Practice-based research and innovation: an overview

Engaging all our health professionals in inventing the future of health care

Sunnybrook has 1.2 million patient visits each year. It is the largest single-site, research-intensive teaching hospital in Canada, and is fully affiliated with the University of Toronto. Donor support is enhancing Sunnybrook’s ability to provide outstanding quality clinical care, offer expert training to health care professionals, and conduct groundbreaking research that changes the way patients are treated locally and around the world.

Aligned with its vision of inventing the future of health care, Sunnybrook has launched a practice-based research and innovation strategy under the leadership of Lisa Di Prospero, who has a clinical background in radiation therapy and an M.Sc. in molecular radiation biology.

“The focus is on engaging health professionals to critically examine and improve their practice to advance high-quality and evidence-based patient-centred care,” she says. “The strategy is founded on the belief that those who directly care for patients and families know what needs to be improved and how best to improve it.”

Supported by donors, Sunnybrook awards innovation fellowships and practice-based research seed grants through a competitive process to enable health professionals to critically examine and improve their practice.

Innovation fellowships

Innovation fellowships offer clinicians the opportunity to develop and implement innovative quality improvement projects to improve patient and family care at Sunnybrook. Staff are given two days per week away from their regular positions over six months to work on these projects.

Fellows also engage in weekly seminars where they learn with peers about leading change in a complex academic health organization, how to manage a project and how to engage with stakeholders and members of the interprofessional care team for a successful and sustained project outcome.

Graduates of the fellowship program often:

• continue as informal leaders on their units and take on new quality improvement initiatives
• pursue further education
• move into formal leadership roles.

The cost of a fellowship is $22,500. All funds are used to ensure that patient care needs of the unit are fully covered while fellows work on their projects.

Meeting geriatric patients’ needs in the Emergency Department

Sunnybrook staff noticed that geriatric patients were coming to the emergency department (ED) with both acute medical and complex functional needs. While the ED team was well positioned to meet the medical needs of these patients, they were often unable to meet the need for functional assessment and comprehensive care planning. In some cases, patients were sent home at risk of falling and having to come right back to the ED.

“Our emergency department staff identified that these patients were not seeing the right health care provider at the right time,” Di Prospero says. “They identified a gap in practice.”

In response, occupational therapist (OT) Emily Stairs and physiotherapist (PT) Meghan Kinlin, were awarded an innovation fellowship to create an integrated OT/PT role in the ED called the FACTeam, short for the functional assessment consult team.

This new and integrated rehabilitation professional role provides functional assessment of physical, cognitive and psychosocial abilities of older patients in the ED. They ensure patients experiencing significant functional decline are either admitted to hospital or sent home with the necessary supports in place for a safe recovery.

Practice-based research seed grants

At $11,250 each, seed grants provide clinicians support to perform high-quality research focused on advancing practice for high-quality patient care. Seed grants come with no protected research time, but recipients do receive educational support and mentorship.

Seed grant funds can be used to buy the time of a research assistant to recruit participants and collect data, to purchase equipment or software, or to cover the costs of transcription or poster printing. Two years is allotted to complete each project. Study results are shared through internal presentations and externally through conference presentations and publication.

“The program gives health professionals who have an interest in research and improving care the opportunity to learn about the research process and participate in or lead clinical investigations,” says Di Prospero. “The experience can also lead to a new career trajectory in advanced practice or in research. Essentially, we are building our own future leaders and scientists.”

Decreasing wait times for patients in a specialty shoulder clinic

Patients with shoulder pain who wait a long time to see an orthopaedic surgeon often suffer significant pain and loss of ability to participate in daily activities such as lifting children, driving, playing sports or gardening. Productivity losses and paid sick leave amount to millions of dollars each year.

Dr. Helen Razmjou, an advanced practice physiotherapist (APP), and her team received a practice-based research grant to examine the success of a new service model implemented at Sunnybrook’s Holland Centre. This model expanded the role of APPs who are physiotherapists with graduate degrees and have extensive orthopaedic clinical experience.

Here, patients in the shoulder clinic are now assessed by an APP rather than waiting much longer for an appointment to see a surgeon. The APP examines the patient and recommends treatment that might or might not lead to surgery. Razmjou’s research examined agreement between the orthopaedic surgeon and the APP on assessment, diagnosis and management plans, along with comparative wait times and patient satisfaction.

Her study, published in Physiotherapy Canada in 2013, found that agreement between the APP and orthopaedic surgeon was excellent. Patient satisfaction increased in APP-led clinics and wait times decreased substantially.

Supporting professionals to improve care

“It’s about creating a culture of inquiry,” Di Prospero says. “The only way we are going to invent the future of health care is if we have every health professional questioning their practice and striving to improve it every day. This is how we will achieve best patient and family care at Sunnybrook. Philanthropic support at all levels is critical to allowing Sunnybrook to offer these essential opportunities that will benefit our health professionals and ultimately patients.”

Fellowships and seed grants are available through a competitive process for Sunnybrook staff. See costs outlined below. Donor support will help us build this new program, ultimately enhancing our ability to provide optimal care for our patients and their families when it matters most.

If you have any questions about the practice-based research and innovation overview, contact:

Jessica Carn
Advancement director
Sunnybrook Foundation
Phone: 416-480-4560
Email: jessica.carn@sunnybrook.ca

Lisa Di Prospero
Director practice-based research and innovation
Sunnybrook Health Sciences Centre
Phone: 416-480-6100 ext. 689513
Email: lisa.diprospero@sunnybrook.ca

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