Engaging Patients to Improve Outcomes
Essential Hospitals Engagement Network
July 25, 2013
1
OUR NEW NAME
We’ve rebranded! The National Association of Public Hospitals and Health
Systems is now America’s Essential Hospitals.
Although we’ve 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
2
“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.
3
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.
4
SPEAKER INFORMATION
John W. Young, RN, MBA
Improvement Coach
Essential Hospitals Engagement Network
5
TODAY’S 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
6
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
7
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 society’s most vulnerable
populations
• Special Focus: increasing health equity
8
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
9
Patient Partnership in PIT
Teams - Lessons Learned
July 25, 2013
Soma Stout
Ziva Mann
VP PCMH Development, CHA
Patient Partner on PIT Team
Customer Lead, CHA
@challiance
Cambridge Health Alliance
Public health
Customers
100,000 underserved
patients, served by
integrated care
delivery system
Community
Health (7
Cities)
(10 clinics, 2 hospitals, specialty sites)
11
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.
Models for partnership
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.
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 Patient’s Footsteps
• Patient and family partners as part
of PCMH practice improvement
teams piloted.
• Spread this approach throughout
primary care.
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.
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 wouldn’t want to be seen there
anymore.
• Patients worried about offending their
healthcare team by criticizing
the clinic and about tokenism.
17
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
18
Publication No.10-0083-EF. Rockville, MD: Agency for Healthcare Research and Quality.
Lifecycle of Customer
Partnership
Recruitment
Departure
Team Integration
Ongoing support
Foundation of readiness
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.
12
• Ongoing support and resources available to help teams 20
and
patient partners to develop.
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.
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 team’s work to date and the patient partner’s role in
these.
Provide a mentor (ombudsperson) and a team buddy.
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.
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.
24
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 Patient’s 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
Contact Information
• Ziva Mann
– zmann@challiance.org
• Soma Stout
– sstout@challiance.org
Resources
• Society for Participatory Medicine and the Journal of
Participatory Medicine www.participatorymedicine.org
• Institute for Patient- and Family-Centered Care.
www.IPFCC.org
• NICHQ (PFAC toolkit and “Powerful Partnerships”)
www.nichq.org
• Coming soon! Our toolkit on partnering with patients
on QI teams. Safety Net Medical Home Initiative
www.safetynetmedicalhome.org
• And your biggest resource--YOU!
Questions / Comments
SPEAKER INFORMATION
Beverley H. Johnson
President/CEO
Institute for Patient- and Family-Centered Care
29
Patient- and Family-Centered Care:
Approaches to Measurement
Beverley H. Johnson
IPFCC President and CEO
America’s Essential Hospitals
Safety Network HEN
July 25, 2013
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.
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 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 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.
Individuals responsible for
organizational measurement and
dashboards create opportunities
to involve patients and families in
their work.
Bronson Medical Center
Kalamazoo, Michigan
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.
Families as Full Research Partners —
King County Blended Funding Project
Children’s Mental
Health Program
Vander Stoep et al,
The Journal of
Behavioral Health
Services &
Research, 1999.
University of Michigan Health System
Quality Measures
Using the STEEP Framework, health care should be patientcentered:
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.
Happy Health System
Patient- and Family-Centered Care Dashboard
December 2013
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%
Issues or types of issues addressed/resolved:
How often did nurses listen carefully to you?
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.
Degree to which the staff involved/supported your family in planning
and managing care.
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.
Media Coverage:
00%
Patient understands purposes of medications.
PHYSICIAN SURVEY AND RETENTION RATE
Happy Hospital is committed to patient- and
family-centered care at all levels of the
organization. 00%
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 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
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
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 family’s 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.
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?
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 RN’s on waiting list.
▼ Change in perceptions of the unit by doctors, staff, and
house staff.
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.
Measurement of the Process
and Impact of Patient and
Family Advisory Councils
▼ 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.
Patient and Family Advisory Council
Annual Reports
Patient and Family Advisory Councils:
A Review of 2011 PFAC Reports
Available from the Health Care for All at:
www.hcfama.org
http://www.ipfcc.org/advance/topics/annual-reports.html
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
activities—describe these issues, materials, activities,
and outcomes (when available).
▼ Meetings held with community leaders, government
agencies, potential funders, accreditors, others.
Develop an Annual Report to Share the
Story and Profile Benefits of Partnering with
Patients and Families (cont’d)
▼ 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.
New IPFCC Resources with Information on Measurement
http://www.ipfcc.org/resources/guidance/index.html
In Measuring the Change in the
Organizational Culture of a Hospital,
Clinic, or Health System . . .
Partnering with Patients
and Families is Key
SPEAKER INFORMATION
Timothy Thompson-Cook
VP, Service Excellence
Harbor-UCLA Medical Center
Dorothy Marks
Patient Advocate
Harbor-UCLA Medical Center
52
SUMMARY
• Carefully recruit, orient and support improvement teams
• Anticipate the improvement team “life cycle”
• Measure and celebrate successes
53
THANK YOU FOR ATTENDING!
• Save the Date: Nov 7th 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
54