The Care Attendant: FOR the user THROUGH Logistics

When the Chaudière Appalaches Integrated Health and Social Services Centre (CISSS) first read about CFHI’s Executive Training Program (EXTRA), it was the “focus on learning through project development” that truly resonated with the organization’s action-focused approach. It’s also what motivated them to apply to the program, according to Daniel Paré, President and CEO of the CISSS. 

The organization is responsible for all health and social services within the territory of Chaudière Appalaches, in Quebec. With over 12,000 employees and 1,000 doctors, the organization has a strong presence in urban and rural districts.

Despite the relatively large size of the organization, however, the CISSS is facing a problem: a severe shortage of care attendants.

“Many positions are vacant and our current employees lack motivation,” said Paré. After interviewing employees and union representatives, the CISSS discovered that part of the problem was rooted in the the growing needs within senior care, and in the way the work was organized at the CISSS.  

“Many technical support tasks, like managing inventory and transporting goods, fall into the hands of care attendants,” said Paré. These tasks, he explained, take up a lot of time and can be draining. Because care attendants provide direct patient care alongside nurses and nursing assistants, a problem with care attendants means a problem in service delivery to patients. “The care attendants are pivotal in many things such as hygiene care, meal delivery, mobility assistance and daily activities.”

 EXTRA Team Photo

Collaboration for improvement

The CISSS set out to remedy the situation by finding out the reasons for the shortage and why employees lacked motivation. Part of that remedy meant joining the EXTRA program and making the EXTRA improvement project part of the organization’s priorities.

The CISSS put together a team composed of a clinical expert, a logistics expert, and a director of research, as well as Paré. The team was accepted into the 13th cohort of the EXTRA program in 2017.

The CISSS team’s project aims to maximize the tasks performed by care attendants. By upgrading care attendants’ skills through logistical analysis designed to pool and synchronize all work flow tasks affecting patient’s care, care attendants are empowered to play a privileged role in caring for patients and ensuring their well-being.

Since their journey through EXTRA’s quality improvement program, the biggest breakthrough for the team has been the decision to highlight the work of care attendants.

“At this point in our project, we’ve interviewed our employees and identified the non-clinical tasks to be removed from their daily responsibilities,” said Paré. “It’s encouraging to employees, as they are used to working behind the scenes.”

An invaluable experience

Another breakthrough was the team-building that came along with being a part of the EXTRA cohort.

Paré and his team saw how they could bring different experts together to solve a problem.

“We felt the group synergy! What’s more, the knowledge we acquired during webinars and residency sessions helped us structure our ideas and communicate our goals.” In fact, Paré says, EXTRA’s August residency session allowed the CISSS team to spend time together and forge bonds, encouraging them to share their concerns with the purpose of designing and developing a quality improvement project  that would have the best impact for service users.

Over the course of the residency session, Paré and his team felt privileged to be able to attend high-quality presentations about the challenges that affect healthcare and social services management.

 It also reinforced the importance of knowledge exchange.          

“One of the EXTRA program’s core values is the importance of exchanging information and being part of a network of individuals with whom we can share our achievements and challenges,” Paré said.

Varying perspectives

For the CISSS, quality improvement means involving a variety of perspectives, from clinicians to patients.

Paré says that when clinicians are involved in improvement projects, it becomes possible to implement small- and large-scale changes that directly impact the population, and that expertise from clinicians is essential to success because they are aware of all the small, daily details.

Patient engagement is also key ‒ the CISSS team is currently working with a user-partner as a consultant.

Additionally, the team is using residents’ committees, composed mainly of family members of service users’, to provide consultation.

“A fully collaborative partner approach with service users and the residents’ committee will help us create the necessary synergy to complete our project,” says Paré. “Their experiential knowledge is helping us in the different stages of project development, through co-design.”

Paré is proud of the team’s work and their project so far and believes it will do more than just help the CISSS.

“The problem is present in many regions of Quebec and Canada. We anticipate that our work will generate a lot of interest, and we will be happy to share our discoveries and results.”