The Canadian economy posted its second straight month of impressive growth in July, strengthening the case that the country's economic fortunes have turned a corner following a trying first half of the year.

Statistics Canada reported that Canada's real gross domestic product grew by 0.34 per cent month-over-month in July, building on the 0.44-per-cent growth posted in June. The two-month upturn marks a sharp reversal from the first five months of the year, when the economy contracted each month, bogged down by the impact of the oil shock and an unusually harsh winter. After a cumulative GDP decline of 0.9 per cent over the first five months of 2015, the economy has now rebounded by nearly 0.8 per cent over the past two months of data.

"After a growth stumble in the first part of the year, the Canadian economy appears to be picking itself back up," said CIBC economist Nick Exarhos in a research note.

The July result topped economists' consensus estimate of 0.2 per cent. However, Statscan did revise its June growth estimate down slightly, from an originally reported 0.5 per cent. Still, the solid July result bolstered confidence that the third quarter of the year is on track for a strong rebound in growth, after the economy contracted at an annualized rate of 0.5 per cent in the second quarter and 0.8 per cent in the first quarter.

Economists now believe third-quarter GDP is on track for annualized growth of between 2.5 and 3 per cent, well above the 1.5 per cent that the Bank of Canada projected in its most recent forecast in mid-July.

"This rebound from the weak growth over the first half of the year reflects in large part strengthening exports and consumer spending starting to more than offset continued declines in energy investment," said Royal Bank of Canada assistant chief economist Paul Ferley in a research report.

July's growth was led by a 2.9-per-cent jump in mining and oil and gas extraction, adding to the 2.6-per-cent growth in June that had snapped a seven-month streak of declines. The oil and gas segment surged 9.1 per cent, mainly owing to a recovery in oil sands output, which continued to come back after being slowed by maintenance shutdowns and production glitches over the spring.

The manufacturing sector was also a major contributor to July's GDP gains, posting its second consecutive 0.6-per-cent monthly increase. Much of the gain was driven by the motor vehicles segment, as auto makers shortened their usual seasonal maintenance downtime in order to feed strong demand in the U.S. market. But with the autos segment now having bounced back strongly in the past two months from the maintenance and retooling shutdowns, experts cautioned that the manufacturing sector may be due for a pause from the brisk early-summer pace.

"Considering the subsequent decline in activity at U.S. auto assemblies, factory gains may not extend to August," said National Bank of Canada senior economist Krishen Rangasamy in a research note.

But while economists doubted whether the goods-producing side of the economy could sustain its strong growth of the past two months (up 0.8 per cent in July and 0.7 per cent in June), they expressed optimism over the services side of the economy, which continued its trend of steady growth. Services industries rose 0.2 per cent in July, the sixth consecutive month of expansion. In particular, they said, that bodes well for job growth, which has remained resilient this year despite the stumbles in economic growth in the first half.

"The solid growth of the labour-intensive services sector over the last year is a sign that the Canadian labour market is holding up better than Canadian output in 2015," said Bill Adams, senior international economist at PNC Financial Services Group.

Finance Minister Joe Oliver, speaking from his campaign office in Toronto, held the July GDP report up as evidence that the Canadian economy is back on track.

"What it signals is clearly we are on the move. Our economy is growing," he said. "Canada is going to have solid, strong growth in the second half of the year and experience positive growth for the full year."

But economists cautioned that a significant portion of the July gain reflects a bounce-back in activity to more normal levels after some temporary slowdowns in the first half of the year, and particularly from the downtime in auto and oil sands production. As a result, that pace of growth could prove hard to sustain in the final few months of the year once these rebound effects wane – especially given the still-uneven nature of the economy's fragile recovery.

"Nine of 19 non-oil sectors had zero or negative growth in July," said economist Jim Stanford of Unifor, Canada's biggest private-sector trade union. "The strong headline number was all about oil rebounding from spring problems, and that cannot continue in subsequent months."

1. What are the main drivers of GDP growth rate in the Canadian economy according to this article? Explain fully.

2. Why does the article sound a cautionary note to the otherwise upbeat GDP data.

"Darn! I have to call Pharmacy again," Lisa, staff nurse on 6 East, muttered under her breath. "This is the third time today and it's not even noon!" She left the Omni-Cell Cart in the medication room and proceeded to the phone at the nurses' station. She dialed the familiar number-she had it memorized of course and thought, "There has to be a better way." For the past few days, she had noticed an increase in the number of medications missing from the medication carts. Two days in a row, she was able to get a vitamin from another patient's medication drawer and administer it to her patient, but she knew this did not solve the problem. She was just trying to make it through her shift and get the patients what they needed. In the meantime, on 6 West across the hall, Deirdre had a similar issue. The morning dose of her patient's oral antibiotic was not in the drawer, so she gave the dose that was labeled "evening dose." The evening shift nurse then had no evening antibiotic dose in the drawer and had to call the pharmacy to get a replacement. Numerous calls were being placed to the pharmacy. The pharmacy technicians were so busy fielding phone calls that none of them were available to deliver medications, so the staff nurses had to leave their units and patients and go to the pharmacy in the basement to retrieve their missing doses. The pharmacy technicians began complaining to their supervisors that those 6th floor nurses call so frequently that they do not have time to do their work. Nurses complained to each other that pharmacy was not stocking the medication carts correctly. DISCUSSION QUESTION 1. In an organization that espouses a good patient safety culture, what should happen next? 564 CHAPTER 18 HEALTH CARE MANAGEMENT CASE STUDIES AND GUIDELINES Part Two Nune Lisa notified her nurse manager, Katie, that there was an increase in the number of Likewise, Marcus, the nurse manager on 6 West, heard from his night shift nurses tha medication doses that were unavailable at the time of their scheduled administration, were not in the medication cart. That same morning, Katie was on the way to a b they had to "run to pharmacy" many times during the night to get medications tha greetings, Katie asked Marcus how it was going. Marcus explained that several of his mus complained about pharmacy not stocking the medication carts appropriately, but he had Manager Meeting when she ran into her colleague on 6 West, Marcus. After exchanging Katie explained that one of her staff nurses made this same complaint earlier that day. They no time yet to verify this or to talk to the pharmacist. It was on his "to do" list though both decided to raise this as an issue to be discussed at the Nurse Manager Meeting "Is anyone else having trouble with Pharmacy?" Marcus asked at the end of the meeting "My staff nurses are complaining that the med carts are not stocked correctly." Many hands went up, and others chimed in that they thought it was an issue only for their specific units, but now they realized how widespread this problem was. Because the Nurse Managers practice shared governance, they appointed Katie and Marcus to lead a Performance Improvement (PI) Team to figure out what the problem was and to take action. Three other Nurse Managers volunteered and joined the team; after a short meeting, the team agreed upon a plan. DISCUSSION QUESTION 1. At this point, what should the PI Team's plan entail? Part Three The Pl Team members queried their respective staffs to better understand the problem. The staff nurses' main complaint was that the 10:00 a.m. medications for patients were not in the medication carts. The pharmacy techs' main complaints were the massive number of phone calls and that the carts were being returned with unused medications that were being thrown away. The nurse managers and pharmacy representatives on the team met together to develop a process flow diagram of the medication order and administration process. Figure 18-7 depicts their process flow diagram. The PI Team also agreed to maintain a 24-hour record of missed doses and calls to pharmacy during the next work day. The team met again in two days and determined the numbers of missed doses and calls to pharmacy over a 24-hour period in the five units that were participating in the PI Team. Figure 18-8 contains this information depicted in a run chart format with time on the horizontal axis (hours of the day) and missed medication dosages on the vertical axis. TROUBLE WITH THE PHARMACY New Order: Provider prescribes medication for patient on order in the computer Order transmitted to pharmacy and to nursing 545 Pharmacy Transcribes onder into nursing section of Eu Evaluates order; enters into pharmacy computer system Selects medication and prepares medication for unit dose Assesses patient at beginning of shit, nes medication orders and times notes alerges and any premedication monitoring requirements in checking heart rats and or blood pressu Dispenses dose to unit; schedules frequency for refilling Refils carts daily for recurring medications Prior to medication administration time writy orders and select medications, conduct premedication assessments Identify patient verbally, verity allergies scan barcoded medication packet and patients 10 Educate patient about medication, administer medication Document medication administration in EMR Assess patients responses to medication and document Move on to next patient and repeat process 4 to 7 times depending on patient assignments -7 Process Flow Diagram of Medication Administration Process TROUBLE WITH THE PHARMACY 567 DISCUSSION QUESTION 1. What solution should the nurse managers and the pharmacy director implement? Part Five A simple change in the cart turnover time to 11:00 a.m. quickly rectified the problem, thus increasing the doses available for morning and twice-daily medications, decreasing the phone calls to pharmacy, decreasing wasted medications, and eliminating the workarounds that were potentially hazardous to patient safety. DISCUSSION QUESTION 1. Given the solution, is there a need for any additional quality improvement in the medication administration process? CHAPTER 18 HEALTH CARE MANAGEMEN 4 South 4 North -4 West AM 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 FIGURE 18-8 Run Chart of the Number of Missed Doses and Calls to Pharmacy DISCUSSION QUESTIONS 1. Please compare Figure 18-7, the process flow diagram of the medication process, and Figure 18-8, the run chart of missed doses and calls to pharmacy. What is missing in the flow diagram (Figure 18-7) that is evident in the run chart (Figure 18-8)? Explain your answer. 2. Given the data that has been collected and analyzed (see Figures 18-7 and 18-8), what is still missing from the quality improvement analysis? Part Four After examining the flow chart and the run chart, the PI Team discussed why medications were missing during administration around 10:00 a.m. The pharmacy representatives shared that the pharmacy had changed their policy on cart restocking based upon what the new Pharmacy Director was accustomed to in his last job-carts changed out at 9:00 a.m. What the Pharmacy Director did not understand (and did not bother to ask) was that medication times for routine (once) daily medications were set by the hospital for 10:00 a.m. Based on the hospital's once-daily schedule, the nursing staff scheduled twice-daily medications for 10:00 a.m. and 10:00 p.m. As a result of the change by the Pharmacy Director, medications that were supposed to be given at 10:00 a.m. were being returned to pharmacy as unused. 566 35 30 25 20 15 10 5 East 6 West DISC 1. W Part 1 A simp increa phone that v DIS 1.