Healthy Living in the North

Facility engagement removes silos, improves teamwork in the North

Article submitted by Doctors of BC.

A group of stakeholders at the Change Day event at UHNBC.
Change Day at UHNBC – a group of stakeholders.

Facility Engagement is a provincial initiative of the Specialist Services Committee that aims to strengthen relationships and engagement between health authorities and facility-based physicians, to improve the shared work environment and the delivery of patient care.

Dr. John Smith, Past President of Medical Staff at the University Hospital of Northern British Columbia (UHNBC) and an internal medicine specialist, has been a significant contributor to the work of Facility Engagement since its inception, both as a local physician leader and as a member of the provincial Specialist Services Committee (SSC) Facility Engagement Provincial Working Group.  

Dr. Smith says that the initiative is already fixing some challenges at UNHBC. He noted that administrators are responsible for making budgetary and policy decisions, while doctors are responsible for delivering the expenditure through patient care. “Yet none of the groups were talking to each other,” he says, “which quite obviously was not leading to useful results.”

He says that as a solution, facility engagement has created opportunities and incentives for increased teamwork between the doctors and administrators, who no longer work in isolation. Benefits are already showing in the areas of patient care, physician communication, and relationships with staff and administration.

One example involves solving the difficulties of getting adequate physician coverage for hospitalized patients, because GPs need to return to their individual family practices after morning hospital rounds and may be unable to return later in the day if needed. This is a common challenge at hospitals where GPs see inpatients.

“If the physician is only at the hospital between 8 am and 10 am,” says Dr. Smith, “it’s very hard for teamwork, planning and multidisciplinary rounds to occur. As a solution, we consulted with physicians and Northern Health to establish a general internal medicine unit. It’s a completely new structure developed to foster internal medical care, co-led by a doctor and an administrator.”

Under this unit, internists were recruited to look after the needs of hospitalized patients, and take pressures off of other GPs. The internist is able to make multiple rounds of patient visits, and address urgent concerns when needed in the middle of the day. With clear benefits for patient care, Northern Health was more than happy to collaborate on the project, and fund and sustain the new unit. “It’s simply a better system. The patients who are sick are looked after in a better way,” says Dr. Smith.

Another area of change he emphasized as a result of facility engagement has been improvements in physician communication. For example, internists and family doctors felt that each did not understand the other group’s pressures and needs. “With the help of Facility Engagement, they came together, expressed their concerns and agreed on a set of rules. They have found they have greatly improved communication and collaboration.”

A third area of improved collaboration is within the general hospital community, including staff and administration. Last fall, the entire hospital community convened a “Change Day” in which physicians came together with staff and pledged to change something in the hospital for the better.

“For the first time, something like this happened in Prince George and it was very successful,” says Dr. Smith. A total of 296 pledges were collected, placing Prince George fifth in the province. The main outcome of the event was broad collaboration.

Now that internal collaboration is becoming more firmly established in UNHBC, plans are under way to broaden collaborative efforts through a planning session for all hospitals in the region. “At the moment, Prince George has a lot of effect on Fort St. John, for example,” says Dr. Smith, “but the latter has no real say in Prince George.”

Dr. Smith says that facility engagement is a “very sensible initiative. It has increased the number of physicians who are active in hospital improvements and activities. If you told me three years ago that we’d have 40 per cent of physicians involved, I’d say ’no way’, but it is happening.”

And even though he’s retiring soon, Dr. Smith says that with the exciting opportunities that this initiative has created, “I would love to be starting again!”

Sanja Knezevic

About Sanja Knezevic

Sanja is a communications advisor with Northern Health’s medical affairs department and is based in Prince George. She moved to Canada in 1995 from former Yugoslavia to Fort Nelson where she lived for a few years before moving to Prince George in 2000. Sanja enjoys photography, curling up with a good book, cooking and spending time with her friends and family.

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Change Day – what’s your pledge?

Bulletin board with Change Day materials

Change Day is about trying something new or doing one small thing to improve care. Have you pledged yet?

My first introduction to Change Day was at the Quality Forum in Vancouver earlier this year. It was described as a global social movement with a simple premise: if you are involved with health, community or social care, try something new or do one small thing to improve care.

We were all invited to pledge to make just one small change that would improve the system for everyone. With the unveiling of a newly released Change Day video, there was a lot of hype and excitement in the room. However, I must admit that this was not when I truly felt inspired. That moment came when our CEO of Northern Health, Cathy Ulrich, stood up in this room filled with hundreds of people and pledged to “on a weekly basis, acknowledge a person or team who has undertaken a quality improvement initiative.” I remember thinking that this pledge was a such small act on her part, yet so powerful in terms of employee engagement!

I did not make my pledge that day; as I am, I needed some time to process what this meant for me. Several months later, I was listening to a presentation about culture and how it affects the change process when it struck me what my Change Day pledge would be. As I was learning about the importance of creating a culture of safety and how we need to lower the cost for speaking up and raise the cost for staying quiet, I had an “aha” moment. As I work with interprofessional teams to improve or develop new process, I always make an effort to hear everyone’s ideas and feedback. However, I knew that I could also create more space to encourage this. After all, they know best! Hence my Change Day pledge, “to be purposeful in seeking front-line opinions and ideas.

What’s your “one thing”? Make your pledge today!

Marna deSousa

About Marna deSousa

Marna has worked in Northern Health for 27 years. Her background is nursing and she currently works in Fraser Lake as a Care Process Coach and Practice Support Coach. In her spare time, Marna loves to be horseback riding and spending time at the cottage with family and friends.

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What would you change?

Person holding a pledge sign

Marlene from Northern Health has also made a pledge. What are you waiting for?

Every day, I come to work and I’m pretty happy. I enjoy the work that I do and the people I work with. But, every now and again, I notice things – small things – that could make our lives just a little better. These things are in my control, but then life gets busy or I don’t see others making an effort, so I don’t either. But … what if I did?

Every day, there are little things. Washing the dirty dishes that accumulate in the lunch room, or cleaning the fridge (I know, right?!). I also think about going out of my way to smile a little more and take a minute to say “good morning,” but I don’t want to bother people. But, would they be bothered?

Sometimes I notice things that could make a difference for the people we serve. For example, people get lost in my building regularly. When I see them wandering around looking lost, what if I went up to them and offered them directions? On this blog, we often post lots of health-supporting information developed by our experts within Northern Health, but what if I got two or more of these people together? Maybe we could develop information that is more appropriate for some of the people to whom we provide health information? Could I provide that information in a more accessible or interesting way?

What if I introduced myself by name to the next person who I respond to online? I wonder how that would make them feel? Maybe I could relieve some anxiety they may have for asking questions about our organization?

What do you need to make these changes?

Right now, there is a global movement happening to support small, helpful changes in the workplace. Started by the National Health Service in the U.K. in 2013, Change Day encourages people like me to commit to making one small change. The idea is that the movement builds on the ideas that I have about how I can make my workplace better for me, my colleagues, and those we serve. This isn’t about big, system-level change (though, who knows?! It may lead to that!). This is about changes that I can make today.

This isn’t only limited to Northern Health. This is open to all of us who work in the health, social, and community care sector in B.C. And, really, the principle is applicable to us all in our work and personal lives.

So, I took the leap. I decided to make a change. I publicly made my pledge at changedaybc.ca. As of today, Northern Health has 79 pledges of a total of 864 pledges. I know that when Northerners put their hearts into something they want, there is no stopping them.

What is stopping you from pledging today?

Chelan Zirul

About Chelan Zirul

Chelan Zirul is the Regional Manager for Health Promotions and Community Engagement for Northern Health. As a graduate from UNBC, she did her Master's of Arts in Natural Resources and Environmental Studies. She explored regional development decision-making and is an advocate for policy that is appropriate for the needs of northerners. This, combined with her personal interest in health and wellness, drew her to work in health communications. Born in northern B.C., she takes advantage of the access to outdoor living. She enjoys hunting and exploring the backcountry with her dog and husband and enjoys finding ways to use local foods.

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