the role of management in establishing and sustaining a patient advisory committee
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Addiction Research and Treatment Corporation Developing and Implementing Patient Advisory Committees in Opioid Dependency Maintenance Programs. Presented by: Robert E. Sage, Ph.D., CASAC Monica A. Joseph, CSW, M.Phil. Ralph E. Savarese, M.Ed. - PowerPoint PPT PresentationTRANSCRIPT
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Addiction Research and Treatment Corporation
Developing and Implementing Patient Advisory Committees in Opioid Dependency
Maintenance Programs
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Presented by:
Robert E. Sage, Ph.D., CASAC
Monica A. Joseph, CSW, M.Phil.
Ralph E. Savarese, M.Ed.
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The Role of Management
in Establishing and Sustaining a
Patient Advisory Committee
Robert E. Sage, Ph.D.Senior Vice PresidentAddiction Research and Treatment Corporation
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Addiction Research & Treatment Corporation (ARTC)
Beny J. Primm, Executive Director
Established in 1969
Seven (7) Opioid Treatment Programs
Manhattan and Brooklyn
3,000 patients/ 95% minority
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ARTC
Three (3) Outpatient Drug Free Programs
Research, Evaluation and Continuous Quality Improvement
CARF Accredited
Comprehensive Care
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Rationale for Establishing a
Patient Advisory Committee
(PAC)
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Identifying the unmet needs of the agency
:Perception of opioid treatment
Perception of program in the community
Building staff-patient alliances
Obtaining patient feed-back
Patient recruitment and retention
Creating a clinic community
Enhancing accreditation outcomes
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Identifying Unmet Needs of Patients
Alternative ways to enhance treatment
Patient input in program policy
(clinic policy vs regulations/ standards
Enhancing initial patient integration and socialization within the program
Outlet for complaints and suggestions
Leadership potential
Pre-vocational activities
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Identifying and Meeting
Your Patient Advisory
Committee (PAC)
Objectives
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Developing Pride in the Treatment Modality
PAC members become mentors
PAC presents positive image to staff and other patients
Patients oriented towards treatment
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Enhancing Program Image in the Community
PAC leaders become spokespersons
Community projects and events
Representatives of the program
Encourage feedback from the community
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Developing Patient Leaders
Organizing and maintaining a component
Developing and organizing clinic activities
Mentors or “buddies” to new patients
Working within a component
Encouraging patients to become “part of the solution”
Enhancing treatment progress
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Enhancing Patient Feedback and Input
Presenting ideas to administration and staff
Assisting with patient complaints/ feedback
Administering Satisfaction Surveys
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Initiating a
Patient Advisory Committee
(PAC) Component
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Support from Executive Staff
Commitment to addressing needs
Perceiving PAC as a positive strategy
Commitment to outcomes
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Support from Program Managers and
Staff
Addressing and reducing concernsIdentifying positive aspectsDeveloping a unified missionAddressing workload issuesBuilding the staff into the process
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Selecting a PAC Coordinator
Central Office
Program Specific
One site vs Multi-Site
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Clinical Staff Investment
in Developing and Implementing
Patient Advisory Committees
Monica A. Joseph, CSW, M.Phil.
Vice President of Treatment Services, Addiction Research and Treatment Corporation
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Patient Advisory Committee
(PAC) Development
as a Social Process
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Agency Culture
Each agency has culture of its own, i.e. accepted norms, values (Glisson, 2000), ways of doing
Established by management, but staff must support
Dynamic as agency as a whole must respond to the internal and external environment for survival
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Agency Culture
Individual staff must also grow/ respond for survival
Not all staff equally responsive
Majority will not buy into the value of new initiatives until they see that others are okay with and already participating
Initiatives such as PAC must thus be spread through a social process
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Social Process
Social Process called Diffusion
Diffusion Theory (Rogers, 1995) similar to Social Learning (Bandura, 1977)
Stresses that persons adapt observed behaviors through modeling
Diffusion, however, focuses on the outcome, i.e.
What will staff adopt or reject
What role will staff’s social networks play
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Importance of Clinical StaffMust get clinical staff (supervisors, direct practitioners, medical and non-medical staff, etc.) involved and invested:
Constitute the treatment team Have the most contact with patients (especially direct practitioners)Are in the best position to influence the choices that patients makeAre integral to bridging the gap between patient and programmatic activities
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Facilitating the
Diffusion Process
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Cultivating the Critical Mass
Management must focus on getting a core group of staff to buy into/ adopt the idea of PAC and the underlying philosophy
Psycho-graphic profile of the staff can impact, i.e. the combination of their psychological and social/demographic characteristics (Moore, 1991), which can influence their willingness to invest
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Stages of Diffusion
Must be mindful that staff buy-in will occur in stages:
(i) Early Adoption
(ii) Middle Adoption
(iii) Late Adoption
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Targeting Staff
Must also be mindful based on assessment of staff who will be more likely to be the:
(i) Innovative Staff(ii) Early Adopting Staff(iii) Early Majority Adopting Staff(iv) Late Majority Adopting Staff(v) Laggards (Moore, 1991)
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Early Adoption Strategies Goal:
To get to the critical mass of
staff, who will in turn, encourage
patients and other staff to buy-in to
PAC
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Early Adoption StrategiesStep 1: Senior management must champion PAC sending a meta-communication that staff needs to get on board
Step 2: Select and target Innovative Staff, potential Early Adopters, i.e. supervisors, counselors, etc.
Must demonstrate energy, effective interpersonal skillsMust be willing to act as leaders
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Early Adoption Strategies
Send a clear and direct message to the core group about the value of PACGet group to begin to sell PAC to other staff and patients
PAC Coordinator can act as leader
Create climate for staff to demonstrate creativity, e.g. by allow some flexibility with PAC agendas and activities
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Incentives
Make participation attractive by using tangible and intangible incentives, e.g.:
Reductions in staff workload (even if minimal, can still be effective)Opportunities for staff and patients to share their success with othersTransportation assistanceRefreshment Good old praise
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Remember!
More productive to depend on a smaller core group of motivated staff
Ultimately they hold more influence and can establish stronger critical mass
Once reach critical mass, initial development has taken root
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Middle Adoption Strategies
Goal:
To expand the circle of staff and patients
who are involved and invested in the PAC
implementation and integration process
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Expanding staff investment
Target staff who have the potential to become Early Majority and Late Majority Adopters
Early Majority persons want to know that PAC is working before they buy into them
Late Majority Adopters will get on the PAC bandwagon only when they have to
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InteractivityUtilize critical mass (innovators, early adopters) to influence other staff by creating opportunities for staff interactivity
Interactivity is the degree to which staff in a communication process can exchange roles in, and manage their interaction (Williams, Rice, & Rogers, 1988)
Allows staff to begin to process: (i) How can contribute to PAC; (ii) How can adapt the roles to make easier on selves
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InteractivityFacilitates peer to peer feedback as it allows staff to develop a better understanding of what PAC is, what is positive and what is not positive
More benefits perceived, the greater the likelihood that staff will be convinced to adopt
Allows negative feedback to be dealt with appropriately by the Innovators and Early Adopters (critical mass) as they are already invested
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InteractivityFacilitate interactivity between managerial staff and clinical staff
Management’s role is to continue to shape staff’s perceptions of PAC by indicating that:
This continues to be desirable Its implementation is inevitableA core group of staff/patients (the critical mass) have already bought in to the process
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Patient Benefits
Crucial for staff to connect PAC’s benefits to patients
Disseminate the responsibility for interacting with patients about PAC to as many staff as possible
Facilitate by integrating PAC as a treatment tool
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Patient Benefits
Integrate PAC into the treatment process: Discuss with patients during intake, orientation
Include as part of the strategies for attaining and maintaining abstinence on the treatment plan
Utilize as a natural support system for ongoing case management
Encourage patients who have completed treatment to continue to participate
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Late Adoption Strategies
Goal:
To continue to expand and
strengthen clinical staff’s support for
the viability of the PACs
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Dealing with the LaggardsStill need to deal with clinical staff who are Late Adopters, Laggards
Simply don’t want to be part of the process
Can impact the momentum and cause earlier gains to be lost
Only way would become involved is if have no choice
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Dealing with the Laggards
Integrating PAC as part of treatment planning helps to ensure that these staff make some kind of contribution
Managers must be alert for non-productive messages sent by staff in these groups
Counter these with ongoing interactivity and keeping a high profile for PAC
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Dealing with the Laggards
Use information dissemination, regular updates on PAC progress, i.e. posting bulletins, circulating brochures, etc. to keep the message upfront
PAC must encounter problems with patients, consensus, etc. Address these
Engage both staff and patients in the problem solving process
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Demonstrate PAC is Working
Let patients assume an increasingly dominant role to demonstrate that the underlying philosophy is working, i.e.
That patients have the capacity to contribute meaningfully to their own treatment
That patients can provide valuable feedback to improve the organization
That patients can enhance their civic environment
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Summary
Developing, implementing and integrating PAC is a social process
Diffusion principles provide a framework to facilitate staff adoption of PAC
Getting a critical mass can provide the momentum to integrate PAC across the treatment process
Having a PAC Coordinator can guide and nurture the process
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Role of a PAC Coordinator in
Mobilizing and Sustaining
Patient Advisory Committees
Ralph E. Savarese, M. Ed.Director of Training Addiction Research andTreatment Corporation
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Getting Started
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Building the FoundationSetting the stage:
Support from Senior Vice PresidentSenior Staff LiaisonClinic Staff Liaison
Effective communication
Obtaining cooperation and collaboration for patient selection
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Early ImplementationIdentifying specific themes and agendas
Developing Meeting Protocol and Bye-Laws
Ensuring democracy (elections)
Dealing with power issue
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Making it Work
Integrating the clinic components:
Clinical
Recreational
Cultural
Advocacy
Fund Raising
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PAC Responsibilities
Finding a programmatic niche:
Orientation/ Mentoring
Patient Satisfaction Surveys
Patient Spokesperson to Staff/ Program
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Maintaining a High Program Profile
Information DisseminationDedicated Bulletin Boards NewslettersOrientation ParticipationOnsite patient celebrations, eventsCommunity InvolvementIntegrating into Treatment Plan (productive activity, relapse prevention mechanism)
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Growing Pains
Agenda problems
Misconceptions of rules, functions, roles and responsibilities
Patient burnout
Staff burnout
Power vacuums (patient death, illness, separation from program)
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Addressing Problems
Redefining roles:Clinical DirectorStaff Liaisons/ Staff changes Patients
Elections
Increased patient interaction/ support
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Current Status
Number of PACs
Membership
Activities/ projects
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Future Pursuits
Corporate PAC
Increased funding
New projects/ activites
Increased membership
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Summary
PAC Coordinator serves role of bringing various components together
Instrumental in recruitment, keeping patients focused
Troubleshooter for emerging problems
Anticipates needs of specific sites
Serves as morale booster for patients
Provides timely feedback to management
Reinforces the mission of the agency
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Bibliography
Bandura, A. (1977). General theory: Social Learning Theory. Englewood Cliffs, NJ: Prentice-Hall.
Glisson, C. (2000). Organizational climate and culture. Handbook of Social Welfare Management. D. R.J. Patti. CA: Sage Publications, Inc.
Moore, G. (1991). Crossing the chasm. NY: Harper Row.
Rogers, E. (1995). Diffusion of Innovations. NY: The Free Press.
Williams, F., Rice, R. & E. Rogers (1988). Research Methods and the New Media, New York: The Free Press.