Delivering Patient / Client Centred Care
Improving the quality of patient care and safety is at the top of the list when it comes to NHS priorities and a major focus has been underway in the last year to adopt a patient/client centred care model. Defined as "consciously adopting the patient's perspective…about what matters" (Gerteis et al.), the model's key principles of respect, dignity, collaboration and participation in care complements the NHS's core values and mission. This model puts patients first and at the centre of everything that we do. It recognizes the autonomy of patients, the need for patient choice in decision-making and the patient as a full partner in providing compassionate and co-ordinated care.
To raise awareness and promote the adoption of the model throughout the NHS, a shared vision is vital and with upwards of 50 different inpatient units at our seven sites, providing a consistent model of care is complex, to say the least. The first order of business was for Sue Payeur-Grenier, Project Leader for Patient/Client Centred Care, to carry out an environmental scan of the NHS which highlighted current practices and emerging trends within the various programs.
RPN Murna Vanderklok with patient Sarah Partridge, Welland Hospital Site Complex Continuing Care Unit (Woolcott Wing)
Building Momentum
"I found that patient/client centred care initiatives have been implemented in several programs of the NHS while other programs are at the initial stages of implementation," Sue comments. "It's also important to note that while this initiative started in the nursing program through the NHS Nursing Strategic Plan, it will be expanding to other allied health care areas, such as Diagnostic Imaging, Cardiorespiratory, Pharmacy, Laboratory, Occupational and Physiotherapy, and other clinical departments, where health care professionals interact with patients."
Since a primary strategy to build momentum for any change effort is to provide information and education, Sue presented numerous educational sessions related to patient/client centred care attributes and strategies to promote change. "What we're really talking about here is providing care based on the patient's values, cultural diversity, needs, preferences and choices," Sue explains. To help spread the message, Sue gave general and detailed presentations to senior leaders, regional directors, three inter-professional councils, nursing leadership, program leadership and charge nurses. As well, patient/client centred care became a standing agenda item at all allied health and nursing council meetings.
In spring 2007, a Patient/Client Centred Care Steering Committee was established, comprised of a cross-section of NHS staff with the sole goal of advancing the patient/client centred care model. In addition, Dr. Johan Viljoen, Dr. Peter Willard and Dr. Keith Greenway stepped forward to support implementing the patient/client centred care model.
The Steering Committee is going strong at monthly meetings and is proud of many recent accomplishments:
- The Development of the Patient/Client Centred Care Project Charter, and its integration into the Nursing Strategy - A Blueprint for Nursing
- Integration of Patient/Client Centred Care education into general orientation sessions, new leader orientation and Brock student orientation
- Evaluation of new policies and procedures for congruency with Patient/Client Centred Care
- Participation and representation on the Cultural Diversity Focus Group
- Development of Patient/Client Centred Care web information (www.niagarahealth.on.ca/nursing)
- Promotion of philosophy through attendance at the 2007 and 2008 Registered Nurses Association of Ontario Best Spotlight Organization Reunions
Turning concepts into practice at the bedside is an ongoing process, and to date, more than a few clinical units have begun to change the patient-care experience. The Maternal/Child team has recently completed their in-depth assessment of family-centred care and is developing an action plan in collaboration with the quality improvement team. The Mental Health program has partnered with the Royal Ottawa Hospital to implement a new alternative model for mental health recovery, which emphasizes the nurse-patient relationship, the person's lived experience and a focus on documentation using the person's own voice. The program is developing strategies and assessment tools to capture the patients' stories of the need for care.
The ICU Critical Care program at St. Catharines General Site now provides a new model of care with dedicated intensivist specialists, which has transformed the patient's experience of care and involvement in decision-making through daily staff rounds and patient care meetings. Another example is the Total Patient Care Service Delivery Model, adapted by the Surgical program at Welland Hospital Site, which clearly demonstrates the transformation of a health care experience in which patients/clients and families feel cared for, respected and involved.
What happens next?
In its effort to determine priorities for change and improvement this year, the Steering Committee is currently completing a hospital assessment inventory. This tool, adapted from the Institute for Family Centred Care, will help to make the patient's perspective a priority for planning and integration into practice.
So far, over 100 NHS staff have gathered together to explore the meaning of patient/client centred care through story-telling exercises, discussion of strategies for integration into clinical practice and learning how to measure and to make improvements through the use of patient satisfaction surveys. Nursing Grand Rounds are also a key strategy for leveraging change on the clinical units.
"On a daily basis, we are seeing that more nurses and other practitioners have embedded our principles of compassion, professionalism and respect in their daily practice," Sue says. "However, to be truly effective, most recognize that to share the vision and have the passion to change the culture to one of caring 'through the patients eyes', widespread understanding of the need for change and action must occur. Through continuous quality improvement initiatives and partnerships with patients/clients and families we can strengthen our capacity to achieve patient/client centred care at all levels."
A Project Charter has been developed, to provide detail on the scope of the project as well as goals and objectives.