Saint Elizabeth Health Care has built a culture of falls prevention with their staff, in terms of the orientation they provide, assessments for identifying clients who are high risk, and processes for reporting and evaluating falls to proactively reduce falls and injuries from falls. With over 8,000 employees in 24 offices across the country Saint Elizabeth's Falls Prevention Committee works across the entire organization to look at trends and investigate higher risk falls to identify lessons learned and address what is happening across all areas. On the Rehabilitation side, exercise programs for community dwelling and long term care seniors is helping to improve balance and reduce the frequency of falls; and that is having a positive impact on their client's quality of life.

Even with the comprehensive approach to falls prevention, Saint Elizabeth was seeing an increased level of frailty in seniors, and as a result an increase in falls. The not-for-profit organization joined the Home Care Safety Falls Collaborative to refocus their efforts with the support of a larger collaboration. They wanted to see what their peers were doing and learn from experts in falls prevention.

"At the end of the day, we wanted to have a greater impact and we knew that a collaborative and partnership approach would help us to have the desired effect," says Rheta Fanizza, Chief Business Officer and Senior VP Innovation at Saint Elizabeth Health Care. "By working with the Falls Collaborative we learned that there are some practical things that you can do to really make a big difference."

Saint Elizabeth's multi-pronged approach involved an Interprofessional group, including a patient representative, to put falls prevention strategies in place. The Collaborative team met with staff, introduced online education and did joint visits to ensure the education was brought into practice. The results were impressive! On average, over a six-month period, one group had recorded 7.6 falls and that metric was reduced to 1.6.

Fanizza – who also serves as Chair of the Home Care Safety Leads Group for the Integrated Patient Safety Action Plan – says that the Collaborative team had varying levels of knowledge about quality improvement and part of their involvement was to develop foundational quality improvement processes. Through monthly teleconferencing the team discussed what are the quality improvement initiatives? How do you know if you have achieved success? What do you measure? How do you set targets? How do you set stretch goals? Each month, a team member would be accountable to report back to the Collaborative about the initiatives that had been put in place and the outcomes. "By engaging with the group, there was an inherent accountability and it had the desired effect for the clients that we care for," says Fanizza.

Saint Elizabeth is looking to implement quality improvement initiatives across all business lines. One area they have been looking at is the juncture between falls and incontinence. They have had a consensus building day, and are in the process of developing a white paper on falls and incontinence.

"Looking at the literature, there are a lot of reasons why seniors fall, but one of them is that they are rushing because they have incontinence issues," says Fanizza. "On the flip side, they have generalized weakness and they fall. With the leadership of our staff across all the disciplines, we are not only taking a look at what we can do to prevent falls, but to reduce the level of incontinence in the clients that we see. We are developing strategies to help staff identify those that are at risk for falls and those that are incontinent, and implementing best practice treatment recommendations."

"The overall impact of participating in the Collaborative is that the clients we care for are falling less," says Fanizza. "By increasing the quality of care we provide, we have seen a correlation in fewer falls being reported and investigations being conducted, and a reduction in the number of follow-up visits by supervisors. As an organization, this is a great example of how investing in staff training and development, collaborating with others, and embracing continuous improvement can yield amazing results."

The Canadian Patient Safety Institute, the Canadian Home Care Association and the Canadian Foundation for Healthcare Improvement launched the Home Care Safety Falls Collaborative in the fall of 2015. Organizations providing care in the home participated in a series of online virtual meetings and received individualized coaching and support to prevent falls in the home. Teams participating in the Collaborative included: the Canadian Red Cross, Eastern Health, Saint Elizabeth Health Care, VHA Home HealthCare and the Winnipeg Regional Health Authority.