Patient and Family Centered Care Recommendations PDF

**DAY 4 - PATIENT AND FAMILY CENTERED CARE** **Partnerships and Culture in Health Care** **The Council's Ten Recommendations** "The Premier's Council has reviewed a substantial amount of research, listened to Ontarians, and developed a set of 10 strategic policy recommendations to help the govern...

**DAY 4 - PATIENT AND FAMILY CENTERED CARE** **Partnerships and Culture in Health Care** **The Council's Ten Recommendations** "The Premier's Council has reviewed a substantial amount of research, listened to Ontarians, and developed a set of 10 strategic policy recommendations to help the government stay on track to end hallway health care and build a sustainable health system." **The Council's Ten Recommendations** **Integration** 1\. Patients should be well-supported and treated with dignity and respect throughout all interactions with the health care system. 2\. Improve patients' and providers' ability to navigate the health care system, simplify the process of accessing and providing care and improve digital access to personal health information. 3\. Support patients and providers at every step of a health care journey by ensuring effective primary care is the foundation of an integrated health care system. **Innovation** 4\. Improve options for health care delivery, including increasing the availability and use of a variety of virtual care options. 5\. Modernize the home care sector and provide better alternatives in the community for patients who require a flexible mix of health care and other supports. **Efficiency and Alignment** 6\. Data should be strategically designed, open and transparent, and actively used throughout the health care system to drive greater accountability and to improve health outcomes. 7\. Ensure Ontarians receive coordinated support by strengthening partnerships between health and social services, which are known to impact determinants of health. 8\. As the health care system transforms, design financial incentives to promote improved health outcomes for patients, population health for communities and increased value for taxpayers. **Capacity** 9\. Address short- and long-term capacity pressures including wait times for specialist and community care by maximizing existing assets and skills and making strategic new investments. Build the appropriate health care system for the future. 10\. Champion collaborative and interprofessional leadership development focused on system modernization capabilities. **How was This Information Gathered?** Input received from over 1,500 patients, caregivers, families, health care professionals, and organizations through: - Ten regional engagement sessions with over 650 participants from throughout Ontario; - A virtual engagement session with over 250 Francophone stakeholders and participants in 16 sites across the province; - Initial dialogue with Indigenous communities and partners; - Ongoing input from over 80 health sector leaders participating in six Premier's Council Sub-Committees; and, Over 500 written survey responses and emails. **What was the Response?** - Many Ontarians read the first report and responded by sharing personal experiences using: hallwayhealthcare\@ontario.ca. - Over 50 submissions from health care professionals or associations, and many met with us, providing research and discussion - Feedback received through these engagement activities was reviewed and considered in the development of this report. **Themes were Similar Throughout the Province** - Publicly available services that are easy to understand and access. - Patients want more options and flexibility in how they access health care, and they want to know that the system is supporting them throughout the process, ensuring they are engaged and empowered throughout their health care journey. - Ontarians would feel more confident in a health care system knowing their primary care provider was acting as a quarterback for them: championing their needs, guiding them through a complex system and providing leadership they can count on. **What Partnerships Patients Would Like to See** - Patients want to see closer partnerships between housing, social services, and health care. - Patients want to have more choices in how they connect with their care providers -- broad support for improving options for connecting with care while maintaining patient choice. **Feelings of Patients and their Families** - Research from The Change Foundation on the experience of caregivers in Ontario has uncovered concerns with accessing and navigating services across the province - Family caregivers are frustrated that health care providers do not always communicate with one another, resulting in caregivers having to re-tell a patient's story, and spend unnecessary time clarifying information. - Caregivers and health care providers are both looking for one clear point of contact that ensures patients' needs are met at every segment of their health care journey. **Improved Scheduling** - Caregivers would like improved scheduling and timing of appointments. - A report from 2016, "Ontario's Family Caregivers/The Caring Experience", addressed that "primary care appointments and home care visits can cause significant stress for a caregiver who must shift their personal commitments to accommodate a disjointed schedule of health care appointments". - For family caregivers supporting patients with dementia, extended hours for respite or additional access to support overnight would help make it possible to keep their family member at home longer rather than moving them to a long-term care home. - These examples point to areas where the health care system can redesign and re orient services to better support the day-to-day realities facing patients, their families, and caregivers. **Patients Want to be Partners in Their Health Care** - Patients view health care as a shared responsibility between patients and providers. - Patients and providers would both prefer a health care system where health information was easily shared across providers working in different parts of the system, and more readily available to patients. **Patient Experience Feedback** - The health care system should deliver a better patient experience, ensuring patients" are always treated with respect and dignity. - The Premier's Council received strong feedback throughout the province about the need to create a better experience for patients and families accessing care. - If the patient is at the centre of the health care system, certain decisions should change to improve interactions and information sharing between patients and providers. - For example, patients want information about publicly-funded care options, and conversations with providers that are respectful, proactive and easy to understand. - Patients should be confident that the system is paying attention to their unique health care needs and should be comfortable asking questions at any time along their health care journey. **Build on Established Partnerships** - The public strongly believes that existing partnerships throughout the health care system should be maintained and protected. - The Premier's Council heard clearly that patients and providers like the care that's currently delivered through integrated primary care teams, and they appreciate creative solutions and partnerships that already exist between care settings in their local communities. - Patients believe that when they receive care, it is generally of high quality. - Access remains a challenge. Often, access to care is delayed and the system continues to struggle with transitions in care due to a lack of system-wide integration. **Digital Health Services -- The Current System** - Telemedicine has been a critical tool in improving access to care in remote, rural, Francophone, and Indigenous communities that do not always have sufficient in-person capacity to meet local health care needs. - Remote patient monitoring and digital self-care enables a small number of providers to "coach" many patients. The province should continue to build on these successes by ensuring technology continues to supplement health care resources**.** **Hoping for an Integrated Health Care System** - Ontario Health Agency and Ontario Health Teams are integral in creating an integrated health care system. - An integrated health care system will improve access to services in the health care system, will have a positive impact on wait times, and will assist in solving hallway health care". - When teams of health professionals work together to serve the same group of people, and when they are supported by common resources, performance expectations and planning tools at the provincial level, patients will receive coordinated and integrated health care. - In an integrated health care system, resources would follow the patient. - This will create an emphasis on prevention and well-being, which would help divert patients from hospital-level care or from seeking care from the emergency department. - Efficient processes, such as centralized intake and shared electronic medical records, are key features of a well-integrated health care system because they are tools designed to improve the allocation of services and connect patients with the right level of care at the most appropriate time. **Ontario's Patient Engagement Framework** Creating a strong culture of patient engagement to support high quality health care Source: **\ ** **Framework Overview** - To begin, the framework starts with its purpose, or strategic goal: ***To create a strong culture for patient, caregiver and public engagement in Ontario to support health care quality.*** - It highlights the core principles for success partnership, transparency, learning, responsiveness, empowerment, and respect. - Engagement should be balanced across each domain of the health system -- when patients are making personal health care decisions with their health care professionals; when organizations are designing new programs and making improvements to existing services; and when it comes to policy, strategy and governance. - It highlights the spectrum of engagement approaches -- from sharing, to consulting, to deliberating, to collaborating-- and recognizes that these approaches should be customized depending on the engagement goals and setting. - It highlights the enablers that make high quality engagement possible -- a dedication to continuous quality improvement; the provision of easy-to-understand information; a commitment to engaging all, including those from under-served populations; and rigorous research and evaluation to constantly learn from our efforts. - The framework is designed to inspire action towards the goal -- ***a strong culture of engagement that drives continuously towards better care and better health for Ontarians.*** **The Six Guiding Principles of Engagement** 1. **Partnership**-- Meaningful patient engagement requires authentic, timely and mutually beneficial relationships forged between patients, their family members, other informal caregivers, health professionals and the organizations they work with. 2. **Learning**-- All participants in patient engagement should expect to learn -- about each other's perspectives and experiences, about facts about the issue at hand, and about how things may improve and be better. 3. **Empowerment**-- Patients and their caregivers need to feel empowered to openly express their needs, perspectives and concerns without fear of reprisal, and to make informed decisions with confidence. 4. **Transparency**-- Transparency means that health care professionals and organizations are honest about their apprehensions, resource limitations, and knowledge gaps when it comes to engaging with patients and caregivers. 5. **Responsiveness**-- Being responsive means that health care professionals and organizations act upon the voices of patients, their caregivers and the general public in ways that demonstrate the positive impact of this input. 6. **Respect**-- Health care professionals and organizations demonstrate respect for their patient and caregiver partners by actively showing signs of appreciation for their time, ideas, lived experiences, various worldviews and cultural locations. **Domains for Patient Engagement**  **Personal Care and Health Decisions (Domain A)** - Health care professionals' partner with patients and their caregivers in processes of shared decision-making and care. - For example, effective engagement in this domain includes the ways patients, their caregivers, physicians, nurses and allied health professionals' partner to ensure care plans best reflect a patient's needs, wants, and circumstances. - Includes providing support for patients and caregivers to be effective members of a care team, by giving them education and supportive resources. - The result of health care professionals effectively engaging patients in their personal care and health decisions are improved and more trusting relationships, increased patient activation and capacity to manage health conditions, adherence to a care plan, and ultimately better health outcomes. **Program and Service Design (Domain B)** - Health organizations initiate engagement activities that invite patient and caregiver input for the purpose of improving specific health programs, services, or other organization-wide projects such as quality and safety improvement initiatives. - Often a specific health care unit, program, project team or working group within the organization that undertakes patient engagement in this domain. For example, a fracture clinic within a community hospital may wish to partner with patients and their caregivers to choose a new layout and seats for their waiting room. - Engaging patients is an important way for organizations to develop new programs and services, and to determine whether existing programs or services are meeting the needs of the patient and caregiver populations they serve. **Policy, Strategy, and Governance** - Health organizations and government collaborating with patients and caregivers to identify, and develop more accountable health priorities, policies, and governance models. - Policy priorities and resource allocation reflect the values and priorities of past, current, and future patients. - Patient engagement is a key way that health organizations, health associations, provincial government agencies, and policy-makers can demonstrate accountability, promote transparency, and respond to patient needs. - For health care organizations, examples of engagement in this domain include appointing patient representatives to a board or to the hiring committee for the CEO; hosting a public meeting to engage patients in the development of a new strategic plan; or striking a patients' panel to provide advice on an important strategic decision. **Approaches to Patient Engagement** The key to integrated and successful patient engagement is matching the right approach, to the right situation, at the right time -- and often using more than one approach to achieve the intended goal. **Share** Methods that health organizations provide information that is easy for patients and their caregivers to... - Get - understand and act upon, - support personal care decisions, - support engagement about a program, service, policy or decision. **Consult** The method that health professionals, organizations and system planners use to obtain feedback from patients and caregivers on a health issue, policy, or decision that needs to be made. **Deliberate** Patients, caregivers, health professionals, planners, and organizations problem-solve and apply solutions together to a health issue, policy, or decision. **Collaborate** Ways patients and their caregivers are engaged to discuss a health issue, policy, or decision, and begin to explore solutions with health care professionals. **Enablers of Patient Engagement** - Recent research has highlighted that "engagement-capable environments" require foundational ethics and values, knowledge and understanding, infrastructure, and resource support to develop successful and integrated patient engagement activities. - These enablers support meaningful patient engagement and health system change by integrating patient perspectives into quality improvement efforts.