Category: Healthy Organizations

The power of burnout and taking action to address macro issues

Leo Eisenstein links everyday practice to the social determents of health within organizational contexts.

The clinician who coined the term “burnout” was not a primary care physician buried under paperwork, nor an emergency physician beset by an unwieldy electronic health record. He was Herbert Freudenberger, a psychologist working in a free clinic in 1974.1 Discussing risk factors for burnout, he wrote about personal characteristics (e.g., “that individual who has a need to give”) and about the monotony of a job once it becomes routine. He also pointed to workers in specific settings — “those of us who work in free clinics, therapeutic communities, hot lines, crisis intervention centers, women’s clinics, gay centers, runaway houses” — drawing a connection between burnout and the experience of caring for marginalized patients.

In recent years, burnout has become a chief concern among physicians and other front-line care providers. But somewhere along the way, the concept was separated from its original free-clinic context. The link between marginalized patients and clinician burnout seems to have gotten lost. …


See the article:


Ontario Nonprofit Network opens up the conversation on actions to engage in the Ontario election

The Ontario Nonprofit Network Election 2018 site provides a rich set of resources on how to enter the fray of an election. to move towards greater recognition of the role of  the nonprofit sector for people living in Ontario.

They state:

Elections provide meaningful opportunities for public benefit nonprofits to engage communities and capture the attention of political parties and candidates.


… It’s time for public benefit nonprofits to get involved!

You can meet with candidates, invite them to meet your board, volunteers and/or staff and learn about your organization, attend all-candidates meetings and ask questions, and share information about voting with your colleagues and the people you serve. Check out our election toolkit for more information, tips and the rules to be aware of – but not afraid of!  …

Nonprofit sector advocacy examples

Some great advocacy examples are emerging as the provincial election approaches:

Below is their Graphic, “when democracy doesn’t work,” it helps to explain why nonprofits need to enter the election arena and bridges well with health practitioners working with clients to strengthen their participation in the community as citizens, aka as a critical component of – the social determinants of health.

Pat Armstrong helps us think about Canadian delivery of health care

Pat Armstrong’s 15 minute talk encourages us to consider the structure and process’ of long term care (nursing homes).  It shines a light to help us think about the role of “profit” in health care, and perhaps find our own ways to participate in decision making where ever each of us fits in our system of care.



Learn more about the Ontario Patient Ombudsman via their in depth annual report

The 2016/17 Annual Report and website of the Ontario Patient Ombudsman who is mandated to: 

 … champion for fairness in Ontario’s health sector organizations defined as public hospitals, long-term care homes and home and community care services coordinated by the Local Health Integration Networks (LHINs, formerly CCACs).

It would be useful to hear from practitioners/clients their local experience here in Ottawa as this new initiative has great potential to contribute to care change/improvements.


Ontario Patient Ombudsman

…we are asking patients and caregivers to continue to be fearless in bringing their complaints to our office and for health sector organizations to be fearless in working with us to help improve Ontario’s healthcare system.

See the report here:

Policy Partnerships within government itself, ingredients for “buy-in”

The Centre for Urban Studies via  supports linking of policy to practice. One example of their efforts focus’ specifically on policy development within government itself, providing this paper below.  

Using Win-Win Strategies to Implement Health in All Policies: A Cross-Case Analysis

  • Agnes Molnar,
  • Emilie Renahy,
  • Patricia O’Campo,
  • Carles Muntaner,
  • Alix Freiler,
  • Ketan Shankardass


Our results yielded no support for the use of awareness-raising or directive strategies as standalone approaches for engaging partners to implement HiAP. However, we found strong evidence that mechanisms related to “win-win” strategies facilitated implementation by increasing perceived acceptability (or buy-in) and feasibility of HiAP implementation across sectors. …

Win-win strategies were facilitated by mechanisms related to several activities, including:…

  • the development of a shared language to facilitate communication between actors from different sectors;
  • integrating health into other policy agendas (eg., sustainability) and use of dual outcomes to appeal to the interests of diverse policy sectors;
  • use of scientific evidence to demonstrate the effectiveness of HiAP;
  • and using health impact assessment to make policy coordination for public health outcomes more feasible and to give credibility to policies being developed by diverse policy sectors. …

A brief self questionnaire to encourage us to reflect and assess as individuals within yea old system

I’ve been following the research of Judy Foster – who has been a leader in England on social work role in mental health.  She takes both a psychodynamic and systems approach and has been involved at leadership levels of training for the practice end of mental health for decades.

She later shifted focus to research and a phd thesis which incorporates the everyday experience of: individual social workers within team as well as the context of the organization and its position in responding to government policy in the broader systems of care. Foster, Judy (2009) Thinking on the Front Line: Why some social work teams struggle and others thrive.

She also wrote a book on this 

See more about the actual thesis here:  


I thought, the above self questionnaire with its questions on the 5 factors that contribute to effective social work teams, will encourage us to reflect and assess as individuals within yea old system.


“Okay. [laughter] How long have you got? I can talk about engagement for a really long time. (P41, executive director)”

This article revisits how workers and organizational systems engage in practice change. It is rich with practical snapshots of individual perspectives from all levels of an organization. It brings a refreshing approach to the front line engaging in organizational… Vision and practice change.

  • a voice at the table;
  • interesting and relevant problem;
  • shared vision and decision making

 For me, especially exciting to see in discussion the endorsement of engaging practitioners themselves to contribute to the research on practice as a way to engage.

… The theme individual participation reflects the definition of medical engagement put forth by Spurgeon et al. ([17], p. 214): “the active and positive contribution of doctors within their normal working roles to maintaining and enhancing the performance of the organisation.” It is also consistent with the CFIR [33] domain characteristics of individuals and the multidimensional employee engagement construct from organizational research, which represents the notion of an individual being engaged in change [23242526]. In contrast, stakeholders in our study predominantly referred to the action of engaging others (with the goal for individuals to be engaged) [23]. This is an important distinction because it implies that engagement is a process or series of actions (arguably, an intervention) and an antecedent to engagement (as a state of being or mechanism). Engagement is not static but rather a process that requires cultivation over time. Like the predominant discourse throughout the implementation science literature, engagement was seen by stakeholders as inviting people to come together to participate across phases of healthcare improvement, from early priority setting to sustainment of initiatives. …

How do stakeholders from multiple hierarchical levels of a large provincial health system define engagement? A qualitative study