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Jane Hollett Patient-Centred Care Project Manager University Health Network Corporate Nursing Acute Care Toronto, Ontario Jane.Hollett@UHN.on.ca
When was your practice implemented? Sept 2008 - August 2009
Describe the issue that prompted the implementation of your practice: University Health Network has been engaged in a strategy to create a patient-centred culture since 2004. The education strategy had evolved over time as a way to improve the experience of patients and families and a way to improve the quality of work life of staff. In this project the question to be answered was "What is the impact of providing patient-centred education to a whole intact team on one in-patient unit while also developing unit leaders to lead for PCC and actively engaging physicians and the IP team in the culture shift?" The organization was interested to see if patient satisfaction scores could be improved through this initiative and what other shifts could be noticed.
Describe your practice: The practice involved 4 key elements: 1) Education* Six 3-day comprehensive patient-centred care courses were offered to approximately 80 staff between October 2007 and February 2008.2) Leadership development* Leadership Engagement: Meetings with leadership team occurred throughout the duration of the project. Outcomes included the creation of a unit vision, identification of PCC-related projects and collaborative integration strategies.3) Engaging physicians and the IP team, and * Meetings with physicians were held to understand key motivators/concerns and to explore how they could participate; focused discussions on how patient-centred care linked to their practice; observed physicians and APNS in practice and held two facilitated team meetings.4) Discovering how to both keep the gains made through the project activities and "fan the flames" of ongoing change.* Strategies to maintain momentum include focus groups, joint projects, & tracking changes.
Describe how your practice was implemented and the resources required (e.g. people, time, money): The practice was implemented at the request of the CEO and involved a team of 7 from corporate nursing and organization & employee development. Two staff were dedicated to education,and others worked collaboratively on all the other components of the initiative, devoting varying amounts of time at different phases. The cost of staff replacement to attend the courses was $22,000. To better understand the patient satisfaction survey a statistician became part of the team supported by the CEO. A working group has been formed to further analyze the patient satisfaction data.
Explain the impact of your practice: Team developed a common understanding of PCC; members are better able to support and hold one another accountable for practicing in a PCC way; members take more risks such as calling each other on non-PCC practice and communicate with each other with less hesitation; members have a better understanding of roles & increased respect for other perspectives. Increased leaders? personal understanding of PCC; a focus for frontline leaders? role as coaches; staff valued leaders visibly modeling PCC; team focused on common interests and challenges; less morale distress experienced related to some types of patient discharge, outdated protocols eliminated, patient education revamped and patient's pain and experience is now guiding post surgical ambulation and adls. Patient satisfaction increased by 2% from year before the intervention and patient complaints are down by 70% during year of intervention.
How did it improve quality of worklife? * Staff know each other in a deeper way and greater trust and respect have led to smoother relationships, more risk taking and self leadership. * Actions that have resulted such as cancellation of patient education classes that had been based on outdated information have led to much less conflict between team, patients and physicians. * First quarter of year following intervention only 1 person complained. * Staff free to make decision to begin mobilizing patients.* Addressing moral distress.* Gates open for meaningful projects, free to adjust to the situation, not as afraid.* Leaders have new focus - feeling successful.* Rising stars 'feel good'.* Ongoing support for 'living lab' concept.
How do you know? (e.g. surveys to staff, a formal evaluation process, specific outcomes, feedback) * One-on-one private interviews with an external person with 50% of the staff, all the leaders and physician lead.* Comparison of patient satisfaction scores for the year prior to the intervention, and the year of the intervention. Scores will be monitored for the year following the intervention.* Comparison of patient complaint data.* Project team reflection.* Patient satisfaction - analysis of comments included in the patient satisfaction survey.* Quarterly focus groups with leaders and unit council.* Track practice changes.
What lessons learned and issues to consider are you able to share with colleagues? Spend time on the unit before hand to understand the leadership group, organizational structure, unit culture and patient flow, then design the training, resources and supports; identify clearly who the leaders are - formal and informal; understand the leaders' challenges, goals and priorities and respond by providing practical tools, resources and support when and where needed; expect to provide ongoing regular support after the intervention year, even if less often. Do homework to understand what is important to physicians and what practice issues are challenging them; take an exploratory approach to identify how they might be engaged in PCC work; ask 'what is in it for you?' and build the physician strategy based on that; spend time observing to better understand their world; much of the impact of this project came from supporting inter-professional team building through facilitated dialogue.
