where we’re going… partnering with patients: a bed’s eye view...pfcc, pfe & px so many new...

2/29/2016

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Partnering with Patients:

A Bed’s Eye View

Tiffany Christensen

Where we’re going…

A “Hybrid Patient” Perspective

•Defining PFCC•Operationalizing PFCC

via TeamSTEPPS•Burn out

Thinking in a PFCC way re:•Patient Advisory Councils•Patient Activation

Why the culture change?

*Pts with more access to information* Competitive markets

* Questions about boundaries and rights

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PFCC, PFE & PXSo many new words for how wecare for patients and families!

~The Institute for Patient and Family Centered Care

Patient- and family-centered care is an approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care providers, patients, and families. It redefines the relationships in health care.

Providing care that is respectful of, and responsive to, individual patient preferences, needs, and values; and ensuring that patient

values guide all clinical decisions.

~Institute of Medicine

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So how do we keep up with shifting expectations?

How do we improve the patient experience while attending to so

many other demands?

“My organization is working at improving

the patient experience by being more patient and family centered

but not all of our staff/leaders are on board. What can we

do to help them understand the

importance of this effort?”

Answer:

Always start with STORY…

A Bed’s Eye View

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Diagnosed at 6 months old with the

gift of cystic fibrosis

I had a relatively normal childhood

I had my first hospital stay at

Age 12

I had three weeks of intravenous

antibiotics and got my first taste for

the need to be an advocate

This was just the beginning…

There would be countless more days spent in the hospital during my

lifetime

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By age 21, I was sick almost all of the time.

I was attending the North Carolina School of the Arts and

I just couldn’t keep up.

I had to give up my Hollywood dreams and drop out.

I was on oxygen getting tube feedings.

The doctors put me on the

list for a bilateral lung transplant.

I waited 4 years for my “call”

I was 95 pounds and my lung function was

25% of capacity

Facing Medical Error

Surgical Error:

“Wet Run” and an apology

Ripple Effect of Reactions:

In the OR

In the Transplant Protocols

In Safety Procedures Hospital Wide

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Patient and Family Centered Care Guiding Principle:

Information Sharing I waited 1 more year for my first set of donor lungs

Now, due largely to the surgical error,

I was 87 pounds and my lung function was

18% of capacity

April 4th, 2000


Participation

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A patient perception of a short walk I was healthier and puffier than ever before!

I traveled a winding road of confusion and self-doubt.

I didn’t know how I wanted to make my mark on this world.

I didn’t know how to live a life with healthy lungs.

In June of 2002, my lung function started to drop.

I was diagnosed with my second terminal illness 6

months later. I had Chronic

Rejection.

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The Deafening Diagnosis

Within two years, my lung function had dropped to 10% of

capacity.

I was 73 pounds.

I was dying and the doctors gave me 6 more months to live.

Loss of Purpose and Worth

I asked my doctors if I

could have a second lung transplant.

They said no.

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After the stages of grief…the soft arms of acceptance I reconnected with

the understanding of my childhood

CF was my greatest teacher

and I was grateful

I was at peace

We got a new transplant

coordinator.

Only 4 months after I was listed,I got “the call”

My fear was overwhelmingGoing into the OR, I was looking

for comfort

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Patient and Family Centered Care Guiding

Principle:

Dignity and Respect

On March 28, 2004

Despite my team’s

concern, the recovery was easier than

the first time.

Unlike after the first time, I was not confused about what to do

with my life.

I felt a strong calling to reach out to others touched by illness.

I wanted to share what I had learned…

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Loved and Lost Love…again

And…again

And…again

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And…again

Sister, Daughter, Friend

And working on that other thing...

Duke PAC

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Preaching Partnership!

News flash:Patients are not all like me!

• Experience with healthcare

• Cultural/family/regional background carrying conscious or unconscious beliefs

• Motivation based on illness, prognosis etc

• Support varying from invasive to non-existent

• Socio-economic background shifting focus or worry from health to something else (including health literacy)

• Personality!

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Is Partnership Possible?I was tired

• Less compassion—more a survival mode

• Saw a disappointing view of humanity

Overall, I saw other people…

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First, I had to understand my state of being

• Emotional exhaustion

• Depersonalization

• Inefficacy

(I now know these are the

top 3 signs of burnout)

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All of the symptoms of burnout block partnership Creating authentic partnership

can help to alleviate burnout

PFE = Kelly Clarkson

Sick Girl Speaks:The Power ofPartnership?

Part 2

Tiffany Christensen

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Where were we?

Understanding Burnout

• Emotional exhaustion

• Depersonalization

• Inefficacy

What do these terms mean

to you?

All of the symptoms of burnout block partnership

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What do you think are the primary contributors to MD

burnout?

Top 3 primary contributors to MD burnout

• EMR

• Mismatch of values between MD and organization/administration

• Social relationships at work

Shannon, Diane W., 2014, Written for the Beryl Institute“An Invisible Barrier to Compassionate Care: The Implications of Physician Burnout on Patient & Family Experience”

What do you think are the primary

contributors to RN burnout?

Top 3 primary contributors to RN burnout:

• Social conflict

• Relationships between MDs and RNs

• Inadequate staffing

Vahey, D. C., Aiken, L. H., Sloane, D. M., Clarke, S. P., & Vargas, D. (2004). Nurse Burnout and Patient Satisfaction. Medical Care, 42(2 Suppl), II57–II66. http://doi.org/10.1097/01.mlr.0000109126.50398.5a

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https://www.studergroup.com/industry-impact/healing-physician-burnout

ReducingBurnout

with PFE Best

Practices

Burnout symptoms and PFE “Turn Arounds”

Feeling a lack of efficacy

Symptom Authentic partnership

“Turn Around”

Build out the team

with Patient

Activation

PFE Best Practice

DepersonalizationSymptom Lower stress“Turn

Around”Stories, tell more stories and tell

another

PFE Best Practice

Emotional exhaustionSymptom

Connect and

revitalize

“Turn Around”

Work with PFAs

PFE Best Practice



SymptomAuthentic

partnership“Turn

Around”

Build out the team

with Patient Activation

PFE Best Practice


Around”

Stories, tell more stories

and tell another

PFE Best Practice

Emotional exhaustionSymptom

Connect and

revitalize

“Turn Around”

Work with PFAs

PFE Best Practice

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What causes emotional exhaustion?

Burnout is a state of emotional, mental, and physical exhaustion caused by excessive and prolonged stress. It occurs when you feel overwhelmed and unable to meet constant demands.

Burnout reduces your productivity and saps your energy, leaving you feeling increasingly helpless, hopeless, cynical, and resentful. Eventually, you may feel like you have nothing more to give.

•http://www.helpguide.org/articles/stress/preventing-burnout.htm

Address emotional exhaustion by working with PFAs

Why? Because when it’s done well, it is FUN and FULLFILLING!


Collaboration

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How do we primarily receive patient/family feedback?

How is the feedback we get from PFAs different?

Choose PFAs wisely:Choose PFAs wisely:

● The ability to work and communicate in the spirit of partnership and in an environment of mutual respect

● An outlook that is solution-focused without having a specific “agenda”

● The ability to serve as a representative voice

● An aptitude for constructive collaboration

● A teachable spirit

•Structure and plan

•Train PFAs

•Leader support and participation

•Create an environment of mutual respect

•Discover a perspective that you would have never otherwise have known!

•Love working with patient/family partners as a reminder of why you got into medicine

Create a fulfilling experience by approaching

the work strategically:

Create a fulfilling experience by approaching

the work strategically:

PFAC Table

Task Groups

Peer Rounding, Interviewing staff/leaders and otherwise integrated into operations

PFAs in RCAs

PFAs as Patient Activation Coaches

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We can not improve the patient experience unless we have patients and families sitting with us at the table of change!




“Turn Around”

Build out the team

with Patient

Activation

PFE Best Practice


Around”Stories, tell more

stories and tell another

PFE Best Practice

Emotional exhaustion

SymptomConnect

and revitalize

“Turn Around”

Work with PFAs

PFE Best Practice

First step to culture change: STORY

Noah’s mom, Tanya, who was asked “is he vomiting blood?”

Whit, bride-to-be who didn’t want that chest tube

Lisa, daughter who knew that something was wrong

The patient/family story is not the only story that needs to be told!

Tell your story, keeping it to yourselfmakes you tired

Go deeper than usual

Connect with the reality of what you do, see, feel

Take an honest assessment of what is hardTake an honest assessment of what is meaningful

Take an honest assessment of how you canbetter support yourself

Address emotional exhaustion

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Practice

Tell your story

Keeping it to yourselfmakes you tired

Go deeper than usual

Take some time and write it down

Share it

Think of a timein healthcare:“I was never

the same afterthat…”




“Turn Around”

Build out the team

with Patient

Activation

PFE Best Practice


Around”

Stories, tell more stories

and tell another

PFE Best Practice

Emotional exhaustionSymptom Connect and

revitalize“Turn

Around”Work with

PFAsPFE Best Practice

Why do we feel we are not effective in our healthcare roles?

• Same problems, challenges and patterns of behavior over and over

• Not enough time with patients/families; too much time documenting etc.

• Patients and families who are disrespectful (sometimes, even mean)

• Patients who make demands of providers without personal accountability for own health, well-being etc.

The recent evolution of roles:Our challenge and our opportunity

PassivePassive Advocate (reactive)Advocate (reactive)

Activated

(pro-active)

Activated

(pro-active)

Dictate care

Dictate care

Consider patient input

Consider patient input

Co-design care planCo-design care plan

Patients and Families

Healthcare Providers

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We trust the education and skills of the provider. Now it’s time for the provider

to help the patient trust him/herself. A bird sitting on a tree

is never afraid of the

branch breaking

because her trust is not

on the branch,

but on her own wings.

Staying the course even under stress

Taking action to maintain

and improve one’s health

Having necessary

confidence & knowledge to take action

Believing the patient role is

important

Adapted from Patient Activation Measure (PAM)

Patient Activation

Passive

Advocates

Activated Dictate Care

Consider pt. input

Co-Design

Care

Patients & Families Healthcare Providers

Improved adherenceImproved safetyReduced readmissionsReduced ED visitsImproved overall outcomes

Optimization of Care

Activation addresses many of today’s most pressing concerns

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Health Disparities and Inequity are often ignored OR

misinterpreted as noncompliance, resistance or a lack of desire to get well.

This contributes to a feeling of lack of efficacy as a healthcare provider.

We must reframe the way we see our patients/families.

We must be the safe space.This will help reduce burnout.

• Smoking cessation in

the Southside of Chicago

• Improved diabetes outcomes in rural NC

Where do we begin?

THE PLATINUM RULE• Diversity respected

• Fewer missed opportunities

• Improved satisfaction

Building out the team:“Ensure patient values

guide all clinical decisions”

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TeamSTEPPS• An evidence-based teamwork system to improve

communication and teamwork skills among health care professionals. (Based on the aviation model of safety)

• Scientifically rooted in more than 20 years of research and lessons from the application of teamwork principles.

• Developed by Department of Defense's Patient Safety Program in collaboration with the Agency for Healthcare Research and Quality.

• Increases team awareness and clarifies team roles and responsibilities.

• Resolves conflicts and improves information sharing.

• Eliminates barriers to quality and safety.

Yes and….

Where is the patient?

SBAR for PFEPartnering for Action

A technique for communicating in a clear, concise and complete way when time is of the essence. This strategy specifically streamlines the intake process so that a patient’s symptoms, pain, concerns etc. can be addressed more quickly.

Situation/Symptoms -- What has brought you in to be seen?

Background: -- Write down 1-3 sentences describing your medical history.

Assessment: -- Have you ever had these symptoms before? If so, what happened? If not, what do you think might be going on?

Recommendation Request: -- What do you need? That includes immediate needs, like a blanket, and needs for home or discharge, like a prescription refill.

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CUS for PFEFor times of frustration or confusion

I am CARED!

Taught to patients and families at admission and in other environmentswhere patients and families shouldbe utilized to ensure information sharedis accurate and complete

Example from Madigan Hospital inTacoma, Washington:

Admitting Team Member(s):

“At any time during this admission, if you have a safety concern or a crucial question, please let us know so wecan discuss your concerns as a team.

This is called a safety Call Out.

To make it easier to do this, we ask allof our patients and families to make the“time out” symbol with their hands toalert us that you have a safety call out.

Let’s try it.”

CALL OUT for PFEPartnering for Safety

A strategy to empower patients and families to communicate important or critical information

“in the moment”

Watch “CUS for Patients” in action at sickgirlspeaks.com: go to “our videos”

Activation is a process

One Step at a Time Patient: One simple “job” at a time

Eager Patient and Family: Track own data and medicines

Expert Patient and Family: Coach peer patients

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What is the value add in building out the team?

(Think: reducing burnout)

Safety isn’t just about our bodies!

Emotional Safety

Emotional Safety

Betty’s story…

Examine this story from

the perspective of PFCC.

Using the 4 Guiding Principles discuss:

• How safe is if for Betty to go home today?

• How might the conversation have gone differently?

4 PFCC Guiding Principles

• Respect and dignity

• Information Sharing

• Participation

• Collaboration

Using the 4 Guiding Principles discuss:

• How safe is if for Betty to go home today?

• How might the conversation have gone differently?

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PFE = Kelly Clarkson

It’s a Ripple Effect.

Board of Directors/Trustees

Healthcare Administration

Direct Patient Care

Support Staff

Patient-Centered Care at Every Step

Thank you!!

Tiffany ChristensenPatient & Family Engagement Specialist, (919) 677-4119

www.sickgirlspeaks.com

Find me on Facebook:

“Tiffany Christensen is

Sick Girl Speaks”

where we’re going… partnering with patients: a bed’s eye view...pfcc, pfe & px so many new...

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