Approach to Implementing the
SMHPL in a Large Health
Organization
St. Joseph’s Health Care, London
Site Liaison – Dr. Maggie Gibson
Site Facilitator – Julia Horan
jhoran@uwo.ca
Background
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Located in London, ON
One of Ontario’s leading teaching hospitals
Advancing health care, education and
research
Partner in London’s academic health sciences
community
Publicly funded Catholic health care
organization
Background
Owned by the St. Joseph’s 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
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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
Discussion Questions
1.
2.
3.
4.
5.
6.
Have you ever heard of the SMHPL?
Are there any processes in place in terms of policy
and programs where seniors’ perspectives and
values are addressed?
Are there any processes in place that would benefit
from the seniors’ mental health perspective?
Are you aware of any examples at SJHC where
consideration of seniors' mental health issues
specifically helped to shape the development of a
policy?
What value might be added by a specific
consideration of senior's mental health issues in
policy development?
What thoughts/recommendations do you have on
how a tool such as the SMHPL could be of use to St.
Joseph's?
Approach to Implementing SMHPL
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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
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Get references to other contacts
Contacts at SJHC
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Deb Wiltshire – Veterans Care leader at
Parkwood Hospital
Lisa Van Bussel – Psychiatrist at Regional
Mental Health Care, London and St. Joseph’s
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)
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
1.
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
Responses
2.
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
Responses
Kendra
Kasubeck
-Corporate policy manual
-Reviewed every 2 years unless it’s 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 it’s 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
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
Responses
3.
Are there any processes in place that would
benefit from the seniors’ mental health
perspective?
Deb Wiltshire
-Don’t have an explicit checklist like this in place and may benefit from
using it
-Do consider seniors’ needs, but make assumptions
-Don’t 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
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
Responses
4.
Are you aware of any examples at St.
Joseph’s 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
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
Responses
5.
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
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 aren’t 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
Responses
6.
What thoughts/recommendations do you
have on how tool such as the Seniors’
Mental Health Policy Lens could be of use to
St. Joseph’s?
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
Responses
Lisa Van Bussel
-Talking through is beneficial in itself
-Perhaps make it bilingual if that hasn’t 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
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
What We Learned
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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
Next Step
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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
Feedback
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1.
2.
3.
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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?
Survey Feedback
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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
Survey Feedback
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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
Survey Feedback
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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
Challenges
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Because SJHC is a large organization directed
to seniors’ needs, they have procedures in place
and are committed to making facilities seniorfriendly 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
Follow-up Opportunities
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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
Follow-up Opportunities
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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
Conclusion
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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