Understanding the care experience through the eyes of patients

The Challenge: Work processes and physical environments impede the delivery of safe, effective and efficient care

Nurses at the McGill University Health Centre were spending too much time “hunting and gathering” to find needed equipment, and too little time with their patients. They were tired and frustrated, which was negatively affecting patients’ levels of satisfaction with the care they were receiving as well as with health outcomes. To address the problem, the hospital enlisted patients and front-line staff in an initiative to redesign work so that staff would have more time to meet patient needs.

The Improvement Project: Transforming care at the bedside

Patricia O’Connor, Director of Nursing, MUHN led the initiative, funded by the Canadian Foundation for Healthcare Improvement. It was based on an approach called Transforming Care at the Bedside (TCAB). The hospital created groups with both staff and patient representatives on five inpatient units and directed them to focus on specific modules with clear deliverables for each. The first module focused on improving the physical work environment, the second was on patients’ experience of care, while the third focused on admission and discharge procedures.

The Result: Inpatient units make significant changes to how they operate

Nursing stations, medication rooms, family visiting rooms, treatment rooms and supply rooms have been redesigned; equipment relocation means nurses spend less time searching for needed equipment (and, as a side benefit, some $3,000 worth of equipment was found and returned to the biomedical engineering department). Whiteboards have been added to each patient’s bedside as a two-way communication tool among patients, families and staff. Nurses now take time to ask a few basic questions of their patients on every shift so they know patients’ priorities for the day. In addition, the admission process for mental health patients, which used to take more than four hours and required meeting separately with nurses, physicians, psychologists and social workers, now takes less than one hour.

The overall result has been a 30 percent increase in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores related to responsiveness of care from the patient’s perspective, surpassing US benchmarks.

The Impact: Collaboration has resulted in a deep culture shift

More important has been the culture shift that has taken place. Front-line staff are stepping up as champions of change and taking ownership of initiatives to improve quality indicators. Patients are also making the transition from observers to active collaborators in staff-patient groups. Director of Nursing Patricia O’Connor says patient involvement has been the key to the initiative’s success, noting “how much better the answers and improvements are when patients are there co-creating them.” As for the patient representatives, they feel their contribution is valued.

Patricia OConnor image


Patricia O’Connor
Director of Nursing
Montreal University Health Network (MUHN)
Montreal, Quebec


To learn more about CFHI Patient and Family Engagement initiatives, please visit: cfhi-fcass.ca/patientengagement or email us at info@cfhi-fcass.ca.