Today’s health care system can be characterized as one that is under enormous strain given our demographic and economic realities. The changes underway in Ontario are nothing short of daunting and the stakes couldn’t be higher. At the heart of this transformation is a desire to sustain our cherished system that is anchored on the principle of universality, while we also pursue improved service access for our communities and better quality of care for our patients.
There is no doubt that to achieve these lofty goals, our system will need to adapt in so many ways – deploying new medical technologies, leveraging electronic health records, integrating our providers to remove the silos within the system, and embracing a more holistic approach to health and wellness, to name a few. I believe that one particular strategy holds the most promise in leading this health system transformation – the relationship and approach we take as providers with our patients, their families, and caregivers.
There is a growing body of research and evidence on the links between the patient experience and clinical safety and health outcomes, as well as improvements in satisfaction and system cost effectiveness. Other jurisdictions have long recognized the importance of engaging patients when redesigning their health care system. For example, in 2004, the British Design Council noted: “The biggest untapped resources in the health system are not doctors but users (of the service). We need systems that allow people and patients to be recognised as producers and participants, not just receivers of systems … At the heart of the approach users will play a far larger role in helping to identify needs, propose solutions, test and implement them, together.”
The British National Health Service’s Institute for Innovation and Improvement embraced this approach and defined five ‘core principles’ of experience-based co-design in a health care context:
- A partnership between patients, staff, and carers;
- An emphasis on experience rather than attitude or opinion;
- Narrative and storytelling approach to identify ‘touch points’;
- An emphasis on the co-design of services;
- Systematic evaluation of improvements and benefits.
In short, redesigning services is seen as a shared activity between providers and their patients, families, and caregivers. It’s a partnership approach that requires direct user and provider participation in a face-to-face collaborative venture to co-design services. The focus is shifted to one of designing experiences as opposed to systems or processes, thereby requiring new methods, such as narrative-based approaches and in-depth observation.
A patient-centred philosophy to care represents a paradigm shift for our health care system, and it also means a cultural shift at the institutional level. At the system level in Ontario, this transformation is not only recognized as essential, but it’s well underway. The Ministry of Health and Long-Term Care has set the stage and expectations through their action plan, Patients First: Action Plan for Health Care, which is “designed to deliver on one clear promise – to put people and patients first by improving their health care experience and health outcomes.” In addition, Health Quality Ontario has identified the patient experience as a top priority with dedicated resources to support providers and patients to implement leading practices. New regulations further enhance the involvement of patients and provider responsiveness to their needs, such as patient participation in preparing the hospital’s annual Quality Improvement Plans.
At the institutional level, there are numerous organizations in the province that have led the way – shout outs go to Kingston General Hospital for their comprehensive patient engagement strategy, including their Patient and Family Advisory Councils, and the groundbreaking Northumberland PATH (Partners Advancing Transitions in Healthcare) project sponsored by The Change Foundation, among others.
At The Scarborough Hospital, we have a longstanding history of understanding and adapting to the needs of one of Canada’s most diverse populations. We were one the first hospitals in Ontario – over twenty years ago – to dedicate a department and a director focused on diversity, to meet the needs of our changing community and patient profile. In 2009, we took our actions a step further, embedding the patient experience in the core of our new mission statement, “To provide an outstanding care experience that meets the unique needs of each and every patient.”
Over the years, this mission has become a passion and an intrinsic way in which we operate. It’s clear our team has a strong foundation to guide this journey of transformation and further evolve our culture of patient engagement. Our approach at The Scarborough Hospital is multi-faceted and touches the organization at all levels – from Board governance, to the program/service level, and at the front-line.
At the governance level, earlier this year our Board of Directors approved a new strategic plan, and ‘Patients as Partners’ was identified as one of four new strategic directions for the organization. We wish to engage patients and families in a meaningful way to enhance their experience, promote shared care, and improve quality of care.
As well, our hospital recently transitioned its community council to one that now includes the ‘patient voice.’ The Community and Patient Advisory Council will provide guidance on overarching patient engagement activities and reports directly to the Board of Directors. In addition, the Quality and Safety Committee of the Board is focused on how to best monitor and measure our success in achieving better outcomes from these patient engagement activities.
At the patient program/service level, The Scarborough Hospital adopted Lean quality improvement methods a number of years ago. A core principle of Lean is to engage those who perform the work – namely, the front-line staff – in designing better solutions to remove waste in their processes and focus on adding value to our patients. We have extended these Lean activities to include patients and caregivers to co-design our processes and take into account their experiences.
At the front-line level, an enhanced model of interprofessional care, based on key patient-centred principles, is being developed with a goal of learning with, from and about each other (providers and patients) to develop better perspectives. Other deliverables being pursued that engage patients and caregivers span the organization: the development of shared care plans; change of shift reports at the patient bedside; a review of the hospital’s visitor policy; patient involvement in new staff orientation; and, improvement in hospital way finding; to name a few.
From international best practice research, to what we’ve learned right here in our own hospital, it’s clear that collaboration with our patients and families will lead to better care experiences, improved quality outcomes, and a more efficient health care system overall. While this journey may not always be smooth, it’s worthy of our collective energy and commitment.