Roundtable Discussion Advancing Workplace Mental Health in Healthcare Settings BC Roundtable Summary Report Prepared by: The Mental Health Commission of Canada and HealthCareCAN December 2015
Table of Contents Backstory...2 Purpose...3 People...3 Roundtable Discussions...3 Panel Discussion: Learning from the Case Studies...4 Group Discussions...5 Supporting the implementation of the Standard in healthcare settings...7 Next Steps...9 Participant List... 10 Advancing Workplace Mental Health in Healthcare Settings 1
Backstory In January 2013, Canada became the first country in the world to launch a voluntary standard on psychological health and safety in the workplace. The National Standard for Psychological Health and Safety in the Workplace (the Standard) is a voluntary set of guidelines, tools and resources focused on promoting employees psychological health and preventing psychological harm due to workplace factors. The Mental Health Commission of Canada (MHCC) championed its development and soon after its launch, HealthCareCAN released Psychological Health and Safety in Canadian Healthcare Settings, a policy statement that encourages its members and all health stakeholders to commit to taking action to implement the Standard. Since its launch, numerous healthcare organizations across Canada have begun to implement the Standard. These organizations recognize the significance of protecting and promoting the psychological health of the healthcare workforce. Simply put, good psychological health is integral to being an effective healthcare worker and protecting the psychological health of healthcare workers may contribute to fewer medical errors and patient-safety incidents. Evidence-based research is, however, needed. To help address this, MHCC is leading a multi-year Case Study Research Project following over 40 Canadian organizations as they implement the Standard. Fifteen of these organizations are in the health sector. They represent a wide range of organizations including large academic health sciences centres, local family health units, regional and provincial health authorities and private industry. MHCC and HealthCareCAN are committed to broadening the awareness and importance of workplace mental health and the Standard within the healthcare sector across Canada. To achieve this, together we are co-hosting a series of roundtables in various Canadian locations at events that will strategically leverage existing efforts (i.e. relevant conferences). The first roundtable meeting was held on November 2, 2014 at the Metro Toronto Convention Centre as an invitation-only pre-conference roundtable session at the 2014 HealthAchieve conference. A similar second roundtable meeting was held on June 17, 2015 at the Prince Edward Island Convention Centre in Charlottetown following the 2015 National Health Leadership Conference. The third session was held following the BC Health Leaders Conference in Vancouver, British Columbia, on October 22, 2015. This summary report provides an overview of the third session in this series, where possible, building on findings from the previous two roundtables. Advancing Workplace Mental Health in Healthcare Settings 2
Purpose The overall purpose of the series of roundtables is to build relationships, coordinate efforts and identify areas of collaboration among healthcare organizations who are implementing or who wish to begin implementing, the Standard. Specifically, the objectives are to: 1. Take stock of the Standard and its implementation in the health sector; 2. Learn from those who are implementing the Standard in the health sector; 3. Explore ways to increase uptake of the Standard within the sector; and 4. Identify and share tools and resources that can assist with the implementation of the Standard and identify tools and resources that are missing and could be developed. People The third roundtable brought together 14 health leaders from various health care organizations including Presidents and CEOs, Vice-Presidents, Directors, and Advisors from the acute, long term care and home care sectors as well as health authorities. The bulk of participants represented organizations located in the Western Provinces and the North; adding diversification from the Ontario-focus of the first session in Toronto and the Atlantic-focus of the second session in Charlottetown. Four of the participants were from organizations participating in the MHCC Case Study Research Project. The others expressed interest in workplace mental health. Some are members of HealthCareCAN. The complete list of participants can be found on page 10. The roundtable series was co-hosted by HealthCareCAN and the Mental Health Commission of Canada (MHCC). The third session in BC was facilitated by Ed Mantler, Vice President of Programs and Priorities at the MHCC. Jennifer Kitts, Director, Policy & Strategy presented on behalf of HealthCareCAN. Staff from the MHCC and HealthCareCAN attended the roundtable to support its facilitation, record the discussion and prepare this summary. Roundtable Discussions The format of the roundtable was largely based on facilitated discussions including break-out group sessions. The Agenda included: 1) Opening remarks, including an overview of workplace mental health and the Standard and the purpose of these roundtable sessions 2) Introductions 3) Facilitated discussions a. Panel discussion: learning from the case studies b. Group discussion I enablers to support committing to implementing the Standard c. Group discussion II barriers and challenges to committing to implementing the Standard d. Group discussion III supporting implementation of the Standard in healthcare settings 4) Next steps The facilitated discussions are summarized below. Advancing Workplace Mental Health in Healthcare Settings 3
Panel Discussion: Learning from the Case Studies With a panel of four case study representatives, each took the lead answering one of four questions. Remaining panel members provided additional input, where applicable. Question 1: What was the reason or precipitating factor(s) behind your organization addressing workplace mental health and committing to implementing the Standard? Fiona O Connor from Regina Qu Appelle Health Region, shared that at the time there wasn t an issue with high staff turnover or sick rates, but the mental health clinic within the larger organization wanted to be proactive towards these and related issues that many organizations face. The health of staff was considered a priority and as a mental health clinic there was a need to walk the talk to ensure the promotion of staff mental health was present. Regina Qu Appelle surveyed employees revealing low staff morale and engagement, but with no follow-up. There was recognition that the Standard could help guide strategies to address this. Jennifer Yelland from Alberta Health Services added that there were monetary drivers to implementation of the Standard in their organization due to poor results for incidence of injury and unexplained absences. Question 2: What was one of your organization s first key decisions or steps once committed to implementing the Standard? Wolf Klassen of Toronto East General Hospital indicated that their corporate strategy was light on addressing staff wellness so they created a policy on psychological health and safety for staff. Prior to the Standard, they followed the Excellence Canada program which recommended a mental health plan and when the Standard came out they saw it as an opportunity to refresh the plan. This exemplifies what is true of other organizations; they already had some pieces in place, they weren t starting from scratch and a policy statement can be a starting point. Lauren Mathany from BC Provincial Health Services emphasized that you can t do it all at once and that it needs to be based on continuous improvement. Question 3: What leadership was in place or required for your organization to commit to implementing the Standard? Jennifer Yelland, Alberta Health Services, shared that in their large organization (over 100,000 employees across the province) there needed to be a targeted approach and it was key to find a leader with passion and a vested interest in workplace mental health. This was hard to find due to competing priorities and rejection by some that psychological safety sounded like jargon and fluff. Educating leaders on the importance is key while addressing language barriers. Leaders need to understand what is in it for them and drive the bottom line and patient care etc. Jennifer stressed that it takes time and recommends focusing on the early adopters at top levels to keep moving forward. Question 4: What have been the early (or not so early) successes or outcomes? Advancing Workplace Mental Health in Healthcare Settings 4
Lauren Mathany, from BC s Provincial Health Services Authority, indicated that the critical incidence/emergency services area of the organization has been the focus of their efforts to date. Peer support was key to their efforts; of their 4000 paramedics there were originally four peer defusers, who were experiencing - or were on the verge of experiencing - burnout, and now there are 58. Union support was a challenge early in the process, but now the organization has their dedication and support. Overall, the number one success has been that staff are now talking about mental health in a positive way; there has been a decrease in the blaming culture. They are now in a position to grow beyond their starting focus of critical incidence/emergency services. Jennifer Yelland added that it is important to acknowledge the small successes and recognize that your organization may already be doing some of what is outlined in the Standard. Group Discussions The room was divided into two separate tables, with a mix of participants, case study representatives and one MHCC/HealthCareCAN staff at each table to help facilitate the discussions. Tables were asked to consider the following question, reporting back on their top three enablers. What are or could be the enablers for implementation in your organization? Vancouver Both tables identified strong organizational leadership or CEO/senior leadership team commitment as one of the top three enablers to successful implementation of the Standard. The remaining top three enablers at each table varied. They included culture shift, leveraging existing networks, growing awareness among staff and using data and metrics to support implementation. You need senior level commitment to improve the employee experience. You can t improve the patient experience without improving the employee experience. Other suggested enablers that were identified at the Vancouver roundtable included support from the Ministry of Health, Board support, human resources support, strong relationship and trust of the union(s), and partnerships and committees in place. Themes Enablers When comparing the Vancouver, Charlottetown and Toronto roundtables, a very strong theme emerges in relation to enablers for implementation of the Standard: All three roundtables identified leadership and senior leadership as a top key enabler. Visible leadership commitment; buy-in from a strong leadership team; and, leadership that is focused on quality and a culture of safety are some of the aspects of leadership that were identified. While not a top three, organizational culture was identified as a key enabler by all three roundtables. The Charlottetown roundtable identified organizational culture as an enabler in general. The Toronto roundtable identified culture in relation to the need for leadership that is focused on quality and a culture of safety. And the Vancouver roundtable identified culture in relation to strong organizational leadership and a culture shift that embodies the value system of a caring organization. Advancing Workplace Mental Health in Healthcare Settings 5
Staff engagement in varying forms was also identified in two of the three roundtables as a top enabler. The Toronto roundtable identified it in relation to the need for a commitment to improving the work environment through staff engagement and empowerment. And the Charlottetown roundtable identified it in relation to the need to develop strategies and clear objectives, including communication and staff engagement, to support implementation. Using data and metrics to support implementation of the Standard was identified as a priority key enabler in two of the three roundtables. Existing data and metrics, such as absenteeism reports and employee surveys, are rich in information and can help an organization determine where to start with implementation. What are or could be the barriers or challenges to implementation in your organization? Vancouver Still divided into two tables, the groups were asked to consider the above question and report back on what they see as the top three barriers to implementation. There was significant overlap in the two table s responses. Both identified stigma and competing/too many priorities as top barriers. Other top barriers included lack of leadership and a culture that supports change, physician involvement and language (the need to translate this work into on the ground language). There is change fatigue and a sense of the flavor of the week. This is not a side-of-the-desk assignment. There is a lack of tools and resources with 101 priorities already on the table. Additional barriers identified during this group discussion included lack of time and resources, sustainability, lack of knowledge, fear, lack of trust, change fatigue (rapid and constant change), not knowing where to start and lack of communication. Themes - Barriers Comparing the Vancouver discussion with the Charlottetown and Toronto sessions, there are some very strong similarities among the identified barriers: All three roundtables identified competing priorities among their top three barriers to implementing the Standard in their organization; managers are busy, face tight budgets and increasing demands on their time. Stigma was identified as a top three barrier by two of the roundtables; it was also identified by the other roundtable as a barrier to implementing the Standard. Lack of awareness, a factor that has many inter-related sub-components, including what is the Standard? and how the Standard differs from other initiatives, was identified as a barrier by all three roundtables (as a top three by one roundtable). Lack of union support or labour relations challenges was identified by two of the roundtables. The overall complexity of implementation itself and not knowing where to start was Advancing Workplace Mental Health in Healthcare Settings 6
identified by two of the roundtables. Supporting the implementation of the Standard in healthcare settings The Toronto roundtable session involved identifying tools and resources that are or could be useful for supporting implementation. The group identified several promising practices and ideas being used in the healthcare sector for implementation of the Standard and/or to improve workplace mental health, as well as specific tools and resources. Both are listed below and were shared at the roundtable sessions in Charlottetown and Vancouver. Participants were invited to add to the lists during or after the sessions via email, but there were no further additions provided. Promising practices identified at the Toronto roundtable included: Setting up a leadership committee; Leveraging the joint occupational health and safety committee; Tracking staff engagement using a quarterly pulse survey; Issuing a quarterly dashboard report; Peer support program; Having the health and wellness team partner with in-house psychiatry and mental health staff; Leadership development and coaching programs; Emotional intelligence training; Providing health care workers with tools to help increase their reflective capacity; Employee grounding program; and, Offering online cognitive-behavioral therapy programs for employees. Specific tools and resources being leveraged by the healthcare organizations at the Toronto roundtable included: NRC Picker Survey LEAN management tools Connor-Davidson Resilience Scale (CD-RISC) Stigma scales developed by Scott Patton Stress & Satisfaction Offset Score (SSOS) Resources freely available on the Great-West Life Centre for Mental Health in the Workplace website (https://www.workplacestrategiesformentalhealth.com/) Advancing Workplace Mental Health in Healthcare Settings 7
Over the course of the year that the three roundtables took place, MHCC and HealthCareCAN s planning evolved. Building on discussions from the earlier roundtables, the Vancouver roundtable dedicated time to three questions to help inform planning and identify next steps to further support implementation of the Standard in healthcare settings. Question 1: What are the unique characteristics of the healthcare work setting in relation to workplace mental health? Question 2: What kind of new support/resource could we develop that would address these unique characteristics? Questions 3: What would or could a by health, for health resource look like? From this discussion, a list of characteristics specific to healthcare settings emerged. These included stigma, limited access to updated technology, the complex environment (i.e. shift work, wide variety of roles/disciplines, repeated exposure to and dealing with trauma, employees of varying ages, decreasing budgets, etc.), role as helpers/caregivers, workload and time, employee/health provider self-diagnosis, regulations. It s not just a job work comes home with us. The workload is unrelenting with no end in sight. You are never off. Exposure to trauma is a regular occurrence; it becomes normalized. From this list, participants were then asked to imagine specific supports and resources that could be helpful in supporting the implementation of the Standard specifically in the health sector. Key suggestions are outlined below: Create a network or hub of resources: for mentoring, education, sharing information and resources, tools to gauge one s own health, a list of experts willing to help across Canada. Provide education: workplace curriculum for health professionals to include more than physical safety; webinars and online education. Develop a Community of Practice: to learn from champions and other stakeholders. Identify Champions and Develop Campaigns: awareness and facilitating the ability to have the conversation; include in daily huddles. Develop and/or share tools: communication and access to existing tools. Physicians tend to be isolated; tools to use for yourself to know if you are healthy could be effective. We need to create safe environments, break down the barriers and stigma. Delving deeper into what a potential resource by health, for health could be, the concept of a guide or lengthy document to facilitate implementation of the Standard for healthcare was not seen as a necessity or priority. Short, concise and with checklists were the preferred characteristics of a tool or guide, or even training on how to use the existing guide Assembling the Pieces was suggested. It was agreed that something online and easily accessible was key. A formal network that could be online and perhaps also inperson was well received by this group as well as providing specific data and experiences perhaps from champion organizations. Leveraging Accreditation Canada as a resource was also discussed. Advancing Workplace Mental Health in Healthcare Settings 8
There needs to be something that is practical, easy to use, accessible and quick; a network to not only connect to resources and tools, but to experts and people. Findings from these discussions aligned with factors for consideration that surfaced from previous sessions include, that: There is generally not an appetite to develop a specific guide for the health sector; the sector is already used to adapting CSA standards for their own purposes. A cross-case analysis of what is working and what needs improvement with respect to implementation of the Standard in the health sector is needed. An awareness push for the Standard and implementation guide is needed. Aligning medical schools and other health professional/provider programs with the Standard is needed. Connecting efforts with Accreditation Canada is necessary. Next Steps The roundtable series not only met, but in many ways exceeded expectations. They were well attended by very engaged participants - some who admitted their lack of knowledge at the start expressed satisfaction and motivation by the end. Case study organizations demonstrated that they are true champions, sharing their journey and motivating their peers to start their journey. All three-hour sessions ended with a positive, lively energy in the room, which speaks to the enthusiasm, interest and sense of ability to take action that was achieved within a short but rather jam-packed session. Participants felt heard while also arming themselves with a wealth of information and connections to move forward in their organizations. The MHCC and HealthCareCAN also gained by having a clearer sense of next steps to continue their partnership and facilitate their dedication to advancing mental health in healthcare settings and supporting the implementation of the Standard within the health sector. As we reflect on this past year of roundtables, we are now entering the next phase of our partnership and activities. We are funding a cross-case analysis of the healthcare organizations that are participating in the MHCC Case Study Research Project, with interim results tentatively expected for release at NHLC in June 2016. We are also moving forward with exploring the development of a Community of Practice that will start a more formal network and guide the development of any future by health, for health tools or initiatives. Advancing Workplace Mental Health in Healthcare Settings 9
Participant List Healthcare Organization Representatives: Karen Baillie Chief Executive Officer Menno Place Sarah Bell Provincial Executive Director, Children and Women's Mental Health and Substance Use Programs, BC Children s Hospital Bob Breen President and CEO Louis Brier Home & Hospital and Weinberg Residence, Denominational Health Association Dr. Catherine Clelland Head, Department of Family Practice Royal Columbian Hospital, Fraser Health (HealthCareCAN MEMBER) Jennifer Conley Chief Executive Officer Athabasca Health Authority Sandy Coughlin Director - Occupational Health & Safety Providence Health Care (HealthCareCAN MEMBER) Christine Devine Wellness Specialist Toronto East General Hospital (CASE STUDY) Jeanette Lee Director, Human Resources Menno Place Lauren Mathany Manager, Healthy Workforce Strategies Workplace Health, Provincial Health Services Authority, (HealthCareCAN MEMBER) (CASE STUDY) Michelle Medland Regional Director, Vancouver St. Elizabeth Health Care Tracey Newlands Director, Occupational Health and Safety Island Health (HealthCareCAN MEMBER) Carol Gillis Executive Director, Corporate Services Keewatin Yatthé Regional Health Authority Susan Good Director, Leadership & Organization Development Fraser Health (HealthCareCAN MEMBER) Anne Harvey Vice President, Employee Engagement Vancouver Coastal Health Authority (HealthCareCAN MEMBER) Dave Keen Executive Director, Workplace Health Fraser Health (HealthCareCAN MEMBER) Wolf Klassen Vice President, Program Support Toronto East General Hospital (CASE STUDY) Ricky Kwan Executive Director George Derby Care Society Diane Lau Executive Director Sara Riel Fiona O Connor Director, Mental Health Clinic Regina Qu Appelle Health Region, (CASE STUDY) Stephanie Lauren Thomas Client Service Coordinator Saint Elizabeth Health Care Jennifer Yelland Senior Health & Wellness Advisor, Workplace Health & Safety, Human Resources Alberta Health Services (HealthCareCAN MEMBER) (CASE STUDY) Patty Yoon Operations Leader, Tertiary Mental Health Neuropsychiatry Program - Alder Unit Specialized Eating Disorders Program, Providence Health Care (HealthCareCAN MEMBER) Advancing Workplace Mental Health in Healthcare Settings 10
MHCC and HealthCareCAN Representatives: Ed Mantler Vice President, Programs and Priorities Mental Health Commission of Canada Sandra Koppert Program Manager Prevention and Promotion Initiatives Mental Health Commission of Canada Jennifer Kitts Director, Policy and Strategy HealthCareCAN Susan Anderson Senior Policy Analyst HealthCareCAN Advancing Workplace Mental Health in Healthcare Settings 11