1 Engaging Patients to Improve Outcomes Essential Hospitals
Engagement Network July 25, 2013
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2 OUR NEW NAME Weve rebranded! The National Association of
Public Hospitals and Health Systems is now Americas Essential
Hospitals. Although weve changed our name, our mission is the same:
to champion hospitals and health systems that provide the highest
quality of service to all by achieving the best health outcomes for
every patient, especially those in greatest need. The new name
underscores our members continuing public commitment and the
essential nature of our work to care for the most vulnerable and
provide vital community services, such as trauma care and disaster
response. This is an exciting time for us and our members, as we
lean forward into new care models, opportunities and challenges of
reform, and quality and safety innovations that often take root in
our member systems. Our new website address:
www.EssentialHospitals.org
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3 Q&A AND CHAT Please use the Q&A or Chat tools on the
webinar screen to type in your questions or comments at anytime
during this event.
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4 RAISE YOUR HAND To raise your hand you must be in the
Participants pane. Your line will be un-muted to ask your question.
Once your question has been answered, plus un-raise your hand.
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5 SPEAKER INFORMATION John W. Young, RN, MBA Improvement Coach
Essential Hospitals Engagement Network
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6 TODAYS AGENDA Background Practice Improvement Teams: Pearls
for effective partnerships Cambridge Health Alliance (Cambridge,
MA) Measurement and telling the story: Institute for Patient- and
Family-Centered Care (Bethesda, MD) Reaction from an EHEN member:
Harbor-UCLA Medical Center Q & A
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7 PARTNERSHIP FOR PATIENTS (PfP) A public-private partnership
to help improve the quality, safety and affordability of health
care for all Americans, funded by CMS Innovation Center through the
Affordable Care Act PfP Goals: Decrease 9 preventable
hospital-acquired conditions (HACs) by 40 percent Infections
(CLABSI, CAUTI, SSI, VAP) Morbidity from immobility (falls,
pressure ulcers, VTEs) Adverse events (drugs, obstetrical) Reduce
preventable readmissions by 20 percent Engage patients and families
to accomplish harm reduction goals
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8 ESSENTIAL HOSPITALS ENGAGEMENT NETWORK (EHEN) The PfP funds
26 Hospital Engagement Networks (HENs) to provide a wide array of
initiatives and activities to improve patient safety. HENs
represent 3,700 hospitals nationwide. Essential Hospitals
Engagement Network (EHEN) is the only HEN in the PfP community
focused on serving societys most vulnerable populations Special
Focus: increasing health equity
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9 SPEAKER INFORMATION Somava Stout, MD Vice President of
Patient Centered Medical Home Development Cambridge Health Alliance
Principal Faculty - Leadership, Management and Innovation, Harvard
Medical School Center for Primary Care Ziva Mann, MA Customer Lead
Cambridge Health Alliance
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Patient Partnership in PIT Teams - Lessons Learned July 25,
2013 @challiance Ziva Mann Patient Partner on PIT Team Customer
Lead, CHA Soma Stout VP PCMH Development, CHA
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11 Cambridge Health Alliance 100,000 underserved patients,
served by integrated care delivery system (10 clinics, 2 hospitals,
specialty sites) Public health Community Health (7 Cities)
Customers
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Why? We need to improve healthcare substantially, in order to
meet the needs of our patients. We can only come to the right
solutions if we are designing with the patient. NCQA core
competency every patient centered medical home has to meaningfully
engage patients in the redesign of healthcare.
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Models for partnership
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Goal Create practice improvement teams from a cross-section of
staff and patients. Patients and families working with clinic staff
to make primary care more effective. Core principle of patient
centered medical home transformation: to design with rather than
for the patient.
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Steps Along the Journey Systemwide Patient and Family Advisory
Council formed. Had health center patient and family advisory
councils, but not sustained. Walking in the Patients Footsteps
Patient and family partners as part of PCMH practice improvement
teams piloted. Spread this approach throughout primary care.
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What we learned: Patient-professional partnerships led to more
effective redesign of care. Patient/Family Partners were intimately
involved with practice redesign at every step: from observing the
patient experience, to piloting proposed changes to staff training,
to design of practice improvements. We found potential mistakes
earlier and got much deeper and richer feedback. It was
challenging, and required team-building, trust and facilitation on
both sides. Learned that we often needed to fix the basic
improvement process itself for all team members.
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17 Building trust and partnership Becoming aware of
power/hierarchy and how to equalize as much as possible. Healthcare
team members were anxious about patients seeing the sausage being
made and wouldnt want to be seen there anymore. Patients worried
about offending their healthcare team by criticizing the clinic and
about tokenism.
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18 Who is an effective patient partner? experience from
existing programs suggests that important considerations are the
patients' abilities to: work with the health care team their
breadth of experience with the health care setting their ability
and willingness to communicate concerns [their] ability to
represent patients and families broadly rather than focus narrowly
on a particular issue.1 In addition, we look for leadership,
listening skills and availability 1. Scholle SH, Torda P, Peikes D,
Han E, Genevro J. (2010). Engaging Patients and Families in the
Medical Home. (Prepared by Mathematica Policy Research under
Contract No. HHSA290200900019I TO2.) AHRQ Publication
No.10-0083-EF. Rockville, MD: Agency for Healthcare Research and
Quality.
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Lifecycle of Customer Partnership Ongoing support Departure
Team Integration Recruitment Foundation of readiness
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20 Foundation of readiness Leadership engagement to partner
with patients in systemwide design processes. Shared vision and
agreement of what the improvement work is and what role the
improvement team and patient partners will play. Understanding of
the role customer partners will play and address their concerns.
Trust, relationships, and effective structures and processes within
the Practice Improvement Team: If not, relaunch your teams to
develop this. Need at a basic level: agreement about shared
purpose, norms of collaboration and an understanding of who the
people in the room are and what they bring to the table.
Streamlined HR onboarding process for customer partners. Funding,
if needed. Ongoing support and resources available to help teams
and patient partners to develop. 12
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Recruitment: Slow down to go fast Identify 4-5 potential
patient partners. Have an informational call to introduce the
concept and invite several potential patient partners to an
interview. Explaining: who we are, team goals, team projects to
date, patient partner role in these. Interview several patient
partners and see if the partner is interested and able. Show value:
What would make it easier for you to participate? Clarify mutual
expectations. Select final patient partners; consider other roles
such as Advisory Council membership or focus group participation
for those who are not accepted. Sign agreement.
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Team integration: where am I and who am I? Orient the patient
partner to the clinic structure, systems in place, goals for
improvement. Orient the patient partner to the shared purpose of
the team, team resources, and the norms for collaboration. good
opportunity to revisit this for the whole team if you never
developed these, consider relaunching your team Orient to shared
concepts and language the patient partner may not yet understand:
jargon is a dialect! Review teams work to date and the patient
partners role in these. Provide a mentor (ombudsperson) and a team
buddy.
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Ongoing Support (for as much of the team as possible) Building
skills: active listening, managing conflict, telling your story,
looking beyond your backyard, understanding improvement and change
management. Connecting partners: networks of shared effort to
catalyze change; peer mentorship.
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24 Departure Debrief with the customer partner and the team.
Conduct an exit interview Identify possible alternate opportunities
for participation Departure feedback questionnaire Assure no change
in the relationship as it relates to their care and to the
practice. Express appreciation. Identify opportunities for future
engagement.
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How customer partners have helped change our system Helped set
the agenda for improvement Lead the team (co-chair) Refill process,
access, new patient orientation, better care transitions,
patient-centered care coordination process Give depth to the
patient experience and improvement processes Redesign of Walking In
the Patients Footsteps to formally assess effectiveness of
patient-centered interactions Break impasses and catalyze a move
forward Shared care plans for mental health Adoption of patient
portals, social media Be an active partner/leader in creating the
change Revised pediatric patient instructions to be readable to
patients Redesigned waiting rooms, mental health referrals
Educational events for patients, online resources for parents
Resources Society for Participatory Medicine and the Journal of
Participatory Medicine
www.participatorymedicine.orgwww.participatorymedicine.org
Institute for Patient- and Family-Centered Care. www.IPFCC.org
www.IPFCC.org NICHQ (PFAC toolkit and Powerful Partnerships)
www.nichq.org www.nichq.org Coming soon! Our toolkit on partnering
with patients on QI teams. Safety Net Medical Home Initiative
www.safetynetmedicalhome.org www.safetynetmedicalhome.org And your
biggest resource--YOU!
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Questions / Comments
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29 SPEAKER INFORMATION Beverley H. Johnson President/CEO
Institute for Patient- and Family-Centered Care
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Patient- and Family-Centered Care: Approaches to Measurement
Beverley H. Johnson IPFCC President and CEO Americas Essential
Hospitals Safety Network HEN July 25, 2013
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In our time together... Discuss ways to collaborate with
patients and families in developing a sustainable monitoring system
to track outcomes of patient- and family-centered practice. Learn
strategies to measure patient- and family perceptions of care as
well as the process and impact of partnering with patient and
family advisors.
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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.
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Patient and Family Engagement 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 encounterpatient 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.
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Individuals responsible for organizational measurement and
dashboards create opportunities to involve patients and families in
their work.
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Patient and family advisors meet annually with senior leaders
responsible for strategic planning to discuss the organization's
dashboard and other measures for patient- and family-centered care.
Semi-annual reports are submitted on the composition and work of
the patient and family advisory council and other advisor
endeavors. Bronson Medical Center Kalamazoo, Michigan
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Families as Full Research Partners King County Blended Funding
Project Childrens Mental Health Program Vander Stoep et al, The
Journal of Behavioral Health Services & Research, 1999.
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University of Michigan Health System Quality Measures Patients'
ratings of care. Patient complaint and commendation trends. %
compliance with advance directives. Health Education Resource
Center statistics. # of patients and family members on health
system committees and advisory groups. Interpreter services: # of
requests. # of languages provided. Strong, et al, The Joint
Commission Journal on Quality and Safety, 2009. Using the STEEP
Framework, health care should be patient- centered :
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Happy Health System Patient- and Family-Centered Care Dashboard
December 2013 PHYSICIAN SURVEY AND RETENTION RATE Happy 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 decision- making 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% Retention Rate
STAFF SURVEY AND RETENTION RATE Happy 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 decision- making 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% Retention Rate
PFCC SELF-ASSESSMENT ONLINE SURVEY PATIENT AND FAMILY ADVISORS 00
advisors and 00.00 hours and name of Patient and Family Advisory
Councils (PFACs) 00 Committees/teams with advisors Committee
name(s) 00 Partnership Oversight Committee Meetings 00
Staff/clinicians involved with collaborative endeavors Issues or
types of issues addressed/resolved: Media Coverage: How often did
nurses listen carefully to you? How often did nurses explain things
in a way you could understand? How often did doctors listen
carefully to you? How often did doctors explain things in a way you
could understand? Degree to which patient and family were able to
participate in decisions about your care. How well staff explained
their roles in your care. Degree to which the staff
involved/supported your family in planning and managing care.
Degree to which your choices were respected to have family
members/support persons with you during your care. Patient
preferences included in transition planning. Before leaving
hospital, patient understands his/her responsibilities for managing
his/her health. Patient understands purposes of medications.
PATIENT/FAMILY PERCEPTIONS OF CARE (HCAHPS and Custom Questions
Survey) 00%
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Measuring Patient and Family Perceptions of Care Degree to
which you and your family were able to participate in decisions
about your care. How well staff explained their roles in your care.
Degree to which the staff involved/supported your family in
planning and managing care. Degree to which your choices were
respected to have family members/support persons with you during
your care. Degree to which staff respected your familys cultural
and spiritual needs. NOTE: These questions, developed in
partnership with patient and family advisors, are in the Public
Domain and included in Press Ganey Custom Questions.
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Another Approach to Learning about Patient and Family
Perceptions of Care (postcard or interview format) Please share one
positive example from your recent office visit/hospital experience.
Please share one example that could have been improved. If you
could make one change in the care you received, what would it
be?
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Pilot Unit for Patient- and Family-Centered Care MCG
Neuroscience Results 2004-2010 Patient Satisfaction 10th to above
90th percentile. Length of stay decreased 50% in Neurosurgery.
Reduction in medical error by 62% for 2004-2006; 65% for 2006-2010.
Discharges (volume) increased 15.5%. Staff vacancy rate 7.5% to 0%;
5-7 RNs on waiting list. Change in perceptions of the unit by
doctors, staff, and house staff.
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Measuring QI Projects with Patient/ Family Advisor
Participation Contra Costa Regional Medical Center and Health
Centers held a value stream mapping event to improve behavioral
health emergency care involving patient and family advisors,
community providers, and Medical Center staff. Reduction by 50% in
average number of psychiatric patients who left ED prior to
receiving care; Saved 255 staff hours per month spent on obtaining
patient medical clearances in the ED; and Reduction in
assaults/aggressive acts reported in the ED. The percent of
patients going back into the community with a full discharge plan
has gone from 50% to 90%; and The percent of patients being
discharged on multiple psychotropic drugs has been reduced.
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Measurement of the Process and Impact of Patient and Family
Advisory Councils
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Measurement should be a regular agenda item for Patient and
Family Advisory Councils. An annual report should be produced to
measure and tell the story of the process and outcomes of
partnering with patient and family advisors.
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Patient and Family Advisory Council Annual Reports
http://www.ipfcc.org/advance/topics/annual-reports.html Patient and
Family Advisory Councils: A Review of 2011 PFAC Reports Available
from the Health Care for All at: www.hcfama.org
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Develop an Annual Report to Share the Story and Profile
Benefits of Partnering with Patients and Families Include the
number of: Patient and family advisors involved as well as their
roles and activities. Clinical areas represented. Staff involved in
collaborative endeavors. Issues addressed, products developed,
classes taught, peer support programs coordinated, and other
activitiesdescribe these issues, materials, activities, and
outcomes (when available). Meetings held with community leaders,
government agencies, potential funders, accreditors, others.
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Develop an Annual Report to Share the Story and Profile
Benefits of Partnering with Patients and Families (contd) Summarize
evaluations of classes taught to other patients, families,
students, staff, physicians, new employees. Count the # of people
who participate in classes. Capture quotes from participants in
classes. Summarize stories that they share. Include changes in
patient/family perceptions of care and clinical indicators. Take
photographs (or scan) of products, activities, changes in physical
spaces. Maintain a collection of all the products developed
collaboratively. Record the # of media activities where advisors
are featured.
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New IPFCC Resources with Information on Measurement
http://www.ipfcc.org/resources/guidance/index.html
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In Measuring the Change in the Organizational Culture of a
Hospital, Clinic, or Health System... Partnering with Patients and
Families is Key
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52 SPEAKER INFORMATION Timothy Thompson-Cook VP, Service
Excellence Harbor-UCLA Medical Center Dorothy Marks Patient
Advocate Harbor-UCLA Medical Center
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53 SUMMARY Carefully recruit, orient and support improvement
teams Anticipate the improvement team life cycle Measure and
celebrate successes
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54 THANK YOU FOR ATTENDING! Save the Date: Nov 7 th PFE
Execution Roundtable 2-3 pm Eastern Evaluation: Following the
webinar, when you close out of WebEx, a yellow evaluation of the
webinar will open in your browser. We greatly appreciate your
feedback! Essential Hospitals Engagement Network website:
http://tc.nphhi.org/Collaborate/NAPH-Safety-Network.aspx
http://tc.nphhi.org/Collaborate/NAPH-Safety-Network.aspx