Humboldt Consumer Engagement Across the Spectrum

1. Humboldt Consumer Engagement Across the Spectrum Betsy Stapleton, FNP & Jessica Osborne-Stafsnes

2. A Definition of Patient Engagement “ [Patient Engagement is]… giving voice to the public and involving them in shaping health care delivery.” -Picker Institute Europe

3. Patient Engagement in Humboldt County, Ca CDSMP leaders act as faculty at PCR meeting to discuss the patient perspective of living with a chronic health condition 2009 PCR 3.0 kicks-off. Practices must recruit two patient partners to participate. Patients participate in collaborative and office improvement meetings. 2012 HDNIPA participates in the IHI “Quality Allies” Project 2005-2006 Implementation of the Chronic Disease Self-Management Program (CDSMP) 2008 2011 PCR 2.0 launches with an emphasis on PCMH. Recruitment of a “patient partner” team member is a requirement of participation. Significant infrastructure is built to support this effort. 2012 Community Response To Surgical Variation 2009 HDNIPA adopts collaborative model to improve primary care called: Primary Care Renewal (PCR); 10 PCP practices participate 2007 AF4Q initiative begins, citing patient engagement as a key driver of quality improvement

5. AFH’s Patient Engagement Efforts CDSMP CDSMP Health Information Surgical Rate Project Patient Partners

6. AFH’s Patient Engagement Efforts CDSMP CDSMP Health Information Surgical Rate Project Patient Partners

7. The Patient Partner Project “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

8. Project Specifics • Began in 2011 • Part of QI collaborative • Two patients/team • Patient Partners receive training and support • Ambassadors and advocates Share insights and feedback explicitly focused on collaborative topics

9. Process Development “The process of becoming an intelligent partner in the health process can be hard for people.” -- Toni M.

10. Steps to Engagement • Recruit • Train • Engage and Support • Meetings • Brainstorming

11. 1) Recruit Fundamentals • Role clarity • Leadership Buy-in • Physician and administrative leaders must actively and visibly endorse patient engagement work • Vision for partner role • What is the patient’s role? What “jobs” will they do? • Job description/skill sets • Time commitment • Skill sets • Authority Structure

12. 1) Recruit Cont. Strategies for recruitment • Provider/Staff Recommendation • Partner with CDSMP organization • Flier • Interview • Social Media

13. 2) Train • Patient readiness • Medical Culture • QI process • Methodology • Theory/Philosophy • PCMH • Confidentiality • “Medical-ese” • Chronic Care vs. Acute • Money talks • Group dynamic training

14. 2) Train Cont. • Practice Readiness • Identified facilitator with appropriate skills • CDSMP Leader Training • Loving firmness • Able to remove health system hat • Sense of humor • Commitment to the role • Translational role • Commitment to communication and feedback on patient input • Transparency • Communication • Contingency planning

15. Patient Partner Meetings • Introduce meeting topics and curriculum • Practice updates, brainstorming, and problem-solving • Sharing of “best-practices” • Capture patient recommendations and perspective on meeting subjects.

16. Brainstorming • Premise: • Anyone who has an idea can share it. • No commentary during the brainstorm. • Ideas are clarified or further discussed after the activity is completed.

17. Brainstorming • Premise: • Anyone who has an idea can share it. • No commentary during the brainstorm. • Ideas are clarified or further discussed after the activity is completed.

18. Brainstorming Benefits: • Great tool to generate conversation. • Engages all members of the group. • Recurrent themes are clearly visible. • Makes evident any areas of confusion. • First step towards a topics for further discussion. • Brainstorm: What sort of challenges do you encounter with access?

19. Problem-Solving Identify a problem List ideas Choose 2-3 solutions for further discussion Examine these solutions from the clinical perspective Revise solutions based on clinical feedback

20. Collaborative Meetings Techniques • Standing agenda item that starts meeting and sets tone • Prep patient for presentation • Vary presentation mode to keep interest • Evaluate

21. Team Meetings • Patients attend one “practice improvement” meeting at their office each month. • Some offices have standing agenda items specifically for their patient partners. • Patients offer insight and work on projects specific to the practice. • Sample Projects: • Practice brochure • Patient-friendly language • Practice ombudsman • Testing patient portals • Process development

22. Support Systems Summarized • Practices

23. Whose Home Is It? • Patient’s Home • Patient-centered • Staff uses comprehensible language • Ultimately, patient is in control • Provider/Staff home • Office-centered • Patient Partners learned “Medicalese” • Ultimately, Provider/Staff are in control Medical Home Practice Home Providing Medical Care Patient Experience Doing Business Quality Improvement Practice Redesign Productive Interactions (Stapleton, 2012)

24. Recognizing Success Patient Partners are catalysts for transformation

25. Recognizing Success “They keep our focus centered where it should be: on the patients.” -- Participating Clinician

26. Lessons Learned • Leadership buy-in is essential • Be prepared for learning curves • Have a highly structured and focused framework in place • Thread the value of patient involvement through out the entirety of your work

27. “Put the patient at the center- at the absolute center of your system of care… “… it is the active presence of patients, families and communities in the design, management, assessment, and improvement of care, itself” - Dr. Donald Berwick, 2008