Quality Improvement Project: Informed consent
In 2021, Hearing and Speech Nova Scotia (HSNS) began to collect baseline information on client consent, knowing that we wanted to make improvements to our existing policies and processes. The two types of client consent are:
Consent to Release Information: Clients have the ultimate authority on what happens to their personal health information. HSNS staff members and clients have conversations and sign forms to tell staff with whom they can share client information.
Consent for Assessment, Treatment and Training: We want to ensure that our clients and their family members are fully engaged in understanding their assessment results and in planning treatment that aligns with their personal goals. Clients need to hear information in ways that are meaningful to them to make informed choices about their care.
There were three reasons for doing this:
Many of the quality improvement initiatives at HSNS are driven by client- and family-centered care and patient safety. Gone are the medical model days when ‘experts’ prescribed things and clients and families were passive participants in their care. We continually seek to improve how we collaborate with clients and their families, many of whom have communication challenges.
HSNS has a service agreement with the Department of Health and Wellness that requires us to report on the percentage of clients who have valid and informed consent in their medical record.
Speech-Language Pathologists and Audiologists in Nova Scotia became regulated health professionals in 2019. HSNS wanted to ensure that all staff members met the Professional Standards and Practice Standards required by the Nova Scotia College of Audiologists and Speech-Language Pathologists.
HSNS’s Quality Improvement Working Group, which consists of staff members from around the province, has led this work. Using a Plan-Do-Study-Act framework and supported change principles, the staff members assessed the benefits and shortcomings of the current processes, implemented and supported changes, collected information and feedback about the changes, and then adapted and modified the plans as needed.
Plan-Do-Study-Act is an iterative process that repeats itself as often as is necessary until a good outcome is reached and the change becomes the new normal for the staff members. Since the beginning of the project, the Quality Improvement Working Group has conducted meetings with every site across the province every six months, providing education on consent issues, giving instruction on new procedures and asking for feedback to make improvements.
In 2023-2024, the Quality Improvement Working Group focused on improving the Consent to Release Information form and processes. This work relates to helping our clients and their family members understand how we collect and use their personal health information. HSNS' Partners In Care Advisory Committee, a patient advisory group, was instrumental in helping create a form that was as user-friendly as we could imagine.
In 2024-2025, the focus is shifting to improving processes related to informed Consent for Assessment, Treatment and Training. Partners In Care continues to provide the client perspective on these processes and forms. For example, Partner-in-Care Ferne Mardlin-Smith emphasized the importance of using bold text on printed materials to highlight keywords for people who find reading difficult. This also helps appeal to a variety of learning styles. She also suggested that informed consent would be improved if staff members “let us know if they are going to touch our bodies. It helps us feel more comfortable, even if we have done this before.” Partner-in-Care Shawn Cadden stressed the importance of leaving space for clients to change their minds about their services, because client and family priorities can change from one appointment to the next.
HSNS is confident that the time invested in working with staff and clients to improve these processes will result in higher-quality services. Erin Lamond, co-chair of the Quality Improvement Working Group, states, “Hearing and Speech staff members are highly skilled at co-creating meaningful and functional assessment, treatment and training experiences with their clients. Ensuring our clients and families know they are the co-creators of all their HSNS care plans enhances feelings of trust and safety. In a model where our staff and clients work so collaboratively on goals and plans, making sure our clients know they can trust us and feel safe with us is incredibly important.”