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2. Learning Objectives 2 Define patient and family engagement Explain the importance of engaging patients and family members Determine the level of patient and family engagement at your facility Distinguish between different methods of engaging patients and family members Apply engagement methods to the ASC setting

3. Overview Defining patient and family engagement Importance of patient and family engagement for the ASC Understanding engagement in your facility Identifying barriers, facilitators and motivators Communicating with patients and family members Utilizing patient advisors Opportunities for patient and family engagement in your facility 3

4. Patient-and Family-Centered Care 1 Involves “…collaborating with patients and families of all ages, at all levels of care and in all health care settings…acknowledges that families, however they are defined, are essential to patients’ health and well-being…” Dignity and respect Information sharing ParticipationCollaboration 4

5. What Is Patient and Family Engagement? 2 5 Patient and family engagement: –Is an important component of patient-and-family centered care –Creates an environment where patients, families, clinicians, and hospital staff all work together as partners to improve the quality and safety of health care Involves patients and family as: –Members of the health care team –Advisors who work with clinicians and leaders to improve policies and procedures

6. Benefits for ASC Providers and Facilities 6 Improve quality, patient safety, satisfaction and optimal patient outcomes Reduce institutional and individual cost 3 Comply with patient-centered policies and legislation Increase adherence to treatment regimens, reducing complications 3 Report on engagement as a metric for success Increased rapport between patient and staff Build community relationships

7. Benefits of Participation in Care 4 7 Patient ParticipationFamily Participation Improve safety and awareness Bring important perspectives about care, including cultural and religious preferences Provide timely feedback Access to patient’s history Builds trusting relationship with provider Improve safety and awareness Familiarity with patient medical history, normal behaviors of patient Opportunity to teach family members about post-operative care Provide timely feedback Builds trusting relationship with provider

8. Patient and Family Roles in Engagement 5 8 Patient and their family members: –Generally assume that most care is safe and that there are system checks to prevent medical errors –Blame provider, not system, for medical errors –Underestimate medical errors Patient and family engagement in health care may decrease medical errors by allowing patients and family to: –Be informed, asking questions about, and participating in their care –Help prevent specific safety events and/or medical errors –Report on safety events after the fact

9. Patient and Family Expectations 9 Patients and their family members expect the following to occur when it comes to their health care 1 : To be listened to, taken seriously, and respected as a care partner To be always told the truth To have information communicated to their entire care team To have coordination among all members of the health care team across settings To be supported emotionally as well as physically To receive high quality, safe care.

10. Patient and Family Expectations Specific to Surgical Environments 10 In the ASC facility setting, patients and their family members should expect to: Be educated about preoperative, operative, and postoperative care in-person and through take home written materials Have family, caregivers and advocates included at the patient’s desired, or age-appropriate, level Be respected as an individual and not be identified as a surgical name or number Be given the opportunity to have all of their questions answered Be able to stop the process if they believe there are questions or problems

11. Barriers to Engagement for Patients and Family 3,4 Factors preventing successful engagement for patients and family include: Fear and uncertainty Comprehension and literacy levels Provider bedside manner Family reaction Resources post- surgery Dismissive attitudes 11

12. The Patient’s Ambulatory Surgery Center Experience 12 Patients in an ASC facility may not: –Understand the system or culture –Know who different staff are and what they do –Want to bother busy ASC staff –Have a chance to have their questions answered, because they are only in the facility for a short time Additionally, they may be: –Afraid or uncomfortable about their surgery/procedure –Cared for post-surgery by their family members and caregivers after they leave the ASC setting.

13. Barriers to Engagement for Health Care Personnel 4 13 Perceived level of time and effort Communication challenges –Culture, language, power dynamics, navigating patient and family preferences Professional norms and experiences –Health care workers understanding and knowledge of engagement, workplace culture, patient and family engagement skills (lack of skills or negative experiences) Patient situation upon discharge –Patient sedation, rapid discharge (less than 24 hours) Fear of litigation –Transparency and adverse events, HIPAA compliance

14. Privacy Barriers – HIPAA 6 The Health Insurance Portability and Accountability Act (HIPAA) aims to protect patient health information, but may present unique challenges for patient and family engagement. However, HIPAA and Patient and Family Engagement share the following objectives: HIPAA and Patient and Family Engagement To restore and strengthen trust among patients, families and health care professionals To enhance the patient’s experience To improve the efficiency and effectiveness of care To enhance patient rights 14

15. Privacy Barriers – HIPAA 6 Continued 15 HIPAA Barriers to Patient and Family Engagement Depersonalizes patient experience by referring to patient by a number instead of name Creates concerns with confidentiality by questioning legality of family members Discourages family member presence before and after surgical procedures Recommendations for Patient and Family Engagement with HIPAA Maintain confidentiality by creating cover sheet for patient information but allowing access to patient and family Provide information about patient privacy in preoperative materials Share discharge and summary reports with patient and family members at the patient’s discretion. When possible, encourage family member inclusion before and after surgery

16. Understanding Patient Engagement in Your Facility Measuring baseline culture assessment Tools: –Clinician Attitude Assessment 4 –“Where Do We Stand? ”4 What is your patient and family engagement level in? What are my personal attitudes about patient and family involvement in their own health care? 16

17. Facilitation of Engagement for Health Care Personnel Participating in patient and family engagement can be made easier by: Alignment of patient safety culture and facility goals Leadership models for patient and family engagement Experience with patient and family engagement Increased teamwork 17

18. Facilitators of Patient and Family Engagement 18 For Patient Invitation to participate Information Confidence in abilities to engage in personal health care For Family Member Invitation to participate by patient Understanding of the importance of family involvement in preoperative and postoperative care Inclusion in care discussion by provider

19. Methods of Engaging Patients and Family Members 7 19 Ask patient first, in private, what matters most to them Determine level of family engagement based on patient’s desires and wishes for their care No one size fits all –Patient and family engagement and engagement incentives will look different for practice specialty and patient demographics (i.e., age) Find individual case studies and strategies for engaging health care users in Engaging Health Care Users: A Framework for Healthy Individuals and Communities 8Engaging Health Care Users: A Framework for Healthy Individuals and Communities

20. Communication Guide for Providers 20 Communication techniques 9 –Make eye contact, smile, introduce yourself and others –Ask how the patient would like to be addressed –Include the patient and family as members of the health care team –Ask about and listen to the patient and family’s needs and concerns –Help the patient and family understand the health condition, procedure and next steps in their care –Work with patients to ensure that they fully understand health information and use that knowledge to make informed decisions for self Tool: Communicating to Improve Quality (Tool 5 AHRQ)

21. Communication Guides for Patients and Families 21 Question prompt sheets, such as AHRQ’s “Questions Are the Answer” 10 –Includes questions for patient and family to ask their health care providers before, during and after a procedure Preoperative and postoperative materials for preparation, such as “Helpful Information for the Day of Your Surgery” –Explains how to prepare for surgery and what to expect the day of surgery –Describes health care provider roles Informed consent materials –Details risks of procedures/benefits of procedures

22. Opportunities for Patient and Family Engagement in Your Facility- Introducing Health Care Personnel 22 Video Link: https://www.youtube.com/watch?v=- UAkIh-RB_khttps://www.youtube.com/watch?v=- UAkIh-RB_k

23. Opportunities for Patient and Family Engagement in Your Facility- Checklist Encourage patient and family engagement in the use of the safe surgical checklist: –Patient identifies surgery site. –Patient verbally lists medication allergies. –Patient is active in own surgery preparedness. 23

24. Opportunities for Patient and Family Engagement in Your Facility- Informed Consent 24 Informed Consent: Fully disclose risks using simple, slow, clear language Check understanding of risk and procedure Offer opportunity for questions

25. Opportunities for Patient and Family Engagement in Your Facility- Discharge 25 IDEAL discharge planning 11 Include the patient and family Discuss with the patient and family 5 key areas to prevent problems at home Educate the patient and family throughout their time in the ASC facility Assess how well health care providers explain the diagnosis, condition and next steps in their care – use Teach Back Listen to and honor the patient and family’s goals, preferences, observations and concerns

26. Opportunities for Patient and Family Engagement in Your Facility Disclosure and apology for unexpected adverse outcomes 12 Immediate Steps Provide care for the patient Report to appropriate parties Communicate with the patient and/or family Document event in the medical record Next Steps Investigation Continued communication with the patient and/or family Apology and remediation System and process improvement Measurement and evaluation 26

27. Improving Engagement at Organizational Level - Patient Advisors 27 Advisors are collaborative partners in developing and revising facility policies, procedures and practices. How might that look in the ASC setting? –Patient and family advisory boards Are patients and family members currently playing an advisory role at your facility? If not, is there an opportunity for patient advisors?

28. Summary 28 Effective engagement and communication among patients, family members and other members of the health care team impacts health outcomes and patient, family and staff satisfaction. Although barriers to engagement exist for both patients and families and health care personnel, creating a patient-centered environment that encourages open communication from all parties can facilitate engagement. Opportunities for engagement exist throughout the ambulatory surgery center experience. Organizations should be prepared to respond and communicate proactively when adverse events occur

29. Tools For Patients and Families: Get to Know Your Health Care Team 2 Helpful Information For the Day of Your Surgery 13 Questions Are the Answer 10 For providers: Where Do We Stand? An Assessment Tool 4 Advisor Readiness Checklist 2 A Checklist for Attitudes About Partnering with Patients and Families in Primary Care and Other Ambulatory Settings 4 IDEAL Discharge Planning 11 For more support tools and free downloads, please refer to the Patient-and Family- Centered Care website at http://www.ipfcc.org/tools/downloads-tools.html 4http://www.ipfcc.org/tools/downloads-tools.html For ongoing implementation support, please refer to “A Leadership Resource for Patient and Family Engagement Strategies” 3A Leadership Resource for Patient and Family Engagement Strategies 29

30. References 30 1.Conway J, Johnston B, Edgman-Levitan S, Schlucter J, Ford D, Sodomka P, Simmons L. Institutes for Patient- and Family-Centered Care. Partnering with Patients and Families To Design a Patient- and Family-Centered Health Care System. A Roadmap for the Future. A Work in Progress. 2.Guide to Patient and Family Engagement in Hospital Quality and Safety. Rockville, MD: Agency for Healthcare Research and Quality; May 2013. AHRQ Publication No. 13-0033. 3.A Leadership Resource for Patient and Family Engagement Strategies. Health Research & Educational Trust, Chicago: July 2013. Accessed at www.hpoe.org. 4.Advancing the Practice of Patient-and-Family-Centered Care in Primary Care and Other Ambulatory Settings. How to Get Started…Institute for Patient-and Family-Centered Care. http://www.ipfcc.org/advance/topics/primary-care.html 5.Maurer M, Dardess P, Carman, KL, et al. Guide to Patient and Family Engagement: Environmental Scan Report. (Prepared by American Institutes for Research under contract HHSA 290-200-600019). AHRQ Publication No. 12-0042- EF. Rockville, MD: Agency for Healthcare Research and Quality; May 2012. 6.Institute for Patient-and Family-Centered Care. HIPAA – Providing New Opportunities for Collaboration. Oct 2010. 7.Scholle SH, Torda P, Peikes D, Han E, Genevro J. Engaging Patients and Families in the Medical Home. (Prepared by Mathematica Policy Research under Contract No. HHSA290200900019I TO2.) AHRQ Publication No. 10-0083-EF. Rockville, MD: Agency for Healthcare Research and Quality. June 2010. 8.American Hospital Association. (2013, January). Engaging Health Care Users: A Framework for Healthy Individuals and Communities. Chicago: American Hospital Association, 2012 Committee on Research, Benjamin K. Chu and John G. O’Brien, co-chairs. 9.Strategy 2: Communicating to Improve Quality (Tool 5). Overview of Communication Competencies. Agency for Healthcare Research and Quality. Guide to Patient and Family Engagement. 10.Questions Are the Answer. Agency for Healthcare Research and Quality. 11.Care Transitions from Hospital to Home: IDEAL Discharge Planning Training. Guide to Patient & Family Engagement. Strategy 4: IDEAL Discharge Planning (Tool 4) Agency for Healthcare Research and Quality. 12.Patient Safety and Communicating with Patients After an Adverse Event. Federico, Frank & Frankel, Allen. May 2010. 13.Haskell, Helen. Roadmap to Surgery. Helpful Information For the Day of Your Surgery.