Guide feedback by Occupational Therapist

The following is feedback from an occupational therapist specializing in accessibility and vision.

Introduction and background information

Question: Did the Introduction, Values and Guiding Principles in the Guide document provide sufficient context for the Guidelines? Is there any information that was not covered that would be helpful?

Response:

• The intro was helpful and provided understanding of the context.

Structure and organization

Question: Do you have any feedback on the structure and organization of the Guidelines? From your perspective would you organize them differently? How and why?

Response:

• Provide hyper links in the table of contents to sections of the document.

• Provide hyper links when there is an “also see” section.

Relevance of information

Question: Did any of the information in the Guidelines feel non-applicable, incorrect or insufficient in the context of virtual care?

Response: 

• Will there be a list of resources used to develop this Guide, other published guidelines, articles etc.

Content to consider adding

Question: Is there any information you feel is missing from the Guidelines?

Response:

• An ongoing evaluation component of the virtual care being provided. There is a lot of learning and adjustments that need to be made as we come across specific individual situations and as the environment changes. Team communication is crucial in improving our service delivery, and of course, obtaining feedback from clients. It can be as simple as letting clients know at the beginning of virtual care that we have moved to virtual care and appreciate any feedback in this new service delivery model, or a form/survey after the care to obtain feedback. The guide already talks about building and nurturing trust through feedback so this would fit in well.

Content to consider expanding

Question: Is there any information you feel we should expand upon?

Response:

• Since the guideline is also meant for recipients of care, I am wondering if there should be more focus for the client. How he/she should evaluate when virtual care or face to face care is appropriate. Some clients may not want to receive virtual care but not given the option. Encourage client to inquire about options. What should the client consider before accepting virtual care? Do the benefits outweigh the risks? Will the client receive less than adequate care in a virtual setting? What are the limitations to virtual care? What is the client consenting to when agreeing to virtual care?

Groups or individuals to engage in the future

Question: As we continue the work, whose feedback and participation would you like to see reflected in these Guidelines? Whose feedback do you wish was included or emphasized more? Is there a community, group, person or other we should engage in future Guideline work?

Response:

• I think it would be helpful to know which stakeholders were consulted i.e. client groups,  caregiver groups, healthcare practitioners by disciplines, healthcare practitioner by environment (i.e. hospital, community, school, remote communities), government etc.

Guideline naming and clarity

Question: Naming the Guidelines is important for clarity and meaning. Please review the Guideline names and tell us from your perspective what you would change and what works well.

Response:

• Guideline name is good, very clear.

Language and terminology

Question: Do you have any feedback related to any of the language and terminology used in the Guidelines?

Response:

• With regards to the 5 sections:

  Practice – something more to indicate that these points are suggestions or a change from current practice...”practice considerations / strategies / recommendations / suggestions”

  Software – use only software approach or software solutions, wondering if “technology” would work better than software.

  Should the names of practice and software mirror each other i.e. practice solutions and technology solutions?

  Also make a really clear distinction between these 2 sections. For software approaches, the more specific, the better.

Other Comments

Question: Do you have any other feedback that you would like to share?

Response:

Just random thoughts from my own practice and personal experience.

Provide a response system where clients can receive immediate feedback when information has sent to service provider i.e. faxes/emails sent to the ministry of health

The importance of giving choice in every aspect of your practice as that often addresses multiple barriers at once.

Feedback on specific guidelines in the Guide

Contextualization can individualize healthcare experiences

• I feel like patient centered care should be its own principle. It is such a huge aspect of health care practice.

Physical supports for using technology - Assist camera positioning and framing by using a guide or positioning grid.

• Along the lines of this point, method of mounting and positioning device so client is hands free. If the person has a mount or car mount for a phone that is great. But it can also be low tech like standing a phone in a Kleenex box of cup. 

Humanizing wait queues

• Really like this idea

Enhancing intake process to personalize service delivery - Software approaches

• Software/tech approach: provide accessible documents, ensure client has compatible software to open documents, provide document in multiple formats?

Avoiding assumptions - software approaches

• Maybe a software/tech solution would be to provide items in electronic format so client can share easily with family member to translate or to access computer-based translation software

Improving service by storing and sharing complimentary information

• SO this is an interesting and important point. 

  As a practitioner who is trying to exchange and share forms with PHI with the client, I would love to know what options are available to me.

  i.e. is encryption available? Is there a secure cloud based portal available to store and view PHI documents.  The guide probably can’t suggest actual names of medical platforms (tho I would love it), but maybe general suggestions on secure tech strategies that could be used.

Addressing financial barriers - Software approaches

• This is a practice suggestion. I am not sure if there is a software/tech approach to this problem!

Managing privacy in different contexts - Software approaches

• Encourage client to use mute or stop video if needed. I think the health care relationship may make the client reluctant to use these features.
  

Technical literacy - Practices

• Not sure if this should be under practice/software. But updating your platform and testing features regularly with the different OS i.e. zoom on win/mac/ios…I swear there is always some type of surprise when I switch devices. Clients can be logging in on anyone of these types of combinations and not necessarily the one you are using.

Understandable communication - Software approaches

• Use a multi modal approach. i.e. share screen while reviewing document verbally, have client print out document while simultaneously reviewing it visually through screen share and verbally. I am not sure if it is COVID, added stress, conducting medical care at home (less contextual cues) or just lack of stimulation, but we are all needing extra information to help with comprehension.

Provide extra opportunities for questions and feedback

• SO true in our current situation!!!! I think it is important and reassuring for clients. I think part of it is because there are so many unknowns with COVID and also doing things virtually makes it less concrete and real. I would encourage clinicians to show themselves on camera when working with a client. 

Encourage self-documentation and personal data logging - Software approaches

• [These may be practices instead of software approaches]
  • "Ability to create notes and annotations to allow patient to have further for discussions at follow up appointments."
  • "Where appropriate, consider ways for individuals to share information with their circle of care."

Understandable healthcare processes - software approaches

• This may be taken care of in the see also section, but to regularly update your service’s website so clients can access information readily. Utilize a list serve to update clients.