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P . Understanding and respecting patients' values, preferences and expressed needs is the foundation of patient-centered care. Harvey Picker, founder, visionary, philanthropist, advisor and friendOur healthcare industry exists to provide care to the patient. Unlike other industries, the patient needs a greater voice in determining how that care is best provided. Patient-centered care is at the heart of what that effort should be.Mark Waxman, Esq., Chairman, Picker InstituteIn 1141
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4. Patients and Families: Essential Partners in Achieving Exceptional Quality and Patient Safety Jim Conway
Senior Vice President, IHI
jconway@ihi.org
5. With Enormous Appreciation `
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6. In dedication to Patient and family-centered-care visionaries who show me the way
Patients, families and patient safety advocates: their faces, voices, stories, courage and work fuel our journey
7. Visionaries
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8. IN THEIR NAME
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9. Outline Exceptional Care and Caring
Patient and Family-Centered Care Defined
Learning from a Personal Journey
Designing PFCC into Care: An IHI R&D Effort
Creating an Exceptional Experience for the Hospitalized Patient
Business Case: Patient & Family-Centered Care
Why So Slow?
The Time Is Now
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10. Exceptional Care and Caring
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11. Patient and Family-Centered Care Defined Nothing about me, without me.
12. 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
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13. 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
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14. Learning From aPersonal Journey Childrens Hospital, Boston
Dana-Farber Cancer Institute
National and International Efforts
15. It began with neither a great light nor a book nor a dream
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16. Childrens Hospital, Boston Pushing, experimenting, partnering
Painting bunnies on the door
I dont care who you are
Renovating waiting rooms; explaining waits
Designing hospitals
Informing policies and practices
Building a family resource center
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17. Dana-Farber Cancer Institute, Boston Pediatric experience
Where is the patient and family in adult care?
How do we really know what patients want?
Responding to/learning from a sentinel event
How do we listen to patients when they feel there is a problem?
Longwood Integration of Dana-Farber/ Brigham & Womens Cancer Care
You are changing the system that keeps me alive.
This cannot happen!
How do you know this change is an improvement?
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18. Patient and Family-Centered CareDana-Farber Cancer Institute Mainstreamed patient and family-centered-care model
Adult and Pediatric Patient and Family Advisory Committees (12+ years and 10+ years)
Patient and family participation in operating committees, as well as in all design, measurement, assessment and improvement efforts
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19. Overarching Structures and Processes Committees:
Board Quality
Patient Safety
Strategic Planning
Operating
Patient Education
Disease Centers
Side by Side
Resource Centers
NPSF & IHI meetings
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20. DFBWCC and DFCHCCPatients & Families in Partnership Facility Planning
Patient Care Rounds
Patient Educator Program
Joint Commission
Code Participation
Staff Orientation
Leadership Interviews Complementary Therapy Task Force
Working on the Wait
Emergency Admits
Policy Review
Safety Rounds & Research
Disclosure
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21. Whats Getting Rewarded Around Here!
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22. Learning from National and International Efforts
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23. Publicly Verifiable PFCCExamples of Current Practice Mission, Vision, Values
Leadership, Operations
Advisors
Quality Improvement and Patient Safety
Personnel
Environment and Design
Information and Education
Charting and Documentation
Patterns of Care and Support
Experience of Care
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24. Key Learning:What Do Patients And Families Bring? Their knowledge of the illness
Parents of a child
The chronically ill adult
The actual experience of care
Failures in handoffs, slips, harm
What works for them and what doesnt
Another set of eyes, brain, voice
Checking the chemo, calling the rapid response team
Writing in the record, participating in rounds
This doesnt look right
A passion to achieve the same goals we want
Its about them
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25. Key Learning: For All of Us We dont know what happens daily in our hospitals.
We dont know what patients and family members want and needwe dont see through their eyes.
Patients know the hand-off better than we ever will.
Patients, families and staff have many common goals and can achieve dramatic improvements.
These are patients, going through extraordinary ordeals.
Errors dont erode trust. The way we act can.
Patients want to give back, be involved, contribute to success. They are vested.
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26. Designing PFCC into All Care: Creating an Exceptional Experience for the Hospitalized Patient What can we do in the hospital
for every patient?
27. Every system is perfectly designed to achieve exactly the results it gets.
Paul Batalden
28. 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
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29. Primary Drivers Governance and executive leaders demonstrate that NOTHING is more important in the culture than patient- and family-centered care practiced everywhere in the hospital.
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, evidenced-based care.
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30. Leadership Governance and executive leaders demonstrate that NOTHING is more important in the culture than patient- and family-centered care practiced everywhere in the hospital (individual, microsystem, organization)
In words and actions, leaders communicate that the patients safety and well-being is the critical decision guiding all decision- making.
Patients and families are treated as partners in care at every levelinstitution-wide to individual care.
PFCC is publicly verifiable, rewarded and celebrated.
Sufficient staff are available with the tools and skills to deliver the care the patients need when they need it.
There is relentless focus on measurement, learning and improvement with transparent patient feedback at all levels.
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31. Hearts and Minds The hearts and minds of staff and providers are fully engaged
Staff are recruited for values and talent, supported for success and held accountable individually and collectively for results.
Compassionate communication is an essential competency.
Delivery of exceptional patient- and family- centered care is recognized, communicated and celebrated
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32. Respectful Care Partnership 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)
Patients and families see themselves as part of care team and participate at the level the patient chooses.
Care for each patient is based on a customized interdisciplinary shared care plan with patients educated, enabled and confident to carry out their care plans.
Communication uses words and phrases that the patient understands.
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33. Reliable Care Hospital systems deliver reliable quality care 24/7
The physical environment supports care and healing.
Patients are able to access care and say that there were not long and unreasonable waits and delays.
Patients say that there were staff available to give the care I needed.
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34. Confidence The care team instills confidence by providing collaborative, evidenced-based care
Care is safe and concerns are addressed, and if things go wrong, there is open communication and apology.
Care is coordinated and integrated, and patients dont feel their care fell through the cracks in transitions.
Everyone on the patients care team, including the patient, has the information they need.
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35. Did we get it right for the hospitalized patient? What did we miss? jconway@ihi.org
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36. Business Case: Patient- and Family-Centered Care Nice but not necessary
37. 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
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38. 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
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39. Performance Model Overview Hospitals submit data for all VBP measures that apply.
CMS determines each hospitals performance score on each measure: higher of 0 - 10 points on attainment or improvement.
For each hospital, CMS aggregates scores across all measures within a domain (e.g., clinical process-of-care measures, HCAHPS).
CMS weights and combines each hospitals domain scores to determine the hospitals Total Performance Score.
CMS translates each hospitals Total Performance Score into an incentive payment using an exchange function.
40. Why So Slow?
41. So, Why Dont We Do!Were Just Making Modest Progress Public isnt demanding it, YET.
Most efforts are site-specific and unconnected.
Providers believe they know what patients need.
Belief the hospital/clinic is the center for healthcare vs. the bedroom, bathroom, hospital bed in the dining room
We dont know how to share in care.
Its hard; ITS VERY HARD.
Its not whats rewarded around here.
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42. The Time Is Now If health and/or healthcare is on the table, then the consumer (public, patient, family member) must be at the table, every table. NOW!
43. Extensive Resources Selected Websites Picker Institute
www.pickerinstitute.org
IHI
www.ihi.org
Patient Centered Care
Institute for Family Centered Care
www.familycenteredcare.org
Planetree
www.planetree.org
Coming Monday, Oct. 27, 2008
Picker and Planetree Websites
44. It Will Take Leadership at Every Level Not an if but a when and how discussion.
Its a system to be designed and achieved.
Its a gift to be given.
Its a right to be realized.
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45. IN THEIR NAME
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46. And For All of Us, Our Family, Our Friends, Our Communities
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47. "Do not go where the path may lead; go instead where there is no path and leave a trail. Ralph Waldo Emerson