Advancing Senior Friendly Hospital Care in Ontario

Researchers at Sunnybrook Health Sciences Centre and St. Michael’s Hospital have spearheaded a knowledge translation project to move evidence-based care into hospitals across Ontario, establishing lasting improvements for seniors care. With support from the Health System Research Fund, 87 hospitals are participating in the Senior Friendly Hospitals ACTION program. The program is increasing capacity to deliver senior friendly care using quality improvement methods and change leadership skills. Many hospitals participating in the program are targeting improvements in delirium care and preventing functional decline.

Hospital corridor with chairs and bed SFH4 Young doctor and his sick older male patient


Seniors account for 63% of all acute inpatient days and 43% of all provincial health expenditures in Ontario. We know that over the next two decades, Ontario will experience a significant demographic shift, more than doubling the number of seniors in our population. To prepare for tomorrow, we need to implement solutions for better seniors care today. Thanks to strategic government investments, those solutions are already underway across 87 Ontario hospitals and the numbers continue to grow.

In 2014, the Ministry of Health and Long-Term care invested in a knowledge translation program that aimed to improve the safety and well-being of hospitalized seniors. With support from the Health System Research Fund, Dr. Barbara Liu of the Regional Geriatric Program of Toronto and Dr. Sharon Straus of St. Michael’s Hospital launched the Senior Friendly Hospital ACTION Program, that promotes the translation of research evidence into clinical practice, building capacity to improve seniors care and fostering collaboration across Ontario’s hospital system. To date, 87 hospitals across all 14 of Ontario’s Local Health Integration Networks (LHINs) are participating in the Senior Friendly Hospital ACTION Program. That’s more than 50% of all Ontario hospitals.


Building an evidence-based blueprint for better seniors care

As a scientist at Sunnybrook Health Sciences Centre and Executive Director of the Regional Geriatric Program (RGP) of Toronto, Dr. Barbara Liu could see that health system research was needed to identify gaps and address top priorities to improve care for seniors at the hospital level.

“From environmental scans performed in 2011 and 2014, it was clear that there were opportunities to improve senior friendly hospital care in Ontario,” said Dr. Liu, Co-Chair of the Senior Friendly Hospital ACTION Steering and Advisory Committee. “Organizations had champions willing to lead the work, but they needed teams to support the effort, and enhanced skills especially in quality improvement and change leadership”.

To ensure they had the right tools for sustainable implementation, the Senior Friendly Hospital Strategy was guided by a framework endorsed by the RGPs of Ontario. The framework comprises five inter-linked components:

  • Organization support
  • Emotional and behavioural environment
  • Processes of care
  • Ethics in clinical care and research
  • Physical environment

Evidence has shown that better outcomes for frail seniors emerge when these components are considered together.

In the winter of 2011, LHINs and RGPs across Ontario, including Dr. Liu’s Toronto branch, worked together to generate a provincial summary of Senior Friendly Hospital care. The group identified hospital-acquired delirium and functional decline as top improvement priorities. The impact of delirium and functional decline on older hospitalized patients can be devastating.  Based on published studies:

  • 30 – 60% of frail seniors experienced functional decline while in hospital,
    • Less than 50% regain lost function
  • 10 – 15% of older patients admitted to acute care are delirious at the time of admission
    • 10 – 40% experience new episodes of delirium while in hospital

A provincial working group of 34 subject matter experts identified evidence-based indicators to monitor hospital-acquired delirium and functional decline. 44 hospitals evaluated these indicators and identified the challenges and success factors for broad application.  This led to the development of the Senior Friendly Hospital ACTION Program (Accelerating Change Together in Ontario), designed to enhance capacity and sustainability for senior friendly care.


Spread Success: how the Senior Friendly Hospital Strategy was adopted across 87 hospitals

Through a Health System Research Fund (HSRF) Capacity Award from the Ministry of Health and Long-Term Care, the Regional Geriatric Program of Toronto was able to deliver the Senior Friendly Hospital ACTION Program, an evidence-based training and implementation program for Ontario hospitals.

“Building the content of this program was a collaborative effort,” said Dr. Sharon Straus, Director of the Knowledge Translation Program at St. Michael’s Hospital and Co-Chair of the Senior Friendly Hospital ACTION Steering and Advisory Committees. “We worked with a provincial advisory group to ensure that the program would include the necessary components for successful, sustainable implementation.”

Cohort 1: 44 Hospitals

The Senior Friendly Hospitals ACTION program launched with a 3-day workshop in spring, 2015, where 44 hospitals began their journey to improve seniors care. Teams were provided with training on the Senior Friendly Hospital framework, quality improvement methods, change management, and leadership. They then returned to their hospital organizations to lead the implementation of a Senior Friendly Hospital project, while receiving ongoing coaching and continued networking via phone and webinar.

Cohort 2: 43 Hospitals

The following winter, in 2016, 43 new hospitals attended the 3-day training event, becoming the Senior Friendly Hospital ACTION Program’s second cohort. Leveraging existing champions, the Toronto RGP invited the teams from Cohort 1 to share their learnings and progress over their first 10 months of project implementation with the new hospital recruits.

Embracing patient engagement, Cohort 2 hospitals were invited to nominate community patient advisors to attend the training programs. These advisors now sit on the implementation team and participate directly in the progress of their hospitals’ improvement work. By including the patient voice, many of the Senior Friendly Hospital projects across the province have added specific targets to improve patient experience in the hospital. For example, some hospitals have included a focus on improving meal times, or overall patient satisfaction on the unit.


Changing practice at the system level

In order to participate in the Senior Friendly Hospital program, senior leadership at all 87 hospitals provided written commitment that implementation.

“We’ve seen exceptionally high compliance with these commitments,” said Dr. Liu. “Executive champions have been dedicated to implementing the Senior Friendly Hospital Strategy because evidence has shown direct improvements in patient care processes.” Specifically, reducing functional decline and preventing delirium can reduce length of stay and improve outcomes and the experience for patients and families.

The Senior Friendly Hospital ACTION Program has been endorsed by all 14 LHINs in the province, and several LHINs have included Senior Friendly Hospital commitments as part of their Integrated Health Service Plan and/or Hospital Service Accountability Agreements, establishing committees to further the Senior Friendly Hospital work.

Seniors comprise one of Ontario’s largest and most vulnerable populations. The success of the Senior Friendly Hospital Strategy is a strong example of how collaboration and health system research can translate into real practice change at a system level that puts patient priorities at the centre of care, enabling the Province’s Patients First Promise.



To learn more about the Senior Friendly Hospitals ACTION Program, click here.

This project is an example of how health system research contributes to a healthier, wealthier, smarter Ontario. Learn more at