5/1/2019 PARTNERING WITH PATIENTS and FAMILIES: STRATEGIES TO - - PDF document

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PARTNERING WITH PATIENTS and FAMILIES: STRATEGIES TO ENHANCE QUALITY and SAFETY

May 8, 2019 Kristen Marino and Frann Otte

This material was prepared by Telligen, the Medicare Quality Innovation Network Quality Improvement Organization, under contract with the Centers for Medica re & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. This material is for informational purposes only and does not constitute medical advice; it is not intended to be a substitute for professional medical advice, diagnosis

• r treatment. 11SOW-QIN-B1-04/18/19-3374

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Telligen QIN-QIO

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Objectives

• Discuss strategies related to welcoming and supporting patient/family

partnerships and participation at your organization.

• Review and discuss best practices for partnering with patients/families

with your team in healthcare redesign and improvements.

• Identify various approaches to patient/family engagement.
• Describe at what capacity your organization can integrate

patients/families voice.

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PFA Definition

• Patient and Family Advisors (PFA) serve in a variety of healthcare

settings; sharing their personal stories to represent all patients and families in providing an educated perspective of care by bringing authenticity, empowerment, respect and inspiration to the design and delivery of healthcare systems. PFA roles include partner, educator, speaker, listener, advocate, collaborator and leader; ensuring the focus

• f healthcare is centered on the patient and the family.

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Why is PFE Important?

• It is the right thing to do
• Patients and families have special knowledge to inform improvement
• Patients and families bring energy, passion, commitment, and sustainability to the

movement

• Patient voice

– At the table, not on the table – Practicality of their input

• Rewarding for all
• Can enhance clinician experience, restore joy in work, and result in improved

efficiency and higher quality care

• Great strategy for practice transformation

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Why is PFE Important?-continued

• Better outcomes
• Alignment with volume to value transformation efforts (improvement activity)
• Supports the PCMH fundamentals
• Improvements in patient satisfaction, likeliness to return and willingness to

recommend

• Differentiation from practices not patient-centered
• Improved market share, image and preference
• Potential reduction in malpractice claims
• Low cost and low tech to implement

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What Patient and Family Engagement is NOT

• It’s not

– Compliance with your personal health – A complaint line – A way to get attention, medication or “free” services from your doctor’s office – Judgement on staff, physicians or practice – “The advisor way or the highway” – final say

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Alignment with CMS Goals

1. Actively encourage person and family engagement along the continuum of care within the broader context of health and well-being and in the communities in which we live. 2. Promote tools and strategies that reflect person and/or family values and preferences and enable us to actively engage in directing and self-managing care 3. Create an environment where persons and their families work in partnership with healthcare providers. 4. Improve experience of care for persons, caregivers, and families by developing criteria for identifying PFE best practices and spreading across the USA

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Quality Payment Program – MIPS PFE Activities

• Quality Measures

– 45% of Final Score – 1 Patient Engagement Experience High Priority Measures

• CAHPS for MIPS Clinician/Group Survey
• Improvement Activities

– 15% of Final Score – Full credit Patient-Centered Medical Home Recognized

• Transforming Care Practice Initiative – TCPI

– Practice can demonstrate that it encourages patients and families to collaborate in goal setting, decision making, and self-management. – Practice has a formal approach to obtaining patient and family feedback and incorporating this into the QI system, as well as the strategic and operational decisions made by the practice.

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Patient-Centered Medical Home – Practice Transformation

• PCMH Foundation/Concepts

– Comprehensive Care, Patient-Centered, Coordinated Care, Accessibility, Quality and Safety – Aligns with other models: Team-Based Care, Human-Centered Design, Chronic Care Management, TCPI, QPP

• Patient and Family Engagement -

– Patients actively participate in decision-making and feedback is sought to ensure patients’ expectations are being met. – Patients and families participate in quality improvement activities at the practice level. – Collaboration and development of partnerships with patients

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Approaches to Patient and Family Engagement

Source: Carman KL, Dardess P, Maureer M. Patient and family engagement a framework for understanding the elements and developing interventions and policies. Health Aff (Millwood) 2013.32(2)223-231. (AMA publication)

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Approaches to Patient and Family Engagement

• Care Coordination

– Involving patients/families in their own care – Development of a care plan, shared-decision making

• Patient Feedback

– Surveys – Patient Feedback through suggestion box, follow up calls, interviews

• Patient and Family Advisory Councils

– Practice and/or organization-wide

• Involvement in administration/daily decision-making

– Patient attends staff meetings, quality improvement meetings, leadership and/or board meetings. – Provide feedback as a representative of your practice.

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Polling Question

Select all that apply

• How does your organization currently engage patients & families?

– Practice satisfaction survey – Physician compare – Patient serve on governing body – PFAC is in our organization/health system – None of the above

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Knoxville’s Journey to PFAC

• Ginny Krichau

– Director of Patient Experience, Knoxville Hospital & Clinics

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Ask Yourself

• What is the current state of Patient & Family Engagement in my
• rganization?
• What are you most excited to try to increase PFE footprint?

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What is a PFAC

• Structured program
• Works in partnership with care team to continuously improve overall quality,

safety, and patient experience

• Ensures that patient, family and community perspectives and needs are

represented in business development & program implementation

• Offers insightful contributions to decision-making
• Optimizes materials & strategies that advances PFE, supports patient self-

management, and increases satisfaction

• Supports care team & staff morale by contributing to joy & meaning that

workers experience when patients feel respected and have optimal results

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Steps to Forming a PFAC

• 1. Develop business case for PFAC and ensure leadership support

– Determine readiness – Staff understand the value of patient family engagement – Staff express interest in supporting the development of a PFAC – Designate a CHAMPION

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Steps to Forming a PFAC

• 2. Create a planning committee

– Approved resources & given team accountability – Multidisciplinary (physician, RN, front desk, MA, administrative staff)

Include skeptics

– Decision Separate PFAC Incorporate into existing committee or governing board Project work – Identify potential advisors and plan for interview and selection

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Steps to Forming a PFAC

• 3. Develop action plan, charter, vision statement, and budget

– Action plan include goals, measures of success, and timeline – Charter includes clear purpose, ground rules for confidentiality, meeting attendance, term limits, etc. – Areas where PFAC may advise your practice Patient experience Patient safety Policy and program development Quality improvement Health care delivery re/design Patient education Patient/family communications Marketing Facility design, supplies, and equipment planning

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Components of Charter

• PFAC Name
• Scope: The PFAC will represent our patients, their families and our staff from X clinic.
• Vision Statement
• Membership –

– Terms and General – Members – Expectations – Governance – Structure and Reporting – Additional Projects/Committee Work

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Sample Vision Statements

• With a collaborative approach between care team and patients, X aims to create a change

environment with the voice of the patient and family members as integral to the process of improving the quality and safety of care that we deliver.

• The Patient and Family Advisory Council will represent our patients, their families and our staff from
• X. We strive to deliver a meaningful patient experience by providing compassionate, individualized

and high quality service through the partnership of our patients, their families and our staff.

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Steps to Forming a PFAC

• 4. Invite, interview and select advisors

– Suitability See beyond their personal experience; no hidden agenda Respectful listeners Past experience serving on a team – Representative of your patient population – diagnosis, payer source, age, gender, ethnicity, etc. – Advisor aware of expectations – Interview – Consents – HIPAA, confidentiality, security, photo

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Sample Flyer & Application

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Core Competencies and 9 Ingredients of Partnerships

Source: PFCCpartners

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Steps to Forming a PFAC

• 5. Launch PFAC and support members in their work as advisors

– What interests them in being an advisor? Share a healthcare story – Orientation - Understand organizations’ mission and goals and PFAC details – Meeting frequency – Agenda – Role of organization’s leaders Champion – Confidentiality

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Steps to Forming a PFAC-cont.

• 6. Initiate improvement projects in partnership with PFAC members

– Project important to patients and practice – Project of value->confidence and trust – Data

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Steps to Forming a PFAC-cont.

• 7. Track results of the work

– Accomplishments – Value of PFAC

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Steps to Forming a PFAC-cont.

• 8. Celebrate PFAC successes

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Questions

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Thank you for your participation!

• Kristen Marino, Senior Quality Improvement Facilitator

Kristen.marino@area-d.hcqis.org

• Frann Otte, Program Specialist

Frann.otte@area-d.hcqis.org Telligen QIN-QIO website: www.telligenqinqio.org

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Resources

• CMS Person & Family Engagement Strategy: https://www.cms.gov/Medicare/Quality-Initiatives-

Patient-Assessment-Instruments/QualityInitiativesGenInfo/Downloads/Person-and-Family- Engagement-Strategy-Summary.pdf

• CMS Partnership for Patients: https://partnershipforpatients.cms.gov/
• AHRQ Engaging Patients and Families in Their Health Care:

https://www.ahrq.gov/professionals/quality-patient-safety/patient-family-engagement/index.html

• AMA Steps Forward: https://edhub.ama-assn.org/steps-forward/module/2702594
• PFCCpartners: https://pfccpartners.com/
• Institute for Patient- and Family-Centered Care: www.ipfcc.org
• Telligen BFAC page: https://www.telligenqinqio.com/our-work/beneficiary-and-family-advisory-

council/