What does Patient-Centred Care (PCC) look like in Peri-Operative Services? This is the question that the department set out to answer while going through the OR Transformation Project, which wrapped up earlier this year. Some of the staff had undergone PCC training in the past, but finding the time to reach everyone isn't always easy on a busy unit where staff are needed on the floor. But, with the establishment of a Quality of Worklife Committee (as part of the Transformation Project), the groundwork was put in place to make PCC a reality for Peri-Operative Services.
Peri-Operative Services is unique in that patient interactions are very rapid and short—staff must get patients to the OR on schedule for their surgeries. On the flip side, this means patients themselves are often highly stressed and nervous when they come through the area. The PCC question for staff became, "How do I engage with a patient and have a conversation with them, recognizing that it's a vulnerable time? How can I be sensitive to their needs, but still do my job?"
"One size does not fit all," says Judy Costello, Director, Surgical Services, TGH. "We needed a variety of strategies. We really had to listen to people and what they needed for their area and their roles."
A key part of the process was learning to ask open-ended questions of patients. Staff often think they know what patients need, but that may not always be the case.
Equally important, explains Gillian Gravely, Nurse Manager, OR, TGH and PMH, "we tried to work PCC across the patient's episode of care, to incorporate PCC into the continuity of care."
They found that patients were often more concerned about their family—those were the people who needed the team's support, sometimes more than even the patient. In other words, PCC in the OR sometimes translates into "Family-Centred Care."
The committee's biggest challenge was finding the time to give PCC training to staff—PCC training normally takes up three days, but in Peri-Operative Services, even finding a single day was difficult. Eventually though, they were able to tweak the program to suit hectic schedules. One advantage to come out of that though was that the PCC training took place in their own area, and brought together all staff. Often, people are sent to PCC training with a cross-section of UHN staff. While that has its own benefits—hearing about issues on other units and how people deal with them—bringing it in-house, so to speak, allowed the course to focus exclusively on Peri-Operative issues. Ultimately, over 200 people were involved from across Peri-Operative Services, including the OR, Pre-Operative Care, Post-Care, and Pre-Admit.
They also worked to develop scenarios that were applicable to the area—staff frequently have to deal with issues as widely varied as surgery cancellations and religious or cultural concerns (eg., a patient has a religious object they wish to bring into the surgery suite). "It's really people-centred care, in the end," says Gillian. "We can't be patient-centred until we're centred in ourselves, because as a nurse, you impact the patient."
So, for example, dealing with surgery cancellations was a big issue for staff, and thanks to their PCC training, they're more aware of the distress this puts patients into, and how best to handle it. This has been a big confidence booster in helping staff approach patients and be transparent about what's happening, rather than feeling that they'd rather avoid the interaction.
Patients now have access to DVDs and computers while they wait. Sometimes they're given food, and sometimes they're even given an apology card. The change has positively impacted both staff and patients. It had been particularly hard on frontline staff, who had to deal with frustrated patients.
"It's that humanizing journey for everyone. These are people—both the patients and staff—and it's not easy for anyone involved," says Judy.
