Mapping better care to improve dysphagia services

For Nova Scotians living with dysphagia (difficulty swallowing), timely, coordinated care can make a world of difference in quality of life and overall health. In March 2025, teams from Hearing & Speech Nova Scotia (HSNS) and dietitians from across the province came together with a shared goal: to strengthen how dysphagia services are delivered.

Over the course of three hands-on sessions, staff from multiple disciplines gathered around long sheets of brown paper, visually mapping the swallowing assessment journey from the clients’ perspective. With support from Dalhousie University’s Faculty of Open Learning and Career Development, teams used Lean improvement tools like SIPOC (suppliers, inputs, process, outputs, customers) diagrams and process maps to identify pain points, gaps, and opportunities.

Michele Tenyenhuis, an Administrative Support Professional at HSNS, says the experience offered rich insight. “It provided a valuable opportunity to deepen my understanding of the processes involved in both inpatient and outpatient dysphagia care,” she says. “Understanding this workflow allowed me to identify ways I can better support clinicians by helping to reduce the administrative burden.”

Her experience underscored the value of including diverse roles in efforts to improve care across the system.

“Our inspiration came from a shared desire to move beyond quick fixes,” says Marika Holmes, Professional Practice Development Officer. “We knew that meaningful change would take a structured, data-informed approach, and that we couldn’t do it without everyone at the table.”

The sessions revealed several recurring issues: repeated assessments, duplicated documentation, bottlenecks that caused delays, and referral pathways that left clients feeling like they were starting from scratch.

One particularly impactful insight came when teams realized clients were often asked to retell their story to multiple providers due to disconnected systems. That moment sparked a flurry of ideas around streamlining documentation and improving communication between disciplines.

“Our clients deserve a system that works better for them,” says Marcia Curry, Manager at HSNS. “By collaborating with dietitians, we’re building a more efficient and compassionate process that reduces wait times, cuts down on repetition, and focuses more energy on the care itself.”

While still in the planning phase, the momentum is already strong. Teams have identified several early wins—like aligning intake forms and clarifying referral criteria—and are now working on piloting process changes in select sites before scaling province-wide.

Greg Noel, Director of Adult & Mi’kmaq Hearing and Speech Services, sees the potential for lasting impact. “When we bring together the right people with a shared purpose, we unlock the kind of system-level thinking that leads to real change. This work is about maximizing our collective expertise to serve clients better, reduce waste, and create something more sustainable.”

With a foundation built on collaboration, HSNS and its partners are improving dysphagia services by modelling what’s possible when teams come together with curiosity, commitment, and a clear focus on the client journey.