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

Co-lead: 

  • Allison Kooijman
    UBCO

Team members:

  • Jo Wailing
    Victoria University of Wellington
  • Robert Robson
    Healthcare System Safety and Accountability Inc.
  • Brenda Morrison
    SFU
  • Malcolm MacLure
    UBC
  • Fiona MacDonald 
    Univresity of the Fraser Valley
  • Diane Aubin
    Diane Aubin Consulting
  • Jennifer Llewellyn
    University of Dalhousie
  • Carolyn Canfield
    UBC
  • Deb Prowse
  • Christina Krause
    BCPSQC
  • 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.

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

Co-leads:

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

Trainee:

  • 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.

Exploring women’s experiences in a prediabetes community-based exercise intervention

Dr. Bean will explore women’s experiences throughout their participation in the Small Steps for Big Changes lifestyle counseling program, a community-based exercise intervention for individuals who are living with prediabetes. Interviews with participating women will provide an understanding of women’s attitudes, beliefs, experiences and behaviours related to engaging in a lifestyle community program, in order to best understand the facilitators and barriers to intervention engagement and completion, as well as exercise adherence over the course of one year. 

Women who have been diagnosed as prediabetic but do not have access to a community-based intervention will be interviewed in order to also understand these women’s attitudes, beliefs, experiences and behaviours over the course of the same year. This will help understand the influences and impacts of the intervention program, as well as understand if there is a need for more resources for these prediabetic women. 

Dr. Bean’s research will address several gaps in the current literature, including adopting a qualitative and longitudinal approach and attaining an in-depth understanding of the efficacy of community-based exercise interventions specifically for women. Her findings will be adapted into community learning sessions, which will provide an opportunity for a community of practice to develop for women involved in this study in which they can learn from each other’s experiences. 

 

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.

Improving the implementation and impact of evidence-based health promotion interventions in real world settings

Findings from health promotion research that could help Canadians live healthy lifestyles are often not applied in practice. This gap between health promotion research and health promotion practice is particularly concerning for people with spinal cord injury (SCI). Despite people with SCI's urgent need for interventions that respect their unique challenges and barriers to health behaviour change, there are very few health promotion interventions designed for people with SCI. To ensure health promotion research improves the health of all Canadians, there is an urgent need to improve the use of health promotion research in practice.

The aim of this five-year knowledge translation research program is to examine methods for improving the use of health promotion research in real-world practice. Given the lack of health promotion interventions for people with SCI, this research program will examine how we can improve the use of health promotion evidence to enhance the health of people living with SCI. 

Dr. Gainforth will examine how successful and unsuccessful practitioners apply health promotion techniques when promoting healthy behaviours to people with SCI and develop the first evidence-based guidelines, tools and interventions to improve knowledge translation partnerships between researchers and members of the SCI community. Lessons learned from practitioners will be used to develop and test tools and interventions to help other practitioners successfully promote healthy behaviours to people with SCI.

Ultimately, this research will develop best practices for building capacity among researchers and community members to conduct and share research in partnership. In turn, findings and the approach can support other research teams aiming to use partnerships to conduct and share research that enhances the health of marginalized groups.

Breaking the link between obstructive sleep apnea and cardiovascular disease using a translational experimental approach

Previous research by Dr. Foster has illustrated that angiotensin receptor blockade can abolish the blood pressure response to intermittent hypoxia (IH), reduce oxidative stress and increase nitric oxide bioavailability. In addition, recent work suggests heightened peripheral neurovascular transduction in response to baroreflex activation.

Building on this work, over the next 5 years Dr. Foster will focus on the cardiovascular consequences of IH associated with obstructive sleep apnea (OSA). Since OSA and IH directly contribute to the morbidity and mortality of hypertension, myocardial infarction and stroke, there is an urgent need to establish a treatment capable of protecting OSA patients from IH-induced cardiovascular disease (CVD).

Dr. Foster's research will elucidate the mechanisms by which AT1R antagonists or statins could protect OSA patients from IH-induced CVD. By breaking the link between CVD and OSA, and capitalizing on the pleiotropic properties of angiotensin receptor blockers and statins, this research is ultimately intended to generate a novel treatment. This knowledge will provide the necessary proof of concept for large-scale clinical trials, and will help reduce stress on health care infrastructure and improve the health, quality of life and longevity of Canadians.