Learning To Deliver Consistent Healthcare

Written by Vanessa Santilli and Alan Morantz for QSB Insight on Aug. 18

The Essentials

Variation in medical practices and healthcare decisions accounts for a significant part of health system costs. Some of these variations may be due to “weak best practices” that arise from uncertainty and the vagaries of tacit learning — the informal knowledge that is difficult to transfer to another person. A study in a U.S. academic hospital by David Chan of Stanford School of Medicine found a large variation in spending on medical tests by residents in general medicine but little variation when the same residents worked in a specialized area such as oncology. Because of the difficulty in codifying general medical decisions, it is less likely that “a common way of doing things that is agreed to be superior to other ways” will take root in a healthcare setting, Chan says. Chan presented his findings at the Economics of Organizations workshop at Queen’s School of Business.

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As in many industries, practice variation is a persistent and worrying phenomenon in healthcare. Variation is seen geographically —  you are twice as likely to have cardiac surgery if you live in Kingston than in Toronto — and within healthcare organizations themselves.

Two explanations are generally used to explain practice variation within institutions. One relates to differences in the skills or preferences of healthcare practitioners, the other to differences in medical “schools of thought.”

A third explanation, however, may hit closer to the mark. According to David Chan of Stanford School of Medicine, the variations may be explained by “weak best practices” that arise from uncertainty and the vagaries of tacit learning — the informal knowledge that is difficult to transfer to another person.

To better understand practice variation in a healthcare setting, Chan studied the decisions that went into 3.2 million patient orders (spending on medical tests) made by interns and residents at a large U.S. academic hospital. He traced the spending effects of the same physicians as they progressed through training in different roles on teams and practice environments.

Chan presented his findings at the Economics of Organizations workshop at Queen’s School of Business. Continue reading

So, you want to be a prison doctor?

Work in Canadian jails gives MDs the opportunity to practise good medicine

Written by Vanessa in The Medical Post on May 26

Doctors working in the Canadian penal system must be able to treat a wide range of physical and mental health emergencies. “The scope of pathologies you encounter daily varies from the treatment of a plantar wart to providing palliative care to a patient with terminal-phase cancer,” said Dr. David Lesage, who is employed full-time with Correctional Service Canada at both the medium security Cowansville Institution and the maximum security Donnacona Institution in Quebec.

Dr. Fiona Kouyoumdjian, pictured outside of the Hamilton-Wentworth Detention Centre, believes Canadian prisons give doctors the opportunity to work with a population in our own country dealing with human rights concerns. (Photo by John Haney)

Dr. Fiona Kouyoumdjian, pictured outside of the Hamilton-Wentworth Detention Centre, believes Canadian prisons give doctors the opportunity to work with a population in our own country dealing with human rights concerns. (Photo by John Haney)

“A large proportion of our practice deals with the assessment and treatment of chronic conditions, such as musculoskeletal pathology, diabetes, heart conditions and chronic mental health problems like schizophrenia, bipolar disorder and personality disorders.”

Work in a Canadian prison is done at either the provincial or federal level — and there’s a key difference between the two that ˆ‡†‡ƒ„pertains to the patient population. The federal system is responsible for administering sentences of two or more years for adult offenders, while the provincial systems handle offenders serving less than two years, those who are awaiting sentencing, young offenders and those who are deemed not criminally responsible.

Here are four points to contemplate if you’re considering lending your medical expertise to the prison system.

1. Be ready to stand your ground

In prison, you juxtapose your desire to practise good medicine with a setting that doesn’t see health or medicine as a priority, explained Dr. Ruth Martin, a 17-year veteran of prison clinics withƒ‹•‘ …Ž‹‹…BC Corrections. “Security is their priority,” she said. “So you’re constantly juggling your need to advocate for the patient with how the system functions.” For prison physicians, standing up for patients is just as important as standing ground against questionable patient demands. “There are a lot of patients who have personality and substance abuse disorders, so it’s necessary to be able to set your limits and say no if you think patients are asking for things that are not appropriate or reasonable,” said Dr. Fiona Kouyoumdjian, who works at the Hamilton-Wentworth Detention Centre, a provincial jail in Hamilton. “A classic example is people who want opioid medication for pain control.” Continue reading

Lessons from The Beautiful Game

Written by Vanessa Santilli in QSB Insight on May 14

Maybe you can’t take a corner kick or head a ball but you can dribble through sticky work situations with these soccer insights

Matthias Spitzmuller, an assistant professor of Organizational Behaviour at Queen's School of Business, Insight, knows there are many lessons that can be learned from soccer's approach to team dynamics, conflict resolution, and strategy. (Photo by Claire Bouvier)

Matthias Spitzmuller, an assistant professor of Organizational Behaviour at Queen’s School of Business, knows there are many lessons that can be learned from soccer’s approach to team dynamics, conflict resolution, and strategy. (Photo by Claire Bouvier)

The Essentials

Matthias Spitzmuller has been playing soccer (football to the non-North American cognoscenti) since he was six years old. In his native Germany, passion for the beautiful game is usually passed down from father to son, he says. Spitzmuller’s recent soccer accolades include his playing in the Cosmoleague for the German All Stars Singapore, considered the best amateur league in that country. While in Singapore, he also worked part-time as a television commentator and studio analyst, covering the German league and German international team. As an assistant professor of Organizational Behaviour at Queen’s School of Business, Spitzmuller’s research focuses on team leadership and on helping and cooperative work behaviours. In this conversation with QSB Insight, he discusses the lessons that can be learned from soccer’s approach to team dynamics, conflict resolution, and strategy.

Search For Team Synergy

Part of my research looks at how you motivate teams and the factors that drive a team’s success. For me as a soccer player, I’ve always found it fascinating to see how a collection of individuals rarely defeats a team that really plays as a unit. There’s a synergy, that little something extra that teams can capitalize on if everybody is on the same page and running for each other on the field.

For me, what is especially interesting is how powerful that little something extra can be. A key question is: what is it that drives teams to go that extra mile, both on the soccer field and within organizations, with the primary intention of benefiting the team and not the self?

Assign Specialized Roles

In soccer, the players’ roles are clear, from being a central defender to a left or right winger. Without these very specialized roles, the team would cease to function. In fact, we know that the most successful teams are those that assign roles to individuals and that develop the specific skills that players need to play certain positions. Continue reading

5 tips for would-be cruise ship doctors

Dr. Dan Ezekiel on a trip to shore to visit local wildlife.

Dr. Dan Ezekiel on a trip to shore to visit local wildlife during a voyage with Quark Expeditions.

Written by Vanessa Santilli in The Medical Post on March 17

For over 20 years, Dr. Dan Ezekiel has worked as a cruise ship physician, travelling to Antarctica, the Caribbean, South America and the Mediterranean in his practice on the water. “I’ve been to parts of the world I probably wouldn’t have seen otherwise,” said the Vancouver-based physician. Employed by Holland America, Norwegian Cruise Line and Quark Expeditions (which offers adventure cruises to the North Pole, Arctic and Antarctic aboard ice-breakers and strengthened vessels), Dr. Ezekiel has pulled six-month stretches on ships that hold up to 3,000 people, through he now prefers one-month time stints on smaller vessels.

While some physicians, like Dr. Ezekiel, complete cruise line work sporadically alongside operating a regular practice, others, like Dr. Edward Dees, are at sea practically full time. A senior ship physician with Carnival Cruise Lines, Dr. Dees supervises a medical team in the delivery of health care to everyone on board the vessel under his purview. “The allure of life and work at sea comes naturally to some, but it’s an acquired taste to others,” he said. “But there’s the opportunity to grow beyond your present bounds and to take on the adventure of life on the high seas, visiting distant ports and having unforgettable, rewarding experiences.”

If you’re considering using your medical expertise to become an MD aboard a cruise ship, here are five tips to help you decide whether you’re cut out for life on a boat.

Dr. Dan Ezekiel, wearing the equivalent of an officer's uniform, on the deck of a strengthened vessel.

Dr. Dan Ezekiel, wearing the Antarctic equivalent of an officer’s uniform, on the deck of a strengthened vessel.

  1. Being social is essential

If you have hopes of doing your work and then fading into the background, think again. It’s typical on large cruise ships for the chief medical officer to host a table at dinner, inviting both patients and people they’ve met on deck to join them. “Passengers want to know what it’s like being a cruise ship doctor and they want to hear some stories,” he Dr. Ezekiel. On one particularly memorable night in the dining hall, he saved a passenger from choking at a neighbouring table. “I jumped to action and actually got a standing ovation,” he said. “Everybody liked the fact that there was a doctor on board, and at dinner.”

Outside of meal times, people like to talk to the officers, so being friendly and approachable is just part of the job. “They find it’s an exciting life,” Dr. Ezekiel added. “Even after dinner, you may want to go watch a show or listen to some music, but if you’re wearing your uniform, people will come up to you and start asking you about yourself and your experiences.” Continue reading

Nun has found her happy place

Written by Vanessa Santilli in The Catholic Register on April 26

In Sr. Anna Chan’s earlier career in retail management, she sought happiness through a love of fine clothes, shoes and bags.

Road-Journey“I was looking for happiness,” said Chan, “but I was looking in the wrong place.”

She has found the right place and today, her life is much different.

Chan is foundress of the Servants of the Cross, a journey she began at a retreat in Ottawa in 2003 when she felt God calling her to consecrated life.

“When I felt that call, I had been on a nun run and nothing fit, so I asked, ‘Lord, where are you calling me?’ For some reason, through a prompting of the Holy Spirit, I went to the Companions of the Cross and spoke to the vocations director.”

Chan asked whether the Companions had ever considered a sisterhood. The answer was yes — but that nothing had been started as of yet. Continue reading

In remote Arctic town, religious sisters take to the airwaves

An aerial shot of the community of Fort Good Hope in the Northwest Territories. (Photo courtesy of the Northwest Territories Department of Municipal and Community Affairs)

An aerial shot of the community of Fort Good Hope in the Northwest Territories. (Photo courtesy of the Northwest Territories Department of Municipal and Community Affairs)

Written by Vanessa Santilli in The Catholic Register on April 26

Approximately 800 km northwest of Yellowknife in the Northwest Territories is Fort Good Hope, a remote, mostly First Nations community through which the mighty Mackenzie River flows on its way to the Arctic Ocean.

It’s where Sisters Joan Liss and Pauline Girodat have called home and ministered for the past 12 years. Part of their ministry in the vast, isolated region of forest and tundra is to bring the widespread Catholic community together.

Sisters Pauline Girodat, left, and Joan Liss who work at the Fort Good Hope Mission in the Northwest Territories, host Church Hour at local radio station CBQE. (Photo courtesy of Sisters Girodat and Liss)

Sisters Pauline Girodat, left, and Joan Liss who work at the Fort Good Hope mission in the Northwest Territories, host Church Hour at local radio station CBQE. (Photo courtesy of Sisters Girodat and Liss)

The two School Sisters of Notre Dame have been taking to the airwaves to accomplish this. Each week, the sisters host Church Hour, a weekly radio program that got its start when Liss and Girodat were approached by local station CBQE soon after their arrival at the Fort Good Hope mission.

“That’s been a blessing for us to communicate with the people here,” says Liss, who has spent the past two decades working in the Northwest Territories. “We pray for various intentions, we read the Sunday Gospel and they get the Sunday reflection in case they weren’t at Church,” she says with a laugh.

Continue reading

ISIS committing ‘cultural genocide’ by damaging ancient relics

From left, Sascha Priewe, Clemens Reichel and Patrick Graham take part in a panel discussion on the cultural genocide taking place at the hands of the Islamic State in Iraq and Syria. The discussion took place April 14 at the Royal Ontario Museum in Toronto. (Photo by Vanessa Santilli)

From left, Sascha Priewe, Clemens Reichel and Patrick Graham take part in a panel discussion on the cultural genocide taking place at the hands of the Islamic State in Iraq and Syria. The discussion took place April 14 at the Royal Ontario Museum in Toronto. (Photo by Vanessa Santilli)

Written by Vanessa Santilli in The Catholic Register on April 20

TORONTO – Not only is the Islamic State causing catastrophic human tragedy throughout Syria and Iraq, it is engaged in a “cultural genocide” as it destroys anything in its way that is not part of its idea of Islam, said Sascha Priewe.

The Islamic State’s desire for an Islamic caliphate in the Mideast includes the extermination of cultural heritage as it destroys antiquities in Iraq and Syria that don’t correspond with its ideals, said Priewe, managing director of three of the Royal Ontario Museum’s Centres of Discovery.

“The continued existence of these beacons of civilization have no use in the Islamic State (so) they loot and sell antiquities to finance their war chest,” Priewe told an audience of about 200 people at an April 14 panel discussion at the ROM in downtown Toronto.

The panel, featuring Priewe, ROM’s associate curator of Near Eastern Archeology Dr. Clemens Reichel and journalist Patrick Graham, examined the losses and significance of the destruction of cultural heritage by the Islamic State in the cradle of civilization.

To illustrate the reality taking place, a short video clip was aired showing members of the Islamic State knocking over ancient statues and artifacts and smashing them to pieces with sledgehammers. The clip was taken from a video made by the media-savvy organization. Continue reading

Tripping the limelight fantastic

Donalda Weaver has helped change lives by bringing performing arts to Vancouver’s youth

Written by Vanessa Santilli in CPA Magazine on March 1

I went from singing alone in my bedroom to performing in front of hundreds of people and even appearing on TV. I’ve worked with directors and mentors who taught me about performing and who have had a huge impact on me.”

donalda

So goes just part of the testimony from a participant who said that Project Limelight, a free performing arts program for kids in Vancouver’s Downtown Eastside, changed her life.”It’s been miraculous to see some of the changes in the kids,” says Donalda Weaver.

Weaver, an accountant, and her sister, Maureen Webb, started the program to help foster self-esteem, confidence and community. At Project Limelight, young people are mentored and inspired by professional artists. The program culminates with a performance (there are two each year) in a professional venue with great costumes, sets and makeup.”It’s always a full house,” Weaver says. Continue reading

From fan to collector

Written by Vanessa Santilli on Bankrate Canada on Jan. 26

With the ongoing craze for all things superhero-related, being a “collector” is now mainstream. Fuelled by the onslaught of new superhero movies and the rise of related events, such as FanExpo (which brought more than 100,000 people to the Metro Toronto Convention Centre), it seems that disposable income or not, fans are spending more and more on this niche passion.

Fans dress as their favourite characters at Toronto's annual Fan Expo, which attracted more than 100,000 people this year. (Photo by Daniele Raimondo)

Fans dress as their favourite characters at Toronto’s annual Fan Expo, which attracted more than 100,000 people this year. (Photo by Daniele Raimondo)

But is it possible to be a collector on a budget? Here are some tips from two collectors on how to navigate the often-costly world of collecting:

1. Narrow your collection 

For Ivan Tabac, his passion for collecting comes in the form of Batman collectibles from the original TV series. His collection of approximately 4,000 items ranges from vintage T-Shirts and original photographs, to costumes, games, advertisements, watches and more.

While he admits it’s not always easy to collect on a budget, he suggests fans start by concentrating on something specific.

“If you want to try and keep control over what you’re spending, you need to focus,” says Tabac, an accountant and co-founder of AJAG Professional Development in Richmond Hill, Ont. “Otherwise, you can still make a nice collection out of bits and pieces of everything, but you’ll have less control of the amount of money you’ll need to spend.” Continue reading

This Christmas, shop fair trade

An artisan from Manos Amigas in Lima, Peru, creates an ornament that will be sold through fair trade retailer Ten Thousand Villages. (Photo by Jonathan Bowman)

An artisan from Manos Amigas in Lima, Peru, creates an ornament that will be sold through fair trade retailer Ten Thousand Villages. (Photo by Jonathan Bowman)

Written by Vanessa Santilli in The Catholic Register on Dec. 21

In Pope Benedict’s encyclical Caritas in Veritate, he wrote, “It is good for people to realize that purchasing is always a moral — and not simply economic — act. Hence the consumer has a specific social responsibility, which goes hand-in-hand with the social responsibility of the enterprise.”

As we spend more than usual at Christmastime, it’s important for Catholics to consider where their money is going and what they are supporting through their hard-earned dollars. Shopping fair trade is one way of having a global impact this Christmas.

“Fair trade is a direct trading relationship where not only is fair pay the standard, but also safe working environments, equality for women, sustainable orders and a commitment to long-term relationships,” said Holly deGraaf, director of retail operations and public relations for Ten Thousand Villages, a retailer that sells fair trade products ranging from jewellery and furniture to coffee and toys.

By working with marginalized communities around the world and paying them a fair wage for their work, workers are able to have a good quality of life, food for their kids and education, adds deGraaf. Continue reading