patient- and family-centered care for adults with chronic conditions

Patient- and Family-Centered Care for Adults with Chronic Conditions

Web Event

May 20, 2014

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Patient- and Family-Centered Care for Children and Older Adults

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Patient- and Family-Centered CareImplications for Adults with

Chronic Conditions

Beverley H. Johnson

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Patient- and Family-Centered Core Concepts

▼ People are treated with respect and dignity

▼ Health care providers communicate and share complete and unbiased information with patients and families in ways that are affirming and useful

▼ Patients and families are encouraged and supported for participation in care and decision-making at the level they choose

▼ Collaboration among patients, families, and providers occurs in policy and program development and professional education, as well as in the delivery of care

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Patient- and Family-Centered Core Concepts

Patient- and family-centered care is working with patients and families, rather than to or for them

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A Broad Definition of Family . . .

▼ In health care settings, patients are asked to define their families and how they will be involved in care and decision-making

▼ The American Academy of Family Physicians (2009) defines family as “a group of individuals with a continuing legal, genetic and/or emotional relationship”

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Why Patient- AND Family-Centered Care and not just Patient-Centered Care?

▼ Individuals who are most dependent on health care are most dependent on families

▼ Those with chronic conditions

▼ The very young

▼ The very old

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Why Patient- AND Family-Centered Care and not just Patient-Centered Care?

▼ Families can be allies for quality and safety

▼ Families often are the constant support across settings and assist with transitions of care

▼ Families can participate in the development of a care plan and support the patient in following the plan

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Triple AimPatient- and Family-Centered Care

"The most direct route to the Triple Aim is via patient- and family-centered care in its fullest form.”

- Don Berwick (June 5, 2012)

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Best Care at Lower Cost: The Path to Continuously Learning

Health Care in America

▼ Institute of Medicine Recommendation: “Involve patients and families in decisions regarding health and health care, tailored to fit their preferences” (S-23)

▼ “In a learning health care system, patient needs and perspectives are factored into the design of health care processes, the creation and use of technologies, and the training of clinicians” (5-5)

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Insights From an Institute of Medicine Working Group

“In high-functioning health care teams, patients are members of the team; not simply objects of the team’s attention…”

Wynia, Matthew K., Isabelle Von Kohorn, and Pamela H. Mitchell. "Challenges at the intersection of team-based and patient-centered health care: insights from an IOM working group." JAMA 308.13 (2012): 1327-1328.

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Redesign of Primary Care and the Management of Chronic Conditions

http://www.chcf.org/topics/patient-self-management

Self-Management Support

▼ Information Sharing

▼ Goal Setting

▼ Action Plans

▼ Follow-Up Support

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Open Notes

http://www.myopennotes.org

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Anne Arundel Medical Center Annapolis, MD

Bedside Nurse Change of Shift Report WITH the Patient and Family

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H. Lee Moffitt Cancer Center & Research Institute in Tampa, FL

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Patient and Family Advisors for Change, Improvement, and Health Care

Redesign

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Patient- and Family-Centered Best Practices

▼ Senior leaders believe in the possibility and potential of patient and family partnerships

▼ There is an executive champion for patient- and family-centered care

▼ A designated staff liaison for collaborative endeavors facilitates the process

▼ Orientation and preparation for collaboration are provided to patients, families, staff, clinicians, and leaders

▼ Patient and family involvement from the beginning of a project makes a difference.

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Additional Resources

http://www.ipfcc.org/tools/downloads-tools.html

http://www.ipfcc.org/index.html

Partnering with Patients and Families As Advisors

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Bernard Roberson, MSM, BA, HSC

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Frontline Innovators on Providing Patient- and Family-Centered Care

Patients and Families As Advisors Begins With…

Recruitment

• Referred by faculty, administrators, staff, students and other patient and family members

• Must be utilizing health system services► Patients and families – satisfied or dissatisfied with

services and come with positive recommendations for change

► Highly recommended by faculty, staff, students and others

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Patients and Families As Advisors Begins With…

Qualities advisor should possess• Positive attitude

• Willingness to assist with positive change in patient care, education, research and Patient- and Family-Centered Care initiatives

• Ability to share their experience and insight in a balanced and objective way

• Ability to listen to and reflect on differing points of view

• Ability to keep information confidential

• Willingness to look beyond their own personal issues

• Willingness to work with others as an active member of the team

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When to Partner with Patients and Families as Advisors

• Brainstorming sessions

• Planning new services

• Developing new policies, procedures

• Implementing new policies and procedures

• Interviewing leadership candidates

• Educating staff, students, other personnel

• Changing clinically relevant processes

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Partnering is a Factor in all Aspects of the Health System

• Strategic planning

• Management

• Operations

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Patients and Families are Involved in the Following:

• Patient Satisfaction

• Electronic Personal Health Record (EPHR)

• Family Faculty – Personal Healthcare Stories► University and Staff Educational Programs and Trainings► Conferences

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Patients and Families are Involved in the Following:

• Quality and Safety Committees► Ethics► Performance Improvement► Joint Commission Leadership► Safety and Security► Medication Error and Prevention► Discharge Education and Planning► Quality Unit Council Committees

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Patients and Families are Involved in the Following:

• Community Coalitions and

Outreach Initiatives

• Renovations and New Construction

Projects

• Research: Sub-Investigators

• Board Level Committee

• Human Resources► New Employee Orientation► Employee Interviews

• Administrative Committees► Billing

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Involving Patients and Families in EVERY Aspect of Operations

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Examples of Partnership

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Improving Patient and Family Centered Care Rounds Research

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Improving Patient and Family Centered Care Rounds Research

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Improving Patient- and Family-Centered Care Rounds Research

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Improving Patient and Family Centered Care Rounds Research

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Collaborating with Shock Trauma Unit and Medical Illustration

Breast Health Center Redesign

Renovation

Workflow

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• Improving Hand Washing throughout the Organization► Working on Campaign► Auditing the Faculty and Staff► Confronting the Faculty and Staff► Rewarding the Faculty and Staffo Buttons

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Hand Washing Initiative

Neurosciences Center of ExcellenceResults

• Patient Satisfaction► 10th → 95th percentile► 75th to 90th percentile

• Staff vacancy rate► 7.5% → 0%► Have waiting list

• Discharges increased 15.5%

• 62% decrease in medication errors

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Questions?

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Additional Resources

• Guide to Patient and Family Engagement in Hospital Quality and Safety

• Patient Centered Medical Home (PCMH) Resource Center► Engaging Patients and

Families in the Medical Home

► Strategies to Put Patients at the Center of Primary Care

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The Innovations Exchange

• Visit our Web site► http://www.innovations.ahrq.gov/ ► Frontline Innovators on Providing Patient- and Family-

Centered Care Videos

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info@innovations.ahrq.gov