Since 2015, VHA Home HealthCare (VHA) has been designated a Best Practice Spotlight Organization (BPSO) by the Registered Nurses’ Association of Ontario (RNAO). This credential recognizes providers of the highest level of professional practice and evidence-based care across all disciplines as well as the successful implementation of Best Practice Guidelines (BPGs) over a three-year period. Every two years the designation is reviewed for potential renewal based on the achievement of required deliverables.

“The BPSO designation highlights our organization-wide commitment to ensuring that staff and service providers’ practice is informed by research evidence. Our back-to-back designations over nearly a decade show that we are always focused on continuous improvement,” said Matt Wong, VHA’s Manager of Professional Practice and BPSO Lead.

“By identifying the opportunities that will further align our structures and processes to new and emerging best practices, we will continue to effect change and have a positive impact on client care,” Matt said.

As VHA moves forward to the 2023-2025 designation cycle, here is a look at the guidelines that were most recently implemented as well as the BPGs we plan to work towards in our fifth term.

Ensuring a Safe and Healthy Work Environment

Preventing Violence and Harassment and Bullying Against Health Workers, adopted between 2021-2023, focused on how to prevent, recognize and manage escalating violence against care providers. Research confirms that workers in ‘assisted occupations in support of health services,’ which includes Personal Support Workers (PSWs), are at the highest risk in Ontario for facing violence, harassment and bullying on the job.

“Data on violence against health workers often captures the obvious cases where someone gets physically injured. These numbers consistently leave out the micro-aggressions, harassment or ‘less severe’ incidents which are brushed off, accepted as a part of the job or attributed to a client’s diagnosis,” said Janet Chan, BPG Co-Lead and Professional Practice Specialist.

“We want to change this mindset in our organization by communicating that all violence or harassment should be acknowledged, reported and addressed,” she added.

To manage these complex challenges, an interdisciplinary working group co-led by the Best Practice and Education and Human Resources teams, piloted screening and reporting tools and adopted an education program. Initial testing began with PSWs and will continue to expand across all care models.

“Screening questions used at the start of the referral process identify trends of violence and flag situations that may present a risk. An updated reporting process now supports the immediate disclosure of any and all violence to ensure prompt and appropriate supervisory follow up,” said Adam Benn, BPG Co-Lead and Director of Diversity, Equity and Inclusion.

“Our expanded education program was designed to help staff and clinicians recognize different forms of violence and harassment, employ strategies to deescalate situations and to communicate the importance of reporting incidents to prevent and minimize injury,” Adam said.

These improvements will ensure clients’ care needs are met and advocated for while making sure that appropriate supportive measures are in place for VHA staff and service providers.

Risk Assessment and Interventions for Suicidal Ideation and Behaviour

The second guideline that VHA implemented this designation cycle is Assessment and Care of Adults at Risk for Suicidal Ideation and Behaviour.  

Adults over the age of 65 are at an increased risk for suicidal thoughts and behaviour due to factors that can accompany aging. These may include the loss of loved ones, decreased health or mobility and independence, fewer relationships or social connections and major life changes like retirement. Other home care clients experiencing postpartum depression, living with a difficult and chronic illness or facing a life-altering diagnosis, for example, are also at an increased risk of suicidal ideation.

“Mental health has always been a significant priority at VHA, but as we supported isolated, aging or chronically ill clients—many living with mental illness—through the challenges of the COVID-19 pandemic, the importance of reviewing and adapting our polices and practices around suicide prevention became clear,” said Matt Wong.

To implement this BPG, an interdisciplinary Best Practice Champions Suicide Prevention Committee was formed to compare and review RNAO’s recommendations to VHA’s current clinical practices.

“We gathered feedback from staff, supervisors, clinical leads and service providers to identify gaps in practice and guide our committee’s goals,” said Kristine Coronel, BPG Co-Lead, Registered Nurse and Clinical Educator.

“This assessment led to an updated suicide prevention policy, profession-specific crisis intervention procedures and a complete list of suicide support lines for all of VHA’s service areas,” she said.

The team also piloted a suicide prevention e-module that was adapted and improved on before being released to all VHA staff and new hires. In addition, a group of  ‘BPG Champions’ were mobilized to share suicide prevention training at team meetings.

“One of the most impactful results of this work is that frontline staff are now provided with lanyard cards detailing crisis management procedures and local suicide crisis lines,” said Banu Sundaralingam, BPG Co-Lead, Occupational Therapist and Rehab Professional Practice Specialist and Educator. “This will help our care providers better support a client experiencing a significant mental health crisis and is truly a life-saving intervention.”

As a BPSO, not only do these guidelines need to be met and sustained over time, but VHA must also contribute learnings and evidence-based findings with the wider nursing community. This may be through panels, conferences, published research or other collaborative efforts that help to inform decisions and lead to policy change.

“The collaborative piece of this designation is so valuable as an organization and it helps to inform our advocacy work across the health care sector. We have developed partnerships with other BPSOs and provide support and mentorship to home care agencies beginning their own BPSO journeys,” said Matt Wong.

VHA has long been a champion of evidence-based practices and decision-making at the point of care. As VHA aims to move into a fifth term as a BPSO designate, these efforts continue to demonstrate the organization’s commitment to quality improvement and safety as well as excellence in home care.

To date, VHA has implemented nine Best Practice Guidelines over four terms as a BPSO. In its upcoming review, VHA will be opting to implement two new BPGs: Developing and Sustaining Interprofessional Health Care and Care Transitions.

To learn more about this work at VHA, visit https://www.vha.ca/commitment-to-quality/bpso/.