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Engaging Patients at Every Level - Pt. 1MarthaHayward,IHILeadforPublicandPatientEngagement
September 20, 2017
Thispresenterhasnothingtodisclose
MHAFallConvention
Engaging WITH Patients at Every Level - Part 1
Framework for Public/Patient Engagement4
Patients engaged at improving their own care; Hospital /Clinic/ Office/ Home
PFAs engaged in Improvement ScienceDesign of protocols
PFAs making Organizations AccountaPolicy, Leadership
PFAs broadcasting the need, progress and awareness to all
Public
Organization
System
Personal
PFAs = Patient and Family Advisors
Everyone plays a role
Engaging Patients and Families – What Matters to You?
Engaging Staff – Storytelling
– Best Practices/co-design
Engaging Patient /Family Advisors– PFACs
– Always Events
Engaging the Public – Conversation Project
Session 1
In this session we will focus on:– PERSONAL
– SYSTEM
Session 2 will focus on :– ORGANIZATION
– PUBLIC
Patient and Family Centered Care Is…
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Location Examples
Environment Community, Region, State, Province
•Community groups
•Care Coordination, ACOs, Medical Homes
•Advanced care planning, POLST, MOLST
•School & church programs
•Public health & other consumer campaigns
Organization Health System, Trust, Hospital, Nursing Home
•Experience Surveys, Advisor patient experience rounds
•PFACs, Advisors, faculty, board meetings, operating committees
•Resource Centers, patient portals
•Access to help and care 24/7
•Medication lists
Micro-system Clinic, Ward, Unit, ED, Delivery
•Parent, Advisors, & advisory councils
•Open access, optimized flow
•Family participation in rounding
Experience of care
Bedside, Exam Room, Home
•Access to the chart
•Shared care planning
•“Smart Patients Ask Questions”
Balik B, Conway J, Zipperer L, Watson J. Achieving an Exceptional Patient and Family Experience of Inpatient Hospital Care. Cambridge, Massachusetts: 2011.
Frontline Practices Positively Impacting Patient & Family Experience
IHI Change PackageOpen visitationBedside care roundsBedside shift changeLiteracy assessmentUpdate shared care planTransition plan / planningKnow patient comfort (cultural) expectationsNarrate careAnticipate & address concernsInterdisciplinary practice
Other Practices
Ask patient / family ?s you haveMaintain white boardAsk what’s working?/ to be improvedEmbrace family care participationAlways make introductions“If something is wrong, tell me”Provide access to health recordsEstablish peace and quiet timesUtilize patient / family faculty , patient and family advisors, Councils
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IHI Patient Experience Change Package, Rutherford and Taylor, & Others
The Big Takeaway
To
For
WITH
Moving from ‘doing for’ to ‘doing with’
The balance of knowledge11
PATIENTValuesFearsPersonal ExperiencePreferencesPersonal Circumstances
CLINICIANTrainingClinical ExperienceExpertiseScientific Knowledge
PARTNERSHIP
Patient Experience Defined
Patient Satisfaction
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Satisfaction is about whether a patient’s expectations about a health encounter were met.
Agency for Health Research and Quality. https://www.ahrq.gov/cahps/about-cahps/patient-experience/index.html
Let’s begin with a story
Engaging patients in their own care
Patients are already engaged
The question is, “how do we co-produce health?”
What Matters to You?
n engl j med 366;9 nejm.org march 1, 2012
Enhancing conversations between patients and clinicians from -- “What’s the matter?” to also including “What matters to you?”
Why?
Connect the heart, the soul, the human
Engage family, staff, patients
Understand driving forces
Establish trust
Personal goal setting
Envision the future
Saves time
When?
From the micro to the macro– Procedures
– Transitions
– Annual Visits
– End of Life
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How?
What is the best question? – “What more can I do for you?” is never the right question.
End of Life –– What will make this a good day for you?
At rounds –– What is your greatest concern right now?
Prior to surgery –– What will success look like to you?
What might you ask?
P19
What Matters: A Call to Action
What if every clinician, staff member and community health worker routinely asked “what matters to you?” and listened attentively at every encounter with individuals and their family members?
What would we learn? How would this understanding enhance our ability to develop genuine partnerships with patients toco-create a more customized plan to meet their expressed needs, values, and preferences?
www.ihi.org/whatmatters
Storytelling
Why We Tell Patient Stories
Connect to process
Engages head and heart
Enables empathy
Return to ‘why’
Demonstrate the humanity of our work
Reflects culture
Inspire us to act
Where We Tell Patient Stories
Clinical interaction – one on one – deep listening– Saves time– Provides vital information– Builds trust
Team Interaction– Provides focus and meaning to process– Engages hearts and minds– Enhances improvement
Leadership– Inspires– Models meaning in work– Offers a reference point
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Workload of Cristin Lind (Mother of a Child with Special Needs)
http://www.childrenshospital.org/care-coordination-curriculum/care-mapping
Knowing a person’s “story not only teaches us how to act-
it inspires us to act”Marshall Ganz
P25
Always Events
Always Events®
Always Events® are defined as “those aspects of the patient and family experience that should always occur when patients interact with healthcare professionals and the delivery system.”
Doing To Doing For Doing With
From design to implementation,
Always Events are all about “doing with’.
Engaging patients with everyone29
Always is so much better than Never
Positive
Patients experience what is…not what is absent
Definable, visible, measurable
Always Events Criteria
Important: Patients and families have identified the experience as fundamental to their care
Evidence-based: The experience is known to be related to the optimal care of and respect for patients and families
Measurable: The experience is specific enough that it is possible to accurately and reliably determine whether or not it occurs
Affordable: The experience can be achieved without substantial capital expense
Picker PrinciplesRespect for patients’ values, preferences and expressed needs
Coordination and integration of care
Information, communication and education
Physical comfort
Emotional support and alleviation of fear and anxiety
Involvement of family and friends
Transition and continuity
Why Always Events?
Raise the bar on both provider and patient expectations
Introduce a new organizing principle to help galvanize action and accountability
Demonstrate how the AE concept can be implemented in practice
Widely disseminate AE strategies for national replication
Energize and expand the movement toward a more patient and family centered system
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Big Picture: Link between
Always Events and Reliable Process
Performance
Understand Patient
experience “What matters
to me”
Develop Always Event(s)
Integrate Always Event(s) into
Work Process(es)
Define Work Process (simplify and standardize)
Define Defects and How to Mitigate
Measure and Communicate
From Patient to Process
Do the Work
From Intention to Reliable Performance
Study/Act
Do
Plan
Public Engagement
The Conversation Project
A national public engagement campaign dedicated to assure that everyone’s wishes for end-of-life care are:
Expressed and Respected.
Boards with community representation, business representation, patient and family representation, and physician representation will enable their organization to respond to the new challenges more effectively
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Schummers D. Governance Across the Continuum. The Governance Institute and IHI. June, 2014
37
The single most important factor that distinguishes major culture changes that succeed from those that fail is competent leadership at the top. No single effort at culture change has been successful starting at the bottom
John P. Kotter & James L. Heskett,
Corporate Culture & Performance (Free Press 1992)9/7/2017 ISQUA 38
Public Engagement
Changing the Cultural Norm
A national campaign encouraging everyone to have a conversation about their wishes for end-of-life care
Collaboration to ensure health care systems are ready to receive and honor wishes for end of life care
The Talking Gap
90% of people think it is important to talk about their loved ones’ and their own wishes for end-of-life care.27% of people have discussed what they or their family wants when it comes to end-of-life care.Source: The Conversation Project National Survey (2013)
TCP’s Strategy for Creating Cultural Change
Awareness: National media campaign and community engagement events
Accessible: Tools to help people get started
Available: Bringing TCP to people where they work, where they live, and where they pray
Accessible: Our ToolsConversation Starter KitHow to Talk to Your Doctor Starter KitTranslationsPediatric Starter Kit
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The Starter Kit: Get Ready
The Starter Kit: Get Set….
The Starter Kit: Go
Next Steps…
Have the Conversation
Share Starter Kit & other tools with family and loved ones.
Share your stories on our website, join our monthly webinar
A Soul Doctor and a Jazz Singer
“What would be a good day for you?”
https://www.youtube.com/watch?v=QzdIdb2s144
Patient Experience Strongly Correlated With Other Outcomes
Health outcomes
– Patient adherence
– Process of care measures
– Clinical outcomes
Business outcomes
– Patient loyalty
– Malpractice risk reduction
– Employee satisfaction
– Financial performance
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Edgman-Levitan S., Shaller D. et al. The CAHPS Improvement Guide. Boston: Harvard Medical School: 2003.
Sample of Self-assessment Tools
Family Voices– http://www.familyvoices.org/admin/work_family_centered/files/fcca_FamilyTool.p
df
HRET & Moore Foundation– http://www.hret.org/quality/projects/moore_foundation_patient_family_engagement_survey.s
html
Institute for Healthcare Improvement– http://www.ihi.org/resources/Pages/Tools/PatientFamilyCenteredCareOrganizatio
nalSelfAssessmentTool.aspx
Institute for Patient and Family Centered Care– Leadership with AHA http://www.aha.org/content/00-10/assessment.pdf– Multiple health and care options http://www.ipfcc.org/resources/assessment.html
Planetree– http://planetree.org/designation-criteria-and-self-assessment-tool/
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Financial Benefits of Patient-Centered Care in Planetree
Reduced length of stay
Lower cost per case
Decreased adverse events
Higher employee retention rates
Reduced operating costs
Decreased malpractice claims
Increased market share
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Charmel P, Frampton S. Building the Business Case for Patient Centered Care. HFM. March, 2008