alan manning, executive vice president, planetree

www.planetree.org@PlanetreeAlan

From Patient Advocacy to Patient Engagement

Alan Manning, MPAExecutive Vice President, Planetree


Complex Difficult


Quality CareAccess

InclusionActivation

Choice

Think about care like Maslow did


QQuality Care

WHAT

Treatment

Service

Interactions

Food

Transitions

Quality

HOW

Leadership

Staff Engagement

Patient Involvement

Challenge status quo

interdependent process

"Our Director is honest, so I feel like I can be honest too and speak up if I see something that could improve.“ -staff

80% Serious medical errors involve miscommunication between caregivers during transitions- Joint Commission Online October 21, 2010


Example of Quality

InformedOptions- Benefits & Risks

Values-Based

What’s important to the patient

The Clinician

The Patient

Information

“the process of interacting with patients who wish to be involved in arriving at an informed, values-based choice among two or more medically reasonable alternatives”¹

¹A.M. O'Connor et al, “Modifying Unwarranted Variations In Health Care: Shared Decision Making Using Patient Decision Aids” Health Affairs, 7 October, 2004

https://decisionaid.ohri.ca/docs/das/opdg.pdf


Access to Care

82% say access their medical records is important

Accenture Survey on Patient Engagement - Research Recap: United States, Sept. 2013

41% would consider switching doctors to gain access to their medical

…to loved ones…to resources…to your medical team (hourly rounding)…to your medical record…to safe and unbiased care

80% “Unrestricted visiting in the ICU doesn’t increase infection rates…it’s associated with lower rates of cardiovascular complications and mortality and lower stress hormone levels.” Fumagalli et al. 2011

of family members of ICU patients develop anxiety, and/or PTSD related to their experience


Example of Access- Patient Pathways


Inclusion in CareComprehensive care Planning Patient and family partnership council Bedside shift report

Teaching EmpathyEye contact

Muscles of facial expression

Posture

Affect

Tone of voice

Hearing the whole person (context)Your response

Helen Reiss, Empathetics

Medical professionals who communicate with empathy have higher patient satisfaction ratings. (Riess, 2012)

Patients who experience empathic care have better medical outcomes.(Hojat, 2011)

Adherence to treatment recommendations increases with compassionate care. (Halpern, 2010)

Communicating empathically increases clinician job satisfaction and reduces burnout. (Krasner, 2009; Shanafelt, 2009; West, 2011)

Enhanced empathic care and physician well-being are highly correlated.(Shanafelt, 2005)

Empathic clinician communication improves the quality of all interactions with others; patients, their families, colleagues, and loved ones. (Halpern, 2012)


Inclusion in Care

Steps to Building an Effective PFPC1) Determine the Scope of the Council2) Select the Team 3) Determine a Budget 4) Confirm Team Members5) Conduct the Orientation Meeting 6) Conduct Regular Council Meetings 7) Elicit Public Relations Support & Community Engagement 8) Conclude With a Meeting9) Measure Success10) Sustain the Partnership Model

Leonhardt K, Bonin K, Pagel P. Guide for Developing a Community-BasedPatient Safety Advisory Council. Prepared by Aurora Health Care, Wisconsin.

AHRQ Publication No. 08-0048. Rockville, MD: Agency for HealthcareResearch and Quality. April 2008.

• Getting Started• Integrate diverse

voicesActivate

• Agenda• Charter• Education

Engage-Enable-Energize

• Close the feedback loop

• Measure effectiveness

• Integrate into quality

Enhance

Comprehensive care Planning Patient and family partnership council Bedside shift report


Nurses treat you with courtesy/

respect

Nurses attitude toward requests

Attention to special/personal

needs

Nurses kept you in-fromed

Staff include you in decision re: treat-

ment

Staff worked to-gether to care for

you

8284868890929496

6 months prior to implementation of bedside report 6 months after implmentation of bedside report

Spirit and Intent of Hourly Rounding• More frequent touch-points• Security to patients• Moves from reactive to proactive• 4 P’s- Pain, Personal Needs, Positioning, Placement

Bedside shift report as a time saver• Sharp decline in the number of call lights• Nurses have reported a better ability to prioritize cases • Overall decrease in staff time post-implementation

Inclusion in CareComprehensive care Planning Patient and family partnership council Bedside shift report


A shared space for Bi-directional communication

Example of Inclusion


Activation in Care

Know them

Empower them

Strengthen them

Only 41% of Medicare patients believe that their treatment reflected their preference for palliative care over more aggressive interventions.

40%

Doctors believe 71% of patients with breast cancer rate keeping their breast as top priority. The figure reported by patients is just 7%.

Once patients are informed about the risks of sexual dysfunction after surgery for benign prostate disease, 40% fewer prefer surgery.


23 secs before we interrupt patients

50%Of physicians don’t ask if patients have questions

<1 MinuteSpent discussing new

prescriptions

FEAROf appearing to challenge, keeps patients from asking

questions

We interrupt

JAMA. 1999 Circulation. 2008

Pat Educ and Cnslng. 2009. Health Affairs, 2012

We don’t include

We don’t inform We intimidate

Focus on 1-3 key, need to know items

Avoid medical jargon. Teach & define. Use concrete terms.

Focus on what patient needs to do!

3 STEPS to Enhancing Communication

Know them

Empower them

Strengthen them

Activation in Care

2013 Health Affairs study found that Shared Decision Making:• Reduced the overall cost of care by 5.3%• Reduced admissions by 12.5%• Reduced preference sensitive surgeries by 9.9% (20.9% for heart surgeries)


Activation in Care

Assist with menu selection and feeding

Personal care, baths, manicure, dressing

Discharge planning and preparation

Care coordination

Change dressings, flush catheters

Take temperature, monitor tube feedings

Take blood pressure

From our Designation Criteria IV.: A comprehensive formalized approach for partnering with families in all aspects of the patient’s/resident’s care, and tailored to the needs and abilities of the organization, is developed. An example is a Care Partner Program.

“The doctor told me that I could have surgery and explained the risks. He also said I could take a “wait and see” approach. Then he made sure that I understand both options. He asked me which option sounded the best to me based on what I wanted. He cared about my goals.” -patient

Know them

Empower them

Strengthen them


• Family formally engaged as integral member of care team

• A partnership between family and staff• Provides a source of continuity • Prepares loved one for post-discharge

“They showed my husband how to do my dressing

changes so I don’t have to come here every day. They

asked him questions: Can you see it? Do you

understand? For him to see, he was very informed.”

Example of Activation


Choice in Care

Choice without education & empowerment will lead to less than optimal results


Quality CareAccess

InclusionActivation

Choice

Think about care like Maslow did


Culture PracticesStructures


Alan [email protected]

@PlanetreeAlan

mailto:[email protected]

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