Is Your Health Care System Conversation Ready?

Transcription

1 December 10, :30-2:45 PM ET Is Your Health Care System Conversation Ready? IHI Forum: Workshop C20 Christina Gunther- Murphy and Kelly McCutcheon Adams, IHI Directors Disclosures 2 Christina Gunther-Murphy and Kelly McCutcheon Adams are employees of the Institute for Healthcare Improvement. 1

2 This workshop Since The Conversation Project aims for individuals end of life wishes to be expressed and respected, there is a recognition that our health care system must be prepared to receive an activated public and to fully respect end-oflife wishes. This session will outline what it means to be Conversation Ready and include practical strategies from individuals in the field working to meet these ambitious aims. 3 Agenda History of The Conversation Project and Conversation Ready Christina Gunther-Murphy Current Conversation Ready Principles Kelly McCutcheon Adams Pioneer Sponsor: Beth Israel Deaconess Medical Center Jennie Greene and Lauge Sokol-Hessner Pioneer Sponsor: North-Shore Long Island Jewish Mark Jarrett Pioneer Sponsor: Henry Ford Health System Sue Craft Q&A Phase 2 of Conversation Ready Kelly McCutcheon Adams 2

3 5 The Conversation Project Social Change 6 3

4 The Gap 90% of people think it is important to talk about their loved ones and their own wishes for end-of-life care. 27% of people have discussed what they or their family wants when it comes to end-of-life care. Source: The Conversation Project National Survey (2013) What Is The Conversation Project? National media campaign to support having all people s wishes for end of life care expressed and respected Uses social and traditional media Website and tools to help people get started Working with employers, hospitals, faith-based groups Change culture around end-of-life conversations in America (and beyond) 4

5 9 Our Goal The goal of The Conversation Project is to ensure that everyone s wishes for end-of-life care are expressed and respected. 5

6 Conversation Ready Perspective From the Field "When you talk about dealing with people who are nearing the end of their life and their family members, the work that we do stays with them forever. It's the same way that people tell stories about the birth of their children, they also tell stories about the death of a loved one. And I just feel like you have one chance to do it right, and if we can work harder and harder to get it right on each patient and family, then that's what we have to do. People in the hospital recognize that, even people who may not like working with patients at the end of their life, they understand that when that's their task they have one chance and they need to get it right that time. That's important." Julie Knopp, NP, Palliative Care, Beth Israel Deaconess Medical Center 6

7 Conversation Ready IHI is working with leading health care organizations in the US and internationally to ensure the health care delivery system is prepared to receive, record, and respect patients wishes The Pioneer Sponsor year spanned from October 1, 2012 to September 30, 2013 Pioneers collaborated with IHI to design and test the Conversation Ready principles for use in their own systems and for possible adoption across the US and internationally Now we are ready for Phase 2 Pioneer Sponsors Beth Israel Deaconess Medical Center (Massachusetts) Care New England Health System (Rhode Island) Contra Costa Regional Medical Center (California) Henry Ford Health System (Michigan) Mercy Health (Ohio) North Shore Long Island Jewish Health System (New York) St Charles Health System (Oregon) UPMC (Pennsylvania) Virginia Mason Medical Center (Washington) Contributing Sponsor: Gundersen Lutheran 7

8 Current Conversation Ready Principles 1. Engage with our patients and families to understand what matters most to them at the end of life 2. Steward this information as reliably as we do allergy information 3. Partner with our patients to develop appropriate goals of care 4. Exemplify this work in our own lives so that we understand the benefits and challenges 5. Connect in a manner that is culturally and individually respectful of each patient Engage Steward Partner Exemplify Connect Examples from the Field 1. Engage with our patients and families to understand what matters most to them at the end of life: St Charles Heart Failure University Mercy and Contra Costa Primary Care appointments 8

9 Examples from the Field 2. Steward this information as reliably as we do allergy information Virginia Mason Advance Directive Note Type BIDMC IT revision NSLIJ MOLST work with skilled nursing facilities Examples From the Field 3. Partner with our patients to develop appropriate goals of care Care NE Conversation Nurse UPMC Partners Program 9

10 Examples From the Field 4. Exemplify this work in our own lives so that we understand the benefits and challenges UPMC Day of Conversation Mercy Employee Focus Groups BIDMC Talk Turkey and Story database Examples From the Field 5. Connect in a manner that is culturally and individually respectful of each patient Henry Ford faith community summit Contra Costa medical interpreters 10

11 Conversation Ready Jennifer Greene, MS Project Manager Communications Manager Department of Medicine Lauge Sokol-Hessner, MD Project Leader Attending Hospitalist Instructor in Medicine Associate Director of Inpatient Quality Key Changes Building the infrastructure for large-scale culture change Stories Metrics Champions, Change Agents, Conversation Coaches Information Technology Frameworks, Training and Documentation MOLST 11

12 Key Lessons Learn from and leverage existing structures, programs and leaders Focus on and include patients from the start Shape a vision that sticks and keep sharing it ( Four Rs Reach, Record, Retrieve, Respect) Craft tools that help others change Data for learning, not judgment Information technology support Conversation Ready North Shore-LIJ Health System Mark P. Jarrett, M.D., MBA Chief Quality Officer NSLIJHS Institute for Clinical Excellence & Quality 12

13 Key Lessons We learned the following: As a community we are not prepared to have the Conversation this includes patients, families, and health care workers The local healthcare environment is not conducive to having the conversation we talk about how much care not the right care Can change this situation but need to catalog all of the barriers and figure out how to fix them ONE at a TIME in each site of care Institute for Clinical Excellence & Quality Key Changes First step is to find a few champions especially a Nurse and Physician who are senior and seen as respected clinicians. Others, such as Social Workers, are obvious champions, but may not sway the docs. Engaging families early on Examine the whole workflow process looking for the easiest places to succeed need a few winners to develop momentum. Plan is to form focus groups, inform them of our goals and ask them to come up with triggers, documentation, and measures to test. Institute for Clinical Excellence & Quality 13

14 Sue Craft, MSA, BSN, RN Director, Care Coordination Initiatives Key Changes Tested Engage frontline staff to identify challenges and barriers: Employee focus groups. Woodhaven Clinic Process Test: Passive to Active process for engaging patients. No impact on workflow - positive influence on employee perception of no time to do this work (barrier). Leverage electronic health record to provide easy access and standardized documentation Multidisciplinary team designed & tested documentation approaches within Epic EHR environment. Now in monitoring, tweaking phase. Engage community partners, i.e. post-acute care partners and faith leaders Teams formed, learning cycles in progress Faith leader/health care provider conference scheduled 14

15 Key Lessons Learned A necessary first step is to discover, understand and resolve organizational barriers. Engagement, preparation and readiness of our employees will be critical to success. Provide structure to make it easy to do the right thing No one size fits all approach. Many variables influence values and beliefs including culture, religious beliefs, developmental/psychosocial stage, economic status, health status etc., and present challenges that need to be considered. Faith-based community outreach and partnerships is key to help effect change and sustain progress. 30 Questions? 15

16 What Is Next? Conversation Ready Health Care Community: Schedule Nine month learning and innovation community with approximately organizations Schedule: Pre-work: January 2014 Virtual Learning Session 1: February 2014 In-person Learning Session 2: Spring 2014 (Boston dates TBD) Virtual Learning Session 3: October 2014 Ongoing support through faculty, listserv, extranet, change package, measurement strategy 16

17 What Participants Can Expect Participation in a vigorous and innovative learning community Coaching to accelerate rapid-cycle testing of the change package Peer-to-peer learning with colleagues around the country (and hopefully around the world) Teaching from expert faculty Expectations of Sites Committed Senior leadership support Dedicated project team able to test at the frontline IT representation on team Commitment to join one in-person (in Boston in the spring of 2014) and two virtual Learning Sessions Participation in monthly calls Data sharing Program Fee: $12,000 plus travel to in-person meeting 17

18 How to Learn More oratives/conversationreadycommunity/pages/default.a spx Call or Kelly McCutcheon Adams, LICSW, Director, IHI Ph: