rethinking "patient engagement" evaluation: a mixed methods approach
TRANSCRIPT
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Rethinking “Patient Engagement” Evaluation: a Mixed Methods
Approach
BC Quality Forum
Jessie Checkley
March 3, 2017
cfhi-fcass.ca @cfhi_fcass
Collaborative Aim To build capacity and enhance organizational culture to partner with patients and families in order to improve quality across the healthcare continuum.
Partnering with Patients and Families for Quality Improvement Collaborative 2014-2015
Measurement Focus
VARIABLES OF INTEREST INSTRUMENTS USED FREQUENCY
Ability to complete QI project
Collaborative Assessment Scale (adapted IHI tool)
4 months
Individuals knowledge and skills (PE,PFCC, QI)
Poll Learning Objective and CQI Data
Monthly
Social networks used by teams
New survey developed
T1 & T2
Team effectiveness & team experience
New survey developed ** T1 & T2
Patient advisor experience Interview and survey done 3 months-post Collaborative
3 months post
Team leader experience Interview and survey 4 months post
Patient, staff, organizational outcomes
Final Report from Teams
Post
** Combined measures from West 1996, Orchard 2011, Shortell 2004, IPFCC 2010
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Measurement Tools
1) Collaborative Assessment Scale
2) Social Network Analysis
3) Team Effectiveness and Team Experience Survey
4) Final Report Document Review
5) Interviews/Surveys with Patient and Family Advisors
6) Interviews/Surveys with Teams
7) Polls – Learning objectives and CQI Data
Social Network Analysis
small tightly connected team working closely together
one team member at the centre
sharing information
outwards
small core team connecting
with outer networks
Social Networks and Health: Models, Methods, and Applications. Thomas W. Valente. Oxford: Oxford University. Press, 2010, pp. 277, ISBN: 978-0-19-530101-4.
Level of Engagement – IAP2 Scale Within my QI Project Team, this person…
Informs Consults Involves Collaborates Empowers
…provides me with balanced and objective information to assist me in understanding the problems, alternatives and/or solutions.
…obtains my feedback on analysis, alternatives and/or decisions.
…works directly with me throughout the process to ensure that my concerns and aspirations are consistently understood and considered.
…partners with me in each aspect of the decision, including the development of alternatives and the identification of the preferred solution.
…places final decision‐ making in my hands.
T1 Avg. Per
Resp.
T2 Avg. Per
Resp.
2.2 2.3
2.2 2.4
2.3 2.5
1.9 1.2
0.6 0.6 160
170
177
82
44
176
179
183
150
46
Inform
Consult
Involve
Collaborate
Empower
T1: n=80, T2: n=70
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How Were Patients Engaged To Effect Improvement?
› Consultation and Involvement roles:
• Patient and Family Advisory Forums/Councils
› Partnership & Shared Leadership roles:
• Episodic: Kaizen events, quality improvement teams
• Shared decision-making over time
• At direct care level: providing peer support as part of interdisciplinary team
• At governance/ policy levels: members of ongoing quality committees, board, senior leadership committees
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What Patient Advisors
Had to Say….
1. Involve me from the beginning
2. Inform and educate team on why we are there
3. Facilitation by team lead “sets the stage”
4. Invite more than 1 patient advisor
5. Let us do more than just tell our stories
6. Cover out of pocket expenses
7. Recognition and loop back
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Results: Quality of Care Improvements
• Improved Patient Experience of Care (21 teams)
• Built Patient & Family Engagement Infrastructure (20 teams)
• Coordination of Care & Transitions (7 teams) • Transfer of accountability at change of shift • Transitions from acute to rehab care • Multiple admission & discharge process improvements • Transition to adulthood for youth with complex conditions or
cancer
• Chronic Disease Self-care Management (4 teams) • Improving healthcare provider skills to support self-care
management in diabetic and renal populations • Patient engagement resource guide for primary care • Recruiting and training patient advisors
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Results: Quality of Care Improvements
Timely access to care (3 teams) • Improved response time and effectiveness of response to patient calls
in a busy MS Clinic
• Improved Information about wait times in pediatric rehab
• Cancer care wait times addressed thru re-design of work processes
Peer Mentoring (2 teams) • Bedside Orientation in pediatrics by experienced parent mentors
• Peer mentoring following upper limb amputation
Use of technology in direct care to improve (2 teams) • Transition to adulthood for youth with complex conditions
• Reducing sense of isolation amongst dialysis patients
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Capacity to Lead Improvement
Staff Learning: • How to recruit & orient patient advisors
• Patient and family centered care 101
• Communication skills: teach back, shared decision-making, bedside rounds
• Supporting self-care management in persons with chronic illness
Patient/Family and Staff Joint Learning: • Quality improvement methods: PDSAs,
process mapping, patient journey mapping
• Experience-based co-design methods
• Change management and facilitation
• Measurement
• Storytelling & video production
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Strategies for Sustainability & Spread
Process Changes – 19 organizations
• Standardizing recruitment & orientation processes
for patient advisors; new resources and tools.
Changes in Structure – 14 organizations
• Patient and Family Advisory Councils
• New quality forums with patients as decision-making partners
• Family Partnership Committees focused on patient engagement
• Addition of patient advisors to existing committees or work groups
Creation of New Roles or Change in Roles – 8 organizations o Patient Partnership/Coordinator roles created to facilitate patient
advisor recruitment, and increase patient partnerships in future initiatives
• Paid roles as Patient & Family Coordinators
Regional or Provincial Spread - 13 organizations
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Conclusions
› The Collaborative evaluation generated rich learnings
about organizations' readiness to engage with patients
and families in care design and how care team members
and patients and families can be effectively engaged
and motivated to work collaboratively.
› Effective patient-centered care and patient engagement
require changes in values and relationships which
depend on creating supportive structures, roles, and
policies. More mature contexts for engagement lead to
increasing sophistication of how patients and staff are
engaged together, which can lead to broader changes in
health service re-design.
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The Canadian Foundation for Healthcare Improvement is a not-for-profit organization funded by Health Canada. The views expressed herein do not necessarily represent the views of Health Canada. La Fondation canadienne pour l’amélioration des services de santé est un organisme sans but lucratif financé par Santé Canada. Les opinions
exprimées dans cette publication ne reflètent pas nécessairement celles de Santé Canada.
YOU
Jessie Checkley [email protected]