Co-designing home care with clients and their families

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Incorporating the insights, ideas and feedback of patients and their family members in the design and delivery of health services has been crucial to providing patient-centred care in many hospitals for the last several years. But in , the notion of clients (patients) and their families as “co-designers” of quality improvement initiatives and direct care services is relatively new, and one that Home HealthCare (VHA)—an Ontario-based, not-for-profit, charitable organization in its 90th year—is determined to apply.

In 2013, VHA began paving the way to incorporate the Client and Family Voice into everything it does. The community model VHA developed is largely based on Britain’s National Health Service’s (NHS) transformative “nothing about me without me” philosophy and research, which empower patients and their families to help direct their own care needs. “This model is so exciting,” notes VHA Vice President of Client Services and Chair of the Client and Family Voice Steering Committee, Barbara Cawley, “because it takes client-centred care a step further so clients and their family members are true partners in designing and developing VHA services and how we deliver them.”

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Before creating its own community care-based model, VHA met with hospitals identified as being ahead of the curve in this area, including Holland Bloorview Kids Rehabilitation Hospital and North York General Hospital. “They really helped to steer us in the right direction,” Cawley says. “Based on their advice we determined how to approach the implementation of the Client and Family Voice strategically. They also provided ideas about the nuts and bolts of recruitment— for identifying both Client and Family Voice partners and projects that would greatly benefit from client and/or family input.”

She adds that while insights were extremely helpful, there were some unique challenges VHA had to work out for itself. “We don’t have a ‘building’ in the same way that a hospital does. Our workers and our clients and families are in their home so we knew we’d have a greater challenge with recruiting them for projects. We can’t just walk down to their room to see if they’d be interested in joining,” Cawley says. “Getting the word out amongst our more than 2,000 staff and service providers—so that they understand what we’re doing and how they can support us—was also something we had to consider carefully.”

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Though it is still relatively early days for the initiative, there have already been several successes that signal VHA is headed in a positive, more inclusive direction. One of the most exciting is the creation of a Client and Carer Advisory Council. Two-thirds of the members are VHA clients or caregivers who are receiving or have received services from VHA. The council’s vision is to “act as the voice of the client in planning, developing or evaluating services.” Since its inception in 2014, the team has been involved in: reviewing and making recommendations on VHA’s quality improvement initiatives; advising staff on education to improve the client experience; and sharing personal stories and home care experiences with our board and leadership team, amongst many other activities. Outside of the council, client and family partners at VHA have also been involved in various capacities, including:

  • Discussing their experiences as a client or caregiver during staff education sessions;
  • Providing feedback to Human Resources on hiring;
  • Offering insights and ideas on the design and content of a client and family newsletter;
  • Sharing their experiences with the rehab equipment/Assistive Devices Program (ADP) processes;
  • Nominating staff and service providers for VHA’s newly minted Client Choice Awards.VHA has also begun to pay the knowledge forward by advising other home care organizations on starting their own Client and Family Voice initiatives. Recruitment of clients and family members is also climbing as VHA’s “roadshow” rolls out and an organizational culture shift takes hold. “Our progress wouldn’t have been possible without all the support we received from North York General Hospital and Holland Bloorview Kids Rehabilitation Hospital,” says Cawley. “Though it’s nice to be perceived as innovators, it’s an innovation we need to actively share and support. The more we promote this, the more positive impact it will have on all home care clients—and that’s what’s most important.”
  • The application of client and family partnering to home care is starting to see a lot of interest from other community care agencies, especially after VHA’s presentations on the topic at the Canadian Home Care Conference in Banff and Accreditation Canada’s conference in Vancouver, both held last year. “People were definitely keen to learn more about our experience,” notes Cawley, “especially since client and family involvement will be part of the next wave of accreditation criteria for home care organizations.”