pre-learning session survey highlights
TRANSCRIPT
Presented by:Darcy Shargo, MFA
Chief Operating Officer,
Maine Primary Care Association
February 28, 2012
What needs to happen to integrate quality improvement and patient engagement?
“Simply restructuring the system is probablynot sufficient to facilitate improved patient
navigation. The culture of health carealso has to change. That is, patients needto be seen as partners in care, and theyneed better education about what to do
and why it will make a difference.”
RWJF Issue Brief,
Improving Quality Health Care: The Role of Consumer Engagement,
October 2007
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Maine’s PCMH Pilot– Convened by Maine Quality Forum, Maine Quality Counts, Maine Health Management Coalition– Originally, 3‐year multi‐payer PCMH pilot (now 5 yrs)– Collaborative effort of key stakeholders, most major payers– Adopted common mission & vision, guiding principles for Maine PCMH model– Selected 22 adult / 4 pediatric PCP practices across state‐will be expanding to 20 more adult by 2013– Supporting practice transformation & shared learning beyond pilot practices– Committed to engaging consumers/ patients at all levels– Conducting outcomes evaluation (clinical, cost,patient experience of care)
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PCMH Core Expectation # 7 Inclusion of Patients and Families
7A With assistance from PCMH Pilot staff and consultants, practice has identified at least two patients or family
members to be part of the practice leadership team.
7B Practice is using one of more mechanisms for routinely soliciting input from patients and families on how well the
practice is meeting their needs
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Patients are the “glue for ultimate success”
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“As healthcare continues to be increasingly patient driven, patients, as the
ultimate consumers of their own healthcare, will be called on to
ensure
exceptional healthcare for themselves and their families. As physician
practices, hospitals, and clinics in far‐flung geographic areas continue to
be tied together by healthcare technology, the coalescing glue for
ultimate success will be an attentive and alert patient working
together with his or her healthcare entity to improve health and
ensure that vital clinical information is available at the point
of care
at the moment of need. This is an essential step in the transformation of
the healthcare delivery system into a system for the delivery of
health.”
— John Tempesco, Chief Marketing, Officer for Informatics
Corporation of America
What Patient Engagement Does for Primary Care Practice
Engaging patients in better communication means getting them at the table as quality improvement projects are designed and implemented (nothing about me without me).Most quality measures do not measure across an episode of care. As P4P, ACOs, and other payment reforms kick in, patient input will be critical to the development of new measures that track patients as they navigate the health care system.Since face‐to‐face interactions between providers and patients in the ambulatory setting are limited and occur weeks to months apart, patients must assume a much greater role in and responsibility for managing their own health. 6
PCMH Pilot in Maine: Patient Engagement Activities
Designed survey/interview to discover pilot practices’ approaches to meeting the pilot’s pt. engagement core expectation (7 A and 7 B)
Conducted interviews with practices from April‐August 2011
100% of the practices participated in the survey
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Overview of Survey QuestionsThe interview consisted of 14 questions: Questions 1‐7 about advisory group development
Questions 8‐14 about mechanisms for patient engagement outside the advisory group
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Survey Results: Establishing an Advisory Group
14 PCMH pilot practices (54% of sites) have on‐going advisory groups
3 PCMH pilot practices (11.5% of sites) advisory groups that have met at least once
6 PCMH pilot practices (23% of sites) plan to meet by the end of this year
3 PCMH pilot practices (11.5% of sites) requested planning support to get a group going
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Survey Results: Recruitment EffortsVariedProviders and/or other staff invited patientsPatients invited by letter and/or in personBrochures in lobby, other community settingsApplication at front desk/waiting areaBulletin Board used to advertiseAdvertisement in newspaper
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Survey Results: Orientation ContentVariedExchanges with Other PracticesCame to PCMH Learning SessionsIPFCC website, webinar or boot campOn site consultationUsed hospital or parent organization
SPECIFIC ORIENTATION TOPICS DISCUSSED:What is PCMHDescribing the practiceWhat is HIPAACreating group roles, mission, etc.Signed commitment statements
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Other Forms of Patient EngagementSurveys: AVATAR, Press Ganey, Pickar, CAHPs, homegrown,
or “Question of the Day/Week/Month”
Informal Dialogue: practice manager rounding daily in waiting room; follow up calls re: experience of care;
providers asking, “how was your experience today?”
Written Communication: Website where patients can leave comments, practice newsletters, bulletin board in lobby
with PAG minutes and meeting notices; patients maintain practice bulletin board; comment boxes in all waiting
rooms; “attaboys”
in the front check in desk
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Survey Results: Key Challenges
Getting groups started
Finding a group focus
Finding enough staff and time
Keeping steady patient groups
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Operationalizing Pt EngagementAreas where patient feedback has driven change in Maine’s
PCMH pilot sites:Phone systemTriage SystemOpen accessTimely access‐referralsWaiting providers during and before appointmentFront Office IssuesWalk‐throughSelf‐CareCommunity: Resource Information, Perception and Involvement
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Ingredients for Success:Culture change
Boardrooms to Front Office Willing leadershipStrong meeting/team facilitation Comfort with “ebb and flow” of patient & staff involvementPersistenceShared learning with peers who are grappling with the same challengesBeing creative with what you already have
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Clarity, Trust, Consistency and Competence
Ingredients for success only work if the practice is moving toward true partnership
with patients, using these elements:Clarity: How does your practice gain understanding of what matters to patients and to staff who partner with them?
Trust: How does your practice encourage relationships and allow “humanness” in every interaction?
Consistency: How does your practice show its commitment to patient engagement beyond the latest fad or crisis?
Competence: Are patient engagement expectations built into job descriptions? Are staff getting training they need to provide support for patient engagement? Are patients given the support and training they need to be effective and efficient change agents?
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Sustainability‐the Next Challenge
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Developing a statewide framework for patient and consumer engagement beyond all the pilots
Three “buckets” of engagementActive partner in care (self‐management, support groups, linking to QI data to make better choices about who provides care)Peer Supporter (Serve as Living Well instructor, become peer navigator)Practice Change Advisor/Policy Advisor/Champion for Change (work with primary care practice, serve on BODs)
Linking these engagement roles to a statewide advisory group on patient and consumer engagement work
through Quality Counts Board of Directors
Partnering with Patients
“Patients give you insight into what you cannot see yourself.”
“Providers now go to patients first when they want to know how to change something that
isn’t working.”
“Patient Engagement is the hardest core expectation but the most fun.”
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