HMC/SKI PARTNERSHIP UPDATE REPORT

Transcription

1 1 P a g e HMC/SKI PARTNERSHIP UPDATE REPORT

2 2 P a g e Contents A Message from our Project Sponsor... 3 Background: The Project Team Approach to Year Project Team Organizational Structures... 5 Components of the Partnership... 7 Accomplishments by Task Force... 8 Paediatric Intensive Care Unit (PICU)... 8 Rehabilitation... 9 Pediatric Oncology Child and Adolescent Mental Health Complex Care Pediatric Pain Accomplishments by Functional Area Research Department of Pediatrics Allied Health Nursing Awards and Recognitions The Approach to Year For More Information on the Partnership Acknowledgements Figure 1: Robert Harding, Chair, SickKids Board of Trustees, Mary Jo Haddad, President and CEO, SickKids, and Dr. Abdulla Al Kaabi, HMC Executive Sponsor celebrate the 3rd Anniversary of the HMC/SickKids Partnership

3 3 P a g e A Message from our Project Sponsor It has been another exciting and rewarding year. Both the HMC/SickKids Partnership Project Team and the SickKids team have worked diligently and collaboratively to achieve the outcomes in our third year of the partnership. There has been a continued focus on education and integration of the knowledge into practice at the bedside. The Project Teams have developed key performance metrics and the outcomes associated with these metrics have been impressive. As SickKids continues to provide leadership as the first Canadian hospital to have a partnership in the Middle East, our opportunity to expand our learning beyond the walls of SickKids has been enhanced by this relationship internationally. Our staff remain highly engaged and motivated by our partners whose goal is to be the best paediatric centre in the Gulf. As this report details, we have been working diligently to accomplish this through our work in Qatar. Our work supports our vision of improving children s health globally. Finally, I would like to thank our project teams at SickKids and in Qatar, and the SickKids staff who have generously shared their knowledge, skills and expertise. Our success continues to be a source of great pride to Ontario and Canada. Cathy Séguin Vice-President SickKids International

4 4 P a g e Background: The Project Team Approach to Year 3 Hamad Medical Corporation (HMC) and The Hospital for Sick Children (SickKids) have completed the third year of a five-year partnership agreement (February 2010 to February 2015) to building excellence in paediatric care by enhancing clinical programs, developing child health capacity and providing education to paediatric clinicians in the State of Qatar. In Year 1, the Project Team focused on specific priorities as defined by the HMC Clinical Leads (i.e. Division Heads, Chiefs, CEOs, and Executive Directors). SickKids worked on the execution of the deliverables in the statement of work by planning and arranging Subject Matter Experts (SMEs) to visit Doha to work on specific tasks and priorities, while HMC focused primarily on supporting clinical teams with the implementation of SickKids SME recommendations. This approach shifted in Year 2 when HMC and SickKids worked together on the planning and development of work programs. HMC continued to work alongside the Clinical Leads to implement these programs with support from SickKids. Each Functional Area Team (i.e. Clinical Services and Support, Paediatrics, Peri-Operative Services and Research) prioritized their work to focus on tasks that were essential to support the opening of Sidra in December As the HMC/SickKids Partnership Team continues to support the opening of the new children s hospital, the areas of focus have been re-evaluated to continually meet the needs of our partners. In November 2011, the Project Management Team (PMT) in an annual retreat, agreed that a multi-disciplinary approach to supporting priority areas had a high potential for successful outcomes. This was based on the Project Team s experience and the main factors that contributed to the successes achieved to date, such as the transfer of chronic ventilated children from an acute care unit to a post-acute setting. Six programs were identified as priorities based on: An existing multi-disciplinary team approach: Paediatric Intensive Care (PICU) Rehabilitation National Priorities: Paediatric Oncology Child and Adolescent Mental Health The development of new programs in Qatar: Complex Care Pain Management This is a dynamic and evolving project. Its success is dependent on the project team s flexibility and responsiveness to internal and external factors.

5 5 P a g e Project Team Organizational Structures Figure 2: SickKids International Project Team Structure as of January 2013 From SickKids, the Project is sponsored by Cathy Séguin, Vice President, SickKids International and managed by Lutfi Haj-Assaad, Director, Qatar Projects, supported in Doha by a Sr. Project Coordinator and four Sr. Project Managers. The project is supported by SickKids executives, a Toronto-based SickKids International team and a Hamad Medical Corporation advisory committee. In addition, there is a large number of SMEs who travel to Doha throughout the year to support specific deliverables. Table 1: Number of Visits (all SMEs including PMT) Professional Category Project Year Grand Total Advisor Healthcare PhD Senior Advisor Senior Physician Grand Total

6 6 P a g e Figure 3: Hamad Medical Corporation Project Team Structure as of January 2013 Similarly, the HMC Project Team is led by Dr. Abdulla Al Kaabi, Executive Sponsor and Geraldine Johnston, Project Director. They are supported by HMC senior executives and a project team consisting of a Program Manager, Directors of Nursing, Project Coordinators, a Sr. Project Officer and secretarial staff. Together, with the SickKids International Team, they form the HMC/SickKids Project Management Team.

7 7 P a g e Components of the Partnership The success of the Partnership can be attributed to three key factors: Project Management, Clinical Transformation; and Building Capacity and Sustainability. Combined, these elements provide us with the foundations of managing a successful project as well as direction in striving towards a common goal. Figure 4: Components of Partnership approach spanned over five years Project Management The Team uses project management methodology outlined by the Project Management Institute (PMI) as the foundation for Project execution. This is exemplified through the use of: Document management systems (e.g. Share Point, Project Management Information System (PMIS)) Clear processes such as integrated change control and deliverable sign-off Standardized templates such as Gantt charts, work plans, terms of reference, agendas, etc. A Governance Structure Team Retreats to review and plan for subsequent years A defined communications strategy Clinical Transformation The Team then applies their project management methodology towards Clinical Transformation at HMC. This is achieved through the: Development of the organization s clinical leaders (e.g. Head Nurses and Division Heads) Integration of inter-professional practice in the unit Transfer of knowledge and skills through education, clinical consolidation and mentorship Recruitment of staff into leadership positions Development of Task Forces to attain tangible outcomes

8 8 P a g e Building Capacity and Sustainability Once HMC clinical leads are equipped with the tools and knowledge to transform their areas, the Project Team will shift focus toward building capacity and sustainability at HMC. This will be done through: Developing leaders to become role models with clear roles, responsibilities and accountability Incorporation of inter-professional practice throughout the organization so all disciplines contribute to the care of the child Developing staff through knowledge and skill transfer using evidence-based practice, enhancing their critical thinking skills and one-on-one mentoring Evaluation of impact and making changes stick Accomplishments by Task Force In November 2011, the Project Management Team identified the following priority areas at HMC: Complex Care, Oncology, Mental Health, Pain Management, Rehabilitation and PICU. This section highlights the accomplishments of each Task Force in the last year. Paediatric Intensive Care Unit (PICU) The PICU Task Force was established in 2011 to oversee the implementation and monitoring of clinical transformation in the Hamad General Hospital PICU. The group has spear-headed many initiatives to improve the quality of care of the patient. Some of these include the scheduling of inter-professional case presentations and incorporating quiet time for patients and their families. To date, SickKids SMEs continue to provide education and mentorship to the HMC PICU interprofessional team with disciplines ranging from physicians, nurses, respiratory therapists, occupational therapists, physiotherapists and dietitians. In November 2012, 100% of HMC PICU nurses had completed the SickKids Critical Care nursing subspecialty education program. This curriculum is designed to provide learners with two weeks of inclass education followed by one-on-one mentorship in the unit. Similarly, all PICU respiratory therapists have attended the RT education program developed and taught by SickKids SMEs. The PICU Task Force also oversees the activities of the PICU Nursing Practice Sub-Committee. This forum, supported by SickKids SMEs, works alongside HMC PICU nurses to review and implement nursing core standards of care, evaluate current practices, and champion practice change. Another achievement is the development of a Rapid Response Team (RRT). This is a formally designated multi-disciplinary team that responds to assess and manage medically unstable pediatric patients at Hamad General Hospital. The RRT is now collaborating with the General Pediatric Team to combine

9 9 P a g e efforts in the implementation of a Pediatric Early Warning Score (PEWS) team. These complementary teams aim to provide timely management of care to deteriorating patients. In Year 4, the Project Team in collaboration with the PICU Task Force, will support an evaluation of nursing practice and provide ongoing inter-professional mentorship. Rehabilitation The Rehabilitation Task Force oversees the implementation of the Pediatric Rehabilitation Continuum with seamless evidence-based pediatric rehabilitation service delivery in Qatar. To highlight its mandate, the Task Force was recently re-named the Pediatric Rehabilitation Continuum of Care (PRCC) Task Force. Their vision fosters an environment of inter-professional collaboration of Achieving Maximum Potential Together. With the support of SickKids and Holland Bloorview Kids Rehabilitation Hospital, the leaders of HMC Pediatric Rehabilitation are developing systems and processes to ensure operational transformation is customized within Qatar. Clinicians are working towards pediatric specialization, being champions in their chosen focus areas, developing evidence-based inter-professional programs and collaborating with health care professionals across the continuum. Operational Achievements Leaders in Rehab from SickKids and Holland Bloorview have provided advice and guidance around operations and governance to support the leaders of HMC Pediatric Rehabilitation as they implement a clearly articulated pediatric rehabilitation continuum. The following achievements are instrumental to support and sustain changes in practice: Standard criteria is now used to classify acute and post-acute rehab and inform appropriate referrals Transition plans are underway between acute care hospitals and Al Maha 2 (HMC s inpatient center that opened this year) Data collection is underway to measure percentage of families engaged in treatment, HMC trainer time used to mentor their staff, appointment no-shows and workload measurements Clinical Achievements Rehab Neurodevelopment workshops and clinical consolidation have taken place Acute rehab education is complete; clinical consolidation is taking place Post-acute rehab education has been delivered in Spina Bifida/Spinal Cord Injury and Acquired Brain Injury A child-focused and family-centered approach to care is now being championed by HMC Pediatric Rehab

10 10 P a g e Education was recognized as an Award of Merit within HMC s Stars of Excellence Awards celebrations Outcomes The Early Intervention Program has been successfully implemented at HMC; volumes have increased from 6 patients to 40 Families have provided testimonials of satisfaction Increased use of a child-focused, family-centered collaborative model of care Increased confidence and autonomy within HMC Pediatric Rehabilitation Enhanced profile of HMC Pediatric Rehabilitation Pediatric Oncology In May 2011, the Supreme Council for Health released its National Cancer Strategy document with a primary focus of enhancing cancer care for the nation. In response, HMC and SickKids have worked with stakeholders to further develop the model of care for pediatric cancer patients. Recommendations from a July 2011 report prepared by SickKids SMEs eventually resulted in the development of the Pediatric Oncology Task Force. Led by the HMC Pediatric Hematology/Oncology Section and the HMC/SickKids Project Team, this Task Force aims to determine priorities and develop and implement a plan for the improvement of pediatric cancer care in the State of Qatar. In May 2012, HMC and SickKids conducted a review of the haematology component of the cancer services at HMC. Four overarching themes were identified with recommendations to guide future work: Development and promotion of an inter-professional model of care Identification of consensus building around standards of care and clinical practice guidelines Optimal utilization of the ambulatory clinic/day hospital environment Creation of formalized community partnerships In November 2012, a multi-disciplinary team from SickKids advised on treatment protocol recommendations, supportive care therapies for Pediatric Oncology; central venous line (CVL) management; and stem cell transplant program development. To date, the Task Force has managed to achieve timeline targets for patient referral, diagnosis and treatment in alignment with the National Cancer Strategy. Currently: 90% of children are meeting the target of being seen by a cancer specialist within 48 hours of referral 90% of patients are diagnosed within 14 days of being seen by a cancer specialist 100% of children are meeting the target of 14 days from diagnosis to definitive treatment Escalation policies are being developed in relation to timelines across patient pathways

11 11 P a g e The Oncology Task Force has adopted a multidisciplinary model of care which includes discussion of all suspected pediatric cancer cases at weekly MDT meetings as well as recruitment and nomination of dedicated team members. In addition, the Task Force was responsible for the creation of separate subspecialty clinics for haematology and oncology whereas previously, all cases were seen in one clinic. Child and Adolescent Mental Health The National Health Strategy ( ) released by the Supreme Council of Health, identified the enhancement of mental health services as a priority for the State of Qatar. A Child and Adolescent Mental Health Task Force was established in March 2012, with advisory support from SickKids and Asia- Australia Mental Health, to support this national priority. The Task Force aims to develop and implement a plan for the improvement of mental health services for children and younger people in the State of Qatar. In February 2012, SickKids Nursing SMEs conducted a needs assessment for nursing education in child psychiatry, evaluated adolescent medicine admission processes, and developed safety guidelines for the care of children and adolescents Figure 5: Stakeholders participate in Mental Health Strategy Workshop on an inpatient adult psychiatric unit. This assessment resulted in the development of a curriculum that is comprised of a one-week in-class delivery followed by one week of clinical consolidation. To date, 26 HMC nurses and occupational therapists have participated in the education. SickKids SMEs have worked together with child and adolescent mental health stakeholders in Qatar on the development of clinical guidelines for the most commonly diagnosed pediatric mental health disorders prevalent in the country as well as infrastructure and recommendations for referral/intake processes for pediatric patients. In December 2012, SickKids and Asia-Australia worked with HMC to facilitate a second stakeholder workshop. Representatives from 18 organizations participated and worked together to establish priorities for For some, this was the first time they had met with representatives of other organizations with a common goal, allowing them to discuss plans for future collaborative opportunities.

12 12 P a g e In addition, the Child and Adolescent Mental Health Task Force has prepared a proposal for a new organizational service structure, a physical and organizational identity within HMC, which includes a villa compound for outpatient day programs and the identification of a space for an adolescent dedicated inpatient unit, a first for Qatar. Complex Care The Complex Care Task Force was established to enhance the care of children who are medically complex and provide coordination of medical needs for these children and their families. A multi-disciplinary team from SickKids consisting of a Physician, Social Worker, Nurse Practitioner, Dietitian and Occupational Therapist travelled to Doha in October 2012 to support the establishment of HMC s first Pediatric Complex Care Clinic at Hamad General Hospital. Throughout 2012, three multi-disciplinary, educational workshops were facilitated by the SickKids team followed by clinical mentorship. To date, 27 children have been seen by clinic staff and receive routine follow-up. SickKids will continue to support the Complex Care Team at HMC as they prepare for their first annual program review in October Pediatric Pain Management The model for the Task Force approach follows from the success of the Pediatric Pain Task Force that was established in April The aims of the Task Force were to: Expand the current adult pain management service provided at HMC to include children Use an interdisciplinary approach to pediatric pain management using evidence-based practice through implementation of recommendations with support from SickKids Pain SMEs Enhance awareness and change attitudes toward the management of pediatric pain within HMC and the general public in Qatar One of the specific objectives of the Task Force was to ensure that the current HMC policy is expanded to include pediatric pain assessment. The policy, including pain assessment tools, pharmacological and non-pharmacological interventions, and ongoing management has been drafted and submitted for approval for use across HMC. The second main objective was to provide interdisciplinary education and to raise awareness of pediatric pain for HMC staff, as well as patients and families. This was achieved through the Pediatric Pain Awareness Month held in November The campaign to promote Pediatric Pain Awareness used a marketing strategy that was led by the HMC/SickKids Partnership Project Team. Various forms of media were used, including corporate designed posters, internet website announcements, press releases and television interviews, all of which attracted national public attention to the various aspects of pediatric pain assessment and treatment. Throughout the month of

13 13 P a g e November 2012, education was provided to 242 healthcare professionals including 159 nurses, 41 allied health professionals, and 42 physicians who provide care to children at HMC. Pain Awareness Month was structured to lead up to the 1 st Pediatric Pain Awareness Week which was held from 25 to 28 November. This was the first ever Pediatric Pain Awareness Week in the Gulf Region. There were two booths organized by the Pediatric Pain Task Force and HMC/SickKids Partnership Project Team at Hamad General Hospital and Rumailah Hospital. Education regarding pain management strategies was delivered by the HMC Pediatric Pain Task Force and other inter-professional staff, with some support from the SickKids Pain Team. Information was delivered to patients and families in both English and Arabic. The Pediatric Pain Patient Handbook and gift bag which contained items that could be used for distraction interventions during painful procedures was distributed to over 1000 patients and families. This was the first step to demonstrating the success of the Pain Task Force. The month ended with the 1 st Pediatric Pain Awareness Symposium Figure 6: Mariam Al Mutawa, Director of Nursing, HMC discusses pediatric pain awareness initiatives with families. held on Thursday, November 29, The symposium was a whole-day event which featured a known local motivational speaker introducing the theme of pediatric pain management, guest lecturers from SickKids, and HMC speakers on various aspects related to pain management in infants, children and adolescents. The Hajar Auditorium was filled to capacity with over 300 attendees present, demonstrating the interest and enthusiasm of all healthcare providers at HMC in the pursuit to enhance the current approach to assessing and treating pain in children. As part of a plan to sustain these practices, a specialized education program has been provided to nursing staff to lead practice change in nursing pain assessment and management. There are currently 33 Nursing Pain Champions acting as advocates for improved pediatric pain management at HMC in this role.

14 14 P a g e Accomplishments by Functional Area Research Following the initial developments in setting the direction and priorities, this year was highlighted with success in our strategic investments to raise the profile of child health research in Qatar. Through the outstanding contributions and commitment of scientists and clinical research staff from the Research Institute, we have enabled our partners to be better positioned to have an impact on child health through clinical research. Clinical Research Training Course This year marked the second round of training for research trainees through the HMC-SickKids Partnership. The course was developed in support of the effort to build capacity at HMC related to child health research in Qatar. The overall goal of the course was to address a gap in both knowledge and skill in clinical research for child health researchers at Hamad Medical Corporation (HMC). The specific goals of the course are to: 1) Increase participant knowledge in conducting clinical research 2) Develop participant skill through practical application of knowledge 3) Enhance potential for proposals for submission to a research granting agency Applications to the course were then selected by the SickKids Selection Committee. The highest ranked 15 applicants who completed all of the application requirements (i.e. letter of intent, letter of interest, curriculum vitae, and a letter of support from their clinical supervisor) were accepted into the training program. Participants represented diverse areas of child health research including physicians from the Department of Pediatrics, Obstetrics and Gynaecology, Surgery, Primary Health Care, Nursing, Pharmacy and Rehabilitation. Based on feedback from trainees, the approach used to deliver the course this year was extremely successful and met the objectives of the course. Over 98% of the trainees agreed or strongly agreed that the content of the didactic sessions were relevant and enhanced their knowledge of the subject. Over 96% of trainees agreed or strongly agreed that the content of the workshops or small group sessions were relevant and enhanced their knowledge of the subject. To date, the research proposals developed during this year s course alone were: 1 proposal has been submitted to the QNRF and is awaiting response 1 proposal has been submitted and approved by the MRC-Research Committee and is an ongoing research study 1 proposal has been submitted to MRC and is awaiting approval 6 trainees plan to submit proposals to MRC for approval in the next 1-3 months

15 15 P a g e Table 2: Research Activity of Clinical Training Course Graduates ( ) Clinical Research Trainees with QNRF Submissions with successful QNRF applications 2 with MRC Submissions 3 with active research studies 8 conducting systematic reviews 1 Number 4 (2 submissions 6th cycle, awaiting results) with peer-reviewed publications 6 (1 published in Science ) with submitted abstracts for CHRD with important leadership roles 12 (10 different trainees out of 55 abstracts) Kulluna (Childhood Safety Program and author of Childhood Drowning Incidence in Qatar) National Workshop in Genetics & Genomics Research The National Workshop on Genetics & Genomics Research followed from a national child health research strategy workshop that took place in December 2011 which focussed on how to build capacity and better facilitate collaboration in child health research in Qatar. One agreed-upon strategy that emerged from that first workshop was to organize a series of subsequent meetings each focused on a particular priority within child health research in Qatar, to build on existing capacity in the country and begin to develop research communities across institutional structures. The Genetics and Genomics workshop (the first of three) was held on December 4, 2012, bringing together the genetics and genomics research community in the state of Qatar to discuss the tremendous opportunities to further develop research in this area. Child Health Research Day This is now an annual event aimed at highlighting research relevant to child health in Qatar, hosted by the HMC- SickKids Partnership. Over the last three years, it has been evident that SickKids mentorship has been instrumental in developing the Scientific Committee and Organizing Committee which now effectively organize this event. The 3rd Annual Child Health Research Day was held on March 5, 2013, bringing together various clinicians and researchers across HMC and local external organizations, including Sidra Medical & Research Center, Shafallah Medical Genetics Center, Weill Cornell Medical College- Figure 7: Dr. Debbie O'Connor, Dr. Haitham El Bashir, Dr. Abdulla Al Kaabi and Dr. Hesham Al-Saloos participate in a panel discussion on Child Health Research Day

16 16 P a g e Qatar, University of Calgary School of Nursing and the College of the North Atlantic and the larger Gulf Region. The annual Child Health Research Day is now regarded as one of the most important initiatives within the Department of Pediatrics and Pediatric Surgery. Transforming Leadership The Child Health Research Committee (CHRC) established in January 2011 had been led jointly by SickKids and HMC. The mandate of the CHRC was to formulate the vision and priorities for child health research within Hamad Medical Corporation and develop a practical long-term plan for the implementation of a sustainable research program. Responsibilities comprise planning research infrastructure, including the training of investigators and research support professionals, planning the annual Child Health Research Day, as well as developing a job profile for, and leading the search for a research leader. This committee has inter-professional leadership which has been achieved jointly by HMC and SickKids with a shared vision and goal, formalized through clear Terms of Reference to support the development of the child health research profile. As Research is a functional area that will be transitioning to a new task force in Year 4, the HMC-SickKids Partnership team is well positioned by its well defined priorities, engagement from clinicians interested in research, and leadership support. Department of Pediatrics Medical education programs have been provided by SickKids SMEs over the past three years to support the enhancement of the pediatric residency and the subspecialty fellowships programs, and provide faculty development and continuing education at HMC. An academic health system (AHS) initiative was launched in August 2011 by HMC to integrate education, research and clinical practice in Qatar to achieve excellence in healthcare. Also, as part of this initiative, HMC is applying for residency accreditation from the Accreditation Council for Graduate Medical Education International (ACGME-I) and is hoping to be the second healthcare institution globally to achieve this recognition. In addition, HMC has begun exploring accreditation of its fellowship training program. In response to an evolving academic health system, SickKids has been working closely with HMC in further defining medical education and research needs for the organization. A job profile pilot, developed in partnership with the Research Functional Area, was developed and introduced to 16 heads of section in HMC s Department of Pediatrics to assess the feasibility of a framework to assign job profiles for physicians. Furthermore, a Multi-disciplinary Education Forum was held in December 2012 to define educational priorities for pediatric healthcare professionals and evaluate educational support required for the

17 17 P a g e Academic Health System (AHS) in Qatar. This was the first event of its kind in Qatar where key stakeholders involved in the education of pediatric healthcare professionals convened in one forum to discuss priorities for medical education in the future. This event was co- sponsored by HMC and Sidra Medical and Research Center and attended by representatives from other institutions including the University of Calgary-Qatar, the College of the North Atlantic-Qatar, Weill Cornell Medical College-Qatar, the University of Qatar and the Primary Health Care Corporation. The Pediatrics Functional Area has contributed significantly to the success and is embedded in the work of four other Task Forces: Pediatric Oncology, PICU, Child and Adolescent Mental Health and Complex Care. Allied Health Respiratory Therapy Respiratory Therapists (RTs) have been seconded to SickKids International since January To date, 8 RT SMEs have participated in partnership providing a constant presence in the PICU to support an inter-professional team model, advising systems and processes and providing bedside mentoring. A comprehensive education program on foundational knowledge of pediatric respiratory therapy was delivered to small groups of RTs until all of the pediatric RTs had been educated. This course utilized high-fidelity simulation to integrate a variety of skills and theories learned throughout the course, to support knowledge transfer from classroom to bedside. The respiratory therapy group was given the opportunity to use the facilities and resources at the College of the North Atlantic (CNA-Q). This partnership enabled instructors to utilize the College s high-fidelity simulation laboratories. Competency based assessments (CBA) were implemented during clinical consolidation to support transfer of didactic knowledge from classroom clinical practice. One hundred percent of the pediatric RTs at HMC have now completed the CBAs. RT SMEs have been also been involved in pediatric nursing sub-specialty education delivery which is an excellent platform to model interdisciplinary teamwork and provide support for the respiratory content of the course. RT SMEs have delivered/supported education in nine PICU courses, one cardiorespiratory course and four NICU courses. The SMEs have supported and advised the development of processes and structures to support the role of pediatric Respiratory Therapy. A Shift Accountabilities document has been customized for HMC and implementation is beginning. An emergency tracheostomy kit has been approved by the PICU and RTs are taking the lead role in implementation of this initiative. To support the advancement of the pediatric RTs through a career ladder at HMC, a competency assessment framework has been developed.

18 18 P a g e At the start of the HMC/SickKids Partnership, RTs were rarely present in the PICU. With the support of the Respiratory Therapy Department at SickKids, the HMC RTs are now a constant presence in the unit and an integral part of the team that is committed to improving patient care. Dietetics The Dietetics Department has achieved significant milestones since the beginning of the HMC/SickKids Partnership. The department supported the secondment of three SMEs to SickKids International ranging in time from six weeks to 18 months. In the first two years the SMEs completed diet technician education, provided a clear scope of practice between diet technician and dietitian, and developed nine dietetic pediatric foundation modules to provide a foundation in pediatric dietetic specialization and advance the level of practice for pediatric dietitians. The Dietetics Department also hosted a six-week observership and clinical/leadership rotation to the Acting Assistant Director of Dietetics at HMC, Reem Al Saadi, which informed her plans for pediatric dietetics at HMC. An organizational structure with revised job descriptions was customized for HMC. This year, the focus shifted to include specialized mentorship for pediatric dietitians in Complex Care and PICU, inter-professional working groups, as well as continuation of clinical support and mentorship to all 13 dietitians assigned to cover pediatrics under HMC. The educational focus and mentorship shifted to support the evolving healthcare system and new models of care incorporating a more holistic inter-professional (IP) approach. Four inter-professional workshops were delivered to facilitate inter-professional collaboration between inpatient dietitians and feeding therapists (HMC OT & ST) and to establish an inter-professional feeding team. Dietitian meetings and inter-professional meetings with colleagues (RT, Nursing, OT, NP, and Physicians) and stakeholders were conducted to discuss and collaborate in developing a plan to support advancing practice. Additionally, there has been ongoing collaboration with HMC feeding therapists and pediatric dietitians from the NICU to develop a framework for implementing thickening of formula as an intervention for management of swallowing dysfunction. Dietetic and Nursing SMEs collaborated with the HMC Project Team to support an inter-professional working group (physician, dietitians, nurse leaders from HMC) to educate and implement adherence to the WHO Growth Standards (0 to 5) and WHO Growth References (5-19), and review and purchase necessary anthropometric equipment (scales, length boards, tape measures) for inpatient areas. As task forces from SickKids visit HMC, the Dietetics SME participated in the work. Interdisciplinary education on Feeding and Nutrition for the Complex Care patient was developed and delivered through inter-professional collaboration with SickKids SMEs on the Complex Care Task Force. The approach utilized a variety of modalities including lectures, guided group discussion, and clinical mentorship involving the entire Complex Care team.

19 19 P a g e Responding to the needs of each dietitian, the Dietetic SME has adjusted the amount of support required, from didactic review and refresh education, to mentoring, to coaching to continue the advancement of pediatric specialization in pediatric Dietetics. In 2008, there were only six dietitians working with pediatric patients. Currently, there are 12 dietitians specializing in pediatrics with areas of focus such as GI, Cystic Fibrosis, Metabolics, Complex Care, Hem/Onc, NICU, Renal, PICU, General Pediatrics, and Endocrinology. Additionally, there are now two dietitian supervisors, one specifically for pediatrics. They have an increased presence on the inpatient units, are invited to present on areas of expertise to inter-professional teams, and are active participants in practice change. Changes in practice include: screening and recommending supplementations (e.g. Vitamin D and iron), using nursing flowsheets and medical information to inform nutrition care plans, and communicating nutrition care plans with the team. In PICU, the dietitian has increased knowledge in calculating energy/protein/fat provided by parenteral nutrition and the benefits of cyclic PN in the PICU population. Social Work In the first two years of the HMC/SKI Partnership, the Department of Social Work supported SMEs in visiting Qatar to assess the current state and provide recommendations for a pediatric social worker role. The HMC/SKI Partnership moved to implement the recommendations, and in autumn of 2012 was successful in appointing Ms. Abeer Al Salem as the first dedicated Pediatric Social Worker at HMC. SickKids Social Work Department customized a three-week observation and educational visit for Ms Salem to meet her objectives. She observed social work rounds, met with social workers in programs to inform her role, attended orientation lectures for social work at SickKids and was introduced to familycentred practice, Family Advisory Council and Resources for Patients and Families. During the Complex Care Team visit to Qatar, the SW SME provided support and advice to Ms. Salem as she developed the new role. Quality and Infection Control A team of three SickKids staff with subject matter expertise in Quality Improvement, Patient Safety and Infection Prevention and Control (IPAC) visited Qatar to determine the readiness and strategies most likely to succeed with respect to: 1. Implementing Quality Leader Roles 2. Developing an IPAC curriculum 3. Implementing a structured program such as leadership safety rounds, to engage staff at all levels in quality and safety goals The themes of Quality Improvement, Patient Safety and IPAC were combined in all discussions in recognition of related aims to achieve reliably higher quality, safer patient care. In addition to group discussions, tours of the PICU, NICU, PEC, Pediatric Unit, Al-Maha Unit, the Cardiac Catheterization Unit and peri-operative services were conducted.

20 20 P a g e Recommendations included implementing a Quality Leader role in targeted areas, proceeding with plans to implement Leadership Patient Safety Rounds based on HMC plans with a view to expand to local safety rounds, and enhancing Infection Prevention and Control capacity to effectively develop curriculum by dedicating pediatric Infection Control Practitioners (ICPs) and by building internal partnerships between clinical staff, ICPs, nursing/professional staff educators and quality leaders. HMC has recruited a Quality and Safety coordinator for pediatrics, and is in the process of recruiting a Quality Management Reviewer for pediatrics. Quality and Safety is identified as a high priority for HMC and The Pediatric Quality Task Force is being implemented for Year 4 of the Partnership. Diagnostic Imaging The SickKids Diagnostic Imaging team participated in a site visit from November 4 15, The team jointly spent time in the Diagnostic Imaging department at Hamad General Hospital as well as individual site visits to Woman s hospital, Rumailah and Al Wakra components of Hamad Medical Corporation. They assessed pediatric CT radiation doses, reported on current status of HMC MR Safety zones and related recommendations for required changes. They also supported the Department of Radiology to develop a plan to build pediatric expertise for radiologists, nurses and technologists. The HMC/SickKids Partnership has identified Diagnostic Imaging as a priority for the upcoming year. Plans are underway for an official mission by the HMC Diagnostic Imaging Task Force to visit SickKids. This will inform their priorities for pediatric Diagnostic Imaging as they move forward into year 4. Child Life Child Life Specialist SMEs have participated in the assessment and education of the pediatric initiative at HMC. They contributed to the development and delivery of pediatric nursing education which was an effective platform to model interdisciplinary teamwork and provided a foundation of child development to ensure that life remains as normal as possible for the hospitalized children of HMC. They recommended that a Child Life Service be considered as an essential component of quality pediatric care at HMC, and as such identified a need to develop a Child Life Department. To support this recommendation, they advised on an organizational chart, job descriptions, and competencies for both Director and Staff level positions. The HMC/SKI Partnership is actively recruiting for a Head of Child Life Services and for child life specialists. Many of the programs at HMC are requesting dedicated child life specialists for their population. Laboratory Medicine A group of subject matter experts from SickKids Pediatric Laboratory Services visited HMC to support the development of a strategic plan for pediatric lab services, advise on the status of laboratory workflow at HMC for pediatric patients, and support HMC to develop a plan for optimizing lab services. HMC Laboratory Medicine leaders then traveled to Toronto for a site visit to review processes and services provided at SickKids Laboratory as they plan to optimize services currently provided at HMC.

21 21 P a g e They presented key findings from the visit, objectives and an implementation plan on the outcomes to the HMC Education Steering Committee. This plan includes providing child-focused care, child-friendly facilities, a multidisciplinary team approach, and the introduction of a child life specialist role. The team also demonstrated enthusiasm for introducing Telepathology in the near future for international specimen reviews. Nursing Building capacity has been the foundational theme for the work that has evolved through the Centre for Nursing (CFN) and SKI. Joint efforts of the operational portfolio and the professional practice portfolio have focused on elevating the level of clinical knowledge and skill of HMC nursing staff through comprehensive specialty education, coaching and mentoring. The education model is evidence-based and learner-centred, incorporating interactive development opportunities based on adult learning principles. As the demand for support of international nursing programming has grown, CFN and SKI have also focused efforts on building capacity within SickKids to ensure we can meet the demand of the global education needs. Investment this past year in supporting and educating staff has led to stronger involvement and empowerment, effective relationship building with our partners, and overall satisfaction and engagement with the Qatar project. Supporting Education Infrastructure In order to ensure SickKids nurses are prepared as effective international consultants it has been important to build an infrastructure to support this area of practice. In Year 3, the Centre for Nursing education team has been instrumental in preparing and supporting Subject Matter Experts (SMEs) involved in nursing education and clinical mentorship in Qatar. A structured orientation program and follow-up debriefing sessions have supported SMEs in facilitating crosscultural teaching as well as respectful and effective mentoring roles. The CFN Figure 8: HMC Nurses attend Pediatric Nursing Core Up-skilling Education education team has supported the delivery of the education themselves, as well as providing educational expertise to SMEs remotely when not on the ground in Qatar. In Year 3, two more Advanced Practice Nurse Educators (ANPE) have been hired to the education team dedicated to the

22 22 P a g e HMC/SickKids Partnership raising the number of SickKids International ANPEs to four. Subspecialty Education Delivery & Clinical Integration In 2012, under the leadership of the ANPE, SMEs from SickKids delivered multiple pediatric nursing subspecialty education programs. The programs included one- or two-week curriculum courses in the following subspecialty areas: Pediatric Intensive Care (PICU), Neonatal Intensive Care (NICU), Cardiorespiratory Medicine, Emergency Medicine, Nephrology, Hematology/Oncology, Mental Health and Pediatric Surgery. The programs focus on increasing nursing knowledge in each pediatric subspecialty for nurses at HMC through two components: evidence-based curriculum and clinical integration based on clinical competencies. The courses delivered in the classroom involved lectures, group discussions, case studies and presentations. Objective-structured clinical examinations, skills stations and simulation were also integrated into most subspecialty programs. In the NICU, PICU and Respiratory courses, a number of lectures were co-facilitated by SMEs from Respiratory Therapy and Occupational Therapy to role model inter-professional collaboration. After nurses completed the curriculum, they had the opportunity to work with SME mentors in the clinical environment. The goal of clinical mentorship is to review and solidify known information, provide a foundation for examination and reflection of professional values, and give learners the opportunity for further understanding of pediatric nursing best practices. Evaluation included knowledge testing, satisfaction, and competency checklists. HMC nurses have been shown to improve their level of knowledge and were able to perform advanced clinical skills with varying levels of support. Satisfaction among nurses was high for the education programming across these subspecialties. Pediatric Intravenous Therapy Team It was an exciting close to the year with the establishment of the first Pediatric IV team at HMC. The Vascular Access team from SickKids developed and led the educational workshop for the newly formed Pediatric IV team. The SickKids IV Team provided one month of clinical mentorship following the education to support implementation of this new program. This new team has been received with great enthusiasm both from the HMC healthcare professional team as well as children and families. Follow-up of progress of the team is planned for Year 4. Pediatric Nursing Core Up-skilling In order to ensure there is a common foundation for nursing professional practice at HMC, a program was developed to instill core components of quality pediatric nursing. This one-week program was received with great interest in Year 2 and this continued in Year 3. The course has transitioned to be led by SMEs in collaboration with HMC educators realizing the goal of sustainability. The program focuses on seven core pediatric standards: Family-Centered Care, Respect for Diversity, Inter-professional Collaboration, Continuity of Care, Communication and Comfort and Safety. In Year 3, 123 nurses from throughout the Hamad Medical Corporation attended these up-skilling sessions.

23 23 P a g e Continuing Education Courses Complementary to the subspecialty education programs, educators from the Centre for Nursing have developed continuing education curriculums in 30 areas of nursing practice. Examples of these one-day workshops include: Family-Centered Care, Pain, Central Venous Catheter Care, Chest Tube Management, Asthma, and Respiratory Disorders. SMEs in collaboration with the HMC educators provided workshops this year on Central Venous Catheter Care. Table 3: Y3 Nursing Activity in Qatar NURSING EDUCATION COURSES AND RELATED SME DAYS IN QATAR in YEAR 3 Nursing Education Program Total Courses Offered Total HMC Attendees Classroom Facilitation (SME days) Clinical Instruction (SME days) TOTAL SME days in Qatar PICU NICU Cardio-respiratory Allied Health Professionals co-facilitated lectures in PICU, NICU and Respiratory courses RT 41 OT Hematology/Oncology Nephrology Emergency Pediatric Surgery Mental Health Pediatric IV Team Pediatric Nursing Up-skilling TOTAL * *HMC nurses may have attended more than one SickKids course Sustaining Change in Pediatric Nursing Practice: A Framework The overall vision of the SickKids/HMC Partnership is to provide the best in pediatric care for the children of Qatar. A key component in achieving this goal has been the advancing of nursing practice through comprehensive education programming with an emphasis on clinical integration of knowledge into practice. As the Project Team continues to develop the foundational skills and knowledge of front line nursing staff, it will subsequently re-direct focus toward sustainability. As nursing practice advances, it will be important to create a plan that will ensure the desired changes are maintained and also continue to evolve. The third year ended with the submission of a strategy map for sustainability of

24 24 P a g e leading nursing practice. In partnership, the sustainability framework will guide next steps for Year 4 with a focus on nursing leadership, further engagement of front-line nurses, linking practice, education and research, streamlining policy and procedure processes and developing a robust performance and monitoring approach, all supporting a strong nursing vision. Awards and Recognitions Stars of Excellence The outcome of a great team effort was clearly demonstrated at the 2012 Stars of Excellence Awards Ceremony. A record number of applications, from multiple projects across HMC, were submitted for nomination. Of the 360 applications submitted to the Stars of Excellence Selection Committee, all 3 of the applications, showcasing the achievements accomplished through the HMC/SKI Partnership, were nominated in their respective categories. The HMC/SKI Partnership Project Team was presented with the Rising Star Award for Leadership and Team Impact. Also, the Team was presented with a Merit Award in the Education Category, for their efforts in facilitating Pediatric Nursing and Allied Health Education Program. Lastly, the Child Health Research Initiative, implemented through the Partnership, was recognized with a Merit Award in the Research Category. The Department of Pediatrics, overall, received several honours as multiple projects and services were awarded in recognition of their impact towards improving Figure 9: Dr. Abdulla Al Kaabi receives the Rising Star Award in Leadership from Dr. Hanan Al Kuwari, Managing Director, HMC. the standard of care provided to the children of Qatar. The NICU Clinical Practice Committee received the Award of Merit in the Health: Practice Award Category. Mortality Morbidity Review in Pediatric Emergency was presented with the Star of Excellence and Increased Rate of Compliance in Attendance to Palivizumab was recognized with the Rising Star Award in the Health Performance Category. The

25 25 P a g e Rising Star Award in the Health Service Category was presented to OPD Pediatric Clinics Appointment System. The Star of Excellence was awarded to National Trends in Retinopathy or Prematurity and PEARL Study received the Award of Merit, both in the Research Category. In addition, the HMC/SickKids Partnership accomplishments in Research were honoured with the Award of Merit for developing a child health research profile and fostering collaborations across Qatar in the field of research. Lutfi Haj-Assaad Inducted into SickKids President s Circle In August 2013, during a visit to Toronto, Lutfi Haj-Assaad received the prestigious honour of being inducted into the SickKids President s Circle. Lutfi was recognized for his leadership in the development and successful implementation of an international project to improve the delivery of health care for children in Qatar through the HMC/SKI Partnership. He was also honoured for his ambassadorship role for SickKids in the Middle East. The award was presented to him by Mary Jo Haddad, President and CEO, SickKids. Dr. Abdulla Al Kaabi Receives SickKids Alumni Award In May 2012, Dr. Abdulla Al Kaabi, HMC Project Director and Geraldine Johnston, HMC Project Manager visited SickKids to provide Senior Management, Directors and Managers with an overview of the Partnership s achievements. During their visit, Dr. Abdulla Al Kaabi, HMC Executive Sponsor was presented with the honourary SickKids Alumni Award by Mary Jo Haddad, President and CEO, SickKids, in recognition of his leadership, passion and commitment to improving the health of children and families in Qatar. Figure 10: Mary Jo Haddad presents Dr. Abdulla Al Kaabi with the SickKids Alumni Award. The Approach to Year 4 On October 15, 2012, the HMC/SickKids Project Team convened to review accomplishments from the previous year and develop a plan for Year 4. Building on the success of the Task Force Approach from Year 3, the Project Team identified eight new priority areas for continued development in pediatrics.

26 26 P a g e The following areas were chosen based on their alignment with HMC s new Academic Health System initiative and the following guiding principles: Focus on patient safety Enhancement of the pediatric profile at HMC Driven by clinical champions Measureable outcomes Quick win Alignment with corporate objectives and national priorities As we move toward the final years of the Project, the Team will begin to shift its resource planning activities toward building capacity and sustainability at HMC. The team will continue using a multidisciplinary approach within the eight new priority areas, develop and empower HMC staff and leaders, and maintain the current knowledge transfer model of education delivery followed by clinical mentorship on the units. For More Information on the Partnership Children First e-magazine The first issue of the Children First e-magazine was released in August This quarterly report provides readers with updates on the latest developments in relation to clinical programs, research and education within pediatrics across HMC. For more information, please visit:

27 27 P a g e The Partnership Website The HMC/SickKids Partnership Website is the official site for the Project. It provides readers with information on the history of the Partnership, biographies of the Project Team, information on the 14 Task Forces and regular updates from the Project. For more information, please visit: Figure 11: SickKids Doha Project Team from left: Andrea Riekstins, Penni Kean, Nicky Brookes, Lutfi Haj-Assaad, Leonard Nolasco, Aimee Pastor

28 28 P a g e Acknowledgements [Project Participants Years 1 to 3] The SickKids International Team would like to acknowledge the following individuals for their support in making this project a huge success: HMC Project Team Dr. Abdulla Al Kaabi Geraldine Johnston Mariam Al Mutawa Rawan Hamad Emily Highton Alleli Libacao Greg Malt Asha George Mathew Kayla McLellan Lamea Murtaza Showbeez Pallam Sasi Pooleri Reshma Smit Johnny Townson Bader TV Cynthia Varghese Peter Walsh HMC Senior Management and Clinical Leads Dr. Hanan Al Kuwari Dr. Mariam Abdul Malik Mr. Maqsood Adam Ms. Nazilla Afghani Dr. Abdulla Al Ansaari Dr. Khalid Al Ansaari Dr. Mansour Ahmed Ali Dr. Nawal Al Haddad Ms. Suad Al Hamad Dr. Ahmed Al-Hammadi Dr. Al-Hareth Al-Khater Dr. Huda Hussain Al Mahdi Dr. Nabila Al Meer Dr. Zahra Al-Mejali Dr. Hilal Al Rifai Ms. Reem Khalid Al Saadi Dr. Abdullah Al Nasser Dr. Mohammed Al Qawas Mr. David Astley Dr. Khalid Bshesh Dr. Ann Marie Cannaby Mr. T. Chockalingam Ms. Colene Daniel Dr. Haitham El Bashir Dr. Mamoun Elshekh Sr. Ma. Lourdes Ezpeleta Ms. Mona Farhan Mr. Marwan Hamad Prof. Edward Hillhouse Dr. Ibrahim Janahi Dr. Mohammed Janahi Dr. Rifat Latifi Dr. Ahmed Janaid Omar Dr. Kokash Osama Dr. Robert Owen Mr. Nish Patel Dr. S. Sivagnanam Ms. Leena Varghese Holland Bloorview Kids Rehabilitation Hospital Subject Matter Experts Sheila Jarvis Keith Adamson Jennifer Aldington Chitra Aloysius Natasha Bath Doug Biggar Sarah Bognar Marita Boyce Kim Bradley Kelly Brewer Linda Buskin Viola Cheng Blythe Dalziel Sarah Davidson Maryanne Fellin Joan Ferguson Robert Gagnon Monica Gemeinhardt Pam Green Christa Haanstra Robin Harmer Marion Ivorra Tracy Kitch Donna Kline Nicole Laprade Megan Lynch Kim McFarlane Golda Milo- Manson Gert Montgomery Kim Moody Sean Peacocke Diane Savage Jackie Schleifer- Taylor Irene Simpson Nicole Thomson Andrea Tsuji Jessica Votruba Karen Ward Christie Welch

29 29 P a g e SickKids Subject Matter Experts Mohammed Abdelhaleem Karen Breen-Reid Andrea D Souza Walid Farhat Nael Abumustafa Joan Brennan Trevor Da Silva Rosemarie Farrell Susan Ackerman Suzanne Breton Zelia Da Silva Farran Faus Sherri Adams David Brownstone Allison Dalby Gayle Fellows Nadia Akseer Christina Bumanlag Elizabeth Dale Liz Ferguson Asim Ali Gwen Burrows Rita Damignani Sharon Ferrari Jessie Alsop Craig Campbell Denis Daneman Michael Finelli Kaitlin Ames Melanie C Campbell Catherine Daniels Heather Fleming Adelle Atkinson Paolo Campisi Leanne Davidson Bonnie Fleming-Carroll Nimrita Aujla Cindy Capstick Robert Davidson Jamie Floresca Anne Ayling Campos Denise Carraretto Leonor De Biasio Margot Follett Rowe Corry Azzopardi Paula Carroll-Spence Nicole de Silva Christopher Forrest Sheri Backman Umberto Cellupica Robin Deliva Helen Forrest Darius Bagli Ann Chang Sharon Dell Lisa Fowler Crystal Barker Ellen Charkot Jennifer Dermott Natalie Fox Maru Barrera Arlene Chaves Linda Diebold Lindsay Fraser Edward Barrett Mary Chen Usha Dinesh Jeremy Friedman Frances Barry Monping Chiang Jennifer DiSimone Carrie Fullerton Jennifer Bassin David Chiasson Alison Dodds Karen Fung Christian Bautista Diana Chow Ruth S Doerksen Rose Gaiteiro Sara Belot Raymond Chow Laura Doi Adam Gassas Guila Bendavid Lily Chu Sara Doubleday Kate Gent Caroline Bennett Stephanie Chu Mary Douglas Nicole Gibson Susanne Benseler Vanessa Chu Sandra Doyle Patricia Gilray Michelle Bertoni Marilyn D. Clark James Drake Carrie Glanfield Mavoy Bertram Lindsay Clarke Karen Drybrough Louise Glaude Abby Bezant Lisa Coles Karen Dryden-Palmer Ashley Graham Joanne Bignell Ashley Collins Annie Dupuis Brenda Graydon Lorraine Bird Jocelyne Copeland Laura Lee Dupuis Mark L Greenberg Jennifer Bizzarri Leah Costa Niema Duri Karan Greenock Elena Blackwood Peter Cox Michele Durrant Anne M. Griffiths Victor Blanchette Mark Crawford Linda Edmond Lars Grosse-Wortman Marilyn Booth Daniela Crivianu-Gaita John Edmonds Renee Haldenby Eric Bouffet Beverly Cross Maarten Egeler Lori Hamilton Gabrielle Boulianne Toni Crowell Amanda Ellenberger Maggie Harkness Sarah Bovaird Geraldine Cullen-Dean Andrew Evans Marie-Cecile Hartmann Leonardo Brandao Christine Curtis Abigail Faminial Elizabeth Harvey