From Documents to Conversations: How We re Changing Our Focus The name Honoring Choices Wisconsin is used under license from the Twin Cities Medical Society Foundation.
Leadership
Leadership Commitment
Leadership Resources Commitment
Leadership Time Resources Commitment
Language Awareness Strategic Plans Recognized Roles Reimbursement And more
Mercy Health System Reedsburg Area Medical Center Bellin Health The Not From Scratch Cohort
Kristine Phillips Director of Critical Care Services, Palliative Care and Advance Care Planning
MERCY HEALTH SYSTEMS
BEGAN ADVANCE CARE PLANNING EFFORTS USING RESPECTING CHOICES IN 2013 Baseline data collecting to look at percentage of patients with Advance Directives. Trained 15 facilitators. Focused on patients with highest needs.
LESSONS LEARNED Patients we deemed to need advance care planning were not interested. You can never educate enough! Despite education, someone will say: What s this advance care planning? or I ve never heard of that. It takes a long time to develop a smooth process. Even with great effort, you may not see many documents created.
CONNECTED WITH HONORING CHOICES IN JANUARY 2015 Received additional training on having the conversation. Changed the focus to the conversation instead of the document created. Participated in information sharing with other teams. Leveraged physician connection to the Wisconsin Medical Society and new ACO requirements for ACP conversation during Welcome to Medicare visit. Continued support during initial trial and thereafter. Great resources like the video for group events, brochures and other patient materials.
OUR WORK TODAY 18 facilitators trained throughout our system. 11 clinics now live with the ACP process. One community event and one partner event held in April and our next is scheduled for November. Presenting ACP as a benefit to Mercy partners at our benefit fair in November. Surgeons now referring patients pre-op for Facilitated Conversations. Monthly facilitator meetings to share ideas, frustrations, successes. Implementation guide completed to assist new clinics. Honoring Choices is a part of Mercy s Strategic Plan. Over 100 completed documents since January of 2015!
It s about the conversation! WHAT WE VE LEARNED THROUGH HONORING CHOICES WISCONSIN Make it simple and convenient! Physician engagement and promotion is key to success!
SLOW AND STEADY PATIENCE, PATIENCE, PATIENCE!
Anita Lindholm House Supervisor
Part of this community since 1902 Serving over 23,000 people in Reedsburg and surrounding area Providing jobs for more than 600 people Sponsoring a wide variety of education classes and health screenings Offering general services including obstetrics, pediatrics, inpatient/surgical, intensive care, emergency and urgent care Reedsburg Area Medical Center
In the mid-90s RAMC adopted the Respecting Choices program for ACP with a few trained facilitators, adding facilitators in 2000. An instructor for RAMC was trained in the Respecting Choices model training facilitators for several years including hospital staff, social workers, parish nurses, clergy, and lawyers Developed a taskforce for improving the ACP process in the early 2000s Joined forces in Sauk County forming a Coalition for End of Life Care Scheduled community education programs at churches and in conjunction with attorneys doing estate planning Members of our Ethics committee attended Honoring Choices kickoff in Milwaukee hoping one day RAMC would become a rural pilot group 2014 partnered with Honoring Choices Wisconsin 2015 trial implementation begins ACP HIGHLIGHTS at RAMC
Current ACP Program Referrals come from Diabetic educators in our clinic weekly and are assigned to our 8 facilitators Each facilitator makes contact with referral and sets an appointment time Documentation of the contacts made are recorded in the patient s clinic EMR Completed documents are scanned into both the hospital and clinic EMR and a paper copy remains with the hospital paper chart Non clinic referrals are routed through Spiritual Care Inpatient referrals are routed through House Supervisor
Successes Challenges Increase in referrals following through Increase in depth of conversations and number of contacts Competency for staff well received Improved access to the document on EMR Positive response from clients Inspired moments Full support from leadership FTE Computer systems X 3 Designated space Hours of commitment Staff attendance to ACP programs Contacting referrals Multiple contacts initially 3 times now limited to 2 Keeping appointments
Learnings Set realistic goals Take on one thing at a time Celebrate small steps Communicate with all members Tend to staff needs to gain their support
Next Steps Add our second Diabetic Educator to the referral process Add Welcome to Medicare Visit to the referral process as FTEs allow (target June 2016) Provide formal education with competency development for hospital staff in the steps for finding a HCPOA on the clinic and hospital EMRs Continue collaboration with Leadership on National Health Care Decisions Day Community Education is underway
Thank you
Beth Golonka Case Manager Maria Tielens Chaplain
Bellin Health - Green Bay, WI Integrated healthcare delivery system which has serviced people in Northeast Wisconsin and Michigan s Upper Peninsula since 1908 Bellin Hospital Bellin Psychiatric Center 31 Bellin Health Primary Care Physician Clinics Retail health clinics (Bellin Fast Care) Bellin Health Oconto Hospital Bellin Fitness Bellin College More than 3600 employees
Bellin s Advance Care Planning Journey 2009: Formed an advance care planning committee. Health system recognized the need for improvement based on DNV recommendations. Fall, 2009: Nurse Practitioner and Social Worker sent to Gundersen to become Respecting Choices Advance Care Planning Facilitator Instructors. 2010: Began to use Respecting Choices document and materials. 2010: Began to train Advance Care Planning Facilitators
Bellin s Advance Care Planning Journey Attempted to approach every patient over the age of 18, focusing on whether or not they had a document. 2012/2013: Advance Care Planning Team disbanded as leader took on a new role. October, 2014: Partnered with Honoring Choices. March, 2015: Started Implementation projects at two locations.
Current Advance Care Planning Program- Cancer Team Cancer Team: Targeting every new patient initial consult. Medical Assistant informs the provider of the need for advance care planning conversation. Provider talks to the patient regarding the importance of advance care planning, and encourages a referral to an advance care planning facilitator. Information packet provided, appointment scheduled.
Current Advance Care Planning Program- Primary Care Bellin Health Ashwaubenon Family Medical Center: One Physician and one Nurse Practitioner: Targeting every patient 55 years of age and older presenting for annual physical. Care Team Coordinator (rooming nurse) introduces the topic of advance care planning following a script. Physician/NP educates the patient about the importance of having an advance care planning conversation with a trained facilitator. Care Team Coordinator (rooming nurse) provides informational packet and schedules appointment with ACP facilitator.
Our Numbers Both locations: March, April, May, 2015: 64 people invited to participate in a conversation, 44 conversations occurred. 5 trained facilitators at Cancer Team location. Started with 2, now 1 trained facilitator at Primary Care location.
Bellin Successes
Successes/Patient Story Patients and health care agents were very satisfied. Patients and spouses/loved ones had meaningful conversations. Thinking of staff shifted from document driven to conversation driven. Working on improvements to document storage, and storage of documentation with an advance care planning tab in EPIC. Patient story.
Challenges or Detours to Success Primary Care and Cancer Team: Medical Assistants had a hard time understanding the importance of a conversation versus a document. They were not inviting patient s who had a document scanned. Primary Care: Developed new script for them, and educated about conversation/document. Cancer team: Oncologist encouraged having the conversation with every patient, regardless of document status.
Next Steps Cancer Team: Already spread to four additional providers, with goal of ACP for every new patient clinic wide. Primary Care Clinics: Will spread to providers as part of a larger patient care re-design project with a timeline. Spread plan began 9/18/15 with first additional team. Train one additional ACP Instructor Request FTE for ACP Coordinator role. Meet with Facilitators on a regular basis (monthly or bi-monthly). Assess Facilitators commitment to the role, determine accountability, and refresh education. Spread Honoring Choices educational materials and document system wide.
Mercy Health System Reedsburg Area Medical Center Bellin Health