Always Events. Objectives - Overview

Transcription

1 A21/B21 Presenters have nothing to disclose Always Events Making What Matters Real Barbara Balik, Senior Faculty, IHI; Aefina Partners Martha Hayward, Lead for Patient and Public Engagement, IHI Randall Carter, Senior Vice President, Planetree IHI Forum December 2013 Objectives - Overview Tue 9:30 AM - 10:45 AM/ Tue 11:15 AM - 12:30 PM Always Events (AEs) are evidence-based practices that ensure patient and family engagement. In this session, the guiding principles of Always Events will be shared, and participants will be challenged to create an AE for their own setting. OBJECTIVES Describe the guiding principles of Always Events and how they contribute to patient- and family-centered care. Develop a proposed AE outline for their own care setting. 1

2 Always Events Martha Hayward From Patient to Process Understand Patient experience What matters to me Develop Always Event(s) From Intention to Reliable Performance Plan Define Work Process (simplify and standardize) Define Defects and How to Mitigate Do the Work Do Big Picture: Link between Always Events and Reliable Process Performance Integrate Always Event(s) into Work Process(es) Measure and Communicate Study/Act 2

3 Always is so much better than Never Positive Patients experience what is not what is absent Definable, visible, measurable Picker Principles Respect for patients values, preferences and expressed needs Coordination and integration of care Information, communication and education Physical comfort Emotional support and alleviation of fear and anxiety Involvement of family and friends Transition and continuity 3

4 Always Events Criteria Important: Patients and families have identified the experience as fundamental to their care Evidence-based: The experience is known to be related to the optimal care of and respect for patients and families Measurable: The experience is specific enough that it is possible to accurately and reliably determine whether or not it occurs Affordable: The experience can be achieved without substantial capital expense Why Always Events? 8 Raise the bar on both provider and patient expectations Introduce a new organizing principle to help galvanize action and accountability Demonstrate how the AE concept can be implemented in practice Widely disseminate AE strategies for national replication Energize and expand the movement toward a more patient and family centered system 4

5 From Patient to Process Understand Patient experience What matters to me Develop Always Event(s) From Intention to Reliable Performance Plan Define Work Process (simplify and standardize) Define Defects and How to Mitigate Do the Work Do Big Picture: Link between Always Events and Reliable Process Performance Integrate Always Event(s) into Work Process(es) Measure and Communicate Study/Act So What Always Events? An Always Event is a clear, action-oriented, and pervasive practice or set of behaviors that provides the following: A foundation for partnering with patients and their families; Actions that will assure optimal patient experience and improved outcomes; A unifying force for all that demonstrates an ongoing commitment to person- and family-centered care. 5

6 Always Events at IHI Understand what would it take to scale an Always Event Prototype sites leaders who light the way Always means reliability Cultural transformation true partnerships with patients and families Shaping the future Framing what you are doing already Four Key Fundamentals Leadership Engagement Leaders take ownership of defining the purpose and modeling desired behaviors Identify Always Event Identify the Always Event and needed infrastructure for Always Experiences Testing and implementation of the Event Sustain and Spread Always everywhere, every time, everybody 6

7 Culture What is it? The total learned, shared, taken-for-granted assumptions that a group has learned throughout its history; base of daily behavior Deep, broad, stable Schien, Corporate Culture Survival Guide, 1999 Seen in behavior Changed over time by working on behaviors that eventually shift mental models 13 How Culture is Embedded Primary What leaders do, pay attention to, measure and reward on a regular basis How leaders react to critical incidents and organizational crises Deliberate role modeling, teaching and coaching Observed criteria by which leaders allocate rewards and status Observed criteria by which leaders recruit, select, promote, retire and terminate organizational members Secondary Organizational design and structure Organizational systems and procedures Organizational rites and rituals Design of physical space and buildings Stories, legends and myths about people and events Formal statements of organizational philosophy, values and creed E. Schein, Organizational Culture and Leadership,1994 7

8 Adopting Always Behaviors 15 4 factors aid adopting and sustaining new behaviors: Clarity of Purpose understand why I change Competence feel skilled and comfortable in new behavior knowing what and how to do it Contribute involved in determining the new behavior what, how, and when Doing with not Doing to Connected part of a network, feeling known, cared about and supported in learning the new behavior* *Suchman, A, et al Eds. (2011). Leading Change in Healthcare: Transforming Organizations using Complexity, Positive Psychology, and Relationship-Centered Care. London: Radcliffe. Case Study - Always Use Teach-back! 8

9 17 Help Mid-level Managers Coach Honor the current work through observation Understand that change is hard and uncomfortable Resistance to change is natural; comes from fear of change Promote new skill development Build confidence to integrate the new habit into work patterns Build reliability Manage relapses 9

10 UnityPoint: Comparison of health care provider use of teach-back (TB) question* to assess patient understanding of specific self-care activities** during clinical encounters in the hospital, primary care, and home health setting, before and after the Always Use Teach-back! intervention, Iowa, July 2011 June 2012 From Patient to Process Understand Patient experience What matters to me Develop Always Event(s) From Intention to Reliable Performance Plan Define Work Process (simplify and standardize) Define Defects and How to Mitigate Do the Work Do Big Picture: Link between Always Events and Reliable Process Performance Integrate Always Event(s) into Work Process(es) Measure and Communicate Study/Act 10

11 Harvey Picker Center of Innovation and Applied Research in Long Term Care Charting a Course for Long-Term Care to Always be Person-Centered 11

12 Two Visionaries on Parallel Paths Resulting in Lasting Partnership Harvey Picker, Founder, Picker Institute Angelica Thieriot, Founder, Planetree A Shared Vision As a global catalyst and leader, Planetree promotes the development and implementation of innovative models of healthcare that focus on healing and nurturing body, mind and spirit. Picker Institute s mission is to foster a broader understanding of the theoretical and practical changes needed to facilitatea more patient-centered approach to healthcare, with a focus on the concerns of patients and other healthcare consumers. 12

13 Always Events : Creating an Optimal Patient Experience those aspects of the patient and family experience that should always occur when patients interact with healthcare professionals and the delivery system. Harvey Picker Center of Innovation Leadership National Quality Forum Veterans Administration American Health Care Association American Geriatrics Society Institute for Healthcare Improvement Pioneer Network Picker Institute National Hospice and Palliative Care Organization University of British Columbia George Washington University Latrobe University Erickson School of Aging CT Central Senior Services Asbury Communities Orchard View Manor 13

14 Policy Research Practice Person-Centered Long-Term Care Education and Innovative Practices The Harvey Picker Center of Innovation and Applied Research in Long Term Carewill merge knowledge from research, policy and practice to advance development and dissemination of person-centered LTC educational resources and innovative practices Strategies to Advance Person-Centered LTC Identify and disseminate innovative practices in person-centered LTC Annual grants program Elevate the voices of LTC residents, family, and staff for LTC research, policy, and practice stakeholders Voices of Long-Term Care Annual Report Translate and disseminate research literature for meaningful use Semi-annual Literature Brief 14

15 Literature Review JOURNALS Journal of the American Geriatrics Society Journal of the American Medical Directors Association Journal of Applied Gerontology Journal of Aging Studies Health Affairs HSR: Health Services Research Dementia Implementation Science The Gerontologist Key Terms Resident-centered Person-centered Client-centered Relationship-centered Culture change Individualized Personalized 2013 Timeline Milestones Literature & Focus Group Review Voices of LTC & PC LTC Literature Brief Steering Committee Identifies grant topics Request for LOIs & Proposals issued Review Applications by Steering Committee Announce Awards (five $10,000 grants/year) Educational Resources 15

16 Request for Proposal Topics Person-Centered Long-Term Care Leadership & Innovative Practices Submissions 22 LOIs Submitted Australia Canada USA 17 invited to submit full proposals 14 proposals submitted Long Term Care Providers Hospice Providers Nursing Homes / Skilled Nursing Facilities Veterans Administration Community Living Centers University Research Teams University of Southern California University of Maryland University British Columbia 16

17 Review Criteria 1. Contribution to Person-Centeredness 2. Active Stakeholder Engagement 3. Aptness of Research Design 4. Transportability across Long-Term Care 5. Educational Value 6. Leadership Support 7. Team Strength 8. Organizational Stability 9. Fiscal Responsibility 10. Effective Dissemination Plan Scoring of 14 Full Proposals All proposal reviewed by at least two steering committee members and scored Range: Mean: 69 Five Top Scoring Proposals Range: Mean: 80 Criteria 1 Mean: 8.8 Criteria 1 Mean:

18 Empowerment through Physician Orders for Life-Sustaining Training Dr. Jeannine Forrest Project Manager & Nurse Consultant Rainbow Hospice and Palliative Care, Illinois Retrospective Chart Review Following Implementation of Pain Assessment Tools for Care Aides Dr. Elizabeth Andersen, Assistant Professor School of Nursing, University of British Columbia, Okanagan Campus 18

19 Compassionate Care in a Changing Landscape Rod Cartagena, Executive Director Rekai Centres, Toronto Describing and Assessing Leadership for Person-Centered Nursing Home Care Dr. Jane Straker, Senior Research Scholar Scripps Gerontology Center, Miami University, Ohio 19

20 Weaving Person-Centered Leadership Principles into the Fabric of the LTC Community Julie Norko, Director of Development & Philanthropy Central Connecticut Senior Health Services 20

21 Thank you! Please utilize the literature review for research-based practice recommendations Planetree > Resources & Tools > Harvey Picker Center Using Reliability Concepts to Improve Patient Experience Based on presentation created by Joan Grebe, MA, OT, AICF, with help from Gail A. Nielsen 21

22 From Patient to Process Understand Patient experience What matters to me Develop Always Event(s) From Intention to Reliable Performance Plan Define Work Process (simplify and standardize) Define Defects and How to Mitigate Do the Work Do Big Picture: Link between Always Events and Reliable Process Performance Integrate Always Event(s) into Work Process(es) Measure and Communicate Study/Act How Do We Achieve Reliable Processes? Reduce variation (in order to reduce waste and increase value) Simplify and standardize processes Monitor over time 44 If I had to reduce my message for management to just a few words, I d say it all had to do with reducing variation. W. Edwards Deming 22

23 Reliability design strategy The Reliability Design Strategy 46 Set-up for success Success comes from deliberate design strategy and deployment Use the following three step method: 1.Prevent initial failure using intent and standardization 2.Identify defects (using signals & redundancy) then correct/mitigate 3.Measure communicate learning from defects back into the design process 23

24 Reliability Worksheet Process to make reliable: Population of focus: Who is Process Owner/Work Unit Home: High Level Flow Chart Defects List for Each Step Reliability Goal: Organization: Date: Reliability Worksheet Process to make reliable: White board completion Segment of focus: PCU shift change High Level Flow Chart Update CNA, RN, date during AIDET at beginning of bedside shift handoff Review patient plan for today during bedside shift handoff Perform RN assessment Discuss information with patient Complete white board: with plan for today within 2 hours of change of shift Defects List for Each Step Handoff not at bedside No marker Dry marker Perform AIDET but board not updated Patient is sleeping Not clear if OK to wake up patient Not filled by previous shift Patient taken from unit for testing/ procedure Patient confused Not using common language English may not be patient s primary language Other patient s needs Unexpected interruptions Reliability Goal: The required 5/9 RN section elements of the white board will be completed within 2 hours of shift change 95% of the time * Organization: Tuality Healthcare Date: November 9, 2013 *Housekeeper and MD put on name on board, eat/drink (dietician), move (PT)- not required by RN 24

25 The Set Up for Reliability 49 Select a process where the Always Event obviously fits Determine a high volume segment Build a high level flow chart Learn where the defects occur through observation and data Start with something patients are struggling to do or remember, e.g., take medications, weigh daily, call the physician when symptoms occur Begin design work where the most common defects occur or what causes the greatest friction for patients or staff State the reliability goal. e.g. Outcome: every patient or family member can state in his/her own words critical self-care instructions Process: Discharge preparation for patients with CHF; teach-back method used. Gail A. Nielsen Three Step Method for Reliability 1. Prevent initial failure using intent and standardization Build an infrastructure for standardizing your selected process Who: What: With What: When: Where: How: 25

26 Three Step Method for Reliability 2. Identify defects (using redundancy) and mitigate Redundancy Who: What: With What: When: Where: How: Measure: Correction Strategy: Three Step Method for Reliability 3. Measure and then communicate learning from defects back into the design process Review defects Who: What: With What: When: Where: How: Communicate back to design team Who: What: With What: When: Where: How: 26

27 What s Next?! Be a prototype and source of learning! Become an Always Exemplar! Share with us what you are doing and learning Use the How-To Guide and help IHI make it better 27