​​​​Carol Fancott, Angie Andreoli and Joanne Kwong
(L to R) Carol Fancott, Angie Andreoli and Joanne Kwong consult about recent MSK real-time patient advisory groups. (Photo: UHN)


Sandra Folk's cycling accident left her with multiple traumas including a broken femur and arm.  The university instructor and online business owner, was admitted to Toronto Rehab's Musculoskeletal (MSK) Rehab Program as an inpatient for two weeks.​

While an inpatient, Sandra was told about the real-time patient advisory groups  available to MSK inpatients that facilitate real-time feedback to help inform improvements – big and small—on the unit .

Sandra was curious and decided to attend.

"I think there's value in this type of forum," said Sandra. "When you're in the hospital, you're vulnerable. Some patients feel that you might not be heard and the idea of a patient forum can help give patients a voice."

Sandra did observe that many patients who attended were reluctant to talk and her session began as a forum for complaints, but then switched to a more constructive conversation.

Joanne Kwong, patient engagement project coordinator, notes that the sessions have pre-determined topics, but sometimes the conversation moves in different directions.

"We always acknowledge a patient's point and we encourage patients to feel comfortable having conversations with their core team outside of the real-time patient advisory group sessions," explained Kwong.

"Our goal is to seek patient and family feedback, understand where their feedback is coming from and look at ways in which we can improve patient experience and care." 

Engaging patients to enhance their experience

The real-time patient advisory groups are unique to Toronto Rehab's MSK Program –both for inpatients and outpatients—and  is an innovative quality improvement project funded through the Alternative Funding Plan Innovation Fund.

 "In many cases, the MSK team was already engaging patients informally," said Angie Andreoli, who has facilitated MSK real-time patient advisory groups. "We needed consistency and structure to better understand the patient experience of care – through the eyes of the patients."

The group's facilitators commit to feeding back the input gathered from each patient advisory meeting to the team during huddles the next day.

Staff's initial concerns

"Initially, staff expressed concern about how these real-time groups would run and had apprehension about receiving feedback from patients," said Kwong. "Naturally, people feel vulnerable receiving and giving feedback.   When we report patient feedback to staff, it's not about an individual—it's constructive feedback as well as a learning opportunity for the whole team."

"There has been increasing openness from staff and they are embracing the process.  Receiving real-time feedback from our patients and acting on it are now regular parts of the work we do. "

Kwong's role on the MSK Advisory Committee team has been crucial, as has been the support of the leadership team. 

"Joanne is part of the core MSK Rehab team and acts as a bridge between this initiative and the front-line team," explained Carol Fancott, project co-lead. "She has been an invaluable champion who is setting the tone for everyone."

A new culture of partnership

Program changes have resulted from this initiative since it began in June 2014. For example, patients expressed the need for greater communication about the admission process and what to expect in rehab. As a result, the team, together with input from patients and families, developed an admissions pamphlet specific for their program as part of the welcome package.

Patients also expressed that they'd like more activities to pass the time, especially in the evenings.  The team solicited donations for board games and cards that are available in the patient dining room, as well as developed a patient library: bookshelves in the dining room and lounge full of books, and secured an additional computer for patient use – little things that help to enhance the patient experience while they are here for rehab. 

The team is seeing additional benefits of this initiative. "We're developing a culture of partnership on our unit," said Kwong. "We're seeing a shift that patients have a better understanding of their role in partnering with us, and asking more questions of their care. And staff are engaged and want to hear what patients are saying about their care on our unit.  With these groups, we see a lot of peer-to-peer support, and socializing among patients."

Fancott also mentions that "when patients give feedback on the caring and empathetic nature of staff, it helps to reinforce and validate the care that staff are providing, and they appreciate hearing those comments."

"We're seeing patients on this unit become more open and engaged in their care," said Andreoli.

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