Partnering with Patients - PCPCI · 2013-07-09 · 4 Step Process 1- Staff present on current projects & programs 2- Patient & Family Advisors brainstorm and come up with ideas for

Partnering with Patients

Engaging Patients in Quality Improvement Initiatives Angela Mitchell, MPA Providence Medical Group

Jessica Osborne-Stafsnes Aligning Forces Humboldt

Welcome!

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Patient-Centered Primary Care Institute History and Development

• Launched in 2012 • Public-private partnership • Broad array of technical

assistance for practices at all stages of transformation – Learning Collaboratives – Website (www.pcpci.org) – Webinars & Online Learning

• Ongoing mechanism to support practice transformation and quality improvement in Oregon

Oregon’s PCPCH Model is defined by six core attributes, each with specific standards and measures • Access to Care

– “Be there when we need you” • Accountability

– “Take responsibility for us to receive the best possible health care” • Comprehensive Whole Person Care

– “Provide/help us get the health care and information we need” • Continuity

– “Be our partner over time in caring for us” • Coordination and Integration

– “Help us navigate the system to get the care we need safely and timely manner”

• Person and Family Centered Care – “Recognize we are the most important part of the care team, and we our

responsible for our overall health and wellness” Read more: http://primarycarehome.oregon.gov

PCPCH Model of Care

Hello!

Jessica Osborne-Stafsnes Project Manger-Patient Engagement Aligning Forces Humboldt at CCRP

Angela Mitchell Program Coordinator – Patient and Family Centered Care Providence Medical Group

Margie Turner Patient and Family Advisor Providence Medical Group

Overview

• 2 Models for Patient Engagement in QI

– Patient and Family Advisory Councils

– Patient Partner Model

• Lessons Learned

• Practice and Patient Reflections

• Questions

Providence Medical Group

Providence Medical Group (PMG): • Multi-specialty group - 700 providers • 106+ clinics in Oregon (rural & urban settings) Primary Care: 350 providers & 39 clinics Physician groups include:

– Graduate Medical Education faculty (teaching program)

– Primary Care – Community-based Specialty – Hospital Medicine – Program Specialty

CMO

CEO

President Director

COO

Regional Sr. Medical Director

Patient & Family Advisory Council

Program Coordinator

PFAC MEETINGS

4 Step Process

1- Staff present on current projects & programs

2- Patient & Family Advisors brainstorm and come up with ideas for improvements

3- Ideas are used as projects and programs move forward to incorporate the patients ideas

4- Follow-up with Patient & Family Advisors on how their ideas are being used

Sub-Committees & Special Projects

• Ideas for projects generated at PFAC meetings • Patient & Family Advisors meet with leadership and

other staff outside PFAC meeting • Focus is always on improving the patient experience

– After visit summary increase in usage – Agenda setting form – Policies and materials become patient-centered

Patients asked…

• What does PMG give patient during appointments?

• Agenda Setting Form?

• Over half of PFAC had never received one…

Primary Care Clinic Survey Results

• 29 - Primary Care Clinics PMG North responded – 18 - No – 11 - Yes

• Forms varied in content, style, size, etc.

Agenda Sub-Committee Formed

• Patient & Family Advisors, Provider, Heath Educators, Provider Educators, Program Coordinator met monthly

• Form was created - patients got feedback from Service Improvement Group

• Form was finalized • Video was created to give to managers to show

at their clinics

To help ease your wayPlease tell us what you want to talk about with your provider today

Please list in order of importance the things you want to discuss :

1.

2.

3.

If we cannot discuss everything you have listed, we can schedule a follow-up visit.

Do you need any paperwork filled out by your provider? Yes No

Please list any medication changes since your last visit:

Prescription medications:

Over-the-counter medications:

Herbal supplements:

Do you need a prescription medication refill? Yes No

Please list any changes to your health since your last clinic visit. Examples would be a change to your diet, breathing, sleep or skin. Any sudden or unusual weakness, pain or irregular heartbeat that you have experienced. Or a change to the health of your parents or siblings.

Date:

Leadership’s role

• “The vision and commitment of leaders are essential to advancing the practice of patient- and family-centered care within an organization.” -IPFCC

• Leadership must be… – Open minded – Transparent – Flexible – Supportive – Committed

Patient and Family Advisors role

• Partnership: – Understands that we are all trying to accomplish the

same goal. • Open minded:

– Realizes that other patients, leadership, and staff will have different opinions.

• Sees the big picture: – Culture change; patient and family centered care.

• Advises: – Brings their own experiences plus those from their

family and community to the table.

PFCC Program Role

• Recruitment: – Calls, interviews, handles HR requirements,

keeps personnel files • Training and Orientation:

– Mission and history, vision and core values, HIPAA, code of conduct, ID badge

• Support for Clinic Leadership Team: – Answers questions, gives advice on best

practices, provide resources, keeps updated on PFA recruitment efforts,

• Support for Patients: – Answers questions, addresses concerns, ongoing

education and training, recognition

www.aligningforceshumboldt.org Osborne-Stafsnes for AFH, 2013

• Humboldt County AF4Q Alliance; Part of RWJF’s “Aligning Forces for Quality”

• 1 of 16 communities across the United States. • AF4Q Aim: convene patients, providers, and payers to

improve the quality of healthcare at local, regional, and national levels.

• AFH Focus: to generate meaningful opportunities for patient engagement in healthcare improvement, delivery, and design.

About Aligning Forces Humboldt

Patient Partner Project

Patient Partners share insights and feedback explicitly focused on

collaborative topics

• Effort to involve patients in primary care quality improvement efforts

• Began in 2011 • Part of a larger

community QI project

Program Structure

Patient Partners -2 Per team

Practice Teams -From 10-18 Primary Care Practices Primary Care Renewal: -Community-wide Quality Improvement Collaborative

Participant Roles PC

R Te

ams • 6-8 member

teams composed of providers, front

office, and back office staff

• Work on specific aims

• Meet 1-2x per month

• Recruit and involve two

patient partners • Attend

collaborative Meetings

Patie

nt P

artn

ers • Members of

practice team • Attend team

meetings, collaborative meetings, patient meetings

• Bring forward the patient perspective of care on key focus areas

Coor

dina

tor • Works offsite

• Helps to recruit and train patient partners

• Facilitates patient partner meetings

• Liaison for patients and practices

Project Framework

Patient Partners

Collaborative Meetings

Team Meetings

Patient Partner

Meetings

Primary Care Renewal Collaborative

Engagement in Team Meetings

Patient Partners

Collaborat-ive

Meetings

Team Meetings

Patient Partner

Meetings

Overview 1-2x per month at the practice Approximately an hour in length (varies by team)

Purpose: bring their perspective as a patient of the practice forward on team goals

Involved: Members of the team Standing agenda item

Supported by: Liaison at practice Practice coach Co-patient partner Project Coordinator (tangentially)

Engagement in Team Meetings

Outputs:

Practice brochures

Testing patient portals

Patient surveys

System re-design

Communication/marketing

Influencing tests of change

Engagement in “Patient-only” Meetings

Patient Partners

Collaborat-ive

Meetings

Team Meetings

Patient Partner

Meetings

Overview Every other month; two hours in length

Purpose: Introduce patients to content areas Debrief, ask questions, share challenges and successes

Involved: Collectively offer insight on content areas

Brainstorming; Problem-solving Recommendations to the collaborative at large Spread best practices

Supported by: Project Coordinator

Output: Prepared, confident partners

Engagement in Broad Conversations

Patient Partners

Collaborat-ive

Meetings

Team Meetings

Patient Partner

Meetings

Overview Every other month, 3 hours in length Collaborative Meetings

Purpose: Participate in community-wide QI effort Present broad patient perspective across community of stakeholders

Involved: Team activities during collaborative Set the meeting tone through standing presentation on content areas

Supported by: Patient Partner Meetings Collaborative Staff Project Coordinator

Outputs: Global patient perspective and recommendations Culture change

Lessons Learned

1. Leadership support is essential

2. Have clear role and expectations

3. Provide didactic orientation and

training

4. Support structured solicitation of

input

5. Commit to a transparent

feedback loop

Leadership Support

• Active and public support patient engagement efforts

• Look for opportunities to integrate into existing work

Clear role and expectations

• Interview/intake process

• Have an idea of projects/areas where patients will weigh in

• Be clear about decision making-processes

• Communicate expectations and roles up front

Didactic orientation and training

• Patient-only orientation

• Patient-only meetings

• Resource binders • Access to a trusted team member

Structured solicitation of input

• Focus on goals

– Project Proposal Form

• Agenda items

• Brainstorming

• Problem-solving

Insert picture of the project proposal form here?

Transparent feedback loop

• Discuss non-negotiables • Be willing to talk about the tough stuff!

Staff reflections…

“The advisory council is making amazing accomplishments. We need to have all our providers be exposed to what they’re telling us, because it’s transforming how we think about the care we provide.” –Dr. Ben LeBlanc, Chief Medical Officer, Providence Medical Group

“They keep our focus centered where it should be: on the patients.”

-- Participating Clinician, Patient Partner Project Evaluation

“Practices often struggle with the 'fires' of the day , making it difficult to focus on larger constructs such as patient-centered care. The participation of Patient Partners on practice improvement teams keeps the importance of improving patient care at the forefront of discussion.” --Rosemary DenOuden, Chief Operating Officer, HDNIPA

Reflections from Margie…

Questions?

“… it is the active presence of patients, families and

communities in the design, management, assessment, and improvement of care,

itself” - Dr. Donald

Berwick, 2008

“Put the patient at the center- at the absolute center of your system of care…

Jessica Osborne-Stafsnes Aligning Forces Humboldt

[email protected] (707) 445-2806 x 2

Angela Mitchell, MPA Providence Medical Group [email protected] (503) 893-6613