During April’s Vancouver All-Staff Forum, we received more questions than we could answer in our time together – but we’re determined to answer every one.

Since the forum we’ve focused on answering questions about the primary care services redesign, which you can read all about in the April 17 and April 24 issues of VCH News.

Today, we’re pleased to answer five more questions on a wide range of topics.

If you have a question, we’re listening and we encourage you to email us what’s on your mind.

Today’s answered questions

Q.  Regarding the recent announcement ending employee-directed overtime bank cash-out options: Eliminating this option imposes an undue financial hardship for staff and their families. We need this long-standing benefit maintained — will this change be reviewed and retracted?

A. The VCH Regional Scheduling &Timekeeping Department made the change you’re referring to as a means to streamline operations. Every year the department receives hundreds of requests to pay banked overtime on demand, and processing these requests, and any follow-up requests/clarifications, is very labour-intensive and costly.

The change in process applies only to on-demand requests for banked overtime payouts. Staff may still opt to have their overtime paid out as earned, or staff may choose to take banked time off as before.

For now, while we can’t say whether the change in process will be reversed, it certainly is under consideration. VCH has received feedback from our unions and staff, and the organization is currently reviewing the change. We don’t expect to have a final decision for the next few months.

Q. Why is it that the wards do not follow proper prep instructions when sending patients for MRI? We have very limited resources in MRI and when the prep instructions are not followed this causes a slowdown of our productivity.

The instructions we send are for patient and staff safety.  I find there is a lot of resistance to placing slings under patients who aren’t able to transfer without help from stretchers.  This lack of sling use will surely cause a MSK [musculoskeletal] injury.

A. We recognize that it can be tempting to take short cuts when busy, but patient and staff safety should never be compromised for productivity. Preventing musculoskeletal injuries is a critical focus of Workplace Health. These types of injuries typically constitute 70% of Vancouver Coastal Health’s WorksafeBC claims, and they can often have a long-lasting impact on you, your department and the entire organization.

We share your concern and we’ve taken your question to a Vancouver Acute Patient Services Manager meeting. We had a productive conversation about the use of slings and safety, and the team appreciated our bringing this issue to their attention. More importantly, they’re committed to improving the appropriate use of slings for patients unable to transfer on their own.

Thank you for raising this question, and please let us know if you’re seeing improvement. If you’re not, we want to know that, too. For more information and resources on safe patient handling, we encourage everyone to visit VCH Connect here (internal link).

Q. If the priority is to integrate community and acute, more resources need to be put into the community – the idea of looking into ‘natural informal supports’ vs. formal supports (e.g., home support and community services) should be looked at. More focus on the “social determinants of health” and “social capital” – as presented by Al Condalucci, would help people feel more supported in the community, in a way that does not use dollars from VCH. Thanks for taking the time to consider my points.

A. Thank you for your thoughtful comment about “social capital” as exemplified by the work of Al Condeluci. And thank you for recognizing that health services can’t go it alone if we want the best outcomes possible for our clients and for our communities.

Some examples of this perspective in VCH work can be found in the partnerships we have with municipalities, schoolboards and key community partners. Our public health teams, in particular, are regularly working together with municipalities, community partner agencies and citizens on healthy city initiatives, food security initiatives, healthy families and youth strategies — the focus being all of the other determinants of health, and the goal of which is community development, social capital growth and community connectedness.  We also have unique programs such as the SMART fund that offers grants for communities to identify and develop solutions to meet their own needs.

At the same time, we have a direct role to play in enabling client access into the community, and our community case managers and rehabilitation staff not only support clients with access to health services but also enable and support access to vocational groups, spiritual supports and social activities. For example, our Vancouver Community Rehabilitation and Resource Team and our Vancouver Acute GF Strong Acquired Brain Injury Program – now united as the VCH Community Rehab and Resource Team – is very familiar with Al Condeluci’s work and weave aspects of “social capital”, “community participation” and “interdependence” into their services. Although these priniciples are mostly known and used within our programs supporting adults with disabilities, we could certainly introduce them to programs supporting other populations.

More and more, our volunteer services are also involved in helping clients access and take part in their own community. Supporting our volunteers is yet another way we can help grow the social capital in our communities.

Q. Thank you for you supportive words about the ED iCARE project. While it is important to validate the importance of Quick Response Team (QRT) and Home/Community resources in the initial successes, it is essential to recognize the work of the Geriatric Triage Nurses (GTNs). Without their assessment and collaboration, patients could not be pulled anywhere. I hope that the GTNs’ importance to the iCARE strategy will be acknowledged at a future Forum.

 A. We believe in seizing the day, so why wait for the next All-Staff Forum?

You’re absolutely right — the GTNs are members of the interdisciplinary team implementing the ED iCARE/QRT initiative at VGH. (For those who don’t know, this initiative is designed to help frail seniors projected for discharge from the ED within 24 hours to return home — and stay home — where they have the best chance to regain their strength and independence.) The GTNs have provided significant feedback on the processes to date, which we’ll incorporate in the model as we go forward. In addition to the GTNs, the ED interdisciplinary team participants include social workers, physiotherapists, emergency physicians, the nurse practitioner and the care management leader, all of whom have been valued contributors to the rollout. Ultimately, this important initiative is an example of how the whole is greater than the sum of its parts. The collaboration between acute and community care is essential for our success, for helping patients remain at home and for staying true to our Home is Best philosophy.

Q. I heard that Windows will no longer be offering security updates for Windows XP after April 8, 2014. How will this affect VCH systems and what is the plan to keep these systems secure?

A. The good news is that we’re covered.

Microsoft has offered its corporate customers an extension to their agreements to provide security updates for Windows XP after April 8, 2014. HSSBC has worked with VCH and B.C.’s other health authorities to accept this offer. Security patch coverage for all B.C. health authorities continues as it has in the past.