The Value of Families

1. The Value of Families

2. I have no financial relationships to disclose.

3. WHY???

4. TIPQC Stakeholders/Mission TIPQC seeks to improve health outcomes for mothers and infants in Tennessee by engaging key stakeholders in a perinatal quality collaborative that will identify opportunities to optimize birth outcomes and implement data-driven provider- and community-based performance improvement initiatives.

5. TIPQC TIPQC Stakeholders Providers Families Institutions & Hospitals Payors Government & Non-government Advocacy Data Collectors & Monitors

6. 11 Month Results: The Problem Stakeholder Asked all Hospitals to identify family members to participate in: *Regional Advisory Committees *Annual State Meeting 4 families identified as RAC members Each family participated in one meeting (out of 4-5) One family attended Annual State Meeting for first hour

7. What???

8. Families Customers, Partners or both?

9. Customer One who buys, especially one who buys regularly.

10. Partners One who joins in an activity with another or others; one of two of more persons who own a business; a spouse; either of two persons dancing together; a player of the same team.

11. Both? Customer Partner

12. Patient & Family-Centered Care: Partnerships for Quality and Safety Video Developed by the Joint Commission Resources, Advisory Board Company Presented by the American Hospital Association in partnership with the Institute for Family-Centered Care 13 minutes http://www.aha.org/aha/issues/Quality-and-Patient-Safety/strategies-patientcentered.html

13. Principles of Patient- and Family- Centered Care 1. Dignity & Respect 2. Meaningful Information Sharing 3. Participation 4. Collaboration From: Partnering with Patients & families to Design a Patient- and Family-Centered Health Care System: A Roadmap for the Future. A Work in Progress http://www.familycenteredcare.org/tools/downloads.html The Institute of Medicine’s 2001 report, Crossing the Quality Chasm: A New Health System for the 21st Century The Institute for Family-Centered Care American Hospital Association The Joint Commission Resources The Advisory Board Company

14. Discussion Had you heard the term “patient- and family- centered care before? How would you define it?

15. Patient- & Family-Centered Care “An approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care providers, patients, and families.” • Partnering with Patients & families to Design a Patient- and Family-Centered Health Care System: A Roadmap for the Future. A Work in Progress http://www.familycenteredcare.org/tools/downloads.html)

16. Discussion How can patient and family-centered care help us achieve our goals of quality and safety?

17. Discussion How does TIPQC get input from patients & families?

18. How are we doing?

19. Survey Webinar Survey Results—August 2009 12 hospitals responded on webinar Other 9 received questions via email Total=21

20. Poll Your Hospital 1. Does your hospital encourage collaboration with families? • a. Yes • B. No • C. Don’t know 2. Do patients & families serve as advisors to the hospital? • a. Yes • B. No • C. Don’t know 3. Do patients & families serve on committees, work groups, & QI teams? • a. Yes • B. No • C. Don’t know 4. Are families involved in the selection, development & implementation of quality improvement projects? • a. Yes • B. No • C. Don’t know TIPQC 5-8. What degree are we involving families? Substitute TIPQC in the question.

21. Survey Results

22. Barriers Barriers include difficulty participating because of small children at home, no child care, etc. Would be good to ask families what they think the most important improvement is. For us it isn't any of that it is more finding consistent parental involvement Parent involvement depends on the project. It will much easier to involve parents in the breast milk project Just like with other aspects, families can bring their perspective to the table. I believe the family will discuss the concern that they want to SEE their baby after delivery Responses from 8-26-09 TIPQC webinar

23. Discussion Survey Barriers

24. Barriers Transparency Perceived Risk Unreasonable expectations Staff Concerns Taken from: “Patients and Families: powerful new partners for healthcare and for caregivers,” Healthcare Executive, Jan/Feb 2008, ache.org. HIPAA HIPAA-Providing New Opportunities for Collaboration- Responding to HIPAA: Hospitals Confront New Challenges, Devise Creative Solutions

25. How???

26. Keys to Success 1. Culture Shift 2. Family Selection & Training as Advisors 3. Belief that Family participation is essential! Adapted from “Engaging Patients & Families: A High Leverage Tool for Health Care Leaders.” American Hospital Association Quality Center, H&HN, August 2006, www.hhnmag.com

27. Key #1: Culture Shift

28. Why Should Families be Involved in Your Hospital Quality Improvement and in TIPQC?

29. Evidence Culture of accountability—fiscal, quality & safety Alignment with organizational goals—possible best practice IOM, IHI, AHA Intuitively—makes sense but Intellectually—how will I know it is advancing our performance as an organization?

30. Business Model - Benefits Shorter LOS Higher satisfaction with care Fewer re-admissions Improved rates of breastfeeding Reduced parental stress Improved parental comfort & competence with post-discharge care (Taken from PCNQC, “How’s Your Baby?”)

31. Neuroscience Center for Excellence--Example Higher Patient Satisfaction Lower LOS Lower Medical Errors Higher Discharge Volume Lower staff vacancy Higher perception of unit

32. Medical College of Georgia--Example Framework & strategies to achieve Quality & Safety Goals Enhances Market Share Lowers Costs Strengthens Staff Satisfaction

33. Endorsements American Academy of Pediatrics American Hospital Association The Joint Commission The National Quality Forum Institute for Family Centered Care Institute for Healthcare Improvement Institute of Medicine Agency for Healthcare Research & Quality Society of Critical Care Medicine National Patient Safety Foundation World Health Organization Consumers Advancing Patient Safety Vermont Oxford Network Hospitals, Payors, Foundations, Medical Students, Nursing Groups

34. More reasons: Movement for communication and disclosure when patients are harmed Increased data showing that a satisfied patient is an activated patient Growing consumerism & patient- & family-centered care movements Patients & Families around the world saying, “Listen to me, respect me and trust me as a partner in care.” Taken from: “Patients and Families: powerful new partners for healthcare and for caregivers,” Healthcare Executive, Jan/Feb 2008, ache.org

35. Your Hospital Is it Parent Friendly? Leadership Mission and Definition of Quality Charting and Documentation Patients & Families as Advisors Patient and Family Support Patterns of Care Quality Improvement Information/Education for patients & families Personnel Environment and Design For a complete Hospital Self-Assessment inventory, go to: http://www.aha.org/aha/content/2005/pdf/assessment.pdf

36. Where is your hospital on family involvement?

37. Articles “Engaging Patients & Families: A High Leverage Tool for Health Care Leaders,” August 2008, www. Hhnmag.com “Patients & Families,” IHI, reprinted from Healthcare Executive, ache.org, Jan/Feb 2008 http://www.familycenteredcare.org/pdf/getting_started.pdf

38. Resources Patients As Partners: Toolkit for Implementing the National Patient Safety Goal, Joint Commissionhttp://www.jcrinc.com/Books-and-E-books/PATIENTS-AS-PARTNERS-TOOLKIT-FOR-IMPLEMENTING-NPSG-13/615/ Strategies for Leadership: Patient & Family Centered Care, Joint Commission Resources, Advisory Board Company, Presented by the American Hospital Association in partnership with the Institute for Family-Centered Care http://www.aha.org/aha/issues/Quality-and-Patient-Safety/strategies-patientcentered.html

39. Hospital Team vs. TIPQC Is there a difference in family involvement in TIPQC and at your hospital? What did the poll tell us?

40. Family Participation in TIPQC Teams Local hospital teams (Recommended 2 per team) • RACs (Need at least 2 per RAC) • Oversight Committee (Need 2 nominations)

41. Hospital Team Discussion Is there a mechanism in your hospital for families to serve on QI teams? Barriers? Concerns? WIIFM? Benefits/Gains to: Staff & Physicians/Families/NICU

42. Involving Families as partners and advisors will…. Bring important perspectives about the experience of care. Teach how systems really work. Inspire and energize staff. Keep staff grounded in reality. Provide timely feedback and ideas. Lessen the burden on staff to fix the problems…staff don’t have to have all the answers. Bring connections with the community. Offer an opportunity for patients & families to “give back.” Advancing the Practice of Patient- and Family-Centered Care: How to Get started. Institute for Family-Centered Care

43. Key #2: Appropriate & Trained Parent Partners

44. Who??Would make a good Parent Partner?

45. Family Share?

46. Parental Traits, qualities & characteristics

47. Family Members—Success Factors • Ability to share personal experiences in ways others can learn from • Ability to see the big picture • Interest in more than one issue • Ability to speak candidly in a group • Ability to listen and hear other’s points of view • Ability to connect with people From: Partnering with Patients & Families: A Roadmap for the Future

48. More Success Factors Characteristics NICU Graduate parent Well established on journey Time & energy to give Experience with variety of resources & specialties Effective Communication Skills Sense of Humor Confident Team Player Meeting & team commitments Expectations—not a parent support group, parent who is not overwhelmed Adapted from “Parent Partners Guide,” Center for Medical Home Improvement, Page 6-10.

49. TEAM DISCUSSION: Who could you add to your temperature team?

50. Successfully selectinga parent partner What characteristics would fit well with your team? Ask other physicians, nurses, NNPs, receptionists for suggestions Are there other resources in your hospital? Discuss your options as a team Invite them to join! Adapted from “Parent Partners Guide,” Center for Medical Home Improvement, Page 6-8.