5/16/16. In our time together... PFCC Will Take Leadership at Every Level

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1 Advancing the Practice of Patient- and Family-Centered Care: The Roles of Leaders Beverley H. Johnson, IPFCC President/CEO Wisconsin Hospital Association May 20, 2016 In our time together... u Discuss the essential roles of leaders in advancing the practice of patient- and family-centered care. u Describe ways to link patient- and family-centered care to organizational annual operational plan, strategic plan, and other strategic priorities. u Discuss the infrastructure necessary to support and sustain effective partnerships with patients and families as core strategies to achieve key business metrics. PFCC Will Take Leadership at Every Level u Not an if but a when and how discussion. u It s a system to be designed and achieved. u It s a gift to be given. u It s a right to be realized. Source: Jim Conway, Senior Fellow, Institute for Healthcare Improvement 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 1

2 Pa#ent- and Family-Centered Care at UAMS Pa#ent- and Family-Centered Care at UAMS x A Conversation with Leaders... What are your thoughts and questions about effective leaders advancing the practice of patientand family-centered care? A video from the National Partnership for Women & Families The Role of What are the Best Practices of Effective Leaders? u Believe that the experience of care matters to quality, safety, achieving the best outcomes, and to fiscal performance of the hospital and each clinical area. u Communicate the vision for patient- and familycentered care and how it links to quality, safety, and the best outcomes consistently and clearly. u Communicate this vision in specific clinical areas, throughout the hospital, and to the community. 2

3 Developing Patient- and Family-Centered Vision, Mission, and Philosophy of Care Statements Hospital leadership created the expectation that each HAC committee include a PFA. u Formal PFCC Policy and Video FCC Coordinators do the following: u Recruit PFA with skills, interest, and experience relevant to committee s area of focus. u Partner with the staff champion to mentor PFA. u Provide training for staff champion and PFA. u Accompany PFA to first meetings. Built on a foundation of trust from working with parents on staff. Adapted from DeeJo Miller and Sheryl Chadwick, Coordinators for Family-Centered Care Patient/Family Advisors on Committees Patient/Family Advisors on Committees Parents on staff started PFCC Policy Implemented The Power of the Parent in the Clinic Patient Satisfaction Results Q Q Q Q Score 73.2% 84% 88.4% 96.3% N Size Children's Mercy. All Rights Reserved. 09/ Children's Mercy. All Rights Reserved. 09/13 Organization of PFACs and Other Committees. u Appoint a staff liaison to encourage and support the partnerships with patients and families, an individual with strong facilitation skills and access to organizational leaders. 3

4 The Role of The Role of u Conduct leadership and safety rounds regularly throughout the health care organization. u Include a patient or family advisor who is prepared for their role on the rounding team. u Ensure that there is a comprehensive educational plan in place for patient- and family-centered practice. u Support staff and physicians for change in practice, but also hold them accountable for their behaviors. The Role of The Role of u Include advancing the practice of patient- and familycentered care in the organization's strategic plan. u Create safe places to talk about difficult issues. u Expect each department to have a goal to advance the practice of patient- and family-centered care; track, measure, and reward change and improvement. u Convey that patient and family advisors are to be part of developing the goal, and implementing and evaluating change and improvement. u Support and encourage these partnerships with patients and families and remove the barriers. Patient- and Family-Centered Care Annual Aims u This community hospital began its patient- and familycentered journey in u The COO-CNO served as the initial Executive Sponsor. u The organization sets annual goals for patient- and familycentered care. u In 2010, the annual goals were to begin to partner with patient and family advisors and to change the concept of families as visitors. u Today the hospital has a Patient and Family Advisory Council with members AND over 90 active advisors. u The CNO, CMO, and COO attend Council meetings. u The hospital was recognized as the best hospital in the region by Washingtonian Magazine in u FY 11 o PFAs o Family Presence u FY 12 o Bedside Shift Report o E-access to My Chart for inpatients u FY13 o Palliative Care o E-access to My Chart for ED and outpatients u FY14 o Peer to Peer Mentoring o Interdisciplinary Bedside Rounds u FY15 o IHI Conversation Project o Interdisciplinary Bedside Rounds u FY16 o My Chart access, useability o Patient Education, standard work 4

5 Patient and Family Advisors, Peace Health Medical Group, Eugene, OR Patient Satisfaction 10th to above 90th percentile. Organization Chart refers specifically to the Patient Advisory Council and its reporting relationships The DVD Divas the inspiration for a patient safety video: Your Safety Your Medications Your Medical Visit The Role of u Ensure that behavioral expectations for patientand family-centered practice and partnerships with patients and families are integrated in all phases of human resources management. u Ensure accountability through reflective practice, performance evaluation, and other support. Position Descriptions Traditional Practice The nurse develops, implements, and evaluates the plan of care. Patient- and Family-Centered Practice With the patient, family, and colleagues from other disciplines, the nurse develops, implements, and evaluates the plan of care. Changing all Aspects of Personnel Policies and Practices u Recruiting u Hiring u Orientation u Continuing Education u Have an openness to new ideas a can do attitude. u Set the tone for transformational change u Position Descriptions u Performance Appraisal u Support u Recognition... Encourage risk-taking. 5

6 Oregon Progression of Patient and Family Involvement Track and measure collaboration and change PMG s Director for Education attended PFCC seminar and realized dedicated staff time was essential to building effective, sustained partnerships. PFCC program coordinator was hired. After Visit Summary Subcommittee ü 5 monthly 2-hour meetings ü 7 Patient & Family Advisors, ü Sr. Regional Medical Director, ü Health Educator, Provider Educator ü Program Coordinator ü AVS Data collected for baseline ü Poster created ü Communication plan developed As a Result Three months later, Patient and Family Advisors presented to leadership, clinic managers, and medical directors: The increase in the use of after visit summary increased by 29.29%. This is remarkable work! It shows the power of engaging our patients in quality improvement work as partners. Dr. Ben LeBlanc, CMO Orthopaedics and Spine Hospital u Patient and family advisors participated in facility design planning AND in the design of care processes for the new hospital. u Patient satisfaction has not been below the 96th percentile since the hospital opened three years ago. u The length of stay is one day shorter than benchmarked specialty hospitals across U.S. Contra Costa Regional Medical Center and Health Centers, Martinez, CA Contra Costa Regional Medical Center and Health Centers held a value stream mapping event to improve behavioral health emergency care involving patient and family advisors, community providers, and Medical Center staff. u Reduction by 50% in average number of psychiatric patients who left ED prior to receiving care. u Saved 255 staff hours per month spent on obtaining patient medical clearances in the ED. u Reduction in assaults/aggressive acts reported in the ED. u The percent of patients going back into the community with a full discharge plan has gone from 50% to 90%. u The percent of patients being discharged on multiple psychotropic drugs has been reduced. 6

7 Contra Costa Regional Medical Center and Health Centers, Martinez, CA " " Patients and families influenced the entire process... "There was a prevailing concern that bringing patients and families into the room would change the conversations. This is true; it has changed the conversations for the better, a centering force that grounds us in reality. We are engaging in discussions that were out of reach for our organization previously. Anna Roth, CEO PATIENT AND FAMILY ADVISORS 00 advisors and hours and name of Patient and Family Advisory Councils (PFACs) 00 Committees/teams with advisors Committee name(s) 00 Partnership Oversight Committee Meetings 00 Staff/clinicians involved with collaborative endeavors Issues or types of issues addressed/resolved: Media Coverage: PHYSICIAN SURVEY AND RETENTION RATE The Happy Helpful Hospital is committed to patient- and family-centered care at all levels of the organization. Partnering with patients and families and engaging them in care planning and decisionmaking leads to better clinical outcomes and more efficient use of health care resources. Involving patient and family advisors as part of improvement teams and in program development is beneficial. Retention Rate Retention Rate Happy Helpful Hospital Pa/ent- and Family-Centered Care Dashboard December 2014 PATIENT/FAMILY PERCEPTIONS OF CARE (HCAHPS and Custom Questions Survey) STAFF SURVEY AND RETENTION RATE The Happy Helpful Hospital is committed to patient- and family-centered care at all levels of the organization. Partnering with patients and families and engaging them in care planning and decisionmaking leads to better clinical outcomes and more efficient use of health care resources. Involving patient and family advisors as part of improvement teams and in program development is beneficial. How oaen did nurses listen carefully to you? How oaen did nurses explain things in a way you could understand? How oaen did doctors listen carefully to you? How oaen did doctors explain things in a way you could understand? Degree to which pa#ent and family were able to par#cipate in decisions about your care. How well staff explained their roles in your care. Degree to which the staff involved/supported your family in planning and managing care. Degree to which your choices were respected to have family members/ support persons with you during your care. Pa#ent preferences included in transi#on planning. Before leaving hospital, pa#ent understands his/her responsibili#es for managing his/her health. Pa#ent understands purposes of medica#ons. PFCC SELF-ASSESSMENT ONLINE SURVEY University of Michigan Health System Quality Measures Using the STEEEP Framework, health care should be patient-centered: u Patients' ratings of care. u Patient complaint and commendation trends. u % compliance with advance directives. u Health Education Resource Center statistics. u # of patients and family members on health system committees and advisory groups. u Interpreter services: # of requests. # of languages provided. Strong, et al. (2009). The Joint Commission Journal on Quality and Safety. Expect a PFAC written annual report and create opportunities for this report to be shared inperson with senior leaders and board members and distribute broadly to the community. Chatham-Kent Health Alliance Chatham, Ontario Celebrate Successes and the Progress of Partnerships CEO participating in the Annual Celebration of patient and family advisors, their work, and their annual report 7

8 Leadership Development Building Leadership Commitment Invest in education and leadership development opportunities about PFCC and how to link partnerships with patients and families with health promotion, quality, safety, experience of care, efficiency, building workforce capacity, and other strategic initiatives. Learn from peers in exemplar organizations. Learning in a variety of ways Changing the Culture of Organizations... Sharing of Ideas and Questions A Journey, not a Destination Leadership is Key to Creating Effective Partnerships with Patients and Families in Direct Care and at the Organizational Level 8