Engaging Patients and Families in Improving Care...
Transcript of Engaging Patients and Families in Improving Care...
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Institute for Healthcare Improvement Reducing Avoidable Readmissions Seminar
3/20/2014
Engaging Patients and Families in Improving Care TransitionsEric Coleman and Gail Nielsen
These presenters have
nothing to disclose
April 24, 2014
Objectives
Participants will be able to:
1. Describe the benefits of involving patients and families as partners
2. Recognize the valuable role of family caregivers in high quality care transitions
3. Share tips on getting patients and family members involved and removing barriers to effective partnerships
4. Use a self-assessment tool on readiness for patient engagement
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Institute for Healthcare Improvement Reducing Avoidable Readmissions Seminar
3/20/2014
Qualitative Studies
What do persons and their families
have to teach us about their
experiences during care transitions?
© Eric A. Coleman, MD, MPH
Information Transfer
“They overmedicated me like you
wouldn’t believe [in the NH]. All they
had to do was make one call to my
primary care doctor”
Poor inter-professional and inter-
institutional communication
© Eric A. Coleman, MD, MPH
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Institute for Healthcare Improvement Reducing Avoidable Readmissions Seminar
3/20/2014
Preparation
“The doctor did not know that there was no
way my wife could take care of me”
Family and caregiver needs often
overlooked or expectations for care
provision unrealistic
© Eric A. Coleman, MD, MPH
Self-Management
“A lot of times the questions don’t come
until you get home”
Often did not know the questions to ask or
the person to direct them to
© Eric A. Coleman, MD, MPH
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Institute for Healthcare Improvement Reducing Avoidable Readmissions Seminar
3/20/2014
Empowerment
“You know, we’re responsible for our own
healthcare and its our fault if we fall
through the cracks”
Contribution to care plan not taken
seriously
Need for an advocate
© Eric A. Coleman, MD, MPH
Hospital
HomeAmbulatory
Care Clinic
Skilled Nursing
Facility
SNF
Rehabilitation
FacilityDisease Manager
Adding More Care Managers Won’t Fix It!
© Eric A. Coleman, MD, MPH
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Institute for Healthcare Improvement Reducing Avoidable Readmissions Seminar
3/20/2014
Case Managers Do Not Perform
The Majority of Care Coordination…
© Eric A. Coleman, MD, MPH
Supporting Family Caregivers:United Hospital Fund of New York
http://www.nextstepincare.org/Caregiver_Home/
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Institute for Healthcare Improvement Reducing Avoidable Readmissions Seminar
3/20/2014
Activation Is Developmental
(c) Judith Hibbard, PhD University of OregonJudith Hibbard, PhD University of Oregon www.insigniahealth.com
Literacy vs. Patient Activation
• For most of the behaviors, activation plays an equal or larger role than literacy.
• Taking on and maintaining new behaviors requires self-efficacy as well as knowledge.
• Taking on new behaviors also requires a belief that this is one’s “job” to manage health.
• Where information is the primary requirement (e.g. making Medicare choices), literacy plays a larger role.
Judith Hibbard, PhD University of Oregon
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Institute for Healthcare Improvement Reducing Avoidable Readmissions Seminar
3/20/2014
Share with the large group:
Local examples?
Thoughts?
Surprises?
Questions?
Your Turn
Provocation from Don Berwick
“Are patients and their families…
someone to whom we provide care?
Or,
Are they active partners in managing
and redesigning their care?”
- Donald Berwick, M.D. Plenty, 2002 IHI Forum Plenary
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Institute for Healthcare Improvement Reducing Avoidable Readmissions Seminar
3/20/2014
Three Levels of Engagement
Patients and family caregivers:
1. Participate in shared decision making and care
processes
2. Participate in giving feedback and ideas on
improvement or participate at the project level
3. Are partners in improving, design, or redesign
of care delivery processes or infrastructure
The Patient Engagement Evolution
“Doing to patients
Doing for patients
Doing with patients
Doing with patients and their families”
“It’s a profound paradigm shift.”
Barbara Balik, Common Fire, 2011
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Institute for Healthcare Improvement Reducing Avoidable Readmissions Seminar
3/20/2014
Share at your tables:
1. Your examples of engaging patients and families in improvement
2. Are your examples “To”, “For”, or “With”?
Tables share with the large group:
1. One example of partnering with patients
2. One surprise or Aha!
Table Exercise
Tips for Recruiting Patient
and Family Partners
• Seek referrals from healthcare providers
• Healthcare provider invites the patient to explore
interest in joining the team
• Team lead discusses with interested patients
and family members: information on the project,
roles, responsibilities, and opportunities
– Allow time for them to consider
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Institute for Healthcare Improvement Reducing Avoidable Readmissions Seminar
3/20/2014
Look for patient and family members who:
• Willingly and readily share insights on:
– Things you do not know
– Personal experiences in ways that others can learn
from them
• Show concern for more than one issue
• Listen and respect others’ perspectives
Key Characteristics
for Patient and Family Partners
Key Feedback from Patients
and Family Caregivers
• Spend more time orienting new members to the
organization, the team and to why patient
involvement is important
• Always include more than one patient or family
caregiver
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Institute for Healthcare Improvement Reducing Avoidable Readmissions Seminar
3/20/2014
“Start before you are ready!”
Jim Anderson
Chairman of the Board
Cincinnati Children’s Hospital and Medical Center
Patient and Family Advisory Council:
St. Luke’s Hospital Heart Care Services
Purpose:
“Dedicated to St Luke’s mission ‘Give the health care we’d like our loved ones to receive’ and to support the principles and practice of family-centered care”
Provide input on:
• Enhancing patient and family experience of care
• On delivery of services for patients and families that support or enhance family-centered care
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Institute for Healthcare Improvement Reducing Avoidable Readmissions Seminar
3/20/2014
Provide input and feedback on:
• Educational programs, classes, written materials, and home visits
• Program development
• Facility design or renovation
Participate in:
• Education/orientation of hospital associates
• Annual review of accomplishments and goal setting
• Recruiting new members
St. Luke’s Hospital:
Critical Care/ Heart Care Services
Engagement with Patients
and Their Family Caregivers
To transform transitions in care, engage
them in:
– Treatment and shared care planning
– Improving care and service processes
– Improving communication between health
providers and patients and their families
– Improving care across the continuum
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Institute for Healthcare Improvement Reducing Avoidable Readmissions Seminar
3/20/2014
IPCC Patients as Partners (PasP)
Provincial Steering Committee
IPCC Integration Leadership Committee (ILC)
DRAFTINTEGRATED PRIMARY ACUTE AND COMMUNITY CARE
Patients as Partners
1500 Trained Patient Partners
Toni Cordell
Patient who did not understand found her voice
• Local and national health literacy advocate
- Workshop co-presenter
- Patient partner in health literacy programs
- Faculty in medical residency programs
- Keynote speaker
Turning stumbling blocks into stepping stones: www.tonicordell.com/
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Institute for Healthcare Improvement Reducing Avoidable Readmissions Seminar
3/20/2014
1. Share at your tables: Your examples
of engaging patients and families in
improvement
2. Volunteers share with the large group
Table Exercise
Assessing Readiness and
Depth of Patient Engagement
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Institute for Healthcare Improvement Reducing Avoidable Readmissions Seminar
3/20/2014
"Health Policy Brief: Patient Engagement," Health Affairs, February 14, 2013.
http://www.healthaffairs.org/healthpolicybriefs/
• Individually, or in teams, indicate
where you are in:
• Direct care and
• Organizational design & governance
• Volunteers share thoughts with the
large group
Table Exercise
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Institute for Healthcare Improvement Reducing Avoidable Readmissions Seminar
3/20/2014
The Guide to Patient and Family Engagement
in Hospital Quality and Safety:
Engaging Patients and Families to Improve the
Quality and Safety of Care We Provide
Information to Help Hospitals Get Started;
http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/guide.html
• How to select, implement, and evaluate the Guide’s
strategies
• How patient and family engagement can benefit your hospital
• How senior hospital leadership can promote patient and
family engagement
Results Coming Soon32
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Institute for Healthcare Improvement Reducing Avoidable Readmissions Seminar
3/20/2014
More Information on Partnering
with Patients and Families
• Partnering with Patients and Families to Design a Patient- and Family-Centered Health Care System: A Roadmap for the Future. Cambridge, MA: Institute for Healthcare Improvement. Available at www.ihi.org.
• Tools for Advancing the Practice of Patient- and Family-Centered Care. Institute for Patient- and Family-Centered Care. Available at www.ipfcc.org.
• Berwick D. What ‘patient-centered’ should mean: confessions of an extremist. Health Affairs (Millwod). 2009;28(4):555-65.
• Taylor J, Rutherford P. The pursuit of genuine partnerships with patients and family members: the challenge and opportunity for executive leaders. Health Services Management. 2010;26(4):3-14. Available at www.ihi.org.