Successfully Including Patient Representatives on the Hospital Board and Leadership Committees Workshop for the Tennessee Hospital Association Given by the American Institutes for Research, Person and Family Engagement Contractor for the Partnership for Patients 2.0 Lee Thompson Melissa Scardaville Ushma Patel September 21, 2016 1
Welcome Who is in the room? Tell us about yourself Name Hospital Location One thing you would like to learn today 2
About the PFE Contractor for PfP 2.0 Led by the American Institutes for Research (AIR) in partnership with Econometrica, Inc. and Project Patient Care September 2015 to September 2016 Types of support we offer: Online and in-person technical assistance on PFE metrics Monthly learning webinars and newsletter for HENs Online resources for all PFE metrics available at http://www.healthcarecommunities.org/ 3
A Framework for Today Overview of PFE and HEN Performance in PfP 2.0 Defining, Measuring, and Achieving the PFE Metrics How to Achieve PFE Metric 5: Patient and Family Representatives on a Hospital Governing and/or Leadership Board PFE Metric 5: Examples from the Field Achieving Health Equity to Improve Patient Safety 4
Overview PERSON AND FAMILY ENGAGEMENT (PFE) 5
PfP Vision for PFE 2.0 Hospitals and other healthcare providers achieving quality and safety goals by fully engaging patients and their families, determining what matters most to them in every situation, and partnering with them to make improvements to all aspects of care. 6
PfP 2.0 Definition of PFE Persons, families, their representatives, and health professionals (clinicians, staff, leaders) working in active partnership at various levels direct/point of care; organizational design, policy, and procedure; organizational governance; and community/policymaking across the healthcare system and in collaboration with communities to improve health, health care, and health equity 7
HEN Performance on PFE Metrics in PfP 2.0 8
THA Performance on PFE Metrics in PfP 2.0 9
Topic 1: DEFINING, MEASURING, AND ACHIEVING THE PFE METRICS 10
Metric 1 Implementation of a planning checklist for patients known to be coming to the hospital. 11
The Intent of Metric 1 For scheduled hospital admissions (surgery, labor & delivery). Create a mechanism for patients and families to discuss concerns, preferences, and issues for the hospital stay. The physical checklist serves as a list of items and topics for the conversation. 12
Why This is Important Enables an active partnership in quality and safety from the very start of the hospital stay. Helps patients clarify expectations about the hospital stay and their care. Allows clinical staff to know the concerns, interests, and goals of the patient. Identifies potential safety issues so that patient and clinical staff can work in partnership to avoid them. 13
Achieving the Metric You have achieved this metric when: Hospital provides a pre-admissions checklist to patients with all scheduled admissions. At admission, hospital staff discuss checklist with patient and family. 14
Question #1 Do you feel that your hospital has achieved metric 1? a. Yes b. No c. Need more internal information from our hospital to answer this question d. Need more information from THA to answer this question 15
Metric 2 Hospital conducts shift change huddles and bedside reporting with patients and family members in all feasible cases. 16
The Intent of Metric 2 Include the patient and/or family member in as many conversations about their care as possible throughout the hospital stay. The patient and/or family member is able to hear, question, correct or confirm, and/or learn more about the next steps in their care as it is discussed between nurses changing shifts or clinicians making rounds. 17
Why This is Important Enables the opportunity for correcting errors and clarifying care plans with the patient and family. Encourages the patient and family to be an active partner in their care to the degree they desire. Enables ongoing communication and interaction throughout care. Enhances the patient experience of care. 18
Achieving the Metric You have achieved this metric when: In as many units as possible, but in a minimum of at least one unit, nurse shift change huddles or clinician reports occur at the bedside and involves the patient and/or family members. 19
Question #2 Do you feel that your hospital has achieved metric 2? a. Yes b. No c. Need more internal information from our hospital to answer this question d. Need more information from THA to answer this question 20
Metric 3 Designation of an accountable leader in the hospital who is responsible for patient and family engagement. 21
The Intent of Metric 3 PFE built into hospital management and operations Visible leadership within the hospital Manages PFE plans and activities Has time dedicated to PFE 22
Why This is Important Communicates the value of PFE to all hospital staff, clinicians, patients, families, and the community Enables the hospital to centralize and coordinate PFE efforts Clarifies across the hospital who has authority and responsibility for PFE. Provides a face and name to the hospital s growing PFE culture 23
Achieving the Metric You have achieved this metric when: There is a named hospital employee who is responsible for PFE efforts at the hospital either in a full-time position or as a percentage of time within their current position. Appropriate hospital staff and clinicians can identify the person named as responsible for PFE at the hospital. 24
Question #3 Do you feel that your hospital has achieved metric 3? a. Yes b. No c. Need more internal information from our hospital to answer this question d. Need more information from THA to answer this question 25
Metric 4 Hospital has an active Patient and Family Engagement Committee OR at least one former patient that serves on a patient safety or quality improvement committee or team. 26
The Intent of Metric 4 Hospital has a formal relationship with patient and family advisors who help guide hospital operations, policies, procedures, and quality improvement efforts May be via Patient and Family Advisory Council OR inclusion of advisors on hospital quality or safety (or related) committee Patient/Family Advisors have the same rights and privileges as all other committee members. 27
Why This is Important Help hospital provide care and services based on patient- and family-identified needs and solutions rather than assumptions about what patients and families want or need. Improve overall systems and processes of care, including reduced errors and adverse events Patient-centered systems require patient input! 28
Achieving the Metric You have achieved this metric when: Multiple patient and/or family representatives from the community have been formally named as members of a PFAC. At least one patient serves on another hospital committee. Meetings of the PFAC or other committees with patient and family representatives have been scheduled and/or conducted. 29
Question #4 Do you feel that your hospital has achieved metric 4? a. Yes b. No c. Need more internal information from our hospital to answer this question d. Need more information from THA to answer this question 30
Metric 5 One or more patient representatives serving on the hospital Board of Directors. 31
The Intent of Metric 5 Ensure that at least one board member with full voting rights and privileges provides the patient and family perspective on all matters before the board, similar to other board members who represent specific interests in the community. The ultimate goal of this activity is to ensure that the board works with patient and family perspectives when making governance decisions at the hospital. 32
Reasonable Alternatives Asking for PFEC input on matters before the board, and incorporating a PFEC report into the board agenda. Identifying elected or appointed board members to serve in a specific role, with a written role definition, as representing the patient and family voice on all matters before the board. Requiring all board members to conduct activities that connect them closer to patients and families, such as visiting actual care units in the hospital two times per year and/or attending two PFEC meetings per year. 33
Why This is Important Patient and family needs, interests, and input occurs at the level of hospital governance. Encourages patient-centered decisionmaking by the board. Communicates a commitment to the community about the role of patients and family members in the hospital s operations. Enables patients and families to contribute viable solutions and ideas to accomplishing the mission of the hospital. 34
Achieving the Metric You have achieved this metric when: The hospital has at least one position on the board designated for a patient or family member who is appointed to represent that perspective. If a specific board representative is not possible, an alternative exists to work with patients and families when making hospital governance decisions. 35
Question #5 Do you feel that your hospital has achieved metric 5? a. Yes b. No c. Need more internal information from our hospital to answer this question d. Need more information from THA to answer this question 36
Show of hands Which hospitals CANNOT include a patient representative on its board? 37
Discussion Barriers and Strategies to Achieve the PFE Metrics 38 38
Topic 2: METRIC 5: PATIENT AND FAMILY REPRESENTATIVES ON A HOSPITAL BOARD 39
Role of a hospital governing or leadership board Hospital boards and governing bodies are responsible for: Guiding and ensuring fidelity to the mission and vision of the organization Conducting long-range planning Providing financial oversight Ensuring high quality care Hospital boards play a significant role in shaping the care provided by the organization 40
How can boards strengthen their commitment to PFE? Include patients as members of the governing board! 41
Impact of involving patient and family representatives When you are sitting at the Board table looking at a patient advisor, the numbers your are reviewing become that person s face and that is powerful. -Board Member When the advisor at the table says, I was one of those complications, what are you going to do about it?, it really helped to drive change in the reduction of infections and serious safety events. -Surgeon and Board Chair When the Board pays attention and talks about circumstances around what happened to the patient; they get the data off the paper and into minds and hearts. -Patient/Family Advisor Board Quality Committee 42
Role of patient and family board representatives Board member who serves purely in their capacity as patients Represent ALL patients Typically already involved in the hospital as a patient advisor Term limit: depends on the board s constitution/by laws 43
Role of patient and family board representatives (cont d) To meet PfP PFE Metric 5, CMS expects hospitals to develop a written description of the role of the patient and family representative. 44
Remember your target population Know your patient population and identify vulnerable populations. To be effective in helping the hospital make meaningful changes and include the patient voice, the board must be reflective of the patients served. 45
Recruiting patient and family board representatives Identify someone who is a current patient and family advisor or serves on a patient and family advisory council. Consider their contributions and experiences Have developed a hospital-wide perspective Ask clinicians (physicians and nurses) and key hospital staff to provide recommendations on candidates. 46
Selecting patient and family board representatives Exact process will depend on by laws and will vary by hospital Focus instead on selecting those with certain qualities to ensure success 47
Key qualities of patient and family board representatives Can provide a global patient or family voice beyond the personal story Holds multiple perspectives including high degree of system perspective Well versed in hospital s strategic initiatives and goals Listen to and respect the perspectives of others Work well with different kinds of people Speak comfortably and openly in group settings 48
Onboarding patient and family board representatives How can you make the patient representative feel comfortable and confident in their new role? Provide training or information to describe expectations, roles, responsibilities, and procedures Help them understand the culture of the organization Identify someone who can serve as a resource for or mentor to the patient member 49
Topics to cover during onboarding Background about the organization and board History, procedures, responsibilities, how and types of decisions are made Organization strategic plans Key contacts at the organization leaders, personnel Time commitment and responsibilities Terminology/acronyms 50
Preparing your board for patient and family representatives Help the Board understand that: The patient s role is to provide the patient perspective, and The patient has the same voting rights and privileges as the other board members (unless otherwise specified in the by laws) 51
Patient stories Hospital administrators need to be coached on how to listen to patient stories even if it makes them uncomfortable. And patients and families need to be coached to say things in a way that will be heard. -Patty Skolnik, Patient Advocate and President/CEO, Citizens for Patient Safety, LLC, April PFE Affinity Group and Learning Event: Coaching Hospitals in Person and Family Engagement (PFE): Applying Best Practices and Using the Strategic Vision Roadmap 52
How to include patient stories in board meetings Place at the beginning of meeting agenda Connect the Dot for the board at the beginning and end of the session Relate it to a measure/data Remove medical jargon and acronyms Bring it to life and put a face on the data Source: Guidelines for Telling Patient Stories with Boards; Created by Delnor- Community Hospital, Geneva, Illinois 53
Tips for successful meetings and interactions Establish norms and ground rules Start and end on time, policies about absence, importance of sharing the floor Don t tackle too much at once Be wary of information overload Communicate complex information clearly Plain language, explain clinical terms, explain QI processes, visual depiction of data Provide ongoing support Follow up after meetings to encourage participation, ask about experiences, debrief/pause moments 54
Topic 3: EXAMPLES FROM THE FIELD 55
Vidant Health System, North Carolina 2006-2009 Conduct Board education sessions and retreats on quality, safety, experience Oversee performance using standard quality scorecard Adopt aggressive transparency policy 2010-2012 Hear stories about experiences in care from patients and family members Understand financial impact of harmful events Establish Patient/Family Advisory Councils at all entities Appoint Patient Advisor to VH and VMC Board Quality Committees 2013-2016 Endorse quality model aligned with national quality strategy & population health Create Board Quality Leadership Award to recognize and reward culture of excellence Adopt safety as a core value
Vidant Health System, North Carolina (cont.) Kathy Dutton, MSN, RN, Senior Administrator Joan Wynn, PhD, RN, Chief Quality Officer Henry Skinner, Jr. Patient/Family Advisor Watch the PFE Metric 5 Learning Module at: http://www.healthcarecommunities.org/resourcec enter/partnershipforpatientslibrary.aspx?categoryid =834464&EntryId=99580 57
Roper St. Francis Hospital System, South Carolina Marion Martin, RN, MSN, MBA, LSSBB Althea Cobbs, Patient Chair, Board Quality & Safety Committee Watch the PFE Metric 5 Learning Module at: http://www.healthcarecommunities.org/resourcec enter/partnershipforpatientslibrary.aspx?categoryid =834464&EntryId=99580 59
Discussion 60
Topic 4: ACHIEVING HEALTH EQUITY TO IMPROVE PATIENT SAFETY 61
Why Health Equity Equity is no longer a separate initiative, but is equal to quality it is a strategic imperative. Source: Institute on Assets & Social Policy, Patient and Family Advisory Councils, 2016, p. 1) 62
Key Concepts Health equity is the attainment of the highest level of health for all people. Health and health care disparities are the differences in health and health care between population groups. 63
Key Concepts (cont.) Diversity involves acknowledging and respecting the range of human differences and similarities of all people. Inclusion is the practice of engaging a collective mixture of diverse stakeholders whose involvement recognizes the inherent worth and dignity of all people. Culturally and linguistically appropriate services (CLAS) are inclusive of and responsive to the health beliefs, behaviors, needs, and communication styles of its diverse patient population. 64
Healthy Equity and PFE The most vulnerable populations are often the most at risk for readmissions and medical errors because of miscommunication and mistrust. Knowing how to effectively engage all patients impacts quality. 65
Health Equity and Metric #5 Do the current representatives on our PFAC or board reflect all of our community? Do we engage in outreach to a range of individuals so we can obtain multiple perspectives? What are the potential barriers to someone joining our PFAC/board (e.g. meeting time)? 66
Health Equity and Metric #5 (cont.) How do I know if my PFAC/board is reflective of my community? Look at demographic data https://factfinder.census.gov Collect and analyze REAL data (Race, Ethnicity, Age or Language) REAL data sources can be administrative enrollments, billing records, medical records, patient-reported survey data 67
Potential Barrier to PFE: Low Health Literacy Difficulty in obtaining, processing, and understanding basic health information and services needed to make appropriate health decisions Note: Do not automatically assume low health literacy. 68
Solutions to Address: Low Health Literacy Ensure board and/or PFAC materials are free of jargon and can be easily understood by others (for example, explain acronyms). Plain language is key. Pair the new member with someone else on the board who can provide additional guidance New members may or may not need more time onboarding. 69
Available Tools Plain language is essential to PFE across all five metrics. Plain Language Medical Dictionary http://www.lib.umich.edu/plain-language-dictionary Plain Language Thesaurus for Health Communications http://depts.washington.edu/respcare/public/info/plain_language_th esaurus_for_health_communications.pdf Readability Formulas http://www.readabilityformulas.com/free-readability-formulatests.php 70
Potential Barrier to PFE: Language Issues Persons and families may not understand verbal and/or written communications that are in English only. 71
Solutions to Address: Language Issues Provide dedicated interpreter services during meetings Translate board and/or PFAC resources into the person s preferred language. Train board and/or PFAC members to increase their awareness and understanding of other communities. 72
Potential Barrier to PFE: Trust Issues Some people may distrust healthcare organizations as a result of real and perceived conflicts of interest or negative experiences, or distrust Western medicine in general. 73
Solutions to Address: Trust Issues Commit to transparency. Openly and actively explain all rules official and unofficial and procedures Show someone how they have been heard and how their input has been integrated. 74
Diversity & Inclusion Recommendations for the Five PFE Metrics PFE Metrics 1. Planning checklist for scheduled admissions 2. Shift change huddles / bedside reporting with patients and families 3. PFE leader or function area exists in the hospital 4. PFAC or Representative on hospital committee 5. Patient and family on hospital governing and/or leadership board (hospital governance) Diversity & Inclusion Recommendations Use the checklist regardless of age, race/ethnicity, language or disability Ensure that the checklist uses plain language and considers best practices for health literacy Make the checklist available in languages other than English Ensure that verbal conversation occurs in the patient s preferred language Make interpreters available as needed Include family consider changes that may need to be made in schedule Use plain language when doing shift report at the bedside Encourage active patient and family participation Hire a leader from within the community Use patient and family advisors (PFAs) to identify/hire a leader Recruit diverse members (e.g., race, ethnicity, diagnosis, disability, employment status) Consider and accommodate personal needs of PFAC members, such as time, travel, childcare, financial barriers Recruit diverse representation (e.g., race, ethnicity, diagnosis, disability, employment status) Consider and accommodate personal needs, such as time, travel, childcare, 75 financial barriers
Resources AHRQ s Guide to Patient and Family Engagement: http://www.ahrq.gov/professionals/systems/hospital/engagin gfamilies/guide.html Institute for Patient- and Family-Centered Care: www.ipfcc.org Institute for Healthcare Improvement (IHI): http://www.ihi.org/pages/default.aspx Addendum to the PfP PFE 2.0 Strategic Vision and Roadmap: Defining the Person and Family Engagement (PFE) Metrics for Improved Measurement: Purpose and Intention of the Five PFE Metrics How Patient and Family Engagement Can Help Hospitals Achieve Equity in Health Care Quality and Safety 76
Where to find the Roadmap www.healthcarecommunities.org 77
Contact information Melissa Scardaville mscardaville@air.org 404-260-1046 Lee Thompson lthompson@air.org 703-403-2698 Thank you for your time and participation! 78