a1 alda antunes silvestre - coaching out of the box with families: a sunny hill pilot project
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We Want To Live It!
Coaching Out of the Box With Families:
The Sunny Hill Pilot Project
Feb 28, 2013
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Project Team & Partnerships
• Alda Antunes Silvestre, RN BSN MSN
• Sandy Tatla, MSc. Candidate, MOT,
• Shelley Woodman, RN, BScN
• Dori Van Stolk, RN, BScN, MA, CEC
• Tal Jarus, Phd, OTR
• Susan Greig, Partners in Care Family Liaison
• Meghan Husson, MOT Candidate
• Stacey Burnes, MOT Candidate
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Outline
• Literature Background • The Sunny Hill Experience• Coaching out of the Box • Pilot Project • Preliminary Findings• Lessons Learned• Closing
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Literature Review: The Gap
① Family involvement is frequently identified as a key element of successful rehab Yet, we don’t know how clinicians can best
involve them1 ② Family centered care & effective
communication were among the top quality of care indicators for rehabilitation of children with traumatic brain injury2
③ A strong need exists for improved communication skills3
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Literature continued…
Health care professionals need to work together and also with the patients & their families5
Disrespect or insensitivity reported more commonly than technical errors in diagnosis and treatment4
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Approaches to Improve Communication
Various methods used to improve communication skills, including: training workshops run by
experts lectures and education
sessions interviews and
questionnaires role playing and feedback
in small groups shared decision-making
training
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Our Challenge – “Connecting With” Families
The Chinese Characters for Listening: 1. Ear Gather 2. Eye Perceive
3. Heart Sense 4. King Respect
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Coaching Fundamentals
Who you need to be
Curious Supportive Accepting Focused Committed
How: 5 steps Identify Discover Strategize Clear the way Recap
What Skills To Use Listening- 3
Levels Encouraging Questioning Requesting Action Planning
Level 1 Listening…………………………………………”Scratching The Surface”
Level 2 Listening…………………………………………What is said – Content
Level 3 Listening…………………………………………What We Feel + Think
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Project Aim
1. To demonstrate the feasibility of coach training
2. Improve family & service provider:o Satisfaction o Communicationo Engagemento Collaboration
….To ultimately facilitate a successful rehabilitation experience
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Participants
Multi-disciplinary Acute Rehabilitation Team in pediatric rehabilitation centre
45 health care professionals
Family representatives
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Intervention
2 day Coaching Training
5 Learning Burst Sessions
Workshop 1:• Core Coaching
Competencies & the Case for Coaching
Workshop 2: • Who you need to be
1. Naming Triggers2. Taming Triggers3. Learning Language4. Yours, Mine & Ours: Shared
Goals5. Learning in relationship
Practice, practice… and more practice!
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Mixed Methods Evaluation
Quantitative: Pre & Post Intervention
Feasibility
Measures of Processes of Care-Service Providers (MPOC-SP)
Study-Specific Coaching Skills Questionnaire
Tracking of Communication Related Safety Events
Measures of Processes of Care-Families (MPOC)
Qualitative: Post Intervention
1:1 qualitative interview with families present pre & post
(n=1)
Focus groups: Service providers
Focus groups: Families
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Preliminary Results
Feasibility Participation
93% participation in coaching workshops Triads still in process @ 5 months
Learning Burst workshops in process 1st burst: 75% attendance 2nd burst: 43% attendance (nursing was missing due to staffing
issues) Budget Ongoing facilitation needs Anecdotal results
Satisfaction Communication Engagement Collaboration
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Lessons Learned
Family representation was critical to the program’s success
All stakeholders need to buy-in
Recognizing the different work flows of a multidisciplinary team
Learning as a team was key to providing a shared language &
common approach to care
Practicing the skills & follow-up is critical
Facilitating the sustainability of coaching within our team
Next Steps…..
“Something is happening”……
synergy is occurring as team members learn & journey together
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Closing
Have an understanding of: Literature & Practice Gaps in Communication Coaching Pilot Project Preliminary Findings from the project
“The Road goes ever on and on Down from the door where it began. Now far ahead the Road has gone,
And I must follow, if I can, Pursuing it with eager feet..” J.R. Tolkien
Thank you!
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References
1. Levack, W.M.M., Siegert, R.J., Dean, S.G., & McPherson, K.M. (2009). Goal planning for adults with acquired brain injury: How clinicians talk about involving family.Brain Injury 23(3), 192-202. DOI: 10.1080/02699050802695582
2. Rivara, F.P, Ennis, S.K., Mangione-Smith, R., MacKenzie, E.J. & Jaffe, K.M. (2012).Quality of care indicators for the rehabilitation of children with traumatic brain injury. Arch Phys Med Rehabil, 93, 381-395. DOI:10.1016/j.apmr.2011.08.015
3. Lefebvre, H., Pelchat, D., Swaine, B., Ge’linas, I., & Levert, M.J. (2005). The experiences of individuals with traumatic brain injury families, physicians and health professionals regarding care provided throughout the continuum.Brain Injury 19(8), 585-597. DOI: 10.1080/02699050400025026
4. Jangland, E., Gunningberg, L., & Carlsson, M. (2009). Patients' and relatives' complaints about encounters and communication in health care: evidence for quality improvement. Patient Educ Couns, 75(2), 199-204. doi: 10.1016/j.pec.2008.10.007
5. Legare, F., Politi, M. C., Drolet, R., Desroches, S., Stacey, D., Bekker, H., & Team, Sdm-Cpd. (2012). Training health professionals in shared decision-making: an international environmental scan. Patient Educ Couns, 88(2), 159-169. doi: 10.1016/j.pec.2012.01.002
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Extra Slides
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Next Steps
Continuing coaching & learning bursts in the Fall as part of core competency development for our all staff in our setting
Articulate & integrate these core competencies into our orientation pathway for new staff
Explore strategies to continue to nurture & facilitate the integration of coaching into practice
Move from individual awareness to more dialogue & work on the team
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Challenges/ Limitations
TimeReflection – both in the moment & afterOngoing practice, mentorship, own coachingIntegration + testing of new learning & skills
in the moment; trial + errorRecognition what skills/tools to use in the
moment or context (eg. verbal aggression)Knowledge & wisdom
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Rehab: Philosophy of Care
Maximizing people’s potential Def: “Habilitation includes all the activities & interactions that enable an
individual with a disability to develop new abilities to achieve his/her maximum potential, whereas rehabilitation is the re-learning of previous skills, which often requires an adjustment to altered functional abilities and altered lifestyle. (Pg 4, Edwards, Hertzberg, Hays, + Youngblood, 1999, pediatric Rehab Nursing).
Patient engagement is fundamental – the vehicle – to maximize rehab benefits (Lequerica & Kortte, 2010).
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Mixed Methods Evaluation
Quantitative Pre & Post Evaluation:1. Feasibility2. Measures of Processes of Care-Service Providers (MPOC-SP)3. Study-Specific Coaching Skills Questionnaire4. Tracking of Communication Related Safety Events5. Measures of Processes of Care-Families (MPOC)
Qualitative Evaluation:1. Field notes throughout intervention2. 1:1 qualitative interview with families present pre & post
(n=1)3. Focus groups: Service providers4. Focus groups: Families
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Feasibility
Activity Attendance Dates Budget
2-day coaching training
43/47 Sept & October 2012
6 hours coaching practice in triads
? Nov 2012 - ongoing
Learningburst 1: Identifying triggers
? January 2013 – 3 sessions offered / month
Learning Burst 2: Taming triggers
? February 2013
Learning Burst 3:
March 2013
Learning Burst 4:
April 2013
Learning Burst 5:
May 2013