Each year, staff at Health Quality Ontario read the Quality Improvement Plans (QIPs) submitted by Ontario hospitals, primary care organizations, long-term care homes, and local health integration networks (which administer home care). We identified some stand-out examples from the 2017/18 QIPs showing how organizations have engaged patients or residents and their families and caregivers, and reached out to the people involved to find out more about their experiences.
Here, we spoke with Valerie Armstrong, Director, Quality and Risk at North Simcoe Muskoka LHIN Home and Community Care Services, to discuss the lessons they have learned from their experience engaging patients, caregivers, and families.
Can you tell us a bit about your approach to engagement?
We recognize the importance of engaging patients and caregivers to better understand where there are opportunities for improvement in the care we provide. Our team starts by analyzing the patient/caregiver experience survey data to identify opportunities for improvement, and from there, we talk with a group of patients/caregivers to learn more.
As an example, we have called 25 to 30 patients and asked additional questions to better understand their concerns and to clarify specific opportunities for improvement. It has helped us find out what they are really looking for. For example, what does it mean to patients that they are having a good patient experience? The interviews put context to the answer. For each patient, excellent might mean a different thing.
With the transition of the CCAC to the LHIN, we now have a Patient and Family Advisory Council and can look for new opportunities to further understand patients’ experience of care and to assist us in the co-design.
What did you do?
We engaged patients and/or caregivers in specific opportunities. In one example we included in our QIP, we talked about the Safe at Home webpage. Caregivers and patients gave their feedback on what was missing from this website, what they would use, and what worked well.
We were also aware that we did not have a survey and thus feedback on patient/caregiver experience with the end of life care that was provided. As you will see in our QIP Workplan, we initiated the Caregiver’s Voices survey and started looking at those results to identify opportunities for improvement both as an organization and within in our system, in partnership with the Regional Palliative Care Steering Committee.
We also use our quality of care review process to look at critical incidents and at complaints regarding quality of care, for example about the palliative/end-of-life journey, and invite caregivers to the review to talk with us about how to improve their experience and the experience of other patients/caregivers in the future.
What best practices and lessons learned would you like to share?
We used a combination of patient engagement frameworks and best practices from Health Quality Ontario and the Change Foundation. For the quality of care review process, we use the Canadian Incident Analysis Framework from the Canadian Patient Safety Institute.
We are finding that it is important to engage patients and caregivers in their journey across the continuum (not just within our organization). We may look at a complaint or a critical patient safety incident and that patient’s/caregiver’s voice to better understand their concerns and identify opportunities for improvement. As an example, from a quality of care review following a caregiver complaint, we have learned that in their end-of-life journey patients/caregivers see the care team not as separate organizations such as hospice, home and community care, the primary care provider, etc, but all as one team, and that is how it should be. So we should all be there to participate collectively in a review for the purpose of improvement and to ensure recommendations are implemented collaboratively across the system, and not just by one organization.
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Quorum’s Indicators & Change Ideas page. Find more information about QIP indicators and related change ideas.