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Creating the Culture of Change: The Role for Patients And Families. Susan Edgman-Levitan, PA Executive Director John D. Stoeckle Center for Primary Care Innovation Massachusetts General Hospital. Why Involve Patients and Families in Reducing Harm? .

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Creating the culture of change the role for patients and families

Creating the Culture of Change: The Role for Patients And Families

Susan Edgman-Levitan, PA

Executive Director

John D. Stoeckle Center for Primary Care Innovation

Massachusetts General Hospital


Why involve patients and families in reducing harm
Why Involve Patients and Families in Reducing Harm? Families

  • We can’t afford to to go on “playing short.”

  • Patients and families experience the gaps and fragmentation in the system and see things we miss.

  • Keep health care professionals, agency staff and leaders honest and grounded in reality.


Why involve patients and families in reducing harm1
Why Involve Patients and Families in Reducing Harm? Families

  • Secure timely feedback, new ideas and additional creativity.

  • Inspire and energize staff!


Risk management literature supports patient and family centered principles
Risk Management Literature Supports Patient and Family Centered Principles

  • Communication problems that can lead to malpractice allegations:

    • Failing to understand patient and family perspectives

    • Delivering information poorly

    • Devaluing patient and/or family views

    • Desertion

      (Bechman et al., Archives of Internal Medicine, 1994)


Listening posts
“Listening Posts” Centered Principles

Synthesize all feedback from patients and families in one place:

Surveys

Focus groups

Walkthroughs

Compliment/Complaint letters

Safety hotlines

Patient/Family councils

Staff feedback

Community groups


Guiding principles
Guiding Principles Centered Principles

  • Patients and families partner with healthcare professionals to set policies, design programs and establish priorities for continuous improvement

    • Create Patient and Family Advisory Councils


Guiding principles1
Guiding Principles Centered Principles

  • Patients and families as faculty for the health professions and employees

    • Participate in employee orientation

    • Share experiences in in-service programs

    • Teach medical students and house staff about partnership and disclosure


Guiding principles2
Guiding Principles Centered Principles

  • Never separate the patient and the family, unless the patient requests it.

    • Families are offered ways to keep in touch with clinical staff when they cannot be with the patient such as e-mail, beepers, voice mailboxes, and telephones.

    • Nursing units, intensive care units, and the emergency room will be open to families 24 hours a day, during shift changes, rounds, a code, and other emergency situations.


Guiding principles3
Guiding Principles Centered Principles

  • Never separate the patient and the family, unless the patient requests it.

    • Identify the primary family caregiver/ spokespersons with an ID card. Provide meals, discounted parking, skills training to support them.

    • Family members are welcomed to stay with the patient during anesthesia induction, in the recovery room, in radiology, in the emergency room, and during treatments and procedures.


Guiding principles4
Guiding Principles Centered Principles

  • Never deny the patient and family information, unless the patient requests it.

    • Offer the chart to patients for review: drug allergies, past and family history

    • On admission to the unit or to a new practice, orient the patient and the family to the ICU, the equipment, and introduce the team members.


Guiding principles5
Guiding Principles Centered Principles

  • Never deny the patient and family information, unless the patient requests it.

    • Wash and wipe boards

    • Always provide all test results

    • Offer families and patients scheduled conferences with the interdisciplinary team to discuss care


Guiding principles6
Guiding Principles Centered Principles

  • Never deny the patient and family information, unless the patient requests it.

    • Question and “doc talk” cards for patients and families

      • Procedures and Tests

      • Medications

      • Therapy: PT, OT, RT, other

      • Home care/self care

      • Restrictions: activity, dietary, other

      • Pain control

      • Follow-up


Guiding principles7
Guiding Principles Centered Principles

  • Never deny the patient and family information, unless the patient requests it.

    • Customize written discharge instructions by condition or procedure through the eyes of the patient and family.

    • Make sure the patient and family knows whom to call if they have questions.

    • Do everything possible to ensure NO SURPRISES!


Guiding principles8
Guiding Principles Centered Principles

  • Coordinate care and transfer trust

    • Share care plans and clinical pathways with patients and families

    • When possible, coordinate diagnostic procedures so that a family member can be present, if desired by the patient and family.

    • Facilitate trust by introducing the family and patient to the head nurse of the transitional unit or to new clinicians.


General safety tips for patient and families
General Safety Tips for Patient and Families Centered Principles

  • Emphasize everywhere in every way that it is OK to question any clinician or staff member: “We’re all in this together…”

  • Always question unusual or unexpected tests or medications

  • Buttons: “Ask me to check your armband.”, “Ask me if I’ve washed my hands.”

  • Tent cards in the room with a problem “hot line” contact number for patients, families, and staff

  • Executive walkarounds should include patients as well as staff


National agenda for action patients and families in patient safety

National Agenda for Action: Centered PrinciplesPatients and Families in Patient Safety

Created by the National Patient Safety Foundation

A collaboration of patients, families, patient safety experts, healthcare providers and patient advocates

Public statement and call to action


National agenda for action
National Agenda For Action Centered Principles

I. Education and Awareness for:

  • General public (patients, families, media)

  • Healthcare organizations and professionals

  • Behavioral health professionals (social workers)

    Messages:

  • Knowledge about and prevention of errors

  • Importance of patient/family perspective

  • Experiencing medical errors differs from other types of trauma


National agenda for action1
National Agenda For Action Centered Principles

II. Building a Patient and Family-Centered Culture

Actions include:

  • Patient voice heard through Patient and Family Advisory Counsels and Board representation

  • Disclosure policies

  • Communication skills

  • Effective patient advocacy

  • State patient safety task forces


National agenda for action2
National Agenda For Action Centered Principles

III. Research

Suggested areas for research include:

  • “Bridging the Gap”

  • Disclosure

  • Integrating patients and families into systems

  • Team relationships (including patients/families)

  • Post traumatic stress specific to medical error


National agenda for action3
National Agenda For Action Centered Principles

IV. Services for Patients and Families

Actions Include:

  • National Resource Center and information line

  • Peer resource counseling

  • National training programs

  • Disclosure and communication programs


Creating the culture of change the role for patients and families

NATIONAL PATIENT SAFETY FOUNDATION Centered Principles®