Prevent the flu in you and in patients! / New Echo

By Rik Ganderton - President & CEO
I'm pleased once again to get my flu shot and encourage us all to do so.
To get his year's campaign going, you'll see that many managers and Board members have already rolled up their sleeves to encourage everyone at Rouge to get their shot. This is the best way to prevent us from getting sick with the flu and to prevent spreading it to our patients.
Thank you all for rolling up your sleeves starting next week at flu shot clinics for staff, physicians and volunteers at Rouge Valley. It's your personal decision, but please do consider getting it for your health and for that of our patients.
And my thanks to RN Amanda Fyfe for making it so painless!
...

President's Blog
By Rik Ganderton - President and CEO
Oct. 31, 2008

Even the Echo is transforming ...

Welcome to our new echo.

More than simply a smartly re-designed magazine, echo is now serving a wider audience — reverberating and spreading the good word about the new Rouge, which all of you are so busy transforming.
echo will continue to be a newsletter for staff-physicians-volunteers. But now it will also serve as a community magazine, mailed six times a year (electronically and by post) to health care partners, political leaders and more than 350 community organizations in east Toronto and west Durham.

Please have a good read through this issue and send any comments to Public Affairs and Community Relations Director David Brazeau at dbrazeau@rougevalley.ca. As with everything we do at Rouge, we want it to be the best – reflecting your tremendous ongoing work to constantly improve patient care!

In this issue, we continue to focus on the transformation that is well underway at both Rouge Valley hospital campuses. At our Oct. 1 Transformation Celebration Town Hall, we showcased the successes of our first four kaizen event teams. This was an opportunity for team leaders to showcase the positive changes their teams achieved for patients and for each other. We take an inside look at these kaizen events in our cover story, but I would like to highlight some of the biggest achievements here and offer my own “thank you” to all of our kaizen team members.

RVAP Emergency Department 5S
Clinical Practice Leader Tina Shoemaker showed us how the Rouge Valley Ajax and Pickering emergency department organized itself more efficiently for patient care, by making these key changes:
Cleaned and organized the working environment;
Conducted daily 5S audits (sort, set in order, scrub/shine, standardize and sustain); and
Ongoing monitoring of sustainability.
I want to underline this: sustainability is the key to all kaizen event successes! We must be vigilant in maintaining the truly terrific changes you have made.

RVAP Emergency Department Lab TAT
Senior Technologist Renee Liscio demonstrated how this team improved turn-around time (TAT) for blood and urine specimens. The key changes achieved for our patients were:
Visual management system for specimen pick up was established;
A back-up system was set up to inform our patient services reps that pickup was required; and
Standard work was established for all staff involved.

RVC Medicine Discharge Room TAT
Physiotherapist Louie Lu shared these key turn-around time changes achieved by his kaizen team:
Discharge TAT visual management board established;
Standard work created for staff members to improve patient flow; and
Linen carts have been reorganized using the 5S principles.

RVC Medicine Discharge Process
Outpatient and Corporate Rehab Manager Karl Wong showed us how his team improved flow, coordination of discharge process on the RVC Medicine 9W unit, through these key changes:
Discharge planning visual management board was put in place;
Physician communication tool was created for patient charts; and
Signs were made to educate patients and families about discharge days and times.

Thank you to all team members and to our kaizen process owners: Program Director of Mental Health and Emergency Cheryl Williams; and Program Director of Medicine and Critical Care Margot DaCosta. I would also like to thank all staff, physicians and volunteers for working as a team, at every level of Rouge Valley, to provide the best health care experience for our patients and their families.

And to all our other readers, I hope you enjoy this first issue of the new echo and will continue to come back to these pages to learn more about how Rouge Valley is working to be the best at what we do.

Please feel free to email any questions or comments you have for me to rganderton@rougevalley.ca.

For more from the president:
internal—check out the President’s Page on the RVHS intranet site
external—visit the RVHS Blog at rvhs.blogspot.com

Rouge continues to move forward: wins second court challenge

By Rik Ganderton - President and CEO

Rouge Valley has won its second legal challenge to its Deficit Elimination Plan (DEP).

The Divisional Court has recently ruled in favour of the hospital in a challenge brought forward by the provincial head office of the Ontario Nurses Association. The court ruled that the decision to approve the DEP by the Rouge Valley Board of Directors was an “internal” and "reasonable” decision.

The court accepted the hospital’s arguments that it had consulted about its plan to reduce the deficit. This summer the court also ruled in favour of the Central East LHIN and Rouge Valley in a similar challenge brought forward by OPSEU - Read our August 2008 news release.

This means we can continue to move forward in our well-publicized plan, of March 25, 2008, to fix Rouge Valley's historic financial challenges.

As we've said at leadership forums with managers and Town Halls with all staff, it is thanks to the engagement and participation of staff and physicians that Rouge Valley is now heading in a positive direction on finances and, most importantly, in transforming itself into being the best at what we do for patients.

The complete ruling is available here.

Vitamin D: It's Not Just Another Vitamin

If I described a substance with the following properties, what would you guess it was?

-It's synthesized by the body from cholesterol
-It crosses cell membranes freely
-It has its own nuclear receptor
-It causes broad changes in gene transcription
-It acts in nearly every tissue
-It's essential for health

There's no way for you to know, because those statements all apply to activated vitamin D, estrogen, testosterone and a number of other hormones. Vitamin D, as opposed to all other vitamins, is a steroid hormone precursor (technically it's a secosteroid but it's close enough for our purposes). The main difference between vitamin D and other steroid hormones is that it requires a photon of UVB light for its synthesis in the skin. If it didn't require UVB, it would be called a hormone rather than a vitamin. Just like estrogen and testosterone, it's involved in many processes, and it's important to have the right amount.

The type of vitamin D that comes from sunlight and the diet is actually not a hormone itself, but a hormone precursor. Vitamin D is converted to 25(OH)D3 in the liver. This is the major storage form of vitamin D, and thus it best reflects vitamin D status. The kidney converts 25(OH)D3 to 1,25(OH)D3 as needed. This is the major hormone form of vitamin D. 1,25(OH)D3 has profound effects on a number of tissues.

Vitamin D was originally identified as necessary for proper mineral absorption and metabolism. Deficiency causes rickets, which results in the demineralization and weakening of bones and teeth. A modest intake of vitamin D is enough to prevent rickets. However, there is a mountain of data accumulating that shows that even a mild form of deficiency is problematic. Low vitamin D levels associate with nearly every common non-communicable disorder, including obesity, diabetes, cardiovascular disease, autoimmune disease, osteoporosis and cancer. Clinical trials using vitamin D supplements have suggested that it may protect against cancer, hypertension, type 1 diabetes, bone fracture and enhance athletic performance. However, the evidence is pretty thin for most of these effects and requires more research.

It all makes sense if you think about how humans evolved: in a tropical environment with bright sun year-round. Even in many Northern climates, a loss of skin pigmentation and plenty of time outdoors allowed year-round vitamin D synthesis for most groups. Vitamin D synthesis becomes impossible during the winter above latitude 40 or so, due to a lack of UVB. Traditional cultures beyond this latitude, such as the Inuit, consumed large amounts of vitamin D from nutrient-rich animal foods like fatty fish.

The body has several mechanisms for regulating the amount of vitamin D produced from sunlight exposure, so overdose from this source appears to be impossible. Sunlight is also the most effective natural way to obtain vitamin D. How much vitamin D is optimal? 30 ng/mL 25(OH)D3 is required to normalize parathyroid hormone levels, and 35 ng/mL is required to optimize calcium absorption.  It's probably best to maintain at least 35 ng/mL 25(OH)D3.

Here's how to become vitamin D deficient: stay inside all day, wear sunscreen anytime you go out, and eat a low-fat diet. Make sure to avoid animal fats in particular. Rickets, once thought of as an antique disease, is making a comeback in developed countries despite fortification of milk (note- it doesn't need to be fortified with fat-soluble vitamins if you don't skim the fat off in the first place!). The resurgence of rickets is not surprising considering our current lifestyle and diet trends. In a recent study, 40% of infants and toddlers in Boston were vitamin D deficient using 30 ng/mL as the cutoff point. 7.5% of the total had rickets and 32.5% showed demineralization of bone tissue! Part of the problem is that mothers' milk is a poor source of vitamin D when the mother herself is deficient. Bring the mothers' vitamin D level up, and breast milk becomes an excellent source.

Here's how to optimize your vitamin D status: get plenty of sunlight without using sunscreen, and eat nutrient-rich animal foods, particularly in the winter. The richest food source of vitamin D is high-vitamin cod liver oil. Blood from pasture-raised pigs or cows slaughtered in summer or fall, and fatty fish such as herring and sardines are also good sources. Vitamin D is one of the few nutrients I can recommend in supplement form. Make sure it's D3 rather than D2; 2,000 IU per day hould be sufficient to maintain blood levels in wintertime unless you are obese (in which case you may need more and should be tested).  Vitamin D3 supplements are typically naturally sourced, coming from sheep lanolin or fish livers. A good regimen would be to supplement every day you get less than 10 minutes of sunlight.

People with dark skin and the elderly make less vitamin D upon sun exposure, so they should plan on getting more sunlight or consuming more vitamin D. Sunscreen essentially eliminates vitamin D synthesis, and glass blocks UVB so indoor sunlight is useless. Vitamin D toxicity from supplements is possible, but exceptionally rare. It only occurs in cases where people have accidentally taken grotesque doses of the vitamin. As Chris Masterjohn has pointed out, vitamin D toxicity is extremely similar to vitamin A deficiency. This is because vitamin A and D work together, and each protects against toxicity from the other. Excess vitamin D depletes vitamin A, thus vitamin D toxicity is probably a relative deficiency of vitamin A.

I know this won't be a problem for you because like all healthy traditional people, you are getting plenty of vitamin A from nutrient-dense animal foods like liver and butter. Vitamin K2 is the third, and most overlooked, leg of the stool. D, A and K2 form a trio that act together to optimize mineral absorption and use, aid in the development of a number of body structures, beneficially alter gene expression, and affect many aspects of health.

Thanks to horizontal.integration for the CC photo.

We're Starting to Get It

I just read an interesting post on the Food is Love blog.

According to the USDA (admittedly not always the most reliable source of accurate information, but we’ll go with it for the moment), the number of farmers markets in the US has risen significantly in the last ten years, from 2,746 in 1998 to 4,685 in 2008. If we get another 580 markets, an increase possible in the next year or two if trends continue, we’ll have tripled the number of recorded markets since 1994.

Furthermore,

Plenty of farmers markets don’t get tallied in official lists, of course. Valereee, over at Cincinnati Locavore, points out that the USDA database only lists a quarter of the markets in her hometown. I see a few missing on the Seattle list as well.

People are slowly starting to get it. We're realizing that the processed food industry does not look out for our best interests. We're realizing that the frailty of modern children as well as our own health problems are due to the outsourcing of agriculture and food preparation. We're realizing that local farms and markets build strong communities.

We're realizing that a return to traditional, wholesome food is the only path to whole health and well-being.


Further reading:
My Real Food manifesto.