Research Highlights

Health Human Resource Planning Task Force

HSPRI facilitates the ongoing work of the Health Human Resources Planning (HHRP) Task Force at the request of the Dean, Faculty of Health Sciences. The Task Force operates with an overall aim of:

Gathering information on the current state of HHRP (environmental scan, current/existing frameworks, etc.); and
Providing recommendations on how HHRP may be enhanced in support of healthcare service delivery in Canada.

HHRP Task Force members Drs. Don Drummond and Duncan Sinclair have shared some valuable insights in the following series of policy memos:

Oasis Seniors Supportive Living (Oasis): Leveraging Naturally Occurring Retirement Communities to Support Older Adults

Dr. Catherine Donnelly, along with Co-PI, Dr. Vincent DePaul, have been working in partnership with Oasis to expand and evaluate the program across Ontario and most recently in Vancouver. Oasis was designed to enhance overall well-being of older adults living in naturally occurring retirement communities (NORCs) by offering programs that connect older adults and engage them in meaningful activities. Oasis is driven by the older adult members and includes three programming pillars: communal meals, group-based physical and social activities.

The program is supported by a volunteer community Board of Directors, an on-site coordinator, and the Oasis members. The on-site coordinator works with members to identify, develop and implement activities within the three pillars and engages with community organizations to integrate community programs into Oasis sites. The work is part of a larger program of research examining NORCs and aging-in-place. The initial evaluation and expansion was supported by multiple funding sources including Baycrest, Ministry of Health, and Ministry of Seniors and Accessibility. The research team will be conducting a 4 year CIHR-funded longitudinal evaluation of Oasis and NORCs with partners at Western, McMaster and UHN OpenLabs.

Ontario Health Teams Primary Care Data Report

Dr. Michael Green leads team of primary care researchers and has produced a report that provides primary care data support for all Ontario Health Teams (OHT) in the province. This Primary Care Data Report uses standard health administrative measures in primary care in conjunction with measures for attachment to a primary care provider to deliver a standardized document for all OHTs.

These reports compare key health system measures specific to jurisdictions and provincial averages. A variety of data metrics, using algorithms predominantly based on billing patterns, have been selected for inclusion in this report in response to detailed feedback from health system stakeholders across Ontario. Maps accompany the report, which provide visual representations of attachment patterns to primary care providers within OHT attribution networks.

The measures included are associated with the following are 4 areas: demographics, patient characteristics, health care utilization, and primary care indicators. 6 key OHT Population segments are included in each report:

Given the complexity of Ontario’s health system, it is essential for OHTs to have a comprehensive understanding in real-time of how primary care services are both organized and utilized by its consumers. This report provides varying levels of granularity, both general and detailed information on important health system indicators, which will serve as an important resource for applied health services researchers, health care managers and administrators, and health policy decision makers. More specifically, this report can be used as a performance measurement tool to plan health system reform initiatives for the larger purpose of improving the quality of and equitable access to primary care services in specific OHTs jurisdiction.

Click here to view the report

Optimizing Nursing Contribution and Leadership to Primary Health Care System Transformation

In the past two decades, governments at the federal and provincial/territorial level have substantially invested in strengthening primary healthcare. However, despite these investments and system changes, Canada’s primary care performance lags behind that of many other peer countries. The introduction and support for inter-professional primary healthcare teams is the cornerstone of primary healthcare reforms. Nurses comprise the largest proportion of non-physician healthcare providers within these teams; however, current evidence suggests that primary care nursing roles are not optimized. Thus, nurses have the potential to substantially influence patient care. This research explores how to optimize the nursing contribution within the context of primary healthcare system reforms.

In collaboration with a national group of investigators, a team led by Dr. Joan Tranmer is currently conducting a number of CIHR-funded projects to: better define family practice nursing competencies; explore the impact of funding models on integration of family practice nurses in primary healthcare teams; and determine the short, medium, and long-term effectiveness of interdisciplinary teams and other primary care reforms in Ontario. The findings from these projects willinform system level changes for the planning of primaryhealthcare team-based care.

The project team is also exploring how to best support integrated and coordinated care. Working with the College of Family Physicians of Canada, investigators completed a rapid synthesis review, and determined that the Patient Medical Home (PMH) was associated with improved healthcare utilization patterns with relatively minimal long-term cost impact.

The findings from these research projects are currently being used to inform integration strategies within the Frontenac, Lennox & Addington Ontario Health Team.

Paradigms Found: Lessons Learned in the Fight Against Stigma

As a sequel to Paradigms Lost: Fighting Stigma and the Lessons Learned, this book chronicles all that we have learned as a global community regarding mental illness-related stigma and targeted anti-stigma approaches.

The first four chapters of Paradigms Found: Lessons Learned in the Fight Against Stigma by Drs. Heather Stuart and Norman Sartorius (Oxford University Press) outline the authors' recommended approach to stigma-reduction, based on a model of Enlightened Opportunism, which are described in detail in Paradigms Lost. The subsequent chapters focus on specific target groups (such as healthcare workers, the media, or police officers) to outline what is known about stigma in these groups and approaches that have been successfully used to combat it.

This book is currently in press and is expected to come out later this year.

Discrepancy Awareness

In 2019, the Accessible Canada Act was passed with the aim of promoting full accessibility in the federally-regulated sector. At the time, Minister Qualtrough recognized that the most challenging obstacle to overcome was negative attitudes toward disability.

“Discrepancy Awareness” is an innovative approach to changing negative implicit attitudes toward disability. Derived from Human Resources research and practice, it involves creating opportunities to come face to face with implicit attitudes, and to reconsider them in a safe and supportive environment. This project, led by Dr. Mary Ann McColl and jointly funded by SSHRC and Accessibility Standards Canada, is undertaken in collaboration with researchers at UBC and the CNIB. In partnership with PlaysThatWork, an experiential training and leadership organization, we will train leaders from the business sector (Home Depot Canada) and from the transportation sector to recognize when their attitudes create a barrier for disabled employees/passengers, and to adjust their practice to conform to their desired or professed attitudes.

The project entails the creation of two on-line workshops where actors and participants confront one another to explore attitudes toward disability.

Evaluation of Health Links in the Southeast Local Health Integration Network

In Ontario, a small percentage (5%) of older adults with multi-morbidity and low socioeconomic status consume 67% of healthcare expenditures. According to the Ontario Medical Association, many of these individuals experienced fragmented care and system inefficiencies.

This CIHR-funded study led by Dr. Ana Johnson seeks to assess the impact of a Coordinated Care program on patients, providers, caregivers, and resource utilizatio nwithin the healthcare system.

Research Utilizing Time-Use Data

Dr. Clarke Wilson is currently the principal investigator for the project Measuring Integration of Disabled Persons, contracted with the Statistics Canada Research Data Services Program, which is examining differences among the activity patterns of respondents to the 2015 General Social Survey of Time Use according to reported disability type.

Dr. Wilson is also a co-investigator on the SSHRC sponsored project, COVID-19: How are wemanaging? Time use and well-being during the COVID-19 crisis led by Dorothy Kessler at theSchool of Rehabilitation Therapy.

Ten Stories

Have you ever noticed that elderly people often tell a finite number of stories over and over again? If you are providing care or support to an elderly loved one – a spouse, a parent, a sibling, a friend – maybe you recognize this idea, and feel like you are hearing the same stories over and over.

Many people assume this is because older adults don’t remember having told their stories before; but our research suggests something different. Based on interviews with caregivers who responded to our request to share the stories their elderly loved one tells or told, here’s what we have learned.

There really are just ten stories (give or take) that people tell repeatedly. What’s important about those stories is not the factual details, but the values and meaning embedded in them. If we can listen to those stories differently, we can understand them as containing important messages, giving us a chance to know our loved one at a deeper level, and assisting him or her to achieve consolidation and reconciliation of identity.

Caregivers have the opportunity to give their loved ones an incomparable gift when they receive their stories – the validation that they are important, that they have been seen and heard, and that they will be remembered.

Life can only be understood backwards…although it must be lived forwards
~ Soren Kierkengaard, Danish philosopher

Why tell stories?

Telling stories is one of the ways that we work our way backwards though life in an attempt to understand it. People tell personal stories for a number of reasons. In particular, we tell stories in order to find meaning in life. We seek coherence and continuity in our life story. We bear witness to the time in which we lived and the values and lessons it taught us. We seek to reconcile conflicts, to cement our legacy, and in some cases, even to anticipate judgment at the end of life. At the root of all of these reasons is the desire to be known, both to the self and to others, for who one truly is.

Telling stories in later life has been described by psychologist Erik Erikson, known best for his developmental theory of identity. He elaborated eight stages of life in which the identity is formed as one progresses from one stage to the next. Progress is achieved by reconciling challenges associated with each age and stage. The latter two stages typically give rise to the ten stories.

Stage VII, entitled Generativity vs. Stagnation, is prompted by the challenge of adapting to changes in health and capacity, and remaining interested and hopeful for the future. Resolution of that challenge is achieved by resisting self-absorption, and continuing to invest in relationships, to care about others, and to have faith in humanity.
Stage VIII, entitled Integrity vs. Despair, revolves around the challenge of reconciling fears, regrets, and disappointments. Its resolution requires us to own the totality of life and the wisdom that has come with experience.

Stories are part of the “personal myth” – the meta-narrative that confirms our identity, and satisfies the needs of the ego for meaning, consistency and validation. Many of the stories people tell feature themselves at their centre – sometimes as actor, sometimes as observer. The point of each story is often contained in the teller’s role. Our stories contain what we want the world to know about us.

Research tells us that a disproportionate number of stories emerge from the second and third decades of life – a time when many firsts take place, and when adult identity is being formed.

Perhaps the most important thing to understand about stories is that they are constructed rather than retrieved. In other words, our memories aren’t just sitting there waiting for us to call them up. Remembering and telling stories is a much more active and creative process. Our memories are more like a painting than a photograph. While the image may have been registered in an instant, the final product is rendered over time. We fill in details; we correct flaws; we paint over inconsistencies. Think of the story teller as a minstrel or raconteur, rather than an archivist.

Reminiscences typically privilege the present over the past. We may indulge in some revisionist history in order to make the present make sense. We can be critical of the younger self, as a means of reassuring our older self. We may seek to show what we have learned, and how we are better now as a result of our experience.

Caregiving

There are literally millions of middle-aged and older adults fulfilling caregiving and support roles for their aging loved ones. That role is rewarding in many respects, but it can also be challenging and exhausting. Having to listen to the same stories over and over again can feel like the straw that breaks the camel’s back.

Maybe if we can listen to those stories differently, we can understand them as containing important messages, giving us a chance to know our loved one at a deeper level, and assisting him or her to achieve consolidation and reconciliation of identity.

Story-telling does not exist in a vacuum; rather, it is part of a relationship. It exists in the context of a sender and a receiver. The sender has his reasons for telling a particular story to a particular person, and for highlighting certain details and glossing over others. The ten stories that are told by a husband to his wife will be different from those told by a mother to her son. Furthermore, they will be different for each child, each sibling, each friend.

Listening for the ten stories

Here are some suggestions for listening to uncover your loved one’s Ten Stories:

Focusing on just ten can help make the listening seem less overwhelming.
Be attentive to feelings, sensations, discomfort. These can be clues to the point of the story.
Autobiographical memories typically have 5 characteristics:
1. Sensory vividness – there is often a sight, smell, sound, or even a taste or physical sensation that brings the story to life;
2. Emotional intensity – there is often a strong emotion associated with the story. It can be positive or negative – joy, sorrow, shame, betrayal, pride, to name a few;
3. Repetition — there may be repetition within the stories. The same theme or message may be validated by multiple references;
4. Links – stories often link with one another – characters, locations, or actions may tie one story to another, providing coherence among stories;
5. Tension – there may be unresolved conflict or tension that finds its release in the telling of the story.
Notice your loved one’s role in the story, as the message is often contained in that role.
Write them down. It can be important to step away from them and look at them with some degree of detachment. Writing also challenges you to get the details and sequence right.

Remember that these stories are for you – selected and told in the context of the relationship you have with your loved one. They would be different if they were being told to someone else. It is not the details of these stories that are important – it’s the message. What are the stories about – individually and collectively?

Share your loved one’s stories

We are seeking volunteers to assist us to further this research. We are collecting stories from caregivers and supporters, who volunteer to share with us the stories told to them by their loved ones.

If you would agree to be interviewed about your loved one’s stories, we would be pleased to hear from you.

You can reach us in a number of ways:

Click here to send us a message at yourstory@tenstories.ca.
Call us at 613-533-6000 ext. 78019.
Attend a presentation in your community and sign up there. Unfortunately presentations are temporarily suspended while pandemic restrictions are in force, but watch this space when activities resume.