Reporting Period: 2014-2016 PFCC Goals Establish effective Patient and Family Advisory Councils in the System Participate in new Security Entry System at the hospital campus Update Mission/Vision/Serve Standards incorporating PFCC Language Staff & PFAC Engagement in PFCC Number of staff attending 4 hour training sessions 1400+ Number of projects PFAC members are involved in 70+ Press Ganey/HCAHPS scores reflect the influence of our many PFCC initiatives Major Accomplishments this Period Created Hospital, Luckow, Homecare, NICU/PEDS, Surgical, Cardiac Surgery, Breast Services, Kierker PFACS for a total of 105+ advisors. Hospital PFAC heavily involved in this project, including badging and entry process designs. Completed. All job descriptions now incorporate the new Serve Standards. 2014 2015 2016 Staff attitude toward visitors (guests) 91.1 91.4 91.9 Safety/Quality Implications 10 9.46 Readmission Rate (30 day) Fall Rate 9 8 8.54 8.51 2014 2015 2016 4 2 2.2 2 1.64 Accommodations & comfort of visitors (guests) 84.5 84.7 85.3 Discharge Information Domain 84.7 85.1 86.2 0 2014 2015 2016
Emerging Data Supporting Change in Culture and Change in Practice
Associations Between PFE Practices and HCAHPS Scores PFE Practice Percentage points of patients rating a hospital 9 or 10 Statistical Significance Patient Access to Information 24/7 access to online patient information portal compared to no 24/7 access 1.8 pts. higher p<.05 Full access to health records in hospital compared to partial or no access 2.0 pts. higher p=.053 High commitment to accommodating lower English literacy compared to moderate or low commitment 1.9 pts. higher p<.05 Patient & Family Inclusiveness 24/7 unrestricted access to patients by family & partner across all units compared to some or no units 3.0 pts higher p<.05 High levels of including patients & families in nurse shiftchange reports compared to moderate or no inclusion 1.3 pts. higher p<.05
Integrating Caregivers at Discharge Significantly Reduces Patient Readmissions Identified 10,715 scientific publications related to patient discharge planning and older adults. The meta-analysis focused on 15 RCTs studies. Integrating caregivers into discharge planning was associated with: 25 percent reduction in risk of elderly patient being readmitted to hospital within 90 days; and 24 percent reduction in risk of being readmitted within 180 days, when compared with control groups where no such integration occurred. Rodakowski, et al. (2017). Caregiver integration during discharge planning for older adults to reduce resource use: A metaanalysis. Journal of the American Geriatrics Society.
Associations Between PFE Practices and HCAHPS Scores PFE Practice Committee Engagement Hospital-wide patient & family advisory council compared to no PFAC Over 50% of PFAC is patient & family members compared to under 50% PFAC meets at least quarterly compared to less often or never Inclusion of patients & family members in other hospital committees above average compared to average or below Monitoring Progress Engaging Patients & Families Formal self-assessment of PFE strategy use compared to no formal self assessment 5+ metrics for tracking PFE strategy use compared to fewer metrics Percentage points of patients rating a hospital 9 or 10 1.5 pts. higher 1.7 pts. higher 1.8 pts. higher 1.0 pts. higher 1.2 pts. higher 0.8 pts. higher Statistical Significance p<.05 p<.05 p<.05 p<.05 p<.05 p=.053
Better Together Dashboard Template...Hospital December 2017 Since (date) implementation Number of family/care partners staying overnight Number of problems encountered WELCOMING/FAMILY PRESENCE SURVEY Time Period: Patients & Care Partners: Was this experience helpful and supportive? Yes: % No: % Comments: PATIENT/FAMILY PERCEPTIONS OF CARE (HCAHPS Survey) 00% 00% During this hospital stay, how often did nurses treat you with courtesy and respect? During this hospital stay, how often did nurses explain things in a way you could understand? 00% During this hospital stay, how often did doctors treat you with courtesy and respect? 00% During this hospital stay, how often did doctors explain things in a way you could understand? 00% During this hospital stay, did doctors, nurses or other hospital staff talk with you about whether you would have the help you needed when you left the hospital? Nursing Staff: Was this experience helpful and supportive? Yes: % No: % Comments: 00% 00% During this hospital stay, did you get information in writing about what symptoms or health problems to look out for after you left the hospital? During this hospital stay, staff took my preferences and those of my family or caregiver into account in deciding what my health care needs would be when I left. 00% When I left the hospital, I had a good understanding of the things I was responsible for in managing my health. Security: What challenges or barriers were experienced by security staff? 00% When I left the hospital, I clearly understood the purpose for taking each of my medications. 00% Would you recommend this hospital to your friends and family? WEEKLY PATIENT SURVEY Date: Do you have (or have you had) a family member or care partner with you during your hospital stay? Yes: No: Not Available: If yes, are they being encouraged and included in decisions about care by nurses and physicians? QUALITY AND EFFICIENCY* Quality Measure Number of Medication Errors Hospital-wide 30-day Readmissions Returns to the ED within 30 days Average Length of Stay Current Period Prior Period Last Year BUILDING COMMUNITY AWARENESS How often has welcoming/family presence policy been included in the following: Health related events in the community Newspaper and online articles Social media activities Always Sometimes Never ICU Length of Stay *Changes related to the welcoming/family presence policy & other quality improvement initiatives TV or radio interviews
Sharing Stories as a Strategy to Change Organizational Culture
Facts bring us to knowledge, Stories lead to wisdom. Rachel Remen, MD Kitchen Table Wisdom: Stories That Heal
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 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. Pre-op conversations with the surgical team. 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.
Mame s Story 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 Opportunities for Improvement Discharge date set on a day impossible for family to help with transition to home. No flexibility to include the family. 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 Celebrating her 100 th Birthday in 2013
Mame at 102 AND 104
The Group Sharing Stories as a Strategy to Change Organizational Culture
Recommended Next Steps 1. Appoint an interdisciplinary team, with patient and family advisors on the team, to review visiting or family presence policies and practices, and those for discharge planning, for authentic partnerships. 2. Review Better Together resources and resources for reducing unnecessary readmissions. 3. Conduct online Better Together assessment and review external website and welcome packets. 4. Change policies and support staff for change in practice. 5. Create a shared learning community, establishing metrics from the beginning.
Tools for Changing the Concept of Families as Visitors www.ipfcc.org/bettertogether/
Better Together: Toolkit Strategies for educating staff Guides for families and staff Videos Media resources www.ipfcc.org/better-together/
Other Tools Sharing Personal and Professional Stories Learning From Patient and Family Stories Patient and Family Panels