A patient-centred path for mental health

Dr. Jennifer Wide, MSc, MD, FRCPC

Psychiatrist, St. Paul's Hospital, Providence Health Care

As a psychiatrist in the mental health program at St. Paul’s Hospital, Dr. Jennifer Wide noticed patients are treated by many specialists who don’t always talk to each other.

“The experience of a patient showing up in emergency can be quite scary, and it can be a challenging place to navigate. There are a number of specialists that they meet along the way, and care can be fragmented.” she says.

Jennifer Wide | Change the Labels | 1:16A Path to Better Care

 Wide is part of an effort by Providence Health Care to change that. As a member of a cross-disciplinary team, she is helping to establish a set of guidelines, called an integrated care pathway, that standardizes the clinical care experience for all patients. From the moment a patient enters the health care system through their anticipated long-term recovery needs, an integrated care pathway outlines the stages he or she will experience as they progress through their clinical treatment. Integrated care pathways consider the sequence of care, the disciplines that will be accessed, multiple criteria for successful treatment, and a record of the outcomes.

The goal is to improve the process of delivering care by defining the most efficient and effective set of practices across disciplines.

As someone who works closely with youth populations, Wide is helping implement integrated care pathways for early psychosis patients. She believes that having a clear and consistent method for treating these individuals is essential—if they receive fragmented care provided by different departments without clear communication, it can exacerbate an already fragile mental state, and dissuade patients from seeking further treatment.

“The idea is to have a seamless roadmap in place that anticipates the needs of these youth, so that when they do come into a hospital it’s not as daunting as it could be,” Wide says. “So that youth and all our patients are supported right from the start, in all aspects of their care.”

Accessing expertise across disciplines

Clinical standardization has many benefits, including improved documentation, clearly established goals to use a reference point for each patient, and better collaboration and communication among health care professionals in several departments. For a mental health patient, for example, an integrated care pathway would consider access to a multidisciplinary team that includes a social worker, occupational therapist, spiritual health specialist, music therapist, peer support worker, nurses, pharmacists, psychiatrist and addictions specialist.

  Kofi Bonnie, a clinical nurse specialist in the mental health program and another member of Providence’s clinical standardization team, expects the development of integrated care pathways to show real, measureable improvements in every patient’s experience. He says he anticipates seeing higher patient satisfaction and practitioner confidence, and an overall improvement in the outcomes of acute psychiatric patients.

Kofi Bonnie | Change the Labels | 1:03 A Path to Better Care

“We have looked at the best evidence available and the resources we have as an interdisciplinary team, and put together a pathway that will improve the patient's experience,” he says. “We're looking at ways that clients with similar presentations will have similar treatment with less variance—and not just similar care, but optimum care and evidence-based care,” Bonnie says.

Standardization does not mean ‘one size fits all’

While clinical standardization defines a consistent framework for the patient experience, it does not mean that all patients are treated the same. Far from being a cookie cutter approach, it’s actually a highly patient-centred method of care, as a patient’s individual needs are carefully considered throughout their journey. The integrated care pathway provides a blueprint that outlines the main steps towards improving his or her health, but the details are tailored to each patient’s unique story.

“Patient-centered care means listening to the patient, hearing their experience, and responding to their needs,” Wide explains. “We give a bit of control back to patients by asking what aspects of their care have been most helpful, if they have any suggestions, and getting to know their interests, motivations and goals.”

It’s a huge undertaking to drive widespread internal standardization across so many healthcare disciplines, but early signs are positive in the mental health program, which continues to build confidence internally. Both Wide and Bonnie believe the effort is worth it.

“One in five of us, has a mental illness,” Bonnie notes. “It's time for us to try something very different and it starts with having an honest talk about how we treat mental illness.”