Day three - Toronto to Ottawa

First of all, a couple of corrections. In my somewhat jet lagged state, I said that both Angela Robertson - Director of Equity and Community Engagement and Catherine Classen, Director of Mental Health - were at Toronto General whereas they are actually at Women's College Hospital!!

Yesterday morning was spent with Toronto General. It's big, thousand of employees and several sites across Toronto. I met with Elke who is the manager of Patient Education and Patient and Family Library. Elke is also one of the drivers behind a growing network of professionals who form the Patient Education Network in Toronto (mostly comprising Toronto General, Toronto Western and Princess Margaret. Elke is also on a volunteer panel with the Registered Nurses Association of Ontario to develop a guideline for registered nurses and registered practice nurse

on "Facilitating Client Centred Learning". The best practice guidelines offer a great opportunity to work, and shift culture with nurses around health literacy - nurses who are often the drivers behind this kind of work. Elke has sent me info to be one of the reviewers of the guidelines when they get to that stage.

Today, Ottawa, Canada's capital. From the tightly packed metropolis of Toronto to the spacious, parklands and French architecture of Ottawa. We arrived by train through countryside that is bleak, brown and wintery. It's the the time after the snow has melted but the grass has not yet grown, the trees have not yet sprouted and the sun does not yet shine; though today it did! We arrived in Ottawa and it was a paddock - the station is outside the city! We caught a taxi into town but again it felt like we were in a suburbia laced with the occasional office block. Near the hotel however is the canal, the beautiful parliament buildings and the overwhelming influence of Europe - who needs Paris?

But straight into work for me. First up the Canadian Institute of Population Health who are developing research projects around the immigrant health and health inequities as well as empowering vulnerable populations to be effective consumers. Health literacy is at the core of these projects and the notion of measuring not just health literacy, but the changes brought about by health literacy interventions are a challenge for the researchers. They are looking at tools that have been developed across the globe to identify one that may work in their investigations. I was asked the question about how we measure health literacy outcomes. More on that later.

After that I took a long a expensive taxi journey to the Canadian Health Services Research Foundation and met with Mireille. The Foundation's mandate is to connect researchers with decision makers. Mireille mentioned the work of Jonathan Lomas - who I am sure I have come across before when have been reading about knowledge translation? Anyway, this organisation is about supporting decision makers - CEOs, managers and policy makers, to use evidence in their . . . decisions!.

The CHSR has a number of funded projects that are about patient engagement - and acknowledge that engagement and health literacy are inextricably linked. The projects, in a number of different kinds of health care and health administration orgs aim to collect data on the impact of different kinds of community engagement projects. So this is not about having patients sitting on committees but training patients to be involved, or interviewing patients about their experience of a service and redesigning the care around the learnings from that. Getting the patient perspective on what they are seeing, experiencing and creating sometimes really simple measures to make big changes. Fantastic. Mireille also told me about the South Central Foundation or the Newcombe model of care (don't quote me on spelling etc - this is all memory right now). It's a hospital that the Canadians are raving about in Alaska whcih has completely handed over "ownership" to consumers and integrated primary and hospital care - worth looking into.

My final meeting was with the Canadian Institute of Health Research, where a number of researchers and primary care doctors have come together to discuss primary care and vulnerable populations. But more on that later, this girl has got to sleep.