Partnerships in Person-Centred Approaches (PPCA) Albert Banerjee PhD, York University, Toronto, Ontario Deanne Taylor PhD (Candidate), Fraser Health Authority, British Columbia Anita Wahl RPN, MN, Clinical Nurse Specialist, Fraser Health Authority,

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Partnerships in Person-Centred Approaches
(PPCA)Albert Banerjee PhD, York University,
Toronto, Ontario Deanne Taylor PhD (Candidate),
Fraser Health Authority, British ColumbiaAnita
Wahl RPN, MN, Clinical Nurse Specialist, Fraser
Health Authority, British Columbia
Background
Findings
How does the program work?
This study is a collaboration between a SSHRC
funded MCRI, Re-imagining long-term residential
care, and the Fraser Health Authority of British
Columbia. Traditional approaches in health care
systems address person-centred care and safety
practices separately, despite clear areas of
overlap. Since 2007, the Fraser Health Authority
Residential Care and Assisted Living Program has
implemented and grown an innovative process
called the Partnerships in Person-Centred
Approaches (PPCA), which aims to integrate
workplace safety and quality objectives at the
direct care level. Fostering communication,
teamwork, and leadership is the heart of the
process, and this is achieved through regular,
facilitated meeting between care staff and
management. Short meetings are organized on a
weekly basis, and longer meetings are organized
bimonthly. All follow a staff run agenda.
Presently, eleven residential care facilities are
involved in the process.
A number of qualities were key to staff
experiencing the process as the real deal. We
note a few here. Staff run agenda. When it
changed for us was when we opened the floor and
said, What do you want to talk about? What are
your issues? What matters to you? (RCC) Action
items Staff felt they had a voice not only
because they were listened to but because action
was taken and communicated back to
them. Facilitation The facilitator was perceived
as neutral. And the best meetings ensured
everyone who wanted to speak had a chance no one
dominated dialogue moved quickly with issues
identified, solutions discussed, action items
noted, and a person assigned responsibility for
each task. Mentoring We observed considerable
encouragement, assistance, learning and modeling
by the facilitator, some managers, and other
staff. This process mentored staff in leadership,
problem solving, and communication skills It
has helped me come out of my shell and helped me
to dialogue better, (HCA, I9).
The data was analyzed thematically by the authors
individually and then collectively. Our analysis
was guided by three overarching questions what
does the process do, how does it work, and what
challenges were experienced by participants?
What does the program do?
Fosters dialogue The PPCA process creates a safe
space for communication, free from fear of
reprisals, occupational hierarchies, and is
driven by concerns of staff rather than
management. It provides a forum where gossip and
rumours are addressed, and gives worker a voice.
When all the other crap is aside, you can
actually look at what you are here for.(HCA).
Root-cause analysis Within this context,
problems that were otherwise invisible were able
to be addressed. Bringing together several
occupations, the encouragement of multiple
perspectives, and a spirit of empathetic inquiry,
enabled moving beyond blaming individuals towards
understanding the conflicting concerns and
responsibilities behind issues, and allowed for
mutually beneficial solutions. Integrating
safety and quality. The process allowed for
quality and safety issue to be addressed in
context rather than as abstract training pieces,
addressing working conditions, quality and safety
in an integrated manner. Grass roots practices
The PPCA process has resulted in the development
of practices that respond to workers concerns
and are instituted within units, and at times
shared among facilities and more broadly within
the health authority (e.g. a safety huddle, a
chain of communication, a work-plan for
communication between nurses and care aides).

PURPOSE
Research Questions Methods
The goal of study was to understand what
difference the PPCA process was making and how it
was making this difference from the perspective
of those involved. To answer these questions we
draw on quantitative and qualitative data.
Quantitative data on days lost to injury and
injury claim costs before and after
implementation of the PPCA process were
collected. Qualitative data for this study were
collected through ten observations of weekly and
bimonthly meetings. We also conducted eleven
interviews and eight focus groups. In total, 52
people participated in the study. Our sample
included 23 health care aides (HCA), 11
registered nurses (RN), six facility managers and
senior leadership, six licensed practical nurses
(LPNs), and five allied health professionals, as
well as one facilitator.
Challenges?
Negativity The early stages of the process could
be difficult, particularly if communication was
poor or nonexistent prior to the meetings,
participants reported considerable venting and
negativity. Workload The weekly meetings and
action items added to managers workload,
pointing to the importance of delegating
responsibility. Attendance We also identified a
tension between the consistency of regularly
scheduled meeting and enabling staff on different
shifts to attend and participate.
September 2012