How To Improve Patient And Family Engagement In Hospitals

Transcription

1 MHA Keystone Center Patient & Family Engagement Task Force White Paper October 2013 Authors: Laura Fournier, MA: Project Coordinator, MHA Keystone Center Brittany Bogan: Senior Director, MHA Keystone Center Barbara Lucas, MD, MHSA, CPPS: Project Consultant, MHA Keystone Center Sam Watson, MSA, CPPS: Senior Vice President, MHA Keystone Center Tracey Burtch: Assistant Director, Public Relations and Health Promotion, MHA 1

2 Introduction/Philosophy Despite efforts to improve patient safety and the delivery of high-quality healthcare, patients are often left behind in their own care. Patient and family engagement (PFE) can be defined as bringing the perspectives of patients and families directly into the planning, delivery and evaluation of healthcare, and thereby improving its quality and safety (Institute for Patient- and Family-Centered Care, 2011). Prioritizing patient and family engagement not only optimizes individual patient care, but also results in improvement of numerous measures of hospital performance. According to the Agency for Healthcare Research and Quality, the following areas have seen improvement across hospitals: quality and safety, financial performance, Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospital Survey scores, patient outcomes, market share and competitiveness, employee satisfaction and retention, and The Joint Commission standards. As a leader in patient safety and quality, the Michigan Health & Hospital Association (MHA) Keystone Center is committed to including patients and families in improving care and focusing improvement efforts with a patient-centric approach. One of the overarching goals is to incorporate PFE concepts into all activities of the MHA Keystone Center collaboratives and the MHA Patient Safety Organization (PSO). The national momentum on this topic right now is tremendous, and the MHA Keystone Center has identified a strong focus on PFE as an opportunity to transform healthcare delivery in the state of Michigan. The following White Paper is the product of a Patient and Family Engagement Task Force, convened by the MHA Keystone Center. Task Force Charge and Composition The MHA Keystone Center appointed and convened this task force in the summer of 2013 with the following specific charge: to develop a plan and intervention(s) to support the implementation of patient and family engagement in Michigan Hospitals. The task force was also asked to perform 2 specific activities: 1) review potential interventions and recommend patient and family-centered bundles for adoption by hospitals that are participating with MHA Keystone Center Collaboratives; and 2) identify potential experts to support Michigan hospitals in the implementation of patient-family centered councils. The task force is composed of staff and patient advisors from Michigan hospitals with robust PFE efforts already underway, along with individual stakeholders who share the expertise and passion to advance PFE. A roster of the task force members is included in Appendix C of this report. The initial work of the task force was time-limited, with a White Paper to be issued for the MHA Keystone Board s review and approval on November 7, Preparation of this document included a review by all members of the PFE task force. The purpose of this paper is to give an overview of the current PFE landscape and leading efforts in this arena, as well as disseminate the task force recommendations to all hospitals in the state. Overview: Best Practices in PFE The task force s review of current national and local efforts to advance patient and family engagement identified numerous promising strategies. These best practices can be grouped into four 2

3 major categories of hospital interventions: leadership and culture, infrastructure, education, and process changes. Leadership & Culture Leadership is acknowledged as a critical precursor for change in the hospital and is an essential component in all successful MHA Keystone Center interventions. Strong commitment to the centrality of patient and family engagement starts at the hospital board level, and must occur in order to gain momentum in this arena. Executive champions have been found to bolster PFE efforts. Senior leadership in the hospital who demonstrate the importance of PFE through both their actions and policy decisions are essential for full staff engagement in this philosophy of healthcare delivery. Additionally, buy-in from all levels of management is crucial to establishing an organizational culture that supports, and sustains, patient-centered care. The MHA Keystone Center has always been committed to cultural change and guiding hospitals in this endeavor continues to be a priority. True culture change includes not only policy, process, and infrastructure review in light of enhanced PFE (such as visitation guidelines), but also empowering staff to make bedside decisions and policy interpretations. Finally, aligning incentives to encourage PFE and create policies that support PFE in practice has also been noted to be among successful strategies adopted by hospitals (Maurer, Dardess, Carman, et al., 2012). Hospital Infrastructure Several successful strategies identified on a national level to advance PFE efforts involve rethinking the hospital infrastructure to include patient-family advisors who represent the patient perspective. In the local discussion of PFE in Michigan, several strategies to include patient and family advisors have been recognized, and examples of some of the most critical components are shared here. A methodological approach starts with the simple role delineation of the patient-family advisor, which is the common designation Michigan hospitals have created. A patient-family advisor is defined as an individual that aims to help improve the quality of a hospital s care for all patients and family members. They can accomplish this in a variety of ways by working in partnership with a hospital to spread patient and family-centered care across the entire institution. A patient-family advisor provides feedback to the hospital by sharing an external perspective that represents all patients and families (IFPCC, 2011). There are a variety of potential roles for patient-family advisors (e.g., committee member, experience sharer, communication reviewer, focus group participant, etc.), and it is recommended that advisors self-identify which role they can best contribute. Integration of patient-family advisors into committees and all activities that touch the patient is the next structural progression. This can include participation on established hospital committees such as quality and patient safety, performance improvement and process re-design, and facility upgrades. In this role, advisors can act as a secondary information source to fill in gaps clinical staff may not identify. Infrastructure changes can also include involving patient-family advisors on unit rounds, participating in root cause analysis after adverse events, and board membership. A third strategy implemented by hospitals who are leaders in PFE is the establishment of patient and family advisory councils (PFAC s). These councils meet regularly and interact with established 3

4 hospital committees and work groups to ensure that the patient perspective is heard and incorporated into decision-making and alignment of the organization s goals and strategic planning. Education Best practices in the educational component of PFE are two-fold: improving educational processes and materials for patients, and also providing education to hospital leadership, physicians and staff on the importance of PFE in every aspect of their daily patient care activities. One of the key strategies to engaging patients and improving education about their medical condition involves addressing the problem of health literacy, which is defined as the ability of patients to obtain, understand, and act on health information. Hospitals leading the way in PFE are routinely screening patients for health literacy issues, and utilizing patient-family advisors in developing patient education resources. This inclusion of advisors in the development of all patient education materials increases the likelihood of improved patient understanding of their role in their own healthcare, better outcomes, and a lower risk of re-admission. Education for not only patients and families, but also hospital staff is paramount. Hospitals are encouraged to be mindful about launching PFE activities without appropriate staff training. Although changes may seem simple, they need appropriate preparation to be rolled out successfully. Understanding how to recruit and interact with patient-family advisors is a central educational component that has been achieved by several pioneering Michigan hospitals, who have developed training and staff resources on this topic. While literacy is important to focus on, other factors that advisors have been able to hone in on (e.g., volume of information, visual appeal) should also be taken into consideration. Reaching providers in the early stages of education has been recognized as an incredible opportunity. Engaging patient-family advisors as interviewers in the medical school application process is one tactic being used locally to educate future physicians on the importance of engaging patients and families in all care settings. Another effort made by Michigan hospitals has been to assign medical students to local families so that the students participate in the family healthcare provider appointments and interact with the family during various stages of care. These instances of involvement, from the selection process of future providers, to the inclusion of PFE concepts into clinical curriculum marks progress in the educational field in Michigan. Including advisors in ongoing healthcare provider education is also of great value. Examples include incorporating this voice at new employee orientation; active participation in the role of a family member during clinical simulation training; and educating residents and new nurses on patient family centered care and how that impacts building quality relationships, clinical outcomes and the overall care experience. Process Changes The multitude of processes inherent in healthcare delivery provide a wealth of opportunity for meaningful input by patients and family members, and many Michigan hospitals are already leading the way with innovations in this regard. Provider shadowing is one strategy for patient-family advisors is in use at some Michigan sites, which allows advisors to observe patient-provider interactions and provide feedback to the provider 4

5 after the encounter. Inclusion of patients and families in adverse event debriefing or root cause analysis is another recommended process change. This strategy invites patients and family members to be a part of the adverse event review, helps them to understand what factors lead to the adverse event, and allows them to participate in improving the process so that the event does not reoccur. Michigan hospitals that have used this strategy have identified solutions that might have been overlooked without the perspective of the patient and family. Another example of process change is a fresh look at visitation policies which are more open, and which can be tailored to the unique needs of patients and families. Numerous examples of such policies are available from organizations such as the IPFCC or select Michigan hospitals. To assist staff, patients, and families in understanding the policy and navigating potential challenges, such as privacy issues, resources such as communication guides are also recommended and are available. MHA Keystone Center: Recommended Actions The MHA Keystone Center aims to increase the level of PFE activities in Michigan hospitals and advance patient and family centered care principles across the state. Of the many ideas and opportunities discussed, three priorities have been identified by the task force for the MHA Keystone Center to address in the current program year: networking opportunities development of materials and resources mentoring and leadership engagement Networking The MHA Keystone Center has historically played the role of the convener, and it makes sense to continue this trend to further engage hospitals in this cause. Providing networking opportunities specific to PFE to engage patient-family advisors and others involved in this domain will be a new prospect. These events may take the form of regionally based meetings, or one statewide meeting to bring all groups together. The focus would be to foster shared learning across hospitals and communities. An additional opportunity to network with all levels and departments of hospital staff can be achieved by showcasing PFE efforts with storyboards or poster presentations at the annual MHA Patient Safety & Quality Symposium. By bringing these groups together, the goal is that efforts will be more sustainable and keep improving the way advisory groups improve patient-centered care and involve the community. Another component of this effort will be to utilize a web-based portal for idea sharing and resources. The MHA Keystone Center has an established platform and will create and maintain this portal. Development of Materials & Resources Several national resources have been produced to address and improve PFE in hospitals, and the MHA Keystone Center supports these materials, (e.g. the Agency for Healthcare Research and Quality Guide to Patient & Family Engagement) so to build from these resources; not duplicate them (See Appendices A & B). Although the MHA Keystone Center has baseline information on patient and family engagement from some hospitals in the MHA Keystone Hospital Engagement Network (HEN), more information is needed. To better inform the next steps of the task force, a survey has been developed to evaluate 5

6 current PFE activities and will be sent to each Michigan hospital in October The results will be shared with the task force and presented to the MHA Keystone Board of Directors at their Nov. 7 meeting. The results of the survey will be used to develop metrics that the MHA Keystone Center can use to monitor progress in Michigan hospitals as it relates to the advancement of PFE. Additionally, results may guide the MHA Keystone Center in how it can best serve the needs of its constituent hospitals in the area of PFE and identify hospital leaders to potentially serve as mentors for other institutions. Stories of success facilitate the sharing of experiences and diffusion of best practices. The MHA Keystone Center will aim to generate and share PFE success stories from across the state. Another strategy to disseminate stories is to provide video testimonials of patient-family advisors and the contributions that they have made. This will illustrate the impact of the advisor role and add dimension to the stories. Dissemination of these stories will be especially important for independent hospitals that lack the system support provided to the majority of hospitals represented on the task force. A First Steps resource for hospitals with minimal PFE activities will be created by the MHA Keystone Center with guidance from task force members. This guide will outline the following recommended steps to increase PFE within the hospital: top level commitment from leadership (i.e., building the business case for PFE) patient-family advisor orientation matching hospitals with mentors and facilitating site visits As discussed, there is an abundance of resources addressing implementation of PFE activities. The MHA Keystone Center and PFE task force has reviewed the growing body of information and recommend specific introductory materials to supplement the First Steps resource (See Appendix A). Mentoring & Leadership Engagement Since leadership and board level engagement has been described as such a vital component for PFE success, the MHA Keystone Center will be prepared to support hospitals that encounter impediments in this area. A PFE component will be built into all MHA Keystone Center Board of Director meetings, to emphasize that PFE is a strategic priority for the MHA Keystone Center. With guidance from the task force, a presentation will be created for hospitals to use locally with their own boards. This presentation will encompass materials such as the business case for PFE, success stories and testimonials created by members of the task force and select results of the PFE Readiness Survey. The capacity of hospitals to absorb multiple projects and spread efforts across units is an ongoing challenge that MHA members face. Since leadership plays an essential role in diffusing complex innovations such as PFE (Conway, 2008), the MHA Keystone Center intends to promote content related to PFE at meetings with leadership presence to improve saturation of this information. Additionally, we will commit to the dissemination of PFE materials that specifically target leadership, including evidencebased resources for hospital leaders that build the case for action and provide comprehensive information on implementation steps. Materials targeting this audience have been reviewed and are included as an attachment here (See Appendix B). 6

7 Next Steps In addition to these priorities described above, the task force makes the following recommendations to accelerate the momentum of this effort: 1. The MHA Keystone Center include consumers at all levels of their activities (i.e. workshops, advisory boards, etc.) 2. The MHA Keystone Center measure Michigan s progress with PFE activities over time, using the PFE readiness survey distributed this fall. The task force recommends this survey be analyzed annually. 3. The PFE task force activity be extended for an additional year. Extending the task force will allow for the completion of the recommended activities above. To update the MHA Keystone Center Board on the progress of the task force, quarterly status reports will be submitted by the MHA Keystone Center Staff. Conclusion Using a combination of strategies identified by local experts and nationally recognized resources, the spread of PFE practices can be accomplished in Michigan. Patient and provider roles are changing and will only continue to do so. By building strategies that consider the multitude of barriers patients face in the U.S. healthcare system today and keeping patients at the center of care, more effective interventions can be developed. Although the collaboration of the task force and MHA Keystone Center has immense potential to accelerate PFE activities, it is also recognized that culture change takes time and a commitment to continual improvement. This White Paper has provided an overview of local and national efforts and a strategic plan for the MHA Keystone Center to advance PFE efforts in Michigan. 7

8 Appendix A: Recommended Resources for Getting Started Advancing the Practice of Patient- and Family-Centered Care in Hospitals: How to Get Started. Institute for Patient- and Family-Centered Care. Available from Guide to Patient and Family Engagement in Hospital Quality and Safety. June Agency for Healthcare Research and Quality, Rockville, MD. ndex.html 8

9 Appendix B: Recommended Resources for Leadership A Leadership Resource for Patient and Family Engagement Strategies. Health Research & Educational Trust, Chicago: July Accessed at Supporting Patient and Family Engagement: Best Practices for Hospital Leaders. June Agency for Healthcare Research and Quality, Rockville, MD. Available from howtogetstarted/best_practices_hosp_leaders_508.pdf 9

10 Acknowledgements MHA Keystone Center Patient & Family Engagement Task Force Members MICHUCAN Marjorie Mitchell, PFE task force Chair MHA Keystone Board of Directors Spectrum Health Deb Sprague, Patient & Family Services Program Manager Julie Wallace, Patient Advisor Stephanie Young, Patient Advisor University of Michigan Health System Celeste Castillo Lee, PFE Program Manager, Adult Services Kelly Parent, PFE Program Manager, Pediatrics Bronson Healthcare Group Marilyn Potgiesser, RN, BS, Manager, Patient and Family Centered Care Chris Thomas, Vice-Chair, Patient and Family Advisory Council Hurley Medical Center Theresa Powerski, Patient Relations-Patient Representative The Furst Group Dan Ford, Vice President St. Joseph Mercy Health System Jesse Bernstein, Experience Advisor; past-chair, Patient and Community Engagement Council Susan Kheder, LMSW, Executive Director - Patient and Community Engagement Gail Panoff, Chair, Patient and Community Engagement Council MHA Keystone Center Brittany Bogan, Senior Director Tracey Burtch, Assistant Director, Public Relations and Health Promotion Laura Fournier, MA, Project Coordinator Barb Lucas, MD, MHSA, CPPS, Project Consultant Marie Masuga, MSN, RN, CPPS, Project Manager Ewa Panetta, Project Coordinator Sam Watson, MSA, CPPS, Senior Vice President 10

11 References Advancing the Practice of Patient- and Family-Centered Care in Hospitals. Institute for Patient- and Family-Centered Care, April A Leadership Resource for Patient and Family Engagement Strategies. Health Research & Educational Trust, Chicago: July Accessed at Conway, J. Getting boards on board: engaging governing boards in quality and safety. Jt Comm J Qual Patient Saf 2008; 34(4): Charmel, P. A. & Frampton, S. B. (2008). Building the business case for patient centered care: Patientcentered care has the potential to reduce adverse events, malpractice claims, and operating costs while improving marketshare. Healthcare Financial Management, 62, Guide to Patient and Family Engagement in Hospital Quality and Safety. June Agency for Healthcare Research and Quality, Rockville, MD. ndex.html Maurer, M., Dardess, P., Carman, K.L., et al. Guide to Patient and Family Engagement: Environmental Scan Report. (Prepared by American Institutes for Research under contract HHSA ). AHRQ Publication No EF. Rockville, MD: Agency for Healthcare Research and Quality; May