Transcript What is Patient- and Family

What is Patient- and Family-Centered
Care?
Patient- and family-centered care is an approach to the planning,
delivery and evaluation of health care that is grounded in
mutually beneficial partnerships among patients, families, and
health care practitioners. It is founded on the understanding
that the family plays a vital role in ensuring the health and well being of
patients of all ages.
The ultimate goal of patient- and family-centered care is to create partnerships
among health care practitioners, patients and families that will lead to the best
outcomes and enhance the quality and safety of health care.
Four Core Concepts
DIGNITYANDRESPECT
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Health care practitioners listen to and honor patient and family perspectives
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and choices. Patient and family knowledge, values, beliefs and cultural
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backgrounds are incorporated into the planning and delivery of care.
I N F O R M AT I O N S H A R I N G
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Health care practitioners communicate and share complete and unbiased
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information with patients and families in ways that are affirming and useful.
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Patients and families receive timely, complete and accurate information in
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order to effectively participate in care and decision-making.
PA R T I C I PAT I O N
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Patients and families are encouraged and supported in participating in care
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and decision-making at the level they choose.
CO L L A B O R AT I O N
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Patients, families, health care practitioners, and hospital leaders collaborate
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in policy and program development, implementation and evaluation; in
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health care facility design; and in professional education, as well as in the
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delivery of care.
Patient- and Family-Centered Care:
Why Is It Needed?
“ . . . Care must be delivered by systems that are carefully and
consciously designed to provide care that is safe, effective,
patient-centered, timely,
efficient, and equitable.
Such systems must be designed to serve the needs of
patients, and to ensure that they are fully informed, retain
control and participate in care delivery whenever possible,
and receive care that is respectful of their values and
preferences. “
Institute of Medicine, Crossing the Quality Chasm (2001)
Crossing the Quality Chasm
1. Safe – avoiding injuries to patients from
care
 that is intended to help them.
2. Effective – providing services based on
scientific
 knowledge to all who could benefit and
 refraining from providing services to
those not
 likely to benefit.
3. Patient-centered – providing care that
is
 respectful of and responsive to
individual patient
 preferences, needs and values, and
ensuring that
 patient values guide all clinical
decisions.
4. Timely – reducing waits and sometimes
harmful
 delays for both those who receive and
those
 who give care.
5. Efficient – avoiding waste, in particular
waste
 of equipment, supplies, ideas, and
energy.
6. Equitable – providing care that does
not vary
 in quality because of personal
characteristics
 such as gender, ethnicity, geographical
location,
 and socioeconomic status.
Patient Centeredness
The real business of health care is about preventing
illness, healing those who are ill, meeting the needs of
people who must live their lives with disabilities or
chronic disease, and helping people in our
communities achieve better health.
Patient-centered care includes:
•respect for patients’ values, preferences,
and expressed needs;
•coordination and integration of care;
information, communication, and education;
•physical comfort; emotional support;
and the involvement of family and friends.
R U L E S TO R E D E S I G N A N D
IMPROVE CARE
1. Care based on continuous healing relationships.
Patients should receive care whenever they need it and in many
forms, not just face-to-face visits.
2. Customization based on patient needs and values.
The system of care should be designed to meet
the most common types of needs, but have the
capability to respond to individual patient
choices and preferences.
3. The patient should be the source of control.
Patients should be given the necessary information and the
opportunity to choice over their health care decisions.
4. Shared knowledge and the free flow of information.
Patients should have unfettered access to their
own medical information and to clinical
knowledge. Clinicians and patients should
communicate effectively and share information.
5. Evidence-based decision making.
Patients should receive care based on the best available
scientific knowledge.
6. Safety as a system property
Patients should be safe from injury caused by their care
system.
7.The need for transparency.
The health care system should make information
available to the pts and family that allows them to make
informed decisions when selecting a health plan, hospital
or clinical practice, or choosing among alternative
treatments.
8. Anticipation of needs.
The health system should anticipate patient needs, rather
than simply reacting to events.
9. Continuous decrease in waste.
The health system should not waste resources or patient
time.
10. Cooperation among clinicians.
Clinicians and institutions should actively collaborate and
communicate to ensure an appropriate exchange of
information and coordination of care.
Adapted from Crossing the Quality Chasm: A New Health
Care System for the 21st Century, 2001.
LEAN=Quality Improvement
Principles of the Simpler Business
System
1. The Customer defines value
2. Deliver Value to Customers on Demand
3. Standardize and Solve to improve
4. Transformational Learning requires deep personal
experience
5. Mutual Respect and Shared Responsibility enable
higher performance
Basic ideals derived from decades of experience
Tool
9
Simpler
®
© 1996-2006 Simpler® Business System 11.0
© Simpler Consulting, Inc 1996-2006 ALL RIGHTS RESERVED
For the Express Use of Simpler Members and Clients
Technique
Belief
The 8 Operational Wastes
WIT – D - MOP
8
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Unused Creativity / Talent / Injuries
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WAITING (patients / providers / material)
INVENTORY / Incomplete / Piles
TRANSPORTATION / Transactions / Transfer
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DEFECTS / Wrong info. / Rework / Inaccurate info.
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MOTION / Finding Information / Double entry
OVERPRODUCTION / Duplication / Extra info.
PROCESS / Extra Steps / checks / workarounds
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Tool
15
Simpler
®
© 1996-2006 Simpler® Business System 11.0
© Simpler Consulting, Inc 1996-2006 ALL RIGHTS RESERVED
For the Express Use of Simpler Members and Clients
Technique
Belief
Approach for Success
Value Stream Analysis
conducted with leadership team
Deliverables
May Jun
Agree on the Key Performance
Measures
Value Stream Maps
Do-Its Projects
Three
Events
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Baseline current performance against
Key Performance Measures
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Rapid Improvement Plan
EVENT
TOPIC
Jul
Aug Sep Oct
EVENT
TOPIC
EVENT
TOPIC
EVENT
TOPIC
EVENT
TOPIC
EVENT
TOPIC
EVENT
TOPIC
EVENT
TOPIC
EVENT
TOPIC
EVENT
TOPIC
EVENT
TOPIC
PROJECT
PROJECT
PROJECT
PROJECT
ACTION
ITEM
ACTION
ITEM
ACTION
ITEM
ACTION
ITEM
ACTION
ITEM
ACTION
ITEM
PROJECT
PROJECT
ACTION
ITEM
Value Stream Analysis avoids drive by Kaizen
Tool
1
Simpler
®
© 1996-2006 Simpler® Business System 11.0
© Simpler Consulting, Inc 1996-2006 ALL RIGHTS RESERVED
For the Express Use of Simpler Members and Clients
Technique
Belief
RI Events are the Vehicle of Change
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3 weeks before – Steering Committee reviews plans
2 weeks before – Select teams and collect data
1 week before – Finalize data, review goals
Day 1
Day 2
Day 3
Day 4
Day 5
– Training, study current conditions
– Apply tools and make big changes
– Train stakeholders and run the new process
-Standard work
- Presentation
Information
Involvement &
Encouragement
Renewal
Shock
Denial
Exploring new ways
MORALE
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Open
Blame
Problem
Solving
Hidden
Anger
Confusion
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1st week after – leadership audit, root cause
problem solving
2nd week after – measure, measure, measure
3rd week after – daily management and sustain
Past
Future
Support
Direction
TIME
Elizabeth Kubler Ross
Rapid Improvement Events are the Vehicle of Change
Tool
18
Simpler
®
© 1996-2006 Simpler® Business System 11.0
© Simpler Consulting, Inc 1996-2006 ALL RIGHTS RESERVED
For the Express Use of Simpler Members and Clients
Technique
Belief
Eliminate the Waste
Ideal
Ideal
Future
Future
State
State
Simple Standard
Flows
Work
V/S
Trans- Tight
Design
parency
Connect
Current
Current
State
State
n
A
m
Waste
V
Simpler
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Tool
19
© 1996-2006 Simpler® Business System 11.0
© Simpler Consulting, Inc 1996-2006 ALL RIGHTS RESERVED
For the Express Use of Simpler Members and Clients
Technique
Belief
Transparency - 6-S & Visual Management
APPLY VISUAL TOOLS
VISUAL WIP
INDICATORS
STATUS
UNITS VS PLAN
ALARMS
LOCATIONS
NORMAL
SEE
AT-A-GLANCE
(5 seconds)
ABNORMAL
CORRECTIVE ACTION /
6-SIGMA
OWNED BY THE PEOPLE WHO WORK IN THE AREA
Tool
23
Simpler
®
© 1996-2006 Simpler® Business System 11.0
© Simpler Consulting, Inc 1996-2006 ALL RIGHTS RESERVED
For the Express Use of Simpler Members and Clients
Technique
Belief
Sustaining the RIE
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Visual Management
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Provide a structure for managing and solving problems
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Daily Control Board / Performance Board / Countermeasure
Board
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Real Time Problem Solving
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Problem Solving when the real “root” cause is not known
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5 Whys spoken with data!
A3
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Confirmed state
Capture insights and learning
Close A3 when complete
Information Centers provide essential focus to support Sustainment
Tool
24
Simpler
®
© 1996-2006 Simpler® Business System 11.0
© Simpler Consulting, Inc 1996-2006 ALL RIGHTS RESERVED
For the Express Use of Simpler Members and Clients
Technique
Belief
PATIENT-FAMILY CENTERED
CARE TEAM
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June Sharkey
Debbie Kaszycki
Minnie Frazier
Julie Siggelkow
Judy Downey
Kate Martin
Krista Garner
Ray Quintero
Team Leader:
CHARTER SUMMARY
Project:
Opening 2D ICU-Patient Family Centered Care
Project Date: November 13-16, 06
Champion: Susan Grant
Objectives:
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To coordinate the flow for the family in 2D ICU
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Identify relationship between family, staff and physician
(Rounding, Dr. 99 presence, MD discussion w/ families)
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Develop a plan for tools to facilitate communication for
families including scripting and pt./family literature
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Develop standards of care utilizing best practices (EB) for
patient family centered care(Pastoral care, social services,
Public safety)
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Developing protocols for family room utilization (Facility
management)
Scope:
2D ICU-from initial contact with family and patient to D/C from ICU.
Sponsor: Ray Quintero
Sensei: Sonia Bergmann
Team Leader: June Sharkey
Team Members
Debbie Kaszycki
Minnie Frazier
Julie Siggelkow
Judy Downey
Kate Martin
Krista Garner
Current Family Waiting Area
Current Model vs. Family-Centered
Approach

Historical models of patient care have
been organized around the needs of
healthcare professionals.
A family-centered approach has been
referenced to achieve high levels of quality
care and increased patient satisfaction.

Traditional methods of patient care
delivery rarely involved family in medical
management.
Family-centered care encourages a
collaborative team approach.
Many aspects of patient and family
centered care are cost-efficient and simply
require a paradigm shift.
Implementing a family centered approach
to care is an ongoing commitment.
New Family Waiting Area
Accomplishments
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Lean exercises: Value streams, spaghetti charts, NVA / VA
identification.
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Met with various individuals / ancillary staff:
Pastoral services, Rollins DD, nutrition, day surgery advocate, ER
patient administrative liason, patients’ family members.
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Family Process: Quick Sheet for admission and guidebook.
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Staff Education for new culture of family centered care.
Examples of Accomplishments
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Rough drafts of admission quick sheet for individual
family members as well as for laminated guidebooks to
remain in family waiting areas.
Generated ideas for the job description of the “family
coordinator”
Developed plan for staff education to promote a
smooth transition into family-centered care.
Listed ideas for “signage” throughout the
“mothership/2DICU”
Team Responsibilities
#
1
2
3
4
5
6
7
8
Action
Admission Quicksheet
Guidebook
Family Coordinator Job Description
Waiting room computer education
Consult with nutritional services to coordinate
dietary needs for 2DICU
Family Coordinator Reference Guidebook
Staff Education Inservices
Metrics Coordinator
Target
Finish
Date
Owner
12/8/2006
12/8/2006
12/1/2006
1/12/2007
June Sharkey
June Sharkey
Judy Downey
NICU NPs
12/8/2006
1/5/2007
1/12/2007
continuous
Minnie Frazier
Minnie Frazier
June Sharkey
Debbie Kaszycki
Comments
Team effort
Contact Barbara Fussel
Team effort
Team effort
Key Metrics for the Unit
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Patient & Family Satisfaction
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ICU Survey
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Employee Satisfaction
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Gallup Poll Survey
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Georgia Tech. TBD
MD Satisfaction – ICU Admitting Surgeons & Neurologists
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Baseline next week and then in Feb & Apr ’07 – Ray & Marilyn
Stress Study
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Baseline 11/20 through December - Ray & Aaron
Obtain a validated survey – Marilyn
Family Member time spent with patient
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Family sign in/out
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Baseline units 2&3 11/20 thru Dec ‘07; Future collection Feb-Apr ‘07
Julie will create a form
Lessons Learned
•Family-centered care relies upon COMMUNICATION
amongst all members involved in the care of the patient.
•Family-centered care is a multidisciplinary group endeavor
•We can change the schematics of an ICU and upgrade with
all the fancy stuff in the world but if we don’t upgrade the
way we practice, change will never occur for the good of the
patient.
•The LEAN project has encouraged us to network ideas with
ancillary staff throughout EUH to successfully merge and
create an innovative approach to patient care in the
neuroscience ICUs.
Expectations

The current model of patient care will be transitioned to a
family-incorporated approach.
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May be difficult at first
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In-services and continued staff education should assist with
integration of family-centered values into the unit’s
standards and policies
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Family-Centered care is an ongoing journey.