pqcnc 2014 annual meeting jim conway

8/13/2019 PQCNC 2014 Annual Meeting Jim Conway

1/40

Jim Conway

Adjunct Faculty

Harvard School of Public Health

[email protected]

The Power and Privilege of

Patient and Family Centered Care

PQCNC

1/13/2014 1


2/40

Where does PQCNC Want Me to Go?

Comment on the difference between "patientexperience" and "patient engagement

Discuss the value of including patients/family

members as vital members of health carequality improvement teams

Describe "what it takes" to make patients/familymembers fully integrated members of quality

improvement teams

Highlight the importance of Leadership in patientand family engagement efforts

1/13/2014 2


3/40

How Do You Want Me to Get There?

PQCNC Ten Commandments1. Thou Shalt Not Simply Trot Out thy Usual Shtick.

2. Thou Shalt Dream a Great Dream, or Show Forth a Wondrous New Thing,Or Share Something Thou Hast Never Shared Before.

3. Thou Shalt Reveal thy Curiosity and thy Passion.

4. Thou Shalt Tell a Story.

5. Thou Shalt Freely Comment on the Utterances of Other Speakers for theSake of Blessed Connection and Exquisite Controversy.

6. Thou Shalt Not Flaunt Thine Ego. Be Thou Vulnerable. Speak of thyFailure as well as thy Success.

7. Thou Shalt Not Sell from the Stage: Neither thy Company, thy Goods, thyWritings, nor thy Desperate need for Funding; Lest Thou be Cast Aside

into Outer Darkness.8. Thou Shalt Remember all the while: Laughter is Good.9. Thou Shalt Not Read thy Speech.10. Thou Shalt Not Steal the Time of Them that Follow Thee.

1/13/2014 3


4/40

Outline

Prologue: Definitions and Profound Learning

Dana-Farber Cancer Institute Journey Burden, Responsibility, Power

Patient and Family Centered Care Setting Expectations

Positioning for Success

Action

Challenges Outcomes

Moving Forward

1/13/2014 4


5/40

For your service to your patients,families, staff, and communities.

1/13/2014 5


6/40

Prologue

Definitions: Patient & Family Centered Care

Profound Learning: Childrens Hospital, Boston

1/13/20146


7/40

Patient Centered Care:

Picker Dimensions Respect for patient values, preferences

Coordination and integration

Information, communication, education

Physical comfort

Emotional support

Involvement of family and friends

Transition and continuity

Access to care

Gerteis M, et al. Through the Patients Eyes. San Francisco: Jossey-Bass: 1993.

1/13/201477


8/40

Four Key Concepts of PFCC

Dignity and respect:Providers listen and honor

patient and family perspectives and choices.

Information sharing :Providers share complete and

unbiased information in ways that are affirming anduseful.

Participation:In care and decision-making

Collaboration:In policy and program development,implementation and evaluation, as well as the

delivery of care

8

American Hospital Association and the Institute for Family-Centered Care. (2004). Strategies

for leadershipPatient and family-centered care toolkit. Washington, DC.

1/13/2014


9/40

A set of beliefs and behaviors by patients,family members, and health professionals

and a set of organizational policies,

procedures and interventions that ensure

both the inclusion of patients and families as

central members of the health care team and

active partnerships with providers and

provider organizations.

1/13/2014 9

Patient Engagement Defined

A Leadership Resource for Patient and Family Engagement Strategies. Health

Research & Educational Trust, Chicago: July 2013. Accessed at www.hpoe.org


10/40

Defining Patient Experience

http://www.theberylinstitute.org/?page=PEBENCHMARKING
http://www.theberylinstitute.org/?page=PEBENCHMARKINGhttp://www.theberylinstitute.org/?page=PEBENCHMARKING


11/40

Patient Experience Defined

The Patient Experience refers to the quality and value

of all of the interactionsdirect and indirect, clinical

and non-clinicalspanning the entire duration of thepatient/provider relationship.

Deloitte


12/40

I dont care who youare. I am going to stay

with my child.

Pediatric Mother, 1976

1/13/201412

Popper B, Black A, Ericson E, Peck D. A Case Study of the Impact of a Parent Advisory Committee on Hospital Design and Policy,

Boston Children's Hospital. Childrens Environment Quarterly. Vol 4, No. 3, Fall 1987.

Just cause youre

poor doesnt mean

youre stupidPediatric Mother, ~1984

There is no force in the world stronger than a mother in

your face advocating for her kid J. Conway


13/40

13

DANA-FARBER ADMITS DRUG OVERDOSE CAUSED

DEATH OF GLOBE COLUMNIST, DAMAGE TO SECOND

WOMAN

When 39-year-old Betsy A. Lehman died suddenly last Dec. 3 at Boston's Dana-Farber

Cancer Institute, near the end of a grueling three-month treatment for breast cancer, it

seemed a tragic reminder of the risks and limits of high-stakes cancer care. In fact, it

was something very different. The death of Lehman, a Boston Globe health columnist,

was due to a horrendous mistake: a massive overdose of a powerful anticancer drug

that ravaged her heart, causing it to fail suddenly.

3/23/1995

1/13/2014


14/40

Key Levers / Learning in Journey The responsibility and power of all

leadership [trustee, clinical andadministrative] over safety

The need for relentless vigilance tosafety, risk, error, near-miss, harm

Addressing the multiple victims of error The crucial role the design of systems

and application of technology play insupport of safe practice by excellentstaff

The synergy of interdisciplinary practiceand team work


1/13/2014 14

http://www.asco.org/ASCOv2/Education+%26+Training/Educational+Book?&vmview=edbk_detail_view&confID=40&abstractID=615
http://www.asco.org/ASCOv2/Education+&+Training/Educational+Book?&vmview=edbk_detail_view&confID=40&abstractID=615http://www.asco.org/ASCOv2/Education+&+Training/Educational+Book?&vmview=edbk_detail_view&confID=40&abstractID=615


15/40

Set the Expectation

Position People for Success

Hold Them Accountable

Without clarity of expectations,

deviance cant stand out.Roger Berkowitz,

Trustee, DFCI

CEO, Legal Sea Foods1/13/2014 15


16/40

1996 GOVERNING BOARD PRORITY

DFCI will be patient and family

centered in the model of the IPFCC.

Patients and families will be part of

all care decision making structuresand processes

1/13/201416


17/40

Expectations for PFCC

are clear in PQCNC1. Strongly disagree

2. Disagree

3. Neither

4. Agree

5. Strongly Agree

1/13/2014 17


18/40

Expectations for PFCC are clear in

my healthcare organization1. Strongly disagree

2. Disagree

3. Neither

4. Agree

5. Strongly Agree

1/13/2014 18


19/40

Strategies: Positioning for Success

All Staff

Set clarity ofexpectation

Engaging Board &

leadership Key leadership on-

point

Integrating acrosscare

Listening to concerns

Learning from priorfailures

Coaching, training,

IPFCC programs Pacing and quick wins

Celebrating

Providing support Modeling from the

top

1/13/2014 19


20/40

DFCI: Structures & Processes

Patient and Family Partnerships

Committees:Board Quality Committee

Patient Safety Committee

Strategic Planning

Operating

Leadership Interviews

New Employee Orientation

Side by Side

Resource Centers

Rescue events NPSF & IHI meetings

Pediatric ER Fast Track

End of Treatment

Renovation / Process Redesign

Patient Flow

Understanding Insurance

Embracing Diversity

Adult Safety Rounding

New patient access

Task Force on Disclosure

Working on the Wait Customer Service Training

Falls Task Force

Medication reconciliation

1/13/2014 20

Reid Ponte P, Conlin G, Conway JB, et al. Making patient-centered care come alive: achieving full integration of the patient's perspective. J Nurs Adm 2003; 33(2):82-90.

Reid Ponte P, Connor M, DeMarco R, Price J. Linking patient and family-centered care and patient safety: the next leap. Nurs Econ 2004; 22(4):211-3, 215.


21/40

Implementation Challenges

Nice, not necessary; PR

Staff & patients: people inVERY different places

You are crazy!

Fear of the unknown

We know what they

want

We are different! They will be in the way!

This will be a time hog

Silo: Its mine

Transparency of realities

Shifting power balance

Shifting priorities Learning to ask, listen,

listen more, not jumping

Getting and embracing

diversity Ongoing staff orientation

1/13/2014 21


22/40

Positive Outcomes

All proud of PFCC practice

Problem identification

What they want, wewant!

We are finding things wedidnt know!

Prioritized improvement

Improved outcomes

Informed growingevidence base

Interdisciplinarypartnership

New powerful allies andadvocates

Huge external recognition

Presentations/publications

Funding: Grants & donors Care connection all levels

1/13/2014 22


23/40

I have seen very positive outcomes

from our organizational efforts to

deliver PFCC.1. Strongly disagree

2. Disagree

3. Neither4. Agree

5. Strongly Agree

1/13/2014 23


24/40

15 Years Later

Amazing Work Continues

http://www.dana-farber.org/abo/news/publications/pop/archive.html

1/13/201424
http://www.dana-farber.org/abo/news/publications/pop/archive.htmlhttp://www.dana-farber.org/abo/news/publications/pop/archive.htmlhttp://www.dana-farber.org/abo/news/publications/pop/archive.htmlhttp://www.dana-farber.org/abo/news/publications/pop/archive.htmlhttp://www.dana-farber.org/abo/news/publications/pop/archive.html


25/40

Whats Getting Rewarded!

251/13/2014


26/40

Conclusions. Most hospitalized

patients participated in someaspects of their care.

Participation was strongly

associated with favorable

judgments about hospitalquality and reduced the risk of

experiencing an adverse event.

Weingart SN, Zhu J, Chiappetta L, Stuver SO, Schneider EC, Epstein AM, David-Kasdan JA, Annas CL, Fowler FJ Jr, Weissman JS.

Hospitalized patients' participation and its impact on quality of care and patient safety. Int J Qual Health Care. 2011 Feb 9. [Epub

ahead of print] Center for Patient Safety, Dana-Farber Cancer Institute, Boston, MA, USA.

261/13/2014

Whats Helping Patient Safety Research?


27/40

Fast Forward to 2013A Joint Presentation to International Leaders at

Harvard University

1/13/201427

Shari Berman, Co-Chair, Adult PFAC, DFCI


28/40

Patient and Family Advisory Councils

Mandatory in Mass HospitalsThe purpose of this letter is to inform

hospitals of their obligation to establish

a Patient and Family Advisory Council

(PFAC), as set out in the hospital

licensure regulation effective June 12,2009. A copy of these sections is

enclosed. The regulations require each

hospital to establish a PFAC by October

1, 2010; and each hospital must prepare

a report outlining its plan to establish aPFAC no later than September 30,

2009

1/13/201428

http://www.ipfcc.org/advance/topics/Review-of-PFAC-2011-Reports.pdf

Whats Helping Drive State Policy?

P ti t d F il C t d C
http://www.ipfcc.org/advance/topics/Review-of-PFAC-2011-Reports.pdfhttp://www.ipfcc.org/advance/topics/Review-of-PFAC-2011-Reports.pdfhttp://www.ipfcc.org/advance/topics/Review-of-PFAC-2011-Reports.pdfhttp://www.ipfcc.org/advance/topics/Review-of-PFAC-2011-Reports.pdfhttp://www.ipfcc.org/advance/topics/Review-of-PFAC-2011-Reports.pdfhttp://www.ipfcc.org/advance/topics/Review-of-PFAC-2011-Reports.pdfhttp://www.ipfcc.org/advance/topics/Review-of-PFAC-2011-Reports.pdfhttp://www.ipfcc.org/advance/topics/Review-of-PFAC-2011-Reports.pdfhttp://www.ipfcc.org/advance/topics/Review-of-PFAC-2011-Reports.pdfhttp://www.ipfcc.org/advance/topics/Review-of-PFAC-2011-Reports.pdf


29/40


A Dynamic Push/Pull

PushMaking the Status QuoUncomfortable

Consumer Movement:

It isnt ours alone to decide

Patient Rights

Patient Safety: Voice and face of harm

AHRQ patient reporting

Transparency

Health Reform: Politicians,

Governments, Nations, States Accreditors

AARP, Consumer Reports

NQF, NPP, Picker, Planetree, IFCC,

IHI, Lucian Leape Institute, WHO

Making the Future Attractive

Organizing the healthcare systemaround the patient and family

Optimizing the patient experience Correlates with other outcomes

including staff satisfaction andfinancial outcomes

Patient Centered Outcomes ResearchInstitute

Patient activation/self management Great stories and results busting out

all over: IHI BMJ International Forum Health care organizations Associations

Its the right thing to do

291/13/2014


30/40

Primary Drivers Inpatient PFCC

Governance and executive leaders demonstratethat NOTHING is more important in the culturethan patient- and family-centered carepracticed everywhere in the hospital.

The hearts and minds of staff and providers are

fully engaged. Every care interaction is anchored in a

respectful partnership anticipating andresponding to patient and family needs(physical comfort, emotional, informational,

cultural, spiritual and learning). Hospital systems deliver reliable quality care

24/7.

The care team instills confidence by providingcollaborative, evidenced-based care.

30http://www.ihi.org/IHI/Results/WhitePapers/AchievingExceptionalPatientFamilyExperienceHospitalCareWhitePaper.htm 1/13/2014
http://www.ihi.org/IHI/Results/WhitePapers/AchievingExceptionalPatientFamilyExperienceHospitalCareWhitePaper.htmhttp://www.ihi.org/IHI/Results/WhitePapers/AchievingExceptionalPatientFamilyExperienceHospitalCareWhitePaper.htmhttp://www.ihi.org/IHI/Results/WhitePapers/AchievingExceptionalPatientFamilyExperienceHospitalCareWhitePaper.htm


31/40

Innovations to Advance Genuine

Partnerships with Patients/Families

31

IOM Rule Example

Care is

customized

Open visitation

Family participation in care

Patients establish daily goals

Patient issource of

control

P&F activated rapid response teams Patient choice in meal selection

P&F participation in change of shift report and

multidisciplinary rounds

Knowledgeis shared

Access to medical records Providing effective teaching and facilitating learning

Needs are

anticipated

Conduct observations of patient experiences

Observe peace and quiet times

Taylor, Rutherford. The Pursuit of Genuine Partnerships with patient and family members; the challenge and opportunity

for executive leaders. Frontiers of Health Services. 2010. 26:4.1/13/2014

Patient and Family Centered Care Is


32/40

Patient and Family Centered Care Is

Person Centered Care Is

32

Location Examples

Environment Community,

Region, State,

Province

Community groups

Care Coordination, ACOs, Medical Homes

Advanced care planning, POLST, MOLST

School & church programs

Public health & other consumer campaigns

Organization Health System,Trust, Hospital,

Nursing Home

Experience SurveysP&F Councils, Advisors, Faculty

Resource Centers, patient portals

Access to help and care 24/7

Medication lists

Micro-system Clinic, Ward, Unit,

ED, Delivery

Parent, Advisors, & advisory councils

Open access, optimized flow

Family participation in rounding

Experience of

care

Bedside, Exam

Room, Home

Access to the chart

Shared care planning

Smart Patients Ask Questions

Balik B, Conway J, Zipperer L, Watson J. Achieving an Exceptional Patient and Family

Experience of Inpatient Hospital Care. Cambridge, Massachusetts: 2011.1/13/2014


33/40

In health care, the overarching goal for providers, aswell as for every other stakeholder, must be

improving value for patients, where value is defined

as the health outcomes achieved that matter to

patients relative to the cost of achieving thoseoutcomes. Improving value requires either

improving one or more outcomes without raising

costs or lowering costs without compromising

outcomes, or both.Failure to improve value means, well, failure.

T. Lee & Michael Porterhttp://hbr.org/2013/10/the-strategy-that-will-fix-

health-care/

Strategy That Will Fix Healthcare
http://hbr.org/2013/10/the-strategy-that-will-fix-health-care/http://hbr.org/2013/10/the-strategy-that-will-fix-health-care/http://hbr.org/2013/10/the-strategy-that-will-fix-health-care/http://hbr.org/2013/10/the-strategy-that-will-fix-health-care/http://hbr.org/2013/10/the-strategy-that-will-fix-health-care/http://hbr.org/2013/10/the-strategy-that-will-fix-health-care/http://hbr.org/2013/10/the-strategy-that-will-fix-health-care/http://hbr.org/2013/10/the-strategy-that-will-fix-health-care/http://hbr.org/2013/10/the-strategy-that-will-fix-health-care/http://hbr.org/2013/10/the-strategy-that-will-fix-health-care/http://hbr.org/2013/10/the-strategy-that-will-fix-health-care/http://hbr.org/2013/10/the-strategy-that-will-fix-health-care/http://hbr.org/2013/10/the-strategy-that-will-fix-health-care/http://hbr.org/2013/10/the-strategy-that-will-fix-health-care/http://hbr.org/2013/10/the-strategy-that-will-fix-health-care/


34/40

IOM Report:

Best Care at Lower Cost

Improved patient engagement is

associated with better patient experience,health, and quality of life and better

economic outcomes, yet patient and

family participation in care decisions

remains limited.

iom.edu/bestcare

341/13/2014
http://www.iom.edu/bestcarehttp://www.iom.edu/bestcare


35/40

Patient Clinician Partnerships

Specific Recommendation

Engaged, empowered patientsA learning

health care system is anchored on patient

needs and perspectives and promotes theinclusion of patients, families, and other

caregivers as vital members of the

continuously learning care team.

351/13/2014


36/40

We are collectively anchored on patient

needs and perspectives and we promote the

inclusion of patients, families, and other

caregivers as vital members of the

continuously learning care team.

1. Strongly disagree

2. Disagree

3. Neither4. Agree

5. Strongly Agree

1/13/2014 36


37/40

A Powerful Evolution

Do it to me.Do it for me.

Do it with me.Martha Hayward

Patient Advocate

371/13/2014


38/40

Questions, Comments

Quality improvement begins with love and vision.

Love of your patients. Love of your workIf you begin with technique,

improvement wont be achieved.

A. Donabedian, M.D381/13/2014


39/40

Great New Resource

1/13/2014 39

http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/patfamilyengageguide/howtogetstarted/index.html
http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/patfamilyengageguide/howtogetstarted/index.htmlhttp://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/patfamilyengageguide/howtogetstarted/index.html


40/40

Selected Bibliography for Conway

PresentationDFCI Articles Reid Ponte, P, Donlin G, Conway JB, Grant S, Medeiros C, Nies J, Shulman L, Branowicki P, Conley K. Making

patient-centered care come alive, achieving full integration of the patients perspective. JONA 2003; 33:82-90.

Conway J., Nathan DG, Benz E, et al. Key learning from the Dana-Farber Cancer Institutes ten-year patient

safety journey. In Am Soc Clin Oncol 2006 Ed Book. 42nd Annual Meeting, Atlanta, GA, 2006:615-619.

General PFCC Articles

Conway J, Johnson B, Edgman-Levitan S, Schlucter J, Ford D, Sodomka P, Simmons L. Partnering with patients

and families to design a patient- and family-centered health care system: a roadmap for the future. A work in

progress. Institute for Family-Centered Care and Institute for Healthcare Improvement; June 2006

Johnson B, Abraham M, Conway J, Simmons L, Edgman-Levitan S, Sodomka P, Schlucter J, Ford D. Partnering

with patients and families to design a patient- and family-centered health care system: recommendations and

promising practices. Bethesda, Maryland: Institute for Family-Centered Care and the Institute for Healthcare

Improvement; April 2008.

Balik B, Conway J, Zipperer L, Watson J. Achieving an Exceptional Patient and Family Experience of Inpatient

Hospital Care. IHI Innovation Series White Paper. Cambridge, Massachusetts: Institute for Healthcare

Improvement; 2011. Conway J. Public and Patient Strategies to Improve Health Systems Performance. In: Olsen LA, Saunders RS, and

McGinnis JM. Patients Charting the Course: Citizen Engagement in the Learning Healthcare System. The

Learning Healthcare System Series. 2011. Institute of Medicine.

1/13/2014
http://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://journals.lww.com/jonajournal/Abstract/2003/02000/Making_Patient_centered_Care_Come_Alive__Achieving.4.aspxhttp://journals.lww.com/jonajournal/Abstract/2003/02000/Making_Patient_centered_Care_Come_Alive__Achieving.4.aspxhttp://journals.lww.com/jonajournal/Abstract/2003/02000/Making_Patient_centered_Care_Come_Alive__Achieving.4.aspxhttp://journals.lww.com/jonajournal/Abstract/2003/02000/Making_Patient_centered_Care_Come_Alive__Achieving.4.aspxhttp://www.asco.org/ascov2/Education+&+Training/Educational+Book?&vmview=edbk_detail_view&confID=40&abstractID=615http://www.asco.org/ascov2/Education+&+Training/Educational+Book?&vmview=edbk_detail_view&confID=40&abstractID=615http://www.asco.org/ascov2/Education+&+Training/Educational+Book?&vmview=edbk_detail_view&confID=40&abstractID=615http://www.asco.org/ascov2/Education+&+Training/Educational+Book?&vmview=edbk_detail_view&confID=40&abstractID=615http://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamilies.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamilies.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamilies.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.ihi.org/knowledge/Pages/IHIWhitePapers/AchievingExceptionalPatientFamilyExperienceInpatientHospitalCareWhitePaper.aspxhttp://www.ihi.org/knowledge/Pages/IHIWhitePapers/AchievingExceptionalPatientFamilyExperienceInpatientHospitalCareWhitePaper.aspxhttp://www.ihi.org/knowledge/Pages/IHIWhitePapers/AchievingExceptionalPatientFamilyExperienceInpatientHospitalCareWhitePaper.aspxhttp://www.iom.edu/Reports/2011/Patients-Charting-the-Course-Citizen-Engagement-in-the-Learning-Health-System-Workshop-Summary.aspxhttp://www.iom.edu/Reports/2011/Patients-Charting-the-Course-Citizen-Engagement-in-the-Learning-Health-System-Workshop-Summary.aspxhttp://www.iom.edu/Reports/2011/Patients-Charting-the-Course-Citizen-Engagement-in-the-Learning-Health-System-Workshop-Summary.aspxhttp://www.iom.edu/Reports/2011/Patients-Charting-the-Course-Citizen-Engagement-in-the-Learning-Health-System-Workshop-Summary.aspxhttp://www.iom.edu/Reports/2011/Patients-Charting-the-Course-Citizen-Engagement-in-the-Learning-Health-System-Workshop-Summary.aspxhttp://www.iom.edu/Reports/2011/Patients-Charting-the-Course-Citizen-Engagement-in-the-Learning-Health-System-Workshop-Summary.aspxhttp://www.iom.edu/Reports/2011/Patients-Charting-the-Course-Citizen-Engagement-in-the-Learning-Health-System-Workshop-Summary.aspxhttp://www.ihi.org/knowledge/Pages/IHIWhitePapers/AchievingExceptionalPatientFamilyExperienceInpatientHospitalCareWhitePaper.aspxhttp://www.ihi.org/knowledge/Pages/IHIWhitePapers/AchievingExceptionalPatientFamilyExperienceInpatientHospitalCareWhitePaper.aspxhttp://www.ihi.org/knowledge/Pages/IHIWhitePapers/AchievingExceptionalPatientFamilyExperienceInpatientHospitalCareWhitePaper.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamilies.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamilies.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamilies.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamilies.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamilies.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamilies.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamilies.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamilies.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamilies.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamilies.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamilies.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamilies.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamilies.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamilies.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamilies.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamilies.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamilies.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.asco.org/ascov2/Education+&+Training/Educational+Book?&vmview=edbk_detail_view&confID=40&abstractID=615http://www.asco.org/ascov2/Education+&+Training/Educational+Book?&vmview=edbk_detail_view&confID=40&abstractID=615http://www.asco.org/ascov2/Education+&+Training/Educational+Book?&vmview=edbk_detail_view&confID=40&abstractID=615http://www.asco.org/ascov2/Education+&+Training/Educational+Book?&vmview=edbk_detail_view&confID=40&abstractID=615http://www.asco.org/ascov2/Education+&+Training/Educational+Book?&vmview=edbk_detail_view&confID=40&abstractID=615http://www.asco.org/ascov2/Education+&+Training/Educational+Book?&vmview=edbk_detail_view&confID=40&abstractID=615http://www.asco.org/ascov2/Education+&+Training/Educational+Book?&vmview=edbk_detail_view&confID=40&abstractID=615http://www.asco.org/ascov2/Education+&+Training/Educational+Book?&vmview=edbk_detail_view&confID=40&abstractID=615http://journals.lww.com/jonajournal/Abstract/2003/02000/Making_Patient_centered_Care_Come_Alive__Achieving.4.aspxhttp://journals.lww.com/jonajournal/Abstract/2003/02000/Making_Patient_centered_Care_Come_Alive__Achieving.4.aspxhttp://journals.lww.com/jonajournal/Abstract/2003/02000/Making_Patient_centered_Care_Come_Alive__Achieving.4.aspxhttp://journals.lww.com/jonajournal/Abstract/2003/02000/Making_Patient_centered_Care_Come_Alive__Achieving.4.aspxhttp://journals.lww.com/jonajournal/Abstract/2003/02000/Making_Patient_centered_Care_Come_Alive__Achieving.4.aspxhttp://journals.lww.com/jonajournal/Abstract/2003/02000/Making_Patient_centered_Care_Come_Alive__Achieving.4.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspxhttp://www.ihi.org/knowledge/Pages/Publications/PartneringwithPatientsandFamiliesRecommendationsPromisingPractices.aspx

pqcnc 2014 annual meeting jim conway

Documents