Approach to Implementing the SMHPL in a Large Health Organization

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Approach to Implementing the SMHPL in a Large
Health Organization
St. Josephs Health Care, London

• Site Liaison Dr. Maggie Gibson
• Site Facilitator Julia Horan jhoran_at_uwo.ca

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Background

• Located in London, ON
• One of Ontarios leading teaching hospitals
• Advancing health care, education and research
• Partner in Londons academic health sciences
  community
• Publicly funded Catholic health care organization

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Background

• Owned by the St. Josephs Health Care Society of
  the Roman Catholic Diocese of London
• Volunteer board of directors
• 120 year legacy, advancing a ministry of
  compassionate, excellent service
• Further information see http//www.sjhc.london.on.
  ca/

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Strategy

• Create one page handout to be presented to key
  contacts at SJHC
• Included information re timeline of project,
  introduction to SMHPL, and 6 discussion questions
• Email sent out to 5 contacts within SJHC selected
  by site liaison with attached handout
• Set up meetings with contacts and give them a
  hard copy of the lens or link to online version
  prior to meeting

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Discussion Questions

1. Have you ever heard of the SMHPL?
2. Are there any processes in place in terms of
   policy and programs where seniors perspectives
   and values are addressed?
3. Are there any processes in place that would
   benefit from the seniors mental health
   perspective?
4. Are you aware of any examples at SJHC where
   consideration of seniors' mental health issues
   specifically helped to shape the development of a
   policy?
5. What value might be added by a specific
   consideration of senior's mental health issues in
   policy development?
6. What thoughts/recommendations do you have on how
   a tool such as the SMHPL could be of use to St.
   Joseph's?

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Approach to Implementing SMHPL

• Interview-style meetings, approximately 45
  minutes
• Introduction of SMHPL, examples of use
• Brief background of contacts roles
• Discussion questions
• Conclusion
• Received feedback and obtained consent to be used
  in project
• Create table of responses for comparison
• Get references to other contacts

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Contacts at SJHC

• Deb Wiltshire Veterans Care leader at Parkwood
  Hospital
• Lisa Van Bussel Psychiatrist at Regional Mental
  Health Care, London and St. Josephs Hospital,
  member of Outreach team
• Deb Miller Director of Organizational
  Development and Learning Services at SJHC (phone
  interview)
• Beth McCarthy Director of Specialized Geriatric
  Services (SGS) at Parkwood Hospital
• Lynda Martin Mount Hope, LTC program (response
  pending)

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Contacts at SJHC

• Phyllis Brady Patient Relations and Risk
  Management at LHSC and SJHC
• Kendra Kasubeck Risk Management and Patient
  Safety, Policy development at LHSC and SJHC,
  citywide policy, corporate development

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Responses

• Have you ever heard of the Seniors Mental Health
  Policy Lens?

Deb Wiltshire Yes, through Dr. Gibson Have not used it
Lisa Van Bussel -No, not until I received the email to meet
Kendra Kasubeck -No, not until I received the email to meet
Phyllis Brady -No, not until I received the email to meet
Deb Miller -No, not until I received the email to meet
Beth McCarthy -No, not until I received the email to meet
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Responses

• Are there any processes in place in terms of
  policy and programs where seniors perspectives
  and values are addressed?

Deb Wiltshire -Informal integrated into planning and care (more ingrained) -Get feedback from patients one-on-one -Satisfaction survey to patient and family every 2 years to get feedback -Have no control over the content of these surveys as they are standardized
Lisa Van Bussel -Meetings with seniors and their family depending on cognition of senior -Use of a template, but not explicit -Family given education with social worker in some instances -Evaluations/surveys to patient/caregivers every 2 years -Mail out patient satisfaction surveys -Informal hear experience from other areas of work and bring back to SJHC
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Responses
Kendra Kasubeck -Corporate policy manual -Reviewed every 2 years unless its regarding staff safety then it is every year -6 months before review is due, an email is sent out as a reminder -Template online to follow for formatting and checklists -Policy development companion -Policy coaching tool -This can be used for all people, not just seniors
Phyllis Brady -Corporate policy manual -Reviewed every 2 years unless its regarding staff safety then it is every year -Template online to follow for formatting and stakeholders -Used for all people, not just seniors -New, developing multidisciplinary group ex. Discharge Policy has representatives from different areas
Deb Miller -Clinical program for specific seniors population -Organizational tool for anyone -Follow template for quality workplace considering physical, social and mental well-being not specific to mental health -Informal process
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Responses
Beth McCarthy -Patient satisfaction survey for out-patients and in-patients -Once patients are discharged send a survey in the mail based on their experience -Out-patient survey for new patients is distributed monthly and may receive phone calls about feedback -Evaluation tool for patient and their family at workshops -Review with staff re how patients get referred -Patients given a brochure in acute care with expectations in response to feedback -Upfront management is general change to health care system
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Responses

• Are there any processes in place that would
  benefit from the seniors mental health
  perspective?

Deb Wiltshire -Dont have an explicit checklist like this in place and may benefit from using it -Do consider seniors needs, but make assumptions -Dont generally ask the seniors themselves, so this may be helpful
Lisa Van Bussel -Incorporating what is learned to use in care -No focus group or survey formally asking seniors what they want -Staff and caregivers make the assumptions for them -Would benefit from an explicit seniors perspective with a family council
Kendra Kasubeck -Always looking for areas of improvement and this would help -Could be useful in stakeholder review looking specifically at policies regarding seniors and mental health
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Responses
Phyllis Brady -Not really because Mount Hope and Parkwood which are geared toward seniors already have increased awareness about their perspective and needs
Deb Miller -Yes in terms of the mental health perspective, but not just seniors, more generic
Beth McCarthy -All programs have target group of frail seniors (over 75 years of age with more than one complex medical issue) -Needs are critical to be met in terms of access, barriers, accessibility, and communication -Seniors perspective is already addressed
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Responses

• Are you aware of any examples at St. Josephs
  where consideration of seniors mental health
  issues specifically helped to shape the
  development of a policy?

Deb Wiltshire -No as most are corporate policies, done by the employees -Policy is dealt with mostly by administrative people
Lisa Van Bussel -Patient and Family Handbook gives information on program, roles, expectations and diseases -Initiative Mental Health Program for recovery needs held a Christmas bazaar -City of London and UWO put on Think Tank a meeting that addressed mental health needs and issues and the services available
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Responses
Kendra Kasubeck -End of Life Care policies and Palliative Care policies would involve thinking about seniors needs specifically -Policy decision makers in End of Life Care -Standards for Relationships Policy development as is requires respect for all people -Policy on Accessibility for Persons with Disability
Phyllis Brady -Regional Mental Health Care London -Sites with specific seniors/geriatric population (Parkwood, Mount Hope) -Some involvement at St. Joseph Hospital because of the recent move the demographic in the ambulatory care program changed (more seniors now)
Deb Miller -No, work more with entire population -There would be at program level at Regional Mental Health Care London and Specialized Geriatric Services for example
Beth McCarthy -Standards of Relationships Policy is framework for staff to deal with cognitively impaired and unpredictable behaviour patterns of patients and families that become agitated -Accessing Services of People with Disabilities Policy includes getting information to people who are depressed or cognitively impaired and have physical disabilities -Not specific to mental health, but these policies involve mental health issues
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Responses

• What value might be added by a specific
  consideration of seniors mental issues in policy
  development?

Deb Wiltshire -Policy impacts care and service, not just administrative -Policy for standards of relationship (i.e. staff ? staff, staff ? family, family ? patient, staff ? patient) -Address differences in mental health behaviour of capable vs. incapable
Lisa Van Bussel -Would be valuable for everyone of all ages -High risk nowadays for mental health issues, and having information guides would prepare them -People with variable capacities and the policy should reflect this (flexibility) -Important for health promotion and prevention -Seniors with mental health issues may have complex needs with functional decline and lack capacity
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Responses
Kendra Kasubeck -Strengthen policy development -Allow you to consider all age groups -Helpful to all stakeholders to use as a guide and follow a checklist when they are reviewing a policy -Filling in the gaps of policies
Phyllis Brady -Would be valuable as mental health now affects 1 in 4 people (more prevalent) -Useful to Regional Mental Health Care London and the Family and Patient Council
Deb Miller -Allow groups to meet at a deeper level fulfilling SJHC Catholic mission -Group learning together combining intelligence -Broaden knowledge
Beth McCarthy -Provide a framework to meet the needs of seniors at Parkwood -In a larger perspective, other hospitals that arent targeted to seniors may find this useful in case they miss something -SJHC preadmission clinic may not consider things so this would act as a reminder
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Responses

• What thoughts/recommendations do you have on how
  tool such as the Seniors Mental Health Policy
  Lens could be of use to St. Josephs?

Deb Wiltshire -Meet with leaders/directors of groups who are directly influenced by policy -The process heightens awareness -E-learning tool would increase awareness and can be used for program development keep it short, simple and easy to operate -Create 4 or 5 cue cards or a poster to be placed on back of ID or a brochure that identifies a checklist of keywords as a reminder on a daily basis -Example deck of cards of fire safety reminders is an easy way to reach more people and less formal -Key is keeping it in the forefront and integrated into daily use
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Responses
Lisa Van Bussel -Talking through is beneficial in itself -Perhaps make it bilingual if that hasnt been done already -Create a one page template, similar to what is already in place and keep it simple -Target at the managers level -Provincial LHIN (Local Health Integration Networks) just developed an Aging at Home policy have they considered needs of seniors with mental health issues? (follow-up opportunity) -CCAC is another large organization that may be contacted -Knowledge web based practice SHRTN AKE mechanisms, may discuss/use the SMHPL (follow-up opportunity)
Kendra Kasubeck -Be of use to stakeholders who work directly with mental health -Leaders ? delegate to committees
Phyllis Brady -Short, snappy -Implemented in stakeholder review
Deb Miller -Make available in broader quality workplace initiative -Organizational tool for all staff
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Responses
Beth McCarthy -SMHPL Resource would be helpful to senior-friendly hospitals -Trying to make hospitals a good experience for people, specifically seniors, and this tool would help consider their needs -Approach Ontario Hospital Association (http//www.oha.ca) which is involved in setting policies to be used at all hospitals in Ontario -Each hospital must follow the standard template policy as outlined by OHA -Approach Communications department at SJHC and get approval by senior leadership to have SMHPL Resource placed in SJHC website References section
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What We Learned

• Majority of responses included use of
  standardized policy template at SJHC, but not
  explicit
• Process of going through SHMPL would be valuable
  to gain clarity, gain seniors perspectives, and
  consider things that were missed in
  policy/program development
• Keep it short, simple, and in plain language
• Be directed to individuals of different
  capacities
• Valuable resource for people of all ages

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Next Step

• Create a one-page version of the SMHPL that is
  similar to the processes in place at SJHC,
  providing a shortened version for efficient use
• Take questions directly from Part II Assessing
  Policy/Program Content because Part I Process
  Factors are already accounted for at SJHC
• Follow-up email to contacts with the Seniors
  Mental Health Policy Lens Resource attached

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Feedback

• Online survey of questions to gain feedback based
  on the following questions
• Is the purpose of this resource clear? If not,
  can you explain what is needed?
• Is the wording of each item clear? If not, which
  items need to be re-worked?
• Is the follow up action listed at the bottom of
  the page clear? If not, can you comment on what
  is needed?
• Where would you see this resource being housed in
  the organization?
• Who would you see using this resource?
• Do you have any suggestions as to how to increase
  visibility and use of this resource?

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Survey Feedback

• Clarity of purpose
• Yes I found the introductory overview very
  helpful. Clearly presented using the
  handout/booklet
• Wording of each item
• Yes The framework is clear
• Have the questions be positive or negative but
  not both (consistency)
• Change wording of 3 Handicaps to Barriers

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Survey Feedback

• Clarity of follow-up action
• Yes It provides a great way to evaluate how
  "senior friendly" the policy is and an
  opportunity to understand how to improve (and
  validate) the draft
• Location for potential use of resource
• Policy formulation as it is drafted by the writer
  and then a "checklist" for use by a
  committee/workgroup as a last lens/feedback
• Use of the resource
• Anyone drafting a policy or participating a
  review of a policy

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Survey Feedback

• Suggestions to increase visibility
• Get to senior leadership of organizations to
  incorporate into the development/approval process
  for policies
• New Ontario Act and Regulations is clear that
  accessibility must be considered when policies
  are developed/revised and this reference could be
  added

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Challenges

• Because SJHC is a large organization directed to
  seniors needs, they have procedures in place and
  are committed to making facilities
  senior-friendly already
• Standardized policy templates are city-wide not
  a lot of flexibility
• Not explicit use of templates used as a general
  reminder
• Availability of contacts for scheduling meetings

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Follow-up Opportunities

• Collecting and analyzing feedback from survey
• Approach SHRTN AKE (Seniors Health Research
  Transfer Network, Alzheimers Knowledge Exchange)
  which is a web-based practice in Ontario as
  recommended
• Approach provincial LHIN (Local Health
  Integration Networks) to review Aging at Home
  Policy
• Develop plain language version of lens as a
  companion to the Patient and Family Handbook used
  at SJHC

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Follow-up Opportunities

• Approach Ontario Hospital Association (OHA) to
  get their feedback and approval of lens as
  province wide recommendation
• Approach Communications department at SJHC to
  increase visibility of SMHPL Resource on website

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Conclusion

• In order to implement a policy template into a
  large organization, the best approach is to be
  used as a companion resource to what is already
  in place
• Not a lot of flexibility in terms of what is used
• Meeting with leaders in different areas helps
  represent the broad perspective at SJHC
• Interview style was time efficient, to the point,
  and helped eliminate problems in scheduling
  meetings
• Positive response to the content of the lens
  perhaps different format such as the SMHPL
  Resource