CASE 15: When the Midnight Train is the First of Many: Dealing with Irregular and Unsafe Railway Crossings in the City of London

While visiting a local school, the mayor of London was asked a simple question by a grade three student: “why aren’t there flashing light barriers at all railway crossings that are close to the places where children play?” The mayor did not have an answer to this question or the many other questions that went along with it, but he knew something needed to be done. But what? And by whom? Rail crossings in London are typically prone to risk. In Canada, only 17% of all 17,000 railway crossings have gates, and the primary purpose of these gates is to control motor vehicles. London residents remain frustrated by the delays caused at rail crossings on busy commuter roads. Residents are also concerned about the lack of safety mechanisms at smaller, low-traffic streets. Trains fall into a jurisdictional triangle. Many organizations, local municipalities, and provincial and federal ministries are involved in building and overseeing railways. All parties must work collaboratively to improve safety on the more than 17,000 rail crossings across the country. Decisions about how to move forward with this issue are complex and require mass consultation from government agencies such as Transport Canada and from railroad companies such as Canadian National Railway, Canadian Pacific Railway, and VIA Rail Canada. Pedestrians need to be educated about the dangers of crossing railway tracks. Railway police often give presentations to children and educate them about the risks associated with public rail crossings and trespassing on railway property. In recent years, the number of railway police officers has declined. Cities such as London are no longer able to have police at rail sites. Something needs to change in the City of London and the surrounding area to improve rail safety and prevent further tragedies. Operation Lifesaver believes more education and awareness will help. Community members are pushing for the installation of more active systems but spending more money on rail safety is not always politically favourable. What needs to be done, and by whom, remains uncertain. With so many organizations and groups involved, it is difficult to determine who should ultimately be responsible for this dilemma. Because the reality of train safety in London is not changing, the need to address the concerns about this issue is essential. Unfortunately, London has several dangerous rail crossings that lack gates or other physical barriers to block the crossing. The main concern is the safety of pedestrians at these sites

Case 16 : When the Midnight Train is the first of many: Dealing with Irregular and Unsafe Railway Crossings in the City of London

While visiting a local school, the mayor of London was asked a simple question by a grade three student: “why aren’t there flashing light barriers at all railway crossings that are close to the places where children play?” The mayor did not have an answer to this question or the many other questions that went along with it, but he knew something needed to be done. But what? And by whom? Rail crossings in London are typically prone to risk. In Canada, only 17% of all 17,000 railway crossings have gates, and the primary purpose of these gates is to control motor vehicles. London residents remain frustrated by the delays caused at rail crossings on busy commuter roads. Residents are also concerned about the lack of safety mechanisms at smaller, low-traffic streets. Trains fall into a jurisdictional triangle. Many organizations, local municipalities, and provincial and federal ministries are involved in building and overseeing railways. All parties must work collaboratively to improve safety on the more than 17,000 rail crossings across the country. Decisions about how to move forward with this issue are complex and require mass consultation from government agencies such as Transport Canada and from railroad companies such as Canadian National Railway, Canadian Pacific Railway, and VIA Rail Canada. Pedestrians need to be educated about the dangers of crossing railway tracks. Railway police often give presentations to children and educate them about the risks associated with public rail crossings and trespassing on railway property. In recent years, the number of railway police officers has declined. Cities such as London are no longer able to have police at rail sites. Something needs to change in the City of London and the surrounding area to improve rail safety and prevent further tragedies. Operation Lifesaver believes more education and awareness will help. Community members are pushing for the installation of more active systems but spending more money on rail safety is not always politically favourable. What needs to be done, and by whom, remains uncertain. With so many organizations and groups involved, it is difficult to determine who should ultimately be responsible for this dilemma. Because the reality of train safety in London is not changing, the need to address the concerns about this issue is essential. Unfortunately, London has several dangerous rail crossings that lack gates or other physical barriers to block the crossing. The main concern is the safety of pedestrians at these sites

Case 3 : “School, Interrupted”

Due to the fact that there is currently no national youth mental health strategy, each jurisdiction is faced with managing and preventing mental health issues in their communities. Through school-based mental health interventions public health professionals have the potential to impact a large portion of youth in their community in a setting with which youth are already familiar. Susan Miller, a health promoter with the Great Lakes Public Health Unit, has been tasked with making recommendations about what type of mental health intervention should be implemented in the local elementary and high schools. The main objective of this mental health intervention will be to enhance protective factors among youth as well as to decrease the risk factors that can lead to developing further mental health issues in adulthood

CASE 14: Hiring a Competent Health Promoter: Can Competency Statements Help?

Saraz Frasier has been the manager of Special Programs and Healthy Communities at her health unit for the past five years. She is a true trailblazer within her organization. Saraz has helped transform her team into an innovative, progressive, and health equity-driven team. This team is responsible for promoting health, planning, conducting, and implementing health initiatives and health programs, working with community partners, developing policy, and reducing disparities within the community. Saraz has recently been tasked with hiring a new health promoter for her Healthy Communities team. This new hire will help lead Saraz’s team in health promotion and help plan special health programs. She is determined to find a candidate who will understand and contribute to her team’s current dynamic, work ethic, and equity-related priorities, and to the organization’s vision and desired culture change. The top three candidates were already interviewed this past week. Saraz now needs to decide who the best person is for this position. As she is thinking about finding a reliable way to evaluate and compare the three excellent candidates, Saraz opens her email only to find a webinar on the Pan-Canadian Health Promoter Competencies. It’s a sign! She will use the Competencies to evaluate and compare her three candidates in order to hire the best person for the job. The Pan-Canadian Health Promoter Competencies outline the skills, knowledge, and abilities that health promoters should possess to fulfill their mandate efficiently and adequately (Health Promotion Canada, 2015). These Competencies serve as a framework upon which health promoters, and others who work within health promotion, can base their work and practice their skills in targeting health, health equity, and the social determinants of health (Health Promotion Canada, 2015). Saraz can strategically use these competency statements to create a profile of the perfect candidate for the position, based on the skills, abilities, and knowledge that she requires, and then compare the three qualified candidates to this profile. The candidate who best reflects the Health Promoter Competencies and Saraz’s ideal candidate profile must be chosen soon, as these skills are required to undertake the type of work conducted by the exemplar Healthy Communities team at Saraz’s health unit. All three of Saraz’s candidates are competent, skilled, and knowledgeable. Saraz is looking for an innovative leader who possesses the required education and experience, and understands and values the complexities involved in public health. Saraz has to take one last look at her candidates, using the ideal candidate profile she has developed based on the Competencies, to determine who is most likely to best fulfill her expectations of a competent health promoter

Case 12 : Policy Meets Practice – People Who Inject Drugs (PWID)

Dr. Silverman is the Chief of Infectious Diseases at London Health Sciences Centre (LHSC) and St. Joseph’s Health Care in London, Ontario. He is concerned about the increasing prevalence of people who inject drugs (PWID) in London, and the risk to PWID of bacterial infections due to contamination (e.g., improperly or unsterilized injection equipment, skin not being sterilized before injection). Of primary concern is the risk of infective endocarditis (IE), an infection in a patient’s heart. Treatment for IE entails antibiotics administered through the intravenous (IV) route. IE is generally treated through home care; in London, the South West Community Care Access Centre (CCAC) is responsible for delivering home care. To treat IE at home, a patient would need a peripherally inserted central catheter (a PICC-line) and assistance from a CCAC nurse to administer the antibiotics. This option, however, is not viable for some patients, including those who fall under the category of PWID or who may not have a fixed address. In the case of PWID, the PICC-line, in effect, becomes a “highway” for injecting other drugs; in instances where a patient may not have secure housing or be homeless, the CCAC nurse may not be able to track down the individual. When a patient in one of these situations is being treated for IE, it puts the care team in a difficult position. The alternatives to home care are hospital admittance or no treatment at all, neither of which are ideal solutions. Dr. Silverman is currently in this position, as he must decide on a treatment plan for Mr. W., a patient who has IE, has struggled with drug addiction (the likely cause of his IE), and who does not have stable housing. In making his decision, Dr. Silverman has included on Mr. W.’s care team two other physicians from LHSC, a representative from the CCAC, and the managing director of London CAReS, a community-based housing-first organization. The care team must determine the best treatment plan for Mr. W

Case 17 : Can Hospitals do Health Promotion? Making Hospitals a Place for both Care and Health through Health Promotion

Lauren Kitsman trained as a health promoter and is now working for a hospital. She has been tasked with implementing a health promotion approach in her hospital and has tried to understand the health issues at the hospital and identified potential areas to inform health promotion action. She turned to the ‘health promoting hospitals (HPH) approach’ in order to bridge the gap between acute care and health promotion in the hospital setting. As she looked deeper into HPHs in Ontario, she discovered an advocacy network, the Ontario Health Promoting Hospitals Network (OHPHN). While the initiative had largely been unsuccessful in Ontario, Health Promoting Hospital Networks had been successful and continue to have momentum in Europe and around the world. There seemed to be success stories from other provinces (Quebec, in particular). Why is Ontario so different, and what could be done to overcome the barriers to make the work of this network successful? What can Lauren learn from international HPH efforts to apply in her local context? Lauren wants to make changes that are sustainable and in-line with HPH approaches but needs to remain true to the acute mandate of her hospital. She is unsure of next steps

Case 3 : The Missing Four Million: Working to Increase the Case Finding Rate for People with TB

Paru Hari, an Accredited Social Health Activist (ASHA), lives in Bihar, India, one of the poorest states in the country. Paru is involved in daily outreach within her community to facilitate community member access to health care facilities, administer medications, treat minor ailments, and generate health awareness. The majority of her work involves antenatal checkups, immunizations, and mild sickness treatments. However, with Bihar reporting approximately 70,000 new cases of tuberculosis (TB) annually and many cases going unreported and undiagnosed (Fathima, Varadharajan, Krishnamurthy, Ananthkumar & Mony, 2015; RESULTS Canada, 2018b), Paru decided to take action. She proposed that ASHAs act as TB educators and household screeners for patients who have TB because she was tired of watching people in her community suffer and die from a treatable disease. Paru decided to visit Dr. Tisha Guru, Bihar state’s Regional ASHA Program Director, to share her concerns about how best to integrate TB educational activities and household screening programs into her daily routine. For Paru to gain a clear understanding of what she needs to know to identify TB patients and what they require during diagnosis and treatment, Dr. Guru suggested that she accompany patients from the initial stages of their diagnosis through to treatment. Although Paru did not have an extensive medical background, she knew that the ASHA program required a great deal of funding to ensure it was sustainable and that the necessary resources were available for TB testing and care to be integrated into their daily work. Paru knew action needed to be taken, not only to continue the ASHA program but, more importantly, to help patients who were being overlooked by the current health care system. Paru worked alongside Dr. Guru to identify the key stakeholders who could effectively communicate the critical need for improved TB surveillance, educational activities, and household screening programs into the services ASHAs provided

An Exploration of Core Values and Values Congruence in Local Public Health

Background: Understanding and aligning staff core values with organizational values has been shown to contribute to positive work attitudes and increased organizational performance in the private sector. Little is known about the role of values in local public health. Purpose: To identify public health staff core values, and to improve the alignment between staff values and organizational values (known as values congruence). Methods: A Tribal Leadership exercise was used as part of a multi-stage strategic planning process at Canada’s largest autonomous local public health agency. Results: Five sessions were held with 146 public health staff; 156 different values were reported. These were narrowed down to four core values: collaboration, integrity, empowerment, and striving for excellence. Staff reported high levels of satisfaction with the process and its outcome. Implications: This exploratory case study suggests the Mountains and Valleys exercise can be valuable for assessing public health staff core values, and enhancing values congruence. Further research is needed to explore the relationship between public health values and performance

Case 2 : Saving the Rural Ontario Maternity Services – Can We Do It?

Inaya, manager of the ‘low-risk’ project at Provincial Council for Maternal and Child Health (PCMCH), had to come up with an integrative solution for the issues encompassing maternity care in Ontario. The low-risk project aims “to design and develop effective low risk maternal and newborn strategy for Ontario (2015-2018) to ensure that all women have an equitable choice of delivery options, and access to the right level of care at the right time, no matter where they live in the province”. In response to external and internal challenges facing Ontario’s hospitals, the province has seen the closure of rural maternity programs over the last few years. The women in communities that are unable to sustain local services must travel to access distant services, and depending on the distance to the nearest referral center, may be away from their homes and communities during the critical pregnancy period and child birth. The separation of pregnant women from their families and communities can cause negative outcomes. The health and economic impacts of the inability to access local maternal programs are well documented. Different stakeholders have indicated the importance of alternative, sustainable models of interprofessional collaboration of midwifery, primary and specialty care, and the efficient allocation of human health resources (PCMCH, 2015). To create the framework of the model, PCMCH formed a leadership team and expert panel consisting of different care providers. Inaya had to identify barriers and potential solutions by engaging different care providers and exploring the challenges from their perspectives. The findings would be used to work with relevant partners, such as associations of different health care professionals, to develop potential solutions for the Ministry. The goal of the case is to provide readers with the opportunity to apply the concept of collaboration and also explore the barriers to achieving inter-professional collaboration from the key stakeholders’ perspectives

Case 13 : Sustainable mHealth Innovations - Repurposing The Collective Comfort Pilot Project

The Collective Comfort project (CC project) is a mobile health (mHealth) pilot project created by the Digital Innovation team in the Education Department at the Centre for Addiction and Mental Health (CAMH). The CC project provides safe, online social support networks—a crucial social determinant of health—that are accessible everywhere to people who have anxiety disorders. Unfortunately, funding has come to an end for this pilot project. CAMH’s Director of Education, Heather Grohl, and her team are tasked with repurposing the CC project mobile application for three organizations—the Alzheimer Society of Toronto, Homeless Hub, and Veterans Affairs Canada. These organizations are seeking a digital innovation that would allow their social support groups to be accessed through mobile phones. However, Heather’s boss, the President of CAMH Education, has only approved pitching to one organization. Therefore, her team must divide into three smaller teams to develop a proposal appropriate for each organization. The pitch will consist of a user persona, problem scenarios, user stories, and a prototype that is based on the CC project’s template design. Each pitch will be specifically tailored to the respective organization’s unique needs. The teams are also expected to develop one new innovative feature for the mHealth application that they believe would be useful for their specific organization. For example, an application for the Homeless Hub could incorporate a feature that displays homeless shelters in the area. Each of the teams will then present their prospective pitches to Heather and the President of CAMH Education, who will together decide the winning proposal based on which one best balances both creativity and feasibility