Part III of our four-part Patient’s View Miniseries focuses on BC Mental Health & Substance Use Services!
In Parts I and II of this miniseries we shared how BC Women’s Hospital and BC Cancer Agency engaged Langara nursing students to implement Patient’s View in situations other than the pediatric acute care setting at BC Children’s Hospital, where the tool was developed.
In addition to deploying Patient’s View in a new setting, BC Mental Health & Substance Use Services (BCMHSUS) took on the challenge of adapting the tool to meet the needs of the unique populations served by Forensic Psychiatric Services and the Heartwood Centre for Women.
Robert Tang, Leader, Quality & Safety, was inspired by successes at BC Children’s, BC Women’s, and BC Cancer Agency.
“I was initially unsure how Patient’s View was going to work with the population at BCMHSUS,” says Robert. “We are always looking for new ways to incorporate the client’s voice, but we first needed to determine whether or not Patient’s View would be suitable or adaptable to our clients and services.”
This need was fulfilled by Jade Javier, Alisha Curry, and Aaron Mazon, students at Langara College of Nursing, who elected to work with BCMHSUS from May to July to conduct a feasibility study and pilot Patient’s View.
From left to right: Langara students Jade Javier, Alisha Curry, and Aaron Mazon learn from BCMHSUS Quality Analyst Courtnee Anderson
The feasibility study included adapting the Patient’s View questionnaire to the outpatient mental health setting, conducting patient-centred interviews to collect data, and supporting staff in identifying potential opportunities to improve patient safety.
Sound daunting? Not to this dynamic group of students, who went above and beyond expectations to deliver outcomes that far exceeded the initial goals of the project.
“We asked our students to look at Patient’s View with a fresh set of eyes,” says Robert. “They were exceptional. We challenged them and were hopeful that they would rise to the challenge and they did. We’re very thankful for all their work and the legacy they’ve left.”
Before piloting the Patient’s View questionnaire with BCMHSUS clients, the students first observed Patient’s View processes in the outpatient setting at the BC Cancer Agency. Next they participated in interviewing patients with guidance from Robert and BC Cancer Agency Quality Leader Tracy Lust.
The first BCMHSUS site to pilot Patient’s View was the Heartwood Centre for Women, a residential treatment centre for women with substance misuse and mental health concerns, located at BC Women’s Hospital. At Heartwood, the students found that the interview process could be improved if the questionnaire was tailored to the client population.
The students then began piloting the process at Forensic Regional Clinics, where they interviewed clients with mental health issues who were on probation, bail, or mandated to receive outpatient psychiatric treatment by the British Columbia Review Board.
Through the piloting process, the students realized that each site needed its own version of the tool, while maintaining alignment with the categories in BCPSLS. PDSA cycles (Plan, Do, Study, Act) were used to develop tools for each site that were tested and refined with feedback from clients, families, and staff. The students even developed a questionnaire that case managers could distribute to their off-site clients.
The students also began adapting their interviewing styles to meet the individual needs of each site. For example, at the Vancouver Regional Clinic, it was discovered that using clip boards or iPads during the interview was problematic. When students left their devices outside the interview room, they were able to give clients their undivided attention and the clients were less distracted. They also kept interviews to a maximum of 15-20 minutes in order to avoid potentially agitating clients. For safety reasons, two students and a clinic staff member were always present at the interview. Clients’ case managers did not participate in the interviews in order to promote candid discussion and avoid discomfort.
“Another important aspect was learning about trauma-informed care, in terms of body language, what we’re wearing”, noted Alisha. “We want to avoid creating a trigger for the clients. We were mindful of dressing appropriately and using therapeutic communication. If patients were getting uncomfortable we would change tack. We also explored different times for interviewing and discovered that the clients were most comfortable when the interview took place after their appointment.”
The process of identifying clients for interviewing was also tailored to each site. Flowcharts were developed that demonstrated how the process should be carried out from start to finish. The flowcharts have been used to educate clients, families, and staff about the project and serve as visual aids to identify additional opportunities for improvement as the process is rolled out.
“If Patient’s View was available in settings where safety events take place, it would mitigate a lot of issues,” says Aaron. “Patients often share that they didn’t have a chance to speak or share with nurses otherwise.”
The students also participated in reporting the collected data. They collaborated with the Strategic Information Management (SIM) team, who helped pinpoint relevant data and categorize safety events accordingly. The students analyzed the data to identify trends and suggested opportunities for improvement. The students’ findings were shared with the Forensic Psychiatric Services Quality Council and the Quality & Access Committee of the Provincial Health Services Authority (PHSA) Board.
“I really felt like I got to practice a leadership role”, noted Jade. “This helped me grow as a student nurse. Thinking outside the box was really helpful. Being part of a new initiative was really challenging but very helpful, as well. It also helped with a lot of team building because we worked closely together as a group and collaborated.”
In addition to receiving a full report detailing the students’ deliverables, BCMHSUS staff benefitted from hearing overwhelmingly positive feedback about the care they provide to clients, which isn’t always shared in these settings.
“The students came up with some great strategies,” says Robert. “We would like to ask them to come back after their preceptorships to hand-over their work to the incoming cohort of students in January. Our next steps are to take their recommendations to see if Patient’s View will be feasible at the Burnaby Centre for Mental Health & Addiction and Forensic Psychiatric Hospital.”
Summary of student deliverables:
- Custom questionnaires for each site
- Interviewing strategies including trauma-informed practice
- Flowcharts depicting Patient’s View process at each site
- Detailed results of safety events reported by clients
- Recommendations for roll-out of Patient’s View to other sites and centres
For more information, please contact Robert Tang.
Additional resources:
- Patient’s View Miniseries Part I: BC Women’s Hospital (October 2017)
- Patient’s View Miniseries Part II: BC Cancer Agency (October 2017)
- Patient’s View offer Langara nursing students a close-up and personal look at patient safety (May 2017)
- Patient’s View: Seeing safety through the eyes of families at BC Children’s Hospital (March 2015)
- Establishing a pediatric family-initiated safety reporting program at BCCH…the “Patient’s View” (June 2013)