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www.planetree.org@PlanetreeAlan
From Patient Advocacy to Patient Engagement
Alan Manning, MPAExecutive Vice President, Planetree
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Complex Difficult
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Quality CareAccess
InclusionActivation
Choice
Think about care like Maslow did
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QQuality Care
WHAT
Treatment
Service
Interactions
Food
Transitions
Quality
HOW
Leadership
Staff Engagement
Patient Involvement
Challenge status quo
interdependent process
"Our Director is honest, so I feel like I can be honest too and speak up if I see something that could improve.“ -staff
80% Serious medical errors involve miscommunication between caregivers during transitions- Joint Commission Online October 21, 2010
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Example of Quality
InformedOptions- Benefits & Risks
Values-Based
What’s important to the patient
The Clinician
The Patient
Information
“the process of interacting with patients who wish to be involved in arriving at an informed, values-based choice among two or more medically reasonable alternatives”¹
¹A.M. O'Connor et al, “Modifying Unwarranted Variations In Health Care: Shared Decision Making Using Patient Decision Aids” Health Affairs, 7 October, 2004
https://decisionaid.ohri.ca/docs/das/opdg.pdf
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Access to Care
82% say access their medical records is important
Accenture Survey on Patient Engagement - Research Recap: United States, Sept. 2013
41% would consider switching doctors to gain access to their medical
…to loved ones…to resources…to your medical team (hourly rounding)…to your medical record…to safe and unbiased care
80% “Unrestricted visiting in the ICU doesn’t increase infection rates…it’s associated with lower rates of cardiovascular complications and mortality and lower stress hormone levels.” Fumagalli et al. 2011
of family members of ICU patients develop anxiety, and/or PTSD related to their experience
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Example of Access- Patient Pathways
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Inclusion in CareComprehensive care Planning Patient and family partnership council Bedside shift report
Teaching EmpathyEye contact
Muscles of facial expression
Posture
Affect
Tone of voice
Hearing the whole person (context)Your response
Helen Reiss, Empathetics
Medical professionals who communicate with empathy have higher patient satisfaction ratings. (Riess, 2012)
Patients who experience empathic care have better medical outcomes.(Hojat, 2011)
Adherence to treatment recommendations increases with compassionate care. (Halpern, 2010)
Communicating empathically increases clinician job satisfaction and reduces burnout. (Krasner, 2009; Shanafelt, 2009; West, 2011)
Enhanced empathic care and physician well-being are highly correlated.(Shanafelt, 2005)
Empathic clinician communication improves the quality of all interactions with others; patients, their families, colleagues, and loved ones. (Halpern, 2012)
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Inclusion in Care
Steps to Building an Effective PFPC1) Determine the Scope of the Council2) Select the Team 3) Determine a Budget 4) Confirm Team Members5) Conduct the Orientation Meeting 6) Conduct Regular Council Meetings 7) Elicit Public Relations Support & Community Engagement 8) Conclude With a Meeting9) Measure Success10) Sustain the Partnership Model
Leonhardt K, Bonin K, Pagel P. Guide for Developing a Community-BasedPatient Safety Advisory Council. Prepared by Aurora Health Care, Wisconsin.
AHRQ Publication No. 08-0048. Rockville, MD: Agency for HealthcareResearch and Quality. April 2008.
• Getting Started• Integrate diverse
voicesActivate
• Agenda• Charter• Education
Engage-Enable-Energize
• Close the feedback loop
• Measure effectiveness
• Integrate into quality
Enhance
Comprehensive care Planning Patient and family partnership council Bedside shift report
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Nurses treat you with courtesy/
respect
Nurses attitude toward requests
Attention to special/personal
needs
Nurses kept you in-fromed
Staff include you in decision re: treat-
ment
Staff worked to-gether to care for
you
8284868890929496
6 months prior to implementation of bedside report 6 months after implmentation of bedside report
Spirit and Intent of Hourly Rounding• More frequent touch-points• Security to patients• Moves from reactive to proactive• 4 P’s- Pain, Personal Needs, Positioning, Placement
Bedside shift report as a time saver• Sharp decline in the number of call lights• Nurses have reported a better ability to prioritize cases • Overall decrease in staff time post-implementation
Inclusion in CareComprehensive care Planning Patient and family partnership council Bedside shift report
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A shared space for Bi-directional communication
Example of Inclusion
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Activation in Care
Know them
Empower them
Strengthen them
Only 41% of Medicare patients believe that their treatment reflected their preference for palliative care over more aggressive interventions.
40%
Doctors believe 71% of patients with breast cancer rate keeping their breast as top priority. The figure reported by patients is just 7%.
Once patients are informed about the risks of sexual dysfunction after surgery for benign prostate disease, 40% fewer prefer surgery.
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23 secs before we interrupt patients
50%Of physicians don’t ask if patients have questions
<1 MinuteSpent discussing new
prescriptions
FEAROf appearing to challenge, keeps patients from asking
questions
We interrupt
JAMA. 1999 Circulation. 2008
Pat Educ and Cnslng. 2009. Health Affairs, 2012
We don’t include
We don’t inform We intimidate
Focus on 1-3 key, need to know items
Avoid medical jargon. Teach & define. Use concrete terms.
Focus on what patient needs to do!
3 STEPS to Enhancing Communication
Know them
Empower them
Strengthen them
Activation in Care
2013 Health Affairs study found that Shared Decision Making:• Reduced the overall cost of care by 5.3%• Reduced admissions by 12.5%• Reduced preference sensitive surgeries by 9.9% (20.9% for heart surgeries)
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Activation in Care
Assist with menu selection and feeding
Personal care, baths, manicure, dressing
Discharge planning and preparation
Care coordination
Change dressings, flush catheters
Take temperature, monitor tube feedings
Take blood pressure
From our Designation Criteria IV.: A comprehensive formalized approach for partnering with families in all aspects of the patient’s/resident’s care, and tailored to the needs and abilities of the organization, is developed. An example is a Care Partner Program.
“The doctor told me that I could have surgery and explained the risks. He also said I could take a “wait and see” approach. Then he made sure that I understand both options. He asked me which option sounded the best to me based on what I wanted. He cared about my goals.” -patient
Know them
Empower them
Strengthen them
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• Family formally engaged as integral member of care team
• A partnership between family and staff• Provides a source of continuity • Prepares loved one for post-discharge
“They showed my husband how to do my dressing
changes so I don’t have to come here every day. They
asked him questions: Can you see it? Do you
understand? For him to see, he was very informed.”
Example of Activation
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Choice in Care
Choice without education & empowerment will lead to less than optimal results
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Quality CareAccess
InclusionActivation
Choice
Think about care like Maslow did
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Culture PracticesStructures