The binder actually originated from a co-design event. We had over 70 family caregivers, patients and health care providers and really we were trying to look at ways to improve family caregiver experience and engagement. So they chose and prioritized three themes that they wanted to improve. They were family caregiver involvement, family caregiver education and care transitions. The family caregivers, patients and health care providers felt that the binder could be used as a tool that would help improve all three of those themes. We trialed the binders on a small number of patients and families at Parkwood Institute in the geriatric inpatient and outpatient settings. The binder acts as a place where the staff, no matter what discipline they are from can put the information together in an organized manner. What I had been hearing for quite a long time from our teams was that there was no place to put this information and that it was often scattered at the bedside or patients had some information or educational material stuffed in their bag with their clothing and belongings. All of the papers they receive for education or their schedules is put into this binder so they know its one place to look if they needed any information. So it has helped in that organization, kept them on track, scheduling. We don’t find it has added much to anybody’s workload. We were documenting that same information anyway and so it didn’t take on anything more time wise and it’s actually saved time because it’s there for the patient and we can refer back to it. The tools vary depending on the care area that the binder is being implemented in. But the care areas that we piloted and we trialed on we had for example a roles list. We heard from family caregivers that they were often confused when there were a lot of different people coming into the room and they didn’t know who they were or what they did and so they wanted something they could refer to that had very general terms as to who this person is and what their job description is. The binder has improved the involvement with myself and family caregivers by allowing them to know who I am and how to contact me. A lot of times we want to reach out and we play telephone tag but now it gives them a place to find my name, my phone number and easily contact me at their convenience. One of the tools I really like in the binder is the discharge checklist. I think it’s a wonderful way to capitalize on easy to read, easy to review information that just allows people to put it up on their fridge at a glance, keep it in the binder, wherever they feel helpful. But I think it shows that these are the types of things we are going to address, these are the things you might want us to be addressing. It engages people like if you didn’t see us recording something you could ask that question, like, how come this isn’t indicated on my checklist and it allows us again to have good conversation about what is or maybe isn’t relevant to a patients care. The binder is really helpful in the transition to home because often in the hospital people are at a really vulnerable time in their life and people will often comment that they feel overwhelmed and there is a lot of information provided during that stay. And families are in and out, caregivers are in and out and I think when people get home they really start to process everything that’s happened to them. And most patients are going onward to some sort of outpatient follow-up be it with therapy, their family physicians, a specialist and so I think the binder allows them the opportunity to sort of reflect on that information bring it to those appointments review things and keep planning forward. Through the work of this project, the teams have become more aware and more alert to how much the family caregivers appreciate and acknowledge the information when they are provided it. For them to be as well informed as the patient is certainly paramount to their success. Organizationally I think it’s essential that we are all moving in the same direction. By listening to our patients and family caregivers we can implement very simple strategies that improve the overall quality of care and certainly the patient and family caregiver experience.