Partnering with Families to Improve Patient Safety with Lean Processing

1. Partnering with Families to Improve Patient Safety with Lean Processing Miriam Daniel Jill M. Langle, RPh, MHA

2. Objectives • Identify opportunities to partner with families for patient safety. • Describe the value of the family experience in “Lean” process change. • Use family expertise efficiently to make improvement opportunities visible.

3. Partnering with Families for Patient Safety Families hold a unique piece of the safety puzzle • Constant in child’s life and health • Key expertise and observations • Commitment to best outcomes for all children

4. Value of the Family Voice • Bring data to life --“Tell the Story” • Challenge assumptions and motivate teams • Validate and define burning platform • Make the right decisions as an idea or improvement is developed • Help providers and staff gain skill in collaborating on challenging topics • Share accountability and understanding of Plan-Do-Check-Act (PDCA) cycle with families • Validate parent role as active partner in patient care and in best practices

5. Listening To Families • Family satisfaction and other surveys • Individual interviews • Advisory groups, focus groups and committee participation • Panels and presentations • Family Feedback recorded throughout care experience • eFeedbackNOW – web-based incident and complaint reporting system • “Lean” process improvement teams

6. Safety Improvements with Parent Input • Family Advisory Council • Impetus for system-wide initiative to improve responsiveness to parent concerns • “Parents Make a Difference” video educating parents on effective partnering • Hand hygiene campaign • Shaped strategy, messaging and visuals • Improved comfort with being directive toward staff

7. Use of CPI and “Lean” • Continuous Performance Improvement is Children’s improvement methodology; a set of techniques and tools to remove inefficiencies and waste. • CPI is based on principles of PDCA. • Our strategy for CPI is “Lean” (Toyota Production System). • With CPI, we don’t let the perfect be the enemy of the good. We aim for 50% improvement when implemented then PDCA; striving for 50% again. • CPI is our culture.

8. Interpreter services Ambulatory registration Formula ordering Pre-surgical anesthesia induction Children with complex needs Inpatient medicine rounding practices Design of medically complex service Clinical specialties value stream design events Clinic Referral and Scheduling alignment session Partnering with Parents in CPI

9. Applying Lean Processing to Medication Reconciliation

10. The Case for Medication Reconciliation • While medication reconciliation is a priority national patient safety goal, our own data and parent feedback corroborated the need to take steps. • To ensure successful process improvement, we needed to find a way to effectively involve families in our lean process methodology.

11. What is Medication Reconciliation? • Collect a complete and accurate list of the patient’s home medications • Compare (reconcile) the home medication list with any new orders for medications for omissions and duplications. • Communicate the updated list to the next provider(s) of care

12. The Evidence • Medication errors - the most frequently occurring type of medical error • Ineffective communication - the most frequently cited causes of serious adverse events • Handoffs - the most vulnerable parts of a process • Studies • Approximately 46% of medication errors occur during the patient's admission or discharge. • Discrepancies are frequent, and as many as half of all hospital medication errors occur at the interfaces of care (Admission, Transfer, Discharge)

13. Miriam – One Parent’s Experience • Claire and Madeline • Medication error • Involvement with “Families as Consultants” • Medication Reconciliation team • Challenges and benefits • Impact of family participation • Outcomes for patient and family

15. Rapid Process Improvement Workshop (RPIW) Team Mission Every patient should have a standard, accessible and accurate Medication History that is verified and updated at every entry, transfer and discharge within our system in order to improve patient safety.

16. RPIW Accomplishments • Transformed implementation of Medication Reconciliation from regulatory requirement to “doing the right thing” • Positive family feedback and increased patient safety • There is a new sense of collaboration in place with our families, which helps foster staff engagement at work

17. RPIW Accomplishments • Lean processing focused the team on the family experience and forced us to let go of “doing it one way because that’s what we’ve always done” • Family voice was very compelling to staff and “drove the process” as well as provided crucial input to process design and forms • Successful implementation of a reliable process allows us to more easily adjust to make further gains and improvements

18. RPIW: Learning PointsPreparing Families • Thoughtful selection • Recommendations from staff, self-identification • Parents who can share their story, give suggestions for improvement and apply their experience to the bigger picture • Value the parent’s time and contribution • Preparation • Who will be there, process, expectations, location, honorarium, contact person • Follow-up • Debriefing • Feedback about outcomes • Ongoing support

19. RPIW: Learning Points Preparing Staff • Top down commitment and expectation • What to expect • Families • Are committed to improving our care and systems • Know more than we imagine, warts and all • Will be well-prepared • Someone will facilitate the process to support staff and parents • Be aware of own fears, concerns

20. Challenges • Changing cultural norm to have families at the table • Vulnerability that comes with commitment to transparency, being open and honest about things that go wrong • Variance in readiness and starting point • Leadership and resource commitment • Family participation, time and expertise are valued

21. It’s a Journey • Communicate benefits, especially from voice of leaders and related to outcomes • Build on successes • Communicate and close loop with staff and family partners • Look for opportunities, try different approaches • Plan, Do, Check, Act!

22. Next Steps • Expand parent involvement to develop action plan for new Joint Commission National Patient Safety Goal • Encourage patients’ active involvement in their own care as a patient safety strategy. • Integrate family-centered care into our everyday practices by enlarging the scope of family involvement and promoting successful partnerships at all levels of care and decision-making.

23. Contact Jill M. Langle, MHA, RPh Patient Safety Manager Seattle Children’s jill.langle@seattlechildrens.org