1. Placing Patients First:
3 Years of Patient Centered
Care Conferences
Christina Kulp, LCSW, ACHP-SW

2. Presenter Bio
Christina is a Master’s level graduate of Marywood University School of Social Work and has worked in the geriatric, non-profit and healthcare fields for over 18 years. She is licensed as a Clinical Social Worker in the state of PA.  Christina also has post-graduate certificates in Gerontology, and Palliative/End of Life Care. She is specialty certified in Advanced Hospice and Palliative Social Work through NASW.  
She has an ongoing interest in quality/process improvement, education and program development.  She was deeply involved in the development of the award-winning OACIS service in the Lehigh Valley Health Network.   She is firm believer in a team approach to palliative and end of life care which provides the best possible services to patients and their loved ones.  Christina enjoys providing supervision to student social workers as it provides a fresh view to the discipline through new eyes.  
Christina has presented in National and State conferences as well as being a guest speaker at several colleges. Past work history includes case management, dialysis social work, counseling (individual and group), psychiatric evaluation services, and social service director at a local skilled nursing facility.  Areas of expertise include conflict resolution, counseling, case management, insurance, field education and group facilitation.  

3. Patient Centered Care
Definition: Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions (IOM, 2001).
Picker’s Eight Principles of Patient Centered Care
Listed as one of the 10 components in NHPCO’s Quality of Care

4. The Problem
Clinical reviews demonstrate a poor understanding of patient preferences by caregivers
Prior studies in end-of-life care have focused on specific outcomes deemed important from the providers perspective
Some studies rely on caregivers report of patient preferences
Patient preferences can only be met by receiving care consistent with their goals

5. Barriers Clinicians do not consistently address patient concerns
Clinicians do not always access patients beliefs/understanding of their illness
Clinicians do not always share management options with their patients
Patients frequently fail to recall basic elements of their care plan
Increasingly complex care held across a variety of settings

6. Our Previous reality aka “the Before”
Weekly Interdisciplinary (IDT) on the inpatient unit – every two weeks for home patients
Many patients already died
Multiple disciplines meeting with patient = multiple different stories
Fractured knowledge of patient and family expressed goals
Communication not always consistent even with electronic record

7. successful care planning
Increase frequency of IDT meeting-like communication
Go beyond shift to shift reports
Improve understanding and alignment of IDT members
Improve alignment of all participants in patient circle of care
Timely and meaningful communication

8. Shifting the paradigm Improve access to and continuity with clinicians
Increasing patient participation in care by encouraging them to express their concerns and to become actively involved in their design of care
Supporting patient self-management through systems that facilitate goal setting and increase patient/family self care
Establish more efficient and reliable mechanisms for coordinating care among settings

9. Our Current Reality “The Now”
Specified meeting times
Pre-conference
Housekeeping
Patient Centered Conference
Post-conference

10. Challenges
Overwhelming logistics to get everyone together “It’s like herding cats”
Struggles related to time management
Resistance due to perceived increase in time commitment and structure
Insecurities knowing others would observe performance
Creation of a culture that allows all to have an equal voice

11. What we learned
Improved understanding of individual skills and roles on the team
Allows for group discussion of team concerns as well as patient concerns
Opportunity to support team members when personal struggles surface
Validation of each other
Learning from others by observing communication skills
Raised the bar on collective and individual performance

12. What we learned (continued)
Allowed for transition from multidisciplinary to interdisciplinary
Benefits far outweigh the challenges
Shared common knowledge, goals and purpose
Strengthened team bonds and cohesiveness
Hand-off communication improved

13. Taking The show on the Road
Adjustments for providing patient centered care conferences in the home
Who would best benefit?
Barriers due to home related care
Unintended Benefits
Feedback from staff, patients and families

14. Adjusting to the home setting
Case manager is responsible for input of physician/physician extender as physician will be unable to attend
Social worker will need to coordinate with schedulers regarding home health aid availability and other involved disciplines (massage therapist, spiritual counseling, volunteers)
Location of pre and post conference (parking lot, hospice office, virtual call)
Anticipating education materials and other needs

15. Identifying Cases Triggers and scoring system
Informal caregivers
Substance Abuse/Diversion/Mental Health
Sudden illness/Complex Grief
Family conflict/Incongruent expectations
Timing - start, middle or towards the end
Family request

16. Barriers Some patient homes unable to accommodate entire team at once
Coordination of schedules for team members
Team members not available for other patients during care conference
Lack of private place to pre and post conference
Physician and Physician extenders unavailable

17. Unintended Benefits Increased communication
Enhanced development of team
Improved staff retention
Power of debriefing
Perceived decrease in “crisis” events

18. Feedback Patients/Caregivers/Loved Ones Staff Surveys
Increased sense of value due to time taken
Don’t have to repeat their story
Improved understanding of family member roles
Staff
Family and patient have better understanding of care being provided
Voice of patient and family is heard
Entire team delivers the same message to patient and loved ones decreasing confusion
Surveys

19. Questions?

20. References
Institute of Medicine  Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academies Press.
NHPCO Website. 10 Components of Quality Care.
Picker Institute. Picker’s Eight Principles of Patient Centered Care.