Patient & Family Advisory Councils (PFACs): the Business Case for Starting a PFAC &

PFAC Survey Results

Barbara Lewis, MBA

March 12, 2015

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Barbara Lewis, MBA• Act 1 – Journalist: national publications WSJ to

Ladies Home Journal > Modern Healthcare & BMJ• Act 2 - Founder - marketing company for professional service

firms– MBA from UCLA Anderson School of Management where

I lecture• Act 3 - Founder – Joan’s Family Bill of Rights 2012• Co-chair of The Beryl Institute’s Global Patient & Family

Advisory Council• Member of the Kaiser Permanente Regional Member

Advisory Council• P/T Managing Editor of DocCom – on-line interactive

communication skills learning platform for clinicians and students (DocCom.org) > Beryl Grant (HCAHPS)

• DocCom free trial subscription – send me an email 2

Agenda

• Background

• Survey Results

• PFAC Impact Examples

• Oops…We Forgot to Ask Patients

• Recommendations.

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I’m on a Mission

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Keynoter called for

patients on

committees

State mandate CEO wants to

start a PFAC

Audible groans

from audienceLip service only Needs a business case

Prove that PFACs save hospitals money!

Patient & Family Advisory Council (PFAC) Description

• 5 to 20 members represent the hospital population

• Meet periodically – once a month for 1 to 3 hours

• Snacks and drinks provided

• Perhaps stipend for parking, mileage, babysitting

• Tackle issues members identify or hospital requests feedback.

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Background

• PFACs started in the 1980s

• Pediatric hospitals were some of the first

• In Massachusetts, PFACs are

mandated, also in Canada & England

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Any others? Please let me know.

How Many Hospitals Don’t have a PFAC?

60%

40%No PFAC

PFAC

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~5,000 hospitals in the U.S.

Consumer Research

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2 Surveys

• March 2014

– Supported by the Beryl Institute (TheBerlyiInstitute.org)

– 60 participants

– 17 questions

• November 2014

– Supported by Partnership for Patients (JoansFamilyBillOfRights.com)

– 209 participants

– 22 questions 9

In what areas does the PFAC contribute?

93%

81%78% 76% 74%

57%52% 52% 50%

40% 40% 40%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

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What committees/improvement teams/boards are patients & family

members on?

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57%

48%

38%

24% 23%19%

16% 14%11%

14%

0%

10%

20%

30%

40%

50%

60%

Do PFAC projects have metrics to gauge success?

57%

26%

5%

12%

0%

10%

20%

30%

40%

50%

60%

Sometimes Never Always Don't Know

Let me know if your PFAC measures results. 12

If you have a PFAC or are planning one, do you have a budget?

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42%

58%

0%

10%

20%

30%

40%

50%

60%

70%

Yes No

What’s the Cost?

• Most PFACs have little budget

– Staff devotes some hours

– Food and drinks

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How many full-time employees are engaged in staffing your PFAC?

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No FTEs - the PFAC is staffed by volunteers,

14%

Less than one FTE, 24%

1 to 2 FTEs, 29%

More than 2 FTEs, 15%

Not Applicable, 19%

Do you track return on investment related to your PFAC?

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Yes, 9%

No, 53%

Don't know, 16%

Not Applicable,

22%

PFAC at Work

Problem:

Medication errors in

neuroscience unit

Solution:

Patient explanations

& descriptions

Benefit:

62% less errors

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PFAC at Work

Problem:

Readmission Rate

Solution:

2 council members visit home

Benefit:

Rate dropped to 8% from 15% saving

$000s

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Vanderbilt University Medical Center

• Needed new chairs

• Picked out chairs, but the PFAC nixed

• Saved $540,000 when PFAC members recommended against chair purchase.

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• Patients frustrated over recurring problems with billing practices

• 2 letters to better explain fees & discount for prompt payment

• Result: prompt payments increased by 6 fold– Boosted the net present value of the collections

– Decreased collection costs.

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Oops…We forgot to Ask Patients!• Welcome Packets – cannot use them

• 10-story inpatient tower – Designed Surgical Waiting Room

• No windows

• Long narrow room

• 4 TVs

– Redesign• Modular seating

• Windows and “amazing” murals

• Tables and chairs

• Lockers

• Hundreds of electrical outlets

• Vending machines

• Play area for children21

Mission

• PFAC in every hospital

• Metrics with every project100%

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If you do not have a PFAC, select the reason that best describes why

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43% 43%

29% 29%

14% 14%

29%

14%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Staff toimplement

Timelimitation

Competinginitiatives

Not adesignatedpriority in

ourstrategic

plan

Littleknowledge

about PFACs

Money Don't know Other

If you discontinued your PFAC, select the reason that best describes why

• Change in leadership

• Couldn't find patients to participate

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If you cannot find patients, please explain your the challenges

• Finding patients with specific conditions

• Finding diverse patients

• Lack of time commitment

• Health issues of prospective members

• Finding younger people, especially parents with young children

• Lack of patients’ confidence in public interaction, presentation skills

• Rural location

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Who has virtual PFACs?Please let me know.

Finding Patients to Participate1. Community groups

2. Written comments in survey

3. Patients and family members who have complimented and complained to the hospital and staff

4. Recommendations from staff, ombudsmen, etc.

5. Newsletter articles requesting volunteers

6. Website page that invites visitors to apply

7. Pamphlets in waiting areas

8. Posters in the cafeteria

9. Messages in pharmacy bags

10.Local TV Public Service Announcements (PSAs). 26

Top 10 Recommendations (Have a PFAC)

1. Use metrics before & after

2. Track all projects & results

3. Report on results and distribute to leadership

4. Implement all projects with a process

5. Reboot if PFAC is struggling

6. Train PFAC members on committee participation, story telling,etc.

7. Involve patient & family members on all hospital committees

8. Survey leadership on PFAC’s impact

9. Spread the word about the availability of PFAC for research

10.Treat PFACs as valuable consumer research tools.27

Success Steps to Launch PFAC

1. Conduct feasibility assessment - In your opinion…2. Formally solicit support from leadership3. Identify a high level champion4. Identify PFAC area - e.g. general, pediatric, etc.5. Develop a budget6. Establish a time-line7. Decide on the PFAC size8. Analyze the hospital’s demographics9. Identify the ideal candidate qualities10.Create plan to identify candidates11.Create the application process12.Develop the application.

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Success Steps to Staff Council

1. Identify potential candidates to mirror demographics

2. Invite candidates to apply3. Request applications from candidates4. Interview the candidates5. Select the candidates to attend first meeting6. Identify staff liaison7. Conduct the first meeting8. Train the candidates in PFAC dynamics9. Invite applicants to become members10.Provide hospital training and education11.Provide medical tests.

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Success Steps for Sustainability

1. Create the Vision, Mission and Norms and Charter2. Select the Chair or Co-Chairs3. Identify projects4. Establish metrics5. Institutionalize projects6. Monitor success7. Report results8. Solicit involvement from hospital staff9. Publicize results10.Bring members onto all hospital committees11.Allow PFAC to run on its own.

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What Hospitals Say about PFACs

• “Mutually Beneficial Partnership”

• “We don’t do anything without consulting our PFAC”

• “PFACs are partners in everything that we do”

• “How can a hospital NOT have a PFAC?”

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PFACs…

• …save hospitals money

• …improve safety

• …enhance the patient experience

That’s the Business Case!

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Starting and Sustaining PFACs: from Leadership Assessment to Success Metrics

I. IntroductionII. The PFAC Start-up

A. Leadership SupportB. Making the Business Case for a PFACC. Forgetting to Ask the PFACD. Identifying BarriersE. Finding a ChampionF. Identifying the Staff LiaisonG. Developing the BudgetH. Compensating the MembersI. Creating the Timeline

III. Council MembersA. Deciding on the SizeB. Analyzing the DemographicsC. Identifying the Ideal Candidate QualitiesD. Creating the Job DescriptionE. Deciding on ParametersF. Finding CandidatesG. Using an Application ProcessH. Interviewing the CandidatesI. Interviewing Departing Members

IV. The First MeetingA. Training the CandidatesB. Creating the CharterC. Selecting the Chair or Co-Chairs

V. ProjectsA. Establishing Metrics

1. Survey Results2. Sample Metrics

B. Identifying ProjectsC. Operationalizing ProjectsD. Monitoring SuccessE. Reporting Results

VI. Mature PFACsVII. Institution Support

A. Publicizing ResultsB. Asking Patients to Join Committees

VIII. Black Belt in PFACsIX. Resources

Wiki-type document to add info, comment, etc. 33

Doctella Patient Engagement Solution

Doctella is looking for partners to help get its tools into the hands of patients. We are offering a free 6 month pilot to the first 3 PFACs that express interest.

Doctella is a mobile health company that partners with health care providers to create more meaningful interactions between patients and their doctors. We work with health experts to develop lists of questions specific to each surgery and procedure so that patients can use these to ask the important questions and get answers at each point along their care journey.

Doctella also offers the “Patient Passport” – a guide to make conversations easier in hospitals. The Passport allows patients to prepare in advance their history, any needs or concerns they have, and preferences for treatment and care. Read about the Patient Passport in the Wall Street Journal.

In addition to the pre-prepared list of questions, you can add your own questions in Doctella. Youcan also write notes to yourself, set reminders and appointments that are synced to your calendar,record audio conversations, and review lists of “things to do” after each step of your care journey.Doctella makes it easy to share these functions with your family, friends, and health care team.

If interested in exploring a pilot, please email rachel@doctella.com

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Barbara Lewis, MBA

BarbaraLewis@JoansFamilyBillofRights.com

www.JoansFamilyBillofRights.com

818.784.9888

Google Drive Doc as a Resource & for Comments

Starting and Sustaining Patient & Family Advisory Councils:

From Leadership Assessment to Success Metricshttp://joansfamilybillofrights.com/pfacs-from-starting-up-to-sustaining/

Click on the link on the page

© 2015 Joan’s Family Bill of Rights