KENSINGTON HEALTH QUALITY DAY POSTERS 2018
TABLE OF CONTENTS
Surgeon satisfaction survey plan - Eye Bank of Canada (Ontario Division) ............................. 3 Managing Medical Assistance in Dying - Kensington Hospice ......................................................... 4 Decreasing mammography call-backs - Kensington Diagnostic Imaging Centre .............. 5 Cross-training nursing staff - Kensington Eye Institute ........................................................................ 6 Infection control: fighting against the flu - Kensington Gardens .................................................. 7 Beekeeping at Kensington Gardens - Life Enhancement Department ...................................... 8 Caregiver support program - Second Mile Club .......................................................................................... 9 Building community through Congregate Dining - Second Mile Club ........................................ 10 Improvements to menu choices - Sodexo ...................................................................................................... 11 Tracking and monitoring analytics - The Communications Team ................................................ 12 Improvements to patients' information packages - Kensington Screening Clinic ............. 13 Improvements to our model of care - Kensington Vision and Research Centre ................. 14
SURGEON SATISFACTION SURVEY PLAN Let’s ENGAGE
Eye Bank of Canada (Ontario Division)
OUR SURGEONS
BACKGROUND The Eye Bank of Canada (Ontario Division) did not have a structured process of receiving feedback from surgeons who work with them. Without continuous feedback, the Eye Bank was unable to identify gaps and develop an effective action plan for quality improvement, and build a two-way communication plan with its primary stakeholders.
WHY IS IT IMPORTANT?
WHAT DID WE DO? We developed a Surgeon Satisfaction Plan The Eye Bank implemented a Surgeon Satisfaction Survey designed to collect feedback on areas for improvement. It will be sent to surgeons in Ontario every two years. The survey contains 19 questions developed by a focus group of subject matter experts and administrative staff. The Eye Bank is still waiting for responses from the first survey, but is looking forward to receiving feedback on key aspects of surgical services including: responsive management, needs, overall satisfaction and more.
Improve Customer Service An evaluation is essential to measure the success of how the Eye Bank delivers its services.
Enhance Quality Improvement The results will help develop a plan with focused targets and actions to guide how the Eye Bank will address gaps in the way it supports surgeons.
WHAT DID WE FIND?
WHAT’S NEXT?
The first round of surveys was sent on September 17, 2018. The goal is to reach over a 20% return rate.
• Analyze results • Develop a 2019-2020 Quality Improvement Plan
The satisfaction survey results are currently unknown and the final results will be received in late November, 2018.
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3 2018-11-20 12:35 PM
MANAGING MEDICAL ASSISTANCE IN DYING (MAiD) Let’s ENGAGE
Kensington Hospice
OUR COMMUNITY IN A IN A DISCUSSION ABOUT MAiD DISCUSSION ABOUT MAiD
BACKGROUND As of June 2016, the Supreme Court issued a ruling allowing eligible Canadian adults to request Medical Assistance in Dying (MAiD). As a completely new option for patients, there was lots to learn about how to guide, initiate and carry out the process with a patient, their family, and staff. In addition, every MAiD experience is unique.
Kensington Hospice would like to be a leader in providing the best psychosocial support possible for patients and families who elect for MAiD. It continues to be a sensitive and emotional topic for everyone involved, and the Hospice has significant experience supporting patients and families through the process.
WHAT DID WE DO? Improve the MAiD procedural strategy • Partnered with University Health Network Developed a standard comprehensive process in conjunction with the University Health Network for assessing MAiD requests, arrangements and delivering the procedure for those who qualify.
• Elevate Education Provide seminars, in-services and discussion for staff and volunteers about MAiD to equip them with the proper tools to provide safe, compassionate, competent and ethical care.
WHY IS IT IMPORTANT? MAiD is emotional for everyone involved. It is important to develop and continuously monitor our process (before, during and after) to provide the best possible care for patients, family members and staff.
• Provide notice of MAiD Staff, including volunteers, are free to decline involvement should they feel uncomfortable the day of the procedure.
• Open Communication A debriefing session consisting of an open discussion and reflection about the MAiD experience, which is held after a procedure and is open to all staff and volunteers.
WHAT DID WE FIND?
WHAT’S NEXT?
Families expressed deep gratitude and appreciation for our guidance, support and personal care throughout the MAiD process. Moreover, feedback has been positive from staff and volunteers who appreciate the support and open communication.
• Produce resources to support the community
• Research
Create and develop more literature such as brochures and pamphlets about options of MAiD procedures at Kensington Hospice and expand the education piece into the community.
The Hospice will continue to support and be a leader in research regarding MAiD with other organizations.
38 Major St., Toronto, ON, M5S 2L1 Quality Day Posters 2018 b.indd 2
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4 2018-11-20 12:35 PM
DECREASING MAMMOGRAPHY CALL-BACKS Let’s ENGAGE
Kensington Diagnostic Imaging Centre
OUR PATIENTS, RADIOLOGISTS AND TECHNOLOGISTS
BACKGROUND Kensington Diagnostic Imaging Centre (KDIC) experienced an increase in patients being called back for additional imaging after their screening mammogram, primarily for findings of focal asymmetry (an area of density such as thickened tissue seen on mammograms).
Although thicker tissue may still represent normal breast tissue, further evaluation is needed to exclude cancer. While call-backs for additional imaging are a necessary part of mammographic imaging, they represent great stress for patients especially when the findings are completely normal.
WHAT DID WE DO?
WHY IS IT IMPORTANT?
Understanding relationship between compression force and call-backs
Kensington Diagnostic Imaging Centre will be examining…
Compression force refers to the amount of pressure the mammographic technologists use during mammograms.
a) The relationship between the compression force used during the initial screening mammogram and call backs for additional imaging.
The lower the compression force, the less likely focal asymmetries that represent normal breast tissue will be effaced resulting in patients being called back for additional images.
Moreover, if adequate compression is not applied by the technician during additional imaging, patients may be referred for a biopsy unnecessarily.
b) The contribution of inadequate compression force on false positive biopsies.
Improve quality of images Better quality images allow for more accurate interpretation and decreases the risk associated with biopsies
Reduce unnecessary patient anxiety Patients experience anxiety during imaging procedures because of the uncertainty about the procedure, worry about the results, and other concerns.
WHAT DID WE FIND?
WHAT’S NEXT?
KDIC hopes to find a direct correlation between compression force and unnecessary imaging.
• Perform a historical analysis of cases over the past six to eight months • Correlate and analyze results • Make adjustments to breast screening protocols • Provide feedback to both technologists and radiologists as necessary
By increasing the compression force used during both screening mammograms and call-backs for additional imaging, we hope to reduce the number of unnecessary call-backs, and as a result, reduce patient anxiety surrounding the mammographic process. Moreover, as an Ontario Breast Screening Program (OBSP) site, we are measured on the number of call-backs that result in normal findings and the number of biopsy assessments that are false positives.
340 College, Suite 410, Toronto, ON, M5T 3A9 Quality Day Posters 2018 b.indd 3
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5 2018-11-20 11:41 AM
CROSS-TRAINING NURSING STAFF Let’ s ENGAGE The Kensington Eye Institute
Kensington Eye Institute
OUR NURSING STAFF
BACKGROUND The Kensington Eye Institute (KEI) strives to provide the best possible experience from the moment patients walk in the door, to the time they go home. That said, KEI noticed opportunities to improve their care through the whole patient journey by hiring additional nursing staff.
In the last year, the need to use temporary agency nurses on a weekly basis was very high. Crosstraining full-time nurses will provide consistent care and decrease the dependency on temporary agency nurses which provides cost savings for the program.
Cross-training nurses allows for development of new skills, enhancement of current skills, knowledge and abilities (from pre-procedure to post-procedure) and increases confidence in care delivery, leading to patients receiving optimal care.
WHAT DID WE DO? Enhanced education program Trained full-time nursing sta in the following areas • How to update Electronic Medical ecords specifically how to use the Post-Anesthesia Care Unit (PACU) component • How to manage and identify complications and any reactions to anesthesia • How to effectively communicate surgeon s individualized post-op instructions
WHY IS IMPORTANT? • Host an in-service event so nursing staff have an opportunity to meet with supplier companies
Provide one-on-one Training • Offer job shadowing opportunities to full-time nursing staff • Offer eight nurses the opportunity to be trained in post-operative care
WHAT DID WE FIND? Since reducing the number of agency hires, the Kensington Eye Institute has seen an increase in e cient patient recovery and safety.
• educe post-op patient call-backs regarding patient discharge instructions • Help to anticipate needs of patients • Provide opportunity for professional development • educe costs by leveraging internal talent • Increase productivity even when employees are absent • Be more flexible and adaptable to individualized patient needs
WHAT’S NEXT? By investing in cross-training, KEI has saved significantly by reducing agency hires to once per month.
340 College Street, Suite 600, Toronto, ON, M5T 3A9 Quality Day Posters 2018 b.indd 4
By cross-training full-time nursing sta we were able to
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• KEI is planning to conduct a patient satisfaction survey and include a section dedicated to post-operative care • Create feedback loop with patients to ensure quality and consistency of care • Collect and analyze feedback from staff
www.kensingtonhealth.org
6 2018-11-20 11:41 AM
IN ECTION CONTROL FIGHTING AGAINST THE FLU Let’s ENGAGE
Kensington ardens
ALL STAEye IN LONG-TERM CARE The Kensington Institute
BACKGROUND Influenza, commonly known as the flu, is a serious health threat, especially for vulnerable populations like older adults. It is important that people living with or caring for those with chronic medical conditions and or aging persons get vaccinated against the flu annually.
There is a low percentage of health care workers that have updated influenza immunization. Toronto Public Health recommends health care worker influenza immunization coverage rates of 9 % or greater, and the leadership team wants to ensure the home meets these requirements.
WHAT DID WE DO? A seasonal in uen a vaccine campaign was launched in
WHY IS IT IMPORTANT?
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To achieve the goal of of sta immuni ation the following was implemented
• A video was played on the importance of flu take their flu shot on site and vaccinations in the main lobby requested proof of vaccination or letter from their physician • Memos were posted throughout the building • As incentive, the team in the • Flu Shot Clinic was available 2 hours a day, • Announcements were made to all esident Home Area who was seven days a week, during the month of October employees and residents regarding the 100% vaccinated received a gift arrival of the flu vaccine • esident Team Coordinators and Sta ng certificate for a pizza lunch Coordinators called employees that did not
It is critical that all health care workers recognize the importance of ge ng the flu shot to protect themselves, their families, co-workers, and residents - some of whom are at high risk of serious complications from the flu.
WHAT DID WE FIND? • We achieved a 1 % increase in employees who received the flu vaccine, which accounted for 9 % of all employees in the long-term care home.
R A s that achieved
North Building 2 East Harbord 2 West Harbord
• 98% of residents in the North Building and 87% of residents in the South Building received the flu vaccine.
employee vaccination
R A s that achieved
resident vaccination
South Building 2 West Major 2 East Major 4 West Oxford
North Building 1 West College 2 West Harbord
South Building 3 East Brunswick 4 East Oxford
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WHAT’S NEXT?
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Continue the influenza campaign in 2018-2019 with the goal to achieve a 9 % vaccination rate for employees and residents.
www.kensingtonhealth.org
7 2018-11-20 11:41 AM
BEEKEEPING AT KENSINGTON GARDENS Let’ s ENGAGE The Kensington Eye Institute
ife Enhancement Department
OUR RESIDENTS
BACKGROUND The esidents Satisfaction Survey for Kensington ardens identified the need for a new addition to the ife Enhancement Program. The Beekeeping Program offered an innovative, educational experience that allowed residents to learn new skills.
Beekeeping helps produce local honey, pollinates gardens throughout the city, and helps keep perennial plants alive. With the honey produced from the hives, participating residents felt a sense of accomplishment as they were able to distribute honey produced from the hives back to the community for their enjoyment.
WHAT DID WE DO?
WHY IS IT IMPORTANT?
Implemented a beekeeping program • Involved necessary stakeholders for approval of program • Introduced a beehive to both buildings • Contracted the Urban Beekeeping Company to visit and maintain the beehives
• Coordinated and communicated schedules in ife Enhancement calendar • Staffed for supervision and support • Encouraged residents, staff and visitors to attend and participate in beekeeping maintenance and harvesting sessions • Ensured the implementation of safety protocols • Provided answers to concerns about the program
• esidents felt a sense of belonging because they were helping the community • Assisting in the beehive maintenance keeps residents engaged and connected • Creates a positive impact on our environment and community • Bees are reaching extinction and urban beehives help the bee population to thrive in the city
WHAT DID WE FIND?
WHAT’S NEXT?
Residents were engaged
Increase in sta involvement
Using the honey in-house
Identify new ways to utili e the honey by
It was discovered that current residents had knowledge and experience with beehives in the past and therefore took on leadership roles in educating other participating residents and staff.
Unexpectedly, staff showed a keen interest in participating in the program. When beekeepers arrive, staff not only assisted residents to the outdoor courtyard but also stayed and engaged with the residents.
After extracting and harvesting the honey, the honey was used for the dessert menu of the ife Enhancement lunch program. Profit from honey sales all go back to esidents Council and support the residents ife Enhancement Programs.
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• creating honey-based menu items • fundraising events • donating to local community • adding more bee hives
www.kensingtonhealth.org
8 2018-11-20 11:41 AM
CAREGIVER SUPPORT PROGRAM Let’s ENGAGE
Second Mile Club
UNPAID CAREGIVERS The Kensington Eye Institute IN OUR COMMUNITY
BACKGROUND As more people decide to age within their own home, family members, friends and neighbours are taking on the role of caregiver.
Caregivers shoulder a tremendous responsibility around the clock as they strive to provide the attention and care that is necessary with little to no support. Many caregivers struggle to maintain balance in their life which leads to their own health deterioration. As a result, many caregivers are unable to continue to provide care needed by their loved one, pu ng both people at risk.
WHAT DID WE DO?
WHY IS IT IMPORTANT?
Developed the Caregiver Club
The Caregiver Club is a weekly opportunity for caregivers to come together to
Our goal is to enhance the resiliency and overall well-being of caregivers within the City of Toronto by incorporating a mix of educational and supportive interventions into our program.
• Engage in peer-based support group • isten to speakers on a variety of caregiver related topics • Share a meal together • Network • eceive reiki treatments • Participate in yoga
WHAT DID WE FIND? The Caregiver Program is effective in achieving its goal of reducing the adverse effects of caregiving. Attendees feel more supported and connected which decreases their isolation.
WHAT’S NEXT? An unexpected outcome
• Expand the Caregiver Club to other locations in the City of Toronto
Unexpectedly, attendees have expressed their appreciation for the meal that is provided. It is typically the only time they have a meal prepared and cooked for them, giving them more time to relax and enjoy the program.
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Everyone needs somebody to lean on. Caregivers have expressed that participating in the program is the only thing they do for themselves during the week. They benefit from increased community support to help them manage care for their loved ones and themselves. Meeting other people who are going through a similar situation can decrease feelings of isolation or loneliness.
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9 2018-11-20 11:41 AM
BUILDING COMMUNITY THROUGH CONGREGATE DINING Let’s ENGAGE
Second Mile Club
OUREye MEMBERS The Kensington InstituteOF THE SECOND MILE CLUB
BACKGROUND The Second Mile Club (SMC) supports and engages older adults ( years of age and older) and persons with disabilities to participate in diverse recreational and educational programs. Congregate Dining is a program offered twice a week at the Club. The overall goal of the program is to provide members with a nutritious meal in which they take part in preparing. This program helps to maintain autonomy and independence and gives members a great sense of accomplishment when they are able to prepare and share a meal together.
The Congregate Dining Program takes place in an inclusive and friendly environment that promotes well-being. In the past, the food that was shared during this program was ordered from a restaurant. SMC did not feel this model illustrated the meaning of Congregate Dining.
WHAT DID WE DO?
WHY IS IT IMPORTANT?
The program was restructured to better fit the meaning of Congregate Dining. Two major changes included: advanced menu planning and members involvement. We also partnered with the kitchen in the long-term care home to e ciently purchase food which created cost savings. Members and staff work collaboratively to create nutritious meals, which in turn promotes team building.
Building community is key for seniors to combat isolation. This program provides the members with a feeling of accomplishment and validation while creating an inclusive environment where everyone plays an integral role. Community engagement through different programs is an important aspect of living well.
WHAT DID WE FIND?
WHAT’S NEXT?
• elationships were strengthened as members became more connected through this engagement initiative • Heightened awareness and education on nutrition and the importance of healthy meal preparation • Decreased isolation and an increase in socialization and independence
• Expanding the program to additional days during the week • Creation of a cook book with simple recipes that can support this population and enhance the knowledge of Congregate Dining in the community
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10 2018-11-20 11:41 AM
IMPROVEMENTS TO MENU CHOICES Let’ s ENGAGE The Kensington Eye Institute
Sodexo
OUR RESIDENTS AT KENSINGTON GARDENS
BACKGROUND The Sodexo team recognizes that quality nutrition, and pleasurable dining influence residents psychological, social and physical well-being. For this reason, it was important to acknowledge the results of the 2017 esident Satisfaction Survey which prompted the need for improvements to the menu items served during meal times. We wanted our menu items to have improved taste, texture, and the presentation of a home-cooked meal.
Thanks to a generous gift from an anonymous donor, we were able to further improve our menu items for residents.
WHAT DID WE DO?
WHY IS IT IMPORTANT?
Improved menu items
• To ensure resident satisfaction • To meet nutritional needs and well-being of the residents
• Enhanced menu items by increasing fresh fruit and vegetables • Added one more option to the Always Being Served menu • Improved the process of pureed food
WHAT DID WE FIND?
WHAT’S NEXT?
• Dietitians and Food Services Team noticed an increase in satisfaction from residents • esidents crave a lot more flavour. There s a need to increase flavour without increasing the sodium content while maintaining the correct amount of nutrients
• Analyze 2018 Resident and Family Surveys to benchmark success
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11 2018-11-20 11:41 AM
TRACKING AND MONITORING ANALYTICS Let’s ENGAGE
The Communications Team
OURInstitute STAKEHOLDERS The Kensington Eye (from left to right)
Jessica erhey Justine Humphries Nina Ambros Anil osai
BACKGROUND The Communications Team is responsible for all marketing, media relations, digital communications, employee and community engagement, and events at Kensington Health.
The Team works to increase awareness of Kensington s programs and services in the community.
Prior to creating the uarterly Analytics eport, the Team did not have a coordinated system of collecting and tracking performance of communication products and evaluating the success of campaigns.
WHAT DID WE DO?
WHY IS IT IMPORTANT?
Through a combination of conferences, boot camps and independent research, the Communications Team gained an understanding of best practices in measuring performance and establishing key performance indicators to help evaluate products and campaigns. The Team began to track and report on key metrics including oogle Analytics.
• ecognize trends, track performance, and where necessary, pivot approach to better communicate to stakeholders • Use data to benchmark performance year after year
WHAT DID WE FIND? Inquiries sent to KensingtonHealth.org ‘Contact Us’ were related to three key areas: • Appointment bookings • olunteer opportunities • Booking a tour The Team recognized the need for clear call-to-action icons on the website to help people find the information they need quickly and e ciently.
WHAT’S NEXT? Some sections of Kensington ealth org perform much be er than others Using oogle Analytics, the Team monitored tra c on the website, and measured key performance indicators including: • Bounce rate • Average duration • Average depth • Average frequency • High value action • App rating and reviews
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LinkedIn posts shared by Senior Leadership Team led to increased engagement When a member of the Senior eadership Team at Kensington Health shared a inkedIn post, the Team saw an increase in engagement, followers, and likes.
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• Continue to analyze quarterly results and formulate strategic decisions based on findings • Continue Communications Team training program in analytics to enhance digital experience for stakeholders
www.kensingtonhealth.org
12 2018-11-20 11:41 AM
IMPROVEMENTS TO PATIENT INFORMATION PACKAGES Let’ s ENGAGE The Kensington Eye Institute
Kensington Screening Clinic
OUR PATIENTS
BACKGROUND Since opening in 2009, the Kensington Screening Clinic (KSC) has performed more than 0,000 screening procedures. KSC wants to continuously improve patient experience by increasing access to the services at the clinic while also increasing e ciency through productivity.
The information package given to patients prior to their appointment is inconsistent. Patients are therefore unsure of how to prepare, and what to expect during and after the procedure. This can result in unanswered questions and increased levels of patient anxiety.
WHAT DID WE DO?
WHY IS IT IMPORTANT?
To address the inconsistency of the information packages the following was implemented
Patients experience anxiety during medical procedures because of the uncertainty about the procedure, worry about the results and other concerns. Helping patients feel less anxious and making sure their individual needs are met means they will have a better experience.
• eview all information the patient receives before, during and after procedures • Met with different stakeholders (patients, endoscopists, administration, nurses and anesthesiologists) regarding the information they needed and wanted to share • eviewed the common questions patients had and identified gaps in the current information packages • Standardized language to avoid contradictions and highlighted important information • Ensured information was presented at an appropriate readability standard • Included pictograms to provide a visual and reinforce the information being provided • Determined the most predominant communities coming through our clinic and offered versions of our information package translated to their preferred language
WHAT DID WE FIND? Patients felt less anxious preparing for their appointment had less questions regarding how to prepare and what to expect. The information packages provided all necessary information related to the procedure being performed including: • How to prepare days before your appointment • What to except on the day of your procedure • Discharge information • How to manage at home after your appointment
WHAT’S NEXT? In addition, the package includes general information on how to get to the clinic, where to park, what dietary restrictions are necessary and how to cancel or change an appointment if necessary.
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• Continue to analyze quarterly results and formulate strategic decisions based on results • Utilize Communications Team to build a digital communications strategy to connect with patients
www.kensingtonhealth.org
13 2018-11-20 11:41 AM
IMPROVEMENTS TO OUR MODEL OF CARE Let’ s ENGAGE The Kensington Eye Institute
Gabriele Tai is one of the four Clinical Assistants at Kensington ision and Research Centre
Kensington ision and esearch Centre
OUR PATIENTS, DOCTORS AND STAFF
BACKGROUND Kensington ision and esearch Centre (K C) is committed to providing patients with the highest quality of ophthalmology care. With the increasing amount of patients and complexity of procedures each day, the team identified gaps in physician work-flow which could have an impact on patient satisfaction.
A review of the patient journey outlined opportunities for streamlining the process to better utilize resources, improve patient flow through the clinic and provide reassurance and support to patients and their families.
WHAT DID WE DO?
WHY IS IT IMPORTANT?
The role of Clinical Assistant (CA) was developed and adapted based on capacity and clinic needs. In general there is one clinical assistant for every two physicians. This individual focuses on managing patient flow, and becomes a main point of contact for the patients of K C. They help prepare and guide the patient through all the necessary steps prior to seeing the physician.
Clinical Assistants improve K RC s overall e ciency and increase sta and patient satisfaction by creating a process that is
The role of the Clinical Assistant includes
• Patient-centered: CAs help to coordinate patient flow, and maintain open lines of communication • Timely: CAs help to move the patients to their appointment at the appropriate time and reduce wait-times
• Preparing and bringing patients to the appropriate rooms • Ensuring informed consent is signed and any necessary diagnostic tests are complete • Preparing patients for ocular procedures • Providing answers to questions that patients and families may have • Providing instructions on next steps
• Effective: CAs reduce rescheduling of appointments due to lack of tests and preparations
WHAT DID WE FIND?
WHAT’S NEXT?
A er interviewing seven eye physicians at K RC all were in agreement that the addition of the Clinical Assistant role
The CA role will include inventory management:
• Improved clinical workflow • Increased number of patients seen per day • Provided patients with consistent instructions
• Streamlined the consent process • Increased e ciency of ocular procedures As a result, K C decided to hire two additional clinical assistants.
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• Track and manage supplies • Ordering of ocular injections • Ensure proper handling of ocular surgical tools: sterile environment
www.kensingtonhealth.org
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