Engaging Patients at Every Level - Pt. 1MarthaHayward,IHILeadforPublicandPatientEngagement

September 20, 2017

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MHAFallConvention

Engaging WITH Patients at Every Level - Part 1

Framework for Public/Patient Engagement4

Patients engaged at improving their own care; Hospital /Clinic/ Office/ Home

PFAs engaged in Improvement ScienceDesign of protocols

PFAs making Organizations AccountaPolicy, Leadership

PFAs broadcasting the need, progress and awareness to all

Public

Organization

System

Personal

PFAs = Patient and Family Advisors

Everyone plays a role

Engaging Patients and Families – What Matters to You?

Engaging Staff – Storytelling

– Best Practices/co-design

Engaging Patient /Family Advisors– PFACs

– Always Events

Engaging the Public – Conversation Project

Session 1

In this session we will focus on:– PERSONAL

– SYSTEM

Session 2 will focus on :– ORGANIZATION

– PUBLIC

Patient and Family Centered Care Is…

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Location Examples

Environment Community, Region, State, Province

•Community groups

•Care Coordination, ACOs, Medical Homes

•Advanced care planning, POLST, MOLST

•School & church programs

•Public health & other consumer campaigns

Organization Health System, Trust, Hospital, Nursing Home

•Experience Surveys, Advisor patient experience rounds

•PFACs, Advisors, faculty, board meetings, operating committees

•Resource Centers, patient portals

•Access to help and care 24/7

•Medication lists

Micro-system Clinic, Ward, Unit, ED, Delivery

•Parent, Advisors, & advisory councils

•Open access, optimized flow

•Family participation in rounding

Experience of care

Bedside, Exam Room, Home

•Access to the chart

•Shared care planning

•“Smart Patients Ask Questions”

Balik B, Conway J, Zipperer L, Watson J. Achieving an Exceptional Patient and Family Experience of Inpatient Hospital Care. Cambridge, Massachusetts: 2011.

Frontline Practices Positively Impacting Patient & Family Experience

IHI Change PackageOpen visitationBedside care roundsBedside shift changeLiteracy assessmentUpdate shared care planTransition plan / planningKnow patient comfort (cultural) expectationsNarrate careAnticipate & address concernsInterdisciplinary practice

Other Practices

Ask patient / family ?s you haveMaintain white boardAsk what’s working?/ to be improvedEmbrace family care participationAlways make introductions“If something is wrong, tell me”Provide access to health recordsEstablish peace and quiet timesUtilize patient / family faculty , patient and family advisors, Councils

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IHI Patient Experience Change Package, Rutherford and Taylor, & Others

The Big Takeaway

To

For

WITH

Moving from ‘doing for’ to ‘doing with’

The balance of knowledge11

PATIENTValuesFearsPersonal ExperiencePreferencesPersonal Circumstances

CLINICIANTrainingClinical ExperienceExpertiseScientific Knowledge

PARTNERSHIP

Patient Experience Defined

Patient Satisfaction

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Satisfaction is about whether a patient’s expectations about a health encounter were met.

Agency for Health Research and Quality. https://www.ahrq.gov/cahps/about-cahps/patient-experience/index.html

Let’s begin with a story

Engaging patients in their own care

Patients are already engaged

The question is, “how do we co-produce health?”

What Matters to You?

n engl j med 366;9 nejm.org march 1, 2012

Enhancing conversations between patients and clinicians from -- “What’s the matter?” to also including “What matters to you?”

Why?

Connect the heart, the soul, the human

Engage family, staff, patients

Understand driving forces

Establish trust

Personal goal setting

Envision the future

Saves time

When?

From the micro to the macro– Procedures

– Transitions

– Annual Visits

– End of Life

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How?

What is the best question? – “What more can I do for you?” is never the right question.

End of Life –– What will make this a good day for you?

At rounds –– What is your greatest concern right now?

Prior to surgery –– What will success look like to you?

What might you ask?

P19

What Matters: A Call to Action

What if every clinician, staff member and community health worker routinely asked “what matters to you?” and listened attentively at every encounter with individuals and their family members?

What would we learn? How would this understanding enhance our ability to develop genuine partnerships with patients toco-create a more customized plan to meet their expressed needs, values, and preferences?

www.ihi.org/whatmatters

Storytelling

Why We Tell Patient Stories

Connect to process

Engages head and heart

Enables empathy

Return to ‘why’

Demonstrate the humanity of our work

Reflects culture

Inspire us to act

Where We Tell Patient Stories

Clinical interaction – one on one – deep listening– Saves time– Provides vital information– Builds trust

Team Interaction– Provides focus and meaning to process– Engages hearts and minds– Enhances improvement

Leadership– Inspires– Models meaning in work– Offers a reference point

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Workload of Cristin Lind (Mother of a Child with Special Needs)

http://www.childrenshospital.org/care-coordination-curriculum/care-mapping

Knowing a person’s “story not only teaches us how to act-

it inspires us to act”Marshall Ganz

P25

Always Events

Always Events®

Always Events® are defined as “those aspects of the patient and family experience that should always occur when patients interact with healthcare professionals and the delivery system.”

Doing To Doing For Doing With

From design to implementation,

Always Events are all about “doing with’.

Engaging patients with everyone29

Always is so much better than Never

Positive

Patients experience what is…not what is absent

Definable, visible, measurable

Always Events Criteria

Important: Patients and families have identified the experience as fundamental to their care

Evidence-based: The experience is known to be related to the optimal care of and respect for patients and families

Measurable: The experience is specific enough that it is possible to accurately and reliably determine whether or not it occurs

Affordable: The experience can be achieved without substantial capital expense

Picker PrinciplesRespect for patients’ values, preferences and expressed needs

Coordination and integration of care

Information, communication and education

Physical comfort

Emotional support and alleviation of fear and anxiety

Involvement of family and friends

Transition and continuity

Why Always Events?

Raise the bar on both provider and patient expectations

Introduce a new organizing principle to help galvanize action and accountability

Demonstrate how the AE concept can be implemented in practice

Widely disseminate AE strategies for national replication

Energize and expand the movement toward a more patient and family centered system

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Big Picture:  Link between 

Always Events and Reliable Process 

Performance

Understand Patient 

experience “What matters 

to me”

Develop Always Event(s)

Integrate Always Event(s) into 

Work Process(es)

Define Work Process (simplify and standardize)

Define Defects and How to Mitigate

Measure and Communicate

From Patient to Process

Do the Work

From Intention to Reliable Performance

Study/Act

Do

Plan

Public Engagement

The Conversation Project

A national public engagement campaign dedicated to assure that everyone’s wishes for end-of-life care are:

Expressed and Respected.

Boards with community representation, business representation, patient and family representation, and physician representation will enable their organization to respond to the new challenges more effectively

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Schummers D. Governance Across the Continuum. The Governance Institute and IHI. June, 2014

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The single most important factor that distinguishes major culture changes that succeed from those that fail is competent leadership at the top. No single effort at culture change has been successful starting at the bottom

John P. Kotter & James L. Heskett,

Corporate Culture & Performance (Free Press 1992)9/7/2017 ISQUA 38

Public Engagement

Changing the Cultural Norm

A national campaign encouraging everyone to have a conversation about their wishes for end-of-life care

Collaboration to ensure health care systems are ready to receive and honor wishes for end of life care

The Talking Gap

90% of people think it is important to talk about their loved ones’ and their own wishes for end-of-life care.27% of people have discussed what they or their family wants when it comes to end-of-life care.Source: The Conversation Project National Survey (2013)

TCP’s Strategy for Creating Cultural Change

Awareness: National media campaign and community engagement events

Accessible: Tools to help people get started

Available: Bringing TCP to people where they work, where they live, and where they pray

Accessible: Our ToolsConversation Starter KitHow to Talk to Your Doctor Starter KitTranslationsPediatric Starter Kit

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The Starter Kit: Get Ready

The Starter Kit: Get Set….

The Starter Kit: Go

Next Steps…

Have the Conversation

Share Starter Kit & other tools with family and loved ones.

Share your stories on our website, join our monthly webinar

A Soul Doctor and a Jazz Singer

“What would be a good day for you?”

https://www.youtube.com/watch?v=QzdIdb2s144

Patient Experience Strongly Correlated With Other Outcomes

Health outcomes

– Patient adherence

– Process of care measures

– Clinical outcomes

Business outcomes

– Patient loyalty

– Malpractice risk reduction

– Employee satisfaction

– Financial performance

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Edgman-Levitan S., Shaller D. et al. The CAHPS Improvement Guide. Boston: Harvard Medical School: 2003.

Sample of Self-assessment Tools

Family Voices– http://www.familyvoices.org/admin/work_family_centered/files/fcca_FamilyTool.p

df

HRET & Moore Foundation– http://www.hret.org/quality/projects/moore_foundation_patient_family_engagement_survey.s

html

Institute for Healthcare Improvement– http://www.ihi.org/resources/Pages/Tools/PatientFamilyCenteredCareOrganizatio

nalSelfAssessmentTool.aspx

Institute for Patient and Family Centered Care– Leadership with AHA http://www.aha.org/content/00-10/assessment.pdf– Multiple health and care options http://www.ipfcc.org/resources/assessment.html

Planetree– http://planetree.org/designation-criteria-and-self-assessment-tool/

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Financial Benefits of Patient-Centered Care in Planetree

Reduced length of stay

Lower cost per case

Decreased adverse events

Higher employee retention rates

Reduced operating costs

Decreased malpractice claims

Increased market share

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Charmel P, Frampton S. Building the Business Case for Patient Centered Care. HFM. March, 2008