Health system redesign using Collective Impact: implementation of the Behavioural Supports Ontario initiative in Southwest Ontario.

This paper describes how the Collective Impact framework facilitated the design, implementation and development of a quality improvement initiative aimed at changing the way healthcare is provided to older adults living with mental health, addictions, neurocognitive and behavioral issues in southwestern Ontario. By promoting a common agenda, shared measurement systems, mutually reinforcing activities, continuous communication and with leadership from a backbone organization, system-wide change occurred. Outcomes, operational/strategic, clinical, capacity enhancement and community support structures as well as challenges are discussed. Improved coordination with primary care will further support enhanced clinical activities and capacity development strategies. Large-scale, multisectoral change is possible when aligned with a collaborative, problem-solving framework that promotes the commitment of many service providers/agencies to a common agenda.

Relentless Incrementalism: Shifting Front-Line Culture from Institutional to Recovery-Oriented Mental Healthcare.

St. Joseph's Health Care London is a publicly funded hospital that has led mental health service system transformation in south west Ontario following directives from the Health Services Restructuring Commission (HSRC). This paper documents how provincial policy, HSRC directives, organizational planning, research projects, quality initiatives and change management activities drove, shaped and accomplished a cultural shift at the front line to recovery-focused care. Simultaneous to these activities, beds and related ambulatory services were divested to four other hospitals, beds and employment services were closed and two new, state-of-the-art facilities were constructed, adding considerable complexities to achieving cultural change. This paper documents the incremental steps that were taken to achieve that change.

The South West Local Health Integration Network Behavioural Supports Ontario Experience.

Creating a seamless system of care with improved system and patient outcomes is imperative to the estimated 35,000 older adults living with mental health problems and addictions in the South West Local Health Integration Network. Building on existing investments and those offered through the Behavioural Supports Ontario program, strategies to improve system coordination were put in place, cross-sectoral partnerships were fostered, interdisciplinary teams from across the care continuum were linked, and educational opportunities were promoted. This evolving, co-created system has resulted in a decrease in alternate level of care cases among those with behavioural specialized needs and improved client/family perceptions of care. Also, in fiscal year 2014/15, it provided more than 7,000 care providers with learning opportunities.

Moving forward: evaluating a curriculum for managing responsive behaviors in a geriatric psychiatry inpatient population.

PURPOSE: The Gentle Persuasive Approaches (GPA) curriculum was developed as an adjunct to other educational initiatives that were part of Ontario, Canada's Alzheimer Strategy. GPA emphasizes that an individual's unique personal history has a direct application to the interpretation of and response to their behavior. It incorporates strategies into geriatric patient care to assist staff to respond effectively to verbal and physical expressions of need. DESIGN AND METHODS: A pre- and postintervention approach was used to evaluate the effectiveness of GPA: (a) Staff Satisfaction Surveys immediately after GPA training and after 3 months, (b) risk event profiling to monitor aggressive behavior rates, (c) occupational health and safety records pre- and post-GPA training, and (d) Residential Assessment Instrument-Mental Health indicators pre- and post-GPA training. RESULTS: Surveys revealed that GPA training significantly improved staff's response to challenging behaviors, understanding of how brain changes impact behavior, and learning strategies to respond to challenging behaviors. Specific body containment techniques were less employed on geriatric patients who experience responsive behaviors. Pre- and postphysical aggression rates declined over the 6-month period following GPA training. The training did not appear to impact occupational injury rates. IMPLICATIONS: GPA appears to be a useful and positive approach for providing care to an inpatient geriatric psychiatry population. Specific body containment techniques may be less useful when employed with patients who have responsive behaviors. The program evaluation suggests that application of the GPA curriculum may be extended to patients with diagnoses other than dementia.