consumer involvement in quality management/improvement by: daniel tietz program manager for consumer...
TRANSCRIPT
Consumer Involvement inQuality Management/Improvement
By: Daniel TietzProgram Manager for Consumer Affairs
&Daniel Belanger
Director, NYS HIV Quality Management Program
Patient-Centered Care
Consumer AdvocacyC
on
su
me
r In
volv
em
ent
in
Qu
alit
y M
an
age
me
nt
/ Im
pro
vem
en
t
Pa
tien
tS
elf - M
an
ag
em
entEvaluate
Effectiv
eness
Raise Awareness
Provide
Training To
Build
Capacity
Formalize
Input
Provide
Routine Input
Question for Participants
• What is Self-Management?
What is Patient Self-Management?
Self management improves self-efficacy and fosters collaborative goal setting and decision making
between consumers and providers. This relationship allows consumers to monitor and
manage their health. (Bodenheimer, Lorig et al, 2002; Lorig, 2003)
Background: Patient Self-Management
• Most research about self management focuses on arthritis, diabetes, and asthma
• A study from 1993 about arthritis self management found that increased self efficacy lead to better health outcomes
• Key element of the chronic care model
Chronic Care ModelRetrieved on October 9, 2009 from: http://www.improvingchroniccare.org/index.php?p=Health_System&s=20
Self-Management Resources/ToolsResources Tools
Making Sure Your HIV Care is the Best It Can Be Traininghttp://www.nationalqualitycenter.org/index.cfm/5943/13886
Making Sure HIV Patient Self-Management Workshttp://www.nationalqualitycenter.org/index.cfm/5943/16134
Shared decision making toolkitshttp://www.dhmc.org/webpage.cfm?site_id=2&org_id=844&gsec_id=0&sec_id=0&item_id=43192
Workbook on Developing and Evaluating Patient Decision Aidshttp://decisionaid.ohri.ca/docs/develop/Develop_DA.pdf
Tips and resources to help patients become more involved in their health care by asking the right questionshttp://www.ahrq.gov/questionsaretheanswer/
Ottawa Personal Decision Guide- 1 page, 2 pagehttp://decisionaid.ohri.ca/docs/das/OPDG.pdfhttp://decisionaid.ohri.ca/docs/das/OPDG_2pg.pdf
Choosing Health for Life: A Patient Medical Journalhttp://www.nationalqualitycenter.org/index.cfm/5659
My Shared Care Plan- A Health Management Toolhttp://www.ihi.org/IHI/Topics/HIVAIDS/HIVDiseaseGeneral/Tools/My+Shared+Care+Plan.htm
Wallet Sized Appointment Cardhttp://www.ihi.org/NR/rdonlyres/B35A1840-5434-44E8-A0AB-7AB91F3DC22D/358/Tool_WalletSizedApptCard.pdf
Additional Resources
Question for Participants
• What is Patient-Centered Care?
Patient Centered Care
Care that is respectful of and responsive to individual patient preferences, needs, and
values and ensures that patient values guide all clinical decisions. (IOM, 2001)
Aspects of Patient Centered Care• Respect for patients’ values, preferences, and
expressed needs by treating patients as individuals• Collaboration and integration of care • Overcoming the barrier of words in communication• Involvement of family and friends (when appropriate)• Clinical communication/web-based applications for
patients and health care providers• Patient Education• Enhancing physical comfort
(Gerteis et al., 1993)
Examples of Patient Centered Care
• Asking patients, "Do you have any questions that I have not covered today?" This often leads to additional concerns that can be addressed in the visit.
• “Pod” station design: At the center of each pod is a workstation where nurses and medical assistants have their desks. Around the perimeter of the square are countertops and spaces for specific tasks such as taking weights and eye exams. The pod structure was created to enhance both communication and efficiency among staff. The design encourages interaction between clinicians and ancillary staff, such as impromptu consultations or follow-up with patients. At the end of the day physicians and staff from the same pod meet to discuss the day and identify strategies to address any problems.
Case Studies by Dale Shaller and Susan Edgman-Levitan for Commonwealth Fund
Examples of Patient Centered Care“Pod” station design
Consumer Involvement in Quality Management/Improvement
• Quality improvement (QI) models used in health care were created for the automotive industry
• Critical dimension of QI is determining consumer needs as well as developing products and services that meet and exceed customer expectations.
• Adapted for use in health care settings, although many medical
disciplines are still grappling with how and to what extent they should involve consumers
Group Activity 1Barriers to Consumer Involvement in QM/QI
• Have all participants count off by 5’s• Each group chooses a leader• Each group chooses a facilitator (can be same as the
group leader), recorder and someone to report back • Each group will spend 10 minutes brainstorming
barriers to consumer involvement in QM/QI• Each group will report back on barriers identified• Please stay in groups for the remainder of the
training!
Two Dimensions of Quality
Technical Quality
Provider Perceptions of Quality of HIV Care
Experiential QualityPatient Perceptions of Quality of HIV Care
Leonard Berry, Texas A&M University, IHI conference (2001)
Technical & Experiential
Group Activity 2
• Each group should brainstorm 3 technical and 3 experiential areas for improvement
• Each group should agree by consensus and prioritize the TOP area for improvement to focus on (it can be either a technical or experiential area for improvement)
Conceptual frameworkPLWHA involvement in QM/QI
• Defines the ways to FORMALLY involve PLWHA in HIV facility-wide QI activities and the mechanisms during each stage of the QI process
Framework for
PLWHA involvementIn QM/QI
Routinely solicit PLWHA input from
”broadest”recipients receiving
HIV PC services
Routinely informPLWHA ofevolving
QI activities via multiple
communication venues/medium
Annually assess programmatic level
of PLWHA involvement
throughout theHIV Program
Formalize activePLWHA involvement
onInternal QM teams
and support them in this process
Ensure discussionsabout “Quality”
are includedduring all
CAB meetings
Group Activity 3
• From the previous group activity, each group should use top priority area agreed upon for improvement from Group Activity 2
• Develop a “Plan” to involve consumers that your group is assigned from Framework for PLWHA involvement in QM/QI– Group 1: Routinely solicits PLWHA input from “broadest” recipients
receiving HIV PC services– Group 2: Ensures discussions about “Quality” are included during all CAB
meetings– Group 3: Formalizes active PLWHA involvement on Internal QM teams and
support them in this process– Group 4: Routinely informs PLWHA of evolving QI activities via multiple
communication venues/medium – Group 5: Annually assesses programmatic level of PLWHA involvement
throughout the HIV Program
• Each group will report back to the larger group on the “ Plan” developed
PLWHA Involvement in QM/QI
• Routinely solicit PLWHA input from “broadest” recipients receiving HIV primary care services: - Conduct satisfaction surveys, focus groups, or
patient interviews to gather ideas for improvement from the consumer perspective
- Clearly define and prioritize ideas for improvement and share with staff for feedback
PLWHA Involvement
• Ensure that discussions about “Quality” are included during all CAB meetings:- When appropriate, form a CAB and engage in planning
discussions about QI goals/objectives/activities, methods used for data collection, performance measures and areas identified that need to be improved
- Routinely present HIV clinical performance data results to consumers and explain/discuss routine data reports with to solicit PLWHA recommendations when planning (ex: PDSA cycles, fishbone diagrams, etc.) next steps
PLWHA Involvement in QM/QI
• Formalize active PLWHA involvement on Internal QM teams and support them in this process:- Nominate and appoint appropriate consumers as equal members on QI teams to identify and improve aspects of HIV care- Develop skills-building and training opportunities for
consumers so they can fully participate in agency-wide HIV QM committees and QI teams
- Build further understanding among HIV staff about the benefits of engaging consumers in QI activities- Discuss key findings during QM team meetings- Link QI activities of the HIV QM team to CAC discussions
PLWHA Involvement in QM/QI
• Routinely inform PLWHA of evolving QI activities via multiple communication venues/medium:- Openly share the results of QI activities, including performance data results and updates from quality improvement projects, with all patients via displays in the waiting room, storyboards, or newsletters- Inform consumers about facility-wide QI activities and in doing so, highlight their role in improving key aspects of HIV care- Celebrate and publicize the successes of consumer involvement in QI activities among patients and staff
PLWHA Involvement in QM/QI
• Annually assess the programmatic level of PLWHA involvement throughout the HIV Program:
- Develop and/or adopt a standardized assessment tool to evaluate the level and effectiveness of consumer involvement
- Conduct assessment annually and discuss the results with the QM team/committee
- Respond to the findings and make adjustments moving forward
