Improvement Conversations: Interview with Valerie MacDonald of Fraser Health, Dolores Langford of Vancouver Coastal Health, and Judy Battista, B.C.

by Nadine Morris | Sep 28, 2015

Improvement Conversations: Interview Series

CFHI Interview with Valerie MacDonald of Fraser Health, Dolores Langford of Vancouver Coastal Health, and Judy Battista, B.C.

October 2015

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Left to right : Judy Battista, Valerie MacDonald, Dolores Langford

In an occasional feature, we interview leads of CFHI-supported projects currently underway. This month we profile a joint project between Fraser Health and Vancouver Coastal Health in B.C., led by one of 22 teams from healthcare organizations across Canada taking part in CFHI’s Partnering with Patients and Families for Quality Improvement Collaborative, created to enhance the capacity of organizations across Canada to partner with patients and families to improve care across the continuum.


Project lead Dolores Langford, along with Evaluation and Performance Measurement lead Valerie MacDonald and patient/family advisor Judy Battista, describe the progress of their project ‘Good to Go’‘- A Safe and Smooth Transition Home after Hip Fracture, since the project formally launched in July 2014.

Why did Fraser Health and Vancouver Coastal Health decide to undertake this project?

We knew from the literature that 50 percent of patients did not regain their pre-fracture level of mobility and 30 percent died within the first year following hip fracture surgery. Patients and families reported feeling confused, overwhelmed and distressed when they returned home after hip fracture surgery. They lacked basic information on how to manage their care needs and stay safe at home. We believed that the patient experience could be improved with education and support.. We also knew that engaging patients and families with staff in a care redesign would be the best route to improvement.

Could you please describe your project and your target population?

Hip fracture is a life-altering event with dire physical and psychological consequences, including long-term functional impairment and, in some cases, death. A full 95 percent of hip fractures are caused by a fall and many times that fall was related to illness. The average age of patients who suffer from hip fracture is 83 and most have two or more chronic illnesses. Hip fracture is a ‘tracer’ condition for frailty and lessons learned in this population are transferable to other older patient populations. Our project’s aim was to improve the patient experience of the transition home after a hip fracture by determining the optimal tools and processes to support patient/family self-management, confidence and competence. In collaboration with Dr. Maureen Ashe, a provincial team developed Fresh Start (FS), a tool kit for patients and families with hip fracture. This evidence-based self-management tool kit offered a framework for the patient/family role across the care continuum. We wanted to learn how to best support patients/families in a safe and smooth return home. We used the Canadian Patient Experiences survey, qualitative interviews and focus groups with staff and patients to guide our work and track our progress.

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Dolores Langford, Physiotherapy Practice Coordinator, Coastal Community of Care, Vancouver Coastal Health and Kathleen Jackson, patient, ‘Good to Go’ hip project.

What are their most pressing healthcare issues that are being addressed?

We are addressing gaps in the ability to foresee and address preventable health care risks, such as pneumonia, infection, blood clots, as well as teaching and supporting patients and families to take charge of their recovery, and stay on track with mobility and health goals.

Had you wanted to implement this type of quality improvement prior to joining the CFHI collaborative?

Yes, we needed to do this work, but the funding, structure and support offered by CFHI provided a foundation to proceed with our project. We feel that this project is one of the highlights of our career; it has been a true collaboration and a transformative journey for us all.

How did you hear about this opportunity?

We were interested CFHI’s work and received their monthly e-newsletters , so when the details of the collaborative were announced, it seemed like a natural fit with our philosophies and the direction we wanted to pursue with our work.

Describe your lessons learned, results and greatest successes to date. How have patients and their families a) been involved in and b) benefited from your work?

We tried various ways of delivering the FS Tool Kit to our patients and families. Just providing written information alone was not successful. We tried running group classes but found it impossible to meet the diverse individual needs within the population and family schedules. We also learned that a subset of patients did not recall the teaching in the hospital and we are now going to pilot a focused home follow-up visit.

What strategies have you used to ensure community providers are informed and engaged?

Our patient advisor, Judy Battista, has been instrumental in ensuring that the patient and caregiver voice has been heard. We’ve also begun working with an interdisciplinary team of home health providers on a pilot project to offer structured support at home.

What have been your biggest challenges and obstacles?

Our biggest challenge has been communication across sites -- we are working across two large and diverse health authorities with very different cultures and populations. We also find that it takes a concerted effort to coordinate patient and family meetings for self-management support and coaching, and time is at a premium. It’s a culture shift for staff to recognize that this time investment is vitally important for patient safety and experience.

How engaged are the staff?

We have been amazed at the level of engagement of our staff. We have had enthusiastic champions at each of our sites that gather and report patient feedback to point-of-care staff. We had a focus group bringing staff and patients together. It was powerful for staff to hear directly from the patients about their experiences and their ideas for improvement.

Is your senior leadership supportive?

Yes, we have had support and encouragement from our senior leadership from the beginning, and the project very much aligns with our health authority’s strategic priorities of patient-centered care and patient engagement. Our project was highlighted by Accreditation Canada as an initiative to spread and was appreciated by senior leadership.

How is CFHI funding and support helping you to reach your goals?

The tremendous learning through the collaborative has been made possible by the regular communication, learning and sharing webinars, and the platform for collaboration provided by CFHI. We’ve also had sound guidance from our coaches, Heather Thiessen and Lena Cuthbertson.

How do you plan to sustain quality of life improvements for these patients?

We have a sustainability plan in place to continue our work after the end of the collaborative, and much of our work, such the communication tools, have now been embedded into daily practice. We are also continuing with Phase 2, involving Home Health in a community pilot project to provide evidence-based support for patients at home.

Do you foresee the ability to scale up your work to other sites in your region?

Absolutely, we are working with the BC Hip Fracture redesign provincial group to ensure knowledge translation occurs from our project to all 28 hospitals across BC.