Thursday, May 4, 2017

Folks on Facebook are complaining about my comments. I don't know why. They say they are spam. Well if my comments are spam I find this odd as every one of them is unique and spam is not. In fact, the contents of my comments may be what bugs folks. If you don't like what you read, then don't read my comments. I say what I think and what I think isn't what most folks think. Or it might be what some folks think but keep to themselves because in Alberta you gotta think alike or you're spam. But let me not be grumpy. Let me be light. Let me think love, flowers and such like. It's a surgery day. Dad is going to have a corneal transplant. I won't think about what Dr. Climenhaga will actually do in dad's eye as this makes me feel queasy. I will focus on the poetry book and the chocolate chip cookies. Maybe I should go for a walk later. For entertainment here are the banning policies developed by the good folks at AHS: https://extranet.ahsnet.ca/…/clp-prov-visitation-family-pre… TITLE VISITATION WITH A FAMILY PRESENCE FOCUS And here is the procedure. Every policy comes with a procedure so that there is quality control in the banning process; famlies get to enter the appeal process that is internal to AHS: https://extranet.ahsnet.ca/…/clp-prov-visitation-visitor-mg… TITLE VISITOR MANAGEMENT APPEAL


I just dropped Helva for the winter tire change. I think it is safe now to get the winter tires removed. The sun is very lukewarm outside and a big fly is stuck on the window of the writing room so summer must be imminent. Fat buds are crusting the wrists of the branches and there are shoots springing out of the ground. I don't want to take dad too early to the Royal Alex as it is going to be a big wait so I will head over to his place around 9:30 am. It will take ages to get him into the car and then through rush hour traffic to the Royal Alexandra Hospital, then through admitting and to find the place. I will stick to him like a burr and read while we wait. Most of the time these events are all about waiting.
As I am very sleepy I am having a morning cup of coffee. I don't know when we will be able to go rescue Helva as the whole day is shot. The baby minivan is 18 years old and her suspension is broken so coming back with her was rather back to the past in terms of driving experiences.
Once the trip to the Royal Alexandra Hospital is done I have to get the laundry out of the washing machine and hang them on the line outside. It is very dusty outside but at least there is no rain.
The big fly on my window looks at the world from a vantage point of high. It's been ages since I have looked at the carpet of lawsuit papers on the floor of the writing room. I was supposed to bring Rebecca home tomorrow but I have to take dad for the follow up appointment to Dr. Climenhaga tomorrow so I don't know how long that will take. It's downtown as well.
The geraniums in my writing room are very dehydrated and I have the African violets looking very papery as well. Most of the time I note their sad drooping state and tell myself --Gosh I'd better water them soon and then I get diverted and they are left panting.
It is already May. The garden is a mess, the house is full of clothes and the bag of clothes that do not fit me still waits for a trip to Goodwill. I have yet to do the application for the Alice Modin Award for Ruth that I will get signed by her on the Monday meeting (May 8, 2017) of the Elder Advocates Working Group. Folks on Facebook are complaining about my comments. I don't know why. They say they are spam. Well if my comments are spam I find this odd as every one of them is unique and spam is not. In fact, the contents of my comments may be what bugs folks. If you don't like what you read, then don't read my comments. I say what I think and what I think isn't what most folks think. Or it might be what some folks think but keep to themselves because in Alberta you gotta think alike or you're spam.
But let me not be grumpy. Let me be light. Let me think love, flowers and such like. It's a surgery day. Dad is going to have a corneal transplant. I won't think about what Dr. Climenhaga will actually do in dad's eye as this makes me feel queasy. I will focus on the poetry book and the chocolate chip cookies. Maybe I should go for a walk later.
For entertainment here are the banning policies developed by the good folks at AHS:
https://extranet.ahsnet.ca/…/clp-prov-visitation-family-pre…
TITLE
VISITATION WITH A FAMILY PRESENCE FOCUS
And here is the procedure. Every policy comes with a procedure so that there is quality control in the banning process; famlies get to enter the appeal process that is internal to AHS:
TITLE
VISITOR MANAGEMENT APPEAL
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https://extranet.ahsnet.ca/teams/policydocuments/1/clp-prov-visitation-family-presence-focus-pol-hcs-199.pdf

 POLICY © Alberta Health Services (AHS) PAGE: 1 OF 9 TITLE VISITATION WITH A FAMILY PRESENCE FOCUS SCOPE Provincial DOCUMENT # HCS-199 APPROVAL AUTHORITY Executive Leadership Team INITIAL EFFECTIVE DATE June 15, 2017 SPONSOR Quality and Chief Medical Officer REVISION EFFECTIVE DATE Not applicable PARENT DOCUMENT TITLE, TYPE AND NUMBER Not applicable SCHEDULED REVIEW DATE June 15, 2020 NOTE: The first appearance of terms in bold in the body of this document (except titles) are defined terms – please refer to the Definitions section. If you have any questions or comments regarding the information in this document, please contact the Policy & Forms Department at policy@ahs.ca. The Policy & Forms website is the official source of current approved policies, procedures, directives, standards, protocols and guidelines. OBJECTIVES • To support and encourage family presence within Alberta Health Services (AHS) settings. All AHS programs will follow the AHS Visitation With a Family Presence Focus Policy principles. There may be some programs which require further specific program limitations due to legislation or program requirements (such as health care in correctional facilities, addiction and mental health recovery centres, among others). • To provide clear and transparent guidance which supports clinical judgment in those rare and unique circumstances where limitations to visitors or family presence will benefit the patient or protect the health or safety of others. • To outline processes of resolution and appeal should individuals disagree with imposed visitors or family presence limitations. PRINCIPLES Visitors and family presence are integral to patient safety, the healing process, the patient’s medical and psychological well-being, comfort and quality of life. Patients and their families are welcomed as full partners in care. Families are essential members of the care team: they are not visitors in the lives of the patient. Families provide pertinent information essential to the patient’s care plan and should be respected and recognized for their knowledge and expertise about the patient and his/her care needs and preferences. Visitors and family presence shall be balanced in consideration of patients and health care providers while protecting the confidentiality and privacy of all patients. Limitations by AHS to visitors and/or family presence shall be a last resort and communicated collaboratively with the © Alberta Health Services (AHS) PAGE: 2 OF 9 POLICY TITLE EFFECTIVE DATE DOCUMENT # VISITATION WITH A FAMILY PRESENCE FOCUS June 15, 2017 HCS-199 patient and family. AHS shall make all reasonable efforts to accommodate patient wishes, family presence, and visitors. Health and safety are paramount considerations for patients, families, visitors and health care providers and sometimes necessitates limitations on visitation or family presence. AHS shall follow a transparent, consistent and predictable process in terms of addressing and managing limitations on visitors or family presence. APPLICABILITY Compliance with this document is required by all Alberta Health Services employees, members of the medical and midwifery staffs, Students, Volunteers, and other persons acting on behalf of Alberta Health Services (including contracted service providers as necessary), excluding community care settings. ELEMENTS 1. Visitors and Family Presence 1.1 AHS is committed to creating and fostering a welcoming, respectful and supportive environment that ensures the well-being, safety and security of all individuals - patients, family, visitors and health care providers. 1.2 AHS welcomes and promotes family presence and visitation in all AHS settings. 1.3 Patients and/or their alternate decision makers have an ongoing right to decide who is to be identified as the patient’s family, as well as their desired level of family support and involvement. 1.4 Particularly in complex situations, designating a family spokesperson is recommended and encouraged, if possible. This can facilitate effective and efficient communication among family, visitors and health care providers. 1.5 For some unique program areas, based upon the clinical needs of the patient, it may be appropriate to limit the number of family and visitors. AHS’ accommodation of the number of family and visitors shall, wherever possible, be decided in collaboration with the patient and/or their alternate decision maker, family or visitors, and care team. AHS, in its duty to all, retains the final decision to introduce necessary limitations. 2. Expectations and Responsibilities – Health Care Providers 2.1 Health care providers shall: a) acknowledge the presence of families and visitors and provide a welcome through identifying one’s name, occupation and duty (NOD); b) respond to requests, questions or concerns in a timely manner; c) demonstrate cultural understanding and sensitivity; © Alberta Health Services (AHS) PAGE: 3 OF 9 POLICY TITLE EFFECTIVE DATE DOCUMENT # VISITATION WITH A FAMILY PRESENCE FOCUS June 15, 2017 HCS-199 d) treat all patients, families and visitors with respect, dignity and compassion; e) share information and education on how families and visitors can help to support safe and caring visitation and assist in the accommodation of patient and unit particular circumstances; and f) share information only in accordance with privacy laws, and in accordance with the AHS Collection, Access, Use and Disclosure of Information Policy. 3. Expectations and Responsibilities – Family and Visitors 3.1 AHS staff shall inform family and visitors that they are expected to: a) respect the dignity and privacy of all individuals, including health care providers, other patients and their family, and visitors; b) be respectful and courteous and assist health care providers in complying with any privacy legislation and applicable governance (i.e.. policies, procedures and practice support documents) when taking photographs, video recordings or audio recordings of health care providers, other patients, their families or visitors; c) assist in providing a safe (following proper hand hygiene, isolation precautions, etc.) and restful environment for patients to recover. This may include closely supervising children brought to visit; d) be mindful and sensitive to the needs of other patients, their families and visitors by keeping noise and disturbances to a minimum; e) respect designated quiet times; f) communicate with health care team to address any concerns or questions; and g) discuss and participate in any specific requirements or limitations to support patients’ health. 4. Considerations Prior to Imposing Limitations to Visitors or Family Presence 4.1 Limitations to visitors or family presence in an AHS setting by AHS shall be a last resort and occur only after careful consideration. 4.2 AHS shall not impose limitations on visitors or family presence based on age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, gender, sexual orientation and/or gender identity or expression. 4.3 Specific recommendations related to visitors and family presence limitations that support patients’ wellness and the provision of health care services shall be © Alberta Health Services (AHS) PAGE: 4 OF 9 POLICY TITLE EFFECTIVE DATE DOCUMENT # VISITATION WITH A FAMILY PRESENCE FOCUS June 15, 2017 HCS-199 discussed with the patient and/or their alternate decision maker, documented on the chart and, as appropriate, discussed with family and visitors. 4.4 When imposing limitations to visitors or family presence, the least restrictive approach shall first be attempted, advancing through progressively more restrictive interventions as may be required by the situation. Limitations to family presence or visitation imposed by AHS may include, but are not limited to: a) a conversation to outline expectations of conduct for visitors or family. The conversation should include the collaborative development of an action plan; b) partial restrictions (e.g., visitor or family requires supervision or may be limited to attend at designated times and/or designated spaces, potentially supervised, alternate days); or c) complete restriction of family presence or visitation, in which there is no access to the AHS setting for a specified period of time. 4.5 Concerns about limitations to visitation or family presence may be voiced at any time to any member of the health care team, the accountable leader or alternatively, to the AHS Patient Relations Department. 5. Implementation of Limitations to Visitors and Family Presence 5.1 Visitors and family presence considerations include, but are not limited to: a) the patient and/or their alternate decision maker’s wishes; b) the patient's health status; c) the health care or treatment/procedure being provided; d) the potential impact on others (patients, staff); e) environmental, shared spaces or program constraints; f) time of day (rest and quiet hours); and g) length of stay. 5.2 After review and discussions of the considerations in element 5.1 of this policy with patient and/or their alternate decision maker, family, visitor(s) and health care team, limitations on family presence or visitation may be required or actioned as below: a) wishes of the patient and/or their alternate decision maker or due to legal authority of court order: © Alberta Health Services (AHS) PAGE: 5 OF 9 POLICY TITLE EFFECTIVE DATE DOCUMENT # VISITATION WITH A FAMILY PRESENCE FOCUS June 15, 2017 HCS-199 (i) AHS acknowledges that patients with capacity have the right to determine who is to be identified as their family or who may visit them; (ii) alternate decision makers, with the requisite legal authority, may specify parameters around family presence or visitation presence; and (iii) court orders may provide the requisite legal requirement and authority to limit family or visitor access to a patient. b) Patient’s health status: (i) clinically-based determinations of the care team may require limits on visitors or family presence where care of the patient could be compromised or the health or safety of other patients could be negatively impacted. The patient and/or their alternate decision maker shall be consulted and the patient's needs and preferences shall be considered in the decision. c) Need for privacy (impacts on others, space constraints): (i) visitors or family presence may be limited in situations where a patient in a shared room/space requires enhanced privacy due to health or personal reasons (e.g., a sensitive/private discussion or treatment/procedure); and (ii) standing limitations in specific environments may be beneficial to all patients and families to ensure privacy, rest, procedural requirements, inter-disciplinary consultations and health information privacy. d) Presence of an illness or a communicable disease: (i) visitors and family should be discouraged from visiting a patient, or they may be asked to refrain from visiting a patient, if they are feeling ill; (ii) visitors and family should not visit a patient if they or the patient are at risk of transmitting an infectious or communicable disease;and (iii) during a declared outbreak, visitors and family may be asked to refrain from visiting a patient. e) Conduct of an individual visiting an AHS setting: (i) visitors or family may have limitations placed on them if their words or actions negatively impact: © Alberta Health Services (AHS) PAGE: 6 OF 9 POLICY TITLE EFFECTIVE DATE DOCUMENT # VISITATION WITH A FAMILY PRESENCE FOCUS June 15, 2017 HCS-199 • the ability of health care providers to carry out their duties; • others within the AHS setting to feel safe and secure; and/or • the well-being and safety of any patients, family, visitors or health care providers. f) Urgent need to protect the well-being, safety and security of any person: (i) if there are reasonable grounds to believe that limiting visitors or family presence is immediately necessary to protect the well-being or safety of any person, the accountable leader may impose an urgent limitation on that person to the AHS setting without first conducting any informal resolution as described in section 6 of this policy. Note: Refer to the AHS Workplace Violence: Prevention and Response Policy for strategies for the prevention of and response to violence against AHS staff. 6. Issuing a Limitation to Visitors or Family Presence 6.1 The accountable leader shall make a decision with respect to any necessary limitation to visitors or family presence. Decisions to impose a limitation shall be in alignment with the considerations outlined in section 4 of this policy. 6.2 Any decision to limit visitors or family presence shall be communicated by the accountable leader to: a) the patient and/or their alternate decision maker, and to the family or visitor (done both verbally and in writing); b) health care providers of the AHS setting; and c) anyone else identified by the AHS setting as necessary to be informed. 6.3 The decision to limit visitors or family presence shall: a) identify the reason and duration of the limitation; b) identify when the matter will be next reviewed, including how to request a modification to the current limitation; c) outline available resources and options to attempt to resolve the issue; d) be communicated within a timeframe that is appropriate to the situation; and e) be appropriately documented. © Alberta Health Services (AHS) PAGE: 7 OF 9 POLICY TITLE EFFECTIVE DATE DOCUMENT # VISITATION WITH A FAMILY PRESENCE FOCUS June 15, 2017 HCS-199 7. Concerns Resolution 7.1 Individuals, including patients and/or their alternate decision maker, family or visitors who raise concerns about limitations to visitors or family presence shall not be subject to any negative repercussions for doing so and may voice their concern following steps in this section of this policy and the AHS Visitor Management Appeal Procedure (#HCS-199-01), if required. 7.2 Whenever possible, concerns about limitations imposed by AHS to visitors or family presence shall be addressed as close as possible in time and place to the concern with the patient and/or their alternate decision maker being afforded an opportunity to participate. 7.3 All concerns shall be reviewed in a fair, respectful, and transparent manner, in accordance with the AHS Ethics Framework and the Patient Relations Administrative Fairness: The Fine Art of Fairness Resource. Efforts will be taken to resolve the concern in a timely manner. 7.4 Anyone who raises a concern about limitations to visitors or family presence shall be informed by a health care team member of the process for managing their concern. This shall include information about informal dispute resolution as outlined in this policy, as well as the role of the AHS Patient Relations Department. The option of the Visitor Management Appeal Panel (VMAP), as per the AHS Visitor Management Appeal Process Procedure shall also be outlined. 7.5 If the proposed limitations to family visitors or family presence is not found to be acceptable to the patient and/or their alternate decision maker and family and visitors and resolution attempts are not satisfied at the unit/local level, then the issue shall be escalated to either the Patient Relations Department or the accountable leader of the AHS setting, with the agreement from the individual who lodged the concern. 7.6 Should the AHS Patient Relations Department be requested to provide assistance, dialogue on how best to resolve the concern shall take place with: a) the accountable leader of the AHS setting; b) the individual who lodged the concern; and c) the patient and/or their alternate decision maker. 7.7 The VMAP may be requested by anyone identified in section 6.3 of this policy or their advocates; however, agreement by the patient and/or their alternate decision maker is required in order to access the services of VMAP. Any appeal pursuant to the VMAP shall proceed pursuant to the AHS Visitor Management Appeal Process Procedure. © Alberta Health Services (AHS) PAGE: 8 OF 9 POLICY TITLE EFFECTIVE DATE DOCUMENT # VISITATION WITH A FAMILY PRESENCE FOCUS June 15, 2017 HCS-199 8. Documentation 8.1 Health care providers shall document: a) the wishes of the patient and/or their alternate decision maker with respect to who may visit as well as individuals to be identified as family; b) any limitation to visitors or family presence, including the grounds upon which the decision was made; and c) communication and steps taken to resolve any concerns pertaining to any limitation to visitors or family presence. DEFINITIONS Accountable leader means, for the purposes of this policy, the individual who has ultimate accountability to ensure consideration and completion of the listed steps in the management of the Visitation and Family Presence Policy. Responsibility for some or all of the components of management may be delegated to the appropriate level responsible administrative leader, but accountability remains at the senior level of management of care in the applicable AHS setting. Alberta Health Services (AHS) setting means any environment where treatment/procedures and other health services are delivered by, on behalf of or in conjunction with, Alberta Health Services. Alternate decision maker means a person who is authorized to make decisions with or on behalf of the patient. These may include a specific decision maker, a minor’s legal representative, a guardian, a ‘nearest relative’ in accordance with the Mental Health Act [Alberta], an agent in accordance with a Personal Directive, or a person designated in accordance with the Human Tissue and Organ Donation Act [Alberta]. Capacity means (1) the patient understands the nature, risks and benefits of the procedure, and the consequences of consenting or refusing; and (2) the patient understands that this explanation applies to him/her. In the context of treatment of a formal patient or a person subject to a Community Treatment Order under applicable mental health legislation, capacity is addressed in section 26 of the Mental Health Act [Alberta], which states that a person is mentally competent to make treatment decisions if the person is able to understand the subject matter relating to the decisions and able to appreciate the consequences of making the decisions. Family means one or more individuals identified by the patient as an important support, and who the patient wishes to be included in any encounters with the health care system, including, but not limited to, family members, legal guardians, friends and informal caregivers. Health care provider means a person who provides goods or services to a patient, inclusive of health care professionals, staff, students, volunteers and other persons acting on behalf of or in conjunction with Alberta Health Services. © Alberta Health Services (AHS) PAGE: 9 OF 9 POLICY TITLE EFFECTIVE DATE DOCUMENT # VISITATION WITH A FAMILY PRESENCE FOCUS June 15, 2017 HCS-199 Limitation (to visitation/family presence) means, for the purpose of this document, the establishment of reasonable boundaries for accessing an AHS setting based upon circumstances. Limitations can range from visitation based on adherence to agreed-upon actions to a complete restriction in which access is denied. Patient means an adult or child who receives or has requested health care or services from Alberta Health Services and its health care providers or individuals authorized to act on behalf of Alberta Health Services. This term is inclusive of residents, clients, and outpatients. Patient Relations Department means, for the purpose of this document, the department of Alberta Health Services, led by the Patient Concerns Officer and Executive Director, who facilitates the patient concerns resolution process as guided by the Patient Concerns Resolution Process Regulation 124/2006 and supports the patients and staff/management/medical staff involved in the process. Patient safety means the reduction of harm associated with health care. Resolution means the point at which the review of the concern is concluded and where there is a level of mutual understanding of the outcome between parties involved. Resolution may differ with individual concerns and could mean that the complainant is: a) satisfied with the review process and outcome; b) satisfied with the review process and dissatisfied with the outcome; c) dissatisfied with the review process and satisfied with the outcome; d) dissatisfied with the review process and the outcome; or e) the concern is dismissed as frivolous or vexatious, or it is found that no follow-up is possible/practical. Treatment/procedure means a specific treatment, investigative procedure(s), or series of treatments/procedures planned to manage a clinical condition. REFERENCES • Alberta Health Services Governance Documents: o Code of Conduct o Collection, Access, Use and Disclosure of Information Policy(#1112) o Visitor Management Appeal Process Procedure (# HCS-199-01) o Workplace Violence: Prevention and Response Policy (# 1115) • Alberta Health Services Resources: o Administrative Fairness: The Fine Art of Fairness [Patient Concerns/ Patient Relations] o Ethics Framework VERSION HISTORY Date Action Taken Click here to enter a date Optional: Choose an item Click here to enter a date Optional: Choose an item


https://extranet.ahsnet.ca/teams/policydocuments/1/clp-prov-visitation-visitor-mgmt-appeal-pro-hcs-199-01.pdf

 PROCEDURE © Alberta Health Services (AHS) PAGE: 1 OF 9 TITLE VISITOR MANAGEMENT APPEAL SCOPE Provincial DOCUMENT # HCS-199-01 APPROVAL AUTHORITY Executive Leadership Team INITIAL EFFECTIVE DATE June 15, 2017 SPONSOR Quality and Chief Medical Officer REVISION EFFECTIVE DATE Not applicable PARENT DOCUMENT TITLE, TYPE AND NUMBER Visitation and Family Presence Policy SCHEDULED REVIEW DATE June 15, 2020 NOTE: The first appearance of terms in bold in the body of this document (except titles) are defined terms – please refer to the Definitions section. If you have any questions or comments regarding the information in this document, please contact the Policy & Forms Department at policy@ahs.ca. The Policy & Forms w ebsite is the official source of current approved policies, procedures, directives, standards, protocols and guidelines. OBJECTIVES • To outline the process of resolution and appeal should individuals disagree with imposed visitation limitations. • To ensure the Visitor Management Appeal Panel (VMAP) process is fair, accessible, efficient, sufficiently informal and in keeping with the principles of procedural fairness. APPLICABILITY Compliance with this document is required by all Alberta Health Services employees, members of the medical and midwifery staffs, Students, Volunteers, and other persons acting on behalf of Alberta Health Services (including contracted service providers as necessary). ELEMENTS 1. Visitor Management Appeal Panel Process (VMAP) 1.1 Should VMAP be utilized in resolving the concern (pursuant to Section 7 of the Visitation with A Family Presence Focus Policy #HCS-199), the scheduling and coordination shall be provided by the AHS Patient Relations Department. 1.2 The VMAP is not required to hold a hearing session for an appeal that is, in the opinion of the VMAP, frivolous or vexatious, or has not been made in good faith, or does not deal with a decision that the VMAP has the mandate or authority to review. If such a recommendation is made by the VMAP, it will be communicated in writing by the VMAP to the individual who lodged the concern. The Patient Concerns Officer would make that final determination (refer to the Patient Concerns Resolution Process). © Alberta Health Services (AHS) PAGE: 2 OF 9 PROCEDURE TITLE EFFECTIVE DATE DOCUMENT # VISITOR MANAGEMENT APPEAL June 15, 2017 HCS-199-01 1.3 If the VMAP process is being pursued once all the criteria of the Policy are met, the application to the VMAP may be prepared in conjunction with the Patient Relations Department (refer to section 7.10 of the policy). An application to the VMAP must include: a) a brief explanation of why the decision offered by the decision maker is not acceptable; b) any documents the petitioner wishes to submit to the VMAP; c) a signed Consent to Disclose Health Information (AHS Form #18028) and agreement for the VMAP process to proceed signed by the patient, and/or the patient’s alternate decision maker with requisite authority; and d) full contact information for the petitioner/Third Party Advocate/representative, including email address. 1.4 The VMAP process shall, at minimum: a) have a panel of at least three (3) individuals selected in accordance with Section 6 of this Procedure to participate in the hearing session; b) have processes in place to ensure that information is disclosed in accordance with the Health Information Act [Alberta], the Freedom of Information and Protection of Privacy Act [Alberta], and the AHS Collection, Access, Use and Disclosure of Information Policy; c) provide the opportunity for both the accountable leader of the Alberta Health Services (AHS) setting, and the individual who lodged the concern to submit and exchange relevant documentation in advance of the hearing session; as well as an opportunity to present oral submissions at the hearing session; and d) allow the opportunity for both the accountable leader of the AHS setting, and the individual who lodged the concern to attend the VMAP meeting and to be accompanied or represented by others of their choosing such as an AHS Patient Concerns Consultant, a health care provider, legal counsel, third party advocate, or an agent, to support or represent them through the process. This is to be in accordance with the AHS Interaction between Alberta Health Services and Third Party Advocates Policy. The VMAP must be informed in advance of any third party attendance and involvement, including contact information. 1.5 VMAP, in making its recommendation(s) shall consider the well-being and safety of all patients, family, visitors and health care providers. The recommendation(s) may: a) uphold the decision of the accountable leader of the AHS setting; © Alberta Health Services (AHS) PAGE: 3 OF 9 PROCEDURE TITLE EFFECTIVE DATE DOCUMENT # VISITOR MANAGEMENT APPEAL June 15, 2017 HCS-199-01 b) provide an alternate solution; or c) delay a recommendation pending further information and provide an interim plan. 1.6 VMAP's recommendation(s) shall be in writing and shall include: a) details of the recommendation, including the rationale; b) any next steps, including timeframes; and c) a listing of the VMAP members and all those present at the VMAP meeting. 1.7 VMAP's recommendation(s) shall be provided by the VMAP Chair to the AHS Patient Relations Department within a reasonable time following the last VMAP meeting with the individual who lodged the concern and the accountable leader of the AHS setting. 1.8 Within a reasonable time after receiving the VMAP recommendation(s) from the VMAP Chair, the AHS Patient Relations Department shall provide the VMAP recommendation(s) to the relevant: a) AHS Chief Zone Officer; b) AHS Senior Program Officer/Chief Program Officer; and c) Chief Executive Officer (CEO) of the Contracted Service Provider, as applicable. Note: A designate shall be appointed by the AHS Chief Zone Officer, the AHS Senior Program Officer?Chief Program Officer; or the CEO of the Contracted Service Provider, as applicable, if he or she has had previous involvement in the matter. The designate shall perform all required duties outlined in Sections 1.7 to 1.12. 1.9 As soon as reasonably practical after the receipt of the recommendation(s) a decision shall be made by the decision maker. The decision shall be made by either: a) the relevant AHS Chief Zone Officer in consultation with the relevant AHS Senior Program Officer/Chief Program Officer; or b) the CEO of the Contracted Service Provider, as applicable, in consultation with the relevant AHS Chief Zone Officer and the AHS Senior Program Officer/Chief Program Officer. 1.10 The decision may: a) uphold the recommendation(s) of VMAP; or © Alberta Health Services (AHS) PAGE: 4 OF 9 PROCEDURE TITLE EFFECTIVE DATE DOCUMENT # VISITOR MANAGEMENT APPEAL June 15, 2017 HCS-199-01 b) provide an alternate solution. 1.11 The AHS Chief Zone Officer or the CEO of the Contracted Service Provider, as applicable, shall issue a written summary that shall include: a) the recommendation(s) from VMAP; b) the decision; c) the rationale for the decision; and d) any recommendation(s) or next steps, including timeframes. 1.12 The decision shall be communicated to the individual who lodged the concern, the patient/alternate decision maker, and health care providers of the AHS setting. A representative of the AHS setting who is able to share and explain the decision shall communicate the decision and provide a written copy of the decision to the individual who lodged the concern and to the affected patient/alternate decision maker. The decision will not be otherwise published or disseminated external to the panel. 1.13 After issuing a decision, the AHS Chief Zone Officer or the CEO of the Contracted Service Provider, as applicable, may at any time correct a typographical error, an omission or any other similar error in its decision without prior notice to the parties. The AHS Chief Zone Officer or the CEO of the Contracted Service Provider, as applicable, will notify the parties of its correction to the decision. 1.14 The decision of the AHS Chief Zone Officer or the CEO of the Contracted Service Provider, as applicable, is final, subject only to any further avenues of appeal that the person who lodged the concern may wish to pursue. Refer to Section 5 for external options for further review. 1.15 If the individual who lodged the concern issues a new additional concern later to VMAP then: a) there is no requirement that the membership of subsequent VMAPs be identical to, or different from, one concern to the next; and b) a VMAP member does not have a conflict of interest just because he/she had previously issued a recommendation(s) for an earlier VMAP concern that was adverse to the interests of the person who lodged the concern. 2. Costs 2.1 The VMAP will not pay the fees or out of pocket expenses incurred by any party, Third Party Advocate or representative to prepare for, attend or participate in the VMAP process. © Alberta Health Services (AHS) PAGE: 5 OF 9 PROCEDURE TITLE EFFECTIVE DATE DOCUMENT # VISITOR MANAGEMENT APPEAL June 15, 2017 HCS-199-01 2.2 The VMAP will not direct any party to pay for the fees or out of pocket expenses incurred by any party, Third Party Advocate or representative to prepare for, attend or participate in the VMAP process. 3. Timelines 3.1 Every attempt shall be made to resolve the appeal process within 10 days, and no longer than 15 business days. 3.2 The VMAP will provide the decision maker with a complete copy of the appeal application as soon as possible and not longer than five (5) days of receiving the petitioner’s application. 3.3 The VMAP will provide the individual who lodged the concern or his/her Third Party Advocate or representative with a complete copy of the decision maker’s information as soon as possible and not longer than 10 days of receiving the decision maker’s response. 3.4 The VMAP process is designed to occur within 15 days. If the concern is not resolved before a patient is discharged, then the individual expressing the concern can follow the established Patient Concerns Resolution Process. 3.5 This process may be accelerated in urgent situations by submitting a request to the Patient Concerns Department. 4. AHS Patient Relations and Patient Concerns Officer 4.1 The individual who lodged the concern may contact the AHS Patient Relations Department at any point in the process, as per the AHS Patient Concerns Resolution Policy and the AHS Patient Concerns Resolution Process Procedure. 4.2 If the individual who lodged the concern is not satisfied by the outcome of VMAP, or in situations where VMAP was not utilized, the AHS Patient Concerns Officer may review the decision as the final step in the Patient Concerns Resolution process. 5. External Options for Review 5.1 The Alberta Ombudsman may also conduct a review of the concern resolution process in accordance with the Ombudsman Act [Alberta], typically once a review has been completed by the AHS Patient Concerns Officer. 5.2 In addition to raising a concern with AHS, in accordance with Alberta’s Health Charter, the individual(s) may without limitation, and at any time, raise their concerns with the: a) Health Advocate; b) Seniors Advocate; or © Alberta Health Services (AHS) PAGE: 6 OF 9 PROCEDURE TITLE EFFECTIVE DATE DOCUMENT # VISITOR MANAGEMENT APPEAL June 15, 2017 HCS-199-01 c) Mental Health Patient Advocate; and/or d) others as appropriate (professional colleges, Office of the Information and Privacy Commissioner of Alberta, etc.). 6. VMAP Membership 6.1 Each year, AHS Executive Directors, with support from the AHS Patient Relations Department Directors, shall identify a pool of potential VMAP members. From this pool, individuals who will function as the Chair of VMAP shall be identified. 6.2 Each VMAP shall be comprised of members who are knowledgeable about the AHS Patient Concerns Resolution Process and who have had no prior involvement with the affected patient/alternate decision maker or the concern. 6.3 VMAP membership shall be chosen by the AHS Executive Directors; with support from the applicable AHS Patient Relations Department Director, and shall be comprised of at least the following three (3) multi-disciplinary members from the available pool: a) at least one (1) Patient and Family Advisor; and b) two (2) additional members most suited to the nature of the concern from among the following list: (i) health care provider from an AHS Provincial team; (ii) medical staff member; (iii) health care professional, either internal or external (e.g. Contracted Service Provider) to AHS; or (iv) representative from the AHS Clinical Ethics Department. 7. VMAP Procedural Authority 7.1 VMAP has the discretion to hold any VMAP meetings in person, teleconference and/or videoconference. 7.2 Any VMAP meetings to deliberate the concern and to arrive at VMAP's recommendation(s) shall be done in private, without the presence of either the individual who lodged the concern or the accountable leader of the AHS setting. 7.3 If a process issue is not addressed in this Procedure, then VMAP may provide whatever direction it feels is necessary to address the issue. 7.4 If it considers it appropriate in the circumstances, VMAP may depart from or vary the VMAP process outlined in this Procedure. © Alberta Health Services (AHS) PAGE: 7 OF 9 PROCEDURE TITLE EFFECTIVE DATE DOCUMENT # VISITOR MANAGEMENT APPEAL June 15, 2017 HCS-199-01 7.5 If VMAP makes a process decision that conflicts with this Procedure, then the process decision shall prevail over this Procedure. 8. Documentation 8.1 Health care providers shall document communication and steps taken to resolve any concerns pertaining to any limitation to visitation or family presence. 8.2 The AHS Patient Relations Department shall retain all documentation related to the VMAP process in accordance with the AHS Records Management Policy and AHS Records Retention Schedule. DEFINITIONS Accountable leader means, for the purposes of this procedure, the individual who has ultimate accountability to ensure consideration and completion of the listed steps in the management of the Visitation and Family Presence Policy. Responsibility for some or all of the components of management may be delegated to the appropriate level responsible administrative leader, but accountability remains at the senior level of management of care at the applicable AHS setting. Alberta Health Services (AHS) setting means any environment where treatment/procedures and other health services are delivered by, on behalf of or in conjunction with, Alberta Health Services. Alberta Ombudsman means the Officer of the Legislative Assembly of Alberta with the authority to investigate complaints under the Ombudsman Act [Alberta]. Alternate decision maker means a person who is authorized to make decisions with or on behalf of the patient. These may include a specific decision maker, a minor’s legal representative, a guardian, a ‘nearest relative’ in accordance with the Mental Health Act [Alberta], an agent in accordance with a Personal Directive, or a person designated in accordance with the Human Tissue and Organ Donation Act [Alberta]. Decision Maker means, for the purpose of this document, the accountable leader for the AHS program/service area or the Contracted Service Provider that made a decision that is being appealed by a petitioner. Family means one or more individuals identified by the patient as an important support, and who the patient wishes to be included in any encounters with the health care system, including, but not limited to, family members, legal guardians, friends and informal caregivers. Health care professional means an individual who is a member of a regulated health discipline, as defined by the Health Disciplines Act [Alberta] or the Health Professions Act [Alberta], and who practices within scope and role. Health care provider means a person who provides goods or services to a patient, inclusive of health care professionals, staff, students, volunteers and other persons acting on behalf of or in conjunction with Alberta Health Services. © Alberta Health Services (AHS) PAGE: 8 OF 9 PROCEDURE TITLE EFFECTIVE DATE DOCUMENT # VISITOR MANAGEMENT APPEAL June 15, 2017 HCS-199-01 Hearing Session means, for the purpose of this document, a meeting that occurs during the hearing involving the VMAP, the petitioner, and the decision-maker. Limitation (to visitation/family presence) means, for the purposes of this procedure, the establishment of reasonable boundaries for accessing an AHS setting based upon circumstances. Limitations can range from visitation based on adherence to agreed-upon actions to a complete restriction in which access is denied. Medical staff means physicians, dentists, oral & maxillofacial surgeons, podiatrists, or scientist leaders who have an Alberta Health Services Medical Staff appointment. Patient means an adult or child who receives or has requested health care or services from Alberta Health Services and its health care providers or individuals authorized to act on behalf of Alberta Health Services. This term is inclusive of residents, clients, and outpatients. Patient and Family Advisor means a patient or family member from anywhere in Alberta with firsthand experience of the health care system who volunteers to help make a positive impact on the quality, safety and patient experience in Alberta’s health care system. The role of the Patient and Family Advisor is to advise and work with the public, Alberta Health Services and its senior leaders, healthcare providers, staff and physicians on policies, practices, planning, delivery, and education of Patient and Family Centered Care. The Patient and Family Advisors encourage public participation between those receiving health services and leaders, staff, and healthcare providers by representing a strong patient voice in advancing Patient and Family Centered Care and patient engagement throughout the organization. Patient Relations Department means, for the purposes of this procedure,the department of Alberta Health Services, led by the Patient Concerns Officer and Executive Director, who facilitates the patient concerns resolution process as guided by the Patient Concerns Resolution Process Regulation 124/2006 and supports the patients and staff/management/medical staff involved in the process. Petitioner means, for the purpose of this document, the individual who lodged the concern with the VMAP. Representative means, for the purpose of this document, any lawyer who has been formally identified as acting on behalf of a petitioner or a decision maker for the purpose of the Hearing. Resolution means, for the purposes of this procedure, the point at which the review of the concern is concluded and where there is a level of mutual understanding of the outcome between parties involved. Resolution may differ with individual concerns and could mean that the complainant is: a) satisfied with the review process and outcome; b) satisfied with the review process and dissatisfied with the outcome; c) dissatisfied with the review process and satisfied with the outcome; d) dissatisfied with the review process and the outcome; or the concern is dismissed as frivolous or vexatious, or it is found that no follow-up is possible/ practical. © Alberta Health Services (AHS) PAGE: 9 OF 9 PROCEDURE TITLE EFFECTIVE DATE DOCUMENT # VISITOR MANAGEMENT APPEAL June 15, 2017 HCS-199-01 Third Party Advocate means any person who has been formally identified by the patient or family, who supports a patient in navigating the concern appeal process and in seeking information to achieve their goal, such as a friend, member of the media, or a third party advocacy group member. REFERENCES • Alberta Health Services Governance Documents: o Code of Conduct o Collection, Access, Use and Disclosure of Information Policy (#1112) o Interaction Between Alberta Health Services And Third Party Advocates Policy (#PRR- 04) o Patient Concerns Resolution Policy (#PRR-02) o Patient Concerns Resolution Process Procedure (#PRR-02-01) o Records Management Policy (#1133) o Visitation with a Family Presence Focus Policy (#HCS-199) • Alberta Health Services Resources: o Records Retention Schedule (#1133-01) • Non-Alberta Health Services Documents: o Alberta's Health Charter [Government of Alberta, Alberta Health, Alberta Health Advocates] o Freedom of Information and Protection of Privacy Act [Alberta] o Health Information Act [Alberta] o Ombudsman Act [Alberta] o Patient Concerns Resolution Process Amendment Regulation 28/2016 [Alberta] VERSION HISTORY Date Action Taken Click here to enter a date Optional: Choose an item Click here to enter a date Optional: Choose an item

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