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The content of this presentation is proprietary

to Prince Health, LLC and protected by intellectual property laws, and is not to be

disseminated without permission.

Five Executive Actions to Engage Patients for

Meaningful Results

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LARRY PRINCE, Ed.M. CEO, Prince Health, LLC

More than 30 Years of Healthcare and Pharma Industry Experience

-  Leadership Effectiveness -  Change Management -  Communications -  Patient Engagement -  Patient Outcomes

Health Care Public Speaker

Education: ๏  Ed.M.: Columbia University – Applied Exercise Physiology

973-670-6304 larry@med-revu.com

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Gaelynn – a Patient’s Journey

•  Age 82; lives alone in a single family home

•  Admitted to hospital with heart failure

•  Diabetes, hypertension and osteoarthritis

•  Two daughters - they live 100 miles away

•  Gaelynn is close to her pastor & church

Aim: Keep Gaelynn

out of the Hospital &

Safe at Home

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To Keep Gaelynn out of the Hospital and

Safe at Home

Engage Gaelynn and her Care Partner Support Network à Self Care

KEY à The Work of Home Health Organizations

Our Mission This Morning

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Why Engaging Patients Matters

•  It’s Good Patient Care to do so

•  Higher Patient Satisfaction

•  Stronger and more Meaningful Results

•  Save the Institution and the System $

•  Build Stronger Career Skills

•  Clinician-Employee Satisfaction

•  Competitive Advantage

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Learning Objectives Think – Learn - Act

•  Define patient engagement

•  Assess the factors in engaging patients, like Gaelynn

•  Learn FIVE EXECUTIVE ACTIONS

•  Share best practices

•  Commit to action plan for change

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Meaningful Results One Example: Readmission Rates

•  79% of hospitals were penalized by Medicare

•  All cause 30-day RR for HF range from 20% - 25%

•  More than 25% of 30-day readmissions occur within the first five days post-discharge

•  Almost 30% of post-discharged patients who are referred for HH care services do not receive HH

•  If referred and receive HH = 7.3% less readmissions

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“…Healthcare communities with higher performing nursing homes and higher performing home health agencies were more likely to have lower 30-day risk-standardized readmission rates.”

Home Health Care Manag Pract. Wang, et al, 2016, Nov; 28(4): 201–208.

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It’s a Culture Change

Old Model: TELLING Patients

New Model: ENGAGING Patients

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Let’s Define Patient Engagement

BUILD PATIENT knowledge & skills, while uncovering

a patient’s desire to make change

Leading to Personal Goals & Commitment to Self Care

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“No one can care for you, like you can care for yourself!”

Floor Nurse Kingsbrook Jewish Medical Center

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The Clinician-to-Patient Interface Leading to Self-Care

Importance of:

-  Connecting Emotionally

-  Short-term Goal Setting

-  Social Support – Care Partners

-  Professional Skills

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Boniva Strategy 2011 LEVELS OF PATIENT INTERACTION

(1) TELL

One direction – imparting information. “Here is what you need to know.”

(3) ENGAGE

Connect with the patient at a personal level. “What is important to you? What will you commit to?”

(2) TEACH

Ask questions to involve the patient. “Let’s talk about ... What are your thoughts...?”

The content of this presentation contains information confidential and proprietary to Prince Health, LLC DBA Med-Revu.

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Let’s Pause

Where does your organization and clinicians fall on the Tell – Teach –

Engage Continuum?

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Holistic Elements in Engaging Gaelynn

•  Cultural Views and Values

•  Health Literacy and Education

•  Degree of Disease Progression and Health Priority

•  Social Support System

•  Financial

•  Use of Technology (phone, text, app)

•  Resource Support

•  Motivational, Emotional & Social Factors

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Patient Engagement

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Information

Emotional

commitment to making change

•  Intellectual •  Social Needs •  Short-term •  Support •  Do differently

TELL ENGAGE

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Clinical-Think vs Patient-Think

๏  “I don’t want to die!” ๏  “I just want to walk up the

stairs and not be out of breath.”

๏  “I need to stay healthy for the holidays”

๏  “I want to attend a family event in a month”

๏  “I need to get back to work”

Patients do not relate to clinical values; they relate to behaviors that matter to them. The

goal is to get the patient to verbalize those things that matter to them.

“I need to improve this patient’s...”

๏  Ejection Fraction

๏  Arrhythmias

๏  Blood Pressure

๏  HbA1C and blood glucose

๏  Cholesterol/LDL/HDL/TG

๏  BMI

clinician

person with heart failure

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Tell vs. Ask-Engage Approach

Most patients do not respond to being told what to do; they relate to being ASKED based upon their

personal short-term needs and motivations.

•  “Here’s what you need to do…”

•  “Here’s why this is good for you”

•  “Here’s more information that will help you”

•  “You must do this to help with…”

Tell and Urge Ask and Engage •  “Here is what has been

recommended for you ... what do you think?”

•  “What would you like to be able to do or look forward to doing in the next few weeks?”

•  “What do you think about making a commitment to a goal for this week? Here are a couple of choices...”

•  “Who can help you with your goal and how can he or she help you?”

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STARTING POINT FOR POSITIVE CHANGE

Patient Sets Short-Term

Health Goal with Support from Care Partners

Behavior Change

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Examples of Personal, Short-term, Social Goals

๏  “I’ll eat less sugar so that I give myself a better chance of attending my niece’s graduation.”

๏  “I’ll take my new medicines every morning because I want to get well enough to water my plants”

๏  “I’ll take my medicine every morning because I don’t want to be out of breath walking down the block.”

๏  “I will start walking so I can attend a family event in two weeks”

๏  “I will take my diabetes pills so that I don’t end up with my sugar crashing at night.”

KEY ENGAGEMENT INSIGHTS

Asking vs. Telling

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vs. Self-Motivation How Much You Know

vs. Short-term Goal Long-Term

vs. Care Partnership Alone

vs. Multiple Touch Points One Time Interaction

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Tell me and I’ll Forget,

Show me and I may understand,

Involve me and I will understand.

Chinese Proverb

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Five Executive Actions Change Takes Leadership

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5 Executive ACTIONS To Engage Patients A Framework

1.  Build a Culture of Patient Engagement & Self Care

2.  Multi-Disciplinary Team to form a Plan

3.  Clinician Skill Building and Tools

4.  Social Network and Care Partner Support

5.  Communications, Collaboration & Coordination The Handoff – Handover - Handshake

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#1 - Build a Culture of Patient Engagement & Self Care A Leadership Movement - Purpose

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Define what Patient Engagement is and

what it is not for your organization.

Customize! What does it look like when you’re successful at patient engagement?

Step 1: Define Patient Engagement

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Define Purpose for making change

Determine results you seek

Step 2: Determine End in Mind Purpose and Results

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Develop the rationale for making

change, and how it benefits all stakeholders in their terms. WIFFM.

Energize your Teams!

Create a Movement – a Cause! Consider “the work itself”

Step 3: Gain Buy-in Case for Change – “Here’s Why?”

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Recognize what people need from you

as leaders:

- Ongoing leadership cheerleading -  Time to learn new skills

-  Resources -  Specialized roles = Practice Champions

Step 4: Lead the Change It’s a Process

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#2 - Multi-Disciplinary Project Team

- A change to a culture of patient engagement requires a TEAM

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q Clinicians

q Clinical Leaders

q Coordination

q Sales

q Leadership Team

q Hospital – System - ACO

q Sub-acute – SNF

q Community

Stakeholders – Broad-based Planning Team Who is at the planning table?

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#2 Multi-Disciplinary Project Team Best Practices

q  Team sets and aligns around purpose and goals

q  Project Team develops plan that includes: action steps, roles, training needs, metrics, timelines…

q  Project Team Leader - respected and knowledgeable

q  Implement phased rollout – embrace small wins

q  Anticipate implementation challenges: $, time, support

q  Recognize team members commitment and outcomes

q  Collect and share best practices for sustained success

q  Develop practice champions

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#3 Develop Clinician Communications and Health Coaching Skills

“My team is committed to learning new

skills.”

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Boniva Strategy 2011

Core Skills

Active Listening & Framing the Conversation

Teach-Back Method

Health Coaching & Health Literacy

PATIENT ENGAGEMENT SKILLS AND PROCESS STEPS

(1) Build Rapport and Trust

Showing the patient & their family that you

care increases the acceptance for your teaching.

(3) Goal Setting & Ownership

Work with the patient & their family to set short-term goals based upon the patient’s

personal interests, activities and motivation. Patient visualizes then records their Goals.

(2) Core Teaching

Once trust is built, patients will be more receptive to receive your teaching related to their medicines and managing disease. Use

communications skills for 2-way conversation.

Clinician Handoff Communications & Process

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#3 – Build Clinician Skills

1.  Identify specific skill development needs for team and individuals

2.  Develop a learning program – include mentoring

3.  Build skills over time (train-the-trainer, practice champions)

4.  Incorporate into performance management plan

Patient Personal Goal Setting

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Say it = Verbalize

See it = Visualize

Set it = Write it Down

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ACTIVE CHOICE

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Do you want to take your medicine in the kitchen or in the bathroom?

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Examples of Personal, Social Goal Setting

๏  “I’ll take my new medicines every morning because I want to get well enough to water my plants”

๏  “I’ll take my medicine every morning because I don’t want to be out of breath walking down the block.”

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#3 Patient Communications Tools Capture Patient Commitment in Writing

•  Enhances Patient Interaction

•  Patient Takes Ownership

•  At-home Support

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#4 – Social Network and Care Partner Support

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q  Spouse and Immediate Family

q  Close Friend

q  Trusted Neighbor

q  Religious Leaders and Organization

q  Senior Groups and Centers, Community, Library

q  Local Pharmacist

q  Adult Companion Care and Services

q  Accountant and Attorney

q  Building Super and Handyman

Who’s in Gaelynn’s Social-Care Partner Support Network?

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#4 - Social Network and Care Partner Support

1.  Identify and document Gaelynn’s network

2.  Handoff à determine point person within the network; include point person in the process

3.  Align Care Partner’s role to needs and desires of patients like Gaelynn (do not assume!)

4.  Determine best means to communicate to point person and the network (why, when, how…)

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#5 – Ongoing Communications,

Collaboration, Coordination and Support The Handoff - Handshake

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#5 Clinician ß à Clinician

q Team meetings to discuss patient’s like Gaelynn: treatment, changes (Dx, Rx & Tx) and progress

q Phone calls

q Texting

q Apps: Practice Unite and Uniphy

q Tele-health

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#5 Clinician ß à Patient

q All interactions refer back and reinforce Gaelynn’s personal, short-term goal

q Maximize patient touch points à “Check Ins”

q Ask Gaelynn and her point person CarePartner to share progress – have it come from the patient

q F/U phone calls with Gaelynn and/or caregiver

q Help Gaelynn F/U with MD visits and Rx Refills

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#5 Resources and Tools to Engage Gaelynn

q  Transportation – MD & Rx

q  Community resources - senior groups – church groups

q  Pill Box and medication reminder tools

q  Life emergency tools

q  IT tools and portals to access health information and connect to caregiver support network

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Text Tying Together

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5 Executive ACTIONS To Engage Patients A Summary

1.  Build a Culture of Patient Engagement & Self Care It’s a Leadership Movement

2.  Multi-Disciplinary Team to form a Plan

3.  Clinician Skill Building and Tools Skills beget Confidence

4.  Social Network of Care Partner Support

5.  Communications, Collaboration & Coordination The Handoff – Handover - Handshake

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Lessons from Coach Belichick

•  Set the bar high - accountability

•  Team first

•  Rely on your “dependables”

•  Prepare exhaustively

•  Care about your people

•  Help people do their jobs

•  Develop Captains

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What did you learn today to help Gaelynn?

•  Age 82; lives alone in a single family home

•  Admitted to hospital with CHF

•  Diabetes, Hypertension and Osteoarthritis

•  Two daughters - they live 100 miles away

•  Gaelynn is close to her pastor

Aim: Keep Gaelynn out of the Hospital &

Safe at Home

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Ask Yourself …

Based upon today’s talk, what do you see applying or doing

differently?

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Organizational Improvement & Development

Determine 2-3 areas to improve patient engagement (Align these areas with your organizational goals and mission)

•  Why is it important for your organization to make this change? Develop a case for change and set goals

•  Who will be on the team to form and implement a plan?

•  What is the specific plan? How measure?

•  By when do you aim to complete this plan?

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Conclusion

Patient Sets Short-Term

Health Goal with Support from Care Partners

Behavior Change

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Conclusion

Creating a Culture Focused on Patient Engagement

Leads to Higher Clinician Satisfaction à More Meaningful Results

Takes Leadership

Commitment

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Prince Health, LLC Core Team

Larry Prince, Ed.M.., CEO larry@med-revu.com (973) 324-5336 Susan Friedman, RN, BSN, Director, Nurse Education susan@med-revu.com (973) 220-6753 Helaine Wasserman, Director, Business Development helaine@med-revu.com (908) 789-2384

The content of this presentation is proprietary to Prince Health, LLC and protected by intellectual property laws, and is not to be disseminated without permission.