Partnering with Patients

1. Partnering with Patients ASHNHA Quality Meeting Barb Forss, Patient Advisor , PeaceHealth Marla Sanger, CEO, Wrangell Medical Center December 5th, 2013

2. Key Topics • Historical Perspectives on Patient Involvement • Design of Human Experiences vs. Processes • Patient/Family Partnership: What and How • National Momentum: Patient/Family Partnerships • Patient- and Family-Centered Care • Learning From The Patient Experience

3. Historical Continuum of Patient Influence Complaining Giving Information Listening and responding Consulting and advising Paul Bate, Glenn Robert – Quality and Safety in Health Care 2006; 15:307-310. Doi:10.1136/qshc.2005.016527

4. PeaceHealth Values & Promise The Language of Partnership Respect Stewardship Collaboration Social Justice “We are sensitive to the unique preferences of individual patients, and treat patients and family members as active, informed participants in the care process.” From Our Promise on peacehealth.org

5. Safe (Evidence-based), Compassionate Care It’s more than the right treatment for the right patient at the right time Reliability Science – every time Design Science and Usability – every touch

6. Healthcare is familiar with: Performance (evidence-based practice, pathways and process design) Engineering (clinical governance, standards, safeguards) Design Sciences • Healthcare is not as familiar with: • Design of human experiences, as distinct from designing processes

7. Components of Good Design

8. Targeting the Experience A perfect process (fast, efficient, smooth flow) or pathway that is evidence-based does not always produce a positive experience http://crossroads/PatientExperience/

9. Experience-Based Design User-focused design process with the goal of making the user experience accessible to the designersallowing experiences, rather than services, to be imagined and designed

10. Historical Continuum of Patient Influence Complaining Giving Information Listening and responding Consulting and advising . . . . . Experience-based co-design Paul Bate, Glenn Robert – Quality and Safety in Health Care 2006; 15:307-310. Doi:10.1136/qshc.2005.016527

11. Co-designing Services with Patients Next generation of improvement methods: Perception, Attitude, Expectations, Experience A particular kind of knowledge acquired from close and direct personal observation or contact. Paul Bate, Glenn Robert – Quality and Safety in Health Care 2006; 15:307-310. Doi:10.1136/qshc.2005.016527

12. Patient Stories Inspire Improvement http://www.webmm.ahrq.gov/perspective.aspx?perspectiveID=58

14. Patients influence quality, safety and the healthcare experience by telling their storiesand participating on: Performance improvement teams Ambulatory, hospital, and community advisory teams Nationally recognized collaboratives Medical staff committees (P&T, Medical Executive Committee, etc.)

15. How Do We Find Each Other? • Word of mouth and focus groups • Volunteers interested in larger commitment • Patients in our care who seem like a good fit • Healthcare experience + personal passion • Individuals involved in patient advocacy

16. Volunteer Application as Entry Point Patient contacts Volunteer Office and expresses an interest in improvement or “other projects” Patient is recruited by an employee who identifies he/she would be a good team member Volunteer application is completed and turned in. After one week, the patient makes an appointment with the Director of Volunteer Services for an interview

17. Screening for Interest, Availability, Fit • How did you learn about participating on an improvement team or committee within PeaceHealth? • Why are you interested in being involved? • Tell us about a time when you had a positive experience working with others to promote a common cause, goal or solve a shared concern / problem. • Are there barriers such as transportation, timing of meetings, language or illness that need to be accommodated to allow your participation?

18. Orientation to the Organization - Examples • Organizational integrity, HIPAA, and confidentiality training module with quiz • Signed confidentiality agreement (annual requirement) • TB tests and background check • Half to full day Volunteer / HR Orientation • Photo ID badge is issued • Method for tracking hours is explained • Improvement team or committee orientation

19. Patients as Partners on Teams • Patients on Quality Improvement Teams • Staff acceptance of patient partnership • Medical Staff acceptance of patient partnership

20. Patients as Partners on Safety and Quality Improvement Teams • IHI Intensive Care Collaborative • Imaging Re-design Team • Healing Healthcare Task Force • New Dept Customer Service • Emergency Dept Council • Medication Reconciliation • Organ Donation Council • Medication Delivery Team • Patient Care Committee • Safe Patient Handling • Seclusion / Restraint • PACU / ACU Redesign • Rapid Response Team • Joint Camp • Rehab Quality Council • Stroke Care • Surgical Care Improvement Project

21. Patients as Partners on Planning, Leadership, and Regulatory Teams • PeaceHealth System-wide Collaboratives • Medication Safety • Discharge Process • Mission/Values Audit • CEO Search • TJC System Tracers • Regional Advisory Boards • Regional Advisory Councils • Hospital Quality Committees • PHMG Quality Committees • Medical Staff Committees • Medical Executive Committee • Pharmacy & Therapeutics

22. Medical Staff Leaders Drive Quality

23. Medical Executive Committee Orientation • Tour of hospital facility • Booklet with organizational information provided • Test booklet for orientation provided • Fraud and abuse DVD and Security training • Tours and Observations: • Emergency Department, Cardiovascular Services, Orthopedic Surgery Services, Intensive Care Unit • Introduction to Medical Executive Committee (hot topics, agenda items, expectations) • Introduction to Peer Review, Risk Management, Credentialing and Privileging

25. Crossing the Quality Chasm 2001 IOM Chasm Report Six Aims are STEEEP Care that is: Safe Timely Efficient Effective Equitable Patient (& Family) Centered Patient Involvement Patient Centered Crossing the Quality Chasm: A New Health Care System for the 21st Century Institute of Medicine, March 2001

26. Crossing the Quality Chasm Ten Rules for Health Care in the 21stCentury • Care is based on continuous healing relationships. • Care is customized according to patient needs/values. • The patient is the source of control. • Knowledge is shared and information flows freely. • Decision making is evidence-based. • Safety is a system property. • Transparency is necessary. • Needs are anticipated. • Waste is continuously decreased. • Cooperation among clinicians is a priority. Crossing the Quality Chasm: A New Health Care System for the 21st Century Institute of Medicine, March 2001

28. NQF Convenes National Priorities Partnership in 2008 National Institutes of Health Leapfrog Group Centers for Medicare & Medicaid Institute of Medicine National Governors Association CDC National Quality Forum Joint Commission Agency for Healthcare Research and Quality Physician Consortium for Quality Improvement convened by the AMA . . . . . and 22 other organizations! http://www.qualityforum.org/Setting_Priorities/Addressing_National_Priorities.aspx

29. NQF Convenes National Priorities Partnership in 2008 Engaging patients and families in managing their healthcare and making decisions about their care Improving the health of the population Improving the safety and reliability of America’s healthcare system Ensuring patients receive well-coordinated care within and across all healthcare organizations, settings and levels of care Guaranteeing appropriate and compassionate care for patients with life-limiting illnesses Eliminating overuse while ensuring the delivery of appropriate care http://www.qualityforum.org/Setting_Priorities/Addressing_National_Priorities.aspx

30. Patient (and Family) Partnership There are many ways that hospitals and clinics can involve patients in their own care

31. Institute for Patient- and Family-Centered Care: “Patient- and Family-Centered Care is not System-Centered Care, Patient-Focused Care or Family-Focused Care” Patient- and family-centered care is working with patients and families, rather than doing to or for them http://www.ipfcc.org/

32. Patient / Family-Centered Care Core Concepts • People are treated with respect and dignity • Collaboration among patients, families, and • providers occurs in policy and program development, professional education and in the delivery of care. • Individuals and families build on their strengths • through participation in experiences that enhance control and independence. • Health care providers communicate and share • complete and unbiased information with patients and families in ways that are affirming and useful.

33. First Hand Knowledge of the Experience Family Friends Patient Neighbors Co-workers

35. Powerful first impression . . .

36. What is a Family? The unit consisting of parents and their children; persons related by blood or marriage; the group of persons who live in one household or under one head. -Webster’s Dictionary, 1971 Two or more persons related by birth, marriage, or adoption who reside in the same household -US Census Bureau A family is a group of people who make an irrational commitment to each other’s wellbeing to the point of making each other crazy. -Uri Bronfenbrenner

37. Families are not visitors They are allies in quality and safety

38. What Patients and Families Want to Know What is the problem? How can it be diagnosed and treated? `````````````````````````````````````````````````````` How can I contribute to the process to enhance the quality and safety of care? When / where / how will we communicate? Will you listen? What does this mean for my family’s life? What is the plan? How will we best continue care at home?

39. “Two words, information and communication are often used interchangeably, but they signify quite different things. Information is giving out; communication is getting through.” . . . Sidney Harris

40. Tips for Avoiding Success

41. Tips for Achieving Success • Honor natural supports • Share knowledge and information • Treat each person as an individual • Say “I’m sorry” when a mistake is made • Assist in problem solving and teach choice • Say “I don’t know” when you don’t know • Make the primary care/specialist relationship work • Respect patient/family knowledge of own health needs • Develop roles for patient and family consultants

42. “The family is respected as part of the care team — never visitors — in every area of the hospital, including the emergency department and the intensive care unit.” “Patients share fully in decision-making and are guided on how to self-manage, partner with their clinicians and develop their own care plans. They are spoken to in a way they can understand and are empowered to be in control of their care.” Leape L, Berwick D, Clancy C, et al. Transforming healthcare: A safety imperative. Quality and Safety in Health Care. 2009;18:424-428. Transforming Healthcare: A Safety Imperative http://www.ihi.org/IHI/Topics/PatientSafety/SafetyGeneral/Literature/TransformingHealthcareASafetyImperative.htm

43. Co-Designing Services with Patients Next generation of improvement methods: Perception, Attitude, Expectations Experience • A particular kind of knowledge acquired from close and direct personal observation or contact. It is expressed in what a person thinks, feels and says about the experience of a service, process or product

44. Purchased Poster

45. New Poster

46. Imagined by Patient Advisors

47. Partners in Quality Improvement

48. “Act Into New Thinking”Goran Henriks, Chief of Learning and Innovation, Jonkoping County Council, Sweden