Innovation by PFA

At Thunder Bay Regional Health Sciences Centre (TBRHSC), patients are first. Most hospitals would say the same. In fact, this one touted that claim for years. Then, in early 2009, we adopted the Patient and Family Centred Care (PFCC) model of care and learned what it really meant to put patients first.

We now know that outcomes tend to be much better when patients are engaged and involved in their own healthcare. Within 18 months of starting the PFCC journey, TBRHSC improved inpatient satisfaction scores by 6.8% to 21.6% in all eight dimensions of care as reported by National Research Corporation (NRC) Picker™. It did not happen overnight, nor without effort.

Innovative strategies, including an organization-wide pledge, encouraged staff at all levels to understand and buy into the PFCC model. Creative approaches were applied to engage patients and family members who had experiences with us and involve them as Patient Family Advisors (PFAs). PFAs are central to the PFCC model of care. They call upon their own experiences to help guide improvements in all areas of care. Inspired activities helped to persuade staff to embrace PFA input, including large group planning sessions with staff, managers and PFAs. Once the value of the PFAs was realized, the PFCC model spread its wings.

We did extremely well. In fact, Thunder Bay Regional Health Sciences Centre is the first and only hospital to receive a Leading Practice designation in PFCC from Accreditation Canada. To become leaders in PFCC, we had to be innovative. And because of PFCC, we continue to be innovative.

Innovation inspires innovation

PFAs sit on every decision-making committee, providing invaluable insights into how efficiently our academic health sciences centre operates today and how to make improvements for tomorrow. Over 90 PFAs ranging in age from eight to 85 have been integrated into everything we do, including staff hiring, senior management and board quality committees, education, strategic planning and program/service councils.

Each program and service at TBRHSC has a responsibility to partner with patients and families in the development of annual action plans, ensuring their needs and values are considered in the delivery of care and services. As a result, innovative ideas to improve and advance patient care happen almost every day. PFAs bring with them new perspectives and they challenge us to approach patient care in completely different ways. And the results are very well received.

Family Tour Nights is one of many examples of PFCC initiatives making experiences at TBRHSC better for patients and families. Our Health Sciences Centre serves 1,100 paediatric patients who require surgery every year. PFAs partnered with us to bridge the gap between what we thought our paediatric surgical patients and families needed and what they actually needed.

“One of the worst feelings in the world is handing your child to a stranger, listening to them cry, as they are taken away and the OR doors close,” said one of our PFAs. We cannot change the fact that children need surgery, but we can change the process to create a better experience. PFAs applied their first-hand experiences with the surgical journey to identify how it could be improved.

Now, the families of paediatric surgical patients are invited to take part in an organized group tour of the Operating Room (OR) before their scheduled surgeries. The tour takes the child and family on the entire surgical journey, from the admitting process to returning to their room after surgery. Nurses from the OR guide the families to the paediatric unit to visit the playroom and the area where they will wait until the young patient takes a ride to the OR in a little red wagon (another stress-reducing initiative, this one recommended by our youngest PFA who was just nine years of age at the time).

Once in the OR holding room, everyone changes into OR attire, and the children are given their very own OR scrubs to take home. The children can walk or ride on a stretcher into the operating theatre, where they and their parents are entertained by an interactive puppet who explains, with the help of surgical team members, all of the machines and noises in the room, as well as all that will take place when they come in for their surgeries. The tour gives the children an opportunity to play with flavoured oxygen masks, finger probes, “sticky pads”, and other equipment. After the show, the children ride to the recovery room to see where mom and dad will be waiting for them after surgery. The tour ends with snacks and playtime with the other children.

When asked what they liked best, tour participants listed the puppet show, ride, and pictures taken of the whole family “dressed up” (the parents particularly enjoy this as well). Learning what was behind the closed doors of the Operating Room helped dramatically to reduce the anxiety for both the child and parent and has improved the patient and family experience. The Family Tour Night has had immediate and significant improvements in our patients’ and families’ experience of care.

The Family Tour Night clearly demonstrates that innovation often comes in many forms. As healthcare professionals, we tend to consider innovation in terms of technological advancement and medical research break-throughs. These are, of course, important areas of focus that enable all of us to deliver more effective and efficient care. However, it’s also important to recognize that innovation at the grass roots level can result in profound improvements that effect better patient outcomes. This sort of success generates momentum.

Hearing the perspectives of patients and family members has been enormously beneficial. So much so that it inspired yet another simple yet effective innovation – the sharing of patient stories as a way to open all council meetings. The Senior Management Council, for example, begins with the telling of a recent patient experience. The group reflects on the story and discusses whether or not the activities and decisions around the care were patient and family centred, and how they could be more so. We focus on learning and improvement. We focus on the care the patient the received, as opposed to the people who delivered it. This sharing of patient stories sets the tone for the meeting. Whether we are dealing with budgets, policies or procedures, we never forget why we are together: to deliver a better experience and better outcomes for our patients and families.

Together, PFAs, healthcare professionals and employees collaborate to identify inspired new ideas. They build on their achievements and those of their colleagues. They are encouraged to think outside the box to find creative solutions. Their innovative strategies continue to change the way healthcare is delivered at Thunder Bay Regional Health Sciences Centre, truly Patient and Family Centred. We are becoming healthy together.