Advancing Patient-Family Centered Care

Through Executive & Advisor Leadership

Sue Collier, Vice President

Patient-Family Experience

Presented at:

The Beryl Institute

2013 Patient Experience Conf.

April 17-19, 2013

Dallas, Texas

Advancing Patient-Family Centered Care

Through Executive & Advisor Leadership

Objectives • Apply the IHI Leadership for Improvement framework to

drive system-level performance improvements in patient-

family centered care

• Propose performance improvement strategies for your

organization that advance meaningful partnerships with

patients and families

• List specific healthcare leadership skills necessary to

engage advisors as change agents, enhance collaboration

among leaders and advisors and improve patient

experience performance

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2

The Leader’s Role

What it takes to Improve

• Will to change the current system

Strong positive leadership and a realistic

appraisal of the resources and barriers

• Ideas about changes that will improve

the system And a theory that links changes to outcomes

• Execution of the ideas And a way to distinguish successful from

unsuccessful changes

Will

Ideas Execute

PI

3

4

Leadership for Improvement:

Key Elements of the IHI Model

1. Define mission, vision, strategy

2. Establish the foundation –

prepare self, align the team(s)

3. Build will

4. Generate ideas

5. Execute change

5

Leadership for Improvement:

Key Element

Define mission,

vision, strategy

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7

8

900+ Bed AMC

Freestanding ASC

6-bed CAH 21-bed CAH

9

End in Mind

Exceptional patient experience

Demonstrated outcomes – safe,

timely, efficient, effective,

equitable and patient centered

Best in region access

System of Care

10

Definition of Quality

Care that is…

• Safe

• Timely

• Efficient

• Effective

• Equitable

• Patient Centered

IOM, 2000

11

Patient • Employee • Physician

Leading practices • Publicly reported measures • Peer review • Mortality • Reliability

Regulatory compliance • Harmful Events Safety culture • Infections • National patient safety goals

Excellence

Performance Improvement

Safety

FY 2013

Partnerships with patients, families, physicians, and staff • Care transitions

Patient/Family

Experience

VH Quality Model

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Patient-Family Experience

Vision

All planning, development, and evaluation of services & programs reflects the needs and interests of the people we serve…the patients, families and communities

Aim

Exceptional patient and family experience of care (safe, effective, patient-centered, timely, efficient, equitable)

Key Strategy

Foster meaningful partnerships that support patient engagement

14

Leadership for Improvement:

Key Element

Establish the

foundation –

prepare self, align

the team(s)

15

PFCC Best Practices

• Patient-family advisor councils

• Program planning with patients & families as faculty

• Advisors on leadership teams and performance improvement teams (quality, safety, patient experience)

• Patient stories in meetings

• HR policies & procedures reflect PFCC as a priority

• Patients design facilities and access to personal information on Electronic Medical Record

• Patients help design policies and practices in physician offices

Leadership at All Levels

Staff & Physicians: Bedside rounds, shift reports,

interdisciplinary rounds, patient experience champions

Patients & Families: Activated and engaged in self-care;

advocates for improvement in services

Unit/Service Line & Quality: Coach & mentor staff; conduct

leader rounds to reinforce best practices

Hospital/System Executives: Hold self and others responsible

for making patient-family experience performance a priority

Board Members: Advocate for patient engagement in

development, implementation and evaluation of services

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Leadership for Improvement:

Key Element

Build will

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LEADERSHIP COMMITMENT

“Vidant Health will provide

100% optimal care,

best patient experience, and

zero events of preventable harm

by October 1, 2013.”

Board of Trustees

April 20, 2010

Best Practice: Transparency

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Best Practice: Leadership Attention

& Accountability

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“Facts bring us to knowledge

but stories lead to wisdom.”

Rachel Naomi Remen

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Best Practice: Storytelling

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Leadership for Improvement:

Key Element

Generate ideas

Patients & Family As

Team Members and Team Leaders

“Leverage point four is the leverage point

with the greatest potential to drive the

long-term transformation of the entire system.”

IHI Seven Leadership Leverage Points to Drive Organizational Improvement

2008 IHI innovation series 24

Patient-Family Advisors

• Guiding principle: Partnerships with patients and

families help us achieve safe and reliable quality

care and exceptional experiences

• Corporate policies: Guidance concerning how to

identify, select and orient advisors

• Performance Improvement teams: Advisors are

recognized as part of the team

• Diversity in engagement opportunities: Formal and

informal, long-term, short-term, advisor councils,

specific projects or committees

• Corporate structure: Entity and system-wide teams

to guide policy and evaluation of services

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ENGAGED PATIENTS = EXCELLENCE

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PATIENT-FAMILY ENGAGEMENT PROJECTS

Patient communication tools

Redesign & edit patient

education materials

Family presence guidelines

Facility design and

renovation teams

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Patient Portal/

Electronic Medical Record

Recruitment

and

Retention

Safety Liaisons & PI Teams

Patient-Family advisors serve as Safety Liaisons

Liaisons complete risk assessments, HIPPA training and role orientation

Advisors participate in safety rounds and use consistent questions

Findings are documented and staff and advisors conduct debriefs with patient safety manager

Advisors serve on performance improvement teams (e.g. Falls, CaUTI, Skin Breakdown, Medication Errors with Harm, VAP, Hand Hygiene, Central Lines

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System Wide Advisor Structure

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http://vhatv.vha.com/media/2012

/vha/Vidant-Health.asx

31

Leadership for Improvement:

Key Element

Execute change

Vidant Health Patient-Family Centered Care Evolution

Institute

of PFCC

CEO site

visit

AMC

developed

Advisor

Roles in

Children’s

and Rehab

2000-2006

Executive

staff

attended

IPFCC

training

Presidents

share patient

stories with

Board

Jim Conway at

Annual Board

Retreat

Completed PFCC

hospital self-

assessments

Annual Board

Retreat - Dr.

Jim Reinertsen

Established

Corporate office

Patient

Experience

Board Quality

Committee hears

patient share

story

System 5-year

Quality plan

includes PFCC

AMC

established

Office of Patient

and Family

Experience CFO engaged in

improving patient

experiences

Advisor councils at 8

hospitals, five primary

care practices, 6 AMC

service lines, home health

& hospice, and employee

wellness center

2007 2009-2010 2011-2012

System policies &

team structure

implemented

2008

Board Quality

Committee

engages patients

to share their

stories

Advisors

engaged in

existing teams

and system-wide

PFCC curriculum

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• 90 day plans, annual plans, long range plans

• Entity audits and rounds

• System Coordination Group Meetings (e.g.

Quality/Accreditation, Patient Experience,

Surgery Services)

• Performance Scorecards

• Collaboration, coaching and support

• Patient Safety and Performance Improvement

Committees

• Transparency

System & Executive Leadership

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Patient-Family Engagement Bedside to the Boardroom

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OUTCOMES

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• 82% REDUCTION IN HAI SINCE 2008

• 98% OPTIMAL CARE ON CORE MEASURES FOR ALL 10 HOSPITALS COMBINED (UP 20 PERCENTAGE POINTS SINCE 2007)

• FINANCIAL IMPACT IN FY 12 = $1,811,650

• SYSTEM-WIDE HCAHPS PATIENT EXPERIENCE AT 91ST PERCENTILE IN FY2012

• VIDANT MEDICAL CENTER RANKED #1 FOR PATIENT CENTEREDNESS (2012 UHC QUALITY AND ACCOUNTABILITY PERFORMANCE SCORECARD)

Leadership For Improvement:

Prepare to Improve

• Define your organization’s or your

mission, vision, and strategy

• Establish the foundation – How have you

prepared yourself and aligned your

team(s)?

• Build will – What can or will you do to

build will?

• Generate ideas – What are you ideas?

• Execute change – What will you change?

36

Leadership at All Levels

Staff & Physicians: Bedside rounds, shift reports,

interdisciplinary rounds, patient experience champions

Patients & Families: Activated and engaged in self-care;

advocates for improvement in services

Unit/Service Line & Quality: Coach & mentor staff; conduct

leader rounds to reinforce best practices

Hospital/System Executives: Hold self and others responsible

for making patient-family experience performance a priority

Board Members: Advocate for patient engagement in

development, implementation and evaluation of services

37

The Leadership Imperative

• Start with yourself

• Sustain relentless focus

• Celebrate successes

• Practice transparency

• Support champions

• Deliver on the bold aims

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The Leadership Imperative

Start with yourself • Demonstrate (words,

actions, and expectations)

that nothing is more

important than patient

safety, optimal outcomes

and exceptional patient

and family experiences

• Be the vision

39

The Leadership Imperative

Sustain relentless focus • Know the best practices and build on what you

already have in place

• Ready, set, DO SOMETHING!

• Measure, learn, improve

• COMMUNICATE - Post results, talk about what worked and what didn’t work, ask why and why not

• Run towards every opportunity to demonstrate what is really important

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The Leadership Imperative

Develop & Support Champions

• Patient-Family Advisors

• Safety coaches

• Staff

• Physicians

• Community

• Policy makers

• Others

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The Leadership Imperative

Celebrate successes

• Find the stories and imbed in your

communications

• Reward and recognize

• Challenge other leaders to replicate

best practices

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The Leadership Imperative

Role Model Transparency • Provide context (the why) and

support (the how)

• Remember -- transparency is not just about data

• Listen to patients, families, staff, physicians and community – then do something with the knowledge you obtain

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The Leadership Imperative

Deliver on the broad aims

• Exceptional patient experience (every patient, every time, every place)

• Get to zero serious safety events and 100% optimal care

• Be an advocate for the primary drivers of patient-family centered care

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Leader Self-Assessment

Start with yourself:

Describe your words, actions and expectations

Sustain relentless focus:

Describe your passion for the work

Celebrate successes:

List the successes you can celebrate

Practice transparency:

Describe the “why” and “how” of your work

Support champions:

List your champions

Deliver on the broad aims:

Describe your organization’s broad aims

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How will I know if I am successful?

• Hearts and minds of staff are fully engaged in work

– Generate ideas for improvement

– Raise awareness to safety concerns

– Peer mentoring and accountability is natural

• Experiences of care reflect that nothing is more

important than safety, optimal outcomes and

exceptional experiences

• Bold aims are achieved

• My role as a leader is reflected in the people I lead

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The Leadership Imperative

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Not if….but when and how

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What it takes to Improve

• Will to change the current system

Strong positive leadership and a realistic

appraisal of the resources and barriers

• Ideas about changes that will improve

the system And a theory that links changes to outcomes

• Execution of the ideas And a way to distinguish successful from

unsuccessful changes

Will

Ideas Execute

PI

51

52

For more information contact

Sue Collier, MSN, RN, FABC

Vice President, Patient/Family Experience

scollier@vidanthealth.com

252.847.4565

After April 1, 2013

Performance Improvement Specialist

NC Quality Center/NC Hospital Association

scollier@ncha.org

919.677.4157