Engaging Families As A Strategy To Advance Quality & Safety
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Engaging Families As A Strategy To Advance Quality & Safety Daniel Hyman, MD, MMM September 21, 2012
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Engaging Families As A Strategy To Advance Quality & Safety. Daniel Hyman, MD, MMM September 21, 2012. Family Engagement Objectives. Describe at least two best practices to engage patients/families in quality and safety in your organization - PowerPoint PPT Presentation
Transcript of Engaging Families As A Strategy To Advance Quality & Safety
Engaging Families As A Strategy To
Advance Quality & Safety
Daniel Hyman, MD, MMMSeptember 21, 2012
Family Engagement Objectives
• Describe at least two best practices to engage patients/families in quality and safety in your organization
• Discuss the benefits of patient/family involvement at the bedside and at system or strategic decision-making levels within your organization.
• Begin to develop a plan for advancing the engagement of patients/families in quality/safety programs within 30 days, including recruitment, training and orientation.
• And, do you want to talk about “risks”?
Adoption of Change
History of Family Engagement
• From innovation…. To early adoption…. To mainstream Where are we in that arc?
• Pursuing Perfection and My personal experience IHI ~2005
• Institute for Patient and Family Centered Care Polly Arango – co-founder Family Voices
• MSCH/NYP• Children’s Hospital Colorado
http://www.youtube.com/watch?v=LkhGoIXsHQo
www.josieking.org
On February 22, 2001, eighteen-month old Josie King died from medical errors. 98,000 people die every year from medical errors, making it the fourth leading cause of death in the United States. The Josie King Foundation’s mission is to prevent others from dying or being harmed by medical errors. By uniting healthcare providers and consumers, and funding innovative safety programs, we hope to create a culture of patient safety, together.
www.josieking.org
AHRQ 2012 report
AHRQ Report SummaryGoal – promote patient/family engagement with tools, resources, materials, training
Support the involvement of patients and family members in the safety and quality of their care.
Encourage the involvement of patients and family members in improving quality and safety within the hospital setting.
Facilitate the creation of partnerships between health professionals and patients/family members.
Outline the steps needed to implement changes.
Individual involvement• Well accepted by patients and providers
Obtaining information, involvement in decision making
• Less comfort with confrontational behaviors Hand washing, surgical marking e.g.
• Barriers and facilitators + self efficacy, information,
support/invite - fear, uncertainty, low literacy, norms
Organizational context
• External and influences to engaging families in quality/safety
• Organizational processes and structures that enable?
• Intervention strategies
Influencers
• Internal Serious events Business case Improvement Altruism
• External “steal
shamelessly” Policies/
regulation Influential
advocacy Public reporting
Structures/Processes
• No evidence that one or another structure is a barrier/enabler of patient/family engagement
• Organizational ability to absorb and sustain change, strength of leadership, resource/bandwidth are relevant factors
Strategies• Implementation – readiness
assessment; shared vision; execution plan; staff engagement; leadership
• Hospital level interventions – policies, structures; health care team level; management processes
• Individual level interventions – educating, informing, activating patients and providers; facilitate communication at all levels
Our story• At the bedside• Microsystem involvement• Organizational involvement
Projects Committees and Councils Family Advisory Council Board level
Engaging Families at the Bedside:
Watchful Eye of the Parent• At the bedside- listening to families
• Family centered rounds• Intentional inclusion in decision making
• Speak Up!- How it can improve outcomes?• Need measurement strategy
Speak Up
Hand hygiene!
RRTs!
Patient Identification!
Speak Up
Falls!
Pressure Injuries!
Projects and Service Lines• Initial involvement may best be at
project or clinical team level Partnership for Patient Safety (staff
education) Hand hygiene Patient Identification Consult and team communication Ambulatory Access Speak Up!
• Service Line Quality Committees
What Family Advisory Councils Can Provide
Hospitals• Parent voice is heard by
administration• Activities that are done by active
parents• Parent education
Family Advisory Council Web Link(s)
• MSCH FAC-
• CHCO FAC
Parent Partnership, ColoradoFAMILY ADVISORY COUNCIL
Focus Areas 2012:Family AdvocacyPolicy/Procedure InputMarketing of FAC/partnership opportunities
Governance/Quality Councils
-Quality/Safety Committee of the Board-Quality safety and Performance Improvement Council-Patient Safety Committee
Service Lines, Projects/Initiatives, etc.
Heart Institute QI; “Speak Up”; Hand hygiene; Patient ID; teamwork/communication/consult coordination; CF, GEDP; (others are recruiting)
“HACs” New! (ADE, CLA-BSI)- Others to follow
Experience at Children’s Colorado
• Parent placement on multiple committees/councils and projects Selection process- especially important at
the start• Recruitment strategies
Family Advisory Council Programs themselves Family Relations/Risk management referrals Ad hoc contacts
• Orientation documents and processes Parent orientation session- includes
volunteer training Committee member orientation needed too
Experience at Children’s Colorado
• Overcoming resistance /concerns• Meeting management
Acronyms, jargon Asking for input Managing defensiveness When people forget we have parents in the room….
• Debriefing is helpful after meetings• What we really need is an objective
evaluation strategy other than that it feels good and seems like the right thing to do!
“It will be easy working with families”
strongly disagree
disagree neutral agree strongly agree
0%
10%
20%
30%
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Families will call out “white elephants”
strongly disagree
disagree neutral agree strongly agree
00.10.20.30.40.50.60.70.80.9
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Families will express new viewpoints
strongly disagree
disagree neutral agree strongly agree
0%
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100%
Meetings will be more effective
strongly disagree
disagree neutral agree strongly agree
0%10%20%30%40%50%60%70%80%90%
100%
Members will have legal concerns
not likely possibly not sure likely definitely0%
10%
20%
30%
40%
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Members will hesitate to share concerns (“dirty laundry”)
not likely possibly not sure likely definitely0%
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100%
Where Hospitals are Today
• Assessing Family Engagement at Children’s Hospitals in the US
• 33 children’s hospitals participating in a national patient safety network
• Family engagement is a goal
Yes No N/A02468
1012141618 17
11
5
Parents/Families in Leadership roles re: safety
Yes No N/A02468
101214161820 18
10
5
Parents/Families on QI teams
OCHSPS - QI Assessment Survey Results for Family Engagement
10 hospitals said Yes to both questions
Framework
• Self assessment framework• Tools/Resources
Framework AssessmentFramework for assessing system level integration of family engagement
Family engagement is a system level value operationalized at multiple levels within the organization
AHRQ definition of Family Engagement: “A set of behaviors by patients, family members, and health professionals and a set of organizational policies and procedures that foster both the inclusion of patients and family members as active members of the health care team and collaborative partnerships with providers and provider organizations. The desired goals of patient and family engagement include improving the quality and safety of health care in a hospital setting”
System Levels Experience level of care
Practices used by the Health Care Team to engage families.
Practices/policies used to facilitate communication between patients/families and care providers
Practices used to increase patient knowledge, skills and abilities in care coordination
Microsystem level Patients/families advise and engage in
development of systems to engage families as part of the health care team, facilitate communication, and support care coordination
Organizational level Strategies used to involve family
members in management and processes within the hospital – feedback; participation in design, establishing system level priorities
Examples of Practices and Processes by Organization Level Consider Family Feedback on Dignity &
Respect; Information Sharing; Participation
Bedside shift-to-shift report Bedside team rounds Family activated RRT Tracers – to evaluate practices Patient empowerment training Care Journals “Quiet Time”
Consider Family Feedback on Participation; Collaboration
Family participation in improvement teams
Formal/established mechanisms to obtain participation and feedback
Consider Family Feedback on Participation; Collaboration
Family Advisory Board(s) Family representation as Board
member or Quality Committee of the Board member
Families participate in prioritization of hospital strategic initiatives
Concerns and Risks• You tell me…. What are some reasons you
would hesitate to engage patients/families…. In decision making and advocacy at the bedside? in quality/safety initiatives?
• Breach of privacy/confidentiality?• Litigation?• Derailing meetings?
How you can get started• Find early adopter parent/patient/family,
staff leader• Start with a project or task force, then
another…..• Discuss committee options• Develop, adapt or steal orientation
materials• PDSA Cycles!• Patient/family selection strategies• Hospital staff preparation• Dealing with concerns/resistance• “Start before you’re ready”
Questions and Answers
