partnering with patients* to improve care and systems
TRANSCRIPT
Partnering with patients* to
improve care and systems
Working Together for Meaningful Engagement ForumMaria Judd, Senior Director, CFHI
March 3, 2016
@CFHI_FCASScfhi-fcass.ca |
We will address and discuss:
Today’s Session
• What are the key features (environment and context) of
patient-centered health systems?
• How do systems partner with patients, families and
communities and in what ways does that partnership lead
to improved care, health and costs? (Triple Aim)
• What application does this have within Ontario and the
Champlain LHIN? (from consultation to co-design)
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The Canadian Foundation for Healthcare Improvement (CFHI)
We accelerate the spread of proven innovations by supporting healthcare organizations to adapt, implement and measure improvements in patient care, population health and value for money.
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CFHI’s Six Levers For Accelerating
Healthcare ImprovementTM
Source: www.cfhi-fcass.ca/AssessmentTool4
Improving the health of the populations
Improving the patient experience of care
Reducing the per capita cost of health care
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Deficit-thinking Asset-thinking
Problem-oriented
How can we fix this problem?
Someone needs to sort this out … us vs. them
Do things to people
Strength-based
How can we engage the community?
What can I/we do? How can we work together?
Work with people
Source: Adapted from Kretzmann & McKnight (1993); Goldman & Schmalz (2005)
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Patient Engagement
• Patient engagement is the involvement of patients and/or family members in decision-making and active participation in a range of activities (e.g. planning, evaluation, care, research, training, and recruitment).
• Starting from the premise of expertise by experience, patient engagement involves collaboration and partnership with professionals.
Source: Adapted from Tambuyzer A, Pieters G, Van Audenhove C, “Patient involvement in mental health care: one size does not fit all,” Health Expectations, (2011): 5.
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Voices of Patients, Families, Communities, Providers & Researchers
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3 inter-related concepts =an important lever for quality improvement
i. Patient experience
ii. Patient- and family-centred care
iii. Patient engagement
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©2007 International Association for Public Participation http://www.iap2.org/
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Improved health outcomes & changes in
service utilization
Patient & organizational improvements e.g
patient experience, safety and effectiveness
Changes in improvement priorities
& resourcing
Source: Carman, et al.,Health Affairs, 2013
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Reflection Question
• Where is your organization on the Carman continuum?
CONSULT: We survey patients about their care
experiences INVOLVE:
Formal roles and opportunities for patients to advise (e.g. patient experience advisors)
Patient and family advisory council(s)
PARTNER: Patients co-lead committees
(e.g. QI committee)
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Three Foundations of Meaningful Engagement
Values Based
Decision Oriented
Goal Focused
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Survey Data
Concerns Data
Comment Cards
Interviews
Focus Groups
Mapping the Patient Journey
Patient and Family Care
Stories
Leadership Rounds
Care Giver interactions
Patient and Community Engagement Researchers
Quality Teams
& Committees
Patient & Family
Councils
The Voice of Patients and
Families
Collecting Feedback
Real-Time Encounters
Collaborating at the Planning Table
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Emerging evidence suggests that patient and family engagement translates into patient and organizational improvements (primarily in the areas of safety and effectiveness) but the mechanisms that translate patient and family engagement into better outcomes are not well understood.
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Case Studies of Patient Engagement in 3 Countries
• Case studies provide insights into the strategies & mechanisms that translate patient engagement into better outcomes
• Identify key investments, structures, processes that support meaningful patient engagement for improvement
Organizations Networks
McGill University Health Centre Northumberland PATH Project (ON)
Kingston General Hospital Collaborative Chronic Care Network (US)
Georgia Regents Health System (US) Patient Partners (British Columbia)
Cincinnati Children’s Hospital (US)
Whittington Health, London (UK)
Northumbria Trust (UK)17
Engagement Capable Environments: leadership, staff and patients
Enlisting and Preparing Patients
Engaging staff to involve patients
Ensuring leadership support and strategic focus
Communicating patientexperiences to staff
Asserting patientexperience and patient-centered
care as key values and goals
Supporting teams and removing barriers toengaging patients and improving quality
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Collaborative Chronic Care Network (C3N)
Source: C3N - http://c3nproject.org/about-c3n-project
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C3N
• IBD patients and families are the co-designers of care, involved in every step of the process from consultations to partnerships and shared leadership
• Partnership is aimed at co-production and design of services to ensure appropriateness and value to patients and the health system
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Collaborative Chronic Care Network (C3N)
Elements of Success
1. Building partnerships *
2. Organizational structures that support patient engagement
3. Applying a network-based approach
4. Horizontal hierarchy across the network
5. Offering flexible engagement opportunities
6. Providing tools to support patient engagement in direct care
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Peter Margolis, Cincinnati Children’s Hospital23
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The patient is not just at the centre of care but is part of the care team, and is considered an actor of care.
– Vincent Dumez, Faculty of Medicine, Université de Montréal
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Partnering with Patients and Families for Quality Improvement:
A CFHI pan-Canadian collaborative
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Top 4 Domains of Quality(identified by teams):*many teams are measuring multiple domains of quality
Care Environments• 7 Primary care & community care• 4 Rehabilitation or Continuing care• 9 Acute care: 7 adult & 2 pediatric• 2 Mix of acute care & cancer agencies
Aim: To build capacity and
enhance organizational culture to partner with patients and families in order to improve quality across the healthcare continuum.
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How are patients engaged to effect improvement?
Consultation roles
• Patient and Family Advisory Forums/Councils
Co-design
• Short term/Episodic:
• Kaizen events, Quality Improvement teams for specific issues
• Long term/Continuous:
• Included as members of ongoing Governance structures (MUHC)
• Providing peer support as part of interdisciplinary care team (CHUM)
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“Good to Go’‘ A Safe and Smooth Transition Home after Hip Fracture-improving patient experience
(Vancouver Coastal Health and Fraser Health Authority team, BC)
Teach-back for safe transitions
(The St. Joseph’s Healthcare Hamilton, ON)
Embedding peer coaches in teams
(CHUM, Quebec and Stollery, AB)
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Champlain LHIN
• Healthy people and communities supporting by a quality, accessible health system
• Building a strong foundation of integrated primary, home and community care
• Improving coordination and transitions of care
• Improving coordination and integration of services among hospitals
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Visitation Policies: One size does NOT fit all
Open Visitation Policy
Family Presence Policy
Are you a…
Designated partner in
care
Visitor
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Family Presence: A Policy and a Practice
…enables patients to designate partner(s) in care who are welcome in the hospital 24 hours a day
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Policy elements:
• Family as defined by the patient
• Welcome families 24 hours a day
• Identify preferences for how family will be involved in care planning and decision-making
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The Benefits
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Campaign Objectives
Families are more than visitors. They’re partners in care and allies for safety and quality.
Champlain LHIN:
• Welcoming families and loved ones as partners in care, and engaging them in care planning and decision-making based on patient preferences.
• Take the CFHI Better Together pledge!
• Join the free Better Together e-Collaborative (March 2016)
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Patient Platform: Strengthening the Patient and Caregiver Voice
• Representing 102 patient organizations • Brings together cross-disease concerns• Advocates with federal authorities on behalf of member
organizations
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Patient Engagement Resource HubLooking for tools and resources to support you
on your patient engagement journey?Start at the Patient Engagement Resource Hub!
Our online resources can help at the stages of assessing, designing, implementing or evaluating your initiative.
For more information: www.cfhi-fcass/PatientEngagementResourceHub
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118 resources from 6 countries: Canada (35 %), United States, United Kingdom, Australia, New Zealand, Belgium
Hub resources include Canadian and international open source tools. Use them in patient and family engagement initiatives to improve health and healthcare.
CFHI Resource Hub expansion in the works!Have resources to suggest? [email protected]
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Developing true partnerships:Are patients a “Guest” or “Partner” at the table?
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Resources and References
Continuums of engagement• IAP2 Spectrum of Participation
http://c.ymcdn.com/sites/www.iap2.org/resource/resmgr/Foundations_Course/IAP2_P2_Spectrum.pdf
• Patient and family engagement: a framework for understanding the elements and developing interventions and policies. Kristin L. Carman, Pam Dardess, Maureen Maurer, Shoshanna Sofaer, Karen Adams, Christine Bechtel, Jennifer Sweeney. Health Aff (Millwood) 2013 February; 32(2): 223–231. doi: 10.1377/hlthaff.2012.1133. http://content.healthaffairs.org/content/32/2/223.long#content-block
• Bate P, Robert G. Experience-based design: from redesigning the systems around the patient to co-designing services with the patient. Qual Saf Health Care. 2006;15:307–10. doi: 10.1136/qshc.2005.016527. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565809/
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Resources and References
Patient and Family Centered care – Institute for Patient- and Family-Centered Care (IPFCC) – Planetree– Institute for Healthcare Improvement (IHI)– The Beryl Institute
• http://www.kingsfund.org.uk/projects/pfcc• The Puckett Institute (Carl Dunst)
Transitions in Care: Australian Commission on Safety and Quality in Healthcare: Engaging Patients in Communication at Transitions of Care
• Link to the Report: http://www.safetyandquality.gov.au/wp-content/uploads/2015/03/Engaging-Patients-in-Communication-at-Transitions.pdf
• Link to The Commission’s Patient-Clinician Communication Program: http://www.safetyandquality.gov.au/our-work/clinical-communications/patient-clinician-communication/
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Resources and References
Meaningful and successful engagement• FCASS Plateforme de ressources sur la participation du patient
• CFHI key ingredients briefs http://www.cfhi-fcass.ca/WhatWeDo/PatientEngagement.aspx
• Coulter, A (2012):Leadership for Patient Engagement King’s Fund. http://www.kingsfund.org.uk/sites/files/kf/leadership-patient-engagement-angela-coulter-leadership-review2012-paper.pdf
• EBCD toolkit: http://www.kingsfund.org.uk/projects/ebcd
• Resources to support patient and family engagement http://patientfamilyengagement.org/resources
• Agency for Healthcare Research and Quality (AHRQ): Guide to Patient and Family Engagement in Hospital Quality and Safety
• http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/guide.html
• Leadership for Safety “How To”Guide” guide: Using Patient Stories with Boards.http://www.patientsafetyfirst.nhs.uk/Content.aspx?path=/interventions/Leadership/
• Bring it on - 40 ways to support Patient Leadership. NHS Midlands and East. http://centreforpatientleadership.com/aboutus/ourclients/
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