A Framework for Creating Health Equity - Mount Sinai Hospital

A Framework for Creating Health Equity
In the Toronto Central LHIN

Acknowledgements
The development of the Mount Sinai Hospital Health Equity plan was the result of considerable effort by
many individuals, each playing an invaluable role. This project was led by members of the Health Equity
Committee,
whose members are:
Jocelyn Bennett, Uppala Chandrasekera, Sharon Currie, Camala Day, Jackie DeSouza, Joanne Fine-
Schwebel, Celia Fredericks, Molly Fuchs, Lilace Hudson, Marylin Kanee, Patti Lalla, Dr. Molyn Leszcz,
Christina Lenz-Campbell, Linda Muraca, Navid Nabavi, Hadar Nestel, Gabriella Rattner, Diane Savage,
Altaf Stationwala, Rosalie Steinberg, Joyce Telford, Leslie Vincent and Jennifer Snider.
The time and commitment of the Hospital’s Senior Leadership, led by CEO Joseph Mapa, contributed
greatly towards the development of this plan. Altaf Stationwala, Senior Vice President of Operations
and Redevelopment, chaired the Health Equity Committee, and provided his knowledge and support
to the process.
Thank you to the many dedicated participants of the Mount Sinai Hospital community who gave their
time and expertise to create this plan.

Table of Contents
The Toronto Central LHIN Context...........................................................................................................1
Our Hospital’s Vision of Health Equity....................................................................................................1
Section 1: Access, Priority Setting and Planning..................................................................................6
Section 2: Promising Practices...............................................................................................................8
Section 3: Policies, Procedures and Standards ..................................................................................10
Section 4: Governance..........................................................................................................................15
Section 5: Targets and Measurement..................................................................................................16
Section 6: Communications..................................................................................................................17
Section 7: Potential Roles for the Toronto Central LHIN....................................................................18
Section 8: Attachments.........................................................................................................................18
Section 9: Contact and Authorization..................................................................................................19
Appendix A.............................................................................................................................................21
Appendix B.................................................................................................................................................
Appendix C..................................................................................................................................................

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A brief description of the Toronto Central LHIN
The Toronto Central LHIN was designated by the Ministry of Health & Long-Term Care to plan, integrate and
fund local health services. In fiscal 2008/09 we fund nearly 200 unique health service providers that provide
a variety of services, including a community care access centre, community health centres, community
support services, hospitals, long-term care homes and mental health and addiction services.
Health Service Programs within the
Toronto Central LHIN Mandate 2008/09
Community Care Access Centres 1
Community Health Centres 18
Public Hospitals 18
Long Term Care Homes 38
Community Mental Health & Addictions 94
Community Support Services Assisted Living in
Supportive Housing
98
Total Number of Funded Programs 259
Distinct Health Service Providers
*Some agencies provide multiple programs or have
programs in more than one sector
196*
An important aspect of what we do
involves working with community
residents and health service providers
to ensure that our health care plans
for the Toronto Central LHIN area
make the best use of available
resources and meet the needs of the
communities served.
Communities served in the Toronto
Central LHIN are diverse in every
way. Here is a snapshot of our urban
population.
Income disparity. Our LHIN is a study in contrasts with some of Ontario’s lowest income neighbourhoods
and many of Ontario’s high income, high education neighbourhoods.
First home for recent immigrants and refugees. Residents come from over 200 countries and speak over
160 languages and dialects.
Socio-economic need that includes high rates of lone parent families, low income populations, people with
low English language fluency, people with HIV/AIDS, youth unemployment and seniors living alone.
High concentration of people who are homeless including: psychiatric consumer survivors and people with
serious mental illness.
Daily inflow of commuters. 500,000 people travel in and out of the Toronto Central LHIN every day.
Why we are asking hospitals to focus on health equity
Health equity means ensuring equal opportunities for health for all. As the most socially diverse urban LHIN
(for example: ethno-racial groups, women, LGBT, disabilities, seniors, mental health, homeless, HIV, children/
youth etc.), we face enormous challenges in making this vision a reality. The health needs that go along with
diversity are great, for example:
• Diabetes is twice as high in low income versus high income neighbourhoods
• New immigrants are more likely to have cardiovascular disease because of language and other barriers
to getting appropriate health care
• More low income people are living with pain and disability because they are receiving 60 per cent fewer
hip replacements than people with higher incomes
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LHINs are accountable for improving the health care system. We will know we have been successful
when everyone, particularly those in greatest need, has access to the right care, at the right time and
in the right place.
The Toronto Central LHIN expects the providers we fund to be accountable for promoting equity. In the fall
of 2007, the LHIN announced that hospitals would be submitting Health Equity Plans. The LHIN will also be
requesting plans from community providers, in the future. The hospitals plans will provide an understanding
of current priorities and actions toward reducing health inequity at individual hospitals and uncover themes
and common activities across the hospital sector.
How the Toronto Central LHIN will use these plans
The Toronto Central LHIN and hospital members of the Hospital Collaborative on Marginalized Populations
created this template for the health equity plans, collaboratively. The Toronto Central LHIN will conduct an
internal review of the plans. The plans will provide important data to aid the LHIN in its role as health system
manager. For example, the plans will help:
• Identify promising practices and potential areas for collaboration that could be promoted across the LHIN
and among LHINs; particularly GTA partners with whom we share boundaries and patients/clients
• Develop performance indicators that will be incorporated into accountability agreements
• Guide community health service providers’ equity plans
• Identify LHIN-wide data support and analysis needs and opportunities
• Provide input into the refresh of the Integrated Health Service Plan (IHSP)
Equally important, it is anticipated that the creation and sharing of the results of these plans will further aid
the hospitals in their collaborative efforts to address health equity. For example, the members of the Hospital
Collaborative have pledged to share the plans and to use them to continue to build on current projects and
identify other opportunities for integration.
Toronto Central LHIN contact for more information:
Krissa Fay,
Senior Community Engagement Consultant
416-969-3278
email: krissa.fay@lhins.on.ca
Hospital Name: Mount Sinai Hospital
Does your hospital have a health equity vision and if so, please describe how it aligns with
the Toronto Central LHIN’s definition? If not, is there a plan to develop one?
The Toronto Central LHIN’s health equity vision defines health disparities or inequities as differences in
health outcomes that are avoidable, unfair, and systematically related to social inequality and disadvantage.
Similarly, the Mount Sinai Hospital health equity vision states, “Mount Sinai Hospital was founded to welcome
practitioners and patients who were excluded from other medical facilities. That legacy continues today
with Mount Sinai’s commitment to health equity and to providing exceptional care that is accessible to all
members of our community. We will work with communities and community organizations to promote
health care services and research aimed at eliminating the health risks associated with discrimination,
marginalization, and social inequality.”
The Mount Sinai Hospital health equity vision aligns with the LHIN health equity vision because it promotes
equity for patient access to services and promotes equity in patient-centred care through the way we as
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healthcare providers treat and care for patients when they do access services. Our vision reiterates our
historical commitment to equity and access while renewing that commitment for the future.
Please outline your hospital’s access and equity priority areas. Through what process did your
hospital select these? (e.g. those involved, environmental factors, community engagement,
who took leadership, etc.)
Mount Sinai Hospital recognizes its responsibility to provide opportunities for underserved populations to
access its health care services. It is the Hospital’s goal to better understand the community it serves, to
identify gaps in service and barriers to service delivery and to facilitate better access and equity for its
community. A breadth of programs and services have been developed to help Mount Sinai Hospital address
these gaps. Specifically, Mount Sinai Hospital has identified certain access and equity priority areas, which are
listed below.
The Mount Sinai Hospital access and equity priority areas are:
• Seniors
• People with mental illness and addictions
• Chronic disease management
• Women’s and infants’ health
• Access for people with disabilities
• People who are lesbian/gay/bisexual/transgender
• Poverty and income barriers (including homeless)
• Immigrants and language barriers
• Health human resources
• Policies, strategies and measurement
• Organizational culture
These priority areas were determined by the Mount Sinai Hospital Health Equity Committee, a multi-disciplinary
committee consisting of front-line medical, administrative and allied health staff, management and senior
leadership. The Mount Sinai Hospital Community Advisory Committee and the Mount Sinai Hospital Diversity
& Human Rights Committee were also consulted prior to identifying these priorities. In addition, these health
equity priorities were developed based on the Mount Sinai Hospital organizational strategic priorities to
better serve the needs of the vulnerable populations within the hospital catchment area.
Accordingly, the Mount Sinai Hospital Diversity & Human Rights policy was adopted by the hospital in May
2004 and was reviewed and revised in 2008 to comply with changes in Human Rights legislation. Below are
some highlights of the policy that relate to health equity:
The Mount Sinai Hospital Diversity & Human Rights policy is designed to bring about systemic and
organizational change by outlining the steps required to implement the hospital’s plan to achieve equity,
fairness, and due process as articulated in its mission and value statements; Foster a positive work/learning
environment through proactive measures, barrier free systems analysis and enforcement; and ensure that all
members of the hospital community are treated equitably and with dignity and respect. Proactive education
and organizational training and development at the Hospital is aimed at providing an environment that is
healthy, respectful, welcoming, accessible, and free of discrimination and/or harassment.
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The Hospital’s implementation plan under this policy is comprised of the following four areas:
A. Education, Organizational Training and Development
B.
C.
D.
Review of Policy and Procedures
Developing Diversity Plans
Rights and Responsibilities
Education and Training will focus on the following areas:
A. Complaint Resolution
B.
C.
D.
Diversity & Human Rights
Related human resource functions (i.e., bias free hiring and performance management)
Patient centered care/equitable access to services
As a result of Training and Education with respect to Diversity & Human Rights, members of the
Hospital Community will:
A. Demonstrate the skills and knowledge necessary to model behaviour, which is respectful and cognizant
of issues of Diversity & Human Rights (managers).
B. Be accountable for maintaining human rights, diversity and respectful behaviour standards through the
incorporation of these competencies in performance management systems (managers).
C. Demonstrate a leadership role in promoting and accommodating diversity in the provision of services.
D. Promote equity in the implementation of Hospital policy and procedures.
E. Foster an environment that is positive and supportive for employees with disabilities.
Human Resources
When Human Rights training involves Human Resources related functions, Human Resources will be involved
in the development and/or delivery. As a result of this training, managers will:
• Be accountable for demonstrating leadership in supporting Diversity & Human Rights principles and
practices articulated by the Hospital
• Implement equitable principles and practices in human resources areas such as: recruitment and
selection, retention, promotion, mentoring, disciplining, and performance management
Patient Centered Care
As a result of cultural competency training delivered through the Diversity & Human Rights office, hospital
service providers will:
• Accommodate the needs of diverse patients and co-workers as required by Hospital policy and legislation
• Demonstrate equitable behaviour with patients and co-workers
• Interact respectfully and consistently with all members of the Hospital community, while accommodating
differences when required
• Continue to develop knowledge and skills in accommodating Diversity & Human Rights
• Continue to develop knowledge and skills in conflict resolution
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Review of Policy and Procedures
The Hospital will establish proactive measures to review all departmental/corporate policies and procedures
including issues such as scheduling, orientation, visiting hours, and others, to ensure that systemic/constructive
discrimination is not occurring.
Accommodation based on Religious and other Human Rights Grounds:
The Hospital will also develop guidelines to address accommodation procedures based on religion, family
status, and other prohibited human rights grounds. If there are disputes arising from accommodation plans,
the Office of Diversity & Human Rights will act as a consultant to provide guidelines necessary to meet our
legal and social obligations.
Developing Diversity Plans
Management Responsibilities:
The Office of Diversity & Human Rights and the Diversity & Human Rights Committee will provide leadership
in developing programs aimed at implementing Mount Sinai Hospital’s Diversity & Human Rights Checklist for
Organizational Change.
The Senior Management Team will:
1. Work with the Diversity & Human Rights Office and the Diversity & Human Rights Committee to ensure
that a plan is developed to integrate Diversity & Human Rights considerations in organizational planning,
budgeting, research, ethics, training, clinical work, strategic planning, health promotion, marketing,
communications, etc.
2. Develop priorities and assign responsibilities for achieving the Hospital’s Diversity & Human
Rights objectives.
3. Build strong, meaningful and responsible relationships with all of our diverse stakeholders and
community partners.
4. Develop evaluation mechanisms of these goals as part of the performance review every year.
Patient/Family Centered Care:
The Hospital recognizes diversity as a critical component of patient centered care and consequently will:
1. Articulate and develop an approach to cultural competence that is standardized at the organizational
level and specified in measurable ways at the level of individual programs.
2. Provide access to all its services and programs for communities it serves in ways that are culturally
appropriate, respectful and inclusive by reviewing its practices and actively working to remove
systemic barriers if and where they exist. Areas for review include but are not limited to clinical care,
information dissemination, physical barriers, language/cultural interpretation resources, translation
services, dietary requirements, methods of care, health promotion, community partnerships, research,
and employment practices.
3. Develop programs and initiatives to provide accommodation (physical and otherwise) for the diverse
needs of its stakeholders.
4. Will actively seek out and build community partnerships with the various communities it serves
such as racialized, cultural, and lesbian/gay/bisexual/transgender communities in order to achieve
these objectives.
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Section 1: Access, Priority Setting and Planning
1a: How do your hospital utilization patterns compare to the profile of who lives in your
catchment? (If your catchment is undefined, where do the majority of your patients/
clients come from?) Please indicate data sources.
We have mapped our patient population using a Three-City Analysis created by the Centre for Urban and
Community Studies at the University of Toronto (please see attached document titled Appendix A). Mount
Sinai Hospital has not defined a catchment area; however, we have mapped our inpatient and ER patient
population using patient postal codes which provide us with a picture of our catchment area. We were also
able to identify our patient population by age group. We then compared our patient population to the 3 City
Analysis to infer other demographic characteristics of our patients. This is not conclusive information about
our patient population and further data collection and analysis is needed.
Mount Sinai Hospital in the GTA
• Emergency visits predominantly from City of Toronto; very strong clusters in downtown area; relatively
strong clusters in City of Toronto; weak clusters elsewhere in the GTA
• In-patient visits exhibit strong clusters both within City of Toronto and elsewhere in the GTA
• Identification of Mount Sinai Hospital with Toronto’s Jewish community appears to be reflected in
inpatient visits, but not in emergency visits
No Fixed Addresses*
Patients with no fixed address
*Does not include patients who may have provided a shelter address.
Patterns of usage by age
Total 2005 to 2006 2006 to 2007 2007 to 2008
4,189 1,366 1,535 1,288
• Little obvious variation in geographic clustering by age for Emergency visits
• Variations exhibited in geographic clustering by age for Inpatient visits
What the data suggests
• Mount Sinai appears to draw patients disproportionately from City #1 (rapidly growing income) and the
parts of City #2 in which individual real income is growing
• The hospital’s identification with Toronto’s Jewish community is reflected in inpatient visits, but not
emergency visits
• The data suggests that there are about 1,500 visits by patients with no fixed address
• To the extent that Mount Sinai patients are disproportionately from City #1, they would also tend to
exhibit disproportionately other characteristics of the residents of City #1 relative to the City as a whole:
• Predominantly Canadian born
• Predominantly white
• Predominantly English speaking
• Predominantly university educated
• Predominantly not low-income
• Predominantly white-collar workers
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Data limitations
• Mount Sinai Hospital patient data accessible for analysis limited to postal code and age
• No data for clinic/outpatient visits
• Not possible to isolate characteristics of individual patients (for example, we can say that patients live
in census tracts whose residents tend to exhibit certain characteristics)
• We cannot create a profile of socioeconomic characteristics of Mount Sinai Hospital patients and compare
that profile with corresponding population characteristics
• We cannot say that Mount Sinai Hospital patients have higher or lower incomes than average
• We cannot say whether Mount Sinai Hospital patients are more or less likely to be racialized people
• We do not have data on patients living in shelters or marginally housed patients
1b: What major inequities exist in regards to the social determinants of health among
your patient/client populations? Please indicate data sources.
The following inequities were identified at the Mount Sinai Hospital Health Equity Committee, the Diversity &
Human Rights Committee, the Patient Relations Office, the AODA Committee and Senior Leadership as being
the major inequities that practitioners in the hospital address in the course of their practice:
• Health and child development (i.e. high-risk pregnancy, young mothers)
• Gender (i.e. violence against women, lack of education opportunities for women)
• Income and social status (i.e. poverty)
• Housing (i.e. homelessness)
• Social support networks (i.e. language barriers, immigrants, racism, homophobia)
• Access to services for patients with disabilities
1c. Are there any specific health equity gaps and challenges that require greater attention
at your hospital?
• We need to expand our reach to populations who are not currently accessing our services, particularly
where we are offering unique and/or specialized services, such as IBD, high risk pregnancies
• Information on our patient population is a challenge to obtain and therefore this is a gap
• Staff are not representative of the diversity of Toronto in the upper managerial positions of the hospital
• Need training and education throughout the organization regarding health equity and the health
of marginalized populations
• There are not sufficient access points and services in the community to underserviced groups
• Building and sustaining connections with community organizations and services around needs identified
by front-line service providers
• Research that is focused on determinants of health and marginalized populations
• Identification of barriers to service throughout the hospital
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Section 2: Promising Practices
2a: Please briefly describe a maximum of five current hospital initiatives that help to improve
access to health services by underserved or underrepresented populations?
1. Gateways to Cancer Screening: A Participatory Needs Assessment of Women with Mobility Disabilities
2. Talk to Me: Violence Against Women Awareness Program
3. Association for the Advancement of Blacks in Health Sciences (AABHS) Summer Mentorship Program
4. Assertive Community Treatment Team (ACTT)
5. PHA ACCESS: Clinic for HIV-Related Concerns
Which population do they target and/or which access barrier do they seek to remove?
In what ways is success being measured and what outcomes yielded as a result? Please
provide samples of related documents if any.
Please see attached document titled Appendix B: Response to Section 2a.
2b: Are there hospital based initiatives that address the social determinants of health
identified in Section 1b? Please describe briefly.
The social determinants of health are broadly defined as the economic and social conditions that influence
the health of individuals and communities, including:
• Income and social status
• Social support networks
• Education
• Employment and working conditions
• Social environments
• Physical environments
• Health and child development
• Personal health practices and coping skills
• Biology and genetic endowment
• Health services
• Gender
• Culture
• Discrimination due to racism, homophobia, etc.
Mount Sinai Hospital provides a variety of services to address the major inequalities that exist among its
patient/client populations in regards to the social determinants of health identified in question 1b including:
Health and child development (i.e. high-risk pregnancy, young mothers):
• Prenatal HIV clinic
• Young Moms Program for pregnant women (age 17 to 20) who are isolated from their family and/or
lack social support
• NICU Parent Buddy Program in support of new immigrant parents
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• Great Start Together Perinatal Program
• Perinatal Outreach Program
Gender (i.e. violence against women, lack of educational opportunities for women):
• Anti-Homophobia/Transphobia Action Group
• Gateways to Cancer Screening: A Participatory Needs Assessment of Women with Mobility Disabilities
• Talk to Me: Violence Against Women Awareness Program
• Clothing Drive for Sistering Women’s Shelter
Income and social status (i.e. poverty):
• Participation in inter and intra hospital committees to address access to care for uninsured patients
• Social Work Department Special Needs Fund to support low-income patients
Housing (i.e. homelessness):
• Mount Sinai Hospital provides respectful and appropriate treatment to homeless patients
• Client Access to Integrated Services and Information (CAISI) Program
Social support networks (i.e. language barriers, immigrants, racism, homophobia):
• Interpreter services
• American Sign Language Services
• Social Work Department Chinese In-Patient Program
• Multicultural calendar available on Mount Sinai Hospital intranet
• Synagogue and Spiritual Oasis for meditation, prayer and contemplation
• Multi-faith chaplaincy services
• Mount Sinai Hospital offers vegetarian, Kosher, Halal, and Asian foods to in-patients
(accommodations are made for patients who request Halal food using Kosher food products which
meet the same requirements)
• Mount Sinai Hospital food outlets offer vegetarian, Kosher, and Halal foods for patients, visitors, staff,
physicians, volunteers and associates
Access to services for patients with disabilities:
• Accessibility devices for patients who are deaf/deafened/hard of hearing
• Renew Sinai redevelopment project plans were reviewed by disability consultant from
Designable Environments
• More accessible building entrances were created based on recommendations from AODA Committee
• Signage and way-finding made accessible to patients and staff through Renew Sinai capital
redevelopment project
• Dental program for persons with disabilities
Please note: These initiatives are a sample of the work being done to address these social determinants of
health. Other examples can be found throughout other sections of this document.
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2c: Describe specific partnerships, projects or activities that your hospital has undertaken
with other organizations to address health equity, including those addressing the broader
social determinants of health. Please include the names of those organizations and
outcomes of the projects.
Please see attached document titled Appendix B: Response to Section 2c.
Section 3: Policies, Procedures and Standards
3a: What specific policies, procedures and/or standards does your hospital have to ensure
equitable access and treatment for all patients/clients? (e.g. a Patient Charter)
• Mount Sinai Hospital Diversity & Human Rights policy
• Patient Abuse policy
• Care for Persons with Disability Policy
• Accessibility Plan
• Policy for protecting the identities of patients who are victims of intimate partner violence
• Implementation of evidenced based guidelines for care for all patients including guidelines for HIV,
diabetes, asthma, MRI bookings, Assertive Community Treatment Team access to services
• Fair Employment Opportunities policy
• Workplace Violence Prevention policy
• Partnership Policy Framework developed using an inclusive community engagement approach which
included a broad array of community stakeholders (primarily community agencies) whose mandate is
to serve marginalized groups
How do you ensure that these policies are followed?
The above stated Mount Sinai Hospital policies, procedures and standards are monitored by the Diversity &
Human Rights Committee, Risk Management, AODA Committee, Social Work, Patient & Family Centred Care
Committee, Corporate Quality Committee and the Patient Safety Steering Sub-Committee, through patients
complaints management, patient satisfaction survey, Diversity & Human Rights complaints management,
incident reporting, union grievances, accessibility plan implementation, balanced scorecard, patient
compliments and interpreter requests.
In addition, all Mount Sinai Hospital managers are held accountable for these policies and procedures,
and mandatory Diversity & Human Rights training is provided for all healthcare providers. Mount Sinai
Hospital has also gathered feedback from staff and patients regarding our policies, procedures and standards
through the Made in Sinai Competencies community consultation and the Diversity in the Work Environment
research project.
3b: How does your hospital provide for the delivery of culturally-competent care? Please
provide specific examples.
In keeping with Mount Sinai Hospital’s identified equity priority areas, the Hospital provides for the delivery
of culturally-competent care through the following programs and services:
Seniors:
• Eye and ear screening program for immigrants/seniors
• Seniors Wellness Centre — Health Promotion and Mental Health Access Service
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• Specialized care through Geriatric Care Team
• Participant in TC LHIN’s Aging at Home initiative
• Home at Last Program
People with mental illness and addictions:
• Department of Psychiatry Cultural Competency Team which is accessible by the entire department to
provide support and consultation around any case where cultural and/or language may be a factor in
the assessment or treatment of a mental health patients
• Department of Psychiatry Trauma Program
• Department of Psychiatry hosts and coordinates cultural psychiatry day, an annual full-day educational
forum to discuss and exchange new ideas related education, clinical care and research at the intersection
of culture and mental health
• Assertive Community Treatment Team (ACTT)
• Seniors Wellness Centre — Health Promotion and Mental Health Access Service
Chronic disease management:
• Hip and Knee Arthritis Program
• Providing telephone consultations at night for patients in the Day-Oncology Program
• Mount Sinai Hospital’s Samuel Lunenfeld Research Institute: diabetes research in Sandy Lake
First Nations community
Women’s and infants’ health:
• Building Breast Healthy Neighbourhoods
• Great Start Together Perinatal Program
• HIV/Infectious Disease Clinic
• NICU Parent Buddy Program
• Young Moms Program
• Participation in Chinese/Vietnamese Breastfeeding Network of Toronto
• Mount Sinai Hospital’s Samuel Lunenfeld Research Institute: Developmental Origins of Health
and Disease
Access for people with disabilities:
• Gateways to Cancer Screening: A participatory needs assessment of women with mobility disabilities
• Provided training for staff regarding diversity, human rights and disability issues including presentations
by Dr. Mark Nagler and David Lepofsky
• For more detailed information, please see the response to Section 3e.
People who are lesbian/gay/bisexual/transgender:
• Psychiatrist consultant for lesbian, gay, bisexual, and transgender populations
• Anti-Homophobia/Transphobia Action Group
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Poverty and income barriers (including homeless):
• Mount Sinai Hospital provides respectful and appropriate treatment to homeless patients
• Client Access to Integrated Services and Information (CAISI) Program
• Social Work Department Special Needs Fund to support low-income patients
Immigrants and language barriers:
• Eye and ear screening program for immigrants/seniors
• Psychiatrist consultant for Canadian Centre for Victims of Torture
• Interpreter services, Language Line, translation of documents
• Sign language services and assisted devices program
Health human resources:
• Lunch ‘n Learn presentations to educate staff about cultural competency including: Lunar New Year,
Black History Month, International Women’s Day, National Aboriginal Day, Pride Week, International Day
of Disabled Persons, National Day for Remembrance and Action on Violence Against Women, Cultural
Psychiatry Day, etc.
• Mandatory Diversity & Human Rights training for staff and physicians
• Health Equity communication campaign sponsored by Diversity & Human Rights Department
• Nursing mentorship through Care for Nurses Program
• Personal safety audit conducted throughout the hospital with particular emphasis on the safety
of women, people with disabilities and racialized people
Policies, strategies and measurement:
• Revising strategic plan to incorporate stronger emphasis on equity
• For more detailed information, please see the response to Section 3a.
Organizational culture:
• Social Work Department Chinese In-Patient Program
• Synagogue/Spiritual Oasis for meditation, prayer and contemplation
• Multi-faith chaplaincy services
• Mount Sinai Hospital offers vegetarian, Kosher, Halal, and Asian foods to in-patients
(accommodations are made for patients who request Halal food using Kosher food products which
meet the same requirements)
• Mount Sinai Hospital food outlets offer vegetarian, Kosher, and Halal foods for patients, visitors, staff,
physicians, volunteers and associates
• Communications — posters, brochures
• Training — Diversity & Human Rights training, violence prevention training, information brochures
• Diversity & Human Rights office
Do you have any special programs or policies that address the needs of Aboriginal
and Francophone communities? Please describe.
• AABHS Summer Mentorship program which provides a range of health care experiences to Black and
Aboriginal students with the goal of developing future Black and Aboriginal health care providers
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• Assertive Community Treatment Team (ACTT) works with diverse cultural populations, including
Aboriginal populations, and individuals who suffer from severe and persistent mental illnesses, providing
an accessible, culturally sensitive program of excellent mental health outreach services for severely
mentally ill patients
• Interpreter services for patients who speak French
3c: What non-English language services are provided corporately?
• Interpreter Services Program provided 3,000 interpretations in 42 languages in 07/08
• American Sign Language Services (99 in 07/08) and accessibility devices for patients who are
deaf/deafened/hard of hearing
• Language Line services are available in all areas after hours and if an interpreter is not available
• Chinese Outreach Social Work program has special focus on the needs of Chinese-speaking patients in
the hospital and allied community programs
• Translation of corporate and department print materials for patients and families
How are these services provided?
(e.g. Volunteers, staff, contractual agreements, family members, telephone, etc.)
• Volunteer Services coordinates Interpreter Services through the use of contracted Agency Interpreters,
internal volunteers and through Language Line telephone interpretations services; Internal staff are
used occasionally
• Volunteer Services coordinates the ASL interpreter services through Canadian Hearing Society (CHS),
and coordinates the distribution of accessibility devices for patients
• An evaluation of the current program model was completed in 2008, and the results are being considered
• Assertive Community Treatment Team (ACTT) provides services in Cantonese, Mandarin, Vietnamese
and Tamil
Please name or attach the list of languages available and the number of requests you receive
for each language, if this is recorded.
Please see attached document titled Appendix B: Response to Section 3c.
3c: Does your hospital have dedicated FTE or other positions that promote, lead or address
your health equity goals? (e.g. Director of Corporate Diversity, Access or Human
Rights Officer, Mentorship Coordinator, Equity Trainer, etc.) If yes, please list main role
components.
• The Diversity & Human Rights Office at Mount Sinai Hospital consists of three full-time positions: Director
Diversity and Human Rights, Diversity & Human Rights Specialist and Diversity & Human Rights Assistant.
The department advises on, mediates and investigates human rights complaints; provides training
on diversity, human rights, conflict, and violence; organizes workshops, educational campaigns and
celebrations of diversity; conducts research on diversity-related questions that affect patients and staff;
undertakes a census of the hospital workforce; and develops policies on discrimination, fair employment,
violence and related issues.
• Interpreter Services Coordinator (full-time)
• Patient Relations Facilitator (full-time), and Administrative Assistant to Patient Relations Facilitator
(full-time)
• Director of Community Development and Integration (full-time), and Assistant to Director of Community
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Development and Integration (full-time)
• Bioethicist (full-time)
3d: How has your hospital implemented any special initiatives to mentor, recruit and retain
staff from diverse communities? (e.g. where jobs are posted, Internationally Educated
Professionals projects, staff education, etc.)
• Fair Employment Opportunities policy and training
• Conducted 2007 Include me! Workforce Census
• Partner with U of T faculty of Medicine and host 15 to 20 students each summer for the Association
for the Advancement of Blacks in Health Sciences (AABHS) Summer Mentorship Program
• Anti-Homophobia/Transphobia Action Group — GLBT hospital community members and allies
• Partnership with Strategic Employment Solutions to recruit staff with visible and invisible disabilities
• Provide accommodation for staff with visible and invisible disabilities
• Sponsored Toronto Regional Immigrant Employment Counsel (TRIEC) conference for internationally
trained professionals and hosted health care sector sessions
• Partner in DiverseCity to promote diverse leadership throughout Toronto
• Mentorship hospital for Care for Nurses Program
• Top 75 Employer
• Positions available in the Department of Psychiatry Assertive Community Treatment Team (ACTT) are
posted in Cantonese and Mandarin newspapers
3e: Please give some examples of how your hospital accommodates patients/clients, visitors
and staff with disabilities and/or other special needs in compliance with the Ontarians
with Disabilities Act.
Through the Mount Sinai Hospital Accessibility Plan for 2007 to 2008, the following improvements were
made to the hospital to accommodate patients, visitors and staff with disabilities and/or other special needs:
• Redesign in process for access to both Mount Sinai Hospital front and back entrances to ensure
accessibility and safety; The goal is to achieve integrated access for all entrances
• Completed all recommendations from disability consultant regarding improvements to the main entrance
at the 60 Murray Street site
• Construction in progress for an accessible/integrated service counter in Admitting Department
• List of available wheelchair accessible washrooms created; In the process of determining best method
of communicating locations to staff
• Developed Mount Sinai Hospital Accommodation Policy as defined by Human Rights legislation;
Accommodation Policy in the process of being approved by Senior Leadership
• Ongoing translation of documents into multiple languages as identified through interpreter
services statistics
• Developed appropriate process for identifying disability needs before admission to a radioactive
iodine room
Toronto Central LHIN Equity

15
• Conducted focus groups with patients with disability to better understand their experiences;
Recommendations for 2008 to 2009 Accessibility Plan developed as a result of focus groups
• Provided training for staff regarding diversity, human rights and disability issues including presentations
by Dr. Mark Nagler, David Lepofsky and an MNet presentation led by patients with disabilities, HIV/AIDS
and transgender status
• In the process of quoting the price to install speaker system and Braille buttons on elevators
• Mount Sinai Hospital Internet site upgraded to a Content Management System that is
accessibility compliant
• Provide American Sign Language Services for patients and for the staff who require it
• Provide accessibility devices for patients who are deaf/deafened/hard of hearing
• Gateways to Cancer Screening: A Participatory Needs Assessment of Women with Mobility Disabilities
provides education and research; five Focus groups were carried out in the GTA with women who identify
as living with a mobility disability; Provide outreach to diverse groups throughout the city
Staff are accommodated on the basis of disability through collaboration between Occupational Health and
Safety and management. Some examples of employee accommodation are:
• Staff who have had their work schedule changed (either hours of work or number of consecutive shifts)
• Change in work assignments based on physical demands of job
• Work areas changed related to environmental factors that impact the individual’s underlying
medical condition
• Provision of ergonomic furniture or assistive devices
• Installation of visual alarms (lights) to identify emergency code notification to supplement overhead
voice announcements
• Meeting the needs of staff and patients who have allergies and/or scent sensitivities
• Provide staff access to Occupational Therapy services; Provide staff access to ergonomic assessments
of their workspace
Section 4: Governance
4: Do you collect information to evaluate how well your employees and Board of Directors
reflect the communities you serve? If yes, please describe how well your employees and
Board reflect your communities and indicate your data sources. If not, please explain why.
In 2007, Mount Sinai Hospital conducted a census of our staff, physicians, volunteers and Board members
through the include me! Workforce Census. There was a 55 per cent response rate to this workforce census,
and the data gathered, when compared to the Toronto Census Metropolitan Area, revealed the following:
see Demographic Characteristics next page
Mount Sinai Hospital

16
Demographic Characteristic
Mount Sinai
Hospital
Visible minority persons 38% 36.8%
Persons with a disability 6% 2.5%
Persons who immigrated to Canada 47% 45%
Persons of Aboriginal ancestry 1.3% 0.4%
Persons of Jewish faith 10%* 4%
Persons of Catholic faith 28% 34%
Persons with no religious or spiritual affiliation 20% 17%
Female 77%** 48.6%
Male 23% 51.4%
Persons who are lesbian, gay, bisexual, questioning or Two-Spirited 5%*** 10%
Toronto CMA
*Mount Sinai Hospital originated as a Jewish faith-based organization, therefore a higher percentage of persons at Mount Sinai
Hospital are of the Jewish faith compared to the external population.
**Healthcare providers are disproportionately female.
***Under-reporting is possibly the result of privacy concerns and fear of discrimination.
For more detailed information, please see attached document titled Appendix B: The Results Are In!:
include me! Workforce Census 2007.
As a historically Jewish hospital, Mount Sinai Hospital has received much of its support and volunteer
leadership from the Jewish community. Through our partnership with DiverseCity, we intend to become more
diverse and representative at our board committee level which feeds members to our board of directors.
Section 5: Targets and Measurement
5a: Please outline the goals and action plans to address your health equity
and access priorities.
Please see attached document titled Appendix B: Response to Section 5a.
5b: Please provide some examples of how you incorporate your access and equity objectives,
or use an equity lens, in your initiatives to address the MOHTLC and LHIN priorities?
(e.g. Strategic Plan, Wait Times Reduction, Patient Safety, Staff Interactions, Capital
Projects including Facility Improvements, etc.)
Please see attached document titled Appendix B: Response to Section 5b.
5c: What indicators and tools are used to monitor progress?
(e.g. interpreter requests, accessibility plan implementation, balanced scorecards,
patient compliments and complaints, etc.)
Progress is monitored by the Diversity & Human Rights Committee, Risk Management, AODA Committee,
Social Work, Patient & Family Centred Care Committee, Corporate Quality Committee and the Patient
Safety Steering Sub-Committee, through patients complaints management, patient satisfaction survey,
Diversity & Human Rights complaints management, incident reporting, union grievances, accessibility plan
implementation, balanced scorecard, patient compliments and interpreter requests. In addition, all Mount
Sinai Hospital managers are held accountable for these policies and procedures, and mandatory training is
Toronto Central LHIN Equity

17
provided for all healthcare providers. Mount Sinai Hospital has also gathered feedback from staff and patients
regarding our policies, procedures and standards through the Made in Sinai Competencies community
consultation and the Diversity in the Work Environment research project.
5d: What information and data do you require in order to better identify and monitor
health inequities?
• Patient demographic data including: race, language, sexual orientation, income, education, disability
status, family structure, who is accessing inpatient clinics, who is accessing outpatient clinics, treatment,
health outcomes
• Ongoing collection of workforce demographic data
5e: How are members of diverse communities, staff and board members involved in planning
and setting health equity priorities for action by your hospital?
(e.g. community engagement approaches)
• Mount Sinai Hospital Health Equity Committee
• Community Advisory Committee
• Community representative on the Diversity & Human Rights Committee
• AODA Committee conducts consultations with people with disabilities
• 2007 include me! Workforce Census
• Made in Sinai Competencies community consultation
• Diversity in the Work Environment research project
• Patient advisors on Patient and Family Centred Care Committee and various clinical teams
• Community volunteers on Diversity & Human Rights Committee and several subcommittees
Section 6: Communications
6: In what ways are your health equity goals communicated to the following groups?
Staff & Physicians: posters, brochures, training workshops, intranet site, employee newsletter (Sinai Scene),
CEO email newsletter (Connecting with Joe), senior leadership training, MNet presentations, 2007 include
me! Workforce Census report.
Board of Directors: through CEO and through Mount Sinai Hospital annual reports.
Patients/Clients, Families and Community Members: posters, brochures, communication with front-line
staff, Sinai Scene, Internet site, virtual tour, Community Advisory Committee, Patient Advisory Committee,
Patient Services Guide, and earned media (print and broadcast).
Health and Social Service Partners: communication with staff, Internet site, OHA Committees, Hospital
News Magazine, and collaborative committees through University of Toronto.
The Toronto Central LHIN: through the LHIN Health Equity Plan and with meetings at the LHIN.
Mount Sinai Hospital

18
Section 7: Potential Roles for the Toronto Central LHIN
7: Does your hospital have specific requests, actions or comments that the LHIN should
consider to ensure a system-wide approach to improving health equity?
• Collect and share patient data LHIN-wide
• Determine what data to collect so that we can collectively benchmark and compare data
• Appropriate compensation for hospital and practitioners when providing care for patients who require
more time for appointments (eg. patients with disabilities, seniors, patients who need interpretation, etc.)
• Support trained health interpretation and translation services
• Support transportation for patients
• Support uninsured patients
• Support low-income patients who do not have funds to cover the costs for services that are not listed
by OHIP
• Support funding for hospital-wide health equity training
• Support bundling healthcare services for people who face access barriers
• Provide feedback regarding benchmarks (let us know how we are doing)
Section 8: Attachments
8: Please list all attachments to this report here.
Appendix A:
Change in Average Individual Income, City of Toronto, 1970 to 2005................................................................... A1
Characteristics of the “Three Cities” in Toronto, 1971 to 2006.............................................................................A2-5
Neighbourhood Concentrations of Jewish Populations 2006.................................................................................. A6
Emergency Visits to Mount Sinai Hospital 2007 to 2008 Per 10,000 People by Patient Census Tract............... A7
Emergency Visits to Mount Sinai Hospital 2007 to 2007 by Patient Postal Code................................................. A8
Inpatient Visits to Mount Sinai Hospital 2007 to 2008 Per 10,000 People by Patient Census Tract................... A9
Inpatient Visits to Mount Sinai Hospital 2007 to 2007 by Patient Postal Code................................................... A10
Appendix B:
Response to Section 2a....................................................................................................................................... B2a,1-2
Response to Section 2c..................................................................................................................................... B2c,1-12
Response to Section 3c.......................................................................................................................................... B3c,1
The Results Are In!: include me! Workforce Census 2007......................................................................... Census 1-4
Response to Section 5a.....................................................................................................................................B5a,1-13
Response to Section 5b....................................................................................................................................... B5b,1-2
Appendix C:
Diversity & Human Rights Policy and Procedures
Fair Employment Opportunity Policy
Made in Sinai Health Equity Competencies: Delivering Healthcare to Diverse Communities
Toronto Central LHIN Equity

19
Section 9: Contact and Authorization
Joseph Mapa
President and Chief Executive Officer
Mount Sinai Hospital
600 University Avenue, Room 335
416-586-4800 ext. 5063
jmapa@mtsinai.on.ca
Sandra Harrison
Administrative Assistant
416-586-4800 ext. 5062
sharrison@mtsinai.on.ca
Signature: _______________________________
Date: ________________________
Lawrence Bloomberg
Chair, Board of Directors
416-869-6676
lawrence.bloomberg@nbfinancial.com
Signature: _______________________________
Date: ________________________
Mount Sinai Hospital

Change in Average Individual Income, City of Toronto, 1970 to 2005
Appendix A: Change in Average Individual Income, City of Toronto, 1970 to 2005
Average Individual Income from all sources, 15 Years and Over, Census Tracts
Average Individual Income from all sources, 15 years and Over, Census Tracts
A1
Steeles Ave
3
Hwy 401
Hwy 401
2
1
Yonge St
Bloor St W
Danforth Ave
City of Toronto
Priority Neighbourhoods (2005)
Highways (2005)
Subway (2005)
Old Toronto (1996)
No Data
Analysis: R. Maaranen.
Source: Statistics Canada,
Census 1971, 2006
5 2.5 0 5 Kilometers
Change in the Census Tract Average Individual Income
as a percentage of the Toronto CMA Average, 1970-2005
Increase of 20% or More (100 Census Tracts, 19% of the City)
Increase or Decrease is Less than 20% (208 Census Tracts, 40% of the City)
Decrease of 20% or More (206 Census Tracts, 40% of the City)
Greater Toronto Urban Observatory
www.gtuo.ca www.NeighbourhoodChange.ca
Note: Census Tract 2001 boundaries shown. Census Tracts with no income data
for 1970 or 2005 are excluded from the analysis. There were 527 total census tracts in 2001.

A2 Appendix A: Characteristics of the “Three Cities” in Toronto, 1971 to 2006
OVERVIEW & POPULATION
INCOME
Characteristicsofthe“ThreeCities”inToronto,19712006
1. Number and % of census tracts in the City (based on
census 2001 geography. City total of 527 includes suppressed
tracts not classified in the three cities study sample due to
insufficient data.)
www.GTUO.ca DRAFT, Last Updated 19/08/2008
Characteristics of the Three Cities
grouped on the basis of 30-year Individual
Income trends, 1970 to 2005, by census tract
City #1
Income
Increased
20% or more
since 1970
City #2
Income
Increased or
decreased
less than
20%
City #3
Income
Decreased
20% or more
since 1970
100 / 19% 208 / 39% 206 / 39%
City of
Toronto
= City #1 +
City #2 +
City #3 +
censored
census
tracts
2. Land Area, square kilometres and % of City land area 102 / 16% 238 / 38% 278 / 44% 632
3. Total Dwellings (thousands) and % of the City, 2001 183 / 19% 373 / 39% 369 / 39% 934
4. Total Dwellings (thousands) and % of the City, 2006 189 / 20% 386 / 41% 372 / 39% 943
527 /
100%
5. Population in 2001 (thousands) and % of City 419 / 17% 950 / 38% 1,080 / 44% 2,481
6. Population in 2006 (thousands) and % of City 428 / 17% 947 / 38% 1,067 / 43% 2,503
7. White population %, 2001 / 2006 83% / 82% 68% / 65% 40% / 34%
8. Black population %, 2001 / 2006 2% / 2% 6% / 6% 12% / 12% 8% / 8%
9. Chinese population %, 2001 / 2006 7% / 7% 9% / 9% 14% / 15%
10. South Asian population %, 2001 / 2006 2% / 2% 5% / 6% 17% / 20% 9% / 12%
11. Change in average individual income,1970 to 2005, as a
% of the CMA average
12. Change in average individual income,2000 to 2005, as a
% of the CMA average
13. Average individual income (before tax, all sources,
persons 15 and over), 2005
14. Taxation Rate on Individuals, 2005 (difference between
before and after tax average individual income)
15. Average employment income (before tax, wages &
salaries only, persons 15 and over), 2005
16. Average household income (before tax, all sources,
persons 15 and over), 2005
17. Taxation Rate on Households, 2005 (difference between
before and after tax average household income)
18. Households with Income $20,000 or Less (constant 2000
dollars), 1970 / 2000
19. Households with Income $20,000 or Less (constant 2000
dollars), 2005
57% /
53%
10% /
11%
+99% -3% -37% -3%
+29% 0% -4% +3%
$88,400 $35,700 $26,900 $40,400
30% 18% 13% 20%
$90,800 $38,200 $29,000 $43,700
$172,900 $71,500 $59,200 $80,300
30% 18% 14% 21%
16% / 11% 15% / 17% 9% / 20%
15% /
18%
14% 18% 21% 19%

A3
Cities Centre, University of Toronto www.GTUO.ca
Characteristics of the “Three Cities” in Toronto, 1971-2006
20. Households with Income $100,000 or More (constant
2000 dollars), 1970 / 2000
17% / 38% 7% / 17% 8% / 13% 9% / 18%
21. Households with Incomes $100,000 or more (constant
2000 dollars), 2005
22. Persons in Households Below Statistics Canada Low-
Income Cutoff (LICO, before tax), 2005
37% 18% 11% 18%
14% 22% 30% 25%
23. Economic Family Income from Employment (wages &
salaries only), % of total economic family income in 2005
24. Economic Family Income from Government Transfer
Payments (e.g. welfare, Canada pension plan), % of total
economic family income in 2005
25. Economic Family Income from Other Sources (e.g.
investments, non-government pensions), % of total
economic family income in 2005
26. Average Property value of owner-occupied dwellings,
2001 (constant 2006 dollars)
83% 79% 76% 79%
3% 11% 15% 9%
14% 10% 9% 12%
$514,000 $284,700 $229,500 $314,500
Appendix A: Characteristics of the “Three Cities” in Toronto, 1971 to 2006
HOUSING & TENURE
27. Average Property value of owner-occupied dwellings,
2006
www.GTUO.ca DRAFT, Last Updated 19/08/2008
$699,700 $382,900 $310,200 $413,600
28. Home Owners in 1971 / 2001, % of total dwellings 54% / 63% 57% / 57% 54% / 50%
29. Home Owners in 2006, % of total dwellings 64% 60% 53% 54%
30. Owner-occupied Condos, % of total dwellings, 2001
Note: not released by Statistics Canada for Census Tracts in 2006
and not available for renter-occupied condos which are simply pooled
with all renter-occupied dwellings.
51% /
51%
10% 7% 14% 11%
31. Average Monthly Rent, 2001 (constant 2006 dollars) $1,130 $950 $950 $950
32. Average Monthly Rent, 2006 $1,120 $940 $900 $930
33. Renters in 1971 / 2001, % of total dwellings 46% / 37% 43% / 43% 46% / 50% 49% / 49%
34. Renters in 2006, % of total dwellings 36% 40% 47% 46%
35. Dwellings Built Before 1971 as of 2006, % of total dwellings 72% 69% 48% 58%
36. Dwellings Built After 1971 as of 2006, % of total dwellings 28% 31% 52% 42%
37. Dwellings Built 2001 to 2006 as of 2006, % of total dwellings 6% 5% 3% 6%
38. Dwellings in Need of Regular Maintenance only, 2006 65% 63% 66% 66%
39. Dwellings in Need of Minor Repairs, 2006 28% 29% 26% 27%
40. Dwellings in Need of Major Repairs, 2006 7% 8% 8% 7%
41. Owner households spending more than 30% of income
on housing, 1981 / 2001 (% of owners)
42. Owner households spending more than 30% of income
on housing, 2006 (% of owners)
43. Renter households spending more than 30% of income
on housing, 1981 / 2001 (% of renters)
44. Renter households spending more than 30% of income
on housing, 2006 (% of renters)
45. Social housing units 1999 (thousands) & share of total
dwellings, 2001
17% / 19% 17% / 22% 15% / 27%
17% /
23%
21% 27% 32% 28%
31% / 36% 30% / 42% 27% / 45%
28% /
42%
41% 45% 47% 47%
11 / 6% 33 / 9% 41 / 11% 91 / 10%

Appendix A: Characteristics of the “Three Cities” in Toronto, 1971 to 2006
Cities Centre, University of Toronto www.GTUO.ca
Characteristics of the “Three Cities” in Toronto, 1971-2006
EDUCATION
IMMIGRANTS
FAMILIES & HOUSEHOLDS
46. Persons 20 or over with a university degree, 1971 / 2001 14% / 49% 6% / 24% 7% / 20% 8% / 27%
47. Persons 25 or over with a university certificate, diploma or
degree, 2006
48. Persons 20 or over without a school certificate, diploma
or degree, 2001
49. Persons 25 over over without a school certificate, diploma
or degree, 2006
50. Persons 25 and Over with a docorate degree (PhD),
2006, number and %
61% 35% 31% 39%
8% 15% 17% 14%
7% 20% 21% 18%
8,880 / 3% 8,320 / 1%
5,020 /
0.6%
51. Not born in Canada in 1971 / 2001 35% / 32% 38% / 48% 31% / 62%
23,100 /
1%
52. Not born in Canada in 2006 28% 45% 61% 50%
53. Immigrants arrived between 1965 & 1971 in 1971 10% 13% 10% 12%
54. Immigrants arrived between 1996 & 2001 in 2001 4% 9% 16% 11%
55. Immigrants arrived between 2001 & 2006 in 2006 4% 8% 15% 11%
56. Persons per household, 1971 / 2001 3.0 / 2.3 3.4 / 2.6 3.6 / 3.0 3.3 / 2.7
57. Persons per household, 2006 2.3 2.5 2.9 2.7
58. One person households, 1971 / 2001 20% / 33% 13% / 27% 8% / 20%
59. One person households, 2006 34% 29% 21% 30%
60. Households with Six or More Persons, 2006 2% 3% 7% 4%
61. Children and youth under 20 years, 1971 / 2001 26% / 20% 33% / 22% 40% / 26%
62. Children and youth under 20 years, 2006 20% 20% 25% 22%
63. Family Households (% of households), 2001 / 2006 60% / 60% 67% / 66% 76% / 75% 68% / 65%
64. Non-Families (% of households), 2001 / 2006 40% / 40% 33% / 34% 24% / 25% 32% / 35%
65. Single parent families (% of families) in 1971 / 2001 11% / 14% 10% / 19% 8% / 22% 10% / 20%
66. Single parent families (% of families), 2006 14% 20% 23% 20%
37% /
50%
14% /
28%
32% /
23%
67. Seniors, 65 and over, 1971 / 2001 13% / 14% 8% / 15% 5% / 13% 9% / 14%
68. Seniors, 65 and over, 2006 14% 15% 14% 14%
69. Multiple family households (% of households), 2001 / 2006 1% / 1% 3% / 3% 6% / 6% 4% / 3%
70. White collar occupations, 1971 / 2001
(managerial/professional jobs excluding clerical workers)
24% / 60% 14% / 39% 18% / 32%
17% /
40%
EMPLOYMENT
71. White collar occupations, 2006 (managerial/professional
jobs excluding clerical workers)
72. Blue collar occupations, 1971 / 2001 (manufacturing,
transportation, construction, utilities)
73. Blue collar occupations, 2006 (manufacturing,
transportation, construction, utilities)
58% 39% 30% 40%
18% / 6% 30% / 18% 26% / 25%
27% /
18%
5% 16% 24% 17%
74. Arts, literary, recreation occupations, 1971 / 2001 3% / 9% 1% / 5% 1% / 2% 2% / 5%
75. Arts, literary, recreation occupations, 2006 10% 6% 2% 5%
76. Unemployment Rate, 15 years and over, 1971 / 2001 7% / 5% 8% / 6% 6% / 8% 7% / 7%
A4
www.GTUO.ca DRAFT, Last Updated 19/08/2008

A5
Cities Centre, University of Toronto www.GTUO.ca
Characteristics of the “Three Cities” in Toronto, 1971-2006
77. Unemployment Rate, 15 years and over, 2006 5% 7% 9% 8%
78. Youth Unemployment, 15-24 years, 2006 17% 15% 18% 17%
79. Self-Employed, 15 years and over, 1971 / 2001 6% / 20% 4% / 12% 4% / 8% 5% / 12%
80. Self-Employed, 15 years and over, 2006 20% 12% 8% 12%
81. Total jobs by place of work, 2001 (thousands)
Note: not released by Statistics Canada in Census 2006 for Census Tracts
82. Jobs in the Area Per 100 Persons of Working Age Living
in the Area (15-64 Years), 2001
83. Jobs in the manufacturing industry by place of work
(thousands) and % of the City, 2001
Note: not released by Statistics Canada in Census 2006 for Census Tracts
84. Jobs in the finance, insurance and real estate industry by
place of work (thousands) and % of the City, 2001
Note: not released by Statistics Canada in Census 2006 for Census Tracts
354 531 378 1,327
113 81 52 78
17 / 10% 61 / 35% 92 / 53% 173
47 / 27% 89 / 52% 26 / 15% 171
85. Travel to work by car as driver or passenger, 2001 / 2006 56% / 54% 56% / 55% 63% / 61% 59% / 56%
86. Travel to work by public transit, 2001 / 2006 30% / 30% 34% / 35% 33% / 34% 33% / 34%
Appendix A: Characteristics of the “Three Cities” in Toronto, 1971 to 2006
TRAVEL & PLACE OF WORK
CRIME & SAFETY
87. Working Inside City of Toronto, 2006 (persons with a
usual place of work as % of labour force)
88. Working Outside City of Toronto, 2006 (persons with a
usual place of work as % of labour force)
69% 67% 63% 66%
11% 14% 20% 16%
89. Working at Home, 2006 (% of labour force) 12% 7% 4% 7%
90. Working Outside Canada, 2006 (% of labour force) 1% 0.5% 0.5% 1%
91. With No Fixed Workplace Address, 2006 (% of labour force) 7% 12% 11% 10%
92. Number & % of Toronto Transit subway stations within
the area or on the edge of the area (within 300 metres),
2006
40 / 59% 50 / 74% 19 / 28% 68
93. Total Homicides 2005-2007, number and % of City 28 / 12% 71 / 31% 126 / 54% 232
94. Homicide by Shooting 2005-2007, number and % of
column total homicides
17 / 61% 31 / 44% 69 / 55% 121 / 52%
95. Homicide Rate 2005-2007 per 100,000 people 2006 7 8 12 9
96. Homicide Victims 2005-2007, Male % and Female % 82% / 12% 75% / 25% 78% / 22% 78% / 22%
97. Average Age of Homicide Victims 2005-2007 32.6 years 33.4 years 28.9 years 31 years
98. Homicide Victims 20 Years or Younger, 2005-2007,
number and % of column total homicides
99. Total Marijuana Grow-Ops Broken-Up by Police (2006,
2007), number and % of City
5 / 18% 14 / 20% 33 / 26% 53 / 23%
19 / 4% 155 / 32% 310 / 63% 489
100. Marijuana Grow-Op Rate (per 10,000 dwellings 2006) 1 4 8 5
Notes: 1) Figures reported for City #1, #2 and #3 are for census tracts based on estimating data for census 2001 geography over time
where census tracts are previously larger areal units by assuming equal proportions/averages/ratios in each smaller part. This is necessary in
order to measure one-to-one change in census tracts across the City with current geographic detail. Any Census tracts subdivided in the
2001-2006 period have their data aggregated back to the 2001 geography. Data is most accurate for those census tracts which have never
been subdivided in the entire 1971-2006 period.
2) Totals across the columns may not add up to City of Toronto totals and City totals may differ slightly from other sources due to
data suppression, rounding, aggregation, weighting and estimation effects that are inherent in calculations using Census data.
Sources: 1) Statistics Canada, Profile Series, Basic Cross-Tabulations, Topic-Based Tabulations Census 1971 to 2006. 2) Statistics
Canada, Custom Tabulations: E0985, E0982, E01171. 3) Social Housing Data - City of Toronto, Social Development , Finance and
Administration. 4) Crime Data - University of Toronto Map Library with permission from the Toronto Star
www.GTUO.ca DRAFT, Last Updated 19/08/2008

A6
Neighbourhood Concentrations of Jewish Populations,
by Census Tracts, Toronto CMA, 2006
Appendix A: Neighbourhood Concentrations of Jewish Populations
by Census Tract, Toronto CMA, 2006
Caledon
Richmond Hill
Vaughan
Markham
Brampton
Pickering
Ajax
Toronto
Mississauga
Subway (2005)
Municipalities (2006)
Milton
No Data
Jewish Population
Percentage, 2006
Oakville
5 2.5 0 5 Kilometers
Less than 1%
1% to 10%
10% to 30%
30% or More
Based on analysis by R. Maaranen, UofT Cities Centre
Source: Statistics Canada, Census Profiles 2006
(c) Centre for Urban and Community Studies, University of Toronto, 2008
Neighbourhood Change Community University Research Alliance, SSHRC
See: www.NeighbourhoodChange.ca & www.gtuo.ca
Community Partner: St. Christopher House, Toronto
Principal Investigator: J.D. Hulchanski www.urbancentre.utoronto.ca

Appendix A: Emergency Visits to Mount Sinai Hospital 2007 to 2008 per 10,000 People
Emergency Visits to Mount Sinai Hospital 2007-2008 Per 10,000 People by Patient Census Tract
by Patient Census Tract, Toronto, Oshawa and Metropolitan Areas
Toronto, Oshawa and Hamilton Census Metropolitan Areas
A7
Total Emergency Visits
2007/04/01 to 2008/03/31
Per 10,000 People Living
in a Census Tract (2006)
Less than 10
10 to 50
50 to 100
100 to 200
200 or More
Orangeville
Mono
Caledon
Brampton
New
Tecumseth
Bradford
West Gwillimbury
King
Vaughan
Aurora
Richmond
Hill
Markham
Georgina
East Gwillimbury
Newmarket
Whitchurch-
Stouffville
Uxbridge
Pickering
Whitby
20 10 0 20 Kilometers
Sources:
(1) Mount Sinai Hospital Joseph and Wolf Lebovic Health Complex,
Office of Quality and Performance Measurement, 2008
(2) Statistics Canada Postal Code Covnersion File March 2008
(3) Statistics Canada Census Subdivision Boundary File 2006
Halton Hills
Toronto
Ajax
Oshawa
Clarington
Milton
Mississauga
Oakville
Burlington
Hamilton
Grimsby

Emergency A8 Visits to Mount Sinai Hospital 2007-2008 by Patient Postal Code
Appendix A: Emergency Visits to Mount Sinai Hospital 2007 to 2008 by Patient Postal Code
Toronto, Oshawa and Hamilton Census Metropolitan Areas
Toronto, Oshawa and Hamilton Census Metropolitan Areas
Total Visits by Municipality
(2007/04/01 to 2008/03/31)
Ajax 162
Aurora 62
Bradford West Gwillimbury 12
Brampton 529
Burlington 94
Caledon 72
Clarington 49
East Gwillimbury 24
Georgina 30
Grimsby 2
Halton Hills 25
Hamilton 135
King 27
Markham 419
Milton 36
Mississauga 933
Mono 2
New Tecumseth 25
Newmarket 91
Oakville 185
Orangeville 18
Oshawa 85
Pickering 162
Richmond Hill 332
Toronto 35,487
Uxbridge 10
Vaughan 945
Whitby 134
Whitchurch-Stouffville 19
Total Visits Mapped 40,106
Other Visits 3,631
Grand Total 43,737
Orangeville
Mono
Halton Hills
Caledon
Brampton
New
Tecumseth
Bradford
West Gwillimbury
King
Vaughan
Georgina
East Gwillimbury
Newmarket
Aurora
Whitchurch-
Stouffville
Richmond
Hill
Markham
Toronto
Uxbridge
Pickering
Ajax
Whitby
20 10 0 20 Kilometers
Sources:
(1) Mount Sinai Hospital Joseph and Wolf Lebovic Health Complex,
Office of Quality and Performance Measurement, 2008
(2) Statistics Canada Postal Code Covnersion File March 2008
(3) Statistics Canada Census Subdivision Boundary File 2006
Oshawa
Clarington
Note: "Other Visits" includes those patients
who came from outside the
Toronto-Oshawa-Hamilton metropolitan area
and those with undisclosed or
invalid postal codes.
Milton
Mississauga
Oakville
Burlington
Hamilton
Grimsby

Appendix Inpatient A: Inpatient Visits to Visits Mount to Mount Sinai Sinai Hospital Hospital 2007-2008 to 2008 Per per 10,000 10,000 People by Patient Census Tract
by Toronto, Patient Census Oshawa Tract, Toronto, and Oshawa Hamilton and Census Metropolitan Metropolitan Areas Areas
A9
Total Inpatient Visits
2007/04/01 to 2008/03/31
Per 10,000 People Living
in a Census Tract (2006)
Less than 10
10 to 50
50 to 100
100 to 200
200 or More
Orangeville
Mono
Caledon
Brampton
New
Tecumseth
Bradford
West Gwillimbury
King
Vaughan
Aurora
Richmond
Hill
Markham
Georgina
East Gwillimbury
Newmarket
Whitchurch-
Stouffville
Uxbridge
Pickering
Whitby
20 10 0 20 Kilometers
Sources:
(1) Mount Sinai Hospital Joseph and Wolf Lebovic Health Complex,
Office of Quality and Performance Measurement, 2008
(2) Statistics Canada Postal Code Covnersion File March 2008
(3) Statistics Canada Census Subdivision Boundary File 2006
Halton Hills
Toronto
Ajax
Oshawa
Clarington
Milton
Mississauga
Oakville
Burlington
Hamilton
Grimsby

A10
Inpatient Visits to Mount Sinai Hospital 2007-2008 by Patient Postal Code
City of Toronto
Appendix A: Inpatient Visits to Mount Sinai Hospital 2007 to 2008 by Patient Postal Code
City of Toronto
North York
Etobicoke
Scarborough
York
East York
Toronto
5 2.5 0 5 Kilometers
Total Visits by Former Municipality
(2007/04/01 to 2008/03/31)
East York 641
Etobicoke 1,528
North York 3,354
Scarborough 1,246
Toronto 8,764
York 1,639
City of Toronto Total 17,172
Highway
Subway
Former Municipalities (1996)
Sources:
(1) Mount Sinai Hospital Joseph and Wolf Lebovic Health Complex,
Office of Quality and Performance Measurement, 2008
(2) Statistics Canada Postal Code Covnersion File March 2008
(3) Statistics Canada Census Subdivision Boundary File 1996

LHIN Health Equity Plan, Appendix B: Response to Section 2a
B2a-1
2a: Please briefly describe a maximum of five current hospital initiatives that help to improve access to health services by underserved or underrepresented populations?
Which population do they target and/or which access barrier do they seek to remove? In what ways is success being measured and what outcomes yielded as a result?
Please provide samples of related documents if any.
Mount Sinai
Hospital Initiative
1. Gateways
to Cancer
Screening:
A Participatory
Needs
Assessment
of Women
with Mobility
Disabilities
Target Population Access Barrier Addressed Method of Measurement Outcomes
Women with
mobility disabilities.
Architectural, attitudinal, socioeconomic, past
negative experiences with health screening,
healthcare system (multiple constraints and delays),
transportation, lack of knowledge by individuals
and healthcare professional’s knowledge re cancer
screening & people with disabilities.
Architectural, attitudinal,
socioeconomic, past negative
experiences with health
screening, healthcare system
(multiple constraints and delays),
transportation, lack of knowledge
by individuals and healthcare
professional’s knowledge re
cancer screening & people with
disabilities.
Education and research. Five focus groups carried out
in the GTA with women who identify as living with
a mobility disability— outreach to diverse groups
throughout the city.
2. Talk to Me:
Violence
Against Women
Awareness
Program
• Women who are
experiencing
Intimate Partner
Violence
• Frontline
healthcare
providers
Although many women living with Intimate Partner
Violence (IPV) routinely seek treatment from
healthcare providers, they typically go unidentified
in most clinical encounters. Unless health care
providers are open to disclosure of abuse and
ask appropriate questions to elicit disclosure, the
opportunity to intervene in cases of intimate partner
violence is missed. Women who are abused are
likely to visit a health care facility 11 times before
it is recognized. Intimate Partner Violence is a
significant healthcare issue that is recognized by the
World Health Organization as a critical determinant
of health. Women with a history of intimate partner
violence are more likely to experience many health
problems. Abused women are also more likely to
have preterm babies and babies with low birth
weight.
• The ‘Talk to Me’ training
program is routinely assessed
through participant surveys and
feedback forms.
• The program was also formally
evaluated by an external peer
reviewer from the University of
Toronto’s Sociology and Equity
Studies department.
Health care providers are trained to:
• Identify signs of abuse.
• Communicate to patients verbally and non-verbally
that they are open to disclosures of violence
• Respond appropriately and helpfully to patient
disclosures of abuse
• Access resources in the hospital and larger community
to assist women
‘Talk to Me’ campaign provides:
• Buttons to healthcare practitioners that read, “Are you
or your children being abused or hurt? Talk to me.”
• “Violence against women is a health care issue”
brochures and posters throughout the hospital for
patients and staff
• ‘Safety Plan’ pamphlets in Arabic, Chinese, English,
French, Italian, Hindi, Polish, Portuguese, Spanish,
Tagalog, Punjabi, Urdu and Vietnamese.
These initiatives aim to change the culture of healthcare
settings by promoting a safe environment for the
disclosure of IPV. By wearing the “Talk to Me” button and
displaying the posters, healthcare practitioners relay that
they are approachable, and open to disclosures of IPV.

B2a-2
LHIN Health Equity Plan, Appendix B: Response to Section 2a
Mount Sinai Hospital Initiative Target Population Access Barrier Addressed Method of Measurement Outcomes
3. Association for the Advancement of
Blacks in Health Sciences (AABHS)
Summer Mentorship Program
Encourage future black
and aboriginal health
care providers
Toronto has an identified need for
Health Care providers from immigrant
groups, to better represent the patients
who we serve.
The AABHS Mentorship Program
serves to expose disadvantaged young
students to future careers in health care
and provide role-models and mentors.
U of T is tracking statistics for
the program
Mount Sinai Hospital is the largest site for
this program, taking 16 out of the total of
20 students for the GTA. Physicians are very
willing to mentor students and provide
outstanding support.
Graduates of the Mentorship program have
successfully entered Medical School and other
health professions.
4. Ethnocultural Assertive Community
Treatment Team
Asian, South East
Asian, Tamil, African,
Caribbean, and
Aboriginal, clients
and families with
severe and persistent
mental illness
Use of bilingual/bicultural staff;
intensive training in cultural
competency knowledge and skill for all
staff; educate clients and families about
mainstream mental health system and
help them to incorporate into their
own health values and cultures; use
of culturally appropriate programs and
services to facilitate and enhance their
treatment outcome and rehabilitation.
Demonstrated reduction of
hospitalization days, psychiatric
admissions, and severity of
symptoms. Also measured via
feedback using client and family
satisfaction scores. Published
article in Psychiatric Services on
one-year outcomes (better than
Ontario average).
We are in the process of
measuring quality of life
indicators to be completed by
end of 2008.
This is the only ethnocultural ACT Team in
Canada. The team responds to community
needs by hiring diverse staff to reflect recent
immigration and settlement patterns. For
example, it recently added In Korean and
Vietnamese speaking staff. The team has
demonstrated exceptional outcomes with
respect to reduction of hospital days and
psychiatric admissions as compared with
its mainstream counterparts. The MSH ACTT
has been awarded numerous national and
international awards. As the only ethnocultural
ACTT in Canada, the team routinely receives
international visitors who come to study and
replicate its unique model.
Education and research. The project provided
2-day workshops in art, mindfulness, and
narrative modalities to community-based HIV
workers and volunteers and then provided
biweekly support and consultations during
eight to ten week interventions. Clients who
were not willing or able to come to a tertiary
psychiatric clinic were able to receive services
in their community agencies or in the case of
a house-bound client at home. Referral and
consultation processes between the community
agencies and the clinic were improved.
5. Clinic for HIV-Related Concerns PHA
ACCESS project is a community-based
research project testing a model of
community-hospital collaboration,
knowledge exchange, and capacity
building, aimed at increasing access
of people living with HIV to mental
health services by training and
supporting AIDS service organization
(ASO)
People living with
HIV in diverse
communities
Many people are averse to going for
specialized psychiatric or mental health
services because of stigmatization
of mental illnesses and fear of being
identified within their communities
as HIV+. The cultures in areas of the
world where HIV is endemic often lack
of mental health treatment constructs.
These challenges are exacerbated by
the difficulties CBAOs have advocating
for their clients in the mental health
system. The impact of high need
in combination with low access to
specialized HIV mental health services
can be devastating on individual
well-being and could lead to serious
clinical consequences.
Collaboration, training and
intervention effectiveness is
being assessed through
qualitative thematic analysis
of in-depth interviews or focus
groups with all clients, trainees,
trainers and co-investigators.
Intervention effectiveness is
being assessed through the
American Group Psychotherapy
Association’s Core Battery of
process and outcomes measures;
analyzed using repeated
measures tests and ANOVAs.

LHIN Health Equity Plan, Appendix B: Response to Section 2c
B2c-1
2c: Describe specific partnerships, projects or activities that your hospital has undertaken with other organizations to address health equity, including those addressing
the broader social determinants of health. Please include the names of those organizations and outcomes of the projects.
Mount Sinai Hospital
Initiative
Building
Breast Healthy
Neighbourhoods
Great Start Together
Perinatal Program
(a part of the Canada
Prenatal Nutrition
Program)
Target Population Social Determinant of Health Addressed Partnerships Activities
All women living in the
South Riverdale area.
Pregnant women and
nursing mothers with
low-income, who
are under-housed,
who are immigrants
or refugees, who
are undocumented
from diverse cultural
communities including:
Chinese, Portuguese,
Spanish and
Vietnamese.
Language, cultural beliefs, socioeconomic—
focusing on low income women or homeless, lack
of breast health awareness/education/ how to
navigate the healthcare system.
• Income and social status
• Social support networks
• Education
• Employment and working conditions
• Social environments
• Health and child development
• Personal health practices and coping skills
• Health services
• Gender
• Culture
• Discrimination due to racism, homophobia, etc.
South Riverdale Community Health
Centre, Canadian Cancer Society,
Toronto Public Health, Parent
Resources, Ralph Thornton Centre,
St. Michael’s Hospital—Ontario
Breast Screening Program
Queen West Community Health
Centre, Toronto Public Health,
Toronto Western Hospital,
St. Stephen’s Community Centre,
Scadding Court Community Centre,
Access Alliance Multicultural
Health Services.
Lactation Consultant from Mount
Sinai Hospital provides weekly
services to this program.
• Training and support: for Breast Health
Champions — who deliver sessions in the
community
• Capacity Building: Will contact 50 agencies with
the hope that 10 will agree to disseminate and
evaluate breast health awareness strategies.
• Community Campaign: five annual events related
to breast health awareness
• Access: Underserved, low income — using
incentive — like a mammogram coupon and
educational tools.
• Women visit this weekly program throughout their
pregnancy and up to 10 visits after giving birth
• Receive education regarding prenatal health, what
to expect during pregnancy, how to make healthy
baby food, lactation consulting, nursing care,
counselling and settlement services
• If the patient does not have a primary care
physician or OB/GYN, she is referred to a physician
• Financial assistance provided for hospital stay
during labour and delivery
• Healthy lunch is provided each week

B2c-2
LHIN Health Equity Plan, Appendix B: Response to Section 2c
Mount Sinai Hospital
Initiative
Clothing Drive for Sistering
Women’s Shelter
Target Population Social Determinant of Health Addressed Partnerships Activities
Women living in the
shelter system who have
escaped situations of
intimate partner violence.
Women, income, homelessness,
discrimination
Sistering Women’s Shelter
• Sistering receives financial donation and goods
and clothing to distribute to women in need
• Relationship between Sistering and Mount
Sinai Hospital is reinforced
NICU Parent Buddy Program
Parents who currently
have children in the NICU
• Social support networks
• Social environments
• Physical environments
• Health and child development
• Personal health practices and coping skills
• Gender
• Culture
Parents who previously had
children in the NICU program
• Provide two training sessions a year for
the Buddies
• About 70 available Buddies at any one time,
and over 20 languages represented
• Make home visits to parents needing support
• Approximately 120 mothers and fathers are
matched with a Buddy each year
• Buddies communicate with parents by
telephone, email and face-to-face
• Efforts are made to match Buddies based on
language and culture
Young Moms Program
Young pregnant women
(age 16 to 24) who are
isolated from family and
other supports and whose
educations have been
interrupted due to
early pregnancy
• Social support networks
• Education
• Health and child development
• Personal health practices and coping skills
• Health services
• Gender
• Culture
Ryerson University, Seneca
College in partnership with
Universities and Colleges
in GTA
Part of this program is to prepare these young
mothers for when it is time to bring their
babies home. We go through everything from
breastfeeding to bathing to nutrition and
discipline.
This group is co-led by an RN and Social Worker.
The goal is to provide prenatal education and
support. A hot meal is provided at each session
as well as a grocery gift card. Upon completion
of the program, the participants receive a gift
basket. The RN also connects the participants to
other hospital resources, such as Social Workers.
Mount Sinai Hospital is currently seeking funding
for a demonstration project that links young
moms to certificate and degree programs while
social supports are established to support them
through their education.

LHIN Health Equity Plan, Appendix B: Response to Section 2c
B2c-3
Mount Sinai Hospital
Initiative
Mount Sinai Hospital
Samuel Lunenfeld
Research Institute
initiative:
Dr. Stephen
Lye’s ‘DOHAD’
(Developmental Origins
of Health and Disease)
study that follows 3000
children from the womb
to adult years and
monitors connection
between low birth
weights and life
long health
Target Population Social Determinant of Health Addressed Partnerships Activities
The population was enrolled
in 1989 over a three — year
period. Mothers were recruited
from the general Perth
population registering with
the main maternity hospital in
Perth. There were no specific
efforts to recruit any special
group — rather they represent
the entire population.
If anything they probably
over represent marginalized
groups since some of the more
affluent women would go to
private hospitals.
No social determinants of health were
specifically addressed in the research to date,
though there are many social indicators in the
cohort data base, including job type, family
circumstances, risk factors such as smoking
and alcohol use etc. Our research overall is
interested in 'at risk' populations since these
might be predicted to have increased adverse
health outcomes in later life. However, since
the cohort is only 18 years old, these have not
really been addressed yet.
The funded human research
studies are conducted on a birth
cohort population collected in
Perth, Australia. The partnership
is with the Raine Study Group
based at the University of Western
Australia. Another collaboration
with the MYCRN group (Mothers
Youth Children Research Network)
to investigate gene-environment
interactions involved in childhood
obesity in Canada is now in
discussion. In the future a
partnership across the University of
Toronto and its teaching hospitals
relating to developmental health
may be possible.
The Raine cohort currently includes about
2,000 youth (around 18 years of age).
Over 80 publications document studies on
the group. The first manuscript is currently
being written .
HIV/Infectious
Disease Clinic
• Pregnant women with HIV
or other infectious diseases
(e.g. TB, syphilis), new
immigrants and refugees,
uninsured patients, lowincome
women, racialized
women.
• Social support networks
• Education
• Health and child development
• Personal health practices and coping skills
• Biology and genetic endowment
• Health services
• Gender
• Culture
• Discrimination due to racism,
homophobia, etc.
• University Health Network HIV
Program, the Therese Group for
women living with HIV
Women are treated in a respectful clinic
from caregivers with expertise in their
illnesses who also provide support around
trauma. The clinic provides care and
treatment for the pregnancy and the
infectious disease.
The clinic collects data on birth outcomes,
on the efficacy of treatment of the
infectious condition and on the types
of infectious conditions.
Women with HIV and other infectious
diseases did hot have access to high
quality care as there was little expertise
in this area. This clinic is staffed by care
providers with expertise in providing
care to women with HIV and infectious
diseases.
There are efforts made to accommodate
uninsured women without financial
means.

B2c-4
LHIN Health Equity Plan, Appendix B: Response to Section 2c
Mount Sinai Hospital
Initiative
Eye and Ear Screening Program
for New Immigrants/Seniors
Seniors Wellness Centre —
Health Promotion & Mental
Health Access Service
Target Population Social Determinant of Health Addressed Partnerships Activities
Asian and Southeast
Asian Immigrants (many
with no OHIP), primarily
older adults and seniors.
Chinese community
(aged 55+).
Linguistic and Cultural Barriers; financial
barriers (insurance).
The Toronto Study (Sadavoy, Meier, et al, 2004)
• Stigma and shame associated with having
psychiatric illnesses
• Lack of knowledge about MH disorders and
available resources
• Attempts to contain problems within
the family
• Lack of linguistically and culturally
appropriate MH services
• Reliance on family for MH service utilization
• Geographically inaccessible services; inability
to travel to specialized treatment/
service location
• Long waiting periods for service
• Delay seeking care until crisis; Reliance on
ER services
Other Barriers:
• Under-detection of psychogeriatric problems
at primary care (Health Quality Council, 2004)
• Worry about the dominance of drug therapy
and medication side-effects
(Li, Logan, et al, 1999)
• Culturally based beliefs about determinants
of mental disturbances in elders
(Ng, 1997; Li, Logan, et al, 1999)
Mount Sinai Hospital and
Scadding Court Community
Centre work collaboratively to
plan and deliver this program.
Each contributes services inkind
to sustain the program.
Hong Fook Mental Health
Association and Yee Hong
Centre for Geriatric Care.
Provision of culturally appropriate screening
services in an accessible community-based
setting which are subsequently supported
by the hospital should follow up services be
required. The hospital coordinates interpreter
services when interventional services are
provided at one of the hospital’s eye and
hearing clinics. Also addresses needs of noninsured
community.
Program Initiatives/Development Strategies:
• A Hospital — community partnership of
a teaching hospital and two major ethic
community agencies; widely advertised
through community education programs
• Focus on early identification/intervention with
flexible paths of access
• Culturally acceptable, family – as-unit-of-care
model, routinely focussing on and supporting
family and caregivers as appropriate.
• Geographically accessible storefront location
in a shopping plaza near the centre of the
target community
• Culturally familiar environment and wellness
activities foster a de-stigmatized environment
• Multidisciplinary service team made up of
professional staff (psychiatrist, social workers,
health promoter, psychological counsellor)
hired from the target community
• Simplified referral process and timely
response
• Culturally-relevant treatment options and
self-help wellness programs Integrated with
evidence-based western psychiatric care
• Formal service/shared care alliance with
primary care physicians (CMHCN) and social
services agencies in the target community

LHIN Health Equity Plan, Appendix B: Response to Section 2c
B2c-5
Mount Sinai Hospital
Initiative
Home at Last
Program
Target Population Social Determinant of Health Addressed Partnerships Activities
Patients over 60
with no support
to assist them in
returning home from
hospital
Promote safe discharge for people who do not
have resources, are isolated, and might otherwise
not take prescribed medication. Home at Last
provides access to support and safe transportation
home.
TCLHIN, St. Christopher House
• Accompany patient home from hospital
• Provide safe transport home
• Pick up prescriptions, equipment
• Pick up groceries, ensure meal is prepared
• Visits by Personal Support Worker for several days
to ensure safe transition home
Hip and Knee Arthritis
Program
Chinese seniors,
Jewish seniors and
elderly patients
with arthritis
• Social support networks
• Physical environments
• Personal health practices
• Health services
• Gender
• Culture
Scadding Court Community Centre,
Jewish Community Centre
• Wait-time reduction strategy
• Assessment of patients for hip and knee surgery
• Outreach to Chinese community
• Outreach to Jewish community
Provide mentorship
for Nurses through
the Care for Nurses
Program
Nurses with
international
qualifications who
are not currently
employed as Nurses
Income and social status, social support networks,
social inclusion, education, employment and
working conditions.
Care for Nurses Centre for
Internationally Educated Nurses
• Provide mentorship and education about the role
of Nursing in Ontario's health system
• Gain experience in working in hospital
• Get advice on how to search for work and prepare
for employment
• Learn nursing terms used in Canada
• Assess their clinical skills and upgrade or review
areas where they still need help
• Receive personal guidance on their nursing career

B2c-6
LHIN Health Equity Plan, Appendix B: Response to Section 2c
Mount Sinai Hospital Initiative Target Population Social Determinant of Health Addressed Partnerships Activities
Provide workshops for
Social Workers
• Income and social status, social support Internationally Educated • Provide training for social work employers
Social Work employers on fair with international networks, social inclusion, education, Social Workers Program at about equitable hiring practices and barriers
qualifications who are employment and working conditions. Ryerson University
facing internationally trained professionals
hiring processes, participate
not currently employed
in mock interview processes,
• Participate in mock interview process for
as Social Workers and
internationally educated social workers
and provide mentorship potential employers.
• Provide mentorship opportunities for
opportunities
internationally educated social workers
Psychological Trauma Program
Individuals who
have witnessed or
experienced difficult life
events that may include:
• Accidents
• Fires or explosions
• Natural hazards such
as floods earthquakes
or hurricanes
• Physical and/or sexual
assault or intimidation
in childhood or as
an adult
• Exposure to combat,
war zones or torture
• Social support networks
• Health and child development
• Personal health practices and coping skills
• Health services
• Gender
• Culture
Canadian Centre for Victims
of Torture
• Provide extended assessment, consultation
and treatment for individuals who are
suffering from symptoms related to their
past unresolved psychological trauma(s)

LHIN Health Equity Plan, Appendix B: Response to Section 2c
B2c-7
Mount Sinai
Hospital Initiative
Mental Health Court
Support Program
Target Population Social Determinant of Health Addressed Partnerships Activities
South East Asian,
Tamil, African -
Caribbean Offenders
of the Mental Health
Court at Old City Hall.
Targets mentally ill offenders from
ethnocultural backgrounds involved with the
justice systems. Barriers include different
understanding of legal and mental health
systems due to language
and cultural barriers; inadequate
understanding; stigma.
We work closely with the Mental
Health Court at Old City Hall and are
support by our Ethnocultural Assertive
Community Treatment Team. We
also have informal partnership
with ethno-specific mental health
community agencies such as Hong
Fook Mental Health Association,
Access Alliance, Across Boundaries
and different ethnic community
centers.
Intensive community outreach model; help clients
navigate through the law and mental health systems.
Enables clients to understand the forensic mental
health system in Ontario by employing multicultural,
multilingual staff who provide comprehensive
treatment and rehabilitation and who are able to
actively engage clients who otherwise would not
access the mainstream mental health system.
Sign Language
Services and
Assistive Devices
Program
Deaf, deafened, hard
of hearing patients
and their families.
Patients who have hearing impairments require
supports and services to enable them equitable
access to health care.
Member of Healthcare Interpretation
Network — one focus has been on the
provision of service to patients who
require sign language assistance and
devices. Work closely with CHS/OIS;
Collaborate with Mount SInai Hospital
Audiology Services re: patient needs.
Provided 99 Interpretations in ASL to patients and
families in 2007-08. Provide Pocket Talkers, TTYs, and
other assistive devices to patients who have hearing
impairments.

B2c-8
Mount Sinai Hospital
Initiative
Dental Program for
Persons with Disabilities
Client Access to Integrated
Services and Information
(CAISI) Project
LHIN Health Equity Plan, Appendix B: Response to Section 2c
Target Population Social Determinant of Health Addressed Partnerships Activities
Persons with disabilities, • Dental disease is much more prevalent in
specifically patients with persons with disabilities
Developmentally delayed, • In Canada 12 per cent of the population
Autistic, Cerebral Palsy, Down is disabled
Syndrome, Quadriplegia,
• Ontario 1.5 million
Acquired Brain Injury, CVA,
(14 per cent are disabled)
Parkinsons, Dementia,
Severe Cardiac.
• Number of people with disabilities
is increasing
Most patients are referred by:
• Dentists in the community
• Physicians
• Public Health
• Group Homes
• Chronic Care Facilities
• Disability community
support groups
and advocates
Chronic homeless who are
frequent users of hospital
emergency rooms
and shelters.
Chronic Homelessness, lack of Family
Physician, lack of follow up or continuity
between medical appointments (ie homeless
are “frequent fliers” at various emergency
rooms across the city. CAISI enables the
electronic sharing of client information
between providers, including hospitals and
shelters. This supports reduced duplication,
sharing of medical records and more
comprehensive follow up on the health
status of this marginalized population.
Pediatric Dentistry at the
University of Toronto
Street Health,
St. Michael’s Hospital,
Seaton House, City of
Toronto
• Provide all types of dental care to persons
with disabilities
• Treat patients in a regular dental clinic which
is accessible
• Provide required dental care under general
anesthesia when: 1: The primary reason is
inability to cooperate for dental care in a clinic
setting; 2: Medically unstable therefore anesthesia
management is required to optimize patient safety.
Treatment provided by:
• Undergraduate and graduate dental students under
attending staff supervision
• Hospital Dental Residents (six per year)
• Staff Dentists/Dental Specialists
• Treatment provided in ambulatory clinic, operating
room and emergency room facilities
CAISI Project aims to reduce the plight of chronic
homelessness by enhancing the integration of care
between agencies at the individual and population
levels using an electronic information system. The
project includes: 1: The development of the open
source system software; and 2: Building community
and agency capacity in using the system to integrate
care between agencies.
At the individual level, the project includes the rapid
assessment of clients, referral to appropriate shelters
and agencies, managing waiting lists into services,
support multi-agency case management ultimately
leading to client placement into appropriate housing
or community placement.
At the population level, the project enhances the
ability of the community to gather data that can
be used by activists and decision makers to
help effect positive social change to end chronic
homelessness by advocating for more affordable
and supportive housing.

LHIN Health Equity Plan, Appendix B: Response to Section 2c
B2c-9
Mount Sinai Hospital
Initiative
Target Population
Social Determinant of Health
Addressed
Income, education, social supports.
Partnerships
Activities
Investing in Our
Diversity Scholarship
and Employment
Program
High school
students living in
low income at-risk
neighbourhoods.
• Scadding Court Community Centre
• Toronto Community Housing
Recognize the commitment of young people involved
in anti-racism, diversity and/or leadership on building
healthy communities initiatives. This scholarship
provides high school graduating students with $4,000
to cover costs of tuition fees, books, tools, etc for your
first year of the post secondary education program they
are attending. Mount Sinai Hospital participates annually
in the scholarship program and provides summer
employment for the scholarship winner.
Mount Sinai Hospital
Samuel Lunenfeld
Research Institute
initiative:
Dr. Robert Casper’s
innovative new
glasses created for
night shift workers
that regulate
circadian rhythm and
protect health
Night shift workers
e.g. nurses, etc.
We choose our
target populations
as per inclusion/
exclusion criteria
and objectives of the
study.
For our nursing study
we are choosing
nurses irrespective
of ethnicity however
we would not
compose our entire
study population
on any one ethnic
background. For our
clinical study, we
chose participants
from all major
ethnic backgrounds.
We included both genders in our study.
The study was conducted in English as all
study instruments used were in English
and cannot be readily translated to other
languages. We did not address any other
social determinants of health in our studies.
Ontario Centres of Excellence
13 individuals studied. Hormone secretion, gene
expression, behaviour. Exposure to light at night disrupts
endocrine, genetic and behaviour rhythms that can be
prevented by filtering short wavelengths from nocturnal
lighting.

B2c-10
LHIN Health Equity Plan, Appendix B: Response to Section 2c
Mount Sinai Hospital
Initiative
Mount Sinai Hospital Samuel
Lunenfeld Research Institute
initiative:
Dr. Bernard Zinman’s
diabetes research in
Sandy Lake First Nations
community
Target Population Social Determinant of Health Addressed Partnerships Activities
Aboriginal community.
The community
approached Stewart Harris
for help to combat the
increasing prevalence
of diabetes mellitus.
• Education
• Health and child development
• Personal health practices and coping skills
• Biology and genetic endowment
• Health services
• Culture
The Sandy Lake diabetes
program is a partnership
between the community
of Sandy Lake and Mount
Sinai Hospital (Dr. Zinman);
University of Toronto (Tony
Hanley, Department of
nutritional sciences); Stewart
Harris ( University of Western
Ontario); and Rob Hegele
(Robarts)
Identified very high rates of diabetes mellitus
and its complications. Introduced community
based intervention.
Interpreter Services
Limited English speakers
and their families.
Patients and their families who have
language barriers cannot receive equal
access to quality health care. Lack of
understanding can lead to inappropriate
treatment, low compliance with treatment
plans, increased risk of medication and other
errors. Staff have access to interpreting
agencies, volunteers, and Language Line
telephone interpreting service.
Referrals for interpreters
are made by community
agencies such as physicians
who treat large immigrant
patient groups, CCACs. Mount
Sinai Hospital is an active
member of the Healthcare
Interpretation Network, a
not-for-profit organization
that develops strategies to
promote awareness of the
language barriers that inhibit
the quality of health care, the
development of standards to
guide the training of language
interpreters, and exchange of
information.
Staff are encouraged to use interpreters at any
time that patients cannot fully participate in their
care. 3,000 interpretations in 42 languages were
carried out last year.

LHIN Health Equity Plan, Appendix B: Response to Section 2c
B2c-11
Mount Sinai
Hospital Initiative
Member of
Healthcare
Interpretation
Network
Target Population Social Determinant of Health Addressed Partnerships Activities
Patient populations
with limited English
proficiency
• Social support networks
• Education
• Health services
• Culture
Healthcare Interpretation Network
Founded in 1990 to develop strategies that promote
awareness of and address language barriers that
inhibit the quality of health care provided to patient
populations with limited English proficiency.
Hospital
Collaborative
on Marginalized
Populations
• Uninsured patients
• Patients from
marginalized
populations
• Income and social status
• Physical environments
• Health and child development
• Personal health practices and coping skills
• Health services
• Gender
• Culture
• Discrimination due to racism,
homophobia, etc.
The Hospital Collaborative (HC) is a
group of Chief Executive Officers, and
their designated representatives,
from Toronto-area Acute Care
Hospitals working in partnership
to reduce health inequities for
vulnerable and marginalized
populations.
• Define principles for dealing with non-insured patients
• Develop a consistent approach to the registration of
non-insured patients and subsequent management by
Patient Accounts
• Develop across-hospital consistency in the definitions
of resident/non-resident for billing purposes
• Develop a consistent structure for accounting and
cost recovery
• Standardize relations among hospitals and community
health centres (CHCs) re: referral and treatment of
non-insured patients; OB/GYN is the primary area
of opportunity
• Set up a non-insured fee schedule that is valid across
Toronto’s hospitals
• Advocate provincially and federally on behalf of the
non-insured

B2c-12
LHIN Health Equity Plan, Appendix B: Response to Section 2c
Mount Sinai Hospital
Initiative
Membership on University
of Toronto Faculty of
Medicine Advisory
Committee on Equity
and Diversity
Target Population Social Determinant of Health Addressed Partnerships Activities
Medical staff and students
• Social support networks
• Education
• Employment and working conditions
• Social environments
• Health services
• Gender
• Culture
• Discrimination due to racism, homophobia, etc.
University of Toronto
Faculty of Medicine
• Adoption through Medical Advisory Committee
and staff physicians education/dissemination
of “Standards of Professional Behaviour for
Medical Clinical Faculty” as developed by this
Faculty committee
• Standards refer to role modelling, behaviour,
and absence of defined inappropriate conduct
regarding discrimination, intimidation,
harassment, boundary violations, etc.
• All physicians who are party to hospitaluniversity
affiliation agreement are bound by
these standards
Health Equity Council
Patients from marginalized
communities.
• Income and social status
• Social support networks
• Education
• Employment and working conditions
• Social environments
• Physical environments
• Health and child development
• Personal health practices and coping skills
• Biology and genetic endowment
• Health services
• Gender
• Culture
• Discrimination due to racism,
homophobia, etc.
Community healthcare
organizations and
hospitals
The mandate of the HEC is to engage in advocacy,
research, organizational change management,
community partnerships, collaboration and other
matters as requested to enhance Diversity, Equity
and Inclusion in all facets of health and wellness.

LHIN Health Equity Plan, Appendix B: Response to Section 3c
B3c-1
Please name or attach the list of languages available and the number of requests you receive for each
language, if this is recorded.
Language Total: 2,781* *Language total does not include 151 Language Line interpretation services.
2007 to 2008 Alphabetical Listing 2007 to 2008 Listing by Usage
Albanian 3 Lithuanian 1 Cantonese 901 Cambodian 11
Amharic 29 Maltese 1 Mandarin 524 Japanese 11
Arabic 18 Mandarin 524 Vietnamese 230 Bengali 10
ASL 99 Polish 45 Spanish 159 Croatian 6
Bengali 10 Portuguese 107 Russian 112 Lip Reading 6
Bulgarian 1 Punjabi 43 Portuguese 107 Serbian 5
Burmese 3 Romanian 13 ASL 99 Ukranian 5
Cambodian 11 Russian 112 Italian 69 Yiddish 5
Cantonese 901 Serbian 5 Turkish 66 Albanian 3
Croatian 6 Singhalese 2 Korean 55 Burmese 3
Dari 3 Slovanian 1 Tamil 48 Dari 3
Farsi 43 Somalian 37 Polish 45 German 3
French 37 Spanish 159 Farsi 43 Singhalese 2
German 3 Squaw 1 Punjabi 43 Tagalog 2
Greek 20 Tagalog 2 French 37 Tigrinya (Ethio) 2
Gujarati 1 Tamil 48 Somalian 37 Bulgarian 1
Hebrew 1 Tigrinya (Ethio) 2 Amharic 29 Gujarati 1
Hindi 15 Turkish 66 Greek 20 Hebrew 1
Hungarian 13 Ukranian 5 Arabic 18 Lithuanian 1
Italian 69 Urdu 14 Hindi 15 Maltese 1
Japanese 11 Vietnamese 230 Urdu 14 Slovanian 1
Korean 55 Yiddish 5 Hungarian 13 Squaw 1
Lip Reading 6 Romanian 13
Mount Sinai Hospital

Census 1
!
nclude me!
WORKFORCE CENSUS 2007
WINTER 2008
THE RESULTS ARE IN!
Hello everyone,
Last spring, our Bright Minds and Big Hearts at Mount Sinai Hospital
once again showed their dedication to making us an inclusive
organization that encourages and respects diversity by participating
in include me!, our innovative Workforce Census 2007.
The results of the Workforce Census are now in and we’re pleased
to show the first cut of the data. It’s no surprise that our workforce
is made up of people from a wide variety of ethnic and cultural
backgrounds — much like the patients and families we serve and
provide care for every day.
It’s also not surprising that our workforce is highly educated. This
is consistent with Mount Sinai’s dedication to being a learning
organization and to our special role as an academic health sciences
centre affiliated with the University of Toronto.
I want to thank everyone who took the time to fill out the Workforce
Census. The information gleaned will help us move forward on a
number of fronts such as training, education, and policy. It also gives
us an idea if there are groups at Mount Sinai we could serve better.
I am proud of our tradition of diversity and inclusiveness. It’s part of
what makes Mount Sinai an employer of choice for so many people
from all walks of life who want to work, teach, volunteer, conduct
research, and, of course, care for our patients here.
As a Top 50 Employer, we want to be able to do everything we can
to provide a fair and inclusive workplace for all our employees and
include me! Workforce Census 2007 is an important first step. I invite
you to take a look at the report, which is posted on the Intranet on
the Workforce Census home page.
If you have any questions, please contact the Diversity
and Human Rights office at ext. 7519 or send an e-mail to
diversity&humanrights@mtsinai.on.ca.
Thank you again for participating in this important initiative as we
continue to build on the best at Mount Sinai. You are our Bright Minds
and Big Hearts — and now we know more about you!
Sincerely,
Joseph and Wolf Lebovic Health Complex
Joseph Mapa
President and CEO, Mount Sinai Hospital
Mount Sinai Hospital

2 Census
In May 2007, Mount Sinai Hospital launched a
comprehensive workforce census to provide detailed
information about our employees. The results are now
in and we are pleased to share some highlights.
Our Culture and Ethnicity
Our society is diverse and so is our
workforce. The census showed that
staff and volunteers represent more
than 100 ethnic and cultural groups!
Here is what else we learned:
Mount Sinai employees have a
wide range of affiliations with
ethnic and cultural groups, most
notably with Chinese (ten per cent),
Jewish (nine per cent), Filipino
(six per cent), West Indian (six per
cent), and English (six per cent).
One third of Mount Sinai
employees from abroad entered
Canada within the last 10 years.
People who immigrated to
Canada or were educated abroad
were less likely to be using their
credentials in their jobs (21 per
cent) than those educated or born
here (34 per cent).
38 per cent of respondents are
racialized, a term that expresses
race as a social construct rather
than perceived physical traits.
This is a consistent reflection
of the external community as
is the number of people who
immigrated to Canada.
See Figure 1.
Sexual Orientation
As an organization, we strive to
be inclusive of all members of the
community. Understanding the
scope of the sexual diversity of
our employees ensures ours is a
welcoming work environment for
everyone.
Five per cent of Mount Sinai
Hospital employees identify as
bisexual, gay, lesbian, questioning,
or Two-Spirited. (GLBQ2)
This percentage reflects the
response in a study conducted
by the Canadian government,
but does not reflect the GLBQ2
population of Toronto, which is
expected to be at least 10 per
cent. Under-reporting is possibly
the result of privacy concerns and
fear of discrimination.
Mount Sinai Hospital has Faith
We also take pride in our religious
diversity and at Mount Sinai our
workforce is associated with
many religions.
Catholicism is the religion with
the highest level of representation
at Mount Sinai followed by the
Protestant faith.
59 per cent of the workforce
engages in religious practice.
See Figure 2.
The Languages We Speak
Some of our patients and families
are unable to speak English fluently,
so we provide interpreters to assist
in translation. It turns out that at
Mount Sinai, 57 per cent of our
workforce can speak in a language
other than English.
Other than English, the most
common languages that we speak
include European and Asiatic
Languages, and French.
Mount Sinai employees have used
a language other than English to
better connect with the community.
In fact, 11 per cent of respondents
have used European languages,
nine per cent Asiatic languages,
and eight per cent French in their
position at Mount Sinai.
21 per cent of respondents have
provided informal interpretation
assistance on the job.
Overtime, Playtime, Me Time
The census shows that Mount Sinai
staff are active! We now know
how much time we spend at work,
pursuing activities outside of the
Hospital, and the amount of time
we spend caring for children and
other dependents.
MOUNT SINAI HOSPITAL
WORKFORCE
CENSUS
MAY 14-27 2007
Include yourself!
You can fill out the 2007 Workforce
Census any time between May 14 - 27.
In complete confidentiality:
All census information is filed
anonymously, and will be kept strictly
confidential.
Online: please go to
www.twiinc.com/includeme
and fill out the online form.
On paper: get your census form
from your manager or the
Diversity and Human Rights Office,
Room 1536, 600 University Ave.
Any questions? Contact the
Diversity and Human Rights Office at:
t. 416-586-4800 ext. 7519 or email
diversity&humanrights@mtsinai.on.ca
“In order to bring
about change we
have to participate.
Stand up and
be counted.
It’s Census time!”
– Joyce Kerr,
Medical Transcriptionist
and Chief Steward,
SEIU Clerical
Toronto Central LHIN Equity

Sincerely,
Sincerely,
Census 3
Joseph Mapa
Joseph President Mapa and CEO
President Page 2: and Census CEO results
Page 2: Census results
Who are we?
Who are we?
In May 2007, Mount Sinai Hospital launched a comprehensive workforce census to
In provide May 2007, detailed Mount information Sinai Hospital about launched our employees. a comprehensive The results workforce are now census in and to there
provide are some detailed exciting information highlights about to share. our employees. The results are now in and there
are some exciting highlights to share.
Our Culture and Ethnicity
Our Culture and Ethnicity
Our society is diverse and our workforce is too. The census showed that staff and
Our Sincerely, volunteers society is represent diverse and more our than workforce 100 ethnic is too. and The cultural census groups! showed Here that is staff what and else we
volunteers learned: represent more than 100 ethnic and cultural groups! Here is what else we
50 per cent of our workforce learned: 77 per cent obtained their
In addition, 69 per cent of the
Joseph Mapa
spends less than five hours
President and
education
CEO
in Canada.
Mount Sinai workforce have
commuting to and from work Page at
• 2: Mount Census Of the Sinai results respondents employees with
pursued additional training and
have a wide range of affiliations with ethnic and
the Hospital and almost 40 per • Mount cultural international Sinai groups, employees credentials, most have notably the a wide with range Chinese
education. of affiliations (10 per
58
cent),
per with cent
Jewish ethnic received
(nine and per
cent spend five to 14 hours per Who are cultural cent), we? countries Filipino groups, identified (six most per with notably cent), the with West Chinese Indian financial (six (10 per support cent), from Jewish and the English (nine Hospital (six per per
week commuting.
cent), cent). highest Filipino frequency (six per are cent), the United West Indian and (six 66 per per cent), received and English time (six off per
One in three volunteers spends In May cent). 2007, Kingdom, Mount the Sinai Philippines, Hospital launched the a comprehensive work as support. workforce census to
two full days or more at Mount provide • One detailed United third States, information of Mount and China. Sinai about employees Most our of employees. from 65 abroad per The cent results entered of Mount are Canada now Sinai in within and there
Sinai Hospital.
are • some One last exciting these
third 10 years. employees
of highlights Mount Sinai
are to using share. employees
their
from
employees
abroad entered
who sought
Canada within the
last 10 years.
36 per cent of staff volunteer designation in their current role, additional education did so in
Our • Culture People who immigrated to Canada or were educated abroad were less likely to
outside of work.
and and most Ethnicity are MDs and RNs.
relation to their current positions,
• People be using who their immigrated credentials to Canada in their or jobs were (21 educated per cent) abroad than those were educated less likely or to
26 per cent have a job outside Within past nine months, and 20 per cent were engaging
Our society be born using is here diverse their (34 credentials and per cent). our workforce in their jobs is too. (21
the Hospital.
nearly a quarter of employees in
The per
training
census cent) than
toward
showed those
a future
that educated staff and or
volunteers born represent here (34 per more cent). than 100 ethnic and cultural groups! Here is what else we
21 per cent spend one to five • 38 were per cent enrolled of respondents in school, college, position at Mount Sinai.
learned:
are racialized.* This is a consistent reflection of the
• 38
hours per week and 44 per cent external per or university. cent community, of respondents as is are the racialized.* number of people This is who a consistent immigrated reflection to Canada. of the
Sexual external Orientation community, as is the number of Compiled people and who reported immigrated to Canada.
spend six to 14 hours per week Sexual on Orientation
by Madeline Cuadra
housework and maintenance.
• Mount Sinai employees have a wide range of affiliations with ethnic and
As an 30% Figure 1
83 per cent of the workforce As organization,
cultural organization, groups, we
we
most strive
strive
notably to be inclusive
to be inclusive
with Chinese of all
of all members
(10 members per cent), of the
of the
Jewish community.
community.
(nine per
Understanding 30%
Understanding cent), Filipino the scope
25% the scope (six of per of sexual
sexual cent), diversity West diversity Indian of our
of our (six members
members per cent), will
will and allow
allow English us to
us to (six create
create per
spend time on physical fitness. a welcoming MSH
a welcoming cent).
work environment for everyone.
25% work environment for everyone.
20%
MSH
84 per cent of the Mount Sinai
20% Five per cent of Mount Sinai Hospital employees identify as bisexual, T.O. CMA gay,
workforce pursue a hobby; 52 per • Five One 15% third per cent of Mount of Mount Sinai Sinai employees Hospital from employees abroad identify entered as Canada bisexual, within gay, the
lesbian, questioning, or Two-Spirited
T.O. CMA
cent spend up to five hours per lesbian, last 15%
This
10 years. questioning, or Two-Spirited
10% percentage reflects the response in a study conducted by the Canadian
week on their hobbies. This 10% government percentage but reflects does not the reflect response the in GLBQ2 a study population conducted of by Toronto the Canadian which is
• government People 5% who immigrated but does not to reflect Canada the or GLBQ2 were educated population abroad of Toronto were which less likely is to
54 per cent of the workforce have expected to be least 10 per cent. Underreporting is possibly the result of
expected be 5% using their to be credentials at least 10 in per their cent. jobs Underreporting (21 per cent) is than possibly those the educated result of or
dependent care responsibilities.
privacy 0% concerns and fear of discrimination.
privacy born here concerns (34 per and cent). fear of discrimination.
0%
One quarter of these employees
Mount Sinai Hospital has Faith
provide dependent care for Mount We • also 38 Sinai per take Hospital cent pride of in respondents our has religious Faith are diversity racialized.* and at Mount This is Sinai a consistent our workforce reflection is of the
elders and 74 per cent provide We associated also external take with pride community, many in our religions. religious as is diversity the number and of at people Mount Sinai who our immigrated workforce to is Canada.
dependent care for children. associated with many religions.
Arab Arab
Black Black
Chinese Chinese
Filipino Filipino
Japanese Japanese
Korean Korean
Latin Latin American American
Mixed Mixed Race Race
South South Asian Asian
Southeast Southeast Asian Asian
West West Asian Asian
40% Figure 2
Levels of Education
40% 30%
35%
Mount Sinai has a highly educated 35% 25%
30%
MSH
workforce.
30%
20%
25%
25%
T.O. CMA
93 per cent of Mount Sinai
15% 20%
employees have an education 20%
10% 15%
beyond secondary school: 20 per 15%
cent have completed college; 28 5% 10%
10%
5%
per cent have completed their
5% 0%
first university degree; 27 per
0%
0%
cent have an advanced, postgraduate
degree. In addition, 11
per cent have a doctoral and/or
medical degree.
Faith T.O. CMA = Toronto Census Metropolitan Area
Faith
• Catholic is the religion with the highest level of representation at Mount Sinai
• Catholic followed is by the Protestant. religion with the highest level of representation at Mount Sinai
followed by Protestant.
• 59 per cent of the workforce engages in religious practice.
• 59 per cent of the workforce engages in religious practice.
The Languages We Speak
The Languages We Speak
Arab
No No Affiliation Affiliation
Black
Buddhist Buddhist
Chinese
Catholic Catholic
Filipino
Christian Christian Japanese
Hindu Hindu Korean
Latin Jewish Jewish American
Muslim Mixed Muslim Race
Other Other
South Asian
Orthodox Orthodox
Southeast Asian
Protestant Protestant
West Asian
Sikh Sikh
Other
Other Other
Mount Sinai Hospital

4 Census
Census Forums
Thursday, March 13
12 noon to 1 p.m.
11th Floor Classroom
Friday, March 21
12 noon to 1 p.m.
15th Floor Classroom
Attend a census forum and learn more about the census
results and next steps. RSVP to the Diversity and Human
Rights Office at ext. 7519. Light refreshments will be served.
Interesting Facts
Mount Sinai Hospital is a
predominantly female workforce.
with 77 per cent female and 23
per cent male.
49 per cent of the Mount Sinai
workforce are in their late 20s
to early 40s (age 25 to 44), and
23 per cent are in their late 40s
to early 50s (45 to 54).
51 per cent of the MSH
workforce is married and 32
per cent is single. There is
a slightly higher percentage
of the MSH workforce in
common-law relationships
than is observed in the
external population.
19 per cent of MSH
employees plan to retire
within the next 10 years.
Six per cent of Mount Sinai
employees identify that they
have a disability. 90 per cent
of employees with disabilities
have a disability that is not
visible, and 53 per cent have a
chronic illness.
A total of 52 per cent
staff participated.
1, 917 Female
558 Male
Total 2,475
What’s next for the Workforce Census?
By Marylin Kanee
Diversity and Human Right Advisor
We will be reviewing the data and looking at ways to ensure that we are
meeting the needs of our workforce and our patient communities.
We want to examine where there are gaps between the make-up of our
existing workforce and that of the City of Toronto. If we identify barriers
to having a representative workforce, we can develop programs that will
support diversity throughout the organization. We have already developed
a new Fair Employment Opportunity policy and have been conducting
workshops on how to conduct fair recruitment and hiring.
We will be implementing a comprehensive wellness initiative to
address work-life balance and overall health and fitness for all of us. The
information from the census will also help us direct changes in our benefit
plans to better meet our needs.
We will be able to identify the languages we need to add for
interpretation for our patients. And we have information on how to
better support our volunteers.
As some people working at Mount Sinai have encountered barriers to
having their credentials and qualifications recognized, we will look at ways
to help our volunteers and staff have these acknowledged. We also want
to ensure that everyone who wishes to pursue educational opportunities
has equitable access and support, so we will be looking at the data to see
what else we can do in this area.
We will continue offering education on human rights and diversity
through lobby displays and educational sessions so that our environment
is inclusive and welcoming of all staff and patients. And we will provide
departments with specific information to guide them in working toward
their goals.
We’ve only begun to think of how we can use all the information we
obtained through the include me! Workforce Census.
You can view the entire report on the Workforce Census website, at
http://info2/intranet/projects-and-activities/workforce-census. Please pass
along your comments and ideas to the Diversity and Human Rights Office
at diversity&humanrights@mtsinai.on.ca.
200801255
Toronto Central LHIN Equity

LHIN Health Equity Plan, Appendix B: Response to Section 5a
B5a-1
5a: Please outline the goals and action plans to address your health equity and access priorities. Goals and action plans have one to three year timelines.
Access
and Equity
Priority Area
Seniors
Initiative
Implementation
of geriatric
initiatives
within hospital
and within
community
pending funding
of submitted
proposals.
Target Population/
Determinant of
Health
• Seniors in hospital
• Seniors in high priority
neighbourhoods
• Social inclusion
• Income & its
distribution
• Social safety net
Outcomes Hospital Programs Affected Partners
Hospital provides
improved quality
of care to seniors
within hospital
Hospital coordinates
services with other
hospitals and
community agencies
to fill gaps in service
and support seniors
in their homes.
General internal medicine,
Cardiology, Surgery, Psychiatry
Integrated Geriatric
and Geriatric
Psychiatry Outreach
Teams: Meeting client
needs in high priority
neighbourhoods:
• COTA Health
• West Park
• St. Michael’s
• St. Joseph’s
• Baycrest
• Sunnybrook
• Providence
• Toronto CCAC
West Toronto Seniors
Assessment Program
(WTSAP):
• West Toronto
Support Services
• Access Alliance
• Toronto CCAC
• Davenport
• Four Villages
• Castleview
Wychwood
• CAMH
• Kensington
• LAMP
• Regional Geriatric
Programs
• St. Clair West
Services for Seniors
• St. Christopher
House
• St. Joseph’s
• Stonegate
• Toronto
Rehabilitation
Centre
• UHN
• VHA Homecare
• West Park
• West Toronto
Support Services
Method of
Measurement of
Outcomes/Progress
Project partners
will evaluate the
effectiveness of
interventions in
improving coordination
and outcomes for
seniors.

B5a-2
LHIN Health Equity Plan, Appendix B: Response to Section 5a
Access and Equity
Priority Area
Seniors
Initiative
• Home at Last LHINfunded
Aging at Home
Project coordinated by
St. Christopher House is
an integrative hospital-
CCAC-community
collaboration
• Implementation of
initiatives related to the
Seniors mental Health
and Addictions Project
(TCLHIN Funded)
Target Population/
Determinant of Health
Frail Seniors 60+ with no
family or social supports
who require a safe and
supportive transition home
upon discharge from
hospital. This may include
escort and transportation
home and help with
settling in. e.g. picking up
prescriptions, light grocery
shopping, meal preparation
and linkage with local
community support services
agency.
Age (frailty), language
and cultural barriers; social
exclusion.
• Seniors in hospital/ED
• Seniors in high priority
neighbourhoods
• Social inclusion
Outcomes
The objectives of this
program are to reduce
likelihood of hospital
readmission and establish or
reinforce relationship with
local community support
service agency.
Hospital provides improved
quality of care to seniors
within ED
Hospital coordinates services
with the community and
Long Term Care Facilities to
enhance communication and
to seniors.
Hospital Programs
Affected
• Medicine and Surgical
units, Emergency Room
• All seniors in the
Emergency Department
• Seniors admitted
through the ED for the
following services:
General internal
medicine, Cardiology,
Surgery, Psychiatry
Partners
• St. Christopher
House and other
community
support service
agencies LHINwide;
CCAC; LHIN
partner hospitals
• St Michaels
Hospital, Long
Term Care
Facilities,
Community
Agencies
Method of Measurement
of Outcomes/Progress
• Increased Patient Flow
• Reduced LOS
• Lower Readmission Rates
• Patient Satisfaction
08/09 has focussed on
the development of the
initiatives, and the staff
education, programming and
monitoring will be ongoing
through 2009/10.
Immigrants
Sponsorship of Canadian
Refugee Health Conference
• Health care workers Anticipated outcomes from
this conference include,
advocacy and enhanced
evidence-based health
policies for the refugee
populations, decreased
barriers and better
understanding of refugee
health and improved health
care and outcomes for
refugee families arriving in
Canada.
All programs
• St. Michael’s
Hospital
• COSTI
• Access Alliance
• University of
Toronto Faculty
of Medicine
• CAMH
Evaluation of conference by
participants and organizers

LHIN Health Equity Plan, Appendix B: Response to Section 5a
B5a-3
Access and Equity
Priority Area
Immigrants
Initiative
Partner with Toronto
Region Immigrant
Employment Council
(TRIEC) to provide
mentorship to immigrants
through the Mentoring
Partnership Program
Target Population/
Determinant of Health
Immigrant professionals
Outcomes
Immigrant professionals are
provided with mentorship
leading to increased access
to job opportunities in their
field
Hospital Programs
Affected
All programs are potential
mentors
TRIEC
Partners
Method of Measurement
of Outcomes/Progress
Evaluation of mentorship
relationship by mentor,
mentee and TRIEC
Partnership in DiverseCity:
The Greater Toronto
Leadership Program
Immigrant professionals
Increase the representation
of racialized immigrants
in leadership positions
on boards and within
organizations in Toronto
Hospital committees DiverseCity Increased representation of
racialized people on hospital
committees
People with
mental illness
and addictions
Chronic disease
management
Training of volunteer
interpreters and training
of hospital staff on use of
interpreters.
Psychiatry Department
Online course for Residents
about Refugee Mental
Health
Conduct Pilot Assessment
for Hip and Knee Arthritis
Program at Scadding Court
Community Centre
• Volunteer interpreters
• MDs and hospital staff
Refugees with mental
health issues
Immigrant seniors
• Volunteer interpreters
are qualified to provide
medical interpretation
• MDs and hospital staff use
interpreters appropriately.
• Education about refugees
and their specific mental
health needs
• Interview refugees from
the Canadian Centre for
Victims of Torture
• Education for writing
psychiatric reports for
refugee board hearings
• Increase advocacy for
refugees
Increased access to medical
services at MSH for people
with hip and knee arthritis
All clinical programs
Department of Psychiatry
Trauma Program
• Rehabilitation
• Orthopedics
University of
Toronto, Royal
College of
Physicians and
Surgeons, CanMEDS
Scadding Court
Community Centre
Volunteer interpreters
complete training.
Increased usage of
interpreters. Interpreters
report appropriate use of
their services.
Evaluation of acquisition of
skills, knowledge and values
Participants in the groups will
be followed to assess their
access to treatment
Explore provision of
diabetes education
targeting specific
populations.
Women of childbearing age
in underserved groups
Reduce diabetes risk in
pregnancy of women in
marginalized groups
• Diabetes clinic
• Family Health team
Community groups
to be determined
Education for FHT and
community clinics. Pre and
post survey.

B5a-4
LHIN Health Equity Plan, Appendix B: Response to Section 5a
Access and Equity
Priority Area
Chronic disease
management
Initiative
Provide Medical Imaging
clinics to underserved
populations in collaboration
with community partners.
Target Population/
Determinant of
Health
• Immigrant women;
• women with
disabilities;
• seniors
Outcomes
Medical Imaging has worked
with community partners
to identify underserved
populations who are not
accessing medical diagnostics
such as mammograms and
bone density screening. MI
will work with community
organizations to create access
to services.
Hospital Programs
Affected
Marvelle Koffler
Partners
Scadding Court,
St. Christopher’s House
Method of Measurement
of Outcomes/Progress
A minimum of one
partnership with a
community agency has
been established which
facilitates access to diagnostic
services for an underserved
population.
Women’s and
infants’ health
IVF clinic providing
services accessible to HIV +
patients.
People living with HIV
Patients confirm that service
is accessible and they have
been treated with respect
Women and Infants
Sherbourne Health Centre,
Psychiatry
Patient surveys, Focus groups
Improving the Breast
Cancer Screening
Experience for Women
with Physical Disabilities:
An Educational Intervention
with Healthcare
Providers — pending
approval
• Women with physical
disabilities
• Access to health care
• Discrimination
This project will develop,
implement and evaluate
an innovative educational
strategy aimed at increasing
healthcare professional
competencies in working
with women with mobility
disabilities accessing breast
cancer screening
• Nursing
• Diagnostic Imaging
• Marvelle Koffler
Breast Centre
• Centre for Independent
Living Toronto
• Springtide Resources
• University of Toronto
• Ismaili Cancer Support
Network
• Ontario Breast Screening
Program
This project will be conducted
in three phases. Each phase
will have deliverables and
indicators of success. The
Project Advisory Committee
will provide oversight. The
project manger will monitor
and report on project
progress
Community Based Peer
Navigation: A study to
engage immigrant women
in Breast Health Education
and Screening— Pending
approval
Immigrant women
Increase screening and
awareness of breast health
amongst underserved
immigrant women
• Marvelle Koffler
Breast Centre
• Medical Imaging
South Riverdale
Community Health Centre,
Toronto Public Health,
St. Michaels Hospital,
Ralph Thornton Centre,
Parent Resources, and
Korean Canadian Women’s
Association.
This project proposes to
use existing knowledge,
experience, expertise and
partnerships to develop a
model that can be applied
to these and other groups of
women in the future.

LHIN Health Equity Plan, Appendix B: Response to Section 5a
B5a-5
Access and Equity
Priority Area
Women’s and
infants’ health
Initiative
Pan-Canadian Best
Practices to Engage
Seldom- or Never-
Screened Women in Cancer
Screening — Pending
approval
Target Population/
Determinant of
Health
Immigrant women,
Women from other
marginalized groups
Outcomes
Increase access to screening
for immigrant and other
marginalized women
Hospital Programs
Affected
Marvelle Koffler
Breast Centre
Partners
South Riverdale
Community Health
Centre, Cancer Care
Ontario — Breast and
Cervical Programs, Toronto
Sunnybrook Regional
Cancer Centre, Toronto
Public Health, Canadian
Cancer Society, Korean
Canadian Women’s
Association and the Centre
for Independent Living in
Toronto
Method of Measurement
of Outcomes/Progress
• Improved access for
agencies to resources for
planning and implementing
initiatives to increase
cancer screening rates for
vulnerable populations.
• A strengthened and
expanded pan-Canadian
network of health
professionals and agencies
who have come together
to address the needs of
seldom or never-screened
women.
Access for people
with disabilities
MSH Samuel Lunenfeld
Research Institute
initiative:
Dr. Julia Knight’s Vitamin
D and breast cancer
population-based study
Implement AODA Customer
Service Training
Women without
exclusion
All staff and associates
In the future, Dr. Knight
hopes to receive funding for
a study that looks at specific
racial groups (European, East
Asian and South Asian) to
study genetic factors and
Vitamin D
Staff interact with persons
with disabilities as outlined
in AODA customer service
standards
Samuel Lunenfeld
Research Institute
All hospital
programs
Canadian National
Institute for the Blind
(CNIB), Canadian Hearing
Society (CHS), The Ottawa
Hospital Rehabilitation
Centre, Augmentative
Communication
Community Partnerships,
Centre for Independent
Living Toronto
Successful completion of
e-learning modules; Patient
satisfaction surveys; Patient
focus goups
Conduct focus groups with
patients with disabilities
to better understand their
experiences
• People with disabilities
• Access for persons
with disabilities
Identify gaps and needs for
patients with disabilities
using services at Mount Sinai
Hospital
All programs
Potential: Community
agencies serving people
with disabilities – CILT,
Anne Johnston CHC, others
Improvement in access for
people with disabilities
Focus groups, patient
satisfaction surveys

B5a-6
LHIN Health Equity Plan, Appendix B: Response to Section 5a
Access and Equity
Priority Area
Access for people
with disabilities
People who
are lesbian/
gay/bisexual/
transgender
Initiative
Implement speaker
systems in public facilities
such as classroom,
auditorium and board
room to facilitate access
for people who are hard of
hearing
Development of
Transgender policy
Target Population/
Determinant of
Health
People who are hard of
hearing
Transgender populations
Outcomes
Improved access for hard
of hearing staff, associates,
volunteers and patients
Needs of trans patients are
addressed in all areas of
service at MSH
Increase involvement of MSH
in trans community
Hospital Programs
Affected
• Audiology
• AODA committee
• Anti Homphobia/
Trans-Phobia
Committee;
• Dept. of Psychiatry
• Dept. of Medicine
• Health Records
Partners
Canadian Hearing Society
Rainbow Health Network
Method of Measurement
of Outcomes/Progress
Feedback from participants
that access has improved
Feedback from Rainbow
Health Network; Focus group
feedback
Poverty and
income barriers
(including
homeless people)
Develop antihomophobia/
transphobia
communication campaign
Participation in inter and
intra hospital committee to
address access to care for
uninsured patients (CFO,
OHA).
All staff, patients,
visitors, associates, and
volunteers at Mount
Sinai Hospital
Uninsured patients
Respectful and appropriate
treatment of GLBTTQ
members of hospital
community
Development of a
coordinated and equitable
approach to addressing cost
of hospital care for uninsured
patients is developed at MSH
and province-wide.
All hospital
programs
ER, Women’s and
Infants Health. All
programs
Rainbow Health Network;
Sherbourne CHC
OHA, CFO, Hospital
Collaborative
Staff satisfaction survey; AHA
committee feedback; focus
group feedback
Policy and procedures for
funding of care for uninsured
patients.
Mount Sinai will refer
medically stable, homeless
patients requiring minimal
follow up care and
increased housing needs
to the Sherbourne
Infirmary. The infirmary is
currently operating at 8
beds but hope to increase
referrals and bed capacity
to 20.
Homeless patients who
require minimal follow
up care and increased
housing needs
Homeless patients are
discharged into a safe
environment for their
recovery. In the infirmary,
they will be connected
with needed community
resources, including housing.
• Social Work
department
• Nursing
• Medicine
Sherbourne Community
Health Centre
Track the number of
emergency room visits, and
improve the health and well
being of this vulnerable
and under served group.
Collect data on the number
of patients being transferred
directly to Sherbourne from
the Emergency Department.

LHIN Health Equity Plan, Appendix B: Response to Section 5a
B5a-7
Access and Equity
Priority Area
Language barriers
Health human
resources
Initiative
Translate information
brochures from Hip and
Knee Arthritis Program into
multiple languages
All staff are evaluated
on equity and cultural
competencies, including
compliance with human
rights and diversity policies
and procedures.
Target Population/
Determinant of
Health
Immigrant seniors with
arthritis and limited
English
• Discrimination
• Employment and
working conditions
• Social exclusion
• Staff belonging to
marginalized groups
Outcomes
Increased knowledge about
hospital services for people
with arthritis
Increased staff accountability
for skills and knowledge
related to equity and human
rights.
Hospital Programs
Affected
• Rehabilitation
• Geriatrics
• Orthopedics
• All programs
• Organizational
Development
Partners
Scadding Court Community
Centre
Method of Measurement
of Outcomes/Progress
Feedback from program
participants; Increase in
# of immigrant seniors
accessing services (need data
collection)
Competencies have been
identified and included in
performance appraisals.
All managers attend Fair
Employment training.
All managers
Increased representation
of staff from marginalized
groups in leadership
positions
Employees describe
employment systems as fair
and transparent
• Human Resources
• Diversity & Human
Rights
All managers have attended
Fair Employment training and
follow policy guidelines.
Hiring and promotion
for all staff includes
consideration of the
candidates’ commitment
to diversity and human
rights as well as other
qualifications.
All managers and
medical chiefs
All staff hired at Mount Sinai
Hospital have equity and
human rights competencies.
All programs
All hiring processes contain
proof that the process
included assessment of the
candidates’ competencies in
equity and human rights
All hiring follows
principles outlined in Fair
Employment Opportunities
policy and training sessions
All hiring managers
All managers have
competencies to hire and
retain staff fairly
• Human Resources
• Diversity & Human
Rights
• All programs
Increase in participation and
hiring of underrepresented
groups (racialized people and
people with disabilities)
Targets and timelines
for the recruitment and
hiring of underrepresented
groups of staff and MDs
are established
Employment and
working conditions
Racialized staff, staff
with disabilities, staff
from other marginalized
groups
Representation of
underrepresented groups has
increased when measured in
early 2011.
• Diversity & Human
Rights
• Human Resources
2011 Census reflects increase
in racialized and disabled
individuals in management
and MDs.

B5a-8
LHIN Health Equity Plan, Appendix B: Response to Section 5a
Access and Equity
Priority Area
Health human
resources
Initiative
Managers are accountable
for actively supporting the
recruitment, training and
promotion of qualified
underrepresented
staff through meeting
hiring targets. (includes
committee participation,
conferences and learning
opportunities)
Target Population/
Determinant of
Health
Employment and
working conditions
Racialized staff, staff
with disabilities, staff
from other marginalized
groups
Outcomes
Managers are evaluated on their
successful recruitment, promotion and
retention of underrepresented staff.
Hospital Programs
Affected
Human Resources
Partners
Method of Measurement
of Outcomes/Progress
Criteria are incorporated
into managers’ performance
appraisals.
Staff and physician
satisfaction surveys include
questions on the workplace
environment and manager
fairness
All hospital staff and
physicians
Mount Sinai Hospital measures
satisfaction of staff on equity
indicators
• Organizational
Development
• Diversity & Human
Rights
Staff satisfaction surveys
include questions on equity
The Diversity & Human
Rights office has adequate
resources to support
hospital programs in
the development and
evaluation of health equity
initiatives
All hospital departments.
Departments are provided with
support and resources to develop,
implement and monitor health equity
initiatives
Diversity & Human Rights office can
provide training and resources to
support health equity initiatives
All departments
Departments have made
progress on health equity
initiatives and report having
adequate support and
resources.
An equity communication
campaign is implemented,
with posters and brochures
to challenge attitudinal
barriers and encourage
the “Made in Sinai” equity
competencies
Mount Sinai Hospital
staff and patients
Staff and patients are aware of their
rights and responsibilities under
Diversity & Human Rights policies and
aware of health equity language.
Diversity & Human Rights study
outcomes are communicated to
hospital community.
• Communications
• Diversity & Human
Rights
• AODA
Posters and brochures are
created. Increased awareness
in Mount Sinai Hospital
community reflected in
competencies, complaints.
A systemic employment
review is conducted in
order to identify and
eliminate any barriers
to equal employment
opportunities
Employment and
working conditions
Racialized staff, staff
with disabilities, staff
from other marginalized
groups
An action plan to eliminate systemic
barriers in employment systems is
developed.
• Human Resources
• Diversity & Human
Rights
Systemic barriers in
employment systems are
eliminated.

LHIN Health Equity Plan, Appendix B: Response to Section 5a
B5a-9
Access and Equity
Priority Area
Health human
resources
Initiative
Assess Best Practice
policies with regard to
Appointment Procedures
for MDs, with regard to
D and HR (use University
Policy and scan of peer
hospitals in developing
this) and then review
and revise as appropriate
Mount Sinai Hospital
required appointment
procedures for MDs to
meet standards.
Target Population/
Determinant of
Health
• Social exclusion
• Employment and
working conditions
Outcomes
Appointment policies and procedures
are developed to ensure best
practices and equity.
Hospital Programs
Affected
MAC
Partners
Method of Measurement
of Outcomes/Progress
Appointment policies
and procedures are fair,
transparent and merit-based.
Development of Intimate
Partner Violence staff
policy
Mount Sinai Hospital
staff who are victims of
intimate partner violence
All staff are aware of rights and
responsibilities related to IPV of staff.
All staff, physicians,
volunteers and
associates
Springtide
Resources
Monitored by Diversity &
Human Rights, Occupational
Health & Safety, Human
Resources and Security
departments
Policies,
strategies and
measurement
Support quality
improvement initiatives
that will facilitate the
use of evidence-based
guidelines in clinical
settings as a means of
reducing the impact of
health care provider bias.
Members of
marginalized groups
Technology used to document that
clinical guidelines are utilized.
Outcomes are tracked and measured.
• Prioritized clinical
programs
• Clinical leaders
The # of clinicians following
clinical guidelines increased.
Health outcomes improved.
Health Records and
Quality Improvement
develop systems to collect
demographic data on
patients and staff that lead
to improved access and
equitable treatment of
patients.
Patients who are
racialized, have a
disability, use a language
other than English, are
a religious minority and
are GLB or T.
Mount Sinai Hospital will have piloted
the collection of demographic data
with inpatients, ER and 2 outpatient
clinics.
• Admitting and Health
Records
• Ambulatory programs
Toronto Central
LHIN
Mount Sinai Hospital has
consistent and usable data
on key demographics of
our patient population.
The methodology can be
transferred and shared with
the LHIN.
May include pilot project to
collect data on Mount Sinai
Hospital patients.

B5a-10
LHIN Health Equity Plan, Appendix B: Response to Section 5a
Access and Equity
Priority Area
Policies,
strategies and
measurement
Initiative
Quality and Performance
Measurement to support
demographic data
collection and analysis of
pt population for Centers
of Excellence, to be used
in assessing equity and
diversity of care provision,
and developing balanced
score card indicators and
targets with respect to
these measures.
Target Population/
Determinant of
Health
Underserved groups
Outcomes
MSH can identify demographic
characteristics of inpatients, ER
patients and ambulatory patients.
Methods of measuring outcomes of
care are identified.
Hospital Programs
Affected
Centres of Excellence
Partners
Community
Social Research
and Data
Consortium
Method of Measurement
of Outcomes/Progress
Data on demographic
characteristics of patients
is collected and available
for analysis. Inequities re:
access to services can be
determined.
Funding decisions are
reviewed through a
diversity lens.
All departments
Budget requests include evidence that
initiatives will not adversely effect
marginalized populations and/or will
increase access and appropriate care
for marginalized populations.
All programs Diversity &
Human Rights
• Health Equity
Council
• Hospital
Collaborative
Inclusion of diversity lens
questions in all funding
requests.
Reallocation of funds for
health equity training and
other initiatives
Funding provided for health equity
training and other health equity
initiatives outlined in health
equity plan.
Programs identified in
health equity plan.
Funding allocated.
Ensure that marginalized
populations are included in
genetic, epidemiology and
clinical studies.
Health care
Better understand health disparities in
marginalized populations
• SLRI
• Programs operating
clinical studies
Director and chiefs ensure
that genetic, epidemiological
and clinical studies include
marginalized populations.
Ensure that existing
research is inclusive of
marginalized populations.
• Health care
• Social inclusion
Increase participation of marginalized
populations in research studies.
• SLRI
• Programs operating
clinical studies
Director will ensure that
research is inclusive.
The Hospital’s strategic
plan and balanced
scorecard emphasizes the
importance of diversity
• Health care
• All determinants
of health
Increased accountability around health
equity throughout hospital
All programs
All programs and Centres of
Excellence monitor progress
on health equity outcomes

LHIN Health Equity Plan, Appendix B: Response to Section 5a
B5a-11
Access and Equity
Priority Area
Policies,
strategies and
measurement
Initiative
All Centres of Excellence and Hospital departments
identify cohesive health equity projects and
programs in their operational plans to ensure their
services are accessible and relevant to marginalized
populations.
Target Population/
Determinant of Health
• Health care
• All determinants of health
Outcomes
Increased awareness and
progress on increasing
health equity throughout
the hospital
Hospital Programs
Affected
• Centres of
Excellence
• Hospital programs
Method of Measurement
of Outcomes/Progress
Operational plans include
health equity initiatives and
measurements
Organizational
culture
All staff receive Diversity & Human Rights training
and Health Equity training. Training to address the
following determinants of health
• Aboriginal status
• Early life education
• Employment and working conditions
• Food security
• Gender
• Health care services
• Housing
• Income and its distribution
• Social safety net
• Social exclusion
• Unemployment and employment security
• All determinants of health
• All Mount Sinai Hospital staff
Staff better prepared
to work with diverse
customers
• All hospital
businesses
• Diversity & Human
Rights
LMS confirms attendance
Evaluation forms, focus groups
Review revenue-generating programs to ensure
there is no differential impact on access for
marginalized groups.
Marginalized groups
No group is differentially
impacted by a business
venture of the hospital
• Drugstore, private
clinic, IVF clinic
• Diversity & Human
Rights
Completion of access checklist
Ensure that businesses in hospital appeal
to minority customers. (images, location of
advertising, monitor customers)
• Customers who are
racialized, with disabilities,
and GLBT
Promotional materials
include images and
examples of nontraditional
families,
people with disabilities
and racialized people
Food choices are
culturally appropriate
and meet the needs
of staff, visitors and
patients.
• Drugstore, private
clinic, IVF clinic,
food outlets
• Communication
Review by Communications,
Diversity & Human Rights
committee

B5a-12
LHIN Health Equity Plan, Appendix B: Response to Section 5a
Access and Equity
Priority Area
Organizational
culture
Initiative
Increase diversity of foundation donors by
partnering with community organizations
and cultivating positive relations with
donors from marginalized populations.
Target Population/
Determinant of Health
Social exclusion
Outcomes
Donor population more reflective of
City of Toronto.
Foundation actively develops
partnerships with community
organizations working with
marginalized communities to expand
donor base.
Hospital Programs
Affected
Community
organizations
Method of Measurement
of Outcomes/Progress
Increased diversity of donor
population.
Identify projects that will result in
increased access and care for marginalized
communities and market those as donor
opportunities.
• Social exclusion
• Access to services
Projects are identified and promoted
to donors.
• Community
organizations
• Scadding Court
Community Centre
Increase in number of projects
offered to donors that increase
access to marginalized
communities.
Adoption through Medical Advisory
Committee, and staff MD education and
dissemination of “Standards of Professional
Behaviour for Medical Clinical Faculty” as
developed by this Faculty committee (refer
to role modeling, behaviour, and absence
of defined inappropriate conduct re
discrimination, intimidation, harassment,
and boundary violations etc.
All medical clinical faculty
All MDs are aware of responsibilities
under Standards of professional
Behaviour for Medical Clinical Faculty.
• U of T Faculty of
Medicine
All medical clinical faculty can
identify responsibilities under
the standards.
MAC addresses violations
accordingly.
Review food choices to ensure that they
meet the needs of patient population.
• Food security
• Social exclusion
Patients’ needs for culturally
appropriate foods are met while in
hospital.
• Corporate Services
• Business
Development
Culturally and religiously diverse
food choices are offered to
patients, staff and visitors.

LHIN Health Equity Plan, Appendix B: Response to Section 5a
B5a-13
Access and Equity
Priority Area
Organizational
culture
Initiative
Implement AODA initiatives
Target Population/
Determinant of
Health
Patients, visitors and
staff with disabilities
Outcomes
The hospital environment is accessible
to persons with disabilities.
Staff have competencies to work with
patients with a range of disabilities.
Hospital Programs
Affected
All programs
Partners
CNIB, Canadian
Hearing Society,
Augmentative
and Alternative
Communication
Partnerships —
Canada
Method of Measurement
of Outcomes/Progress
All AODA Customer Service
initiatives have been
implemented.
AODA workplan
implemented.
Ensure that all public and
internal communications,
community reports,
advertisements, health
education materials, web
sites, posters, etc. are
accessible to and reflective
of the diverse community
we serve. (written content
as well as images).
• Internal: staff,
associates, volunteers,
donors
• External: community
at large
Standards for all hospital
communications are developed to
ensure that hospital communications
are accessible for the intended
audience (literacy) and reflective of
the broader Toronto community.
All programs
Community
agencies
Feedback from community
partners; Diversity & Human
Rights committee
Provide communication
support for health equity
initiatives.
Hospital and community
Hospital community are aware of and
understand health equity initiatives.
Initiatives of interest to the
community at large are
communicated externally.
All programs
Community
media
Staff satisfaction survey;
Diversity & Human Rights
committee; presence of
articles, etc. on health equity
Ensure that patient and
community advisory
committees reflect
diversity of Toronto
• Health care
• Social inclusion
People who are racialized, with
disablities, GLBTTQ, and immigrants
are members of hospital committees
All programs with
patient and community
advisory committees
DiverseCity
Workforce Census

LHIN Health Equity Plan, Appendix B: Response to Section 5b
B5b-1
5b: Please provide some examples of how you incorporate your access and equity objectives, or use an equity lens, in your initiatives to address the MOHTLC and LHIN
priorities? (e.g. Strategic Plan, Wait Times Reduction, Patient Safety, Staff Interactions, Capital Projects including Facility Improvements, etc.)
Mount Sinai Hospital Initiative Access and Equity Objective Outcomes
Renew Sinai Capital Redevelopment Project
• Increase access for people with disabilities
• Facility improvements to benefit all patients, staff, physicians,
volunteers and associates
Capital redevelopment project was created with input from a
disability consultant from Designable Environments.
With Respect to Old Age: A plan through which
Mount Sinai Hospital can work to provide the
best care for its older patients
• Increase access for seniors and elderly patients
• Increase access to patients from different ethno-cultural
communities
• Eldercare Strategic Planning Consultant hired to develop a
plan for creating an elder-friendly environment. Plan includes
improvements to: social behavioural climate; policies and
procedures; care systems, processes and services; and
physical design
• Secured funding for a Geriatric Team including Geriatric
Emergency Management Nurse
• Increased Emergency Department care resources with the ER
Geriatric Nurse position
• Secured funding through Health Force Ontario to plan and design
a framework to support the implementation of an
Interprofessional Acute Care of Elderly (ACE) Team at Mount
Sinai Hospital
• Participant in West Toronto Seniors Assessment Program —
a partner in the assessment, intervention and at-home
treatment; agency lead for the ACE Team; and developer of
standardized assessment tools (H-SIP has been submitted to the
TC LHIN)
• Implementing integrated specialized geriatric outreach teams,
composed of geriatric medicine and geriatric psychiatry outreach
team members — partnering with Regional Geriatric Program
of Toronto and other health service providers (H-SIP has been
submitted to the TC LHIN)

B5b-2
LHIN Health Equity Plan, Appendix B: Response to Section 5b
Mount Sinai Hospital Initiative Access and Equity Objective Outcomes
Hip and Knee Arthritis Program
• Wait-time reduction strategy for hip and knee surgery
Hip and Knee Arthritis Program is provided in partnership with
• Increase access to services for Chinese seniors, Jewish seniors and Scadding Court Community Centre and Jewish Community Centre.
elderly patients with arthritis
Mount Sinai Hospital will offer assessments for patients requiring
hip and knee surgery. This service is provided for patients on-site
• Outreach to Chinese community
at SCCC.
• Outreach to Jewish community
Renewal for Greater Excellence Strategic Plan
2009 to 2012 (Draft)
(in process and under review)
• The Hospital recognizes its responsibility to provide opportunities
for underserved populations to access our health care services
• As part of its revised strategic plan, the goal is to better
understand the community we serve, to identify gaps in service
and barriers to service delivery, and to facilitate better access and
equity for
our community
It is a priority of the hospital to provide a continuum of care for
patients by improving access to services that concentrate on
health promotion and primary care and help patients prevent or
better manage chronic disease.
We will achieve this through further developing partnerships
with local community agencies to provide and build capacity for
health education and disease management intervention.
In addition, we will create inroads beyond the hospital to expand
access to our services and reduce barriers. Incorporating this
strategy as a key element of Mount Sinai’s vision for the future
aligns with the government’s direction and investments in
primary care and chronic disease management.

GENERAL MANUAL – POLICY Page:- I-d-15-39
MOUNT SINAI HOSPITAL
Form MS 204 A Effective Date: May, 2004
Revised: September, 2008
Issued By:- Administration
Reference:- Diversity and Human Rights Committee
Title:-
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
Table of Contents
I. INTRODUCTION ......................................................................................................................................2
A. PREAMBLE ...........................................................................................................................2
B. POLICY STATEMENT.......................................................................................................2
C. PURPOSE ...............................................................................................................................2
D. OUTCOMES..........................................................................................................................3
E. APPLICATION .....................................................................................................................5
II. POLICY IMPLEMENTATION...............................................................................................................5
A. EDUCATION, ORGANIZATIONAL TRAINING
AND DEVELOPMENT........................................................................................................5
B. REVIEW OF POLICY AND PROCEDURES...............................................................7
C. DEVELOPING DIVERSITY PLANS………………………………. .....................9
D. RIGHTS AND RESPONSIBILITIES ............................................................................11
III. CODE OF CONDUCT............................................................................................................................13
A. DISCRIMINATION...........................................................................................................13
B. HARASSMENT ...................................................................................................................14
C. SEXUAL HARASSMENT………………………………..........................................15
D. SEXUAL ASSAULT ...........................................................................................................17
E. HATE CRIME .....................................................................................................................17
F. NEGATIVE ENVIRONMENT......................................................................................17
G. PERSONAL HARASSMENT...........................................................................................18
H. REPRISALS ..........................................................................................................................18
I. FRIVOLOUS, VEXATIOUS COMPLAINTS..............................................................19
J. CAREGIVER PREFERENCE.........................................................................................19
IV. INTERNAL PROCESS FOR COMPLAINTS ....................................................................................19
A. STATEMENT OF GENERAL PRINCIPLES .............................................................19
B. PARALLEL PROCEEDINGS .........................................................................................19
C. EARLY RESOLUTION ....................................................................................................23
D. FORMAL RESOLUTION ................................................................................................25
E. REMEDIES AND SANCTIONS ....................................................................................28
V. TIME ............................................................................................................................................................29
VI. COSTS..........................................................................................................................................................29
VII.QUESTIONS ..............................................................................................................................................30
VIII.GLOSSARY ...............................................................................................................................................30
Mount Sinai Hospital Page 1
Diversity and Human Rights Policy and Procedures

GENERAL MANUAL – POLICY Page:- I-d-15-39
MOUNT SINAI HOSPITAL
Form MS 204 A Effective Date: May, 2004
Revised: September, 2008
Issued By:- Administration
Reference:- Diversity and Human Rights Committee
Title:-
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
MOUNT SINAI HOSPITAL
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
I. Introduction
A. Preamble
Mount Sinai Hospital is committed to fostering a healthy and positive environment, which recognizes and
respects the personal worth, dignity and diversity of each member of the Hospital Community.
B. Policy Statement
1. It is the policy of Mount Sinai Hospital to provide an environment which is free of
discrimination and harassment. Members of the Hospital Community are entitled to fair
and equitable treatment.
2. The Hospital will not tolerate any form of discrimination or harassment as defined in this
policy or under the Ontario Human Rights Code.
3. This policy was developed in consultation with the Mount Sinai Hospital Diversity and
Human Rights Committee, comprised of senior management team members, union
representatives, employees and community representatives.
C. Purpose
4. This comprehensive policy has been prepared to ensure that all members of the Hospital
Community are aware of their rights and responsibilities, and to maintain a discrimination
and harassment free environment. All members of the Hospital Community are expected
to review and actively support the principles of this policy and the Human Rights Code.
5. Consistent with the aims and objectives of the Canadian Charter of Rights and Freedoms,
the Human Rights Code, and consistent with its mission and values, Mount Sinai Hospital
recognizes that organizations reflect the power relations based on race, gender, ethnic
origin, religion, disability, sexual orientation, gender orientation and expression and other
social categories seen throughout society.
6. This policy is comprised of the following four elements:
Mount Sinai Hospital Page 2
Diversity and Human Rights Policy and Procedures

GENERAL MANUAL – POLICY Page:- I-d-15-39
MOUNT SINAI HOSPITAL
Form MS 204 A Effective Date: May, 2004
Revised: September, 2008
Issued By:- Administration
Reference:- Diversity and Human Rights Committee
Title:-
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
i. The rationale and implementation goals for Mount Sinai Hospital’s diversity and human
rights plan;
ii. Community members rights and responsibilities under this policy with regards to human
rights and diversity;
iii. Internal procedures for the resolution of complaints that fall under this policy and;
iv. An evaluation process for the diversity and human rights policy
D. Outcomes
7. The policy is designed to bring about systemic and organizational change that will meet our
objectives under the Human Rights Code, evolving Human Rights case law, Employment
Standards and other relevant statutes to create a healthy and respectful environment. This policy
is also designed to foster the conditions that create a healthy, respectful and positive work
environment. Specifically, this policy is designed to accomplish the following outcomes:
i. Outline the steps required to implement the hospital’s plan to achieve equity, fairness, and
due process as articulated in its mission and value statements;
ii. Foster a positive work/learning environment through proactive measures,
barrier free systems analysis and enforcement;
iii. Ensure that all members of the hospital community are treated equitably and with dignity
and respect;
iv. Address breaches of this policy and settle disputes quickly, fairly and as close to the
source as possible;
v. Ensure that all members of the hospital community are aware of their rights and
responsibilities under this policy
E. Application
8. This policy applies to members of the Hospital Community at Mount Sinai Hospital, which
includes all employees, health care professionals, students, researchers, interns, volunteers,
patients, families, visitors, advisory groups, public community-based partners, affiliated research
institutes and associations, suppliers, contractors, and other health care and business partners
with Mount Sinai Hospital.
9. This policy applies to all activities which take place at the Hospital, as well as to Hospitalrelated
activities which occur elsewhere, including but not limited to business undertakings,
teaching or training programs, research initiatives, community projects, partnership activities,
Mount Sinai Hospital Page 3
Diversity and Human Rights Policy and Procedures

GENERAL MANUAL – POLICY Page:- I-d-15-39
MOUNT SINAI HOSPITAL
Form MS 204 A Effective Date: May, 2004
Revised: September, 2008
Issued By:- Administration
Reference:- Diversity and Human Rights Committee
Title:-
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
social functions, fundraising events, and activities involving access to the Hospital’s computer or
communications systems.
10. All contractual relationships between the Hospital and its business, research, and
community partners are governed by this policy. All such contracts and agreements will include
a provision requiring compliance with this policy.
II.
Policy Implementation
11. Proactive education and organizational training and development at the Hospital is aimed at
providing an environment that is healthy, respectful, welcoming, accessible, and free of
discrimination and/or harassment. The Hospital will support diversity and human rights training
and development initiatives to ensure that all staff under their direction develop the skills and
competencies in the area of diversity, and understand their rights and obligations in meeting the
Hospital’s objectives under this policy.
12. The Hospital’s implementation plan under this policy is comprised of the following four (4)
areas:
A. Education, Organizational Training and Development
B. Review of Policy and Procedures
C. Developing Diversity Plans
D. Rights and Responsibilities
A. Education, Organizational Training and Development
13. Education, organizational training and development is aimed at providing an environment that is
accommodating, accessible, free of harassment and discrimination, welcoming and safe for all
Community members, specifically those identified as most vulnerable to differential treatment
(groups identified under the Ontario Human Rights Code).
14. Education and Training will focus on the following areas:
i. Complaint Resolution
ii. Diversity and Human Rights
iii. Related human resource functions (i.e., bias free hiring and performance management)
iv. Patient centered care/equitable access to services
15. For all of the above areas managers will support diversity and human rights training and
Mount Sinai Hospital Page 4
Diversity and Human Rights Policy and Procedures

GENERAL MANUAL – POLICY Page:- I-d-15-39
MOUNT SINAI HOSPITAL
Form MS 204 A Effective Date: May, 2004
Revised: September, 2008
Issued By:- Administration
Reference:- Diversity and Human Rights Committee
Title:-
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
development initiatives to ensure that all staff under their supervision develop the skills and
competencies in the area of diversity and understand their rights and obligations in meeting
organizational objectives.
Complaint Resolution
16. As a result of education and training with respect to dispute resolution and complaints,
members of the Hospital Community will:
i. Demonstrate behaviours that contribute to a positive and respectful working and
learning environment;
ii. Act on their responsibilities under this Policy to assist in creating and maintaining a safe
and secure learning and working environment free from discrimination and harassment
under prohibited human rights grounds as well as personal harassment/bullying;
iii. Identify and address systemic and direct discrimination in the Hospital
iv. Be aware of their rights under the policy, and of the internal and external complaint
mechanisms available;
v. Use the complaints resolution process to address harassment and discrimination
complaints and other Code of Conduct violations; and,
vi. Develop programs for their areas to ensure positive and respectful work and learning
environments (managers)
Diversity and Human Rights
17. As a result of Training and Education with respect to Diversity and
Human Rights, members of the Hospital Community will:
i. Demonstrate the skills and knowledge necessary to model behaviour, which is respectful
and cognizant of issues of Diversity and Human Rights (managers).
ii. Be accountable for maintaining human rights, diversity and respectful behaviour
standards through the incorporation of these competencies in
performance management systems (managers).
iii. Demonstrate a leadership role in promoting and accommodating diversity in the
provision of services.
iv. Promote equity in the implementation of Hospital policy and procedures
v. Foster an environment that is positive and supportive for employees with disabilities.
Human Resources
18. When Human Rights training involves Human Resources related functions,
Human Resources will be involved in the development and/or delivery. As a result of
Mount Sinai Hospital Page 5
Diversity and Human Rights Policy and Procedures

GENERAL MANUAL – POLICY Page:- I-d-15-39
MOUNT SINAI HOSPITAL
Form MS 204 A Effective Date: May, 2004
Revised: September, 2008
Issued By:- Administration
Reference:- Diversity and Human Rights Committee
Title:-
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
this training, managers will:
i. Be accountable for demonstrating leadership in supporting diversity and human
rights principles and practices articulated by the Hospital.
ii. Implement equitable principles and practices in human resources areas such as:
recruitment and selection, retention, promotion, mentoring, disciplining, &
performance management.
Patient Centered Care
19. As a result of cultural competency training delivered through the Diversity and
Human Rights office, hospital service providers will:
i. Accommodate the needs of diverse patients and co-workers as required by Hospital
policy and legislation
ii. Demonstrate equitable behaviour with patients and co-workers
iii. Interact respectfully and consistently with all members of the Hospital community,
while accommodating differences when required
iv. Continue to develop knowledge and skills in accommodating diversity and human
rights
v. Continue to develop knowledge and skills in conflict resolution
B. Review of Policy and Procedures
20. Systemic discrimination occurs where a practice requirement, qualification or factor is not
overtly or intentionally discriminatory, but still negatively affects a person or group upon
grounds prohibited by the Human Rights Code. Though organizational policies, practices,
procedures, actions or inactions of people in authority may appear to be neutral, it is
recognized that they may have an adverse impact on individuals protected by the Human Rights
Code and may therefore be discriminatory. Consequently, the Hospital will establish proactive
measures to review all departmental/corporate policies and procedures including issues such
as scheduling, orientation, visiting hours, and others, to ensure that systemic/constructive
discrimination is not occurring.
Human Resources
21. Human Resources is a critical area within organizations for ensuring fair and equitable
treatment. Consequently the Hospital will review policies and practices to ensure there are no
systemic barriers in the areas of:
i. Recruitment and Selection:
Mount Sinai Hospital Page 6
Diversity and Human Rights Policy and Procedures

GENERAL MANUAL – POLICY Page:- I-d-15-39
MOUNT SINAI HOSPITAL
Form MS 204 A Effective Date: May, 2004
Revised: September, 2008
Issued By:- Administration
Reference:- Diversity and Human Rights Committee
Title:-
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
ii.
iii.
iv.
- Processes and or criteria that screen out certain groups, e.g., reliance on nonessential
criteria such as personal “comfort” or “fit” which reflect personal biases
- Differential treatment based on race or gender, i.e., lack of objective, neutral
and merit based compensation criteria
Promotion, Secondment and Transfer:
- Lack of a process or policy, which may result in arbitrary decisions
- Disadvantaging some groups, limiting racialized groups to specific and secondary
roles in the institution
Evaluation and Development of Performance Indicators:
- Inadequate performance evaluation systems that result in subjective
judgments based on group membership
Training and Development:
- Lack of a process may result in favouritism- based group membership,
- Restriction of educational opportunities due to budget constraints applied
inequitably
v. Termination:
- Redundancy decisions results in racialized people being the last hired, first fired
vi.
vii.
viii.
Treatment of Employees:
- Disciplining an employee with a non-Canadian accent more severely than a white
employee for the same infraction
Assignment of Privileges/Duties:
- Males given preference over females in assigning operating room time
Accommodation (Physical Or Otherwise):
- Individuals have to go through unnecessary red tape and delays to be
accommodated
- Failure to accommodate to the point of undue hardship, i.e., an individual
capable of performing the essential duties of the job when provided with reasonable
accommodation is not considered as capable as a similarly qualified individual who
requires no accommodation
The Department of Occupational Health and Safety and The Human
Resources Department in consultation with the Office of Diversity and Human
Rights
Mount Sinai Hospital Page 7
Diversity and Human Rights Policy and Procedures

GENERAL MANUAL – POLICY Page:- I-d-15-39
MOUNT SINAI HOSPITAL
Form MS 204 A Effective Date: May, 2004
Revised: September, 2008
Issued By:- Administration
Reference:- Diversity and Human Rights Committee
Title:-
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
22. Responsible for developing a process to implement evolving human rights standards,
which state that all workplace rules, standards and procedures must accommodate individual
differences to the point of undue hardship. Individual managers are responsible for
implementing the accommodation recommendations.
Accommodation based on Religious and other Human Rights Grounds:
23. The Hospital will also develop guidelines to address accommodation procedures based on
religion, family status, and other prohibited human rights grounds. If there are disputes
arising from accommodation plans, the Office of Diversity and Human Rights will act as a
consultant to provide guidelines necessary to meet our legal and social obligations.
C. Developing Diversity Plans
Management Responsibilities
24. The Office of Diversity and Human Rights and the Diversity and Human Rights
Committee will provide leadership in developing programs aimed at implementing Mount
Sinai Hospital’s Diversity and Human Rights Checklist for Organizational Change.
The Senior Management Team will:
i. Work with the Diversity and Human Rights Office and the Diversity and Human
Rights Committee to ensure that a plan is developed to integrate Diversity and Human
Rights considerations in organizational planning, budgeting, research, ethics, training,
clinical work, strategic planning, health promotion, marketing, communications, etc.
ii. Develop priorities and assign responsibilities for achieving the Hospital’s Diversity and
Human Rights objectives.
iii. Build strong, meaningful and responsible relationships with all of our diverse
stakeholders and community partners.
iv. Develop evaluation mechanisms of these goals as part of the performance review every
year.
Patient/Family Centered Care
25. The Hospital recognizes Diversity as a critical component of patient centered care and
consequently will:
Mount Sinai Hospital Page 8
Diversity and Human Rights Policy and Procedures

GENERAL MANUAL – POLICY Page:- I-d-15-39
MOUNT SINAI HOSPITAL
Form MS 204 A Effective Date: May, 2004
Revised: September, 2008
Issued By:- Administration
Reference:- Diversity and Human Rights Committee
Title:-
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
i
ii
Articulate and develop an approach to cultural competence that is standardized at the
organizational level and specified in measurable ways at the level of individual
programs.
Provide access to all its services and programs for communities it serves in ways that
are culturally appropriate, respectful and inclusive by reviewing its practices and actively
working to remove systemic barriers if and where they exist. Areas for review include
but are not limited to clinical care, information dissemination, physical barriers,
language/cultural interpretation resources, translation services, dietary requirements,
methods of care, health promotion, community partnerships, research, and employment
practices.
iii Develop programs and initiatives to provide accommodation (physical and otherwise)
for the diverse needs of its stakeholders.
iv Will actively seek out and build community partnerships with the various communities
it serves such as racialized, cultural, and gay/lesbian/ bisexual/transgender
communities in order to achieve these objectives.
D. Rights and Responsibilities
Rights of Members of the Hospital Community
26. Pursuant to this policy, and in accordance with the Human Rights Code, all members of the
Hospital Community have a right to:
• be free from discrimination and harassment;
• be communicated with in a respectful manner;
• be treated in a supportive, respectful and equitable manner; and
• bring a complaint under this policy without fear of reprisal.
Responsibilities of Members of the Hospital Community
27. Each member of the Hospital Community has a personal responsibility to:
i. ensure that their own behaviour and conduct complies with this policy;
ii. support and promote practices in the Hospital Community that foster a respectful
environment which discourages and prevents discrimination and harassment;
iii. immediately report to their supervisor/manager or the Diversity and Human Rights
Advisor any discriminatory or harassing conduct in the Hospital Community that they
Mount Sinai Hospital Page 9
Diversity and Human Rights Policy and Procedures

GENERAL MANUAL – POLICY Page:- I-d-15-39
MOUNT SINAI HOSPITAL
Form MS 204 A Effective Date: May, 2004
Revised: September, 2008
Issued By:- Administration
Reference:- Diversity and Human Rights Committee
Title:-
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
witness or become aware of; and
iv. fully and truthfully cooperate with investigations under this policy.
28. Every supervisor, manager, and physician leader in the Hospital Community is further
responsible for:
i. establishing and maintaining a respectful work environment which is free of
discrimination and harassment;
ii. developing plans to implement the goals and objectives of this policy;
iii. actively working to eliminate any discrimination or harassment which may occur;
iv. taking appropriate steps to address in a timely fashion any incident or situation
involving discrimination or harassment which s/he is aware of, or reasonably ought to
have been aware of, and promptly informing the Diversity and Human Rights Advisor
of any such incident or situation;
v. reporting any matter involving criminal or quasi-criminal conduct to the Diversity and
Human Rights Advisor, the Manager of Security, and the Manager of Occupational
Health and Safety; and
vi. communicating and reinforcing this policy.
29.Members of the Hospital’s Diversity and Human Rights Committee are responsible for:
i. advising senior management on the development and implementation of the Hospital’s
diversity plan; and
ii. reviewing and evaluating the effectiveness of this policy and the diversity plan every
three (3) years
30. The Hospital’s Diversity and Human Rights Advisor is responsible for:
i. the coordination, implementation and operation of this policy;
ii. advising senior management and the Diversity and Human Rights Committee on: (i) the
development and implementation of the Hospital’s diversity plan; and (ii) the
discrimination and harassment complaint procedure under this policy;
iii. providing information and education to all members of the Hospital Community on
discrimination and harassment related issues, including the interpretation and
application of this policy;
iv. providing consultation on specific issues related to diversity and human rights which
are raised by members of the Hospital Community; and
v. managing the complaints resolution process under this policy in an expeditious and
confidential manner
Mount Sinai Hospital Page 10
Diversity and Human Rights Policy and Procedures

GENERAL MANUAL – POLICY Page:- I-d-15-39
MOUNT SINAI HOSPITAL
Form MS 204 A Effective Date: May, 2004
Revised: September, 2008
Issued By:- Administration
Reference:- Diversity and Human Rights Committee
Title:-
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
31. An employee of the Hospital who becomes aware of conduct which may be a possible
breach of this policy and who does not report the incident within a reasonable time will
infringe this policy and may be liable to sanctions. In addition, a member of the Hospital’s
management team may incur liability for failing to report any discrimination or harassment
which violates the Human Rights Code.
III.
Code of Conduct
32. Any Member of the hospital community who violates the following code of conduct
provisions whether on Hospital Property or not, breaches proper conduct and is liable
to sanction under this Policy:
A. Discrimination
33. “Discrimination” means unfair treatment because of a “Prohibited Ground” under the
Human Rights Code, which includes race, sex, sexual orientation, gender orientation and
gender expression, same sex partner status, colour, ancestry, place of origin, ethnic origin,
marital status, age, disability, citizenship, family status, or religion.
34. Discrimination includes, but is not restricted to: the denial, withholding and delay of
access to opportunities, services or facilities, so long as these actions and behaviours are based
on the prohibited grounds listed above.
Examples of direct discrimination include:
• Disinterest on the part of a supervisor or manager to recognize or increase his/her
awareness of the workplace impact of a disability when one of his/her staff has that
disability
• Firing an employee because the supervisor became aware that the employee may file or
has filed a complaint of harassment
• Making such statement as, “that is not the way we do it in Canada”, to a colleague or
other member of the hospital community who is from a racialized group and/or first
generation Canadian
• A refusal to hire employees of a particular race, sexual orientation, etc.
• Designated groups (or members of) are excluded from the decision making process
• Community groups representing designated groups are not part of the network with
which the organization connects
• Experiences and expertise of ethno-racial groups are not valued by the organization
• A failure to properly accommodate a person’s employment limitations which are caused
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Diversity and Human Rights Policy and Procedures

GENERAL MANUAL – POLICY Page:- I-d-15-39
MOUNT SINAI HOSPITAL
Form MS 204 A Effective Date: May, 2004
Revised: September, 2008
Issued By:- Administration
Reference:- Diversity and Human Rights Committee
Title:-
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
by disability or illness.
35. Systemic discrimination refers to: policies, practices and procedures that appear neutral
on the surface, but may serve (whether intentionally or not), to exclude, deny
opportunities and rights to human rights protected individuals and groups. Employment
related systemic discrimination is common in organizations and is normally identified
through an Employment Systems Review.
Examples of Systemic Discrimination include:
• Recruitment and Selection processes and/or criteria that screen out certain groups, e.g.,
reliance on non-essential criteria such as personal “comfort” or “fit” which reflect
personal biases
• Limiting racialized groups to specific and secondary roles in the institution
• All materials regarding a specific procedure are available only in English. Patients who
cannot read English are not provided with critical information
B. Harassment
36. “Harassment” includes behaviour or comments that demean, insult, or offend, and may
constitute a form of discrimination where such conduct is based on a Prohibited Ground
(i.e., race, sex, sexual orientation, gender orientation and gender expression, , same sex
partner status, colour, ancestry, place or origin, ethnic origin, marital status, age, disability,
citizenship, family status, or religion) where the person knows or ought to know that such
behaviour or comments are unwelcome.
37. Harassment may be by words, gestures, electronic messages (including, but not limited
to, telephone, voicemail, fax or computer messages), innuendoes, graffiti, signs, pictures
or other acts.
Examples of harassment include, but are not limited to:
• Remarks, jokes, taunts, or insults about a person or a group of people identified by a
Prohibited Ground (i.e., such things as race, colour, place of origin, ancestry, ethnic
background, creed, disability, etc.);
• The displaying of racist, sexually suggestive or other offensive or derogatory pictures,
cartoons or material
• Insulting gestures or practical jokes based on sexual, racial or ethnic grounds which
cause embarrassment or awkwardness
• Knowingly making a false complaint
Mount Sinai Hospital Page 12
Diversity and Human Rights Policy and Procedures

GENERAL MANUAL – POLICY Page:- I-d-15-39
MOUNT SINAI HOSPITAL
Form MS 204 A Effective Date: May, 2004
Revised: September, 2008
Issued By:- Administration
Reference:- Diversity and Human Rights Committee
Title:-
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
• insisting that employees only speak English if it does not negatively affect the work
being done
• Making ridiculing, taunting, belittling, humiliating or insulting comments;
• Physically intimidating behaviour or threats;
• Use of profane, abusive or threatening language;
• Harassment does not include appropriate direction, evaluation, appraisal or discipline of
an employee by a supervisor or manager.
C. Sexual Harassment.
38. “Sexual Harassment” means engaging in a course of harassing conduct related to a
person’s sex, sexual-orientation, gender orientation and gender expression, same sex partner
status, or any sexualized activity that is known or might reasonably be known to be
unwelcome, unwanted, offensive, intimidating, hostile, or otherwise inappropriate.
39. Incidents involving sexual harassment include unwelcome sexual advances,
requests for sexual favours, or other verbal or physical conduct of a sexual nature when:
• Such conduct might reasonably be expected to cause insecurity, discomfort, offence or
humiliation to another person or group; OR
• Submission to such conduct is made either implicitly or explicitly a condition of
employment, appointment, approval of privileges, an educational/training opportunity,
or receipt of services or a contract; OR
• Submission to or rejection of such conduct is used as a basis for any employment,
reappointment, or advancement decision (including, but not limited to, matters of
promotion, raise in salary, job security and benefits affecting the employee); OR
• Such conduct has the purpose or the effect of interfering with a person’s work
performance or creating a difficult, intimidating, hostile or offensive work environment.
40. Within this context, types of behaviour which constitute sexual harassment include, but are
not limited to:
• Sexist jokes causing embarrassment or offence
• Leering (suggestive staring)
• Sexually derogatory or degrading remarks directed towards a person because of their
sex or sexual orientation, gender orientation or gender expression
• Sexually suggestive or obscene comments or gestures
• Unwelcome inquiries or comments about a person’s sex life
• Inappropriate or unwelcome focus/comments on a person’s physical attributes or
appearance
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Diversity and Human Rights Policy and Procedures

GENERAL MANUAL – POLICY Page:- I-d-15-39
MOUNT SINAI HOSPITAL
Form MS 204 A Effective Date: May, 2004
Revised: September, 2008
Issued By:- Administration
Reference:- Diversity and Human Rights Committee
Title:-
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
• Persistent or unwelcome sexual flirtation(s), advance(s), proposition(s)
• Displaying printed material of a suggestive or sexually offensive nature.
• An implied or expressed promise of a reward, benefit or advancement in return for
sexual favours, or reprisal if such favours are not given
• Persistent unwanted contact or attention after the end of a “consensual” relationship
• Unwanted touching or patting
• Verbal abuse or threats
D. Sexual Assault
41. “Sexual Assault” includes the actual or threatened use of force of a sexual nature such that
the sexual integrity of the victim is violated. It is a form of sexual harassment, and may
further constitute a criminal offence under the Canadian Criminal Code.
Examples of sexual assault include, but are not limited to:
• Touching which is committed in circumstances of a sexual nature; and
• The threatened use of violence to force a person to engage in sexual conduct.
42. The Diversity and Human Rights Advisor should be consulted in cases
involving sexual assault complaints, however the Hospital’s carriage of such complaints resides
with the Manager of Security.
E. Hate Crime.
43. “Hate Crimes” refer to the publication, display, transmission or distribution of a notice,
sign, symbol, emblem or other representation that expresses or implies an intention to
discriminate upon any of the Prohibited Grounds, or to incite others to discriminate upon
any of the Prohibited Grounds. It is a form of discrimination and harassment, and may
further constitute a criminal offence under the Criminal Code.
F. Negative Environment.
44. A negative learning or work environment is created when a Member makes one or a series
of comments or actions based upon prohibited grounds of discrimination which have the effect
of creating or maintaining an offensive, hostile or intimidating climate for work or learning at
the Hospital. An individual or group does not have to be a direct target to be affected by a
negative environment. Graffiti, signs, electronic messages, cartoons, remarks, exclusion and
adverse treatments are examples of actions that can create a negative environment.
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GENERAL MANUAL – POLICY Page:- I-d-15-39
MOUNT SINAI HOSPITAL
Form MS 204 A Effective Date: May, 2004
Revised: September, 2008
Issued By:- Administration
Reference:- Diversity and Human Rights Committee
Title:-
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
G. Personal Harassment.
45.Any member of the Hospital Community who uses his or her authority or influence in a
way that is unfair, or who engages in a course of unfair conduct that is known or should
reasonably be known to differentially treat another person, whether on a Prohibited Ground
or not, will infringe this policy.
46. Personal harassment involves excessive, unwelcome behaviour, directed at an
individual, not linked to the prohibited grounds, which is known or ought reasonably to
be known to be unwelcome/unwanted, offensive, intimidating, hostile, inappropriate and
results in an unhealthy work environment.
Examples may include, but are not limited to:
• Ridiculing, taunting, belittling or humiliating another person;
• Physically intimidating behaviour and/or threats;
• Derogatory name-calling;
• Use of profane, abusive or threatening language;
• Differential treatment - treating someone differently than others in the same
department or area
H. Reprisals.
47. All members of the Hospital Community have the right to file a complaint, participate or
co-operate in an investigation, provide information relevant to a complaint, or act in any
role under this policy without reprisal or threat of reprisal. For the purpose of this policy,
retaliation against an individual for having:
• invoked this policy (whether on behalf of oneself or another individual);
• participated or co-operated in any investigation under this policy; or
• been associated with a person who has invoked this policy or participated in these
procedures, will be treated as harassment and dealt with accordingly.
I. Frivolous, Vexatious Complaints.
48. For the purpose of this policy, any member of the Hospital Community who makes a
frivolous, vexatious, false, or bad faith complaint under this policy shall be treated as having
engaged in harassment and will be dealt with accordingly.
J. Caregiver Preference
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Diversity and Human Rights Policy and Procedures

GENERAL MANUAL – POLICY Page:- I-d-15-39
MOUNT SINAI HOSPITAL
Form MS 204 A Effective Date: May, 2004
Revised: September, 2008
Issued By:- Administration
Reference:- Diversity and Human Rights Committee
Title:-
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
49. Patients may be given their preference with regard to their caregivers on the basis of gender,
religion, and applicable treatment needs. Patient requests regarding their caregivers which
contravene the Human Rights Code will not be met.
IV.
Hospital Internal Process for Complaints of Discrimination or Harassment
A. Statement of General Principles
50. The objective of the following internal complaint process is to provide for the early
and local resolution of any violations under this policy.
51. A member of the Hospital Community (the “Complainant”) who believes that s/he or
another member has been discriminated against and/or harassed contrary to this policy may take
one (1) or more of the following steps.
B. Parallel Proceedings
52. In addition to the rights and procedures under this policy, community members may have
further recourse outside of this policy to address behaviour and conduct which is not
permitted under the Code of Conduct. Community members may have the ability to file a
grievance under a collective agreement, begin legal proceedings, and/or seek recourse
through outside bodies which include (but are not limited to) educational institutions in
partnership with the Hospital, professional self-regulating bodies (for instance, the College of
Physicians and Surgeons of Ontario, the College of Nurses of Ontario, etc.), regulatory
agencies (such as the Ontario Human Rights Commission), and/or law enforcement,
depending upon the circumstances.
53. Should an employee seek recourse outside of this policy for a breach of the Code of Conduct,
or alternatively should an outside body make inquiries or otherwise take steps to address
such a breach, the Hospital reserves the right to: (i) pursue its own investigation under this
policy into that matter; and/or (ii) pursue recourse within and/or outside of this policy, as it
deems necessary, to address the breach.
54. Should a community member file a grievance under a collective agreement for a breach of the
Code of Conduct, then that member is understood to be waiving his or her rights to
thereafter file a complaint under this policy regarding the subject matter of that grievance,
and agrees that no such complaint under this policy shall proceed.
C. Early Resolution
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Diversity and Human Rights Policy and Procedures

GENERAL MANUAL – POLICY Page:- I-d-15-39
MOUNT SINAI HOSPITAL
Form MS 204 A Effective Date: May, 2004
Revised: September, 2008
Issued By:- Administration
Reference:- Diversity and Human Rights Committee
Title:-
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
Step 1 - Discussion with Responding Party
55. The Complainant may discuss his or her concerns directly with the person who is believed
to have violated this policy, by telling that person (the “Responding Party”) to stop the
unwelcome behaviour or conduct.
Complainants should provide feedback respectfully and in an appropriate time and location
that is private and occurs when the other party is not busy.
56. The Complainant should take notes of any conduct which is believed to violate this policy,
and to record the particular incident(s) at issue including relevant date(s), time(s), place(s),
witness(es), conduct and behaviour, reactions to requests for the discontinuation of such
conduct, as well as any other details of events which have transpired and any actions taken.
Step 2 - Initiating a Complaint
57. Should a Complainant feel unable to approach the Responding Party, or if the
discrimination and/or harassment continues after the Complainant has discussed the matter
and asked the Responding Party to stop, the Complainant may bring a complaint under this
policy by contacting his or her manager, or the Chief of Department, or the Diversity and
Human Rights Advisor, to discuss the matter.
58. A complaint may be oral or in writing, and should be made as soon as possible after
the alleged discriminating or harassing conduct has occurred. Under this policy, a complaint
must be made within one year of the circumstances giving rise to it, unless the delay was
incurred in good faith and no substantial prejudice will result to any person affected by the
delay.
59. A manager or Chief of Department who receives an oral or written complaint should
immediately inform the Diversity and Human Rights Advisor of the matter.
60. A complaint against a senior officer of the Hospital (i.e., a person holding the position of
Vice-President or equivalent, or a higher position) shall be made to the Diversity and
Human Rights Advisor.
61. A person who is a Responding Party to a complaint and who has reason to believe that the
complaint is frivolous, vexatious, in bad faith, or itself a form of harassment, has the right to
make a complaint under this policy.
62. Two (2) or more complaints alleging violations by the same person, or having facts in
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Diversity and Human Rights Policy and Procedures

GENERAL MANUAL – POLICY Page:- I-d-15-39
MOUNT SINAI HOSPITAL
Form MS 204 A Effective Date: May, 2004
Revised: September, 2008
Issued By:- Administration
Reference:- Diversity and Human Rights Committee
Title:-
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
common, may be dealt with in the same proceeding.
63. The Hospital may initiate a complaint where alleged violations of this policy are reported
and there is no individual complainant.
64. A Complainant may, in his or her discretion, decide to withdraw a complaint at any point in
the procedure under this policy. However, it is understood that the Hospital may pursue a
complaint notwithstanding the withdrawal of a complaint by a Complainant.
65. While parties are encouraged to seek advice and counsel, persons with knowledge of a
complaint are required to maintain the confidential nature of the complaint in order to preserve
the integrity of the complaint process.
66. All complaints shall be held in confidence wherever possible, except where disclosure is
necessary to aid in an investigation, to take disciplinary action, or as required by law. The
Complainant, the Responding Party, and all witnesses to a complaint are required to maintain
confidentiality.
Step 3 - Review of Complaint
67. Within five (5) working days of receiving a complaint, the manager or Chief of Department
shall meet with the Complainant to review the matter, and may then:
• meet with the parties (i.e., the Complainant and the Responding Party), either separately
or together, to discuss ways of resolving the issue(s) at hand;
• recommend Early Resolution to the parties;
• recommend that the complaint be investigated;
• request an educational session on discrimination and harassment for any work unit that
may be involved in the matter;
• refer the Complainant to the Diversity and Human Rights Advisor for assistance;
• advise the Complainant that the matter does not fall within the scope of this policy, and
suggest alternative routes; or
• take other action appropriate to the circumstances.
68. Under this policy, “working day” means any day of the week from Monday to Friday,
excluding a statutory holiday and any other day that the Hospital is officially closed by order
of the President or by virtue of a government order or legislation.
Mount Sinai Hospital Page 18
Diversity and Human Rights Policy and Procedures

GENERAL MANUAL – POLICY Page:- I-d-15-39
MOUNT SINAI HOSPITAL
Form MS 204 A Effective Date: May, 2004
Revised: September, 2008
Issued By:- Administration
Reference:- Diversity and Human Rights Committee
Title:-
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
Step 4 - Request for Early Resolution
69. The goal of Early Resolution is to encourage parties to resolve their disputes under this
policy through an early, local, flexible, and informal resolution process such as mediation,
facilitated discussion, or a negotiated settlement. Early Resolution is intended to mediate
complaints and arrive at resolutions which are mutually acceptable to the parties and the
Hospital. Managers and Chiefs of Departments will be trained in mediation and conflict
resolution in order to assist members of the Hospital Community with Early Resolution.
70. The Complainant and/or the Responding Party may request Early Resolution by making a
request to the manager, Chief of Department, or Diversity and Human Rights Advisor, within
ten (10) working days from the date the complaint was made.
71. Within five (5) working days of a request for Early Resolution, the manager, Chief of
Department, or Diversity and Human Rights Advisor shall consult with the other party (i.e., the
Complainant or the Responding Party, as applicable) to ask whether Early Resolution is
acceptable. Where that party declines Early Resolution or fails to respond to consultation by
the manager, Chief of Department, or Diversity and Human Rights Advisor within five (5)
working days from being advised of the request for Early Resolution, the complaint shall
proceed to an investigation under Step 5.
72. Despite the above provisions, the Hospital reserves the right to require that a complaint be
investigated under Step 5 where it determines that the matter is not appropriate for Early
Resolution.
73. Should the Complainant and the Responding Party agree to Early Resolution, a mediator or
facilitator who is acceptable to the parties will be assigned to the matter within ten (10) working
days from the request for Early Resolution. An Early Resolution mediation session or meeting
shall then normally be conducted within ten (10) working days from the date the mediator or
facilitator is assigned to the matter. The mediator or facilitator shall remain impartial in the
matter.
74. At the Early Resolution session, the mediator or facilitator shall meet with the parties, shall
provide each party with an opportunity to present the relevant facts, and shall assist them in
arriving at a mutually agreeable solution in order to effect a settlement of the complaint. Parties
to an Early Resolution session may be accompanied by a representative with the agreement of
the parties, the mediator or facilitator, and the Diversity and Human Rights Advisor. The
discussion that takes place during the mediation sessions or facilitated discussions shall remain
confidential as between the parties and the mediator
Mount Sinai Hospital Page 19
Diversity and Human Rights Policy and Procedures

GENERAL MANUAL – POLICY Page:- I-d-15-39
MOUNT SINAI HOSPITAL
Form MS 204 A Effective Date: May, 2004
Revised: September, 2008
Issued By:- Administration
Reference:- Diversity and Human Rights Committee
Title:-
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
75. An Early Resolution session may be adjourned with the agreement of the parties, the
mediator, and the Diversity and Human Rights Advisor. Early resolution shall normally
conclude not later than twenty (20) working days after the appointment of the mediator or
facilitator. The parties, the mediator or facilitator and the Diversity and Human Rights Advisor
mutually agree to an extension of this time limit.
76. Should Early Resolution be successful, the parties will enter into a resolution agreement
which shall conclude the complaint process. A confidential written account of the complaint or
the mediation outcome report and/or the resolution agreement will be kept by the Diversity
and Human Rights Advisor and the managers or Chiefs of the parties for the purposes of
monitoring the agreements and for statistical reporting purposes.
77. Should the Early Resolution process be unsuccessful in resolving the complaint, the
mediator or facilitator will advise the Diversity and Human Rights Advisor within five (5)
working days of the conclusion of early resolution, and the complaint will proceed to an
investigation under Step 5.
D. Formal Resolution
Step 5 - Complaint and Fact Finding Investigation
78. Where a complaint does not proceed through Early Resolution, or remains unresolved after
proceeding through Early Resolution, the Complainant will be asked by the Diversity and
Human Rights Advisor to submit a signed complaint. A formal complaint must be submitted
within one year from the date of the incident complained of, unless any further delay was
incurred in good faith and no substantial prejudice will result to any person affected by the
delay, and must identify:
(i) the nature of the complaint;
(ii) all relevant dates;
(iii) all relevant times;
(iv) all relevant places;
(v) all relevant parties,
(vi) all relevant behaviour and conduct;
(vii) all relevant witnesses; and
(viii) the remedy sought.
79. Within ten (10) working days from receiving a formal complaint, the Diversity and Human
Rights Advisor shall advise the Responding Party that the formal complaint was made, and shall
provide a copy of the complaint. If the complaint involves a physician, the Chief of Department
Mount Sinai Hospital Page 20
Diversity and Human Rights Policy and Procedures

GENERAL MANUAL – POLICY Page:- I-d-15-39
MOUNT SINAI HOSPITAL
Form MS 204 A Effective Date: May, 2004
Revised: September, 2008
Issued By:- Administration
Reference:- Diversity and Human Rights Committee
Title:-
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
and the Chair of the Medical Advisory Council (MAC) will be notified. If the complaint
involves an employee, the manager will be notified.
80. The Diversity and Human Rights Advisor shall ensure that a fact finding investigation into
the allegations giving rise to the complaint is commenced as soon as possible thereafter. The
investigation may be conducted by the Diversity and Human Rights Advisor, or by an
investigator appointed by the Diversity and Human Rights Advisor, and shall include an
interview with the Complainant, the Responding Party, persons that may have information
relevant to the complaint, and any other person(s) requested by a party that may have additional
relevant information. The Complainant, the Responding Party, and witnesses have the right to
be accompanied during their investigation interview by a person of their choice. The
investigator has the right to determine which witnesses are relevant to the complaint.
81. All parties and persons being interviewed during a fact finding investigation are expected to
cooperate fully by providing the investigator with all knowledge and information (including
documents and other evidence in their care and control) which is related to the complaint.
82. The fact finding investigation shall afford due process by having each party provided with
sufficient information of the evidence and the other party’s position in order to afford a
reasonable opportunity to respond.
83. The investigation report normally shall be completed within sixty (60) working days from
the start of the fact-finding investigation into the complaint. The report may include
recommendations, but shall not make any decisions on sanctions, and shall be submitted to the
Chief Advisor of the Diversity and Human Rights Committee upon completion for
consultation.
84.Within thirty (30) working days from the completion of the investigation
report, the Diversity and Human Rights Advisor must submit the report to the
appropriate Vice-President or Chief of Department (in the case of physicians)
who then shall determine the appropriate sanction(s), if any, to be imposed after
consulting with the Diversity and Human Rights Advisor. In the case of a
complaint against a senior officer of the Hospital other than the President, the
report shall be submitted to the President for disposition. In the case of a
complaint against the President, the report shall be submitted to the Chair of the
Board of Governors for disposition.
85. Within ten (10) working days of receiving the investigation report and
consulting with the Diversity and Human Rights Advisor, the Vice-President or
Chief of Department shall notify in writing the Responding Party, his or her
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Diversity and Human Rights Policy and Procedures

GENERAL MANUAL – POLICY Page:- I-d-15-39
MOUNT SINAI HOSPITAL
Form MS 204 A Effective Date: May, 2004
Revised: September, 2008
Issued By:- Administration
Reference:- Diversity and Human Rights Committee
Title:-
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
manager or Chief of Department (in the case of physicians, the Chair of the MAC), and the
Diversity and Human Rights Advisor of the sanction(s), if any, to be imposed. In the case of a
physician, sanctions may be imposed pursuant to section 7 of the Medical Staff By-Laws.
Representation
86. All unionized members of the Hospital Community have a right to be
represented by their unions or professional associations, as applicable, and
shall be informed of this right to representation before attending any meeting
which is convened under this policy. Non-unionized members may arrange for
their own representation, and may seek advice from the Diversity and Human
Rights Advisor.
Termination of Complaint Process
87. Following consultation with the Diversity and Human Rights Advisor, the appropriate
manager or Chief of Department may terminate the complaint process at any time where it is
determined that:
i. the behaviour or conduct complained of does not fall under this policy;
ii. the complaint fails to meet the time requirements under this policy; or
iii. the complaint is frivolous, vexatious, or made in bad faith.
E. Remedies and Sanctions
88. The primary purpose of any actions taken in consequence of a violation of this policy is to
create an environment that is discrimination and harassment free.
89. Where it is found that a violation of this policy has occurred, the Hospital may take
appropriate action, including but not limited to one (1) or more of the following remedies and
sanctions:
• an apology (verbal or written);
• counselling, education or training;
• discipline;
• written warnings;
• behavioural contract;
• activity restrictions;
• job or program transfer;
Mount Sinai Hospital Page 22
Diversity and Human Rights Policy and Procedures

GENERAL MANUAL – POLICY Page:- I-d-15-39
MOUNT SINAI HOSPITAL
Form MS 204 A Effective Date: May, 2004
Revised: September, 2008
Issued By:- Administration
Reference:- Diversity and Human Rights Committee
Title:-
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
• change of work assignment or appointment;
• withholding of a promotion;
• compensation;
• termination of appointment;
• discontinuation of volunteer assignment;
• contract cancellation;
• removal from premises and issue of trespass order;
• notification to professional association or governing body;
• removal, dismissal, or expulsion;
• letter of complaint to individual or regulatory/governing body;
• provide support/counselling for those affected by discrimination and/or harassment;
and/or
• follow-up to ensure that any discrimination and/or harassment has stopped, and that
no incidents of reprisal have occurred.
90. Where it is determined that a complaint under this policy was made in good faith and is not
substantiated, there shall be no adverse consequences and no record of the complaint shall
appear on any person’s file.
91. An affected unionized employee who is unsatisfied with the outcome of a complaint
under this policy may submit a grievance in accordance with applicable collective agreement
procedures.
92. An affected non-unionized employee, who is not a senior officer of the Hospital or a
physician, and who is unsatisfied with the outcome of a complaint under this policy may submit a
written request for reconsideration to the President within ten (10) working days of receipt of the
decision of the applicable Vice-President regarding the disposition of the complaint. The
President will normally reply to the request for reconsideration within fifteen (15) working days,
and may uphold, waive, vary, or amend any decision regarding the complaint. The President’s
decision on reconsideration shall be final.
93. An affected physician who is unsatisfied with the outcome of a complaint under this policy
may pursue his or her rights in accordance with the Medical Staff By-Laws.
94. In the case of a complaint against a senior officer of the Hospital, a decision by the
President or the Chair of the Board of Governors, as applicable, regarding remedies or sanctions
is final and cannot be reconsidered.
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GENERAL MANUAL – POLICY Page:- I-d-15-39
MOUNT SINAI HOSPITAL
Form MS 204 A Date:- May, 2004
Revised: September, 2008
Issued By:-
Reference:-
Title:-
Administration
Diversity and Human Rights Committee
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
V. Time
Time limits may be reasonably extended by agreement of the parties, or by the Diversity and
Human Rights Advisor as required. The Hospital reserves the right to extend or not extend
time limits under this policy.
VI.
Costs
While the Hospital is responsible for the cost of administering this policy, the Hospital is
not responsible for any legal costs or disbursements incurred by any party to a complaint.
VII.
Questions
Questions regarding this policy may be directed to the Mount Sinai Hospital Diversity and
Human Rights Advisor.
VIII. Glossary
Accommodation – an adaptation of the learning or work environment for persons who, as a
result of their membership in a group identified by a prohibited ground of Discrimination, are
disadvantaged by a requirement, qualification or practice which is otherwise legitimate in the
circumstances. Accommodation ensures that an Employee who is otherwise systemically
discriminated against, is given the opportunity to perform the essential duties of a job at the
same level as another Employee in a similar job who is not subject to systemic discrimination.
Assault -
Occurs when a person:
• without the consent of another person, applies force intentionally to that other
person directly or indirectly;
• attempts or threatens, by an act or gesture, to apply force to another person, if he or
she has, or causes that other person to believe, on reasonable grounds, that he or
she has present ability to effect his or her purpose; or,
• while openly wearing or carrying a weapon or an imitation thereof, accosts or
impedes another person, and this definition applies to all forms of assault,
including sexual assault, sexual assault with a weapon, threats to a third party or
causing bodily harm and aggravated sexual assault.
Board of Governors - the Board of Governors for Mount Sinai Hospital.
Diversity and Human Rights Advisor - a person employed by the Hospital who is to
24

GENERAL MANUAL – POLICY Page:- I-d-15-39
MOUNT SINAI HOSPITAL
Form MS 204 A Date:- May, 2004
Revised: September, 2008
Issued By:-
Reference:-
Title:-
Administration
Diversity and Human Rights Committee
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
oversee diversity and human rights matters. The Advisor is responsible for the coordination,
implementation and operation of this Policy and for carrying out the specified duties defined
by this policy.
Due Diligence –
Includes the following:
• A written discrimination and harassment policy which has been communicated
throughout the organization
• Quick and effective resolution of complaints
• Appropriate responses to prevent similar occurrences in the future
Code of Conduct - the code of conduct applicable to Members of the Hospital Community
and as set out in Part III of this Policy.
Fact finding/investigation - a process to collect, review, analyze, and assess facts with
respect to the merit or veracity of an allegation. Facts are derived from evidence provided by
the complainant, the respondent, and witnesses; from documentation; and may include
inferences drawn by the investigator from the evidence received.
Hospital - Mount Sinai Hospital established pursuant to the Public Hospital’s Act.
Members of the Hospital Community - students, employees, senior officers, contract
workers, physicians, volunteers, including advisory committees, research institutes or
associations directly connected to joint Hospital initiatives.
Hospital Sponsored Event - any event sponsored by the Hospital or any association
directly affiliated and registered with the Hospital, whether on or off Hospital property.
Chief of Department - head of a medical department of the Hospital who also has
disciplinary authority over physicians.
Discrimination - conduct as described in Part III.A of this Policy.
Early Resolution - the informal resolution mechanism set out in Part IV B of this Policy.
Employee - a person who works for or provides services to the Hospital on a full- or parttime
basis, whether unionized (belonging to a bargaining unit) or not, including supervisory
staff, and administrative staff, but not including Senior Officers.
Harassment - various forms of harassment are described in Part III B of this Policy.
Manager - an Employee of the Hospital, who supervises, directs or manages the work of any
other Employee and includes Senior Officers.
25

GENERAL MANUAL – POLICY Page:- I-d-15-39
MOUNT SINAI HOSPITAL
Form MS 204 A Date:- May, 2004
Revised: September, 2008
Issued By:-
Reference:-
Title:-
Administration
Diversity and Human Rights Committee
DIVERSITY AND HUMAN RIGHTS POLICY AND PROCEDURES
Mediator - a person appointed by the Diversity and Human Rights Advisor to carry out the
duties of a Mediator as specified in this Policy and who has satisfied training criteria
satisfactory to the Hospital with respect to dispute resolution.
Medical Advisory Council - the body referred to in the Public Hospitals Act as the Medical
Advisory Committee and provides supervision over the practice of medicine in the Hospital
Senior Officer - the President of the Hospital, the Vice-Presidents Chair of the Medical
Advisory Council.
Threat - any person who, wrongfully and without lawful authority, for the purpose of
compelling another person to abstain from doing anything that he or she has a lawful right to
do, or to do anything that he or she has a lawful right to abstain from doing:
• uses violence or threats of violence to that person, or injures his or her
property;
• intimidates or attempts to intimidate that person by threats that violence or other
injury will be done to or punishment inflicted upon, him or her, or his or her relative,
or that the property of any of them will be damaged;
• persistently follows that person about from place to place;
• hides any personal property owned or used by that person, or deprives or hinders
him or her of such property in the use thereof; or,
• blocks or obstructs that person.
Working Days - Monday through Friday, except statutory holidays and when the Hospital is
officially closed by order of the President or by virtue of any governmental order or regulation.
26

GENERAL MANUAL – POLICY Page:- IV-k-20-26
MOUNT SINAI HOSPITAL
Form MS 204A Date:- O: January, 1999
R: March, 2006
R: May, 2006
Issued By:- Administration
Reference:- Human Resources Department – Policies and Procedures Manual
Title:-
Fair Employment Opportunity Policy
Section 1: Introduction
I. Preamble
Mount Sinai Hospital is committed to fostering a positive employment environment, which recognizes and
respects the personal worth, dignity and diversity of each member of the Hospital Community. This policy intends
that the hospital will recruit qualified individuals on the basis of merit and provide equal employment
opportunities to individuals holding the required qualifications regardless of race, ancestry, place of origin, colour,
ethnic origin, citizenship, creed, sex, sexual orientation, age, marital status, family status or disability.
Mount Sinai Hospital aims to create a work environment in which every member can realize their growth
potential, and where diversity within departments is welcome. This includes the elimination of any barriers to
employment, or success in employment, that adversely affect any member of the hospital or candidate because of a
characteristic listed in s. 5(1) of the Ontario Human Rights Code.
The Hospital complies fully with the Employment Standards Act, the Ontario Human Rights Code and all
pertinent legislation governing the fair recruitment and employment of qualified candidates.
All employees are encouraged to pursue their education in related areas of employment in order to enhance their
growth potential and improve their future employment opportunities. Managers must ensure these opportunities
are distributed equitably.
Provisions in collective agreements shall prevail.
This policy applies to all employment decisions unless superseded by a non-discriminatory provision in a
collective agreement.
II. Non-Discrimination Provisions
(a)
(b)
Mount Sinai Hospital acknowledges that discriminatory practices and attitudes are often entrenched within the
workplace and may serve (whether intentionally or not), to exclude, deny opportunities and rights to human rights
protected individuals and groups.
The Hospital recognizes that discrimination can present itself directly, adversely or systemically, and prohibits
these forms of treatment pursuant to The Diversity and Human Rights Policy and Procedures Code of Conduct,
s.III, ss. 32 through 35.
III. Policy Objectives
(a)
(b)
(c)
(d)
It is the policy of Mount Sinai Hospital to recruit qualified individuals for employment opportunities on the basis
of merit and to uphold principles of dignity, fair treatment and candidate self-worth during the recruitment process.
Mount Sinai Hospital aims to increase diversity representation in all positions, levels and employment capacities
and ventures within the institution.
It is the policy of Mount Sinai Hospital to recruit candidates in a manner that is free from discrimination and
harassment in accordance with the Ontario Human Rights Code.
This policy was developed in consultation with the Diversity and Human Rights Department, the Diversity and
Human Rights Committee the Human Resources Department, union representatives, and senior management team
members.

GENERAL MANUAL – POLICY Page:- IV-k-20-26
MOUNT SINAI HOSPITAL
Form MS 204A Date:- O: January, 1999
R: March, 2006
R: May, 2006
Issued By:- Administration
Reference:- Human Resources Department – Policies and Procedures Manual
Title:-
Fair Employment Opportunity Policy
Section 2: The Administration of the Policy
IV. Application of Policy
(a)
(b)
This Equal Opportunity policy applies to all employment capacities and institutions within, and affiliated with the
hospital.
This policy applies to the following employment decisions:
i. Recruitment
ii. Hiring
iii. Job advertising
iv. Advancement
v. Remuneration
V. Recruitment and Enforcement Jurisdiction
(a)
(b)
(c)
(d)
Recruitment of all employees is coordinated by the Human Resources Department. The department strives, in
conjunction with the hiring manager, to recruit and retain the best employees based on the Hospital staffing needs,
position requirements and candidates’ qualifications.
In accordance with employee collective agreements, internal employees will be given preference for vacant
positions, provided that they meet the essential qualifications for the position and have a satisfactory performance
and attendance history.
Hiring managers are charged with the responsibility of initiating the recruitment process through the determination
of vacancies within the department.
All managers are responsible for enforcing the relevant provisions of this policy.
VI. Administration and Review of the Policy
(a)
(b)
(c)
(d)
(e)
This policy shall be reviewed by the Human Rights and Diversity Department and the Human Resources
department after its first year and subsequently after every three years. Any revisions at this time shall be
submitted for approval to the Human Rights and Diversity Committee in accordance with s. V., ss. (a) of this
policy.
This policy shall be made available to all staff members. Furthermore, all staff in a recruitment capacity shall
regularly familiarize themselves with the objectives and procedures contained within the policy.
This policy shall be made available to prospective employment candidates on our website.
All employees shall be encouraged to communicate their comments surrounding this policy to both Human
Resources and the Diversity and Human Rights Department on an ongoing basis.
A process shall be developed by the Diversity and Human Rights Department and the Human Resources
Department to respond to comments surrounding this policy and to incorporate relevant suggestions in subsequent
revisions.

GENERAL MANUAL – POLICY Page:- IV-k-20-26
MOUNT SINAI HOSPITAL
Form MS 204A Date:- O: January, 1999
R: March, 2006
R: May, 2006
Issued By:- Administration
Reference:- Human Resources Department – Policies and Procedures Manual
Title:-
Fair Employment Opportunity Policy
VII. Demographic Data
(a)
(b)
The Diversity and Human Rights Department commits itself to the collection and analysis of demographic data for
the purpose of identifying employment trends.
The Hospital commits itself to ameliorating past barriers to equal recruitment opportunities across all employment
categories and intends to match diversity targets identified through the analysis of the data obtained by the
collection of employee demographic data.
VIII. Enforcement of Non-Discrimination Practices during Recruitment
(a)
(b)
The Human Resources Department keeps abreast of changes to Human Rights and related legislation throughout
ongoing professional development and strives to ensure that no discriminatory or unfair recruitment or
employment practices exist.
The Human Resources Department and the Diversity and Human Rights Office shall provide advice and support to
management to enable them to fulfill their responsibility to provide an environment where all employees are
treated in a fair, consistent and non-discriminatory manner.
IX. Temporary Positions
(a)
(b)
(c)
(d)
Temporary positions include those positions where staff will be employed for a period of three months or less. All
positions over 3 months will be recruited and hired as stated in this policy.
Upon attaining three months employment and subject to any collective agreement provisions, individuals
employed in a temporary capacity must formally apply for the position through the standard recruitment channels
and procedures outlined in this Equal Opportunity Policy.
Mount Sinai Hospital recognizes that temporary positions can act as learning opportunities and encourages hiring
managers to distribute these positions equitably in order to encourage individual education and self-fulfillment.
Mount Sinai Hospital encourages Hiring Managers to develop departmental procedures for the fair distribution of
recurring temporary positions to provide for a broader pool of experienced employees.
X. Accommodation
(a)
(b)
In accordance with the Ontario Human Rights Code the Hospital will provide any required accommodation, up to
the point of undue hardship, for any qualified disabled applicant who has been recruited.
The Hospital will provide any required accommodation, up to the point of undue hardship, for any disabled
candidate during the selection process. The hiring manager or Human Resources will inquire as to whether
accommodation is required prior to an interview or testing.

GENERAL MANUAL – POLICY Page:- IV-k-20-26
MOUNT SINAI HOSPITAL
Form MS 204A Date:- O: January, 1999
R: March, 2006
R: May, 2006
Issued By:- Administration
Reference:- Human Resources Department – Policies and Procedures Manual
Title:-
Fair Employment Opportunity Policy
Section 3: The Recruitment Process
XI. Employment Vacancies
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
A vacancy is defined as an opening in a job classification where the number of persons required exceeds the
number classified therein.
The responsibility for selecting the most qualified candidate to fill a vacant position lies with the department
head and the hiring manager of the department.
When a vacancy exists, the hiring Manager will complete a Recruitment Request form (Form MS194,
attached), obtain signatures from the appropriate Vice-President(s) and forward the form to the Human
Resources department. Upon the receipt of this form Human Resources will then initiate the appropriate
process.
Provisions (d) through (h) apply to Internal Hospital Candidates:
Internal Candidates are defined as: individuals employed by the Hospital who have completed their
probationary period and who are not prevented from applying to an available employment opportunity due to
a prior contract or a limitation placed upon the individual by way of a collective agreement.
Vacancies will be posted internally on the Job Posting Boards (outside Human Resources and the Cafeteria)
for 5 days excluding Saturdays, Sundays and Holidays. Vacancies covered by a collective agreement will be
posted in accordance with the appropriate collective agreement. All job postings will indicate a satisfactory
performance and attendance record is required. All internal applicants must complete an Application for Job
Posting form and submit a current resume as indicated on the job posting.
Any employee may apply for any posted vacancy, provided they have completed their probationary period.
Employees on probation may also apply providing they have the prior written approval of their manager.
External Candidates are defined as individuals not employed within the Hospital’s operating
units/departments and those who do not fall within the definition of internal candidates outlined in ss. (d).
XII. Employment Advertising
(a)
(b)
All external job positing may utilize a wide variety of sources and mediums in order to reach a wide range of
potential candidates and foster diversity within the applicant pool.
All employment postings shall contain a detailed job description that includes, but is not limited to:
i. A position summary that accurately reflects the needs of the department.
ii. A list of the essential experience, ability, or characteristics required to perform the job.
iii. The minimum essential educational qualifications needed to perform the job.
iv. A detailed account of the essential previous experience that a candidate must possess in order to perform
the job.
v. Where required, a list of specific skills or qualifications that a candidate must possess in order to perform
the job.
vi. The duties, responsibilities and tasks that the candidate will perform on a regular basis.
(c)
The writing of the detailed job description shall conform to the following four procedures:

GENERAL MANUAL – POLICY Page:- IV-k-20-26
MOUNT SINAI HOSPITAL
Form MS 204A Date:- O: January, 1999
R: March, 2006
R: May, 2006
Issued By:- Administration
Reference:- Human Resources Department – Policies and Procedures Manual
Title:-
Fair Employment Opportunity Policy
i. Identify the skills and knowledge essential to the performance of the job and indicate the criteria on the
employment positing.
ii. Identify the education and experience essential to the performance of the job and indicate the criteria on
the employment positing.
iii. Review the qualifications stated using the Human Rights Checklist for Qualifications (refer to Appendix
A).
iv. Ensure that all qualifications are bona fide in accordance with the three part test for bona fide
occupational requirements (refer to Appendix B).
(d)
(e)
External advertising will normally not occur before an internal search for qualified candidates has been conducted.
All employment and recruitment postings shall state that Mount Sinai Hospital is an Equal Opportunity Employer.
XIII. Initial Recruitment
(a)
(b)
(c)
(d)
(e)
Selection committees shall be created at the time of recruitment. These committees will determine the appropriate
evaluations method(s) for vacant positions using the materials available through the Human Resources Department
intranet website.
Mount Sinai Hospital encourages all hiring managers to construct diverse screening and selection committees that
are representative of the diversity of the hospital and larger community. .
If requested, Human Resources will screen the applications and resumes of potential candidates who apply for an
employment posting in order to determine if their qualifications meet the minimum qualifications listed in the
relevant posting.
Departments will receive only the applications and supporting documentation of candidates who meet the
minimum qualifications.
Departments may predetermine the number of candidates who will be interviewed. If this option is exercised the
following shall occur:
i. Applications and resumes will be further scrutinized to identify the individuals that represent the best
qualified of the applicant pool.
ii. Position-related and measurable criteria will be used to rank the candidates in order to determine which of
the applications shall be granted further review.
iii. Departments must document how the ranking were determined and where the cut-off for further review
occurred.
XIV. Interviews
(a) The Hospital recognizes that employment interviews are the least reliable predictors of future employee
performance, due to the subjectivity of the process and the possibility for bias. As a result, Mount Sinai requires
the usage of a wide variety of evaluation methods for candidates selected to undergo the interview process in order
to provide for a reliable and equitable assessment.
(b)
These required methods may include, but are not limited to:
i. The use of skills and knowledge testing (before or following interview).
ii. The use of writing samples.
iii. The use of case study analysis/ scenario analysis.
iv. The use of behavioural interview questions.

GENERAL MANUAL – POLICY Page:- IV-k-20-26
MOUNT SINAI HOSPITAL
Form MS 204A Date:- O: January, 1999
R: March, 2006
R: May, 2006
Issued By:- Administration
Reference:- Human Resources Department – Policies and Procedures Manual
Title:-
Fair Employment Opportunity Policy
v. The use of standardized questions with expected answers accompanying these questions for ranking
purposes.
vi. References and credentials.
XV. The Hiring Decision
(a)
For non-union vacancies, the most qualified internal applicant will be selected to fill a vacancy, provided that the
applicant fully meets the requirements of the job and has a satisfactory performance and attendance history. In
cases of promotion, demotion or transfer, the following factors shall be considered:
i. Skill, ability, experience, education and other qualifications.
ii. Attendance history.
iii. Service (hospital wide).
iv. Performance and discipline history.
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)
Where, in the judgment of the Hospital, factors (i) and (ii) are for all purposes equal between two (2) or more
employees, hospital-wide service shall govern.
The Selection Committee, in consultation with the Human Resources department, will make the final hiring
decision. Human Resources staff will make the job offer after discussing with the hiring manager/designate the
appropriate starting salary. When the vacancy falls under a collective agreement the Human Resources staff is
responsible for ensuring compliance with all collective agreement provisions.
A transferred or promoted employee will ordinarily begin working in the new position no later than one-month
following their acceptance of the new job. The date of transfer will be arranged between the respective department
managers/designates. All transfers that result in a change in employee type or a change in bargaining unit must be
effective the first day of a pay period. The new manager/designate is responsible for completing and forwarding to
Human Resources, prior to the effective date, an Personnel Action Form, (PAF).
If the vacancy is filled by an external applicant, Human Resources will confirm its verbal offer of employment in
writing with a copy to the hiring manager.
The successful candidate must be at least 16 years of age, be competent in written and verbal English at a level
essential to the position and be legally eligible to work in Canada.
Applicants will not be considered for employment unless they are Canadian citizens, landed immigrants or possess
the necessary documents from the Department of Employment and Immigration indicating their ability to accept
employment in Canada. The Human Resources Department will ensure that applicants for employment possess
the necessary immigration status prior to their start date.
Relatives of existing employees may be hired provided they will not have a direct reporting relationship. For this
purpose department is defined as a separately managed and distinct operational unit. For this purpose, "Relative"
is defined as: parent, step-parent; foster parent, grand-parent, spouse, including same-sex partner, relative of the
employee who is dependent on the employee for care or assistance.
All employees will follow safe work practices and comply with the roles and responsibilities that are outlined with
respect to health and safety policies, procedures and training at Mount Sinai Hospital. In accordance with Hospital
policy and legislated health and safety requirements, employment is conditional upon the completion of a health
review.

GENERAL MANUAL – POLICY Page:- IV-k-20-26
MOUNT SINAI HOSPITAL
Form MS 204A Date:- O: January, 1999
R: March, 2006
R: May, 2006
Issued By:- Administration
Reference:- Human Resources Department – Policies and Procedures Manual
Title:-
Fair Employment Opportunity Policy
XVI. New Positions and New Titles
(a)
Increases in departmental staff complements will be done in compliance with the annual budget. The President is
the final authority for increasing staffing in any department. The hiring manager/designate is responsible for
ensuring prior written approval is obtained from either of them before any change is made to the number of
positions or job classifications established by the budget.
(b) The written approval of the appropriate departmental Director and the Director, Human Resources or designate
is required prior to implementing a change to any position title.
(c)
An updated job description must be provided to Human Resources for the purpose of job evaluation before the
recruitment process is initiated for any new or reclassified position.
XVII. Conditions of Employment
(a)
All new employees will:
i. Complete the Hospital's Application for Employment form.
ii. Supply documentation and credentials where required, e.g. Professional registration or proof of
employment eligibility.
iii. Sign the offer letter and return to manager.
iv. Undergo a health review by the Occupational Health and Safety department, in compliance with the
Public Hospitals Act.
v. Attend the General Orientation program.

Made in Sinai Health Equity Competencies:
Delivering Healthcare to Diverse Communities
Community Consultation Summary Findings

Made in Sinai Health Equity Competencies:
Delivering Healthcare to Diverse Communities
Community Consultation Summary Findings
Ruby Lam, CITTA Consultants
A project of the Mount Sinai Hospital Diversity and Human Rights Committee

Table of Contents
Foreword 1
Universal Themes of Family and Patient Centred Care 4
Voices of People Living with HIV/AIDS 6
Voices of Homeless People 8
Voices of People Living with Physical Disabilities 10
Voices of People Who Are Lesbian, Gay and Bisexual 12
Voices of People Who Are Transgender 14
Voices of People Living with Mental Illness 17
Voices of Aboriginal People 19
Voices of Francophone Canadians 21
Voices of Immigrants 24
Voices of Seniors 26
Appendix: Focus Group Questions 28

Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
Community Consultation Summary Findings
Foreword
Please look beyond the label to see the person that I am.
Sickness knows no race, sex, religion or culture.
Neither should my doctor. If I’m sick, I want to be cured, and that’s all.
I want to be treated as a person,
with respect, and not singled out or treated differently.
The layers of bias have to be ironed out so that there is equal care for everyone.
Often when we don’t understand why someone is different from us we assign blame, judgment and stigma.
Their otherness scares us and we jump to stereotypes to make sense of their difference. We can’t see beyond
the labels to recognize their humanity and personhood.
Toronto is a vibrant city with a culturally diverse mix of people. Cultural identity may be defined by many
factors, including: race, ethnicity, age, gender, sexual orientation, religion, language, physical or mental ability,
educational background, and socio-economic status. There is nothing inherently good or bad about difference;
it is what we make of it. With the right leadership and in the right environment, differences can enrich our
lives. Without that leadership, differences can be used to exclude and to cast people to the margins of society.
No matter how our particular cultural identity is defined, we all want to feel welcome, understood, accepted,
and safe. We all deserve to be included and to have our needs met.
If universal health is a fundamental right that we, as Canadians, value and hold dear, why are some
communities not seeking the medical attention that they need? Recognizing the changing face of the
city and the importance of equitable access to healthcare, MSH embarked on a community consultation
process to identify the competencies that would enable its healthcare providers to better meet the needs of
underserved communities.
MSH consulted with ten distinct cultural communities that have traditionally experienced barriers to healthcare,
and asked their views on the following question (a full list of the questions is attached under Appendix A).
A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting
1

Community Consultation Summary Findings
Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
“What are the values, attitudes, knowledge and skills that health care professionals at
Mount Sinai Hospital need to have to be able to serve clients and families from diverse
communities in culturally-appropriate ways?”
This Report
This report summarizes the concerns and suggestions raised during the community consultation process. It
describes the unique challenges faced by different populations that have difficulty accessing healthcare services
due to barriers such as homelessness, poverty, linguistic barriers, and social exclusion.
The report is intended to help MSH in policy development, staff training, and evaluation efforts with the
ultimate goal of increasing the Hospital’s cultural competency and broadening service access for culturally
diverse and marginalized populations.
It is important to note the following caveats:
1.
2.
The people who were consulted raised concerns and provided suggestions about healthcare access in
general; many of these comments do not relate specifically to MSH. When it was felt that these ideas
would offer useful context and insight, they were included in the report.
The suggested steps outlined in this report for healthcare providers and hospitals to undertake towards
cultural competency are by no means exhaustive; they are simply the ideas offered by those individuals
consulted for this report.
Who Was Consulted?
MSH heard from ten distinct cultural communities that have traditionally experienced barriers to healthcare.
They are:
• People who are homeless or underhoused
• People living with physical disabilities
• People living with HIV/AIDS
• Aboriginal people
• Seniors
• People living with severe mental illness
• Francophone Canadians
• Immigrants
• People who are lesbian, gay and bisexual
• People who are transgender
Consultation participants congratulate the Hospital for posing the important question: ‘How should our staff
care for you with competence and respect?’ ‘Finally, someone is asking!’ they say. Again and again, the groups
that were consulted demonstrated their eagerness to continue engagement and dialogue with the Hospital.
Through this process of community consultation, Mount Sinai Hospital has created a wonderful opportunity for
partnering with diverse and marginalized communities to improve their access to healthcare and close any
existing health disparities.
2
A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting

Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
Community Consultation Summary Findings
MSH greatly thanks the individuals who came to the consultations for sharing so generously of their personal
stories. Their voices came across loud and clear, and will undoubtedly help MSH and its healthcare providers
become more responsive to the needs of diverse communities.
MSH is also grateful for the partnership of the following agencies, which hosted the community consultations:
• Anne Johnston Health Station
• Les Centres D’Accueil Heritage
• Mount Sinai Hospital / Assertive Community Treatment Team
• Queen West Community Health Centre / Four Winds Program
• Seaton House
• Sistering
• St. Christopher House / Seniors Community Development Program
• St. Clair West Services for Seniors
• The 519 Church Street Community Centre
• Toronto People With AIDS Foundation / Speakers Bureau
• Trans Health Lobby Group / Rainbow Health Network
A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting
3

Community Consultation Summary Findings
Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
Universal Themes of Family and Patient Centred Care
Mount Sinai Hospital (MSH) is located in downtown Toronto, surrounded by the full range of the city’s cultural
diversity. It is committed to providing high-quality patient and family centred care that meets the needs of
different communities in an accessible, effective and culturally competent manner. However, despite this strong
commitment to diversity, some populations in the city do not use the Hospital’s services. MSH, like many other
healthcare institutions in the city, faces the challenge of offering services that are relevant to the needs of the
city’s many diverse communities, and delivering them in ways that are truly accessible.
Recognizing the importance of equitable access to healthcare, MSH embarked on a community consultation
process to identify the competencies needed that would enable its healthcare providers to better meet the
needs of underserved communities.
MSH consulted with ten distinct cultural communities that have traditionally experienced barriers to healthcare,
and asked their views on the following question:
“What are the values, attitudes, knowledge and skills that healthcare providers need
to have to be able to serve you in a culturally-appropriate manner?”
Across all the equity-seeking communities that were consulted for this report, several core themes emerged:
People want to be regarded as individuals, and not singled out or treated differently
Those consulted had one unanimous message: they want healthcare providers to look beyond stereotypes and
labels and treat them as individuals. All too often, what stands out as different seems to be the only thing that
healthcare providers see.
People want to be treated for the condition for which they are seeking medical attention, and not singled
out, treated differently, or ‘outted.’ Stereotypes — and the behaviours that result from them — pose the
greatest access barrier to healthcare because they interfere with the ability of healthcare providers to provide
objective, patient-centred care. Until the cloak of prejudice is lifted, people from marginalized communities will
continue to worry about how they may be treated by healthcare providers and will therefore stay away from
mainstream healthcare establishments.
Each person deserves to be treated with dignity, regardless of their circumstances
The individuals interviewed for this report say they want healthcare providers to treat them with compassion,
dignity and respect. Whatever their circumstances — whether they are poor, homeless, struggling with an
addiction, or don’t speak English — each person deserves good-quality, respectful, nonjudgmental care. Look
beyond the labels to recognize each person’s humanity.
4
A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting

Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
Community Consultation Summary Findings
People respond to a smile or a nod
Positive body language and communication make a huge difference in how people feel about seeking medical
care. Making eye contact, being greeted, providing a gentle touch and simple statements like: ‘Are you
comfortable?’, ‘What do you need?’, ‘I understand’, and ‘You’re going to be okay’ make a world of difference to
those seeking help.
People want more input in their healthcare
Respondents say that healthcare providers do not seek their input, and if input is offered it is generally ignored.
People with physical disabilities and people living with HIV/AIDS, in particular, have lived with their conditions
for a long time and feel they know their bodies best. Respondents would like healthcare providers to engage
them as partners in their own healthcare, working together to diagnose health problems and identify solutions.
Healthcare providers must become more culturally competent in dealing with
diverse communities
Right across the board, the communities consulted feel that healthcare providers should have a basic level of
knowledge about their health issues and to demonstrate a level of comfort in dealing with them. They would
like hospitals to provide more tailored care and supports such as: more specialists (i.e. to serve people with
HIV), better access to interpretation, and hire staff to advocate for distinct communities (i.e. with Aboriginal
patients, or with people with disabilities).
People want longer appointments with their healthcare providers
Generally, the unspoken rule is that you should bring only one health complaint to a medical appointment
at a time. But this does not work for individuals with complex health needs, such as people with disabilities
or people living with HIV/AIDS. They need more time with their healthcare providers to address multiple and
concurrent health issues. Respondents would like healthcare providers to give them more information about
their health, and take the time to explain diagnoses, procedures and treatments.
Hospitals should gather community feedback on how they are doing
Respondents feel that patients should be able to provide anonymous, confidential feedback about their
experiences in hospitals and with individual healthcare providers. Suggested methods of collecting this
information include:
• Customer satisfaction surveys
• Hospital report cards based on customer satisfaction surveys
• Suggestion boxes
Anti-oppression training should be required of all staff
Those who were consulted feel strongly that all hospital employees (including reception staff and custodians)
should receive anti-oppression training. There should be consistent consequences for discrimination and
harassment. Hospitals should develop clear policies that articulate their expectations of staff regarding the
respectful, fair and culturally competent manner in which patients should be treated.
A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting
5

Community Consultation Summary Findings
Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
Voices of People Living with HIV/AIDS
They see HIV. They don’t see you as a person.
After my friend died, I overheard one nurse say to another:
“At least the poor guy is out of his suffering.” The other nurse replied:
“Oh, he didn’t suffer enough.”
I object to that colour-coded sticker on the front of my chart that says I am HIV+.
Doctors must realize that there is stigma and discrimination attached to being positive.
That sticker is not the same as the other stickers.
When a doctor ‘double gloves’ it sends me the message that I am that much
less of a human being. It affirms that I am dangerous and poisonous to them.
Their behaviour makes people shut up about their status.
They don’t bother soliciting my views about what might be happening to my body,
even though I’ve been living with these symptoms for years.
Core issues identified by consultation participants
Everyone wants to be treated with compassion and respect. This is perhaps even more important when
you are ill and feeling vulnerable. When healthcare providers are seen to be taking more precautions than
necessary or doing so in an insensitive manner, it is a humiliating experience for people living with HIV/AIDS.
As a result, many people living with HIV/AIDS often avoid seeking care.
HIV+ consultation participants stated that the following types of behaviour by healthcare providers are
insensitive and demeaning:
• Dramatic shifts in body language and behaviour after finding out about a person’s HIV status
(i.e. recoiling, examining the person with only the finger tips)
• Upon finding out the person’s status, leaving the room and returning fully gowned, masked and
gloved, with no explanation
• Using double and triple gloves
• Asking visitors to put on gowns and gloves
• Passing the chart to another healthcare provider and pointing to the HIV sticker in front the patient
• Nurses who peep in to see who the HIV+ person is
• Being scolded by healthcare providers for not disclosing one’s status
• Automatically sending in a psychiatrist and thus making assumptions about how the person
might be feeling
• Being treated like a drug addict when you are in extreme pain
6
A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting

Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
Community Consultation Summary Findings
Consultation participants say that when healthcare providers act in these ways, it makes them feel ‘subhuman,’
‘dirty,’ and ‘toxic.’ Many people living with HIV/AIDS already report a sense of low self-esteem, which
is further diminished when healthcare providers treat them as if they are disgusting, scary or dangerous. As a
result of this treatment, people with HIV/AIDS wonder whether they are receiving the level of care they need
and deserve if healthcare providers feel such fear and negativity towards them.
Consultation participants note that healthcare providers tend to be more sympathetic towards people who
contract HIV through blood transfusions than towards those who contract it sexually.
There is also the element of homophobia that views HIV+ gay men as being at fault for contracting the disease
and regards the disease as ‘payback’ for their behaviour.
People with AIDS say that at any given time, they may have 6 to 8 health issues that require attention, a situation
they feel that is not fully understood nor accommodated by healthcare providers. People with AIDS would like
longer appointments with healthcare providers in order to address the many facets of a complex disease.
Culturally competent care for people living with HIV/AIDS
People living with HIV/AIDS would like healthcare providers to refrain from judging them. HIV/AIDS is an
illness, just as cancer is an illness. People living with HIV/AIDS deserve the same dignity, treatment and care
from medical professionals that are afforded to people with other diseases.
Perhaps the two most important factors to providing culturally competent care for people living with HIV/
AIDS are appropriate body language and effective communication. People living with HIV/AIDS understand
that precautions must be taken and that sometimes these precautions are to protect the patient. But there is a
world of difference between a healthcare provider who acts with sensitivity and explains why they are taking
precautions, and someone who does not. To illustrate this point, one informant described a positive encounter
with a physiotherapist who informed him that she had a cold and was putting on a mask and gloves to protect him.
Suggested Steps for Healthcare Providers
DD Use masks, gowns and gloves only when medically necessary
DD When using masks/gowns/gloves, explain what you are doing and why
DD Do not double/triple glove
DD Do not ask how a person contracted HIV unless the information is medically necessary
DD Refrain from judgment
Suggested Steps for Hospitals
DD An HIV/AIDS specialist should be on call around the clock
DD Hire and equip staff with knowledge about HIV/AIDS
DD Consider either removing the sticker from patients’ charts altogether, or placing it inside the chart
DD Triage people who are experiencing a health crisis related to AIDS as urgent in the ER
DD Ask whether the patient would like a psychiatric consultation; don’t assume
DD Automatically schedule longer appointments for people living with HIV/AIDS
A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting
7

Community Consultation Summary Findings
Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
Voices of Homeless People
They see your homelessness first.
Once they find out you were a psych patient they discriminate against you all the way.
I’d like to be treated with respect and compassion, like I’m worthy.
Treat the illness, not the label.
They are so sure that someone like me must be a drug head.
They paint a wide brush with homeless people. Take away the judgment.
I’m sick, not morally defective.
I feel that when I go to the hospital I am confronted by all these stereotypes.
I could see on his (the doctor’s) face that all he saw was a runaway, a poor black teen.
You have money or you don’t have your health.
Core issues identified by consultation participants
When homeless people go to the hospital they are confronted by negative stereotypes. A common belief is
that all homeless people are alcoholics or drug addicts. There is also the belief that homeless people fabricate
their illnesses in order to get a bed for the night or to obtain drugs. The line of questioning at hospitals often
reveals these underlying beliefs and misconceptions: ‘How many drinks did you have tonight?’, ‘When was the
last time you took drugs?’ To a homeless person, these questions seem unrelated to the health concern that
brought them to the hospital in the first place, and many find this treatment deeply insulting.
As a result, homeless people often feel they have to convince healthcare providers that they are indeed sick
and worthy of medical attention. Many feel that they have no choice but to oversell their health condition in
order to get treatment. Some homeless people simply choose not to seek medical attention at all unless their
situation is absolutely critical.
Homeless people also confront the belief that they are mentally ill. Respondents say that doctors routinely
prescribe anti-depressants or anti-psychotic medicines to them, even though the homeless person does not
bring up any mental health concerns.
Respondents say they encounter a level of callousness and disrespect in hospitals. They say they are often
treated roughly by healthcare providers who ‘try to get the upper hand.’ Some have been called derogatory
terms by medical staff like ‘pillhead.’ Homeless people who have a history of mental illness say that healthcare
providers treat them particularly poorly.
8
A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting

Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
Community Consultation Summary Findings
A final issue raised by respondents was that they feel hospitals push them out before they are well enough to
leave. At one local health centre, for example, almost immediately after being admitted, homeless patients are
expected to commit to an exit plan. The consultation participants question whether anyone else with a serious
illness would be asked when they plan to leave.
Given the extremely difficult conditions that homeless people live in, it is no wonder that many are
chronically ill. And when you have been traumatized, abused, neglected or ostracized, it is even harder
to get back on your feet after an illness. While a homeless person may not be sick enough to stay in the
hospital, neither may he be well enough to return to the street. Instead of sending homeless patients back
to the shelter, respondents say they need more time in the hospital to recover and get well. They would
like hospitals to assign social workers to help connect them to ongoing medical and social supports (i.e.
housing). They would also appreciate if healthcare providers could take the time to help them learn how to
take better care of themselves.
Culturally competent care for homeless people
Many homeless respondents say that community health centers are their preferred site of care because this
is where they know they will be treated with respect, void of judgment. Community health centers also tend
to adopt a more collaborative model, where patients work in partnership with healthcare providers on their
healthcare plans.
Suggested Steps for Healthcare Providers
DD Provide care compassionately, void of judgment
DD Even if there may be issues related to addictions, don’t overlook other valid health concerns
DD Address underlying, chronic health conditions
DD Refrain from using derogatory and dehumanizing terms in relation to homeless people
(i.e. ‘pillhead’)
Suggested Steps for Hospitals
DD Provide appropriate supports
(i.e. social worker, help with chronic conditions, referral to other supports such as housing)
DD Allow homeless people adequate time to recuperate
A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting
9

Community Consultation Summary Findings
Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
Voices of People with Physical Disabilties
The doctor didn’t even say hello to me. She kept looking at my friend,
even though I was answering the questions. When we left,
the doctor said to my friend, “I’m going to give you these (papers),
since you’re the responsible one.”
No one asked my opinion; it was all done to me.
I approached several staff in the hospital to help me use the bathroom.
No one helped me. I no longer go to the hospital.
Their (doctors’ and nurses’) first response is always: “Who’s with you?”
Well, why does anyone have to be with me?
In the hospital they told me I was lazy and that I should get up and walk.
They left my legs dangling in the wheelchair. It was abuse.
It’s about respecting the individual. Listen to what the individual is telling you
because they know their body and how the condition affects them
better than the health care professional.
I would like them to eliminate the words ‘lazy’ and ‘dear’ from their vocabulary.
Core issues identified by consultation participants
People with disabilities are confronted with a barrage of stereotypes that hinder their ability to access healthcare.
For example, there is the common association of physical disability with mentally disability. Consequently
healthcare providers often treat people with physical disabilities as if they are unable to communicate their needs
or represent their own interests. One informant recounted an experience where her doctor told a medical intern
— in front of her — that ‘people with cerebral palsy tend to be mentally handicapped.’
All too often, doctors address questions and give treatment information to the family member or friend who
accompanies the person with the disability, rather than directly to the patient. Consultation participants say
that doctors often do not ask the patient with a disability — even when they are adults — for their opinions
or preferences, but seek the input of their parents instead. This type of behaviour objectifies them. It is
disrespectful, demeaning and dehumanizing.
Respondents say that their common experience is that the only thing healthcare providers seem to see is their
disability. This clouded perception sometimes results in the discriminatory refusal to treat disabled people at all.
Even before they know are told what is wrong, respondents say many healthcare professionals simply turn
them away, claiming that they have no expertise treating people with disabilities. One nurse told a WheelTrans
driver: “You might as well turn right around and take her back because we don’t treat people like that here.”
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A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting

Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
Community Consultation Summary Findings
While no one wants to be rushed, people with disabilities feel they justifiably need longer appointments
with health professionals in order to address their complex and multiple health concerns. Longer
appointments are particularly critical for people with a hearing loss or speech impairment, since it takes
more time to communicate.
Culturally competent care for people with physical disabilties
People with disabilities would like medical professionals to see them first and foremost as people and as
individuals, not as a condition or a disability. Healthcare providers must understand that people with physical
disabilities are fully capable of representing their own health interests.
Respondents are clear that culturally competent healthcare settings are the ones with the equipment,
expertise and experience to deal with people with disabilities. The Anne Johnston Health Station and
Sunnybrook Hospital are cited as providers that have acquired many of the necessary competencies to care for
people with physical disabilities competently and respectfully.
Suggested Steps for Healthcare Providers
DD Maintain eye contact and pose questions to the person with the disability (not to their family
members or companions)
DD Deal directly with the person with the disability on treatment information and any follow-up
required, unless requested otherwise by that individual
DD Solicit input from the person with the disability about what may be the problem (i.e. ‘what
brings you here today?’)
DD Refrain from using offensive language like ‘lazy’, ‘silly’
DD Address the individual by his/her name; refrain from terms like ‘sweetie’ or ‘dear’
DD When speaking about a patient with a disability to another healthcare provider, use their name
and not terms like ‘the spina bif patient’
DD Don’t speak especially loudly to people with cerebral palsy; they are not deaf
Suggested Steps for Hospitals
Access:
DD Adapt at least one examination/diagnostic room to accommodate wheelchairs
DD Equip the emergency room and at least one examination/diagnostic room with a hoyer lift
DD Lower diagnostic machines
DD Have at least one accessible washroom on every floor of every building
DD Follow-up treatment instructions should be in plain language and available in a variety of formats
(i.e. audio, large print, Braille)
DD Ensure that a designated, qualified attendant or advocate is available round the clock to provide
practical support to people with disabilities (i.e. lift them out of wheelchairs, help to use the
bathroom), as well as to help them interface with medical personnel
Safety:
DD Ensure that bathrooms are clean so that someone getting in/out of a wheelchair does not slip
DD All bathrooms should be equipped with a panic/emergency button
DD Ensure that staff are trained in safely lifting a person out of a wheelchair
A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting
11

Community Consultation Summary Findings
Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
Voices People Who are Lesbian, Gay and Bisexual
I feel like I have to educate my doctor every time; I shouldn’t have to.
Even after I tell my doctor that I am a lesbian,
he still asks whether I’m on the pill or might be pregnant.
I shouldn’t have to always come out.
The space should let me know that it’s safe to be who I am.
I’ve told my doctor several times that we’re married,
but he keeps referring to my wife as my partner. This is frustrating.
Please don’t rule out the possibility that I may wish to have
a family because I’m queer.
I don’t always want to be ‘othered.’ I don’t always want to be made to feel different.
Core issues identified by consultation participants
The pervasive assumption in society is that everyone is heterosexual. People who are lesbian, gay, bisexual
or transgender (LGBT) must constantly challenge this assumption in order that services meet their needs. For
example, people who are LGBT often find themselves having to explain their sexual identity when they meet a
new healthcare provider. They have to ‘come out’ in order to reorient a heterosexist line of inquiry that includes
questions such as: ‘Do you use birth control?
Seeking healthcare is sometimes a stressful experience for people who are LGBT because they are unsure how
the healthcare provider will react to their sexual orientation. Respondents talk about the body language that
reveals the discomfort that healthcare providers have about their sexual orientation, including:
• Dropping all eye contact
• Physically pulling back
• Rushing though the appointment
• The long silence followed by the “Oh”
• Asking either no questions at all about their lives or asking inappropriate/unnecessary questions
(i.e. questions about one’s sex life)
Those consulted spoke about the low level of awareness they’ve encountered in the medical community about
the health issues that are important to people who are LGBT. For example, one woman was told she didn’t
need a pap smear after telling her doctor that she was a lesbian. People who are LGBT often find themselves
having to educate healthcare providers about the diversity of their families and the health issues that are
important to them.
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A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting

Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
Community Consultation Summary Findings
Culturally competent care for people who are lesbian, gay and bisexual
People who are LGBT would like doctors to have a basic level of knowledge about their health issues and to
demonstrate a level of comfort in dealing with them.
An inclusive environment that eliminates heterosexism would, for example, ask everyone about their sexual
orientation and not place the burden only on people who are people to explain theirs.
The Hassle Free Clinic and Sherbourne Health Centre were cited as the preferred healthcare providers for
the LGBT community because of their specialized services and because there are no assumptions made nor
judgment about sexual orientation. These providers are also appreciated for their deliberate presence in the
LGBT community.
Suggested Steps for Healthcare Providers
DD Be aware of your body language, ask appropriate questions
DD Ask open-ended questions that are not heterosexist:
àà
Instead of: ‘When was the last time you had sex?’ (Infers sexual intercourse for many
lesbians), ask: ‘Are you sexually active?’
DD Focus on behaviour rather than labels:
àà
Instead of asking whether someone is gay or straight (individual may be closeted or
otherwise not identify with that label), ask: ‘Do you have sex with men, women, or both?’
Suggested Steps for Hospitals
DD Hang posters that indicate that the hospital is a queer positive site
DD Remove heterosexist materials
DD Diversity offices should take up LGBT issues in a more meaningful way
DD Provide training to staff on LGBT issues
DD Establish a presence in the LGBT community:
àà
Contribute to community events
àà
Offer public workshops on health issues of interest to the LGBT community
(i.e. reproductive health issues unique to lesbians)
A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting
13

Community Consultation Summary Findings
Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
Voices of People Who are Transgender
If you have a broken bone, does it really matter what gender you are?
I get the impression that my healthcare and my life doesn’t matter as much.
You would think in a medical environment they would
understand the multiplicity of genders.
But I face the same prejudice here as on the street.
We don’t have personhood because for them we are not male or female.
Some trans people avoid going to the bathroom for hours because of
how awkward — and dangerous — the situation could be.
Sex reassignment surgery is not the only determinant of my gender identity.
I shouldn’t have to wait until the surgery before I can be addressed
in the way I choose.
Core issues identified by consultation participants
For people who are transgender (which includes people who are transsexual, Two-Spirited, queer, gender
questioning, gender variant, and intersexed) there is a constant underlying fear that their ‘trans status’ will
affect the quality of medical attention they receive. In a society that generally does not understand people
who are transgender, meeting new healthcare providers is always stressful. Will they have to deal with that
person’s discomfort and judgment? Will they be mistreated because of their life choices?
The Ministry of Health and Long-Term Care allows a person’s gender to be changed on their OHIP card only
after sex reassignment surgery has been performed. This limited notion of gender identity focuses only on the
physical aspects of gender and does not acknowledge the psychological aspects that make up a person’s core
sense of identity.
Because of this rule, for some people who are transgender, the name and gender on their health card does not
match their presenting identity. This is especially problematic for people in early transition. It is also a problem
for people who are transgender who do not choose to have any sex reassignment surgery at all. The resulting
situation is often confusing for hospital staff, which address patients by the wrong pronoun even when their
appearance is obviously that of the opposite gender (i.e. calling a woman who is transgender ‘he’ or ‘sir’).
In particular, having to explain why the information on their health card does not match their appearance is a
humiliating experience for people who are transgender. As well, consultation participants talk about hospital
staff who refuse to address them by their chosen gender and who argue with them about this in public areas,
in front of other patients.
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A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting

Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
Community Consultation Summary Findings
The people consulted for this report spoke about the inappropriate behaviour they routinely encounter in the
health system. Sometimes healthcare providers express their judgment on the life choices of the person who is
transgender - even though their opinion was not solicited – or ask inappropriate questions about their personal
lives (i.e. ‘do you sleep alone?’).
Other times healthcare providers are so uncomfortable with someone who is transgender that they rush
through the appointment, making no eye contact and leaving no room for the patient to ask questions. One
respondent recounted his experience of having a bone scan conducted incompletely because the attendant
was so visibly uncomfortable with his transgender status that she rushed through the procedure.
All too often, their transgender status seems to be the only thing that healthcare providers see. Respondents
talk about going into the hospital for a specific unrelated health condition but being subjected to interrogation
by a team of interns who want to learn about transgender issues. Respondents say this makes them feel like
guinea pigs. People who are transgender want to be treated for the condition for which they are seeking
medical attention, and not singled out, treated differently, or ‘outted.’ Unless they come in for conditions
specifically related to their social identity, patients who are transgender would like to be treated like anyone
else: this patient with the sinus infection, that one with the broken toe.
Culturally competent care for people who are transgender
The central message from consultation participants is that healthcare providers should respect the way in which
people who are transgender define themselves. People who are transgender also want the same treatment
and care as that afforded to any other patient.
Suggested Steps for Healthcare Providers
DD Ask the individual how they would like to be addressed and respect their wish to be
acknowledged by their chosen gender
DD As a general rule, address the person by their appearance (their presenting gender)
rather than by the name/gender on their health card
DD When in doubt, address the individual by their first name
DD Refrain from gossip and related behaviour (i.e. pointing out the patient who
is transgender to others)
DD Respect the confidentiality of a patient’s transgender status
Suggested Steps for Hospitals
Access:
DD Expand approval sites for sex reassignment so that there are sites outside the Greater Toronto Area
DD Make sex reassignment surgery available in public hospitals
(currently it is performed only in private clinics)
DD Create single stall gender-neutral washrooms on every floor
A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting
15

Community Consultation Summary Findings
Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
Service Delivery:
DD Create room on the intake form for the individual to indicate how they would like to be
addressed (i.e. Mr. Mrs. Ms.)
DD Ask patients who are transgender in which gender wards they would like to be placed
DD As a general rule, place patients who are transgender in wards accordingly to their presenting
gender, not the gender indicated on their health cards
DD For safety reasons, when patients who are transgender are in wards, situate them closest
to the nurse’s station
DD If a person who is transgender is unconscious and unable to communicate their preference,
place them in a private room
Policy and Training:
DD Create a hospital policy that articulates the appropriate treatment of people who are transgender
DD Place messages in waiting areas that communicate equity values which inform people how they
will be treated
DD Integrate ‘Trans Issues 101’ into diversity training for staff
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A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting

Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
Community Consultation Summary Findings
Voices of People Living with Mental Illness
No one told me that I would recover. I thought I’d always
be crazy. I got very depressed.
Going to the hospital means that my illness is really bad.
The most important thing is to give people hope.
I want to live like a normal person, not as a patient in a hospital.
When I left the hospital I had no one to turn to. I didn’t know how I would manage.
Core issues identified by consultation participants
For many people living with severe mental illness, hospitals carry strong negative associations. Respondents
say they feel anxious in the hospital because they are medicated against their will. They especially don’t like
being sedated all the time. In hospitals they feel they lose their autonomy.
Some people with severe mental illness are admitted involuntarily and hence they know that being in the
hospital means that their condition is serious. In these times, respondents say that it is critical for healthcare
providers to take the time to explain their diagnosis and prognosis so that they don’t lose hope: what will the
future look like, will they get better, and how long might it take?
A common concern among respondents is the lack of support offered to patients when they leave the hospital.
Some respondents say they have been discharged even though they were still very ill and had no one to pick
them up or help them home. Leaving the hospital to a secure place to live and being able to manage the
chores of daily life are common concerns for people with mental illness.
Culturally competent care for people living with mental illness
Perhaps more so for people living with mental illness, a show of humanity by a healthcare provider is so
important. Making a kind gesture, having supportive facial expressions, and taking the time to describe a
hopeful future make a big difference.
A clear message from respondents was the need for some autonomy while staying at the hospital. In concrete
terms, people with mental illness would like the freedom to take walks (even accompanied), go outside for a
smoke, and be able to go to the convenience store to buy the food that they enjoy.
People with mental illness also want autonomy over their body and health. Respondents feel strongly that
they should have the right to refuse medicines and tests while at the hospital.
Respondents would like hospitals to coordinate more with community-based services so that there is a
continuum of support for people with mental illness after they leave the hospital. Basic things like decent and
cheerful housing have a huge impact on their mental health and outlook on life.
A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting
17

Community Consultation Summary Findings
Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
Case management, assistance to secure appropriate housing, help accessing financial support, vocational
training, life skills training, and social supports are all needed to help people with mental illness through this
transition. Respondents say that culturally and linguistically appropriate supports like those offered by Hong
Fook Mental Health Association are especially appreciated.
Suggested Steps for Healthcare Providers
DD Take more time to explain the diagnosis and prognosis
DD Do not over-sedate
DD Respect the right of patients to refuse treatment
Suggested Steps for Hospitals
DD Give patients more freedom to take walks and go outside
DD Have staff accompany patients for walks
DD Provide more opportunities for exercise (i.e. a gymnasium)
DD Develop a stronger referral system to community-based supports
18
A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting

Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
Community Consultation Summary Findings
Voices of Aboriginal People
The first question they ask me is ‘How much have you been drinking,
not ‘Where does it hurt?’ That makes me angry.
When you have a drug problem and you say you want help,
they just throw you back on the street.
Any questions about your kids and you stop talking because someone
might come knocking at your door.
Our hearts beat the same red blood.
Core issues identified by consultation participants
Most respondents say they avoid seeking medical attention from mainstream healthcare providers because of
their reluctance to accommodate Native healing approaches into treatment regimes. There is also a concern
that Western healthcare providers overmedicate.
Whereas value for personal choice is part of the Native approach to medicine, respondents find that Western
healthcare providers usually present only one option to them. They say that there is not much tolerance in
mainstream medicine for people who want to vary the type or pace of treatment, or if someone wishes to
refuse medical attention altogether. Respondents prefer Native healing because it is integrated with their
spirituality, but also because there is respect for personal choice.
Respondents say they routinely encounter prejudice and disrespect from mainstream healthcare providers. If
an Aboriginal person is in the ER, for example, the common assumption is that he or she is a ‘drunken Native.’
When one respondent refused treatment, the nurse said to her: “I suppose you people have other ways to
treat pain.”
For those individuals who struggle with addictions, they often face harsh judgments from healthcare providers.
Some respondents say that they are often the last to be seen by the doctor, which makes them feel like
‘second class citizens.’ Also since more and more detoxification programs are closing, there is less support for
those who want to battle their addictions. Once in the hospital, respondents with addictions say they would
like more time to recuperate and make plans to change their future.
Respondents point out examples of systemic prejudice in hospitals. For example, when a person is involuntarily
admitted, the intake form asks whether they are Aboriginal — while other ethno-cultural groups are not
mentioned. The respondents question how information will be used. Unless it is to arrange for a Native elder
to be part of the care team, they feel that this information is irrelevant and should not be asked at all.
A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting
19

Community Consultation Summary Findings
Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
Respondents also suspect that systemic prejudice is happening when hospitals ask Aboriginal women: “Who
is taking care of your children?” While others may experience this as an innocuous question, for Aboriginal
people — especially when they suspect that they are being singled out — the insinuation is that they don’t
take adequate care of their children.
This question raises fear that the authorities may be called and their children taken away. As a result,
respondents say that when they go to the hospital they refrain from providing any more information than is
absolutely necessary.
Culturally competent care for aboriginal people
Quite understandably after a long history of injustice, Aboriginal people are mistrustful of mainstream authority
and institutions. The respondents say that they would be more willing to use a hospital’s services if the
hospital had a Native health advocate on staff. Such a person would have an understanding of Native culture
and spirituality. Aboriginal patients would be able to talk to the advocate in confidence without fear that the
information would be used against them. In the words of the respondents, this person would “work with you,
not against you.”
Suggested Steps for Hospitals
DD Hire an advocate to work with Aboriginal patients
DD Provide more street-health programs
DD Create more referral relationships with community-based agencies that serve the Aboriginal
community (i.e. Anishnawbe Health, Native Child and Family Services)
DD Train healthcare providers about Native culture and healing
DD Screen intake procedures and ensure that questions don’t single out any one community
20
A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting

Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
Community Consultation Summary Findings
Voices of Francophone Canadians
I was frightened because I knew it was serious. I knew I would have a better chance of
surviving if I could communicate. I didn’t know what was going on around me.
I felt very alone.
When you’re sick, it’s your language of comfort that is most important.
When you call 911 they ask so many questions so quickly.
They should stop to figure out that you don’t even speak English.
When you go to the ER, you’re in panic mode.
They yell at you: ‘Follow the yellow lines,’ ‘Don’t you see the sign?’
But don’t they see that at this time you can’t use your brain;
you just need to be helped.
Sometimes in the doctors office your name is so mispronounced.
You don’t even know that they’ve called your name.
As soon as they see that you don’t speak English,
they think that trying to communicate with you is useless.
Core issues identified by consultation participants
Many of the concerns raised by the francophone participants were the same as those of immigrants, namely,
that both populations face challenges related to linguistic access. But unlike immigrants, the linguistic rights
of francophone Canadians have a historic and legal basis. In Ontario, the right to receive healthcare services in
French is stipulated in the French Language Services Act.
The urgent need for services in one’s first language is most pronounced when there is an emergency health
crisis. The person is under tremendous stress, time is critical, and the inability to effectively communicate can
profoundly alter the health outcome. Accordingly, consultation participants speak passionately of the fear they
feel when they call 911, and are alone in the ambulance or ER where no one speaks French.
Francophone Canadians find themselves fending off assumptions that hinder their access to care, in particular
the assumption that everyone speaks English. Respondents speak of how overwhelmed they feel when 911
dispatchers and medical staff fire questions at them in English, especially in emergency situations.
Aside from the critical elements of any health situation, respondents say that the lack of bilingual capability in
Toronto’s health system poses a burden for their family members and friends, who must take time off work to
accompany them to medical appointments.
A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting
21

Community Consultation Summary Findings
Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
The service providers at the consultation spoke of their frustratation at the lack of coordination and awareness
of the existing health services available in French, even amongst French-language agencies. For example,
Mount Sinai Hospital is the designated French-language provider of women and infants’ health programs in
the Toronto Central Local Health Integration Network catchment area, yet none of the service providers at
the consultation knew this. Furthermore, there are dedicated long-term care beds for francophone seniors in
Toronto, and yet, these spots are usually not filled. This is not due to lack of demand, but because healthcare
and social service providers — francophone and otherwise — do not know about these services and therefore
do not refer francophone seniors accordingly.
Culturally competent care for francophone canadians
Suggested Steps for Healthcare Providers
DD At initial contact with a new patient, ask only essential questions (i.e. ‘Where do you live?’,
‘Where does it hurt?’) and quickly determine whether the patient has sufficient command of
English (this is especially important for 911 dispatchers and ER staff)
DD One respondent advises: ‘Assume that you are addressing an elderly, deaf person who doesn’t
speak English until proven otherwise.’
DD Continue trying to communicate even if the patient only has a basic command of English
DD Provide written as well as verbal instructions for follow-up care (patient or family members can
translate instructions at home)
DD In the reception area, annunciate clearly; repeat names and numbers
Suggested Steps for Hospitals
Linguistic Access:
DD Build French language capability in emergency departments
DD At least one bilingual health provider should be on duty in the hospital at all times
DD Use professional medical interpreters, not family members
DD Hire more hospital staff with bilingual capability
Outreach:
DD Have a button on the Hospital’s website where pertinent information is in French; this sends a
welcoming message to Francophones
DD Create an outreach position to liaise with the francophone community
DD Advertise the Hospital’s French-language services in community channels: i.e. 211, Le Centre
Francophone, French-language newspapers, information that goes home with children at French
immersion schools
DD Create a directory of health providers and services that are bilingual
Building Capacity:
DD Cultivate a French-language health force by offering more French-language health degrees and
courses in Ontario
DD Create more local French-language medical internship opportunities
(i.e. at places like Le Centre Francophone)
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A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting

Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
Community Consultation Summary Findings
Suggestions Steps For Non-Hospital Health Care Providers
DD Build French language 911 capability
DD Build French language capability for paramedic teams
DD 911 dispatchers should know the French-language sites in the city (i.e. Les Centres D’Accueil
Heritage) and notify paramedic and emergency staff accordingly
DD Health Ontario should be able to refer francophone callers to French-language healthcare
providers and services in their communities
DD The five local health integration networks (LHINs) in the Greater Toronto Area should coordinate
French-language services
A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting
23

Community Consultation Summary Findings
Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
Voices of Immigrants
When you’re sick you’re already vulnerable.
It’s worse when no one understands what you are saying.
Canada is a multicultural country that promotes itself as such, and yet it does not have
the proper infrastructure to support all the different communities it opens its doors to!
When I first went to the hospital I was scared. I asked not to be touched. The doctor
said in a harsh way: ‘Don’t talk to me like that.’ His face went sour, serious, rotten.
Doctors become very impatient with you if you don’t speak English.
In the ER the first thing they do is ask for your OHIP card.
But that’s the wrong message. They should focus on helping you first.
I don’t want to go unless I have a family member with me.
However, I feel bad that they would have to miss work.
I feel angry that my whole family is affected.
Core issues identified by consultation participants
Cultural and linguistic barriers and a lack of familiarity with the healthcare system are the greatest barriers that
immigrants face in their ability to utilize existing healthcare services (i.e. knowing about them and using them).
While these services are available to the broad public, this does not mean that everyone can use them. This is
the daily reality for immigrants.
Immigrants are uniquely disadvantaged in that they are often entirely dependent on others (i.e. family
members, volunteers) to meet their healthcare needs. Specifically, they require assistance to navigate the
healthcare system, make appointments, communicate with healthcare providers, and even to physically
get to medical appointments. There are simply not enough culturally and linguistically appropriate
healthcare providers.
While it is true that most of us find it very difficult to trust when you do not know or understand what’s going
on, this is especially pronounced for immigrants who experience linguistic and cultural barriers.
The inability to communicate is not only difficult for patients, it is also frustrating for healthcare providers who
cannot get the information they need to diagnose and treat accurately, sooth the patient’s worries, or answer
their questions.
Immigrants not only experience linguistic barriers; many also face a cultural divide. Some immigrants come
from countries where there is very poor healthcare infrastructure and they associate hospitals with a place to die.
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A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting

Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
Community Consultation Summary Findings
Others come from places where figures of authority — including doctors — cannot be trusted. Outreach and
education about the healthcare system is vital to changing attitudes about healthcare for these immigrants
and making healthcare more accessible for them.
There are also immigrants in Toronto with no official immigrant status. To them, going to a hospital exposes
them to serious risk (being discovered and deported). They also know that they may be acquiring huge
medical expenses that they cannot afford to pay. Respondents say that when non-status immigrants go to
the ER, it is because their situation is serious and urgent. When hospital staff ask to see a person’s OHIP card
immediately upon arrival, this is a barrier for non-status immigrants. Instead, respondents suggested that
hospitals separate administrative issues (i.e. a person’s ability to pay) from treatment. The focus should be
on helping the person first.
Culturally competent care for immigrants
Suggested Steps for Hospitals
Service Delivery:
DD Triage individuals with linguistic barriers separately
DD Provide services free of charge, if necessary, to immigrants with no status
DD Create more culturally competent healthcare services in various first languages
DD Build linkages to community-based organizations that serve immigrants
Access:
DD Ensure access to medical interpretation, especially in the ER
DD Asking “Do you need interpretation?” should be part of the initial intake process
DD Translate important health documents into various languages
DD Expand the pool of healthcare and support workers with cultural knowledge and can speak
different languages
DD Conduct targeted outreach to immigrants to make them aware of services
A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting
25

Community Consultation Summary Findings
Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
Voices of Seniors
The doctors don’t take my complaints seriously.
They say that all my problems are related to my age.
Look in my eyes and use my name. Don’t just fill out forms.
I waited for six hours in the ER in pain and then see the doctor for one minute.
I left with no answers about what was wrong with me.
There is no dignity in hospitals. One time I was waiting in the ER for hours and was
bleeding quite seriously. No one offered me a towel to wipe myself.
They told me they don’t accept patients over 55. It seemed unfair.
Core issues identified by consultation participants
The most common complaint from seniors is the long wait times and crowded conditions in doctors’ offices and
emergency rooms. Waiting a long time poses a serious strain for many seniors, especially if there is nowhere
for them to sit. As a result, many seniors avoid seeing a doctor unless it is absolutely necessary.
The respondents say that they sometimes encounter age discrimination in healthcare settings. One blatant
example is when doctors’ offices don’t accept new patients over the age of fifty-five. Other times, age
discrimination is expressed as a doctor giving up on an individual because they are elderly. In one instance a
doctor told a respondent that she should ‘Just try to live as long as you can,’ but offered her no treatment for
what was later diagnosed as Hepatitis B. She left feeling depressed and hopeless about her condition.
Some seniors say that their age seems to dominate the perspective of healthcare providers. Some respondents
worry that their health complaints are not taken seriously enough by doctors who seem to chock up all
ailments to old age.
Culturally competent care for seniors
Like other groups of people consulted for this report, seniors would like doctors to take more time to
explain the diagnosis and treatment. They would like to be treated with patience, dignity and respect, and
to be reassured.
Seniors would like hospitals to screen waiting areas from a geriatric perspective, as they already do for children
(i.e. by placing toys in waiting areas). Taking simple steps like making seniors a priority group for seating in
waiting areas would help immensely.
Scheduling must take into account that many seniors rely on volunteers or WheelTrans to get to appointments,
and the transportation process may start many hours before the actual appointment. As a general rule, seniors
should not be scheduled for early morning appointments.
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A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting

Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
Community Consultation Summary Findings
Respondents were unanimous that a geriatric program set in a hospital that considers the unique needs of
seniors would be extremely attractive to them. They say that the existence of such a program would make
them switch to that hospital. Auxiliary services like a WheelTrans type of transportation system that could bring
them to and from the hospital for medical appointments, as well as interpretation services, would also be
strong draws.
Suggested Steps for Hospitals
DD Post signs that gives priority seating for seniors in waiting areas
DD Make wheelchairs available to help seniors enter the hospital
DD Do not schedule seniors for early morning appointments
DD Expedite referrals to specialists
DD Establish a geriatric program at the hospital
DD Create a transportation system to bring seniors to/from medical appointments
A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting
27

Community Consultation Summary Findings
Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex
Appendix
Focus Group Questions
1.
Do you generally feel comfortable going to a hospital or seeing a health care provider? Why?
2.
3.
4.
5.
6.
Describe a positive experience you’ve had either in a hospital or with a health care provider. What was
it about the hospital or the health care provider that made that interaction so positive?
Describe a negative experience you’ve had either in a hospital or with a health care provider. What was
it that made the experience negative?
Have you ever felt that being ____________ affected the way a health care professional treated you,
either positively or negatively?
In your opinion, what are the values, attitudes and skills that health care providers should have in order
to provide you with optimal treatment?
How would you like to be treated when you see a health care professional?
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A project of the Mount Sinai Hospital Diversity and Human Rights Committee
Ruby Lam, CITTA Consulting

Diversity and Human Rights Department
1536–600 University Avenue
Toronto, Ontario, Canada M5G 1X5
t 416-586-4800 ext. 7519
Diversity&HumanRights@mtsinai.on.ca
www.mountsinai.ca
200802089