Background

1. Partnerships in Person-Centred Approaches (PPCA)Albert Banerjee PhD, York University, Toronto, Ontario Deanne Taylor PhD (Candidate), Fraser Health Authority, British ColumbiaAnita Wahl RPN, MN, Clinical Nurse Specialist, Fraser Health Authority, British Columbia Background Findings How does the program work? This study is a collaboration between a SSHRC funded MCRI, Re-imagining long-term residential care, and the Fraser Health Authority of British Columbia. Traditional approaches in health care systems address person-centred care and safety practices separately, despite clear areas of overlap. Since 2007, the Fraser Health Authority Residential Care and Assisted Living Program has implemented and grown an innovative process called the Partnerships in Person-Centred Approaches (PPCA), which aims to integrate workplace safety and quality objectives at the direct care level. Fostering communication, teamwork, and leadership is the heart of the process, and this is achieved through regular, facilitated meeting between care staff and management. Short meetings are organized on a weekly basis, and longer meetings are organized bimonthly. All follow a staff run agenda. Presently, eleven residential care facilities are involved in the process. A number of qualities were key to staff experiencing the process as the “real deal.” We note a few here. Staff run agenda. “When it changed for us was when we opened the floor and said, What do you want to talk about? What are your issues? What matters to you?” (RCC) Action items: Staff felt they had a voice not only because they were listened to but because action was taken and communicated back to them. Facilitation:The facilitator was perceived as neutral. And the best meetings ensured everyone who wanted to speak had a chance; no one dominated; dialogue moved quickly with issues identified, solutions discussed, action items noted, and a person assigned responsibility for each task. Mentoring: We observed considerable encouragement, assistance, learning and modeling by the facilitator, some managers, and other staff. This process mentored staff in leadership, problem solving, and communication skills: “It has helped me come out of my shell and helped me to dialogue better, (HCA, I9). The data was analyzed thematically by the authors individually and then collectively. Our analysis was guided by three overarching questions – what does the process do, how does it work, and what challenges were experienced by participants? What does the program do? Fosters dialogue: ThePPCAprocess creates a safe space for communication, free from fear of reprisals, occupational hierarchies, and is driven by concerns of staff rather than management. It provides a forum where gossip and rumours are addressed, and gives worker a voice. When “all the other crap is aside, you can actually look at what you are here for….(HCA). Root-cause analysis: Within this context, problems that were otherwise invisible were able to be addressed. Bringing together several occupations, the encouragement of multiple perspectives, and a spirit of empathetic inquiry, enabled moving beyond blaming individuals towards understanding the conflicting concerns and responsibilities behind issues, and allowed for mutually beneficial solutions. Integrating safety and quality. The process allowed for quality and safety issue to be addressed in context rather than as abstract training pieces, addressing working conditions, quality and safety in an integrated manner. Grass roots practices: The PPCA process has resulted in the development of practices that respond to workers’ concerns and are instituted within units, and at times shared among facilities and more broadly within the health authority (e.g. a safety huddle, a chain of communication, a work-plan for communication between nurses and care aides). PURPOSE Research Questions & Methods The goal of study was to understand what difference the PPCA process was making and how it was making this difference from the perspective of those involved. To answer these questions we draw on quantitative and qualitative data. Quantitative data on days lost to injury and injury claim costs before and afterimplementation of the PPCA process were collected. Qualitative data for this study were collected through ten observations of weekly and bimonthly meetings. We also conducted eleven interviews and eight focus groups. In total, 52 people participated in the study. Our sample included 23 health care aides (HCA), 11 registered nurses (RN), six facility managers and senior leadership, six licensed practical nurses (LPNs), and five allied health professionals, as well as one facilitator. Challenges? Negativity: The early stages of the process could be difficult, particularly if communication was poor or nonexistent prior to the meetings, participants reported considerable venting and negativity. Workload: The weekly meetings and action items added to managers’ workload, pointing to the importance of delegating responsibility. Attendance: We also identified a tension between the consistency of regularly scheduled meeting and enabling staff on different shifts to attend and participate. September 2012