Creating a culture of innovation in senior health care

We are on the threshold of a new era: an unprecedented shift in global population aging, with the number of persons over the age of 60 expanding by 1.2 billion in the next 40 years.

While many will remain healthy enough to enjoy greater longevity, there are serious challenges for healthcare systems resulting from this demographic shift, specifically, a significant increase in the number of older people living with chronic medical illnesses and dementia. But out of serious challenge can result serious opportunity.

The solutions to optimizing the physical health, mental well-being, autonomy and safety of increasing numbers of seniors in Ontario and elsewhere, are not solely to be found in expanding our present model of primary care or building more capacity in the same traditional models of institutional care – hospitals, nursing homes and complex continuing care. There must be more cost-effective treatment settings for seniors who require increased intensity of medical intervention as an alternative to emergency room visits and acute care hospital admissions. When hospitalized out of necessity in an acute care setting, seniors should be discharged earlier to new alternative, less intensive, community-based care environments before going safely home. A nursing home or complex continuing care admission should not have to be the only option available if a frail senior cannot be safely discharged from acute care directly back to their own home. If we could be more innovative, new methods of service delivery to seniors would be created and serve as alternatives to the rigid, compartmentalized structures and approaches we have today.

Such solutions include the development of more community-based sub-acute and rehabilitative programs and better resourced home care. In addition, we should provide primary care physicians with improved access to the consultative functions of specialists in chronic disease management in the elderly and dementia care. In the nursing home setting, we could be focusing more on restoring the functional capacity of our residents as the primary goal. However, under today’s reimbursement methodology for long-term residential healthcare services, facilities are reimbursed on the basis of how frail their residents are. The frailer the resident population is, the higher the reimbursement to the facility. Maybe we should be tying a portion of such reimbursement to the facility’s success in restoring function through innovative rehabilitation strategies and, thereby, reducing frailty.

 Breaking out of our traditional and inadequate models of providing care to seniors and becoming truly innovative, requires a radical change in the culture of healthcare organizations and the mindset of their leaders. Our healthcare system is a large and complex entity with ingrained assumptions and defined paradigms of thinking that govern what we do, how we do them, and why we do them. Our standards of practice, professional competencies, and ongoing quality improvement approaches are there to support consistent, reliable, safe, efficient and effective practices. They are undoubtedly important and necessary for an organization to be able to run its core business of health care delivery. While we need to ensure that those standards are upheld, how do we do that and innovate at the same time? How do we foster reliability and standardized processes that are efficient and predictable, while also forging ahead to explore the unknown, the ambiguous, and the yet-to-be-discovered breakthrough ideas?

We must have the courage to shed our current thinking about what residential long-term and acute care should look like, and consider what it could look like to optimize frail seniors’ autonomy and well-being. This requires a different kind of approach that invites us to re-examine the lived experience of the older person, challenge our current assumptions, and experiment with strategies that encourage generative thinking to look for alternative solutions. Rather than ask for the answer or the best answer, we must ask about possibilities, options and considerations. All ideas generated are then re-examined to find patterns or connections until the key breakthrough ideas emerge.

At Baycrest, we are increasingly focused on how to best generate, test and evaluate break- through ideas to advance the cost-effectiveness of healthcare delivery to seniors. One way we do this is through the Innovation, Technology and Design (ITD) Lab. This new program has a group of dedicated individuals versed in design thinking and creative ideation who work with staff in our programs and services to catalyze and support innovation.

The ITD Lab’s activities include the following strategies:

  • Inviting staff to be curious, ask questions, and engage in robust dialogue with a diverse group of others who bring different non-traditional perspectives to the table, including sociologists, artists, designers, anthropologists, and senior consumers.
  • Guiding staff to engage in deep listening and understanding of the lived experience through observation, video, storytelling, interviews, and other techniques – a human-centered approach that allows us to explore opportunities that can make life easier for our seniors and harness technology that can be useful. In this way, we learn how seniors interact with their environments, utilize shared and private spaces, care for their bodies and their minds, and stay in touch with friends and the world.
  • Creating tangible representations (prototypes) of our ideas to quickly get them out there so that we can investigate customer acceptance and feasibility, and explore what it would take to make them work.
  • Creating a clear process and roadmap for ideas that take the good ones from conception to launch with built-in evaluation criteria and business/system model components.

One project underway in our ITD Lab involves a diverse group of thinkers – from the hospitality and retirement home industries, psychology, art and design, as well as seniors who live in the community and in long-term care – to engage in redesigning the culture in our nursing home.

We have asked the hospitality industry to share how they satisfy the needs of their clients (i.e., the kinds of emotional touch points they use to enhance customer service). A psychologist will share his research findings on what brings people pleasure and satisfaction. Seniors will share their needs and wants, and describe the physical and cognitive challenges of aging that can impact their ability to thrive in their home or in long-term care. Students and designers from Ontario College of  Art & Design University (OCAD U) will share their design ideas for nursing homes of the future, as well as private homes that will allow seniors to age in place.

As healthcare providers, we must be more receptive to new perspectives, especially those from outside of our sector. We need to do more to listen to those who are receiving our care and to learn from their insights. We should encourage the continuous infusion of novelty, risk taking and innovation in our healthcare settings. Out of the challenge of an comes the opportunity to significantly change for the better what it means to be cared for when we are old.