PATIENT- AND FAMILY-CENTERED CARE: Partnerships for Safety & Quality All Employee Learning Modules

Our Time Together ▼ Review your understanding of patient- and family- centered care and how it complements the VA’s strategic goals and priorities. ▼ Review the progress that has been made throughout VISN 7 in the last two years. ▼ Explore ways that everyone can actively contribute as team members to support Veterans and their families as essential partners in their health care.

You Should Be Able To… ▼ Restate/define the core concepts of patient- and family- centered care. ▼ Connect VISN 7’s goals to patient- and family-centered best practices. ▼ Describe how patient- and family-centered care is being implemented in the workplace. ▼ Describe patient- and family-centered behaviors and their impact on the Veteran’s and family experience of care. ▼ Identify ways to positively influence Veterans’ and families’ experience of care using patient- and family- centered communication skills and strategies.

VISN 7 Aligning With VA Priorities ▼ VHA Mission Statement ▼ VHA Vision ▼ VHA Office of Patient-Centered Care–2010 ▼ VHA national patient-centered pilot of four Field-based Implementation Teams (FIT): Birmingham VAMC

Honor America's Veterans by providing exceptional health care that improves their health and well-being. Veterans Health Administration (VHA) Mission Statement

Veterans Health Administration (VHA) Mission Statement Veterans Health Administration (VHA) Vision Statement VHA will continue to be the benchmark of excellence and value in health care and benefits by providing exemplary services that are both patient-centered and evidence-based.

PROMISE ONE:To provide care, second to none– the best care anywhere! PROMISE TWO:To maintain and expand health services wherever possible. PROMISE THREE:To ensure that every Veteran will be personally satisfied with the care that they receive based on the highest quality of outcomes. VISN 7 Three Promises to Veterans

Office of Patient Centered Care and Cultural Transformation

Office of Patient-Centered Care and Cultural Transformation ▼ Contract to implement PCC nationally awarded to Planetree. ▼ New Director – Tracy Gaudet M.D., formerly the Director for the Duke Center for Integrated Medicine.

FY11 VHA Patient-Centered Care Implementation Plan ▼ Establish Regional Centers of Innovations (COI) Four Regional Host sites for Field-based Implementation Teams Region 1 – West: Greater Los Angeles HCS (VISN 22) Region 2 – Central: North Texas HCS (VISN 17) Region 3 – South: Birmingham VAMC (VISN 7) Region 4 – Northeast: New Jersey HCS (VISN 3) Washington DCVAMC selected as 5 th COI ▼ COIs selected based on their advanced PCC practices and culture

FY11 VHA Patient-Centered Care Implementation Plan ▼ Recruit and hire Field-based Implementation Team (FIT) members, responsible for PCC implementation in respective region ▼ Conduct intense 10-week PCC Certification training of FIT Consultants ▼ Determine staging of implementation rollout of remaining VISNs ▼ Begin PCC implementation rollout simultaneously within each region.

The VA’s 12 Patient Centered Care Principles

The VA’s 12 Principles Principle 1.Honor the Veteran's expectation of safe, high quality, and accessible care. Principle 2.Enhance the quality of human interactions and therapeutic alliances. Principle 3.Solicit and respect the Veteran's values, preferences, and needs. Principle 4.Systematize the coordination, continuity, and integration of care

The VA’s 12 Principles Principle 5.Empower Veterans through information and education. Principle 6.Incorporate the nutritional, cultural, and nurturing aspects of food. Principle 7.Provide for physical comfort, and management of pain. Principle 8.Ensure emotional and spiritual support.

The VA’s 12 Principles Principle 9.Encourage involvement of family and friends. Principle 10.Provide an architectural layout and design conducive to health and healing. Principle 11.Introduce creative arts into the healing environment. Principle 12.Support and sustain an engaged workforce as key to providing patient-centered care.

What Does It Mean To Be Patient- And Family-Centered? Actively striving to see the experience of care through the patient’s eyes so that delivery of health care is centered around the choices and priorities of Veterans and their families.

A fully engaged partnership of Veteran, family, and health care team. Established through continuous healing relationships. Provided in optimal healing environments. In order to improve health outcomes and the Veteran’s experience of care. Patient- and Family-Centered Experience of Care Goals in the Veterans Health Administration

Patient- and Family-Centered Care Core Concepts ▼ People are treated with respect and dignity. ▼ Health care providers communicate and share complete and unbiased information with patients and families in ways that are affirming and useful. ▼ Individuals and families build on their strengths through participation in experiences that enhance control and independence. ▼ Collaboration among patients, families, and providers occurs in policy and program development and professional education, as well as in the delivery of care.

A. A fully engaged partnership of Veteran, family, and health care team. B. Established through continuous healing relationships. C. Provided in optimal healing environments. D. In order to improve health outcomes and the Veteran's experience of care. Patient- and Family- Centered Care Core Concepts A.People are treated with respect and dignity. B.Health care providers communicate and share complete and unbiased information with patients and families in ways that are affirming and useful. C.Individuals and families build on their strengths through participation in experiences that enhance control and independence. D.Collaboration among patients, families, and providers occurs in policy and program development and professional education, as well as in the delivery of care. VHA Patient- and Family-Centered Care

Patient–Family Story

Who is family?

“Families” – Broadly Defined The term “family” has many meanings and includes not only traditional bonds created by marriages and common ancestry, but also bonds created by close friendships, commitments, shared households, shared child- rearing responsibilities and romantic attachments. Hollywood, Florida Families are the patient’s primary support persons…the individuals on whom they rely for support in difficult situations…relatives, friends, neighbors…

Who is Your “Family?”

Why Patient- and Family-Centered Care? Families–or the Veterans’ “supportive networks”–are often the constant across transitions and settings. Families are important to the patient’s health and wellbeing, and the management of chronic conditions. Identifying and building on strengths of patients and families is an essential aspect of professional practice in 21 st century health care.

Dignity and Respect Courtesy, Sensitivity, Empathy, and Compassion

Dignity and Respect

Dignity and Respect Courtesy, Sensitivity, Empathy, and Compassion ▼ Explain your roles in our care, as well as the role of the team. ▼ Be sensitive to the difficulties of our situation. ▼ Maintain concern for our privacy and personal dignity. ▼ Respond to our concerns. ▼ Accommodate our special needs.

Dignity and Respect Courtesy, Sensitivity, Empathy, and Compassion ▼ Include us in treatment decisions. ▼ Listen to and respect our perspectives and choices. ▼ Include our values, beliefs, and cultural backgrounds in care planning and decision- making. ▼ Address our emotional needs.

Listen To Me. Trust Me. Respect Me As A Partner In Care. Dignity and Respect Courtesy, Sensitivity, Empathy, and Compassion

Dignity and Respect in Action ▼ Interdisciplinary Team (IDT) Care Plans. ▼ Written in the first person “I-Care” format. ▼ Veteran Resident directed–choices for wake-up time, bathing, spiritual preferences in the community living centers.

Resident Care Plan ▼ Social History: I am Frankfort Fox. My friends call me “Frank”. I was born in Fargo, North Dakota way back in My parents were farmers. They raised my six older brothers and worked very hard. My parents valued a good education. All of us boys graduated from Washington High School in Fargo. Shortly after graduation, I hopped a train to Colorado. I got off in a town called Marble, way up in the Rockies…

Information Sharing

Providers communicate and share complete and unbiased information with patients and families, doing so in ways that are affirming and useful. Patients and families receive timely, complete, accurate information in order to effectively participate in care and decision-making.

Patient and Family Resources William Jennings Bryan Dorn VA Medical Center, Columbia, SC Information Sharing My Health E-Vet Carl Vinson VA Medical Center Dublin, GA

Participation

Nothing About Me… Without Me. Patients and families are encouraged and supported in participating in care and decision-making at the level they choose.

“The fundamental shift in my understanding has been how care changes when the plan is discussed and formulated WITH a family as opposed to simply being told TO a family.” Jeffrey Simmons, MD, The Hospitalist, 2006 Participation

▼ My Daily Plan–Charleston ▼ Next Steps in Care–Dublin ▼ Nursing Post-Discharge Call–Dublin ▼ Just Ask–Atlanta ▼ Family Initiated Rapid Response Team–Atlanta

Participation

Collaboration Veterans and Families as Advisors

Collaboration

Veteran and Family Advisors ▼ Policies and Procedures ▼ Patient Information and Education ▼ Facilities Design ▼ Systems and Processes ▼ New Initiatives and Programs ▼ Peer Support ▼ Staff Development and Education

Patient and Family Collaboration Staff Education Ralph H. Johnson Medical Center Charleston, SC My Health E-Vet New Programs and Services

▼ Female Veteran participating in design of Women’s Wellness project ▼ Veterans on special task forces, “Timely Reporting of Test Results” ▼ Parking Committee ▼ Environment of Care Rounds Committee ▼ Daily Plan Implementation Committee ▼ CLC Patient and Family Council ▼ Inpatient Pain Program ▼ Subcommittee on Admission and Discharge Process Improvement ▼ Patient Handbook Committee ▼ Pet Therapy Program ▼ Ethics Committee ▼ Visiting Hours Team ▼ My Health E-Vet Education Program Examples of Veteran and Family Advisor Involvement

Family–Veteran Centered Care Your Can Become a Veteran Family Advisor For Information Contact laDonna Golden At (334) x4439 Join the Family– We NEED everybody’s point of view

Misconceptions About Patient- and Family-Centered Care ▼ Patient- and family-centered care is not just “being nice.” ▼ Patient- and family-centered care does not mean the staff give up all decision-making to patients and families. ▼ Patient- and family-centered care does not mean there are “no boundaries.” ▼ Patient- and family-centered care does not mean that patients and their families may be rude or abusive to staff.

HIPAA—Complying with the Law and the Intent of the Law ▼ Health information can be disclosed for:  Treatment  Health care operations  Payment ▼ HIPAA acknowledges incidental disclosures may occur. This is not a HIPAA violation as long as you:  Take reasonable safeguards to protect privacy  Only disclose or use the minimum information necessary ▼ Information about HIPAA is shared with patients and families and asking for their cooperation in respecting the privacy of others, conveying that staff and physicians are making the same commitment…mutuality.

New Ways of Working

1. After reviewing patient and family satisfaction surveys, the cafeteria increases it options of food for differing cultures.

4. A multidisciplinary clinic committee purchases new patient and family cardiac health education models and materials to place in individual provider rooms and Patient Health Education Room.

5. In the Plan of Care/Next Step in Care each patient is provided current information on condition, treatment, and the next step in plan of care.

6. In nursing post-discharge calls patients are asked if their family members received information at discharge for continuing their care at home.

8. The staff link a patient, newly diagnosed with behavioral health concerns, to a peer mentor.

9. A nurse teaches a young Veteran and his the mother how to manipulate the prosthetic device after his amputation. They are provided a staff member name and phone number to call with specific questions, as well as a list of orthopaedic related community resources.

10. The cardiac critical care unit states that visitors may visit for 10 minutes each hour.

New Ways of Working

Patient- and Family-Centered Care What’s In It For Us?

What’s In It For Us?

Benefits to Staff ▼ Physicians, nurses, and other health professionals reconnect with their real purpose…taking caring of human beings, in this case Veterans and their families. ▼ Patient- and family-centered care approaches to care save time in the long run. ▼ Patient and family involvement and participation reduces risks for all. ▼ Patient- and family-centered care enhances teamwork, reduces conflict, and enhances safety.

Best Patient Satisfaction Outcomes FY2009 Trend continues in FY2010 – 3% above the Peer Index

What’s In It For Us?

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Where Are We On The Journey: Applying Best Practices In Your Workplace

Advancing the Practices of Patient- and Family-Centered Care in VISN 7

Emerging Best Practices at VISN 7 Facilities

How Can You Support Moving Forward in Patient- and Family- Centered Care? Recognize the Expectations Is it Patient- and Family-Centered… or NOT?

Veterans and Families Expect That You Will… ▼ Introduce yourself and describe your role on the care team. ▼ Connect and engage with them in a welcoming and positive way. ▼ Show respect and appreciation for the Veteran’s military service. ▼ Show empathy for the Veteran and family. ▼ Respect their social, cultural, and spiritual diversity and values.

Veterans and Families Expect That You Will… ▼ Respect their perspectives and include their needs and preferences in the plan of care. ▼ Identify the ways they prefer to learn and their priorities for education and information about their health, medications, and treatment choices. ▼ Actively promote their right to make choices about their plan of care.

Veterans and Families Expect That You Will… ▼ Work collaboratively with other staff and with Veterans and families to move toward a more patient- and family-centered environment of care. ▼ Continue learning about patient- and family-centered practices and developing collaboration and communication skills.

As Staff, How Do We Meet These Expectations?

Patient- and Family-Centered Care

You are at the reception desk of the specialty clinic. At 11:00 am you realize that three patients are still waiting to be seen in the clinic. You inquire and find out the doctor has been called away, but no one told the Veterans and their families in the waiting room. What should you do? a)Announce to the people in the waiting room that Dr. D. is gone and they will need to re-schedule through the automated system. b)Call each person up to the desk, apologize, and offer to re-schedule them. c)Tell the Clinic staff they have to tell the patients about the SNAFU. d)Apologize to the patients, offer them a choice to see another physician or re-schedule, and facilitate whichever option they choose.

A patient’s wife and two adult sons came with the patient to his appointment. They have now been told he has to be admitted immediately. However, they did not bring either a change of clothing or money for food. What should you do? a)Tell them there is nothing you can do. They need to go home, get money and clothing, and come back. b)Tell them to go to the Social Worker’s office. c)Express empathy and tell them where they can find an ATM and a computer to check for hotels. d)Take the family to the Social Work office, introduce them and their situation to the Social Worker; express confidence that the Social Worker can help them. Make sure they know how to contact you so you can follow up with the patient.

A patient’s wife waits for 6 hours outside the Intensive Care Unit (ICU) in a cramped vending machine area. The surgeon has told her the surgery was successful and the patient is recovering in the ICU. The ICU nurse sees the very anxious woman, who asks if she may come in to see her husband. If you were that nurse, what should you do? a)Explain that the ICU is not private and she will need to wait until the patient is moved to a room. b)Explain that visitors are an infection risk and she will needs to go to the official waiting room until called. c)Express empathy with her feelings and bring her in for a few minutes to hold her husband’s hand. d)Tell her you are sorry, but you really can’t break the rules.

The nurse comes into the room to educate the patient about chemotherapy medications. The patient’s husband, who is present, wants to wait until later in the day so their daughter can also be there. If you were the nurse, what should you do? a)Tell the husband that you will explain everything to him and when the daughter comes she can call you with questions. b)Find out when the daughter is coming; make a commitment to return then; or, if your shift is ending, bring in the oncoming nurse and explain the family’s request to her at the bedside. c)Express empathy with her feelings and encourage her to come and be at her husband's side for as long as she wishes. d)Review the basics of the information with the husband, give him a notepad to write down questions.

The wife of a Veteran with heart disease asks the clinic staff to print out her husband’s latest lab results and send them to their home. What should you do? a)Tell the wife that only the physician can share results and that the patient will have to call the doctor. b)Check the patient’s record for a consent/surrogate form; then print the results and send them. c)Tell the wife you will call the physician for the ok and then send the results to their home. d)Tell the wife you will call the physician for the ok but you can only send the results to the referring community clinic.

A Veteran with chronic obstructive pulmonary and heart disease is told that he must have several more tests at the VAMC. He lives in a community some hours away from the clinic. He asks if the tests could be scheduled at the same time so that he only has to make one trip. What should you tell him? a)Agree that it would be the best for him, but explain that the tests are in different departments and they schedule individually. b)Tell him only his community based outpatient clinic (CBOC) physician can make those arrangements. c)Offer to contact each department and make the arrangements for tests over two days so he can come and stay overnight. d)Call the various departments and make the arrangements before the patient returns home.

A Veteran is resting comfortably after a particularly difficult outpatient procedure. His wife is in the hallway, and has been told she cannot come into the small recovery room to be with him. When the physician comes to tell him the results, she follows the physician into the room. What should you do? a)Nothing. b)Apologize to the physician and ask the wife to leave the room. c)Ask the physician’s permission to allow her to stay. d)Introduce the wife to the physician and support her desire to be with her husband while the results are discussed.

The partner of a Veteran hospitalized for abdominal surgery wants to spend the night in the patient’s (private) room. Visiting hours are officially over at 8 pm. What should you do? a)Ask the patient if she wants her partner there, and if so, make sure there is a sleeper chair in the room and provide access. b)Tell the charge nurse to make the decision. c)Explain to the partner that visiting hours are over and there is nothing you can do. d)Check with the patient; if she wants her partner there, explain to the partner that she can stay but has to be out of the room before morning shift change.

A patient undergoing treatment for breast cancer refuses to eat, saying that the smell of food makes her sick. The physician’s orders are to make sure she gets adequate nutrition. What should you do? a)Ask the patient if there are some food options she would find appealing to eat and contact the dietician and/or physician to see if there are alternative nutritional approaches for this patient. b)Tell the patient that she may change her mind so you will just leave the tray in the room for her. c)Tell the patient she has to eat, and sit with her while she does. d)Call the physician and report that the patient is being non-compliant.

A Veteran residing in a Community Living Center likes to sleep until noon and then have his breakfast. He stays up late, then asks for a “midnight” snack and walks around the building. He gets very agitated when he is told he must eat at regular mealtimes and observe lights-out time. What should you do to handle this situation? a)Hold a family conference and tell them they have to make him understand he has to change his behavior. b)Bring the nurse manager in to tell the Veteran resident he has to follow the rules, period. c)Task the Care Assistant with waking him up on time, and putting him to bed on time. d)Hold a team conference to individualize his care plan and support his lifestyle.

The Power Of Words

Allow….…….Encourage Permit…….…Support Informed Consent….…….Informed Choice

The Power of Words ▼ Allow ▼ Permit ▼ Require Use ▼ Offer ▼ Choose ▼ Support Avoid

The Power of Words Words to Eliminate ▼ Prohibited ▼ Chief Complaint ▼ Problem Conference ▼ Analgesic ▼ Anti-inflammatory ▼ Ambulatory Clinic Words to Use ▼ Encouraged ▼ Patient/Family Observations or Concerns ▼ Conference for challenging situations ▼ Medicine for Pain ▼ Reduces swelling ▼ Walk-in Clinic

The Power of Words ▼ Dysfunctional ▼ Non-Compliant ▼ Uninvolved Words to Avoid

La Familia Medical Center Santa Fe, New Mexico Diabetics... Take off your shoes. With the suggestion of the patients, the poster was changed to: Show off your feet.

“Medical staff members also need to recognize that families also suffer the stress of a wounded child or spouse. They deserve answers to their questions that they can comprehend – not medical textbook jargon that the intern is "practicing.” -1st Lt. Ryan Miller

The Words We Use A Brainstorming Exercise

The Words We Use

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As Staff We Can!

Care Scenarios

Care Scenario 1 1. What are the issues in this scenario from a patient- and family-centered care perspective? 2. What would have more positively influenced the experience of care for this Veteran and his family? 3. What specifically could this nurse have said to determine if the patient wanted his family present? 4. Assume you are the next staff person this patient and his family interacts with. They are agitated and upset as they tell you this story. What specifically should you say and do now?

Care Scenario 2 1. What do you think the Nurse said or did? 2. What should she have done? And why? 3. What are the issues in this scenario from a patient- and family-centered care perspective? 4. What would positively influence the experience of care for this Veteran and his family?

What really happened next in Care Scenario 2: The Nurse said: “I don’t work in admissions or surgery prep, but come with me and I will get this straightened out.” Within minutes, the patient had a room and lunch is ordered for him and tests and preparations for surgery are started.

Says the Veteran who wrote this scenario: “This is great that a Nurse goes the extra mile to be vigilant for patients needing extra help, even patients she is not assigned to at the moment. The patient’s anxiety is greatly reduced, he is taken from the high risk coughing and sneezing sick patients in emergency room waiting area, and now feels good and comfortable that someone really cares about him and is going to take good care of him. Unfortunately, the patient did not get the Nurse’s name but is going to try and find out who she is. The Nurse needs to be immediately rewarded for this assertiveness, great service, compassion, kindness, and attention to patients.”

Patient- and Family-Centered Care A Journey…Not a Destination

Personal Commitment

What Will YOU Do To Support Our PFCC Journey???

Thank You

After the call to serve, many Veterans continue to pay a high price for the sacrifices they made at home and abroad. Getting to know their stories becomes part of the healing. “Let us not forget.” Adapted from: Jillian Van Ens CNE, “Our Veteran Population”, Spokane VAMC, June 2010