4th Annual Patient and Family Advisory Council Conference Strengthening Patient and Family Engagement in Massachusetts Hospitals PFAC as Consultant to Hospital Initiatives Lois Erhartic, Colleen McCauley, Linda S. Melillo, Caroline Moore Objectives: Appraise the advantages and drawbacks of PFAC consultation services Describe a strategy to generate real-time patient and family feedback in the in-patient setting Identify how a multidisciplinary work group can explore and resolve patient transition issues Provide input and discusse themes in collaboration with Marketing Departments for multiple avenues of promotion/advertising materials Thursday, June 23, 2016 Sheraton Four Points Norwood, MA 1
PFAC as Consultant to Hospital Initiatives Colleen McCauley, PT, DPT, NCS Linda S. Melillo, MA, MS, CPHRM, CPXP 4th Annual PFAC Conference bit.ly/pfac2016 2
Spaulding Cape Cod Patient & Family Advisory Council Representatives from both Inpatient and Outpatient for both patients, family members, and staff In 2014 made changes to all of our charter documents As a group searching for a different way to have a greater impact upon hospital functions 4th Annual PFAC Conference bit.ly/pfac2016 3
Spaulding Cape Cod Patient & Family Advisory Council Past 2 years focus on educational and marketing materials Working as a consultant body has allowed a greater impact of our committee within the hospital setting getting the most bang for our buck Provides members with satisfaction of participation at a hospital wide level vs. committee level 4th Annual PFAC Conference bit.ly/pfac2016 4
Why are we the best committee to provide this information? Patient experience Patient/family friendly language Visual layout/presentation of information Removing extraneous/overwhelming information 4th Annual PFAC Conference bit.ly/pfac2016 5
Benefits of Patient and Family Perspective Loss of Independence Fears Lack of familiarity with hospitals Lack of understanding with healthcare systems Unique view of intended audience Interpretation of materials from intended audience 4th Annual PFAC Conference bit.ly/pfac2016 6
Areas of Consultation Marketing Admission information Website Inpatient Educational Materials Discharge Planning Information 4th Annual PFAC Conference bit.ly/pfac2016 7
Sampling of Materials Patient Safety Guide Strength Books Pediatric Calendar Patient Guide Sexual Function Education Sheet Diabetic Teaching Materials Environmental Services Signage Patient Bulletin Boards Patient and Family FAQs information Website Design 4th Annual PFAC Conference bit.ly/pfac2016 8
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Pros and Cons Pros Larger Voice Valued Voice Unique Experiences Tangible Impact Cons Not always able to follow the flow of information Delayed turn Decreased ownership of projects Broad Range Perspective 4th Annual PFAC Conference bit.ly/pfac2016 10
PFAC as Consultant to Hospital Initiatives Caroline Moore, MPH 4th Annual PFAC Conference bit.ly/pfac2016 11
Advisor Rounding at Beth Israel Deaconess Medical Center 4th Annual PFAC Conference bit.ly/pfac2016 12
How we got started in 2015 November November 18 Jan - April Explore models of Advisor Rounding April - June Generate leadership buy-in; establish units for pilot June - Aug Create volunteer role; select / invite/ screen Advisors Aug - Nov Design and implement training; design data tool Meet with unit directors and staff to review plan and schedule 4th Annual PFAC Conference bit.ly/pfac2016 13
Training Advisors: 3 sessions, 2 hours each Introduction to the project rationale, goals, logistics DHMC video Listening skills, empathy, dealing with challenging communication issues DHMC video Orientation to the units tour, who s who on the floor, precautions, hand-hygiene Rounding coaching: o Entering the room o Explaining who you are and purpose of the visit o Starting the conversation o Responding to complaints o Ending an encounter o Documenting observations and comments o Sharing feedback with unit appropriate staff when necessary, with patient/family permission Add-on session - role plays 4th Annual PFAC Conference bit.ly/pfac2016 14
BIDMC s Advisor Rounding Pilot Launches! Since November 18, 2015 12 Advisors round individually on three different inpatient floors At start of shift, nurse leader informs advisor which patients should not be visited Shifts are 1 1.5 hours (3 4 visits per hour) 225 patient visits in first six months Real time feedback is documented shortly after visit Feedback shared with nurse leaders monthly via summary reports 4th Annual PFAC Conference bit.ly/pfac2016 15
Web-based form completed on ipad, smartphone, or computer 4th Annual PFAC Conference bit.ly/pfac2016 16
Monthly summary reports for each floor shared with Nurse Directors 4th Annual PFAC Conference bit.ly/pfac2016 17
BIDMC Advisor Rounding: 6 Month Outcomes 225 Patients Positive Feedback Negative Feedback 4th Annual PFAC Conference bit.ly/pfac2016 18
What is one thing that would make the experience on the floor better for you? For people to understand you hand yourself over and give up control... you sign your life away when you come to the hospital. Patient said there could be better communication around discharge status/timing There needs to be better communication between providers to keep stories straight Better communication with him and between medical staff Not being told by the food services person on the phone taking his order that he cannot have something He would rather be told in advance by a nutritionist. We feel like people are not listening to us and keeping us in the loop so better communication would make it better for us. Better use of the white board in his room would help with communication. He said that there should be better communication between attending/specialists and the nurses. He was waiting for a GI Doc to visit but could not get any time frame. Pt said that there should be some way to have an email or mass phone call to communicate with family members, updating the patient status after surgery and when coming out of ICU, and possibly notifying when the patient can have visitors. 4th Annual PFAC Conference bit.ly/pfac2016 19
Examples of other outcomes A patient finally completed her health care proxy after an advisor helped her feel less fearful A chaplain was called to the bedside of a cardiac patient who was near death A patient learned how to use her call button (nobody had taught her how) Another patient got a recliner moved into her room so that she could begin to get out of bed she had been afraid to ask Many friendships were formed between patients sharing rooms as a result of the conversations A housekeeper received a bonus, and advisors successfully advocated her when she had an HR issue A Patient Care Technician received a prestigious BIDMC award after receiving more special mentions than any other provider BIDMC leaders are taking notice and seeking information and data from the project 4th Annual PFAC Conference bit.ly/pfac2016 20
Outcomes Naromie Caidor, Farr 6 4th Annual PFAC Conference bit.ly/pfac2016 21
Lessons Learned Thoughtful advisor selection is critical! Advisors had to become comfortable with going deeper in conversation to elicit actionable feedback Patient/families are generally curious, accepting, and grateful Negative feedback and complaints are rare but clear themes are emerging: Communication Environmental concerns Care transitions Advisor rounding has not been disruptive on the floors but familiarity of floor staff took time Special Mentions have led to bonuses, awards, and other recognition Advisor rounding is resource-intensive Increase awareness leads to requests for information, data and introducing new floors 4th Annual PFAC Conference bit.ly/pfac2016 22
PFAC as Consultant to Hospital Initiatives Lois Erhartic 4th Annual PFAC Conference bit.ly/pfac2016 23
About Saint Anne s Hospital 175 bed community hospital Service areas include Southeastern Massachusetts and Rhode Island 750 physicians and advanced practice professionals, 50 specialists, 150 PCPs Core Values Compassion Accountability Respect Excellence Stewardship 4th Annual PFAC Conference bit.ly/pfac2016 24
Formation of our Transitions Workgroup Patient transitions were a recurring theme in PFAC discussions Concerns and problems with transitions within the hospital, between home and hospital and from hospital to the next level of care Scope of the problems suggested solutions could best be found and implemented with a multidisciplinary workgroup 4th Annual PFAC Conference bit.ly/pfac2016 25
Composition of the Workgroup (25 members) PFAC members with recent experience with patient transitions Local Skilled Nursing and Rehabilitation Facilities Emergency Medical Services Liaison from PrimaCARE Saint Anne s physician partner Hospital Members Nursing staff (orthopedics, medical, telemetry, intensive care) Emergency Department Case Management Pharmacy Palliative Care NICHE (Nurses Improving Care for Healthsystem elders) Professional Practice Research and Development Clinical Integration and Outreach Student, DNP (Doctor of Nursing Practice/ Nurse Practitioner) 4th Annual PFAC Conference bit.ly/pfac2016 26
Initial Determinations The purpose of the group was established: To improve the effectiveness of patient care transitions as guided by patients and their families The group would be a workgroup not a discussion group Smaller problems (low hanging fruit) would be identified and acted upon first Larger issues would be unraveled as they revealed themselves The group would meet monthly with the expectation that work would be done during each month to move us closer to our solutions A PFAC member was appointed co-chair 4th Annual PFAC Conference bit.ly/pfac2016 27
Agenda for First Meeting Brainstorm a list of all the possible transition points Identify some key concerns Person to contact was not well defined, current or consistent leading to frustration for family members Advance directives were hard to find or absent, and not well understood by physicians and staff Discharge information is overwhelming, not patient specific, and difficult for families and patients to understand Patients/family members are unclear as to role of a hospitalist and their interface with outpatient care providers Recognize and accept that the foundation for the work of improvement comes from the patient and families perspective Healthcare staff and physicians were hearing the families perspectives clearly for the first time! 4th Annual PFAC Conference bit.ly/pfac2016 28
Outcomes after First 6 Months Eliminated confusion about person to contact Investigated how person is identified in the electronic record Now allow staff nurses to change person to contact so that it is current and accurate for this care episode Created new hospital position - Coordinator of Clinical Integration and Outreach This person follows up on advance directives/ health care proxies to make sure they are current, accurate and easy to find Staff education on this topic has been initiated and will continue 4th Annual PFAC Conference bit.ly/pfac2016 29
Outcomes after First 6 Months (continued) Addressed patient and family confusion about the role of a hospitalist by creating a hospitalist FAQ document available for hand out and on our website Explored patient/family frustration with multiple repeat questioning by nursing staff Triage nurse in ED now explains that questions will be repeated to soften the experience Inpatient RNs provided with a suggested script, I have ED information but I want to review it to make sure we have everything Patients are showing appreciation of this approach and it seems to be helping with the frustration 4th Annual PFAC Conference bit.ly/pfac2016 30
Outcomes after First 6 Months (continued) Developed medication information folder Two versions are being trialed: a checklist version and a fill in version Medication information was simplified to facilitate patient comprehension Folder will be used throughout inpatient stay and sent home with patient upon discharge 4th Annual PFAC Conference bit.ly/pfac2016 31
Outcomes after First 6 Months (continued) Subgroups were formed to address: Time from discharge decision to actual discharge, and how to streamline and clarify what is most important and relevant to the patient Compassionate communication skill development for staff Transition to Skilled Nursing Facilities 4th Annual PFAC Conference bit.ly/pfac2016 32
General Lessons Learned Patient/family problems can best be resolved when healthcare professionals approach the issues from the patient/family perspective Small changes made quickly maintain momentum and inspire confidence that work is getting done 4th Annual PFAC Conference bit.ly/pfac2016 33