PHSI Distress Management Project: A pan-Canadian knowledge translation strategy

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The Dowager Countess Faces change by: Denies. Rejects. Doesn’t see the necessity; change can be dangerous! “I couldn’t have electricity in the house. I couldn’t sleep a wink. All those vapours seeping about.” Countess Cora’s self-care advice: Stand apart from the fray. This is not the right time for you to engage. And, dear Violet, look after yourself by indulging in whatever your pleasure might be. Perhaps reflecting on the virtues of the English?

Our numbers are growing! We need a total of 80 nurses to complete the English version of the Partnership in Health Service Improve-ment (PHSI = fizzy) project and currently have 62 on board. By this Fall, we hope to have 18 more nurses join us, with the last group enrolling in November. Stay tuned for more information on a face-to-face meeting planned for Toronto in October in conjunction with the Canadian Association of Nurses in Oncology (CANO). We’ll be exploring how knowledge users such as managers address barriers to distress management. We’ll also have the final analysis of the phase I date, which explored barriers to distress management, more to share. Change is a constant in health care and we imagine all of you are managing change on many levels, not only with this project but with the myriad of other projects with which you are involved. In this newsletter we provide an overview of where health care is heading. We also take a humorous “Downtown Abbey” look at how you might be coping with change and how to look after yourself. Through war, Spanish Flu, and plunging necklines they have faced considerable change. So have we in health care. When it comes to facing change, which Downton Abbey character are you? What would Countess Cora advise you? Take it to heart, she’s a wise and loving woman. Enjoy! With appreciation, Project co-leads: Dr. Deborah McLeod, Clinician Scientist, Psychosocial Oncology Team (NSCC), Nova Scotia Health Authority, Halifax Dr. Mary Jane Esplen, Director, de Souza Institute, Toronto

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V O L U M E 2 I S S U E 2 S P R I N G / S U M M E R 2 0 1 5

Mrs. Patmore Faces change by: Panics! But is open to persua-sion. Regarding the telephone has said, “It sounds like the cry of the banshee… I wouldn’t touch it with a 10 foot pole.” Countess Cora’s self-care advice: Mrs. Patmore, there’s no need for you to use the telephone right this moment. Wait. Talk to people who have used it. No reason at all to rush in. Use it when you’re ready. In the meantime, have you tried Yoga, Tai Chi or Jogging to help with your stress? Mrs. Patmore: “Do I LOOK like a Frolicker?”

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Where is health care heading? Care First, Systems Second The over-arching direction for health care change is essentially the same across the west: putting care needs ahead of system needs. The chart below is adapted from a UK document explaining health care cultural shifts there. It’s applicable to our project. Kinda makes you proud to be part of an important shift, eh?

Moving from a Current Culture that:

Toward a Future Culture that:

Layers fix on fix from the outside

Improves from the inside out

Compels individuals to trust themselves and provide care despite the system

Encourages people to know their limits and to trust the system and their team

Provides care that primarily concerned with safety for the masses

Provides the right care for the individual

Manages episodes of care

Cares for populations and the patient as human beings rather than illnesses

Uses evidence mediated by colleagues or “experts” (word of mouth; habit; a single journal article)

Uses evidence systematically (e.g. from clinical practice guidelines)

Provides learning in professional silos

Provides learning in inter-professional teams that include patients and families

Teaches people by applying science through practice

Teaches by encouraging reflec-tion on complex cases in prac-tice, informed by science and experience.

Adapted from: Grossmann, C., Goolsby, W. A., Olsen, L., & McGinnis, J. M. (Eds.). (2011). Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary. National Academies Press.

Lady Mary Faces change by: Copes. Likes the way things were but can see the value in the new. Is willing to try and see how it goes. “I hope you know that really smart people sleep in separate rooms.” Countess Cora’s self-care advice: Darling Mary. You are the perfect daughter for leading us into change. But let’s not leap without looking, shall we? Ask one of your city companions for help with the skills you’ll need to take on change. Talk to others. Be grateful! You’re willingness to try new things will serve you well. And I think Robert and I shall remain in our single bed.

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Why did you join the project? I was hoping the course would give me a toolkit to make my practice more patient focused and less task -oriented. Is it what you expected? Very much so. I do struggle to fit everything in. I have 10 grand-children and twin grand-babies here in a couple of days, plus a full time job, but I don't think the course is too much work for the average person.

What is the most valuable thing that you have learned so far? I think the variety of tools . . . like the thought record. They help me to delve into the person’s experience and connect beyond the tasks we do. How do you imagine it will change your practice? This course has already helped me to organize my thoughts in dealing with patients and families who are experiencing distress. I think I will just have many more tools to help people to manage distress.

Distress is such a big word – anyone who experiences cancer is distressed. Learning to use some evidence based tools to help patients with these very common symptoms – fatigue, pain, anxiety & distress - appealed to me. I think we are too focused on the physical and these areas get missed a lot. I think we can become so much more helpful and patient centered if we could respond well to distress. We do respond – but in a less systematic way. What I am finding, the way the course is taught, is that I am gaining the tools a need to be more focused, systematic, and helpful.”

Darlene Grantham has been an oncology nurse for 25 years, and is currently working as an oncology clinical nurse specialist at the Health Sciences Centre in Winnipeg, Manitoba. She has completed the first module in the course on fatigue and is currently taking the pain module.

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S U S T A I N I N G M O M E N T U M I N C H A N G E I N I T I A T I V E S

Sustaining momentum during a change is challenging! When we find ourselves in the midst of continuous change, it can be very challenging indeed. This is the case in health care were change has become a way of life. Kimball, (2005) describes the cycle of change as one of renewal in which new practices evolve in a repetitive sequence of “germinating, emerging, thriving, harvesting, a return to germinating - and beginning anew. Change resolves old challenges and inherently creates new ones, which in turn create opportunities for growth” (p. 26). Kimball (2005) identified 5 areas of ongoing change for health care… we think you will recognize yourself and your institution. Perhaps it helps manage the pressures of change initiatives when we recognize we are part of a world-wide phenomenon! People - Developing new champions, behavioral interviewing, ongoing training and development for all, leadership mentoring, succession planning, employee health and wellness,

understanding the DNA of next generation leaders Integration - Standardizing evi-denced based practices, increasing physician engagement, establishing more effective incentives and rewards, hospital wide shared governance, increasing patient involvement. Systems - To create alignment, restructuring systems for patients without “care partners,” detecting early warning signals, measuring the costs of failures and benefits of reliability, better comparative data, building infrastructure, use of information technology to support goals, developing networks and partnerships for information and experimentation. Sustaining Momentum - Fostering restlessness, “raising the bar,” constantly improving and innovat-ing, “never accepting that we are good enough,” delivering on the promise to our patients, relentless rigor, sustaining credibility, build-ing identity, advocating for public disclosure, never losing sight of values, seeing through the patient’s eyes Uncharted Territory - Ever-changing patient expectations and needs, establishing new industry standards and benchmarks for safety/ satisfaction/workforce vitality, focusing on the safety net, address-ing the needs of the marginalized,

Isobel Crawley Faces change by: Embraces change with a passion! Wonders why every-one else is not as excited as she. “That's enough. I will not listen to this. If I am not appreciated here I will seek some other place where I will make a difference.” Countess Cora’s self-care advice: Your enthusiasm is energizing and also overwhelming to others I’m afraid my dear. Take a moment to listen carefully because there’s always something important in what someone else has to say. Keep your enthusiasm but balance your passion by slowing down. Take time to look after yourself. Surely you’ve already embraced medita-tion, yoga, tai chi? What Countess Cora knows is we must respect who we are and take care of each other, and ourselves, no matter how we face change. As she’s says, “We'll manage”. Perhaps you could share how you cope with change? Good advice from a fine lady.

The project is actively recruiting! To participant please contact your partner site or Dr. Deborah McLeod at (902) 473-2964 or Deborah.McLeod@nshealth.ca With appreciation for all that you do. - The PHSI project Team