Exploring Indigenous community access to airway health prevention and care: Towards the development of community-driven interventions

Indigenous peoples across Canada continue to be disproportionately impacted by respiratory diseases (RD) (i.e. asthma, COPD, long COVID); however, there is limited evidence describing their Indigenous peoples respiratory healthcare needs and ways in which respiratory healthcare services can be improved. Given this knowledge gap, this project seeks to engage Indigenous peoples with RD to understand their experiences living with RD; to explore Indigenous peoples’ healthcare experiences; and to identify promising practices that can improve the treatment experiences and outcomes among Indigenous peoples with RD. In order to accomplish this, we plan to hold a minimum of five talking circles with Indigenous peoples with RD across urban and rural areas of the Vancouver Coastal Health (VCH) region. A graphic facilitator will guide a journey mapping exercise with community members in order to understand community members’ experiences when attempting to access services, while also elucidating promising practices in the treatment of RD. In addition to the benefits that this project may have for the health of Indigenous peoples in the VCH region, findings also have implications for Indigenous peoples living in other parts of British Columbia.

Implementing quality indicators through clinician and patient online toolkits to improve rehabilitation care and outcomes after hip and knee replacement for osteoarthritis

Each year, more than 18,000 British Columbians have joint replacement surgery for hip or knee osteoarthritis. Many face challenges in getting timely, quality rehabilitation before, and especially after surgery. I have developed quality indicators that set minimum standards of rehabilitation care for joint replacements. Focusing on 10 of these quality indicators for care after surgery, my team of clinicians, patients and researchers have created online toolkits to help make these indicators available to patients and clinicians who provide joint replacement rehabilitation in BC. The toolkits contain resources such as checklists, videos, and posters. After first testing our study procedures, I will run a study to see if the toolkits make a difference in overall quality of rehabilitation care and lead to better experiences and results for patients. Patients, clinicians and those who make decisions about healthcare services, will be part of every stage of this work. I will share my findings widely to researchers, clinicians and patients locally and across Canada. This research will lead to better, more consistent care for patients and improve the joint replacement rehabilitation services available in BC.

Informing the COVID-19 Response for Vancouver’s Urban Indigenous Population Using Community-driven Methods and Big Data Analytics

COVID-19 poses a significant threat to Urban Indigenous populations. To identify gaps and improve the response, Vancouver Coastal Health Aboriginal Health will use a community-driven approach to examine patient data collected within Vancouver health centres using the Vancouver Community Analytics Tool (VCAT), along with the advice of key urban Indigenous community organizations and stakeholders. Analyzed data will be used to develop an extensive data profile of Indigenous peoples who access care in the Vancouver region, including COVID-19 risk, comorbidities, and impacts to health service access. We will review the current Urban Indigenous COVID-19 response in Vancouver with existing networks to develop recommendations for BC that are driven by and for the Urban Indigenous community.

Evaluating the response to British Columbia’s overdose crisis within Vancouver Coastal Health: Moving research into practice

The opioid crisis has been hardest felt in British Columbia (BC), which declared a public health emergency in 2016. Last year, there were 1510 drug overdose deaths recorded in BC, which represented 4.5 times the deaths from motor vehicle accidents. The overdose crisis has been largely driven by increasing contamination of the illicit drug supply with powerful synthetic opioids (e.g., fentanyl). Despite efforts to expand harm reduction services and treatments for opioid use disorder, these have had limited success in curbing the current crisis. Innovative strategies to mitigate the crisis have become an urgent public health priority. This includes a critical need to evaluate the response to the overdose crisis to help develop and implement a comprehensive addiction treatment program across BC and ultimately prevent future drug-related fatalities. Vancouver Coastal Health (VCH) provides services to more than 1.25 million residents in BC (nearly 25% of the population), and has been a primary player at the heart of the overdose crisis response. As such, alongside the newly implemented VCH Regional Addiction Program, VCH has identified key policy-related challenges that the proposed work will seek to address: prevent fatal overdoses, reduce drug-related harms, increase access to low barrier services, and improve integration of harm reduction and treatment. The proposed work will consist of several overlapping components to achieve the overarching goal to establish comprehensive and integrated addiction care programs across the region. This will include evaluating the impacts of 'naturally occurring' interventions (e.g., supervised consumption sites) and efficacy of novel clinical therapies, conducting health system and program evaluation to identify gaps in care and healthcare provider capacity, and engaging in integrated knowledge translation to mobilize research into evidence-based policies and practices across the health system.

The implementation of an Indigenous cultural safety initiative within a large urban hospital in Vancouver, British Columbia

Co-leads:

Executive sponsor:

  • Patricia Daly
    VCH

Vancouver Coastal Health (VCH) Aboriginal Health is implementing an Indigenous Cultural Safety initiative with two units at Vancouver General Hospital (VGH) to improve the experience of Aboriginal patients and clients at VGH. The units, which include 350 VGH staff members, will complete a number of activities during March 2018 – March 2019.

This project will examine the implementation of the cultural safety initiative through a research team guided by two-eyed seeing, Indigenous cultural principles and implementation science frameworks for the purpose of guiding future spread of cultural safety training across diverse health authority settings.

The learnings from this pilot project will be used to spread the approach to other VGH departments and ultimately other hospital sites and facilities across BC. A number of hospital-wide and unit-specific activities will be piloted, falling into four streams:

  • Creating a welcome space: Visible acknowledgements of local First Nations (artwork, signage, booth displays etc).
  • Culturally competent VGH staff: Three hours Indigenous Cultural Safety training, 30 minute education sessions, monthly presentations by local chiefs, staff learning resources, webinars, and creation of advocacy roles.
  • Cultural resources and policies: Communications, patient cultural safety/support, and traditions and protocols booklets.
  • Access to cultural supports: Elders and Aboriginal patient navigators.

The indicators of success will be jointly developed in partnership with an Aboriginal advisory group to be convened at the conception of the study. It is key that the indicators of successful transformation reflect the needs of the Aboriginal patients served by the system. This will include indicators such as staff and patients reporting an observed change in the look and feel of VGH, improvement in cultural safety knowledge and understanding among VGH pilot unit staff level, staff perceptions of how practice will change as a result of attending training and education sessions, and staff perceptions of their ability to advocate for Aboriginal patient issues (allyship).

Vancouver community health research through an Indigenous lens: A collaborative learning workshop using two-eyed seeing

Co-leads:

  • Leslie Bonshor
    Vancouver Coastal Health
  • David Hall
    Vancouver Coastal Health
  • Michael Norbury
    Vancouver Coastal Health
  • Andrew Day
    Vancouver Coastal Health
  • Laurel Jebamani
    Vancouver Coastal Health
  • Krisztina Vasarheiyi
    Vancouver Coastal Health
  • Brittany Bingham
    Simon Fraser University

Trainee:

  • Teila Gabriel
    University of British Columbia
  • Andreas Pilarinos
    University of British Columbia

Indigenous peoples experience disproportionately poor health and social inequities as the direct result of Canada’s colonial history, including the Indian Act and Residential Schools. Indigenous people face discrimination in accessing health services and are often underrepresented in health research.

The Truth and Reconciliation Commission’s 94 Calls to Action demonstrate the need for system-wide transformation for creating Indigenous cultural safety within health systems. Call to Action 23 calls on all levels of government to improve cultural competency of healthcare professionals. Culturally safe care requires providers to understand how power dynamics created by colonization persistently affect Indigenous people’s health. The regional Aboriginal Health Program at Vancouver Coastal Health is leading innovative activities that use Indigenous methodologies to facilitate system-wide culture change, including cultural safety training at a large acute care facility, embedding Elders and Knowledge Keepers in care systems, and providing cultural practice guidelines to front-line staff.

A Two-Eyed Seeing research team will be formed to integrate Western and Indigenous perspectives on health research. The team will engage with Indigenous communities in three focus group sessions in fall 2018. Feedback will be provided on: respectfully conducting health research with/for Indigenous people; ways research can genuinely serve — not tokenize — communities participating in studies; and the health and wellness themes of highest priority to communities. Focus groups will be held with: (1) Indigenous women attending the Necamat Aboriginal Women’s Village of Wellness held in October in Vancouver’s Downtown Eastside; (2) Musqueam First Nation; and (3) Vancouver General Hospital Indigenous Peoples Advisory Group.

A knowledge translation team — consisting of (at least) one community representative, one knowledge user with knowledge translation expertise, and trainees — will synthesize community feedback to inform the development of content for Research Day and to produce a final report for knowledge dissemination.

The Research Day will be hosted by Vancouver Community health services at Vancouver Coastal Health in spring of 2019 to expand awareness of Indigenous perspectives on health and research among Vancouver Community staff. The morning will include a traditional opening by an Elder, a community panel discussion to explore themes of the focus group sessions, and a keynote presentation. Respected Indigenous leaders and researchers will speak and moderate discussions. In the afternoon, 25 registered Vancouver Community health researchers will attend a workshop on cultural safety and Indigenous research methods.

Evaluation of Collaborative Practice Project

The focus of this evaluation program will be the impact of Collaborative Practice on three residential facilities: Banfield Pavilion, Evergreen House and Minoru Residence. Collaborative Practice Program has two key characteristics: 1) it is an approach to matching staff to patient needs through participation of nurses, unions, professional practice and clinical and operational leaders; 2) it promotes a team-oriented model of nursing care. The purpose of the evaluation will be to assess and compare the impact of the program at these three sites on health human resources and patient outcomes.

The evaluation of Collaborative Practice will include six main areas of focus:

  •     impact on clinical outcomes
  •     impact on health human resources
  •     nursing staff engagement
  •     consistent collaborative approach to care
  •     impact on clinician roles
  •     productivity