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When there was an elephant in the room, how did you start talking about it and resolve it ?

Health Care Professional – South East: 

We meet every 2 months with CCAC Case managers and the nursing providers. Cases are discussed in order to make improvements. We also celebrate the cases that went well. All issues are discussed and resolved.

Helen Pyle – Lead Physician Ian Anderson House, Oakville, ON: 

Sometimes with humor. Sometimes just with honesty. We have had situations where patients have been discharged from hospital and the nursing agency has been switched intentionally or accidentally. That has often caused great friction when we try to understand why. We do inject levity in these meetings to break tensions. We will share quirky stories about pets, hoarding, family dynamics and even death.

Palliative Nurse Practitioner – Niagara North: 

No elephants that I know of.

Health Care Professional – Central LHIN: 

It depends on what the situation is however; our focus is to be patient centered, so we like to begin all discussions with the patient in mind. When we identified specific barriers, it was important to work as partners with open and honest communication. Face to face communication is key to fostering understanding and communication.

Cheryl Moore, Director, Stedman Hospice: 

You have to talk about the issues, “call a spade a spade”

Denise Marshall – Chair of Ontario’s Collaborative Palliative Care Clinical Council: 

You need to name the problem, or at least someone needs to have the courage to name it. You need to be professional, gracious and clear. Transparency and clarity on an issue is important for trust. These ‘elephants’, in my experience, are never one offs so you need to develop a safe space to hash out the common ground and common vision.

Health Care Professional: 

Somebody needs to have the courage to raise that issue and have to be really conscious of raising it in a way that you’re not blaming people, you’re not pointing fingers, you’re really trying to point out there is an issue here, it’s getting in the way of what we’re trying to do. Then we need to have a discussion, we need to get the team members or players that are involved with this issue together even if it’s a conference call, somewhere where there’s a way we can communicate about what’s going on. The focus needs to stay on what we’re trying to do; provide the best care for someone at end of life. If there is something that is a consistent problem that keeps on coming up we have to be able to say it and sometimes there’s a release in the room when people can actually say yes, that is a problem and it’s getting in our way. It’s often processes and bureaucracies that are getting in the way of us being able to achieve what we need to achieve. So if we can be brave enough to say it, say what it is, we can then begin to deal with it. We can create ways of improving our own situation, ways of getting around any obstacle and focus on creating a better outcome for our patients.

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