Developing a research program on using a restorative approach to address secondary harm to patients, families and clinicians after adverse events in our healthcare system


  • Allison Kooijman

Team members:

  • Jo Wailing
    Victoria University of Wellington
  • Robert Robson
    Healthcare System Safety and Accountability Inc.
  • Brenda Morrison
  • Malcolm MacLure
  • Fiona MacDonald 
    Univresity of the Fraser Valley
  • Diane Aubin
    Diane Aubin Consulting
  • Jennifer Llewellyn
    University of Dalhousie
  • Carolyn Canfield
  • Deb Prowse
  • Christina Krause
  • Devin Harris
    Interior Health
  • Sandi Kossey
    Canadian Patient Safety Institute
  • Jan Byrd
    Canadian Patient Safety Institute
  • Glenn McRae
    Interior Health
  • Wendy Nicklin
    International Society for Quality in Patient Care
  • David Gustafson
    Community Justice Initiatives Association
  • Alika Fontaine
    University of Alberta
  • Derek Puddester
    College of Physicians and Surgeons of BC
  • Ainsley Young
    Island Health
  • Ryan Sidorchuk
    Island Health

Patient harm in providing health services is a significant safety issue. Many efforts have been made to improve patient safety and prevent harm, however high rates of patient safety events continue. When patient harm does occur, there are negative effects for patients, families and health providers involved. Significant barriers prevent healing after harm. Patients have difficulty finding justice, health providers experience shame and self-doubt, and healthcare facilities are concerned with litigation and reputation. This disconnect between the health system (meant to heal) and the justice system (meant to punish) creates confusion for patients and health providers when medical treatment goes wrong. This process can prevent healing for both patients and health providers. A restorative approach builds relationships, shares experiences related to the harm, and focuses on fairness for individuals involved and to society as a whole. Such an approach has not yet been used in healthcare in Canada. This project brings together a team of researchers and knowledge-users to develop a program of research to address priority questions on this approach, to provide solutions for the impacts of harm for patients, families and health providers.

Supporting integration through primary health care teams: A comparative policy analysis across four Canadian provinces

MSFHR is contributing match-funding towards Dr. Nelly Oelke’s research, awarded through SPOR Networks in Primary and Integrated Health Care Innovations – Provincial/ Territorial Comparative Program and Policy grant. Dr. Oelke is undertaking this pan-Canadian project across four provinces (BC, AB, ON, and QC) with a team of researchers including the following PIs: S. Montesanti (AB), S. Johnston (ON), and M. Breton (QC).

Primary health care (PHC) models in Canada continue to change. There are still many gaps in understanding what works and what doesn’t work for PHC teams, specifically, to promote integration and continuity of care for patients with complex needs (e.g. more than one chronic condition). The goal of this research is to study provincial and regional policy documents (guiding principles and courses of action) that support health services integration for patients with complex needs through PHC teams. Patient engagement in developing and applying policies will also be looked at.

This study will include three phases.

  • Phase 1: Collecting and analyzing all policy documents from the four provinces. Individual case reports will be developed and then policies will be compared across provinces.
  • Phase 2: Patient interviews from each province and then a disussion session with those patients to review the results and come up with an action plan.
  • Phase 3: Feedback will be gathered through online and web-based discussions from a broad group of provincial and national stakeholders including patients. These stakeholders will be asked to develop recommendations and actions based on the research results.

The results of this study will provide a better understanding of BC’s current policies for PHC teams, and how these support or create barriers to integrated health services delivery. It will also provide a better understanding of how BC patients and caregivers are involved in developing and applying policies in this area. Given BC’s focus on primary health care transformation, these will be most beneficial in supporting change.

Finally, the study will provide a set of leading national practices for integrated health services delivery through PHC teams that will be helpful to all participating provinces, other provinces in Canada, and internationally.

End of Award Update: May 2022

Most exciting outputs

1. Primary Health Care (PHC) teams need to be integrated at the individual level (at the point of care to improve patient’s care), PHC teams also need to be integrated at the health system level to facilitate integrated health services delivery.

  • Clearly defined roles for team members are needed for effective PHC teams.
  • Strong support for co-located teams, but not always feasible given geography, and the increase in virtual care. More research is needed in comparing co-located and virtual teams, particularly in today’s context of increased virtual care delivery.
  • Interoperability and access to electronic health records, impacts team functioning. An accessible and shared electronic health record is needed for teams to function effectively.
  • Financial remuneration models continue to impact effective functioning of PHC teams.
  • Limited structure and information exist on performance measurement in PHC teams and integrated health services delivery. More work is needed at both the clinical and health system levels in performance measurement.

2. Ontario was more advanced in terms of engaging patients in policy activities, however, patients, family members, and caregivers who were engaged had similar experiences in policy engagement across the provinces. Patients were more often engaged in the development of policy, but engagement throughout the policy process (development, implementation, and evaluation) was much less clear.

3. Three key themes were identified: motivation for policy engagement, experiences with policy engagement, and barriers to engagement in policy, such as opportunities for engagement, power imbalances, tokenism, bureaucracy, accessibility, racism, sexism, and ageism.

4. Training in policy for patients, family members, and caregivers is needed to be better engaged throughout the policy process.

5. Opportunities for patients, family, and caregivers to engage in policy should be increased to facilitate inclusiveness and increase the diversity of perspectives.

Impacts so far

Our policy analysis on PHC teams and integrated health services delivery in four provinces in Canada, is to our knowledge the first of its kind. Our research results have been shared and we have discussed the same with the Primary Care, BC Ministry of Health. We have also shared the results of patient engagement in PHC policy with various stakeholders via the Putting Patients First Conference and the Canadian Association for Health Services and Policy Research Conference. Policy analysis results were also shared with international audiences through conferences and publications.

Potential future influence

Our research results have the potential to improve integrated health services delivery through PHC teams and to increase patient, family member, and caregiver engagement in PHC policy. The findings of the study can be utilized by other projects investigating what really makes PHC teams work, and which also include a policy analysis as well.

Next steps 

Knowledge translation: A virtual national knowledge translation event with patients, researchers, policymakers, decision-makers, and providers to share the results, as well as gather feedback on the findings. We will also share the results via plain language summary, infographics, and publications in academic journals.

Useful links


Engaging Patients, Family Members, and Caregivers in Policy for Primary Health Care Teams Integration (Putting Patients First Conference, March 2022)

Autism community connects: A co-design web-platform to facilitate the uptake of research evidence by families


  • Suzanne Lewis
    Pacific Autism Family Network / University of British Columbia
  • Dawn McKenna
    Pacific Autism Family Network

Team member:

  • Caylee Raber
    Emily Carr University


  • TBC

The objective is to support research dissemination and knowledge translation in the autism spectrum disorders (ASD) community by co-designing a web-platform that will facilitate the uptake of research evidence by families and individuals with ASD. This platform will link research users to credible sources of information, research, and services by acting as a knowledge broker and research wayfinding system.

ASD is a growing condition impacting society in profound ways; it is the most common neurological disorder in children, affecting approximately 60,000 people in BC. There is an urgent need for a more fulsome approach to the dissemination of knowledge to families about best practices, new research, evidence-based treatments and support. Families are essentially left to their own devices to make critical decisions about what services are most beneficial for their child and hence where best to direct their funding. This is critical because the earlier treatment is started, the better the outcome.

The Pacific Autism Family Network’s (PAFN) mandate is to be a Knowledge Centre of Excellence: bringing together state of the art resources for research, information, learning, assessment, treatment and support across BC. Since 2015, PAFN has collaborated with the Health Design Lab (HDL) at Emily Carr University to better understand the communication challenges and needs of researchers and families in the ASD community. Through this collaboration in 2016/17, it was found that access to reliable and credible research for families is a significant challenge due to barriers including time, money, location, language and format. To improve knowledge exchange, researchers and families identified the need for a web-platform that will curate credible ASD research for families and disseminate it through more diversified and accessible communication modes.

To meet this challenge of co-designing the web-platform, workshops with the ASD community will be held. Based on input from researchers and research-users, the HDL will design and prototype a web-platform. This will facilitate knowledge exchange and support research users (families and self-advocates) in making informed decisions based on best-practice research. It will also enable researchers to connect with families to support their research endeavors creating direct linkages and ongoing connectivity with the ASD community.

Symposium for supporting safe and active recreation for Okanagan families with children living with autism


  • Lise Olsen 
    University of British Columbia – Okanagan
  • Rachelle Hole
    Centre for Inclusion and Citizenship / University of British Columbia
  • Vicki Cairns
    Autism Okanagan Kelowna

Team member:

  • Alison McManus
    University of British Columbia – Okanagan 


  • Matthew Ferrier
    Undergraduate student
  • Zarka Kiktavy
    MSW student
  • Crystal Shannon
    MSN student

This project aims to communicate and stimulate stakeholder interest in developing strategies to better support Okanagan families with autism spectrum disorder children, thus enabling them opportunities to pursue safe and active recreation.

The activity will be a one-day symposium at the Okanagan campus with a proposed date of March 2018. The short term goals are to share research findings and build a stronger network and researcher/practice connections. The long term goals are to build a community of interest, identify and agree on key areas of needed practice and policy change in the Okanagan, and develop a strategy through a funding proposal to enact such changes. Specific objectives of this activity include:

  1. For a symposium planning group to oversee the development of the symposium activities and strategies.
  2. Raising awareness among stakeholders about research in this area.
  3. Providing a forum for interaction between attendees and researchers on this topic.
  4. Providing an opportunity for stakeholders in the Okanagan communities to become involved in developing an ongoing plan based on current research evidence for furthering research and intervention development.

Engaging champions in the process of embedding a type 2 diabetes prevention lifestyle program into a community setting: A collaborative approach


  • Mary Jung
    University of Bristish Columbia Okanagan
  • Karlene Sewell
    YMCA Okanagan


  • Tineke Dineen
    University of British Columbia Okanagan
  • Corliss Bean
    University of British Columbia Okanagan

Translating effective health interventions into the community are often not applied in practice. The gap between research and practice is concerning for community members who can benefit from early access to effective health interventions. Knowledge translation (KT) activities and community partnerships are demonstrated methods to close the gap, yet there is a need for quality partnerships to ensure research findings are implemented into communities so it ensures sustainability, rigour and quality programming through planning, preparation and time to foster the partnership.

KT events can include dissemination and uptake of research evidence to further inform programming. Through a partnership between the YMCA of Okanagan, a leader in community programming, and the Small Steps for Big Changes (SSBC) research team, a group with an evidence-based program for improving health and exercise adherence in individuals with prediabetes, an influential partnership began with a goal to translate the SSBC program into the YMCA.

In this proposed work, the event aims to formally unite the two partners and establish a common goal, mission, vision and values. A key outcome is to establish a plan for the pilot of embedding the SSBC program into three YMCA locations within the Okanagan community. This plan is significant to the successful translation and sustainability of the program. Key to the success of the partnership is agreement on all aspects of the translation. The proposed work includes multiple translation events to work towards a long-term, successful partnership.

Vital to the collaborative nature of the partnership, feedback from YMCA of Okanagan managers, staff, past participants and present SSBC trainers will optimize the planning stages. Input from all parties will be collected and combined into a suitable plan, an appropriate training program, timeline for the translation, usability of program documents by YMCA staff and the respective roles of the YMCA and SSBC research team in program sustainability and ongoing fidelity. Finally, a video knowledge product will document the process of the partnership, with information about the program, outcomes and the partnership using video footage during the meetings and voice-over from SSBC alumni and YMCA staff. The knowledge product will be used for promotional material for distribution via each partner’s respective media platforms.

Incorporating practical, high-intensity interval training (HIIT) into the workplace: Examining the impact on physiological and psychological health, absenteeism, and work productivity

Among office workers, physical activity has been shown to have the potential to improve absenteeism, work productivity and psychological and physical health.

Dr. Stork’s research will incorporate physical activity into the workplace using high-intensity interval training (HIIT) – short-duration exercise that consists of multiple brief, high-intensity efforts, separated by periods of rest.

In Phase 1, physically inactive office employees will undergo an 8-week HIIT program of either one daily HIIT session completed during lunch break, or brief exercise bouts dispersed throughout the workday as 'exercise snacks.' Phase 2 will deliver an 8-week optimized HIIT program designed for sustainability based on a process evaluation of Phase 1. Dr. Stork will measure physical and psychological health, physical activity behaviour, absenteeism and work productivity immediately and up to six months following the program.

The HIIT programs will be implemented in Kelowna's Landmark Centre office towers. Community partners will be engaged early on in the research process to work together to successfully ensure that the program is evidence-based and implemented in a sustainable manner that adequately serves the community. The HIIT programs implemented will undergo a process evaluation to better understand the barriers and facilitators and to optimize and tailor the design and delivery of future programs.

Effect of exogenous ketone supplementation on brain blood flow, metabolism, and cognitive function in Type II Diabetes

Exogenous ketone body (KB) ingestion is an emerging therapeutic strategy for combating the harmful health conditions associated with type 2 diabetes (T2D), including a heightened risk for neurological disease and cognitive decline.

Evidence from animal models and early studies in humans supports its potential; however, high-quality research trials examining the effect of KB ingestion on brain function in humans with T2D have not been performed.

Dr. Walsh’s research will investigate the acute (single dose) and short-term (14 day) effects of KB supplementation on aspects of brain function in people with T2D, including measures of cognition (i.e., memory and attention) and circulating growth factors related to cognition.

The results of this research will help determine the therapeutic potential of exogenous KB supplementation for improving brain, vascular, and metabolic health in people with T2D.

Innovative uses of technology to prevent secondary events after stroke

Stroke is a leading cause of death and disability in Canada, costing our economy $3.6 billion per year. More than 405,000 people are currently living with the effects of stroke. This number is expected to rise to 720,000 by 2038.

We all know that a stroke is an emergency health issue requiring immediate medical attention. Fewer people, however, know that strokes also have long-term health effects that patients live with on a daily basis, including muscle weakness and balance and coordination issues. Unlike other diseases with long-term health effects, such as heart failure and diabetes, there has been little research to improve the health services provided to stroke patients after they return home from the hospital. As a result, it is common for these people to have another stroke, have many hospital visits, and report other health issues. More research is needed to improve the access to and delivery of health services to stroke patients to better manage their health over time.

The purpose of this five-year research project is to improve long-term care for stroke patients. Dr. Sakakibara will work with stroke patients to ensure the research focuses on what is important to them, and then evaluate new programs (delivered using mobile technologies and the internet) to help patients plan their return home from hospital; improve lifestyle behaviours to prevent other health issues; and better manage their health and well-being for long-term health benefits.

Translating an exercise program for adults at high risk for type 2 diabetes to the community

Type 2 diabetes (T2D) is a chronic disease with serious health implications (e.g., cardiovascular disease) that can be prevented with lifestyle changes. Lifestyle-based interventions are particularly needed in the community to help reduce the incidence of chronic disease in Canadian adults, and are critical for preventing T2D. 

For example, the Diabetes Prevention Program (DPP) is a lifestyle change program that promotes healthy eating and physical activity. This program translates to a 58% risk reduction for developing T2D for individuals who maintain 150 min/week of moderate physical activity and lose 7% of their body weight. However, the DPP is less sustainable in community settings because it is costly and lengthy (~12 months long). Diabetes prevention programs are needed that can be implemented and scaled up in the community for adults at high risk of developing T2D.

Towards the pursuit of preventing T2D with brief-behavioural interventions, the Health and Exercise Psychology Laboratory at UBC Okanagan developed a diabetes prevention program called Small Steps for Big Changes, which has proven effective in enhancing health outcomes of low-active adults at risk for diabetes and, excitingly, demonstrates long-term physical activity adherence.

Given the promising findings, knowledge translation research is needed to ensure successful research uptake of Small Steps for Big Changes into the community. The aim of Dr. Ivanova’s research will be to translate this evidence-based exercise intervention for use in the community with adults who are at risk for T2D.

Small Steps for Big Changes will be implemented in a YMCA centre (Kelowna, BC) to ensure that this evidence-based program is integrated in a sustainable manner and that it adequately serves the community. The Knowledge-to-Action (KtA) framework will be used to guide this knowledge translation effort, and the results of this research will be the development of knowledge products, namely manuals for Small Steps for Big Changes, a two-day train-the-trainer workshop, and audiovisual training materials that will be used to train the knowledge users how to deliver Small Steps for Big Changes. 

Dr. Ivanova will co-lead the sharing of these results, alongside research end users, guiding the path for sustained use of Small Steps for Big Changes at the YMCA and for feasible continued scale-up. 


Optimizing lifestyle approaches for the prevention and treatment of type 2 diabetes

The rising incidence of type 2 diabetes (T2D) puts financial stress on health care systems in British Columbia and across the world. Lifestyle interventions can improve cardiometabolic health to prevent or treat T2D, but optimal lifestyle strategies (e.g. exercise intensity, type, timing; diet composition) are not well-defined and adherence is notoriously poor.

The goals of Dr. Little's research are to optimize lifestyle interventions for improving cardiometabolic outcomes and uncover potential mechanisms underlying these health benefits. The research program aims to improve cardiometabolic health and reduce inflammation via a series of translational studies to define the optimal exercise and diet strategies and uncover cellular mechanisms underlying the benefits. To translate findings for true health impact, YMCA has partnered to implement an HIIT walking intervention in the community. In addition, a randomized controlled trial will be implemented to evaluate the effectiveness of a pharmacist-led intervention, implemented through a network of 13 BC pharmacies, to teach patients with T2D how to follow a low-carb, high-fat (LCHF) diet while also reducing their medications. This has tremendous potential to change diabetes management in BC through an innovative pharmacist-led therapeutic nutrition program using LCHF diets.

The long-term goals of this research will be to develop optimal evidence-based exercise and diet interventions that improve patient health and inform clinical practice guidelines for the prevention and treatment of T2D. Elucidation of the cellular and molecular mechanisms underlying the anti-inflammatory effects of exercise and diet approaches will also be used to define the best anti-inflammatory lifestyle interventions, and identify potential therapeutic targets for prevention and treatment of T2D.