May 28 Town Hall Q&A: Part One
The following Town Hall questions were answered with information that was current at the time. Information around COVID-19 and our response continues to evolve. If you are unsure if the information below is still current, or if you can’t find the information elsewhere on the website, please talk to your leader or email: COVIDemail@example.com
If you missed the Thursday, May 28 PHC All-Staff Town Hall, here’s Part One of the Q&A, which includes answers to the questions that were addressed during the session.
The number next to each question indicates the approximate time the question was addressed in the webcast playback.
- I'm so impressed about the "Bare below the Elbow" policy. In my country, it is a normal behavior. I was shocked when I started in BC healthcare that people had rings and jewelry on in clinical setting. I'm happy to see this change! Keep it please. (34:25)
It is a culture change. We’ve had lots of questions from people about having to buy new clothes. No, you don't need to buy new clothes. All you need to do is just roll your sleeves up. So let's keep it simple.
We do get questions about whether there is evidence. To be clear, there is no randomized control trial or clinical evidence that shows there is an impact on the infection rates for patients. However, this is an intervention that's really cheap and easy. It is a bit of a cultural change because it makes you think, “If I go into a clinical area, I roll up my sleeves, now I'm washing my hands, now I'm behaving differently.”
So, we will try to keep going and if everyone could please be a champion for this, that would great.
- Continued access to using Zoom technology. It would be great if we were able to use the record function on it. (36:02)
- There are assessments going on across the province in terms of what technology should be used. There's Microsoft Teams, Zoom, Skype, etc. We've had a good opportunity to test out a lot of these. We’re not sure which ones we will continue to use, but absolutely, the province will be making continued investment in remote technology.
- My leader does not trust me when I WFH (“work from home”). She asks if I will answer my phone/email. She asks if I will work on the previously agreed upon work. When I am in the office, she doesn't ask any of these questions or even connect some days. What resources are there to help a leader trust their employees? (36:59)
This is something we need to think through as an organization. How do we do this? How do we set expectations? Expectations will be different for every team and need to be organized between individuals and their managers.
There will be very few teams that will be working at home all the time. Equally, there will be lots of people who prefer a mixed environment and this needs to be negotiated between leader and individual, because we have different personal styles. There are some people who love working at home. There are some people who really don't. And there are some people for whom their home environment is hard to work in and want to come to work. Equally, there are some teams who need everyone here, and some teams who don't.
This is a big job for us and for our organizational development over the next six months and we will be looking at how we work through it.
We did a survey in real time and had 600 of our staff answered that survey. We asked some really deep and personal work-related questions about how we're doing. On the positive side, 85 to 95 per cent of our staff who were working remotely felt connected to their manager and to the culture. It also revealed that there was some new learning to do so the surveys allowed us to share some tips in the bulletin.
- iPads for patients and families in the ICU so they can Skpe/Facetime with their loved ones. There have always been lots of family members that could not be at their loved one's bedside when critically ill. We have learned this was easy to implement and very appreciated by family members. (39:23)
We've deployed five iPads into the ICU. It was an early idea and we definitely have heard very positive feedback. We have additional iPads and we're looking for good use cases to deploy them. This is definitely a technology that's here to stay.
We’ve heard similar feedback from our long-term care team. This is not the ideal replacement for face-to-face visits, and we certainly want to return to face-to-face visits when we can. But we do have many family members who don't live close by, who previously had been really challenged to connect with their loved one in long-term care. Using iPads is something we'd want to continue as an alternative and one more way to serve our residents.
- Regarding the $4 increase for HEU members, who are qualified and when will this show up in our pay stubs? (40:52)
- We are still waiting for information on eligibility. It’s resting with the Ministry and the Health Employers Association of BC. As soon as we have information we will make sure that it is available as quickly as it possibly can be.
- Have the visiting guidelines changed for acute care? Especially, are families once again allowed to bring homemade food to patients? (42:05)
The visiting guidelines haven't changed yet. We are still following the original guidelines the Ministry produced for acute care, which restrict visitors to compassionate or essential visits only. Long-term care remains under the same Public Health order, so that hasn’t changed either.
We are reaching out to our Family Council to give us advice on what the policy should look like going forward. We are feeding that advice back to the Ministry of Health.
This has been hard, not only for the staff at the frontline, but the families as well and especially in long-term care. A big thank you to all the staff for coming up with creative ways to have face-to-face visits without actually having visitors in the building.
In terms of food, the instructions from day one were that people could bring in food for their loved ones, but there are restrictions. We can’t store the food in a central refrigerator. We are only accepting food that can be served at a meal, or that doesn’t require refrigeration to stay safe. We won’t return dishes and cutlery. So there hasn't been a ban on food, but people may have thought they couldn't bring it. Our greeters understand what they can allow through the doors.
- Once visiting hours are reinstated, can we return to reduced visiting hours such as 10-10 (of course, with end-of-life and critically ill patient exceptions)? It has made the medical units much SAFER at night ... less in and out of "visitors" to the units, less drug dealing on 7 ABCD and 10C. (44:30)
This is really difficult in terms of how we how we manage this. Visitation is a provincial decision, but we are trying to feed in how we can manage this balance. We want to ensure clearly that families, friends and loved ones can come and visit.
We anticipate a change will not be made to visiting until a change is also made to parking because visitors need parking and the two things are related.
- Continuance of virtual care for those that want it, recognizing that in non-COVID-19 times it is best not to base it on the "what" you're seeking care for, but also consider some always need in-person care. (46:50)
Absolutely. How did we think it was alright to bring someone down from Prince George for a 10-minute conversation which could be done over the phone or on virtual health? We absolutely cannot and will not allow that to go forwards. Having said that, we need to balance what's best in person and what isn't.
One great example is the Crosstown group, who now have a Zoom room in the clinic where they're doing virtual addictions visits, which has made things so much better and removed a huge patient barrier.
We did a workshop back in February, pre-COVID, talking about the digital future for Providence. We talked about some of the limitations that we perceived. Two key limitations were lack of sufficient bandwidth to support video calling, and lack of a provincial-wide video platform to do those calls. Both of those major obstacles got solved in a matter of weeks, when perhaps they otherwise would have taken years. So that is a silver lining of COVID. Those were very significant upgrades to both our back-end infrastructure to support voice and video, and also the technology. The future is looking very positive for virtual health.
- More, better real-time reports. There were some great COVID-19 reports created and it really showcased having good real-time data to base decisions on. We need more customized, well designed, intentionally created reports. (48:32)
We have Cerner, and Cerner gives us so much data. We now know, potentially, so much that we didn't know. But that data is not any use if it's just in a massive database. What we need is to work out what we really want to know, and how to get reports that give us that information to make decisions.
This is a nice example of both collaborating – so working with other health authorities to roll up information so that it is useful, and working with the province – and standardization of the way information is shared and presented.
We are investing in our own capabilities at Providence. We’ve revitalized our data analytics team and are doing some exciting work with the new opportunities of Cerner and with the clinical informatics team as well. Positive changes are coming in the future.
- Working from home for non-clinical staff has been surprisingly successful (thank you IMITS!). But our team environment and sense of community within Providence is suffering. What is being done to help keep us connected and supported? (51:40)
We recently conducted a staff survey about working remotely, and what the survey revealed to us is the balance that is needed and not being black and white about this. The human connection matters so we can't make one rule for how people connect, but we are encouraging our teams and leaders to think about the level of frequency that you need to be together. That's a really important part. That connection is what Providence is about. So we will find a way to make this work. We encourage staff to please put in your ideas in terms of what might help us to keep connected and supported both in terms of in person connections, but also virtual connections.
- Can we keep iPads and incorporate them into daily rounds so family are up-to-date and included in care planning, which will reduce much of the ambiguity about transitions out of hospital to home/community/placement etc? (52:50)
We’re absolutely not planning on taking the iPads away, but we could do more on this. We will be working with Finance and the Virtual Health teams to maximize our use of things like iPads.
I think this is a really good idea and I think this just adds to all the creativity that everyone did during COVID but this would be wonderful to actually bring the family and the patient into the care rounds and certainly the iPads will be helpful for that so it's great that we have them and we can certainly purchase more if needed. So, good idea.
- Great that coaching and spotting is happening in SPH and MSJ. Should this be happening in LTC homes as well to ensure staff are following PPE and physical distancing guidelines? (55:10)
- Absolutely. We want to support everybody in using their PPE and ensuring that they understand all the principles behind physical distancing. With the onset of the pandemic we were so fortunate to have the education team and the regional rapid response team step in to support our long term care facilities so that the very small team we have in infection control could focus on acute care. But over the last week we've started thinking about if that regional support is going to dissipate, how are we going to move in to actually provide that similar support for long term care? I don't have an answer for you right now, but it is on our radar and we actually do think it was an incredibly important part of what we did to keep this pandemic at bay by really supporting one another to use their PPE to its highest effectiveness. So thank you for raising it and more information will come.
- The pandemic showed how hospital staff needed accommodation nearer to the hospitals and sites. It was good to have those hotel rooms available near SPH. Can this be planned for the new St. Paul's? (56:25)
There are, in the rezoning for the new St. Paul’s, there are two potential buildings and one we have a potential rezoning for a hotel. We also have potential rezoning for accommodation, which we would anticipate giving first choice to our staff. There is some more work that we should really think about in terms of new, different ways of working and what do people want. So, one extreme, do people want to literally live right next door to the hospital, full time permanently? And there may be some people who do want to do that. There are other people who do want to always go home. There are some people who maybe want to live further away than you would want to reasonably commute every day, but would want accommodation in a short term way between their shifts, or there may be some people who want different things at different seasons. There's a kind of significant piece of work to work out how we try to support that. Space and buildings in central Vancouver is expensive and is scarce. So we need to make sure that the space that we have were used to the absolute best of our ability.
The model for actually having people on site and close that we developed ended up actually being the norm across the province so just kudos to the innovative way that we supported each other and we were pleased to partner with the ministry on that.
I think there's opportunity with our long term care redevelopment projects as well and that we are also thinking about this and that this theme was something we heard strongly last year when we did our original engagement around the strategic plan things about staff accommodation, and also services, child care, health, other health care services and so it is something that was already in our strategic plan, as a piece of work, and I think that our COVID experience has just highlighted how effective it can be, and what some of the opportunities are so thank you to the person who highlighted this.
We have a number of pieces of land, not just the new St. Paul’s, but also MSJ or long term care sites. A number of them are relatively close together. And so we could provide accommodation at one if you worked at another one, or vice versa, there's opportunities.
- The extra staff supports (parking, accommodations, etc.) have been helpful during the pandemic. Where is PHC at with regard to looking at future child care options and resources for staff? It would make us a more attractive employer. (1:00:36)
- We absolutely said that one of the things this year would be that we would look at those childcare options. We've done an initial scan which was one of our 2019/2020 key deliverables around childcare options in the city, seeing what other organizations are doing, and we expect by June or July, to have a deliverable report with some recommendations and next steps that we could move forward as an organization.
- Blanket consent form on admission to allow patients to be approached for research and biobank of remnant samples similar to what has been done at BCCH and Fraser Health. (1:01:36)
- There is a provincial strategy at the moment to try and harmonize a lot of the consent and safety approvals to deal with COVID. Because of the number of players involved it's going a little bit slower than we all anticipated. We are working very hard on our own version for Providence, and it's going through our EB approvals as we speak. Our aim is to do exactly that, get a blanket consent form to approach people to donate some blood - at any time, but preferably when they leave the hospital. We don't have an update on how long it's going to take, hopefully it will be in the realm of days to a week or two before we have a formal answer. The provincial mandate through BCCDC and PHSA is still a little ways off. So we're hoping to have our own version which we can provide to the pool when it's approved.
- What basic equipment or infrastructure improvements can be made - or are planned to be made - at our sites to make us more infection-proof? Can we start looking at more automatic doors (less door knobs/handles) or better waiting rooms, usage/appointment making? (1:03:21)
I think we're all super conscious now of how many doorknobs we touched at any point and so on. And overall, I think what we've seen over the last few months is how inadequate frankly all of our buildings are. And it's great that we are advanced in terms of new buildings which will be really transformational, but they are still six seven years away. We've been thinking ahead and working with facilities and we've gone out and made some purchases of automatic door openers and those are going first I believe to the soil utility rooms, to try to improve those areas. But there's also been some exploration of microbial copper, which apparently is quite effective at not allowing for infections to survive and so looking at doorknobs and other surfaces.
Both of those are being implemented right now on the 7A demonstration unit. We've actually been incredibly lucky to create bring in rapid UV disinfecting machines. They're in St Paul's right now and we're moving forward to actually start to implement them. Brian (Simmers) and his team are working on different pieces of technology that will help us with our appointment making and our waiting rooms, not just for social distancing but in a way that will be really respectful of people's times as well. So instead of bringing a bunch of people together into a room and having them sit and wait their turn, are there better ways that we can do that so that we don't have to force people to be in that close proximity.
Shout out to the ophthalmology team at MSJ, who would have made that happen by purchasing little restaurant buzzers. Let's keep our innovation and ideas going.
- Are there recommendations for health care workers regarding social distancing? I imagine that in general we should be more careful than the general population but how should we approach a return to seeing friends and family in a responsible way? (1:06:07)
- The advice is not different for health care workers than it is for the general public, so the advice from public health that's directed to the public around how to balance the risks of increasing contacts is going to stay the same. This is going to apply to health care workers just as it does to the general public, so please follow the public health guidance.