Resident and Family Engagement in Quality Improvement Compassion Excellence Spirituality Sacredness of Life Justice
Overview Our Resident and Family Centred Care model and guiding principles Data from the Health Quality Council of Alberta Long Term Care Family Experience Surveys and the Continuing Care Health Services Standards is used as a framework to support advancement of resident and family centred care. Creating a culture of engagement moving from residents/families being receivers of LTC services to active participation, advocacy, education and the role of the continuing care system. What are the drivers of resident and family engagement? How do we use these drivers to advance quality of life and quality improvement in the continuing care system? Introduction and use of Resident and Family Advisors to support and improve quality improvement.
2011 Health Quality Council of Alberta LTC Family Experience Survey 2008 and 2011 LTC Family Experience Surveys What they told us. Resident centred care domains of the survey showed significant improvement in the two survey cycles. The survey results showed that our resident-centred care model was operationalized and becoming part of the organization s culture.
Person and Family Centred Care Charter Person and family centred care is about a special and unique story, each resident s journey past and present and the part you now play. It is about respecting and supporting choices. It is about working with the resident and their family, listening, learning and sharing about what is really important to them. Guiding Principles Dignity and Respect active listening, honouring resident and family values, beliefs, cultural norms, choices and decisions. Participation residents and families are encouraged and supported in participating in their care and making informed decisions. Information Sharing communication that is two-way, timely, complete and transparent. Collaborative residents and families are provided meaningful opportunities to engage with care providers and leaders regarding care planning, policy and program development. Guiding Principles - Adapted from Patient Centred Care Model, Government of British Columbia, Ministry of Health 2012
Our Vision of Resident and Family Centred Care The Resident s Voice is anchored in all behaviours and drive activities and decision making throughout our organization. A Culture of Engagement is self evident and integrated throughout our organization. Programs and Services are planned, implemented and evaluated upon Resident and Family Centred Care principles.
2011 Health Quality Council of Alberta LTC Family Experience Survey Question 42 In the last six months have you been involved in decisions about your family member s care? (Yes/No) Q42 - Involvement in Decisions About Family Member's Care FATHER LACOMBE (2010) 90.70% FATHER LACOMBE (2007) 88.50% CALGARY ZONE (2010) 85.10% ALBERTA (2010) 83.20% 78% 80% 82% 84% 86% 88% 90% 92%
2011 Health Quality Council of Alberta LTC Family Experience Survey Question 43 In the last six months, how often were you involved as much as you wanted to be in the decisions about your family member s care? (Always) Q43 - Involved as much as wanted in decisions about Family Member's Care FATHER LACOMBE (2010) 74.60% FATHER LACOMBE (2007) 57.40% CALGARY ZONE (2010) 55.70% ALBERTA (2010) 56.90% 0% 10% 20% 30% 40% 50% 60% 70% 80%
2011 Health Quality Council of Alberta LTC Family Experience Survey Question 47 If Someone needed nursing home care, would you recommend this nursing home to them? (Definitely Yes) Q47 - Recommending the Long Term Care Centre FATHER LACOMBE (2010) 78.90% FATHER LACOMBE (2007) 63.20% CALGARY ZONE (2010) 51.40% ALBERTA (2010) 55.90% 0% 20% 40% 60% 80% 100%
Opportunities Quality Improvement Our Journey In 2012 we started a focus group consisting of families, residents, physicians and frontline staff. The purpose of the focus group was to explore further opportunities to engage residents and families in quality improvement. One of the recommendations was to establish Resident and Family Advisors to identify and support quality improvement through the lens of the customer. ie: residents, clients, families and volunteers.
Our Journey Opportunities Quality Improvement We developed a Quality of Life assessment tool to better understand what defines quality of life through the experiences of our residents and families. The assessment scale is from 1 not important to 5 very important. The assessment is completed upon admission, after 3 months (to allow for transition) and annually thereafter. Data shows the top ranking quality of life indicators. having my pain be well managed. 4.88 having staff always treat me with respect. 4.75 includes being recognized as a person, not as my illness. 4.72 being involved in decision making about my care. 4.70 knowing that I m getting the proper medications. 4.65 having food that is nutritious and of good quality. 4.60 feeling that I or my family member can complain without fear of retribution. 4.56 having a comfortable bed and pillows. 4.55 having all my personal care needs met in a timely manner. 4.55 having staff who are friendly and courteous. 4.54 having the environment be clean and odor free. 4.53 knowing the building is safe and secure. 4.52
What is a Resident and Family Advisor A Resident/Family Advisor is a person who has had a recent experience of being a resident or the family member of a resident and is partnering with staff and physicians to provide direct input into policies, programs and practices which affect resident care and quality of life. What is the Role of a Resident and Family Advisor To partner with staff to ensure resident and family centered care is provided in manner that is compassionate, evidence based and honouring dignity and sacredness of life. To keep the resident and family as the focal point of our health system. To build partnerships with health care professionals based on mutual respect and open communication. To participate in quality improvement and program development To support Father Lacombe in their process improvement projects
Partnering with Resident and Family Advisors Benefits of Partnering with Advisors Advisors influence quality improvement and resident safety in three ways: 1. Health care professionals make fewer assumptions about what residents and families want and engage in more dialogue about what solutions are possible. 2. Advisors see things differently, and will ask, Why do you do it this way? Health care professionals often realize there is no evidence-base or valid answer. This helps organizations let go of processes that don t work for residents, families, clinicians, and staff and find better solutions that benefit all. 3. Advisors challenge the status quo. Adapted from Institute for Family and Patient Centred Care
Quality Improvement Projects supported by Resident and Family Advisors During the past two years, Resident and Family Advisors have brought forward or participated in the following Quality Improvement projects. Quality Improvement Dashboards public reporting Care Conference changes and experience survey Participation in Client Safety Committee Participation in Pharmacy and Therapeutics Committee Participation in review of the organization s employee dress code Participation in Care Manager and RN Team Leader interviews Participation in Accreditation, Continuing Care Health Services Standards review, Accommodation Standards Attends staff/unit meetings Participates in Board strategic planning Participates in dining experience planning and implementation
Resident and Family Advisor - Quality Improvement Story 1 Quality Indicators and Public Reporting In collaboration with the Client Safety Committee, two family advisors have identified an opportunity to publically share six quality indicators: Medication Incidents Pressure Ulcer Reduction Falls Antipsychotic Use Urinary Tract Infections and Catheter Associated UTIs Pain Management Using a balanced scorecard format, all resident family members/legal representatives receive a quarterly report outlining progress and outcomes related to these indicators.
Sample Quality Improvement Quarterly Report Quality of Care Report and Dashboard Using a balanced scorecard format, all resident family members/legal representatives receive a quarterly report outlining progress and outcomes related to these indicators. The balanced scorecard identifies standards or relationships with strategic partners such as Accreditation Canada, the Continuing Care Health Services Standards (2008), Attributes of Quality Health Quality Council of Alberta and our organization s mission, vision, values and strategic direction.
Resident and Family Advisors - Quality Improvement Story 2 Care Conferences Resident and Family Advisors provided feedback on the Care Conference process. Quality improvement activities included: Care conference packages are sent to family/legal representatives two weeks prior to the conference. The care conference package includes the resident care plan, quarterly interventions and goals, the Medication Administration Record (MAR) and the Goals of Care designation. This allows family members to review information and be an active participant in the conference process. A health care aide attends the conference, providing input and observations. A member of the interdisciplinary team provides a resident story. At the conclusion of the care conference a Care Conference Experience survey is provided to the family/resident.
Resident and Family Advisors - Quality Improvement Story 2 The Care Conference Survey The care conference survey is similar to the HQCA Family Experience Survey. The survey allows comparison of resident and family experiences related to person-centred care, quality of life and overall satisfaction with the services provided. Results from the surveys are recorded and a Care Conference Experience Report is provided to all committees, advisors, residents and family members.
The Care Conference Survey Tool
The Care Conference Experience Report (sample pages)
Other Quality Improvement Reporting Other Quarterly Reporting provided to residents/families: Call Bell Response Times and Escalations Caregiver (Health Care Aide) assignments Ratio of casual and regular staff Staffing shortages or reassignments
2011 2013 2015 2011 2013 2015 Quality Outcomes Where we are in 2015 In the last six months have you been involved in decisions about your family member s care? (Q42 HQCA-LTC) If someone needed a nursing home, would you recommend this one? (Q47 HQCA-LTC) 90.7% 90.0% 91.8% 78.9% 86.2% 88.7% 2011 2013 2015 In the last six months, how often were you involved as much as you wanted to be in the decisions about your family member s care? (Q43 HQCA-LTC) 83.0% 86.3% 2011 2013 2015 The dining experience is pleasant, welcoming and not rushed 58.4% 66.7% 78.6% 74.6%
Questions? Compassion Excellence Spirituality Sacredness of Life Justice