Transcript We Want to Live It! - Quality Forum 2015

Coaching Out of the Box
With Families:
The Sunny Hill Pilot Project
We Want To
Live It!
Feb 28, 2013
Project Team & Partnerships
•
Alda Antunes Silvestre, RN BSN MSN
•
Sandy Tatla, MSc. Candidate, MOT,
•
Shelley Woodman, RN, BScN
•
Dori Van Stolk, RN, BScN, MA, CEC
•
Tal Jarus, Phd, OTR
•
Susan Greig, Partners in Care Family Liaison
•
Meghan Husson, MOT Candidate
•
Stacey Burnes, MOT Candidate
Outline
• Literature Background
• The Sunny Hill Experience
• Coaching out of the Box
• Pilot Project
• Preliminary Findings
• Lessons Learned
• Closing
Literature Review: The Gap
① Family involvement is frequently identified as a key
element of successful rehab
Yet, we don’t know how clinicians can best involve
them1
② Family centered care & effective communication
were among the top quality of care indicators for
rehabilitation of children with traumatic brain
injury2
③ A strong need exists for improved communication
skills3
Literature continued…
 Health care professionals need to work together and
also with the patients & their families5
 Disrespect or insensitivity reported more commonly
than technical errors in diagnosis and treatment4
Approaches to Improve Communication
 Various methods used to
improve communication
skills, including:





training workshops run by
experts
lectures and education
sessions
interviews and questionnaires
role playing and feedback in
small groups
shared decision-making
training
Our Challenge – “Connecting With” Families
The Chinese Characters for Listening:
1. Ear
Gather
2. Eye
Perceive
3. Heart
Sense
4. King
Respect
Who you need to be





Curious
Supportive
Accepting
Focused
Committed
How: 5 steps





Identify
Discover
Strategize
Clear the way
Recap
Level 1 Listening…………………………………………”Scratching The
Surface”
Level 2 Listening…………………………………………What is said –
Content
Level 3 Listening…………………………………………What We Feel +
Think
What Skills To Use





Listening- 3 Levels
Encouraging
Questioning
Requesting
Action Planning
Coaching Fundamentals
Project Aim
1. To demonstrate the feasibility of coach training
2. Improve family & service provider:
o Satisfaction
o Communication
o Engagement
o Collaboration
….To ultimately facilitate a successful rehabilitation
experience
Participants
 Multi-disciplinary
Acute Rehabilitation
Team in pediatric
rehabilitation centre
 45 health care
professionals
 Family representatives
Intervention
Workshop 1:
• Core Coaching
Competencies & the Case
for Coaching
Workshop 2:
• Who you need to be
2 day
Coaching
Training
Practice,
practice…
and more
practice!
6 hours
Triad
Practice
1.
2.
3.
4.
5.
Naming Triggers
Taming Triggers
Learning Language
Yours, Mine & Ours: Shared Goals
Learning in relationship
5 Learning
Burst
Sessions
Mixed Methods Evaluation
Quantitative:
Pre & Post Intervention
Qualitative:
Post Intervention
Feasibility
1:1 qualitative interview with
families present pre & post (n=1)
Measures of Processes of CareService Providers (MPOC-SP)
Study-Specific Coaching Skills
Questionnaire
Focus groups: Service providers
Tracking of Communication
Related Safety Events
Measures of Processes of CareFamilies (MPOC)
Focus groups: Families
Preliminary Results
 Feasibility


Participation
 93% participation in coaching workshops
 Triads still in process @ 5 months
Learning Burst workshops in process
 1st burst: 75% attendance
 2nd burst: 43% attendance (nursing was missing due to staffing issues)
 Budget
 Ongoing facilitation needs
 Anecdotal results




Satisfaction
Communication
Engagement
Collaboration
Lessons Learned
 Family representation was critical to the program’s success
 All stakeholders need to buy-in
 Recognizing the different work flows of a multidisciplinary team
 Learning as a team was key to providing a shared language & common
approach to care
 Practicing the skills & follow-up is critical
 Facilitating the sustainability of coaching within our team
 Next Steps…..
“Something is happening”……
synergy is occurring as team members learn & journey together
Closing
 Have an understanding of:
 Literature & Practice Gaps in Communication
 Coaching Pilot Project
 Preliminary Findings from the project
“The Road goes ever on and on
Down from the door where it began.
Now far ahead the Road has gone,
And I must follow, if I can,
Pursuing it with eager feet..” J.R. Tolkien
Thank you!
References
1.
2.
3.
4.
5.
Levack, W.M.M., Siegert, R.J., Dean, S.G., & McPherson, K.M. (2009). Goal planning for adults
with acquired brain injury: How clinicians talk about involving family.Brain Injury 23(3), 192-202.
DOI: 10.1080/02699050802695582
Rivara, F.P, Ennis, S.K., Mangione-Smith, R., MacKenzie, E.J. & Jaffe, K.M. (2012).Quality of care
indicators for the rehabilitation of children with traumatic brain injury. Arch Phys Med Rehabil,
93, 381-395. DOI:10.1016/j.apmr.2011.08.015
Lefebvre, H., Pelchat, D., Swaine, B., Ge’linas, I., & Levert, M.J. (2005). The experiences of
individuals with traumatic brain injury families, physicians and health professionals regarding care
provided throughout the continuum.Brain Injury 19(8), 585-597. DOI:
10.1080/02699050400025026
Jangland, E., Gunningberg, L., & Carlsson, M. (2009). Patients' and relatives' complaints about
encounters and communication in health care: evidence for quality improvement. Patient Educ
Couns, 75(2), 199-204. doi: 10.1016/j.pec.2008.10.007
Legare, F., Politi, M. C., Drolet, R., Desroches, S., Stacey, D., Bekker, H., & Team, Sdm-Cpd. (2012).
Training health professionals in shared decision-making: an international environmental scan.
Patient Educ Couns, 88(2), 159-169. doi: 10.1016/j.pec.2012.01.002
Extra Slides
Next Steps
 Continuing coaching & learning bursts in the Fall
as part of core competency development for our all
staff in our setting
 Articulate & integrate these core competencies into
our orientation pathway for new staff
 Explore strategies to continue to nurture &
facilitate the integration of coaching into practice
 Move from individual awareness to more dialogue
& work on the team
Challenges/ Limitations
 Time
 Reflection – both in the moment & after
 Ongoing practice, mentorship, own coaching
 Integration + testing of new learning & skills in the
moment; trial + error
 Recognition what skills/tools to use in the moment
or context (eg. verbal aggression)
 Knowledge & wisdom
Rehab: Philosophy of Care
Maximizing people’s potential
 Def: “Habilitation includes all the activities & interactions that enable an individual
with a disability to develop new abilities to achieve his/her maximum potential,
whereas rehabilitation is the re-learning of previous skills, which often requires an
adjustment to altered functional abilities and altered lifestyle. (Pg 4, Edwards,
Hertzberg, Hays, + Youngblood, 1999, pediatric Rehab Nursing).
 Patient engagement is fundamental – the vehicle – to maximize rehab benefits
(Lequerica & Kortte, 2010).

Mixed Methods Evaluation
 Quantitative Pre & Post Evaluation:
1.
2.
3.
4.
5.
Feasibility
Measures of Processes of Care-Service Providers (MPOC-SP)
Study-Specific Coaching Skills Questionnaire
Tracking of Communication Related Safety Events
Measures of Processes of Care-Families (MPOC)
 Qualitative Evaluation:
1.
2.
3.
4.
Field notes throughout intervention
1:1 qualitative interview with families present pre & post (n=1)
Focus groups: Service providers
Focus groups: Families
Feasibility
Activity
Attendance
Dates
2-day coaching
training
43/47
Sept & October
2012
6 hours coaching
practice in triads
?
Nov 2012 ongoing
Learningburst 1:
Identifying
triggers
?
January 2013 – 3
sessions offered /
month
Learning Burst 2:
Taming triggers
?
February 2013
Learning Burst 3:
March 2013
Learning Burst 4:
April 2013
Learning Burst 5:
May 2013
Budget