A customized Effective Governance Program for Quality and Patient Safety program was developed for the primary care sector in Ontario. One-day sessions were delivered throughout the province earlier this year, with one session tailored to First Nations communities that included some traditional ceremonial aspects. The Effective Governance for Quality and Patient Safety programs helps Boards to develop and implement evidence-informed approaches to governance and leadership and to share innovative health governance practices, resources and tools.
The First Nations view governance with a spirit of ceremony, not just a fiduciary responsibility. The ceremonial experience is the thread of their meetings in reliance of the collective wisdom of ancestors, both past and present. It incorporates consensus building where decisions are made with the understanding of everyone.
The Effective Governance for Patient Safety and Quality program contextualized for First Nations started and ended with ceremony which continued throughout the day. On arrival, both First Nations and non-First Nations participants were invited to enter into a large circle where an Elder talked about a circle being the equilibrium in the First Nations culture and custom. No one is above or below; everyone is equal, shoulder to shoulder, sitting as one to share teachings and understandings. The significance of tobacco as sacred was introduced to offer prayers for the meeting in order to activate the spirits and to aid the participants as helpers, so that any decisions would be made in a mindful and focused manner, as the impacts of those decisions carry on for seven generations. A traditional purification ceremony was done with the group as a way to dissolve the present potential negative, to realign and protect the room, and increase the positive experience. Throughout the day, another medicine was used, sage. Sage was burned to help participants to be conscience of their ability to control their attitude and emotions and remind them to focus on the good actions and not the person, helping them to navigate through difficult conversations.
The First Nations believe that to communicate in a good way is honorable. They never end a meeting without allowing people the opportunity to speak and contribute to the dialogue of the meeting and to have the opportunity to share their experiences. The meeting closed with a travel prayer and blessing, along with the understanding that when you go back to your community you have a responsibility and obligation to bring the messages or information to your community so there is a greater understanding of whatever decisions were made and their impact on the tribe or community.
Grounded in traditional values and ceremony, the N’Mninoeyaa (I am Fine) Aboriginal Health Access Centre’s (AHAC)First Nations/Partner sites have a better understanding of their responsibility to guide the quality function and what comes with that process since attending the Effective Governance for Quality and Patient Safety program. Their Boards are now in the process of building performance metrics through dashboards for quality improvement for the purpose of reporting on their indicators. N’Mninoeyaa AHAC includes seven First Nation communities along the north shore of Lake Huron, that spans from Sudbury to Sault Ste. Marie and the Indian Friendship Centre located in Sault Ste. Marie, Ontario.
“After the session, one of our board members said that they never knew that they were liable or what questions they should ask,” says Roger Boyer II, N’Mninoeyaa Aboriginal Health Access Centre. “The board member did not want to overstep the boundary between operations and governance. They learned how to ask questions in an effective and , safe way. The case studies were a very valuable tool that made the content more real and relevant.”
Roger Pilon, a Practicing Nurse Practitioner who teaches at the Laurentian University School of Nursing developed a case study for one of the sessions that looked at patient safety from a community level. The scenario focuses on a member of a First Nations community who goes to a local hospital, is assessed and diagnosed with a new chronic condition. The individual is hospitalized, receives treatment and medications, and then is sent home.
The case study demonstrates how often there is a breakdown between the hospital and community that exposes the patient to risks. On discharge, the patient was instructed to have lab work done to monitor the response to their medications, but not given a lot of direction as to how to make the follow-up happen. The patient did not know how to navigate the system to have the lab work done and did not have a local healthcare provider.
“Many participants had similar experiences, but had not thought about their role in addressing these issues at a community level,” says Roger Pilon. “Using situations or cases that are as close to reality as possible makes it more realistic. The case study generated some good discussion and reinforced the need for the community leaders and health centres to work together to develop policy at a local level to prevent these types of events from happening in the future.”
“When you serve on a Board your role is more general, providing global oversight rather than getting involved in day-do-day operations,” adds Pilon. “The Effective Governance program helps those who sit on Boards to have a better appreciation of what is expected of them in a governance role.”
“Our Board is now having meaningful conversations about LEAN methodologies and quality improvement as a business strategy versus a program,” says Roger Boyer II. “When we look at national and provincial benchmarks, it allows us to say now what can we do to learn from their experiences? Our Board and staff understand that quality is everyone’s responsibility.”
For more information about the Effective Governance for Quality and Patient Safety program, visit www.patientsafetyinstitute.ca