10. Profile of Resident Population
• 120 residents
• Age range 21 – 87 years; average and median: 57 years
• 62% male, 38% female
• Approximately 19 admissions/year
• Neurological conditions
• Severe physical disabilities
• 50% able to direct care, 50% unable to direct care
• Average length of stay - 17 years
• 50% of residents using power – 50% using manual wheelchair
• 19 residents with tracheostomies + 20 with trachs and require
ventilator
• 46 residents with tube feeding
• 4-6 residents move out to the community/year
• 10-13 residents pass away/year
11. Profile of Staff
• 240 FTEs, approx 300 staff
• 20% male; 80% female
• Average age – 51 years
• FT staff: 67% have worked 10 years +
• RNs (23%), LPNs (12%), RCAs (33%)
• Allied Health Staff (9%)
• 48% are from Vancouver area
12. Drivers for Change
• Resident and staff feedback
• Continuation of the Eden Journey
• Pre-planning for GPC redevelopment
• Multiple review documents with
recommendations
• Strong advocacy group
• Media/PR concerns
13. Process for determining priorities
January 2012:
• Development of Steering Committee
• Interview staff, residents & other stakeholders
• Developed themes
• Review of historical documents
February 2012:
• Planned details of improvement opportunities
March/April 2012:
• Implementation of improvement work
• Conduct resident Eden Warmth survey (pre metric)
14. Not everything that is faced
can be changed.
But nothing can be changed
until it is faced.
James Baldwin
15. Improvement Priorities
1. Practicing all aspects of Person-Centred
Approach
2. Improving basic care practices
3. Improving collaboration across nursing
roles and enhancing supporting structure
4. Strategic Deployment of Lean
Management
5. Developing a communication strategy
16. #1 – Practicing Person-Centered Care Approach
We will achieve this by….
• Completing the Vision/Values work
• Developing can education program where
staff learn to improve their empathic skills
and reinforce professional presence
• Exploring strategies to enhance support to
meet residents’ emotional needs
• Holding everyone accountable to living the
vision/mission/values of GPC
17. Vision
Great place to live and work with a
Passion for excellence and a
Commitment to safe and respectful care
Biln, 2010
20. # 2 – Enhancing Basic Care Practices
We will achieve this by…..
• Delivering education specific to
addressing/managing behavioral issues
• Ensuring that orientation is standardized
• Resurrecting the one-day GPC specific
orientation
• Doing a needs assessment for education to
develop an ongoing program
21. #3 – Improving Collaboration among Nurses
We will achieve this by……
• Adjusting staffing complement
• Delivering education sessions re scope of
practice, roles and responsibilities of RN/LPN
• Developing structure on various shifts to
enhance collaboration – shift report, huddles,
routines, assignment
• Redesign how work is shared among RN, LPN
and RCA
22. # 4 - Strategy Deployment
We will achieve this by….
• Having a focus on Quality Improvement
• Using Lean Management principles and
tools
– Daily Status Sheets
– Improvement Board
– K board
– Breakthrough Improvement Lane
– Standardized work
23. # 5 – Improving Communication
We will achieve this by….
• Including a Communications Leader as a
member of Steering Committee
• Posting all information Bulletin board to
communicate work
• Using Neighborhood Meetings and Resident
Council to communicate changes and
improvements
• Using newly developed monthly staff forums
• Sharing and celebrating improvement work on
an ongoing basis
24. Measurements
• Eden Elder Warmth Survey
• Staff Engagement and Safety Survey
• Sick Time
• Overtime
• MSIP Injuries
• Accreditation
• Provincial Resident Satisfaction Survey
25. Measurements
• # of complaints through CARMA/Client
Relations
• % of complaints related to disrespectful
care
26. Period 1 YTD SICK TIME Rates
Measurements
• # of complaints through CARMA/Client
Relations
• % of complaints related to disrespectful
care
27. Measurements
• # of complaints through CARMA/Client
Relations
• % of complaints related to disrespectful
care
28. Measurements
• # of complaints through CARMA/Client
Relations
• % of complaints related to disrespectful
care
29. Measurements
• # of complaints through CARMA/Client
Relations
• % of complaints related to disrespectful
care
30. Eden Elder Warmth Survey Overview
Total 21 questions in the survey
– Satisfaction on staff (8 questions - Q2, 3, 5, 7, 8, 13, 17, 19)
– Satisfaction on services (9 questions - Q1, 4, 9, 10, 11 12, 15, 16, 21)
– Patients’ mood (5 questions - Q6, 14, 18, 20)
49 questionnaire have been completed
Overall, 41% of residents responded with positive answers
– 35.7% with positive response for staff related questions
– 50.8% positively responded with satisfaction (agree or strongly agree) on
facility condition & services related questions
– 29.4% with positive response for psychological feeling
31. Eden Elder Warmth Survey Overview
Areas we are doing well (over 50% with positive response)
The administrator knows my name
I feel safe
I trust my physician
The facility is clean
I enjoy my bathing time
32. Eden Elder Warmth Survey Overview
Opportunities for improvement (over 50% with negative response)
I rarely see the administrator
My room looks much like a room in someone’s home
I am comfortable bringing my concerns to a staff member
Staff members take time to talk and listen to me
33. Staff Engagement and Safety Survey 2011
Opportunities for improvement (over 50% with negative response)
I rarely see the administrator
My room looks much like a room in someone’s home
I am comfortable bringing my concerns to a staff member
Staff members take time to talk and listen to me
34. Staff Engagement and Safety Survey 2011
Opportunities for improvement (over 50% with negative response)
I rarely see the administrator
My room looks much like a room in someone’s home
I am comfortable bringing my concerns to a staff member
Staff members take time to talk and listen to me
35. We will know we have been successful when…
• Residents receive care that meets their
physical, medical, emotional and spiritual
needs
• Residents feel safe living at GPC
• Residents feel respected by all staff
• Residents feel that all staff are living the vision
and values of GPC
• Residents have input and control over their
care decisions
36. We will know we have been successful when…
• Residents feel they can raise concerns
without reprisal
• Residents feel that their issues are at least
explored if not resolved
• Residents are reassured that
“management” will facilitate conflict
resolution
• Residents are informed of goings-on at GPC
on a regular and ongoing basis feel
respected by all staff
Joy was diagnosed with polio when she was 11 years old. She was at VGH for 1.5 years and then in 1956 transferred to Pearson for another 1.5 years. She then lived with her family until 1973. She has been at Pearson now for 39 years. She is now 70 years old. When asked why she doesn’t return to the community, she said that she is happy at Pearson. Her full time partner comes and visits her every night and they have dinner together. She is one of the founders of Resident Council back in the days of BC Rehab and continues to be a strong advocate for residents. Her hobbies include painting and she is in the process of writing a book about her life. When I met her in the mid-90s she wasn’t trached, but now she has a trach and requires a ventilator. Whenever I need a sounding board, I go to Joy!
I was Guy’s nurse at Shaughnessy! He has a spinal cord injury from a car accident back in 1992. He has been at Pearson since 1993. He too is content living at Pearson – he has an “office” where he can do all of his techy stuff. He is basically our house IT guy! He is kept busy looking for music and burning CDs for the other residents. He owes his love for computers to a fellow resident who has since passed away. He was my mentor, Guy says. He loves the grounds of Pearson as do many other residents. Guy used to drink a lot but is now sober. Guy is 52 years old.
Diana is 43 years old and has lived at Pearson for 2 years now after being transferred from Purdy. Diana was diagnosed with phocomelia and lymphodema from birth. Prior to living in residential care facilities, Diana lived on her own with home support. She worked at Neil Squire for 2 years and volunteered with CARMA 10 years ago. But when she got sick she had to quit work and volunteering. She is now back with CARMA – I would often see her visiting with other residents and when I chatted with her back in January, she said that she really enjoys making other residents smile, even if it’s only half a smile! Her ultimate goal is to back to the community, go to school or work and volunteer again. Our biggest challenge right now is how we can facilitate her getting up every day when we have to wrap her with an enormous compression device to decrease her systemic edema. Despite those challenges, Diana herself most always maintains a smile on her face!
Karen has dystonia since she was 17 years old, and cannot articulate her words clearly. She uses a communication board where she types what she wants to say and the words come out automatedly. She came to Pearson in 2000 and married a fellow resident Guy in 2006. Karen used to live in the community until she could no longer look after herself. She had the opportunity to move back to the community a few years back but because Guy’s condition is precarious, they decided to stay. Karen can often be seen strolling the grounds of Pearson. Right now she is sad because her husband is at VGH trach and ventilated as his medical condition became worse about 3 weeks ago.
Read out parts of Linda Thomas’ Sept 2011 review re care and neurological conditions (examples)Other indicators: pain: 50% none, between mild to moderate 39%, 11% no recordWounds: stage 1-23%, stage 2 – 43%, stage 3 – 20%, stage 4 – 14%Lulu’s data – 3 years CTAS level and ED admission rates by GPC residents have increase year after year; average lOS in acute 10 days; CMGs UTI, aspiration pneumonia and bacterial pneumonia
Need to validate with Linda/Marion
Use nursing process as framework for assessment, planning, intervention and evaluation
What have we faced that can be changed? Or that we decided to focus on?
Lack of vision, mission and values specific to GPC to guide provision of careGaps in providing emotional needs of residentsStall in implementation of Eden philosophy
Read out statements from document for each value
Dr. S. deRappard’s sessionsStandardized orientation schedule for various roles Using competency tools at the outset for new staffResurrecting one day GPC specific orientationWill conduct Needs Assessment from staff and develop continuing education plan
Addition of LPNs on 2 wardsLack of consistency in operationalizing the LPN role on various shifts/wardsLack of understanding of LPN/RN responsibilitiesLack of teamworkLack of structure / standardized work
Have RCCs start taking Lean classes starting with A3/VSMPesentations to steering committee, interprof practice council, residents council re Lean Management and principles by Lean teamUsing status sheet twice weeklyIntroducing Improvement Board
Lack of robust communication channels Culture of perceived non-transparencySO what have we done?
Need to consider number of staff who residents complain about!
If we get some good 'warmth' then we can feel more confident in making changes (the people of GPC are ready and receptive for changes)Eden Alternative Warmth Surveys measure the levels of optimism, trust and generosity across an organization. This is very different from satisfaction surveys; it is more like a cultural assessment. In order to prepare an organization for change, people need to be optimistic, trusting of leaders and have a generous spirit. These surveys provide the measurements leaders need to know as they guide change on the culture change journey."
Goal is to do more focus groups to drill down on issues especially re bringing up concerns to staff and staff taking time to talk to residents.
Again, focus groups will inform us of much more regarding safety. As we know the response rate was relatively low so definitely need to hear from more staff.
