g6 navigation through the health system: the aboriginal patients journey - v. stewart, a. snow and...

Quality Forum 2012 Engage. Inspire. Lead.

March 9, 2012 Four Seasons Hotel

Vancouver, BC

http://icord.org/files/2010/10/vch_logo_colour.jpg

Navigation through the Health System: The Aboriginal Patients Journey

Presenters: • Agnes Snow, Regional

Director, Aboriginal Health Northern Health

• Victoria Stewart, Lead, Aboriginal Health Engagement and Integration Northern Health

• Jenny Morgan, Aboriginal Patient Navigator, Aboriginal Health Strategies Initiatives, Vancouver Coastal Health

What we will cover

• Aboriginal Patient Experience

• Services in place to support this

• Next Steps


• Aboriginal Patient Liaison Program

June McMullenUniversity Hospital of Northern BC, Prince GeorgePhone: 250-565-2364 [email protected]

Angie CombsHazeltonPhone: 250-842-5211 [email protected]

Melodie JohnsonMills Memorial Hospital, TerracePhone: 250-638-4085 [email protected]

Ken SolonasLakes District Hospital, Burns LakePhone: 250-692-2400 Cell: 250-692-6589 [email protected]

Mary WesleyPrince Rupert Regional HospitalPhone: 250-622-6520 [email protected]


Lillian LewisDze L' Kant Friendship Centre, Smithers Phone: 250-847-5211 [email protected]

Lyndsey RheaGR Baker Memorial Hospital, QuesnelPhone: 250-985-5812 [email protected]

Bev LambertFort St. John/North PeacePhone: 250-262-5351 [email protected]

Yvonne TupperChetwynd/South PeacePhone: 250-788-7224 Cell: [email protected]

The role of the Aboriginal Patient Liaison is tofacilitate Aboriginal people's access to healthcare services that are culturally and linguistically appropriate and to increase thequality of care – Aboriginal patient experience.

mailto:[email protected]










• Aboriginal Patient Navigator ProgramAs a personal guide, the APN is there to help the Aboriginal patient and family with their health care journey. A navigator acts as a bridge between the patient, community and health care system



Dion ThevargeAPN Team Leader and Aboriginal Patient Navigator

• T: 604-875-5600 x 63292• E: [email protected]

Judy MitchellAboriginal Patient Navigator


Jenny MorganAboriginal Patient Navigator






Annual Aboriginal Patient Liaison/Navigator Conference, Vancouver, November 2011



Respect for patient preferences

What else did we learn that was different about the perception of aboriginal respondents?

Arrow represents statistically significant differences, at the 95 % confidence level, from your current score. Your current score is: higher or lower

Aboriginal Results Inpatient Survey – 2008 – Physical Comfort (pain control) - Individual Questions

Arrow represents statistically significant differences, at the 95 % confidence level, from your current score. Your current score is: higher or lower

Aboriginal Results Inpatient Survey- 2008- Physical Comfort (pain control)


Aboriginal In Patient Survey Results - 2008

There are five additional questions within the survey that also showed statistically significant different (lower) results for aboriginal respondents in 2008 (although improved since 2005):

NHA Respondents Non Aboriginal

Question (Dimension or Theme) 2005 Score 2008 Score 2008 NHA

Availability of Dr (Access to Care) 77.6% 77.7% 85.3%

Knew who to call w/ questions (Continuity and Transition) 73.0% 76.2% 85.1%

Dr/Nurse did not explain/say things differently (Coordination of Care) 67.4% 66.0% 74.6%

Wait to go to room was not unnecessarily long (Coordination of Care) 71.9% 70.4% 79.6%

Explained reason for wait in going to room (Information & Education) 85.9% 81.2% 88.0%

Wanted more involvement in decisions (Additional Question) 47.6% 44.3% 67.4%

Preliminary Results 2011/12 – new questionsVisited by the Aboriginal Patient Liaison

Preliminary Results 2011/12 – new questions

Case Example 1: Patient 1 (P1)

Gentleman from a small isolated community past Fort St. John, BC.

He and wife travelled from there to Pr George, then onto Vancouver.

Required his wife to translate.Challenges/Barriers: Having to

travel from their isolated community for the first time, language barrier, and having to coordinate medical appointments for possible cancer diagnosis.



Prince George Vancouver



• Challenge/Barriers: Culture shock being in a new environment, not knowing how to navigate through the city, not familiar with the facilities as his appointments were at different hospitals and clinics.

• P1 remained in Vancouver for a further 3 months undergoing cancer treatments.



Case Example 2: Challenges and barriers, and success…Patient 2 (P2), is a single lady originally from Prince

Rupert, BC, and was residing in Kamloops, she is in her late 50’s. Originally referred as a psychiatric inpatient in Vancouver with a bipolar disorder.

Challenges: Needing to be referred to a mental health community facility, trauma related as one of her daughters was a missing woman from the “highway of tears” missing women in BC, and she recently ended a long term relationship.



• P2 was very catatonic, at times unresponsive. After approx. 1.5 months as an inpatient and noticeable improvement, she was discharged to a mental health group home, where supports were available.

• APN action: accompanied P2 to her mental health worker appointments, doctor follow up appointments, and kept in contact with her mental health team on planning and medication changes.



• Keys to success:Accompanied to alcohol/drug counseling for

trauma issues.Patient referral to residential treatment

program.Patient received news her daughters remains

were found, patient traveled to attend funeral.

Patient felt supported during her recovery.



• P2 returned from the funeral, and appeared to have had closure, and was optimistic of her recovery and moving on with her treatment plan.

• Within a few months, P2 was set to travel to Vancouver Island, to attend a residential treatment program.

• She expressed her gratitude and felt strongly she could not have achieved this level of recovery without the assistance of the APN program.



APL Evaluation Northern Health

Colleague survey (n=14)

Liaison interviews & survey (n=7)

Patient interviews (n=10)

100% of patients felt…

• Their health concerns were heard better

• They were more comfortable with the health care received

• Their health care needs were met

Lillian with a patient

Highlights – Colleague Survey

• 93% felt important to have a APL in the community to support improvements in health care of Aboriginal people

• 73% Felt APLs improved Aboriginal people’s access to care

• 75% felt APLs improved partnerships

Yvonne Tupper and patient

APL Evaluation Most Significant Outcomes

Patient Outcomes

• Patient Satisfaction and comfort

• Patient knowledge and understanding

• Continuity of careSystem Outcomes• Increased collaboration• Improved use of resources• Reductions in health care

gaps

Provider Outcomes• Improved communication

between patients, communities and providers

• Increased awareness of Aboriginal health issues and barriers

• Increased cultural competence

Other things we are doing…

Listening to Community

• Listen to community as they express their experiences with the health care system

• Learn as communities share their local culture

Terrace and area AHIC

Partnering with First Nations Health Council

• On May 26, 2011, First Nations in British Columbia passed a historic resolution to assume greater control and decision-making over their health and wellness.

• Tripartite relationship between Provincial, Federal and First Nations

• For more info: http://www.fnhc.ca/

FNHC – Brian Mairs with NH – Agnes and Victoria

On-line Indigenous Cultural Competency Program

• Designed to increase Aboriginal-specific knowledge, enhance individual self awareness and strengthen skills for health care professional working directly or indirectly with Indigenous people

• To register: http://phsa.culturalcompetency.ca/register

Aboriginal Health Conferences

• 3 conferences each year• One in each of the NW,

NE and NI• Planned by the local

AHICs

Old Massett at the Conference

Aboriginal Health Improvement Committees Evaluation: Most Significant Outcomes

• Increased awareness of – local Aboriginal Health issues– each others health service

realities• Enhanced communication,

relationships, trust and collaboration

• Enhanced service delivery including access

• Cultural competency• Aboriginal Patient Liaison

positions

AHIC Gathering 2010

Communication

• Newsletter• Website• http

://www.northernhealth.ca/YourHealth/AboriginalHealth.aspx

http://www.northernhealth.ca/YourHealth/AboriginalHealth.aspx




Opportunities for Ongoing Improvement

• Strengthen the APL program

• Ongoing survey in field now

• Building upon our Indigenous Cultural Competency strategy

• Deepen the work of Aboriginal Health Improvement Committees

• RecruitmentChrista a NH Chronic Disease Nurse Educator

For More Information:

• Jenny Morgan: 604-875-5600 x63290 [email protected]

• Agnes Snow: 250-649-4812 [email protected]

• Victoria Stewart: 250-622-6303 [email protected]

All Native Basketball Tournament Prince Rupert 2012





g6 navigation through the health system: the aboriginal patients journey - v. stewart, a. snow and...

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