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Person Centered Care Partnering With Patients, Families, and the Public at All Levels of Health

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Person Centered Care Partnering With Patients, Families, and the Public at All Levels of Health & Healthcare Jim Conway, SVP, IHI jconway_at_ihi.org – PowerPoint PPT presentation

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Title: Person Centered Care Partnering With Patients, Families, and the Public at All Levels of Health


1
Person Centered CarePartnering With Patients,
Families, and the Public at All Levels of Health
Healthcare
  • Jim Conway, SVP, IHI
  • jconway_at_ihi.org

2
Objectives
  • Describe the role of senior leaders in advancing
    patient- and family-centered care within an
    organisation
  • Discuss the importance of linking partnerships
    with patients and families to quality and safety
    to improve outcomes and
  • Discuss regional, national, and international
    efforts to further the development of effective,
    sustained partnerships with patients and families.

3
OutlinePerson Centered Care
  • Why me talking about this?
  • Why are all of us talking about this?
  • What is it?
  • Up, down, and all around
  • Great examples, great work
  • What are the challenges?
  • Moving forward

4
Before Going Anywhere ElseThank You for
Everything You Do
Care that is reliably Safe, Effective, Patient
Centered, Timely, Efficient, Equitable IOM,
Crossing the Quality Chasm
5
I dont care who you are. I going to stay with
my child.
  • Pediatric Mother, 1976

5
6
Whats Getting Rewarded Around Here!
7
Patient and Family Centered CareA Dynamic
Push/Pull
  • Making the Future Attractive
  • PushMaking the Status Quo Uncomfortable
  • Organising the healthcare system around the
    patient and family
  • Optimising the patient experience
  • Correlates with other outcomes including staff
    satisfaction and financial outcomes
  • Patient activation/self management
  • Great stories and results busting out all over
  • IHI BMJ International Forum
  • Health care organisations
  • Associations
  • Its the right thing to do
  • Consumer Movement
  • It isnt ours alone to decide
  • Patient Rights
  • Patient Safety
  • Voice and face of harm
  • AHRQ patient reporting
  • Transparency
  • Health Reform Politicians, Governments, Nations,
    States
  • Accreditors
  • AARP, Consumer Reports
  • NQF, NPP, Picker, Planetree, IFCC, IHI, Lucian
    Leape Institute, WHO

8
(No Transcript)
9
Better Together
  • Builds on and spreads existing good practice.
  • Demonstrates local and national improvements.
  • Contributes to measurable progress in
    Scotland-wide patient-centred care.
  • Tests new approaches that build in patient
    experience to service design and delivery.
  • Integrates and aligns these approaches with the
    other national improvement programmes and
    initiatives.
  • Generates evidence of how patients experience
    healthcare through the use of national surveys.

10
Patient and Family Centered Care Person
Centered Care
  • What is it?

10
11
Picker Dimensions
  • Respect for patient values, preferences
  • Coordination and integration
  • Information, communication, education
  • Physical comfort
  • Emotional support
  • Involvement of family and friends
  • Transition and continuity
  • Access to care

Gerteis M, et al. Through the Patients Eyes.
San Francisco Jossey-Bass 1993.
12
Four Key Concepts of PFCC
  • Dignity and respect Providers listen and honor
    patient and family perspectives and choices.
  • Information sharing Providers share complete
    and unbiased information in ways that are
    affirming and useful.
  • Participation In care and decision-making
  • Collaboration In policy and program development,
    implementation and evaluation, as well as the
    delivery of care

Institute for Family Centered Care
13
Up, Down, and All Around
  • So, is it an advisory council, or a patient
    experience survey, or self management? What is
    it?

13
14
Patient and Family Centered Care IsPerson
Centered Care Is
Location Examples
Environment Community, Region, State Community groups, Care Coordination School church programs Public health campaigns
Organisation Health System, Trust, Hospital, Nursing Home Experience Surveys PF Councils, Advisors, Faculty Resource Centers, patient portals Access to help and care 24/7
Micro-system Clinic, Ward, Unit, ED, Delivery Parent programs Advisors advisory councils Open access, optimised flow Full family participation in care
Experience of care Bedside, Exam Room, Home Access to the chart Shared care planning Asking questions
15
Publicly Verifiable PFCCExamples of Current
Practice
  • Mission, vision, values
  • Leadership, operations
  • Advisors
  • Quality improvement
  • Personnel selection
  • Environment and design
  • Information and education
  • Charting and documentation
  • Care structures and support
  • Experience of care

16
As an example, what does it look like for the
hospitalised patient?
  • IHI R D Project

http//www.ihi.org/IHI/Topics/PatientCenteredCare/
PatientCenteredCareGeneral/EmergingContent/Improvi
ngthePatientExperienceofInpatientCare.htm
16
17
Primary and Secondary Drivers Exceptional Patient
Experience
  • Exceptional patient and family inpatient hospital
    experience (safe, effective, patient-centered,
    timely, efficient, equitable) as measured by
    HCAHPS willingness to recommend

http//www.ihi.org/IHI/Topics/PatientCenteredCare/
PatientCenteredCareGeneral/EmergingContent/Improvi
ngthePatientExperienceofInpatientCare.htm
18
Primary Drivers
  • Governance and executive leaders demonstrate
    that EVERYTHING in the culture is focused on
    patient and family centered care, practiced
    everywhere in the hospital (individual,
    microsystem, organisation)
  • The hearts and minds of staff and providers are
    fully engaged
  • Every care interaction is anchored in a
    respectful partnership anticipating and
    responding to patient and family needs (physical
    comfort, emotional, informational, cultural,
    spiritual, and learning)
  • Hospital systems deliver reliable quality care
    24/7
  • The care team instills confidence by providing
    collaborative, evidence based care

19
The PFCC Model at Magee Women's
  • Joint Replacement Programs developed through
    patient and family shadowing
  • Timely feedback and weekly meetings
  • Systems approach pre-op, surgery, post- and
    rehabilitation

20
The PFCC Model at Magee Women's
  • 91.4 satisfaction excellent
  • 99 not limited by pain post op
  • 98 received the right antibiotic at the right
    time
  • 0.3 infection rate in TJR
  • Av LOS 2.8 days
  • 93 discharged without aid
  • 91 discharged directly home

21
At the governance and executive leadership level,
some great examples from the United States
  • What are some of your great examples?

21
22
Leading Edge of Patient and Family Engagement
Action Hospital
Patients/Family on Boards or in Board Committees DFCI, Medical College of Georgia, Childrens of Cincinnati
Patient and their Stories Starting Meetings Exempla, Childrens Cincinnati, Delnor, and many more
Patients at Board Retreats BIDMC, Boston
Board Chair CEO meeting patients monthly Springfield Hospital, Vermont
Inclusion of Patients in Executive Walk Rounds Kaiser Permanente
Patients on Advisory Boards Stoeckle Center, MGH
Trustees and/or Senior Leaders attending PFACs Maine Medical Center, Spectrum
PFACs Dramatic increase
23
Options Involving Patients and Families with
Boards of Trustees
  • Showing video of an infection Ginnys Story
    YouTube
  • Meet my friend Ginny
  • CEO interviews of patients / families reported to
    Board
  • Recent admissions or serious preventable event
  • Inviting patients and families to share there
    experiences of care as part of a board retreat
  • Making a video of a patient / family interview
    and show it at the board meeting.
  • Inviting patients and families to the Board
    meeting to share their experiences
  • Inviting patients / families on Board Quality
    Committee
  • Inviting trustees to interact with patients on
    walk rounds

24
ITS LEADERSHIP AT THE TIME OF CRISISAn IHI
Resource CenterLeadership Response to a Sentinel
Event Respectful, Effective Crisis Management
  • http//tinyurl.com/IHIEffectiveCrisisMgmt

First and Foremost Never lose sight of the
patient and family
25
Listen to me, trust me, respect me as a partner
in care
26
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27
Partnerships with Patients and Families to
Improve Outcomes
  • Show me the data?
  • Nice but not necessary?

27
28
Patient Experience Is Strongly Correlated With
Other Key Outcomes
  • Health outcomes
  • Patient adherence
  • Process of care measures
  • Clinical outcomes
  • Business outcomes
  • Patient loyalty
  • Malpractice risk reduction
  • Employee satisfaction
  • Financial performance

Edgman-Levitan S., Shaller D. et al. The CAHPS
Improvement Guide. Boston Harvard Medical
School 2003.
29
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

Charmel P, Frampton S. Building the Business Case
for Patient Centered Care. HFM. March, 2008
30
We have plenty of international evidence!
  • Improving the Experience of Patient Inpatient Care

30
31
What About the Challenges?
  • Were already doing a good job!
  • Clinicians dont have the time.
  • Can we get away with doing just one thing?
  • Its someone elses job.
  • Lots of tokenism checking the box.
  • Paternalism. We know best and they dont do what
    they are told.
  • It doesnt work here. My patients and family
    members are too _______ (poor, non-compliant,
    illiterate, violent.)

32
From a policy perspective, the widespread
implementation of policies to ensure patients
rights, privacy, and confidentiality is
noteworthy. Patient involvement in quality
improvement activities, on the other hand, so far
appears to be a more rhetorical exercise than a
practice
  • Groene O et al. Is patient-centredness in
    European hospitals related to existing quality
    improvement systems? Analysis of a
    cross-sectional survey (MARQuIS Study). Quality
    Safety in Health Care, February 2009

32
33
Key LearningWhat Do Patients And Families Bring?
  • Their knowledge of the illness Its About Them!
  • Parents of a child
  • The chronically ill adult
  • The actual experience of care
  • Failures in handoffs, slips, harm
  • What works for them and what doesnt
  • Writing in the record, participating in rounds
  • This doesnt look right
  • A passion to achieve the same goals we want

34
PFCC Will Take Leadership at Every Level
  • Not an if but a when and how discussion.
  • Its a system to be designed and achieved.
  • Its a gift to be given.
  • Its a right to be realised.

34
35
Other Resources
  • Associations and Groups
  • Picker Institute
  • www.pickerinstitute.org
  • IHI
  • www.ihi.org
  • WHO Patients for Patient Safety
  • http//www.who.int/patientsafety/patients_for_pati
    ent/en/
  • Institute for Family Centered Care
  • www.familycenteredcare.org
  • Planetree
  • www.planetree.org
  • Partnership for Healthcare Excellence
  • www.partnershipforhealthcare.org
  • Consumers Advancing Patient Safety
  • www.patientsafety.org
  • New Health Partnerships
  • www.newhealthpartnership.org
  • What Patient-Centered Should Mean Confessions
    Of An ExtremistBerwick Health Affairs.2009 28
    w555-w565
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