module 1: patient and family engagement through care teams ... · 17/01/2019 · module 1: patient...
TRANSCRIPT
![Page 1: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/1.jpg)
Module 1: Patient and Family Engagement Through Care Teams
January 17, 2019 at 1pm ET
![Page 2: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/2.jpg)
Welcome to the Learning Collaborative!
![Page 3: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/3.jpg)
Emily KaneCasey Alrich
Hello!
![Page 4: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/4.jpg)
NNCC would like to thank Arizona State University, Interprofessional by Design, and the National Center for Interprofessional Practice & Education at the University of Minnesota for its partnership and collaboration in the development of this training.
Acknowledgements
![Page 5: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/5.jpg)
Conflict of Interest Disclosure
We have no real or perceived vested interests that relate to this presentation nor do we have
any relationship with pharmaceutical companies, biomedical device manufacturers and/or other corporations whose products or services are related to pertinent therapeutic
areas
![Page 6: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/6.jpg)
Teams and Teamwork in Primary Care
![Page 7: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/7.jpg)
Patient & Family Outcomes Team Outcomes
Satisfaction Satisfaction
Engagement Productivity
Adherence Accurate problem identification
Self-care Fewer errors
Fewer missed visits Less turnover
Clinical outcomes
![Page 8: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/8.jpg)
Core Competencies for Interprofessional Collaborative Practice (2016 Update)Interprofessional Education Collaborative (2016)
Values/Ethics for Interprofessional PracticeWork with individuals of other professions to maintain a climate of mutual respect and shared values.
Teams and TeamworkApply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan, delivery, and evaluate patient/population-centered care and population health programs and policies that are safe, timely, efficient, effective, and equitable.
Roles/ResponsibilitiesUse the knowledge of one’s own role and those of other professions to appropriately assess and address the health care needs of patients and to promote and advance the health of populations.
Interprofessional CommunicationCommunicate with patients, families, communities, and professionals in health and other fields in a responsive and responsible manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease.
![Page 9: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/9.jpg)
More satisfied patients
More satisfied providers
Lower total medical costs
Better care
Quadruple Aim Framework
![Page 10: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/10.jpg)
“Teamwork is the predominant form of work organization in healthcare. Clinician occupational well-being and patient safety develop in a teamwork context and are dependent on each other.”
Welp & Manser (2016)
![Page 11: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/11.jpg)
Defining Your Team
![Page 12: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/12.jpg)
Patient Family
Community
Primary Care
Provider
?
Social Worker
Registered Nurse
?
Behavioral Health
![Page 13: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/13.jpg)
Communicating Effectively
![Page 14: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/14.jpg)
CLEAR CONSISTENT COMMUNICATION
Satisfaction
Quality and Outcomes
Care Gaps
Medical Errors
Effective Team Communication
![Page 15: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/15.jpg)
Increased employee turnover and absenteeism
Project failures and failed change management
80% of serious medical errors during transfer
35-40% malpractice claims (1.7 billion
healthcare malpractice costs)
5th leading cause of death in U.S.
COMMUNICATION ERRORS
Ineffective Team Communication
![Page 16: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/16.jpg)
• Frequency
• Timing
• Accuracy
• Focus
Attributes of Communication
![Page 17: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/17.jpg)
Organized Concise
Easy to understand Respectful
Effective Communication for Team Based Care
![Page 18: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/18.jpg)
Defining Team Roles and Responsibilities
![Page 19: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/19.jpg)
• All roles are understood and respected
• Scope and responsibilities of each role are explicit
• Each team member understands how his/her role fits in the work of the team
Roles and Responsibilities for Effective Teamwork
![Page 20: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/20.jpg)
Patient
Provide information about own health
and experience
Describe and report changes in health
status
Share response to self-care and treatments
Identify factors that help and hinder engagement and achieving health
goals
THE PATIENT’S ROLE ON PATIENT-CENTERED PRIMARY CARE TEAMS
![Page 21: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/21.jpg)
• Competencies
• Scope of practice
• Licensure
• Values and ethics
• Education / accreditation standards
Role Clarity
![Page 22: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/22.jpg)
Swim Lane Diagramming
A swim lane diagram assists with role clarification and efficiency.
![Page 23: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/23.jpg)
Example: Swim Lane Diagram for a Physician Assistant Office Visit
Adapted from “Physician Assistant (PA) Office Visit” available at: http://www.hrsa.gov/publichealth/business/healthit/toolbox/HealthITAdoptiontoolbox/index.html
![Page 24: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/24.jpg)
• Responsible, Accountable, Consulted, Informed
• Defining these roles for a task improves clarity, ownership and communication
• Identify functional roles (e.g., front desk, RN, etc.)
• Identify activities or decisions
• Good for QI projects or introducing new EBIs
RACI Matrix
![Page 25: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/25.jpg)
MedicalDirector
RN Manager MA Clinic
DirectorStudentIntern
Research colorectal cancer screening tool R I A
Arrange for training for iFOBT screening work flows R C
Create new screening protocols R C
Identify patients in need of screening in the EHR I R I
Educate patients and provide iFOBT screening kits C R
Run weekly reports to see how many returned kits I R
Call patients to remind them to return cards or discuss follow-up I R
RACI Matrix Example
![Page 26: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/26.jpg)
http://links.asu.edu/fm3
![Page 27: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/27.jpg)
Optimizing Team Roles
![Page 28: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/28.jpg)
DemandTeam compositionVisit schedulingWorkflows
Optimizing Team Roles
![Page 29: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/29.jpg)
• All team members work to their highest level of expertise, skilland licensure
• Team composition driven by:– Patient/family/population needs and– Characteristics of practice.
• Look for potential for cross-training to maximize flexibility andflow
Optimization Principles
![Page 30: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/30.jpg)
Building Continuity
![Page 31: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/31.jpg)
What’s Your Script?
![Page 32: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/32.jpg)
• Greet and introduce by name
• State role on team
• Explain purpose/focus of interaction
Introducing Team Members to Patients and Families
![Page 33: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/33.jpg)
• Introduce by name and role:− “I am a medical assistant, nurse, pharmacist…”
• Describe focus of work and contribution to team:− “I support the work of the team by…”
• Share information about specialized education, certification that relate to work with patients and families as useful:
• “I have specialized education in diabetes care”
Introducing Team Members to Each Other
![Page 34: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/34.jpg)
Care Management
Systems
Chronic Care Management Care Management
Transitions of Care
Care Coordination Population Health Management
Elements of Care Management
![Page 35: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/35.jpg)
“Care Coordination is the deliberate synchronization of activities and information to improve health outcomes by ensuring that care recipients’ and families’ needs and preferences for healthcare and community services are met over time.”
National Quality Forum (2014)
![Page 36: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/36.jpg)
Managing referrals, appointments, EHR notes,
transportation, CCDs, consult reports, etc.
Continuity of Care
Care Coordination and Continuity of Care
Provider Experience Patient Experience
![Page 37: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/37.jpg)
Recognizing Success: Teams
Objective: Measuring Interprofessional “Teamness”
Tool: Assessment for Collaborative Environments (ACE-15)
Measures:• Effective communication• Clear roles• Shared goals• Mutual trust• Measurable process and outcomes• Organizational support
(15 questions, 5 minutes)
![Page 38: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/38.jpg)
ACE-15: Homework
Purpose of the survey• Get baseline attitudes toward care teams for participating learners
Who should take the survey?• All members of your care teams, as well as any other staff involved
with support/supervision of care teams
Due date• Please have submission from staff no later than Friday, January 25th
![Page 39: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/39.jpg)
Final Questions
![Page 40: Module 1: Patient and Family Engagement Through Care Teams ... · 17/01/2019 · Module 1: Patient and Family Engagement Through Care Teams January 17, 2019 at 1pm ET. Welcome to](https://reader035.vdocument.in/reader035/viewer/2022062919/5ee1bab7ad6a402d666c80c5/html5/thumbnails/40.jpg)
Next module: January 31st at 1pm EST
Kelly Smith, Ph.D.Sr. Director, Research
MedStar Institute for Quality and Safety