RTSO Airwaves Spring 2018

RTSO Airwaves 

Spring 2018 

LEADERSHIP 

Do You Have What it Takes to be a Leader? 

Practical Leadership Advice 

Leadership Summit details 

Join us at the RTSO Leadership Summit 

Wednesday June 6, 2018 

ALSO IN THIS ISSUE 

What Does Bitcoin Have To Do With Healthcare?….....................................13 

Ministry of Health Updates…........................................................................30 

Management’s Corner: Difficult Decisions....................................................40 

Student Perspective: E-Cigarettes................................................................42 

Continuing Education Opportunities…………………………………………..44 

Ask aRTee: A3 Problem-Solving…................................................................46 

President’s Message, Executive Director’s Message, and Committee Reports

President 

Kaela Hilderley RRT CRE BEdAEd 

President-Elect 

Mike Iwanow RRT MBA 

Past President; Chair, Executive Committee 

Rob Bryan RRT AA A-EMCA 

Executive Director 

Dilshad Moosa RRT CRE CTE MASc 

Director; Editor, RTSO Airwaves 

Shawna MacDonald RRT FCSRT 

Director; Chair, Student Affairs Committee 

Robyn Klages RRT BSc 

Director; Chair, Hospital-Based Leadership 

Committee 

Sue Martin RRT MA FCSRT 

Director 

Mike Keim MA RRT 

Director; Social Media Relations 

Farzad Refahi RRT CRE HBSc 

Co-Chair, Research Committee 

Marianne Ng RRT BSc MHSM 

Co-Chair, Research Committee 

Louise Chartrand RRT PhD 

Co-Chair, Community RT Committee 

Sara Han RRT CRE BSc 

Co-Chair, Community RT Committee 

Sylvia Mortimer RRT CRE BSc 

Interim Project Advisor 

Nancy Garvey RRT MASc 

Our Mission 

To promote, advance and protect the 

interests of respiratory therapists in 

Ontario through research, professional 

advocacy, growth and development. We 

do this through strategic partnerships, 

professional collaboration and leadership. 

Our Vision 

The RTSO is the voice of respiratory 

therapists in Ontario, dedicated to 

providing the best in respiratory 

care and lung health for all Ontarians, 

one breath at a time. 

RTSO Airwaves may not be reproduced in full or 

in part without prior permission from the RTSO. 

Opinions expressed in RTSO Airwaves do not 

necessarily represent the views of The RTSO. Any 

publication of advertisements does not constitute 

official endorsement of products and/or services. 

Editors - Shawna MacDonald, RRT FCSRT & 

Dilshad Moosa BSc RRT CRE MASc 

Design - Elisabeth Biers 

(Front cover pictures shows participants at 

the RTSO Leadership Summit June 2017) 

RTSO Airwaves Spring 2018 2

President’s Message 

Kaela Hilderley 

RRT CRE BEdAEd 

Congratulations for making it through another Canadian winter! 

Recognizing that RRTs work at many different points along the respiratory continuum of care in 

Ontario, it is important for us to continue to work together. For those of you that work in acute care, 

thank you for your service as I know you continue to be busy as respiratory visits to hospital continue 

beyond the busy winter months. For those of you working outside of acute care, I also thank you for 

your efforts in keeping people with respiratory issues out of hospital. As always, a continued thank 

you goes out to the numerous RTSO volunteers and our new Executive Director, who put in hours 

upon hours working on being the voice for the Respiratory Therapy profession. 

Continuing with the idea of RRTs working together along the spectrum of respiratory care, we are 

nearing our second annual Leadership Summit, planned for June 6th. If you did not attend or have 

not had a chance to read about last year’s Summit, please do so by checking out our website, where 

you will find a few recaps of what we were able to experience; RTSO Airwaves also highlighted the 

summit proceedings in the Summer 2017 issue archived at https://www.rtso.ca/airwaves-summer- 

2017-b/. This year we are looking forward to again connecting RRT leaders from across the province 

to help us navigate our way through another year in our changing healthcare landscape. Our new 

office location at 18 Wynford Drive in Toronto was so graciously warmed by the participants from the 

Summit in 2017 that we look forward to welcoming new faces this year. You can find the preliminary 

agenda for this year’s summit on our website at https://www.rtso.ca/leadership-summit/. 

As a Northern Ontario resident, who also lives in a rural setting, I understand the frustrations of the 

need to travel in order to participate in events like this away from your own community. I am happy 

to remind you that we are accommodating alternative participation by utilizing Ontario Telemedicine 

Network (OTN) if joining face-to-face is not feasible. The networking and connection opportunity 

that comes with participation in this Leadership Summit will continue to prove its value, as over the 

last year the connections have demonstrated that together we are stronger. We look forward to you 

joining us --sharing insights, learning and navigating our future -- together. 


Executive Director’s 

Message 

Dilshad Moosa 

RRT CRE CTE MASc 

Spring signifies growth and rebirth, much like the RTSO is currently experiencing. We are transitioning 

and growing with your support to be the voice for RRT’s in Ontario. 

The health care system in Ontario is evolving and being attuned to this evolution is a key priority for our 

organization. As RRT’s we strive to be at the highest level of patient care and to this end our volunteer 

committees have worked selflessly to improve outcomes for our patients and fellow RRT’s. 

Through the work of our Community RT committee, we have successfully advocated for pay equity 

for RRT’s in primary care and RRT’s are now in the same pay band as other equivalent regulated 

health professionals. Advocacy related to recruitment and retention Improvements for primary care 

professionals continues. This strategy is aligned to the government of Ontario boosting access to 

primary care for people across the province. 

In 2017 there were 294 interprofessional care teams across Ontario delivering care to more than four 

million people. Ontario is investing $248.4 million over the next three years to support existing teams, 

including recruiting new staff and retaining current health care workers. In addition, the Ministry of 

Health and Long-Term Care (MOHLTC) is creating new care teams so that every region in Ontario has 

at least one team (Ministry of Health and Long Term Care, 2017). To this end it is important to “groom” 

professionals including RRT’s to promote the strength of an integrated model of interprofessional care. 

We are excited to have launched an RTSO Communication working group with representation from 

our various committees including: Farzad Refahi, Director Social Media; Shawna MacDonald, Director/ 

Editor RTSO Airwaves; Jesse Abramowitz, SRT, Research Committee; and Robyn Klages, Director 

Student Affairs Committee. The goal of the working group is to support an integrative communication 

strategy across portfolios that includes RRT’s in Ontario. We would like to encourage your participation 

by bringing forth topics that are relevant to you. We are excited to celebrate your achievements as well 

as to highlight issues of importance to RT practice. 

On May 1st the RTSO Executive will have an opportunity to gain some insight from David Lamb, 

Director MOHLTC Health Workforce Planning and Regulatory Affairs Division, about the current 

workforce planning initiative. We will be sharing and receiving advice on a variety of issues facing 

Respiratory Therapists practicing in Ontario. Please stay tuned as we keep you updated through our 

various communication channels. 

I would like to thank and acknowledge the Respiratory Therapy Leaders we are celebrating through this 

issue of Airwaves. As we continue to grow, we look forward to leveraging insights from you as coaches, 

mentors or sponsors to help build our profession to its best capacity. 

Reference: 

Ministry of Health and Long Term Care (2017, May 10). Newsroom. Retrieved from Government of 

Ontario: MoHLTC boosting access to primary care 


Update from the Lung Association on 

the Lung Health Advisory Council 

The Lung Health Advisory Council will provide provincially-based advice and recommendations on 

lung health to the Minister of Health and Long-Term Care to make improvements in lung health 

awareness, diagnosis, treatment and care. The longer-term goal of the Council will be to work 

towards the development and implementation of an Ontario Lung Health Action Plan that will 

provide a coordinated approach to the prevention of lung disease and the improvement of patient 

outcomes. 

The Lung Health Act (Bill 71), which calls for the establishment of the Council, names two permanent 

co-chairs as being representatives of The Lung Association – Ontario and the Ministry of Health and 

Long-Term Care. It also requires the Council to have at least one member that meets each of the 

following criteria: 

• Persons with lung disease 

• Informal caregivers of persons with lung disease 

• Respirologists, other physicians who specialize in lung health or family physicians 

• Respiratory therapists 

• Registered nurses with lung health expertise 

• Other professionals with expertise in the prevention or treatment of lung disease, such as 

pharmacists, physiotherapists or public health workers 

• Researchers in the field of lung health 

• Non-profit organizations with an interest in lung health 

Since the passing of the Lung Health Act, we have been working with the Ministry of Health and 

Long-Term Care on recommendations for candidates to fill the various positions on the Council. A 

final decision on the membership will be made by the Minister of Health and Long-Term Care, with 

formal approval by the Executive Council of Ontario. 

While we don’t yet know the final membership of the Council, we do know that we will need a broad 

base of expertise and support to complement its efforts. With that in mind, we anticipate additional 

opportunities to contribute through working groups and project-based initiatives. Additional 

information on volunteer opportunities such as these will be forthcoming. 

Thank you again for your interest. We look forward to providing additional information on The Lung 

Health Advisory Council as it becomes available. 

In the meantime, if you have further questions, please contact Eric Pegolo, Provincial Manager, 

Government Relations and Public Affairs at epegolo@lungontario.ca, or Peter Glazier, Vice President, 

Marketing, Development and Public Affairs at pglazier@lungontario.ca. 


Editorial 

Shawna MacDonald 

RRT FCSRT 

Happy Spring! 

The healthcare system is changing, and so is the RTSO. Over the next few issues, we’ll be revising 

the look and feel of RTSO Airwaves. We hope to bring you a fresh, modern, more polished-looking 

newsletter that continues to support and celebrate the people, places, practice, products and 

profession of Respiratory Therapy in Ontario. While our focus is not scientific publications, the RTSO 

is receptive to including these pieces to recognize and highlight the great work being done across 

the province. With growth and quality improvement in mind, we’d also like to move forward with 

recruiting an Editorial Board. If you are interested, please refer to the next page for details; put forth 

an expression of interest to office@rtso.ca and we’ll be in touch. 

The focus of this issue is on leadership, highlighting our upcoming RTSO Leadership Summit and 

connecting with RTs across the province about what makes a good leader and what leadership 

means to them. In addition to our regular features, we also bring you an informative article on 

e-cigarettes as well as a fascinating feature exploring the technology behind bitcoin and electronic 

healthcare records. 

The RTSO continues to work diligently on your behalf -- to advocate, inform, educate, research and 

communicate – to lead Ontario RTs into a bright and healthy future. You can read about the great 

work our team of volunteers accomplishes in the President’s Message, Executive Director Update 

and in each Committee Report. You’ll notice that the RTSO promotes the role and interests of the 

profession across all sectors of our healthcare system! It is your membership that grows our voice in 

advocacy to move the profession forward through Ontario’s health care transformation agenda. 

As always, we’d love to hear from you! Share feedback, commentary or your experiences, challenges 

or stories with us. Let’s foster our collaborative culture to further inspire and spark change! 


RTSO Editorial Board recruitment 

The RTSO is seeking members to join an RTSO Airwaves Editorial Board. 

If you are a Respiratory Therapist (RRT, GRT) currently practicing in Ontario, an RTSO member who 

is highly regarded amongst your peers and you possess a strong academic aptitude, we would love 

to hear from you! 

This is a volunteer (unpaid) position for a minimum one-year term. 

This volunteer opportunity will: 

1. Support your personal brand 

2. Develop editorial skills 

3. Build your network 

4. Provide an opportunity to give back to our RRT community 

The role of the editorial board is to advise and support the RTSO Airwaves Editor and Production 

Specialist. Functions may include but are not limited to: 

• Identifying topics and advising on direction for our quarterly newsletter 

• Providing feedback and making suggestions for subject matter and/or potential contributors 

• Provide content by occasionally contributing an editorial, article or other content 

• Approaching potential contributors 

• Reviewing content as received, providing second opinions on submissions 

• Endorsing the newsletter within the profession and with RTSO stakeholders 

Contact office@rtso.ca if you are interested in exploring this opportunity. 


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Committee Reports 

Community RT 

Sylvia Mortimer 

BSc RRT CRE and 

Sara Han 

BSc RRT CRE 

Our Community RT Committee is continuing our advocacy journey by focusing on a few initiatives 

as well as supporting ongoing efforts. As we have successfully advocated for our profession to 

be placed on a compensation level equivalent to other regulated health care professionals in 

primary care, the RTSO has been invited to a provincial committee led by the Association of Family 

Health Teams of Ontario (AFHTO), Association of Ontario Health Centres (AOHC) and the Nurse 

Practitioners Association of Ontario (NPAO), continuing to advocate for recruitment and retention 

to the Ministry of Health and Long-Term Care. As part of this work, they have asked each profession 

to gather information from their members working in primary care and specifically issues they face 

in regards to recruitment and retention. The Community RT Committee has been working with the 

RTSO Research Committee to develop the contents of a survey, which, once approved, will be sent 

out by the RTSO. 

As Ontario’s Patients First Act continues to be implemented in practice, one of the focuses of this 

Act is to improve access to home and community care. Although there are many RRTs who work for 

CCACs, home care companies or are a part of hospital outreach teams, care provided is sporadic 

and not uniform across Local Health Integration Networks (LHINs). There is also a need for more 

RRT services taking care of our elderly and providing support to those who need chronic mechanical 

ventilation, complex airways care and long term oxygen therapy. As we did with our primary care 

advocacy work, our Committee has developed a home care task force which will develop a generic 

job description for the home care RRT highlighting our full scope of practice and we’ll develop a 

position paper that can be used by the RTSO for advocacy to various organizations such as the 

Ministry of Health and Long Term Care and LHINs. 

There is a lot of work that has been done already, but there remains much to be accomplished. We 

cannot do this work without your support and input. Please don’t hesitate to be in touch through the 

office@rtso.ca to let us know about issues or examples relative to your practice in Ontario! 

Submitted by: Sara Han BSc RRT CRE 

Co-Chair, RTSO Community Respiratory Therapy Committee 


Research 


Marianne Ng 

RRT BSc MHSM and 

Louise Chartrand 

RRT PhD 

Spring is here! It is the season of rebirth, renewal and regrowth. 

Starting with “renewal”, have you completed your RTSO membership renewal for 2018-19? By 

being a member, you are supporting the growth of the RT profession, and collectively we are better 

able to meet patients’ needs. 

For “rebirth”, up and coming are some exciting media utilization strategies for the RTSO. We will 

be merging the RTSO Research Committee (RC) Facebook© page with the main RTSO page, in an 

effort to streamline information resources. With the fast pace of technological growth in today’s 

environment, our need to exam how to improve efficiency and effectiveness in our processes and 

practices is inevitable. The RC will continue to focus on promoting education relating to quality 

improvement, research and evidence based practices. 

For “regrowth”, Respiratory Therapy is a profession that is continually growing and evolving. In 

primary care, the RC is supporting the Community RT Committee in gathering feedback from both 

primary care RRTs and other stakeholders, with the intent of utilizing this information to describe 

current state and gaps, which will then guide future RTSO advocacy work. 

Spring is also a great time to start an inventory of opportunities for poster presentations and abstract 

submissions over the next 12 months. A quick tip is to add these into your calendar with alarm 

reminders set for one to two months before a deadline, and to schedule a two hour meeting with 

yourself to complete the work. You don’t want to miss the opportunity to share and showcase your 

research projects! If you have any questions or you need any support in putting together an abstract 

or a poster, please do not hesitate to reach out to the Research Committee either through email or 

our Facebook page. 

Congratulations to Louise Chartrand RRT PhD, who successfully defended her doctorate “Between 

life and death: An Anthropology of the ventilator” on March 16, 2018 at the University of Ottawa. 

We look forward to reading about Louise’s experience in the Fall 2018 issue of RTSO Airwaves. 


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What does Bitcoin have 

to do with healthcare? 

Jesse Abramowitz SRT 

email: jesseabramowitz@hotmail.com 

Honestly, not much…I really just wanted to 

get your attention. However, dig deeper and 

you will see the technology behind bitcoin, 

blockchain. We are moving really fast, let’s slow 

this down and go back to what bitcoin is first. 

If you know feel free to skip ahead; if not, your 

world is about to change…buckle up. 

Anyway, the value of Bitcoin is a network of 

computers that run on a certain protocol. Just a 

set of rules and the rules allow it to maintain a 

ledger, simple information, such as ‘this person 

has this much bitcoin’. So why is that important? 

What is the big deal? Why does one cost 

around $10 000? Many reasons, one being that 

this information is maintained securely without 

any centralized authority, anyone can see the 

ledger and anyone can update the ledger[ 1 ]. 

The idea that anyone can update the 

information and you don’t have to trust these 

updaters (nodes) is something called byzantine 

fault tolerance and it is done in a fascinating 

way. It is done through a mix of technology, 

game theory and economics. 

Let’s start with the economics. We have had 

peer to peer networks before. I am sure most 

of you have used torrents[ 2 ] or Skype[ 3 ]? Well, 

those are peer to peer networks; (although 

Skype has moved to master nodes) the 

only problem is that after someone torrents 

something they have no incentive to keep 

“seeding”, allowing others to download from 

them. Bitcoin solves this by offering these 

nodes (in this case called miners) an incentive 

for maintaining the ledger. That incentive is 

bitcoin[ 1 ] 

So next comes 

game theory 

-- how do you 

maintain a 

decentralized 

ledger while you don’t trust the nodes? How 

to achieve byzantine fault tolerance? This one 

is more complex as it involves solving a giant 

math problem that is hard to solve one way but 

easy to check to make sure it is correct. This is 

the backbone of most of the cryptography we 

use today. This math problem, called a hash, 

is also why bitcoin is immutable (unable to be 

changed, set in stone) because the complex 

math problems would have to be redone 

for anyone to change them (which is next to 

impossible). 

Finally, the technology interestingly is the most 

buzz-worthy word of anything here, but is also 

the most boring part. It is called blockchain. 

Blockchain is a linked list…pretty much a way 

for a computer to organize and search data. 

This is not new to bitcoin, it has been around 

since the 1950s[ 4 ] and it is used by git. 

If I explained it properly, you have a basic idea 

and most likely you are asking, “Ok, so you can 

decentralize a ledger, store it in an immutable 

fashion on a self-propagating network…how 

does this relate to healthcare?” The answer is: 

It doesn’t, yet… 

Enter Ethereum. Ethereum is a network similar 

to Bitcoin with the token aspect called Ether[ 5 ] 

(yes, it is funny when you say you can pay for 

things in Ether). However, where Ethereum 

differs from bitcoin is really in these questions, 

“If we can send a ledger to this network, can 


What does Bitcoin have to do with Healthcare? 

we send Code? Can we send files?” For the 

first two yes, the third not so much; however, 

there are hacks to fix that (which I can get into, 

just email me…it is a little too high level for this 

article). So, I am going to do something here 

that I hate and that every biology teacher has 

done to me since preschool: I am going to lie 

to make things simpler. Yes, Ethereum can hold 

all your data *wink*. 

Now we have a network where anyone can 

maintain it, it is secure, immutable, and 

facilitates the transaction of data from one 

party to another. 

Hopefully this is starting to come together. 

Anyone can access this network but the 

information on the network is more secure than 

any technology we have today. 

Yes…this is for electronic medical records 

(EMR)! A patient can hold access to their own 

medical files, just access to those medical 

files; the medical files would be stored on this 

network (not really today but I am lying to you 

to make it simpler… again, email me if you are 

more curious). Then as they move from doctor 

to doctor they can grant the doctor access to 

view and update their files, then revoke this 

privilege[ 6 ]. (Conflict of interest warning: The 

citation I used is a whitepaper for a company 

I work for. I chose to use it because I helped 

write it and know exactly what is in it. I disclose 

that I do have a monetary incentive.) 

The access is granted by a user’s private key 

that will have to be held by the patient. Thus, 

there are multiple points of failure to the 

network, and unlike our current system, a hack 

can only happen at the individual level; there is 

no honeypot for hackers, which happens all the 

time (most recently Target, Uber, Equifax). 

This is all very fascinating but it is time to 

push this farther. Currently, companies like 

IMS take your data, anonymize it and sell 

it to pharmaceutical companies. Because 

this is a painstaking process which is also 

borderline unethical, it is very hard for the 

average researcher to get this data[ 6 ]. Since 

patients would have access to their data, they 

can choose to sell it. It would be anonymized 

and then encrypted into a smart contract that 

governs access. Think of a smart contract as 

‘rules to how the information can be accessed’. 

The access can be granted for a small fee, 

which can then be split between the patients’ 

who gave the data (to incentivize them to share 

it) and the company maintaining the software. 

Imagine not only a patient being able to 

hold their complete data securely but also a 

researcher able to gain large swaths of data 

for nominal fees. This can go farther than 

research even…imagine if a doctor had to 

choose between two drugs, A and B; both 

drugs performed well but there is no study 

for a patient with the specific pathologies of 

said patient. The doctor hops on the software, 

find a large sample size of data for patients 

with similar age, pathologies, etc. and sees 

the outcomes of patients after they have been 

given both drugs. The doctor can then make a 

more informed and individualized choice. This 

isn’t the only information the doctor would use, 

but rather a tool to help guide him/her. 

Now, full disclosure, I started learning how to 

code in this language, called solidity, half a 

year ago and I work part time for a healthcare 

blockchain Startup. It is fun we spend time 

debating things like ‘what if a patient is 

unconscious…how do we let them give up 

access and maintain security?’ or things like 

‘what if a patient loses their keys?’ There are 

answers, not all perfect, but better than the 

system we have now. Feel free to email me to 

ask about them. 

There are many companies that are attempting 

this. Check the link below that is in fact opensourced, 

where I am also a contributor: https:// 

github.com/acoravos/healthcare-blockchains. 

In conclusion, no you won’t see this tomorrow, 

but in 5 years, 10 years who knows? All I know 

is that you will see it one day and it will change 

so much. 


What does Bitcoin have to do with Healthcare? 

Glossary of Terms 

Term 

Bitcoin 

Nodes 

Miners 

Blockchain 

Seeding 

Cryptography 

Hash 

Git 

Ethereum 

Description 

A cryptocurrency payment system, often referred to as the currency of the 

internet. 

Either a telecommunications redistribution point or a communication endpoint. 

Miners are Bitcoin network participants that perform extra tasks, making mining 

a record-keeping service done through the use of computer processing. While 

traditional money is created through banks, bitcoins are “mined” by bitcoin 

miners who chronologically order transactions by including them in the bitcoin 

blocks they find, preventing a bitcoin user from spending the same bitcoin twice. 

The technology that allows for the storing and organization of the bitcoin ledger; 

the ledger is public and records bitcoin transactions. 

In file sharing between peers, seeding is the uploading of already downloaded 

content for others to download from. 

The practice and study of secure communication in the presence of third parties, 

to prevent third parties or the public from reading private messages or viewing 

private transactions. 

From Wikipedia, the term hash offers a natural analogy with its non-technical 

meaning (to “chop” or “make a mess” out of something), given how hash 

functions scramble their input data to derive their output. A hash function is any 

function that can be used to map data of arbitrary size to data of fixed size, used 

to ensure integrity of transmitted data. A hash value can be used to uniquely 

identify secret information. 

Git is a coding term and it is the most commonly used version control system 

today. Git is a distributed version control system, meaning your local copy of 

code is a complete version control repository, making it easy to work offline or 

remotely. 

A Blockchain App platform: https://ethereum.org 

References 

1. Antonopoulos, A. (n.d.). Mastering Bitcoin. Retrieved 2018/03/30 from https://github.com/ 

bitcoinbook 

2. Cohen, B. (n.d.). Retrieved 2018/03/30 from http://www.bittorrent.org/beps/bep_0003.html 

3. An interview with Jaan Tallinn, co-founder and author of Skype [2014, December 01]. Retrieved 

2018/03/30 from https://web.archive.org/web/20141207051233/http://affairstoday.co.uk/ 

interview-jaan-tallinn-co-founder-author-skype/ 

4. Black, Paul E. (2004); Pieterse, Vreda; Black, Paul E., eds. “linked list”. Dictionary of Algorithms 

and Data Structures. National Institute of Standards and Technology. 

5. Buterin, V. (n.d.). Ethereum/wiki. Retrieved 2018/03/30 from https://github.com/ethereum/wiki/ 

wiki/White-Paper 

6. Healthbase whitepaper draft. (n.d.). Retrieved 2018/03/30 from https://docs.google.com/ 

document/d/1serWbl5HmlbcjTAggq7fcYBQE6V9ouPtjbp7bmlgT78/edit?usp=sharing 



Leadership 

Sue Martin 

RRT MA FCSRT 

ARE YOU A HOSPITAL-BASED LEADER? 

If you are a leader of a Respiratory Therapy (RT) service (such as manager, director, charge therapist, 

educator, professional practice leader, etc.) or you are a Respiratory Therapist in a leadership 

position within a hospital, or you plan to become a leader in a hospital, then this day is for you! 

RTSO Leadership Summit 2018 

We would like to invite you to attend the Leadership Summit 2018 sponsored by the RTSO on 

Wednesday, June 6th from 9 a.m. to 3 p.m. at 18 Wynford Dr., 4th Floor, Toronto. Complementary 

registration is available for in person or online OTN attendance. Pre-registration is required as inperson 

seating is limited, where lunch and refreshments will be provided. Please follow the link 

for online registration and to view the preliminary agenda: https://www.rtso.ca/leadership-summit/. 

OTN registrants will receive connection information prior to the Summit. 

The RTSO believes the changing health care system is providing opportunities for RTs to adapt, 

evolve and continue to make a difference. Through this summit we plan to: 

• Share information related to health system transformation and Patients First 

implementation 

• Showcase products and services related to RT practice 

• Provide a networking opportunity for hospital-based Respiratory Therapy leaders to 

share issues, experiences and lessons learned 

• Solicit participants’ input to inform the RTSO’s supporting role related to advocacy, 

member education and committee work 

The agenda for the day will include the following topics, which we are excited to hear about through 

compelling presentations and discussion: 

• Lung Health Strategy Update: a Provincial Perspective 

• How Leaders Can Prepare for New Trends in Lung Health (Biologic Administration) 

• Pulmonary Diagnostic Testing: Advocating for Quality and Impact on Diagnosis and 

Treatment Outcomes 

• Corporate Sponsor Lightening Round 

• The Ontario Lung Association - New Tools to Support Best Practice 


• Acute Care Bed Utilization: Transitions from Hospital to Long-Term Care and/or 

Homecare 

• Workforce Planning In Ontario: Hospital-Based Opportunities for Respiratory Therapists 

Relative to Role Description 

• The Design and Development of an Advanced Practice Respiratory Therapist 

• College of Respiratory Therapists of Ontario (CRTO) Leadership Updates 

A block of rooms has been set aside at The Don Valley Inn and Suites at a special rate. Individuals 

will be responsible for making their own reservations by calling 1-877-474-6835 or (416) 449-4111. 

We look forward to your participation in this opportunity to meet and greet colleagues from across 

the province, as we think this will lead to some significant plans and outcomes for RRTs and our 

patients! 

For further information please contact either Sue Martin smartin@rtso.ca or Nancy Garvey RRT 

MAppSc, RTSO Interim Project Advisor ngarvey@rtso.ca 

We look forward to seeing you at the Summit! 

Sue Martin RRT MA FCSRT; Chair, RTSO Hospital Leadership Committee 

Kaela Hilderley RRT CRE BEdAEd; RTSO President 

“Leadership is about impact, 

influence, and inspiration. Impact 

involves getting results, influence 

is about spreading the passion you 

have for your work, and you have 

to inspire...” -Robin S. Sharma 


RTSO Leadership Summit 

Wednesday, June 6, 2018 

0900 – 1500 (Refreshments and registration available at 0830) 

18 Wynford Dr., 4th Floor, Toronto 

The RTSO is bringing together respiratory therapy leaders or their designate from hospitals 

across Ontario. The changing health care system is providing opportunities for respiratory 

therapists to adapt and continue to make a difference in patient care. Through this forum, we 

intend to: 

• Share information related to health system transformation and Patients First 

implementation 

• Showcase products and services related to respiratory therapy practice 

• Provide a networking opportunity for hospital-based respiratory therapy leaders to 

share issues, experiences, and lessons learned. 

• Solicit participants input to inform the RTSO’s supporting role related to advocacy, 

member education and committee work. 

Complementary registration is available for in person or online OTN attendance. 

Pre-registration is required as in person seating is limited. OTN subscribers will be sent 

connection information. 

A block of rooms has been set aside at The Don Valley Inn and Suites at a special rate for the 

night of June 5th. Individuals will be responsible for making their own reservations by calling 1- 

877-474-6835 or (416) 449-4111 

https://lnkd.in/eE6nCbX 


Time 

Topic 

8:30 – 9:00 Refreshments and Registration 

Opening remarks – Welcome and Overview of the Day 

Session Chair: Sue Martin RRT MA FCSRT RTSO Director and Chair, Hospital 

9:00 

Leadership Committee with Kaela Hilderley RRT CRE BEdAEd, RTSO President 

RTSO Update: Dilshad Moosa RRT CRE CTE, MASc, Executive Director, RTSO 

Lung Health Strategy Update: a Provincial Perspective 

9:30 

George Habib, President and CEO, The Lung Association - Ontario 

How Leaders Can Prepare for New Trends in Lung Health (Biologic 

Administration) 

9:45 

Madonna Ferrone RRT CRE, Program Coordinator, Asthma Research Group Inc., 

Windsor ON 

10:15 Break 

Pulmonary Diagnostic Testing: Advocating for Quality and Impact on Diagnosis 

and Treatment Outcomes 

Tony Kajnar RRT-AA RCPT(P), Senior Therapist, Pulmonary Function Lab, Sault Area 

10:30 

Hospital 

• Review updates and challenges with diagnostic standards in hospital and 

community organizations 

• Quality assurance measures to improve diagnostic accuracy 

11:00 Corporate Sponsor Lightening Round 

12:00 Lunch 

The Lung Association - Ontario Topic Title TBD 

Jennifer MacKinnon RRT, Manager, Provider Education Program, The Lung 

12:45 

Association - Ontario 

• New tools to support best practice 

Acute Care Bed Utilization: Transitions from Hospital to Long-Term Care and/or 

Homecare 

13:10 

Mika Nonoyama RRT PhD, Assistant Professor Health Sciences, University of Ontario 

Institute of Technology 

Workforce Planning In Ontario: Hospital-based Opportunities for Respiratory 

Therapists Relative to Role Description 

Paula Smith RRT CRE COPD Pathway Lead, Orillia-Soldiers Memorial Hospital 

• Provide a common starting point for the description of quality outcomes-based 

13:40 

respiratory therapist practice in any hospital in Ontario to be shared with Local 

Health Integration Network and hospital CEOs and hospital management staff. 

• Additional skills based on sector such as Primary Care, Home Care, Pulmonary 

Rehabilitation 

The Design and development of an advanced practice respiratory therapist 

Speaker to be confirmed 

14:10 

Objective: 

• Identify processes and challenges on the change this role provides for patient 

care Provide key competencies for advanced practice RRT 

Professional Association Updates: 

• College for Respiratory Therapists of Ontario (CRTO) 

14:40 

• Canadian Society for Respiratory Therapists (CSRT) 

Speakers to be confirmed 

15:00 Wrap up and adjourn 


ON 

FORMULARY 

all provinces and territories 

(except BC) 

Special authorization 

OFEV has been shown to: 2 

SLOW FVC decline 

REDUCE acute exacerbations * 

OFEV significantly reduced the annual rate 

of decline in FVC over 1 year vs. placebo 2 

OFEV FVC -113.6 mL/year 

placebo FVC -223.5 mL/year 

Difference: 109.9 mL/year (p

RTSO CORPORATE MEMBERSHIP PROGRAM 

The RTSO provides the opportunity to showcase your company and products through various 

options that offer you the best exposure to Respiratory Therapists across Ontario. 

With over 3000 Registered Respiratory Therapists in the Province of Ontario, the RTSO 

reaches out to our membership and beyond. 

MEMBERSHIP BENEFITS: 

The Corporate Membership program for 2018 is $2,500 plus HST (total $2,825) per 12month 

period includes: 

• One full page interior advertisement in our quarterly Airwaves editorial 

• Corporate sponsor participation in the annual Leadership Summit 

• Leadership Network contacts updated on a regular basis (courtesy part of program) 

• One 30 Day Job Posting (Web-site, LinkedIn, e-blast) 

• Logo posting and RTSO web link on the RTSO website for one year 

• A Product launch or service information e-blast to members 

• Corporate sponsor acknowledgement as relevant, i.e. during RT week emails/postings, 

presentations to hospital groups, etc. (courtesy part of program) 

• Preferred CME opportunities via Ontario Telemedicine Network, Live Events (CME not 

included in the cost) 

• Reduced rates for booth participation at our annual conference 

• Real World research opportunities through our RRT research network 

To Register…. https://www.rtso.ca/corporate-package-registration/ 

For more information contact: 

Dilshad Moosa BSc RRT CRE MASc 

RTSO Executive Director 

18 Wynford Drive, Suite 405 

Toronto, ON M3C 0K8 

Tel: 647-729-2727 

Toll Free: 1-855-297-3089 

office@rtso.ca 

dmoosa@rtso.ca 

www.rtso.ca 


Partnering 

together 

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outcomes 

Working with Ontario 

RT’s for over 25 years 

Are you thinking about a 

career in respiratory care? 

Tailored COPD management programs 

Sleep apnea treatment programs 

FreshAire TM Newsletter for RRT’s 

Accredited by Accreditation Canada 

More than 100 clinics across the country 

www.vitalaire.ca 

call 1-800-567-0202 

or visit www.vitalaire.ca

Do you have what it takes to be a leader? 

Submitted by 

Shawna MacDonald RRT FCSRT 

Are Respiratory Therapists healthcare’s best kept 

secret? Our diverse, extensive scope of practice 

provides a broad, unique healthcare perspective, 

positioning us to anticipate, adapt, evolve 

and thrive through healthcare transformation. 

We have ample opportunity to demonstrate 

leadership and initiative as well-rounded 

professionals with many facets -- education, 

clinical practice, research, management, acute 

care, complex care, rehabilitation, chronic 

disease management, preventative medicine, 

and the list goes on (Marshall, 2015). 

So what makes a leader? If you think about 

a memorable leader, most quickly recall 

someone with charisma and character, someone 

passionate about the work they do who then 

sparked that passion in others by using their 

influence. Someone with the ability to make 

others feel important, valued and appreciated is 

a leader, too. Leaders don’t need to be in formal 

positions to lead…they just need people to 

believe in them or their philosophy or vision. 

Does a leader need followers, or can someone 

working alone be a leader? A leader can be 

anyone navigating through unchartered territory 

to create a new path or a new product or service. 

“How many entrepreneurs would be where 

they are today had they waited for others to 

get onboard the train before it left the station?” 

(McKisson, 2016). Respiratory Therapists are 

uniquely positioned throughout the healthcare 

system to uncover unmet needs and through 

our knowledge and scope of practice can 

contribute to satisfy those needs. There are 

pockets of amazing trail-blazing RTs leading 

new care pathways, reducing unnecessary 

and costly hospital readmissions and focusing 

on preventative care. There are leading RTs 

providing more affordable, convenient, patientcentered 

primary care in community-based 

settings. I am sure you can all think of at least 

one example where care could have been 

improved, or where you noticed a gap, and 

perhaps there is an innovative role to develop 

that an RT’s can fulfill! How about empowering 

RTs to play a greater role in navigating the 

healthcare system and improving patient 

experience? 

There are so many different leadership styles 

and types of leaders. Google leadership and 

you get 859,000,000 hits. Within Ontario we 

have excellent programs to support leaders. 

Leadership development programs such as 

Health Quality Ontario’s Improving & Driving 

Excellence Across Sectors (IDEAS) program, or 

the Emerging Health Leaders program at the 

DeGroote Health Leadership Academy out of 

McMaster, are two great examples of offerings 

that will challenge your thinking and help you 

gain knowledge and practical skills that will 

improve your leadership ability. There are so 

many more out there. 

When pondering leadership, this Jane Goodall 

(n.d.) quote comes to mind: “You cannot get 

through a single day without having an impact 

on the world around you.”. We are ALL leaders. 

We exert influence around us. Aligned with the 

GROW OM model from the College of Respiratory 

Therapists of Ontario (2014), being a Leader is 

one of the domains of a well-rounded therapist; 

it states, 

“A Leader promotes ethical behaviour 

through their own example. They are 


Do You Have What it Takes to be a Leader? 

strategic thinkers who execute and followthrough 

on new initiatives. Leaders are 

continuously looking for opportunities 

to improve and take action to create 

change. They promote team-building and 

understanding that leadership occurs at all 

professional levels within the health care 

system.” 

Any one of us can develop our leadership 

capacity. Some people have an innate gift for 

it, and some have to work at it. For those of us 

that have to work for it, I assure you that given 

the right situation, one that suits your strengths 

and ignites your passion, you will naturally lead 

and be energized by the experience (Elmore, 

2014). 

According to Giesbrecht (2013, p.9), “formal 

mentoring programs are one tool that successful 

leaders and organizations are using to improve 

performance, retain talent, and shift culture.” 

Find a coach or mentor if you are a new formal 

or informal leader. Determining the most 

appropriate approach to include others in 

decision-making takes skill, experience and a 

balance of confident authority and delegation 

(Thompson, 2011), so it is a blessing to have 

someone to guide you as you grow. 

Play on your strengths, your goals, what makes 

you excited and sparks your passion enough 

that it becomes tangible and contagious to 

those around you. Ask questions to understand. 

Gather multiple perspectives. Stay centred, work 

at developing yourself and evolving over time, 

and know that you have an amazing network of 

RRTs and other healthcare professionals that can 

help you grow your leadership capacity! 

References 

College of Respiratory Therapists of Ontario 

(2014). GROW OM Ongoing Professional 

Growth: Leader. Retrieved 2018/04/04 from 

http://www.crto.on.ca/pdf/GROW/Leader.pdf 

Elmore, T. (2014). Is Everyone a Leader? 

Retrieved 2018/04/05 from https:// 

www.psychologytoday.com/us/blog/ 

artificial-maturity/201402/is-everyoneleader 

Giesbrecht, M. (2013). Creating a Culture of 

Mentorship and Support. Canadian Journal 

of Respiratory Therapy, Fall 2013,Vol 49 (3) 

Marshall, S.G. (2015). Raising Professional 

Presence Through Team Leadership in the 

Critical Care Setting. Respiratory Care 

March 2015, 60 (3) 471-472; DOI: https://doi. 

org/10.4187/respcare.03978 

McKisson, D. (2016). Why being a leader 

can mean going it alone. Retrieved online 

2018/04/05 from https://www.inc.com/ 

dustin-mckissen/what-do-you-call-a-leaderwithout-followers-you-call-them-a-leader.html 

Thompson, L. (2011). Making the team: A guide 

for managers (4th ed.). Toronto, ON: 

Pearson Education. 

Links 

The Emerging Health Leaders program 

at the DeGroote Health Leadership 

Academy, McMaster University https:// 

healthleadershipacademy.ca/emerging-healthleaders-program/ 

Health Quality Ontario IDEAS (Improving & 

Driving Excellence Across Sectors) program 

http://www.hqontario.ca/Quality-Improvement/E- 

Learning-and-Events/IDEAS 


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US/CO/0116/0049

Practical Leadership Advice 

Submitted by: Nancy Garvey RRT CRE MASc 

Leadership principles can sometimes be very 

abstract and vague. Along my respiratory 

therapy journey, I’ve had the fortune to come 

across a book, Lincoln on Leadership: Executive 

Strategies for Tough Times by Donald T. Phillips, 

that provides practical advice on leadership 

based on the philosophies and approach of 

Abraham Lincoln, President of the United States 

during the Civil War, one of the most challenging 

times in American history. I hope that sharing 

the key elements of the leadership principles 

Phillips describes will be helpful and inspire my 

respiratory therapy colleagues to be the best 

leaders they can be! 

1. People 

• Get out of the office and circulate 

among the “troops” 

• Build strong alliances 

• Persuade rather than coerce 

2. Character 

• Honesty and integrity are the best 

practices 

• Never act out of vengeance or spite 

• Have the courage to handle unjust 

criticism 

• Be a master of paradox 

3. Endeavor 

• Exercise a strong hand -- be decisive 

• Lead by being led 

• Set goals and be results-oriented 

• Keep searching until you find your 

“Grant” (leading Union army General 

in the Civil War who later became 

President of the U.S.) 

• Encourage innovation 

4. Communication 

• Master the art of public speaking 

• Influence people through 

conversation and storytelling 

• Preach a vision and continually 

reaffirm it 

Leadership in Respiratory Therapy has made and 

continues to enable all of us to make a significant 

difference in our patients’ lives! 

(The following is a disclaimer for the ad appearing on page 20) 

Clinical use: 

Should not be used in patients under 18 years of age. 

Contraindications: 

• Patients with known hypersensitivity to peanut or soya 

• Pregnancy 

Most serious warnings and precautions: 

Gastrointestinal perforations: Cases reported in clinical studies and postmarketing 

period; many post-marketing events were serious and some 

have resulted in fatal outcomes. Use OFEV in patients with a known risk 

of gastrointestinal perforation only if the anticipated benefit outweighs 

the potential risk. Permanently discontinue OFEV in patients who develop 

gastrointestinal perforation. 

Hemorrhage: Serious and fatal bleeding events reported in clinical trials 

and post-marketing surveillance systems. Use OFEV in patients with known 

risk of bleeding only if the anticipated benefit outweighs the potential risk. 

Other relevant warnings and precautions: 

• Risk of diarrhea, nausea and vomiting 

• Risk of weight loss; monitor weight 

• Should be taken with food 

• Use caution when treating patients with higher cardiovascular risk 

including known coronary artery disease 

• Not recommended in patients with moderate or severe hepatic impairment 

• Drug-induced liver injury 

• Liver enzyme elevations 

• Measure systemic blood pressure, hepatic transaminase and bilirubin levels 

before initiating treatment and periodically after as clinically indicated 

• Based on mechanism of action: potential for increased risk of 

thromboembolic events and impaired wound healing 

• Women: use adequate contraception during OFEV treatment and for at 

least 3 months after the last dose of OFEV 

• Not recommended for use in nursing women or in children and adolescents 

• Safety data for black patients are limited 

For more information: 

Please consult the Product Monograph at www.boehringer-ingelheim. ca/ 

sites/ca/files/documents/ofevpmen.pdf for important information relating 

to adverse reactions, drug interactions and dosing information which have 

not been discussed in this piece. 

The Product Monograph is also available by calling 1-800-263-5103 x 84633. 

References: 1. Raghu G, et al. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline: Treatment of 

Idiopathic Pulmonary Fibrosis: An Update of the 2011 Clinical Practice Guideline. Am J Respir Crit Care 

Med 2015;192:e3-e19. 2. OFEV® (nintedanib) Product Monograph. Boehringer Ingelheim (Canada) Ltd., 

October 24, 2017. 

© 2018 Boehringer Ingelheim (Canada) Ltd. All rights reserved. 

OFEV® is a registered trademark of Boehringer 

Ingelheim International GmbH, used under license. 

POWER IN IPF TREATMENT 

RTSO Airwaves Spring 2018 26 

TBIIPF 20148E PI S03.indd 1 

2/5/18 4:46 PM

We asked RT’s across the province about 

leadership and what it means to them, 

or what makes a good leader. 

Here are some responses: 

A leader is… 

Kendra Mantha, RRT BSc., Hamilton Health Sciences: 

A good leader is passionate about the profession and supportive of their team. Being present is 

imperative … actively listening, building relationships, coaching and mentoring, and ultimately 

encouraging team engagement, collaboration, and resourcefulness. 

Luxsana, SRT: 

A leader is someone that takes initiative and has a goal they are trying to reach. They inspire you to 

do the best you can and encourage you along the way. 

Jamelyn O’Donnell, SRT: 

A good leader is someone people look up to, learn from and flourish with. He or she does not 

demand success but rather uses morale and teamwork to inspire and motivate others to help 

execute a common goal. 

Meah Cote, SRT: 

A leader can be described as someone who not only motivates and encourages success, but works 

synergistically with the team to achieve their goal. They are reliable, approachable, and are a vital 

member to a successful team. 

About leadership… 

Kaela Hilderley RRT CRE BEdAEd: 

Just because an RRT isn’t in a formal position as ‘department head’ or ‘executive director’ doesn’t 

mean they aren’t a leader in a different way. Many RRTs are leaders because of the work that they do, 

but don’t have the title to go with it. RRTs are doing things outside of the norm of working in acute 

care, and are leaders in the sense that they are doing new things for the profession that they weren’t 

necessarily taught in school. 

Kathryn Runstedler SRT: 

To set an idea into motion is not determined solely by the effort of one, but is determined by how 

one inspires and motivates a team…that’s what it means to be a leader. 


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SAVE-THE-DATE! 

SATURDAY, AUGUST11, 2018 

REGISTRATION 

OPENS 

APRIL 20 

In support of 

The RTSO Education & Awards Fund and The HPC Dan Yamasaki Fund

New Minister of Health and Long-Term Care: Dr. Helena Jaczek 

A warm welcome to the newly appointed Health Minister, the 

honorable Dr. Helena Jaczek. Dr. Jaczek currently serves as Minster of 

Health and Long-Term Care, as well as Chair of Cabinet. 

She has previously served as Minister of Community and Social 

Services, as well as Parliamentary Assistant to the Minster of Health 

and Long-Term Care, the Minister of the Environment and the Minister 

of Health Promotion. 

Dr. Jaczek has also served on the Standing Committee on Social Policy, 

as Vice-Chair of the Standing Committee on General Government, the 

Select Committee on Mental Health and Addictions, and the Standing 

Committee on Finance and Economic Affairs. 

For more information, please visit: http://www.health.gov.on.ca/en/common/ministry/minister.aspx 

Former Ontario Health Minister Dr. Eric Hoskins announced his 

resignation as minister on February 26, 2018. 

Dr. Hoskins will chair a federal government advisory council with a 

goal of creating a national pharmacare plan. The council’s mandate 

includes consultation with a wide range of stakeholders, provinces, 

territories, indigenous groups and experts, which will provide 

the government with options on how to proceed with a national 

pharmacare program. 

Read more at https://globalnews.ca/news/4048563/eric-hoskinsresigns/ 


NEWS 

Ministry of Finance 

Delivering a Plan for Care and Opportunity 

Ontario Continuing to Invest in Health Care, Child Care and Mental Health 

March 28, 2018 4:00 P.M. 

Today the government released the 2018 Budget, which includes significant new investments 

in health care, child care, home care and mental health, and new measures to create more job 

opportunities for people across the province. The Budget also focuses on initiatives that make life 

more affordable and provide more financial security during a time of rapid economic change. 

Ontario’s economy is getting stronger, with the unemployment rate at its lowest in almost two 

decades. Yet between the rising cost of living and stable, long-term jobs becoming harder to find, 

many people are struggling to take care of themselves and their families. As the changing economy 

widens the gaps within our society, the government has a plan to build a fairer, better Ontario by 

supporting everyone in the province with the care and opportunity they need to get ahead. 

Charles Sousa, Minister of Finance, introduced the Budget in the legislature today. If passed, Ontario 

would expand OHIP+ with free prescription drugs for everyone 65 and over, improve mental health 

care and addictions services, and introduce free preschool child care for children aged two-and-ahalf 

until eligible for kindergarten. 

Investing in Care 

Ontario is helping ease the mounting pressure that individuals and families are facing and giving 

them every opportunity to care for their loved ones by: 

• Introducing the new Seniors’ Healthy Home Program. This recognizes the costs associated 

with older seniors living at home, where they want to be. It provides a benefit of up to $750 

annually for eligible households led by seniors 75 and over to help them live independently 

and offset the costs of maintaining their homes. 

• Introducing a new Ontario Drug and Dental Program, reimbursing 80 per cent, up to a 

maximum of $400 per single person, $600 per couple and $700 for a family of four with 

two children, of eligible prescription drug and dental expenses each year, for those without 

workplace health benefits or not covered by OHIP+ or other government programs. 

• Providing more affordable, quality child care by making preschool child care free for children 

aged two-and-a-half until they are eligible for kindergarten. This saves a family with one 

child $17,000, on average, and builds on the savings families get from full-day kindergarten. 



Early learning has been demonstrated to improve children’s academic performance 

throughout their lives. 

• Providing better and faster access to mental health and addictions services for hundreds 

of thousands more children, young people and adults across Ontario — bringing the total 

funding to more than $17 billion over four years. 

• Improving hospitals by providing better access to care, reducing wait times, addressing 

capacity issues and better meeting the needs of Ontario’s growing and aging population 

through an additional $822-million investment in 2018–19 — the largest single government 

investment in hospitals in almost a decade. The Province is also investing approximately $19 

billion over 10 years to build and renovate hospitals to provide more and faster health care 

for people. 

• Creating 30,000 new long-term care beds over the next 10 years — adding 5,000 new beds 

by 2022 — to help people who can no longer live independently and provide peace of mind 

for people who care for them. These new beds are in addition to the 30,000 existing beds 

being redeveloped. 

• Building a fair society and enhancing choice and independence by investing $1.8 billion 

to strengthen services for 47,000 adults with developmental disabilities and reforming the 

social assistance system to focus on people rather than on rules and regulations. 

Making Life More Affordable 

Families are facing mounting pressures — whether at work or on their commute or in their 

pocketbook — and it’s having a real impact on people’s lives and our ability to care for our loved 

ones. Ontario is taking steps to make life more affordable and provide more financial security during 

a time of rapid economic change: 

• Making prescriptions completely free for everyone 65 and over through OHIP+, ensuring 

that no senior citizen ever needs to go without necessary drugs. By eliminating the Ontario 

Drug Benefit annual deductible and co-pay, this saves the average Ontario senior $240 per 

year. This expansion of OHIP+ follows the introduction of free prescriptions for everyone 

under the age of 25 in the 2017 Ontario Budget. 

• Providing a public transit tax credit that saves seniors up to $450 a year, as of July 1, 2017, 

and lowering the cost of commuting by about $720 per year for the average commuter 

transferring between the GO/UP Express network and the TTC. 

• Cutting residential electricity bills as of July 1, 2017, by 25 per cent on average, and up to 

40 or 50 per cent for eligible rural and low-income families. 

Creating Opportunity for People 

Ontario is helping people adapt to, and thrive in, a changing economy to make sure the province 



remains the best place to live, work and do business. Actions include: 

• Making college and university tuition free for more than 225,000 students of all ages. Free 

or low tuition is available for students from low- and middle-income families; tuition is free 

for those earning up to $90,000, and students from families who earn up to $175,000 are 

also eligible for financial aid. 

• Preparing students for good jobs by providing $132 million over three years to develop 

postsecondary education programs that respond to the changing needs of students and 

employers — including strengthening partnerships with local employers, offering more 

flexible and experiential learning, and increasing the number of science, technology, 

engineering and mathematics (STEM) graduates by 25 per cent over the next five years, 

from 40,000 to 50,000 per year. 

• Planning to create and retain over 70,000 jobs by renewing and extending the Jobs and 

Prosperity Fund with an increase of $900 million over the next 10 years. 

• Providing $935 million in new funding over three years through the Good Jobs and Growth 

Plan to support Ontario businesses, students and graduates, and help attract good, wellpaying 

jobs. 

• Making workplaces fairer for everyone by tackling the gender wage gap and increasing 

transparency in hiring processes with proposed legislation that would, if passed, require all 

publicly posted jobs to include a pay rate or salary scale. 

• Providing a long-awaited raise for 1.2 million people across Ontario by increasing the 

minimum wage to $14 per hour on January 1, 2018 and $15 per hour on January 1, 2019. 

The province has beaten its fiscal targets every year since the recession, and is forecasting a budget 

surplus in 2017–18. Beginning in 2018–19, Ontario is choosing to make more investments in the care 

and services that the people of this province rely on. As a result, the province will run modest deficits 

of less than one per cent of GDP. The Budget outlines a path back to balance by 2024–25, building 

on the province’s long track record of responsible fiscal management. 

QUOTES 

“Ontario’s economy is getting stronger, businesses are creating record numbers of 

jobs and unemployment is at the lowest rate in almost two decades. Our budget 

is balanced. We have a $600-million surplus. Now, we are using our strengthened 

fiscal position to make life more affordable for families and create new opportunity 

for businesses across the province. The 2018 Budget will include new investments in 

health care, child care and seniors care to help even more families get ahead.” 

- Charles Sousa 

Minister of Finance 


QUICK FACTS 


• The government is choosing to make new investments of $20.3 billion over the next three 

years to support vital public services that people in Ontario rely on, focusing on priority 

areas such as health care, education, child care, seniors, social services, growing the 

economy and creating good jobs. 

• Since the recession, Ontario’s economy has gained over 800,000 net new jobs. The 

unemployment rate has steadily declined to a 17-year low in February 2018, and has 

remained below the national average for 34 consecutive months. 

• Since 2014, Ontario’s economy has grown more than Canada’s and all other G7 countries. 

LEARN MORE 

• Read the 2018 Ontario Budget: A Plan for Care and Opportunity 

• For more details about the government’s plan, read the fact sheets: 

Ontario Budget 2018: Top 10 Highlights 

Making Everyday Life More Affordable 

More Child Care, More Choice 

Caring for Ontario’s Seniors 

Faster, Better Access to Health Care 

A Plan for Care 

Growing Ontario’s Competitiveness and Creating Good Jobs 

Ontario’s Economic and Fiscal Focus 

• 2018 Budget News Release.pdf 

Jessica Martin Minister’s Office 

jessica.martin@ontario.ca 

416-212-5181 

Scott Blodgett Ministry of Finance 

scott.blodgett@ontario.ca 

416-325-0324 

For public inquiries: 1-800-337-7222 

TTY: 1-800-263-7776 

Available Online 

Disponible en Français 


Transformative Investment in Life-Saving Care for Children 

NEWS 

Office of the Premier 


New SickKids Patient Care Centre a Game-Changer for Children’s Health 

March 23, 2018 10:10 A.M. 

Ontario’s Hospital for Sick Children (SickKids) is already one of the world’s largest and most 

respected pediatric hospitals. It has transformed the lives of hundreds of thousands of children and 

their families across Ontario. To make sure SickKids can continue to provide the most advanced, 

compassionate care to children from all over Ontario, Premier Kathleen Wynne announced today 

that the upcoming provincial Budget will support a new Patient Care Centre at SickKids. 

The Premier was joined at SickKids today by Charles Sousa, Minister of Finance, and Dr. Helena 

Jaczek, Minister of Health and Long-Term Care, to explain how Ontario’s investment will provide 

leading care for the youngest patients from all across the province. 

Premier Wynne announced that Ontario is investing up to $2.4 billion for design and construction as 

part of this massive redevelopment that will transform SickKids into a 21st-century facility, modernize 

aging equipment and spaces, and boost the hospital’s capacity to provide leading-edge care for 

children. 

The new Patient Care Centre will bring together vital services, including emergency and critical care, 

surgical care, bone marrow transplants, as well as diagnostic services and specialty clinics. It will 

provide a more comfortable experience for families and give doctors and researchers the tools they 

need to translate research discoveries into new treatments, giving more children and their families 

faster access to the best care. 

Building a SickKids that can continue to provide the world’s best care to Ontario’s children is part 

of a broader health care infrastructure commitment that is bringing faster, better care to people 

in communities across the province. The province is investing more than $19 billion over the next 

10 years to improve and expand hospitals. There are 40 major hospital projects either under 

construction or in planning stages. 

Investing in new hospitals and the best in children’s health care is part of the government’s plan to 

support care, create opportunity and make life more affordable during this period of rapid economic 

change. The plan includes a higher minimum wage and better working conditions, free tuition for 

hundreds of thousands of students, easier access to affordable child care, and free prescription 

drugs for everyone under 25 and everyone 65 and over through OHIP+, the biggest expansion of 

medicare in a generation. 

QUOTES 

“As any parent knows, when a child is sick nothing else matters. The incredible 

physicians, nurses and staff members at SickKids understand that. What they do for 

families every day is extraordinary. We have to support that. We have to make sure 

they can provide the world’s best care to every child who comes through these doors. 



That’s what this historic investment in SickKids is all about, and it’s why we’re building 

new and improved hospitals around the province. Care has to come first.” 

- Kathleen Wynne 

Premier of Ontario 

“Our government is dedicated to making sure hospitals across the province 

have the support required to meet the growing needs of their communities. This 

transformational investment would enable SickKids to continue providing leadingedge 

children’s health care well into the future. Increasing access to critical services at 

hospitals like SickKids will mean more children across Ontario will be able to grow up 

healthy, strong and able to reach their full potential.” 

- Dr. Helena Jaczek 

Minister of Health and Long-Term Care 

“This historic and important investment will ensure that we are able to deliver safe, 

cutting-edge care to the most critically ill children in Ontario for generations to come. 

It will allow us to build a state-of-the-art facility that will continue to give patients 

and families hope and comfort as they face serious illness and injury. A redeveloped 

SickKids will also attract more of the world’s top clinicians and researchers to join 

SickKids in our fight against childhood illness and disease.” 

- Dr. Michael Apkon 

President and CEO, the Hospital for Sick Children 

QUICK FACTS 

• SickKids is the largest centre in the country dedicated to improving children’s health 

and one of a handful of Ontario hospitals that sees patients from all 14 Local Health 

Integration Networks (LHIN). It is the only hospital in Ontario that conducts pediatric 

heart transplants, bone marrow transplants and most solid organ transplants. 

• The 2018 Budget will renew our focus on the supports and services families in the 

province need right now — including more investments in hospitals, mental health, longterm 

care and child care. 

• In addition to building new hospitals, Ontario is increasing operating funding for 

hospitals by $822 million in 2018–19, a 4.6 per cent boost. This includes an extra $109 

million for hospitals in the Toronto Central LHIN and a funding increase of $15.4 million 

in 2018-19 for SickKids. 

• Ontario is the first province to provide free drug coverage to all children and youth under 

the age of 25, saving families the high cost of life-saving drugs. Since OHIP+ began this 

January, over one million children and youth have benefited from having access to free 

prescription medications. 

• Starting in August 2019, Ontario plans to make prescription drugs free for seniors 

through OHIP+ for Seniors 65 and over. 

• Ontario is launching a historic expansion of mental health and addiction services, with a 

funding boost of $2.1 billion that brings total mental health care spending to more than 

$17 billion over four years — the biggest provincial investment in Canadian history 

LEARN MORE 

• Speech from the Throne 

• Patients First: Action Plan for Health Care 

• OHIP+: Children and Youth Pharmacare 

• Building Together: Ontario’s Long-Term Infrastructure Plan 


Don’t take a Gamble on 

Insurance Coverage! 

Protect yourself and your family 

The PL&I Package offered by the RTSO 

provides you with the following: 

• Professional Liability & Indemnity Insurance coverage: $2M/incident / 

$4M Aggregate; Nil Deductible 

• Disciplinary Defence: $175,000/Claim / $175,000 Annual Aggregate 

• Criminal Defence Reimbursement: $200,000/incident / $200,000 

Annual Aggregate 

• Sexual Abuse Counselling & Rehabilitation: $10,000/insured / $250,000 

Annual Aggregate 

• Legal Representation Expenses: Subpoenaed as witness $1,500 each 

claim 

• Complaint $5,000 / Max Annual Aggregate for both $50,000 

Any Questions? 

Contact the RTSO office at office@rtso.ca

PREVENT THE 

PREVENTABLE 

Be by your patients’ side — 

wherever you are 

Vital Sync 

Virtual Patient Monitoring Platform 

The Vital Sync software-based platform 

sends data from bedside monitoring devices 

to your mobile devices, Workstation on 

Wheels, Central Nurse Station and sends 

it to your hospital’s EMR, CIS and alarm 

forwarding systems. 

Vital Sync virtual patient monitoring platform 

may enhance patient safety by enabling 

clinicians to detect clinical distress remotely, 

so they can respond faster to the changing 

needs of patients. 

Vital Sync VPMP 

For more information, please contact your Medtronic representative 

or call Medtronic Canada at 877-664-8926. 

©2016 Medtronic. All rights reserved. Medtronic, Medtronic logo and Further, Together are trademarks of 

Medtronic. All other brands are trademarks of a Medtronic company. CA-PMR-AD001 

Use scan app to read

GE Healthcare 

To learn more visit: 

www.gehealthcare.com/carescape_R860 

HOW THE JEWISH HOSPITAL – MERCY HEALTH 

AND GE HEALTHCARE HOPE TO TAKE A BITE OUT 

OF ICU COSTS 

Admission rates to hospital Intensive Care Units 

(ICU) are rising dramatically – along with the cost 

of critical care. 1 Here’s how nutrition can impact 

the cost of care for ventilated ICU patients. 

GROWING ICU ADMISSIONS 

FIVE 

MILLION 

ICU Patients 1 

INCREASE 

ICU Patients 

2006-2015 2 

UP TO 

50% 

ICU Patients 

Malnourished 2 

Extending this solution across all 

U.S. hospitals could potentially 

impact hospital’s clinical and 

financial outcomes. 

Nutrition is critical 

in ICU recovery. 

GE’s critical care 

ventilators feature an automated 

nutrition assessment application 

to assist caregivers with their 

ventilated patients. 

ICU Patients 

on ventilator 3 

THE JEWISH HOSPITAL 

RESULTS: 90-DAY STUDY 4 

MULTI-DISCIPLINARY CLINICAL NUTRITION PROGRAM 

28% 

REDUCTION 

Average ventilated ICU 

patient LOS 

~ 9k 

LESS 

Avg. cost reduction 

per ICU ventilated 

patient 

$6 

MILLION 

Projected 

annual savings 

1. Department of Health Policy, George 

Washington University School of Public 

Health and Health Sciences, Washington, 

DC, USA. http://www.ncbi.nlm.nih.gov/ 

pubmed/23672362 

2. Reid, CL. Nutritional requirements of surgical 

and critically-ill patients: do we really know 

what they need? Proc Nutr Soc. 2004 

Aug;63(3):467-72. 

3. The American Association for the Surgery 

of Trauma: Trauma Source - Mechanical 

Ventilation in the ICU. Note: % ventilated 

ICU patients referenced is a single source – 

actual % may vary) 

4. The Jewish Hospital Demonstrates Over 

2-Day Reduction in ICU Length of Stay with 

GE Ventilation. 2015. 

Note: GE does not guaranty any cost savings. 

These results are specific to The Jewish 

Hospital only. 

© 2015 General Electric Company. JB36390US 

GE and the GE Monogram are trademarks of 

General Electric Company.

Management’s Corner 

Lucy Bonanno 

RRT MA MBA CAE CHE 

Chief Executive Officer 

Geraldton District Hospital 

In the last few months I’ve had to make some 

tough decisions. I have also heard comments 

made that were the furthest from the truth. 

They said, ‘oh sure, it’s easy for management 

to make those decisions, but they don’t realize 

how it affects us, the staff…’; that comment 

completely threw me, because everyone who is 

in a leadership role, be it a coordinator, a team 

lead, a manager or a director…to everyone’s 

surprise, are people…people with compassion 

and feelings, just like everyone else. 

A difficult decision is always just that…a difficult 

decision. 

When Decisions Cause Distress 

Many new managers or team leaders ask this 

question: How can I develop a team spirit of 

empowerment for all, when I have to make 

decisions that will cause some people to feel 

disempowered or distressed? 

I myself grappled with this for years and continue 

to do so today. I researched the topic as much as 

I could, and I took in what I was seeing around 

me, along with plain and simple life experiences. 

Even in our personal lives as adults, we are faced 

with making difficult decisions, some which will 

inevitably affect family members or those around 

our personal circle that we care deeply about. 

While it may seem obvious, it also helped to fully 

accept that I could not establish a stable state 

of empowerment with everyone all the time. 

Even apart from unpopular decisions, feelings of 

empowerment fluctuate depending on how work 

evolves, with unexpected events, and with the 

way that stress can undermine enthusiasm. 

Most of the time, I see my role, as constantly 

tending to the conditions, which offer the 

best chances for most team members to feel, 

empowered as continuously as possible. One key 

condition is to assure that work conversations 

are safe and honest in order to elicit feelings of 

concerns and address them through problem 

solving. In this way, managers and team leaders 

can use their role, not to demand compliance, 

but to model and assure norms for open and 

safe communication and to assure that difficult 

issues will be discussed. 

Another way to achieve the best level of team 

empowerment is assuring that decision-making 

emphasizes participation and open dialogue. 

Here are a few points to consider: 

1. Always consider consulting with 

others before deciding. Include those 

with relevant expertise. Not only is 

this respectful, but diverse thinking 

will improve the final decision. 

2. Once the decision is made, meet 

with people to let them know 

explicitly how you considered their 


Management’s Corner 

input. Explain your rationale for the 

decision in terms of how it serves 

the vision, mission and values of the 

organization and avoid language of 

control at any level. 

3. Look out for and seek concerns and 

acknowledge them as legitimate. 

Commit to ongoing problem-solving 

to mitigate those concerns without 

derailing forward progress. 

4. Ask team members/staff for help in 

designing and choosing the what 

and how of the implementation 

phase. 

5. Always and regularly review the 

department’s decision-making 

processes. Ask for feedback in terms of 

clarity, timeliness and quality of it all. 

Staying engaged with others’ feelings and 

concerns through open dialogue, while also 

staying the course to desired results by making 

difficult decisions, is emotionally and mentally 

demanding and down right draining from a 

psychological perspective. 

To make difficult decisions in a team environment 

when the ultimate and final decision is yours 

to make, where you know the changes will 

affect staff routine or their day-to-day work 

life, you truly wish to do the best for both the 

organization and your staff team, and this takes 

courage and compassion. 

I did learn a difficult lesson however, that 

despite your best efforts of inclusion, open 

communications and transparency throughout 

the process, you simply cannot please everyone. 

Do the best you can, always! Be open and 

honest in each phase of the decision-making 

process. Empower the staff team and hear them, 

yet communicate what the final end result needs 

to be, and then work together to try and get to 

the end goal together, as a team. 

“The wicked leader is he who the 

people despise. The good leader is 

he who the people revere. The great 

leader is he who the people say ‘We 

did it ourselves.’” – Lao-Tzu 

Thank you to our Corporate Sponsors 


Student Perspective 

E-Cigarettes: Are they a better 

alternative to conventional cigarettes? 

submitted by Vimoshana Vijayakumar SRT 

Recently, there has been increasing popularity in 

the use of Electronic Nicotine Delivery Systems 

(ENDs), also known as electronic cigarettes 

(e-cigarettes), as an alternative to conventional 

smoking. It is widely believed that e-cigarette 

use can help with smoking cessation, and is also 

appealing to smokers of any age due to a variety 

of flavours and their current unregulated use. 

These devices come in a variety of shapes and 

sizes, but all are variations on the same general 

theme: a heating element at one end aerosolizes 

a liquid nicotine solution, and the vapour is 

inhaled through a mouthpiece (Arnold, 2014). 

Since e-cigarettes are fairly new to consumers, 

the information provided is limited. Current 

research has determined aerosol composition 

and deposition in the lungs; however, the 

implications on human health and general 

regulatory standards must be investigated 

to determine how safe of an alternative 

e-cigarettes are. 

What’s in E-Cigarettes? 

E-cigarettes produce aerosols that consist 

of submicron particles from the condensed 

vapour of glycols that contain nicotine and 

flavourants. Some chemicals that are commonly 

found in e-liquids are propylene glycol, 

vegetable glycerine, nicotine, acetaldehyde 

and formaldehyde. Metals such as cadmium, 

lead and nickel are also commonly found. It 

has been proven that the e-liquid doses of 

nicotine are more than double of those in 

conventional cigarettes (Manigrasso et al, 

2015). Greater particle concentration was also 

measured in e-cigarette liquids that contained 

nicotine compared to those that didn’t. A higher 

concentration of smaller particles allows deeper 

penetration of the bronchial tree. 

So what’s the problem? 

Propylene glycol increases the onset of 

asthma, lower airway obstruction, cough and 

mild dyspnea. Heating and vapourization of 

propylene glycol also increases the production 

of formaldehyde, a known carcinogen 

(Offerman, 2014). It was found that 4 of 9 

common chemicals of e-liquids (acetaldehyde, 

formaldehyde, nickel, and lead) put users at 

increased risk of carcinogenic effects according 

to No Significant Risk Level (NSRL) hazard 

quotients for cancer-related health effects 

(Offerman, 2015). Diacetal, found in flavourants, 

is known to be a respiratory irritant and has 

been known to cause acute-onset bronchiolitis 

obliterans (Fuoco et al, 2014). Exposure to 

ultrafine aerosol particles can damage the lung 

tissue by stimulating increased inflammatory 

responses and oxidative stress in lung cells. 

Currently there are no regulations regarding 

e-cigarette use outdoors/indoors. Indirect 

exposure of the aerosol still puts people at risk. 

In order to reduce second hand exposure while 

indoors, building ventilation must be increased 

by 23 times to reduce health risks associated with 

aerosol constituents (Offerman, 2014). Therefore 

more stringent investigation of manufacturing 

processes is necessary to ensure purity of e-liquids 

to minimize associated health-risks. 


What’s the verdict? 

E-cigarette use is becoming increasingly popular 

as an alternative to conventional cigarettes. 

There is currently insufficient available research 

to be conclusive (compared to conventional 

cigarettes) about the physiological and 

environmental effects of its use outdoors and 

indoors. However, many research studies have 

indicated a greater particle concentration per 

aerosol generation, especially notable for 

e-liquids containing nicotine. Smaller particles 

at larger concentrations have a greater ability 

to deposit deeper in the lower respiratory tract. 

In order to state that e-cigarettes are a better 

alternative to conventional smoking, further 

research must be conducted to determine 

long-term effects. Implementation of regulatory 

standards, laws and regulations detailing public 

usage, as well as public education, are also 

necessary. 

References 

Arnold, C. (2014). Vaping and Health: What Do 

Student Prospective 

We Know about E-Cigarettes? 

Environmental Health Perspectives, 

122(9), A244-9 1p. 

doi:10.1289/ehp.122-A244 

Fuoco, F.C., Buonanno, G., Stabile, L., Vigo, P. 

(2014). Influential parameters on 

particle concentration and size distribution 

in the mainstream of e-cigarettes. 

Environmental Pollution, 184: 523-529 

Manigrasso, M., Buonanno, G., Fuoco, F.C., 

Stabile, L., Avino, P. (2015). Aerosol 

deposition doses in 

the human respiratory tree of electronic 

cigarette smokers. Environmental 

Pollution, 196: 257-267 

Offerman, F.J. (2015). Chemical emissions 

from e-cigarettes: Direct and indirect 

(passive) exposures. 

Building and Environment, 93: 101-105 

“Leadership is the capacity to 

translate vision into reality.” 

-Warren Bennis 


Continuing Education Opportunities 

Provider Education Program (PEP) Upcoming Workshops 2018 - 2019 

Workshops Location Date 

Spirometry 

St. Thomas April 18, 2018 

Brampton May 15, 2018 

Peterborough May 24, 2018 

Toronto June 14, 2018 

Toronto - South Riverdale (CHC) June 20, 2018 

Adult and Pediatric Asthma Markham April 11, 2018 

Asthma COPD Overlap OTN May 3, 2018 

COPD 

Newmarket May 2, 2018 

Oshawa May 31, 2018 

Hamilton June 5, 2018 

Please check our website www.olapep.ca for up-to-date information and registration information. 

To set up a free workshop for your team or organization, please contact us at pep@lungontario.ca. We will work with 

you to ensure your learning outcomes are achieved. 


Ask aRTee 

Dear aRTee, 

I was at a meeting recently and someone commented that we should “A3” a process “to see 

where it takes us”. There were a few nods of agreement around the room, but several of 

us looked rather bewildered. There was no time to pause and ask questions as the meeting 

continued at a fast and furious pace. By the time the meeting ended, I had a list of to-do’s a 

mile long and the A3 thing got lost, until I heard it in passing again today. What do you know 

about A3? 

Curious Cal 

Hi Cal, 

Here’s what I could find on A3: 

• A3 describes a worksheet used for improvement processes 

• A3 is actually the paper size of the worksheet, the size of a traditional ledger, or the 

maximum size of paper that can fit through a fax machine (in North America, it is 

approximately an 11” x 17” sheet of paper); you can find an example at https://upload. 

wikimedia.org/wikipedia/commons/a/ad/A3_problem_solving_worksheet.jpg) 

• A3 thinking is a curiosity-driven, problem-solving approach, stemming from the work of 

Shewhart in the 1930’s, then adapted by Deming (1950) into a Plan-Do-Check-Act cycle 

for Toyota, where it took off (Liker & Meier, 2005). This has evolved into the Plan-Do- 

Study-Act (PDSA) cycle many of us are familiar with today. 

Fitting all of this information onto a single sheet of paper requires a team to be clear and concise. 

The A3 worksheet tells a story, beginning with background information and the current state of a 

problem. The problem is then clearly defined and the conditions surrounding it are reviewed before 

setting a target and analyzing why the problem exists. After this work is done, the team develops 

and explores “counter-measures” or possible solutions, tests them, then monitors results and 

processes, eventually solidifying an improvement plan. The final step would be to standardize and 

share successes once they occur. (Toussaint & Ehrlich, 2017). 


Ask aRTee 

A3 thinking is supported because it drives leaders to observe, use a curious mind to think more 

deeply about a problem and ask informed questions before considering a solution (Toussaint & 

Ehrlich, 2017). The template, and the process for improvement, must be supported by a “lean” 

culture that changes how we view problems, where problems are seen as opportunities to improve 

processes and, ultimately, products and people learn more and become better problem-solvers each 

time they perform the process, “the Toyota way” (Liker & Meier, 2005). 

References 

Deming, W. E. (1966) [1950]. Some Theory of Sampling. Dover. ISBN 0-486-64684-X. 

Liker, J.K. & Meier, D. (2005). The Toyota Way Fieldbook: A Practical Guide for Implementing 

Toyota’s 4Ps. McGraw-Hill. ISBN 978-0-07-144893-2. 

Shewhart, D.A. & Deming, W.E. (1939) Statistical method from the viewpoint of quality control. 

Washington, D.C.: Graduate School of the Department of Agriculture. 

Spear, S. & Kent, H. (1999). Decoding the DNA of the Toyota production system. Harv Bus Rev 77: 

96–106. 

Toussaint, J.S. & Ehrlich, S.P (2017). Five Changes Great Leaders Make to Develop an Improvement 

Culture. Retrieved online from https://catalyst.nejm.org/five-changes-great-leadersimprovement-culture/ 

Wikimedia (n.d.). A3 Problem Solving Worksheet. Retrieved 2018/04/02 from https://upload. 

wikimedia.org/wikipedia/commons/a/ad/A3_problem_solving_worksheet.jpg 

“Leadership is practiced not so 

much in words as in attitude and in 

actions.” -Harold S. Geenan 


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RTSO Airwaves Spring 2018

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