Tools & Techniques Engaging Patients in Quality Improvement HQO IDEAS

Transcription

1 Tools & Techniques Engaging Patients in Quality Improvement HQO IDEAS October 13th, 2015 Mim O Dowda Robin Spence Haffner Lisa Hawthornthwaite

2 WELCOME

3 WORKSHOP AGENDA Introductions Who we are and get to know you! The Patient Voice - Mim Educating and inspiring patient and family-centred care Patient experience measurement Decision Making Tool for Patient and Family Engagement Scenarios for group table discussion Share back your considerations and experiences Closure Lessons learned and hopes for the future!

4 The land where we come from

5 14,443

6 50,000

7 700,000

8 40,000

9 940 Adult

10 109 Child

11 36 NICU

12 WELCOME

13 Surveys aren t enough.

14 Patient Stories Learning from the Patient Advisor Experience Stories bring attention to quality improvement and an understanding of what patient and family centred care really means to our patients

15

16 Reflect Respect & Dignity Collaborate & Empowerment Patient & Family - Centered Care Information Sharing & Communication Coordination & Comprehensive What did we learn? How it made us feel?

17 Impact Impact of patient stories for quality improvement See system from the user lens and what they really care about Generates ideas and solutions Help us feel what patient and family centred care really is creates a vicarious experience Self-reflect on personal practice

18 iap2

19 INFORM Used to assist patients to better understand problems, alternatives, and/or solutions One-way communication

20 CONSULT Used to understand the experience of the patients and where and what changes are needed

21 INVOLVE A more in depth way to ensure patient and family experience is well understood and considered in design and decision making

22 COLLABORATE To partner with patients and families and have them as an equal voice in identifying solutions

23 EMPOWER Place decision making in the hands of patients and families

24 Decision Making Tool & Action Aids PATIENT & FAMILY PARTICIPATION GOAL QUALITY IMPROVEMENT TOOLS (SEE CHEAT SHEETS) PROS CONS TIPS TIME COMMITMENT & DURATION WHAT WOULD THIS LOOK LIKE? (EXAMPLES) INFORMED CONSENT REQUIRED? DEGREE OF EXPERTISE REQUIRED INFORM CONSULT INVOLVE COLLABORATE EMPOWER To provide patients & families with balanced and objective information to To obtain patient & family feedback on assist them in understanding the analysis, alternatives and/or decision. problems, alternatives and/or solutions. - Writing for patients and families - Fact sheets - Letters from secretary office - Quick communication to wide audience - "One-way" communication Surveys Focus Groups Surveys: detailed information received quickly Focus Groups: more detailed information is received quickly. Gives opportunity for further engagement Surveys: One-way" communication - Relies on expertise of asking the right questions - Response rates can be challenging Focus Groups: ability to manage negative patient feedback constructively - have Patient Advisors provide - have Patient Advisors provide guidance or guidance or review on communication review on communication material material - Depends on the nature of the material (least resource intensive) - Letters from Physician's office, care instructions, program and service descriptions No - Low (consult with Patient Experience Specialist/Process Improvement Consultant for guidance) Surveys 2-10 hours depending on length of survey. The nature of survey and desired sample size is a factor. Focus Groups: approx. 15 hours planning, session and follow up reports - Family Feedback Survey Children's Hospital - Emergency Department Interview Questionnaire - Ambulatory Care Questions - No (surveys) - Yes (focus groups) - Medium (consult with Patient Experience/Process Improvement for guidance) To work directly with patients & families To partner with patients & families in each throughout the process to ensure that aspect of decision making including the patient & family issues and concerns are development of alternatives and the consistently understood and considered. identification of the preferred solution. - Patient Shadowing - See experiences "through patient's eyes" - Opportunity to ask questions, have meaningful discussion on an ongoing basis. - Patient and Family Advisor volunteers are part of project team - Patient Experience video taped interviews - Patients & families "at the table", telling their story first-hand - Opportunity to ask questions, have meaningful discussion on an ongoing basis - Patient shadowing requires time commitment - Significant time commitment for LHSC & may not accurately capture all patient employees and volunteers & family perspective - Communication effort to identify - Requires a sample of 12 patients per quality representative sample of patients population (EBD) to shadow - Involves patient interview, analysis and - Providers must know & understand the compilation of videos (dependent on purpose & value of the project project requirements) Approximately 12 hours for a surgery patient. This includes: identifying patients; obtaining consent; shadowing *varies with type of patient case - A Process Improvement consultant may shadow and record the flow and interactions from admission to discharge for 20 patients; process flow map with feelings and narrative are displayed for project team to consider - Patient Interview: set-up, interview itself (+ travel) & analysis (3-4 hours per interview) - Information and Consent Letter: development of content and consultation with Privacy (6-8 hours) - 25 patients & families from across the SW LHIN interviewed, themes trended and incorporated into Current State Gap Analysis (along with other quality gaps) to improve stroke care Yes Yes Yes - Medium - Expert (consult with Patient Experience/Process (guidance from PX and Process Improvement for guidance) Improvement Consultant required) To place decision-making in the hands of patients & families. - Patient Advisors part of decision-making body (with voting power) - Experienced Based Co-Design (EBD) Interviews + Co-Design of future state) - True partnership where patients, families leaders and providers find mutually beneficial solutions - Significant time commitment and onboarding process that can be lengthy (application, interviews, police check, risk and privacy) - Budget required for councils - Requires a sample of 12 patients per population (EBD) -Requires strong leadership support to authentically engage patients as equal partners and create new structures with advisors - Patient Interview: set-up, interview itself (+ travel) & analysis (3-4 hours per interview) - Co-Design sessions: dependent on scope of work (consider set-up and organization time, needs thoughtful and flexible scheduling) - Committee/Council work: dependent on committee work requirements (consider set-up and organization time, time to communicate with patients and develop trust, change management) - Project Example: 36 patients with same diagnosis interviewed, 2 patient advisors participated in Gap Analysis sessions, 2 patients on Steering Committee, patients included in future design sessions - Program EBD Example 80+ patients interviewed, future state co-design sessions all videotaped and themes and trends for patient experience improvements reported to Senior Leaders to action Patient and Family Advisory Councils in place with Children's, Renal and Cancer) - Expert (Process Improvement Consultant with guidance from Patient Experience)

25 Action Aids - What, How & Common Steps Writing for Patients and Families Surveys Focus Group Shadowing Patient and Family Advisor Councils Patient Video Interviews Experienced Base Co-design (EBCD)

26 Action Aids Prepare Design Test Execute Analyze & Act Tips and Where Find More Information Level of Engagement Expertise Required

27 SILENCE

28 QUESTIONS

29 SCENARIOS

30 Table Work Using the template review the scenarios at your table

31 What would you recommend and why?

32 DISCUSSION

33 Advice from the field Mim s Top 3 What Have we Learned?

34 Pair and Share As a result of taking this workshop, What is one action that you are going to do differently when you engage with patients?

35 Sources and Credit Institute for Patient- And Family-Centered Care Pinwheel Sponsor. Inspired to Change: Improving Patient Care One Story at a time (2014) Linda R. Larin Patient Experience. Patient and family-centred care. (2015). London Health Sciences Centre. The Beryl Institute Membership. IAP2: Spectrum of Patient Engagement