Measurement of Patient- and Family-Centered Care with Surveys: A Progress Report

Transcription

1 Measurement of Patient- and Family-Centered Care with Surveys: A Progress Report Max Bassett, Family Advisor, Medical Colleges of Georgia Cézanne Garcia, Associate Director, University of Washington Medical Center Bob Wolosin, Research Product Manager, Press Ganey Associates, Inc.

2 Plan for the Session Introduction to Satisfaction Measurement Patient- and Family-Centered Care Metrics Taskforce Development of Questions Metrics of the Measurements Identify Behaviors to Improve Measures Next Steps Challenges and barriers Conclusions/Questions

3 Building a Measurement Toolbox for Patient- and Family-Centered Care Business metrics Quality and safety measures Staff perceptions and culture Patient and family perceptions

4 Engaging Patients and Families to Design and Interpret Measures Popular Methods for Obtaining Patient and Family Feedback to Improve Quality To:.. With: Patient Perspective Snapshots Written Surveys Archival Studies Telephone Surveys Interviews Focus Groups Critical Incident Method Direct Observation Content Analysis of Letters and Comments Patient Partnership Dialog Root Cause Analysis Teams Grievance Committee Quality Committees PFCC Steering Committee Quality Improvement Teams Adults with Congenital Heart Disease Improving Nursing Rounds

5 Engaging Patients and Families to Improve Care Informed Choice Role Navigate the system Choose highperforming providers, plans, hospitals Adapted from Engaging Health Care Consumers to Improve the Quality of Care, by Judith H. Hibbard, DrPH, University of Oregon s Department of Planning, Public Policy and Management Coproducer Role Prevention Collaborative care and shared decision-making Self-care Chronic disease self-management Improved Care Coevaluator Role Share experiences as learnings Determine how well system supports their Coproducer Role Meaningfulness of measures Design and define evaluation of outcomes of care

6 Underlying Model of Satisfaction [Survey] Recommend Experience Evaluation Behavior Return

7 Exploring Options for Building PFCC Measurement in Our Programs Best Fit Utilizing Current Survey Questions Specific core concepts that articulate and focus the organization s PFCC priorities Joe DiMaggio Children s Hospital, Hollywood, FL University Hospital, Syracuse, NY Choice Communication Collaboration THE THE PFCC PFCC Pyramid of of Caring Caring Partnering Partnering Reassurance Reassurance and and Support Support Complete Complete Information Information Need to to be be near Option: Retrofit PFCC core concepts to standard questions

8 Choice Positions UH as employer and provider of choice. Q. Overall rating of care. Q. Likelihood of your recommending this hospital to others.

9 Communication Health care providers communicate and share complete and unbiased information with patient/families in ways that are affirming and useful. Q. Degree to which RNs kept you informed about you/your loved one's condition using language you could understand. Q. MD's concern for you/your loved one's questions and worries.

10 Collaboration Patients and families are partners in decisionmaking related to delivery of care. Q. Degree to which patients and families were able to participate in the pain management (how well pain was controlled). Q. Staff attitude toward family and visitors.

11 Retrofitting Questions to Core Dimensions Strengths/Opportunities Convenient Built-in benchmarking Starting place for transitioning hospital s understanding of PFCC Risks/Shortfalls Standard questions lack specificity to PFCC dimension Numerous confounding variables: other improvement initiatives Patient/family advisors may disagree with good-enough fit

12 Patient and Family Perceptions Patient and Family as Co-Evaluators to Design Satisfaction Measurement: What Matters? Initial Q: How can we keep abreast of the care experience of current patients and families to guide our Council s work?

13 Gap Analysis DISCONNECT between PFCC dimensions and existing measures Paired Advisor and Staff to Review UWMC s Perinatal NICU Satisfaction Measurement Tools to Seek Questions to Track the Council s Identified Dimensions of PFCC Practices National Research Corporation Survey Press Ganey Surveys UWMC-authored NICU Satisfaction Survey Post-hospitalization follow-up phone calls Comment cards

14 Defined Eight PFCC Practices Important to Council s Patient and Family Advisors Welcomed member of the team. Preferences honored. Role as parent respected. Coordination and quality of care. Family and support persons welcomed and supported. Access to information to help make decisions. Participate in planning for discharge and self care at home. Lodging complaints and concerns and their resolution.

15 Conclusion: Design Questions to Measure Patientand Family-Centered Care Practices Council defined dimensions and questions. Council co-leads shared and solicited support of UWMC s PFCC Steering Committee. UWMC Operating Plan secured leadership commitment to incorporate custom questions in satisfaction survey. Broaden stakeholder investment in survey question design: solicit membership for multi-organizational PFCC Satisfaction Metrics Taskforce.

16 Membership of PFCC Metrics Taskforce Members Children s Specialized Hospital at Fanwood Plaza, Fanwood, NJ Consortium for Comprehensive Cancer Centers Institute for Family Centered Care, Bethesda MD Joe DiMaggio Children s Hospital, Hollywood, FL Lee H. Moffitt Cancer Center & Research Institute Memorial Hospital West, Pembroke Pines, FL Memorial Regional Hospital, Hollywood, FL Medical Colleges of Georgia, Augusta, GA Spectrum Care, Grand Rapids, MI Sutter Health, Sacramento, CA University of Washington Medical Center, Seattle, WA Consultant: Press Ganey Research and Development Team Demographics of Membership Patient and Family Advisors, Pediatric and Adult Care Systems, IFCC, Press Ganey Research and Development California to Florida Primary to Quaternary Care and Rehabilitation All Hospital Members Utilize Press Ganey for Satisfaction Measurement New PFCC Program to 10 Years Experience

17 The Forest from the Trees Love for My Children Family and Patient Advisors can challenge the institutional status quo without fear of retaliation. Experienced Family and Patient Advisors can communicate more effectively with administrative and medical staff. Advisors are cultivated over time, the investment will yield a significant payback Chronic illnesses or medical conditions provide a wellspring of new experiences and ideas, benefiting the hospital. Advisors are loyal customers who want to see the hospital succeed.

18 Goals of PFCC Satisfaction Metrics Taskforce Design 3 to 5 PFCC questions for hospitals with PFCC programs to add to their patient satisfaction questionnaires. Engage Press Ganey Tools for pilot and involve consultations from their Research and Development Team. Effective questions: focus, brevity, clarity Face, content and consensus validities Add PFCC custom question set to Taskforce members surveys to establish baseline and build benchmarking capability.

19 Reiterative Process Built consensus definitions and prioritized dimensions knowing we would not be able to include all desired PFCC attributes. Small teams designed 1 or 2 questions per dimension and brought forward to group for consensus-defined version. Drafted questions were brought forward to taskforce memberships councils or small advisor teams for their input and further revision. ASK ADVISORS which do they prefer? Submitted to Press Ganey Research team for editorial revisions. Finalized.

20 Taskforces Advisors Recommended Top Four PFCC Dimensions to Measure 1. Patients and family members feel welcomed and supported. Family members are provided choices that respect their need-to-be-near preferences. 2. Patients and families are informed of their plan of care, and are given access to information to help them make decisions. Programs, supports and services offer families good information and access to information. 3. Patients and families are clear who is involved in their care and foster mutual trust and respect participate with their providers in planning their care. 4. The patients' and families' preferences are included in their plan of care. Programs, supports, and services promote family choice and control.

21 Patient and Family Centered Care Practice Measures: Actionable Behaviors How well staff explained their roles in your care. Degree to which your choices were respected to have family members/friends with you during your care. Degree to which you and your family were able to participate in decisions about your care. Degree to which staff respected your family s cultural and spiritual needs. Degree to which the staff supported your family throughout your healthcare experience.

22 Inpatient Item Descriptive Statistics (6 facilities) I5. Response concerns/ complaints Correlations O4. Overall rating - care given O3. Likelihoodrecommend hospital Overall Satisfaction N Mean S.D. I172. Family able to participate decision I173. Staff explained roles in care I174. Staff supported family throughout I175. Staff respected having family with I176. Staff respected cultural/spiritual Average of patient and family centered items (Reliability =.93)

23 Outpatient Oncology Item Descriptive Statistics (6 facilities) O2. Care given at this facility Correlations I3. Sensitivity to difficulties/incn vnc O3. Likelihoodrecommend services Overall Satisfaction N Mean S.D. I76. Family able to participate decision I77. Staff explained roles in care I78. Staff supported family throughout I79. Staff respected having family with I80. Staff respected cultural/spiritual Average of patient and family centered items (Reliability =.93)

24 Pediatric Inpatient Item Descriptive Statistics (1 facility) O3. Care given at this hospital Correlations I4. Response to concerns/ complaints O4. Likelihoodrecommen d Overall Satisfaction N Mean S.D. I74. Family able to participate decision I75. Staff explained roles in care I76. Staff supported family throughout I77. Staff respected having family with I78. Staff respected cultural/spiritual Average of patient and family centered items (Reliability =.94)

25 Medical Practice Item Descriptive Statistics (1 facility) O3. Care received during visit Correlations I2. Our sensitivity to patients' needs O4. Likelihood-- recommend practice Overall Satisfaction N Mean S.D. I97. Family able to participate decision I98. Staff explained roles in care I99. Staff supported family throughout I100. Staff respected having family with I101. Staff respected cultural/spiritual Average of patient and family centered items (Reliability =.94)

26 Ambulatory Surgery Item Descriptive Statistics (2 facilities) F116. Overall rating of care Correlations F3. Likelihoodrecommend center Overall Satisfaction N Mean S.D. PI31. Family able to participate decision PI32. Staff explained roles in care PI33. Staff supported family throughout PI34. Staff respected having family with PI35. Staff respected cultural/spiritual Average of patient and family centered items (Reliability =.93)

27 Outpatient Services Item Descriptive Statistics (1 facility) E14. Overall rating of care E102. Response to concerns/ complaints Correlations E4. Likelihoodrecommend Overall Satisfaction N Mean S.D. PI65. Family able to participate decision PI66. Staff explained roles in care PI67. Staff supported family throughout PI68. Staff respected having family with PI69. Staff respected cultural/spiritual Average of patient and family centered items (Reliability =.94)

28 Emergency Department Item Descriptive Statistics (1 facility) F2. Staff cared about you as person F68. Overall rating of care Correlations F4. Likelihoodrecommend Overall Satisfaction N Mean S.D. J38. Family able to participate decision J39. Staff explained roles in care J40. Staff supported family throughout J41. Staff respected having family with J42. Staff respected cultural/spiritual Average of patient and family centered items (Reliability =.96)

29 Identifying Actionable Behavioral Indicators for Each Question Three Taskforce Organizations Are Currently Engaging Their Advisors in Identifying Specific Behaviors for Each Question Support Staff Success in Meeting These Specific Measures Opportunities Job Descriptions and Related Core Competency Statements Incorporate Related Behavioral Interview Questions for Prospective Employees

30 Small Group Discussion to Identify Actionable Behaviors for Each Question 1. How well staff explained their roles in your care. 2. Degree to which your choices were respected to have family members/friends with you during your care. 3. Degree to which you and your family were able to participate in decisions about your care. 4. Degree to which staff respected your family s cultural and spiritual needs. 5. Degree to which the staff supported your family throughout your healthcare experience.

31 What Patients and Families Identify as Actionable Behaviors How Well Staff Explained Their Roles in Your Care 1. Introduce yourself to me and my family. 2. Explain your responsibilities and role in my care. 3. Describe your purpose on my care team. One day, I I counted different people coming into my room to to provide my care. Only one-third of of the nursing staff wrote their names on on the dry erase board, therefore I I didn t know who my nurses were.

32 What Patients and Families Identify as Actionable Behaviors Degree to Which Your Choices Were Respected to Have Family Members/Friends with You During Your Care 1. Ask me if I want my family/friend with me. 2. Listen to my family. 3. Comfort my family. I was in in ICU after a procedure and when I I was asleep, they would not let let my husband join me. I I woke up up more scared than I I should have been. It was so so helpful to to have my husband with me until it it was time for me to to be be wheeled into surgery.

33 What Patients and Families Identify as Actionable Behaviors Degree to Which You and Your Family Were Able to Participate in Decisions About Your Care 1. Explain my diagnostic and treatment options. 2. Ask me what my choice is about my care options. 3. Ask who I want involved in my care decisionmaking. Every effort was made by by social workers and nurses to to make sure we had help coping and the information we needed They helped us us get situated at at the housing apartments.

34 What Patients and Families Identify as Actionable Behaviors Degree to Which Staff Respected Your Family s Cultural and Spiritual Needs 1. Ask me what my religious and/or cultural practice needs are, and how I want to have them accommodated. 2. Treat my cultural and spiritual practices respectfully. My spiritual needs were discussed. It It was helpful. 3. Talk with me and my family about my cultural and spiritual needs throughout my care.

35 What Patients and Families Identify as Actionable Behaviors Degree to Which Staff Supported Your Family Throughout Your Health Care Experience 1. Ask me if I want my family/friend with me during my care. 2. View my family involvement as a strength and their involvement in my care as a partner. 3. Accommodate my family s presence and offer for them to accompany me. We feel very safe at at the facility. The staff includes my wife, always.

36 Press Ganey Desired Procedure for Adding PFCC Question Set Press Ganey maximum recommendation of +/- 10 to 12 custom questions Internal negotiations to add 5 questions Your hospital s designated contact for patient satisfaction must request your hospital s Press Ganey consultant to add the PFCC custom question set to your survey Takes 3 weeks Questions for Press Ganey: Contact Robert Wolosin in Research and Development

37 Implications: A New Focus for Quality Improvement How are patients and families involved with care? What can I look at quickly? (PI page) What s important to patients? (correlations with overall, ltr) Solution Starters Quality improvement tips

38 Suggestions to Transition from Old Paradigm to New Paradigm PFCC Metrics Taskforce Recommendations of Areas For Continued Work Concept of the patient and family as an active member of the health care team: integrating patient and family choices To, not With: Doctor s concern to keep you informed about your treatment. Questions about family are separate from visitor questions Articulates patient/family strengths

39 Building Measurement Important Attributes That These Questions Provide: Important to organization Valid (represent what they intend to measure) Reliable (produce similar results when used repeatedly) Feasible (affordable to collect data) Usable for the people expected to employ the data to improve PFCC Have universal applicability within organization

40 The question no longer is: Can we do this? The question now is: How soon can we do this? Perinatal Neonatal Intensive Care Unit Rehabilitation Services PFCC Steering Committee Inpatient Oncology

41 Any questions? Thank you for attending this presentation Robert J. Wolosin, PhD Research Product Manager, Press Ganey Associates, Inc. (574) Toll Free: X297 Max Bassett Co-Chair, MCG/CMC Family Advisory Council MCG Health System Cézanne Garcia, MPH Associate Director, Patient and Family Centered Care and Education Services, University of Washington Medical Center (206)