health website. See how Northern Health is trying to improve the primary care system by integrating health care services.
Cathy Ulrich, Northern Health’s President and Chief Executive Officer, tells the workshop participants that she’d like “the heavy lifting” of the system transformation to be done in the next couple of years.
“We’re now at a crossroads where we have to bring together all of the learning from the prototype communities,” Ulrich says. “There’s some urgency to this work, to get going with full implementation. Providing patient-centred care is in our strategic plan. We need to design our services with the people we serve at the centre of our minds.”
Ulrich notes that major system changes will be taking place at Northern Health in the next few years in a climate of reduced provincial health care spending. And that’s where leadership and the courage to do things differently will be critical.
“We need to be careful that we don’t stall trying to get to 100 per cent,” says Ulrich. “The process is developmental so we can all learn as we go.”
Top left: (l-r) Lucy Beck and Raquel Miles; (l-r) Penny Anguish and Tanis Hampe; Bottom left: Angela De Smit; Bottom right: foreground (l-r) Michael Melia, April Hughes and Mike Simpson.
All photos: Joanne MacDonald
P | 21
P | 22
NH | integrated accessible health services
Fort St. James: Partnering in CareBy Pam Mulroy, Consultant to Medical Affairs, [email protected]
In fall 2011, the community of Fort St. James was in crisis over the provision of primary health care. Three physicians had departed and Dr. Paul Stent
was left alone to provide care for the community and surrounding area’s 5,000 patients. Dr. Stent, along with intermittent locum support and a nurse practitioner serving the community, did what he could to meet patient needs at the Fort St. James Medical Clinic and Stuart Lake Hospital. But the impossible workload resulted in only sporadic availability of the hospital’s emergency department and an inability to maintain primary care services. Residents were forced to frequently travel 45 minutes to Vanderhoof, the next closest community, to access care.
“More than anything else, I felt frustrated not being able to look after my patients. I’d been for many years recruiting doctors to come here and then having to turn around and recruit still others because the first ones weren’t going to stay,” says Dr. Stent. “It’s been the same situation for the last 15 years or more.”
It was clear to Northern Health that a new approach to physician funding and the provision of primary care was required in Fort St. James. Funding constraints to the provincial Alternative Payment Program (APP) meant a lack of resources for physician service contracts. With only fee-for-service as an alternative, an innovative approach for physician compensation was needed. A consultant was hired to evaluate funding options. The objective was to develop a funding model that was attractive to physicians and would enable them to practice without being concerned with the business operations of a medical clinic.
The solution was found in the development of a guaranteed income model that provided stable wages for physicians, who could then focus on the delivery of high quality primary care. The guaranteed income model was funded through Medical Services Plan fee-
Dr. Sean Ebert Photo: Nicole Ebert
Dr. Paul Stent
“More than anything else, I felt frustrated not being able to look after my patients. I’d been for many years recruiting doctors to come here and then having to turn around and recruit still others because the first ones weren’t going to stay.”
Dr. Paul Stent, Fort St. James physicianAll photos pages 22-24: Ann McCormick
P | 23P | 23
NH | integrated accessible health services
Dr. Laurren Rodgers
Dr. Anthon Meyer (right) with Omineca Thomas (left)
for-service payments, thus requiring that the practice management be efficient and cost-effective.
For Northern Health, the Fort St. James situation mirrored those in other northern rural communities that struggle to maintain stable primary care while facing physician shortages and unfeasible fee structures. Dr. Sean Ebert, Northern Health’s Medical Director for the Lakes/Omineca region, advocated for the new approach in Fort St. James.
“Rural practice, much like rural life, is about facing challenges by being creative and innovative and working together,” Dr. Ebert says. Through the principles of a good and fair practice opportunity for physicians, the provision of high quality primary care, and system sustainability, a business model emerged that would support the diverse but aligned interests of the physicians, Northern Health, and the community.
Community PartnershipsFor communities that face physician shortages, there is often a feeling of vulnerability that impacts not only the health of the population, but also the community’s economic viability and well-being.
“There was a lot of angst in the community and a lot of uncertainty,” says Fort St. James Mayor Rob MacDougall.
So, community members banded together to look for solutions. They established partnerships with community stakeholders, the local First Nations and Northern Health. They formed the not-for-profit Fort St. James Primary Care Society and positioned it to manage the delivery of health services in Fort St. James and the surrounding area. Run by a local board of directors, the society would provide the leadership for a vision of a stable primary care system at the Fort St. James Medical Clinic.
The Recruitment JourneyTo address the physician shortage in Fort St. James, Northern Health and the community embarked on an innovative recruitment process. Recruitment to rural communities centers on finding the right fit, to ensure that the practice opportunity and the community offers the physician and their family the personal and professional lifestyle they are seeking. The right fit not only supports recruitment, but also retention.
As traditional recruitment efforts — including website, journal advertising and colleague referrals — were not yielding the desired results, the district council of Fort St. James decided there was no one better positioned to promote the community than the community
“Rural practice, much like rural life, is about facing challenges by being creative and innovative and working together.”
Dr. Sean Ebert, Northern Health’s Medical Director, Lakes/Omineca region
P | 24
NH | integrated accessible health services
(l-r) Celia Evanson, nurse practitioner, with Dr. Pieter van Zyl
Dr. Marile van Zyl
itself. Collaboration and engagement between the community, physicians, and Northern Health became central to promoting the practice opportunity, with the community rallying to showcase the reasons they love to live in Fort St. James.
“We found the physicians and brought them to the community, but it was the people living in Fort St. James that recruited them,” says Charlene Thomas, a targeted recruiter with Northern Health.
When physicians and their families came to Fort St. James for site visits, community members took the visitors on helicopter tours of the local First Nation communities, fed them home-made meals, gave them extensive community tours, and tours of the Nak’azdli Health Centre.
Four physicians accepted the offer to practice in Fort St. James.
“The community’s incredible effort, combined with the enthusiasm and genuine warm welcomes towards the physician candidates were the determining intangible factors in the successful outcome of the recruiting drive,” says Thomas.
Journey Towards Stability The clinic is now staffed with five physicians, with a clear vision to build a stable system of high quality primary care for Fort St. James. As the clinic establishes the delivery of comprehensive primary care, there are plans to evaluate service access, health outcomes, patient satisfaction and provider satisfaction.
Dr. Stent says he’s relieved the community’s once dire physician situation has been reversed.
“The point of being alone is that it was band-aid care. You couldn’t offer the care to people with chronic diseases that they needed,” says Dr. Stent.
“We’re now in a situation where we can catch up with these people and make sure their conditions don’t deteriorate. We can see them more often and monitor their outcomes. It’s what family physicians in the whole country should be doing — keeping people out of hospital.”
Dr. Ebert agrees, commending all involved in the effort to stabilize primary care in the community.
“The Fort St. James model will find success because of the will and effort of those involved,” says Dr. Ebert. “This is a very important piece of work that will bring long-term benefits to the people of the area.”
“We found the physicians and brought them to the community, but it was the people living in Fort St. James that recruited them.”
Charlene Thomas, Recruiter, Northern Health.
P | 25P | 25
Men’s Health – Let’s blog about it!By Jim Coyle, RN, Tobacco Cessation Coordinator, Men’s Health program, [email protected]
NH | a population health approach
I’ve had the privilege for more than a year of writing blogs for the Northern Health Men’s Health website. In that time, I’ve covered many topics from quitting tobacco to
male breast cancer. The blog, located in the Tales from the Man Cave section of the Men’s Health website is quite personal at times, with “glory days” stories included to highlight a point such as male risk-taking behavior. The idea is to keep the subject matter as light and as entertaining as possible, while also being informative. Various writers from within Northern Health have contributed to the blog, sharing information on a range of topics. There is no pretense at expert opinion but there are multiple links to solid information on such websites as Health Canada and other information sources.
This may sound straightforward to most people, but let me tell you that as a registered nurse by profession, writing blogs was not exactly something that I ever saw myself doing. I used to think that such things as posting on Twitter and Facebook, along with using cell phones and tablets, were the preserve of the young. Ahem! Younger!
“Men are coming up consistently short across a whole range of health outcomes—and are dying, on average, earlier than women.”
Jim Coyle, RN, Tobacco Cessation Coordinator, Men’s Health program
Left: Jim Coyle Photo: Louise Coyle
Above: Men discussing men’s health Photo submitted
NH | a population health approach
Yet since I started, I’ve posted 24 blogs. I’ve also had a video or “vlog” on prostate cancer posted on our Northern Health YouTube channel. The mantra for our Men’s Health website is, “Men’s Health Matters Because Men Matter”. That’s because men are coming up consistently short across a whole range of health outcomes and are dying, on average, earlier than women. There are many reasons for this — one being that men often do not think about their health until something is wrong with it.
Psychologically, this may reflect men’s discomfort with vulnerability or not wanting to be seen as wimpy — particularly in the north. Or thinking about health perhaps implies illness, which interferes with our self-image and perhaps elicits anxiety. Whatever the cause, it’s dysfunctional in that many disease processes can be changed by altering our habits and thus ensuring that we can have healthier lives. Often these changes do not require great commitment. Simply moving more, getting out in nature, or making a slight change in diet are good examples of healthy choices. Other changes, such as stopping smoking, however, require a max effort, as does stopping excess alcohol consumption or other substance use.
For all of the above reasons, there are a variety of topics to communicate on our Men’s Health blog. Our main message to men: Visit your doctor while you are well, and get a full checkup, blood work, rectal exam, etc. Look after yourself, because so many people at work and at home rely upon you to be there for them.
I’m happy to say that our blog posts have prompted some feedback on our Northern Health social media channels, so we know that our men’s health messaging is getting out there. We still have work to do but, in the meantime, please send me your story ideas on the men’s health issue that interests you: [email protected]
And always remember: You are important, the people who love you are important, and they need and want you around for as long as possible.
To view Jim Coyle’s song about prostate exams click here.
“Our main message to men: Visit your doctor while you are well, and get a full checkup.”
Jim Coyle, RN, Tobacco Cessation Coordinator, Men’s Health program
Bottom: The Dudes Club Photo: Brandon Grant
Top right: Jim Coyle Photo: Selfie
P | 26
P | 27P | 27
NH | a population health approach
2014 All Native Basketball Tournament: More than a sporting eventBy Theresa Healy, Regional Manager, Healthy Community Development, [email protected] and Doreen Bond, Tobacco Reduction Coordinator, [email protected]
Unity, pride, and community: these are the off-court principles that push the All Native Basketball Tournament to its inarguable
success. Held in Prince Rupert every February, the 2014 event drew thousands of spectators and 56 basketball teams from Aboriginal communities across northern BC. The tournament, which has been held for over 50 years, has the honour of being the longest-held sports event in BC.
The All Native Basketball Tournament is a destination and focus for northern communities, as the prestige associated with the event encourages healthy choices by team members, their families and supporters in the run-up to the games themselves.
For many communities, the annual trip to the tournament is an important social and cultural event as they can gather with friends and families from other remote communities across northern BC and the rest of the province. The sport and cultural atmosphere also provides a powerful connection and place of belonging
and, perhaps most importantly, instills a great sense of pride in the communities and First Nations that attend.
Northern Health has been proud to be part of the event since 2006, which started with one lone information table on tobacco reduction. Since then, Northern Health has made a conscious effort to expand its presence by not only promoting healthy living, but also offering participants and spectators information on a range of integrated health services such as mental health and addictions, public health, and acute care at the Prince Rupert Regional Hospital.
On-site health screenings were still offered as in previous years, but Northern Health opted in 2014 to also feature a gathering and comforting space for all to use, rather than primarily a clinical space. This quiet space was furnished with cozy furniture and low lighting, which provided a retreat where Elders could rest in comfort, nursing moms could feed their babies in peace, and traditional stories could be shared.
The space was reflective of supporting a complete healthy community, and a way of integrating a social and cultural gathering with health services. While the tournament is an important contributor to the health and well-being of northern First Nations, this year, for the first time, people spoke of the tournament as a place where, sport, culture and health came together.
A version of this article first appeared in the April 2014 issue of A Healthier You magazine, a joint publication of Northern Health and The Prince George Citizen.
the northern way of caring
Semiguul (Fanny Nelson)Metlakatla Matriarch and four generations of her family
Basketball YESTobacco NO
“Together we make a family ~ health is one of life’s greatest blessings that connect the lines from generation to generation”
DOOR PRIZES
Thinking about quitting?
Call the Health Unit at 250-622-6380 or 811 BC Smoking Cessation Program
or QUITNOW 1-877-455-2233
Health Screening will be available in Raven Room (Blood Pressure, Blood Sugar, Cholesterol, in addition to Dental & Wellness Screening)
For more information about Men’s Health Visit: men.northernhealth.ca
Photo: Jonathon Dyck
P | 28
NH | a population health approach
Health promotions team makes healthy living fun and accessibleBy Jessica Quinn, Regional Manager, Health Promotion and Community Engagement [email protected]
A population health approach is one of the primary pillars of Northern Health’s strategic plan. This is the basis for the work of the
Health Promotions team, as we focus on promoting the upstream, positive, public health work that directly engages northern communities, partners and staff.
The Health Promotions team, comprised of myself, Rosemary Dolman, Chelan Zirul and Michael Erickson, was created in 2013 and sits with one foot in the Communications department and one foot in Public Health, which allows our team to be more directly involved with the great work and stories coming out of Public Health.
Lucy Beck, Regional Director, Public Health — Population and Protection, says two things make Northern Health’s approach to health promotions unique.
“Firstly, we have put together a group, not just an individual, which focuses on health promotions. There’s benefit to having a group of individuals with a variety of skill sets, who can work well together. Secondly, we have tied the group very closely to public health, so that the work is a cooperative process,” says Beck. “The strategy meetings we have and the action plans we create make a far superior outcome than just responding to issues, or public health going to communications when we need a campaign. It’s this aspect of working together that gives us a far broader approach to health promotion activities.”
She says the process crystallized for her during a discussion about a CEO video blog that was filmed for the Stop Smoking Before Surgery initiative.
“We were able to get this video created, and then the promotions group looked at how we could promote this in a bunch of different places. When Public Health asks what else we can do, the Health Promotions team comes at it with a ‘can do’ attitude,” says Beck. “There are never any road blocks, but instead always solutions that will make what we want to do better. This comes from having a dedicated group that knows what public health wants to do and then makes it happen.”
Our goals, as we develop health promotion campaigns and messaging, are to share stories about health and engage with the public around ideas for living a healthier life. We have developed a comprehensive digital and social media strategy to create connections with communities across the northern region. The NH blog exemplifies our goals. It focuses on personal storytelling from our own people — a celebration of our staff — and offers practical tips, ideas and tools.
Through our work with the Healthier You Promotions and Engagement team (HYPE) — a regional, cross-departmental group of passionate Northern Health staff — we have created exciting campaigns that have reached a large number of northern BC residents. They include:
• theflashmobatUHNBCduringtheHealthyLivingChallenge;
• thePictureYouHealthychallengethataskedpeople to submit photos illustrating health in their community;
• theMyHealthyWorkplacecampaignthatsawover 60 teams from workplaces across the north compete to highlight how they incorporated health and wellness into their work.
By engaging groups of people in health promotions — online, in communities and within Northern Health — we strive to make health a more accessible, fun and attainable goal.
My Healthy Workplace team submission for a Northern Health physical activity challenge.
Photo submitted
P | 29
My name is Kendra and I’m a nurse in Dawson Creek, BC. I’m a wife, a mother to three beautiful children, a daughter, a sister and a
friend. This is my story of survival.
On Friday, January 25, 2013, I had the most wonderful gift, a brand new baby girl. Lucy was our third baby, and our last, third time lucky!
We started breastfeeding but Lucy wasn’t a good feeder. The next day I was tired and sore. I was discharged on Saturday. That night I was hot, cold, shivering.
By Sunday morning, I was exhausted, my nipples were cracked and Lucy, although hungry, would not go near my breasts. In hindsight, I thank the angels every day that she was aware enough to intuitively stay away.
We went shopping and my right arm and leg started to throb. When my husband insisted I call maternity, the RN advised me to go to emergency, maybe I had a clot.
In her own words . . . A woman’s harrowing journey with sepsisBy Kendra Kiss, Director of Care, Dawson Creek and District Hospital [email protected]
At emergency, a nurse took my vitals, but there was nothing unusual; just intense stabbing pain in my right
arm and leg. The emergency doctor checked my urine, it was full of blood, but I was two days postpartum. He diagnosed me with a severe urinary tract infection, then said maybe I’d retained product from the birth. Come back tomorrow for an ultrasound.
NH | a focus on our people
“Overnight, my pain got worse and my anxiety ran high . . . I heard the word sepsis — a potentially life-threatening illness that results when the whole body reacts to an infection spread through the bloodstream.”
Kendra Kiss, RN, sepsis survivor
Kendra Kiss with her three children
Photo: Laura Dyck
NH | a focus on our people
P | 30
We got ready to go, but I was instead sent to maternity because I was now on morphine for the pain in my arm. In maternity, the baby could stay with me. My husband went home and my mum stayed. The maternity nurses called my OBGYN. He came in, called for an ultrasound; it concluded no clots, no placenta. My OBGYN asked the maternity staff to keep him updated through the night.
Overnight, my pain got worse and my anxiety ran high. A fresh emergency doctor assessed me and told the mat nurses to monitor my vitals hourly and keep on top of my pain. My mum noticed my arm swelling and said my face was beet red. She called the nurse, who called the doctor. I heard the word sepsis— a potentially life-threatening illness that results when the whole body reacts to an infection spread through the bloodstream.
The sepsis protocol was started on me at 0023, and stopped at 0053. A doctor diagnosed cellulitis, a bacterial infection of the skin, saying, “She’ll be fine in the morning.” But at 0630, my OBGYN came in. He demanded blood work and that I be transferred out.
As I was wheeled away from my family who were now at the hospital, I heard my OBGYN say, “You need to prepare, she’s very sick and she may not make it.” I saw tears in my husband’s eyes. By 0900, I was in a BC ambulance going to Grande Prairie, Alberta, because that was the closest internist who could accept me. My arm was now twice its size, I was dehydrated and my leg and arm started to bruise.
In Grande Prairie, I was diagnosed with sepsis, toxic shock and disseminated intravascular coagulation (DIC) from a Strep A infection. In the end, my physician said it was the DIC that was going to take my life, a rare condition that prevents blood from clotting normally. The infection attacked my skin, causing a great threat of necrotizing fasciitis — flesh-eating disease. I remember a doctor standing above me, inserting a central line, saying to my husband, “Mr. C, you need to call her parents and prepare, I don’t know if she’s going to make it.”
“I remember a doctor standing above me, inserting a central line, saying to my husband, ‘Mr. C, you need to call her parents and prepare, I don’t know if she’s going to make it.”
Kendra Kiss, sepsis survivor
The various stages of Kendra Kiss’ sepsis infection.
Photos: Francois Cournoyer
P | 31
NH | a focus on our people
Beth Ann Derksen, Executive Lead, Northern Health’s Critical Care Program, points to information urging health care workers to use sepsis protocols. Photo: Joanne MacDonald
Four days later, I woke up in an intensive care unit, hooked up to machines. I couldn’t move. My right arm was covered in what looked like burns and blisters and my right leg was the same.
“Kendra,” a voice said, “You’re in Grande Prairie. You have a Strep A infection. You’re on a cocktail of antibiotics and you’re in isolation. I’m sorry you can’t see your family until you’re clear. We’re also monitoring you for necrotizing fasciitis.” Flesh-eating disease? I’d just had a baby, how did this happen?
I was in the hospital in Grande Prairie for one month. I had to relearn how to eat, walk, and feed myself. I was then transferred to hospital in Dawson Creek for eight days before going home. It took me almost eight months to regain my strength physically, and today I still have moments of anxiety around being sick. Besides the emotional scars, I have a toonie-sized hole on my right arm as a reminder.
Sepsis caused me to miss my daughter’s first two months of life, my children’s dance recitals and karate lessons. I couldn’t breastfeed my baby. My family was put on antibiotic prophylaxis.
I don’t know how I got sepsis. But it changed my life forever. As a nurse, I know there is a sepsis protocol in our hospitals and it’s simple to see the signs. I know, too, that it’s easy to miss the signs; that’s why education
Turn off the lights! Northern Health takes team approach to energy conservationBy Joanne MacDonald, Communications Officer, [email protected]
It’s simple: Every dollar saved on energy can be redirected to providing patient care. That’s the mantra of John Johnston, Northern Health’s Director
of Engineering and Environmental Sustainability, who leads the organization’s energy conservation team.
Johnston says Northern Health has conducted energy audits on more than 25 facilities in recent years and implemented close to 100 conservation measures, with an estimated savings of $160,000.
“In the big picture, Northern Health spends about 1.1%, or $8 to $9 million of Northern Health’s operating budget on energy,” he says.
Electricity and natural gas are the two biggest expenditures, with some Haida Gwaii facilities fired with fuel oil because natural gas is not available. Facilities in Dease Lake and McBride use propane for the same reason.
“Regardless of the energy source, we have a goal to make each facility as efficient as we can within the economic realities that we’re dealing with,” says Johnston. “Over the last four years, we’ve avoided paying about $3.75 million in energy costs; our target going forward is to save a cumulative 2% per year; however, BC Hydro’s 9% rate increase that has just come into effect is going to make that more difficult.”
and awareness among our staff is so important. Early identification, early antibiotics, early IV fluids — one in five people will be saved if we use simple, effective treatments in our emergency departments.
My name is Kendra and I survived sepsis.
“Regardless of the energy source, we have a goal to make each facility as efficient as we can within the economic realities that we’re dealing with.”
John Johnston, Northern Health’s Director of Engineering and Environmental Sustainability
NH | a focus on our people
P | 32
The energy team’s budgeting strategy is largely tied to incentives from energy providers, BC Hydro and FortisBC. This year, Northern Health can apply for new capital funding to the Ministry of Health’s Carbon Neutral Capital Program to reduce GHG emissions. Utilities, faced with a tough choice of either building more capacity (expensive) or taking steps to manage the growth in demand, have opted to offer financial incentives to help customers invest in measures that actively reduce their energy needs by using more efficient products or processes.
“We benefitted from this demand-side incentive with our new Fort St. John Hospital, where we received an incentive of $315,000 from BC Hydro,” says Johnston, noting that capital incentives are calculated based on the amount of electrical energy savings a
building will achieve. “We hope to scale back the energy requirements for that
facility through better design, so BC Hydro was prepared to share
that benefit. It’s a win-win.”
The rebates are used by Northern Health in various w a y s : t o m a k e q u a l i t y improvements by adjusting our operating methods to match current needs, u p g r a d i n g t o m o r e e n e r g y - e f f i c i e n t technolog ies, and
addressing building deficiencies to reduce the amount of energy consumed to circulate air/water, as examples.
Two of Northern Health’s current energy conservation projects that benefited from FortisBC’s Custom Commercial program include:
• UniversityHospitalofNorthernBC,PrinceGeorge: Damper controls have been installed in the hospital’s power plant to reduce energy losses when boilers are not operating, thus retaining heat. Projected annual energy savings: $25,000.
• GRBakerHospital,Quesnel,withFortisBC:Anew, smaller boiler is being installed to run in tandem with a larger boiler in summer, rather than using two large boilers year-round. Projected annual energy savings: $17,000.
Johnston says the Continuous Optimization Program through BC Hydro/FortisBC is also used across Northern Health, offering ongoing incentives, tools and supports to help our facilities team keep their buildings in good working order. Additionally, Johnston’s team promotes the Workplace Conservation Awareness program, which encourages energy conservation among staff in Northern Health offices and care facilities.
“Technology will only take you so far. At the end of the day, the actual consumer has to take some responsibility and control. And that’s where daily actions like turning off the lights come in,” says Johnston.
“With the predicted increase in both electric and gas rates, it’s become more important for all of us to be cognizant of how we invest in and use our energy. It’s a big team effort working with all of our facility management crews across the region. They know how our facilities work on a daily basis – they regularly help us figure out how to save money. We can then reinvest the savings into patient care. I couldn’t do this without their support.”
Editor’s note: Since writing this article, John Johnston has resigned from Northern Health and moved to Ontario with his wife.
“Technology will only take you so far . . . and that’s where daily actions like turning off the lights come in.”
John Johnston, Northern Health’s Director of Engineering and Environmental Sustainability
Top left: Fort St. John Hospital and Peace VillaPhoto: Sandra Milner
Bottom: John JohnstonPhoto: Joanne MacDonald
P | 33
NH | a focus on our people
Hospital replacement projects to offer health care services in modern environments By Jonathon Dyck, Lead, Public Affairs and Media Relations, [email protected]
Construction is well underway on two hospital replacement projects in the Northern Health region.
The Lakes District Hospital and Health Centre in Burns Lake, BC, was fully enclosed in January 2014, and crews are working on the interior of the facility. Construction on the facility officially began in June 2013, when a local contractor began excavation work.
“Staff and physicians in Burns Lake are excited about the new facility as it will enhance working conditions, which will allow our fantastic team to deliver better patient care,” says Marie Hunter, Health Services Administrator, Lakes District. “Staff and physicians are getting excited about moving into the new workspace next year.”
The 6,100 square-metre (65,000 square feet) facility will include 13 acute care beds; an isolation bed; a palliative care room; a labour/delivery/recovery suite; public health services; mental health and addictions; and home and community care services. There will also be local physician and emergency services, a pharmacy, emergency services, diagnostic imaging, a laboratory, and more. This facility will replace a facility that is over 50 years old and has reached the end of its life. This project will enable Northern Health physicians and clinicians to deliver client-focused, health care services in a modernized environment that will ultimately improve outcomes for patients.
On Haida Gwaii, excavation work is underway on the new Queen Charlotte/Haida Gwaii Hospital project. The hospital is being built around the current facility, and will be triple the size at 5,000 square metres (54,000 square feet).
“The new hospital on Haida Gwaii will be a cornerstone of medical services for Queen Charlotte, Skidegate, and the surrounding communities,” says Kerry Laidlaw, Queen Charlotte Islands General Hospital Site Administrator. “The new facility will be a great space for patients, staff, physicians, and visitors.”
The new hospital will feature bright, modern facilities with traditional Haida designs, expanded single-bed rooms with private washrooms, and secure patio space with views of the ocean for patients and their families. There will be eight acute care beds; a labour/
delivery/recovery suite; a home and community care wing with eight residential-care beds; a primary care centre; and space for diagnostic imaging, laboratory and pharmacy services.
The $55-million Lakes District Hospital and Health Centre is funded by the Province of BC and Stuart Nechako Regional Hospital District; and the $50-million Queen Charlotte/Haida Gwaii Hospital is funded by the Province of BC and the North West Regional Hospital District. Construction on both facilities is expected to be completed in the fall of 2015.
(l-r) Burns Lake Mayor Luke Strimbold and Marie Hunter, Health Services Adminstrator, Lakes District, at the construction site of the new Lakes District hospital.
Photo: Jonathon Dyck
NH | a focus on our people
P | 34
Artist’s rendering of the new Queen Charlotte/Haida Gwaii Hospital Replacement Project
Artist’s rendering of the new Lakes District Hospital and Health Centre Project
Ask us how we can help you with
Whether it’s our views on how mutual funds can be used to achieve your financial goals, or tax and estate advice, we will work with you to develop a comprehensive plan that is tailored to your individual needs.
OPEN A WORLDOF OPPORTUNITIESFOR YOUR INVESTMENTPORTFOLIO.
Assante Capital Management Ltd.1460 – 4th AvenuePrince George, B.C. V2L 3J7Tel: (250) 564-2020Toll Free: 1-800-957-7777Fax: (250) 561-2020Ted Brown, Financial PlannerEmail: [email protected]
CAPITAL MANAGEMENT LTD.
Assante Capital Management Ltd. is a member of the Canadian Investor Protection Fund and is registered with the Investment Industry Regulatory Organization of Canada.
Commissions, trailing commissions, management fees and expenses all may be associated with mutual fund investments. Please read the prospectus before investing. Mutual funds are not guaranteed, their values change frequently and past performances may not be repeated. Sponsored in part by Dynamic Funds.
Call us for a Free Mortgage Check-Up!We’d be delighted to advise you on how to get the most from your mortgage:
• Transfer consumer debt to a lower interest rate.
• Pay off your mortgage early & save thousands, or free up money for a rainy day savings fund.
• Access the lowest-cost funds for renovations.
Call Us First For expert Mortgage adviCe and CUstoMized FinanCing solUtions.
attention HoMeownersDo you have the best mortgage strategy for YOU?
www.pgMortgageBroker.com
BonUs!If you sign a mortgage with us,
we will say tHanK YoU with a complimentary
$200 visa gift card!Exclusive offer for Northern Health employees!
Michelle MohrMorTgAgE brokEr
Jamie CunninghamMorTgAgE brokEr
*oAC, E&oE