Tuesday, February 26, 2019

'I wanted to make sure this didn't happen to another kid'

By Louise Kinross

Laura Oxenham-Murphy is the interim director of Quality, Safety and Performance at Holland Bloorview. Laura first thought about improving hospital care when she was a child. That's because at age eight, she was on the receiving end of a medical error. "It ended up having a huge impact on my life," Laura says. We spoke about how this experience spurred her career.

BLOOM: Can you tell us more about your story?

Laura Oxenham-Murphy:
When I was eight I was scheduled to have a routine surgery to remove three child teeth. That was that, and I was supposed to go on my merry way. But the surgeon that was operating on me had the wrong patient chart. He ended up doing a procedure that was completely incorrect and removing three adult teeth.

It meant three or four follow-up surgeries that I wouldn't have had to have. And quarterly visits to a specialist, who lived over an hour from my house, from age eight to 18. What was most significant was that the incorrect surgery was visibly obvious for many years. For all of junior high I was missing teeth. It wasn't pleasant.

BLOOM: Why did you have to have the follow-up surgeries?

Laura Oxenham-Murphy:
They removed enough adult teeth that the bone disintegrated, or stopped growing, so when I was old enough to have a permanent implant put in, the bone structure wasn't there. I had to have bone grafts and the recovery from that involved missing a lot of school. Then I had to have surgeries for permanent implants. It was painful. And none of this had to happen.

BLOOM: How did you initially cope?

Laura Oxenham-Murphy:
Even as an eight-year-old you're concerned with what will people say, or what will people think at school? I'm going to look a bit different from other people. At eight, I didn't really understand why this happened. Why did he make the mistake?

When I went back to follow up with a different specialist, even as a child I could recognize that he was trying to cover up what happened and minimizing it. 'Well, you might have had to have these teeth taken out anyway' was the argument he got into with my mom. I piped up: 'No, I specifically remember I was told it would only be my baby teeth and it wouldn't have affected my adult teeth.'

BLOOM: How did that experience lead you into quality?

Laura Oxenham-Murphy:
From a young age I wanted to make sure this didn't happen to another kid. At first I thought that meant going into clinical practice.

But my mom is a health-care practitioner and she said if you really want to make change at a system level, you should consider doing a master's in health administration and work in an administrative and leadership capacity. That spurred me into taking a pretty non-traditional route into the role I have today. I went straight into the administrative role, as per my mom's coaching.

BLOOM: Has not having a clinical background been challenging?

Laura Oxenham-Murphy:
It can be, and certainly comes up from time to time, primarily in job interviews and when I meet new colleagues for the first time. However, I think I'm able to bring a different lens and ask different questions.

That said, when working on quality and safety improvement projects I make sure to have a strong team that always includes clinicians.

I don't regret the path I've chosen. When I got into my master's and was able to take a couple of elective courses in quality improvement, that's where it hit me. Yes, yes, this is what I've been thinking about since I was 10 years old!

BLOOM: What is a typical day here like?

Laura Oxenham-Murphy:
Oh boy. You may have a plan for what you hope to accomplish, which are mostly projects at a strategic level. But then incidents, complaints or concerns come up, and most often those are things that require immediate attention, so your plan for the day gets derailed. I manage urgent risk cases as they come to me, or privacy concerns.

I work closely with the people on my Quality, Safety and Performance team, as well as others across the hospital. We're a very close-knit QSP team, so to meet deadlines and get the work done, I rely on my colleagues. It's a very dedicated team and I'm proud to be part of it.

I spend a lot of time in meetings, and work with my counterparts in other hospitals to further the quality agenda at a system level. We share resources and best practices we can take back to our own organization.

BLOOM: What's the greatest challenge of the job?

Laura Oxenham-Murphy:
The unpredictability. Some days you might have nothing out of the ordinary, and you're able to get into a good flow on some of our projects and initiatives. Other days, one thing after another happens and you're not able to open your e-mail till 5 p.m.

BLOOM: How do you manage stress?

Laura Oxenham-Murphy:
I wake up at 5:30 every morning and exercise. We have a bare-bones home gym/yoga studio and my husband and I are both very committed to getting each other out of bed. We go down to the gym or if the weather permits, we go for a run. It's the only time we get to spend together on weekdays as our jobs pull us in different directions in the evenings.

I wouldn't be able to do what I do here without that. We'll exercise for 45 minutes to an hour, then spend time together eating a solid breakfast of oats, coffee and some fruit. I find it really grounds me. And we try as much as possible not to talk about work.

BLOOM: What's the greatest joy of your job here?

Laura Oxenham-Murphy:
I love when there's been a risk issue and I'm able to interact with clients and families, as well as front-line staff, and we're able to come to a resolution, or even to see small differences, that shift the relationship to a more positive one.

I love bringing together passionate people—clinicians, leaders, clients and families—to work collaboratively on a particular quality improvement initiative, and supporting their capability and commitment. We are so fortunate as a hospital to have such a highly engaged group of clinical and non-clinical staff, and I see my role as enabling our staff in their commitment to quality and safety.

BLOOM: What's an example?

Laura Oxenham-Murphy:
One of the things I'm most proud of is our recent success with our last Accreditation cycle. It's not about the exceptional results we received from the surveyors. What I'm really proud of is playing a role in having our clinicians, leaders and clients and families partner together more closely on quality and safety.

BLOOM: How often do you work with parents and kids?

Laura Oxenham-Murphy:
On a weekly, even daily, basis. When I'm wearing my risk and privacy hat I'm dealing with clients and families. In the quality world, I'm interacting with family and youth leaders. Interacting with our clients and families is truly one of my favourite parts of the job, and really helps to ground me in what we are collectively striving toward.

One of the interesting dichotomies to get my head around is the perspective of how we merge, or think about, what are the important issues from the perspective of family leaders—a cohort of individuals that are very educated about the system and how to navigate it, and have a clear vision of where they want it to go—with a family that is concerned because their child didn't get the correct medication at a certain time.

BLOOM: What are common risk issues?

Laura Oxenham-Murphy:
There's a lot around informed consent. Parents saying something wasn't explained in a way that they understood, or that resonated for them. When there's a complex family dynamic, there might be two parents who have varying custody arrangements, and one wants to go one way and the other disagrees.

There are concerns about timely access to services or delays in treatment. With all risk cases, I partner closely with clinical teams, Client and Family Integrated Care and Bioethics together with the client and family to come to a mutual resolution.

BLOOM: How does your firsthand experience with a medical error help in these discussions?

Laura Oxenham-Murphy:
I believe it helps me empathize a little differently. It's not something I would ever say. I would never use the words 'I know what you're going through,' because clearly I don't. Every experience is different. But in the back of my mind, I can call up some of those feelings and emotions that I experienced, and my family experienced, which can help me relate to what a family is feeling.

BLOOM: What have you learned from families?

Laura Oxenham-Murphy:
I've learned so much, I don't even know where to start. One of the things I've appreciated the most about working here is the opportunity to interact with patients and families and family leaders. It's helped me to come back to that true sense of why I want to do what I'm doing, and why I'm committed. I want to promote optimal experiences for patients and families and when I get to have conversations with them, it grounds me and makes why I've started on this journey more tangible.

BLOOM: If you could change one thing about children's rehab, what would it be?

Laura Oxenham-Murphy:
I think making the system easier to navigator for our clients and families. So getting certain services doesn't require being connected to the right people and knowing the right questions to ask. If there weren't gatekeepers, and people could just come and learn about different services that were available. If the solutions were simple, we would have implemented them.

Also, from a health equity perspective, I've been thinking a lot about how we ensure our services are meeting the cultural needs of the diverse population we're meant to serve. I credit Aman Sium with helping me understand this better than I had previously.