PeaceHealth Integrated Planning_Measurement Management_PHET Nov2012

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

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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 15307-310. Doi10.1136/qshc.200
  5.016527

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The Language of Partnership

• PeaceHealth Values Promise

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
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• Safe (Evidence-based), Compassionate Care
• Its more than the right treatment
• for the right patient at the right time

Reliability Science every time Design Science
and Usability every touch
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Design Sciences

• Healthcare is familiar with
• Performance (evidence-based practice, pathways
  and process design)
• Engineering (clinical governance, standards,
  safeguards)

• Healthcare is not as familiar with
• Design of human experiences, as distinct from
  designing processes

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Components of Good Design
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• 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/
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• Experience-Based Design

User-focused design process with the goal of
making the user experience accessible to the
designers allowing experiences, rather than
services, to be imagined and designed
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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 15307-310. Doi10.1136/qshc.200
  5.016527

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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 15307-310. Doi10.1136/qshc.200
  5.016527

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Patient Stories Inspire Improvement
http//www.webmm.ahrq.gov/perspective.aspx?perspec
tiveID58
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(No Transcript)
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• Patients influence quality, safety and the
  healthcare experience by telling their stories
  and participating on
• Performance improvement teams
• Ambulatory, hospital, and community advisory
  teams
• Nationally recognized collaboratives
• Medical staff committees (PT, Medical Executive
  Committee, etc.)

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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

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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
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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?

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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

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Patients as Partners on Teams

• Patients on Quality Improvement Teams
• Staff acceptance of patient partnership
• Medical Staff acceptance of patient partnership

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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

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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

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Medical Staff Leaders Drive Quality
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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

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(No Transcript)
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2001 IOM Chasm Report Six Aims are STEEEP
Crossing the Quality Chasm

• 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
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Ten Rules for Health Care in the 21stCentury
Crossing the Quality Chasm

• 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

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(No Transcript)
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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/Add
ressing_National_Priorities.aspx
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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 Americas
  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/Add
ressing_National_Priorities.aspx
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Patient (and Family) Partnership

• There are many ways that hospitals and clinics
  can involve patients in their own care

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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/
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• 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.

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First Hand Knowledge of the Experience
Family Friends Patient Neighbors Co-workers
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Powerful first impression . . .
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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. -Websters 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 others wellbeing
  to the point of making each other crazy.
• -Uri Bronfenbrenner

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Families are not visitors They are allies in
quality and safety
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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 familys life? What is the
plan? How will we best continue care at home?
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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
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Tips for Avoiding Success
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Tips for Achieving Success

• Honor natural supports
• Share knowledge and information
• Treat each person as an individual
• Say Im sorry when a mistake is made
• Assist in problem solving and teach choice
• Say I dont know when you dont know
• Make the primary care/specialist relationship
  work
• Respect patient/family knowledge of own health
  needs
• Develop roles for patient and family consultants

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Transforming Healthcare A Safety Imperative

• 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. 200918424-428.

http//www.ihi.org/IHI/Topics/PatientSafety/Safety
General/Literature/TransformingHealthcareASafetyIm
perative.htm
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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

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Purchased Poster
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New Poster
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Imagined by Patient Advisors
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Partners in Quality Improvement
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Act Into New ThinkingGoran Henriks, Chief of
Learning and Innovation, Jonkoping County
Council, Sweden