Behavioural Supports Ontario (BSO)
Encourage Behavioural Supports Ontario (BSO) teams to practice critical thinking skills while creating and updating care plans for long-term care home residents with responsive behaviours.
Almost 4,000 people in Waterloo-Wellington live in long-term care (LTC) homes. The comfort and quality of life of all residents is of paramount concern, and staff at these homes are constantly trying to provide the best possible care.
However, each LTC resident requires a unique care plan. Those experiencing dementia, complex mental health, substance use and/or other neurological disorder can react to stimulus with responsive behaviours that threaten the wellbeing of staff, other residents, or themselves. These residents require more individualized support than many of their peers. To address these cases, each home has a team to create care plans that help reduce responsive behaviours to improve the wellbeing of all residents.
A good care plan requires that team members assess data from a variety of sources before determining how best to avoid these behaviours. Once generated, the BSO teams train the staff at their facility on new interventions, log the new plan, and measure change.
Pressure to adopt a new course of action incentivizes jumping straight from data collection to action planning, skipping the critical thinking step entirely. Dialectic was engaged to improve the efficacy of BSO care plans by facilitating better critical thinking by team members through targeted design and in-person training.
Workflow nudges disrupt old ways of working, encourage reflective connection building, and lead to more creative, effective plans.
From the beginning, it was clear the Dialectic design team needed greater clarity about the specifics of working and making decisions in an LTC home. Any intervention must suit the environment and ways of working.
We began by developing an understanding of the situation for staff and residents.
After connecting with a BSO team from a nearby LTC home, we spent a half day meeting with the BSO team and shadowing them as they walked through the home.
Three things became clear:
- The BSO team did not have a meeting space of their own
- The physical environment was cluttered and busy
- An over-complicated solution would only add greater strain
With this in mind, our design team zeroed in on a simple critical thinking model built around three key stem questions:
- So What?
- Now What?
This model, developed by John Driscoll, encapsulates the stages of critical thinking without adding burden. “What?” is a prompt to gather facts. “So What?” is a call-to-reflection, meant to draw connections between facts gathered in the previous step and surface assumptions. The “Now What?” stage is an action stage, where people draw on the facts from the first stage and the analysis from the second stage to build a response plan.
Before our involvement, the BSO teams were already experts at “What?” and “Now What?” questions. Our challenge was to help them practice “So What?” thinking at the moments when team members needed it.
With the opportunity and challenges clear, we designed “So What?” stickers to attach to the tools BSO teams use most often during care planning: on binders where case files were reviewed, and on computers where care plans would be developed.
Of course, a sticker wasn’t the only solution. Implementing new patterns of thinking takes practice. To introduce our model to the BSO team members across the Local Health Integration Network (LHIN), we led a hands-on workshop built around the What?/So What?/Now What? model.
During the key second stage of the workshop, participants use red string to physically make connections between different facts that they had learned about our example case, externalizing the analysis stage to make clear the value of stepping back and considering all known facts in totality.
BSO teams took home a simple critical thinking model they could transfer to practice immediately.
The session was a huge success. Attendees were engaged with the process and actively working through how to incorporate the new way of thinking into their existing models. They enjoyed being on their feet and truly practicing the information sharing and analysis skills necessary to do their jobs well.
Feedback was very positive. As one participant told us: “Now our job will be easier.” Another said the model was “easily transferable to practice.” Participants praised the takeaway stickers and tools to do the “beyond the surface” thinking.
We have stayed in touch with the LHIN and are hoping to expand our involvement soon. Big things are possible – this short session and small intervention are just the first steps.