A chief technology officer stands in the foreground of a digital health unit

The future of digital health in our hospitals

By Duane Bender, Chief Technology Officer, Hamilton Health Sciences

Online shopping, banking, food ordering and a thing called Uber. This is the digital age.

Has the Canadian health care sector caught up?

I have been a technologist my entire life. When I was a little kid I tried to understand electricity by taking apart live lamps and cutting batteries in half. I have all of the scars to prove it.

Looking under the hood of our most basic and complex technologies is something that keeps me going in my day-to-day work.

The digital health plan will improve the employee experience by introducing modern tools for safety and communications.

It’s this passion for technology innovation and a desire to make a positive impact on my community that led me to Hamilton Health Sciences (HHS).

An unlimited list of applications

We are one of the largest academic hospital systems in Canada. I envision us to be leaders in care delivery to people throughout the entire life cycle, supported by a wide range of patient-focused and clinical technologies.

My wish is for us to be a “learning health system,” continuously improving through the strategic collection and analysis of clinical evidence.

As Chief Technology Officer, I evaluate current industry trends such as mobile, wearable, cognitive computing and cloud technologies. All the fun toys consumers have experienced for years.

Hospitals exist in an age where the question, ‘Where is that really expensive piece of equipment right now?’ can be answered with real-time location-based services technology.

We have in-home monitoring solutions that would shorten hospital stays but we can still support people with great care through sensors and communication tools.

It’s an unlimited bank of opportunities that we can address with the right investments.

A digital health plan that improves your experience

Last year, HHS developed a digital health plan to map out the various improvements we want to make across our sites.

Every aspect of the plan will improve the way we deliver care. It was designed with that purpose as the central principle.

We are investing in digital technology in ways that will provide that experience to our community in the not-so-distant future.

From a patient perspective, we are currently piloting our new patient portal, which will improve communications with our patients by opening online access to their medical records.

The digital health plan will also improve the employee experience by introducing modern tools for safety and communications. This will enhance the mobile and wireless experience. Information will get to the right people at the right time.

We also plan to expand and improve our networks, including internet and Wi-Fi access that will lay the foundation for exciting applications to come.

If we execute the digital health plan, we will have modern IT systems that will enable a truly mobile workforce, provide timely information to patients and clinicians, and plant the seeds for advanced analytical capabilities such as machine learning and artificial intelligence.

We are investing in digital technology in ways that will provide that experience to our community in the not-so-distant future.

Exciting days are ahead. Our patients, employees and physicians deserve a hospital system that works with the latest technology.

Dr. Andrew Mente in the produce aisle of a grocery store

The evolving relationship between diet and health

By Dr. Andrew Mente
Principal Investigator, Population Health Program, Population Health Research Institute
Associate Professor, Health Research Methods, Evidence and Impact, McMaster University

Understanding how food affects our health is not a new journey, but as our societies change and evolve, so must our explorations.

In the early 1900s, researchers were focused on the role of vitamins and minerals in human health, since common conditions like scurvy were a result of nutritional deficiency. By the 1950s, Western countries saw a major increase in heart disease, so attention shifted to the “heart-healthy diet”. While this concept is still in focus today, it’s being examined through many new and different lenses.

Early Western-led studies on the effects of nutrition on health focused only on Western countries, and it was these studies that provided the evidence that informed global dietary guidelines. Since then, we’ve learned much more about nutrition around the world and we know now that we can’t take a ‘one-size-fits-all’ approach to educating people about nutrition. Increasingly, as researchers, we need to look from a global perspective as we continue to explore the relationship between diet and health. Because health concerns like heart disease are now a global issue, broadening our scope can have a greater impact and help people around the world live healthy lives.

Broadening our scope can help people around the world live healthy lives.

In 2002, myself and a team of researchers at Population Health Research Institute began the challenge of capturing dietary patterns on a global scale. This is ongoing, but we’re analyzing data from over 50 countries on six continents to explore how food intake affects the health of people all over the world from all walks of life.

So far we’ve learned that, contrary to popular belief, a higher intake of fat is actually linked to lower health risks. By contrast, a diet higher in carbohydrates is associated with a higher health risks. This means that a moderate amount of fat and lower intake of carbohydrates is best for our overall health.

As expected, a high intake of salt increases a person’s risk of health problems such as heart disease. However, we also found that a very low intake can be detrimental, too. This means that a moderate intake is salt is the healthiest option – an amount that the majority of people already consume.

Our work is already challenging common nutritional wisdom.

We also believe a strong case can be made for increasing the consumption of potassium-rich foods since we’ve found that it contributes to decreased rates of stroke in people from all countries. Since fruit, vegetables and certain dairy foods are high in potassium and consumption is low worldwide, this may be a good place to start.

These are only a few observations so far. However, our work is already challenging common nutritional wisdom and will hopefully begin to influence public health recommendations.

Since one of the largest research biobank’s in the country is onsite, we’re lucky to continually have access to the samples collected. This means the opportunities are endless on our nutritional explorations. We hope to venture into finding out why we’ve found these results – what the foods or nutrients are doing within our bodies to cause heath issues like heart disease and stroke.

For now, regardless of our dietary guidelines, “everything in moderation” is the key.

Dr. Andrew Mente, explorer

Dr. Stacey Marjerrison

Improving care for Indigenous children with cancer

Written By: Dr. Stacey Marjerrison, pediatric oncologist at McMaster Children’s Hospital and assistant professor at McMaster University.

Treating childhood cancer is an incredible privilege. Most days, I get to meet families facing their worst nightmare, and have the honour of watching them find strength they didn’t know they had. I get to giggle with kids who somehow manage to find joy and humour in the most trying circumstances. I get to say the words: “the cancer is in remission” and see parents’ faces light up with relief. But, that isn’t every day.

One in five children with cancer will not survive. We do not yet have the tools to save every child’s life. We do, however, have the tools to make their cancer journey better. When days get tough, being able to take a step back and think about how I can improve the cancer journey for all of the families that I help care for makes those awful days easier.

We know that for marginalized families, the cancer journey is tougher than average. Families from low-income neighbourhoods and low-income countries face additional hurdles to those of an average family. Among them are Indigenous families living in Canada. Improving care for marginalized families, including Indigenous families, is the major focus of my research.

I noticed early in my career the differences in survival that Indigenous kids with cancer were facing.

I’m a childhood cancer doctor and a researcher, but I am not an expert on Indigenous health. I noticed early in my career the differences in survival that Indigenous kids with cancer were facing across American studies. Working with experts in Indigenous health, I set about trying to answer the question being asked by many of our Indigenous patients: does this difference also exist in Canada? Our analysis in Ontario showed that First Nations, Inuit and Métis kids diagnosed with childhood cancer had about a 15 per cent lower survival rate than the general population. But, we noted that this difference doesn’t seem to be due to factors such as the time it took for a child to be diagnosed, their adherence to treatment, individual characteristics (age, gender, nutritional status), the severity of the disease, or the strength of the treatment. Our findings differed from a study from Manitoba (which showed no worse outcomes for First Nations children), so we’re now working together on a Canadian-wide analysis. We hope this will help us discover if outcomes have been worse for Indigenous kids with cancer, and if so, why this difference exists and how we can close the gap.

Research is an opportunity for us  to learn how we can make the cancer journey easier for our patients and their families.

Beyond survival, we must also improve the health journey for families. We know that Indigenous Canadians often face systemic racism when interacting with the healthcare system, and when participating in healthcare research. Working with Dr. Chelsea Gabel – an expert in Indigenous well-being – my colleagues and I published a review of ways to improve Indigenous health research in Canada. Ensuring meaningful partnership with Indigenous communities and scholars, considering Indigenous methods and methodologies, and making sure that research findings are considered within the context of Colonial history and current inequities are some of the ways forward.

We also need to ensure that healthcare providers are educated to provide culturally safe and informed care to Indigenous patients. As such, I’m helping to develop new curricula for post-graduate students under the umbrella of the McMaster University Faculty of Health Sciences Indigenous Health Initiative. We hope to build on the lessons we’re learning through a qualitative evaluation of the pediatric residency curriculum this past year, applying our findings across the programs at McMaster.

Inside the hospital, we also hope that the recent opening of Mkoonhs Zhongehgii Iako’nikonhrahnira:ton, our Indigenous family room at the McMaster Children’s Hospital, creates a space where all our Indigenous families feel welcome.

Finally, on an international scale, I’m working with global experts to evaluate how to safely integrate Traditional and complementary medicines into childhood cancer care; a priority for many Indigenous Peoples.

Walking with families through their childhood cancer journey is an honour. Research is an opportunity for us – as healthcare providers – to learn how we can make that journey easier for our patients and their families.

A portrait of Dr. Catherine Ross standing in a laboratory setting

Better relationships with doctors means better care

By Dr. Catherine Ross, pathologist, and member of Hamilton Health Sciences’ Physician Hospital Partnership


A few years back, an email from Hamilton Health Sciences’ lead doctor popped up in my inbox.

He was launching a new committee to explore ways to improve relations between the hospital and its doctors and was looking for people to join.

I jumped at this opportunity.

The hospital is listening.

Not necessarily because I thought the relationship was bad, but because I thought it could use some help.

Committee strengthening relationships

For those who don’t know, in Ontario, most doctors don’t work for the hospitals where they practice. They bill the government directly for their services.

While not intentional, the absence of an employer-employee relationship has often allowed doctors’ input to be overlooked. This is common at hospitals across Ontario.

Our expertise is always considered when it comes to patient care.

In my 10-plus years at HHS, I wouldn’t say physicians have been completely excluded, but we haven’t always been included. Our expertise is always considered when it comes to patient care, but less so for operational matters.

That email told me change was happening.

Our committee, the Physician Hospital Partnership, has been working since 2014 to understand the issues, and figure out solutions to strengthen this important relationship.

We are making progress.

For example, we worked to adjust hospital budgeting processes to require physician input, providing a platform for physician advocacy on how money gets spent on the units.

More physician-hospital interaction

We’re also creating opportunities for more interaction between doctors and hospital leadership, to build trust and to share ideas. HHS executive leaders regularly attend medical department meetings to have open and honest conversations about the realities of care, both on the frontline and in the administration.

Last year, we held a summit which brought all parties together to figure out how to improve hospital decision making. We’re currently figuring out how to put some of these ideas into practice to provide value to our doctors.

It’s a great time for physicians to speak up and have a greater say in your hospital.

There’s plenty of work in this area still to do and there are many opportunities for physicians to get involved.

Ultimately, better physician-hospital relationships mean better care for patient. The hospital is listening. It’s a great time for physicians to speak up and have a greater say in your hospital.


Supporting nurses to provide palliative care

What is palliative care?

Palliative care is a holistic approach to care that improves the quality of life for patients facing a life-threatening or life-limiting illness. As providers, we know through research that patients suffering from a non-curable illness want honest and timely information about their condition including treatment options. They want to know their physical symptoms will be managed to relieve suffering, and they want to die in a place of their choice.

Palliative Care Nursing Practice Committee at HHS

Nursing is a pivotal role in achieving patient goals and supporting family members. In 2016, the Director of Oncology Critical Care & Palliative Care and Interprofessional Practice Chief, established the HHS Palliative Care Nursing Practice Committee to support and enhance nursing practice in order to deliver a positive experience for patients and families.

The committee is co-chaired by Charissa Cordon, Chief of Nursing Practice and Cathy Reis, Clinical Nurse Specialist with the Juravinski Hospital and Cancer Centre Palliative Care Team. The committee meets monthly and is comprised of nursing representation from across HHS sites, including nurse leaders, advanced practice nurses, point of care nurses, the office of ethics, and a patient/family advisor.

The committee has made efforts to understand the knowledge, strengths and gaps of nursing at HHS to develop educational strategies and a work plan prioritizing the needs of various HHS nursing groups.

In addition to staff input, a family advisor has been an active member of this committee. Based on her experience with a loved one, she has helped us understand the importance of early identification of supports that would assist in enhancing quality of life and open, clear communication between staff, physicians, patients and family.

“providing palliative care services alongside disease specific treatment is becoming more recognized as an approach to care that can improve the quality of a person’s life”

A work in progress

The committee aims to bridge the gap between nursing education and nursing practice and ultimately raise the profile of palliative care nursing across HHS. They have begun implementing education strategies in addition to supporting several initiatives at HHS. Work to date includes:

• The development of an education module on palliative care that has been incorporated into the HHS Health Professional Orientation (HPO) for all new staff members.

• The development of an HHS Palliative Care Nursing site with nursing specific resources, patient information material and nursing education opportunities.

• Embedding knowledge of a palliative care philosophy and care competencies into targeted nursing orientation programs such as oncology, intensive care, and at select program-specific annual skills update.

• Development of learning pathways and implementing symptom management guides in St Peter’s Hospital specialized palliative care unit.

• The committee recognizes the importance of clear, quality conversations with patients and families which leads to creating care plans that align with a patient’s wishes and values. Several committee members had an opportunity to attend an education workshop led by members of the Serious Illness Conversation Program in an effort to build training skills and mentor others.

• Member contribution to the development of the Ontario Hospice Palliative Care Standards.

• Provincial recognition and award for best oral presentation at the Hospice Palliative Care Ontario Conference in April 2018.

Improving quality of life

As co-chair of the HHS Quality End of Life Steering Committee and Clinical Ethicist for HHS, Sandra Andreychuk has observed a shift in the perception of living with a non-curable illness. The notion of providing palliative care services alongside disease specific treatment is becoming more recognized as an approach to care that can improve the quality of a person’s life.

Teams are beginning to appreciate that all health care professionals have a role in assisting patients and families in delivering care plans that align with a patient’s wishes and values. The Nursing Palliative Care Practice Committee has taken the lead on identifying how best to build capacity among their discipline to facilitate this across units at HHS.

As HHS’ Palliative Care Physician Dr. Joshua Shadd would say, “palliative care is everybody’s business” and the Palliative Care Nursing Practice Committee is making that happen.

Stelios Georgiades, autism researcher, explorer

Autism research should be based on individual strengths

By: Dr. Stelios Georgiades
Co-Director, McMaster Autism Research Team (MacART)
Scientist, Offord Centre for Child Studies
Assistant Professor, Psychiatry and Behavioural Neurosciences, McMaster University

Autism is challenging and complex. It impacts different aspects of life in different ways. It changes throughout development and over time. It touches no two people the same.

However, traditional research approaches to autism tend to “lump” children into large groups based on their symptoms and behaviours at any given point in time. These approaches are too simplistic and don’t capture the complexity and diversity we see across the spectrum and the lifespan. Bottom line – much of our research efforts to date have had limited success in advancing autism care.

We hope to inform the development of more individualized and adaptive, family-centred services and supports.

In my opinion, autism is about diverse perspectives and how these are communicated. How do children with autism see the world? How do they see themselves in the world? How does the world see them? These perspectives shape how each child interacts differently with their family, peers, teachers, care providers, and community. If we can better understand these interactions and the perspectives that influence them, we can help support the child along the most appropriate developmental path.

So, my colleagues and I at the McMaster Autism Research Team (MacART) and the Offord Centre for Child Studies are exploring autism using a strengths-based approach to understand how children grow and develop within their surroundings. Ultimately, we hope to inform the development of more individualized and adaptive, family-centred services and supports.

Our new Pediatric Autism Research Collaborative (PARC) project is embedded within the autism clinic at the Ron Joyce Children’s Health Centre of McMaster Children’s Hospital. Our research team is working alongside clinicians to gain a better understanding of which services, or combinations of services, contribute to healthier outcomes for children with autism. Of course, there is no one answer for this, so we’re hoping to find some positive trends that can help parents and care teams navigate the system effectively for each child.

An optimal outcome should be based on each child’s personal characteristics and individual growth over time.

As autism researchers, we’re not striving for a single discovery. Instead, we aim to ensure that every child with autism has an “optimal outcome”. But first, we want to re-define what that means.

In my 15 years as an autism researcher, I have had the opportunity to work with some of the world’s best clinicians and scientists. But, the most valuable lessons I’ve learned are from my interactions with children with autism and their families. Based on this, my team and I believe that an optimal outcome should be based on each child’s personal characteristics and individual growth over time, within a system of care that adapts to their changing needs. That’s the vision we’re working toward.

Creating a sustainable future for our patients

By Donna LaForce, Director, HHS Sustainability

A hospital’s budget can be thought of in much the same way as your family’s household budget.

At home, a good portion of every paycheck is spent on costs you can’t do much about like your mortgage or rent payment, your car payment, groceries and utilities. What’s left after you cover all those costs is usually a much smaller amount to be used for the balance of what you want and need in your life.

In the hospital setting, 70 per cent of our funding is earmarked for specific activities, through programs like the health based allocation model (HBAM) – a complex formula which dishes out provincial funding between hospitals for certain services – and quality-based procedures (QBPs) like day treatments and surgeries.

Finding system opportunities while refining how we work.

The remaining 30 per cent, called “global funding,” isn’t tied to specific activities, but needs to cover everything else, from support staffing to building operating costs to equipment needs. At HHS, and across the hospital sector, these costs continue to outpace available funding.

Essence of Sustainability

We’ve been open about the financial pressure we’re facing and what we’re doing to address it. Just like a family would do in this situation, we’re looking at all of our inputs and outputs to see whether we can do things differently. This is the essence of our Sustainability efforts – finding system opportunities while refining how we work.

While we’re required to balance our books each year, our challenge, and our opportunity, is much bigger than just finding short-term savings to temporarily get out of the red and into the black. It’s about how we can progress our work to provide continuous value for our patients and families.

Small actions can make a big difference.

The good news: across the global health care sector, there’s a constant stream of new ideas on how hospitals can achieve these efficiencies. Getting there will take understanding, flexibility and commitment from everyone involved. But collectively, many small actions can make a big difference.

Providing continuous value for patients

For example, we’re bringing almost a million dollars back to the hospital each year by changing how staff access their compression stocking benefit. Making HHS pharmacies the sole provider may have been a little less convenient for some, but it means we now have new opportunities to reinvest in our patients’ experience.

Shift from business as usual to constantly seeking to improve value for patients.

Another example is work being done around outpatient medications, like intravenous (IV) iron shots. Until now, HHS has covered this cost to the tune of tens of thousands of dollars annually. After taking a hard look at the situation, we’re now transferring this expense to the Ontario Drug Benefit plan or to patients’ private insurance – arguably where it should’ve been all along – freeing up much needed cash for hospital services. All without impacting our patients.

The shift from business as usual to a state of constantly seeking to improve value for our patients, what we call operational excellence, is a journey and in many ways, we’re just at the beginning. Looking inward may be challenging at times, but doing so will get our financial house in order to ensure we can deliver the sustainable future our patients, families and community deserve.

Dr. John You

Quality of life vs. prolonged life

By Dr. John You, Internist, Hamilton Health Sciences and Associate Professor, McMaster University

Research shows that up to 70 per cent of seriously ill, hospitalized older Canadians are receiving invasive treatments that they don’t want.

This could be your mother or your grandfather. Maybe someday, it will be you.

We know that many older patients with serious illness want to maintain quality of life rather than prolong it. However, the use of aggressive life-sustaining technologies in this vulnerable population is common. Instead of a peaceful experience, they are receiving unwanted invasive medical treatments, even during their last days.

Too little, too late

A national, multi-year study involving seriously ill older Canadians revealed that even though 28 per cent of the participants stated a preference for “comfort care” (meaning no curative treatments), this was documented in only four per cent of their charts. This discrepancy can lead to a poor patient experience and an increase in family distress.

Why is this happening? Often, it comes down to a lack of communication. Even though studies have shown that seriously ill patients and families have identified communication and decision-making as high priority targets for quality improvement, conversations about what matters most to patients when they are faced with serious illness are typically “too little, too late, and not great.”

Conversations about what matters most to patients when they are faced with serious illness are typically “too little, too late, and not great.”

The gap doesn’t just exist within the hospital setting. A 2014 Ipsos Reid survey revealed that 60 per cent of Canadians want their family doctor to talk to them about their preferences for care during serious illness, but only 26 per cent of primary-care physicians are comfortable having those discussions. Sixty-seven per cent of primary-care physicians said they need more resources and information.

These conversations are also rare in long-term care homes, even though death is commonplace in this setting.

It’s clear that we are missing opportunities to have important conversations with older Canadians at the most vulnerable time of their lives.

A road map for conversations

We’re hoping to change this trend.

I’m leading a new three-year national study, called iCAN-ACP in collaboration with colleagues in CARENET, the Canadian Researchers at End of Life Network. The project aims to address these problems by introducing and evaluating “advance care planning” tools. We hope this will result in more, earlier and better conversations between older adults, families and their health-care teams.

Advance care planning involves thinking about and communicating your preferences for care in a way that expresses your values. It also includes choosing someone to be your “substitute decision-maker,” someone who could speak for you and make decisions if you couldn’t speak for yourself.

The iCAN-ACP project, funded by the Canadian Frailty Network, has just been launched in long-term care homes, family doctors’ offices and hospitals across Canada, bringing together a team of 32 investigators from 16 universities, five international collaborators and 42 partner organizations.

Our goal is to identify valuable tools that will reduce unwanted treatments and ensure that patient voices are heard.

The project will study conversation aids, including workbooks and interactive websites for older adults and their families, and conversation guides for health-care practitioners.

We know from past research that advance-care planning can have a significant impact on end-of-life experiences for both patients and their families. But all too often, these conversations are not happening early or often enough.

iCAN-ACP will engage older Canadians living with frailty, and their families, as well as clinicians, health organizations and related patient associations — to evaluate several of these conversation aids.

Our goal is to identify valuable tools that will reduce unwanted treatments and ensure that patient voices are heard.

Guillaume Pare, HHS researcher, explorer

Unlocking the code

By: Dr. Guillaume Paré
Medical biochemist, Hamilton Health Sciences
Senior Scientist, Population Health Research Institute
Associate Professor, Department of Pathology and Molecular Medicine, McMaster University

April marks the 15th anniversary of the completion of the Human Genome Project, a thirteen-year journey led by scientists from around the globe to map all of the genes of the human species and one of the biggest undertakings in scientific history.

When the project began in 1990, the goal was to not only understand genetic factors in human disease, but to set the course for new treatments and prevention methods for ailments like cancer and heart disease. It was a costly project with a price tag of about 3 billion dollars, but the investment was worthwhile: it gave way to a whole new era of discovery in the pursuit of global health.

The last decade and a half has also seen an acceleration in technological advancement. Our genetics lab at HHS is now fully automated – extracting, mapping, sequencing and copying DNA – allowing our team to quickly generate substantial amount of data to support many of the large-scale, global research studies that we lead from right here in Hamilton. These advancements have happened so quickly that, today, our lab could do the same work as the Human Genome Project in less than one week for only a few thousand dollars.

Machine for DNA extraction in the HHS genetics lab

The results of these extraordinary advances are clear. We’re now able to classify more than 1,800 genetic diseases, including genetic forms of common diseases as breast cancer, Alzheimer’s, diabetes and heart disease. Furthermore, scientists have been able to develop tests to better predict a family member’s genetic risk, allowing healthcare providers to help prevent the development of potentially devastating diseases.

We’re now able to classify more than 1,800 genetic diseases.

But, we’re also left with a new set of challenges. Although we’ve unlocked the mystery of our genetic make-up, we’re now dealing with the surge of genetic data we’re able to generate with modern technology. Indeed, the bottleneck in research projects is often data analysis, meaning that the role of “scientist” is evolving in to “data scientist”.

In recent years, we’ve learned that it’s not always a single gene responsible for disease, but that different variations in our genetic makeup can equate to risk. So, what does that mean in terms of data? To start, every person has around 20,500 genes, but within each gene are subtle differences called genetic variants. We’ll record anywhere between 500,000 to 1,000,000 genetic variants per person. Then, multiply that by the thousands of people in a research study. Fifteen years ago, this would have been simply impossible. Not only would it take years to complete by hand, we just didn’t have the computing power to store the data. Currently, we have over 200 terabytes of genetic data stored at HHS. That’s the equivalent of 40 million minutes of high-quality YouTube videos!

Currently, we have over 200 terabytes of genetic data stored at HHS.

Building these data and sophisticated analysis techniques, my team at HHS’ Population Health Research Institute introduced a test earlier this year that can predict an individual’s genetic risk of early heart disease with high accuracy by combining information from a large number of variants. This discovery was made on the shoulders of the Human Genome Project and large-scale international collaborations aiming to decipher the genetic underpinnings of heart disease.

As is the essence of research, the original question that the Human Genome Project sought to answer opened up the floodgates to countless new queries. The endeavour shed a new light on the most precious part of humanity, but we still haven’t fully broken our genetic code. We’ve made immense progress in the last 15 years, but there’s lots more we need to learn.

This is what drives us as researchers and clinicians: to always find new and better ways to prevent disease in people around the world. It’s an ambition we all share; it’s in our DNA.

Dr. Guillaume Pare, medical biochemist, explorer

Juravinski Hospital and Cancer Centre

A healthcare vision for Hamilton’s future

By: Rob MacIsaac, president and CEO, Hamilton Health Sciences

Hamilton Health Sciences (HHS) is on year three of a multi-year process to reimagine our hospitals for the next generation and beyond. We’ve looked at projected population changes and disease trends. We have forecasted the changing role technology will play in health care. Most importantly, we have listened to the voices of thousands of people across our community and our region.

Planning for the next 20 years is complex, to say the least. HHS is one of the largest hospital systems in the country. We currently operate on five sites and serve a catchment area of more than 2.3 million people. But with the best thinking of our staff and physicians, our community partners and the people we serve, we put together a vision for the future Hamilton Health Sciences. I am happy to say that we have now received an endorsement of that vision from the Hamilton Niagara Haldimand Brant Local Health Integration Network (HNHB LHIN).

Here is our vision in a nutshell:

Create a healthier city and region by getting ahead of the demand for hospital care. We will work with community-based health partners to help people stay out of hospital. An early example of this work: we currently have an HHS outreach team that makes home visits to people who have been frequent users of the Emergency Department (ED). This award-winning program is proving very successful at addressing the root causes of people’s health challenges, with ED visits reduced by 46 per cent for program participants. In the future, we will expand this type of approach.

We have listened to the voices of thousands of people across our community and our region.

Work beyond our walls. Some kinds of health care absolutely need to occur in hospital, but other types do not. We are exploring how, when and where it makes sense to provide HHS care in community settings rather than making people come to the hospital. A current example is our LiveWell partnership with the YMCA of Hamilton/Burlington/Brantford. Together we are providing rehabilitation, injury prevention and disease management programs at local YMCA facilities. It is safe, highly effective and a better environment for our patients than the hospital. We will look to create more opportunities like this one.

Modernize our facilities for the next generation. Our oldest hospital facilities are not capable of meeting our region’s needs over the next 20 years and beyond. We need to modernize and grow our hospital space by 50 per cent to meet evolving standards of care, and population growth. We will cluster our acute care services around the Hamilton General Hospital on Barton Street, and the Juravinski Hospital and Cancer Centre on Concession Street, expanding and modernizing these campuses.

We will relocate the programs offered at St. Peter’s Hospital to the Concession Street campus so we can serve more people. At the General Hospital campus we will build a new children’s and women’s hospital on Wellington Street, replacing the current facility at McMaster University Medical Centre. We will also modernize the General Hospital. In West Niagara, we will rebuild West Lincoln Memorial Hospital with a focus on short-stay and day services, providing a gateway to the specialty services located at other HHS hospitals.

Ultimately, our aim is to create a healthier community, where people can more easily access services in a variety of settings.

This new physical footprint will take approximately 20 years to achieve. We’re proposing that it unfold in two stages, with the first projects – the Juravinski and West Lincoln redevelopment – beginning in approximately five years if funding and approvals are received. We see the redevelopment at the General Hospital campus as Phase 2, with an estimated start time of approximately 10 years, again pending the necessary approvals and funding. The Ministry of Health and Long-Term Care is now reviewing our facilities plan and will determine the sequencing.

This plan addresses the input we heard from our communities that the status quo in health care delivery is not an option. Our population is aging and with age comes a higher likelihood of chronic disease and disability. More than half of all our adult admissions at HHS last year were for people older than 65. Even cancer is now recognized as a disease associated with aging – the Canadian Cancer Society predicts a 40 per cent increase in new cases diagnosed over the next dozen years, largely because of the aging demographic. For these reasons, there is a real sense of urgency to modernize and expand the Juravinski Hospital, host of the Regional Cancer Program, and including the relocated St. Peter’s programs that primarily serve older adults.

Ultimately, our aim is to create a healthier community, where people can more easily access services in a variety of settings and can better manage their own health. We thank everyone who has helped us in our planning to date and we will keep the community updated as we progress.

For more information please visit our dedicated website: www.ourhealthyfuture.ca.

Mike McGillion, Nurse Scientist, Explorer

The technological revolution of healthcare

By: Dr. Michael McGillion
Nurse scientist, Population Health Research Institute
Associate professor, School of Nursing, McMaster University

Like most health care professionals, I became a nurse to make a difference. Then, I became a scientist to understand how best to make that difference.

We’re in an exciting time of emerging technologies in health care. We’re finding ways to improve the delivery of care so that patients can recover better and get back to their daily lives faster. This is unchartered territory, making it an exciting journey as a researcher.

Today, patients undergoing surgery are going home sooner, with a larger portion of recovery time at home. This, however, means that they’re not monitored as well as when in hospital, and patients can have complications, particularly in the first 30 days at home. At the Population Health Research Institute (PHRI), we’re exploring how to bridge this gap between a patient and their hospital team using remote monitoring technology. The SMArTVIEW project is a unique collaboration that’s looking specifically at improving outcomes for patients who undergo cardiac and vascular surgery, where the risk of complication is relatively high. We’re leveraging the academic and clinical expertise of groups across McMaster University and Hamilton Health Sciences to develop a solution that we hope will make a difference for cardiac patients in Hamilton, Canada, and beyond.

Solutions like SMArTVIEW have the potential to revolutionize how we provide care, in and out of hospital.

We’ve never had access to this kind of technology before. Solutions like SMArTVIEW have the potential to revolutionize how we provide care, in and out of hospital. But the technology can’t stand on its own. The support and expertise of our clinical teams is crucial to success. In SMArTVIEW, for example, registered nurses actively review the monitored health data, and check-in with patients daily via video chat to ensure their recovery is going smoothly. The input and support from our nursing and clinical teams has been imperative. Without them, the technology would serve no purpose.

SMArTVIEW is just one example of how our focus on digital health allows us to go beyond the walls of the hospital and create new care pathways. It’s exciting to think about the global reach we can have with these technologies, and what they can help us achieve in supporting our patients through their recovery.

There remains a lot to discover in the growing field of digital health. Where are the best areas to implement hospital-to-home technologies? How can we use these technologies most effectively to manage early signs of complications after surgery? How do we overcome connectivity issues in such a vast country with remote areas? If we make great strides, how will these systems be distributed and managed? I find these questions compelling, and answering them requires far greater collaboration than ever before – not just among investigators, clinicians and research staff, but IT, biomedical technology, informatics and security as well.

The input and support from our nursing and clinical teams has been imperative.

Being part of this cross-cutting community of explorers has allowed me to become part of a growing network that’s inspired to leverage the opportunities that modern technology presents to improve health for people around the globe. It’s an exciting time to be a health researcher, as we help to lay the groundwork for the digital future of health care.

Michael McGillion, Nurse Scientist, Explorer

Click here for more stories on the explorations at Hamilton Health Sciences.

Regional Stroke Centre improves access to stroke care in Central South Ontario

By: Teresa Smith, Vice President, Adult Regional Care, Hamilton Health Sciences

Winnie Doyle, Executive Vice President, Clinical Services, Mental Health and Addictions and Chief Nursing Executive, St. Joseph’s Healthcare Hamilton

Specialization of stroke care at Hamilton General Hospital

Last year, over 1,000 people in our community experienced a stroke.

It can be terrifying. You may lose strength in one side of your body. You may have trouble speaking. Your face will often start to droop, among other signs of stroke. When a stroke happens, timely access to safe, quality best-practice care is critical to survival and recovery.  Everyone in our region deserves this access.

A greater chance of being alive and living at home in the year following a stroke

Across the city, we are fortunate that Hamilton Health Sciences and St. Joseph’s Healthcare Hamilton are centres of excellence, which, until recently, have shared responsibility to provide care for patients experiencing stroke. As of this month, all stroke care is now provided at the Hamilton General Hospital – the Regional Stroke Centre.

The reason for this is simple: evidence shows that patients who are treated on a designated stroke unit achieve better outcomes. This means a greater chance of being alive and living at home in the year following a stroke.

The Hamilton General has a designated stroke unit staffed by a team of doctors and health care providers from a range of related specialties. These doctors, nurses and other care professionals primarily treat stroke patients and have expertise gained through specialization. The more patients they see, the more they understand about this disease.

The site is also home to our region’s rehabilitation centre, which helps patients recover during and beyond their stay in hospital.

The Hamilton General’s record speaks for itself. For example, in the most urgent stroke cases, it has the fastest time in Ontario for patients to receive clot-busting medication. Considering that up to 1.9 million brain cells die each minute a stroke is untreated, this is essential.

The Hamilton General is also the regional stroke endovascular therapy centre serving 2.2 million residents – one of only six Ontario hospitals to offer this treatment. This innovative and life-saving approach removes the blood clot from the brain, reducing the impact of the stroke.

This is not the first time our hospitals have come together to centralize the delivery of care to improve patient outcomes. Rather it’s the next phase in a long history of collaboration. Think of adult mental health and kidney care at St. Joseph’s Healthcare, or pediatric and cardiac treatment at Hamilton Health Sciences.

In modern health care, specialization is the best approach. We know that our integration of stroke care will help continue on this legacy of working together to improve our community’s health.