January 5, 2007 Robin Buckland RN MScN Senior Policy Analyst Health Canada

1. Health Canada’s HealthyWorkplace Initiative - Promoting Wellness in Canada’s Health Human Resources January 5, 2007 Robin Buckland RN MScN Senior Policy Analyst Health Canada

2. Overview • Why healthy workplaces? • What makes a workplace healthy? • What is the federal government doing about it? • The Healthy Workplace Initiative • What’s next

3. Why ‘Healthy Workplaces’? 1. Absenteeism and on-the-job injuries are high among health care workers: • Average number of days of work lost due to illness or disability has been at least 1.5 times greater than the average for all workers (CIHI, 2005) • CMA’s 2003 study of Canadian physicians found that 46% are in advanced stages of burnout. 2. Unhealthy workplaces cost our health system: • productivity costs, wage replacements, disability pay-outs and workplace absenteeism costs around $30 billion a year (Corbett, 2003) • On an annual basis, nursing hours lost to absenteeism cost the Canadian health system $17.7 million – the equivalent of 9,754 full-time positions (CNA 2006).

4. Why ‘Healthy Workplaces’? 3. Quality work environments, worker satisfaction and productivity are directly correlated with patient outcomes: • Hospital nurses working more than 12.5 hours at a time are three times more likely to make mistakes. Errors and medical incidents increase significantly when nurses work more than 40-hour weeks or when they work overtime (CHSRF, 2001).

5. What is a Healthy Workplace? • …a working definition: • “practice settings that maximize the health and well-being of health care workers, quality patient outcomes, and organizational performance”

6. What Makes a Workplace Healthy? • Major elements: • Physical environment – safe, healthy, secure; equipment, technology. • Professional environment - human resources/staffing practices, leadership, practice issues (e.g., autonomy, scopes of practice, workload). • Psychosocial/cultural environment – recognition, respect, communication, values, support.

7. What Is the Federal Government Doing About It? • Health Canada’s Healthy Workplace Initiative • Health Accord 2003 • First Ministers Meeting 2004 • Pan-Canadian Health Human Resources Strategy

8. The Healthy Workplace Initiative Objectives… • Improve the health and well-being of health care workers • Decrease absenteeism, turnover and overtime of health care workers to improve health system productivity • Establish policies/settings that enhance the workplace, thereby improving provision of quality health care

9. The Healthy Workplace Initiative Desired Impact: • Improve working environment for all health care workers • Improve workers’ health and well-being • Improve quality of care • Improve patient safety • Improve health providers’ job satisfaction • Improved recruitment and retention • Improve efficiency of health care organizations

10. The Healthy Workplace Initiative Four core areas… • Knowledge generation • guidelines, surveys, complementary projects (VON, RNAO, CFNU) • Leading practice application • targeted funding of approximately $3.5 million to support 11 innovative projects in health care organizations nominated by P/T ministries of health • Change management • Provinces/Territories, employers, providers, etc. • Quality of Worklife – Quality of Healthcare Collaborative • Knowledge translation and transfer • 5 knowledge utilization projects • Knowledge Exchange activities

11. The Healthy Workplace Initiative Four core areas… • Knowledge generation • Guidelines, surveys, complementary projects (VON, RNAO, CFNU) • Five knowledge utilization projects • Leading practice application • Targeted funding of approximately $3.5 million to support 11 innovative projects in health care organizations nominated by P/T ministries of health • Change management • Provinces/Territories, employers, providers, etc. • Quality of Worklife – Quality of Healthcare Collaborative • Knowledge translation and transfer • Knowledge Exchange Days • HWI Dissemination Framework

12. Knowledge Generation National Survey of the Work and Health of Nurses • First nationally representative survey of nurses in Canada • Partnership between CIHI, Health Canada and Statistics Canada • Data collection: October 2005 – January 2006 • Response rate: 80% (18,676 nurses) • Survey objectives: • Provide information on the health and working conditions of the 3 regulated nursing professions (RNs, LPNs, and PRNs) • Comparisons among provinces and territories • Compare nurses with the total employed population

13. Knowledge Generation National Survey of the Work and Health of Nurses • Results: • Nurses worked more paid overtime: • Women: 30% of nurses vs. 13% of all employed • Men: 37% of nurses vs. 28% of all employed • Nurses more likely to have more that one job: • Women: 19% vs. 9% • Men: 23% vs. 9%

14. Knowledge Generation National Survey of the Work and Health of Nurses • Results: • Perceived changes in quality of care in past year: • 27%: deteriorated • 16%: improved • 57%: no change • Main reason given for deterioration: • Fewer staff (67%) • Too many patients (38%)

15. Knowledge Generation National Survey of the Work and Health of Nurses • Results: • Nurses’ reports of adverse events in past year • Patient received wrong medication or dose – 18% • Patient nosocomial infection – 35% • Complains from patients or families – 38% • Patient injured in a fall – 31% • Nurse injured while working – 9%

16. Knowledge Generation National Survey of the Work and Health of Nurses • Results: • 29% reported physical assault by a patient in past year • 67% reported often too much work for one person – role overload • 31% female nurses reported high job strain where the psychological demands of the job exceed worker’s discretion in deciding how to do it • 45% female nurses reported low co-worker support

17. Knowledge Generation National Survey of the Work and Health of Nurses • Results: • Job dissatisfaction was more common in nurses than in total employed: • Women: 12% vs. 9% • Men: 12% vs. 8% • 9% of nurses had experienced depression in the last year • 7% reported fair or poor general health • 6% reported fair or poor mental health • 14.5 sick-days/year on average • 14% took more than 20 sick-days in past year

18. Leading Practice Application A Snapshot Across the Country Labrador - Grenfell East Central Health PEI DOH MRHA BC MOH WRHA McGill AVH Sask Health VON CFNU West Park, et al. QWQCC Halton Healthcare

19. Leading Practice Application HWI Targeted Funding Projects Results and significant learnings in 2007/08 • Newfoundland - Labrador Grenfell Regional Integrated Health Authority on behalf of all provincial RIHAs: Creating a Culture of Safety • PEI Health and Social Services: Provincial Musculoskeletal Injury Prevention Strategy for Health Care Workers: An Expansion and Enhancement Project • New Brunswick - Miramichi Regional Health Authority: MRHA Workplace Wellness Initiative • Ontario - Halton Health Care: Kailo Workplace Wellness Program • Alberta - East Central Health: Quality of Worklife Project

20. Leading Practice Application HWI Targeted Funding Projects • Ontario – West Park Health Centre: A Healthy Workplace Initiative Best Practice Initiative • Québec – Centre Universitaire de santé McGill: Programme interhospitalier de recherche action sur le climat de travail • Saskatchewan Health: Electronic Survey Tool (EST) • Manitoba – Winnipeg Regional Health Authority: WRHA Healthy Workplace Program • British Columbia Ministry of Health Services: A Collaborative Approach to Supporting Health in the Workplace • Nova Scotia - Annapolis Valley Health: Organizational Health: Quality and Healthy Workplace Integration

21. Change Management Quality of Worklife – Quality of Healthcare Collaborative • To help stakeholders find the most effective ways to build a foundation of excellence in work environments and human resources practices • Why? • Gap – mechanisms to share info and coordinate actions nationally • Opportunity for interprofessional collaboration to address QWL issues of relevance to all health professionals • Common strategy to raise the standards for QWL across the system

22. Change Management Quality of Worklife – Quality of Healthcare Collaborative Mandate: Develop a national framework and action strategy for healthcare stakeholders to build a foundation of excellence in quality healthcare work environments and HHR practices Facilitate recognition of strategic link between high quality , healthy work environments and high quality patient care and patient safety Create a national clearinghouse for QWL practices

23. Knowledge Translation/Transfer • Five knowledge utilization projects completed in April 2006 • To inform our understanding of the utilization of recommendations resulting from national and other reports aimed at improving the workplaces of health professionals • (e.g., Commitment and Care, CNAC report, CPRN reports, Listening for Directions, Kirby report, Romanow report, provincial reports, etc.)

24. Knowledge Translation/Transfer “The Supply, Distribution and Working Context of Health Professionals: Why Do Things (Almost) Never Change” McMaster U. (Lavis) “Building Quality Health Care Workplaces: Nurses as Knowledge Sharers in Atlantic Canada” Acadia U.(Leiter) “Canada’s Experience Translating Workplace Knowledge in a Cancer Setting” Sunnybrook & Women’s College Health Sciences Centre (Fitch) “Knowledge Utilization: Creating Quality Northern Rural Health Workplaces” Laurentian U. (Rukholm) “Promoting High Quality Health Care Workplaces: Learning from Saskatchewan” U. of Saskatchewan (Smadu)

25. What’s next? • Learning from 11 ‘targeted funding’ projects • Learning from complementary projects • Move to focus between worker health and well-being and patient safety & quality care • Evaluation of the HWI – more lessons learned! • Moving forward together – Quality of Worklife, Quality of Healthcare Collaborative • Knowledge Exchange and Uptake

26. Some final thoughts… “If we want to create a workplace that values idealism, human connection, and real, in depth learning, we will have to create it ourselves.” - Peter Block

27. Thank you! Merci! Robin Buckland RN MScN Senior Policy Analyst, Health Canada Visit us online! www.healthcanada.gc.ca/hwi www.santecanada.gc.ca/ipsmt