Monthly Bulletin of the Alliance's Learning Health System |
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Advance Indigenous Cultural Safety in Your Organization |
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Screening Backlog?
Let's fix it together!
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Best Nursing Practices
Spotlighted @ Quest
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Closing the Digital Divide |
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Quality Standards Support for Asthma |
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Learning Events & Opportunities |
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Get Involved: Research & Sharing |
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All Our Relations: IPHCC Advances Cultural Safety with Release of Ne’ iikaanigaana Toolkit |
The new Ne’ikaanigaana Toolkit is the first of a series of resources from the Indigenous Primary Healthcare Council (IPHCC) to help mainstream organizations create safer environments for Indigenous people. It’s free to individuals and organizations, both within and beyond the healthcare system. Nicole Blackman and Mallika Patil* spoke to us about how the toolkit can help your organization work with Indigenous partners, whether they be clients, staff, or other stakeholders, in a better way.
Structural racism has been with us since colonization, and it permeates our health system and its institutions. The impacts of anti-Indigenous racism are most easily seen in high-profile events such as the deaths of Brian Sinclair and Joyce Echaquan. Less visible are its continuous impacts on population health outcomes. The Ne’ikaanigaana Toolkit (Ne’ikaanigaana is Anishnaabe for “All our Relations”) can help organizations identify and correct systemic and institutional racism in their structures and practices.
The toolkit was created through a co-design process that included representatives from the IPHCC’s knowledge keepers’ circle. It is the starting point for what will be a series of online modules. Together, these resources will empower people and organizations to build accountability for cultural safety into their work. Although the Ne’ikaaanigaana Toolkit will help individuals improve their own understanding of cultural safety. it is designed for organizations, because cultural safety is both an individual and an organizational responsibility, and accountability applies at both ends. ..
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What’s inside the toolkit?
- Ten strategies for advancing cultural safety. For each strategy, there is a list of concrete actions that can advance it. For example, one suggested action for the strategy “Wholistic continuum of care,” is to include frontline workers in weekly rounds with traditional healers, to find ways to incorporate traditional practices into care.
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Guidance on how to meaningfully partner with Indigenous people at the onset in developing culturally safe programs and policies, during idea conception. Too often, organizations seek to “Indigenize” what they’ve already developed.
- Links to other resources that can help you and your organization get started.
What’s next?
This fall will see the rollout of an organizational self-assessment tool, which will help organizations understand how culturally safe they are and where they need to improve. This will be followed by a series of modules to support organizational change and help “move the needle.” The goal for this toolkit and the modules that follow is not to be a “checklist” of things to look out for but a living, sustainable resource that will support a meaningful shift in the way organizations approach care for Indigenous people as well as continuous growth and improvement. Currently, the toolkit is available only in English, but a French translation is forthcoming.
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*Correction: In the emailed version of this newsletter, Mallika Patil's name was misspelled. We apologize for the error. |
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Cancer screening backlog after COVID-19?
We've got a learning collaborative for that!
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The EPIC Learning Health System is growing again! This summer, we will launch the first in what will be a series of learning collaboratives. This one will be focused on tackling the cancer-screening backlog that’s built up during the pandemic. To sign up, email Sara Bhatti, Research and Policy Analyst at the Alliance.
What is a learning collaborative? In short, it’s a group of peers who join forces to tackle a shared goal, with guidance from a coach or practice facilitator, over a defined period of time. A learning collaborative uses quality improvement (QI) methodologies to accelerate widespread improvement. Many learning collaboratives alternate between learning sessions, which combine didactic teaching with presentations and workshops, and action periods, in which members apply changes using the plan-do-study-act cycle and evaluate measures to assess whether the changes they make are resulting in improvement. It is an iterative, all-teach/all-learn process.
Why cancer screening? Lately, members have been telling us that one of their growing concerns is the rising backlog of cancer screenings. Over the past 15 months, many people have had to defer their regular screenings because lockdowns prevented providers from offering in-person preventive care. Others chose to delay due to pandemic-related anxiety. As the pandemic eases, it will be essential to get caught up. But what’s the most effective and equitable way to do this? How can we do this without sacrificing other essential activities?
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This is a way to build your
QI muscle.
Even world champions get up and practice the next day.
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Not sure if your team has anything to offer or gain? Even if you are not a QI rockstar, you have experiences and a unique perspective that can help shed light on the problem. And even if you are a QI rockstar, there is always more to learn. As Jennifer Rayner, our Director of Measurement and Evaluation, notes, “This is a way to build your QI muscle. Even if you have strong muscles, you can always improve. Even world champions get up and practice the next day.” And as an extra incentive, physicians can earn MAINPRO continuing medical education credits for participating.
What’s involved? The cancer screening learning collaborative will officially launch in September 2021. One or two introductory pre-work sessions with a QI coach/facilitator will be followed by four alternating two-hour learning sessions and action phases. A practice facilitator will help you implement the changes in your organization and measure their impact. At the end of the collaborative, we will be able to answer three questions:
- How can you best tackle a screening backlog?
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How can we best learn and teach collaboratively?
- How can we best share what we’ve learned with our sector and health system peers?
What’s next? This is only the first of a series of learning collaboratives to come! Members are also telling us they want QI support for sociodemographic data collection and panel size. What we learn about collaborative learning and teaching from this first learning collaborative will help us make the others even better. Watch for them in 2022!
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Quest CHC First in Ontario
to Receive BPSO Designation
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Quest Community Health Centre is currently the only CHC in Ontario to be designated as a Best Practice Spotlight Organization (BPSO) by the Registered Nurses Association of Ontario (RNAO). Program Director Jenny Stranges and NP Emily Kedwell spearheaded the project at Quest, and NP Joanna Lynsdale is taking up the torch from Kedwell. The three of them spoke with us about the process and what comes next.
Since their inception in 2010, the team at Quest CHC has been dedicated to evidence-based care and continuous learning, so pursuing BPSO designation was a natural step. To be recognized as a BPSO, an organization must choose and implement five of RNAO’s Best Practice Guidelines and demonstrate a commitment to continuous measurement, improvement, and dissemination of knowledge.
BPSO pre-designate organizations enter a three-year partnership with the RNAO. The RNAO provides support, access to implementation resources, opportunities to participate in research, and networking opportunities with other BPSOs. After applying to the program in 2017, Quest was accepted into the 2018 pre-designate cohort, completing the program in 2021.
The team chose to implement the following five guidelines:
- Assessment and Management of Pain
- Integrating Tobacco and Nicotine Interventions into Daily Practice
- Care and Assessment of Youth and Adults at Risk for Suicidal Ideation and Behaviour
- Engaging Clients Who Use Substances
- Crisis Intervention
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Most BPSO designates are large hospitals and long-term care facilities, and their designation activities are focused on nursing practice. Quest, being a small, interprofessional team, took a different approach. The unifying goal was to develop consistent practices across the organization without requiring staff members to get bogged down in details that weren’t relevant to their roles. The project leads worked with staff and clients to contextualize the guidelines so they made sense for everyone – clinicians, care coordinators, outreach workers, and clients. RNAO enthusiastically agreed to this approach and are in full support of working with an interdisciplinary team.
In practical terms, this meant a number of changes to practice at Quest. The centre standardized the way they make and document internal referrals to programming, to allow more consistent tracking. They updated their assessment tools for pain and substance use, to enable more holistic treatment planning. To better support the safety of clients with mental health and substance use challenges, they implemented a crisis intervention initiative, a suicide risk assessment tool, and a standardized practice for recording clients’ safety plans in the EMR so all members of a client’s care team can easily access and update it.
Once BPSO designation has been awarded, the spotlight organization must continue to uphold the practice guidelines they implemented, implement new ones each year, and participate in capacity-building and knowledge-sharing activities with system partners. Over the next two years, they will be working with RNAO to implement best practice guidelines for 2SLGBTQ+ care and palliative care. They are already advancing Transgender care and capacity building throughout the region, including partnering with Home & Community Support Services staff to enhance post-operative care for people after gender-affirming surgery. Quest is excited to continue to explore future initiatives including working with other BPSO designated organizations in their OHT. s.
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An additional requirement for the designation is that one or more members of the nursing staff complete an advanced clinical fellowship. Steven Athanasas, an RN at Quest, used this opportunity to advance the centre’s expertise in prescribing pre-exposure prophylaxis (PrEP) medication. He participated in professional development on the topic and then led training sessions for prescribers and nursing staff who support clients taking PrEP. As a result of this work, Quest has now opened a PrEP clinic to members of the community.
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How will You Close the Digital Divide
in Your Community?
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The COVID-19 pandemic and the shift to virtually and remotely delivered health care have made it increasingly clear that digital equity is a necessary component of health equity. Our sector's commitment to health equity is grounded in our Model of Health and Wellbeing. In November 2020, it was encoded in our revised Health Equity Charter. A new suite of resources from the Alliance will help you develop a digital equity strategy for use in your centre and with your community and OHT partners.
Digital equity is a condition where all individuals and communities have the information technology capacity they need, in order to fully participate in our society, democracy, and economy. Digital equity is increasingly necessary for full civic and cultural participation, employment, lifelong learning, and access to essential services such as health care.
The Digital Equity Resource Package is a suite of tools developed by a team of Alliance staff and staff from Alliance member agencies. It was built through consultation with people from across our sector, and it incorporates learnings from the UK’s National Health Service and from digital equity coalition groups in Charlotte, Seattle, Boston, Vancouver, and Toronto. It consists of the following elements:
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The Digital Equity Examples Diary (DEED) is a living document where the Alliance and our members will share our digital equity journeys and learn from one another. It includes a section for member entries, where members can document their digital equity initiatives, as well as sections on Alliance advocacy, digital equity resources, and public policy documents.
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The Digital Equity Playbook outlines 15 actions your organization and partners can take together to advance digital equity in your region or community. This document will be expanded with more actions based on our members’ learnings.
- The Digital Equity “Join Us” video is a 2-minute audio-visual overview of what digital equity is and why it matters, which you can use to recruit fellow travellers. There are two versions: One optimized for social media platforms, and another optimized for websites and presentations.
We look forward to hearing and learning from you! If you have questions about any of these resources or how to use them, please reach out to our Information Management Strategy team. |
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New Resources to Support
Asthma Quality Standards
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May 5 was World Asthma Day. Asthma is one of the most common chronic conditions in Canada. Two million people in Ontario are living with asthma, and about 90% of them have uncontrolled asthma that could be improved with appropriate medication. Flare-ups of uncontrolled asthma can lead to avoidable emergency department visits, and with the pandemic it's more important than ever to avoid this outcome. To help you manage your clients' asthma, Ontario Health has relesed a new infographic, developed in partnership with the Lung Health Foundation. It highlights what high-quality asthma care looks like during the COVID-19 pandemic. (French version)
Quality Standards Placemats
Ontario Health has also released placemats based on the asthma quality standards. These can support you and your clients living with asthma. The placemat is a quick-reference tool that concisely summarizes key information from the quality standard and can be used by primary care providers to facilitate client-centered discussions.
EMR Resources for primary care providers
Ontario Health is making the QS placemats more accessible by supporting their use within electronic medical record (EMR) systems. We have developed EMR user guides to help you access the QS placemats in Accuro and Practice Solutions Suite EMR systems. A step-by-step guide to support OSCAR EMR users will be available soon.
We encourage you to share these resources with your colleagues and networks. Please let us know how these resources are being used in the field and in your EMR systems. To share your feedback, please email qualitystandards@hqontario.ca.
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Learning Events and Opportunities |
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What have we learned so far about COVID-19 and pregnancy? Over the past year, the Better Outcomes Registry and Network (BORN) Ontario have collected case reports of pregnant individuals with COVID-19 infections and have used this information to improve care and inform decision-making. Join researchers from BORN and Public Health Ontario (PHO) for a special PHO Rounds, where they will share what they’ve learned and how they plan to continue collecting and developing this data. Tuesday, May 25, 12:00-1:00pm. Register now. For more info on this and other PHO Rounds: events@oahpp.ca.
Are you looking for support managing your most complex clients? Apply for ECHO Ontario Integrated Mental and Physical Health. Free, virtual, interactive sessions connect you with the expertise of leading clinicians and a panel of your peers. By learning together, you will not be alone in finding the best path ahead for your clients. Fridays, 12:00-1:15 PM, June 4 – August 27.
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Get Involved: Research & Sharing Opportunities |
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How can sexual health care be culturally safer and more accessible for South Asian men? A new study at the University of Waterloo is exploring the social, structural, and personal factors that influence the accessibility of sexual health services for South Asian immigrant men in Canada. Participants will be compensated $20 for a 30-60 minute phone interview. Please share this recruitment poster with your clients and community members. For more info, email Yamin Jahangir .
Share your knowledge about substance use and its impacts to help develop new capacity-building tools. The Canadian Public Health Association is working on a new project to help build knowledge and capacity for a public health approach to substance use. As part of this work, they're asking healthcare professionals to complete this 30-minute survey about their experiences and perspectives and to help understand the impacts of substance use and opportunities for a public health response. Open until June 30.
Want to share your learnings on COVID-19 and collaborate with partners to discover more? CanCOVID, a federally-funded open science network of researchers, providers, patient partners, and others, has room at the table for you! Members get access to data and a community of researchers and partners to collaborate with.
Want to learn more about practice-based research, network with peers, and nourish your curiosity? If you are a clinician or interprofessional healthcare worker at an Alliance-member agency, consider joining the EPIC PBLN and the POPLAR Network (see the flyer in French here). We know pandemic response and vaccination efforts are a priority for most of our members, so we’ve put EPIC PBLN meetings on hiatus until fall. But if you sign up now, we can all hit the ground running together when the time is right! Email Sara.Bhatti@AllianceON.org for more information.
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Free, high-quality health data about your community: Ontario Community Health Profiles are produced by a partnership group that includes health-care planners, hospital administrators, health agencies, and researchers. Currently available profiles : City of Toronto; Central, HNHB, South West, and Erie St. Clair LHINs. Coming soon: Sub-regions, other LHINS, and Ontario Health regions. Partners include ICES, Health Commons Solutions, Toronto Public Health, Access Alliance, the Wellesley Institute, LHINs, and more.
Multilingual websites and translated materials about health and community. Remote Interpretation Ontario’s Multilingual Information eXchange (riomix) is a collaborative, centralized, and accessible repository of materials for providers and for clients, in dozens of languages. Looking for a place to start? Try going to the service-provider/guest interface and enter #mix-covax in the keyword search. You’ll get a recommended “mix” of materials relating to COVID vaccines.
New website for COVID-19 information and resources. CanCOVID has free, bilingual tools and knowledge products, including a weekly speakers’ series, monthly workshops, links to relevant trusted resources, and a digital library. Check it out!
COVID-19 Community Resource Guide: An annotated list of online toolkits and resources. The Lab for Knowledge Translation in Health at Western University compiled this list from links shared with them by community partners over the last six months. The collection is organized into four categories: Communications tools, vaccine information, equity resources, and COVID data visualizations, with summary information accompanying each link. Explore the draft resource guide here; send feedback or resources you’d like added to Gina Uppal.
In case you missed it: Slides and recording from Understanding the Differences between Rural & Urban Healthcare Needs. This Lunch 'n' Learn Webinar was presented by student researcher Natalie Pallisco on May 12. Recording here. Slide deck here.
In case you missed it: Slides available for CAHSPR presentation on Alliance virtual care research. Sara Bhatti, Research and Policy Analyst at the Alliance, has shared some Alliance research on what we've learned about virtual care from the current pandemic, and how this can inform virtual care delivery in future, just this morning at the Virtually CAHSPER 2021 conference. Abstract and link to slides now available in the Alliance research library.
New guidance: Primary care & general medical imaging for vaccine-related adenopathy. Lymphadneopathy (swelling of the lymph nodes) is being reported as a common side effect of the COVID-19 vaccination and showing up through client reports, breast screening procedures, and other medical imaging. New guidance is now available on managing suspected vaccine-related adenopathy.
Resources and Slide Deck now available for When Grief Comes to Work: Loss in Community Health Care. You can access the slide deck and other resources mentioned during the session here. These resources can help you process your own grief and loss related to the multiple ongoing pandemics our sector is grappling with, and support your colleagues in their own journey.
Recording: Fireside Chat with the Black Scientists’ Task Force on Vaccine Equity. This recorded fireside chat from April 17 addresses issues related to COVID-19 testing, vaccination, and care that are of specific relevance to Black communities, including LGBTQ+ communities, in Ontario. It takes an intersectional perspective that considers sexuality, gender, immigration, housing, socioeconomic status, and neighbourhood. Co-presented by the Black Gay Men’s Network of Ontario and co-sponsored by the Regional HIV/AIDS Connection and the Gay Men’s Sexual Health Alliance.
New hub for children, youth and families in Duram Region: Carea Community Health Centre and Durham Children’s Aid Society (DCAS) have partnered to create a multiservice serving children, youth and families from marginalized and vulnerable populations in Durham Region. Carea will operate a clinic at the DCAS site starting next month. More partners, programs, and services will be announced as funding is secured.
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