IntroductionRecent shifts in the patient, family and caregiver engagement field have focused greater attention on measurement and evaluation, including the impacts of engagement efforts. Current evaluation tools offer limited support to... more
IntroductionRecent shifts in the patient, family and caregiver engagement field have focused greater attention on measurement and evaluation, including the impacts of engagement efforts. Current evaluation tools offer limited support to organizations seeking to reorient their efforts in this way. We addressed this gap through the development of an impact measurement framework and accompanying evaluation toolkit—the Engage with Impact Toolkit.MethodsThe measurement framework and toolkit were co‐designed with the Evaluating Patient Engagement Working Group, a multidisciplinary group of patient, family and caregiver partners, engagement specialists, researchers and government personnel. Project activities occurred over four phases: (1) project scoping and literature review; (2) modified concept mapping; (3) working group deliberations and (4) toolkit web design.ResultsThe project scope was to develop a measurement framework and an evaluation toolkit for patient engagement in health sys...
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Introduction: During the pandemic many Canadian hospitals made significant changes to their ‘open family presence’ and ‘visitor policies’ to reduce the spread of COVID-19 by instituting restrictive or ‘zero visiting’ policies in... more
Introduction: During the pandemic many Canadian hospitals made significant changes to their ‘open family presence’ and ‘visitor policies’ to reduce the spread of COVID-19 by instituting restrictive or ‘zero visiting’ policies in healthcare facilities. These policies have the potential to create great hardship, anxiety and stress for patients, families, caregivers and frontline healthcare providers (HCPs); along with concerns about the quality and safety of patient care. The presence of family members and other caregivers as essential partners in care is an explicit expression of the philosophy of patient- and family-centred care (PFCC) in action. The purpose of this study is to increase our understanding of how changes to family presence and visiting policies and practices during the COVID-19 pandemic have impacted patients, family caregivers and frontline healthcare providers (HCPs) in acute care hospitals. Methods A total of 38 in-depth semi-structured interviews were conducted wi...
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Table S1. Analysis of patient engagement strategies to improve quality of care. Identification of facilitators and barriers to patient engagement and subsequent evaluation of patient experiences. (DOCX 160Â kb)
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Figure S1. PRISMA diagram. (DOC 57 kb)
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Table S3. PRISMA checklist. (DOC 63 kb)
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This study implemented and evaluated the adapted Situation-Background-Assessment-Recommendation (SBAR) tool for use on two inter-professional rehabilitation teams for the specific priority issue of falls prevention and management. SBAR... more
This study implemented and evaluated the adapted Situation-Background-Assessment-Recommendation (SBAR) tool for use on two inter-professional rehabilitation teams for the specific priority issue of falls prevention and management. SBAR has been widely studied in the literature, but rarely in the context of rehabilitation and beyond nurse-physician communication. In phase one, the adapted SBAR tool was implemented on two teams with a high falls incidence over a six-month period. In phase two, process and outcome evaluations were conducted in a pre-post design comparing the impact of the intervention with changes in the rest of the hospital, including the perceptions of safety culture (as measured by the Hospital Survey on Patient Safety Culture); effective team processes, using the Team Orientation Scale;
Background Patient and public engagement (PPE) in research is growing internationally, and with it, the interest for its evaluation. In Canada, the Strategy for Patient-Oriented Research has generated national momentum and opportunities... more
Background Patient and public engagement (PPE) in research is growing internationally, and with it, the interest for its evaluation. In Canada, the Strategy for Patient-Oriented Research has generated national momentum and opportunities for greater PPE in research and health-system transformation. As is the case with most countries, the Canadian research community lacks a common evaluation framework for PPE, thus limiting our capacity to ensure integrity between principles and practices, learn across projects, identify common areas for improvement, and assess the impacts of engagement. Objective This project aims to build a national adaptable framework for the evaluation of PPE in research, by: Building consensus on common evaluation criteria and indicators for PPE in research; Defining recommendations to implement and adapt the framework to specific populations. Methods Using a collaborative action-research approach, a national coalition of patient-oriented research leaders, (patie...
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There has been a recent upsurge in the use of patient stories to better understand patients’ experiences of illness and of care, and to inspire leaders and staff for quality and safety within healthcare. However, to fully realize the... more
There has been a recent upsurge in the use of patient stories to better understand patients’ experiences of illness and of care, and to inspire leaders and staff for quality and safety within healthcare. However, to fully realize the potential of patient stories, a more nuanced understanding is needed of how they are used, who tells them, for what purpose, and in what context. Using a constructivist case study methodology with qualitative methods, this study examined four healthcare organizations that are known leaders in the systematic and deliberate use of patient stories, exploring the storytellers, the types of stories told and their purposes. It also examined the contexts that enable the use of stories and the impact they have had on organizational learning and quality improvement. An interpretivist approach to analysis highlighted the specific types of stories told by patients and of patients, and how they were co-constructed from stories of chaos into quest stories for learni...
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The dominant narrative through the pandemic focused on the perils associated with the transmission of COVID-19. This led to restrictive policies in long-term care that prevented family caregivers from being physically present to... more
The dominant narrative through the pandemic focused on the perils associated with the transmission of COVID-19. This led to restrictive policies in long-term care that prevented family caregivers from being physically present to participate in their loved ones' care. There is growing evidence that such policies resulted in harm to residents, family members and staff. The path forward highlights the need for balanced policies and practices to ensure that compassionate, person-centred and partnered care is not lost, whether in times of calm or crisis.
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PurposeIn this paper, we contribute to the theorizing of patient involvement in organizational improvement by exploring concepts of “learning from patients” as mechanisms of organizational change. Using the concept of metaphor as a... more
PurposeIn this paper, we contribute to the theorizing of patient involvement in organizational improvement by exploring concepts of “learning from patients” as mechanisms of organizational change. Using the concept of metaphor as a theoretical bridge, we analyse interview data (n = 20) from participants in patient engagement activities from two case study organizations in Ontario, Canada. Inspired by classic organizational scholars, we ask “what is the organization that it might learn from patients?”Design/methodology/approachPatient involvement activities are used as part of quality improvement efforts in healthcare organizations worldwide. One fundamental assumption underpinning this activity is the notion that organizations must “learn from patients” in order to enact positive organizational change. Despite this emphasis on learning, there is a paucity of research that theorizes learning or connects concepts of learning to organizational change within the domain of patient involv...
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Background: The scale-up of evidence-based innovations is required to reduce waste and inequities in health and social services (HSS). However, it often tends to be a top-down process initiated by policy-makers, and the values of the... more
Background: The scale-up of evidence-based innovations is required to reduce waste and inequities in health and social services (HSS). However, it often tends to be a top-down process initiated by policy-makers, and the values of the intended beneficiaries are forgotten. Involving multiple stakeholders including patients and the public in the scaling-up process is thus essential but highly complex. We propose to identify relevant strategies for meaningfully and equitably involving patients and the public in the science and practice of scaling up in HSS.Methods: We will adapt our overall method from the RAND/UCLA Appropriateness Method. Following this, we will perform a two-prong study design (knowledge synthesis and Delphi study) grounded in an integrated knowledge translation approach. This approach involves extensive participation of a network of stakeholders interested in patient and public involvement (PPI) in scaling up and a multidisciplinary steering committee. We will conduc...
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To identify the strategies and contextual factors that enable optimal engagement of patients in the design, delivery, and evaluation of health services. We searched MEDLINE, EMBASE, CINAHL, Cochrane, Scopus, PsychINFO, Social Science... more
To identify the strategies and contextual factors that enable optimal engagement of patients in the design, delivery, and evaluation of health services. We searched MEDLINE, EMBASE, CINAHL, Cochrane, Scopus, PsychINFO, Social Science Abstracts, EBSCO, and ISI Web of Science from 1990 to 2016 for empirical studies addressing the active participation of patients, caregivers, or families in the design, delivery and evaluation of health services to improve quality of care. Thematic analysis was used to identify (1) strategies and contextual factors that enable optimal engagement of patients, (2) outcomes of patient engagement, and (3) patients' experiences of being engaged. Forty-eight studies were included. Strategies and contextual factors that enable patient engagement were thematically grouped and related to techniques to enhance design, recruitment, involvement and leadership action, and those aimed to creating a receptive context. Reported outcomes ranged from educational or t...
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Healthcare organizations face growing pressures to increase patient-centred care and to involve patients more in organizational decisions. Yet many providers worry that such involvement requires additional time and resources and do not... more
Healthcare organizations face growing pressures to increase patient-centred care and to involve patients more in organizational decisions. Yet many providers worry that such involvement requires additional time and resources and do not see patients as capable of contributing meaningfully to decisions. This article discusses three efforts in four organizations to engage patients in quality improvement efforts. McGill University Health Centre, Saskatoon Health Region, and Vancouver Coastal and Fraser Health Regions all engaged patients in quality improvement and system redesign initiatives that were successful in improving care processes, outcomes, and patient experience measures. Patient involvement in redesigning care may provide a way to demonstrate the value of patients' experiences and inputs into problem-solving, building support for their involvement in other areas. Further study of these cases and a broader survey of organizational experiences with patient involvement may ...
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This study implemented and evaluated the adapted Situation-Background-Assessment-Recommendation (SBAR) tool for use on two inter-professional rehabilitation teams for the specific priority issue of falls prevention and management. SBAR... more
This study implemented and evaluated the adapted Situation-Background-Assessment-Recommendation (SBAR) tool for use on two inter-professional rehabilitation teams for the specific priority issue of falls prevention and management. SBAR has been widely studied in the literature, but rarely in the context of rehabilitation and beyond nurse-physician communication. In phase one, the adapted SBAR tool was implemented on two teams with a high falls incidence over a six-month period. In phase two, process and outcome evaluations were conducted in a pre-post design comparing the impact of the intervention with changes in the rest of the hospital, including the perceptions of safety culture (as measured by the Hospital Survey on Patient Safety Culture); effective team processes, using the Team Orientation Scale; and safety reporting, including falls incidence, severity and near misses. This study suggests that the adapted SBAR tool was widely and effectively used by inter-professional rehab...
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We conducted a Functional Organizational Readiness for Change Evaluation (FORCE) to assess the characteristics of readiness for change across two programs (N=216 employees) in an interprofessional rehabilitation hospital that was about to... more
We conducted a Functional Organizational Readiness for Change Evaluation (FORCE) to assess the characteristics of readiness for change across two programs (N=216 employees) in an interprofessional rehabilitation hospital that was about to undergo strategic changes as part of a planned physical merger within the next two years. The study used a mixed-method approach: a quantitative survey, previously validated in a drug rehabilitation setting, followed by key informant interviews to further enlighten survey findings. Statistical analyses identified correlations between demographic variables (age, education and experience) and readiness for change, as well as the prevalence of specific organizational characteristics (motivation for change, access to resources, staff attributes, organizational climate, and exposure/ use of training opportunities) that facilitate or impede change. Findings were intended to better inform the tactics for successful implementation of upcoming initiatives. Much like assessing a patient prior to initiating a treatment, FORCE can serve as a management tool to direct the planning and implementation of changes intended to improve hospital performance.
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The link between poor communication and patient safety is well recognized in the healthcare community (Joint Commission on Accreditation of Health Care Organizations (JCAHO), 2004; Sutcliffe et al....
Research Interests: Program Evaluation, Rehabilitation, Focus Groups, Medicine, Medical errors, and 10 moreHumans, Ontario, Safety Management, InterProfessional Education in Health Care, Patient Care Team, Public health systems and services research, Rehabilitation Centers, Interdisciplinary Communication, Nursing staff, and interprofessional relations
Objectives The purpose of this study was: (1) to identify key total joint replacement (TJR) care processes and structures from acute care and rehabilitation hospitals; (2) to determine the perceived implications of practice patterns and... more
Objectives The purpose of this study was: (1) to identify key total joint replacement (TJR) care processes and structures from acute care and rehabilitation hospitals; (2) to determine the perceived implications of practice patterns and processes on wait times, discharge planning, transitions in care, utilization of rehabilitation services, and outcomes; and (3) to understand how acute care hospitals funded for additional cases were addressing current and future rehabilitation needs.Methods A qualitative descriptive approach using key informant interviews was used to provide further insights and depth of understanding to current practice patterns, structures and processes of care for TJR patients.Results Twenty‐three key informants from a total of 15 hospitals across Ontario participated in this project. Themes that emerged related to processes of care (e.g. patient education, preoperative services, clinical pathways), and structures that supported these processes of care (e.g. o...
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The goal of the helpline is to assist individuals with chronic obstructive pulmonary disease (COPD) better manage their disease through improved understanding of COPD, its symptoms and treatment. The purpose of this project was to develop... more
The goal of the helpline is to assist individuals with chronic obstructive pulmonary disease (COPD) better manage their disease through improved understanding of COPD, its symptoms and treatment. The purpose of this project was to develop and validate a protocol for a COPD helpline. Ten key informants with expertise in helpline development or COPD were interviewed. Fifty individuals with COPD participated in content validation of the protocol. An initial protocol for the helpline aimed to provide: (1) information and education regarding COPD and its management via the telephone and with written materials; (2) guidance regarding course of management; (3) resource links to other support services and programs locally, provincially, and/or nationally; and (4) caring support and reassurance to those with COPD and their families. The majority of the calls from individuals with COPD sought medical information (74%) and required 36.6 +/- 14.5 min (range: 15-85) to complete. Many different topics were discussed, with medication and exercise being the most common. The availability of the call center was identified as one means of replacing information sought from other health care providers, mainly physicians and pulmonary rehabilitation staff. A protocol of a helpline for COPD has been developed based on the literature, theoretical knowledge, and input from key informants and individuals with COPD.
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Objectives The purpose of this study was: (1) to identify key total joint replacement (TJR) care processes and structures from acute care and rehabilitation hospitals; (2) to determine the perceived implications of practice patterns and... more
Objectives The purpose of this study was: (1) to identify key total joint replacement (TJR) care processes and structures from acute care and rehabilitation hospitals; (2) to determine the perceived implications of practice patterns and processes on wait times, discharge planning, transitions in care, utilization of rehabilitation services, and outcomes; and (3) to understand how acute care hospitals funded for additional cases were addressing current and future rehabilitation needs.Methods A qualitative descriptive approach using key informant interviews was used to provide further insights and depth of understanding to current practice patterns, structures and processes of care for TJR patients.Results Twenty-three key informants from a total of 15 hospitals across Ontario participated in this project. Themes that emerged related to processes of care (e.g. patient education, preoperative services, clinical pathways), and structures that supported these processes of care (e.g. organizational supports, increased funding and resources). The results point to a number of key practices that can facilitate smooth, integrated care for TJR patients, particularly in relation to best practices to decrease length of stay and increase surgical volumes. Increased funding related to strategic priorities placed on TJRs by the provincial government was viewed as an important impetus to implement a number of these key practices.Conclusion From a rehabilitation perspective, there is need for consistent funding to secure more rehabilitation services for both preoperative and post-operative management of care that allows for shorter lengths of stay and to ensure optimal outcomes.