Family-Centered Care Education: Evaluation of the Boyle Community Pediatrics Program William E....

Family-Centered Care Education:

Evaluation of the Boyle Community Pediatrics Program

William E. Boyle, Jr. MD

Toni LaMonica, MSW

Learning Objectives

(1) Understand a successful strategy for implementing a qualitative evaluation.

(2) Understand how community partners improve patient and family centered medical education.

(3) Apply components of a successful program to your own setting.

Boyle Community Pediatrics Program Mission

To recognize and reduce the burden of illness on families of children with serious health issues by creating educational experiences for medical learners.

To enhance patient and family-centered care throughout CHaD/Dartmouth Hitchcock Medical Center.

Boyle Community Pediatrics ProgramVision

Physicians fully integrate and value the unique contributions that the family and

community bring to children’s health.

Community

Health Providers

Family

Boyle Program: 1998-2007Services & Initiatives

Patient Partnerships

Family Faculty

Community Pediatrics Residency Training

CHaD Family Center

CHaD Family Advisory Board

Schwartz Center Rounds

… and more

(A Children’s Hospital within a Hospital)

80 inpatient beds Pedi/adolescent unit PICU ICN 95,461 outpatient visits in 2006

Why Evaluate? Why Now?

Fresh, unbiased review to guide decisions about the future.

Obligation to medical center leadership and program funders.

Anticipated leadership changes in the next 3 years.

First Steps

Develop a partnership with Dartmouth Medical School, Center for the Evaluative Clinical Sciences

Hired Aricca Van Citters, MS

Decided on qualitative research methodology -Appreciative Inquiry (AI)

Appreciative Inquiry (AI)

Developed by David Cooperrider of Case Western Reserve University in 1980.

Basic idea Focuses on existing capabilities and

successful experiences, as a foundation for creating more of what is desired.

Builds upon the strengths of a program.

Appreciate Inquiry 4-D Cycle

DiscoveryAppreciating

DreamEnvisioning

Results

DesignCo-constructing

DestinySustaining

Goals of the Evaluation:Addressing the First Two Components of AI

To Discover: Which aspects of the

program were most meaningful?

What are the opportunities for improvements?

Are we making a difference?

To Dream Where should we be

heading over the next five years?

Design and Destiny:

The 3-5 year plan

Study Design

Selection of 21 stakeholders for interviews5 Parents

• 14 Parents in Parent Task Force

• 26 Families in Family Faculty

• 9 Parents in the CHaD Family Advisory Board

6 Community Members (n of 17)*

4 Medical Students (n of 24)

6 Pediatric Residents (n of 39)

*Including 2 DHMC staff

Interview Questions How did you get connected to the program and what

have your experiences been? Can you think of a special time that you were most

engaged? - What really mattered to you?- How did this special time relate to or reinforce your own

values? What is the heart of the experience you had with the

Boyle Program? What do you wish might be strengthened or built into

the Program?

Interview Data

17 interviews conducted in person 4 interviews by telephone Interviews lasted from 35-80 minutes Interviews audiotaped and transcribed

Analysis Process

Responses were combined into groups - Teachers: family members, community and

staff partners

- Learners: medical students, pediatric residents

Transcriptions analyzed for common and unique themes within and across the teacher and learner groups.

Analytic Framework

Participants-What I value?-How I got connected-What I brought

Experiences-What I did?

Looking Back-What is at the heart or core of this experience?-What makes the Boyle Program work?-How has the program reduced the burden of illness for children and their families?

Looking Forward-What do I take from this program?-What can this program doto affect future practice?

Content Analysis

Identified major themes related to analytic framework.

Examined similarities and differences between teachers and learners.

Participant quotations to illustrate themes.

Themes – these and more

Advocacy Altruism Communication Community Compassion Continuity Education Family-centered care (FCC)

Holistic Improve care Partnerships Relationships Real world impact Reflection Resources

Top 10 of 30 Themes88

82

69 67

50 48 46 44 40 39

0102030405060708090

100

Education

RelationshipsImprove Care

Real-worldImpact

Understandpatients

Community

FCC

Models ofcare

LeadershipResources

Quotes

Analytic Framework





Most Common Themes:“What I Value”

1. Improve care

2. Education

3. Relationships

4. Altruism

5. Real-world impact

5. Understand patients

81%

67%62%

48%

38% 38%

0%

25%

50%

75%

100%

Improve care

Education

Relationships

AltruismReal-world

impact

Understandpatients

% of Participants

What I Value

CommunityContinuityExposure

FCCHolistic

AdvocacyCommunication

InterestPartnershipsResources

AltruismEducate

Improve CareReal-world impact

RelationshipSupport

Understand patients

Teachers Only

Both Learners Only

Participants – What I value?

“Med school just runs you down. You come home after being in class for 6 hours …, you have to make dinner, you have to make time for your husband, you have to do the laundry. It is just an overwhelming cycle. Then I take some time out of my day and call [my Patient Partner] and I get this happy inner feeling like I connected with somebody…” Medical student

How I Got Connected?

LearnersPatient Partnership is a

DMS voluntary program.

Community Pediatrics & Family Faculty are requirements of the pediatric residency curriculum.

TeachersFamilies & Community

Partners are invited by the Boyle Program.

Most Common Themes:“What I Brought”

1. Interest

2. Energy

2. Education

4. Clinical Complexity

5. Relationships


5. Improve care

45%40% 40%

30%25% 25% 25%

0%

25%

50%

75%

100%

InterestEnergy

EducationComplex

Relationships

Real-worldimpact

Improve care

% of Participants

What I Brought

InterestUnderstand patients

Clinical ComplexityImprove care

Real-world impactEducateEnergy

Teachers Only

Both Learners Only

What I Brought? “[We brought] a dedication and

a real desire to have some sort of impact… to be able to really have somebody understand. I think that is what it comes down to, you just really want somebody out there to understand the goods and the bads and that life with a child with chronic illness and/or disabilities is not all awful and it is not all wonderful. There are right ways to handle things.” ~ Family member

Analytic Framework





Examples of Experiences

Learners Meetings with partners Reflections with peers

and MD facilitators Visits to community

organizations Working in community

practice setting Family Faculty home

and school visits

Teachers Parent Task Force Develop and Advise

CHaD Family Center Family Faculty members Community mentors

Experiences

“I meet with [the residents] at a school and then I show them around the school, introduce them to some of the people, the guidance people and special ed people, kind of give them a tour of the school, and then I would bring them around to the different schools. ... From there I would drive them around to show them some of the neighborhoods, … just to give them an idea of where these kids are coming from.”

~ Community member

Analytic Framework





Most Common Themes:“What’s at the Heart of the Experience”

1. Education

2. Understand patients


4. Relationships

5. FCC5. Exposure

86%

76%71%

67%

52% 52%

0%

25%

50%

75%

100%

EducationUnderstand

patientsReal-worldimpact

Relationships

FCC

Exposure

% of Participants

What’s at the Heart of the Experience?

Common Themes

Teachers Only Both: Teachers & Learners

EducationExposure

FCCHolistic

LeadershipPartnerships

Real-world impactRelationships

ResourcesUnderstand patients

AltruismCommunication

CompassionContinuity

Improve careReflection

School

What’s at the heart of the experience?

“The absolute heart of this is putting the family’s view of their child’s healthcare first and then supporting it and figuring out a way for our view of healthcare and the family’s view of their child’s healthcare to integrate. … Let them tell their story and then tell our story and integrate them into the best possible combination of stories.” ~ Staff member

Most Common Themes:“What Makes the Program Work?”

1. Leadership

2. Relationships

3. Education

4. Dedicated time

5. Community

63%

53%

37%32%

26%

0%

25%

50%

75%

100%

LeadershipRelationships

Education

Time

Community

% of Participants

What Makes the Program Work?

AltruismCommunityUnderstand

patients

CommunicationContinuityEducation

FCCFlexibility

Improve careResources

Sustainability

Educate RelationshipsDedicated time

Teachers Only

Both Learners Only

What Makes the Program Work?

“Family members and community members are willing to take voluntary time to help shape future pediatricians. I was a resident at the time so that is my world, but they went out of their way to make sure we learned this new dimension of learning.” ~ Pediatric resident

How has the program reduced the burden of illness for children and their families?

Domains of interest Social Isolation Lack of personal contact and peer

relationships Financial issues Uncertainty of health outcomes

Social Isolation

“I felt privileged that he allowed me, at least for a time, to be his refuge from diabetes and that I was able to help him develop the skills he needed to create those social contacts that he was so craving to have.”

~ Medical student

Lack of Peer Contact

“Right there in the Family Center there is always somebody who can address questions. Kids are busy playing and parents feel welcome.”

~ Community member

Financial Issues

“For our shelter guests it was important… These are folks that … feel like invisible people in society. Here they are with an M.D. sitting in their living room or kitchen speaking with them for extended periods of time, not just 5 or 10 minutes that you get when you see a doctor, but an hour, hour and a half, in depth discussions about their kids. So I think for our guests it was like, ‘Wow, all of sudden I have a friend who is a doctor’. I think it just made them feel very, very encouraged.”

~ Community member

Uncertainty of Health Outcomes

It gives you an understanding of living with chronic disease and what that means in the greater context of the patient’s life, and not just what medications they take….” ~ Medical student

Analytic Framework





What do I take from the program?

“I think the program allows you to practice medicine the way you ideally wanted to practice medicine when you started this whole journey.”~ Pediatric resident

What can the program do to affect future practice?

“I realize that they [parents] know a lot about their kids and we better listen when they come. Often our experiences are these short little inpatient visits and there is a huge other aspect to the child and the family’s experiences having this child.”

~ Pediatric resident

Next Steps: Design& DestinyPlanning & Prioritizing

DiscoveryAppreciating

DreamEnvisioning

Results

DesignCo-constructing

DestinySustaining

Most Common Themes:“Opportunities for Improvement and Continued Attention”

1. Continuity

2. Education

3. Advocacy

4. FCC

5. Resources

38%33%

29%24%

19%

0%

25%

50%

75%

100%

ContinuityEducationAdvocacy

FCC

Resources

% of Participants

Opportunities for Improvement and Continued Attention

Community

EducationFCC

PartnershipsSchool

Sustainability

Continuity

Teachers Only

Both Learners Only

Using the Evaluation to Improve Education and Care

Improve the Boyle Program

Disseminate knowledge to other educational settings

Encourage partnerships with patients, families, and community members to create unique opportunities to teach patient and family centered care. You can do this too!

Improvements for the Boyle Program

Increase community network Develop closer connections among

members of Family Faculty Support advocacy projects that build

connections and continuity Form strategic planning council for Boyle

Program

Unexpected Findings

Recruitment of family and community members easier than we expected.

The community is a rich resource for teaching - it is a vast, free classroom.

Our efforts in the community have improved the reputation of DHMC.

Both learners and teachers want more.

Dissemination

AI as a process for understanding program strengths

Applications to residency programs, medical schools, and other health provider education programs

Successful model of achieving ACGME general competencies• e.g., Communication and Professionalism

Partnerships with Patients, Families, and Community Members

Families and community members are eager to participate in medical education – to give back and make care better next time.

Learners and teachers understand this is a shared journey toward the minimization of the burden of illness in people’s lives.

In Conclusion AI is a successful strategy for program evaluation. Families and community members offer unique

knowledge and experiences to medical learners. Medical learners value “real world” exposure and

experience. Engaging patients and families in medical education is a

natural extension of the Patient & Family Centered Care movement in health care.

Families and community members want to be involved – they are willing and interested and a resource available in every community.

References and Further Information

Boyle Program Evaluation and PowerPoint: www.dhmc.org/goto/boyleprogram

Appreciative Inquiry: www.aiconsulting.org www.centerforappreciativeinquiry.net Suresh Srivastva, David L. Cooperrider, and

associates. Appreciative management and leadership: the power of positive thought and action in organizations, San Francisco: Jossey-Bass, 1990

Family-Centered Care Education: Evaluation of the Boyle Community Pediatrics Program William E....

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