Transcript Integrating Staff Safety and Person-Centred Care - Re

Partnerships in Person-Centred Approaches (PPCA)
Albert Banerjee PhD, York University, Toronto, Ontario
Deanne Taylor PhD (Candidate), Fraser Health Authority, British Columbia
Anita Wahl RPN, MN, Clinical Nurse Specialist, Fraser Health Authority, British Columbia
Background
This study is a collaboration between a SSHRC funded
MCRI, Re-imagining long-term residential care, and
the Fraser Health Authority of British Columbia.
Traditional approaches in health care systems address
person-centred care and safety practices separately,
despite clear areas of overlap. Since 2007, the Fraser
Health Authority Residential Care and Assisted Living
Program has implemented and grown an innovative
process called the Partnerships in Person-Centred
Approaches (PPCA), which aims to integrate
workplace safety and quality objectives at the direct
care level. Fostering communication, teamwork, and
leadership is the heart of the process, and this is
achieved through regular, facilitated meeting between
care staff and management. Short meetings are
organized on a weekly basis, and longer meetings are
organized bimonthly. All follow a staff run agenda.
Presently, eleven residential care facilities are involved
in the process.
PURPOSE
Research Questions & Methods
The goal of study was to understand what difference the
PPCA process was making and how it was making this
difference from the perspective of those involved. To
answer these questions we draw on quantitative and
qualitative data. Quantitative data on days lost to injury
and injury claim costs before and after implementation of
the PPCA process were collected. Qualitative data for this
study were collected through ten observations of weekly
and bimonthly meetings. We also conducted eleven
interviews and eight focus groups. In total, 52 people
participated in the study. Our sample included 23 health
care aides (HCA), 11 registered nurses (RN), six facility
managers and senior leadership, six licensed practical
nurses (LPNs), and five allied health professionals, as well
as one facilitator.
Findings
The data was analyzed thematically by the authors
individually and then collectively. Our analysis was
guided by three overarching questions – what does the
process do, how does it work, and what challenges
were experienced by participants?
What does the program do?
Fosters dialogue: The PPCA process creates a safe
space for communication, free from fear of reprisals,
occupational hierarchies, and is driven by concerns of
staff rather than management. It provides a forum
where gossip and rumours are addressed, and gives
worker a voice. When “all the other crap is aside, you
can actually look at what you are here for….(HCA).
Root-cause analysis: Within this context, problems
that were otherwise invisible were able to be addressed.
Bringing together several occupations, the
encouragement of multiple perspectives, and a spirit of
empathetic inquiry, enabled moving beyond blaming
individuals towards understanding the conflicting
concerns and responsibilities behind issues, and
allowed for mutually beneficial solutions.
Integrating safety and quality. The process allowed
for quality and safety issue to be addressed in context
rather than as abstract training pieces, addressing
working conditions, quality and safety in an integrated
manner.
Grass roots practices: The PPCA process has resulted
in the development of practices that respond to
workers’ concerns and are instituted within units, and
at times shared among facilities and more broadly
within the health authority (e.g. a safety huddle, a chain
of communication, a work-plan for communication
between nurses and care aides).
How does the program work?
A number of qualities were key to staff experiencing
the process as the “real deal.” We note a few here.
Staff run agenda. “When it changed for us was
when we opened the floor and said, What do you want
to talk about? What are your issues? What matters to
you?” (RCC)
Action items: Staff felt they had a voice not only
because they were listened to but because action was
taken and communicated back to them.
Facilitation: The facilitator was perceived as neutral.
And the best meetings ensured everyone who wanted
to speak had a chance; no one dominated; dialogue
moved quickly with issues identified, solutions
discussed, action items noted, and a person assigned
responsibility for each task.
Mentoring: We observed considerable
encouragement, assistance, learning and modeling by
the facilitator, some managers, and other staff. This
process mentored staff in leadership, problem
solving, and communication skills: “It has helped me
come out of my shell and helped me to dialogue
better, (HCA, I9).
Challenges?
Negativity: The early stages of the process
could be difficult, particularly if
communication was poor or nonexistent prior
to the meetings, participants reported
considerable venting and negativity.
Workload: The weekly meetings and action
items added to managers’ workload, pointing to
the importance of delegating responsibility.
Attendance: We also identified a tension
between the consistency of regularly scheduled
meeting and enabling staff on different shifts to
attend and participate.
September 2012