06 Partnerships with Patients and Familiesapp.ihi.org/Events/Attachments/Event-2523/Document... · Edgar H. Schein, Organizational Culture and Leadership, Jossey-Bass, 2010 A Learning

Institute for Healthcare Improvement

Partnerships with Patients and Family Members: The Key to Developing Meaningful Always EventsMartha Donovan Hayward and Pat Rutherford

These presenters have nothing to disclose

November 4, 2014

Workshop Agenda

Identifying and preparing patients and family members to

engage in quality improvement and care re-design

Developing competencies of health care team members

for creating respectful partnerships

Utilizing a transformational learning process to

understand the patients’ experiences and “What matters

to them?”

Co-designing Always Events for testing and

implementation


Objectives

Explore new ways to form effective partnerships

between clinicians/staff and individuals and their family

members

Describe a process for utilizing a transformational

learning process to understand the patients’ experiences

and “What matters to them?”

Describe a method for co-designing Always Events (i.e.

new processes and/or behaviors that are important to

patients)

Formal Roles

• Support

• Policy

• Provide Assistance

• Executive Team

• Advisor

• Family Leader

• Customer Service

• Trainer

• Develop training for staff

• Voice of Patient & Family

• Represent Patient

• Hospital Volunteer on Unit

• Chair PFAC

• Train residents

• Recruit

• Sit on Committees

• Partner

• Market patient stories

• Activate patient

• Teaching peers

• Member of Patient Voices network

• Speaking

• Consumer Advisory Board

• Education staff on DME

• Access to Board

• Facilitate community groups

• Being assertive

• Share stories

• Teleconferences – share info


Informal Roles

• Bring urgency

• Compassion

• Cookies

• Dignity

• Non-threatening

• Listening

• Affirmation of patient experience

• Confirmation

• Comfort

• Sense of humor

• Hospitality

• Hope

• Balance & level headedness

• Empathy

• Humanity

• Framework for discussion

• Understanding

• Expertise

• Respect for all views

• Perspective

• Empower

• Caring

• Change

• Inform

• Engage

• Organize

• Truth teller

Working Definition of Patient/Family Advisor

A patient & family advisor works in a variety of

healthcare settings sharing their personal stories to

represent all patients & families in bringing authenticity,

empowerment, respect and inspiration to the design and

delivery of healthcare systems. Patient & Family

Advisors roles include educator, speaker, advocate,

collaborator and leader, ensuring the focus of healthcare

is on the patient & the family.


What Is The Role of a Patient/Family Advisor?

Patient Activist

Community Advocate

Patient/Family Advisor

Partner in Care

Engaged Patient

Speaker

Leader

Organizer

Who is Ready?

A patient or family member in your setting with current

experience

Reached a state of healing – wants to make the world

better for others

Has a community outside health care that “holds” them;

family, office, social, spiritual

Ask a busy person.


Identifying Patients and Families

Ask clinicians “Do you know a patient/family member

that comes to mind as a potential members?”

Are there patients/family members who have contacted

healthcare leaders about concerns and who were highly

effective in communicating their requests?

Are there Patients/Families with unique perspectives as

previous patients or family caregivers for a project?

Use your internal and external network of Board

members, faith community, volunteers to cast a wide

search

Developing Competencies of Patient

and Family Members


Moving from patient-centered models of care to developing genuine

partnerships with patients and family members will require new skills

and behaviors

– Will require health care leaders and clinicians to give up

some control

– Will require new levels of listening skills and empathy

– Will require a new level of skill to reach the goals of creating

genuine partnerships and shared decision-making

Care processes are often designed to optimize the roles of

clinicians and care teams; need to move to co-design of care

processes

.

Developing Competencies of the Health Care Team to Develop Genuine Partnerships with Patients and Family Members

Understand

Patient

experience

“What matters

to me”

From Patient to

Process

State the

Always

Event(s)

Translate

Always

Event(s) into

Standard Work

Practice and Improve

Standard Work, over time

(Daily Management)

Use Standard Work

Process

Know how to measure

defects and mitigate

Plan

Do the work

DO

Measure and

Communicate

Study/Act

Big Picture:

Link

between

Always

Events and

Reliable

Process

Performance

12


Transformative Learning

Not spontaneous (requires work and discipline)

– Creates new meaning to life, events, facts, interactions with others

– Results in change in perception; knowing which requires different action or structure

What is the learning that creates a new habit of mind?

– Change perspectives and paradigms

– Challenge and validate assumptions

– Critical self-reflection

– Include and integrate experiences

Based on the work W. Edwards Deming

Transformational Learning: 1st Reflection

Think of a time in your life (situation or incident) where you were vulnerable.

• Where were you?

• Who was involved?

• What happened?

• What made you feel vulnerable?

• Make note of your feelings

What advice did you or would you have liked to give those who could influence your experience?

Developed by Jane Taylor and Pat Rutherford


Transformational Learning: 2nd Reflection

Think of a time in your life when someone provided you genuinely “helpful” help and exceeded your expectations.

• What was your experience?

• What did you feel?

• Describe the characteristics of “helpful” helping

Think of a time when someone provided you some “not-so helpful” help.

• What was your experience?

• What did you feel?

• Describe the characteristics of “not-so helpful” helping

Developed by Jane Taylor and Pat Rutherford

Design Principles for Co-Designing an

Always Event or Process

.

.

.

.

.

.

.

.


Understand

Patient

experience

“What matters

to me”

From Patient to

Process

State the

Always

Event(s)

Translate

Always

Event(s) into

Standard Work

Practice and Improve

Standard Work, over time

(Daily Management)

Use Standard Work

Process

Know how to measure

defects and mitigate

Plan

Do the work

DO

Measure and

Communicate

Study/Act

Big Picture:

Link

between

Always

Events and

Reliable

Process

Performance

17

How might we co-design….

Examples of specific themes that emerged from

the reflections (Ideas should be actionable)

• ?

• ?

• ?


Rules for Brainstorming

Chose one or two “how might we scenarios….

• encourage wild ideas

• go for quantity – want more than 500 ideas

• defer judgment

• be visual – draw pictures

• one conversation at a time

• build on ideas of others

• stayed focused on topic (“how might we…” scenarios)

Write each idea on post-it notes

Multi-voting to Select Top Ideas

Cluster together similar ideas from brainstorming exercise

Use 8 – 10 dots to vote:

� What are your personal favorites?

� What idea would you most like to try on your unit?

� What idea do you think will have the biggest

impact toward achieving the “how might we…”

Participants can distribute their dots however they want –-all on one idea, each dot on a separate idea, or anything in between

Report out on favorite ideas (where there are most dots)


Matrix of Change Ideas

Difficult to Implement

Easy to Implement

High Impact Low Impact

Enactments

• Create an enactment to illustrate an

extreme future vision for your prototype

• Create storyline and build

• Rehearse and refine

• Present to whole group

• Select elements and build on ideas


Learning New Behaviors

Edgar Schein has described the anxiety of

change that can lead to a freezing of

existing behavior, the very antithesis of

change which requires self-reflection, new

insights and the development of new

competencies and behaviors.

Edgar Henry Schein is a former professor at the MIT Sloan School of Management

Factors which aid adoption and sustainability of new

behaviors:

− Clarity of Purpose – understand why I need to

change

− Competence – feel skilled and comfortable in new

behavior; knowing what and how to do it

− Contribute – involved in determining the new

behavior – what, how, and when

− Connected – part of a network, feeling known,

cared about and supported in learning the new

behavior

behavior**Suchman, A, et al Eds. (2011). Leading Change in Healthcare: Transforming Organizations

using Complexity, Positive Psychology, and Relationship-Centered Care. London: Radcliffe.

Learning New Behaviors


Personal Improvement Process

in the Organizational Context

Edgar H. Schein, Organizational Culture and Leadership,

Jossey-Bass, 2010

Learning Loop in a Protected

(Rehearsal) Space

Edgar H. Schein, Organizational Culture and Leadership, Jossey-Bass, 2010


Putting it All Together

Creating a Learning Organization

Edgar H. Schein, Organizational Culture and Leadership, Jossey-Bass, 2010

A Learning Healthcare System

Respect the insights of the front-lines of care

Learn from patients & family members (co-design)

Learn from clinicians and staff

Build on the evidence-base and add to it

Build measurement systems that enable continuous

learning

Co-design an approach to act on that learning (a method

for improvement)

Align priorities to support continuous learning and

improvement


The voyage of discovery

is not in seeking new landscapes

but in having new eyes.

Marcel Proust

Documents

06 Partnerships with Patients and Familiesapp.ihi.org/Events/Attachments/Event-2523/Document... · Edgar H. Schein, Organizational Culture and Leadership, Jossey-Bass, 2010 A Learning