OROT provides crucial guidance in the creation of solutions that match users’ needs

It’s mid-morning and the elderly resident of a long-term care centre is becoming increasingly worried: Her relative was supposed to drop by for visit some time ago, but he still hasn’t shown up.

Maybe he had to take his kids somewhere. Or perhaps he had a problem with his car. Or could he even have been in an accident?

If he knew he’d be late or unable to come, wouldn’t he have sent word via someone on the centre’s staff?

In fact, the relative did try—and he got nowhere, because the lines of communication were not working properly in the long-term care centre.

When he called the nursing station, the phone just rang and rang and was never picked up. All he could do was keep leaving a recorded message. But by the time a member of staff heard his messages and finally relayed the information, the resident was nervous and agitated.

Surely, there must be a more effective and humane solution—which is why OROT has been brought in to help find a better, faster way to connect residents’ representatives with staff, especially when time is of the essence.

Since its launch in the summer of 2020, OROT, the connected health innovation hub of CIUSSS West-Central Montreal, has become known for linking private-sector entrepreneurs with public-sector experts to improve various aspects of care.

By undertaking a rigorous process of inquiry into the fine details of a problem, OROT is able to play a major role in the development of practical and relevant solutions.

This in-depth inquiry and its subsequent steps—collectively known as “design thinking”—focus on the needs of residents, patients, clients and their representatives, with the objective of improving the quality of care.

That’s why OROT convened a day-long session not long ago at Donald Berman Maimonides Geriatric Centre.

There the participants explored the many ways in which communication takes place—and sometimes breaks down—in long-term care centres when an attempt to contact a member of staff is made by a resident’s representative (a relative or other person who is designated to speak on behalf of the resident).

Observations were shared among a pair of residents’ representatives and more than a dozen professionals in such fields as Nursing, Rehabilitation, Administration, Orderly Services, Therapeutic Recreation, and Communications and Media Relations.

The participants learned, for example, that contacting a member of staff is often harder in a larger long-term care centre than in a smaller facility. As well, significant delays may occur even when an external doctor tries to reach the centre’s staff physician.

“Everyone is trying to do a good job, but it’s just so complex,” said Leah Berger, Assistant to the Director of the Support Program for the Autonomy of Seniors (SAPA). “Unfortunately, too many opportunities exist for a ‘broken telephone’ situation.”

Joe Fineberg, President of the Users’ Committee of Donald Berman Jewish Eldercare Centre, also noted: “If the phone isn’t answered in a timely manner, you lose satisfaction and confidence in the system, regardless of whatever else the staff is doing well. It negates a lot of the good things that are happening.”

Small wonder that OROT has been asked to lend a hand. “Bringing together people of various backgrounds and different types of expertise is what helps make design thinking such a powerful method of solving problems,” says Danina Kapetanovic, the CIUSSS’s Chief Innovation Officer and Head of OROT.

Embracing empathy, optimism and creativity

“Thinking like a designer can transform the way organizations develop products, services, processes and strategy. To be engaged in design thinking is to dream big ideas, take the time to play with them, test them out, and if necessary, be prepared to fail at an early stage in the process.

“It also means adopting a mindset that embraces empathy, optimism, creativity and even some degree of ambiguity. Most critically, as long as we stay focused on the people we’re designing for—and listen to them directly—we can arrive at optimal solutions that meet their needs.”

By the end of the day, many said they had gained a much deeper understanding of the problem than would have been possible during a free-for-all brainstorming discussion.

Sticky, colour-coded notes were placed on charts to demonstrate how communication takes place and among whom it occurs. According to Ms. Pallard, this helped illustrate where significant barriers may arise if a resident’s relative or representative needs to speak with a member of staff.

Ms. Pallard adds that this process of making notes, categorizing them and assigning priorities to them also keeps participants from going off on a tangent, a pitfall that’s common in poorly defined brainstorming sessions.

After the design thinking workshop at Maimonides, OROT provided SAPA’s leaders with a summary of the session’s findings. This will be followed by discussions with residents’ representatives from additional CIUSSS sites to determine which communication tools and channels they would prefer to use.

SAPA is also planning to introduce a digital solution, Ms. Kapetanovic notes, and OROT will help to determine how it can be smoothly integrated into the activities of the long-term care centres.

“The reflex nowadays is to say, ‘Surely there must be a useful app we can give to families and staff to improve communication.’ Perhaps there is, but into what kind of device would it be downloaded? To whom would that device belong? How securely would the confidential information on that device be stored and protected?

“Our overall objective is to take advantage of digital technology in any situation where it has the potential to improve the quality of care. But we also have to be sure we’re choosing the right tool for the job.”

As the communication project moves ahead, more requests for assistance are being submitted. Notably, Ms. Kapetanovic says, the Frontline Services Directorate is asking OROT to look into the design of future CLSCs.

With the CIUSSS’s population expected to grow by 75,000 in the coming years, more CLSCs are likely to be needed, and OROT will be called upon to help answer some key questions: Is the configuration of the current CLSCs adequate or should the design be rethought? If change is introduced in the new facilities, how far should it go? If a redesign is implemented, could or should any of its more innovative elements be retrofitted into existing CLSCs?

Other projects involve the use of virtual care in mental health services, as well as improving the mobility of hospitalized patients to prevent further deterioration in their condition.

In all of these endeavours, Ms. Kapetanovic is looking forward to the constructive role that OROT can play. “Over the past year, what has really impressed me is the abundance of creative thinking that is already taking place,” she says.

“What I find so exciting about OROT is that it can function as a catalyst and as a guiding force that can unite us and carry us forward together.”