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7/8/2014
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Voice of the Patient: Patient/Family Advisors in the Primary Care Practice Setting
A Collaborative Partnership with MiPCT, GDHAC and IPFCC
Integrating Patient & Family Voices into Primary Care Practice Settings
July 9, 2014 Webinar
Presenters:Mary Minniti Patty BlackProgram and Resource Specialist Program Coordinator/Patient AdvisorIPFCC PeaceHealth Medical Group
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In our time together . . .
▼Learn strategies to involve patients and families in a patient-centered medical home or primary care.
▼Collect practical tips on how to recruit, select and support patients and family in new roles as advisors in quality and safety work.
▼Understand the role of leaders in guiding collaborative efforts and how to prepare staff.
▼Explore how your participation in MiPCT and GDAHC collaborative could enhance your existing efforts.
The Joint Principles for the Patient-Centered Medical Home . . . An Opportunity
▼ “. . . A care planning process driven by a compassionate, robust partnership between physicians, patients, and the patient’s family. . .
▼ Patients actively participate in decision-making. . .▼ Care is coordinated and/or integrated across all elements of the
complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient’s community (e.g., family, public and private community-based services). . . in a culturally and linguistically appropriate way.
▼ Information technology is utilized appropriately to support optimal patient care, performance measurement, patient education, and enhanced communication.
▼ Patients and families participate in quality improvement at the practice level.”
http://www.pcpcc.net/content/joint-principles-patient-centered-medical-home
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Patient- and Family-Centered Core Concepts
▼ People are treated with respect and dignity.
▼ Health care providers communicate and share complete and unbiased information with patients and families in ways that are affirming and useful.
▼ Patients and families are encouraged and supported in participating in care and decision-making at the level they choose.
▼ Collaboration among patients, families, and providers occurs in policy and program development and professional education, as well as in the delivery of care.
Patient- and family-centered care is working "with" patients and families, rather than just doing "to" or "for" them.
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Why Patient- AND Family-Centered Careand not just Patient-Centered Care?
Social isolation is a risk factor.
Research is clear that isolating patients at their most vulnerable times from the people who know them best places them at risk for medical error, emotional harm, inconsistencies in care, and costly unnecessary care (Cacioppo & Hawkley, 2003;Clark, 2003).
The majority of patients have some connection to family or natural support.
Cacioppo, J. T., & Hawkley, L. C. (2003). Social isolation and health, with an emphasison underlying mechanisms. Perspectives in Biology and Medicine, 46(3), S39-S52.
A Broad Definition of Family . . .
In health care settings, patients are asked to define their families and how they will be involved in care and decision-making.
The American Academy of Family Physicians which defines “family” as “a group of individuals with a continuing legal, genetic and/or emotional relationship”.
(American Academy of Family Physicians, 2009).
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"The most direct route to the Triple Aim is via patient- and family-centered care in its fullest form.”
Don BerwickJ 5 2012
Health of Populations
Patient Experience
Reducing Costs
Triple Aim — Patient- and Family-Centered Care
Patient- and Family-Centered Core Concept Respect and Dignity
Patients and families are seen as essential membersof the health care team in all settings across the continuum of care.
Staff and clinicians introduce themselves to patients and their family members in all encounters.
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Patient- and Family-Centered Core Concept Information Sharing
Health care providers communicate and share complete and unbiased information with patients and families in ways that are affirming and useful.
Staff and clinicians build on a patient’s and family strengths and provide information to them in all encounters.
Patient- and Family-Centered Core Concept Participation
Patients and families are encouraged and supported in self-management of chronic conditions.
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Patient- and Family-Centered Core Concept Collaboration
Health care professionals invite patients and families to join quality improvement teams and safety efforts.
Staff and clinicians build on the expertise and experience of patients and families to improve or redesign services, care processes, and information/education resources.
Picture of primary care doctor in poster recruiting patients to participate in clinic redesign.
Approval logo that appears on all materials reviewed by the advisors.
Patient- and family-centered care provides the framework and strategies to improve the experience of care, and enhance quality, safety, and efficiency.
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Patient and Family Engagement
Patient and family engagement is a priority consideration essential to health reform at four levels:
At the clinical encounter…patient and family engagement in direct care, care planning, and decision-making.
At the practice or organizational level…patient and family engagement in quality improvement and health care redesign.
At the community level…bringing together community resources with health care organizations, patients, and families.
At policy levels…locally, regionally, and nationally.
How to Scale Up Primary Care Transformation: What We Know and What We Need to Know?
“Becoming a medical home is a radical change, requiring both a new mental model for primary care and the skills and resources to accomplish it.”
Homer, C. J., & Baron, R. J. (2010). How to scale up primary care transformation: What we know and what we need to know? Journal of General Internal Medicine, 25(6), 625-629.
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How to Scale Up Primary Care Transformation: What We Know and What We Need to Know? (cont’d)
“In our experience, the unique perspective that family members bring refocuses transformation efforts away from provider concerns and toward bringing value for families and patients.”
Homer, C. J., & Baron, R. J. (2010). How to scale up primary care transformation: What we know and what we need to know? Journal of General Internal Medicine, 25(6), 625-629.
What are your concerns about partnering with patients and families in
this way?
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How Patient-Centered Practices Involve Patients in Quality Improvement
▼ Surveyed 112 patient-centered medical home clinics in 22 states.
▼ Nearly all solicited patient feedback.
▼ Only 32% involved patients as advisors on QI teams or councils.
▼ A high level of involvement group was seen as having advisors and surveys.
▼ Leadership commitment essential.
Han, E., et al., (2013). Survey shows that fewer than a third of patient-centered medical home practices engage patients in quality improvement. Health Affairs, 32(2), 368-375.
High Level Practices Saw Benefit!
“These practices stated that robust patient involvement in every aspect of the practice, including designing effective patient engagement strategies, positively affected the way in which patients and families interacted with physicians and staff, supporting stronger relationships and enabling patients to feel more empowered to become active partners in their care.”
Han, E., et al., (2013). Survey shows that fewer than a third of patient-centered medical home practices engage patients in quality improvement. Health Affairs, 32(2), 368-375.
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What Is an Advisor?
Advisors - Patients, Families, Residents
Any role in which those who receive care work together with health care professionals to improve care for everyone. Advisors share insights and perspectives about the experience of care and offer suggestions for change and improvement.
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Successful Advisors can:
▼ Share insights and experiences in productive ways
▼ See beyond his/her own personal experience▼ Respect diversity and differing opinions▼ Listen well▼ Like to work together with others on solutions
Note: Make sure that those you select represent the populations served by the organization. Diversity in age, gender, ethnicity, and socioeconomic means provide much richer experiences and outcomes in the work.
What is a Patient and Family Advisory Council?
▼ Formal mechanism within an organization to create authentic collaboration and partnerships.
▼ Establishes ongoing relationships over time with regular meeting times and terms of service.
▼ Seeks diverse perspectives representing the populations served.
▼ Organizational leadership sponsors the effort.
▼ Council provides input vehicle for a variety of issues.
▼ Role of Advisors:
� Partners in key areas within the organization (quality, safety, program development, policy).
� Initiates and identifies opportunities for improvement in patient and family experience of care.
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Collaboration Beyond Advisory Councils
Advisory Councils are only one way to partner with advisors. Here are some other effective ways:▼ Invite patients with a chronic condition to participate in
a clinic team working on improving educational materials or programs to that population of patients.
▼ Identify patients new to the clinic to participate in a “photo walk-about” to take pictures of ways the clinic is welcoming and places where the messages could be more positive or where way-finding is confusing.
▼ Ask patients and family what is one change we could make that would improve your experience? Collect the responses and form a clinic team with advisors to follow-up on suggestions.
Examples of Advisory Roles
▼ Serving on a Patient and Family Advisory Council.▼ Joining a “lean event” focused on a particular unit or
service line.▼ Creating and/or reviewing educational materials,
patient portals and outreach materials.▼ Members of teams involved in any of the following:
� Facility design or remodeling or wayfinding improvements.
� Quality Improvement projects.� Patient-Centered Medical Home redesign.� Patient safety, quality, experience of care and ethics
committees.▼ Peer mentors, educators or coaches.
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Useful Framework for ParticipationDepth of Engagement
Patients and Family Role
Things to Consider
Ad Hoc Input Survey or Focus Group Participants
Ensure diversity and representation, validity
Structured Consultation
Council or Advisors-provides QI input
Early consult supports partnership model
Influence OccasionalReview/Consultants to project
Allows flexible ways to participate; requires background/orient.
Negotiation Member of QI Group Training in QI approach
Delegation Co-Chair of QI Group High level of expertise or skill
Advisor Control Implementer or peer support role
Strong training component, mentoring and compensation
Possibilities for an Initial Structure?
▼ An Informal Workgroup
Allows time to build trust among advisors and staff, supports the development of processes, begin to address issues, and explore ways to work together effectively.
▼ A Patient and Family Advisory Council
A formal mechanism for involving patients and families in clinic policy and program development and quality and safety initiatives.
▼ Members of the Safety or Quality Team
Improvement partners.▼ Clinic-based team focused on a Specific Issue
Improvement partners.
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Seek advisors that represent populations served and who have had recent (within 1-2 years) actual experiences.
Develop clear roles for advisors, select for “fit”, orient to organization and provide ongoing coaching and support.
Use advisors where input is valued and will be utilized.
Close the loop and let advisors know what changes were made as result of input.
Goal:
Meaningful opportunities for advisors to make a positive difference.
Best Practices:
Assume patients are the experts on their own experience and that they have information you need to hear and act on.
Know that families are primary partners in a patient’s experience and health.
Change The Assumptions
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Preparing Staff and Clinicians for Collaborative Efforts
▼ Value the perspectives and experiences of all.
▼ Ask open-ended questions about concerns, fears and issues.
▼ Listen, Listen, Listen.▼ Debunk the myths.▼ Provide the evidence. ▼ Make it easy; take care of the
operational details.▼ Show appreciation for everyone’s
contributions.
Role of Leaders
Creating a culture of meaningful collaboration with patients and families
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Reporting Structure
Organization chart;
Included in Process improvement team and other important meetings; and
Physical location of office.
Tips on Recruitment
• Many possibilities – newspapers, outside community centers, your organizations newsletters, home page, doctor/staff referrals, waiting room signs
• Initial Interview
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Selection Considerations
Patient‐ and family‐centered approach;
Recent, relevant experience; Does not have “an ax to grind;” Availability to meet time requirement;
Professionalism;
Team player; and
Good fit with the culture.
Supporting Collaboration in the Office Visit
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PDI Collaborations
5. Discharge Visit Summaries for inpatient arena
4. Opioid Medical Contract using Language of Caring Principles
3. After Visit Summary for outpatient arena
2. Patient Connection – Patient Portal. Helped to design and update to broaden the ways to use. Held sign‐up clinics at Gerontology clinic
1. Walk‐abouts
▼ What excites you about inviting patients and families to join you in improving quality and safety efforts?
▼ What is it about your organization (mission/vision/values), its clinicians, staff and administrators that supports patient and family partnerships?
▼ What is it about your patients and families that confirms their active and sustained participation will add value?
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Questions for Patty
A Quick Tour of Collaborative Examples
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A welcome poster developed by patient and family advisors placed at the entrance.
Conveying respect and creating the expectation for partnership.
Patient- and Family-Centered Care linked with cultural and linguistic competency.
Each patient/family receives a business card with organizational phone numbers and this message about partnerships.
Creating the Expectation for Partnership in Clinical Care
Community Health Partners, Livingston, MT
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A. F. Williams Family Medicine Center’s New Leadership Statements
Making Explicit the Leadership Commitment
A. F. Williams Family Medicine Center
Positive first impressions — patient portal sign up information, health nutrition, and recognition of people coming from different regions of the world
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Building a Family Health Center Advisory Board
Recruitment
Referrals from PCPs and staffEmails
Nomination card
Staff meeting announcements (invite current patient advisors)
Invitations from PAB members
Meetings are the Last Thursday of the Month From 3:30 - 5:00pm If Interested Contact: Julia at [email protected] Make a Difference! Become a Patient Advisor
General Medicine Clinic, 1M San Francisco General Hospital
1001 Potrero Ave. San Francisco, CA 94110
Advisory Board Meeting
The General Medicine Clinic Patient Advisory Board
Patients and Caregivers coming together to help improve the
General Medicine Clinic
Team Up for Health Sharp Rees-Stealy Medical Group
Patient advisors participate in the communications training with physicians and staff.
www.teamupforhealth.org
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Leaders participated in a Collaborative to learn about Partnerships with patient and family advisors at Ocean Park Health Center, San Francisco, CA
Patient and family advisors planned the “walk and talk series.”
Leadership is KEY . . .
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Ocean Park Health CenterSan Francisco, CA
The Patient Advisory Council members have been enthusiastic, and interested in improving care of patients and outreaching to the community.
Each time I attend their meetings, their energy and passion revitalizes me and helps me to remember the reasons for which we are all here: to serve our patients.
Lisa Golden, MD, Medical DirectorOcean Park Health Center, San Francisco, CA
Patient Advisory Board
Team Up for Health Humboldt Open Door ClinicAppointment of an administrative leader and a staff liaison
• Redesigning the clinic’s bulletin boards.
• Helping to improve community resource referrals.
• Reviewing the telephone system.
• Developing a patient/friendly business card for clinic patients.
• Promoting provider engagement.
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St. Mary’s Family Medicine Center and Residency Program, Grand Junction, CO
Laminated card to use with each patient accompanied by bubble chart
Keys to Organizational Success
▼Identify an executive sponsor.▼Align with existing projects, initiatives and
strategic plans. ▼Seek out “champions” across the organization;
nurture these relationships.▼When just starting out, choose small projects
with short timeframes.▼Track accomplishments and communicate
successes broadly to build momentum.▼Network with others in similar positions to
learn, maintain flexibility and optimism.
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What we are learning about creating effective patient and family partnerships . . .
▼ Senior leaders that believe in the possibility and potential of patient and family partnerships enhance the likelihood of success.
▼ A designated staff liaison for collaborative endeavors facilitates the process.
▼ Patient and family involvement from the beginning of a project makes a difference.
▼ Successful recruitment strategies include direct invitation from clinicians and invitations from patients, families, and community outreach workers.
What we are learning about creating effective patient and family partnerships . . .
▼ Having meaningful, concrete projects to work on, especially at the beginning, is helpful.
▼ Up-front clarification of the roles for advisors and advisory groups helps prevent problems and reduce confusion.
▼ The most successful programs:
■ Have more than one advisor on a QI committee or task force.
■ Offer many ways for patients and families to participate as advisors.
■ Track and measure the work and its impact.
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What we are learning about creating effective patient and family partnerships . . .
▼ Orientation and preparation for staff, physicians, and patients and families are essential.
▼ It takes time to develop comfort and confidence with working in this new way and to achieve measurable results.
▼ Invest in patient and family leadership development.
▼ There may be bumps in the road, but ...
▼ It’s important to trust the process and to work on the process.
Resources
A Checklist for Attitudes How to Conduct a "Walk About” Patient-Centered Medical Home –Engaging Patients and Families – Benefits for Physician Practices Preparing Advisors for Quality and Safety Committees Partnering with Patients and Families to Accelerate
Improvement Readiness Assessment Tips for Group Leaders Involving Patients and Families Framework for Patient and Family Involvement in Quality
Improvement Selecting Patients and Families as Advisors in Primary
Care
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Helpful Resources
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Redesigning Primary Care. . .
A Journey, Not a Destination
Invite patients and families to join you to create meaningful changes for all.
To Apply:Send email to : subject line: “Patient Advisor Training Application’ to: [email protected] by August 1stwith the following information:
Name of PO and interested practices
List names of the operational leader and clinical champion with contact information. They will participate in the webinar and ongoing activities
Identify which approach you wish to pursue
How does this assistance align with your activities and strategic priorities
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Questions?
