Shifting organizational culture is challenging, but Scarborough and Rouge Hospital (SRH) is finding creative ways of embedding the philosophy of patient- and family-centred care (PFCC) – the concept of doing things “with” patients, rather than “to” or “for” them – throughout the hospital; a concept described in the Registered Nurses’ Association of Ontario (RNAO) best practice guidelines.
“I absolutely have been involved in my care here. That should be the way we do things in our community hospitals,” said patient Barbara Marco. “We can’t just expect to sit back and let everyone else do for us; we have to contribute to that care and the needs of keeping ourselves healthy.”
At SRH, work geared towards improving the patient experience began many years ago. Then, in 2015, “Patients as Partners” was identified as one of four strategic directions in the hospital’s strategic plan. This occurred in tandem with the organization becoming a RNAO Best Practice Spotlight Organization (BPSO) candidate.
However, the PFCC Steering Committee quickly discovered that the patient advisor toolkit developed to support the process of recruiting patient advisors to hospital committees wasn’t quite resonating with the local population of Scarborough, Ontario. This is one of Canada’s most culturally diverse communities, but not everywhere in the world are patients used to being active participants in their care.
The committee needed to truly understand the unique perspectives held by community members (more than half of whom hail from outside Canada and speak a primary language other than English or French) to embed PFCC into patient care. They made sure that patients and their families knew that the hospital wanted to hear their voices and that they understood their value in helping to inform its path with PFCC.
“As a patient advisor participating in the process of this cultural shift, and experiencing the change in care practices first-hand, I feel my voice is being heard,” said Merritt Burstein, a patient advisor on the PFCC Steering Committee.
Partnering with clinical staff was equally important in creating a culture of PFCC. The initial plan relied on developing an interactive online module describing the four principles of PFCC and how to practice, until technical difficulties forced the committee to find another approach.
They developed a PFCC Roadshow, joining clinical huddles to engage staff and influence practice changes in real-time. During the roadshow, they asked clinical staff, “What can we change today?”
“This is when we realized that face-to-face interaction was far more effective than technology,” said Liora Krinsky, Clinical Resource Leader, Medicine and Specialized Geriatrics. “It was a ‘lightbulb’ moment: we needed to engage with our staff the way we wanted them to engage with our patients!”
The roadshow evolved to include an interactive game. Clinical staff received cards describing a range of patient scenarios. They were asked to identify if these situations illustrated care that was done to, for, or with the patient. Playing the game revealed that many staff believed they were already delivering PFCC, when they were actually caught between doing “for” and “with” patients. Setting daily goals with patients became one of the first steps in active patient participation and collaboration.
Spreading PFCC to clinical areas challenged the hospital to ensure that PFCC is front and centre in the organization, from new staff orientation to the patient’s bedside. And, with help from the Rising Stars program for emergent leaders, the committee is also determining how to demonstrate to non-clinical staff the deep connection between PFCC and their roles, even though they may not work directly with patients.
Every creative step will be taken with patients to continue this culture shift across the organization. The patient voice is essential.
This work is part of the BPSO designation, funded by the Ontario Ministry of Health and Long-Term Care. For more information about the RNAO BPSO Designation, please visit www.rnao.ca.