why am i doing this? matching px efforts to organizational ... · 4/24/2018 · why am i doing...
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Why am I doing this? Matching PX Efforts to Organizational Needs Tiffany Christensen | Vice President, Experience Innovation, The Beryl Institute
April 24, 2018
Improving the Patient Experience
- The Beryl Institute
Defining Patient Experience
www.theberylinstitute.org
PX Continuing Education Credits
• In order to obtain patient experience continuing education credit, participants must attend the program in its entirety and return the completed evaluation.
• The planning committee members and presenters have disclosed no relevant financial interest or other relationships with commercial entities relative to the content of the educational activity.
• No off label use of products will be addressed during this educational activity.
• No products are available during this educational activity, which would indicate endorsement.
This webinar is eligible for 1 patient experience continuing education (PXE) credit. Participants interested in receiving PXEs must complete the program survey within 30 days of attending the webinar. Participants can claim PXEs and print out PXE certificates through Patient Experience Institute. As an on demand webinar, it offers PXE for two (2) years from the live broadcast date.
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Our Presenter
Tiffany ChristensenVice President, Experience InnovationThe Beryl Institute
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Headliner WebinarApril 24, 2018
Tiffany Christensen, VP Experience Innovation
Why Am I doing This?Matching PX Efforts to Organizational Needs
Welcome!
• Brief overview of the The Beryl Institute and the Experience Journey• Explore how we choose partnership and bedside/exam
table/gurney PX Strategies• Consider our toolbox of potential strategies• Explore new ways for assessing opportunity/implementation of
strategies (including ROI)• Looking ahead• Q and A
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What is The Beryl Institute?
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Community of Practice Body of Knowledge
Research Professional Certification
Tiffany Christensen
• Cystic fibrosis patient, has received two double lung transplants
• Began career as PFA• TeamSTEPPS Master Trainer• Nationally recognized public speaker and the
author of three books • Served as a patient advocate in Oncology• Program designer for Patient/Family Advisor
Program for a large academic medical system• Patient and Family Engagement Specialist at the
State Hospital Association• Vice President for Experience Innovation at The
Beryl Institute
The Field of Patient Experience
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Experience is…
Experience is somethingwe have lived through.It is about something thathappened and it is ourlasting story…
It is defined in all that isperceived, understoodand remembered…
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To satisfy is to cause (someone) to be happy or pleased.
Satisfaction is in the moment.
It is the idea of how positive someone feels about their expectations
of an encounter.
Satisfaction…
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An ExpandedPerspective
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Patient Experience Defined
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Evidence to Support a Focus on Experience
Financial Return: https://theberylinstitute.site-ym.com/store/ViewProduct.aspx?id=902589
Improved clinical outcomes, financial outcomes, consumer loyalty, and community reputation: http://pxjournal.org/journal/vol3/iss1/1/
Additional journals across a variety of clinical specialties: http://pxjournal.org/do/search/?q=outcomes&start=0&context=5521800&facet=
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PX Defined by The Beryl Institute: • The sum of all interactions, shaped by an
organization’s culture, that influence patient perceptions across the continuum of care
2010: Awareness that better care requires deep understanding of
actual experience, which is different than satisfaction
PFE Defined by IOM: • Providing care that is respectful of, and responsive to,
individual patient preferences, needs, and values; and ensuring that patient values guide all clinical decision
2001: Realizing that patients/family values can be included in clinical aspects of
care
PFCC Defined by IPFCC:• Patient- and family-centered care is an approach to
the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships...
1992: A new focus on thinking about how patients receive care
Our journey at a glance
Why this webinar topic?
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We have been traveling this journey together for quite some time
We now have a large toolbox filled with strategies and evidence
At one time, when this work was brand new, we implemented strategies by modeling ourselves after
other organizations
Today, we are ready to be more strategic in what approach we choose and why
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Standard Improvement MethodFor Quality and Safety
Choose a PX Strategy
How do we implement this PX strategy?
How will we know that our PX Strategy is
making improvements?
What are we trying to accomplish?
Commonly used approach for implementing PX strategies
It’s time to flip the model
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TIME
Define Solve
Simplifying for today’s conversation
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Partnership with patients, families and community members
Partnership at the
bedside, exam table or
gurney
Primarily: reflecting on past experiences Primarily: currently receiving care
Community and PFA Partnership Strategies
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Common approaches to partnering with PFAs
PFAC
PFAs on boards and leadership
committees
PFAs in QI (RCAs, RIEs, Falls
committees)
PFAs as influencers (Peer Rounding, Staff Interviews, Secret Shoppers)
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Challenges in the PFA model
PFACHigh Resource Requirement &
Agenda Burnout over time
PFAs on boards and leadership
committeesLimited space leads
to limited representation
PFAs in QI Resistance from
“risk” perspective leads to low
sustainability
PFAs as influencers Higher level of
training and staff coaching/supervision
needed
WHY AM I DOING THIS?
Lack of needsintervention
analysis leads to doing it because
that’s what others do
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A Missing Puzzle Piece
A customized orientation for any PFA strategy sets everyone up for success.
Is design and implementation of
orientation for PFAs AND staff a part of your plan?
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PFA Strategy
Readiness
Choosing a strategy: What’s the ROI?
Time required for the program
Volume of people and
other resources required
Dollars or cost required
Current value to the
organization Values a
successful project will
yield
www.theberylinstitute.org 31Adapted from Six Sigma
Saving dollars, improving
experience, increasing Joy in
work, etc
Improving community
relationships, hearing the VOPF,
etc
VOPF = Voice of patients/families
Additional Partnership Considerations
Leadership support
VOPF connected w/ power to change
VOPF represents population served
Process for orienting PFAs and staff
PFAs well matched to opportunity www.theberylinstitute.org 32
VOPF =Voice of
Patient & Family
Example: PFAC Challenges
• What was your goal for having a PFAC?
• Why did you choose to utilize a PFAC to meet that goal?
• Is there a strategy that could potentially be a better fit?
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My organization started a PFAC 6 months ago. It was really hard to get off the ground. Now, I’m not
sure what to do with the PFAs we have.
Why a PFAC?
• Original Aim: PFAC was formed to hear the voice of the patient
• Is this aim specific?
• If you could rewrite the aim, how might you rewrite it?
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Suggested aim (for purpose of today’s discussion)
Primary Aim/Goal: Improve community relationship by hearing the VOPF and, in so doing, naturally cultivating ambassadors
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Strategy costs/benefits
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Strategy Cost Time and people (in relationship to other potential strategies)
Potential value (in relationship to other potential strategies)
Additional Resources
PFAC Key considerations: Pay for staff?Pay for PFA transport?Materials cost?
High: Monthly meetings with agenda prep and logistics planning, ongoing recruitment
Low: Requires PFAs on PFAC be active and skilled in sharing efforts with community
Orientation program development, Meeting room, printing
Peer Rounding Key considerations:Pay for PFA transport?
Medium: Requires training for PFAs and staff + “buddy system” and process for measurement
Medium: Small sample size of community members touched but with high impact
Orientation program development
PFA Storytellers in community settings
Aside from ”time and people,” no associated costs
Low (but specialized): Coach required for impact and alignment of message
High: If well-organized, larger sample size, high impact if stories well-crafted
Coordinator/process for finding opps and scheduling
Additional Considerations
0
1
2
3
4
5
6
7
8
Representation Leader Support Value to Org
Evaluating 3 partnership strategies
PFAC P. Rounding Storytellingwww.theberylinstitute.org 37
Making a choice: Importance/Difficulty Matrix
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PFACPeerRounding
PFAStories
Primary Aim/Goal: Improve community
relationship by hearing the VOPF and, in so
doing, naturally cultivating ambassadors
Making a choice: Importance/Difficulty Matrix
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PFACPeerRounding
PFAStories
Luxury
Targeted (easy)
Strategic
High Value
How will we know we’ve made an impact?
Chosen Strategy: PFAC 2.0• Meet every 2 months (instead of
every month)• During meetings: Focus on
projects and programs in early stages to ensure VOPF is woven into to development
• Work on recruiting for and building capacity among current members to be community “ambassadors”
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What might be your impactindicators or measures?
Partnership Strategies at the Bedside or Exam Table
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To For With
PFCC and Co-Design: The Evolution
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With
ForTo
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Honoring Experience
Common practices for PFE
Passive Information Sharing
(White Boards, Access to EMR, )
Teach back
Rounding (Hourly, Leadership, Safety, Waiting Room etc)
Shared Decision Making
(Decision-Making Aids, PAM + MI, )
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Challenges with PFE
Passive Information Sharing
Inability to assess comprehensionOften unclear if
information is utilized
Teach-BackLack of consistency with
practiceResistance due to perception of time
RoundingOften lack of clear aim in
roundingOften lack of system to make changes based on
data collected while rounding
Shared Decision MakingMany tools to choose
from, most require skill set
Sense that patients/families are not
able to make decisions
WHY AM I DOING THIS? Practices are often
perceived as “flavor of the month” or o0ffensive to those “already doing
this.” Resistance leads to lack of understanding
practice + a lack of hardwiring
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A Missing Puzzle Piece
A one-size-fits-all approach will lead to
frustration and perception that the practice is
ineffective
Is assessing and facilitating readiness a part of your
plan?
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PFE Strategy
Readiness
PFE Bedside Practices: ROI Case Study
• What was your goal for Leader Rounding?
• Why did you choose to utilize Leader Rounding to meet that goal?
• Is there a strategy that could potentially be a better fit?
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Leaders in my organization started rounding about 6 months ago. At first,
everyone was really enthusiastic. Lately, they have been saying they
aren’t sure if it’s making an impact and some leaders have been decreasing
the amount of time they spend rounding.
Why Leader Rounding?
• Original Aim: Leader rounding was implemented to ensure leadership was visible to frontline staff
• Is this aim specific?
• If you could rewrite the aim, how might you rewrite it?
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Suggested aim (for purpose of today’s discussion)
Primary Aim/Goal: Provide more timely recognition to staff to increase joy in work
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What change will we make to meet the aim?How do we enhancing Leadership Rounding?
Contextual Inquiry (Shadowing with Narration)
Fly on the Wall Observation
Interviewing “How might we make working here better?”
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Choosing the approach with Rose, Thorn, Bud
Rose = Positive (vote FOR)
Thorn = Negative (Vote AGAINST)
Bud = Opportunity (New idea, Variation)
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For the purpose of today’s discussion:
Contextual Inquiry (Shadowing with Narration)
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How will we know this change made an improvement?
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Healthcare’s move into the “Design” space: EBCD and HCD
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This woman is putting away files. What does she need?
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Design, Human-Centered Design & Co-Design
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Thinking Alongside
Thinking About
Thinking
The Experience-Based Co-Design process
patients at the heart of the quality improvement effort -
but not forgetting staff
a focus on designing experiences, not just systems
or processes
where staff and patients participate alongside one
another to co-design services
Donetto S, Pierri P, Tsianakas V and Robert G. (2015) ‘Experience-based Co-design and healthcare improvement: realising participatory design in the public sector’, The Design Journal, 18(2): 227-248
What distinguishes EBCD from the other approaches?
• Works as a first step or as a next step• Does not assume to know issues or
priorities• Nimble • Allows for more diversity• Measurement is built into process• Staff voice is equally weighted to
Patient/family voice• Process increases buy-in which increases
sustainability
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WHERE WE GO FROM HERE
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“The sweet spot of innovation”
Staff Experience
Expert Observations
from The Beryl Institute
Patient/Family Experience
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Comments and Questions
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Tiffany Christensen919.928.2958
Vice President of Experience Innovationwww.theberylinstitute.org
Thank you for participating!
Please look for a post- webinar evaluation coming soon.
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Thank you for participating