PATIENT AND FAMILY CENTERED CARE (PFCC) EDUCATIONAL RESOURCE

Developed by PFCC Resource Team

Covenant Health Spring 2016

PFCC Learning Huddle Material

PFCC LEARNING HUDDLE MATERIAL Spring 2016 Developed by the PFCC Resource

Support Team to facilitate local

discussion and learning about PFCC

Each Huddle Discussion guide briefly

presents the topic, provides some

discussion points and a link for further

resources on the topic

Materials are to be used in the way

most useful to your needs and settings

– for self learning, in “Friday Files” or

other electronic communication with

staff, in team meetings or as posters

You will have an opportunity to provide

evaluation of the material and make

suggestions for new topics

An electronic copy of this material can

be found on CompassionNET - Patient

Relations Page

* For additional Information: Please contact Carol Ellis, Clinical Quality Consultant; 780-735-2589

PFCC Resource Team:

Carol Ellis Clinical Quality Consultant

Joy Hurst Corporate Lead, Patient Relations

Loren Jacula Organizational Development Consultant

Learning Huddle Material

Adverse Events

Care Environment

Communication (101, 102, 103)

Continuity of Care

Client Experience Dimensions

Dignity Preserving Care

Leading PFCC Practices (IDEAL Model)

Measuring & Monitoring PFCC Practices

Team Performance

What Is PFCC

Patient & Family Centered Care (PFCC)

Resources: What Is PFCC? https://www.youtube.com/watch?v=6UnEDk4JaCU Person-Centered Care: https://www.youtube.com/watch?v=6Dk3CV-Wt38 PFCC - Definitions resources: *http://www.ipfcc.org/pdf/CoreConcepts.pdf http://www.Plaintree.org http://cgp.pickerinstitute.org/?page_id=1319 PFCC is defined in different ways by those who use it. The links above will help explore how PFCC is described by 3 leaders in Health Care Research: IPCC, Planetree, and Picker Institute https://www.saintelizabeth .com/Services-and-Programs/Research-Centre/Person-and-Family-Centred-Care.aspx

What is Patient & Family Centered Care? Patient and family-centered care (PFCC) is a method of planning, delivery, and evaluation of health care that is based on mutually beneficial partnerships among health care providers, patients, and families.* It is both organizational and personal. PFCC is an approach to care that shifts from “doing for” to “doing with.” It is a whole person approach to understanding the holistic needs of those we serve. PFCC is a way to live the mission, vision and values of Covenant Health.

Guiding Principles: 1) Respect & Dignity 2) Information Sharing 3) Participation 4) Collaboration

Discuss: What do these practices mean from a patient’s point of view? Describe a scenario entirely from the patient perspective. How is it different from a provider’s viewpoint?

For more information please contact Carol Ellis, Clinical Quality Consultant. May 2016

PFCC Leading Practices

The IDEAL* discharge planning model follows the patient journey from admission through discharge. When patients and families are engaged in their care the benefits are measureable improvements in safety, quality and satisfaction.

Include the patient and family as full partners in the discharge planning process Discuss with the patient and family five key areas to prevent problems at home: • Describe what life at home will be like • Review medications • Highlight warning signs and problems • Explain test results • Make follow-up appointments Educate the patient and family in plain language about the patient’s condition, the discharge process, and next steps at every opportunity throughout the hospital stay

Assess how well doctors and nurses explain the diagnosis, condition, and next steps in the patient’s care to the patient and family and use teach back. Listen to and honor the patient and family’s goals, preferences, observations, and concerns.

Include

Discuss Educate Assess Listen

Self Reflection:

What are some of the methods I can use to engage patients and families?

*Strategy 4: Care Transitions From Hospital to Home: IDEAL Discharge Planning. June 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy4/index.html

For more information please contact Carol Ellis, Clinical Quality Consultant.

May 2016

Patient and Family Centered Care: Measuring and Monitoring PFCC Leading Practices

Sample Observation Tool

IDEAL* Behaviours I – Include D – Discuss E – Educate A – Assess L – Listen *Adapted from the Agency for Healthcare Research and Quality

Can be a formal or informal process. Start by asking 1 patient per week about his/her experience. Respond in a meaningful way to the information received. Talk to staff about what is working and what is not and why?

Observation/Discussion Comments: Examples Interaction/Inclusion: Eye contact, NOD – name, occupation, duty Identify family/friends Include in decisions Discuss: Review medications, treatments, Plan of care and discharge Educate: Demonstrated teach back methods Used timely, plain and easily understood language Assess: Asked open ended questions. Ask 3 Offered Comfort Rounds Listen: Heard, respected and acted on goals, preferences and concerns of the patient/family

Every interaction is an opportunity to build relationships, engage and improve quality.

For more information please contact Carol Ellis, Clinical Quality Consultant. May 2016

Four Dimensions to measuring client experience: Accreditation Canada

Sample Questions: Were you encouraged to participate in decisions about your care? Did you understand your care plan including your medications? Did you get the help/information you needed to prepare for admission, treatments, tests and discharge? Was your pain managed and did you receive support and assistance when needed?

►Respecting client values, expressed needs and preferences ►Sharing information, communication and education ► Coordinating and integrating services ► Enhancing quality of life in the care environment and in activities of daily living

Partner with staff to choose a leading PFCC practice to implement. How? By reflecting on the Core Principles of PFCC: 1. respect and dignity 2. information sharing 3. participation 4. and collaboration Monitor progress through feedback from patients and staff members. Share the results and plan for improvements.

Accreditation Standards: • Investing in Quality Services

• Monitoring Quality and Achieving Positive Outcomes • Building a Prepared and Competent Team

Examples of PFCC Current Practices: - Path to Home – Bedside shift report,

NOD, Ask 3, Comfort Rounds - Elder Friendly Care - Baby Friendly Care - Restorative Care - Resident Family Councils - Advanced Care Planning - Falls Prevention - Medication Reconciliation - Patient admission database form

For more information please contact Carol Ellis, Clinical Quality Consultant. May 2016

Notes:

Resources: http://insite.albertahealthservices.ca/pe/tms-pe-what-is-patient-family-centred-care.pdf The Institute for Patient and Family Centred Care http://www.ipfcc.org/ Agency for Healthcare Research and Quality http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/guide.html Quality Improvement video: https://www.youtube.com/watch?v=jq52ZjMzqyI Speak up for Patient Safety https://www.youtube.com/watch?v=URCIGK9upTE

For more information please contact Carol Ellis, Clinical Quality Consultant. May 2016

PFCC Learning Huddle Discussion Guide

Care Environment Observe the surroundings from a patient’s perspective. What do you see? Hear? Smell? A “walk-about” is an activity that can be used to obtain patient and family perspectives about the experience of care and how organizational policies, practices, and environment support patients and families in engaging as key partners on their health care team.*

Where do we start? Take a look at the reception area, admitting office, lab, imaging services, inpatient units…can you follow the patient’s journey? Observe staff and clinician interactions – how are patients welcomed, orientated. How and where is information presented? Is it accessible and are educational materials available? Are there multiple formats ie brochures, pamphlets, posters, signage? Are there assistive devices nearby, ie Wheelchairs, seating, washrooms? Resource: https://www.youtube.com/watch?v=OIgBQcH-m2w

Skills Development Discussion General: Explore how to welcome, support, educate, and comfort patients and families and encourage active participation in care and decision-making. Managers: How will I support, engage and empower the unit and staff to consider these questions and act in a responsive, intentional way? Staff: Ask yourself, how can I make a difference in this particular patient’s stay on this particular day? How will I support and communicate with my colleagues and my patients every day?

For more information please contact Carol Ellis, Clinical Quality Consultant.

May 2016

PFCC Learning Huddle Discussion Guide

Dignity Preserving Care Healthcare providers listen to and honor patient and family perspectives and choices. Patient and family make-up, knowledge, values, beliefs, and religious and cultural backgrounds are incorporated into care planning and delivery.

How do we demonstrate these behaviours? Invite questions

Include family members Goals of Care discussions

Ask what is important to him/her. Show your compassion and kindness

Acknowledge the whole person instead of “the patient” Resource: https://youtube/OIgBQcH-m2w

Skill Development Discussion

Be fully present in interactions. What is your patient feeling, thinking, seeing and hearing? Reflect on your own attitudes, assumptions, personal belief and values. How do they influence your interactions in care? Consider the person first, not the diagnosis. How do YOU show compassion, respect and kindness? How do we recognize and respond to individual needs, make shared-decisions, advocate and actively listen?

For more information please contact Carol Ellis, Clinical Quality Consultant. May 2016

PFCC Learning Huddle Discussion Guide Team Performance

Good Practices:* Know your role and the role of others. Communicate clearly and as often as necessary among all members of the team. Be supportive.

As a team leader or member, communicate respectfully, clearly and provide sufficient information in a timely way. Create a shared vision for compassionate, responsive, knowledgeable care.

Resources: * https://www.cmpa-acpm.ca/serve/docs/ela/goodpracticesguide/pages/key_concepts/key_concepts-e.html?open=patient_safety Collaborative practice http://www.compassionnet.ca/Page2183.aspx https://www.youtube.com/watch?v=ue3hCVHtZZY

Consider: How could you share and approach team members about patient and family centered care practices. Discuss: We are trying to ensure our care is supportive and information is shared appropriately and effectively. Ask: Staff and patients - How would you describe YOUR experience? What is working well for you? What could be improved? Is there anything you would like me to know to help with providing/receiving care?

Skill Development Discussion

For more information please contact Carol Ellis, Clinical Quality Consultant. May 2016

PFCC Learning Huddle Discussion Guide Continuity of Care

Ever increasing complexity of care often means patients are seeing a wide variety of care providers in multiple settings. As a result, important information may be missed, misunderstood or misinterpreted. Connecting all the different pieces along the patient’s journey is challenging but can be critical. Continuity of care requires effective information sharing and service coordination.

Resources: http://www.compassionnet.ca/Policies/vii-b-255_Internal_Transfer_Report.pdf

Skill Development Discussion Discuss: What enhances or detracts from continuity of care? What are some of the methods we use to ensure timely information-sharing and follow up? Eg: bedside shift report, transfer of accountability record, documentation, policy and procedures, continuing care shift report, care conferences, discharge planning conferences. What do we mean by Continuity of Care?¹ Relational: relationships that take place with providers. Informational: Communication and information transfer across care settings; gathering of holistic information about the patient Management: accessibility between care levels, individualized care and supportive discharge process; patient involvement What are some of the key benefits and/or challenges of multidisciplinary teamwork? How do we communicate effectively? Eg: Know and understand the skills, competencies, experience and scopes of practice of team members, including overlaps and gaps in the team’s capabilities. Protect privacy and confidentiality; use plain, jargon-free language, support oral and written information with patient education tools. Communicate with other providers clearly and check for understanding during transfers of care. ¹“What do we know about Patients’ Perceptions of Continuity of Care?” International Journal for Quality in Health Care. 2012;24(1):39-48.

For more information please contact Carol Ellis, Clinical Quality Consultant. May 2016

PFCC Learning Huddle Discussion Guide

Communication 101 Safe, high-quality care is dependent on effective, clear communication between health care providers, patients, and families. Communication is an ongoing process and includes written, verbal and non-verbal methods.

Did you know…* Face-to face communication is affected by: 58 % body language 35% tone of voice 7% content or words used Telephone communication: 18% words used 82% tone of voice * Information Technology Project Management Fifth Edition, copyright 2007

If you can do nothing else, you can always be KIND.

Resource: https://www.youtube.com/watch?v=-4EDhdAHrOg

Skills Development Discussion Respect and empathy are cornerstones to effective communication. Understand and be aware of both your own and a patient/family’s personal values, culture, and perspectives. Communication also includes clear, concise documentation and includes actions taken.

Communication Basics: • Respect. • Cooperate. • Clarify. • Listen. WHAT are you communicating? Is it urgent? Time-sensitive? WHO needs to know? WHY does he or she need this information? HOW will you provide It? ie written, verbal, nonverbal, electronic WHEN is the information needed?

For more information please contact Carol Ellis, Clinical Quality Consultant. May 2016

PFCC Learning Huddle Discussion Guide

Interpersonal Conflict: Conflict can occur anywhere, particularly when the stakes are high and the investment is personal, such as between colleagues, management, care providers and even with patients and families. Conflict is often the result of a breakdown in communication. It is important to recognize that our behaviours can cause conflict or make it worse. However, there are skills that we can use to help ease a situation and/or prevent it from happening in the first place. http://compassionnet.ca/Tip_Sheet.PDF

Communication 102

Try the following self-assessment and find out your score on how you react to conflict. Go to http://www.dalecarnegie.ca/wp-content/files/remote/Conflict_Resolution_Guide.pdf

Skills Development Discussion Discuss: What did you think and/or feel about your score profile? Did you recognize yourself in any of the descriptions? Reflect: Can you think of any times or situations on your unit that lead to conflict? Was it resolved? If so, how? What behaviours initiated or escalated the conflict? What strategies could be used to create a better outcome? Tips for coping with conflict: Stop. Take a breath. Pay attention and actively hear the words, the tone and the volume of what is being said. Watch for nonverbal cues. Anxiety is often masked as aggression. Ask respectful questions. Use “I” and “we” messages instead of “you.” Avoid blame. Focus on fixing the problem, not on the person and look for a workable solution. If necessary, take a break and allow for space and time to think. Admitting a mistake and a sincere apology goes a long way. Be brave. Not all conflict is negative. Express yourself and be willing to acknowledge another point of view.

For more information please contact Carol Ellis, Clinical Quality Consultant. May 2016

PFCC Learning Huddle Discussion Guide Communications 103 Intentional Relationships: *All parties involved in relationship-centered care should experience a sense of: • Security – safety within the

relationship • Belonging – to feel a part of things • Continuity - consistency • Purpose – a personal goal • Achievement – progress towards the

goal • Significance – to feel he/she matters *“What families and patients say about their needs and interactions with professionals” ppt Nov. 2015 ES Brintnell, University of Alberta

Resource: http://www.compassionnet.ca/Patient-PatientRelations-RelateRespond.pdf

Skills Development Discussion We all have ways or patterns of communicating and may tend to default to our favored method in most situations. However, there are times in a therapeutic relationship when purposeful communication refers to:* 1. Advocacy – speaking on behalf of our patients and acting as a

representative for his/her needs. 2. Collaboration – cooperation with our multi-disciplinary partners including

our patients 3. Empathy – respect and seeing another’s perspective; “walking in their

shoes” 4. Encouragement – providing support, building confidence and hope 5. Instructional – providing education, training and guidance 6. Problem-solving – the process of finding solutions at times includes unique or complicated situations Discuss: What is your preferred communication method?

For more information please contact Carol Ellis, Clinical Quality Consultant. May 2016

PFCC Learning Huddle Discussion Guide

Adverse Events Reporting and Learning System (RLS) RLS is a province-wide method of electronic reporting of patient safety incidents. Consistent reporting of hazards, close calls and adverse events is encouraged for the purpose of learning about and improving patient safety.

Skills Development Discussion Key Principles of the System • Everyone feels safe and encouraged to report patient safety hazards, close

calls and adverse events • Patient safety events are often driven by system errors rather than human

error • Learning by analyzing trends and sharing information • Reporting is not to be used for performance management • Accessible and intuitive online or telephone reporting

Discuss: How do we access the RLS? (refer to listed resources) • AHS Reporting & Learning System for Patient Safety (RLS) http://insite.albertahealthservices.ca/1820.asp

Did you know? The RLS website offers E-learning modules on how to complete an RLS • http://ahamms01.http.internapcdn.net/ahamms01/Content/InSite_Videos/Employee_Tools/

et-rls-every-report-matters/story.html

Resources: http://insite.albertahealthservices.ca/assets/et/rls/et-rls-12-3-qrg-severityalgorithm.pdf

For more information please contact Carol Ellis, Clinical Quality Consultant. May 2016