engaging patients and families in improving care...

1

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

2


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


3


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


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


4


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


Hospital

HomeAmbulatory

Care Clinic

Skilled Nursing

Facility

SNF

Rehabilitation

FacilityDisease Manager

Adding More Care Managers Won’t Fix It!


5


3/20/2014

Case Managers Do Not Perform

The Majority of Care Coordination…


Supporting Family Caregivers:United Hospital Fund of New York

http://www.nextstepincare.org/Caregiver_Home/

6


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

7


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

8


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

9


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

10


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

11


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

12


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

13


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/

http://www.tonicordell.com/

14


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

15


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

http://pearsonreport.com

http://pearsonreport.com

16


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

http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/howtogetstarted/index.html

17


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.

http://www.ihi.org/

http://www.ipfcc.org/

http://www.ihi.org/

engaging patients and families in improving care...

Documents