1. Person and Family Engagement (PFE) as a Strategy to Improve Patient Safety
Defining and Achieving the 5 Partnership for Patients (PfP) PFE Metrics
Thomas Workman, PhD
Project Director, PfP PFE Contractor
March 9, 2017

2. Today’s Session The Impact of PFE on Patient Safety
Defining and Achieving the 5 PfP PFE Metrics
PFE in Action
Questions and Discussion
PFE 1: Planning checklist for scheduled admissions
PFE 2: Shift change huddles / bedside reporting with patients and families
PFE 3: PFE leader or function area
PFE 4: PFAC or Representative on quality improvement team
PFE 5: Patient and family on hospital governing and/or leadership board

3. The Impact of PFE on Patient Safety

4. The Critical Role of PFE
Successful implementation of PFE may result in benefits for patients, providers, and hospitals:
Improved patient experiences
Reduced length of stay
Improved health and safety outcomes for patients
Reductions in hospital acquired infections and conditions
Reductions in preventable readmissions
Lower costs associated with hospitals or providers
Increased employee satisfaction and retention

5. Connecting PFE to Outcomes
N = 146 Vizient HEN hospitals
High PFE performers meet 4 or 5 of the PFE metrics
Low PFE performers met 3 or less of the PFE metrics
Source: Vizient Presentation, January 28, 2016.
Tom
N = 146 Vizient HEN hospitals
PFE metrics cover five areas of engagement at three levels – bedside, organizational policies and procedures and organizational governance
High PFE performers meet 4 or 5 of the PFE metrics
Low PFE performers met 3 or less of the PFE metrics

6. Connecting PFE to Outcomes
Tom
The State of Minnesota HEN compared potentially preventable readmissions (PPR) rates of their hospitals that met 0-3 of the PfP patient and family engagement national metrics (orange line) to those that met 4-5 (the blue line). Those that met more of the PFE metrics had a lower PPR ratio.
Source: Vizient Presentation, January 28, 2016.

7. The PfP PFE Metrics

8. Metric 1
Implementation of a planning checklist for patients known to be coming to the hospital

9. The Intent of Metric 1
For scheduled hospital admissions (surgery, labor & delivery)
Create a mechanism for patients and families to discuss concerns, preferences, and issues for the hospital stay
The physical checklist serves as a list of items and topics for the conversation
Intent: The intent of this metric is to create a mechanism and procedure so that patients and families scheduled for admission are sent a checklist and then have an opportunity to talk with hospital staff at admission. The physical checklist serves as a list of items and topics for the conversation and could address: what patients should expect, concerns and preferences for their care, potential safety issues (pre-admission medicines, history of infections, etc.), and any relevant home issues, such as needs for additional support, transportation, and care coordination. The intent of this metric is not the distribution of the physical checklist alone but the use of it by admissions staff, an admitting nurse or physician, or other health care professional to guide a conversation with patients and families at the earliest point possible before their care. The conversation should be documented and the preferences, concerns, and expectations expressed by patients/family members should be captured and shared with the entire hospital care team for ongoing communication throughout the hospital stay. Patients and families should retain a copy of the checklist.

10. Why This is Important
Enables an active partnership in quality and safety from the very start of the hospital stay
Helps patients clarify expectations about the hospital stay and their care
Allows clinical staff to know the concerns, interests, and goals of the patient
Identifies potential safety issues so that patient and clinical staff can work in partnership to avoid them

11. Achieving the Metric
We have achieved this metric when: • Hospital provides a pre-admissions checklist to patients with all scheduled admissions • At admission, hospital staff discuss checklist with patient and family

12. Metric 2
Hospital conducts shift change huddles and bedside reporting with patients and family members in all feasible cases

13. The Intent of Metric 2
Include the patient and/or family member in as many conversations about their care as possible throughout the hospital stay
The patient and/or family member is able to hear, question, correct or confirm, and/or learn more about the next steps in their care as it is discussed between nurses changing shifts or clinicians making rounds
Intent: The intent of this metric is to include the patient and/or family caregiver in as many conversations about their care as possible throughout the hospital stay. The patient and/or family member is able to hear, question, correct or confirm, and/or learn more about the next steps in their care as it is discussed between nurses changing shifts or clinicians making rounds. Patients and/or family members should be more than present during these meetings. They should be encouraged and prompted by the clinical staff to be active participants to whatever degree they desire, and add to the information being shared between the nurses or other clinicians discussing their care. Clinical staff should make an effort to adjust their use of medical jargon, acronyms, and other technical language to ensure that the patient and family member can easily follow the conversation. If necessary due to language barriers, an interpreter should be present. The patient/family member should be part of the entire conversation concerning their care, and not just select parts.

14. Why This is Important
Enables the opportunity for correcting errors and clarifying care plans with the patient and family
Encourages the patient and family to be an active partner in their care to the degree they desire
Enables ongoing communication and interaction throughout care
Enhances the patient experience of care

15. Achieving the Metric We have achieved this metric when:
In as many units as possible, but in a minimum of at least one unit, nurse shift change huddles or clinician reports occur at the bedside and involves the patient and/or family members.

16. Metric 3
Designation of an accountable leader in the hospital who is responsible for patient and family engagement
Metric 3 looks for hospitals to identify a person or position in the hospital leadership who is responsible for patient and family engagement.

17. The Intent of Metric 3
PFE built into hospital management and operations
Visible leadership within the hospital
Manages PFE plans and activities
Has time dedicated to PFE
The intent of this metric is to ensure that PFE efforts are built into the management of hospital operations and given the attention and resources needed to be successful and sustained over time. This should be an individual or position that all hospital staff and stakeholders recognize as managing the hospital’s PFE plans and activities. The position should have time dedicated to PFE – at least 12 hours per week.

18. Why This is Important
Communicates the value of PFE to all hospital staff, clinicians, patients, families, and the community
Enables the hospital to centralize and coordinate PFE efforts
Clarifies across the hospital who has authority and responsibility for PFE.
Provides a face and name to the hospital’s growing PFE culture
When a hospital designates a position specifically for PFE, it sends a signal – to the staff, to clinicians, to the board, to patients and families, and to the community – that the hospital is committed to making patient and family experiences central to its culture. The PFE lead becomes a starting point for anyone who wants to improve the person and family experience, and the lead can help make sure those changes spread through the organization.

19. Achieving the Metric We have achieved this metric when:
There is a named hospital employee who is responsible for PFE efforts at the hospital either in a full-time position or as a percentage of time within their current position
Appropriate hospital staff and clinicians can identify the person named as responsible for PFE at the hospital

20. Metric 4
Hospital has an active Patient and Family Engagement Committee OR at least one former patient that serves on a patient safety or quality improvement committee or team
Metric 4 brings the patient voice formally into the hospital. This can be through a full Patient and Family Engagement Committee or Advisory Council, but hospitals can also get started by having at least one patient serve on a committee for patient safety or quality improvement.

21. The Intent of Metric 4
Hospital has a formal relationship with patient and family advisors who help guide hospital operations, policies, procedures, and quality improvement efforts
May be via Patient and Family Advisory Council OR inclusion of advisors on hospital quality or safety (or related) committee
Patient/Family Advisors have the same rights and privileges as all other committee members
While a Patient and Family Advisory Council is the recommended best practice to accomplish the intention of this metric, a hospital may wish to begin by identifying a smaller number of patient and family advisors from the community to serve on existing hospital committees such as the hospital’s Patient Education committee or the Quality Improvement committee. These patient representatives should have all the same rights and privileges of all other committee members, and efforts should be made to enable these representatives to share their unique perspective as patients or family members at meetings.

22. Why This is Important
Help hospital provide care and services based on patient- and family-identified needs and solutions rather than assumptions about what patients and families want or need
Improve overall systems and processes of care, including reduced errors and adverse events – patient-centered systems require patient input!
Patients and family members see things differently than hospital staff and clinicians, and when we make them part of our processes for improving quality, safety and the patient experience, we benefit from their first-hand knowledge. This can happen in several ways.
First, patient and family advisors can help us build services that are based on their identified needs rather than hospitals making assumptions about what they want. All across the country, patient and family advisors have given input on everything from how to share information at the bedside to how to plan for discharge or make hospitals safer. You’ll hear some of these examples today.
Second, many times patient and family advisors have seen first-hand the causes of errors and adverse events. These patients and family members can be wonderful advisors and allies because they can help identify how systems and processes have fallen short, and how to make them better. Patient and family advisors share a hospital’s motivation to reduce risks and improve quality.

23. Achieving the Metric We have achieved this metric when:
Multiple patient and/or family representatives from the community have been formally named as members of a PFAC
At least one patient serves on another hospital committee
Meetings of the PFAC or other committees with patient and family representatives have been scheduled and/or conducted
So what does it look like when we’ve achieved Metric 4?

24. Metric 5
One or more patient representatives serving on the hospital Board of Directors

25. The Intent of Metric 5
Ensure that at least one Board member with full voting rights and privileges provides the patient and family perspective on all matters before the Board, similar to other Board members who represent specific interests in the community
The ultimate goal of this activity is to ensure that the Board works with patient and family perspectives when making governance decisions at the hospital
Intent: The intent of this metric is to ensure that at least one Board member with full voting rights and privileges provides the patient and family perspective on all matters before the Board, similar to other Board members who represent specific interests in the community. Ideally, at least one board member with full voting rights would specifically be appointed for this purpose and with a written role definition as a patient representative. The ultimate goal of this activity is to ensure that the Board works with patient and family perspectives when making governance decisions at the hospital.

26. Reasonable Alternatives
Asking for PFEC input on matters before the Board, and incorporating a PFEC report into the Board agenda
Identifying elected or appointed Board members to serve in a specific role, with a written role definition, as representing the patient and family voice on all matters before the Board
Requiring all Board members to conduct activities that connect them closer to patients and families, such as visiting actual care units in the hospital two times per year and/or attending two PFEC meetings per year
While designating at least one patient representative on the board is the preferred mechanism to ensure co-governance, certain laws or policies may not allow the formation of a patient or family representative seat on the Board. Until these laws change, alternatives that meet the intent of the metric include:
• Asking for PFEC input on matters before the Board, and incorporating a PFEC report into the Board agenda.
• Identifying elected or appointed Board members to serve in a specific role, with a written role definition, as representing the patient and family voice on all matters before the Board.
• Requiring all Board members to conduct activities that connect them closer to patients and families, such as visiting actual care units in the hospital two times per year and/or attending two PFEC meetings per year.

27. Why This is Important
Patient and family needs, interests, and input occurs at the level of hospital governance.
Encourages patient-centered decisionmaking by the Board.
Communicates a commitment to the community about the role of patients and family members in the hospital’s operations.
Enables patients and families to contribute viable solutions and ideas to accomplishing the mission of the hospital.

28. Achieving the Metric We have achieved this metric when:
The hospital has at least one position on the Board designated for a patient or family member who is appointed to represent that perspective
If a specific board representative is not possible, an alternative exists to work with patients and families when making hospital governance decisions T

29. PFE in Action

30. PFE Metric 1: AMITA Health St
PFE Metric 1: AMITA Health St. Alexius and Alexian Brothers Medical Centers
Identified pain management as a top priority through its HCAHPS scores
PFAC developed a pre-surgery guide to educate orthopedic patients about how to prepare for surgery and “what to expect” on the day of the surgery and during your hospital stay
The guide addresses pain management and includes planning tools and checklists to help patients and families be partners in their health care
The guide, “Your Guide for Total Knee Replacement Success,” is available at:
%20Replacement%20Education%20Booklet.pdf

31. PFE Metric 4: Maine Coast Memorial Hospital Patient and Family Partnership Council - Falls Prevention
The problem
Fall rates in the medical-surgical unit were above national average
Poor patient compliance with instructions
Educational efforts with nurses were ineffective
The solution – get the patient perspective
Council identified a number of program issues (e.g., poor signage) and made recommendations
Leaders and frontline staff worked with the council to implement recommendations including new signage
The outcome – between Q and
Q2 2015, falls decreased by 77.4%

32. PFE Metric 5: Vidant Health System, North Carolina
Vidant Health System in North Carolina is part of the Vizient HEN
This slide demonstrates how their board drives quality

33. Impact of Involving Patient and Family Representatives
“When you are sitting at the Board table looking at a patient advisor, the numbers you are reviewing become that person’s face and that is powerful.” -Board Member
“When the advisor at the table says, ‘I was one of those complications, what are you going to do about it?’, it really helped to drive change in the reduction of infections and serious safety events.” -Surgeon and Board Chair
“When the Board pays attention and talks about circumstances around what happened to the patient; they get the data off the paper and into minds and hearts.”
-Patient/Family Advisor, Board Quality Committee

34. PFE Metric 5: Getting Started with Patient Stories
Place at the beginning of meeting agenda
‘Connect the Dot’ for the board at the beginning and end of the session
Relate it to a measure/data
Remove medical jargon and acronyms
Bring it to life and put a face on the data
Source: Guidelines for Telling “Patient Stories” with Boards, Delnor-Community Hospital, Geneva, Illinois

35. Questions and Discussion

36. Available in the PfP Resource Library at:
Resources
PfP Strategic Vision Roadmap for PFE: Provides six strategies to guide efforts to (1) implement PFE that is effective, sustainable, and reflect the core principles of PFE and (2) meet the five PfP PFE metrics to improve patient safety
PFE Metric Learning Modules: Recorded webinars provide “just in time training” to help hospitals implement and meet the five PFE Metrics (each training addresses a specific PFE Metric)
Available in the PfP Resource Library at:
tientsLibrary.aspx

37. 100 Europa Drive, Suite 315 Chapel Hill, NC 27517 http://www.air.org
Thomas Workman, PhD
100 Europa Drive, Suite 315 Chapel Hill, NC 27517
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