Examining the Influence of the Patient Declaration of Values on Hospital Policies and Practices

The purpose of this study was to explore how a leading Ontario hospital operationalizes their Patient Declaration of Values (PDoV) in policy and in practice. This was a single case study, which took place in a leading patient-centred Ontario hospital. The study included 18 individual interviews with employees and patient experience advisors, as well as, document analysis of strategic planning reports (n=10). Five themes emerged: (1) setting the stage, (2) inspiring change, (3) organizational structures, (4) organizational and environmental barriers, and (5) reflection and improvement. This study has highlighted the role of the PDoV within a leading Ontario hospital. It lends itself to providing a process with core strategies for creating change in an acute health care organization; to embed a culture of patient and family centred care

Using patient value statements to develop a culture of patient-centred care: a case study of an Ontario, Canada hospital

Patient-centred care (PCC) is not a new concept; however, in recent years it has garnered increasing attention in the research literature and clinical practice. PCC in clinical practice has been found to improve clinical outcomes, resource allocation, and the patient experience. In response to the need for PCC and quality in healthcare, the Ontario, Canada government developed the Excellent Care for All Act (ECFAA) in 2010. The ECFAA imposes six obligations to Ontario hospitals, one of which is developing and publishing a Patient Declaration of Values (PDoV). The purpose of this study was to explore how a leading patient-centred Ontario hospital operationalized their patient value statement in policy and practice. The objectives of this research were to: a) understand what role the patient value statement played in policy and practice within a leading Ontario hospital and b) to examine how a leading Ontario hospital incorporated these values into their overarching organizational structures. This was a qualitative case study, which took place in a leading patient-centred Ontario hospital. The study included 18 interviews with employees and patient/family advisors. The analysis found a five-step process including: 1) setting the stage, 2) inspiring change, 3) organizational capacity, 4) barriers, and 5) reflection and improvement. This study has highlighted the role of a patient value statement within a leading Ontario hospital. The findings provide a five-step process with 12 core strategies for creating change in a healthcare organization; to embed a culture of patient-centred care

Assessment of Quality Improvement in Ontario Public Health Units

Background: Quality Improvement (QI) approaches are used extensively in healthcare settings and increasingly in public health. However, the proliferation of QI in Canadian public health settings is unknown. Purpose: The purpose of this study was to (a) assess the QI maturity in Ontario local public health units in Canada, and (b) to determine the relevance of the QI Maturity Tool in a Canadian setting Methods: The QI Maturity Tool (Version 5) was used to conduct a cross-sectional assessment of the QI maturity of 36 local public health units in Ontario, Canada. After tool items were reviewed for relevance, individuals most responsible for QI at each health unit were surveyed. Descriptive statistics were used to analyze the data. Results: Thirty-one individuals responded (response rate: 86%). Respondents reported strong leadership support for QI, but limited training and resources available to advance this area. Approximately half of public health units were found to be at the ‘beginner’ stage of QI maturity; 19% and 26% were in the ‘emerging’ and ‘progressive’ stages, respectively. Only 3% were in the ‘achieving’ stage and none are in the ‘excelling’ stage. Implications: The QI Maturity Tool is valuable for determining the maturity of QI in Ontario public health settings. There appears to be strong support for advancing QI across local public health in Ontario, but limited infrastructure to enable associated QI activities

Experience-based co-design: A method for patient and family engagement in system-level quality improvement

Integrating patient and family member needs, wants and preferences in healthcare is of utmost importance. However, a standardized patient and family engagement model to understand these needs, wants and preferences in order to translate into high quality improvement activities is lacking. Experience based co-design (EBCD) is an approach that enables patients, family members and healthcare providers to co-design improvement initiatives together. In this study, EBCD was employed to: 1) assess the current state of information and educational resources at a local oncology center and 2) partner with patients, family members, and healthcare providers to create quality improvement initiatives targeting identified issues. Three focus groups were conducted: 1) patient and family member-specific, 2) healthcare provider-specific, and 3) all participants (including patients, family members and healthcare providers). Discussion questions were focused around current educational resources, barriers encountered throughout the cancer continuum, and recommendations for improvement. Six themes emerged from the two initial focus groups with patients and family members and healthcare providers: 1) patient-provider communication, 2) accessing information, 3) tailored information, 4) side effect information, 5) caregiver information, and 6) partners in care. Themes were presented to participants to ensure findings accurately depicted their experience and five quality improvement projects were created, aligning with the themes. This study provides an example of how EBCD helped to foster a safe environment, where patients, family members, and healthcare providers worked together in order to improve educational resources

Engaging under- and/or never-engaged populations in health services: A systematic review

Patient engagement is a mechanism used to facilitate person-centred care, however, has not been realized in all patient populations. Often, many marginalized populations still remain under- and/or never-engaged. The purpose of this systematic review was to: 1) identify methods or interventions that have been used to engage under- and/or never-engaged populations in health services and 2) identify outcomes that are associated with engaging under- and/or never-engaged populations in health services. A comprehensive search using the Ovid MEDLINE, EMBASE and CINAHL databases was conducted to examine literature between January 2002 and January 2015. Twenty-nine studies met the inclusion criteria. Data was extracted from these studies and findings are synthesized based on discrete themes that map to the research objectives. The majority of studies were quantitative, repeated-measures designs and concentrated in the United States. Hispanic and Latino/a populations were most frequently included in these studies. The main methods of recruitment included: 1) referral from a healthcare provider, 2) patient self-referral after seeing advertisements on mass media or targeted media, 3) directly approached by researcher in-person or telephone, and 4) administrative databases. Interventions occurred primarily at the individual-level, however some system-level interventions were identified. Five main outcomes resulted from the interventions, including: 1) behavioural change, 2) physiological, 3) psychosocial, 4) system and 5) process. Finally, culture-specific components were embedded in the interventions, both as surface and deep structures. This study provides future direction for patient engagement related projects, as it relates to under-and never-engaged population in healthcare. Experience Framework This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens

A generative network model of neurodevelopmental diversity in structural brain organization

Funder: RCUK | Medical Research Council (MRC); doi: https://doi.org/10.13039/501100000265Funder: James S. McDonnell Foundation (McDonnell Foundation); doi: https://doi.org/10.13039/100000913Funder: Cambridge Commonwealth, European and International Trust (Cambridge Commonwealth, European & International Trust); doi: https://doi.org/10.13039/501100003343Abstract: The formation of large-scale brain networks, and their continual refinement, represent crucial developmental processes that can drive individual differences in cognition and which are associated with multiple neurodevelopmental conditions. But how does this organization arise, and what mechanisms drive diversity in organization? We use generative network modeling to provide a computational framework for understanding neurodevelopmental diversity. Within this framework macroscopic brain organization, complete with spatial embedding of its organization, is an emergent property of a generative wiring equation that optimizes its connectivity by renegotiating its biological costs and topological values continuously over time. The rules that govern these iterative wiring properties are controlled by a set of tightly framed parameters, with subtle differences in these parameters steering network growth towards different neurodiverse outcomes. Regional expression of genes associated with the simulations converge on biological processes and cellular components predominantly involved in synaptic signaling, neuronal projection, catabolic intracellular processes and protein transport. Together, this provides a unifying computational framework for conceptualizing the mechanisms and diversity in neurodevelopment, capable of integrating different levels of analysis—from genes to cognition

Moving transboundary conservation from Indigenous engagement to Indigenous leadership: Working across borders for a resilient Cascadia

As the number of transboundary conservation initiatives continues to grow in response to the twin threats of climate change and biodiversity loss, so too have calls for Indigenous-led conservation that recognizes Indigenous rights and supports Indigenous land and wildlife stewardship. And yet, because many transboundary initiatives have historically been settler-led, such efforts are now contending with how best to pivot toward models of more meaningful Indigenous engagement and leadership. Here, we describe the Cascadia Partner Forum’s recently completed Blueprint for a Resilient Cascadia, a collaborative strategy for supporting large-landscape resilience in the transboundary region of Washington and British Columbia. We reflect on the history of the Cascadia Partner Forum, the collaborative process employed in its development of the Blueprint for a Resilient Cascadia, and its commitment and ongoing effort to ethically and effectively engage with Tribes and First Nations. We pay particular attention to a transformational shift that occurred during Blueprint development: a move from an initial goal of “Indigenous engagement” toward one of “centering Indigenous leadership,” and describe the resulting effort to provide a space for leadership by Tribes and First Nations while supporting the capacity such leadership requires. We hope our reflections can help inform other transboundary conservation initiatives working to move away from what has been a predominantly colonizing model of conservation to one promoting Indigenous-led governance

The Person-Centred Care Guideline: From Principle to Practice

Background: A standardized definition and approach for the delivery of person-centered care (PCC) in cancer care that is agreed upon by all key policy makers and clinicians is lacking. The PCC Guideline defines core PCC principles to outline a level of service that every person accessing cancer services in Ontario, Canada should expect to receive. This article describes the dissemination of the PCC Guideline in practice. Methods: Three strategies were utilized: (1) educational intervention via a PCC video, (2) media engagement, and (3) research/knowledge user networks. Results: As of October 2016, the PCC video has been viewed 7745 times across 92 countries. Significant mean differences pre- and post-PCC video were found for understanding of PCC principles ( P < .001) and perceived ability to bring these PCC principles to practice ( P < .001). Through content analysis, the PCC Guideline recommendations were referenced 236 times, with “Enabling Patients to Actively Participate in their Care” (n = 81), and “Essential Requirements of Care” (n = 79) being referenced most frequently. Conclusions: These strategies are an effective way to target multiple PCC stakeholders in the health-care system to increase awareness of the PCC Guideline, in order to further impart knowledge of PCC behaviors

Ask Suicide-Screening Questions to Everyone in Medical Settings: The asQ'em Quality Improvement Project

BACKGROUND: Suicide in hospital settings is a frequently reported sentinel event to the Joint Commission (JC). Since 1995, over 1,000 inpatient deaths by suicide have been reported to the JC; 25% occurred in non-behavioral health settings. Lack of proper “assessment” was the leading root cause for 80% of hospital suicides. This paper describes the “Ask Suicide-Screening Questions to Everyone in Medical Settings (asQ’em)” Quality Improvement Project. We aimed to pilot a suicide screening tool and determine feasibility of screening in terms of prevalence, impact on unit workflow, impact on mental health resources, and patient/nurse acceptance. METHODS: We piloted the asQ’em 2-item screening instrument that assesses suicidal thoughts and behaviors, designed specifically for nurses to administer to medical patients. Educational in-services were conducted. A convenience sample of adult patients 18 years or older, from three selected inpatient units in the National Institutes of Health Clinical Center, participated. RESULTS: 331 patients were screened. 13 (4%) patients screened “positive” for suicide risk and received further evaluation. No patient had acute suicidal thoughts or required an observational monitor. Screening took approximately 2 minutes; 87% of patients reported feeling comfortable with screening. 81% of patients, 75% of nurses, and 100% of social workers agreed that all patients in hospitals should be screened for suicide risk. DISCUSSION: Nurses can feasibly screen hospitalized medical/surgical patients for suicide risk with a 2-item screening instrument. Patients, nurses, and social workers rated their experience of screening as positive, and supported the idea of universal suicide screening in the hospital