Welcome to the final installment of our four-part Patient’s View Miniseries!
Parts I-III of this miniseries shared how three agencies of the Provincial Health Services Authority engaged Langara College of Nursing students to implement Patient’s View in a variety of settings.
This time we’re venturing over to Island Health to feature Patient’s View in the pediatric acute care setting for which it was originally designed…but there’s an innovative twist! Patient’s View at Victoria General Hospital was initiated by medical students.
Meagan McKeen and Elisabeth Pharo were second-year medical students in 2015 when they first approached the 25-bed pediatric unit at Victoria General Hospital to propose piloting Patient’s View. Meagan had previously participated in Patient’s View at BC Children’s Hospital as a volunteer.
The students’ interest in the project was supported by the Island Medical Program, which delivers the University of British Columbia’s undergraduate medical program in collaboration with the University of Victoria.
A mandatory component of the curriculum is participation in activities that build scholarly inquiry and social accountability into students’ future practice. Then called DPAS (Doctors, Patients & Society), the course is now referred to as FLEX, reflecting its guiding principle of flexible enhanced learning. FLEX supports students to engage with professionals in the community to gain hands-on experience in a variety of activities, such as research projects or workshops.
From left to right: current second-year Island Medical Program FLEX students Heather McMath and Alex McLean with fourth-year nursing student Jayden Lontayao
The team at Victoria General Hospital recognized the potential value of Meagan and Elisabeth’s proposal and began to put the supports in place to make it happen.
The students spent several months liaising with patients, families, and staff to develop the program. They partnered with hospital volunteers to help conduct interviews and enter the data into BCPSLS.
“We had an amazing team working on this and still do,” notes Emma Carrick, Clinical Nurse Educator. “Meagan and Liz really brought the project forward and helped it become established. We also had involvement from a parent representative who was familiar with Patient’s View at BC Children’s. Our project coordinator at the time, Edith Imber, was also instrumental. It’s been a collaborative effort with families, staff, medical students, and nursing student volunteers.”
Although Meagan and Elisabeth have completed their FLEX requirement and moved on to their busier clerkship years, the project has been successful in engaging new medical students each year to continue the work.
Each member of the team contributes to its overall functioning and success. Medical students have a pivotal role in recruiting volunteers and meeting regularly with staff to exchange ideas. Emma liaises with staff to ensure they are informed and engaged in the project, and regularly reviews results together with the team. Interviews have primarily been completed by nursing student volunteers.
Long-time Island Health volunteer Simi Ono (left) with Diane Edwards, Child Life Specialist
Patient’s View is also supported by Diane Edwards, Child Life Specialist, who helps identify families that may be approached for interviewing, based on patient-centred selection criteria.
“Patient’s View provides a fantastic opportunity for patients and families to share their experiences with us,” says Diane. “The parents are the ones who are there watching everything and tracking it and the information they share with us helps us improve the hospital experience for others. We learn so much hearing about things from their perspective. Parents often have compliments about the staff and it is so good for the clinical team to feel recognized for the work they are doing.”
One of the first improvement initiatives targeted privacy and confidentiality on the unit. Families reported through Patient’s View that staff conversations taking place at the central nursing station were audible from patients’ rooms. The team recognized this as a potential privacy risk and worked together to keep conversation volumes low, particularly when discussing patient information.
In addition to sharing Patient’s View results and initiatives in staff newsletters, the team is developing a quality improvement/welcome wall for patients, families, and staff within the unit. The display will highlight Patient’s View results, quality improvements, and other measures and initiatives such as hand hygiene and accreditation.
Draft mock-up of Victoria General Hospital’s pediatric unit Quality Wall
“Now that the program is operational, the students are focusing on using the data to its full extent and sharing the information with patients and families,” says Andrew Watters, a third-year medical student who completed his FLEX requirement with Patient’s View and maintains a continued interest in the project. “We realized that we have been collecting all this great information and weren’t giving anything back.”
Moreover, regular quality improvement meetings have been initiated to review data from Patient’s View, discuss strengths and opportunities, and consider quality improvement activities to address gaps.
The team is also developing a staffing board to post within the unit. Parents shared through Patient’s View that it can sometimes be challenging to know which staff members are involved in their child’s care on a day-to-day basis. Also, parents don’t always know who to ask when they have questions about a specific aspect of care like medication, diet, or exercise. To address this, the team plans to post staff names along with their positions and schedules. The board is intended to empower families to reach out to staff members by name and serve as a reference for their child’s daily and weekly care.
“I’ve been really impressed with the feedback that’s come out of the data,” adds Meagan Sims, Coordinator, Patient Safety & Learning System, Island Health. “We’ve been able to pull such positive information about how hard the team works and we can also identify opportunities for improvement. It’s important for both of these elements to be shared back with families and the team.”
Since the project’s launch, the medical students have continued to explore ways to make the program better. One of the challenges has been finding enough volunteers to conduct interviews on the unit three times per week, particularly in the summer months. The annual handover of the project from second-year medical students to first-years can also be problematic. Students who elect to remain on the project after their course is complete help with continuity, but a certain amount of turnover is unavoidable. The team continues to look at options that could enhance the permanence of the program while maintaining involvement of medical students.
“The information was super useful as I’ve gone through my medical education, thinking of things I could say or do that would improve the patient experience,” says Andrew. “I’ve been a patient many times and I’m a father and have experienced the health care system with my children, as well. I remember doing my first couple interviews with patients and hearing a lot of concerns that a medical student or physician may never think about during the course of their day.”
We hope you enjoyed our Patient’s View Miniseries!
BCPSLS is honoured to have been a part of this initiative since Dr. Mark Ansermino and colleagues conducted the Bedside Observer research project at BC Children’s Hospital in the late 2000’s.
Building on the success of this research project, BCPSLS Patient’s View began on a single unit at BC Children’s Hospital in 2012. Now, five years later, Patient’s View is well-established in all inpatient units at BC Children’s and, as we’ve chronicled in this miniseries, has expanded to BC Women’s Hospital, BC Cancer Agency, BC Mental Health & Substance Use Services, and Victoria General Hospital.
We thank everyone who has supported patients and families to share their safety concerns and we look forward to the ongoing journey of this valuable initiative.
- 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 Miniseries Part III: BC Mental Health & Substance Use Services (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)