National Content Call

1. National Content Call Patient-and-family Centered Care April 9, 2013

2. Our Presenters Christine Goeschel ScD, MPA, MPS, RN, FAAN Assistant Professor, Johns Hopkins School of Medicine Joint Appointment, Schools of Public Health and Nursing And Gail Panoff Chair, Patient and Community Engagement Council St. Joseph Mercy Health System Ann Arbor, MI

3. Your Opinion Matters! We rely on your opinion to shape future content calls. At the end of today’s call, please complete our survey using this link: https://www.surveymonkey.com/s/CAUTI_Content

4. Session Objectives • Describe CUSP as an intervention to improve health care delivery and care outcomes • Define patient-and-family engagement • Discuss ways that CUSP can be used to support patient and family engagement • Discover how one patient and family experience council engages patients and their families in care outcomes at the hospital

5. Patient and Family Engagement and CUSP CAUTI More work, Different work, Same work? Presented by: Chris Goeschel, ScD MPA MPS RN FAAN Assistant Professor, Johns Hopkins School of Medicine Joint Appointment, Schools of Public Health and Nursing Director, Strategic Development and Research Initiatives, Armstrong Institute for Patient Safety and Quality cgoesch1@jhmi.edu

6. Challenging …So Many Solutions? CUSP

7. Culture Change Model Comparison Table

8. What is CUSP? Comprehensive Unit-based Safety Program An intervention to learn from mistakes and improve safety culture for sustained improved patient outcomes

9. What Is Patient and Family Engagement ? Patient and family engagement involves: “collaborating with patients and families of all ages, at all levels of care, and in all health care settings. [Patient and family engagement] acknowledges that families, however they are defined, are essential to patients’ health and well-being.”

10. How and Where to EngagePatients and Families • Engaging in planning and design • Infrastructure advisory • Engaging in everyday care • How-to strategies • Engaging with after an adverse event

11. Hopkins Model for Leading Change The 4 Es

12. CUSP and CAUTI InterventionsPatients and Families as “Team”

13. CUSP Science of Safety Principles of Safe Design • Standardize • Eliminate steps if possible • Create independent checks • Learn when things go wrong • What happened • Why • What did you do to reduce risk • How do you know it worked

14. What are Goals of theCAUTI Project? To reduce average CAUTI rates in participating unit by 25% through the following steps: • To educate health care workers and patients and families about the appropriate management of urinary catheters, including indications for the placement and continued use of urinary catheters • To prevent the placement of unnecessary urinary catheters • might patients and families have a role in determining “unnecessary”? • To promptly remove urinary catheters that are no longer needed • What role might patients and families play in achieving this goal?

15. Principles of Safe Design Apply to Technical and Teamwork

16. Safe Teamwork : Challenge of Communicating

17. Involving Patients and Family Members as “Team” Serve on the CUSP team Provide input to improve policies and procedures Advise on how to communicate an adverse event to a patient and family members Present at staff meetings “stories of care”

18. Teams Make Wise Decisions When There is Diverse and Independent Input • Wisdom of Crowds • Seek involvement from clinicians at all levels of the organization, and patients and families • Alternate between convergent and divergent thinking • What does everyone think? • What will be “our” policy/procedure/practice? • Get from the dance floor to the balcony level • Individual challenges • System challenges Heifetz R, Leadership Without Easy Answers,1994.

19. Core Concepts of Patient and Family Engagement Dignity and respect Information sharing Participation Collaboration

20. Dignity and Respect Health care practitioners listen to and honor patient and family perspectives and choices. Patient and family make-up, knowledge, values, beliefs, religious and cultural backgrounds are incorporated into the care planning and delivery.

21. Information Sharing Health care practitioners share complete and unbiased information with patients and families in ways that are easily understood and address concerns or questions. Patients and families receive timely, complete, and accurate information to participate in care and decision making.

22. Participation Patients and families are encouraged to participate in care and decision making at the level they choose.

23. Collaboration Patients, families, health care practitioners, and health care leaders collaborate inpolicy and program development, implementation, and evaluation

24. Summary • Safety is a property of system • We need lenses to see the system including patient and family lenses • We need to provide a safe space for all stakeholders, including patients and families to share their voice • CUSP is a structured approach to learn from mistakes and improve safety culture • Educating on the Science of Safety is Step 1

25. Action Items • Have all members of the CUSP CAUTI Team view the Science of Improving Patient Safety video • Imagine all of the places where “patient lenses” would add dimension to your improvement efforts • Develop a plan to invite patients and families to join your team • Consult with your CUSP executive to gain support for your plan • Consider whether the Science of Safety Video might be valuable for patient/family advisors

26. Additional Resources CUSP tools are available online by visiting the AHRQ Web site: www.ahrq.gov/cusptoolkit.

27. The Role of the Patient Experience Advisor Gail Panoff Chair, Patient and Community Engagement Council Saint Joseph Mercy Health System Ann Arbor, MI

28. Overview of the Council • Council is a part of Saint Joseph Mercy Hospital Health Systems • Foundation: around 2010 • The PCEC and St Joseph Mercy Health System share a common goal to assure the voice of the patient and family are heard to help shape how care and service are delivered • 15 Council members / 55 Patient Advisors • Our council meets for 2 hours, once a month

29. Reporting Mechanism (Structure) • The executive director for patient and community is the champion for this effort and serves on the council • Council is directly accountable to the executive director of the patient and community engagement at the hospital • The executive director, chairperson or delegate presents a report to the quality and safety committee of the system board annually on council activities and outcomes

30. How to Recruit and Become an Advisor • Recruitment • Brochure • Website • Hold message • Referrals • Service recovery following complaint • Application process • Interview • Orientation/ training • Executive director of patient and community engagement facilitates this process

31. Roles of an Advisor • Committee Member • Focus Groups • Communication Reviewer • Experience Sharing

32. Representation of the Patient and Community Engagement Council • Council Members – 1/3= staff 2/3=patients & family members • Departments include: • Clinical Quality Safety and Risk • Nursing • Service Excellence • Medical Staff • Patient and Community Engagement *Other departments are brought in as needed to learn, observe and participate. Example: representatives from other hospitals and executive leadership participation in meeting*

33. Representation of the Patient and Community Engagement Council (continued) • Patients and family • Goal: 2/3 patients or family members • Diversity • Very important component • Age, gender, varied experiences, race, ethnicity, religion- representation from all communities

34. Contributions of the Council • Welcome Video to welcome new patients to the hospital • C- Diff flyer • Brochure on Pressure Ulcers • Noise Reduction Sleep Time Sign • Nurse Residency Program- Testimonials • Food and Quality Improvements  • Discharge Pharmacy Program • Patient’s Rights and Responsibilities Brochure • Patient Discharge Instructions • Simulations- Disaster recovery (example: tornado)

35. Councils that Advisors Serve on • Advisors serve on the following councils: • NICU CPT • Stroke CPT • Pain CPT • Ann Arbor Quality and Safety Committee • Ambulatory Patient Experience Committee • Comprehensive Breast Care Center Steering Committee • Ann Arbor Patient Satisfaction Improvement Team • Patient and Community Engagement Council • Patient Experience CPT • Rehab Steering Committee • Cardiovascular Patient Education Committee • NICU Family Advisory Board

36. End Result We believe that by engaging patients and their family members in the care process and improving education about health care needs, patients can continue to take an active role in the decisions that effect their care Patient and family engagement is a powerful tool for improving all facets of care

37. For More Information Contact: Susan Kheder, LMSU Executive Director, Patient & Community Engagement Saint Joseph Mercy Health System Ann Arbor, MI Kheder@trinityhealth.org 734-712-4945

38. Questions?

39. Your Opinion Matters! We rely on your opinion to shape future content calls. At the end of today’s call, please complete our survey using this link: https://www.surveymonkey.com/s/CAUTI_Content