.png)
The concept of Quality Improvement (QI) should not be an emerging trend in healthcare, but rather a continuous standard. My experience in LTC has reflected this as the increase in person-centredness, cultural safety, inclusivity, and trauma informed practice has drastically improved even in my relatively short career. However well intentioned, the QI process in care homes that I have been involved with has historically been self-directed, independent, and often lead by clinicians and healthcare professionals with little knowledge of the principles of QI or the PDSA cycle.
The staggering loss of life, dignity, and quality of life among PRCs during the COVID-19 pandemic thrust LTC into the spotlight, revealing areas in dire need of a more standardized, systematic approach to QI. In response to this need Healthcare Excellence Canada (HEC) was created and launched structured initiatives to support health authorities in targeted QI projects. Currently in BC, HEC and the BC Patient Safety and Quality Council (BCPSQC) has partnered to support care homes in the province with funding, consultation, practice support, and tools to address the potential inappropriate use of antipsychotics among PRCs in LTC.
So what does all this mean for clinical education in LTC? First let’s take a look at what QI in healthcare actually looks like:
Sounds simple right? As an educator in LTC my first a-ha moment watching the video above was the initiative fatigue. The caregivers working in LTC are constantly bombarded with new priorities, new projects, new initiatives, and they don’t always align with the individual priorities that a caregiver has to provide safe and appropriate care today, on their current shift. Complicate that with the ongoing staffing crisis and it is safe to say that most caregivers are struggling just to get through their day. They don’t have the room for looking at overarching QI projects when they are wondering if anyone coming in to replace them at the end of their shift.
This issue pairs nicely with my second a-ha moment: not asking what matters but asking what matters to you. This is already a concept that is embedded in our LTC standard for person-centred care that we ask of those living in LTC – but it is not something we readily ask the caregivers working in LTC. This area of healthcare is unique and rewarding but not glamourous. People do not enter this field for prestige, or accolades, they do it to improve the lives of those they care for. To me that means that the seed of motivation for QI is there, but it may need to be nurtured and coaxed out to grow and gain traction.
The 4 core principles of andragogy can provide this nurturing by reminding us that QI initiatives need to be relevant and be backed up with sound rationale for adult learners to buy in – learners need to identify what this initiative means for them. Adults learn experientially - quality initiatives should incorporate the experiences of caregivers and improvement should be demonstrated through changes in those experiences. LTC caregivers are problem solvers, and their knowledge and creative solutions should be incorporated into QI right from the planning stage. And finally, quality initiatives need to provide immediate value to the caregivers and learners in a way that is tangible – making it easier to do the right thing.
In LTC, and particularly in relation to the current province wide quality initiative to decrease the use of antipsychotics, the resources, support from HEC and BCPSQC, funding, are all identified. If andragogy guides the planning and doing phases of the PDSA cycle we could see success in this emerging trend of structured Quality Improvement in LTC.
References:
BC Patient Safety & Quality Council, (2023). Reimagining LTC 3.0: Enabling a health workforce to provide person-centred care January 2023-December 2023. https://bcpsqc.ca/improve-care/long-term-care/reimagining-ltc-3-0/
Canadian Institute for Health Information, (2021). COVID-19’s impact on Long-term care. https://www.cihi.ca/en/covid-19-resources/impact-of-covid-19-on-canadas-health-care-systems/long-term-care
Culatta, Richard. (2023). Andragogy: Malcom Knowles. Instructional Design.org. https://www.instructionaldesign.org/theories/andragogy/#:~:text=Andragogy%20makes%20the%20following%20assumptions,topic%20is%20of%20immediate%20value.
Healthcare Excellence Canada, (2021). Foundations of quality improvement for long-term care, assisted living, and retirement homes. https://www.healthcareexcellence.ca/en/what-we-do/all-programs/ltc-acting-on-pandemic-learning-together/foundations-of-quality-improvement/
Healthcare Excellence Canada, (2023). About us. https://www.healthcareexcellence.ca/en/about/about-us/
Healthcare Excellence Canada, (2023). Reimagining LTC: Enabling a healthy workforce to provide person-centred care. https://www.healthcareexcellence.ca/en/what-we-do/all-programs/ltc-acting-on-pandemic-learning-together/enabling-a-healthy-workforce-to-provide-person-centred-care/
Health Quality Ontario, (n.d). PDSA cycles: Plan do study act. http://www.hqontario.ca/portals/0/documents/qi/rf-document-pdsa-cycles-en.pdf
Morris, Judy. (2022). Dr. Judy Morris – Canada’s healthcare workforce crisis. Canadian Institute for Health Information. https://www.cihi.ca/en/podcast/dr-judy-morris-canadas-health-workforce-crisis#:~:text=There's%20a%20critical%20shortage%20of,delayed%20treatment%20for%20everyone%20else.
Comments