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

Policy Implementation in Higher Education: The Dynamics of a Fall Break

A case study using mixed methods that critically appraises the implementation of a mental health policy in higher education in the absence of evidence to inform the policy using an exemplar case from one mid-sized post-secondary institution was the motivation for this research. Explanation building was used to iteratively analyse data on rival explanations of the implementation of the fall break policy. Analyses from the surveys revealed that overall, only 36.9 per cent of students perceived an increase in workload before the break and only 29.6 per cent of students perceived an increase in workload after the break. However, the focus groups and professor interviews revealed that the timing of the fall break had an impact on how students and professors experienced the break and their perceptions on its impact on student mental health. If baseline data regarding the implementation of the fall break would have been collected prior to its implementation, we could have possibly avoided the implementation issues that arose. While this research provides an exemplar case of a fall break policy at one post-secondary institution, the policy learning is universal

Organizational interventions in response to duty hour reforms

Abstract Background Changes in resident duty hours in Europe and North America have had a major impact on the internal organizational dynamics of health care organizations. This paper examines, and assesses the impact of, organizational interventions that were a direct response to these duty hour reforms. Methods The academic literature was searched through the SCOPUS database using the search terms “resident duty hours” and “European Working Time Directive,” together with terms related to organizational factors. The search was limited to English-language literature published between January 2003 and January 2012. Studies were included if they reported an organizational intervention and measured an organizational outcome. Results Twenty-five articles were included from the United States (n = 18), the United Kingdom (n = 5), Hong Kong (n = 1), and Australia (n = 1). They all described single-site projects; the majority used post-intervention surveys (n = 15) and audit techniques (n = 4). The studies assessed organizational measures, including relationships among staff, work satisfaction, continuity of care, workflow, compliance, workload, and cost. Interventions included using new technologies to improve handovers and communications, changing staff mixes, and introducing new shift structures, all of which had varying effects on the organizational measures listed previously. Conclusions Little research has assessed the organizational impact of duty hour reforms; however, the literature reviewed demonstrates that many organizations are using new technologies, new personnel, and revised and innovative shift structures to compensate for reduced resident coverage and to decrease the risk of limited continuity of care. Future research in this area should focus on both micro (e.g., use of technology, shift changes, staff mix) and macro (e.g., culture, leadership support) organizational aspects to aid in our understanding of how best to respond to these duty hour reforms

Characteristics of expert development in rhythmic gymnastics: A retrospective study

The development of expertise for two groups of rhythmic gymnasts was studied where a group of elite (Olympic) gymnasts was compared to a group of sub-elite (International) gymnasts. Structured interviews were used to collect retrospective information about the gymnasts?health, training resources, level and ranking, and hours spent in training activities. The gymnasts rated practice activities during the last period of their development (age 16 and older) with respect to their perceived physical effort, mental concentration, and fun. The Olympic gymnasts were involved in significantly fewer activities and sports throughout their development compared to the International gymnasts. All gymnasts reported engaging in five practice activities of warm-up, ballet, technique training, routines, and conditioning in their rhythmic gymnastics training. Olympic gymnasts allocated substantially more time to the practice activities of ballet, technique, routines, and conditioning, compared to the International gymnasts. Olympic gymnasts also rated their health as lower than the International gymnasts. All gymnasts reported that the practice activities of technique and routine training required more physical effort and mental concentration than warm-up, ballet, and conditioning. The Olympic gymnasts reported experiencing less fun in their participation overall. The findings of this study provide a comprehensive description of early activity involvement, training activities, training resources, and health and injury ratings of expert level rhythmic gymnasts and help to further the understanding of how to assess sport expertise development

Stress Testing the University Fall Break Policy: Understanding the Impact on Student Mental Health

Attempting to support student mental health, many Canadian universities have implemented a fall break with the assumption it would be helpful in alleviating students’ stress and anxiety. However, there is no baseline data regarding stress level or mental illness burden of students to understand its effectiveness. Using case study methodology with mixed methods, this research sought to appraise, given a lack of baseline data, the impact of a fall break on student mental health. While the surveys revealed that students overwhelmingly liked the break and perceived it to reduce their school related stress, the focus groups revealed key insights into understanding stress and coping among university students about how students like to de-stress that have practical implications for any policy aimed at promoting students’ mental wellness. This research offers practical policy suggestions to help post-secondary institutions determine whether a fall break week can be effective in addressing students’ stress and anxiety.Pour soutenir la santé mentale des étudiants, des universités canadiennes ont instauré un congé d’automne visant à atténuer le stress et l’anxiété. Toutefois, il n’existe aucune donnée sur le niveau de stress ou le fardeau de la maladie mentale chez les étudiants. Avec la méthodologie d’une étude de cas et une combinaison d’approches, cette étude visait à évaluer les effets du congé sur la santé mentale des étudiants. D’après les enquêtes, le congé est apprécié de la majorité des étudiants, qui considèrent qu’il permet de réduire le stress lié aux études. Les groupes de discussion ont révélé des éléments clés sur le stress et sa gestion chez les étudiants, qui ont des incidences  pratiques sur toute politique sur le mieux-être mental desétudiants. L’étude offre des suggestions de politiques pour aider les établissements postsecondaires à déterminer l’efficacité d’une semaine de congé dans la réduction du stress et de l’anxiété des étudiants

Stress Testing the University Fall Break Policy: Understanding the Impact on Student Mental Health

Attempting to support student mental health, many Canadian universities have implemented a fall break with the assumption it would be helpful in alleviating students’ stress and anxiety. However, there is no baseline data regarding stress level or mental illness burden of students to understand its effectiveness. Using case study methodology with mixed methods, this research sought to appraise, given a lack of baseline data, the impact of a fall break on student mental health. While the surveys revealed that students overwhelmingly liked the break and perceived it to reduce their school related stress, the focus groups revealed key insights into understanding stress and coping among university students about how students like to de-stress that have practical implications for any policy aimed at promoting students’ mental wellness. This research offers practical policy suggestions to help post-secondary institutions determine whether a fall break week can be effective in addressing students’ stress and anxiety.Pour soutenir la santé mentale des étudiants, des universités canadiennes ont instauré un congé d’automne visant à atténuer le stress et l’anxiété. Toutefois, il n’existe aucune donnée sur le niveau de stress ou le fardeau de la maladie mentale chez les étudiants. Avec la méthodologie d’une étude de cas et une combinaison d’approches, cette étude visait à évaluer les effets du congé sur la santé mentale des étudiants. D’après les enquêtes, le congé est apprécié de la majorité des étudiants, qui considèrent qu’il permet de réduire le stress lié aux études. Les groupes de discussion ont révélé des éléments clés sur le stress et sa gestion chez les étudiants, qui ont des incidences  pratiques sur toute politique sur le mieux-être mental desétudiants. L’étude offre des suggestions de politiques pour aider les établissements postsecondaires à déterminer l’efficacité d’une semaine de congé dans la réduction du stress et de l’anxiété des étudiants