Engagement in Action

September 2014

Patient and Family Centred Care

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At Horizon, patient and family centred care is defined as compassionate health care based on a partnership among practitioners, patients and families (as explained by the patient). It is our goal to ensure decisions respect patients’ needs, values and preferences. Its outcome provides patients with information, knowledge and support to participate in their care.

It is a rounded process that shapes all health-care decisions including policies, programs, and especially daily interactions between staff, patients and families.

Over the last year, Horizon Health Network (Horizon) has been working

to improve communication with its staff, patients and community.

Hearing what you have to say is important, but for communication to be

successful, Horizon must be committed not only to listen but to respond

and share the results of its community engagement. This report provides

an overview of some of Horizon’s leadership-led community engagement

activities and how it has responded to the issues that were raised.

~ Definition developed by Horizon’s Patient and Family Advisory Council

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Since joining Horizon last year, it has been my priority to ensure that our communities, especially patients and their families, have a voice when it comes to the delivery of their health care.

Making ourselves available to listen to the needs and concerns of patients and families takes concerted effort and persistence. Community engagement is a skill that many health-care providers aim to master, and the importance of understanding ways we can improve cannot be overstated.

Over the past 18 months, I have met with hundreds of stakeholders including business leaders, foundations, auxiliaries and alumnae, associations, unions, medical societies, staff, physicians, politicians and health-care affiliates. These meetings were instrumental in revealing the potential for a better connection with patients and communities as a whole.

Following these meetings, I researched leading practices of health organizations, across Canada and internationally, in the field of community engagement. Not surprisingly, the common theme expressed within these organizations, and our own, is that patients and their families want to be at the centre of any decisions that might affect them and the care they receive.

While an emphasis on patient and family centred care has been alive and well in a number of areas within Horizon, it became clear that this approach needed to permeate everything we do. With Margaret Melanson, Vice President of Quality and Patient Centred Care, as the lead, this initiative is taking shape and bringing new focus to our services. We are also very serious in our commitment to service delivery in both official languages. We are working to ensure our Horizon community fully embraces our bilingual identity within New Brunswick.

Our staff play an integral role implementing the values of patient and family centred care, and I am especially pleased with their involvement in these projects. I want to thank the employees, staff and physicians who took the time to provide invaluable feedback, and have taken this redefinition of our roles as health-care providers to heart.

I want to thank the communities throughout our network for supporting our efforts. I am especially grateful to the community groups and civic leaders for their involvement, direction and wealth of feedback. Our many discussions with former patients provided substantial insight to their personal experiences. Their feedback was instrumental in helping us to improve our services. Along with new strategic decisions from the Horizon Board, we have begun to mould what we learned into a plan for the future. We have made positive steps in the right direction and I look forward to building upon this strong foundation.

John McGarry President and Chief Executive Officer

People Connecting with People

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Community engagement has been conducted extensively by various Horizon programs and services for many years. Horizon is a large organization but we heard from the staff, foundations and auxiliaries, along with the communities we serve, that we needed to do a better job. A community engagement initiative was launched in 2013 and has been an opportunity for Horizon leadership to discuss with our staff, patients and communities, what we can do to improve the care we provide.

Horizon’s first priority has always been to provide safe, quality health care to patients and their families in a considerate and respectful way. There are some areas in our system where these experiences can be significantly improved. It is our goal to act with openness and collaboration; doing more, more often. Our leadership in health care calls on us to act upon what we learn from the community.

Community engagement is a way of opening a dialogue, finding strengths and weaknesses and remaining accountable to Horizon staff, as well as to the patients, families and communities that support them.

Staff Conversations with JohnIn large organizations such as Horizon, which has more than 12,000 employees, it is easy for frontline staff to feel isolated from its executive leadership. This past winter, John McGarry, Horizon’s President and Chief Executive Officer, met with staff from across Horizon. “Conversations with John” was a series of open-forum meetings that were hosted at all Horizon hospitals, including rural hospitals such

as Grand Manan. More than 350 staff members attended

in order to discuss their concerns and ask questions directly of Mr. McGarry.

Engaging with staff enables better management of Horizon. Staff whose concerns are addressed can then focus on professional excellence in a supportive environment. Frontline staff can be the creators of policies that will produce lasting benefits throughout Horizon, and their input is highly valued.

“The discussions were candid. It’s not easy to hear that you have failed staff and patients,” said McGarry. “That’s why it’s important that we take the time to listen to those on the frontline. Without these conversations, we cannot implement change.”

Key learnings from staff

• Workforce Adjustment - Staff reductions are leading to concerns regarding job security for employees, and for patient care.

• Rural challenges - Staff want to continue to work and provide service in their home communities.

• Role of Licensed Practical Nurses - The right person in the right job, at the right time is critical.

• Regionalization - Ensure regional managers are available and have a presence in rural locations.

• Continuity of policies - Policies and procedures are not as consistent across Horizon as they could be.

Participants were asked to provide feedback at the end of the session. It was noted that the

majority of respondents felt that their expectations from the event were met

and that their ideas were heard. More importantly, a large percentage (more than 80 per cent) of staff said they felt comfortable voicing their opinions.

Leadership in Community Engagement

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Patient and Family Ideas and Solutions ForumsThe Patient and Family Ideas and Solutions Forums were created to help guide the direction of policy and enhance the patient and family experience throughout Horizon. Conducted throughout Horizon’s service areas, the forums were an opportunity for patients and families to speak directly to decision makers. We commit to continue these forums in the future.

As an organization we realize that for all the times we get it right, there are times when we do not meet the expectations of our patients. During these forums, participants had the opportunity to share their personal stories. The conversations were open, honest, and emotional as patients and family members recounted their frustrating and disappointing experiences within our organization.

The sessions were an important first step on the road to understanding the major concerns of our patients. This input will lead to better programs and service changes to benefit patients, family and staff. Following the sessions, the Horizon Patient and Family Advisory Council was established to ensure an ongoing collaboration with patients and families.

An evaluation survey was completed at the end of each forum. The results showed that participants felt encouraged and empowered by being there. Ninety-five per cent of participants felt their ideas were heard, with nearly 90 per cent finding the discussion open and valuable.

Key learnings from our patients and community

• Improved communications: Patients and their families want to be more involved and have greater communication with their physician and the medical staff.

• Transition of care: Staff should provide smooth and safe patient transitions throughout the episode of care.

• Cleanliness: Horizon has an aging infrastructure that must be kept clean and clear of clutter.

• Empathy for patient: Patients want to feel respected and that their care is our top priority.

• Professionalism: Staff should dress and act professionally, not argue, or have inappropriate conversations.

• Identification: Patients are unable to identify staff by uniforms, ID cards are too small, and staff should introduce themselves.

• Infection control: Patients are worried about infections and safety and want to be part of the solution to help prevent them.

• Chronic care: Horizon should have a plan to better manage chronic disease and encourage healthy lifestyles.

• Prevention: Programs are needed to prevent illnesses or injuries in our communities.

• Patient outreach: Patient representatives and other programs need to be easily accessible.

Common Themes Through community engagement, Horizon was able to determine five major

themes that staff, patients and the community feel strongly about:

Identification Cleanliness

Caring culture Coordination of care

Efficiency of care 4

The most important component of community engagement is an organization’s ability to respond to what it has heard. A significant number of initiatives have begun since Horizon began engaging in these dialogues with our patients and community. The following are just a few of the initiatives Horizon has developed.

Twenty Patient Touches — Leadership Rounds This is an initiative in which Horizon’s leadership team and managers make purposeful visits to a Horizon facility each month. During this time they speak to members of staff, patients, and their families, to determine opportunities for improvement to patient care and safety. They also identify areas for process improvement through direct observation of where adjustments and improvements are most needed.

Leadership rounds are also a tremendous communication tool that fosters open, two-way communication that is not restricted by reporting structures or access. Being on the frontline, talking with staff and patients, allows leaders to hear ideas for improvements.

Patient and Family Advisory Council The Horizon Patient and Family Advisory Council has been developed to foster a partnership in order to provide advice and guidance for patient and family centred care experiences and the culture of care throughout Horizon.

Patient and Family Advisory Council members are committed to working towards developing a culture of patient and family care, where patients are the highest priority. They provide guidance and advice; promote collaboration between Horizon and the greater community; provide feedback on policies, programs,

education, and practices; participate in planning and committees; and provide input on communications and evaluations.

Members are expected to:

• have a sincere interest in improving the patient experience;

• sign a confidentiality agreement;

• understand the responsibilities of the committee; and

• work constructively with a wide variety of health-care professionals and administrators.

Patient Experience AdvisorsIn conjunction with the Patient and Family Advisory Council, Horizon is also providing training and support to recent patients or family members of patients to advise on health-care policies, programs, practices and projects that affect patient care and services. Any patient or family member of a patient who was treated in a Horizon facility in the last three years may apply. There are no special qualifications required.

I.D. Card RedesignIdentification cards have been redesigned to improve staff recognition. The first name and position are now more prominent. The photo has been enlarged and they are double-sided.

Patient Experience SurveyThe Patient Experience Survey was conducted in May 2014. The intent of the survey was to hear from inpatients about their recent stay in hospital, in order to amend programs or change practices that may not be meeting their needs or expectations. Further surveys will be conducted throughout the year and the results will be posted on Horizon’s website.

Engagement in Action

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Proactive Patient RoundingProative Patient Rounding connects patients to the nursing staff that interact with them. This program adds significant benefits to the patient experience including assurance of assistance and a feeling of security. It also increases communication and ensures that the nursing staff is continuing to perform their duties competently. This nursing initiative was launched in Miramichi and will be rolled out to the rest of Horizon.

As part of the Proactive Patient Rounding, nurses visit patients hourly and use the 4Ps to ensure their patients are comfortable.

The 4Ps Questions asked each hour

Pain How is your pain?

Position Are you comfortable?

Personal Toileting

Do you need to use the bathroom / bedpan / urinal?

Possessions Do you need your phone, call bell, light, water, bedside table, glasses, hearing aids, etc?

Nurse Manager Amended Duties The roles and responsibilities of Nurse Managers have recently been amended in order to ensure that they are on their unit each morning to meet with patients, families and staff. This opportunity for one-on-one response helps set the tone for comprehensive care throughout the day and throughout the unit.

Public Participation TrainingNearly two dozen Horizon managers and directors took part in a training opportunity from the International Association for Public Participation. The training taught them to recognize opportunities for community engagement and provided them with a wide range of techniques that can be used when engaging the public.

The H.E.L.P. ProgramThe newly created H.E.L.P. program is an integral part of Horizon’s shift towards patient and family centred care. H.E.L.P is comprised of four simple steps that remind staff to better communicate with patients, their families, friends, and with each other.

• “H” is for Hello/Bonjour: Always greet people with a smile and the Active Offer of both official languages.

• “E” is for Explain: Introduce who you are, what you will be doing and for how long.

• “L” is for Listen: Listen carefully and with courtesy, and repeat the information to clarify miscommunication.

• “P” is for Professional: Be respectful, know your roles and responsibilities, and maintain professionalism.

These simple steps will ensure we are providing the best possible care to our patients in a considerate and respectful manner. This program will be implemented this fall.

Creating Healthy and Clean EnvironmentsHorizon is working to ensure its physical environment is welcoming, caring, comforting and compassionate. A recent example of this is the Dr. Everett Chalmers Regional Hospital refurbishment project and M.Y. Place – “Mine and Yours” – sustainability plan, which demonstrates Horizon’s commitment to creating a healthy and clean physical environment, supporting staff, and providing quality care to patients. To achieve this, Horizon is developing criteria for areas such as signage, posters and space utilization, with a continued focus on reducing clutter. Everyone - staff, patients and visitors - plays an important role in keeping our facilities in top shape.

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Strategic DirectionsAs Horizon continues to strive for excellence in patient and family centred care, better community engagement will continue to be a clear goal.

This past spring, Horizon’s Board approved a strategic planning process that created opportunities for staff, physicians, patients and community members to have a say in defining the priorities for Horizon over the next three to five years. Our new Strategic Plan will guide the organization’s mission, and focus its service efforts.

Engagement in ActionIf you have any questions about this publication or would like to learn more about community engagement initiatives and outcomes at Horizon Health Network, please contact Communications@HorizonNB.ca or President@HorizonNB.ca

About Horizon Health Network Horizon Health Network operates 12 hospitals and more than 100 medical facilities, clinics and offices, with services ranging from acute care to community-based health services. Horizon leads the way in delivering sustainable, safe and quality health-care services to residents of New Brunswick, northern Nova Scotia and Prince Edward Island in both official languages.

Horizon held a number of strategic focus groups with various community stakeholders, and offered an online process to solicit information from the public. The Senior Leadership Team and Board have been evaluating the input and preparing a draft Strategic Plan for further consultation in the fall. Horizon’s Board will approve the final Strategic Plan by the end of the calendar year, when it will be shared broadly, both internally and externally.

If you have experiences, impressions or questions to add to our ongoing conversation, please contact us at StrategicPlanning@HorizonNB.ca or on Twitter @HorizonHealthNB.

www.HorizonNB.ca

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