Transcript Promoting Patient and Staff Interactions at the Facility Level

Fostering Partnership at the
Facility Level
Patient and Staff
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Aims:

Build sustainable partnerships among facility staff, patients
and the families/caregivers.

Change minds…there is always room for improvement.
Go beyond the norm!
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Become a patient and staff liaison.

Foster Communication.
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Can you
hear me?
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Patient-Centered Care: Definitions
 Patient-centered care is a model in which providers partner with
patients and their families to identify and satisfy the full range of
patient needs and preferences, while simultaneously supporting
the professional and personal aspirations of their staff. http://www.patientcenteredcare.org/inside/abouttheguide.html
 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 health care providers,
patients, and families. It redefines the relationships in health care.
http://www.ipfcc.org/faq.html
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Patient-Centered Care: Definitions
 Patient-centered care supports active involvement of patients and their
families in the design of new care models and in decision-making
about individual options for treatment. The IOM (Institute of
Medicine) defines patient-centered care as: "Providing care that is
respectful of and responsive to individual patient preferences, needs,
and values, and ensuring that patient values guide all clinical
decisions." [1] Institute on Medicine "Crossing the Quality Chasm: A New Health System for the 21st Century".
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Patient-Centered Care: Definitions
 Patient-centered care is also one of the overarching goals of
health advocacy, in addition to safer medical systems, and greater
patient involvement in healthcare delivery and design.[2] …. care
that is truly patient-centered cannot be achieved without active
patient engagement at every level of care design and
implementation. Institute on Medicine "Crossing the Quality Chasm: A New Health System for the 21st
Century".
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Where to begin:
Creating a level of (patient) integration requires important preliminary work
within the organization.
 There must be a shared understanding of the critical components of
patient-centered care.
 There must be strong advocacy for the concept at the highest levels of the
administrative leadership team.
 And there must be in place a strong, interdisciplinary
work team, for it is premature to think about integrating
patients and families into a team if the underpinnings
of effective teamwork are not yet in place.
Ponte PR, Conlin G, Conway JB, Grant S, Medeiros C, Nies J, Shulman L, Branowicki P, Conley K. Making
Patient-Centered Care Come Alive: Achieving Full Integration of the Patient's Perspective; 2003
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We cannot solve our
problems with the same
thinking we used when
we created them.
- Albert Einstein
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Patient & Staff
Partnership
We are a team!
 Anyone at the unit may rise to the challenge and spearhead the role of
building these valuable partnerships.
 Working with patients and families in a “patient and family-centered”
manner is not new from what you already do.
 Every staff member at the facility supports and influences the care
and services patients receive.
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Changing Minds
Times have changed.
Pre- patient engagement:
“A patient’s interests were best judged by the patient’s doctor. That was part of
what a doctor did. Patients knew nothing of clinical matters. How could they
be expected to decide what was good for them?”
Post- patient engagement:
“A better educated population, exposed through a variety of media to the idea
of choice and impressed by the language of rights, began to see themselves
differently. They were no longer passive receivers of goods and services,
grateful for whatever came their way, but consumers with choices who were
entitled to expect good quality and to complain if they were not satisfied.”
BMJ-Kennedy, I. Patients are experts in their own field: The interests of patients and healthcare professionals are intertwined; 2003
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Who is best to judge a patient's interests?
Two bodies of knowledge:
Just as the doctor is an expert in clinical matters, the patient is an expert in
his/her personal experiences, feelings, fears, hopes, and desires.
Both the Doctor and Patients are the experts!
Caring for a patient requires both parties to recognize and respect the other’s
area of expertise.
“Together they can pool their knowledge and choose the way forward.
The language of partnership becomes the currency—not a swing of the
pendulum from doctor power to patient power but a relationship of
interactive partnership.”
BMJ-Kennedy, I. Patients are experts in their own field: The interests of patients and healthcare professionals are intertwined; 2003
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Emphasis:
Let’s not confuse autonomy and motivation of the patient with freedom to let the
patient do whatever he/she wants without regard to the rules of the unit.
It is a collaboration!
 Patient and family-centered interaction means working "with" the patients and
families, instead of doing "to" or "for" them.
Without the patient there wouldn’t be anything to talk about!
 Learn from them.
 Listen to their valuable information and use it to improve outcomes.
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Patient & Staff Liaison
The contact or connection maintained by communications within
parties of an organization in order to ensure action, cooperation,
and engagement.
 Often times the Social Worker represents this role at the unit.
But anyone may rise to the challenge and spearhead this role!
 This person supports and facilitates the activities of the unit that
impact the care and services patients receive.
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Ask Yourself!
 What motivates me to invite patients and families to join in
improving quality and patient participation?
 What is it about my unit - its mission, vision, values, staff and
administrators that supports patient and family partnerships?
 How do I envision my patients and families’ active and
sustained participation benefiting/adding value to
the operations of the unit?
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Working Together
 Identify patients that represent your unit’s population (maybe one or
two from every shift).
 Develop clear roles for their support.
 Recognize the areas in your unit where these patients’ inputs and
recommendations will be valuable.
 Invite one or two at a time to attend meetings and allow them to share
their opinions/findings.
Collaboration instills a sense of belonging and responsibility
towards the unit.
Provide patients with the opportunity to make a difference!
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Example of Patients’ Roles
 Serving on a Patient and Family Advisory Council.
 Creating and/or reviewing educational and outreach materials.
 Assist in making patient entrances/waiting room more
welcoming.
 Advise staff on how to improve Clinical Quality Project results.
 Advise on improving patient safety, and experience of care at
the unit.
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Example of Patients’ Roles
(cont.)
 Become peer mentors, educators or coaches to other patients.
 Developing a Quarterly Unit Newsletter.
 Collect concerns from other patients and share them at Quality
Improvement meetings.
 Help develop a Patient/Family Resource Center (Collect and
disseminate family education – resource library).
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What not to do…
 Allowing patients to decide how much weight they want off
during treatment time, and/or decide how long they should be
on dialysis.
 Allowing patients to shut off alarms on dialysis machines.
 Fail to communicate with patients when there are changes at the
facility.
 Fail to invite patients to their Plan of Care meetings or fail to
give them options to be active participants.
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Realizing the Benefits
It has been proven that patients who become active participants in
their care will be more inclined and motivated to assume
responsibility for managing their own health.
Some of the benefits are:
 Better health outcomes for the patient & lower healthcare costs.
 Increased patient collaboration.
 Increased patient satisfaction with their care.
 Patients are more involved and willing to learn.
 Easement of conflict.
 Ultimately, it means better performance results for the unit.
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“Fostering Communication”
Your Key to Overcoming
Patient and Staff Engagement Barriers
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 Communicating effectively with patients and families is a
cornerstone of providing quality health care.
 Patients who understand their providers are more likely to
accept their health problems, understand their treatment
options, modify their behavior and adhere to follow-up
instructions.
 Patient surveys have demonstrated when communication is
lacking, it is palpably felt and can lead to patients feeling
increased anxiety, vulnerability and powerlessness.
PATIENT-CENTERED CARE IMPROVEMENT GUIDE - VII.A. COMMUNICATING EFFECTIVELY WITH PATIENTS AND FAMILIES © 2008 by Planetree (www.planetree.org) and Picker Institute
(www.pickerinstitute.org). PRACTICAL APPROACHES FOR BUILDING A PATIENT-CENTERED CULTURE
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The Patients’ Perspective:
 “I like it when staff let me know what they are doing when
providing care.”
 “When the machine’s alarms go off it would be nice to know
what happened.”
 “If my facility had a suggestion box I would be more open to
voicing my opinion.”
 “Use layman’s terms when talking to me about my care. I don’t
understand all the medical terms staff use.”
 “I don’t want to bother the staff with my silly questions, they
seem too busy.”
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Fostering patient relationships through “enhanced
communications strategies”
 One-on-one interactions with patients have demonstrated the
profound difference between communicating to patients and
families and communicating with them.
 Identify ways to humanize and personalize even the most routine
interactions with patients.
 Optimal patient and family communication is about conveying a
message and establishing a connection. As caregivers, our
intentions for communication are rooted in our desire to help,
support and provide care.
PATIENT-CENTERED CARE IMPROVEMENT GUIDE - VII.A. COMMUNICATING EFFECTIVELY WITH PATIENTS AND FAMILIES © 2008 by Planetree (www.planetree.org) and Picker Institute
(www.pickerinstitute.org). PRACTICAL APPROACHES FOR BUILDING A PATIENT-CENTERED CULTURE
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Special care and sensitivity is also in order when communicating with
a patient or family member who has a complaint about their care.
Example:
The Cleveland Clinic uses the acronym H.E.A.R.T. to describe how
staff members are expected to respond to patient and family
complaints and/or concerns:
Hear the Story – “Listen attentively”
Empathize – “I can hear/see that you are upset.”
Apologize – “I’m sorry that you were disappointed”
Respond to the problem – “What can I do to help you?”
Thank them – “Thank you for taking the time to talk with me
about this.”
PATIENT-CENTERED CARE IMPROVEMENT GUIDE - VII.A. COMMUNICATING EFFECTIVELY WITH PATIENTS AND FAMILIES © 2008 by Planetree (www.planetree.org) and Picker Institute
(www.pickerinstitute.org). PRACTICAL APPROACHES FOR BUILDING A PATIENT-CENTERED CULTURE
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Many times we hear or say the expression
“that’s just the way it is”
and keep moving on without effecting change.
Let’s Change that State of Mind!
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HELPFUL KEY COMMUNICATION PHRASES
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No, or I can’t
I don’t know
That’s not my job
You’re right, this stinks
That’s not my fault
We’re short staffed
Calm down
I’m busy right now
I’ll tell you how to go there
I can’t release any information to
you
- What I can do is….
- I’ll find out for you.
- I’ll get someone to help you.
- I understand your concerns.
- Let’s see what we can do about this.
- Tell me how I can help you.
- I am sorry you feel…
- I’ll be with you in just a moment.
- I’ll take you where you need to go.
- As I am sure you understand,
patient privacy is very important.
Let me check with the patient first.
PATIENT-CENTERED CARE IMPROVEMENT GUIDE - VII.A. COMMUNICATING EFFECTIVELY WITH PATIENTS AND FAMILIES © 2008 by Planetree (www.planetree.org) and Picker Institute
(www.pickerinstitute.org). PRACTICAL APPROACHES FOR BUILDING A PATIENT-CENTERED CULTURE
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What is your vision?
 What would you do if you had the proverbial
“magic wand” and could change things in an instant?
Don’t reject any idea as too crazy or unrealistic!
Don’t let your expectations become influenced and
entwined with barriers.
(Don’t use the “I can’t achieve this because…” statement)
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Remember
 You support and facilitate the level of patient’ involvement at
your facility.
 Showing respect and dignity will increase patients’ level of
participation, and collaboration!
When engaged…
Patients and families will assist your facility in making changes for
the better!
“You must help guide them and keep them focused on what is
truly important…their health”
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Thank you!
Contact Information
Telephone: (609)490-0310 ♦ Fax: (609)490-0835
Toll Free Number: 1-888-877-8400 ♦ www.qirn3.org
109 South Main St, Suite 21
Cranbury, NJ 08512
Please email or dial ext. 2431 with questions to:
Yessi Cubillo [email protected]
The analyses upon which this publication is based were performed under Contract Number HHSM-500-2013-NW003C, entitled “End Stage Renal Disease Network Organization Number 3”,
sponsored by the Centers for Medicare & Medicaid Services, Department of Health and Human Services. The conclusions and opinions expressed, and methods used herein are those of the
author. They do not necessarily reflect CMS policy. The author assumes full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the
Health Care Quality Improvement Program initiated by CMS, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore
required no special funding on the part of this contractor. Ideas and contributions to the author concerning experience in engaging with issues presented are welcomed.
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