As an Quality Improvement Advisor for the Improving & Driving Excellence Across Sectors (IDEAS) Program, I have the pleasure of working with different health care teams as they embark on projects to improve the quality of health care in their organization through the Advanced Learning Program. This program is designed to equip health care professionals with the knowledge, skills and tools to lead quality improvement initiatives.
In our most recent cohort of teams, the N’Mninoeyaa Aboriginal Health Access Center (AHAC) joined the IDEAS Advanced Learning Program to work on a Quality Improvement project.
Improving advance care planning
Many First Nation clients receiving care through the N’Mninoeyaa AHAC who have been diagnosed with a life limiting illness do not have formal Advance Care Plans in place. As a result, their wishes for their end of life journey under Creator’s Care are not realized.
The aim of the team was as follows:
- By March 31st, 2019, 90% of N’Mninoeyaa AHAC health service providers will report being comfortable with having goals of care and advance care planning conversations.
- Provide training and resources to health care providers to increase comfort level with having goals of care (GOC) and advance care planning (ACP) discussions using cultural teachings as a foundation.
- Create a standardized process for documentation in the electronic medical record.
- Create a clinical pathway for having GOC/ACP discussions.
- Develop culturally appropriate resources for clients and families on GOC/ACP using a trauma informed lens.
The team developed the following change ideas to tackle their project.
Figure 1: Driver diagram used to achieve the quality improvement project goal
As a first step, a training program called the Learning Essential Approaches to Palliative Care (LEAP) was delivered to several health care providers. They report understanding where they fit in the process of developing advance care plans.
Team member Edith Mercieca, Director of Community Support Services shares:
“It was evident that client/family comfort with having goals of care/advance care planning discussions was a large factor as well as health care provider comfort. The training program developed helps to fill this gap.”
The team’s next steps are to continue to implement their change ideas including:
- Delivering agency wide LEAP training and using the train-the-trainer model for onboarding new staff in the future.
- Tracking goals of care and advance care planning discussions in the electronic medical record as part of individual service provider performance monitoring.
- Developing a Creators Care palliative care model including a formalized clinical pathway for establishing advance care plans with the larger team.
- Completing a post survey with health care providers.
- Developing culturally appropriate resources for clients/families for advance care planning.
Edith Mercieca shares:
“The IDEAS quality improvement tools, such as the fish bone exercise, assisted us greatly in confirming assumptions made at the beginning of our IDEAS journey. The tools also helped us to analyze and articulate our data effectively. We look forward to sharing our journey, tools and resources more widely.”
You may also be interested in these other palliative care posts on Quorum.