Patient, Family and Provider Partnership Councils: The Next Evolution of Patient Safety and Quality Kellie Goodson Director, Program Administration VHA Center for Applied Healthcare Studies
VHA Inc. Who are we? Center for Applied Healthcare Studies vha.com/cahs Research and Demonstration Divisions One of 26 Hospital Engagement Network (HEN), part of the Center for Medicare and Medicaid s (CMS) Partnership for Patients (PfP) initiative Worked with nearly 200 hospitals in over 30 states Third largest HEN Project to help hospitals create Patient and Family Partnership Councils for Quality & Safety (PFPCQS) 14 hospitals participated in the 9-month project Partnered with H2Pi h2pi.org Marty Hatlie & Armando Nahum
Council Evolution: Quality and Safety Focus Patient-Centered Care focused Traditional PFACs Builds on lesson learned from hospitals in action since the 1990s Emphasis on principles of patient centered-care & patient experience Members typically patients / family members, supported by hospital staff Reporting relationships vary widely Safety, Outcomes & Partnership focused Evolving to PFPCQS Builds on foundational elements of PFACs; adds high reliability elements & quality improvement work Emphasis on outcomes Models partnership - both users & providers of care are council members Reports to Board of Directors or senior management Aligns with emerging research opportunities Aligns with developing federal measures 5
National Trends Financial Incentives for Patient and Family Engagement Penalties for Readmissions and Hospital Acquired Conditions (HACs) Incentives for Patient Portals HCAHPS Scores / Hospital Compare / Star Ratings Patient-Centered Outcomes Research Institute (PCORI) Partnership for Patients Campaign 60% of hospitals have Patient / Family Councils Huge shift in conducting bedside shift change reports Patient and Family involvement in hospital governance still needs improvement 6
Patient and Family Council Work What do Patient and Family Councils work on? Outcomes improvement Communicating effectively Transitions of care Patient, family & hospital staff/associate education Environment of care Care for the caregiver Supporting family caregivers Supporting hospital staff safety and wellness Care for the community the hospital serves 7
MedStar Health, Inc. PFACQS Sample of Project Topics Hand hygiene in the ER Falls Mobility Delirium: dispelling misconceptions and creating community understanding This is really important and I never heard of it before from my doctor Delirium is treatable - Let us help! My family member is not usually like this Need tools to be individualized - I never liked activity cubes 8
MedStar Health, Inc. PFACQS Misconceptions Dispelling Misconceptions Delirium is a sudden onset of confusion Can happen at any age when someone becomes ill. Delirium is a treatable medical condition. It is NOT a psychiatric disorder. 9
MedStar Health, Inc. PFACQS Delirium Alert List for Families and Caregivers What is delirium? Delirium is a sudden onset of confusion that can happen at any age when someone becomes ill Delirium is a treatable medical condition. What can cause Delirium? Infection Medication side effects Recent surgery w/ anesthesia Worsening of a chronic disease Pain Recent fall with injury Recent hospital stay or room change History of dementia Report any changes to healthcare provider Not thinking clearly Having trouble paying attention Not aware of what is going on around them Hearing or seeing things not there Note when last known normal Other changes to look out for: Unusual sleepiness or lethargy Extreme restlessness or agitation Inability to recognize relatives Confusion about where they are Saying strange things Resistant to medical care 10
MedStar Health, Inc. PFACQS Prevention Techniques for Delirium Provide familiar items from home i.e. photo, blanket, pillow Improve sensory input through use of hearing aides, amplifiers, eyeglasses, dentures and adequate lighting Encourage family/ friends and/or community involvement Maximize orientation - Use large clocks and calendars Control environment by reducing overstimulation, promote normal rest and sleep cycles (i.e. lights on during day and off at night) Minimize relocation and maintain consistency of routine Be consistent in dosage and timing of medications 11
Vidant Health Results 12
Vidant Health Results Top quartile in 8 of 9 dimensions of HCAHPS Reduced serious safety events by 85% Reduced hospital acquired infections by 74% Achieved 98% optimal care on CMS core measures All participating entities are winners in Value Based Purchasing 2013 John M. Eisenberg Award Recipient 13
Butler Health System Patient and Family Partnership Council for Quality and Safety Cheryl Ramsey, Manager, Hospitality Services
Butler Health System: Organizational Structure for Council Board of Directors Quality and Professional Affairs Committee Patient and Family Partnership Council for Quality and Safety Patient Safety Committee
What It Is Identifiable Goals Achieving patient and family centered care Improving safety, quality, and outcomes of care Reputation management Increased transparency Improving the patient / family experience See care through the patients / significant others eyes A place to share opportunities for improvement A safe place to voice opinions A forum to hear and consider patient centered needs Focus on BHS and not other facilities
Outcomes Changes made to the Patient Handbook Feedback given to marketing regarding the website appearance and social media responses Patient members volunteered to observe in the waiting room of the ER and provided feedback to the ER Director Patient Expectation video reviewed and feedback given Quiet Protocol posters changes made based on suggestions Reviewed Medical Education and Side-effects, including Bedside Shift report Environmental Services changed current practices based on feedback Proposed a recognition program for staff patient and family vouchers to give to staff who provide exceptional service
Outcomes (Continued) Previewed orthopedic patient engagement software and provided feedback during revision project Patient and family members being interviewed for employee mandatory inservice video Review of Patient and Family Portal to provide feedback Hand Hygiene Poster for Visitors
Expectations vs Experience Challenges: Getting the group, and not hospital personnel, to identify current issues or projects Getting participation from all group members Changes within the group dynamics as members come and go Follow up from departments that have been identified as having opportunities for improvement(s)
Future Plans CEO Goal Fiscal Year 2016 Implement at least 2 examples of demonstrated service improvement as an outgrowth of the Patient and Family Partnership Council for Quality and Safety.
PFPCQS How Can They Help? Review of current hospital initiated projects Review of Complaints and Grievances Review of comments on HCAHPS surveys
Future of Councils Different types of councils Ambulatory (physician practices, nursing homes, etc.) Regional (large integrated health systems, ACOs, etc.) Service line or disease specific (cardiac care, diabetes, etc.) More research is needed, connect the work of councils to improved patient outcomes CMS expectations & national metrics 22
Future of Councils National Metrics: Patient and Family Engagement PfP Campaign Point of Care Use a discharge checklist Shift change and huddles at the bedside Organizational Policy & Protocol Dedicated patient engagement staff Patient and Family Advisory Councils Proposed additional measures: Partner with patients and families Informed decision-making Patient activated Rapid Response Teams Proposed additional measures: Engaging patients in rounding Engaging patients in Root Cause Analysis Organizational Governance Patients and families serving on Governing Boards or Board Committees Proposed additional measures: Patients and family stories presented to Governing Boards
For more information, contact Kellie Goodson kgoodson@vha.com 972.830.0609 24
Cheryl Ramsey cheryl.ramsey@butlerhealthsystem.org 724.284.4306