Researcher on call
Conference of 18 June 2008
Introduction
The Réseau des soins de santé de qualité and the Canadian Health Services
Research Foundation are pleased once again to be associated with the Researcher on
Call initiative.
Researcher on Call is an interactive series that brings together researchers and
decision makers to discuss a key topic in the healthcare field. This conference call in
French will focus on optimizing management of the healthcare workplace. I am
honoured to welcome our two speakers, Chantal Viens, full professor with the Faculty of
Health Sciences at Université Laval and lead researcher in the Pro-Actif project, as well
as Nicole Labrie, Director of Hôtel-Dieu Saint-Joseph in Saint-Quentin, New Brunswick.
Allow me to give the floor to Dr. Chantal Viens.
Presentation by Chantal Viens – Pro-Actif
We
first
must
ask
the
question,
“What
is
the
relevance
of
this
Pro-Actif program?” Pro-Actif, as you can see at the top of the slide, refers to
participatory and evaluative research program to optimize workplace management:
application of knowledge, transfer of expertise, innovative interventions and training of
transformational leaders. You can understand that such a program entails not just me
but also many other partners, from the Association québécoise des établissements de
soins de services et de santé and from the Ministère de la Santé et des Services
sociaux, as well as very accomplished researchers to support and mentor this team of
researchers, practitioners and decision makers.
Thus, our first project, for which I will be presenting various results in a moment,
truly targets the training that managers would like to obtain to properly launch these
organizational transformations.
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The
second
project,
which
involved
a
participatory
and
evaluative
research-action, entails some 30 investigative projects in four provinces: Ontario,
Quebec, Nova Scotia and New Brunswick. Later, our friend Nicole will talk to you about
what is happening in New Brunswick. We genuinely wanted to examine the promising
practices and to try to identify the scenarios, approaches and solutions so we could
disseminate them and then generalize them to a large group of people.
You will understand that having found and identified this knowledge, we now
must disseminate it. So the third project involves truly looking at how to disseminate and
transfer this knowledge. We also realized that there is an absolute need for managers
who serve as “work organization coaches” to mentor people. This brings us to the next
slide, because this is one of that findings that effectively updated this third project.
Slide 5 shows the results of our first project, at least a synthesis of the results,
which confirm that it is truly worth the effort to develop evidence that will be accessible
to managers. This is what we checked with managers in our questionnaires: Does
conducting work organization project management actually require evidence? People
told us: yes, we need evidence; then the managers told us that they understand the
evidence, referred to the evidence in most of their cases, had access to it, and used the
evidence, but… and that is where it gets truly interesting – while they do use it, they
reported that they make particular use of knowledge obtained from their colleagues and
of the experience of their colleagues. You can now see the full relevance of the third
project for having coaches as work organization champions to mentor them with the
various tools we have developed.
I will now hand you over to my colleague, Nicole Labrie, who is going to explain
her project in New Brunswick.
Presentation by Nicole Labrie
Thank you very much, Dr. Viens. I am pleased to tell you about this wonderful
experiment that actually began three years ago. In Authority 4, we had major problems
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in surgery, with claims that our unit harked back to Vietnam, with major problems
affecting the safety and quality of our patient care.
The atmosphere was characterized by a total lack of any sense of belonging on
this team, which made daily work on the team very difficult.
There was also high level of staff instability. Many staff working in this unit had
no position linked to the unit. Thus, in the morning, a person might work with one
assistant, then the next morning, with another assistant. And teamwork was already
challenging enough.
The schedules were also challenging. Staff may have had responsibility over
two or three consecutive relays for the 25 patients in a unit. So there was a great deal of
instability related to data-gathering, which could lead to major errors.
We’ll now look at Slide 8.I In our project, we had identified very specific
objectives: maximize the role of each practitioner by optimizing his or her basic training,
adopt a care delivery model, then optimize multidisciplinary team work by factoring in
the daily operation of the physical facilities. To achieve this, we actually began with
training. We obtained training from Mr. Bédard on reorganizing care and services. All
managers in Authority 4 were able to attend this training, a key component for following
the best practice in organization of care. A team was identified with a head nurse as
mentor. A mentor for us is a person who oversees the integration of new graduates and
new staff into the care units. I personally served on the team. We had truly taken the
time to develop a logic framework, our communications plan, and our very specific
timelines, which were subsequently approved by the piloting team. That team was very
important for us, because it was a senior team, which made many decisions and
provided administrative support, and because its composition served as a guide to
proper orientations, sound planning and effective co-ordination.
We then expanded our team in the unit itself with a nurse, an assistant and a
clerk. These people joined the team on a volunteer basis.
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Chantal Viens
I think we could allow the people listening to us to ask any questions they may
have. Mylène, would you like to handle the question period?
Mylène
Yes. Thank you, Chantal. So thank you very much for these very interesting
presentations. We are now ready to start the interactive period.
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Question period
Q.
I have a question for Ms. Labrie. I believe you said that the absenteeism rate
dropped in the first year, after which it rose. Do you have any plans to address this or
did I understand correctly?
R.
<Nicole Labrie> Yes, you understood correctly. There was an improvement in the
year following the reorganization while in the past year we are again seeing an upward
trend. What we did was to truly go back and reassess the workload in the unit, and we
found that at certain times of day, we still needed to add staff to handle the load.
Unfortunately, we had an administrative reorganization of health care in New Brunswick
that led us to slow down our reassessment a little, but we must also look at the
generational trend, which also affects attendance. We actually have to look at it from
another angle. Regional Health Authority 4 did add a person responsible for studying
attendance. With that person, we can actually see whether there is room for
improvement in our reorganization as well the effect on attendance.
R.
<Chantal Viens> If I may add, Nicole, there is a factor I found excessively strong
in our institution. This allowed us to introduce a measurement that I have difficulty
implementing in the other provinces. You established a workload measurement with the
graph, and each day, you quantify your graph. You know when you’re at 93, 97 percent
and we noticed that when you exceed 93 percent to 97 percent of the intensity of care,
that we were under that and there were indicators that began to be able to… because
the lengths of stay, oops!, began to be able to lengthen, and absenteeism could rise. In
the graph that you produced, I found that this allowed for a good staff mix and staff
skills, to determine whether we chose the right person to perform the right intervention.
This was a great strength, because work intensity measurements are not very popular
because they are not effective in capturing everything. The approach you used, and in
particular, Nicole, the way you managed it, is an exemplary measurement. The tool
may have its shortcomings, but you have made up for these by looking at each activity
to ensure that we have them all. In addition, what you did for each activity was to
examine what can be done by whom, so that allowed you to look at your graph: oops!,
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your absenteeism is rising. You look at whether this is linked to intensity – or is it a new
generation effect? This lets us start to identify the indicators specifically to determine
what is causing the shift in a given moment. Then, there are the studies by
Linda O’Brien-Pallas that tell us that when we exceeded 85 percent, we began to see a
slight shift in our indicators to the negative side. Your people confirmed that in
reorganizations, we could go as high as 93, 95 percent, but beyond that, we truly began
to see problems.
So I just wanted tell people that you had this tool which, in my opinion, was
relevant and should be applied to other settings.
<end>
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