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After 33 years of progressive leadership positions, a legacy of transforming culture and coaching for exceptional outcomes, Senior Clinical Director Judy Costello has retired from UHN.
Joining UHN as a Clinical Nurse Specialist in the cardiac program in 1987, Judy quickly rose through successive leadership positions which included Director of Nursing at Toronto GeneralHospital (TGH), Senior Clinical Director of Surgical Services at TGH and Princess Margaret Cancer Centre (PM) and, most recently, Senior Clinical Director, Malignant Hematology, Blood Disorders and Supportive Care at PM, UHN.
She has co-authored many papers on quality and safety, innovative approaches to goal setting in a complex organization to improve staff engagement and patient satisfaction, and on personalizing care in a highly technical environment by adding patient photos at the bedside of a critical care unit.
Judy has also presented nationally and internationally on patient-centred care, quality and safety, professional practice and pain management. She is cross-appointed to the Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto.
With her characteristic friendly smile, engaging personality and fierce drive to do better, Judy has had a profound impact on operations and practice portfolios at UHN. She credits her start in nursing in Newfoundland for instilling a desire to always keep on learning and growing.
"Early in my career in Newfoundland, I was socialized to the profession of nursing in an environment where our nurse managers and medical leaders expected us to act and function as leaders," says Judy, who retired on July 31.
"It was a great environment to work in – expectations were high, and, as a result, we were a great interprofessional team who had fun too."
Judy brought that cheerful,can-do attitude and collaborative skill set to every opportunity to effect change and achieve exceptional outcomes at UHN.
As the Director of Nursing at TGH, Judy was highly engaged in the implementation of patient-centred care at UHN, as well as the development of a professional practice model for nursing and allied health.
In her role as leading Surgical Services at TGH, Judy worked with the Surgeon-in-Chief and others to implement a surgical scorecard to drive performance and efficiency. In addition, she was part of a collaborative, interprofessional team that transformed Operating Room (OR) culture for a healthier work environment, and included a code of conduct team charter, coaching for conflict resolution, a comprehensive educational component to build a deeper understanding and appreciation for interprofessional team members, and "Respect in Motion" Team Charter Recognition Awards.
Three years after the transformation began, scores from an employee survey had increased more than 40 per cent on key elements such as recognition, communication, teamwork and respect. And requests for the OR Respect tool kit and plans poured in from departments across UHN and beyond.
"We invested in every staff member and physician," Judy says. "We gave them the tools and methods to communicate effectively, calmly, with civility, in a high-intensity environment.
"Then, both leaders and individuals were held accountable for these changes."
At PM, Judy's portfolio included malignant hematology, hematology and UHN Palliative Care. Judy was co-chair of the Toronto Central LHIN Palliative Care Council, and participated in a number of PM and Ontario Health (formerly Cancer Care Ontario) priorities to advance care and system flow for Acute Leukemia and models of care for Complex Malignant Hematology. She also co-chaired the Princess Margaret Quality Committee, and worked to support the transformation of quality and safety at PM.
"Judy is passionate about quality care, and making change that directly impacts patients and families for better care," says Jan Newton, Clinical Vice President, UHN, who has known Judy for more than 20 years in various leadership roles. "She's curious, asks a lot of questions, and she knows how to bring people together.
"She's got a great sense of humour, and people just naturally like to work with her."
With her usual focus and rigour, Judy helped develop four Quality Campaigns at Princess Margaret to facilitate a shift in culture and awareness of Safety and Quality throughout the hospital. In-depth and consistent reporting helped bring out and solve system issues, while also engaging physicians and staff at all levels to report safety incidents.
Branding the work "Quality Lives Here," Judy and staff began daily team huddles, embedded visual reminders on the units to, for example, "transfer (patients) with care" from one team member to another at shift change, and gave out "Good Catch Awards"in the form of a baseball mitt and ball.
As a result, reporting of critical and severe incidents increased by 117 per cent, and reports of good catches – anything that prevented patient harm –increased by 36 per cent.
"By creating standards and setting expectations, we encouraged staff to talk about incidents, and what could be done to prevent them in the future," says Judy. "We developed tools and templates to help with reporting.
"And we made sure to talk about this in a blame-free culture, with an emphasis on patient safety as everyone's responsibility."
Dr. Christine Chen, hematologist and Medical Director of the Cellular Therapy Program, characterizes Judy's strengths as thinking and acting nimbly, while taking into account many factors. This, coupled with a desire to listen carefully and respectfully, while being open to new ideas, makes Judy an effective leader in gathering the resources and teams together for successful projects.
"She's very good at juggling many different balls in the air," says Dr. Chen. "If the team runs into road blocks, she's great at directing them towards solutions.
"It's rare to be so skilled at navigating a complex environment, while keeping the team focused and working so well."
One key project was the expansion of the Allogenic Stem Cell Program – which uses stem cells from a related or unrelated donor – in response to Ontario leukemia patients having to go out-of-province to receive life-saving transplants.
In 2016, many Ontario patients had to be referred to U.S. centres for transplants because there was no space or staff to treat these patients.
Judy led the team to plan and implement a Ministry of Health Capital Plan to double the number of allogenic transplants at the Princess Margaret by opening a unit with 12 new designated beds.
Along with a new inpatient pharmacy and initiation of next generation sequencing for human leukocyte antigen (HLA) typing for best donor matches for bone marrow and blood transplant, the expansion resulted in a 45 per cent decrease in wait times for patients.
Another project was the planning and development of a new Day Hospital for outpatients receiving stem-cell transplants. By helping the team transform select inpatient resources into a new six-chair Day Hospital, one half of all 300 autologous stem cell transplants are now done as outpatients.
"It's very patient-centred," says Dr. Chen. "Patients get treated here, surrounded by their loved ones, and recover in the comfort of their homes. It's better care and outcomes for our patients."
Judy also helped lead the development of a comprehensive bone marrow transplant data base which can be easily accessed by all teams involved in acute leukemia and transplants, recalls Dr. Chen, adding that rich data and outcomes are now available for the teams, so they can analyze, plan ahead and improve clinical care.
In international work by the Princess Margaret, Judy conducted a mock accreditation at Kuwait Cancer Control Centre and collaborated in the development of a site-based leukemia program at the National Centre for Cancer Care and Research in Qatar, where she co-led the team through a retreat and a three-year plan to transform their program.
For Senior Clinical Director Mary Kay McCarthy, who has been a colleague for more than 30 years, Judy has been a generous and kind mentor.
"Judy always gave us golden nuggets of advice, reminding us about evidence-based practice," says Mary Kay. "She taught us how to focus and finish projects, and to feel included and heard.
She is a gracious leader."
In retirement, Judy plans on continuing with her adventures in mountain trekking, visiting foreign countries, conducting Accreditation Canada surveys, and "taking every opportunity to grow."