What is Patient- and Family- Centered Care?

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1 Patient- and Family-Centered Care: Partnerships for Quality and Safety A Perspective from North America Beverley H. Johnson Improving Together: Consumers, Clinicians, and Services Quality Forum Auckland and Christchurch, New Zealand October 4, 2011 Our time together... Define core concepts of patient- and family-centered care. Discuss emerging best practices in patient- and familycentered care and for creating partnerships with patients and families in clinical care and decisionmaking and in health care redesign and improvement. Describe ways organizational leaders and partient and family leaders can advance the practice of patient- and family-centered care and enhance quality, safety, and the experience of care within regions and organizations within New Zealand. What is Patient- and Family- Centered Care? System-Centered Care Patient-Focused Care 1

2 Family-Focused Care Patient- and Family-Centered Core Concepts People are treated with respect and dignity. Health care providers communicate and share complete and unbiased information with patients and families in ways that are affirming and useful. Patients and families are encouraged and supported in participating in care and decision-making at the level they choose. Collaboration among patients, families, and providers occurs in policy and program development and professional education, as well as in the delivery of care. Patient- and family-centered care is working with patients and families, rather than just doing to or for them. Facts bring us to knowledge, Stories bring us to wisdom. Rachel Remen Mame s Story A vibrant, dynamic 94-year old breaks her left shoulder, left hip, and right hand on February 18th. This bilateral involvement imposes total dependence for 5 weeks. Mame s Story (cont d) Every person except one in the community hospital introduces themselves upon entering her room. No signs about visiting hours. The patient room has a family bed that functions as a bed, a desk, and a dining room table. The transition to the rehab hospital... When requested, the discharge summary is provided to the family... the nurse asks the family to help in its completion. 2

3 Mame s Story (cont d) When a list of medications is requested, the nurse prints out the list and offers an explanation for how the list is organized. Therapists connected with Mame s goals and priorities and with her as a person. Excellent teachers and included the family. Mame s Story (cont d) Opportunities for Improvement Discharge date set on a day impossible for family to help with transition to home. No flexibility to include the family in the rounds discussion with the physician. Discharge instructions given at the moment of discharge to Mame with the nurse s back turned to the family member and blocking the view of the medication list. Two different medication lists provided, neither consistent with Mame s list upon admission or the bottles at home. Mame s Story (cont d) Patients and Families as Advisors Mame... celebrating her 95th birthday with some of her great grandchildren on July 7, 2008, watching football at 96 with family November, 2009, and hugging some of the newest great grandchildren in 2011 at the age of 98. Learning about the patient s and family s experience... Focus groups and surveys are not enough! Hospitals, health systems, primary care practices, and other ambulatory settings must create a variety of ways for patients and families to serve as advisors. A Key Lever for Leaders... Putting Patients and Families on the Improvement Team In a growing number of instances where truly stunning levels of improvement have been achieved... Leaders of these organizations often cite putting patients and families in a position of real power and influence, using their wisdom and experience to redesign and improve care systems as being the single most powerful transformational change in their history. Reinertsen, J. L., Bisagnano, M., & Pugh, M. D. Seven Leadership Leverage Points for Organization-Level Improvement in Health Care, 2 nd Edition, IHI Innovation Series, Available at 3

4 Patient and Family Advisors, Peace Health Medical Group, Eugene, OR The DVD Divas the inspiration for a patient safety video: Your Safety Your Medications Your Medical Visit Integrating Patient- and Family-Centered Concepts into the Infrastructure of Health Care Organizations Vision/Values Facility Design Patterns of Care Information Sharing Family Support Charting/Documentation Linkages to Community Quality Improvement Human Resources Professional Education United States Commitment to Advancing the Practice of Patientand Family-Centered Care - At the National Level - At the Organizational Level Measurement Surgeon General C. Everett Koop 4

5 1988 The Maternal and Child Health Bureau and later the HIV/AIDS Bureau... Collaborating with women affected or infected with HIV and their families to build the system of care s: Maternal and Child Health Bureau Leadership Integrating family-centered care in the expansion of emergency services for children. Laying the Groundwork for Change... Institute of Medicine Why Patient- AND Family-Centered Care? Social isolation is a risk factor. The majority of patients have some connection to family or natural support. Individuals, who are most dependent on hospital care, are most dependent on families The very young; The very old; and Those with chronic conditions. American Hospital Association AHA McKesson Quest for Quality Prize AHA has developed leadership strategies to make the six aims of the Institute of Medicine s Report a reality in hospitals. AHA distributed a Patient- and Family-Centered Toolkit to the CEO of every U.S. Hospital and the Commanding Officer of every military hospital. Patients/pt-family-centered-care.html... integrating patientand family-centered care with quality and safety agendas. 5

6 Agency for Healthcare Research and Quality (AHRQ) A 3 year contract awarded to a team of organizations to develop, evaluate, and implement a Guide to Patient and Family Engagement to promote patient and family engagement in hospital settings. Institutes for Research (AIR); u Institute for Patient- and Family Centered Care (IPFCC); u Consumers Advancing Patient Safety (CAPS); u Joint Commission; and u Health Research and Education Trust (HRET); and u The Carilion Health Clinic. Other organizations contributing to the project include Planetree, the Maryland Patient Safety Center (MPSC), and Aurora Health Care. Transforming Healthcare: A Safety Imperative We envisage patients as essential and respected partners in their own care and in the design and execution of all aspects of healthcare. In this new world of healthcare: Organizations publicly and consistently affirm the centrality of patient- and family-centered care. They seek out patients, listen to them, hear their stories, are open and honest with them, and take action with them.... continued Transforming Healthcare: A Safety Imperative (cont d) The family is respected as part of the care team never visitors in every area of the hospital, including the emergency department and the intensive care unit. Patients share fully in decision-making and are guided on how to self-manage, partner with their clinicians, and develop their own care plans. They are spoken to in a way they can understand and are empowered to be in control of their care. Leape, L., Berwick, D., Clancy, C., & Conway, J., et al. (2009). Transforming healthcare: A safety imperative, BMJ s Quality and Safety in Health Care. Perham Memorial Home, Perham, MN A Profile on Leadership for a Rural Community Hospital and Home Perham Memorial Hospital and Home Perham, Minnesota Partnering with older individuals and families for change in organizational culture, facilities and care processes to improve the quality of life... 6

7 Perham Memorial Home Perham, MN Perham Memorial Home's Community Council...with leaders and resident participation discussing a variety of issues including end-of-life care The emerging data from partnering with residents and families to change organizational culture: Decrease in falls. Weight gain for frail patients. Reductions in negative behaviors. Increases in resident, family, and staff satisfaction. Perham Memorial Hospital Partners in Care Council, Perham, MN Redesigned brochure for prevention of surgical site infections. Serving on Quality and Safety Councils (three members). Signing appreciation letters for staff. Contributing to Pharmacy's new safety strategies presence on inpatient units, reviewing meds daily, and encouraging family presence. Discussing improvements in endof-life care, building on the Perham Home's experience. Partnering in Ambulatory Care Team Up for Health Strategies Comprehensive Approach to Organizational Change. Core Leadership Team. Performance Improvement Team with a Coach. Communications Training for Staff and Physicians. Patient- and Family-Centered Care and Partnerships with Patients and Families. Results Positive trends for patient perception of patient/provider communication, patient- and family-centered care, and self care. Positive trends in clinical and process measures (A1c, LDL, and blood pressure). Improved provider perceptions of the benefits of selfmanagement support. Improvement in organization. of health care delivery. 7

8 NEVHC Preparing and Supporting Patient and Family Advisors A Patient and Family Advisory Council meets monthly. Participation in QI projects for wait times in the lab and the pharmacy refill process. A video storytelling project captures patient and family experience of care. Involvement of advisors in the clinic's patient portal project and in the development of a staff and provider reward and recognition program. An advisor serving as a member of the CMO search committee. Developed a notebook to track progress of the PFA Council. "I want to thank the Council for having me part of this work. When I share information about the changes we are making at the clinic with my family and friends in the community, I feel better about myself as a diabetic trying to manage my condition." Oswalda Davila, Patient Advisor Team Up for Health Humboldt Open Door Clinic Redesigning the clinic s bulletin boards. Helping to improve community resource referrals. Reviewing the telephone system. Developing a patient/ friendly business card for clinic patients. Promoting provider engagement. Patient Advisory Board Team Up for Health Sharp Rees-Stealy Medical Group Patient advisors participate in the communications training with physicians and staff. Recovery Model of Care for Mental Health Services SAMHSA and the Veteran Affairs Standard of Care Applying Patient- and Family-Centered Concepts in Mental Health The Recovery Model 8

9 The Recovery Model... Improving Behavioral Health Medical College of Georgia Augusta, GA A collaboration with the Georgia Department of Human Resources to immerse psychology and psychiatry faculty and residents in the Recovery Model and to learn, teach, and use peer support as a treatment modality. Since 2006, certified peer specialists, patients who have experienced mental illness, have become an integral part of the clinical team, teach psychiatry and psychology trainees, and serve as the liaisons to the Behavior Health Advisory Councils. Certified Peer Specialist, Project GREAT, Medical College of Georgia, Augusta, GA Participate in morning rounds for adult inpatients. Meet individually with inpatients as requested by attending physician teams. Create personalized relapse prevention plans with inpatients. Report outcome of individual inpatient consultations to medical students and residents. Facilitate inpatient and outpatient peer support groups. Distribute weekly Pulse memo about inpatients perceptions of care. Participate in Medical Students Education Committee and Residents Education Committee. Provide operational support to the Behavioral Health Advisory Council (consumers, family members, residents, staff and faculty). MCG Patient Satisfaction Scores " 2006 Inpatient Psychiatry 60 th Percentile 2009 Inpatient Psychiatry 96 th Percentile Outpatient Psychiatry 60 th Percentile 2009 Outpatient Psychiatry 98 th Percentile * Note: Peer Support Specialist was hired and the Behavioral Health Advisory was started in Veterans Health Administration VISN 7 Leadership Training PFCC Coordinators and Steering Committees Introductory PFCC Education Sessions Train-the-Trainer Series Trainers Learning Network Sharing Medication Lists and Daily Plan of Care with Patients and Families James Haley Veterans Hospital, Tampa, FL At the end of the shift on a daily basis, the night nurse prints out the list of medications for the next 24 hours and leaves it with the patient and family, if they are present. The list includes the name of the drug, dosage, times, and how it will be administered. The Daily Plan of Care is now being shared with the patient and family. Cystic Fibrosis Foundation Partnering with patients and families in quality improvement. 9

10 The Province of Saskatchewan Canadian Commitment to Advancing the Practice of Patientand Family-Centered Care - The Province of Saskatchewan - Chatham-Kent Health Alliance, Ontario - Thunder Bay Regional Medical Centre, Ontario - Calgary South Health Campus, Alberta 2007 Commissioned Report Patients First Report Recommendations. Extensive Education Across Province. Health Ministry developed annual, provincial strategic plans Developed patient- and family-centred care framework for the system Strategic plan included expectations for PFCC implementation. Among the expectations is the establishment of a steering committee with patient and family advisors and a 10-year implementation plan for acute and non-acute care settings. Two $10,000 awards for patient- and familycentered innovation. Planned and convened patient-and family-centered education. Chatham-Kent Health Alliance Chatham, Ontario The work began in the Women & Children s Health Program in 2001 with the theme, Birth is a Celebration. As the health system s knowledge and commitment increased, the wording and focus of strategic directions changed: Strategic Direction 2006: Together we will provide safe, quality, patient & family-centred care. Strategic direction : We will provide safe, quality, patient & family-centred care. Strategic Direction: : We will partner with patients and families in the delivery of safe, quality care. Chatham-Kent Health Alliance Chatham, Ontario Chief Nursing Executive/Chief Health Professions Officer serves as Executive Sponsor for PFCC/Service Excellence. Full-time Patient- and Family-Centered Care Coordinator. 13 patient/family advisors serving on the PFCC Steering committee. Patient/family advisors also serve on the following:. u Ethics Committee; u Accessibility Committee; u Medicine Program Council; u ED Quality Council; u Mental Health and Addictions Quality Care Team; and u CCC/Rehab/CDM Quality Council 10

11 Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario Journey began with search for model of care. Vice President & Chief Nursing Executive serves as Executive Sponsor for Patient- and Family-Centered Care. Full-time staff member assigned as Patient- and Family- Centered Care Lead. Governing Board, Senior Leaders, Managers, PFCC staff champions, and patients and families participated in a visioning and education retreat that led to revision of mission, vision, and values. Corporate Commitment Boards signed by Governing Board, Senior Management Team, Medical Advisory Committee (chiefs of all services), staff (in process), and patient and family advisors. What is PATIENT & FAMILY CENTRED CARE? Patient and Family Centred Care (PFCC) is the provision of care that is respectful of, and responsive to individual patient/family preferences, needs and values, and ensures that those values guide all clinical decisions. our VISION To lead world-class patient and family centred care. our MISSION To advance world-class patient and family centred care in an academic and research-based, acute care environment. our VALUES At Thunder Bay Regional Health Sciences Centre, we believe in: Patients and Families being at the centre of everything we do The value of our staff, physicians, volunteers and regional partners Team-based compassionate care Diversity, dignity and respect Helpful and empowering communication Life-long learning, innovation and discovery We will achieve these values by: Creating a caring and welcoming environment Building relations and partnerships based on dignity and respect Sharing information and communicating openly, consistently and clearly Collaborating for safe and accessible care Ensuring continuity of care Fostering a learning environment Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario Senior executives identified the key institutional committees/teams/workgroups where patient and families needed to be placed. 60 patient/family advisors now serve on 77 committees/ teams/workgroups. Patient/family advisors serve on accreditation preparation teams and contributed to selection criteria for new CEO. Engagement, NOD, and Listen are the three core change strategies with assigned metrics. Engagement retreats are being held with each clinical area, bringing senior leaders together, managers, frontline staff and clinicians, and patient and family advisors to develop action plans for two specific initiatives. Calgary, Alberta A family leader appointed Project Manager for Partnerships & Citizen Engagement. She is part of the leadership team preparing for the Campus opening in 2012 and serves as the lead for patient and family centred initiatives and processes at the new health campus, the wellness-related services, demonstration kitchen, community resource centre, retail services, and wayfinding strategies. References and Resources Changing the Culture of an Organization... A Journey, not a Destination Partnering with Patients and Families is Key n Advancing the Practice of Patient- and Family-Centered Primary Care and Other Ambulatory Settings: How to Get Started. Available from: n Advancing the Practice of Patient- and Family-Centered Care: How to Get Started (In Hospitals). Available from: tools/downloads.html n American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, & American Osteopathic Association. (2010, November). Joint principles for accountable care organizations. Available from media/releases/2010b/aco-jointprinciples.html n American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, & American Osteopathic Association. (2007, February). Joint principles of the patient centered medical home. Retrieved from Patient-Centered Primary Care Collaborative: 11

12 n American Hospital Association Committee on Research. (September, 2010). Patient-centered medical home: AHA synthesis report. Chicago, IL: Author. Available from patientcentered/patient-centered.shtml n American Hospital Association, Institute for Family-Centered Care. (2004). Strategies for leadership: Patient and family-centered care. Chicago, IL: American Hospital Association. Washington, DC. Available from Safety/strategies-patientcentered.html n Angood, P., Dingman, J., Foley, M. E., Ford, D., Martins, B., O Regan, P., et al. (2010). Patient and family involvement in contemporary health care. Journal of Patient Safety, 6(1), n Aronson, P. L., Yau, J., Helfaer, M. A., & Morrison, W. (2009). Impact of family presence during pediatric intensive care unit rounds on the family and medical team. Pediatrics, 124(4), n Balik B, Conway J, Zipperer L, Watson J. Achieving an Exceptional Patient and Family Experience of Inpatient Hospital Care. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; Available at: IHI/Results/WhitePapers/ AchievingExceptionalPatientFamilyExperienceHospitalCareWhitePa per.htm n Blaylock, B. L., Ahmann, E., & Johnson, B. H. (2002). Creating patient and family faculty programs. Bethesda, MD: Institute for Family-Centered Care. n Crocker, L., & Johnson, B. (2006). Privileged presence: Personal stories of connections in health care. Boulder, CO: Bull Publishing Company. n Davidson, J. E., Powers, K., Hedayat, K. M., Tieszen, M., Kon, A. A., Shephard, E., et al. (2007). Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American college of critical care medicine task force Critical Care Medicine, 35(2), n Edwards, J. (2010). Memorial Healthcare System: A Public System Focusing on Patient-and Family-Centered Care. Available from the Commonwealth Fund at: Publications/Case-Studies/2010/Jul/Memorial-Healthcare- System.aspx n Epstein, R. M., Fiscella, K., Lesser, C. S., & Strange, K. C. (2010). Why the nation needs a policy push on patient-centered health care. Health Affairs, 29(8), n Gruman, J., & Jeffress, D. (2009). Supporting Patient Engagement in the Patient-Centered Medical Home. Available from: n Homer, C. J., & Baron, R. J. (2010). How to scale up primary care transformation: What we know and what we need to know? Journal of General Internal Medicine, 25(6), n Institute for Patient- and Family-Centered Care: n Johnson, B., Abraham, M., Conway, J., Simmons, L., Edgman- Levitan, S., Sodomka, P., Schlucter, J., & Ford, D. (2008). Partnering with patients and families to design a patient- and family-centered health care system: Recommendations and promising practices. Bethesda, MD: Institute for Family-Centered Care. Available from: n Leape, L., Berwick, D., Clancy, C. Conway, J. Gluck, P., et al. (2009). Transforming healthcare: A safety imperative, Quality and Safety in Health Care, 18, n McGreevey, M. (Ed.) (2006). Patients as Partners, How to Involve Patients and Families in Their Own Care. Oakbrook Terrace, IL: Joint Commission Resources. n McMullan, C., Parker, M., & Sigwart, J. (2009). Developing a unitbased family advocacy board on a pediatric intensive care unit. The Permanente Journal, 13(4), n Muething, S. E., Kotagal, U. R., Schoettker, P. J., Gonzalez del Rey, J., & DeWitt, T. G. (2007). Family-centered bedside rounds: A new approach to patient care and teaching. Pediatrics, 119(4), n National Working Group on Evidence-Based Health Care. (August, 2008). The role of the patient/consumer in establishing a dynamic clinical research continuum: Models of patient/consumer inclusion. Available from n Patient-Centered Medical Home Resource Center home/ 1483 n Peebles, S., Mabe, A., Fenley, G., et al., (2009). Immersing practitioners in the recovery model: An educational program evaluation. Community Mental Health Journal, 45, n Phipps, L. M., Bartke, C. N., Spear, D. A., Jones, L. F., Foerster, C. P., Killian, M. E., et al. (2007). Assessment of parental presence during bedside pediatric intensive care unit rounds: Effect on duration, teaching, and privacy. Pediatric Critical Care Medicine, 8(3), n Reinersten, J. L., Bisognano, M., & Pugh, M. D. (2008). Seven leadership leverage points for organization-level improvement in health care (2 nd ed). Cambridge, MA: Institute for Healthcare Improvement. (Available at n Rosen, P., Stenger, E., Bochkoris, M., Hannon, M. J., & Kwoh, C. K. (2009). Family-centered multidisciplinary rounds enhance the team approach in pediatrics. Pediatrics, 123(4), e603-e608. Available from n Scholle, S.H., Torda, P., Peikes, D., Han, E. & Genevro, J. (2010) Engaging patients and families in the medical home. Rockville, MD: Agency for Healthcare Research and Policy. n Shaller, D. (2008). High Performing Patient- and Family-Centered Academic Medical Centers. Available at n Sodomka, P. (August 2006). Engaging patients and families: A high leverage tool for health care leaders. Hospitals and Health Networks, Available at: n Strong, D. L., Kin, J. M., Kratochwill, E. W., & Typaldos, C. (2008). University of Michigan: Quality and safety in anacademic medical center. The Joint Commission Journal on Quality and Patient Safety, 34(11), a. 12

13 n Uhlig, P. N., Brown, J., Nason, A. K., Camelio, A., & Kendall, E. (2002). System innovation: Concord Hospital. The Joint Commission Journal on Quality Improvement, 28(12), n Webster, P. D., & Johnson, B. H. (2000). Developing and Sustaining a Patient and Family Advisory Council. Bethesda, MD: Institute for Family-Centered Care. n Weingart, S. N., Simchowitz, B., Eng, T. K., Morway, L., Spencer, J., Zhu, J., et al. (2008).The you CAN campaign: Teamwork training for patients and families in ambulatory oncology. The Joint Commission Journal on Quality and Patient Safety, 35(2):63-71 n Weingart, S. N., Cleary, A., Seger, A. Eng, T. K., Saadeh, M., Gross, A., et al. (2007). Medication reconciliation in ambulatory oncology. Joint Commission on Accreditation of Healthcare Organizations, 33 (12): n Weingart, S. N., Price, J., Duncombe, D., Connor, M., Sommer, K., Conley, K. A., et al. (2007). Patient and family involvement: Patientreport safety and quality of care in outpatient oncology. Joint Commission Journal on Quality and Patient Safety, 33(2):