Engaging Families As
A Strategy To Advance
Quality & Safety
Daniel Hyman, MD, MMM
September 21, 2012
Family Engagement Objectives
• Describe at least two best practices to engage
patients/families in quality and safety in your
organization
• Discuss the benefits of patient/family involvement
at the bedside and at system or strategic
decision-making levels within your organization.
• Begin to develop a plan for advancing the
engagement of patients/families in quality/safety
programs within 30 days, including recruitment,
training and orientation.
• And, do you want to talk about “risks”?
Adoption of Change
History of Family Engagement
• From innovation…. To early adoption…. To
mainstream
 Where are we in that arc?
• Pursuing Perfection and My personal experience
 IHI ~2005
• Institute for Patient and Family Centered Care
 Polly Arango – co-founder Family Voices
• MSCH/NYP
• Children’s Hospital Colorado
http://www.youtube.com/watch?v=LkhGoIXsHQo
On February 22, 2001, eighteen-month old Josie King died from medical errors.
98,000 people die every year from medical errors, making it the fourth leading
cause of death in the United States.
The Josie King Foundation’s mission is to prevent others from dying or being
harmed by medical errors. By uniting healthcare providers and consumers, and
funding innovative safety programs, we hope to create a culture of patient safety,
together.
www.josieking.org
www.josieking.org
AHRQ 2012 report
AHRQ Report Summary
Goal – promote patient/family engagement with
tools, resources, materials, training
 Support the involvement of patients and family
members in the safety and quality of their care.
 Encourage the involvement of patients and
family members in improving quality and safety
within the hospital setting.
 Facilitate the creation of partnerships between
health professionals and patients/family
members.
 Outline the steps needed to implement
changes.
Individual involvement
• Well accepted by patients and providers
 Obtaining information, involvement in decision
making
• Less comfort with confrontational behaviors
 Hand washing, surgical marking e.g.
• Barriers and facilitators
 + self efficacy, information, support/invite
 - fear, uncertainty, low literacy, norms
Organizational context
• External and influences to engaging families in
quality/safety
• Organizational processes and structures that
enable?
• Intervention strategies
Influencers
• Internal




Serious events
Business case
Improvement
Altruism
• External
 “steal shamelessly”
 Policies/regulation
 Influential
advocacy
 Public reporting
Structures/Processes
• No evidence that one or another structure is a
barrier/enabler of patient/family engagement
• Organizational ability to absorb and sustain
change, strength of leadership, resource/bandwidth
are relevant factors
Strategies
• Implementation – readiness assessment;
shared vision; execution plan; staff
engagement; leadership
• Hospital level interventions – policies,
structures; health care team level;
management processes
• Individual level interventions – educating,
informing, activating patients and providers;
facilitate communication at all levels
Our story
• At the bedside
• Microsystem involvement
• Organizational involvement
 Projects
 Committees and Councils
 Family Advisory Council
 Board level
Engaging Families at the Bedside:
Watchful Eye of the Parent
•
•
At the bedside- listening to families
•
Family centered rounds
•
Intentional inclusion in decision making
Speak Up!- How it can improve outcomes?
•
Need measurement strategy
Speak Up
Hand hygiene!
RRTs!
Patient
Identification!
Speak Up
Falls!
Pressure
Injuries!
Projects and Service Lines
• Initial involvement may best be at project
or clinical team level






Partnership for Patient Safety (staff education)
Hand hygiene
Patient Identification
Consult and team communication
Ambulatory Access
Speak Up!
• Service Line Quality Committees
What Family Advisory Councils
Can Provide Hospitals
•
Parent voice is heard by administration
•
Activities that are done by active parents
•
Parent education
Family Advisory Council Web Link(s)
• MSCH FAC-
• CHCO FAC
Parent Partnership, Colorado
FAMILY
ADVISORY
COUNCIL
Focus Areas 2012:
Family Advocacy
Policy/Procedure Input
Marketing of FAC/partnership
opportunities
Governance/Quality -Quality/Safety Committee of the Board
Councils
-Quality safety and Performance
Improvement Council
-Patient Safety Committee
Service Lines,
Projects/Initiatives,
etc.
Heart Institute QI; “Speak Up”; Hand
hygiene; Patient ID;
teamwork/communication/consult
coordination; CF, GEDP; (others are
recruiting)
“HACs”
New! (ADE, CLA-BSI)- Others to follow
Experience at Children’s Colorado
• Parent placement on multiple committees/councils
and projects
 Selection process- especially important at the
start
• Recruitment strategies
 Family Advisory Council
 Programs themselves
 Family Relations/Risk management referrals
 Ad hoc contacts
• Orientation documents and processes
 Parent orientation session- includes volunteer
training
 Committee member orientation needed too
Experience at Children’s Colorado
• Overcoming resistance /concerns
• Meeting management
 Acronyms, jargon
 Asking for input
 Managing defensiveness
 When people forget we have parents in the room….
• Debriefing is helpful after meetings
• What we really need is an objective evaluation
strategy other than that it feels good and seems
like the right thing to do!
“It will be easy working with families”
60%
50%
40%
30%
20%
10%
0%
strongly
disagree
disagree
neutral
agree
strongly
agree
Families will call out “white elephants”
1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
strongly
disagree
disagree
neutral
agree
strongly
agree
Families will express new viewpoints
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
strongly
disagree
disagree
neutral
agree
strongly agree
Meetings will be more effective
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
strongly
disagree
disagree
neutral
agree
strongly
agree
Members will have legal concerns
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
not likely
possibly
not sure
likely
definitely
Members will hesitate to share
concerns (“dirty laundry”)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
not likely
possibly
not sure
likely
definitely
Where Hospitals are Today
•
Assessing Family Engagement at Children’s
Hospitals in the US
•
33 children’s hospitals participating in a
national patient safety network
•
Family engagement is a goal
OCHSPS - QI Assessment Survey Results
for Family Engagement
Parents/Families in Leadership roles re:
safety
18
16
14
12
10
8
6
4
2
0
17
11
5
Yes
No
N/A
Parents/Families on QI teams
20
18
18
16
14
12
10
10
8
5
6
4
2
0
Yes
No
N/A
10 hospitals said
Yes to both
questions
Framework
• Self assessment framework
• Tools/Resources
Framework Assessment
Framework for assessing system level integration of family engagement
 Family engagement is a system level value operationalized at multiple levels within the organization
 AHRQ definition of Family Engagement: “A set of behaviors by patients, family members, and health professionals and a set of organizational policies
and procedures that foster both the inclusion of patients and family members as active members of the health care team and collaborative
partnerships with providers and provider organizations. The desired goals of patient and family engagement include improving the quality and
safety of health care in a hospital setting”
System Levels
Experience level of care
 Practices used by the Health Care
Team to engage families.
 Practices/policies used to
facilitate communication
between patients/families and
care providers
 Practices used to increase patient
knowledge, skills and abilities in
care coordination
Microsystem level
 Patients/families advise and engage in
development of systems to engage
families as part of the health care team,
facilitate communication, and support
care coordination
Organizational level
 Strategies used to involve family
members in management and
processes within the hospital –
feedback; participation in design,
establishing system level priorities
Examples of Practices and Processes by Organization Level
Consider Family Feedback on Dignity &
Respect; Information Sharing;
Participation
 Bedside shift-to-shift report
 Bedside team rounds
 Family activated RRT
 Tracers – to evaluate practices
 Patient empowerment training
 Care Journals
 “Quiet Time”
Consider Family Feedback on Participation;
Collaboration
 Family participation in improvement
teams
 Formal/established mechanisms to obtain
participation and feedback
Consider Family Feedback on
Participation; Collaboration
 Family Advisory Board(s)
 Family representation as Board
member or Quality Committee of
the Board member
 Families participate in prioritization
of hospital strategic initiatives
Concerns and Risks
• You tell me…. What are some reasons you would
hesitate to engage patients/families….
 In decision making and advocacy at the bedside?
 in quality/safety initiatives?
• Breach of privacy/confidentiality?
• Litigation?
• Derailing meetings?
How you can get started
• Find early adopter parent/patient/family, staff
leader
• Start with a project or task force, then another…..
• Discuss committee options
• Develop, adapt or steal orientation materials
• PDSA Cycles!
• Patient/family selection strategies
• Hospital staff preparation
• Dealing with concerns/resistance
• “Start before you’re ready”
Questions and Answers