1. Patient & Family Engagement: a Framework
Patient & Family Engagement Planning Committee
November 4, 2015
Marie Dotseth
Catherine Schramm
Kathy Welte

2. Welcome and Introductions!

3. MAPS Background and Focus on Patient and Family Engagement (PFE)
MAPS Vision:
“Safe Care Everywhere”
MAPS Mission:
“Engage a stakeholder coalition to achieve Safe Care Everywhere”
MAPS Strategic Area of Focus:
“Engaging Patients, Providers and the Community for Better, Safer Care Across the Continuum”
Convene and help align community – engagement for safety
Focus on the Patient and the process of health care, including transitions
Strengthen relationships between patient and their care teams

4. Why MAPS for Advancing PFE?
Broad perspective and representation
Neutrality & independence from any one provider organization, public agency or consumer group – collaborative approach
Ability to have a 100K foot view
Look at multiple levels of engagement – Direct care, organizational design, policy
Focus on factors influencing engagement:
Patient – beliefs, literacy, education
Organization – policies, best practices, culture
Society – social norms, expectations, regulations, policy

5. MAPS Completed, Current, and Future Work Related to PFE
Completed “You: your own best medicine” Campaign
Completed in 2014
Focus was directed at an individual care level (building patient/resident knowledge; individual interactions with care providers)
Current grant-inspired work
Starting in 2015
Focus likely directed at an organizational level (councils, committees, care process and delivery design decisions for safety and quality)
Future, broader work
Continue building on individual and organizational initiatives to influence bigger advocacy and societal issues across care settings for engagement

6. Engagement as a pathway to:
Triple Aim
Better quality of care
Increase cost efficiency
Improve population health
“Patient engagement is the blockbuster drug of the century”
Forbes.com internet blog 2012
“the holy grail of the healthcare system”
MedPage Today blog by KevinMD.com 2012

7. PFE Planning Committee
Welcome!
PFE Planning Committee to initiate grant-inspired work and formation of tool(kit) deliverables to advance PFE work within organizations
across the state and across care settings
Today’s next steps:
Review the grant contract
Review and discuss possible framework (from Health Affairs) to guide approach and work going forward

8. Grant-inspired long-term work and objectives
Synthesize existing tools and best practices across settings of care
Develop simplified tool(kit) for providers
Include a organizational gap analysis
Include legal guidance
Develop patient and family guidance
Host community-wide educational event(s)
Begin convening planning, advisory, resource committees

9. Grant Proposal Specifics (see handout)
MAPS will synthesize existing tools and research on best practices for patient and family engagement in different settings of care in to develop simplified, standardized guidance for providers and patients when implementing engagement best practices in different care settings.
MAPS will convene the community to establish a shared baseline of understanding about patient and family engagement and to align around a set of priorities and expectations for patient and family engagement in MN, and
Establish a first of its kind “Patient Family Advisory Council across settings of care.”

10. Framework for Patient and Family Engagement
Needed to provide a standardized way to look at definitions and how it works
Forms engagement can take
Levels engagement can occur across the health care system
Factors that influence engagement
Implications for development of interventions and policies to support engagement
Research agenda

11. Adopting a framework for MAPS’s Approach
Patient and Family Engagement: A Framework for Understanding the Elements and Developing Interventions and Policies
Authors: Kristin L. Carman, Pam Dardess, Maureen Maurer, Shoshanna Sofaer, Karen Adams, Christine Bechtel, and Jennifer Sweeney
Published in Health Affairs 32, No. 2 (2013):
Several authors from the American Institutes for Research

12. Multidimensional Framework
Organizational Level
Model construct
Levels of engagement
Direct care
Organizational design and governance
Policy making
Continuum of engagement
Consultation
Involvement
Partnership and shared leadership
Partnership & shared leadership
Consultation
Involvement
Organizational design and governance
Organization surveys patient re: care experiences
Hospital involves patients as advisers or advisory council members
Patient’s co-lead hospital safety & quality improvement committees

13. A Multidimensional Framework for Patient & Family Engagement in Health and Health Care
Continuum of engagement
Levels of Engagement
Consultation
Involvement
Partnership & shared leadership
Direct Care
Patients receive information about a diagnosis
Patients are asked about their preferences in treatment plan
Treatment decisions are made based on patients’ preferences, medical evidence and clinical judgment
Organizational design & governance
Organization surveys patients about their care experiences
Hospital involves patients as advisors or advisory council members
Patients co-lead hospital safety and quality improvement committees
Policy making
Public agency conducts focus groups with patients to ask opinions about a health care issue
Patients’ recommendations about research are used by public agency to make funding decisions
Patients have equal representation on agency committee that makes decisions about how to allocate resources to health programs
Factors influencing engagement:
Patient (beliefs about patient role, health literacy, education)
Organization (policies and practices, culture)
Society (social norms, regulations, policy)
Carmen K L et al. Health Aff 2013;32:
Copyright by Project HOPE – The People-to-People Health Foundation, Inc.

14. Factors influencing engagement
Patient: individual factors
Knowledge, attitudes, beliefs
E.g. experience with healthcare system
Implications for vulnerable populations
Organization: all types
Encourage by demonstrating patient participation and leadership are welcome
Organizational policies-how open is the organization
Bedside rounding, shift reports at bedside, open visitor policy, EHR access
Society: norms, regulations, policies
Create mechanisms encouraging real input

15. Implications for developing interventions to promote engagement
Continuum of engagement-extent to which patients are involved in decision making
Possibility that a greater impact from implementing interventions across multiple levels of engagement
Design interventions addressing factors that influence patient engagement

16. Research agenda
What factors or combination of factors are most important?
What supports are needed at organizational level to increase effectiveness at direct care level?
What are most effective methods for organizations and policy makers to create opportunities for patient engagement?
How to translate research finding into routine practice?
How to effectively track and monitor progress?

17. Discussion: does this model make sense for our current grant deliverables and broader PFE work?

18. Next Meeting Draft Objectives
Review again grant proposal deliverables
Begin to review published literature related to existing tool(kits)
Review to be provided
Discuss and provide direction on how MAPS may contribute, either through simplification or existing resources, or creation of novel tool(kits), or both
Understand, acknowledge and discuss gaps for various settings of care