Partnering with Patients

© 2011 PeaceHealth 1

Partnering with Patients

ASHNHA Quality MeetingBarb Forss, Patient Advisor , PeaceHealth

Marla Sanger, CEO, Wrangell Medical CenterDecember 5th, 2013

2© 2011 PeaceHealth

Key Topics

• Historical Perspectives on Patient Involvement

• Design of Human Experiences vs. Processes

• Patient/Family Partnership: What and How

• National Momentum: Patient/Family Partnerships

• Patient- and Family-Centered Care

• Learning From The Patient Experience


Historical Continuum of Patient Influence

Complaining

Giving Information

Listening and responding

Consulting and advising

Paul Bate, Glenn Robert – Quality and Safety in Health Care 2006; 15:307-310. Doi:10.1136/qshc.2005.016527


PeaceHealth Values & Promise

Respect Stewardship

Collaboration Social Justice

From Our Promise on peacehealth.org

“We are sensitive to the unique preferences of individual patients, and treat patients and family members as active, informed participants in the care process.”

The Language of Partnership


Safe (Evidence-based), Compassionate Care

It’s more than the right treatment

for the right patient at the right time

Reliability Science – every time

Design Science and Usability – every touch


Healthcare is familiar with: • Performance (evidence-based practice, pathways and

process design)

• Engineering (clinical governance, standards, safeguards)

Healthcare is not as familiar with: •Design of human experiences, as distinct from designing processes

Design Sciences

Components of Good Design Performance

+

Engineering

+

The aesthetics of

the experience

How well it does the job or is fit for purpose

How safe, well engineered and

reliable it is

How the whole interaction with the product or

service “feels” or is experienced

Functionality Safety Usability

Berkin S. Programmers, designers and the Brooklyn Bridge. 2004. http://www.scottberkun.com/essays/essay30.htm Bate SP, Robert G, Bevan H. The next phase of health care improvement: what can we learn from social movements? Qual Safety Health Care 2004; 13:62-6


Targeting the Experience

A perfect process (fast, efficient, smooth flow) or pathway that is evidence-based does not always produce a positive experience

http://crossroads/PatientExperience/


Experience-Based Design

User-focused design process with the goal of making the user experience accessible to the designers allowing experiences, rather than services, to be imagined and designed


Historical Continuum of Patient InfluenceComplaining

Giving Information

Listening and responding

Consulting and advising

. . . . . Experience-based co-design



Co-designing Services with Patients

Next generation of improvement methods:

Perception, Attitude, Expectations, Experience

A particular kind of knowledge acquired

from close and direct personal

observation or contact.



Patient Stories Inspire Improvement

http://www.webmm.ahrq.gov/perspective.aspx?perspectiveID=58



Patients influence quality, safety and the

healthcare experience by telling their stories

and participating on:

– Performance improvement teams

– Ambulatory, hospital, and community advisory

teams

– Nationally recognized collaboratives

– Medical staff committees (P&T, Medical Executive

Committee, etc.)


How Do We Find Each Other?

• Word of mouth and focus groups

• Volunteers interested in larger commitment

• Patients in our care who seem like a good fit

• Healthcare experience + personal passion

• Individuals involved in patient advocacy


Volunteer Application as Entry Point

Patient is recruited by an

employee who identifies

he/she would be a good

team member

Patient contacts Volunteer

Office and expresses an

interest in improvement

or “other projects”

Volunteer application is completed and turned in. After

one week, the patient makes an appointment with the

Director of Volunteer Services for an interview


Screening for Interest, Availability, Fit • How did you learn about participating on an improvement

team or committee within PeaceHealth?

• Why are you interested in being involved?

• Tell us about a time when you had a positive experience

working with others to promote a common cause, goal or

solve a shared concern / problem.

• Are there barriers such as transportation, timing of meetings,

language or illness that need to be accommodated to allow

your participation?


Orientation to the Organization - Examples

• Organizational integrity, HIPAA, and confidentiality training

module with quiz

• Signed confidentiality agreement (annual requirement)

• TB tests and background check

• Half to full day Volunteer / HR Orientation

• Photo ID badge is issued

• Method for tracking hours is explained

• Improvement team or committee orientation


Patients as Partners on Teams

• Patients on Quality

Improvement Teams

• Staff acceptance of

patient partnership

• Medical Staff

acceptance of patient

partnership


Patients as Partners on Safety and Quality Improvement Teams• IHI Intensive Care Collaborative

• Imaging Re-design Team

• Healing Healthcare Task Force

• New Dept Customer Service

• Emergency Dept Council

• Medication Reconciliation

• Organ Donation Council

• Medication Delivery Team

• Patient Care Committee

• Safe Patient Handling

• Seclusion / Restraint

• PACU / ACU Redesign

• Rapid Response Team

• Joint Camp

• Rehab Quality Council

• Stroke Care

• Surgical Care Improvement

Project


Patients as Partners on Planning, Leadership, and Regulatory Teams

• PeaceHealth

System-wide

Collaboratives

– Medication Safety

– Discharge Process

• Mission/Values Audit

• CEO Search

• TJC System Tracers

• Regional Advisory Boards

• Regional Advisory Councils

• Hospital Quality Committees

• PHMG Quality Committees

• Medical Staff Committees

– Medical Executive Committee

– Pharmacy & Therapeutics


Medical Staff Leaders Drive Quality


Medical Executive Committee Orientation• Tour of hospital facility

• Booklet with organizational information provided

• Test booklet for orientation provided

• Fraud and abuse DVD and Security training

• Tours and Observations:

– Emergency Department, Cardiovascular Services,

Orthopedic Surgery Services, Intensive Care Unit

• Introduction to Medical Executive Committee (hot topics,

agenda items, expectations)

• Introduction to Peer Review, Risk Management,

Credentialing and Privileging



2001 IOM Chasm Report Six Aims are STEEEP

Care that is: Safe

Timely

Efficient

Effective

Equitable

Patient (& Family) Centered

Patient Involvement Patient Centered

Crossing the Quality Chasm

Crossing the Quality Chasm: A New Health Care System for the 21st Century Institute of Medicine, March 2001


Ten Rules for Health Care in the 21stCentury1. Care is based on continuous healing relationships.

2. Care is customized according to patient needs/values.

3. The patient is the source of control.

4. Knowledge is shared and information flows freely.

5. Decision making is evidence-based.

6. Safety is a system property.

7. Transparency is necessary.

8. Needs are anticipated.

9. Waste is continuously decreased.

10. Cooperation among clinicians is a priority.

Crossing the Quality Chasm: A New Health Care System for the 21st Century Institute of Medicine, March 2001

Crossing the Quality Chasm



NQF Convenes National Priorities Partnership in 2008

National Institutes of Health Leapfrog Group

Centers for Medicare & Medicaid Institute of Medicine

National Governors Association CDC

National Quality Forum Joint Commission

Agency for Healthcare Research and Quality

Physician Consortium for Quality Improvement convened by the AMA

. . . . . and 22 other organizations!

http://www.qualityforum.org/Setting_Priorities/Addressing_National_Priorities.aspx

•Engaging patients and families in managing their healthcare and

making decisions about their care

•Improving the health of the population

•Improving the safety and reliability of America’s healthcare system

•Ensuring patients receive well-coordinated care within and across

all healthcare organizations, settings and levels of care

•Guaranteeing appropriate and compassionate care for patients with

life-limiting illnesses

•Eliminating overuse while ensuring the delivery of appropriate carehttp://www.qualityforum.org/Setting_Priorities/Addressing_National_Priorities.aspx

NQF Convenes National Priorities Partnership in 2008


Patient (and Family) Partnership

There are many

ways that hospitals

and clinics can

involve patients in

their own care

Institute for Patient- and Family-Centered Care:

“Patient- and Family-Centered Care is not System-Centered Care, Patient-Focused Care or Family-Focused Care” Patient- and family-centered care

is working with patients and families, rather than doing to or for them

http://www.ipfcc.org/


Patient / Family-Centered Care Core Concepts•People are treated with respect and dignity

•Collaboration among patients, families, andproviders occurs in policy and program development, professional education and in the delivery of care.

•Individuals and families build on their strengthsthrough participation in experiences that enhance control and independence.

•Health care providers communicate and sharecomplete and unbiased information with patients and families in ways that are affirming and useful.


FamilyFriendsPatient

NeighborsCo-workers

First Hand Knowledge of the Experience

04/20/23 33


Powerful first impression . . .

What is a Family?

The unit consisting of parents and their children; persons related

by blood or marriage; the group of persons who live in one

household or under one head. -Webster’s Dictionary, 1971

Two or more persons related by birth, marriage, or adoption who

reside in the same household -US Census Bureau

A family is a group of people who make an irrational commitment to

each other’s wellbeing to the point of making each other crazy.

-Uri Bronfenbrenner


Families are not visitors They are allies in quality and safety


What Patients and Families Want to Know

What is the problem?

How can it be diagnosed and treated?

``````````````````````````````````````````````````````How can I contribute to the process to enhance the quality and safety of care?

When / where / how will we communicate?

Will you listen?

What does this mean for my family’s life?

What is the plan?

How will we best continue care at home?


“Two words, information and communication are often used interchangeably, but they signify quite different things. Information is giving out; communication is getting through.”

. . . Sidney Harris


Tips for Avoiding Success


Tips for Achieving Success

• Honor natural supports

• Share knowledge and information

• Treat each person as an individual

• Say “I’m sorry” when a mistake is made

• Assist in problem solving and teach choice

• Say “I don’t know” when you don’t know

• Make the primary care/specialist relationship work

• Respect patient/family knowledge of own health needs

• Develop roles for patient and family consultants


“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.”

Leape L, Berwick D, Clancy C, et al. Transforming healthcare: A safety imperative. Quality and Safety in Health Care.

2009;18:424-428.

Transforming Healthcare: A Safety Imperative

http://www.ihi.org/IHI/Topics/PatientSafety/SafetyGeneral/Literature/TransformingHealthcareASafetyImperative.htm


Co-Designing Services with Patients

Next generation of improvement methods:

Perception, Attitude, Expectations

Experience

– A particular kind of knowledge acquired from

close and direct personal observation or

contact. It is expressed in what a person

thinks, feels and says about the experience of

a service, process or product


Purchased Poster


New Poster


Imagined by Patient Advisors


Partners in Quality Improvement


“Act Into New Thinking”Goran Henriks, Chief of Learning and Innovation, Jonkoping County Council, Sweden

Documents

Partnering with Patients