1. Learning From Patients Engaging Patients in Primary Care Tanya Lord, PhD 1

2. Learning Objectives By the end of this module you will be able to: Demonstrate the difference between engaging patients in their own healthcare and practice improvement Describe three ways that engaging patients can be valuable to your practice (own healthcare and practice improvement) Understand/use patient engagement methods 2

3. “Nothing about me without me.” "Nothing about me without me" was the concept of a five-day global seminar held in 1998 to develop ideas for improving the quality of healthcare by involving patients. 3 Patient Engagement

4. 4 Stages of Patient Engagemen t Clinical RelationshipPractice Improvement INFORMGive information INVOLVEUse patient preferences to inform patient care Ask for opinions from patients PARTNERMaking treatment decisions with patient Design, implement and evaluate improvements with direct patient input from the beginning

5. Engaging Patients Clinical Relationship 5

6. Clinical Relationship: Why Engage Patients? Patients are becoming more informed! Improves communication Improves diagnosis Improves family history Provides better understanding  Barriers to care  Adherence to treatment and medical advice 6

7. Clinical Relationship: How to Engage Patients? Inform  Provide information on diagnosis and treatment plan  Provide health education Involve  Ask patient’s opinion  Discuss options based on patient’s  Priorities, preferences, perspectives  Use patient portals or other IT methods to connect Partner  Share understanding of expectations  Solve problems and set goals jointly  Share decision making 7

8. Shared Decision Making: Partnering with Patients Providers and patients exchange important information Providers help patients understand medical evidence about the decision they are facing Patients help providers understand their needs, values, and preferences concerning these decisions After time to reflect, patients and providers decide together on a care plan consistent with medical science and personalized to the patient Reference: Gafni 1997. 8

9. 9 Clinical Relationship: Involve AGENDA SETTING FORM

10. Clinical Relationship: Involve 10 WHAT ELSE ???

11. Clinical Relationship: Partner Behavior Changes “Do you mind if I give you some advice about that?” Treatment Changes “Do you mind if I give you some recommendations regarding your treatment” 11

12. Engaging Patients Practice Improvement 12

13. Practice Improvement: Why Engage Patients/Families? Provide unique insights and perspectives on practice policies and procedures 13

14. Practice Improvement: Why Engage Patients/Families? Provide unique insights and perspectives on practice policies and procedures Provide i nnovative ideas for improvement 14

15. Practice Improvement: Why Engage Patients/Families? Provide unique insights and perspectives on practice policies and procedures Provide i nnovative ideas for improvement Maintain a tireless passion and interest 15

16. Practice Improvement: How to Engage Patients/Families? Inform  Tell patient improvements being made on their behalf Involve  Solicit patient input (suggestion box)  Choose initiatives based on patient input  Ask patients after an improvement initiative  Did things improve? What worked? What didn’t? Partner  Include patient at the beginning of initiatives  Create patient advisory council 16

17. Effective Engagement Basic Principles: Designate a staff member or key contact for working patients 17

18. Effective Engagement Basic Principles: Designate a staff member or key contact for working patients Provide opportunities where patients can make a real difference 18

19. Effective Engagement Basic Principles: Designate a staff member or key contact for working patients Provide opportunities where patients can make a real difference Clearly define expectations, including timelines, deadlines, and responsibilities for both patients and staff 19

20. Ready to Partner with Patients? Can you answer ‘yes’ to these questions? I believe that patient opinion and input are valuable to this practice I believe that patients and family members bring a perspective to a project that no one else can provide We are able and willing to make time to engage patients We have patients who have expressed opinions, just not in a formal method I am willing to create a culture where patients feel comfortable to speak freely 20

21. PROMISES: Patient Engagement Informing Patients Patients are educated about what to ask at the pharmacy 21

22. PROMISES: Patient Engagement Involve Patients Patient surveys Suggestion boxes 22

23. PROMISES: Patient Engagement Partnering with Patients Including a patient in planning how to improve rates of colonoscopy Offered insight about trust and relationship with clinicians 23

24. Other Ideas—Invite Patients: To attend evening meetings to discuss improvement planning (1/month, 1/quarter) To speak at a staff meeting To attend your improvement discussions 24

25. Recruit Patients That: Have patient experience in your organization 25

26. Recruit Patients That: Have patient experience in your organization Have concern for more than one issue 26

27. Recruit Patients That: Have patient experience in your organization Have concern for more than one issue Can express their experiences constructively 27

28. Recruit Patients That: Have patient experience in your organization Have concern for more than one issue Can express their experiences constructively Are representative of your patient population 28

29. Ready to Partner with Patients? Can you answer ‘yes’ to these questions? I believe that patient opinion and input are valuable to this practice I believe that patients and family members bring a perspective to a project that no one else can provide We are able and willing to make time to engage patients We have patients who have expressed opinions, just not in a formal method I am willing to create a culture where patients feel comfortable to speak freely 29

30. Getting Ready! Ask: What internal changes are needed to become open to having patient input? Discuss barriers to partnering with patients Evaluate staff readiness Brainstorm how patients could be valuable to the practice PDSA: Start small and test each idea 30

31. 31 Stages of Patient Engagement Clinical RelationshipPractice Improvement INFORMGive information INVOLVEUse patient preferences to inform patient care Ask for opinions from patients PARTNERMaking treatment decisions with patient Design, implement and evaluate improvements with direct patient input from the beginning

32. “The greatest asset we have underutilized is all the assets of the patient.” Maureen Bisognano President and CEO Institute for Healthcare Improvement 32 Our Greatest Asset

33. Thank You! 33 Thank you for your time and attention today

34. A Few References Charles C, Gafni A,Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med. 1997;44(5):681–92. Salzburg statement on shared decision making. BMJ 2011;342:d174.5 34