Advancing a Vision for Leadership and Accountability for Patient Centred Care Wynne de Jong Director of Nursing Toronto General Hospital-University Health Network Collaborative Academic Practice
From Rhetoric to Action Sharing the story of UHN s 10 year journey to create a culture shift to patient centred care Moving from that story to the current context to share discoveries, possibilities, meaning making Look to future and health system trends that shape the discourse and prompt different questions
Setting the current context POLITICAL FORCES SHAPING THE AGENDA: Institute of Medicine 2001 Crossing the Quality Chasm Report ; LHIN Act (2006); ECFAA Act (Bill 146) SOCIAL FORCES SHAPING A SHARED GOVERNANCE MODEL: Patient Safety: focus on medical errors and risk Technology and Access to health information, i.e. patient portals Health Literacy, Cultural Competence & Health Equity & Diversity Evidence-based experiential design of healing spaces CONSUMER FOCUSED ORGANIZATIONS LEADING AND PARTNERING TO MOBILIZE THE CULTURE SHIFT: The Patient s Association of Canada Canadian Association for People-Centred Health Patients for Patient Safety Canada (supported by CPSI) INTEGRATED MEDICINE, PERSONALIZED/INDIVIDUALIZED MEDICINE, TELEHEALTH, TECHNOLOGY ENABLED CARE.
What is Patient Centred Care? An approach that consciously adopts the patient s perspective.about what matters. Through the Patient s Eyes (Gerteis et al, 1993)
Patient Centred practice is guided by values of. Respect means treating people with courtesy, esteem and accepting their choices without judgment, even when their decisions/choices are not what you would make for yourself Human dignity means treating people like human beings not like problems, objects or diagnoses.think of people first Person as leader means that individuals direct their lives and care. We support this belief by seeking to understand what is important to the person, acting on their priorities, and being guided by their goals for themselves
What does PCC look like? 1. Respect for Patient s Values, Beliefs and Concerns 2. Coordination/Integration of Care 3. Communication, Education, Information 4. Promotion of Physical Comfort 5. Promotion of Emotional/Spiritual Health 6. Involvement of Family and Friends 7. Transition and Continuity of Care 8. Access to Care (Picker Dimensions)
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Setting the Context: University Health Network UHN comprised of Toronto General, Toronto Western, Princess Margaret, and Toronto Rehab Overall umbrella organization that supports each of the hospitals "Network" expresses members' independence, interdependence and interactivity Our network is patient centred: our resources focus on the patient, resulting in highly responsive, effective and streamlined care Model embraces the growing role of the patient as a partner in health care
Setting the Context: UHN Strategic Directions 2016 5 domains linked to UHN Balanced Scorecard CARING strategic theme linked to Patient Outcomes Linked to patient and staff satisfaction, Inter-Professional Care, access to information and health equity
Patient Centred Care (PCC) at UHN 2002-2012 Goal to change culture to be more patient centred and shift patient satisfaction scores by advancing leadership through accountability mechanisms processes Change model used as framework PCC strategically aligned to BSC and Senior Management (governance) Core focus on communicating the vision via PCC reflective education and deepening meaning for staff and leaders
PCC Governance & Structure Transition Management & Implementation Support Teams 2004-2007 Transition Management Team (TMT)- Senior stakeholder membership Implementation support team (IST) Working Group OD, N & AH, Op IST 2007 merged TMT & IST addition of patient representative 2009 - Transition to PCC council
Creating a culture shift to PCC Rotman School Leadership Development Program (partnered with Experience Point) E X P E R I E N C E C H A N G E M O D E L Global Tech
Respect, Dignity, Person as Leader Core value of reflective education with intact inter-professional teams Tailored and customized course content to teams, groups Guided by the core value of the dialogue to seek patient s perspective Process to reflect on, engage in and model person centred care in action
Patient Centred Care Change: Putting it all Together Involvement & Empowerment Data gathering Improvement teams Discretionary service decisions PEOPLE Education Education program to build awareness, commitment & competencies HR Alignment Recruitment / retention, competencies, performance management, etc. PATIENTS & FAMILIES Recognition Individual & team recognition Vision & Commitment Alignment & integration with UHN strategy Corporate, site & department priorities Board Quality Committee Communication Frequent Stories Multiple vehicles STRATEGY Standards Care delivery model Leadership Service agreements SYSTEMS Measurement Picker survey Real time unit surveys Employee Opinion Survey Individual am I meeting your needs? Improved Care Delivery System Process Improvement Policy alignment
A unique starting point.. Strategy for Deeper Integration of PCC Individual Science PCC Community Infrastructure Wilber, 2001
Anchors, Catalysts, Enablers Unique starting place at the level of individual Inter-professional Patient Centred Care: Team Patient Centred practice is Relational inquiry Intentional and generative interactions Strength-based, Appreciative inquiry approach
Key Learning s Make it a priority for everyone Corporate strategy Leadership is pivotal Formal leaders Lead for PCC Staff lead from where they stand Focus on Practice and Operations goals & objectives PCC Reflective Education key foundational strategy Sharing knowledge through narratives, research and innovation Including patients in a more intentional way
Key Learning s Patient Satisfaction Scores a key part but is data representative of true patient experience? Openness to link to social determinants of health: Health Equity, Diversity, Cultural Competence Recognize that change is slow stay the course and focus on the journey
An Idea Book Achieving Patient Experience Excellence in Ontario LEARN MORE OHA, 2013
10 years 10,000 hours Patient Centred Care Patient & Families as Partners Shifting Culture & Language Building Synergies Building Internal Capacity Asking Different Questions
The Sigmoid Curve Growth X Maturity Y Decline Start-Up The Age of Paradox ~ Charles Handy, 1995
the patient/person at the center
What We re Striving to Achieve A Leading Model of High Quality Patient-Centred Inter-professional Care
l e a d i n g p r a c t i c e s
Bundling Care at the bedside IP Rounds w/family Nursing Bedside Report Point of Care Staff and Teams IP Documentation Unit Environment Patient/Person Experience Unit Assignment and Team Patient Education Teach Back Enablers: Engaging point of care IP teams Positive Deviance LEAN Methods Shared governance: Unit Councils Huddles System Hourly Rounding Technology Dashboard + practice audits Continuum of Care Models of Care
...PCC is reflection in and on action...pcc is reflection in and on action
W E A R E A L L C O N N E C T E D
w e a r e a l l o n a j o u r n e y
collaboration is everything
a s e a o f c h a n g e
T H A N K Y O U q u e s t i o n s?