Transcript Culture Counts: The Senior Executive's Role in Making

The Power of Patient,
Family, Public Engagement
Outline
• Patient / Family Centered Care: A Growing
Expectation
• Patient and Family-Centered Care Defined
• Publicly Verifiable Elements of PFCC
─ How’s your organization doing
• Designing PFCC into the Care and the County
Council
• Business Case: Patient & Family-Centered Care
• The Time Is Now
“I don’t care who you are. I
going to stay with my child.”
Pediatric Mother, 1976
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Patient and Family Centered Care
A Dynamic Push/Pull
Push—Making the Status Quo
Uncomfortable
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Making the Future Attractive
• Organizing the healthcare system
Consumer Movement:
around the patient and family
─ It isn’t ours alone to decide • Optimizing the patient experience
Patient Rights
─ Correlates with other outcomes
Patient Safety:
including staff satisfaction and
─ Voice and face of harm
financial outcomes
─ AHRQ patient reporting
• Patient activation/self management
Transparency
• Great stories and results busting
Health Reform: Politicians,
out all over:
Governments, Nations, States
─ IHI BMJ International Forum
Accreditors
─ Health care organizations
AARP, Consumer Reports
─ Associations
NQF, NPP, Picker, Planetree, • It’s the right thing to do
IFCC, IHI, Lucian Leape
Institute, WHO
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Patient and Family Centered Care
What is it? Per the IOM
• Care based on continuous healing
relationships
• Customized according to patient needs
and values
• Patient is the source of control
• Knowledge is shared and information
flows freely
• Transparency is necessary
• Needs are anticipated
Four Key Concepts of PFCC
• Dignity and respect: Providers listen and honor
patient and family perspectives and choices.
• Information sharing : Providers share complete
and unbiased information in ways that are
affirming and useful.
• Participation: In care and decision-making
• Collaboration: In policy and program
development, implementation and evaluation, as
well as the delivery of care
Institute for Family Centered Care
It is also what clinicians want…
…it is why they went into health care.
…it just isn’t designed into health care.
Patient and Family Centered Care Is…
Person Centered Care Is…
Location
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Examples
Environment Community,
County Council,
Region, State
•Community groups
•Care Coordination, ACOs, Medical Homes
•Advanced care planning, POLST, MOLST
•School & church programs
•Public health & other consumer campaigns
Organization Health System,
Trust, Hospital,
Nursing Home
•Experience Surveys
•P&F Councils, Advisors, Faculty
•Resource Centers, patient portals
•Access to help and care 24/7
•Medication lists
Microsystem
Clinic, Ward,
Unit, ED,
Delivery
•Parent, Advisors, & advisory councils
•Open access, optimized flow
•Family participation in rounding
Experience
of care
Bedside, Exam
Room, Home
•Access to the chart
•Shared care planning
•“Smart Patients Ask Questions”
Publicly Verifiable PFCC
Examples of Current Practice
• Mission, vision,
values
• Leadership,
operations
• Advisors
• Quality improvement
• Personnel selection
• Environment and
design
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• Information and
education
• Charting and
documentation
• Care structures and
support
• Experience of care
How is your organization doing?
What Patient & Family Centered Care
Activities are Underway?
How about public / community?
Discuss for 10 minutes
Provide a few examples.
Leading Edge of Patient and
Family Engagement
Action
Hospital
Patients/Family on Boards or in
Board Committees
DFCI, Medical College of Georgia,
Children’s of Cincinnati
Patient and their Stories Starting
Meetings
Exempla, Children’s Cincinnati,
Delnor, and many more
Patients at Board Retreats
BIDMC, Boston
Board Chair & CEO meeting
patients monthly
Springfield Hospital, Vermont
Inclusion of Patients in Executive
Walk Rounds
Kaiser Permanente
Patients on Advisory Boards
Stoeckle Center, MGH
Trustees and/or Senior Leaders
attending PFACs
Maine Medical Center, Spectrum
PFACs
Dramatic increase
The PFCC Model at Magee Womens
• Joint Replacement Programs
developed through patient and
family shadowing
• Timely feedback and weekly
meetings
• Systems approach: pre-op,
surgery, post- and rehabilitation
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The PFCC Model at Magee Womens
• 91.4% satisfaction excellent
• 99% not limited by pain post op
• 98% received the right
antibiotic at the right time
• 0.3% infection rate in TJR
• Av LOS 2.8 days
• 93% discharged without aid
• 91% discharged directly home
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What’s Getting Rewarded
Around Here!
April, 2008
Business Case: Patient- and
Family-Centered Care
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“Nice but not necessary”
Patient Experience Is Strongly
Correlated With Other Key Outcomes
• Health outcomes
─Patient adherence
─Process of care measures
─Clinical outcomes
• Business outcomes
─Patient loyalty
─Malpractice risk reduction
─Employee satisfaction
─Financial performance
Edgman-Levitan S., Shaller D. et al. The CAHPS Improvement
Guide. Boston: Harvard Medical School: 2003.
Financial Benefits of PatientCentered Care in Planetree
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Reduced length of stay
Lower cost per case
Decreased adverse events
Higher employee retention rates
Reduced operating costs
Decreased malpractice claims
Increased market share
Charmel P, Frampton S. Building the Business Case for Patient Centered
Care. HFM. March, 2008
What About the Challenges?
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We’re already doing a good job!
Clinicians don’t have the time.
Can we get away with doing just one thing?
It’s someone else’s job.
Lots of tokenism; checking the box.
Paternalism. We know best and they don’t do what they
are told.
• It doesn’t work here. “My patients and family members
are too _______ (poor, non-compliant, illiterate, violent.)”
• “My patients don’t want to be engaged.”
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From a policy perspective, the
widespread implementation of policies to
ensure patients’ rights, privacy, and
confidentiality is noteworthy. Patient
involvement in quality improvement
activities, on the other hand, so far
appears to be a more rhetorical exercise
than a practice
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Groene O et al. Is patient-centredness in European hospitals related to existing
quality improvement systems? Analysis of a cross-sectional survey (MARQuIS
Study). Quality & Safety in Health Care, February 2009
The Time Is Now
If health and/or healthcare is on
the table, then the consumer
(public, patient, family member)
must be at the table, every table.
NOW!
Lucian Leape Institute, 2008
PFCC Will Take
Leadership at Every Level
•Not an “if” but a when and how discussion.
•It’s a system to be designed and achieved.
•It’s a gift to be given.
•It’s a right to be realized.
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