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

1. 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

2. Outline • Context of PFCC at Mount Sinai Hospital • Evaluation Framework • Examples • Successes and Lessons Learned

3. Health Care in Ontario • 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)

4. External and Internal Driving Forces • Culture of accountability – fiscal, quality and safety • Alignment with organizational strategy • “stickiness factor”

5. The Challenge at MSH • 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

7. PFCC at MSH • 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

8. MSH Balanced Scorecard

9. Complexities of Measurement Challenges to evidence improvement Versus Systems that don’t lend themselves easily to measurement

11. Where to Focus? • 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

12. Framework for Indicators Process Outcomes Structure Corporate Micro Systems (i.e. team, unit, dept) SpecificInitiatives

13. Strategy for PFCC Evaluation • 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

14. Goal to be achieved 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

15. Parent Evaluations: Examples from the NICU • Parent Buddy Program • Parents on Rounds • Accreditation • Patient Satisfaction Survey • Annual Dialogue with NICU Leadership

16. Parent Buddy Program • 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)

17. Parents On Rounds • 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

18. Accreditation • 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)

19. NRC Picker Survey • Questions customized for NICU population • Results reported to Neonatal and Management teams quarterly

20. Annual Dialogue with NICU Administration • 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

21. Lessons Learned • 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

22. Lessons Learned • 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

23. Leadership • Strategy and action intersect • Continue to take opportunities to spotlight PFCC • The work is never done...

24. Contact Information Jocelyn Bennett jbennett@mtsinai.on.ca Tracy Kitch tkitch@mtsinai.on.ca Maureen Riley rileym@smh.toronto.on.ca