1. Consumer Involvement in Quality Management/Improvement By: Daniel Tietz Program Manager for Consumer Affairs & Daniel Belanger Director, NYS HIV Quality Management Program

2. Patient-Centered Care Consumer Advocacy Consumer Involvement in Quality Management / Improvement Patient Self - Management Evaluate Effectiveness Raise Awareness Provide Training To Build Capacity Formalize Input Provide Routine Input

3. Question for Participants What is Self-Management?

4. What is Patient Self-Management? Self management improves self-efficacy and fosters collaborative goal setting and decision making between consumers and providers. This relationship allows consumers to monitor and manage their health. (Bodenheimer, Lorig et al, 2002; Lorig, 2003)

5. Background: Patient Self-Management Most research about self management focuses on arthritis, diabetes, and asthma A study from 1993 about arthritis self management found that increased self efficacy lead to better health outcomes Key element of the chronic care model

6. Chronic Care Model Retrieved on October 9, 2009 from: http://www.improvingchroniccare.org/index.php?p=Health_System&s=20

7. Self-Management Resources/Tools ResourcesTools Making Sure Your HIV Care is the Best It Can Be Training http://www.nationalqualitycenter.org/index.cfm/5943/138 86 Making Sure HIV Patient Self-Management Works http://www.nationalqualitycenter.org/index.cfm/5943/161 34 Shared decision making toolkits http://www.dhmc.org/webpage.cfm?site_id=2&org_id=84 4&gsec_id=0&sec_id=0&item_id=43192 Workbook on Developing and Evaluating Patient Decision Aids http://decisionaid.ohri.ca/docs/develop/Develop_DA.pdf Tips and resources to help patients become more involved in their health care by asking the right questions http://www.ahrq.gov/questionsaretheanswer/ Ottawa Personal Decision Guide- 1 page, 2 page http://decisionaid.ohri.ca/docs/das/OPDG.pdf http://decisionaid.ohri.ca/docs/das/OPDG_2p g.pdf Choosing Health for Life: A Patient Medical Journal http://www.nationalqualitycenter.org/index.cf m/5659 My Shared Care Plan- A Health Management Tool http://www.ihi.org/IHI/Topics/HIVAIDS/HIV DiseaseGeneral/Tools/My+Shared+Care+Pla n.htm Wallet Sized Appointment Card http://www.ihi.org/NR/rdonlyres/B35A1840- 5434-44E8-A0AB- 7AB91F3DC22D/358/Tool_WalletSizedAppt Card.pdf

8. Additional Resources

9. Question for Participants What is Patient-Centered Care?

10. Patient Centered Care Care that is respectful of and responsive to individual patient preferences, needs, and values and ensures that patient values guide all clinical decisions. (IOM, 2001)

11. Aspects of Patient Centered Care Respect for patients’ values, preferences, and expressed needs by treating patients as individuals Collaboration and integration of care Overcoming the barrier of words in communication Involvement of family and friends (when appropriate) Clinical communication/web-based applications for patients and health care providers Patient Education Enhancing physical comfort (Gerteis et al., 1993)

12. Examples of Patient Centered Care Asking patients, "Do you have any questions that I have not covered today?" This often leads to additional concerns that can be addressed in the visit. “Pod” station design: At the center of each pod is a workstation where nurses and medical assistants have their desks. Around the perimeter of the square are countertops and spaces for specific tasks such as taking weights and eye exams. The pod structure was created to enhance both communication and efficiency among staff. The design encourages interaction between clinicians and ancillary staff, such as impromptu consultations or follow-up with patients. At the end of the day physicians and staff from the same pod meet to discuss the day and identify strategies to address any problems. Case Studies by Dale Shaller and Susan Edgman-Levitan for Commonwealth Fund

13. Examples of Patient Centered Care “Pod” station design

14. Consumer Involvement in Quality Management/Improvement Quality improvement (QI) models used in health care were created for the automotive industry Critical dimension of QI is determining consumer needs as well as developing products and services that meet and exceed customer expectations. Adapted for use in health care settings, although many medical disciplines are still grappling with how and to what extent they should involve consumers

15. Group Activity 1 Barriers to Consumer Involvement in QM/QI Have all participants count off by 5’s Each group chooses a leader Each group chooses a facilitator (can be same as the group leader), recorder and someone to report back Each group will spend 10 minutes brainstorming barriers to consumer involvement in QM/QI Each group will report back on barriers identified Please stay in groups for the remainder of the training!

16. Two Dimensions of Quality Technical Quality Provider Perceptions of Quality of HIV Care Experiential Quality Patient Perceptions of Quality of HIV Care Leonard Berry, Texas A&M University, IHI conference (2001)

17. Technical & Experiential

18. Group Activity 2 Each group should brainstorm 3 technical and 3 experiential areas for improvement Each group should agree by consensus and prioritize the TOP area for improvement to focus on (it can be either a technical or experiential area for improvement)

19. Conceptual framework PLWHA involvement in QM/QI Defines the ways to FORMALLY involve PLWHA in HIV facility-wide QI activities and the mechanisms during each stage of the QI process

20. Framework for PLWHA involvement In QM/QI Routinely solicit PLWHA input from ”broadest” recipients receiving HIV PC services Ensure discussions about “Quality” are included during all CAB meetings Formalize active PLWHA involvement on Internal QM teams and support them in this process Routinely inform PLWHA of evolving QI activities via multiple communication venues/medium Annually assess programmatic level of PLWHA involvement throughout the HIV Program

21. Group Activity 3 From the previous group activity, each group should use top priority area agreed upon for improvement from Group Activity 2 Develop a “Plan” to involve consumers that your group is assigned from Framework for PLWHA involvement in QM/QI – Group 1: Routinely solicits PLWHA input from “broadest” recipients receiving HIV PC services – Group 2: Ensures discussions about “Quality” are included during all CAB meetings – Group 3: Formalizes active PLWHA involvement on Internal QM teams and support them in this process – Group 4: Routinely informs PLWHA of evolving QI activities via multiple communication venues/medium – Group 5: Annually assesses programmatic level of PLWHA involvement throughout the HIV Program Each group will report back to the larger group on the “ Plan” developed

22. PLWHA Involvement in QM/QI Routinely solicit PLWHA input from “broadest” recipients receiving HIV primary care services: - Conduct satisfaction surveys, focus groups, or patient interviews to gather ideas for improvement from the consumer perspective -Clearly define and prioritize ideas for improvement and share with staff for feedback

23. PLWHA Involvement Ensure that discussions about “Quality” are included during all CAB meetings: - When appropriate, form a CAB and engage in planning discussions about QI goals/objectives/activities, methods used for data collection, performance measures and areas identified that need to be improved -Routinely present HIV clinical performance data results to consumers and explain/discuss routine data reports with to solicit PLWHA recommendations when planning (ex: PDSA cycles, fishbone diagrams, etc.) next steps

24. PLWHA Involvement in QM/QI Formalize active PLWHA involvement on Internal QM teams and support them in this process: - Nominate and appoint appropriate consumers as equal members on QI teams to identify and improve aspects of HIV care - Develop skills-building and training opportunities for consumers so they can fully participate in agency-wide HIV QM committees and QI teams - Build further understanding among HIV staff about the benefits of engaging consumers in QI activities - Discuss key findings during QM team meetings - Link QI activities of the HIV QM team to CAC discussions

25. PLWHA Involvement in QM/QI Routinely inform PLWHA of evolving QI activities via multiple communication venues/medium: - Openly share the results of QI activities, including performance data results and updates from quality improvement projects, with all patients via displays in the waiting room, storyboards, or newsletters - Inform consumers about facility-wide QI activities and in doing so, highlight their role in improving key aspects of HIV care - Celebrate and publicize the successes of consumer involvement in QI activities among patients and staff

26. PLWHA Involvement in QM/QI Annually assess the programmatic level of PLWHA involvement throughout the HIV Program: -Develop and/or adopt a standardized assessment tool to evaluate the level and effectiveness of consumer involvement -Conduct assessment annually and discuss the results with the QM team/committee -Respond to the findings and make adjustments moving forward

27. Thank You! Contact Information: – Dan Tietz: det01@health.state.ny.usdet01@health.state.ny.us – Dan Belanger: drb08@health.state.ny.usdrb08@health.state.ny.us