Post on 25-Jun-2020
Institute for Healthcare Improvement
IHI ExpeditionImproving Patient Experience Session 1
Wednesday, June 26, 2013
These presenters have
nothing to disclose
Barbara Balik, RN, EDd
Kelly McCutcheon
Adams, LICSW
Expedition Coordinator2
Kayla DeVincentis, CHES, Project Coordinator, Institute for Healthcare Improvement, currently manages web-based Expeditions and the Executive Quality Leaders Network. She began her career at IHI in the event planning department and has since contributed to the State Action on Avoidable Rehospitalizations (STAAR) Initiative, the Summer Immersion Program, and IHI’s efforts for Medicare-Medicaid enrollees. Kayla leads IHI’s Wellness Initiative and has designed numerous activities, challenges, and educational opportunities to improve the health of her fellow staff members. In addition to implementing the organization’s first employee health risk assessment, Kayla is certified in health education and program planning. Kayla is a graduate of Northeastern University in Boston, MA, where she obtained her Bachelor of Science in Health Science with a concentration in Business Administration.
Institute for Healthcare Improvement
WebEx Quick Reference
• Welcome to today’s session!
• Please use chat to “All Participants” for questions
• For technology issues only, please chat to “Host”
• WebEx Technical Support: 866-569-3239
• Dial-in Info: Communicate / Join Teleconference (in menu)
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Select Chat recipient
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All Participants
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Chat Time!
What is your goal for participating in this Expedition?
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Join Passport to:
• Get unlimited access to Expeditions, two- to four-month, interactive, web-based programs designed to help front-
line teams make rapid improvements.
• Train your middle managers to effectively lead quality improvement initiatives.
. . . and much, much more for $5,000 per year!
Visit www.IHI.org/passport for details.
To enroll, call 617-301-4800 or email improvementmap@ihi.org.
Institute for Healthcare Improvement
What is an Expedition?
ex•pe•di•tion (noun)
1. an excursion, journey, or voyage made for some specific purpose
2. the group of persons engaged in such an activity
3. promptness or speed in accomplishing something
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Expedition Support
All sessions are recorded
Materials are sent one day in advance
Listserv address for session communications: PatientExperienceExpedition@ls.ihi.org
– To add colleagues, email us at info@ihi.org
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Where are you joining from?
Expedition Director10
Kelly McCutcheon Adams, LICSW has been a Director at the Institute for Healthcare Improvement since 2004. Her primary areas of work with IHI have been in Critical Care and End of Life Care. She is an experienced medical social worker with experience in emergency department, ICU, nursing home, sub-acute rehabilitation, and hospice settings. Ms. McCutcheon Adams served on the faculty of the U.S. Department of Health and Human Services Organ Donation and Transplantation Collaboratives and serves on the faculty of the Gift of Life Institute in Philadelphia. She has a B.A. in Political Science from Wellesley College and an MSW from Boston College.
Institute for Healthcare Improvement
Today’s Agenda11
Ground Rules & IntroductionsFoundational Elements to Improve Patient and Family Experience – Why is this so hard?– Learning from Participants– The Tale of Two Hospitals– What We Know from Evidence and
Exemplars– Skills to Engage Others
Using the Model for ImprovementAssignment for Next Session
Ground Rules12
We learn from one another – “All teach, all learn”
Why reinvent the wheel? – Steal shamelessly
This is a transparent learning environment
All ideas/feedback are welcome and encouraged!
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Overall Program Aim
Using the IHI Patient Experience Change Package, this program will aid participants in a) harvesting updated concepts to improve
the culture and strategies for improving patient and family experience; and b) assuring the foundations for success are identified and implemented to support the stickiness of their
strategies.
Expedition Objectives
At the end of the Expedition each participant will be able to:
Identify new concepts to test that will improve patient experience
Explain how attention to reliability affects the utility of change ideas
Describe key issues to address when planning spread of effective ideas
Modify current practices to increase reliability and ability to spread
Recommend actions to engage colleagues at all levels in patient and family experience culture change
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Institute for Healthcare Improvement
Schedule of Calls
Session 1 – Foundational Elements to Improve Patient and Family ExperienceDate: Wednesday, June 26, 1:00 PM – 2:30 PM ET
Session 2 – Latest Thinking and New Ideas – Engaging Others for the JourneyDate: Wednesday, July 10, 1:30 – 2:30 PM ET
Session 3 – Using Reliability Concepts to Improve Patient ExperienceDate: Wednesday, July 24, 1:30 – 2:30 PM ET
Session 4 – Spread and AdaptabilityDate: Wednesday, August 7, 1:30 – 2:30 PM ET
Session 5 – Live Case Studies of Improving Patient ExperienceDate: Wednesday, August 21, 1:30 – 2:30 PM ET
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Faculty16
Barbara Balik, RN, EdD, Principal, Common Fire Healthcare Consulting, is also Senior Faculty at the Institute of Healthcare Improvement. Her areas of expertise include leadership and systems for a culture of quality and safety, including patient- and family-centered care, patient experience, systems to improve transitions in care, and transforming care prior to or with optimization of an electronic health record implementation. She works with leaders to develop adaptive systems to excel and innovate in complex organizations, and to ensure sustained improvement and innovation every day. Ms. Balik'spublications include the book, The Heart of Leadership, and the IHI white paper on "Achieving an Exceptional Patient and Family Experience of Inpatient Hospital Care," among others. Previously, she served in senior leadership roles at Allina Hospitals and Clinics, United Hospital, and Minneapolis Children's Medical Center.
Institute for Healthcare Improvement
Foundational Elements to Improve Patient and Family Experience
Why is this so hard?
This presenter has nothing to disclose.
Session Objectives
At the conclusion of this session, participants will be able to:
Describe the Expedition process and how to gain the most from it
Explain the Patient and Family Experience Driver Diagram and high impact changes to improve patient/family experience
Apply selected lessons from evidence and the field to enable sustained Experience results
Apply two tools to engage colleagues in understanding the culture change for patient and family experience
Identify assets and gaps in current approach to Patient and Family Experience
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Learning from Participants:Where you are in the journey
Poll Questions
Have you participated in previous IHI Patient Experience programming (seminar, Expedition, etc.)?
Have you eliminated visiting restrictions for family members (and family is defined by patient)?
Do you have active Patient/Family partnerships?
– E.g. one or more of these:
– Ask Patients/Families for their ideas on potential improvement
– Patient/Family Advisors on teams
– Patient/Family Advisors on a council
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Learning from Participants:Where you are in the journey
Have you implemented White Boards?
– If so, what is your reliability in those departments?
Have you implemented bedside connections?
– If so, what is your reliability in those departments?
Have you implemented leader rounding (executive through departmental leader)?
– If so, what is your reliability in those departments?
Why do you think your tactics worked?
– Chat your thoughts into the chat box!
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A Tale of Two Hospitals:Reliability Hospital
Hospital Unit Working Together Filled Up Whiteboard
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A Tale of Two Hospitals:Inconsistency Hospital
Pizza
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Why implementation matters…
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Model for Improvement & Reliability
Definition of Patient Experience
Do you have a definition of patient experience for your organization other than “HCAHPS scores”?
– If yes, please share your definition in the chat box
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Patient- and Family-Centered Care
Connections: Patient-and Family-Centered Care and Patient Experience
– To be truly patient centered, healthcare providers must partner with patients and families to see what the experience is like through their eyes . . .
– Patients and families are architects and designers
of an effective healthcare system
• Picker Institute – Always Events Healthcare Solutions
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Patient- and Family-Centered Care:One definition
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 my care; policy and program development; implementation and evaluation
• Institute for Patient-and Family-Centered Care
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Roadmap
– from –
RANDOM ACTS OF GOODNESS
– to –
AN INTEGRATED SYSTEM
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It is Not About –28
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It is Not About –29
It is Not About –30
“Our patients are…
– Older
– Sicker
– Crabbier
– In a busy clinic
– In double rooms
– In the ED
– …”
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What Patients Want31
“What patients want is not rocket science, which is really unfortunate because if it were rocket science, we would be doing it. We are great at rocket science. We love rocket science. What we’re not good at are the things that are so simple and basic that we overlook them.”
—Laura Gilpin, Griffin Hospital
What Patients and Families Want
Patient- and Family-Centered – no helplessness for those served or serving
Safe – no needless harm or deaths
Effective – no needless pain or suffering
Timely – no unwanted waiting
Efficient – no waste
Equitable – for all
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Institute for Healthcare Improvement for Patient- and Family-Centered Care
Institute for Healthcare Improvement
A Framework
What We Know from Exemplars:
– Leadership
– Engage the hearts and minds
– Respectful interactions
– Reliable systems
– Evidence based care
Balik B, Conway J, Zipperer L, Watson J. Achieving an Exceptional Patient and Family Experience of Inpatient Hospital Care. Institute for Healthcare Improvement; 2011. (Available on www.IHI.org)
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Exceptional patient and family inpatient hospital experience
(safe, effective, patient centered, timely, efficient,
equitable) as measured by
HCAHPS willingness to recommend or
rating
Governance and executive leaders demonstrate that EVERYTHING in
the culture is focused on patient and family centered
care, practiced everywhere in the
hospital (individual, microsystem, organization)
In words and actions leaders communicate that the patient’s safety and well being is the critical
decision guiding all decision making
Patients and families are treated as partners in care at every level: on decision making bodies
to team members with individual care
PFCC is publicly verifiable, rewarded, and celebrated with relentless focus on
measurement, learning, and improvement with transparent patient feedback
Sufficient staff are available with the tools and skills to deliver the care the patient needs when
they need it
The hearts and minds of staff and providers are fully
engaged
Staff and providers are recruited for values and talent, supported for success, and accountable
individually and collectively for results
Compassionate communication and teamwork are essential competencies
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 are 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 and meets their
emotional needs
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 “there were staff available to give the care I needed”
The care team instills confidence
by providing collaborative,
evidenced based care
Care is safe, concerns are addressed and if things go wrong, there is open communication
and apology
Care is coordinated and integrated through use of a shared can plan and everyone on the
patient’s care team, including the patient, has the information they need
Patients get the outcomes of care they expect
IHI Patient Experience Driver Diagram
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Patient Experience Actions: OverviewKey areas for improving specific
domains of patient experience
Staff and Physicians Patient and FamilyConnection
Leadership EngagementImprovement/
Infrastructure
Foundational Elements for Improving Patient Experience
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High Impact Changes Overview
Connections – the Big Deal
– Nurses in Hospitals; Home Health
– Providers in Clinics
– Tactics that strengthen the connections done reliably
Lessons Learned
– Variety of settings
– New literature
Foundational supports
– Without them risk Random Acts of Goodness
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Institute for Healthcare Improvement
Patient Experience Actions: OverviewKey areas for improving specific
domains of patient experience
Staff and Physicians Patient and FamilyConnection
Leadership EngagementImprovement/
Infrastructure
Foundational Elements for Improving Patient Experience
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Connections
The core of Experience
Sample Tactics:
– Bedside connections
– Care rounds
– White Boards
– Everyone is a caregiver
– Bundle: Knock, Introduce, Sit, “What are you most worried about?”, Listen
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Patient Experience Actions: OverviewKey areas for improving specific
domains of patient experience
Staff and Physicians Patient and FamilyConnection
Leadership EngagementImprovement/
Infrastructure
Foundational Elements for Improving Patient Experience
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Key Actions: Leadership
Leaders take ownership of defining purpose of work and modeling desired behaviors.
– Purpose
– Label and link
– “All in” behaviors
– Storytelling
– Leadership rounding
– Leadership behaviors
– Champions
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Patient Experience Actions: OverviewKey areas for improving specific
domains of patient experience
Staff and Physicians Patient and FamilyConnection
Leadership EngagementImprovement/
Infrastructure
Foundational Elements for Improving Patient Experience
Key Actions: Engagement
Staff, leaders, and physicians engage patients and families so that efforts to improve patient experience reflect actual patient experience.
– Definition
– Advisors and leaders
– Improvement initiatives
– Tools
– Physical design
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Health care significantly lags
When patient, family, or community members’ view is absent – high risk of:
– Professionally or organizationally centered
– Over-designed
– Wasteful
We find out what really matters
Fast, simple, safe, easy, cheap
Why Partner with Patients and Families?
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Patient Experience Actions: OverviewKey areas for improving specific
domains of patient experience
Staff and Physicians Patient and FamilyConnection
Leadership EngagementImprovement/
Infrastructure
Foundational Elements for Improving Patient Experience
Institute for Healthcare Improvement
Key Actions:Improvement Infrastructure
Improvement teams are solidly grounded with skills to affect reliable change and gain meaningful understanding of data.
– Daily improvement
– Measurement system
– Reliability
– Patient journey
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Engaging Colleagues
Major barrier – we already think we are patient-centered!
Actions to engage others – All In!
– Purpose: What and Why
– Define Patient Experience
– To – For – With
– Observe the Journey
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Institute for Healthcare Improvement
Purpose – What and Why
Patient Experience:
– Most lacking a clear, concise definition
Actions:
– What is it and why is it important
– How does it link to the organization’s mission and strategies
– How do I contribute – everyone is a caregiver
– 20 foot talk
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Doing To – Doing For – Doing With
Engaging Colleagues:
Where are you in your journey?
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Institute for Healthcare Improvement
Doing To
You know you are doing to when:
We say – you do: schedules; visiting hours
We waste your time – come to the clinic & wait
We determine what and when you eat
Information is not shared or understandable
We determine if you are compliant
There is helplessness – when the patient/family say:– I don’t know what is the plan of care and what happens
next.
– I don’t know who is in charge of my care.
– I don’t feel like you know me.
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Doing ForYou know you are doing for when:
Family presence is defined by the patientWe keep the patient in mind when designing or improving programs – then askWe design the teams to help you – without youDedicated efforts to improve the patient experienceWe manage your expectations about waitingInformation is openly shared with patientsEarly use of health literacy We teach you – lots & lots & lotsWe are beginning to get it about cross-continuum care but don’t know much about the white spaces
Barbara Balik
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Institute for Healthcare Improvement
Doing For
“We are really good about caring what you think about us. We are not good about caring what you think.”– Catherine Lee, VP Service Excellence, McLeod Regional Medical Center
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Doing With
Barbara Balik
You know you are doing with when:
Build on Doing for and move beyondPatient/family advisors are on teams to design or improve programs that follow the patient journeyAll key decisions are mutual – including who is on my teamAll staff are viewed as caregivers and are skilled in respectful communication and teamworkHealth Literacy is everywhere in patient careSenior leaders model that patient’s safety and well-being guide all decisionsStaff, providers, leaders are recruited for values & talent; patient/family advisors involved in hiring
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Where are we in doing to-for-with?53
To-For-With Assessment Patient and Family
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1. Individually – complete 1-2 examples in each category2. Review as a group3. What do your lists tell you? What gets in the way of doing with?
Doing To – Patients and Families
Doing For – Patients and Families
Doing With – Patients and Families
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Key Change Ideas:Improvement Infrastructure
Improvement teams are solidly grounded in skills to effect reliable change and gain meaningful understanding of data
– Daily Improvement
– Measurement System
– Reliability
– Patient Journey
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Action Period Assignment
Observe one patient using options in observation guide (will be shared by listserv after session)
After the observation by Mon 7/8 - post on listserv:– What surprised you?
– What delighted you?
– What confused you?
Be prepared to share what you learned
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Questions?57
Raise your hand
Use the Chat
What are we trying toaccomplish?
How will we know that a
change is an improvement?
What change can we make that
will result in improvement?
Model for Improvement
Act Plan
Study Do
Aim of Improvement
Measurement of
Improvement
Developing a Change
Testing a Change
Adapted from Langley, G. J., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. San Francisco, CA: Jossey-Bass, 1996.
Institute for Healthcare Improvement
Plan• Compose aim
•Pose questions/predictions
•Create action plan to carry
out cycle (who, what, when,
where)
•Plan for data collection
DoStudy
Act
• Carry out the test and
collect data
•Document what occurred
•Begin analysis of data
• Complete data analysis
•Compare to predictions
•Summarize learning
• Decide changes to make
•Arrange next cycle
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Principles & Guidelines for Testing
A test of change should answer a specific question
A test of change requires a theory and prediction
Test on a small scale
Collect data over time
Build knowledge sequentially with multiple PDSA cycles for each change idea
Include a wide range of conditions in the sequence of tests
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Repeated Use of the PDSA Cycle
Hunches
Theories
Ideas
Changes That
Result in
Improvement
A P
S D
A P
S D
Very Small Scale Test
Follow-up Tests
Wide-Scale Tests of Change
Implementation of Change
Sequential building of
knowledge under a
wide range of
conditions Spread
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Aim: Implement Rapid Response Team on non-ICU unit
Improved Communication
A P
S D
A P
S D
Cycle 1: ICU nurse responds to rapid response team calls on one unit,
one shift for one day
Cycle 2: Repeat cycle 1 for three days
Cycle 3: Have Respiratory Therapist attend
rapid response calls with ICU Nurse
Cycle 4: Expand coverage of RRT on unit
to one unit for one shift for five days
Cycle 5: Have Nurse Practitioner
respond to calls in addition to RT and
RN
Cycle 6: Expand rounds to
one unit for one shift seven
days a week
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Questions?63
Raise your hand
Use the Chat
Action Period Assignment
Observe one patient using options in observation guide (will be shared by listserv after session)
After the observation by Mon 7/8 - post on listserv:– What surprised you?
– What delighted you?
– What confused you?
Be prepared to share what you learned
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Institute for Healthcare Improvement
Expedition Communications
Listserv for session communications: PatientExperienceExpedition@ls.ihi.org
To add colleagues, email us at info@ihi.org
Pose questions, share resources, discuss barriers or successes
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Next Session
Wednesday, July 10, 1:30 PM – 2:30 PM ET
Session 2 – Latest Thinking and New Ideas –Engaging Others for the Journey
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