Tools & Techniques

Engaging Patients in

Quality Improvement

HQO IDEAS

October 13th, 2015

Mim O’Dowda

Robin Spence Haffner

Lisa Hawthornthwaite

WELCOME

WORKSHOP AGENDA Introductions

Who we are and get to know you!

The Patient Voice - Mim

Educating and inspiring patient and family-centred care

Patient experience measurement

Decision Making Tool for Patient and Family Engagement

Scenarios for group table discussion

Share back your considerations and experiences

Closure

Lessons learned and hopes for the future!

The land where we come from

14,443

50,000

700,000

40,000

940

Adult

109

Child

36

NICU

WELCOME

Surveys

aren’t

enough.

Patient Stories

Learning from the

Patient Advisor Experience

Stories bring attention to

quality improvement and

an understanding of what

patient and family –

centred care really means

to our patients

Reflect

What did we learn?

How it made us feel?

Respect

& Dignity

Collaborate

& Empowerment

Information Sharing

& Communication

Coordination

&

Comprehensive

Patient & Family -

Centered Care

Impact

Impact of patient stories

for quality improvement

See system from the user lens and what

they really care about

Generates ideas and solutions

Help us feel what patient and family centred

care really is – creates a vicarious

experience

Self-reflect on personal practice

iap2

Used to assist patients to better understand problems,

alternatives, and/or solutions

One-way communication

INFORM

Used to understand the experience of the patients and

where and what changes are needed

CONSULT

INVOLVE

A more in depth way to ensure patient and family

experience is well understood and considered in

design and decision making

COLLABORATE

To partner with patients and families and have them

as an equal voice in identifying solutions

EMPOWER

Place decision making in the hands of patients and

families

Decision Making Tool & Action Aids INFORM CONSULT INVOLVE COLLABORATE EMPOWER

PATIENT & FAMILY PARTICIPATION GOAL

To provide patients & families with balanced and objective information to assist them in understanding the problems, alternatives and/or solutions.

To obtain patient & family feedback on analysis, alternatives and/or decision.

To work directly with patients & families throughout the process to ensure that patient & family issues and concerns are consistently understood and considered.

To partner with patients & families in each aspect of decision making including the development of alternatives and the identification of the preferred solution.

To place decision-making in the hands of patients & families.

QUALITY IMPROVEMENT TOOLS

(SEE CHEAT SHEETS)

- Writing for patients and families- Fact sheets- Letters from secretary office

SurveysFocus Groups

- Patient Shadowing- Patient and Family Advisor volunteers are part of project team- Patient Experience video taped interviews

- Patient Advisors part of decision-making body (with voting power)- Experienced Based Co-Design (EBD) Interviews + Co-Design of future state)

PROS - Quick communication to wide audience

Surveys: detailed information received quicklyFocus Groups: more detailed information is received quickly. Gives opportunity for further engagement

- See experiences "through patient's eyes"- Opportunity to ask questions, have meaningful discussion on an ongoing basis.

- Patients & families "at the table", telling their story first-hand- Opportunity to ask questions, have meaningful discussion on an ongoing basis

- True partnership where patients, families leaders and providers find mutually beneficial solutions

CONS - "One-way" communication

Surveys: One-way" communication- Relies on expertise of asking the right questions- Response rates can be challenging Focus Groups: ability to manage negative patient feedback constructively

- Patient shadowing requires time commitment& may not accurately capture all patient & family perspective

- Significant time commitment for LHSC employees and volunteers

- Significant time commitment and onboarding process that can be lengthy (application, interviews, police check, risk and privacy) - Budget required for councils

TIPS - have Patient Advisors provide guidance or review on communication material

- have Patient Advisors provide guidance or review on communication material

- Communication effort to identify quality representative sample of patients to shadow- Providers must know & understand the purpose & value of the project

- Requires a sample of 12 patients per population (EBD)- Involves patient interview, analysis and compilation of videos (dependent on project requirements)

- Requires a sample of 12 patients per population (EBD) -Requires strong leadership support to authentically engage patients as equal partners and create new structures with advisors

TIME COMMITMENT & DURATION

- Depends on the nature of the material (least resource intensive)

Surveys 2-10 hours depending on length of survey. The nature of survey and desired sample size is a factor. Focus Groups: approx. 15 hours planning, session and follow up reports

Approximately 12 hours for a surgery patient. This includes: identifying patients; obtaining consent; shadowing *varies with type of patient case

- Patient Interview: set-up, interview itself (+ travel) & analysis (3-4 hours per interview)- Information and Consent Letter: development of content and consultation with Privacy (6-8 hours)

- Patient Interview: set-up, interview itself (+ travel) & analysis (3-4 hours per interview)- Co-Design sessions: dependent on scope of work (consider set-up and organization time, needs thoughtful and flexible scheduling)- Committee/Council work: dependent on committee work requirements (consider set-up and organization time, time to communicate with patients and develop trust, change management)

WHAT WOULD THIS LOOK LIKE? (EXAMPLES)

- Letters from Physician's office, care instructions, program and service descriptions

- Family Feedback Survey Children's Hospital- Emergency Department Interview Questionnaire - Ambulatory Care Questions

- A Process Improvement consultant may shadow and record the flow and interactions from admission to discharge for 20 patients; process flow map with feelings and narrative are displayed for project team to consider

- 25 patients & families from across the SW LHIN interviewed, themes trended and incorporated into Current State Gap Analysis (along with other quality gaps) to improve stroke care

- Project Example: 36 patients with same diagnosis interviewed, 2 patient advisors participated in Gap Analysis sessions, 2 patients on Steering Committee, patients included in future design sessions- Program EBD Example80+ patients interviewed, future state co-design sessions all videotaped and themes and trends for patient experience improvements reported to Senior Leaders to action Patient and Family Advisory Councils in place with Children's, Renal and Cancer)

INFORMED CONSENT REQUIRED?

No- No (surveys)- Yes (focus groups)

Yes Yes Yes

DEGREE OF EXPERTISE REQUIRED

- Low(consult with Patient Experience Specialist/Process Improvement Consultant for guidance)

- Medium(consult with Patient Experience/Process Improvement for guidance)

- Medium(consult with Patient Experience/Process Improvement for guidance)

- Expert (guidance from PX and Process Improvement Consultant required)

- Expert (Process Improvement Consultant with guidance from Patient Experience)

Action Aids - What, How & Common Steps

Writing for Patients and Families

Surveys

Focus Group

Shadowing

Patient and Family Advisor Councils

Patient Video Interviews

Experienced Base Co-design (EBCD)

Action Aids

Prepare

Design

Test

Execute

Analyze & Act

Tips and Where Find More Information

Level of Engagement

Expertise Required

SILENCE

QUESTIONS

SCENARIOS

Table Work

Using the

template review

the scenarios at

your table

What would

you

recommend

and why?

DISCUSSION

Advice from the field

Mim’s Top 3

What Have we

Learned?

Pair and Share

As a result of taking this

workshop,

What is one action that you are

going to do differently when

you engage with patients?

Sources and Credit

Institute for Patient- And Family-Centered Care

Pinwheel Sponsor. http://www.ipfcc.org/

Inspired to Change: Improving Patient Care One Story

at a time (2014) Linda R. Larin

Patient Experience. Patient and family-centred care.

(2015). London Health Sciences Centre.

The Beryl Institute Membership.

http://www.theberylinstitute.org/

IAP2: Spectrum of Patient Engagement

http://www.iap2.org/