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1© 2011 TMIT
Welcome to
Engaging, Activating, and Partneringwith Patients and Families
A Four-Part Webinar Series – Webinar Two
Hosted by TMIT
For resource downloads go to:
www.safetyleaders.org
2© 2011 TMIT
Charles Denham, MD
Chairman, TMITCo-chairman, NQF Safe Practices Consensus Committee
Chairman, Leapfrog Safe Practices Program
TMIT High Performer WebinarMarch 17, 2011
Welcome
3© 2011 TMIT
With regard to webinar soundvolume, please check the WebExvolume (see example above in redbox), computer volume, andexternal speaker (if any) volume.
If you are still having difficultyhearing the webinar, please click on“Request Phone” button to receivea toll dial-in number (see exampleon right-hand side in red box).
6© 2011 TMIT
The following panelists certify:
that unless otherwise noted below, each presenter provided full disclosure information,does not intend to discuss an unapproved/investigative use of a commercialproduct/device, and has no significant financial relationship(s) to disclose. Ifunapproved uses of products are discussed, presenters are expected to disclose thisto participants.
Joseph McCannon: Employed by Centers for Medicare & Medicaid Services
Paul McGann: Employed by Centers for Medicare & Medicaid Services
Jean Moody-Williams: Employed by Centers for Medicare & Medicaid Services
Helen Burstin: Employed by National Quality Forum
Maureen Connor: Employed by North Shore Medical Center
Farris Timimi: Employed by Mayo ClinicSusan Sheridan: Has no relevant financial interests in this presentationBarton Hill: Employed by St. Luke’s Boise Medical CenterSteve Rel: Has no relevant financial interests in this presentationCharles Denham: Chairman, TMIT; TMIT education grantee of CareFusion and AORN with co-productionby Discovery Channel for Chasing Zero documentary and Toolbox including models, education grantee ofGE with co-production by Discovery Channel for Chasing Zero documentary and Toolbox includingmodels. HCC Corporation contractor for Siemens.
Disclosure Statement
Chasing Zero® is a registered trademark of CareFusion
7© 2011 TMIT
TMIT certifies that:
• No funder or educational grantor had any influence or anydirect contact with researchers, analysts, or hospitalleaders contracted with TMIT involved in generation ofmodels, impact calculators, or consensus panels.
• Confidentiality of collaborators, patient data, and populationdata has been and will be strictly maintained.
Disclosure Statement
8© 2011 TMIT
TMIT Mission
Accelerate performance solutions thatsave lives, save money, and build valuein the communities we serve andventures we undertake.
9© 2011 TMIT
The Voice of the Patient and Family
Steve Rel
TMIT Patient Safety AdvocateCo-founder, Braxton Memorial Hockey
Scholarship Fund
10© 2011 TMIT
Speaker Panelists
Charles Denham Paul McGannJoseph McCannon Helen BurstinJean Moody-Williams
Maureen Connor Farris Timimi Susan SheridanBarton Hill
11© 2011 TMIT
Joseph McCannon
Senior Advisor to the AdministratorCenters for Medicare & Medicaid Services (CMS)
TMIT High Performer WebinarMarch 17, 2011
The Message from CMSUpdate on Direction
Including HACs and Readmissions
12© 2011 TMIT
Paul E. McGann, MD
Acting CMS Chief Medical Officer and Deputy Chief Medical OfficerCenters for Medicare & Medicaid Services (CMS)
TMIT High Performer WebinarMarch 17, 2011
The Message from CMSMessage from the Acting CMO of CMS
13© 2011 TMIT
Jean Moody-Williams, RN, MPP
Group Director, CMS Quality Improvement Group (QIG)Centers for Medicare & Medicaid Services (CMS)
TMIT High Performer WebinarMarch 17, 2011
The Message from CMSAn Update for QIOs and ESRD Networks
14© 2011 TMIT
Charles Denham, MD
Chairman, TMITCo-chairman, NQF Safe Practices Consensus Committee
Chairman, Leapfrog Safe Practices Program
TMIT High Performer WebinarMarch 17, 2011
Leadership Structures and Systems:Involving Patients and Families
Quality Committee Chair
RiskManagement
PatientSafety
QualityPerformanceImprovement
CEO
GovernanceBoard
GovernanceChair
COO CQOCFOCRO CNO
The High Performance Hospital: Patient and Family Input
Patients & Family Input
Patients & Family Input
Patients & Family Input
Patients & Family Input
Patients & Family Input
17© 2006 HCC, Inc. CD000000-0000XX 17© 2011 TMIT
CMS QualityNet Conference Sparking innovation, igniting action, lighting theway to tomorrow's healthcareVideos of presentations, transcripts, and Slide Sets:http://www.safetyleaders.org/qualityNetOnline/
© 2006 HCC, Inc. CD000000-0000XX 18© 2011 TMIT
Facts are re-told…
Stories are retained…
Quaid D, Thao J, Denham CR. Story power: The secret weapon. J Patient Saf 2010 Mar;6(1):5-14.
20© 2006 HCC, Inc. CD000000-0000XX 20© 2011 TMIT
CMS National Conference on Care Transitions: Videos of presentations,transcripts, and Slide Sets:http://www.safetyleaders.org/qualityNetOnline/care_transitions.jsp
21© 2011 TMIT
At the Leadership-Practices-Technology Intersection
Leadership
PracticesTechnology
The High Performance Envelope
© 2006 HCC, Inc. CD000000-0000XX 22© 2011 TMIT
“Not one of the board chairmen in the bottom 10%of quality thought they were below average”
Ashish JhaChasing Zero Documentary
23© 2011 TMIT
Information Management andContinuity of Care
Medication Management
Healthcare-AssociatedInfections
Condition- &Site-Specific Practices
Consent & Disclosure
Culture
Workforce
Consent and Disclosure
2010 NQF Report
© 2006 HCC, Inc. CD000000-0000XX 25© 2011 TMIT
The six National Priorities are:patient and family engagementto provide patient-centered,effective care…(Safe Practice 1)
© 2006 HCC, Inc. CD000000-0000XX 26© 2011 TMIT
A structure and system shouldbe established to obtain directfeedback from patients aboutthe performance of theorganization.(Safe Practice 1)
© 2006 HCC, Inc. CD000000-0000XX 27© 2011 TMIT
…patient and/or familiesrepresenting the populationserved should be included in thedesign of educational meetingsor should participate on formalcommittees that provide inputto leadership…
29© 2011 TMIT
Patient Advocates
Nancy Conrad Mary FoleyJennifer Dingman Becky MartinsDan Ford
Moose Millard Dennis QuaidPatti O’Regan Sue SheridanArlene Salamendra
31© 2006 HCC, Inc. CD000000-0000XX 31© 2011 TMIT
To order NQF Safe Practices for Better Healthcare:Go to www.qualityforum.org
32© 2011 TMIT
National Collaboratives Provide Performance Metrics:
Impact Calculators ProvideCFO Validated Performance Impact
39© 2011 TMIT
Helen Burstin, MD, MPH
Senior Vice President for Performance MeasuresNational Quality Forum
TMIT High Performer WebinarMarch 17, 2011
A Message from theNational Quality Forum
40© 2011 TMIT
Maureen Connor, BSN, MPh
Executive Director of Quality and Safety, Patient Care ServicesNorth Shore Medical Center
TMIT High Performer WebinarMarch 17, 2011
The Dana-Farber Story, and the Powerof One at North Shore Medical Center
Dana-Farber Cancer Institute (DFCI)
• Executive leadership commitment toadvancing patient- and family-centeredcare
• Partnership with patients and familiesbegan shortly before DFCI inpatientbeds were physically relocated to theBrigham and Women’s Hospital.
41
Getting Started
• Captured patients’ and family members’perspectives
• Patients and families helped on the dayof the move transferring patients andequipment
• Conducted post-move “rounds”
42
• Adult Patient and Family AdvisoryCouncil created in 1998, and thePediatric Council one year later
• Councils report to the Board throughthe QI structure
• Adult co-chairs are patients and/orfamily members, whereas PediatricCouncil co-chairs consist of a familymember and a staff member
Further Development
43
• Quality Improvement Committees
• Board level quality committee
• Other committees, e.g., ethics anddiversity, task forces and teams
• Volunteer Services
Organizational Integration
44
• Working on the Wait
• Hand hygiene campaign
• New Building (2020 Committee)
• Care Improvement Team
• Rounding
• Healing Environment
• Satellite Clinics
Examples of Projects and Initiatives
45
Emergency DepartmentChildren’s Hospital, Boston
• Pediatric Patient and Family AdvisoryCouncil’s First Initiative
• Treatment of pediatric oncology patients
for fever and neutropenia in the ED
• Widespread impact
• Need for continued monitoring
46
Members of theFull Disclosure Working Group
• Janet Barnes, RN, JD, Director, Risk Management, Brigham & Women’s Hospital• Maureen Connor, RN, MPH, VP for Quality Improvement and Risk Management, Dana-
Farber Cancer Institute• Connie Crowley-Ganser, RN, MS, Principal, Quality HealthCare Strategies• Thomas Delbanco, MD, General Medicine and Primary Care, Beth-Israel Deaconess Medical
Center• Frank Federico, BS, RPh, Director, Institute for Healthcare Improvement• Arnold Freedman, MD, Medical Oncology, Dana-Farber Cancer Institute• Mary Dana Gershanoff, Patient, Co-chair, Dana-Farber Adult Patient & Family Advisory
Council• Robert Hanscom, JD, Director, Loss Prevention & Patient Safety, Risk Management
Foundation• Cyrus C. Hopkins, MD, Director, Office of Quality and Safety, Massachusetts General
Hospital• Gary Jernegan, Parent, Co-chair, Dana-Farber Pediatric Patient & Family Advisory Council• Hans Kim, MD, MPH, Medical Director, Clinical Effectiveness, Beth-Israel Deaconess Medical
Center• Lucian Leape, MD, Health Policy Analyst, Harvard School of Public Health, Chair• David Roberson, MD, Program for Patient Safety and Quality, Children's Hospital• John Ryan, JD, Attorney, Sloane & Wal, Risk Management Foundation• Luke Sato, MD, Chief Medical Officer and Vice President, Risk Management Foundation• Frederick Van Pelt, MD, Director, Out-of-OR Anesthesia, Brigham & Women’s Hospital
49
Teamwork Training
• Campaign rather than education orresearch
• Focus on hazards rather than skills
• Wrong chemo, last-minute change, handhygiene
• Bringing messages to the patient
• Empowerment without obligation
• “You CAN… check, ask, notify”
50
You CAN Campaign,July-Sept 2007
• Staff briefings
• Lobby tables
• Volunteer rounders
• Surveys
• Plasma screen, brochures, posters
• Pens, pins, mugs, wallet cards
• DFCI announcements
53
Variable use of teamwork skills
Question Baseline*
(n=204)
Follow up*
(n=201)
Would you notice if the colorof your chemotherapy orpills were different thanusual?
20% 21%
Would you feel comfortableasking your doctor or nurseif they washed their hands?
55% 56%
Did the nurse tell you whatto expect during your lasttreatment?
7% 5%
* % indicating probably or definitely NOT
54
Awareness & Impact of Campaign
• 32% (≈ 1,100 patients) were aware of the campaign.
• 39% of those aware of the campaignsaid that it changed their behavior.
55
North Shore Medical Center
• The power of one
• Intensive Care Unit
• Cardiac Surgical ICU
• TCAB on Med/Surg Units
• Partnering with patients and families ondelirium project and care plans for pain
56
NQF Safe Practices
• Each Safe Practice in the updatedNQF consensus report includes asection entitled “Opportunities forPatient and Family Involvement.”
• This section provides specificinformation about how to involvepatients and families in theimplementation of each Safe Practice.
57
References
• Weingart, SN, Simchowitz B, Eng TK, et al. The YouCAN campaign: teamwork training for patients andfamilies in ambulatory oncology. Jt Comm J QualPatient Saf 2009 Feb;35(2):63-71.
• Weingart SN, Price J, Duncombe D, et al. Patient-reported safety and quality of care in outpatientoncology. Jt Comm J Qual Patient Saf 2007Feb;33(2):83-94.
• Leape L, Barnes J, Connor M, et al. When Things GoWrong: Responding to Adverse Events. A ConsensusStatement of the Harvard Hospitals. Burlington (MA):Massachusetts Coalition for the Prevention of MedicalErrors; 2006 Mar.
59
• Reid Ponte P, Connor M, DeMarco R, et al. Linkingpatient and family-centered care and patientsafety: the next leap. Nurs Econ 2004 Jul-Aug;22(4):211-3, 215.
• Ponte PR, Conlin G, Conway JB, et al. Makingpatient-centered care come alive: achieving fullintegration of the patient's perspective. J Nurs
Adm 2003 Feb;33(2):82-90.
60
References
• http://www.familycenteredcare.org
• http://www.aha.org/aha/issues/Quality-and-Patient-Safety/strategies-patientcentered.html
• http://www.dana-farber.org/images/pdfs/side-by-side/2006-spring.pdf
• Maureen Connor
61
References
62© 2011 TMIT
Farris K. Timimi, MD
Director, Cardiology Education ClinicAssistant Professor of Medicine, Mayo College of Medicine
Medical Director, One Voice, Division of Cardiovascular Disease
TMIT High Performer WebinarMarch 17, 2011
The Mayo Experience
How did we get here?
• Primary value
• Focus on PRC performance data
• MN Quality Award Application
• Recognition that the 75% of H-CAHPS’ survey questionsdirectly/indirectly addresscommunication skills of providers
63
JONA, 39, 6:266-275
Direct Care-20%Documentation-35%
Medication-17% Care Coordination-21%
Assessment/Vitals-7%
64
How did we get here?
Fundamental Lessons
• Guideline-centric vs. patient-centric care
• In acute encounters, patients place apremium on morbidity and mortality, sothere is no conflict
• However, individual accommodations arebecoming a feature of patient-providercompact
65
• Patient perception of quality often differsfrom our perception of quality
• For most patients, quality is viewed as anexpectation of the care they receive, notas a differentiating factor
66
Fundamental Lessons
The level of the patient/provider
• Patient with moderate hypertension, whoopts to delay medical treatment
• Patient with AF and a low Chads-2 score,who opts for anticoagulation instead ofASA
• In each case, the patient is making achoice divergent from guidelines, butconsistent with his own values
68
The level of family and friends
• Partners in Care, empowering patientsand their family members to ask, “Did youwash your hands?” increased hand-washing, on average, by 50%
69
Institutional Policy and Procedure
• Depression Improvement AcrossMinnesota: Offering a New Direction
• DIAMOND provides a depression caremanager to contact the patient onschedule, to monitor compliance and side-effects
70
• At initial roll-out, enrollment was 32.4%
• PFAC Review: the program be introducedas standard of care, the patient’s physicianintroduce care manager, clear educationas to the care manager’s role
• Enrollment increased to 96.5%
71
Institutional Policy and Procedure
National Healthcare Policy
• Clearly, partnership with all stakeholders iscritical to designing an ideal healthcaresystem
72
Patient Family Advisory Council
• An advisory council providing contentreview and creation regarding policiesand procedures
• Meets on schedule; agenda-driven
• Defined terms of service
• Adheres to confidentiality requirementsas defined by volunteer services
73
Structure
• Present and former patients and families
• Not currently in acute care
• Capacity to contribute, while not seeking apersonal or single agenda
• Initial closed recruitment with clearscreening, orientation, and trainingpolicies
• Clearly articulated expectations
74
Critical Elements
• Leadership engagement
• A clear strategic vision
• Involvement of patients and families atmultiple care levels
• Beware of the myth of partnership
75
Fundamental Lessons
• The concepts defining patient-centric careare integral to all healthcare institutions
• The fundamental shift centers onpartnering with trained patients serving asadvisors
76
Action Steps
• Leadership identifies and provides trainingfor a patient liaison
• Liaison engages care providers toparticipate
• Liaison recruits, orients, and trains patientadvisors
77
79© 2011 TMIT
Barton Hill, MD, MPA
Vice President for Medical Affairs and Chief Quality OfficerSt. Luke’s Boise and Meridian Medical Centers
TMIT High Performer WebinarMarch 17, 2011
The St. Luke’s Experience
St. Luke’s Boise
Beds: 403
Employees: 5,286
St. Luke’s MeridianBeds: 165
Employees: 1,227
St. Luke’s Magic ValleyBeds: 226
Employees: 1,830
St. Luke’s Wood River
Beds: 25Employees: 360
As of February 15, 2011
St. Luke’s McCallBeds: 15
Employees: 191
82
St. Luke’s Health System 2011
Patient & Family Safety and Partnership CouncilDevelopment Project Members
Barton Hill, MD
VP Medical Affairs
A.J. Balukoff
Chair,
Board Quality Committee
Deb Gaspar, RN, MS,MPA
Interim Director,
Quality & Patient Safety
Sue Sheridan, MIM, MBA
Co-founder,
Consumers AdvancingPatient Safety
Monica Zelley, MPA
Manager,
Patient & FamilyRelations
Gregory Janos, MD
Medical Director,
St. Luke’s Children’sHospital
Belinda Day, BS, RN,CPN
Director,Pediatrics/PICU/Child
Life
Rhonda Bright
PatientRelations/Performance
ImprovementCoordinator
Magic Valley
Suzanne Miller, BS, RN
Manager,
Patient Care,
Quality & Safety
Wood River
Jennifer Caple,
Social Services
McCall
What EVERY Patient Experience SHOULD BE
• “Nothing about me without me”
- Diane Plamping
• “If health or healthcare is on the table, thepatient/consumer must be at the table, every table.Now!” - Lucian Leape Institute
Our Mission
Our councils will be partnerships with patients andfamilies to improve patient safety and the quality of their
experience at St. Luke’s.
85
Connection to St. Luke’s Strategic Plan
Goal: To engage with our patients and families in amanner that brings all of us to a commonunderstanding of what it fundamentally means toprovide health services to our community at large.
Our proposal is the creation of a patient and familysafety and partnership council as a strategicinitiative to advance the organization’sachievement of safe, quality, patient-centered care;optimizing the patient and family experience at St.Luke’s.
86
Introduction
• Historical basis for Patient Family Advisory Councils –response to significant events, improve patient satisfaction,to support Patient- & Family-Centered Care;
• Growing emphasis on engagement of patients & families;
• Incorporating patient/family perspectives to transform thetraditional approach of healthcare delivery;
• Councils evolving into a more active role in supporting thedevelopment of practices and policies that truly impact theoverall patient experience.
87
Current State of Councils at St. Luke’s
• Children’s Hospital – 2 current councils (Pediatrics & NICU)
• Magic Valley
88
Development of a Vision
Vision components:
• Our aim is for zero harm to patients;
• Active patient and family engagement to patient-centered,relationship-based care;
• True understanding and appreciation for the patient & familyexperience;
• Partnership with our community to achieve transformation ofhealthcare;
• Effective integration of the healthcare continuum.
89
Desired Outcomes
• Improved quality and safety outcomes;
• Strengthened community relationships.
• Improved patient satisfaction;
• Continued promotion of transparency;
• Enhanced patient education;
• True patient-centered experiences;
Cultural Transformation
90
Scope & Structure of the Councils
• Projects, issues, and opportunities identified by patients,families, and the organization;
• Multiple councils across the health system, to include allareas of our healthcare operations where patients andfamilies are impacted;
• Each council uniquely defined and supported with resources;
• Projected size of each council – 10-20 members
• Patients and family members
• Administrative leadership
• Physicians
• Key staff
91
Projected Initial Budgeting Requirements
• 1.2-1.5 FTEs – approx. $86,000 annually
• Coordinator (1.0 FTE)
• Administrative support (0.2 FTE)
• Additional resources – approx. $65,000
93
Existing Strengths
• Current experience with several patient and family councils;
• St. Luke’s reputation for a caring philosophy within theorganization that is relationship-based;
• Significant physician integration;
• Leadership support for safety, quality, and patientengagement;
• Opportunity to customize our councils from inception;
• Strong support at many levels of the organization.
94
Potential Barriers
• Lack of understanding and knowledge about councils;
• Ability to recruit effective members to the councils;
• Fear of initial failure;
• Multiple variations for this model exist nationally;
• Creating a model that fits within our culture.
95
Next Steps
• Define operational and logistical details of ourproposal in the next 60 days.
• Implement our proposal by 9/1/11.
96
98© 2011 TMIT
Susan E. Sheridan, MIM, MBA
Co-Founder and President, Consumers Advancing Patient SafetyLead, Consumer Action, World Alliance for Patient Safety
World Health Organization
TMIT High Performer WebinarMarch 17, 2011
The St. Luke’s Experience
99© 2011 TMIT
Reactor Panelists
J. Michael HendersonChief Quality Officer
Cleveland Clinic
Jonathan SugarmanPresident and CEO
Qualis Health
Regina HollidayPatient Rights
Arts Advocate
Steve RelPatient Safety
Advocate
100© 2011 TMIT
J. Michael Henderson, MD
Chief Quality Officer, Cleveland Clinic
TMIT High Performer WebinarMarch 17, 2011
Reaction to Presentations
101© 2011 TMIT
Jonathan R. Sugarman, MD, MPH
President and CEO, Qualis Health
TMIT High Performer WebinarMarch 17, 2011
Reaction to Presentations
102© 2011 TMIT
Regina Holliday
Patient Rights Arts Advocate
TMIT High Performer WebinarMarch 17, 2011
Reaction to Presentations
103© 2011 TMIT
Reaction to Presentations
Steve Rel
TMIT Patient Safety Advocate Team MemberCo-Founder, Braxton Memorial Hockey Scholarship Fund
TMIT High Performer WebinarMarch 17, 2011
104© 2011 TMIT
Questions and Answers
Maureen Connor Farris Timimi Susan Sheridan Barton Hill
Joseph McCannon Paul McGann Jean Moody-Williams Helen Burstin
105© 2011 TMIT
Charles Denham, MD
Chairman, TMITCo-chairman, NQF Safe Practices Consensus Committee
Chairman, Leapfrog Safe Practices Program
TMIT High Performer WebinarMarch 17, 2011
Closing Comments:Future Opportunities