Staff Competencies for Patient and Family Centered Care

1. Staff Competencies for Patient and Family Centered Care Ann Buzaid & Kirk Hennig Co-leads of the Rehabilitation Services Patient and Family Advisory Council at University of Washington Medical Center

2. University of Washington Medical Center Department of Rehabilitation Medicine • Inpatient Acute Rehabilitation Unit: 20 Bed, CARF Accredited Unit Team approach with patient & family including: Physiatrist Occupational Therapist Physical Therapist Speech Language Pathologist Recreational Therapist Nurse Psychologist Rehabilitation Counselor Prosthetics and Orthotics

3. Department of Rehabilitation Medicine • Outpatient Services Outpatient Rehabilitation Medicine and Therapy clinics • Inpatient services provided throughout the Medical Center

4. Rehabilitation Services Patient & Family Advisory Council • Founded in January 2003 • Composed of 10 patient and family advisors, the medical director, occupational therapy manager, and 4 direct care staff. Ad hoc members include the inpatient nurse manager, outpatient medical clinic manager, and the patient care services administrator.

5. Rehabilitation Patient & Family Advisory Council • Meets monthly • Develops annual work plan • Participates in facility and departmental initiatives • Members of the Rehab Advisory Council serve on other hospital committees such as the ADA committee, the Aesthetics committee, and other special projects

6. Development of staff competencies for patient and family centered care • Council has always been interested in developing ways of bringing patient and family centered principles into direct patient care by training staff in patient family centered principles and behaviors. • Competencies are reviewed with staff annually as part of the performance review process and training to these competencies is provided to staff. • Development of patient family centered competencies was specifically made part of the Sept 2006 work plan for the council.

7. Preparation • Reviewed outside literature • Reviewed behavioral dimensions developed by the Perinatal/NICU Advisory councils, patient satisfaction results, PFCC patient satisfaction questions, and the annual performance evaluation including the job description and competencies • Formed a sub-committee that consisted of 3 patient advisors, the Occupational Therapy Manager & council co-lead and a direct care staff person (PT)

8. Review of literature • “Templates – Philosophy of Care Statements, Definitions of Quality, and PositionDescriptions” from the Institute for Family-Centered Care developed through a subcontract with Axiom Resource Management, Inc. Sept 27, 2005-Sept 26, 2006

9. Behavioral Dimensions for PFCC Perinatal & NICU Councils • Demonstrates respectful caring. • Demonstrates collaborative orientation to working with patients and families. • Understands and describes patient perspective. • Recognizes and empathizes with multiple points of view. • Demonstrates knowledge and application of patient and family centered care. • General communication approaches.

10. Patient Satisfaction • Press Ganey survey • Patient Family Centered Care steering committee developed 5 custom questions to be included in the survey.

11. Custom Questions • How well staff member explained his/her role. • The degree to which staff supported your family. • The degree to which your choice to have family present is respected. • The degree to which staff respected your cultural and spiritual needs. • The degree to which staff supported your participation in decisions regarding your health care.

12. Job Descriptions/Performance Evaluations/Competencies • 12 page document that is reviewed with staff upon hire, 6 mos, and then annually • Occupational Therapist II job description was selected to represent Rehabilitation Services • Manager is on Rehabilitation Advisory Council • Majority of Occupational Therapists are Occupational Therapist II • Duties represented would be able to be generalized to other job descriptions

13. Format • Job Summary • Duties and Responsibilities • UWMC–Wide Competencies • Professional Requirements

14. Human Resource considerations • Meeting with human resource manager: • Not able to change the UWMC-wide as the competencies require an approval process that had already been completed. • Hospital is in process of standardizing total number of duties and responsibilities to 12. • Need to use the current rating scale.

15. 4 hour sub-committee retreat • Changed language of the Job Summary – was important that the first sentence start with the inclusion of patients and their families (see handouts). • Identified 8 out of 18 duties and responsibilities that contain patient and family competencies.

16. Sub-committee retreat • Introduced 1 new competency to professional requirements. • Revised the Service Orientation and Relationships and Teamwork competencies under UWMC-Wide as a recommendation to Human Resources. • All changes made by the sub-committee were reviewed by the full Rehab Patient Family Advisory Council.

17. Original Job Summary • Job Summary: Responsible for evaluation, planning, directing and administering occupational therapy evaluation and intervention to patients referred by a licensed provider. Administers treatments, training and physical agents as determined by the evaluation in an effort to restore function and prevent disability following injury, disease or physical disability. Evaluates and administers treatment for functional living skills such as self care, homemaking, range of motion, muscle testing, cognitive, visual perception, vocational and avocational skills, splinting, assistive technology and community integration. Reports data in both written and oral form following the policy and procedures of the OT department and the Medical Center. Provides supervision to less experienced therapists, students, COTAs, aides, and volunteers. Participates in the operational aspects of the department, maintains performance improvement activities within the department and participates in Quality Improvement activities. Follows procedures and standards for cost effectiveness. Ensures that patient charges are accurate and entered in a timely basis. Participates in all infection control, departmental equipment training, organizational safety and fire safety programs.

18. Patient/Family Centered Changes to the Job Summary • Job Summary: In collaboration with patients, families (asdefined by thepatient), and staff across disciplines and departments is responsible for evaluation, planning, directing and administering occupational therapy evaluation and intervention to patients referred by a licensed provider. Administers treatments, training and physical agents as determined by the evaluation in an effort to restore function and prevent further disability following injury, disease or physical disability. Partners with the patient and family and,considering the patient’s environment, evaluates and administers treatment for functional living skills such as self care, homemaking, range of motion, muscle testing, cognitive, visual perception, vocational and avocational skills, splinting, assistive technology and community integration. Reports data in both written and oral form following the policy and procedures of the OT department and the Medical Center. Provides supervision to COTAs, aides, and volunteers. Participates in operational aspects of the department, maintains performance improvement activities within the department and participates in Quality Improvement activities. Follows procedures and standards for cost effectiveness . Ensures that patient charges are accurate and entered in a timely basis. Participates in all infection control, departmental equipment training, organizational safety and fire safety programs.

19. Original Duties and Responsibilities 2. Ability to observe and evaluate treatment effect. Communicates with physician and other team members as needed. 3. Ability to perform an appropriate evaluation on all patients as related to the therapy requested and provided and reassessments as per protocol. This includes adolescent, geriatric patients and the general patient population.

20. Patient/Family Centered Changes 1. Using feedback from the patient and family, performs an appropriate evaluation as related to the therapy requested, observes and evaluates the effect of treatment, and progresses the plan accordingly.

21. Original Duty and Responsibility 10. Interacts professionally with patient/family and involves patient/family in the formulation of the plan of care.

22. Patient/Family Centered Changes 2. Involves the patient/family in the formulation of the plan of care by interacting professionally and compassionately with the patient/family.

23. Original Duty and Responsibility 4. Able to assess patient pain interfering with optimal level of function or participation in rehabilitation – makes appropriate physician contact for intervention.

24. Patient/Family Centered Changes 3. In discussion with the patient and/or family, assesses patient pain interfering with optimal level of function or participation in rehabilitation, makes appropriate provider contact for intervention.

25. Original Duty and Responsibility 6. Formulates a teaching plan based upon identified learning needs and evaluates effectiveness of learning, family is included teaching as appropriate.

26. Patient/Family Centered Changes 4. Formulates a teaching plan, with the patient and family members, based upon identified learning needs and evaluates effectiveness of learning.

27. Original Duty and Responsibility 11. Communicates appropriately and clearly to physicians, staff and administrative team.

28. Patient/Family Centered changes 5. Communicates, orally and in writing, appropriately and clearly to physicians, staff, patients and their families, the administrative team, and outside entities. Maintains records pertinent to personnel and operation of the department.

29. Original Duty and Responsibility 8. Treats patients and their families with respect and dignity. Identifies and addresses psychosocial, cultural, ethnic and religious/spiritual needs of patients and their families.

30. Patient/Family Centered Changes 6. Interacts respectfully with patients and their families.In collaboration with patients and their families, identifies and addresses psychosocial, cultural, ethnic and religious/spiritual needs.

31. Original Duty and Responsibility 12. Coordinates and directs patient care to ensure patients’ needs are met and hospital policy is followed.

32. Patient/Family Centered Changes 7. Is attentive to ensure that the needs of patients and their families are met and hospital policy is followed. (For example: offering a glass of water, ensuring that the call light is accessible, etc).

33. Original Duty and Responsibility 14. Consults with other departments as appropriate to collaborate in patient care and performance improvement activities.

34. Patient/Family Centered Changes 10. Collaborates with patient and/or family members, and other departments, in the development of performance improvement activities.

35. UWMC-Wide Competency 24. Service Orientation – Supports the organizational and service area’s mission and vision.Demonstrates knowledge of and applies the UWMC Standards for Service Excellence: Introduces themselves; Escorts as needed; Responds and follows through with complaints; Asks what name the person wishes to be called; Refers people to those who can give assistance; Apologizes and provides additional services for patients who have been inconvenienced or who need special assistance; Assists if someone looks lost; Privacy is maintained and care-related discussions are conducted in private settings; Anything else is always the manner in which conversations are ended. Demonstrates the ARISE (Accountability Respect Innovation Service Excellence) values.

36. Patient/Family Recommendations 24. Service Orientation – Supports the organizational and service area’s mission and vision.Demonstrates knowledge of and applies the UWMC Standards for Service Excellence: • Introduces themselves. • Escorts as needed. • Responds and follows through with complaints. • Asks what name the person wishes to be called and ends conversations by asking if anything else is needed. • Refers people to those who can give assistance. • Apologizes and provides additional services for patients who have been inconvenienced. • Assists if someone looks lost or needs special assistance. • Privacy is maintained and care-related discussions are conducted in private settings. • Demonstrates the ARISE (Accountability Respect Innovation Service Excellence) values.

37. UWMC-Wide Competency 25. Relationships and Teamwork – Communicates effectively and respectfully with individuals and groups. Contributes to positive working relationships and collaborative teamwork with all disciplines and departments. Recognizes own stress and the impact on others. Identifies and manages stressors utilizing the guidance of others. Remains flexible with changes that are occurring in the department and/or medical center. Concerns/issues regarding departmental/organizational operations are communicated to the employee’s supervisor/manager.

38. Patient/Family Recommendations 25. Relationships and Teamwork – Communicates effectively and respectfully with individuals and groups. Contributes to positive working relationships and collaborative teamwork with all disciplines, departments, patients and their families. Recognizes own stress and the impact on others. Identifies and manages stressors utilizing the guidance of others. Remains flexible with changes that are occurring in the department and/or medical center. Concerns/issues regarding departmental/organizational operations are communicated to the employee’s supervisor/manager.

39. New Professional Requirement 31.Introduces self and explains his or her role to patients and their families.

40. Rollout of New Competencies • Reviewed and enthusiastically embraced by the Occupational Therapy staff. • Reviewed by the Rehabilitation leadership of Rehab Nursing, Physical Therapy, Speech Pathology, Rehab Psychology, Therapeutic Recreation, and Rehab Counseling. Commitment that all job descriptions and competencies would include the patient/family centered language by October, 2007. • Reviewed with Human Resources. UWMC-wide recommendations to be discussed in the coming year.

41. Staff development/training Training program is being developed by the Rehab Patient/Family Advisory council to include: 1) Introduces self and explaining his/her role. 2) Communicate with patients/families: allow time for explanations and questions. 3) Involves the patient/family in the formulation of the plan of care by interacting professionally and compassionately with the patient and family. 4) Staff will work with patient/families to clarify needs and ensure access in the environment. 5) Self examination of ones own biases towards other cultures and professional background.

42. Resource contact information Ann Buzaid abuzaid@u.washington.edu For templates: e-mail Sarah Kaufman at IFCC For powerpoint: Tools for Change www.familycenteredcare.org