Bringing Value-Based Perspectives to Care: Including Patient and Family Members in Decision-Making Processes.

BACKGROUND: Recent evidence shows that patient engagement is an important strategy in achieving a high performing healthcare system. While there is considerable evidence of implementation initiatives in direct care context, there is limited investigation of implementation initiatives in decision-making context as it relates to program planning, service delivery and developing policies. Research has also shown a gap in consistent application of system-level strategies that can effectively translate organizational policies around patient and family engagement into practice. METHODS: The broad objective of this initiative was to develop a system-level implementation strategy to include patient and family advisors (PFAs) at decision-making points in primary healthcare (PHC) based on wellestablished evidence and literature. In this opportunity sponsored by the Canadian Foundation for Healthcare Improvement (CFHI) a co-design methodology, also well-established was applied in identifying and developing a suitable implementation strategy to engage PFAs as members of quality teams in PHC. Diabetes management centres (DMCs) was selected as the pilot site to develop the strategy. Key steps in the process included review of evidence, review of the current state in PHC through engagement of key stakeholders and a co-design approach. RESULTS: The project team included a diverse representation of members from the PHC system including patient advisors, DMC team members, system leads, providers, Public Engagement team members and CFHI improvement coaches. Key outcomes of this 18-month long initiative included development of a working definition of patient and family engagement, development of a Patient and Family Engagement Resource Guide and evaluation of the resource guide. CONCLUSION: This novel initiative provided us an opportunity to develop a supportive system-wide implementation plan and a strategy to include PFAs in decision-making processes in PHC. The well-established co-design methodology further allowed us to include value-based (customer driven quality and experience of care) perspectives of several important stakeholders including patient advisors. The next step will be to implement the strategy within DMCs, spread the strategy PHC, both locally and provincially with a focus on sustainability.

Implementation and evaluation of a best practice initiative. Venipuncture in the well baby.

Venipuncture is now the standard method of phlebotomy for well newborn infants at Kingston General Hospital (KGH), Canada. Newborn infants require at least one blood sample for mandatory genetic screening. Some will require additional samples for monitoring of hyperbilirubinemia or other laboratory tests. A change from capillary heel sticks to venipuncture was implemented when the lancets in use were discontinued and a suitable replacement could not be found at the time. A review of the literature discovered a Cochrane Neonatal Review that supported newborn venipuncture as a safe, pain-reducing practice when performed by trained phlebotomists. As a result, a quality improvement project was developed to implement the practice of venipuncture for the well newborn. The implementation and evaluation included lectures, demonstrations, return demonstrations, and eventual integration into clinical practice. Process and summative evaluation demonstrated a willingness of staff to learn a new procedure, particularly when they had identified the need for change. In addition, infants were not subjected to multiple, ineffective blood draws.

Collaborative partnerships: managing increased healthcare demand without increasing overall system capacity.

Collaborative partnerships can help improve integration and quality in local healthcare systems. We describe an innovative approach that was implemented following the formation of a tri-provider partnership between homecare and two acute care hospitals. The approach questioned the prevailing thought that the home is always the most appropriate and least costly location to provide services to clients traditionally served by homecare. The goal was to improve the delivery of healthcare by better integrating patient characteristics with services provided by homecare, hospitals and family physicians. The result was the implementation of a pilot project in which both homecare clients and non-urgent hospital patients could be served in a hospital-based ambulatory nursing care clinic.