| Barbara Vahle MSN, RN | May 20, 2014

1. The Guide to Patient and Family Engagementin Quality and Safety:Engaging Patients and Families to Improve the Quality and Safety of Care We Provide | Barbara Vahle MSN, RN | May 20, 2014 Information to Help Hospitals Get Started

2. Today’s presentation is about…. • Improving the care we provide through patient and family engagement Information to Help Hospitals Get Started

3. Patient and family engagement: Improving the care we provide Information to Help Hospitals Get Started

4. What is patient and family engagement? Patient and family engagement: • Creates an environment where patients, families, clinicians, and staff work together as partners to improve the quality and safety of care • Involves working with patients and family members as: • Members of the health care team • Advisors at the organizational level Information to Help Hospitals Get Started

5. Patient- and family-centered care • Patient and family engagement is an important part of providing patient- and family-centered care • Core concepts of patient- and family-centered care: • Dignity and respect • Information sharing • Involvement • Collaboration Information to Help Hospitals Get Started

6. Benefits of patient and family engagement • Improves multiple aspects of hospital performance • Overall improvements in quality and safety • Patients and families as allies in safe medication use, infection control initiatives, observing care processes, reporting complications • Reduction in preventable readmissions • Improved patient outcomes • Emotional health, symptom resolution, pain control, physiologic measures • Improved CAHPS® Hospital Survey scores • Patient-provider communication, pain management, medications, provision of discharge information Information to Help Hospitals Get Started

7. Benefits of patient and family engagement • Better response to the Joint Commission standards or other accreditation • Improved financial performance • Decreased litigation and malpractice claims • Lower costs per case due to complications • Improved patient flow • Less waste associated with higher call volume, repetitive patient education efforts, diagnostic tests • Enhanced market share and competitiveness • Establishment of brand identify around patient and family engagement • Increased employee satisfaction and retention Information to Help Hospitals Get Started

8. Benefits of patient and family engagement • Patient and family engagement also: • Is consistent with BRCN mission and vision : To provide excellence in professional nursing and healthcare career education. • Is consistent with Blessing Hospital mission and vision :“To improve the health of our community.” • Helps us meet a strategic priority – Quality and Safety in patient care • Is the right thing to do Information to Help Hospitals Get Started

9. The Guide to Patientand Family Engagement • What is it? • What do we want to do? Information to Help Hospitals Get Started

10. Guide to Patient and Family Engagement • Tested, evidence-based resource to help agencies work as partners with patients and families to improve quality and safety. • Includes strategies that reflect critical opportunities for patient and family engagement • Addresses real-world challenges • Contains detailed implementation guidance • Includes tools for hospital leaders, managers, clinicians, patients, and families Information to Help Hospitals Get Started

11. Guide to Patient and Family Engagement • Includes four strategies to support engagement: • Working with Patients and Families as Advisors • Working with Patients and Families at the Bedside:Communicating to Improve Quality • Working with Patients and Families at the Bedside:Nurse Bedside Shift Report • Working with Patients and Families at the Bedside:Care Transitions from Hospital to Home: Discharge Planning Information to Help Hospitals Get Started

12. Why work with patients and families as advisors? • Patient and family advisors help us provide care and services based on patient- and family-identified needs rather than our assumptions. • Patient and family advisors offer: • Insight on our strengths and areas where changes may be needed • Feedback on practices and policies that can help patients and families be active partners in their care …. • Feedback that is timely and gives a fuller picture of the care experience than standard patient and family satisfaction surveys Information to Help Hospitals Get Started

13. Why focus on communication? • It’s the foundation of all interactions with patients and families • Research shows patient-centered communication can improve: • Patient safety • More than 70% of adverse events caused by breakdowns in communication • Patient outcomes • Including emotional health, functioning, and pain control • Patient experiences of care • Who do I go to for information or help? • Who can provide a clearer understanding of how to ask questions….and what to ask? • How can I participate in my care? Information to Help Hospitals Get Started

14. Why focus on bedside shift report? • Transitions in care have potential for medical errors • Research shows bedside shift report can improve: • Patient safety and quality • Improved communication • Decrease in hospital-acquired complications • Patient experiences of care • Talk with me…..not about me….. • Allow the patient to decide who their “family” is… • Time management among and accountability between nurses • Decrease in time needed for shift report • Decrease in overshift time Information to Help Hospitals Get Started

15. Why focus on discharge planning? • Nearly 20% of patients experience an adverse event within a month of discharge, of which ¾ could be prevented. • Common complications post-discharge are adverse drug events, healthcare-associated infections, and procedural complications. • Many complications can be attributed to problems with discharge planning. • Changes in medicines before and after discharge • Inadequate preparation for patients and families • Disconnect between information giving and patient understanding • Discontinuity between in-patient and out-patient providers Information to Help Hospitals Get Started

16. Moving forward • What do we need from you? Information to Help Hospitals Get Started

17. What do we need from you? • Nursing needs to take the lead …… • Why nurses? • Why not nurses? • What barriers may be encountered? Are we ready to give up some control? Do we value patient input? Are patients ready, willing , and appropriately informed to make decisions about their health care? Information to Help Hospitals Get Started

18. Other ways to support patient and family engagement • Communicate the vision and values related to patient and family engagement. • Serve as role models for engaging in partnerships with patients and family members. • Provide the necessary infrastructure and resources. • Involve and support clinicians and staff in patient and family engagement initiatives. • Integrate patient and family engagement into personnel policies and practices. • Reassess visitor policies • Assist family while in the hospital Information to Help Hospitals Get Started

19. What nurses can do to promote patient and family engagement… • When patients question or want to check the medications you are giving them….listen to them, welcome it! • When family members comment….”I didn’t see you wash your hands,” …..thank them for reminding you and do it! • Whenfamily members ask about a test or diagnosis…encourage their interest and value their input. Information to Help Hospitals Get Started

20. What nurses can do to promote patient and family engagement… • Help family members move into a more active role in care… • Provide information that is understood by them….clarify and simplify the information. • Explain reasons for medications, labs, diagnostic tests, NPO etc • Value patient/family participation in care and decision making…. help them transition into a more active role • Remember that information is not enough….create reminders and charts to help them with care…..I & O charts, NPO reminders, turn/repositioning check lists, need for specimens, bedrest…… Information to Help Hospitals Get Started

21. What nurses can do to promote patient and family engagement……. • Encourage patient networking…patients with similar problems know what other patients want and need to know… (www.Patientslikeme.com …website of information with 1500 diseases) • Encourage patients to seek out information on their diagnosis… Google is a start….. • EHR (electronic health records) …online access to their own records….currently used by the VA Information to Help Hospitals Get Started

22. Better Patient Engagement….. • Leads to higher HCAHPS scores (Hospital Consumer Assessment of Healthcare Providers and Systems) • Leads to higher reimbursement…. outcomes of care are being measured and payments are made based on HCAHPS scores • Makes good business sense….. • FOLLOW THE MONEY….. Information to Help Hospitals Get Started

23. Better Patient Engagement….. • Leads to happier more satisfied patients…. • Leads to increased patient involvement and accountability… • Leads to happier more satisfied nurses…. • Leads to nurse retention….. • Leads to safety and quality of care…. • It is the right thing to do…. • Leads to a WIN – WIN situation! Information to Help Hospitals Get Started

24. Patient Engagement….let’s get started! • Ten minute sit down…. • Spirituality ….. • Patient updates…. • Educating the entire family…. Information to Help Hospitals Get Started

25. Thank you! • For questions or more information: Barb Vahle MSN, RN Assistant Professor Blessing-Rieman College of Nursing vahleb@BRCN.edu 217-228-5520 ext:6912 • Agency for Healthcare Research and Quality: Advancing Excellence in Health Care www.ahrq.gov Information to Help Hospitals Get Started

26. References 1. LeapeL, Berwick D, Clancy C, et al. Transforming healthcare: a safety imperative. QualSaf Health Care 2009;18(6):424–8. 2. Walker EP. CMS releases final rule on same-sex hospital visits 2011. http://www.medpagetoday.com/Washington-Watch/Washington-Watch/23496. Accessed April 5, 2013. 3. Institute for Healthcare Improvement NICHQ. Elements of hospital-based patient- and family-centered care. 2009. 4. Weiner BJ, Shortell SM, Alexander J. Promoting clinical involvement in hospital quality improvement efforts: the effects of top management, board, and physician leadership. Health Serv Res 1997;32(4):491–510. 5. LiebhaberA, Draper DA, Cohen GR. Hospital strategies to engage physicians in quality improvement. Issue Brief Cent Stud Health Syst Change 2009;(127):1–4. 6. Draper DA, Felland LE, Liebhaber A, et al. The role of nurses in hospital quality improvement. Res Briefs 2008;(3):1–8. 7. MastalMF, Joshi M, Schulke K. Nursing leadership: championing quality and patient safety in the boardroom. Nurs Econ 2007;25(6):323–30. 8. Conway J, Nathan D, Benz E, et al. Key learning from the Dana-Farber Cancer Institute’s 10 year patient safety journey. American Society of Clinical Oncology 2006 Educational Book. 2006:615–9. 9. Curtis JR, Cook DJ, Wall RJ, et al. Intensive care unit quality improvement: a 'how-to' guide for the interdisciplinary team. Crit Care Med 2006;34(1):211–8. Information to Help Hospitals Get Started

27. References 10. Conway J. Getting boards on board: engaging governing boards in quality and safety. JtComm J Qual Patient Saf 2008;34(4):214–20. 11. American Hospital Association, Institute for Family-Centered Care. Strategies for leadership: advancing the practice of patient- and family-centered care. 2004. http://www.aha.org/advocacy-issues/quality/strategies-patientcentered.shtml. Accessed March 12, 2013. 12. Graham S, Brookey J, Steadman C. Patient Safety Executive Walkarounds In: Advances in Patient Safety: From Research to Implementation (Volume 4: Programs, Tools, and Products). Rockville, MD: Agency for Healthcare Research and Quality; 2005 Feb. 13. Frankel A, Grillo SP, Pittman M, et al. Revealing and resolving patient safety defects: the impact of leadership walkrounds on frontline caregiver assessments of patient safety. He13. Frankel A, Grillo SP, Pittman M, et al. Revealing and resolving patient safety defects: the impact of leadership walkrounds on frontline caregiver assessments of patient safety. Health Serv Res 2008;43(6):2050–66.alth Serv Res 2008;43(6):2050–66. 14. Frankel A, Graydon-Baker E, Neppl C. Patient safety leadership walkrounds. JtComm J QualSaf 2003;29(1):16-26. 15. Frampton S, Guastello S, Brady C, et al. Patient-centered care improvement guide. Derby, CT: Planetree; October 2008. 16. Milne, Judy, Patient Safety Officer at Duke University Hospital. Interviewed by American Institutes of Research project staff. July 9, 2010. 17. KeroackMA, Youngberg BJ, Cerese JL et al. Organizational factors associated with high performance in quality and safety in academic medical centers. Acad Med 2007;82(12):1178–86. 18. Silow-CarollS, Alteras T, Stepnick L. Patient-centered care for underserved populations: definition and best practices. Washington, D.C.: Economic and Social Research Institute. January 2006. Information to Help Hospitals Get Started