St. Joseph's Healthcare Hamilton (ON)

  • Michelle Joyner, Manager, Medical Affairs, St. Joseph's Healthcare Hamilton, Hamilton, Ontario
  • Laura Wheatley, Senior Manager, Clinical Development, St. Joseph's Healthcare Hamilton, Hamilton, Ontario 

Enhancing the Patient Voice at St. Joseph's Healthcare Hamilton

Problem Statement: Current patient involvement at St. Joseph’s Healthcare Hamilton (SJHH) occurs in an uncoordinated and inconsistent manner, resulting in missed opportunities for staff and patients. 

Context: There are four distinct areas where discussions around patient engagement are being advanced, and these are important to contextualize for this paper: the local context at SJHH, the external environment beyond SJHH, the overall national patient movement, and change in chronic disease states amongst the population. 

  • SJHH is a 691 bed, multi-site, regional, tertiary academic and research health science centre dedicated to providing values-based compassionate care to patients and their families of the Hamilton Niagara Haldimand Brant Local Health Integration Network (HNHB LHIN) and its neighbouring regions. 
  • The concept of patient engagement has been evolving and increasingly leading to compulsory regulations for health organizations to address.
  • The public is demanding to be involved in both their care decisions and in setting and monitoring the quality of care provided in their community.
  • Healthcare provision has switched from acute episodic events to support management of chronic diseases. 

Anecdote: In 2010 a sophisticated and well spoken father came to the board and told his story of frustration and difficulties navigating the mental health system for his child. He commented that despite his family’s expertise and familiarity with the healthcare system it still did not meet his child’s needs and that after several days in our institution his child had committed suicide.

Evidence: There is a great deal of evidence supporting the benefits of patient engagement and patient-centered care. In a study comparing two types of patient care units (one  using the Planetree model and the other without), it was found that the former model resulted in shorter average lengths of stay, statistically significant lower cost per case, and higher overall patient satisfaction scores. Engaging patients has also been shown to result in better management of chronic conditions, reduction in patient anxiety and stress, and shorter lengths of stay.

Intervention: After a thorough literature review and discussions with experts in the healthcare field, it was decided that an intervention project focusing on patient engagement would be carried out. The goal of this project was to introduce patients onto each of the organization’s 13 clinical quality councils. This choice was based on discussions with Kingston General Hospital and findings from the work of the Dana Faber Institute (Groene, 2011). The intent of introducing patients and families onto quality councils was to develop meaningful collaboration between patient and family advisors and the staff on the council and as a structured initiative to begin to advance patient engagement within the culture of SJHH.

Implementation: Explicit support from senior leadership greatly assisted in leading this intervention project. We were directed by Kotter’s change model. The change process was designed to ensure ongoing two way communication occurred with key stakeholders and groups that would assist in influencing others to adopt the change.

Results: Recruitment and integration of patients into a number of quality councils was an accomplishment, however the question arises “was it in meaningful?” We chose to monitor this change by focusing on the collaboration that occurred within each of the councils. This was done using the Assessment of Interprofessional Team Collaboration Scale (Orchard, King, Khalili, & Bezzina, 2012).  We found a statistically significant difference in team collaboration after one year of patient inclusion in the councils. In addition, qualitative comments from both staff and patients and family advisor focus groups found their work on quality councils to be meaningful. Intangible results have included a greater awareness among SJHH staff of what patient engagement involves, and its benefits. For example, the EXTRA fellows have been approached many times by various groups in the organization looking for advice on the best way to include the patient voice in their work.

Lessons Learned: Regular and timely communication with key stakeholders is vital, reinforcement from external agencies is needed, dedicated corporate resources are required, and a clear vision of the goal of the project is essential.