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Imagine being asked to find and integrate a new care model for a 375-bed state-of-the-art acute care facility in northwestern Ontario, Canada. Now, imagine that your catchment area of 250,000 patients is equivalent in size to the country of France. Such an endeavor would be overwhelming for most. However, like most major initiatives, change begins with capable leadership and forward vision. Both of these elements are integral to the story of how Thunder Bay Regional Health Sciences Centre (TBRHSC) became a model of multi-disciplinary teamwork, integrated teaching and research, and patient- and family-centered care (PFCC).
In 2006, the chief executive officer of TBRHSC tasked the vice present and chief nursing executive, Dr. Rhonda Ellacott, to find and integrate a new care model for patients and families at TBRHSC. After months of researching different models of care, Dr. Ellacott and other hospital leaders decided to base their care model on the Medical College of Georgia’s PFCC model of care. This is where Bonnie Nicholas, PFCC lead and patient advocate at TBRHSC, comes into the story. "This was a change of culture and philosophy” says Bonnie, who had worked at TBRHSC before and was brought back to help implement the care model. "We brought together all the stakeholders in the hospital system to create a new model of care”.
Bonnie had previously been involved in helping patients and families waiting for organ transplants before returning to TBRHSC. "I was exposed to the power of the story and saw how the stories of patients and families moved even the most hardened staff members to change”. One of Bonnie’s first ideas was to hold a "Visioning Retreat” in which all staff members participated in providing input. From this input, corporate strategies were created. For example, as part of the new care model, staff members were required to state their NOD (name, occupation, do) every time they met a patient and family member for the first time. "We found that most problems were happening around communication” states Bonnie. Staff members began listening more and paying attention to the needs of patients and families.
Another corporate strategy was to engage patients and families in the development of new initiatives the hospital. Some of the fruit of this joint effort includes televisitation (audio and video communication between patients and loved ones when barriers created by circumstance, geography, and weather are present), pediatric family tours of operation rooms, transportation of children through the hospital on Radio Flyer wagons, and a new visitation policy. "We changed our visiting hours. Now there are no restrictions on care partners visiting, whoever that may be”.
Patient advisors play a major role at the hospital. These are volunteer patient and family advisors who serve on committees and councils in the hospital. New policies and projects must be approved by these advisors. Says Bonnie, "They can be any age; we have patient and family advisors who are as young as eight years old and as old as 83. They’re involved in everything we do.” When asked how many committees and councils patient advisors have served on, Bonnie stated "Patient advisors are in our DNA. I stopped counting after 400”.
Advisors also play a role in helping new professionals orient to the culture and expectations at TBRHSC. There are even learning modules and tests available for staff members who wish to certify in patient- and family-centered care at the hospital. In fact, all new hospital staff members are required to agree and commit to the care model before they begin working at the hospital.
Input and stories from patients and families play a big role at TBRHSC. And the outcome data shows that hospital leaders are on the right track. Within 18 months of implementing the PFCC model, patient satisfaction increased on average by 12% along several dimensions (care-access, information sharing, education, physical comfort, emotional support, continuity, and transition). Provider satisfaction was also shown to increase as well. Says Bonnie: "It’s critical to making improvements in patient satisfaction. Who knows best about their own health and satisfaction than the patients and families themselves?”
|Matt Martin is a licensed marriage and family therapist and is currently working as a post-doctoral fellow with the Chicago Center for Family Health and the Illinois Masonic Family Practice Residency Program. He received a master’s degree in Marriage and Family Therapy from Brigham Young University and just recently a doctoral degree in Medical Family Therapy from East Carolina University. His interests include integrated primary care, behavioral health, and family medicine residency education.|