humboldt consumer engagement across the spectrum · implementation . of the chronic disease ....
TRANSCRIPT
Moderator:
Judith Schaefer, MPH, MacColl Institute for Healthcare Innovation at Group Health
Speakers:
Betsy Stapleton, FNP, Consumer Engagement Leader, and Jessica Osborne-Stafsnes, Program
Manager - Patient Engagement, Aligning Forces Humboldt at The California Center for Rural
Policy, Humboldt State University
Humboldt Consumer Engagement Across the Spectrum
8 Change Concepts for Practice Transformation 1. Foundational Changes
Engaged Leadership
QI Strategy
Empanelment
2. Changing Care Delivery Continuous, Team-based Healing Relationships
Patient-Centered Interactions Organized, Evidence-based Care
3. Changing Patient Experience
Enhanced Access
Care Coordination
HUMBOLDT CONSUMER ENGAGEMENT ACROSS THE SPECTRUM
Betsy Stapleton, FNP & Jessica Osborne-Stafsnes
Hi There!
Jessica Osborne-Stafsnes
Program Manager- Patient Engagement
Aligning Forces Humboldt at The California Center for Rural Policy
At Humboldt State University
Fun fact: I once won a hula-hoop contest!
Betsy Stapleton
Retired FNP; Consumer Engagement Leader Aligning Forces Humboldt at
The California Center for Rural Policy At Humboldt State University
Fun fact: I love to drive tractors!
Special Guest
Mary Romaidis
Patient Partner Eureka Community Health Center
Opendoor Health System Fun Fact: I like to line dance!
Humboldt County AF4Q Alliance; Part of RWJF’s “Aligning Forces for Quality”
1 of 16 communities across the United States. AF4Q Aim: convene patients, providers, and payers to improve
the quality of healthcare at local, regional, and national levels.
AFH Focus: to generate meaningful opportunities for patient engagement in healthcare improvement, delivery, and design.
www.aligningforceshumboldt.org
About Aligning Forces Humboldt
Now, a little about you….
What 3 words come to mind when you think about involving patients in your quality improvement efforts?
(Type in your answers
in the chat box)
Today’s webinar
Present a model for involving patients in quality improvement
Present tools for engaging patients in improving the experience of care
Will address two components of PCMH: Patient Self-Management Support Patient Communication
A Definition of Patient Engagement
“ [Patient Engagement is]…
giving voice to the public and
involving them in shaping
health care delivery.”
-Picker Institute Europe
Patient Engagement in Humboldt County, Ca
HDNIPA participates in the IHI
“Quality Allies” Project 2005-2006
2007 AF4Q initiative begins,
citing patient engagement as a key driver of
quality improvement
Implementation of the Chronic Disease
Self-Management Program (CDSMP)
2008
2009 HDNIPA adopts
collaborative model to improve primary
care called: Primary Care Renewal
(PCR); 10 PCP practices
participate
CDSMP leaders act as faculty at PCR meeting to discuss the patient perspective of living with a chronic health
condition 2009
2011 PCR 2.0 launches with an emphasis on PCMH.
Recruitment of a “patient partner” team
member is a requirement of participation.
Significant infrastructure is built to support this
effort.
PCR 3.0 kicks-off. Practices must recruit
two patient partners to participate. Patients
participate in collaborative and office improvement meetings.
2012
2012 Community Response
To Surgical Variation
Patient Core Function Levels
Recommended Patient Role Key Patient Characteristics Necessary Support Practice Readiness
1. Help individual patients better manage their own health
Partner in care • Willing to develop self-awareness about personal role in managing health •Receptivity to initiate better health care behaviors • The ability to communicate with care team
Offer peer-support resources, such as referrals to community-based chronic disease self-management programs (often available both in-person or online), group visits, etc.
Starting to engage in viewing patients as partners in chronic condition management. Beginning practice redesign efforts. Willingness to explore new models of care. Leadership support
2. Becoming a leader beyond personal health. Support others in better managing their own health. Using health information to make informed decisions.
Partner in care • Desire to seek information about specific health issues • The ability to discuss information with provider (ask questions, seek clarification, etc.) • Desire to become peer leader and provide support to others.
Access to training for peer leader roles. Access to personal health information, resources on specific disease states, decision support is available, etc.
Starting to implement internal self-management support. Documenting and tracking self-management goals. Practice open and receptive to chronic disease peer leaders. Developing systems to direct patients to decision support material. Leadership support
3. Assist individuals to weigh in on patient experience (resulting in weighing in on quality improvement efforts, office workflows, and patient experience).
Advisor • Communication skills • Can collaborate with diverse individuals • Desire to increase knowledge • Can contribute and provide collective pt. perspective comfortably • Focused on improving care related to the team goals
Offer information and training on key focus areas. Ask specific questions. Create a culture that values patient insight. Significant investment in resources.
Link into external support that will aid your practice in working with patients in a quality improvement setting. Leadership support.
4. Foster and support champion patients as equal core members of committees that drive redesign efforts at the highest levels
Advisor and Champion •Skills listed above and: •Can articulate pt. insight and bring pt. feedback to the forefront • Functions in a fast-paced and technical setting • Problem-solves in inclusive ways
Create roles for a patient/patient advocate on committees. Solicit patient feedback. Offer educational and training opportunities. Significant investment in resources.
Link into external support that will aid your practice in working with patients in a quality improvement setting. Leadership support. (Stapleton & Osborne-Stafsnes, 2012)
CDSMP
AFH’s Patient Engagement Efforts
Patient Partners Surgical Rate Project
CDSMP Health
Information Engagement in personal
health
Engagement beyond personal health
Patient Engagement
in Patient
Experience
Fostering Patient
Champions at policy
levels
CDSMP- an introduction
Chronic Disease Self-Management Program (CDSMP)
Six week workshop series, meeting once a week for 2 ½ hours for six weeks Developed by researchers at Stanford University Patient Education Research Center Evidence based Highly interactive Trained Peers as leaders
CDSMP- Core Curriculum
Workshop Topics Goal setting Exercise Communication Nutrition Managing emotions Problem solving Symptom management
CDSMP Applied
“I am going to the doctor, getting
regular check-ups, keeping track and self-managing to stay in the good
place that I am at right now.”
CDSMP Near You
CDSMP is offered across the United States, Online and Internationally.
Find a program near you! : Http://patienteducation.stanford.edu/organ/cdsites.html
CDSMP
AFH’s Patient Engagement Efforts
Patient Partners Surgical Rate Project
CDSMP Health
Information Engagement in personal
health
Engagement beyond personal health
Patient Engagement
in Patient
Experience
Fostering Patient
Champions at policy
levels
The Patient Partner Project
“Practices often struggle with the 'fires' of the day , making it difficult to focus on larger constructs such as patient-centered care. The participation of Patient Partners on practice improvement teams keeps the importance of improving patient care at the forefront of discussion.”– Rosemary DenOuden, Chief Operating Officer, HDNIPA
Project Specifics
• Began in 2011
• Part of QI
collaborative
•Two patients/team
• Patient Partners
receive training and
support
• Ambassadors and
advocates
Share insights and feedback explicitly
focused on collaborative topics
Conceptual Framework
Patient Partner
Collaborative Meetings
Team Meetings
Patient Partner
Meetings
“The process of becoming an intelligent partner in the health process can be hard for people.”
-- Toni M.
Process Development
Steps to Engagement
1. Recruit 2. Train 3. Engage and Support
1. Meetings 2. Brainstorming
1) Recruit
Fundamentals Role clarity
Leadership Buy-in Physician and administrative leaders must actively and visibly
endorse patient engagement work Vision for partner role What is the patient’s role? What “jobs” will they do?
Job description/skill sets Time commitment Skill sets Authority Structure
1) Recruit Cont. Strategies for recruitment Provider/Staff Recommendation Partner with CDSMP organization Flier Interview Social Media
Mary’s Reflection
1. How were you recruited to this project?
2. In your experience, what was successful about the recruitment process?
3. What recommendations would you make to practices looking to recruit patients to participate in similar activities?
2) Train
Patient readiness Medical Culture QI process Methodology Theory/Philosophy
PCMH Confidentiality “Medical-ese” Chronic Care vs. Acute Money talks Group dynamic training
2) Train Cont.
Practice Readiness Identified facilitator with appropriate skills CDSMP Leader Training Loving firmness Able to remove health system hat Sense of humor Commitment to the role
Translational role Commitment to communication and feedback on patient input Transparency Communication Contingency planning
Mary’s Reflection
1. What was the most valuable part of the training process?
2. What would you do differently?
3) Engage and Support
Patient Partner
Collaborative Meetings
Team Meetings
Patient Partner
Meetings
Patient Partner Meetings
• Introduce meeting topics and curriculum • Practice updates, brainstorming, and problem-solving • Sharing of “best-practices” • Capture patient recommendations and perspective on meeting subjects.
Premise:
•Anyone who has an idea
can share it.
•No commentary during
the brainstorm.
•Ideas are clarified or
further discussed after the
activity is completed.
Brainstorming
Premise:
•Anyone who has an idea
can share it.
•No commentary during
the brainstorm.
•Ideas are clarified or
further discussed after the
activity is completed.
Brainstorming
Practice Brainstorm
Using the chat box, brainstorm responses to the following question:
What sort of quality improvement projects or activities could you engage patients in?
Brainstorming
Benefits: • Great tool to generate conversation. • Engages all members of the group. • Recurrent themes are clearly visible. • Makes evident any areas of confusion. • First step towards a topics for further discussion.
Brainstorm: What sort of challenges do you encounter with access?
Problem-Solving
1. Identify a problem
2. List ideas
3. Choose 2-3 solutions for further discussion
4. Examine these solutions from the clinical perspective
5. Revise solutions based on clinical feedback
Conceptual Framework
Patient Partner
Collaborative Meetings
Team Meetings
Patient Partner
Meetings
Collaborative Meetings
Techniques
Standing agenda item
that starts meeting and
sets tone
Prep patient for
presentation
Vary presentation mode
to keep interest
Evaluate
Conceptual Framework
Patient Partner
Collaborative Meetings
Team Meetings
Patient Partner
Meetings
Team Meetings • Patients attend one “practice improvement” meeting at their office each month.
• Some offices have standing agenda items specifically for their patient partners.
• Patients offer insight and work on projects specific to the practice.
Sample Projects:
•Practice brochure
• Patient-friendly language
• Practice ombudsman
• Testing patient portals
• Process development
Mary’s Reflection
What has your team done to engage you during team meetings?
3) Engage & Support Cont.
For Practices: Formal collaborative requirement Patient partner work aligns with pre-existing
practice goals Adequately trained patient partners Close communication with practice coaches Assistance with recruitment, patient training, etc.
Support Systems Summarized
Prac
tice
• Recruitment assistance
• Third-party support
• Patient Partner Contract
• Patient Partner training
• Recommendations for engagement
Patie
nt P
artn
ers • Orientation
• Resource Binder • Patient Partner
Meetings • “Buddy System” • Transparency • Strong structure Pr
actic
es
Addressing Challenges
• Recruitment • Transformation • Outside Opportunities
Unbalanced Engagement
• Initiate with a project in mind • Clarity and intent with requests • Sharing of ideas/best-practices
In-office Engagement
• Patient training and support • Creative solutions to meeting
coordination barriers
Clinical Culture
Whose Home Is It?
Providing Medical Care Patient Experience
Practice Home
Doing Business Quality Improvement
Practice Redesign
Medical Home
(Stapleton, 2012)
•Patient’s Home •Patient-centered
• Staff uses comprehensible
language •Ultimately, patient is
in control
• Provider/Staff home
• Office-centered • Patient Partners
learned “Medicalese” •Ultimately,
Provider/Staff are in control
Recognizing Success
Patient Partners are catalysts for transformation
Recognizing Success
4.35
4
4.19
4.1
4.35
4.04
3.88
3.79
3.98
3.5
3.6
3.7
3.8
3.9
4
4.1
4.2
4.3
4.4
February 2 March 31 May 26 August 4 September 22
Scor
e
Meeting Date
PCR 2.0 Meeting Evaluations - Scale 1 to 5
Did the Patient Partner Presentation/Skit aid your understanding of patient perspective?
Was the information shared by the keynote speaker useful?
“They keep our focus centered where it should be: on the patients.” -- Participating Clinician
Recognizing Success
“They keep our focus centered where it should be: on the patients.” -- Participating Clinician
Focus Groups Surgical Rate Project Empanelment Process Development Backlog reduction
Lessons Learned
Leadership buy-in is essential
Be prepared for learning curves
Have a highly structured and focused framework in place
Thread the value of patient involvement through out the entirety of your work
Mary’s Reflection
What final thoughts would you like to share?
Tell Us….
What next steps will you take to begin working or continue working effectively with patients?
(Type in your answers
in the chat box)
“… it is the active presence of patients, families and communities in the design, management, assessment, and
improvement of care, itself” - Dr. Donald Berwick, 2008
“Put the patient at the center- at the absolute center of your system of care…