Patient and Family Centered Care - Day 5 PDF

**DAY 5 - PATIENT AND FAMILY CENTERED CARE** **Biases and Tools** ***Barriers to Patient and Family Centred Care*** **Staffing Constraints and Reduced Levels of Staff Experience** ♣ Managers stated that staffing issues negatively impacted Patient and Family-Centred Care (PFCC). ♣ A common issue...

**DAY 5 - PATIENT AND FAMILY CENTERED CARE** **Biases and Tools** ***Barriers to Patient and Family Centred Care*** **Staffing Constraints and Reduced Levels of Staff Experience** ♣ Managers stated that staffing issues negatively impacted Patient and Family-Centred Care (PFCC). ♣ A common issue was that units were often below their fulltime-equivalent staffing numbers due to recruitment delays and staff leave. ♣ A lack of management staff to support clinicians was identified as limiting time for PFCC. ♣ Another reason for the negative impact on PFCC was that staff leaves were often not backfilled. ♣ Unfortunately, reduced staffing was also identified as demotivating managers and staff. ♣ Even when a leave was back-filled by casual staff, there was an impact on PFCC because "often these staff did not have the same level of context-specific experiential knowledge as permanent staff". **High Staff Workloads and Time Pressures** Those in health care management often state "high workloads and time pressures as barriers to PFCC". **Physical Resource and Environment Constraints** ♣ Physical resource and environment constraints refers to "a lack of space available for private conversations with patients and families and a lack of equipment such as beds, computers and comfortable chairs". ♣ Budgetary constraints were stated as a factor. **Unsupportive Staff Attitudes** ♣ Staff were not supportive of PFCC.\ ♣ Behaviours identified are: --- Cynical views toward PFCC --- Inflexible decision-making --- Little motivation for change --- Lack of engagement with quality improvement **Guiding Principles to Achieve Patient and Family-Centred Care** 1\. Greet and connect 2\. Introduce computer as tool 3\. Reassure the person/family of privacy and confidentiality 4\. Connect the person/family to their electronic medical record 5\. Invite the person/family to view information in the screen ***Enablers of Patient and Family Centred Care*** **Leadership Focus on PFCC** ♣ Importance of leadership for developing a PFCC culture ♣ Focus on People Leaders to lead PFCC amongst their teams.\ ♣ Leadership facilitates employee engagement and buy-in into PFCC. --- Supporting positive staff relations and communicating clear expectations for PFCC **Staff Satisfaction and Positive Staff Relations\ **♣ Staff satisfaction and good working relations between and within teams are important for enabling PFCC. ♣ Staff well-being programs enable PFCC through facilitating staff resilience and promoting job satisfaction. **Formal Structures and Processes to Support PFCC** ♣ Formal processes and structures within an organization enable PFCC. ♣ Infrastructure supports communication between hospital staff and patients and/or patient families. **Staff Cultural Diversity** ♣ The workforce is made up of staff from a range of different cultural backgrounds and this diversity enables PFCC through promoting respect for patient and family cultural considerations. ♣ However, there is an alternate view to consider... --- This diversity can also act as a barrier to PFCC by making communication difficult. **Health Professional Values and Role Expectations** **Clinical Managers**: ♣ Describe PFCC as ***core business*** and something that they ***must do.*** ♣ Identify professional values and expectations of health professionals as influential enablers of PFCC. Respect Communication Partnership **Creating a Collaborative Care Plan** ♣ Effective problem-solving emphasizes patient-centredness and avoids the clinician imposing goals and plans on the patient. ♣ ***Building a collaborative care plan*** presents the steps in goal setting and action plan development with tips, suggested questions, and examples of patient responses. ♣ A flexible approach is needed based on the clinician\'s experience, the nature of the goal, and the patient\'s pre-existing problem-solving skills. **Nine Steps to Building a Collaborative Care Plan** 1\. ***Help the Patient Focus on a Specific Goal*** - tip - Make it the patient\'s goal more than yours. - script - *Can you think of a goal to improve your health?* - example - We want to help you. Weight control. 2\. ***Brainstorm Activities to Accomplish the Goal*** - tip - Ask the patient to list some possible ways to achieve the goal. Hold back sharing your suggestions and let the patient identify ideas first. - script - *What are some different ways you can accomplish your goal? List anything that comes to mind.* - Example - Consult a nutritionist; exercise more; snack less; eat less chocolate; use smaller portions. 3\. ***Choose an Activity*** - tip - Help the patient choose one activity. Too many choices may be overwhelming and less feasible, increasing the risk of failure. - script - *These are all good ideas, but I suggest you start with one activity.* - example - Exercise. 4***. Focus the Activity*** - tip - The more specific the activity, the more likely it will be accomplished. A second round of brainstorming may help determine the activity most likely to be adopted. - script - *Can you think of one kind of exercise that you are most likely to accomplish?* - example - Walking. 5\. ***Identify How Often or How Long the Activity will Occur*** - tip - Help the patient be specific but realistic. If they are too ambitious, counsel the patient to set a less ambitious goal at the outset and then increase frequency or duration. - script *- How often will you exercise?* - example - Three times a week for 15 minutes 6\. ***Identify When the Activity Will Take Place*** - tip - The patient may need a little time to ponder when it is feasible to do the activity. - script - *When would you like to take a walk?* - example - Mondays and Tuesdays during my lunch hour and on Saturday mornings. 7\. ***Consider Barriers*** - tip - Identifying barriers helps the patient refine the plan, increasing feasibility and probability for success. - script - *What barriers can you foresee that might prevent you from reaching your goal?* - example - I might not walk if it is raining or if I feel lonely and want company. 8\. ***Assess Confidence on a Scale of 1 (Low) to 10 (High)*** - tip - Rating one\'s confidence helps identify social or psychological barriers. Once named, these barriers may have less power. - script - *How would you rate your confidence if 1 is the lowest chance of success and 10 is a sure thing?* - example - I think my confidence is a 7. 9\. ***Identify Ways to Increase (or Sustain) Confidence*** - tip - Having patients think about ways to increase confidence helps reduce the influence of all barriers. - script - *What can you do to increase your confidence? How can we help you?* - example Maybe it would be helpful to talk about this with my husband and coworkers. They could walk with me sometimes. **A Collaborative Care Plan Does Not End...** ♣ Once the care plan is collaboratively created, it needs to be printed and given to the patient. ♣ It is imperative that follow-up appointments be made. ♣ The regular appointments impact the success of the patient's plan. **Patient Experience Surveys** ♣ Patient experience surveys are the best method of gathering feedback when you want to know the views of many people. ♣ The purpose is to study trends regarding specific experiences. ♣ They show if a problem happens and who is experiencing it. ♣ Questions should be created with patients before they are used. ♣ Surveys can be carried out by mail, telephone, or electronically. **An Example of National Patient Surveys** ♣ Health care organizations in England and Scotland are required to conduct surveys through the mail. The survey focuses on patients' views of their recent health care experience. ♣ These large surveys provide a detailed picture of patients' experiences. ♣ Regularly repeating the same type of survey enables changes over time to be monitored and performance compared. ♣ National surveys are valuable because they allow you to compare results locally against the performance of similar organizations. ♣ The results also enable regulators and policy makers to examine individual organizations and overall performance across the country. **Tailored Surveys** *Tailored surveys enable specific areas to be examined in greater detail.* Examples are: ♣ **Community services** -- such as physiotherapy, community nursing ♣ **Condition specific** -- coronary heart disease, stroke care, cancer ♣ **Care settings** -- emergency, inpatient, outpatient, ambulance care ♣ **Patient specific** -- including young patients and maternity **Alternatives to Paper-Based Surveys** *There are several ways of conducting surveys, depending on audience and location:* ♣ **Online surveys** -- Recipients respond to the questionnaire from a personal computer and submit their responses electronically. ♣ **Telephone surveys** -- Completed with a trained researcher taking a participant through each question and recording answers on their behalf. Issues can be explored in greater depth as they arise in conversation. ♣ **Hand-held electronic** devices -- Can be used for short, tailored surveys in a wide variety of situations such as onwards, in clinics or following consultations. **Population Surveys** ♣ Surveys of the local population can provide a detailed picture of variations in the views and experiences of local people from different geographical areas and communities. ♣ They can be designed to focus on specific issues of local importance, for example a proposed service redesign, or to obtain more general views on community priorities. **The Primary Goal** ♣ The primary goal in engaging patients in quality committees is ***to increase the chance that the care delivered at the front line is patient-centred***. ♣ Patient representatives (champions, advisors or partners) possess a valuable and unique perspective which represents the sum of their personal experience as a user of the health care system, as a member of a patient group, and as a member of the community. **What do Patients Bring to the Committee?** ♣ Identify gaps in service. ♣ Identify imbalances of power and safety in the health care system. ♣ Identify gaps in knowledge and evidence that could lead to new research and initiatives. ♣ Participate in discussions and decisions about programs, policies, practices.\ ♣ Identify and evaluate outcomes that matter to the patient, family, and community. ♣ Contribute to staff and organizational learning, growth, and development. **Committees with Patients are Supported** ♣ Organizations, regions, and systems are encouraged to set up patient groups where clients, residents, patients, families, and citizens with a desire to make care safer can become involved. ♣ Members are provided with orientation, training, and support throughout their journey as partners in patient safety and quality improvement efforts. **Patients and Families Should...** ♣ Reflect on their readiness to be on this committee as patient safety incidents can trigger strong emotions. ♣ Ensure questions are answered to ensure that as a member, you understand why and how you contribute. ♣ Request that there is at least one other patient representative on the committee. ♣ Participate in training and orientation before participating in patient safety and quality committees. ♣ Ensure you understand the confidentiality and privacy aspects related to this work. ♣ Ask questions and provide feedback throughout the collaboration. ♣ Be polite and assertive when providing on the patient perspective. ♣ Communicate to the chair of the committee if your role is different than what you expected. ♣ Provide feedback to ensure your experience and the experience of other advisors is the best it can be. **Providers and Organizations Should...** ♣ Recruit experienced patients. ♣ Begin by having patients join a task force, a smaller project, or just observe, if the committee has concerns. ♣ Offer an opportunity for the patients and committee chair to meet before they make the decision to join a patient safety committee. ♣ Have the committee chair meet with patients prior to their participation to welcome and orient them to the committee members and the work, and to be their contact person. ♣ Have a staff liaison meet with the committee ahead of time to explain why and how the patient representatives were selected and oriented, and ways they can contribute. ♣ Have the committee chair formally introduce the patients and encourage dialogue and collaboration throughout. ♣ Identify and offer committee members and patients opportunities to share updates about their work and its impact on others. **The Importance of This Partnership** ♣ A successful partnership results in more opportunities for patients to partner either in other patient safety areas or at higher organizational levels. ♣ Strong leadership together with patient/family engagement is an integral part in sustainable change. **What is a Patient Advisory Council?** "A patient advisory council (PAC), also known as a 'patient advisory board' or a 'patient and family advisory council,' is a representative group of patients and caregivers who meet regularly with clinic staff to help improve clinic performance". **What is the Evidence Saying about Patient Advisory Councils?** ♣ PACs are new to health care; therefore, there is not a lot of evidence to support their existence. ♣ Existing evidence demonstrates that PACs are positively related to patient experience. ♣ **An Example:** - One study showed that clinics where patients and providers jointly set clinic priorities were more likely to follow the core tenets of the chronic care model and the PCMH model than clinics where providers alone chose the priorities. - In interviews, front-line staff involved in PCMH development often name patient involvement in advisory councils as one of the key factors to successfully implementing the PCMH model. - Inpatient research has been more robust, with patient involvement credited with improving rates of both readmission for heart failure and hand washing by staff. **Examples of Successful Projects Led by PAC Input** ♣ Improved patient communication - Designing welcome packages ♣ Patient Experience of Care - Designing patient satisfaction surveys ♣ Practice Improvement Initiatives - Assisting in improving clinic and phone wait times ♣ Improvements to clinic space - Performing a waiting room walk-through to identify needed improvements ♣ Quality Improvement - Recommending plan-do-study-act projects **A Concrete Example...** *Challenge* ♣ Clinic leaders have decided to double the size of the clinic, which is in a dense urban area with high growth potential. ♣ They are looking for the best way to publicize this decision to their patients. *Solution* ♣ The medical director presented the expansion plan to the PAC members, most of whom were surprised, despite existing publicity efforts. ♣ The PAC recommended a multi prong approach using email, the online patient portal, new signage, and advertisements in local publications. **How to Build a PAC**  1\. ***Engaged Clinic Leadership*** ♣Clinic leadership must be dedicated to supporting the time staff and patients invest in the PAC, as well as to respecting their input. ♣It is beneficial to have an assigned nonclinical staff champion for sustainability. 2\. ***Diverse Recruitment*** ♣Ensures the council is representative ♣Ways to recruit: "clinics can ask providers and staff for nominations; mention the council in newsletters, flyers, and clinic signs; and notify patients of the opportunity through recruitment emails and letters". ♣The average PAC should include between eight and 12 patients who will serve on the council for six months to one year. 3\. ***Adequate Funding*** ♣Staff members working with the council usually have dedicated time for PAC work. ♣The patient members are often volunteers, although it is appropriate to provide them a financial reward such as dinner or a gift card to show respect for their time. ♣Funding can also be used to decrease the barriers that could prevent some patient members from participating (lack of transportation, childcare, interpreters). ♣Meeting refreshments or taxi vouchers can be helpful. 4\. ***Mission Statement*** ♣PAC members should create a mission statement and vision. 5\. Outside Resources ♣Accessing outside resources can also help practices establish effective PACs. ♣The *Institute for Patient and Family-CentredCare* and the *Patient-CentredPrimary Care Collaborative* support patient engagement and can suggest how to recruit, sustain, and renew PACs.