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Photo of Kathryn Thornton, Liz Murray and Kellie O'RourkeFeature
Public engagement
Citizen panels play key role in health-care planning
LHIG members Kathryn Thornton (left) and Liz Murray (right) with Winnipeg West COO Kellie O'Rourke (centre).
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By Bob Armstrong
May/June 2018

It's about 5:45 p.m. on a recent Tuesday, and the dozen or so members of the St. James-Assiniboia/Assiniboine South Local Health Involvement Group are ready to get down to work.

It's a good thing, too, because the meeting, which is being held at the Winnipeg West Access Centre on the Grace Hospital campus, is shaping up to be a busy one.

At the top of the agenda is a discussion with Karen Dunlop, Chair of the Winnipeg Regional Health Authority's board. Dunlop is here to talk to the group about the implementation of Healing Our Health System, the Region's blueprint for consolidating and improving health services.

It's not the first time the Region's Chair has attended a Local Health Involvement Group (LHIG) meeting. In addition to the St. James group, there are five other LHIGs in the city - Downtown/Point Douglas, River East/Transcona, Seven Oaks/Inkster, St. Boniface/St. Vital and River Heights/Fort Garry - and Dunlop tries to visit each of them at least twice a year. Other Region leaders, including President and CEO Réal Cloutier, attend meetings as often as possible.

For Dunlop and other Region leaders, the LHIGs are more than a chance to chat about matters related to health care. They are an integral part of the Region's planning and governance process. That is particularly true now, as the Region continues to push on with its blueprint for change, says Dunlop.

"We have seen the enormous value in having public input and feedback in making the biggest change to the system in a generation," she says. "They are critically important stakeholders for us. It's been really helpful."

Colleen Schneider, Co-ordinator of Engagement for the Region, agrees. As she explains, LHIGs are part of a broader community engagement strategy that also employs other program and population-specific advisory councils to address a range of topics related to the delivery of health care.

Photo of Julie Muise, Matthew McBurney and Liz Murray
St. James-Assiniboia/Assiniboine South LHIG members, from left: Julie Muise, Matthew McBurney, and Liz Murray.

"It's a way to have an ongoing discussion with the public," she says. "Program leaders come to [LHIG] meetings to discuss issues. The organization's culture is changing to see the value of engagement . . . it adds value to the health system."

The give and take between Dunlop and the group on this evening underscores the point.

In recent months, the Region has implemented a number of changes as part of its consolidation plan, including converting the emergency department at Victoria Hospital to urgent care and phasing out urgent-care services at Misericordia Health Centre. Other elements of the initiative include plans to enhance care in the community and consolidate emergency department services at St. Boniface Hospital, Grace Hospital and Health Sciences Centre Winnipeg.

One LHIG member says the changes appear to be having a positive effect, and relays the story of her son's visit to the Grace Hospital emergency department.

"It was such a good experience - as good as any experience with emergency can be," she says.

Another group member asks about the transition at Misericordia, wondering what is being done to serve people who had used the urgent-care services at the hospital.

Dunlop explains that some people in the community were going to urgent care at the Misericordia because they did not have a family doctor or regular clinic to receive primary care. In preparation for the closing, the Region worked with the Community Area Director and local agencies and clinics to attach the most vulnerable to a primary care home.

"I really appreciated being offered an avenue to contribute to the well-being of people in our province."

To accommodate additional traffic to the nearby Health Sciences Centre, Dunlop says additional doctor and nurse hours were added to those facilities. Staffing increases at the Grace and St. Boniface hospitals also occurred during the consolidation, as did a number of other changes, including the addition of expanded clinical assessment units.

Dunlop also updated the group on the results of a 90-day evaluation of the changes, which was released in January. It indicated that emergency visits were down in the city, perhaps signalling that some people who had gone to emergency for non-emergency, same-day service in the past were now going to see their own doctor, regular clinic or Access Centres or walk-in clinics.

The 90-day evaluation shows a region-wide reduction in waiting times for emergency and urgent care, dropping to an average wait of 1.47 hours, compared to 1.82 hours a year before. It also shows a significant reduction in the number of patients waiting in hospitals for personal care home beds to be assigned, with only nine people in hospitals waiting for personal care beds in January, compared to the year before.

Throughout the evening, group members talk about ideas to make sure that vulnerable populations are kept up-to-date on where to go for health care. Some suggest partnerships with various community agencies. One speaks of the importance of translation services for those who need them, leading to a discussion about the availability of services for scores of languages.

Following the session with Dunlop, the group returns to the regular business on the agenda. For much of the last year, this LHIG has been discussing ways to enhance the delivery of health care under the broad heading of "access and navigation." The idea is to explore ways the public can not only access care, but navigate the system once they are in it.

Photo of WRHA Board Chair Karen Dunlop
"We have seen the enormous value in having public input and feedback in making the biggest change to the system in a generation," says WRHA Board Chair Karen Dunlop.

On this evening, the group will continue discussing ideas that have been shaped during meetings over the last few months, particularly in the areas of access, advocacy, quality of care and communication. Indeed, the issue of communication between health-care providers and patients generates much of the discussion.

"A large part of the [health-care] experience starts with the very first person you meet," one group member says.

To punctuate the point, a woman in the group shares a memorable experience from decades ago when she was having her first child.

A nurse yelled at her, she says. "It really bothered me - it was really unhelpful."

Another woman, herself a nursing student, nods sympathetically. "And you still remember that."

Later, another woman will share an experience at a cancer facility in the United States. She was assigned a "patient advocate" whose job was to work with her throughout her experience.

Twenty years later, she still recalls the patient advocate's name, and smiles when she says it.

Group members are quick to share ideas and experiences related to communication.

The nursing student in the group describes how helpful it was for her class - and ultimately the patients they worked with - when they had an orientation presentation from spiritual care. As a result of what she learned in that presentation, she says, she was able to make a referral to spiritual care for a patient who just wanted to be able to watch a football game. Sometimes, the group agrees, improving care can be as simple as that.

The value of simple communication is endorsed by another member, who describes how beneficial it was to get "a simple follow-up call from the doctor to ask how I'm doing."

At one point, the discussion turns to people missing appointments for MRIs or CT scans - and thereby leaving important devices idle when they could be used for someone else.

Communication ideas come forth. One woman mentions how a popular cosmetic company uses text messages to remind clients of their appointments. Could a simple fix like that help the WRHA make the best use of its resources?

People decide to volunteer for a LHIG for various reasons. It may be due to a lifelong connection to health care or just simply a way to give back to the community.

"You have to talk to people to see what their experience has been. There is
So much out there that's reinforcing the value of patient and caregiver engagement."

Matthew McBurney, who is completing his second year on the St. James-Assiniboia/Assiniboine South LHIG, says his interest in joining the group was prompted by the experience of family members who had served on it earlier.

"It's nice to feel that you're a part of helping the [Region] navigate these changes," he says.

Learning more about the health-care system also brings personal benefits for members of the LHIGs. "It's helped us as a family to navigate the changes - you get a peek behind the curtain."

For three-year LHIG member Kathryn Thornton, membership in the LHIG is a new way of contributing to health care. A retired spiritual care provider who worked at Health Sciences Centre Winnipeg and at the Montreal General Hospital, Thornton says, "Health care is something dear to my heart."

She's appreciated having the opportunity to contribute to discussions on important ideas in health care during her three years in the group. Before this year's focus on consolidation, she took part in a year-long focus by LHIGs on the concept of aging in place, which entails having older Manitobans stay in their own home as long as possible before moving to assisted living or a personal care home.

"We were vigorously advocating in favour of aging in place," she says, noting that the health-care system is more focused on that approach than ever before. "I really appreciated being offered an avenue to contribute to the well-being of people in our province," she says.

Engaging Patients and Families

The Local Health Involvement Group is a key tool for engaging the community on matters related to heath care. But the Winnipeg Regional Health Authority also has other mechanisms for gathering public input, including several program and area advisory councils. Click here to learn more.

Like others in the group, she appreciates being able to have an inside view and a voice as the health-care system evolves. "Transition is like going from one train car to another," Thornton says. "The only way to do that is to go over the wobbly bits."

Clearly, there are a lot of people having in-depth discussions about health care as a result of the Region's engagement efforts. But how does engagement contribute to positive change in health care?

As the Region and Manitoba have evolved new ways to provide care in the community, work toward greater equity in health, and reduce wait times for care, viewpoints gathered through engagement programs have prompted progress.

Michelle Meade, Manager of the Region's Chronic Disease Collaborative, says the community engagement process has helped the health-care system respond to the needs of people with chronic illnesses in a number of ways. She offers the Family Doctor Finder and My Health Teams as two examples.

Photo of Kathryn Thornton
Kathryn Thornton is a member of the St. James-Assiniboia/Assiniboine South LHIG.

Several years before the creation of the Family Doctor Finder - a program designed to help people connect with a family doctor who's taking new patients - the LHIGs had spent a year focusing their engagement on questions surrounding management of chronic disease.

One of the memorable conclusions of the LHIG report that year, Meade notes, was, "It's not okay to not have a doctor, and this becomes critical when a person has a chronic illness."

Developments such as Family Doctor Finder have helped more Manitobans - including those with chronic illnesses - connect with a family doctor instead of depending on walk-in clinics or urgent care.

Meade's work involves engaging patients who have experience with chronic disease, such as chronic obstructive pulmonary disease (COPD) and congestive heart failure. In the focus groups she organizes with patients, she receives input that reinforces the messages coming out of LHIGs on the importance of communication and patient focus.

For example, in recent focus groups for people with COPD, many expressed the feeling that during a hospital stay for COPD, the amount of information provided by different health professionals - nurses, doctors, respiratory therapists, physiotherapists, dietitians - can be confusing. That feedback is encouraging efforts to ensure more standardized language and messages in communicating to patients. Patient input has also informed development of a free workshop offered by the Region called COPD Essentials. Meade is currently working on focus groups for people with congestive heart failure.

Another focused engagement effort involved working with patients who had long stays in hospital. In involving these patients, the Region sought to learn if there was some gap in care that contributed to the long stay, says Meade.

"It's nice to feel that you're a part of  helping the [Region] navigate these changes."

That effort dovetails with the creation of My Health Teams, a provincial program that provides financial support for physicians to have other health professionals - such as dietitians, nurses, mental health workers or even social workers - available to help patients with their health needs. Meeting all of a patient's needs at their doctor's office can ensure that people with complex health conditions get the care they need in the community and reduce the need for long hospital stays.

Meade's group has also surveyed people with diabetes, focusing on what they need to manage their condition in the community.

One of the findings of that research was that although people with diabetes are urged to exercise, they may not know what exercise is right for them.

That insight has led to the development of a free workshop, advertised in the City of Winnipeg's Leisure Guide, called Exercise Health Sense. A joint venture involving the Region, the City of Winnipeg and exercise physiologists at the University of Manitoba, the workshop is designed to be an introductory activity to help people get started on exercise that is right for them.

"You have to talk to people to see what their experience has been," says Meade. "There's so much happening that's reinforcing the value of patient and caregiver engagement."

Bob Armstrong is a Winnipeg writer.

Read More

Réal Cloutier, Interim President and CEO of the Winnipeg Regional Health Authority, says public engagement is a key element of a patient-centred health-care system. Click here to read more.

Get Involved!

Would you like to have a say in your health care?

The Winnipeg Regional Health Authority is currently accepting applications from members of the public interested in joining one of its six Local Health Involvement Groups (LHIGs).

LHIGs are a key component of the Winnipeg Regional Health Authority's public consultation and engagement process and report to the Region's board.

The groups meet four times a year between October and April to discuss specific issues relating to the delivery of health care in Winnipeg before coming together for a meeting to review the work carried out by individual groups.

In order to make LHIGs accessible to all, the Region will pay for child care or respite care. This helps ensure that specific health-care experiences and needs of people caring for children, seniors or people with disabilities aren't under-represented. Financial help with transportation to meetings is also available.

LHIGs are located in St. James-Assiniboia/Assiniboine South, Downtown/Point Douglas, River East/Transcona, Seven Oaks/Inkster, St. Boniface/St. Vital and River Heights/Fort Garry.

For more information about LHIGs or other patient advisory councils, contact Colleen Schneider at 204-803-7294 or visit www.wrha.mb.ca/about/engagement.

LHIG Achievements

In 2016, Accreditation Canada cited public and patient engagement as one of the strengths of the Winnipeg Regional Health Authority. Here are a few examples of the impact LHIGs have had on the delivery of care:

  • Produced a 2017 report entitled Innovation in Health Care: Public Perspectives, which outlined numerous ways in which the Region could improve the delivery of care through innovation.
  • Provided the Chronic Obstructive Pulmonary Disease Working Group with a presentation on public and patient engagement to assist with developing a patient and family engagement strategy.
  • Developed best practices and supported staff facilitating public and patient engagement.
  • Helped shape the Region's strategic plan priorities, particularly on the importance of addressing health inequities.
  • Provided feedback on the Peachey report, which has been used to support the Region's health-care consolidation plan, also known as Healing Our Health System.
  • Helped develop the Declaration of Patient Values, along with other volunteer groups.
  • Produced reports that help shape development of primary-care strategies and chronic disease initiatives.
  • Provided recommendations to support the Region's Indigenous cultural competency training for staff.

To read more about the work being done by Local Health Involvement Groups, visit www.wrha.mb.ca/about/engagement/lhig/reports.php.