We Want To Live It!

Coaching Out of the Box With Families:

The Sunny Hill Pilot Project

Feb 28, 2013

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

Outline

• Literature Background • The Sunny Hill Experience• Coaching out of the Box • Pilot Project • Preliminary Findings• Lessons Learned• Closing

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

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

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

Our Challenge – “Connecting With” Families

The Chinese Characters for Listening: 1. Ear Gather 2. Eye Perceive

3. Heart Sense 4. King Respect

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

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

Participants

Multi-disciplinary Acute Rehabilitation Team in pediatric rehabilitation centre

45 health care professionals

Family representatives

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!

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

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

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

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!

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

Extra Slides

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

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

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).

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

Feasibility

Activity Attendance Dates Budget2-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