The implementation of an Indigenous cultural safety initiative within a large urban hospital in Vancouver, British Columbia

Co-leads:

Executive sponsor:

  • Patricia Daly
    VCH

Vancouver Coastal Health (VCH) Aboriginal Health is implementing an Indigenous Cultural Safety initiative with two units at Vancouver General Hospital (VGH) to improve the experience of Aboriginal patients and clients at VGH. The units, which include 350 VGH staff members, will complete a number of activities during March 2018 ‚Äď March 2019.

This project will examine the implementation of the cultural safety initiative through a research team guided by two-eyed seeing, Indigenous cultural principles and implementation science frameworks for the purpose of guiding future spread of cultural safety training across diverse health authority settings.

The learnings from this pilot project will be used to spread the approach to other VGH departments and ultimately other hospital sites and facilities across BC. A number of hospital-wide and unit-specific activities will be piloted, falling into four streams:

  • Creating a welcome space: Visible acknowledgements of local First Nations (artwork, signage, booth displays etc).
  • Culturally competent VGH staff: Three hours Indigenous Cultural Safety training, 30 minute education sessions, monthly presentations by local chiefs, staff learning resources, webinars, and creation of advocacy roles.
  • Cultural resources and policies: Communications, patient cultural safety/support, and traditions and protocols booklets.
  • Access to cultural supports: Elders and Aboriginal patient navigators.

The indicators of success will be jointly developed in partnership with an Aboriginal advisory group to be convened at the conception of the study. It is key that the indicators of successful transformation reflect the needs of the Aboriginal patients served by the system. This will include indicators such as staff and patients reporting an observed change in the look and feel of VGH, improvement in cultural safety knowledge and understanding among VGH pilot unit staff level, staff perceptions of how practice will change as a result of attending training and education sessions, and staff perceptions of their ability to advocate for Aboriginal patient issues (allyship).

Embedding health care technologies in real-world contexts: Developing the scale-up, spread and sustainability of assistive technologies in homes, communities and health systems

Co-leads:

Executive sponsor:

  • Heather Davidson
    BC Ministry of Health

Too often, promising technological innovations are not adopted, are abandoned, or face other serious challenges to their uptake, spread and sustainability in real-world contexts, including in people’s homes, community settings, or health systems more broadly.

This project aims to apply a new framework for theorizing and evaluating this phenomenon. The non-adoption, abandonment, scale-up, spread, and sustainability (NASSS) framework will be app/node/5126lied to several innovative assistive technologies (ATs) currently being developed in British Columbia for older adults.

By using a community-based participatory research methodology, this work will bring researchers, key health system decision-makers, technology developers, care-givers and older adults together into an inquiry team, focused on overcoming challenges to embedding ATs in end users’ real-world contexts and identifying positive factors that support their uptake, spread and sustainability.

This project will directly address the health system priority of services for seniors with complex medical conditions and the commitment to keeping seniors in their homes as long as safely possible (aging in place). The ATs in this project will be focused on improving the health and quality of life of older adults living with complex care needs, and multiple, chronic health conditions as well as the onset of frailty.

This research will also contribute to enhancing access to effective primary health care. ATs are a crucial medium for accomplishing this, as many of the innovations are aimed at making communication and interventions between older adults and their primary health care practitioners, including physicians, nurses and home support workers more effective.

This project will work towards directly improving the uptake, spread and sustainability of promising ATs in British Columbia, and will develop and sustain effective partnerships between the research community, the BC Ministry of Health, CanAssist and other relevant organizations.

Breaking the cycle of recurrent fracture: Scaling up a fracture prevention program in British Columbia

Co-leads:

  • Sonia Singh
    Fraser Health
  • Larry Funnell
    Patient partner
  • Tania Bubela
    SFU
Executive sponsor:

  • Teresa O‚ÄôCallaghan
    Fraser Health

Low-trauma fractures (fractures that occur spontaneously or following minor trauma) are a frequent consequence of osteoporosis, leading to significant disability and even death for patients.

One low-trauma fracture often leads to a cycle of recurrent fracture. For example, half of patients who suffer a hip fracture have a history of past fracture. In BC, the cost for osteoporosis-related fractures has been estimated at $269 million for hospitals, the medical services plan, and Pharmacare alone.

Despite the availability of effective treatments that reduce future fracture risk by up to 50%, fewer than 20% of patients suffering low trauma fractures receive such treatments in their post-fracture care. This is the osteoporosis care gap.

The evidenced-based Fracture Liaison Services (FLS) model has been recognized and adopted worldwide as the most effective model for preventing recurrent osteoporosis-related fractures in a cost-effective manner. FLS involves a dedicated coordinator who ‚Äúcaptures‚ÄĚ the patient at the point of orthopedic care for the low-trauma fracture and seamlessly integrates secondary fracture prevention into the overall fracture experience. FLS coordinators link up with community family physicians to ensure sustainability and follow-through of the initiated interventions to prevent further fractures.

In 2012, the Secondary Fracture Prevention Research Team at Fraser Health brought together osteoporosis and fall prevention experts locally, nationally and internationally, to develop an FLS model that fit the context of the BC health care environment. In 2014, the model was implemented at Peace Arch Hospital (PAH) in BC. A controlled before and after study demonstrated a three-fold increase in appropriate fracture prevention interventions received by low trauma fracture patients in the FLS group compared to a control group. FLS is now a permanent program at PAH.

This project will explore how the FLS model implemented at one hospital in BC can be successfully adapted and scaled-up to other hospital sites within BC. The Consolidated Framework for Implementation Research will inform the implementation strategy and the RE-AIM model will frame the process and outcome evaluation. The key outcome will be to inform an FLS implementation strategy that can be used to scale up to other hospital sites across BC, improving patient quality of life after low trauma fractures and decreasing health care costs related to recurrent fractures.

Implementing an evidence-based exercise program to reduce falls in community-dwelling seniors

Co-leads:

Executive sponsor:

  • Megan Oakey
    PHSA

Each year, 30% of seniors fall at least once, and half of those fall more than once. In fact, nine out of ten hip fractures result from falls.

Fortunately, falls are preventable. There is strong evidence that the Otago Exercise Program, which consists of strength and balance training, can reduce falls in this population. Seniors who have had a fall recently are the group most likely to benefit from the Otago program, but only 28% of people who start the program end up continuing with it over time.

It has recently been shown that exercise coaching with the use of consumer wearables, such as a Fitbit, is feasible and can help older people with chronic disease to stay active.

In this project, exercise coaching will be adapted for seniors who have had a recent fall, and then two visual feedback approaches will be tested for implementing the Otago Exercise Program within two BC health authorities ‚Äď Fraser Health and Provincial Health Services Authority. The success of these approaches will be measured by the degree to which the coaching is delivered as intended by a provider, and the degree to which the exercise program is followed by seniors at 6 and 12 months.

Given the serious consequences, falls prevention is a high priority in BC. To this end, this team includes national leaders in falls prevention and implementation science, as well as health system partners and a prominent national patient group.

A culturally safe pathway for scaling up a patient-centred mHealth technology in northern BC (WelTel Haida Gwaii)

Co-leads:

Executive sponsor:

  • Ciro Panessa
    Northern Health

Rural and remote areas in northern BC experience a greater burden of chronic disease than the rest of the province. The management of chronic disease in primary care settings on Haida Gwaii, in particular, is limited by remoteness and the lack of continuity in outpatient care. The delivery of care to diverse populations in northern BC, including First Nations, requires innovative approaches due to constraints on health system resources.

WelTel is an evidence-based digital health intervention (EBI) that links patients and care providers via text messaging to enhance the timeliness, access to, and quality of chronic disease care. With funding from Doctors of BC, WelTel currently serves 120 patients at Xaayda Gwaay Ngaaysdll Naay/Haida Gwaii Hospital & Health Centre (XGNN). Feedback has been positive on its usefulness, but it has not yet been adopted widely and equitably for patients with chronic disease.

Scaling up WelTel could improve chronic disease management in rural and remote areas of northern BC, address BC health system priorities and advance inter-organizational and patient-centred care. Establishing a process for implementing health innovations that are culturally appropriate will speed up adoption of EBIs in the future.

The goals of this research are to enroll a majority of chronic disease patients in WelTel at XGNN, to expand across primary care on Haida Gwaii, and serve as a model for rural BC. This will include conducting rigorous implementation science research, and a continuation of existing work to construct a mobile health EBI evaluation tool. This will be modified from the Consolidated Framework for Implementation Research (mCFIR) tool which identifies facilitators and barriers associated with expansion to ensure equitable access for all patients.

The mCFIR tool will be complemented with the He Pikinga Waiora Implementation Framework (HPWIF), a community-based participatory framework rooted in Indigenous self-determination. HPWIF will explore critical cultural intricacies and direct the ethical conduct of research in these communities.

This research is poised to explore the complexities of providing care in Haida Gwaii and establish a culturally safe pathway for implementation of EBIs within the community and in similar settings.