national content call 1 patient-and-family centered care april 9, 2013
TRANSCRIPT
National Content Call
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Patient-and-family Centered Care
April 9, 2013
Our Presenters
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Christine Goeschel ScD, MPA, MPS, RN, FAANAssistant Professor, Johns Hopkins School of Medicine
Joint Appointment, Schools of Public Health and Nursing
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Gail Panoff Chair, Patient and Community Engagement Council
St. Joseph Mercy Health System Ann Arbor, MI
Your Opinion Matters!
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We rely on your opinion to shape future content calls. At the end of today’s call, please complete
our survey using this link:
https://www.surveymonkey.com/s/CAUTI_Content
Session Objectives
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• Describe CUSP as an intervention to improve health care delivery and care outcomes
• Define patient-and-family engagement • Discuss ways that CUSP can be used to
support patient and family engagement • Discover how one patient and family
experience council engages patients and their families in care outcomes at the hospital
More work, Different work, Same work?
Presented by:Chris Goeschel, ScD MPA MPS RN FAAN
Assistant Professor, Johns Hopkins School of Medicine Joint Appointment, Schools of Public Health and Nursing
Director, Strategic Development and Research Initiatives,Armstrong Institute for Patient Safety and Quality
Patient and Family Engagement and CUSP CAUTI
Challenging …So Many Solutions?
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Culture Change Model Comparison Table
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Objective Kotter: Leading Change
Kouzes and Posner: Leadership Challenge CUSP As Applied to CAUTI
Developing Engagement
Create a sense of urgency.
Encourage the heart. ENGAGE, EDUCATE: Science of Safety, the Josie King Story Communicate number of CAUTIs in unit, potential or real
patient harm that could occur, financial cost of CAUTI.[1]
Team Development Create a guiding coalition.
Model the way. ENGAGE: Senior Leadership Partnership with the CUSP Team
Establish unit team with direct care providers, nurses, nurse manager or charge nurse, infection control professional and a physician.
Developing Alignment Develop a shared vision.
Inspire a shared vision ENGAGE: “What hill do we climb?”
Identify with the team what it would look like if catheter utilization was low and CAUTIs were prevented?
Sharing Approach Communicate the vision.
Educate others in daily rounding assessing for catheter presence and indication
Empowerment Empower others to act.
Enable others to act. EXECUTE: Direct care provider involvement, teamwork and communication tools
Work with care team to establish protocols to remove when no longer needed and not to place catheter unless it is indicated
Implementing Change Generate short-term wins.
Challenge the process. ENGAGE, EXECUTE, EVALUATE, Learning from Defects
Improve utilization practices, evaluate improvement in compliance with indications and in symptomatic CAUTI
Spread Consolidate gains and produce more change
ENGAGE, EXECUTE, EVALUATE, Learning from Defects
Work with ICP and senior executive to spread to other units in the organization
Sustainability Anchor news approaches in culture.
Part of the Daily WorkMake daily rounding and catheter utilization assessment part of routine patient care
What is CUSP?
• Comprehensive Unit-based Safety Program
• An intervention to learn from mistakes and improve safety culture for sustained improved patient outcomes
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What Is Patient and Family Engagement ?
Patient and family engagement involves: “collaborating with patients and families of all ages, at all levels of care, and in all health care settings. [Patient and family engagement] acknowledges that families, however they are defined, are essential to patients’ health and well-being.”
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How and Where to EngagePatients and Families
• Engaging in planning and design – Infrastructure advisory
• Engaging in everyday care – How-to strategies
• Engaging with after an adverse event
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Hopkins Model for Leading Change
Senior Leaders Team Leaders Frontline Staff Patients and Families
Engage Why is this important? Stories are often used to engage
Educate What do I need to know? Evidence is used to educate
Execute What do I need to do? Tools are used to help implement changes
Evaluate How will I know my actions made a difference? Results are shared
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The 4 Es
CUSP and CAUTI InterventionsPatients and Families as “Team”
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CUSP Science of Safety Principles of Safe Design
• Standardize – Eliminate steps if possible
• Create independent checks
• Learn when things go wrong– What happened– Why– What did you do to reduce risk– How do you know it worked
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What are Goals of theCAUTI Project?
To reduce average CAUTI rates in participating unit by 25% through the following steps:
• To educate health care workers and patients and families about the appropriate management of urinary catheters, including indications for the placement and continued use of urinary catheters
• To prevent the placement of unnecessary urinary catheters – might patients and families have a role in determining “unnecessary”?
• To promptly remove urinary catheters that are no longer needed – What role might patients and families play in achieving this goal?
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Principles of Safe Design Apply to Technical and Teamwork
Safe Teamwork : Challenge of Communicating
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Involving Patients and Family Members as “Team”
• Serve on the CUSP team• Provide input to improve policies and procedures• Advise on how to communicate an adverse event
to a patient and family members• Present at staff meetings “stories of care”
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Teams Make Wise Decisions When There is Diverse and Independent Input
• Wisdom of Crowds – Seek involvement from clinicians at all levels of the
organization, and patients and families
• Alternate between convergent and divergent thinking– What does everyone think?– What will be “our” policy/procedure/practice?
• Get from the dance floor to the balcony level– Individual challenges– System challenges
Heifetz R, Leadership Without Easy Answers,1994.
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Core Concepts of Patient and Family Engagement
• Dignity and respect • Information sharing • Participation• Collaboration
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Dignity and Respect
• Health care practitioners listen to and honor patient and family perspectives and choices.
• Patient and family make-up, knowledge, values, beliefs, religious and cultural backgrounds are incorporated into the care planning and delivery.
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Information Sharing
• Health care practitioners share complete and unbiased information with patients and families in ways that are easily understood and address concerns or questions.
• Patients and families receive timely, complete, and accurate information to participate in care and decision making.
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Participation
• Patients and families are encouraged to participate in care and decision making at the level they choose.
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Collaboration
• Patients, families, health care practitioners, and health care leaders collaborate in policy and program development, implementation, and evaluation
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Summary
• Safety is a property of system• We need lenses to see the system including
patient and family lenses• We need to provide a safe space for all
stakeholders, including patients and families to share their voice
• CUSP is a structured approach to learn from mistakes and improve safety culture
• Educating on the Science of Safety is Step 124
Action Items
• Have all members of the CUSP CAUTI Team view the Science of Improving Patient Safety video
• Imagine all of the places where “patient lenses” would add dimension to your improvement efforts
• Develop a plan to invite patients and families to join your team– Consult with your CUSP executive to gain support for your
plan– Consider whether the Science of Safety Video might be
valuable for patient/family advisors
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Additional Resources
CUSP tools are available online by visiting the AHRQ Web site: www.ahrq.gov/cusptoolkit.
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The Role of the Patient Experience Advisor
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Gail Panoff
Chair, Patient and Community Engagement Council Saint Joseph Mercy Health System
Ann Arbor, MI
Overview of the Council
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• Council is a part of Saint Joseph Mercy Hospital Health Systems
• Foundation: around 2010• The PCEC and St Joseph Mercy Health System share a
common goal to assure the voice of the patient and family are heard to help shape how care and service are delivered
• 15 Council members / 55 Patient Advisors• Our council meets for 2 hours, once a month
Reporting Mechanism (Structure)
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• The executive director for patient and community engagement is the champion for this effort and serves on the council
• Council is directly accountable to the executive director of the patient and community engagement at the hospital
• The executive director, chairperson or delegate presents a report to the quality and safety committee of the system board annually on council activities and outcomes
How to Recruit and Become an Advisor
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• Recruitment– Brochure– Website– Hold message – Referrals – Service recovery following complaint
• Application process– Complete application – Interview– Orientation/ training
Roles of an Advisor
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• Committee Member- Member on a hospital committee represents the patient or family member perspectives to quality improvement efforts
• Focus Groups- Past patients or family members share perspectives and ideas on specific topics
• Communication Reviewer- Reviews Patient education materials ,newsletters, websites and other materials. Done remotely & electronically
• Experience Sharing- Provides experiences of their health care journey as to learn what is helpful and what is not. Presentations may be at new orientations, educational seminars, dept. or committee meetings, Simulations & Patient Testimonials
Representation of the Patient and Community Engagement Council
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• Council Members – 1/3= staff 2/3=patients & family members
• Departments include: – Clinical Quality Safety and Risk– Nursing– Service Excellence– Medical Staff– Patient and Community Engagement
*Other departments are brought in as needed to learn, observe and participate. Example: representatives from other hospitals and executive leadership participation in meeting*
Representation of the Patient and Community Engagement Council (continued)
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• Patients and family– Goal: 2/3 patients or family members – Diversity
• Very important component • Age, gender, varied experiences, race,
ethnicity, religion- representation from all communities
Contributions of the Council
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• Welcome Video to welcome new patients to the hospital• C- Diff flyer• Brochure on Pressure Ulcers • Noise Reduction Sleep Time Sign• Nurse Residency Program- Testimonials• Food and Quality Improvements • Discharge Pharmacy Program• Patient’s Rights and Responsibilities Brochure • Patient Discharge Instructions• Simulations- Disaster recovery (example: tornado)
Councils that Advisors Serve on
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• Advisors serve on the following councils:– NICU CPT– Stroke CPT– Pain CPT– Ann Arbor Quality and Safety Committee– Ambulatory Patient Experience Committee– Comprehensive Breast Care Center Steering Committee – Ann Arbor Patient Satisfaction Improvement Team – Patient and Community Engagement Council– Patient Experience CPT– Rehab Steering Committee – Cardiovascular Patient Education Committee – NICU Family Advisory Board
End Result
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We believe that by engaging patients and their family members in the care process and
improving education about health care needs, patients can continue to take an active role in
the decisions that effect their care
Patient and family engagement is a powerful tool for improving all facets of care
For More Information Contact:
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Susan Kheder, LMSWExecutive Director, Patient & Community Engagement
Saint Joseph Mercy Health SystemAnn Arbor, MI
[email protected] 734-712-4945
Questions?
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Your Opinion Matters!
We rely on your opinion to shape future content calls. At the end of today’s call, please complete
our survey using this link:
https://www.surveymonkey.com/s/CAUTI_Content
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