Qualitycast North – Details, episodes & analysis

With the current challenges faced by healthcare organizations around the world, maintaining staff morale and Joy in Work is a daunting task. The response of one medical imaging department in Northern British Columbia? Competitive baking! This week we interview James Cheesman, a Medical Radiation Technologist at The University Hospital of Northern British Columbia about “The Great X-Ray Bake Off”. With staff bakers competing for the Grandmaster Baker title and trophy, all other staff tasting and scoring the delicious entries and a resulting improvement in departmental morale and camaraderie, it’s a win-win solution for everyone.

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Links:
Northern Health Physician Quality Improvement Program
Cake by Numbers – The UHNBC Grandmaster Bake off

When improving or making changes to the way organizations provide health care, it often seems the last person consulted is the patient themselves. This seemingly perverse order of priority is a lingering throwback to a more historical and paternalistic model of care. One person looking to change this is today’s guest Kim Eggers, the Patient Partner Advisor for Northern Health’s Physician Quality Improvement program. In this episode we learn about Kim’s background, her motivation for patient advocacy and her vision for the co-creation of health care services.

Resources:

Patient Voices Network of British Columbia

Northern Health Physician Quality Improvement Program

It is well established that Indigenous peoples accessing the health system are subject to harm, and a lower quality of care. Many healthcare organizations are acknowledging this truth and making commitments to address systemic anti-Indigenous racism and improve cultural safety within the healthcare system. In this episode, we’re hearing from Northern Healths collaborative medical leads for Indigenous Health Drs Todd Alec and Sheona Mitchell-Foster. Dr. Alec is an Indigenous physician originally from Nak'azdli Whut'en, Beaver Clan. He currently practices family medicine with Carrier Sekani Family Services, located on the traditional territories of the Lheidli T’enneh (colonially known as Prince George), and also provides care through the First Nations Health Authority's Virtual Doctor of the Day program. 
Dr. Sheona Mitchell-Foster is a settler obstetrician-gynecologist also based on unceded Lheidli T’enneh territory. In addition to providing high risk obstetrical care and full spectrum surgical gynecology, she teaches with the Northern Medical Program and has research interests in low-barrier options of cervical cancer screening for Indigenous women in the north.
Drs Alec and Mitchell-Foster share their experiences and learnings, and discuss how healthcare providers can strive to deliver culturally safe care, to uphold Indigenous people’s rights to self- determined health and wellness. They also share how they live their values, and find joy in sharing time  and staying active with their families in Northern BC.
We’d like to note that Indigenous is a general term inclusive of First Nations, Métis, and Inuit. We acknowledge that inclusive terms have the potential to diminish diversity and the unique realities of different peoples. The use of Indigenous in this case is intended as an inclusive commitment to improving health outcomes for each group. 

We're back with our 3rd season of Qualitycast North, with a great episode on improvement in the Ultrasound department.
Ultrasound departments everywhere have never been busier and patients with complaints involving all parts of the body visit the department every day. 
Ultrasound is the first line choice for visualization of the appendix when diagnosing possible appendicitis in children, young adults and pregnant women. When the appendix is not visualized on ultrasound, the patient may be scheduled for a CT which introduces additional radiation and may delay diagnosis and therefore delay treatment. At the University Hospital of Northern BC (UHNBC), finding the appendix was proving to be challenging and the department was visualizing the appendix at rates much lower than expected based on the literature.  Karina Hansen, the former ultrasound supervisor of the UHNBC ultrasound department and Carly Phinney, a Northern Health Quality Improvement Facilitator, teamed up with a local radiologist to tackle the problem. They were able to support the department to improve their appendix visualization  and brought the rate up to 76.9%, representing a total increase in visualization of 42.4% from baseline. The change ideas they trialed were so successful, they have been adopted as routine practice by the sonographers, and are being spread to other facilities throughout Northern BC.

Approximately 10% of the population (which translates to around 500,000 people in BC) believes they have a penicillin allergy and are labelled as such in their patient records, but in reality, more that 90% of these patients do not have a true penicillin allergy.  These false penicillin allergy labels can have serious consequences to both individual patients and the system; a false allergy label can lead to the use of an alternative antibiotic, which may have increased side effects, increased costs, and can lead to antibiotic resistance. Proactively ‘de-labelling’ patients that have an inaccurate penicillin allergy label can help avoid these risks. Dr. Tiffany Wong is a pediatric allergist based at BC Women’s and Children’s Hospital and is an advocate for choosing the best medications for patients, which involves proving or refuting true drug allergies. Dr. Wong and her team have developed a mobile de-labelling tool to support healthcare providers to do this work in their own settings with their patients. This involves a risk assessment and follow-up processes to accurately diagnose patients deemed as high-risk in a way that is safe, standardized, and evidence based. She has also been working with patient partners to co-design patient resources, so patients and caregivers can be empowered to understand penicillin allergies. These resources are available at https://www.dropthelabel.ca/. This work is also currently being adopted at the University Hospital of Northern BC, with support from the Spreading Quality Improvement Initiative, so the benefits of penicillin allergy de-labelling, and associated improvements to patient care, will be realized in the North. Dr. Wong also shares how having a pet and participating in family based activities with her children and husband out in nature helps her to avoid burnout.

Links:

Drop the Label resources for providers, patients, and caregivers: https://www.dropthelabel.ca/

Assessment of multiple-opinion referrals and consults at the BC Children’s Hospital Allergy Clinic
Allergy, Asthma & Clinical Immunology Adam P. Sage and Elliot James and Megan Burke and Edmond S. Chan and Tiffany Wong DOI: 10.1186/s13223-023-00806-2
06/2023

In this episode, we are featuring the Physician Quality Improvement (PQI) program’s provincial alumni co-leads, Dr. Lawrence Yang and Dr. Hussein Kanji. Dr. Yang practices in a ‘family-family’ practice alongside his wife and brothers, providing cradle-to-grave care in Surrey, BC. Dr. Kanji is a critical care physician that works primarily in the ICU at Vancouver General Hospital and is passionate about developing the ECMO (extracorporeal membrane oxygenation) programming there. Both Drs Yang and Kanji came to the PQI program though a need to solve their own frustrations with the healthcare system. After graduating from their respective level 3 PQI cohorts (which is equivalent to the Virtual Action Learning, aka ‘VALS’, series offered by Northern Health PQI) and engaging with PQI for several years, they collectively took on the roles of provincial alumni co-leads. All physicians in BC that graduate from the PQI trainings join the provincial alumni network, which provides these physicians who are now experienced and knowledgeable in quality improvement methodologies and tools, to continue to apply their skills and passions to ongoing system improvement, while also engaging in a province-wide community.

As provincial alumni co-leads, Drs Yang and Kanji work together (Kanji describes himself as the ‘yin’ to Lawrence's ‘Yang’) to support, embody, and connect with all quality improvement enthusiasts across the province, and facilitate ‘cross-pollination’ of ideas to drive positive change. They also share their love of all of the spectacular nature we are blessed to have in BC and share their strategies for preventing burn-out and maintaining mental health while working in such fast paced careers.

Dr. Shannon Douglas grew up in the Omineca area of Northern BC and has been dog sledding in the Fort St James area since her youth. She now practices medicine in the same region and is the Medical Director for the Lakes Omineca region and loves the diversity of patients she cares for everyday. This region includes Vanderhoof, Fraser Lake, Fort St. James, Burns Lake, Southside and Granisle. Chronic pain is a debilitating, complex condition that effects >60,000 people within the Northern Health region, and many patients use opioids to manage their pain. In 2016-2017 it became apparent that that opioid prescribing for chronic pain was contributing to the  opioid overdose public health crisis. There was a need for improved processes for patients to access their medication in a way that was safe, timely, and evidence based. Dr. Douglas initiated an improvement project aimed at redefining the way chronic pain patients were supported in primary care. She worked together with the local interprofessional team to create a new pathway and screening process, that ensured prescription renewals became comprehensive care episodes. Changing the approach required self-reflection and challenging the status quo of 'the way it's always been done’. The project was successful, and patients really enjoyed the new approach, since getting medication can be really challenging for chronic pain patients. Ultimately the patients were able to manage their pain in a safe and supported way, and many were empowered to eventually transition away from opioids.

The Northern Medical Program (NMP) is an inspiring Northern success story based on community action.  The NMP is a unique medical undergraduate program that educates future doctors with a focus on rural health. Dr. Paul Winwood is the current Regional Associate Dean of the program, a position he has had for over 10 years. Originally from the United Kingdom, Dr. Winwood settled in Prince George to practice gastroenterology, academic medicine, and provide leadership to the NMP. He loves the community here and especially enjoys spending time outdoors with his family, skiing in the winter and boating in the summer. In this episode Dr. Winwood shares the history of the NMP and describes the various ways the program ensures the quality of education,  performance, and learning experiences of the students. We discuss how the profile of medical learners has changed to improve the diversity of physicians entering medical practice, and how the program has influenced physician retention in the North, especially in Indigenous communities.

In this episode, Qualitycast North is leaving the snowy North (yes we still have snow in March) and heading South to showcase some of the excellent Quality Improvement work being done by  2 physicians in the Fraser Valley area; Dr. Diala El-Zammar and Dr. Raj Johal.  Dr. El-Zammar and her family came to Surrey, BC, Canada from Lebanon when she was 9. A self-described ‘nerd’, her love of sciences led her to medicine, and she now practices in the Emergency Department at Chilliwack General Hospital. Dr. Johal also grew up in Surrey and was influenced to pursue medicine by his parents who worked in healthcare and the sciences. He is currently a family physician in his hometown of Surrey and is the provincial PQI champion for publishing.

Dr. El-Zammar shares her very successful  and innovative quality improvement work in implementing a virtual follow up process for emergency department patients. Integral to quality improvement is sharing the work and results through a variety of media including publishing.  Also in today’s episode, Dr. Johal discussing the topic of QI publishing, including the why and how of publishing QI work, and what supports are available to PQI teams, and we’ll hear about Dr. El-Zammar’s experience publishing her QI work in the ‘BMJ Open Quality’ journal. They also share what they enjoy most about living and working in BC.

You can read Dr. El-Zammar and Dr. Johal published article here:

El-Zammar D, Johal R, Eng J, Schultz, T. Implementation of an emergency department virtual follow-up care process in a community-based hospital: a quality improvement initiative. BMJ Open Quality 2022;11:e001782. doi: 10.1136/bmjoq-2021-001782

Dr. Magda Du Plessis is passionate about maternal care, providing the best patient care possible, and quality improvement. She is part of the multidisciplinary team at the Chickadee Maternity Collaborative in Dawson Creek, BC, that includes other physicians, nurses, midwives, pharmacists, and administrative staff. Dr. Du Plessis led the team through a quality improvement project that aimed to have 100% of eligible pregnant patients in the South Peace registered with the Chickadee Maternity Collaborative, to ensure comprehensive, wrap-around care, while also seeking to decrease the rate of caesarean sections and patient safety events. With support from a physician quality improvement coach and a practice support coach, and the use quality improvement tools, the team met their goals; within the first year of operation 100% of eligible patients were registered within the collaborative, the caesarean section rate dropped from 33% to 25%, and there were zero patient safety reports. Dr. Du Plessis credits this success to teamwork, coaching, and the passion of the team. While there were challenges, patients ultimately appreciated the new, team-based, collaborative model of care that includes longer appointment times, and supportive discussions throughout the reproductive health experience. She also shares how her and her family enjoy all of the recreational activities the South Peace has to offer, from fishing, to skiing, to snowmobiling.