The Hallways are Buzzing: Harbour View Hospital welcomes families as partners in care
These days, Harbour View Hospital is full of activity. But it wasn’t always that way.
In early 2016, Harbour View – a long-term care and rehabilitation facility in Sydney Mines, Nova Scotia – came to the realization that change was needed to enhance quality of care.
At that time, it was felt that staff were working in silos and that interprofessional collaboration between staff could be improved.
The facility’s diverse client population is served by an equally diverse multidisciplinary team that includes nursing, occupational therapy, physical therapy, recreation, social work, orthotics, hearing and speech, dietary, and others.
Based on the perceived need to address problems with internal communication, Harbour View used funds from an innovation nursing grant to work on improving inter-professional collaboration on its rehabilitation unit.
Part of the grant work included conducting a survey of all the clients in the rehab program. The survey asked clients what they felt could be improved at Harbour View.
The results were, in a word, surprising.
The “ah-ha” moment
“All along, our focus had been on what we thought was an inter-professional role issue, so we were expecting feedback on that,” says Angela Stairs, Director for Rehabilitation Services for the Nova Scotia Health Authority Eastern Zone.
However, the overwhelming message was that clients wanted their families and loved ones to be more involved in their care.
“The issue did end up being about communication – not between professions, but with clients and families,” Angela explains. Families wanted more information on the day-to-day routine and treatment plans for their loved ones, and recommended that they be given more notice when clients were to be discharged. Clients and families alike also wanted flexible visiting hours.
The bottom line? “The survey showed us clearly that families wanted more involvement,” says Angela. “They felt they were welcome as visitors, but not as true partners in caring for their loved ones.”
First steps to improvement
Armed with this information, one of Harbour View’s first tasks was to do a full walk-about of the facility to identify areas for improvement in client-centred care. “We discovered right away that we had some challenges,” says Lorna O’Grady, manager of resident care for Harbour View site.
The building has a single entrance that splits off into two hallways: one leads to the long term care side of the facility, and the other to rehabilitation/restorative care. No signs were posted on the long term care side indicating what the visiting hours were, whereas the rehab side had signs posted at the building entrance saying that visitors were allowed in the rehab unit between 4 p.m. and 8 p.m.
Adding to the confusion were announcements made over the P.A. system every day at 8 p.m. asking all visitors to leave. “It was confusing for people who were visiting their families, in all parts of the facility,” explains Lorna. “Families and clients didn’t know what to expect, and staff weren’t happy either.”
Collaborating for improvement
In March 2016, CFHI launched a pan-Canadian family presence e-collaborative initiative. The e-collaborative built on the work of the Better Together campaign and was designed to encourage organizations to examine and modify their family visiting policies.
For Harbour View, the call for proposals to CFHI’s Better Together e-collaborative was the right thing at the right time. “We had the results of our client survey and were thinking about what to do next,” says Lorna. “When we saw the CFHI call for applications we thought it was a perfect fit, so we went for it!”
Harbour View began its participation in CFHI’s 11-month e-collaborative in May 2016, along with 11 other sites from across Canada. Particularly valuable, according to Angela, were the regularly scheduled affinity calls that provided opportunities for all the organizations in the e-collaborative to share best practices and talk about solutions to common challenges.
Involving families, improving care
Almost right away, Harbour View began to make some changes. They designed a new client and family information booklet and implemented revised visiting guidelines to include 24/7 visiting hours for families and loved ones. Education sessions and focus groups were delivered by former clients to give staff, families and clients an opportunity to ask questions and suggest improvements.
Angela and Lorna admit that change is not always easy. There were some concerns expressed by clients, families and staff about issues such as privacy breaches and interruptions to treatment. “Some worried that the floodgates would open and that families would be there all night, all day, potentially compromising the delivery of care,” Angela explains.
However, almost immediately it became clear that having family members present was helpful for everyone. Staff are now reporting that having an extra pair of hands and eyes helps to provide consistency in care, and is especially valuable when it comes to transitioning care from facility to home.
Changes for the better
Harbour View Hospital has seen lots of changes since implementing its 24/7 visiting hours. The recreation department, for example, has ensured that the facility is equipped with family-friendly activities such as a newly purchased a shuffleboard that is used daily by clients and their families. Family members are regularly attending care plan sessions and the facility is seeing many more visitors – of all ages – all day, every day.
“The hallways are buzzing with activity,” says Lorna. “Our staff are thrilled with having families so involved.” And, she adds, the organization has ripped up the visiting hour signs at the front entrance. “That’s hugely symbolic,” Lorna says. “We’re proud of the work that we’ve done.”