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Patients Are A virtue

Hamilton General Hospital President Teresa Smith is making community health her business

By Ted McIntyre

Teresa Smith very nearly required the services of her future place of employment during her first job interview. Having received her Bachelor of Science degree in Biology at Western University, she heeded a suggestion of a pulmonary function technician acquaintance to pursue the field of respiratory therapy, which Smith went on to study at Fanshawe College in London.

"I went to a job fair after that and Hamilton Civics (Hamilton General and Henderson Hospital) were looking for a respiratory therapist," she recalls. "I vividly remember coming down from London for the interview. There was a big snowstorm, and on the way down the escarpment there's a curve in the highway and I almost wiped out into the guardrail."

Fortunately for all concerned, Smith gathered her emotions and steadied her course. But after spending an hour at her humble office at Hamilton General, one gets the feeling she does that on a routine basis. There is an air of calmness about her—conveyed in both in demeanour and voice—and it's easy to see how quality of patient care has been a longtime passion.

But Smith is as deeply invested in the community that surrounds Hamilton General's walls and has taken great strides—literally and figuratively—to improving their lots in life. At the same time, she appreciates fully the massive economic engine that is Hamilton Health Sciences. Striking that balance has been her focus since assuming the presidential reins in January 2010.

BIZ: What was your first job?
TS: I worked at the snack bar in the A&P from age 16—24 hours a week and full-time in the summer. I put myself through university.

Was it a big change, moving from whitecollar London to Hamilton in the 1980s?
My friends said, "That's Steeltown!" That's how I ended up living in Brantford—it was halfway between everyone I knew and my job. I figured I'd be here for two years doing bedside work, but I've now been here for 25.

You've been a clinical educator at the General, you've managed the Intensive Care Unit, and you spent 10 years managing quality and patient safety. Obviously that background prepared you well for your role as president.
With the various jobs I've had here, I've seen this whole building. And managing an ICU is a highly complex, multi-disciplinary environment with lots of teamwork, so that helped too. The quality/patient safety work that I still do covers all HHS. Working across the entire system—both within and outside the organization— really prepared me for this job.

What's your management style?
Pretty down-to-earth. I'm still very connected to what it's all about—that being patient care. It's hard to take the roots of compassion and empathy out of what was a caregiver at one point. It's like I belong here. I have a sense of commitment and passion for the site.

Do you have any time for a personal life?
It's demanding, but I'm pretty balanced. Growing up, the house was always full of sports, so I've always been super active. I played relatively competitive hockey, and also played basketball, fastball, and I run. I also took up golf this past summer.

So you appreciate that it's not just about restoring the health of the sick or injured, it's about enabling them to have productive lives going forward.
Having a unique relationship at this campus in which the hospital and rehab centre are joined by a bridge is on purpose. It's about saving lives and saving quality of lives.

The General's relationship with its community is very important to you.
The neighbourhood ("Code Red") study that was done in 2010 was probably the impetus. The disparity between different communities within Hamilton was unbelievable, particularly life expectancy. For the boundary around Rice St., Mohawk, Upper Paradise and the Brow, the life expectancy was around 86 years—better than the Canadian average. Then you come down to the inner core—the corner of Barton and Wellington, which is one of the corners of this building, then out to the Bay, and to Sherman—the average is like 65. That's a 21-year discrepancy. Why is that? You get into the socio-economic status, the employment rate, kids living in poverty. Of late, right up to our board level, we're having discussions about what role we as Hamilton Health Sciences and Hamilton General should play in trying to partner with city planners or other community programs and community health centres.

Several of your neighbours are lucky that the General specializes in in many of the same ailments they suffer from.
They do have more cardiovascular disease and a higher propensity to have strokes, so they end up here. Part of the reason is the social determinants of their health and where they're living. We have a responsibility to do something. It's craziness that we're in health care, but we're not getting to the root cause of why people get sick.

From an economic standpoint, if you solve those issues, you create consumers that can contribute to the economy.
Absolutely. It's a vicious cycle. There is actually a physiological response in your body when you have no job and no income, because you're always stressed and depressed. There's a higher propensity of mental health issues. You're more likely to smoke, to drink, to not have a good diet… We partnered with St. Joseph's Healthcare in Hamilton and got some money from the LHIN and hired a navigator to better understand and assist the small number of patients that regularly visit emergency departments throughout the region. Approximately 70% of these patients have mental health or addiction issues in addition to their medical condition. The top 10 frequent ED visitors in our LHIN visit an ED 450 times a year! The top one visited 171 times within a single year!

They purposely come to an ED because it's anonymous. They often have a family doctor, but don't want to feel like they're being judged. With their permission, we'll sit with them and other community providers and establish a care plan, so that the next time they arrive we can flag it and the care plan is electronically available so that the nurses in the ED know what to do and what supports they have in the area and how we can get that person back into the community and prevent that next ED visit.

As we try to step forward with our role in the community, I'd like to see it evolve into things like setting aside some of the entrylevel jobs to local kids—purposefully opening our doors so that kids in the community can get training and exposure to a whole host of great professions within health care. For some you have to be pretty educated, and others you might just need a high school education. The cleaning and kitchen staff are as important as the nurses and doctors to making the whole machine work. Those are examples of non-traditional ways this hospital could play a huge role.

From a business standpoint, you're part of a vital economic engine for the city.
Hamilton Health Sciences is a billion-dollar organization. My portfolio is $160 million. We're the biggest employer in Hamilton. When I came here in 1980, Hamilton was still a steel town. Although manufacturing is still important, it's now very much driven by knowledge-based and service-based sectors. Many of our 10,000 employees live in Hamilton and spend lots of money locally, so we're definitely good for the economy. And with the Strides for The General fundraising run/walk we reached out and got great support from the Barton Village BIA. That's another attempt by us to recognize that there are business communities out there we ought to support.

Unfortunately, there are a lot of specialties and accomplishments at Hamilton General that receive little appreciation.
We serve all of Hamilton, Niagara, Haldimand and Brant, and in a lot of cases Waterloo/ Wellington. There were 1,671 cardiac surgeries here last year. We have one of the biggest single-site ICUs in Ontario. We're the premier cardiac surgical program in Ontario, the largest heart investigation/cardiac catheterization program in Ontario. This is under-appreciated in our own backyard.

A hospital facelift wouldn't hurt.
We're actually going through a facilities master planning process. In our ideal state we would take down some old buildings on the campus here and build brand new towers that have in-patient and state-of-the-art diagnostic imaging and such. We're probably talking $50 million to $70 million. That's another economic multiplier effect, though— we develop, so we create construction jobs. HHS has done $500 million worth of capital development in the past few years.

What's the future of health care here?
I predict that it will look dramatically different here in five years. The system absolutely needs to integrate more. We have long-term care homes that stand alone, home care agencies that stand alone, hospitals that stand alone. We have patients that use multiple hospitals. There's no doubt that we'll integrate programs more. An example is us working with the Niagara Health System. They're going to bring up a cardiac catheterization lab to St. Catharines. In order for that to work, we're actively partnering with them, and some of the infrastructure will be shared.

What's the biggest challenge?
Trying to continue to provide quality of care, plus a great patient experience, as well as keeping staff satisfied in a fiscally constrained environment. You've got baby boomers getting sicker, needing health care more, and resources compressing. Balancing all of that is the challenge.

What do you want your legacy to be?
Part of it the community aspect we talked about. Given my background, of coming up from quality and patient safety, I want folks to think that under my watch I had something to do with running a pretty slick operation. Earlier, I was with our quality patient safety steering team. We talked about how we can prevent patients from falling once they're in our hospital and how we can prevent medication errors. We had a presentation on IV pumps and there's technology there that can be hardwired into it to make sure we don't give too big a dose. You tell a mini-computer what drug you're giving and it sets limits of what's safe.

The patient experience is a huge passion of mine. Health care is quite traditional. We need to shift our thinking a lot. Sometimes we're better than others, but I'm not sure we listen to patients and families enough and treat them like our customer. I'd like to reinforce that culture.



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