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Kari White has noticed a trend among long-serving staff at Unity Health Toronto. When asked why they have stayed at the organization throughout the years, most people will talk about the relationships they have built with their colleagues.

“Nine times out of ten – or even 9.9 times out of 10 – they say it’s because of the people they work with,” says White, who is a clinical leader in the St. Michael’s Hospital Surgery and Critical Care program and has been working at the hospital for over 25 years. “I got to thinking, maybe that feeling people have towards their team is about how they work and function together.”

In 2023, White was part of a group who built and launched a training program for Critical Care teams at St. Michael’s focused on building and reinforcing the behaviours and capabilities of highly functional teams. The two-day, evidence-informed program is called the Team Training and Clinical Excellence Academy – or the TTrACE Academy.

“We have staff performing at their full scope of practice and who provide excellent clinical care,” says White. “This program is less about what we do – the clinical care – and more about how we do the work together.”

Learners in TTrACE Academy participate in a mixture of theory, panel discussions, simulations and interactive activities about topics like stress and performance, team emotional intelligence, advanced communication skills, health equity, and team psychological safety and trust.

These highly functional behaviours regularly come into play when all staff and physicians are working together on a Critical Care unit – but they can be equally important to building and maintaining patient, family and team member relationships. We connected with three TTrACE Academy graduates to learn more about their experience in the program and how they are using the lessons they’ve learned in both their work life and their personal lives.

Debbie Snatenchuk, nurse on the Medical Surgical Intensive Care Unit at St. Michael’s Hospital

Debbie Snatenchuk

A critical care nurse who has worked at St. Michael’s for over 20 year, Debbie Snatenchuk is no stranger to the ups and downs of a busy intensive care unit. Nonetheless, she appreciates opportunities to continually learn and grow. This winter, Snatenchuk participated in the most recent TTrACE Academy training. 

“I thought it was excellent,” she says of the program. “It allows you to reflect on your work and what you could be doing differently. It gives you that positive feeling that you want to go back and make some changes in yourself – in how you practice.”

One of Snatenchuk’s biggest takeaways from the program was how important it is to meet people where they are at – especially with patients and families in critical care. While Snatenchuk knew this going into the program, the TTrACE Academy helped by giving her more practical ways to apply this in her interactions.

“For me, it’s asking ‘What do you need from me today?’” says Snatenchuk. “I always thought that families wanted to know the whole picture, but I was wrong. It’s not about yesterday or tomorrow. It’s what they need today.”

This lesson has also proven helpful when talking to her sons, who are in their late teens and early twenties. Snatenchuk recounted a recent situation where her son called her from school to tell her about something that had happened to him.

“Instead of me telling him how I was feeling, I asked him how he was feeling and what he needed from me,” she recounts. “He told me he didn’t need anything; he just wanted to call.”

In that moment, she wasn’t exactly sure what to say or do but she was glad she focused in on her son’s needs.

“I reminded him that he can call me anytime and that I’m always here for him,” she says. “Maybe in other times I wouldn’t have reacted that way but, this time, I looked at it differently.”

Bari Zittell, Patient and Family Partner at Unity Health Toronto

Bari Zittell

In 2016, Bari Zittell’s husband developed acute respiratory distress syndrome after a pneumonia infection and received care at St. Michael’s. After her husband’s full recovery, she got involved in providing input on hospital initiatives, particularly in the area of critical care. For over five years now, Zittell has been a Patient and Family Partner at Unity Health.

Zittell was asked to provide her recommendations on how they could infuse the TTrACE program with patient and family perspectives when they were developing the curriculum. Now that the program is up and running, she shares her story on a patient and family member panel.

Zittell appreciates how the TTrACE Academy learners are so open and appreciate hearing from patients and caregivers about both their positive experiences in critical care and what could have been done differently.

“It reinforces to the staff that patient and family engagement is worthwhile and how it actually makes for better outcomes and improves how people regard the hospital,” she says.

As far as lessons she’s learned from TTrACE Academy, Zittell says she always goes early so she can hear more of the sessions because they help to reinforce practical techniques for dealing with stressful scenarios.

“I had a situation last week when things became a little overwrought and I was feeling particularly stressed,” she recounts. “I was able to pull myself back and take a minute to do some breathing and regroup.”

“I’m not sure they always have that luxury in the ICU,” she says with a knowing laugh. “But – at the end of a stressful day – I’m sure it would be a really useful technique.”

Pulkit Bhuptani, Clinical Pharmacist for the Medical Surgical Intensive Care Unit at St. Michael’s Hospital

Pulkit Bhuptani

Pulkit Bhuptani has been at St. Michael’s for nearly 10 years as a clinical pharmacist, primarily working in Critical Care. He was in one of the first groups to complete the TTrACE Academy program, and now leads the Emotional Intelligence section as a facilitator.

One of Bhuptani’s key learnings was about listening to understand, rather than to react.

“Most of the time, when you’re listening to someone, you’re already starting to think about how you want to formulate your response or troubleshoot that person’s experience,” he explains.  “But sometimes all they really need is a good listening ear.”

This lesson has also come in handy outside of work, particularly with his partner. He tries to make more of an effort – even if it’s just for 10 minutes a day – to sit down, ask his partner how their day went and actively listen with his full attention.

Bhuptani also says the lesson of taking a few deep breaths before responding when your emotions are running high has become a helpful tool as the parent of two young children.

“My youngest is still learning emotional regulation and, as a parent, you can lose your cool because your child is acting in a way that triggers a stress response,” says Bhuptani. “I’ve become more mindful of that and try to take a few deep breaths before I engage in those situations.”

Overall, Bhuptani feels that the TTrACE Academy was a very rewarding experience and he continues to enjoy his involvement as a facilitator.

“A forum like this is important, especially as frontline health care workers where you’re constantly dealing with very high stress situations,” he says. “You don’t often have the opportunity to reflect on what’s important to you and your team.”

Thank you to the many staff, leaders and patient and family partners who participated in the development of the Team Training and Clinical Excellence Academy and who currently help to run the program. Special thank you to the following people and teams: Karlie DeAngelis, clinical educator – nursing; Critical Care; Education; Leadership & Organizational Development; Patient Safety; Patient Experience; Anti-Racism, Equity & Social Accountability; and Mission & Values.   

By: Robyn Cox