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Demonstrating a Difference: Developing an Organizational Framework for Evaluation of the Impact of Patient and Family Centred Care. Jocelyn Bennett RN MScN, CON(C) – Senior Director, Acute and Chronic Medicine and Nursing

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Demonstrating a Difference: Developing an Organizational Framework for Evaluation of the Impact of Patient and Family Centred Care

Jocelyn Bennett RN MScN, CON(C) – Senior Director, Acute and Chronic Medicine and Nursing

Tracy Kitch RN, MScN – Senior Director, Women's and Infants Health and Nursing

Maureen Riley – Parent Advisor


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Outline Framework for Evaluation of the Impact of Patient and Family Centred Care

  • Context of PFCC at Mount Sinai Hospital

  • Evaluation Framework

  • Examples

  • Successes and Lessons Learned


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Health Care in Ontario Framework for Evaluation of the Impact of Patient and Family Centred Care

  • Regionalized system – increased integration of care across the continuum

  • Single payer through the Ministry of Health and Long Term Care ($37.9 B in 07/08)


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External and Internal Driving Forces Framework for Evaluation of the Impact of Patient and Family Centred Care

  • Culture of accountability – fiscal, quality and safety

  • Alignment with organizational strategy

  • “stickiness factor”


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The Challenge at MSH Framework for Evaluation of the Impact of Patient and Family Centred Care

  • How will we know that this will make a difference?

  • Intuitively – it makes sense but intellectually – how will I know that this is advancing our performance as an organization

  • You can’t manage what you don’t measure – striking a balance


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PFCC at MSH Framework for Evaluation of the Impact of Patient and Family Centred Care

  • Key deliverable – the evaluation framework

  • Integration of existing tools

    • Balanced Scorecard

    • NRC Picker Patient Satisfaction Survey

    • Canadian Council on Health Services Accreditation – Required Organizational Practices for Patient Safety


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MSH Balanced Scorecard Framework for Evaluation of the Impact of Patient and Family Centred Care


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Complexities of Measurement Framework for Evaluation of the Impact of Patient and Family Centred Care

Challenges to evidence improvement

Versus

Systems that don’t lend themselves easily to measurement


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Where to Focus? Framework for Evaluation of the Impact of Patient and Family Centred Care

  • Organizationally – how to affect change?

  • Organizational subsets or microsystems

    • where patients, families and staff interact

  • Allows for rapid cycle improvement of issues and continued growth over time


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Framework for Indicators Framework for Evaluation of the Impact of Patient and Family Centred Care

Process

Outcomes

Structure

Corporate

Micro Systems

(i.e. team, unit, dept)

SpecificInitiatives


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Strategy for PFCC Evaluation Framework for Evaluation of the Impact of Patient and Family Centred Care

  • Goal to be Achieved

    • At the level of the organization

  • Principle to Operationalize

  • Strategy

    • Team based level

  • Measurement Metrics

    • Structure, process and outcome objectives

  • Link to Balanced Scorecard


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Goal to be achieved Framework for Evaluation of the Impact of Patient and Family Centred Care

Mutually beneficial Partnerships

Principle to operationalize

Participation in care

Strategy to enact

Patients/Families on Rounds

Daily goal setting

Metrics (structure, process &/or outcome)

Patient Satisfaction

Chart audits

Implementation of tool/process

Balanced Scorecard

Strategy for PFCC Implementation and Evaluation

Goal  focus on the organization

Strategy  focus at the microsystem


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Parent Evaluations Framework for Evaluation of the Impact of Patient and Family Centred Care: Examples from the NICU

  • Parent Buddy Program

  • Parents on Rounds

  • Accreditation

  • Patient Satisfaction Survey

  • Annual Dialogue with NICU Leadership


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Parent Buddy Program Framework for Evaluation of the Impact of Patient and Family Centred Care

  • Parent Initiated in 1990

  • Shared common experience provides support

  • Critical role of parents in shaping the evaluation strategy

Effectiveness of a Parent Buddy Program for Mothers of very preterm infants in a neonatal intensive care UnitA non equivalent control group design (CMAJ April 2003)


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Parents On Rounds Framework for Evaluation of the Impact of Patient and Family Centred Care

  • IFCC conference Boston (2003)

  • Parent persistence kept this issue on the team agenda, despite the challenges in implementation

  • Pre and Post surveys of staff and parents

  • Importance of using post survey data to monitor team performance


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Accreditation Framework for Evaluation of the Impact of Patient and Family Centred Care

  • 2 Parent Advisors attend monthly multi-disciplinary team meetings

  • Have participated in 2003, 2006 accreditation

  • “This dynamic team absolutely works as a team. Parent Representatives are actively engaged.” (CCHSA, 2006)


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NRC Picker Survey Framework for Evaluation of the Impact of Patient and Family Centred Care

  • Questions customized for NICU population

  • Results reported to Neonatal and Management teams quarterly


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Annual Dialogue with NICU Administration Framework for Evaluation of the Impact of Patient and Family Centred Care

  • Chief of Paediatrics and NICU NUA attend

    • Parents share accomplishments and future projects

    • Staff share developments in NICU

  • Opportunity to for parents to become partners in planning and evaluation

    • establish goals for the next year

    • proposal for parent position discussed this year


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Lessons Learned Framework for Evaluation of the Impact of Patient and Family Centred Care

  • If you chase two rabbits both will escape

    • Focus our energies

    • Choosing an enterprise wide goal with a focus on strategy at the microsystem

  • Differentiate indicators being monitored versus actioned

    • Many feel overwhelmed by the challenge of measurement

    • Start simple and grow


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Lessons Learned Framework for Evaluation of the Impact of Patient and Family Centred Care

  • Build into current reporting processes and accountability structures

    • Reporting on the balanced scorecard

    • Consider inclusion of indicators “under development”

  • The importance of evidence

    • “What’s in it for me?” (WIIFM)

    • Ability to engage all team members

    • Penetration into business models


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Leadership Framework for Evaluation of the Impact of Patient and Family Centred Care

  • Strategy and action intersect

  • Continue to take opportunities to spotlight PFCC

  • The work is never done...


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Contact Information Framework for Evaluation of the Impact of Patient and Family Centred Care

Jocelyn Bennett

jbennett@mtsinai.on.ca

Tracy Kitch

tkitch@mtsinai.on.ca

Maureen Riley

rileym@smh.toronto.on.ca