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1© 2011 TMIT

Welcome to

Engaging, Activating, and Partneringwith Patients and Families

A Four-Part Webinar Series – Webinar Two

Hosted by TMIT

For resource downloads go to:

www.safetyleaders.org

2© 2011 TMIT

Charles Denham, MD

Chairman, TMITCo-chairman, NQF Safe Practices Consensus Committee

Chairman, Leapfrog Safe Practices Program

TMIT High Performer WebinarMarch 17, 2011

Welcome

3© 2011 TMIT

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6© 2011 TMIT

The following panelists certify:

that unless otherwise noted below, each presenter provided full disclosure information,does not intend to discuss an unapproved/investigative use of a commercialproduct/device, and has no significant financial relationship(s) to disclose. Ifunapproved uses of products are discussed, presenters are expected to disclose thisto participants.

Joseph McCannon: Employed by Centers for Medicare & Medicaid Services

Paul McGann: Employed by Centers for Medicare & Medicaid Services

Jean Moody-Williams: Employed by Centers for Medicare & Medicaid Services

Helen Burstin: Employed by National Quality Forum

Maureen Connor: Employed by North Shore Medical Center

Farris Timimi: Employed by Mayo ClinicSusan Sheridan: Has no relevant financial interests in this presentationBarton Hill: Employed by St. Luke’s Boise Medical CenterSteve Rel: Has no relevant financial interests in this presentationCharles Denham: Chairman, TMIT; TMIT education grantee of CareFusion and AORN with co-productionby Discovery Channel for Chasing Zero documentary and Toolbox including models, education grantee ofGE with co-production by Discovery Channel for Chasing Zero documentary and Toolbox includingmodels. HCC Corporation contractor for Siemens.

Disclosure Statement

Chasing Zero® is a registered trademark of CareFusion

7© 2011 TMIT

TMIT certifies that:

• No funder or educational grantor had any influence or anydirect contact with researchers, analysts, or hospitalleaders contracted with TMIT involved in generation ofmodels, impact calculators, or consensus panels.

• Confidentiality of collaborators, patient data, and populationdata has been and will be strictly maintained.

Disclosure Statement

8© 2011 TMIT

TMIT Mission

Accelerate performance solutions thatsave lives, save money, and build valuein the communities we serve andventures we undertake.

9© 2011 TMIT

The Voice of the Patient and Family

Steve Rel

TMIT Patient Safety AdvocateCo-founder, Braxton Memorial Hockey

Scholarship Fund

10© 2011 TMIT

Speaker Panelists

Charles Denham Paul McGannJoseph McCannon Helen BurstinJean Moody-Williams

Maureen Connor Farris Timimi Susan SheridanBarton Hill

11© 2011 TMIT

Joseph McCannon

Senior Advisor to the AdministratorCenters for Medicare & Medicaid Services (CMS)


The Message from CMSUpdate on Direction

Including HACs and Readmissions

12© 2011 TMIT

Paul E. McGann, MD

Acting CMS Chief Medical Officer and Deputy Chief Medical OfficerCenters for Medicare & Medicaid Services (CMS)


The Message from CMSMessage from the Acting CMO of CMS

13© 2011 TMIT

Jean Moody-Williams, RN, MPP

Group Director, CMS Quality Improvement Group (QIG)Centers for Medicare & Medicaid Services (CMS)


The Message from CMSAn Update for QIOs and ESRD Networks

14© 2011 TMIT

Charles Denham, MD




Leadership Structures and Systems:Involving Patients and Families

Quality Committee Chair

RiskManagement

PatientSafety

QualityPerformanceImprovement

CEO

GovernanceBoard

GovernanceChair

COO CQOCFOCRO CNO

The High Performance Hospital: Patient and Family Input

Patients & Family Input





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17© 2006 HCC, Inc. CD000000-0000XX 17© 2011 TMIT

CMS QualityNet Conference Sparking innovation, igniting action, lighting theway to tomorrow's healthcareVideos of presentations, transcripts, and Slide Sets:http://www.safetyleaders.org/qualityNetOnline/

© 2006 HCC, Inc. CD000000-0000XX 18© 2011 TMIT

Facts are re-told…

Stories are retained…

Quaid D, Thao J, Denham CR. Story power: The secret weapon. J Patient Saf 2010 Mar;6(1):5-14.

19© 2010 TMIT

The Chains That Seem to Bind Us

Constrained byConditioning…

20© 2006 HCC, Inc. CD000000-0000XX 20© 2011 TMIT

CMS National Conference on Care Transitions: Videos of presentations,transcripts, and Slide Sets:http://www.safetyleaders.org/qualityNetOnline/care_transitions.jsp

21© 2011 TMIT

At the Leadership-Practices-Technology Intersection

Leadership

PracticesTechnology

The High Performance Envelope

© 2006 HCC, Inc. CD000000-0000XX 22© 2011 TMIT

“Not one of the board chairmen in the bottom 10%of quality thought they were below average”

Ashish JhaChasing Zero Documentary

23© 2011 TMIT

Information Management andContinuity of Care

Medication Management

Healthcare-AssociatedInfections

Condition- &Site-Specific Practices

Consent & Disclosure

Culture

Workforce

Consent and Disclosure

2010 NQF Report

© 2006 HCC, Inc. CD000000-0000XX 24© 2011 TMIT

Culture

© 2006 HCC, Inc. CD000000-0000XX 25© 2011 TMIT

The six National Priorities are:patient and family engagementto provide patient-centered,effective care…(Safe Practice 1)

© 2006 HCC, Inc. CD000000-0000XX 26© 2011 TMIT

A structure and system shouldbe established to obtain directfeedback from patients aboutthe performance of theorganization.(Safe Practice 1)

© 2006 HCC, Inc. CD000000-0000XX 27© 2011 TMIT

…patient and/or familiesrepresenting the populationserved should be included in thedesign of educational meetingsor should participate on formalcommittees that provide inputto leadership…

© 2006 HCC, Inc. CD000000-0000XX 28© 2011 TMIT

29© 2011 TMIT

Patient Advocates

Nancy Conrad Mary FoleyJennifer Dingman Becky MartinsDan Ford

Moose Millard Dennis QuaidPatti O’Regan Sue SheridanArlene Salamendra

30© 2011 TMIT

31© 2006 HCC, Inc. CD000000-0000XX 31© 2011 TMIT

To order NQF Safe Practices for Better Healthcare:Go to www.qualityforum.org

32© 2011 TMIT

National Collaboratives Provide Performance Metrics:

Impact Calculators ProvideCFO Validated Performance Impact


34© 2011 TMIT


37Chasing Zero® is a registered trademark of CareFusion

3838© 2011 TMIT


39© 2011 TMIT

Helen Burstin, MD, MPH

Senior Vice President for Performance MeasuresNational Quality Forum


A Message from theNational Quality Forum

40© 2011 TMIT

Maureen Connor, BSN, MPh

Executive Director of Quality and Safety, Patient Care ServicesNorth Shore Medical Center


The Dana-Farber Story, and the Powerof One at North Shore Medical Center

Dana-Farber Cancer Institute (DFCI)

• Executive leadership commitment toadvancing patient- and family-centeredcare

• Partnership with patients and familiesbegan shortly before DFCI inpatientbeds were physically relocated to theBrigham and Women’s Hospital.

41

Getting Started

• Captured patients’ and family members’perspectives

• Patients and families helped on the dayof the move transferring patients andequipment

• Conducted post-move “rounds”

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• Adult Patient and Family AdvisoryCouncil created in 1998, and thePediatric Council one year later

• Councils report to the Board throughthe QI structure

• Adult co-chairs are patients and/orfamily members, whereas PediatricCouncil co-chairs consist of a familymember and a staff member

Further Development

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• Quality Improvement Committees

• Board level quality committee

• Other committees, e.g., ethics anddiversity, task forces and teams

• Volunteer Services

Organizational Integration

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• Working on the Wait

• Hand hygiene campaign

• New Building (2020 Committee)

• Care Improvement Team

• Rounding

• Healing Environment

• Satellite Clinics

Examples of Projects and Initiatives

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Emergency DepartmentChildren’s Hospital, Boston

• Pediatric Patient and Family AdvisoryCouncil’s First Initiative

• Treatment of pediatric oncology patients

for fever and neutropenia in the ED

• Widespread impact

• Need for continued monitoring

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ED Fast Track

47

Disclosure of Medical Errors

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Members of theFull Disclosure Working Group

• Janet Barnes, RN, JD, Director, Risk Management, Brigham & Women’s Hospital• Maureen Connor, RN, MPH, VP for Quality Improvement and Risk Management, Dana-

Farber Cancer Institute• Connie Crowley-Ganser, RN, MS, Principal, Quality HealthCare Strategies• Thomas Delbanco, MD, General Medicine and Primary Care, Beth-Israel Deaconess Medical

Center• Frank Federico, BS, RPh, Director, Institute for Healthcare Improvement• Arnold Freedman, MD, Medical Oncology, Dana-Farber Cancer Institute• Mary Dana Gershanoff, Patient, Co-chair, Dana-Farber Adult Patient & Family Advisory

Council• Robert Hanscom, JD, Director, Loss Prevention & Patient Safety, Risk Management

Foundation• Cyrus C. Hopkins, MD, Director, Office of Quality and Safety, Massachusetts General

Hospital• Gary Jernegan, Parent, Co-chair, Dana-Farber Pediatric Patient & Family Advisory Council• Hans Kim, MD, MPH, Medical Director, Clinical Effectiveness, Beth-Israel Deaconess Medical

Center• Lucian Leape, MD, Health Policy Analyst, Harvard School of Public Health, Chair• David Roberson, MD, Program for Patient Safety and Quality, Children's Hospital• John Ryan, JD, Attorney, Sloane & Wal, Risk Management Foundation• Luke Sato, MD, Chief Medical Officer and Vice President, Risk Management Foundation• Frederick Van Pelt, MD, Director, Out-of-OR Anesthesia, Brigham & Women’s Hospital

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Teamwork Training

• Campaign rather than education orresearch

• Focus on hazards rather than skills

• Wrong chemo, last-minute change, handhygiene

• Bringing messages to the patient

• Empowerment without obligation

• “You CAN… check, ask, notify”

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Team Training

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You CAN Campaign,July-Sept 2007

• Staff briefings

• Lobby tables

• Volunteer rounders

• Surveys

• Plasma screen, brochures, posters

• Pens, pins, mugs, wallet cards

• DFCI announcements

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Variable use of teamwork skills

Question Baseline*

(n=204)

Follow up*

(n=201)

Would you notice if the colorof your chemotherapy orpills were different thanusual?

20% 21%

Would you feel comfortableasking your doctor or nurseif they washed their hands?

55% 56%

Did the nurse tell you whatto expect during your lasttreatment?

7% 5%

* % indicating probably or definitely NOT

54

Awareness & Impact of Campaign

• 32% (≈ 1,100 patients) were aware of the campaign.

• 39% of those aware of the campaignsaid that it changed their behavior.

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North Shore Medical Center

• The power of one

• Intensive Care Unit

• Cardiac Surgical ICU

• TCAB on Med/Surg Units

• Partnering with patients and families ondelirium project and care plans for pain

56

NQF Safe Practices

• Each Safe Practice in the updatedNQF consensus report includes asection entitled “Opportunities forPatient and Family Involvement.”

• This section provides specificinformation about how to involvepatients and families in theimplementation of each Safe Practice.

57

“Nothing About Me

Without Me”

58

References

• Weingart, SN, Simchowitz B, Eng TK, et al. The YouCAN campaign: teamwork training for patients andfamilies in ambulatory oncology. Jt Comm J QualPatient Saf 2009 Feb;35(2):63-71.

• Weingart SN, Price J, Duncombe D, et al. Patient-reported safety and quality of care in outpatientoncology. Jt Comm J Qual Patient Saf 2007Feb;33(2):83-94.

• Leape L, Barnes J, Connor M, et al. When Things GoWrong: Responding to Adverse Events. A ConsensusStatement of the Harvard Hospitals. Burlington (MA):Massachusetts Coalition for the Prevention of MedicalErrors; 2006 Mar.

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• Reid Ponte P, Connor M, DeMarco R, et al. Linkingpatient and family-centered care and patientsafety: the next leap. Nurs Econ 2004 Jul-Aug;22(4):211-3, 215.

• Ponte PR, Conlin G, Conway JB, et al. Makingpatient-centered care come alive: achieving fullintegration of the patient's perspective. J Nurs

Adm 2003 Feb;33(2):82-90.

60

References

• http://www.familycenteredcare.org

• http://www.aha.org/aha/issues/Quality-and-Patient-Safety/strategies-patientcentered.html

• http://www.dana-farber.org/images/pdfs/side-by-side/2006-spring.pdf

• Maureen Connor

• [email protected]

61

References

62© 2011 TMIT

Farris K. Timimi, MD

Director, Cardiology Education ClinicAssistant Professor of Medicine, Mayo College of Medicine

Medical Director, One Voice, Division of Cardiovascular Disease


The Mayo Experience

How did we get here?

• Primary value

• Focus on PRC performance data

• MN Quality Award Application

• Recognition that the 75% of H-CAHPS’ survey questionsdirectly/indirectly addresscommunication skills of providers

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JONA, 39, 6:266-275

Direct Care-20%Documentation-35%

Medication-17% Care Coordination-21%

Assessment/Vitals-7%

64

How did we get here?

Fundamental Lessons

• Guideline-centric vs. patient-centric care

• In acute encounters, patients place apremium on morbidity and mortality, sothere is no conflict

• However, individual accommodations arebecoming a feature of patient-providercompact

65

• Patient perception of quality often differsfrom our perception of quality

• For most patients, quality is viewed as anexpectation of the care they receive, notas a differentiating factor

66

Fundamental Lessons

Four Geographic Domains

67

The level of the patient/provider

• Patient with moderate hypertension, whoopts to delay medical treatment

• Patient with AF and a low Chads-2 score,who opts for anticoagulation instead ofASA

• In each case, the patient is making achoice divergent from guidelines, butconsistent with his own values

68

The level of family and friends

• Partners in Care, empowering patientsand their family members to ask, “Did youwash your hands?” increased hand-washing, on average, by 50%

69

Institutional Policy and Procedure

• Depression Improvement AcrossMinnesota: Offering a New Direction

• DIAMOND provides a depression caremanager to contact the patient onschedule, to monitor compliance and side-effects

70

• At initial roll-out, enrollment was 32.4%

• PFAC Review: the program be introducedas standard of care, the patient’s physicianintroduce care manager, clear educationas to the care manager’s role

• Enrollment increased to 96.5%

71

Institutional Policy and Procedure

National Healthcare Policy

• Clearly, partnership with all stakeholders iscritical to designing an ideal healthcaresystem

72

Patient Family Advisory Council

• An advisory council providing contentreview and creation regarding policiesand procedures

• Meets on schedule; agenda-driven

• Defined terms of service

• Adheres to confidentiality requirementsas defined by volunteer services

73

Structure

• Present and former patients and families

• Not currently in acute care

• Capacity to contribute, while not seeking apersonal or single agenda

• Initial closed recruitment with clearscreening, orientation, and trainingpolicies

• Clearly articulated expectations

74

Critical Elements

• Leadership engagement

• A clear strategic vision

• Involvement of patients and families atmultiple care levels

• Beware of the myth of partnership

75

Fundamental Lessons

• The concepts defining patient-centric careare integral to all healthcare institutions

• The fundamental shift centers onpartnering with trained patients serving asadvisors

76

Action Steps

• Leadership identifies and provides trainingfor a patient liaison

• Liaison engages care providers toparticipate

• Liaison recruits, orients, and trains patientadvisors

77

What is Patient-Centered Care?

• Care we would want our family to receive

[email protected]

78

79© 2011 TMIT

Barton Hill, MD, MPA

Vice President for Medical Affairs and Chief Quality OfficerSt. Luke’s Boise and Meridian Medical Centers


The St. Luke’s Experience

Patient & Family Safety andPartnership Council

March 17, 2011

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St. Luke’s Health System 2011

St. Luke’s Boise

Beds: 403

Employees: 5,286

St. Luke’s MeridianBeds: 165

Employees: 1,227

St. Luke’s Magic ValleyBeds: 226

Employees: 1,830

St. Luke’s Wood River

Beds: 25Employees: 360

As of February 15, 2011

St. Luke’s McCallBeds: 15

Employees: 191

82

St. Luke’s Health System 2011

Patient & Family Safety and Partnership CouncilDevelopment Project Members

Barton Hill, MD

VP Medical Affairs

A.J. Balukoff

Chair,

Board Quality Committee

Deb Gaspar, RN, MS,MPA

Interim Director,

Quality & Patient Safety

Sue Sheridan, MIM, MBA

Co-founder,

Consumers AdvancingPatient Safety

Monica Zelley, MPA

Manager,

Patient & FamilyRelations

Gregory Janos, MD

Medical Director,

St. Luke’s Children’sHospital

Belinda Day, BS, RN,CPN

Director,Pediatrics/PICU/Child

Life

Rhonda Bright

PatientRelations/Performance

ImprovementCoordinator

Magic Valley

Suzanne Miller, BS, RN

Manager,

Patient Care,

Quality & Safety

Wood River

Jennifer Caple,

Social Services

McCall

What EVERY Patient Experience SHOULD BE

• “Nothing about me without me”

- Diane Plamping

• “If health or healthcare is on the table, thepatient/consumer must be at the table, every table.Now!” - Lucian Leape Institute

Our Mission

Our councils will be partnerships with patients andfamilies to improve patient safety and the quality of their

experience at St. Luke’s.

85

Connection to St. Luke’s Strategic Plan

Goal: To engage with our patients and families in amanner that brings all of us to a commonunderstanding of what it fundamentally means toprovide health services to our community at large.

Our proposal is the creation of a patient and familysafety and partnership council as a strategicinitiative to advance the organization’sachievement of safe, quality, patient-centered care;optimizing the patient and family experience at St.Luke’s.

86

Introduction

• Historical basis for Patient Family Advisory Councils –response to significant events, improve patient satisfaction,to support Patient- & Family-Centered Care;

• Growing emphasis on engagement of patients & families;

• Incorporating patient/family perspectives to transform thetraditional approach of healthcare delivery;

• Councils evolving into a more active role in supporting thedevelopment of practices and policies that truly impact theoverall patient experience.

87

Current State of Councils at St. Luke’s

• Children’s Hospital – 2 current councils (Pediatrics & NICU)

• Magic Valley

88

Development of a Vision

Vision components:

• Our aim is for zero harm to patients;

• Active patient and family engagement to patient-centered,relationship-based care;

• True understanding and appreciation for the patient & familyexperience;

• Partnership with our community to achieve transformation ofhealthcare;

• Effective integration of the healthcare continuum.

89

Desired Outcomes

• Improved quality and safety outcomes;

• Strengthened community relationships.

• Improved patient satisfaction;

• Continued promotion of transparency;

• Enhanced patient education;

• True patient-centered experiences;

Cultural Transformation

90

Scope & Structure of the Councils

• Projects, issues, and opportunities identified by patients,families, and the organization;

• Multiple councils across the health system, to include allareas of our healthcare operations where patients andfamilies are impacted;

• Each council uniquely defined and supported with resources;

• Projected size of each council – 10-20 members

• Patients and family members

• Administrative leadership

• Physicians

• Key staff

91

Proposed Structure – SLHS Patient & FamilySafety and Partnership Councils

Projected Initial Budgeting Requirements

• 1.2-1.5 FTEs – approx. $86,000 annually

• Coordinator (1.0 FTE)

• Administrative support (0.2 FTE)

• Additional resources – approx. $65,000

93

Existing Strengths

• Current experience with several patient and family councils;

• St. Luke’s reputation for a caring philosophy within theorganization that is relationship-based;

• Significant physician integration;

• Leadership support for safety, quality, and patientengagement;

• Opportunity to customize our councils from inception;

• Strong support at many levels of the organization.

94

Potential Barriers

• Lack of understanding and knowledge about councils;

• Ability to recruit effective members to the councils;

• Fear of initial failure;

• Multiple variations for this model exist nationally;

• Creating a model that fits within our culture.

95

Next Steps

• Define operational and logistical details of ourproposal in the next 60 days.

• Implement our proposal by 9/1/11.

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97

98© 2011 TMIT

Susan E. Sheridan, MIM, MBA

Co-Founder and President, Consumers Advancing Patient SafetyLead, Consumer Action, World Alliance for Patient Safety

World Health Organization


The St. Luke’s Experience

99© 2011 TMIT

Reactor Panelists

J. Michael HendersonChief Quality Officer

Cleveland Clinic

Jonathan SugarmanPresident and CEO

Qualis Health

Regina HollidayPatient Rights

Arts Advocate

Steve RelPatient Safety

Advocate

100© 2011 TMIT

J. Michael Henderson, MD

Chief Quality Officer, Cleveland Clinic


Reaction to Presentations

101© 2011 TMIT

Jonathan R. Sugarman, MD, MPH

President and CEO, Qualis Health



102© 2011 TMIT

Regina Holliday

Patient Rights Arts Advocate



103© 2011 TMIT


Steve Rel

TMIT Patient Safety Advocate Team MemberCo-Founder, Braxton Memorial Hockey Scholarship Fund


104© 2011 TMIT

Questions and Answers

Maureen Connor Farris Timimi Susan Sheridan Barton Hill

Joseph McCannon Paul McGann Jean Moody-Williams Helen Burstin

105© 2011 TMIT

Charles Denham, MD




Closing Comments:Future Opportunities

106© 2011 TMIT

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108© 2011 TMIT

The Voice of the Patient and Family

Steve Rel

TMIT Patient Safety AdvocateCo-founder, Braxton Memorial Hockey

Scholarship FundBraxton Rel

TMITWebinar PanelistSlides 03 17 11 finalsafetyleaders.org/downloads/tmitwebinar_panelistslides_03_17_11... · HCC Corporation contractor for Siemens. ... Scholarship Fund ... •

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