This document summarizes information about the George Pearson Centre:
- It has 120 residents between ages 21-87, with most having neurological conditions requiring physical assistance. Staff include 240 FTEs who are mostly female and have worked there for over 10 years.
- Improvement priorities were identified in 5 areas: practicing person-centered care, enhancing basic care practices, improving nurse collaboration, using lean management strategies, and improving communication.
- Metrics like resident and staff surveys, complaints, sick time and injuries will be used to measure progress. Initial surveys showed opportunities to improve residents seeing administrators and staff taking time to listen.
- Success will be seen when residents feel their physical, emotional and spiritual needs are met
Part 3 of 4. David Fillingham of AQuA presents 'Building an improvement movement' through the alliance's key learning and priorities, starting with the Quality Curve.
Outcomes for children and young people seen in specialist mental health servicesNHSECYPMH
This workshop aims to enable viewers to take evidence from recent research as well as the collective ‘on the ground’ learning from the Child Outcomes Research Consortium (CORC) members and apply it to their service or individual practice in order to improve mental health outcomes for children and young people.
Part 3 of 4. David Fillingham of AQuA presents 'Building an improvement movement' through the alliance's key learning and priorities, starting with the Quality Curve.
Outcomes for children and young people seen in specialist mental health servicesNHSECYPMH
This workshop aims to enable viewers to take evidence from recent research as well as the collective ‘on the ground’ learning from the Child Outcomes Research Consortium (CORC) members and apply it to their service or individual practice in order to improve mental health outcomes for children and young people.
Developments in Urgent Care Services: Children and Young People's Mental Heal...NHSECYPMH
This presentation goes through the urgent care work that has been achieved within CYPS in TEWV and further developments in urgent care mental health services for young people and their families.
Transforming CYP Community Eating Disorders Services: Children and Young Peop...NHSECYPMH
The Durham and Darlington Eating Disorders Team shares with you our progress; reflecting on both successes and challenges, and offering the chance to share experiences. There are further developments and challenges ahead and we will consider what the future may hold.
Multi-agency working for Looked After Children in Sheffield - WorkshopCYP MH
CYPMH conference 2016 Future in Mind Vision to Implementation
Multi-agency working for Looked After Children in Sheffield -
Alex Espejo (Sheffield Children’s NHS Foundation Trust)
Seven Day Services - Top tips to engage your stakeholders in the delivery of ...NHS England
This presentation describes the strategic plan and journey of how Universal Hospital Southampton NHS Foundation Trust have developed and implemented out of hours and seven day services, using innovative workforce models and supporting culture change. This has led to improvements in patient outcomes, patient and staff experience and more effective patient pathways.
161207 iHV leadership conf - Jane PowellJulie Cooper
Presentation by Jane Powell, FIHV, Interim Head of Service Universal 0-5 Birmingham Community Health Trust., at the iHV Leadership conference on 7 December 2016.
Engaging Stakeholders to design and develop helth visiting services.
Healthy Minds – Sheffield’s Work in Schools: Children and Young People's Ment...NHSECYPMH
This presentation focuses on the work of Sheffield's “Healthy Minds Framework”, which we have developed as part of our participation in the CAMHS School Link Programme.
Involving Young People in Commissioning – Young People’s Involvement in the C...CYP MH
CYP IAPT 2014 National Conference
This workshop focuses on the Sheffield model of involving young people in commissioning Mental Health Services, incorporating examples of existing good practice in young people’s participation in decision making in the commissioning process. Discussions will explore key implementation factors, such as what this means for commissioners, the challenges and opportunities involved, how individual services can make this work for them and what kind of support may be necessary.
Using Feedback and Clinical Outcome Tools to Improve Collaborative Practice a...CYP MH
CYP IAPT 2014 National Conference
This workshop will explore how the use of feedback forms and clinical outcome measures can be used to improve collaborative practice and shared decision making in CAMHS, and how the information can be used to enhance clinical supervision. The workshop will set out some of the uses and evidence base for the use of feedback and outcome forms, explore the uses of the information in clinical practice and in supervision, and draw on delegates’ own experiences and ideas of using feedback and outcome forms to improve clinical practice
To Each His Own - New Research on Rewards, Incentives and MotivatorsClaudia Rimerman
New survey information from Corporate Wellness 365 illustrating employees' increased engagement in a wellness program when they are offered a broader definition of "wellness activities" and allowed to choose their own path
161207 iHV leadership conf - Sharin BaldwinJulie Cooper
Presentation by Sharin Baldwin, FiHV, NIHR Clinical Doctoral Fellow King's College London/ Health Visiting Clinical Academic Lead, London North West Healthcare Trust, t iHV leadership conference on 7 December 2016.
Leadership in Health Visiting
Linda, here is the presentation to VOI converted into the template for SET. I haven't changed anything yet. Would love your comments re where you might consider changes or insertion of photos etc. Winnie needs this and BN (which Alyssa is working on) by this Wednesday. thanks, Ro
Developments in Urgent Care Services: Children and Young People's Mental Heal...NHSECYPMH
This presentation goes through the urgent care work that has been achieved within CYPS in TEWV and further developments in urgent care mental health services for young people and their families.
Transforming CYP Community Eating Disorders Services: Children and Young Peop...NHSECYPMH
The Durham and Darlington Eating Disorders Team shares with you our progress; reflecting on both successes and challenges, and offering the chance to share experiences. There are further developments and challenges ahead and we will consider what the future may hold.
Multi-agency working for Looked After Children in Sheffield - WorkshopCYP MH
CYPMH conference 2016 Future in Mind Vision to Implementation
Multi-agency working for Looked After Children in Sheffield -
Alex Espejo (Sheffield Children’s NHS Foundation Trust)
Seven Day Services - Top tips to engage your stakeholders in the delivery of ...NHS England
This presentation describes the strategic plan and journey of how Universal Hospital Southampton NHS Foundation Trust have developed and implemented out of hours and seven day services, using innovative workforce models and supporting culture change. This has led to improvements in patient outcomes, patient and staff experience and more effective patient pathways.
161207 iHV leadership conf - Jane PowellJulie Cooper
Presentation by Jane Powell, FIHV, Interim Head of Service Universal 0-5 Birmingham Community Health Trust., at the iHV Leadership conference on 7 December 2016.
Engaging Stakeholders to design and develop helth visiting services.
Healthy Minds – Sheffield’s Work in Schools: Children and Young People's Ment...NHSECYPMH
This presentation focuses on the work of Sheffield's “Healthy Minds Framework”, which we have developed as part of our participation in the CAMHS School Link Programme.
Involving Young People in Commissioning – Young People’s Involvement in the C...CYP MH
CYP IAPT 2014 National Conference
This workshop focuses on the Sheffield model of involving young people in commissioning Mental Health Services, incorporating examples of existing good practice in young people’s participation in decision making in the commissioning process. Discussions will explore key implementation factors, such as what this means for commissioners, the challenges and opportunities involved, how individual services can make this work for them and what kind of support may be necessary.
Using Feedback and Clinical Outcome Tools to Improve Collaborative Practice a...CYP MH
CYP IAPT 2014 National Conference
This workshop will explore how the use of feedback forms and clinical outcome measures can be used to improve collaborative practice and shared decision making in CAMHS, and how the information can be used to enhance clinical supervision. The workshop will set out some of the uses and evidence base for the use of feedback and outcome forms, explore the uses of the information in clinical practice and in supervision, and draw on delegates’ own experiences and ideas of using feedback and outcome forms to improve clinical practice
To Each His Own - New Research on Rewards, Incentives and MotivatorsClaudia Rimerman
New survey information from Corporate Wellness 365 illustrating employees' increased engagement in a wellness program when they are offered a broader definition of "wellness activities" and allowed to choose their own path
161207 iHV leadership conf - Sharin BaldwinJulie Cooper
Presentation by Sharin Baldwin, FiHV, NIHR Clinical Doctoral Fellow King's College London/ Health Visiting Clinical Academic Lead, London North West Healthcare Trust, t iHV leadership conference on 7 December 2016.
Leadership in Health Visiting
Linda, here is the presentation to VOI converted into the template for SET. I haven't changed anything yet. Would love your comments re where you might consider changes or insertion of photos etc. Winnie needs this and BN (which Alyssa is working on) by this Wednesday. thanks, Ro
Early indicators of concern in adult care settings E40Sophie40
Workshop that highlights the work done with the University of Hull to identify early indicators of concern in care settings which may, if unresolved, affect the safety and well being of residents. Further development has been undertaken to develop these early indicators into good practice guidance, which assists staff members and other relevant stakeholders to work in a preventative way and promotes good partnership working. Contributed by: Dundee City Council
Chief Allied Health Professions Officer’s Conference 2016
Workshop 3: Integrated Care – Chair Lindsey Hughes
iCares – population based delivery of care. Ruth Williams, Clinical Directorate Lead, Community and Therapies Clinical Group. Sandwell and West Birmingham Hospitals NHS Trust.
Patient Satisfaction
Patient Satisfaction Today
• Has become an important buzzword in health
care.
• Patients have access to hospital “report card”
patient satisfaction and quality scores.
– Ex: Hospital Compare
• Hospital placing high priority for patient
satisfaction due to scores being tied to
reimbursement rates.
Patient Satisfaction Today
• Patients are better informed.
• Patients want to understand their medical
care and be a part of the decision-making
process.
• Health care is featured almost daily in the
media, increasing patient expectations of the
care provided.
How is Patient Satisfaction Measured?
• Hospital Consumer Assessment of Healthcare Providers
and Systems (HCAHPS) Survey.
• Standardized survey to gather and compare data across
the nation.
• 27 questions based on:
– Physician/Nurse/Staff Communication
– Hospital Environment
– Pain Management
– Overall rating
– Recommendation of Hospital
• Conducted through mail and/or telephone.
• Conducted after patient discharge.
Sample HCAHPS Questionnaire
• During this hospital stay, how often did nurses treat you with courtesy and
respect?
1. Never 2. Sometimes 3. Usually 4. Always 5. Non Applicable
• During this hospital stay, how often did doctors treat you with courtesy
and respect?
1. Never 2. Sometimes 3. Usually 4. Always 5. Non Applicable
• During this hospital stay, how often was the area around your room quiet at night?
1. Never 2. Sometimes 3. Usually 4. Always 5. Non Applicable
• Would you recommend this hospital to your family and friends?
1. Definitely No 2. Probably No 3. Probably Yes 4. Definitely Yes
• Using any number from 0–10, where 0 is worst hospital possible and 10 is
the best hospital possible, what number would you use to rate this
hospital?
Hospital Compare
Impact of ACA on Patient Satisfaction
• Pay For Performance (P4P).
• DRG payments are adjusted based on
performance on HCAHPS (30%) and clinical
process measures (70%).
• Patient satisfaction makes up 30% of hospital’s
score.
– Recommend Hospital
– Rate Hospital 9–10
Excellent Patient Satisfaction
• Excellent customer satisfaction goes beyond
patient interaction during hospital stay.
• Organizations judged on customer service the
instant contact is made with patient or family
member (phone, face-to-face, email, etc.).
• Higher patient satisfaction with inpatient care
and discharge planning is associated with
lower 30-day readmission rates.
» Source: AM J Managed Care, 2011; 17(1): 41-48
Trickle Down Effect of Excellent Service
• Providing excellent service leads to happy
patients who are less anxious.
• Less anxious patients are more cooperative,
leading to positive results.
Patient Needs
• Customer-friendly environment.
• Compassionate, caring, and individualized
care.
• Respect for privacy.
• Cultural sensitivity.
• Timely and proper explanations about ...
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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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.