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Summer Break

We’re taking a break for summer. See you in September.

One helluva story

Glenn French, President and CEO of the Canadian Initiative on Workplace Violence.

Glenn French, President and CEO of the Canadian Initiative on Workplace Violence.

Glenn French has a helluva story to tell.

The President and CEO of the Canadian Initiative on Workplace violence provided the keynote speech after two days of meetings by OPSEU’s Mental Health Division.

He spoke about a cleaner in a long-term residential facility in Newfoundland.

The man was well-liked and enjoyed his work.

One day he was struck with a lamp by a resident in a senseless act of violence.

While his colleagues quickly attended to the perpetrator of the act, nobody attended to the cleaner, who took himself off to what he perceived would be a safe place. It was an hour before anyone had thought to give any attention to the victim.

French says that when violence happens in the workplace it has a ripple effect, like a stone being thrown into a pond.

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Mental Health: No easy answers, but there are still answers

Nancy Casselman, TEGH's Director of Human Resources and Organizational Quality, Safety and Wellness.

Nancy Casselman, TEGH’s Director of Human Resources and Organizational Quality, Safety and Wellness.

There are no easy answers, but that doesn’t mean there aren’t answers.

We’ve been meeting in downtown Toronto to try and tackle the issues behind the injuries front line professional and support staff are sustaining by simply going to work to help others recover from or cope with a mental illness.

We know that individuals with a mental illness are no more likely to physically and verbally strike out than anyone else.

The evidence is clear — this is not even a debate.

Queen’s University professor Dr. Heather Stuart pointed out that only three per cent of violent crimes are committed by individuals with a serious mental illness. There’s another seven per cent committed by those with addictions.

Yet in popular culture that perception is much greater. Stuart points out that in the world of popular fiction that rate is closer to 20 per cent. When one in five violent crimes are committed on TV by fictional mentally ill people, what does that tell us? How does that shape our view?

Academics, clinicians, and other experts – including our own members – have been spending the past day trying to solve the riddle poised by the very real injuries these front line workers are sustaining. On paper this is not supposed to happen – at least not to this extent.

Nor is it exclusive to this one corner of health care.

Speaking about violence and mental health in the same sentence is likely to raise the spectre of stigma, yet stigma itself is likely a big part of why mental health receives so little attention and funding which in turn fosters these kinds of system breakdowns.

There is, after all, a direct proven correlation between the level of staffing and likelihood of patient’s striking out. Under the circumstances many of us would be provoked into a fight or flight response.

Clearly the system is not working as it should.

Several managers from The Toronto East General Hospital showed up in the morning to talk about the incredible work they are doing to reduce workplace violence.

There are positive models out there – theirs is but one. They would gladly take the calls of any hospital that would like to learn from them. The entire room wanted Nancy Casselman’s business card. Casselman is the hospital’s Director, Human Resources and Organizational Quality, Safety and Wellness.

They are making progress in part because they have serious buy-in from the top. At one point the CEO actually sat on the joint occupational health and safety committee. How many other CEOs see health and safety as that kind of priority? Maybe they should given the high price of WSIB premiums from injured workers. How many joint occupational health and safety committees even have participation from managers who have significant clout within the hospital or agency structure?

Instead of discouraging workers from reporting incidents, TEGH encourages it. If you can’t measure it, you can’t expect decision-makers to sit up and take notice. That’s a lesson for everyone.

Workers could see the results of their reporting in the policies that were jointly developed at TEGH, including a unique flagging system for patients who pose serious risk to themselves and others. Results prompt more diligent reporting because workers knew it wouldn’t just get lost in the void.

Workload also is a factor. If an incident derails a worker’s day, they might think twice about taking the time to fill out the forms and report it to their supervisor.

TEGH says the results are there – they have only had one related lost time injury in three years. Imagine that?

We also heard from front line staff in other psychiatric hospitals and mental health agencies who talked about the blame game that goes on when an incident is reported. How the heck do health providers expect to work towards change when the first words from a manager are, “what did you do to provoke this?”

That’s a sure fire way to ensure accurate reporting never takes place.

Every hospital likes to talk about best practices, but in this field there are too few that are supported by evidence. The reality is stigma also keeps funding away from researchers who could be building evidence towards such best practices.

We heard that least restraint, when implemented whole, can actually make a difference in reducing workplace violence. The bad news is that when implemented piecemeal, it tends to have the opposite effect.

That doesn’t mean that no patient should ever be placed under physical, chemical or environmental restraint (seclusion). We heard how considerable confusion exists between the policy of least restraint and no restraint. Much of it depends on the individual – the best decision remains the one that is patient-centered.

That’s why there is such complexity in addressing this issue. Those with mental illness hate being described by their illness. They are right to resent such labelling. Why do we think one size fits all when it comes to mental health care?

We also heard about training and competencies. How many hospitals even have a list of competencies for front line staff? This is skilled work and its time those who do it well earn some respect and assistance.

The work of our mental health agencies and institutions also deserves respect.

It is real work that gets real results when done competently. It’s hard to convince government to increase funding if the perception is there is no value in it.

Mental illness is not something you can physically see. Dr. Stuart spoke of her experience in a run-down hospital where bugs were crawling out of the ceiling. Management’s first reaction was to make a joke of it, asking if the bugs were real or in the heads of the patients. When they caught the bugs and sent a container of them to the CEO, she was no longer laughing.

What do those run-down surroundings even say about how we view mental health care?

The Chief Physician for the Ministry of Labour spoke early in the proceedings and then stuck around to hear what everyone else had to say. We appreciate that.

The Minister of Labour was originally supposed to open our meeting, but then an election happened.

They have a clear role to play and need to show some courage in applying laws meant to protect workers.

We had a lot of people in and out of our little room today.

Some connections got made. Some new doors were opened.

We’ve been banging around like a bull in a China shop over this for too long.

It’s time to turn the page and do some real politics for ourselves and the patients we serve.

Change starts now.

One of three break-out groups speak about their experiences and search for best practices.

One of three break-out groups speak about their experiences and search for best practices.

The day after: health care issues still smoldering

There’s got to be a morning after.

Tim Hudak has announced he is stepping down and the Kathleen Wynne Liberals now have a majority parliament.

So what happens now?

There are several outstanding issues in health care.

The first is the fate of the Local Health Integration Networks. The standing committee charged with conducting the legislated review travelled the province holding hearings over the winter. Despite Tim Hudak’s promise to replace them with “health hubs,” there was little interest in the issue on the campaign trail. The likely result will be some minor tinkering and they will soldier on. After eight years the LHINs appear to have found their legs although clearly there are still some community members who feel left out of the process. Last year’s five per cent cut to their budgets likely didn’t help the LHINs connect with those communities.

We’ve noticed that despite a province-wide Ontario Health Coalition campaign opposing the siphoning off of hospital services to private clinics, the province is moving forward with competitions to auction cataract surgeries, endoscopies and other diagnostic services. The Windsor Regional Hospital is already in one of these competitions with the private MyHealth Vision Care. MyHealth manages 16 Independent Health Facilities in Ontario and say they are developing 18 more. The hospital is the midst of capital planning for a new outpatient facility. Being caught in these kind of arbitrary competitions makes it difficult to plan. CEO David Musyj told the Windsor Star that the cataract decision will have an effect on the entire health system. “We don’t want to do something prematurely that negatively impacts what we’re trying to create into the future for the community.” The Wynne government could find themselves in a considerable battle over this issue. The Ontario Health Coalition have collected nearly 100,000 postcards from Ontarians who don’t want to see private clinics take over this work. They plan to present the postcards to Queen’s Park soon.

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Tories can’t add — Hudak way off on LHIN savings

Somebody please go to the buck store and get PC leader Tim Hudak a calculator.

We previously reported that the Tories long-standing pledge to eliminate the Local Health Integration Networks (LHINs) was missing from their platform.

Tim Hudak did eventually get around to the issue, renewing this promise.

Unfortunately, the promise also revealed more bad math. Far from being a “straight shooter,” Hudak’s campaign appears to be untroubled about facts.

Inside Queen’s Park reported yesterday that Hudak said he will cut 2,000 positions at the LHINs and save about $250 million.

Really?

Given there are 14 LHINs that would represent an average staff of 142.8 and an operating budget of nearly $18 million each.

We’ve sat through enough LHIN board meetings to realize this is way off. That prompted us to trek through the 14 annual reports presented on-line by the LHINs to check out their audited statements. We also went looking for their staff directories to add ‘em up.

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Who’s values will prevail on Thursday?

Whoever shows up to the polls tomorrow may determine Ontario’s next Premier and whether she or he enjoys a majority or minority government.

The question is, will that be decided by a majority of Ontarians, or will it reflect a different set of values decided upon by a much more motivated minority?

Diablogue Election Primer graphicWe do know that turnout to the advance polls was six per cent lower than last time, when the current minority government was decided by less than half of the eligible voters.

Worst still, according to ThreeHundredEight.com, only about one in four eligible voters admit that they have been following the election closely.

All you have to do is look around your community to observe so many fewer election signs.

That’s frightening given what is at stake.

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The end of efficiency – will appropriate care become the new system of rationing hospital services?

Former OHA President Tom Closson speaking at Longwood's Breakfast With The Chiefs June 10.

Former OHA President Tom Closson speaking at Longwood’s Breakfast With The Chiefs June 10.

The relentless pursuit of efficiency may be coming to an end for Ontario hospitals.

Thank goodness.

As former OHA chief Tom Closson said today at Longwood’s Breakfast With The Chiefs forum, year after year it gets more difficult for hospital CEOs to balance their budgets — “you can’t cut the same thing as you cut last year.”

This hardly means that hospitals are about to enter a new era of sustainable funding, especially in Ontario where public health care spending is already the lowest per capita of any Canadian province. Closson says Ontario hospitals also have the lowest worked hours per weighted case, the shortest length of stay in acute care, and the fewest beds per capita.

Have we found bottom yet?

Closson says we still have to reduce costs “because we have to.” Instead of seeking more efficiency, a new approach is needed.

Closson was joined by the Hay Group’s Mark Hundert and Chris Helyar to preach the new orthodoxy of appropriateness and to suggest that the HBAM (Hospital Based Allocation Model) of funding needs fixing.

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Parties respond to Alliance questionnaire on mental health

We’ve previously noted that all parties had little to say in their official platforms when it comes to mental health care.

The Ontario Mental Health and Addictions Alliance recently surveyed the four main parties asking a series of specific questions about mental health care. The Greens, Liberals and NDP answered the questions, the PCs instead sent a form letter about Tim Hudak’s widely discredited Million Jobs Plan, reiterated the PC health hubs plan and made some non-specific comments about integration. The official PC platform only says that mental health will be a priority. “We will take the fragmented services now offered and replace them with a comprehensive approach to help some of our most vulnerable citizens,” they say.
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Two-thirds of Ontarians would vote for a strong health care platform — Nanos

It was a curious decision by the media conglomerate putting on the Tuesday’s leaders debate. Limiting viewer questions to six, you’d have thought one of them would have dealt with Ontario’s struggling health care system.

As it was, health care was raised only by NDP leader Andrea Horwath, when she noted the NDP’s wait time pledge in her final summary.

The Ontario Medical Association and Nanos suggest Ontarians were dealt a disservice by the way the conglomerate produced the program. According to a poll taken between May 22-26, more than two-thirds of Ontarians (67.6%) said a strong health care platform would have an impact on their vote.

Further 87.9 per cent said that health care is an important issue to them personally.

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Beach Reads: Intersection between commerce and health care leads to murder

The intersection of health and commerce perpetually raises the question whether the impetus for change is motivated by good health practice or private greed?

Book Cover Deadly ErrorsOur pollster regularly reminds us that profit is not a dirty word, but when it comes to health care, you want to be sure that the prescribed treatment is safe and based on good evidence, not necessarily on the best rate of return for the prescriber.

U.S. publisher Astor + Blue have recently sent us two works of fiction – a thriller and a mystery – that both pivot on this intersection of commerce and health.

The first, Deadly Errors by Allen Wyler, is actually a reprint of 2005 thriller written by the Seattle-based neurosurgeon turned fiction-writer.

The novel deals with a Dr. Tyler Matthews who discovers a series of unexplainable medical errors that he suspects may be linked to a new Med-InDx electronic health record that is being piloted at the Seattle-based hospital where he works.
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