Profiles of Change
Thunder Bay Regional Health Sciences Centre
Thunder Bay Regional Health Sciences Centre (TBRHSC) is a 375-bed state-of-the-art acute care facility serving the health care needs of people living in Thunder Bay and Northwestern Ontario, Canada. It is the only Health Sciences Centre in Canada awarded "Leading Practice" for patient and famly centred care1 by Accreditation Canada.2
An Ambitious Strategic Plan 2006 - 2010
In 2006, Thunder Bay Regional Health Sciences Centre and the Northern Ontario School of Medicine formed a partnership to become Ontario's newest academic health sciences centre. With this new focus, Dr. Rhonda Crocker Ellacott led the development of the Clinical Engagement Task Force to look for a model that, among other things, promoted multi-disciplinary teamwork, integrated teaching and research, and provided coordinated and continuous care. After months of research, including visits to hospitals around North America, the committee found an approach that would work well: Patient and Famly Centred Care (PFCC).
The Patient and Famly Centred Care model is respectful of and responsive to patient and family preferences, needs, and values, and provides a guide for all clinical decisions. PFCC does this by recognizing that the delivery of health care is a collaborative partnership among patients, families, and caregivers including all Health Sciences Centre health care professionals and staff.
Knowing that there are many challenges to integrating a system-wide change and approach to health care, Thunder Bay found the best way to do this was to implement it systematically over time.
Beginning in 2008, TBRHSC began engaging staff, physicians, and community partners in a discussion about care. Reviewing leading practices and research from organizations across the nation enabled Thunder Bay to build support and momentum around a model of care that would help advance the organization as a new academic health sciences centre.
Throughout that summer, Dr. Rhonda Crocker Ellacott was able to secure organizational funds for PFCC and invest in a full-time PFCC Program Lead—Bonnie Nicholas. This change set the foundation, taking the organization on a journey with a richer appreciation of what it means to work in a collaborative partnership with patients, families, staff, physicians, and volunteers, across all disciplines and departments and develop a new PFCC culture. In the fall and winter, leadership met to draft a new Mission and Values Statement for the Health Sciences Centre to reflect the commitment to PFCC. The leadership laid the groundwork for creating Patient and Family Advisory Teams, and started recruiting members.
In March 2009, the committee held a PFCC Leadership Visioning Retreat that marked the official beginning of PFCC at the Health Sciences Centre. Patients, families, staff, leaders, Board Members, physicians, volunteers, and community partners met to share stories and create plans to innovate and integrate PFCC into "our plan of care." Objectives included: improved patient, staff, and physician satisfaction, better health outcomes, enhanced teamwork, improved quality and safety, fewer medical errors, and better use of resources. Patient and famly centred care was formally adopted as the model of care.
Recognizing the importance of family in the care process, Thunder Bay developed an approach to care that is supported through collaborative partnerships with patients, families, and other members of the care team. Thunder Bay has declared its mission, "To advance world-class Patient and Famly Centred Care in an academic and research-based, acute care environment".
This model of care cultivates vital partnerships at the bedside, in care plan decision-making, healing relationships, and individual patient/professional interactions. As a result, access, coordination of care, safety, physical comfort, emotional support, and involvement of friends and family all greatly improve.
In 2010 and 2011, partnering and collaboration were the key drivers of achievement. All of Thunder Bay's significant initiatives demonstrate the value placed in working across disciplines with patients and families.
Patient and Family Involvement
Patient and Family Centred Care is the driving force behind positive changes in the organization. This journey of partnership with patients and families has created a foundation of trust and collaboration. Patients and family members may be involved in a one-time activity, such as sharing the hospital experience with health care providers, or on-going participation in a committee, working group, or team.
Patient and Family Advisors (PFAs) assist in all endeavors—from sitting on formal committees, sharing their stories, to being part of a working group. Patient and Family Centred Care Pediatric tours of the Operating Room began as a result of suggestions from advisors. Patient and Family Advisors have helped develop educational materials, the PFCC Resource Handbook, Emergency Department signage, and other hospital policies.
Any policy affecting patients and families must be developed with patients and families in order to be approved, all management positions require a PFA on the interview panel, including the hiring of a new CEO, and PFCC orientation for new staff is done by PFAs.
Seventy-Nine (79) Patient and Family Advisors are members of program and service teams and committees to transform the delivery of health care and improve collaboration, participation, communication, and the overall care experience.
One example of a practice change is the use of bedside white boards to engage patients and families in their care. Patients, their family members, and other members of the health care team use bedside whiteboards to communicate information, goals, and readiness for discharge among other information. Initial audits of the process indicated poor completion in most clinical areas. Staff and Patient and Family Advisors felt that It was important for whiteboards to be completed with accurate information and with the participation and engagement of patients and families in the process. In 2011, staff and Patient and Family Advisors developed a plan to increase whiteboard completion and set a goal to improve by 10%, particularly with the involvement of family and friends, and information/education.
Other examples of positive changes resulting from engagement with patients and families include:
- Action Plans developed in each department in collaboration with patients and families based on their needs and priorities;
- New and evolving wait-time reporting methods;
- Changes to meal delivery times to inpatients to better meet their needs;
- Transitions in care improvements from the Emergency Department to the Intensive Care, from initial triage and registration;
- Development of a free patient E-mail Service offers the opportunity for loved ones to keep in touch during a hospital stay; and
- Tele-visitation is a service offered to patients to promote the participation of family and friends in the care process when barriers created by circumstance, geography, or weather are present— also designated a Leading Practice by Accreditation Canada 2011.
A movie short, produced by the TBRHSC Department of Communications and Engagement with input from pediatric patients, features the S.I.C.K. Team (Special Infection Control Kids Team), a group of children who promote better hand hygiene at the Health Sciences Centre. The movie is meant to be a fun reminder for patients, families, staff, and visitors alike that good hand hygiene is crucial to reducing the spread of infection.
NOD: Name, Occupation, Do
It is important, in terms of patient care, to know who you are interacting with and build the foundation to have a meaningful conversation. Thunder Bay Regional Healthcare System is committed to NOD: name, occupation and do, which identifies the staff members name, explains each person's role in care, and what the plan is for their interaction. To that end, staff—with the help of Patient and Family Advisors—created corporate education learning modules, an intranet site, videos, and orientation education materials, to teach NOD principles to each member of the health care team. A quality improvement goal for 2011 is for ALL employees throughout the hospital—on their first interaction with patients and families—to state their name, occupation, and duty (NOD).
Quality and Safety
Quality and safety of health care is a top priority at the Thunder Bay Regional Health Sciences Centre. The patient's and family's experience is the driver for safety and quality improvement. This collaboration is symbolized by TBRHS motto: Caring Together.
Through the Patient and Family Centred Approach to Caring Together, TBRHS has engaged in several strategies to improve the experience of care. Staff, with input from patients and their families, developed the Quality Improvement Strategic Plan, using data from the patient relations process, patient and employee/provider surveys, aggregated critical incident data, and patient safety indicators.
Thunder Bay Regional Health Sciences Centre's Board of Directors has designated two Quality of Care Committees to provide oversight and structure for patient safety and quality care within the organization. Patients are integral members of these committees.
Aboriginal Advisory Group
The TBRHSC Board of Directors has identified Aboriginal Health as one of the cornerstones of care delivery in the new TBRHSC Strategic Plan. Delivering appropriate acute care to Aboriginals while addressing the various cultural needs of patients and families in Northwestern Ontario is a corporate initiative. Engaging native Aboriginal patient partners in addressing health care, cultural, and language issues has resulted in significant gains, but the Committee believes that more has to be done in the delivery of patient care information, transportation for appointments, interpretation and translation, and dialect considerations with phonetic and syllabic needs.
French Language Advisory Committee
Thunder Bay Regional Health Sciences Centre is mandated by the French Language Services Act in Ontario to provide acute care to people requiring service in the French language. Due to the regional demographic, where some communities are above the 10% French speaking threshold, various initiatives have been undertaken. For example, hundreds of TBRHSC positions have been designated as requiring a person to be able to speak both English and French fluently. As qualified bilingual candidates become available, positions are filled. As a component of Patient and Family Centred Care, patient information relating to "care instructions" is being translated and made available for French speaking patients and families. In addition, this committee is tackling "signage" in TBRHSC to improve way-finding for French speaking patients and their families.
Spiritual and Religious Care
The Department of Spiritual and Religious Care at TBRHSC welcomes community spiritual leaders of all denominations to visit patients of their faith. The Spiritual Care team provides services that are sensitive to, and respectful of, the diverse expression of spirituality and religion, as well as those with no faith tradition. The Multifaith Spiritual Centre is open 24 hours/day for patient and family use and houses resources for worship. It is equipped to accommodate rituals such as Smudging and Pipe Ceremonies. Sacred Bundles (medicine bundles or collections of sacred items held by designated carriers from Native American tribes) are available upon request. Individuals can request assistance for these services from the staff Chaplains or are welcome to use the Spiritual Centre at their convenience.
Accountability is an integral part of effective Patient and Family Centred Care. For example, the Quality and Risk Management Department developed a number of new patient care programs and changes to Patient Satisfaction Surveys. The Safer Healthcare Now program is designed to increase patient safety by sharing and implementing procedures known to decrease the risk of adverse effects.
Studies show that organizations that rate high in transparency tend to outperform those that are less transparent; therefore results from the most recent TBRHSC Patient Satisfaction Surveys are posted on the website. Nine safety indicators are reported on the website, including data on hospital-related infections and the success rates of health care professionals practicing proper hand hygiene to prevent the spread of disease.
Clinical Pathways are interprofessional care plans incorporating best clinical practice for specified groups of patients with a particular diagnosis. Benefits to the patient include coordinated Patient and Family Centred Care, with consistent evidenced-based and best practice standards of care. Patients follow a care map from time of admission and some Clinical Pathways may extend to other facilities such as rehabilitation units or community for continued care. The patient and the family work with all members of the health care team. The "path" is used as a communication tool between patient, family, and other members of the health care team. All care is provided with the patient being the center of the plan and all health care team members, including family members, are educated and aware of the expected care and treatment plans.
The Ethics Team is available for consultation for specific ethical decisions, by invitation from patients, their substitute decision maker and their families or any one of the care team members.
TBRHSC has embraced Patient and Family Centred Care and as a result is changing the way TBRHSC cares for people. Patient and Family Advisors are central to all "go forward" strategies. As TBRHCS health care teams apply "best practice" strategies, patients and families are fully involved.
In December of 2010, Thunder Bay Regional Health Sciences Centre embarked on a new Strategic Planning process anchored in engagement. This new Strategic Plan provides guidance to TBRHSC as a leading academic health sciences centre through 2015. Patients and families have not only been involved in the development of this plan, they will figure prominently in its successful implementation.
1Thunder Bay Regional Health Sciences Centre uses the spelling: "patient and family centred care."
2Accreditation Canada is a not-for-profit, independent organization that provides health organizations with an external peer review to assess the quality of their services based on standards of excellence. Accreditation Canada is accredited by the International Society for Quality in Health Care and, since 1958 has fostered quality in health services across Canada and internationally.