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Engaging Families As A Strategy To Advance Quality & Safety. Daniel Hyman, MD, MMM September 21, 2012. Family Engagement Objectives. Describe at least two best practices to engage patients/families in quality and safety in your organization
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Engaging Families As A Strategy To Advance Quality & Safety Daniel Hyman, MD, MMM September 21, 2012
Family Engagement Objectives • Describe at least two best practices to engage patients/families in quality and safety in your organization • Discuss the benefits of patient/family involvement at the bedside and at system or strategic decision-making levels within your organization. • Begin to develop a plan for advancing the engagement of patients/families in quality/safety programs within 30 days, including recruitment, training and orientation. • And, do you want to talk about “risks”?
History of Family Engagement • From innovation…. To early adoption…. To mainstream • Where are we in that arc? • Pursuing Perfection and My personal experience • IHI ~2005 • Institute for Patient and Family Centered Care • Polly Arango – co-founder Family Voices • MSCH/NYP • Children’s Hospital Colorado
On February 22, 2001, eighteen-month old Josie King died from medical errors. 98,000 people die every year from medical errors, making it the fourth leading cause of death in the United States. The Josie King Foundation’s mission is to prevent others from dying or being harmed by medical errors. By uniting healthcare providers and consumers, and funding innovative safety programs, we hope to create a culture of patient safety, together. www.josieking.org
AHRQ Report Summary Goal – promote patient/family engagement with tools, resources, materials, training • Support the involvement of patients and family members in the safety and quality of their care. • Encourage the involvement of patients and family members in improving quality and safety within the hospital setting. • Facilitate the creation of partnerships between health professionals and patients/family members. • Outline the steps needed to implement changes.
Individual involvement Well accepted by patients and providers • Obtaining information, involvement in decision making Less comfort with confrontational behaviors • Hand washing, surgical marking e.g. Barriers and facilitators • + self efficacy, information, support/invite • - fear, uncertainty, low literacy, norms
Organizational context External and influences to engaging families in quality/safety Organizational processes and structures that enable? Intervention strategies
Influencers Internal Serious events Business case Improvement Altruism External • “steal shamelessly” • Policies/regulation • Influential advocacy • Public reporting
Structures/Processes No evidence that one or another structure is a barrier/enabler of patient/family engagement Organizational ability to absorb and sustain change, strength of leadership, resource/bandwidth are relevant factors
Strategies Implementation – readiness assessment; shared vision; execution plan; staff engagement; leadership Hospital level interventions – policies, structures; health care team level; management processes Individual level interventions – educating, informing, activating patients and providers; facilitate communication at all levels
Our story • At the bedside • Microsystem involvement • Organizational involvement • Projects • Committees and Councils • Family Advisory Council • Board level
Engaging Families at the Bedside:Watchful Eye of the Parent • At the bedside- listening to families • Family centered rounds • Intentional inclusion in decision making • Speak Up!- How it can improve outcomes? • Need measurement strategy
Speak Up Hand hygiene! RRTs! Patient Identification!
Speak Up Falls! Pressure Injuries!
Projects and Service Lines • Initial involvement may best be at project or clinical team level • Partnership for Patient Safety (staff education) • Hand hygiene • Patient Identification • Consult and team communication • Ambulatory Access • Speak Up! • Service Line Quality Committees
Parent voice is heard by administration Activities that are done by active parents Parent education What Family Advisory Councils Can Provide Hospitals
Family Advisory Council Web Link(s) MSCH FAC- CHCO FAC
Experience at Children’s Colorado • Parent placement on multiple committees/councils and projects • Selection process- especially important at the start • Recruitment strategies • Family Advisory Council • Programs themselves • Family Relations/Risk management referrals • Ad hoc contacts • Orientation documents and processes • Parent orientation session- includes volunteer training • Committee member orientation needed too
Experience at Children’s Colorado • Overcoming resistance /concerns • Meeting management • Acronyms, jargon • Asking for input • Managing defensiveness • When people forget we have parents in the room…. • Debriefing is helpful after meetings • What we really need is an objective evaluation strategy other than that it feels good and seems like the right thing to do!
Assessing Family Engagement at Children’s Hospitals in the US 33 children’s hospitals participating in a national patient safety network Family engagement is a goal Where Hospitals are Today
OCHSPS - QI Assessment Survey Results for Family Engagement 10 hospitals said Yes to both questions
Framework Self assessment framework Tools/Resources
Concerns and Risks • You tell me…. What are some reasons you would hesitate to engage patients/families…. • In decision making and advocacy at the bedside? • in quality/safety initiatives? • Breach of privacy/confidentiality? • Litigation? • Derailing meetings?
How you can get started Find early adopter parent/patient/family, staff leader Start with a project or task force, then another….. Discuss committee options Develop, adaptor steal orientation materials PDSA Cycles! Patient/family selection strategies Hospital staff preparation Dealing with concerns/resistance “Start before you’re ready”
