TPIGS Newsletter Strengthening the Voice of Terrace Physicians Terrace Physician Initiative Group Society (TPIGS) is supporting physicians to make change in the health care system, improving their work environment and patient care. TPIGS is part of the Facility Engagement Initiative (FEI), resulting from a master agreement between Doctors of BC and the Provincial Government, the first initiative of its kind in Canada. Currently, 67 facilities are involved across British Columbia. FEI works to build physician leadership in the health system. TPIGS was incorporated as a society in 2016. The initial years of the society were spent building the governance structures necessary to run as a not-for-profit. 2017 saw the renovation of the physician lounge, a project realized in collaboration with Northern Health, as well as quarterly physician engagement dinners, events which developed relationships and a sense of community. A new board of directors, Drs. Willem Lombard, Andrea Geller and Ariane Mundhenk, was elected in the fall of 2017 and in The ER Simulation Program, led by Drs. Natasha DeSousa and Ariane Mundhenk is building a positive learning environment, and improved critical event care amongst RN s and physicians. Strengthening the Voice of Terrace Physicians 1
January 2018, TPIGS hired project manager, Sarah Panofsky. Since January, TPIGS has been running full steam. In early March, we completed our annual review process, conducted by FEI, and were awarded another year of full-funding. We have five strategic goals for 2018-2019: 1. Strengthen TPIGS governance; 2. Improve communication and collaboration between physicians; 3. Improve communication and collaboration between physicians and Northern Health; 4. Review and adapt systems and protocol for local context; and 5. Implement collaborative strategies to adapt to space constraints. TPIGS is at a critical moment. We have the support of a project manager and Northern Health. Momentum has been built and physicians are engaged and enthusiastic about health care improvement. We have a strategic plan that targets priorities and builds In April we hosted a cause on strengths, and we have projects running successfully. We are excited and effect mapping session about the coming year and our potential to make positive change. to better understand the Current Projects (for additional information please get in touch with the physician lead) factors that contribute to disjointed resuscitation efforts in the trauma room. The main causes highlighted are role clarification and ER Simulation Program room organization. Lead: Dr. Natasha De Sousa Low fidelity cases are being simulated in the ER Department with nurses and physicians to practice high-acuity cases, given the infrequent nature of these events in a rural center. The simulations occur twice per month. Outcomes include: improved team functioning, increased preparedness of ER staff for high-acuity cases, and development of a learning culture. Physician Quality Improvement Development Lead: Dr. Dawid Janse van Rensburg In collaboration with Northern Health s Physician Quality Improvement Program, physicians are undergoing QI training through the Institute of Health Care Improvement. This project is designed to support physicians to develop the skills and knowledge needed to carry-out projects for health Strengthening the Voice of Terrace Physicians 2
care change. We aim to increase knowledge of QI, involvement in QI project and activities, and competence to move QI theory into practice. ER Department Journal Club Lead: Dr. Natasha De Sousa A monthly journal club reviews articles relevant to particular ER presentations, providing a chance for physicians to share experience and knowledge, and to engage as a group. Students, residents and all physicians are invited to attend. The club is rotated monthly to various physicians houses. The club has been accredited so that participants receive CME credits. OR/PACU Simulation Program This activity is developing simulated perioperative emergencies in the OR with participation from nurses, anesthetists, surgeons and learners. Scenarios will relate to issues specifically encountered in the OR/PACU and aim to provide both education and team building. Shirley Nichol, Director of Care and Dr. Denise Jaworsky measure a banana as a part of the Quality Improvement Course facilitated by Dr. Dawid Janse van Rensburg. We hope to offer another course, in collaboration with Northern Health s Physician Quality Improvement Program in the fall. relationships and to promote the recruitment and retention of FPA s to rural communities. This program will involve Terrace FPA s and regional locums. PCEA for Labour Epidural/Surgical Patients Clinical Coaching for Excellence- Family Practice Anesthesiology Rural anesthetists often feel isolated from their counterparts in larger centers. The Clinical Coaching for Excellence- Family Practice Anesthesiology stream provides FPA s in rural areas with access to anesthesia-specific education locally. This program aims to support the continued delivery of high-quality FPA directed care in rural communities, establish collaborative peer-topeer By having the opportunity to initiate and work through projects, the medical staff have become inquisitive and engaged. -Dr. Andrea Geller The current MMH protocol for labour/ epidurals allows for continuous infusion of local anesthetic plus short acting opioid. The current standard practice for labour epidurals is Patient Controlled Epidural Strengthening the Voice of Terrace Physicians 3
Analgesia (PCEA), a continuous infusion of local anesthetic plus fentanyl as well, patients may also receive additional bolus doses controlled by them. Implementation of PCEA labour epidurals involves obtaining and developing an appropriate protocol, reviewing the current pump settings, and providing education on the use of PCEA to the labour room nurses. PCEA for Surgical Patients Continuous infusion epidurals for post-op patients are currently not permitted outside the ICU. PCEA for post-operative analgesia, particularly ERAS patients, is considered the gold standard for care and is not easily accessible to patients or practitioners. This activity will work towards providing this service on the Med- Surg floor, rather than in the ICU only. Similar to labour PCEAs, this would involve obtaining and developing an appropriate protocol, reviewing the current pump settings and providing education on the use of PCEA to the med-surg nurses. ER Scheduling Optimization Lead: Dr. Natasha De Sousa Previously, ER scheduling was done manually through an excel spreadsheet. The ER Department is now piloting Shiftadmin, an online emergency scheduling tool. Feedback to date has been very positive and includes: improved efficiency, higher degree of fairness, greater ability to accommodate schedule changes. The physician lounge is becoming a focal point for food, relaxation and collegiality. Physician Wellness Lead: Dr. Ariane Mundhenk This activity uses the physician lounge as a focal space for promoting physician wellness including: providing healthy food and offering a comfortable and quiet place to relax at MMH. To come in the fall is physician and family yoga. Lounge Lunches Lead: Dr. Andrea Geller We host casual lunches in the physician lounge, to promote relationships and conversation between Northern Health management and physicians. These lunches are an opportunity to share information about current TPIGS projects, identified gaps and opportunities for collaboration. Strengthening the Voice of Terrace Physicians 4
Emerging Projects Pediatric ECG s Lead: Dr. Zaneta Lim AM Lab Blood Work ER Protocol Review Lead: Dr. Ariane Mundhenk ICU APACHE II Scores Lead: Dr. Mike Kenyon Greening the Work Environment: Bike Shelter Collaboration Inpatient Simulation Program Lead: Dr. Abe Torchinsky Streamlining Pre-Operative Care for Cataract Surgery Lead: Dr. Abe Torchinsky Quality Improvement Collaboration with Northern Health Event Lead: Board of Directors Trauma Room Team Functioning First Nations Cultural Sensitivity/Humility Do you have a Project Idea? In April, twenty-one OR staff members participated in the ESCAPE Course offered through Lifecycle of a TPIGS Project UBC. The course was the launch TPIGS is committed to building a project structure that works for of the OR Simulation program. physicians and meets the objectives of the Memorandum of Understanding, signed in 2014 by the Ministry of Health, Health Authorities and Doctor s of BC. The MOU delineates how FEI funding is be spent and highlights priority areas: Opportunities for physicians and health authority leaders to strengthen communication and teamwork; Opportunities for physicians to have a meaningful voice in decision-making; and Funding the support physician involvement and leadership in activities. We are still learning what is most effective for the Terrace context and look forward to your feedback on how we can improve our process. If you have a project idea, please approach one of the board members, or our project manager, to assess whether it meets the TPIGS criteria. Strengthening the Voice of Terrace Physicians 5
TPIGS Project Process Map Project Idea Does it meet requirements of MOU/TPIGS Strategic Plan? no yes Help find other support for project Conversation Phase no Help find other support for project Board Approval yes TPIGS Project Proposal Claim on FEMS under Working Group -Meet with Project Manager/Board Members to flush out project. -What s already in place? -What is needed? -Who are the stakeholders? -Does the project directly impact Northern Health (staff, infrastructure, process etc)? -Consult stakeholders + Northern Health (HSA + Director of Care). -Adjust project as needed. Claim on FEMS under project title TPIGS Project Process map guides the development of a project from the idea phase to implementation. Add project to FEMS Gather team members + write project charter Is it a QI project? yes no Move project into ACTION Share Results Review + evaluate Wrap-up project Upcoming Events Meet the New Medical Students Lunch: June 11, 12-1pm in the physician lounge. Working Group Meetings: A monthly meeting of physicians leading projects. This is an opportunity to talk through and offer feedback on emerging and ongoing TPIGS projects. Next meeting is Monday, June 18, 6:45-8:30pm at Ninja. Lounge Lunch: Learn about TPIGS activities and FEI. Next Lunch is Friday, June 29, 12-2pm in the physician lounge. Summer BBQ: A family friendly event. Friday, August 10, 6-9pm at Heritage Park Museum. Physician and Family Yoga: A gentle and beginner friendly yoga class. Tuesdays 7-8pm at Cedar River Physiotherapy, September 11- October 2. Drinks, Appetizers & and Wellness Workshop: Workshop facilitated by Dr. Maureen Mayhew, from Physician Health Program. October 26, 7-10pm at Yellow Cedar Lodge. For more information or to get involved contact: TPIGS Project Manager, Sarah Panofsky (250)842-8527 Terrace.tpigs@gmail.com Strengthening the Voice of Terrace Physicians 6