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Behind the scenes of My VCH Projects: increasing nursing home health capacity

Above photo: David Graham (standing, far left) with his Home Health team.\

Ever wonder how our staff are making Vancouver Coastal Health a better place?

What gave you the idea for this project?

One of our priorities in home health is to ensure we meet growing demands in the home and clinic setting. We have many complex clients in the community that require home care and can't leave their home, and to balance this we have to make sure we increase our capacity in the clinics for those who are able to attend.

It's potentially more efficient for us to see clients in the clinic rather than at home, and we recognized there were remaining opportunities to shift some of our home visits to the clinic setting. Clients get the same level of care, but we have efficiency advantages and better capacity.  It's about having the right care at the right time – and in the right location.

How is your team working to increase the number of nursing visits in the clinic to grow home health capacity?

We are now more systematic about our client screening process when determining if we should see people in the clinic or at home. There's more built in oversight and accountability, which is one of the biggest changes we've made. Our official project launch was in April 2018, and while we're still doing some fine-tuning of processes and performance indicators we've already seen some net improvement in our percentage of clinic participation – especially within the last month. It's a work in progress.

How did using the new My VCH Projects pathway affect your project outcome?

We are moving in the right direction with achieving our project goal of increasing capacity, but we've also seen some benefits by developing better and more consistent workflow processes. We are always thinking of new things we can do and aspects we can refine.

The main challenge of the new approach was not only finding the time to do the development work, but also sticking to a tight schedule in order to get the results that were needed to launch the project. Another challenge – but also an opportunity – was making sure staff participated as fully as possible in feedback and development throughout the process. In the spirit of My VCH, we have worked hard to engage the nursing staff, and we continue to receive feedback from them.  I also want to emphasize how important our local clinical leadership team (Clinical Operations Supervisor, Clinical Resource Nurses, Wound & Ostomy Clinician, and Family & Social Support Practitioner) has been in the development and support of this work.

How did it feel when your project was successfully implemented?

It feels good to have taken the project as far as we have. I think it has helped to further shift the culture around expectations of how we do care in the community, which is positive. The success of the project thus far also demonstrates to me the viability of the My VCH Projects approach, and I think it would be particularly well suited to smaller scale quality improvement opportunities.

It's important to acknowledge that our staff members have done a great job supporting the prioritization of this work. The frontline nurses are the ones who have most of the difficult conversations with clients about this, and they have been - and continue to be - vital in the project's success.

Project Name: Increasing Proportion of Nursing visits in Clinic setting to increase Home Health Capacity
Initiative Owner: David Graham, Manager, Home Health 

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