Person Centered Care Partnering With Patients, Families, and the Public at All Levels of Health & Healthcare

1. Person Centered CarePartnering With Patients, Families, and the Public at All Levels of Health & Healthcare Jim Conway, SVP, IHI jconway@ihi.org

2. Objectives • Describe the role of senior leaders in advancing patient- and family-centered care within an organisation; • Discuss the importance of linking partnerships with patients and families to quality and safety to improve outcomes; and • Discuss regional, national, and international efforts to further the development of effective, sustained partnerships with patients and families.

3. OutlinePerson Centered Care • Why me talking about this? • Why are all of us talking about this? • What is it? • Up, down, and all around • Great examples, great work • What are the challenges? • Moving forward

4. Before Going Anywhere Else…Thank You for Everything You Do Care that is reliably: Safe, Effective, Patient Centered, Timely, Efficient, Equitable [IOM, Crossing the Quality Chasm]

5. “I don’t care who you are. I going to stay with my child.” Pediatric Mother, 1976 5

6. What’s Getting Rewarded Around Here!

7. Patient and Family Centered CareA Dynamic Push/Pull Push—Making the Status Quo Uncomfortable Making the Future Attractive Organising the healthcare system around the patient and family Optimising the patient experience Correlates with other outcomes including staff satisfaction and financial outcomes Patient activation/self management Great stories and results busting out all over: IHI BMJ International Forum Health care organisations Associations It’s the right thing to do • Consumer Movement: • It isn’t ours alone to decide • Patient Rights • Patient Safety: • Voice and face of harm • AHRQ patient reporting • Transparency • Health Reform: Politicians, Governments, Nations, States • Accreditors • AARP, Consumer Reports • NQF, NPP, Picker, Planetree, IFCC, IHI, Lucian Leape Institute, WHO

9. Better Together • Builds on and spreads existing good practice. • Demonstrates local and national improvements. • Contributes to measurable progress in Scotland-wide patient-centred care. • Tests new approaches that build in patient experience to service design and delivery. • Integrates and aligns these approaches with the other national improvement programmes and initiatives. • Generates evidence of how patients experience healthcare through the use of national surveys.

10. Patient and Family Centered CarePerson Centered Care What is it? 10

11. Picker Dimensions • Respect for patient values, preferences • Coordination and integration • Information, communication, education • Physical comfort • Emotional support • Involvement of family and friends • Transition and continuity • Access to care Gerteis M, et al. Through the Patient’s Eyes. San Francisco: Jossey-Bass: 1993.

12. Four Key Concepts of PFCC • Dignity and respect: Providers listen and honor patient and family perspectives and choices. • Information sharing : Providers share complete and unbiased information in ways that are affirming and useful. • Participation: In care and decision-making • Collaboration: In policy and program development, implementation and evaluation, as well as the delivery of care Institute for Family Centered Care

13. Up, Down, and All Around “So, is it an advisory council, or a patient experience survey, or self management? What is it?” 13

14. Patient and Family Centered Care Is…Person Centered Care Is…

15. Publicly Verifiable PFCCExamples of Current Practice • Mission, vision, values • Leadership, operations • Advisors • Quality improvement • Personnel selection • Environment and design • Information and education • Charting and documentation • Care structures and support • Experience of care

16. As an example, what does it look like for the hospitalised patient? IHI R& D Project http://www.ihi.org/IHI/Topics/PatientCenteredCare/PatientCenteredCareGeneral/EmergingContent/ImprovingthePatientExperienceofInpatientCare.htm 16

17. Primary and Secondary Drivers Exceptional Patient Experience • Exceptional patient and family inpatient hospital experience (safe, effective, patient-centered, timely, efficient, equitable) as measured by HCAHPS willingness to recommend http://www.ihi.org/IHI/Topics/PatientCenteredCare/PatientCenteredCareGeneral/EmergingContent/ImprovingthePatientExperienceofInpatientCare.htm

18. Primary Drivers • Governance and executive leaders demonstrate that EVERYTHING in the culture is focused on patient and family centered care, practiced everywhere in the hospital (individual, microsystem, organisation) • The hearts and minds of staff and providers are fully engaged • Every care interaction is anchored in a respectful partnership anticipating and responding to patient and family needs (physical comfort, emotional, informational, cultural, spiritual, and learning) • Hospital systems deliver reliable quality care 24/7 • The care team instills confidence by providing collaborative, evidence based care

19. The PFCC Model at Magee Women's • Joint Replacement Programs developed through patient and family shadowing • Timely feedback and weekly meetings • Systems approach: pre-op, surgery, post- and rehabilitation

20. The PFCC Model at Magee Women's • 91.4% satisfaction excellent • 99% not limited by pain post op • 98% received the right antibiotic at the right time • 0.3% infection rate in TJR • Av LOS 2.8 days • 93% discharged without aid • 91% discharged directly home

21. At the governance and executive leadership level, some great examples from the United States… What are some of your great examples? 21

22. Leading Edge of Patient and Family Engagement

23. Options: Involving Patients and Families with Boards of Trustees • Showing video of “an infection”: Ginny’s Story YouTube • “Meet my friend Ginny” • CEO interviews of patients / families reported to Board • Recent admissions or serious preventable event • Inviting patients and families to share there experiences of care as part of a board retreat • Making a video of a patient / family interview and show it at the board meeting. • Inviting patients and families to the Board meeting to share their experiences • Inviting patients / families on Board Quality Committee • Inviting trustees to interact with patients on walk rounds

24. IT’S LEADERSHIP AT THE TIME OF CRISISAn IHI Resource CenterLeadership Response to a Sentinel Event: Respectful, Effective Crisis Management http://tinyurl.com/IHIEffectiveCrisisMgmt First and Foremost: Never lose sight of the patient and family

25. Listen to me, trust me, respect me as a partner in care

27. Partnerships with Patients and Families to Improve Outcomes Show me the data? Nice but not necessary? 27

28. Patient Experience Is Strongly Correlated With Other Key Outcomes • Health outcomes • Patient adherence • Process of care measures • Clinical outcomes • Business outcomes • Patient loyalty • Malpractice risk reduction • Employee satisfaction • Financial performance Edgman-Levitan S., Shaller D. et al. The CAHPS Improvement Guide. Boston: Harvard Medical School: 2003.

29. Financial Benefits of Patient- Centered Care in Planetree • Reduced length of stay • Lower cost per case • Decreased adverse events • Higher employee retention rates • Reduced operating costs • Decreased malpractice claims • Increased market share Charmel P, Frampton S. Building the Business Case for Patient Centered Care. HFM. March, 2008

30. We have plenty of international evidence! Improving the Experience of Patient Inpatient Care 30

31. What About the Challenges? • We’re already doing a good job! • Clinicians don’t have the time. • Can we get away with doing just one thing? • It’s someone else’s job. • Lots of tokenism; checking the box. • Paternalism. We know best and they don’t do what they are told. • It doesn’t work here. “My patients and family members are too _______ (poor, non-compliant, illiterate, violent.)”

32. From a policy perspective, the widespread implementation of policies to ensure patients’ rights, privacy, and confidentiality is noteworthy. Patient involvement in quality improvement activities, on the other hand, so far appears to be a more rhetorical exercise than a practice Groene O et al. Is patient-centredness in European hospitals related to existing quality improvement systems? Analysis of a cross-sectional survey (MARQuIS Study). Quality & Safety in Health Care, February 2009 32

33. Key Learning:What Do Patients And Families Bring? • Their knowledge of the illness; It’s About Them! • Parents of a child • The chronically ill adult • The actual experience of care • Failures in handoffs, slips, harm • What works for them and what doesn’t • Writing in the record, participating in rounds • This doesn’t look right • A passion to achieve the same goals we want

34. PFCC Will Take Leadership at Every Level Not an “if” but a when and how discussion. It’s a system to be designed and achieved. It’s a gift to be given. It’s a right to be realised. 34

35. Other Resources What ‘Patient-Centered’ Should Mean: Confessions Of An ExtremistBerwick Health Affairs.2009; 28: w555-w565 Associations and Groups • Picker Institute • www.pickerinstitute.org • IHI • www.ihi.org • WHO Patients for Patient Safety • http://www.who.int/patientsafety/patients_for_patient/en/ • Institute for Family Centered Care • www.familycenteredcare.org • Planetree • www.planetree.org • Partnership for Healthcare Excellence • www.partnershipforhealthcare.org • Consumers Advancing Patient Safety • www.patientsafety.org • New Health Partnerships • www.newhealthpartnership.org