PATIENT & FAMILY ENGAGEMENT COLLABORATIVE Learning Collaborative #1 April 17, 2015

Patient- and Family-Centered Care: Building Authentic Partnerships for Quality and Safety Through Implementation of Patient and Family Engagement Strategies Mary Minniti, CPHQ Program & Resource Specialist Patty Black, BS IPFCC Faculty

Thank You for Joining Us!

How many new colleagues can you meet in 10 minutes?

In our time together …  Create shared language around patient- and family-

centered care concepts, tools and practices  Learn about best practices in the field

 Promote teambuilding within sites and across sites

to build on “know-how” and awareness of what’s possible.  Identify your approach to build or strengthen a

patient and family advisory program  Prioritize key PFE content areas for the

collaborative participants related to each hospital’s action plan

Building Momentum for Change

Patient- and Family-Centered Core Concepts  People are treated with respect and dignity.  Health care providers communicate and share

complete and unbiased information with patients and families in ways that are affirming and useful.  Patients and families are encouraged and supported in

participating in care and decision-making at the level they choose.  Collaboration among patients, families, and providers

occurs in policy and program development and professional education, as well as in the delivery of care.

Patient- and family-centered care is working "with" patients and families, rather than just doing "to" or "for" them.

Why Patient- AND Family-Centered Care and not just Patient-Centered Care? Individuals, who are most dependent on health care, are most dependent on families… The very young;

The very old; and Those with chronic conditions.

Families can be allies for quality and safety; they often are the constant support across settings and assist with transitions of care. They can participate in the development of a care plan and support adherence to the plan.

Why Patient- AND Family-Centered Care and not just Patient-Centered Care? Social isolation is a risk factor. Research is clear that isolating patients at their most vulnerable times from the people who know them best places them at risk for medical error, emotional harm, inconsistencies in care, and costly unnecessary care (Cacioppo & Hawkley, 2003;Clark,Drain, & Malone 2003). The majority of patients have some connection to family or natural support. Cacioppo, J. T., & Hawkley, L. C. (2003). Social isolation and health, with an emphasis on underlying mechanisms. Perspectives in Biology and Medicine, 46(3), S39-S52. Clark P. A., Drain, M., & Malone, M. P. (2003). Addressing patients' emotional and spiritual needs. Joint Commission Journal on Quality and Safety 29(12), 659-70.

A Broad Definition of Family . . . In health care settings, patients are asked to define their families and how they will be involved in care and decision-making. The American Academy of Family Physicians which defines “family” as “a group of individuals with a continuing legal, genetic and/or emotional relationship”. (American Academy of Family Physicians, 2009).

Patient- and Family-Centered Care Patient Engagement Patient Experience

Patient Engagement

“…actions individuals must take to obtain the greatest benefit from the health care services available to them.” Center for the Advancement of Health, 2010 http://www.cfah.org http://www.cfah.org/fileCFAH_PACT_WhitePaper_current.pdf

g

‘Blockbuster Drug’ Patient Engagement

“Engagement, broadly defined, is an active partnership among individuals, families, health care clinicians, staff, and leaders to improve the health of individuals and communities, and to improve the delivery of health care.” Health Affairs, 32(2) 2013

Collaborative Patient and Family Engagement Collaborative patient and family engagement is a strategy for building a patient- and family-centered system of care. It is a priority consideration and essential to health reform at four levels:  At the clinical encounter—patient and family engagement in direct care, care planning, and decision-making.

 At the practice or organizational level—patient and family engagement in quality improvement and health care redesign.  At the community level—bringing together community resources with health care organizations, patients, and families.  At policy levels—locally, regionally, and nationally.

Weaving Patient- and FamilyCentered Concepts into the Infrastructure of Health Care Organizations  Vision/Values

Charting/Documentation

 Facility Design

Linkages to Community

 Patterns of Care

Quality Improvement

 Information Sharing

Human Resources

 Family Support

Professional Education

 Measurement

Patient- and family-centered care provides the framework and strategies to transform organizational culture and improve the experience of care, and enhance quality, safety, and efficiency.

Major Unnecessary Costs in Health Care  Inconsistent Quality

 Poor Communication  Errors, especially in the Transitions

and Transfers  Infections  Unsatisfied Customers  Poor Design of Facilities

If we asked…….. what stories might we hear?

Patient Engagement - Why Now? Evidence compelling:  Improves quality, safety and outcomes of care  Ensures that patients receive care that fits their

preferences  Reduces:  Use of diagnostics and health care services  Health care costs  Increases:  Buy-in to prescribed treatment  Patient experience and satisfaction scores  Staff and clinicians’ satisfaction and retention

Triple Aim — Patient- and Family-Centered Care

Health of Populations

Patient Experience

Reducing Costs

"The most direct route to the Triple Aim is via patient-and family-centered care in its fullest form.” Don Berwick June 5, 2012

Transforming Healthcare: A Safety Imperative “We envisage patients as essential and respected partners in their own care and in the design and execution of all aspects of healthcare. In this new world of healthcare: Organizations publicly and consistently affirm the centrality of patient-and family-centered care. They seek out patients, listen to them, hear their stories, are open and honest with them, and take action with them. . . . Continued Leape, L., Berwick, D., Clancy, C., & Conway, J., et al. (2009). Transforming healthcare: A safety imperative, BMJ’s Quality and Safety in Health Care. Available at: http://qshc.bmj.com/content/18/6/424.full

Transforming Healthcare: A Safety Imperative (cont’d) The family is respected as part of the care team— never visitors—in every area of the hospital, including the emergency department and the intensive care unit. Patients share fully in decision-making and are guided on how to self-manage, partner with their clinicians and develop their own care plans. They are spoken to in a way they can understand and are empowered to be in control of their care.”

Best Care at Lower Cost: The Path to Continuously Learning Health Care in America The IOM report has 10 key recommendations; the 4th recommendation states: “Involve patients and families in decisions regarding health and health care, tailored to fit their preferences. Patients and families should be given the opportunity to be fully engaged participants at all levels, including individual care decisions, health system learning and improvement activities, and community-based interventions to promote health.” S-23 “In a learning health care system, patient needs and perspectives are factored into the design of health care processes, the creation and use of technologies, and the training of clinicians.” 5-5. www.iom.edu/Reports/2012/Best-Care-at-Lower-Cost-The-Path-to-Continuously-Learning-Health-Care-inAmerica.aspx

A Key Lever for Leaders . . . Putting Patients and Families on the Improvement Team In a growing number of instances where truly stunning levels of improvement have been achieved... Leaders of these organizations often cite—putting patients and families in a position of real power and influence, using their wisdom and experience to redesign and improve care systems—as being the single most powerful transformational change in their history. Reinertsen, J. L., Bisagnano, M., & Pugh, M. D. Seven Leadership Leverage Points for Organization-Level Improvement in Health Care, 2nd Edition, IHI Innovation Series, 2008. Available at www.ihi.org.

Entire issue devoted to Patient- and Family-Centered Care April 2010

A recent (2014) report from the NPSF Lucian Leape Institute at the National Patient Safety Foundation affirms that “patients and families can play a critical role in preventing medical errors and reducing harm.”

Change The Assumptions Assume patients are the experts on their own experience and that they have information you need to hear and act on. Know that families are primary partners in a patient’s experience and health.

Patients and Families are Essential Partners for Innovation, Quality Improvement, and Health Care Redesign

Imagine!

Profiles of Change: Advancing the Practice of Patient- and Family-Centered Care  Valley Health System Valley Hospital

Ridgeway, NJ

 Children’s Mercy Hospital

Kansas City, MO

 Vidant Health System Vidant Bertie

Greenville, NC Windsor, NC

 Perham Health

Perham, MN

PFCC Staff Training 4-hours, 60-65 staff in each group, 12 groups in 2013, 18 groups in 2014 — Co-taught with a patient advisor.

.

Patient and Family Advisors Serve on QI Team

History of Patient and Family Advisory Councils

Teen Advisory Board 1999

Parents hired on staff 2008

El Consejo de Familias Latinas/Hispanas 2008 36

Family Advisory Board 2003

ICN Family Staff Advisory Council 2012

©2013 Children's Mercy. All Rights Reserved. 09/13

Early Accomplishments • Developed membership guidelines • Designed application and interview questions • Set short-term and long-term goals • Created PFAC page on hospital website • Provided feedback to various departments • Published PFAC annual report • Strengthened partnership with hospital leadership

37

©2013 Children's Mercy. All Rights Reserved. 09/13

Evolution of PFAC Involvement • Consulted on facility enhancements

• Updated and created new policies • Provided education for staff

• Developed tools for patients and families • Served on committees and workgroups

• Changed the culture

38

©2013 Children's Mercy. All Rights Reserved. 09/13

Patient/Family Advisors on Committees Patient/Family Advisors on Committees 180 PFCC Policy Implemented

160

156 149

140 Parents on staff started

120

108

109

100

91 80

75

60

42

40

28 20

0

15

17

31

33

19

3 1998

39

16

30

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

©2013 Children's Mercy. All Rights Reserved. 09/13

2009

2010

2011

2012

2013

Patient and Family Advisors on QI Teams Hospital leadership created the expectation that each Hospital Acquired Condition (HAC) committee include a PFA.  Formal PFCC Policy and Video

FCC Coordinators do the following:  Recruit PFAs with skills, interest, and experience relevant to committee’s area of focus.  Partner with the staff champion to mentor PFA.  Provide training for staff champion and PFA.  Accompany PFA to first meetings. Built on a foundation of trust from working with parents on staff. Adapted from DeeJo Miller and Sheryl Chadwick, Coordinators for Family-Centered Care

The Power of the Parent in the Clinic Patient Satisfaction Results

Score N Size 41

Q1 2013 73.2% 82

Q2 2013 84% 81

Q3 2013 88.4% 86

©2013 Children's Mercy. All Rights Reserved. 09/13

Q4 2013 96.3% 80

Greenville, NC  The Board and senior executive team have made an

explicit commitment to patient- and family-centered care.  The Quality Strategic Pillar reinforces this commitment

with the words: "Partner with patients and families to achieve safe, high quality care and exceptional experiences.”  Within the Office of Patient/Family Experience, there is

an Administrator that serves as a staff liaison for collaborative endeavors and builds synergy with all efforts to improve the patient experience.

The Role of Leadership During the interview process in hiring physicians, the CEO of Vidant Bertie and Vidant Chowan hospitals always conveys the following about the health system’s key values and priorities: If you don’t embrace PFCC and patient . and family partnerships AND if you do not embrace Just Culture, there is no need to talk further.

Vidant Bertie Windsor, NC  6-bed critical access hospital in North Carolina.  12-member Patient and Family Advisory Council —

“Small and mighty group of advisors” . . . Amy Jones, Administrator, Vidant Health  President and CNO regularly attend the monthly

meetings—6:00 pm Monday nights.  These patient and family advisors are helping the

hospital be “real” about population health and think beyond the walls of the hospital and clinic.  After meetings, the Council attendees round in the ED

and all inpatient beds.

Vidant

2007 — 2014 Improvement 20 Advisors in 2007 and 112 Active Advisors in 2014  83% Reduction in serious safety events.  62% Decrease in hospital acquired infections.  HCAHPS top quartile patient experience system-

wide.  Improvement in the UHC Quality and Accountability:

top decile performer for patient-centeredness: ranked 12th in 2008.

Perham Health Hospital Progress  Partnership Council started - September, 2009

 Change of shift report at the bedside  Signage changes  White Board Design  Family Resource Center  Developed a directory of services for patients and

families  Patient/family members added to Quality Council, Patient Safety, Nursing Home Community Council  Food Team

Perham Memorial Hospital Partners in Care Council, Perham, MN Redesigned brochure for prevention of surgical site infections. Signing appreciation letters for staff. Contributing to Pharmacy's new safety strategies —presence on inpatient units, reviewing meds daily, and encouraging family presence. Discussing improvements in endof-life care and developing a “walk of honor,” building on the Perham Home's experience.

Perham Memorial Home's Community Council ...with leaders and resident participation discussing a variety of issues including end-of-life care

Perham Memorial Hospital PFCC education for 100% of employees in 2010

In 2014, Partners in Care Council are wanting to repeat PFCC education and include it in new employee orientation.

Partnerships Expanding  Desire to have patient and family advisors’ input for

specific areas of the new hospital building project  Patient and family representation on key committees:  Quality Committee  Safety Committee  Readmission within 30 days  Falls Committee  How to operate out of two sites when new hospital opens (nursing home will no longer be adjacent)  Strategic planning process

Perham Memorial Hospital Partners in Care Council, Perham, MN

Perham Memorial Hospital Perham, MN In 2014, the Partners in Care Council initiated a new patient interview program to identify dissatisfying issues earlier during a hospital experience. Patient partners have a general script for questions and have practice sessions to prepare for their roles.

Perham Health 2009-2014 Measuring Change and Improvement  Likelihood to Recommend (hospital)  33rd to 83rd Percentile on Press Ganey  Overall Satisfaction (hospital)  18th to 63rd Percentile on Press Ganey  Stability  Increased Outpatient Services by 20% and stable

Inpatient Admissions (in last two years) … 90% of Minnesota hospitals saw a decrease.  Maintained 98 nursing home beds while State reduced by 25% and neighbors reduced by 45%.

Hospital Survey Review

Advancing the Practice of Patient- and Family-Centered Care In Hospitals Survey 6.1% 3.0%

18.2%

Senior Executive 33.3%

Administrative Director/Director Manager/Supervi sor Nurse Other

33.3% 36.4%

Staff Member

 30 of 35 hospitals completed the survey  86% response rate  Aggregate report for 33 total surveys analyzed

Integration of Patient- and Family-Centered Care as a Core Value/Priority (Before) 18 16

# of Respondents

14

12

Avg.

10

4.3 8 4.3 6

8 6 4 2 0 Not at all

2

3

4

5

6

Fully

Not Sure

Organization Unit

Leadership in the Organization 100% 90% 80% 70% 60% 50% 40% 30%

5.6 9

5.3 4

20%

5.2 2

10%

4.4 1

0% Mission

Quality

Staff Accountability

Physician Accountability

Strongly Agree

Agree

Somewhat Agree

Neither A-D

Somewhat Disagree

Disagree

Strong Disagree

Not Sure

Patient and Family Advisory Councils 3% 22% Yes No Not Sure

75% Only 37% of advisors represent the diversity of population served

Patients and Families as Advisors 16 14 12 10 8 6 4 2 0 Yes

No Ambulatory Clinics

Not sure Service Lines

Advisors Involved in Committees and Groups 27 respondents Patient Safety Self-Management Support Community Services & Programs

Patient Family Experience of Care Quality Improvement Patient/Family Education Facility Design Ethics Discharge/Transition planning Culturally/linguistically svcs

Use of IT Staff orient./education Peer-led education/support Research Initiatives Policy and Proc. Develop

0%

10%

20%

30% YES

NO

40%

50%

NOT SURE

60%

70%

80%

90%

100%

Design of Hospital Strong Disagree

Disagree

Somewhat Disagree

Neither A-D

Somewhat Agree

Agree

Strongly Agree

Not Sure

5.5 6

5.4 1

14

12

5.1 3

4.3 4

4.7 4

5.2 5

Respondents

10

8

6

4

2

0

Welcoming Impression Message of Essential Role

Reflects diversity of patients/families

Provides forpt/family Supports the presence Supports Collaboration privacy and comfort and participation of among physicians and families staff across disciplines

Participation in Care and Decision-Making Strong Disagree

Disagree

Somewhat Disagree

Neither A-D

Somewhat Agree

Agree

Strongly Agree

Not Sure

14

12

4.9 3

5.3 2

5.6 7

5.8 1

Respondents

10

8

6

4

2

0 Essential Allies

Patients ID family/role in decisionmaking

PF supported as care planning.decisions participants

Cultural/spirtual beliefs respected and incorporated

Participation in Care and Decision-Making Strong Disagree

Disagree

Somewhat Disagree

Neither A-D

Somewhat Agree

Agree

Strongly Agree

Not Sure

14

12

4.8 6

4.5 9

4.9 0

5.3 7

Respondents

10

8

6

4

2

0 Essential Allies

Patients ID family/role in decisionmaking

PF supported as care planning.decisions Cultural/spirtual beliefs respected and participants incorporated

Access to Information and Education Strong Disagree

Disagree

Somewhat Disagree

Neither A-D

Somewhat Agree

Agree

Strongly Agree

Not Sure

18 16 14

5.4 3

5.1 6

4.9 7

5.5 3

6.2 9

Respondents

12 10 8 6 4 2 0 Unbiased/useful info

Understand purpose of medications

Understand their responsibility for managing health

Receive info in primary language and educ levels

Access to Interpreters

Information and Education (cont.)

10 9 8

Strong Disagree

Disagree

Somewhat Disagree

Neither A-D

Somewhat Agree

Agree

Strongly Agree

Not Sure

3.5 0

4.4 7

Respondents

7 6 5 4 3 2 1 0

Peer-led educ available

PF provided strategies on how to partner

Documentation Systems and Charting Provide Patients and Families have easy access to: Strong Disagree

Disagree

Somewhat Disagree

Neither A-D

Somewhat Agree

Agree

Strongly Agree

Not Sure

12

10

5.8 0

4.6 3

5.4 3

5.5 7

Respondents

8

6

4

2

0 Clinical info

Daily recording of care

Discharge Summary

Medical Records

Documentation Systems and Charting: Recording of Patient and Family’s Strong Disagree

Disagree

Somewhat Disagree

Neither A-D

Somewhat Agree

Agree

Strongly Agree

Not Sure

12

10

5.0 0

4.9 3

5.0 6

5.1 9

8

6

4

2

0

PF Priority Concerns

PF Observations

PF Goals

PF Preferences

Human Resources Systems

Rewards and Recognition for PFCC Practice

4.2 7 4.1 3

Systems ensure PFCC staff "Hire for Fit"

1.6 1

PF involved in hire for Clinical Leaders

PF involved in hire for admin leaders

2.2 9

5.1 0

Our org. personnel reflects diversity

4.6 8

HR support PFCC Practice

1

2

3

4

Average Rating

5

6

7

HR– Explicit Expectations for Respect and Collaboration with Patients and Families

Performance Appraisal Process

4.5 7

Position Descriptions

4.6 8

1

2

3

4 5 Average Rating

6

7

Orientation and Education Students and Trainees

Physicians

Staff

Leaders

Patients and Families as Trainers Orientation and Education

Culturally responsive practice

Orientation Prepare for collaboration with Patients and Families in Decision-Making

1

2

3

4

5

Average Ratiing

6

7

Integration of Patient- and Family-Centered Care as a Core Value/Priority (Before) 18 16

# of Respondents

14

12

Avg.

10

4.3 8 4.3 6

8 6 4 2 0 Not at all

2

3

4

5

6

Fully

Not Sure

Organization Unit

Integration of Patient- and Family-Centered Care as a Core Value/Priority (After) 18 16

# of Respondents

14 12

Avg.

10

3.77

Organization

8

4.00 6 4 2 0 Not at all

2

3

4

5

6

Fully

Not Sure

Unit

Getting Started…Top Areas 1. 81%

Patient/family experience of care

2. 45%

Quality improvement

3. 35%

Patient safety

4. 26%

Patient/family education

5. 25%

Discharge/transition planning Staff orientation and education

Community services and programs Use of health information technology Ethics Culturally and linguistically appropriate services and materials Research initiatives Peer-led education and support Policy and procedure development Facility design

0

5

10

15

20

25

30

Team Activity #1

Identifying Your Opportunities

BREAK 10:00 – 10:15 am

Structure of the Collaborative

Patient & Family Engagement Collaborative

Milestones:  Assessment of current level of patient-and familycentered care practice  Development of a robust patient and family advisory program  Enhancement of existing programs with key opportunity for current advisors to participate on team collaborative  Identification and implementation of a direct care engagement strategy

PATIENT & FAMILY ENGAGEMENT COLLABORATIVE AT-A-GLANCE CALENDAR

3-2015 to 5-2016

PFE Measurement – Quarterly Reporting Type of Measure

PFE Indicator

Process

Discharge Planning: Prior to admission, hospital staff provides and discusses a planning checklist with every patient similar to CMS’ Discharge Planning Checklist, allowing for questions or comments from the patient or family.

Process

Continuity of Care: Hospital personnel conduct shift change huddles and bedside reporting with patients and family members in all feasible cases.

Outcome

Dedicated PFE Liaison: Hospital has a person or functional area dedicated and proactively responsible for PFE, and systematically evaluates PFE activities (e.g., open chart policy, PFE establishment and trainings, ).

Outcome

Patient Representation on Quality and Safety Councils: Hospital or PFE Council has an active PFE Council or at least one former patient who serves on a patient safety or quality improvement Council.

Outcome

Patient Representation on Governing Entities: Hospital has at least one or more patient(s) who serve on a governing or leadership board as a patient representative.

Executive Leadership Book Profiles: www.ipfcc.org/profiles/index.html www.ipfcc.org/advance/topics/ profiles-of-institutional-change.html

Developing Patient- and Family-Centered Vision, Mission, and Philosophy of Care Statements

Resources For Getting Started

www.ahrq.gov/professionals/systems/hospital/engagingfamilies/index.ht ml?utm_medium=email&utm_source=govdelivery ©2013 Children's Mercy. All Rights Reserved. 09/13

HRET RESOURCES www.hrethen.org/index.php?option=com_phocadownload&view=category&id=39 7&Itemid=375  Newsletter #1: Changing Visiting Policies and Practice  Newsletter #2: How to Get Started in Partnering with    

 

Patients and Families Newsletter #3: Recruiting Patient and Family Advisors Newsletter #4: Orienting Patient and Family Advisors Newsletter #5: Facilitating Meeting with Patient and Family Advisors . . . Newsletter #6 Placing and Supporting Patient and Family Advisors on Committees and Quality Improvement Teams Newsletter #7 Measuring and Communicating the Impact of Patient and Family Partnerships Newsletter #8 Recognition and Celebration of Partnerships

Additional National Resources

Team Activity #2

Review of IPFCC Materials

Large Group Activity

Exploring and Prioritizing PFCC Content:

What Matters to You?

Lunch

11:50 am - 12:20

Last 10 minutes Valley Hospital Journey

A Conversation with Leaders . . .

https://www.youtube.com/watch?v=VXfqF87Z3_Q&feature=youtu.be

Establishing An Advisory Program: Building the Infrastructure to Support Effective Partnerships

Learning about the patient’s and family’s experience . . . Focus groups and surveys are not enough! Hospitals, health systems, primary care practices, clinics, dialysis centers, and other community-based agencies must create a variety of ways for patients and families to serve as advisors.

What Is an Advisor?

Advisors - Patients, Families, Residents Any role in which those who receive care work together with health care professionals to improve care for everyone. Advisors share insights and perspectives about the experience of care and offer suggestions for change and improvement.

Why Involve Patients and Families as Advisors?  Bring important perspectives.

 Teach how systems really work.  Keep staff grounded in reality.  Provide timely feedback and ideas.  Inspire and energize staff.  Lessen the burden on staff to fix the problems…

staff do not have to have all the answers.  Bring connections with the community.  Offer an opportunity to “give back.”

Qualities and Skills of Successful Patient and Family Advisors  The ability to share personal experiences in ways that

others can learn from them.  The ability to see the bigger picture.  Interested in more than one agenda issue.  The ability to listen and hear other points of view.  The ability to connect with people.  A sense of humor.

 Representative of the patients and families served by

the hospital and clinics.

What Is a Patient and Family Advisory Council?  Formal mechanism within an organization to create

authentic collaboration and partnerships.  Establishes ongoing relationships with regular meeting

times and terms of service.  Seeks diverse perspectives representing the populations

served.  Organizational leadership sponsors the effort.  Council provides input mechanism for a variety of issues.  Role of Advisors:

 Partners in key areas within the organization (quality,

safety, program development, policy).  Initiates and identifies opportunities for improvement in

patient and family experience of care.

What It Is Not…

A support group!

Collaboration Beyond Advisory Councils  Invite patients with a chronic condition to participate in

a team working on improving educational materials or programs to that population of patients.  Identify patients new to the hospital to participate in a

“photo walk-about” to take pictures of ways the environment is welcoming and places where the messages could be more positive or where wayfinding is confusing.

 Ask patients and family what is one change we could

make that would improve your experience? Collect the responses and form an improvement team with advisors to follow-up on suggestions.

Useful Framework for Participation Depth of Engagement

Patients and Family Role

Things to Consider

Ad Hoc Input

Survey or Focus Group Participants

Ensure diversity and representation, validity

Structured Consultation

Council or Advisorsprovides QI input

Early consult supports partnership model

Influence

Occasional Allows flexible ways to Review/Consultants to participate; requires project background/orient.

Negotiation

Member of QI Group

Training in QI approach

Delegation

Co-Chair of QI Group

High level of expertise or skill

Advisor Control

Implementer or peer support role

Strong training component, mentoring and compensation

They say

to becoming Advisors Why?

Tips and Tools for Success

Advisory Council Basics  Determine council structure, size, meeting schedule,

operating procedures, and bylaws.  Define the role, purpose, and vision.  Orient and prepare advisors and staff.  Encourage increasing ‘ownership’ of council.  Provide resources for administration, ongoing

mentoring and skill development.  Build access to leadership and align with organizational priorities.  Evaluate achievements, participation, and processes.

Recruiting Advisors  Ask staff and physicians for suggestions.  Contact support groups and community organizations

such as Rotary, Kiwanis, fire stations, and religious organizations.  Ask current patient and family advisors.  Ask patients/families during a clinic visit or during a

hospital stay when appropriate.  Post signs/brochures on bulletin boards in waiting

areas, corridors, and lobbies.  Place notices in the clinic’s, hospital’s, or nursing

home’s publications, websites, and TV systems.

 Post information on Twitter and Facebook.  Place announcements in local newspapers.

A Recruiting Tool

Peace Health Medical Group Eugene, OR (EA page 133 for FD)

Partnership with Volunteer Department  Recruitment  Background checks  Health Assessment (TB tests)

 Photo Consent  Photo ID Badge ................................  Basic Orientation  Confidentiality / HIPAA training  Database for contact, interest, and tracking hours and involvement  Recognition Efforts

Learning About the Hospital and Clinics  Mission, Values, Priorities for Team,

Unit/Department, Clinic, or Hospital  Who’s Who in the Organization or on the Team

 Hospital/Clinic Tour 

“Day in the Life” or “Why I Choose to Work Here”



Speaking the Language–Medical Jargon 101



Meeting Attendance Expectations



Roles and Responsibilities

How To Be an Effective Advisor  How to ask questions, state  

  

opinions, and provide feedback. What to do when there is a disagreement. Listening and learning from other’s viewpoints. Thinking beyond your own experience. Sharing your story. Telling “negative” stories in a positive way.

Support for Advisors and Staff

Kaizen Board

Improving Discharge Process  Kaizen Event – 2 days

 Interdisciplinary team of hospitalists, nursing

staff, IT staff, educators, patients  Goal: Create a discharge process and

follow-up to help reduce readmissions  Identified two interventions to support patient

and family: Discharge Form and Follow-up Phone Call

What We Learn from Patients and Families

• 7 pages long • Follow-up Appointment on page 5 • No information on pending labs • Unclear instructions on danger signs

• Eliminated Noise - 3 pages only! • Moved F/U appt. to first page • Identified missing information • Suggested visual ways to ensure understanding

PAGE 2 MORE INDIVIDUALIZED

F/U APPT

DANGER SIGNS PAGE 3 GENERAL INFO

Document, Measure and Celebrate A Panel of Advisors Train New Nursing Students on:  Being advisors  Living with chronic illness Chronic Illness: Questions for Chronic Illness Patient Advisory Group Panel

Questions about the Patient Advisory Group 1. 2. 3. 4.

How did you become involved with the Patient Advisory Group? How does this group foster health care provider partnerships? How do most patients become involved with the Patient Advisory Group? How has your involvement benefited your own health?

Questions Related to Chronic Illness 1. Adaptability = do well o What has been the hardest part of having a chronic illness? o What has been the easiest part of having a chronic illness? o What changes have improved your quality of life? 2. How has this impacted your o Career goals? o Family? (Have you experienced role changes?) o Ability to enjoy life? 3. What things have others done to help? o Family? o Friends? 4. Did the medical community appropriately (sufficiently) prepare you for the changes you would experience? 5. What could health care workers (the medical community) do better? 6. Have you experienced any access to care challenges? 7. Have you experienced a financial impact? 8. Do you get help with managing o Financial issues? o Paperwork? 9. Looking back, is there anything you wish that you knew before? 10. Have you felt any stigma related to having your illness? 11. If you could tell new nurses anything, what would it be?

Seal of Approval for Patient and Family Information and Educational Materials

Document Accomplishments Patient Advisory Council [PAC] Accomplishments 2008- April 2013 Patient Advisors influence before the PAC:  Diabetes Redesign Team  Medication Oversight Team  Idealized Patient Experience at PHMG which informed the 5-year strategic plan

Council Established in January 2008: • Built important and respectful relationships with key leaders in PHMG and with each other • Reached out to the community at large to bring their voices to the table- Questions That Matter, a series of questions that ask for patient/family perspective about important health issues/concerns and delivery of services • Completed a major DVD project on Patient Safety, which has been used as a model of the impact of advisors across the nation and in Europe. • Shown a willingness to learn, be curious and be GREAT partners in healthcare policy, services and approaches • Provided input about RiverBend Pavilion wayfinding, amenities, patient care department by department, and communications to patients regarding the move • Provided input to Ethicist about the regional process of ethical discernment- as a result of his experience a patient advisor has been added to the system Ethicist Committee that meets quarterly • Advisors have participated in the Regional Network of Care on the steering committee as well as the Breast Cancer Navigation Team Redesign • Provided feedback to the University District Hospital Renewal about health information being available to patient/families in common areas • Created ways to recruit advisors with advisors and was successful in adding diversity of gender and ethnicity • Provided feedback to the upgrade of www.peacehealth.org, Welcome Packet and Media Materials • Advisors are invited and attend quarterly All Provider Meetings • Provided a panel of patients who shared their stories at the 2008!ADVANCE! Generating keen interest and interaction with the clinicians of PHMG. Attend !ADVANCE! yearly • Advisors serve on the Quality Committee for PHMG and liaison back to the PAC on issues • Participated in the AHRQ Medication Management at Home grant as consultants on the study design, conclusions and suggestions about interventions to improve partnership 2007-2010 • PAC Chairs collaborated with hospital advisor at NICU to make recommendations in 2010 to the PeaceHealth Executive Team of Oregon Region on how to increase the use of advisors in helping improve the experience of care. • Established an annual Patient- and Family-Centered Award to recognize and highlight examples of great practice at PHMG • Promotes visibility of PAC and partnership with staff through random site visits to thank staff and presentations during staff meetings, OPS meetings, etc. • Advisors providing feedback about wayfinding and artwork selection for UD-PHMG remodel/move • Advisors connecting with Surgery Institute and wayfinding at the RiverBend hospital facility • Provided feedback on Patient Connection project • Input on the CHF Communication Toolkit, Revaccination Project, and redesigned the Consent to Treat form • Patients and Families Partnerships for New Nurse orientations • Participates in Employee Appreciation Days • Provided feedback on Sports/Camp Physical letter • Provided input on the Patient Satisfaction Survey • Provided feedback on new Welcome Brochures • Partnered with Diabetes Outreach Program with CHI – experience of care and patient communication • Partnered with Service For Excellence: Front Office Experience including course content • Patient Advisors serving on the Pain Management Committee – Pain Management Contract • Patient Advisors serving on the Dismissed Patient Process Review Committee – new policy • Provided feedback on the “No News is NOT Good News” project

Recognizing Patient- and Family-Centered Care

Patient Advisory Council Awards PFCC Award to Nurse Midwifery Birth Center

Look for Ways to Increase Visibility

Offer Variety in the Complexity of Projects

Insights  Always wear my patient

perspective hat and be willing to represent the voice of the patient  Importance of trust  Make a difference together  Engage early

Team Activity #3

Reviewing the Checklist for Success

BREAK 1:30 – 1:45 pm

Engaging Leadership

Who is leading? 93% of healthcare leaders say patient experience is among their top five priorities

While 72% of senior healthcare leaders say that patient experience has been more of a priority in the past year, only 1 of 8 CEOs has primary responsibility for it. Reported by Anna Roth, CEO of Contra Costa Medical Center October 2013

Contra Costa Regional Medical Center, Martinez, CA

Implementing a new philosophy of welcoming families . . . With a commitment to learning and quality improvement as integral to the process.

Resources for Sharing Stories A key competency of leaders of high performing organizations is the ability to share stories.

http://pulsemagazine.org/ Staff.cfm?dropdown_us=1

Resources for Sharing Stories

The Role of Effective Leaders . . .  Believe that the experience of care matters to

quality, safety, achieving the best outcomes, and to fiscal performance of the hospital and each clinical area.  Communicate the vision for patient-and family-

centered care and how it links to quality, safety, and the best outcomes consistently and clearly.  Communicate this vision in specific clinical

areas, throughout the hospital, and to the community.

Leadership Best Practices for Effective Sustained Partnerships  Make an explicit commitment to partnerships.

 Provide resources and support for partnerships.  Encourage partnerships as a pathway to quality.

 Partner with patients and families in strategic initiatives.  Measure the outcome of partnerships.

 Recognize that partnerships take time.

Effective Leaders . . .

Appoint a staff liaison for collaborative endeavors, an individual with strong facilitation skills and access to organizational leaders.

Happy Helpful Hospital Patient- and Family-Centered Care Dashboard December 2014 PATIENT AND FAMILY ADVISORS

PATIENT/FAMILY PERCEPTIONS OF CARE (HCAHPS and Custom Questions Survey)

00 advisors and 00.00 hours and name of Patient and Family Advisory Councils (PFACs)

00%

00 Committees/teams with advisors Committee name(s)

00%

How often did nurses explain things in a way you could understand?

00%

How often did doctors listen carefully to you?

00 Partnership Oversight Committee Meetings 00 Staff/clinicians involved with collaborative endeavors

00%

How often did doctors explain things in a way you could understand?

00%

Degree to which patient and family were able to participate in decisions about your care.

00%

How well staff explained their roles in your care.

Issues or types of issues addressed/resolved:

Degree to which the staff involved/supported your family in planning and managing care.

00%

Media Coverage:

00%

Degree to which your choices were respected to have family members/support persons with you during your care.

00%

Patient preferences included in transition planning.

00%

Before leaving hospital, patient understands his/her responsibilities for managing his/her health.

00%

Patient understands purposes of medications.

PHYSICIAN SURVEY AND RETENTION RATE The Happy Helpful Hospital is committed to patient- and family-centered care at all levels of the organization. 00%

STAFF SURVEY AND RETENTION RATE The Happy Helpful Hospital is committed to patient- and family-centered care at all levels of the organization. 00%

Partnering with patients and families and engaging them in care planning and decisionmaking leads to better clinical outcomes and more efficient use of health care resources. 00%

Partnering with patients and families and engaging them in care planning and decisionmaking leads to better clinical outcomes and more efficient use of health care resources. 00%

Involving patient and family advisors as part of improvement teams and in program development is beneficial. 00%

Involving patient and family advisors as part of improvement teams and in program development is beneficial. 00%

00%

Retention Rate

How often did nurses listen carefully to you?

00%

Retention Rate

PFCC SELF-ASSESSMENT ONLINE SURVEY

2012

2014

Leadership commitment to patient- and family-centered care

5.8 0.0

Patient and Family Participation in Care and Decision-Making in Inpatient Settings

5.5 0.0

Patient and Family Access to Information and Education

5.4 0.0

Integration of Patient- and Family-Centered Concepts in Human Resources

4.1 0.0 1

2

3

4

5

6

7

Preparing Staff and Clinicians to Partner

Mental Barriers — Anticipate and Respond Proactively  HIPAA will not permit this.  Patients and families will hear negatives about our

organization.  We don't want to air our dirty laundry.  This is nice to talk about, but we don’t have time.  Patients and families just don’t understand our system.  They will want things that cost too much and we'll have to tell them "no."  We need to be better organized, before involving them. For further information: Essential Allies, page 41

Preparing Staff and Clinicians for Collaborative Efforts  Value the perspectives and

experiences of all.  Ask open-ended questions about concerns, fears and issues.  Listen, Listen, Listen.  Debunk the myths.  Provide the evidence.  Make it easy; take care of the operational details.  Show appreciation for everyone’s contributions.

Fostering a Successful Beginning: Staff Roles on the Council  Serve as a connection between other staff and

the advisory group.  Be a Patient- and Family-centered “champion.”

 Respond to issues in their respective areas

based on concerns and/or suggestions presented to the advisory group.  Provide information for the advisory group.

Fostering a Successful Beginning: Orienting Staff  Explain how staff should be involved.  Be open to questions and challenges.  Try not to be defensive. Defensiveness usually has a negative

effect.  Assist in communicating activities of the

advisory group to other staff.

Team Activity #4

Creating Your Own Action Plan

Large Group Activity

Stating Your Intention: What Will You Do?

“We continue to strive for excellence and breakdown barriers” Western Wayne Physicians

Learn from our mistakes Identify bumps in the road Trust in the Process

Please let us know how to improve! Leave evaluations on the tables.

It’s a Journey….Have Fun!

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