Patients and their families or caregivers are often an untapped resource when it comes to identifying opportunities to improve quality of care and patient safety. But at BC Children’s Hospital an innovative face-to-face patient/provider engagement tool called Patient’s View is helping to solicit feedback about quality and safety from the unique perspective of patients and families.

Building on the successful Bedside Observer research project conducted by Dr. Mark Ansermino and colleagues at BC Children’s a few years earlier, Patient’s View began on a single unit in late 2012, and has since expanded to all inpatient units, the Pediatric Intensive Care Unit (PICU) and the Clinical Decision Unit (CDU) that’s currently being trialled in the Emergency Department (ED) as part of the BC Children’s and BC Women’s Redevelopment Project.

Unlike other hospital surveys about the overall patient experience or specific topics such as the quality of food, for example, Patient’s View collects information about complications of care, problems with medication or equipment and miscommunication with families or among staff. This kind of information is important to gauge quality of care and patient safety, and to identify opportunities for improvement.

Also unique to Patient’s View is a successful volunteer model that involves a select group of trained volunteers who meet with patients and families prior to discharge to collect their feedback and help them enter it in a version of the BC Patient Safety & Learning System (BC PSLS). Patient’s View volunteer positions are often filled by individuals with aspirations for future careers in the healthcare sector.

Mehvesh Mallick Ahmed, BC PSLS Project Lead for Patient’s View, began as a volunteer when the initiative was first launched and knows first-hand how much patients and families appreciate the opportunity to share their stories. She says parents are very motivated to talk about their child’s care while the experience is fresh in their minds as they await discharge from the hospital.

“It’s great to see how open and willing parents are when speaking about their child and the quality of care their child received,” Mehvesh says. “I find that parents of sick children, especially those who have a child with a chronic condition, are experts in the care of their child and very knowledgeable about being in hospital. The parents at BC Children’s are at the bedside around the clock and notice things during the care of their child that others might not, so they’re very receptive to talking about safety concerns and providing as much feedback as they can. I think this process is also a healing and mitigating process for these families because they’re able to voice their concerns and be heard as valued members of the care team.”

Suzanne Steenburgh, Program Manager, Medical/Surgical Inpatients, says, “We want to create an environment that works best for our patients and families. The feedback we’re receiving through Patient’s View adds so much depth to what we’re doing – it’s real-time, it’s meaningful and it gives us an entirely new perspective on how we can improve quality of care and safety in our area.”

“One example of the impact of Patient’s View is the new whiteboards we’ve planned for patient rooms in the Teck Acute Care Centre (new BC Children’s Hospital),” says Ciara McGeough, Clinical Lead, C&W Redevelopment Project, Medical/Surgical Inpatients. “We plan to use the whiteboards to write down the names of the child’s doctors, nurses and other health professionals, the plan for the day and discharge, when treatments are scheduled and any questions the family may have. It’s a simple approach towards improving communication with patients and families. The benefits and importance of this was reinforced by speaking with families and reviewing the feedback in Patient’s View.” 

Patient’s View is also being used in the new Clinical Decision Unit (CDU) and proving to be an effective strategy for learning how to improve care in that area. The unit is separated from the hustle and bustle of the Emergency Department (ED) and provides a distinct setting for patients who require additional monitoring, investigation and treatment prior to transfer to another area of the hospital, or discharge home. The CDU is being considered as a long-term solution for the ED in the Teck ACC.

“Patient’s View is helping us obtain feedback from patients and families on quality of care and patient safety in a timely manner, which is something the Ministry of Health has asked us to measure to ensure optimal performance,” says Denise Hudson, Clinical Project Lead, C&W Redevelopment Project. “Just-in-time feedback from patients and families has helped us make positive changes to our delivery of care from day one, and also validates the positive aspects of running a CDU in the new building. We learned that we needed to improve communication with families about their child’s treatment plan and explain the purpose of the CDU. Families also validated our assumptions about the positive aspects of running a CDU – providing a quieter space for observation and treatment and a shorter stay in hospital by avoiding an inpatient admission.”

Kris Thibault, Quality and Safety Leader, Critical Care, and BC Children’s Project Lead for Patient’s View, has been involved with the initiative since the pilot and has her eye on the bigger picture.

“As an organization we demonstrate our commitment to patient safety and quality of care by engaging families in these types of conversations to better understand our systems and opportunities for improvement.”

“It’s through the eyes of patients and families that we’re learning how safety events impact their experience and how partnerships with families can help us build a better system.” 

Laurie Johnson, Quality and Safety Leader, Neurosciences and Surgery, says Patient’s View allows a deeper understanding of what patients and families experience when they’re in hospital. “Looking at Patient’s View data has become part of our daily routine. We talk together as a team and brainstorm ideas for improving quality of care based on the feedback we receive through Patient’s View. Staff are now accustomed to seeing Patient’s View volunteers on the units and speaking with families. Staff encourage volunteers to see any family that is willing to participate. We’re learning a lot from what parents have to say, and it’s nice for staff when parents have positive feedback for us.” 

Like most innovative undertakings, Patient’s View has required determination, patience and collaboration from a wide range of participants. Support from operational leaders and the department of Volunteer Services at BC Children’s and the PHSA Patient Safety and Quality group, along with BC PSLS Central Office, has been critical to the success of Patient’s View.

Pat Gillis, Manager, Volunteer Resources, has taken an active role to ensure a pool of volunteers are available and trained to administer the Patient’s View survey to families before discharge from hospital.

“It’s been a great opportunity to offer this unique experience to our enthusiastic and committed volunteers. Many volunteers are motivated to learn more and this volunteer assignment gives them a chance to use their communications skills and knowledge of the inpatient experience at BC Children’s. Volunteers are always eager to develop skills that will help them on their career path. I know several Patient’s View volunteers who are now in medical and nursing schools across Canada, and this was one volunteer experience that really made the difference for them.” 

The concept of Patient’s View has been shared with interested organizations in Canada and internationally and has been used to inform similar efforts in other pediatric hospitals.

Future goals are to offer Patient’s View to other healthcare organizations in BC, including adult care facilities, and to look at its application in ambulatory care settings.

A proof-of-concept project is underway at BC Children’s to test a more user-friendly interface of the Patient’s View survey tool, using iPads supplied as part of a research initiative. 

 

 

 

 

 

 

Additional resources:

• Canadian Paediatric Adverse Events Study
• A human factors and survey methodology-based design of a web-based adverse event reporting system for families
• Identification by families of pediatric adverse events and near misses overlooked by health care providers
• Children’s Hospital takes a lesson from parents