finding common ground: supporting change in healthcare and at home
TRANSCRIPT
Finding Common Ground: Supporting Change in Healthcare
and at Home
A new kind of relationship
• RuthJean Francois, Patient Advisor, Cambridge Health Alliance
What is self-management?
“The individual’s ability to manage the symptoms, treatment, physical and social consequences and lifestyle changes inherent in living with a chronic condition.”
Barlow et al, Patient Educ Couns 2002;48:177
What is self-management support?
Making and refining the health care system to facilitate patients and families managing chronic health problems self-management. This includes at the level of patient-provider, patient-health care team, patient-health care system and the community.
Glasgow et al
What is Self-Management Support?
• Skills and Tools
• A change in CULTURE to a whole new relationship
– Tom Bodenheimer
Setting the Stage: PatientsSetting the Stage: Patients
Differences Between Acute and Chronic Conditions
ACUTE CHRONIC
Beginning Rapid Gradual
Cause Usually one Many
Duration Short Indefinite
Diagnosis Commonly accurate
Often uncertain
Diagnostic tests
Often decisive
Often limited value
Treatment Cure common
Cure rare
Differences Between Acute and Chronic Care Roles
ACUTE CHRONIC
Role of Professional
Select and conduct therapy
Teacher/coach and partner
Role of Patient
Lorig 2000
Follow orders Partner/ Daily manager
Symptom Cycle
Vicious Cycle
Disease
Tense musclesFatigue
Depression
Anger/Frustration/Fear
Stress/Anxiety
A philosophical shift
Professional - patient
Professional - Patient
Patient - Professional
Patient - professional
Person - professional
Person-Person
Adapted from Tom Janisse
Learning Community Journey
Pilot Collaborative
on Self-Management Support
Karen’s Story in NHP
• Quality Allies and New Health Partnerships – A bigger sea to swim in
• Finding our place as patient and family faculty
• More than “giving feedback”, bringing patient and family members in from the beginning
Participation at all levels
• Patient and family participation on the National Advisory Committee.
• Patient and family participation on the faculty team.
• Patient and family participation on the learning community teams.
Changing Practice, Changing Lives
1. Through collaborative self-management support, enhancing partnerships with patients and families.
2. Engaging patients and families in quality improvement and the redesign of ambulatory processes, practices, programs, and facilities.
The PatientThe Medical Assistant
The Provider
Leaves with scripts, referrals, and instructions
Integrated planMedical
&SMG
The Patient
The Medical Assistant
The Provider
Other Activated Patients
Typical experience with their PCP
First key service…
1) Planning and preparation- MA planned visits with goal setting
2)The Provider- taught how to negotiate a medical plan and integrate with a patient-oriented self-management goal (SMG)
BBSWAR
ACKGROUNDARRIERSUCCESSESILLINGNESS…CTION PLANEMEMBER
NON-DIRECTIVE COUNSELLING
And our Group Visits…
Patients helpingPatients…
3) The MINI-group visit4) The Open-Office Group
visit
Stressors, depressed mood, barriers, difficulty coping ALWAYS covered
Coping strategies developBoth involve goal setting
• Participation on QI teams and traveling with the team.
Clinic Patient and Family Advisory Council
Helping to develop informational and educational materials.
Teaching classes such as the Healthier Living Series.
Developing Bulletin Boards
Designing charting and documentation forms
Improving Electronic Medical Records
Patient and Family Advisors serve on the Patient Safety and Medicine Reconciliation Committees.
Patient and Family Advisors teach residents and medical and nursing students and participate in staff orientation.
Developing peer support and buddy programs, especially for newly diagnosed patients.
Family HealthCare Center, Fargo, ND
Creating a Patient Advisory Council, developing patient portals on the Center’s website, and planning, implementation, and evaluating group visits.
Humboldt Del Norte IPA, Eureka, CA
Participating on the QI team, teaching classes in the Healthier Living Series, and training peer support group facilitators.
Participating in the design of Web sites.
www.NewHealthPartnerships.org
What’s it like being involved: What’s it like being involved: Dennis MalloyDennis Malloy,,patient with COPD, Chair of Lambeth Breathe Easy Grouppatient with COPD, Chair of Lambeth Breathe Easy Group
‘You’ve given us the
lollipop and we’re not giving
it back’