Patient Centered Care: A Team Perspective

1. Suzanne Hughes, MSN, RN, AACCClinical Education Project Director Preventive Cardiovascular Nurses Association Patient Centered Care: A Team Perspective

2. Integration of non-physician members into the ACC • The team approach in a patient-centered model of care • Communication as a critical element

5. Preventive Cardiovascular Nurses Association Survey 479 respondents; Feb 2013

6. Preventive Cardiovascular Nurses Association Survey 479 respondents; Feb 2013

7. Health Policy Statement | June 2012 ACCF 2012 Health Policy Statement on Patient-Centered Care in Cardiovascular MedicineA Report of the American College of Cardiology Foundation Clinical Quality Committee Mary Norine Walsh, MD, FACC; Alfred A. Bove, MD, PhD, MACC; Russell R. Cross, MD, FACC; Keith C. Ferdinand, MD, FACC; Daniel E. Forman, MD, FACC; Andrew M. Freeman, MD, FACC; Suzanne Hughes, MSN, RN; Elizabeth Klodas, MD, FACC; Michelle Koplan; William R. Lewis, MD, FACC; Brian MacDonnell; David C. May, MD, PhD, FACC; Joseph V. Messer, MD, MACC; Susan J. Pressler, PhD, RN; Mark L. Sanz, MD, FACC; John A. Spertus, MD, MPH, FACC; Sarah A. Spinler, PharmD, AACC; Louis Evan Teichholz, MD, FACC; John B. Wong, MD; Katherine Doermann Byrd

8. Provision 3 | Code of Ethics for Nurses • The nurse promotes, advocatesfor, and strives to protect the health, safety, and rights of the patient. • …an advocateas "someone that supports or promotes the interests of others"

10. We are what we repeatedly do. Excellence, then, is not an act, but a habit. Will Durant, paraphrasing Aristotle Durant W. The Story of Philosophy. New York, NY: Simon & Schuster, Inc; 1991.

11. Of the practices operating in a team-based care environment, increased efficiency (63%), improved quality of care (53%), and increased patient satisfaction (50%) were the primary improvements cited. …According to the survey, team-based care providers were most likely to implement patient education (69%) …

12. Dimensions and Attributions of a Patient-Centered Health Care System • Interpersonal: How we relate to our patients • Clinical: How care is provided • Structural: How systems are organized Greene SM The Permanente Journal/ Summer 2012/ Volume 16 No. 3

13. Interpersonal: How we relate to patients • COMMUNICATION • Listening • Trust • Empathic Communication • Includes family • KNOWING THE PATIENT • Pt as whole and unique • Common ground on the basis of pt preferences • Facilitates healing relationships • TEAMS • Responsiveness by entire team • Recognizes that actions of all staff influence perceptions of care Greene SM The Permanente Journal/ Summer 2012/ Volume 16 No. 3

15. Clinical: How care is provided • DECISION SUPPORT • Shared Decision Making- using best evidence coupled with patient preferences • Supports self-management • COORDINATION AND CONTINUTY • Manages care transitions and seamless flow of information • Coordinates with community resources • TYPES OF ENCOUNTERS • Accommodates virtual visits (phone, e-mail) as well as face to face • Reimbursement structure supports range of encounters that meet varied needs Greene SM The Permanente Journal/ Summer 2012/ Volume 16 No. 3

16. Structural: How systems are organized • BUILT ENVIRONMENT • Calm, welcoming space • Accommodates pt, clinician & family needs • Emphasizes easy “way-finding” through the system • ACCESS • Easy appt-making process • Minimizes clinic wait times • Payment system accommodates pts’ circumstances • Coordinated, consistent, efficient • I.T. • Supports pt and clinician before, during, after encounters • Tracks patients’ preferences, values, & needs dynamically • Provides self-management tools & Info Greene SM The Permanente Journal/ Summer 2012/ Volume 16 No. 3

17. Patient Rights It is neither just, nor fair, to expect a patient to make appropriate health decisions and safely manage his/her care without first understanding the information needed to do so. Reducing the Risk by Designing a Safer, Shame-Free Health Care Environment. AMA, 2007

18. Health literacy is the degree to which individuals have the capacity to • obtain, process, and understand basic health information and services • needed to make appropriate health care decisions. Ratzan and Parker, 2000)

19. The main problem with communication is the assumption that it has occurred. George Bernard Shaw

20. 7% 71% 59% 96% 33% 80% 33% 0% What matters most depends on who you ask Doctors Women High quality care is care patients want when they are fully informed Doctors and patients see trade-offs in treatments very differently Keep breast Live as long as possible Look natural without clothes Avoid a prosthesis Source: Karen Sepucha, MD, Massachusetts General Hospital

21. 2 schools of thought in health literacy:Test and evaluate everyone, and educate based on need, or… The universal precautions approach: assume everyoneneeds to be communicated with using “living room language”

22. Literacy Declines with Age, Regardless of Education J. Gerontol. B Psychol. Sci. Soc. Sci

23. Adults at each health literacy level, by age National Assessment of Adult Literacy, Health Literacy Component, 2003.

27. “In our country, patients are the most under-utilized resource, and they have the most at stake. They want to be involved and they can be involved. Their participation will lead to better medical outcomes at lower costs with dramatically higher patient & customer satisfaction.” Charles Safran, M.D. President, American Medical Informatics Association Testimony Before the Subcommittee on Health of the House Committee on Ways and Means