Engaging Families As A Strategy To Advance Quality & Safety
Daniel Hyman, MD, MMM September 21, 2012
Slide 2
Family Engagement Objectives Describe at least two best
practices to engage patients/families in quality and safety in your
organization Discuss the benefits of patient/family involvement at
the bedside and at system or strategic decision-making levels
within your organization. Begin to develop a plan for advancing the
engagement of patients/families in quality/safety programs within
30 days, including recruitment, training and orientation. And, do
you want to talk about risks?
Slide 3
Adoption of Change
Slide 4
History of Family Engagement From innovation. To early
adoption. To mainstream Where are we in that arc? Pursuing
Perfection and My personal experience IHI ~2005 Institute for
Patient and Family Centered Care Polly Arango co-founder Family
Voices MSCH/NYP Childrens Hospital Colorado
Slide 5
http://www.youtube.com/watch?v=LkhGoIXsHQo
Slide 6
Slide 7
www.josieking.org On February 22, 2001, eighteen-month old
Josie King died from medical errors. 98,000 people die every year
from medical errors, making it the fourth leading cause of death in
the United States. The Josie King Foundations mission is to prevent
others from dying or being harmed by medical errors. By uniting
healthcare providers and consumers, and funding innovative safety
programs, we hope to create a culture of patient safety,
together.
Slide 8
www.josieking.org
Slide 9
AHRQ 2012 report
Slide 10
AHRQ Report Summary Goal promote patient/family engagement with
tools, resources, materials, training Support the involvement of
patients and family members in the safety and quality of their
care. Encourage the involvement of patients and family members in
improving quality and safety within the hospital setting.
Facilitate the creation of partnerships between health
professionals and patients/family members. Outline the steps needed
to implement changes.
Slide 11
Individual involvement Well accepted by patients and providers
Obtaining information, involvement in decision making Less comfort
with confrontational behaviors Hand washing, surgical marking e.g.
Barriers and facilitators + self efficacy, information,
support/invite - fear, uncertainty, low literacy, norms
Slide 12
Organizational context External and influences to engaging
families in quality/safety Organizational processes and structures
that enable? Intervention strategies
Slide 13
Influencers Internal Serious events Business case Improvement
Altruism External steal shamelessly Policies/regulation Influential
advocacy Public reporting
Slide 14
Structures/Processes No evidence that one or another structure
is a barrier/enabler of patient/family engagement Organizational
ability to absorb and sustain change, strength of leadership,
resource/bandwidth are relevant factors
Slide 15
Strategies Implementation readiness assessment; shared vision;
execution plan; staff engagement; leadership Hospital level
interventions policies, structures; health care team level;
management processes Individual level interventions educating,
informing, activating patients and providers; facilitate
communication at all levels
Slide 16
Slide 17
Our story At the bedside Microsystem involvement Organizational
involvement Projects Committees and Councils Family Advisory
Council Board level
Slide 18
Engaging Families at the Bedside: Watchful Eye of the Parent At
the bedside- listening to families Family centered rounds
Intentional inclusion in decision making Speak Up!- How it can
improve outcomes? Need measurement strategy
Slide 19
Slide 20
Speak Up Hand hygiene! RRTs! Patient Identification!
Slide 21
Speak Up Falls! Pressure Injuries!
Slide 22
Projects and Service Lines Initial involvement may best be at
project or clinical team level Partnership for Patient Safety
(staff education) Hand hygiene Patient Identification Consult and
team communication Ambulatory Access Speak Up! Service Line Quality
Committees
Slide 23
What Family Advisory Councils Can Provide Hospitals Parent
voice is heard by administration Activities that are done by active
parents Parent education
Slide 24
Family Advisory Council Web Link(s) MSCH FAC- CHCO FAC
Slide 25
Parent Partnership, Colorado FAMILY ADVISORY COUNCIL Focus
Areas 2012: Family Advocacy Policy/Procedure Input Marketing of
FAC/partnership opportunities Governance/Quality Councils
-Quality/Safety Committee of the Board -Quality safety and
Performance Improvement Council -Patient Safety Committee Service
Lines, Projects/Initiatives, etc. Heart Institute QI; Speak Up;
Hand hygiene; Patient ID; teamwork/communication/consult
coordination; CF, GEDP; (others are recruiting) HACsNew! (ADE,
CLA-BSI)- Others to follow
Slide 26
Experience at Childrens Colorado Parent placement on multiple
committees/councils and projects Selection process- especially
important at the start Recruitment strategies Family Advisory
Council Programs themselves Family Relations/Risk management
referrals Ad hoc contacts Orientation documents and processes
Parent orientation session- includes volunteer training Committee
member orientation needed too
Slide 27
Experience at Childrens Colorado Overcoming resistance
/concerns Meeting management Acronyms, jargon Asking for input
Managing defensiveness When people forget we have parents in the
room. Debriefing is helpful after meetings What we really need is
an objective evaluation strategy other than that it feels good and
seems like the right thing to do!
Slide 28
It will be easy working with families
Slide 29
Families will call out white elephants
Slide 30
Families will express new viewpoints
Slide 31
Meetings will be more effective
Slide 32
Members will have legal concerns
Slide 33
Members will hesitate to share concerns (dirty laundry)
Slide 34
Where Hospitals are Today Assessing Family Engagement at
Childrens Hospitals in the US 33 childrens hospitals participating
in a national patient safety network Family engagement is a
goal
Slide 35
OCHSPS - QI Assessment Survey Results for Family Engagement 10
hospitals said Yes to both questions
Concerns and Risks You tell me. What are some reasons you would
hesitate to engage patients/families. In decision making and
advocacy at the bedside? in quality/safety initiatives? Breach of
privacy/confidentiality? Litigation? Derailing meetings?
Slide 39
How you can get started Find early adopter
parent/patient/family, staff leader Start with a project or task
force, then another.. Discuss committee options Develop, adapt or
steal orientation materials PDSA Cycles! Patient/family selection
strategies Hospital staff preparation Dealing with
concerns/resistance Start before youre ready
