Mélanie Lavoie-Tremblay, inf, PhD professeure adjointe École des sciences infirmières Université McGill melanie.lavoie-tremblay@mcgill.ca

La nécessité de collaborer Ce que nous savons : Les prestateurs de soins de santé sont plus stressés, insatisfaits et malades que les autres travailleurs canadiens. Nous avons un nombre défini de travailleurs de la santé qui œuvrent dans un milieu dont les besoins se font de plus en plus nombreux (et le vieillissement de la population a un effet sur les deux) Les patients ne se portent pas aussi bien là où le milieu de travail est malsain dans un organisme de santé. Bon nombre de rapports et de recommandations indiquent ce qui doit être amélioré dans le milieu des soins de santé. On s'entend généralement pour dire qu'il faut faire davantage, et ce, dès maintenant! The recent National Survey of the work and health of Nurses shows that nurses are more stressed, more dissatisfied and sicker than all other Canadian workers. These results echo a number of research reports written over the past decade that have sparked concern about the unhealthy working conditions and their impact on the health of all people working in healthcare. We know that health human resources shortages are a major concern in every nation. Within the next few years 1/3rd of Canadian nurses are eligible for retirement and many more are leaving the profession regardless of their age due to poor quality of worklife. Most disturbingly, a recent study at the University of Western Ontario shows that 66% of new nursing graduates report experiencing severe levels of emotional exhaustion or burnout. As a result, many new graduates are leaving their jobs within 2 years of graduation. Burnout is also a critical issues for physicians as a recent Canadian Medical Association survey shows that 46% of physicians are in advanced stages of burnout. We know that patients don’t do as well in unhealthy healthcare workplaces and are at much greater risk of adverse events when we stretch nurses, doctors, and all healthcare workers too thin. We know that we will not be able to sustain any improvements in wait times unless we have healthy people to provide the service. At meeting of key national health organizations in 2004 it was decided that Canada’s health system needs a comprehensive and collaborative approach to workplace and workforce renewal….an approach that does not pit one organization against another in a zero-sum quest for recruitment. They achieved consensus that although we have many reports that tell us what we need to do to improve the quality of worklife in healthcare organizations…what we don’t have is enough concentrated and coordinated action. The ideas that were born out of this initial meeting set the stage for the formation of the Quality Worklife – Quality Healthcare Collaborative and its guiding principles.

Qui fait partie de la Coallition? 11 organismes nationaux de soins de santé Conseil canadien d’agrément des services de santé (secrétariat de coordination) Academy of Canadian Executive Nurses Association canadienne des institutions de santé universitaires Collège canadien des directeurs de services de santé Fédération canadienne des syndicats d'infirmières/infirmiers Association canadienne des soins de santé Fondation canadienne de la recherche sur les services de santé Association médicale canadienne Association des infirmières et infirmiers du Canada Institut national de la qualité Infirmières de l'Ordre de Victoria Membres d'office : Santé Canada – Bureau de la politique des soins infirmiers (principal partenaire financier) Direction générale de la santé des Premières nations et des Inuits, Santé Canada Représentant des provinces et des territoires du Comité consultatif sur la prestation des soins de santé et les ressources humaines Des experts-conseils (plus de 45 de partout au pays) The Collaborative is a coalition of 11 National Healthcare Partners including those listed here on the slide. Health Canada funds the Collaborative through their Healthy Workplace Initiative (which came out of the 2003 First Ministers Health Accord). The Canadian Council on Health Services Accreditation provides the secretariat support. The Collaborative is guided by a National Steering Committee and 45 quality worklife experts from across the country on the working groups. (Including, mention some key members from your jurisdiction)

Nous croyons.... qu’un moyen fondamental d’améliorer les soins de santé est d’assainir les milieux de travail des employés de ce domaine, et qu’il est inacceptable de financer, de gouverner ou de diriger des établissements de santé malsains tout autant que d’y travailler ou que d’y recevoir des soins. This powerful shared belief statement has guided the work of the Collaborative. It speaks to the notion that we all have a role to play to address the health of healthcare workplaces.

Stratégies d’action Engagement Indicateurs Activités prioritaires Echange des connaissances Released April 2007 Over 3000 copies widely distributed Over 5400 hits to web page in first week The Action Strategy focuses on 4 main areas: increasing awareness and engagement, measurement of standard indicators, priority activities and knowledge exchange

Charte de la direction saine régissant les soins de santé Engagement Charte de la direction saine régissant les soins de santé En signant cette charte, nous démontrons notre engagement à agir maintenant afin... de faire de la qualité de vie au travail une priorité stratégique; d’évaluer les indicateurs de la qualité de vie au travail, y compris les indicateurs standard déterminés par la Coalition, d’en faire le suivi et d’en présenter les résultats; d’arrêter des stratégies d’actions prioritaires à mettre en œuvre et à évaluer; de déceler et d’acquérir des connaissances en matière de pratiques exemplaires liées à la qualité de vie au travail; d’échanger des connaissances et de former un réseau avec les autres dirigeants du secteur de la santé relatifs aux pratiques propres à un milieu de travail sain. First, to build awareness and engagement in this issue; the Collaborative has developed A Healthy Healthcare Leadership Charter that all health leaders will be encouraged to sign to show their level of engagement and their commitment to act on this issue. To further drive this focus on action, the Collaborative has also provided a simple tool for leaders to specify which activity areas they will focus their immediate attention on and also to identify where they may have a potential leading practice that could be shared with others.

Indicateurs standard de la qualité de vie au travail Niveau organisationnel Roulement/stabilité Postes vacants Formation et perfectionnement Heures supplémentaires Absentéisme Taux d'accidents du travail ayant entraîné des arrêts de travail Satisfaction des employés Satisfaction des patients Par rapport au système Indicateurs de la qualité de vie au travail intégrés aux ententes de rendement indicateurs de la qualité de vie au travail compris dans les plans fédéraux, provinciaux et territoriaux en matière de ressources humaines en santé The Collaborative has developed a standard set of quality of worklife indicators that all health organizations should build into their management information systems, performance agreements and accountability reports. The Collaborative selected this parsimonious group of indicators because they are commonly used by most organizations, are relevant to all sectors and employees, and there is evidence to show that the factors these indicators measure relate to patient, provider and system outcomes. While there are currently many different definitions used for these indicators, the Collaborative has offered some proposed standard definitions to start the movement towards a Pan-Canadian comparable dataset. By building a pan-Canadian database to support the measurement and transparent reporting of these standard indicators, we can benchmark and identify areas of excellence across the country or areas requiring more focused attention. The Collaborative has also identified system level indicators to show the commitment by funders and governors of the healthcare system to improve quality of worklife.

Activités prioritaires niveau organisationnel Leadership et un système de gestion stratégiques en matière de qualité de vie au travail Stratégie complète et intégrée en matière de ressources humaines, de milieu de travail sain et de perfectionnement organisationnel système de prévention et gestion des invalidités mieux-être des employés milieu propice à la guérison leadership sain et programme de perfectionnement collaboration en milieu de travail formation et perfectionnement gestion de l'épuisement gestion de la charge du travail et du personnel Lier la qualité de vie au travail aux mécanismes de gestion du rendement Bons procédés internes et externes d’échange de connaissances Next the Collaborative have identified 4 priority activities for organizational leaders to put into place. For each of these priority areas, the Collaborative has provided a menu of evidence-informed leading practices and have provided a recommended overall change management process to give leaders some ideas of where to begin and how best to proceed. This “menu” approach provides flexibility for a wide range of health organizations each with their own particular challenges and opportunities for change. An important priority step is to create a strategic leadership and management system for QWL. This means that the mission/vision/values of the organization acknowledges that our health human resources are the organization’s core long-term asset, and that the health of the work environment is of strategic importance. Senior leaders will be actively involved in creating a strategic and comprehensive approach to improving QWL and it is linked to the organization’s overall strategic plan. When leaders make decisions, they use evidence-informed management decision approaches that consider the health of workers and the health of the work environment. Secondly, it is important for organizations to get their “acts together”. This means integrating or at least coordinating your Human Resources, Workplace Health, Learning or Organizational Development, Patient Safety and Quality Improvement functions in a way that aligns everyone who is working to improve the quality of the work environment. Under this Integrated QWL Strategy Area, leading practices are themed into 8 topic areas listed here on this slide. Every organization will likely identify that they are working on improving one or more of these areas of activity based on your own particular challenges and opportunities. The third priority activity, is the linking of QWL measurement to performance management systems. This means taking a “balanced scorecard” type of approach and considering the linkages between healthy and productive workers and your organization’s overall performance. The fourth priority activity the development of organizational capacity to build, translate and transfer knowledge related to QWL. It is important to support QWL champions to drive improvements internally throughout the organization, and also to connect with the Pan-Canadian community to share and develop leading practices.

Activités prioritaires pour les dirigeants du système Base de données nationale permettant de signaler les indicateurs standard de la qualité de vie au travail Améliorer les ententes de rendement, les normes d'agrément Un réseau de connaissances pancanadien visant la reconnaissance et l’échange de pratiques exemplaires; Un programme national des milieux de travail dans le domaine des soins de santé qui amène les organismes de santé à devenir des modèles de milieux de travail sains dans leur communauté To support health organizations to achieve success in implementing the recommended priority activities, the Collaborative has also identified priority areas for system leaders to focus their attention on. The first priority activity for system leaders to focus their attention on is a national database for reporting standard QWL indicators. This would allow the organizations to focus more attention on activities to improve the quality of worklife. The second priority activity is for federal, provincial and territorial funders to work towards including QWL indicators in their performance agreements or accountability reports. The CCHSA is also encouraged to continue to enhance its QWL performance measures as part of the accreditation program. The third priority activity for the system leaders is to support the sustainable development of a Pan-Canadian Knowledge Network that has a main purpose of finding leading practices and spreading them quickly to other organizations across the country. Finally, the fourth priority activity is to build on past health promotion and workplace health initiatives to develop a national workplace health program that starts within the health sector to build health organizations as models of healthy workplaces for their communities. We have an estimated 1.5 million people employed in the health sector (which represents 1 in every 10 employed people in this country). This represents a powerful avenue to change health promoting behaviours of the entire Canadian population.

Structure de l'échange de connaissances explicites Rapports Feuillets de renseignement Outils Indicateurs Guides de meilleures pratiques Communautés de pratique Agence de transmission Revues sur des études de cas Congrès Réseaux d’information Sites Web Échange de connaissances tacites Programme d’échange Programme de mentorat Occasions de bavarder Site Web Récits de vie inspirants Champions Bureau des conférenciers Réseau de connaissances Rédacteurs doivent saisir l’information Base de données sur les pratiques exemplaires Base de données de références – mise à jour Engagement relationnel actif Centre d’échange d’information ou un site Web Personne-ressource Connaissances de l’organisme Réseaux régionaux Rencontres d’équipes Connaissances pancanadiennes Collaborations Réseaux Finally, the Collaborative has proposed a Pan-Canadian knowledge exchange structure to promote the sharing of research and leading practices. There are many innovative practices that are improving the working lives of health providers across the country; but we must work better to uncover these ideas and spread them to all other health organizations faster. The centerpiece of this knowledge exchange strategy is a national network to connect all the great efforts that are going on across the country. It includes the support for topic-specific networking groups, a reference and leading practices database that is regularly updated, and a central clearinghouse to provide “one-stop” shopping for all stakeholders.

Les activités des partenaires cette année: Leadership – signer la charte, promotion auprès de leurs membres Expliquer & promouvoir des opportunités d’action Soutien pour une base de données Pan-Canadienne pour les indicateurs Qualité de vie au travail Favoriser échange des connaissances (website & QWQHC Summit in March 2008) Publier des rapports d’étape dans chaque province Déterminer une approche pour le suivi du QWQHC Autres…. QWQHC indicateurs pour les ententes de gestion (ex: hôpitaux en Ontario) Utilisation du cadre de référence par différentes organisations pour dresser le portrait de la situation, implanter et évaluer des initiatives

Pour plus de renseignements veuillez visiter le Questions? Pour plus de renseignements veuillez visiter le www2.cchsa.ca/QWQHC Some potential questions to ask the audience….. Do you think the Collaborative’s action strategy will support the building of healthier health workplaces? Do you understand the relationship between a healthy workplace and quality, safe patient care? What priority action areas should this organization focus its attention on? In what areas might we have developed leading practices? Do you want to become part of a group (network or community of practice) to link with others and exchange knowledge, practices and ideas in this quality worklife area?